Ethnic Dis
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American Indians (AI) have some of the highest smoking rates in the United States. The Muscogee Nation of Oklahoma developed a culturally targeted program called "Second Wind" based on the American Cancer Society's FreshStart smoking cessation program, but it has not been formally tested. ⋯ American Indian smokers are unique because of their traditional use of tobacco. Our participants felt that smoking cessation can be accomplished without discouraging traditional use of tobacco. We suggest ways to improve the "Second Wind" curriculum so that it is targeted for a heterogeneous group of AI smokers.
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In populations predisposed to cardiovascular disease, type 2 diabetes and visceral obesity, use of additional measurements of waist girth and waist/hip ratio (WHR) can help define risk levels associated with body mass index (BMI) for screening and clinical purposes. ⋯ Prevalence of the metabolic syndrome in Indian Americans aged 29- 59 years using the NCEP ATP III criteria was similar to rates reported in urban populations in India. Low HDL-C, hypertriglyceridemia, high waist circumference, and high blood pressure were most prevalent risk factors in this study. Among obesity measures, waist girth was significantly associated with most risk factors for the syndrome; WHR was most significant for two-hour glucose in women, whereas BMI mostly correlated with HDL-C for men. While BMI < or = 24.9 was associated with absence of all risk factors, BMI in overweight range was associated with presence of metabolic syndrome. These results point to clinical significance of using additional measures of obesity in addition to BMI to determine health risk in this population, particularly in premenopausal Asian Indian women.
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The purpose of this study was to evaluate racial differences in preference for life-sustaining interventions in the context of various physical and mental health scenarios. ⋯ We have shown that ambulatory Black patients aged > or = 50 years are more likely than White patients to prefer life-sustaining care, and that these preferences persist across a wide range of mental and physical disabilities. This attitude conflicts with the prevailing ethic regarding end-of-life care, and Black patients and their families may consequently find have difficulty obtaining medical care that is consistent with their cultural values and beliefs. Policy decisions regarding end-of-life care must reflect a culturally diverse perspective.
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This report contains information from the Health Policy Summit, held in conjunction with the Fifth Annual Primary Care Conference and the Tenth Annual HeLa Women's Health Conference. During this Summit's presentation, Warren A. Jones, MD provided information on the Medicaid system and the challenges facing administrators at the state level, specifically those in Mississippi and calls for an improved Medicaid system that will: provide a better definition of benefits; remember the children; offer a humane system of care for the elderly; eliminate fraud; and use a synergistic team of leadership to deliver the program.
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We compared the prevalence of, and reasons for, perceived discrimination in health care among American Indian/Alaska Natives (AI/ANs) and persons of AI/AN + White heritage to African Americans, Asian Americans, and Whites. ⋯ AI/ANs, and especially those who identify as AI/AN + White, were the most likely among racial groups to report discrimination in health care.