Ethnic Dis
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The already inadequate health systems of Africa, especially sub-Saharan Africa, have been badly damaged by the migration of their health professionals. There are 57 countries with a critical shortage of healthcare workers, a deficit of 2.4 million doctors and nurses. Africa has 2.3 healthcare workers per 1000 population, compared with the Americas, which have 24.8 healthcare workers per 1000 population. ⋯ There is a need for concerted political will and funding support that will allow them to do what is necessary. It may well be asked why special measures should be necessary to influence the migration of health professionals rather than engineers or football players or any other category. The answer must surely be that no other category of worker is so essential to the well-being of the population of every nation.
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The purpose of this review is to address the global incidence and management of snakebite envenomation and to describe the clinical characteristics and pathogenesis of envenomation by species of the family Viperidae, genera Bothrops and Crotalus, the most common venomous snakes in Brazil. We focus on the pathogenesis of the acute renal failure induced by these snakes. ⋯ In developed nations, snake bite typically occurs during recreational activities, whereas in developing countries it is an occupational disease more likely to affect young agricultural workers, predominantly men. Scarcity and delay of administration of antivenom, poor health services, and difficulties with transportation from rural areas to health centers are major factors that contribute to the high case-fatality ratio of snakebite envenomation.
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Randomized Controlled Trial
Patient-physician race concordance and its relationship to perceived health outcomes.
Race concordance occurs when the race of a patient matches the race of his/ her physician and discordance occurs when races do not match. Previous research has suggested an association between race concordance and measures of patient satisfaction and health outcome. In this study, we examined the relationship between race concordance and perceived quality of care, self-reported general health, and the SF-12 measures of physical and mental health in a community-based sample of 2001 adults. ⋯ Settings that employ a larger number of African American physicians in Nashville, Tennessee are places that people without insurance are more likely to seek health care. For health satisfaction and perceived health status, socioeconomic status and access to quality health care are likely more important than whether one's physician is of a similar or dissimilar race.
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In adults with insulin-treated diabetes, self-monitoring of blood glucose (SMBG) rates may be lower in minority or low-income populations, but the effect of income on racial/ethnic differences in SMBG is unknown. ⋯ Among US adults with insulin-treated diabetes, Hispanics and Blacks performed daily SMBG less frequently than did Whites. Stratification by income revealed a disparity gradient in the income < $20,000 group: SMBG rates decreased from Whites to Blacks to Hispanics. Low-income Hispanics with limited English proficiency are at greater risk for reduced SMBG than are those proficient in English.
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Chronic kidney disease is at least 3-4 times more frequent in Africa than in developed countries. Hypertension affects approximately 25% of the adult population and is the cause of chronic kidney failure in 21% of patients on renal replacement therapy in the South African Registry. The prevalence of diabetic nephropathy is estimated to be 14%-16% in South Africa, 23.8% in Zambia, 12.4% in Egypt, 9% in Sudan, and 6.1% in Ethiopia. ⋯ The transplant rate in Africa averages 4 pmp and is 9.2 pmp in South Africa. The goal for sub-Saharan Africa should be to have a circumscribed chronic dialysis program, with as short a time on dialysis as possible, and to increase the availability of transplantation (both living related and cadaver) and promotion of prevention strategies at all levels of health care. Screening for kidney disease in high-risk populations, eg, patients with hypertension and diabetes mellitus and a family history of kidney disease, should be instituted as the first step in kidney disease prevention in developing countries.