PubMed HealthSearch

PubMed · 8216647

Developing therapeutic relationships in multicultural settings.

Abstract

The expertise of native peoples as well as resources drawn from humanities, education, and arts organizations in Arizona contributed to an educational program to heighten the cultural sensitivity of health care professionals at the Children's Health Center of St. Joseph's Hospital. The sentiment expressed by Kraut that "respect for the cultural preferences and taboos of more traditional medical systems thus renders American physicians more effective and in the long run more efficient" is supported by our experience with this program.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

S B Rankin, M S Kappy. 1993. Developing therapeutic relationships in multicultural settings.. https://doi.org/10.1097/00001888-199311000-00004

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

Common charge-shift mutation Glu65Lys in K+ channel β₁-Subunit KCNMB1: pleiotropic consequences for glomerular filtration rate and progressive renal disease.

BACKGROUND: Glomerular filtration rate (GFR) is a heritable trait, and hyperfiltration (GFR increment in remnant nephrons) may accelerate renal functional decline in chronic kidney disease (CKD). Mesangial and vascular smooth myocytes control GFR by contraction, dependent on voltage-gated Ca(2+) influx, which is controlled by the regulatory β₁-subunit (KCNMB1) of large-conductance heteromeric K+ ('BK') channels. KCNMB1 gain-of-function variant Glu65Lys results in generalized vasorelaxation and thus protection against systemic hypertension. Here we asked whether the Glu65Lys variant influences GFR, in the basal state or during progressive renal decline. METHODS: We explored Glu65Lys effects on GFR in three populations spanning two ethnicities and two diseases (hypertension and nephrosclerosis). GFR was either estimated (eGFR from serum creatinine) or directly measured (iothalamate clearance). RESULTS: The 65Lys variant was relatively common, occurring on ∼5-10% of chromosomes in different biogeographic ancestry groups, and 65Lys carriers exhibited higher eGFR in two primary care populations: extreme BP values in Kaiser clinics (p = 0.029, accounting for ∼0.2% of trait variance), or treated hypertensives in VA clinics (p = 0.017, accounting for ∼0.9% of trait variance). In blacks with progressive renal disease (NIDDK AASK), 65Lys carriers displayed a steeper slope in GFR chronic decline (p = 0.030, accounting for ∼0.4% of trait variance), and Glu65Lys genotype also predicted time of onset of renal failure (log rank p = 0.019). CONCLUSIONS: Common KCNMB1 gain-of-function variant Glu65Lys influences GFR, and 65Lys carriers exhibit not only elevated baseline GFR, but also more rapid GFR decline (and consequent development of renal failure) in CKD. The results suggest that profiling patients at Glu65Lys can assist in gauging renal prognosis as well as selection of rational therapy in hypertension with progressive renal disease.

Black or African American

Racial disparity in cardiac decision making: results from patient focus groups.

BACKGROUND: While numerous studies suggest that African Americans receive fewer invasive cardiac procedures than whites, the basis for these treatment differences is not understood. METHODS: We conducted focus group sessions with patients who had received treatment in the hospital or the emergency department within the preceding 3 months for ischemic heart disease at 2 urban, university-affiliated hospitals. RESULTS: Discussions with patients identified the following factors that influenced their decision making: clarity, simplicity, and consistency of treatment recommendations; advice from friends and family about whether to accept recommendations; availability to speak with others who accepted similar recommendations; and having honest and caring physicians. African American patients identified the following additional factors that influenced their decision making: perceptions of health care discrimination; perceptions of undesirable physician behavior; faith in God to control one's destiny; and patient-physician camaraderie. CONCLUSIONS: Participants identified common issues influencing health care decision making, regardless of race. However, additional factors were expressed only by African American participants. These factors conveyed racial differences in perceptions of the health care system that may, in part, contribute to differences in health care decision making and treatment.

Black or African American

Postneonatal mortality surveillance--United States, 1980-1994.

PROBLEM/CONDITION: This report contains public health surveillance data that describe trends in postneonatal mortality (PNM) and that update information published in 1991. REPORTING PERIOD COVERED: 1980-1994. DESCRIPTION OF SYSTEM: National death certificate data characterizing PNM were reported by hospital physicians, coroners, and medical examiners. Data for 1980-1994 were compiled by the National Center for Health Statistics (NCHS) and obtained from NCHS public-use mortality tapes. RESULTS: The PNM rate per 1,000 live births declined 29.8% from 4.1 in 1980 to 2.9 in 1994 (31.7% decline among white infants and 25.8% among black). Most of the decline resulted from reduced mortality from infections and sudden infant death syndrome (SIDS). The PNM ratio between blacks and whites remained steady at approximately 2.1 during 1982-1988 and gradually increased to 2.4 by 1994 [corrected]. Autopsy rates for cases of SIDS increased from 82% to approximately 95% and did not differ among black infants and white infants. The decline of PNM rates for birth defects was greater for white infants than for black infants. The racial gap in PNM rates widened regionally during the study period, except in the South and the Northeast where ratios remained stable. In 1994, the largest gap persisted in the north-central region followed by the West and Northeast. INTERPRETATION: In 1994 as in 1980, PNM remained an important contributor to infant mortality, but nearly half of these deaths are caused by potentially preventable causes such as SIDS, infections, and injuries. The use of interventions for SIDS, birth defects, infections, and injuries can help reduce PNM and narrow the associated racial gap. ACTIONS TAKEN: This surveillance information, which will be distributed to administrators of state maternal and child health programs and to community-based organizations nationwide, will be useful in planning infant mortality reduction programs and to target PNM prevention efforts.

Black or African American