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You call the dietitian to alert him to this patient's cultural concerns. 4Center for Disease Control and Prevention, "Leading Causes of Death," accessed at www.cdc.gov/men/lcod/index.htm; and Richard Allen Williams, "Cultural Diversity, Health Care Disparities, and Cultural Competency in American Medicine," Journal of the American Academy of Orthopedic Surgeons, Vol. Adding to the language barrier is the pitfall of false fluency, when physicians mistake the meaning of a Spanish word because of unfamiliarity with cultural or linguistic subtleties. Related letter: Chagas Disease Is a Consideration in Latino Patients. Addiction is a chronic, yet treatable brain condition similar to other chronic illnesses like diabetes. Research is reviewed demonstrating that BSFT is a promising family-based approach to treating Hispanic youth behavior problems and drug abuse. Conveying medical instructions to patients with limited English skills can be frustrating. Each person is unique and simultaneously formed by a variety of cultures and subcultures, not to mention personal choices and socioeconomic circumstances. Master the basics of the Virta Treatment and understand the full patient experience. , may be one strategy to increase treatment . Neurocysticercosis, a leading cause of seizures in Mexico, and pulmonary tuberculosis are more common in Latino immigrants.10 Interferon gammarelease assay blood testing for tuberculosis is now preferred over tuberculin skin testing in immigrants with a history of bacille Calmette-Gurin vaccination because of a high rate of false-positive results with skin testing (although skin testing is still recommended for children younger than five years).13 Publicized fears of contagion from illegal immigration may be overblown. 7Hyon B. Shin and Rosalind Bruno, "Language Use and English-Speaking Ability: 2000," Census 2000 Brief, U.S. Census Bureau, October 2003, accessed at: www.census.gov/prod/2003pubs/c2kbr-29.pdf. Herbal therapies play a major role in Latino folk medicine, so knowing the Spanish names of common herbs can be helpful (eTable A). First among these, of course, is a language barrier. The progress made in expanding health insurance coverage for Latinos is now at risk, because of the COVID-19 economic recession's disproportionate impact on Latino workers. Patient activation will help motivate the patient to become involved in his or her own care. A large selection of herbal teas are available from botanicas or yerberas in most Latino neighborhoods. In fact, the number of Latino physicians dramatically lags behind Latino population growth; and, according to cross-cultural health care expert Larry Purnell, Latinos are the most underrepresented major minority group in the entire U.S. health care workforce.5 This discrepancy contributes to many different linguistic and cultural hurdles for Latino patients, as well as for their health care providers. placed on religious beliefs in the maintenance of health and the treatment of illness. Similarly, in a national epidemiological survey of Latino households in the U.S., of those who reported awareness of a problem with at least one symptoms (overweight, binge eating, or weight control), only one fifth to one third of Latinos in this sample reported ever receiving treatment for an eating disorder (Alegria et al., 2007). There is ample evidence that Latinos, especially those of Mexican and Central American origin, face significant obstacles to obtaining health care, especially language barriers.4 Many hospitals and offices lack trained interpreters and rely on ad hoc interpretation by bilingual staff or even the children of patients. 2U.S. Recent immigrants may face additional obstacles to care, including illegal immigration status (fears of deportation), illiteracy, and a radically different set of health beliefs. Addressing patients properly can be another challenge. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Maria needs to eat fruit; she should also consume more fiber to counteract her high-carbohydrate diet. Latinx/Hispanic Communities and Mental Health Mental Health America Offers information about mental health issues in Latinx/Hispanic communities, including demographics, prevalence, treatment issues, and more. There are also differences in drug use within the Hispanic population as shown in Figure 1. Data Synthesis: Hispanics were identified homogenously in some studies and more correctly as a heterogeneous population in others. By comparison, only 35% of Hispanics 50 and older say the same - a 30-percentage-point gap. | Mar 1, 2011. Thus, when working with diverse populations in the United States . Her husband died in an industrial accident four years ago, and she is still grieving. Low levels of hypertension awareness are a major problem in the Latino community. A chaperone is often appreciated if a same-sex physician is not available. Treatment referral and information, 24/7, Visit the SAMHSA Facebook page A high-carbohydrate and high-calorie diet, a more sedentary lifestyle in the United States, and genetic factors may contribute. Three types of medications include: (1) agonists, which activate opioid receptors; (2) partial agonists, which also activate opioid receptors but produce a smaller response; and (3) antagonists, which block the receptor and interfere with the rewarding effects of opioids. Themes common to Latino participants were: "We are put off to one side"; "If I can't work, I can't survive"; and "Without documents, you are no one." Guide to Statistics and Methods; Guidelines; Hair Disorders; Health Care Delivery Models; . Hispanic Heritage Month, September 15 - October 15, is an important opportunity to raise awareness about these trends and more importantly, identify culturally and linguistically appropriate prevention and treatment strategies to reduce mental and substance use disorders in the Hispanic/Latino population. These terms are derived from the Spanish verb curar, which means to heal. Among Hispanics who needed but did not receive treatment in the past year, 95.8% did not feel the need for it, 2.2% felt the need for treatment but did not make an effort to get it, and 2.0% felt the need for treatment and did make an effort to get it. The initial arrival of Chinese immigrants to the United States began as a slow trickle in the 1820s, with barely 650 living in the U.S. by the end of 1849. The specific herbs mentioned in this study for use of treatment of diabetes included: nopal (cactus), aloe vera, nispero (loquat leaves), garlic, and diabetina. Cold water with lemon for high blood pressure. Bridging such cultural gaps, wide or narrow, will result in better physician-patient relationships and more effective care. These factors have not been studied in Hispanics/Latinos with chronic kidney disease (CKD). High level of belly fat or metabolic syndrome. Rue for earache. Because of less access to health care, Latinos with diabetes are often diagnosed later and have a greater risk of complications.15,16 Despite these unfavorable health and socioeconomic statistics, overall mortality is lower than would be expectedan anomaly termed the Hispanic paradox.17 Latinos live an average of 2.5 years longer than non-Latino whites (to 80 years, seven months of age) and 7.7 years longer than non-Latino blacks.1 It is not known what protective factors exist, but immigrant hardiness, social integration, and diet may have a role.1 Raising awareness about the consequences of obesity is necessary in Latino communities, especially because being somewhat overweight (gordito) can be considered healthy. A total of 31.2% received care from health care professionals assigned to ETC participation, and 33.6% had Medicare fee-for-service . Puerto Ricans have a 14 percent higher rate of hypertension-related mortality than other Latino groups. According to Pew Research, a law passed by Congress in 1976 defined Hispanics as . We sought to compare the treatment outcomes of undocumented and documented patients 12-months after entering HIV care. SAMHSA's mission is to lead public health and service delivery efforts that promote mental health, prevent substance misuse, and provide treatments and supports to foster recovery while ensuring equitable access and better outcomes. (Kaiser Foundation Health Plan, 2001): 4. Lower rates of hypertension awareness, treatment, and control have been observed in Hispanics/Latinos compared with non-Hispanic whites. The commentaries provide perspective and insight on what went right, what went wrong, and how things might have gone differently in these culturally challenging situations. Still, being aware of these larger values may help health care providers to understand a particular patient's behaviors and actions in the context of larger cultural inclinations. 1 This change resulted in a substantial increase in the prevalence of hypertension from ~32% to ~46% in the United States (US) adult population. As with any circumscribed ethnic group, there is, of course, enormous cultural heterogeneity among Latino patients-to the point where it seems almost ludicrous to try to identify broad cultural tendencies across such diversity. Despite a lack of U.S. studies, a Norwegian study found that although immigrants from tuberculosis-endemic regions did bring more strains of tuberculosis with them, they did not significantly contribute to the spread of tuberculosis within the resident population.18, Non-Latino physicians may be perplexed by references to folk healing and illness in Latino patients. Hispanic people are the youngest population, with 33% below age 18, and 57% below age 34 (Figure 4). Objective Breast cancer is the leading cause of cancer death among Hispanic women. About 23 percent of Latinos in the United States live in poverty.2. Although patients of all cultural backgrounds warrant kindness, a personal connection, and respect, the consequences of omitting these traditional values may be more problematic with Latinos. In Santa Clara County the figure is 25.7 percent-over a quarter of the total population. savoie's real cajun dressing mix; PURPOSE Though patient variables are likely to play an important role in the undertreatment of depression, little is known of patients' perceptions of standard depression treatments. Posttraumatic shock or anxiety may be attributed to susto (soul loss) rather than posttraumatic stress disorder. Most, although not all, alternative therapies in the Latino community are not harmful and may be combined with conventional care. Topics. Latino healing traditions include curanderismo in Mexico and much of Latin America, Santeria in Brazil and Cuba, and espiritismo in Puerto Rico.19 Curanderos, traditional healers, distinguish between hot and cold illnesses (Table 220 ) and occasionally between natural and unnatural (sorcery-related) diseases.19,20 Patients may seek out the care of brujos or brujas (wizards or witches) for the latter conditions. In this article I will make use of both terms, relying more heavily, however, on "Latino. Free and confidential support for people in distress, 24/7, Behavioral Health Treatment Services Locator Cultural Barriers to Treatment and Compliance. . In one survey of Mexican American nurses, family support was identified as one of the most important areas to which health care providers should attend while caring for Latino patients. A significant share of Hispanic adults who lack a regular health care provider are native born, have a high school diploma, speak English and have health insurance. The same is also applies to the substance abuse treatment. al., "Important Health Care Issues for California Latinos: Health Insurance and Health Status," UCLA Center for Health Policy Research, January 2003. Visit SAMHSA on Instagram [4] ", In 2007, the total U.S. Hispanic or Latino population surpassed 45 million, or 15 percent of the total U.S. population. The ethnic terms Latino or Hispanic refer to a diverse population of Latin American descent that includes many nationalities and races. Mexican Americans with hypertension are less likely to be treated than non-Latino whites (35 versus 49 percent). Fluegelman, Andrew, ed. You use teach back to ensure that Maria understands your directions, and you provide her with Spanish-language handouts about the benefits of controlling her diabetes and hypertension. Nevertheless, Hispanic Americans are very heterogeneous in the circumstances of their migration and in other characteristics. Pharmacologic therapies for hypertension have been highly effective in Hispanic subjects participating in clinical trials. While Hispanic refers to language and those whose ancestry comes from a country where Spanish is spoken, Latino refers to geography. Allow extra visit time for patients with limited English proficiency, Hire bilingual staff and physicians, and encourage existing staff to learn Spanish, Make printed and Web-based cultural information available to staff, Offer flexible scheduling: patients may be seen in sign-in order rather than fixed appointments, Post bilingual or Spanish-language signage, Provide cultural sensitivity training for staff (e.g., monthly lunchtime discussions, in-service training, a bulletin board devoted to cultural issues, ethnic food potlucks), Provide culture-specific interventions in nursing care plans, Provide interpretation services for patients with limited English, proficiency (required under Title VI of the 1964 Civil Rights Act); whenever possible, try to avoid using patient's family or friends as interpreters, Provide Spanish-language medical handouts and patient forms, Recognize Latino holidays (e.g., Cinco de Mayo [May 5], Day of the Three Kings [January 6]). Although most Latinos living in the U.S. do speak at least some English, 60 percent of Latino adults speak primarily Spanish at home.6 According to the U.S. Census, more than half of U.S. Latino residents age 5 and older speak English "very well," but a nevertheless significant number of Latino adults speak English "not well" or "not at all. Courtney Parker, CC BY. Media Contact . For instance, 2002 estimates of life expectancy for Latinos was 77.2/83.7 years (male/female) compared to 68.4/75.1 for African-Americans and 74.7/80.1 for non-Hispanic whites.3 Latinos are less likely than non-Hispanic whites and African-Americans to suffer from heart disease (which is nevertheless the leading cause of death in all three groups). 17.4% were Hispanic, and 49.1% were White. She has lost 10 lb (4.5 kg), and for the first time has acceptable blood pressure and fasting glucose levels. Still, at the risk of oversimplifying, several trends emerge: -simpatia-politeness and the avoidance of hostile confrontation -personalismo-the value of warm personal interaction -respeto-the importance of showing respect to authority figures, usually including health care providers -familismo-collective loyalty to extended family and commitment to family obligation; -fatalismo-the belief that individuals cannot do much to alter fate15. Delayed immigration protocols and anti-immigration legislation may contribute to stress. Such patient activation or motivation for change is more challenging in foreign-born Latinos, but may be achieved through active dialogue and discussion.32 Hopeful involvement in the care plan should replace fatalism or resignation. Her face lights up when you share this. The Concurrent Integration of Treatment Modali-ties in Social Work Practice." D.S.W. Mexico's rate of C-sections is 30 percent above the rate recommended by the World Health Organization. Table 3 lists some common Latino folk illnesses, their symptoms, and treatment.19 Therapies for these conditions may seem odd, but most are harmless, with a few exceptions. Using the LEARN model, you listen to her story about her poor control of diabetes and frustration with her diet. Treatment of Various Ocular Manifestation of Systemic Lupus Erythematosus with Therapeutic Plasma Exchange. She has three grown children: two still live in Mexico, and the third lives in a distant U.S. city. Latinos are a diverse ethnic group that includes many different cultures, races, and nationalities. Results: Teas were most commonly used for colic, upper respiratory tract symptoms, and abdominal pain. Traditionally, conditions may be referred to as either "hot" or "cold". Recent immigration trends have contributed heavily to the increases in the U.S. Latino population. One way of describing the distinction is that modern Western doctors are primarily trained to diagnose and treat diseases (in a purely biomedical sense), while traditional healers approach the patient as one suffering from an illness-that is, a culturally located experience of sickness.12 Among some Latino subcultures, folk illnesses such as empacho (a digestive ailment), mal de ojo (the "evil eye"), mollera caida (fallen fontanelle), susto (fright illness), and nervios (vulnerability to stressful experiences) are commonly described; and traditional healers range from curanderos (Mexican healers) and sobadores (traditional masseuses and bone setters) to yerberos (herbalists) and espiritistas (spiritual healers).13 Reliance on folk medicine certainly is not to be found in every, or even most, Latino communities; but it does exist as part of the health care landscape and is found among many patients from Mexico, as well as from various other regions within Latin America. "7 In the context of a hospital or medical clinic, where medical terminology can be complicated and communication often takes place quickly and amidst elevated emotions, this language barrier can be especially problematic. Additionally, within this family-centric decision making structure, there may be particular gender-based roles. Abdominal pain may be attributed to empacho, or food stuck in the intestine. These barriers include language, lack of insurance, different cultural beliefs, and in some cases, illegal immigration status, mistrust, and illiteracy. Racial/Ethnic and Sex Differences in Somatic Cancer Gene Mutations among Patients with Early-Onset Colorectal Cancer. Exposure to U.S. media is changing traditional Latino perceptions of health, diet, and body image, even as non-Latino Americans are influenced by Mexican cuisine and culture. Author disclosure: No relevant financial affiliations to disclose. 4 Another. dissertation, University of Southern Cali-fornia, 1973. While not considering Hispanics as a distinct race, the U.S. Census (utilizing federally delineated categories) defines someone "Hispanic" or "Latino" as "a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. These numbers include Mexican-Americans, Puerto Ricans, Central and South Americans, Cubans, and many other communities although, throughout California, the vast majority of Latinos identify themselves as of Mexican background. Some states have extremely large Latino populations; for instance, as of 2006, 36 percent of Californians (13.2 million people) identified themselves as Hispanic or Latino, as did 36 percent of Texans (8.6 million people). National Network to Eliminate Disparities in Behavioral Health, SAMHSA National Survey on Drug Use and Health (NSDUH), AHRQ National Healthcare Quality and Disparities Reports, OMH National Standards on Culturally and Linguistically Appropriate Services in Health and Health Care (National CLAS Standards), 988 Suicide & Crisis Lifeline 1 (Sept. 2007). Latinos comprise nearly 16 percent of the U.S. population, and this proportion is anticipated to increase to 30 percent by 2050. 1. Many Latinos are accustomed to self-treating because most pharmaceuticals are available without prescription in their home countries. Latino/Hispanic families can provide much support to a child with the disorder and protect him or her from the development of conduct problems (Bauermeister et al., 2005). In fact, compared to both white Americans and African-Americans, Latinos generally report feeling less listened to and understood by their doctors, as well as less able themselves to understand their doctors; and they are twice as likely to leave a doctor's office with unasked questions. Moreover, 32.7 percent (nearly one-third) of all U.S. Latinos completely lacked health insurance that year, compared with 15.3 percent in the general population; and nearly half of Latinos reported being uninsured at some point during the previous year.9 Latinos are nearly two and a half times more likely than whites to report that they have no regular doctor.10 Even among many insured Latinos, coverage and care are far from adequate. Approximately 11.8 percent of Latinos older than 20 years and 13.3 percent of Mexican Americans have diabetes. Hispanics' experience with discrimination or being treated unfairly varies greatly by age. Using don or doa with the given or full name indicates even greater respect for older patients. For instance, Latino mothers may determine when medical care is warranted for a family member, though a male head of household may formally make the decision to send the family member to a medical center.16. 12Arthur Kleinman, Leon Eisenberg, and Byron Good, "Culture, Illness, and Care: Clinical Lessons from Anthropologic and Cross-Cultural Research," Annals of Internal Medicine 88: 251-258 (1978). US Hispanics, currently the largest minority group in the country, face disparities in the recognition and treatment of major depression. Missing data was handled using this carry-forward method. The agency is contracted with the leading insurance carriers and works diligently to secure contracts with additional funding sources on an on-going basis. 3 Essentially, a curandero or curandera removes mental, emotional, physical and spiritual illnesses or imbalances. 15Glenn Flores, "Culture and the Patient-Physician Relationship: Achieving Cultural Competency in Health Care," Journal of Pediatrics 136 (January 2000): 14-23; see also Maria R. Warda, "Mexican Americans' Perceptions of Culturally Competent Care," Western Journal of Nursing Research 22/2 (2000): 203-224. This is especially (though far from uniquely) true in the agricultural sector of the U.S. economy. Prayer was reported as helping to reduce stress and anxiety. Other healing specialties include yerberas (herbalists), hueseros (bone setters), parteras (midwives), and sobradores (similar to physical therapists).21, Symptoms are often interpreted differently based on cultural presuppositions. A few candles were lit in the dark, curtained bedroom.
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