A recent study conducted at the University of Miami Miller School of Medicine found that first-generation Hispanic immigrants living in Florida are 40% more likely to develop cancer than people who did not emigrate from their native countries. While researchers admit that further research is needed to determine the cause of this group’s higher cancer rate, culture has an obvious impact.
The increase in cancers among first-generation immigrants living in Florida may be due to the development of unhealthy habits. In addition, more widespread diagnostic measures in the U.S. that lead to greater detection could play a part. - Dr. Paulo Pirheiro, Lead Researcher
Certainly, better access equals better health care; however, the influence of a new culture should not be discounted. Different eating habits, changes in leisure and fitness activities, and other lifestyle modifications are common immigrant experiences and can all have an impact on a person’s health and wellbeing.
But what about stress? Immigration to a new country and culture can be an extremely stressful event. How this stress impacts the health of the 30,000 study participants is a perspective that warrants further study. Established research confirms that long-term, chronic psychological stress has a negative impact on a person's overall health, yet there are conflicting results concerning it’s impact on cancer development.
Visit the National Cancer Institute for more information about the link between stress and cancer: http://www.cancer.gov/cancertopics/factsheet/Risk/stress.
Wednesday, August 19, 2009
Wednesday, July 15, 2009
Medical Insurance is Not Enough
Our current quarterly newsletter, CONNECT, focuses on language barriers in healthcare. (Not on our mailing list? Send an email to audrey.miller@atkinsinternational.com and include your name and email or mailing address.)
Our blog this week will continue with this theme.
A study led by Z. Jennifer Huang at the Department of International Health at Georgetown University supports the conclusion that simply having and affording medical insurance does not guarantee healthcare usage in this country. Language in fact can be a barrier to being healthy.
Ms. Huang studied 76 families from 3 different socioeconomic groups in the metropolitan D.C. area (42% of this area’s immigrant families are Asian.) To qualify for the study, families had to have both parents born in China and speaking Mandarin as their primary language.
From suburban areas there were 20 families in the low-income bracket, 45 in the middle to high income bracket and 11 urban families in the low income bracket from D.C.’s Chinatown area. Most families had access to either private or public health insurance coverage.
Families were asked if in the past year there was a time their child was sick and they chose not to seek health care. Anyone responding with a “yes” received a more detailed inquiry as to why.
According to Ms. Huang, the researchers were “surprised to find out the delayed care is more common in this population, especially the middle income group.” Since many in this group were insured, the researchers looked for issues beyond insurance coverage that affected healthcare utilization.
Ms. Huang found most parents did not get care because they could not find a Chinese speaking doctor or were unable to find an interpreter.
“Not many recent immigrant families know they can request translation service at clinics with federal funding.” Huang said.
More detailed reporting of this study can be found in the May 2009 issue of the Journal of Healthcare for the Poor and Underserved.
http://www.press.jhu.edu/journals/journal_of_health_care_for_the_poor_and_underserved/
by Sherry Dineen
Our blog this week will continue with this theme.
A study led by Z. Jennifer Huang at the Department of International Health at Georgetown University supports the conclusion that simply having and affording medical insurance does not guarantee healthcare usage in this country. Language in fact can be a barrier to being healthy.
Ms. Huang studied 76 families from 3 different socioeconomic groups in the metropolitan D.C. area (42% of this area’s immigrant families are Asian.) To qualify for the study, families had to have both parents born in China and speaking Mandarin as their primary language.
From suburban areas there were 20 families in the low-income bracket, 45 in the middle to high income bracket and 11 urban families in the low income bracket from D.C.’s Chinatown area. Most families had access to either private or public health insurance coverage.
Families were asked if in the past year there was a time their child was sick and they chose not to seek health care. Anyone responding with a “yes” received a more detailed inquiry as to why.
According to Ms. Huang, the researchers were “surprised to find out the delayed care is more common in this population, especially the middle income group.” Since many in this group were insured, the researchers looked for issues beyond insurance coverage that affected healthcare utilization.
Ms. Huang found most parents did not get care because they could not find a Chinese speaking doctor or were unable to find an interpreter.
“Not many recent immigrant families know they can request translation service at clinics with federal funding.” Huang said.
More detailed reporting of this study can be found in the May 2009 issue of the Journal of Healthcare for the Poor and Underserved.
http://www.press.jhu.edu/journals/journal_of_health_care_for_the_poor_and_underserved/
by Sherry Dineen
Monday, July 13, 2009
Understanding is Key to Staying Out of the Hospital - Part II
Monday’s Blog discussed how many Medicare patients end up being readmitted to the hospital in part due to lack of understanding of follow-up care.
Another recent study by the Northwestern University Feinberg School of Medicine, found 78% of patients do not fully understand their discharge instructions before leaving the emergency department. To make matters worse, they found that 80% of the time patients were not even aware they did not understand their discharge instructions.
Kirsten Engel, M.D., lead study author and instructor of emergency medicine at the Feinberg School of Medicine said, “Patients who fail to follow discharge instructions may have a greater likelihood of complications after leaving the emergency department.”
The study assessed 138 patients from Anne Arbor, Michigan according to four categories of comprehension (diagnosis and cause, emergency department care, post-emergency department care and return instructions.) Fifty-one percent did not fully understand what they were told in 2 or more categories.
According to Engle, “The bottom line is that we need better strategies for identifying patients who are having difficulty understanding their care instructions in the emergency department… When you are in the emergency department, be honest and don’t be afraid to ask questions.”
It turns out understanding what you should do at home after leaving a doctor’s care is important for your recovery. Yet many patients do not fully understand their post-hospital care instructions and are not even aware of their misunderstanding.
As far as we know the study did not account for language difficulties so we assume the study participants were English speakers. Imagine what the study would find for Non-English speakers…
By Sherry Dineen
This study was published online in July of 2008 by the Annals of Emergency Medicine.
www.annemergmed.com/
Another recent study by the Northwestern University Feinberg School of Medicine, found 78% of patients do not fully understand their discharge instructions before leaving the emergency department. To make matters worse, they found that 80% of the time patients were not even aware they did not understand their discharge instructions.
Kirsten Engel, M.D., lead study author and instructor of emergency medicine at the Feinberg School of Medicine said, “Patients who fail to follow discharge instructions may have a greater likelihood of complications after leaving the emergency department.”
The study assessed 138 patients from Anne Arbor, Michigan according to four categories of comprehension (diagnosis and cause, emergency department care, post-emergency department care and return instructions.) Fifty-one percent did not fully understand what they were told in 2 or more categories.
According to Engle, “The bottom line is that we need better strategies for identifying patients who are having difficulty understanding their care instructions in the emergency department… When you are in the emergency department, be honest and don’t be afraid to ask questions.”
It turns out understanding what you should do at home after leaving a doctor’s care is important for your recovery. Yet many patients do not fully understand their post-hospital care instructions and are not even aware of their misunderstanding.
As far as we know the study did not account for language difficulties so we assume the study participants were English speakers. Imagine what the study would find for Non-English speakers…
By Sherry Dineen
This study was published online in July of 2008 by the Annals of Emergency Medicine.
www.annemergmed.com/
Understanding is Key to Staying Out of the Hospital - Part I
A recent study by the Northwestern University Feinberg School of Medicine examined the frequency of rehospitalization, the risk of readmission and the frequency of follow-up outpatient doctor visits before being discharged from the hospital. The study looked at fee-for-claims service data for roughly 12 million Medicare patients discharged from a hospital in the years 2003 and 2004.
What the study found was astounding.
One out of five Medicare patients is readmitted to the hospital. The healthcare tab for readmissions in 2004 was 17 billion dollars. More than half of the patients that are rehospitalized within 30 days did not see a physician as an outpatient after being released the first time.
The study found that the rate of readmission increases as time passes from the first hospitalization. Thirty-four percent of patients were readmitted within 90 days of release and that number increases to 56.1 percent after one year of release.
Of those readmitted, 70 percent suffered from complications that could easily have been prevented by follow-up doctor visits such as urinary tract infections or pneumonia.
The study co-author, Mark Williams, M.D., chief of hospital medicine for Northwestern’s Feinberg School of Medicine and Northwestern Memorial Hospital, commented that Medicare does not pay doctors or pharmacists to spend time with patients to make sure they understand their discharge and medication instructions when they leave the hospital. “They pay for quantity of service, not quality.” He further adds, “They [Medicare] do not target payments to improve patient understanding of their care and their need for follow-up.”
“When patients and their caregivers understand the goals of their care, they commonly get better relief from their symptoms and use less health care services at their request,” Williams said.
Creating understanding for all patients regardless of their age or language spoken is the key to reducing our country’s healthcare costs by keeping needless hospital readmissions to a minimum.
Check back on Wednesday for Part II and read about another study linking understanding with improved healthcare.
by Sherry Dineen
The study was published in the New England Journal of Medicine on April 2, 2009 and can be found using the following link:
http://content.nejm.org/cgi/content/full/360/14/1418
Mr. Williams’ comments can be found at: http://www.northwestern.edu/newscenter/stories/2009/04/medicare.html
What the study found was astounding.
One out of five Medicare patients is readmitted to the hospital. The healthcare tab for readmissions in 2004 was 17 billion dollars. More than half of the patients that are rehospitalized within 30 days did not see a physician as an outpatient after being released the first time.
The study found that the rate of readmission increases as time passes from the first hospitalization. Thirty-four percent of patients were readmitted within 90 days of release and that number increases to 56.1 percent after one year of release.
Of those readmitted, 70 percent suffered from complications that could easily have been prevented by follow-up doctor visits such as urinary tract infections or pneumonia.
The study co-author, Mark Williams, M.D., chief of hospital medicine for Northwestern’s Feinberg School of Medicine and Northwestern Memorial Hospital, commented that Medicare does not pay doctors or pharmacists to spend time with patients to make sure they understand their discharge and medication instructions when they leave the hospital. “They pay for quantity of service, not quality.” He further adds, “They [Medicare] do not target payments to improve patient understanding of their care and their need for follow-up.”
“When patients and their caregivers understand the goals of their care, they commonly get better relief from their symptoms and use less health care services at their request,” Williams said.
Creating understanding for all patients regardless of their age or language spoken is the key to reducing our country’s healthcare costs by keeping needless hospital readmissions to a minimum.
Check back on Wednesday for Part II and read about another study linking understanding with improved healthcare.
by Sherry Dineen
The study was published in the New England Journal of Medicine on April 2, 2009 and can be found using the following link:
http://content.nejm.org/cgi/content/full/360/14/1418
Mr. Williams’ comments can be found at: http://www.northwestern.edu/newscenter/stories/2009/04/medicare.html
Thursday, June 25, 2009
Culture Affects Fitness
Exercise (no surprise) and culture (surprise!) were part of the focus at the Annual Meeting of the American College of Sports Medicine in Seattle at the end of May.
As part of the research presented, one study, conducted by Rafer Lutz, Ph.D., came to the conclusion that when under stress, college women who do not exercise regularly are less likely to exercise.
According to Lutz, “Someone who isn’t regularly active may view exercise as ‘one more burden’ when stressed.”
On the other hand, the study found college women with consistent exercise levels, “accumulate more physical activity” when similarly stressed. Lutz again expounds, “those who make it [exercise] a part of daily life may view it as a stress reliever and an escape from pressure.”
A second study presented at the Annual Meeting examined exercise differences between 400 American and Chinese college students. Researchers found that Americans exercise for weight control and physical appearance, whereas the Chinese students exercised for health and enjoyment reasons.
Lead study author, Zi Yah, M.S. concluded, “Although we didn’t study the origins of these exercise motivations, it may be a reflection of cultural values and what young people are taught to prioritize about themselves.”
Expanding this connection between exercise and culture further to include older women, another study is of note. In 2005, at the Second International Conference on Women, Heart Disease and Stroke, University of California San Francisco School of Nursing researchers proposed that exercise in tune with culture creates better program compliance.
They provided a Tai Chi program to older Chinese women with at least one major risk factor for coronary heart disease. Normally exercise programs for women with heart disease have high dropout rates but the retention rate for this one was 96% and there was a waiting list for the next session.
Part of the success of the study resulted from the researchers being culturally in tune with the group. One researcher, Ms. Taylor-Piliae had spent 15 years in Hong Kong, speaks Cantonese and is familiar with the culture. "Language was not a barrier to understanding in this study," she said. "This is important."
Researchers learned that Tai Chi appears to be a form of exercise that is safe and acceptable to Chinese women. "I think the key is to find out what already is a popular form of exercise within an ethnic group. If it is safe and is equivalent to brisk walking, then it not only may be effective, but more acceptable."
As part of the research presented, one study, conducted by Rafer Lutz, Ph.D., came to the conclusion that when under stress, college women who do not exercise regularly are less likely to exercise.
According to Lutz, “Someone who isn’t regularly active may view exercise as ‘one more burden’ when stressed.”
On the other hand, the study found college women with consistent exercise levels, “accumulate more physical activity” when similarly stressed. Lutz again expounds, “those who make it [exercise] a part of daily life may view it as a stress reliever and an escape from pressure.”
A second study presented at the Annual Meeting examined exercise differences between 400 American and Chinese college students. Researchers found that Americans exercise for weight control and physical appearance, whereas the Chinese students exercised for health and enjoyment reasons.
Lead study author, Zi Yah, M.S. concluded, “Although we didn’t study the origins of these exercise motivations, it may be a reflection of cultural values and what young people are taught to prioritize about themselves.”
Expanding this connection between exercise and culture further to include older women, another study is of note. In 2005, at the Second International Conference on Women, Heart Disease and Stroke, University of California San Francisco School of Nursing researchers proposed that exercise in tune with culture creates better program compliance.
They provided a Tai Chi program to older Chinese women with at least one major risk factor for coronary heart disease. Normally exercise programs for women with heart disease have high dropout rates but the retention rate for this one was 96% and there was a waiting list for the next session.
Part of the success of the study resulted from the researchers being culturally in tune with the group. One researcher, Ms. Taylor-Piliae had spent 15 years in Hong Kong, speaks Cantonese and is familiar with the culture. "Language was not a barrier to understanding in this study," she said. "This is important."
Researchers learned that Tai Chi appears to be a form of exercise that is safe and acceptable to Chinese women. "I think the key is to find out what already is a popular form of exercise within an ethnic group. If it is safe and is equivalent to brisk walking, then it not only may be effective, but more acceptable."
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