UNASSIGNED: Hispanics, the largest minority in America, have increased risk of several medical issues and face noteworthy health disparities. This study compares care-seeking behaviors and choice experience among Hispanics, Asians, Blacks, and Whites, considering SES (income, education, and insurance status) and across five healthcare provider (HCP) types. Concurrent analysis provides a comprehensive view of how and where inequity manifests in healthcare.
UNASSIGNED: A cross-sectional online survey assessed 1485 adults (Hispanic=314, Asian=313, Black=316, White=542, recruited through a panel agency) of the frequency of visiting primary care providers, dentists, optometrists, gynecologists, and specialists for chronic conditions. Participants also rated the importance of self-selecting a HCP and difficulty in finding one.
UNASSIGNED: Whites visited each HCP most regularly. Compared to Asians, more Hispanics saw specialists regularly (45.1% vs 56.5%, p=0.042), and Blacks saw dentists less (47.0% vs 38.3%, p=0.028) and gynecologists more often (21.2% vs 33.1%, p=0.024). No other frequency differences were observed among minorities. Low-income participants across four races saw dentists and gynecologists with comparable infrequency. Hispanics and Asians assigned similarly significantly lower self-choice importance and experienced more difficulty relative to Whites or Blacks. Participants with lower income or education visited HCPs less regularly yet perceived the same choice importance as higher-SES peers (p>0.05). Notably, discrepancies in visit frequency between Whites and minorities were more pronounced in higher-SES than lower-SES group. Differences in experiencing care-seeking difficulty were associated with income (p=0.029) and insurance type (p=0.009) but not education (p>0.05).
UNASSIGNED: Higher income and education increase healthcare utilization; however, racial disparities persist, particularly among higher-SES groups. Despite similarities among minorities, the extent of disparities varied by SES and provider type. The findings help explain evident inequity in healthcare access and health outcomes. Tailored patient education, culturally-specific navigation support, and more inclusive services are needed to address barriers faced by minorities and disadvantaged populations.

BACKGROUND: Although underserved populations- including those from ethnic minority communities and those living in poverty-have worse health and poorer healthcare experiences, most primary care research does not fairly reflect these groups. Patient and public involvement (PPI) is usually embedded within research studies in the United Kingdom (UK), but often fails to represent underserved populations. This study worked with patient and public contributors and local community leaders, situated in a socio-economically deprived and ethnically diverse urban area, to explore under-representation in primary healthcare research.
METHODS: We undertook a focus group with a purposive sample of 6 members of a Patient and Public Involvement Group (PPIG), and interviews with 4 community leaders (representing Black, South Asian, Roma and socio-economically deprived communities). An iterative analysis process based on template analysis was used. Focus group 1 was rapidly analysed, and a template created. Findings were presented in focus group 2, and the template further developed. The Cultural Trauma concept was than applied to the template to give a wider theoretical lens. In-depth analysis of focus groups and interviews was then performed based on the template.
RESULTS: Wider societal and historical influences have degraded trust in academic and healthcare institutions within underserved populations. Along with more practical considerations, trust underpins personal motivations to engage with research. Researchers need to invest time and resources in prolonged, mutually beneficial engagement with communities of importance to their research, including sharing power and influence over research priorities. Researcher reflexivity regarding differential power and cultural competencies are crucial. Utilising participatory methodologies including co-production demonstrates a commitment to inclusive study design.
CONCLUSIONS: Re-framing evidence-based medicine to be more useful and relevant to underserved populations with the highest burden of ill health is urgently needed. Lack of representation in primary healthcare research reflects wider societal inequalities, to which Cultural Trauma provides a useful lens. However, there are actions that researchers can take to widen representation. This will ultimately help achieve the goal of increased health equity by enhancing scientific rigour and research generalizability.
OBJECTIVE: People living in poverty, and people from ethnic minority communities may be referred to as ‘underserved’. Underserved communities benefit less from health services, and along with other factors, this leads to health inequalities. Primary care research does not include enough people from these communities. This makes the health inequalities  worse.
UNASSIGNED: This study looks at why people from underserved communities are not included in research. It also looks at what might help. We had focus group discussions with members of a Patient and Public Involvement Group (PPIG). These are individuals who do not have research expertise, but use their lived experience as patients to influence the research process. This group was formed in 2017, from areas where more people live with social disadvantage. We also interviewed local community leaders. Interviews and focus groups ask open questions, so are a good way to explore what people think about an issue. We found a useful theory about how cultural history affects what people can do. We used this to help us to understand how our findings could improve and widen participation in research within underserved communities.
UNASSIGNED: We found that trust is very important. There needs to be trust between people and organisations. There are also practical reasons people from underserved communities might not be able to get involved in research. Researchers need to be aware of these things, and work with people from these communities throughout all stages of research. Long term relationships need to develop between institutions and people doing research. Understanding each other’s culture and history makes it easier to work together.

BACKGROUND: The number of cancer survivors has increased in recent decades, and the majority of them suffer from sequelae of their disease and treatment. This study, which is part of the larger research project OPTILATER, aims to explore different aspects of care services for long-term survivors (≥ 5 years after initial cancer diagnosis) in Germany. The study places an emphasis on the situation of people from different age groups, with different socio-demographic and cultural backgrounds, and sexually and gender diverse individuals.
METHODS: To investigate experiences related to follow-up care, focus groups (n = 2) will be conducted with members of patient advisory councils and advocacy groups, representatives of communities, healthcare workers and networks, as well as members of Associations of Statutory Health Insurance Physicians. Guided interviews will be carried out with patients and relatives (n = 40) to investigate needs, barriers and obstacles in terms of follow-up care. On this basis, additional focus groups (n = 2) will be carried out to derive possible scenarios for improving the consideration of needs. Focus groups and interviews will follow a semi-structured format and will be analysed content-analytically. Focus groups and interviews will be conducted online, recorded, transcribed, and analysed independently by two persons.
CONCLUSIONS: The qualitative approach is considered suitable because of the exploratory research aims. The identification of experiences and barriers can reveal disparities and optimization potential in the care of long-term cancer survivors.

BACKGROUND: Increased pre-exposure prophylaxis (PrEP) use is urgently needed to substantially decrease HIV incidence among Black sexual minority men. Low perceived risk for HIV (PRH) is a key unaddressed PrEP barrier for Black sexual minority men. Peers and smartphone apps are popular intervention tools to promote community health behaviors, but few studies have used these together in a multicomponent strategy. Therefore, we designed a multicomponent intervention called POSSIBLE that used an existing smartphone app called PrEPme (Emocha Mobile Health, Inc) and a peer change agent (PCA) to increase PRH as a gateway to PrEP.
OBJECTIVE: This paper aims to describe the feasibility and preliminary impact of POSSIBLE on PRH and willingness to accept a PrEP referral among Black sexual minority men.
METHODS: POSSIBLE was a theoretically guided, single-group, 2-session pilot study conducted among Black sexual minority men from Baltimore, Maryland between 2019 and 2021 (N=69). POSSIBLE integrated a PCA and the PrEPme app that allows users to self-monitor sexual risk behaviors and chat with the in-app community health worker to obtain PrEP service information. PRH was assessed using the 8-item PRH scale before and after baseline and follow-up study visits. At the end of each study visit, the PCA referred interested individuals to the community health worker to learn more about PrEP service options.
RESULTS: The average age of participants was 32.5 (SD 8.1, range 19-62) years. In total, 55 (80%) participants were retained for follow-up at month 1. After baseline sessions, 29 (42%) participants were willing to be referred to PrEP services, 20 (69%) of those confirmed scheduled appointments with PrEP care teams. There were no statistically significant differences in PRH between baseline and follow-up visits (t122=-1.36; P=.17).
CONCLUSIONS: We observed no statistically significant improvement in PRH between baseline and month 1. However, given the high retention rate and acceptability, POSSIBLE may be feasible to implement. Future research should test a statistically powered peer-based approach on PrEP initiation among Black sexual minority men.
BACKGROUND: ClinicalTrials.gov NCT04533386; https://clinicaltrials.gov/study/NCT04533386.

UNASSIGNED: Pediatric burns are common, especially in underdeveloped countries, and these can physically affect the children involved and have an impact on their mental health. The aim of the present study was to assess the effect of pediatric burns in underdeveloped minority areas of China.
UNASSIGNED: Case information from 192 children was collected from outpatient and inpatient clinics using a survey questionnaire. These included 90 pediatric burn cases and 102 controls who were children without burns. A stepwise logistic regression analysis was used to determine the risk factors for pediatric burns in order to establish a model. The goodness-of-fit for the model was assessed using the Hosmer and Lemeshow test as well as receiver operating characteristic and internal calibration curves. A nomogram was then used to analyze the contribution of each influencing factor to the pediatric burns model.
UNASSIGNED: Seven variables, including gender, age, ethnic minority, the household register, mother\'s employment status, mother\'s education and number of children, were analyzed for both groups of children. Of these, age, ethnic minority, mother\'s employment status and number of children in a household were found to be related to the occurrence of pediatric burns using univariate logistic regression analysis (p < 0.05). After a collinearity diagnosis, a multivariate logistic regression analysis of variables with tolerances of >0.2 and variance inflation factor <5 showed that age was a protective factor for pediatric burns [odds ratio (OR) = 0.725; 95% confidence interval (CI): 0.665-0.801]. Compared with single-child parents, those with two children were at greater risk of pediatric burns (OR = 0.389; 95% CI: 0.158-0.959). The ethnic minority of the child and the mother\'s employment status were also risk factors (OR = 6.793; 95% CI: 2.203-20.946 and OR = 2.266; 95% CI: 1.025-5.012, respectively). Evaluation of the model used was found to be stable. A nomogram showed that the contribution in the children burns model was age > mother\'s employment status > number of children > ethnic minority.
UNASSIGNED: This study showed that there are several risk factors strongly correlated to pediatric burns, including age, ethnic minority, the number of children in a household and mother\'s employment status. Government officials should direct their preventive approach to tackling the problem of pediatric burns by promoting awareness of these findings.

Knowledge related to how oncology treatment trial design influences enrollment of racial and ethnic minorities is limited. Rigorous identification of clinical trial design parameters that associate favorably with minority accrual provides educational opportunities for individuals interested in designing more representative treatment trials. We identified oncology trials with a minimum of 10 patients at an NCI-Designated Comprehensive Cancer Center from 2010 to 2021. We defined a study endpoint of racial and ethnic minority accrual greater than zero. Multivariable logistic regression was used to determine whether co-variables predicted our study endpoint. P-values of less than 0.05 were considered significant. A total of 352 cancer trials met eligibility criteria. These studies enrolled a total of 7981 patients with a total of 926 racial and ethnic minorities leading to a median enrollment of 10%. Trials open in community sites (yes versus no) were more likely to have a minority patient (OR, 2.21; 95% CI, 1.02-4.96) as well as pilot/phase I studies compared to phase II/III (OR, 3.19; 95% CI, 1.34-8.26). Trials incorporating immunotherapy (yes versus no) were less likely to have a minority patient (OR, 0.47; 95% CI, 0.23-0.94). Trials open in community sites as well as early phase treatment studies were more likely to accrue minority patients. However, studies including immunotherapy were less likely to accrue racial and ethnic minorities. Knowledge gained from our analysis may help individuals design oncology treatment trials that are representative of more diverse populations.

International guidelines highlight the importance of using appropriate and culturally fair test materials when conducting clinical psychological assessments. In the present study, the generalizability of the Swedish WISC-V with Scandinavian normative data was explored in 6-16-year-old Swedish-speaking children in Finland (N = 134), as no local test versions or norms are available for this minority. First, metric measurement invariance was established, i.e., the constructs measured were equivalent between the standardization data and the present sample. Second, the performance of this minority group on the Swedish WISC-V was compared to the Scandinavian normative mean. The findings showed that the Finland-Swedish children performed overall higher than the normative mean on the Swedish WISC-V, with an FSIQ of 103. The performance was significantly higher also in the indexes VSI, FRI, and WMI as well as in several subtests. However, in the subtest Vocabulary, the Finland-Swedish children achieved significantly lower scores than the Scandinavian mean. Further analyses showed significant associations between cognitive performance and age as well as parental education. For the VCI and the FSIQ, performance increased significantly with age, despite the use of age-standardized scaled scores. The general high performance was suggested to relate to the overall high educational level of the Finland-Swedes as well as to other cultural and test-related factors. The results have implications for clinicians conducting assessments with this minority, but also highlight the importance of establishing test fairness by validating tests when used in different cultural groups.

Collective identification is vital for adolescents, fostering well-being and connection, but scant attention has been given to drivers of national identification and their contextual variations in youth. To address this, two longitudinal studies examined how values, as guiding goals defining what individuals consider important in their lives, relate to the trajectory of national identification in majority and minority youth. Study 1 (N = 568; Mage = 16.24, SD = 0.71) and Study 2 (N = 678; Mage = 13.78, SD = 0.73) focused on majority youth (Jewish-Israelis), while Study 2 also included minority (Arab citizens of Israel). The findings highlight values as important motivators of national identification over time. Conservation values, emphasizing the preservation of the status quo and a preference for stability, were prominent motivators for the majority of adolescents. In contrast, power values, which center around climbing the social ladder and accumulating wealth, held greater significance among their minority counterparts; however, both sets of values correlated with increased national identification. The discussion touches on motivations underlying national identification, their contextual diversity, and implications for future studies.

The aim of this project was to explore the understanding and awareness of dementia in the Pakistani-origin community in a deprived urban region of the UK. The study was unique in accessing and interviewing Pothwari speakers, some of whom could not read or understand spoken English. Data generated from an earlier study were used to construct five scenarios, which were used as the basis for face-to-face semi-structured interviews with 11 male and female participants from the Pakistani-origin community spanning two generations. Braun and Clarke\'s six phases of thematic analysis were used to analyse the data to answer the research questions. Themes constructed from these interviews indicated a lack of awareness and understanding of dementia, a range of attitudes and assumptions, reluctance to seek external support, and a significant role for the cultural background in shaping the individuals\' responses. The study found that poor understanding, cultural differences, and language issues presented barriers to accessing services in the British Pakistani community, particularly among those who had been born in Pakistan and/or spoke Pothwari in preference to English. Services and information may need to be offered by Pothwari speakers in order to reach this neglected sector of the population.

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