Archive for June, 2009
Posted by Alex
Basic research questions regarding the relative contributions, possible interactions, and mutability of the multiple risk factors discussed above undoubtedly remain unanswered. Regardless of the cause of asthma, however, a gap exists between the current capacity to treat the condition and the availability of medical therapies in real world settings, particularly among under-served populations. Clinicians and public health officials can take steps to reduce this avoidable gap in the morbidity of asthma between Latino and non-Latino children.
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The individual clinician can be aware of the increased morbidity among Puerto Rican children and of the environmental risk factors associated with increased morbidity in both these and other children. He or she can make a special effort to keep up-to-date on high quality asthma medical management. The clinician can take additional steps when treating high-risk patients, such as monitoring changes in clinical status, modifying medical therapy more frequently, and facilitating the elimination of detrimental home exposures.
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Posted by Alex
This paper has examined what is known about why children of Latino backgrounds have different prevalences of asthma. This review raises two questions. Why do Puerto Rican children have the highest prevalence of asthma among all Latino and non-Latino children in the United States? Why do Mexican American children, in spite of poverty and lack of access to care, appear to have a lower prevalence of asthma than Puerto Rican children?
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Posted by Alex
Table 2 presents a conceptual summary of the possible risk and prognostic factors for asthma prevalence and morbidity that we have identified through a review of the scientific literature and clinical experience. For the purposes of this discussion, we distinguish between risk and prognostic factors. Causal risk factors are positively associated with incidence of disease, protective risk factors are negatively associated with incidence of disease, and prognostic factors affect the disease’s morbidity and remission, once it has occurred. Research to date, however, has not completely clarified whether certain factors are risk factors, prognostic factors, or both.
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Posted by Alex
Research indicates that asthma prevalence rates vary among subgroups of Latino children, but little is known about differences in morbidity. Table 1 summarizes key studies indicating that mainland and island Puerto Rican children have the highest asthma prevalence of all Latino and non-Latino children in the United States.
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Using data from HHANES, Carter-Pokras and Gergen estimated a point prevalence of asthma for Mexican American children (2.7%) similar to that of non-Hispanic white children (3.3%), but much lower than that of mainland Puerto Rican children (11.2%), non-Hispanic black children (5.9%), and Cuban American сЫШгеп (5.2%). Lifetime prevalence of asthma was 20.1% among mainland Puerto Rican, 8.8% among Cuban American, and 4.5% among Mexican American children.
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Posted by Alex
Latino children represent a significant proportion of all US children, and asthma is the most common chronic illness affecting them. Previous research has revealed surprising differences in health among Latino children with asthma of varying countries of family origin. For instance, Puerto Rican children have a higher prevalence of asthma than Mexican American or Cuban American children. In addition, there are important differences in family structure and socioeconomic status among these Latino populations: Cuban Americans have higher levels of education and family income than Mexican-Americans and Puerto Ricans; mainland Puerto Rican children have the highest proportion of households led by a single mother. Our review of past research documents differences in asthma outcomes among Latino children and identifies the possible genetic, environmental, and health care factors associated with these differences. Based on this review, we propose research studies designed to differentiate between mutable and immutable risk and prognostic factors. We also propose that the sociocultural milieus of Latino subgroups of different ethnic and geographic origin are associated with varying patterns of risk factors that in turn lead to different morbidity patterns. Our analysis provides a blueprint for future research, policy development, and the evaluation of multifactorial interventions involving the collaboration of multiple social sectors, such as health care, public health, education, and public and private agencies. Viagra Professional 100 mg
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Posted by Alex
Although we have an emotional commitment to improving the welfare of children, we have morbidity and mortality statistics that call into question the level of that commitment. More than 20% of children in the United States live in poverty, and millions do not have access to basic medical care. Approximately one third of all children are either unserved or underserved. Infant mortality is as high as 11% in some communities. Among certain groups of minority youth, death from homicide approaches 160 per 100,000.
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Although we tend to distinguish the statistical differences between ethnic groups, we should be aware of the substantial variations within these groups as well. For example, the Hispanic Health and Nutrition Examination Survey of 1982-1984 (HHANES) reports varying prevalences of medical, behavioral, and developmental disorders among different Hispanic or Latino groups. According to this survey, Puerto Rican children have a higher prevalence of asthma than Mexican American or Cuban American children. Mexican American and Cuban American children have higher birth weights than Puerto Rican children. Thus, given the variations among populations, minorities should not be grouped into a single category for statistical purposes.
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Posted by Alex
The photograph:
Oakland, California,
History Room; 1918 flu
epidemic; auditorium
filled with cots of people
dying! Crosscurrents
in memory…
a little girl running our
farm’s meadow like a
young doe wide-eyed
startled wonderment;
eyes flooded, dark-ringed
in Argyrol, keep flu away!
Leaning into the photograph,
swift heartbeat, the story came…
Philadelphia; my 18-year-old
cousin, hopping his bike,
delivering, door to door,
the corner druggist’s medicines;
home, exhausted to bed,
doctor said, Too late.
He’s gone. Flu, three days, dead!
1997: photograph “in time,” emotion
feeling his dark curly hair
neatly arranged over a passive,
pale face, movement of the glide
into death, mine.