Preferences for labor and delivery practices between pregnant immigrants and U.S.-born patients: a comparative prospective antenatal survey study.

OBJECTIVE: To compare preferences in pregnant Somali and Sudanese immigrants with US-born women for different labor and delivery procedures and practices. STUDY DESIGN: Pregnant women who received prenatal care services at the Jericho Road Family Practice were surveyed. Ninety-three consecutive patients agreed to participate. A translator-facilitated questionnaire was administered to Somali-, Sudanese-, and U.S.-born women during antenatal visits. RESULTS: For pain relief in labor, 66.7% of U.S.-born, 64.0% of Somali, and 12.5% of Sudanese women preferred epidural analgesia (p = .002). More U.S.-born women preferred for the umbilical cord to be cut by their partners (76.2%) vs. Somali (6.7%) and Sudanese (0%) (p < .001). For infant feeding, more U.S.-born women (47%) preferred only formula feeding (Somali, 3.4%; Sudanese, 0%; p < .001). Responses were not statistically different for other preference questions, such as mobility/position in labor, attendants in labor, and duration of hospital stay. CONCLUSIONS: This prospective survey quantifies the differences in preferences for labor and delivery practices from two foreign populations and from U.S.-born women. This information is useful for all physicians who wish to better meet the needs of individual patients, especially those who are from different cultures and backgrounds.

Burden of Mental Illness and Non-communicable Diseases and Risk Factors for Mental Illness Among Refugees in Buffalo, NY, 2004-2014.

INTRODUCTION: Limited is known about mental illness and non-communicable diseases (NCDs) and their risk factors among refugees. These were studied using data collected from a refugee population in Buffalo, NY. METHODS: Longitudinal data collected on 1055 adults (> 18 years) at a large refugee health center in Buffalo, NY, during 2004-2014 were used. Main outcomes were hypertension, diabetes, tobacco use, obesity, overweight/obesity, and mental illness. Risk factors were assessed using multivariate regression models. RESULTS: Compared to those without mental illness, refugees with mental illness had higher rates of hypertension (16.9 vs 28.4%, P < 0.001), diabetes (8.4 vs 13.6%, P = 0.03), tobacco use (9.3 vs 18.3%, P < 0.001), obesity (13.0 vs 25.4%, P < 0.001), and overweight/obesity rates (45.0 vs 61.5%, P < 0.001). During 2004-2014, obesity rates increased among those with mental illness (25.4 to 36.7%, P < 0.001) and without mental illness (13.0 to 24.5%, P < 0.001). The overall mental illness prevalence among refugees was 16%, ranging from 6.9% among Asians to 43.9% among Cubans. Women were more likely to have mental illness (odds ratio = 2.45; 95% confidence interval [CI] = 1.68-3.58) than men. Refugees who lived longer in the USA were more likely to carry psychiatric diagnoses (OR = 1.12; 95% CI = 1.04-1.21). CONCLUSION: Mental illness rates varied considerably across various refugee groups. Rates of obesity and NCDs among refugees with mental illness were higher than among those without mental disorders. Gender, region of origin, and length of stay in the USA were associated with mental illness. Accurate and culturally sensitive screenings and assessments of mental illness are needed to reduce these health disparities.

Disease Burdens and Risk Factors for Diabetes, Hypertension, and Hyperlipidemia among Refugees in Buffalo, New York, 2004-2014.

INTRODUCTION: Limited is known about prevalence and risk factors for diabetes, hypertension, and hyperlipidemia among refugees. METHODS: At a refugee clinic in Buffalo, N.Y. (2004-2014), 1,570 adults were studied using multivariate logistic regression. RESULTS: Prevalences of diabetes, hypertension, and hyperlipidemia were 7.8%, 24.1%, and 27.1%, respectively. Among refugees, 49.2% of diabetes and 46.7% of hypertension were uncontrolled. Obesity (odds ratio [OR]=2.49; 95% confidence interval [CI]=1.61-3.85) and length of stay (OR=1.25; 95%CI=1.16-1.35) were risk factors for diabetes. Eastern European origin (OR=4.09; 95%CI=2.00-8.38), obesity (OR=2.62; 95%CI=1.92-3.58), length of follow-up (OR=1.06; 95%CI=1.00-1.12), gender (OR=0.59; 95%CI=0.44-0.78) and tobacco use (OR=1.54; 95%CI=1.00-2.38) were associated with hypertension. Age (OR=1.02; 95%CI=1.01-1.04) was associated with hyperlipidemia. CONCLUSIONS: Refugees had comparable burden of non-communicable diseases, but a greaterleast once during the study period proportion of refugees than of the U.S. population had uncontrolled conditions. Duration of follow-up, obesity, tobacco use, gender, age, and region of origin were risk factors for diagnosis. Culturally-tailored chronic disease management strategies are needed.

Longitudinal Changes and High-Risk Subgroups for Obesity and Overweight/Obesity Among Refugees in Buffalo, NY, 2004-2014.

INTRODUCTION: Very few studies have been conducted on non-communicable diseases among resettled refugees. The purpose of the study was to examine longitudinal changes in obesity and overweight/obesity rates among resettled refugees and identify high-risk subgroups. METHODS: Longitudinal health assessment data of 818 children (2-18 years) and 1055 adults (≥19 years) were used from a refugee clinic in Buffalo, NY, during 2004-2014. Univariate and bivariate analyses were performed. Risk factors of obesity and overweight/obesity were assessed using multivariate regression models. RESULTS: Obesity (8.7 to 12.7%) and overweight/obesity (16.9 to 26.7%) rates increased among children over 4.5 years (p < 0.01). Over 3.9 years, overweight/obesity rates increased in men (39.6 to 58.6%, p < 0.01) and women (55.1 to 73.5%, p < 0.01), exceeding the prevalence of overweight/obesity of 65.8% in US-born women. Interestingly, longitudinal overweight/obesity rates decreased among Middle Eastern (81.4 vs 78.0%, p < 0.01) and East European (75.0 vs 70.8%, p < 0.01) women. African children had 2.31-folds (odds ratio [OR] = 2.31; 95% confidence interval [CI] = 1.46-3.67) greater overweight/obesity risk than Asians. African girls who were not overweight or obese at baseline had the highest risk of becoming obese at follow-up visits (OR = 0.21; 95%CI = 0.09-0.52). For each additional year refugees lived in the USA, overweight/obesity risk among men (OR = 1.23; 95%CI = 1.09-1.39) and women (OR = 1.18; 95%CI = 1.04-1.35) increased. CONCLUSION: Obesity and overweight/obesity rates increased among refugees, but significant variations existed. Overweight/obesity rate among refugee women surpassed the US average. African origin, baseline weight, and longer duration of stay in the USA were risk factors. Culturally tailored programs are needed to prevent obesity and reduce health disparities among refugees.

Lessons Learned from the Evolution of an Academic Community Partnership: Creating "Patient Voices".

THE PROBLEM: Long-term partners received federal funding to develop the Patient Voices Network, a partnership of safety-net family practices and their patients to develop health improvement strategies. The scope and structure of the newly funded grant presented unexpected challenges that threatened the future of the partnership.Purpose of Article: To present a case study of the evolution of an existing partnership and offer lessons learned along with recommendations for future partnerships. KEY POINTS: Federal funding formalized the partnership in a way that required looking at it through a new lens. Leadership, programmatic, personnel, and financial challenges emerged. Short-term and long-term strategies were applied to address evolving needs. CONCLUSIONS: This case study demonstrates how federal funding raises the bar for academic-community partnerships and how challenges can be worked through, particularly if the partnership embraces the key principles of community-based participatory research (CBPR). Recommendations have been applied successfully to future initiatives.

The impacts of "growing our own": a pilot project to address health disparities by training health professionals to become certified diabetes educators in safety net practices.

PURPOSE: The purpose of the study was to examine the impact of incorporating certified diabetes educator trainees into medical practices on patient diabetes outcomes. METHODS: This was a mixed methods practice-based evaluation study undertaken in 2 primary care practices in high-poverty neighborhoods in Buffalo, New York. The evaluation entailed a physician-referred patient cohort with pre- and postanalysis of chart review data corresponding to the American Diabetes Association's diabetes indicators. Patient charts were reviewed at baseline and 12 months. A brief survey was administered to the providers and staff to ascertain the extent to which the certified diabetes educator trainees were perceived as useful as part of the medical practice team. RESULTS: Among 74 patients enrolled in diabetes classes, A1C levels decreased from a mean of 8.8% to 8.3%. Among a subset of patients (35%) with poorly controlled diabetes at baseline (A1C ≥ 9), there was a 15% decrease in A1C levels. Overall improvement in A1C was observed among 219 patients seen by a diabetes educator, in either a diabetes education class or a one-on-one visit. CONCLUSIONS: Results suggest that having a certified diabetes educator trainee as part of the primary care practice team may advance diabetes care, as evidenced by improvements in glucose control. Responses from providers and staff suggest that the certified diabetes educator trainees were well integrated into the practices and were perceived as instrumental in educating patients to better manage their diabetes.