Patient- and Family-Centered Care as an approach to reducing disparities in asthma outcomes in urban African American children: A review of the literature.

We thank Cathy Eames (Director, Library Services, Detroit Medical Center) for valuable input and assistance with the search strategy. Funding for this research was supported by a grant from Children's Hospital of Michigan Research Foundation (Principal Investigator: Terrance L. Albrecht, Ph.D.). BACKGROUND: Patient- and family-centered care (PFCC) has the potential to address disparities in access and quality of healthcare for African American pediatric asthma patients by accommodating and responding to the individual needs of patients and families. STUDY OBJECTIVES: To identify and evaluate research on the impact of family-provider interventions that reflect elements of PFCC on reducing disparities in the provision, access, quality, and use of healthcare services for African American pediatric asthma patients. METHODS: Electronic searches were conducted using PubMed, CINAHL, and Psyclnfo databases. Inclusion criteria were peer-reviewed, English-language articles on family-provider interventions that (a) reflected one or more elements of PFCC and (b) addressed healthcare disparities in urban African American pediatric asthma patients (≤18years). RESULTS: Thirteen interventions or programs were identified and reviewed. Designs included randomized clinical trials, controlled clinical trials, pre- and post-interventions, and program evaluations. CONCLUSIONS: Few interventions were identified as explicitly providing PFCC in a pediatric asthma context, possibly because of a lack of consensus on what constitutes PFCC in practice. Some studies have demonstrated that PFCC improves satisfaction and communication during clinical interactions. More empirical research is needed to understand whether PFCC interventions reduce care disparities and improve the provision, access, and quality of asthma healthcare for urban African American children. ELECTRONIC DATABASES USED: PubMed, CINAHL, and Psyclnfo ABBREVIATIONS: AA-African American: CCT-Controlled clinical trial; ED-Emergency Department; ETS-Environmental tobacco smoke; FCC- Family Centered Care; PFCC-Patient and Family Centered Care; RCT- Randomized, controlled trial.

Leprosy among foreign missionaries in Northern Nigeria

This paper is a descriptive epidemiologic study of the occurrence of leprosy among foreign Protestant missionaries in Nigeria and neighboring parts of French West Africa. The material on the studied population and leprosy cases among them was collected by means of questionnaires sent out to the individual missionaries and the doctors of the missions participating in the study. 1- Among 907 missionaries in NOrthern Nigeria, there were 12 leprosy cases, giving a prevalence rate of 13.2 per 100 persons. Thre is a leprosy prevalence of 35 per thousand in the indigenous population of this Region. 2- Among 302 missionaries in the southern part of Nigeria and neighboring parts of French West Africa there were no leprosy cases. Some suggestions are offered to explain this difference. 3- In 2 schools for missionaries' children in Northern Nigeria, with a total of 223 children, we found one early case (indeterminate type). This single case gives a leprosy prevalence in the children of 4.5 per 1000 persons. 4 Most of the 12 infected adults had mild forms of leprosy, 8 of them being minor tuberculoid. There were also 2 dimorphous cases, and 2 persons with the lepromatous type. 5- All the people who developed leprosy were born in the United States or Canada. We do not know why, of the persons born in other parts of the world and representing one-third of the studied population, none developed leprosy. 6- Those missionaries who had the largest amount of contact with the local population and / or known leprosy cases - clergymen, persons doing leprosy work, and female evangelistic workers - had higher attack rates than teachers and persons doing general medical work. Similarly, single women had a higher attack rate than married women.