Impact on routine psychiatric diagnostic practice from implementing the DSM-5 cultural formulation interview: a pragmatic RCT in Sweden.

BACKGROUND: Culture and social context affect the expression and interpretation of symptoms of distress, raising challenges for transcultural psychiatric diagnostics. This increases the risk that mental disorders among migrants and ethnic minorities are undetected, diagnosed late or misdiagnosed. We investigated whether adding a culturally sensitive tool, the DSM-5 core Cultural Formulation Interview (CFI), to routine diagnostic procedures impacts the psychiatric diagnostic process. METHOD: We compared the outcome of a diagnostic procedure that included the CFI with routine diagnostic procedures used at Swedish psychiatric clinics. New patients (n = 256) admitted to a psychiatric outpatient clinic were randomized to a control (n = 122) or CFI-enhanced diagnostic procedure (n = 134) group. An intention-to-treat analysis was conducted and the prevalence ratio and corresponding 95% confidence intervals (CI) were calculated across arms for depressive and anxiety disorder diagnoses, multiple diagnoses, and delayed diagnosis. RESULTS: The prevalence ratio (PR) of a depressive disorder diagnosis across arms was 1.21 (95% CI = 0.83-1.75), 33.6% of intervention-arm participants vs. 27.9% of controls. The prevalence ratio was higher among patients whose native language was not Swedish (PR =1.61, 95% CI = 0.91-2.86). The prevalence ratio of receiving multiple diagnoses was higher for the CFI group among non-native speaking patients, and lower to a statistically significant degree among native Swedish speakers (PR = .39, 95% CI = 0.18-0.82). CONCLUSIONS: The results suggest that the implementation of the DSM-5 CFI in routine psychiatric diagnostic practice may facilitate identification of symptoms of certain psychiatric disorders, like depression, among non-native speaking patients in a migration context. The CFI did not result in a reduction of patients with a non-definite diagnosis. TRIAL REGISTRATION: ISRCTN51527289 , 30/07/2019. The trial was retrospectively registered.

[Adolescents opinions regarding Plato del Bien Comer Maya as nutrition health promotion tool.] / Opiniones de adolescentes sobre el Plato del Bien Comer Maya como herramienta de promoción de la salud.

OBJECTIVE: To know opinions of adolescents from Cholul, Yucatán, about Plato del Bien Comer Maya in order to improve it as health promotion tool. MATERIALS AND METHODS: Qualitative study, formative research. Three focus groups were carried out, participating 28 adolescents: 12-16 years old. Criteria of inclusion: studying middle school; to have native family from the town. Analysis of the data made manually. RESULTS: Comparatively with the national Plato del Bien Comer, the Plato Maya was better identified because have local food products easier to obtain and cheaper. The principal finding was to understand Fruto is a linguistic variation word which represents in Maya context both fruits and vegetables. This might be an important key to improve health promotion activities with that population. CONCLUSIONS: In order to have better results in nutritional interventions, it is necessary to design educational-communicative strategies in accordance with the local culture.

OBJETIVO: Conocer opiniones sobre el Plato del Bien Comer Maya de adolescentes de Cholul, Yucatán, para mejorar la herramienta comunicativa y utilizarla en actividades depromoción de la salud. MATERIAL Y MÉTODOS: Estudio cualitativo, de investigación formativa. Se realizaron tres grupos focales, participaron 28 adolescentes de secundaria: 12-16 años. Criterios de inclusión: pertenecer a alguno de los tres grados de la escuela y tener familias originarias del poblado. El análisis de los datos se realizó manualmente. RESULTADOS: En comparación con el Plato del Bien Comer nacional, el Plato Maya fue mejor identificado por tener elementos locales a los que pueden acceder fácilmente y con costos menores. Se identificó la palabra fruto como una variación lingüística que representa en ese contexto tanto a las frutas como a las verduras. CONCLUSIONES: Para tener mejores resultados en intervenciones nutricionales es necesario diseñar estrategias educativo-comunicativas acordes con la cultura local.

Does the Cultural Formulation Interview for the fifth revision of the diagnostic and statistical manual of mental disorders (DSM-5) affect medical communication? A qualitative exploratory study from the New York site.

OBJECTIVES: Cross-cultural mental health researchers often analyze patient explanatory models of illness to optimize service provision. The Cultural Formulation Interview (CFI) is a cross-cultural assessment tool released in May 2013 with DSM-5 to revise shortcomings from the DSM-IV Outline for Cultural Formulation (OCF). The CFI field trial took place in 6 countries, 14 sites, and with 321 patients to explore its feasibility, acceptability, and clinical utility with patients and clinicians. We sought to analyze if and how CFI feasibility, acceptability, and clinical utility were related to patient-clinician communication. DESIGN: We report data from the New York site which enrolled 7 clinicians and 32 patients in 32 patient-clinician dyads. We undertook a data analysis independent of the parent field trial by conducting content analyses of debriefing interviews with all participants (n = 64) based on codebooks derived from frameworks for medical communication and implementation outcomes. Three coders created codebooks, coded independently, established inter-rater coding reliability, and analyzed if the CFI affects medical communication with respect to feasibility, acceptability, and clinical utility. RESULTS: Despite racial, ethnical, cultural, and professional differences within our group of patients and clinicians, we found that promoting satisfaction through the interview, eliciting data, eliciting the patient's perspective, and perceiving data at multiple levels were common codes that explained how the CFI affected medical communication. We also found that all but two codes fell under the implementation outcome of clinical utility, two fell under acceptability, and none fell under feasibility. CONCLUSION: Our study offers new directions for research on how a cultural interview affects patient-clinician communication. Future research can analyze how the CFI and other cultural interviews impact medical communication in clinical settings with subsequent effects on outcomes such as medication adherence, appointment retention, and health condition.

Social and Racial Disparities in Food Consumption Among Brazilian College Students: a Nationwide Study.

This study aims to assess the association between economic class, race/skin color, and food consumption among Brazilian college students. A cross-sectional web-based survey was conducted with college students from all over Brazil. Demographic data, economic class, self-reported race/skin color, anthropometry, and food consumption markers from the Brazilian Food and Nutrition Surveillance System were collected. The final sample comprised 5843 participants with a mean age of 24.1 (SD: 6.3) years, 4292 (73.5%) were female, and 810 (13.9%) in the highest economic stratum. We observed a progressive decrease in the frequency of fresh fruits and vegetables consumption from higher to lower economic classes (p < 0.01 for both). Contrarily, there was a progressive increase in the frequency of consumption of beans from higher to lower economic classes (p < 0.01). The frequency consumption of vegetables was also associated with race/skin color (p < 0.01), being lower in brown (PR: 0.94; CI 95%: 0.90; 0.98), and black (PR: 0.91; 95% CI: 0.85; 0.98) individuals, compared to white individuals. Brown individuals showed higher frequency consumption of beans (PR: 1.10; 95% CI: 1.05; 1.15) than whites. When compared to individuals of white race/skin color, brown (PR: 1.07; 95% CI: 1.01; 1.13) and black (PR: 1.15; 95% CI: 1.07; 1.23) individuals showed higher frequency consumption of sweetened beverages. Economic class and race/skin color were independent factors associated with the food consumption of Brazilian college students.

Racial biases in healthcare: Examining the contributions of Point of Care tools and unintended practitioner bias to patient treatment and diagnosis.

Sophisticated algorithms are used daily to search through hundreds of medical journals in order to package updated medical insights into commercial databases. Healthcare practitioners can access these searchable databases-called Point of Care (PoC) tools-as downloadable apps on their smartphones or tablets to comprehensively and efficiently inform patient diagnosis and treatment. Because racist biases are unintentionally incorporated into the search reports that the companies generate and that practitioners regularly access, the aim of this article is to examine how healthcare practitioners' "pre-existing" racial stereotypes interact with pithy conclusions about race and ethnicity in PoC tools. I use qualitative research methods (content analysis, discourse analysis, open-ended semi-structured interviews, and role play) to frame the analysis within the Public Health Critical Race Praxis (PHCRP). This approach facilitates an understanding of how biological racism-the use of scientific evidence to support inherent differences between races-that is embedded in PoC algorithms informs a practitioner's assessment of a patient, and converges with persistent racial bias in medical training, medical research and healthcare. I contextualize the study with one semi-structured interview with an Editor of a leading PoC tool, MedScope (pseudonomized), and 10 semi-structured interviews with healthcare practitioners in S.E. Ontario, Canada. The article concludes that PoC tools and practitioners' personal biases contribute to racial prejudices in healthcare provision. This warrants further research on racial bias in medical literature and curriculum design in medical school.

'Through a kaleidoscope': A Foucauldian discourse analysis of Belgian policy regarding patients with a migration background and depression in general practices.

A higher prevalence of depression is found among patients with a migration background within the Belgian population. Nevertheless, this group is underrepresented in ambulant and residential mental health care services. Since general practitioners (GPs) have a crucial gatekeeping role, this led some researchers to investigate the possibility of a provider bias influencing GPs' assessment and referral of depressed patients with a migration background. However, GPs' accounts may be influenced by wider professional discourses present at the policy level, which are inevitably linked to institutions regulating the conduct of GPs. Therefore, this study applied a Foucauldian discourse analysis (a) to identify broader professional discourses in Belgian policy documents regarding patients with a migration background and depression in general practices, (b) to examine how patients with a migration background are discursively positioned and (c) to investigate which different balances of power in the relationship between GPs and patients with a migration background are demonstrated in the identified discourses. We identified three recurring discourses: (a) the othering discourse, (b) the health literacy discourse, and (c) the person-centred discourse. Our analysis demonstrated that the former two discourses illustrate the perpetuation of a biomedical discourse. While the last discourse is aligned with a counter-discourse associated with the person-centred care model in health care. Consequently, our analysis demonstrated the construction of a contradictory discursive framework throughout the various policy documents on which GPs might rely when speaking about patients with a migration background suffering from depression.

Non-Vaccination Stage Model (NVST): The decision-making process among Israeli ultra-orthodox Jewish parents.

Although vaccination uptake is high in most countries, pockets of suboptimal coverage remain, such as those observed among ultra-orthodox Jews in Israel and elsewhere, posing a threat to both individual and public immunity. Drawing on the Precaution Adoption Process Model (PAPM), this study proposes a Non-Vaccination Stage Model (NVSM) to analyze the decision-making process among Non-Vaccinating Parents (NVPs), focusing on the ultra-orthodox Jewish population of Israel. In-depth interviews were conducted with 10 Israeli ultra-orthodox Jewish NVPs (mothers). The interviews revealed five stages in the participants' decision-making process: Being good mothers who vaccinate their children; Emergence of doubts regarding the risks of vaccination; Personal vaccination policy-hesitancy concerning vaccination; Decision not to vaccinate; Confirmation signs of what participants perceive as a wise decision. NVSM can help understand parents who consider non-vaccination to be healthier behavior and explore the various stages of their decision-making process. Differentiating among the various stages of NVPs' decision-making processes enables application of different intervention approaches by policymakers and healthcare practitioners.

Epistemic racism in the health professions: A qualitative study with Black women in Canada.

Systemic racism within health care is increasingly garnering critical attention, but to date attention to the racism experienced by health professionals themselves has been scant. In Canada, anti-Black racism may be embodied in structures, policies, institutional practices and interpersonal interactions. Epistemic racism is an aspect of systemic racism wherein the knowledge claims, ways of knowing and 'knowers' themselves are constructed as invalid, or less credible. This critical interpretive qualitative study examined the experiences of epistemic racism among 13 healthcare professionals across Canada who self-identified as Black women. It explores the ways knowledge claims and expert authority are discredited and undermined, despite the attainment of professional credentials. Three themes were identified: 1. Not being perceived or portrayed as credible health professionals; 2. Requiring invisible labour to counter professional credibility 'deficit'; and 3. Devaluing knowledge while imposing stereotypes. The Black women in our study faced routine epistemic racism. They were not afforded the position of legitimate knower, expert, authority, despite their professional credentials as physicians, nurses and occupational therapists. Their embodied cultural and community knowledges were disregarded in favour of stereotyped assumptions. Adopting the professional comportment of 'Whiteness' was one way these health care providers strived to be perceived as credible professionals. Their experiences are characteristic of 'misogynoir', a particular form of racism directed at Black women. Anti-Black epistemic racism constitutes one way Whiteness is perpetuated in health professions institutions.

Sourcing and framing in cancer control continuum: A content analysis of Malaysian English and Chinese online cancer news.

Background: In health news production, sourcing and framing are two critical mechanisms that influence how newsreaders think about and perceive the severity of a health issue. Understanding how local media covers the cancer control continuum is vital. However, very limited studies have looked at the effect of sourcing and framing in cancer news coverage, and it is still unknown how sources and news frames shape cancer coverage, especially in non-Western countries. Objective: This study examines framing and sourcing patterns in news stories reporting on cancer control in Malaysian mainstream (English) and ethnicity (Chinese) online news sites, uncovering underlining associations between essential news components, source, and framing. Methods: We used a predesigned code book to conduct a quantitative content analysis on cancer news stories (n = 841) published on two Malaysian English and Chinese online news sites from 2017 to 2019. Cancer news received adequate coverage in Malaysian English and Chinese media and was also session-centered. Results: Two logistic regression models demonstrated the internal relationships between sourcing, framing, and different elements in cancer coverage. In terms of news sources, the results revealed that medical journals were the most likely to be cited when the news focused on medical research, followed by primary cancer prevention. When the news concentrated on statistical cancer reports and environmental/occupational risk factors, government agencies were more likely to be interviewed. Of news frames, when the news articles engaged with medical institutions and mentioned medical publications, the lifestyle frame was very likely to be shown, but the environmental frame was more likely to be portrayed when interviewing medical practitioners. Conclusion: This study is the first comprehensive assessment to analyze and compare Malaysian English and Chinese online cancer news coverages and uncover underlying associations between news components, sourcing, and framing paradigms. We contributed to the scholarly understanding of cancer news coverage. This study can serve as a model for future health promotion researchers, journalists, and policymakers. Implications for cancer risk communication research, health journalist practices, and health policymaking were discussed.

A question of justice: Critically researching suicide with Indigenous studies of affect, biosociality, and land-based relations.

This paper considers how Indigenous studies can inform the evolution of critical research on suicide. Aligned with critiques of mainstream suicidology, these methodological approaches provide a roadmap for structural analysis of complex systems and logics in which the phenomenon of suicide emerges. Moving beyond mere naming of social determinants of suicide and consistent with calls for a theory of justice within suicide research, Indigenous studies helps to advance conceptual knowledge of suicide in descriptive means and enhance ethical responses to suicide beyond psychocentric domains. Through centering Indigenous theories of affect, biosociality, and land-based relations, this article examines what new knowledge of suicide can emerge, as well as what ethical responses are possible to suicide and to a world where suicide exists. This new knowledge can inform practices for critical suicide studies which are invested in resisting structural violence, nourish agency, dignity and freedom for those living and dying in often-unlivable presents, and enhancing livability for individuals, communities, and the environment living under shadows of empire. Implications for theory, ethics, and suicide research and prevention practice are considered.

'Think before you drink': Challenging narratives on foetal alcohol spectrum disorder and indigeneity in Canada.

Foetal Alcohol Spectrum Disorder (FASD) has emerged as a significant public health issue, in Canada and elsewhere. Health experts increasingly acknowledge that the disproportionate impact of FASD on indigenous people is driven by social and historical contexts, especially in settler colonial states like Canada. However, they generally frame FASD as preventable through abstinence and the effects of FASD as manageable through provision of appropriate medical and legal protection to affected offspring. Drawing from Marxist, anticolonial and anti-imperial theories and applying a Critical Discourse Analysis approach, we identify the (re) production of colonial and capitalist dominance in the expert literature. We show that dominant narratives depoliticize FASD by conceptualizing settler colonialism as a past event, ignoring ongoing, contemporary forms of settler colonial dispossession and resituating FASD within an expert language that locates solutions to FASD within affected individuals and communities. In so doing, these narratives legitimize, and contribute to perpetuating, existing disease inequities, prevent the formulation of policies that address the very real and as yet unmet needs of FASD affected individuals, families and communities and erase from the public discourse discussions about changes that could truly address FASD inequities at their root. We conclude by elaborating on the implication of these narratives for policy, practice and equity, in Canada and other settler colonial states.

The chronotype conjecture in the association between dietary carbohydrate intake and high-sensitivity C-reactive protein (hs-CRP): a cross-sectional study from NHANES 2015 data.

Substantial evidence suggests that the timing of macronutrient intake affects cardiovascular health. The present study aims to assess the association between the dietary carbohydrate intake (DCI) and the high-sensitivity C-reactive protein (hs-CRP) combined with the implication of the chronotype. Thus, we explored the most recently released National Health and Nutrition Examination Survey (NHANES) data. We analysed data from 5,616 participants of the NHANES in 2015. We selected participants with available data for the DCI, sleep and wake-up time, and the hs-CRP. Chronotypes were categorized according to the sleep times. Binary logistic regression analysis was performed to predict participants with low or high levels of hs-CRP based on the DCI and chronotypes. Moderation analysis was used to investigate the effect of the chronotypes on the DCI-hs-CRP's association. A higher DCI was significantly associated with the higher hs-CRP levels (odds ratio (OR) = 1.36, 95% confidence interval (CI) = [0.9-1.8]). Moderate evening (ME) chronotypes had higher risk for high hs-CRP level (OR = 1.15, 95% CI = [1.22-1.23]) compared to the intermediate and the morning chronotypes. The chronotype significantly moderated the hs-CRP given the DCI (moderation coefficient, α2=0.05, 95% CI = [0.01-0.08]). The chronotype diminished the hs-CRP predicted by the DCI. The findings of the study underscore the significance of assessing the protective effect of individuals' chronotype concerning cardiovascular health.

Impacts of Self Perceived Malocclusion on the Oral Health Related Quality of Life of Young Adults.

Self-awareness of poorly arranged teeth can influence the quality of life. This study aimed to report the impacts of self-perceived malocclusion in young adults and the association between demographic characteristics and oral health related quality of life (OHRQoL). In this cross-sectional study, six-hundred-forty-three subjects from Selangor, Malaysia selected using a multistage sampling technique answered the Psychosocial Impact of Dental Aesthetics (PIDA) questionnaire and self-rated their dental appearance using the Aesthetic Component of the Index of Orthodontic Treatment Need. Data were analyzed using multifactorial ANOVA to identify the association between demographic characteristics and total PIDA score. Five-hundred-twenty-four subjects (81.5%) completed the questionnaires. Overall, 87.8% had impacts on their OHRQoL. Psychological impact was the most impacted domain (75.8%), followed by dental self-confidence (59.4%), social impact (48.9%) and aesthetic concern (22.1%). 16.8% reported significant impacts on all domains. Their mean PIDA score was 36.3 (SD 17.1). Prevalence, extent and severity of impacts were higher amongst those with self-perceived malocclusion. Gender, ethnicity, and self-perceived malocclusion status were associated with PIDA score (p < 0.05). Sub-urban and rural females had significantly higher PIDA scores than sub-urban and rural males. In conclusion, majority of Malaysian young adults especially those with self-perceived malocclusion were impacted by their dental aesthetics.

A scoping review of the use of co-design methods with culturally and linguistically diverse communities to improve or adapt mental health services.

Mental health services are increasingly encouraged to use co-design methodologies to engage individuals and families affected by mental health problems in service design and improvement. This scoping review aimed to identify research that used co-design methods with Culturally and Linguistically Diverse (CALD) communities in mental health services, and to identify methodological considerations for working with this population. In October 2019, we searched five electronic databases (CINAHL, PsycINFO, EMBASE, MEDLINE, Web of Science) to identify papers published in which people from CALD backgrounds were engaged in the co-design of a mental health service or program. Searches were limited to peer-reviewed articles published in English in the last 25 years (1993-2019). The search identified nine articles that matched the inclusion criteria. Using a scoping review methodology, the first author charted the data using extraction fields and then used qualitative synthesis methods to identify themes. Data were grouped into themes relevant to the research question. The two key themes relate first, to improving the experience for CALD communities when engaging in co-design research and second, to the development of co-design methods themselves. These findings support the need for further research into the transferability of co-design tools with CALD communities, particularly if co-design is to become a best practice method for service design and improvement. This scoping review identified methodological and practical consideration for researchers looking to use co-design with CALD communities for mental health service design, re-design or quality improvement initiatives. Further research is required to explore experiences of co-design methods, including documented protocols such as experience-based co-design, with CALD communities. This review indicates that explanatory models of mental health, community and co-design impact partnerships with CALD communities, and need to be understood to optimise the quality of these relationships when using co-design methods.

Social inequalities and their association with the leprosy burden in a Brazilian city of low endemicity: An ecological study.

OBJECTIVE: To analyse the association between social inequalities and the leprosy burden in a low endemicity scenario in the state of São Paulo, Brazil. METHODS: This ecological study was carried out in the city of Ribeirão Preto, state of São Paulo, Brazil, considering leprosy cases notified from 2006 to 2016. Regarding social inequalities, dimensions related to high household density, literacy, home occupation conditions, health conditions, household income, ethnicity and age were considered. The generalised additive model for location, scale and shape (GAMLSS) was used to verify the association between the social inequalities and leprosy burden. RESULTS: The increase in men and women with no education and people with an income of 1 to 2 minimum wages was associated with a relative increase in the number of leprosy cases (7.37%, 7.10% and 2.44%, respectively). Regarding the ethnicity variables, the increase in the proportion of men (black) and women (mixed race) with no schooling was associated with a relative increase in the number of cases of the disease (10.77% and 4.02%, respectively). Finally, for people of mixed race or ethnicity, the increase in the proportion of households with 1/2 to 1 minimum wage was related to a relative decrease in the total number of cases (-4.90%). CONCLUSION: The results show that the determinants associated with the increase in leprosy cases are similar to those in Brazilian hyperendemic regions, and that even in cities with low endemicity, social inequality is one of the main determinants of the disease.

Patients' and clinicians' experiences of the DSM-5 Cultural Formulation Interview: A mixed method study in a Swedish outpatient setting.

This study is an evaluation of clinicians' and patients' experiences of the core Cultural Formulation Interview (CFI) in DSM-5. The CFI provides a framework for gathering culturally relevant information, but its final form has not been sufficiently evaluated. Aims were to assess the Clinical Utility (CU), Feasibility (F) and Acceptability (A) of the CFI for clinicians and patients, and to explore clinicians' experiences of using the CFI in a multicultural clinical setting in Sweden. A mixed-method design was applied, using the CFI Debriefing Instrument for Clinicians (N = 15) and a revised version of the Debriefing Instrument for Patients (N = 114) (DIC and DIP, scored from -2 to 2). Focus group interviews were conducted with clinicians. For patients (response rate 50%), the CU mean was 0.98 (SD = 0.93) and F mean 1.07 (SD = 0.83). Overall rating of the interview was 8.30 (SD = 1.75) on a scale from 0 and 10. For clinicians (response rate 94%), the CU mean was 1.14 (SD = 0.52), F 0.58 (SD = 0.93) and A 1.42 (SD = 0.44). From clinician focus-group interviews, the following themes were identified: approaching the patient and the problem in a new manner; co-creating rapport and understanding; and affecting clinical reasoning and assessment. Patients and clinicians found the CFI in DSM-5 to be a feasible, acceptable, and clinically useful assessment tool. The focus group interviews suggested that using the CFI at initial contact can help make psychiatric assessment patient-centred by facilitating patients' illness narratives. We argue for further refinements of the CFI.

Ethnicity and Health: Experience with an Urban Mapuche Health Program from the Perspective of Key Actors.

This article explores the relationships and tensions between ethnicity and health, describing the perspectives of various social actors on a Mapuche clinic in the context of a national health program. A qualitative methodology was used to carry out this case study of the Mapuche clinic "La Ruka," located in an urban area of the Metropolitan Region of Chile. The study analyzes the narratives of traditional health practitioners (including a machi, lawentuchefe, lonko, and intercultural facilitator), consumers, conventional healthcare professionals, and local health authorities and community leaders who share a physical, political, and symbolic space around the Mapuche health experience. The systemization of experiences method was applied to the data, acquired through nonparticipant observation, individual interviews, and focus groups. The results suggest that this healthcare experience is highly valued by its protagonists. However, there is a tension surrounding cultural diversity programs that recognize non-Western approaches to healing, such as indigenous practices. This study examines the health-related, cultural, and political tensions involved in projecting indigenous traditions into a homogenizing space such as healthcare in a multicultural neoliberalism system.

The Amish health culture and culturally sensitive health services: An exhaustive narrative review.

As the Amish population is growing, researcher and practitioner interest in the Amish health culture is also growing. This is largely due to demand from practitioners for population-specific cultural guidance. Once a small area of study, health-themed publications in Amish studies (n = 246) now account for approximately one-fourth of all peer-reviewed publications, and a sizeable percentage address the health culture, i.e. Amish beliefs, practices, attitudes, decision-making processes, financing, and values. In this article, we provide a first-ever exhaustive narrative review of the Amish health culture literature (addressing Amish health conditions elsewhere). Specifically, we address Amish use of modern medicine, complementary & alternative medicine, cultural norms for birthing and intercourse, support and care for the sick and aged, health knowledge, payment for services, barriers to service access, service provider effectiveness, health programming, and ethical conflicts. Our goal is to organize the literature, synthesize findings, identify orienting perspectives, and clarify research questions and directions. Following our synthesis, we reflect on the current state of Amish health culture research, drawing particular attention to strengths and limitations of the oft-used cultural competency paradigm, and recommending more rigorous social scientific theorization of the Amish health culture.

Racial and ethnic disparities in premature births among pregnant women in the NISAMI cohort, Brazil / Disparidades étnicas e raciais nos partos prematuros entre gestantes da coorte NISAMI, Brasil

Abstract The incidence of premature birth has increased worldwide, unequally distributed by race/ethnicity. Racism generates economic inequalities, educational disparities, and differential access to health care, which increases the risk of preterm birth. Thus, this study aimed to evaluate the factors associated with preterm birth and racial and ethnic disparities in premature birth among pregnant women attending prenatal care at the Brazilian Unified Health System health units in the urban area of Santo Antônio de Jesus, Bahia, Brazil. This study used data from 938 pregnant women aged between 18 to 45 years within the NISAMI prospective cohort. Premature birth prevalence was 11.8%, with a higher prevalence among black than non-black women (12.9% versus 6.0%, respectively). Maternal age between 18 and 24 years was the only factor associated with premature birth. A higher risk of premature birth was found among black women than non-black women (RR 3.22; 95%CI 1.42-7.32). These results reveal the existence of racial and social inequalities in the occurrence of premature birth.

Resumo A incidência de parto prematuro tem aumentado em todo o mundo, distribuída de forma desigual por raça/etnia. O racismo gera desigualdades econômicas, disparidades educacionais e acesso diferenciado à saúde, o que aumenta o risco de parto prematuro. Assim, este estudo teve como objetivo avaliar os fatores associados à prematuridade e disparidades raciais e étnicas no parto prematuro entre gestantes atendidas durante o pré-natal em unidades de saúde do Sistema Único de Saúde na zona urbana de Santo Antônio de Jesus, Bahia, Brasil. Este estudo utilizou dados de 938 mulheres grávidas com idade entre 18 e 45 anos dentro da coorte prospectiva do NISAMI. A prevalência de prematuridade foi de 11,8%, sendo maior entre as negras do que entre as não negras (12,9% versus 6,0%, respectivamente). A idade materna entre 18 e 24 anos foi o único fator associado ao parto prematuro. Foi encontrado maior risco de prematuridade entre as mulheres negras do que entre as não negras (RR 3,22; IC95% 1,42-7,32). Esses resultados revelam a existência de desigualdades raciais e sociais na ocorrência do parto prematuro.

Itinerários terapêuticos para cuidados em saúde bucal de adultos quilombolas de um distrito rural da Bahia, Brasil / Therapeutic itineraries of quilombola adults for oral health care in a rural district of Bahia, Brazil

Resumo O estudo analisou os itinerários terapêuticos relacionados à saúde bucal de adultos quilombolas de um distrito rural de Vitória da Conquista, Bahia. Trata-se de uma pesquisa qualitativa, na qual foram realizadas dez entrevistas semiestruturadas com adultos quilombolas em maio de 2021, transcritas e analisadas por meio da análise de conteúdo. Os resultados evidenciaram ausência e/ou precariedade na higiene bucal em alguma fase da vida, especialmente infância e adolescência; utilização de práticas populares para cuidado a saúde bucal e experiências de cuidado profissional marcados pela exodontia. A utilização de serviços de saúde foi relatada, em sua maioria, apenas no período anterior à pandemia de COVID-19, os entrevistados divergiram quanto à percepção de facilidade do acesso aos serviços de saúde em sua comunidade. Os relatos sobre a satisfação da saúde bucal destacaram a necessidade de uso ou substituição de próteses dentárias. À guisa de conclusão, entende-se que é necessária a promoção de saúde bucal de forma articulada com ações que possibilitem a prevenção de agravos, a reabilitação odontológica e a valorização do conhecimento e da visão de mundo da população quilombola.

Abstract This study examined the oral health-related therapeutic itineraries of quilombola adults in a rural district of Vitória da Conquista, Bahia. This qualitative study involved ten semi-structured interviews of adult members of the quilombola community, in May 2021, which were then transcribed and analysed using content analysis. The results showed little or poor oral hygiene at some stage of life, especially in childhood and adolescence, the use of popular oral health care practices, and experiences of professional care featuring tooth extraction. Use of health services was mostly reported only in the period prior to the COVID-19 pandemic. Responses as to perceived ease of access to health services in the community varied. One common complaint as to satisfaction with oral health was the need to use or replace dental prostheses. This study concluded that oral health must be promoted jointly with disease prevention, dental rehabilitation and recognition for the knowledge and worldview of the quilombola population.