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Patient-centered culturally sensitive health care: model testing and refinement.
Tucker, CM, Marsiske, M, Rice, KG, Nielson, JJ, Herman, K
Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2011;30(3):342-50
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Plain language summary
Patient-centred culturally sensitive health care is based on views of culturally diverse patients rather than the views of health care professionals. Empowering patients to share their views concerning culturally sensitive health care is a manifestation of patient centeredness. This study presents an empirical evaluation of a literature-based Patient Centred Culturally Sensitive Health Care Model. The model was designed to explain the link between patient-centred culturally sensitive health care and patients’ treatment adherence, health promoting behaviours, and health outcomes. A total of 229 patients participated in this study, out of which 110 were African American and 119 self-identified as non-Hispanic White American. Results revealed significant links between patient-perceived provider cultural sensitivity and patient adherence to provider recommended treatment regimen variables, with some differences in associations emerging by race/ethnicity. Among both racial/ethnic groups, providing cultural sensitivity had direct effects on trust and satisfaction with care. The effect on care satisfaction was stronger for the African American patients whereas the effect on trust was stronger for the White American patients. Authors conclude that empowering racial/ethnic minorities and individuals with low household incomes to have increased control in patient-provider interactions and in community participatory health promotion interventions may be an important strategy for improving their health and health care utilization.
Abstract
OBJECTIVES This article presents the results of an empirical test of a literature-based Patient-Centered Culturally Sensitive Health Care Model. The model was developed to explain and improve health care for ethnically diverse patients seen in community-based primary care clinics. DESIGN Samples of predominantly low-income African American (n = 110) and non-Hispanic White American (n = 119) patients were recruited to complete questionnaires about their perceived health care provider cultural sensitivity and adherence to their provider's treatment regimen recommendations. MAIN OUTCOME MEASURES Patients completed written measures of their perceived provider cultural sensitivity, trust in provider, interpersonal control, satisfaction with their health care provider, physical stress, and adherence to provider-recommended treatment regimen variables (i.e., engagement in a health promoting lifestyle, and dietary and medication adherence). RESULTS Two-group path analyses revealed significant links between patient-perceived provider cultural sensitivity and adherence to provider treatment regimen recommendations, with some differences in associations emerging by race/ethnicity. CONCLUSION The findings provide empirical support for the potential usefulness of the Patient-Centered Culturally Sensitive Health Care Model for explaining the linkage between the provision of patient-centered, culturally sensitive health care, and the health behaviors and outcomes of patients who experience such care.
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Plasma ghrelin concentrations are lower in binge-eating disorder.
Geliebter, A, Gluck, ME, Hashim, SA
The Journal of nutrition. 2005;135(5):1326-30
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Plain language summary
Binge Eating Disorder (BED) is characterised by eating a large quantity of food (objectively) at least 2 times a week for 6 months, and is associated with a loss of feelings of self control. It is found it around 30% of obese individual who participate in weight loss programs. There may be a biological element to this disorder with possible mechanisms including heritability, an enlarged stomach capacity and genetic mutations. Hormones may also play a role in BED. This study aimed to establish whether obese individuals had higher fasting and post feeding ghrelin levels, and slower gastric emptying compared to a non-obese BED control group. 38 overweight and obese women were recruited and classified into one of three groups; non binge eaters (12), binge eaters but not meeting full BED criteria (14) and BED syndrome (11). 10 of the 11 BED women were randomly allocated to a 6 week treatment of either a) cognitive behavioural therapy (CBT) and a diet or b) a non treatment wait-list control. The study found that the BED women had a lower fasting ghrelin level and that ghrelin also declined less after a meal for this group. The authors stated that this appeared to be counterintuitive because ghrelin (which stimulates hunger) was expected to be higher for overweight and obese people. They suggest that binge eating may down-regulate ghrelin and be a response to over-eating (often when not hungry). They also suggested that ghrelin declining less for overweight and obese BED women may suggest that the magnitude of the ghrelin fall may be linked to higher satiation (so they have lower satiation and continue eating compared to other individuals).
Abstract
Binge-eating disorder (BED), characterized by binge meals without purging afterward, is found in about 30% of obese individuals seeking treatment. The study objective was to ascertain abnormalities in hormones influencing appetite in BED, especially ghrelin, an appetite-stimulating peptide, which was expected to be elevated. Measurements were made of plasma insulin, leptin, glucagon, cholecystokinin, and ghrelin, as well as glucose following an overnight 12-h fast, prior to and after ingestion (from 0 to 5 min) of a nutritionally complete liquid meal (1254 kJ) at 0830 h, at -15, 0, 5, 15, 30, 60, 90, and 120 min. Appetite ratings including hunger and fullness were also obtained. An acetaminophen tracer was used to assess gastric emptying rate. Three groups of comparably obese women (BMI = 35.9 +/- 5.5; % body fat = 44.9 +/- 4.7) participated: 12 nonbinge eating normals (NB), 14 subthreshold BED, and 11 BED. The BED subjects, compared to NB subjects, had lower baseline ghrelin concentrations prior to the meal, a lower area under the curve (AUC), with lower levels at 5, 15, 30, 90, and 120 min, and a smaller decline in ghrelin postmeal (all P < 0.03). The other blood values did not differ among groups, and neither did gastric emptying rate nor ratings of fullness. The BED subjects were then randomly assigned to treatment with cognitive-behavior therapy and diet (n = 5) or to a wait-list control (n = 4). Baseline ghrelin (P = 0.01) and AUC increased (P = 0.02), across both conditions, in which most subjects (7 of 9) stopped binge eating. The lower fasting and postmeal plasma ghrelin levels in BED are consistent with lower ghrelin levels in obese compared to lean individuals and suggests downregulation by binge eating.