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Clinical Pharmacology and Therapeutics Aug 2019Health disparities exist among minorities in the United States, with differences seen in disease prevalence, mortality, and responses to medications. These differences... (Review)
Review
Health disparities exist among minorities in the United States, with differences seen in disease prevalence, mortality, and responses to medications. These differences are multifactorial with genetic variation explaining a portion of this variability. Pharmacogenomics aims to find the effect of genetic variations on drug response, with the goal of optimizing drug therapy and development. Although genome-wide association studies have been useful in unbiasedly surveying the genome for genetic drivers of clinically relevant phenotypes, most of these studies have been conducted in mainly participants of European and Asian descent, contributing to a growing health disparity in precision medicine. Diversity is important to pharmacogenomic studies, and there may be real advantages to the use of these complex genomes in pharmacogenomics. In this review we will outline some of the advantages and confounders of pharmacogenomics in minorities, describe the role of genetic variation in pharmacologic pathways, and highlight a number of population-specific findings.
Topics: Biotransformation; Health Status Disparities; Humans; Minority Groups; Pharmacogenetics; Pharmacogenomic Variants
PubMed: 31038731
DOI: 10.1002/cpt.1491 -
Annals of Internal Medicine Aug 2021The year 2020 saw the largest social movement in response to the police killings of Black people and anti-Black racism in U.S. history. As a result, medical schools and...
The year 2020 saw the largest social movement in response to the police killings of Black people and anti-Black racism in U.S. history. As a result, medical schools and professional societies such as the American Medical Association and the Association of American Medical Colleges are reckoning with their role in perpetuating racial inequality and the impact of structural racism on medical training. Whether these efforts will translate into meaningful change has yet to be determined. Success depends on a deep understanding of the fundamental role racism plays in how medical schools function and an acknowledgment that current organizational structures and processes often serve to entrench, not dismantle, racial inequities. Drawing on racialized organizations theory from the field of sociology, this article gives an overview of scholarship on race and racism in medical training to demonstrate how seemingly race-neutral processes and structures within medical education, in conjunction with individuals' biases and interpersonal discrimination, serve to reproduce and sustain racial inequality. From entrance into medical school through the residency application process, organizational factors such as reliance on standardized tests to predict future success, a hostile learning climate, and racially biased performance metrics ultimately stunt the careers of trainees of color, particularly those from backgrounds underrepresented in medicine (URM). These compounding disadvantages contribute to URM trainees' lower matching odds, steering into less competitive and lucrative specialties, and burnout and attrition from academic careers. In their commitment against structural racism in medical training and academic medicine, medical schools and larger organizations like the Association of American Medical Colleges should prioritize interventions targeted at these structural barriers to achieve equity.
Topics: Cultural Diversity; Humans; Minority Groups; Organizational Objectives; Racial Groups; Racism; School Admission Criteria; Schools, Medical; Societies, Medical; United States
PubMed: 34058105
DOI: 10.7326/M21-0369 -
Journal of Intellectual Disability... Aug 2006Compared with that in mental illness, cultural variation in popular conceptualisations of intellectual disability has been rarely addressed. (Review)
Review
BACKGROUND
Compared with that in mental illness, cultural variation in popular conceptualisations of intellectual disability has been rarely addressed.
METHODS
A survey of the relevant literature was conducted.
RESULTS AND CONCLUSION
Preliminous conclusions are that local conceptualisation does not lead to invariant social response, but that intellectual disability is generally distinguished from mental illness.
Topics: Cross-Cultural Comparison; Cultural Diversity; Emigration and Immigration; Humans; Intellectual Disability; Mental Disorders; Minority Groups; Prejudice; Public Opinion; Social Values; Stereotyping
PubMed: 16867062
DOI: 10.1111/j.1365-2788.2006.00834.x -
Medical Education Mar 2021This review aims to identify and summarise the literature pertaining to the implementation of affirmative action programmes (AAP) for selection of ethnic minorities and... (Review)
Review
OBJECTIVE
This review aims to identify and summarise the literature pertaining to the implementation of affirmative action programmes (AAP) for selection of ethnic minorities and Indigenous peoples into selective specialist medical and surgical training programmes.
METHODS
A systematic literature search was conducted to identify relevant studies reporting on the background, implementation and results of AAP for ethnic minorities and Indigenous peoples into medical and surgical training. MEDLINE, EMBASE, PubMed, Scopus and Google Scholar databases were queried from inception through to 1 February 2020. All included studies were subjected to inductive thematic analysis in order to systematically collate study findings. Articles were read through several times in an iterative manner to allow the identification of themes across the included studies. The themes were cross-compared among the authors to establish their interconnectedness.
RESULTS
Forty-five articles described AAP pertaining to ethnic minorities in the United States of America (African-Americans and Hispanic Americans), women and ethnic minorities, Indigenous peoples (New Zealand Māori) and people with low socio-economic status. Four themes were identified. These included the need for social responsiveness in clinical training organisations, justification and criticism of AAP, how clinical training agencies should participate in AAP and what constitutes an effective AAP for specialist medical and surgical training.
CONCLUSIONS
Affirmative action programmes have been effective at increasing numbers of ethnic minority medical school graduates but have not been used for specialist medical or surgical training selection. AAP achieve the best results when they are associated with a comprehensive programme of candidate preparation, support and mentorship beginning prior to application, and support and mentorship extending through training and subsequently into the post-training period as an independent professional. The overall aim of any AAP in medical or surgical training must be graduation of significant numbers of minority and Indigenous trainees into successful practice with appointment to faculty member and leadership positions.
Topics: Ethnicity; Female; Humans; Leadership; Minority Groups; Public Policy; Schools, Medical; United States
PubMed: 32895996
DOI: 10.1111/medu.14350 -
International Review of Psychiatry... 2022In the past few decades, affirmative therapies for sexual minorities have burgeoned. These are appropriate therapies but often there is a lack of adequate research. We... (Review)
Review
In the past few decades, affirmative therapies for sexual minorities have burgeoned. These are appropriate therapies but often there is a lack of adequate research. We set out to study the research evidence available. For this mixed-methods review, we identified 15 studies looking into the experiences of lesbian, gay and bisexual people in psychological therapies. These included nine qualitative, five quantitative and one mixed method studies. Minority stress hypothesis may explain some of the major difficulties LGB individuals face. Studies showed computer based therapies may reduce or even eliminate unhelpful responses on part of the therapist. Challenges related to confidentiality and privacy in this context remain. Therapists may focus on minority stress but other stressors and not just discrimination may contribute to various mental health problems and their clinical presence. And finally, divergent findings found internalized homophobia may best explain discrimination-based minority stress and that therapist self-disclosure of own sexuality produced better results than the therapists who did not self-disclose. These findings are discussed and future directions for research are identified.
Topics: Bisexuality; Female; Homophobia; Humans; Minority Groups; Sexual and Gender Minorities; Sexuality
PubMed: 36151830
DOI: 10.1080/09540261.2022.2051443 -
Issues in Mental Health Nursing Jul 2012A systematic review of the literature was performed to answer the following questions (a) What factors contribute to the emotional responses of school-age children who... (Review)
Review
A systematic review of the literature was performed to answer the following questions (a) What factors contribute to the emotional responses of school-age children who have asthma? (b) What are the potential gaps in the literature regarding the emotional responses of school-age children (ages 6-12) who have asthma? (c) Are children with a lower socioeconomic status (SES) and those who are minorities represented in the literature proportionate to their prevalence? Two main focus areas regarding emotional responses were identified: (a) factors related to children who have asthma and (b) factors related to caregivers of children who have asthma. Internalizing disorders were reported consistently for children and caregivers of children who have asthma. Negative consequences of asthma for children included panic and asthma attacks, missed school days, and behavioral problems. Issues for caregivers included higher levels of anxiety and depressive symptoms, asthma management deficits, and lower caregiver warmth and involvement. Gaps in the literature included separated studies for children ages 6-12, a lack of a standardized method to define SES, studies that were of a more experimental nature, and a disparate number of studies of minority children and caregivers relative to their asthma prevalence.
Topics: Absenteeism; Adaptation, Psychological; Asthma; Caregivers; Child; Child Behavior Disorders; Cost of Illness; Cross-Sectional Studies; Emotions; Female; Humans; Male; Minority Groups; Panic Disorder; Sick Role; Students
PubMed: 22757594
DOI: 10.3109/01612840.2012.682327 -
LGBT Health Apr 2021Health disparities among sexual minority men remain and continue to demand novel interventions. Other than risk reduction, a promising approach is to identify pathways...
Health disparities among sexual minority men remain and continue to demand novel interventions. Other than risk reduction, a promising approach is to identify pathways to health-promoting behaviors. In this study, depressive symptoms, internalized homophobia, and sense of community connectedness were hypothesized to result from the experience of harassment and rejection, and in turn either promote or inhibit an individual's tendency toward health-promoting behaviors. We accounted for subgroup differences by examining the hypothesized model in gay and bisexual men separately. This was a cross-sectional survey study. One thousand three hundred eighty-one gay (81.5%) and bisexual (18.5%) Taiwanese men 18-49 years of age (mean = 26.56, standard deviation = 6) were recruited through a social media advertisement and completed an online survey. Structural equation modeling was employed to simultaneously examine multiple hypothesized paths. Harassment and rejection were associated with greater depressive symptoms, internalized homophobia, and sense of community connectedness, which in turn yielded direct or indirect associations with health-promoting behavior among gay men. For bisexual men, depressive symptoms remained an important mechanism linking harassment and rejection and health-promoting behavior, whereas the roles of internalized homophobia and sense of community connectedness appeared less obvious. These findings cast new light on the behavioral implications of minority stress and elucidate the possible underlying mechanisms. The study suggests that more effort should be invested to understand and promote the drivers of health-promoting behavior to reduce health disparities in this population.
Topics: Adolescent; Adult; Cross-Sectional Studies; Health Behavior; Homosexuality, Male; Humans; Male; Middle Aged; Minority Groups; Models, Psychological; Sexual and Gender Minorities; Stress, Psychological; Surveys and Questionnaires; Taiwan; Young Adult
PubMed: 33625267
DOI: 10.1089/lgbt.2020.0194 -
Journal of Behavioral Medicine Oct 2020Sexual minority (non-heterosexual) individuals experience higher rates of physical health problems. Minority stress has been the primary explanatory model to account for... (Review)
Review
Sexual minority (non-heterosexual) individuals experience higher rates of physical health problems. Minority stress has been the primary explanatory model to account for this disparity. The purpose of this study was to identify in published research empirically established relationships between minority stress processes and biological outcomes and identify avenues for future research. The PubMed database was queried with search terms relevant to minority stress and a comprehensive list of physical and biological outcomes. To be included in the analysis, studies had to examine the relationship between minority stress and a biological outcome among sexual minority individuals. Those meeting inclusion criteria were coded for key variables including methodology used, positive and null results, participant characteristics, and specific minority stress processes and biological outcomes considered. In total, 26 studies met inclusion criteria. Studies tested relationships between specific minority stress processes including prejudice, expectations of prejudice, concealment of sexual orientation, and internalized stigma and multiple biological outcomes, such as overall physical health, immune response, HIV specific outcomes, cardiovascular outcomes, metabolic outcomes, cancer related outcomes, and hormonal outcomes. Studies included both analyses that detected this relationship (42% of analyses) and analyses that did not detect this relationship (58%). There is substantial evidence to support the relationship between minority stress and biological outcomes, yet additional research is needed to identify the measurements and outcomes that have the most rigorous and replicable results.
Topics: Bisexuality; Female; Humans; Male; Minority Groups; Sexual Behavior; Sexual and Gender Minorities; Social Stigma; Stress, Psychological
PubMed: 31863268
DOI: 10.1007/s10865-019-00120-6 -
Health Promotion International Apr 2022Addressing the USA diversity gap in science, technology, engineering, mathematics and medicine (STEM-M) through strategic alliance partnerships (SAPs) is an innovative...
Addressing the USA diversity gap in science, technology, engineering, mathematics and medicine (STEM-M) through strategic alliance partnerships (SAPs) is an innovative solution toward combating the educational inequalities presented in K-12 education for marginalized youth interested in STEM-M professions. We present a model that unites multiple stakeholder s committed to diversifying the workforce in STEM-M, through the implementation of a multi-year high school pipeline program designed to better achieve STEM-M equity, access and opportunity at the secondary school level. We developed a unique model based on an SAP in a large metropolitan area in the Midwest that joins an Academic Medical Center and a local Public High School. Our results involving 46 students over 8 years demonstrate 100% high school graduation rates; 97% college attendance with full or partial scholarship support, and early evidence of post-graduation aspirations in STEM-M careers. Our early progress calls for more rigorous study against standard educational practices. If our program is proven to be more effective, then potentially more strategic public-private partnerships to foster K-12 pipeline programs to better achieve equity through educational access, opportunities and resources should be developed and targeted for those marginalized youth that have been historically denied STEM-M opportunities. After 10 years of dedicated effort, we see evidence of potential benefits of this SAP to develop K-12 pipeline programs with similar aims of STEM-M diversification, particularly by way of more-equitable provision of educational opportunities to students belonging to minority racial and ethnic groups.
Topics: Adolescent; Humans; Mathematics; Minority Groups; Students; Technology; Universities
PubMed: 34427310
DOI: 10.1093/heapro/daab094 -
The Journal of Medicine and Philosophy Jun 2013Moral and legal notions engaged in clinical ethics should not only possess analytic clarity but a sound basis in empirical findings. The latter condition brings into...
Moral and legal notions engaged in clinical ethics should not only possess analytic clarity but a sound basis in empirical findings. The latter condition brings into question the expansion of the mature minor exception. The mature minor exception in the healthcare law of the United States has served to enable those under the legal age to consent to medical treatment. Although originally developed primarily for minors in emergency or quasi-emergency need for health care, it was expanded especially from the 1970s in order to cover unemancipated minors older than 14 years. This expansion initially appeared plausible, given psychological data that showed the intellectual capacity of minors over 14 to recognize the causal connection between their choices and the consequences of their choices. However, subsequent psychological studies have shown that minors generally fail to have realistic affective and evaluative appreciations of the consequences of their decisions, because they tend to over-emphasize short-term benefits and underestimate long-term risks. Also, unlike most decisionmakers over 21, the decisions of minors are more often marked by the lack of adequate impulse control, all of which is reflected in the far higher involvement of adolescents in acts of violence, intentional injury, and serious automobile accidents. These effects are more evident in circumstances that elicit elevated affective responses. The advent of brain imaging has allowed the actual visualization of qualitative differences between how minors versus persons over the age of 21 generally assess risks and benefits and make decisions. In the case of most under the age of 21, subcortical systems fail adequately to be checked by the prefrontal systems that are involved in adult executive decisions. The neuroanatomical and psychological model developed by Casey, Jones, and Summerville offers an empirical insight into the qualitative differences in the neuroanatomical and neuropsychological bases of adolescent versus adult decision making. These and other data, as well as developing law bearing on the culpability of juvenile criminal offenders, argue for critically re-evaluating the expansion of the mature minor exception with regard to medical decision making, as well as in support of a rebuttable presumption in favor of treating minors as immature decisionmakers. The clinical ethics of adolescent medical decision making will need foundationally to be reconsidered.
Topics: Adolescent; Adolescent Development; Brain; Cognition; Decision Making; Ethics, Medical; Humans; Informed Consent; Mental Competency; Minors; Models, Psychological; Risk-Taking; United States
PubMed: 23615057
DOI: 10.1093/jmp/jht013