Ethnic Gloss

Globally, over 20.4 million people need palliative care services annually. The majority of these people (19 million) are adults, with 34% of them being patients diagnosed with cancer. With the current increase in the aging population, especially in developed countries, the number of adults requiring palliative care is expected to rise. Furthermore, how palliative care is offered and received continues to be shaped by culture and ethnicity. Likewise, culture and ethnicity influence how palliative care patients experience diseases like cancer, and seek and utilize palliative care services. Also, healthcare providers sometimes find it challenging to address the palliative care needs of patients from different ethnocultural groups. Sometimes these challenges are believed to be due to cultural incompetence of the care provider. When palliative care patients and their providers differ in their perception of care needs and how to address them, negative palliative care experiences are likely to ensue. Therefore, as the demand for palliative care increases, and ethnocultural factors continue to affect palliation, it is important to gain a better understanding of palliative care experiences of patients from different ethnocultural groups.The terms culture and ethnicity have been defined and used differently in literature which sometimes lead to confusion. Ethnicity has been defined as distinctive shared origins or social backgrounds and traditions of a group of people that are maintained between generations and bring about a sense of identity that may encompass a common language and religion. Ethnicity is fluid and should not be confused with nationality or migration or race. In this review, we define ethnicity in relation to the self-identification of participants in studies that will be included in the review.Culture refers to patterns of explanatory models, beliefs, values and customs. These patterns may be informed and expressed in things like diet, clothing or rituals, or in the form of language and social or political systems. Culture may be fluid because of developments in people's lives. In light of the aforementioned definitions, and recognizing the inconsistency in how these terms are sometimes used, the authors of this review define ethnocultural patients, as described in papers to be reviewed, as those who belong to an ethnic group by way of involvement, attachment, self-labelling or attitude towards the group, and who share cultural traditions, ancestry, language, nationality or country of origin.Palliative care in the context of cancer focuses on the improvement of the quality of life of patients by addressing their physical, emotional and spiritual needs, and by supporting their families. Palliative care is often associated with supportive and hospice care. Supportive care emphasizes meeting patients' needs such as physical, mental, social, psychological, emotional and material needs from the period before diagnosis, during diagnosis, treatment to the follow-up period in the cancer trajectory. Hospice care in the context of cancer aims to relieve patients' pain and suffering, and improve their quality of life. Hospice care includes palliative care services and other services such as case management, respite care and bereavement care. Hospice care focuses on patients with terminal illness (i.e. with expected survival of less than six months) and their families. Moreover, hospice care is facilitated by a multidisciplinary team of physicians, nurses, social workers, chaplains, home health aides and volunteers.Palliative care needs for cancer patients are numerous and may include needs related to activities of daily living, communication, sexuality, physical needs, psychological needs, fear, spiritual wellbeing, socioeconomic aspects and insufficiency of information. Cancer patients often report of suffering, pain and being in constant need of support. In dealing with their suffering, some patients seek internal motivation by looking at the disease as a life challenge. Other patients turn to external sources of motivation like religion, or peer and family support groups.Patients from different ethnocultural groups report similar as well as dissimilar palliative care needs and experiences. With respect to similarities, a study from the United States found that African American and Caucasian patients alike valued practical assistance from social groups. Participants from both ethnocultural groups valued friends and families that listened to their cancer-related concerns. Similarly, Turkish and Moroccan patients in a study conducted in Netherlands valued friends and family members that were there for them. Additionally, participants particularly of African American descent treasured positive attitudes from people around them and valued support from religion and faith communities. These sentiments are echoed in a palliative care study conducted in the United Kingdom. In the UK study, Caribbean Blacks and British White patients appreciated the significance of social networks and partner or spousal support in their cancer trajectory.In regards to unsupportive palliative care experiences, authors of the United States study report that African Americans and Caucasians had more similarities than differences. Firstly, both ethnocultural groups shared experiences of losing association with family and close friends after they learnt of the patients' diagnosis. These sentiments were also reported by Danish-born and immigrant patients in a study by Kristiansen and colleagues. Secondly, both African American and Caucasian patients felt responsible for the emotional wellbeing of their loved ones.When it comes to differences in palliative care needs and experiences, Grange and colleagues report that African American and Caucasian participants valued provision of housing which included daily patient care. Participants treasured the opportunity to either move or have family members move in and live with them. However, more African American than Caucasian participants had experiences of moving in with a family member. Important differences in unsupportive palliative care were also reported. Although both African Americans and Caucasians lost friends and family members following knowledge of the cancer diagnoses, more African Americans than Caucasians were likely to report losing friendship. Additionally, African Americans experienced diminished independence mainly because of overprotection from family and friends. Diminishing independence is echoed in the Dutch study involving Turkish and Moroccan patients. However, in the Dutch study, healthcare providers appeared to advocate for patients' independence which contradicted with the value placed by family members in protecting their loved one.In another American study, Latina women desired health-related information more often than their Caucasian American counterparts. The need for information by Latina women was irrespective of their socio-demographic factors, including level of education.The aforementioned similarities and differences in palliative care experiences call for further exploration of ethnocultural palliative care patients' experiences. A better understanding of their experiences will create avenues for finding better ways of providing palliative care, preventing psychological distress and improving quality of life and death.Understanding ethnocultural issues is important because the unique characteristics of ethnocultural groups often inform approaches to palliative care. Ethnocultural meanings of illness, suffering and dying define the theoretical underpinnings that patients and healthcare providers draw upon in their relations. Furthermore, Baker suggests that the provision and receipt of palliative care is more related to culture or ethnicity than to age, education, socioeconomic status or other variables. Moreover, culture affects communication, decision-making, response to symptoms, treatment choices and emotional expression at the end of life.Palliative care patients often regard recommendations from healthcare providers as very useful. Similarly, healthcare providers may find ethnocultural knowledge beneficial in the provision of palliative care. When ethnocultural knowledge is lacking, healthcare providers, especially those with minimal training on ethnocultural issues, may provide unsatisfactory palliative care. Similarly, when ethnocultural differences are overlooked or inadequately addressed, inferior care often occurs. Inferior care which may involve inequality in utilization of and access to palliative care services, pain and symptom management and location of death, is especially disturbing when adequate palliative care resources exist in some health institutions.Although qualitative and quantitative research has been conducted in this area, no systematic review compiling findings on ethnocultural patients' experiences of palliative care has been conducted or is underway as per the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, Cochrane Database of Systematic Reviews or PROSPERO. The purpose of this systematic review is to summarize findings of qualitative studies that focus on ethnocultural patients' experience of palliative care. (ABSTRACT TRUNCATED)

BackgroundThe prevalence of dementia varies around the world, potentially contributed to by international differences in rates of age-related cognitive decline. Our primary goal was to investigate how rates of age-related decline in cognitive test performance varied among international cohort studies of cognitive aging. We also determined the extent to which sex, educational attainment, and apolipoprotein E ε4 allele (APOE*4) carrier status were associated with decline.Methods and findingsWe harmonized longitudinal data for 14 cohorts from 12 countries (Australia, Brazil, France, Greece, Hong Kong, Italy, Japan, Singapore, Spain, South Korea, United Kingdom, United States), for a total of 42,170 individuals aged 54–105 y (42% male), including 3.3% with dementia at baseline. The studies began between 1989 and 2011, with all but three ongoing, and each had 2–16 assessment waves (median = 3) and a follow-up duration of 2–15 y. We analyzed standardized Mini-Mental State Examination (MMSE) and memory, processing speed, language, and executive functioning test scores using linear mixed models, adjusted for sex and education, and meta-analytic techniques. Performance on all cognitive measures declined with age, with the most rapid rate of change pooled across cohorts a moderate -0.26 standard deviations per decade (SD/decade) (95% confidence interval [CI] [-0.35, -0.16], p < 0.001) for processing speed. Rates of decline accelerated slightly with age, with executive functioning showing the largest additional rate of decline with every further decade of age (-0.07 SD/decade, 95% CI [-0.10, -0.03], p = 0.002). There was a considerable degree of heterogeneity in the associations across cohorts, including a slightly faster decline (p = 0.021) on the MMSE for Asians (-0.20 SD/decade, 95% CI [-0.28, -0.12], p < 0.001) than for whites (-0.09 SD/decade, 95% CI [-0.16, -0.02], p = 0.009). Males declined on the MMSE at a slightly slower rate than females (difference = 0.023 SD/decade, 95% CI [0.011, 0.035], p < 0.001), and every additional year of education was associated with a rate of decline slightly slower for the MMSE (0.004 SD/decade less, 95% CI [0.002, 0.006], p = 0.001), but slightly faster for language (-0.007 SD/decade more, 95% CI [-0.011, -0.003], p = 0.001). APOE*4 carriers declined slightly more rapidly than non-carriers on most cognitive measures, with processing speed showing the greatest difference (-0.08 SD/decade, 95% CI [-0.15, -0.01], p = 0.019). The same overall pattern of results was found when analyses were repeated with baseline dementia cases excluded. We used only one test to represent cognitive domains, and though a prototypical one, we nevertheless urge caution in generalizing the results to domains rather than viewing them as test-specific associations. This study lacked cohorts from Africa, India, and mainland China.ConclusionsCognitive performance declined with age, and more rapidly with increasing age, across samples from diverse ethnocultural groups and geographical regions. Associations varied across cohorts, suggesting that different rates of cognitive decline might contribute to the global variation in dementia prevalence. However, the many similarities and consistent associations with education and APOE genotype indicate a need to explore how international differences in associations with other risk factors such as genetics, cardiovascular health, and lifestyle are involved. Future studies should attempt to use multiple tests for each cognitive domain and feature populations from ethnocultural groups and geographical regions for which we lacked data.

Women Presidents: Now 26.4% but Still Underrepresented

Children of Color: Psychological Interventions With Culturally Diverse Youth, 2nd ed.

East Meets Black: Asian and Black Masculinities in the Post–Civil Rights EraRacial Reconstruction: Black Inclusion, Chinese Exclusion, and the Fictions of Citizenship

Estimates of migraine prevalence from African and Asian populations are lower than those observed in European and North American populations. To determine if these international differences reflect differences in cultural, environmental, or genetic factors, we compared the prevalence of migraine among Caucasians, African Americans, and Asian Americans in the United States. If genetic factors predominate, racial differences should persist in the United States. In Baltimore County, Maryland, 12,328 individuals 18 to 65 years of age were selected by random-digit dialing and interviewed by telephone about their headaches. Migraine diagnoses were assigned using International Headache Society criteria. In women, migraine prevalence was significantly higher in Caucasians (20.4%) than in African (16.2%) or Asian (9.2%) Americans. A similar pattern was observed among men (8.6%, 7.2%, and 4.2%). African Americans were less likely to report nausea or vomiting with their attacks, but more likely to report higher levels of headache pain. In contrast, African Americans tended to be less disabled by their attacks than Caucasians. There were no statistically significant differences in associated features between Asian American and Caucasian migraineurs. In the United States, migraine prevalence is highest in Caucasians, followed by African Americans and Asian Americans. While differences in socioeconomic status, diet, and symptom reporting may contribute to differences in estimated prevalence, we suggest that race-related differences in genetic vulnerability to migraine are more likely to predominate as an explanatory factor.

This article identifies the specific explanatory variables of self‐employment prevalent among ethnocultural groups. An interdisciplinary literature review results in the identification of several schools of thought suggesting four spheres of influence: the individual or self, the ethnocultural environment, the circumstances in society, and a combination of these. A conceptual framework is then developed, identifying two types of self‐employment, orthodox entrepreneurship and reactive self‐employment. A model links different ethnocultural communities (from empirical studies in the literature) to the explanatory variables relative to specific ethnocultural groups.RésuméCet article identifie les variables explicatives partic‐ulières au travailleur indépendant qui prévalent parmi les communautés ethnoculturelles. Une revue de littéra‐ture permit l'identification de plusieurs écoles de pensée lesquelles suggèrent quatre variables explicatives: l'in‐dividu ou le moi, l'environnement ethnoculturel, les cir‐constances et une combinaison environnement‐circon‐stance. Un cadre conceptuel est alors développé, identi‐fiant deux types de travail indépendant: l'entrepreneurial orthodoxe et le travail indépendant réactif Un mod‐èle est ensuite développé, afin de relier l'appartenance culturelle (d'après les études empiriques dans la littéra‐ture) avec les variables explicatives pertinentes à ces groupes ethnoculturels précis.

The effects of client-therapist ethnic match and client ethnicity on therapist-evaluated Global Assessment of Function (GAF) and visitation were investigated. The sample consisted of several thousand outpatient clients of a Southern California community mental health center. Findings indicated that unadjusted GAF-intake and GAF-termination scores were higher for ethnically matched Latino and Asian Americans but not for African and White Americans. Unadjusted GAF-difference scores for ethnically matched Latino and White Americans were higher than for African American clients. Unadjusted visitation or total visits was lower for ethnically matched Asian and Latino American clients, while African and White American clients had relatively high visitation levels regardless of the ethnic match status. After adjusting for 12 other variables, ethnically matched Asian American therapists consistently evaluated clients higher than did ethnically matched African American therapists. Adjusted visitation revealed fewer total visits for ethnically matched Latino and African American clients, while White Americans garnered higher visit levels when ethnically matched, and Asian Americans evidenced relatively high levels of visitation regardless of ethnic match status. Separate diagnostic category analyses revealed higher GAF-termination scores for ethnically matched African, Asian, and Latino American (schizophrenic) clients and ethnically matched Latino and Asian(mood disorder) clients. Implications for future research are discussed. © 2000 John Wiley & Sons, Inc.

Background: The anxiety disorders specified in the fourth edition, text revision, of The Diagnostic and Statistical Manual (DSM-IV-TR) are identified universally in human societies, and also show substantial cultural particularities in prevalence and symptomatology. Possible explanations for the observed epidemiological variability include lack of measurement equivalence, true differences in prevalence, and limited validity or precision of diagnostic criteria. One central question is whether, through inadvertent “over-specification” of disorders, the post-DSM-III nosology has missed related but somewhat different presentations of the same disorder because they do not exactly fit specified criteria sets. This review canvases the mental health literature for evidence of cross-cultural limitations in DSM-IV-TR anxiety disorder criteria. Methods: Searches were conducted of the mental health literature, particularly since 1994, regarding cultural or race/ethnicity-related factors that might limit the universal...

&lt;p&gt;This dissertation reassesses the impact of U.S. annexation of Arizona and New Mexico in 1848 by recovering the imposition of and resistance to the new national border and identities among Spanish-Mexican, mestiza, and Euro-American women from 1846 to 1941. I analyze the impact of U.S. annexation of Arizona and New Mexico on gender roles, ethnic identity, and cultural practices by focusing on the roles of the domestic space, food culture, and material culture in dividing and bringing together women across these ethnocultural groups. By exploring the political intent and consequences of quotidian choices, this dissertation demonstrates the centrality of women in the daily and domestic negotiations over national and cultural borders during the territorial period (1850-1912) and the era of early statehood (1912-1941). Using English and Spanish-language sources, this dissertation argues that Euro-American and Spanish-Mexican women continuously used their homes, housekeeping, cultural customs, and foodways to define their new statuses in the region and negotiate the new cultural, physical, and national boundaries. Euro-Americans used their own and others’ cultural practices to maintain their whiteness and to construct Mexicans, Mexican-Americans, and American Indians as non-white and to define gender and class in the region. Simultaneously, Spanish-Mexican women negotiated the new physical, social, and cultural boundaries by asserting their cultural citizenship even though they were denied full citizenship.&lt;/p&gt; &lt;p&gt;In the first three chapters, I study the U.S.-Mexico War and the territorial period (1846-1912) by analyzing the roles of material and food culture and the homespace in shaping each group’s constructions of whiteness, nationalism, and ethnic identity and in shaping the processes of cultural assimilation and resistance. I highlight how Euro-Americans used the newly established U.S.-Mexico border to “other” the people and practices they associated with Mexico or “savagery.” Additionally, I argue that Spanish-Mexican and Mexican American worked around gender and legal borders by engaging in trade, traveling across the international border, and inserting themselves in the political and legal activities of Euro-Americans to maintain their homespaces.&lt;/p&gt; &lt;p&gt;In Chapters 4 and 5, I address how women across ethnocultural groups used cookbooks and historical memory to create their place in community, state, and national identities after Arizona and New Mexico were incorporated in 1912. Using literary and cultural studies approaches, I address the narrative spaces, such as cookbooks and pioneer histories, in which women across ethnocultural groups claimed a stake in the public memory and community identities. I argue that Euro-American women appropriated some Spanish cultural practices and celebrated the pioneer past while denying full citizenship to people of color. Simultaneously, I argue, Spanish-Mexican and American Indian women used cookbooks and/or oral histories to challenge narratives of their inferiority and to claim their cultural citizenship.&lt;/p&gt; &lt;p&gt;This dissertation brings light to the persistent and continuous roles of women, the body, and the home in shaping daily politics in the region. By pushing at the edges of U.S.-Mexico borderlands history methodology to include gender studies methodology, this dissertation introduces the homespace and motherhood as gendered and raced contact zones that were sometimes used to enforce and at other times challenge U.S. territoriality. I argue that the domestic activities of women offer significant, new insight to the political narratives of settler-colonialism, gender roles, nationality, and race in the U.S.-Mexico borderlands. This dissertation moves away from overtly political acts to the seemingly “mundane” activities of cooking, dressing, and housekeeping to broaden our understanding of the connections between political behavior and cultural practices. These gendered negotiations provide a critical history of the intimate ways U.S. colonial efforts in the American Southwest played out and shaped the current dynamics of borderlands communities.&lt;/p&gt;

We examined potential processes by which children decide to make hard as opposed to easy choices to accomplish a goal. Five- to 7-year olds (N = 100, 52 girls, 61% White, 7% Hispanic or Latine, 5% Asian or Asian American, 5% Black or African American, 2% Native American, American Indian, or Alaskan Native, 13% Mixed Race, 7% not reporting) constructed a gear machine by choosing between easy and hard building instructions. Children chose to take on more difficult instructions based on their accuracy on previously difficult choices (OR = 3.60). Accuracy on easy choices did not relate to their subsequent decisions. These results suggest that children monitor performance on more challenging decisions and use this information to control their decision making about future efforts adaptively.

First-generation undergraduate students are underrepresented in medicine and face challenges that affect their application and matriculation to medical school. To understand the barriers and available support at the individual, interpersonal, and organizational levels for first-generation students in premedical programs. This qualitative study was part of a larger project on professional identity formation among US medical students from low socioeconomic backgrounds with a focus on first-generation undergraduate students. Semistructured online interviews of 48 students (37 of whom were first-generation students) from 27 US medical schools were conducted from November 1, 2021, through April 30, 2022, and secondary analyses regarding their premedical experiences were performed. Interviews were recorded, transcribed, deidentified, assigned an alphanumeric code, and analyzed using an inductive thematic approach from June 1 through December 30, 2024. Participants were offered a $20 gift card in appreciation for their time. Experiences of students identifying as first-generation college students in premedical training. Main outcomes included themes and subthemes at the individual, interpersonal, and organizational levels constructed from interview data. Bronfenbrenner's ecological systems theory was used as a guiding interpretive framework to analyze participants' experiences within their broader social and environmental contexts. This model allowed examination of how individual perspectives were shaped by interactions across personal, social, and structural contexts. The team engaged in reflexive discussions, memos, and consensus-based refinement to identify key themes. Among 37 participants identified as first-generation students, 21 (56.8%) identified as female (mean [SD] age, 27.3 [2.8] years). One participant (2.7%) identified as American Indian or Alaska Native; 7 (18.9%) as Hispanic, Latino, or Spanish origin; 8 (21.6%) as non-Hispanic Asian or Asian American; 9 (24.3%) as non-Hispanic Black or African American; and 12 (32.4%) as non-Hispanic White. Analyses revealed key themes across all 3 levels of the ecological systems model: individual, interpersonal, and organizational. Individual themes included personal and family background, such as financial instability and lack of clinical exposure. Interpersonal themes included access to premedical advisors, faculty mentors, and peer networks. Organizational themes included limited institutional resources and pathway programs. In this qualitative study of first-generation students, financial instability, limited medical school-related social connections and resources, and unfamiliarity with academic systems were found to uniquely burden these students. By identifying and improving resources such as tailored mentorship, individualized advising, and participation in pathway programs, medical schools can help reduce structural barriers for aspiring physicians who are first-generation college students.

This study explored whether affectively oriented forms of communication are accorded the same significance in the friendships of Asian and African Americans as they are in the friendships of European Americans. Participants (72 Asian American men and women; 50 African American men and women; and 55 European American men and women) indicated the importance of affectively versus instrumentally oriented communication skills using a revised version of the authors’ Communication Functions Questionnaire. Results indicated a complex pattern of differences due to ethnicity, sex, and type of communication skill. In particular, European American women viewed the affectively oriented skills of their same-sex friends as more important than did African American women. These and related findings are discussed in terms of the role communication plays in friendships, and how this role is moderated by ethnicity and sex.

Book reviews

Abstract #5099 Background: Many women fear breast cancer, but may know a great deal about the disease. We assessed the breast cancer attitudes and knowledge of women who self-identified as Caucasian, African American, Asian American, and Hispanic/Other.&amp;#x2028; Methods: We created a survey to measure women's attitudes and knowledge regarding breast cancer. We surveyed women outside retail establishments in Michigan and Washington, DC. We obtained 160 responses. We analyzed the data using the students t-test for continuous variables and the chi-square test for categorical variables, with significance set at the 0.05 level.&amp;#x2028; Results: The racal distribution was: Caucasian, N = 119 (74.4%); African American, N = 19 (12%); Asian American, N = 17 (11%); other, 4 (2.5%), one respondant did not state her race. We asked: (1) Have you ever had a mammogram? Caucasian, No = 38 (32%); African American, No = 6 (33%); Asian American, No = 13 (76%): P=0.007. (2) True/False: A mammogram does not use radiation to image the breast. Caucasian, False = 72 (64%); African American, False = 13 (76%); Asian American, False = 9 (56%): P = 0.07. (3) True/False: All women with breast cancer need chemotherapy. Caucasian, False = 88 (93%); African American, False = 11 (92%); Asian American, False = 10 (77%): P = 0.03. (4) True/False: All women who need chemotherapy receive it. Caucasian, False = 88 (93%); African American, False = 11 (92%); Asian American, False = 10 (77%): P = 0.04.&amp;#x2028; Discussion: Caucasians and African Americans were very similar in their breast cancer knowledge, but Asian Americans were less likely to have had a mammogram, less likely to know about radiation and mammograms, less likely to believe that all women with breast cancer need chemotherapy, and more skeptical regarding whether women who need chemotherapy actually receive it. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5099.