Context Perceived discriminatory experiences in society have been associated with a higher burden of pain among some minority patient populations. Objectives To describe the extent to which patients with sickle cell disease (SCD) perceive discrimination from health care providers, and to examine the association of these experiences with the burden of chronic SCD pain. Methods Cross-sectional analysis of data collected at baseline of a prospective cohort study of SCD patient experiences of care (n = 291). Perceived race-based and disease-based discrimination from health care providers were measured using subscales adapted from the Interpersonal Processes of Care Survey. Discrimination scores were examined for their association with patient characteristics and measures of pain burden using descriptive, bivariate, and multivariate analytic techniques. Results Respondents reported a greater burden of race-based discrimination from health care providers than has been previously reported by African Americans, and they reported a greater amount of disease-based versus race-based discrimination. While age and having difficulty persuading providers about pain were the only patient characteristics independently associated with race-based discrimination, older age, greater emergency room utilization, having difficulty persuading providers about pain, daily chronic pain, fewer “good days” during a week, and a higher severity of pain on their “good days” were independently associated with greater disease-based discrimination. Conclusion Perceived disease-based, but not race-based, discrimination was found to be associated with a greater range of self-reported pain among patients with SCD. If causal, this finding could signal an important new approach to mitigating the burden of pain experienced by persons with SCD.

How to cite this article: Medina A, Altamar G, Fernández-Ávila DG, et al. Clinical characteristics and impact of treatment gap of fragility fractures in Colombia: experience of 10 Fracture Liaison Services (FLS).

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Birth certificates and a sample of hospital obstetric records for Indochinese refugees in Santa Clara County, CA, 1979CA, -1980, were reviewed. Among 542 live births, the overall median birthweight of 3175 gm and 5.7 per cent rate of low birthweight were favorable; it is our impression that the more recent arrivals, especially Cambodians and Laotians, present at greater risk, lacking prenatal care, and have more infants of low birth rate and more pregnancy complications. (Am J Public Health 1982; 72:742-744.) Since 1975, nearly 400,000 Indochinese refugees have resettled in the United States. Early waves of immigrants were mostly Vietnamese of higher socioeconomic status. New groups include Laotians, Cambodians, and ChineseVietnamese, who have less education and are less accustomed to urban living.' Health assessments have revealed substantial pre-existing nutritional deprivation, tuberculosis and other infectious diseases, parasitic infestation, and lack of routine immunizations.2-7The locale of this study, Santa Clara County (SCC), California, a 1300 square mile valley south of San Francisco Bay, has a population of 1,300,000, approximately 30,000 (2.3 per cent) of whom are Indochinese. A monthly influx of over 500 new arrivals has greatly strained existing services, and has seen the establishment of the Indochinese Refugee Assistance Project. We undertook to look at the characteristics of the increasing numbers of births to the Indochinese: 201 in 1979Indochinese: 201 in , 341 in 1980 Methods A listing was prepared indicating the child's name and mother's maiden name for all non-Chinese, non-Japanese Oriental births for 1979-80 in SCC. The ethnicity of each name was checked to ensure that the study population would ResultsThe pre-immigration casualty of this population was evident by findings that 9 per cent of birth documents reported the prior loss of at least one child; of the 610 children previously born to this group, 33 were deceased.The median age of the 542 mothers was 26 years. Teenage pregnancies (< 18 years) accounted for I per cent of the total; mothers age 35 and over accounted for 9 per cent. Parity was not high: 70 per cent were having their first or second child, and only 3 per cent were grand multiparae.Where recorded,** 65 per cent of mothers reported initiating prenatal care in the first trimester, 23 per cent in the second trimester, and 12 per cent in the last trimester or no prenatal care at all.The birth records data revealed a median birthweight of 3175 gm and 5.7 per cent low birthweight (LBW -

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