This study characterizes patient understanding of hypertension and its management in a Cape Verdean immigrant community. We conducted 20 semi-structured interviews with Cape Verdean Creole-speaking adults about their beliefs and behaviors regarding hypertension. Fourteen women and six men ages 35-87 were interviewed. The majority of the participants believed hypertension is symptomatic, with headache being the most common symptom. Many reported taking anti-hypertensive medication, though some took medication only when they felt symptoms. The majority were unfamiliar with a normal blood pressure reading. Most believed hypertension is related to stress and salt intake, though few reported making the recommended lifestyle changes. None of the participants communicated with physicians in their native language, relying instead on interpreters, family members or other languages to communicate. Participants identified language as a serious barrier to care. Our sample had a poor understanding of hypertension as a chronic, asymptomatic disease. Given the high prevalence of hypertension in this community, and the unavailability of Cape Verdean Creole-speaking interpreters and providers for individual patient visits, Cape Verdean patients may benefit from group education or medical visits conducted in Creole.
Health disparities fall along racial lines, in part, due to structural inequalities limiting health care access. The concept of race is often taught in health professions education with a clear biologic underpinning despite the significant debate in the literature as to whether race is a social or biologic construct. The teaching of race as a biologic construct, however, allows for the simplification of race as a risk factor for disease. As health care providers, it is part of our professional responsibility and duty to patients to think and talk about race in a way that is cognizant of broader historical, political, and cultural literature and context. Openly discussing the topic of race in medicine is not only uncomfortable but also difficult given its controversies and complicated context. In response, we provide several evidence-based steps to guide discussions around race in clinical settings, while also hopefully limiting the use of bias and racism in the practice of medicine.
INTRODUCTION: One in six American women experience sexual abuse in their lifetime, which pre-disposes a large percentage of our patients to post-traumatic stress disorder. Patients report being re-traumatized when undergoing exams during childbirth and routine Ob/Gyn visits. Very little is known about whether Ob/Gyn physicians are trained to care for patients who have experienced trauma. METHODS: This study was a cross-sectional survey administered to program directors at all US and Canadian Ob/Gyn Residency programs in September of 2019. RESULTS: At this time, 58 out of 241 (24%) program directors have responded to the survey and represent all ACOG districts. Over 20% of programs have formal training that occurs every year, 63.8% have had some training occur in the past though not on a regular basis, and 15.5% have never had any training. When asked about the primary barrier to providing this training, 27.6% of respondents cited the lack of facilitators to teach it, followed by lack of time within the residency curriculum (17.2%). About 30% of respondents are satisfied with the current training provided at their program. All respondents agree that Ob/Gyn residents need to be trained in trauma informed care, 60.3% believe it should be a CREOG educational objective, and 88% would be somewhat or extremely likely to implement a training program specifically designed for Ob/Gyn residents if one became available. CONCLUSION: Most Ob/Gyn residency programs are providing some training on the care of patients who have experienced trauma, however respondents in our sample are largely unsatisfied with how this occurs.
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