Background American Indian children have high rates of emergency department (ED) use and face potential discrimination in health care settings. Objective Our goal was to assess both implicit and explicit racial bias and examine their relationship with clinical care. Research Design We performed a cross-sectional survey of care providers at five hospitals in the Upper Midwest. Questions included American Indian stereotypes (explicit attitudes), clinical vignettes and the Implicit Association Test (IAT). Two IATs were created to assess implicit bias toward the child or the parent/caregiver. Differences were assessed using linear and logistic regression models with a random effect for study site. Results A total of 154 care providers completed the survey. Agreement with negative American Indian stereotypes was 22–32%. Overall, 84% of providers had an implicit preference for non-Hispanic white adults or children. Older providers (≥ 50 years) had lower implicit bias than those middle aged (30–49 years), (p = 0.01). American Indian children were seen as increasingly challenging (p = 0.04) and parents/caregivers less compliant (p = 0.002) as the proportion of American Indian children seen in the ED increased. Responses to the vignettes were not related to implicit or explicit bias. Conclusions The majority of ED care providers had an implicit preference for non-Hispanic white children or adults compared to those who were American Indian. Provider agreement with negative American Indian stereotypes differed by practice and respondents’ characteristics. These findings require additional study to determine how these implicit and explicit biases influence healthcare or outcomes disparities.

SummaryDNA damage response (DDR) and the centrosome cycle are two of the most critical processes for maintaining a stable genome in animals. Sporadic evidence suggests a connection between these two processes. Here, we report our findings that six Fanconi Anemia (FA) proteins, including FancI and FancJ, localize to the centrosome. Intriguingly, we found that the localization of FancJ to the mother centrosome is stimulated by a DNA interstrand crosslinker, Mitomycin C (MMC). We further show that, in addition to its role in interstrand crosslinking (ICL) repair, FancJ also regulates the normal centrosome cycle as well as ICL induced centrosome amplification by activating the polo-like kinase 1 (PLK1). We have uncovered a novel function of FancJ in centrosome biogenesis and established centrosome amplification as an integral part of the ICL response.

Native American children seem to have greater challenges compared with whites obtaining care in rural areas. Native American children were more likely to be frequent ED visitors, despite having to travel farther from their residence to the ED. Native American children visiting rural and midsize urban EDs had a much higher prevalence of mental health problems than whites. Additional efforts to provide both medical and mental health services to rural NA are urgently needed.

Emergency department (ED) utilization by American Indian (AI) children is among the highest in the nation. Numerous health disparities have been well documented in AI children, but limited information is available on parental experiences of care for AI children in the ED. Our objective was to understand parental attitudes towards ED care for AI children. Focus groups were held with AI parents/caregivers at five sites in the Upper Midwest. Traditional content analysis was used to identify themes. A total of 70 parents participated in ten focus groups. Three main themes were identified: healthcare environment, access to care, and interaction with providers. Healthcare environment issues included availability of specialists, wait times, and child-friendly areas. Transportation and financial considerations were major topics in access to care. Issues in interaction with providers included discrimination, stereotyping, and trust. This is one of the first studies to assess parent perspectives on ED use for AI children. Obtaining parental perspectives on ED experiences is critical to improve patient care and provide important information for ED providers.

Although lung cancer screening with annual low-dose chest computed tomography has been shown to reduce lung cancer deaths, it remains underutilized. Northern Plains American Indian and Alaska Native communities experience extreme lung cancer disparities, and little is known about the acceptance and adoption of lung cancer screening in these groups. We conducted interviews with healthcare professionals and focus groups with patients in an urban Minnesota community clinic serving AI/AN. Data collection took place during Winter 2019-2020. Indigenous researchers collected and analyzed the data for emergent themes using simultaneous collaborative consensus with a lung cancer screening researcher. Participants reported some similar barriers to lung cancer screening as previous studies reported but also shared some new insights into traditional ways of knowing and recommendations for effectively implementing this evidence-based preventive care service. Lung screening is largely acceptable to patients and healthcare personnel in an AI/AN-serving community clinic. We identified barriers as previously reported in other populations but also identified some unique barriers and motivators. For example, the concept of the seven generations may provide motivation to maintain one’s health for future generations while providing additional support during screening for persons traumatized by the Western medicine health system may facilitate increased screening uptake.