Attention deficit/hyperactivity disorder in adults: A case study.

Attention-Deficit/Hyperactivity Disorder (ADHD) is often misdiagnosed or mistreated in adults because it is often thought of as a childhood problem. If a child is diagnosed and treated for the disorder, it often persists into adulthood. In adult ADHD, the symptoms may be comorbid or mimic other conditions making diagnosis and treatment difficult. Adults with ADHD require an in-depth assessment for proper diagnosis and treatment. The presentation and treatment of adults with ADHD can be complex and often requires interdisciplinary care. Mental health and non-mental health providers often overlook the disorder or feel uncomfortable treating adults with ADHD. The purpose of this manuscript is to discuss the diagnosis and management of adults with ADHD.

Schizophrenia Spectrum Disorder Disparity Among African-Americans.

Worldwide, Schizophrenia Spectrum Disorder (SSD) affects a low percentage of individuals, but a severe health disparity exists for African-Americans, especially men. Several factors are contributing to this inequality. These factors occur at the individual, social, and organizational levels. With the other challenges facing African-Americans, SSD disparity is another shackle affecting this population. For health care providers, the challenges are treating a complex disorder in a hard to reach and stigmatized population. The purpose of this article is to provide an overview of the SSD disparity among African-Americans as identified in the literature and to discuss the role that Advanced Practice Nurses and other mental health providers have in reducing the disparity.

Black and Blue: Depression and African American Men.

Depression is a common mental disorder affecting individuals. Although many strides have been made in the area of depression, little is known about depression in special populations, especially African American men. African American men often differ in their presentation of depression and are often misdiagnosed. African American men are at greater risk for depression, but they are less likely to participate in mental health care. This article explores depression in African American by looking at environmental factors, sigma, role, and other unique to this populations, such as John Henryism. Interventions to encourage early screening and participation in care are also discussed.

Exploring women's perceptions about their role in supporting partners' and sons' reproductive health care.

Women serve as important health information sources for young men. No previous study has explored women's perceptions about this role related to young men's sexual and reproductive health (SRH) care. Twenty African American women recruited from two clinics participated in three focus groups to explore perceptions to engage young men in SRH care. Themes were identified that may facilitate and/or hinder women to engage young men in SRH care: 1) communication/actions to provide support; 2) challenges in providing support; 3) traditional gender role perceptions and other access barriers; and 4) motivation, influence and control. Participants were interested and willing to support young men's SRH including sharing information about clinics (95%), making appointments (90%), going to visits together (90%), and having joint appointments (67%). Findings provide a foundation for programs interested to engage women as health promotion agents to improve young men's SRH care access. Future efforts should explore the generalizability of study findings.

Low-income and minority patient satisfaction with visits to emergency departments and physician offices for dental problems.

OBJECTIVES: Individuals lacking access to dentists may use hospital emergency departments (EDs) or physicians (MDs) for the management of their dental problems. This study examined visits by minority and low-income individuals to physicians and hospital emergency departments for the treatment of dental problems with the goal of exploring the nature of treatment provided and patient satisfaction with the care received. METHODS: Eight focus group sessions were conducted with 53 participants drawn from low-income White, Black, and Hispanic adults who had experienced a dental problem and who had sought MD/ED care at least once during the previous 12 months. RESULTS: Toothache pain or more generalized jaw/face pain was the most frequent oral problem resulting in MD/ED visits. Pain severity was the principle reason for seeking care from MDs/EDs, with financial barriers most often mentioned as the reason for not seeking care from dentists. Expectations of MD/ED visits were generally consistent with care received; most participants limited their expectations to the provision of antibiotics or pain medication. Nearly all of the participants thought they would eventually need to see a dentist for resolution of their dental problem. CONCLUSIONS: Poor/minority individuals seek relief from oral pain through MDs/ EDs while recognizing that such care is not definitive.

Influence of family history and preventive health behaviors on colorectal cancer screening in African Americans.

BACKGROUND: African Americans (AAs) have low rates of colorectal cancer (CRC) screening. To the authors' knowledge, factors that influence their participation, especially individuals with a family history of CRC ("family history"), are not well understood. METHODS: A secondary analysis of the 2002 Maryland Cancer Survey data examined predictors of risk-appropriate, timely CRC screening ("screening") in AAs with a family history and in individuals without a family history. Predictors that were evaluated included age, sex, family history, mammogram or prostate-specific antigen (PSA) screening, body mass index, activity, fruit/vegetable consumption, alcohol, smoking, perceived risk of cancer, education, employment, insurance, access to a healthcare provider, and healthcare provider recommendation of fecal occult blood test (FOBT) and/or sigmoidoscopy/colonoscopy. RESULTS: In individuals without a family history of CRC (N = 492), recommendation for FOBT (odds ratio [OR] of 11.90; 95% confidence interval [95% CI], 6.84-20.71) and sigmoidoscopy/colonscopy (OR of 7.06; 95% CI, 4.11-12.14), moderate/vigorous activity (OR of 1.74; 95% CI, 1.06-2.28), and PSA screening history (OR of 2.68; 95% CI, 1.01-7.81) were found to be predictive of screening. In individuals with a family history (N = 88), recommendation for sigmoidoscopy/colonscopy (OR of 24.3; 95%, CI 5.30-111.34) and vigorous activity (OR of 5.21; 95% CI, 1.09-24.88) were found to be predictive of screening. However, family history did not predict screening when the analysis was controlled for age, education, and insurance. AAs who had a family history were less likely to screen compared with their white counterparts (N = 293) and compared with AAs who were at average risk for CRC (P < .05). CONCLUSIONS: Regardless of family history, healthcare provider recommendation and activity level were important predictors of screening. Lower screening rates were observed in AAs who had a family history compared with individuals who did not. The authors believe that, for AAs who have a family history, further examination of barriers and facilitators to CRC screening within the cultural context is warranted.

Reaching African American men: a qualitative analysis.

African American men are disproportionately affected by most illnesses and associated complications. These men are also less likely to participate in primary and secondary prevention interventions. Little is known about reaching them. The purpose of this study(1) was to explore factors associated with effectively reaching African American men. Ethnographic methods were used. Key and general informants from an urban Northeastern community were recruited for this study. The data revealed 3 major themes as essential to reaching African American men: a trusted and respected community member providing the outreach, a perceived safe and caring environment during outreach, and a perceived benefit from participating in the outreach. The findings from this study provided a foundation for designing community interventions that will increase participation among African American men. Future research efforts should focus on operationalizing these findings in the community.

To screen or not to screen: factors influencing the decision to participate in prostate cancer screening among urban African-American men.

While prostate cancer screening recommendations vary, experts agree that an individual should be provided with information and allowed to make a decision. Social factors influencing a decision to participate in prostate cancer screening among urban African-American men age 40 and over were explored. The men in this study expressed an interest in participating in prostate cancer prevention strategies that were culturally appropriate.

Exploring older adolescents' and young adults' attitudes regarding male hormonal contraception: applications for clinical practice.

BACKGROUND: Male hormonal contraceptive methods (HCM) are in Phase I clinical trials in the USA. International studies report that adults have positive attitudes regarding male HCM, but little is known about US minority young peoples' attitudes--a population that experiences high unintended pregnancy rates. METHODS: Thirty urban African American young persons [50% males; mean age = 18.8 (SD = 2.5)] participated in semi-structured interviews to explore attitudes regarding male HCM. Data were independently analysed by two researchers according to qualitative research methodology, including transcript coding for content, categorization of codes, performance of content analysis for theme development, and corroboration of findings by a third researcher. RESULTS: The data revealed five major themes that can facilitate and/or hinder male HCM adoption: (1) impact of reversing roles in HCM use; (2) men's lack of involvement in health care; (3) men's reliability to use HCM effectively; (4) perceived responsibility of men who use HCM; and (5) men's apprehension to use new medicines. Overall, participants had positive impressions about male HCM (67% male; 67% female) and female partner trust of males' use was high (85%), as were males' intentions (60%). CONCLUSIONS: Findings provide a foundation for clinical interventions including: (1) increasing males' involvement in reproductive health; (2) helping males to overcome apprehensions about male HCM safety; and (3) standardizing male HCM education in the clinical setting. Future research efforts should examine whether study findings hold for other populations.

Factors influencing HIV-risk behaviors among HIV-positive urban African Americans.

Urban African Americans are disproportionately affected by HIV, the virus associated with AIDS. Although incidence and mortality appear to be decreasing in some populations, they continue to remain steady among inner-city African Americans. A major concern is the number of HIV-positive individuals who continue to practice high-risk behaviors. Understanding factors that increase risks is essential for the development and implementation of effective prevention initiatives. Following a constructionist epistemology, this study used ethnography to explore social and cultural factors that influence high-risk behaviors among inner-city HIV-positive African Americans. Leininger's culture care diversity and universality theory guided the study. Individual qualitative interviews were conducted with HIV-positive African Americans in the community to explore social and cultural factors that increase HIV-risky behaviors. For this study, family/kinship, economic, and education factors played a significant role in risky behaviors. Reducing HIV disparity among African Americans is dependent on designing appropriate interventions that enhance protective factors. Clinicians providing care to HIV-positive individuals can play a key role in reducing transmission by recognizing and incorporating these factors when designing effective prevention interventions.

Sociostructural factors influencing health behaviors of urban African-American men.

African-American men are suffering disproportionately from most illnesses. Seemingly, action is needed if health disparities that disproportionately affect African-American men as compared to their White and female counterparts are to be reduced or eliminated. An important step in decreasing common health disparities evidenced among African-American men is to understand social factors that act as motivators and barriers to seeking care for most of this vulnerable population. Following a constructionist epistemology, this study used ethnography to explore social structure factors that motivate urban African-American men to seek care. Leininger's Culture Care Diversity and Universality Theory guided this study. Qualitative interviews were conducted with urban African-American men and other individuals in the community to explore understanding, attitudes, and beliefs about health. Critical issues examined included social factors associated with health seeking behaviors. Themes that emerged from these data indicated that critical social factors include: 1) Kinship/significant others; 2) accessibility of resources; 3) ethnohealth belief; and 4) accepting caring environment. The data also indicated a relationship between these social factors and health seeking behaviors of urban African-American men.