The lived experiences of racial and ethnic minorities in hotel management: A phenomenological study

Diversity and Inclusion in Pancreatic Cancer Clinical Trials

BackgroundDepression is a potentially modifiable risk factor for dementia. People from minority ethnic (ME) backgrounds are at greater risk of developing depression but are less likely to receive treatment, perpetuated by health inequalities. Non‐pharmacological interventions are recommended as the first‐line treatment for depression and may potentially play a preventative role for longer term conditions such as dementia. This scoping review aimed to address a critical gap by mapping international evidence on non‐pharmacological interventions specifically targeting depression in ME populations aged 40 and above, an area overlooked in traditional reviews.MethodA scoping review was performed up to December 2024 using Medline, PsycINFO, CINAHL, Psychology and Behavioral Sciences Collection, Allied and Complimentary Medicine Database and Embase. Articles reporting on non‐pharmacological interventions targeting depression in the ME population, with a mean age of 40 and above were included. Two authors independently screened the articles, following the Joanna Briggs Institute guidelines.ResultTwenty‐one studies were included. Six interventions were identified: Cognitive Behaviour Therapy, Behavioural Activation, Mindfulness‐based, Logo‐Autobiography, Social Group intervention and Reminiscence Therapy. Interventions were adapted for ME populations via translation of materials and delivering the intervention in the target language. Interventions were also adapted to the ‘local context’ such as incorporating cultural norms and understanding of depression. Most of the studies were conducted in the USA with African American populations. This review found a lack of non‐pharmacological interventions for depression in people of ME backgrounds in the UK.ConclusionA need for ME focused non‐pharmacological interventions for depression in the UK was indicated. A greater focus is required on recruiting people of ME backgrounds over the age of 40 for randomised controlled trials. This is an under‐represented group both in research and within mental health services. It is recommended that non‐pharmacological interventions for depression are culturally adapted and co‐produced with the target population. Cognitive deficits in depression are common but overlooked, it is recommended that assessment of cognition is made part of treatment. This will identify areas of need to support functional recovery of depression, to reduce the risk of relapse, and potentially prevent long‐term conditions such as dementia.

People from minority ethnic (ME) backgrounds are at greater risk of developing depression but are less likely to receive treatment, perpetuated by health inequalities. Non-pharmacological interventions are recommended as the first-line treatment for depression. This scoping review aimed to map international evidence on non-pharmacological interventions for depression in ME populations aged 40 and above. A scoping review was conducted using Medline, PsycINFO, CINAHL, Psychology and Behavioral Sciences Collection, AMED and Embase. Twenty-one studies were included. Six interventions were identified: Cognitive Behavior Therapy, Behavioral Activation, Mindfulness-based, Reminiscence Therapy, Logo-Autobiography and Social Group intervention. Interventions were adapted for ME populations via translation of materials and to the ‘local context’ such as incorporating cultural norms and understanding of depression. This review found a lack of non-pharmacological interventions for depression in people of ME background in the UK. This review indicates a need for non-pharmacological interventions for depression in ME populations in the UK. Recruiting people of ME backgrounds over the age of 40 for randomized controlled trials requires prioritization. It is recommended that non-pharmacological interventions for depression are culturally adapted and co-produced with ME populations.

Pediatric obesity is a growing epidemic, and children of ethnic or racial minority background are at greatest risk. The purpose of this review is to identify disparities in PA levels among racial and ethnic minority children and identify successful interventions. We searched MEDLINE (PubMed) for the following mesh terms: population groups, obesity, child, infant, adolescent, exercise, or sports. Studies were included if written in English and reported on racial and ethnic families, physical activity (PA) parameters, and children <18 yr. Studies were excluded for lack of comparison with national recommendations or another racial group. Three main categories of studies (N = 24) were found: (a) assessment of PA levels by race/ethnicity, (b) analysis of PA interventions, and (c) parental influences on child PA. A variety of methods were used to measure the amount of PA. Studies using measured objective data for PA levels generally found no difference among races and ethnicities, whereas studies using self-reported PA levels suggested differences among them. The common strategies used in most successful interventions were tailoring activities to the specific target population, including family members, and making the activities enjoyable. Studies also indicated that parental behaviors were strongly associated with the behaviors of their children. The studies included in this systematic review suggest that children of racial and ethnic minority backgrounds may perform less PA than other populations and national recommendations. However, there are several different types of interventions and strategies that can increase PA in these children.

Attainment inequalities exist for ethnic minority students graduating from higher education institutes (HEIs) in the UK. Previous research has investigated the outcomes and experiences of students from ethnic minority backgrounds on health and social care programmes. However, studies exploring ethnic minority speech and language therapy (SLT) students' experiences have only focused on international students and were conducted in Australia. No known studies exploring the experiences of both home-domiciled and international SLT students from ethnic minority backgrounds have been conducted in the UK. To explore the experiences of home-domiciled and international ethnic minority students on a SLT training programme and to identify ways to improve these experiences. All SLT students attending a pre-registration postgraduate course who identified as being from an ethnic minority background were invited to participate. Two focus groups, one for three international students and one for six home students, were conducted. Data were analysed using reflexive thematic analysis. Three themes were identified that illustrated students' current experiences and how experiences could be improved: (1) feeling an outsider, explores students' sense of belonging in SLT education; (2) finding ways to manage, describes the strategies used by students to cope with their experiences of marginalization, and how adopting these strategies impact on their well-being; and (3) promoting inclusion, explains how the training programme could be modified to improve the experience of ethnic minority students. A better understanding of the experiences of ethnic minority SLT students can help others to support them more effectively. The findings suggest that making changes to SLT training programmes could improve ethnic minority students' outcomes and experiences. These include: more training for staff and students, support groups for ethnic minority students, sharing lived experiences of students and experienced SLTs from ethnic minority backgrounds, and clearer ways of reporting racist incidents. International students would benefit from receiving more information on HEI support services and cultural practices in the UK. What is already known on this subject Previous studies have investigated the experiences of ethnic minority students on a range of HEI programmes, including those for students of physiotherapy and occupational therapy. The only studies investigating the experiences of ethnic minority SLT students are those exploring how international SLT students in Australia can be supported on professional placement. What this paper adds to the existing knowledge This study explores the experiences of home and international SLT students in the UK who identify as being from minority ethnic backgrounds. Findings suggest that these students feel like outsiders, affecting their sense of belonging. The need to find and implement strategies to manage their feelings of marginalization impacts on their well-being. What are the potential or actual clinical implications of this work? The findings suggest measures to promote the inclusion of ethnic minority SLT students to improve their experiences and support their well-being. These include more training for all staff and students and the creation of a 'lived experiences library' where students and experienced SLTs from ethnic minority backgrounds could share positive experiences as well as ways of dealing with challenges. Clearer ways of reporting racist incidents would be beneficial for all students. International students would benefit from receiving more information on HEI support services and cultural practices in the UK. It is important that ethnic minority SLT students are involved in developments that aim to improve their experiences.

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

We aimed to estimate the prevalence of clinical and modifiable sociodemographic characteristics of individuals from ethnic minority backgrounds who died by suicide and, where possible, compare them to the majority population. Databases were searched for studies published between 01/01/2000-19/12/2023. Absolute and relative prevalence estimates of characteristics were reported by minority group (Indigenous; migrant; other ethnic minority) then stratified by continent and, where applicable, migrant sub-type and ethnicity. A narrative synthesis was conducted with moderate-high quality studies. We identified fifty-seven studies across 16 countries; the majority from North America, Europe and Oceania. When examining moderate-high quality evidence, there were generally limited numbers of studies reporting the prevalence of each characteristic by ethnic minority status, especially for social factors. Based on the available data, we found a high prevalence mental health problems among people who died by suicide from Indigenous (20.8-60.7%), migrant (37.2-42.9%) and other ethnic minority (29.9-37.3%) backgrounds. However, people from Asian/Pacific Islander, Black and Hispanic backgrounds were less likely to have mental health problems reported compared to majority populations. Indigenous people and migrants generally had lower contact with mental health services compared to majority groups. We also found evidence of a lower prevalence of depression and higher prevalence of alcohol and substance use problems among Indigenous compared to non-Indigenous individuals, and greater levels of economic disadvantage among migrants compared to non-migrants. Our findings highlight differences in the characteristics of people who die by suicide based on ethnicity and migration status and identify potential targets for research and suicide prevention strategies.

Medication safety remains a pertinent issue for health systems internationally, with patients from ethnic minority backgrounds recognized at increased risk of exposure to harm resulting from unsafe medication practices. While language and communication barriers remain a central issue for medication safety for patients from ethnic minority backgrounds, increasing evidence suggests that unconscious bias can alter practitioner behaviours, attitudes and decision-making leading to unsafe medication practices for this population. Systemwide, service and individual level approaches such as cultural competency training and self-reflections are used to address this issue, however, the effectiveness of these strategies is not known. While engagement is proposed to improve patient safety, the strategies currently used to address unconscious bias seem tokenistic. We propose that including consumers from ethnic minority backgrounds in design and delivery of the education programs for health professionals, allocating extra time to understand their needs and preferences in care, and co-designing engagement strategies to improve medication related harm with diverse ethnic minority groups are key to mitigating medication related harm arising as a result of unconscious bias.

Racism in Pain Medicine: We Can and Should Do More

Diversity Matters

An Institute of Medicine report titled U.S. Health in International Perspective: Shorter Lives, Poorer Health documents the decline in the health status of Americans relative to people in other high-income countries, concluding that “Americans are dying and suffering from illness and injury at rates that are demonstrably unnecessary.”1 The report blames many factors, “adverse economic and social conditions” among them. In an editorial in Science discussing the findings of the Institute of Medicine report, Bayer et al2 call for a national commission on health “to address the social causes that have put the USA last among comparable nations.” Although mortality from cardiovascular disease (CVD) in the United States has been on a linear decline since the 1970s, the burden remains high. It accounted for 31.9% of deaths in 2010.3 There is general agreement that the decline is the result, in equal measure, of advances in prevention and advances in treatment. These advances in turn rest on dramatic successes in efforts to understand the biology of CVD that began in the late 1940s.4,5 It has been assumed that the steady downward trend in mortality will continue into the future as further breakthroughs in biological science lead to further advances in prevention and treatment. This view of the future may not be warranted. The prevalence of CVD in the United States is expected to rise 10% between 2010 and 2030.6 This change in the trajectory of cardiovascular burden is the result not only of an aging population but also of a dramatic rise over the past 25 years in obesity and the hypertension, diabetes mellitus, and physical inactivity that accompany weight gain. Although there is no consensus on the precise causes of the obesity epidemic, a dramatic change in the underlying biology of Americans is …

We studied all patients (total 53,611) whose referral-to-treatment (RTT) ended in hospital admission ("admitted pathways") between 01/2019 and 12/2023. Their health status and RTT waiting times were related to indices of deprivation (IMD: combined data from income, employment, education, health, crime, barriers to housing and services, and living environment) and to ethnicities (87% Caucasians; 6% South Asians; 5.1% Other Ethnicities; 0.9% Blacks; 0.7% Mixed Race; 0.3% Chinese). The risk of RTT waiting times > 18weeks was assessed by logistic regression, adjusted for confounding factors (age, sex and number of comorbidities) and presented as odds ratios (OR) and 95% confidence intervals: least-deprived areas (IMD decile = 10) and Caucasians were reference levels. Patients' median age (66years, interquartile range = 51-77) was representative of "admitted pathways" UK patients. Major chronic diseases were more common amongst patients from ethnic minority and deprived backgrounds. Risks of RTT waiting times > 18weeks for elective admissions rose progressively with increasing deprivation: OR = 1.20 (1.05-1.36), compared to the least deprived areas; and mixed race: OR = 1.39 (1.10-1.76), other ethnicities: OR = 1.15 (1.05-1.26), and all ethnic minorities: OR = 1.11 (1.05-1.18), compared to Caucasians. Our findings provide evidence for health and healthcare inequalities associated with individuals from deprived areas and ethnic minority backgrounds, particularly those of mixed race. More research and resources are needed to address these inequalities that include policy interventions to reduce barriers that hinder access to healthcare and advocating for policies that address underlying social determinants of health that reduce inequalities in education, employment and housing.

ABSTRACTThe appropriateness of innovative educational concepts for students from a low socioeconomic status (SES) or ethnic minority background is sometimes called into question. Disadvantaged students are supposed to benefit more from traditional approaches with Programmatic Instruction (PI). We examined Developmental Education (DE), an innovative approach, inspired by Vygotskian theory, in which reading skills are developed through meaningful reading of texts corresponding to students’ self-generated problems. The effectiveness of DE is compared to PI in terms of reading comprehension, strategy knowledge, and reading motivation of 4th-grade students; 170 students from ethnic minority or low SES background participated in a pretest-posttest natural 2-group design. Outcomes were similar in both approaches, with one exception: Students with an ethnic minority background in DE performed better on strategy knowledge than similar students in PI. These results are discussed in relation to previous studies on the appropriateness of innovative curricula for disadvantaged students.

To present and discuss implementation experiences regarding the involvement of community pharmacists with ethnic minority backgrounds in a medication review intervention for ethnic minority poly-pharmacy patients in Denmark. Data sources include 1) reflection notes from an introductory seminar with pharmacists and the cross-disciplinary research team and 2) five individual interviews and one focus group interview with pharmacists. Data were thematically coded and synthesised to identify underlying rationales and challenges encountered when involving professionals with ethnic minority backgrounds in interventions for ethnic minorities. Informants perceived the need for interventions targeted at ethnic minority poly-pharmacy patients, and highlighted the potential of involving professionals with diverse ethnic backgrounds in such interventions. However, implementation created challenges, because the professional identity of the pharmacists reduced their options for serving as peers with the same ethnic background. Furthermore, issues related to organisational difficulties and overcoming language barriers in the intervention impacted on the potential of involving professionals with ethnic minority backgrounds. Involving healthcare professionals with ethnic minority backgrounds in encounters with ethnic minorities holds potential for the adaptation of services to ethnically diverse populations, thus improving access to and quality of care. However, it is important to ensure sufficient personal and organisational support and to acknowledge the delicate balance between simultaneously serving as a peer and as a professional.

SummaryBackgroundExisting evidence suggests that some individuals from ethnic minority backgrounds are at increased risk of suicide compared to their majority ethnic counterparts, whereas others are at decreased risk. We aimed to estimate the absolute and relative risk of suicide in individuals from ethnic minority backgrounds globally.MethodsDatabases (Medline, Embase, and PsycInfo) were searched for epidemiological studies between 01/01/2000 and 3/07/2020, which provided data on absolute and relative rates of suicide amongst ethnic minority groups. Studies reporting on clinical or specific populations were excluded. Pairs of reviewers independently screened titles, abstracts, and full texts. We used random effects meta-analysis to estimate overall, sex, location, migrant status, and ancestral origin, stratified pooled estimates for absolute and rate ratios. PROSPERO registration: CRD42020197940.FindingsA total of 128 studies were included with 6,026,103 suicide deaths in individuals from an ethnic minority background across 31 countries. Using data from 42 moderate-high quality studies, we estimated a pooled suicide rate of 12·1 per 100,000 (95% CIs 8·4–17·6) in people from ethnic minority backgrounds with a broad range of estimates (1·2–139·7 per 100,000). There was weak statistical evidence from 51 moderate-high quality studies that individuals from ethnic minority groups were more likely to die by suicide (RR 1·3 95% CIs 0·9–1·7) with again a broad range amongst studies (RR 0·2–18·5). In our sub-group analysis we only found evidence of elevated risk for indigenous populations (RR: 2·8 95% CIs 1·9–4·0; pooled rate: 23·2 per 100,000 95% CIs 14·7–36·6). There was very substantial heterogeneity (I2 > 98%) between studies for all pooled estimates.InterpretationThe homogeneous grouping of individuals from ethnic minority backgrounds is inappropriate. To support suicide prevention in marginalised groups, further exploration of important contextual differences in risk is required. It is possible that some ethnic minority groups (for example those from indigenous backgrounds) have higher rates of suicide than majority populations.FundingNo specific funding was provided to conduct this research. DK is funded by Wellcome Trust and Elizabeth Blackwell Institute Bristol. Matthew Spittal is a recipient of an Australian Research Council Future Fellowship (project number FT180100075) funded by the Australian Government. Rebecca Musgrove is funded by the NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC-2016-003).