Francesca M Gany, M.D.

A Community Intervention: AMBER: Arab American Breast Cancer Education and Referral Program
Ayash, Claudia; Axelrod, Deborah; Nejmeh-Khoury, Sana; Aziz, Arwa; Yusr, Afrah; Gany, Francesca M
2011 Dec;13(6):1041-1047, Journal of Immigrant & Minority Health
Although the number of Arab Americans is growing in the United States, there is very little data available on this population's cancer incidence and screening practices. Moreover, there are few interventions addressing their unique needs. This study aims to determine effective strategies for increasing breast cancer screening in at-risk underserved Arab American women. AMBER utilizes a community based participatory approach to conduct formative research and program interventions, including culturally appropriate Arabic language breast cancer education, screening coordination, and cultural competency training for healthcare professionals in New York City. In 2 years, 597 women were educated, 189 underserved women were identified as being in need of assistance, 68 were screened, one new case of breast cancer was detected, and four active cases in need of follow-up reconnected with care. The AMBER model is an important intervention for breast cancer screening and care in the underserved Arab American community
— id: 140520, year: 2011, vol: 13, page: 1041, stat: Journal Article,

Hypertension beliefs and practices among South Asian immigrants: a focus group study
Changrani J; Pandya S; Mukherjee-Ratnam BR; Acharya S; Ahmed A; Leng J; Gany F
2011 ;9(1):98-103, Journal of immigrant & refugee studies
South Asian immigrants are a large rapidly growing community in the United States. The rate of cardiovascular disease in
— id: 133329, year: 2011, vol: 9, page: 98, stat: Journal Article,

Targeting Social and Economic Correlates of Cancer Treatment Appointment Keeping among Immigrant Chinese Patients
Gany F; Ramirez J; Chen S; Leng JC
2011 Feb;88(1):98-103, Journal of urban health
Chinese immigrants have high rates of a variety of cancers and face numerous social and economic barriers to cancer treatment appointment keeping. This study is a nested cohort of 82 Chinese patients participating in the Immigrant Cancer Portal Project. Twenty-two percent reported having missed appointments for oncology follow-up, radiation therapy, and/or chemotherapy. Patients most commonly reported needing assistance with financial support to enable appointment keeping. Efforts to further address social and economic correlates in cancer care should be developed for this population
— id: 120756, year: 2011, vol: 88, page: 98, stat: Journal Article,

Mexican urban occupational health in the US: a population at risk
Gany, Francesca; Dobslaw, Rebecca; Ramirez, Julia; Tonda, Josana; Lobach, Iryna; Leng, Jennifer
2011 Apr;36(2):175-179, Journal of community health
Mexicans are the largest immigrant group in the US. Little is known about their urban occupational health status. We assess occupational illness, injury, and safety training among New York City Mexican immigrants. This study is a consecutive sample of the Mexican immigrant population utilizing Mexican Consulate services in New York City over two weeks in March 2009. Bilingual research assistants approached persons waiting in line at the Consulate and administered an occupational health questionnaire. 185 people agreed to participate. Most work in restaurants (37%), cleaning (18%), construction (12%), babysitting/nanny (7%), retail (9%), and factories (5%). 22% had received safety training. 18% reported work-related pain or illness. 18% suffered from a job-related injury since immigrating. Most injuries were in construction, factories, and restaurants. 29% had not reported their injury. This study provides evidence that the urban Mexican immigrant population is at high risk for work-related illness and injury, is not receiving adequate safety training, and is under-reporting occupational injury. Culturally and linguistically responsive community outreach programs are needed to provide occupational health and safety information and resources for urban Mexican workers
— id: 138163, year: 2011, vol: 36, page: 175, stat: Journal Article,

DIABETES CARE AND LANGUAGE DISCORDANCE AMONG CHINESE AND LATINO PRIMARY CARE PATIENTS
Gany, Francesca; Leng, Jennifer C. F.; Winston, Ginger; Tseng, Chi-Hong; Qin, Angie; Changrani, Jyotsna
2011 ;21(4):473-479 FAL, Ethnicity & disease
Objectives: To assess differences in diabetes processes of care among Chinese and Latino patients across medical interpreting methods. Design and Setting: This is a nested cohort study of patients with diabetes, comparing interpreting methods and their impact on medical outcomes at the primary care clinic of a New York City municipal hospital. Participants: 54 Spanish and Chinese-speaking language discordant diabetic patients were enrolled and followed for one year. Intervention: Language discordant patients received either Remote Simultaneous Medical Interpreting (RSMI), or usual and customary (U&C) interpreting. Main Outcome Measures: Composite medical care scores were calculated for physician ordering and patent completion of diabetes care measures. Results: RSMI patients, compared with U&C patients, had trends towards higher mean patient completion (.29 vs .25) and physician ordering (.41 vs .37) scores. Overall rates of completion of diabetes care measures in both groups were very low. Conclusions: Overall rates of physician ordering and patient completion of diabetes care measures were distressingly low in our study. Further studies are needed to explore the potential role of RSMI in addressing the language barrier and improving diabetes care for Chinese- and Spanish-speaking patients. (Ethn Dis. 2011;21(4):473-479)
— id: 149890, year: 2011, vol: 21, page: 473, stat: Journal Article,

Cancer portal project: a multidisciplinary approach to cancer care among Hispanic patients
Gany, Francesca; Ramirez, Julia; Nierodzick, Mary Lynn; McNish, Thelma; Lobach, Iryna; Leng, Jennifer
2011 Jan;7(1):31-38, Journal of Oncology Practice
PURPOSE: This study investigates the impact of a multilingual, multidisciplinary team targeting social and economic determinants of cancer treatment adherence among at-risk Hispanic immigrants. METHODS: Patients were recruited at 10 hospital-based cancer clinics in New York City between December 2008 and November 2009. This is a nested cohort study of Hispanic patients and their sociodemographic characteristics, areas of needed assistance, and reported impact of meeting service needs on keeping appointments. At the core of the intervention is the trained, bilingual Portal Access Facilitator, who assesses needs and synchronizes an individualized set of transdisciplinary services for each patient. RESULTS: A total of 328 Hispanic patients participated in the study. Of these, 89% preferred to speak Spanish in the health care setting, and 17% had no health insurance. The most common cancer diagnosis among participants was breast cancer (35%) followed by GI (17%) and gynecologic (16%) cancers. Patients most commonly requested financial support (59%), food support (37%), transportation assistance (21%), social work services (14%), psychosocial support (6%), help with health insurance issues (5%), and legal services (5%). In a follow-up assessment of high-need patients in urgent need of financial support, 86% reported that portal services helped them attend cancer care and treatment appointments, and 72% reported that portal services decreased worry about their care. CONCLUSION: Most patients reported that financial, social, and logistical support would help them attend their appointments for cancer care and treatment. Further multidisciplinary interventions should be implemented and evaluated to address social and economic determinants in cancer care for this population
— id: 131970, year: 2011, vol: 7, page: 31, stat: Journal Article,

Doctor, what do I have? Limited-English proficient patients and cancer diagnosis knowledge
Leng CF; Yogendran L; Massie D; Ramirez J; Lee T; Lobach I; Gany F
2011 ;29(Suppl):?-? #6100, Journal of clinical oncology
ackground: Screening, diagnosis and treatment have significantly reduced the cancer burden of several cancers in the US for certain populations. Incorrect knowledge of cancer diagnosis can hinder treatment. Immigrant minorities and the underserved face unique challenges in the receipt of appropriate cancer care. Barriers to understanding cancer diagnoses include language, culture, and health literacy. This study investigates knowledge of cancer diagnosis among immigrant minorities. Methods: Patients were recruited at ten hospital-based cancer clinics in New York City between September 2008 and December 2010. Bilingual staff administered a survey for a sample of 471 patients with a clinical cancer diagnosis. Demographic and self-reported diagnosis and treatment information were collected. Patient charts were reviewed to ascertain cancer diagnosis. Results: 92% of patients were foreign-born. 81% preferred to speak a language other than English in the health care setting. 64% of foreign-born patients had resided in the US for 15 years or less. 25% were uninsured. Among those who were insured, 50% had Medicaid only, and 39% had Medicaid for Emergency Services only. 60% did not have a primary care provider, and 84% did not have a social worker assisting them with their care. The most common cancer diagnoses were breast (28%), colorectal (9%), cervical (8%), and lung (7%). 14% had incorrect knowledge of their cancer diagnosis. An additional 6 participants reported the correct metastatic site, but wrong primary cancer, or correct site, but wrong type of cancer. Of the 68 patients with incorrect knowledge of their diagnosis, 91% preferred a non-English language in the health care setting. Conclusions: Among this cohort of predominantly immigrant cancer patients, a considerable proportion were unaware of their correct cancer diagnoses. This may have a significant impact on subsequent cancer treatment and care. Language discordance likely has an important role in this miscommunication between patients and the health care system. Limited English proficient patients may be at particular risk for suboptimal cancer care. More research is needed to better understand cancer care in the language discordant encounter
— id: 132474, year: 2011, vol: 29, page: ?, stat: Journal Article,

Language discordance and testing for latent tuberculosis infection among recent Asian and Latino immigrants
Leng, Jennifer C F; Changrani, Jyotsna; Gany, Francesca M
2011 Apr;36(2):228-230, Journal of community health
The foreign-born population is disproportionately affected by tuberculosis (TB). Testing to identify persons with latent TB infection is critical. The aim of this study was to assess clinic-based testing for latent tuberculosis infection among recent Asian and Latino immigrants. A randomized controlled trial of interpreting methods and their impact on medical outcomes was conducted at the primary care clinic of a New York City municipal hospital. This study is a nested cohort of recruited patients with an indication to receive tuberculin testing, based on recent migration to the US from endemic areas. Medical record data were abstracted to determine referral for, and completion of, tuberculin testing. Bivariate analyses were used to test for differences in tuberculin testing between language concordant and discordant groups. Seven hundred and eighty-two patients were enrolled. One hundred and ninety-one had migrated within 5 years of enrollment from endemic areas. None spoke English as a primary language. Seventy percentage of patient-provider encounters were language discordant. Seventeen of 191 were referred for testing. Fifteen (88%) completed testing. Six (40%) had positive results. There were no significant differences between language concordant and discordant patients. In this at-risk population, every patient in clinical care should be considered for testing if indicated by country of origin
— id: 138311, year: 2011, vol: 36, page: 228, stat: Journal Article,

Mental health concerns among African immigrants
Venters, Homer; Adekugbe, Olayinka; Massaquoi, Jacob; Nadeau, Cheryl; Saul, Jack; Gany, Francesca
2011 Aug;13(4):795-797, Journal of Immigrant & Minority Health
African immigrants represent a rapidly expanding group of immigrants in the United States. In New York City, Africans constitute the fastest growing segment of immigrants but the needs and practices of African immigrants in the U.S. remain poorly understood. A community based organization (CBO) serving African immigrants in Staten Island, NY began a health screening program in 2008 with the goal of promoting access to primary care. Over 18 months, 296 visits were recorded at African Refuge health screenings, representing a total of 87 people who averaged just over 3 visits per person. The screenings identified mental health among the top three medical problems of clients but referral to mental health services was rare. Dedicated services are required to better screen for mental health concerns and refer African immigrants to mental health care
— id: 138312, year: 2011, vol: 13, page: 795, stat: Journal Article,

Mental health concerns among African immigrants
Venters, Homer; Adekugbe, Olayinka; Massaquoi, Jacob; Nadeau, Cheryl; Saul, Jack; Gany, Francesca
2011 ;13(4):795- 797, Journal of Immigrant Health
African immigrants represent a rapidly expanding group of immigrants in the United States. In New York City, Africans constitute the fastest growing segment of immigrants but the needs and practices of African immigrants in the U.S. remain poorly understood. A community based organization (CBO) serving African immigrants in Staten Island, NY began a health screening program in 2008 with the goal of promoting access to primary care. Over 18 months, 296 visits were recorded at African Refuge health screenings, representing a total of 87 people who averaged just over 3 visits per person. The screenings identified mental health among the top three medical problems of clients but referral to mental health services was rare. Dedicated services are required to better screen for mental health concerns and refer African immigrants to mental health care.
— id: 148711, year: 2011, vol: 13, page: 795, stat: Journal Article,

African immigrant health
Venters, Homer; Gany, Francesca
2011 Apr;13(2):333-344, Journal of Immigrant & Minority Health
As the number and diversity of Africans in the U.S. increases, there is a growing need to assess their health care needs and practices. Although infectious diseases have been a traditional point of contact between health care systems and African immigrants, there is a clear and unmet need to determine the risks and prevalence for chronic diseases. This review includes what has been published concerning the health of African immigrants in the U.S. and draws on European studies to supplement this assessment. While African immigrants arrive in the U.S. with some unique health problems, namely infectious diseases, they are generally healthier than African Americans of the same age. This 'healthy immigrant effect' has been well documented, but the acquisition of risk factors for chronic diseases such as coronary artery disease, hypertension, diabetes and cancer is poorly understood among African immigrants. More information must be gathered in the broad categories of chronic disease, health attitudes and health access to better promote the health of African immigrants
— id: 138356, year: 2011, vol: 13, page: 333, stat: Journal Article,

A randomized controlled trial of a multilevel intervention to increase colorectal cancer screening among Latino immigrants in a primary care facility
Aragones, Abraham; Schwartz, Mark D; Shah, Nirav R; Gany, Francesca M
2010 Jun;25(6):564-567, Journal of general internal medicine
BACKGROUND: Latino immigrants face a higher burden of colorectal cancer (CRC) and screening rates are low. OBJECTIVE: To assess the effectiveness of a multilevel intervention in increasing the rate of CRC screening among Latino immigrants. DESIGN: A randomized controlled trial, with randomization at the physician level. PARTICIPANTS: Pairs of 65 primary care physicians and 65 Latino immigrant patients participated, 31 in the intervention and 34 in the control group. INTERVENTION: CRC educational video in Spanish on a portable personal digital video display device accompanied by a brochure with key information for the patient, and a patient-delivered paper-based reminder for their physician. MEASUREMENTS: Completed CRC screening, physician recommendation for CRC screening, and patient adherence to physician recommended CRC screening. RESULTS: The overall rate of completed screening for CRC was 55% for the intervention and 18% for the control group (p = 0.002). Physicians recommended CRC screening for 61% of patients in the intervention group versus 41% in the control group (p = 0.08). Of those that received a recommendation, 90% in the intervention group adhered to it versus 26% in the control group (p = 0.007). CONCLUSIONS: The intervention was successful in increasing rates of completed CRC screening primarily through increasing adherence after screening was recommended. Additional efforts should focus on developing new strategies to increase physician recommendation for CRC screening, while employing effective patient adherence interventions
— id: 116474, year: 2010, vol: 25, page: 564, stat: Journal Article,

Reducing clinical errors in cancer education: interpreter training
Gany, Francesca M; Gonzalez, Carlos Javier; Basu, Gaurab; Hasan, Abdullah; Mukherjee, Debjani; Datta, Minakshi; Changrani, Jyotsna
2010 Dec;25(4):560-564, Journal of cancer education
Over 22 million US residents are limited English proficient. Hospitals often call upon untrained persons to interpret. There is a dearth of information on errors in medical interpreting and their impact upon cancer education. We conducted an experimental study of standardized medical interpreting training on interpreting errors in the cancer encounter, by comparing trained and untrained interpreters, using identical content. Nine interpreted cancer encounters with identical scripts were recorded and transcribed. Using an 'Error Analysis Tool,' a bilingual linguist and two bilingual medical providers scored the transcripts for interpreting errors made, including their potential clinical severity. Trained interpreters were 70% less likely to have clinical errors than untrained ones. The likelihood of medical error increased with the length of the concept and decreased with the precision of vocabulary. It is important to train medical interpreters and to ensure their availability in cancer education encounters to minimize the risk for errors
— id: 115417, year: 2010, vol: 25, page: 560, stat: Journal Article,

Barriers and facilitators to public health insurance enrollment in newly arrived immigrant adolescents and young adults in new york state
Hearst, Adelaide A; Ramirez, Julia M; Gany, Francesca M
2010 Aug;12(4):580-585, Journal of Immigrant & Minority Health
This study was designed to identify barriers and facilitators to enrollment in public health insurance programs in immigrant adolescents and young adults. Focus groups were held in English, Spanish and Mandarin to assess barriers and facilitators to insurance enrollment. Twenty-nine students participated in the focus groups, 11 Chinese speakers, 13 English speakers and 5 Spanish speakers. They were between the ages of 18 and 24. The major factors affecting failure to enroll were lack of correct information about enrollment process and qualifications, fear of being reported to immigration, and language barriers. In general, newly arrived students had less information and many more questions. Facilitators to enrollment included perceived need for health insurance, requiring help with medical care costs, and assistance with information gathering. To increase enrollment, we suggest school-based approaches to education and enrollment, increased presence of facilitated enrollers, and increased visibility of existing informational outlets
— id: 110863, year: 2010, vol: 12, page: 580, stat: Journal Article,

Detection of depression with different interpreting methods among chinese and latino primary care patients: a randomized controlled trial
Leng, Jennifer C F; Changrani, Jyotsna; Tseng, Chi-Hong; Gany, Francesca
2010 Apr;12(2):234-241, Journal of Immigrant & Minority Health
Language barriers may contribute to the under-detection of depression in Latinos and Asians. A total of 782 English, Spanish, and Chinese-speaking primary care patients were enrolled in a randomized controlled trial. Language discordant patients were randomized to Remote Simultaneous Medical Interpreting (RSMI) or usual and customary (U&C) interpreting. The Beck Depression Inventory-Fast Screen (BDI-FS) was administered. Patients were tracked for 1 year. A total of 462 patients completed the BDI-FS. Thirty-three percent had a positive (>/=4) screen. Twenty-seven percent of BDI-FS positive patients were diagnosed with depression. Among BDI-FS positive patients, Chinese-speakers were less likely to be diagnosed compared with English speakers (31% vs. 10%, P < 0.05). There was a trend towards greater diagnosis with RSMI (27% detection with RSMI vs. 20% U&C, P = 0.41). The diagnosis of depression among BDI-FS positive patients in our population was low, particularly among Chinese-speakers. RSMI could be an important part of a multi-faceted approach to improving the detection of depression
— id: 108425, year: 2010, vol: 12, page: 234, stat: Journal Article,

EDUCATE, SCREEN, AND REFER: THE USE OF CULTURALLY FAMILIAR HEALTH CAMPS TO IDENTIFY CARDIOVASCULAR RISK FACTORS IN SOUTH ASIAN IMMIGRANTS
Levy, Andrew; Gany, Francesca; Leng, Jennifer; Basu, Piali; Changrani, Jyotsna; Ayinikal, Anto; Mantha-Thaler, Kamala; Poretsky, Leonid; Keller, Norma
2010 JUN ;25(9):261-262, Journal of general internal medicine
— id: 115898, year: 2010, vol: 25, page: 261, stat: Journal Article,

South Asians and risk of cardiovascular disease: current insights and trends
Mangalmurti, Sandeep S; Paley, Ari; Gany, Francesca; Fisher, Edward A; Hochman, Judith S
2010 Autumn;20(4):474-478, Ethnicity & disease
Patients from the Indian subcontinent have a distinct cardiovascular risk profile with profound health consequences. South Asians tend to develop more severe coronary artery disease at a younger age, and may also suffer from earlier myocardial infarction and heart failure. The genesis of this risk is multi-factorial. One important culprit is increased insulin resistance, possibly due to recently identified genetic polymorphisms. Another possible explanation is subclinical inflammation and a prothrombotic environment, as evidenced by increased levels of homocysteine, plasminogen activator inhibitor-1, and fibrinogen. The lipid profile of South Asians may play a role, as this population is known to have elevated levels of lipoprotein (a), as well as lower levels of HDL. In addition, this HDL may be dysfunctional, as this population may have a higher prevalence of low levels of HDL2b, as well as an increased preponderance of smaller HDL. Current guidelines for primary and secondary prevention have not reflected our growing insight into the unique characteristics of the South Asian population, and may need to evolve to reflect our knowledge
— id: 125449, year: 2010, vol: 20, page: 474, stat: Journal Article,

Cancer screening practices among physicians serving Chinese immigrants
Aragones, Abraham; Trinh-Shevrin, Chau; Gany, Francesca
2009 Feb;20(1):64-73, Journal of health care for the poor & underserved
Chinese immigrants in the United States are broadly affected by cancer health disparities. We examined the cancer screening attitudes and practices of physicians serving Chinese immigrants in the New York City (NYC) area by mailing a cancer screening survey, based on current guidelines, to a random sample of physicians serving this population. Fifty three physicians (44%) completed the survey. Seventy-two percent reported following the guidelines for breast cancer, 35% for cervical cancer screening, and 45% for all colorectal cancer screening tests. Sixty-eight percent of physicians were satisfied with their current rates of cancer screening with their Chinese immigrant patient population. Physicians serving the Chinese community in NYC follow cancer screening guidelines inadequately. Cancer screening rates in this population could likely be increased by interventions that target physicians and improve awareness of guidelines and recommended best practices
— id: 95044, year: 2009, vol: 20, page: 64, stat: Journal Article,

Mexican immigrant male knowledge and support toward breast and cervical cancer screening
de Bocanegra, Heike Thiel; Trinh-Shevrin, Chau; Herrera, Angelica P; Gany, Francesca
2009 ;11(4):326- 333, Journal of Immigrant Health
Background: We conducted a focus group study to assess the influence of partner communication on breast and cervical cancer screening and the perceived existing and potential support from male partners in participating in cancer screening. Secondarily, Mexican male and female views on health care and cancer were explored. Methods: Seven focus groups (two female-only, three male-only, and two couples) were conducted in Spanish. Results: Findings suggest that knowledge about cervical cancer was significantly less than knowledge about breast cancer among both men and women. Barriers to cancer screening included language barriers, lack of health insurance, and lack of awareness of the need for screening. Male partners expressed willingness to support their female partners in cancer screening activities. Conclusion: Cervical cancer education is desperately needed, including education on the availability of free and low cost screening services. Education efforts should include the male community members, especially as the males perceive themselves as responsible for the financial burden of care.
— id: 106904, year: 2009, vol: 11, page: 326, stat: Journal Article,

Colon Cancer Knowledge and Attitudes in an Immigrant Haitian Community
Francois, Fritz; Elysee, Greta; Shah, Susan; Gany, Francesca
2009 Aug;11(4):319-325, Journal of Immigrant & Minority Health
Objective To qualitatively evaluate the views of Haitian immigrants on cancer and the influence of cultural and socio-ecological factors on cancer screening behavior. Methods Six focus groups, consisting of 4-10 individuals each, were conducted among Haitian adults at average risk for colorectal cancer. The interviews were conducted in Haitian Creole and featured questions that addressed beliefs and attitudes about general health, access to health care, colon cancer, and screening practices. Results The focus groups provided insight into the health service utilization patterns in the Haitian community, as well as the factors driving them including language and the pattern of accessing healthcare only for emergencies. Conclusions Many misconceptions regarding cancer and its development were evident in the discussions. However participants were willing to follow the recommendations of a physician. This highlighted the importance in this community of disseminating information at every opportunity about preventative care, including colorectal cancer screening
— id: 78625, year: 2009, vol: 11, page: 319, stat: Journal Article,

Mexican Immigrant Male Knowledge and Support Toward Breast and Cervical Cancer Screening
Thiel de Bocanegra, Heike; Trinh-Shevrin, Chau; Herrera, Angelica P; Gany, Francesca
2009 Aug;11(4):326-333, Journal of Immigrant & Minority Health
Background We conducted a focus group study to assess the influence of partner communication on breast and cervical cancer screening and the perceived existing and potential support from male partners in participating in cancer screening. Secondarily, Mexican male and female views on health care and cancer were explored. Methods Seven focus groups (two female-only, three male-only, and two couples) were conducted in Spanish. Results Findings suggest that knowledge about cervical cancer was significantly less than knowledge about breast cancer among both men and women. Barriers to cancer screening included language barriers, lack of health insurance, and lack of awareness of the need for screening. Male partners expressed willingness to support their female partners in cancer screening activities. Conclusion Cervical cancer education is desperately needed, including education on the availability of free and low cost screening services. Education efforts should include the male community members, especially as the males perceive themselves as responsible for the financial burden of care
— id: 90137, year: 2009, vol: 11, page: 326, stat: Journal Article,

Online cancer support groups: Experiences with underserved immigrant Latinos
Changrani, Jyotsna; Lieberman, Morton; Golant, Mitch; Rios, Peggy; Damman, Jennifer; Gany, Francesca
2008 ;15(10):55-62 Oct, Primary Psychiatry
Online support groups (OSGs) may be a particularly promising option for immigrants. They can be a cost-effective method that easily addresses geographic isolation and immigrants' needs for privacy This article examines the viability of OSGs for Hispanic immigrants with breast cancer and the effectiveness of OSGs for the participants. The authors hypothesized that OSGs are a feasible mechanism for delivering support to Latina women with breast cancer, as immigrant Latinas with breast cancer in OSGs showed significant improvement compared to a control group on depression, in coping with pain, in quality of life, and personal growth. Of 85 potential participants approached, 68 Spanish-dominant speaking immigrant women with breast cancer were recruited into the Virtual Community for Immigrants with Cancer (VCIC). Forty-eight were randomly assigned to OSGs and 20 were assigned to a usual care control group. VCIC participants were grouped into OSGs with eight participants in each. Each group met for 90 minutes once a week for 30 weeks. The groups were facilitated by trained bilingual facilitators and issues of interest to the group were discussed, such as managing symptoms and side effects from medications, family concerns, and alienation. The dropout rate from the groups was 13%. The VCIC experiences suggest that OSGs are acceptable to and feasible for immigrant minorities, including those with limited English proficiency. While none of the outcome measures showed statistically significant change pre-post compared to the control group, statistical trends were noted suggesting beneficial impact on outcomes. When compared to the controls, the experimental had increases in seeing new possibilities (F = 2.81, P = .09) and increased feelings of strength (F = 3.59, P = .06).
— id: 97119, year: 2008, vol: 15, page: 55, stat: Journal Article,

Cancer screening and Haitian immigrants: the primary care provider factor
Gany, Francesca; Trinh-Shevrin, Chau; Aragones, Abraham
2008 Jun;10(3):255-261, Journal of Immigrant & Minority Health
BACKGROUND: Haitian immigrants, among the fastest growing immigrant communities in the United States, have low cancer screening rates. Several patient barriers have been identified and associated with low screening rates but little is known on provider barriers for cancer screening. To address this gap, we assessed the cancer screening practices, attitudes, and beliefs of primary care providers serving the Haitian community. METHODS: We surveyed a random sample of physicians serving first generation Haitian immigrants in New York City, identified through their zip codes of practice. Participants completed a questionnaire to assess their beliefs, attitudes and practices surrounding cancer screening, and their perceptions of patient barriers to screening. RESULTS: 50 of 87 physicians (58%) consented to participate in the study. Cancer site-specific and overall cancer screening scores were created for breast, cervical, and colorectal cancer screening. 75% of providers followed breast cancer screening guidelines, 16% for cervical cancer, and 30% for colorectal cancer. None of the providers in the sample were following guidelines for all three cancer sites. Additionally, 97% reported recommending digital rectal exam and PSA annually to patients 50 years or older with no family history, and 100% to patients over 50 years old with family history. CONCLUSIONS: The reported practices of providers serving the Haitian immigrant community in New York City are not fully consistent with practice guidelines. Efforts should be made to reinforce screening guideline knowledge in physicians serving the Haitian immigrant community, to increase the utilization of systems that increase cancer screening, and to implement strategies to overcome patient barriers
— id: 78684, year: 2008, vol: 10, page: 255, stat: Journal Article,

Arab American Immigrants in New York: Health Care and Cancer Knowledge, Attitudes, and Beliefs
Shah, Susan M; Ayash, Claudia; Pharaon, Nora Alarifi; Gany, Francesca M
2008 Oct;10(5):429-436, Journal of Immigrant & Minority Health
Arab immigrants living in the United States total between 1.5 million and 3.5 million, and have been growing in number each decade. New York's Arab population, at 405,000, ranks third in the U.S. after California and Michigan. Despite the large numbers, little health research has focused on this population. Data about the cancer incidence, mortality, and screening practices of Arab Americans is overwhelmingly lacking. To better understand the health care and cancer knowledge, attitudes, and beliefs of Arab American immigrants, five single-gender focus groups were convened with Arab men and women in New York City. Attention was given to factors that act as barriers to utilization of general health care services, and of cancer prevention, treatment, and support services. The data revealed the importance of providing culturally and linguistically appropriate health interventions in partnership with trusted community leaders, and the need for follow-up research of this understudied immigrant population
— id: 78830, year: 2008, vol: 10, page: 429, stat: Journal Article,

The impact of medical interpretation method on time and errors
Gany, Francesca; Kapelusznik, Luciano; Prakash, Kavitha; Gonzalez, Javier; Orta, Lurmag Y; Tseng, Chi-Hong; Changrani, Jyotsna
2007 Nov;22 Suppl 2:319-323, Journal of general internal medicine
BACKGROUND: Twenty-two million Americans have limited English proficiency. Interpreting for limited English proficient patients is intended to enhance communication and delivery of quality medical care. OBJECTIVE: Little is known about the impact of various interpreting methods on interpreting speed and errors. This investigation addresses this important gap. DESIGN: Four scripted clinical encounters were used to enable the comparison of equivalent clinical content. These scripts were run across four interpreting methods, including remote simultaneous, remote consecutive, proximate consecutive, and proximate ad hoc interpreting. The first 3 methods utilized professional, trained interpreters, whereas the ad hoc method utilized untrained staff. MEASUREMENTS: Audiotaped transcripts of the encounters were coded, using a prespecified algorithm to determine medical error and linguistic error, by coders blinded to the interpreting method. Encounters were also timed. RESULTS: Remote simultaneous medical interpreting (RSMI) encounters averaged 12.72 vs 18.24 minutes for the next fastest mode (proximate ad hoc) (p = 0.002). There were 12 times more medical errors of moderate or greater clinical significance among utterances in non-RSMI encounters compared to RSMI encounters (p = 0.0002). CONCLUSIONS: Whereas limited by the small number of interpreters involved, our study found that RSMI resulted in fewer medical errors and was faster than non-RSMI methods of interpreting
— id: 75479, year: 2007, vol: 22 Suppl 2, page: 319, stat: Journal Article,

Patient satisfaction with different interpreting methods: a randomized controlled trial
Gany, Francesca; Leng, Jennifer; Shapiro, Ephraim; Abramson, David; Motola, Ivette; Shield, David C; Changrani, Jyotsna
2007 Nov;22 Suppl 2:312-318, Journal of general internal medicine
BACKGROUND: Growth of the foreign-born population in the U.S. has led to increasing numbers of limited-English-proficient (LEP) patients. Innovative medical interpreting strategies, including remote simultaneous medical interpreting (RSMI), have arisen to address the language barrier. This study evaluates the impact of interpreting method on patient satisfaction. METHODS: 1,276 English-, Spanish-, Mandarin-, and Cantonese-speaking patients attending the primary care clinic and emergency department of a large New York City municipal hospital were screened for enrollment in a randomized controlled trial. Language-discordant patients were randomized to RSMI or usual and customary (U&C) interpreting. Patients with language-concordant providers received usual care. Demographic and patient satisfaction questionnaires were administered to all participants. RESULTS: 541 patients were language-concordant with their providers and not randomized; 371 were randomized to RSMI, 167 of whom were exposed to RSMI; and 364 were randomized to U&C, 198 of whom were exposed to U&C. Patients randomized to RSMI were more likely than those with U&C to think doctors treated them with respect (RSMI 71%, U&C 64%, p < 0.05), but they did not differ in other measures of physician communication/care. In a linear regression analysis, exposure to RSMI was significantly associated with an increase in overall satisfaction with physician communication/care (beta 0.10, 95% CI 0.02-0.18, scale 0-1.0). Patients randomized to RSMI were more likely to think the interpreting method protected their privacy (RSMI 51%, U&C 38%, p < 0.05). Patients randomized to either arm of interpretation reported less comprehension and satisfaction than patients in language-concordant encounters. CONCLUSIONS: While not a substitute for language-concordant providers, RSMI can improve patient satisfaction and privacy among LEP patients. Implementing RSMI should be considered an important component of a multipronged approach to addressing language barriers in health care
— id: 75478, year: 2007, vol: 22 Suppl 2, page: 312, stat: Journal Article,

Access to multilingual medication instructions at New York City pharmacies
Weiss, Linda; Gany, Francesca; Rosenfeld, Peri; Carrasquillo, Olveen; Sharif, Iman; Behar, Elana; Ambizas, Emily; Patel, Priti; Schwartz, Lauren; Mangione, Robert
2007 Nov;84(6):742-754, Journal of urban health
An essential component of quality care for limited English proficient (LEP) patients is language access. Linguistically accessible medication instructions are particularly important, given the serious consequences of error and patient responsibility for managing often complex medication regimens on their own. Approximately 21 million people in the U.S. were LEP at the time of the 2000 census, representing a 50% increase since 1990. Little information is available on their access to comprehensible medication instructions. In an effort to address this knowledge gap, we conducted a telephone survey of 200 randomly selected NYC pharmacies. The primary focus of the survey was translation need, capacity, and practice. The majority of pharmacists reported that they had LEP patients daily (88.0%) and had the capacity to translate prescription labels (79.5%). Among pharmacies serving LEP patients on a daily basis, just 38.6% translated labels daily; 22.7% never translated. In multivariate analysis, pharmacy type (OR = 4.08, 95%CI = 1.55-10.74, independent versus chain pharmacies) and proportion of Spanish-speaking LEP persons in the pharmacy's census tract (OR = 1.09, 95%CI = 1.05-1.13 for each 1% increase in Spanish LEP population) were associated with increased label translation. Although 88.5% of the pharmacies had bilingual staff, less than half were pharmacists or pharmacy interns and thus qualified to provide medication counseling. More than 80% of the pharmacies surveyed lacked systematic methods for identifying linguistic needs and for informing patients of translation capabilities. Consistent with efforts to improve language access in other health care settings, the critical gap in language appropriate pharmacy services must be addressed to meet the needs of the nation's large and ever-growing immigrant communities. Pharmacists may require supplemental training on the need and resources for meeting the verbal and written language requirements of their LEP patients. Dispensing software with accurate translation capability and telephonic interpretation services should be utilized in pharmacies serving LEP patients. Pharmacists should post signs and make other efforts to inform patients about the language resources available to them
— id: 78831, year: 2007, vol: 84, page: 742, stat: Journal Article,

Comment on "Patterns of communication through interpreters: a detailed sociolinguistic analysis"
Aragones, Abraham; Gany, Francesca
2006 Dec;21(12):1357-1357, Journal of general internal medicine
— id: 78833, year: 2006, vol: 21, page: 1357, stat: Journal Article,

Paan and Gutka Use in the United States: A Pilot Study in Bangladeshi and Indian-Gujarati Immigrants in New York City
Changrani J; Gany FM; Cruz G; Kerr R; Katz R
2006 ;4(1):99-110, Journal of immigrant & refugee studies
Smokeless tobacco and areca nut are popular with South Asians and South Asian immigrants, most commonly used as paan and gutka. Their regular use leads to oral cancer. The South Asian community in the U.S. is rapidly growing, where paan and gutka are readily available. The study was the first exploration of the migration of the paan and gutka habits, and their use in the U.S.A 108-item questionnaire on paan and gutka usage and beliefs was administered to 138 first-generation Bangladeshi and Indian-Gujarati immigrant adults at community sites in the New York metropolitan area. Forty-five percent Indian-Gujaratis reported ever-regular paan use; of which 5% are current users. Thirty-one percent reported ever-regular gutka use; of which 77% are current users. Thirty-five percent Bangladeshis reported ever-regular paan use; of which 70% arc current users. Nine percent reported ever-regular gutka use; of which 67% are current users. Bangladeshis are more likely to identify paan as causing oral cancer. Indian-Gujaratis are more likely to identify gutka as causing oral cancer.Between the two communities, there were significant differences in paan and gutfca usage, migration effects, and oral career risk perception. There is a need for comprehensive migration studies on the determinants of usage, and for community-specific interventions for these carcinogenic products
— id: 78832, year: 2006, vol: 4, page: 99, stat: Journal Article,

Follow-up care after a diagnosis of Helicobacter pylori infection in an Asian immigrant cohort
Cho, Alex; Chaudhry, Amina; Minsky-Primus, Lisa; Tso, Alan; Perez-Perez, Guillermo; Diehl, David L; Marcus, Stuart G; Gany, Francesca M
2006 Jan;40(1):29-32, Journal of clinical gastroenterology
GOAL: To study the rate at which Helicobacter pylori infection is treated in an immigrant cohort after diagnosis by esophagogastroduodenoscopy (EGD). BACKGROUND: Gastric cancer is the second leading cause of cancer death worldwide, and is especially prevalent in East Asia; immigrants from this part of the world remain at higher risk. Infection with H. pylori is a known risk factor for gastric cancer. There have been no studies of completion of H. pylori treatment in immigrant populations. STUDY: Prospective cohort study of East Asian immigrants diagnosed with H. pylori infection who underwent EGD in a gastric cancer screening protocol. Our primary outcome was self-report or chart evidence of completion of treatment of H. pylori. RESULTS: Sixty-eight of the 126 participants (54%) tested positive for H. pylori infection on EGD. Forty-nine (72%) were seen for a follow-up visit at one of the clinics involved in the study. According to clinic records, 39 of these 49 participants (57% of all H. pylori-positive participants) were prescribed treatment. Only 31 participants (46%) completed treatment. Of possible explanatory factors, only having a 'regular doctor' was significantly associated with treatment completion (odds ratio=5.6; 95% confidence interval, 1.2-25.0). CONCLUSIONS: In a sample of Asian immigrants, the rate of treatment of H. pylori infection, a potentially modifiable risk factor, was lower than expected. Having a 'regular doctor' appeared to increase the likelihood of receiving appropriate follow-up care
— id: 61482, year: 2006, vol: 40, page: 29, stat: Journal Article,

Acceptance of repeat esophagogastroduodenoscopy to detect gastric cancer in a chinese immigrant cohort
Cho, Alex; Chaudhry, Amina; Minsky-Primus, Lisa; Tso, Alan; Perez-Perez, Guillermo; Diehl, David; Marcus, Stuart G; Gany, Francesca M
2006 Aug;40(7):606-611, Journal of clinical gastroenterology
GOAL: To study the feasibility of using repeat esophagogastroduodenoscopy (EGD) to screen for Helicobacter pylori infection and gastric cancer in an Asian immigrant cohort. BACKGROUND: Immigrants in the United States (US) from countries with high per capita rates of gastric cancer remain at higher risk for gastric cancer. The existence of the possibly modifiable risk factor of H. pylori infection and the poor outcomes associated with late-stage disease make screening higher-risk groups with EGD an appealing possibility. It is unknown whether Asian immigrants in the US would accept an EGD-based strategy for gastric cancer screening. STUDY: Cross-sectional study of adult Chinese immigrants in New York City with dyspepsia who underwent EGD in an earlier gastric cancer detection study, who were offered a second EGD four years later. Our main outcome measure was acceptance or refusal of repeat EGD. RESULTS: Seventy-three of the 115 Chinese participants in the earlier study were successfully contacted for this current study. Twenty-three of 73 (32%) underwent repeat EGD. Leading reasons given for declining were lack of symptoms and lack of time. Significantly associated with acceptance of repeat EGD was the belief that EGD will find stomach cancer 'nearly always' in someone who has it (P=0.0054; odds ratio=14.0, 2.1 to 94.2 95% confidence interval). CONCLUSIONS: Acceptance of repeat EGD for gastric cancer detection in a cohort of Chinese immigrants was relatively low despite the mitigation of cost and language factors, 2 major barriers to healthcare access. Relocation seemed to be a factor as well. In this population, perceptions of the benefits of EGD may influence acceptance of testing for cancer detection purposes
— id: 68529, year: 2006, vol: 40, page: 606, stat: Journal Article,

Attitudes, knowledge, and health-seeking behaviors of five immigrant minority communities in the prevention and screening of cancer: a focus group approach
Gany, Francesca M; Herrera, Angelica P; Avallone, Michelle; Changrani, Jyotsna
2006 Feb;11(1):19-39, Ethnicity & Health
Despite an observed decrease in overall cancer death rates in the USA, immigrant minorities continue to experience disproportionately higher cancer incidence and mortality rates. Thirteen focus groups were conducted in the Haitian, English-Speaking Caribbean, Latino, Korean, and Chinese communities of New York City to better understand their health-seeking behaviors with respect to cancer prevention, screening, and treatment. Focus groups addressed the degree to which cultural, linguistic, and systematic barriers impact these behaviors and explored methods to support salutary behaviors. Findings underscored that, while there are many similarities across immigrant groups, there are significant variations between the immigrant groups to necessitate a tailored community-based approach. The prevalent misinformation observed among all groups warrants the prompt development of culturally competent programs for cancer control with immigrant minorities
— id: 63801, year: 2006, vol: 11, page: 19, stat: Journal Article,

New York City's immigrant minorities: reducing cancer health disparities
Gany, Francesca M; Shah, Susan M; Changrani, Jyotsna
2006 ;107(8 Suppl):2071-2081, Cancer
One million newcomers arrive in the United States every year; 11.7% of the total U.S. population is foreign-born. Immigrants face cancer care and research access barriers, including economic, immigration status, cultural, and linguistic. In 2000, the Center for Immigrant Health, NYU School of Medicine, launched the Cancer Awareness Network for Immigrant Minority Populations (CANIMP), a network comprising community- and faith-based organizations, local and national government health institutions, clinical service providers, researchers, and immigrant-service and advocacy organizations. This community-based participatory program chose as its priorities high- incidence cancer sites in the overall immigrant community (colorectal, lung, breast, cervical, prostate), as well as sites with strikingly high incidence in specific immigrant groups (gastric, liver, oral). CANIMP has developed successful outreach, education, screening, survivorship, training, and research programs to decrease cancer disparities. Over 2500 at-risk community members have been reached, 25 junior minority researchers trained, 60 minority interns mentored, numerous cancer disparities research projects funded and conducted, and vital partnerships to improve cancer data developed. These initiatives serve as models to address community, systems, physician, and cancer research gaps in immigrant communities. Cancer 2006. (c) 2006 American Cancer Society
— id: 68717, year: 2006, vol: 107, page: 2071, stat: Journal Article,

Online cancer education and immigrants: effecting culturally appropriate websites
Changrani, Jyotsna; Gany, Francesca
2005 Fall;20(3):183-186, Journal of cancer education
The online population is becoming increasingly diverse. Cancer information websites are a popular destination. However, culturally-appropriate cancer information websites are lacking. METHODS: An Internet behavior and preference study was conducted in Caribbean immigrant women. 60 English-speaking Caribbean immigrant women in New York City participated in website review sessions. RESULTS: Three-quarters of the participants used computers regularly. Over 80% accessed the Internet from home. Over 50% felt confident using the Internet. However, only 6% used the Internet to search for health information. CONCLUSION: A 'cultural digital divide' exists. The Internet should be tailored to immigrants to facilitate web-based cancer education
— id: 63731, year: 2005, vol: 20, page: 183, stat: Journal Article,

Paan and Gutka in the United States: an emerging threat
Changrani, Jyotsna; Gany, Francesca
2005 Apr;7(2):103-108, Journal of Immigrant Health
Smokeless tobacco and areca nut usage are integral cultural traditions in South Asia. Paan and gutka are two commonly used products which contain these ingredients. They are immensely popular in South Asia and with South Asian immigrants. Regular paan and gutka use is associated with several deleterious health consequences, most significantly oral cancer. Of particular concern is the markedly increased risk of oral cancer in South Asian immigrants when compared with the natives in new areas of settlement. The South Asian community in the United States is large and rapidly growing. Paan and gutka are legal in the United States, and readily available in ethnic enclaves. Smokeless tobacco prevention and cessation research and interventions have not yet addressed the unique sociocultural circumstances of this growing, at-risk community. The medical, dental, and public health communities need to join forces to combat this emerging threat
— id: 56037, year: 2005, vol: 7, page: 103, stat: Journal Article,

More innovative strategies needed to achieve the goal of tuberculosis elimination - Response
Gany, F; Changrani, J
2005 OCT ;95(10):1675-1675, American journal of public health. AJPH
— id: 58655, year: 2005, vol: 95, page: 1675, stat: Journal Article,

Drive-by readings: a creative strategy for tuberculosis control among immigrants
Gany, Francesca M; Trinh-Shevrin, Chau; Changrani, Jyotsna
2005 Jan;95(1):117-119, American journal of public health. AJPH
OBJECTIVES: We explored an innovative strategy for targeted testing and disease management among immigrant communities at risk for tuberculosis. METHODS: Taxi drivers were recruited at an airport holding lot to undergo tuberculin skin testing (Mantoux). After receiving their test results in a location convenient for them, drivers with positive results were referred for evaluation and treatment. We conducted baseline and follow-up assessments. RESULTS: Of 123 drivers who participated, two thirds (82) were at high risk for tuberculosis. Seventy-eight (63%) of the 123 returned for test readings; 62% of these drivers had positive test results. All drivers with positive results received a complete physician evaluation, but 64% of those evaluated were not treated for latent TB infection. Of the untreated drivers, 37.5% were at high risk. Systemic and physician barriers (e.g., lack of knowledge, erroneous beliefs regarding vaccines) affected adherence to evaluation and treatment. CONCLUSIONS: Targeted testing and treatment are important to the control of tuberculosis. The results of this study highlight the need for an aggressive physician educational campaign to identify latent tuberculosis infection and to tailor service delivery to meet the unique needs of foreign-born communities
— id: 48113, year: 2005, vol: 95, page: 117, stat: Journal Article,

Can a web-based curriculum improve students' knowledge of, and attitudes about, the interpreted medical interview?
Kalet, Adina L; Mukherjee, Debjani; Felix, Karla; Steinberg, Sarah E; Nachbar, Martin; Lee, Amy; Changrani, Joytsna; Gany, Francesca
2005 Oct;20(10):929-934, Journal of general internal medicine
OBJECTIVES: To develop and evaluate a web-based curriculum to introduce first year medical students to the knowledge and attitudes necessary for working with limited English proficient (LEP) patients through interpreters. METHOD: Six hundred and forty first year medical students over 4 consecutive years took this curriculum as part of their Patient Physician and Society course. They viewed 6 patient-physician-interpreter video vignettes, gave open text analyses of each vignette, and compared their responses to those generated by experts, thereby receiving immediate formative feedback. They listened to video commentaries by a cultural expert, lawyer, and ethicist about working with LEP patients, completed pre- and postmodule questionnaires, which tested relevant knowledge and attitudes, and were provided a summative assessment at the end of the module. Students completed an optional survey assessing the educational value of, and providing open text commentary about, the module. RESULTS: Seventy-one percent (n=456) of first year students who completed the module consented to have their data included in this evaluation. Mean knowledge (19 items) scores improved (46% pre- to 62% postmodule, P<.001), reflecting improvements in knowledge about best interpreter practices and immigration demographics and legal issues. Mean scores on 4 of 5 attitude items improved, reflecting attitudes more consistent with culturally sensitive care of LEP patients. Mean satisfaction with the educational value of the module for 155 students who completed the postmodule survey was 2.9 on a scale of 1 to 4. CONCLUSION: Our web-curriculum resulted in short-term improvement in the knowledge and attitudes necessary to interact with LEP patients and interpreters. The interactive format allowed students to receive immediate formative feedback and be cognizant of the challenges and effective strategies in language discordant medical encounters. This is important because studies suggest that the use of these skills in patient encounters leads to greater patient and provider satisfaction and improved health outcomes
— id: 66677, year: 2005, vol: 20, page: 929, stat: Journal Article,

Beliefs about betel quid and gutkha chewing in an Indian population
Kerr, AR; Jean, Y; Verma, S; Cruz, GD; Gany, FM; Changrani, JG; Sur, J; Gupta, J; Katz, RV
2005 APR ;1(1):71-71, Oral oncology
— id: 62537, year: 2005, vol: 1, page: 71, stat: Journal Article,

Understanding immigrant Chinese Americans' participation in cancer screening and clinical trials
Lin, Jennifer S; Finlay, Alyssa; Tu, Angela; Gany, Francesca M
2005 Dec;30(6):451-466, Journal of community health
The purpose of this study was to identify potential barriers and facilitators to Chinese immigrant participation in cancer screening and clinical trials. A series of focus groups, in English, Cantonese, and Mandarin, were conducted with physicians, community leaders, and first generation members of the Manhattan Chinatown community. Participants were asked to discuss their beliefs about cancer, cancer screening, clinical trials, and cancer health education materials. Focus group data were stratified by respondent group and analyzed for thematic content. Eleven physicians, 15 community leaders, and 38 community members participated. Some community members were not familiar with cancer screening as a preventive measure and had not received common screens such as PAP smears or mammograms. They described widespread misconceptions about cancer that act as screening deterrents, e.g. testing for cancer can cause cancer. Community members were unfamiliar with clinical trials and would not participate in a clinical trial unless 'sick,' and only on the recommendation of their physicians. Physicians did not see the relevance or value of clinical trials for their patients. Among first generation Chinese immigrants, there are many perceptual barriers to cancer screening and clinical trials recruitment. There is a need for effective culturally tailored health education on these health topics to address persistent misconceptions about cancer and to increase knowledge about cancer screening and clinical trials. Health education efforts and clinical trial recruitment in this community must involve community physicians
— id: 62399, year: 2005, vol: 30, page: 451, stat: Journal Article,

Good provider, good patient: changing behaviors to eliminate disparities in healthcare
de Bocanegra HT; Gany F
2004 ;10 Special Issue:SP20-8 Sep, American journal of managed care
We examined the relationship between cross-cultural provider-patient interactions and health outcomes through a literature review. Results were presented in the form of guiding principles to an expert panel of health care administrators, medical practitioners, and medical care providers. This expert panel met at the work-shop 'Changing Patient Behavior' during a conference convened by the office of Minority Health, US Department of Health and Human Services, February 17-18, 2000. The panel reviewed the themes and formulated suggestions for program and policy change. Six principles were identified: (1) Physicians should acknowledge that patients may be actively involved in health maintenance long before they seek medical care. (2) Patients should be empowered to be active participants in their medical care. (3) Providers should critically evaluate their own assumptions and underlying values about what constitutes a 'good' patient and consider how these assumptions and values affect their communication strategies. (4) The patient's behavior change in the medical interaction should result from a process of negotiation between provider and patient. (5) The medical system should focus on community empowerment in addition to individual empowerment. (6) Accessible and understandable health out-come data will empower the community to participate in the elimination of health disparities
— id: 81364, year: 2004, vol: 10 Special Issue, page: SP20, stat: Journal Article,

An academic dental center grapples with oral cancer disparities: current collaboration and future opportunities
Kerr, A Ross; Changrani, Jyotsna G; Gany, Francesca M; Cruz, Gustavo D
2004 May;68(5):531-541, Journal of dental education
This article reviews the epidemiology of oral cancer in the United States, explores the complex reasons for its disproportionate burden in minority groups, and describes the efforts of New York University's College of Dentistry to address these oral cancer disparities. These efforts include the development of state and regional consortia and networks, public education and community screening efforts, undergraduate dental curriculum development, professional education, intensive research efforts, and significant dental-medical collaborations. Future directions include the need to develop and assess oral cancer education/awareness programs, specifically customized to the various dental-medical professionals/trainees and to populations at risk. Improving the quality of life of patients during and following treatment for oral cancer is another important area that has great opportunity for dental-medical collaboration
— id: 44870, year: 2004, vol: 68, page: 531, stat: Journal Article,

Good provider, good patient: changing behaviors to eliminate disparities in healthcare
Thiel de Bocanegra, Heike; Gany, Francesca
2004 Sep;10 Spec No(49):SP20-SP28, American journal of managed care
We examined the relationship between cross-cultural provider-patient interactions and health outcomes through a literature review. Results were presented in the form of guiding principles to an expert panel of health care administrators, medical practitioners, and medical care providers. This expert panel met at the workshop 'Changing Patient Behavior' during a conference convened by the office of Minority Health, US Department of Health and Human Services, February 17-18, 2000. The panel reviewed the themes and formulated suggestions for program and policy change. Six principles were identified: (1) Physicians should acknowledge that patients may be actively involved in health maintenance long before they seek medical care. (2) Patients should be empowered to be active participants in their medical care. (3) Providers should critically evaluate their own assumptions and underlying values about what constitutes a 'good' patient and consider how these assumptions and values affect their communication strategies. (4) The patient's behavior change in the medical interaction should result from a process of negotiation between provider and patient. (5) The medical system should focus on community empowerment in addition to individual empowerment. (6) Accessible and understandable health outcome data will empower the community to participate in the elimination of health disparities
— id: 46458, year: 2004, vol: 10 Spec No, page: SP20, stat: Journal Article,

Initial behavioral health assessment of Asian Americans. Part 1. Key principles
Chung, Henry; Nguyen, Dustin; Gany, Francesca
2002 Sep;176(4):233-236, Western journal of medicine
— id: 68530, year: 2002, vol: 176, page: 233, stat: Journal Article,

Part 2. Putting principles into practice
Chung, Henry; Nguyen, Dustin; Gany, Francesca
2002 Sep;176(4):236-238, Western journal of medicine
— id: 44871, year: 2002, vol: 176, page: 236, stat: Journal Article,

Working with interpreters: an interactive Web-based learning module
Kalet, Adina; Gany, Francesca; Senter, Lindsay
2002 Sep;77(9):927-927, Academic medicine
OBJECTIVE: Medical students are presented with unique challenges when they care for patients with limited English proficiency. Students must learn a complex set of skills needed to care for patients across cultural and language barriers and to understand the impact of their own attitudes and beliefs about caring for these patients. We developed and piloted a multimedia interactive Web-based module aimed at teaching students effective strategies for working with interpreters and diverse patient populations, and at raising their awareness of important legal, ethical, and cultural issues. DESCRIPTION: First the learner completes a 37-multiple-choice-question (MCQ) pre-test that assesses attitudes, factual knowledge, and ability to analyze written clinical scenarios relevant to the module's content. Learners are then shown a series of professionally produced video vignettes, which reflect diverse patient populations, interpreters, and effectiveness of interpretation strategies (e.g., a Russian-speaking woman with chest pain whose daughter interprets, a medical student interpreting for a Chinese-speaking man using herbal medication, a Haitian woman told of an abnormal mammogram through a trained simultaneous interpreter). In each case, learners submit short answers to on-screen questions analyzing the effectiveness of the interpretation strategies demonstrated. Immediate feedback is given comparing student responses with those of experts. At any time during the module, the learners may view video commentary by legal, ethics, and cultural experts, or access a glossary and Web site links. Students conclude the module by again taking the MCQ test. A final screen compares their pre- and post-MCQ test responses and shows best answers, allowing them to assess their learning. The learners also complete a survey, providing personal cultural information and feedback on the module. DISCUSSION: All 160 first-year medical students completed the module and evaluated its effectiveness this year. On average, students improved by 20% on the MCQ post-test and 86% of the students were satisfied with the learning experience and acquired new knowledge. As a result of their participation in the module, students examined their own cultural and linguistic backgrounds and made the following comments: 'I am interested in exploring the way my own culture and cultural biases could impact my working with patients from other cultures'; 'This module has opened my eyes to the fears and concerns of immigrants who do not speak English.' Therefore, this pilot of the module effectively imparted guidelines for, and raised awareness of, medical interpreting. The most common critique of the module was that as a result of technical difficulties, it was time-consuming. A more rigorous evaluation is planned for the next academic year. We are also working to enrich and enhance the module for more experienced clinicians (GME and CME). As a complementary educational tool, the Internet has the advantages of allowing students to work at their own paces, view engaging video clips, and participate in interactive learning with immediate feedback and self-assessment
— id: 36047, year: 2002, vol: 77, page: 927, stat: Journal Article,

Culture and multicultural competence
Ferran E; Tracy LG; Gany FM; Kramer EJ
Immigrant women's health: problems and solutions San Francisco, CA : Jossey-Bass Publishers., 1999,
— id: 4192, year: 1999, vol: , page: 19, stat: Chapter,

Be a player or be a victim: Description and evaluation of a health policy curriculum for primary care residents
Rein, S B; Reisman, A; Gany, F; Lipkin, M
1999 Apr 29-May 1;14(SUPPL. 2):152-152, Journal of general internal medicine
— id: 15901, year: 1999, vol: 14, page: 152, stat: Journal Article,

Maternal-child immigrant health training: changing knowledge and attitudes to improve health care delivery
Gany F; de Bocanegra HT
1996 Jan;27(1):23-31, Patient education & counseling
This paper reports the development, implementation and evaluation of a training program for all levels of staff of Maternity Infant Care Family Planning Centers in New York City. The learner-centered training is designed to enhance cross-cultural sensitivity and communication skills. It provides epidemiological and patient management skills for serving ethnically diverse populations and focuses on skills training, such as the cross-linguistic, cross-cultural interview, and using epidemiological principles in diagnosis and treatment. In addition to the core curriculum, each module is tailored to the site-specific information needs of the participants, as determined during individualized needs assessments. There are five sessions: the cross-cultural medical interview and working with interpreters; epidemiologic issues; attitudes and practices in maternal child health; family dynamics and interactions; and a session devoted to follow-up and evaluation. This training has been very successful in enhancing health care providers' sensitivity toward immigrant health issues. Pre- and post-test measurements found statistically significant improvements in the knowledge and attitudes of participants. Patient care has been greatly improved
— id: 12686, year: 1996, vol: 27, page: 23, stat: Journal Article,

Overcoming barriers to improving the health of immigrant women
Gany, F; Thiel de Bocanegra, H
1996 Aug-Oct;51(4):155-160, Journal of the American Medical Womens Association (1972)
Approximately half a million women migrate to the United States annually; more than two-thirds of them of childbearing age. Early entry into the health care system may be the most effective way to ensure positive health at lower costs and to enable ever-shrinking health care resources to be used most effectively. Immigrant women, however, face economic, legal, linguistic, and cultural barriers to health care. Successful programs have been developed to systematically address immigrant women's health care issues, targeting preventive health services and education to diverse communities
— id: 97802, year: 1996, vol: 51, page: 155, stat: Journal Article,

Language barriers in medicine in the United States
Woloshin, S; Bickell, N A; Schwartz, L M; Gany, F; Welch, H G
1995 Mar 1;273(9):724-728, JAMA
— id: 97803, year: 1995, vol: 273, page: 724, stat: Journal Article,

IMMIGRANT HEALTH AND THE EPIDEMIOLOGIC LITERATURE - CLOSING THE GAPS
GANY, F; BOCANEGRA, M; FRUCHTER, R
1993 APR ;41(2):A587-A587, Clinical research
— id: 54308, year: 1993, vol: 41, page: A587, stat: Journal Article,

INTEROBSERVER VARIABILITY IN READING TUBERCULIN SKIN-TESTS AND SUBSEQUENT REFERRAL DECISIONS
SCHWARTZ, MD; GANY, F; HU, HP; LUCK, C; WINFIELD, S
1993 APR ;41(2):A550-A550, Clinical research
— id: 54306, year: 1993, vol: 41, page: A550, stat: Journal Article,

Available epidemiologic data on New York's Latino population: a critical review of the literature
Thiel de Bocanegra H; Gany F; Fruchter R
1993 Fall;3(4):413-426, Ethnicity & disease
The increasing diversity of New York's Latino population creates complex challenges for the health care provider and planner, such as how to plan for divergent health risks, disease patterns, and health behaviors. However, most research on Latinos has been done in the southwestern United States. This paper reviews the epidemiologic data published since 1980 on Latino groups in New York State. The review covers the following areas: maternal and child health, infectious diseases, depression, tobacco and substance use, chronic diseases, neoplasms, and mortality statistics. We compare New York data with studies done in other areas of the United States. We identify serious methodological shortcomings in the epidemiological assessment of New York's Latino population, including (1) imprecise definition of 'Latino,' (2) misclassification, (3) census undercount of minority groups, and (4) lack of data on socioeconomic status. We argue that the epidemiological and cultural diversity of Latino groups demands the inclusion of such variables as place of birth, length of stay, and language preference in research and service statistics. This would facilitate targeted program planning and help to determine environmental, sociopolitical, behavioral, and genetic influences on diseases
— id: 13335, year: 1993, vol: 3, page: 413, stat: Journal Article,

Screening devices for diminished cognitive capacity
Strain, J J; Fulop, G; Lebovits, A; Ginsberg, B; Robinson, M; Stern, A; Charap, P; Gany, F
1988 Jan;10(1):16-23, General hospital psychiatry
This study compares three commonly used tests to detect organic mental disorders: the Mini-Mental State (MMS), Cognitive Capacity Screening Examination (CCSE), and Tachistoscope (T-Scope). Ninety-seven medical-surgical inpatients at the Mount Sinai Hospital referred for psychiatric consultation had a Missouri Mental Status Examination performed by a psychiatrist who also rated the patients' organic mental disorder as 'none,' 'mild,' 'moderate,' or 'severe.' The CCSE, MMS, and T-Scope, respectively, showed: sensitivity--0.54, 0.52, 0.68; specificity--0.85, 0.76, 0.79; and positive predictive value--0.83, 0.74, 0.79. False negatives occurred more often among those patients with mild organic mental disorders with all instruments (p = 0.05), while the T-Scope could not be administered in 27% of the patients. Screening instruments with increased acceptability, sensitivity, and specificity need to be developed to identify a potentially life-threatening disorder
— id: 97804, year: 1988, vol: 10, page: 16, stat: Journal Article,