It has been widely reported that people with mental illness, who come from more traditional cultures have a better outcome than Anglo American patients, but up until now no one knew why. A new study points to levels of hostility and criticism in different cultures, as a determining factor in the prognosis of patients suffering from mental illness, and proposes culturally sensitive therapies to improve their prognosis.

Starting in the 1970s the World Health Organization did a series of studies in different countries around the world and found – counter intuitively – that while the prevalence of the disease was pretty stable worldwide, the course was much more benign in traditional cultures, said Amy Weisman de Mamani, professor at the University of Miami Psychology Department and the study’s principal investigator.

“Since family attitude plays an important role in patient outcome, we looked at what happens within the families in these cultures that may provide a more adaptive course for the illness” Weisman de Mamani said. “While all cultures value family, what is seen as most important in different societies comes thru in the way that family members react towards a relative with mental illness.”

According to the study, criticism and hostility towards a mentally ill relative is significantly higher among Anglo American families, than among Latinos and Asians and more detrimental than for African Americans in the United States.

Family members of a person with mental illness become impatient, when an ill relative fails to live up to culturally desired behaviors and values, the study says. When this occurs, there is a breakdown in communication between family and patient, and the harsh and disapproving attitudes that emerge makes the ill person more vulnerable to the disease.

Since Anglo American cultural values emphasize independence and responsibility, they are much more likely to be critical about a relative not being able to hold a job, or act independently, the study says.

“Among Anglos in the United States, there is this notion that with hard work you can overcome anything. In the context of mental illness, this attitude can lead to more criticism of the individual that, because of the illness, does not act in an independent and productive manner” Weisman de Mamani said.

On the other hand, Latino and Asian families emphasize interdependence and family connectedness. Thus criticism arises less frequently, usually, when family unity and harmony is disrupted.

“We found that Latinos are more likely to criticize patients for not taking a shower, not interacting, or not showing their emotions,” Weisman de Mamani said. “This sense of interconnectedness, may encourage a more supportive environment.”

Interestingly, criticism of the mentally ill among African American families is as frequent as in the Anglo community however, it is not as harmful. What people in other cultural groups may consider criticism may not be perceived as such by African Americans, said Jennifer A. Kymalainen, co-author and post doctoral fellow at the Edith Nourse Rogers Memorial Medical Center, Bedford Massachusetts.

“Black patients do not appear to take criticism from family members as personally,” Kymalainen said “Although communication tends to break down around some of the same issues as other groups, blacks may interpret the criticism as a sign of family concern,”

Weismann de Mamani explained that spiritual values also play a role, so that families that have a belief system to fall back on helps them make sense of the illness in a way that helps them bear the adversity more easily and helps both the patient and the families cope, and they may have more of a buffer and support system in place at church, for example.

The study concludes that understanding cultural patterns for patients with Schizophrenia can predict relapse and stabilization of the affected individual, and suggest that clinicians and researches focus family interventions on specific issues related to the patients’ cultural norms to greatly improve the patients’ outcome.



The West Palm Beach VA Medical Center is proud of our record of accomplishment for 2008, prouder still of the approximately 2,000 employees of the West Palm Beach VA who daily fulfill President Lincoln’s promise to care for veterans and their families, and proudest to have had the opportunity to serve men and women whose dedicated service to our nation in all its wars has enabled generations of Americans to live their lives in freedom. Major accomplishments of the Medical Center for this year include:

  • Helping make a reality the first Internal Medical Residency Program in Palm Beach County.
  • Ranking 14 among 170 VA Medical Centers in the country in performance (access, quality, patient satisfaction).
  • Medical Center Director being selected as the recipient of the 2008 Presidential Rank Award of Meritorious Executive. Less than 5% of Senior Executive Service federal employees receive this award.
  • Exceeding revenue collection goal for FY 2008.
  • Scoring well on Office of General Inspector, Environmental Care and System-wide Ongoing Review Strategy (SOAR) reviews.
  • Expansion of Pain Management, Mental Health, Home Based Primary Care and Mental Health Intensive Case Management programs and securing construction funding for a Cancer Center for 2010 and a Mental Health Outpatient Clinic & Administrative building.
  • Improving Employee Satisfaction scores in every category.
  • Hosting VA Secretary Dr. James B. Peake’s visit to West Palm Beach. Secretary Peake was very complimentary about the WPB VA Medical Center’s work.
  • Providing the bulk of logistical support for the South Florida National Cemetery’s dedication ceremony.
  • Being designated as one of the BEST Workplaces for Commuters by the National Center for Transit Research at the University of South Florida for meeting the National Standard of Excellence for outstanding commuter benefits.


There should certainly be nothing more natural for the Director of Research of the Florida Heart Research Institute to focus on than the editorial topic for this month: heart health. On the other hand, for those of us who spend our days scaling the “trees”, commenting on the “forest”, this can be a daunting task. It is perhaps wisest to divide the topic into two general areas—what can we, the scientific professionals, do to improve heart health, and what can you, the lay public do to improve your own heart health?

Regarding the focus of our research efforts at the Institute, we seek to open vital new areas of exploration that do not have a logical “patron” (such as a drug or device company), nor have they yet reached the “critical mass” necessary to attract NIH or other major support. Bone marrow stem cell mediators, genetic control patterns governing native cardiac stem cells, the role of period acceleration (back and forth motion) in releasing endogenous mediators which prevent inflammation and protect against reperfusion injury, genetic profiling of coronary artery disease, sudden cardiac death and inflammatory cardiomyopathy, exploring the role of diet in altering the molecular mediators of heart disease in obesity, novel use of CT imagining to identify preclinical coronary artery disease—a lot of mumbo jumbo? Maybe … These are a few of the areas in which FHRI is actively creating cross-institutional collaborations and pursuing research. Each of them is an extremely promising area, but each of them will remain a bit of “mumbo jumbo” until we are able to foster their development into areas that have a firm enough scientific footing to join the brave and exciting future of clinical medicine.

Although it may perhaps be reassuring to know that so many people are working so hard to gain greater insight into heart disease and to develop novel and exciting therapies, the fact remains that as we begin 2009 we find that cardiovascular disease is still the leading killer of men and women in this country, and one of the three leading killers of men and women in the world. In the United States alone, approximately 2,500 people succumb each day! And that is despite the 30% drop in mortality we have witnessed over the past two decades! Even more daunting is the epidemic of obesity rampant in our youth and our general population—one which is associated with diabetes, hypertension and heart disease, and one which is on track to overtake cigarette smoking as the leading cause of preventable disease in this country. In short, human behavior is defeating scientific advancement.

Therefore, although it may be somewhat comforting to know that there doctors and scientists out there forever seeking to expand knowledge and increase the opportunities for cure, we all must address the simple issue that cardiovascular disease, as lethal as it may be, is largely preventable. Although there is an increasing panel of measureable parameters—genetic, molecular, biochemical—associated with the incidence of coronary events, it is the classic “modifiable risk factors” defined by the Framingham study so many years ago that remain the core of a wise preventive strategy. Attention to these three risk factors: elevated LDL, smoking, hypertension, in addition to weight (if your waist in inches in more than half your height in inches you are in trouble!), physical activity (30 minutes anaerobic activity 6 times per week would be nice, but the most important thing is to find something that you will actually do, even moderate exercise helps), a diet rich in vegetables, fruits, whole grains, high fiber, healthy fats (canola and olive oil, omega 3’s) and you may never need the help of the scientific brain trust working so hard to try to help save your life. There is no doubt in the mind of even the most sophisticated scientist in the field of cardiovascular research, that the brightest future lies in the area of prevention. To put it another way, you are in the driver’s seat! Happy Heart Month!



Patricia Rowe-King, M.D., FAAP

A native of Kingston, Jamaica, Dr. Patricia Rowe-King relocated to the United States after high school and attended Boston University where she obtained a B.A. in Biology with a minor in Psychology. After graduating Cum Laude from Boston University she went on to the University of Miami School of Medicine and completed her pediatric residency at Jackson Memorial Hospital. Since completing her residency program, Dr. Rowe-King was a private practitioner in Tamarac, FL and has held privileges at Broward Health for the past eighteen years. In addition, she has served as a Pediatric Hospitalist since 1997 and is currently the Assistant Medical Director for the Pediatric Hospitalist Program at the Chris Evert Children’s Hospital at Broward General Medical Center.

Dr. Rowe-King has several passions which include being the current Chair of the Credentialing and Qualifications Committee at Broward General Medical Center and serving as a Physician Committee member on the Statewide Children’s Medical Services Physician Review Committee.

Dr. Rowe-King has a vested interest in the delivery of complex medical care to children with special needs. Beginning in 2003 until 2006, she served as Medical Director of the Children’s Multidisciplinary Assessment Team of Children’s Medical Services for Broward County.

Dr. Rowe-King has committed herself to the development of health care services in underserved rural communities. She has been the Medical Mission Team Director of “Friends Reaching Friends,” a nonprofit organization that conducts mission work in Jamaica and the Dominican Republic. She has led the Medical Mission Team to the Dominican Republic for the past 8 years and has been accompanied by pediatricians, gynecologists, nurse practitioners and on staff nurses from Broward Health. It is in these underserved communities where pediatric clinics are set up and run from homes and area schools.

Dr. Rowe-King is currently the Vice-Chair of the Department of Pediatrics at the Chris Evert Children’s Hospital and has been nominated to become Chair of the department in May of 2009.



One of the hottest topics among medical professionals today is national healthcare reform. And while there have been some policy statements released on the subject, the fact is, no one really knows what to expect. For this reason, the Florida Orthopaedic Society (FOS), along with other state medical and specialty organizations, is working to keep its members up-to-date on all of the information available.

“A great number of people are concerned with the idea of government-directed or government-controlled healthcare reform,” explained Julio Gonzalez, M.D., a member of the FOS Board of Councilors. “There are many different ideas out there about how that can look—whether it’s a universal single payer system, which is the classic idea of universal healthcare, or a multipayer, government-directed system. There aren’t a lot of details available on which way the administration, and the leadership in the House and Senate, want to direct the plan.”

For the past year, Dr. Gonzalez has been heavily involved in the healthcare reform debate. “I was catapulted to a much higher level of debate after reading Call to Action: Healthcare Reform 2009 by Senate Finance Committee Chairman Max Baucus,” he explained. “When I read about the amount of government intervention, manipulation and oversight inherent in the plan, I was appalled. I felt threatened, for myself and for my patients.”

In answer to the Montana senator’s paper, Dr. Gonzalez wrote a book entitled Health Care Reform: The Truth. He also began working with state medical organizations to inform their members, and started a grass-roots group, The Alliance for Responsible Healthcare Reform, to bring more attention to the issues. Through this group, medical professionals from all sectors, including nursing homes, physical therapy groups and hospitals meet with district congressman to voice their concerns.

According to Dr. Gonzalez, there are many factors that need to be addressed in the healthcare reform debate, including the timeline of the reform itself. “I find it appalling and irresponsible that the Legislature wants to come out with a bill by June, and have it ready to go before the president by October 15,” he explained. “By all accounts, they are revamping the way we deliver healthcare in this country in what is essentially a four-month process, without sharing the contents of their bill with the public for discussion and debate.”

While a few policy statements have provided a general overview of the plan, Dr. Gonzalez, and many other medical professionals, are alarmed by the lack of detail on funding, logistics and short- and long-term goals. “I went to Washington, D.C. in April, and met with Republican and Democratic members of Congress,” he explained. “Not only does the public not know what’s in the bill, but even members of both parties are not familiar with what it contains.”

Of specific interest to medical specialty groups are issues dealing with the loss of autonomy for patients in choosing the provider and the type of healthcare they receive, and the concept of bundling payments to a hospital. “A hospital will get reimbursed for all of the care provided to the patient, and then they are responsible for deciding how and to whom they divvy up the payments,” said Dr. Gonzalez. “This is going to cause a lot of politicking between different team member within the patient care delivery system who should be working together.”

The ‘budget neutral’ concept, in which general physicians receive enhanced reimbursements at the expense of specialty physicians, is also a sticking point. “A budget-neutral approach to increasing reimbursement for generalists and primary care at the expense of specialists ignores the fact that there is a universal shortage of physicians, affecting specialists and generalists alike,” said Dr. Gonzalez. “Enhancing reimbursement of one group at the expense of the other will lead to shortages in specialty care like you see in Canada and Europe.”

Dr. Gonzalez is also alarmed by the government’s idea of not allowing physicians to own hospitals, citing conflict-of-interest. “Some of the greatest hospitals in the country—the Mayo Clinic, Cleveland Clinic, New York University Hospital for Specialty Surgery, Venice Regional Medical Center in Florida—were all created by physicians,” he said. “This concept ignores the fact that physician expertise and involvement lead to the creation of top-notch medical centers.”

Until the actual bill comes out, Dr. Gonzalez is working with a number of organizations to raise awareness, and encouraging people to review the bill with thought, an open mind, insight and research. “It is imperative that patients know what’s coming, and determine if this is what they really want,” he said. “I have a feeling that the American patient really doesn’t want to have the government dictate what will happen in the exam room.”