Anthropological research on health-related behaviors in the United States has tended to emphasize folk illnesses among particular subcultural groups, obscuring the heterogeneity of popular culture health beliefs and practices in the lay health system. The development of theoretical models for this complex society will require research that stresses similarity as well as diversity within and between population groups. The health seeking process is proposed in this paper as a means to document natural histories of illness in any subculture. Concepts from medical anthropology and medical sociology are related to five components of health seeking -- symptom definition, illness-related shifts in role behavior, lay consultation and referral, treatment actions, and adherence. Illustrative propositions to guide further research are proposed.

In the process of initiating a new community-based research project, the authors wanted to understand the experiences of community members and researchers in community-based research projects and to develop guidelines to improve future projects. They conducted qualitative, key informant interviews with 41 people involved at all levels of community-based research projects in Seattle. Respondents were identified using a snowball sampling technique. More problems than successes were discussed by informants, including dissatisfaction with the focus of research, which some said is marked by a lack of cultural appropriateness and relevance. Power imbalances, lack of trust, and communication difficulties impeded collaboration. According to respondents, many problems could be avoided if the community were involved from the beginning in setting research priorities and developing and implementing interventions. Meaningful collaboration between communities and researchers is characterized by early involvement of communities, power sharing, mutual respect, community benefit, and cultural sensitivity.

Active collaboration between communities and researchers is critical to developing appropriate public health research strategies that address community concerns. To capture the perspectives of inner-city Seattle communities about issues in community-researcher partnerships, Seattle Partners for Healthy Communities conducted interviews with community members from the ethnically diverse neighborhoods of Central and Southeast Seattle. The results suggest that effective community-researcher collaborations require a paradigm shift from traditional practices to an approach that involves: acknowledging community contributions, recruiting and training minority people to participate in research teams, improving communication, sharing power, and valuing respect and diversity.

Work on cultural competence has a long history in nursing, yet we have not successfully institutionalized these attitudes and skills throughout education and practice. An effective approach to promoting widespread cultural competence is to work at the system level in which coalitions of community agencies partner with academic and health care organizations. A systems approach includes all health practitioners, reducing current discrepancies across disciplines, and establishes cultural competence as the standard. Work in and with communities places students and practitioners more consistently in cross-cultural circumstances. Implementing this vision will require national as well as local leadership across public and private sectors.

In aortic stenosis (AS), left ventricular (LV) adaptation to exercise has poorly been examined. Changes in LV ejection fraction may lack accuracy in identifying the presence of intrinsic myocardial impairment. AimsWe sought to determine the impact of aortic stenosis (AS) on left ventricular (LV) longitudinal function at exercise in a series of asymptomatic patients with AS and preserved LV ejection fraction. Methods and resultsLong-axis function was assessed at rest and at exercise by using 2D speckle tracking of myocardial deformation in 207 AS patients (aortic valve area 0.87 + 0.19 cm 2 ) and 43 aged-matched control subjects. When compared with control subjects, patients with AS have reduced longitudinal myocardial function at rest (220.2 + 2.7 vs. 215.4 + 4.0%) and at peak exercise (225.0 + 3.7 vs. 216.5 + 4.9%) (P , 0.0001 for both). Exercise changes in global longitudinal strain were correlated with changes in LV ejection in controls but not in patients with AS. Changes in LV global longitudinal strain during test were lower in AS patients with an abnormal response to exercise (20.5 + 2.7 vs. 21.5 + 2.8%, P ¼ 0.001). In multivariate analysis, a lower global longitudinal strain at rest (P ¼ 0.04), a higher increase in mean trans-valvular pressure gradient (P , 0.001) at exercise, and smaller exercise-induced changes in global longitudinal strain (P , 0.001) were associated with an abnormal exercise test. ConclusionIn AS, subnormal LV function can be reliably identified by 2D strain imaging at rest and during a sub-maximal exercise. That sensitive measure of LV systolic function is depressed in AS and even more in patients having the most severe AS. --- KeywordsAortic valve stenosis † Exercise echocardiography † Strain † Left ventricle * Corresponding author. Tel: +33 2 99 28 25 25; fax: +33 2 99 28 25 11,