A Note from the Editor

In the heart of the long summer, after a spring full of weather-related calamities world-wide, we turn our thoughts to wellness and the prevention of disease. The present issue has four themes:

• • Wellness and Clinical Care

• • Race. Ethnicity, and Cancer

• • Race, Ethnicity, and Other Conditions

• • Health Policy

Supplementing this issue is a volume guest-edited by Dr. Rueben C. Warren, Director of the National Center for Bioethics in Research and Health Care at Tuskegee University, on faith communities and pandemic flu preparedness (JHCPU 22.3 Suppl). That volume is an outgrowth of a conference sponsored jointly by the Interdenominational Theological Center and the Centers for Disease Control and Prevention in Atlanta.

The regular issue opens with an ACU Column on the role of clinicians in empowering others concerning the built environment, followed by two Commentaries, both proposing new approaches to persistent problems. Sana Loue, of Case Western Reserve University, explores the Islamic construction of jihad as a possible tool in the fight against the spread of HIV/AIDS, offering a scholarly exploration of the construct's religious and pragmatic facets. Luke Shaefer and Matthew Miller from the University of Michigan discuss pros and cons of expanding access to oral health care by establishing mid-level dental practitioners more widely in the U.S. The authors explain, "Mid-level dental providers [MDPs] are generally permitted to perform basic preventive and basic restorative dental procedures under the direct, indirect, or general (depending on the model) supervision of a dentist, with the goal of extending access to care to underserved populations. The ability to provide basic restorative care such as fillings and simple extractions is the main feature differentiating MDPs from programs in some states that allow dental hygienists to provide dental hygiene and preventive care outside of a dental office or clinic. Mid-level dental providers now practice in a variety of capacities in more than 50 countries, including Great Britain, New Zealand, Australia, and Canada. Alaska and Minnesota are the only two U.S. states that have approved MDP providers, but policymakers in a number of other states are seriously considering such proposals." The Brief Communication by Carlos Quiñonez and colleagues from the University of Toronto on expanding dental coverage for low-income populations (in Part 4) complements this Commentary nicely.

Part 1: Wellness and Clinical Care

Part 1 opens with a Report from the Field by Monica Avillar and colleagues from the University of Texas Health Science Center at San Antonio on developing and sustaining community health workers, who have become crucial contributors to care in many facilities serving low-income and other underserved populations. Recommendations include establishing training standards, evaluating the financial benefits of employing community health workers, strategizing Medicaid reimbursement, and creating support networks. The Original Paper by Judith Savageau and colleagues on recruiting and retaining primary care physicians in Massachusetts community health centers complements the paper by Avillar et al.

Next, a Brief Communication by a team of psychiatrists from the Federal Neuropsychiatric Hospital in Enugu State, Nigeria, led by Dr. Muideen O. Bakare, reports on neuropsychiatric diagnoses and psychotropic medication prescription in their child and adolescent program. The work provides important baseline data for the region.

Three of the remaining Original Papers in Part 1 concern social and interactive elements in well-being and clinical care. Shoshana Bardach and colleagues from the University of Kentucky explore how vulnerable rural residents manage multiple comorbidities and what types of support they find most helpful. Felicia Hodge and Karabi Nandy from the UCLA School of Nursing report on their survey of 457 American Indian adults who receive care at one of 13 rural health care sites in California. The focus of their research is wellness, both how it is understood by the respondents, especially how it is shaped by cultural connectivity, and also how it is affected by adverse childhood events. The authors recommend culturally-tailored education and interventions. Vanessa Watts Simonds, of the Robert Wood Johnson Center for Health Policy at the University of New Mexico, and colleagues report on their exploration of patient-provider interactions in a rural...