Neutropenia in 6 ethnic groups from the Caribbean and the U.S.

BACKGROUND: Low white blood cell counts (WBC) or absolute neutrophil counts (ANC) may delay or prevent the completion of appropriate chemotherapy, especially among women receiving adjuvant therapy for breast and colon cancer, and affect cancer survival. Because race/ethnicity is also associated with survival, the authors compared WBC and ANC in healthy American-born women of African descent and European descent, and women from Barbados/Trinidad-Tobago, the Dominican Republic, Haiti, and Jamaica. METHODS: Blood samples from 261 healthy women ages 20 to 70 years were tested for WBC with differential, cytokine and growth factor levels, and ancestry informative and neutrophil elastase polymorphisms. The authors analyzed the association between neutropenia and serum WBC growth factor levels, cytokine levels, and neutrophil elastase c199a polymorphism. RESULTS: The median WBC and ANC differed among the 6 groups (P < .01 for WBC and P < .0001 for ANC). Dominicans were found to have higher median WBC and ANC than all other groups (P < .03). Neutropenia (ANC < 1500 cu/mm) was observed among 2.7% to 12.5% of the groups of predominantly African descent; no other groups were found to have neutropenia (P < .05). Granulocyte-colony-stimulating factor was found to be lower in white women, but tumor necrosis factor-alpha and C-reactive protein were not found to be correlated with ethnicity. Women of African origin were more likely to have polymorphisms of African ancestry (P < .001) and c199a alleles (P < .0001), which were also associated with low ANC levels. CONCLUSIONS: In the current study, the authors observed a strong association between neutropenia and African descent among asymptomatic women from the U.S. and the Caribbean. Among women of African descent who develop a malignancy, this association may contribute to racial disparities in treatment and outcomes.

Periodontal pathogen-specicfic antibodies predict birth weight [abstract]

OBJECTIVE: This study evaluated the relationship between periodontal disease and low birth weight (LBW) in a predominantly black population. METHODS: Using the nested case-control design, we evaluated the periodontal pathogen specific maternal serum IgG levels during pregnancy in relation to birth weight, while controlling for the known risk factors for LBW. RESULTS: There was a significant negative correlation (r= -0.37; p= 0.004) between the birth rate of the infant and Porphyromonas gingivalis (Pg) specific maternal serum IgG levels (LBW group - mean/SE 14.73ñ4.67 ug/ml; p= 0.003). Regression analysis indicated that one unit increase of IgG against Pg in the mother resulted in 5.07g decrease in the birth weight of the infant (p=0.005). CONCLUSION: Our ability to demonstrate a significant difference in the serum IgG levels, against at least one periodontal pathogen (Pg) lends further credibility to the biologic plausibility of the association between poor periodontal health and LBW, and the temporal sequence of this association. (AU)

Obesity in a cohort of black Jamaican children as estimated by body mass index (BMI) and other indices of adiposity [abstract]

OBJECTIVE: To examine the relationships of Body Mass Index (BMI) to obesity indices derived from anthropometry and to determine tracking of obesity between late childhood and early adolescence. We also compared identification of over-weight children using the International Obesity Task Force (IOTF) BMI cut points with skinfolds. METHODS: Three hundred and six children were examined at 7-8 years and at 11-12 years. Triceps (TSF) and subscapular (SSF) skin folds, height, and weight were measured. The sum of the skinfolds (sum SF), BMI, and fat mass (FM) were calculated. Pubertal stage was assessed at 11-12 years. RESULTS: At age 7-8 years, 11 children were overweight compared with 29 at 11-12 years. BMI was better correlated with the other indices of adiposity in girls than in boys and in the older age group than in the 7-8-year-olds. In regression analysis, BMI predicted FM best and explained 52 percent and 61 percent of the variance in FM among boys and girls at 7-8 years. Using the IOTF cut points, BMI had low sensitivity to identify children >85th percentile of the NHANES references for SSF. The sensitivity for those assessed by TSF and sum SF was higher but between 14 percent and 30 percent of the children were misclassified. The specificity of BMI was high. CONCLUSION: Adiposity increased between mid-childhood and early adolescence but the children remained realtively lean. Girls were fatter than boys, reflecting adult obesity patterns. Children identified as overweight by the IOTF BMI cut points are likley to have high body fatness. However, the concern would be that the BMI cut points may not identify many children with high body fatness. (AU)

Outcome of first contact schizophrenia in Jamaica

Several previous studies have identified high incidence rates, high relapse rates and poor short term outcome for schizophrenia in African-Caribbeans in the United Kingdom (UK). Studies in the Caribbean have found the incidence of schizophrenia to be within worldwide levels, and one-year outcome to be much lower than that reported for African Caribbean patients in the UK. First contact patients with schizophrenia identified prospectively by the Present Status Examination were followed prospectively for one year. The main outcome measures which were collected from case notes included: clinical status and medication usage at contact with clinical service, employment status, outpatient clinic compliance, relapse rate and in-patient hospital status, after 12 months. Three hundred and seventeen patients between ages 15 and 55 years who had made first contact with the psychiatric service in Jamaica in 1992 received a computer diagnostic programme for the present status examination (CATEGO) diagnosis of schizophrenia. The majority 197 (62 percent) were treated at home, and 120 (38 percent) were admitted to hospital for treatment. Two hundred and sixty four (83 percent) were still being seen after one year. The relapse rate was 13 percent (41 patients), higher for admissions (24, 20 percent) than for those treated at home (17, 9 percent; p<0.001). The relapse rate was higher for patients brought into care by the police and mental health officers (p<0.005). One hundred and thirty five (43 percent) were in gainful employment within the 12 month period of follow up, contrasted with the 40 percent unemployment rate for the 2.4 million population of the island (chi square = 39.322, p<0.001). There was a self-reported use of medication in 213 (67 percent) patients, with 142 (45 percent) on monthly intramuscular depot medication. The low relapse rates and good outcome measures after 12 months of first srevice contact with schizophrenia are related to high levels of gainful employment and good intramuscular medication compliance. The favourable short term outcome in Jamaica does not correspond to the high relapse rate for this condition found in African Caribbeans in the UK. (AU)

Incidence of open-angle glaucoma and blood pressure [abstract]

PURPOSE: The relationship of open-angle glaucoma (OAG) to blood pressure (BP) is uncertain, with inconsistent result reported. clarification is needed because vascular factor may influence OAG incidence, but only OAG prevalence between data has been available. In addition, few analyses have accounted for the correlation between BP and intraocular pressure (IOP), or for the effects of antihypertensive treatment (AHT) and IOP-lowering treatment. We describe the role of BP as a risk factor for the 4-year incidence of OAG in Barbados Incidence of Eye Disease (BISED) participants of African descent, while controlling for relevant variables. METHODS: BISED re-examined 3,427 or 85 percent of eligible members of a population-based cohort, 4 years after baseline. The protocol included two BP measurements (random zero sphygmomanometer). Applanation tonometry, Humphrey perimetry; stereo disc photos (graded at the Reading Center); an interview and an ophthalmological examination. OAG criteria required visual field and disc damage, with opthalmological confirmation. The results are reported as ajusted relative risks (RR) from logistic regression analyses. RESULTS: The 4-year OAG incidence was 2.2 percent (n=67.2989 at risk). While the RR increased markedly with IOP, it tended to decrease with systolic BP. The RR for SBP 140 mmHg at baseline, with or without AHT, was 0.5(95 percent Confidence Interval; w/AHT = 0.23, 1.08; w/o AHT = 0.26, 1.03). Hypertension (BP>140/90 mmHg or AHT) reduced OAG risk (RR = 0.48 (0.28, 0.82)). Consistent results were found evaluating perfusion pressure (PP), as persons with lower PP were at higher risk of OAG (RR:SPP<101 mmHg=2.6 (1.3,4.9); DPP<55 mmHg=3.2 (1.6, 6.6): mean PP<42=3.1 (1.6, 6.0). Results were similar when stratifying by age or IOP. CONCLUSION: The 4-year risk of OAG in the cohort was decreased by one-half in those with hypertension at baseline. Risk tended to decreased as SBP increased. Persons with lower SPP, DPP or mean PP had 2-3 times increased OAG risk. Results may have implications for OAG pathogenesis and assessment of risk. (AU)

Corneal thickness and intraocular pressure [abstract]

PURPOSE: To describe the relationship between corneal thickness and Intraocular Pressure (IOP) in a predominantly black population. METHODS: BISED II conducted a 9 year follow up of a population based cohort. The protocol involved an interview and comprehensive ophthalmologic examination including Applanation Tonometry and Pachymetry (KMI ultrasound RK500 pachymeter). RESULTS: Among the participants with pachymetry (n = 616; 1223 eyes) mean age was 63.4 years and 60 percent were female. Most individuals were of African descent (n = 582), with smaller subgroups of mixed (African and Caucasian, n=13) and Caucasian/others (n=21). The IOP was highest among those of African descent (mean= SD; 16.7= 3.8 mmHg) followed by those with mixed (15.5= 3.5 mmHg) and Caucasian/other ancestry (14.7= 3.1 mm Hg). However, the participants of African descent tended to have lower values of corneal thickness (mean= SD; 529.7= 37.0 um) than the mixed (533.6+29.8 um) and Caucasian/other participants (542.2= 43.5 um) respectively. Although sample size was small, significant correlations between corneal thickness and IOP were noted among Caucasian participants (r=-0.36,p=0.03), but no correlations were found for participants of African descent or of mixed ancestry. CONCLUSIONS: Individuals of African descent tend to have thinner cornea than Caucasian participants. Corneal thickness and IOP were positively correlated in Caucasians, but not mixed race participants or those of African descent. (AU)

The black eye

PURPOSE: The paper highlights the differences in appearance of the normal and diseased states and frequency and nature of disease processes as they occur in the eye of persons of African descent compared with the Caucasian. METHODS: The observations of an opthalmologist who has practised in a racially mixed population, but predominantly among individuals of African descent for over 20 years, have been catalogued and compared with his experience in a predominantly Cacucasian community. Photographic images of these differences are presented. RESULTS AND CONCLUSIONS: Significant differences in both the normal apperance and clinical features of important ocular diseases occur between patients of predominantly African origin and Caucasians. It is important that ophthalmologists practicising among these racial groups be aware of the differences.(AU)

Positive predictive value (PPV) of prostate specific antigen (> ng/ml) and abnormal digital rectal exam for prostate cancer on the Caribbean island of Tobago

OBJECTIVE: To establish and compare the positive predictive values (PPV) for elevated (4 ng/ml) prostate specific antigen (PSA) and abnormal digital rectal exam (DRE) in an Afro-Caribbean population. DESIGN AND METHODS: We screened 728 men aged 40-79 years, recruited from the general population on the Caribbean island of Tobago. Ninety-five percent reported African ancestry. This population had not previously undergone screening for prostate cancer. RESULTS: PSA was elevated (> or = 4 ng/ml) and/or DRE was abnormal in 291 (40 percent) men. Pathological diagnosis of random sextant biopsies was completed in 191 (66 percent) of men. Ninety-two (13 percent) of the screened men were diagnosed with prostate cancer. Among men biopsied for abnormal DRE in the presence of normal PSA, PPV for abnormal DRE was 26 percent (11/43), range 9-50 percent across age groups. Among men with elevated PSA and normal DRE, the PPV for PSA was 46 percent (29/63), range 42-54 percent (no men aged 40-49 years (n=105) fell into this category). When all men with elevated PSA were considered, ignoring DRE status, PPV for PSA was 55 percent (79/144), range 50-60 percent. If both PSA and DRE were abnormal, the PPV was 63 percent. CONCLUSIONS: The PPV of abnormal DRE was similar to that observed in other populations undergoing screening for the first time. We speculate that a lower PSA cut-off point may be appropriate for optima ascertainment of cases in this high-risk population.(Au)

Suicide and homicide in Caribbean nations

The suicide and homicide rates of 14 Caribbean islands in the 1970s were predicted in part by the proportion of the population of African descent.(Au)

Low birth weight: race and maternal nativity - impact of community income

BACKGROUND: The purpose of this article is to determine the effect of community income as a co-factor in the association of low birth weight, race, and maternal nativity in New York City. METHODS: New York City birth records, 1988 through 1994, provided data on maternal and infant characteristics. There were 274,121 white and 279,826 black mothers included in this study. Black mothers were classified as US-born (South and Northeast) and foreign-born (the Caribbean, South America, and Africa). Based on the 1990 US census income data, census tracts of the city were aggregated by tertile of per capita income as low-, middle-, and high-income communities. Incidence of low birth weight was estimated by race, maternal nativity in the city as a whole, and each income community. RESULTS: Overall, black women had a substantially higher risk of low birth weight infants (<2500 g) than did whites (13.1 percent vs 4.8 percent). Foreign-born black mothers had a birth weight advantage over US-born black mothers (10.0 percent vs 16.7 percent). After controlling for socioeconomic and medical characteristics, the risks of low birth weight for blacks compared with whites were 0.95 (95 percent confidence interval: 0.86-1.03) and 0.86 (0.69-1.02) for Caribbean- and African-born black mothers, respectively. Moreover, in low-income communities, compared with white mothers, the risks for Caribbean- and African-born black mothers were 0.88 (0.79-0.97) and 0.77 (0.61-0.96), respectively. By contrast, US and South American-born black mothers had a consistently higher risk of low birth weight infants, regardless of community income level. CONCLUSION: Low birth weight was significantly less frequent among whites than among blacks. However, this overall finding masked substantial variation among blacks, determined by maternal nativity and the income level of the community in which they lived. In fact, Caribbean- and African-born black mothers had birth outcomes generally similar to and, in poor communities, even more favorable than those for whites.(Au)

Prevalence of diabetes and impaired glucose tolerance in Nigerians, Jamaicans and US blacks

The prevalence of type 2 diabetes, impaired glucose tolerance and associated risk factors were compared in sample surveys in Africa and the Caribbean with the Third National Health and Nutrition Survey (NHANES-III) from the United States. A total of 856 Nigerians, 1286 Jamaicans, and 1827 US blacks were included in the study. Body mass index (BMI) increased in a stepwise fashion across the three population groups, ie, 23 kg/m2 in Nigerians, 26 kg/m2 in Jamaicans, and 28 kg/m2 in US blacks. The persons aged 25-74, were 1 percent, 12 percent, 13 percent. Jamaican women were found to have the same prevalence of type 2 diabetes as US women (14 vs 13 percent, respectively); mean BMI was likewise very similar (28 kg/m2 in Jamaican and 29 kg/m2 in US women). BMI and waist-to-hip ratio were both associated with type 2 diabetes prevalence. Findings of this study confirm the marked gradient in type 2 diabetes risk among these genetically related populations and suggest that the blacks in the island nations of the Caribbean and the United States are at particularly high risk. Nigerians exhibited remarkably well-preserved glucose tolerance. Understanding the factors that limit the risk of type 2 diabetes in West Africa, beyond relative absence of obesity, would have considerable public health significance.(Au)

Estimating African American admixture proportions by use of population-specific alleles

We analyzed the European genetic contribution to 10 populations of Africans descent in the United States (Maywood, Illinois; Detroit; New York; Philadelphia; Pittsburgh; Baltimore; Charleston, South Carolina; New Orleans; and Houston) and in Jamaica, using nine autosomal DNA markers. These markers either are population-specific or show frequency differences >45 percent between the parental populations and are thus especially informative for admixture. European genetic ancestry ranged from 6.8 percent (Jamaica) to 22.5 percent (New Orleans). The unique utility of these markers is reflected in the low variance associated with these admixture estimates (SEM 1.3 percent -2.7 percent). We also estimated the male and female European contribution to African Americans. on the basis of informative mtDNA (haplogroups H and L) and Y Alu polymorphic markers. Results indicate a sex-biased gene flow from Europeans, the male contribution being substantially greater that the female contribution. mtDNA haplogroups analysis shows no evidence of a significant maternal Amerindian contribution to any of the 10 populations. We detected significant nonrandom association between two markers located 22 cM apart (FY-null and AT3), most likely due to admixture linkage disequilibrium created in the interbreeding of the two parental populations. The strength of this association and the substantial genetic distance between FY and AT3 emphasize the importance of admixed populations as a useful resources for mapping traits with different prevalence in two parental populations (AU)

Social environment and substance misuse: a study of ethnic variations among inner London adolescents

OBJECTIVES: To explore ethnic variations in drug, tobacco and alcohol use and their correlation with other factors which operate through peer, familial and religious influences. DESIGN: Semi-structured interviews with 132 12-13-year-old young people from four ethnic groups attending secondary schools in two inner London boroughs and a follow-up interview completed approximately 17 months later. RESULTS: The data was analysed using chi-square and McNemar tests. Familial, religious and peer influence closely correlated with ethnicity. Bangladeshi young people showed lower levels of peer and higher levels of religious and familial involvement and lower levels of substance use. White young people reported higher levels of peer, lower levels of religious and familial involvement, and a higher level of substance use. Black African and Black Caribbean young people lay between the two extremes. CONCLUSION: The findings suggest that young people with lower levels of familial and religious influence, or higher levels of peer influence, have higher levels of substance consumption than other young people. Health education initiatives need to promote personal decision-making skills within the context of the young people's individual culture. Cultural diversity should be recognised within local health education needs assessment.(Au)

Migration and prostate cancer: an international perspective

There are intra- and interracial differences in prostrate cancer incidence and mortality rates worldwide. The environment and migration patterns seem to influence the disparities in cancer statistics. The lowest incidence rate is recorded in Chinese, followed by other Asians, South Americans, southern Europeans, and northern Europeans, in ascending order. However, people of African descent have the highest incidence so far. Until recently, African Americans in Alameda County (California) in the United States had the highest reported incidence (160/1000,000). An incidence of 314/100,000 recently was reported in African Caribbeans from Jamaica. These high rates contrast with the low incidence rates reported in continental (Sub-Saharan) Africa. Angwafo et al have reported higher age-adjusted incidence rates in Yaounde, Cameroon (93.8/100,000). They highlighted the importance of diagnostic techniques and trained manpower, and adjustments for the age distribution of populations when comparing incidence rates between regions. The great disparity in cancer statistics over large geographic areas and races has oriented studies toward genes and gene products susceptible to environmental risk factors such as diet, ultraviolet rays, and cadmium, which may be associated with or causative of prostate cancer. Randomized studies on suspected risk factors and promoters of prostrate cancer need to be conducted worldwide. However, caution is in order when inferences are made comparing populations with access to health care to those without. (Au)

Association of waist circumference with risk of hypertension and type 2 diabetes in Nigerians, Jamaicans, and African-Americans

OBJECTIVE: Prior studies have supported that waist circumference correlates better with visceral adipose tissue and is a better predictor of cardiovascular disease than are BMI and waist-to-hip ratio. In this study, we reexamine the role of waist size on the risk of hypertension and type 2 diabetes in African-origin populations from three contrasting environments. RESEARCH DESIGN AND METHODS: A cross-sectional survey was conducted of 5,042 men and women 25-74 years of age from Nigeria, Jamaica, and the U.S. The relationship between waist, blood pressure, and fasting blood glucose was assessed using multiple linear regression analyses. Logistic regression analyses using sex-specific empirical waist cut-points were used to determine the risks of hypertension and type 2 diabetes. RESULTS: Waist circumference was positively correlated with blood pressure and fasting blood glucose (P < 0.05). Increasing waist quartiles were significantly associated with higher risks of hypertension in the three populations, as estimated from age-adjusted odds ratios obtained from sex-specific logistic regression models. A highly elevated risk of type 2 diabetes-10-fold for Jamaican men and 23-fold for African-American women - was observed in the comparison of lowest to highest quartiles of waist circumference. CONCLUSIONS: Substantial reduction in hypertension and diabetes in men and women is achievable if the waist size is decreased in these populations. Intervention programs designed to reduce waist circumference through lifestyle modification, including exercise and diet, may have significant public health significance in reducing the incidence of hypertension and adult-onset diabetes in these populations (Au)

Nutrient intakes among UK African-Caribbeans: changing risk of coronary heart disease [letter]

Present findings in a food-frequency questionnaire (FFQ) given to Caribbean-born people of African descent, to try and determine why this section of the population has lower rates of coronary heart disease (COD). Findings; statistics; Greater consumption of fruits and vegetables found in the people who answered the FFQ.(AU)

Acne in black women

Although acne is rampant in young black women, many of them do not really understand the nature of the disease and what treatment is available. Common as acne is, there is no easily understood book available to black people, hence the need for this publication. In Acne in Black Women, in plain simple language, I address concerns such as cosmetics, and newer treatments for acne such as peels, facials and laser treatments. I discuss how to use certain medicines to get the most benefit from them. How certain drugs work on acne and how long a patient should be kept on the drug is also addressed. We also take a look at the patient's general health in the management of acne... This book contains information for all black people who have acne or who have relatives who suffer from this disease. You will find advice on how to prevent acne, and how to treat it. This book is not meant to replace a visit to your dermatologist. In most cases he/she alone has the experience to treat your acne, and to combine different medications, so that you can get the best results from them (AU)