RESUMO
BACKGROUND: Plasma proenkephalin A (PENK-A) is a precursor of active enkephalins. Higher blood concentrations have been associated with estimated glomerular filtration rate (eGFR) decline in European populations. Due to the significant disparity in incident chronic kidney disease (CKD) between White and Black people, we evaluated the association of PENK-A with incident CKD and other kidney outcomes among a biracial cohort in the U.S. METHODS: In a nested cohort of 4,400 participants among the REasons for Geographic And Racial Differences in Stroke, we determined the association between baseline PENK-A concentration and incident CKD using the creatinine-cystatin C CKD-EPI 2021 equation without race coefficient, significant eGFR decline, and incident albuminuria between baseline and a follow-up visit 9.4 years later. We tested for race and sex interactions. We used inverse probability sampling weights to account for the sampling design. RESULTS: At baseline, mean (SD) age was 64 (8) years, 49% were women, and 52% were Black participants. 8.5% developed CKD, 21% experienced ≥ 30% decline in eGFR and 18% developed albuminuria. There was no association between PENK-A and incident CKD and no difference by race or sex. However, higher PENK-A was associated with increased odds of progressive eGFR decline (OR: 1.12; 95% CI 1.00, 1.25). Higher PENK-A concentration was strongly associated with incident albuminuria among patients without diabetes mellitus (OR: 1.29; 95% CI 1.09, 1.53). CONCLUSION: While PENK-A was not associated with incident CKD, its associations with progression of CKD and incident albuminuria, among patients without diabetes, suggest that it might be a useful tool in the evaluation of kidney disease among White and Black patients.
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Precursores de Proteínas , Insuficiência Renal Crônica , Acidente Vascular Cerebral , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Albuminúria/epidemiologia , Fatores Raciais , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Acidente Vascular Cerebral/epidemiologia , EncefalinasRESUMO
BACKGROUND: Mounting evidence is revealing disparities in cognitive function and heightened dementia risk among refugees, yet research in this area remains scant. Despite bearing most of the world's refugee burden, limited-resource countries like Jordan are facing challenges when dealing with refugee health. There is a lack of research on the attitudes toward dementia and the cognitive healthcare gaps among refugees in Jordan. METHODS: 32 older (≥ 55 years) Syrian refugees resettled in Jordan were recruited through a local community-based organization and interviewed in four focus groups (2 female and 2 male groups). Interviews were transcribed and translated, then coded using inductive thematic analysis. RESULTS: Mean age of the sample was 60.1 years and 53.1% were female. Only 34.4% rated their memory as good or excellent. Themes were organized using the socioecological model: 1) At the individual level, participants believed high levels of stress, including low socioeconomic status, poor health, and traumatic history from their refugee experience increased their dementia risk. 2) Interpersonally, there is a fear of dementia due to the possible impact and burden on loved ones, particularly with the stigma surrounding dementia. 3) At the community level, participants noted that resettlement in Jordan - with a shared language, religion, and culture - offered protective effects due to facilitated access to social connection, information, and mental health self-care. 4) At the institution and policy level, participants believed older refugees faced restrictive policies for economic aid, healthcare, and employment, presenting a significant barrier to healthy aging. CONCLUSIONS: Findings from this study are the first to examine the attitudes of Syrian refugees in Jordan toward dementia and cognitive aging. These results could provide essential data inclusive of refugees as Jordan develops its National Dementia Plan. Investing in dementia awareness interventions and age-friendly neighborhoods may benefit aging refugees in limited-resources settings.
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Envelhecimento Cognitivo , Demência , Refugiados , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Refugiados/psicologia , Jordânia/epidemiologia , Síria , Demência/epidemiologiaRESUMO
IMPORTANCE: Only a limited amount of research has investigated the impact of prolonged refugee status of Palestinian refugees who have been displaced for more than 70 yr. OBJECTIVE: To explore lived experiences of Palestinian refugees in Jordan and understand their occupational disruption. DESIGN: Thematic analysis guided by descriptive phenomenology with one-on-one and group interviews. SETTING: An AlBaqa'a community-based rehabilitation center or participants' homes. PARTICIPANTS: First-generation Palestinian refugees who fled Palestine and live in Jordan. RESULTS: Fifteen Palestinians, mainly widowed women in their 70s, participated in this study. Ten completed interviews, and five participated in two group interviews. Four themes emerged: (1) Palestinian pride, (2) trauma leaving one's home country, (3) challenges of living in a host country, and (4) internalized prejudice. CONCLUSIONS AND RELEVANCE: After 70 yr, prolonged refugeeism has led to occupational disruption and negative implications for occupational justice, especially in the absence of social justice. The area most negatively affected was social participation; however, participants still had a great sense of pride about their homeland and their heritage. What This Article Adds: This foundational research explores the occupational injustices of the protracted refugee status of first-generation Palestinians in Jordan and identifies meaningful interventions to promote the alleviation of occupational disruption.
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Refugiados , Humanos , Feminino , Jordânia , Árabes , Justiça Social , EmoçõesRESUMO
This qualitative study, conducted in Meru and Kajiado counties in Kenya, explored the perceptions and attitudes of men and women regarding male involvement in FGM in order to inform the design of male involvement strategies in FGM abandonment. We used focus group discussions to collect the data which was then subjected to thematic analysis. Three main themes emerged from the data: i) culture and the role of men; ii) perceived awareness and knowledge of FGM among men, and iii) credible and customised education and engagement. The study found widespread agreement on the importance of male involvement in FGM abandonment. Culture played an important role in determining the extent of involvement, or lack thereof. We conclude that while culture needs to be respected it ought to be challenged to avoid the continued harm to girls. The potential of men as a collective to bring about change was evident, and policy makers and NGOs should utilise the power of male collectives to support efforts to abandon FGM.
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Circuncisão Feminina , Humanos , Masculino , Feminino , Quênia , Grupos Focais , Pesquisa Qualitativa , Conhecimentos, Atitudes e Prática em SaúdeRESUMO
RATIONALE & OBJECTIVE: The associations of the glomerular markers of kidney disease, estimated glomerular filtration rate (eGFR) and albuminuria, with frailty and cognition are well established. However, the relationship of kidney tubule injury and dysfunction with frailty and cognition is unknown. STUDY DESIGN: Observational cross-sectional study. SETTING & PARTICIPANTS: 2,253 participants with eGFR<60mL/min/1.73m2 in the Systolic Blood Pressure Intervention Trial (SPRINT). EXPOSURE: Eight urine biomarkers: interleukin 18 (IL-18), kidney injury molecule 1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), chitinase-3-like protein 1 (YKL-40), monocyte chemoattractant protein 1 (MCP-1), α1-microglobulin (A1M), ß2-microglobulin (B2M), and uromodulin (Umod). OUTCOME: Frailty was measured using a previously validated frailty index (FI), categorized as fit (FI≤0.10), less fit (0.10
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Pressão Sanguínea/fisiologia , Cognição/fisiologia , Fragilidade/urina , Túbulos Renais/lesões , Túbulos Renais/metabolismo , Insuficiência Renal Crônica/urina , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/urina , Quimiocina CCL2/urina , Estudos Transversais , Feminino , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Taxa de Filtração Glomerular/fisiologia , Receptor Celular 1 do Vírus da Hepatite A/metabolismo , Humanos , Túbulos Renais/patologia , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologiaRESUMO
Methamphetamine use, sexual relationship power (SRP), and partner violence (PV) are associated with increased risk of sexually transmitted infections (STIs) among women. The objective of our study was to examine the association of recent PV and SRP on STIs by partner type among HIV-negative, heterosexual women who use methamphetamine in San Diego, CA. Using baseline survey data from 209 women enrolled in FASTLANE II, an HIV behavioral intervention trial, we conducted logistic regression analyses to examine associations between PV, SRP, and self-reported lifetime STIs (e.g., chlamydia, gonorrhea). Models focused on PV perpetrated within the past 2 months by: (1) spouse, live-in, or steady sexual partners and (2) casual or anonymous sexual partners. Seventy-eight percent of women reported lifetime physical PV and 57% reported lifetime sexual PV. In the past 2 months, 19.6% reported physical and/or sexual violence by a spouse, live-in, or steady sexual partner, and 7.2% reported physical and/or sexual PV by a casual or anonymous partner. Median SRP score was 2.36 (interquartile range: 2.02-2.68). Twenty-six percent of women reported ever being diagnosed with ≥ 1 STI. While recent physical violence and sexual violence were not associated with STI history among women in steady relationships, women who reported recent sexual violence by casual/anonymous partners were approximately 8 times more likely to ever have an STI compared with those with no history of recent PV by casual/anonymous partners (AOR: 7.70; 95% CI: 1.32, 44.84). SRP was not associated with lifetime STIs among women who reported either partner type. Our findings support a relationship between recent sexual violence perpetrated by casual/anonymous partners and women's STI history. Women who use methamphetamine need help in navigating partner violence experiences. Risk reduction interventions to support this marginalized population are needed.
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Metanfetamina , Poder Psicológico , Parceiros Sexuais , Infecções Sexualmente Transmissíveis , Maus-Tratos Conjugais , Transtornos Relacionados ao Uso de Substâncias , Adulto , California/epidemiologia , Feminino , Humanos , Masculino , Fatores de Risco , Parceiros Sexuais/psicologia , Infecções Sexualmente Transmissíveis/epidemiologia , Maus-Tratos Conjugais/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaAssuntos
Aterosclerose , Hipertensão , Humanos , Rim , Biomarcadores , Túbulos Renais , Fatores de RiscoRESUMO
BACKGROUND: The United Nations has declared the Syrian refugee crisis to be the biggest humanitarian emergency of our era. Neighbouring countries, such as Jordan, strain to meet the health needs of Syrian refugees in addition to their own citizens given limited resources. OBJECTIVES: This study aimed to determine the perspectives of Syrian refugees in Jordan, Jordanian health care providers and other stakeholders in addressing the public health issues of the refugee crisis. METHODS: Qualitative and quantitative methodologies were used to explore Syrian refugee health needs and services in camp and urban settings in Jordan. Focus group discussions and key informant interviews were used to identify needs, challenges and potential solutions to providing quality health care to refugees. By-person factor analysis divided refugee participants into 4 unique respondent types and compared priorities for interventions. RESULTS: Focus group discussions and key informant interviews revealed a many different problems. Cost, limited resources, changing policies, livelihoods and poor health literacy impeded delivery of public and clinical health services. Respondent Type 1 emphasized the importance of policy changes to improve Syrian refugee health. Type 2 highlighted access to fresh foods and recreational activities for children. For Type 3, poor quality drinking-water was the primary concern, and Type 4 believed the lack of good, free education for Syrian children exacerbated their mental health problems. CONCLUSIONS: Syrian refugees identified cost as the main barrier to health care access. Both refugees and health care providers emphasized the importance of directing more resources to chronic diseases and mental health.
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Pessoal de Saúde/psicologia , Necessidades e Demandas de Serviços de Saúde , Refugiados/psicologia , Adulto , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Jordânia , Masculino , Síria/etnologiaRESUMO
Forced migration affects overall health, especially when it happens at a young age. Focus group discussions and the Peace Evaluation Across Cultures and Environments (PEACE) survey were used to compare the effects of the programme on two groups: refugee university students who received full tuition support and a monthly living stipend (intervention group) and unsponsored Syrian students who were preparing for the end of high school examination (control group). The overall mean PEACE score among the intervention group was 152.0 (95% confidence interval [CI]: 147.4-156.5), while the control group mean score was 134.1 (95% CI: 129.1-139.1), p < 0.01. In addition to significantly higher mean total PEACE scores, the intervention group demonstrated better results for each of the seven constructs in the scale (t-test p < 0.05), with the largest differences seen in personal safety, group cohesion and agency. This effect was further elucidated in the focus group discussions, highlighting the psychosocial benefits of the scholarship programme due to improvements in their academic and financial status. This combined education and economic intervention for Syrian refugee youth has measurable positive effects on feelings of peace, security and well-being and can be used as a framework from which to design similar initiatives in other contexts of displacement.
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Bolsas de Estudo , Refugiados/educação , Refugiados/psicologia , Universidades , Adolescente , Feminino , Nível de Saúde , Humanos , Jordânia , Masculino , Segurança , Síria/etnologia , Adulto JovemRESUMO
BACKGROUND: The United States has the highest incarceration rate in the world which has created a public health crisis. Correctional facilities have become a front line for mental health care. Public health research in this setting could inform criminal justice reform. We determined prevalence rates for mental illnesses and related comorbidities among all inmates in a state prison system. METHODS: Cross-sectional study using the Iowa Corrections Offender Network which contains health records of all inmates in Iowa. The point prevalence of both ICD-9 and DSM-IV codes for mental illnesses, timing of diagnosis and interval between incarceration and mental illness diagnosis were determined. RESULTS: The average inmate (N = 8574) age was 36.7 ± 12.4 years; 17% were ≥50 years. The majority of inmates were men (91%) and white (65%).Obesity was prevalent in 38% of inmates, and 51% had a history of smoking. Almost half of inmates were diagnosed with a mental illness (48%), of whom, 29% had a serious mental illness (41% of all females and 27% of all males), and 26% had a history of a substance use disorder. Females had higher odds of having both a mental illness and substance use disorder. Almost all mental illness diagnoses were first made during incarceration (99%). The mean interval to diagnosis of depression, anxiety, PTSD and personality disorders were 26, 24, 21 and 29 months respectively. Almost 90% of mental illnesses were recognized by the 6th year of incarceration. The mean interval from incarceration to first diagnosis (recognition) of a substance abuse history was 11 months. CONCLUSIONS: There is a substantial burden of mental illness among inmates. Racial, age and gender disparities in mental health care are coupled with a general delay in diagnosis and treatment. A large part of understanding the mental health problem in this country starts at prisons.
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Transtornos Mentais/epidemiologia , Serviços de Saúde Mental/organização & administração , Prisioneiros/psicologia , Prisões/organização & administração , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Classificação Internacional de Doenças , Iowa/epidemiologia , Masculino , Pessoa de Meia-Idade , National Institute of Mental Health (U.S.) , Prevalência , Estados Unidos , Adulto JovemRESUMO
OBJECTIVES: We sought to determine natural disaster preparedness levels among older US adults and assess factors that may adversely affect health and safety during such incidents. METHODS: We sampled adults aged 50 years or older (n = 1304) from the 2010 interview survey of the Health and Retirement Study. The survey gathered data on general demographic characteristics, disability status or functional limitations, and preparedness-related factors and behaviors. We calculated a general disaster preparedness score by using individual indicators to assess overall preparedness. RESULTS: Participant (n = 1304) mean age was 70 years (SD = 9.3). Only 34.3% reported participating in an educational program or reading materials about disaster preparation. Nearly 15% reported using electrically powered medical devices that might be at risk in a power outage. The preparedness score indicated that increasing age, physical disability, and lower educational attainment and income were independently and significantly associated with worse overall preparedness. CONCLUSIONS: Despite both greater vulnerability to disasters and continuous growth in the number of older US adults, many of the substantial problems discovered are remediable and require attention in the clinical, public health, and emergency management sectors of society.
Assuntos
Planejamento em Desastres/estatística & dados numéricos , Desastres , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Pessoas com Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados UnidosRESUMO
OBJECTIVES: We sought to determine natural disaster preparedness levels among older US adults and assess factors that may adversely affect health and safety during such incidents. METHODS: We sampled adults aged 50 years or older (n = 1304) from the 2010 interview survey of the Health and Retirement Study. The survey gathered data on general demographic characteristics, disability status or functional limitations, and preparedness-related factors and behaviors. We calculated a general disaster preparedness score by using individual indicators to assess overall preparedness. RESULTS: Participant (n = 1304) mean age was 70 years (SD = 9.3). Only 34.3% reported participating in an educational program or reading materials about disaster preparation. Nearly 15% reported using electrically powered medical devices that might be at risk in a power outage. The preparedness score indicated that increasing age, physical disability, and lower educational attainment and income were independently and significantly associated with worse overall preparedness. CONCLUSIONS: Despite both greater vulnerability to disasters and continuous growth in the number of older US adults, many of the substantial problems discovered are remediable and require attention in the clinical, public health, and emergency management sectors of society.
Assuntos
Planejamento em Desastres , Idoso , Idoso de 80 Anos ou mais , Planejamento em Desastres/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados UnidosRESUMO
OBJECTIVES: We sought to determine natural disaster preparedness levels among older US adults and assess factors that may adversely affect health and safety during such incidents. METHODS: We sampled adults aged 50 years or older (n = 1 304) from the 2010 interview survey of the Health and Retirement Study. The survey gathered data on general demographic characteristics, disability status or functional limitations, and preparedness-related factors and behaviors. We calculated a general disaster preparedness score by using individual indicators to assess overall preparedness. RESULTS: Participant (n = 1 304) mean age was 70 years (SD = 9.3). Only 34.3% reported participating in an educational program or reading materials about disaster preparation. Nearly 15% reported using electrically powered medical devices that might be at risk in a power outage. The preparedness score indicated that increasing age, physical disability, and lower educational attainment and income were independently and significantly associated with worse overall preparedness. CONCLUSIONS: Despite both greater vulnerability to disasters and continuous growth in the number of older US adults, many of the substantial problems discovered are remediable and require attention in the clinical, public health, and emergency management sectors of society.
Assuntos
Planejamento em Desastres/estatística & dados numéricos , Desastres , Atividades Cotidianas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos de Coortes , Coleta de Dados , Feminino , Habitação , Humanos , Masculino , Pessoa de Meia-Idade , Aposentadoria , Estudos de Amostragem , Fatores Socioeconômicos , Meios de Transporte , Estados UnidosRESUMO
PURPOSE: This study sought to understand family functioning surrounding weight in Mexican American women with obesity. METHODS: Semi-structured in-depth interviews were conducted with mothers and adult daughters (N = 116). RESULTS: Thematic analysis identified five themes. 1) The communication process drives perception of supportive messages. Messages perceived as non-supportive consist of directives as interventions, confirmation of faults, and critical compliments whereas supportive consist of compliments, encouragement, empathetic listening, and disclosure. 2) Acculturation differences interfere with intergenerational alliance. Differences involve dissonance in communication, behavioural expectations, and weight-related practices. 3) Maladaptive conflict responses contribute to relational strain. These responses include avoidance, withdrawal, and defensiveness. 4) Role transformations alter the generational hierarchical relationship. Daughters serve as role models, caregivers, or collaborators. 5) Low communal coping heightens psychological distress. It does so by challenging family roles, increasing social isolation, and compromising social support. CONCLUSION: Obesity interventions for Mexican American women may benefit from targeting relational skills to improve family functioning.
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Adaptação Psicológica , Americanos Mexicanos , Mães , Obesidade , Apoio Social , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Aculturação , Comunicação , Relações Familiares/psicologia , Relação entre Gerações , Americanos Mexicanos/psicologia , Mães/psicologia , Obesidade/psicologia , Obesidade/etnologia , Pesquisa QualitativaRESUMO
The prevalence rates and correlates of mental or physical disability among recently resettled refugees, who undergo strenuous journeys before arriving in the US, remain unknown, masking potential health disparities. Self-reported disability was measured by the 2018 Annual Survey of Refugees (ASR), and defined as having a physical, mental, or other health condition for more than 6 months that precluded one from working. Prevalence rates of self-reported disability and sample correlates were investigated using descriptive and logistic regression analyses. Of N = 4259 participating refugees in ASR (Mean Age = 28.2, SD = 17.2; 52.5% male), 2875 responded to the disability question and 21.4% reported disability. About 33.7% were born in the Middle East region, 29.5% had no formal education, and 35% had an income of less than $15,000. Age (OR = 1.06, 95% Confidence Interval (CI) [1.06,1.07], p < 0.001), region of birth (OR = 1.82, 95% CI [1.31, 2.51], p < 0.001), employment status (OR = 3.31, 95% CI [2.67, 4.11], p < 0.001), and receiving food stamps (OR = 2.09, 95% CI [1.66, 2.62], p < 0.001) were associated with self-reported disability. Disability levels among refugees recently resettled in the United States are comparable to national disability rates in the US. Our results suggest that multiple aspects of the refugee experience (i.e., demographics, socioeconomic status, contextual migration history) need to be considered to understand the risk for health outcomes. Future investigations of disabilities in diverse refugee populations over time and tailored public health interventions to mitigate potential risk factors are warranted to promote health equity.
Assuntos
Pessoas com Deficiência , Refugiados , Autorrelato , Fatores Socioeconômicos , Humanos , Refugiados/estatística & dados numéricos , Masculino , Feminino , Adulto , Estados Unidos/epidemiologia , Pessoas com Deficiência/estatística & dados numéricos , Pessoa de Meia-Idade , Adulto Jovem , Adolescente , Fatores Sociodemográficos , Fatores Etários , Prevalência , Nível de Saúde , IdosoRESUMO
Importance: The US has historically resettled more refugees than any other country, with over 3.5 million refugees since 1980. The National Institutes of Health (NIH) is the largest public funder of biomedical research and development, but its role in mitigating many health disparities refugees experience through its funded research remains unknown. Objective: To examine the NIH's research funding patterns on refugee health research over the last 2 decades. Design, Setting, and Participants: Secondary analysis of NIH-funded grants between 2000 and 2020 using a cross-sectional study design. The NIH Research Portfolio Online Reporting Tools database was used to find relevant grants. Data were analyzed from November 2021 to September 2022. Main Outcomes and Measures: NIH grants awarded by year, state, grant type, research area, funding institute, grant duration, and amount funded. Results: Of 1.7 million NIH grants funded over the 20-year study period, only 78 addressed refugee health. Funded grants were mostly training grants (23 grants [29%]), followed by hypothesis-driven research (R01 grants; 22 grants [28%]), pilot or preliminary investigation proposals (13 grants [17%]), and other types of grants (20 grants [26%]). The most studied research domain was mental health (36 grants [46%]), followed by refugee family dynamics and women's and children's health (14 grants [18%]). A total of 26 grants (33%) were funded by the National Institute of Mental Health and 15 (19%) were funded by the National Institute of Child Health and Human Development. Most grants were US-based (60 grants [76%]) and the state of Massachusetts received the greatest amount of funding ($14â¯825â¯852 [18%]). In 2020, the NIH allocated about $2.3 million to refugee health research, or less than 0.01% of its $42 billion budget that year. The number of grants funded in each time period did not always reflect changes in the number of refugees resettled in the US over the years. Conclusions and Relevance: This cross-sectional study found that there remain significant gaps in the understanding of and interventions in the health research needs of refugees locally and along the migratory route. To close these gaps, the NIH should increase its investments in comprehensive studies assessing the physical, mental, and social well-being of this expanding population. This can be achieved by ensuring that all NIH institutes allocate budgets specifically for refugee health research and extend support for the training of refugee researchers.
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Refugiados , Estados Unidos , Criança , Feminino , Humanos , Saúde da Criança , Estudos Transversais , Saúde da Mulher , National Institutes of Health (U.S.)RESUMO
Neurocognitive impairment and metabolic syndrome (MetS) are prevalent in persons with HIV (PWH). We examined disparities in HIV-associated neurocognitive function between Hispanic and non-Hispanic White older PWH, and the role of MetS in explaining these disparities. Participants included 116 community-dwelling PWH aged 50-75 years enrolled in a cohort study in southern California [58 Hispanic (53% Spanish speaking) and 58 age-comparable non-Hispanic White; overall group: age: M = 57.9, standard deviation (SD) = 5.7; education (years): M = 13, SD = 3.4; 83% male, 58% AIDS, 94% on antiretroviral therapy]. Global neurocognition was derived from T-scores adjusted for demographics (age, education, sex, ethnicity, language) on a battery of 10 cognitive tests. MetS was ascertained via standard criteria that considered central obesity, and fasting elevated triglycerides, low high-density lipoprotein cholesterol and elevated glucose, or medical treatment for these conditions. Covariates examined included sociodemographic, psychiatric, substance use and HIV disease characteristics. Compared with non-Hispanic Whites, Hispanics showed worse global neurocognitive function (Cohen's d = 0.56, p < 0.05) and had higher rates of MetS (38% vs. 56%, p < 0.05). A stepwise regression model including ethnicity and significant covariates showed Hispanic ethnicity was the sole significant predictor of worse global neurocognition (B = -3.82, SE = 1.27, p < 0.01). A model also including MetS showed that both Hispanic ethnicity (B = -3.39, SE = 1.31, p = 0.01) and MetS (B = -2.73, SE = 1.31, p = 0.04) were independently associated with worse neurocognition. In conclusion, findings indicate that increased MetS is associated with worse neurocognitive function in both Hispanic and non-Hispanic White older PWH, but does not explain neurocognitive disparities. MetS remains an important target for intervention efforts to ameliorate neurocognitive dysfunction among diverse older PWH.
Assuntos
Infecções por HIV , Hispânico ou Latino , Síndrome Metabólica , Testes Neuropsicológicos , População Branca , Humanos , Hispânico ou Latino/estatística & dados numéricos , Hispânico ou Latino/psicologia , Masculino , Feminino , Pessoa de Meia-Idade , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/etnologia , Síndrome Metabólica/psicologia , Infecções por HIV/psicologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/etnologia , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Idoso , California/epidemiologia , População Branca/estatística & dados numéricos , População Branca/psicologia , Prevalência , Disparidades nos Níveis de Saúde , Estudos de Coortes , Cognição , Disfunção Cognitiva/epidemiologiaRESUMO
Objectives: The COVID-19 pandemic limited refugees' access to healthcare. Increased use of telehealth could enable continuity of care but also create barriers to chronic disease management. This study explores refugees' experience with telehealth and hypertension management during the pandemic. Methods: We recruited 109 refugee participants diagnosed with hypertension. We conducted semi-structured interviews about their experience with telehealth during the COVID-19 pandemic. Interviews were transcribed, translated, and data was coded using inductive thematic analysis. Results: 86% used telehealth modalities at least once during the pandemic. Interviews highlighted three main themes: (1) Social isolation worsened mental health, affecting their motivation to manage their blood pressure; (2) telehealth alleviated discontinuity of care but posed logistical and cultural challenges; (3) participants relied on public blood pressure monitors that were not available during the pandemic which affected disease management. Conclusion: Refugees faced challenges managing their hypertension during the COVID-19 pandemic. Virtual community building may alleviate their stress and isolation. Telehealth must be adapted to account for language, cultural, and technological barriers. Communities with hypertension should increase access to personal or public blood pressure monitors.
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COVID-19 , Hipertensão , Refugiados , Telemedicina , Humanos , COVID-19/epidemiologia , Pandemias , Hipertensão/epidemiologia , Hipertensão/terapiaRESUMO
OBJECTIVES: This study investigates whether the year of arrival to the United States (U.S.) and birthplace relate to postmigration cognitive difficulties among foreign- and U.S.-born Arab Americans in later life. METHODS: We analyzed 19 years (2000-2019) of data from the American Community Survey Public Use Microdata Samples (weighted N = 393,501; ages ≥ 50 years). Cognitive difficulty was based on self-reported data, and weighted means, percentages, adjusted prevalence estimates, and adjusted odds ratio were calculated. RESULTS: Controlling only for demographics, foreign-born Arabs reported higher odds of cognitive difficulty compared to U.S.-born Arabs across all arrival cohorts (p < .001). After accounting for economic and integration factors, those who arrived between 1991 and 2000 had higher odds (odds ratio [OR] = 1.06, 95% confidence interval [CI] =1.00, 1.19, p < .01), while those who arrived after 2001 had lower odds (OR = 0.87, 95% CI = 0.78, 0.97, p < .001) of cognitive difficulty. Lacking English proficiency (OR = 1.90, 95% CI = 1.82, 1.98, p < .001) was related to higher odds, whereas not being a U.S. citizen was significantly associated with lower odds (OR = 0.89, 95% CI = 0.52, 0.94, p < .001) of cognitive difficulty. Yet, results varied by birthplace. Migrants born in Iraq consistently reported the highest odds of cognitive difficulty across all arrival cohorts. DISCUSSION: Migration history and birthplace may be important factors explaining cognitive disparities among the diverse group of Arab migrants and Arab Americans. Future research examining mechanisms underlying these associations and the impact of migration on cognitive health is needed to address cognitive disparities in migrants.