The use of medicinal plants by rural populations of the Pastaza province in the Ecuadorian Amazon / Uso de plantas medicinais por populações rurais da província de Pastaza, na Amazônia equatoriana

Mera, Santa Clara and Pastaza municipalities are located in the Ecuadorian Amazon region. The objective of the study was to identify plant species used in traditional medicine by small farmers of these localities, and to classify these plants according to locality, farmer ethnicity and purposes of use. It was also investigated whether the use of medicinal plants differs between the ethnic groups. Data were collected by applying a questionnaire and personal interview with 213 farmers belonging to two ethnicities (Kichwa and mestizo), and to different municipalities (Mera, Santa Clara and Pastaza). Generated data were analyzed using contingency tables and frequency and the most representative species were determined by proportion analysis comparison. A total of 34 families and 52 species of medicinal plants were identified. The most used species was Ilex guayusa which was cited 48 times. Santa Clara municipality and Kichwa farmers used the highest number of species. These species belonged to the Lamiaceae and Solanacease family, and the plants were used for treating stomach pain, cold and inflammations. There were significant differences (Chi square test p < 0.05) between localities and ethnicities (Kichwa and mestizo). There were differences in the use of medicinal plant species among members of the Kichwa ethnicity and mestizo farmers, depending on locality, being Ilex guayusa the most used species.

A pesquisa foi desenvolvida em três municípios da Província de Pastaza, (Mera, Santa Clara e Pastaza), na Amazônia equatoriana. O objetivo do estudo foi identificar espécies vegetais utilizadas na medicina tradicional pelos agricultores nestas localidades e classificar as espécies segundo a localidade, etnia do produtor e as aflições nas que eram utilizadas. Alem disso, na pesquisa analisaram-se as diferença de uso das plantas entre as etnias Kichwa e Mestiça. A metodologia do trabalho consistiu na aplicação de questionários e entrevistas pessoais com 213 agricultores das diferentes etnias. Utilizaram-se as tabelas de contingência por freqüência de uso com os dados gerados, para determinar as espécies mais representativas e em cada grupo realizou-se comparação por análise de proporções. Os principais resultados mostraram a existência de 52 espécies de plantas medicinais pertencente a 34 famílias. A espécie mais utilizada foi Ilex guayusa com 48 registros. Os produtores Kichwa do município Santa Clara registraram o maior número de espécies pertencente às famílias Lamiaceae e Solanacease e as plantas foram utilizadas para tratamento de dor de estômago, gripe e inflamações. A prova de "chi quadrado" mostrou diferenças (p < 0,05) entre os municípios e as etnias. Conclui-se que existe diferença no uso de plantas medicinais entre as localidades e os grupos étnicos estudados. A espécie Ilex guayusa foi a planta medicinal mais usada pelos agricultores independentemente da localidade e a etnia.

Influence of Race, Ethnicity and Social Determinants of Health on Diabetes Outcomes.

BACKGROUND: There is strong evidence that race, ethnicity and social determinants of health significantly influence outcomes for patients with diabetes. A better understanding of the mechanisms of these relationships or associations would improve development of cost-effective, culturally tailored programs for patients with diabetes. METHODS: This article reviews the current state of the literature on the influence of race and ethnicity and social determinants of health on process of care, quality of care and outcomes for diabetes, with particular emphasis on the rural South to give an overview of the state of the literature. RESULTS: The literature review shows that racial or ethnic differences in the clinical outcomes for diabetes, including glycemic, blood pressure (BP) and lipid control, continue to persist. In addition, the literature review shows that the role of social determinants of health on outcomes, and the possible role these determinants play in disparities have largely been ignored. Psychosocial factors, such as self-efficacy, depression, social support and perceived stress, show consistent associations with self-care, quality of life and glycemic control. Neighborhood factors, such as food insecurity, social cohesion and neighborhood esthetics have been associated with glycemic control. Perceived discrimination has also been associated with self-care and the psychological component of quality of life. CONCLUSION: Healthcare professionals need to be skilled in assessing social determinants of health and taking them into consideration in clinical care. In addition, more research is needed to identify the separate and combined influence of race and ethnicity and social determinants of health on process of care, quality of care and outcomes in diabetes, especially in the South, where the burden of disease is particularly high.

A Phylogenetic Comparative Study of Bantu Kinship Terminology Finds Limited Support for Its Co-Evolution with Social Organisation.

The classification of kin into structured groups is a diverse phenomenon which is ubiquitous in human culture. For populations which are organized into large agropastoral groupings of sedentary residence but not governed within the context of a centralised state, such as our study sample of 83 historical Bantu-speaking groups of sub-Saharan Africa, cultural kinship norms guide all aspects of everyday life and social organization. Such rules operate in part through the use of differing terminological referential systems of familial organization. Although the cross-cultural study of kinship terminology was foundational in Anthropology, few modern studies have made use of statistical advances to further our sparse understanding of the structuring and diversification of terminological systems of kinship over time. In this study we use Bayesian Markov Chain Monte Carlo methods of phylogenetic comparison to investigate the evolution of Bantu kinship terminology and reconstruct the ancestral state and diversification of cousin terminology in this family of sub-Saharan ethnolinguistic groups. Using a phylogenetic tree of Bantu languages, we then test the prominent hypothesis that structured variation in systems of cousin terminology has co-evolved alongside adaptive change in patterns of descent organization, as well as rules of residence. We find limited support for this hypothesis, and argue that the shaping of systems of kinship terminology is a multifactorial process, concluding with possible avenues of future research.

Modeling Future Cardiovascular Disease Mortality in the United States: National Trends and Racial and Ethnic Disparities.

BACKGROUND: Accurate forecasting of cardiovascular disease mortality is crucial to guide policy and programming efforts. Prior forecasts often have not incorporated past trends in rates of reduction in cardiovascular disease mortality. This creates uncertainties about future trends in cardiovascular disease mortality and disparities. METHODS AND RESULTS: To forecast US cardiovascular disease mortality and disparities to 2030, we developed a hierarchical bayesian model to determine and incorporate prior age, period, and cohort effects from 1979 to 2012, stratified by age, sex, and race, which we combined with expected demographic shifts to 2030. Data sources included the National Vital Statistics System, Surveillance, Epidemiology, and End Results (SEER) single-year population estimates, and US Bureau of Statistics 2012 national population projections. We projected coronary disease and stroke deaths to 2030, first on the basis of constant age, period, and cohort effects at 2012 values, as is most commonly done (conventional), and then with the use of more rigorous projections incorporating expected trends in age, period, and cohort effects (trend based). We primarily evaluated absolute mortality. The conventional model projected total coronary and stroke deaths by 2030 to increase by ≈18% (67 000 additional coronary deaths per year) and 50% (64 000 additional stroke deaths per year). Conversely, the trend-based model projected that coronary mortality would decrease by 2030 by ≈27% (79 000 fewer deaths per year) and stroke mortality would remain unchanged (200 fewer deaths per year). Health disparities will be improved in stroke deaths but not coronary deaths. CONCLUSIONS: After prior mortality trends and expected demographic shifts are accounted for, total US coronary deaths are expected to decline, whereas stroke mortality will remain relatively constant. Health disparities in stroke but not coronary deaths will be improved but not eliminated. These age, period, and cohort approaches offer more plausible predictions than conventional estimates.

Race, Ethnicity, and Exposure to Alcohol Outlets.

OBJECTIVE: Prior studies suggest that Black and Hispanic minority populations are exposed to greater concentrations of alcohol outlets, potentially contributing to health disparities between these populations and the White majority. We tested the alternative hypothesis that urban economic systems cause outlets to concentrate in low-income areas and, controlling for these effects, lower demand among minority populations leads to fewer outlets. METHOD: Market potential for alcohol sales, a surrogate for demand, was estimated from survey and census data across census block groups for 50 California cities. Hierarchical Bayesian conditional autoregressive Poisson models then estimated relationships between observed geographic distributions of outlets and the market potential for alcohol, income, population size, and racial and ethnic composition. RESULTS: Market potentials were significantly smaller among lower income Black, Hispanic, and Asian populations. Block groups with greater market potential and lower income had greater concentrations of outlets. When we controlled for these effects, the racial and ethnic group composition of block groups was mostly unrelated to outlet concentrations. CONCLUSIONS: Health disparities related to exposure to alcohol outlets are primarily driven by distributions of income and population density across neighborhoods.

Prevalence of High-Risk Sexual Behaviors Among Monoracial and Multiracial Groups from a National Sample: Are Multiracial Young Adults at Greater Risk?

The present study compared the prevalence and variation in high-risk sexual behaviors among four monoracial (i.e., White, African American, Asian, Native American) and four multiracial (i.e., White/African American, White/Asian, White/Native American, African American/Native American) young adults using Wave IV data (2008-2009) from the National Longitudinal Study of Adolescent to Adult Health (N = 9724). Findings indicated differences in the sexual behavior of monoracial and multiracial young adults, but directions of differences varied depending on the monoracial group used as the referent and gender. Among males, White/African Americans had higher risk than Whites; White/Native Americans had higher risk than Native Americans. Otherwise, multiracial groups had lower risk or did not differ from the single-race groups. Among females, White/Native Americans had higher risk than Whites; White/African Americans had higher risk than African Americans. Other comparisons showed no differences or had lower risk among multiracial groups. Variations in high-risk sexual behaviors underscore the need for health research to disaggregate multiracial groups to better understand health behaviors and outcomes in the context of experiences associated with a multiracial background, and to improve prevention strategies.

Pluripertencimentos e comunicação intercultural nos fluxos migratórios: percursos transnacionais entre migrantes na cidade de São Paulo / Multi-belonging and intercultural communication on migration: transnational routes between migrants in São Paulo / Pluripertencimentos y comunicación intercultural sobre la migración: rutas transnacionales entre los migrantes en São Paulo

O artigo propõe uma reflexão sobre as noções de transnacionalidade e interculturalidade na definição dos múltiplos pertencimentos dos migrantes da cidade de São Paulo, especialmente os bolivianos e latinoamericanos. Fruto de uma pesquisa etnográfica desenvolvida entre os anos de 2011 e 2013, esta reflexão é norteada pelos diálogos travados com migrantes, cujas experiências e visões de mundo são passíveis de alimentar os imaginários sobre o fenômeno migratório, sobre os lugares de origem, os percursos e os lugares de destino e, articularmente, sobre o que é ser migrante na época contemporânea em uma cidade cosmopolita como São Paulo. Propomos aqui a interpretação de uma identidade que se abre aos pluripertencimentos e aos diálogos interculturais proporcionados pelo fenômeno da migração...

This paper proposes a reflection on the notions of transnational and intercultural setting of multipleaffiliations of migrants in São Paulo, especially the Bolivian and Latin American. Result of an ethnographicresearch conducted between the years 2011 and 2013, this reflection is guided by its exchanges with migrants,whose experiences and worldviews are likely to feed the imaginary on the migration phenomenon on placesof origin, routes and places of destination and, particularly, about what is being a migrant in contemporarytime in a cosmopolitan city like São Paulo. We propose here the interpretation of an identity that opens thepluripertencimentos and intercultural dialogues provided by the phenomenon of migration...

El artículo propone una reflexión sobre las nociones de transnacional e intercultural en la definiciónde múltiples afiliaciones de los migrantes de São Paulo, en especial el de Bolivia y de América Latina.El resultado de una investigación etnográfica realizada entre los años 2011 y 2013, esta reflexión se guíapor los diálogos con los migrantes, cuyas experiencias y visiones del mundo es probable que alimentar elimaginario sobre el fenómeno de la migración, en los lugares de origen, las vías y los lugares de destino, yen particular sobre lo que está siendo un migrante en la época contemporánea en una ciudad cosmopolitacomo São Paulo. Proponemos aquí la interpretación de una identidad que abre las pluripertencimentos y eldiálogo intercultural proporcionados por el fenómeno de la migración...

Do Sexually Oriented Massage Parlors Cluster in Specific Neighborhoods? A Spatial Analysis of Indoor Sex Work in Los Angeles and Orange Counties, California.

OBJECTIVE: Social determinants of health may be substantially affected by spatial factors, which together may explain the persistence of health inequities. Clustering of possible sources of negative health and social outcomes points to a spatial focus for future interventions. We analyzed the spatial clustering of sex work businesses in Southern California to examine where and why they cluster. We explored economic and legal factors as possible explanations of clustering. METHODS: We manually coded data from a website used by paying members to post reviews of female massage parlor workers. We identified clusters of sexually oriented massage parlor businesses using spatial autocorrelation tests. We conducted spatial regression using census tract data to identify predictors of clustering. RESULTS: A total of 889 venues were identified. Clusters of tracts having higher-than-expected numbers of sexually oriented massage parlors ("hot spots") were located outside downtowns. These hot spots were characterized by a higher proportion of adult males, a higher proportion of households below the federal poverty level, and a smaller average household size. CONCLUSION: Sexually oriented massage parlors in Los Angeles and Orange counties cluster in particular neighborhoods. More research is needed to ascertain the causal factors of such clusters and how interventions can be designed to leverage these spatial factors.

Psychosocial factors associated with medication adherence in ethnically and socioeconomically diverse patients with epilepsy.

The current study examined psychosocial correlates of medication adherence in a socioeconomically and racially diverse sample of patients with epilepsy. Fifty-five patients with epilepsy completed standardized self-report questionnaires measuring depression, stress, social support, and medication and illness beliefs. Antiepileptic drug (AED) adherence was measured using the 8-item Morisky Medication Adherence Scale 36% reported poor adherence. We tested which psychosocial factors were independently and most strongly associated with AED adherence. Stress and depression were negatively correlated with adherence, while perceived social support was positively correlated with adherence (Ps<.05). When all three of these variables and relevant covariates in a multiple regression model were included, only perceived social support remained a significant predictor of adherence (P=.015). This study is one of the first to suggest the importance of targeting social support in screening and intervention approaches in order to improve AED adherence among low-income, racially/ethnically diverse patients with epilepsy.

Out-of-school time activity participation among US--immigrant youth.

BACKGROUND: Structured out-of-school time (OST) activities are associated with positive academic and psychosocial outcomes. METHODS: Data came from the 2007 National Survey of Children's Health, restricted to 36,132 youth aged 12-17 years. Logistic regression models were used to examine the joint effects of race/ethnicity and immigrant family type on the participation in OST activities. RESULTS: Compared with US-born (USB) non-Hispanic White youth with USB parents, USB Hispanic youth with USB parents were less likely to participate in sports, whereas non-Hispanic Black youth with immigrant parents were more likely to participate in sports. White youth with at least 1 immigrant parent had higher odds of participating in after-school clubs. All Hispanic youth were less likely to participate in after-school clubs. USB Hispanic youth, USB Black youth, and White youth and "other" youth with at least 1 immigrant parent had higher odds of engaging in community services. Youth from immigrant families had lower odds of doing paid work. CONCLUSIONS: Hispanic youth were less likely to participate in OST activities. Non-Hispanic youth with immigrant parents did not engage in fewer OST activities compared with USB White youth with USB parents. Intervention and recruitment strategies for OST activities may need to be customized for immigrant groups.

Medicinal plant knowledge in Caribbean Basin: a comparative study of Afrocaribbean, Amerindian and Mestizo communities.

BACKGROUND: The Caribbean Basin has complex biogeographical and cultural histories that have shaped its highly diverse botanical and cultural landscapes. As a result, the current ethnic composition of the Basin is a heterogeneous mixture including Amerindian, Afrocaribbean and a wide range of Mestizo populations. A comparison was done of the medicinal plant repertoires used by these groups to identify the proportion of native species they include and any differences between the groups. METHODS: The TRAMIL program has involved application of ethnopharmacological surveys to gather data on the medicinal plants used for primary care in 55 locations the Caribbean Basin. Three Afrocaribbean, three Amerindian and three Mestizo communities were selected taking in account the Ethnic prevalence. Differences in native and exotic plant used by groups and between groups were done using contingency tables. Identification of differences in the numbers of native and exotic plants used within each group was done with a one sample Z -test for proportions. Similarity in medicinal species use was estimated using the Sørensen Similarity Index. Species use value (UV) was estimated and a principal components analysis (PCA) run to determine differences between groups. RESULTS: The 1,753 plant records generated from the surveys of the nine communities included in the analysis covered 389 species from 300 genera and 98 families. The studied groups used different numbers of native and exotic species: Afrocaribbean (99 natives, 49 exotics); Amerindian (201 natives, 46 exotics); and Mestizo (63 natives, 44 exotics). The proportion of natives to exotics was significantly different in between the Afrocaribbean and Amerindian communities, and between the Amerindian and Mestizo communities, but not between the Afrocaribbean and Mestizo communities. In the PCA, the groups were disparate in terms of the use value they assigned to the medicinal species; these were determined according to species with high use value and those used exclusively be a particular group CONCLUSIONS: Although migration, cultural intermixing and a consequent hybridization of medicinal plant knowledge have occurred in the Caribbean Basin, the results highlight differences between the three studied groups in terms of the medicinal plant repertoire they employ for primary health care.

Ethnic discrimination and health: the relationship between experienced ethnic discrimination and multiple health domains in Norway's rural Sami population.

OBJECTIVE: Self-reported ethnic discrimination has been associated with a range of health outcomes. This study builds on previous efforts to investigate the prevalence of self-reported ethnic discrimination in the indigenous (Sami) population, and how such discrimination may be associated with key health indicators. STUDY DESIGN: The study relies on data from the 2003/2004 (n=4,389) population-based study of adults (aged 36-79 years) in 24 rural municipalities of Central and North Norway (the SAMINOR study). Self-reported ethnic discrimination was measured using the question: "Have you ever experienced discrimination due to your ethnic background?" Health indicators included questions regarding cardiovascular disease, diabetes, chronic muscle pain, metabolic syndrome and obesity. Logistic regression was applied to examine the relationship between self-reported ethnic discrimination and health outcomes. RESULTS: The study finds that for Sami people living in minority areas, self-reported ethnic discrimination is associated with all the negative health indicators included in the study. CONCLUSION: We conclude that ethnic discrimination affects a wide range of health outcomes. Our findings highlight the importance of ensuring freedom from discrimination for the Sami people of Norway.

Exploring culturally and linguistically diverse consumer needs in relation to medicines use and health information within the pharmacy setting.

BACKGROUND: Low health literacy may result in adverse health outcomes for patients and is a problem faced by countries with multi-ethnic demography. For those of culturally and linguistically diverse (CALD) backgrounds, this problem can be compounded by language barriers such as low English proficiency (LEP). The pharmacy is often the last point of health-care provider contact before patients begin taking their medicines and the first point of care for minor ailments. There is a paucity of data exploring or establishing the needs of this population with respect to general medicine use/health information and pharmacist assistance. OBJECTIVE: This study aimed to investigate the needs of CALD Australians with low or negligible English proficiency, specifically in regards to their understanding of health and medicines and the role of pharmacy in achieving best medicine use outcomes for this population. METHODS: A qualitative method was employed. Semi-structured interviews were conducted with individuals of CALD backgrounds with a self-reported low or negligible English proficiency. The interviews explored past experiences with medicines use and interaction with health care professionals. A grounded theory approach with the method of constant comparison was undertaken for analyzing the data. Interviews were conducted until there was a saturation of themes. RESULTS: Thirty-one interviews were conducted, and data analyses identified themes relating to medicine use of CALD community members which were broadly categorized into: (1) health information, (2) interactions with health care professionals, (3) social networks and (4) perceptions and beliefs influencing health-related behavior. CONCLUSIONS: In CALD communities there are significant barriers to patient understanding and optimal use of medicines. There is significant potential for pharmacy to facilitate in addressing these issues as currently pharmacy is largely playing the role of dispenser of medicines. Whilst timely access of medicines is being ensured, there seems to be ample room for improvement in terms of pharmacy's role in facilitating appropriate and efficacious use of medicines with such CALD community members.

A novel ecological methodology for constructing ethnic-majority life tables in the absence of individual ethnicity information.

BACKGROUND: Deprivation-specific life tables have been in use for some time, but health outcomes are also known to vary by ethnicity over and above deprivation. The mortality experiences of ethnic groups are little studied in the UK, however, because ethnicity is not captured on death certificates. METHODS: Population data for all Output Areas (OAs) in England and Wales were stratified by age-group, sex and ethnic proportion, and matched to the deaths counts in that OA from 2000 to 2002. We modelled the relationship between mortality, age, deprivation and ethnic proportion. We predicted mortality rates for an area that contained the maximum proportion of each ethnic group reported in any area in England and Wales, using a generalised linear model with a Poisson distribution adjusted for deprivation. RESULTS: After adjustment, Asian and White life expectancies between 1 and 80 years were very similar. Black men and women had lower life expectancies: men by 4 years and women by around 1.5 years. The Asian population had the lowest mortality of all groups over age 45 in women and over 50 in men, whereas the Black population had the highest rates throughout, except in girls under 15. CONCLUSIONS: We adopted a novel ecological method of constructing ethnic-majority life tables, adjusted for deprivation. There is still diversity within these three broad ethnic groups, but our data show important residual differences in mortality for Black men and women. These ethnic life tables can be used to inform public health planning and correctly account for background mortality in ethnic subgroups of the population.

Culture and context in understanding child maltreatment: Contributions of intersectionality and neighborhood-based research.

In the early 1990s, the U.S. Advisory Board on Child Abuse and Neglect commissioned a series of reviews that appeared as the edited volume, Protecting Children from Abuse and Neglect (Melton & Barry, 1994). Using the 1994 review "Sociocultural Factors in Child Maltreatment" (Korbin, 1994) as a background, this article reconsiders culture and context in child maltreatment work. Since 1994, conditions promoting research and practice attention in this area include immigration-driven global increases in diverse, multicultural societies where different beliefs and practices meet (and clash); expanding purview of the human rights discourse to children; and the disproportionate and disparate representation of cultural, ethnic, and racial groups in child-welfare systems. Although research on child maltreatment has advanced in many ways over 20 years, the complexity of child maltreatment leaves many critical questions demanding further attention, culture and context among them. To help address these questions, we propose two approaches for future maltreatment research: intersectionality - the simultaneous examination of multiple identities (such as gender, race, and socioeconomic status) - as a framework for understanding the complexity of cultural factors; and neighborhood-based research as a means for understanding the context of child maltreatment from the perspective of an ecological framework.

"More than skin deep": stress neurobiology and mental health consequences of racial discrimination.

Ethnic minority groups across the world face a complex set of adverse social and psychological challenges linked to their minority status, often involving racial discrimination. Racial discrimination is increasingly recognized as an important contributing factor to health disparities among non-dominant ethnic minorities. A growing body of literature has recognized these health disparities and has investigated the relationship between racial discrimination and poor health outcomes. Chronically elevated cortisol levels and a dysregulated hypothalamic-pituitary-adrenal (HPA) axis appear to mediate effects of racial discrimination on allostatic load and disease. Racial discrimination seems to converge on the anterior cingulate cortex (ACC) and may impair the function of the prefrontal cortex (PFC), hence showing substantial similarities to chronic social stress. This review provides a summary of recent literature on hormonal and neural effects of racial discrimination and a synthesis of potential neurobiological pathways by which discrimination affects mental health.

Healthcare consumption by ethnic minority people in their country of origin.

BACKGROUND: Studies from the USA, New Zealand and Denmark suggest that many ethnic minority citizens obtain healthcare in their country of origin. Their reasons for doing so and the possible consequences remain unclear. METHODS: We used data from the Healthy Life in an Urban Setting study to investigate the magnitude, types, self-reported reasons and determinants of past-year healthcare consumption in the country of origin by ethnic minority people living in the Netherlands. Individuals of African Surinamese (n = 2059), South-Asian Surinamese (n = 1915), Ghanaian (n = 1426), Moroccan (n = 1516) and Turkish (n = 2245) origin were included (recruited 2011-2013). We performed descriptive and stepwise logistic regression analyses. RESULTS: Respondents of Turkish origin reported the highest healthcare utilization in the country of origin (21.3%) compared with Moroccan (9.8%), Ghanaian (6.6%), African Surinamese (4.8%) and South-Asian Surinamese (3.0%) respondents. The main services used were outpatient clinics, pharmacies and health centres. The chief reported motivations were healthcare for illness, dissatisfaction with care in the residence country and seeking second opinions. Physical health status, cultural distance to the Dutch healthcare system and Turkish origin were all independently associated with healthcare use in countries of origin. CONCLUSION: Both health status and attitudes towards services in the countries of residence and origin are significantly associated with cross-border healthcare use. Further research is needed to clarify the reasons for the relatively high rates shown by Turkish respondents and to explore the consequences for health and for healthcare utilization in the country of residence.

Pharmacogenetics of coumarin anticoagulants in Brazilians.

INTRODUCTION: Coumarin vitamin K antagonists are the mainstay of anticoagulant therapy in atrial fibrillation, prosthetic heart valves and thromboembolic conditions. Concerns with these drugs include large inter-individual variability in dose requirements, narrow therapeutic index and need to monitor prothrombin time repeatedly. AREAS COVERED: Pharmacogenetic studies and dosing algorithms for warfarin and phenprocoumon. EXPERT OPINION: Gene candidate studies in Brazilian patients verified consistently the association of warfarin and pheprocoumon stable dose requirements with CYP2C9 and VKORC1 polymorphisms, and minor or no influence of other pharmacogenes (e.g., CYP4F2 and F7). The predictive power of warfarin and phenprocoumon dosing algorithms developed for Brazilians compares favorably with those reported for other populations. A warfarin dosing algorithm derived for an admixed cohort performed equally well in self-reported White and Black patients, in marked contrast with the considerably poorer performance of other warfarin algorithms in patients of African descent compared to those of European ancestry. This discrepancy is ascribed to the extensive European/African admixture among Brazilians. Prospective studies of clinical utility of coumarin dosing algorithms, in the context of the Brazilian Public Health System, would represent an important counterpart to recently published trials in European and North American cohorts with predominant or exclusive European ancestry.

Ethnic disparities in ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage incidence in the Netherlands.

BACKGROUND AND PURPOSE: Data on the incidence of stroke subtypes among ethnic minority groups are limited. We assessed ethnic differences in the incidence of stroke subtypes in the Netherlands. METHODS: A Dutch nationwide register-based cohort study (n=7 423 174) was conducted between 1998 and 2010. We studied the following stroke subtypes: ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Cox proportional hazard models were used to estimate incidence differences between first-generation ethnic minorities and the Dutch majority population (ethnic Dutch). RESULTS: Compared with ethnic Dutch, Surinamese men and women had higher incidence rates of all stroke subtypes combined (adjusted hazard ratios, 1.43; 95% confidence interval, 1.35-1.50 and 1.34; 1.28-1.41), ischemic stroke (1.68; 1.57-1.81 and 1.57; 1.46-1.68), intracerebral hemorrhage (2.08; 1.82-2.39 and 1.74; 1.50-2.00), and subarachnoid hemorrhage (1.25; 0.92-1.69 and 1.26; 1.04-1.54). By contrast, Moroccan men and women had lower incidence rates of all stroke subtypes combined (0.42; 0.36-0.48 and 0.37; 0.30-0.46), ischemic stroke (0.35; 0.27-0.45 and 0.34; 0.24-0.49), intracerebral hemorrhage (0.61; 0.41-0.92 and 0.32; 0.16-0.72), and subarachnoid hemorrhage (0.42; 0.20-0.88 and 0.34; 0.17-0.68) compared with ethnic Dutch counterparts. The results varied by stroke subtype and sex for the other minority groups. For example, Turkish women had a reduced incidence of subarachnoid hemorrhage, whereas Turkish men had an increased incidence of ischemic stroke and intracerebral hemorrhage compared with ethnic Dutch. CONCLUSIONS: Our findings suggest that Surinamese have an increased risk, whereas Moroccans have a reduced risk for all the various stroke subtypes. Among other ethnic minorities, the risk seems to depend on the stroke subtype and sex. These findings underscore the need to identify the root causes of these ethnic differences to assist primary and secondary prevention efforts.