Análise Hierarquizada da Hipertensão Arterial Sistêmica com a Variante Polimórfica do Gene da ECA e Outros Fatores de Risco em Idosos / Hierarchical Analysis of Hypertension with the Polymorphic Variant of the ACE Gene and Other Risk Factors in the Elderly

Fundamento: A hipertensão arterial sistêmica (HAS) é uma condição clínica de etiologia multifatorial e de sério agravo à saúde do idoso. Apesar das alterações cardiovasculares influenciarem o desenvolvimento da HAS nesta faixa etária, vários outros fatores genéticos e ambientais têm sido descritos na literatura, incluindo a variante polimórfica do gene da enzima conversora da angiotensina (ECA) e a distribuição da gordura corporal. Objetivo: Avaliar a prevalência da HAS entre idosos e sua possível correlação com a variante polimórfica I/D do gene da ECA e outros fatores de risco associados. Métodos: Estudo de base populacional com 387 idosos residentes na zona urbana de Ibiaí (MG, Brasil) utilizando, para tal, um modelo hierarquizado. Resultados: À análise estatística, a variante polimórfica do gene da ECA não se mostrou associada à HAS (p = 0,316). Por outro lado, mostraram associação significativa com a HAS os fatores: sexo feminino, ausência de companheiro, consumo de mais de uma porção de sal ao dia e alterações nos índices de massa corporal e na relação cintura-quadril. Conclusão: Apesar da variante polimórfica da ECA não ter mostrado influência sobre a prevalência de HAS em idosos, algumas variáveis individuais, socioeconômicas, metabólicas e de hábitos comportamentais mostraram associação com esta condição

Background: Hypertension is a clinical condition of multifactorial etiology that imposes serious harm to the health of elderly individuals. Despite the fact that cardiovascular disorders influence the development of hypertension in this age group, several other genetic and environmental factors have been described in the literature, including the polymorphic variant of the angiotensin-converting enzyme (ACE) gene and the distribution of body fat. Objective: To assess the prevalence of hypertension among elderly individuals and its possible correlation with the I/D polymorphic variant of the ACE gene and other associated risk factors.Methods: Population-based study using a hierarchical model and including 387 elderly individuals residing in the urban area of Ibiaí (Minas Gerais, Brazil).Results: On statistical analysis, the polymorphic variant of the ACE gene was not associated with hypertension (p = 0.316). On the other hand, there was a significant association between hypertension and the variables female sex, absence of a partner, consumption of more than one portion of salt per day, and changes in body mass index and waist-to-hip ratio. Conclusion: Although the polymorphic variant of the ACE gene showed no influence on the prevalence of hypertension in elderly individuals, some variables such as individual, socioeconomic, metabolic, and behavioral habits were associated with this condition

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.

Role of Coronary Artery Calcium Score of Zero and Other Negative Risk Markers for Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis (MESA).

BACKGROUND: Limited attention has been paid to negative cardiovascular disease (CVD) risk markers despite their potential to improve medical decision making. We compared 13 negative risk markers using diagnostic likelihood ratios (DLRs), which model the change in risk for an individual after the result of an additional test. METHODS AND RESULTS: We examined 6814 participants from the Multi-Ethnic Study of Atherosclerosis. Coronary artery calcium score of 0, carotid intima-media thickness <25th percentile, absence of carotid plaque, brachial flow-mediated dilation >5% change, ankle-brachial index >0.9 and <1.3, high-sensitivity C-reactive protein <2 mg/L, homocysteine <10 µmol/L, N-terminal pro-brain natriuretic peptide <100 pg/mL, no microalbuminuria, no family history of coronary heart disease (any/premature), absence of metabolic syndrome, and healthy lifestyle were compared for all and hard coronary heart disease and all CVD events over the 10-year follow-up. Models were adjusted for traditional CVD risk factors. Among all negative risk markers, coronary artery calcium score of 0 was the strongest, with an adjusted mean DLR of 0.41 (SD, 0.12) for all coronary heart disease and 0.54 (SD, 0.12) for CVD, followed by carotid intima-media thickness <25th percentile (DLR, 0.65 [SD, 0.04] and 0.75 [SD, 0.04], respectively). High-sensitivity C-reactive protein <2 mg/L and normal ankle-brachial index had DLRs >0.80. Among clinical features, absence of any family history of coronary heart disease was the strongest (DLRs, 0.76 [SD, 0.07] and 0.81 [SD, 0.06], respectively). Net reclassification improvement analyses yielded similar findings, with coronary artery calcium score of 0 resulting in the largest, most accurate downward risk reclassification. CONCLUSIONS: Negative results of atherosclerosis-imaging tests, particularly coronary artery calcium score of 0, resulted in the greatest downward shift in estimated CVD risk. These results may help guide discussions on the identification of individuals less likely to receive net benefit from lifelong preventive pharmacotherapy.

Relationship of Usual Volume and Heavy Consumption to Risk of Alcohol-Related Injury: Racial/Ethnic Disparities in Four U.S. National Alcohol Surveys.

OBJECTIVE: National population data on racial/ethnic disparities and risk of alcohol-related injury are scarce. Alcohol-related injury and drinking patterns are examined in a sample of respondents from four (1995, 2000, 2005, 2010) U.S. National Alcohol Surveys using risk function analysis. METHOD: Self-reported consumption of 15,476 current drinkers was assessed as the average number of drinks consumed monthly and, separately, the frequency of consuming five or more drinks in a day (5+ days) in the last year. Alcohol-related injury was defined as drinking within 6 hours before the event. Risk curves were defined, separately for Whites, Blacks, and Hispanics, using fractional polynomial regression. RESULTS: Risk was greatest for Hispanics to 110 drinks per month (3-4 drinks per day) and above 240 drinks per month, whereas risk was greatest for Whites between these levels. Blacks were at lower risk at all monthly volume levels when demographic and socioeconomic status characteristics were controlled for. Whites had the highest risk of an alcohol-related injury based on 5+ drinking days at all levels up to nearly daily 5+ drinking, whereas Blacks had the lowest risk at all levels of 5+ drinking. CONCLUSIONS: A disparity in alcohol-related injury was found for Hispanics compared with Whites at the same average monthly volume of consumption at lower and higher volume levels, but not at the same number of 5+ drinking days, and a lower risk of alcohol-related injury was found for Blacks for both consumption measures when demographic and socioeconomic status characteristics were taken into account. Although exposure to hazards other than alcohol, which could account for some of the racial/ethnic disparity observed, was not taken into account, these mixed findings suggest this is an important area deserving future research attention.

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.

Larger FVC and FEV1 among Tibetans compared to Han born and raised at high altitude.

OBJECTIVES: This study compares forced vital capacity (FVC) and Forced Expiratory Volume at 1 Second (FEV1 ) of Tibetans with those of Han who were born and raised at high altitude. MATERIALS AND METHODS: FVC and FEV1 tests were conducted among 1,063 children and adolescents between the ages of 6 and 20 years, and 184 adults between the ages of 21 and 39 years who had lived their entire lives at 3200 m, 3800 m and 4300 m in Qinghai Provence, Peoples Republic of China. RESULTS: Even though FVC and FEV1 values of Han born and raised at high altitude are generally lower than those of Tibetans through age 15 in girls and age 16 in boys, differences are largely explained by variation in stature (height-squared) and chest circumference. Among older adolescents and adults, the FVC and FEV1 values of Tibetans are significantly larger than those of Han born and raised at high altitude; and are much larger than would be predicted, based on stature and chest circumference. DISCUSSION: These results indicate that the large FVC and FEV1 values of Tibetan adults develop primarily from an accelerated pattern of lung growth that begins during mid-to-late adolescence and possibly extends into young adulthood. This developmental pattern is not only distinct from that of Han born and raised at high altitude, but also from those of Andean Quechua and Aymara. The pace of lung function growth may therefore represent another feature distinguishing the Tibetan from the Andean pattern of adaptation to high altitude hypoxia. Because of this, a search for features in the Tibetan genome related to this lung function growth phenotype might be productive and important.

Kidney Function and Cardiovascular Events in Postmenopausal Women: The Impact of Race and Ethnicity in the Women's Health Initiative.

BACKGROUND: Kidney disease disproportionately affects minority populations, including African Americans and Hispanics; therefore, understanding the relationship of kidney function to cardiovascular (CV) outcomes within different racial/ethnic groups is of considerable interest. We investigated the relationship between kidney function and CV events and assessed effect modification by race/ethnicity in the Women's Health Initiative. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: Baseline serum creatinine concentrations (assay traceable to isotope-dilution mass spectrometry standard) of 19,411 postmenopausal women aged 50 to 79 years who self-identified as either non-Hispanic white (n=8,921), African American (n=7,436), or Hispanic (n=3,054) were used to calculate estimated glomerular filtration rates (eGFRs). PREDICTORS: Categories of eGFR (exposure); race/ethnicity (effect modifier). OUTCOMES: The primary outcome was the composite of 3 physician-adjudicated CV events: myocardial infarction, stroke, or CV-related death. MEASUREMENTS: We evaluated the multivariable-adjusted associations between categories of eGFR and CV events using proportional hazards regression and formally tested for effect modification by race/ethnicity. RESULTS: During a mean follow-up of 7.6 years, 1,424 CV events (653 myocardial infarctions, 627 strokes, and 297 CV-related deaths) were observed. The association between eGFR and CV events was curvilinear; however, the association of eGFR with CV outcomes differed by race (P=0.006). In stratified analyses, we observed that the U-shaped association was present in non-Hispanic whites, whereas African American participants had a rather curvilinear relationship, with lower eGFR being associated with higher CV risk, and higher eGFR, with reduced CV risk. Analyses among Hispanic women were inconclusive owing to few Hispanic women having very low or high eGFRs and very few events occurring in these categories. LIMITATIONS: Lack of urinary albumin measurements; residual confounding by unmeasured or imprecisely measured characteristics. CONCLUSIONS: In postmenopausal women, the patterns of association between eGFR and CV risk differed between non-Hispanic whites and African American women.

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.

Who were they really? model-free and model-bound dental nonmetric analyses to affirm documented population affiliations of seven South African "Bantu" samples.

OBJECTIVES: For bioarchaeological biodistance analyses it is common to "assume" that skeletal samples are representative of the populations to which they are attributed. Here, alternatively, samples with "known" attribution in the Raymond A. Dart Collection are assessed regarding their suitability for use in such analyses. Prior curation issues may call their ascribed identities into question. MATERIALS AND METHODS: These 20th century samples ostensibly derive from South African Ndebele, Sotho, Swazi, Tswana, Venda, Xosa, and Zulu populations. First, the mean measure of divergence (MMD) is used to obtain among-sample dental phenetic distances for comparison with documented population relationships. Second, the Mantel test evaluates fit of the isolation-by-distance model between MMD and geographic distances, i.e., among the historic homelands. Third, R-matrices and minimum and estimated Fst from MMD distances give an indication of genetic micro-differentiation. RESULTS: Output from these model-free and model-bound analyses suggest that five and perhaps six samples are representative of their attributed populations-presenting differences along population lines and evidence of more ancient ancestry. DISCUSSION: Other than the Swazi and perhaps Nedebele, the among-sample variation: 1) mirrors documented population history, 2) reveals a moderately positive correlation between phenetic and geographic distances, and 3) although evidencing much homogeneity, provides measures of genetic distance in support of the phenetic distances. Therefore, with the two noted exceptions-perhaps from collection issues, swamping of past genetic structure, or both, most samples appear suitable for bioarchaeological analyses. On this basis, results are offered to supplement published findings concerning the biological relationships of these peoples.

Mediterranean diet and brain structure in a multiethnic elderly cohort.

OBJECTIVE: To determine whether higher adherence to a Mediterranean-type diet (MeDi) is related with larger MRI-measured brain volume or cortical thickness. METHODS: In this cross-sectional study, high-resolution structural MRI was collected on 674 elderly (mean age 80.1 years) adults without dementia who participated in a community-based, multiethnic cohort. Dietary information was collected via a food frequency questionnaire. Total brain volume (TBV), total gray matter volume (TGMV), total white matter volume (TWMV), mean cortical thickness (mCT), and regional volume or CT were derived from MRI scans using FreeSurfer program. We examined the association of MeDi (scored as 0-9) and individual food groups with brain volume and thickness using regression models adjusted for age, sex, ethnicity, education, body mass index, diabetes, and cognition. RESULTS: Compared to lower MeDi adherence (0-4), higher adherence (5-9) was associated with 13.11 (p = 0.007), 5.00 (p = 0.05), and 6.41 (p = 0.05) milliliter larger TBV, TGMV, and TWMV, respectively. Higher fish (b = 7.06, p = 0.006) and lower meat (b = 8.42, p = 0.002) intakes were associated with larger TGMV. Lower meat intake was also associated with larger TBV (b = 12.20, p = 0.02). Higher fish intake was associated with 0.019 mm (p = 0.03) larger mCT. Volumes of cingulate cortex, parietal lobe, temporal lobe, and hippocampus and CT of the superior-frontal region were associated with the dietary factors. CONCLUSIONS: Among older adults, MeDi adherence was associated with less brain atrophy, with an effect similar to 5 years of aging. Higher fish and lower meat intake might be the 2 key food elements that contribute to the benefits of MeDi on brain structure.

Prophylactic Antiepileptic Drug Use and Outcome in the Ethnic/Racial Variations of Intracerebral Hemorrhage Study.

BACKGROUND AND PURPOSE: The role of antiepileptic drug (AED) prophylaxis after intracerebral hemorrhage (ICH) remains unclear. This analysis describes prevalence of prophylactic AED use, as directed by treating clinicians, in a prospective ICH cohort and tests the hypothesis that it is associated with poor outcome. METHODS: Analysis included 744 patients with ICH enrolled in the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study before November 2012. Baseline clinical characteristics and AED use were recorded in standardized fashion. ICH location and volume were recorded from baseline neuroimaging. We analyzed differences in patient characteristics by AED prophylaxis, and we used logistic regression to test whether AED prophylaxis was associated with poor outcome. The primary outcome was 3-month modified Rankin Scale score, with 4 to 6 considered poor outcome. RESULTS: AEDs were used for prophylaxis in 289 (39%) of the 744 subjects; of these, levetiracetam was used in 89%. Patients with lobar ICH, craniotomy, or larger hematomas were more likely to receive prophlyaxis. Although prophylactic AED use was associated with poor outcome in an unadjusted model (odds ratio, 1.40; 95% confidence interval, 1.04-1.88; P=0.03), this association was no longer significant after adjusting for clinical and demographic characteristics (odds ratio, 1.11; 95% confidence interval, 0.74-1.65; P=0.62). CONCLUSIONS: We found no evidence that AED use (predominantly levetiracetam) is independently associated with poor outcome. A prospective study is required to assess for a more modest effect of AED use on outcome after ICH.

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.

How should ethnicity-related information be included on drug labels? Considerations based on comparison of multiregional clinical trial data on the label between Japan and the United States.

Clinical data on various ethnicities collected in multiregional clinical trials (MRCTs) have increased in regulatory review for drug approval. However, how such data should be included on the drug labels has not been discussed. We compared information related to ethnicities on the labels of drugs that were approved in both Japan and the United States, and discussed the issues to be considered for providing better information to healthcare professionals in this era of globalized drug development.