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1.
BMC Public Health ; 19(1): 1146, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429735

RESUMO

BACKGROUND: UK African and Caribbean (AfC) communities are disproportionately burdened by type 2 diabetes (T2D). Promoting healthy eating and physical activity through structured education is the cornerstone of T2D care, however cultural barriers may limit engagement in these communities. In addition, changes in lifestyle behaviour are shaped by normative influences within social groups and contextual factors need to be understood to facilitate healthful behaviour change. The Behaviour Change Wheel (BCW) and associated COM-B framework offer intervention designers a systematic approach to developing interventions. The aim of this study was to apply the BCW in the design of a culturally sensitive self-management support programme for T2D in UK AfC communities. METHODS: An intervention development study was conducted. Focus groups were held with 41 AfC patients with T2D to understand healthful weight-management, diet and physical activity behaviours. The COM-B framework and BCW were used to evaluate the qualitative data, identify appropriate behaviour change techniques and specify the intervention components. RESULTS: Participants were motivated to avoid diabetes-related consequences although did not always understand the negative impact of their current health behaviours on long-term diabetes outcomes. Barriers to healthful behaviour included gaps in knowledge related to diet, physical activity and weight management guidance. In addition, motivation and social opportunity barriers included an acceptance of larger body sizes, rejection of body mass index for weight guidance and cultural identity being strongly linked to consumption of traditional starches. There was a lack of social opportunity to perform moderate to vigorous physical activity, although walking and dance were culturally acceptable. The resulting Healthy Eating & Active Lifestyles for Diabetes (HEAL-D) intervention uses social support, social comparison, credible sources and demonstration as key behaviour change techniques. CONCLUSION: Use of COM-B and the BCW highlighted the need for an intervention to address motivational and social opportunity barriers to engaging in healthful behaviours, as well as addressing key gaps in knowledge. This framework facilitated the linkage of theoretical behaviour constructs with evidence-based behaviour change techniques, which will enable us to evaluate operationalisation of our chosen BCTs and their impact on behaviour change in a future feasibility study.


Assuntos
Terapia Comportamental/educação , Assistência à Saúde Culturalmente Competente/métodos , Diabetes Mellitus Tipo 2/etnologia , Dieta para Diabéticos/métodos , Educação de Pacientes como Assunto/métodos , Autogestão/educação , Adulto , Grupo com Ancestrais do Continente Africano/educação , Terapia Comportamental/métodos , Região do Caribe/etnologia , Diabetes Mellitus Tipo 2/terapia , Dieta para Diabéticos/etnologia , /métodos , Exercício , Feminino , Grupos Focais , Comportamentos Relacionados com a Saúde/etnologia , Estilo de Vida Saudável , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Avaliação de Programas e Projetos de Saúde , Autogestão/métodos , Apoio Social , Reino Unido
2.
BMJ Open ; 9(2): e023733, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30826792

RESUMO

INTRODUCTION: Black British communities are disproportionately burdened by type 2 diabetes (T2D) and its complications. Tackling these inequalities is a priority for healthcare providers and patients. Culturally tailored diabetes education provides long-term benefits superior to standard care, but to date, such programmes have only been developed in the USA. The current programme of research aims to develop the Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) culturally tailored T2D self-management programme for black British communities and to evaluate its delivery, acceptability and the feasibility of conducting a future effectiveness trial of HEAL-D. METHODS AND ANALYSIS: Informed by Medical Research Council Complex Interventions guidance, this research will rigorously develop and evaluate the implementation of the HEAL-D intervention to understand the feasibility of conducting a full-scale effectiveness trial. In phase 1, the intervention will be developed. The intervention curriculum will be based on existing evidence-based T2D guidelines for diet and lifestyle management; codesign methods will be used to foster community engagement, identify the intervention's underpinning theory, identify the optimal structure, format and delivery methods, ascertain adaptations that are needed to ensure cultural sensitivity and understand issues of implementation. In phase 2, the intervention will be delivered and compared with usual care in a feasibility trial. Process evaluation methods will evaluate the delivery and acceptability of HEAL-D. The effect size of potential primary outcomes, such as HbA1c and body weight, will be estimated. The feasibility of conducting a future effectiveness trial will also be evaluated, particularly feasibility of randomisation, recruitment, retention and contamination. ETHICS AND DISSEMINATION: This study is funded by a National Institute of Health Research Fellowship (CDF-2015-08-006) and approved by National Health Service Research Ethics Committee (17-LO-1954). Dissemination will be through national and international conferences, peer-reviewed publications and local and national clinical diabetes networks. TRIAL REGISTRATION NUMBER: NCT03531177; Pre-results.

3.
Int J Behav Nutr Phys Act ; 16(1): 19, 2019 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-30736801

RESUMO

BACKGROUND: Evidence on the relationship between fruit and vegetable consumption (FV) and mental health in adolescence is sparse and inconsistent. Social determinants of FV include ethnicity, family environments and economic disadvantage. We investigated the relationship between FV and mental health in the British multi-ethnic Determinants of Adolescents (now young Adult) Social well-being and Health (DASH) longitudinal study. METHODS: A longitudinal study of 4683 adolescents living in London at age 11-13 years and followed up at 14-16 years. FV was measured using validated questions on the number of portions consumed daily. Mental health was measured by the Strengths and Difficulties Questionnaire as mean Total Difficulties Score (TDS) and by classification as a 'probable clinical case' (TDS > 17). Social measures included ethnicity, parenting and socioeconomic circumstances. Multilevel modelling was used to investigate the association between FV and mental health throughout adolescence. RESULTS: Low FV was common among adolescents, with approximately 60-70% of adolescents reporting < 5 portions/day and 20-30% reporting < 1 portion/day. In late adolescence, most ethnic minority groups reported lower FV than their White peers. In fully adjusted models, < 1 portion/day remained a significant correlate with mean TDS (Coef: 0.55, 0.29-0.81, P < 0.001) and TDS > 17 (Odds Ratio: 1.43, 1.11-1.85, P = 0.007). Gender- or ethnic-specific effects were not observed. Low parental care partly attenuated the association between FV and mental health. CONCLUSIONS: Low FV is a longitudinal correlate of poor mental health across adolescence. A focus on FV in parenting interventions could yield interrelated benefits across developmental outcomes given its importance to both physical and socioemotional health.


Assuntos
Comportamento do Adolescente , Adolescente , Dieta , Comportamento Alimentar , Frutas , Saúde Mental , Pais , Verduras , Comportamento do Adolescente/etnologia , Criança , Estudos de Coortes , Dieta/etnologia , Dieta/normas , Inquéritos sobre Dietas , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Estudos Longitudinais , Masculino , Transtornos Mentais/etnologia , Saúde Mental/etnologia , Grupos Minoritários , Razão de Chances , Poder Familiar , Fatores Socioeconômicos , Reino Unido , População Urbana
4.
Br J Nutr ; 121(9): 1069-1079, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30764887

RESUMO

Unfavourable dietary habits, such as skipping breakfast, are common among ethnic minority children and may contribute to inequalities in cardiometabolic disease. We conducted a longitudinal follow-up of a subsample of the UK multi-ethnic Determinants of Adolescent Social well-being and Health cohort, which represents the main UK ethnic groups and is now aged 21-23 years. We aimed to describe longitudinal patterns of dietary intake and investigate their impact on cardiometabolic risk in young adulthood. Participants completed a dietary behaviour questionnaire and a 24 h dietary intake recall; anthropometry, blood pressure, total cholesterol and HDL-cholesterol and HbA1c were measured. The cohort consisted of 107 White British, 102 Black Caribbean, 132 Black African, 98 Indian, 111 Bangladeshi/Pakistani and 115 other/mixed ethnicity. Unhealthful dietary behaviours such as skipping breakfast and low intake of fruits and vegetables were common (56, 57 and 63 %, respectively). Rates of skipping breakfast and low fruit and vegetable consumption were highest among Black African and Black Caribbean participants. BMI and cholesterol levels at 21-23 years were higher among those who regularly skipped breakfast at 11-13 years (BMI 1·41 (95 % CI 0·57, 2·26), P=0·001; cholesterol 0·15 (95 % CI -0·01, 0·31), P=0·063) and at 21-23 years (BMI 1·05 (95 % CI 0·22, 1·89), P=0·014; cholesterol 0·22 (95 % CI 0·06, 0·37), P=0·007). Childhood breakfast skipping is more common in certain ethnic groups and is associated with cardiometabolic risk factors in young adulthood. Our findings highlight the importance of targeting interventions to improve dietary behaviours such as breakfast consumption at specific population groups.

5.
Proc Nutr Soc ; 77(4): 456-469, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30260313

RESUMO

Childhood obesity is a common concern across global cities and threatens sustainable urban development. Initiatives to improve nutrition and encourage physical exercise are promising but are yet to exert significant influence on prevention. Childhood obesity in London is associated with distinct ethnic and socio-economic patterns. Ethnic inequalities in health-related behaviour endure, underpinned by inequalities in employment, housing, access to welfare services, and discrimination. Addressing these growing concerns requires a clearer understanding of the socio-cultural, environmental and economic contexts of urban living that promote obesity. We explore opportunities for prevention using asset based-approaches to nutritional health and well-being, with a particular focus on adolescents from diverse ethnic backgrounds living in London. We focus on the important role that community engagement and multi-sectoral partnership play in improving the nutritional outcomes of London's children. London's children and adolescents grow up in the rich cultural mix of a global city where local streets are characterised by diversity in ethnicities, languages, religions, foods, and customs, creating complex and fluid identities. Growing up with such everyday diversity we argue can enhance the quality of life for London's children and strengthen their social capital. The Determinants of young Adult Social well-being and Health longitudinal study of about 6500 of London's young people demonstrated the positive impact of cultural diversity. Born to parents from over a hundred countries and exposed to multi-lingual households and religious practices, they demonstrated strong psychological resilience and sense of pride from cultural straddling, despite material disadvantage and discrimination. Supporting the potential contribution of such socio-cultural assets is in keeping with the values of social justice and equitable and sustainable development. Our work signals the importance of community engagement and multisectoral partnerships, involving, for example, schools and faith-based organisations, to improve the nutrition of London's children.


Assuntos
Diversidade Cultural , Dieta , Grupos Étnicos , Comportamentos Relacionados com a Saúde , Estado Nutricional , Obesidade Pediátrica/prevenção & controle , População Urbana , Adolescente , Adulto , Criança , Cidades , Cultura , Humanos , Londres , Qualidade de Vida , Resiliência Psicológica , Discriminação Social , Fatores Socioeconômicos , Adulto Jovem
6.
Community Dent Oral Epidemiol ; 46(4): 392-399, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29767840

RESUMO

OBJECTIVE: To assess the interrelationship between ethnicity, migration status and dental caries experience among adults in East London. METHODS: We analysed data from 1910 adults (16-65 years) representing 9 ethnic groups, who took part in a community-based health survey in East London. Participants completed a supervised questionnaire and were clinically examined by trained dentists. Dental caries was assessed with the number of decayed, missing and filled teeth (DMFT). The association of ethnicity, nativity status and migration history with DMFT was assessed in negative binomial regression models controlling for demographic, socioeconomic and behavioural factors. RESULTS: White migrants had greater DMFT than UK-born adults, whereas every Asian and Black migrant group had lower DMFT than adults of the same ethnic group born in the UK (albeit significant only for Black Caribbean and Asian Others). Among foreign-born adults, age at arrival (Rate Ratio: 1.03; 95% Confidence Interval: 1.01-1.05) and length of residence (1.04; 95% CI: 1.02-1.06) were positively associated with DMFT. A significant interaction between both factors was also found, with more pronounced differences between older and younger migrants at longer stay in the UK for White Others, Black Caribbean and Asian Others. CONCLUSION: Large inequalities in caries experience were found between foreign- and UK-born adults, with considerable variation across ethnic groups. Looking beyond cultural explanations, in favour of social and environmental factors, may help to explain those inequalities.


Assuntos
Cárie Dentária/epidemiologia , Emigrantes e Imigrantes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Índice CPO , Cárie Dentária/etnologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Psicologia , Fatores Socioeconômicos , Adulto Jovem
7.
PLoS One ; 13(1): e0190496, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29364959

RESUMO

INTRODUCTION: Studies, predominantly from the US, suggest that positive parenting, social support, academic achievement, and ethnic identity may buffer the impact of racism on health behaviours, including smoking, but little is known about how such effects might operate for ethnically diverse young people in the United Kingdom. We use the Determinants of young Adult Social well-being and Health (DASH), the largest UK longitudinal study of ethnically diverse young people, to address the following questions: a) Is racism associated with smoking? b) Does the relationship between racism and smoking vary by gender and by ethnicity? (c) Do religious involvement, parenting style and relationship with parents modify any observed relationship? and d) What are the qualitative experiences of racism and how might family or religion buffer the impact? METHODS: The cohort was recruited from 51 London schools. 6643 were seen at 11-13y and 4785 seen again at 14-16y. 665 participated in pilot follow-up at 21-23y, 42 in qualitative interviews. Self-report questionnaires included lifestyles, socio-economic and psychosocial factors. Mixed-effect models examined the associations between racism and smoking. RESULTS: Smoking prevalence increased from adolescence to age 21-23y, although ethnic minorities remained less likely to smoke. Racism was an independent longitudinal correlate of ever smoking throughout adolescence (odds ratio 1.77, 95% Confidence Interval 1.45-2.17) and from early adolescence to early 20s (1.90, 95% CI 1.25-2.90). Smoking initiation in late adolescence was associated with cumulative exposure to racism (1.77, 95% CI 1.23-2.54). Parent-child relationships and place of worship attendance were independent longitudinal correlates that were protective of smoking. Qualitative narratives explored how parenting, religion and cultural identity buffered the adverse impact of racism. CONCLUSIONS: Racism was associated with smoking behaviour from early adolescence to early adulthood, regardless of gender, ethnicity or socio-economic circumstances adding to evidence of the need to consider racism as an important social determinant of health across the life course.


Assuntos
Fumar Cigarros , Racismo , Adolescente , Feminino , Humanos , Estudos Longitudinais , Masculino , Fatores Socioeconômicos , Reino Unido , Adulto Jovem
8.
J Adolesc Health ; 61(3): 317-328, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28587795

RESUMO

PURPOSE: The purpose of the study is to test whether bullying in adolescents relates to poor mental health and whether social support mitigated this effect. METHODS: In 2001, 28 schools in East London were randomly selected for surveys of two representative mixed ability classes: year 7 (11-12 years) and year 9 (13-14 years). Repeated measures were obtained from the same pupils 2 years later, using the Strengths and Difficulties Questionnaire (total difficulties score [TDS]) as a measure of psychological distress. A simple one-level random intercepts model with measurements nested within pupils was used to investigate the effects of bullying and social support from friends and family on TDS. We also assessed whether culturally congruent friendships offered a mental health advantage. RESULTS: Bullying was associated with a higher mean TDS (coefficient, 95% confidence interval: White British: 2.15, 1.41-2.88; Bangladeshi: 1.65, .91-2.4); a high level of family social support was associated with a lower TDS (White British: -2.36, -3.33 to -1.39; Bangladeshi: -2.34, -3.15 to -.149). Social support from friends was helpful for White British adolescents (-1.06, -2.07 to -.04). Culturally congruent friendships offered no general advantage. CONCLUSION: Bullying is associated with psychological distress; family social support is independently associated with less psychological distress.


Assuntos
Bullying , Grupos Étnicos/estatística & dados numéricos , Apoio Social , Estresse Psicológico/psicologia , Adolescente , Bangladesh/etnologia , Criança , Cultura , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Amigos/psicologia , Humanos , Londres , Masculino , Inquéritos e Questionários
9.
J Hypertens ; 35(11): 2185-2191, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28661960

RESUMO

BACKGROUND: Vascular and lung function develop and decline over the life course; both predict cardiovascular events and mortality but little is known of how they develop over time. We analysed their relationship in a multiethnic cohort study to test whether lung function from early adolescence to young adulthood affected vascular indices. METHODS: 'DASH' (http://dash.sphsu.mrc.ac.uk) included 6643 children aged 11-13 years in 2003; a representative 10% sample (n = 665) participated in a pilot follow-up in 2013. Psychosocial, anthropometric, blood pressure (BP), and lung function measures were collected in both surveys; aortic pulse wave velocity (PWV) and augmentation index (AIx) were measured at aged 21-23 years. Relationships between forced expiratory volume Z-scores in 1 s (zFEV1), after global initiative-ethnic adjustments and BP, PWV, and AIx were tested in linear regression and general estimating statistical models. RESULTS: In total, 488 people with complete data were included. At 11-13 years, SBP was positively associated with zFEV1 (coefficient = 1.90, 95% confidence interval 1.11-2.68, P < 0.001); but not at 21-23 years. The 10-year increase in zFEV1 was associated with rise in SBP (1.38, 0.25-1.51, P < 0.05) in mixed effect models adjusted for age, sex, ethnicity, waist to height ratio, employment, reported racism, smoking, and alcohol use but DBP change was unrelated. In fully adjusted models, neither PWV nor central AIx were associated with zFEV1 at 11-13 years or 21-23 years (P > 0.05). CONCLUSION: Forced expiratory volume change is positively and independently associated with SBP change from adolescence to young adulthood, suggesting earlier lung function plays important roles in SBP development. Vascular indices were unrelated to lung function or its change.


Assuntos
Pressão Sanguínea/fisiologia , Fenômenos Fisiológicos Respiratórios , Adolescente , Adulto , Criança , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Humanos , Estudos Longitudinais , Análise de Onda de Pulso , Testes de Função Respiratória , Reino Unido/epidemiologia , Adulto Jovem
10.
Health Educ J ; 76(4): 398-410, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28596618

RESUMO

OBJECTIVE: To examine cultural barriers and participant solutions regarding acceptance and uptake of the human papillomavirus (HPV) vaccine from the perspective of Black African, White-Caribbean, Arab, Indian, Bangladeshi and Pakistani young people. METHODS: In total, 40 young people from minority ethnic communities in Scotland took part in a qualitative study, involving seven focus groups and four paired interviews, to explore their views and experiences of the HPV vaccine. Using critical discursive psychology, the analysis focused on young people's accounts of barriers and enablers to information, access and uptake of the HPV vaccination programme. RESULTS: Participants suggested innovative strategies to tackle intergenerational concerns, information design and accessibility, and public health communications across diverse contexts. A cross-cultural community engagement model was developed, embracing diversity and contradiction across different ethnic groups. This included four inter-related strategies: providing targeted and flexible information for young people, vaccine provision across the life-course, intergenerational information and specific cross-cultural communications. CONCLUSION: This is the first HPV cross-cultural model inductively derived from accounts of young people from different ethnic communities. We recommend public health practitioners and policymakers consider using the processes and strategies within this model to increase dialogue around public engagement, awareness and receptivity towards HPV vaccination.

11.
Prev Med Rep ; 6: 130-136, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28316908

RESUMO

Small-scale, detailed exploration of the recruitment, assessment, and evaluation processes of obesity intervention among minority ethnic children. The study took place in schools and places of worship during 2008-2010 in London, UK. Measures included 3-day food diaries, 24 h dietary recalls, the Youth Physical Activity Questionnaire, accelerometry, and diet and physical activity self-efficacy questionnaires. Potential intervention components were evaluated via observation, questionnaires, and focus group discussions. Schools and places of worship that reflected the ethnic and religious diversity of inner city London populations (Hindus, Muslims and Christians) were targeted. Telephone invitations to 12 schools achieved recruitment of five schools (42% response); 181 invitations to 94 places of worship, recruited eight organisations (9%). Multi-strategy approaches were required to build relationships with faith organisations. Sixty-five children aged 8-13 years participated in the testing of measures. High completion rates were achieved for 24 h recalls, diet and PA self-efficacy questionnaires (ranging from 89% to 100%), with more consistent quality in schools. Dietary assessment highlighted inadequacies in composition data for minority ethnic foods. Intervention sessions were tested among 155 children in all five schools, and 33 children in a church, temple and mosque. Evaluation coverage was more consistent in these places of worship than in schools. Schools may logistically be more straightforward settings for delivery of interventions but, despite complex issues (engagement strategies; cultural foodways), places of worship provide opportunities for effective reach of children, families and communities. We suggest community based participatory research between researchers, schools and community organisations to harness culturally-specific support.

12.
BMJ Open ; 6(12): e013221, 2016 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-27979836

RESUMO

OBJECTIVE: To examine influences of adiposity from early adolescence to early 20s on cardiovascular disease (CVD) risk in the multiethnic Determinants of young Adult Social well-being and Health (DASH) longitudinal study. METHODS: In 2002-2003, 6643 11-13-year-olds from 51 London schools participated at baseline, and 4785 were seen again at 14-16 years. Recently, 665 (97% of invited) participated in pilot follow-up at 21-23 years, with biological and psychosocial measures and blood biomarkers (only at 21-23 years). Regression models examined interplay between ethnicity, adiposity and CVD. RESULTS: At 21-23 years, ∼30-40% were overweight. About half of the sample had completed a degree with little ethnic variation despite more socioeconomic disadvantage in adolescence among ethnic minorities. Regardless of ethnicity, overweight increased more steeply between 14-16 years and 21-23 years than between 11-13 years and 14-16 years. More overweight among Black Caribbean and Black African females, lower systolic blood pressure (sBP) among Indian females and Pakistani/Bangladeshi males compared with White UK peers, persisted from 11-13 years. At 21-23 years, glycated haemoglobin (HbA1c) was higher among Black Caribbean females, total cholesterol higher and high-density lipoprotein (HDL) cholesterol lower among Pakistani/Bangladeshis. Overweight was associated with a ∼+2 mm Hg rise in sBP between 11-13 years and 21-23 years. Adiposity measures at 11-13 years were related to allostatic load (a cluster of several risk markers), HbA1c and HDL cholesterol at 21-23 years. Ethnic patterns in CVD biomarkers remained after adjustments. CONCLUSIONS: Adolescent adiposity posed significant risks at 21-23 years, a period in the lifespan generally ignored in cardiovascular studies, when ethnic/gender variations in CVD are already apparent.


Assuntos
Adiposidade , Grupo com Ancestrais do Continente Africano , Grupo com Ancestrais do Continente Asiático , Doenças Cardiovasculares/etiologia , Grupos Étnicos , Grupo com Ancestrais do Continente Europeu , Obesidade/complicações , Tecido Adiposo/metabolismo , Adolescente , África , Ásia Ocidental , Biomarcadores/sangue , Pressão Sanguínea , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/etnologia , Região do Caribe , HDL-Colesterol/sangue , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Londres/epidemiologia , Estudos Longitudinais , Masculino , Obesidade/epidemiologia , Obesidade/etnologia , Obesidade/metabolismo , Sobrepeso , Fatores de Risco , Adulto Jovem
13.
BMC Health Serv Res ; 16(1): 401, 2016 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-27535665

RESUMO

BACKGROUND: As the number of breast cancer survivors continues to rise, Western populations become more ethnically and socially diverse and healthcare resources become ever-more stretched, follow-up that focuses on monitoring for recurrence is no longer viable. New models of survivorship care need to ensure they support self-management and are culturally appropriate across diverse populations. This study explored experiences and expectations of a multi-ethnic sample of women with breast cancer regarding post-treatment care, in order to understand potential barriers to receiving care and inform new models of survivorship care. METHODS: A phenomenological qualitative research design was employed. In-depth interviews were conducted with women from diverse socio-demographic backgrounds in England, who completed treatment for breast cancer in the 12 months prior to the study. Data were analysed using Framework Analysis. RESULTS: Sixty-six women participated and reported expectations and needs were unmet at follow-up. Whilst there were more commonalities in experiences, discernible differences, particularly by ethnicity and age, were identified relating to three key themes: emotional responses on transition to follow-up; challenges communicating with healthcare professionals at follow-up; and challenges finding and accessing information and support services to address unmet needs. CONCLUSIONS: There are cultural differences in the way healthcare professionals and women communicate, not necessarily differences in their post-treatment needs. We do not know if new models of care meet survivors' needs, or if they are appropriate for everyone. Further testing and potential cultural and linguistic adaptation of models of care is necessary to ensure their appropriateness and acceptability to survivors from different backgrounds. New ways of providing survivorship care mean survivors will need to be better prepared for the post-treatment period and the role they will have to play in managing their symptoms and care.


Assuntos
Neoplasias da Mama/terapia , Autocuidado , Adulto , Assistência ao Convalescente , Idoso , Neoplasias da Mama/etnologia , Neoplasias da Mama/mortalidade , Inglaterra/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Satisfação do Paciente , Pesquisa Qualitativa , Apoio Social , Taxa de Sobrevida , Sobreviventes/psicologia , País de Gales/epidemiologia
14.
J Hypertens ; 34(11): 2220-6, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27490950

RESUMO

OBJECTIVE: Traditional cardiovascular risk factors do not fully account for ethnic differences in cardiovascular disease. We tested if arterial function indices, particularly augmentation index (AIx), and their determinants from childhood could underlie such ethnic variability among young British adults in the 'DASH' longitudinal study. METHODS: DASH, at http://dash.sphsu.mrc.ac.uk/, includes representative samples of six main British ethnic groups. Pulse wave velocity (PWV) and AIx were recorded using the Arteriograph device at ages 21-23 years in a subsample (n = 666); psychosocial, anthropometric, and blood pressure (BP) measures were collected then and in two previous surveys at ages 11-13 years and 14-16 years. For n = 334, physical activity was measured over 5 days (ActivPal). RESULTS: Unadjusted values and regression models for PWVs were similar or lower in ethnic minority than in White UK young adults, whereas AIx was higher - Caribbean (14.9, 95% confidence interval 12.3-17.0%), West African (15.3, 12.9-17.7%), Indian (15.1, 13.0-17.2%), and Pakistani/Bangladeshi (15.7, 13.7-17.7%), compared with White UK (11.9, 10.2-13.6%). In multivariate models, adjusted for sex, central SBP, height, and heart rate, Indian and Pakistani/Bangladeshi young adults had higher AIx (ß = 3.35, 4.20, respectively, P < 0.01) than White UK with a similar trend for West Africans and Caribbeans but not statistically significant. Unlike PWV, physical activity, psychosocial or deprivation measures were not associated with AIx, with borderline associations from brachial BP but no other childhood variables. CONCLUSION: Early adult AIx, but not arterial stiffness, may be a useful tool for testing components of excess cardiovascular risk in some ethnic minority groups.


Assuntos
Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/epidemiologia , Grupos de Populações Continentais/estatística & dados numéricos , Adolescente , Adulto , Angiografia , Determinação da Pressão Arterial , Criança , Grupos Étnicos , Feminino , Humanos , Masculino , Análise de Onda de Pulso , Fatores de Risco , Reino Unido/epidemiologia , Rigidez Vascular , Adulto Jovem
15.
Hypertension ; 67(6): 1133-41, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27141061

RESUMO

Early determinants of aortic stiffness as pulse wave velocity are poorly understood. We tested how factors measured twice previously in childhood in a multiethnic cohort study, particularly body mass, blood pressure, and objectively assessed physical activity affected aortic stiffness in young adults. Of 6643 London children, aged 11 to 13 years, from 51 schools in samples stratified by 6 ethnic groups with different cardiovascular risk, 4785 (72%) were seen again at aged 14 to 16 years. In 2013, 666 (97% of invited) took part in a young adult (21-23 years) pilot follow-up. With psychosocial and anthropometric measures, aortic stiffness and blood pressure were recorded via an upper arm calibrated Arteriograph device. In a subsample (n=334), physical activity was measured >5 days via the ActivPal. Unadjusted pulse wave velocities in black Caribbean and white UK young men were similar (mean±SD 7.9±0.3 versus 7.6±0.4 m/s) and lower in other groups at similar systolic pressures (120 mm Hg) and body mass (24.6 kg/m(2)). In fully adjusted regression models, independent of pressure effects, black Caribbean (higher body mass/waists), black African, and Indian young women had lower stiffness (by 0.5-0.8; 95% confidence interval, 0.1-1.1 m/s) than did white British women (6.9±0.2 m/s). Values were separately increased by age, pressure, powerful impacts from waist/height, time spent sedentary, and a reported racism effect (+0.3 m/s). Time walking at >100 steps/min was associated with reduced stiffness (P<0.01). Effects of childhood waist/hip were detected. By young adulthood, increased waist/height ratios, lower physical activity, blood pressure, and psychosocial variables (eg, perceived racism) independently increase arterial stiffness, effects likely to increase with age.


Assuntos
Bem-Estar da Criança , Grupos Étnicos/estatística & dados numéricos , Hipertensão/prevenção & controle , Análise de Onda de Pulso/métodos , Rigidez Vascular/fisiologia , Adolescente , Fatores Etários , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/prevenção & controle , Criança , Feminino , Nível de Saúde , Humanos , Hipertensão/etnologia , Estudos Longitudinais , Masculino , Medição de Risco , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Reino Unido , Adulto Jovem
16.
PLoS One ; 11(4): e0154336, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27119342

RESUMO

METHODS: Spirometry datasets from South-Asian children were collated from four centres in India and five within the UK. Records with transcription errors, missing values for height or spirometry, and implausible values were excluded(n = 110). RESULTS: Following exclusions, cross-sectional data were available from 8,124 children (56.3% male; 5-17 years). When compared with GLI-predicted values from White Europeans, forced expired volume in 1s (FEV1) and forced vital capacity (FVC) in South-Asian children were on average 15% lower, ranging from 4-19% between centres. By contrast, proportional reductions in FEV1 and FVC within all but two datasets meant that the FEV1/FVC ratio remained independent of ethnicity. The 'GLI-Other' equation fitted data from North India reasonably well while 'GLI-Black' equations provided a better approximation for South-Asian data than the 'GLI-White' equation. However, marked discrepancies in the mean lung function z-scores between centres especially when examined according to socio-economic conditions precluded derivation of a single South-Asian GLI-adjustment. CONCLUSION: Until improved and more robust prediction equations can be derived, we recommend the use of 'GLI-Black' equations for interpreting most South-Asian data, although 'GLI-Other' may be more appropriate for North Indian data. Prospective data collection using standardised protocols to explore potential sources of variation due to socio-economic circumstances, secular changes in growth/predictors of lung function and ethnicities within the South-Asian classification are urgently required.


Assuntos
Coleta de Dados/métodos , Espirometria/métodos , Adolescente , Algoritmos , Antropometria , Grupo com Ancestrais do Continente Asiático , Criança , Pré-Escolar , Estudos Transversais , Interpretação Estatística de Dados , Bases de Dados Factuais , Feminino , Humanos , Índia , Masculino , Modelos Estatísticos , Estudos Prospectivos , Valores de Referência , Reino Unido
17.
Aust N Z J Public Health ; 40(1): 49-54, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26122013

RESUMO

OBJECTIVE: The shift from an industrial to a service-based economy has seen a decline in work-related injuries (WRIs) and mortality. How this relates to migrant workers, who traditionally held high-risk jobs is unknown. This study examined deaths and hospital admissions from WRI, among foreign and Australian-born workers. METHODS: Tabulated population data from the 1991 to 2011 censuses, national deaths 1991-2002 and hospital admission for 2001-10. Direct age standardised mortality and hospital admission rates (DSRs) and rate ratios (RRs) were derived to examine differences in work-related mortality/hospital admissions by gender, country of birth, employment skill level and years of residence in Australia. RESULTS: DSRs and RRs were generally lower or no different between Australian and foreign-born workers. Among men, mortality DSRs were lower for nine of 16 country of birth groups, and hospital admissions DSRs for 14 groups. An exception was New Zealand-born men, with 9% (95%CI 9-13) excess mortality and 24% (95%CI 22-26) excess hospital admissions. CONCLUSIONS: Four decades ago, foreign-born workers were generally at higher risk of WRI than Australian-born. This pattern has reversed. The local-born comprise 75% of the population and a pro-active approach to health and safety regulation could achieve large benefits.


Assuntos
Acidentes de Trabalho/estatística & dados numéricos , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Traumatismos Ocupacionais/mortalidade , Migrantes/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Austrália/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Vigilância da População , Fatores de Risco , Distribuição por Sexo , Adulto Jovem
18.
Eur J Epidemiol ; 31(7): 655-65, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26362812

RESUMO

This study aimed to examine differences in all-cause mortality and main causes of death across different migrant and local-born populations living in six European countries. We used data from population and mortality registers from Denmark, England & Wales, France, Netherlands, Scotland, and Spain. We calculated age-standardized mortality rates for men and women aged 0-69 years. Country-specific data were pooled to assess weighted mortality rate ratios (MRRs) using Poisson regression. Analyses were stratified by age group, country of destination, and main cause of death. In six countries combined, all-cause mortality was lower for men and women from East Asia (MRRs 0.66; 95 % confidence interval 0.62-0.71 and 0.76; 0.69-0.82, respectively), and Other Latin America (0.44; 0.42-0.46 and 0.56; 0.54-0.59, respectively) than local-born populations. Mortality rates were similar for those from Turkey. All-cause mortality was higher in men and women from North Africa (1.09; 1.08-1.11 and 1.19; 1.17-1.22, respectively) and Eastern Europe (1.30; 1.27-1.33 and 1.05; 1.01-1.08, respectively), and women from Sub-Saharan Africa (1.34; 1.30-1.38). The pattern differed by age group and country of destination. Most migrants had higher mortality due to infectious diseases and homicide while cancer mortality and suicide were lower. CVD mortality differed by migrant population. To conclude, mortality patterns varied across migrant populations in European countries. Future research should focus both on migrant populations with favourable and less favourable mortality pattern, in order to understand this heterogeneity and to drive policy at the European level.


Assuntos
Causas de Morte , Emigrantes e Imigrantes/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Mortalidade , Migrantes/estatística & dados numéricos , Adolescente , Adulto , África do Norte , Distribuição por Idade , Idoso , Criança , Pré-Escolar , Europa (Continente)/epidemiologia , Europa Oriental/epidemiologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Adulto Jovem
19.
Eur Respir J ; 46(6): 1662-71, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26493801

RESUMO

Can ethnic differences in spirometry be attributed to differences in physique and socioeconomic factors?Assessments were undertaken in 2171 London primary schoolchildren on two occasions 1 year apart, whenever possible, as part of the Size and Lung function In Children (SLIC) study. Measurements included spirometry, detailed anthropometry, three-dimensional photonic scanning for regional body shape, body composition, information on ethnic ancestry, birth and respiratory history, socioeconomic circumstances, and tobacco smoke exposure.Technically acceptable spirometry was obtained from 1901 children (mean (range) age 8.3 (5.2-11.8) years, 46% boys, 35% White, 29% Black-African origin, 24% South-Asian, 12% Other/mixed) on 2767 test occasions. After adjusting for sex, age and height, forced expiratory volume in 1 s was 1.32, 0.89 and 0.51 z-score units lower in Black-African origin, South-Asian and Other/mixed ethnicity children, respectively, when compared with White children, with similar decrements for forced vital capacity (p<0.001 for all). Although further adjustment for sitting height and chest width reduced differences attributable to ethnicity by up to 16%, significant differences persisted after adjusting for all potential determinants, including socioeconomic circumstances.Ethnic differences in spirometric lung function persist despite adjusting for a wide range of potential determinants, including body physique and socioeconomic circumstances, emphasising the need to use ethnic-specific equations when interpreting results.


Assuntos
Tamanho Corporal , Grupos Étnicos , Pulmão/fisiologia , Fatores Socioeconômicos , Poluição por Fumaça de Tabaco/estatística & dados numéricos , Grupo com Ancestrais do Continente Africano , Grupo com Ancestrais do Continente Asiático , Estatura , Criança , Pré-Escolar , Grupo com Ancestrais do Continente Europeu , Feminino , Volume Expiratório Forçado , Humanos , Londres , Pulmão/fisiopatologia , Masculino , Tamanho do Órgão , Fatores Sexuais , Espirometria , Tórax/anatomia & histologia , Capacidade Vital
20.
Soc Psychiatry Psychiatr Epidemiol ; 50(8): 1173-88, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25861790

RESUMO

PURPOSE: The Determinants of young Adult Social well-being and Health longitudinal study draws on life-course models to understand ethnic differences in health. A key hypothesis relates to the role of psychosocial factors in nurturing the health and well-being of ethnic minorities growing up in the UK. We report the effects of culturally patterned exposures in childhood. METHODS: In 2002/2003, 6643 11-13 year olds in London, ~80 % ethnic minorities, participated in the baseline survey. In 2005/2006, 4782 were followed-up. In 2012-2014, 665 took part in a pilot follow-up aged 21-23 years, including 42 qualitative interviews. Measures of socioeconomic and psychosocial factors and health were collected. RESULTS: Ethnic minority adolescents reported better mental health than White British, despite more adversity (e.g. economic disadvantage, racism). It is unclear what explains this resilience but findings support a role for cultural factors. Racism was an adverse influence on mental health, while family care and connectedness, religious involvement and ethnic diversity of friendships were protective. While mental health resilience was a feature throughout adolescence, a less positive picture emerged for cardio-respiratory health. Both, mental health and cultural factors played a role. These patterns largely endured in early 20s with family support reducing stressful transitions to adulthood. Education levels, however, signal potential for socio-economic parity across ethnic groups.


Assuntos
Diversidade Cultural , Grupos Étnicos/classificação , Grupos Étnicos/estatística & dados numéricos , Saúde Mental/etnologia , Racismo/etnologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/etnologia , Criança , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu , Feminino , Seguimentos , Nível de Saúde , Inquéritos Epidemiológicos , Humanos , Londres/epidemiologia , Estudos Longitudinais , Masculino , Grupos Minoritários/psicologia , Grupos Minoritários/estatística & dados numéricos , Psicologia , Religião e Psicologia , Resiliência Psicológica , Autorrelato , Família de Pais Solteiros/etnologia , Fumar/etnologia , Comportamento Social , Apoio Social , Fatores Socioeconômicos , Inquéritos e Questionários , Desemprego/estatística & dados numéricos , Adulto Jovem
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