A Scholar's Reflection on Intimate Partner Violence in the Cape Verdean Community.

The #MeToo and Time's Up movements have sparked a significant cultural shift in the United States around sexual harassment and abuse by creating an environment of support, rather than one that punishes and silences women and men who come forward to tell their stories about abuse of all kinds. The Cape Verdean community faces a variety of complex challenges and barriers in addressing intimate partner violence. This article chronicles my experiences reporting the study findings from the Cape Verdean Women's Project (CVWP), which included Cape Verdean women's perceptions of intimate violence and their recommendations for social change.

Attempted suicide of ethnic minority girls with a Caribbean and Cape Verdean background: rates and risk factors.

BACKGROUND: WHO data shows that female immigrants in Europe attempt suicide at higher rates than 'native' women and 'native' and immigrant men. Empirical studies addressing attempted suicide of female immigrants of Caribbean (Antillean-Dutch and Creole-Surinamese-Dutch) as well as Cape Verdean descent in Europe are however scarce. We aim to increase knowledge about rates and risk factors of girls of Caribbean and Cape Verdean descent living in the Netherlands. METHODS: We conducted logistic regression on a dataset that consisted of self-reported health and well-being surveys filled out by 5611 female students, age 14-16, in Rotterdam, the Netherlands (Antillean Dutch N = 357, Creole-Surinamese-Dutch N = 130, and Cape Verdean-Dutch N = 402, and Dutch 'natives' N = 4691). We studied if girls of these minority groups had elevated risk for attempted suicide. Risk indicators that were suspected to play a role were investigated i.e. household composition, socio-economic class, externalizing problems, emotional problems and sexual abuse. RESULTS: We found that rates of attempted suicide among Antillean (14%), Creole-Surinamese young women (15.4%) were higher than of 'native' Dutch girls (9.1%), while rates of Cape-Verdean girls (8.3%) were rather similar to those of 'native' girls. Not living with two biological parents was a risk factor for 'native' girls, but not for girls of Caribbean and Cape Verdean descent. Emotional problems and sexual abuse seems to be a risk indicator for suicidality across all ethnicities. Aggressive behaviour was a risk factor for Antillean Dutch and 'native' girls. CONCLUSIONS: Our findings underscore the need for developing suicide prevention programs for minority girls in multicultural cities in western Europe, in particular those of Caribbean descent. Results suggest the importance of addressing socio-economic class and educational background for suicide prevention, which bear particular relevance for Caribbean populations. Referral in the case of sexual trauma and low psychological wellbeing seems critical for reducing suicidal behaviour in girls, regardless of ethnicity.

GROWING UP IN PORTUGAL: CAPE VERDEAN ANCESTRY CHILDREN EXHIBIT LOW OVERWEIGHT AND OBESITY COMPARED WITH PORTUGUESE IN URBAN LISBON.

Portugal has one of the highest rates of childhood overweight and obesity in Europe. However, little is known about the health of ethnic minorities living in its capital city, Lisbon. The Cape Verdean community in Lisbon tend to have low educational levels, material deprivation and struggle with discrimination and racism, factors that would probably be associated with a higher prevalence of overweight and obesity. Data for the Cape Verdean population were collected in three different time periods by three different research teams in 1993, 2009 and 2013 and included children aged 6-12 years living in the Cova da Moura neighbourhood of the Greater Lisbon Metro Area. The Portuguese national survey was conducted between 2009 and 2010 at public and private schools in mainland Portugal and included height, weight, skinfolds and arm and waist circumferences. From these survey data body mass index (BMI) and prevalence of stunting (chronic malnutrition - low height-for-age) and underweight (low weight-for-age) were calculated according to reference values proposed by Frisancho (2008). Overweight and obesity prevalence values were defined based on the references established by the International Obesity Task Force. The results show significant differences in height between Cape Verdean and Portuguese boys and girls. Generally, Cape Verdeans' growth falls within the healthy range of international growth references across all of the survey data collected. Cape Verdean rates for combined overnutrition (overweight and obesity) in 2013 (9.8% for boys and 16.7% for girls) were lower than those of the Portuguese (33% for boys and 31.7% for girls). Logistic regression models showed that Cape Verdean children had a lower risk of being overweight or obese when accounting for breast-feeding, birth weight, maternal education and occupation. Despite living in a deprived neighbourhood these Cape Verdean children seemed to have grown more healthily than Portuguese ancestry children. The challenge for policymakers will be to support improvement of the poverty-related living conditions of this community without creating a risky environment for increasing prevalence of overweight and obesity.

Ethnic disparities in maternal obesity and weight gain during pregnancy. The Generation R Study.

OBJECTIVE: To examine ethnic disparities in maternal prepregnancy obesity and gestational weight gain, and to examine to which extent these differences can be explained by socio-demographic, lifestyle and pregnancy related characteristics. METHODS: In a multi-ethnic population-based prospective cohort study among 6444 pregnant women in Rotterdam, the Netherlands, maternal anthropometrics were repeatedly measured throughout pregnancy. Ethnicity, socio-demographic, lifestyle and pregnancy related characteristics were assessed by physical examinations and questionnaires. RESULTS: The prevalence of prepregnancy overweight and obesity was 23.1% among Dutch-origin women. Statistically higher prevalences were observed among Dutch Antillean-origin (40.8%), Moroccan-origin (49.9%), Surinamese-Creole-origin (38.6%) and Turkish-origin (41.1%) women (all p-values <0.05). Only Dutch Antillean-origin, Moroccan-origin, Surinamese-Creole-origin and Turkish-origin women had higher risks of maternal prepregnancy overweight and obesity as compared to Dutch-origin women (p-values <0.05). Socio-demographic and lifestyle related characteristics explained up to 45% of the ethnic differences in body mass index. Compared to Dutch-origin women, total gestational weight gain was lower in all ethnic minority groups, except for Cape Verdean-origin and Surinamese-Creole-origin women (p-values <0.05). Lifestyle and pregnancy related characteristics explained up to 33% and 40% of these associations, respectively. The largest ethnic differences in gestational weight gain were observed in late pregnancy. CONCLUSION: We observed moderate ethnic differences in maternal prepregnancy overweight, obesity and gestational weight gain. Socio-demographic, lifestyle and pregnancy related characteristics partly explained these differences. Whether these differences also lead to ethnic differences in maternal and childhood outcomes should be further studied.

Early origins of ethnic disparities in cardiovascular risk factors.

BACKGROUND: Not much is known about the ethnic differences in cardiovascular risk factors during childhood in European countries. We examined the ethnic differences in childhood cardiovascular risk factors in the Netherlands. METHODS: In a multi-ethnic population-based prospective cohort study, we measured blood pressure, left ventricular mass, and levels of cholesterol, triglyceride and insulin at the median age of 6.2years. RESULTS: As compared to Dutch children, Cape Verdean and Turkish children had a higher blood pressure, whereas Cape Verdean, Surinamese-Creole and Turkish children had higher total-cholesterol levels (p-values<0.05). Turkish children had higher triglyceride levels, but lower insulin levels than Dutch children (p-values<0.05). As compared to Dutch children, only Turkish children had an increased risk of clustering of cardiovascular risk factors (odds ratio: 2.45 (95% confidence interval 1.18, 3.37)). Parental pre-pregnancy factors explained up to 50% of the ethnic differences in childhood risk factors. In addition to these factors, pregnancy and childhood factors and childhood BMI explained up to 50%, 12.5% and 61.1%, respectively. CONCLUSIONS: Our results suggest that compared to Dutch children, Cape Verdean, Surinamese-Creole and Turkish children have an adverse cardiovascular profile. These differences are largely explained by parental pre-pregnancy factors, pregnancy factors and childhood BMI.

Perspectives on quality mental health care from Brazilian and Cape Verdean outpatients: implications for effective patient-centered policies and models of care.

Mental health providers are increasingly coming into contact with large and growing multi-racial/ethnic and immigrant patient populations in the United States. Knowledge of patient perspectives on what constitutes quality mental health care is necessary for these providers. The aim of this study was to identify indicators of quality of mental health care that matter most to two underrepresented immigrant patient groups of Portuguese background: Brazilians and Cape Verdeans. A qualitative design was adopted using focus group discussions. Six focus groups of patients (n=24 Brazilians; n=24 Cape Verdeans) who received outpatient mental health treatment through public safety net clinics in the northeast region of the United States were conducted. The Consensual Qualitative Research analytic method allowed us to identify three quality of care domains: provider performance, aspects of mental health care environment, and effectiveness of mental health care treatment. Provider performance was associated with five categories: relational, communication, linguistic, cultural, and technical competencies. Aspects of mental health care environment were linked to two categories: psychosocial and physical environment. Effectiveness of mental health care treatment was related to two categories: therapeutic relationship and treatment outcomes. Study findings provide useful data for the development of more culturally appropriate and effective patient-centered models and policies in mental health care.

Ethnicity is a strong predictor for Helicobacter pylori infection in young women in a multi-ethnic European city.

BACKGROUND AND AIM: At the same time that Helicobacter pylori prevalence is declining in Western countries, immigrants from developing countries with high H. pylori prevalence have settled in Western urban areas. Actual epidemiological data on H. pylori in a migrant community may help in realizing a more selective approach to assess H. pylori-related diseases. We aimed to define H. pylori prevalence as well as risk groups for H. pylori in a cohort of young women living in a multi-ethnic European city. METHODS: We measured Immunoglobulin G (IgG) anti-H. pylori and CagA-antibodies in serum of pregnant women included in a population-based prospective cohort study, the Generation R study. Information on demographics and socioeconomic status was collected by questionnaires. Chi-square and logistic regression were used. RESULTS: In total, 3146 (46%) of the 6837 tested women (mean age 29.7 ± 5.3) were H. pylori-positive and 1110 (35%) of them were CagA-positive. The H. pylori prevalence in Dutch women was 24%, which was significantly lower than in non-Dutch women (64%; P < 0.001). In particular, H. pylori positivity was found in 92% of Moroccan (odds ratio 19.2; 95% confidence interval 11.8-32.0), 80% of Cape Verdean (7.6; 5.0-11.5), 81% of Turkish (9.0; 6.7-12.1), 60% of Dutch Antillean (3.3; 2.3-4.7), and 58% of Surinamese women (3.0; 2.3-3.8). Among H. pylori-positive Dutch subjects, 19% were CagA-positive compared with 40% of the non-Dutch subjects (P < 0.001). CONCLUSIONS: Despite a general trend of declining prevalence in Western countries, H. pylori remains highly prevalent in migrant communities, which may constitute target groups for screening and eradication to prevent H. pylori-related diseases.

Retention in mental health care of Portuguese-speaking patients.

We compared service outcomes of dedicated language and cultural competency services in adequacy of care, ER, and inpatient care among Portuguese-speaking patients in ethnic- and non-ethnic-specific behavioral health clinics. We assessed adequacy of mental health care, and use of inpatient emergency department among Portuguese-speaking patients, comparing individuals receiving care from a culturally and linguistically competent mental health care setting (the Portuguese Mental Health Program [PMHP]) with usual mental health care in a community health care system in the USA. Propensity score matching was used to balance patients in treatment and control groups on gender, marital status, age, diagnosis of mental disorder, and insurance status. We used de-identified, longitudinal, administrative data of 854 Portuguese-speaking patients receiving care from the PMHP and 541 Portuguese-speaking patients receiving usual care from 2005-2008. Adequate treatment was defined as receipt of at least eight outpatient psychotherapy visits, or at least four outpatient visits of which one was a psychopharmacological visit. PMHP patients were more likely to receive adequate care. No differences were found in rates of ER use or inpatient mental health care. The present study suggests increased quality of care for patients that have contact with a clinic that dedicates resources specifically to a minority/immigrant group. Advantages of this setting include greater linguistic and cultural concordance among providers and patients. Further research is warranted to better understand the mechanisms by which culturally appropriate mental health care settings benefit minority/immigrant patients.

[An unusual cause of sinusitis]. / Een ongewone oorzaak van sinusitis.

BACKGROUND: Larvae of the sheep botfly (Oestrus ovis) normally have sheep or goats as host. In humans the larvae can survive for a short time in the nose or under the eyelids, after which they die or are sneezed out. CASE DESCRIPTION: We describe a 47-year-old woman who during a stay in the Cape Verde Islands developed symptoms of sneezing, a swollen face and an itchy feeling in her nose. These symptoms were due to an infestation of three fully-developed larvae of the O. ovis species in her sinus maxillaries which were later evacuated by endoscopy. CONCLUSION: In exceptional cases larvae of the O. ovis species can fully mature in a healthy person after a visit to an endemic area. Development into the mature stage has only been described in patients with a poor mucosal immune response.

Physiological and behavioral factors related to physical activity in black women with type 2 diabetes mellitus.

PURPOSE: To describe relationships among physical activity (PA), physiological factors, and psychological factors in Black women with type 2 diabetes mellitus (T2DM). METHODS: A cross-sectional design was used (N = 109). Data were collected on PA(activity/inactivity, TV hours, bed confinement), physiology (blood pressure, lipids, hemoglobin A1c), psychology (anxiety,emotional distress, physical functioning, bodily pain, vitality), and health care provider (HCP) support. RESULTS: Walking was the preferred PA; TV viewing averaged 3.7 hours/day, and 24% reported confinement to bed >1 week in the last year. Inactive women had greater physiological and psychological problems than active women. Women watching TV >2 hours/day had more physiological problems than women watching TV <2 hours/day. Women reporting >1 week of confinement to bed in the last year had more physiological and psychological problems than those confined to bed <1 week. CONCLUSIONS: PA interventions in Black women with T2DM should promote walking, address TV viewing time, incorporate HCP's role of PA counseling/support,and address several psychological factors.

Explaining ethnic differences in late antenatal care entry by predisposing, enabling and need factors in The Netherlands. The Generation R Study.

Despite compulsory health insurance in Europe, ethnic differences in access to health care exist. The objective of this study is to investigate how ethnic differences between Dutch and non-Dutch women with respect to late entry into antenatal care provided by community midwifes can be explained by need, predisposing and enabling factors. Data were obtained from the Generation R Study. The Generation R Study is a multi-ethnic population-based prospective cohort study conducted in the city of Rotterdam. In total, 2,093 pregnant women with a Dutch, Moroccan, Turkish, Cape Verdean, Antillean, Surinamese Creole and Surinamese Hindustani background were included in this study. We examined whether ethnic differences in late antenatal care entry could be explained by need, predisposing and enabling factors. Subsequently, logistic regression analysis was used to assess the independent role of explanatory variables in the timing of antenatal care entry. The main outcome measure was late entry into antenatal care (gestational age at first visit after 14 weeks). With the exception of Surinamese-Hindustani women, the percentage of mothers entering antenatal care late was higher in all non-Dutch compared to Dutch mothers. We could explain differences between Turkish (OR = 0.95, CI: 0.57-1.58), Cape Verdean (OR = 1.65. CI: 0.96-2.82) and Dutch women. Other differences diminished but remained significant (Moroccan: OR = 1,74, CI: 1.07-2.85; Dutch Antillean OR 1.80, CI: 1.04-3.13). We found that non-Dutch mothers were more likely to enter antenatal care later than Dutch mothers. Because we are unable to explain fully the differences regarding Moroccan, Surinamese-Creole and Antillean women, future research should focus on differences between 1st and 2nd generation migrants, as well as on language barriers that may hinder access to adequate information about the Dutch obstetric system.

Mitochondrial DNA patterns in the Macaronesia islands: Variation within and among archipelagos.

Macaronesia covers four Atlantic archipelagos: the Azores, Madeira, the Canary Islands, and the Cape Verde islands. When discovered by Europeans in the 15th century, only the Canaries were inhabited. Historical reports highlight the impact of Iberians on settlement in Macaronesia. Although important differences in their settlement are documented, its influence on their genetic structures and relationships has yet to be ascertained. In this study, the hypervariable region I (HVRI) sequence and coding region polymorphisms of mitochondrial DNA (mtDNA) in 623 individuals from the Azores (120) and Canary Islands (503) were analyzed. Combined with published data, these give a total of 1,542 haplotypes from Macaronesia and 1,067 from the Iberian Peninsula. The results obtained indicate that Cape Verde is the most distinctive archipelago, with an mtDNA pool composed almost exclusively of African lineages. However, the other archipelagos present an mtDNA profile dominated by the presence of West-Eurasian mtDNA haplogroups with African lineages present in varying proportions. Moreover, no signs of integration of typical Canarian U6 lineages in the other archipelagos were detected. The four Macaronesia archipelagos currently have differentiated genetic profiles, and the Azores present the highest intra-archipelago differentiation and the lowest values of diversity. The analyses performed show that the present-day genetic profile of the Macaronesian archipelagos was mainly determined by the initial process of settlement and further microdifferentiation probably as a consequence of the small population size of some islands. Moreover, contacts between archipelagos seem to have had a low impact on the mtDNA genetic pool of each archipelago.

AIDS mortality in African migrants living in Portugal: evidence of large social inequalities.

OBJECTIVE: To examine infectious disease and AIDS mortality among African migrants in Portugal, gender and socio-economic differences in AIDS mortality risk, and differences between African migrants to Portugal and to England and Wales. METHODS: Data from death registrations, 1998-2002, and the 2001 Census were used to derive standardised death rates by country of birth, occupational class (men only), and marital status. RESULTS: Compared with people born in Portugal, African migrants had higher mortality for infectious diseases including AIDS. There was considerable heterogeneity among Africans, with those from Cape Verde having the highest mortality. Death rates were more than five times higher among those who were unmarried than those who were. A larger proportion of Africans were unmarried accounting for some excess mortality. Death rates were also higher among men from manual occupational classes than among men from non-manual. A comparison with England and Wales shows that death rates for infectious disease and AIDS in Portugal are much higher and Africans in Portugal also fare worse than Africans in England and Wales. CONCLUSION: AIDS mortality rates were higher among Africans than those born in Portugal and were associated with socio-environmental factors. Further research is required to interpret the excess mortality among Africans and there is a need to ensure the inclusion of relevant data items on ethnicity in national monitoring and surveillance systems.

The importance of social context in understanding and promoting low-income immigrant women's health.

Understanding the social context and realities of Cape Verdean women in the U.S. as well as other immigrant and ethnic/racial groups is important to promote their overall health and well-being more effectively. The aim of this study was to gain a contextual understanding from the perspectives of health promoters who work with marginalized women. In-depth, semi-structured interviews were conducted with nine Cape Verdean women health promoters about their perspectives and experiences of health promotion practice with immigrant women in their community. Using a Glaserian grounded theory approach to analysis, six salient themes describing women's social context emerged: community and domestic violence, loss and isolation, economic injustice, immigration-related issues and abuse, unequal gender-based power relations, and cultural taboos. These findings challenge health researchers and practitioners to understand health problems and health promotion not only at an individual level, but at multiple levels of influence including interpersonal, family, neighborhood, and structural levels.

Mutuality at the center: health promotion with Cape Verdean immigrant women.

OBJECTIVE: Public health care researchers, policy makers, and providers are increasingly interested in developing more effective and culturally responsive health promotion theories and interventions for diverse immigrant populations. The purpose of this study was to develop health promotion theory that validates the local knowledge and experiences of Cape Verdean women health promoters who work with immigrant women in their community. DESIGN: In-depth, semi-structured interviews were conducted with nine culturally savvy, community-based Cape Verdean women health promoters about their perspectives and daily experiences of health promotion practice with Cape Verdean immigrant women. This study used Glaserian grounded theory to analyze the interviews. This approach identified concepts and developed an integrated process through which to theorize about the practice of health promoters. RESULTS: For Cape Verdean women health promoters, a process of creating relationships was a key to promoting women's health. The relational theory of health promotion practice reflects these dynamic processes, properties, and stages through which Cape Verdean women health promoters develop mutually engaging relationships with immigrant women. CONCLUSION. These findings challenge health care professionals to broaden the repertoire of health promotion strategies to include relationship-building between health promoters and community women. Through these relationships health promoters can understand the complex structural, cultural, and community factors that influence immigrant women's health and incorporate that knowledge into more effective health promotion practices.

Culture and disability: a Cape Verdean perspective.

The Cape Verdean community has a long history in the United States, yet little is known about its culture and health behaviors as they relate to disability and illness. This article discusses how Cape Verdeans with disabilities and their families perceive disability and how it differs from service providers' perceptions. Additionally, it addresses several reasons that explain why cultural competency protocols are not as successful as they should be in reaching the Cape Verdean community. Finally, recommendations for culturally relevant service delivery are presented.

Smoking during pregnancy in ethnic populations: the Generation R study.

Patterns and correlates of maternal smoking could differ according to ethnic background, and these differences might have consequences for intervention strategies. In the Generation R study, we examined patterns of smoking during pregnancy and the associations of socioeconomic (educational level), demographic (maternal age, marital status, generational status, parity) and lifestyle (alcohol consumption, partner smoking) correlates with smoking during pregnancy in 5,748 women of Dutch, Turkish, Moroccan, Surinamese-Hindustani, Surinamese-Creole, Capeverdean and Antillean ethnic background. Smoking rates before pregnancy were highest in the Turkish group (43.7%) and lowest in the Moroccan group (7.0%). Compared with Dutch women (24.1%), Turkish and Moroccan women were less likely to quit smoking before pregnancy (17.0% and 5.9%, respectively; p<.001). Turkish and Moroccan women (72.0% and 70.6%, respectively) were more likely to continue smoking during pregnancy compared to Dutch women (58.6%, p<.001). Lower education was associated with smoking during pregnancy only in the Dutch group. No significant association of education with smoking was seen in the non-Dutch groups. Second-generation (i.e., foreign-born) Turkish and Capeverdean women were more likely to smoke during pregnancy compared with first-generation women. Partner smoking was associated with smoking during pregnancy in all ethnic groups except for Surinamese-Creole and Antillean. Maternal alcohol consumption was associated with smoking during pregnancy in all ethnic groups except for Capeverdean. Smoking rates and correlates of smoking during pregnancy varied by ethnic background. These observations should be considered when designing maternal smoking prevention and intervention strategies.