Ageism Linked to Culture, Not Demographics: Evidence From an 8-Billion-Word Corpus Across 20 Countries.

OBJECTIVES: Ageism has increased over 200 years and costs the U.S. health care system $63 billion a year. While scholars agree on the consequences of ageism, there are disagreements on whether it is related to the demographics of aging, or society's cultural values. We test both hypotheses across 20 countries. METHOD: To circumvent the sampling limitations of survey studies, we used an 8-billion-word corpus, identified 3 synonyms with the highest prevalence-aged, elderly, old people-and compiled the top 300 words (collocates) that were used most frequently with these synonyms for each of the 20 countries. The resulting 6,000 collocates were rated on an ageism scale by 2 raters to create an ageism score per country. Cultural dimension scores-Power Distance, Individualism, Masculinity, Uncertainty Avoidance, and Long-term Orientation-were taken from Hofstede, and demographics-size and speed of population aging-came from the World Development Indicators. RESULTS: Of the 20 countries, UK topped the ageism table, while Sri Lanka had the lowest ageism score. Multiple regression models showed that higher levels of masculinity and long-term orientation are associated with ageism, controlling for other cultural dimensions, demographics (size and speed of aging), and economics (GDP-per-capita). DISCUSSION: Our findings blunt the deterministic nature of ageism at the societal level. Demographics is only one side of the ageism coin, and the cultural side is equally, if not more important. This study lays the groundwork to tackle societal ageism-one of our generation's most pernicious threats.

Caribbean Diaspora Healthy Nutrition Outreach Project (CDHNOP): A Qualitative and Quantitative Approach to Caribbean Health.

Background: Obesity prevention and its associated co-morbidities such as diabetes require a multi-tiered, culturally sensitive, population-based approach. South Florida's tri-county area is home to approximately 75% of Florida's total Caribbean immigrant population. This project is the first Caribbean-focused intervention using the Go-Slow-Whoa or GSW format which designates whether a food or beverage should be chosen frequently (Go - green), less often (Slow - yellow), or rarely (Whoa - red) based on the content of nutrients, sodium, fat, and sugar. Specific Aims: 1. To create and evaluate culturally appropriate nutrition materials for the Caribbean diaspora population in Broward County (i.e. tailor existing GSW evidence-based materials for this population). 2. To quantify which social determinants of health are most relevant to this population. Methods: Mixed methods were utilized in this study. The qualitative, exploratory arm consisted of semi-structured focus groups that included 38 subjects from five Caribbean countries most represented in South Florida: Jamaica, Haiti, Trinidad and Tobago, Cuba and Dominican Republic. The quantitative arm employed descriptive and inferential statistics to analyze social determinants of health (SDOH) obtained from a modified National Association of Community Health Centers' PRAPARE survey. Intercept survey data was also collected from a convenience sample of 24 Caribbean immigrants in Broward County. Findings: Analysis revealed a lack of culturally appropriate foods and exercise examples in the current GSW materials. At 92% and 82% respectively, an overwhelming majority of our intercept surveys indicated that our revised, culturally appropriate materials were helpful in making positive food and beverage choices. Further study is required to determine which SDOH variables are relevant to this population. Conclusions: Health disparities and inequity in the healthy living education of our Caribbean subpopulation are best addressed using an inclusive research frame that captures the cultural essence and preferences of this understudied community.

Precarious patients: health professionals' perspectives on providing care to Mexican and Jamaican migrants in Canada's Seasonal Agricultural Worker Program.

INTRODUCTION: The intersecting vulnerabilities of migrant agricultural workers (MAWs) impact both their health and their access to health care in rural areas, yet rural clinicians' voices are rarely documented. The purpose of this study was to explore health professionals' perspectives on health care for MAWs in sending countries and rural Ontario, Canada. METHODS: Qualitative research design occurred over three distinct projects, using a multi-methodological approach including semi-structured interviews in Mexico, Jamaica and rural Ontario (n=43), and session field notes and questionnaires administered to healthcare providers (n=65) during knowledge exchange sessions in rural Ontario. A systematic analysis of these data was done to identify common themes, using NVivo software initially and then Microsoft Excel for application of a framework approach. RESULTS: Structural challenges posed by migrant workers' context included difficulties preventing and managing work-related conditions, employers or supervisors compromising confidentiality, and MAWs' fears of loss of employment and return to countries of origin prior to completing treatments. Structural challenges related to health services included lack of adequate translation/interpretation services and information about insurance coverage and MAWs' work and living situations; scheduling conflicts between clinic hours and MAWs' availability; and difficulties in arranging follow-up tests, treatments and examinations. Intercultural challenges included language/communication barriers; cultural barriers /perceptions; and limited professional knowledge of MAWs' migration and work contexts and MAWs' knowledge of the healthcare system. Transnational challenges arose around continuity of care, MAWs leaving Canada during/prior to receiving care, and dealing with health problems acquired in Canada. A range of responses were suggested, some in place and others requiring additional organization, testing and funding. CONCLUSION: Funding to strengthen responses to structural and intercultural challenges, including research assessing improved supports to rural health professionals serving MAWs, are needed in rural Canada and rural Mexico and Jamaica, in order to better address the structural and intersecting vulnerabilities and the care needs of this specific population.

Intragroup Differences among African Jamaican and African American Women: Empowerment, Male Condom-use Intentions and Negotiation.

African American/Black women's rate of HIV infection has been explored along several variables. Understanding how the epidemic affects different ethnic groups of women is crucial in developing effective prevention strategies. There remains a gap in knowledge around the effects of ethnicity on the rate of infection among the culturally diverse groups of women living in the U.S. subsumed under the label African American/Black. The purpose of the study is to explore whether cultural differences exist among African Jamaican and African American women that may affect their empowerment and condom-use intentions, placing them at a more heightened risk of contracting HIV. The results indicate that women's sense of power, either in their relationships or within themselves, was not related to their condom-use self-efficacy or condom-use intentions. Although none of the five hypotheses was fully supported, related significant findings suggest that women's level of acculturation was negatively related to their intentions to negotiate condom use. The longer women were in the United States, the lower their condom-use intentions.

Behavioral and Academic Adjustment of Remotely Acculturating Adolescents in Urban Jamaica.

Remote acculturation (RA) is a modern form of non-migrant acculturation toward distant cultures prompted by indirect/intermittent globalization-related cultural exposure. RA theory holds that not only are global cultures now pouring into local neighborhoods, but many youth are also internalizing these remote cultures. How well do they fare? Prior studies in Jamaica and elsewhere have reported that U.S./Western-oriented adolescents exhibit poorer health habits. However, no studies have yet investigated adolescents' behavioral or academic adjustment in the context of RA, whether in Jamaica or elsewhere. Therefore, 245 adolescents and their mothers from high schools in Kingston, Jamaica (Madolescent_age   = 13.3; Mmother_age  = 40.2) completed questionnaires assessing their RA in terms of behaviors and values, as well as the adolescents' behavioral resilience and grades. SEM analyses revealed that RA was, indeed, linked to adolescent behavioral and academic adjustment in Jamaica. Overall, Jamaican orientation was associated with better adaptation whereas European American orientation was associated with worse.

Food and Nutrient Intakes of Jamaican Immigrants in Florida.

This study assessed dietary intakes, nutritional composition, and identified commonly eaten foods among Jamaicans in Florida. Dietary intake was assessed among 44 study participants to determine commonly eaten foods and nutrient composition. Weighed recipes were collected and analyzed to determine nutrient composition for traditional foods. Top foods that contributed to macronutrient and micronutrient intake were identified and adherence to dietary recommendations was evaluated. Mean daily energy intake was 2879 (SD 1179) kcal and 2242 (SD 1236) kcal for men and women respectively. Mean macronutrient intakes were above dietary recommendations for men and women. Top foods contributing to energy included rice and peas, sweetened juices, chicken, red peas soup, and hot chocolate drink. Results showed sodium intake was more than double the adequate intake estimate (1300-1500 mg). Findings highlight the need to include commonly eaten traditional foods in dietary questionnaires to accurately assess diet-related chronic disease risk. Findings have implications for risk factor intervention and prevention efforts among Jamaicans.

Predictors of diastolic dysfunction in ethnic groups: observations from the Hypertensive Cohort of The Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES).

The study aimed to establish a relationship of ethnicity to diastolic dysfunction in subjects of African-Caribbean and South Asian origins and the impact of diastolic dysfunction and ethnicity on all-cause and cardiovascular mortality. Hypertensive subjects with ejection fraction ≥55% and no history of ischaemic heart disease/valve pathology (n = 1546, 830 South Asians and 716 African-Caribbeans) were identified from the Ethnic-Echocardiographic Heart of England Screening Study (E-ECHOES). Diastolic function and cardiac remodelling were measured by echocardiography. African-Caribbean ethnicity was associated with lower prevalence of having diastolic dysfunction (odds ratio 0.67, 95% confidence interval 0.51-0.87, p = 0.003) and increased left ventricular filling pressure (odds ratio 0.48, 95% confidence interval 0.34-0.69, p < 0.001) as well as lower left atrial index (p < 0.001). This was the case despite the fact that African-Caribbean ethnicity was independently associated with higher left ventricular mass index (p < 0.001). Ninety-two deaths (6%) occurred during 68 ± 21 months follow-up. On Cox regression analysis, South Asian ethnicity (p = 0.024) was predictive of all-cause death before adjustment for parameters of diastolic dysfunction, but it was no longer predictive of death after accounting for these variables. South Asian ethnicity is independently associated with worse parameters of diastolic function in hypertension, despite African-Caribbeans having more prominent hypertrophy.

ESRD among Immigrants to Ontario, Canada: A Population-Based Study.

Background The epidemiology of ESRD requiring maintenance dialysis (ESRD-D) in large, diverse immigrant populations is unclear.Methods We estimated ESRD-D prevalence and incidence among immigrants in Ontario, Canada. Adults residing in Ontario in 2014 were categorized as long-term Canadian residents or immigrants according to administrative health and immigration datasets. We determined ESRD-D prevalence among these adults and calculated age-adjusted prevalence ratios (PRs) comparing immigrants to long-term residents. Among those who immigrated to Ontario between 1991 and 2012, age-adjusted ESRD-D incidence was calculated by world region and country of birth, with immigrants from Western nations as the referent group.Results Among 1,902,394 immigrants and 8,860,283 long-term residents, 1700 (0.09%) and 8909 (0.10%), respectively, presented with ESRD-D. Age-adjusted ESRD-D prevalence was higher among immigrants from sub-Saharan Africa (PR, 2.17; 95% confidence interval [95% CI], 1.84 to 2.57), Latin America and the Caribbean (PR, 2.11; 95% CI, 1.90 to 2.34), South Asia (PR, 1.45; 95% CI, 1.32 to 1.59), and East Asia and the Pacific (PR, 1.34; 95% CI, 1.22 to 1.46). Immigrants from Somalia (PR, 4.18; 95% CI, 3.11 to 5.61), Trinidad and Tobago (PR, 2.88; 95% CI, 2.23 to 3.73), Jamaica (PR, 2.88; 95% CI, 2.40 to 3.44), Sudan (PR, 2.84; 95% CI, 1.53 to 5.27), and Guyana (PR, 2.69; 95% CI, 2.19 to 3.29) had the highest age-adjusted ESRD-D PRs relative to long-term residents. Immigrants from these countries also exhibited higher age-adjusted ESKD-D incidence relative to Western Nations immigrants.Conclusions Among immigrants in Canada, those from sub-Saharan Africa and the Caribbean have the highest ESRD-D risk. Tailored kidney-protective interventions should be developed for these susceptible populations.

Understanding and Reducing Sexual Prejudice in Jamaica: Theoretical and Practical Insights From a Severely Anti-Gay Society.

Jamaica has earned an international reputation for severe sexual prejudice-perhaps disproportionately so compared to other severely anti-LGBT (lesbian, gay, bisexual, and transgender) societies. Until recently, however, no quantitative empirical research had investigated Jamaica's sexual prejudice, leaving the prejudice poorly understood and methods of reducing it unclear. This article reviews empirical research on Jamaican anti-LGBT prejudice from the past 15 years. It situates Jamaica within the global context, explains the current understanding of the severity and nature of the problem, evaluates solutions currently being explored, and suggests promising strategies based on available evidence. Importantly, this article also reflects on lessons learned from Jamaica that are relevant for other severely anti-LGBT societies.

"Sex Is a sin": Afro-Caribbean Parent and Teen Perspectives on Sex Conversations.

This study characterized (a) mothers' childhood and teenage experiences with sex conversations and (b) families' perceptions of current parent-child sex conversations within two underserved Afro-Caribbean communities in the U.S. Fourteen dyads comprised of Haitian and Jamaican mothers and teens (aged 14-18) living in Miami, Florida, completed semi-structured interviews sharing their experiences with sex conversations. Researchers analyzed data using thematic content analysis. Mothers' mean age was 41.85 years, (SD = 5.50) and teens' mean age was 16.35 years, (SD = 1.31). Most mothers reported forbidden or little childhood experiences with parent-child sex conversations. They affected their sexual attitudes, behaviors, and ability to discuss sex with their children. Although some mothers benefited from educational and skill development others shared fear-based messages with their children that some teens believed adversely affected the mother-child relationship quality. Culturally appropriate, skill-based approaches are necessary to improve families' communication self-efficacy for healthy sex conversations to occur in Afro-Caribbean families.

Feel American, Watch American, Eat American? Remote Acculturation, TV, and Nutrition Among Adolescent-Mother Dyads in Jamaica.

Globalization prompts remote acculturation toward U.S. culture in Jamaica; this study used a bioecological systems approach to examine its proximal impact on nutrition through U.S. cable TV consumption, and maternal influences in the home. Overall, 330 randomly selected adolescent-mother dyads from schools in Kingston, Jamaica (Madolescent_age  = 13.8 years, SDadolescent_age  = 1.8) completed questionnaires reporting American identity and behavioral preferences, daily time spent watching U.S.-produced TV programs, and frequency of eating unhealthy foods. Actor-partner interdependence models revealed that girls' American identity/behavior directly predicted their unhealthy eating, whereas girls' mothers and boys' American identity/behavior indirectly predicted unhealthy eating as mediated by their U.S. TV hours. Additionally, mothers' American identity/behavior predicted daughters' unhealthy eating as mediated by mothers' U.S. TV hours. Remote acculturation theory may facilitate more targeted research and prevention/intervention.

Body image disturbance and skin bleaching.

This study looks at body image disturbance among Jamaicans who bleach their skin. The hypothesis states that there is a positive relationship between skin bleaching and body image disturbance. The study used a convenience sample of 160 participants with a skin bleaching group (n = 80) and a non-bleaching comparison group (n = 80). The instrument included demographic questions, the body image disturbance questionnaire (BIDQ), and questions about skin bleaching. The results of a t-test revealed that the skin bleaching group (M = 1.5255, SD = 0.42169) was not significantly different from the non-bleaching group (M = 1.4938, SD = 0.74217) in terms of body image disturbance, t(158) = 0.333, p = .740. The participants who bleached did not suffer from body image disturbance. Self-reports revealed that they bleached to acquire beauty, attract a partner, elude the police, and market skin bleaching products. The practice was fashionable and popular and it made some participants feel good, while others were fans of a popular musical artiste who bleached his skin. The majority of participants bleached because of the perceived personal, social, and entrepreneurial benefits of the practice and not because they suffered emotional distress, anxiety, and functional impairment because of their skin colour. However, there was some level of BID among the minority of participants who argued that they bleached because they wanted to be pretty so they were emotionally distressed about there body image and experienced functional impairment.

Testosterone and Jamaican Fathers : Exploring Links to Relationship Dynamics and Paternal Care.

This paper investigates relationships between men's testosterone and family life in a sample of approximately 350 Jamaican fathers of children 18-24 months of age. The study recognizes the role of testosterone as a proximate mechanism coordinating and reflecting male life history allocations within specific family and cultural contexts. A sample of Jamaican fathers and/or father figures reported to an assessment center for an interview based on a standardized questionnaire and provided a saliva sample for measuring testosterone level. Outcomes measured include subject demographics such as age and relationship status as well as partnership quality and sexuality and paternal attitudes and behavior. The variation in these fathers' relationship status (e.g., married co-residential fathers, fathers in new non-residential relationships) was not associated with men's testosterone. Too few stepfathers participated to enable a direct test of the prediction that stepfathers would have higher testosterone than biological fathers, although fathers who reported living with partners' (but not his own) children did not have higher testosterone than fathers not reporting residing with a non-biological child. Fathers' relationship quality was negatively related to their testosterone. Measures of paternal attitudes and behavior were not related to fathers' testosterone. Consistent with previous ethnography, this sample of Jamaican fathers exhibited variable life history profiles, including residential status. We discuss why fathers' relationship quality was found to be negatively related to their testosterone level, but other predictions were not upheld.

Prostate cancer among Jamaican men: exploring the evidence for higher risk.

BACKGROUND: Historically, black men of African descent have been disproportionately affected by prostate cancer compared with Caucasian men. African-Caribbean men are generally at higher risk of prostate cancer, with Jamaican men noted to have the highest incidence in the world. No robust evidence exists for the increased incidence among Jamaican men, or indeed, a clear explanation for the reasons these men are at a greater risk of developing the disease in comparison with other African-Caribbean men. METHODS AND FINDINGS: A literature review was undertaken. The findings indicated that black men of African descent, specifically Jamaican men, are at greater risk of prostate cancer and this finding applies to Africa, the Caribbean, the UK and USA. CONCLUSIONS: Current evidence for the higher incidence of prostate cancer among Jamaican men remains inconclusive and does not provide a clear explanation for its prevalence. More comparative studies are required to identify any predisposing factors responsible for this anomaly, worldwide. The involvement of health professionals in these research undertakings is important to obtaining insight into prostate cancer and in devising strategies to improve management and health outcomes.

Jamaica, Three Years Later: Effects of Intensified Pro-Gay Activism on Severe Prejudice Against Lesbians and Gay Men.

Jamaica has developed an international reputation for severe anti-gay prejudice. However, in the past few years, between 2012 and 2015, intensified waves of activism have increased the visibility of lesbian, gay, bisexual, and transgender (LGBT) Jamaicans, and supported their social and legal inclusion in Jamaican society. This research investigated the effects of that activism by taking advantage of two large, representative surveys of Jamaicans' attitudes toward lesbians and gay men: one in 2012 and one in 2015. Over the three-year period there were significant reductions in desire for social distance and opposition to gay rights. However, there was no significant change in anti-gay attitudes, and there was evidence of an increase in anti-gay behaviors. There was also no evidence of polarization of responses to gay men and lesbians; rather, the most prejudiced Jamaicans showed the largest reductions in bias. Implications of these findings for activism in Jamaica and other anti-gay countries are discussed.

Maternal Origin and Risk of Neonatal and Maternal ICU Admission.

OBJECTIVES: To evaluate maternal world region of birth, as well as maternal country of origin, and the associated risk of admission of 1) a mother to a maternal ICU, 2) her infant to a neonatal ICU, or 3) both concurrently to an ICU. DESIGN: Retrospective population-based cohort study. SETTING: Entire province of Ontario, Canada, from 2003 to 2012. PATIENTS: All singleton maternal-child pairs who delivered in any Ontario hospital. MEASUREMENTS AND MAIN RESULTS: We explored how maternal world region of birth, and specifically, maternal country of birth for the top 25 countries, was associated with the outcome of 1) neonatal ICU, 2) maternal ICU, and 3) both mother and newborn concurrently admitted to ICU. Relative risks were adjusted for maternal age, parity, income quintile, chronic hypertension, diabetes mellitus, obesity, dyslipidemia, drug dependence or tobacco use, and renal disease. Compared with infants of Canadian-born mothers (110.7/1,000), the rate of neonatal ICU admission was higher in immigrants from South Asia (155.2/1,000), Africa (140.4/1,000), and the Caribbean (167.3/1,000; adjusted relative risk, 1.41; 95% CI, 1.36-1.46). For maternal ICU, the adjusted relative risk was 1.79 (95% CI, 1.43-2.24) for women from Africa and 2.21 (95% CI, 1.78-2.75) for women from the Caribbean. Specifically, mothers from Ghana (adjusted relative risk, 2.71; 95% CI, 1.75-4.21) and Jamaica (adjusted relative risk, 2.74; 95% CI, 2.12-3.53) were at highest risk of maternal ICU admission. The risk of both mother and newborn concurrently admitted to ICU was even more pronounced for Ghana and Jamaica. CONCLUSIONS: Women from Africa and the Caribbean and, in particular, Ghana and Jamaica, are at higher risk of admission to ICU around the time of delivery, as are their newborns.

The prevalence of major potential drug-drug interactions at a University health centre pharmacy in Jamaica / Prevalencia de interacciones potenciales medicamento-medicamento en una farmacia de centro de salud universitario en Jamaica

Objective: To identify major potential drug-drug interactions (DDIs) on prescriptions filled at the University Health Centre Pharmacy, Mona Campus, Jamaica. Methods: This investigation utilised a cross-sectional analysis on all prescriptions with more than one drug that were filled at the Health Centre Pharmacy between November 2012 and February 2013. Potential DDIs were identified using the online Drug Interactions Checker database of Drugs.com. Results: During the period of the study, a total of 2814 prescriptions were analysed for potential DDIs. The prevalence of potential DDIs found during the study period was 49.82%. Major potential DDIs accounted for 4.7 % of the total number of interactions detected, while moderate potential DDIs and minor potential DDIs were 80.8 % and 14.5 % respectively. The three most frequently occurring major potential DDIs were amlodipine and simvastatin (n=46), amiloride and losartan (n=27) and amiloride and lisinopril (n=16). Conclusion: This study has highlighted the need for educational initiatives to ensure that physicians and pharmacists collaborate in an effort to minimise the risks to the patients. These interactions are avoidable for the most part, as the use of online tools can facilitate the selection of therapeutic alternatives or guide decisions for closer patient monitoring and thus reduce the risks of adverse events (AU)

Objetivo: Identificar interacciones potenciales medicamento-medicamento (DDI) en las prescripciones atendidas en la farmacia del centro de salud de Universitario del campus de Mona, Jamaica. Métodos: Esta investigación utilizó un análisis transversal de todas las prescripciones con más de un medicamento que fueron atendidas en el centro de salud universitario entre noviembre de 2012 y febrero de 2013. Las DDI potenciales se identificaban en el Drug Interactions Checker de la base de datos Drugs.com. Resultados: Durante el periodo de estudio, se analizaron a la busca de DDI un total de 2.814 prescripciones. La prevalencia de DDI potenciales encontrada durante el estudio fue del 49,82%. Las DDI major potenciales totalizaron el 4,7% del total de interaciones detectadas, mientras que las moderadas y minor fueron el 80,8% y el 14,5%, respectivamente. Las tres DDI potenciales major que aparecieron más frecuentemente fueron amlodipina y simvastatina (n=46), amilorida y losartan (n=27), y amilorida y lisinopril (n=16). Conclusión: Este estudio ha remarcado la necesidad de iniciativas educativas para asegurar que los médicos y los farmacéuticos colaboren en el esfuerzo de minimizar los riesgos de los pacientes. Estas interacciones eran evitables en su mayor parte, ya que el uso de herramientas online puede facilitar la selección de tratamientos alternativos o guiar decisiones para monitorizar más de cerca a los pacientes, y así reducir el riesgo de eventos adversos (AU)