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1.
Eur J Cancer Care (Engl) ; 28(2): e12997, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30748056

RESUMO

INTRODUCTION: A shift in focus towards risk stratification and survivorship in early stage endometrial cancer (EC) has led to the replacement of hospital follow-up (HFU) with patient-initiated follow-up (PIFU) schemes. METHODS: A mixed methods study was undertaken prospectively to investigate utility and patient satisfaction with a newly introduced PIFU scheme. RESULTS: Two hundred and twenty-eight women were enrolled onto PIFU in the first 18 months, median age 65 years (range 42-90 years). Twenty-four (10.5%) women were non-British White ethnicity. Forty-five women contacted the Clinical Nurse Specialist (CNS) at least once (19.7%), the primary reason being vaginal bleeding/discharge (42%). Contact was greater in first six months on the scheme compared to the second 6 months, and women who made contact were significantly younger than those who did not (57 years vs. 65 years, p < 0.001). CONCLUSIONS: PIFU appears to be well received by the majority of women. Although many of the CNS contacts were due to physical symptoms, a number were for psychological support or reassurance. Younger women had greater CNS contact indicating that they may benefit from a greater level support. Patient feedback of the PIFU scheme was positive, with many women reporting that it enabled them to have more control over their own health.


Assuntos
Neoplasias do Endométrio/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Grupo com Ancestrais do Continente Africano/etnologia , Assistência ao Convalescente , Idoso , Idoso de 80 Anos ou mais , Ásia Ocidental/etnologia , Neoplasias do Endométrio/etnologia , Neoplasias do Endométrio/psicologia , Inglaterra/epidemiologia , Grupo com Ancestrais do Continente Europeu/etnologia , Feminino , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Satisfação do Paciente , Estudos Prospectivos , Qualidade de Vida , Classe Social , Hemorragia Uterina/etnologia , Hemorragia Uterina/etiologia , Descarga Vaginal/etnologia , Descarga Vaginal/etiologia , Índias Ocidentais/etnologia
2.
J Head Trauma Rehabil ; 34(1): E46-E54, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29863616

RESUMO

OBJECTIVE: To examine the influence of nativity and residential characteristics on productive activity among Hispanics at 1 year after traumatic brain injury (TBI). SETTING: Acute rehabilitation facilities and community follow-up. PARTICIPANTS: A total of 706 Hispanic individuals in the TBI Model Systems National Database. DESIGN: Secondary data analysis from a multicenter longitudinal cohort study. MAIN MEASURES: Nativity (foreign born or US native), productive activity derived from interview questions regarding employment status, and other demographic information. Census data were extracted by zip code to represent residential characteristics of aggregate household income and proportion of foreign language speakers (FLS). RESULTS: Among foreign-born individuals with TBI, those living in an area with a higher proportion of FLS were 2.8 times more likely to be productive than those living in areas with a lower proportion of FLS. Among individuals living in an area with a lower proportion of FLS, US-born Hispanics were 2.7 times more likely to be productive compared with Hispanic immigrants. CONCLUSION: The relationship between nativity and productive activity at 1 year post-TBI was moderated by the residential proportion of FLS. Findings underscore the importance of considering environmental factors when designing vocational rehabilitation interventions for Hispanics after TBI.


Assuntos
Lesões Encefálicas Traumáticas/etnologia , Emigrantes e Imigrantes , Emprego , Hispano-Americanos , Meio Social , Adulto , América Central/etnologia , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , México/etnologia , Características de Residência , Estados Unidos/epidemiologia , Índias Ocidentais/etnologia
3.
Eur J Cancer Care (Engl) ; 28(2): e12977, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30548713

RESUMO

Access and recruitment barriers may have contributed to the underrepresentation of Black African/Caribbean men and their partners in current psychosocial research related to prostate cancer survivors. Whilst some studies have explored recruitment barriers and facilitators from participants' perspectives, little is known from researchers' point of view. This paper aimed to address this gap in the literature. Recruitment strategies included the following: cancer support groups, researchers' networks, media advertisement, religious organisations, National Health Service hospitals and snowball sampling. Thirty-six eligible participants (men = 25, partners = 11) were recruited into the study. Recruitment barriers comprised of gate-keeping and advertisement issues and the stigma associated with prostate cancer disclosure. Facilitators which aided recruitment included collaborating with National Health Service hospitals, snowball sampling, flexible data collection, building rapport with participants to gain their trust and researcher's attributes. Findings highlight that "hard to reach" Black African/Caribbean populations may be more accessible if researchers adopt flexible but strategic and culturally sensitive recruitment approaches. Such approaches should consider perceptions of stigma associated with prostate cancer within these communities and the influence gatekeepers can have in controlling access to potential participants. Increased engagement with healthcare professionals and gatekeepers could facilitate better access to Black African/Caribbean populations so that their voices can be heard and their specific needs addressed within the healthcare agenda.


Assuntos
Grupo com Ancestrais do Continente Africano/etnologia , Seleção de Pacientes , Neoplasias da Próstata/etnologia , Adolescente , Adulto , Publicidade , Afro-Americanos/etnologia , Afro-Americanos/psicologia , Grupo com Ancestrais do Continente Africano/psicologia , Idoso , Revelação , Feminino , Controle de Acesso , Acesso aos Serviços de Saúde , Humanos , Relações Interinstitucionais , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Neoplasias da Próstata/psicologia , Pesquisa Qualitativa , Parceiros Sexuais , Estereotipagem , Índias Ocidentais/etnologia , Adulto Jovem
5.
Prog Urol ; 28(8-9): 442-449, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29789237

RESUMO

PURPOSE: Few studies have investigated predictive risk factors of biochemical recurrence (BCR) after radical prostatectomy (RP) in other than Caucasian and Asian populations. We aimed to identify pre- and post-operative predictors of BCR after RP in an Afro-Caribbean population in Guadeloupe (French West Indies). PATIENTS AND METHODS: The study included 964 patients who underwent RP for clinically localized prostate cancer between April 1, 2000 and December 31, 2010 in the University Hospital of Guadeloupe. The hazard ratio (HR) and corresponding 95% confidence interval (CI) for single variable associations with BCR were calculated using the Cox proportional hazards regression. Multiple variable analyses for association with BCR were performed, including all variables that reached statistical significance (P value<0.05) in univariate analysis. A backward selection model was then applied with a P value ≥0.1 for retention in the final model. Sensitivity analysis was performed and restricted to patients with known values for all variables (complete case analysis). RESULTS: With a median follow-up of 4.8 years, the BCR rate was 26.7%. In multivariable analysis, predictors of BCR before surgery were diabetes mellitus type 2 (DT2) (HR: 1.37, 95% CI: 1.02-1.85; P=0.038), pre-operative PSA>7.5ng/ml (1.49, 1.15-1.92; P=0.002), clinical stage T2 (1.55, 1.21-1.98; P=0.0006), Gleason score>7 or 4+3 (2.12, 1.54-2.91; P<0.0001), and percentage of length of biopsy positive scores (1.66, 1.24-2.20; P=0.0006). Predictors of BCR after surgery were DT2 (HR: 1.37, 95% CI: 1.01-1.85; P=0.045), pre-operative PSA>7.5ng/ml (1.37, 1.06-1.79; P=0.018), pathological Gleason score>7 or 4+3 (2.36, 1.74-3.19; P<0.0001), pathological stage pT3b (1.68, 1.15-2.45; P=0.007), positive surgical margins (1.72, 1.32-2.45; P=0.0001), and perioperative blood loss>2000ml (3.74, 1.37-10.2; P=0.01). The results were virtually the same by sensitivity analysis (complete cases), except for DT2, which was associated with BCR with borderline statistical significance in the pre-operative model and not retained in the post-operative model. CONCLUSIONS: Afro-Caribbean populations in French West Indies share the same major clinical and pathological risk factors of BCR after RP identified in other ethnic groups. Perioperative blood loss appears to be an additional and independent predictive factor of BCR. LEVEL OF PROOF: 4.


Assuntos
Biomarcadores Tumorais/sangue , Recidiva Local de Neoplasia/diagnóstico , Prostatectomia/métodos , Neoplasias da Próstata/etnologia , Neoplasias da Próstata/cirurgia , Adulto , Grupo com Ancestrais do Continente Africano/etnologia , Idoso , Biomarcadores Tumorais/análise , Seguimentos , Guadalupe/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/etnologia , Recidiva Local de Neoplasia/mortalidade , Valor Preditivo dos Testes , Prognóstico , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Fatores de Risco , Análise de Sobrevida , Índias Ocidentais/etnologia
6.
Gynecol Oncol ; 149(1): 63-69, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29605052

RESUMO

OBJECTIVE: We studied cervical cancer patients who presented to the Public Hospital System in ethnically-diverse Queens, New York from 2000 to 2010 with the purpose of examining the relationship between nativity (birthplace) and survival. METHODS: A retrospective review of tumor registries was used to identify patients diagnosed with cervical cancer between January 1, 2000 and December 31, 2010. Using electronic medical records, data from 317 patients were available for this analysis. RESULTS: The majority of patients were born outside the United States (US) (85.5% versus 14.5%). One hundred patients (31.5%) were born in Latin America, 105 in the Caribbean Islands (33.1%), 48 in Asia (15.1%), 8 in the South Asia (2.5%), 10 in Russia/Eastern Europe (3.2%) and 46 (14.5%) in the United States. Patients presented at varying stages of disease: 51.4% at stage I, 19.6% at stage II, 19.6% at stage III, and 8.5% at stage IV. Kaplan-Meier estimated survival curves stratified by birthplace demonstrated significant differences in survival distributions among the groups using the log-rank test (P<0.0001). The most favorable survival curves were observed among patients born in Latin America and Asia whereas the least favorable was demonstrated in US-born patients. Time to death was analyzed using the Cox proportional hazards model. Adjusting for age at diagnosis, insurance status, stage and treatment modality, nodal metastases and hydronephrosis, birthplace was significantly associated with survival time (P<0.0001). CONCLUSION: An immigrant health paradox was defined for foreign-born Latino and Asian patients presenting with cervical cancer to the Public Hospital System of Queens, New York as patients born in Latin America and Asia were less likely to die at any given time compared to those born in the United States.


Assuntos
Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/mortalidade , Ásia/etnologia , Emigrantes e Imigrantes/estatística & dados numéricos , Europa Oriental/etnologia , Feminino , Disparidades nos Níveis de Saúde , Hospitais Públicos/estatística & dados numéricos , Humanos , América Latina/etnologia , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Grupos Populacionais/estatística & dados numéricos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Índias Ocidentais/etnologia
7.
Diabet Med ; 35(6): 737-744, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29460341

RESUMO

AIMS: To estimate the incidence of Type 2 diabetes in children aged <17 years, compare this with similar data 10 years ago, and characterize clinical features at diagnosis in the UK and Republic of Ireland. METHODS: Using the British Paediatric Surveillance Unit reporting framework, cases of Type 2 diabetes diagnosed in children aged <17 years between 1 April 2015 and 30 April 2016 were reported each month. RESULTS: A total of 106 cases were reported, giving a UK incidence of 0.72/100 000 (95% CI 0.58-0.88). Children from ethnic minorities had significantly higher incidence compared with white children (0.44/100 000) with rates of 2.92/100 000 and 1.67/100 000, in Asian and BACBB (black/African/Caribbean/black British) children respectively. Sixty-seven percent were girls and 81% had a family history of Type 2 diabetes. The mean BMI sd score at diagnosis was 2.89 (2.88, girls; 2.92, boys); 81% were obese. Children of Asian ethnicity had a significantly lower BMI sd score compared with white children (P<0.001). There was a trend in increased incidence from 2005 to 2015, with a rate ratio of 1.35 (95% CI 0.99-1.84), although this was not statistically significant (P=0.062). There was statistical evidence of increased incidence among girls (P=0.03) and children of South-Asian ethnicity (P=0.01) when comparing the 2005 and 2015 surveys. CONCLUSIONS: Type 2 diabetes remains far less common than Type 1 diabetes in childhood in the UK, but the number of cases continues to rise, with significantly increased incidence among girls and South-Asian children over a decade. Female gender, family history, non-white ethnicity and obesity were found to be strongly associated with the condition.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Adolescente , Ásia/etnologia , Índice de Massa Corporal , Criança , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/etnologia , Grupo com Ancestrais do Continente Europeu/etnologia , Feminino , Humanos , Incidência , Irlanda/epidemiologia , Masculino , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/etnologia , Estudos Prospectivos , Distribuição por Sexo , Inquéritos e Questionários , Reino Unido/epidemiologia , Índias Ocidentais/etnologia
8.
J Immigr Minor Health ; 20(1): 124-139, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-27646823

RESUMO

Despite an abundant literature on social support and health, relatively less is known about how support and its impact on physical health vary within the Black population. Using the National Survey of American Life (NSAL), this paper examines which sources and types of support are associated with physical health among African Americans, U.S.-born Caribbean Blacks and foreign-born Caribbean Blacks. The results showed that for U.S.-born Caribbean Blacks, being married was especially beneficial to health. Closeness to family was associated with better health while negative interactions with family members was associated with worse health for African Americans and foreign-born Caribbean Blacks. Different sources of instrumental support affected all three groups. Overall, the findings reveal that, among Black Americans, the association between social support and physical health is contingent upon ethnicity, nativity, and the ways in which social support and health are operationalized.


Assuntos
Afro-Americanos , Grupos Étnicos , Nível de Saúde , Apoio Social , Adulto , Região do Caribe/etnologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Índias Ocidentais/etnologia
9.
J Immigr Minor Health ; 20(3): 536-545, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29209931

RESUMO

We sought to characterize non-communicable disease (NCD)-related and overall health service use among African and Caribbean immigrants living with HIV between April 1, 2010 and March 31, 2013. We conducted two population-based analyses using Ontario's linked administrative health databases. We studied 1525 persons with HIV originally from Africa and the Caribbean. Compared with non-immigrants with HIV (n = 11,931), African and Caribbean immigrants had lower rates of hospital admissions, emergency department visits and non-HIV specific ambulatory care visits, and higher rates of health service use for hypertension and diabetes. Compared with HIV-negative individuals from these regions (n = 228,925), African and Caribbean immigrants with HIV had higher rates of health service use for chronic obstructive pulmonary disease [rate ratio (RR) 1.78; 95% confidence interval (CI) 1.36-2.34] and malignancy (RR 1.20; 95% CI 1.19-1.43), and greater frequency of hospitalizations for mental health illness (RR 3.33; 95% CI 2.44-4.56), diabetes (RR 1.37; 95% CI 1.09-1.71) and hypertension (RR 1.85; 95% CI 1.46-2.34). African and Caribbean immigrants with HIV have higher rates of health service use for certain NCDs than non-immigrants with HIV. The evaluation of health services for African and Caribbean immigrants with HIV should include indicators of NCD care that disproportionately affect this population.


Assuntos
Comorbidade , Emigrantes e Imigrantes , Infecções por HIV/epidemiologia , Doenças não Transmissíveis/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Adolescente , Adulto , África/etnologia , Idoso , Bases de Dados Factuais , Feminino , Infecções por HIV/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/etnologia , Ontário/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Índias Ocidentais/etnologia , Adulto Jovem
10.
Diabet Med ; 35(4): 513-518, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29266374

RESUMO

AIMS: To describe early progress of the Healthier You: NHS Diabetes Prevention Programme, a behavioural intervention designed to prevent or delay onset of Type 2 diabetes in people in England already identified to be at high risk, to assess numbers of referrals received by Programme providers and the proportion that attended the initial assessment, and to identify the factors associated with attendance rates. METHODS: These analyses examine the data for referrals received between June 2016 and March 2017. RESULTS: There were 43 603 referrals received, 16% higher than expected. Of those referred, 49% attended the initial assessment, higher than the 40% modelled uptake. Of those referred, there was no significant difference in uptake by sex (P=0.061); however, attendance per 100 000 population varied significantly by sex, age group, ethnicity and deprivation; it was significantly lower for men (P<0.001), higher as age increased (P<0.001) and higher for individuals from Asian, Afro-Caribbean, mixed and other ethnic groups compared with individuals from white European groups (P<0.001). There was significant interaction between attendance rates by ethnicity and deprivation (P<0.001) such that attendance rates were significantly higher in the most deprived quintile vs the least deprived quintile for Asian, Afro-Caribbean, mixed and other ethnic groups but not significantly different for white European ethnic groups. CONCLUSION: The analyses show that referral numbers and percentage uptake are in excess of prior modelled values. Characteristics of attendees suggest that the programme is reaching those who are both at greater risk of developing Type 2 diabetes and who typically access healthcare less effectively.


Assuntos
Terapia Comportamental/estatística & dados numéricos , Diabetes Mellitus Tipo 2/prevenção & controle , Adulto , Idoso , Ásia/etnologia , Diabetes Mellitus Tipo 2/etnologia , Inglaterra/epidemiologia , Grupo com Ancestrais do Continente Europeu/etnologia , Utilização de Instalações e Serviços , Feminino , Promoção da Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Índias Ocidentais/etnologia
11.
J Racial Ethn Health Disparities ; 5(4): 808-819, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-28842841

RESUMO

BACKGROUND: Despite the well-established literature on the protective effect of socioeconomic status (SES) on physical and mental health, there are a few reports on poor mental health of blacks with high SES. Using a national sample, this study investigated the association between household income and risk of major depressive disorder (MDD) in black youth based on ethnicity, gender, and their intersection. METHODS: One thousand one hundred seventeen black adolescents (810 African Americans and 360 Caribbean blacks) were included in the current study. Household income was the main predictor. MDD (lifetime, 12-month, and 30-day) was the main outcome. Age was the covariate. Ethnicity and gender were the focal moderators. Logistic regressions were used for data analysis. RESULTS: In the pooled sample, household income was not associated with risk of MDD (lifetime, 12-month, or 30-day). We found significant interactions between income and gender on lifetime and 12-month MDD, suggesting a stronger protective effect of income on MDD for females than males. We also found significant interaction between income and ethnicity on 30-day MDD, suggesting stronger protective effect of income against MDD for Caribbean blacks than African Americans. In African American males, high household income was associated with higher risk of lifetime, 12-month, and 30-day MDD. For Caribbean black males and females, high household income was associated with lower odds of 30-day MDD. CONCLUSION: Findings suggest that ethnicity and gender influence how socioeconomic resources such as income are associated with MDD risk among black youth. Higher household income may be associated with higher risk of MDD for African American males.


Assuntos
Afro-Americanos/psicologia , Grupo com Ancestrais do Continente Africano/psicologia , Transtorno Depressivo Maior/etnologia , Inquéritos Epidemiológicos/estatística & dados numéricos , Fatores Socioeconômicos , Adolescente , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Estudos Transversais , Humanos , Masculino , Fatores de Risco , Estados Unidos/etnologia , Índias Ocidentais/etnologia
12.
Eur J Neurol ; 24(5): 694-702, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28236340

RESUMO

BACKGROUND AND PURPOSE: Although there is growing and convincing evidence that socially deprived patients are at higher risk of stroke and worse outcomes, it remains controversial whether or not they suffer more severe stroke. This study aimed to evaluate the influence of social deprivation on initial clinical severity in patients with stroke. METHODS: A total of 1536 consecutive patients with an acute first-ever stroke (both ischaemic stroke and intracerebral hemorrhage) were prospectively enrolled from six French study centers. Stroke severity on admission was measured by the National Institutes of Health Stroke Scale score. Social deprivation was assessed at the individual level by the Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examen de Santé (EPICES) score, a validated multidimensional questionnaire, and several additional single socioeconomic indicators. Polytomous logistic regression analyses were performed to evaluate the association between social deprivation and stroke severity. RESULTS: In univariate analysis, the EPICES score (P = 0.039) and level of education (P = 0.018) were the only two socioeconomic variables associated with stroke severity. Multivariate analysis of the association between EPICES and National Institutes of Health Stroke Scale scores showed that more deprived patients presented a significantly higher risk of both mild and moderate/severe stroke (odds ratio for mild versus minor stroke, 1.39; 95% confidence interval, 1.06-1.84; odds ratio for moderate/severe versus minor stroke, 1.44; 95% confidence interval, 1.09-1.92). A non-significant trend towards a higher risk of both mild and moderate/severe stroke in less educated patients was observed. CONCLUSIONS: Social deprivation was associated with a more severe clinical presentation in patients with stroke. These findings may contribute to the worse outcome after stroke in deprived patients, and underline the need for strategies to reduce social inequalities for stroke.


Assuntos
Carência Psicossocial , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/complicações , Hemorragia Cerebral/etiologia , Estudos de Coortes , Feminino , França/etnologia , Guiana Francesa/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Índias Ocidentais/etnologia
13.
Cultur Divers Ethnic Minor Psychol ; 23(3): 348-361, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28206778

RESUMO

OBJECTIVES: This study examined directionality between personal (i.e., coherence and confusion) and cultural identity (i.e., ethnic and U.S.) as well as their additive effects on psychosocial functioning in a sample of recently immigrated Hispanic adolescents. METHOD: The sample consisted of 302 recent (<5 years) immigrant Hispanic adolescents (53% boys; Mage = 14.51 years at baseline; SD = .88 years) from Miami and Los Angeles who participated in a longitudinal study. RESULTS: Results indicated a bidirectional relationship between personal identity coherence and both ethnic and U.S. identity. Ethnic and U.S. affirmation/commitment (A/C) positively and indirectly predicted optimism and negatively predicted rule breaking and aggression through coherence. However, confusion predicted lower self-esteem and optimism and higher depressive symptoms, rule breaking, unprotected sex, and cigarette use. Results further indicated significant site differences. In Los Angeles (but not Miami), ethnic A/C also negatively predicted confusion. CONCLUSION: Given the direct effects of coherence and confusion on nearly every outcome, it may be beneficial for interventions to target personal identity. However, in contexts such as Los Angeles, which has at least some ambivalence toward recently immigrated Hispanic adolescents, it may be more beneficial for interventions to also target cultural identity to reduce confusion and thus promote positive development. (PsycINFO Database Record


Assuntos
Aculturação , Cultura , Emigrantes e Imigrantes/psicologia , Hispano-Americanos/psicologia , Identificação Psicológica , Identificação Social , Adolescente , América Central/etnologia , Colômbia/etnologia , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Florida , Hispano-Americanos/estatística & dados numéricos , Humanos , Estudos Longitudinais , Los Angeles , Masculino , México/etnologia , Índias Ocidentais/etnologia
14.
J Immigr Minor Health ; 19(5): 1009-1017, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-27334006

RESUMO

Puerto Ricans in the US experience higher deaths from diabetes and other causes compared to non-Hispanic Whites and other Hispanic groups. We compared mortality in Puerto Rico to that of Puerto Ricans in the US as a first step to investigate if similar or worse mortality patterns originate from the sending country (Puerto Rico). Age-adjusted death rates were generated using national vital statistics databases in the US and territories for all-cause and the top ten causes of death among Hispanics in 2009. Mortality ratios in the archipelago of Puerto Rico (APR) were compared to mainland US Puerto Ricans (MPR). Rates for other ethnic/racial groups (Mexican Americans, Cubans, and non-Hispanic Whites, Blacks, American Indians, and Asians) were calculated to provide a context. APR had significantly higher all-cause mortality and death rates for diabetes, nephritis, pneumonia/influenza, and homicide/assault compared to MPR (APR/MPR ratio for all-cause: 1.08, diabetes: 2.04, nephritis: 1.84, pneumonia/influenza: 1.33, homicide/assault: 3.15). Death rates for diabetes and homicide/assault (particularly among men) were higher among APR compared to any other racial/ethnic groups in the US. In contrast, deaths from heart disease, cancer, and chronic liver disease were significantly lower for APR compared to MPR (MPR/APR ratio 0.72, 0.91, 0.41, respectively). Among APR women, death rates for these causes were also lower compared to any other group in the US. Substantial mortality variability exists between Puerto Ricans in Puerto Rico and those in the US, re-emphasizing the need to study of how socio-environmental determinants of health differ in sending and receiving countries. Explanations for disparate rates include access to and availability of healthcare and unique factors related to the migration experience of this group.


Assuntos
Hispano-Americanos/estatística & dados numéricos , Mortalidade/etnologia , Causas de Morte , Grupos de Populações Continentais/estatística & dados numéricos , Estudos Transversais , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Porto Rico/epidemiologia , Estados Unidos/epidemiologia , Índias Ocidentais/etnologia
15.
Rheumatology (Oxford) ; 56(3): 445-450, 2017 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-27940591

RESUMO

Objectives: Granulomatosis with polyangiitis (GPA) mainly affects white Europeans, but rarely GPA may also affect non-Europeans. This study aimed to describe GPA clinical-biological presentation and outcome in black sub-Saharan Africans and Afro-Caribbeans and in North Africans. Methods: Among 914 GPA patients included in the French Vasculitis Study Group database, geographic origin and ethnicity were known for 760. Clinical-biological presentations and outcomes of white Europeans vs black sub-Saharans and Afro-Caribbeans and vs North Africans were analysed. Results: Among the 760 patients, 689 (91%) were white Europeans, 33 (4.3%) were North Africans and 22 (2.9%) were sub-Saharans (n = 8) or Afro-Caribbeans (French West Indies, n = 14). Black sub-Saharans and Afro-Caribbeans, compared with white Europeans, were significantly younger at GPA diagnosis (P = 0.003), had more frequent central nervous system involvement (P = 0.02), subglottic stenosis (P = 0.002) and pachymeningitis (P = 0.009), and tended to have more frequent chondritis and retroorbital tumour. Median serum creatinine levels and Birmingham Vasculitis Activity Score were significantly lower in sub-Saharans and Afro-Caribbeans (P = 0.002 and P = 0.003, respectively). In contrast, in comparison with white Europeans, North Africans had only less frequent arthralgias (P = 0.004). Time to relapse was shorter for black sub-Saharans and Afro-Caribbeans compared with white Europeans [adjusted HR = 1.96 (95% CI: 1.09, 3.51) (P = 0.02)], and did not differ for North Africans. In contrast, overall survival was not significantly different according to ethnicity. Conclusion: Our findings indicated different GPA clinical presentations in white Europeans and sub-Saharans and Afro-Caribbeans, with black patients having more frequent severe granulomatous manifestations. In addition, time to relapse was significantly shorter for black sub-Saharans and Afro-Caribbeans compared with white Europeans.


Assuntos
Doenças das Cartilagens/etnologia , Granulomatose com Poliangiite/etnologia , Laringoestenose/etnologia , Meningite/etnologia , Vasculite do Sistema Nervoso Central/etnologia , Adulto , África ao Sul do Saara/etnologia , África do Norte/etnologia , Grupo com Ancestrais do Continente Africano/etnologia , Distribuição por Idade , Idoso , Doenças das Cartilagens/etiologia , Creatinina/sangue , Grupo com Ancestrais do Continente Europeu/etnologia , Feminino , França/epidemiologia , Granulomatose com Poliangiite/sangue , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/fisiopatologia , Humanos , Laringoestenose/etiologia , Masculino , Meningite/etiologia , Pessoa de Meia-Idade , Recidiva , Fatores de Tempo , Vasculite do Sistema Nervoso Central/etiologia , Índias Ocidentais/etnologia
16.
Arch Dis Child ; 102(3): 232-237, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27672135

RESUMO

OBJECTIVE: Early puberty in girls is linked to some adverse outcomes in adolescence and mid-life. We address two research questions: (1) Are socioeconomic circumstances and ethnicity associated with early onset puberty? (2) Are adiposity and/or psychosocial stress associated with observed associations? DESIGN: Longitudinal data on 5839 girls from the UK Millennium Cohort Study were used to estimate associations between ethnicity, family income, adiposity and psychosocial stress with a marker of puberty. MAIN OUTCOME MEASURE: Reported menstruation at age 11 years. RESULTS: All quoted ORs are statistically significant. Girls in the poorest income quintile were twice as likely (OR=2.1), and the second poorest quintile nearly twice as likely (OR=1.9) to have begun menstruation compared with girls in the richest income quintile. Estimates were roughly halved on adjustment for Body Mass Index and markers of psychosocial stress (poorest, OR=1.5; second poorest, OR=1.5). Indian girls were over 3 times as likely compared with whites to have started menstruation (OR=3.5) and statistical adjustments did not attenuate estimates. The raised odds of menstruation for Pakistani (OR=1.9), Bangladeshi (OR=3.3) and black African (OR=3.0) girls were attenuated to varying extents, from about a third to a half, on adjustment for income and adiposity. CONCLUSIONS: In contemporary UK, excess adiposity and psychosocial stress were associated with social inequalities in early puberty, while material disadvantage and adiposity were linked to ethnic inequalities in early puberty among girls.


Assuntos
Puberdade Precoce/etnologia , Adiposidade/etnologia , Ásia Ocidental/etnologia , Criança , Feminino , Humanos , Renda , Estudos Longitudinais , Menarca/etnologia , Menstruação/etnologia , Estudos Prospectivos , Fatores Socioeconômicos , Estresse Psicológico/etnologia , Reino Unido/epidemiologia , Índias Ocidentais/etnologia
17.
Br J Cancer ; 114(5): 597-604, 2016 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-26867159

RESUMO

BACKGROUND: Cancer fear and fatalism are believed to be higher in ethnic minorities and may contribute to lower engagement with cancer prevention and early detection. We explored the levels of cancer fear and fatalism in six ethnic groups in the United Kingdom and examined the contribution of acculturation and general fatalism. METHODS: A cross-sectional survey of 720 White British, Caribbean, African, Indian, Pakistani, and Bangladeshi women (120 of each) was conducted. Three items assessed cancer fear and two cancer fatalism. Acculturation was assessed using (self-reported) migration status, ability to speak English, and understanding of health leaflets; general fatalism with a standard measure. RESULTS: Relative to White British women, African and Indian women were more fearful of cancer, Bangladeshi women less fearful, and Pakistani and Caribbean women were similar to White British women. Cancer fatalism was higher in all the ethnic minority groups compared with White British women. Less acculturated women were less likely to worry (ORs 0.21-0.45, all P<0.05) or feel particularly afraid (ORs 0.11-0.31, all P<0.05) but more likely to feel uncomfortable about cancer (ORs 1.97-3.03, all P<0.05). Lower acculturation (ORs 4.30-17.27, P<0.05) and general fatalism (OR 2.29, P<0.05) were associated with the belief that cancer is predetermined. CONCLUSIONS: In general, cancer fear and fatalism are more prevalent among ethnic minority than White British women and even more so in less acculturated ethnic minorities. This may affect their participation in cancer prevention and early detection.


Assuntos
Aculturação , Atitude Frente a Saúde/etnologia , Emigrantes e Imigrantes/psicologia , Grupos Étnicos/psicologia , Medo/psicologia , Grupos Minoritários/psicologia , Neoplasias/psicologia , Mulheres/psicologia , Adulto , África/etnologia , Grupo com Ancestrais do Continente Africano/psicologia , Grupo com Ancestrais do Continente Asiático/psicologia , Bangladesh/etnologia , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/psicologia , Feminino , Humanos , Índia/etnologia , Pessoa de Meia-Idade , Paquistão/etnologia , Reino Unido , Índias Ocidentais/etnologia
18.
Diabet Med ; 33(6): 786-93, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26484398

RESUMO

AIMS: To determine the cultural competence of diabetes services delivered to minority ethnic groups in a multicultural UK city with a diabetes prevalence of 4.3%. METHODS: A semi-structured survey comprising 35 questions was carried out across all 66 general practices in Coventry between November 2011 and January 2012. Data were analysed using descriptive statistics. The cultural competence of diabetes services reported in the survey was assessed using a culturally competent assessment tool (CCAT). RESULTS: Thirty-four general practices (52%) responded and six important findings emerged across those practices. (1) Ninety-four per cent of general practices reported the ethnicity of their populations. (2) One in three people with diabetes was from a minority ethnic group. (3) Nine (26.5%) practices reported a diabetes prevalence of between 55% and 96% in minority ethnic groups. (4) The cultural competences of diabetes services were assessed using CCAT; 56% of practices were found to be highly culturally competent and 26% were found to be moderately culturally competent. (5) Ten practices (29%) reported higher proportionate attendance at diabetes annual checks in the majority white British population compared with minority ethnic groups. (6) Cultural diversity in relation to language and strong cultural traditions around food were most commonly reported as barriers to culturally competent service delivery. CONCLUSIONS: Seven of the eight cultural barriers identified in the global evidence were present in the city. Use of the CCAT to assess existing service provision and the good baseline recording of ethnicity provide a sound basis for commissioning culturally competent interventions in the future.


Assuntos
Assistência à Saúde Culturalmente Competente/normas , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Atenção Primária à Saúde/normas , Agendamento de Consultas , Ásia Ocidental/etnologia , Cidades , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 2/etnologia , Inglaterra/epidemiologia , Medicina Geral/normas , Pesquisas sobre Serviços de Saúde , Humanos , Grupos Minoritários , Saúde da População Urbana , Índias Ocidentais/etnologia
19.
Am J Respir Crit Care Med ; 193(4): 386-95, 2016 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-26451874

RESUMO

RATIONALE: Asthma has been reported to be more prevalent among Hispanics of Puerto Rican heritage than among other Hispanics and among Hispanics born in the United States or who immigrated as children than among those who came as adults; however, direct comparisons across Hispanic groups are lacking. OBJECTIVES: To test whether asthma is more prevalent among Hispanics of Puerto Rican heritage than among other Hispanic groups, whether asthma is associated with age of immigration, and whether chronic obstructive pulmonary disease varies by heritage in a large, population-based cohort of Hispanics in the United States. METHODS: The Hispanic Community Health Study/Study of Latinos researchers recruited a population-based probability sample of 16,415 Hispanics/Latinos, 18-74 years of age, in New York City, Chicago, Miami, and San Diego. Participants self-reported Puerto Rican, Cuban, Dominican, Mexican, Central American, or South American heritage; birthplace; and, if relevant, age at immigration. A respiratory questionnaire and standardized spirometry were performed with post-bronchodilator measures for those with airflow limitation. MEASUREMENTS AND MAIN RESULTS: The prevalence of physician-diagnosed asthma among Puerto Ricans (36.5%; 95% confidence interval, 33.6-39.5%) was higher than among other Hispanics (odds ratio, 3.9; 95% confidence interval, 3.3-4.6). Hispanics who were born in the mainland United States or had immigrated as children had a higher asthma prevalence than those who had immigrated as adults (19.6, 19.4, and 14.1%, respectively; P < 0.001). Current asthma, bronchodilator responsiveness, and wheeze followed similar patterns. Chronic obstructive pulmonary disease prevalence was higher among Puerto Ricans (14.1%) and Cubans (9.8%) than among other Hispanics (<6.0%), but it did not vary across Hispanic heritages after adjustment for smoking and prior asthma (P = 0.22), by country of birth, or by age at immigration. CONCLUSIONS: Asthma was more prevalent among Puerto Ricans, other Hispanics born in the United States, and those who had immigrated as children than among other Hispanics. In contrast, the higher prevalence of chronic obstructive pulmonary disease among Puerto Ricans and Cubans was largely reflective of differential smoking patterns and asthma.


Assuntos
Asma/epidemiologia , Emigrantes e Imigrantes/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Hispano-Americanos/etnologia , Hispano-Americanos/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , Fatores Etários , América Central/etnologia , Estudos de Coortes , Emigração e Imigração , Feminino , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Fatores de Risco , América do Sul/etnologia , Espirometria , Inquéritos e Questionários , Estados Unidos/epidemiologia , Índias Ocidentais/etnologia
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