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1.
Int J Cancer ; 146(3): 699-711, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30924138

RESUMO

Previous studies using different exposure methods to assess air pollution and breast cancer risk among primarily whites have been inconclusive. Air pollutant exposures of particulate matter and oxides of nitrogen were estimated by kriging (NOx , NO2 , PM10 , PM2.5 ), land use regression (LUR, NOx , NO2 ) and California Line Source Dispersion model (CALINE4, NOx , PM2.5 ) for 57,589 females from the Multiethnic Cohort, residing largely in Los Angeles County from recruitment (1993-1996) through 2010. Cox proportional hazards models were used to examine the associations between time-varying air pollution and breast cancer incidence adjusting for confounding factors. Stratified analyses were conducted by race/ethnicity and distance to major roads. Among all women, breast cancer risk was positively but not significantly associated with NOx (per 50 parts per billion [ppb]) and NO2 (per 20 ppb) determined by kriging and LUR and with PM2.5 and PM10 (per 10 µg/m3 ) determined by kriging. However, among women who lived within 500 m of major roads, significantly increased risks were observed with NOx (hazard ratio [HR] = 1.35, 95% confidence interval [95% CI]: 1.02-1.79), NO2 (HR = 1.44, 95% CI: 1.04-1.99), PM10 (HR = 1.29, 95% CI: 1.07-1.55) and PM2.5 (HR = 1.85, 95% CI: 1.15-2.99) determined by kriging and NOx (HR = 1.21, 95% CI:1.01-1.45) and NO2 (HR = 1.26, 95% CI: 1.00-1.59) determined by LUR. No overall associations were observed with exposures assessed by CALINE4. Subgroup analyses suggested stronger associations of NOx and NO2 among African Americans and Japanese Americans. Further studies of multiethnic populations to confirm the effects of air pollution, particularly near-roadway exposures, on the risk of breast cancer is warranted.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Neoplasias da Mama/epidemiologia , Material Particulado/efeitos adversos , Afro-Americanos/estatística & dados numéricos , Idoso , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Americanos Asiáticos/estatística & dados numéricos , Neoplasias da Mama/etiologia , California/epidemiologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Incidência , Pessoa de Meia-Idade , Material Particulado/análise , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo
2.
Med Care ; 57(11): 861-868, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31634267

RESUMO

OBJECTIVES: We examined changes in health care access and utilization associated with the Patient Protection and Affordable Care Act (ACA) for different Asian American subgroups relative to non-Latino whites (whites). RESEARCH DESIGN: Using 2003-2017 California Health Interview Survey data, we examined changes in 4 health care access measures and 2 utilization measures among whites and 7 Asian American subgroups. We estimated the unadjusted and adjusted percentage point changes on the absolute scale from the pre-ACA to post-ACA periods. Adjusted estimates were obtained from multivariable logistic regression models that controlled for predisposing, enabling, and need factors. We also estimated the pre-ACA to post-ACA changes between whites and Asian American subgroups using a difference-in-difference approach. RESULTS: After the ACA was implemented, uninsurance decreased among all Asian American subgroups, but improvements in disparities relative to whites in these measures were limited. In particular, Koreans had the largest absolute reduction in uninsurance (-16.8 percentage points) and were the only subgroup with a significant reduction in terms of disparities relative to whites (-10.1 percentage points). However, little or no improvement was observed in the other 3 access measures (having a usual source of care, delayed medical care in past year, or delayed prescription drug use in past year) and 2 utilization measures (having a physician visit or emergency department visit in past year). CONCLUSIONS: Despite coverage gains among Asian American subgroups, especially Koreans, disparities in access and utilization persisted across all Asian American subgroups.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Patient Protection and Affordable Care Act , Adulto , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde , Humanos , Cobertura do Seguro/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
3.
Health Serv Res ; 54 Suppl 2: 1467-1471, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31650534

RESUMO

OBJECTIVE: To summarize findings from this Special Issue, which examine reported experiences of discrimination among six underrepresented groups in public opinion research-blacks, Latinos, Native Americans, Asian Americans, lesbian, gay, bisexual, transgender, or queer (LGBTQ) adults, and women. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey of 3453 US adults, conducted January-April 2017. METHODS: We calculated the percent of adults reporting discrimination in several domains, including health care. PRINCIPAL FINDINGS: In health care encounters, 32 percent of black adults reported discrimination, as did 23 percent of Native Americans, 20 percent of Latinos, 18 percent of women, 16 percent of LGBTQ adults, and 13 percent of Asian Americans. Significant shares also reported experiencing racial, gender, or LGBTQ identity-based violence against themselves or family members, including 51 percent of LGBTQ adults, 42 percent of blacks, 38 percent of Native Americans, and 21 percent of women. At least one in seven blacks (22 percent), LGBTQ adults (18 percent), Latinos (17 percent), and Native Americans (15 percent) reported avoiding health care for themselves or family members over concerns of anticipated discrimination or unfair treatment. CONCLUSIONS: Taken together, this polling effort illustrates the significant and widespread level of discrimination against many groups in America today, as well as the complex manifestation of these experiences across different groups and different areas of life. While it is beyond the scope of these results to make specific recommendations for how to end discrimination in each area of life we studied, this Special Issue provides important evidence that more research and practice on discrimination are sorely needed in health services research.


Assuntos
Disparidades em Assistência à Saúde/etnologia , Racismo/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Adulto , Afro-Americanos/estatística & dados numéricos , Americanos Asiáticos/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Racismo/psicologia , Inquéritos e Questionários , Telefone , Estados Unidos
4.
Health Serv Res ; 54 Suppl 2: 1419-1430, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31657465

RESUMO

OBJECTIVE: To examine experiences of racial discrimination among Asian Americans, which broadly contribute to poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey, including 500 Asian and a comparison group of 902 white US adults, conducted January to April 2017. METHODS: We calculated the percent of Asian Americans reporting discrimination in several domains, including health care. We used logistic regression to compare the Asian-white difference in odds of discrimination, and among Asians only to examine variation by geographic heritage group (South Asian versus East Asian) and gender. PRINCIPAL FINDINGS: 13 percent of Asians reported discrimination in healthcare encounters. At least one in four adults reported experiencing discrimination in employment (27 percent job applications, 25 percent equal pay/promotions); housing (25 percent); and interpersonal interactions (35 percent microaggressions, 32 percent racial slurs). In unadjusted models, East and South Asians were more likely than whites to report experiences of institutional discrimination, and South Asians were more likely than whites to report microaggressions. In adjusted models, Asians had higher odds than whites of reporting avoiding health care due to discrimination concerns and also when obtaining housing. CONCLUSIONS: Asians in the United States experience discrimination interpersonally and across many institutional settings, including housing and health care. South Asians may be especially vulnerable to forms of institutional discrimination and microaggressions. These results illustrate a need for greater investigation into the unique experiences of Asian subgroups and greater protections for groups at higher risk of discrimination, within health care and beyond.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Racismo/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Adolescente , Adulto , Americanos Asiáticos/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Racismo/psicologia , Fatores Socioeconômicos , Inquéritos e Questionários , Telefone
5.
Comput Inform Nurs ; 37(9): 455-462, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31518339

RESUMO

Web-based interventions that promote physical activity have been tested in various populations and proven effective. However, information on recruiting and retaining ethnic minorities in these interventions is limited. This study discusses practical issues in recruitment and retention of Asian Americans using three strategies: (1) only Web-based intervention (Group 1), (2) one with Fitbit Charge HR (Group 2), and (3) one with Fitbit Charge HR and office visits (Group 3). Recruitment and retention rates, minutes of weekly research team meetings, and the researchers' memos were collected. Retention rates were analyzed using descriptive statistics, and the minutes and memos were content analyzed following Weber's methods. Retention rates varied by the end of the first (12% in Group 3, 36.9% in Group 2) and third month (0% in Group 3, 36.9% in Group 2). The practical issues were (1) difficulties in recruitment across strategies, (2) the necessity of using community consultants/leaders across strategies, (3) subethnic differences across strategies, (4) timing issues across strategies, (5) Fitbit as a facilitator with several hindrances, and (6) office visits as an inhibitor. Fitbits with user guidelines and community consultants'/leaders' involvement are proposed for future Web-based interventions to promote physical activity in Asian Americans.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Exercício/fisiologia , Promoção da Saúde , Internet , Seleção de Pacientes , Adulto , Exercício/psicologia , Humanos , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Dispositivos Eletrônicos Vestíveis , Adulto Jovem
6.
Artigo em Inglês | MEDLINE | ID: mdl-31443586

RESUMO

Objective Asian Americans' food purchasing, cooking, and eating patterns are not well understood. Greater insight into these behaviors is urgently needed to guide public health interventions of dietary behaviors in this population. The present study aims to examine the effects of a community-level intervention on food purchasing and preparation, nutrition knowledge, and health awareness in Asian Americans. Methods From 2015 to 2017, we conducted the Improving Diets with an Ecological Approach for Lifestyle (IDEAL-REACH) intervention to increase access to healthy food or beverage options for the Asian-American population in the Philadelphia metropolitan area. Participants (1110 at pre- and 1098 at post-assessment) were recruited from 31 community-based organizations (CBOs). We assessed Asian Americans' dietary behaviors, nutrition knowledge, and awareness of heart health. Results The results of pre-post intervention comparisons showed that the IDEAL-REACH intervention was successful in promoting whole grains consumption, reducing sodium consumption, and raising knowledge and awareness related to nutrition and heart health. Conclusions To our knowledge, this is one of the first initiatives in the U.S. to engage CBOs to promote healthier dietary behaviors. The findings show that CBOs serve as a powerful platform for community-level interventions to improve healthy nutrition behaviors in Asian-American communities.


Assuntos
Dieta/estatística & dados numéricos , Comportamento Alimentar , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Estado Nutricional , Adulto , Americanos Asiáticos/estatística & dados numéricos , Pesquisa Participativa Baseada na Comunidade , Comportamento do Consumidor , Culinária , Feminino , Nível de Saúde , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Philadelphia , Avaliação de Programas e Projetos de Saúde , Sódio na Dieta , Grãos Integrais , Adulto Jovem
7.
Am J Orthopsychiatry ; 89(4): 482-492, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31305116

RESUMO

Racism and race-related stress can negatively impact the mental health status of ethnic minorities. In recent years, college campuses have held demonstrations to promote awareness regarding racism and to call for resources to help improve campus climate and to address the needs of students of color. This study answers this call by developing and evaluating the benefits of a peer-led compassionate meditation program to help students of color heal from race-related stress. To date, no studies have examined whether compassionate meditation (a specific type of meditation) can be used as a therapeutic tool to address racial stress. This article discusses the formative process for developing and pilot-testing the effects of this culturally responsive 8-session compassionate meditation program with Asian American college students. Despite a small sample size, results were promising. and participants evidenced decreases in general distress, as well as depression, anxiety, and PTSD symptoms. Moreover, by the end of the program, fewer students were clinically depressed. The results of this study provide some initial evidence that brief, culturally responsive compassionate meditation interventions may be a promising and cost-effective method for addressing the impact of racism and race-related stress. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Empatia , Meditação/psicologia , Racismo/psicologia , Estresse Psicológico/psicologia , Adulto , Ansiedade/psicologia , Americanos Asiáticos/psicologia , Assistência à Saúde Culturalmente Competente , Depressão/psicologia , Feminino , Humanos , Masculino , Grupo Associado , Projetos Piloto , Estudantes/psicologia , Inquéritos e Questionários , Universidades , Adulto Jovem
8.
BMC Infect Dis ; 19(1): 638, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319805

RESUMO

BACKGROUND: Chronic hepatitis B (CHB) is a major cause of liver-related morbidity and mortality. High HBV prevalence in immigrants and ethnic minorities and numerous barriers to healthcare access are associated with serious health disparities in the United States. Reportedly, self-awareness of HBV infection is low, suggesting a greater need for effective screening and education. Further, low levels of linkage to care (LTC) (completion of a first doctor's visit after the diagnosis of chronic HBV infection) may be responsible for the lack of engagement over the continuum of care and for needed services. METHODS: Demographics and survey data were obtained from 97 Korean American adults chronically infected with HBV, initially identified through a series of community screening events in northern New Jersey between Dec. 2009 and June 2015. Eight year follow-up on these HBV-infected individuals was obtained to determine their access to care, and thus the efficacy of a campaign to improve LTC. The participants' self-awareness of HBV infection and other factors for LTC were also evaluated. RESULTS: Of a total of 97 HBV-infected participants (age range 30 to 79), 74 were aware of their infections at screening. The remaining 23 had been unaware of their infections until screening. Eight years after the campaign, some 66 of these 97 individuals accessed care (LTC rate 68%). Health insurance status, presence or absence of symptoms and level of knowledge of CHB were among the most significant factors in LTC. CONCLUSION: A community-based hepatitis B screening and education campaign can be instrumental in prompting HBV infected individuals to access care, as demonstrated in the cumulative increase in LTC in our cohort. Despite many years of awareness of HBV infection, many are not accessing care owing to a lack of health insurance, suggesting a pressing need for advocacy and health education to improve access to affordable coverage in the Asian American population. Community efforts and strategies similar to the ones employed in the current study may serve as a model to improve the engagement of HBV-infected individuals in high risk immigrant populations.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Hepatite B/epidemiologia , Adulto , Idoso , Americanos Asiáticos/estatística & dados numéricos , Emigrantes e Imigrantes , Feminino , Seguimentos , Hepatite B Crônica/prevenção & controle , Humanos , Seguro Saúde , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , New Jersey/epidemiologia , Prevalência
9.
Geriatr Gerontol Int ; 19(8): 829-833, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31282019

RESUMO

AIM: Japan introduced dementia-friendly initiatives into its national policies to help people with dementia remain involved in society for as long as possible. However, some people might choose to live in a nursing home to avoid care burden on family members. Understanding middle-aged adults' preferences for place of care and identifying factors that influence their preferences would help policy decision-makers promote dementia-friendly initiatives. The present study aimed to investigate the care preferences of middle-aged adults if they acquired dementia in Japan and the USA. METHODS: We carried out a cross-sectional observational study using an internet-based questionnaire survey of Japanese residents with Japanese ethnicity, Japanese Americans, and non-Asian Americans aged 40-70 years. A total of 301 participants, including 104 Japanese residents, 93 Japanese Americans and 104 non-Asian Americans, completed the survey. Participants were asked to answer the items based on a hypothetical situation in which they had acquired dementia requiring regular care and supervision. RESULTS: Participants preferred nursing home care (29.9%), followed by professional home care (19.6%), family home care (17.6%) and hospital care (11.3%). Japanese residents had a significantly lower preference for professional home care than did Japanese or non-Asian Americans (adjusted odds ratio 0.28, 95% confidence interval 0.10-0.75). Between-ethnicity difference in care preferences was not observed. CONCLUSIONS: A low preference for professional home care among the middle-aged adults might be influenced by country-specific long-term and dementia care systems. Policy decision-makers should develop professional home care services that are more available for families of people living with dementia. Geriatr Gerontol Int 2019; 19: 829-833.


Assuntos
Demência , Serviços de Assistência Domiciliar , Preferência do Paciente , Instituições de Cuidados Especializados de Enfermagem , Idoso , Americanos Asiáticos/psicologia , Americanos Asiáticos/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/psicologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Comparação Transcultural , Estudos Transversais , Demência/etnologia , Demência/psicologia , Feminino , Humanos , Vida Independente/psicologia , Vida Independente/estatística & dados numéricos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Preferência do Paciente/etnologia , Preferência do Paciente/estatística & dados numéricos , Estados Unidos/epidemiologia
10.
J Drugs Dermatol ; 18(7): 633-641, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31329401

RESUMO

Background: As facial aesthetic procedures have become more widely accepted, the racial and ethnic diversity of aesthetic patient populations has increased. Asian Americans represent a growing segment of this population and have specific aesthetic concerns that should be differentiated from the broader Caucasian population. Objective: An online study was designed to survey facial aesthetic concerns, treatment priorities, and future treatment considerations among a US-based population of Asian American women. Materials and Methods: A total of 403 participants ages 30 to 65 years reported perspectives on facial aging, current facial conditions, most bothersome facial areas, most/least likely to be treated first, awareness of treatment options and consideration rates, and motives/barriers impacting the consideration rate of injectable treatments. Results: Treatment interests reflected predominant issues; uneven skin tone, wrinkles, and sun damage. Most bothersome facial areas included the periorbital area, forehead, and submental area, and also among areas designated as most likely to treat first. The majority of participants would consider injectables. However, safety/side effects, cost, and concerns about not looking natural were primary barriers. Conclusion: Understanding the aesthetic concerns and priorities specific to Asian American women may help guide treatment plans more aligned with the goals and expectations of this patient population. J Drugs Dermatol. 2019;18(7):633-641.


Assuntos
Americanos Asiáticos/psicologia , Atitude Frente a Saúde/etnologia , Técnicas Cosméticas/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Envelhecimento da Pele/etnologia , Adulto , Idoso , Americanos Asiáticos/estatística & dados numéricos , Técnicas Cosméticas/economia , Estética , Face , Feminino , Humanos , Pessoa de Meia-Idade , Pigmentação da Pele , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos
12.
Matern Child Health J ; 23(8): 1098-1107, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31197548

RESUMO

OBJECTIVES: Pregnancy-associated hypertension (PAH) includes gestational hypertension, preeclampsia and eclampsia. Although a protective effect of multi-parity on PAH has been reported in previous studies, the association has not been examined among Asian American women in the U.S. METHODS: Using data from 2014 U.S. National Vital Statistics System, we examined the prevalence of PAH among Asian American women who had singleton live births (N = 235,303), and its association with parity (number of previous pregnancies including live births and fetal deaths) controlling for potential confounders. We estimated adjusted odds ratios (aORs) and 95% confidence intervals (CI) using multivariable logistic regression analysis. RESULTS: Overall, 2.72% (95% CI 2.66%, 2.79%) of Asian American women were recorded to have PAH during pregnancy. Parity was inversely associated with PAH in our study, where Asian American women who had 1-2 and 3 or more previous pregnancies had significantly lower odds of PAH (aOR 0.61, 95% CI 0.58, 0.65; and aOR 0.62, 95% CI 0.57, 0.68, respectively) compared to nulliparous women, after controlling for potential confounders. CONCLUSIONS: Recent U.S. vital statistics data revealed that nulliparity is significantly associated with PAH among Asian American women. Future studies should identify specific factors that are associated with PAH and factors contributing to disparities in PAH risk among Asian American women.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Paridade/fisiologia , Adulto , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Análise Multivariada , Razão de Chances , Pré-Eclâmpsia/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Fatores de Risco , Estados Unidos/epidemiologia
13.
JMIR Mhealth Uhealth ; 7(6): e13256, 2019 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-31199340

RESUMO

BACKGROUND: Disparities in cervical cancer incidence and mortality signify the need for intervention efforts targeting Korean American immigrant women. OBJECTIVE: The purpose of this study was to demonstrate how a culturally targeted and tailored mobile text messaging intervention, mobile screening (mScreening), was developed to promote the uptake of Papanicolaou tests and human papillomavirus vaccine among young Korean American immigrant women. METHODS: Guided by the Fogg behavior model, the mScreening intervention was developed through a series of focus groups. Braun and Clarke's thematic analysis was used to identify core themes. RESULTS: Overall, 4 themes were identified: (1) tailored message content (ie, basic knowledge about cervical cancer), (2) an interactive and visual message format (ie, age-appropriate and friendly messages using emoticons), (3) brief message delivery formats to promote participant engagement, and (4) use of an incentive to motivate participation (ie, gift cards). CONCLUSIONS: This study demonstrated the processes of gathering culturally relevant information to develop a mobile phone text messaging intervention and incorporating the target population's perspectives into the development of the intervention. The findings of the study could help guide future intervention development targeting different types of cancer screening in other underserved racial or ethnic groups.


Assuntos
Emigrantes e Imigrantes/psicologia , Teste de Papanicolaou/psicologia , Vacinas contra Papillomavirus/uso terapêutico , Adulto , Americanos Asiáticos/psicologia , Americanos Asiáticos/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Grupos Focais/métodos , Promoção da Saúde/métodos , Promoção da Saúde/normas , Promoção da Saúde/estatística & dados numéricos , Humanos , Imunização/psicologia , Imunização/estatística & dados numéricos , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pesquisa Qualitativa , Telemedicina/métodos , Mensagem de Texto/normas , Mensagem de Texto/estatística & dados numéricos , Estados Unidos
14.
Diabetes Res Clin Pract ; 154: 17-26, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31228493

RESUMO

AIMS: We examined the longitudinal association between change in body composition directly measured by computed tomography (CT) and future insulin sensitivity. METHODS: This was a prospective study with 10 years of follow-up with 297 Japanese-American without diabetes. Intra-abdominal fat area (IAFA) and abdominal subcutaneous fat area (SCFA), and thigh SCFA were measured by CT. Insulin sensitivity was calculated by HOMA-IR and the Matsuda index. RESULTS: Baseline and change in IAFA were significantly and independently associated with change in HOMA-IR and Matsuda index during follow-up. In multivariate analysis, IAFA and 10-year change in IAFA (Δ IAFA) was significantly and positively associated with 10-year HOMA-IR (p < 0.001) and significantly and negatively associated with 10-year Matsuda index (p < 0.001). The association with Matsuda index though was non-linear and best modeled as a quadratic function (Δ IAFA +â€¯Δ IAFA2). No significant associations in multivariate analyses were seen between thigh SCFA and insulin sensitivity or abdominal SCFA and HOMA-IR but an increase in abdominal SCFA was associated with diminished insulin sensitivity measured by the Matsuda index. CONCLUSIONS: An increase in visceral adiposity predicts diminished insulin sensitivity over 10 years of follow-up independent of the size of this adipose depot at baseline.


Assuntos
Adiposidade , Americanos Asiáticos/estatística & dados numéricos , Resistência à Insulina , Gordura Intra-Abdominal/diagnóstico por imagem , Gordura Subcutânea Abdominal/diagnóstico por imagem , Coxa da Perna/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
15.
Community Dent Oral Epidemiol ; 47(4): 340-345, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31050020

RESUMO

OBJECTIVES: Based on Andersen's healthcare utilization model, the present study examined factors associated with dental service use in older Korean Americans. Focus was on predisposing characteristics (age, gender, marital status, education and region), oral health needs (problems with teeth or gums and self-rated oral health) and enabling factors (dental health insurance, length of stay in the United States, acculturation and family network). METHODS: Using data from surveys with Korean Americans aged 60 or older (N = 2128), a Poisson regression model examined predictors of dental visit in the past 12 months. FINDINGS: More than 21% of the sample reported having a problem with teeth or gums, and over half rated their oral health as either fair or poor. Approximately 71% lacked dental health insurance. The number of dental visits in the past 12 months averaged 1.40 (SD = 1.74), with about 38% having no dental visits at all. Multivariate analyses showed that higher levels of education, the presence of a problem with teeth or gums, dental health insurance coverage, longer length of stay in the United States, and larger family networks were associated with 1.01-1.35 times higher number of dental visits. CONCLUSION: The findings not only confirmed the critical role of dental health insurance as a service enabler but also highlighted the importance of considering older ethnic immigrants' oral health and dental care from the perspectives of culture and family.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Assistência Odontológica/estatística & dados numéricos , Serviços de Saúde Bucal/estatística & dados numéricos , Aculturação , Idoso , Idoso de 80 Anos ou mais , Pré-Escolar , Humanos , Seguro Odontológico , Saúde Bucal , Estados Unidos
16.
Public Health Rep ; 134(4): 338-343, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31120804

RESUMO

Few studies have examined the asthma burden among small racial/ethnic minority groups such as Asian children. We examined asthma disparities among children aged 4-17 in 6 small non-Hispanic racial/ethnic minority groups (American Indian/Alaska Native [AI/AN], Asian Indian, Chinese, Filipino, other Asian, and multiple race) by using the 2006-2015 National Health Interview Survey. These small minority groups represented a weighted 6.1% of the study population (6770 of 88 049). The prevalence of current asthma ranged from 5.5% (95% confidence interval [CI], 3.5%-7.5%) among Chinese children to 13.8% (95% CI, 10.4%-17.2%) among multiple-race children and 14.6% (95% CI, 10.8%-18.4%) among AI/AN children. Compared with non-Hispanic white children, AI/AN (adjusted odds ratio [aOR] = 1.6; 95% CI, 1.2-2.2) and multiple-race (aOR = 1.4; 95% CI, 1.0-2.0) children had higher odds for current asthma. Several small racial/ethnic minority groups are at heightened risk of asthma-associated outcomes, highlighting the need for further research on these populations.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Asma/etnologia , Asma/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Razão de Chances , Vigilância da População , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia , Estados Unidos/etnologia
17.
Comput Inform Nurs ; 37(5): 243-249, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31094913

RESUMO

This paper aims to discuss the challenges faced during a pilot study that tested a technology-based cancer pain management program among Asian American survivors of breast cancer and provide directions for future technology-based interventions for racial and ethnic minorities. Data consisting of research diaries and meeting minutes underwent content analysis to extract themes that reflected the challenges. The challenges included those related to (1) diversities within the population of Asian American survivors of breast cancer; (2) survivors' treatment and healing process; (3) Internet resources from the participants' countries of origin; (4) building trust between researchers and participants/gatekeepers; (5) fidelity of the intervention; and (6) cultural sensitivity. Future design and implementation of technology-based programs for racial and ethnic minorities must consider these challenges.


Assuntos
Sobreviventes de Câncer/psicologia , Manejo da Dor/métodos , Mídias Sociais/tendências , Americanos Asiáticos/psicologia , Americanos Asiáticos/estatística & dados numéricos , Neoplasias da Mama/complicações , Neoplasias da Mama/psicologia , Sobreviventes de Câncer/estatística & dados numéricos , Assistência à Saúde Culturalmente Competente/métodos , Feminino , Humanos , Internet , Pessoa de Meia-Idade , Manejo da Dor/tendências , Projetos Piloto
18.
Pediatr Dermatol ; 36(4): 448-454, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30993772

RESUMO

OBJECTIVES: To characterize clinical differences among nonwhite/multiethnic vs white children, adolescents, and young adults with melanoma or atypical melanocytic neoplasms, including atypical Spitz tumors. PATIENTS AND METHODS: A cohort of 55 patients (< 25 years of age) prospectively followed from 1995 to 2018 in the Stanford Pigmented Lesion and Melanoma Program was analyzed for differences in clinical presentation, including skin phototype, race/ethnicity, age, sex, tumor/melanoma characteristics, and outcome. RESULTS: Seventeen patients (9 males and 8 females) were classified as nonwhite (predominantly skin phototype IV) and of Hispanic, Asian, or Black/African American ethnicity, and 38 patients (21 males and 17 females) were classified as white (predominantly phototypes I/II). Ages ranged from 6 months to 24 years, and median follow-up was 36 months (range 1-180 months). Melanomas were diagnosed in 87% of whites in our cohort, compared to 65% of nonwhites, with the remainder representing mainly atypical Spitz tumors. Lesions were usually brought to the attention of a health care provider by the patient or family (P < 0.05). Compared with whites, nonwhites were more likely to present at a younger mean age (10.9 years vs 15.4 years, P < 0.05) and with pink/clinically amelanotic tumors (59% vs 24%, P = 0.02). CONCLUSIONS: This long-term prospective institutional study showed clinically relevant differences between nonwhite vs white children, adolescents, and young adults diagnosed with melanoma and atypical melanocytic neoplasms. Nonwhite patients presented at a younger age and had more clinically amelanotic melanocytic tumors. Increased recognition of clinical factors and risk of these tumors in nonwhites could result in earlier diagnosis.


Assuntos
Melanoma/epidemiologia , Melanoma/patologia , Nevo de Células Epitelioides e Fusiformes/patologia , Sistema de Registros , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Adolescente , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Distribuição por Idade , Americanos Asiáticos/estatística & dados numéricos , Criança , Pré-Escolar , Estudos de Coortes , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Melanoma/diagnóstico , Nevo de Células Epitelioides e Fusiformes/diagnóstico , Nevo de Células Epitelioides e Fusiformes/epidemiologia , Pediatria , Prevalência , Estudos Retrospectivos , Medição de Risco , Distribuição por Sexo , Neoplasias Cutâneas/diagnóstico , Estados Unidos/epidemiologia , Adulto Jovem
19.
Artigo em Inglês | MEDLINE | ID: mdl-30979006

RESUMO

This study investigated the prevalence of unmet mental health care needs (UMHCN) and their associated factors among 2344 Asian Americans directly exposed to the World Trade Center (WTC) attack 10-11 years afterwards. Given the pervasive underutilization of mental health services among Asians, their subjective evaluation of unmet needs could provide more nuanced information on disparities of service. We used the WTC Health Registry data and found that 12% of Asian Americans indicated UMHCN: 69% attributing it to attitudinal barriers, 36% to cost barriers, and 29% to access barriers. Among all the factors significantly related to UMHCN in the logistic model, disruption of health insurance in the past year had the largest odds ratio (OR = 2.37, 95% confidence interval: 1.61-3.48), though similar to functional impairment due to mental disorders. Post-9/11 mental health diagnosis, probable mental disorder and ≥14 poor mental health days in the past month were also associated with greater odds of UMHCN, while greater social support was associated with lower odds. Results suggest that continued outreach efforts to provide mental health education to Asian communities to increase knowledge about mental illness and treatment options, reduce stigmatization of mental illness, and offer free mental health services are crucial to address UMHCN.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Ataques Terroristas de 11 de Setembro/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Prevalência , Adulto Jovem
20.
Asia Pac J Public Health ; 31(3): 199-209, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30947524

RESUMO

The purpose of this study was to determine similarities and differences in health effects, safety concerns, and health service utilization among Korean and Chinese immigrant women working in nail salons in the Greater New York City area. In this cross-sectional study, analyses involved descriptive statistics, t tests, and χ2 tests. Koreans had longer work experience and more work-related health effects and concerns, but were less likely to use personal protective equipment than Chinese workers. Although Koreans reported better socioeconomic status than Chinese workers, they were less likely to have health care access and utilized less health services. To prevent prolonged exposure to toxic chemicals, nail salon employees need education regarding the importance of personal protective equipment use. Reducing structural barriers and increasing health care access for all nail salon workers are especially important in improving their health service utilization.


Assuntos
Americanos Asiáticos/psicologia , Indústria da Beleza , Emigrantes e Imigrantes/psicologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Unhas , Doenças Profissionais/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Americanos Asiáticos/estatística & dados numéricos , China/etnologia , Estudos Transversais , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , República da Coreia/etnologia , Medição de Risco
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