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1.
PLoS One ; 14(2): e0211972, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30768624

RESUMO

Recurrence of TB in an individual can occur due to relapse of the same strain or reinfection by a different strain. The contribution of reinfection and relapse to TB incidence, and the factors associated with each are unknown. We aimed to quantify and describe cases attributable to relapse or reinfection, and identify associated risk factors in order to reduce recurrence. We categorised recurrent TB cases from notifications in London (2002-2015) as relapse or reinfection using molecular (MIRU VNTR strain type) and epidemiological information (hierarchical approach using time since notification, site of disease and method of case finding). Factors associated with each outcome were determined using logistic regression in Stata Version 13.1 (2009-2015 only). Of 43,465 TB cases, 1.4% (618) were classified as relapse and 3.8% (1,637) as reinfection. The proportion with relapse decreased from 2002 (2.3%) to 2015 (1.3%), while the proportion of reinfection remained around 4%. Relapse was more common among recent migrants (<1 year, odds ratio (OR) = 1.99, p = 0.005), those with a social risk factor (OR = 1.51, p = 0.033) and those with central nervous system, spinal, miliary or disseminated TB (OR = 1.75, p = 0.001). Reinfection was more common among long term migrants (>11 years, OR = 1.67, p = <0.001), those with a social risk factor (OR = 1.96, p = <0.001) and within specific areas in London. Patients with social risk factors were at increased risk of both relapse and reinfection. Characterising those with relapsed disease highlights patients at risk and factors associated with reinfection suggest groups where transmission is occurring. This will inform TB control programs to target appropriate treatment and interventions in order to reduce the risk of recurrence.


Assuntos
Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Diagnóstico Precoce , Feminino , Humanos , Incidência , Modelos Logísticos , Londres/epidemiologia , Londres/etnologia , Masculino , Pessoa de Meia-Idade , Vigilância da População , Recidiva , Fatores Socioeconômicos , Migrantes , Adulto Jovem
2.
Psychiatry Res ; 272: 618-627, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30616132

RESUMO

Black ethnicity is associated with increased risk for psychosis in South London. This study explored the distribution of ethnicity among services users at ultra high risk for psychosis (UHR) and examined the influence of ethnicity on service access, treatment uptake and incidence of psychosis. The ethnic distribution of 228 people at UHR for psychosis, seen in an early detection clinical service over 10 years, was compared with 146 people with first episode psychosis from the same geographic region and census figures for the local population. Black service users were significantly over-represented in the UHR group compared to the background population (34% vs 21%; p < 0.05); but less so than in the first episode sample (58% vs 19%; p < 0.05). Within the UHR sample, there was no strong evidence of differences between ethnic groups in the types of treatment provided, nor in the rate of transition to psychosis over 2 years. The absence of differences between ethnic groups in rates of transition to psychosis raises the possibility that access to mental health care at the high risk stage might have reduced the influence of ethnicity on the incidence of psychosis in this sample. This would need to be replicated in a larger sample.


Assuntos
Grupos Étnicos/psicologia , Acesso aos Serviços de Saúde , Transtornos Psicóticos/etnologia , Transtornos Psicóticos/psicologia , Adolescente , Adulto , Diagnóstico Precoce , Feminino , Acesso aos Serviços de Saúde/tendências , Humanos , Incidência , Londres/etnologia , Masculino , Transtornos Psicóticos/terapia , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
3.
J Appl Res Intellect Disabil ; 31(6): 1133-1143, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29974586

RESUMO

BACKGROUND: Little is known about the lives of parents with intellectual disabilities from minority ethnic communities. Previous research suggests that what it means to live with intellectual disabilities varies across cultural contexts. The current research aimed to explore how cultural values and practices impact upon the experiences of parents with intellectual disabilities within the Bangladeshi community in London, England. METHOD: Six members of the Bangladeshi community, four Bangladeshi parents with intellectual disabilities and four of their family members were interviewed. Thematic analysis was used to identify key themes. RESULTS: Both parenting and intellectual disability are thought about in this community in ways that make parenting more accessible for people with learning disabilities, but also create tensions to be negotiated. CONCLUSIONS: Bangladeshi family carers face dilemmas balancing the benefits and risks of promoting parenting for sons and daughters with intellectual disabilities, particularly in the context of service principles of autonomy and informed consent.


Assuntos
Crianças Adultas/etnologia , Deficiência Intelectual/etnologia , Relações Pais-Filho/etnologia , Poder Familiar/etnologia , Adulto , Bangladesh/etnologia , Feminino , Humanos , Londres/etnologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
4.
BMC Nephrol ; 18(1): 201, 2017 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-28637442

RESUMO

BACKGROUND: Membranous nephropathy (MN) is the leading cause of nephrotic syndrome in adults. MN is a clinically heterogeneous disease and it is difficult to accurately predict outcomes (including end stage renal failure) at presentation and whom to treat with potentially toxic therapies. We aimed to identify factors predicting outcome in MN in our cohort from two large tertiary London units by undertaking a retrospective data analysis of 148 biopsy-proven MN patients from North East and Central London between 1995 and 2015. METHODS: Review of clinical and biochemistry databases. RESULTS: Surprisingly, patients that reached end stage renal failure (ESRF) had a less severe nephrosis compared to those that did not develop ESRF; serum albumin 33 g/L (3.3 g/dL) versus 24 g/L (2.4 g/dL), p = 0.002 and urinary protein creatinine ratio (uPCR) 550 mg/mmol (5500 mg/g) versus 902 mg/mmol (9020 mg/g), p = 0.0124. The correlation with ESRF was strongest with the presenting creatinine; 215 µmol/L (2.43 mg/dL) compared to 81 µmol/L (0.92 mg/dL), p < 0.0001. Patients presenting with creatinine of >120 µmol/L (1.36 mg/dL; corresponding to an eGFR of ≤60 ml/min in non-Black males) had an increased rate of ESRF and a faster decline. Other traditional risk factors for progression were not significantly associated with ESRF. Black patients presented with higher serum creatinine but no statistically significant difference in the estimated glomerular filtration rate, a higher rate of progression to ESRF and had a poorer response to treatment. CONCLUSIONS: This ethnically diverse cohort does not demonstrate the traditional risk profile associated with development of ESRF. Thus, careful consideration of therapeutic options is crucial, as current risk modelling cannot accurately predict the risk of ESRF. Further studies are required to elucidate the role of antibodies and risk genes.


Assuntos
Glomerulonefrite Membranosa/diagnóstico , Glomerulonefrite Membranosa/etnologia , Idoso , Feminino , Seguimentos , Glomerulonefrite Membranosa/terapia , Humanos , Londres/etnologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
PLoS One ; 12(6): e0179332, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28640854

RESUMO

OBJECTIVE: To investigate the ethnicity-specific association between body mass index (BMI) and diabetes in pregnancy, with a focus on the appropriateness of using BMI cut-offs to identify pregnant women at risk of diabetes. STUDY DESIGN: Analysis of routinely-collected data from a maternity unit in London, UK. Data were available on 53 264 women delivering between 2004 and 2012. Logistic regression was used to explore the association between diabetes in pregnancy and BMI among women of different ethnicities, and adjusted probability estimates were used to derive risk equivalent cut-offs. ROC curve analysis was used to assess the performance of BMI as a predictor of diabetes in pregnancy. RESULTS: The prevalence of diabetes in pregnancy was 2.3% overall; highest in South and East Asian women (4.6% and 3.7%). In adjusted analysis, BMI category was strongly associated with diabetes in all ethnic groups. Modelled as a continuous variable with a quadratic term, BMI was an acceptable predictor of diabetes according to ROC curve analysis. Applying a BMI cut-off of 30 kg/m2 would identify just over half of Black women with diabetes in pregnancy, a third of White (32%) and South Asian (35%) women, but only 13% of East Asian women. The 'risk equivalent' (comparable to 30 kg/m2 in White women) threshold for South Asian and East Asian women was approximately 21 kg/m2, and 27.5 kg/m2 for Black women. CONCLUSIONS: This study suggests that current BMI thresholds are likely to be ineffective for diabetes screening in South and East Asian women, as many cases of diabetes will occur at low BMI levels. Our results suggest that East Asian women appear to face a similarly high risk of diabetes to South Asian women. Current UK guidelines recommend diabetes screening should be offered to all pregnant South Asian women; extending this recommendation to include women of East Asian ethnicity may be appropriate.


Assuntos
Índice de Massa Corporal , Grupos Étnicos/estatística & dados numéricos , Mães , Adulto , Diabetes Mellitus/etnologia , Feminino , Humanos , Londres/etnologia , Gravidez , Risco , Adulto Jovem
6.
Soc Sci Med ; 177: 27-34, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28157566

RESUMO

Housing is a significant determinant of health and substandard housing is a public health issue. East London has long had a shortage of social and affordable housing, worsened in recent years by a combination of stressors. In one of East London's most deprived boroughs, Newham, changes brought about by the 2011 Localism Act and the unique demands of being the host Olympic borough in 2012 have brought considerable pressures to bear on social infrastructure. This paper examines how these pressures were experienced by local residents via their narratives of social housing and health. The data reported here are from a qualitative study comprising two waves of data collection. Narrative family interviews and go-along interviews were conducted with 40 Newham residents at wave one and 28 at wave two. A narrative analysis with a Bakhtinian interpretation was undertaken. This revealed that residents framed experiences of social housing in terms of an inherent system-level ideology based on notions of need and waiting. A particularly striking feature of this ideology was the extent to which descriptions of ill health and impairment were implicated in constructions of housing need; participants directly attributed a range of health complaints to their housing predicaments, including stress, depression, cancer scares, panic attacks and loss of sleep. Understanding the contested ideology of social housing can illuminate both the dynamic processes of social exclusion and the ways in which its subjects seek to resist it.


Assuntos
Nível de Saúde , Habitação/tendências , Narração , Percepção , Adulto , Grupos de Populações Continentais/psicologia , Grupos de Populações Continentais/estatística & dados numéricos , Feminino , Humanos , Renda/tendências , Londres/etnologia , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Fatores Sexuais , Fatores Sociológicos
7.
J Autism Dev Disord ; 47(2): 393-404, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27873140

RESUMO

Diagnosing Autism Spectrum Disorders (ASD) is important throughout the lifespan. The objective was to investigate the transcultural diagnostic validity of the Social Communication Questionnaire (SCQ) in a clinical sample of 451 adults with Intellectual Developmental Disorder (IDD) with and without ASD in Germany, the U.S.A. and Great Britain. Variables associated with higher SCQ sum-scores were higher levels of IDD, male gender, a diagnosis of ASD and the study site (Germany > U.S.A > G.B.). An ROC analysis revealed a cut-score of 13, which resulted in a sensitivity of 0.87 and a specificity of 0.58. It is recommended to adjust the cut-score according to level of IDD and gender. Further research is needed to align diagnostic assignment of ASD across different sites and countries.


Assuntos
Transtorno do Espectro Autista/etnologia , Comunicação , Comparação Transcultural , Deficiência Intelectual/etnologia , Relações Interpessoais , Inquéritos e Questionários/normas , Adulto , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/psicologia , Berlim/etnologia , Feminino , Humanos , Deficiência Intelectual/diagnóstico , Deficiência Intelectual/psicologia , Londres/etnologia , Masculino , Ohio/etnologia , Reprodutibilidade dos Testes , Estudos Retrospectivos
8.
Psychoneuroendocrinology ; 76: 144-153, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27923182

RESUMO

OBJECTIVE: Hypothalamic-pituitary-adrenal (HPA) measures are crucial for research into stress and stress-related disorders. Most HPA measures fluctuate depending on diurnal rhythms and state confounders. Hair cortisol concentrations (HCC) are less susceptible to such fluctuations, but less is known about trait-like confounders. Using a community sample, we tested the relationship between HCC and a range of variables including demographic variables, hair treatment, and medication, as well as psychosocial variables, namely childhood trauma, critical life events, and depressive symptoms. METHODS: Hair samples were collected from 144 individuals from the South East London Community Health (SELCoH) study. Childhood trauma, life events, and depressive symptoms were measured, together with age, sex, ethnicity, relationship status, educational attainment, employment status, occupational social class, hair washing frequency, hair treatments, season reflected in the hair sample, hazardous drinking, smoking, medication intake, and body mass index. Hair samples reflecting the past 3 months were collected and analysed using immunoassays. First, correlations (continuous variables) and simple linear regressions (dichotomous variables) were conducted to identify sociodemographic, hair-related, and lifestyle determinants of HCC. Next, multiple linear regressions were conducted to test the relationship between psychosocial variables and HCC when controlling for the identified confounders. RESULTS: Age (r=-0.17, p=0.050), White British ethnicity (ß=-0.19, p=0.023), heat-based treatments (ß=-0.22, p=0.010), and winter season (ß=-0.18, p=0.024) were associated with lower HCC, whereas summer season (ß=0.24, p=0.024), painkillers (ß=0.25, p=0.003), anxiolytics/antidepressants (ß=0.21, p=0.014), and hormonal contraceptives (ß=0.27, p=0.006) were associated with higher HCC. Controlling for these confounders, physical neglect during childhood (ß=-0.17, p=0.057), war-related experiences (ß=0.20, p=0.027), separation (ß=0.18, p=0.054), and being the victim of a serious crime (ß=-0.17, p=0.062) were linked with altered HCC. CONCLUSION: Our findings suggest that variation in HCC occurs according to sociodemographic, hair-related, and lifestyle variables, and that certain associations between stress and altered HCC can only be revealed when accounting for these confounders.


Assuntos
Adultos Sobreviventes de Eventos Adversos na Infância/estatística & dados numéricos , Hidrocortisona/metabolismo , Estilo de Vida/etnologia , Estresse Psicológico/etnologia , Estresse Psicológico/metabolismo , Adolescente , Adulto , Idoso , Feminino , Cabelo/química , Humanos , Londres/etnologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
9.
Fontilles, Rev. leprol ; 30(6): 597-609, sept.-dic. 2016. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-159090

RESUMO

Objetivos: La prednisolona y la talidomida se administran frecuentemente en el control del eritema nodoso leproso (ENL) y proporcionan alivio a los pacientes con esta condición en todo el mundo. Sin embargo, tanto el ENL como sus tratamientos causan gran morbilidad. Este trabajo describe el espectro del ENL observado en el Hospital para Enfermedades Tropicales de Londres (HTD), la utilización de esteroides y el uso de esteroides y talidomida en su control y las consiguientes complicaciones. Metodología: Se llevó a cabo una revisión retrospectiva de los pacientes diagnosticados con ENL entre 1996 y 2013. Los datos se obtuvieron de los archivos clínicos, incluyendo la severidad y duración del episodio, además del tratamiento y efectos adversos. Resultados: Entre 1996 y 2013 se diagnosticaron 30 pacientes con ENL. El índice bacteriológico (IB) promedio en el momento del diagnóstico fue > 4.65, superior al aceptado en otros estudios. La mayoría de los pacientes desarrollaron ENL durante el tratamiento (67%) y presentaron ENL crónico (57%). La duración media del ENL fue de 60 meses (rango 9-192); los pacientes con IB > 4.5 presentaron períodos de tiempo más largos. El 87% de los pacientes recibieron prednisolona durante 9 meses; 33% desarrolló efectos adversos, incluyendo diabetes e hipertensión; el 87% de los pacientes recibió talidomida durante 16 meses y el 65% presentó efectos adversos. No hubo casos de embarazo o tromboembolismo. El 77% de los pacientes dejó la prednisolona a los dos meses de iniciar la talidomida. No hubo casos de fallecimiento en nuestro grupo. Conclusión: Describimos el curso clínico del ENL en un país no endémico con acceso a la talidomida y prednisolona. El ENL puede durar mucho más que el tiempo descrito anteriormente y tiene un gran impacto sobre la salud del paciente. En el Reino Unido, la talidomida es esencial para cesar la administración de los esteroides, prevenir efectos adversos y la mortalidad por esteroides, lo cual esté documentado en otros trabajos


Objectives: Prednisolone and thalidomide are commonly used in the management of erythema nodosum leprosum (ENL) and bring relief to patients with this condition worldwide. However, both ENL and its treatments can cause significant morbidity. This study describes the spectrum of ENL seen at The Hospital for Tropical Diseases, London (HTD), the use of steroids and thalidomide in its management and the complications of their use. Study Design: We conducted a retrospective audit of patients diagnosed with ENL between 1996 and 2013. Data were obtained from hospital records including severity and length of disease, together with treatments received and adverse effects. Results: Between 1996 and 2013, 30 patients were diagnosed with ENL. The median bacillary index (BI) at diagnosis was 4.65, higher than in previous studies. Most patients developed ENL during leprosy treatment (67%) and had chronic ENL (57%). The median length of ENL was 60 months (range 9–192); patients with BI. 4.5 had significantly longer duration of disease. 87% patients received prednisolone for median nine months; 35% developed adverse effects including diabetes and hypertension. 87% patients received thalidomide for median 16 months; 65% complained of side effects. There were no pregnancies or venous thromboembolisms. 77% patients stopped prednisolone within two months of starting thalidomide. There were no deaths in our cohort. Conclusion: We describe the clinical course of ENL in a non-endemic country with access to thalidomide and prednisolone. ENL may last far longer than previously described and has significant impact on a patient’s health. In the UK, thalidomide is essential as a steroid-sparing agent, to prevent the adverse effects and mortality of longterm steroids which have been documented elsewhere


Assuntos
Humanos , Masculino , Feminino , Esteroides/administração & dosagem , Esteroides/provisão & distribução , Talidomida/administração & dosagem , Eritema Nodoso/metabolismo , Eritema Nodoso/patologia , Serviço Hospitalar de Registros Médicos/classificação , Morbidade , Neurite (Inflamação)/patologia , Esteroides/efeitos adversos , Esteroides/farmacologia , Talidomida/provisão & distribução , Eritema Nodoso/complicações , Eritema Nodoso/prevenção & controle , Londres/etnologia , Neurite (Inflamação)/metabolismo
10.
Am J Phys Anthropol ; 161(4): 620-633, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27535009

RESUMO

OBJECTIVES: To examine hot flashes in relation to climate and activity patterns, and to compare subjective and objective hot flashes among Bangladeshi immigrants to London, their white London neighbors, and women still living in their community of origin, Sylhet, Bangladesh ("sedentees"). METHODS: Ninety-five women, aged 40-55, wore the Biolog ambulatory hot flash monitor. Objective measurements and subjective hot flash reports were examined in relation to demographic, reproductive, anthropometric, and lifestyle variables; temperature and humidity at 12:00 and 18:00; and time spent on housework and cooking. Concordance of objective and subjective hot flashes was assessed by Kappa statistics and by sensitivity of hot flash classification. RESULTS: During the study period, Bangladeshi sedentees reported more subjective hot flashes (p < .05), but there was no difference in number of objective hot flashes. White Londoners were more likely to describe hot flashes on their face and neck compared to Bangladeshis (p < .05). Sedentees were more likely to describe hot flashes on their feet (p < .05). Postmenopausal status, increasing parity, and high levels of housework were significant determinants of subjective hot flashes, while ambient temperature and humidity were not. Measures of subjective/objective concordance were low but similar across groups (10-20%). The proportion of objective hot flashes that were also self-reported was lowest among immigrants. DISCUSSION: Hot flashes were not associated with warmer temperatures, but were associated with housework and with site-specific patterns of cooking. The number of objective hot flash measures did not differ, but differences in subjective experience suggest the influence of culture.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Fogachos/etnologia , Fogachos/epidemiologia , Bangladesh/etnologia , Feminino , Humanos , Londres/etnologia , Menopausa , Pessoa de Meia-Idade , Temperatura Ambiente
11.
Psychol Med ; 46(14): 3051-3059, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27523979

RESUMO

BACKGROUND: It has been observed that mental disorders, such as psychosis, are more common for people in some ethnic groups in areas where their ethnic group is less common. We set out to test whether this ethnic density effect reflects minority status in general, by looking at three situations where individual characteristics differ from what is usual in a locality. METHOD: Using data from the South East London Community Health study (n = 1698) we investigated associations between minority status (defined by: ethnicity, household status and occupational social class) and risk of psychotic experiences, common mental disorders and parasuicide. We used a multilevel logistic model to examine cross-level interactions between minority status at individual and neighbourhood levels. RESULTS: Being Black in an area where this was less common (10%) was associated with higher odds of psychotic experiences [odds ratio (OR) 1.34 95% confidence interval (CI) 1.07-1.67], and attempted suicide (OR 1.84 95% CI 1.19-2.85). Living alone where this was less usual (10% less) was associated with increased odds of psychotic experiences (OR 2.18 95% CI 0.91-5.26), while being in a disadvantaged social class where this was less usual (10% less) was associated with increased odds of attempted suicide (OR 1.33 95% CI 1.03-1.71). We found no evidence for an association with common mental disorders. CONCLUSIONS: The relationship between minority status and mental distress was most apparent when defined in terms of broad ethnic group but was also observed for individual household status and occupational social class.


Assuntos
Grupo com Ancestrais do Continente Africano/etnologia , Transtornos Mentais/etnologia , Grupos Minoritários/estatística & dados numéricos , Transtornos Psicóticos/etnologia , Classe Social , Tentativa de Suicídio/etnologia , Adulto , Feminino , Humanos , Londres/etnologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Br J Soc Psychol ; 55(3): 522-43, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27256485

RESUMO

Research suggests that positive intergenerational contact can improve young people's attitudes towards older adults. However, today's age-segregated society may not provide ample opportunities for positive contact between younger and older adults to occur on a regular basis. In three studies, we investigated whether the positive attitudinal outcomes associated with direct contact might also stem from a more indirect form of intergenerational relationship: extended contact. In Study 1 (N = 70), extended contact was associated with more positive attitudes towards older adults even when controlling for direct intergenerational contact (contact frequency and contact quality). In Study 2 (N = 110), the positive effects of direct and extended contact on young people's age-related attitudes were mediated by reductions in intergroup anxiety and ageing anxiety. The mediational effects of intergroup anxiety were replicated in Study 3 (N = 95) and ingroup norms additionally emerged as a mediator of the positive effects of extended contact on young people's attitudes towards older adults. Discussion focuses on the implications for strategies aimed at tackling ageism.


Assuntos
Ageismo/etnologia , Ansiedade/etnologia , Atitude/etnologia , Processos Grupais , Relação entre Gerações/etnologia , Adolescente , Adulto , Humanos , Londres/etnologia , Adulto Jovem
13.
Neurol Sci ; 37(11): 1759-1763, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27351545

RESUMO

Iran has the highest prevalence of multiple sclerosis (MS) in the Middle East and Asia. Rate of emigration has been significantly raised among Iranians and though, multiple studies have been published on prevalence of MS among Iranian emigrants. Here we systematically reviewed these publications. We performed a comprehensive literature search was performed on April 30, 2015 in data bases of MEDLINE, EMBASE, Scopus and Google Scholar for the terms 'multiple sclerosis', 'incidence', 'prevalence', 'epidemiology', 'migration', 'emigrant', 'immigrant', 'Iran', 'Parsis' and 'Persian'. Study location, prevalence day or period, and age of at disease onset were recorded for all the included publications. Nine publications from Sweden, Canada, Norway, UK, and India were included. Only three reported age-adjusted prevalence and six reported age of disease onset. MS prevalence among Iranian emigrants varied from 21 per 100,000 people in Bombay, India in 1985 to 433 per 100,000 people in British Columbia, Canada in 2012. Five studies reported the prevalence in the region of interest, ranging from 1.33 in Bombay, India to 240 in British Columbia, Canada. Five studies also reported the prevalence of MS in the population of the destination country, and in all of them, the prevalence of MS was higher in Iranian immigrants compared to native people. Prevalence studies performed in Iran and also on Iranian emigrants indicate roles for both genetic and environmental factors in MS susceptibility. Data might indicate that living in a high-risk area increases the susceptibility to MS.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Esclerose Múltipla/etnologia , Colúmbia Britânica/etnologia , Humanos , Índia/etnologia , Irã (Geográfico)/etnologia , Londres/etnologia , Noruega/etnologia , Prevalência , Suécia/etnologia
14.
Psychol Med ; 46(6): 1321-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26879871

RESUMO

BACKGROUND: Studies have linked ethnic differences in depression rates with neighbourhood ethnic density although results have not been conclusive. We looked at this using a novel approach analysing whole population data covering just over one million GP patients in four London boroughs. METHOD: Using a dataset of GP records for all patients registered in Lambeth, Hackney, Tower Hamlets and Newham in 2013 we investigated new diagnoses of depression and antidepressant use for: Indian, Pakistani, Bangladeshi, black Caribbean and black African patients. Neighbourhood effects were assessed independently of GP practice using a cross-classified multilevel model. RESULTS: Black and minority ethnic groups are up to four times less likely to be newly diagnosed with depression or prescribed antidepressants compared to white British patients. We found an inverse relationship between neighbourhood ethnic density and new depression diagnosis for some groups, where an increase of 10% own-ethnic density was associated with a statistically significant (p < 0.05) reduced odds of depression for Pakistani [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.70-0.93], Indian (OR 0.88, CI 0.81-0.95), African (OR 0.88, CI 0.78-0.99) and Bangladeshi (OR 0.94, CI 0.90-0.99) patients. Black Caribbean patients, however, showed the opposite effect (OR 1.26, CI 1.09-1.46). The results for antidepressant use were very similar although the corresponding effect for black Caribbeans was no longer statistically significant (p = 0.07). CONCLUSION: New depression diagnosis and antidepressant use was shown to be less likely in areas of higher own-ethnic density for some, but not all, ethnic groups.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/etnologia , Prescrições de Medicamentos/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Adulto , Grupo com Ancestrais do Continente Africano , Conjuntos de Dados como Assunto , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Londres/etnologia , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Análise de Regressão , Características de Residência , Adulto Jovem
15.
Biomed Res Int ; 2015: 745865, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26273642

RESUMO

BACKGROUND: Despite the rise in prevalence of waterpipe tobacco smoking, it has received little legislative enforcement from governing bodies, especially in the area of health warning labels. METHODS: Twenty regular waterpipe tobacco smokers from London took part in five focus groups discussing the impact of waterpipe tobacco pack health warnings on their attitudes towards waterpipe smoking. We presented them with existing and mock waterpipe tobacco products, designed to be compliant with current and future UK/EU legislation. Data were analysed using thematic analysis. RESULTS: Participants felt packs were less attractive and health warnings were more impactful as health warnings increased in size and packaging became less branded. However, participants highlighted their lack of exposure to waterpipe tobacco pack health warnings due to the inherent nature of waterpipe smoking, that is, smoking in a café with the apparatus already prepacked by staff. Health warnings at the point of consumption had more reported impact than health warnings at the point of sale. CONCLUSIONS: Waterpipe tobacco pack health warnings are likely to be effective if compliant with existing laws and exposed to end-users. Legislations should be reviewed to extend health warning labels to waterpipe accessories, particularly the apparatus, and to waterpipe-serving premises.


Assuntos
Atitude Frente a Saúde , Promoção da Saúde/estatística & dados numéricos , Rotulagem de Produtos/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/epidemiologia , Fumar/psicologia , Informação de Saúde ao Consumidor/estatística & dados numéricos , Humanos , Londres/etnologia , Masculino , Projetos Piloto , Embalagem de Produtos/estatística & dados numéricos , Abandono do Hábito de Fumar/psicologia , Produtos do Tabaco , Adulto Jovem
16.
Br J Psychiatry ; 207(6): 523-9, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26294370

RESUMO

BACKGROUND: Some patients are at higher risk of contact with criminal justice agencies when experiencing a first episode of psychosis. AIMS: To investigate whether violence explains criminal justice pathways (CJPs) for psychosis in general, and ethnic vulnerability to CJPs. METHOD: Two-year population-based survey of people presenting with a first-episode of psychosis. A total of 481 patients provided information on pathways to psychiatric care. The main outcome was a CJP at first contact compared with other services on the care pathway. RESULTS: CJPs were more common if there was violence at first presentation (odds ratio (OR) = 4.23, 95% CI 2.74-6.54, P<0.001), drug use in the previous year (OR = 2.28, 95% CI 1.50-3.48, P<0.001) and for high psychopathy scores (OR = 2.54, 95% CI 1.43-4.53, P = 0.002). Compared with White British, CJPs were more common among Black Caribbean (OR = 2.97, 95% CI 1.54-5.72, P<0.001) and Black African patients (OR = 1.95, 95% CI 1.02-3.72, P = 0.01). Violence mediated 30.2% of the association for Black Caribbeans, but was not a mediator for Black African patients. These findings were sustained after adjustment for age, marital status, gender and employment. CONCLUSIONS: CJPs were more common in violent presentations, for greater psychopathy levels and drug use. Violence presentations did not fully explain ethnic vulnerability to CJPs.


Assuntos
Direito Penal/estatística & dados numéricos , Transtornos Psicóticos/complicações , Transtornos Psicóticos/terapia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Violência/estatística & dados numéricos , Adulto , Grupo com Ancestrais do Continente Africano , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Modelos Logísticos , Londres/etnologia , Masculino , Psicoterapia , Adulto Jovem
17.
Br J Psychiatry ; 207(6): 530-5, 2015 12.
Artigo em Inglês | MEDLINE | ID: mdl-26206866

RESUMO

BACKGROUND: Obsessive-compulsive disorder (OCD) has similar prevalence rates across ethnic groups. However, ethnic minorities are underrepresented in clinical trials of OCD. It is unclear whether this is also the case in clinical services. AIMS: To explore whether ethnic minorities with OCD are underrepresented in secondary and tertiary mental health services in the South London and Maudsley (SLaM) NHS Foundation Trust. METHOD: The ethnic distribution of patients with OCD seen between 1999 and 2013 in SLaM (n = 1528) was compared with that of the general population in the catchment area using census data. A cohort of patients with depression (n = 22 716) was used for comparative purposes. RESULTS: Ethnic minorities with OCD were severely underrepresented across services (-57%, 95% CI -62% to -52%). The magnitude of the observed inequalities was significantly more pronounced than in depression (-29%, 95% CI -31% to -27%). CONCLUSIONS: There is a clear need to understand the reasons behind such ethnic inequalities and implement measures to reduce them.


Assuntos
Transtorno Depressivo/epidemiologia , Grupos Étnicos/psicologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Transtorno Obsessivo-Compulsivo/complicações , Transtorno Obsessivo-Compulsivo/etnologia , Adolescente , Adulto , Criança , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Londres/etnologia , Sistema de Registros , Centros de Cuidados de Saúde Secundários , Centros de Atenção Terciária
18.
Infect Dis (Lond) ; 47(10): 719-24, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26077035

RESUMO

BACKGROUND: Infections with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) are encountered worldwide, particularly in certain regions of the world and in certain ethnic groups. Simple criteria for identification of patients likely to be infected with ESBLE may enable clinicians to select appropriate empirical antibiotics for treatment. The aim of this study was to explore the association between ESBLE bacteriuria and readily available key demographic characteristics (age, gender and ethnicity) in a multiethnic population. METHODS: In this cross-sectional observational study, we explored the association between ESBLE bacteriuria and age, gender and ethnicity in 134 831 patients who submitted urine specimens for culture during 2007-2009 in two multiethnic boroughs in London, UK. RESULTS: In multivariate analysis, the risk of ESBLE bacteriuria was higher in males (odds ratio, OR = 1.3) and in patients older than 60 years (OR > 2). Patients from an Asian ethnic group were significantly more likely than White British subjects to have ESBLE bacteriuria (Indians, OR = 2.7; Asians of any other background, OR = 2.4; and Pakistanis, OR = 1.8). In contrast, patients who were of white ethnic background other than Irish were 0.66 times less likely to have ESBLE bacteriuria than White British patients (p = 0.025). CONCLUSIONS: Our study shows that in our local multiethnic population, older patients (> 60 years), males and those of South Asian ethnicity were significantly more likely to have ESBLE bacteriuria than others. Knowledge of these simple and readily available demographic data can help identify groups of patients at risk of urinary tract infection (UTI) with ESBLE and may aid in choice of empirical antibiotics.


Assuntos
Bacteriúria/etnologia , Bacteriúria/microbiologia , Infecções por Enterobacteriaceae/etnologia , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/enzimologia , beta-Lactamases/biossíntese , Fatores Etários , Idoso , Antibacterianos/uso terapêutico , Bacteriúria/epidemiologia , Estudos Transversais , Demografia , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/epidemiologia , Feminino , Humanos , Londres/epidemiologia , Londres/etnologia , Masculino , Pessoa de Meia-Idade , Urina/microbiologia , Adulto Jovem
19.
Rev. patol. respir ; 18(2): 57-62, abr.-jun. 2015. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-141194

RESUMO

Las pruebas de función pulmonar son básicas para el diagnóstico y seguimiento del paciente respiratorio. Su correcta interpretación es fundamental para distinguir lo normal de lo patológico. La aparición de las primeras ecuaciones globales para todas las edades (Global Lung Initiative [GLI]-2012) supone un reto para cualquier médico encargado de interpretar una espirometría, no solo por los cambios "numéricos" esperables al utilizar otros patrones de referencia, sino por la necesidad de expresar los resultados como desviaciones de la media (z-scores) y abandonar el clásico porcentaje sobre el valor predicho. La visión de los pediatras neumólogos, acostumbrados a trabajar con pacientes en constante cambio, puede ayudar a entender la necesidad de este tipo de ecuaciones. Este artículo pretende revisar el concepto de normalidad, los parámetros necesarios para interpretar una espirometría, las características ideales de una ecuación de referencia y las bondades y defectos de las nuevas ecuaciones GLI-2012


Pulmonary function tests are basic in the diagnosis and monitoring of respiratory patients. The proper interpretation of these tests is essential to distinguish normal from pathological. The first global equations for all ages (Global Lung Initiative [GLI]-2012) poses a challenge for any physician responsible for interpreting spirometry, not only due to the "numerical" changes expected when using a new reference equation, but also because of the need to express the results as deviations from the mean (z-scores) and leave the classical percentage of the predicted value. The view of the paediatric pulmonologists, who are used to working with patients in constant evolution, can help to understand the need for this type of equations. This article reviews the concept of normality, the parameters required to interpret a spirometry, the ideal characteristics of a reference equation and the virtues and defects of the new GLI-2012 equations


Assuntos
Criança , Feminino , Humanos , Masculino , Testes de Função Respiratória/métodos , Testes de Função Respiratória/enfermagem , Pneumologia/educação , Pneumologia/ética , Pediatria , Espirometria/métodos , Espirometria , Londres/etnologia , Testes de Função Respiratória/instrumentação , Testes de Função Respiratória/normas , Pneumologia , Pneumologia/métodos , Pediatria/métodos , Espirometria/classificação , Espirometria/enfermagem
20.
BMC Neurol ; 15: 72, 2015 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-25935418

RESUMO

BACKGROUND: Epidemiological studies describe a latitude gradient for increased MS prevalence and a preponderance of disease in Caucasian individuals. However, individuals from other ethnic backgrounds and low-risk regions can acquire a raised risk through migration. Nearly a fifth of the London population is of Asian/Asian-British origin and a significant proportion of referrals are from this group. METHODS: We investigated whether there were differences in timing, presentation, severity, and immunology of disease (with respect to CD4 myelin epitope recognition) between individuals in London with MS who were either of S. Asian or Caucasian origin. Individuals of S. Asian origin with MS were compared with healthy S. Asian controls, individuals with MS and of Caucasian origin and Caucasian controls. RESULTS: Age at MS onset is significantly lower in the S. Asian group, attributable to earlier onset specifically in UK-born individuals, though clinical presentation is similar. Analysis of CD4 autoimmunity to myelin antigens shows disease in S. Asian individuals to encompass recognition of novel epitopes; immunity to MBP116-130 in S. Asian individuals was highly disease-specific. CONCLUSIONS: These findings emphasize the need to define disease profiles across ethnicities and identify environmental triggers conferring acquired risk. Such findings must inform choices for immunotherapeutic interventions suitable for all, across ethnicities.


Assuntos
Autoimunidade/imunologia , Esclerose Múltipla/etnologia , Esclerose Múltipla/imunologia , Bainha de Mielina/imunologia , Adulto , Idade de Início , Bangladesh/etnologia , Feminino , Humanos , Índia/etnologia , Londres/etnologia , Masculino , Pessoa de Meia-Idade , Paquistão/etnologia , Sri Lanka/etnologia
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