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This study investigated the association of the intersectional categories of gender-race/color with inadequate blood pressure (BP) control in Brazilian adults using antihypertensive drugs to treat hypertension. This is a cross-sectional analysis conducted with 4448 participants living with hypertension from visit 2 (2012-2014) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) undergoing pharmacological treatment. The association of the intersectional categories - White woman, Brown woman, Black woman, White man, Brown man, Black man - with inadequate BP control (systolic BP levels ≥140 mmHg and/or diastolic BP levels ≥90mmH) was estimated by the prevalence ratio (PR) and 95% confidence interval (95% CI) obtained by generalized linear models with Poisson distribution, adjusted covariates. The age-standardized prevalence of inadequate BP control ranged from 18.9% (White women) to 35.6% (Black men). After adjusting for sociodemographic characteristics, health-related behavior, health conditions, and the class number of antihypertensive medications, compared to White women, Black men (PR: 1.49 95% CI: 1.26-1.75), Brown men (PR: 1.42 95% CI: 1.18-1.72), Black women (PR: 1.36 95% CI: 1.12-1.65), and White men (PR: 1.32 95% CI: 1.09-1.60) showed poorer BP control. Results corroborate a higher prevalence of inadequate BP control in Black and Brown men. Furthermore, this intersectional approach evidenced that the prevalence of inadequate BP control in Black women is higher than that in White men, when compared to White women. Findings highlight that, for the development of more equitable BP control strategies, one must consider the specificities of socially marginalized intersectional groups, especially Black men and women.

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Objectives: To examine cancer mortality rates in Colombia by ethnic groups (Indigenous, Rom, Raizal, Afro-Colombian, and Mestizo) and assess trends from 2011 to 2022. Methods: National vital statistics from death certificates and the Colombian census data were used. Crude and direct age-standardized mortality rates were determined by ethnicity for the study period, by year, sex, and cancer type and Joinpoint analysis was conducted to examine trends. Results: Age-standardized cancer mortality of Mestizos (60.1 per 100,000 population) was lower than in Rom and Raizales (557.3 and 77.7 per 100,000), and higher than for Afro-Colombians and Indigenous (37.2 and 20.0 per 100,000). Indigenous people in Colombia had greater proportions of individuals under 45 dying of cancer than Mestizos (18.7% vs. 9.7%, p-value = <0.01). Compared to the Mestizo population, Raizales and Afro-Colombians experienced disproportionately higher age-standardized mortality rates due to prostate cancer (26.6/100,000 and 8.6/100,000 vs. 8.1/100,000), and for Raizales and Rom breast cancer (14.0/100,000 and 103.2/100,000 vs. 9.1/100,000). Conclusion: The disparities in cancer mortality in ethnic minorities in Colombia call for investigating cancer etiology and access to care among the Rom and the Raizal populations.

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Quilombola women are primarily responsible for maintaining ethnopharmacological knowledge. Their knowledge is transmitted orally to their descendants, preserving cultural identity and ensuring the survival of Quilombola communities. Was conducting a scoping review on the use of medicinal plants by Quilombola women. Based on the PPC strategy (population, concept, and context) and the "Joanna Briggs Institute Reviewer's Manual", this systematic scoping review sought to answer the guiding question: which medicinal plants are used for diseases that compromise women's health in Brazilian communities of African descent? The article has registered this research in the Open Science Framework available at osf.io/eb2nc, at identifier DOI https://doi.org/10.17605/OSF.IO/5N24Y. Using the search keys, 888 studies were found. After reading the titles and abstracts, 38 studies moved on to the next stage. During the reading of the texts in full, 32 were excluded for not meeting all the inclusion criteria and six studies were included in the research. In all, 44 plants, belonging to 23 families, were mentioned in the studies. The plants reported by the study have a plurality in their therapeutic use, the form of preparation, and part of the plant used. Regarding women's health, plants were recorded for sexual, menstrual, and postpartum care. The appreciation and recognition of this ancestral knowledge contribute not only to Women's health but also to strengthening the identity and rescuing the cultural roots of these communities.

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Multimorbidity is associated with negative effects on the health of individuals, increasing the complexity of health care. This study aimed to determine the prevalence of multimorbidity and associated factors in the adult Indigenous population living in villages in Aracruz, Espírito Santo State, Brazil. This is a cross-sectional study using data from the project called Assessment of the Prevalence and Severity of Chronic Diseases in the Indigenous Population of Espírito Santo State. Data were collected from 2020 to 2022. Multimorbidity was defined as the presence of two or more chronic morbidities in a group of eight morbidities. As a measure of association, the prevalence ratio (PR) and its 95% confidence interval (95%CI), calculated by Poisson regression with robust variance, in crude models and models adjusted for covariates were used. The prevalence of multimorbidity was 52.1% (95%CI: 49.1-55.2), being significantly higher among women (PR = 1.47; 95%CI: 1.29-1.67), those aged ≥ 40 years (40-59 years: PR = 1.49; 95%CI: 1.28-1.73; ≥ 60 years: PR = 1.85; 95%CI: 1.55-2.20) and lower for individuals with higher education (PR = 0.65; 95%CI: 0.47-0.89). The prevalence of multimorbidity in the Indigenous population living in villages in Espírito Santo State was higher than that found in other studies in the general Brazilian population. There was association between the presence of multimorbidity and sex, age and education level.

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OBJECTIVES: Anti-MDA5 autoantibodies are strongly associated with interstitial lung disease (ILD) and rapidly progressive ILD (RP-ILD) in Asian patients with dermatomyositis (DM) or amyopathic DM (ADM). However, this association has not yet been established in Brazilian patients with anti-MDA5(+) DM/ADM. This study aimed to investigate the phenotypic differences between Brazilian and Japanese patients with anti-MDA5(+) DM/ADM, with a particular focus on ILD. METHODS: This was an international, tricentric, retrospective cohort study conducted in one Brazilian and two Japanese tertiary centres. Patients diagnosed with anti-MDA5(+) DM/ADM at the three centres were enrolled. Clinical characteristics and outcomes were collected using a pre-standardised protocol and compared between Brazilian and Japanese patients. RESULTS: Thirty-four Brazilian and 65 Japanese patients were analysed. Brazilian patients were younger at the time of diagnosis than Japanese patients. The prevalence of muscle weakness, myalgia, dysphagia, heliotrope rash, V-sign, calcinosis, Raynaud's phenomenon, and digital ulcers was higher in Brazilian patients, whereas mechanic's hands were more prevalent in Japanese patients. The prevalence of ILD was significantly lower in Brazilian patients than in Japanese patients (50.0% vs. 98.5%, p<0.001). RP-ILD was observed in 34 (52.3%) Japanese patients and in only one (3.3%) Brazilian patient (p<0.001). Outcomes including overall survival and the frequency of relapses and complications, such as severe infection and malignancy, were comparable between the two populations. CONCLUSIONS: Brazilian patients with anti-MDA5(+) DM/ADM had a higher prevalence of skin and muscle involvement, whereas the prevalence of ILD and RP-ILD was significantly lower than in Japanese patients.

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Wellbeing levels have been a global concern during the COVID-19 pandemic, but there is a lack of attention to invariance questions that allow a robust examination of wellbeing dynamics across cultures. Questions of temporal stability that are crucial for examining the impact of the pandemic on wellbeing have received even less attention. Some studies suggested that measures may not be stable after the onset of the pandemic. We examine invariance parameters, the factorial structure and variability of wellbeing variables (life satisfaction, pandemic worries, anxiety and depression screenings) across five different cultural contexts from 2020 to 2022 (N = 4387, total observations = 13,161). A three-factor model separating life satisfaction, worry and distress performed best in terms of model fit and parsimony. We observed scalar invariance across times and identified little variability of wellbeing measures during the pandemic, suggesting that wellbeing levels remained stable during the pandemic in each of the countries sampled. In contrast, we only identified metric invariance across countries at each time point, and found a weakening of correlations between life satisfaction and a depressive/anxious symptoms scale in lower income countries. We discuss implications of our findings for discussions of wellbeing dynamics.

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Spinocerebellar ataxia type 10 (SCA10) is a neurodegenerative disease predominant in Latin American individuals with Indigenous American ancestry. SCA10 is caused by an expansion of ATTCT repeat within the ATXN10 gene. Healthy individuals carry 9-32 ATTCT repeats, whereas SCA10 patients carry an expansion of 280 repeats and higher. Recently, intermediate alleles (over than 32 repeats) have been identified in healthy Peruvian Indigenous American individuals, with unclear significance. This study aims to characterize the variability of the ATTCT repeats within the ATXN10 gene across self-declared Indigenous American and Mestizo subpopulations from Peru. A total of 871 samples (754 Mestizo and 117 Indigenous American) were analyzed using PCR, and RP-PCR when suspecting apparent homozygosity due to larger alleles. 8.7% of the total of healthy individuals (76/871) carry at least one intermediate allele. The 14-repeat allele being the most common for both subpopulations (41.5%). Intermediate alleles were detected in the Peruvian population (4.5%) with a significantly higher frequency among self-declared Indigenous American compared to Mestizo, suggesting a possible association with the ethnic origin. The G allele at the SNP rs41524547 had a frequency of 51.39% in individuals with intermediate alleles, with not significantly difference between subpopulations. Further analysis should be performed to confirm the size and composition of ATTCT repeat tract, as well as the contribution of rs41524547 in SCA10.

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BACKGROUND: Ethnic and racial discrimination in maternal health care has been overlooked in academic literature and yet it is critical for achieving universal health coverage (UHC). There is a lack of empirical evidence on its impact on the effective coverage of maternal health interventions (ECMH) for Indigenous women in Mexico. Documenting progress in reducing maternal health inequities, particularly given the disproportionate impact of the Covid-19 pandemic on ethnic minorities, is essential to improving equity in health systems. METHODS: We conducted a population-based, pooled cross-sectional, and retrospective analysis for 2009-2023, using data from the last three waves (2014, 2018, and 2023) of a nationally representative demographic survey (ENADID). Our study included n = 72,873 (N = 23,245,468) Mexican women aged 12-54 with recent live births. We defined ECMH as adequate antenatal care (ANC), skilled and/or institutional delivery care, timely postpartum care, and complication-free postpartum/puerperium. After describing sociodemographic characteristics and maternal health coverage by Indigenous status, we estimated a pooled fixed-effects multivariable regression model to adjust ECMH for relevant covariates. We used the Blinder-Oaxaca decomposition for nonlinear regression models to quantify inequities in ECMH due to ethnic-racial discrimination, defined as differences in outcomes attributable to differential treatment. FINDINGS: Indigenous women had lower education, labor market participation, and socioeconomic position, higher parity, and more rural, poorer state residence than non-Indigenous women. They faced significant health coverage loss due to the dismantling of Seguro Popular, a public health insurance mechanism in place until the end of 2019, right before the start of the Covid pandemic. Adjusted ECMH was 25.3% for non-Indigenous women and 18.3% for Indigenous women, peaking at 28.8% and 21.2% in 2013-2018, declining to 25.7% and 18.7% pre-Covid (January 2019 to March 2020), and further declining to 24.0% and 17.4% during Covid, with an increase to 26.6% for non-Indigenous women post-Covid, while remaining similar for Indigenous women. Decomposition analyses revealed that during the analyzed period, 30.8% of the gap in ECMH was due to individual characteristics, 51.7% to ethnic-racial discrimination, and 17.5% to their interaction. From 2009 to 2012, 42.2% of the gap stemmed from observable differences, while 40.4% was due to discrimination. In the pre-Covid-19 phase, less than 1% was from observable characteristics, with 75.3% attributed to discrimination, which remained in the post-Covid-19 stage (78.7%). CONCLUSIONS: Despite modest health policy successes, the ethnic gap in ECMH remains unchanged, indicating insufficient action against inequity-producing structures. Ethnic and racial discrimination persists, exacerbated during the pandemic and coinciding with the government's cancellation of targeted social programs and public health insurance focused on the poorest populations, including Indigenous peoples. Thus, prioritizing maternal and child health underscores the need for comprehensive policies, including specific anti-racist interventions. Addressing these inequities requires the recognition of both observable and unobservable factors driven by discriminatory ideologies and the implementation of targeted measures to confront the complex interactions driving discrimination in maternal health care services for Indigenous women.

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Neighborhood factors and the built environment (e.g., sidewalks, bike lanes and public transportation) are important social determinants of mental health. Yet scarce research explores their impact on Latinx mental health in Colonias (unincorporated, rural communities with limited access to basic utilities like water and electricity) along the U.S.-Mexico border. Secondary analysis of baseline data from a promotora-led, physical activity intervention in Colonias examined relationships between neighborhood environment and mental health among Spanish-speaking Latinas (N = 620) mostly born in Mexico (86%). The Physical Activity Neighborhood Environment Scale (PANES) assesses the perceived neighborhood environment such as neighborhood safety, infrastructure, and access to destinations. Multivariate linear regressions assessed associations between the PANES, the Built Environment Index (BEI), stress (PSS-10) and depression (CESD-10), controlling for age, marital status, education, income, and nativity. Most participants (90%) reported moderate to high stress (PSS ≥ 14), and approximately 30% were at risk for clinical depression (CESD ≥ 10). Analyses indicated that higher PANES total scores were significantly associated with lower depression (ß = -0.88, p < 0.05) and stress (ß = -1.67, p < 0.001). Similarly, higher BEI total scores were significantly associated with lower stress (ß = -0.53, p < 0.001). Individual BEI items, including greater housing density (ß = -1.26) and neighborhood access to recreation facilities (ß = -0.97), were significantly associated with lower depression scores (p < 0.05). The built environment had a significant impact on mental health among Latinas residing in Colonias. Neighborhood density and access to recreation facilities were particularly important, potentially serving as protective factors for mental health. Investment in the built environment in Colonias could improve mental health.

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BACKGROUND: Timely palliative and hospice care, along with advanced care planning, can reduce avoidable high-intensity care and improve quality of life at the end of life (EoL). OBJECTIVE: We examined patterns of care at EoL and evaluated predictors of high-intensity care at EoL among adults aged 18-64 with cancer. METHODS: Using data from the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database, we examined 1359 patients diagnosed with cancer in 2010-2019, who died of cancer between 2017 and 2019 at 64 years and younger, and who were enrolled in Medicaid or private health insurance in last 30 days before death. We used composite measures for high-intensity and recommended EoL care using claims-based indicators in the last 30 days before death. Multivariable logistic regression was used to examine predictors associated with high-intensity EoL care. RESULTS: About 70.3% of young and middle-aged Hispanic cancer patients received high-intensity EoL care, whereas only 20.6% received recommended EoL care. Patients without recommended EoL care were more likely to receive high-intensity EoL care (aOR=4.23; 95% CI=3.18-5.61). High-intensity EoL care was more likely in female patients (aOR=1.43; 95% CI=1.11-1.85) and patients with hematologic cancers (aOR=1.91; 95% CI=1.13-3.20) and less likely in patients who survived >12 months after cancer diagnosis (aOR=0.55; 95% CI=0.43-0.71). CONCLUSIONS: A high proportion of Hispanic adults with cancer in Puerto Rico receive high-intensity EoL care and have unmet needs at EoL. Tailored interventions can reduce high-intensity EoL care and increase recommended EoL care. Recommended EoL care can ease pain, reduce distress, honor personal preferences, and cut unnecessary medical costs.

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This article aims to identify the relationship between material deprivation and mortality from breast, cervical, and prostate neoplasms in the Brazilian adult population and the relationship between ethnicity/skin color and material deprivation. This cross-sectional ecological study calculated the mean mortality rate per 100,000 inhabitants, and deaths were standardized by age and gender and redistributed per to ill-defined causes, stratified by age group and ethnicity/skin color. We applied the Negative Binomial model, containing the interaction between ethnicity/skin color and the Brazilian Deprivation Index (IBP). We analyzed 85,903 deaths, and the most prevalent were those due to female breast neoplasms. The risk of death from cervical cancer was 8.5% higher for Black women than white women. In other places, mortality was higher among white people. For all causes, mortality increased with age. There was a significant interaction between ethnicity/skin color and IBP for all causes. Only deaths due to cervical neoplasms increased with higher IBP, while a decline was observed in other causes but was less significant among Black people. The IBP offers a multidimensional view of the socioeconomic conditions of the Brazilian population, allowing a better understanding of how social determinants operate on selected neoplasms.

O objetivo deste artigo é identificar a relação entre privação material e mortalidade por neoplasias de mama, colo do útero e próstata, na população adulta brasileira, e a relação existente entre raça/cor e privação material. Estudo ecológico transversal, calculou-se a taxa média de mortalidade/100.000 habitantes, com óbitos padronizados por idade e sexo e redistribuídos por causas mal definidas, estratificados por grupo etário e raça/cor. Aplicou-se o modelo Binomial Negativo, contendo a interação entre raça/cor e Índice Brasileiro de Privação (IBP). Foram analisados 85.903 óbitos, sendo mais prevalente os por neoplasias de mama. O risco de morte por neoplasia de colo do útero foi 8,5% maior para negras do que para brancas, nos demais sítios a mortalidade foi maior entre brancos. Para todas as causas com aumento da idade ocorreu aumento da mortalidade. Houve interação significativa entre raça/cor e IBP para todas as causas, apenas os óbitos por neoplasia de colo do útero aumentou com o aumento do IBP, nas demais houve redução. O IBP oferece uma visão multidimensional das condições socioeconômicas da população brasileira, permitindo melhor compreensão de como os determinantes sociais operam sobre as neoplasias selecionadas.

El objetivo es Identificar la relación entre privación material y mortalidad por neoplasias de mama, cuello uterino y próstata en la población adulta brasileña, y la relación entre raza/color y privación material. Este estudio ecológico transversal calculó la tasa media de mortalidad/100.000 habitantes, con defunciones estandarizadas por edad y sexo y redistribuidas según causas mal definidas, estratificadas por grupo de edad y raza/color. Se aplicó el modelo Binomial Negativo conteniendo la interacción entre raza/color y el Índice Brasileño de Privación (IBP). Se analizaron 85.903 defunciones, siendo las más prevalentes las debidas a neoplasias de mama. El riesgo de defunción por cáncer de cuello uterino fue 8,5% mayor para mujeres negras que para blancas. En otros lugares, la mortalidad fue mayor entre las personas blancas. Para todas las causas, hubo un aumento de la mortalidad con el aumento de la edad. Se observó una interacción significativa entre raza/color e IBP para todas las causas. Solo las defunciones por neoplasia cervical aumentaron con el aumento del IBP, en las demás hubo una reducción, pero menos significativa entre las personas negras. El IBP ofrece una visión multidimensional de las condiciones socioeconómicas de la población brasileña, permitiendo una mejor comprensión de cómo los determinantes sociales operan sobre neoplasias seleccionadas.

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The aim is to identify the epidemiological profile of mortality among Brazilian indigenous children under five years of age, through an integrative review. Articles that evaluated the mortality of indigenous Brazilian children under one and/or five years of age, from 2000 to 2020, in Portuguese, English, and/or Spanish, in the LILACS, SciELO, and MEDLINE databases were included. Of the 3,229 publications found, 22 were included in the review. Infant mortality ranged from 15.2/1,000 live births (LB) (1995-1999) for the Kayabí ethnic group to 307.7/1,000 LB (2000) for the Hupdäh ethnic group. Among the studies that evaluated infant mortality by age components, the post-neonatal period stands out, with proportions that varied from 15.2% (1990-1994), for indigenous children from Paraná, to 83.3% (2007- 2008) for the Guarani ethnic group. The main cause of mortality was respiratory diseases, ranging from 17.1% (2010) to 75% (2007-2008) among the Guarani ethnic group. Brazilian indigenous children under one year of age experienced high mortality rates, when compared to non-indigenous children, for all ethnicities and regions of the country. Among the IMT components, a high number of deaths were observed in the post-neonatal period, with respiratory system diseases representing the main causes of death.

O objetivo é identificar, por meio de uma revisão integrativa, o perfil epidemiológico da mortalidade em crianças indígenas brasileiras menores de cinco anos. Foram incluídos artigos que avaliaram a mortalidade de crianças indígenas brasileiras menores de um e/ou cinco anos, entre 2000-2020, em português, inglês e/ou espanhol, nas bases LILACS, SciELO e MEDLINE. Das 3.229 publicações encontradas, 22 foram inseridas na revisão. A mortalidade infantil variou de 15,2/1.000 NV (1995-1999) para a etnia Kayabí a 307,7/1.000 NV (2000) para a etnia Hupdäh. Entre os estudos que avaliaram a mortalidade infantil pelos componentes etários, destaca-se o período pós-neonatal, com proporções que variaram de 15,2% (1990-1994), para crianças indígenas do Paraná, a 83,3% (2007-2008) para a etnia Guarani. A principal causa de mortalidade foram as doenças respiratórias, variando de 17,1% (2010) a 75% (2007-2008) entre a etnia Guarani. Crianças indígenas brasileiras menores de um ano apresentaram taxas de mortalidade elevadas, quando comparadas às crianças não-indígenas, para todas as etnias e regiões do país. Entre os componentes de TMI, observou-se elevado número de óbitos no período pós-neonatal, tendo como principal causas de óbito as doenças do aparelho respiratório.

El objetivo es identificar el perfil epidemiológico de la mortalidad en niños indígenas brasileños menores de cinco años, a través de una revisión integradora. Se incluyeron artículos que evaluaron la mortalidad de niños indígenas brasileños menores de uno o cinco años, entre 2000-2020, en portugués, inglés o español, en las bases de datos LILACS, SciELO y MEDLINE. Se incluyeron 22 de las 3.229 publicaciones encontradas en la revisión. La mortalidad infantil osciló entre 15,2/1.000 NV (1995-1999) para el grupo étnico Kayabí y 307,7/1.000 NV (2000) para el grupo étnico Hupdäh. Entre los estudios que evaluaron la mortalidad infantil por componentes de edad, se destaca el período posneonatal, con proporciones que variaron desde el 15,2% (1990-1994), para los niños indígenas de Paraná, hasta el 83,3% (2007-2008) para la etnia guaraní. La principal causa de mortalidad fueron las enfermedades respiratorias, oscilando entre el 17,1% (2010) y el 75% (2007-2008) entre la etnia guaraní. Los niños indígenas brasileños menores de un año experimentaron altas tasas de mortalidad en comparación con los niños no indígenas en todas las etnias y regiones del país. Entre los componentes del TMI, se observó un elevado número de muertes en el período posneonatal, siendo las enfermedades del sistema respiratorio las principales causas de muerte.

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OBJECTIVE: To characterize the association between maternal ethnicity and infant survival to discharge without major morbidity. STUDY DESIGN: This is secondary analysis of a prospective cohort of infants born <27 weeks of gestation at National Institute of Child Health and Human Development Neonatal Research Network centers from 2006 through 2020. The primary outcome was survival to discharge without major morbidity (sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia grade 3, intracranial hemorrhage grade ≥3, periventricular leukomalacia, and advanced retinopathy of prematurity). Outcomes were compared by ethnicity and adjusted for center, perinatal characteristics, and sociodemographic characteristics. RESULTS: Of 14 029 subjects, 2155 (15%) were Hispanic, 6116 (44%) non-Hispanic Black, and 5758 (41%) non-Hispanic White. Infants of Hispanic mothers had the lowest survival to discharge without major morbidity (Hispanic 523/2099 [25%], non-Hispanic Black 1701/5940 [29%], non-Hispanic White 1494/5597 [27%], P = .002). Adjusted odds of survival without major morbidity differed between Hispanic and non-Hispanic Black (adjusted odds ratio [aOR] 0.80, 95% CI 0.69-0.93), but not between Hispanic and non-Hispanic White infants (aOR 1.07, 95% CI 0.92-1.25). At 2 years, children of non-Hispanic White mothers had the lowest incidence of neurodevelopmental impairment (Hispanic 544/1235 [44%], non-Hispanic Black 1574/3482 [45%], and non-Hispanic White 1004/3182 [32%], P < .001). Odds of impairment were greater for Hispanic than non-Hispanic White children (aOR 1.25, 95% CI 1.05-1.48) but did not differ between Hispanic and non-Hispanic Black children (aOR 0.88, 95% CI 0.74-1.04). CONCLUSIONS: In a multicenter cohort, infants of Hispanic mothers had lower odds of survival to discharge without major morbidity than infants of non-Hispanic Black mothers and similar odds of survival without major morbidity as infants of non-Hispanic White mothers. GOV ID: Generic Database: NCT00063063.

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Brazilians are a rapidly growing immigrant population in the United States (U.S.), yet little is known about their mental health and access to mental healthcare. Our goal was to access associations between the pursuit of- and access to-mental healthcare with mental health status and socio-demographic characteristics among Brazilian immigrant women. We conducted an online survey of Brazilian women aged 18 or older who reported being born in Brazil and currently residing in the U.S. We recruited respondents via Brazilian cultural media, community organizations serving Brazilian immigrants, and social media. We assessed respondents' perceived access to mental healthcare, self-reported mental health (CES-D-10), and socio-demographic characteristics and conducted multivariable logistic regression. Our analysis included 351 participants. Half (52%) had CES-D-10 scores indicating high levels of depressive symptomatology. A third (33%) reported seeking care for their mental health in the past 12 months, 87% of whom reported obtaining care. Results of multivariable logistic regression determined that respondents who sought mental healthcare were more likely to have higher CES-D-10 scores (OR = 1.09, 95% CI 1.03-1.15), very low incomes (<$10,000 per year; OR = 0.34, 95% CI 0.12-0.96), and were marginally more likely to have a primary care provider (OR = 2.11, 95% CI 1.00, 4.46). We found that despite a high level of depressive symptomology, only one-third reported accessing care. While difficulty accessing care for mental issues is a widespread issue, our findings suggest that efforts are needed to ameliorate mental health issues for Brazilian women to reduce systemic, interpersonal, and individual barriers to seeking care among the 13% who sought healthcare but were unable to receive it.

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INTRODUCTION: Latin America and the Caribbean (LAC) is one of the regions most affected by the climate crisis, which is connected to international migration through a complex nexus. During the last years, migratory flows on the continent have increasingly included children and adolescents who are migrating through non-authorised crossing points. The existing literature shows how inequities negatively affect migrant children and the role that healthcare systems can play to mitigate them. OBJECTIVE: Based on a qualitative study, the paper aims to analyse the role of the climate crisis on the healthcare needs of migrant children from LAC who are currently living in Chile, from the point of view of parents from five main countries of immigration in Chile and healthcare professionals. METHOD: An exploratory study was conducted in Arica, Antofagasta and Santiago. In-depth interviews with 20 migrant parents and 20 healthcare professionals were carried out. The interviews were transcribed verbatim and a thematic analysis was performed. RESULTS: Three findings emerged from this study: (1) food insecurity affects LAC migrant children in their country of origin and during their migratory trajectories to Chile, (2) natural disasters and environmental degradation in the countries of origin are not the only drivers of migration for LAC families but also prevent returns, even when they remain undocumented and (3) LAC migrant children are exposed to urban pollution and contaminants in informal settlements due to difficulties in accessing formal housing, among others. CONCLUSIONS: The climate crisis must be integrated into the study of migrant health in LAC, considering the current context of multiple political, health and economic crises in the region. Healthcare professionals and communities play a central role in creating interventions to build sustainable and resilient universal healthcare systems.

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BACKGROUND: This study investigates acculturative stress and its impact on psychological distress among Mexican immigrant women in the United States, with a particular focus on contextual factors shaping these acculturative stress experiences. It also seeks to provide actionable insights to address Mexican immigrant women's mental health needs. METHODS: Using the data from a total of 257 Mexican immigrant women in the National Latino Asian American Survey (NLAAS), path analysis was conducted to examine the relationships between acculturative stress, psychological distress, and various contextual factors. RESULTS: Acculturative stress was found to significantly contribute to psychological distress among Mexican immigrant women. Key factors affecting acculturative stress include contentment with the decision to move to the United States, English language proficiency, experiences of racial discrimination, difficulties associated with visiting family abroad, religiosity, and age at immigration. Critical determinants of psychological distress in the studied cohort, according to the results, are familismo values and racial discrimination. CONCLUSION: The results of this study underscore the need to consider contextual factors in understanding and addressing acculturative stress and psychological distress among Mexican immigrant women. Practical and policy implications include the necessity to develop culturally sensitive interventions, enhance educational opportunities, improve access to mental health services, and implement anti-discrimination policies. By adopting these strategies, mental health professionals and policymakers can foster resilience, wellbeing, and successful integration of Mexican immigrant women in the U.S. society.

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BACKGROUND: The use of urban green spaces differs by social characteristics, including gender, ethnicity, and socioeconomic position. We examined motives, means and prerequisites to visit green space of marginalised populations with high cardiometabolic risk in the Netherlands, namely women with a Turkish or South Asian Surinamese background residing in disadvantaged neighbourhoods. METHODS: We conducted six focus group discussions in two Dutch cities. The study was performed in collaboration with social workers from the local communities with similar ethnic backgrounds as the participants. A thematic analysis was carried out. RESULTS: Sixteen Turkish women and 30 South Asian Surinamese women participated. Motives, means and prerequisites that emerged covered four themes: social, personal, environmental characteristics and undertaking activities. Socializing was an important motive to visit green space. Personal motives mainly consisted of positive effects on mental and physical well-being. Activities undertaken in green space were often a means to socialize or improve well-being. Many environmental factors, including safety, aesthetics, and (sanitary) facilities, influenced motivation to visit green space. Except for environmental characteristics, motives, means and prerequisites largely overlapped between ethnic groups. There were notable interactions between the themes. CONCLUSION: Motives, means and prerequisites to visit green space of women with a Turkish or South Asian Surinamese background who live in disadvantaged neighborhoods span multiple interacting themes. Future studies examining the relationship between green space and health should consider interactions between motives, means, prerequisites and ethnicity. The possibility of expanding the multifunctionality of green spaces to provide marginalized populations with more equitable access and activities should be further explored.

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BACKGROUND: Stress indicators, including perceived discrimination and depression, have been linked with chronic diseases. Studies have also linked persistent prescription opioid use (PPOU) with depression. With increasing numbers of opioid overdose deaths among Hispanics (predominantly Puerto Rican) in Massachusetts, investigating how perceived discrimination and depression affect PPOU is relevant to public health efforts to address the opioid crisis. This study examined the effect of depression on PPOU and whether depression mediated the association between perceived discrimination and PPOU among Puerto Rican adults. METHODS: Data derived from a prospective population-based Boston Puerto Rican Health Study, at baseline and ~2- and ~6-year follow-up, were used to estimate the association between perceived discrimination and PPOU. Baron and Kenny's method was used to examine the potential mediating effect of depression. RESULTS: A total of 798 Puerto Rican adults (aged 56.5 ± 7.5 years, 72.9% women) participated in the study at all three time points, and 6.5% used prescription opioids persistently. Both depressive symptoms (Center for Epidemiological Studies Depression Scale score range: 0-60; OR = 1.03, 95% CI [1.00, 1.05], p = .03) and perceived discrimination (yes/no; OR = 2.43, 95% CI [1.28, 4.61], p = .006) were associated with PPOU. Depressive symptomatology partially mediated the effect of perceived discrimination on PPOU, by 10.3%. CONCLUSIONS: Among Puerto Rican adults in Massachusetts, depressive symptomatology partially explained the effects of perceived discrimination on PPOU. Other unidentified factors could play a role in the relationship between perceived discrimination and PPOU. Discussion on the potential risks of PPOU should be considered among underserved populations experiencing chronic pain, discrimination, and depressive symptoms.

RESUMO

BACKGROUND: People of Haitian descent were initially blamed as a cause of the HIV epidemic. Although progress has been made, people of Haitian descent have been disproportionately affected by both HIV and HIV stigma. OBJECTIVE: This scoping review aimed to assess publications focused on interventional HIV research with Haitian and Haitian-descent populations, particularly studies involving HIV prevention and treatment. ELIGIBILITY CRITERIA: The eligibility criteria for this scoping review were broad and included HIV prevention and/or treatment interventions that focused on people of Haitian descent. There were no date or language restrictions. We excluded review articles, opinions, editorials, supplement letters, withdrawn articles and viewpoints. SOURCES OF EVIDENCE: For the purposes of this scoping review, eight bibliographic databases were searched: PubMed, Embase, Medline, Cochrane Library, Scopus, Web of Science, PsychINFO and CINAHL. CHARTING METHODS: The entire data charting process, from review of titles and abstracts, full-text review and data extraction for relevant articles was conducted in Covidence. RESULTS: Our review found that there were limited studies regarding Haitian populations. Of the 575 articles found, 39 were included in this review. Most of the included studies focused on women of Haitian descent and were conducted in Haiti. Furthermore, few studies focused on adolescents, and most studies did not leverage community-based participatory research strategies. CONCLUSION: To address HIV-related health disparities among people of Haitian descent, new, research-based and community-based strategies are critically needed.

RESUMO

BACKGROUND:  Indigenous populations globally face significant health disparities compared to non-Indigenous groups, primarily due to marginalization and limited access to healthcare. In Mexico, which is home to the largest Indigenous population in the Americas, these disparities were further exacerbated by the COVID-19 pandemic, with impacts intensified by factors such as marginalization, discrimination, and inadequate access to essential services. METHODS: This study aimed to investigate the COVID-19 pandemic's impact on mortality, vaccination access and uptake, and official birth registration among a predominantly Indigenous population in San Juan Chamula, Chiapas. We conducted an online survey among high school students at the Colegio de Bachilleres del Estado de Chiapas, supplemented with epidemiological and socio-demographic data (N = 107). RESULTS: The survey revealed that 14% of respondents reported being infected with COVID-19, while national dashboard data indicated only 212 confirmed cases and one death in Chamula between April 2021 and June 2023. Additionally, 79.4% of respondents were unvaccinated, with significant communication barriers and a lack of information in Indigenous languages contributing to low vaccination rates. Additionally, 5.6% of surveyed family members and 4.7% of community residents lacked official birth certificates, significantly impeding their ability to access essential services such as education, healthcare, and vaccinations. CONCLUSION: Our findings highlight significant underreporting of COVID-19 cases and deaths in Indigenous communities, likely due to inadequate diagnostic resources and medical evaluation. The study underscores the urgent need for tailored public health strategies that integrate local Indigenous languages, cultures, and knowledge systems supported by trusted Indigenous leaders. Investing in education in Indigenous languages is crucial for improving vaccination adherence and overall public health outcomes. These strategies can inform national preparedness and response plans to address the unique challenges faced by Indigenous populations during pandemics and other public health crises.