RESUMO
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.
Assuntos
Ambiente Construído , Depressão , Hispânico ou Latino , Características de Residência , Estresse Psicológico , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Depressão/etnologia , Depressão/psicologia , Exercício Físico/psicologia , Hispânico ou Latino/psicologia , Saúde Mental , México/etnologia , População Rural , Estresse Psicológico/etnologia , Estresse Psicológico/psicologia , Estados Unidos/epidemiologiaRESUMO
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.
Assuntos
COVID-19 , Serviços de Saúde Materna , Racismo , Cobertura Universal do Seguro de Saúde , Humanos , Feminino , Racismo/estatística & dados numéricos , Adulto , Estudos Transversais , México/etnologia , Serviços de Saúde Materna/estatística & dados numéricos , Estudos Retrospectivos , Adolescente , Adulto Jovem , COVID-19/epidemiologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Gravidez , Criança , Minorias Étnicas e Raciais/estatística & dados numéricos , Etnicidade/estatística & dados numéricosRESUMO
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.
Assuntos
População Negra , Neoplasias da Mama , Neoplasias da Próstata , Fatores Socioeconômicos , Neoplasias do Colo do Útero , População Branca , Humanos , Brasil/epidemiologia , Estudos Transversais , Feminino , Adulto , Pessoa de Meia-Idade , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/etnologia , Masculino , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/etnologia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/etnologia , Idoso , População Negra/estatística & dados numéricos , População Branca/estatística & dados numéricos , Adulto Jovem , Disparidades nos Níveis de Saúde , Fatores Etários , Adolescente , Idoso de 80 Anos ou maisRESUMO
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.
Assuntos
Mortalidade da Criança , Indígenas Sul-Americanos , Mortalidade Infantil , Humanos , Brasil/epidemiologia , Lactente , Pré-Escolar , Mortalidade Infantil/etnologia , Mortalidade Infantil/tendências , Indígenas Sul-Americanos/estatística & dados numéricos , Mortalidade da Criança/tendências , Recém-Nascido , Causas de Morte , Etnicidade/estatística & dados numéricos , Doenças Respiratórias/mortalidade , Povos Indígenas/estatística & dados numéricosRESUMO
OBJECTIVE: The epidemiology of meningiomas for patients with Hispanic ethnicity is mainly unknown beyond a few studies. Evidence supporting the ethnic influence over meningioma World Health Organization (WHO) grade is limited. This study aimed to investigate a Hispanic population in Puerto Rico with intracranial meningiomas regarding the WHO grade. METHODS: This study retrospectively reviewed 173 Hispanic patients who underwent pathology-proven intracranial meningioma resection by a single surgeon at a tertiary care facility during 25 years. Descriptive statistics were used to investigate clinical and histopathological differences among the patients. RESULTS: The cohort had 71.1% female patients, with a female-to-male ratio of 2.6:1. The median age of the patients was 53 years, ranging between 19 and 87 years. Analysis showed that 159 patients had a WHO grade 1 meningioma (91.9%), 13 patients had a WHO grade 2 meningioma (7.5%), and one patient had a WHO grade 3 meningioma (0.6%). Recurrence occurred in ten patients (5.8%). CONCLUSION: This study reveals a higher percentage of Hispanic patients with WHO grade 1 meningiomas in Puerto Rico than for Hispanic patients living in the United States.
Assuntos
Hispânico ou Latino , Neoplasias Meníngeas , Meningioma , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Neoplasias Meníngeas/epidemiologia , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/etnologia , Meningioma/epidemiologia , Meningioma/patologia , Meningioma/etnologia , Gradação de Tumores , Recidiva Local de Neoplasia/epidemiologia , Porto Rico/epidemiologia , Estudos RetrospectivosRESUMO
BACKGROUND: Rural-urban disparities in access to health services and the burden of diet-related noncommunicable diseases are exacerbated among Mexican immigrant farmworkers due to work demands, social and geographical isolation, literacy issues, and limited access to culturally and language-competent health services. Although mobile health (mHealth) tools have the potential to overcome structural barriers to health services access, efficacious mHealth interventions to promote healthy eating have not considered issues of low literacy and health literacy, and food preferences and norms in the Mexican immigrant farmworker population. To address this critical gap, we conducted a series of preliminary studies among Mexican immigrant farmworkers with the long-term goal of developing a culture- and literacy-specific smartphone app integrating dietary assessment through food photography, diet analyses, and a non-text-based dietary intervention. OBJECTIVE: This study aimed to report adherence and reactivity to a 14-day food photography dietary assessment protocol, in which Mexican immigrant farmworker women were instructed to take photos of all foods and beverages consumed. METHODS: We developed a secure mobile app with an intuitive graphical user interface to collect food images. Adult Mexican immigrant farmworker women were recruited and oriented to the photography protocol. Adherence and reactivity were examined by calculating the mean number of food photos per day over time, differences between the first and second week, and differences between weekdays and weekends. The type of foods and meals photographed were compared with reported intake in three 24-hour dietary recalls. RESULTS: In total, 16 Mexican farmworker women took a total of 1475 photos in 14 days, with a mean of 6.6 (SD 2.3) photos per day per participant. On average, participants took 1 fewer photo per day in week 2 compared with week 1 (mean 7.1, SD 2.5 in week 1 vs mean 6.1, SD 2.6 in week 2; P=.03), and there was a decrease of 0.6 photos on weekdays versus weekends (mean 6.4, SD 2.5 on weekdays vs mean 7, SD 2.7 on weekends; P=.50). Of individual food items, 71% (352/495) of foods in the photos matched foods in the recalls. Of all missing food items (n=138) and meals (n=36) in the photos, beverages (74/138, 54%), tortillas (15/138, 11%), snacks 16/36, 44%), and dinners (10/36, 28%) were the most frequently missed. Most of the meals not photographed (27/36, 75%) were in the second week of the protocol. CONCLUSIONS: Dietary assessment through food photography is feasible among Mexican immigrant farmworker women. For future protocols, substantive adjustments will be introduced to reduce the frequency of missing foods and meals. Our preliminary studies are a step in the right direction to extend the benefits of mHealth technologies to a hard-to-reach group and contribute to the prevention and control of diet-related noncommunicable diseases.
Assuntos
Emigrantes e Imigrantes , Fazendeiros , Aplicativos Móveis , Fotografação , Telemedicina , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Estudos de Viabilidade , Americanos Mexicanos , México/etnologia , Avaliação NutricionalRESUMO
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.
Assuntos
Hispânico ou Latino , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Analgésicos Opioides/uso terapêutico , Boston/epidemiologia , Depressão/epidemiologia , Hispânico ou Latino/psicologia , Hispânico ou Latino/estatística & dados numéricos , Massachusetts/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Estudos Prospectivos , Porto Rico/etnologiaRESUMO
INTRODUCTION: The COVID-19 pandemic has deeply affected Latin American countries, with countless COVID-19 cases and deaths. In countries like Mexico, Brazil, Peru, Colombia and Ecuador, the public health system collapsed and the lack of testing capacity did not allow control of the spread of SARS-CoV-2 during the first year of the COVID-19 pandemic. Moreover, rural and Indigenous communities in these countries, particularly isolated ones like those in the Amazon Basin, were neglected in terms of access to COVID-19 testing and medical aid. METHODS: In this study, we retrospectively analyzed the impact of COVID-19 outbreaks among several endangered Amazonian ethnic groups during the first wave of the COVID-19 pandemic in Ecuador. From June to August 2020, 21 Amazonian communities were included in a COVID-19 surveillance led by Indigenous community leaders and non-profit organizations. RESULTS: A total of 853 individuals were tested for SARS-CoV-2 infection by RT-qPCR. A high SARS-CoV-2 infection rate of 54.05% (461 positive individuals) was found. Only one community was COVID-19 free, and the other 20 communities had severe COVID-19 outbreaks with infection rates up to 90%. For the different ethnic groups, the infection rates were 46.0% for Waoranis, 66.15% for Sionas, 49.8% for Kichwas, 54.9% for Kofans and 62.3% for Shuars. Additionally, 29 individuals had SARS-CoV-2 viral load values higher than 108 copies/mL. CONCLUSION: Our findings confirm that Indigenous communities of Ecuadorian Amazonia were exposed to SARS-CoV-2 community transmission since the early stages of the COVID-19 pandemic, with the potential occurrence of superspreading events. As the COVID-19 national surveillance program was focussed on symptomatic individuals attending hospital facilities, rural and remote Indigenous communities in the Ecuadorian Amazonia, including endangered ethnic minorities, were neglected during the first wave of the COVID-19 pandemic.
Assuntos
COVID-19 , SARS-CoV-2 , Humanos , COVID-19/epidemiologia , COVID-19/etnologia , Equador/epidemiologia , Estudos Retrospectivos , Estudos Transversais , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adolescente , Adulto Jovem , Povos Indígenas/estatística & dados numéricos , Idoso , Criança , Pandemias , Surtos de Doenças , População Rural/estatística & dados numéricos , Pré-EscolarRESUMO
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.
Assuntos
Grupos Focais , Motivação , Características de Residência , Humanos , Feminino , Países Baixos , Suriname/etnologia , Adulto , Turquia/etnologia , Pessoa de Meia-Idade , Populações Vulneráveis/psicologia , Fatores de Risco CardiometabólicoRESUMO
OBJECTIVE: We performed a scoping review of randomised clinical trials (RCTs) assessing pharmacological therapies for the initial management of lupus nephritis (LN), focusing on study design, included populations and outcome definitions, to assess the generalisability of their results and identify gaps in the evidence. METHODS: RCTs evaluating pharmacological interventions for the initial therapy of LN published between 2000 and 2024 were evaluated. Extracted variables included study design, selection criteria, outcome definitions, populations recruited and clinical characteristics of participants. Each study arm was included as intervention and segregated into guideline-recommended regimens (cyclophosphamide (CYC), mycophenolic acid analogues (MPAAs), calcineurin inhibitors and belimumab) or other regimens. Data were analysed by descriptive statistics, and Fragility Index (FI) was estimated to assess robustness of studies. RESULTS: We included 124 intervention arms within 61 RCT, involving 7058 participants. Seventy-nine arms (63.7%) corresponded to guideline-recommended therapies: 33 (26.6%) MPAA, 28 (22.6%) NIH-CYC and 7 (5.6%) triple-drug therapies. While 100% of triple-drug therapies RCT were multinational, only 7.1% of NIH-CYC and 0% of tacrolimus RCTs were conducted in more than one country. Only 9 (14.8%) had follow-up ≥24 months. Ten (16.4%) RCTs exclusively included participants with severe or refractory LN. Only 29 (47.5%) reported serious adverse events, and few described patient-reported outcomes. Black and other race participants were under-represented, as well as participants from Middle East, North Africa, and the sub-Saharan African region. Response was variably defined and assessed at different intervals. Robustness of RCTs evaluating double-drug guideline-recommended therapies were mostly low, with FI ranging from 1 to 3. CONCLUSIONS: Considering new recommendations for the management of LN, we call for broader inclusion of under-represented populations and homogenisation of study design. This study provides the rationale for evaluating unexplored treatment comparisons and conducting research on newer interventions in clinical settings where evidence is currently lacking.
Assuntos
Ciclofosfamida , Imunossupressores , Nefrite Lúpica , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Nefrite Lúpica/tratamento farmacológico , Nefrite Lúpica/etnologia , Imunossupressores/uso terapêutico , Ciclofosfamida/uso terapêutico , Ácido Micofenólico/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Inibidores de Calcineurina/uso terapêutico , Quimioterapia Combinada , Lacunas de EvidênciasRESUMO
Introduction: metabolic dysfunction associated fatty liver disease (MAFLD) is a condition characterized by hepatic steatosis (HS) of metabolic origin. To predict it, HS serum indices (HSSI) have been proposed and validated, whose performance in indigenous populations is unknown. Objectives: to describe the variation of cardiometabolic risk (CMR) indicators according to four SHSI in indigenous Venezuelans of the Piaroa ethnic group, and to explore the frequency of non-alcoholic fatty liver disease (NAFLD) and MAFLD in this population. Methodology: non-experimental, descriptive, correlational and cross-sectional study, with non-probabilistic and intentional sampling, in 75 indigenous Piaroas adults (18 to 65 years). The HSSI were used: FLI (Fatty Liver Index), HSI (Liver Steatosis Index), LAP (Lipid Accumulation Product) and VAI (Visceral Adiposity Index). Results: FLI values were higher in men and LAP values in women. FLI, LAP and VAI were higher in individuals ≥ 40 years old. Individuals with body mass index (BMI) ≥ 25 kg/m2 showed higher FLI, HSI and LAP values compared to individuals with lower BMI. Depending on the applied HSSI, the frequency of NAFLD varied between 1.3% and 40.5%, while for MAFLD it was between 2.7 and 21.6%. Conclusion: the increase in HSSI was associated with changes in CMR indicators compatible with the presence of fatty liver. The study of the metabolic profile of HS in the Piaroas indigenous people must be expanded, in order to design better focused prevention and therapeutic strategies
Introducción: la enfermedad por hígado graso asociada a disfunción metabólica (EHGDM) es una afección caracterizada por esteatosis hepática (EH) de origen metabólico. Para predecirla, se han propuesto y validado índices séricos de EH (ISEH), cuyo desempeño en poblaciones indígenas se desconoce. Objetivos: describir la variación de indicadores de riesgo cardiometabólico (RCM) según cuatro ISEH en indígenas venezolanos de la etnia Piaroa, y explorar la frecuencia de enfermedad por hígado graso no alcohólico (EHGNA) y de EHGDM en esta población. Metodología: estudio no experimental, descriptivo, correlacional y transversal, con muestreo no probabilístico e intencional, en 75 indígenas Piaroas adultos (18 a 65 años). Se emplearon los ISEH: FLI (Índice de Hígado Graso), HSI (Índice de Esteatosis Hepática), LAP (Producto de Acumulación de Lípidos) y VAI (Índice de Adiposidad Visceral). Resultados: los valores de FLI fueron más elevados en los hombres y los de LAP en las mujeres. FLI, LAP y VAI fueron más elevados en individuos ≥ 40 años. Los individuos con índice de masa corporal (IMC) ≥ 25 kg/m2 mostraron valores de FLI, HSI y LAP superiores respecto de individuos con menor IMC. Según el ISEH aplicado, la frecuencia de EHGNA varió entre 1,3% y 40,5%, mientras que para EHGDM se ubicó entre 2,7 y 21,6%. Conclusión: el incremento de los ISEH se asoció a cambios en indicadores de RCM compatibles con la presencia de hígado graso. Debe ampliarse el estudio del perfil metabólico de la EH en los indígenas Piaroas, para diseñar estrategias de prevención y terapéutica mejor enfocadas.
Assuntos
Hepatopatia Gordurosa não Alcoólica , Humanos , Feminino , Adulto , Estudos Transversais , Venezuela , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/sangue , Hepatopatia Gordurosa não Alcoólica/etnologia , Masculino , Adulto Jovem , Adolescente , Idoso , Índice de Massa Corporal , Fatores de Risco Cardiometabólico , Indígenas Sul-Americanos/estatística & dados numéricos , Fígado Gorduroso/sangue , Fígado Gorduroso/etnologia , Biomarcadores/sangueRESUMO
PURPOSE: HER2-low has garnered significant attention for the treatment of HER2-negative breast cancer. We aimed to determine the prevalence of HER2-low expression in Hispanic/Latino women with breast cancer (BC). METHODS: We searched in Embase, LILACS, and Medline databases for articles reporting the expression of HER2 immunohistochemistry with scores reported as 0, 1+, 2+, or 3+, with equivocal cases (2+) confirmed through in situ hybridization (ISH). RESULTS: A total of 12 articles were finally included, comprising 73,467 individuals. The prevalence of HER2-zero, HER2-low and HER2 positive cases among all BC (0, 1+, 2+/ISH-, 2+/ISH+ and 3+), was 45.0%, 32.0%, and 23.0%, respectively. The prevalence of HER2-zero and HER2-low expression among negative cases (0, 1+ and 2+/ISH-), was 53.0% and 47.0%, respectively. CONCLUSION: There is an important percentage of Hispanic/Latino individuals who would benefit from HER2-targeted therapies, even in HER2 negative cases. Additional research on the prevalence of HER2-low tumors across a wider range of Latin American countries is required to better understand the molecular epidemiology of this biomarker within the Hispanic/Latino population.
Assuntos
Neoplasias da Mama , Hispânico ou Latino , Receptor ErbB-2 , Feminino , Humanos , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/etnologia , Neoplasias da Mama/genética , Prevalência , Receptor ErbB-2/genéticaRESUMO
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.
Assuntos
COVID-19 , Povos Indígenas , Vacinação , Humanos , México/epidemiologia , México/etnologia , COVID-19/prevenção & controle , COVID-19/epidemiologia , Feminino , Masculino , Vacinação/estatística & dados numéricos , Adolescente , Povos Indígenas/estatística & dados numéricos , SARS-CoV-2 , Inquéritos e Questionários , Declaração de Nascimento , Adulto Jovem , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Vacinas contra COVID-19/administração & dosagemRESUMO
Indigenous populations show high prevalence rates of mental disorders and limited access to mental health services. The aim of this study was to analyze the mental health care trajectories of indigenous youth living in the Metropolitan Area of Oaxaca, Mexico. Between May and August 2023, we conducted a qualitative study involving non-participant observation, in-depth interviews with seven indigenous youth, and semi-structured interviews with nine health professionals, healers, or leaders of mutual support groups. We identified processes, not exempt of tensions, in how these young people perceive themselves as both young and indigenous, in the development of their mental disorders, and in the ways they seek treatment. Their care involved the use of psychological and psychiatric services, mutual support groups, and, to a limited extent, traditional medicine. This study concludes that these dynamics are interwoven and amplified by interpersonal, institutional and epistemic racism, which must be dismantled to improve the mental health of indigenous youth.
Las poblaciones indígenas presentan altas prevalencias de trastornos mentales y limitado acceso a servicios de salud mental. El objetivo del estudio fue analizar las trayectorias de atención a trastornos mentales de jóvenes indígenas residentes en la Zona Metropolitana de Oaxaca, México. Entre mayo y agosto de 2023, se llevó a cabo un estudio cualitativo basado en observación no participante, entrevistas en profundidad a siete personas jóvenes indígenas y entrevistas semiestructuradas a nueve personas profesionales de la salud, curanderas o responsables de grupos de ayuda mutua. Se identificaron procesos de occidentalización, no exentos de tensiones, en la forma de concebirse como jóvenes e indígenas, en el desarrollo de sus trastornos mentales y en la atención de estos, para lo cual utilizaron servicios psicológicos, psiquiátricos, grupos de ayuda mutua y, de manera limitada, medicina tradicional. Se concluye que en estos procesos se articulan y potencian racismos interpersonales, institucionales y epistémicos, que será necesario desarticular para mejorar la salud mental de personas jóvenes indígenas.
Assuntos
Transtornos Mentais , Pesquisa Qualitativa , Racismo , Humanos , México/etnologia , Adolescente , Masculino , Feminino , Racismo/psicologia , Transtornos Mentais/etnologia , Transtornos Mentais/terapia , Transtornos Mentais/psicologia , Saúde Mental/etnologia , Serviços de Saúde Mental , Adulto Jovem , Entrevistas como Assunto , Acessibilidade aos Serviços de Saúde , População Urbana , Saúde da População Urbana/etnologia , Povos Indígenas/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologiaRESUMO
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.
Assuntos
Infecções por HIV , Estigma Social , Humanos , Infecções por HIV/prevenção & controle , Haiti/etnologiaRESUMO
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.
Assuntos
Mudança Climática , Pessoal de Saúde , Pais , Pesquisa Qualitativa , Migrantes , Humanos , Chile/epidemiologia , Migrantes/psicologia , Migrantes/estatística & dados numéricos , Masculino , Pais/psicologia , Criança , Feminino , Adolescente , Pessoal de Saúde/psicologia , Adulto , Abastecimento de Alimentos/estatística & dados numéricos , Entrevistas como Assunto , Saúde da Criança , Região do Caribe/etnologiaRESUMO
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.
Assuntos
Aculturação , Emigrantes e Imigrantes , Americanos Mexicanos , Angústia Psicológica , Estresse Psicológico , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Emigrantes e Imigrantes/psicologia , Emigrantes e Imigrantes/estatística & dados numéricos , Americanos Mexicanos/psicologia , Americanos Mexicanos/estatística & dados numéricos , México/etnologia , Racismo/psicologia , Racismo/estatística & dados numéricos , Estresse Psicológico/psicologia , Estresse Psicológico/etnologia , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
INTRODUCTION: Schizophrenia is a severe and persistent mental disorder that affects around 21 million people worldwide. The etiology of schizophrenia is currently understood as heterogeneous and multifactorial. Genetic and environmental factors are the most common explanations for the onset of schizophrenia, but along with these, hybridized cultural ideas coexist between medical, superstitious, and religious paradigms. The objective was to identify the relationship between cultural beliefs about schizophrenia, etiology and expressed emotion. METHODS: The present study used a mixed-method design, with an analytical approach for ethnographic research. The sample consisted of 40 people, relatives of patients diagnosed with schizophrenia, selected using simple random probabilistic sampling. RESULTS: A valid cultural consensus was found with statistical significance (p≤.05). Emotional trauma in childhood was identified as the leading cause of schizophrenia, followed by hereditary factors, emotional problems, head trauma, mistreatment, and divine will. The better-informed relatives expressed less emotion than those with less cultural competence (Mann-Whitney's U=1.000; p<.001). CONCLUSIONS: Mexican families in this study had a high degree of scientific knowledge about the etiology of schizophrenia, but religious ideas and compassionate explanations were part of this hybridized model.
Assuntos
Emoções Manifestas , Família , Esquizofrenia , Humanos , Esquizofrenia/etnologia , Esquizofrenia/etiologia , México/etnologia , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Família/psicologia , Cultura , Adulto Jovem , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Competência Cultural , Psicologia do Esquizofrênico , IdosoRESUMO
BACKGROUND: This study investigates breast cancer screening disparities among Mexican immigrant women in rural and urban U.S. communities, focusing on cultural beliefs, healthcare access, and geographical differences. METHODS: A cross-sectional study of 350 Mexican immigrant women aged 40+ without prior cancer diagnosis was conducted in rural (<2000 population) and urban parts of the U.S. in 2015. Culturally tailored surveys during household visits, clinic appointments, and community meetings assessed cultural beliefs, mammography engagement, and family support. Comparative analyses t-tests and chi-square tests were conducted, with significance set at P < .05. RESULTS: Rural women demonstrated higher adherence to spiritualismo (M = 4.31, SD = 1.13) compared to their urban counterparts (M = 3.91, SD = 1.36), marianismo (M = 3.33, SD = 0.45 vs M = 3.21, SD = 0.48), and machismo (M = 3.02, SD = 0.52 vs M = 2.80, SD = 0.61). The rural women also reported higher mammography rates (54.4% vs 45.6%), with 60.4% undergoing four or more mammograms. Despite barriers such as doctor non-recommendation (55.0% rural vs 45.0% urban) and embarrassment (67.9% rural vs 32.1% urban), rural women engaged more in family discussions about cancer screenings (61.7% vs 38.3%) and received more family assistance in finding health information (59.8% vs 40.2%). CONCLUSIONS: This study elucidates significant rural-urban disparities in cultural adherence and family support among Mexican immigrant women, underscoring the necessity for culturally tailored interventions to enhance breast cancer screening rates and health outcomes.
Assuntos
Neoplasias da Mama , Detecção Precoce de Câncer , Mamografia , População Rural , População Urbana , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/etnologia , Estudos Transversais , Detecção Precoce de Câncer/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde/etnologia , Mamografia/estatística & dados numéricos , Americanos Mexicanos/estatística & dados numéricos , População Rural/estatística & dados numéricos , Estados Unidos , População Urbana/estatística & dados numéricosRESUMO
Current body mass index (BMI) cutoff points (≥ 30 kg/m2) underestimate obesity prevalence in older adults. The aim of the present study was to propose new BMI cutoff points for identifying obesity in older Hispanic adults. In this study, new internally derived (ID) BMI cutoff point for obesity in older Hispanic adults was developed by analyzing data from the National Health and Nutrition Survey of 2018-2019 from Mexico. To evaluate the performance/validation of this newly proposed cutoff point, data from the "Study of the 1000", conducted in Northern Mexico, was utilized. Sensitivity, and negative predictive value (NPV) were assessed using receiver operating characteristic analysis, with obesity defined by fat mass index (FMI; ≥ 9.0 kg/m2 for men and ≥ 12.0 kg/m2 for women) as the reference method. The newly proposed ID BMI cutoff point was ≥ 27.2 kg/m2 which demonstrated high sensitivity (≥ 99.4%) and NPV (≥ 99.5%) in the total sample. Furthermore, the prevalence of obesity estimated by the new BMI cutoff point was comparable to that estimated by the FMI. The newly proposed BMI cutoff point provides a more accurate identification of obesity in older Hispanic adults. These findings have implications for improving obesity diagnosis and management in this population.