Ethnicity & Disease最新文献

Objective: To assess the absence of diabetic foot examination in Brazil and how ethnicity affected this outcome.

Design: This is an analysis of a nationwide survey held in Brazil in 2019. Participants with diabetes and that were 15 years of age or older were eligible for inclusion in the analysis. Adjusted Poisson regression with robust variance was used to calculate prevalence ratios (PRs) and 95% confidence intervals (95% CIs) of never having had the foot examined, with separate models according to ethnicity. Stata 14.2 was used for all calculations.

Results: We included 6216 individuals with diabetes; 52.1% (95%CI: 50.0%-54.2%) reported never having had their feet examined by a health care professional and 61% self-declared as Black (Black and Brown [Brazilian mixed race]). A higher frequency of negligence was observed among Black individuals (55.3%; 52.5%-58.1%) than among White individuals (48.2%; 45.0%-51.5%). Negligence was higher between 15- to 39-year-old participants (PR = 1.34, 1.14-1.57), lower educational level (PR = 1.37, 1.13-1.65), higher alcohol consumption (PR = 1.18, 1.06-1.31), fair health status (PR = 1.11, 1.01-1.21), and diabetes diagnosis of up to 10 years (PR = 1.42, 1.28-1.57). Among Blacks, tobacco use and other factors increased the frequency of the outcome, whereas participation in the Brazilian Unified Health System primary care program was a protection factor (P<.05).

Conclusion: Black Brazilians with diabetes had higher negligence of foot examination by health care professionals. Strengthening primary care would help mitigate systemic racism in Brazil.

Objectives: To examine the relationship between acculturation, cultural perceptions surrounding mental health (MH) burden and utilization of MH services among South Asian (SA) adults in the United States.

Design: Cross-sectional study.

Setting: Online survey.

Participants: Four hundred five SA adults (≥18 years old) residing in the United States.

Methods: Cross-sectional study of acculturation, attitudes toward MH burden, and MH service utilization was conducted via online survey. Multivariate logistic regression models were employed to understand how these factors were associated with MH service utilization.

Main outcome measure: Utilization of MH services.

Results: Among the 405 participants, 49.0% identified as immigrants (75.1% Indian, 8% Bangladeshi, 5.5% Pakistani, and 3.8% from other SA countries). Current utilization of MH services was associated with comfort conversing in English (odds ration [OR]=5.99; 95% confidence interval [CI]=1.63, 27.02), having English-speaking peers (OR=3.80; 95% CI=1.12, 12.93), and having family (OR=2.37; 95% CI=1.21, 4.64) and peers (OR=5.64; 95% CI=1.71, 18.66) who used MH services. Participants with mostly SA peers (OR=0.48; 95% CI=0.23, 0.97) reported lower lifetime MH service utilization, and those with positive perceptions about MH burden reported higher lifetime utilization (OR=1.04; 95% CI=1.01, 1.09).

Conclusions: Comfort expressing emotions in English, knowledge of family/peer MH service use, and type of social connections were associated with MH service utilization among SA immigrants. Interventions should aim to increase SA languages in which MH services are offered and to engage with SA communities to increase acceptance of MH service utilization.

The lack of diversity in genomic studies is a disparity that influences our understanding of human genomic variation and threatens equity in the benefits of precision medicine. Given our current genomic research with Black older adults, we conducted a qualitative study to elucidate participants' knowledge, attitudes, and beliefs about genomic research and research participation and what factors contribute to their willingness to participate and to gain insights into barriers that researchers may have in recruiting Black Americans. We conducted semistructured interviews (N=16) with previous genomic research participants, and an inductive thematic approach was used to code and interpret the data. The mean age was 70, 82% reported <$15,000 annual income, and 100% participated in genomic research. The results note that genomic research is poorly understood despite participation in prior genomic studies, and cultural beliefs about health and managing health impact an individual's research participation. Although not all participants identified with historical distrust, those who did report health system distrust also contributed distrust in research. Relationship building facilitates research participation, especially when perceived as personally relevant and meaningful. Participant incentives and convenience to engage in the study are less important if the personal benefits or relevance of the research are clear. Our results provide new context into the importance of relationship building and research literacy and highlight new considerations for engaging racially diverse populations in research.

Objective: To evaluate the potential of using specific biopsychosocial instruments in capturing data on the relationship between stress and obesity and determine if job satisfaction influences the effect estimate.

Participants: Fifty-three Black employees at a Historically Black College and University (HBCU).

Methods: Logistic regression analyses were used to determine associations.

Results: Initially, perceived stress is not associated with obesity (adjusted odds ratio [AOR], 1.17; 95% CI, 1.01-1.36). The dimension of job satisfaction related to contingent/performance-based rewards had a negative significant relationship with obesity (AOR, 0.60; 95% CI, 0.37-0.96). The relationship between perceived stress and obesity became positively significant in the presence of job satisfaction related to contingent/performance-based rewards (AOR, 1.36; 95% CI, 1.02-1.84).

Conclusions: Results indicate that perceived stress in conjunction with job satisfaction related to contingent/performance-based rewards may be related to obesity. This underscores the need for further investigation of obesity, stress, and job satisfaction among HBCU employees. The instruments and tools used showed promising capacity for use among this understudied population.

Introduction: Resettled refugees have been exposed to stressful and life-threatening events preresettlement and are among the most marginalized and vulnerable groups in society. Postresettlement, they face challenges when assimilating to an unfamiliar host country, which renders them vulnerable to adverse health outcomes including obesity, a major public health burden. This study was conducted to examine the association of mental health and sociodemographic factors, including language proficiency and educational attainment, with obesity in first-generation resettled refugees.

Methods: We used data from electronic health records from the Adult Ambulatory Medicine Clinic of the State University of New York Upstate, Syracuse, NY. The probability of being overweight and obese (class I and class II) relative to normal weight was estimated using fully adjusted multinomial logistic regression models with relative risk ratios (RRRs).

Findings: Relative to male refugees, female refugees were more likely to have class I obesity (RRR=1.83; 95% confidence interval [CI]=1.19, 2.80) and class II obesity (RRR=4.07; 95% CI=2.41, 6.87). Limited English proficiency increased the risk of being overweight (RRR=2.02; 95% CI=1.29, 3.17) and having class II obesity (RRR=2.14, 95% CI=1.20, 3.81). A clinical mental health diagnosis increased the risk of class I (RRR=2.00; 95% CI=1.35, 2.96) and class II (RRR=1.76; 95% CI=1.15, 2.71) obesity. Having no formal education was associated with decreased risk of class II obesity (RRR=0.42; 95% CI=0.19, 0.90).

Discussion: Obesity prevalence and subsequent related morbidity continue to be major public health burdens in vulnerable, often underserved populations in the United States. Further investigation into social determinants of obesity in refugees in a community setting that captures the unique experiences of heterogenous refugee groups outside the clinical setting is warranted.

Background: Currently, researchers are examining the feasibility of integrating electrophysiological biomarkers in the clinical assessment of older adults (≥65 years of age) with Alzheimer's disease (AD). This research has been executed predominantly in older Caucasian adults. Older African-American adults have not been effectively recruited for this research. This issue has resulted in a significant gap in the literature about electrophysiological biomarkers and potential clinical utility in assessing for and diagnosing AD in older African-American adults.

Purpose: To share an opinion about the invisibility of older African-American adults in electrophysiological research on AD and potential outcome their inclusion can have on the integration of electrophysiological biomarkers into clinical practice.

Methods: For this commentary, it was necessary to determine the status of older African-American adults in electrophysiological research. Studies were identified using the search engines PUBMED, CINAHL, Elsevier, and Scopus with a time range of between 2016 and 2022. Nineteen peer-reviewed studies supported this commentary.

Results: In older Caucasian adults with AD, electrophysiological biomarkers were associated with the onset and progression of AD. These biomarkers related to the cognitive impairment of AD and its manifestations. There were no studies characterizing any electrophysiological biomarkers in older African-American adults with AD.

Conclusion: Research is growing to support the integration of electrophysiological biomarkers into clinical practice. The invisibility of older African-American adults in this research affects the reliability of electrophysiological biomarkers and their application to persons with AD in racially diverse groups. This invisibility also contributes to health disparities confronting older African-American adults with AD and their caregivers.

Objectives: Sleep disturbances may partially account for the health-related quality of life (HRQoL) disparities experienced by Black older adults when compared to non-Hispanic White (NHW) adults. The present study examined the role of self-reported sleep duration and the belief that one is not getting enough sleep on physical and mental HRQoL among Black older adults.

Design: Participants were 281 community-dwelling, economically disadvantaged Black older adults between 60 and 97 years of age (Mean=69.01, SD=6.97) who lived in a large city in the Southeastern United States. The present study uses baseline data from a larger intervention study aimed at promoting social connection and food security among older adults. For this study (and as part of the larger intervention), participants completed an assessment battery that included (1) a demographic data and health questionnaire that included self-reported sleep duration and a belief that one is not getting enough sleep questions; (2) the CDC (Centers for Disease Control and Prevention) Health-Related Quality of Life-14 Healthy Days Core Module; and (3) the World Health Organization Quality of Life-Brief Form.

Results: Descriptive results show that most participants slept less than 7 hours and felt like they did not get enough sleep. Results from 2 hierarchical regressions also showed that believing one is not getting enough sleep predicts lower self-reported mental and physical HRQoL.

Conclusion: While sleep deprivation has a serious impact on quality of life for Black older adults, sleep disturbances in this population are understudied. Interventions to improve sleep duration and quality among Black older adults may help reduce disparities in quality of life between Black older adults and NHW adults.

Background: High rates of physical inactivity persist in the United States, with higher rates among non-Hispanic Black adults than among their White peers. However, a comparison of physical activity engagement across nativity among Black adults in the United States has yet to be fully documented. The purpose of this cross-sectional study was to examine physical activity engagement rates among African immigrant and Afro-Caribbean immigrant adults compared with native-born African American adults using data from the 2010 to 2018 National Health Interview Survey.

Methods: Using data from the 2010 to 2018 National Health Interview Survey, we used generalized linear models to compare levels of physical activity (meeting the moderate-to-vigorous physical activity [MVPA] recommendations) by ethnic subgroups of Black adults, sequentially adjusting for sociodemographic and health-related risk factors.

Results: Data from 38,037 adults (58.8% female, 21% college/graduate degree, and 41.4% with obesity) were included. Only 41.9% of all participants met the MVPA recommendations. In the fully adjusted models across the 9 years, higher levels of MVPA were seen among African Americans (42%) than among African immigrants (38%) and Afro-Caribbean immigrants (41%). Compared with African Americans, African immigrants were less likely to engage in physical activity that met the MVPA guidelines (prevalence ratio: 0.90; 95% confidence interval: 0.85, 0.96), whereas there were no differences in meeting the guidelines between Afro-Caribbean immigrants (prevalence ratio: 0.96; 95% confidence interval:0.90, 1.02) and African Americans.

Conclusion: Culturally tailored interventions addressing socioenvironmental barriers and facilitators of physical activity may have important impacts on physical activity promotion and long-term disease burden among Black adults across nativity.

Background: While the youth of Flint are at risk from the effects of the water crisis, little is known about their perspective of the impact of the water on their health.

Objective: To explore adolescents' perceptions of living in Flint during the water crisis, its impact on their health, and ways to address the crisis and rebuild trust.

Methods: In summer 2018, four focus groups were conducted with adolescents in Flint (ages 13 to 17 years). Group sessions were conducted by trained facilitators who were Flint residents along with members of the community-academic research team. Group sessions were audio-recorded and transcribed. Transcripts were reviewed and themes identified by the research team and youth from the focus groups.

Results: Of the 53 participants, most identified as Black (66%) and male (64%). Participants expressed concern about the impact of the water on their health. They knew people who developed rashes, experienced cognitive changes, and who died, they believed, owing to the water. The crisis also led to psychological consequences for youth. They expressed ongoing mistrust of the water and of institutions that should protect them, as well as concern that exposure may have long-term effects on their health and their children's health. Despite these concerns, participants expressed resilience and a desire to share that they had the potential to live successful lives.

Conclusion: Youth expressed concern about current and long-term health sequelae of the water crisis. Further work is needed to monitor the consequences of the crisis and to identify resident-informed approaches to mitigate its effects and rebuild trust.

Objectives: We investigated the associations of lifetime and everyday discrimination with cognitive function.

Methods: Data were from the Chicago Community Adult Health Study (n=2952, mean age=43 years [SD=17]). We fitted multivariable linear regression models to quantify the discrimination-cognition associations.

Results: Major lifetime (β_{1 vs 0 episodes of discrimination}  = 0.56; 95% CI, 0.15-0.96; β_{2+ vs 0 episodes of discrimination}  = 0.64, 95% CI, 0.31-0.97) and everyday (β=0.10, 95% CI, 0.06-0.14) discrimination were positively associated with cognition, and these associations did not differ by race/ethnicity. Among older adults, major lifetime discrimination, but not everyday discrimination, was positively associated with cognition (β_{2+ vs 0 episodes of discrimination} =1.79; 95% CI, 0.79-2.79).

Discussion: Measurement and selection bias may partially explain the counterintuitive study findings. We call for longitudinal research to further investigate the discrimination-cognition relationship.