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Introdução: As desvantagens ligadas ao gênero feminino são visualizadas em diversos aspectos da vida, mediante ao patriarcado. É possível compreender que, no caso de mulheres negras, estas se encontram desfavorecidas frente as estruturas sociais, atravessadas por condicionantes de classe, raça e gênero. Além disso, é visto que, em diversos casos, as cuidadoras mulheres, sobretudo, mulheres negras, não escolhem de forma voluntária este papel dentro da conjuntura familiar. Objetivo: Identificar as implicações do cuidado ao familiar adoecido realizado por mulheres negras cuidadoras considerando suas condições socioculturais. Metodologia: Este trabalho é uma revisão integrativa, cuja busca no banco de dados foi realizada em dezembro de 2020, onde 3 resultados foram encontrados na base de dados Web of Science, 48 na base de dados PubMed e 29 na base de dados LILACS. Depois de ler os resumos dos 80 artigos e aplicar os critérios de exclusão, 7 artigos foram selecionados para leitura completa. Finalmente, 4 artigos foram incluídos para análise. Resultados: Apenas um estudo abordou exclusivamente mulheres, e a maioria eram afro-americanos. Dados indicam que, dentro de uma comunidade quilombola, o cuidado com a saúde é repassado do mais velho para o mais novo, como símbolo de respeito aos saberes ancestrais. Além disso, ficou evidente que cuidadores afro-americanos de pessoas com demência precisam de informações de qualidade sobre cuidados e autocuidado, necessitando de recursos em sua comunidade. Conclusão: É possível notar as desigualdades de acordo com as construções históricas, políticas e culturais causadas, para diferenciar homens e mulheres no cuidado familiar. Havendo uma necessidade de debates que tenham como enfoque a população negra, principalmente as cuidadoras, visando estratégias para reduzir sua sobrecarga para cuidar de familiares em adoecimento.
Introducción: Las desventajas vinculadas al género femenino se visualizan en diversos aspectos de la vida, a través del patriarcado. Es posible entender que, en el caso de las mujeres negras, ellas están en desventaja frente a las estructuras sociales, atravesadas por condiciones de clase, raza y género. Además, se observa que, en varios casos, las cuidadoras, especialmente las mujeres negras, no eligen voluntariamente este rol dentro del contexto familiar. Objetivo: Identificar las implicaciones del cuidado a un familiar enfermo realizado por cuidadoras negras considerando sus condiciones socioculturales. Metodología: Este trabajo es una revisión integradora, cuya búsqueda en la base de datos tuvo lugar en diciembre de 2020, donde se encontraron 3 resultados en la base de datos Web of Science, 48 en la base de datos PubMed y 29 en la base de datos LILACS. Después de leer los resúmenes de los 80 artículos. y aplicar los criterios de exclusión, se seleccionaron 7 artículos para su lectura íntegra. Finalmente, 4 artículos fueron incluidos para el análisis. Resultados: Solo un estudio se refería exclusivamente a mujeres, y la mayoría eran afroamericanas. Los datos indican que, en el seno de una comunidad quilombola, los cuidados de salud se transmiten de los más ancianos a los más jóvenes, como símbolo de respeto a los conocimientos ancestrales. Además, se puso de manifiesto que los cuidadores afroamericanos de personas con demencia necesitan información de calidad sobre cuidados y autocuidados y precisan recursos en su comunidad. Conclusión: Es posible percibir las desigualdades según las construcciones históricas, políticas y culturales provocadas, para diferenciar hombres y mujeres en el cuidado de la familia. Hay una necesidad de debates que se centren en la población negra, especialmente en las cuidadoras, con miras a elaborar estrategias para reducir su carga para cuidar a los familiares enfermos.
Introduction: The disadvantages linked to the female gender are viewed in different aspects of life, through patriarchy. It is possible to understand that, in the case of black women, they are disadvantaged in the face of social structures, crossed by class, race and gender conditioning factors. In addition, it is seen that, in several cases, female caregivers, especially black women, do not voluntarily choose this role within the family environment. Objective: To identify the implications of care for a sick family member performed by black women caregivers considering their sociocultural conditions. Methodology: This work is an integrative review, whose search in the database was carried out in December 2020, where 3 results were found in the Web of Science database, 48 in the PubMed database and 29 in the LILACS database. After reading the abstracts of the 80 articles and applying the exclusion criteria, 7 articles were selected for full reading. Finally, 4 articles were included for analysis. Results: Only one study exclusively addressed women, and most were African Americans. Data indicate that, within a quilombola community, health care is passed on from the oldest to the youngest, as a symbol of respect for ancestral knowledge. In addition, it became evident that African-American caregivers of people with dementia need quality information about care and self-care, requiring resources in their community. Conclusion: It is possible to notice the inequalities according to the historical, political and cultural constructions caused, in order to differentiate men and women in family care. There is a need for debates that focus on the black population, especially caregivers, aiming at strategies to reduce their burden to care for sick family members.
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Resumo O objeto de estudo se refere às representações da espiritualidade e da religiosidade para mulheres que pertencem às religiões afrodiaspóricas, em específico às que são fiéis da umbanda e do candomblé. Buscou-se analisar a estrutura representacional da espiritualidade e da religiosidade para mulheres umbandistas e candomblecistas com vistas a se pensar um modelo explicativo dessa construção simbólica e as implicações para a prática de cuidado na área da saúde. Estudo qualitativo, à luz das representações sociais em sua abordagem estrutural. Dados coletados com 207 mulheres umbandistas e candomblecistas por meio de evocações livres aos termos indutores espiritualidade e religiosidade, além da caracterização e da escala de religiosidade. As evocações foram submetidas às análises prototípica e de similitude com o Iramuteq, e os dados quantitativos, pela estatística descritiva. Os resultados mostram que os elementos centrais para a religiosidade são fé, crença, Deus e amor, enquanto para espiritualidade, fé, Orixás, Deus, paz e amor. A árvore de similitude explicita a centralidade da fé para a estruturação dessa representação. As representações se organizam ao redor da ideia de relação entre o humano e o divino.
Abstract The object of study refers to the representations of spirituality and religiosity for women who belong to Afro-diasporic religions, specifically those who are faithful to Umbanda and Candomblé. The objective was to analyze the representational structure of spirituality and religiosity for Umbandist and Candomblecist women with the aim of thinking of an explanatory model of this symbolic construction and implications for the practice of care in the area of health. Qualitative study, in the light of Social Representations in its structural approach. Data collected with 207 Umbandist and Candomblecist women through free evocations of the inducing terms "spirituality" and "religiosity", in addition to the characterization and scale of religiosity. The evocations were submitted to prototypical and similarity analyses with Iramuteq, while quantitative data to descriptive statistics. The results show that the central elements for religiosity are faith, belief, God and love, while for spirituality, they are faith, Orixás, God, peace and love. The tree of similarity explains the centrality of faith for the structuring of this representation. The representations are organized around the idea of a relationship between the human and the divine.
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Diabetes is an epidemic in the United States and is ranked as the sixth leading cause of death in the District of Columbia. According to the US Census population in 2010, >52,000 out of 610,000 residents have been diagnosed with diabetes. The highest prevalence was noted in wards 4, 5, 7, and 8, with the worst impact recorded in ward 8. The diabetes death rate among African Americans is five times that for Caucasians living in Colombia district, according to the DC department of health. There is an 11% disparity in the prevalence of diabetes when comparing black- and white people in the district (14% and 3%, respectively). This amounts to more than double the 6% disparity in the national population. This is also evident at both district and nationwide levels (prevalence of diabetes among people with no high school diploma, 21%; that in college graduates, 5%). The incidence of end-stage renal disease (ESRD), a life-threatening condition and diabetes-related complication is increasing in Colombia district and is rated as the number one cause of death from diabetes. In 2010, the newly diagnosed ESRD cases (420) and total number of ESRD cases due to diabetes (642) in the district were twice that of neighboring states (Maryland, Virginia, and West Virginia) and the entire US. In this review, the importance of implementing an evidence-based public health program in solving the epidemic of diabetes among the black community living in Ward 8 is emphasized. This study applies to every poor or minority ethnic group worldwide and in the US.
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Atopic Dermatitis, also called atopic eczema, is a complex systemic inflammatory disease with heterogeneous clinical morphologies. Common features are eczematous lesions, intense pruritus and chronic or relapsing disease course. Eczematous lesions typically show an age-related distribution. However, this disease can present different phenotypes, like follicular/papular dermatitis and prurigo nodularis. We reported a male, 22 years old, phototype IV, African descent, with personal and familial history of atopy. He reported pruritus, xerosis and lesions on skin since he was 2 years-old, with relapsing and chronic course. Clinical examination showed disseminated perifollicular accentuation and rough follicular papules. Extensor surfaces of the legs showed excoriated papules and nodules, beside generalized post-inflammatory hypopigmentation. He had lichenified plaques on the back, neck, hands and foot. Skin biopsy showed spongiosis, parakeratosis and irregular acanthosis at the epidermis. The diagnosis was late and occurred only in adulthood. Due to the extensive and relapsing presentation, he received Cyclosporin 3 mg/Kg/day, associated to steroids and emollients, with improvement of pruritus, xerosis and lechinification. But he maintained perifollicular accentuation. The patient presented common features of Atopic Dermatitis, like chronic and relapsing lesions, history of atopic, dry skin, pruritus, and early disease onset. However, atypical morphologies were presented, exemplified by prurigo nodularis and follicular/papular dermatitis. Other relevant finding it was the fact that the lesions occurred outside the classic areas, with prevalence on extensor surfaces and trunk. These atypical morphologies and unusual location of lesions are prevalent on adults with high phototypes, as seen in this case. It is essential to identify these challenging phenotypes, because the diagnosis of Atopic Dermatitis is clinical. Given the diversity of clinical presentation and difficult to recognize some cases, this article will contribute to demonstrate atypical manifestations and common features in non-white patients, facilitating correct diagnosis and early treatment.
A dermatite atópica, também chamada de eczema atópico, é uma doença inflamatória sistêmica complexa, com morfologias clínicas heterogêneas. As características comuns são lesões eczematosas, prurido intenso e curso crônico ou recidivante. Lesões eczematosas geralmente mostram uma distribuição relacionada à idade. No entanto, essa doença pode apresentar diferentes fenótipos, como dermatite folicular/papular e prurigo nodular. Relatamos um homem, 22 anos, fototipo IV, afrodescendente, com história pessoal e familiar de atopia. Referia prurido, xerose e lesões na pele desde os 2 anos, com recidiva e curso crônico. O exame clínico mostrou acentuação perifolicular disseminada e pápulas foliculares ásperas. As superfícies extensoras das pernas apresentavam pápulas e nódulos escoriados, além de hipopigmentação pós-inflamatória generalizada. Notaram-se placas liquenificadas no dorso, pescoço, mãos e pés. A biópsia de pele demonstrou espongiose, paraqueratose e acantose irregular na epiderme. O diagnóstico foi tardio e ocorreu apenas na idade adulta. Devido ao quadro clínico extenso e recidivante, recebeu Ciclosporina 3 mg/Kg/dia, associada a esteroides e emolientes, com melhora de prurido, xerose e liquenificação, mas manteve a acentuação perifolicular. O paciente apresentava características comuns de dermatite atópica, como lesões crônicas e recidivantes, história de atopia, pele seca, prurido e início precoce da doença, no entanto, foram apresentadas morfologias atípicas, exemplificadas por prurigo nodular e dermatite folicular/papular. Outro achado relevante foi o fato das lesões localizarem-se em áreas não clássicas da doença, com predomínio nas superfícies extensoras e tronco. Essas morfologias atípicas e localizações incomuns são prevalentes em adultos com fototipos elevados, como visto neste caso. É essencial identificar esses fenótipos desafiadores, porque o diagnóstico de dermatite atópica é clínico. Devido à diversidade de apresentações clínicas e dificuldade de reconhecimento de alguns casos, este artigo contribuirá para demonstrar manifestações atípicas e características comuns em pacientes não brancos.
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Humanos , Masculino , Adulto Jovem , Fenótipo , Hipopigmentação , População Negra , Dermatite Atópica , Prurido , Pele , Terapêutica , Dorso , Ciclosporina , Diagnóstico , Tronco , Pé , Mãos , PescoçoRESUMO
OBJECTIVES: This study sought to: 1) understand how the perceived food environment (availability, accessibility, and affordability) is associated with cardiometabolic health outcomes in predominately low-income Black residents in urban neighborhoods with limited healthy food access; and 2) examine the association of shopping at specific store types with cardiometabolic health outcomes. METHODS: We report on cross-sectional data from 459 individuals participating in the Pittsburgh, PA Hill/Homewood Research on Neighborhoods and Health (PHRESH) study. Mean participant age was 60.7 (SD=13.9); 81.7% were female. We used logistic regression to examine associations between three factors (perceived fruit and vegetable availability, quality, and price; primary food shopping store characteristics; and frequency of shopping at stores with low or high access to healthy foods) and cardiometabolic and self-rated health. RESULTS: Adjusting for sociodemographic characteristics, participants with higher perceived fruit and vegetable accessibility (AOR:.47, 95%CI: .28-.79, P=.004) and affordability (AOR:.59, 95%CI: .36-.96, P=.034) had lower odds of high blood pressure. Shopping often (vs rarely) at stores with low access to healthy foods was associated with higher odds of high total cholesterol (AOR:3.52, 95%CI: 1.09-11.40, P=.035). Finally, primary food shopping at a discount grocery (vs full-service supermarket) was associated with lower odds of overweight/obesity (AOR:.51, 95%CI: .26-.99, P=.049). CONCLUSIONS: These results suggest that both perceived accessibility and affordability of healthy foods are associated with reduced cardiometabolic risk factors in this urban, low-income predominantly Black population. Additionally, discount grocery stores may be particularly valuable by providing access and affordability of healthy foods in this population.
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Doenças Cardiovasculares , Abastecimento de Alimentos , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Feminino , Humanos , Características de Residência , VerdurasRESUMO
COVID-19 is a threat to health systems worldwide, with a tremendous impact in many areas of human endeavors. The impact of the COVID-19 pandemic in the United States is far-reaching and the minority groups are disproportionately affected. The longstanding injustice and inequity fueled by systemic racial inequalities have been exacerbated by the pandemic in the United States especially among the minorities, including African Americans. It is clear that without high coverage of the COVID-19 vaccination among all groups, curbing the pandemic is a mirage. In this article, I commented on COVID-19 vaccine and hesitancy among African Americans and its implications for the pandemic response.
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ABSTRACT Aim: Current guidelines do not address between-person variability in markers of bone and mineral metabolism across subgroups of patients, nor delineate treatment strategies based upon such factors. Methods: A cross sectional study was carried out to analyze data from 20,494 United States Veterans and verify the variability of Vitamin D (25(OH)D) and parathyroid hormone (PTH) levels across race and stage of chronic kidney disease. Results: PTH levels were higher in Black Americans (BA) than White Americans (WA) at all levels of 25(OH)D and across eGFR strata. There was a progressive decline in PTH levels from the lowest (25(OH)D < 20) to highest quartile (25(OH)D >=40) in both BA (134.4 v 90 pg/mL, respectively) and WA (112.5 v 71.62 pg/mL) (p<0.001 for all comparisons). Conclusion: In this analysis, higher than normal 25(OH)D levels were well tolerated and associated with lower parathyroid hormone values in both blacks and whites. Black Americans had higher PTH values at every level of eGFR and 25(OH)D levels suggesting a single PTH target is not appropriate.
RESUMO Objetivo: as diretrizes atuais não abordam a variabilidade entre as pessoas nos marcadores do metabolismo ósseo e mineral em subgrupos de pacientes, nem traçam estratégias de tratamento com base em tais fatores. Métodos: realizamos um estudo transversal para analisar dados de 20.494 veteranos de guerra dos Estados Unidos e verificar a variabilidade nos níveis de vitamina D (25 (OH) D) e hormônio da paratireóide (PTH) entre a raça e o estágio da doença renal crônica. Resultados: os níveis de PTH foram maiores em americanos negros (AN) do que em americanos brancos (AB) em todos os níveis de 25 (OH) D e em todos os estratos de TFGe. Houve um declínio progressivo nos níveis de PTH do quartil mais baixo (25 (OH) D <20) para o quartil mais alto (25 (OH) D> = 40) em AN (134,4 v 90 pg/mL, respectivamente) e AB (112,5 v 71,62 pg/mL) (p <0,001 para todas as comparações). Conclusão: Nesta análise, níveis de 25 (OH) D acima do normal foram bem tolerados e associados a valores mais baixos do hormônio da paratireóide em negros e brancos. Os americanos negros tinham valores de PTH mais altos em todos os níveis de TFGe e 25 (OH) D, sugerindo que uma única meta de PTH não é apropriado.
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Humanos , Deficiência de Vitamina D , Insuficiência Renal Crônica , Hormônio Paratireóideo , Vitamina D/análogos & derivados , Estudos Transversais , Fatores RaciaisRESUMO
RATIONALE & OBJECTIVES: Preeclampsia, which disproportionately affects Black women, is a leading cause of preterm delivery and risk for future hypertension and chronic kidney disease (CKD). Apolipoprotein L1 (APOL1) kidney risk alleles, common among Black individuals, contribute substantially to CKD disparities. Given the strong link between preeclampsia and CKD, we investigated whether maternal and fetal APOL1 risk alleles can jointly influence preeclampsia risk, and explored potential modifiers of the association between APOL1 and preeclampsia. STUDY DESIGN: Nested case-control study. SETTING & PARTICIPANTS: 426 Black mother-infant pairs (275 African Americans and 151 Haitians) from the Boston Birth Cohort. EXPOSURE: Maternal and fetal APOL1 risk alleles. OUTCOMES: Preeclampsia. ANALYTICAL APPROACH: Logistic regression models with adjustment for demographic characteristics were applied to analyze associations between fetal and maternal APOL1 risk alleles and risk of preeclampsia and to investigate the effects of modification by maternal country of origin. RESULTS: Fetal APOL1 risk alleles tended to be associated with an increased risk of preeclampsia, which was not statistically significant in the total genotyped population. However, this association was modified by maternal country of origin (P<0.05 for interaction tests): fetal APOL1 risk alleles were significantly associated with an increased risk of preeclampsia among African Americans under recessive (odds ratio [OR], 3.6 [95% CI, 1.3-9.7]; P=0.01) and additive (OR, 1.7 [95% CI, 1.1-2.6]; P=0.01) genetic models but not in Haitian Americans. Also, maternal-fetal genotype discordance at the APOL1 locus was associated with a 2.6-fold higher risk of preeclampsia (P<0.001) in African Americans. LIMITATIONS: Limited sample size in stratified analyses; self-reported maternal country of origin; pre-pregnancy estimated glomerular filtration rate (eGFR) and proteinuria data in mothers were not collected; unmeasured confounding social and/or environmental factors; no replication study. CONCLUSIONS: This study supports the hypothesis that fetal APOL1 kidney risk alleles are associated with increased risk for preeclampsia in a recessive mode of inheritance in African Americans and suggests that maternal-fetal genotype discordance is also associated with this risk. These conclusions underscore the need to better understand maternal-fetal interaction and their genetic and environmental factors as contributors to ethnic disparities in preeclampsia.
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Apolipoproteína L1/genética , Negro ou Afro-Americano/genética , Pré-Eclâmpsia/genética , Adulto , Estudos de Casos e Controles , Feminino , Feto , Genótipo , Haiti , Humanos , Gravidez , Medição de Risco , Estados Unidos , Adulto JovemRESUMO
COVID-19 is said to be a pandemic that does not distinguish between skin color or ethnic origin. However, data in many parts of the world, especially in the United States, begin to show that there is a sector of society suffering a more significant impact from this pandemic. The Black population is more vulnerable than the White population to infection and death by COVID-19, with hypertension and diabetes mellitus as probable predisposing factors. Over time, multiple disparities have been observed between the health of Black and White populations, associated mainly with socioeconomic inequalities. However, some mechanisms and pathophysiological susceptibilities begin to be elucidated that are related directly to the higher prevalence of multiple diseases in the Black population, including infection and death by COVID-19. Plasma vitamin D levels and evolutionary adaptations of the renin-angiotensin-aldosterone system (RAAS) in Black people differ considerably from those of other races. The role of these factors in the development and progression of hypertension and multiple lung diseases, among them SARS-CoV-2 infection, is well established. In this sense, the present review attempts to elucidate the link between vitamin D and RAAS ethnic disparities and susceptibility to infection and death by COVID-19 in Black people, and suggests possible mechanisms for this susceptibility.
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Negro ou Afro-Americano/genética , COVID-19/mortalidade , Disparidades nos Níveis de Saúde , Sistema Renina-Angiotensina/genética , Determinantes Sociais da Saúde/etnologia , Fatores Socioeconômicos , Deficiência de Vitamina D/mortalidade , Vitamina D/análogos & derivados , Biomarcadores/sangue , COVID-19/etnologia , COVID-19/genética , Predisposição Genética para Doença , Humanos , Fatores Raciais , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/etnologiaRESUMO
ABSTRACT Objective To carry out a socioeconomic, demographic and parasitological evaluation of quilombola communities in two of the oldest municipalities in Brazil. Material and Methods Between December 2015 and June 2016, of the total of 231 residents of the communities, socioeconomic questionnaires were applied and fecal samples collected from 150 individuals were analyzed by spontaneous sedimentation method and the Kato-Katz method. Results It was observed that 95.3% (n=143) of the interviewees had piped water at their residence, and 76% (n=114) came from wells or springs; 85.3% (n=128) reported that the toilet drain was made in a rudimentary septic tank and 59.3% (n=89) reported having litter buried or burned, showing precarious conditions in basic sanitation. Still on socioeconomic aspects, 80.7% (n=121) of the individuals reported having access to the public health service. Parasitological tests were positive for 48% (n=72) of the analyzed samples, and 25% (n=18) had two or more parasites. The most frequent organism in the study population was the commensal Entamoeba coli (55.6%, n=40), followed by Ascaris lumbricoides (19.4%, n=14) and the commensal Endolimax nana (16.7%, n=12). The Poisson regression showed an increase of 1.59 in the prevalence of parasites for individuals who do not have access to the public health service, when compared to those who have access to these services. Conclusions The results indicate the need to implement public health measures in order to reduce, prevent and treat the parasitological condition of the population to obtain better conditions and quality of life.
RESUMEN Objetivo Realizar una evaluación socioeconómica, demográfica y parasitológica de las comunidades quilombolas en dos de los municipios más antiguos de Brasil. Materiales y Métodos Entre diciembre de 2015 y junio de 2016, del total de 231 residentes de las comunidades, se aplicaron cuestionarios socioeconómicos y se analizaron muestras fecales de 150 individuos mediante el método de sedimentación espontánea y el método Kato-Katz. Resultados Se observó que el 95,3% (n=143) de los entrevistados tenían agua entubada en su residencia y el 76% (n=114) provenía de pozos o manantiales; El 85,3% (n=128) informó que el desagüe del inodoro se realizó en un tanque séptico rudimentario y el 59,3% (n=89) informó que tenía basura enterrada o quemada, que mostraba condiciones precarias en el saneamiento básico. Aún en aspectos socioeconómicos, el 80,7% (n=121) de las personas reportaron tener acceso al servicio de salud pública. Las pruebas parasitológicas fueron positivas para el 48% (n=72) de las muestras analizadas, y el 25% (n=18) tenía dos o más parásitos. El organismo más frecuente en la población de estudio fue el comensal Entamoeba coli (55.6%, n=40), seguido de Ascaris lumbricoides (19.4%, n=14) y el comensal Endolimax nana (16.7%, n=12). La regresión de Poisson mostró un aumento de 1,59 en la prevalencia de parásitos para las personas que no tienen acceso al servicio de salud pública, en comparación con aquellos que tienen acceso a estos servicios. Conclusión Los resultados indican la necesidad de implementar medidas de salud pública para reducir, prevenir y tratar la condición parasitológica de la población para obtener mejores condiciones y calidad de vida.
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In 2017, migrants were 4.35% of the Chilean population, mainly from Peru and Colombia. From 2015, the amount of migrants from Central America, particularly from Haiti increased notably. This process changed the phenotype of the male population, increasing the proportion of black men, mainly between 20 and 50 years. Afro-descendant men have a higher risk for prostate cancer, and the tumor can appear as early as 40 years of age among them. This increase will have future repercussions on the public health system, since part of these men have low income and poor living conditions. Therefore, it is necessary to discuss early detection strategies focused on this population, including education for both patients and health professionals. This review includes data on the reality of migration in Chile and its impact on the health system. The higher incidence and mortality of prostate cancer in the migrant population is reviewed and risk-adjusted screening strategies are proposed.
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Humanos , Masculino , Neoplasias da Próstata , Emigrantes e Imigrantes , Peru/epidemiologia , Negro ou Afro-Americano , Chile/epidemiologia , Colômbia , HaitiRESUMO
OBJECTIVE: The purpose of this study is to evaluate the role mitochondrial inheritance plays in primary open-angle glaucoma (POAG) characteristics in African Americans. METHODS: POAG cases from the L1c2 and L1b mitochondrial haplogroups were compared in a retrospective case-case study. Twenty-six pairs of self-identified African American POAG cases from L1c2 and L1b mitochondrial haplogroups matched on age (mean [SD] = 71.2 [9.6] and 71.3 [9.6] years, respectively; p = 0.97), sex (21 female and 5 male pairs), and family history of glaucoma (positive in 15/26 [58%] pairs) were included. RESULTS: L1c2 subjects displayed higher vertical cup-to-disc ratio (0.75 [0.12] and 0.67 [0.16], respectively; p = 0.01, Bonferroni-corrected p = 0.08), worse pattern standard deviation on visual field (VF) testing (5.5 [3.5] and 3.5 [2.7]; p = 0.005, Bonferroni-corrected p = 0.02), and more severe glaucoma based on American Glaucoma Society staging criteria (p = 0.04, Bonferroni-corrected p = 0.32) compared to L1b subjects. L1c2 also trended towards worse mean deviation on VF compared to L1b (-8.2 [7.6] and -5.8 [6.8], respectively, p = 0.17). Best corrected visual acuity, central corneal thickness, maximum intraocular pressure (IOP), and cataract severity were comparable between L1c2 and L1b haplogroups (p ≥ 0.49), as was retinal nerve fiber layer thickness on optical coherence tomography (75.1 [14.1] and 75.1 [13.0]; p = 0.99). CONCLUSION: Results demonstrated worse glaucomatous cupping and more severe VF loss in the L1c2 compared to the L1b haplogroup despite comparable IOP. Findings implicate mitochondrial inheritance as a factor affecting POAG severity and may ultimately contribute to stratifying POAG patients into phenotypically and genotypically distinct subgroups.
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OBJECTIVE: The purpose of this study was to report the results of a meta-analysis conducted on the effects of clinical trials in breast cancer screening for African American women between 1997 and 2017. DATA SOURCES: Articles published in English and in the United States, between January 1997 and March 2017, were eligible for inclusion if they (1) conducted psychosocial, behavioral, or educational interventions designed to increase screening mammography rates in predominantly African American women of all ages; (2) utilized a randomized, controlled trial (RCT) design; and (3) reported quantitative screening rates following the intervention. STUDY DESIGN: Randomized clinical trials on breast cancer screening in African American women, published between January 1997 and March 2017, were selected from database searches. DATA COLLECTION METHODS: Data collected included effect size of screening versus comparison interventions, intervention characteristics, and a number of study characteristics to explore potential moderators. Search results yielded 327 articles, of which 14 met inclusion criteria and were included in analyses. PRINCIPAL FINDINGS: Findings indicated that screening interventions for African American women were significantly more likely to result in mammography than control (OR = 1.56 [95 percent CI = 1.27-1.93], p < .0001). Although no patient or study characteristics significantly moderated screening efficacy, the most effective interventions were those specifically tailored to meet the perceived risk of African American women. CONCLUSIONS: Screening interventions are at least minimally effective for promoting mammography among African American women, but research in this area is limited to a small number of studies. More research is needed to enhance the efficacy of existing interventions and reduce the high morbidity and mortality rate of this underserved population.
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Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Neoplasias da Mama/etnologia , Detecção Precoce de Câncer/estatística & dados numéricos , Neoplasias da Mama/diagnóstico , Competência Cultural , Detecção Precoce de Câncer/métodos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Pesquisa sobre Serviços de Saúde/organização & administração , Pesquisa sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Mamografia/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Estados UnidosRESUMO
This study aimed to assess the factors associated with home meal preparation (HMP) and fast-food sources use (FFS) frequencies of low-income African-American adults and their healthy food beliefs and attitudes, food-related psychosocial factors, food acquisition patterns, food sources use, and BMI. We used cross-sectional data from 295 adults living in Baltimore, USA. HMP was inversely associated with FFS, which had lower odds of HMP ≥1 time/day and higher BMI scores. HMP was positively associated with positive beliefs and self-efficacy toward healthy foods, getting food from healthier food sources, and lower FFS. Higher odds of HMP ≥1 time/day were associated with getting food from farmers' market and supermarkets or grocery stores. FFS had an inverse association with positive beliefs and self-efficacy toward healthy foods, and a positive association with less healthy food acquisition scores. Higher odds of FFS ≥1 time/week were associated with getting food from corner stores, sit-down restaurants, and convenience stores.
Assuntos
Negro ou Afro-Americano , Comércio , Fast Foods , Manipulação de Alimentos , Refeições , Pobreza , População Urbana , Adulto , Baltimore , Índice de Massa Corporal , Estudos Transversais , Dieta , Dieta Saudável , Comportamento Alimentar , Feminino , Abastecimento de Alimentos , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Obesidade/etiologia , Restaurantes , AutoeficáciaRESUMO
OBJETIVOS: Investigar a associação entre parâmetros antropométricos e hipertensão arterial sistêmica e identificar os melhores preditores antropométricos dessa condição em mulheres afrodescendentes, de comunidades remanescentes de quilombos. MÉTODOS: Estudo transversal realizado com mulheres quilombolas do Estado de Alagoas. Foram investigados pressão arterial, parâmetros antropométricos (índice de massa corporal, circunferência da cintura, razão cintura-quadril, razão cintura-estatura, índice de conicidade, gordura corporal), variáveis sociodemográficas, tabagismo e paridade. As associações entre parâmetros antropométricos e hipertensão arterial sistêmica foram averiguadas por meio da regressão de Poisson com ajuste robusto da variância. A capacidade desses parâmetros em predizer a presença de hipertensão arterial sistêmica foi analisada por meio de curvas ROC (Receiver Operating Characteristic). RESULTADOS: Foram avaliadas 1.553 mulheres, com idades entre 20 e 59 anos. A prevalência de hipertensão arterial sistêmica foi 35,8% e a de excesso de peso foi 48,5%. A presença de hipertensão arterial sistêmica associou-se a índice de massa corporal, circunferência da cintura, razão cintura-quadril, razão cintura-estatura e gordura corporal, mesmo após o ajuste para idade, classe socioeconômica e tabagismo. A partir das curvas ROC, foram encontrados os seguintes pontos de corte: índice de massa corporal ≥26,2 kg/m², circunferência da cintura ≥81,6 cm, razão cintura-quadril ≥0,84, razão cintura-estatura ≥0,54, índice de conicidade ≥1,20 e gordura corporal ≥35,4%. Gordura corporal, razão cintura-quadril e razão cintura-estatura apresentaram igual capacidade em predizer a hipertensão arterial sistêmica. CONCLUSÕES: Todos os indicadores de obesidade global e os de obesidade central, excetuando-se o índice de conicidade, associaram-se à hipertensão arterial sistêmica nessa amostra de mulheres afrodescendentes quilombolas. Os melhores preditores antropométricos de hipertensão arterial sistêmica foram porcentagem de gordura corporal, razão cintura-quadril e razão cintura-estatura. Essas medidas tiveram igual, embora baixo, poder discriminatório para a presença de hipertensão arterial sistêmica nessa população.
AIMS: To determine the association between anthropometric parameters and systemic arterial hypertension and to identify the best anthropometrics predictors of this disease in afro-descendant women from remaining quilombo communities. METHODS: A cross-sectional study was conducted with quilombola women from Alagoas State. Blood pressure, anthropometric parameters (body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio, conicity index, body fat), sociodemographic variables, smoking and parity were investigated. The associations between anthropometric parameters and systemic arterial hypertension were investigated using Poisson regression with robust variance adjustment. The ability of these parameters to predict the presence of systemic arterial hypertension was analyzed using Receiver Operating Characteristic (ROC) curves. RESULTS: A total of 1,553 women, aged between 20 and 59 years, were evaluated. The prevalence of systemic arterial hypertension was 35.8% and that of overweight was 48.5%. The presence of systemic arterial hypertension was associated with body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio, and body fat, even after adjusting for age, socioeconomic class, and smoking status. From the ROC curves, the following cutoff points were found: body mass index ≥26.2 kg/m², waist circumference ≥81.6 cm, waist-to-hip ratio ≥0.84, waistto-height ratio ≥0.54, conicity index ≥1.20 and body fat ≥35.4%. Body fat, waist-to-hip ratio and waist-to-waist ratio were equally able to predict systemic arterial hypertension. CONCLUSIONS: All indicators of global obesity and those of central obesity, except for the conicity index, were associated with systemic arterial hypertension in this sample of Afro-descendant quilombola women. Percentage of body fat, waist-to-hip ratio and waist-to-height ratio were the best anthropometric predictors of systemic arterial hypertension. These measures had equal, albeit low, discriminatory power for the presence of systemic arterial hypertension in this population.
Assuntos
Feminino , Pressão Arterial , Saúde das Minorias Étnicas , ObesidadeRESUMO
BACKGROUND: Hepatitis C (HCV) is more prevalent in African Americans than in any other racial group in the United States. However, African Americans are more likely to be deemed ineligible for HCV treatment than non-African Americans. There has been limited research into the origins of racial disparities in HCV treatment eligibility. AIM: The purpose of this study was to compare medical and non-medical characteristics commonly assessed in clinical practice that could potentially contribute to HCV treatment ineligibility disparities between African American and non-African American patients. MATERIAL AND METHODS: Patients with confirmed HCV RNA considering treatment (n = 309) were recruited from university-affiliated and VA liver and infectious disease clinics. RESULTS: African Americans and non-African Americans did not differ in prevalence of lifetime and current psychiatric disorders and risky behaviors, and HCV knowledge. HCV clinical characteristics were similar between both groups in terms of HCV exposure history, number of months aware of HCV diagnosis, stage of fibrosis, and HCV virologic levels. African Americans did have higher proportions of diabetes, renal disease, and bleeding ulcer. CONCLUSIONS: No clinical evidence was found to indicate that African Americans should be more often deemed ineligible for HCV treatment than other racial groups. Diabetes and renal disease do not fully explain the HCV treatment ineligibility racial disparity, because HCV patients with these conditions are priority patients for HCV treatment because of their greater risk for cirrhosis, steatosis, and hepatocellular carcinoma. The findings suggest that an underlying contributor to the HCV treatment eligibility disparity disfavoring African Americans could be racial discrimination.
Assuntos
Negro ou Afro-Americano , Definição da Elegibilidade , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde/etnologia , Hepatite C/etnologia , Hepatite C/terapia , População Branca , Comorbidade , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Comportamentos de Risco à Saúde , Hepatite C/diagnóstico , Humanos , Estilo de Vida/etnologia , Masculino , Pessoa de Meia-Idade , Prevalência , Racismo , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Texas/epidemiologia , Washington/epidemiologiaRESUMO
BACKGROUND: Studies have suggested that social inequalities in chronic disease outcomes differ between industrialized and developing countries, but few have directly compared these effects. We explored inequalities in hypertension and diabetes prevalence between African-descent populations with different levels of educational attainment in Jamaica and in the United States of America (USA), comparing disparities within each location, and between countries. METHODS: We analyzed baseline data from the Jackson Heart Study (JHS) in the USA and Spanish Town Cohort (STC) in Jamaica. Participants reported their highest level of educational attainment, which was categorized as 'less than high school' (
Assuntos
População Negra , Países Desenvolvidos , Países em Desenvolvimento , Diabetes Mellitus/epidemiologia , Escolaridade , Disparidades nos Níveis de Saúde , Hipertensão/epidemiologia , Adulto , Região do Caribe/epidemiologia , Estudos de Coortes , Feminino , Humanos , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologiaRESUMO
Disparities between African American and Caucasian men in prostate cancer (PCa) diagnosis and treatment in the United States have been well established, with significant racial disparities documented at all stages of PCa management, from differences in the type of treatment offered to progression-free survival or death. These disparities appear to be complex in nature, involving biological determinants as well as socioeconomic and cultural aspects. We present a review of the literature on racial disparities in the diagnosis of PCa, treatment, survival, and genetic susceptibility. Significant differences were found among African Americans and whites in the incidence and mortality rates; namely, African Americans are diagnosed with PCa at younger ages than whites and usually with more advanced stages of the disease, and also undergo prostate-specific antigen testing less frequently. However, the determinants of the high rate of incidence and aggressiveness of PCa in African Americans remain unresolved. This pattern can be attributed to socioeconomic status, detection occurring at advanced stages of the disease, biological aggressiveness, family history, and differences in genetic susceptibility. Another risk factor for PCa is obesity. We found many discrepancies regarding treatment, including a tendency for more African American patients to be in watchful waiting than whites. Many factors are responsible for the higher incidence and mortality rates in African Americans. Better screening, improved access to health insurance and clinics, and more homogeneous forms of treatment will contribute to the reduction of disparities between African Americans and white men in PCa incidence and mortality.
RESUMO
STUDY OBJECTIVES: The mechanisms that underlie differences in sleep characteristics between European Americans (EA) and African Americans (AA) are not fully known. Although social and psychological processes that differ by race are possible mediators, the substantial heritability of sleep characteristics also suggests genetic underpinnings of race differences. We hypothesized that racial differences in sleep phenotypes would show an association with objectively measured individual genetic ancestry in AAs. DESIGN: Cross sectional. SETTING: Community-based study. PARTICIPANTS: Seventy AA adults (mean age 59.5 ± 6.7 y; 62% female) and 101 EAs (mean age 60.5 ± 7 y, 39% female). MEASUREMENTS AND RESULTS: Multivariate tests were used to compare the Pittsburgh Sleep Quality Index (PSQI) and in-home polysomnographic measures of sleep duration, sleep efficiency, apnea-hypopnea index (AHI), and indices of sleep depth including percent visually scored slow wave sleep (SWS) and delta EEG power of EAs and AAs. Sleep duration, efficiency, and sleep depth differed significantly by race. Individual % African ancestry (%AF) was measured in AA subjects using a panel of 1698 ancestry informative genetic markers and ranged from 10% to 88% (mean 67%). Hierarchical linear regression showed that higher %AF was associated with lower percent SWS in AAs (ß (standard error) = -4.6 (1.5); P = 0.002), and explained 11% of the variation in SWS after covariate adjustment. A similar association was observed for delta power. No association was observed for sleep duration and efficiency. CONCLUSION: African genetic ancestry is associated with indices of sleep depth in African Americans. Such an association suggests that part of the racial differences in slow-wave sleep may have genetic underpinnings.
Assuntos
População Negra/genética , Negro ou Afro-Americano/genética , Sono/genética , Sono/fisiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Características de Residência , População Branca/genéticaRESUMO
BACKGROUND: Metabolic outcomes of obesity and its associated disorders may not be equivalent across ethnicity and diabetes status. AIM: In this paper, we examined the association of abdominal obesity, by ethnicity and diabetes status, for indicators of glucose metabolism in Blacks. METHODS: A cross sectional study was conducted in Haitian Americans (n= 186) and African Americans (n= 148) with and without type 2 diabetes mellitus (T2DM). Student's t-test and Chi-squared test were used to assess differences in mean and proportion values between ethnicities with and without type 2 diabetes mellitus. Relationship between insulin resistance, ethnicity, diabetes status, abdominal obesity, and adiponectin levels were analyzed by analysis of covariance while controlling for confounding variables. RESULTS: Haitian American participants were older (P = .032), had higher fasting plasma glucose (P = .036), and A1C (P = .016), but had lower levels of Hs-CRP (P < .001), insulin and HOMA2-IR and lower abdominal obesity (P = .030), than African Americans. Haitian Americans had significantly lower HOMA2-IR (P = .008) than African Americans when comparing both ethnicities with T2DM, high abdominal obesity, and adiponectin levels lower than the median (<14.75 ng/mL). CONCLUSION: The clinical significance of observed differences in insulin resistance, abdominal obesity, and adiponectin levels between Haitian Americans and African Americans could assist in forming public health policies that are ethnic specific.