RESUMO
INTRODUCTION: To determine the prevalence of prescription opioid (PO) use among Hispanics/Latinos with arthritis symptoms and to characterize how demographic and cultural factors are associated with PO use. METHOD: Cross-sectional analysis of baseline visit data during 2008 to 2011 from the Hispanic Community Health Study/Study of Latinos, a population-based cohort study of 16,415 Hispanics/Latinos living in Chicago, Illinois, Miami, Florida, Bronx, New York, and San Diego, California. Included participants self-reported painful inflammation or swelling in one or more joints. Multivariate models controlling for physical and mental health scores were constructed to assess how demographic and cultural factors were associated with PO use. RESULTS: A total of 9.3% were using POs at the time of the baseline visit. In multivariate models, persons of Cuban background (adjusted odds ratio [AOR] = 0.42, 95% confidence interval [CI; 0.21, 0.81]) and of Dominican background (AOR = 0.38, 95% CI [0.18, 0.80]) were significantly less likely to use POs compared with a reference group of persons of Mexican background. Greater language acculturation was also negatively associated with PO use (AOR = 0.68, 95% CI [0.53, 0.87]). CONCLUSION: POs were used relatively uncommonly, and use showed marked variation between Hispanic/Latino groups. Future study should determine mechanisms for why greater use of English among Hispanics/Latinos might influence PO use.
Assuntos
Analgésicos Opioides/uso terapêutico , Artrite/tratamento farmacológico , Hispânico ou Latino , Dor/tratamento farmacológico , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Medicamentos sob Prescrição/uso terapêutico , Adulto , Idoso , Artrite/complicações , Artrite/etnologia , Cuba/etnologia , República Dominicana/etnologia , Feminino , Humanos , Idioma , Masculino , México/etnologia , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Dor/etnologia , Dor/etiologia , Estados UnidosRESUMO
The impact of living with arthritis in a rural Mexican Mayan community along with the barriers encountered by people living with this chronic condition were investigated in this study. The community needs around this health issue were investigated by conducting an ethnographic study using data obtained during two time periods (August 2012-April 2013 and December 2013-December 2014). During the first period, fieldwork observations and interviews with 65 individuals, which included people with arthritis, health professionals, traditional health providers, and community leaders were undertaken. During the second period, 46 community meetings were conducted to identify the needs associated with arthritis in the municipality. Data were analyzed following a modified version of the Framework approach. The results show that arthritis reduces the health-related quality of life of the people in Chankom through a process of disablement, conditioning a need to access culturally sensitive healthcare. Availability, attainability, and acceptability barriers prevent access to this type of healthcare and result from power imbalance between indigenous and non-indigenous people. There is a need to develop culturally sensitive rehabilitation services for people living with arthritis in Chankom. Mayan people should be involved in the design and implementation of these services. Moreover, it is important to improve our understanding of the processes behind the healthcare access inequities identified in this study by attending to the historical generation of current social, economical, cultural, and political structures.
Assuntos
Artrite/tratamento farmacológico , Assistência à Saúde Culturalmente Competente , Acessibilidade aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Qualidade de Vida , Artrite/etnologia , Pessoas com Deficiência , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Indígenas Norte-Americanos , Masculino , México , Pesquisa Qualitativa , População RuralAssuntos
Artrite/diagnóstico , Artrite/etiologia , Emigração e Imigração , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/diagnóstico , Doença Aguda , Adulto , Artrite/etnologia , Biópsia , Colômbia/etnologia , Humanos , Hansenostáticos/uso terapêutico , Hanseníase Virchowiana/etnologia , Linfonodos/microbiologia , Linfonodos/patologia , Masculino , Mycobacterium leprae/isolamento & purificação , Prednisona/uso terapêutico , Pele/microbiologia , Pele/patologia , Espanha , Talidomida/uso terapêutico , Resultado do TratamentoRESUMO
OBJECTIVE: To examine the association between self-reported physician-diagnosed arthritis and health-related quality of life among older Mexican Americans. DESIGN: Cross-sectional study involving population-based survey. SETTING: Hispanic Established Population for the Epidemiologic Study of the Elderly (EPESE) survey conducted in Texas, Arizona, New Mexico, Colorado, and California. PARTICIPANTS: 839 non-institutionalized Mexican American older adults (> or = 75 years) participating in Hispanic EPESE. MAIN OUTCOME MEASURES: Self-reported physician-diagnosed arthritis; sociodemographic variables; medical conditions; body mass index; and the physical and mental composite scales from the Medical Outcomes Study Short Form 36 Health Survey (SF-36). RESULTS: 518 (62%) of the subjects reported physician-diagnosed arthritis. Participants with arthritis had significantly lower scores on the physical composite scale (PCS) (mean = 35.3, SD = 11.3) and the mental composite scale (MCS) (mean = 53.5, SD = 10.8) of the SF-36 compared to persons without arthritis (PCS mean = 42.9, SD = 10.9; MCS mean = 57.0, SD = 8.8). Multiple regression showed that arthritis was associated with decreased PCS and MCS (model estimates of -5.74 [SE = .83]; and -3.16 [SE = .64]), respectively, after controlling for sociodemographic and clinical covariates. CONCLUSIONS: Arthritis is a highly prevalent medical condition in Mexican American older adults. Our findings suggest that deficits in both physical health and mental function contribute to reduced quality-of-life in this population.
Assuntos
Artrite/etnologia , Nível de Saúde , Americanos Mexicanos , Qualidade de Vida , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artrite/complicações , Artrite/psicologia , Estudos de Casos e Controles , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Fatores SocioeconômicosRESUMO
Puerto Ricans living in the United States mainland present multiple disparities in prevalence of chronic diseases, relative to other racial and ethnic groups. Allostatic load (AL), or the cumulative wear and tear of physiological responses to stressors such as major life events, social and environmental burden, has been proposed as a possible mechanism for the inequalities observed in minority groups, but has not been studied in Puerto Ricans. The aim of this study was to determine the association of AL to six chronic diseases (abdominal obesity, hypertension, diabetes, and self-reported cardiovascular disease (CVD), arthritis and cancer) in Puerto Ricans, and to contrast AL to metabolic syndrome (MetS). Participants of the Boston Puerto Rican Health Study (n=1116, ages 45-75 years) underwent a home-based interview, where questionnaires were completed and biological samples collected. A summary definition of AL was constructed using clinically-defined cutoffs and medication use for 10 physiological parameters in different body systems. Logistic regression models were run to determine associations between AL score and disease status, controlling for age, sex, smoking, alcohol use, physical activity, total fat intake and energy intake. Parallel models were also run with MetS score replacing AL. We found that increasing categories of AL score were significantly associated with abdominal obesity, hypertension, diabetes and self-reported cardiovascular disease (CVD) and arthritis, but not with self-reported cancer. The strength of associations of AL with all conditions, except diabetes and cancer, was similar to or larger than those of MetS score. In conclusion, Puerto Rican older adults experienced physiological dysregulation that was associated with increased odds of chronic conditions. AL was more strongly associated with most conditions, compared to MetS, suggesting that this cumulative measure may be a better predictor of disease. These results have prospective research implications for Puerto Ricans and other ethnic groups.
Assuntos
Alostase , Doença Crônica/etnologia , Disparidades nos Níveis de Saúde , Hispânico ou Latino/estatística & dados numéricos , Idoso , Artrite/etnologia , Boston/epidemiologia , Doenças Cardiovasculares/etnologia , Diabetes Mellitus/etnologia , Feminino , Inquéritos Epidemiológicos , Humanos , Entrevistas como Assunto , Modelos Logísticos , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Neoplasias/etnologia , Obesidade Abdominal/etnologia , Porto Rico/etnologia , Fatores de RiscoRESUMO
This multicenter study estimated the prevalence of major depressive disorder (MDD) among emergency department patients in Latin America. To identify patients with MDD, we used a combination of DSM IV- criteria interview and a questionnaire screen including the center for Epidemiological Studies Depression Scale. We analyzed data from consecutive adult patients from hospitals in Argentina, Brazil, Chile, Colombia, and Mexico and described the demographic and health status differences between MDD and non-MDD patients. Prevalence of MDD ranges from 23.0 to 35.0%. The estimates are based on a total of 1,835 patients aged 18 years and over, with response rates of 83.0%. Compared to non-MDD patients, MDD patients were more likely to be middle-aged, female, smokers, of lower socioeconomic status, and to report a diagnosis of asthma or arthritis/rheumatism. Multivariate analysis identified a lower level of education, smoking, and self-reported anxiety, chronic fatigue, and back problems to be independently associated with MDD. Our data suggest that the prevalence of MDD is elevated among emergency department patients in Latin American countries. The integration of depression screening into routine emergency care merits serious consideration, especially if such screening can be linked to psychiatric treatment.
Assuntos
Comparação Transcultural , Transtorno Depressivo Maior/etnologia , Transtorno Depressivo Maior/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Artrite/epidemiologia , Artrite/etnologia , Asma/epidemiologia , Asma/etnologia , Comorbidade , Estudos Transversais , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Incidência , Masculino , Programas de Rastreamento/estatística & dados numéricos , México , Pessoa de Meia-Idade , Doenças Reumáticas/epidemiologia , Doenças Reumáticas/etnologia , Fatores Sexuais , Fumar/epidemiologia , Fumar/etnologia , Fatores Socioeconômicos , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/epidemiologia , Transtornos Somatoformes/etnologia , Transtornos Somatoformes/psicologia , América do Sul , Adulto JovemRESUMO
This study examines the prevalence of self-reported arthritis and arthritis symptoms and their relationship to functional limitations in elders from Latin America and the Caribbean and in Mexican Americans from the southwestern United States. This study includes 8,122 elderly aged 60 and older from seven Latin America and Caribbean countries and 2,580 noninstitutionalized Mexican Americans aged 65 or older residing in the southwestern United States. The estimated prevalence of self-reported arthritis ranged from 23.8% in Mexico City to 55.6% in Havana. The prevalence of self-reported pain among arthritic subjects across all countries ranged from 30.7% in older Mexican Americans to 83.7% in Santiago. Arthritis was independently associated with any Activities of Daily Living and any Instrumental Activities of Daily Living limitation across the eight countries after controlling for relevant factors. Self-reported arthritis and arthritis symptoms are highly prevalent among elders from Latin America and the Caribbean and older Mexican Americans and is a significant cause of disability in all studied populations.
Assuntos
Artrite/epidemiologia , Prevalência , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Artrite/etnologia , Região do Caribe/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , América Latina/epidemiologia , Masculino , Americanos Mexicanos , Pessoa de Meia-Idade , Sudoeste dos Estados Unidos/epidemiologiaRESUMO
INTRODUCTION: There is substantial evidence that marriage is beneficial to health, but evidence on whether the health status of one spouse is similar, or concordant, with the other spouse is limited. This study assessed whether a chronic condition of one spouse is a risk factor for the same chronic condition in the other spouse. METHODS: The study used baseline data from the Hispanic Established Populations for the Epidemiologic Studies of the Elderly on 553 couples (1106 individuals) who are representative of approximately 500,000 older (> or =65 years) Mexican Americans living in the southwestern United States. Logistic regression was used to predict six chronic conditions among couples: heart condition, stroke, hypertension, diabetes, arthritis, and cancer. Analyses were adjusted for age, education, U.S. nativity, blood pressure, body mass index, smoking, and alcohol consumption. RESULTS: The wife's history of hypertension, diabetes, arthritis, and cancer was associated with higher odds that the husband would have these conditions. A history of hypertension, arthritis, and cancer in the husband was associated with higher odds that the wife would have these conditions. CONCLUSION: These results provide preliminary evidence that chronic conditions in one spouse are associated with an increased risk of developing like conditions in the other spouse among older Mexican American couples. We propose that the reciprocal influence that marital partners have on each other may be caused by shared living arrangements and shared health risks. Health promotion activities should target family systems. In particular, health providers should gather health histories not only from patients and their genetic family members but also from spouses.
Assuntos
Doença Crônica/epidemiologia , Saúde da Família/etnologia , Americanos Mexicanos/estatística & dados numéricos , Cônjuges/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Artrite/etnologia , Diabetes Mellitus/etnologia , Feminino , Cardiopatias/etnologia , Humanos , Hipertensão/etnologia , Modelos Logísticos , Masculino , Neoplasias/etnologia , Sudoeste dos Estados Unidos/etnologia , Cônjuges/etnologia , Acidente Vascular Cerebral/etnologiaRESUMO
OBJECTIVE: To examine the relationship between positive affect and subsequent functional disability in older Mexican Americans with self-reported physician-diagnosed arthritis. METHODS: We conducted a 2-year prospective cohort study using a population-based sample of 1,084 noninstitutionalized Mexican American subjects aged > or =65 years residing in 5 southwestern states. Measures included self-reported diagnoses of various medical conditions, functional ability, body mass index, and ratings of positive and negative affect. RESULTS: For 937 subjects with arthritis who reported no limitations in activities of daily living (ADLs) at baseline, 697 remained ADL independent, 84 became ADL dependent, 41 died, and 115 were lost to followup 2 years later. There was a significant association between high positive affect (score = 12) and reduced risk of ADL disability 2 years later, controlling for baseline sociodemographic variables, medical conditions, and negative affect (odds ratio 0.46, 95% confidence interval 0.22-0.94). There was an interaction effect between positive affect and sex, with positive affect having a larger effect in reducing risk of ADL dependence in men than in women. CONCLUSION: High positive affect was associated with lower incidence of ADL disability in older Mexican Americans with self-reported physician-diagnosed arthritis. The strength of the positive affect is stronger in men than in women.
Assuntos
Atividades Cotidianas/classificação , Afeto , Artrite , Avaliação da Deficiência , Nível de Saúde , Americanos Mexicanos , Idoso , Artrite/etnologia , Artrite/fisiopatologia , Artrite/psicologia , Feminino , Humanos , Masculino , Americanos Mexicanos/estatística & dados numéricos , Estudos Prospectivos , Fatores Sexuais , Sudoeste dos Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To estimate the impact of self-reported diagnosis of arthritis at baseline on the two year incidence of limitation in activities of daily living and instrumental activities of daily living in initially non-disabled Mexican-American elderly. DESIGN: Longitudinal study. SETTING Southwestern United States (Texas, New Mexico, Colorado, Arizona and California). SUBJECTS: A probability sample of 2,167 non-institutionalized Mexican-American men and women, aged 65 or older. MEASURES: Having ever been told by a doctor that a subject had arthritis, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), depressive symptomatology, presence of chronic diseases (diabetes mellitus, heart attack, stroke, cancer), and body mass index (BMI). RESULTS: Among non-disabled persons at baseline, 11.2% of subjects with arthritis reported at least one ADL limitation after two years, compared to 6.9% of subjects without arthritis. Similarly, among non-disabled persons at baseline, 34.7% of subjects with arthritis reported at least one IADL limitation after two years, compared to 27.0% of subjects without arthritis. In logistic regression analysis, depression, diabetes, and arthritis were found to be predictive of the development of ADL disability, controlling for sociodemographic variables. Depression was the only condition that significantly predicted IADL disability. CONCLUSIONS: Subjects with arthritis were more likely to develop ADL and IADL disability over a two-year period than those without arthritis.