RESUMO
Background The epidemiology of ESRD requiring maintenance dialysis (ESRD-D) in large, diverse immigrant populations is unclear.Methods We estimated ESRD-D prevalence and incidence among immigrants in Ontario, Canada. Adults residing in Ontario in 2014 were categorized as long-term Canadian residents or immigrants according to administrative health and immigration datasets. We determined ESRD-D prevalence among these adults and calculated age-adjusted prevalence ratios (PRs) comparing immigrants to long-term residents. Among those who immigrated to Ontario between 1991 and 2012, age-adjusted ESRD-D incidence was calculated by world region and country of birth, with immigrants from Western nations as the referent group.Results Among 1,902,394 immigrants and 8,860,283 long-term residents, 1700 (0.09%) and 8909 (0.10%), respectively, presented with ESRD-D. Age-adjusted ESRD-D prevalence was higher among immigrants from sub-Saharan Africa (PR, 2.17; 95% confidence interval [95% CI], 1.84 to 2.57), Latin America and the Caribbean (PR, 2.11; 95% CI, 1.90 to 2.34), South Asia (PR, 1.45; 95% CI, 1.32 to 1.59), and East Asia and the Pacific (PR, 1.34; 95% CI, 1.22 to 1.46). Immigrants from Somalia (PR, 4.18; 95% CI, 3.11 to 5.61), Trinidad and Tobago (PR, 2.88; 95% CI, 2.23 to 3.73), Jamaica (PR, 2.88; 95% CI, 2.40 to 3.44), Sudan (PR, 2.84; 95% CI, 1.53 to 5.27), and Guyana (PR, 2.69; 95% CI, 2.19 to 3.29) had the highest age-adjusted ESRD-D PRs relative to long-term residents. Immigrants from these countries also exhibited higher age-adjusted ESKD-D incidence relative to Western Nations immigrants.Conclusions Among immigrants in Canada, those from sub-Saharan Africa and the Caribbean have the highest ESRD-D risk. Tailored kidney-protective interventions should be developed for these susceptible populations.
Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Falência Renal Crônica/etnologia , Falência Renal Crônica/terapia , Diálise Renal/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ásia/etnologia , Feminino , Guiana/etnologia , Humanos , Incidência , Jamaica/etnologia , Falência Renal Crônica/epidemiologia , América Latina/etnologia , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Prevalência , Somália/etnologia , Sudão/etnologia , Trinidad e Tobago/etnologia , Adulto JovemAssuntos
Infecções por HIV/complicações , Leishmania braziliensis , Leishmaniose Cutânea/diagnóstico , Leishmaniose Mucocutânea/diagnóstico , Adulto , América Central , Dermatologia , Emigração e Imigração/legislação & jurisprudência , Humanos , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/parasitologia , Leishmaniose Mucocutânea/tratamento farmacológico , Leishmaniose Mucocutânea/parasitologia , Masculino , Minnesota , Somália/etnologia , América do SulRESUMO
BACKGROUND: Underimmunization of certain immigrant populations can place them at high risk of experiencing vaccine-preventable disease outbreaks. METHODS: We conducted a retrospective cohort study between January 1, 2008, and May 1, 2013, among children included in the Washington State Immunization Information System. We assessed receipt of 1 or more doses of measles-containing, hepatitis A, pneumococcal, and diphtheria-tetanus-acellular pertussis-containing vaccines between 12 and 23 months of age. We compared children with 1 or more parents born in Somalia, Ukraine, Russia, Mexico, or India to children with 2 parents born in the United States. Poisson regression models with robust SEs were used to provide prevalence ratios adjusted for maternal education and number of prenatal visits. RESULTS: We identified 277 098 children, including 65 466 with foreign-born parents. Children of Somali-born parents were less likely to be immunized against measles than children of US-born parents (prevalence ratio: 0.82; 95% confidence interval: 0.80-0.84); this decrease became more pronounced over time (P < .01). No such disparity between these groups was observed with other vaccines. Compared with children of US-born parents, children of Ukrainian-born and Russian-born parents were less likely to be immunized, whereas children of Mexican-born and Indian-born parents were more likely to be immunized with any of the specified vaccines. CONCLUSIONS: We found country-specific patterns of immunization that may reflect underlying cultural or other beliefs. Certain immigrant communities with higher rates of immunization refusal may be at risk for vaccine-preventable diseases and require new forms of public health outreach.
Assuntos
Atitude Frente a Saúde/etnologia , Emigrantes e Imigrantes , Pais , Vacinação/estatística & dados numéricos , Estudos de Coortes , Feminino , Humanos , Índia/etnologia , Lactente , Masculino , México/etnologia , Estudos Retrospectivos , Federação Russa/etnologia , Somália/etnologia , Ucrânia/etnologia , WashingtonRESUMO
Immigrants and refugees to the United States exhibit relatively low levels of physical activity, but reasons for this disparity are poorly understood. 16 gender and age-stratified focus groups were conducted among 127 participants from heterogenous immigrant and refugee groups (Cambodian, Mexican, Somali, Sudanese) in a small Minnesota urban community. We found many similarities in perceived barriers and facilitators to physical activity between heterogeneous immigrant and refugee groups. While the benefits of physical activity were widely acknowledged, lack of familiarity and comfort with taking the first steps towards being physically active were the most significant barriers to physical activity. Participants described being motivated by social support from family, friends, and communities to be physically active. Our findings suggest that shared experiences of immigration and associated social, economic, and linguistic factors influence how physical activity is understood, conceptualized and practiced.
Assuntos
Atitude Frente a Saúde , Emigrantes e Imigrantes/psicologia , Atividade Motora , Refugiados/psicologia , Adolescente , Adulto , Camboja/etnologia , Criança , Pesquisa Participativa Baseada na Comunidade , Feminino , Grupos Focais , Humanos , Masculino , México/etnologia , Minnesota , Somália/etnologia , Sudão/etnologiaRESUMO
Views of ethnic immigrant women's experiences about mammography screening are important to determine barriers to cancer screening. We explored perceptions and barriers about mammography screening and breast health services among Haitian, Hispanic, Portuguese, and Somali women (n = 51) using semistructured interviews. Providers (n = 19) offered insight into health system barriers. Content analysis was conducted using qualitative data from the 2011 Komen Massachusetts needs assessment. Grounded theory was employed to explore themes and patterns in narratives. Six themes represented knowledge, health care, culture, spirituality, survivorship, and health systems improvement. Results may inform breast health policies that impact ethnic immigrant women in Massachusetts.
Assuntos
Neoplasias da Mama/prevenção & controle , Emigrantes e Imigrantes/psicologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Mamografia/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , População Negra , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/etnologia , Detecção Precoce de Câncer , Feminino , Grupos Focais , Haiti/etnologia , Acessibilidade aos Serviços de Saúde , Hispânico ou Latino , Humanos , Entrevistas como Assunto , Massachusetts , Pessoa de Meia-Idade , Percepção , Relações Profissional-Paciente , Pesquisa Qualitativa , Fatores Socioeconômicos , Somália/etnologiaRESUMO
Tuberculous pleurisy was diagnosed in two patients, a 21-year-old Somali woman and a 19-year-old Surinam man. The first patient suffered from a paradoxical (immunological) reaction and the other had an infectious reaction. Both patients recovered after treatment with tuberculostatic agents and pleural drainage. The pathophysiology of the paradoxical reaction is still largely unclear. Culture continues to be the gold standard in diagnosing tuberculous pleuritis but, in many cases, bacteriological confirmation is not obtained. The (probable) diagnosis is then often made on the basis of a combination of the patient's history, estimation of the risk, physical examination, radiology and histology, and on the basis of a (trial) treatment with tuberculostatic agents. In the diagnostic process, a PCR on the Mycobacterium tuberculosis complex can be helpful. The routine determination of adenosine deaminase and interferon gamma in patients with tuberculous pleurisy is not useful in low-incidence countries such as The Netherlands. The measurement of the in-vitro T-cell reactivity against M. tuberculosis-specific antigens may be of more value in the future. The pharmacotherapy of tuberculous pleurisy is the same as that of pulmonary tuberculosis. Rinsing the pleural cavity is recommended in the case of an infectious reaction. Drainage of pleural fluid is indicated in the case of a paradoxical reaction if there are mechanical difficulties.
Assuntos
Antituberculosos/uso terapêutico , Tuberculose Pleural/diagnóstico , Adulto , Feminino , Humanos , Masculino , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/imunologia , Países Baixos , Paracentese , Derrame Pleural , Somália/etnologia , Suriname/etnologia , Tuberculose Pleural/tratamento farmacológico , Tuberculose Pleural/etnologiaRESUMO
OBJECTIVE: To determine the incidence and characteristics of type-1 diabetes mellitus (DM) in children aged 0-14 years during the period 1996-1999 and to compare this with previous measurements of the incidence. DESIGN: Descriptive. METHOD: Data were collected via reports from all practicing paediatricians to the Dutch Paediatric Surveillance Unit and a questionnaire among members of the Dutch Diabetes Association. The incidence was calculated by the capture-recapture method, and the characteristics and symptoms of the children were determined from the questionnaires. RESULTS: The incidence of DM type 1 among 0-14-year-olds increased to 18.6/100,000/year (95% CI: 17.7-19.4) compared to 11.1/100,000/year (10.5-11.7) in 1978-1980. The increase was highest in the youngest age group, 0-4 years. DM type 1 was diagnosed at an average age of 7.6 years (7.4-7.9) and in 1988-1990 at 9.2 years (9.0-9.5). The boy-girl ratio also increased. Children with a mother from Surinam, Turkey or The Netherlands Antilles had lower risk of DM type 1 while a higher risk was calculated for children from Moroccan and Somali mothers. In comparison with 1993-1994, there were less frequent lethargy or dehydration; lower average serum-glucose values, a better blood pH and less frequent ketonuria at the time of diagnosis. Treatment on an outpatient basis had increased. However, over the time span 1993-1999, Moroccan children (n = 108) showed dehydration, ketonuria and low blood-pH values more frequently than children of Dutch parents (n = 1825) and their hospital admission lasted longer. CONCLUSION: The incidence of DM type 1 had increased and the disease manifested itself at a younger age. The clinical condition at time of diagnosis, however, was better. The incidence and clinical characteristics differed between children of different ethnic origin.
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Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/epidemiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/etnologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Marrocos/etnologia , Países Baixos/epidemiologia , Antilhas Holandesas/etnologia , Fatores de Risco , Fatores Sexuais , Somália/etnologia , Suriname/etnologia , Inquéritos e Questionários , Turquia/etnologiaRESUMO
OBJECTIVES: To compare measles, mumps, and rubella antibody levels in Somali immigrant, Hispanic migrant, and US children in Rochester, Minn, and to determine whether parental vaccination reports predict seropositivity. SUBJECTS AND METHODS: From 1995 to 1997, we conducted a cross-sectional analysis using measles, mumps, and rubella antibody levels obtained from a sample of Somali, Hispanic, and Rochester children. Volunteers provided blood samples, vaccination histories, and demographic information. We assessed differences in measles, mumps, and rubella antibody levels among the 3 groups of children and calculated positive and negative predictive values to determine whether parental report of vaccination predicted seropositivity. RESULTS: Study participants included 79 Hispanic migrant, 69 Somali immigrant, and 730 Rochester children. Somali children reported vaccination at significantly older ages compared with Hispanic or Rochester children (P<.001). Most children were seropositive for all 3 antibodies. Parental reports of vaccination had high positive predictive values (71%-100%) but low negative predictive values (0%-50%). CONCLUSION: Somali and Hispanic children were as likely as Rochester children to be seropositive for measles, mumps, and rubella antibodies despite poor documentation of vaccination. Somali children, however, tended to receive vaccinations at significantly older ages than Hispanic and Rochester children.
Assuntos
Anticorpos Antivirais/sangue , Emigração e Imigração/estatística & dados numéricos , Vírus do Sarampo/imunologia , Vírus da Caxumba/imunologia , Pais/psicologia , Refugiados/estatística & dados numéricos , Vírus da Rubéola/imunologia , Migrantes/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Criança , Comparação Transcultural , Estudos Transversais , Documentação/normas , Feminino , Humanos , Masculino , México/etnologia , Minnesota , Valor Preditivo dos Testes , Características de Residência/estatística & dados numéricos , Somália/etnologia , Inquéritos e QuestionáriosRESUMO
Four cases of hypovitaminosis D were seen in a general practitioner's population in the Netherlands: a Somalian veiled woman aged 53 and her 11-year-old daughter, a dark-skinned Surinam woman aged 31, and a veiled Moroccan woman aged 56 years. This cause of myopathy has only been recently recognised and is more prevalent than often thought, especially in high-risk groups such as veiled and dark-skinned immigrants who lack sunlight in the Netherlands. Symptoms are muscle pain and mainly proximal muscle weakness resulting in difficulties in ascending a staircase or getting up out of a chair. The diagnosis is made on the basis of a detailed history and measurement of serum 25-hydroxyvitamin D. Calcium and serum alkaline phosphatase activity may be normal. Treatment with ergocalciferol is effective and cheap. As diagnosis and treatment are relatively simple, finding and treating hypovitaminosis D is a rewarding challenge to primary health care practitioners in the Netherlands.
Assuntos
25-Hidroxivitamina D 2/deficiência , Ergocalciferóis/uso terapêutico , Estilo de Vida , Doenças Musculares/etiologia , Pigmentação da Pele , Deficiência de Vitamina D/diagnóstico , Adulto , Criança , Características Culturais , Feminino , Humanos , Pessoa de Meia-Idade , Marrocos/etnologia , Debilidade Muscular/etiologia , Países Baixos , Dor/etiologia , Fatores de Risco , Somália/etnologia , Suriname/etnologia , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/tratamento farmacológico , Deficiência de Vitamina D/etiologiaRESUMO
Essential hypertension appears to be more prevalent among blacks than among whites and has an earlier onset in blacks. Many data in this field come from studies in the African-American population. Hypertension-related complications, e.g. ischaemic heart disease, (end stage) renal failure and cerebrovascular disease, are encountered more often among blacks and frequently run a more severe course. Factors that might explain the racial difference in prevalence of hypertension and hypertensive complications include both genetic and environmental variables. Hypertension in blacks is characterized by salt sensitivity, a tendency towards expanded plasma volume and low plasma renin levels. Socioeconomic factors, the higher prevalence of obesity and insulin resistance may contribute to the high prevalence of hypertension in blacks. Aggressive antihypertensive therapy appears mandatory in the black hypertensive, possibly with lower goal blood pressures than the 140/90 mmHg generally recommended. Diuretic monotherapy proves to be the first-line therapy, calcium channel blockers are an attractive alternative. Black patients are frequently less responsive to monotherapy with angiotensin-converting enzyme (ACE) inhibitors and beta-blocking agents. This black/white difference in therapeutic response can, however, be eliminated by addition of a diuretic.