Multiple sclerosis (MS) most commonly affects individuals of Northern European descent who live in countries at high latitude. The relative contributions of ancestry, country of birth and residence as determinants of MS risk have been studied in adult MS, but have not been explored in the pediatric MS population. In this study, we compare the demographics of pediatric- and adult-onset MS patients cared for in Toronto, Ontario, Canada, a multicultural region. The country of birth, residence during childhood, and ancestry were compared for 44 children and 573 adults. Our results demonstrate that although both the pediatric and adult cohorts were essentially born and raised in the same region of Ontario, Canada, children with MS were more likely to report Caribbean, Asian or Middle Eastern ancestry, and were less likely to have European heritage compared with individuals with adult-onset MS. The difference in ancestry between the pediatric and adult MS cohorts can be explained by two hypotheses: (1) individuals raised in a region of high MS prevalence, but whose ancestors originate from regions in which MS is rare, have an earlier age of MS onset, and (2) the place of residence during childhood, irrespective of ancestry, determines lifetime MS risk -- a fact that will be reflected in a change in the demographics of the adult MS cohort in our region as Canadian-raised children of recent immigrants reach the typical age of adult-onset MS.
Burkholderia pseudomallei is a pathogen identified with increasing frequency in the respiratory tracts of cystic fibrosis (CF) patients from endemic areas such as Southeast Asia and northern Australia. The following report describes the first known reported case in a CF patient from the Caribbean attending a North American CF clinic.
Cites: Clin Infect Dis. 2002 Dec 15;35(12):e138-4012471591
Using the New Immigrant Survey Pilot, we compare answers to the census question on year of arrival in the United States with answers to questions about the dates and durations of earlier U.S. trips. We show that the year identified by the census does not correspond to the year of either the first or the last U.S. trip. Because many immigrants enter and leave the United States several times before becoming legal immigrants, the census question produces estimates of U.S. experience that are quite different from those produced by direct questions about trip durations.
To explore differences in severity and nature of symptoms of first-episode psychosis (FEP) according to ethnic group and migrant status.
We administered rating scales to assess positive and negative symptoms, as well as general psychopathology, to 301 consecutive patients presenting with an FEP within a defined catchment area in Montreal, Quebec, classified according to ethnicity and migrant status. Symptom scores of Euro-Canadian patients without a recent history of migration, that is, the reference group (n = 145), were compared with those of African and Afro-Caribbean (n = 39), Asian (n = 27), Central and South American (n = 15), Middle Eastern and North African (n = 24), and European and North American (n = 39) patients.
Except for referral source, there were no significant differences between ethnic groups on any demographic variables. The African and Afro-Caribbean group had a higher level of negative symptoms (especially alogia) and general psychopathology scores on the Positive and Negative Syndrome Scale (especially, uncooperativeness, preoccupation, and poor attention), compared with the reference group. Ethnic groups did not differ on the Scale for the Assessment of Positive Symptoms scores.
A comparison of FEP patients from different ethnic groups and native-born Euro-Canadians revealed no significant differences in the nature of positive symptoms at first presentation or in age at onset, suggesting that there was no evidence for the hypothesis that ethnic minorities are misdiagnosed as psychotic. Increased severity of negative symptoms and general psychopathology, specifically among the black ethnic minority group, may have implications for the role of ethnicity for the treatment and outcome of the initial episode of psychotic disorders.
This study examined Portuguese Canadian and Caribbean Canadian immigrants' perceptions of health research and informed consent procedures. Six focus groups (three in each cultural group) involving 42 participants and two individual interviews were conducted. The focus groups began with a general question about health research. This was followed by three short role-plays between the moderator and the assistant. The role-plays involved a fictional health research study in which a patient is approached for recruitment, is read a consent form, and is asked to sign. The role-plays stopped at key moments at which time focus group participants were asked questions about their understanding and their perceptions. Focus group transcripts were coded in QSR NUDIST software using open coding and then compared across cultural groups. Six overriding themes emerged: two were common in both the Portuguese and Caribbean transcripts, one emphasized the importance of trust and mistrust, and the other highlighted the need and desire for more information about health research. However, these themes were expressed somewhat differently in the two groups. In addition, there were four overriding themes that were specific to only one cultural group. In the Portuguese groups, there was an overwhelming positive regard for the research process and an emphasis on verbal as opposed to written information. The Caribbean participants qualified their participation in research studies and repeatedly raised images of invasive research.
Previous studies focused on obesity and weight management have ignored the cultural uniqueness of Afro-Caribbean individuals. The purpose of this study was to examine the cultural context for notions of good health and health practices, and perception of obesity and weight management, among African American and Caribbean American women.
Four focus groups of Afro-Caribbean and African American women (age 40 and older) were conducted between May and July of 2007 to explore cultural factors related to physical activity, healthy eating and weight management.
Cultural variation was observed among Afro-Caribbean and African American woman in terms of indigenous traditions of food and food preparation, and perceptions of obesity.
In the development of community-based interventions to counter trends towards obesity among people of African descent, it may be important not to assume that 'one size fits all' cultures.
Current immigration research has revealed little about how immigrants compare to those who do not migrate. Although most scholars agree that migrants are not random samples of their home countries' populations, the direction and degree of educational selectivity is not fully understood. This study of 32 U.S. immigrant groups found that although nearly all immigrants are more educated than those who remain in their home countries, immigrants vary substantially in their degree of selectivity, depending upon the origin country and the timing of migration. Uncovering patterns of immigrant selectivity reveals the fallacy in attributing immigrants' characteristics to national groups as a whole and may help explain socioeconomic differences among immigrant groups in the United States.
A recent study of very-late onset schizophrenia-like psychosis (SLP) in South London showed an increase in first contact rates amongst African- and Caribbean-born elders compared to British-born ones. This study investigates incident first contact rates in an area of East London with a high Bangladeshi population, to investigate if Bangladeshi-born elders also have an increased referral rate for SLP.
Retrospective case note review of first contacts to the old age psychiatry service from 1997 to 2002 identifying cases of schizophrenia-like psychosis. In addition, a one-year review of first contacts for all diagnostic categories was completed. Gender, ethnicity and place of birth were established from the case notes.
Among the African- and Caribbean-born, but not the Bangladeshi-born, the odds ratio (OR) of being referred with SLP was significantly higher than for the British-born population. We observed a loss of the reported effect of female gender. For Whites the odds ratio for female gender and psychosis was 2.5 (1.0-6.1) and for non-Whites 0.8 (0.3-2.7) which was a trend away from the expected male to female ratio. In the one-year review there was a higher rate of referrals for organic disease in Bangladeshi men compared to Bangladeshi women and British-born men and women.
Bangladeshi elderly migrants do not have an increased rate of SLP compared to indigenous elders. The usual female preponderance of SLP is not apparent in this elderly migrant population. Old age psychiatry services in the UK should take into account the increasing needs of Bangladeshi elders with dementia.
Black women bear a disproportionate burden of HIV/AIDS in North America. The purpose of this investigation was to explore Black Canadian women's perspectives on HIV risk and prevention. Four 90-minute focus groups (n=26) and six key informant interviews were conducted in Toronto with Black women of African and Caribbean descent and low socioeconomic status. Data analysis revealed a number of potent barriers to existing HIV preventive interventions: stigma, cultural disconnections, lack of engagement of Black religious institutions, and multiple intersecting forms of discrimination. Recommended HIV prevention opportunities included the Black church, mainstreaming, health care providers, and ethno-specific agencies. HIV prevention strategies for North American Black women, rather than focusing on HIV and individual risk behaviors, may benefit from a primary focus on social and structural factors (e.g., promoting gender equality, economic opportunity, women-controlled prevention technologies and combating racism in health care) thereby integrating HIV prevention into the larger context of community health and survival.
The future availability of HIV vaccines can increase options available to Canadian Black women for risk reduction. However, current conceptual frameworks do not adequately address barriers to HIV prevention for this population, and may be inadequate to address challenges with vaccines. This study explored knowledge and attitudes regarding HIV vaccines and associated prevention methods to inform appropriate conceptual frameworks for their dissemination to Canadian Black women. We completed four 90-min focus groups with women (n=26) of African or Caribbean origins, and six interviews with key informants providing health and social services in the Black communities of Toronto. The participants suggested that there were significant risks associated with seeking prevention information and attempting to reduce exposure to HIV infection. They described individual, familial, community and institutional domains of risk and predicted the same spectrum of risk for HIV vaccines. Participants advocated for education, empowerment and institutional change to create a supportive environment for vaccines and other HIV prevention methods. They further indicated that preparation for vaccine dissemination will need to prioritize building trust between women of the Black communities and institutions in the research, health and government sectors.