[Emergence of Chagas' disease in Europe: description of the first cases observed in Latin American immigrants in mainland France]

This article describes the first cases of imported Chagas' disease detected in Paris, France. A total of 18 cases were recorded in two teaching hospitals between 2004 and 2007. There were 12 women and six men with a mean age of 38 years. All patients were Latin American immigrants who had recently arrived in France from Bolivia (Cochabamba and Santa-Cruz departments) 17 cases and from Salvador in 1. Eleven patients presented an asymptomatic indeterminate form of the chronic disease. Seven presented chronic Chagas cardiomyopathy including two with severe symptoms requiring placement of a pacemaker. Obtaining serological tests to confirm the diagnosis was difficult. All except one patient who was older than 50 years were treated with benznidazole. Based on these findings, the main priorities for management imported Chagas' disease in France are improvement of serological diagnosis and prevention of vertical transmission.

Sex and sentiment in Cuban tourism

Helen Safa has been a leading program builder and pioneer in research that examines the complex intersections of gender, race, class, and nation in Latin America and the Caribbean. Her comparative research culminated in her influential book, The Myth of the Male Breadwinner: Women and Industrialization in the Caribbean (1995), which examined gender, family, and employment across three Caribbean societies. Over several decades Safa has inspired scholarship throughout the Caribbean and the Americas and her work is exemplary of engaged anthropology in the region. Here I present work I conducted in Cuba that was guided, like my work in Peru, Nicaragua, and southern Mexico by the writings of Safa and others who saw the critical need to bring gender into meaningful discussion in the field of Latin American and Caribbean studies. In what follows, drawn from my broader research on tourism in four nations, I explore and reflect on the contemporary dynamics of sex and romance tourism in Cuba. I suggest that the allure of this domain of tourism may be enhanced by Cuba's global political identity, and that Cuban women participating in commodified and intimate exchanges reveal an ability to get along in a market economy that generally excludes them.

Leaving to get ahead: assessing the relationship between mobility and inequality in Peruvian migration

Analysis of the impact of international migration on the socioeconomic conditions of migrants and their families in Peru, using data from the Latin American Migration Project, suggests that international migration contributes to individuals' socioeconomic well-being. While those who migrate tend to come from relatively privileged backgrounds in the first place, they gain further relative economic advantage by moving out of the country. A possible implication of this is that the growing international migration observed today is likely to exacerbate rather than ameliorate the already uneven distribution of income and rigid socioeconomic hierarchy in Peru.

Reconstructing Indigenous ethnicities: the Arapium and Jaraqui peoples of the lower Amazon, Brazil

In Latin America, indigenous identity claims among people not previously recognized as such by the state have become a key topic of anthropological and sociological research. Scholars have analyzed the motivations and political implications of this trend and the impacts of indigenous population's growth on national demographic indicators. However, little is known about how people claiming indigenous status constructs the meaning of their indigenous ethnicity. Drawing from sixty-four indepth interviews, focus-group analyses, and participant observation, this article explores the double process of identity construction: the reconstruction of the Arapium indigenous identity and the creation of the Jaraqui indigenous identity in Brazil's Lower Amazon. The findings reveal six themes that contribute to the embodiment of a definition of indigenous identity and the establishment of a discursive basis to claim recognition: sense of rootedness, historical memory, historical transformation, consciousness, social exclusion, and identity politics.

[Dissemination of German medicine in Spain and Latin America: the "Revista Médica de Hamburgo" and the "Revista Médica Germano-Ibero-Americana" (1920-1933)]

This article presents the development of the journals "Revista Médica de Hamburgo" and "Revista Médica Germano-Ibero-Americana," which were created to promote and disseminate the German science among the medical community in Latin America and Spain between the two World Wars. Shaken by the loss of Germany's colonies in Africa, the difficulties faced due to post-war economy, and the restrictions imposed by the armistice, the Germans sought to restore their cultural and scientific prestige through such initiative.

Tales of deviance and control: on space, rules, and law in squatter settlements

In Latin American cities, around a third of the urban population lives in tenure situations that can be designated as informal, yet variation in the ways and extent to which these arrangements do not comply with law is extensive. Furthermore, informal dwellers often employ a variety of strategies to legitimize and ultimately legalize their tenure, implying a dynamic rather than a static relationship between illegality and legality. Conceiving of land tenure in dichotomous terms, as simply being either legal or illegal, therefore, fails to reflect this diversity, nor does it capture the evolving nature of the relationship between informal settlements and the state system. Drawing from the development of squatter settlements in Buenos Aires, this article proposes an alternative perspective and shows how settlements alternate strategies of noncompliance with adaptation to the state legal system to gradually increase their legality.

Pre-historic eating patterns in Latin America and protective effects of plant-based diets on cardiovascular risk factors

In this review, we present the contributions to nutrition science from Latin American native peoples and scientists, appreciated from a historic point of view since pre-historic times to the modern age. Additionally, we present epidemiological and clinical studies on the area of plant-based diets and their relation with the prevention and treatment of cardiovascular diseases conducted in recent decades, and we discuss challenges and perspectives regarding aspects of nutrition in the region.

[Chagas disease in France: estimated number of infected persons and cardiac diseases in 2009, by risk groups]

An estimation of the number of Trypanosoma cruzi infected individuals and expected number of Chagasic cardiomyopathies in France (excluding French Guyana) was conducted in June, 2009 by InVS. Different risk groups were identified: Latino-Americans (LA) from endemic area (naturalized, legal and illegal migrants, adopted children), children born from LA's mother, French Guyanese living in Metropolitan France, expatriated and travellers from endemic countries. Prevalence rates by country of origin were applied to official data on risk populations obtained from the International Adoption Agency, Tourism Direction and French ministries (Finances, Foreign Affairs and Migrations). Around 157,000 individuals were potentially exposed. It is estimated than 1,464 [895-2,619] are infected by T. cruzi, of which 63 to 555 may evolve towards a chronic cardiomyopathy. This figure is within the range of earlier estimations of InVS and Guerri-Guttenberg. Taking into account illegal immigrants, the expected number of infected individuals in France should increase greatly this estimation.

[Congenital Chagas disease in Geneva: diagnostic and clinical aspects]

Chagas disease, a parasitic infection with Trypanosoma cruzi, recently emerged in Europe and in Switzerland. Mother-to-child infection represents a major mode of transmission in non endemic areas. In 2008, 305 Latin American pregnant women consulting at the Geneva University Hospitals were screened by serology. Overall prevalence was 2% and 8.8% in Bolivian women. All infected women were in the indeterminate form of the chronic phase. Two newborns were congenitally infected. Considering the potential for vertical transmission and the risk of long-term complications, screening programs for persons at risk need to be implemented.

BRCA1 and BRCA2 mutations in women of different ethnicities undergoing testing for hereditary breast-ovarian cancer

BACKGROUND

In women at increased risk for breast and ovarian cancer, the identification of a mutation in breast cancer gene 1 (BRCA1) and BRCA2 has important implications for screening and prevention counseling. Uncertainty regarding the role of BRCA1 and BRCA2 testing in high-risk women from diverse ancestral backgrounds exists because of variability in prevalence estimates of deleterious (disease-associated) mutations in non-white populations. In this study, the authors examined the prevalence of BRCA1 and BRCA2 mutations in an ethnically diverse group of women who were referred for genetic testing.

METHODS

In this cross-sectional analysis, the prevalence of BRCA1 and BRCA2 mutations was assessed in a group of non-Ashkenazi Jewish women who underwent genetic testing.

RESULTS

From 1996 to 2006, 46,276 women who met study criteria underwent DNA full-sequence analysis of the BRCA1 and BRCA2 genes. Deleterious mutations were identified in 12.5% of women, and recurrent deleterious mutations (prevalence >2%) were identified in all ancestral groups. Women of non-European descent were younger (mean age, 45.9 years; standard deviation [SD], 11.6 years) than European women (mean age, 50 years; SD, 11.9 years; P < .001). Women of African (15.6%; odds ratio [OR], 1.3 [95% confidence interval (95% CI), 1.1-1.5]) and Latin American (14.8%; OR, 1.2 [95% CI, 1.1-1.4]) ancestries had a significantly higher prevalence of deleterious BRCA1 and BRCA2 mutations compared with women of Western European ancestry (12.1%), primarily because of an increased prevalence of BRCA1 mutations in those 2 groups. Non-European ethnicity was associated strongly with having a variant of uncertain significance; however, reclassification decreased variant reporting (from 12.8%-->5.9%), and women of African ancestry experienced the largest decline (58%).

CONCLUSIONS

Mutation prevalence was found to be high among women who were referred for clinical BRCA1 and BRCA2 testing, and the risk was similar across diverse ethnicities. BRCA1 and BRCA2 testing is integral to cancer risk assessment in all high-risk women.

[Chagas disease: an emerging public health problem in Italy?]

Chagas' disease is an endemic parasitic illness in the American continent, affecting around 16 to 18 million people. Given that 9.5% of immigrants to Italy are from Latin America and that the infection can be transmitted in non-endemic countries congenitally by organ donations and blood transfusions, Chagas disease should be regarded as an emerging public health problem in Italy. Clinical guidelines as well as health protocols are needed to deal with this rarely recognized disease.

Evaluation of the implementation of a socio-educational program with immigrant families: a case study

There exist an increasing number of studies that demonstrate the necessity to evaluate the processes which characterize a program and guarantee its implementation and evaluation. This paper deals with the implementation of a program designed to improve the acculturation of immigrant families in Spain (EU). Implementation followed a process that has proved successful in other settings, but is being applied here for the first time. Qualitative and quantitative measures are employed to assess each stage of implementation, with a particular emphasis on fidelity to program design. The intent was to guide effective revision of the program, and to establish it in a form that can be implemented on a larger scale.

Evidence of organizational injustice in poultry processing plants: Possible effects on occupational health and safety among Latino workers in North Carolina

BACKGROUND

Over 250,000 workers are employed in poultry processing, one of the most dangerous industries in the US. These jobs are increasingly held by immigrant workers who are frequently undocumented, lack knowledge of workers' rights to workplace safety, and who are reluctant to pursue their rights. This situation creates the potential for organizational injustice, made visible through abusive supervisory practices, and leads to situations in which occupational illnesses and injuries are likely to occur.

METHODS

This paper draws on data collected during the research phases of a community-based participatory research and social justice project. Two hundred survey interviews and 26 in-depth interviews were collected in representative, community-based samples in western North Carolina. Analyses describe associations between one aspect of organizational injustice, abusive supervision, and worker injuries.

RESULTS

Workers' reports of abusive supervision are associated with a variety of specific and summary health indicators. The associations are stronger for women than for men. These suggest that the use of relative power within the plant may be the basis for injuries and illnesses. Three types of power relations are described that form the basis for these abusive interactions in the plant: ethnicity (American vs. Latino), immigration status ("good papers" vs. undocumented), and rank (supervisor vs. worker). Two factors modify these relations: kinship (preferences and privileges for family members) and gender.

CONCLUSIONS

Among Latino immigrants working in poultry plants, power differences reflecting organizational injustice in the form of abusive supervision may promote occupational illnesses and injuries, particularly for women.

North African and Latin American parents' and adolescents' perceptions of physical discipline and physical abuse: when dysnormativity begets exclusion

This research documents the cultural norms around physical discipline and physical abuse among immigrant parents and youth, and assesses the impact that perceived divergences in these norms have on the relation between the family and the outer social world. Interviews were conducted with 10 parents and 10 adolescents from North African Arab countries, and 10 parents and 10 adolescents from Latin America living in Canada. Results highlight that divergent discipline practices were perceived by participants as an important source of tension when they were accompanied with a demeaning image, projected by the host society onto the immigrant family.

Ethnicity, socio-economic status and self-harm in Swedish youth: a national cohort study

BACKGROUND

Previous studies have shown an elevated risk for self-harm in adolescents from ethnic minorities. However, potential contributions to this risk from socio-economic factors have rarely been addressed. The main aim of this article was to investigate any such effects.

METHOD

A national cohort of 1009 157 children born during 1973-1982 was followed prospectively from 1991 to 2002 in Swedish national registers. Multivariate Cox analyses of proportional hazards were used to estimate the relative risk of hospital admission for self-harm. Parental country/region of birth was used as proxy for ethnicity.

RESULTS

Youth with two parents born outside Sweden (except those from Southern Europe) had higher age- and gender-adjusted hazard ratios (HRs) of self-harm than the majority population (HR 1.6-2.3). The HRs decreased for all immigrant groups when socio-economic factors were accounted for but remained significantly higher for immigrants from Finland and Western countries and for youth with one Swedish-born and one foreign-born parent.

CONCLUSIONS

Socio-economic factors explain much of the variation by parental country of birth of hospital admissions for self-harm in youth in Sweden.

[Trichophyton violaceum: an emerging pathogen]

Population changes taking place in recent years, such as more frequent travel to endemic areas, immigration, and international adoptions, have all contributed to a resurgence of certain pathogens in our geographical area. This is the case of Trichophyton violaceum. A retrospective review was made of all cases of superficial mycosis caused by T. violaceum in patients receiving in-hospital treatment during the years 2000 to 2006. This microorganism accounted for 18.5% of the 275 dermatophytes isolated during the above-mentioned period. In 96% of T. violaceum infections, the lesion manifested as tinea capitis, and all the patients were foreigners. We report in increase of tinea capitis caused by T. violaceum among pediatric patients that appears to be directly related to immigration.

Immigrant advantage? Substance use among Latin American immigrant and native-born youth in Spain

This article reports the results of a descriptive study conducted with middle school and high school age youth residing in northwestern Spain. The main outcome of the study is to advance knowledge about the drug use attitudes and behaviors of immigrants versus native youth in a social context where Latin American immigrants share a common language and a set of core cultural norms with the host society. The research was conducted by a bi-national Spain-US research team as a preliminary study leading to the development of joint culturally appropriate prevention interventions for youth in the northern region of Galicia, Spain. Surveys were administered in Spring 2005 to 817 students in 7th to 10th grades in 10 urban, secondary schools with high immigrant enrollment. The sample included Spanish natives (two-thirds) and Latin American immigrants (one-third), mainly from Colombia, Argentina, and Venezuela. Multiple regression analyses predicted substance use intentions, and a composite variable measuring lifetime and last 30-day frequency and amount of alcohol, cigarette and marijuana use. Controlling for the fact that the immigrant students were generally older and performing less well academically than natives, and for other predictors, Latin American immigrant youth were less at risk than native youth on their intentions to use substances and on their reported actual substance use. In a mediational analysis, most of the key explanatory variables in youth substance use etiology failed to account for the immigrant versus native differences, including a range of risk and protective factors for substance use, substance use norms, strength of ethnic identity, and degree of social integration within native-born social networks. Differential access to drugs mediated the immigrant-native gap in substance use intentions but did not mediate differences in actual substance use.

Maturational profiles and migration in the female adolescent population of Madrid: is there a need for a new perspective?

The aim of this study is to assess anthropometric changes and menstrual cycle characteristics during the maturation process of an adolescent female sample in Madrid, Spain. The new demographic context of Madrid, with a 33.9% of girls coming from Central and South America, makes this study relevant in terms of new epidemiological situations that could possible develop. The sample consists of 284 girls, ages 9 to 16 years, measured and interviewed in four school centres of Madrid. Results show that menarche is slightly earlier in the Spanish girls, but there are no other important differences regarding the characteristics of their menses. However, the Spanish girls have a significantly higher intake of menarcheal pain related drugs. The anthropometric changes accompanying menarche are greater in the immigrants, especially in terms of trunk fatness, leading to an "overweight" characterisation of this sub-sample. These maturational profiles show the need for educational programs, especially focussed on the foreign adolescent population, to cope with health risks related to overweight.

Rural hospitals and Spanish-speaking patients with limited English proficiency

Between 1990 and 2000, the Latino population in the United States increased by 61 percent, becoming the largest minority group. Language differences contribute to patient safety and access to healthcare concerns for limited English proficiency (LEP) Latinos. The objectives of this research were to determine the techniques rural hospitals use to accommodate Spanish-speaking LEP patients, to identify strengths and barriers to providing language services, and to describe local approaches to language assistance services. Surveys were mailed to 841 hospitals in 544 rural counties with moderate to high Latino growth rates between 1990 and 2000. A total of 319 rural hospitals responded. Nearly all rural hospitals reported having tools to help patients communicate language needs. The most commonly used tools include brochures, language identification posters, and language identification cards. Strengths were institutional support for language assistance services, staff willingness to use interpreters, and access to telephone language lines. Principal barriers included lack of funding for interpreters, lack of local language training programs, and lack of state agency support. Hospitals that serve counties with higher Latino population growth rates reported higher demand for services compared with those counties with smaller Latino population growth rates. Several innovative approaches were also identified. Various language accommodation resources, tools, and strategies are available for hospitals to help them serve LEP clientele. Hospitals should routinely review their policies and procedures for language assistance services to ensure compliance with federal and Joint Commission standards.

[Maternal satisfaction with the quality of epidural analgesia for pain relief in labor]

OBJECTIVE

To measure patient satisfaction with epidural analgesia in labor and to analyze the sociodemographic characteristics of the obstetric population treated in our hospital.

MATERIAL AND METHODS

We administered an anonymous questionnaire in July and December 2003 to all patients who received epidural analgesia during labor to obtain information on the intensity of pain before analgesia and the efficacy of this procedure.

RESULTS

A total of 1067 questionnaires were returned. Of the patients who responded to the questionnaire, 91.3% were satisfied with the process of epidural anesthesia, 93.8% stated that they would recommend the technique used in our hospital, and 94% responded that they would request the technique again in our hospital. Spanish nationals accounted for 74.8% of the surveyed patients; the remaining 25.2% were from other countries-mainly from Central and South America (18% of the total). Before administration of epidural analgesia, 23.3% of Spanish primiparas defined labor pain as severe compared to 40.7% of foreign primiparas (P<.001). Of the multiparas, 212% of Spanish patients described the pain as severe compared to 40.4% of foreign women (P<.001).

CONCLUSIONS

The overall level of satisfaction with the process of epidural analgesia is very high and was not influenced by sociodemographic factors. Labor pain is perceived as being more intense by non-Spanish women.

[Self-medication amongst illegal Latino-American immigrants: necessary or inapropriate]

Self-medication is well known risk in Latin America. This situation can partly be explain by the difficult access to doctors and poorly regulated drug sales. Illegal Latino-American immigrants import their practice of self-medication and their drugs with them. The economic advantage of this practice makes it popular and confronts medical practitioners to question the benefice/risk of such behavior. Taking the particular situation of illegal Latino-American immigrants, this review discusses the necessity of abording systematically the question of self-medication during a medical consultation.

Influence of immigration and other factors on caries in 12- and 15-yr-old children

In recent years the Valencia region has undergone mass immigration, mainly of people from eastern Europe, North Africa, and Latin America. The objective of this study was to assess the effect of immigration on caries prevalence and experience in 12- and 15-yr-old children in the Valencia region, and to relate this to other socio-economic and oral hygiene-related variables. The data were obtained from the epidemiological study of oral health carried out in the Valencia Region in 2004. The study group comprised 478, 12-yr-old children and 401, 15-yr-old children. Immigration status, age, toothbrushing frequency, and intake of cariogenic foods between meals showed significant association in a multiple linear regression model using the decayed, missing or filled teeth (DMFT) count as the dependent variable. Of all the predictive variables, the one that made the highest contribution to the model was immigration status. In a multiple logistic regression analysis with caries presence as the dependent variable, immigration status, intake of cariogenic foods, social class, and age were significantly associated with the presence of caries. As immigrant children have significantly higher caries levels than Spanish children, future public health service planning should pay attention to this risk group.

Infección por el VIH en inmigrantes: diferencias clínico-epidemiológicas con la población autóctona en un área de salud de la Comunidad de Madrid (2001-2004)

OBJECTIVE

To describe the incidence and characteristics of immigrant patients attended in a dedicated HIV Unit in Madrid (Spain).

METHODS

Cross-sectional study including all patients whose first visit to our HIV Unit took place between January 2001 and December 2004.

RESULTS

Among a total of 516 new patients seen during the study period, 101 (19.6%) were immigrants (59% from Latin America, 27% from sub-Saharan Africa). Considering only patients who had not received previous clinical care in other centers (n = 298), 25.5% were immigrants. As compared to Spanish patients, there was a higher proportion of women among the immigrant population (40% vs. 26%: P = 0.008), age was lower (35 vs. 38 years; P = 0.003), and educational level was higher (39% vs. 13% secondary or higher education; P < 0.0001), with no statistical differences regarding employment (37% vs. 27% were unemployed; P = 0.07). Sexual transmission was more frequent among immigrants (85% vs. 37%; P < 0.0001), but the main sexual route of infection in both groups was heterosexual contact (71% and 66%). There were no differences in the baseline clinical, immunological, or virological status.

CONCLUSION

A large number of new patients attended for the first time in a dedicated HIV Clinic in Madrid were immigrants. Although these patients showed some differences in demographic characteristics and the mechanism of HIV transmission, no significant differences were found in their clinical or immunological characteristics as compared to Spanish patients.

Immigrant youth at risk for disorders of mood: recognizing complex dynamics

The number of youth immigrating to the United States from Latin America and the Caribbean has consistently and dramatically been increasing. However, little research or epidemiological data that capture the mental health status of these youth from their countries of origin or once they enter the United States exist. As a result of migration and the acculturation process, these youth are at risk for exacerbation of preexisting mood disorders or development of mood or other psychiatric symptoms. Pre-migration social and environmental stressors affecting this population include poverty, exposure to violence, sexual or physical victimization, and substance abuse. Post-migration stressors include loss (of friends, family, country, and lifestyle), changes in social support, negative experiences in the United States, language difficulties, and academic challenges. This review of the existing literature will describe the contextual experiences of immigrant Latin American and Caribbean youth from their country of origin and as new immigrants in the United States, discuss their risk for mood disorders, highlight relevant assessment data that should be obtained, and identify treatment implications for advanced practice psychiatric-mental health nurses working with this population.

The Latino paradox in neighborhood context: the case of asthma and other respiratory conditions

OBJECTIVES

Evidence indicates that foreign-born Latinos have a health advantage compared with US-born persons of the same socioeconomic status. An explanation for this paradox has remained elusive. We examined the extent to which this paradox exists for the prevalence of asthma and other respiratory conditions. We then explored the role of neighborhood social context in understanding any observed advantage. We invoked theories of social organization, collective efficacy, and the urban ethnic enclave.

METHODS

We combined data from the Project on Human Development in Chicago Neighborhoods Community Survey with 2 other data sources and used hierarchical generalized linear modeling techniques.

RESULTS

We found a distinctly graded effect for asthma and other breathing problems among foreign-born Latinos, depending on community composition. Foreign-born Latinos embedded in a neighborhood that had a high percentage of foreign-born residents experienced a significantly lower prevalence of asthma and other breathing problems; those in communities that had a low percentage of foreign-born residents had the highest prevalence overall (even when compared with African Americans).

CONCLUSIONS

Foreign-born Latinos have a respiratory health advantage only in enclave-like settings. Contexts such as these may provide the cohesiveness critical for effective prevention.

Parental interactions with Latino infants: variation by country of origin and English proficiency

This study examined variation in mother-infant interactions, father engagement, and infant cognition as a function of country of origin, socioeconomic status, and English language proficiency in a national sample of Latino infants (age 9 months) born in the United States and living with both biological parents (N=1,099). Differences between Mexican-American infants, who had lower mother-infant interaction scores and less father physical play than did the other Latino infants, were associated with differences in acculturation (both parents' English proficiency). Indicators of acculturation and paternal reports of happiness with partner were associated with paternal engagement. Indicators of acculturation were also related to mother-infant interactions. Infant cognitive scores were associated with maternal interaction but not father engagement, and maternal but not paternal mental health.

Effects of Multiple Daily Insulin Injections on Peripheral Glucose Disposal in Latin Americans with Type 2 Diabetes Mellitus

OBJECTIVE

To evaluate the effects of insulin in multiple daily injections (MDI) on peripheral glucose disposal in Latin American patients with type 2 diabetes.

METHODS AND RESULTS

Ten Latin American patients (four men and six women) with type 2 diabetes between the ages of 32 and 45 years were evaluated. All women were premenopausal and had regular menstrual periods. A hyperinsulinemic-euglycemic clamp procedure was performed at baseline and was repeated approximately 2 years after insulin monotherapy on MDI was initiated. Both genders had comparable baseline anthropometric and laboratory features, including a mean body mass index > 30 kg/m2 and percent body fat > 30%. Baseline percent hemoglobin A1c (HbA1c%) was 9.5 +/- 1.5%, and post-intervention HbA1c% was 7.0 +/- 1.2%. The peripheral glucose disposal rate at baseline was 4.5 +/- 2.2 mg/kg/min fat-free mass and at postintervention was 3.6 +/- 2.3 mg/kg/min fat-free mass.

CONCLUSIONS

Despite a significant improvement in glycemic control, MDI did not seem to increase the insulin-mediated glucose disposal rate. Underlying obesity and increased percent body fat may have been the most counteracting factors on the potential improvement in insulin sensitivity expected with insulin monotherapy.

The interpreter as cultural educator of residents: improving communication for Latino parents

OBJECTIVE

To determine whether augmentation of the Spanish interpreter's role to include cultural education of residents can improve the satisfaction of Latino patients.

DESIGN

We assessed parent satisfaction during 4 sequential 2-month periods between June 1, 2004, and February 11, 2005, using different interpretation methods: telephone interpretation (n = 91 patient encounters), trained in-person interpretation (n = 49), in-person interpretation with cultural education of residents (n = 65), and postprogram telephone interpretation (n = 45).

SETTING

General pediatric practice at a large teaching hospital.

PARTICIPANTS

A total of 250 Spanish-speaking parents who were limited in English proficiency.

INTERVENTIONS

The cultural education program included 3 brief preclinic conferences taught by an interpreter and one-on-one teaching of residents about language and cultural issues after each clinical encounter.

MAIN OUTCOME MEASURES

Parent satisfaction was assessed using 8 questions that have previously been validated in Spanish. Lower scores indicated more satisfaction.

RESULTS

Because they were limited in English proficiency, our Spanish-speaking patients were significantly more satisfied when an in-person interpreter was used compared with a telephone interpreter (mean total satisfaction score of 14.5 [in-person] vs 17.4 [telephone]; P = .006) but were even more satisfied when the interpreter educated residents in cultural and language issues (mean, 11.5 [in-person with education] vs 17.4 [telephone]; P<.001).

CONCLUSION

Although use of an in-person interpreter can increase Latino parents' satisfaction, a program using an interpreter to educate residents in cultural and language issues can increase satisfaction further.

Ascertainment of Hispanic ethnicity on California death certificates: implications for the explanation of the Hispanic mortality advantage

OBJECTIVES

We determined the size and correlates of underascertainment of Hispanic ethnicity on California death certificates.

METHODS

We used 1999 to 2000 vital registration data. We compared Hispanic ethnicity reported on the death certificate to Hispanic ethnicity derived from birthplace for the foreign-born and an algorithm that used first and last name and percentage of Hispanics in the county of residence for the US-born. We validated death certificate nativity by comparing data with that in linked Social Security Administration records.

RESULTS

Ethnicity and birthplace information was concordant for foreign-born Hispanics, who have mortality rates that are 25% to 30% lower than those of non-Hispanic Whites. Death certificates likely underascertain deaths of US-born Hispanics, particularly at older ages, for persons with more education, and in census tracts with lower percentages of Hispanics. Conservative correction for under-ascertainment eliminates the Hispanic mortality advantage for US-born men.

CONCLUSIONS

Hispanic ethnicity is accurately ascertained on the California death certificate for immigrants. Immigrant Hispanics have lower age-adjusted mortality rates than do non-Hispanic Whites. For US-born Hispanics, the mortality advantage compared with non-Hispanic Whites is smaller and may be explained by underreporting of Hispanic ethnicity on the death certificate.

Co-occurrence of mental and physical illness in US Latinos

BACKGROUND

This study describes the prevalence of comorbid physical and mental health problems in a national sample of US Latinos. We examined the co-occurrence of anxiety and depression with prevalent physical chronic illnesses in a representative sample of Latinos with national origins from Mexico, Cuba, Puerto Rico, and other Latin American countries.

METHOD

We used data on 2,554 Latinos (75.5% response rate) ages 18 years and older from the National Latino and Asian American Study (NLAAS). The NLAAS was based on a stratified area probability sample design, and the sample came from the 50 states and Washington, DC. Survey questionnaires were delivered both in person and over the telephone in English and Spanish. Psychiatric disorders were assessed using the World Mental Health Survey Initiative version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI). Physical chronic illness was assessed by self-reported history.

RESULTS

Puerto Ricans had the highest prevalence of meeting criteria for any comorbid psychiatric disorder (more than one disorder). Puerto Ricans had the highest prevalence (22%) of subject-reported asthma history, while Cubans had the highest prevalence (33%) of cardiovascular disease. After accounting for age, sex, household income, number of years in the US, immigrant status, and anxiety or depression, anxiety was associated with diabetes and cardiovascular disease, in the entire sample. Depression and co-occurring anxiety and depression were positively associated with having a history of asthma but not with other physical diseases, in the entire sample. Interestingly, Puerto Ricans with a depressive disorder had a lower odds of having a history of cardiovascular disease than Puerto Ricans without a depressive disorder. The relationship between chronic physical and mental illness was not confounded by immigration status or number of years in the US.

DISCUSSION

Despite previous findings that link acculturation with both chronic physical and mental illness, this study does not find that number of years in the US nor nativity explain the prevalence of psychiatric-medical comorbidities. This study demonstrates the importance of considering psychiatric and medical comorbidity among specific ethnic groups, as different patterns emerge than when using aggregate ethnic measures. Research is needed on both the pathways and the mechanisms of comorbidity for the specific Latino groups.

La importancia de la detección y el tratamiento de los síntomas somáticos en pacientes latinoamericanos con depresión mayor

OBJETIVO: La depresión mayor es una enfermedad caracterizada por la presencia tanto de síntomas mentales como somáticos, los cuales afectan en forma significativa los procesos diagnósticos y terapéuticos así como el pronóstico. MÉTODO: Usamos una búsqueda de artículos publicados hasta Junio 2006 cruzando términos que nos permitieran incluir artículos que hiciesen referencia a la comorbilidad entre depresión mayor y síntomas somáticos, a la prevalencia de dicha comorbilidad en Latinoamericanos y/o al impacto y el patrón de uso de antidepresivos en pacientes con depresión mayor y síntomas somáticos asociados. RESULTADOS: Los síntomas somáticos en Latinoamericanos con depresión mayor son frecuentes, probablemente más que en otras poblaciones, afectan significativamente la respuesta al tratamiento, se asocian a mayor refractariedad y cronicidad y no siempre son tenidos en cuenta en la práctica psiquiátrica de algunos países Latinoamericanos, donde la práctica usual de prescribir dosis bajas de antidepresivos podría comprometer el control de los síntomas somáticos residuales y asociarse a mayores tasas de recurrencias. CONCLUSIÓN: Los clínicos que laboran en Latinoamérica deben ser acuciosos en la detección de los síntomas somáticos de sus pacientes con depresión mayor y siempre procurar la prescripción de dosis terapéuticas del antidepresivo de su selección.

Ethnic considerations in the treatment of Hispanic and Latin-American patients with hyperpigmentation

Latin-Americans have a heterogeneous ancestry that is defined by their place of domicile, while Hispanics are defined as those persons of Spanish descent. These two groups have a diverse range of skin phototypes and pigmentation and are prone to an increased incidence of melasma and post-inflammatory hyperpigmentation. Little research has been conducted to evaluate the frequency, course, effects, tolerability and treatment response of skin diseases in Hispanic and Latin-American populations. From the limited data that are available it is considered that the treatment of melasma in these two groups does not differ from the general population. First-line therapy of melasma should consist of effective topical therapies, mainly a fixed triple combination of hydroquinone, retinoic acid and fluocinolone acetonide. Where patients have either sensitivity or triple combination therapy is unavailable, other compounds with dual ingredients may be considered as an alternative. Options for second-line therapy include peels either alone or in combination with topical therapy. Lasers should rarely be used in the treatment of melasma and then only as third-line therapy in cases of melasma which is resistant to all other therapies. If applied, skin type must be taken into account. Irritation and sensitivity can be a concern in darker-skinned Hispanic patients and for this reason, the risk of post-inflammatory hyperpigmentation (PIH) following treatment should be considered.

Development of a tool to assess past food insecurity of immigrant latino mothers

OBJECTIVE

The purpose is to describe the development and validation of a tool to measure the degree of past food insecurity in an immigrant US population.

DESIGN

Focus group discussions and a structured interview. As a first step, focus group discussions were conducted among immigrant Latino mothers. Based on these discussions, an 8-item tool was developed and pilot-tested in a convenience sample of mothers.

SETTING

California.

PARTICIPANTS

Twenty-two low-income Latino mothers with children, ages 4 to 5 years, in the focus groups and 85 low-income Latino and white mothers of young children in the structured interviews.

ANALYSES

Constant comparative analysis, Cronbach alpha, Spearman correlations, Chi-square, and Kruskal-Wallis test.

RESULTS

Internal consistency of the remaining 7 items was good (Cronbach alpha = 0.84). Evidence of convergent validity included significant correlations between past food insecurity and maternal education (r = -0.45, p < .0001), crowding in the mother's childhood household (r = +0.30, p < .006), and past food insufficiency (r = +0.74, p < .0001). Foreign-born Latino mothers reported significantly greater levels of past food insecurity than US-born mothers, demonstrating discriminant validity (p < .01).

CONCLUSIONS AND IMPLICATIONS

This tool may be useful to determine how past deprivation influences current food choices and other nutrition-related behaviors in low-income Latino immigrants.

Higher prevalence of human papillomavirus infection in migrant women from Latin America in Spain

OBJECTIVES

To estimate prevalence and determinants of high risk (HR) human papillomavirus (HPV) by country of origin in women attending a family planning centre (FPC) in Alicante, Spain.

METHODS

Cross sectional study of all women attending a FPC from May 2003 to January 2004. An ad hoc questionnaire was designed and data were collected prospectively. HR HPV infection was determined through the Digene HPV test, Hybrid Capture II, and positive samples for PCR were directly sequenced. Data were analysed through multiple logistic regression.

RESULTS

HR HPV prevalence in 1011 women was 10% (95% CI: 8.2 to 12). Compared to Spaniards (prevalence 8.2%) HR HPV prevalence in Colombians was 27.5% (OR: 4.24 95% CI: 2.03 to 8.86), 23.1% in Ecuadoreans (OR: 3.35 95% CI: 1.30 to 8.63), and 22.73% in women from other Latin American countries (OR: 3.29 95% CI: 1.17 to 9.19). Women with more than three lifetime sexual partners had an increased risk of HR HPV infection (OR 3.21 95% CI: 2.02 to 5.10). The higher risk of HR HPV infection was maintained in Latin American women in multivariate analyses that adjusted for age, number of lifetime sexual partners, and reason for consultation. The commonest HPV types in women with normal cervical smears were HPV-18 (20%), HPV-16 (14%) and HPV-33 (11%).

CONCLUSIONS

Prevalence of HR HPV is more than three times higher in Latin Americans than in Spaniards. Latin American women's HPV prevalence resembles more that of their countries of origin. It is essential that health service providers identify these women as a priority group in current cervical screening programmes.

Adherence to latent tuberculosis infection therapy among latino immigrants

BACKGROUND

One third of the world population is infected with Mycobacterium tuberculosis. In the United States, a key component for eliminating tuberculosis (TB) is treating latent TB infection (LTBI) in high-risk persons such as immigrants.

OBJECTIVE

Examine the prevalence of adherence to LTBI therapy and the influence of basic conditioning factors on adherence among Latino immigrants, guided by Orem's Self-Care Deficit Theory. Adherence was treated as a health deviation self-care requisite; the self-care practice of taking daily medication for 9 months is essential to LTBI adherence. Conditioning factors include gender, age, sociocultural factors, environment, and health state.

DESIGN

Exploratory, cross-sectional.

SAMPLE

Nonprobability sample (n=53) of Latino immigrants attending an urban public health clinic in the Washington, DC metropolitan area.

METHODS

Participants completed a brief questionnaire documenting selected conditioning factors, and 9-month adherence to LTBI therapy was determined from their medical records.

RESULTS

Adherence dropped from 98% in month 2 to 72% at 9 months. The mean number of months adherent was 7.4. Adherence was not significantly associated with gender, country of origin, languages spoken, age, education, or years in the United States. Adherence was slightly lower (t=2.059, p=.059) in persons who knew someone with TB.

CONCLUSIONS

Nurses should emphasize the importance of adherence for the full 9 months to this population.

Parental interactions with Latino infants: variation by country of origin and English proficiency

This study examined variation in mother-infant interactions, father engagement, and infant cognition as a function of country of origin, socioeconomic status, and English language proficiency in a national sample of Latino infants (age 9 months) born in the United States and living with both biological parents (N=1,099). Differences between Mexican-American infants, who had lower mother-infant interaction scores and less father physical play than did the other Latino infants, were associated with differences in acculturation (both parents' English proficiency). Indicators of acculturation and paternal reports of happiness with partner were associated with paternal engagement. Indicators of acculturation were also related to mother-infant interactions. Infant cognitive scores were associated with maternal interaction but not father engagement, and maternal but not paternal mental health.

Listening to different voices

Grounded theory research provides the foundation for this case analy sis about listening to the voices of refugee immigrant women in order to improve access to health care. The authors share the case study of "Elena" (pseudonym), a Latin American refugee immigrant to Canada, and explore listening as an individual and collective intervention. The feeling of being degraded, ignored or dismissed by others has serious consequences for refugee immigrants to Canada. The authors recommend a social advocacy approach with both individual and collective strategies for responding to the lack of cultural sensitivity and genuine listening evidenced by Elena's case. Inclusive and partnership approaches, an "inequities imagination" and relational approaches to difference are required to loosen our thinking about what shapes refugee immigrant health. A critical cultural perspective asks that practitioners not only listen for history and context in individual practice, but also take those discoveries further to change policy and practice systemically.

Making a case for the examination of ethnicity of Blacks in United States Health Research

Important differences between Blacks of different ethnicities in the U.S. in chronic disease morbidity and mortality have been reported. Blacks in the U.S. constitute a heterogeneous group, including immigrants from Africa, Caribbean nations, Central and South America, as well as people now known as African Americans. Ethnicity among Blacks is seldom examined in health research, although in-depth examination of the ethnicity and culture-related pathways through which psychosocial factors may act to influence health have the potential to improve our understanding of health disparities. This improved understanding could in turn lead to the development of new, innovative, culturally based interventions that may reduce health disparities in the U.S. We briefly review the literature that examines Black ethnicity and birthplace, health outcomes, health-related knowledge and behaviors, and health-related psychological and social factors. We present a conceptual framework to aid in understanding the links between these factors and health. Suggestions are offered for conducting research in the future.

Weight, Diet, and Physical Activity-Related Beliefs and Practices Among Pregnant and Postpartum Latino Women: The Role of Social Support

OBJECTIVES

Eating and physical activity patterns may contribute to excessive pregnancy weight gain and postpartum retention that increase the risks of obesity and diabetes for both Latino mothers and their children. Social support is an important health determinant and may affect health-related beliefs and behaviors. The objective of this study was to investigate the influence of social support on weight, diet, and physical activity-related beliefs and behaviors among pregnant and postpartum Latinas.

METHODS

A community-based participatory project, Promoting Healthy Lifestyles among Women, was conducted in southwest Detroit to plan interventions aimed at reducing risks of obesity and type 2 diabetes. Qualitative analyses of in-depth semistructured interviews with dyads of 10 pregnant and postpartum Latinas, and 10 people who influenced them were conducted.

RESULTS

Husbands and some female relatives were primary sources of emotional, instrumental, and informational support for weight, diet, and physical activity-related beliefs and behaviors for Latina participants. Holistic health beliefs and the opinions of others consistently influenced Latinas' motivation and beliefs about the need to remain healthy and the links between behavior and health. Absence of mothers, other female relatives, and friends to provide childcare, companionship for exercise, and advice about food were prominent barriers that limited women's ability to maintain healthy practices during and after pregnancy.

CONCLUSION

The findings support evidence that low-income, recently immigrated pregnant and postpartum Latinas could benefit from community-based, family-oriented interventions that provide social support necessary to promote and sustain healthy lifestyles.

Internationally adopted children: a new challenge for pediatricians

Children adopted from abroad by Italian families have increased during the last years. Since 2001 to 2004 they have been more than 10,000, mainly from Eastern Europe, and all indications suggest that they will continue to increase. Most of the internationally adopted children reside in orphanage before adoption where they may experience malnutrition, exposure to infectious diseases, environmental deprivation, neglect. Moreover, their pre-adoptive records are scarcely reliable and their immunization status is not always adequate. The most common long-term problems of internationally adopted children concern developmental and scholastic delay especially if they come from a long and severely deprived institutional setting, precocious puberty and, during adolescence, depressive disorders as well as antisocial behaviours. Inter-country adopted children are at increased risk for health and social problems and have to be recognized as a group of subjects requiring special medical attentions. Specialized centres for internationally adopted children where they could receive medical evaluations upon arrival and a prolonged health follow-up should be set up.

Low postpartum rubella vaccination rates in high-risk women, Miami, Florida, 2001

OBJECTIVE

To evaluate adherence to the Advisory Committee on Immunization Practices' recommendations on postpartum rubella vaccination in hospitals with a high proportion of foreign-born Latina mothers, the highest risk group for congenital rubella syndrome.

METHODS

In four large hospitals in Miami-Dade County, maternal medical records for births in 2001 were randomly selected. Using demographic information from birth certificates, vaccination information from medical records, and policy information from a hospital survey, postpartum rubella vaccination rates were characterized among women eligible for vaccination (non-immune and not screened) through univariate and multivariable analyses. Data collection was performed in 2002-2003 and the analysis was completed in 2004-2005.

RESULTS

Among 1991 women, 1209 (61%) were foreign born. Overall, 410 (21%) were eligible for vaccination, and of these 44 (11%) were vaccinated. Vaccination rates were not associated with maternal race/ethnicity or the existence of institutional standing-order vaccination policies. A vaccination order was recorded for 59% (240/410), but even in the presence of an order, only 17% (31/240) of those women were vaccinated.

CONCLUSIONS

Despite policies and standing orders to vaccinate, postpartum rubella vaccination rates were very low among all racial/ethnic subgroups in a sample of hospitals caring for high-risk, foreign-born women. These findings suggest that additional system-level interventions, such as comprehensive operational guidelines, must accompany standing orders to vaccinate rubella non-immune women postpartum.

Prevalence of colonisation with group B Streptococci in pregnant women of a multi-ethnic population in The Netherlands

OBJECTIVE

This study was performed to determine the prevalence of GBS and to identify GBS colonisation risk factors in a multicultural population of pregnant women in The Netherlands. We calculated predictive values of cultures in pregnancy for intrapartum GBS carriage.

STUDY DESIGN

From a total of 1702 women visiting several antenatal outpatient departments, rectovaginal swabs were collected at 35-37 weeks' gestation. In 761 women swabs were repeated at time of delivery. Carriage of GBS late in third trimester and at time of delivery was analysed in relation to age, parity, ethnicity and socio-economic status.

RESULTS

Twenty-one percent was GBS carrier late in pregnancy. Compared to Europeans, African women were at a higher risk (29%, RR 1.4, CI 1.1-1.7) and Asian women were at lower risk (13%, RR 0.6, CI 0.4-0.8) for GBS carriage. No differences in colonisation were found between women with respect to age, parity or socio-economic background. Positive predictive value of GBS carriage at 35-37 weeks' gestation for carriage at time of parturition was 79% and negative predictive value was 93%.

CONCLUSIONS

It was not possible to identify a group of pregnant women at high risk for GBS colonisation. Predictive values of antenatal genital group B streptococci cultures at 35-37 weeks' gestation for intrapartum GBS carriage are lower than previously reported.

A Comparison of Birth Outcomes Among US-Born and non–US-Born Hispanic Women in North Carolina

OBJECTIVE

To compare birth outcomes between non-US-born and US-born Hispanic women in North Carolina (NC).

METHODS

A retrospective comparison of birth outcomes from linked NC birth/death certificate data (1993-1997) for 22,234 Hispanic births by mother's place of birth was conducted.

RESULTS

Mexico-born Hispanic women (58%) had significantly fewer medical risks, tobacco or alcohol use during pregnancy; however, they also had significantly less education and prenatal care than US-born Hispanic women (21%). Infant mortality rate, low birth weight, and prematurity were low and did not differ significantly. Lethal anomalies were the primary cause of infant mortality in non-US-born Hispanics versus Sudden Infant Death Syndrome (SIDS) in US-born Hispanics.

CONCLUSIONS

Despite increased risk factors among US-born women, we found no difference in Hispanic birth outcomes in NC by mother's place of birth. These data contradict national data and may be related to findings of both positive and negative aspects of acculturation in NC.

Study of the integrated cognitive model of depression among Latin-Americans

OBJECTIVE

The objective of the present study is to test the validity of the integrated cognitive model (ICM) of depression proposed by Kwon and Oei with a Latin-American sample. The ICM of depression postulates that the interaction between negative life events with dysfunctional attitudes increases the frequency of negative automatic thoughts, which in turns affects the depressive symptomatology of a person. This model was developed for Western Europeans such as Americans and Australians and the validity of this model has not been tested on Latin-Americans.

METHOD

Participants were 101 Latin-American migrants living permanently in Brisbane, including people from Chile, El Salvador, Nicaragua, Argentina and Guatemala. Participants completed the Beck Depression Inventory, the Dysfunctional Attitudes Scale, the Automatic Thoughts Questionnaire and the Life Events Inventory. Alternative or competing models of depression were examined, including the alternative aetiologies model, the linear mediational model and the symptom model.

RESULTS

Six models were tested and the results of the structural equation modelling analysis indicated that the symptom model only fits the Latin-American data.

CONCLUSIONS

Results show that in the Latin-American sample depression symptoms can have an impact on negative cognitions. This finding adds to growing evidence in the literature that the relationship between cognitions and depression is bidirectional, rather than unidirectional from cognitions to symptoms.

Breastfeeding as health-promoting behaviour for Hispanic women: literature review

AIM

This paper reports a literature review to synthesize the evidence that breastfeeding is a health-promoting behaviour for Hispanic women and to demonstrate the usefulness of the Health Promotion Model in understanding and increasing breastfeeding behaviours in Hispanic women.

BACKGROUND

While breastfeeding has been shown to promote the health of both mother and infant, it has not been widely viewed from the perspective of the Health Promotion Model.

METHODS

The CINAHL and MEDLINE databases were searched using the terms 'Hispanic' or 'Latina', 'breastfeeding' and concepts specific to the Health Promotion Model (interpersonal relationships, social support, acculturation, self-efficacy, barriers, benefits, and commitment). Only papers in the English language from 1990 to 2003 (except for classic papers) that used research techniques were reviewed. Only those addressing breastfeeding intention, initiation or duration were included. The reference lists of each paper were examined for additional empirical papers that linked any of the determinants of the Health Promotion Model to breastfeeding among Hispanic women. Papers were organized using the ten determinants as headings: prior related behaviour, personal factors, perceived benefits, perceived barriers, perceived self-efficacy, activity-related affect, interpersonal influences, situational influences, immediate competing demands, and commitment to a plan of action. The review was conducted in 2003.

FINDINGS

The literature verifies that each of the 10 determinants of health-promoting behaviour also promotes breastfeeding for Hispanic women, particularly through the constructs of acculturation, interpersonal support, self-efficacy and immediate competing demands. Breastfeeding is not consistently defined in all studies, nor are Hispanic population groups uniformly classified according to country of origin. Specific interventions to promote breastfeeding have been implemented for women of Latin American origin, but randomized designs to measure outcomes have not been consistently employed with Hispanic women in the United States of America. Further intervention research is needed to confirm breastfeeding as a health-promoting behaviour and to inform breastfeeding education for this group.