Transition in Older Parent-Adult Child Relations in U.S. Chinese Immigrant Families

BACKGROUND AND OBJECTIVES

The family fundamentally underpins the immigration and acculturation processes. But most existing research on acculturation focuses on individual instead of family experience. Guided by Berry's acculturation theory and Intergenerational Solidarity Theory, this study examined continuity and changes in parent-adult child relations of older Chinese immigrants over a 2-year period, and their implications for older adults' depression and quality of life (QoL).

RESEARCH DESIGN AND METHODS

Participants included 2,605 older Chinese immigrants from the Population Study of Chinese Elderly in Chicago (PINE). Latent Transition Analysis (LTA) was used to identify transitions in multidimensional parent-child relations over time. Negative binomial and logistic regressions were used to examine the influence of family transitions on depression and QoL, respectively.

RESULTS

LTA revealed five types of family relations: traditional, modified traditional, coresiding-unobligated, independent, and detached. Over 40% of the respondents shifted to a different relation type, with more families classified as modified traditional or independent over time. Transitioning into modified traditional relations or out of detached relations was associated with fewer depressive symptoms and better QoL at the follow-up. Transitioning into independent relation was associated with more depressive symptoms over time.

DISCUSSION AND IMPLICATIONS

Parent-child relations among Chinese older immigrants demonstrate significant complexity, including both heterogeneity and fluidity. Better well-being of these older adults seems to stem from the optimal combination of retaining the supportive heritage culture and embracing the host society's instrumental cultural elements. Services to this population need to include the family context in assessment and interventions.

Health Assessment of the Arab American Community in Southwest Chicago

Chicago is among the top five metropolitan areas in the United States where Arab Americans reside; however, we have little available data on their perceptions of personal or community health. We collected 200 community health surveys in collaboration with a community-based organization that serves mainly Arabs in Chicago's southwest suburbs. The survey evaluated perceived community and personal health. In a mostly female, married, and low-income sample, participants identified cancers, diabetes, and high blood pressure/cholesterol as the top three health problems, while alcohol abuse, drug abuse, and overweight/obesity as the top three risky behaviors within the community. Gender differences, age differences, and educational level differences were found on certain determinants of health regarding the health of the community, perceived health problems, and risky behaviors. Our data validates previous findings from the literature highlighting cancer, diabetes, and high blood pressure as health priorities among Arabs, but offers new insights into unidentified issues within the Arab American community in Southwest Chicago such as alcohol, drug abuse, and child neglect/abuse. Furthermore, our findings warrant the need for classifying Arabs as a separate minority population facing health disparities.

A cross-sectional study of coping resources and mental health of Chinese older adults in the United States

OBJECTIVES

This study examined the potential influence of coping resources at individual (sense of mastery), family (spousal and family support, children's filial piety), and community levels (community cohesion) on the mental health (depression, anxiety) of U.S. Chinese older adults.

METHODS

The data were derived from the Population Study of Chinese Elderly in Chicago (N= 3,159). Negative binomial regressions were performed to predict depression and anxiety, respectively, by entering the three sets of coping resources separately and jointly, controlling for socio-demographic and acculturation variables.

RESULTS

Stronger sense of mastery and greater perception of children's filial piety were associated with better mental health outcomes. Spousal support was not associated with any mental health outomes, and family support was actually assciated with greater depression and anxiety. Stronger community cohesion was associated with fewer depressive symptoms but greater anxiety.

CONCLUSION

Older immigrants' sense of control and perception that children adhere to traditional family norms are important mental health protective factors. Whereas depending on families for support may compromise their well-being, community cohesion could be a double-edged sword for their mental health. Future studies shall further disentangle the associations among sense of mastery, reliance on family and ethnic enclaves for support, and older immigrants' well-being.

Association of Self-Reported Discrimination and Suicide Ideation in Older Chinese Americans

OBJECTIVE

This study examines racial discrimination as a potential novel risk factor for suicide ideation among older Chinese Americans.

DESIGN

In a cross-sectional analysis, this study drew on data collected in the Population-based Study of Chinese Elderly in Chicago on Chinese older adults age 60 + in the Greater Chicago area (N = 3,157). Thirty-day suicide ideation was a dichotomous variable, derived from items of the Physical Health Questionnaire and the Geriatric Mental State Examination-Version A. Self-reported discrimination was dichotomously coded, based on the Experiences of Discrimination instrument, which asks respondents whether they have ever experienced discrimination in nine situations because of their race/ethnicity/color.

RESULTS

About 4.1% of the sample reported 30-day suicide ideation and 21.5% reported discrimination. Self-reported discrimination was significantly associated with suicide ideation before and after adjusting for covariates including sociodemographic characteristics; neuroticism; social relationships; and physical, cognitive and mental health. In the fully adjusted model, those who reported discrimination had 1.9 times higher odds (OR: 1.9; 95% CI: 1.18-3.08; Wald χ2 = 6.9, df = 1, p = 0.01) of suicide ideation than those who did not.

CONCLUSION

Chinese American seniors who reported discrimination had an almost twofold greater odds of 30-day suicide ideation compared with those who did not. Clinicians need to recognize the impact of discrimination on ethnic minority elders. For those who report experiencing discrimination, assessment of suicide risk may be necessary. Efforts to promote civil rights and reduce discrimination may also be a form of primary prevention of suicide.

Trauma symptoms in a diverse population of sexually abused children

OBJECTIVE

The role of ethnicity, age, and gender in studies of sexually abused children has been overlooked. Yet, studies have found that African American and Latino sexually abused children suffer from more severe symptoms at treatment presentation and longer lasting effects than Caucasian children. Furthermore, evidence suggests that age and gender impact symptoms resulting from sexual abuse. This study focused on examining demographic differences in trauma symptoms and posttreatment data in an urban, ethnically diverse population of sexually abused children.

METHOD

The sample was selected from archival data of 176 children who ranged from the ages of 8 to 16. Therapists administered the Trauma Symptom Checklist for Children (TSCC) at pretreatment and posttreatment.

RESULTS

Symptom scores were significantly lower for 41 children who completed 3 months of trauma-focused cognitive-behavioral therapy (TF-CBT) on all TSCC scales except Sexual Concerns, Dissociation, and Overt Dissociation. For the entire sample, mean symptom scores for Sexual Preoccupation were significantly higher for African American children compared to Latino and Caucasian children. Older children had significantly higher scores on scales for Anxiety, Depression, Anger, Posttraumatic Stress, Dissociation, and Sexual Distress. Sexual Distress scale scores were significantly higher among females.

CONCLUSION

Findings indicate that trauma symptoms significantly improved after 3 months of TF-CBT. Trauma symptoms differed for children by ethnic group, age, and gender. Identifying factors that impact symptomatology is critical to providing effective, culturally competent treatment for ethnic minority children who are child sexual abuse victims. (PsycINFO Database Record

Study design and protocol for moving forward: a weight loss intervention trial for African-American breast cancer survivors

BACKGROUND

Breast cancer survival rates are significantly lower among African-American women compared to white women. In addition, African-American women with breast cancer are more likely than white women to die from co-morbid conditions. Obesity is common among African-American women, and it contributes to breast cancer progression and the development and exacerbation of many weight-related conditions. Intervening upon obesity may decrease breast cancer and all-cause mortality among African-American breast cancer survivors.

METHODS/DESIGN

Moving Forward is a weight loss intervention being evaluated in a randomized trial with a projected sample of 240 African American breast cancer survivors. Outcomes include body mass index, body composition, waist:hip ratio, and behavioral, psychosocial and physiological measures. Survivors are randomized to either a 6-month guided weight loss intervention that involves twice weekly classes and text messaging or a self-guided weight loss intervention based on the same materials offered in the guided program. The guided intervention is being conducted in partnership with the Chicago Park District at park facilities in predominantly African-American neighborhoods in Chicago. Recruitment strategies include direct contact to women identified in hospital cancer registries, as well as community-based efforts. Data collection occurs at baseline, post-intervention (6 months) and at a 12-month follow-up.

DISCUSSION

This study evaluates a community-based, guided lifestyle intervention designed to improve the health of African-American breast cancer survivors. Few studies have addressed behavioral interventions in this high-risk population. If successful, the intervention may help reduce the risk for breast cancer recurrence, secondary cancers, and co-morbid conditions, as well as improve quality of life.

TRIAL REGISTRATION

U.S. Clinicaltrials.gov number: NCT02482506, April 2015.

Impact of religiosity on the sexual risk behaviors of young men who have sex with men

Young men who have sex with men (YMSM), particularly Black YMSM, bear a disproportionate burden of new human immunodeficiency virus (HIV) infections in the United States. Several studies support the positive and protective role of religion in health and the prevention of morbidity and mortality. However, little empirical research has been conducted looking at religion with the context of YMSM and HIV prevention. We examined the impact of religious attendance and faithfulness on sexual risk among a community-based sample of 450 YMSM in Chicago ages 16 to 20. Participants were mostly racial/ethnic minorities, that is, Black (53.4%) and Latino (19.9%). Multivariate logistic regression indicated that faithfulness in combination with frequent formal religious attendance was associated with a decrease in reported number of unprotected anal sex acts, including unprotected receptive anal sex with male partners. These association trends were also found for the Black YMSM in our sample, suggesting that religious involvement and faithfulness is a potential protective factor for the acquisition of HIV among this high-risk population.

Effectiveness, efficiency, duration, and costs of recruiting for an African American women's lifestyle physical activity program

In a 48-week lifestyle physical activity controlled trial in African American women, we analyzed recruitment effectiveness, efficiency, duration, and costs. Social networking was the most effective approach for inviting women to the trial. Of the 609 who responded to invitations, 514 completed telephone screening; of these, 409 (80%) were found eligible. The health assessment screening was completed by 337 women; of these, 297 (88%) were found eligible. The mean number of days from completion of the telephone and health assessment screenings to beginning the intervention was 23.01, and the mean cost was $74.57 per person. Results suggest that provision of health assessment screening by study staff as part of recruitment is effective for minimizing attrition and also might be cost-effective.

Psychosocial distress and stroke risk in older adults

BACKGROUND AND PURPOSE

To investigate the association of psychosocial distress with risk of stroke mortality and incident stroke in older adults.

METHODS

Data were from the Chicago Health and Aging Project, a longitudinal population-based study conducted in 3 contiguous neighborhoods on the south side of Chicago, IL. Participants were community-dwelling black and non-Hispanic white adults, aged 65 years and older (n=4120 for stroke mortality; n=2649 for incident stroke). Psychosocial distress was an analytically derived composite measure of depressive symptoms, perceived stress, neuroticism, and life dissatisfaction. Cox proportional hazards models examined the association of distress with stroke mortality and incident stroke over 6 years of follow-up.

RESULTS

Stroke deaths (151) and 452 incident strokes were identified. Adjusting for age, race, and sex, the hazard ratio (HR) for each 1-SD increase in distress was 1.47 (95% confidence interval [CI]=1.28-1.70) for stroke mortality and 1.18 (95% CI=1.07-1.30) for incident stroke. Associations were reduced after adjustment for stroke risk factors and remained significant for stroke mortality (HR=1.29; 95% CI=1.10-1.52) but not for incident stroke (HR=1.09; 95% CI=0.98-1.21). Secondary analyses of stroke subtypes showed that distress was strongly related to incident hemorrhagic strokes (HR=1.70; 95% CI=1.28-2.25) but not ischemic strokes (HR=1.02; 95% CI=0.91-1.15) in fully adjusted models.

CONCLUSIONS

Increasing levels of psychosocial distress are related to excess risk of both fatal and nonfatal stroke in older black and white adults. Additional research is needed to examine pathways linking psychosocial distress to cerebrovascular disease risk.

Evangelical Church polity and the nuances of white flight: a case study from the Roseland and Englewood neighborhoods in Chicago

Present patterns of residential segregation have been proven to have antecedents in the so-called white flight of the 1950s, 1960s, and 1970s. Close scrutiny of this social phenomenon has yielded results that indicate complicated impetuses and call into question sweeping assumptions about white flight. A case study of seven congregations from a denomination called the Christian Reformed Church in North America (CRC) who left the Englewood and Roseland neighborhoods of Chicago during the juncture in question further reveals the dubious role of religious practices and arrangements in the out-migration of white evangelical Christians. By utilizing church histories, council minutes, and field interviews, it became readily apparent that the departure of the members of these congregations found sanction within the hierarchical apparatus (or lack thereof) of the church. The response of these CRC congregations exemplified how the political structures (congregational polity) and social networks of a particular denomination could allow for an almost seamless process of white flight.

Who has time for Ćejf? Postsocialist migration and slow coffee in neoliberal Chicago

The official end to communism in Eastern Europe marked the onset of major migratory movements. Perhaps the most abrupt of these population shifts was the displacement of more than two million people in Yugoslavia's violent dissolution. Much of the existing literature on refugee migration has focused on victimization and citizenship claims. Alternatively, I draw on ethnographic research among Bosnian refugee-immigrants in Chicago to examine how a group of adult women migrants used one commodity - coffee - to manage and evaluate their displacements. The kind of slow-coffee drinking described here is informed by an ethics of consumption developed under Yugoslav socialism, nostalgias for pre-Yugoslav Islam and pre-Ottoman Bosnia, and exposure to U.S. neoliberalism. Placing consumption at the center of analysis reveals the structural constraints of the postconflict period and brings to light refugees’ active navigations of everyday life and society in their postsocialist present, lived out as refugees in the United States.

“Stones run it”: taking back control of organized crime in Chicago, 1940-1975

In the 1960s and 1970s African American “supergangs” emerged in Chicago. Many scholars have touted the “prosocial” goals of these gangs but fail to contextualize them in the larger history of black organized crime. Thus, they have overlooked how gang members sought to reclaim the underground economy in their neighborhoods. Yet even as gangs drove out white organized crime figures, they often lacked the know-how to reorganize the complex informal economy. Inexperienced gang members turned to extreme violence, excessive recruitment programs, and unforgiving extortion schemes to take power over criminal activities. These methods alienated black citizens and exacerbated tensions with law enforcement. In addition, the political shelter enjoyed by the previous generation of black criminals was turned into pervasive pressure to break up street gangs. Black street gangs fulfilled their narrow goal of community control of vice. Their interactions with their neighbors, however, remained contentious.

The northern “Black Metropolis” of the early twentieth century: a reappraisal

The new perspective of the "Black Metropolis" implies that conditions created by the Great Migration helped blacks in northern cities to establish themselves in professional, entrepreneurial, and artistic, entertainment and mass media occupations. The present study evaluates this argument with Census data, focusing on the nation's largest black communities, Harlem (New York) and Bronzeville (Chicago), at time points that capture the first wave of the Great Migration. Contrary to expectations, the odds of black employment in the aforesaid occupations declined or remained essentially unchanged in both communities over the study period. Harlem and Bronzeville were surprisingly limited in their potential to offer opportunities for blacks to become professionals, entrepreneurs, and artists, entertainers and writers, perhaps because these communities were saturated by the tremendous influx from the South. Accordingly, it is recommended that the Black Metropolis perspective be modified, to provide a more accurate view of the consequences of the Great Migration.

Responding to the second ghetto: Chicago's Joe Smith and Sin Corner

World War Two and its aftermath transformed Chicago's African American community. The Great Migration entered a second and more intense phase as black migrants flooded into Northern cities. This massive relocation of Southern blacks resulted in the expansion and reformulation of Chicago's ghettoes on both the West and South Sides of the city. The question of a response to this Second Ghetto from African Americans themselves presents itself. White politicians, cultural elites and businessmen still controlled the city and could impose their will on its neighborhoods simply redrawing ghetto boundaries to reflect the new realities of the postwar era. The strange case of Joe Smith and Sin Corner sheds some light on black agency in the 1950s. The African American middle class had resources it commanded to try and protect itself from racial injustice. These resources, however, were based on class privileges not enjoyed by most in the African American community.

Charitable collaborations in Bronzeville, 1928-1944: the "Chicago Defender" and the Regal Theater

In the twentieth century, race-based residential and commercial segregation that supported racial oppression and inequality became an elemental characteristic of urban black communities. Conflict-ridden, black-white relationships were common. However, the Chicago Defender Charities, Inc., the entity that sponsors the largest African American parade in the country and that emerged in 1947, embodied a tradition of charitable giving, self-help, and community service initiated in 1921 by Chicago Defender newspaper founder and editor, Robert S. Abbott. The foundation of this charitable tradition matured as a result of an early and sustained collaboration between Chicago’s white-owned Regal Theater and the black-owned Chicago Defender newspaper. Thus, in segregated African American communities, black and white commercial institutions, under certain conditions, were able to find important points of collaboration to uplift the African American communities of which they were a part.

"But burn - no": the rest of the crowd in three civil disorders in 1960s Chicago

Examining the internal dynamics of three civil disturbances on the West Side of Chicago during the late 1960s, this article describes the presence of numerous people who were not participating in the upheaval. It pays particular attention to “counterrioters,” civilian residents of the neighborhoods and members of local organizations, who tried to persuade those engaging in violence to stop. Local dissent from the tactic of violence suggests that historians should describe these events using the neutral language of social science rather than the politically loaded labels of “riot” or “rebellion.” The article argues that American historians of urban disorders should use the methods of European scholars of the crowd to study the actions of participants in order to ascertain their political content, rather than relying on an examination of their motives.

Gentrification and community fabric in Chicago

Critical authors of gentrification point to its deleterious impacts on displaced residents. Research on the nature or actual forms of impacts has not advanced much, however. This paper attempts to specify impacts on low-income racial/ethnic groups (Latinos in particular) in five Chicago neighbourhoods, with a particular focus on neighbourhood-based fabrics of support and advancement. Limited in their mobility and exchange value resources, lower-income groups depend on such fabrics far more than do the higher income. In fact, they have fewer choices and are most vulnerable to place-based shifts. The case seems especially challenging for minorities who, like European immigrants before them, depend largely on place-based platforms/social fabrics but, unlike them, confront the added factors of race and urban restructuring.

Community violence and urban childhood asthma: a multilevel analysis

We examined the association between community violence exposure and childhood asthma risk in a multilevel, multimethod, longitudinal study controlling for individual- and neighbourhood-level confounders and pathway variables. Analyses included 2,071 children aged 0-9 yrs at enrolment from the Project on Human Development in Chicago Neighborhoods. Multilevel logistic regression models estimated the likelihood of asthma, controlling for individual-level (child's age, sex, race/ethnicity, maternal asthma, socioeconomic status and family violence in the home) and neighbourhood-level confounders (concentrated disadvantage, collective efficacy and social disorder), and pathway variables (maternal smoking, breastfeeding). In adjusted analyses, medium (OR 1.60, 95% CI 1.17-2.19) and high levels (OR 1.56, 95% CI 1.12-2.18) of community violence were associated with increased asthma risk, relative to low levels. The increased asthma risk remained for African Americans when models included community violence and all other individual-level covariates, but attenuated to borderline nonsignificance when further adjusting for collective efficacy. Community violence is associated with asthma risk when controlling for individual- and neighborhood-level confounders. Neither community violence, nor the other individual-level factors, fully accounted for the excess asthma burden among African Americans. These data suggest that public health interventions outside the biomedical model may be needed to reduce asthma in disadvantaged populations.

Exploding cities: housing the masses in Paris, Chicago, and Mexico City, 1850-2000

In The Mystery of Capitalism , the darling of neoliberalism, Hernando de Soto posits that secure property titles explain “why capitalism triumphs in the West and fails everywhere else.” While social scientists have taken him to task for an oversimplification of the causes and remedies of poverty, historians have contributed little to this important policy debate. Applying comparative methods across time and space, such a retrospective analysis exposes serious flaws in de Soto’s thesis. Case studies of Paris, Chicago, and Mexico City covering successive, fifty-year periods support his contention that property law was the single most important factor in determining the fate of rural migrants trying to find a place to live in these exploding cities. But in each case, residential property played a far more complex role in creating the social and physical geography of the city than its simple exchange value. This article illuminates some of these alternative economic uses and embedded cultural meanings of identities of place. It also shows how urban growth machines create capital value in property for some by creating environmental injustice of substandard conditions of everyday life for others.

The Berlin tradition in Chicago: Franz Alexander and the Chicago Institute for Psychoanalysis

Freud considered Franz Alexander, the first graduate of the Berlin Psychoanalytic Institute and an assistant in the Berlin Polyclinic, to be "one of our strongest hopes for the future." Alexander went on to become the first director of the Chicago Institute for Psychoanalysis in 1932 and modeled some of the Chicago Institute's mission on his Berlin experiences. He was also a researcher in psychosomatic medicine, a prolific writer about psychoanalysis and prominent in psychoanalytic organizations. As he proposed modifications in psychoanalytic technique, he became a controversial figure, especially in the elaboration of his ideas about brief therapy and the corrective emotional experience. This paper puts Alexander's achievements in historical context, draws connections between the Berlin and Chicago Institutes and suggests that, despite his quarrels with traditional psychoanalysis, Alexander's legacy may be in his attitude towards psychoanalysis, characterized by a commitment to scientific study, a willingness to experiment, and a conviction about the role of psychoanalysis within the larger culture.

Of voices few and far between: white Appalachian women migrants in postwar Chicago, 1950-70

Oral history has been an indispensible tool in documenting the lives of those previously invisible from broad historical movements of people. "The Oral History Review" has been among the major vehicles for the inclusion of women's voices. The migration of white southerners is well documented in historical literature. However, most historical accounts of the postwar urban migration of millions of whites from the South have focused on the male experience. While women are conspicuously absent from discussions of the southern Diaspora, Appalachian women as subjects of research are even more obscure. In this article, the voices of Appalachian women are at the center of the migration experience to Uptown, Chicago. In addition to secondary sources, the content of personal interviews reveals how Appalachian women responded to the demands of migration and urban life in postwar Chicago.

Dosage effects on school readiness: evidence from a randomized classroom-based intervention

Variations in the dosage of social interventions and the effects of dosage on program outcomes remain understudied. This study examines the dosage effects of the Chicago School Readiness Project, a randomized, multifaceted classroom-based intervention conducted in Head Start settings. Using a principal score matching method to address the issue of selection bias, the study finds that high-dosage levels of teacher training and mental health consultant class visits have larger effects on children's school readiness than the effects estimated through intention-to-treat (ITT) analyses. Low-dosage levels of treatment are found to have effects that are smaller than those estimated in ITT analyses or to have no statistically significant program effects. Moreover, individual mental health consultation services provided to high-risk children are found to have statistically significant effects on their school readiness. The study discusses the implications of these findings for research and policy.

Living in a mixed-income development: resident perceptions of the benefits and disadvantages of two developments in Chicago

Policy-makers in several countries are turning to income- and tenure-mixing strategies in an attempt to reverse decades of social and economic isolation in impoverished urban areas. In the US city of Chicago, all high-rise public housing developments across the city are being demolished, public housing residents are being dispersed throughout the metropolitan area and 10 new mixed-income developments are being created on the footprint of former public housing complexes. Findings are presented from in-depth interviews with residents across income levels and tenures at two mixed-income developments and the paper explores residents' perceptions of the physical, psychological and social impacts of the mixed-income setting on their lives.

Addressing fear of crime in public space: gender differences in reaction to safety measures in train transit

Research has identified several factors that affect fear of crime in public space. However, the extent to which gender moderates the effectiveness of fear-reducing measures has received little attention. Using data from the Chicago Transit Authority Customer Satisfaction Survey of 2003, this study aims to understand whether train transit security practices and service attributes affect men and women differently. Findings indicate that, while the presence of video cameras has a lower effect on women's feelings of safety compared with men, frequent and on-time service matters more to male passengers. Additionally, experience with safety-related problems affects women significantly more than men. Conclusions discuss the implications of the study for theory and gender-specific policies to improve perceptions of transit safety.

Diseased, maimed, mutilated: categorizations of disability and an ugly law in late nineteenth-century Chicago

The article places Chicago's "ugly" law—an 1881 municipal ordinance that fined "any person who is diseased, maimed, mutilated or in any way deformed so as to be an unsightly or disgusting object" for appearing in public—within the context of late nineteenth-century imaginings of disability. Drawing on the framework of disability studies, this paper demonstrates that nineteenth-century understandings of disability had little to do with the impairments of individuals but instead were tied to the status of the person with the disability. Examining the role of disabled people as workers, as bodies and as charity recipients reveals the hierarchies of disability in late nineteenth-century Chicago and demonstrates who the ugly law intended to restrict and, just as importantly, who it did not. While the law appears to be a blanket indictment of all physically disabled people, multiple sources indicate that the public expected disabled veterans, workers, and freak show performers to occupy the public realm; they therefore cannot be the intended objects of the ordinance. Instead, Chicago's ugly law was one of many pieces of legislation enacted in the wake of the panic of 1873 that attempted to eradicate street begging in general by specifically targeting beggars with disabilities.

The effect of genetic variation in angiotensinogen on serum levels and blood pressure: a comparison of Nigerians and US blacks

Molecular variants of angiotensinogen (AGT) have been associated with AGT level and hypertension (HT). However, results from reported studies vary considerably between- and within-studied populations. We performed association analysis of AGT gene variants with AGT levels and HT in samples of African descent families, including 595 Nigerians and 901 African Americans. We evaluated association using haplotypes defined by a set of single-nucleotide polymorphisms selected from a previous detailed study of the gene haplotype structure. In the sample of Nigerian families, AGT haplotype H1 was associated with high plasma level. Results were not significant for blood pressure (BP) or HT. For the African-American population, we found significant association between low plasma AGT level and haplotype H7. Furthermore, we found weak associations of H1 with hypertensive status and H7 with low systolic BP. However, no significant association between H1 and high plasma level was found. We conclude that the two distantly related haplotypes, H1 and H7, are associated, but have opposite effects on the phenotypes in two populations of African origin.

Ethnic differences in the presentation of chronic hepatitis C

Hispanics comprise 13% of the population in the United States and are the fastest growing minority group. Features of hepatitis C in Hispanics have not been well characterized. The aims of this study were to compare features of hepatitis C among Hispanics, Whites, and African-Americans and to characterize hepatitis C infection in Hispanics. A retrospective analysis was performed on 1225 consecutive patients with hepatitis C seen at the University of Illinois at Chicago including 227 Hispanics, 508 Whites, and 490 African-Americans. Data collection consisted of demographic variables, risk factors for hepatitis C, history of alcohol use, laboratory parameters and liver histology. Pair-wise comparisons showed that Hispanics had higher aminotransferase levels than Whites and African-Americans. Hispanics had higher portal inflammation scores on liver biopsy than African-Americans (P = 0.002) and Whites (P = 0.043). Hispanics had a higher frequency of cirrhosis than African-Americans (P < 0.001) and a trend towards more cirrhosis than Whites (P = 0.165). There was a trend towards a higher prevalence of cirrhosis in Hispanic women (56%) than in Hispanic men (45%) [P = 0.14]. A cross-sectional analysis of patients at our liver center showed that Hispanics with hepatitis C had higher aminotransferase levels, more portal inflammation than Whites and African-Americans, and a higher prevalence of cirrhosis than African-Americans.

The co-occurrence of depression and alcohol dependence symptoms in a community sample of lesbians

Numerous studies have found an association between depression and alcohol use disorders in women. Little is known, however, about the relationship between depression and alcohol use among lesbians. We examined the prevalence of depression and alcohol dependence symptoms as well as the co-occurrence of these two health problems in a large community-based sample of women who self-identified as lesbian. Past year alcohol dependence symptoms were significantly associated with both past year and lifetime depression. Lifetime depression was higher among White and Latina lesbians than among African American lesbians. Younger women and those not currently in a committed relationship more commonly reported past year depression. Younger age was the strongest predictor of the co-occurrence of depression and alcohol dependence symptoms.

An Imported Case ofBlastomyces DermatitidisInfection in Mexico

Blastomycosis is an acute or chronic primary infection of the respiratory system, endemic in North America (United States of America and Canada), Africa and Asia. We report a case in Mexico, in a three years old child who had been born in California and lived in Chicago, U.S.A. The patient presented pulmonary symptoms prior to development of a skin ulcer. Blastomyces dermatitidis was identified by mycological and molecular procedures. The patient was successfully treated with amphotericin B, oral ketoconazole and itraconazole.

Urinary sodium and potassium profile of blacks and whites in relation to education in two different geographic urban areas. TOMHS Research Group. Treatment of Mild Hypertension Study

The high Na/low K environment of modern society is related to the genesis of hypertension and stroke. There is prior evidence of racial, geographical, and social class differences in Na and K intake and blood pressure. Baseline data from the Treatment of Mild Hypertension Study (TOMHS) was used to assess urinary Na and K excretion profiles by race, clinic geographic area, and education. Participants were adult black and white hypertensive patients from the Birmingham, Alabama, and Chicago, Illinois, area. Level of education was categorized as: less than college graduate and college graduate or more. Two overnight urine samples were collected and analyzed for Na and K at entry from 154 blacks and 281 whites. The urinary Na:K ratio was significantly higher in both blacks (5.1 v 3.8, P < .001) and whites (4.1 v 3.4, P < .005) in Birmingham compared with Chicago. This was primarily due to the lower excretion of urinary K in blacks (12.8 v 16.9 mmol/8 h, P < .01) and whites (14.0 v 16.5 mmol/8 h, P < .01). The highest urinary Na:K ratio was observed in blacks in Birmingham with lower education level; urinary Na excretion was high in blacks with a lower education level in both cities. No such differences were seen in whites. Although TOMHS was not population-based, these findings suggest the possibility that potassium intake among persons with stage 1 hypertension is related to geographic area in both blacks and whites, and sodium intake is inversely related to education level in blacks.

Privatizing higher education in Bangladesh: an American professor's involvement during the transition

The topic of teaching abroad is a timely one in light of the increasing involvement of students, educators and industry professionals in international exchange programs. The author hopes that other educators, in particular, may benefit from the very personal insights brought by this paper into the early stages of experience of a professor who took on the challenge of a teaching assignment in Bangladesh during its significant period of transition from public to private higher education.

Pediatric orthopaedic mission to Colombia: taking care of the children

This team of nurses and doctors donated a week's vacation, the cost of their airline tickets, and many hours of preparation to help more than 200 children who could not afford orthopaedic care in Colombia. During the outreach mission, Colombian health care staff worked closely with the American team to exchange knowledge of orthopaedic skills and surgical techniques. The impact that members of this team have on the care of these needy children makes the countless hours of preparation for the mission and the work in Colombia very worthwhile. The sharing of time, knowledge, and expertise has not only influenced the orthopaedic health care for children in this small area of the world, but is also a rewarding educational experience for all involved.

Health systems and policy in the USA and in the United Kingdom: an overseas programme

An international programme, especially in a developed country, dramatically increases a student's understanding of health care systems. Students from a university programme in the USA learn about the development and structure of the British National Health Service through lectures and discussion in the US and England, and through 2 weeks of experience in England which include working with community health nurses in a district health authority. Related special experiences are planned which may include interviews with nurses involved in policy development, education, administration and specialty areas. Each student identifies an interest to pursue independently from the perspective of community care. As the student participates in the programme, alternative ways to give familiar care challenge formerly held beliefs. Health care emerges as a dynamic system, one that responds to issues, effects policy, and influences the role of health care providers.

Weight and dieting concerns in adolescents, fashion or symptom?

Attitudes toward body weight and dieting and the relations of these attitudes to psychological adjustment were investigated in 497 randomly selected adolescents who were in their senior year in one urban and two suburban midwestern high schools. Most students reported feeling physically healthy. Two thirds of female adolescents were preoccupied with weight and dieting compared with only a small number (approximately 15%) of male adolescents. Black female adolescents were found to be less weight- and diet-conscious than white female adolescents. Increased weight and dieting concerns were associated with greater body and self-image dissatisfaction, with a depressed mood, and greater overall symptomatic distress in both male and female adolescents. The fairly common fear of being overweight and thoughts about dieting experienced by contemporary female adolescents, in part, seem to reflect the greater aesthetic value that contemporary society places on thinness for women. Overall, the findings suggest that preoccupation with weight and/or dieting concerns in either male or female adolescents are likely to indicate psychological problems.