Ghanaian Participants Research Articles

Preliminary Validation of Measures of Experienced, Perceived, and Internalized Stigma Among Adults Who Are d/Deaf or Hard of Hearing in the United States and Ghana.

In this article, we examine the psychometric performance of 3 scales measuring experienced, perceived, and internalized d/Deaf or hard of hearing (d/DHH) stigma among adult (18 and older) populations of individuals who are d/DHH, including those who have been d/DHH since before they developed language (lifelong) and those who became d/DHH after they developed language (acquired) in the United States and Ghana. The preliminary validation study took place in the Greater Accra and Eastern regions of Ghana and across the United States. In the United States, all data were collected online via self-administered surveys in English. In Ghana, trained interviewers who are d/DHH and fluent in Ghanaian Sign Language conducted interviews with participants who are lifelong d/DHH using a video survey. Ghanaian participants with acquired d/DHH status were surveyed by trained hearing interviewers. We calculated polychoric correlation matrices between the measures to remove redundant and unrelated items and used exploratory factor analysis to create the final scales. We also tested the association between the factor scores and a simple summing method for calculating the scale. The study sample included people who have been d/DHH since before they developed language (Ghana: n = 171, United States n = 100) and people who became d/DHH after they developed language (Ghana: n = 174, United States: n = 219). The final experienced, perceived, and internalized scales included six, seven, and five items, respectively. All three scales performed well as unidimensional measures across all four samples. Across the four samples, the experienced, perceived, and internalized stigma scales yielded ordinal αs ranging from 0.725 to 0.947, 0.856 to 0.935, and 0.856 to 0.935, respectively. It would be acceptable to operationalize all stigma scales as sum-of-item scores. The scales performed well and appear to provide a valid means of measuring different types of stigma among diverse groups of people who are d/DHH. Future work should refine and validate these scales in additional contexts.

Documenting the Reuse of Modern Buildings

This paper looks into the 2022 writing workshop sponsored by the British Academy with Nigerian and Ghanaian participants. It was focussed on the present status of modern buildings, which are quickly replaced by newer ones, eroding the prevailing vernacular of the landscape of African university campuses. A new approach was adopted to documenting the stories of these buildings, which had existed prior to the time, by Africans, not foreigners. Postgraduate students were co-opted to participate in a five-day writing workshop across three universities in Nigeria. The teams were headed by Early Career Researchers (ECRs) led by a Nigerian Co-Investigator (Co-I), similar to a workshop held in Ghana just a week before. The Principal Investigator (PI) was based in the United Kingdom and assisted by two co-investigators, one from Nigeria and one from Ghana. For the Nigerian contingent, the loci group comprised four participants per group (12 participants in each of the three universities in Lagos, Jos, and Enugu campus). At each university, the participants selected modern buildings on the campus to write about, guided by the ECRs. Scheduled meetings were arranged for expert presentations, site visits, and group meet-ups to discuss their working papers. Recommendations were made for architectural histories and criticisms to be introduced into the students’ curriculum, from which publications and documentation of these buildings can be carried out concurrently. Grants and awards can also be targeted at universities both locally and globally to further improve this approach. Emphasis on the cultural point of view was encouraged in the writing exercise to preserve the heritage aspects of the buildings.

Conceptualised psycho-medical footprint for health status outcomes and the potential impacts for early detection and prevention of chronic diseases in the context of 3P medicine

BackgroundThe Suboptimal Health Status Questionnaire-25 (SHSQ-25) is a distinctive medical psychometric diagnostic tool designed for the early detection of chronic diseases. However, the synaptic connections between the 25 symptomatic items and their relevance in supporting the monitoring of suboptimal health outcomes, which are precursors for chronic diseases, have not been thoroughly evaluated within the framework of predictive, preventive, and personalised medicine (PPPM/3PM). This baseline study explores the internal structure of the SHSQ-25 and demonstrates its discriminatory power to predict optimal and suboptimal health status (SHS) and develop photogenic representations of their distinct relationship patterns.MethodsThe cross-sectional study involved healthy Ghanaian participants (n = 217; aged 30–80 years; ~ 61% female), who responded to the SHSQ-25. The median SHS score was used to categorise the population into optimal and SHS. Graphical LASSO model and multi-dimensional scaling configuration methods were employed to describe the network structures for the two populations.ResultsWe observed differences in the structural, node placement and node distance of the synaptic networks for the optimal and suboptimal populations. A statistically significant variance in connectivity levels was noted between the optimal (58 non-zero edges) and suboptimal (43 non-zero edges) networks (p = 0.024). Fatigue emerged as a prominently central subclinical condition within the suboptimal population, whilst the cardiovascular system domain had the greatest relevance for the optimal population. The contrast in connectivity levels and the divergent prominence of specific subclinical conditions across domain networks shed light on potential health distinctions.ConclusionsWe have demonstrated the feasibility of creating dynamic visualizers of the evolutionary trends in the relationships between the domains of SHSQ-25 relative to health status outcomes. This will provide in-depth comprehension of the conceptual model to inform personalised strategies to circumvent SHS. Additionally, the findings have implications for both health care and disease prevention because at-risk individuals can be predicted and prioritised for monitoring, and targeted intervention can begin before their symptoms reach an irreversible stage.

Hypertension incidence among Ghanaian migrants and non-migrants: the RODAM-Pros cohort

Abstract Background Sub-Saharan African (SSA) migrants are disproportionately affected by hypertension, compared to the European-host population. Underlying reasons for the increased hypertension prevalence are still unclear, and longitudinal data are lacking. The aim of this study was to describe hypertension prevalence and incidence rates among Ghanaian migrants residing in the Netherlands, compared to non-migrants residing in Ghana, and the European-Dutch host population. Methods We analysed data of the multicentre Research on Obesity and Diabetes among African Migrants prospective (RODAM-Pros) study collected at baseline (2011-2015) and follow-up (2019-2021). Hypertension was defined as a systolic blood pressure ≥140mmHg and/or diastolic ≥90mmhg and/or the use of antihypertensive medication. Results In the follow-up data collection, 2165 Ghanaian participants (n = 638 from rural Ghana, n = 608 from urban Ghana, and n = 919 Ghanaian migrants in Amsterdam) and 2098 European-Dutch participants were included. Preliminary results show age-standardised prevalence rates of hypertension at follow-up of 36.9% in rural Ghana, 54.3% in urban Ghana, 59.5% in Amsterdam-Ghanaians, and 33.2% in European-Dutch males. Age-standardised 6-years incidence rates of hypertension were 29.0% in rural Ghana, 27.6% in urban Ghana, 34.4% in Amsterdam-Ghanaians, and 7.3% in European-Dutch females. Conclusions These first results show high prevalence and incidence rates of hypertension with differing rates between Ghanaians living in Ghana and in Europe. Future analysis will aim to identify determinants underlying these rates. The findings from the RODAM-Pros study will be valuable for designing effective prevention and clinical management strategies to prevent the burden of hypertension and related complications, both in SSA and SSA migrants in Europe. Key messages • Hypertension prevalence and incidence are highest in Ghanaian migrants, and incidence rates are substantial in non-migrants in Ghana. • Determinants of these rates need to be elucidated to design effective preventive strategies.

Fatty liver biomarkers and insulin resistance indices in the prediction of non-alcoholic fatty liver disease in Ghanaian patients.

Scant West African data on non-alcoholic fatty liver disease (NAFLD) means there is little representation of this population in the modelling used to derive biomarkers and predictive indices for risk stratification of patients for the presence of hepatic steatosis. This study evaluates the performance of the fatty liver index (FLI), hepatic steatosis index (HSI) and triglyceride-glucose (TyG) index and its derivatives in predicting ultrasound detected NAFLD in a locally resident population of Ghanaian participants. A post hoc analysis of data from a cross sectional assessment of NAFLD and cardiovascular risk was performed. Data from 210 participants without significant alcohol intake, or secondary causes of fatty liver and not on steatogenic drugs was evaluated. A structured questionnaire had been used to collect demographic data, medical and drug history. Anthropometry, blood sampling for liver chemistry and fasting lipids were performed. Hepatic steatosis was detected by ultrasonography. A retrospective analysis involving multivariate binary logistic regression assessed FLI, HIS, TyG (and its derivatives) as predictors of NAFLD with p < .05 considered statistically significant. Sensitivity, specificity, predictive values, likelihood ratios were calculated and accuracy of the proxies evaluated from area under the receiver operating characteristics curve (AUROC). All the biomarkers and indices were significantly associated with NAFLD (p ≤ .001). All the lipid and fatty liver indices assessed performed acceptably as predictors of NAFLD. FLI (AUC = 0.8, 95% CI [0.74-0.87]), TyG-WC (AUC = 0.81, 95% CI [0.75-0.88]) and TyG-WHtR (AUC = 0.81, 95% CI [0.74-0.88]) performed best at predicting NAFLD. Whilst in all cases the markers had good specificity (>90%) they lacked sufficient sensitivity with FLI having the highest sensitivity of 36.7%. Their overall accuracy was greater than 70% in each case. The overall accuracy of HSI, FLI, TyG index and its derivatives (TyG WHtR, TyG BMI, TyG WC) was acceptable for predicting NAFLD in this population. Given their performance in this study and in light of their low cost, accessibility, easy interpretation and non-invasive nature; they are suitable tools for screening in the Ghanaian population.

Stage-Dependent Increase of Systemic Immune Activation and CCR5+CD4+ T Cells in Filarial Driven Lymphedema in Ghana and Tanzania.

Chronic lymphedema caused by infection of Wuchereria bancrofti is a disfiguring disease that leads to physical disability, stigmatization, and reduced quality of life. The edematous changes occur mainly on the lower extremities and can progress over time due to secondary bacterial infections. In this study, we characterized participants with filarial lymphedema from Ghana and Tanzania as having low (stage 1-2), intermediate (stage 3-4), or advanced (stage 5-7) lymphedema to determine CD4+ T cell activation patterns and markers associated with immune cell exhaustion. A flow cytometry-based analysis of peripheral whole blood revealed different T cell phenotypes within participants with different stages of filarial lymphedema. In detail, increased frequencies of CD4+HLA-DR+CD38+ T cells were associated with higher stages of filarial lymphedema in patients from Ghana and Tanzania. In addition, significantly increased frequencies of CCR5+CD4+ T cells were seen in Ghanaian participants with advanced LE stages, which was not observed in the Tanzanian cohort. The frequencies of CD8+PD-1+ T cells were augmented in individuals with higher stage lymphedema in both countries. These findings show distinct activation and exhaustion patterns in lymphedema patients but reveal that immunological findings differ between West and East African countries.

A PROOF-OF-PRINCIPLE EPIGENOME-WIDE ASSOCIATION STUDY OF PLASMA RENIN AND ALDOSTERONE CONCENTRATION IN A GHANAIAN POPULATION: THE RODAM STUDY

Objective: The epigenetic regulation of the renin-angiotensin-aldosterone system (RAAS) potentially plays a role in the pathophysiology underlying the high burden of hypertension in sub-Saharan Africans (SSA). In this first epigenome-wide association study (EWAS) of plasma renin and aldosterone concentrations, we explored the association between DNA methylation and concentrations of renin and aldosterone. Design and method: Epigenome-wide DNA methylation was measured using the Illumina 450k array on whole blood samples of 68 Ghanaian participants of the Research on Obesity and Diabetes among African Migrants Study (RODAM). Differentially methylated positions (DMPs) were assessed for plasma renin and aldosterone concentration using linear regression models adjusted for age, sex, body mass index, diabetes mellitus, hypertension, and technical covariates. Additionally, we extracted methylation loci previously associated with hypertension, kidney function, or that were annotated to RAAS-related genes, and associated these with renin and aldosterone concentration. Results: We identified one epigenome-wide significant DMP associated with renin, and ten DMPs associated with aldosterone. Top DMPs were annotated to the PTPRN2, SKIL, and KCNT1 genes, which have been reported in relation to cardiometabolic risk factors, atherosclerosis, and sodium-potassium handling. Moreover, EWAS loci previously associated with hypertension, kidney function, or RAAS-related genes, were also associated with renin and aldosterone concentration. Conclusions: In this first EWAS on RAAS hormones, we identified DMPs associated with renin and aldosterone in a SSA population. These findings are a first step in understanding the role of DNA methylation in regulation of the RAAS in general, and in a SSA population specifically. The results of this proof-of-principle study will inform new analyses including a larger sample size and a new methylation array (Illumina Infinium MethylationEPIC), which will we use to replicate these initial findings. This will help to further establish the role of DNA methylation and the RAAS system in the hypertension burden in SSA populations.

HYPERTENSION SUSCEPTIBILITY IN AFRICAN MIGRANTS: SOLVING THE PUZZLE THROUGH TRANSCONTINENTAL PROSPECTIVE COHORT STUDY DESIGN. THE RODAM-PROS STUDY

Objective: Sub-Saharan African (SSA) migrants are disproportionately affected by hypertension, compared to the European-host population. Underlying reasons for the increased hypertension prevalence are still unclear, but suggest that rapid changes in lifestyle and environment after migration, in combination with genetic factors, might be responsible. The aim of the Research on Obesity and Diabetes among African Migrant prospective (RODAM-Pros) cohort study is to identify key changes in environmental exposures and epigenetic modifications driving the high prevalence of hypertension among African migrants. Design and method: The multicentre RODAM-Pros study included non-migrant Ghanaians residing in rural and urban Ghana, Ghanaians who migrated and are residing in Amsterdam (the Netherlands), and European-Dutch population who participated in baseline (2011-2015) and follow-up data collection (2019-2021). Data were collected on anthropometrics, blood pressure, biological samples, sociodemographic, health, lifestyle and environmental factors. Moreover, ∼1300 participants were included for DNA methylation analysis (Infinium® 850K DNA Methylation BeadChip) to assess methylation loci associated with incident hypertension in a nested case-control study. Results: In the follow-up data collection, 2165 Ghanaian participants (n = 638 from rural Ghana, n = 608 from urban Ghana, and n = 919 Ghanaian migrants in Amsterdam) and 2098 European-Dutch participants were included. The participation rates were 90.8 % in rural Ghana, 95.3% in urban Ghana, 52.7% among Amsterdam-Ghanaian and 67.2% among European-Dutch. Preliminary results show unstandardised prevalence rates of hypertension at follow-up of 43.3% in rural Ghana, 48.7% in urban Ghana, 60.1% in Amsterdam-Ghanaians, and 25.8% in European-Dutch. Unstandardised 5-year hypertension incidence rates were 18.5% in rural Ghana, 17.7% in urban Ghana, 14.1% in Amsterdam-Ghanaians, and 8.5% in European-Dutch. Conclusions: The preliminary findings show significant differences in hypertension prevalence and incidence rates among Ghanaians living in Ghana and in Europe. Future analysis are aimed to identify epigenetic and environmental determinants responsible for the increased prevalence of hypertension in SSA migrants. The findings from the RODAM-Pros study will be valuable for designing effective prevention and clinical management strategies to prevent the burden of hypertension and related complications, both in SSA and SSA migrants in Europe.

Epigenome-wide association study of plasma lipids in West Africans: the RODAM study.

DNA-methylation has been associated with plasma lipid concentration in populations of diverse ethnic backgrounds, but epigenome-wide association studies (EWAS) in West-Africans are lacking. The aim of this study was to identify DNA-methylation loci associated with plasma lipids in Ghanaians. We conducted an EWAS using Illumina 450k DNA-methylation array profiles of extracted DNA from 663 Ghanaian participants. Differentially methylated positions (DMPs) were examined for association with plasma total cholesterol (TC), LDL-cholesterol, HDL-cholesterol, and triglycerides concentrations using linear regression models adjusted for age, sex, body mass index, diabetes mellitus, and technical covariates. Findings were replicated in independent cohorts of different ethnicities. We identified one significantly associated DMP with triglycerides (cg19693031 annotated to TXNIP, regression coefficient beta-0.26, false discovery rate adjusted p-value 0.001), which replicated in-silico in South African Batswana, African American, and European populations. From the top five DMPs with the lowest nominal p-values, two additional DMPs for triglycerides (CPT1A, ABCG1), two DMPs for LDL-cholesterol (EPSTI1, cg13781819), and one for TC (TXNIP) replicated. With the exception of EPSTI1, these loci are involved in lipid transport/metabolism or are known GWAS-associated loci. The top 5 DMPs per lipid trait explained 9.5% in the variance of TC, 8.3% in LDL-cholesterol, 6.1% in HDL-cholesterol, and 11.0% in triglycerides. The top DMPs identified in this study are in loci that play a role in lipid metabolism across populations, including West-Africans. Future studies including larger sample size, longitudinal study design and translational research is needed to increase our understanding on the epigenetic regulation of lipid metabolism among West-African populations. European Commission under the Framework Programme (grant number: 278901).

‘Ghanaian first’: Nationality, Race and the Slippery Side of Belonging for Mixed-Race Ghanaians

This article explores the multifaceted ways in which race impacts on processes of identification with the Ghanaian nation for mixed-race Ghanaians. Using a constructionist approach to identity, which highlights the agency of actors, the article underscores the shifting and racialising nature of national identity in transnational contexts. The article argues that whether they were born and raised in Ghana or they grew up in a Western country, mixed-race Ghanaians mainly identify as ‘Ghanaian first’. Their affiliation to Ghana stems both from growing up in the country and from being identified as black outsiders in countries of the white Western world. In both contexts, identifying as a Ghanaian is a source of pride and empowerment. However, their membership of the Ghanaian nation is often contested in their everyday life by the majority black-identified Ghanaian population, based on ethnoracial (non)authenticity premises. As such, mixed-race Ghanaian participants actively shape their Ghanaianness to justify their right to belong.

Ethnic differences in urinary monocyte chemoattractant protein-1 and heparanase-1 levels in individuals with type 2 diabetes: the HELIUS study

IntroductionWe aimed to investigate ethnic differences in two urinary inflammatory markers in participants with type 2 diabetes mellitus (T2DM).Research design and methodsWe included 55 Dutch, 127 South-Asian Surinamese, 92 African...

Virtual Ultrasound Training in a Multinational Teaching Program.

Before the COVID-19 pandemic, a 1-week in-person Clinical Ultrasound Course was taught in African nations as part of a U.S. Department of State-funded program that supports and trains African peacekeepers serving with the United Nations and African Union. In order to maintain active engagement with host nations despite the travel restrictions due to the COVID-19 pandemic, portions of the course were taught virtually in 2021 to providers in Ghana, Senegal, and Rwanda. An abbreviated course was delivered covering the Focused Assessment with Sonography in Trauma (FAST) trauma exam and vascular access. The goal of this study is to assess the effectiveness of the Clinical Ultrasound Course while taught in a virtual classroom. Thirty-six participants enrolled in the program. Participants completed a pre-course survey before the training. Training consisted of a pre-recorded lecture followed by hands-on ultrasound instruction. After the training, participants completed a post-course survey. Eight participants were excluded from the study because they did not complete both surveys. Survey questions assessed the participants' comfort with ultrasound mechanics and the FAST exam. Participant responses were measured utilizing a visual analog scale. Based on survey results, all participants gained a better understanding of the indications and limitations of the FAST exam from the virtual Clinical Ultrasound Course. All participants also felt more comfortable using ultrasound in clinical practice than they did before the course. Ghanaian and Senegalese participants showed greater improvement in all areas studied than Rwandan participants. This is likely due to the fact that the Rwandan hospital system had prior ultrasound training and a higher baseline understanding than their counterparts. The Rwandan hospital system had previously completed the in-person sessions of the Clinical Ultrasound Course and therefore had some institutional knowledge, while the Ghanaians and Senegalese took the course for the first time during this study. Virtual delivery of the Clinical Ultrasound Course was successful. Participants felt more comfortable in all aspects of ultrasound taught during the course and indicated that they were more likely to use ultrasound in clinical practice. This demonstrates that virtual ultrasound teaching is a viable option for international educational programs in the future.

When being obese is a good thing: voices of Ghanaian participants in a dance reality TV show

ABSTRACT The discussion on (mis)representations of black women's bodies often focuses on their hyper-corporeality and hyper-sexualisation, with little attention paid to the women thus represented and their views. Reality shows are roundly criticised for objectifying women, being unAfrican and offering little to Africans. This paper contests this perspective by drawing on interviews with 19 contestants in a dance reality show in Ghana. We demonstrate that African participants in this show have a much more affirming view of the show. For them, the show offers benefits including celebrity status, training and employment opportunities. These benefits were not lost on family and friends who supported the candidates in various ways. Given the economic conditions in Ghana, this reality show offers obese women an opportunity to turn their condition into an asset and to do so largely with the backing of friends and family.

Characteristics of Women Receiving Emergency Caesarean Section: A Cross-Sectional Analysis from Ghana and Dominican Republic.

Significant inequalities still exist between low- and high-income countries regarding access to optimum emergency obstetric care including life-saving emergency caesarean section. These relationships are considerably stronger between population-based caesarean section rates and socio-economic characteristics with poorest households experiencing significant unmet needs persistently. To explore the characteristics of women receiving emergency C-section using a new, validated definition in Ghana and the Dominican Republic. This was a cross-sectional study conducted in Ghana and the Dominican Republic. Multivariable logistic regression analysis was used to determine women's characteristics associated with emergency C-section. This analysis included 2166 women who had recently delivered via C-section comprising 653 and 1513 participants from Accra and Santo Domingo, DR, respectively. Multivariable analyses showed that women, both in Ghana and the DR, were more likely to have an emergency C-section if they did not have a previous C-Section (adjusted Odds Ratio (aOR): 2.45, 95% CI [1.57-3.81]; and aOR: 15.5, 95% CI [10.5-22.90], respectively) and if they were having their first childbirth, compared to women with previous childbirth (aOR: 1.77, 95%CI [1.13-2.79]; and aOR: 1.46, 95%CI [1.04-2.04], respectively). Also, preterm birth was associated with significantly decreased likelihood of emergency C-section compared with childbirth occurring at term in both Ghana and the DR (aOR: 0.31, 95%CI [0.20-0.48]; and aOR: 0.43, 95%CI [0.32-0.58], respectively). Among the Ghanaian participants, having an emergency C-section was positively associated with being referred and negatively associated with being older than 35years of age. Characteristics such as education, religion, marital status, and residence did not differ between women's emergency versus non-emergency C-section status. Emergency C-section was found to be significantly higher in women with no prior C-section or those having their first births but lower in those with preterm birth in both Ghana and the DR. Data from additional countries are needed to confirm the relationship between emergency C-section status and socio-economic and obstetric characteristics, given that the types of interventions required to assure equitable access to potentially life-saving C-section will be determined by how and when access to care is being denied or not available.

Construct validity of the Suboptimal Health Status Questionnaire-25 in a Ghanaian population

BackgroundThe Suboptimal Health Status Questionnaire-25 (SHS-Q-25) developed to measure Suboptimal Health Status has been used worldwide, but its construct validity has only been tested in the Chinese population. Applying Structural Equation Modelling, we investigate aspects of the construct validity of the SHS-Q-25 to determine the interactions between SHS subscales in a Ghanaian population.MethodsThe study involved healthy Ghanaian participants (n = 263; aged 20–80 years; 63% female), who responded to the SHSQ-25. In an exploratory factor and parallel analysis, the study extracted a new domain structure and compared to the established five-domain structure of SHSQ-25. A confirmatory factor analysis (CFA) was conducted and the fit of the model further discussed. Invariance analysis was carried out to establish the consistency of the instrument across multi-groups.ResultsThe extracted domains were reliable with Cronbach’s alpha of 0.846, 0.820 and 0.864 respectively, for fatigue, immune-cardiovascular and cognitive. The CFA revealed that the model fit indices were excellent left( {{text{RMSEA}} = 0.049~ < ~0.08,,{text{CFI}} = 0.903 > 0.9,,{text{GFI}} = 0.880 < 0.9,,{text{TLI}} = 0.907 > 0.9} right). The fit indices for the three-domain model were statistically superior to the five-domain model. There were, however, issues of insufficient discriminant validity as some average variance extracts were smaller than the corresponding maximum shared variance. The three-domain model was invariant for all constrained aspects of the structural model across age, which is an important risk factor for most chronic diseases.ConclusionThe validity tests suggest that the SHS-Q25 can measure SHS in a Ghanaian population. It can be recommended as a screening tool to early detect chronic diseases especially in developing countries where access to facilities is diminished.

Rural and urban migration to Europe in relation to cardiovascular disease risk: does it matter where you migrate from?

ObjectivesTo assess whether the environmental context (i.e. rural vs urban) in which individuals in low- and middle-income countries have resided most of their lives is associated with estimated cardiovascular disease (CVD) risk after migration to a high-income country. Study designData from the Research on Obesity and Diabetes among African Migrants (RODAM) study were used including 1699 Ghanaian participants aged 40–79 years who had migrated to Europe from Ghana (1549 of urban origin, 150 of rural origin). MethodsTen-year CVD risk was estimated using the Pooled Cohort Equation, with estimates ≥7.5% defining elevated CVD risk. Comparisons between urban and rural origin migrant groups were made using proportions and adjusted odds ratios (ORs). ResultsThe proportion of migrants with an elevated CVD-risk score was substantially higher among rural migrants than among urban migrants (45% vs. 37%, OR = 1.44, 95% confidence interval [CI]:1.03–2.02), which persisted after adjustment for education level, site of residence in Europe (London, Amsterdam or Berlin), length of stay in Europe, physical activity, energy intake and alcohol consumption (OR = 1.67, 95% CI: 1.05–2.67). ConclusionOur findings indicate that migrants who spent most of their lives in a rural setting before migration to Europe may have a higher CVD risk than those of urban origins. Further work is needed to confirm these findings in other migrant populations and to unravel the mechanisms driving the differential CVD risk between urban and rural migrants.

Depression and hypertension awareness, treatment, and control in a multiethnic population in the Netherlands: HELIUS study

Individuals belonging to ethnic minority groups are more susceptible to depression and comorbid hypertension than European host populations. Yet, data on how depression is related to hypertension in ethnic groups in Europe are lacking. Therefore, we studied the association between significant depressed mood (SDM) and hypertension prevalence, awareness, treatment, and control among ethnic groups. Data from the HELIUS study included 22,165 adults (aged 18–70) from six ethnic backgrounds in the Netherlands. Logistic regression analysis was used to explore the association between SDM and hypertension prevalence, awareness, treatment, and control with adjustment for age, sex, and for sensitivity analysis purposes also for anti-depressants. After adjustment for age and sex, Dutch with SDM had an increased odds of hypertension (OR 95% CI 1.67; 1.08–2.59). Among Turkish, SDM was associated with higher odds of hypertension awareness (2.09; 1.41–3.09), treatment (1.92; 1.27–2.90) and control (1.72; 1.04–2.83). Among Moroccans, SMD was associated with an increased odds of hypertension awareness (1.91; 1.14–3.21) but decreased odds of hypertension control (0.42; 0.20–0.89). Additional adjustment for anti-depressant medications did not change the results. There were no associations between SDM and hypertension, awareness, treatment and control in South-Asian Surinamese, African Surinamese and Ghanaian participants. The results underline significant differences in the association between SDM and hypertension awareness, treatment and control between ethnic groups. Our findings emphasize the necessity to further study ethnicity-related factors that may influence the association between SDM and hypertension to promote hypertension control especially, among Moroccans with SDM.

Socioeconomic Differences in Sympathovagal Balance: The Healthy Life in an Urban Setting Study.

Alterations in sympathovagal balance are associated with cardiovascular disease. If sympathovagal balance differs across socioeconomic groups, it may reflect a mechanism through which disparities in cardiovascular disease occur. We therefore assessed the association between education and occupation with measures of sympathovagal balance in a large multiethnic sample. We included cross-sectional data of 10,202 South Asian Surinamese, African Surinamese, Ghanaian, Turkish, Moroccan, and Dutch-origin participants from the Healthy Life in an Urban Setting study. Sympathovagal balance was measured by baroreflex sensitivity (BRS) and the standard deviation of the interbeat interval, calculated from changes in blood pressure and interbeat intervals, from 5-minute recordings. We calculated geometric means and estimated the relative index of inequality, using age- and ethnicity-adjusted linear regression, to quantify the association between education and occupation and sympathovagal balance. In addition, we assessed whether the association was consistent across ethnic groups. The geometric means of BRS ranged from 8.16 ms/mm Hg (confidence interval [CI] = 7.91-8.43 ms/mm Hg) in low-educated to 14.00 ms/mm Hg (CI = 13.53-14.48 ms/mm Hg) in highly educated women, and from 8.32 ms/mm Hg (CI, 7.97-8.69 ms/mm Hg) in low-educated to 12.25 ms/mm Hg (CI = 11.86-12.66 ms/mm Hg) in highly educated men. High education and occupation were statistically significantly associated with higher BRS and standard deviation of the interbeat interval. Compared with the participants of Dutch origin, a pattern of weaker associations was found in the Surinamese and Ghanaian ethnic groups, but not the Turkish and Moroccan groups. There is a clear socioeconomic gradient in measures of sympathovagal balance, indicating that sympathovagal balance may play a role in socioeconomic disparities in cardiovascular morbidity and mortality.

Dilemma Tales as African Knowledge Practice: An Example From Research on Obligations of Support.

This contribution to the Frontiers research topic collection on African Cultural Models considers dilemma tales: an African knowledge practice in which narrators present listeners with a difficult choice that usually has ethical or moral implications. We adapted the dilemma tale format to create research tasks. We then used these research tasks to investigate conceptions of care, support, and relationality among participants in Ghanaian, African American, and European American settings that vary in affordances for embedded interdependence vs. modern individualism. Results revealed hypothesized patterns, such that judgments about the inappropriateness of institutionalized eldercare (vs. home elder care) and prioritization of material support to parent (over spouse) were greater among Ghanaian participants than European American participants. Responses of African American participants were more ambiguous, resembling European American acceptance of institutionalized eldercare relative to Ghanaian participants, but resembling Ghanaian tendencies to prioritize support to parent (over spouse) relative to European American participants. Results illuminate that standard patterns of hegemonic psychological science (e.g., tendencies to prioritize obligations to spouse over mother) are the particular product of WEIRD cultural ecologies rather than context-general characteristics.

Lifestyle clusters related to type 2 diabetes and diabetes risk in a multi-ethnic population: The HELIUS study

Little is known about how health-related behaviours cluster across different populations and how lifestyle clusters are associated with type 2 diabetes (T2D) risk. We investigated lifestyle clusters and their association with T2D in a multi-ethnic population. 4396 Dutch, 2850 South-Asian Surinamese, 3814 African Surinamese, 2034 Ghanaian, 3328 Turkish, and 3661 Moroccan origin participants of the HELIUS study were included (2011–2015). K-medoids cluster analyses were used to identify lifestyle clusters. Logistic and cox regression analyses were performed to investigate the association of clusters with prevalent and incident T2D, respectively. Pooled analysis revealed three clusters: a ‘healthy’, ‘somewhat healthy’, and ‘unhealthy’ cluster. Most ethnic groups were unequally distributed: Dutch participants were mostly present in the ‘healthy’ cluster, Turkish and Moroccan participants in the ‘somewhat healthy’ cluster, while the Surinamese and Ghanaian participants were equally distributed across clusters. When stratified for ethnicity, analysis revealed three clusters per ethnic group. While the ‘healthy’ and ‘somewhat healthy’ clusters were similar to those of the pooled analysis, we observed considerable differences in the ethnic-specific ‘unhealthy’ clusters. Fruit consumption (3–4 days/week) was the only behaviour that was consistent across all ethnic-specific ‘unhealthy’ clusters. The pooled ‘unhealthy’ cluster was positively associated with prediabetes (OR: 1.34, 95%CI 1.21–1.48) and incident T2D (OR: 1.23, 95%CI 0.89–1.69), and negatively associated with prevalent T2D (OR: 0.80, 95%CI 0.69–0.93). Results were similar for most, but not all, ethnic-specific clusters. This illustrates that targeting multiple behaviours is relevant in prevention of T2D but that ethnic differences in lifestyle clusters should be taken into account.