Important Ethnic Differences Research Articles

International Migration and Cardiovascular Health: Unraveling the Disease Burden Among Migrants to North America and Europe.

Europe and North America are the 2largest recipients of international migrants from low-resource regions in the world. Here, large differences in cardiovascular disease (CVD) morbidity and death exist between migrants and the host populations. This review discusses the CVD burden and its most important contributors among the largest migrant groups in Europe and North America as well as the consequences of migration to high-income countries on CVD diagnosis and therapy. The available evidence indicates that migrants in Europe and North America generally have a higher CVD risk compared with the host populations. Cardiometabolic, behavioral, and psychosocial factors are important contributors to their increased CVD risk. However, despite these common denominators, there are important ethnic differences in the propensity to develop CVD that relate to pre- and postmigration factors, such as socioeconomic status, cultural factors, lifestyle, psychosocial stress, access to health care and health care usage. Some of these pre- and postmigration environmental factors may interact with genetic (epigenetics) and microbial factors, which further influence their CVD risk. The limited number of prospective cohorts and clinical trials in migrant populations remains an important culprit for better understanding pathophysiological mechanism driving health differences and for developing ethnic-specific CVD risk prediction and care. Only by improved understanding of the complex interaction among human biology, migration-related factors, and sociocultural determinants of health influencing CVD risk will we be able to mitigate these differences and truly make inclusive personalized treatment possible.

Emotion expressivity, suicidal ideation, and explanatory factors: Differences by Asian American subgroups compared with White emerging adults.

The relationship between emotion expressivity and psychological symptoms varies by race/ethnicity, and reduced expression of emotions has been implicated in risk for suicidal ideation. The present study examined differences in the relation between emotion expressivity and suicidal ideation through well-documented correlates of suicide risk (i.e., hopelessness, depressive symptoms) among Asian American subgroups compared with White emerging adults. A sample of 829 emerging adults, Ages 18 to 28 years, identifying as Asian American (27% East Asian, 18% South Asian, 11% Southeast Asian) or White (44%) completed measures of emotion expressivity, hopelessness, depressive symptoms, and suicidal ideation. Lower emotion expressivity was statistically associated with higher levels of suicidal ideation, via hopelessness and depressive symptoms, among White, East Asian, and South Asian American emerging adults, but not among Southeast Asian Americans, though this difference in mediation was not statistically significant. A focus on Asian Americans as a homogenous group occludes important ethnic differences in the relation between emotion expressivity and vulnerability to suicidal ideation. Ethnic differences in the function of emotion expressivity should be considered in suicide prevention and interventions among Asian American emerging adults. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Predictors of visceral and subcutaneous adipose tissue and muscle density: The ShapeUp! Kids study

Background and aimsBody fat distribution, i.e., visceral (VAT), subcutaneous adipose tissue (SAT) and intramuscular fat, is important for disease prevention, but sex and ethnic differences are not well understood. Our aim was to identify anthropometric, demographic, and lifestyle predictors for these outcomes. Methods and resultsThe cross-sectional ShapeUp!Kids study was conducted among five ethnic groups aged 5–18 years. All participants completed questionnaires, anthropometric measurements, and abdominal MRI scans. VAT and SAT areas at four lumbar levels and muscle density were assessed manually. General linear models were applied to estimate coefficients of determination (R2) and to compare the fit of VAT and SAT prediction models. After exclusions, the study population had 133 male and 170 female participants. Girls had higher BMI-z scores, waist circumference (WC), and SAT than boys but lower VAT/SAT and muscle density. SAT, VAT, and VAT/SAT but not muscle density differed significantly by ethnicity. R2 values were higher for SAT than VAT across groups and improved slightly after adding WC. For SAT, R2 increased from 0.85 to 0.88 (girls) and 0.62 to 0.71 (boys) when WC was added while VAT models improved from 0.62 to 0.65 (girls) and 0.57 to 0.62 (boys). VAT values were significantly lower among Blacks than Whites with little difference for the other groups. ConclusionThis analysis in a multiethnic population identified BMI-z scores and WC as the major predictors of MRI-derived SAT and VAT and highlights the important ethnic differences that need to be considered in diverse populations.

Ethnic differences in the association between age at diagnosis of diabetes and the risk of cardiovascular complications: a population-based cohort study

BackgroundWe examined ethnic differences in the association between age at diagnosis of diabetes and the risk of cardiovascular complications.MethodsWe conducted a population-based cohort study in Ontario, Canada among individuals with diabetes and matched individuals without diabetes (2002-18). We fit Cox proportional hazards models to determine the associations of age at diagnosis and ethnicity (Chinese, South Asian, general population) with cardiovascular complications. We tested for an interaction between age at diagnosis and ethnicity.ResultsThere were 453,433 individuals with diabetes (49.7% women) and 453,433 matches. There was a significant interaction between age at diagnosis and ethnicity (P < 0.0001). Young-onset diabetes (age at diagnosis < 40) was associated with higher cardiovascular risk [hazard ratios: Chinese 4.25 (3.05–5.91), South Asian: 3.82 (3.19–4.57), General: 3.46 (3.26–3.66)] than usual-onset diabetes [age at diagnosis ≥ 40 years; Chinese: 2.22 (2.04–2.66), South Asian: 2.43 (2.22–2.66), General: 1.83 (1.81–1.86)] versus ethnicity-matched individuals. Among those with young-onset diabetes, Chinese ethnicity was associated with lower overall cardiovascular [0.44 (0.32–0.61)] but similar stroke risks versus the general population; while South Asian ethnicity was associated with lower overall cardiovascular [0.75 (0.64–0.89)] but similar coronary artery disease risks versus the general population. In usual-onset diabetes, Chinese ethnicity was associated with lower cardiovascular risk [0.44 (0.42–0.46)], while South Asian ethnicity was associated with lower cardiovascular [0.90 (0.86–0.95)] and higher coronary artery disease [1.08 (1.01–1.15)] risks versus the general population.ConclusionsThere are important ethnic differences in the association between age at diagnosis and risk of cardiovascular complications.

The Role of Faculty In Faculty–Student Engagement: Disaggregated Analyses by Ethnicity for Southeast Asian American College Students

The Role of Faculty In Faculty–Student Engagement:Disaggregated Analyses by Ethnicity for Southeast Asian American College Students Soua Xiong (bio) Higher education institutions have struggled to support the degree completion of Southeast Asian American (SEAA) college students (Keo & Noguera, 2018), a population that has been historically understudied and underserved (Museus, 2014). Thus, increased attention to the success of this group of students is important. Research has indicated that faculty–student engagement is a contributing factor to degree completion (Price & Tovar, 2014). Given the importance of faculty–student engagement on degree completion, understanding its predictors can be important to begin addressing degree completion rates for SEAA college students. Some research on SEAA college students has suggested that faculty–student engagement is a function of the conditions created by faculty (Vang, 2018; Xiong & Wood, 2020). For example, students' perceptions of the number of faculty who validate them were found to be a significant predictor of faculty–student engagement for SEAA students (Xiong & Wood, 2020). However, these studies have been limited in scope, focusing primarily on faculty validation and faculty belonging practices as predictors of faculty–student engagement. In addition to these practices, the current study included student perceptions of faculty relationship and welcoming engagement inside and outside of the classroom as predictor variables of faculty–student engagement. Research on faculty–student engagement that has included Asian American participants has infrequently disaggregated analyses by specific Asian ethnic groups (e.g., Chang, 2005; Cole, 2010). Analyses based on an aggregation of ethnic Asian populations may mask important ethnic differences. Therefore, disaggregated analyses for specific Asian ethnic groups are warranted since research has suggested the experiences of SEAA college students vary by ethnicity (Xiong, 2021). The current study analyzed faculty–student engagement data that could be disaggregated by Southeast Asian ethnic groups (e.g., Cambodian, Hmong, Laotian, Vietnamese) to examine ethnic differences. As such, the purpose of the current study was to examine how student perceptions of faculty practices predicted engagement with faculty and whether significant predictors of faculty–student engagement varied by ethnicity among SEAA college students. This study is the first to systematically examine these relationships for SEAA students. The current investigation is also the first empirical study to conduct disaggregated analyses on faculty–student [End Page 461] engagement among SEAA students. In addition to advancing the knowledge base on SEAA college students and the broader literature on faculty–student engagement, findings from this study can contribute to building the capacity of higher education institutions in advancing success outcomes for SEAA students. METHODS Data for the current study come from the Community College Success Measure (CCSM), an institutional needs assessment tool designed to examine factors impacting the success of historically underserved students in community colleges. The CCSM was selected for the current investigation because it allowed for the analysis of student perceptions of faculty practices and student engagement with faculty that can be disaggregated by specific Southeast Asian ethnic groups. While more than 13,000 students from 12 community colleges across four states completed the CCSM between 2015 and 2018, the analytic sample for this study included a total of 605 participants who identified as Southeast Asian: Cambodian (n = 72, 11.9%), Hmong (n = 262, 43.3%), Laotian (n = 39, 6.4%), Vietnamese (n = 129, 21.3%), and Other Southeast Asian (n = 103, 17.0%). Predictor variables consisted of composite variables that assessed student perceptions of faculty practices and included the following five measures of faculty practices: (a) faculty belonging, reflecting students' perceptions that faculty members make them feel they belong in class; (b) faculty relationship, indicating students' perceptions that faculty members know important information about them; (c) faculty validation, assessing students' perceptions of the number of faculty members who communicate validating messages to them; (d) faculty welcoming engagement (inside the classroom), reflecting students' perceptions that their engagement in class is both welcome and encouraged by faculty members; and (e) faculty welcoming engagement (outside the classroom), reflecting students' perceptions that their engagement outside of class is both welcome and encouraged by faculty members. The faculty belonging, relationship, and welcoming engagement items are measured on a 6-point Likert scale that ranges from 1 = strongly disagree to 6 = strongly agree. The faculty validation...

Inflammation and its associations with aortic stiffness, coronary artery disease and peripheral artery disease in different ethnic groups: The HELIUS Study.

Backgroundevidence shows important ethnic differences in vascular dysfunction rates; however, the mechanisms driving these differences remain unclear. One potential factor is the ethnic differences in the role of inflammation in vascular injury. We tested the hypothesis that low-grade inflammation is unequally associated with vascular dysfunction in different ethnic groups.Methodswe included 5698 participants (similar-sized Dutch, African Surinamese, South-Asian Surinamese, Ghanaians, Turkish, and Moroccans) of the HELIUS study (the Netherlands) conducted between 2011 and 2015. Logistic regression was used to examine the associations of Z-score inflammatory biomarker concentration (high sensitivity C-reactive protein [hs-CRP], fibrinogen, and d-dimer) with vascular dysfunction (aortic stiffness, coronary artery disease [CAD], and peripheral artery disease [PAD]), with adjustments for age, sex, smoking (pack-years), BMI, hypertension, HbA1c, total cholesterol, and statin useFindingsin the fully adjusted models, higher Z-score hs-CRP was positively associated with CAD in Dutch [OR 1·63, (95% CI 1·21–2·18)] and PAD in South Asians [1·25(1·03–1·53)], respectively. Higher Z-score fibrinogen was positively associated with CAD in African Surinamese [1·28(1·03–1·59)] while higher Z-score d-dimer was positively associated with PAD in Moroccans [1·39(1·01–1·93)]. Higher Z-score hs-CRP [0·71(0·54–0·94)] and fibrinogen [0·75(0·58–0·97)] concentrations were negatively associated with PAD in African Surinamese.Interpretationour study shows that inflammatory biomarkers are unequally associated with vascular dysfunction in different ethnic groups. These observations provide opportunities for future studies aimed at assessing the predictive roles of inflammation on vascular disease in different ethnic groups.

Diabetes-related lower extremity complications in a multi-ethnic Asian population: a 10\xa0year observational study in Singapore

Aims/hypothesisDiabetes progression and complication risk are different in Asian people compared with those of European ancestry. In this study, we sought to understand the epidemiology of diabetes-related lower extremity complications (DRLECs: symptomatic peripheral arterial disease, ulceration, infection, gangrene) and amputations in a multi-ethnic Asian population.MethodsThis was a retrospective observational study using data obtained from one of three integrated public healthcare clusters in Singapore. The population consisted of individuals with incident type 2 diabetes who were of Chinese, Malay, Indian or Other ethnicity. We examined incidence, time to event and risk factors of DRLECs and amputation.ResultsBetween 2007 and 2017, of the 156,593 individuals with incident type 2 diabetes, 20,744 developed a DRLEC, of whom 1208 underwent amputation. Age- and sex-standardised incidence of first DRLEC and first amputation was 28.29/1000 person-years of diabetes and 8.18/1000 person-years of DRLEC, respectively. Incidence of both was highest in individuals of Malay ethnicity (DRLEC, 36.09/1000 person-years of diabetes; amputation, 12.96/1000 person-years of DRLEC). Median time from diabetes diagnosis in the public healthcare system to first DRLEC was 30.5 months for those without subsequent amputation and 10.9 months for those with subsequent amputation. Median time from DRLEC to first amputation was 2.3 months. Older age (p < 0.001), male sex (p < 0.001), Malay ethnicity (p < 0.001), Indian ethnicity (p = 0.014), chronic comorbidities (nephropathy [p < 0.001], heart disease [p < 0.001], stroke [p < 0.001], retinopathy [p < 0.001], neuropathy [p < 0.001]), poorer or missing HbA1c (p < 0.001), lower (p < 0.001) or missing (p = 0.002) eGFR, greater or missing BMI (p < 0.001), missing LDL-cholesterol (p < 0.001) at diagnosis, and ever-smoking (p < 0.001) were associated with higher hazard of DRLEC. Retinopathy (p < 0.001), peripheral vascular disease (p < 0.001), poorer HbA1c (p < 0.001), higher (p = 0.009) or missing (p < 0.001) LDL-cholesterol and missing BMI (p = 0.008) were associated with higher hazard of amputation in those with DRLEC. Indian ethnicity (p = 0.007) was associated with significantly lower hazard of amputation.Conclusions/interpretationThis study has revealed important ethnic differences in risk of diabetes-related lower limb complications, with Malays most likely to progress to DRLEC. Greater research efforts are needed to understand the aetiopathological and sociocultural processes that contribute to the higher risk of lower extremity complications among these ethnic groups.Graphical abstract

Hospital efficiency and quality of prostate cancer care.

223 Background: There is no consistent evidence with respect to the role of hospital efficiency in improving quality of prostate cancer care. Study objective was to examine the association between hospital efficiency and quality of care in African American, Hispanic, and white Medicare beneficiaries with prostate cancer. Methods: Population-based cohort study using Surveillance, Epidemiological, and End Results-Medicare (SEER-Medicare) data from 2000–2016 for prostate cancer patients aged 66 or older. SEER-Medicare data was linked to American Hospital Association data. We computed hospital technical efficiency using data envelopment analysis. Outcomes were emergency room visits, complications, hospitalizations, cost, treatment and mortality (all-cause and prostate cancer-specific). We used competing risk analysis for survival, log-link GLM models for cost, and Poisson (zero inflated) models for count data. Propensity score and instrumental variable approaches were used to minimize potential biases. Results: We identified 87,117 eligible prostate cancer patients. Of these, 86% were white, 11% were African American, and 3% were Hispanic. Table shows the association between four quartiles of efficiency and outcomes. Higher hospital efficiency was consistently associated with decreased all-cause mortality, prostate cancer-specific mortality and emergency room visits. Association between hospital efficiency and mortality varied between racial and ethnic groups. Conclusions: Increasing hospital efficiency may reduce some of the disparity in prostate cancer outcomes. Our findings indicate important racial and ethnic differences that should be considered while planning hospital efficiency models to improve quality of prostate cancer care. Policies to redirect minority patients to hospital with higher efficiency may reduce racial and ethnic disparity in quality of care and outcomes. [Table: see text]

Ethnic disparities in vaccine safety attitudes and perceptions of family doctors/general practitioners

Ethnic groups have disparate perceptions of and experiences with family doctors/General Practitioners (GP), yet little is known about differences in GP influence on vaccine safety perceptions across ethnic groups in New Zealand. Using data from the 2017 New Zealand Attitudes and Values Study survey (N = 17,072), the current study investigates the correlation between vaccine safety agreement and GP satisfaction, perceived GP cultural similarity, GP cultural respect, healthcare access and diverse demographic factors among Māori, Pacific, Asian and European New Zealanders. Europeans expressed greater positive perceptions of GPs and high vaccine safety agreement (74.7%) relative to other ethnic groups (Asian: 72.3%; Pacific: 65.8%; Māori: 59.4%). Increased GP satisfaction, healthcare access and education were key correlates of higher vaccine safety agreement among Europeans. Increased GP satisfaction, healthcare access and being non-religious were key correlates among Māori. Higher vaccine safety agreement was significantly and strongly associated with being non-religious, born overseas and having a partner among Pacific peoples. Among Asian peoples, men, younger, more educated individuals, and those with greater perceived GP cultural respect showed higher agreement. Our findings highlight important ethnic differences in the shaping of vaccine attitudes and inform the development of tailored interventions for specific ethnic groups.

Ethnic Differences in Resting Total Peripheral Resistance: A Systematic Review and Meta-Analysis.

Decades of research suggest that there may be important ethnic differences in the hemodynamic mechanisms that co-determine arterial blood pressure, the primary diagnostic index of hypertension. In general, studies have observed that, compared with European Americans (EAs), African Americans (AAs) exhibit higher total peripheral resistance (TPR), an important summative index of peripheral vascular constriction. In contrast, EAs have been reliably shown to exhibit greater cardiac output (CO), which is directly linked to left ventricle and overall cardiac blood flow. We have previously proposed that elevated basal TPR, in particular, represents one component of the cardiovascular conundrum, characterized, paradoxically, by elevated resting heart rate variability among AAs relative to EAs. The present meta-analysis and systematic review of the literature sought to extend this previous work by establishing the magnitude of the empirically implied ethnic differences in resting TPR and CO. A search of the literature yielded 140 abstracts on differences in TPR between AAs and EAs; 40 were included. Sample sizes, means, and standard deviations for baseline TPR with samples that included EAs and AAs were collected, and Hedges g was computed. Findings indicated that AAs had higher baseline TPR than did EAs (Hedges g = 0.307, SE = 0.043, confidence interval= 0.224 to 0.391, p < .001). In addition, EAs had higher resting CO than did AAs (Hedges g = -0.214, SE = 0.056, confidence interval = -0.324 to -0.104, p < .001). We discuss the present findings in the context of the role of elevated TPR in the deleterious effects of high blood pressure specifically for AAs.

Incidence and Outcomes of CNS Tumors in Chinese Children: Comparative Analysis With the Surveillance, Epidemiology, and End Results Program.

PURPOSEDespite being the most common pediatric solid tumors, incidence and outcome of CNS tumors in Chinese children have not been systematically reported. We addressed this knowledge gap by comparing the epidemiology of pediatric CNS tumors in Hong Kong and the United States.PATIENTS AND METHODSData between 1999 and 2016 from a population-based cancer registry in Hong Kong, China, on patients < 18 years old with CNS tumors (Hong Kong cohort) and from the US SEER Program (Asian/Pacific Islander and all ethnicities) were compared. Incidence and overall survival (OS) by histology were evaluated.RESULTSDuring the study period, 526 children were newly diagnosed with CNS tumors in Hong Kong (crude incidence rate, 2.47 per 100,000; 95% CI, 2.26 to 2.69). Adjusted incidences were significantly lower in the Hong Kong (2.51; 95% CI, 2.30 to 2.74) than in the SEER (Asian/Pacific Islander: 3.26; 95% CI, 2.97 to 3.57; P < .001; all ethnicities: 4.10 per 100,000; 95% CI, 3.99 to 4.22; P < .001) cohorts. Incidences of germ cell tumors (0.57 v 0.24; P < .001) were significantly higher, but those of glial and neuronal tumors (0.94 v 2.61; P < .001), ependymomas (0.18 v 0.31; P = .005), and choroid plexus tumors (0.08 v 0.16; P = .045) were significantly lower in Hong Kong compared with SEER (all ethnicities) cohorts. Compared with the SEER (Asian/Pacific Islander) cohort, histology-specific incidences were similar except for a lower incidence of glial and neuronal tumors in Hong Kong (0.94 v 1.74; P < .001). Among cohorts, OS differed only for patients with glial and neuronal tumors (5-year OS: Hong Kong, 52.5%; SEER [Asian/Pacific Islander], 73.6%; SEER [all ethnicities], 79.9%; P < .001).CONCLUSIONWe identified important ethnic differences in the epidemiology of CNS tumors in Chinese children. These results will inform the development of pediatric neuro-oncology services in China and aid further etiologic studies.

ETHNIC AND AGE-RELATED PECULIARTIES OF LIPID PEROXIDATION AND ANTIOXIDATIVE PROTECTION

The relevance of this research is determined by a number of factors including Chernobyl tragedy, enforced usage of computer technologies and telecommunication, environmental problems, unhealthy diet poor in poor in vegetables and fruits. This promotes the condition for increased free radical production by the body and antioxidant system emaciation. Alzheimer’s and Parkinson’s diseases, lateral amyotrophic sclerosis and cataract, stroke, brain and spine traumatic injuries have been reported as rapidly growing worldwide. Less common diseases with ethio-pathogenetic mechanisms mentioned above include peroxisomal biogenesis disorders (X-linked adrenoleukodystrophy, Zellweger syndrome), Friedreich ataxia, Niemann-Pick diseases, neurodegeneration accompanied with brain iron accumulation, infantile neuroaxonal dystrophy, ferritinopathy, aceruloplasminemia. Intensive production of free oxygen species underlies the emergence of the diseases, therefore studying their ethiology, pathogenesis, clinical courses and the approaches in their early detection, treatment and prevention is one of the priority directions for genetics, biology, theoretical and applied medicine in order to determine important ethnic and age-related differences. This is of quite significance as many diseases known before as age-related now are affecting more and more of young population. Some diseases are traditionally more prevalent in some populations identified as races due to their common ancestry. It also includes altered prevalence and patterns in different ethnic groups. But nowadays the population of many countries is become more and more ethnically mixed. This is critical in diagnosing and managing some diseases as cardiovascular diseases, some autism forms with epilepsy, ischemic-hypoxic encephalopathy in children. The authors highlight lately determined mechanisms of the impairment in pro-oxidative-antioxidative status as well as some modern medicines and approaches for the correction for some pathological conditions.

Self-criticism, self-compassion, and perceived health: moderating effect of ethnicity

A caring and compassionate attitude toward the self (i.e., self-compassion) has been linked to various mental and physical health benefits. The Self-Compassion Scale (SCS) is widely used in psychology literature in order to assess global self-compassion. However, recent evidence suggests that the single factor model comprising positive and negative items of the SCS in fact measures two distinct constructs (i.e., self-criticism/self-coldness and self-compassion) with different psychological correlates. Given these recent findings, in addition to other research that highlights cultural differences in self-conceptualizations and self-evaluations, the present study examined potential ethnic differences in the relationships between self-criticism, self-compassion, and perceived health. Participants included 728 college students (141 Asian American, 449 European American, and 138 Hispanic/Latinx individuals) attending a university in the northeast United States. Results indicated that the relationship between self-criticism and self-compassion was significantly different across ethnicity. In addition, the relationships between these two constructs (i.e., self-criticism and self-compassion) and perceived health were moderated by ethnicity. Our findings suggest that focusing on global self-compassion scores (i.e., total SCS scores) may miss some of the important cultural or ethnic differences in the relationships between self-criticism, self-compassion, and perceived health.

Body size, Mental health and Inequalities: The burden of obesity in South Africa

Abstract Background Given the substantial burden of obesity in South Africa, it is important to understand how specific aspects of socioeconomic position influence the risk of unhealthy weight in different gender or ethnic groups. Methods We investigated body mass index distributions among subjects aged 15+ years from the South African National Health and Nutrition Examination Survey. Determinants of underweight, overweight and obesity were studied in 1655 (73%) men and 3104 (74%) women who had data available on social and mental health characteristics. Logistic and multinomial regressions were used to study associations with weight categories. Results Less than half of the subjects had healthy weight, 22% were overweight and 29% were obese. The proportion of healthy weight decreased and the risk of obesity increased with age up to 65 years. African women had a particularly high risk of overweight and obesity compared to men (age adjusted OR 4.65, 95% CI 3.94-5.50). The effect of gender was smaller in non-Africans (age adjusted OR 3.02, 95% CI 2.41-3.79; test for statistical interaction p = 0.004). Employment and higher education were associated with higher risk of overweight and obesity and a lower risk of underweight. Married subjects were at a higher risk of overweight and obesity. In men, higher income was associated with overweight and obesity. We found weak evidence of poor mental health being associated with unhealthy BMI. Conclusions There are social gradients and gender and ethnic differences in how underweight, overweight and obesity are distributed in the South African population. A high prevalence of obesity among women and positive associations of education, employment and income with overweight and obesity call for investments into health literacy. Action is also needed to prevent undernutrition among socially disadvantaged groups, and men in particular. Key messages There are strong social gradients and important gender and ethnic differences in how underweight, overweight and obesity are distributed in the South African population. High prevalence of obesity in women and positive associations of socioeconomic position with obesity indicate poor health literacy. Undernutrition needs to be reduced among socially disadvantaged.

Can We Predict Which Children With Autism Will Have Obstructive Sleep Apnea?

Can We Predict Which Children With Autism Will Have Obstructive Sleep Apnea?

Social and Psychological Predictors of Body Mass Index among South Africans 15 Years and Older: SANHANES-1.

This study investigated how psychological distress and the proxies for social position combine to influence the risk of both underweight and overweight in South Africans aged 15 years and older. This was a cross-sectional study that included 2254 men and 4170 women participating in the first South African National Health and Nutrition Examination Survey (SANHANES-1). An analysis exploring the associations of social and mental health characteristics with body mass index (BMI) was conducted using binary and multinomial logistic regressions. Results suggested that, overall, women had a higher risk of overweight/obesity compared to men (age-adjusted odds ratio [AOR] 4.65; 95% confidence intervals [CI] 3.94–5.50). The gender effect on BMI was smaller in non-African participants (AOR 3.02; 95% CI 2.41–3.79; p-value for interaction = 0.004). Being employed and having a higher level of education were associated with higher risks of overweight and obesity and a lower risk of underweight. Being single or without a spouse and poor mental health were found to increase the odds of being underweight, especially in men. To conclude, there are strong social gradients and important gender and ethnic differences in how BMI is distributed in the South African population.

Expert panel consensus recommendations for ambulatory blood pressure monitoring in Asia: The HOPE Asia Network.

Hypertension is an important public health issue because of its association with a number of significant diseases and adverse outcomes. However, there are important ethnic differences in the pathogenesis and cardio-/cerebrovascular consequences of hypertension. Given the large populations and rapidly aging demographic in Asian regions, optimal strategies to diagnose and manage hypertension are of high importance. Ambulatory blood pressure monitoring (ABPM) is an important out-of-office blood pressure (BP) measurement tool that should play a central role in hypertension detection and management. The use of ABPM is particularly important in Asia due to the specific features of hypertension in Asian patients, including a high prevalence of masked hypertension, disrupted BP variability with marked morning BP surge, and nocturnal hypertension. This HOPE Asia Network document summarizes region-specific literature on the relationship between ABPM parameters and cardiovascular risk and target organ damage, providing a rationale for consensus-based recommendations on the use of ABPM in Asia. The aim of these recommendations is to guide and improve clinical practice to facilitate optimal BP monitoring with the goal of optimizing patient management and expediting the efficient allocation of treatment and health care resources. This should contribute to the HOPE Asia Network mission of improving the management of hypertension and organ protection toward achieving "zero" cardiovascular events in Asia.

Hypertension Prevalence, Treatment, and Related Behaviors Among Asian Americans: An Examination by Method of Measurement and Disaggregated Subgroups.

Data on hypertension among Asian Americans is lacking and often aggregated, which can mask important ethnic differences. This study aims to provide a comprehensive view of hypertension and hypertension-related behaviors, including hypertension treatment, management, and information seeking, among Chinese, Korean, and Vietnamese Americans. Data were collected from 600 foreign-born Asian Americans (201 Chinese, 198 Korean, and 201 Vietnamese participants) in the Washington-Baltimore metropolitan area, aged 18years and over, from 2013 to 2014. Hypertension was assessed using direct measurement and self-report of having ever been told by a physician. Hypertension prevalence was compared based on the method of assessment, ethnicity, and sex. The age-adjusted hypertension prevalence from direct measurement was 27.5%, which is higher than the 2011-2014 National Health and Nutrition Examination Survey estimate for Asians (24.9%). Hypertension prevalences from self-report among Chinese, Korean, and Vietnamese were 13.4%, 23.2%, and 22.9%, respectively, which are lower than 2014 California Health Interview Survey estimates (15.6%, 18.4%, and 25.8%) with the exception of Korean participants. In regard to hypertension-related behaviors, 67.8% of hypertensive adults received management, 64.3% took antihypertensive medication, and 67.0% sought information to improve their hypertension. Disaggregated data on hypertension based on measured blood pressure may prevent underestimation from self-report, particularly among those with limited healthcare access. More accurate and objective assessment of hypertension is needed for improved monitoring of hypertension among Asian-American subgroups.

MTHFR - Ala222Val Effects on Metabolic Syndrome Progression

Abstract Objective: Methylene-tetrahydrofolate reductase (MTHFR) is involved in adapting metabolism to environmental challenges by various mechanisms, including the control of gene expression by epigenetic and post-translational changes of transcription factors. Though a metabolic syndrome candidate gene, association studies of its common polymorphism rs1801133 (MTHFR-Ala222Val) remain inconclusive with important ethnic differences, and the effect on disease progression was not addressed. Methods: 307 middle-aged metabolic syndrome patients in a central Romanian hospital setting were investigated metabolically, and genotyped by PCR-RFLP. Disease progression was assessed by the age of onset of metabolic components, as well as development of non-alcoholic fatty liver disease and atherosclerotic complications. Results: The minor allele frequency of rs1801133 was 30.13%. Metabolic parameters showed no statistically significant differences according to genotype, but variant carriers developed dysglycemia and dyslipidemia earlier (53.28±10.8 vs 59.44±9.31 years, p&lt;0.05 and 58.57±11.31 vs 64.72±10.6 years, p&lt;0.1).While the polymorphism did not influence hepatic complications, an inverse association was found for manifest atherosclerosis (OR=0.49, p=0.006, 95%CI:0.29-0.81), which may be folate-status dependent, and needs further investigations. Simultaneous analysis with transcription factor polymorphisms (rs1801282, rs8192678) showed that the more protective genotypes were present the later metabolic disturbances developed, and in the presence of the other two variants the apparent protective cardiovascular effect disappeared. Conclusions: The common functional polymorphism rs1801133 may influence metabolic syndrome progression, the age of onset of components and development of atherosclerotic complications. Besides simple additive effects, complex mitigating and aggravating variant interactions may exist, and the protective or predisposing outcome may depend on modifiable environmental factors.

Differences in Value-Orientations: The Broader Implications

Canada's educators, like its politicians (and like politicians and educators in other places), are confronted with what are perhaps the two essential data of this century - a society which is convergent but in which there are clearly distinguishable and rather permanent variations. The convergence, or tendency for Canadians to become more like each other, that is accompanying rural-to-urban migration, industrialization, improved roads and television, is largely in the direction of the urban, middle-class, large-scale-organization way of life; the persisting variations are chiefly socioeconomic and regional, although there are important religious and ethnic differences as well.