For several decades, researchers from the South African Medical Research Council have made invaluable contributions towards improving the health of the population through the analysis and ...interpretation of cause of death data. This article reflects the mortality trends in pre-and post-apartheid South Africa (SA), and describes efforts to improve vital statistics, innovations to fill data gaps, and studies to estimate the burden of disease after adjusting for data deficiencies. The profound impact of HIV/AIDS, particularly among black African children and young adults, is striking, within a protracted epidemiological transition and the current reversals of multiple epidemics. Over the next 20 years, it will be important to sustain and enhance the country's capacity to collect, analyse and utilise cause of death data. SA needs to support development in the region, harnessing new data platforms and approaches such as including verbal autopsy tools in the official system and improving data linkage.
In the 1980s, George Marcus spearheaded a major critique of cultural anthropology, expressed most clearly in the landmark book Writing Culture, which he coedited with James Clifford. Ethnography ...through Thick and Thin updates and advances that critique for the late 1990s. Marcus presents a series of penetrating and provocative essays on the changes that continue to sweep across anthropology. He examines, in particular, how the discipline's central practice of ethnography has been changed by "multi-sited" approaches to anthropology and how new research patterns are transforming anthropologists' careers. Marcus rejects the view, often expressed, that these changes are undermining anthropology. The combination of traditional ethnography with scholarly experimentation, he argues, will only make the discipline more lively and diverse.The book is divided into three main parts. In the first, Marcus shows how ethnographers' tradition of defining fieldwork in terms of peoples and places is now being challenged by the need to study culture by exploring connections, parallels, and contrasts among a variety of often seemingly incommensurate sites. The second part illustrates this emergent multi-sited condition of research by reflecting it in some of Marcus's own past research on Tongan elites and dynastic American fortunes. In the final section, which includes the previously unpublished essay "Sticking with Ethnography through Thick and Thin, " Marcus examines the evolving professional culture of anthropology and the predicaments of its new scholars. He shows how students have increasingly been drawn to the field as much by such powerful interdisciplinary movements as feminism, postcolonial studies, and cultural studies as by anthropology's own traditions. He also considers the impact of demographic changes within the discipline--in particular the fact that anthropologists are no longer almost exclusively Euro-Americans studying non-Euro-Americans. These changes raise new issues about the identities of anthropologists in relation to those they study, and indeed, about what is to define standards of ethnographic scholarship.Filled with keen and highly illuminating observations, Ethnography through Thick and Thin will stimulate fresh debate about the past, present, and future of a discipline undergoing profound transformations.
Objective:Attenuated psychosis syndrome (APS) has recently been included in the appendix of DSM-5 as a condition for further study. This study compared public stigma associated with four mental ...health conditions among study participants in Hong Kong.Methods:The cross-sectional study involved 204 participants (154 members of the general public general public and 50 health care professionals) recruited through a public awareness campaign and the e-mail network of the University of Hong Kong. Participants read four vignettes describing persons with schizophrenia, depression, APS, or psychosis-like experiences. For each vignette, they used a scale to rate their level of stigma in seven domains: social distance, traditional prejudice, exclusionary sentiments, negative affect, perceptions of dangerousness, treatment carryover, and disclosure carryover. Analyses compared ratings within and across vignettes.Results:Schizophrenia received the highest public stigma ratings, followed by APS, depression, and psychosis-like experiences. Total stigma scores were higher for the general public than for health care professionals. Public stigma associated with APS was similar to that associated with depression. Ratings of treatment carryover indicated that participants believed that being known to have received treatment for APS or depression would have lasting consequences.Conclusions:Stigma should be considered in the development of mental health services and research in China, particularly in regard to people with schizophrenia and those at risk of psychosis.
IMPORTANCE: The prevalence of leading risk factors for morbidity and mortality in the US significantly varies across regions, states, and neighborhoods, but the extent these differences are ...associated with a person’s place of residence vs the characteristics of the people who live in different places remains unclear. OBJECTIVE: To estimate the degree to which geographic differences in leading risk factors are associated with a person’s place of residence by comparing trends in health outcomes among individuals who moved to different areas or did not move. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study estimated the association between the differences in the prevalence of uncontrolled chronic conditions across movers’ destination and origin zip codes and changes in individuals’ likelihood of uncontrolled chronic conditions after moving, adjusting for person-specific fixed effects, the duration of time since the move, and secular trends among movers and those who did not move. Electronic health records from the Veterans Health Administration were analyzed. The primary analysis included 5 342 207 individuals with at least 1 Veterans Health Administration outpatient encounter between 2008 and 2018 who moved zip codes exactly once or never moved. EXPOSURES: The difference in the prevalence of uncontrolled chronic conditions between a person’s origin zip code and destination zip code (excluding the individual mover’s outcomes). MAIN OUTCOMES AND MEASURES: Prevalence of uncontrolled blood pressure (systolic blood pressure level >140 mm Hg or diastolic blood pressure level >90 mm Hg), uncontrolled diabetes (hemoglobin A1c level >8%), obesity (body mass index >30), and depressive symptoms (2-item Patient Health Questionnaire score ≥2) per quarter-year during the 3 years before and the 3 years after individuals moved. RESULTS: The study population included 5 342 207 individuals (mean age, 57.6 SD, 17.4 years, 93.9% men, 72.5% White individuals, and 12.7% Black individuals), of whom 1 095 608 moved exactly once and 4 246 599 never moved during the study period. Among the movers, the change after moving in the prevalence of uncontrolled blood pressure was 27.5% (95% CI, 23.8%-31.3%) of the between-area difference in the prevalence of uncontrolled blood pressure. Similarly, the change after moving in the prevalence of uncontrolled diabetes was 5.0% (95% CI, 2.7%-7.2%) of the between-area difference in the prevalence of uncontrolled diabetes; the change after moving in the prevalence of obesity was 3.1% (95% CI, 2.0%-4.2%) of the between-area difference in the prevalence of obesity; and the change after moving in the prevalence of depressive symptoms was 15.2% (95% CI, 13.1%-17.2%) of the between-area difference in the prevalence of depressive symptoms. CONCLUSIONS AND RELEVANCE: In this retrospective cohort study of individuals receiving care at Veterans Health Administration facilities, geographic differences in prevalence were associated with a substantial percentage of the change in individuals’ likelihood of poor blood pressure control or depressive symptoms, and a smaller percentage of the change in individuals’ likelihood of poor diabetes control and obesity. Further research is needed to understand the source of these associations with a person’s place of residence.
There are few data on the incidence rates of diabetes and prediabetes (dysglycemia) in Asian Indians. This article presents the incidence of diabetes and prediabetes and the predictors of progression ...in a population-based Asian Indian cohort.
Data on progression to diabetes and prediabetes from 1,376 individuals, a subset of 2,207 of the Chennai Urban Rural Epidemiology Study (CURES) cohort (phase 3) with normal glucose tolerance (NGT) or prediabetes at baseline, who were followed for a median of 9.1 years (11,629 person-years), are presented. During follow-up, 534 died and 1,077 with NGT and 299 with prediabetes at baseline were reinvestigated in a 10-year follow-up study. Diabetes and prediabetes were diagnosed based on the American Diabetes Association criteria. Incidence rates were calculated and predictors of progression to prediabetes and/or diabetes were estimated using the Cox proportional hazards model.
The incidence rates of diabetes, prediabetes, and "any dysglycemia" were 22.2, 29.5, and 51.7 per 1,000 person-years, respectively. Among those with NGT, 19.4% converted to diabetes and 25.7% to prediabetes, giving an overall conversion rate to dysglycemia of 45.1%. Among those with prediabetes, 58.9% converted to diabetes. Predictors of progression to dysglycemia were advancing age, family history of diabetes, 2-h plasma glucose, glycated hemoglobin (HbA1c), low HDL cholesterol, and physical inactivity.
Asian Indians have one of the highest incidence rates of diabetes, with rapid conversion from normoglycemia to dysglycemia. Public health interventions should target modifiable risk factors to slow down the diabetes epidemic in this population.
OBJECTIVE:We aimed to systematically assess the evidence for differences in the incidence of stroke and distribution of its subtypes in Chinese compared with white populations.
METHODS:We ...comprehensively sought studies conducted since 1990 in Chinese populations of 1) first-ever stroke incidence (community-based studies only), and 2) pathologic types/subtypes of stroke (hospital- or community-based studies of first-ever or recurrent strokes). We identified community-based studies in white populations from a recent systematic review. For each study, we calculated age-standardized stroke incidence and the proportions of each pathologic type and ischemic subtype, using random-effects meta-analysis to pool proportions of stroke types/subtypes in Chinese and in white populations.
RESULTS:Age-standardized annual first-ever stroke incidence in community-based studies was higher among Chinese than white populations (for ages 45–74 years, range 205–584 vs 170–335 per 100,000, respectively). Intracerebral hemorrhage accounted for a larger, more variable proportion of strokes in China than Taiwan (range 27%–51% vs 17%–28%), in Chinese community-based than hospital-based studies (27%–51% vs 17%–30%), and in community-based Chinese than white studies (pooled proportion 33% vs 12%). Although the overall proportion of lacunar ischemic stroke appeared higher in Chinese than white populations, variable study methodologies precluded reliable comparisons.
CONCLUSIONS:There is good evidence for a slightly higher overall stroke incidence and higher proportion of intracerebral hemorrhage in Chinese vs white populations, but no clear evidence for different distributions of ischemic stroke subtypes. Studies using comparable, population-based case ascertainment and similar classification methods are needed to address this.
Children in low-income and minority populations are at risk for poor dietary quality. At least one-third of the calories consumed by children are eaten between meals (ie, snacks). The contribution of ...snacking to diet quality among children is poorly understood.
The current study examined associations between snacking and children’s diet quality along with differences across ethnicity or race, sex, and weight status.
Cross-sectional data came from Phase I of the Family Matters Study, an observational study.
This study included 150 families with children aged 5 to 7 years old from six ethnic or racial groups (n=25 from each: African American, Hispanic, Hmong, Native American, Somali, non-Hispanic white); data were collected in Minneapolis–Saint Paul, MN in 2017-2018.
Total daily energy (kilocalories), overall diet quality using the Healthy Eating Index (HEI-2010), and food group intakes (eg, fruit, vegetables, refined grains, sugar-sweetened beverages SSB) were assessed using three 24-hour dietary recalls.
Conditional fixed effects estimators (within-child variation) were used in regression analyses to characterize the relationship between daily snacking and dietary intake relative to dietary intake at all other daily meal occasions. Mean (±standard deviation) overall dietary intake including all meals and snacks was compared with mean (±standard deviation) intake of meals only.
Among boys, snacking was found to contribute positively to HEI-2010 scores (HEI-2010=57.6, HEI-2010 without snacks=55.0; effect size ES=0.28, P=0.03). Snacking was an important source of fruit (ES=0.71) and dairy (ES=0.53), but also contributed to children’s consumption of refined grains (ES=0.68) and SSB (ES=0.31). Very few vegetables were consumed as snacks. Furthermore, snacks contributed more to the overall diet quality (HEI-2010) of Native American (ES=0.30) and Somali (ES=0.35) youth as compared with youth from other ethnic or racial backgrounds.
Findings suggest that snacks have the potential to improve diet quality in children. Future research should examine influences on children’s food choices at snack times and barriers to serving more healthful foods as snacks that are faced by ethnically or racially diverse families.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background & Aims
In patients with cirrhosis, the risk of hepatocellular carcinoma (HCC) depends upon age, gender and the etiology of liver disease. Few studies are available in Caucasian patients ...with alcoholic or metabolic cirrhosis without viral hepatitis.
Methods
Cross‐sectional clinical data from 905 HCV‐ and HBV‐negative Caucasian patients with alcoholic or metabolic cirrhosis were prospectively collected in four French centres. The risk factors for HCC were identified by logistic regression analysis in the whole population and in a nested case–control study.
Results
The etiology of cirrhosis was alcoholic (48%), metabolic (7%) or mixed (45%). Patients were predominantly male (80%), mean age 62 years old and 31% had HCC. Mean body mass index (BMI) was 27 ± 5 and 30% were obese at inclusion. The maximum BMI reached throughout life was 31 ± 6 and 63% had been obese. Ninety percent of the population had daily alcohol consumption, 73% were smokers.
Hepatocellular carcinoma was independently related to male gender (P < 0.0001), older age (P < 0.0001), past obesity (P = 0.007), diabetes (P = 0.037), abnormal levels of transaminases (P < 0.0001) and tobacco consumption (P = 0.007). The case–control study (200 HCC cases matched with 400 non‐HCC cases for gender, age and Child‐Pugh score) confirmed past obesity, tobacco and abnormal levels of transaminases.
Conclusions
Beside diabetes, male gender and age, a past history of obesity, but not an existing overweight, as well as exposure to tobacco and elevated transaminases were three risk factors which could improve the strategy for HCC screening in Caucasian cirrhotic patients without hepatitis B or C.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
There is a robust literature base documenting gender differences and racial/ethnic differences in exposure to potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) diagnosis. ...Yet, to the best of our knowledge, this is the first study to evaluate the risk of PTEs and PTSD between genders, stratified by race/ethnicity. We aimed to better understand whether factors associated with poor psychological adjustment following PTEs (e.g., PTE type, sociodemographic factors, social support) varied by gender and race/ethnicity.
Data were collected from three U.S.-based national studies comprising the Collaborative Psychiatric Epidemiologic Surveys (CPES; N = 13,649). Trained lay interviewers administered questionnaires and collected data on PTE exposure, PTSD, and psychosocial covariates. Regression analyses were conducted to investigate relations between PTEs, PTSD, and gender, stratified by race/ethnicity.
Adjusting for sociodemographic variables, mental health comorbidity, social support, and PTE frequency, White, African-American, and Afro-Caribbean women had higher odds of PTSD than men in their respective racial/ethnic groups, whereas gender differences were not observed for Latinos or Asians.
Findings suggest that risk of exposure to PTEs and PTSD may differ by gender and race/ethnicity. Future studies should consider the contributions of social, cultural, and contextual factors in estimating PTSD risk.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Adverse life events (ALEs) are a risk factor for chronic pain; however, mechanisms underlying this association are not understood. This study examined whether cumulative ALE exposure impairs ...endogenous inhibition of pain (assessed from pain report) and spinal nociception (assessed from nociceptive flexion reflex; NFR) in healthy, pain-free Native Americans (n = 124) and non-Hispanic Whites (n = 129) during a conditioned pain modulation (CPM) task. Cumulative ALE exposure was assessed prior to testing by summing the number of potentially traumatic events experienced by each participant across their lifespan. Multilevel modeling found that ALEs were associated with NFR modulation during the CPM task even after controlling for general health, body mass index, sex, age, blood pressure, sleep quality, stimulation intensity, stimulus number, perceived stress, and psychological distress. Low exposure to ALEs was associated with NFR inhibition, whereas high exposure to ALEs was associated with NFR facilitation. By contrast, pain perception was inhibited during the CPM task regardless of the level of ALE exposure. Race/ethnicity did not moderate these results. Thus, ALEs may be pronociceptive for both Native Americans and non-Hispanic Whites by impairing descending inhibition of spinal nociception. This could contribute to a chronic pain risk phenotype involving latent spinal sensitization. PERSPECTIVE: This study found that adverse life events were associated with impaired descending inhibition of spinal nociception in a sample of Native Americans and non-Hispanic Whites. These findings expand on previous research linking adversity to chronic pain risk by identifying a proximate physiological mechanism for this association.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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