Influence of Geographical Origin and Ethnicity on Mortality in Patients on Antiretroviral Therapy in Canada, Europe, and the United States

Our objective was to assess differences in all-cause mortality, as well as AIDS and non-AIDS death rates, among patients started on antiretroviral therapy (ART) according to their geographical origin and ethnicity/race in Europe, Canada, and the United States. METHODS: This was a collaboration of 19 cohort studies of human immunodeficiency virus-positive subjects who have initiated ART (ART Cohort Collaboration) between 1998 and 2009. Adjusted mortality hazard ratios (AHRs) were estimated using Cox regression. A competing risk framework was used to estimate adjusted subdistribution hazard ratios for AIDS and non-AIDS mortality. RESULTS: Of 46 648 European patients, 16.3% were from sub-Saharan Africa (SSA), 5.1% Caribbean and Latin America, 1.6% North Africa and Middle East, and 1.7% Asia/West; of 1371 patients from Canada, 14.9% were First Nations and 22.4% migrants, and of 7742 patients from North America, 55.5% were African American and 6.6% Hispanic. Migrants from SSA (AHR, 0.79; 95% confidence interval [CI], .68-.92) and Asia/West (AHR, 0.62; 95% CI, .41-.92) had lower mortality than Europeans; these differences appeared mainly attributable to lower non-AIDS mortality. Compared with white Canadians, mortality in Canadian First Nations people (AHR, 1.48; 95% CI, .96-2.29) was higher, both for AIDS and non-AIDS mortality rates. Among US patients, when compared with whites, African Americans had higher AIDS and non-AIDS mortality, and hazard ratios for all-cause mortality increased with time on ART. CONCLUSIONS: The lower mortality observed in migrants suggests "healthy migrant" effects, whereas the higher mortality in First Nations people and African Americans in North America suggests social inequality gaps. KEYWORDS: HIV infection, antiretroviral therapy, ethnic minorities, migrants Comment in Addressing disparities in HIV mortality: antiretroviral therapy is necessary but not sufficient. [Clin Infect Dis. 2013]

Ethnic Minority Children’s Active Commuting to School and Association with Physical Activity and Pedestrian Safety Behaviors

Background: Children's active commuting to school, i.e. walking or cycling to school, was associated with greater moderate-to-vigorous physical activity, although studies among ethnic minorities are sparse. Objectives: Among a low-income, ethnic minority sample of fourth grade students from eight public schools, we examined (1) correlates of active commuting to school and (2) the relationship between active commuting to school and moderate-to-vigorous physical activity. Methods: We conducted a cross-sectional analysis of baseline measurements from a sample of participants (n=149) aged 9-12 years from a walk to school intervention study in Houston, Texas. The primary outcome was the weekly rate of active commuting to school. Daily moderate-to-vigorous physical activity, measured by accelerometers, was a secondary outcome. Child self-efficacy (alpha=0.75), parent self-efficacy (alpha=0.88), and parent outcome expectations (alpha=0.78) were independent variables. Participant characteristics (age, gender, race/ethnicity, distance from home to school, acculturation, and BMI percentile) were independent sociodemographic variables. We used mixed-model regression analyses to account for clustering by school and a stepwise procedure with backward elimination of non-significant interactions and covariates to identify significant moderators and predictors. School-level observations of student pedestrians were assessed and compared using chi-square tests of independence. Results: Among our sample, which was 61.7% Latino, the overall rate of active commuting to school was 43%. In the mixed model for active commuting to school, parent self-efficacy (std. beta = 0.18, p=0.018) and age (std. beta = 0.18, p=0.018) were positively related. Latino students had lower rates of active commuting to school than non-Latinos ( 16.5%, p=0.040). Distance from home to school was inversely related to active commuting to school (std. beta = 0.29, p<0.001). In the mixed model for moderate-to-vigorous physical activity, active commuting to school was positively associated (std. beta = 0.31, p <0.001). Among the Latino subsample, child acculturation was negatively associated with active commuting to school (std. beta = -0.23, p=0.01). With regard to school-level pedestrian safety observations, 37% of students stopped at the curb and 2.6% looked left-right-left before crossing the street. Conclusion: Although still below national goals, the rate of active commuting was relatively high, while the rate of some pedestrian safety behaviors was low among this low-income, ethnic minority population. Programs and policies to encourage safe active commuting to school are warranted and should consider the influence of parents, acculturation, and ethnicity.

Validity assessment of the Breast Cancer Risk Reduction Health Belief scale.

BACKGROUND: : Women at increased risk of breast cancer (BC) are not widely accepting of chemopreventive interventions, and ethnic minorities are underrepresented in related trials. Furthermore, there is no validated instrument to assess the health-seeking behavior of these women with respect to these interventions. METHODS: : By using constructs from the Health Belief Model, the authors developed and refined, based on pilot data, the Breast Cancer Risk Reduction Health Belief (BCRRHB) scale using a population of 265 women at increased risk of BC who were largely medically underserved, of low socioeconomic status (SES), and ethnic minorities. Construct validity was assessed using principal components analysis with oblique rotation to extract factors, and generate and interpret summary scales. Internal consistency was determined using Cronbach alpha coefficients. RESULTS: : Test-retest reliability for the pilot and final data was calculated to be r = 0.85. Principal components analysis yielded 16 components that explained 64% of the total variance, with communalities ranging from 0.50-0.75. Cronbach alpha coefficients for the extracted factors ranged from 0.45-0.77. CONCLUSIONS: : Evidence suggests that the BCRRHB yields reliable and valid data that allows for the identification of barriers and enhancing factors associated with use of breast cancer chemoprevention in the study population. These findings allow for tailoring treatment plans and intervention strategies to the individual. Future research is needed to validate the scale for use in other female populations. Cancer 2009. (c) 2009 American Cancer Society.

Wie fremdenfeindlich ist die Schweiz? Fünf Feldexperimente über prosoziales Verhalten und die Diskriminierung von Ausländern

Umfragen über Vorurteile führen oft zu verzerrten Ergebnissen, da die Befragten häufig „sozial erwünschte“ Antworten geben. In unserer Studie über Vorurteile und Diskriminierung haben wir dagegen vier Feldexperimente in der Stadt Zürich durchgeführt, in denen jeweils von Angehörigen verschiedener Nationalitäten oder religiöser Gruppen eine Hilfeleistung erbeten wurde. Beispielsweise wurden Passanten von einer Person mit Kopftuch um eine Hilfeleistung gebeten; in der Kontrollbedingung dagegen ohne Kopftuch. In einem anderen Experiment wurden Personen in Hochdeutsch angesprochen und in der Kontrollsituation im Schweizer Dialekt. Ein fünftes Experiment bezog sich auf die Reaktionen von Arbeitgebern auf Initiativbewerbungen. Es zeigte sich, dass im Alltagsverhalten keine signifikanten Unterschiede im Ausmaß der Hilfeleistung zwischen den Gruppen nachweisbar waren. Alle vier Experimente zu kleinen Hilfen im Alltag ergaben weder bezüglich Deutschen noch muslimischen Minderheiten Hinweise auf diskriminierendes Verhalten. Deutliche Hinweise gibt es dagegen für die Diskriminierung bestimmter ethnischer Gruppen auf dem Arbeitsmarkt, auch wenn Bewerber die gleiche Qualifikation wie Schweizer und die Schweizer Staatsbürgerschaft besitzen.

The epidemiology of chronic fatigue in San Francisco

Chronic fatigue syndrome (CFS) is a recently defined condition characterized by severe disabling fatigue that persists for a minimum of six months, and a host of somatic and neurocognitive symptoms. Although conditions similar to CFS have been described in the medical literature for over 100 years, little is known about the epidemiology of CFS or of chronic fatigue generally. The San Francisco Fatigue Study was undertaken to describe the prevalence and characteristics of self-reported chronic fatigue and associated conditions in a diverse urban community. The study utilized a cross-sectional telephone survey of a random sample of households in San Francisco, followed by case/control interviews of fatigued and nonfatigued subjects. Respondents were classified as chronically fatigued (CF) if they reported severe fatigue lasting six months or longer, then further classified as having CFS-like illness if, based on self-reported information, their condition appeared to meet CFS case definition criteria. Subjects who reported idiopathic chronic fatigue that did not meet CFS criteria were classified as having ICF-like illness.^ 8004 households were screened, yielding fatigue and demographic information on 16970 residents. CF was reported by 635 persons, 3.7% of the study population. CFS-like illness was identified in 34 subjects (0.2%), and ICF-like illness in 259 subjects (1.6%). Logistic regression analysis indicated that prevalence odds ratios for CFS-like illness were significantly elevated for females compared to males (OR = 2.9), and in Blacks (OR = 2.9) and Native Americans (OR = 13.2) relative to Whites, but significantly lower in Asians (OR = 0.12). Above-average household income was protective for all categories of CF. CFS-like subjects reported more symptoms and were more severely disabled than ICF-like subjects, but the pattern of symptoms experienced by both groups was similar. In conclusion, unexplained chronic fatigue, including CFS-like illness, occurs in all sociodemographic groups, but may be most prevalent among persons with lower incomes and in some racial minorities. Future studies that include clinical evaluation of incident cases of CFS and ICF are required to further clarify the epidemiology of unexplained chronic fatigue in the population. ^

Motifs slaves dans les lettres autrichiennes du XIXe siècle: tentative de compréhension et de synthèse dans le cas de Marie von Ebner-Eschenbach

Marie von Ebner-Eschenbach (1830-1916) was born and grew up in Moravia. Despite the fact that her very first language was Czech, all her literary work was written in German ; despite of her Czech origins from her fatherside, all the references to be found in her work concerning the social and national development of the Czech society of that time express, if not animosity, at least a total lack of understanding. Everthing happens as if the author just wanted to confirm and uphold the official views of the Austrian Monarchy. In this article, I’d like to show, mainly on the example of the novel Božena (1876), that a more careful reading which would take into account not only the textual statements of the writer, but as well the composition of the plot and the various behaviors of the Czech and German protagonists, could allow to bring nuances to Ebner-Eschenbach’s position towards the Czech – namely to see that she was perfectly aware and respectful of the cultural diversity and complexity of the Czech lands and that she felt a deep compassion for the claims of the minorities asking for the transformation of the Habsburg Empire into a Federation of free nations.

Who Supports Minority Rights in Popular Votes? Empirical Evidence from Switzerland

Recent research shows that well-educated citizens are more supportive of minority rights in direct democratic votes than people with less education. This article however suggests that educational effects on minority rights only emerge under certain conditions. A Bayesian multilevel analysis of 39 referendums and initiatives on minority rights in Switzerland (1981–2009) shows that educational effects are particularly strong when the rights of lesser-known cultural minorities are to be extended. They are entirely absent, however, when referenda address the curtailment of rights for well-known minority groups.

Victims of War must be loyal to deserve protection: International law and national legislation on enemy aliens 1907-1918

In international law the internment of civilians has only been regulated in writing in the context of the 4th Geneva Convention of 1949. Nevertheless this did not mean that civilians were not protected by at least some rules of customary international law before that date and especially in World War I. Furthermore specialists of international law expected states – at least those considered to be part of the community of civilized nations – to continue to treat all men equal before the law even in wartime. As research already conducted (Bird, Panayi, Fischer) has shown, this was not the case during World War I. Based on these findings the presentation proposed here wants to look into the development of international law and into some national preparations for treating so called “enemy aliens” in the period before 1914 (Austria-Hungary, Australia, United Kingdom), in order to see to what extent principles of international law protecting civilians from the consequences of war can be detected in the pre-war preparations. As far as can be judged so far the issue of loyalty was central in this context. Looking at the war itself, the presentation proposed here will try to look at how far the principles of international law alluded to above continued to influence the policies on “enemy aliens” in the countries mentioned and to see, how the International Committee of the Red Cross tried to use them to legitimize and expand its protective policies in regard to civilians interned in belligerent as well as neutral countries throughout the war.

Minority Rights and Humanitarianism: The international campaign for the Ukrainians in Poland, 1930-31

In October 1930, violent action of the Polish security forces against the Ukrainian population in Eastern Galicia resulted in an international campaign for the Ukrainians in Poland. Its central claim was the condemnation of these incidents as a violation of the Minorities Treaty of the League of Nations. The article focuses on the involved British extra-parliamentary groups and their international federations as well as leftist intellectuals, socialist parties and the Labour and Socialist International. In most cases, the commitment of the activists was motivated by the desire to expose a humanitarian scandal while the implementation of minority rights played a minor role. When it turned out that the first reports had presented an exaggerated version of the events, they shifted their focus to the Polish opposition whose persecution started in November 1930.

Cleverer than we thought: the change in discourse of the Georgian Orthodox Church

This paper will focus on three episodes of contemporary church-state relations in Georgia, in particular, the conflicting interaction between law and religion in the public space. The first episode will be an open confrontation between the church and the state over the law on Registration of Religious Minority organizations (2011) which allowed the religious minorities to freely register; second: the Law on Self-governance (2013) which Georgian Orthodox Church considered “a threat to territorial integrity of Georgia”; and lastly: the Law on Anti-discrimination (2014) which was deemed “legitimization of Sodomic sin”. By reflecting on the three examples where for the first time after the collapse of Soviet Union, the Georgian state openly confronted the church and made a decision notwithstanding its position, I will attempt to argue that the role of the Orthodox Church in influencing the law making process is in gradual decline. However, on the other hand, by presenting the results of an ethnographic study conducted in 23 eparchies and perishes in 7 regions of Georgia in 2014, I will also show that church has adapted to its declining role over policy making, and to regain its political influence it gradually started to employ a civic rather than ethno nationalist discourse on matters of religious freedom while engaging with government. The paper will suggest that both unilateral decision-making of the state and civic shift in the discourse of the church constitute an important change in understanding church-state dynamics in the post-communist Orthodox Christianity dominated society.