Abnormal retinal vascular function and lipid levels in a sample of healthy UK South Asians

Background/aims To investigate ethnic differences in retinal vascular function and their relationship to traditional risk indicators for cardiovascular disease (CVD). Methods A total of 90 normoglycaemic subjects (45 South Asian (SA) and 45 age- and gender-matched white Europeans (WEs)) were recruited for the present study. Retinal vessel reactivity to flickering light was assessed by means of the dynamic retinal vessel analyser according to a modified protocol. Fasting plasma glucose, triglycerides (TG), total, LDL and HDL cholesterol were also measured in all individuals. Results SA individuals showed higher fasting triglyceride (p=0.001) and lower HDL levels (p=0.007), leading to a higher TG:HDL-C ratio (p=0.001) than age-matched WE subjects. Additionally, in SAs, the retinal arterial reaction time in response to flicker stimulation was significantly longer in the last flicker cycle than in the WEs (p=0.039), and this change correlated positively with measured plasma TG levels (r=0.60; p=0.01). No such relationship was observed in the WEs (p>0.05). Conclusion Even in the absence of overt vascular disease, in otherwise healthy SAs there are potential signs of retinal vascular function impairment that correlates with established plasma markers for CVD risk.

Retinal vascular function and cardiovascular risk factors

The current platform of conventional cardiovascular risk assessments tends to forsake the importance of endothelial function - a key biological mechanism by which cardiovascular risk factors exert their propensity for adverse vascular events. Moreover, the presence and severity of endothelial dysfunction in ‘low-risk’ individuals suggests considerable variability in pre-clinical risk that could potentially be detected well before the onset of disease. The aim of the present thesis was to investigate the presence and impact of retinal vascular dysfunction, as a barometer of endothelial function, in otherwise healthy individuals with one or more cardiovascular risk factors, but low to moderate cardiovascular risk. Systemic circulatory influences on retinal vascular function were also evaluated. The principle sections and findings of this work are: 1. Ageing effect on retinal vascular function • In low-risk individuals, there are age differences in retinal vascular function throughout the entire functional response curve for arteries and veins. Gender differences mainly affect the dilatory phase and are only present in young individuals. 2. Retinal vascular function in healthy individuals with a family history of cardiovascular disease • In low-risk individuals with a family history of cardiovascular disease, impairments in microvascular function at the retinal level correlate with established plasma markers for cardiovascular risk. 3. Ethnic differences in retinal vascular function • When compared to age-matched White Europeans, in low-risk middle-aged South Asians, there are impairments in retinal vascular function that correlate with established cardiovascular risk indicators. 4. Systemic circulatory influences on retinalµvascular function • Systemic antioxidant capacity (redox index) and plasma markers for cardiovascular risk (lipids) influence retinal microvascular function at both arterial and venous levels. 5. Retinal vascular function in individuals with obstructive sleep apnoea: a preliminarystudy • Patients with moderate to severe sleep apnoea exhibit attenuated retinal vascular function.

Global variations and time trends in the prevalence of childhood myopia, a systematic review and quantitative meta-analysis:implications for aetiology and early prevention

The aim of this review was to quantify the global variation in childhood myopia prevalence over time taking account of demographic and study design factors. A systematic review identified population-based surveys with estimates of childhood myopia prevalence published by February 2015. Multilevel binomial logistic regression of log odds of myopia was used to examine the association with age, gender, urban versus rural setting and survey year, among populations of different ethnic origins, adjusting for study design factors. 143 published articles (42 countries, 374 349 subjects aged 1- 18 years, 74 847 myopia cases) were included. Increase in myopia prevalence with age varied by ethnicity. East Asians showed the highest prevalence, reaching 69% (95% credible intervals (CrI) 61% to 77%) at 15 years of age (86% among Singaporean-Chinese). Blacks in Africa had the lowest prevalence; 5.5% at 15 years (95% CrI 3% to 9%). Time trends in myopia prevalence over the last decade were small in whites, increased by 23% in East Asians, with a weaker increase among South Asians. Children from urban environments have 2.6 times the odds of myopia compared with those from rural environments. In whites and East Asians sex differences emerge at about 9 years of age; by late adolescence girls are twice as likely as boys to be myopic. Marked ethnic differences in age-specific prevalence of myopia exist. Rapid increases in myopia prevalence over time, particularly in East Asians, combined with a universally higher risk of myopia in urban settings, suggest that environmental factors play an important role in myopia development, which may offer scope for prevention.

The influence of perception of forgetting and gender, ethnicity, and closeness on likelihood of caregiving

As life expectancy increases, the population of older adults is increasing rapidly. The caregiving of older parents by adult children has become a normative experience. Much of the gerontological literature has examined the caregiving experience, particularly in terms of the stresses involved. However, research is only beginning to examine the factors which motivate adult children to begin caregiving. The research described here examined how an elderly parent's memory behavior might influence caregiving decisions. In addition, gender, ethnicity, and parent-adult child closeness were examined to explore how these individual difference variables might influence those caregiving decisions.^ Participants read one of two vignettes describing a social visit with an elderly widow (target). In the vignette, the elderly target experiences several instances of forgetting. The vignettes depicted forgetting behavior established in pilot work as normal or serious. The normal forgetting vignette did not arouse concern and the serious forgetting vignette did arouse concern when the middle-aged participants imagined their mothers in the role of the vignette target. Participants rated their likelihood of engaging in eight caregiving behaviors if their mothers behaved like the vignette target. They also rated their closeness with their own mothers.^ Multivariate analyses of variance indicated main effects for vignette type, gender, ethnicity, and attachment. The likelihood of caregiving was higher when forgetting was more serious and when participants were female, Hispanic, and were highly attached to their mothers. Interaction effects showed that gender differences decreased with increased seriousness of forgetting, and ethnic differences were only significant for the normal forgetting condition.^ Multiple regression analyses indicated that attachment was the most significant predictor of likelihood of caregiving. Gender and ethnicity predicted specific caregiving behaviors. Females were more likely to engage in phoning and cooking, and Hispanics were more likely to engage in visiting and suggesting mother move in. ^

The influence of weak parental and peer attachment on academic achievement among late adolescent college students

The current study examined the influence of weak parental and peer attachment on academic achievement among late adolescent college students. In previous research, weak attachment to parents and/or peers had been found to have an adverse influence on the academic success of college students. This study also examined the potential moderating influence of several cognitive and non-cognitive psychosocial variables that might act as protective factors for weakly attached students and, therefore, enhance their academic competence. Data regarding attachment, cognitive variables, and non-cognitive variables were collected using several self-report measures. The multi-ethnic sample of students in this study (n = 357) attended an urban university. Students were classified into one of nine parental-peer attachment groups (e.g., Low-Low, Medium-Medium, High-High). Attachment groups were compared in terms of cognitive and non-cognitive variables. Contrary to the hypothesis, no statistically significant academic achievement differences were revealed for the group of college students who perceived themselves to be weakly attached to both parents and peers. Analysis of variance (ANOVA) identified the High-High group to be significantly different in terms of academic outcome variables from the other eight groups while the Low-Low group had significantly lower levels of non-cognitive variables than several of the other attachment groups. Hierarchical multiple regression analyses revealed that cognitive variables accounted for significant amounts of variance in academic outcomes and that several non-cognitive variables were significant predictors of scholastic competence. Correlational analyses revealed that parental and peer attachment were positively correlated with several cognitive and non-cognitive variables but neither was significantly correlated with self-reported college GPA. In general, the findings do not provide support for a main effect of weak attachment to parents and peers upon academic adversity among college students. Results suggest that both cognitive variables and non-cognitive variables may moderate academic risk due to weak attachment to parents and peers. Descriptive within group analyses of the Low-Low group revealed a heterogeneous group of students with regards to academic outcomes and scores on non-cognitive measures. Gender and ethnic differences were found for attachment status but not for cognitive or non-cognitive variables. Implications for interventions and suggestions for future research are presented. ^

Health beliefs and health care options of disparate black communities in the United States

According to the 1999 U.S. Census, there were approximately thirty-three million African Americans and approximately 1.8 million non-Hispanic black immigrants in the United States. The 1997 U.S. Census estimated that there were as many as 554,000 foreign-born Haitians and 505,000 foreign-born Jamaicans living in the United States, mainly residing in Florida and New York. The U.S. Census claims that blacks are one of the largest emerging ethnic groups in America constituting at least twelve percent of this country's population. Because of this increase, their specific health beliefs and health care options are increasingly nationally significant. ^ In the present intra-black and inter-ethnic study, two hundred seventy African Americans, Haitian immigrants, and Jamaican immigrants residing in South Florida were quantitatively and qualitatively surveyed in order to investigate their health beliefs and health care options. According to the reviewed literature, the three black ethnic groups researched in this study have not been compared or contrasted before in relation to these beliefs and health care choices. ^ As was discovered by the present research, differing health beliefs and health care options were the cultural products of the ethnic differences of the researched communities. It was expected that differing health beliefs among the researched black groups might indicate disparate patterns of health care utilization of either western or non-western models. Additionally, it was projected that by investigating the health beliefs and the health care options of these emerging black ethnic groups, western health care providers in the United States could become better versed in medically servicing growing ethnically-disparate black populations. The study yielded results about the researched groups that supported major findings in the reviewed literature. The data were reported and examined, and theoretical generalizations from the data were discussed. The most important of these findings was that, within a race, health beliefs and health care options were determined by specific ethno-cultural variables dependent on national origins. ^

Outdoor experiential team -building and the college adjustment and persistence of freshmen in learning communities

Student retention is a primary goal in all higher education institutions. Students who are more adjusted to college life are more likely to persist. The purpose of this research was to determine the effects of an outdoor experiential team-building program on the college adjustment of first-semester freshmen in learning communities at a diverse, urban university. The participants in this quasi-experimental study were first-semester freshmen enrolled in learning communities. A total of 123 students participated, with 61 students in the experimental group and 62 students in the comparison group. There were no significant differences between the two groups in relation to age, gender, or ethnicity. The students in the experimental group participated in the team-building program, which consisted of three events spaced three and four weeks apart. At the end of the semester, students in both the experimental and comparison groups completed the Student Adaptation to College Questionnaire (SACQ), a 67-item self-report survey. ^ Independent samples t-test of the SACQ scores (for attachment to the institution, social adjustment, and overall adaptation to college) between groups was done, and the analyses revealed no statistically significant differences. Chi-square analyses revealed no significant difference in the enrollment pattern between the two groups over a four-year period. Repeated measures ANOVAs revealed that from the first semester of enrollment to the second semester there was a significant drop in GPA for students from the comparison group and no such drop in GPA for students from the experimental group who had participated in at least two of the team building activities. A repeated measures ANOVA was conducted for the first year by semester and ethnicity. No ethnic differences were found, and no interaction was found by ethnicity and semester. ^ Should colleges and universities continue to utilize outdoor experiential team-building programs as a creative way to influence students' connection to the institution they should further investigate its value on students' adjustment to college. Future studies should also consider other variables influenced by team-building programs that affect students' college adjustment, such as collaborative learning. Faculty should be included in the planning process to increase their participation. ^

The Role of Family/Friend Social Support in Diabetes Self-Management for Minorities with Type 2 Diabetes

This study investigated how ethnicity, perceived family/friend social support (FSS), and health behaviors are associated with diabetes self-management (DSM) in minorities. The participants were recruited by community outreach methods and included 174 Cuban-, 121 Haitian- and 110 African-Americans with type 2 diabetes. The results indicated that ethnicity and FSS were associated with DSM. Higher FSS scores were associated with higher DSM scores, independent of ethnicity. There were ethnic differences in several elements of FSS. DSM was highest in Haitian- as compared to African-Americans; yet Haitian Americans had poorer glycemic control. The findings suggest FSS together with ethnicity may influence critical health practices. Studies are needed that further investigate the relationships among minorities with diabetes, their intimate network (family and friends) and the diabetes care process.

Diabetes Self-management Behaviors, Medical Care, Glycemic Control, and Self-rated Health in US Men by Race/Ethnicity

Men, particularly minorities, have higher rates of diabetes as compared with their counterparts. Ongoing diabetes self-management education and support by specialists are essential components to prevent the risk of complications such as kidney disease, cardiovascular diseases, and neurological impairments. Diabetes self-management behaviors, in particular, as diet and physical activity, have been associated with glycemic control in the literature. Recommended medical care for diabetes may differ by race/ethnicity. This study examined data from the National Health and Nutrition Examination Surveys, 2007 to 2010 for men with diabetes (N = 646) from four racial/ethnic groups: Mexican Americans, other Hispanics, non-Hispanic Blacks, and non-Hispanic Whites. Men with adequate dietary fiber intake had higher odds of glycemic control (odds ratio = 4.31, confidence interval [1.82, 10.20]), independent of race/ethnicity. There were racial/ethnic differences in reporting seeing a diabetes specialist. Non-Hispanic Blacks had the highest odds of reporting ever seeing a diabetes specialist (84.9%) followed by White non-Hispanics (74.7%), whereas Hispanics reported the lowest proportions (55.2% Mexican Americans and 62.1% other Hispanics). Men seeing a diabetes specialist had the lowest odds of glycemic control (odds ratio = 0.54, confidence interval [0.30, 0.96]). The results of this study suggest that diabetes education counseling may be selectively given to patients who are not in glycemic control. These findings indicate the need for examining referral systems and quality of diabetes care. Future studies should assess the effectiveness of patient-centered medical care provided by a diabetes specialist with consideration of sociodemographics, in particular, race/ethnicity and gender.

The other side of the kitchen door: Domestic service in Lima, Peru

Domestic service refers to the work required to complete duties pertaining to the maintenance and functioning of the household, particularly when performed by employed labor. This study provides an ethnographic account of domestic service through an analysis of social behavior and cultural patterns. The participants in the social structure of domestic service are the señora (the lady of the house), her family, and the empleadas (domestic workers) all of whom have specific social identities and roles within the household. The señora/empleada dyad is central to the institution and all other participants are secondary. This study contributes to the growing body of work in anthropology that concentrates on elite sectors of society and explores theoretical issues relating to gender, class, and ethnic differences in Peru.

Integração de alunos imigrantes e refugiados no Instituto Federal de Brasília - IFB

Dissertação apresentada para obtenção a grau de mestre na área de Educação Social e Intervenção Comunitária

Integração de alunos imigrantes e refugiados no Instituto Federal de Brasília - IFB

Dissertação apresentada para obtenção a grau de mestre na área de Educação Social e Intervenção Comunitária

LUNG CANCER IN NEPAL: THE ROLE OF TRADITIONAL TOBACCO PRODUCTS AND COMBUSTION RELATED HOUSEHOLD AIR POLLUTION

The burden of chronic diseases such as cancer is increasing in low and middle income countries around the globe. Nepal, one of the world’s poorest countries, is no exception to this trend, with lung cancer as the leading causes of cancer deaths. Despite this, limited data is available on the environmental and behavioral risk factors that contribute to the lung cancer etiology in Nepal. The objectives of this dissertation are to: 1) investigate the ethnic differences in consumption of local tobacco products and their role in lung cancer risk in Nepal; 2) evaluate urinary metabolite of 1,3-butadiene as a biomarker of exposure to combustion related household air pollution (CRHAP); 3) investigate the association between CRHAP exposure and lung cancer risk using urinary metabolite of 1,3-butadiene as a biomarker of exposure; 4) investigate the association between CRHAP exposure and lung cancer risk using questionnaire based measure of exposure. Lung cancer cases (n=606) and frequency matched controls (N=606) were recruited from B.P. Koirala Memorial Cancer Hospital. We obtained biological samples and information on lifestyles including cooking habits and type of fuels used. We used liquid chromatograph tandem mass spectrometer (LC-MS/MS) to quantify urinary metabolites of 1,3-butadiene in urine samples. We employed a combination of logistic and linear regression models to detect any exposure-disease associations while controlling for known confounding variables. Overall, we found that ethnic groups in Nepal use different tobacco products that have different differing cancer potency -we observed the highest odds ratios for the traditional tobacco products. The biomarker analysis showed strong evidence that monohydroxybutyl mercapturic acid is associated with biomass fuel use among participants. However, we did not find significant association between urinary MHMBA and lung cancer risk. When we used questionnaire based measure of exposure to household air pollution, we observed significant, dose-response associations between CRHAP exposure and lung cancer risk, particularly among never-smokers. Our results show that important role of local tobacco products in lung cancer risk in Nepal. Furthermore, we demonstrate that CRHAP exposure is a risk factor for lung cancer risk, independent of tobacco smoking.

An Investigation of Child and Adolescent Dental Sealant Predictors, NHANES 2011-2012

Objective: To examine sociodemographic and dental factors for associations with dental sealant placement in children and adolescents aged 6-18 years old. Methods: Secondary data analysis of 2011-2012 NHANES data was conducted. Multiple logistic regression models were used to assess relationships between predictor variables and sealant presence. Results: More than a third (37.1%) of children and adolescents have at least one sealant present; 67.9% of children compared with 40.4% of adolescents. Racial/ethnic differences exist, with Non-Hispanic black youth having the lowest odds of having sealants. Sealant placement odds vary by presence of dental home; the magnitude of the odds varies by age group. Those with untreated decay have lower odds of having sealants than those who do not have untreated decay (child OR: 2.6, 95% CI: 1.83-3.72; adolescent OR: 3.9, 95% CI: 2.59-6.07). Conclusion: Disparities exist in odds of sealant prevalence across racial/ethnic groups, income levels, and dental disease and visit characteristics. Further research is necessary to understand the reasons for these differences and to inform future interventions.

Essays in the Economics of the Family and Cultural Transmission

My research aims at identifying the role cultural-ethnic traits play in marriage choices and at uncovering the implications of marital sorting on consequent intra-household decisions. From different perspectives, this thesis focuses on intermarriages, within the Italian marriage market. In the first chapter, I explore the role of ethnic endogamy on marital instability. I document the existence of a positive differential in marital instability of interethnic marriages compared to homogeneous ones and I demonstrate that genetic and ethnolinguistic measures of cultural diversity are informative about the incidence of marital dissolution. The second chapter investigates a novel channel, which explains the differential in household stability and investments across family types: cultural socialization of children. I propose a marital matching model along cultural-ethnic lines, to study the process of family formation and intra-household decision making in a context where ethnic differences between spouses potentially matter both in terms of preferences and technologies for household production. The observed intermarriage, fertility, separation and socialization rates are in line with theoretical predictions and they are consistent with strong preferences of parents toward cultural socialization of children to their own ethnic identity. In the third chapter, I propose and estimate a marital matching model along ethnic lines. I argue that gains to intermarriage depend on both cultural preferences and legal status motives. Taking advantage of the exogenous EU enlargements to East European countries in 2004 and 2007, I show that gains to intermarriage of East European migrants significantly decrease in response to the acquisition of the legal status. The final chapter aims to understand whether judicial decisions respond to the ethnic identity of spouses and what incentives those judgments are guided, by looking at separation and divorce sentences. Studying the legal custody assignment of children, I document a significant differential interacting mothers’ ethnicities with the family type.