Does Racism Discriminate? Racial and Ethnic Discrimination Among Nigerians and Jamaicans in Houston Texas

As a result of more racially inclusive immigration policies in the U.S., the African and Caribbean population has increased. Thus far, scholarly inquiry on Black immigrants have focused on their incorporation into the racial hierarchy, their experiences with racism, and their relationships with African Americans. While beneficial, these studies overlook the impact of ethnic discrimination for Black immigrants. Although all individuals of African descent share similar racialized experiences in the U.S., I hypothesize that diverse Black immigrant groups endure unique discriminatory experiences because of their ethnic identities. Thus, through in-depth interviews with 27 Nigerian and 20 Jamaican respondents, this paper explores Black immigrants’ experiences with racial and ethnic discrimination. I found that, regardless of ethnic background, 80% of my Nigerian and Jamaican respondents encountered racism. In contrast, ethnic discrimination varied between my Nigerian and Jamaican respondents. My Nigerian respondents were more likely to report their encounters with ethnic discrimination. These experiences ranged from being accused of internet scamming to being mocked for having an accent. On the other hand, not only were my Jamaican respondents less likely to report ethnic discrimination, but they were also more likely to see their ethnicity as an advantage.

Anthropometric cut-offs to identify hyperglycemia in an Afro-Caribbean population: a cross-sectional population-based study from Barbados

IntroductionBody mass index (BMI) and waist circumference (WC) cut-offs associated with hyperglycemia may differ by ethnicity. We investigated the optimal BMI and WC cut-offs for identifying hyperglycemia in the predominantly Afro-Caribbean population of Barbados.Research design and methodsA cross-sectional study of 865 individuals aged ≥25 years without known diabetes or cardiovascular disease was conducted. Hyperglycemia was defined as fasting plasma glucose ≥5.6 mmol/L or hemoglobin A1c ≥5.7% (39 mmol/mol). The Youden index was used to identify the optimal cut-offs from the receiver operating characteristic (ROC) curves. Further ROC analysis and multivariable log binomial regression were used to compare standard and data-derived cut-offs.ResultsThe prevalence of hyperglycemia was 58.9% (95% CI 54.7% to 63.0%). In women, optimal BMI and WC cut-offs (27 kg/m2 and 87 cm, respectively) performed similarly to standard cut-offs. In men, sensitivities of the optimal cut-offs of BMI ≥24 kg/m2 (72.0%) and WC ≥86 cm (74.0%) were higher than those for standard BMI and WC obesity cut-offs (30.0% and 25%–46%, respectively), although with lower specificity. Hyperglycemia was 70% higher in men above the data-derived WC cut-off (prevalence ratio 95% CI 1.2 to 2.3).ConclusionsWhile BMI and WC cut-offs in Afro-Caribbean women approximate international standards, our findings, consistent with other studies, suggest lowering cut-offs in men may be warranted to improve detection of hyperglycemia. Our findings do, however, require replication in a new data set.

Socio-demographic factors in relation to habitual sodium and potassium intakes among adults in Trinidad and Tobago

Background: Approximately one-third of adults in Trinidad and Tobago have high blood pressure (hypertension). Excessive consumption of sodium (Na+) is a known risk factor for hypertension. Aim: We investigated Na+ and potassium (K+) intakes and their correlates in a multi-ethnic Caribbean population. Method: Volunteers completed a self-administered questionnaire comprising socio-demographic items, physical activity (PA) and a semiquantitative food frequency questionnaire. Foods eaten were classified by level of processing using the NOVA classification system and analysed for Na+ and K+ levels using appropriate dietary analysis software. The study was approved by the University of the West Indies at Saint Augustine Ethics Committee. Results: 11,783 adults participated in the study. Approximately 83.2% of total calories, 79% of Na+ and 40% of K+ was derived from the consumption of highly processed foods. Median daily Na+ and K+ intakes were 2759 mg and 2853 mg, respectively. Na+ intakes showed significant nonlinear increases with age ( p < 0.001) and body mass index (BMI) ( p < 0.001), and non-linear decreases with educational attainment ( p < 0.001). K+ intakes showed significant nonlinear decreases with age ( p < 0.001) and BMI ( p < 0.001), and linear increases with educational attainment ( p < 0.001). Males had higher intakes of Na+ and K+ than females. Na+: K+ was lower among persons participating in moderate to high intensity PA ≥ 150 minutes/week compared to those participating in such activities < 150 minutes/week. Conclusion: Socio-demographic factors were significantly correlated with Na+ and K+ intakes among participants and must be considered in strategies aimed at achieving healthy intakes of these nutrients.

Microvascular Angina : A Diagnosis Hidden in Plain Sight

Background: Patients who are initially suspected of having ischemic heart disease, but in whom normal coronaries are discovered at angiography, are frequently believed to have pain of a non-cardiac aetiology. Micro vascular angina is hardly ever diagnosed save in peri-menopausal women. Physicians traditionally tend to view coronary microvascular disease and obstructive coronary artery disease as two separate entities. Notwithstanding, recent studies have begun to focus on endothelial dysfunction as being a key component in all cardiovascular diseases, with or without obstructive coronary lesions. Hypothesis: Patients suspected of having obstructive coronary disease associated with a significant risk factor burden, but in whom normal coronaries are found at angiography, in reality possess microvascular dysfunction. Objectives: • To determine the prevalence of normal coronaries at elective angiography compared to subjects with significant obstructive lesions. • To examine the influence of risk factor burden in patients who present normal coronaries in comparison with those who demonstrate obstructive lesions at angiography. • To suggest endothelial dysfunction as the common nexus underlying the disparities in cardiovascular morbidity observed among population samples. Methods: A group of 90 patients were randomly selected from clinical files of those who underwent elective coronary angiography between January, 2013 and May, 2017. The study cohort was comprised of 55 males and 35 females between the ages of 43 to 84 years. All subjects presented chest pain suspected of being coronary in origin. Coronary risk factors were recorded for each patient and the results were compared with findings at coronary angiography and then correlated with those encountered in medical literature. Results: Normal coronary angiograms were more prevalent in the African-Caribbean population (54.16%), than within the Mestizo-Mayan population (37.5%) Conversely, the finding of an obstructive lesion was more common in the Mestizo-Mayan population (56.25%), than within the African-Caribbean group (31.25%). The African-Caribbean group generally possessed a greater risk factor burden than their Mestizo-Mayan counterparts. Mayan counterparts. The percentage of women with normal coronaries (52.94%) showed a slight increase over that of men (47.05%). Males possessed a prevalence for obstructive disease of almost 4 times greater (79.48% vs. 20.5%) than females, yet females demonstrated a greater risk factor burden than males in most risk parameters. Hypertension was the most prevalent risk factor followed by dyslipidaemia and diabetes mellitus but these factors were more commonly encountered in patients with “normal” coronaries, than in those with obstructive lesions. Conclusion: Our study reported a significant number (56.66%) of “normal” coronaries at angiography. The majority (54.16%) of this figure pertained to the African-Caribbean sub-group, which in other studies also appeared to have a lesser coronary disease morbidity and mortality than their white counterparts despite having a greater risk factor burden. This is particularly true in the female African-Caribbean population. Several research papers have made reference to racial, ethnic and gender disparities in the manifestation of cardiovascular diseases. Paradoxically in some cases risk factor burden may be higher in the non-obstructive group rather than in the obstructive population. Convincing research has led us to believe that the vascular endothelium in its state of dysfunction plays a key role in explaining these disparities. Wherever cardiovascular risk factors exert their damage, endothelial injury and dysfunction ensues. Therefore, having an established risk factor burden portends microvascular dysfunction independently of any angiographic result.

Dietary Intake Patterns, Nutrient Adequacy and Associated Factors in a Multi-Ethnic Caribbean Population

Objectives To evaluate the distribution and correlates of foods consumed among persons 18–65 years. Methods Participants completed a questionnaire consisting of dietary, demographic and lifestyle items. Anthropometry was self reported with 15% of participants having weight and heights measured using recommended procedures. Dietary intakes were analyzed for nutrient composition using the NutriGenie 7.0 software. Foods were categorized by the level of processing as unprocessed/minimally processed or processed/ultra-processed. Inadequate intakes were categorized as energy-adjusted nutrient intakes &lt; estimated average reference intake (EAR) or average intakes (AI) according to the Institute of Medicine 2006 recommendations. Dietary patterns were determined by principal component analysis (PCA). The study was approved by The University of the West Indies Ethics Committee. Participation was voluntary follow oral and written consent Results Altogether, 11783 persons (females = 6743; males 5040) participated in the study. Approximately 72.5% of participants reported habitual plausible energy intakes (i.e., a Goldberg ratio of 1.35–2.40). Mean calorie intakes were higher in males than females (2771 ± 674 vs. 2270 ± 599 kcals; P &lt; 0.001). Persons of South Asian- and Mixed-descents were more likely that those of African-descent to report plausible intakes of calories. PCA reveal three predominate dietary intake patterns designated ‘Typical’, ‘Fruit and Vegetables’, and ‘Prudent’ that explain 44% of the variance in nutrient adequate diets. Process/ultra-process foods accounted for 83% of calories consumed and 60–80% of micronutrient intakes with the exception of potassium, vitamin C, folate and fibre. Overall nutrient inadequacies were noted for potassium, magnesium, vitamins D, E, &lt; K and fibre; and vitamin B12 and iron among females. Conclusions Among participants process/ultra-processed foods were the main sources of nutrients. Furthermore participants may be at risk for inadequate intakes of key nutrients. Our food policy needs to create an environment that fosters availability and consumption of nutrient- rather that energy-dense foods. Funding Sources Self funded.

Assessment of Commercial SARS-CoV-2 Antibody Assays, Jamaica

The performance of the Roche Elecsys® Anti-SARS-CoV-2, Abbott Architect SARS-CoV-2 IgG, Euroimmun SARS-CoV-2 IgA, Euroimmun SARS-CoV-2 IgG ELISA, and Trillium IgG/IgM rapid assays was evaluated in Jamaica, the largest country of the English-speaking Caribbean. Diagnostic sensitivities of the assays were assessed by testing serum samples from SARS-CoV-2 PCR-confirmed persons. Serum samples collected ≥14 days after onset of symptoms, or ≥14 days after an initial SARS-CoV-2 RT-PCR positive test for asymptomatics, showed diagnostic sensitivities ranging from 67.9-75.0% when including all possible disease severities and increased to 90.0-95.0% when examining those with moderate to critical disease. Grouping moderate to critical disease showed a significant association with a SARS-CoV-2 antibody positive result for all assays. Diagnostic specificity, assessed by testing serum samples collected during 2018-2019 from healthy persons and from persons with antibodies to a wide range of viral infections, ranged from 96.7-100.0%. For all assays examined, SARS-CoV-2 real-time PCR cycle threshold (Ct) values of the initial nasopharyngeal swab sample testing positive were significantly different for samples testing antibody positive versus negative. These data from a predominantly African descent Caribbean population shows comparable diagnostic sensitivities and specificities for all testing platforms assessed and limited utility of these tests for persons with asymptomatic and mild infections.

A Caribbean perspective: Quality of Life in Major Lower Extremity Amputees

PURPOSE:Lower extremity amputations and diabetic foot-related complications in the Caribbean population have been previously reported [1-3]. However, there is a lack of evidence which assesses the Quality of life experienced in such amputees. The aim of this study was to determine the health-related Quality of life (HRQoL) in patients after a major lower limb amputation.METHODS:All major lower limb amputations undertaken at a tertiary care institution in Trinidad and Tobago, between January 2012 to December 2016 were analysed. The quality of life was assessed using the EURO QOL 5D-5L tool. Statistical analysis was performed using t-test, ANOVA across various subgroups and Kaplan-Meier for mortality. RESULTS:A total of 134 individuals were still alive and willing to participate in the study. The average of HRQoL index value for the cohort was (0.598), which was significantly lower compared to the population norm p < .05 [4]. Statistically significant differences were also seen between patients who ambulated with a prosthesis (.759) compared to those who used another device (0.562), p < 0.05 and to patients who did not ambulate. A comparable Quality of life was seen between the level of amputation (transtibial versus transfemoral) and gender (males versus females), p values were .96 and 1.0 respectively. The overall mortality rate was 14% at 30-days and 27% at one year.CONCLUSION:Overall Quality of life after major amputation, as well as independent mobilisation with a prosthesis, continues to be problematic in the Caribbean population. Factors adversely related to Quality of life post major amputation include increasing age, problems related to mobility and non-ambulatory patients.