Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Caribbean”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources
PubMed2006

Simian immunodeficiency virus SIVagm.sab infection of Caribbean African green monkeys: a new model for the study of SIV pathogenesis in natural hosts.

Caribbean-born African green monkeys (AGMs) were classified as Chlorocebus sabaeus by cytochrome b sequencing. Guided by these phylogenetic analyses, we developed a new model for the study of simian immunodeficiency virus (SIV) infection in natural hosts by inoculating Caribbean AGMs with their species-specific SIVagm.sab. SIVagm.sab replicated efficiently in Caribbean AGM peripheral blood mononuclear cells in vitro. During SIVagm.sab primary infection of six Caribbean AGMs, the virus replicated at high levels, with peak viral loads (VLs) of 10(7) to 10(8) copies/ml occurring by day 8 to 10 postinfection (p.i.). Set-point values of up to 2 x 10(5) copies/ml were reached by day 42 p.i. and maintained throughout follow-up (through day 450 p.i.). CD4(+) T-cell counts in the blood showed a transient depletion at the peak of VL, and then returned to near preinfection values by day 28 p.i. and remained relatively stable during the chronic infection. Preservation of CD4 T cells was also found in lymph nodes (LNs) of chronic SIVagm.sab-infected Caribbean AGMs. No activation of CD4(+) T cells was detected in the periphery in SIV-infected Caribbean AGMs. These virological and immunological profiles from peripheral blood and LNs were identical to those previously reported in African-born AGMs infected with the same viral strain (SIVagm.sab92018). Due to these similarities, we conclude that Caribbean AGMs are a useful alternative to AGMs of African origin as a model for the study of SIV infection in natural African hosts.

Animals↗
PubMed2001

Increased common carotid intima-media thickness in UK African Caribbeans and its relation to chronic inflammation and vascular candidate gene polymorphisms.

BACKGROUND AND PURPOSE: Individuals of African Caribbean descent who live in the United Kingdom have an increased risk of stroke. The reasons for this are not fully understood, but differences in genetic predispositions or other novel stroke risk factors could play a role. US blacks have been reported to have increased common carotid artery wall thickness, or intima-media thickness (IMT), measured by ultrasound. We measured carotid IMT in UK African Caribbeans compared with UK whites and determined whether different distributions of polymorphisms in potential candidate vascular genes or differences in measures of chronic inflammation or infection could account for any difference. METHODS: In a population study, common carotid artery IMT was measured in 202 white men and 89 African Caribbean men. The distribution of polymorphisms in ACE, paraoxonase 1, paraoxonase 2, and methylenetetrahydrofolate reductase genes was determined. Serum C-reactive protein and Helicobacter pylori seropositivity were determined. RESULTS: Carotid IMT was increased in African Caribbeans even after controlling for cardiovascular risk factors, including homocysteine and social class: beta=0.113, 95% CI 0.036 to 0.189, P=0.004. There was a significant interaction with smoking and mean IMT (P=0.022), and the difference in both measures of IMT between ethnic groups was largely limited to individuals who had never smoked. There were significant ethnic differences in the distributions of 3 of the 4 candidate genes studied (ACE, paraoxonase 1, and methylenetetrahydrofolate reductase). H pylori seropositivity was increased in African Caribbeans (78.7% versus 53% in UK whites). However, neither the genetic polymorphisms nor H pylori seropositivity was related to IMT, and ethnic differences in their distribution did not account for the increased IMT seen in African Caribbeans. CONCLUSIONS: Carotid IMT is increased in UK African Caribbeans even after controlling for conventional risk factors. There are highly significant ethnic differences in the distribution of many potential cerebrovascular candidate genes. Although those we examined did not explain the ethnic differences in IMT, other genetic predispositions or environmental exposures could account for these differences.

Adult↗
PubMed1994

Schizophrenia in the Afro-Caribbean community.

Previous studies have shown high rates of schizophrenia among the Afro-Caribbean population in Britain. In order to assess the role of genetic factors in the aetiology of this phenomenon, we have used a standardised family history method (FHRDC) to compare lifetime morbidity risks for first-degree relatives of Afro-Caribbean and white patients with RDC schizophrenia admitted in Central Manchester between 1982 and 1988. Lifetime morbidity risk for parents of Afro-Caribbean subjects was 8.9%, and for parents of white patients 8.4%. For the siblings of black probands, however, the risk was 15.9%, as compared with 1.8% for white siblings (P < 0.05). Among siblings of UK-born Afro-Caribbean probands, morbid risk was even higher at 27.3% (P = 0.001). High rates among siblings of younger Afro-Caribbean patients are consistent with previous reports of a higher incidence in the UK-born. These observations suggest that schizophrenia among Afro-Caribbeans is no less familial than for the remainder of the population, but that the increased frequency of the disorder is due to environmental factors which are most common in the Afro-Caribbean community, and capable of precipitating schizophrenia in those who are genetically predisposed.

Adult↗
PubMed2002

The distribution of Mini-Mental State Examination scores in an older UK African-Caribbean population compared to MRC CFA study norms.

OBJECTIVE: to describe normative data for the Mini-Mental State Examination (MMSE) in a UK African-Caribbean population and compare these with norms for white UK-born elders. DESIGN: a comparison of MMSE data from two cross-sectional surveys. METHOD: the MMSE had been administered to a community UK African-Caribbean population and scores were compared to norms from the Medical Research Council Cognitive Function and Ageing Study (CFAS). MMSE data were analysed for 248 African-Caribbean participants aged 55-75 and 5379 CFAS participants aged 65-74, without visual or auditory problems. Distributions of scores were tabulated and error rates for individual items compared. RESULTS: Median MMSE scores were 25 (interquartile range 22-27) for the whole African-Caribbean sample, 24 (22-27) for those aged 65-75 in the African-Caribbean sample, and 27 (25-29) for CFAS. Differences in error rates were specific to particular items: naming the season, serial seven subtraction, phrase repetition, three-stage command, and copying intersecting pentagons. These differences persisted when both samples were restricted to those with statutory duration of education, who were literate and who had worked in non-manual occupations. Normative data are displayed for MMSE scores in both groups. CONCLUSION: different distributions of MMSE scores between UK African-Caribbean and Caucasian groups can be principally explained by cultural bias in certain items. If the MMSE is to be administered to older African-Caribbean people, specific normative data should be referred to or else a culturally modified version of the instrument should be used.

Aged↗
PubMed1999

Factors associated with obesity in South Asian, Afro-Caribbean and European women.

OBJECTIVE: To investigate correlates of body mass index (BMI) and other anthropometric measurements in South Asian, Afro-Caribbean and European women in the UK. SUBJECTS: 291 South Asian, 303 Afro-Caribbean, and 559 European women aged 40-69y in West London, UK. DESIGN: Cross-sectional survey. MAIN OUTCOME MEASURES: BMI, waist-to-height ratio (WHt), and skinfold thicknesses. RESULTS: Compared with European women, South Asian and Afro-Caribbean women were more like to be obese (odds ratios (OR) 1.83 and 3.01, respectively), but less likely to rate themselves as overweight (BMI-adjusted OR 0.19 and 0.34, respectively). The proportion of women who walked at least 2.5 km/d, excluding activity at work, was lower in South Asians (22%) than in Europeans (44%) or Afro-Caribbeans (40%). Among employed women, the proportion who were active at work was higher in South Asians (63%) and Afro-Caribbeans (70%) than in Europeans (49%). In Europeans, obesity was inversely associated with social class, education, smoking, alcohol intake, and distance walked, and positively associated with time spent watching television. Adjustment for alcohol intake, smoking, education and transport, physical activity explained over 80% of the difference in BMI between South Asians and Europeans, but not the difference between Afro-Caribbeans and Europeans. CONCLUSION: The factor that may be most amenable to intervention in South Asian women is low physical activity outside the workplace. The high prevalence of obesity in Afro-Caribbean women, however, is not accounted for by any behavioural factors measured in this study, and the reasons for high rates of obesity in this group remain to be established.

Adult↗
PubMed1999

Prevalence of anxiety and depressive illness and help seeking behaviour in African Caribbeans and white Europeans: two phase general population survey.

OBJECTIVE: To determine the prevalence of common mental disorders (anxiety and depression) and help seeking behaviour in African Caribbeans and white Europeans. DESIGN: Two phase survey in a general population sample. The first phase comprised screening with the 12 item general health questionnaire; the second phase was standardised psychiatric assessment and interview about help seeking. SETTING: People registered with four general practices in central Manchester. PARTICIPANTS: Of 1467 people randomly selected from family health services authority lists, 864 were still resident. 337 African Caribbeans and 275 white Europeans completed the screening phase (response rate 71%); 127 African Caribbeans and 103 white Europeans were interviewed in the second phase. MAIN OUTCOME MEASURES: One month period prevalence of anxiety and depressive disorders in each ethnic group. RESULTS: 13% of African Caribbeans (95% confidence interval 10% to 16%) and 14% (10% to 18%) of white Europeans had one or more disorder. Anxiety disorders were significantly less common among African Caribbeans (3% (1% to 5%) v 9% (6% to 12%) in white Europeans). Depressive disorders were significantly more common among African Caribbean women than white women (difference 8% (1% to 15%)). Medical help seeking was similar in the two groups, but African Caribbeans with mental disorders were more likely to seek additional help from non-medical sources (12/29 v 5/29, P=0.082). CONCLUSIONS: In an inner city setting the prevalence of common mental disorders is similar in these two ethnic groups.

Black or African American↗
PubMed1995

Child and adolescent psychiatric presentations of second-generation Afro-Caribbeans in Britain.

BACKGROUND: A clinical sample was used to investigate whether second-generation Afro-Caribbean children differed from other British-born children in their psychiatric presentation or vulnerability to risk factors. METHOD: Second-generation Afro-Caribbean patients (n = 292) were compared with a predominantly white group of patients (n = 1311) who lived in the same inner-city area and attended the same child psychiatric clinic between 1973 and 1989. Data on psychiatric presentation and background factors were systematically recorded at the time of the initial clinical assessment. RESULTS: Afro-Caribbean patients were exposed to more socio-economic disadvantage but less family dysfunction. The ratio of emotional to conduct disorders was lower among Afro-Caribbean than among the comparison patients--an effect that was not evidently due to demographic factors or diagnostic bias. Most risk factors for emotional or conduct disorders had comparable effects on Afro-Caribbean and comparison patients. Psychotic and autistic disorders were disproportionately common among the Afro-Caribbean patients. CONCLUSIONS: Second-generation Afro-Caribbean children differ somewhat from other British-born children in their psychiatric presentation--a difference that has persisted over the 1970s and 1980s and that deserves more investigation than it has received to date.

Acculturation↗
PubMed1998

Hormonal findings in African-American and Caribbean Hispanic girls with premature adrenarche: implications for polycystic ovarian syndrome.

BACKGROUND: Premature adrenarche refers to the early maturation of the adrenal zona reticularis such that the resultant modest hyperandrogenism causes the early appearance of pubic hair before the age of 8 years in girls and 9 years in boys. The precise etiology of premature adrenarche is not known. However, recent studies indicate that certain girls with premature adrenarche are at risk of developing functional ovarian hyperandrogenism, polycystic ovarian syndrome, and hyperinsulinism. Caribbean Hispanic women in general are at increased risk of developing polycystic ovarian syndrome, and African-Americans are at increased risk of developing the complications of hyperinsulinism. Previously, girls with premature adrenarche were reported to have androgens in the range found in normal children in the early stages of puberty. We noted that many of our African-American and Caribbean Hispanic patients with premature adrenarche had androgens that were much higher than what has been reported previously. OBJECTIVE: This retrospective study was performed to characterize the adrenocorticotropin-stimulated androgen response in an African-American and Caribbean Hispanic population of girls with premature adrenarche. METHODOLOGY: The androgen response to adrenocorticotropin stimulation in 72 African-American and Caribbean Hispanic girls with premature adrenarche was compared with those reported for normal girls in early puberty (Tanner stages II and III). The mean age was 6.8 +/- 0.8 years, bone age was 8 +/- 1.5 years, pubic hair was Tanner stages II and III, and body mass index was 18.6 +/- 4. RESULTS: Of the girls, 28% were found to have elevated stimulated 17OHPregnenolone (17OHPreg) levels that were >2 SD units above the mean for normal early pubertal children. The stimulated ratio of 17OHPreg/17OHProgesterone also was elevated in 18% of the girls and showed a modest correlation with body mass index. CONCLUSION: In contrast to previous studies of girls of mixed ethnic backgrounds with premature adrenarche, 28% of the 72 African-American and Caribbean Hispanic girls with premature adrenarche had adrenocorticotropin-stimulated 17OHPreg levels that were significantly higher than those seen in early pubertal girls. Because 17OHPreg hyperresponsiveness has been described previously in women with hirsutism or polycystic ovarian syndrome, the similar finding in many African-American and Caribbean Hispanic girls with premature adrenarche suggests that the two conditions may share a common mechanism for their hyperandrogenism. Therefore, the hyperandrogenism in certain African-American and Caribbean Hispanic girls with premature adrenarche may not be benign and may be the first presentation of polycystic ovarian syndrome.

Black or African American↗
PubMed2001

A founder mutation in presenilin 1 causing early-onset Alzheimer disease in unrelated Caribbean Hispanic families.

CONTEXT: Genetic determinants of Alzheimer disease (AD) have not been comprehensively examined in Caribbean Hispanics, a population in the United States in whom the frequency of AD is higher compared with non-Hispanic whites. OBJECTIVE: To identify variant alleles in genes related to familial early-onset AD among Caribbean Hispanics. DESIGN AND SETTING: Family-based case series conducted in 1998-2001 at an AD research center in New York, NY, and clinics in the Dominican Republic. PATIENTS: Among 206 Caribbean Hispanic families with 2 or more living members with AD who were identified, 19 (9.2%) had at least 1 individual with onset of AD before the age of 55 years. MAIN OUTCOME MEASURE: The entire coding region of the presenilin 1 gene and exons 16 and 17 of the amyloid precursor protein gene were sequenced in probands from the 19 families and their living relatives. RESULTS: A G-to-C nucleotide change resulting in a glycine-alanine amino acid substitution at codon 206 (Gly206Ala) in exon 7 of presenilin 1 was observed in 23 individuals from 8 (42%) of the 19 families. A Caribbean Hispanic individual with the Gly206Ala mutation and early-onset familial disease was also found by sequencing the corresponding genes of 319 unrelated individuals in New York City. The Gly206Ala mutation was not found in public genetic databases but was reported in 5 individuals from 4 Hispanic families with AD referred for genetic testing. None of the members of these families were related to one another, yet all carriers of the Gly206Ala mutation tested shared a variant allele at 2 nearby microsatellite polymorphisms, indicating a common ancestor. No mutations were found in the amyloid precursor protein gene. CONCLUSIONS: The Gly206Ala mutation was found in 8 of 19 unrelated Caribbean Hispanic families with early-onset familial AD. This genetic change may be a prevalent cause of early-onset familial AD in the Caribbean Hispanic population.

Age of Onset↗
PubMed2000

Cognitive function in UK community-dwelling African Caribbean and white elders: a pilot study.

In recent years there has been interest in risk of cognitive impairment and dementia in populations of African origin. Little is known about this risk in older African Caribbean residents in the UK. One difficulty is lack of consensus over an adequate cognitive test battery for this community. Forty-five African Caribbean and 45 age and gender matched white community residents were recruited by household enumeration of an inner London electoral ward. These participants were administered the MMSE during a screening interview. Where possible, this was followed up by tests from the CERAD and CAMCOG neuropsychological batteries, a medical examination, and a structured interview with an informant. Based on these data, a psychiatrist blind to ethnicity independently rated 86 of these participants (41 of the African Caribbeans, all 45 of the whites) as cognitively normal, cognitively impaired, or demented. Of 41 African Caribbeans, 18 (44%) were rated as cognitively normal, 9 (22%) were rated as cognitively impaired, and 14 (34%) were rated as demented. Of the 45 whites, 39 (87%) were rated as cognitively normal, 4 (9%) were rated as cognitively impaired, and 2 (4%) were rated as demented. African Caribbeans scored significantly lower than whites in most cognitive test scores, which was not accounted for by their lower educational and occupational attainment, or their higher frequency of cardiovascular risk factors. African Caribbean elders in the UK appear to be at high risk of cognitive impairment and dementia. However, the influence of potential confounding factors such as socio-economic position and ill-health, and the effect of cultural test bias, cannot be ruled out.

Aged↗
PubMed1997

Petroleum pollution in the Gulf of Mexico and Caribbean Sea.

In 1976, IOC-UNESCO and UNEP convened a meeting in Port of Spain to analyze the marine pollution problems in the region, noting that petroleum pollution was of regionwide concern and recommended initiating a research and monitoring program to determine the severity of the problem and monitor its effects. The Wider Caribbean is potentially one of the largest oil-producing areas in the world. Major production sites include Louisiana and Texas in the U.S.; the Bay of Campeche, Mexico; Lake Maracaibo, Venezuela; and the Gulf of Paria, Trinidad. All these are classified as high-risk production accident zones. Main sources of petroleum pollution in the Wider Caribbean are production, exploitation, transportation, urban and municipal discharges, refining and chemical wastes, normal loading and unloading operations, and accidental spills. About 5 million barrels of crude oil are transported daily in the Caribbean, thus generating an intense tanker traffic. It has been estimated that oil discharges from tank washings within the Wider Caribbean could be as high as 7 million barrels/yr. The results of the Caribbean Pollution Regional Program (CARIPOL) conducted between 1980 and 1987 pointed out that significant levels of petroleum pollution exist throughout the Wider Caribbean, including serious tar contamination of windward exposed beaches, high levels of floating tar within the major current systems, and very high levels of dissolved and dispersed hydrocarbons in surface waters. Major adverse effects of this type of pollution include: high tar levels on many beaches that either prevent their recreational use or require very expensive cleanup operations, distress and death for marine life, and responses in the enzyme systems of marine organisms that have been correlated with declines in reproductive success. Finally, the presence of polycyclic aromatic hydrocarbons (PAHs) in tissues of important economic species has been reported, creating a risk for public health because of the potential carcinogenic effects.

Accidents, Occupational↗
PubMed2005

Differences in the association between type 2 diabetes and impaired microvascular function among Europeans and African Caribbeans.

AIMS/HYPOTHESIS: Diabetes is associated with microvascular damage in all populations, but diabetic patients of Black African descent (African Caribbeans) have a greater risk of vascular target organ damage than would be anticipated for any given blood pressure level. We investigated whether this may be due to differences in the microvasculature. MATERIALS AND METHODS: To assess the maximum hyperaemic response to heating and the post-ischaemic response, Laser Doppler fluximetry was performed on 51 and 100 Europeans, and on 66 and 88 African Caribbeans with and without diabetes, respectively. Subjects were aged between 40 and 65 years and recruited from the general population. Echocardiographic interventricular septal thickness (IVST) was measured as a proxy for vascular target organ damage. RESULTS: In diabetic subjects of both ethnic groups, the maximum hyperaemic response and peak response to ischaemia were attenuated as compared to the corresponding non-diabetic subjects (p=0.08 for diabetic and 0.03 for non-diabetic Europeans; p=0.03 and 0.1 for African Caribbeans). Adjustment for cardiovascular risk factors, in particular insulin and blood pressure, abolished these differences in Europeans (p=0.8 for diabetic and 0.2 for non-diabetic Europeans), but not in African Caribbeans (p=0.03 and 0.05). CONCLUSIONS/INTERPRETATION: Persisting microvascular dysfunction in African Caribbeans may contribute to the increased risk of target organ damage observed in diabetes in this population. The weak contribution of conventional cardiovascular risk factors to these disturbances indicates that conventional therapeutic interventions may be less beneficial in these patients. There was a risk-factor-independent, inverse association between IVST and maximal hyperaemia. These ethnic differences in microvascular responses to temperature and arterial occlusion could account for increased target organ damage in African Caribbeans.

Aged↗
PubMed2002

Lower prevalence of pre-morbid neurological illness in African-Caribbean than White psychotic patients in England.

BACKGROUND: It has been suggested that the increased incidence of psychosis in African-Caribbeans living in England may be due to illnesses in which social stress plays an important aetiological role. If this is the case, the prevalence of factors associated with psychosis that predate illness onset such as obstetric complications, pre-morbid neurological illness and poor childhood social adjustment may be expected to be lower in African-Caribbean than Whites psychotic patients. METHOD: Details of obstetric complications, pre-morbid neurological illness, and pre-morbid social adjustment were obtained for 337 psychotic patients by patient interview, interviews of mothers and chart review. The proportions of patients with each 'risk factor' in the African-Caribbean (N = 103) and White (N = 184) groups were compared using regression analysis; age, sex, social class, diagnosis and referral status were possible explanatory variables. RESULTS: African-Caribbean patients were less likely to have suffered a pre-morbid neurological disorder than their White counterparts (odds ratio 0.19, 95% CI 0.06-0.61). There was no significant difference in pre-morbid social adjustment or obstetric complications between the two groups, though fewer obstetric complications were reported in the African-Caribbean group (21.5%) than the White group (30.9%). CONCLUSIONS: African-Caribbean patients with psychosis have experienced less pre-morbid neurological illness.

Black or African American↗
PubMed1997

Incidence and outcome of schizophrenia in whites, African-Caribbeans and Asians in London.

BACKGROUND: Several previous studies have indicated high rates of schizophrenia in African-Caribbeans in the UK compared to White population. METHOD: All people aged 18 to 64 years residing in two health districts in London who made contact with hospital or community services over a 1-year (Whites) or 2-year (ethnic minorities) period were screened for psychotic symptoms. RESULTS: One hundred and twenty-three patients passed the screen, of whom 100 were assigned a schizophrenic class by the CATEGO program. Of these, 38 were White, 38 African-Caribbean and 24 Asian. The incidence rate for broad schizophrenia was significantly higher for African-Caribbeans than for Whites. Asians showed a high rate among people age 30 and over, particularly women. Poor outcome at 1-year follow-up was significantly more common for African-Caribbeans than for the other two groups. The proportion of African-Caribbeans with a poor outcome was two and a half times greater than that of Whites. On a range of seven socio-demographic variables, African-Caribbeans differed from the other two groups only on unemployment. CONCLUSIONS: A multitide of factors play a role in the aetiology of schizophrenia. Comparison of environmental factors in these groups may identify factors that contribute to the aetiology of schizophrenia.

Adolescent↗
PubMed1999

Nutrient intake trends among African-Caribbeans in Britain: a migrant population and its second generation.

OBJECTIVE: To explore British African-Caribbean (AfC) nutrient intake by migration status (place of birth), diet (traditional Caribbean or more European) and age and relate this ecologically to coronary heart disease (CHD) mortality rates. DESIGN: Cross-sectional. SETTING: Inner-city Manchester, UK. SUBJECTS: Two hundred and fifty-five adults of AfC origin aged 25-79 years, randomly sampled from population registers. RESULTS: Caribbean-born people (mean age 56, and mean time in Britain 30 years) had significantly lower per cent energy from total and saturated fat than younger British-born AfC people (mean age 29 years) (31.3% vs. 35%, difference in total fat 3.7%, 95%CI 2-5%; in saturated fat 10.9% vs. 12.6%, difference 1.7%, 95%CI 1-2.5%). The Caribbean-born group also ate more fruit (+84g/day-1, 95%CI 36-132g/day-1) and green vegetables (+26 g/day-1, 95%CI 3-49 g/day-1). Men following a traditional diet (> or = 5 days week-1) similarly had a lower per cent energy from fat, at 30.4%, than less traditional eaters, at 33.1% (difference 2.7%, 95%CI 0.7-4.8%). African-Caribbean women, at relatively greater CHD risk than AfC men, had higher body mass indices (BMIs) than AfC men. Compared with national data, AfC subjects consumed some 7% and 5% less energy from total fat and saturated fat, respectively, with over 9% more from carbohydrate. However, there was marked convergence towards the national average in the youngest AfC groups aged 25-34 years, whatever their place of birth. CONCLUSIONS: Caribbean birthplace has an independent effect on total fat intake and percentage of energy from fat. Together with higher fruit and vegetable intake, these results are consistent with the dietary fat/antioxidant/CHD hypothesis.

Adult↗
PubMed2004

Diabetic retinopathy progression and visual outcome after phacoemulsification in South-Asian and Afro-Caribbean patients with diabetes.

PURPOSE: To determine diabetic retinopathy or maculopathy progression and visual outcome following phacoemulsification in South-Asian and Afro-Caribbean patients with diabetes. METHODS: Review of notes of patients with type II diabetes undergoing phacoemulsification by one surgeon. The inclusion criteria were: (a) South-Asian or Afro-Caribbean ethnicity, (b) monocular cases with a minimum postoperative follow-up of 6 months, and (c) binocular cases with an interval of at least 6 months between the operation in the two eyes. The nonoperated eye was used as control. The development or progression of diabetic retinopathy or maculopathy and final visual acuity were recorded. RESULTS: In all, 30 diabetic patients were included. There were 19 South-Asians (Pakistani, Indian, and Bangladeshi) and 11 Afro-Caribbeans. The mean (+/-SD) age was 68.9 (+/-10) years. Retinopathy or maculopathy progression was noted in seven patients (23.4%), two South-Asians, and five Afro-Caribbeans. There was no significant difference in the number of operated and fellow eyes whose retinopathy or maculopathy progressed postoperatively. Progression of retinopathy or maculopathy occurred more often in Afro-Caribbeans compared to South-Asians (P=0.02, logistic regression analysis). The mean (+/-SD) postoperative follow-up was 12.4 (+/-6.5) months. Visual acuity improved by at least two or more Snellen lines in 19 eyes (63.3%); 26 eyes (86.7%) achieved a final visual acuity of at least 6/12. CONCLUSIONS: Afro-Caribbeans may be at a higher risk of progression of retinopathy or maculopathy after phacoemulsification.

Adult↗
PubMed2004

Dying to be home? Preferred location of death of first-generation black Caribbean and native-born white patients in the United Kingdom.

Although preference for location of death has been studied in the general population little is known about the experience of people from different ethnic backgrounds and nothing about the black Caribbean population living in the United Kingdom. Over 13 months we surveyed the family and friends of deceased first-generation black Caribbean and native-born white patients with advanced disease. Of the 106 black Caribbean and 110 white patients identified, 50 interviews per ethnic group were conducted, a response rate of 47% and 45%. It was found that 21% of all patients surveyed died in their own home, 61% in hospital, 12% in a hospice, and 6% in a residential/nursing home. Thirty-four percent of black Caribbean compared to 27% native-born white patients were reported to have expressed a preference for location of death and of these over 80% of all patients wanted to die at home. Similar proportions of patients from the Caribbean (53%) and white (56%) patient groups who wanted to die at home did so. This was not related to restrictions in patients' activities of daily living or self-reported caregiver burden. Fewer respondents representing Caribbean than white patients stated that neither they (chi(2) = 8.9, p = 0.01) or the deceased patients (chi(2) = 8.6, p = 0.03) were given sufficient choice about the location of death. Our findings suggest: (1) a need to improve training in discussing care and treatment choices, including location of death, and (2) a deeper qualitative understanding of the cultural and other factors that may facilitate or prevent home deaths.

Aged↗
PubMed2001

A comparison of left ventricular abnormalities associated with glucose intolerance in African Caribbeans and Europeans in the UK.

OBJECTIVE: To determine whether abnormalities of the left ventricle differ by glucose tolerance status, to explore reasons for differences, and to assess ethnic differences in these relations. DESIGN: Population based prevalence study. SETTING: London, UK. PATIENTS: 1152 African Caribbeans and Europeans. METHODS: Echocardiograms, blood pressure, obesity, fasting and two hour blood glucose, insulin and lipids, and urinary albumin excretion rate were measured. MAIN OUTCOME MEASURES: Left ventricular mass index, wall thickness, and early (E) to atrial (A) wave ratio. RESULTS: Left ventricular mass index was greater in diabetic Europeans than in normoglycaemic Europeans (mean (SE), 95.6 (5.0) v 79.7 (0.8) g/m(2), p = 0.001) and in diabetic African Caribbeans than in normoglycaemic African Caribbeans (88.6 (2.5) v 82.4 (0.9) g/m(2), p = 0.02). Similar, but weaker associations were observed for the E:A ratio. beta Coefficients between left ventricular mass index and fasting glucose in the normoglycaemic range, adjusted for age and sex, were 2.43 in Europeans (p = 0.05) and 3.74 in African Caribbeans (p = 0.02). These were attenuated to 1.19 (p = 0.4) and 3.03 (p = 0.08) in Europeans and African Caribbeans, respectively, when adjusted further for blood pressure and obesity. Adjustments for other risk factors made little difference to the coefficients. There were no ethnic differences in risk factor relations. CONCLUSIONS: Abnormalities of the left ventricle occur in response to glucose intolerance and are observable into the normoglycaemic range. These disturbances are largely accounted for by associated obesity and hypertension. African Caribbeans have a greater degree of left ventricular structural impairment, emphasising the importance of tight blood pressure control.

Adult↗