Kamal Eldeirawi

Associations of acculturation and country of birth with asthma and wheezing in Mexican American youths

Background: Mexican Americans have lower rates of asthma than other ethnic groups in the United States. Objective: To examine the relationship between country of birth and acculturation with asthma and wheezing among Mexican American youths. Methods: We used Chi-squared statistics and logistic regression analyses to determine the associations of country of birth and acculturation with asthma and wheezing among 1,770 Mexican Americans age 12–19 years who participated in the National Health and Nutrition Examination Survey 1999–2002. Results. Mexican American adolescents born in the United States and those with high acculturation levels reported significantly higher prevalence rates of asthma, wheezing, and hay fever than their peers with low acculturation levels and born in Mexico. In multivariate analyses, youths with a high acculturation level had a higher risk of asthma than those with a low acculturation level independent of country of birth. Highly acculturated youths born in the US had a higher risk for wheezing compared with less acculturated US-born or Mexico-born participants after adjusting for confounding variables. In contrast, associations of asthma and wheezing with country of birth were not significant after controlling for acculturation. Conclusions. Our findings showed that both acculturation and country of birth were linked with the risk of asthma and wheezing, with acculturation having stronger effects than country of birth, among Mexican American youths. These findings may imply that factors modified by immigration and acculturation could influence the risk of asthma and wheezing. Identification of such factors could help in the design of asthma prevention programs.

Association of gender with outcomes in critically ill patients

IntroductionThe influence of gender on mortality and other outcomes of critically ill patients is not clear. Different studies have been performed in various settings and patient populations often yielding conflicting results. We wanted to assess the relationship of gender and intensive care unit (ICU) outcomes in the patients included in the Acute Physiology and Chronic Health Evaluation (APACHE) IV database (Cerner Corporation, USA).MethodsWe performed a retrospective review of the data available in the APACHE IV database. A total of 261,255 consecutive patients admitted to adult ICUs in United States from 1 January 2004 to 31 December 2008 were included. Readmissions were excluded from the analysis. The primary objective of the study was to assess the relationship of gender with ICU mortality. The secondary objective was to evaluate the association of gender with active therapy, mechanical ventilation, length of stay in the ICU, readmission rate and hospital mortality. The gender-related outcomes for disease subgroups including acute coronary syndrome, coronary artery bypass graft (CABG) surgery, sepsis, trauma and chronic obstructive pulmonary disease (COPD) exacerbation were assessed as well.ResultsICU mortality was 7.2% for men and 7.9% for women, odds ratio (OR) for death for women was 1.07 (95% confidence interval (CI): 1.04 to 1.1). There was a statistically significant interaction between gender and age. In patients <50 years of age, women had a reduced ICU mortality compared with men, after adjustment for acute physiology score, ethnicity, co-morbid conditions, pre-ICU length of stay, pre-ICU location and hospital teaching status (adjusted OR 0.83, 95% CI: 0.76 to 0.91). But among patients ≥50 years of age, there was no significant difference in ICU mortality between men and women (adjusted OR 1.02, 95% CI: 0.98 to 1.06).A higher proportion of men received mechanical ventilation, emergent surgery, thrombolytic therapy and CABG surgery. Men had a higher readmission rate and longer length of ICU stay. The adjusted mortality of women compared to men was higher with CABG, while it was lower with COPD exacerbation. There was no significant difference in mortality in acute coronary syndrome, sepsis and trauma.ConclusionsAmong the critically ill patients, women less than 50 years of age had a lower ICU mortality compared to men, while 50 years of age or older women did not have a significant difference compared to men. Women had a higher mortality compared to men after CABG surgery and lower mortality with COPD exacerbation. There was no difference in mortality in acute coronary syndrome, sepsis or trauma.

Associations of physician-diagnosed asthma with country of residence in the first year of life and other immigration-related factors: Chicago Asthma School Study

BACKGROUND Among Mexican Americans in the United States, US-born children have higher rates of asthma than their Mexico-born peers. OBJECTIVE To evaluate the associations of immigration-related variables with physician-diagnosed asthma in a sample of Mexican American children. METHODS We analyzed data from the ongoing Chicago Asthma School Study, a population-based cross-sectional study, for 10,106 Mexican American schoolchildren in Chicago, Illinois. RESULTS Mexican American children who lived in the United States in the first year of life were more likely to have physician-diagnosed asthma than their peers who lived in Mexico in the first year of life, independent of age, sex, income, language, and country of birth (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.09-2.94). The risk of asthma in US-born children was higher (but not significantly) than that observed in Mexico-born children after accounting for covariates, including country of residence in the first year of life (OR, 1.37; 95% CI, 0.86-2.18). Long-term immigrants (lived in the United States for 10 years) had an increased risk of asthma compared with short-term immigrants (lived in the United States for <10 years), independent of country of residence in the first year of life (OR, 1.93; 95% CI, 1.00-3.73). CONCLUSION These findings confirm the importance of early childhood exposures and environmental factors that are modified with migration and acculturation in asthma development.

Associations of Doctor-Diagnosed Asthma with Immigration Status, Age at Immigration, and Length of Residence in the United States in a Sample of Mexican American School Children in Chicago

OBJECTIVES Among Mexican Americans in the United States, children who were born in the US had higher rates of asthma than their Mexico-born peers. The purpose of this study was to examine the associations of doctor-diagnosed asthma with immigration-related variables and to investigate whether these associations could be explained by factors that may change with migration. METHODS We surveyed parents of 2,023 school children of Mexican descent and examined the associations of asthma with nativity, age at immigration, and length of residence in the US after adjusting for potential confounding variables. RESULTS In multivariate analyses, US-born children had a 2.42-fold (95% confidence interval [CI]: 1.52-3.83) increased odds of asthma compared with their Mexico-born peers. Mexico-born participants who moved to the US before 2 years of age were almost twice as likely to experience asthma compared with Mexico-born children who moved to the US >or=2 years of age. In addition, Mexico-born participants who lived in the US for 10 years or more were 2.37 times more likely to have asthma than Mexico-born students who lived in the US for less than 10 years. These associations were not explained by a wide variety of factors such as place of residence in infancy; exposure to animals/pets; history of infections, Tylenol use, and antibiotic use in infancy; breastfeeding; exposure to environmental tobacco smoke; daycare attendance and number of siblings; and language use. CONCLUSIONS Our findings point to the effects of nativity, age at immigration, and duration of residence in the US on the risk of asthma in Mexican American children, suggesting that potentially modifiable factors that change with migration may be linked with the disease. The findings of this study should stimulate further research to explain factors that may be responsible for the observed differentials in the risk of asthma among Mexican Americans.

Postpartum depression in mothers of infants in neonatal intensive care unit: risk factors and management strategies.

OBJECTIVE The aim of this study is to assess incidence, risk factors, and management strategies for Postpartum depression (PPD) in mothers of neonatal intensive care unit (NICU) infants. STUDY DESIGN A total of 131 mothers completed the study assessment tool (Edinburgh Postnatal Depression Scale with additional questions). Score of 10 or above was considered to indicate risk for PPD (subclinical depression). Risk factors were examined with particular emphasis on length of stay (LOS). RESULTS Approximately 19.1% of mothers experienced (subclinical) PPD. Depression during current and previous pregnancy, and problems with current delivery were strong predicting risk factors for PPD. As the LOS increased beyond 2 weeks, the odds of PPD risks initially increased, then leveled off, and then decreased after 31 days. CONCLUSION We recommend that the mothers of NICU infants be routinely screened for PPD and aggressively treated.

Frequent ear infections in infancy and the risk of asthma in Mexican American children.

Objectives. This study examined the associations of history of ear infections in infancy with doctor-diagnosed asthma in a large sample of Mexican American children. Methods. In this population-based cross-sectional study, parents of 2023 children completed a questionnaire that collected data on doctor-diagnosed asthma, doctor-diagnosed ear infections, as well as antibiotics use in infancy, and other potential confounding variables. Results. Children with a history of ear infections in infancy were more likely to have asthma compared with those who had no history of ear infections in infancy; the adjusted odds ratios (ORs) were 2.52 (95% confidence interval [CI]: 1.35–4.69) and 1.27 (95% CI: 0.79–2.04) in children who had ≥3 and 1–2 (versus none) ear infections in infancy, respectively, p for trend = .0074. These associations were independent of antibiotics use, acetaminophen consumption, and history of various infections (other than ear infections) in the first year of life. In stratified analyses, the increased risk of asthma in children with recurrent ear infections in infancy persisted among children whose parents reported no lifetime history of rhinitis but not in children who had a history of rhinitis. Conclusions. This study demonstrated significant associations of asthma with history of ear infections in infancy, with a significant dose-response effect of repeated ear infections on the odds of asthma. These findings add to the growing body of literature linking early childhood infections with the risk of asthma and highlight the need for more research to identify the mechanisms through which ear infections may be associated with asthma.

Association of neighborhood crime with asthma and asthma morbidity among Mexican American children in Chicago, Illinois

BACKGROUND There is increasing evidence that neighborhood-level factors, in addition to individual-level factors, may contribute directly or indirectly to childhood asthma by affecting environmental and lifestyle factors. Exposure to neighborhood crime and violence has been associated with poor health outcomes, especially among underserved and minority populations, and its effect on respiratory health is an area of active research. OBJECTIVE To examine the association of residential neighborhood crime with asthma and asthma-related outcomes among Mexican American children. METHODS This cross-sectional study was conducted with parents of 2,023 Mexican American children. We derived measures of neighborhood (census tract) violent, property, and drug abuse crime and used multilevel generalized estimating equations to test associations of neighborhood crime counts with respiratory conditions. RESULTS In multiple regression models, a 1-SD increase in neighborhood property crimes significantly increased the odds of lifetime asthma, lifetime wheezing, lifetime emergency department (ED) visits attributable to asthma or wheezing, and lifetime hospitalization attributable to asthma or wheezing by 25%, 18%, 44%, and 62%, respectively. A 1-SD elevation in neighborhood violent crime was positively and significantly associated with 21% and 57% higher odds of lifetime wheezing and ED visits, respectively. We also observed 13% and 44% significantly increased odds of lifetime wheezing and ED visits, respectively, for a 1-SD increase in drug abuse crime. These findings were not explained or modified by individual- and neighborhood-level covariates. CONCLUSION Higher neighborhood crime was associated with greater odds of asthma and asthma morbidity in Mexican American children.

Nativity and Serum Concentrations of Antioxidants in Mexican American Children: A Cross-Sectional Study

There is limited research on the effect of immigration on biological markers of nutrition among children of Mexican origin in the United States. The purpose of this cross-sectional study was to examine data from the Third National Health and Nutrition Examination Survey (NHANES III) (1988–1994), on a national and representative sample of 1559 Mexican American children, 4–16 years of age, and assess the associations of country of birth with serum concentrations of carotenoids, vitamin A, and vitamin E. In multiple regression analyses, Mexico-born Mexican American children had significantly higher serum concentrations of α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin, vitamin A, and vitamin E than their counterparts who were born in the United States after adjustment for age, sex, poverty income ratio, level of education of family reference person, body mass index, total serum cholesterol, serum cotinine, total energy intake, and vitamin/mineral consumption. Our findings confirm evidence for a negative effect of immigration/acculturation on dietary quality in this population. These findings also suggest that immigrant Mexican families should be encouraged to maintain their consumption of fruits and vegetables. Prospective studies are needed to further assess the effects of immigration/acculturation on diet and other health outcomes in children of Mexican origin and immigrants.

Vitamin D deficiency and its determinants in adults: A sample from community-based settings in the United Arab Emirates

Background. Vitamin D deficiency (VDD) is a public health concern in adults worldwide. This study aims to explore the extent of VDD and its associated factors among adults in the United Arab Emirates (UAE). Subjects and Methods. Quantitative, cross-sectional research was used to assess VDD and its associated factors in 216 adults recruited from randomly selected community-based healthcare settings over a six-month period. Recent values of vitamin D and glycated hemoglobin (HbA1c) were abstracted from medical records, followed by interviews with participants to obtain information on factors related to VDD and other covariates and to measure their heights and weights. Results. A total of 74% of participants demonstrated VDD (vitamin D serum level ≤ 30 nmol/L). Emirati participants had higher odds of having VDD compared to non-Emiratis (OR: 2.95; 95% CI: 1.58–5.52), with also significantly increased odds of the condition appearing in older, less educated, and employed adults. Diabetes type 2 (HbA1c ≥ 6.5%), depression, and obesity were significantly associated with an increased likelihood of VDD after accounting for other covariates. Conclusion. VDD is a significant problem for UAE adults and requires attention by public health policy makers. Diabetes, obesity, and depression need to be considered when screening for vitamin D.

Partner development praxis: The use of transformative communication spaces in a community-academic participatory action research effort in a Mexican ethnic enclave in Chicago

Trusting, productive relationships between traditionally discordant stakeholders—community members and researchers—are critical for successful Community-Based Participatory Research. Practical guidance on processes allowing for partner trust-building and collaborative leadership development in Community-Based Participatory Research literature lacks specificity. In this paper, we introduce our praxis of Transformative Communication Spaces to facilitate purposeful, iterative discourse that occurs in, and fuels each research phase. We elaborate on the use of Transformative Communication Spaces through Pláticas de Salud, Oral History Listening Events, and Data Analysis Think Tanks within the framework of our Little Village Participatory Community Health Assessment. We believe the integrity and potential of Community-Based Participatory Research is contingent on the use of Transformative Communication Spaces strategies to foster trusting partnerships necessary for shared learning and co-leadership.