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Background Sub-Saharan and Caribbean immigrants are particularly affected by HIV in Europe, and recent evidence shows that a large portion of them acquired HIV after arrival. There is a need for efficient interventions that can reduce immigrants’ exposure to HIV. We describe the pilot phase of a community-based empowerment outreach intervention among sub-Saharan and Caribbean immigrants in the greater Paris area aimed at 1) constructing the intervention, 2) assessing its feasibility, and 3) assessing the feasibility of its evaluation based on a stepped-wedge approach. Methods 1) To develop the intervention, a literature review was conducted on existing interventions and participatory approaches developed, including the constitution of peer groups. 2) To assess the intervention’s feasibility, a pilot was conducted between April 2018 and December 2018. A daily register was used to collect data on sociodemographic characteristics of all persons who visited the mobile team to assess eligibility and acceptability. 3) To assess the feasibility of performing a stepped-wedge trial to evaluate the intervention, we compared eligibility, enrolment and retention at 3 months in two arms (immediate vs deferred). Chi-squared tests were used to compare reach and retention between the two arms. Results Intervention development. The Makasi intervention was designed as an outreach intervention that starts with the persons’ capacities and helps them appropriate existing resources and information and obtain knowledge about sexual health , based upon motivational interviewing techniques. Intervention Feasibility . Between April 2018 and December 2018, a total of 485 persons were identified as eligible. Participation in the intervention was proposed to 79% of eligible persons. When proposed, the persons enrolled in the intervention with a response rate of 69%. Some were lost to follow-up, and 188 persons were finally included. Evaluation Feasibility. The proportions of eligible (45 and 42%) individuals and of enrolled individuals (65 and 74%) were similar and not significantly different in the immediate and deferred arms, respectively. Conclusions A community-based outreach intervention aimed at improving sub-Saharan and Caribbean immigrants’ empowerment in sexual health is feasible. The pilot phase was key to identifying challenges, designing a relevant intervention and validating the stepped-wedge protocol for evaluation.

ObjectivesTo assess whether genotype-guided selection of oral antiplatelet drugs using a clinical decision support (CDS) algorithm reduces the rate of major adverse cardiovascular and cerebrovascular events (MACCEs) among Caribbean Hispanic patients, after 6 months.DesignAn open-label, multicentre, non-randomised clinical trial.SettingEight secondary and tertiary care hospitals (public and private) in Puerto Rico.Participants300 Caribbean Hispanic patients on clopidogrel, both genders, underwent percutaneous coronary intervention (PCI) for acute coronary syndromes, stable ischaemic heart disease and documented extracardiac vascular diseases.InterventionsPatients were separated into standard-of-care (SoC) and genotype-guided (pharmacogenetic (PGx)-CDS) groups (150 each) and stratified by risk scores. Risk scores were calculated based on a previously developed CDS risk prediction algorithm designed to make actionable treatment recommendations for each patient. Individual platelet function, genotypes, clinical and demographic data were included. Ticagrelor was recommended for patients with a high-risk score ≥2 in the PGx-CDS group only, the rest were kept or de-escalated to clopidogrel. The intervention took place within 3–5 days after PCI. Adherence medication score was also measured.Primary and secondary outcomesThe occurrence rate of MACCEs (primary) and bleeding episodes (secondary). Statistical associations between patient time free of events and predictor variables (ie, treatment groups, risk scores) were tested using Kaplan-Meier survival analyses and Cox proportional-hazards regression models.ResultsThe genotype-guided group had a clinically lower but not significantly different risk of MACCEs compared with the SoC group (8.7% vs 10.7%, p=0.56; HR=0.56). Among high-risk score patients, genotype-driven guidance of antiplatelet therapy showed superiority over SoC in reducing MACCE incidence 6 months postcoronary stenting (adjusted HR=0.104; p< 0.0001).ConclusionsThe potential benefit of implementing our PGx-CDS algorithm to significantly reduce the incidence rate of MACCEs in post-PCI Caribbean Hispanic patients on clopidogrel was observed exclusively among high-risk patients, with apparently no evident effect in other patient groups.Trial registration numberNCT03419325.

People of Black African and Black Caribbean ethnicity experience higher rates and poorer outcomes of type 2 diabetes (T2D) than people of White European ethnicity; these inequalities are compounded by poor healthcare access. Cultural tailoring of diabetes self-management education and support (DSMES) programs has the potential to improve healthcare engagement and clinical outcomes for ethnic minority groups. Healthy Eating & Active Lifestyles for Diabetes (HEAL-D) is a co-designed, culturally tailored group-based DSMES program for adults of Black African and Black Caribbean ethnicity. This trial aims to evaluate the clinical and cost effectiveness of the HEAL-D intervention, compared to standard DSMES programs, in Black African and Black Caribbean adults living with T2D. A 24-month, multicenter, pragmatic, open-label, 2-arm, parallel-group, individually randomized group treatment trial will be conducted, with primary end point (glycated hemoglobin [HbA ]) assessment at 12 months. Black African and Black Caribbean adults with T2D (n=300), recruited from 3 to 5 centers in the United Kingdom (including London, West Midlands, and Greater Manchester), will be randomized in a 1:1 ratio to HEAL-D (intervention) or a standard DSMES program (control). HbA , blood lipids, anthropometric outcomes, blood pressure, physical activity, and patient-reported outcome measures relating to psychological well-being and self-management support, lifestyle behaviors, and health economics will be collected at baseline and follow-up visits (6, 12, and 24 months). Cost-effectiveness will be assessed through a cost-utility analysis conducted from a health and social care perspective. A mixed methods process evaluation will provide a formative evaluation of delivery, intervention fidelity, and implementation of HEAL-D, and an embedded study within a project will assess the impact of multiple long-term conditions on uptake of, and engagement with HEAL-D, and the impact of HEAL-D on multiple long-term conditions. The trial received Research Authority and Research Ethics Council approval on April 22, 2024. Funding began in August 2023. Site \"green light\" was received on August 15, 2024, for London; November 29, 2024, for Manchester; and January 31, 2025, for the West Midlands. Recruitment commenced in August 2024 and is due to run for 11 months. As of March 26, 2025, a total of 76 participants have consented. Last patient, last visit is expected in June 2027; primary data analysis is expected to begin in July 2027. Final results are anticipated to be available in September 2027, and publication is expected by the end of 2027. The HEAL-D trial will address whether a culturally tailored DSMES program, provided in-person or via videoconferencing, is clinically and cost-effective compared to standard DSMES at improving diabetes management in Black African and Black Caribbean adults. If effective, this would provide an evidence-based model of equitable DSMES services and improve the implementation of healthcare programs for ethnic minority groups. ISRCTN 1434448; https://www.isrctn.com/ISRCTN14344948. DERR1-10.2196/71861.

This research attempted to test an HIV prevention intervention for Afro-Caribbean female teens. The purpose was to improve knowledge and attitudes concerning HIV/AIDS, improve mother-daughter sexual communication, and to reduce risky sexual behaviors. Using a community-based approach, sixty mother and daughter pairs were randomly assigned. One condition was experimental using the Making Proud Choices Caribbean Style (MPCCS); another was a comparison of General Health Education. Independent t-tests were used for analysis between the pretest, posttest and 90 days posttests. MPCCS indicated clear usage with other Caribbean teens. This study helped to support the theory when Afro-Caribbean (AC) teens feel they need to become sexually active (subjective norm), and have referent support (parental support), they may blend values, knowledge, and skills (control beliefs), and are likely to make proud choices to reduce risky sexual behavior in minimizing HIV in their communities.

ObjectivesTo estimate the incidence and prevalence of systemic lupus erythematosus (SLE) in the UK over the period 1999–2012.MethodsA retrospective cohort study using the Clinical Practice Research Datalink (CPRD). The incidence was calculated per 100 000 person-years and the prevalence was calculated per 100 000 people for the period 1999–2012 and stratified by year, age group, gender, region and ethnicity. Three definitions of SLE were explored: (1) systemic lupus, (2) a fully comprehensive definition of lupus including cutaneous only lupus and (3) requiring supporting evidence of SLE in the medical record.ResultsUsing our primary definition of SLE, the incidence during the study period was 4.91/100 000 person-years (95% CI 4.73 to 5.09), with an annual 1.8% decline (p<0.001). In contrast, the prevalence increased from 64.99/100 000 in 1999 (95% CI 62.04 to 67.93) (0.065%) to 97.04/100 000 in 2012 (95% CI 94.18 to 99.90) (0.097%). SLE was six times more common in women. The peak age of incidence was 50–59 years. There was regional variation in both incidence and prevalence. People of Black Caribbean ethnicity had the highest incidence and prevalence. Alternative definitions of SLE increased (definition 2) or decreased (definition 3) estimates of incidence and prevalence, but similar trends were found.ConclusionsThe incidence of SLE has been declining but the prevalence has been increasing in the UK in recent years. Age, gender, region and ethnicity are risk factors for SLE. This is the first study to report ethnic differences on the incidence and prevalence of SLE using the CPRD.

Dan Nicolae, Carole Ober and colleagues report a meta-analysis of genome-wide association studies for asthma in a collection of ethnically diverse North American populations. They identify a newly associated susceptibility locus at PYHIN1 in individuals of African descent. Asthma is a common disease with a complex risk architecture including both genetic and environmental factors. We performed a meta-analysis of North American genome-wide association studies of asthma in 5,416 individuals with asthma (cases) including individuals of European American, African American or African Caribbean, and Latino ancestry, with replication in an additional 12,649 individuals from the same ethnic groups. We identified five susceptibility loci. Four were at previously reported loci on 17q21, near IL1RL1 , TSLP and IL33 , but we report for the first time, to our knowledge, that these loci are associated with asthma risk in three ethnic groups. In addition, we identified a new asthma susceptibility locus at PYHIN1 , with the association being specific to individuals of African descent ( P = 3.9 × 10 −9 ). These results suggest that some asthma susceptibility loci are robust to differences in ancestry when sufficiently large samples sizes are investigated, and that ancestry-specific associations also contribute to the complex genetic architecture of asthma.

Women from Black, Asian and Minority Ethnic (BAME) backgrounds are less likely to attend cervical screening than White British women. This study explored sociodemographic and attitudinal correlates of cervical screening non-attendance among BAME women. Women (30-60 years) were recruited from Indian, Pakistani, Bangladeshi, Caribbean, African and White British backgrounds (n=720). Participants completed structured interviews. BAME women were more likely to be non-attenders than white British women (44-71% vs 12%) and fell into two groups: the disengaged and the overdue. Migrating to the United Kingdom, speaking a language other than English and low education level were associated with being disengaged. Being overdue was associated with older age. Three attitudinal barriers were associated with being overdue for screening among BAME women: low perceived risk of cervical cancer due to sexual inactivity, belief that screening is unnecessary without symptoms and difficulty finding an appointment that fits in with other commitments. BAME non-attenders appear to fall into two groups, and interventions for these groups may need to be targeted and tailored accordingly. It is important to ensure that BAME women understand cancer screening is intended for asymptomatic women and those who have ceased sexual activity may still be at risk.

COPD is increasingly being recognized as a major health problem in America’s multicultural black population. [...]recent studies such as COPDGene (Genetic Study of the Epidemiology of COPD) (2), which recruited a significant number of black individuals, there have not been many COPD studies inclusive enough of the black population in America to understand how the disease affects or may differ in the black population. [...]socioeconomic disparities could affect treatment and subsequent severity of acute exacerbations in that lower socioeconomic status is a known predictor of lower lung function and is more common among African Americans (48). First steps should be to ensure the inclusion of black individuals in both observational and interventional studies, with appropriate collection of data on place of birth, country of origin, tobacco use habits, biomass smoke exposure, and socioeconomic status to better capture the diversity within this racial group. [...]because black individuals in America are disproportionately impacted by low socioeconomic status (poverty) and lower health insurance rates, increasing health insurance coverage and developing culturally sensitive policies to address healthcare barriers (i.e., low health literacy, nonadherence to therapy, patient beliefs, and cultural competency of healthcare providers) will help improve the care of America’s black patients with COPD. 1.

(1) Background: This study was conducted in the small island developing state of Barbados, which has dubiously earned the title of “amputation capital of the world”, to understand perspectives of persons living with diabetic foot ulceration. (2) Methods: An exploratory multi-lens approach was used (focus groups; dyads; and triads) to gather indigenous Afro-Caribbean perspectives of living with diabetic foot ulceration that may be obscured by using a single method. (3) Results: Findings in this group highlighted the necessity of creating culturally sensitive education tools, as well as understanding how mistrust of local health systems may play a role in decisions to delay seeking health services despite ease of access with no cost at point of care. Problematic historical relationships with health systems among Afro-Caribbean people, for whom oral traditions motivate preference for traditional medicines instead of Western/colonial treatments from North America or Europe, may be deeply entrenched in this population and contribute to health beliefs and behaviors. (4) Conclusions: This paper addresses the gap in the literature regarding the use of qualitative methodologies to explore the beliefs of Afro-Caribbean people within their native context to inform design of culturally responsive self-education programs.

Before the colonial period, California harboured more language variation than all of Europe, and linguistic and archaeological analyses have led to many hypotheses to explain this diversity 1 . We report genome-wide data from 79 ancient individuals from California and 40 ancient individuals from Northern Mexico dating to 7,400–200 years before present ( bp ). Our analyses document long-term genetic continuity between people living on the Northern Channel Islands of California and the adjacent Santa Barbara mainland coast from 7,400 years  bp to modern Chumash groups represented by individuals who lived around 200 years  bp . The distinctive genetic lineages that characterize present-day and ancient people from Northwest Mexico increased in frequency in Southern and Central California by 5,200 years  bp , providing evidence for northward migrations that are candidates for spreading Uto-Aztecan languages before the dispersal of maize agriculture from Mexico 2 – 4 . Individuals from Baja California share more alleles with the earliest individual from Central California in the dataset than with later individuals from Central California, potentially reflecting an earlier linguistic substrate, whose impact on local ancestry was diluted by later migrations from inland regions 1 , 5 . After 1,600 years  bp , ancient individuals from the Channel Islands lived in communities with effective sizes similar to those in pre-agricultural Caribbean and Patagonia, and smaller than those on the California mainland and in sampled regions of Mexico. Genome-wide analyses of ancient DNA from individuals from California and Mexico shed light on the spread of Mexican ancestry to California and how it correlates with linguistic flow.