Conectar
by Andrea Lopez-Soto, Esmeralda Ramírez, Duyen H. Vo, Aigerim Alpysbekova, Seo Woo Lee, Maria Duque, Lawrence Watkins, Cory L. Cobb, Beyhan Ertanir, Alejandra Garcia Isaza, Evelyn Gualdron, Sumeyra Sahbaz, Collette Steed, Neel Devan Youts, Shriya Senapathi, Seth J. Schwartz, Pablo Montero-Zamora
There is a limited understanding of how different subgroups of Latin American immigrant parents experience cultural stressors, as well as its impact on family dynamics, health behaviors, and mental health. The present study aimed to (1) identify latent cultural stress profiles among Latin American immigrant parents in the U.S. and (2) examine differences among these profiles concerning family intimacy, democratic parenting style, family conflict, hazardous alcohol use, and depressive and anxiety symptoms. Participants consisted of a sample of 1,351 parents (61.9% female; M age = 39.83, 62% first-generation; North America [61%], Central America and the Caribbean [21%], and South America [19%]) of children aged 8–16. We used latent profile analysis to identify subgroups of cultural stress, defined by perceived discrimination (PDS) and negative context of reception (NCR). Multinomial logistic regression was conducted to examine key correlates of profile membership. Five latent profiles were identified (1) Low PDS/NCR (22.2%), (2) Low PDS/Elevated NCR (14.8%), (3) Moderate PDS/NCR (18.7%), (4) Elevated PDS/NCR (33.5%), and (5) Highest PDS/NCR (10.8%). Compared with Profile 1 (Low PDS/NCR), parents in Profiles 2–5 generally reported lower family intimacy (RRR = 0.93–0.97). Parents in Profile 5 (Highest PDS/NCR) reported more family conflict (RRR = 1.13), hazardous alcohol use (RRR = 1.20), depressive symptoms (RRR = 1.31), and anxiety symptoms (RRR = 1.29), with markedly elevated depressive (RRR = 22.94) and anxiety symptomatology (RRR = 17.48) compared with Profile 1. Our findings suggest the presence of vulnerable subgroups due to cultural stress among Latin American parents in the United States. A better understanding of cultural stress patterns may improve current and future interventions tailored for Latin American families, addressing health disparities within this population.
Routine childhood immunisation is vital to preventing life-threatening illness; however, global coverage of routine childhood immunisations has fallen in recent years, leaving over 14 million children globally without protection. This study aimed to identify shared and context-specific drivers of routine childhood immunisation dropout in select sites in Mozambique and Malawi through a secondary analysis of qualitative data.
We conducted a secondary inductive thematic analysis on qualitative data from a community-based participatory research study. Co-creation workshops, guided by a human-centred design approach, were held to develop context-specific solutions in each study site. Data for this analysis were collected between February 2020 and March 2021 in Mozambique and between July 2022 and February 2023 in Malawi.
Zambezia, Mozambique and Lilongwe and Mzimba North Districts, Malawi.
Participants included caregivers of partially (n=60) and fully vaccinated (n=22) children aged 25–34 months, healthcare workers (n=12), community healthcare workers (n=30), Expanded Programme on Immunisation staff (n=11) and community representatives (n=14). Caregivers were identified through vaccination registers and with support from health workers, community leaders and health volunteers.
We identified four key contextual and health system differences between Malawi and Mozambique affecting dropout: the composition of the immunisation workforce, the state of the vaccine ecosystem, vaccination card policies and vaccination outreach models. Common challenges across both countries included gender roles that burdened mothers, limited vaccine information, negative health worker interactions, pandemic-related disruptions and stockouts. Common solutions generated through co-creation workshops included improving health worker–caregiver communication, vaccine education and immunisation outreach resources. Solutions in Mozambique emphasised strengthening the community health worker (CHW) role in immunisation, while in Malawi, whose CHW workforce already administers vaccines, solution ideas focused on improving CHW data management.
Our analysis highlights the opportunity for scalable solutions to identified common immunisation barriers, including tailored vaccine education that addresses caregiver knowledge gaps, improved caregiver–health worker communication, improved outreach models and addressing gender dynamics and vaccine stockouts.
To describe diagnostic and management characteristics of acute rheumatic fever (ARF) among participants in the ‘Searching for a Technology-Driven Acute Rheumatic Fever Test’ study, in order to answer clinical questions and determine epidemiological and practice differences in different settings.
Multisite, prospective cohort study.
One hospital in northern Australia and two hospitals in New Zealand, 2018–2021.
143 episodes of definite, probable or possible ARF among 141 participants (median age 10 years, range 5–23; 98% Indigenous).
Participant characteristics, clinical, biochemical and echocardiographic data were explored using descriptive data. Associations with length of stay were determined using multivariable regression analysis.
ARF presentations were heterogeneous with the most common ARF ‘phenotype’ in 19% of cases being carditis with joint manifestations (polyarthritis, monarthritis or polyarthralgia), fever and PR prolongation. The total proportion of children with carditis was 61%. Australian compared with New Zealand participants more commonly had ARF recurrence (22% vs 0%), underlying RHD (48% vs 0%), possible/probable ARF (23% vs 9%) and were underweight (64% vs 16%). Erythrocyte sedimentation rate (ESR) provided an incremental diagnostic yield of 21% compared with C reactive protein. No instances of RHD were diagnosed among participants in New Zealand. Positive throat Group A Streptococcus culture was more common in New Zealand than in Australian participants (69% vs 3%). Children often required prolonged hospitalisation, with median hospital length-of-stay being 7 days (range 2–66). Significant predictors for length of stay in a multivariable regression model were valve disease (adjusted OR (aOR) 1.56, 95% CI 1.23 to 1.98, p
This study provides new knowledge on ARF characteristics and management and highlights international variation in diagnostic and management practice. Differing approaches need to be aligned. Meanwhile, locally specific information can help guide patient expectations after ARF diagnosis.
FreshRSS