Endogamy and variation in blood pressure levels in Croatian island isolates.
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Blood pressure variation was investigated among populations inhabiting islands and peninsula of Middle Dalmatia, Croatia. The number of previous anthropological studies pointed to isolation and different genetic population structure in this environmentally fairly homogeneous area. Variation in blood pressure (systolic and diastolic) among the populations of the islands of Brac, Hvar, Korcula, and the Peljesac peninsula was assessed at three levels involving village populations, regional (western and eastern) populations and the entire island populations. The blood pressure data were collected from 3834 adult individuals inhabiting 37 rural communities and were adjusted for age and body mass index. Variation in blood pressure levels existed among regions and villages. Due to the history of differential settlement, small village sizes and high levels of reproductive isolation, the observed blood pressure variation could be attributed to founder effect, genetic drift and inbreeding. The involvement of genetic factors was tested by relating blood pressure variation among villages to degree of isolation among them. Blood pressure means and proportions of hypertensives increased with endogamy levels in males. In females, this effect could not be observed. However, in both sexes the highest proportions of hypertensives (more than 40%) were found in villages that are most reproductively closed (endogamy greater than 80%). These populations are considered particularly promising for further genetic epidemiological research. (+info)
The modernizing Kazakhstan: a review of biomedical data.
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In order to focus the situation of Kazakhstan today in relation to the processes of modernization and transition to a market economy and to evidence their effects on the biology and health status of the population of Kazakhstan, we have reviewed recently available data for this region (1993-1999). Kazakhstan is still characterized by a pyramid shaped age distribution of its population and by a high incidence of not communicable diseases and lack of nutrient and micronutrients, especially among children. However, the population of Kazakhstan seems to be not immune to the diseases of the modernization. I.e., among women obesity is more frequent than underweight, especially in the urban areas. In rural populations the frequency of clinically relevant hypertension resulted low in the more isolated and traditionally living communities but it increased to 20% in the less isolated one. Although it is expected a strong increase of urbanized population in the next 25 years, currently, modernization is probably influencing life style and nutritional habits of almost only a minority of the inhabitants of Kazakhstan. (+info)
Virtual anthropology (VA): a call for glasnost in paleoanthropology.
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The adventurous scientist, with a hat protecting him from the fierce sun as he travels from one remote place to another, hunting for fossils of our ancestors, has been a part of the romantic imagination associated with anthropological research in the 20th Century. This picture of the paleoanthropologist still retains a grain of truth. Indeed, many new sites were discovered under troublesome conditions in the recent past and have added substantial information about our origins. But on another front, probably less sensational but no less important, are contributions stemming from the analysis of the already discovered fossils. With the latter, a rapid evolution in anthropologic research took place concurrently with advances in computer technology. After ambitious activities by a handful of researchers in some specialized laboratories, a methodologic inventory evolved to extract critical information about fossilized specimens, most of it preserved in the largely inaccessible interior as unrevealed anatomic structures. Many methodologies have become established but, for various reasons, access to both the actual and the digitized fossils is still limited. It is time for more transparency, for a glasnost in paleoanthropology. Herein are presented some answers to the question of how a high-tech approach to anthropology can be integrated into a predominantly conservative field of research, and what are the main challenges for development in the future. (+info)
Vietnamese diabetic patients and their physicians: what ethnography can teach us.
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OBJECTIVES: To describe the cultural context of type 2 diabetes mellitus among Vietnamese immigrants in the United States, including people's ideas about cause and proper treatment; and to suggest ways in which better control of the disease can be achieved in this population. DESIGN: The method was ethnographic. A native speaker used a structured interview guide to talk with 38 Vietnamese patients, and family members of 2 other patients, being treated for type 2 diabetes. In addition, 8 Vietnamese health providers--5 physicians, 2 nurses, and an herbalist--were interviewed. SETTING: A low-income area of southern California populated by a large number of Vietnamese. PARTICIPANTS: Forty patients being treated for type 2 diabetes and 8 health practitioners. RESULTS: Three quarters of the patients had not achieved good control of their diabetes. Ideas about the cause and proper treatment of the disease were culturally shaped. Many patients used eastern (herbal) medicine and described a strong aversion to insulin injections. Patients stopped taking their oral medications when using eastern medicine, and a quarter lowered their dose whenever they felt "out of balance." Almost two thirds had used traditional home remedies for diabetes. Two had received nonstandard medical care from neighborhood physicians trained in Viet Nam; 1 of these patients died during the study. CONCLUSION: The Vietnamese community and physicians serving that community need culturally appropriate education about type 2 diabetes and modern therapy for the disease. (+info)
Darkness in El Dorado: human genetics on trial.
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A recent book by a freelance journalist makes major accusations against genetic studies by J. V. Neel in the Amazon a generation ago. Contrary to these charges, there was no connection of Neel's work with human experiments conducted by the Rochester Manhattan project twenty years earlier, nor did the studies serve as a control for survivors of the atomic bombs in Japan. Neel was not a eugenicist. His program of measles vaccination reduced mortality, and was not in any sense an experiment. Given the passage of time and lack of supporting evidence, further investigation of these charges is pointless. However, the political climate in which human populations are studied has changed dramatically over the last generation. Unless guidelines reflect an international consensus, the benefits of population studies to human welfare and science will be jeopardized. The World Health Organization guidelines should be extended to cover current research. (+info)
Safety-net institutions buffer the impact of Medicaid managed care: a multi-method assessment in a rural state.
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OBJECTIVES: This project used a long-term, multi-method approach to study the impact of Medicaid managed care. METHODS: Survey techniques measured impacts on individuals, and ethnographic methods assessed effects on safety-net providers in New Mexico. RESULTS: After the first year of Medicaid managed care, uninsured adults reported less access and use (odds ratio [OR] = 0.46; 95% confidence interval [CI] = 0.34, 0.64) and worse barriers to care (OR = 6.60; 95% CI = 3.95, 11.54) than adults in other insurance categories. Medicaid children experienced greater access and use (OR = 2.11; 95% CI = 1.21, 3.72) and greater communication and satisfaction (OR = 3.64; 95% CI = 1.13, 12.54) than children in other insurance categories; uninsured children encountered greater barriers to care (OR = 6.29; 95% CI = 1.58, 42.21). There were no consistent changes in the major outcome variables over the period of transition to Medicaid managed care. Safety-net institutions experienced marked increases in workload and financial stress, especially in rural areas. Availability of mental health services declined sharply. Providers worked to buffer the impact of Medicaid managed care for patients. CONCLUSIONS: In its first year, Medicaid managed care exerted major effects on safety-net providers but relatively few measurable effects on individuals. This reform did not address the problems of the uninsured. (+info)
Consumer demand for caesarean sections in Brazil: informed decision making, patient choice, or social inequality? A population based birth cohort study linking ethnographic and epidemiological methods.
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OBJECTIVES: To investigate why some women prefer caesarean sections and how decisions to medicalise birthing are influenced by patients, doctors, and the sociomedical environment. DESIGN: Population based birth cohort study, using ethnographic and epidemiological methods. SETTING: Epidemiological study: women living in the urban area of Pelotas, Brazil who gave birth in hospital during the study. Ethnographic study: subsample of 80 women selected at random from the birth cohort. Nineteen medical staff were interviewed. PARTICIPANTS: 5304 women who gave birth in any of the city's hospitals in 1993. MAIN OUTCOME MEASURES: Birth by caesarean section or vaginal delivery. RESULTS: In both samples women from families with higher incomes and higher levels of education had caesarean sections more often than other women. Many lower to middle class women sought caesarean sections to avoid what they considered poor quality care and medical neglect, resulting from social prejudice. These women used medicalised prenatal and birthing health care to increase their chance of acquiring a caesarean section, particularly if they had social power in the home. Both social power and women's behaviour towards seeking medicalised health care remained significantly associated with type of birth after controlling for family income and maternal education. CONCLUSIONS: Fear of substandard care is behind many poor women's preferences for a caesarean section. Variables pertaining to women's role in the process of redefining and negotiating medical risks were much stronger correlates of caesarean section rates than income or education. The unequal distribution of medical technology has altered concepts of good and normal birthing. Arguments supporting interventionist birthing for all on the basis of equal access to health care must be reviewed. (+info)
The paradoxical nature of hunter-gatherer diets: meat-based, yet non-atherogenic.
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OBJECTIVE: Field studies of twentieth century hunter-gathers (HG) showed them to be generally free of the signs and symptoms of cardiovascular disease (CVD). Consequently, the characterization of HG diets may have important implications in designing therapeutic diets that reduce the risk for CVD in Westernized societies. Based upon limited ethnographic data (n=58 HG societies) and a single quantitative dietary study, it has been commonly inferred that gathered plant foods provided the dominant energy source in HG diets. METHOD AND RESULTS: In this review we have analyzed the 13 known quantitative dietary studies of HG and demonstrate that animal food actually provided the dominant (65%) energy source, while gathered plant foods comprised the remainder (35%). This data is consistent with a more recent, comprehensive review of the entire ethnographic data (n=229 HG societies) that showed the mean subsistence dependence upon gathered plant foods was 32%, whereas it was 68% for animal foods. Other evidence, including isotopic analyses of Paleolithic hominid collagen tissue, reductions in hominid gut size, low activity levels of certain enzymes, and optimal foraging data all point toward a long history of meat-based diets in our species. Because increasing meat consumption in Western diets is frequently associated with increased risk for CVD mortality, it is seemingly paradoxical that HG societies, who consume the majority of their energy from animal food, have been shown to be relatively free of the signs and symptoms of CVD. CONCLUSION: The high reliance upon animal-based foods would not have necessarily elicited unfavorable blood lipid profiles because of the hypolipidemic effects of high dietary protein (19-35% energy) and the relatively low level of dietary carbohydrate (22-40% energy). Although fat intake (28-58% energy) would have been similar to or higher than that found in Western diets, it is likely that important qualitative differences in fat intake, including relatively high levels of MUFA and PUFA and a lower omega-6/omega-3 fatty acid ratio, would have served to inhibit the development of CVD. Other dietary characteristics including high intakes of antioxidants, fiber, vitamins and phytochemicals along with a low salt intake may have operated synergistically with lifestyle characteristics (more exercise, less stress and no smoking) to further deter the development of CVD. (+info)