Creating Culturally Competent and Responsive Mental Health Services: A Case Study Among the Amish Population of Geauga County, Ohio.

Providing effective mental health services requires knowledge about and cultural competence across a wide array of beliefs and practices. This study provides an example of a successful project to improve public mental health service delivery in an Amish community. County boards of mental health in a rural area of Northeast Ohio contacted researchers in 1998 to provide assistance in reaching the Amish community because of a concern that mental health services were not being utilized by the Amish population. Following meetings with community leaders, changes were made to improve the relationships of service providers and public funding agencies with the local Amish community, disseminate information about mental health concerns and services, and improve accessibility to mental health services. In 2013, a follow-up analysis of records found a 320% increase in public mental health service utilization by the Amish community within the first five years after these changes were made.

Dietary Patterns and Dietary Adequacy of Street Children in Dhaka, Bangladesh.

The negative impact of poverty on the biological well-being of children is well established. The purpose of the present study was to evaluate the impact of the stress of full-time street life on the dietary patterns and dietary adequacy of street children living in Dhaka, Bangladesh. This was accomplished by comparing the nutritional patterns of full-time street children with those of other poor children in Dhaka who also spend their days on the streets but who return to their families at night. There were few differences between groups, possibly due to street children being a select group. However, there were significant sex differences in both groups of children, with boys tending to have more diverse and more adequate diets than girls. The cause of this latter pattern could not be determined with the available data but may involve cultural values favoring males over females.

Growth and health status of street children in Dhaka, Bangladesh.

The purpose of this study was to assess the effect of street life on the growth and health status of poor children who live and work full-time on the streets of Dhaka, Bangladesh (street children), independent of the effects of poverty. This was accomplished by comparing 142 street children with 150 poor children who live and work on the streets of Dhaka but who return to their families at night (slum children). Children between 7-14 years old were recruited at locales where street and slum children are typically found. Weight and upper arm circumference did not differ significantly between street and slum children (P > 0.05), but energy reserves, as assessed by skinfolds, were significantly larger in street than in slum children (P < 0.05). There was no wasting in either street or slum children. Although the majority of children in both groups were stunted and underweight, there were no significant differences between groups (P > 0.05). The prevalence of disease symptoms tended to be slightly higher in street children than in slum children, but few of the differences were statistically significant (P < 0.05). These data do not support the contention that street children are a particularly high-risk group. The greater-than-expected growth and health status of street children, compared to other poor children, may be due to biologically fitter children being more likely to permanently move to the streets and/or to remain on the streets once the move has been made.

Growth and development of Andean high altitude residents.

Growth and development under conditions of chronic hypoxia result in a different pattern of growth in Andean highlanders than in lowlanders. Growth at high altitude results in a small (1 to 4 cm) delay in linear growth, with most, if not all, of the delay probably established at or soon after birth. It also results in an enhancement of lung volumes, particularly residual volume, which is 70%-80% larger in highland than lowland children, on average, with the magnitude of the increase being positively related to age. In addition, growth and development under conditions of chronic hypoxia result in a blunted ventilatory response to hypoxia, a 4% to 5% reduction in Sa(O2), and a substantial increase in pulmonary diffusing capacity. Andean highlanders have V(O2 max) similar to that of lowlanders at low altitude, suggesting that they have successfully adapted to their hypoxic environment. It is likely that both developmental and genetic factors influence most, if not all, components of the cardiorespiratory system of Andean highlanders, but the relative importance of each is not clear.

Birth seasonality in the Old Order Amish.

The Old Order Amish are a healthy and well-nourished natural fertility population, so that the timing of births is not influenced by behaviours to limit family size, undernutrition or disease. The present study examines the monthly distribution of 8160 births occurring between 1920 and 1991 in the Geauga Settlement in north-east Ohio, USA. The monthly distribution of births in the Geauga Settlement is bimodal, with a major peak extending from August to October, a minor peak in February, and a major trough from April to June. This pattern is almost identical to the pattern found in the US in 1943. The monthly distribution of first births appears to be influenced to some extent by a highly significant seasonal pattern of weddings. The pattern of births in the Old Order Amish is consistent with the hypothesis that the spring trough in US births is at least partially caused by a decrease in coital frequency and/or a decrease in fecundability as a result of hot summer temperatures but is not consistent with the hypothesis that the fall peak in US births is primarily due to an increase in coital frequency during the Thanksgiving and Christmas holiday seasons.

Seasonal variation in the dietary adequacy of highland Pwo and Sgaw Karen (Thailand).

The present report describes seasonal variability (postharvest, preharvest, harvest) in the dietary adequacy of highland Karen farmers (38 Pwo and 51 Sgaw mother-weaned child pairs) in Thailand. Both the Pwo and Sgaw exhibit little functionally significant seasonal variation in either energy or protein intakes, although there is significant seasonal variation in other nutrients. Sgaw Karen mothers and their weaned children had significantly higher intakes of energy, protein, and seven nutrients than their Pwo counterparts during all three study seasons. The cause of this difference appears to be related to the better socioeconomic status of the Sgaw, as well as to differences in belief systems that result in a greater utilization of wild resources by the Sgaw. There were no significant differences in energy intakes between mothers and their children in either ethnic group, while children tended to have significantly greater intakes of protein but significantly lower intakes of other nutrients. These differences in dietary patterns appear to be due to differences in dietary density and dietary preferences, rather than to foods being differentially directed towards adults.

Skin reflectance of lowland Bolivian youths of European ancestry.

The skin reflectances of 257 Bolivian youths of European ancestry (140 males, 117 females; 9.0-19.9 yr) residing in Santa Cruz, Bolivia (average altitude of 400 m) are described. Reflectances were measured at three wavelengths (425 nm, 545 nm, and 685 nm) on two different sites, the medial surface of the inner upper arm and the forehead. Males tended to be darker than females, significantly on the inner upper arm (P < .05). Males tended to darken significantly with age on both the upper arm and the forehead (P < .05), while females tended to lighten with age on the upper arm and darken with age on the forehead. However, with the exception of reflectances at 545 nm on the inner upper arm, the age changes in females were insignificant (P > .05). The results of comparisons between two groups based on maternal and paternal surnames (two Spanish surnames, at least one non-Spanish European surnames) were consistent with expectations, or with those with two Spanish surnames tending to be significantly darker than those with one or more non-Spanish European surname (P < .05). Finally, the results of a principal components analysis of reflectances were similar to those found in a previous study of highland Bolivians of Aymara ancestry. Am. J. Hum. Biol. 10:559-565, 1998. © 1998 Wiley-Liss, Inc.

Total lung capacity in Andean highlanders.

Total lung capacity (TLC), residual volume (RV), and vital capacity (VC), as well as related measures of pulmonary function, were assessed in a sample of 39 male and 23 female native highlanders of Aymara ancestry (20.1-28.8 years) who were residing in La Paz, Bolivia (average altitude of about 3,600 m). After controlling for body and chest size, most measures of respiratory function were significantly larger in males than females (P < .05). Absolute TLC (1 BTPS) was significantly larger in the La Paz Aymara males than in highland Peruvian or Tibetan males (P < .05) but, after controlling for body size, TLC was only 1 and 4% larger in the La Paz Aymara than in highland Peruvians or Tibetans, respectively. Also, comparison of the body size-adjusted percentage increases in TLC, VC and RV above U.S. sea-level reference values in selected highland populations indicated that the enhanced TLCs of highlanders are primarily due to an enhancement of RV and secondarily due to an enhancement of VC. © 1994 Wiley-Liss, Inc.

Skin reflectance of children and young adults of Aymara ancestry.

The skin reflectance of 556 Andean Indians of Aymara ancestry (305 males, 251 females; 10.0-29.9 yr) residing in La Paz, Bolivia (average altitude of about 3,600 m) is described. Reflectances were measured at three wavelengths (425 nm, 545 nm, and 685 nm) on two different sites, the medial surface of the upper arm and forehead. Males tended to be significantly darker than females on both the upper arm and forehead (P < .05). Female Aymara tended to lighten significantly in skin color with age on both the upper arm and forehead, while males tended to lighten significantly with age only on the upper arm (P < .05). The results of comparisons between three categories based on paternal and maternal surnames (two Aymara surnames, one Aymara and one Spanish surname, and two Spanish surnames) were consistent with the hypothesis that the possession of Spanish surnames is positively related to the degree of European admixture in urban Aymara. However, the extent of admixture within each surname category may differ between rural and urban Aymara, making classification by surnames problematic for rural-urban comparisons.

Developmental responses to high-altitude hypoxia in Bolivian children of European ancestry: A test of the developmental adaptation hypothesis.

The developmental adaptation hypothesis (DAH) proposes that highlanders adapt to their hypobaric hypoxic environment during growth and development. This report utilizes data on children (9.0-19.9 yr) of European ancestry residing in Santa Cruz and La Paz, Bolivia, to test selected aspects of the DAH. Previous tests of this hypothesis have been hampered by difficulties in controlling for socioeconomic and genetic influences. However, due to their high socioeconomic status and their relatively short history of residence at high altitudes, these factors can be reasonably well controlled in studies of European children. The data on European children are consistent with some but not all aspects of the DAH. First, examination of the available data on V̇O2 max (ml/kg/min) in European boys suggests that chronic exposure to hypobaric hypoxia results in an enhancement of the overall functional capacity of the oxygen transport system during adolescence, as predicted by the DAH. Second, chronic exposure to hypobaric hypoxia results in a delay in linear growth and maturation in European children, as well as in an enhancement of their lung volumes, also as predicted by the DAH. However, the effects of chronic hypoxia on linear growth, after controlling for health and nutritional status, are not as large as previously believed and, contrary to the expectations of the DAH, they need not be acquired through a distinctive pattern of growth during late childhood and adolescence. Instead, it appears that these patterns are established in European highlanders prior to 9 years of age and are then maintained, rather than accentuated, during later developmental periods.