Immigrant women's experiences of receiving care in a mobile health clinic.

AIM: This paper is a report of a study of the experiences of Portuguese-speaking immigrant women who used a mobile health clinic for their reproductive health care. BACKGROUND: Upon arrival in Canada, immigrant women often are in better health than their Canadian-born counterparts; however, this health status tends to deteriorate over time. One reason for this change is limited access to services. METHOD: Data collection during 2004 and 2005 involved individual interviews with seven Portuguese-speaking women who received care in a mobile health clinic in Toronto, Canada, and with four clinic care providers. Non-participant observation of the interaction between clients and care providers was also conducted. Interviews conducted in Portuguese were translated into English and transcribed, along with those conducted in English. Interview transcripts were read and re-read in the context of observational notes to develop codes. Emerging codes were grouped together to develop subcategories and categories. FINDINGS: Participants' experiences of accessing and receiving care in the mobile health clinic were shaped by their perceptions of health, which included physical, mental, social and spiritual aspects, and their pre- and postmigration care experiences. As an alternative model of care delivery, the mobile health clinic was perceived by participants to address their care needs and to help overcome postmigration barriers by providing accessible, holistic, and linguistically and culturally appropriate care. CONCLUSION: Mobile health clinics should be considered as an alternative care delivery model for immigrant women who may be at a disadvantage because of their socio-economic, cultural, and racialized statuses.

Mitochondrial DNA patterns in the Macaronesia islands: Variation within and among archipelagos.

Macaronesia covers four Atlantic archipelagos: the Azores, Madeira, the Canary Islands, and the Cape Verde islands. When discovered by Europeans in the 15th century, only the Canaries were inhabited. Historical reports highlight the impact of Iberians on settlement in Macaronesia. Although important differences in their settlement are documented, its influence on their genetic structures and relationships has yet to be ascertained. In this study, the hypervariable region I (HVRI) sequence and coding region polymorphisms of mitochondrial DNA (mtDNA) in 623 individuals from the Azores (120) and Canary Islands (503) were analyzed. Combined with published data, these give a total of 1,542 haplotypes from Macaronesia and 1,067 from the Iberian Peninsula. The results obtained indicate that Cape Verde is the most distinctive archipelago, with an mtDNA pool composed almost exclusively of African lineages. However, the other archipelagos present an mtDNA profile dominated by the presence of West-Eurasian mtDNA haplogroups with African lineages present in varying proportions. Moreover, no signs of integration of typical Canarian U6 lineages in the other archipelagos were detected. The four Macaronesia archipelagos currently have differentiated genetic profiles, and the Azores present the highest intra-archipelago differentiation and the lowest values of diversity. The analyses performed show that the present-day genetic profile of the Macaronesian archipelagos was mainly determined by the initial process of settlement and further microdifferentiation probably as a consequence of the small population size of some islands. Moreover, contacts between archipelagos seem to have had a low impact on the mtDNA genetic pool of each archipelago.

Portuguese immigrant families: the impact of acculturation.

Portuguese immigrants to North America represent a large ethnic group with unique family therapy needs. The present study investigates acculturation and the family lives of Portuguese (Azorean) immigrants in Canada. Methods of analytic induction and constant comparison from grounded theory were used to examine transcripts of interviews with 21 Azorean immigrant women and 28 Azorean immigrant men. A model emerged wherein (a) immigration and acculturation act as stressors on the family unit, as described by the categories Process of Change and Family Relationships; (b) family members adopt generation- and gender-specific acculturative strategies, as illustrated by the categories Duas Culturas (Two Cultures) and Falando Portuges (Speaking Portuguese); and (c) as family members acculturate, discords arise and are resolved according to the cultural traits different members have adopted. The categories Discord Resolution and Preocupação (Preoccupations) illustrate this last dynamic. Implications for family therapy with immigrant families include an indication for community-level interventions, emphasis on confidentiality, awareness of acculturation stress and different acculturative strategies within the family, and aiding the family in the negotiation and integration of a new bicultural reality.

Early childhood caries and access to dental care among children of Portuguese-speaking immigrants in the city of Toronto.

OBJECTIVE: To determine the influence of accessibility of dental services and other factors on the development of early childhood caries (ECC) among Toronto children 48 months of age or younger with at least one Portuguese-speaking immigrant parent. METHODS: This population-based case-control study involved 52 ECC cases and 52 controls (i.e., without ECC) identified from community centres, churches and drop-in centres by a process of network sampling. Caries status (dmft/s) was assessed by clinical examination. Access to dental care and risk factors for ECC were determined through a structured interview with the Portuguese-speaking parent. RESULTS: Forty (77%) of the children with ECC but only 28 (54%) of controls had never visited a dentist. Thirty (58%) mothers of children with ECC but only 13 (25%) mothers of controls had not visited a dentist in the previous year. Bivariate analyses revealed that low family income, no family dentist, no dental insurance, breastfeeding, increased frequency of daily snacks and low parental knowledge about harmful child feeding habits were associated with ECC. Non-European-born parents and parents who had immigrated in their 20s or at an older age were 2 to 4 times more likely to have a child with ECC than European parents and those who had immigrated at a younger age. Lack of insurance, no family dentist and frequency of snacks were factors remaining in the final logistic regression model for ECC. CONCLUSIONS: The strongest predictors of ECC in this immigrant population, after adjustment for frequent snack consumption, were lack of dental care and lack of dental insurance. These findings support targeting resources to the prevention of ECC in children of new immigrants, who appear to experience barriers to accessing private dental care and who are exposed to many of the determinants of oral disease.

Peopling of the Azores Islands (Portugal): data from the Y chromosome.

Nine Atlantic islands with approximately five and a half centuries of demographic history constitute the Portuguese archipelago of the Azores. Despite the recent peopling history of these islands, written records regarding the specific origin and relative proportions of the first settlers are scarce and incomplete. To gain insights into the history of the peopling of the Azores and to evaluate to what extent population imports described in historical sources left their marks on the genetic constitution of the present-day populations, we analyzed 11 Y-chromosome biallelic markers in a sample of 145 unrelated individuals of Azorean ancestry. The main results of this study indicate that the genetic profile of the Azorean male population shows high affinities with that of mainland Portugal, in accordance with the general knowledge, derived from historical sources, that the Portuguese were the major contributors to the Azorean founding population. Nevertheless, genetic traces of settlers from other origins also mentioned in historical records can still be found in the present-day population. Thus typically sub-Saharan male lineages were detected in the archipelago, in contrast to what has been described for mainland Portugal. Furthermore, compared to what has been described for the mainland Portugal population, our data support a stronger influence of people of Jewish origin, as detected by an increased frequency of lineages belonging to haplogroup J.

Agonias: the social and sacred suffering of Azorean immigrants.

Agonias, meaning "the agonies," is a culture-specific somatic phenomenon experienced by Azorean immigrants. Although the community's health providers conceptualize agonias as an "anxiety disorder," interviews with community members revealed a more complex phenomenon. For them, agonias is a somatomoral experience--where the somatic, the social, the religious and the moral are inextricably linked. Because agonias connects things that, from the traditional medical perspective, should not be connected, such as mind, body, spirit, and community, it defies our psychiatric categorisation and goes beyond disciplinary boundaries. Agonias is a dynamic multivocal symbol that is not just an inanimate signifier but also a therapeutic act. On an individual level, it connects the sufferer with others and with God, transforming the interpersonal and divine space. On the societal level, it connects a community, losing its way of life, to the past and to its identity, preserving its social and religious traditions.

Machado-Joseph disease of Azorean ancestry in Brazil: the Catarina kindred; neurological, neuroimaging, psychiatric and neuropsychological findings in the largest known family, the Catarina kindred

Há, até o momento, notícia de 9 famílias näo aparentadas com o diagnóstico clínico de doença de Machado-Joseph (MJD) no Brasil. Esta é a maior família do mundo com doença. É de origem açoriana e contem 622 indivíduos na árvore fenealógica. Destes, 236 foram examinados. Dois examinadores julgaron 39 como afetados. Respectivamente 12, 23 e 4 pacientes tinham os fenôtipos I, II e III da doença, com idades no início variando entre 10-48, 14-54 e 30-55. Doença tipo I de início juvenil näo mostrou atrofia täo severa nas imagens por ressonância magnética (RM) quanto doença tipo II de duraçäo igual, demonstrando que severidade clínica e grau de atrofia näo caminham paralelamente. Nenhum dos 8 pacientes examinados por RM tinha atrofia olivar ou anormalidades no globo pálido. Doze pacientes e 23 sob risco foram submetidos a avaliaçäo neuropsicológica. A atençäo foi normal em todos. Memória verbal estava pior nos doentes com maior decaimento com o tempo que nos sob risco. Ambos os grupos tiveram pontuaçäo abaixo do normal na identificaçäo de silhuetas e praxia construtiva. Memória visual estava bem abaixo do normal para ambos, com muitas rotaçöes, porém sem omissöes ou confabulaçäo. Padräo peculiar de multiplicaçäo dos detalhes internos, que denominamos o "efeito olho de mosca" foi visto em 6 doentes e 8 sob risco. Discriminaçäo defeituosa de cores, quando múltiplas cores eram apresentadas lado a lado, na ausência de anomia ou cegueira a cores, caracterizável como "simultagnosia a cores", surgiu como achado e foi pesquisada em 29 sujeitos 4/10 doentes e 6/19 sob risco mostram esta dificuldade. Conclui-se que disfunçöes cognitivas na esfera visual säo proeminentes nesta família. Se seriam próprias da doença e manifestaçäo precoce daqueles sob risco, está ainda para ser estabelecido. Depressäo foi avaliada com critérios do DSM III-R e com o Montgomery-Asberg Depression Rating Scale. Näo houve diferença entre doentes e sob risco. Entretanto, os pacientes tiveram menos depressäo do que tinham tido antes ou nas fases precoces da doença. A MJD plenamente instalada parecia exercer efeito protetor da depressäo

Machado-Joseph disease of Azorean ancestry in Brazil: the Catarina kindred. Neurological, neuroimaging, psychiatric and neuropsychological findings in the largest known family, the "Catarina" kindred.

At the moment 9 seemingly independent families with the clinical diagnosis of MJD are known in Brazil. The largest family tree of Azorean ancestry contains 622 individuals in 9 generations. 236 were examined, 39 found to be affected by two examiners. Phenotypes I, II and III were expressed by 12, 23 and 4 patients with age of onset by phenotypes being 10-48, 14-54 and 30-55 respectively. Although clinically more severe, juvenile onset type I disease did not show as severe a ponto-mesencephalic atrophy on MRI as the father with type II disease of similar symptomatic duration. None of the 8 patients examined with MRI showed olivary atrophy or pallidal abnormalities. 12 affected and 23 at risk were evaluated with neuropsychological tests. Attention was normal in both groups. Verbal memory scores were below normal in the affected and there was greater decay with time than in the risk group. Both scored below normal in identifying silluettes and constructional praxis. Visual memory scores were well below normal for both, with many rotations but no omissions or confabulations. A peculiar pattern of multiplying internal details called "the fly-eye effect" was observed in 6 affected and 8 at risk. Defective color distinction when multiple colors presented close to each other, in face of proper naming of individual colors ("color simulatanagnosia"), was looked for in 29 people. 4/10 affected and 4/19 at risk showed this phenomenon. Cognitive dysfunctions in this MJD family are prominent in the sphere of vision. Whether they constitute an early manifestation in those at risk and thus serve as a clinical identifier of the illness is yet to be established. Depression was looked for in the history of the family with DSM III-R criteria and an attempt at quantification with the Montgomery-Asberg Rating Scale. There was no significant quantitative difference between affected and at risk. Once undeniably symptomatic however, the patients had no, or less depression than themselves before or at the early stages of the illness. Covert depression was appropriately excluded. Fully established MJD in this family seemed to exert a protective effect from depression.

[Understanding the questions on health and disease from adolescents in Azorean families--sexuality and reproduction]. / Compreendendo questões de saúde e doença de adolescentes de família açoriana--sexualidade e reprodução.

This work presents data on a qualitative research conducted with adolescents from a community characterized by Azorean cultural traits. Besides focusing sexuality and reproduction questions of these young men and women in their relation with the sociocultural context, this study also brings to a focus the duty the nurse has to understand such relations, so as to be in a position to offer effective care.

Waiting for the family legacy: the experience of being at risk for Machado-Joseph disease.

Every offspring of an individual with Machado-Joseph disease has a 50% chance of inheriting the disease-causing gene, and symptoms usually do not appear until adult life, usually between the ages of 20 and 40. There are no predictive screening tests available for the disease. This paper, drawn from data collected as part of a larger study of the malady among descendants of Azorean-Portuguese in the Azores Islands and in northern California, explores the subjective state of genetic risk. Although individuals at risk vary in their reactions to the threat of Machado-Joseph disease, there are commonalities of concern that cross-cut individual differences. These differences and commonalities are important for what they might tell us about the experience of genetic risk in general, as well as Machado-Joseph disease in particular.

'The stumbling disease': a case study of stigma among Azorean-Portuguese.

There exists among Azorean-Portuguese a biological malady that is inherited. First recognized by biomedicine in 1972 as a distinct disease entity, it has been in existence in the United States and the Azores Islands since at least the mid-1800s. The malady is generally known as the 'stumbling disease' among the Azorean-Portuguese; the current biomedical literature refer to it as Machado-Joseph disease. Historically an aura of stigma has surrounded affected individuals, their families, and primary ethnic group in which the malady is currently found. Drawing heavily on the work of Erving Goffman Stigma: Notes on the Management of Spoiled Identity. Prentice-Hall, Englewood Cliffs, N.J., 1963) and labelling theory, this paper explores the nature of this stigma. The cultural contexts of a small, face-to-face, homogeneous island setting is contrasted with that of the heterogeneous, anonymous setting of the United States to illuminate various aspects of the stigma configuration. The cultural context has important implications for stigma definitions, modes of social control, and management strategies of the stigmatized.

Machado-Joseph disease: the vestibular presentation.

Three patients presented with Machado-Joseph disease. We documented the vestibular abnormalities characteristic of Machado-Joseph disease during clinical examination. Electronystagmographic (ENG) abnormalities included bilateral gaze nystagmus, saccadic pursuit and failure of fixation suppression suggestive of cerebellar-brainstem pathology. Machado-Joseph disease is a degenerative neurological condition, inherited in an autosomal dominant fashion. It occurs in patients of Portuguese Azorean extraction. We suggest that otolaryngologists with a referral base including a Portuguese community be familiar with this disease as it may present in its early stages with symptoms of non-specific imbalance.

The natural history of Machado-Joseph disease. An analysis of 138 personally examined cases.

We have examined 138 cases of a disorder previously described in people of Portuguese origin and which has received many names. By computer analysis of 46 different items of a standardized neurological examination carried out in each patient, we have been able to delineate the main components of the clinical presentation, to conclude that the marked variability in clinical expressions does not negate the homogeneity of the disorder, and to describe the natural history of this entity which should be called, for historical reasons, "Machado-Joseph Disease". This hereditary disease has an autosomal dominant pattern of inheritance, presenting as a progressive ataxia with external ophthalmoplegia, and should be classified within the group of "Ataxic multisystem degenerations". When the disease starts before the age of 20, it may present with marked spasticity, of a non progressive nature but often so severe that it can be accompanied by "Gegenhalten" countermovements and dystonic postures but little frank dystonia. There are few true extrapyramidal symptoms except akinesia. When the disease starts after the age of 50, the clinical spectrum is mostly that of an amyotrophic polyneuropathy with fasciculations accompanying the ataxia. For all the other cases the clinical picture is a continuum between these two extremes, the main determinant of the clinical phenotype being the age of onset and a secondary factor, the place of origin of the given kindred. The ataxic and amyotrophic components are clearly progressive with time in contrast to the spasticity component. Although the majority of known cases are of Portuguese origin, this is not obligatory. The next research endeavour should be a search for the chromosomal site of the gene, using molecular biology technology such as those for recombinant DNA.

Joseph disease: a multisystem degenerative disorder of the nervous system.

We studied Joseph disease clinically and pathologically in two patients of Portuguese ancestry, but from different families. We found involvement of spinocerebellar tracts, Clarke's column, anterior horn cells, motor cranial nerve nuclei, and substantia nigra. One patient also had pallidosubthalamic and pontocerebellar degeneration with normal inferior olives. The second patient, a Joseph family member, had nerve cell loss in the subthalamic nucleus. The neostriatum appeared normal in both cases. The pigmented nuclei contained a few Lewy bodies. The almost identical pathology in two families support the hypothesis that Joseph disease is a genetic entity.