Ethnocultural heart: another challenge for an emerging diversity.

Race, ethnic origin and culture, as well as other aspects of diversity, affect cardiovascular care. This is relevant to Canada with its ever-increasing diversity. The dynamic interplay of genetic, biological and environmental influences leads to differences and variability. Understanding the role of these determinants leads to the challenge of reducing or eliminating differences in cardiovascular care related to diversity.

Myocardial infarction at 30, 25 and even 20 years of age: chaos in prevention and prevention in order - abstract

A 20-year-old patient develops myocardial infarction (MI) after playing hockey, with another acute event at the age of 30 years despite normal coronary arteries. A 25-year-old non-smoker awakes with chest pain and major anterior MI. A 35-year-old develops stress-induced, threatened major anterior MI. A 45-year-old patient with stable, mild coronary artery disease at catheterization develops MI after a dispute. Patients develop acute coronary syndromes unexpectedly and unpredictably. A few patients with risk factors and a few young patients with few or no usual risk factors developing acute coronary events are presented. Such events may lead an already sceptical public to the notion of futility in risk modification or chaos in prevention. Chaos and Complexity, a new science based on mathematics and physics of nonlinear systems as most of medicine is, offers a model for understanding unexpected events in clinical medicine. Unpredictability is inherent because of the interrelatedness of local and distant events and sensitive dependence on initial conditions where small causes lead to huge effects, and thus variable clinical outcomes. Understanding chaos, complexity and the newer concepts of pathogenesis and acute risk factors should keep prevention, despite unpredictability

Multicultural paediatrics ... Toronto 1993: the new reality - abstract

The new reality of practising paediatrics in Toronto, 1993, is recognition of the city's great ethnic and cultural diversity. The multicultural mix of initial European immigrants and the later influx from the Caribbean, S.E. Asia, Hong Kong, India, Pakistan, Sri Lanka, Africa, South America, the Middle East, Eastern Europe and the former Eastern Block, creates challenges to the practice of medicine and paediatrics. We are now faced with a new medicine - of unusual diseases, homeopathy and herbal medicines of many cultures and of differing concepts of child care and discipline. Language difficulties and distortion from nuances of language, traditional and cultural expectations, adaptation, assimilation and cultural changes, all produce tremendous pressures on children and family. Specifically, the cultural and religious diversity of the new immigrants with differing views on childbirth, child rearing, nutrition