Racial/ethnic disparities in curative-intent treatment for early-stage non-small cell lung cancer patients among heterogeneous Black populations: US-born Black, Afro-Haitian, West Indian Black, and Hispanic Black.

BACKGROUND: Heterogeneous Black populations encounter significant obstacles in accessing cancer care, yet research on lung cancer treatment disparities remains limited. This study investigates whether the disparity in receiving curative-intent treatment (curative-intent surgery and/or stereotactic body radiation therapy [SBRT]) for early-stage non-small cell lung cancer (NSCLC) between non-Hispanic Whites (NHWs) and total Blacks extends to diverse Black populations, including US-born, Afro-Haitian, West Indian Black, and Hispanic Black individuals. METHODS: This cross-sectional study included all Florida cancer registry early-stage NSCLC cases 2005-2017, linked to individual-level discharge data containing comorbidity and specific treatment details (surgery and/or SBRT). Multivariable logistic regression assessed the association between race/ethnicity and the receipt of curative-intent treatment, while accounting for sociodemographic factors (poverty, age, insurance, and smoking status) and clinical variables. RESULTS: Among 55,655 early-stage NSCLC patients, 71.1% received curative-intent treatment: 72.1% NHW and 59.7% Black (non-Hispanic and Hispanic) individuals. Black patients had 35% lower odds (ORadj, 0.65; 95% CI, 0.59-0.70) of receiving curative-intent treatment compared to NHW patients. ORs varied from 0.57 (95% CI, 0.59-0.70) for Hispanic Black to 0.76 (95% CI, 0.56-1.02) for West Indian Black. Remarkably, Black-White disparities persisted despite the availability of curative treatment options (SBRT) for both high Charlson Comorbidity Index (CCI) observed among US-born Blacks and surgery for low CCI patients among all other Black subgroups. CONCLUSIONS: Pronounced disparities in accessing curative-intent treatments for early-stage NSCLC were evident across all Black subgroups, regardless of treatment availability and comorbidity profile. These findings underscore the need to address Black heterogeneity and prompt further research to rectify treatment disparities in early-stage NSCLC.

Exploring the experiences of Haitians/Haitian Americans in Miami-Dade County, Florida during the COVID-19 pandemic: how this community coped with the public health emergency.

Objective: To explore and describe the experiences of Haitians/Haitian Americans in Miami-Dade County, Florida during the COVID-19 pandemic, including their attitudes and practices towards vaccination. Design: We interviewed 15 community members and 15 stakeholders in the Haitian/Haitian American community in Miami-Dade County, Florida using a semi-structured interview guide. The qualitative interviews were conducted between February 4, 2021, and October 1, 2021. They were conducted in both English and Haitian Creole, audio recorded transcribed/translated, and coded using thematic content analysis. Results: The analyses revealed 9 major themes: (1) thoughts about the pandemic, (2) concerns about the COVID-19 vaccines, (3) healthcare access, February-October 2021, (4) intrapersonal relationship dynamics, (5) thoughts about individuals diagnosed with COVID-19, (6) thoughts about prevention measures (e.g., wearing masks, hand hygiene, social distancing, vaccination), (7) mental health struggles and coping, (8) food insecurity, and (9) overall experiences of the pandemic. The findings reveal that the COVID-19 public health emergency negatively affected Haitians/Haitian Americans across several domains, including employment, healthcare access, personal relationships, and food security. Conclusion: This research echoes the compounding negative experiences reported by multiple disadvantaged groups during the COVID-19 pandemic. From loss of employment to healthcare barriers, the pandemic forced many Haitians/Haitian Americans into greater economic and social instability. Interventions addressing these issues should recognize how these factors may interact and compound the experiences of this group. Health and public health agencies should work alongside community partners to build trust so that preventive efforts will be more readily accepted during public health emergencies.

Human T-lymphotropic virus 1/2 infection among immigrants and refugees in Central Brazil, an emerging vulnerable population.

Introduction: Migratory flows play a significant role in the spread of human T-lymphotropic virus 1/2 (HTLV-1/2). In the last decade, a substantial migration of individuals occurred from Haiti and Venezuela to Brazil. However, data on the prevalence of HTLV-1/2 infection among these international migrants in Brazil are scarce. This study describes the prevalence of this infection among immigrants and refugees in Central Brazil. Methods: A cross-sectional study was conducted with 537 international migrants in the State of Goiás, Central Brazil. Participants were interviewed, and blood samples were collected. Serological screening for anti-HTLV-1/2 was performed using an enzyme-linked immunosorbent assay (ELISA; Murex HTLV-I + II, DiaSorin, Dartford, UK), and seropositive samples were submitted for confirmation by a line immunoassay (INNO-LIA HTLV I/II, Fujirebio, Europe N.V., Belgium). Results: The majority of participants were males (54.4%), between 18 and 50 years old (78%; mean age: 29.1 years), self-declared black (55.1%), reported 1 to 12 years of formal education (70.9%), and were either Venezuelans (47.9%) or Haitians (39.7%). Additionally, 50.1% were immigrants, 49% were refugees, and five were Brazilian children (0.9%) born to Haitian immigrant parents. The overall prevalence of anti-HTLV-1/2 was 0.95% (95% CI: 0.31-2.28), with HTLV-1 at 0.19% and HTLV-2 at 0.76%. All seropositive individuals (n = 5) were refugees from Venezuela, resulting in a rate of 2.26% for anti-HTLV-1/2, HTLV-1 (0.45%) and HTLV-2 (1.81%) among Venezuelan refugees. Of the demographic and behavioral characteristics evaluated, unprotected sexual intercourse and having more than one sexual partner (≥2) in the previous 12 months were associated with HTLV-1/2 seropositivity among Venezuelans. Conclusion: This study revealed, despite the low seroprevalence of HTLV-1/2 among international migrants in Central Brazil, evidence of HTLV-1 and HTLV-2 infections in Venezuelan refugees. In addition, their characteristics highlight that specific social and health programs should be implemented for these emergent and socially vulnerable migrant groups.

Juvenile justice-involved Haitian families' experiences of structural racism and socioethnic discrimination.

Objective: This article examines how Haitian families with youth interfacing with the juvenile justice system cope with structural racism and socioethnic discrimination (RSD). Background: Haitian families' experiences of discrimination based on their histories, immigrant status, and positionality illustrates the need for more scientific scrutiny of the experiences of RSD among Black immigrant groups. This National Institute on Drug Abuse (NIDA)-funded study details the narratives of and responses to RSD experienced by Haitian families interfacing with the juvenile justice system. Method: Data are drawn from psychosocial assessment tools, therapeutic sessions, and ethnographic interviews conducted with Haitian families participating in a family-based therapeutic intervention. Using critical race theory, we foreground the voices of those negatively impacted and use Bourdieu's theory of practice to examine the intersectionality of race and ethnicity in this population's experiences of RSD. Results: The different experiences of and responses to RSD among youth and caregivers of Haitian descent are both a variation of the complex continuum of structural racism in the United States and unique to their immigrant experience of marginalization and cultural invalidation by public institutions, community members, and peers. Conclusion: Professionals working with this population must be sensitive to the ways these experiences impact young people's identity development processes, their health, and well-being. Haitian caregivers should be encouraged to protect their children by engaging in racial and socioethnic socialization that validates their RSD experiences. Implications: Understanding the intergenerational experiences of RSD among Black, immigrant groups and encouraging family dialogue and adolescent support will strengthen family cohesion during this period of racial reckoning.

Diabetes Mellitus Prevalence Among Haitian American Afro-Caribbeans in the United States.

To measure the prevalence of diabetes mellitus among Haitian American Afro-Caribbeans, a quantitative descriptive cross-sectional study was conducted using a convenience sample of 151 Haitian Americans in New York, New Jersey, and Florida. The results of the study revealed an age-adjusted prevalence of diabetes mellitus of 39.9% (95% CI 29.8% - 50.1%). This is greater than the prevalence in the U.S. population (12%) (Z = 5.54, p < 0.05) and the prevalence in the Black, non-Hispanic population (16.8%) (Z = 3.35, p < 0.05). There were 79 (52.3%) individuals with diabetes mellitus, of which 21 (13.9%) were individuals who were previously undiagnosed; and 56 (37%) were individuals who were taking medication(s) for controlling glucose. At a 39.9% prevalence rate of diabetes, Haitian Americans have an age-adjusted prevalence rate of diabetes that is more than twice the prevalence rate of diabetes in Black, non-Hispanic Americans and more than 3 times the rate in White, non-Hispanics. This rate is comparable to the prevalence rate in Native Americans of the Pima tribe. An urgent need exists to confirm these findings in a larger cohort.

Conversations about sexual activity within Haitian families: implications for HPV vaccine uptake.

Objective: Parents play an integral role in young adults' sexual health including human papillomavirus (HPV) vaccine decision-making. The objective of this study was to explore conversations regarding sexual activity in Haitian households and the influence of such conversations on young Haitian women's HPV vaccine discussion with their parents.Methods: From a large university in the southeastern United States, 30 Haitian-American college women (ages 17-26) were recruited for semi-structured in-depth interviews. The interviews were recorded and transcribed verbatim. Interview transcripts were analyzed using thematic analysis.Results: Most participants stated that they either did not have conversations regarding sexual activity or the conversations that they had were described as 'uncomfortable' or 'awkward'. Many participants stated that once parents knew that HPV is sexually transmitted, their discussions about the vaccine would be considered an announcement of their sexual debut or sexual activity. Hence, many decided to not discuss the HPV vaccine with their parents.Conclusion: Findings have important implications for HPV vaccine uptake. Results showed that a lack of conversations about sexual activity within Haitian households led to limited discussions about the HPV vaccine among young Haitian-American college women and their parents. Future HPV vaccine uptake efforts should integrate familial and cultural beliefs about female sexuality, while focusing on cervical cancer prevention.

Understanding Type 2 Diabetes Mellitus Among Haitian American Women: A Cultural Perspective.

The prevalence of type 2 diabetes mellitus (T2DM) is 19.7% in Haiti (DeGennaro et al., 2018). Haitian American women (HAW) experience difficulties with adherence to T2DM treatment and management (Bivins, 2016; Magny-Normilus et al., 2019; Vimalananda et al., 2011; Huffman et al., 2013); however, no previous study was found that focused exclusively on Haitian American women with T2DM. Van Manen's six research activities guided this phenomenological qualitative inquiry. Recruitment included 25 Haitian American women (N = 25) with T2DM from three South Florida counties. Data were collected using a vignette and audio-recorded semi-structured interviews with open-ended questions. Recordings were then transcribed and analyzed to identify thematic concepts and patterns. Themes of spiritualizing and shifting cultural norms with the subtheme of dietary restrictions were found. In conclusion, to promote health outcomes nurses must incorporate these salient factors in the care of Haitian American women with T2DM.

Utilização de serviços de saúde por imigrantes haitianos na grande Cuiabá, Mato Grosso, Brasil / Use of health services by Haitian immigrants in Cuiabá-Mato Grosso, Brazil

Resumo O objetivo deste artigo é analisar a utilização de serviços de saúde por imigrantes haitianos residentes na grande Cuiabá, Mato Grosso. Trata-se de um estudo transversal, com uma amostra probabilística de 452 imigrantes haitianos residentes em Cuiabá e Várzea Grande, entrevistados entre dezembro de 2014 e fevereiro de 2015. Foram avaliadas as características sociodemográficas e de saúde, hábitos de vida e a utilização dos serviços de saúde. Na análise dos dados foram calculados o teste de Qui-quadrado e a Regressão de Poisson para investigar os fatores associados à utilização dos serviços de saúde. Verificou-se que 45,6% dos entrevistados utilizaram algum serviço de saúde no Brasil, sendo maior a prevalência entre as mulheres, aqueles com maior renda, maior tempo de residência no Brasil, melhor entendimento da língua portuguesa e que autoavaliaram sua saúde como ruim. Os principais serviços utilizados foram Unidade Básica de Saúde (UBS) e atendimento de urgência e emergência públicos. Conclui-se que os imigrantes foram assistidos pelo SUS em acordo com o princípio constitucional do direito à saúde no Brasil.

Abstract This paper aims to analyze the use of health services by Haitian immigrants in Cuiabá, Mato Grosso. This is a cross-sectional study with a random sample of 452 Haitian immigrants in Cuiabá and Várzea Grande, interviewed between December 2014 and February 2015. Sociodemographic and health characteristics, lifestyle factors, and the use of health services were evaluated. Data analysis included Chi-square test and Poisson regression to investigate the factors associated with the use of health services. We found that 45.6% of respondents used some health service in Brazil, with a higher prevalence of use among women, those with higher income, longer residence time in Brazil, better understanding of the Portuguese language, and with poor self-reported health. The PHC Unit (UBS) and public urgent and emergency care were the primary services used. We conclude by saying that the SUS assisted the immigrants under the Brazilian constitutional principle of the right to health.

High Prevalence of Food Insecurity and Factors Associated with Haitian Immigrants in Southern Chile.

The objective was to determine the association between sociodemographic factors and food insecurity (FI) in Haitian immigrants in southern Chile. An analytical cross-sectional design was used. The sample consisted of Haitian immigrants residing in Southern Chile, who were recruited from community centers and completed a sociodemographic questionnaire and the Latin-American and Caribbean Food Security Scale. Multivariable analyses were performed to identify factors associated with FI. FI prevalence in the 234 participants was 78%; 60% had severe FI. Having children (OR 3.6; 95% CI 1.6-7.4), limited Spanish proficiency (OR 3.5; 95% CI 1.8-7.3), no access to basic services (OR 2.8; 95% CI 1.2-6.4), and not being a legal permanent resident (OR 2.4; 95% CI 1.1-6.1) were associated with significantly higher odds of FI. Over three-quarters of Haitian immigrants in southern Chile suffer from FI. Tailored intervention strategies are needed to address this major public-health issue, with a special focus on those at highest risk, including families with children, and those with limited Spanish proficiency, no access to basic services, and without legal permanent resident status.

Imigração e redes de acolhimento: o caso dos haitianos no Brasil / Immigration and host networks: the case of Haitians in Brazil / Inmigración y redes de acogida: el caso de los haitianos en Brasil

Resumo Este trabalho tem como objetivo analisar o papel das redes de acolhimento no processo migratório dos haitianos no Brasil, procurando entender a razão pela qual tais redes tiveram uma centralidade na gestão dessa imigração e na interlocução das questões por ela engendradas no país e, ao mesmo tempo, balizar o papel que elas tiveram para facilitar a mobilidade desses migrantes internamente, além de retroalimentar o fluxo migratório, iniciado de forma expressiva em 2010. Partindo de dados coletados na fronteira, em Manaus e em algumas cidades brasileiras, onde foram aplicados 279 questionários, que reúnem informações acerca dos migrantes haitianos presentes no Brasil, bem como da família ausente, seja no Haiti ou em outro país, foi possível levantar a hipótese de que, sem essas redes de acolhimento, a chegada e os percursos desses imigrantes pelo Brasil teriam sido muito mais dramáticos do que realmente foram, em razão da falta de políticas públicas de acolhimento e de inserção sociocultural.(AU)

Abstract This paper aims to analyze the role of host networks in the migration process of Haitians to Brazil, trying to understand the extent to which these networks played a central role in the management and communication of the issues engendered by this immigration in the country and, at the same time, if it was able of facilitating their mobility in Brazil, providing feedback to the migratory flow that began in 2010. Based on data collected from the Border, in Manaus and in some Brazilian cities, where 279 questionnaires were filled out, gathering information about the Haitian migrants present in Brazil, as well as their absent families, whether in Haiti or in another country, it was possible to build the hypothesis that without these host networks the arrival and mobility of these immigrants in Brazil would have been much more difficult than it really was, because of the lack of public policies for hosting and sociocultural insertion.

Resumen Este trabajo tiene como objetivo analizar el papel de las redes de acogida en el proceso migratorio de los haitianos en Brasil e indagar en qué medida esas redes han tenido un papel central en la gestión de esta inmigración y en el diálogo en torno a los problemas engendrados por ella en el país y, al mismo tiempo, evaluar en rol que ellas han tenido para facilitar la movilidad de estos migrantes en Brasil, además de retroalimentar la migración que ha sido significativa desde 2010. A partir de los datos recogidos en la frontera, en Manaus y en algunas ciudades brasileñas, donde se aplicaron 279 cuestionarios que recopilan información sobre los migrantes haitianos presentes en Brasil —así como la familia ausente, ya sea en Haití o en otro país—, fue posible construir la hipótesis de que, sin las redes de acogida, la llegada y la movilidad de estos inmigrantes en Brasil hubiera sido mucho más problemática de lo que realmente ha sido, debido a la falta de políticas públicas de acogida y de integración sociocultural.

The recent geodynamics of Haitian migration in the Americas: refugees or economic migrants? / A geodinâmica recente da migração haitiana nas Américas: refugiados ou migrantes econômicos? / La geodinamica reciente de la migracion haitiana en las Americas: refugiados o migrantes econômicos?

Abstract After having presented the specific migration context of Haiti and its multidimensional vulnerability, this paper shows that the diaspora geography explains, to a large extent, the location of Haitian refugees and asylum seekers in North America and the French Caribbean territories. Then, we explore the relation between migration policy evolution and the development of new migration routes towards South America, where the recognition of the multidimensional nature of this migration has paved the way for the legalization of Haitian migrants, particularly in Brazil. The complementary migration functions of Ecuador, Peru, Brazil and Chile created a new regional migration system centered on the Southeast and the South of Brazil. This emerging South-South migration route is part of a larger Haitian migration system that connects Latin America to North America and the Caribbean.

Resumo Depois de apresentar o contexto de migração específico do Haiti e seus aspectos multidimensionais, o artigo demonstra que a geografia da diáspora haitiana explica, em grande medida, a localização dos refugiados e requerentes de asilo na América do Norte e nos territórios franceses do Caribe. Aborda-se a relação entre a evolução da política de migração e o desenvolvimento de novas rotas de migração em direção à América do Sul, onde o reconhecimento do caráter multidimensional dessa imigração abriu caminho para a legalização da presença haitiana, particularmente no Brasil. As funções migratórias complementares do Equador, Peru, Brasil e Chile desenham um novo sistema de migração regional centrado no Sudeste e no Sul do Brasil. Este emergente espaço de migração Sul-Sul faz parte de um sistema migratório haitiano mais amplo, que conecta a América do Sul com a América do Norte e o Caribe.(AU)

Resumen Habiendo presentado el contexto migratorio especifico de Haiti y sus aspectos multidimensionales el articulo mostrará que la geografía de la diáspora explica en gran medida la ubicación de los refugiados y solicitantes de asilo en América del Norte y el Caribe francés. Después, exploraremos la relación entre la evolucion de las políticas migratorias y el desarollo de nuevas rutas de migración hacia América del Sur, donde el reconocimiento del carácter polifacético de esta migración ha abierto el camino para la legalización de la presencia haitiana, especialmente en Brasil. El caracter complementario de las funciones migratorias del Ecuador, Peru, Brasil y Chile define un nuevo sistema migratorio regional centrado en el sureste y el sur de Brasil. Este espacio migratorio Sur-Sur en gestación forma parte de un sistema migratorio haitiano más amplio que conecta América Latina a América del Norte y el Caribe.

Integrative Review on Adherence in Haitians With Diabetes.

In light of a marked increase in the incidence and prevalence of diabetes in the United States in recent years with associated health costs totaling $245 billion for 2012, diabetes has become a major health and fiscal concern. Haitian Americans as a cultural group have unique obstacles to effective treatment and management of diabetes. This paper analyzes recent studies relevant to these challenges in anticipation of new research pertaining to this population. Although medication compliance is generally referred to as adherence, it is a complex concept and key challenge in diabetes care. Accordingly, this paper will further define adherence by describing its relevance in effective treatment and management. It will also analyze key theoretical perspectives in diabetes care, summarize recent research, and make recommendations for effective future research on the impact of diabetes education in Haitian Americans.

Os impactos subjetivos dos fluxos migratórios: os haitianos em Florianópolis (SC) / Los impactos subjetivos de los flujos migratorios: los haitianos en Florianópolis (SC) / The subjective impacts of migratory flows: the haitians of Florianópolis (SC)

Resumo Desde o acordo internacional estabelecido entre Haiti e Brasil, um número significativo de haitianos tem migrado para este país por diversos motivos nos últimos seis anos. A partir de um estudo qualitativo, buscamos investigar as narrativas e modos de vida desses sujeitos que, por desejo e necessidades, buscaram a migração como uma estratégia de ampliação de possibilidades sociais, políticas e subjetivas. A dificuldade com o idioma, a saudade, as rupturas familiares, o preconceito, as práticas discriminatórias, a exaustão pelo excessivo trabalho, a dificuldade de fazer laço social significativo com brasileiros(as), a hospitalidade de alguns brasileiros(as) e as melhores condições de vida foram alguns dos aspectos encontrados no campo desta pesquisa. A psicologia social possui um importante papel na luta pelo direito de migrar, produzindo pesquisas e intervenções capazes de subsidiar olhares mais complexos e menos estereotipados sobre a migração, promovendo e garantindo o lugar de direito e desejo do migrante.

Resumen Dado el acuerdo internacional entre Haití y Brasil, un número significativo de haitianos han emigrado a este país por diversas razones, en los últimos seis años. A partir de un estudio cualitativo, tratamos de investigar las historias y formas de vida de estos sujetos que, por deseo y necesidades, buscaron la migración como una estrategia de expansión de las oportunidades sociales, políticas y subjetivas. La dificultad con el idioma, la nostalgia, la desintegración familiar, los prejuicios, las prácticas discriminatorias, agotamiento por exceso de trabajo, la dificultad de hacer lazo social significativo con los brasileños(as), la hospitalidad de algunos brasileños(as) y las mejores condiciones de vida fueron algunos de los elementos encontrados en el campo de esta investigación. La psicología social tiene un papel importante en la lucha por el derecho a migrar, produciendo investigaciones y intervenciones capaces de subsidiar miradas más complejas y menos estereotipadas sobre la migración, promoviendo y garantizando el lugar de derecho y deseo del migrante.

Abstract Since the international agreement between Haiti and Brazil, a significant number of Haitians have migrated to Brazil for several reasons in the last six years. Through a qualitative study we investigated the narratives and ways of life of these individuals that, by desire and needs, sought migration as a strategy to expand social, political and subjective possibilities. Difficulties with language, homesickness, family ruptures, prejudice, discriminatory practices, exhaustion due to excessive work, difficulty in making a meaningful social bond with Brazilians, the hospitality of some Brazilians and better living conditions were some of the aspects found in the research results. Social psychology plays an important role in the struggle for the right to migrate, producing research and interventions that will subsidize more complex and less stereotyped views on migration, promoting and guaranteeing the rights and wishes of the migrant.

A mudança da política externa brasileira para imigrantes e refugiados: o caso da imigração haitiana no início do século XXI / The change of brazilian foreign policy for immigrants and refugees: the case of haitian immigration in the beginning of the 21st century

Devido ao acentuado fluxo migratório de haitianos com destino ao território brasileiro, verificado especialmente após o ano de 2010, o presente artigo analisa a mudança ocorrida na política externa brasileira para imigrantes e refugiados com foco nesse grupo migratório. O trabalho parte do pressuposto de que ocorreu uma recategorização desses migrantes, anteriormente classificados pelo governo brasileiro como refugiados, frente aos anseios de projeção internacional do país. Tais anseios cristalizaram-se sob a atuação do Brasil nos fóruns regionais sobre a temática de migração e direitos humanos, no comando da Missão das Nações Unidas para a Estabilização no Haiti e com o assento definitivo na Organização Internacional para as Migrações e Alto Comissariado das Nações Unidas para Refugiados, quiçá, um degrau às pretensões do Estado brasileiro junto ao Conselho de Segurança das Nações Unidas. Utilizando-se da abordagem de autores sobre a Política Externa Brasileira contemporânea, vislumbrar-se-á então quais foram as fontes de mudança sofridas na política externa e migratória brasileira, com base no caso do trato dos haitianos, que possivelmente replicam-se para outros grupos destacados, como de sírios e senegaleses. Por fim, o artigo aponta os desafios e pontos de convergência entre estas duas políticas, além das incongruências decorrentes da problemática migratória interna somada aos anseios de inserção estratégica externa do governo brasileiro entre 2010 e 2015.

With regard to the growing migration flow of Haitians towards the Brazilian territory, experienced specially after the year 2010, this article analyses the changes in the Brazilian foreign policy to immigrants and refugees, with special focus on this migratory group. The paper assumes that there had been a recategorization of these migrants, previously classified by the Brazilian government as refugees, with regard to the aspirations of international projection of the country. Such aspirations were crystallized under the action of Brazil in regional forums on migration and human rights issues, in charge of the United Nations Stabilization Mission in Haiti and the permanent seat in the International Organization for Migration and United Nations High Commissioner for Refugees, perhaps, a step to the aims of the Brazilian state with the United Nations Security Council. Using the approaches of authors of the contemporary Brazilian Foreign Policy, this paper will highlight what were the sources of change suffered in the Brazilian foreign and migration policies, based on the case of the Haitians, which possibly is replicated to other relevant groups such as Syrians and Senegalese. Finally, the article points out the challenges and points of convergence between these two policies, in addition to the inconsistencies arising from domestic migration issues in addition to the foreign strategic insertion aspirations of the Brazilian government between 2010 and 2015.

A mudança da política externa brasileira para imigrantes e refugiados: o caso da imigração haitiana no início do século XXI / The change of brazilian foreign policy for immigrants and refugees: the case of haitian immigration in the beginning of the 21st century

Devido ao acentuado fluxo migratório de haitianos com destino ao território brasileiro, verificado especialmente após o ano de 2010, o presente artigo analisa a mudança ocorrida na política externa brasileira para imigrantes e refugiados com foco nesse grupo migratório. O trabalho parte do pressuposto de que ocorreu uma recategorização desses migrantes, anteriormente classificados pelo governo brasileiro como refugiados, frente aos anseios de projeção internacional do país. Tais anseios cristalizaram-se sob a atuação do Brasil nos fóruns regionais sobre a temática de migração e direitos humanos, no comando da Missão das Nações Unidas para a Estabilização no Haiti e com o assento definitivo na Organização Internacional para as Migrações e Alto Comissariado das Nações Unidas para Refugiados, quiçá, um degrau às pretensões do Estado brasileiro junto ao Conselho de Segurança das Nações Unidas. Utilizando-se da abordagem de autores sobre a Política Externa Brasileira contemporânea, vislumbrar-se-á então quais foram as fontes de mudança sofridas na política externa e migratória brasileira, com base no caso do trato dos haitianos, que possivelmente replicam-se para outros grupos destacados, como de sírios e senegaleses. Por fim, o artigo aponta os desafios e pontos de convergência entre estas duas políticas, além das incongruências decorrentes da problemática migratória interna somada aos anseios de inserção estratégica externa do governo brasileiro entre 2010 e 2015.(AU)

With regard to the growing migration flow of Haitians towards the Brazilian territory, experienced specially after the year 2010, this article analyses the changes in the Brazilian foreign policy to immigrants and refugees, with special focus on this migratory group. The paper assumes that there had been a recategorization of these migrants, previously classified by the Brazilian government as refugees, with regard to the aspirations of international projection of the country. Such aspirations were crystallized under the action of Brazil in regional forums on migration and human rights issues, in charge of the United Nations Stabilization Mission in Haiti and the permanent seat in the International Organization for Migration and United Nations High Commissioner for Refugees, perhaps, a step to the aims of the Brazilian state with the United Nations Security Council. Using the approaches of authors of the contemporary Brazilian Foreign Policy, this paper will highlight what were the sources of change suffered in the Brazilian foreign and migration policies, based on the case of the Haitians, which possibly is replicated to other relevant groups such as Syrians and Senegalese. Finally, the article points out the challenges and points of convergence between these two policies, in addition to the inconsistencies arising from domestic migration issues in addition to the foreign strategic insertion aspirations of the Brazilian government between 2010 and 2015.(AU)

Factors Associated with Human Papillomavirus Vaccine Acceptance Among Haitian and African-American parents of Adolescent Sons.

ACKNOWLEDGEMENTS: The authors would like to thank Cecilia Marquez, Justine Lavoye, Elaine Shu and Hailey Tipton for their efforts with participant recruitment and data collection. OBJECTIVE: To assess knowledge, attitudes, beliefs and practices related to HPV vaccination among African-Americans and Haitian immigrant parents, and to compare vaccination rates of their sons. STUDY DESIGN: We performed semi-structured interviews with parents of boys aged 11-17 who had not yet received the HPV vaccine. We used validated surveys of HPV knowledge, trust in physicians, and intention to vaccinate. We probed participants' thought processes about HPV vaccination, and examined parental attitudes, beliefs, and practices toward HPV vaccination using open-ended questions. We then reviewed medical records to determine whether sons were subsequently vaccinated. RESULTS: 25 African-American and 30 Haitian immigrant parents and legal guardians participated in the study. Haitian immigrants were more likely to be married and to practice a religion than African-Americans. Both groups had limited knowledge of HPV (32% of questions were answered correctly by Haitian immigrants vs. 31% by African-Americans). Sixty-four percent of African-Americans and 79% of Haitians intended to vaccinate their sons, however only 24% of African-American and 20% of Haitian sons received vaccination within 12 months of the interview. Open-ended questions revealed that most African-Americans felt that vaccination fell within the parental role, while some Haitian immigrants felt uncomfortable vaccinating against sexually transmitted infections because they felt children should not be having sex. Both groups wanted more information about HPV vaccines. CONCLUSIONS: Improving HPV vaccine rates in Haitian and African-American boys may require culturally competent approaches that address ethnic-specific barriers among their parents.

Use of hemoglobin A1C to detect Haitian-Americans with undiagnosed Type 2 diabetes / Utilização de hemoglobina A1C no rastreamento de haitianos americanos com diabetes tipo 2 não diagnosticado

OBJECTIVE: To evaluate the validity of hemoglobin A1C (A1C) as a diagnostic tool for type 2 diabetes and to determine the most appropriate A1C cutoff point for diagnosis in a sample of Haitian-Americans. SUBJECTS AND METHODS: Subjects (n = 128) were recruited from Miami-Dade and Broward counties, FL. Receiver operating characteristics (ROC) analysis was run in order to measure sensitivity and specificity of A1C for detecting diabetes at different cutoff points. RESULTS: The area under the ROC curve was 0.86 using fasting plasma glucose ≥ 7.0 mmol/L as the gold standard. An A1C cutoff point of 6.26% had sensitivity of 80% and specificity of 74%, whereas an A1C cutoff point of 6.50% (recommended by the American Diabetes Association - ADA) had sensitivity of 73% and specificity of 89%. CONCLUSIONS: A1C is a reliable alternative to fasting plasma glucose in detecting diabetes in this sample of Haitian-Americans. A cutoff point of 6.26% was the optimum value to detect type 2 diabetes.

OBJETIVO: Avaliar a validade da hemoglobina A1C (A1C) como ferramenta para o diagnóstico de diabetes tipo 2 e determinar o ponto de corte mais apropriado para a A1C no diagnóstico de uma amostra de haitianos americanos. SUJEITOS E MÉTODOS: Os sujeitos (n = 128) foram recrutados dos condados de Miami-Dade e Broward na Flórida. A análise ROC (Receiver operating characteristics) foi feita de forma a medir a sensibilidade e especificidade de A1C para a detecção do diabetes em diferentes pontos de corte. RESULTADOS: A área sob a curva ROC foi 0,86 usando a glicemia de jejum ≥ 7,0 mmol/L como padrão-ouro. O ponto de corte de 6,26% para a A1C apresentou sensibilidade de 80% e especificidade de 74%, enquanto o ponto de corte de 6,50% (recomendado pela American Diabetes Association - ADA) apresentou uma sensibilidade de 73% e especificidade de 89%. CONCLUSÕES: A A1C foi uma alternativa confiável para a glicemia de jejum na detecção do diabetes nesta amostra de haitianos americanos. Um ponto de corte de 6,26% foi o valor ótimo para a detecção do diabetes tipo 2.