1.

Understanding immigration as a social determinant of health: Cardiovascular disease in

Hispanics/Latinos and South Asians in the United States.

Immigrants from South Asian and Hispanic/Latino countries make up the largest portion

of the immigrant population in the United States. Some barriers that hinder access to immigrant

care might include language, finances, culture, level of education, and systemic exclusions. In

addition to assessing the social determinants of health, this article also looks into the

epidemiology and risk factors of cardiovascular disease (CVD) within the two aforementioned,

groups.

Hispanics born in the US and those who immigrate to the country have CVD as the

second leading cause of death in adults. Generally, studies indicate that Hispanics have higher

CVD risks. In contrast, immigrant Hispanics claim to have lower risk factors for CVD, including

diabetes, obesity, hypertension, etc. Similarly, the most common cause of death for South Asians

is CVD. They also have the highest occurrence of cardiovascular risk factors and a significantly

higher risk for developing coronary heart disease when compared to other racial subgroups.

Although there are many variations within Hispanic and South Asian populations, it was found

that immigrants initially have better cardiovascular health when compared to those of the same

race/ethnicity US-born. However the immigrant’s cardiovascular health usually decreases as

length of time residing within the United States increases. It is resultant of a lack of physical

activity, poor quality food, and increased sedentary lifestyle.

I like that this article focused on one of the major causes of mortality and morbidity in the

world and its significance within two of the largest groups in the immigration population. It’s

understandable, yet interesting to see that the main reason for the increased CVD risk factors are

the same in both Hispanics and South Asians: a lack of exercise, poor nutrition, and a sedentary
lifestyle. Unfortunately, it is also sad to see that these immigrants come to the United States for a

better life but they accrue worsened overall health. Studies like these are relevant so that we

know how to assist and improve the public health. With immigrants making up such a large

portion of the population it is only logical that immigrant health would be included in American

public health.

Guadamuz JS, Kapoor K, Lazo M, Eleazar A, Yahya T, Kanaya AM, Cainzos-Achirica M, Bilal

U. Understanding Immigration as a Social Determinant of Health: Cardiovascular Disease in

Hispanics/Latinos and South Asians in the United States. Curr Atheroscler Rep. 2021 Mar

27;23(6):25. doi: 10.1007/s11883-021-00920-9. PMID: 33772650; PMCID: PMC8164823.

2. Oral health in the elderly patient and its impact on general well-being: a nonsystematic

review

The overall health of the elderly has been steadily declining due to poor oral health and

subsequent oral diseases. There has been a higher prevalence of cavities, dry mouth, oral cancer,

periodontal disease, and complete or partial edentulism noticed within this group. Reasons

behind the poor oral health might include lack of access to care, chronic disease, and reduced

manual dexterity. Research has shown that a person’s oral health and general health are

interdependent. Geriatric patients are usually on multiple medications which affect salivary

production, and therefore affects their ability to eat. Additionally, poor oral health can affect

general health in that it is linked to, and can exacerbate certain systemic diseases, such as

hypertension, and diabetes. For this reason, the dental team should work closely with the

geriatric patient’s doctors to prevent/reduce complications (especially as it relates to medication

and dental procedures) and increase quality of care. In order to prevent or improve oral health

status, proper oral hygiene practices, including regular tooth brushing, flossing, and dental

check-ups, are essential. Dental visits are also highly recommended for early detection of oral

cancer. The dental team should educate the patient and/or their caregiver on proper oral care or

give modifications based on the patient’s limitations.

This article was very well written and informative. As a dental professional, I do agree

with the recommendations, especially the multidisciplinary approach to care. Oral health is a

pertinent factor when considering overall health, especially when the losing teeth could mean

that the patient is at risk for malnutrition. Being malnourished could lower the body’s ability to

repair itself and fight infections. I believe it definitely is important to educate caregivers as well

as geriatric patients in understanding why oral health is important and related related to their

overall health.

Gil-Montoya, J. A., de Mello, A. L., Barrios, R., Gonzalez-Moles, M. A., & Bravo, M. (2015).

Oral health in the elderly patient and its impact on general well-being: a nonsystematic

review. Clinical interventions in aging, 10, 461–467. https://doi.org/10.2147/CIA.S54630

3. Anorexia nervosa in adolescents

Anorexia nervosa is an eating disorder very commonly seen in adolescents. In this serious

condition, there is noticeable severe weight loss, fear of gaining weight, and a distorted body

image. This disease is most common in teenage girls, but also may be seen in teen boys.

Anorexia nervosa affects a wide age range, but the peak range is 15-19 for both male and female.

Risk factors for the disease include genetic predisposition, psychological factors ( e.g. anxiety,
perfectionism, and low self-esteem), social influences, family dynamics, and media influence

regarding body image. Clinical features of anorexia may include excessive exercise, distorted

body image, self-induced vomiting, restrictive eating, and extreme weight loss. Younger children

may begin showing signs of anorexia nervosa by refusing to eat. A comprehensive clinical

evaluation of BMI, blood tests, dentition, hair, skin and nails may be necessary to confirm the

diagnosis. Another common sign of anorexia nervosa is cardiovascular instability in the form of

bradycardia, hypotension, postural hypotension and hypothermia due to being underweight.

Medication alone is usually not the best course of treatment for anorexia nervosa. The

first course of treatment for medically stable adolescents is anorexia nervosa-focused family

therapy. Other effective courses of treatment might include inpatient care or and psychotherapy.

Early detection and nutritional rehabilitation key intervention factors for the disease. For best

overall care, a multidisciplinary approach is necessary with nutritional, psychological, and

medical specialists.

So many teens are afflicted with this disease, and I believe it is necessary that we are able

to identify the associated signs and symptoms. I love that this article mentions that young men

are also susceptible to anorexia nervosa, because it is often stigmatized to be just girls/women

who suffer from this disease. Overlooking the boys would mean that there are many people

suffering from this disease and are not getting the help they need. One thing I learned from this

article was that family therapy is actually the first course of treatment for anorexia nervosa. I was

unaware of how much of an impact family relations had on anorexia. Nevertheless, it is a

multifactorial disease, and I agree that treatment should focus on psychological, nutritional, and

medial stability.
Neale, J., & Hudson, L. D. (2020). Anorexia nervosa in adolescents. British journal of hospital

medicine (London, England : 2005), 81(6), 1–8. https://doi.org/10.12968/hmed.2020.0099