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African Americans (african + american)
Kinds of African Americans Terms modified by African Americans Selected AbstractsTHE ROLE OF CRIME IN HOUSING UNIT RACIAL/ETHNIC TRANSITION,CRIMINOLOGY, Issue 3 2010JOHN R. HIPP Previous research frequently has observed a positive cross-sectional relationship between racial/ethnic minorities and crime and generally has posited that this relationship is entirely because of the effect of minorities on neighborhood crime rates. This study posits that at least some of this relationship might be a result of the opposite effect,neighborhood crime increases the number of racial/ethnic minorities. This study employs a unique sample (the American Housing Survey neighborhood sample) focusing on housing units nested in microneighborhoods across three waves from 1985 to 1993. This format allows one to test and find that such racial/ethnic transformation occurs because of the following effects: First, White households that perceive more crime in the neighborhood or that live in microneighborhoods with more commonly perceived crime are more likely to move out of such neighborhoods. Second, Whites are significantly less likely to move into a housing unit in a microneighborhood with more commonly perceived crime. And third, African American and Latino households are more likely to move into such units. [source] EXECUTING THE INNOCENT AND SUPPORT FOR CAPITAL PUNISHMENT: IMPLICATIONS FOR PUBLIC POLICYCRIMINOLOGY AND PUBLIC POLICY, Issue 1 2005JAMES D. UNNEVER Research Summary: The issue of whether innocent people have been executed is now at the center of the debate concerning the legitimacy of capital punishment. The purpose of this research was to use data collected by the Gallup Organization in 2003 to investigate whether Americans who believed that an innocent person had been executed were less likely to support capital punishment. We also explored whether the association varied by race, given that African Americans are disproportionately affected by the death penalty. Our results indicated that three-quarters of Americans believed that an innocent person had been executed for a crime they did not commit within the last five years and that this belief was associated with lower levels of support for capital punishment, especially among those who thought this sanction was applied unfairly. In addition, our analyses revealed that believing an innocent person had been executed had a stronger association with altering African American than white support for the death penalty. Policy Implications: A key claim of death penalty advocates is that a high proportion of the public supports capital punishment. In this context, scholars opposing this sanction have understood the importance of showing that the public's support for executing offenders is contingent and shallower than portrayed by typical opinion polls. The current research joins this effort by arguing that the prospect of executing innocents potentially impacts public support for the death penalty and, in the least, creates ideological space for a reconsideration of the legitimacy of capital punishment. [source] Race and religion: differential prediction of anxiety symptoms by religious coping in African American and European American young adults,DEPRESSION AND ANXIETY, Issue 3 2010L. Kevin Chapman Ph.D. Abstract Background: Psychosocial factors, including religious coping, consistently have been implicated in the expression of anxiety disorders. This study sought to investigate the relationship between religious coping on anxiety symptoms among a nonclinical sample of African American and European American young adults. Methods: One hundred twenty-one European American and 100 African American young adults completed measures of anxiety and religious coping. Results: As predicted, results differed according to race. African Americans reported significantly more positive religious coping, less negative religious coping, and experienced fewer anxiety symptoms than European Americans. European Americans demonstrated a significant, positive relationship between negative religious coping and anxiety symptoms, and an opposite trend related to anxiety and positive religious coping. However, no such relationships emerged among the African American sample. Conclusions: Implications and suggestions for future research are discussed. Depression and Anxiety, 2010. © 2008 Wiley-Liss, Inc. [source] Obsessive-compulsive disorder among African Americans and blacks of Caribbean descent: results from the national survey of American life,DEPRESSION AND ANXIETY, Issue 12 2008Joseph A. Himle Ph.D. Abstract Background: There is limited research regarding the nature and prevalence of obsessive-compulsive disorder (OCD) among various racial and ethnic subpopulations within the United States, including African Americans and blacks of Caribbean descent. Although heterogeneity within the black population in the United States has largely been ignored, notable differences exist between blacks of Caribbean descent and African Americans with respect to ethnicity, national heritage, and living circumstances. This is the first comprehensive examination of OCD among African Americans and blacks of Caribbean descent. Methods: Data from the National Survey of American Life, a national household probability sample of African Americans and Caribbean blacks in the United States, were used to examine rates of OCD among these groups. Results: Lifetime and 12-month OCD prevalence estimates were very similar for African Americans and Caribbean blacks. Persistence of OCD and rates of co-occurring psychiatric disorders were very high and also similar between African American and Caribbean black respondents. Both groups had high levels of overall mental illness severity and functional impairment. Use of services was low for both groups, particularly in specialty mental health settings. Use of anti-obsessional medications was also rare, especially among the Caribbean black OCD population. Conclusions: OCD among African Americans and Caribbean blacks is very persistent, often accompanied by other psychiatric disorders, and is associated with high overall mental illness severity and functional impairment. It is also likely that very few blacks in the United States with OCD are receiving evidence-based treatment and thus considerable effort is needed to bring treatment to these groups. Depression and Anxiety, 2008. Published 2008 Wiley-Liss, Inc. [source] Morpheaform Basal Cell Carcinoma in African AmericansDERMATOLOGIC SURGERY, Issue 12p2 2004Uma Nadiminti MD Background. Although it has been established that basal cell carcinoma is an uncommon diagnosis in black patients, the morpheaform subtype is very rare among these individuals. Objective. The objective is to present two cases of morpheaform basal cell carcinoma in African-American patients. Methods. This is a case series and a literature review using the Ovid Medline Database. Key words used in the search include "basal cell carcinoma,""African American,""black,""African,""negros,""morpheaform,""sclerosing,""fibrosing," and "scar-like basal cell carcinoma." The Ovid Medline Database was searched from 1966 to present and was restricted to the English language. Results. A review of the Emory Dermatology clinic charts from 1989 to 2004 revealed two black patients with morpheaform basal cell carcinomas. Conclusions. Although extremely rare, morpheaform pattern basal cell carcinoma must be considered in the differential diagnosis for black patients presenting with nonhealing lesions. [source] The Impact of a Concurrent Trauma Alert Evaluation on Time to Head Computed Tomography in Patients with Suspected StrokeACADEMIC EMERGENCY MEDICINE, Issue 3 2006Esther H. Chen MD Background: Emergency department (ED) overcrowding threatens quality of care by delaying the time to diagnosis and treatment of patients with time-sensitive diseases, such as acute stroke. Objective: The authors hypothesized that the presence of a trauma alert evaluation would impede the time to head computed tomography (hCT) in patients with stroke-like symptoms. Methods: This was a secondary analysis of prospectively collected data on patients with potential stroke who received an hCT in an urban trauma center ED from January 1, 2004, to November 30, 2004. Structured data collection included historical and examination items, National Institutes of Health (NIH) stroke scale score, laboratory and radiographic results, and final diagnosis. Admitted patients were followed in hospital. Patients who presented within one hour following a trauma evaluation were compared with patients who presented without concurrent trauma for triage time until completion of hCT. Chi-square, t-tests, and 95% confidence intervals (95% CIs) were used for comparisons. Results: The 171 patients enrolled had a mean (± standard deviation) age of 60.7 (± 7) years; 60% were female; and 58% were African American. Of these, 72 patients had a significant cerebrovascular event (38 [22%] ischemic stroke, 25 [15%] transient ischemic attack, seven [4%] intracranial hemorrhage, one [0.6%] subarachnoid hemorrhage, and one [0.6%] subdural hematoma). The remaining diagnoses included 4.6% migraine, 2.3% seizure, 2.9% syncope, 2.3% Bell's palsy, and 2.9% vertigo. There was no significant difference in time to hCT in patients who presented during a trauma activation and those who did not (99 minutes [interquartile range (IQR) = 24,156] vs. 101 minutes [IQR = 43,151.5]; p = 0.537). In subgroup analysis of patients with a significant cerebrovascular event, times to hCT were also similar (24 minutes [IQR = 12,99] vs. 61 minutes [IQR = 15,126]; p = 0.26). Conclusions: In the authors' institution, the presence of concurrent trauma evaluation does not delay CT imaging of patients with potential stroke. [source] Subjective social status affects smoking abstinence during acute withdrawal through affective mediatorsADDICTION, Issue 5 2010Lorraine R. Reitzel ABSTRACT Objectives Direct and mediated associations between subjective social status (SSS), a subjective measure of socio-economic status, and smoking abstinence were examined during the period of acute withdrawal among a diverse sample of 421 smokers (33% Caucasian, 34% African American, 33% Latino) undergoing a quit attempt. Methods Logistic regressions examined relations between SSS and abstinence, controlling for socio-demographic variables. Depression, stress, positive affect and negative affect on the quit day were examined as potential affective mediators of the SSS-abstinence association, with and without adjusting for pre-quit mediator scores. Results SSS predicted abstinence to 2 weeks post-quit. Abstinence rates were 2.6 (postquit week 1) and 2.4 (postquit week 2) times higher in the highest versus the lowest SSS quartile. Depression and positive affect mediated the SSS,abstinence relationships, but only depression maintained significance when adjusting for the baseline mediator score. Conclusions Among a diverse sample of quitting smokers, low SSS predicted relapse during acute withdrawal after controlling for numerous covariates, an effect accounted for partially by quit day affective symptomatology. Smokers endorsing lower SSS face significant hurdles in achieving cessation, highlighting the need for targeted interventions encompassing attention to quit day mood reactivity. [source] The added risk of opioid problem use among treatment-seeking youth with marijuana and/or alcohol problem useADDICTION, Issue 4 2010Geetha A. Subramaniam Abstract Objectives To determine the added risk of opioid problem use (OPU) in youth with marijuana/alcohol problem use (MAPU). Methods A total of 475 youth (ages 14,21 years) with OPU + MAPU were compared to a weighted sample of 475 youth with MAPU only (i.e. no OPU) before and after propensity score matching on gender, age, race, level of care and weekly use of marijuana/alcohol. Youth were recruited from 88 drug treatment sites participating in eight Center for Substance Abuse Treatment-funded grants. At treatment intake, participants were administered the Global Appraisal of Individual Need to elicit information on demographic, social, substance, mental health, human immunodeficiency virus (HIV), physical and legal characteristics. Odds ratios with confidence intervals were calculated. Results The added risk of OPU among MAPU youth was associated with greater comorbidity; higher rates of psychiatric symptoms and trauma/victimization; greater needle use and sex-related HIV risk behaviours; and greater physical distress. The OPU + MAPU group was less likely to be African American or other race and more likely to be aged 15,17 years, Caucasian; report weekly drug use at home and among peers; engage in illegal behaviors and be confined longer; have greater substance abuse severity and polydrug use; and use mental health and substance abuse treatment services. Conclusions These findings expand upon the existing literature and highlight the substantial incremental risk of OPU on multiple comorbid areas among treatment-seeking youth. Further evaluation is needed to assess their outcomes following standard drug treatment and to evaluate specialized interventions for this subgroup of severely impaired youth. [source] Progression through early drinking milestones in an adolescent treatment sampleADDICTION, Issue 3 2010Kristina M. Jackson ABSTRACT Aims Research using nationally representative and community samples demonstrates a robust association between early onset of drinking and increased likelihood of numerous adverse outcomes. However, little is known about the subsequent drinking that occurs early in the drinking career. The present study dissects the transition from any alcohol use to treatment entry by taking a fine-grained approach to examining the attainment and progression of drinking events in a sample of adolescents in substance use treatment. Design/Setting Data were taken from the Drug Abuse Treatment Outcome Study for Adolescents (DATOS-A), a multi-site, community-based study of adolescents entering treatment. Participants Respondents included 3331 youth aged 12,18 years (mean = 15.75) admitted to treatment in 1993,95 (74% male, 52% white, 24% African American, 20% Hispanic). Measurements Age of attainment was obtained for five drinking-related milestones, including first drink of alcohol, first time drunk, first monthly drinking, first drank five or more drinks/day on a weekly basis and first drank five or more drinks/day on a daily basis. Findings Most milestones were attained at a very early age, and average progression through adjacent drinking events was relatively swift, Movement through early drinking milestones was accelerated in girls and white youth. Youth who reported their first drink at an early age (age 10 or younger) showed slower progression, suggesting the existence of distinct processes underlying early use and drinking transitions within an individual. Conclusions This study provides data relevant to understanding drinking progression/natural history in a large clinical sample, especially for differences by gender and ethnicity. The findings have implications for the identification of intermediate stages that might benefit from selected intervention programs. [source] Sexual orientation, substance use behaviors and substance dependence in the United StatesADDICTION, Issue 8 2009Sean Esteban McCabe ABSTRACT Aims To assess past-year prevalence rates of substance use behaviors and substance dependence across three major dimensions of sexual orientation (identity, attraction and behavior) in a large national sample of adult women and men in the United States. Design Data were collected from structured diagnostic face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-IV version IV (AUDADIS-IV). Setting Prevalence estimates were based on data collected from the 2004,2005 (wave 2) National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Participants A large national sample of 34 653 adults aged 20 years and older: 52% female, 71% white, 12% Hispanic, 11% African American, 4% Asian and 2% Native American. Findings Approximately 2% of the population self-identified as lesbian, gay or bisexual; 4% reported at least one life-time same-sex sexual partner and 6% reported same-sex sexual attraction. Although non-heterosexual orientation was generally associated with a higher risk of substance use and substance dependence, the majority of sexual minority respondents did not report substance use or meet criteria for DSM-IV substance dependence. There was considerable variation in substance use outcomes across sexual orientation dimensions; these variations were more pronounced among women than among men. Conclusions Results support previous research findings of heightened risk of substance use and substance dependence among some sexual minority groups and point to the need for research that examines the reasons for such differences. Results also highlight important gender differences and question previous findings indicating uniformly higher risk for substance dependence among sexual minorities. Risks appear to vary based on gender and how sexual orientation is defined. Findings have implications for more effective prevention and intervention efforts that target subgroups at greatest risk. [source] Emergency Department Pelvic Examination and Pap Testing: Addressing Patient MisperceptionsACADEMIC EMERGENCY MEDICINE, Issue 4 2004Michael S. Lyons MD Objectives: Failure to obtain cervical cancer screening can be precipitated by limited knowledge. This study describes understanding of Papanicolaou (Pap) smear testing among women undergoing emergency department (ED) pelvic examination and tests the feasibility of educating patients in the ED. Methods: Patients undergoing pelvic examination in an urban, tertiary care ED were surveyed about Pap smear screening. Among the initial cohort, no education was provided prior to survey administration. Subsequently, a pilot study of scripted information provided by physicians alone or both physicians and counselors was conducted. Results: There were 81 patients in the non-intervention cohort and 32 patients in the intervention cohort. Of the 32 intervention patients, 16 received physician-administered intervention, and 16 received reinforced counseling (physician + counselor). Of 113 total patients, 90 (82%) were African American; mean age was 26 years (SD ± 7.7 years). Of the 81 non-intervention patients, six (7%; 95% CI = 3% to 15%) said they were told that a Pap test was not done, and 60 (74%; 95% CI = 64% to 82%) mistakenly believed they had a Pap test. Sixty-six (81.5%; 95% CI = 72% to 88%) patients stated they knew the purpose of a Pap test; only 17 (26%; 95% CI = 17% to 37%) of these correctly identified the Pap test as a test for cervical cancer. All 32 intervention patients were surveyed after physician counseling. Compared with the non-intervention group, fewer (56%; 95% CI = 39% to 72%) thought they had a Pap test, and more (31%; 95% CI = 18% to 49%) said they were told they did not receive a Pap test. All 16 reinforced intervention patients correctly denied receiving a Pap test after counselor education. Conclusions: Knowledge of Pap testing among women undergoing ED pelvic examination is poor; most mistakenly believe they receive a Pap test during ED evaluation. Educating patients may be feasible and effective in the ED setting. [source] Results from two randomized clinical trials evaluating the impact of quarterly recovery management checkups with adult chronic substance usersADDICTION, Issue 6 2009Christy K Scott ABSTRACT Aims Post-discharge monitoring and early reintervention have become standard practice when managing numerous chronic conditions. These two experiments tested the effectiveness of recovery management checkup (RMC) protocols for adult chronic substance users. Intervention RMC included quarterly monitoring; motivational interviewing to provide personalized feedback and to resolve ambivalence about substance use; treatment linkage, engagement and retention protocols to increase the amount of treatment received. Participants and setting Recruited from sequential addiction treatment admissions, participants in the two experiments were, on average, 36 and 38 years of age, mainly female (59% versus 46%), African American (85% versus 80%) and met past-year criteria for dependence (87% versus 76%). Design Participants in both experiments were assigned randomly to the RMC or control condition and interviewed quarterly for 2 years. Measurement The Global Appraisal of Individual Needs (GAIN) was the main assessment instrument. Findings RMC participant outcomes were better than control participants in both experiments. Effect sizes were larger in the second experiment in terms of reducing days to readmission (Cohen's d = 0.41 versus d = 0.22), successive quarters in the community using substances (d = ,0.32 versus ,0.19), past-month symptoms of abuse/dependence (d = ,0.23 versus ,0.02) and increasing the days of abstinence over 2 years (d = +0.29 versus 0.04). Conclusion RMC, which provided ongoing monitoring and linkage, is feasible to conduct and is effective for adults with chronic substance dependence. [source] Effects of home access and availability of alcohol on young adolescents' alcohol useADDICTION, Issue 10 2007Kelli A. Komro ABSTRACT Aims The purpose of the present study was to examine the effects of parental provision of alcohol and home alcohol accessibility on the trajectories of young adolescent alcohol use and intentions. Design Data were part of a longitudinal study of alcohol use among multi-ethnic urban young adolescents who were assigned randomly to the control group of a prevention trial. Setting Data were collected from a cohort of youth, and their parents, who attended public schools in Chicago, Illinois (2002,2005). Participants The sample comprised the 1388 students, and their parents, who had been assigned randomly to the control group and were present and completed surveys at baseline, in the beginning of 6th grade (age 12). The sample was primarily low-income, and African American and Hispanic. Measurements Students completed self-report questionnaires when in the 6th, 7th and 8th grades (age 12,14 years; response rates 91,96%). Parents of the 6th grade students also completed questionnaires (70% response rate). Findings Student report, at age 12, of parental provision of alcohol and home alcohol availability, and parental report of providing alcohol to their child and the accessibility of alcohol in the home, were associated with significant increases in the trajectories of young adolescent alcohol use and intentions from ages 12,14 years. Student report of receiving alcohol from their parent or taking it from home during their last drinking occasion were the most robust predictors of increases in alcohol use and intentions over time. Conclusions Results indicate that it is risky for parents to allow children to drink during early adolescence. When these findings are considered together with the risks associated with early onset of alcohol use, it is clear that parents can play an important role in prevention. [source] Children's Sense of Self in Relation to Clinical Processes: Portraits of Pharmaceutical TransformationETHOS, Issue 3 2009Elizabeth Carpenter-Song This article presents in-depth accounts of pharmaceutical transformation from the perspective of two children diagnosed with behavioral and emotional disorders. These portraits provide the basis for an examination of the complex interrelation between self and clinical processes. Narrative data were collected in the context of a 13-month anthropological study of the lived experiences of children diagnosed with behavioral and emotional disorders and their families living in the northeastern United States. Participating families (N=20) were from diverse racial/ethnic (African American, Euro-American, and Latino) and socioeconomic backgrounds. Psychiatric diagnoses and pharmaceuticals present tangible constraints in the lives of children that call attention to otherwise fluid and ephemeral self processes. These accounts suggest that psychiatric diagnoses and psychotropic medications present dilemmas for children's developing sense of self, revealing limitations to biopsychiatric "pharmaceutical promises." [children, self processes, subjective experience, psychiatric disorder, pharmaceuticals] [source] Cancer and men from minority ethnic groups: an exploration of the literatureEUROPEAN JOURNAL OF CANCER CARE, Issue 4 2000S. Lees The authors reviewed literature which has been published in the last 20 years. Cancer is the second leading cause of death in developed countries and is expected to become a significant cause of death in developing countries. Whilst there are a large number of studies on cancer and men, there is a paucity of data on men from minority ethnic groups. In the USA, African Americans are more likely to develop cancer than any other ethnic group. Although cancer rates amongst minority ethnic groups in the UK are thought to be low, 11% of Indian and African men and 19% of Caribbean men died from cancer during 1979,1983. There is also further evidence in the USA that African American, Filipinos and Native Americans have the lowest cancer survival rates. Service utilization, especially tertiary care, is also thought to be low amongst minority ethnic groups from the USA and the UK. Reasons for these variations include artefactual, cultural, materialist and social selectivist explanations as well as the effects of migration, racism and genetic disposition. This area is under-researched, in particular cultural beliefs about cancer. Further research into this area should apply culturally competent methods to ensure valid data to inform cancer policy, education and practice. [source] Advance Directives in Skilled Nursing Facility Residents Transferred to Emergency DepartmentsACADEMIC EMERGENCY MEDICINE, Issue 12 2001Michael Lahn MD Abstract Objective: Ten years have passed since Congress enacted the Patient Self-Determination Act to promote the use of advance directives (ADs). This study was performed to determine the frequency, type, demographic distribution, and utility of ADs that accompany residents of skilled nursing facilities (SNFs) transferred to emergency departments (EDs). Methods: This was an observational, cross-sectional cohort of SNF residents, transferred to two urban, academic EDs. Chart review and physician interviews were conducted on consecutive patients arriving during 12-hour data collection shifts. Results: Among 715 patients entered, 315 [44%, 95% confidence interval (95% CI) = 40% to 48%] had an AD. Advance directives were significantly more prevalent among white (50%) than African American (34%) or Hispanic (39%) patients (p < 0.001), and varied from 0% to 94% among SNFs. Of the 315 patients with ADs, do-not-resuscitate (DNR) orders were the most prevalent (65%, 95% CI = 58% to 69%). Although 75% (95% CI = 69% to 81%) of the DNR orders addressed cardiopulmonary resuscitation (CPR), only 12% (95% CI = 8% to 16%) addressed intubation. Among 39 patients who required intubation or CPR, 44% had ADs, 82% (95% CI = 57% to 96%) of which were deemed useful. Conclusions: Despite a decade of legislation promoting their use, ADs are lacking in most SNF residents transferred to EDs for evaluation and in most settings in which a clinical indication exists for intubation or CPR. Variation in their prevalence appears to be associated with both ethnicity and SNF origin. Although about three-fourths of DNR ADs addressed CPR, only about one in ten offered guidance regarding intubation. When available, ADs are used in most instances to guide emergency care. [source] Relationship Quality and Changes in Depressive Symptoms Among Urban, Married African Americans, Hispanics, and WhitesFAMILY RELATIONS, Issue 3 2009Jay Fagan Bivariate analyses showed that continuously married urban African American, non-Hispanic White, and Hispanic fathers and mothers reporting greater marital support and less relational control experienced a decrease in depressive symptoms. Multiple regression showed a stronger association between concurrent marital support and decreased depressive symptoms for mothers than fathers. African American and Hispanic fathers reporting higher levels of spousal relationship support when children were infants reported a larger decrease in depressive symptoms when children were age 3 compared to non-Hispanic Whites. Relationship control at age 3 was positively related to increased depressive symptoms among all groups except African American fathers and White mothers. African American and Hispanic fathers with marital problems may need additional support services. [source] Romantic Relationships Among Unmarried African Americans and Caribbean Blacks: Findings From the National Survey of American Life,FAMILY RELATIONS, Issue 2 2008Karen D. Lincoln Abstract: This study investigated the correlates of relationship satisfaction, marriage expectations, and relationship longevity among unmarried African American and Black Caribbean (Caribbean Black) adults who are in a romantic relationship. The study used data from the National Survey of American Life, a national representative sample of African Americans and Caribbean Blacks in the United States. The findings indicated that the correlates of relationship satisfaction, expectations of marriage, and relationship longevity were different for African Americans and Black Caribbeans. For Black Caribbeans, indicators of socioeconomic status were particularly important correlates of relationship satisfaction. For African Americans, indicators of parental status were important for relationship longevity. Policy and practice implications for nonmarital unions are discussed. [source] Examining Risk Factors Associated With Family Reunification for Runaway Youth: Does Ethnicity Matter?FAMILY RELATIONS, Issue 3 2003Sanna J. Thompson This study investigated the likelihood of family reunification across ethnic groups of 14,419 youth using runaway shelter services nationwide. Among White, African American, Hispanic, Native American, and Asian ethnic groups, youths who reported abuse or neglect by their parental figures or had parent(s) who were unemployed were less likely to reunify following a runaway episode. However, completing youth shelter services markedly increased the likelihood of reunification. Implications for cultural sensitivity in service delivery, particularly regarding family issues, are discussed. [source] Participation Patterns in Home-Based Family Support Programs: Ethnic Variations,FAMILY RELATIONS, Issue 1 2003Karen McCurdy This study investigated the relationship between ethnicity and retention among families participating in a national network of home-based family support programs. Using archival data collected on 224 African American, 227 European American, and 219 Latino American mothers of newborns and 153 home visitors, multivariate analyses indicate greater participation by African American and Latino parents as compared with European American parents. Retention predictors vary by ethnicity. Strategies to form a supportive parent-provider alliance are discussed. [source] Linking Employment Status, Maternal Psychological Well-Being, Parenting, and Children's Attributions About Poverty in Families Receiving Government Assistance,FAMILY RELATIONS, Issue 2 2002Velma McBride Murry Functional changes in rural African American single-mother-headed families after the implementation of Temporary Assistance for Needy Families were explored from an ecological risk,protection perspective. The sample included 96 single mothers who received government assistance and their 10- or 11-year-old children. Links among maternal employment status, mothers' physical health and psychological functioning, parenting, and children's attributions about the causes of poverty were examined. Maternal psychological distress was linked with children's attributions about the causes of poverty, both directly and indirectly through its association with parenting. Children who did not attribute poverty to social causes had higher academic goals than did those who attributed poverty to social, economic, or political barriers. Further research is needed on barriers to employment and the influence of maternal psychological functioning on parenting. [source] Epidemiologic Analysis of an Urban, Public Emergency Department's Frequent UsersACADEMIC EMERGENCY MEDICINE, Issue 6 2000Joshua H. Mandelberg BA Abstract. Objectives: To determine how the demographic, clinical, and utilization characteristics of emergency department (ED) frequent users differ from those of other ED patients. Methods: A cross-sectional and retrospective cohort study was performed using a database of all 348,858 visits to the San Francisco General Hospital ED during a five-year period (July 1, 1993, to June 30, 1998). A "frequent user" visited the ED five or more times in a 12-month period. Results: Frequent users constituted 3.9% of ED patients but accounted for 20.5% of ED visits. The relative risk (RR) of frequent use was high among patients who were homeless (RR = 4.5), African American (RR = 1.8), and Medi-Cal sponsored (RR = 2.1). Frequent users were more likely to be seen for alcohol withdrawal (RR = 4.4), alcohol dependence (RR = 3.4), and alcohol intoxication (RR = 2.4). Frequent users were also more likely to visit for exacerbations of chronic conditions, including sickle cell anemia (RR = 8.0), renal failure (RR = 3.6), and chronic obstructive pulmonary disease (RR = 3.3). They were less likely to visit for all forms of trauma (RR = 0.43). Survival analysis showed that only 38% of frequent users for one year remained frequent users the next year. However, 56% of frequent users for two consecutive years remained frequent users in the third year. Conclusions: Frequent use of the ED reflects the urban social problems of homelessness, poverty, alcohol abuse, and chronic illness. Frequent use of the ED shows a high rate of decline from one year to the next. This rate of decline slows after the first year and suggests the existence of a smaller group of chronic frequent users. [source] Improving Care for Minorities: Can Quality Improvement Interventions Improve Care and Outcomes For Depressed Minorities?HEALTH SERVICES RESEARCH, Issue 2 2003Controlled Trial, Results of a Randomized Objective. Ethnic minority patients often receive poorer quality care and have worse outcomes than white patients, yet practice-based approaches to reduce such disparities have not been identified. We determined whether practice-initiated quality improvement (QI) interventions for depressed primary care patients improve care across ethnic groups and reduce outcome disparities. Study Setting. The sample consists of 46 primary care practices in 6 U.S. managed care organizations; 181 clinicians; 398 Latinos, 93 African Americans, and 778 white patients with probable depressive disorder. Study Design. Matched practices were randomized to usual care or one of two QI programs that trained local experts to educate clinicians; nurses to educate, assess, and follow-up with patients; and psychotherapists to conduct Cognitive Behavioral Therapy. Patients and physicians selected treatments. Interventions featured modest accommodations for minority patients (e.g., translations, cultural training for clinicians). Data Extraction Methods. Multilevel logistic regression analyses assessed intervention effects within and among ethnic groups. Principal Findings. At baseline, all ethnic groups (Latino, African American, white) had low to moderate rates of appropriate care and the interventions significantly improved appropriate care at six months (by 8,20 percentage points) within each ethnic group, with no significant difference in response by ethnic group. The interventions significantly decreased the likelihood that Latinos and African Americans would report probable depression at months 6 and 12; the white intervention sample did not differ from controls in reported probable depression at either follow-up. While the intervention significantly improved the rate of employment for whites and not for minorities, precision was low for comparing intervention response on this outcome. It is important to note that minorities remained less likely to have appropriate care and more likely to be depressed than white patients. Conclusions. Implementation of quality improvement interventions that have modest accommodations for minority patients can improve quality of care for whites and underserved minorities alike, while minorities may be especially likely to benefit clinically. Further research needs to clarify whether employment benefits are limited to whites and if so, whether this represents a difference in opportunities. Quality improvement programs appear to improve quality of care without increasing disparities, and may offer an approach to reduce health disparities. [source] The use of near infrared interactance in hemodialysisHEMODIALYSIS INTERNATIONAL, Issue 1 2005N. Sarhill Forty-one consecutive admissions to a hemodialysis center were evaluated. Demographic information including age, gender, race, and diagnosis was collected. Patients, >18 years old, with end stage renal disease and on hemodialysis for at least one year were included. Those with edema or known ascites were excluded. Weight was measured before and after hemodialysis (HD) using a standard scale and by considering the amount of fluid loss by the hemodialysis machine. Body composition including total body water (TBW) was calculated before and after HD using near infrared interactance (NIR). All measurements were completed during half hour before and after HD. Forty-one patients included: men (n = 26), women (n = 15); median age 58 (range 28,88 years). Twenty-eight were African American and the rest Caucasians. The amount of intravascular fluid taken after HD (assessed by weight reduction) ranged 0,5 L with median 2.2 L. NIR analysis for the same patients at the same time showed different total body water measurements in 91% of cases (P > 0.05). Moreover, NIR analysis showed increase in total body water in 24% of patients even though the hemodialysis machine showed a loss of total body water; median of 1.3 (range: 0,3L). The error in measuring body composition with NIR was both large and varied (random and not systematic error). We conclude that NIR analysis cannot be considered as a reliable method to evaluate body composition, especially total body water, amongst patients with end stage renal disease undergoing hemodialysis. [source] Comparison of surrogate and direct measurement of insulin resistance in chronic hepatitis C virus infection: Impact of obesity and ethnicity,HEPATOLOGY, Issue 1 2010Khoa D. Lam Studies using surrogate estimates show high prevalence of insulin resistance in hepatitis C infection. This study prospectively evaluated the correlation between surrogate and directly measured estimates of insulin resistance and the impact of obesity and ethnicity on this relationship. Eighty-six nondiabetic, noncirrhotic patients with hepatitis C virus (age = 48 ± 7 years, 74% male, 44% white, 22% African American, 26% Latino, 70% genotype 1) were categorized into normal-weight (body mass index [BMI] < 25, n = 30), overweight (BMI = 25-29.9, n = 38), and obese (BMI , 30, n = 18). Insulin-mediated glucose uptake was measured by steady-state plasma glucose (SSPG) concentration during a 240-minute insulin suppression test. Surrogate estimates included: fasting glucose and insulin, glucose/insulin, homeostasis model assessment (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), insulin (I-AUC) and glucose (G-AUC) area under the curve during oral glucose tolerance test, and the Belfiore and Stumvoll indexes. All surrogate estimates correlated with SSPG, but the magnitude of correlation varied (r = 0.30-0.64). The correlation coefficients were highest in the obese. I-AUC had the highest correlation among all ethnic and weight groups (r = 0.57-0.77). HOMA-IR accounted for only 15% of variability in SSPG in the normal weight group. The common HOMA-IR cutoff of ,3 to define insulin resistance had high misclassification rates especially in the overweight group independent of ethnicity. HOMA-IR > 4 had the lowest misclassification rate (75% sensitivity, 88% specificity). Repeat HOMA-IR measurements had higher within-person variation in the obese (standard deviation = 0.77 higher than normal-weight, 95% confidence interval = 0.25-1.30, P = 0.005). Conclusion: Because of limitations of surrogate estimates, caution should be used in interpreting data evaluating insulin resistance especially in nonobese, nondiabetic patients with HCV. HEPATOLOGY 2010 [source] Effectiveness of hepatitis C treatment with pegylated interferon and ribavirin in urban minority patients,HEPATOLOGY, Issue 4 2010Paul Feuerstadt Randomized controlled trials of hepatitis C virus (HCV) therapy with pegylated interferon and ribavirin have demonstrated sustained viral response rates (SVRs) of 54%-63% (efficacy). Treatment results in clinical practice (effectiveness) may not be equivalent. The goal of this study was to assess the effectiveness of HCV treatment with pegylated interferon and ribavirin in a treatment-naïve, human immunodeficiency virus (HIV)-negative, United States urban population with many ethnic minority patients. We evaluated 2,370 outpatients for HCV therapy from 2001 to 2006 in the Faculty Practice of the Albert Einstein College of Medicine or the attending-supervised Montefiore Medical Center Liver Clinic. Care was supervised by one experienced physician under conditions of everyday clinical practice, and appropriate ancillary resources were made available to all patients. Two hundred fifty-five patients were treated with a mean age of 50 years (60% male, 40% female; 58% Hispanic, 20% African American, 9% Caucasian, 13% other; 68% genotype 1, the remainder genotypes 2 or 3). Patients had at least one liver biopsy. Intention-to-treat analysis (ITT) showed SVR in 14% of genotype 1 patients and 37% in genotype 2/3 patients (P < 0.001). SVR was significantly higher in faculty practice (27%) than in clinic patients (15%) by intention-to-treat (P = 0.01) but not per-protocol analysis (46% faculty practice, 34% clinic). 3.3% of 1,656 treatment-naïve, HIV antibody,negative individuals ultimately achieved SVR. Current hepatitis C therapies may sometimes be unavailable to, inappropriate for, and ineffective in United States urban patients. Treatment with pegylated interferon and ribavirin was less effective in this population than is implied by multinational phase III controlled trials. New strategies are needed to care for such patients. (HEPATOLOGY 2010.) [source] Viral dynamics and response differences in HCV-infected African American and white patients treated with IFN and ribavirinHEPATOLOGY, Issue 6 2003Jennifer E. Layden-Almer Studies have suggested that African American patients infected with hepatitis C virus (HCV) do not respond as well to treatment with interferon (IFN) as white patients. Here we analyzed the difference in the viral kinetic response between genotype 1 HCV-infected African American patients (n = 19) and white patients (n = 16). Patients were treated with 10 mIU IFN-,2b daily with or without ribavirin for 1 month followed by 3 mIU IFN-,2b 3 times a week with ribavirin. The kinetic parameters (,, treatment effectiveness at inhibiting virion production; ,, loss rate of virus-producing cells; c, clearance rate of free virions; ,, delay until viral decline starts) were estimated from the viral load decay profiles using a previously described mathematical model. Differences in early kinetic parameters and viral negativity frequencies at weeks 4, 12, and 48 were compared. Ribavirin did not appear to enhance any of the viral kinetic parameters, although this may have been due to the high dose of IFN used. African American patients exhibited significantly (P = .005) lower drug effectiveness (88.6% vs. 98.2%) compared with white patients, accounting for a 0.8 log lower HCV RNA decrease in the first 24 hours of treatment. Significant differences (P = .006) were also noted for ,. There was no correlation between any of the viral kinetic parameters and either age, body mass index (BMI), or genotype 1 subtype. No patient achieved viral negativity at weeks 4, 12, or 48 without an , greater than 90%. The mean viral decline and viral negativity rates were statistically different between the two races; however, when controlling for treatment effectiveness, these differences were no longer apparent. In conclusion, the failure of IFN response in African American patients infected with genotype 1 HCV is in part due to an impaired ability to inhibit viral production. [source] Ethnic variation in AMD-associated complement factor H polymorphism p.Tyr402His,HUMAN MUTATION, Issue 9 2006Michael A. Grassi Abstract Age-related macular degeneration (AMD) is the most common cause of irreversible visual loss in the developed world. Previous studies have demonstrated that the c.1204T>C, p.Tyr402His allelic variant in the complement factor H (CFH) gene is associated with an approximately three-fold increased risk for AMD in Caucasians of predominantly European descent. Both the prevalence as well as the phenotypic spectrum of AMD varies widely among persons of different ethnicities. We hypothesized that populations with a lower prevalence of AMD might also have a lower prevalence of the CFH risk allele. In this study we sought to determine the frequency of this sequence variant in control populations of Caucasians, African Americans, Hispanics, Somalis, and Japanese. Normal control populations were assembled for each ethnic group: Caucasian (n=148), Somali (n=128), African American (n=75), Hispanic (n=81), and Japanese (n=82). Individuals were genotyped using a restriction digest assay and the frequency of the C allele at nucleotide position 1204 of the CFH gene was determined. A bioinformatic approach was used to identify SNPs in linkage disequilibrium with rs1061170 (c.1204T>C, p.Tyr402His) from the human haplotype map project database (HapMap) in order to validate the findings. We found widely discordant frequencies of the risk allele between some of the different ethnic groups: Japanese 0.07±0.02, Hispanics 0.17±0.03, African-Americans 0.35±0.04, Caucasians 0.34±0.03, and Somalis 0.34±0.03. Allele frequencies generated by analysis of the HapMap database were consistent with these findings. This study suggests that there are other yet unidentified genetic factors important in the pathogenesis of AMD that may mitigate the effects of c.1204T>C, p.Tyr402His variant. Hum Mutat 27(9), 921,925, 2006. © 2006 Wiley-Liss, Inc. [source] The c.43_44insCTG variation in PCSK9 is associated with low plasma LDL-cholesterol in a Caucasian population,,HUMAN MUTATION, Issue 5 2006Pin Yue Abstract The genetic etiology of familial hypobetalipoproteinemia (FHBL) is unclear in the majority of cases. Mutations in apolipoprotein B (APOB) are the only confirmed causes of FHBL. Recently, loss-of-function mutations of PCSK9 gene have been shown to be associated with the hypocholesterolemia phenotype. Our primary goal was to confirm that mutations in PCSK9 could be another cause of FHBL. Using the sequencing approach, we found that the c.43_44insCTG variation in PCSK9, a common in-frame insertion in both African American and Caucasian populations, is associated with the hypocholesterolemia phenotype in three FHBL families. Then we tested whether this variation could be associated with lower cholesterol levels in the general population. A total of 403 subjects from a Caucasian population, in which hypobetalipoprotein (HBL) and normal groups were classified using standard criteria, were sequenced for this variation. The allele frequency of this variation in the HBL group was 0.186, but was only 0.128 in the normal lipid group. The mean plasma low-density lipoprotein (LDL)-cholesterol level in subjects heterozygous for this variant is significantly lower than that in the normal group (p<0.01). Heterozygous subjects also had higher high-density lipoprotein (HDL)-cholesterol levels (p<0.01). In general, LDL-cholesterol concentration in individuals with PCSK9 c.43_44insCTG variation was ,10,15 mg/dL lower than that in normal individuals. We conclude that the c.43_44insCTG variant plays a role in lowering cholesterol in the general population. Hum Mutat 27(5), 460,466, 2006. Published 2006 Wiley-Liss, Inc. [source] Comparative phenotypic and CARD15 mutational analysis among African American, Hispanic, and white children with Crohn's diseaseINFLAMMATORY BOWEL DISEASES, Issue 7 2005Subra Kugathasan MD Abstract Background: Despite a large body of literature on the subject of Crohn's disease (CD), very little information is available on racial/ethnic differences related to disease presentation, clinical course, and genetics. The first identified CD susceptibility gene, CARD15, seems to be present in up to 40% of white children with CD. However, the frequency of this gene among patients with CD of other racial/ethnic groups in the United States is not known. Methods: We conducted a multicenter study on African American and Hispanic children with CD to describe the phenotypic and genotypic (CARD15) features in comparison with white children with CD. We also analyzed the frequency of CARD15 mutations in large control samples from white, African American, and Hispanic children. Results: The disease location and behavior were similar among all 3 groups, with inflammatory behavior and the ileocolonic location being the most frequent phenotype. However, significantly lower frequencies of CARD15 mutations were seen in African American (P < 0.0001) and Hispanic (P < 0.0001) children with CD compared with white children with CD. This lower CARD15 frequency among African American patients with CD was also mirrored in the general population. Conclusions: Phenotypic features of CD are similar among African American and Hispanic children compared with white children. CARD15 mutations are not increased among African American and Hispanic children with CD. CARD15 mutational frequencies among African American and Hispanic children within the general population are lower compared with white children within the general population. Future genetics studies will be required to determine the relationships between genotype and CD phenotype in various ethnic and racial groups. 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