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Racial Differences (racial + difference)
Selected AbstractsRACIAL DIFFERENCES IN PRESSURE ULCER PREVALENCE IN NURSING HOMESJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2005Kate L. Lapane PhD No abstract is available for this article. [source] RACIAL DIFFERENCES IN EMPLOYEE RETENTION: ARE DIVERSITY CLIMATE PERCEPTIONS THE KEY?PERSONNEL PSYCHOLOGY, Issue 1 2007PATRICK F. McKAY Given considerable racial differences in voluntary turnover (Bureau of Labor Statistics, 2006, Table 28), the present study examined the influence of diversity climate perceptions on turnover intentions among managerial employees in a national retail organization. The authors hypothesized that pro-diversity work climate perceptions would correlate most negatively with turnover intentions among Blacks, followed in order of strength by Hispanics and Whites (Hypothesis 1), and that organizational commitment would mediate these interactive effects of race and diversity climate perceptions on turnover intentions (Hypothesis 2). Results from a sample of 5,370 managers partially supported both hypotheses, as findings were strongest among Blacks. Contrary to the hypotheses, however, White men and women exhibited slightly stronger effects than Hispanic personnel. [source] Racial Differences in Division of Labor in Colonies of the Honey Bee (Apis mellifera)ETHOLOGY, Issue 2 2002Charles Brillet We measured the age at onset of foraging in colonies derived from three races of European honey bees, Apis mellifera mellifera, Apis mellifera caucasica and Apis mellifera ligustica, using a cross-fostering design that involved six unrelated colonies of each race. There was a significant effect of the race of the introduced bees on the age at onset of foraging: cohorts of A. m. ligustica bees showed the earliest onset, regardless of the race of the colony they were introduced to. There also was a significant effect of the race of the host colony: cohorts of bees introduced into mellifera colonies showed the earliest onset of foraging, regardless of the race of the bees introduced. Significant inter-trial differences also were detected, primarily because of a later onset of foraging in trials conducted during the autumn (September,October). These results demonstrate differences among European races of honey bees in one important component of colony division of labor. They also provide a starting point for analyses of the evolution of division of labor under different ecological conditions. [source] Racial Differences in the Receipt of Bowel Surveillance Following Potentially Curative Colorectal Cancer SurgeryHEALTH SERVICES RESEARCH, Issue 6p2 2003Gary L. Ellison Objective. To investigate racial differences in posttreatment bowel surveillance after colorectal cancer surgery in a large population of Medicare patients. Data Sources. We used a large population-based dataset: Surveillance, Epidemiology, and End Results (SEER) linked to Medicare data. Study Design. This is a retrospective cohort study. We analyzed data from 44,768 non-Hispanic white, 2,921 black, and 4,416 patients from other racial/ethnic groups, aged 65 and older at diagnosis, who had a diagnosis of local or regional colorectal cancer between 1986 and 1996, and were followed through December 31, 1998. Cox Proportional Hazards models were used to investigate the relation of race and receipt of posttreatment bowel surveillance. Data Collection. Sociodemographic, hospital, and clinical characteristics were collected at the time of diagnosis for all members of the cohort. Surgery and bowel surveillance with colonoscopy, sigmoidoscopy, and barium enema were obtained from Medicare claims using ICD-9-CM and CPT-4 codes. Principal Findings. The chance of surveillance within 18 months of surgery was 57 percent, 48 percent, and 45 percent for non-Hispanic whites, blacks, and others, respectively. After adjusting for sociodemographic, hospital, and clinical characteristics, blacks were 25 percent less likely than whites to receive surveillance if diagnosed between 1991 and 1996 (RR=0.75, 95 percent CI=0.70,0.81). Conclusions. Elderly blacks were less likely than non-Hispanic whites to receive posttreatment bowel surveillance and this result was not explained by measured racial differences in sociodemographic, hospital, and clinical characteristics. More research is needed to explore the influences of patient- and provider-level factors on racial differences in posttreatment bowel surveillance. [source] Racial Differences in the Characteristics of Firearm Suicide Decedents in the United StatesAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 1 2007Sean Joe MSW Focusing on the reported growing use of firearms to complete suicide among African Americans, this article analyzes the 1993 National Mortality Followback Survey to examine the association of firearm suicide with race, education, geographic region, access to a firearm, depressive symptoms, and mental health service utilization on decedents aged 15 years and older. After controlling for demographic, socioeconomic, and clinical variables, the analysis indicates that African American men were twice as likely as White men to use a firearm to complete suicide. The findings suggest the importance for clinicians to screen for the presence of firearms in depressed African Americans and to reduce their access to firearms. In addition, clinicians, social workers, and public health professionals should consider racial differences in correlates of firearm suicide when designing prevention and intervention initiatives. [source] Racial Differences in Parenting Dimensions and Adolescent Condom Use at Sexual DebutPUBLIC HEALTH NURSING, Issue 1 2006Mary F. Cox ABSTRACT Objectives: Parenting style may be a determinant in reducing adolescent risk behavior. Previous studies have relied on a typological parenting approach, with classification into four groups: authoritative, authoritarian, permissive, and neglectful. In this study, two distinct parenting dimensions, demandingness and responsiveness, were examined as independent predictors of adolescent condom use. Design and Sample: This study used a subsample of the National Longitudinal Study of Adolescent Health (Add Health) that included 153 adolescent,mother pairs. Measurement: Maternal demandingness and responsiveness were measured using Wave I mother interviews. Logistic regression analyses were used to predict adolescent condom use at sexual debut at Wave II and to assess moderation by gender and race. Results: (1) Maternal demandingness predicted increased likelihood of condom use in African American adolescents but decreased likelihood of condom use in White adolescents; (2) maternal responsiveness did not predict condom use; and (3) gender moderation was not present. Conclusions: To provide appropriate family counseling, public health nurses need to consider racial differences in contraceptive practices. Education regarding parental supervision practices should be considered as part of nursing interventions intended to increase condom use in African American adolescents. [source] Attenuation of Racial Differences in Health Service Utilization Patterns for Previously Uninsured Children in the DeltaTHE JOURNAL OF RURAL HEALTH, Issue 4 2005Zola K. Moon MA ABSTRACT: Context: A school-based health insurance program for children of the working poor was conducted in 2 isolated, rural communities in the Lower Mississippi Delta region. The larger of the 2 communities had an array of locally available health care providers, whereas the smaller community did not. In response to this lack of available care, the project designed and delivered outreach programs, including transportation to providers. Purpose: The purpose of this paper is to examine the role of race, age, and gender in the relationships between the utilization of care and the impact of outreach programs. Method: General estimating equation models are used to examine the response of utilization variables to race, age, gender, and community. Four years of insurance claims data are analyzed. Findings: Race is seen to be an important component of utilization. The majority of participants were African American; however, children receiving prescription services, emergency room care, routine physician visits, and hospital outpatient services were more likely to be white. Outreach programs in vision and dental services were found to eliminate racial differences and increase utilization. A relatively strong gender effect was found in prescription, wellness, vision, and dental services. Conclusions: Previous research has shown differences by race in utilization of care. Our findings show that targeted outreach programs can significantly diminish these differences. Findings also suggest that barriers to health care for poor rural children are closely linked to transportation and availability of providers, not merely to cost of care or insurance. [source] Racial Differences in Stage and Survival in Head and Neck Squamous Cell Carcinoma,THE LARYNGOSCOPE, Issue 5 2007Anthony C. Nichols MD Abstract Objectives: The goal of this study was to characterize differences in survival between black patients and white patients with squamous cell carcinoma of the head and neck (HNSCCA). Design: Cases of oral tongue and glottic SCCA in black patients or white patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database (years 1988,2002). For each primary site, TNM staging was imputed, and staging distributions were compared between races. For each black patient, a randomly selected white control was matched for age at diagnosis, sex, stage, surgical treatment, and radiation. Kaplan-Meier survival comparisons for both overall and disease-specific survival were then conducted for the matched pairs. Results: From 1,919 cases of carcinoma of the oral tongue, those of 151 black and 1,768 white patients were extracted. Black patients had a significantly elevated T stage (P = .001) and N stage (P = .002) at primary presentation. Of glottic carcinoma, 4,578 cases (625 black and 3,953 white patients) were extracted. Black patients again presented with significantly elevated T stage (P < .001) and N stage (P < .001) compared with white patients. For 43 matched pairs with tongue carcinoma, mean overall survival for black patients was 66.1 months versus 74.8 months for matched white controls (P = .502, log-rank test). Disease-specific survival was 91.1 months for black patients versus 109.6 months for white patients (P = .168). For 401 matched pairs with glottic carcinoma, mean overall survival for black patients was 96.6 months versus 114.5 months for white controls (P < .001). Similarly, the mean disease-specific survival was 149.4 months for black patients versus 167.1 months for white patients (P < .001) Conclusion: Controlling for stage and treatment, black patients demonstrate poorer overall and disease-specific survival with SCCA, implying other intrinsic or extrinsic factors influencing survival. [source] Influence of environmental stress on skin tone, color and melanogenesis in Japanese skinINTERNATIONAL JOURNAL OF COSMETIC SCIENCE, Issue 1 2005K. Kikuchi Introduction It is needless to say that one of the most potent environmental stress for melanogenesis of the human skin is the effect of ultraviolet (UV) light from the sunlight. Characteristic skin aging as a result of this UV light is recognized as photoaging. Clinical features in photoaging are wrinkles, skin laxity, coarseness, leathery, yellowing, lentigenes, mottled pigmentation, telangiectasia, sebaceous hypertrophy and purpura. There is an apparent difference in clinical features in photoaging among different races, i.e. between Caucasians, African American and Asians that include Japanese. Not only photo skin type but also environmental factors, such as climate, latitude, altitude and their habit of sunbathing, smoking and skin care influence the characteristic development of their photoaging. Racial difference in photoaging Caucasians tend to develop skin laxity and fine wrinkles more than Asians [1]. Asians tend to produce coarser wrinkles than the Caucasians although their development is rather late in life. There is also a difference in the skin color. Pigmentation is an earliest and prominent skin changes in Asians [1] and it increases with age [2]. In contrast, pigmentation is not apparent in the Caucasians although redness probably because of an increase in cutaneous vascularization becomes prominent in middle aged Caucasians [2]. Chung reported that seborrheic keratosis is a major pigmentary lesion in men, whereas hyperpigmented macules are prominent features in women in Koreans [3]. Melanogenesis pigmentation disorders in Japanese Ephelides (freckles) are commonly found in those with photo skin type I who have fair skin and red eyes and blond hair. They are also found in the Japanese. Clinical feature reveals that multiple small pigmentary macules on sun-exposed areas mainly on the mid-portion of the face. These lesions seem to be familial, becoming apparent even in early childhood after sun exposure. Melasma is an acquired pigmentary disorder commonly found in middle aged Japanese women characterized by irregular brown macules and patches on the sun-exposed areas on the face typically as bilaterally present macules on the cheeks. An increase in sex hormones as a result of pregnancy and intake of contraceptive pills is one of the etiological factors to develop melasma. Sun exposure also worsens it. Nevus of Ota is also a common pigmentary disorder found in the Japanese. It is usually unilateral, blue-brown to slate-gray pigmentary macules on the eyelid and cheek that appear in early childhood or in puberty. Acquired dermal melanocytosis is also a pigmentary disorder, in which dermal melanocytes are found as shown in nevus of Ota, characterized by bilateral brown to blue-gray macules on the forehead, temple, eyelid and malar areas in middle aged Japanese women. This tends to be misdiagnosed as melasma. Solar lentigo is an acquired pigmented macule induced by sun exposure. Solar lentigines are usually multiple, circumscribed brown macules. There are two types of solar lentigo. One is a small macular type, characterized by multiple, small brown macules whose diameter is less than 5 mm, being similar to ephelides (freckles). The other type is a large macular type, characterized by a few round to oval, brown macules whose diameter is beyond 1 cm. Some of their surface are hyperkeratotic and become elevated to produce seborrheic keratosis. Again, the early sign of photoaging in Japanese is pigmentated spots and these pigmentation disorders increase with age. Among the pigmentary changes, nevus of Ota, acquired dermal melanocytosis, melasma and large macular type of solar lentigo are characteristic skin changes found in the Japanese in addition to ephelides and small macular type of solar lentigo. Seasonal changes of the various functional properties of the skin including skin color assessed by non-invasive bioengineering techniques [4]. When we consider skin tone, color and melanogenesis, UV light from the sunlight is the most potent environmental stress, although we cannot forget also the important influence of environmental relative humidity affects our skin functions as well as its appearance. We investigated seasonal influences on the various properties of the skin in 39 healthy Japanese females consisting of different age groups. Their skin is thought to be affected by the UV light in summer, and by the exposure to the dry and cold air in winter. Materials and methods Biophysical, non-invasive measurements, including transepidermal water loss (TEWL) as a parameter for the barrier function of the stratum corneum (SC), high frequency conductance as a parameter for the hydration state of the SC, skin color and casual surface lipid levels, were conducted during late summer and winter months. Skin color was determined with a chromameter according to the L*a*b* CIE 1976 system, where L* is an attribute on the luminance scale, a* that on the red versus green scale and b* that on the yellow versus blue scale. All the measurements were conducted in an environment controlled-chamber (21 ± 1 °C room temperature, and 50 ± 3% relative humidity). Results The barrier function of the SC was found to be significantly impaired in winter on the cheek as compared with that measured in summer, whereas no such seasonal change was apparent both in the hydration state of the SC and sebum levels on the cheek. In the assessment of the skin color on the cheek, a significant increase in a* (redness) and a decrease in b* (yellowness) were observed in winter. In contrast, on the flexor forearm, the values of L* (luminescence) increased in winter, but no seasonal change was noted in the values of a* and b*. In this study, skin changes with aging were also found by the non-invasive bioengineering methods. The value of TEWL on the cheek tended to increase with age, whereas no significant change was observed in the value of TEWL on the forearm. In the assessment of skin color, b* value on the cheek significantly increased with age whereas a* and L* values on the cheek did not show any significant change with age. Summary of this study We think that such an increase in yellowness with aging of the cheek skin is a phenomenon unique to the Japanese (Asians) since an increase in b* value was not observed in Caucasians [2]. The facial skin that is always exposed shows barrier impairment in a dry and cold winter environment and demonstrates increased yellowness in skin color because of a prolonged exposure to the UV light from the sun in the summer season. The non-invasive bioengineering methods are useful to demonstrate even invisible seasonal changes occurring in the same individuals and changes with age occurring in the skin. References 1.,Goh, S.H. The treatment of visible signs of senescence: the Asian experience. Br. J. Dermatol.122, 105,109 (1990). 2.,LeFur, I., Numagami, K., Guinot, C. et al. Age-related reference values of skin color in Caucasian and Japanese healthy women according to skin site. Pigment Cell Res. 7, 67 (1999). 3.,Chung, J.H., Lee, S.H., Youn, C.S. et al. Cutaneous photodamage in Koreans: influence of sex, sun exposure, smoking, and skin color. Arch. Dermatol. 137, 1043,1051 (2001). 4.,Kikuchi, K., Kobayashi, H., Le Fur, I. et al. Winter season affects more severely the facial skin than the forearm skin: comparative biophysical studies conducted in the same Japanese females in later summer and winter. Exog. Dermatol. 1, 32,38 (2002). [source] Racial differences in effectiveness of ,-fetoprotein for diagnosis of hepatocellular carcinoma in hepatitis C virus cirrhosisHEPATOLOGY, Issue 2 2002Mindie H. Nguyen ,-Fetoprotein (AFP) is frequently used as a diagnostic marker for hepatocellular carcinoma (HCC). Most available data concerning AFP come from studies of patients with chronic hepatitis B or other chronic liver diseases of mixed etiologies. Limited data concerning the diagnostic value of AFP for hepatitis C virus (HCV)-related HCC have to date come only from Asian and European studies, and results are conflicting. There may be significant differences in AFP levels depending on racial backgrounds and etiologies of primary liver disease. We conducted a multicenter, retrospective, case-control study of 163 HCC patients with HCV infection and 149 control patients with HCV-related cirrhosis. The positive likelihood ratios for AFP at 0 to 20, 21 to 50, 51 to 100, and 101 to 200 ng/mL were 0.46, 1.31, 1.15, and 6.90, respectively. No controls had AFP greater than 200 ng/mL. The sensitivity of AFP for the diagnosis of HCC in African Americans with HCV infection was lower than that of patients of all other ethnic groups combined (57.1% vs. 81.6% for AFP > 10 ng/mL, P = .02, and 42.9% vs. 66.0% for AFP > 20 ng/mL, P = .05). The area under the receiver operating characteristics curve was 0.81 for non-African Americans but only 0.56 for African Americans. In conclusion, AFP greater than 200 ng/mL can be used to confirm HCC in patients with HCV-related cirrhosis and a hepatic mass. However, AFP is insensitive for the diagnosis of HCC in African Americans. [source] The Effects of Race and Worker Productivity on Performance EvaluationsINDUSTRIAL RELATIONS, Issue 4 2001Marta Elvira Using personnel data from a large firm, we examine the role of race, supervisor's race, and worker productivity on performance ratings for a diverse employee population. Controlling for worker productivity and other demographic variables, black employees receive lower ratings than whites. These differences in performance evaluations are associated with the racial composition of the subordinate-supervisor pair. Racial differences between subordinate and supervisor lead to lower ratings for both black and white subordinates. [source] Racial differences in promotion candidate performance and reactions to selection procedures: a field study in a diverse top-management contextJOURNAL OF ORGANIZATIONAL BEHAVIOR, Issue 3 2008John Bret Becton The present study examined African-American and White promotion candidates' reactions to and performance on selection procedures that were completed within a police department where African Americans occupied the majority of top-management positions. Reactions (perceived job relatedness and test-taking motivation) of 187 candidates competing for promotion to the rank of sergeant were assessed after completing a written job knowledge test and a situational interview. Analyses showed that both the African-American and White candidates judged the situational interview to be more job-related than the pencil-and-paper job knowledge test. In addition, African Americans perceived both selection measures to be more job-related and reported higher levels of test-taking motivation than White candidates even though African Americans performed more poorly than White candidates on the paper-and-pencil test. These results challenge the contention that lower test-taking motivation for African-American candidates is related to racial differences in performance on pencil- and-paper tests. Implications and directions for future research on reactions to selection procedures for promotion in racially diverse employment settings are discussed. Copyright © 2007 John Wiley & Sons, Ltd. [source] Influence of Recipient Race on the Outcome of Simultaneous Pancreas and Kidney TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010F. L. Luan Racial differences on the outcome of simultaneous pancreas and kidney (SPK) transplantation have not been well studied. We compared mortality and graft survival of African Americans (AA) recipients to other racial/ethnic groups (non-AA) using the national data. We studied a total of 6585 adult SPK transplants performed in the United States between January 1, 2000 and December 31, 2007. We performed multivariate logistic regression analyses to determine risk factors associated with early graft failure and immune-mediated late graft loss. We used conditional Kaplan,Meier survival and multivariate Cox regression analyses to estimate late death-censored kidney and pancreas graft failure and death between the groups. Although there was no racial disparity in the first 90 days, AA patients had 38% and 47% higher risk for late death-censored kidney and pancreas graft failure, respectively (p = 0.006 and 0.001). AA patients were twice more likely to lose the kidney and pancreas graft due to rejection (OR 2.31 and 1.86, p = 0.002 and 0.008, respectively). Bladder pancreas drainage was associated with inferior patient survival (HR 1.42, 95% CI 1.15, 1.75, p = 0.001). In the era of modern immunosuppresion, AA SPK transplant patients continue to have inferior graft outcome. Additional studies to explore the mechanisms of such racial disparity are warranted. [source] Racial and Ethnic Differences in Mortality in Children Awaiting Heart Transplant in the United StatesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 12 2009T. P. Singh Racial differences in outcomes are well known in children after heart transplant (HT) but not in children awaiting HT. We assessed racial and ethnic differences in wait-list mortality in children <18 years old listed for primary HT in the United States during 1999,2006 using multivariable Cox models. Of 3299 listed children, 58% were listed as white, 20% as black, 16% as Hispanic, 3% as Asian and 3% were defined as ,Other'. Mortality on the wait-list was 14%, 19%, 21%, 17% and 27% for white, black, Hispanic, Asian and Other children, respectively. Black (hazard ratio [HR] 1.6, 95% confidence interval [CI] 1.3, 1.9), Hispanic (HR 1.5, CI 1.2, 1.9), Asian (HR, 2.0, CI 1.3, 3.3) and Other children (HR 2.3, CI 1.5, 3.4) were all at higher risk of wait-list death compared to white children after controlling for age, listing status, cardiac diagnosis, hemodyamic support, renal function and blood group. After adjusting additionally for medical insurance and area household income, the risk remained higher for all minorities. We conclude that minority children listed for HT have significantly higher wait-list mortality compared to white children. Socioeconomic variables appear to explain a small fraction of this increased risk. [source] Frequency of varus and valgus thrust and factors associated with thrust presence in persons with or at higher risk of developing knee osteoarthritis,,ARTHRITIS & RHEUMATISM, Issue 5 2010Alison Chang Objective Varus thrust observed during gait has been shown to be associated with a 4-fold increase in the risk of medial knee osteoarthritis (OA) progression. Valgus thrust is believed to be less common than varus thrust; the prevalence of each is uncertain. Racial differences in risk factors may help explain variations in the natural history of knee OA. We undertook this study to determine the frequency of varus and valgus thrust in African Americans and Caucasians and to identify factors associated with thrust presence. Methods The Osteoarthritis Initiative cohort includes men and women who have knee OA or are at increased risk of developing it. Trained examiners assessed thrust presence by gait observation. Logistic regression with generalized estimating equations was used to identify factors associated with thrust presence, and odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated. Results Compared with Caucasians, African Americans had lower odds of varus thrust, controlling for age, sex, body mass index (BMI), injury, surgery, disease severity, strength, pain, and alignment in persons without knee OA (adjusted OR 0.50 [95% CI 0.36, 0.72]) and in those with knee OA (adjusted OR 0.46 [95% CI 0.34, 0.61]). Also independently associated with varus thrust were age, sex, BMI, disease severity, strength, and alignment. The odds of valgus thrust were greater for African Americans than for Caucasians in persons without knee OA (adjusted OR 1.69 [95% CI 1.02, 2.80]) and in those with knee OA (adjusted OR 1.98 [95% CI 1.35, 2.91]). Also independently associated with valgus thrust were disease severity and malalignment. Conclusion Compared with Caucasians, African Americans had lower odds of varus thrust and greater odds of valgus thrust. These findings may help explain the difference between these groups in the pattern of OA involvement at the knee. [source] Racial differences in the associations of neighborhood disadvantage, exposure to violence, and criminal recidivism among female juvenile offenders,BEHAVIORAL SCIENCES & THE LAW, Issue 4 2009Preeti Chauhan M.A. The current study examined the impact of exposure to violence and neighborhood disadvantage on criminal recidivism among Black (n,=,69) and White (n,=,53) female juvenile offenders. Participants were girls between the ages of 13 and 19 (M,=,16.8; SD,=,1.2) who were sentenced to secure custody. Using a multi-method research design, the study assessed neighborhood disadvantage through census level data, exposure to violence through self-report, and criminal recidivism through official records. Results indicated that Black girls were significantly more likely than White girls to live in disadvantaged neighborhoods, but both reported similar levels of parental physical abuse and witnessing neighborhood violence. In structural equation models, neighborhood disadvantage and witnessing neighborhood violence were indicative of future recidivism for the group as a whole. However, multiple group analyses indicated the existence of race specific pathways to recidivism. Witnessing neighborhood violence was associated with recidivism for Black girls while parental physical abuse was associated with recidivism for White girls. Results suggest that characteristics within the neighborhood play a considerable role in recidivism among female juvenile offenders generally and Black female juvenile offenders, specifically. Race specific risk models warrant further investigation, and may help lawmakers and clinicians in addressing racial disparities in the justice system. Copyright © 2009 John Wiley & Sons, Ltd. [source] A black-white comparison of the quality of stage-specific colon cancer treatmentCANCER, Issue 3 2010Jamillah Berry MSW Abstract BACKGROUND: Several studies have attributed racial disparities in cancer incidence and mortality to variances in socioeconomic status and health insurance coverage. However, an Institute of Medicine report found that blacks received lower quality care than whites after controlling for health insurance, income, and disease severity. METHODS: To examine the effects of race on colorectal cancer outcomes within a single setting, the authors performed a retrospective cohort study that analyzed the cancer registry, billing, and medical records of 365 university hospital patients (175 blacks and 190 whites) diagnosed with stage II-IV colon cancer between 2000 and 2005. Racial differences in the quality (effectiveness and timeliness) of stage-specific colon cancer treatment (colectomy and chemotherapy) were examined after adjusting for socioeconomic status, health insurance coverage, sex, age, and marital status. RESULTS: Blacks and whites had similar sociodemographic characteristics, tumor stage and site, quality of care, and health outcomes. Age and diagnostic stage were predictors of quality of care and mortality. Although few patients (5.8%) were uninsured, they were more likely to present at advanced stages (61.9% at stage IV) and die (76.2%) than privately insured and publicly insured patients (p = .002). CONCLUSIONS: In a population without racial differences in socioeconomic status or insurance coverage, patients receive the same quality of care, regardless of racial distinction, and have similar health outcomes. Age, diagnostic stage, and health insurance coverage remained independently associated with mortality. Future studies of disparities in colon cancer treatment should examine sociocultural barriers to accessing appropriate care in various healthcare settings. Cancer 2010. © 2009 American Cancer Society. [source] Racial differences in trust and regular source of patient care and the implications for prostate cancer screening use,CANCER, Issue 21 2009William R. Carpenter PhD Abstract BACKGROUND: Nonmedical factors may modify the biological risk of prostate cancer (PCa) and contribute to the differential use of early detection; curative care; and, ultimately, greater racial disparities in PCa mortality. In this study, the authors examined patients' usual source of care, continuity of care, and mistrust of physicians and their association with racial differences in PCa screening. METHODS: Study nurses conducted in-home interviews of 1031 African-American men and Caucasian-American men aged ,50 years in North Carolina and Louisiana within weeks of their PCa diagnosis. Medical records were abstracted, and the data were used to conduct bivariate and multivariate analyses. RESULTS: Compared with African Americans, Caucasian Americans exhibited higher physician trust scores and a greater likelihood of reporting a physician office as their usual source of care, seeing the same physician at regular medical encounters, and historically using any PCa screening. Seeing the same physician for regular care was associated with greater trust and screening use. Men who reported their usual source of care as a physician office, hospital clinic, or Veterans Administration facility were more likely to report prior PCa screening than other men. In multivariate regression analysis, seeing the same provider remained associated with prior screening use, whereas both race and trust lost their association with prior screening. CONCLUSIONS: The current results indicated that systems factors, including those that differ among different sources of care and those associated with the continuity of care, may provide tangible targets to address disparities in the use of PCa early detection, may attenuate racial differences in PCa screening use, and may contribute to reduced racial disparities in PCa mortality. Cancer 2009. Published 2009 by the American Cancer Society. [source] Racial differences in tumor stage and survival for colorectal cancer in an insured population,CANCER, Issue 3 2007Chyke A. Doubeni MD Abstract BACKGROUND. Despite declining death rates from colorectal cancer (CRC), racial disparities have continued to increase. In this study, the authors examined disparities in a racially diverse group of insured patients. METHODS. This study was conducted among patients who were diagnosed with CRC from 1993 to 1998, when they were enrolled in integrated healthcare systems. Patients were identified from tumor registries and were linked to information in administrative databases. The sample was restricted to non-Hispanic whites (n = 10,585), non-Hispanic blacks (n = 1479), Hispanics (n = 985), and Asians/Pacific Islanders (n = 909). Differences in tumor stage and survival were analyzed by using polytomous and Cox regression models, respectively. RESULTS. In multivariable regression analyses, blacks were more likely than whites to have distant or unstaged tumors. In Cox models that were adjusted for nonmutable factors, blacks had a higher risk of death from CRC (hazard ratio [HR], 1.17; 95% confidence interval [95% CI], 1.06,1.30). Hispanics had a risk of death similar to whites (HR, 1.04; 95% CI, 0.92,1.18), whereas Asians/Pacific Islanders had a lower risk of death from CRC (HR, 0.89; 95% CI, 0.78,1.02). Adjustment for tumor stage decreased the HR to 1.11 for blacks, and the addition of receipt of surgical therapy to the model decreased the HR further to 1.06. The HR among Hispanics and Asians/Pacific Islanders was stable to adjustment for tumor stage and surgical therapy. CONCLUSIONS. The relation between race and survival from CRC was complex and appeared to be related to differences in tumor stage and therapy received, even in insured populations. Targeted interventions to improve the use of effective screening and treatment among vulnerable populations may be needed to eliminate disparities in CRC. Cancer 2007;109:612,620. © 2006 American Cancer Society. [source] Racial differences in diagnosis, treatment, and clinical delays in a population-based study of patients with newly diagnosed breast carcinoma,,CANCER, Issue 8 2004Karin Gwyn M.D., M.P.H. Abstract BACKGROUND Few studies have addressed the issue of whether delays in the interval between medical consultation and the diagnosis and treatment of breast carcinoma are greater for African American women than for white women. The authors examined differences with respect to these delays and analyzed the factors that may have contributed to such differences among women ages 20,54 years who had invasive breast carcinoma diagnosed between 1990 and 1992 and who lived in Atlanta, Georgia. METHODS A total of 251 African American women and 580 white women were interviewed and had their medical records reviewed. The authors estimated racial differences in delay times and used polytomous logistic regression to determine the contributions of various factors (socioeconomic and other) to these differences. RESULTS Although most women in both groups were treated within 3 months of initial consultation, 22.4% of African American women and 14.3% of white women had clinical delays of > 3 months. Compared with white women, African American women were more likely to experience delays in diagnosis and treatment. Access to care (as represented by method of detection and insurance status) and poverty index partially accounted for these differences in delay time; however, racial differences in terms of delayed treatment and diagnosis remained even after adjustment for contributing factors. CONCLUSIONS The findings of the current study suggest that among women ages 20,54 years who have breast carcinoma, potentially clinically significant differences in terms of delayed diagnosis and treatment exist between African American women and white women. Improvements in access to care and in socioeconomic circumstances may address these differences to some degree, but additional research is needed to identify other contributing factors. Cancer 2004. Published 2004 American Cancer Society. [source] ,The Miserablest People in the World': Race, Humanism and the Australian AborigineTHE AUSTRALIAN JOURNAL OF ANTHROPOLOGY, Issue 1 2007Kay Anderson This paper considers how an idea of the Australian Aborigine impacted upon the development of racial thinking throughout the nineteenth century. We distinguish three phases of this development. Against the background of what was considered to be a distinctly human capacity to rise above nature, our central argument however is that the extreme and irremediable savagery attributed to the Aborigine led to the mid-nineteenth shift to a polygenist, or an innatist, idea of race. The first part of our discussion, covering the early 1800s, elicits a specifically humanist puzzlement at the unimproved condition of the Aborigines. But, as we will show in the central part of our discussion, it was not only the Aborigines' inclination but their capacity for ,improvement' that came to be doubted. Challenging the very basis upon which ,the human' had been defined, and the unity of humankind assumed, the Aborigine could not be accommodated within a prevailing conception of racial difference as a mere variety of the human. The elaboration of polygenism may therefore be understood as arising out of this humanist incomprehension: as an attempt to account for the ontologically inexplicable difference of the Australian Aborigine. In the final part of our discussion, we trace the legacy of the Aborigine's place within polygenism through the evolutionary thought of the late nineteenth century. Despite an explicit return to monogenism, here the Aborigine is invoked to support the claim that race constitutes a more or less permanent difference and, for certain races, a more or less permanent deficiency. And as, in these terms, the anomalous Aborigine became an anachronism, so Australia's indigenous peoples came to embody the most devastating conclusion of evolutionary thought: that in the human struggle for existence certain races were destined not even to survive. [source] Ethnic (Black-White) Contrasts in 24-Hour Heart Rate Variability in Male Adolescents with High and Low Blood Pressure: The Bogalusa Heart StudyANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2000Elaine M. Urbina M.D. Background: Heart rate variability (HRV) has been used to study autonomic effects on the heart. The time-domain measure RMSSD (root mean square of successive differences) represents high frequency (HF) changes in HRV reflecting parasympathetic nervous system activity (PS). The frequency-domain ratio of low to high power (LF/HF) represents sympathetic (SYMP) to PS balance. In adults, increased SYMP tone has been found in hypertensive as compared to normals. The present study was performed to look for differences in HRV by race and between young subjects with high and low levels of diastolic blood pressure (DBP). Methods: Subjects included 34 healthy males age 13,17 years (53% white). Half were selected with K4 DBP < 85th% for height (HT) measured twice, 3,5 years apart. Half had DBP < 15th% for HT. Subjects underwent a physical examination including BP, HT, WT, and ECG prior to Holter monitor application. HRV data was analyzed from 24-hour Holter recordings obtained during normal activity. Results: The RMSSD was lower in whites compared to blacks for day, night, and 24-hour average (P , 0.05) with day-time measurements showing the largest racial difference. This suggests increased PS tone in blacks especially with activity. The LF/HF ratio was higher in whites for all times, reaching significance during the day (all P , 0.05) suggesting SYMP predominance in whites during activity. Subjects with higher levels of DBP had lower RMSSD and higher LF/HF ratio for all times, but these did not reach statistical significance. Conclusions: There is a trend towards SYMP predominance in children with higher DBP. Healthy white adolescents exhibit increased SYMP tone compared to blacks when measured during normal daytime activity. [source] Carbon Nullius and Racial Rule: Race, Nature and the Cultural Politics of Forest Carbon in CanadaANTIPODE, Issue 2 2009Andrew Baldwin Abstract:, Critical geographers have paid remarkably scant attention to issues of climate change, even less so to forest carbon management policy. Building on geographic debate concerning the ontological production of nature and race, this paper argues that at stake in the climate change debate are not simply questions of energy geopolitics or green production. Also at issue in the climate debate are powerful questions of identity, the national form and race. This paper considers how a particular slice of the climate debate , forest carbon management discourse pertaining to Canada's boreal forest , enacts a political geography of racial difference, one that seeks to accommodate an imagined mode of traditional aboriginal life to the exigencies of global climate change mitigation and, importantly, to a logic of global capital now well into its ecological phase. [source] Noncompartmental pharmacokinetics analysis of glucose-stimulated insulin response in African,American and Caucasian youthsBIOPHARMACEUTICS AND DRUG DISPOSITION, Issue 3 2009Lanyi Xie Abstract The objective of this study was to examine the differences in glucose and insulin responses between African,American and Caucasian youths and to determine the associations of between-group differences with sex, body mass index (BMI) and pubertal status using a noncompartmental pharmacokinetic approach. Sixteen African,American and 22 Caucasian healthy adolescents were tested using the frequently sampled intravenous glucose tolerance test. Longitudinal t -tests across each observation revealed that (1) African,American youths have higher insulin concentrations between 4 to 19,min; (2) insulin levels remained similar as subjects were grouped according to sex and pubertal status; (3) for glucose, the only difference was found as it approached steady-state basal level (>100,min) between groups with different BMIs. Linear regression showed that insulin concentrations between 4 to 19,min are associated with BMI in Caucasians. African,American youths were found to have higher insulin responses after glucose stimulation and the insulin concentrations were more related to BMI in Caucasians compared with African,Americans. BMI also has a significant effect on the glucose steady state basal level. The acute insulin response to glucose (AIRg) extended to 20,min resulted in a more significant racial difference (p<0.0006) compared with the calculation done over 10,min suggested in the past (p<0.001). Copyright © 2009 John Wiley & Sons, Ltd. [source] Black Women and White Women: Do Perceptions of Childhood Family Environment Differ?FAMILY PROCESS, Issue 2 2007CASSANDRA M. CLAY M.S.W. Introduction: Few studies have examined racial differences in perceptions of childhood. Little is known about how Blacks perceive their own families, particularly the family environment that they experienced in childhood. Methods: A community sample of 290 women (55% White, 45% Black) from two-parent families, heterogeneous in age and social class, was examined using a self-administered questionnaire, including the Family Environment Scale (FES), followed by a focused interview. Siblings were used as collateral informants. Results: The psychometric properties of the FES showed remarkably little variation by race: The internal scale reliability, correlations between scales, and factor structures were quite similar. Although both White and Black women reported good childhood family environments, Black women when compared with White women rated their families of origin as more cohesive, organized, and expressive, and lower in conflict. Sibling responses corroborated these findings. Discussion: This study addresses a gap in the research literature and provides important evidence of strengths in Black family relationships as reported by a community sample of women. The psychometric properties of the FES, found to be strong for families of both races, lends support to our findings and those of other researchers who have used this measure. [source] Genetics of the apnea hypopnea index in Caucasians and African Americans: I. Segregation analysisGENETIC EPIDEMIOLOGY, Issue 3 2002Sarah G. Buxbaum Abstract Differences in age of presentation and anatomic risk factors for obstructive sleep apnea (OSA) in Caucasians and African Americans suggest possible racial differences in the genetic underpinnings of the disorder. In this study, we assess transmission patterns in a Caucasian sample consisting of 177 families (N = 1,195) and in an African American sample consisting of 125 families (N = 720) for two variables: 1) apnea hypopnea index (AHI) log transformed and adjusted for age, and 2) AHI log transformed and adjusted for age and body mass index (BMI). We allowed for residual familial correlations and sex-specific means in all models. Analysis of the Caucasian sample showed transmission patterns consistent with that of a major gene that were stronger in the age-adjusted variable than in the age- and BMI-adjusted variable. However, in the African American families, adjusting for BMI in addition to age gave stronger evidence for segregation of a codominant gene with an allele frequency of 0.14, accounting for 35% of the total variance. These results provide support for an underlying genetic basis for OSA that in African Americans is independent of the contribution of BMI. Genet. Epidemiol. 22:243,253, 2002. © 2002 Wiley-Liss, Inc. [source] Racial Wage Differences among Young Male Job Changers: The Relative Contribution of Migration, Occupation Change, Site Characteristics, and Human CapitalGROWTH AND CHANGE, Issue 1 2006AMY M. WOLAVER ABSTRACT We demonstrated racial differences in the relationship between migration, location, and predicted wages for young male workers who have changed employers. An Oaxaca decomposition allowed a measuring of the contributions of migration, occupation change, site features, and human capital to the racial wage gap. Migration decreases black,white wage differences, and wage compensation for site attributes favors white householders. Constraints on occupation choice and migration dampen the ability of blacks to improve wages. Because most job changes occur in the first ten years of a career, these results on young workers give important general insights into the origins and persistence of racial wage gaps. [source] Short- and Long-Term Mortality after an Acute Illness for Elderly Whites and BlacksHEALTH SERVICES RESEARCH, Issue 4 2008Daniel Polsky Objective. To estimate racial differences in mortality at 30 days and up to 2 years following a hospital admission for the elderly with common medical conditions. Data Sources. The Medicare Provider Analysis and Review File and the VA Patient Treatment File from 1998 to 2002 were used to extract patients 65 or older admitted with a principal diagnosis of acute myocardial infarction, stroke, hip fracture, gastrointestinal bleeding, congestive heart failure, or pneumonia. Study Design. A retrospective analysis of risk-adjusted mortality after hospital admission for blacks and whites by medical condition and in different hospital settings. Principal Findings. Black Medicare patients had consistently lower adjusted 30-day mortality than white Medicare patients, but the initial survival advantage observed among blacks dissipated beyond 30 days and reversed by 2 years. For VA hospitalizations similar patterns were observed, but the initial survival advantage for blacks dissipated at a slower rate. Conclusions. Racial disparities in health are more likely to be generated in the posthospital phase of the process of care delivery rather than during the hospital stay. The slower rate of increase in relative mortality among black VA patients suggests an integrated health care delivery system like the VA may attenuate racial disparities in health. [source] Racial Differences in the Receipt of Bowel Surveillance Following Potentially Curative Colorectal Cancer SurgeryHEALTH SERVICES RESEARCH, Issue 6p2 2003Gary L. Ellison Objective. To investigate racial differences in posttreatment bowel surveillance after colorectal cancer surgery in a large population of Medicare patients. Data Sources. We used a large population-based dataset: Surveillance, Epidemiology, and End Results (SEER) linked to Medicare data. Study Design. This is a retrospective cohort study. We analyzed data from 44,768 non-Hispanic white, 2,921 black, and 4,416 patients from other racial/ethnic groups, aged 65 and older at diagnosis, who had a diagnosis of local or regional colorectal cancer between 1986 and 1996, and were followed through December 31, 1998. Cox Proportional Hazards models were used to investigate the relation of race and receipt of posttreatment bowel surveillance. Data Collection. Sociodemographic, hospital, and clinical characteristics were collected at the time of diagnosis for all members of the cohort. Surgery and bowel surveillance with colonoscopy, sigmoidoscopy, and barium enema were obtained from Medicare claims using ICD-9-CM and CPT-4 codes. Principal Findings. The chance of surveillance within 18 months of surgery was 57 percent, 48 percent, and 45 percent for non-Hispanic whites, blacks, and others, respectively. After adjusting for sociodemographic, hospital, and clinical characteristics, blacks were 25 percent less likely than whites to receive surveillance if diagnosed between 1991 and 1996 (RR=0.75, 95 percent CI=0.70,0.81). Conclusions. Elderly blacks were less likely than non-Hispanic whites to receive posttreatment bowel surveillance and this result was not explained by measured racial differences in sociodemographic, hospital, and clinical characteristics. More research is needed to explore the influences of patient- and provider-level factors on racial differences in posttreatment bowel surveillance. [source] Physician Referral Patterns and Race Differences in Receipt of Coronary AngiographyHEALTH SERVICES RESEARCH, Issue 4 2002Thomas A. LaVeist Objective. This study addresses the following research questions: (1) Is race a predictor of obtaining a referral for coronary angiography (CA) among patients who are appropriate candidates for the procedure? (2) Is there a race disparity in obtaining CA among patients who obtain a referral for the procedure? Study Setting. Three community hospitals in Baltimore, Maryland. Study Design. We abstracted hospital records of 7,927 patients from three hospitals to identify 2,653 patients who were candidates for CA. Patients were contacted by telephone to determine if they received a referral for CA. Logistic regression was used to assess whether racial differences in obtaining a referral were affected by adjustment for several potential confounders. A second set of analyses examined race differences in use of the procedure among a subsample of patients that obtained a referral. Principal Findings. After controlling for having been hospitalized at a hospital with in-house catheterization facilities, ACC/AHA (American College of Cardiology/American Heart Association) classification, sex, age, and health insurance status, race remained a significant determinant of referral (OR=3.0, p<.05). Additionally, we found no significant race differences in receipt of the procedure among patients who obtained a referral. Conclusions. Our results demonstrate that race differences in utilization of CA tend to occur during the process of determining the course of treatment. Once a referral is obtained, African American patients are not less likely than white patients to follow through with the procedure. Thus, future research should seek to better understand the process by which the decision is made to refer or not refer patients. [source] | ||||||||||||||||||||||