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Kinds of Racial Terms modified by Racial Selected AbstractsEtiology, pathogenesis and prevention of neural tube defectsCONGENITAL ANOMALIES, Issue 2 2006Rengasamy Padmanabhan ABSTRACT Spina bifida, anencephaly, and encephalocele are commonly grouped together and termed neural tube defects (NTD). Failure of closure of the neural tube during development results in anencephaly or spina bifida aperta but encephaloceles are possibly post-closure defects. NTD are associated with a number of other central nervous system (CNS) and non-neural malformations. Racial, geographic and seasonal variations seem to affect their incidence. Etiology of NTD is unknown. Most of the non-syndromic NTD are of multifactorial origin. Recent in vitro and in vivo studies have highlighted the molecular mechanisms of neurulation in vertebrates but the morphologic development of human neural tube is poorly understood. A multisite closure theory, extrapolated directly from mouse experiments highlighted the clinical relevance of closure mechanisms to human NTD. Animal models, such as circle tail, curly tail, loop tail, shrm and numerous knockouts provide some insight into the mechanisms of NTD. Also available in the literature are a plethora of chemically induced preclosure and a few post-closure models of NTD, which highlight the fact that CNS malformations are of hetergeneitic nature. No Mendelian pattern of inheritance has been reported. Association with single gene defects, enhanced recurrence risk among siblings, and a higher frequency in twins than in singletons indicate the presence of a strong genetic contribution to the etiology of NTD. Non-availability of families with a significant number of NTD cases makes research into genetic causation of NTD difficult. Case reports and epidemiologic studies have implicated a number of chemicals, widely differing therapeutic drugs, environmental contaminants, pollutants, infectious agents, and solvents. Maternal hyperthermia, use of valproate by epileptic women during pregnancy, deficiency and excess of certain nutrients and chronic maternal diseases (e.g. diabetes mellitus) are reported to cause a manifold increase in the incidence of NTD. A host of suspected teratogens are also available in the literature. The UK and Hungarian studies showed that periconceptional supplementation of women with folate (FA) reduces significantly both the first occurrence and recurrence of NTD in the offspring. This led to mandatory periconceptional FA supplementation in a number of countries. Encouraged by the results of clinical studies, numerous laboratory investigations focused on the genes involved in the FA, vitamin B12 and homocysteine metabolism during neural tube development. As of today no clinical or experimental study has provided unequivocal evidence for a definitive role for any of these genes in the causation of NTD suggesting that a multitude of genes, growth factors and receptors interact in controlling neural tube development by yet unknown mechanisms. Future studies must address issues of gene-gene, gene-nutrient and gene,environment interactions in the pathogenesis of NTD. [source] Racial and Gender Trends in the Use of Implantable Cardioverter-Defibrillators Among Medicare Beneficiaries Between 1997 and 2003CONGESTIVE HEART FAILURE, Issue 2 2009Paul S. Chan MD Differences in the use of implantable cardioverter-defibrillators (ICDs) have been reported, but the extent to which they have widened after the publication of major clinical trials supporting their use is unclear. Using data on Medicare beneficiaries, the authors determined annual age-standardized population-based utilization rates of ICDs for white men, black men, white women, and black women from 1997 to 2003. During the study period, overall use of ICDs increased most for white men (81.7,254.7 procedures per 100,000 from 1997 to 2003) and black men (38.0,151.7 procedures per 100,000), with white women (28.9,98.4 procedures per 100,000) and black women (18.2,77.3 procedures per 100,000) showing smaller increases in comparison. After adjustment with multivariable regression models, differences in utilization rates between whites and men widened compared with blacks and women between 1997 and 2003, a period when indications for ICD therapy have expanded. [source] Racial and Ethnic Disparities in Health: An Emergency Medicine PerspectiveACADEMIC EMERGENCY MEDICINE, Issue 11 2003Janice C. Blanchard MD Abstract Significant disparities exist in health care based on race. Even when controlling for socioeconomic factors, minorities still have lower rates of utilization for certain procedures, higher mortality rates, and differences in usual source of care. There are a multitude of causes for these disparities, including differences based on access to care, the patient,doctor relationship, and insurance status. This article addresses possible factors that account for persistent disparities in health based on race and suggests approaches to remedying these disparities. Although many studies have been done on this topic, further research is needed to examine factors specifically in the emergency department setting. [source] Effects of Poverty and Lack of Insurance on Perceptions of Racial and Ethnic Bias in Health CareHEALTH SERVICES RESEARCH, Issue 3 2008Irena Stepanikova Objective. To investigate whether poverty and lack of insurance are associated with perceived racial and ethnic bias in health care. Data Source. 2001 Survey on Disparities in Quality of Health Care, a nationally representative telephone survey. We use data on black, Hispanic, and white adults who have a regular physician (N=4,556). Study Design. We estimate multivariate logistic regression models to examine the effects of poverty and lack of health insurance on perceived racial and ethnic bias in health care for all respondents and by racial, ethnic, and language groups. Principal Findings. Controlling for sociodemographic and other factors, uninsured blacks and Hispanics interviewed in English are more likely to report racial and ethnic bias in health care compared with their privately insured counterparts. Poor whites are more likely to report racial and ethnic bias in health care compared with other whites. Good physician,patient communication is negatively associated with perceived racial and ethnic bias. Conclusions. Compared with their more socioeconomically advantaged counterparts, poor whites, uninsured blacks, and some uninsured Hispanics are more likely to perceive that racial and ethnic bias operates in the health care they receive. Providing health insurance for the uninsured may help reduce this perceived bias among some minority groups. [source] Addressing Racial and Ethnic Disparities in Health Care: Using Federal Data to Support Local Programs to Eliminate DisparitiesHEALTH SERVICES RESEARCH, Issue 4p1 2006Thomas D. Sequist To reduce racial and ethnic disparities in health care, managers, policy makers, and researchers need valid and reliable data on the race and ethnicity of individuals and populations. The federal government is one of the most important sources of such data. In this paper we review the strengths and weaknesses of federal data that pertain to racial and ethnic disparities in health care. We describe recent developments that are likely to influence how these data can be used in the future and discuss how local programs could make use of these data. [source] Strengthening the Health Services Research to Reduce Racial and Ethnic Disparities in Health careHEALTH SERVICES RESEARCH, Issue 5 2003Carolyn M. Clancy First page of article [source] Socio-economic distance and spatial patterns in unemploymentJOURNAL OF APPLIED ECONOMETRICS, Issue 4 2002Timothy G. Conley This paper examines the spatial patterns of unemployment in Chicago between 1980 and 1990. We study unemployment clustering with respect to different social and economic distance metrics that reflect the structure of agents' social networks. Specifically, we use physical distance, travel time, and differences in ethnic and occupational distribution between locations. Our goal is to determine whether our estimates of spatial dependence are consistent with models in which agents' employment status is affected by information exchanged locally within their social networks. We present non-parametric estimates of correlation across Census tracts as a function of each distance metric as well as pairs of metrics, both for unemployment rate itself and after conditioning on a set of tract characteristics. Our results indicate that there is a strong positive and statistically significant degree of spatial dependence in the distribution of raw unemployment rates, for all our metrics. However, once we condition on a set of covariates, most of the spatial autocorrelation is eliminated, with the exception of physical and occupational distance. Racial and ethnic composition variables are the single most important factor in explaining the observed correlation patterns. Copyright © 2002 John Wiley & Sons, Ltd. [source] Overcoming Racial and Ethnic Disparities in Blood Pressure Control: A Patient-Centered Approach to Cross-Cultural CommunicationJOURNAL OF CLINICAL HYPERTENSION, Issue 8 2008Michael J. Bloch MD "It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.",William Osler1 [source] From White to Western: "Racial Decline" and the Idea of the West in Britain, 1890,1930JOURNAL OF HISTORICAL SOCIOLOGY, Issue 3 2003ALASTAIR BONNETT It was a literature that, whilst claiming to defend and affirm white identity, in fact exposed the limits of whiteness as a form of social solidarity. It is shown how these studies drew together a variety of challenges deemed to be facing the white race and, more specifically, how they exhibited a contradictory desire to defend white racial community whilst attacking "the masses". The idea of the West, developing alongside, within and in the wake of this crisis literature, provided a less racially reductive but not necessarily less socially exclusive identity. [source] Racial and Ethnic Differences in Experiencing Parents' Marital Disruption During Late AdolescenceJOURNAL OF MARRIAGE AND FAMILY, Issue 3 2007Yongmin Sun Using panel data from 9,252 adolescents in the National Education Longitudinal Study, this study finds that among children who experience parents' marital disruption during late adolescence, European, Asian, and African American adolescents exhibit wider and greater maladjustment both before and after the disruption than their Hispanic American counterparts. This finding lends general support to the hypothesis of prevalence of disadvantages, although it is less consistent with the hypothesis of prevalence of divorce. Moreover, whereas Asian American adolescents in predisrupted families are more vulnerable to a shortage of family social resources, their African American peers are affected more by a shortage of financial/human resources. Finally, postdisruption effects on non-Hispanic American adolescents are either completely or partially attributable to predisruption factors. [source] Racial and Ethnic Differences in the Timing of First Marriage and Smoking CessationJOURNAL OF MARRIAGE AND FAMILY, Issue 3 2007Margaret Weden Using data from the National Longitudinal Survey of Youth 1979 (N = 4,050), we consider the relationship between the timing of family formation and positive changes in health behavior. Theories that predict both positive and negative associations are tested. The findings suggest that both mechanisms operate and that the direction of the association depends on the respondent's race or ethnicity. Whites who marry early are less likely to quit smoking, whereas Whites who marry on time and Blacks and Hispanics who marry at all ages are more likely to quit. The analysis refines the understanding of how family formation shapes changes in health behaviors differentially across the life course, and it underscores the difference in this process for individuals from different racial and ethnic backgrounds. [source] Adverse Drinking-Related Consequences Among Lower Income, Racial, and Ethnic Minority Drinkers: Cross-Sectional ResultsALCOHOLISM, Issue 4 2009Anna-Marie Vilamovska Objective:, To examine factors associated with adverse consequences of alcohol consumption among a community sample of drinkers in a low-income, racial, and ethnic minority community. Methods:, A sample of 329 drinkers was recruited from 17 randomly selected off-sell alcohol outlets in South Los Angeles. Respondents were interviewed by trained research personnel on their demographic characteristics, income, drinking patterns and preferences, and alcohol-related adverse consequences (using the Drinkers Inventory of Consequences,DrInC), among other items. We developed logistic regression models predicting high scores on DrInC total score and subscales (impulse control, interpersonal, intrapersonal, physical, and social responsibility). Results:, In this sample, we found drinking patterns,bingeing, drinking outdoors, drinking in the morning,to be significantly associated with total DrInC scores and some subscales. Malt liquor beverage (MLB) use was significantly associated with total DrInC score and interpersonal and social responsibility subscales. Previous alcohol treatment predicted all but 1 DrInC subscale and total score. Conclusions:, A diverse array of factors predicted high DrInC total and subscale scores. More research on the association between MLB use and consequences is required. In addition, studies with community samples are likely to further enrich our understanding of the interactions between drinking patterns and preferences, settings, and negative consequences. [source] The Bar Examination and the Dream Deferred: A Critical Analysis of the MBE, Social Closure, and Racial and Ethnic StratificationLAW & SOCIAL INQUIRY, Issue 3 2004William C. Kidder In this article, the author applies social closure theory to help explain why more than a dozen states have recently enacted more stringent bar exam passing standards and why others are considering similar changes. While higher standards are usually advocated as a way to protect the public from lower student "quality," the author applies social closure theory and argues that changes in passing standards are a response to a perceived oversupply of lawyers, especially among solo practitioners. In the 1990s, crowding among solo practitioners reached record levels, and real earnings eroded substantially. The author then links this labor market analysis to a critical examination of the knowledge claims that justify the bar exam to the legal profession and the public at large. The article's conclusion is that the psychometric research sponsored by the National Conference of Bar Examiners consistently minimizes and obscures the disparate impact and unfairness of the bar exam for people of color. [source] Racial and Ethnic Group Differences in College Enrollment DecisionsNEW DIRECTIONS FOR INSTITUTIONAL RESEARCH, Issue 107 2000Laura W. Perna This chapter reviews and synthesizes what is known from prior research about racial and ethnic group differences in college enrollment and identifies areas for intervention. This chapter is relevant to campus administrators, institutional researchers, and others who are interested in raising the share of African Americans and Hispanics who are enrolling in U.S. colleges and universities. [source] The conceptualization and operationalization of race and ethnicity by health services researchersNURSING INQUIRY, Issue 2 2008Susan Moscou Racial and ethnic variables are routinely used in health services research. However, there is a growing debate within nursing and other disciplines about the usefulness of these variables in research. A qualitative study was undertaken (July 2004 , November 2004) to ascertain how researchers conceptualize and operationalize racial and ethnic data. Data were derived from interviews with 33 participants in academic health centers in differing geographic regions. Content analyses extracted manifest and latent meanings to construct categories depicting respondents' understandings of race and ethnicity in research. Race and ethnicity held several meanings but the subtext was often not clear because these terms were not operationalized. Measuring race and ethnicity quantitatively necessitated uniform classifications thus it was often necessary to impose a single racialized identity. Respondents recognized the problems with racial and ethnic variables but the majority still believed these variables were necessary and useful. Several researchers understood that racial and ethnic variables were used in ways that may stigmatize the populations studied. These respondents collected data on variables other than race and ethnicity to ascertain the causes of health differentials. The policy recommendation calls for a shift in thinking about how to use racial and ethnic variables in research. [source] The Influence of Experimenter Gender and Race on Pain Reporting: Does Racial or Gender Concordance Matter?PAIN MEDICINE, Issue 1 2005Carol S. Weisse PhD ABSTRACT Background., Research on disparities in the treatment of pain has shown that minorities receive less aggressive pain management than nonminorities. While reasons include physician bias, the focus of this study was to examine whether differences in pain reporting behavior might occur when pain is reported to individuals of a different race or gender. Objective., To test whether gender and racial concordance might influence pain reporting and pain behavior in a laboratory setting. Design/Setting., By using a two (subject race)-by-two (subject gender)-by-two (experimenter race)-by two (experimenter gender) quasi-experimental design, pain was assessed in a laboratory through a standard cold pressor task administered by someone whose gender and/or race was similar or dissimilar. Subjects., Subjects were 343 (156 men; 187 women) undergraduates whose ages ranged from 17 to 43 years (mean 20.27 years). Outcome Measures., Pain tolerance was assessed by total immersion time in the ice bath. Pain ratings were obtained by using Gracely scales, which rate the intensity and unpleasantness of the task. Results., Total immersion time was shorter for both blacks and women, and both blacks and women reported higher pain intensity and unpleasantness. Racial and gender concordance did not influence pain reporting or pain tolerance, but interactions between subject race and experimenter gender, as well as subject gender and experimenter race, were revealed. Conclusions., Racial and gender concordance did not influence pain reporting; however, pain reporting was influenced by interactions between gender and race in the subject,experimenter dyads. [source] The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in PainPAIN MEDICINE, Issue 3 2003Carmen R. Green MD ABSTRACT context. Pain has significant socioeconomic, health, and quality-of-life implications. Racial- and ethnic-based differences in the pain care experience have been described. Racial and ethnic minorities tend to be undertreated for pain when compared with non-Hispanic Whites. objectives. To provide health care providers, researchers, health care policy analysts, government officials, patients, and the general public with pertinent evidence regarding differences in pain perception, assessment, and treatment for racial and ethnic minorities. Evidence is provided for racial- and ethnic-based differences in pain care across different types of pain (i.e., experimental pain, acute postoperative pain, cancer pain, chronic non-malignant pain) and settings (i.e., emergency department). Pertinent literature on patient, health care provider, and health care system factors that contribute to racial and ethnic disparities in pain treatment are provided. evidence. A selective literature review was performed by experts in pain. The experts developed abstracts with relevant citations on racial and ethnic disparities within their specific areas of expertise. Scientific evidence was given precedence over anecdotal experience. The abstracts were compiled for this manuscript. The draft manuscript was made available to the experts for comment and review prior to submission for publication. conclusions. Consistent with the Institute of Medicine's report on health care disparities, racial and ethnic disparities in pain perception, assessment, and treatment were found in all settings (i.e., postoperative, emergency room) and across all types of pain (i.e., acute, cancer, chronic nonmalignant, and experimental). The literature suggests that the sources of pain disparities among racial and ethnic minorities are complex, involving patient (e.g., patient/health care provider communication, attitudes), health care provider (e.g., decision making), and health care system (e.g., access to pain medication) factors. There is a need for improved training for health care providers and educational interventions for patients. A comprehensive pain research agenda is necessary to address pain disparities among racial and ethnic minorities. [source] Implications of Racial and Gender Differences In Patterns of Adolescent Risk Behavior for HIV And Other Sexually Transmitted DiseasesPERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH, Issue 6 2004Carolyn Tucker Halpern CONTEXT: Sexual and substance use behaviors covary in adolescence. Prevalence of HIV and other sexually transmitted diseases (STDs) differs according to race and gender, yet few studies have systematically investigated risk behavior patterns by subgroup, particularly with nationally representative data. METHODS: A priori considerations and K-means cluster analysis were used to group 13,998 non-Hispanic black and white participants in the National Longitudinal Study of Adolescent Health, Wave 1, according to self-reported substance use and sexual behavior. Multinomial logit analyses examined racial and gender differences by cluster. RESULTS: Among 16 clusters, the two defined by the lowest risk behaviors (sexual abstinence and little or no substance use) comprised 47% of adolescents; fewer than 1% in these groups reported ever having received an STD diagnosis. The next largest cluster,characterized by sexual activity (on average, with one lifetime partner) and infrequent substance use,contained 15% of participants but nearly one-third of adolescent with STDs. Blacks were more likely than whites to be in this group. Black males also were more likely than white males to be in three small clusters characterized by high-risk sexual behaviors (i.e., having had sex with a male or with at least 14 partners, or for drugs or money). Black females generally were the least likely to be in high-risk behavior clusters but the most likely to report STDs. CONCLUSIONS: Adolescents' risk behavior patterns vary by race and gender, and do not necessarily correlate with their STD prevalence. Further investigation of adolescents' partners and sexual networks is needed. [source] Racial and ethnic disparities in work-related injuries and socio-economic resources among nursing assistants employed in US nursing homes,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 10 2010SangWoo Tak ScD Abstract Background We aimed to estimate the proportion of nursing assistants (NAs) in the US with work-related injuries and insufficient socio-economic resources by race/ethnicity. Methods Data from the 2004 National Nursing Assistant Survey (NNAS), a nationally representative sample survey of NAs employed in United States nursing homes, were analyzed accounting for the complex survey design. Results Among 2,880 participants, 44% reported "scratch, open wounds, or cuts" followed by "back injuries" (17%), "black eyes or other types of bruising" (16%), and "human bites" (12%). When compared to non-Hispanic white NAs, the adjusted rate ratio (RR) for wound/cut was 0.74 for non-Hispanic black NAs (95% confidence interval [CI]: 0.65,0.85). RRs for black eyes/bruises were 0.18 for non-Hispanic black NAs (95% CI: 0.12,0.26), and 0.55 for Hispanic NAs (95% CI: 0.37,0.82). Conclusions Minority racial and ethnic groups were less likely to report having experienced injuries compared with non-Hispanic white NAs. Future research should focus on identifying preventable risk factors, such as differences by race and ethnicity in the nature of NA jobs and the extent of their engagement in assisting patients with activities of daily living. Am. J. Ind. Med. 53:951,959, 2010. © 2010 Wiley-Liss, Inc. [source] Racial and ethnic disparities in low birth weight delivery associated with maternal occupational characteristicsAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 2 2010John D. Meyer MD Abstract Objectives Work characteristics and maternal education have both been associated with low birth weight (LBW) delivery. We sought to examine the relative contribution of these two factors to LBW delivery and determine whether ethnic/racial differentials in educational attainment and work characteristics might play a role in well-described disparities in LBW. Methods Scores for work substantive complexity (SC) derived from the O*NET were imputed to maternal occupation for Connecticut singleton births in 2000. Risks for LBW were estimated separately for black, Hispanic, and white mothers using logistic regression controlling for maternal covariates. Results Using white mothers as a referent, working is associated with reduced LBW risk in black mothers compared to those not in work (OR 2.06 vs. 3.07). LBW in working black women was strongly associated with less that a high school education (OR 4.80, 95% CI 1.68,13.7), and with low work SC in blacks in those with a college education or greater (OR 4.48, 95% CI 1.24,16.2). Examination of work SC scores, controlling for age and educational level, showed lower values for blacks; increased work SC was seen in Hispanics after adjustment for lower educational attainment. A decrease in risk for LBW was seen in black mothers, compared with whites, as work SC increased. By contrast, college-educated black mothers had a greater risk for LBW than those with high school or some college education. Conclusions Maternal employment and work in a job with greater SC were associated with a reduced risk of LBW in black mothers. Improved LBW risk was also seen with employment in Hispanics. Low work SC in those with higher educational attainment was strongly associated with LBW in blacks, but not whites or Hispanics. Education/work mismatch may play a role in racial disparities in birth outcomes. Am. J. Ind. Med. 53:153,162 2010. © 2009 Wiley-Liss, Inc. [source] Race and the Recall: Racial and Ethnic Polarization in the California Recall ElectionAMERICAN JOURNAL OF POLITICAL SCIENCE, Issue 2 2008Gary M. Segura In the 2003 recall election in California, Lt. Gov. Cruz Bustamante received more than 1.25 million fewer votes in the replacement election than votes cast against the recall of Gray Davis. A much smaller group voted "yes" on the recall but voted for Bustamante. The principal underlying explanation is racial and ethnic polarization. Using L.A. Times exit poll data, we compare the characteristics of voters who displayed the two unusual behavioral patterns with those who voted in more conventional ways. We find that Latinos and African Americans are far less likely than non-Hispanic whites and Asian Americans to have defected from Bustamante given a "no" vote on the recall, and far more likely to have voted for Bustamante given a potentially strategic "yes" vote on the recall. The patterns of defection are consistent with racial polarization on Proposition 54, lending further credence to our claim that race and ethnicity persists as an important factor in vote choice, even in environments with a history of minority electoral success. [source] Continuing professional development: Racial and gender differences in obstetrics and gynecology residents' perceptions of mentoringTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 4 2005Victoria H. Coleman MA Research Associate Abstract Introduction: Having a mentor during residency is often linked to greater success in professional development. The present study compares changes in the percentage of residents with mentors in 1999 and in 2004, while considering current residents' perceptions of their mentors, with particular attention focused on what role race and gender might play in resident-mentor interactions. Method: A survey was administered to 4, 721 residents who took the 2004 Council on Resident Education in Obstetrics and Gynecology in-training examination. Data are reported for respondents from four racial categories: white, African American, Hispanic, and Asian/Pacific Islander. Results were compared to those of a similar survey administered in 1999. Responses were analyzed by chi-square analysis and univariate analyses of variance. Results: The response rate was 97%. Most residents (64.9%) reported having a mentor. White female residents were least likely to have a mentor. Compared to results from 1999, the percentage of residents with a mentor, and the percentage of residents with female mentors, has increased. For all residents, personal rapport, knowledge of the field, and similarity in professional interests were the three most important factors in choosing a mentor. The proportion of residents reporting explicit discussions about career options has declined since 1999. Discussion: Ethnic minorities are more likely than white residents to have a mentor, and to report that their mentors provide helpful advice. Although the proportion of residents with a mentor has increased since 1999, the quality of the mentoring relationship is meeting resident expectations but not exceeding them. [source] Debating the Use of Racial and Ethnic Categories in ResearchTHE JOURNAL OF LAW, MEDICINE & ETHICS, Issue 3 2006Susan M. Wolf J.D. First page of article [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] Racial and Sex Differences in Emergency Department Triage Assessment and Test Ordering for Chest Pain, 1997,2006ACADEMIC EMERGENCY MEDICINE, Issue 8 2010Lenny López MD ACADEMIC EMERGENCY MEDICINE 2010; 17:801,808 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, This study assessed whether sociodemographic differences exist in triage assignment and whether these differences affect initial diagnostic testing in the emergency department (ED) for patients presenting with chest pain. Methods:,A nationally representative ED data sample for all adults (,18 years) was obtained from the National Hospital Ambulatory Health Care Survey of EDs for 1997,2006. Weighted logistic regression was used to examine the associations between race and presenting symptom, triage assignment, and test ordering, adjusting for patient and hospital characteristics. Results:, Over 10 years, an estimated 78 million visits to the ED presented with a complaint of chest pain. Of those presenting with chest pain, African Americans (odds ratio [OR] = 0.70; 99% confidence interval [CI] = 0.53 to 0.92), Hispanics (OR = 0.74; 99% CI = 0.51to 0.99), Medicaid patients (OR = 0.72; 99% CI = 0.54 to 0.94), and uninsured patients (OR = 0.65; 99% CI = 0.51 to 0.84) were less likely to be triaged emergently. African Americans (OR = 0.86; 99% CI = 0.70 to 0.99), Medicaid patients (OR = 0.70; 99% CI = 0.55 to 0.88), and uninsured patients (OR = 0.70; 99% CI = 0.55 to 0.89) were less likely to have an electrocardiogram (ECG) ordered. African Americans (OR = 0.69; 99% CI = 0.49 to 0.97), Medicaid patients (OR = 0.67; 99% CI = 0.47 to 0.95), and uninsured patients (OR = 0.66; 99% CI = 0.44 to 0.96) were less likely to have cardiac enzymes ordered. Similarly, African Americans and Hispanics were less likely to have a cardiac monitor and pulse oximetry ordered, and Medicaid and uninsured patients were less likely to have a cardiac monitor ordered. Conclusions:, Persistent racial, sex, and insurance differences in triage categorization and basic cardiac testing exist. Eliminating triage disparities may affect "downstream" clinical care and help eliminate observed disparities in cardiac outcomes. [source] Designs of Deception: Concepts of Consciousness, Spirituality and Survival in Capoeira Angola in Salvador, BrazilANTHROPOLOGY OF CONSCIOUSNESS, Issue 1 2001Margaret WillsonArticle first published online: 8 JAN 200 This paper addresses various questions concerning "consciousness" and related folk concepts through an examination of fundamental principles of capoeira angola. These include, for instance, ideas such as ginga, the sensing of the mind/body through specific movements; or energia, a type of psychic force believed to be engendered through engagement within a group or with an opponent; or mentalidade, the kind of "head" one develops in capoeira angola, referring in part to what we conceptualize as a "state of consciousness," and in this case a highly alert and perceptive state with other elements of psychic ties and influences. This mentalidade includes "street smarts" and a highly developed knowledge about the various ways deception can be used to "get what one needs" in life, in other words, these are tools for survival in a specific kind of environment. Such a discussion must include "race," and class in Brazil. Racial and class discrimination in Brazilian society is seldom expressed explicitly; indeed a rhetoric of "racial democracy" has been popularized in direct contradiction to the reality of a racial oppression that includes class. In this paper, I integrate related issues of "states of consciousness" that have developed in capoeira angola to the conditions of racial and class inequality, power and history that have been its nurturance. In the conclusions, I speculate that notions of consciousness are in the process of change as capoeira angola is being regimented, taken out of context and taught increasingly among middle-class Brazilians and in such places as the United States. [source] Racial and Ethnic Differences in Emergency Care for Acute Exacerbation of Chronic Obstructive Pulmonary DiseaseACADEMIC EMERGENCY MEDICINE, Issue 2 2009Chu-Lin Tsai MD ScD Abstract Objectives:, The objective was to investigate racial and ethnic differences in emergency care for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods:, The authors performed a prospective multicenter cohort study involving 24 emergency departments (EDs) in 15 U.S. states. Using a standard protocol, consecutive ED patients with AECOPD were interviewed, their charts reviewed, and 2-week telephone follow-ups were completed. Results:, Among 330 patients, 218 (66%) were white, 84 (25%) were African American, and 28 (8%) were Hispanic. A quarter of the 24 EDs cared for 59% of all minority patients. Compared with white patients, African American and Hispanic patients were more likely to be uninsured or with Medicaid (19, 49, and 52%, respectively; p < 0.001), were less likely to have a primary care provider (93, 81, and 82%, respectively; p = 0.005), and had more frequent ED visits in the past year (medians = 1, 2, and 3, respectively; p = 0.002). In the unadjusted analyses, minority patients were less likely to receive diagnostic procedures, more likely to receive systemic corticosteroids in the ED, less likely to be admitted, and more likely to have a relapse. After adjustment for patient and ED characteristics, these many racial and ethnic differences in quality of care were nearly completely eliminated. Conclusions:, Despite pronounced racial and ethnic differences in stable COPD, all racial and ethnic groups received comparable quality of emergency care for AECOPD and had similar short-term outcomes. [source] Compliance with Recommended Cancer Screening among Emergency Department Patients: A Multicenter SurveyACADEMIC EMERGENCY MEDICINE, Issue 5 2008Adit A. Ginde MD Abstract Objectives:, The objectives were to measure compliance with, and possible sociodemographic disparities for, cancer screening among emergency department (ED) patients. Methods:, This was a cross-sectional survey in three academic EDs in Boston. The authors enrolled consecutive adult patients during two 24-hour periods at each site. Self-reported compliance with standard recommendations for cervical, breast, testicular, and prostate cancer screening were measured. The chi-square test was used test to evaluate associations between demographic variables and cancer screening compliance. Results:, The authors enrolled 387 patients (81% of those eligible). The participants had a mean (±standard deviation) age of 44 (±18) years and were 52% female, 16% Hispanic, and 65% white. Sixty-seven percent (95% confidence interval [CI] = 60% to 73%) of all women reported Pap smear examinations in the past 3 years, 92% (95% CI = 85% to 96%) of women aged ,40 years reported clinical breast examinations, and 88% (95% CI = 81% to 94%) of women aged ,40 years reported mammography. Fifty-one percent (95% CI = 40% to 61%) of men aged 18,39 years reported testicular self-examinations, and among men aged ,40 years, 79% (95% CI = 69% to 87%) reported digital rectal examinations (DREs) and 51% (95% CI = 40% to 61%) reported prostate-specific antigen (PSA) testing. Racial and ethnic minorities reported slightly lower rates of clinical breast examinations and testicular self-examinations. Conclusions:, Most women and a majority of men in our ED-based study were compliant with recommended measures of cervical, breast, testicular, and prostate cancer screening. No large sociodemographic disparities in our patient population were identified. Based on these data, and the many other pressing public health needs of our ED population, the authors would be reluctant to promote ED-based cancer screening initiatives at this time. [source] Race and Gender Influences on Adjustment in Early Adolescence: Investigation of an Integrative ModelCHILD DEVELOPMENT, Issue 5 2002David L. DuBois This research investigated an integrative model of race, and gender,related influences on adjustment during early adolescence using a sample of 350 Black and White youth. In the proposed model, prejudice/discrimination events, as well as race and gender daily hassles, contribute to a general stress context. The stress context, in turn, influences levels of emotional and behavioral problems in adjustment, with these associations mediated (in part) by intervening effects on self,esteem. Racial and gender identity similarly have positive effects on adjustment via their intermediary linkages with self,esteem. Structural equation modeling analyses provided support for all of these aspects of the model. Findings also revealed theoretically predicted differences in model parameters across race by gender subgroups. These include a direct effect of prejudice/discrimination events on emotional problems specific to Black youth and an effect of gender identity on self,esteem specific to girls. Black girls appeared to be most vulnerable to exhibiting significant adjustment difficulties as a result of the processes under investigation. [source] Virtual anatomy: An anatomist's playgroundCLINICAL ANATOMY, Issue 3 2006Victor M. Spitzer Abstract Virtual anatomy presents significant advantages over the reality of a cadaver as it can provide different views and perspectives, portability, longevity, standardization, diversity and most importantly the opportunity to learn the anatomy of the living human body instead of the corpse. Virtual anatomy is the life-like appearance of visible anatomy, a good example of which is the evolution of the Visible Human. Racial and statistical diversity is already developing as the population of photographic "Visible Humans" is now at least 10. Virtual anatomy should include additional diversity and therefore, consideration should be given to the preparation of more visible anatomy that will better support the virtual integration of all areas of physiology, kinematics, pathology and pathophysiology, development and evolution. Integration of anatomists with mathematicians, computer scientists, information scientists, physiologists, pathologists and clinicians (and LIST other basic scientist) is needed in order to facilitate this development. As this unfolds it is proposed, or challenged, that anatomists should maintain their position of responsibility for building anatomy as the foundation for all medical and healthcare education. In order to maintain that position they must understand and participate in this development and enjoy the rewards of teaching more visually empowering, functional, and clinical anatomy. The trip is a long one and is only about to begin but the train is leaving. Are you on board? Clin. Anat. 19:192,203, 2006. © 2006 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||||||||||||||||||||