In vivo differences between Asian, Black and White in the stratum corneum barrier function

The stratum corneum barrier function of Blacks, Caucasians and Asians were compared in vivo. A noninvasive technic, laser doppler velocimetry (LDV), was used to evaluate the cutaneous penetration of nicotinates by the determination of the lag time before vasodilatation induced by the application of those local vasodilatator drugs. The study was performed on untreated skin and after removal of the stratum corneum by 12 strips. The influence of molecular weight and solubility of different nicotinates (methyl, ethyl, hexyl and vitamin E) were also studied on Japanese skin. Vasodilatation lag times assessed by LDV, with methyl nicotinate (MN), showed that skin permeability was more important in Asians (P < 0.01)=" and=" in=" caucasians=">P < 0.05)=" than=" in=" blacks.=" moreover=" asian=" skin=" was=" significantly=" more=" sensitive=" to=" stripping=">P < 0.05)=" than=" black=" skin.=" a=" significant=" shorter=" lag=" time=" was=" obtained=" with=" small=" and=" hydrophilic=" nicotinates=" (methyl=" and=" ethyl)=">P < 0.01)=" compared=" to=" a=" lipophilic=" one=" (hexyl).=" the=" alteration=" of=" the=" stratum=" corneum=" barrier=" function=" by=" stripping=" showed=" a=" more=" important=" modification=" with=" mn=">P < 0.05)=" than=" with=" hexyl=" nicotinate.=" consequently,=" this=" noninvasive=" method=" can=" evaluate=" the=" modifications=" of=" the=" stratum=" corneum=" barrier=" function=" and=" racial=" origin=" has=" to=" be=" taken=" into=" account=" in=" the=" determination=" of=" skin=">     

The monitoring of racial/ethnic status in the USA: data quality issues

This paper reviews the assessment of racial and ethnic identification in the major data collection systems of the US Department of Health and Human Services. It evaluates the quality of the available data and outlines recommendations for improving the collection of racial data and enhancing our understanding of the role of race in health. Special attention is also given to the role of socioeceonomic status in understanding racial differences in health and the assessment of racial status in data systems in the UK.     

Health inequality and population variation in fertility-timing

We estimate the impact of fertility-timing on the chances that children in poor urban African American communities will have surviving and able-bodied parents until maturity. To do so, we use census and vital statistics data to compute age- and sex-specific rates of mortality and functional limitation among prime-aged adult residents of impoverished African American areas in Harlem, Detroit, Chicago, and the Watts area of Los Angeles and for blacks and whites nationwide. Findings are consistent with the hypothesis that the early fertility-timing characteristic of poor urban African American populations mitigates some of the costs to families associated with excess mortality and early health deterioration in young through middle adulthood.     

Uninsured status may be more predictive of outcomes among the severely injured than minority race

AimWorse outcomes in trauma in the United States have been reported for both the uninsured and minority race. We sought to determine whether disparities would persist among severely injured patients treated at trauma centres where standard triage trauma protocols limit bias from health systems and providers.MethodsWe performed a retrospective analysis of the 2010–2012 National Sample Program from the National Trauma Databank, which is a nationally representative sample of trauma centre performance in the United States. The database was screened for adults ages 18–64 who had a known insurance status. Outcomes measured were in-hospital mortality and post-hospital care.ResultsThere were 739,149 injured patients included in the analysis. Twenty-eight percent were uninsured, and 34 percent were of minority race. In the adjusted analysis, uninsured status (OR 1.60, 1.29–1.98, p < 0.001) and black race (OR 1.24, 1.04–1.49, p = 0.019) were significant predictors of mortality. Only uninsured status was a significant negative predictor of post-hospital care (OR 0.43, 0.36–0.51, p < 0.001). As injury severity increased, only insurance status was a significant predictor of both increased mortality (OR 1.68, 1.29–2.19, p < 0.001) and decreased post-hospital care (OR 0.45, 0.32–0.63, p < 0.001).ConclusionUninsured status is independently associated with higher in-hospital mortality and decreased post-hospital care in patients with severe injuries in a nationally representative sample of trauma centres in the United States. Increased in-hospital mortality is likely due to endogenous patient factors while decreased post-hospital care is likely due to economic constraints. Minority race is less of a factor influencing disparate outcomes among the severely injured.     

Income and race/ethnicity influence dietary fiber intake and vegetable consumption

Grains, fruits, and vegetables are the primary sources of dietary fiber (DF), with the white potato contributing nearly 7% of the DF to the US food supply. The DF composition of the white potato—with or without the skin and regardless of cooking method—compares well with the DF content of other vegetables. Many health benefits, including improved gastrointestinal health, are attributed to greater DF consumption; however, less than 3% of males and females have an adequate intake of DF. Because of this population-wide shortfall, DF is considered to be a nutrient of concern. In this study, using data from the National Health and Nutrition Examination Survey 2009 to 2010, we examined the mean intake of DF across sex, age, race/ethnicity, family income, and poverty threshold. This study shows that mean intake of DF is far below recommendations, with children and adolescents aged 2 to 19 years consuming an average of less than 14 g of DF per day. Adults 20+ years old consume, on average, about 17 g of DF per day, and men consume significantly more DF than women. Non-Hispanic black adults consume significantly less DF compared with other race/ethnic groups. Lower family income and living at less than 131% of poverty were associated with lower DF intakes among adults. Federal and local government policies should encourage consumption of all vegetables, including the white potato, as an important source of DF.     

Disseminating treatment for anxiety disorders: Step 1: Recognizing the problem as a precursor to seeking help

Untreated mental illness is a substantial public health issue in the United States, with only approximately 1/3 of the estimated 46 million adults in the US with mental illness receiving treatment. Many of the individuals with mental illness suffer from excessive anxiety, as over 25% of Americans experience an anxiety disorder during their lifetime and most of these individuals remain untreated. Building from the premise that recognizing one's symptoms precedes requests for help, the current paper presents data from 577 adults (50% Caucasian, 50% African American) in the US regarding their ability to recognize anxiety disorders. Findings from a national survey showed that when presented with detailed vignettes portraying symptoms and their impact, 50% of respondents correctly recognized depression, whereas less than 20% correctly recognized the anxiety disorders. Recognition that the symptoms were a cause for concern was much more common, with 75% or more of the sample noting concern. Responses were surprisingly similar across the two races, and few consistent moderators were found. In conclusion, increasing recognition of anxiety disorders may be a useful first step toward increasing service utilization.     

Racial/Ethnic-Specific Reference Intervals for Common Laboratory Tests: A Comparison among Asians,Blacks, Hispanics,and White

Reference intervals (RIs) for common clinical laboratory tests are usually not developed separately for different subpopulations. The aim of this study was to investigate racial/ethnic differences in RIs of common biochemical and hematological laboratory tests using the National Health and Nutrition Examination Survey (NHANES) 2011–2012 data. This current study included 3,077 participants aged 18–65 years who reported their health status as “Excellent,” “Very good,” or “Good,” with known race/ethnicity as white, black, Hispanic, or Asian. Quantile regression analyses adjusted for sex were conducted to evaluate racial/ethnic differences in the normal ranges of 38 laboratory tests. Significant racial/ethnic differences were found in almost all laboratory tests. Compared to whites, the normal range for Asians significantly shifted to higher values in globulin and total protein and to lower values in creatinine, hematocrit, hemoglobin, mean cell hemoglobin, mean cell hemoglobin concentration, and mean platelet volume. These results indicate that racial/ethnic subpopulations have unique distributions in the labortoary tests and race/ethnicity may need to be incorporated in the development of their RIs. Establishment of racial/ethnic-specific RIs may have significant clinical and public health implication for more accurate disease diagnosis and appropriate treatment to improve quality of patient care, especially for a state with diverse racial/ethnic subpopuations such as Hawai‘i.