Racial disparities in allergic outcomes persist to age 10 years in black and white children

BackgroundPrevious analyses in the WHEALS birth cohort demonstrated that black children are more likely to experience allergic outcomes than white children by age 2 years. The results could not be explained by a host of variables.ObjectiveAssess whether racial disparities persisted to age 10 years and determine whether any differences could be explained by a panel of variables related to early life exposures in WHEALS.MethodsAt age 10 years, WHEALS children (n = 481) completed skin prick testing, spirometry and methacholine challenge, and a physician examination for eczema and asthma. Allergen-specific immunoglobulin Es (sIgE) and total IgE were measured. Inverse probability weighting with logistic and linear regression models was used to assess associations between race (black or white) and the outcomes.ResultsBlack children fared worse than white children with respect to each outcome. Black children were more likely to have eczema, asthma, sensitization (≥1 sIgE ≥ 0.35 IU/L) and at least 1 positive skin pick test; however, some variability was present in the magnitudes of association within subgroups defined by delivery mode, sex of the child, prenatal indoor dog exposure, and firstborn status. In some subgroups, black children were also more likely to have higher total IgE and worse pulmonary function test measures (PC 20 ≤ 25 mg/mL, % predicted forced vital capacity [FVC], forced expiratory volume in 1 second [FEV₁]/FVC, forced expiratory flow from 25% to 75% of vital capacity [FEF_25-75]). Confounding did not explain these differences.ConclusionRacial differences persisted in this cohort through age 10 years. Future studies should include potentially important, but rarely studied factors such as segregation and structural racism, because these factors could explain the observed racial differences.     

A chronicle of racism: the effects of the white medical community on black health.

At no time in history has the health of black Americans equaled that of white Americans. This distinction is particularly evident in the South, where blacks have been subjected to governmental policies promoting discrimination and segregation. The explanations offered for this difference in health status are numerous. The argument presented in this article is that the health status of blacks in the United States has been greatly affected by the attitudes and perceptions of white physicians. From the days of slavery to 1992, the policies and practices of the white medical community have had an enormous impact on the health of blacks. Black physicians have played a large role in changing the delivery of health-care services to the black population. Their fight was a microcosm of the Civil Rights activities taking place in the world around them. This article describes the history of medical care as it relates to black patients and physicians. The progress that has been made over the past century is analyzed, and the need for continued education and persistence is emphasized. Legalized segregation may have been outlawed in the 1960s, but the nation''s vital statistics indicate that equality has yet to be achieved.     

Structural racism and racial health disparities at the state level: A latent variable approach

Introduction Structural racism is increasingly being recognized as a fundamental cause of racial health disparities. We used a novel measure of structural racism at the state level to examine the relationship between structural racism and disparities in death rates from firearm homicide, infant mortality, HIV, diabetes, stroke, hypertension, asthma, and kidney disease between non-Hispanic Black and non-Hispanic White people in the United States.Methods We used confirmatory factor analysis to measure the latent construct of structural racism for all 50 states. The model included seven indicators across the structural racism domains of residential segregation, economic status/employment, education, incarceration, political participation and representation, environmental racism, and racial equity inclusion. Weights for each of the indicators were determined by examining alternative models and selecting the model with the best fit statistics. The resulting factor scores, representing the level of structural racism in each state across the seven domains, were then used as predictor variables in a series of linear regressions with the ratio of Black to White death rates for each health outcome as the dependent variables.Results We found significant relationships between higher levels of the latent structural racism measure and greater disparities between non-Hispanic Black and non-Hispanic White people in age-adjusted death rates for firearm homicide, infant mortality, HIV, asthma, and obesity. The magnitude of this relationship was greatest for firearm homicide, with each one standard deviation increase in a state's structural racism factor score being associated with an increase of 4.54 (95% CI, 2.91-6.17) in that state's Black-White firearm homicide rate ratio.Conclusions This research provides further evidence that structural racism is a fundamental cause of racial health disparities and that to repair these inequities, macro-level changes in societal structures, institutions, resource allocation, representation, and power will be necessary.     

Assessing the readiness of black churches to engage in health disparities research

We assessed church readiness to engage in health disparities research using a newly developed instrument, examined the correlates of readiness, and described strategies that churches used to promote health. We pilot tested the instrument with churches in a church-academic partnership (n = 12). We determined level of readiness to engage in research and assessed correlates of readiness. We also conducted interviews with participating pastors to explore strategies they had in place to support research engagement. Churches scored fairly high in readiness (average of 4.04 out of 5). Churches with a pastor who promoted the importance of good nutrition in a sermon or had a budget for health-related activities had significantly higher readiness scores than churches without such practices. Having a tool to evaluate church readiness to engage in research will inform targeted technical assistance and research projects that will strengthen church-academic partnerships and improve capacity to address health disparities.     

Fragile X syndrome: linkage analysis in black and white populations

Eleven white families and 10 black families have been studied to detect racial differences in the linkage of DNA markers flanking the fragile X site (FRAXA). The differences in the recombination fractions for F9-FRAXA and DX13-FRAXA were not significant. The pair St14-FRAXA exhibited no difference between the two groups. Although the sample size was small, it would appear that these DNA markers can be used in black persons for prenatal diagnosis and genetic counseling. A larger group of families would be necessary to determine if 4D8 and cX55.7 will be equally useful since these appear to have lower heterozygote frequencies in the black population.     

Status of dental health in black and white Americans

The status of dental health in the American population has significantly improved during the past 15 years. The prevalence of dental diseases is similar in children when racial comparisons are made. However, the dental treatment needs are greater and much more severe in both black adults and black children. The most recent national dental survey included employed adults only. Therefore, true differences between races may be even more marked when jobless adults are included. This omission is especially significant for blacks, where unemployment rates are twice those of whites, and this subgroup has not been included in the most recent national survey.     

Expanding our understanding of the relationship between negative life events and depressive symptoms in black and white adolescent girls

BACKGROUND: Little is known about the extent to which negative life events predict depressive symptoms in ethnically diverse groups or whether this relationship is proximal or enduring. METHOD: The relationship between negative life events in adolescence and depressive symptoms in young adulthood was studied in a sample of over 1300 black and white female adolescents. Five domains of life events were assessed at age 16 years and depressive symptoms were measured at age 18 and again at age 21 years. Questions of interest included whether the association continued over time and whether there were specific domains of life events that predicted symptoms better than others. RESULTS: The total number of negative life events at time 1 predicted depressive symptoms at both time 2 and time 3. Interpersonal loss events and other adversities, however, predicted depressive symptoms only at time 2, whereas at time 3, only interpersonal trauma was a significant predictor. No ethnic differences were found, indicating that the relationship between life events and depressive symptoms appears to be similar for black and white adolescent girls. CONCLUSIONS: The results suggest that negative life events and some specific type of stressorsincrease the likelihood of the onset of depression symptoms in future years, for both black and white girls. Early preventive efforts should be directed at adolescents who experience loss due to death of a significant other, traumatic events, and psychosocial adversities to forestall the development of depressive symptoms.     

氧自由基与多器官衰竭

以0.3mg/kg内毒素经家兔耳缘静脉注入复制多器官衰竭模型。动物在注入内毒素4小时后,发生肺、肝、肾及凝血功能障碍,并出现脏器淤血、白细胞浸润及组织坏死等病理变化。与对照组相比,实验组动物血液及脏器中的自由基及脂质过氧化物水平显著升高(P<0.05),超氧化物歧化酶活性明显下降(P<0.01)。自由基水平的升高与脏器功能障碍之间存有一定的关系,提示氧自由基在严重感染所致的多脏器衰竭的发生与发展中有重要的作用。     

Differences in psychological need hierarchies between black and white drug addicts

A total of 109 Black and White heroin and cocaine addicts in treatment for drug abuse were compared on the Adjective Checklist (ACL). We found that the White addict had a significantly different pattern of needs than did the Black addict, characterized by more psychological dependence, distress, and maladjustment. Consistent with the MMPI literature in this area, the ACL provides an accurate evaluation of personality dimensions among drug addicts, and White addicts are more psychologically maladjusted than Black addicts.     

中老年人群脂联素基因多态性与脑白质病变的关系

目的 探讨在中老年人群中脂联素基因多态性与脑白质病变(WML)之间的关系。方法 纳入2012年6月—2013年1月第三军医大学大坪医院神经内科811例中老年(≥50岁)住院患者的临床资料、血液学指标等进行横断面研究。根据头颅MRI检查结果及Fazekas评分标准诊断WML并分组:诊断为WML者419例纳入观察组,非WML者392例纳入对照组。采用连接酶链反应对患者基因进行分型。应用多因素logistic回归分析脂联素基因多态性与WML关系。结果 与对照组比,观察组平均年龄更大,冠心病、既往卒中史、高血压和糖尿病的比例更高,血浆TC、高密度脂蛋白胆固醇(HDL-C)和载脂蛋白A-Ⅰ浓度较低,空腹血糖浓度较高(P值均<0.05)。rs7649121的AA、AT、TT基因型、等位基因A、T频率在两组间的分布差异有统计学意义(P<0.01)。调整了年龄、性别、既往卒中史、冠心病、高血压、糖尿病和HDL-C后,相对AA基因型,AT基因型和TT基因型仍是WML的独立危险因素;在显性模型中,AT/TT基因型患WML的风险是AA基因型的1.73倍。结论在中国中老年人群中首次发现,脂联素基因的rs7649121位点与WML有关,T等位基因是WML发生的易感基因。     

The working relationship between the general practitioner and the health visitor

The views of 40 health visitors from the Cambridge health district on their working relationship with general practitioners are presented. Patterns of attachment and facilities at the work base are described. The health visitors gave ratings for the frequency and facility of their contact with the general practitioners, the types of patients referred to them and their overall relationship with the doctors. The health visitors' own suggestions for improvement in the relationship are discussed.     

The relationship between oral health and nutrition in older people

The oral health of older people is changing with reducing numbers of people relying on complete dentures for function, and retaining some natural teeth. Despite this there are substantial numbers of older people whose ability to chew foods is compromised by their oral health status, either because they have few or no natural teeth. This alteration results in individuals selecting a diet that they can chew in comfort. Such diets are low in fruits and vegetables intake with associated reduction in both non-starch polysaccharide and micronutrient intakes. There is also a trend for reduced dietary intake overall. Salivary flow and function may have an impact in relation to the ability to chew and swallow. Whilst there are few differences in salivary function in fit healthy unmedicated subjects, disease resulting in reduced salivary flow and particularly polypharmacy, with xerostomia as a side effect, are likely to have a role in older people. This paper explores the relationships between oral health status and food's choice and discusses the potential consequences for the individual of such dietary change.     

The relationship between mental health workers and family members

Objective

To study the relationship between family members and mental health care workers to learn more about the support available to family members of mental health patients.

Methods

Eighteen interviews were conducted with family members, seven with professionals and two with patients. Observations were performed at a long-term hospital ward and at family and client council meetings.

Results

Family members perform an important carer role which greatly affects their lives. They need support from mental health professionals in order to cope. However, communication between mental health care workers and family members is problematic. Family members report a lack of information, consultation and support.

Conclusion

Family members and mental health care workers frame the role of family members in the care process differently.

Practice implications

Since the role of family members in the care process can be beneficial for all actors including the mental health patient it is important that mental health professionals acknowledge this and provide support to family members. Considering relatives as fellow carers (reframing their role) could be the way to do this.     

Racial differences in the physical and psychosocial health among black and white women with chronic pain

Gender-based differences in pain epidemiology, pain threshold, attitudes toward pain management, coping styles and social roles are well described, yet little is known about the chronic pain experience in women or the role race plays. A retrospective analysis of self-reported data using a secondary clinical database was performed to elucidate the relationship between race and pain severity, depression, physical disability, posttraumatic stress disorder (PTSD) as well as affective distress in women with chronic pain. White (n=1,088) and black (n=104) adult women were compared based on their responses to the McGill Pain Questionnaire, Beck Depression Inventory, Pain Disability Index, Posttraumatic Chronic Pain Test and items from the West-Haven Yale Multidisciplinary Pain Inventory. After accounting for sociodemographic, medical, psychological and physical confounders, there was no significant race effect for pain severity or affective distress. However, black women with chronic pain experience more physical impairments than white women with chronic pain (beta = 4.622; p<0.005). Except for the family/home responsibilities, similar differences were found on all PDI subscales. We also found that disability mediates the race-depression relationship such that black women are comparatively more vulnerable to depression as a result of higher disability. Due to the economic, social and emotional impact that disability has on women with chronic pain and their families, these findings have significant implications for chronic pain research as well as its management in black women.