Defining Optimal Self-Management in Osteoarthritis: Racial Differences in a Population-Based Sample

The aim of this study was to examine optimal self-management in osteoarthritis and its association with patient-reported outcomes. We recruited a population-based sample of Medicare beneficiaries (n = 551) residing in Allegheny County, PA, USA and elicited an expanded set of self-management behaviors using open-ended inquiry. We defined optimal self-management according to clinical recommendations, including use of hot compresses on affected joints, alteration of activity, and exercise. Only 20% practiced optimal self-management as defined by two or more of these criteria. Optimal and suboptimal self-managers did not differ in sociodemographic features. Both white and African–Americans who practiced optimal self-management reported significantly less pain, but the benefit was greatest in severe disease for whites and for mild-moderate disease among African–Americans. This backdrop of naturally occurring self-management behaviors may be important to recognize in planning programs that seek to bolster self-management skills.     

The correlations among racial/ethnic groups,hypertriglyceridemia, thrombosis,and mortality in hospitalized patients with COVID-19

Reports of racial and ethnic disparities regarding both rates of infection of the SARS-CoV-2 virus and morbidity of the coronavirus disease-19 (COVID-19) contain profound differences depending on the population. Our previous study has shown that patients with COVID-19 who developed hypertriglyceridemia during hospitalization have a 2.3 times higher mortality rate. However, whether the correlation between hypertriglyceridemia and mortality has disparity among different racial and ethnic groups is unknown.In this study, we investigated the impact of race/ethnicity on the correlation between hypertriglyceridemia and mortality in hospitalized patients with COVID-19. De-identified information from 904 hospitalized patients diagnosed with COVID-19 between March 2020 and June 2021 were extracted from the Medical College of Wisconsin Clinical Data Warehouse. A multivariable regression analysis suggested that the Asians and non-White Hispanics had 4 or 3.9 times higher mortality rate, respectively, after adjusting for age, morbid obesity (BMI ≥40), and gender. The hypertriglyceridemia (≥150 mg/dL) was associated with higher mortality, after adjusting for age, gender, and morbid obesity. The baseline hypertriglyceridemia occurrence had relevantly more consistent percentages among all racial/ethnic groups. However, non-White Hispanic and Asian patients had the highest frequencies of peak hypertriglyceridemia occurrence during hospitalization. The peak hypertriglyceridemia developed during hospitalization correlates with the incidence of thrombosis after adjusting for morbid obesity, age, and sex. In summary, in this retrospective study of 904 hospitalized COVID-19 patients, Asians and non-White Hispanics had a greater likelihood of developing hypertriglyceridemia during hospitalization and mortality than White patients.     

Racial disparities in sleep health between Black and White young adults: The role of neighborhood safety in childhood

ObjectivesBlack adults in the United States have shorter sleep durations and poorer sleep efficiency relative to White adults, yet reasons for these disparities are not well explicated. The objective of this study was to examine neighborhood safety in childhood as a mediator of subsequent racial disparities in sleep.MethodsData were from Black and White young adults attending a large, predominantly White university in the Southeastern United States (N = 263; 52% Black, 53% female; Mean age = 19.21 years, SD = 1.01). Sleep parameters were assessed from eight nights of wrist actigraphy (time in bed, sleep duration, and efficiency) and an established self-report measure of daytime sleepiness. Residential histories from birth through age 18 were documented, and retrospective self-reports of neighborhood safety in childhood were assessed.ResultsBlack participants had less time in bed (p < 0.001), shorter sleep duration (p < 0.001), poorer sleep efficiency (p < 0.001), and more daytime sleepiness (p = 0.009) than White participants. Neighborhood safety mediated race differences in time in bed (p = 0.028), sleep duration (p = 0.033), and daytime sleepiness (p = 0.048), but not sleep efficiency. Findings were substantively unchanged after adjustment for family socioeconomic status, BMI, and substance use.ConclusionsFindings support the hypothesis that neighborhood safety in childhood may partially account for race differences in subsequent sleep duration and daytime sleepiness. Addressing racial inequities in childhood neighborhood safety may be an important step toward reducing racial disparities in sleep health.     

The relation between race-related implicit associations and scalp-recorded neural activity evoked by faces from different races

Abstract

The neural correlates of the perception of faces from different races were investigated. White participants performed a gender identification task in which Asian, Black, and White faces were presented while event-related potentials (ERPs) were recorded. Participants also completed an implicit association task for Black (IAT-Black) and Asian (IAT-Asian) faces. ERPs evoked by Black and White faces differed, with Black faces evoking a larger positive ERP that peaked at 168 ms over the frontal scalp, and White faces evoking a larger negative ERP that peaked at 244 ms. These Black/White ERP differences significantly correlated with participants’ scores on the IAT-Black. ERPs also differentiated White from Asian faces and a significant correlation was obtained between the White-Asian ERP difference waves at ~500 ms and the IAT-Asian. A positive ERP at 116 ms over occipital scalp differentiated all three races, but was not correlated with either IAT. In addition, a late positive component (around 592 ms) was greater for the same race compared to either other race faces, suggesting potentially more extended or deeper processing of the same race faces. Taken together, the ERP/IAT correlations observed for both other races indicate the influence of a race-sensitive evaluative process that may include early more automatic and/or implicit processes and relatively later more controlled processes.     

The impact of race on outcomes following emergency surgery: an American College of Surgeons National Surgical Quality Improvement Program assessment

Background

Despite significant evolutions in health care, outcome discrepancies exist among demographic cohorts. We sought to determine the impact of race on emergency surgery outcomes.

Methods

This is a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database (2005 through 2009) for all patients aged ≥16 years undergoing emergency abdominal surgery. Primary outcomes included morbidity and mortality.

Results

We identified 75,280 patients (mean age 48.2 ± 19.9 years, 51.7% female; 79% white, 9.9% black, 5.0% Hispanic, 3.7% Asian, 1.3% American Indian or Alaskan, .2% Pacific Islander). Annual rates of emergency operations ranged from 7.3% to 8.5% (P = .22). The overall complication (18.6%) and mortality rate (4.6%) was highest in the black population (24.3%, 5.3%) followed by whites (18.7%, 4.6%), with the lowest rate in Hispanic (11.7%, 1.8%) and Pacific Islander populations (10.2%, 1.8%; P < .001). Compared with whites, blacks had a 1.25-fold (1.17 to 1.34; P < .001) increased risk of complications, but similar mortality (P = .168). When combining minorities, overall complications were 1.059-fold (1.004 to 1.12; P = .034) higher, however, mortality was reduced 1.7-fold (1.07 to 1.34; P = .001).

Conclusions

Following emergency abdominal surgery, minority race is independently associated with increased complications and reduced mortality.     

Dominant narratives: Complicity and the need for vigilance in the creative arts therapies

We live in societies in which we are shaped and positioned by dominant/subjugating narratives including patriarchy, Eurocentricism, heterosexism, capitalism, psychiatry/psychology, and medical science. This paper explores the ways in which our understandings of ourselves and others are fundamentally shaped by such narratives. These narratives shape how creative arts therapists understand concepts such as therapy, health and wellness, and issues of identity such as gender, race, ability, and sexuality. The author contends that it is imperative that creative arts therapists examine all aspects of identity in therapy, not only aspects of the client's identity, but also those of the therapist, and how these aspects of identity impact, structure, and mediate the therapeutic relationship. That is, as therapists we are not above the fray of complex identity formation shaped by dominant/subjugating narratives. The author discusses the need for creative arts therapists to examine how dominant/subjugating narratives are communicated through the art forms that we engage in within the therapeutic process. Also explored are the ways in which creative arts therapists are complicit with these dominant/subjugating narratives through our educational and research practices. Finally, the author discusses the need for constant vigilance against such dominant/subjugating narratives in order to work toward anti-oppressive practice and social justice.