Assessing Diabetes Care Disparities with Ambulatory Care Quality Measures

ObjectiveTo identify and describe racial/ethnic disparities in overall diabetes management.ConclusionsAlthough this health system has above-average diabetes care quality, significant disparities by race/ethnicity were identified. This underscores the importance of stratifying quality measures to improve care and outcomes for all.     

新疆13～18岁少数民族中学生1985和2010年的身体形态发育状况的比较研究

目的了解新疆地区13~18岁维、哈、柯等三个少数民族中学生的生长发育状况及之间存在的差异和原因,为改善新疆少数民族中学生体质健康水平提供科学依据。方法通过文献资料、数理统计、对比分析等研究方法,利用新疆地区1985年和2010年13~18岁少数民族学生体质健康调研所获得的数据,对该地区维、哈、柯等三个少数民族学生的身体形态发育状况作25年的动态观察、对比和分析。结果近25年间,新疆13~18岁维、哈、柯等少数民族中学生的身高、体重、胸围平均增长值基本保持增长(除了维女生身高,维、柯男生胸围指标外),平均增长值分别为:维男生3.3cm、3.9kg、-0.5cm,维女生-0.2cm、0.9kg、4.2cm;哈男生6.1cm、4.8kg、1.7cm,哈女生4cm、4.1kg、2.6cm;柯男生4.8cm、3.6kg、-0.5cm,柯女生3cm、3.3kg、0.4cm。维、哈、柯等少数民族学生的身体形态发育各有差异,总体水平:哈男、女生的身体形态发育水平优于维、柯男、女生,柯男、女生的优于维男、女生,且差异均有统计学意义(P0.05~0.001)。结论近25年间,新疆维、哈、柯等少数民族中学生的身体形态发育各有差异,身体形态发展不平衡,其原因是多方面的,除了遗传、历史、自然环境、学校、家庭、社会等因素外,最主要与新疆经济发展区域间存在不均衡性有关。     

Racial Disparities in End-of-Life Care Between Black and White Adults With Metastatic Cancer

ContextThe comfort of patients with cancer near the end of life (EOL) is often undermined by unnecessary and burdensome treatments. There is a need for more research examining racial disparities in EOL care, especially in regions with a history of racial discrimination.ObjectivesTo examine whether black adults received more burdensome EOL care than white adults in a population-based data set of cancer decedents in Louisiana, a state with a history of slavery and long-standing racial disparities.MethodsThis was a retrospective analysis of EOL care from the Research Action for Health Network (REACHnet), a regional Patient-Centered Outcomes Research Institute-funded database. The sample consisted of 875 white and 415 black patients with metastatic cancer who died in Louisiana from 2011 to 2017. We used logistic regression to examine whether race was associated with five indicators of burdensome care in the last 30 days of life: chemotherapy use, inpatient hospitalization, intensive care unit admission, emergency department (ED) admission, and mechanical ventilation.ResultsMost patients (85.0%) received at least one indicator of burdensome care: hospitalization (76.5%), intensive care unit admission (44.1%), chemotherapy (29.1%), mechanical ventilation (23.0%), and ED admission (18.3%). Odds ratios (ORs) indicated that black individuals were more likely than white individuals to be hospitalized (OR = 1.66; 95% CI = 1.21–2.28; P = 0.002) or admitted to the ED (OR = 1.57; 95% CI = 1.16–2.13; P = 0.004) during their last month of life.ConclusionFindings have implications for informing health care decision making near the EOL for patients, families, and clinicians, especially in regions with a history of racial discrimination and disparities.     

Can attachment and peer relation constructs predict anxiety in ethnic minority youths? A longitudinal exploratory study

ABSTRACT

Anxiety is the most prevalent psychiatric disturbance in childhood effecting typically 15–20% of all youth. It has been associated with attachment insecurity and reduced competence in peer relations. Prior work has been limited by including mainly White samples, relying on questionnaires, and applying a cross-sectional design. The present study addressed these limitations by considering how at-risk non-White youth (n = 34) responded to the Friends and Family Interview (FFI) in middle childhood and how this linked up with anxiety symptoms and an anxiety diagnosis three years later in early adolescence. Five dimensions of secure attachment, namely, (i) to mother, (ii) to father, (iii) coherence, (iv) developmental understanding, and (v) social competence and quality of contact with best friend in middle childhood, were found to correlate significantly (and negatively) with self-reported anxiety symptoms. Linear regression results showed independent influences of female gender, and (low) quality of best friend contact as the most efficient model predicting anxiety symptoms. Logistic regression results suggested a model that included female gender, low social competence, and immature developmental understanding as efficient predictors of an anxiety diagnosis, evident in only 18% of the sample. These results point to the usefulness of after-school programs for at-risk minority youth in promoting peer competence, developmental awareness, and minimizing anxiety difficulties.     

Seen but not heard: School-based professionals’ oversight of autism in children from ethnic minority groups

Previous studies have shown that ethnic background hinders clinician detection of autistic features in children from non-western minority groups. The use of a structured instrument during evaluation of these children can reduce the risk of hindered detection. The aims of the current studies were to establish the extent of school-based professionals’ involvement in detecting autism and to replicate earlier findings of autism detection amongst school mentors. Results showed that school-based professionals were reported to be the first to suspect autistic features in 20% of children later diagnosed with autism. Additionally, school-based professionals refer to autism more often when judging children from majority than children from minority groups. However, using a structured instrument did not eliminate this bias. Providing these professionals with culture-sensitive education may help maximise their involvement in detecting autism amongst children from all ethnic backgrounds.     

Cardiac risk underestimation in urban,black women

BACKGROUND: Black women have a disproportionately higher incidence of cardiovascular disease mortality than other groups and the reason for this health disparity is incompletely understood. Underestimation of personal cardiac risk may play a role. OBJECTIVE: We investigated the personal characteristics associated with underestimating cardiovascular disease in black women. DESIGN, SETTING, PARTICIPANTS: Trained surveyors interviewed 128 black women during the baseline evaluation for a randomized controlled trial in an urban, academic continuity clinic affiliated with a public hospital system. They provided information on the presence of cardiac risk factors and demographic and psychosocial characteristics. These self-report data were supplemented with medical record abstraction for weight. MEASUREMENTS AND MAIN RESULTS: The main outcome measure was the accurate perception of cardiac risk. Objective risk was determined by a simple count of major cardiac risk factors and perceived risk by respondent's answer to a survey question about personal cardiac risk. The burden of cardiac risk factors was high in this population: 77% were obese; 72% had hypertension; 48% had high cholesterol; 49% had a family history of heart disease; 31% had diabetes, and 22% currently used tobacco. Seventy-nine percent had 3 or more cardiac risk factors. Among those with 3 or more risk factors ("high risk"), 63% did not perceive themselves to be at risk for heart disease. Among all patients, objective and perceived cardiac risk was poorly correlated (kappa=0.026). In a multivariable model, increased perceived personal stress and lower income were significant correlates of underestimating cardiac risk. CONCLUSIONS: Urban, disadvantaged black women in this study had many cardiac risk factors, yet routinely underestimated their risk of heart disease. We found that the strongest correlates of underestimation were perceived stress and lower personal income.     

New Insights on the Risk for Cardiovascular Disease in African Americans: The Role of Added Sugars

African Americans are at increased risk for cardiovascular and metabolic diseases, including obesity, high BP, diabetes, CKD, myocardial infarction, and stroke. Here we summarize the current risks and provide an overview of the underlying risk factors that may account for these associations. By reviewing the relationship between cardiovascular and renal diseases and the African-American population during the early 20th century, the historic and recent associations of African heritage with cardiovascular disease, and modern population genetics, it is possible to assemble strong hypotheses for the primary underlying mechanisms driving the increased frequency of disease in African Americans. Our studies suggest that underlying genetic mechanisms may be responsible for the increased frequency of high BP and kidney disease in African Americans, with particular emphasis on the role of APOL1 polymorphisms in causing kidney disease. In contrast, the Western diet, particularly the relatively high intake of fructose-containing sugars and sweetened beverages, appears to be the dominant force driving the increased risk of diabetes, obesity, and downstream complications. Given that intake of added sugars is a remediable risk factor, we recommend clinical trials to examine the reduction of sweetened beverages as a primary means for reducing cardiovascular risk in African Americans.