There's no place like home: Examining the emotional consequences of Hurricane Katrina on the displaced residents of New Orleans

Using survey data from the Displaced New Orleans Residents Pilot Study (DNORPS), I examine the emotional consequences of Hurricane Katrina on the displaced residents of New Orleans. First, I employ an established framework within disaster research to investigate whether the stress level of displaced residents varies by race, income, and gender. As the residents in this dataset remained uprooted from their homes, I also examine three housing variables, including homeownership status, house type, and four levels of home damage. Contrary to previous research, home damage and homeownership status are significant predictors of displaced residents' emotional distress while the effect of race disappears. These findings suggest that future research on the mental health of disaster survivors, especially for displaced residents, expand the traditional analytical framework to consistently include housing variables, especially different categories of home damage, in addition to race, income, and gender.

What are we to make of the concept of race? Thoughts of a philosopher-scientist

Discussions about the biological bases (or lack thereof) of the concept of race in the human species seem to be never ending. One of the latest rounds is represented by a paper by Neven Sesardic, which attempts to build a strong scientific case for the existence of human races, based on genetic, morphometric and behavioral characteristics, as well as on a thorough critique of opposing positions. In this paper I show that Sesardic's critique falls far short of the goal, and that his positive case is exceedingly thin. I do this through a combination of analysis of the actual scientific findings invoked by Sesardic and of some philosophical unpacking of his conceptual analysis, drawing on a dual professional background as an evolutionary biologist and a philosopher of science.

Racial discrimination: how not to do it

The UNESCO Statements on Race of the early 1950s are understood to have marked a consensus amongst natural scientists and social scientists that 'race' is a social construct. Human biological diversity was shown to be predominantly clinal, or gradual, not discreet, and clustered, as racial naturalism implied. From the seventies social constructionists added that the vast majority of human genetic diversity resides within any given racialised group. While social constructionism about race became the majority consensus view on the topic, social constructionism has always had its critics. Sesardic (2010) has compiled these criticisms into one of the strongest defences of racial naturalism in recent times. In this paper I argue that Sesardic equivocates between two versions of racial naturalism: a weak version and a strong version. As I shall argue, the strong version is not supported by the relevant science. The weak version, on the other hand, does not contrast properly with what social constructionists think about 'race'. By leaning on this weak view Sesardic's racial naturalism intermittently gains an appearance of plausibility, but this view is too weak to revive racial naturalism. As Sesardic demonstrates, there are new arguments for racial naturalism post-Human Genome Diversity Project. The positive message behind my critique is how to be a social constructionist about race in the post-genomic era.

Race and ethnicity of mothers with Spanish surnames

The objective of this study was to assess how hospital designation of race/ethnicity based on Spanish surnames of mothers correlated with the self-report, and explores how these mothers identified their own race/ethnicity using the National Institutes of Health (NIH) categories. 235 mothers were enrolled prospectively and asked to report their race/ethnicity. Positive predictive value (PPV) of using surnames as a tool for assigning race/ethnicity was determined. The PPV of using surnames to identify ethnicity and race was 79 and 30%, respectively. 57% of mothers could not identify their race by the NIH categories. Although Spanish surnames more accurately reflected ethnicity than race, its use was associated with substantial discrepancies.

Disparities in breast cancer treatment and outcomes: biological, social, and health system determinants and opportunities for research

Racial disparities in breast cancer mortality have been widely documented for several decades and persist despite advances in receipt of mammography across racial groups. This persistence leads to questions about the roles of biological, social, and health system determinants of poor outcomes. Cancer outcomes are a function not only of innate biological factors but also of modifiable characteristics of individual behavior and decision making as well as characteristics of patient-health system interaction and the health system itself. Attempts to explain persistent racial disparities have mostly been limited to discussion of differences in insurance coverage, socioeconomic status, tumor stage at diagnosis, comorbidity, and molecular subtype of the tumor. This article summarizes existing literature exploring reasons for racial disparities in breast cancer mortality, with an emphasis on treatment disparities and opportunities for future research. Because breast cancer care requires a high degree of multidisciplinary team collaboration, ensuring that guideline recommended treatment (such as endocrine therapy for hormone receptor positive patients) is received by all racial/ethnic groups is critical and requires coordination across multiple providers and health care settings. Recognition that variation in cancer care quality may be correlated with race (and socioeconomic and health system factors) may assist policy makers in identifying strategies to more equally distribute clinical expertise and health infrastructure across multiple user populations.

Race, life course socioeconomic position, racial discrimination, depressive symptoms and self-rated health

Greater levels of socioeconomic position (SEP) are generally associated with better health. However results from previous studies vary across race/ethnicity and health outcomes. Further, the majority of previous studies do not account for the effects of life course SEP on health nor the effects of racial discrimination, which could moderate the effects of SEP on health. Using data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, we examined the relationship between a life course SEP measure on depressive symptoms and self-rated health. A life course SEP was constructed for each participant, using a framework that included parental education and occupation along with respondents' highest level of education and occupation. Interaction terms were created between life course SEP and racial discrimination to determine whether the association between SEP and health was moderated by experiences of racial discrimination. Analyses revealed that higher levels of life course SEP were inversely related to depressive symptoms. Greater life course SEP was positively associated with favorable self-rated health. Racial discrimination was associated with more depressive symptoms and poorer self-rated health. Analyses indicated a significant interaction between life course SEP and racial discrimination on depressive symptoms in the full sample. This suggested that for respondents with greater levels of SEP, racial discrimination was associated with reports of more depressive symptoms. Future research efforts should be made to examine whether individuals' perceptions and experiences of racial discrimination at the interpersonal and structural levels limits their ability to acquire human capital as well as their advancement in education and occupational status.

Atrial Fibrillation and Race - A Contemporary Review

Atrial fibrillation (AF) is the most commonly encountered clinical arrhythmia and is associated with adverse outcomes and increased healthcare costs. Racial variations in AF are recognized yet poorly understood. In this review we summarize racial differences in AF epidemiology, risk factors, genetics, and outcomes. We identify novel risk factors, inflammatory mediators and biomarkers associated with AF, which have had limited study in racial and ethnic minorities. We describe the mismatch between risk factor burden and AF. We highlight the limited participation of minorities in trials for AF management and stroke prevention that contrasts with observed racial variability in anticoagulation efficacy and practice. Throughout we provide specific strategies for future directions to address gaps in the epidemiology of racial differences and to meet identified racial disparities. We specifically identify areas for further research. We conclude that addressing disparities in prevention and healthcare resource allocation will likely improve AF-related outcomes in minorities.

Thinness expectancies and restraint in Black and White college women: a prospective study

Despite stereotypes to the contrary, women of diverse racial backgrounds, including Black women, experience disordered eating symptoms. While there has been an increase in research comparing disordered eating symptoms across ethnic groups, there remains a dearth of research on the mechanisms of action underlying the development of these symptoms in non-White populations. Thinness expectancies prospectively predict disordered eating symptoms in adolescent girls, but the majority of research on expectancies has been conducted with White samples. Restraint, or self-initiated attempts to restrict food intake, may be precipitated by cognitive factors such as thinness expectancies. In the current study, we followed a sample of Black and White women over one semester of college to assess the influence of thinness expectancies and ethnic identity on restraint. Our sample consisted of 193 college women (93 Black women). We found that White women experienced restraint at higher levels than Black women, but both Black and White women experienced an increase in restraint across the first semester in college. The endorsement of thinness expectancies added significant incremental variance to the prediction of restraint over time, when baseline restraint was included in the model. These effects were not moderated by ethnicity nor ethnic identity. This study adds to the scarce literature on phenomenology of disordered eating in Black women.

The effect of race and gender on pediatric surgical outcomes within the United States

PURPOSE

The purpose of this study was to examine risk-adjusted associations between race and gender on postoperative morbidity, mortality, and resource utilization in pediatric surgical patients within the United States.

METHODS

101,083 pediatric surgical patients were evaluated using the U.S. national KID Inpatient Database (2003 and 2006): appendectomy (81.2%), pyloromyotomy (9.8%), intussusception (6.2%), decortication (1.9%), congenital diaphragmatic hernia repair (0.7%), and colonic resection for Hirschsprung's disease (0.2%). Patients were stratified according to gender (male: 63.1%, n=63,783) and race: white (n=58,711), Hispanic (n=26,118), black (n=9,103), Asian (n=1,582), Native American (n=474), and other (n=5,096). Multivariable logistic regression modeling was utilized to evaluate risk-adjusted associations between race, gender, and outcomes.

RESULTS

After risk adjustment, race was independently associated with in-hospital death (p=0.02), with an increased risk for black children. Gender was not associated with mortality (p=0.77). Postoperative morbidity was significantly associated with gender (p<0.001) and race (p=0.01). Gender (p=0.003) and race (p<0.001) were further associated with increased hospital length of stay. Importantly, these results were dependent on operation type.

CONCLUSION

Race and gender significantly affect postoperative outcomes following pediatric surgery. Black patients are at disproportionate risk for postoperative mortality, while black and Hispanic patients have increased morbidity and hospital resource utilization. While gender does not affect mortality, gender is a determinant of both postoperative morbidity and increased resource utilization.

Ethnic differences in dry eye symptoms: effects of corneal staining and length of contact lens wear

PURPOSE

To explore the relationships among length of contact lens (CL) wear, degree of corneal staining and severity of dryness symptoms, and to determine whether these relationships differ between Asians and non-Asians.

METHODS

Adapted soft CL wearers (n=395; 180 Asian, 215 non-Asian) were required to discontinue CL wear for at least 24h and report to the University of California, Berkeley Clinical Research Center (UCB-CRC). Fluorescein corneal staining was graded according to Brien Holden Vision Institute scales. Length of CL wear was reported by subjects and subjective dryness ratings were collected using the UCB-CRC Dry Eye Flow Chart (DEFC).

RESULTS

More Asian CL wearers exhibited corneal staining compared to non-Asians, and Asian CL wearers had a higher mean grade of corneal staining (p<0.001), as well as a higher mean DEFC classification (p<0.001). The difference between Asians and non-Asians in grades of corneal staining extent and depth were significant (p<0.001). Among non-Asian CL wearers, dryness symptoms decreased with more years of CL wear and increased in the presence of corneal staining, which was not the case for Asian CL wearers.

CONCLUSIONS

Asian soft CL wearers reported more severe dryness symptoms and demonstrated more severe corneal staining overall compared to non-Asians. Among non-Asians, dryness symptoms were less severe on average with increased years of CL wear and more severe in the presence of corneal staining. Dryness severity does not appear to be related to years of CL wear or corneal staining among Asians.

Racial and ethnic disparity in food allergy in the United States: a systematic review

BACKGROUND

The prevalence of food allergy is rising among US children. Little is known about racial/ethnic disparities in food allergy.

OBJECTIVE

We performed a systematic literature review to understand racial/ethnic disparities in food allergy in the United States.

METHODS

We searched PubMed/MEDLINE, Embase, and Scopus for original data about racial/ethnic disparities in the diagnosis, prevalence, treatment, or clinical course of food allergy or sensitization, with a particular focus on black (African American) race. Articles were analyzed by study methodology, racial/ethnic composition, food allergy definition, outcomes, summary statistic used, and covariate adjustment.

RESULTS

Twenty of 645 identified articles met inclusion criteria. The studies used multiple differing criteria to define food allergy, including self-report, sensitization assessed by serum food-specific IgE to selected foods without corroborating history, discharge codes, clinic chart review, and event-reporting databases. None used oral food challenge. In 12 studies, black persons (primarily children) had significantly increased adjusted odds of food sensitization or significantly higher proportion or odds of food allergy by self-report, discharge codes, or clinic-based chart review than white children. Major differences in study methodology and reporting precluded calculation of a pooled estimate of effect.

CONCLUSION

Sparse and methodologically limited data exist about racial/ethnic disparity in food allergy in the United States. Available data lack a common definition for food allergy and use indirect measures of allergy, not food challenge. Although data suggest an increased risk of food sensitization, self-reported allergy, or clinic-based diagnosis of food allergy among black children, no definitive racial/ethnic disparity could be found among currently available studies.

Influence of vascular comorbidities and race on erectile dysfunction after prostate cancer radiotherapy

INTRODUCTION

Vascular comorbidities (VC) (hypertension, diabetes, and hyperlipidemia) are known factors related to erectile dysfunction (ED) in men. However, no data are yet available for the effects of VC on ED incidence after prostate cancer radiotherapy (XRT).

AIM

To investigate the influence of VC on post-XRT ED incidence and to further characterize ED incidence by racial groups.

MAIN OUTCOME MEASURES

ED incidence.

METHODS

We reviewed 732 charts of patients (267 Caucasian and 465 African American [AA]) who received prostate XRT (external beam radiotherapy and/or brachytherapy) with or without hormone therapy between 1999 and 2010. The number of pre-XRT VC (0, 1, 2, or 3) was determined by medical history and medication list. ED (defined by use of erectile aids or by documentation of moderate or high sexual dysfunction on patient history) was determined pre-XRT as well as 1, 2, and 4 years post-XRT.

RESULTS

ED incidence progressively increased from 22% pre-XRT to 58% 4 years post-XRT (P < 0.01). Additionally, ED incidence significantly increased with number of VC-4-year incidence between patients with 1 vs. 0 (P = 0.02), 2 vs. 0 (P < 0.01), 3 vs. 0 (P < 0.01), 3 vs. 1 (P < 0.01), and 3 vs. 2 (P = 0.04) VC (2 vs. 1 VC was nonsignificant). Compared with the Caucasian patients, ED incidences were slightly higher for the AA group with 0, 1, 2, and 3 comorbidities at 4 years follow-up (but statistically nonsignificant).

CONCLUSIONS

The number of VCs have a significant effect on development of post-XRT ED. Pre- and post-XRT ED appear to be independent of race when number of VCs are considered. Our results can be used to guide physicians in counseling patients on the incidence of ED by number of VC and as preliminary data for prospective efforts aimed at reducing post-XRT ED.

Disparities in uterine cancer epidemiology, treatment, and survival among African Americans in the United States

OBJECTIVE

The objective of this article is to comprehensively review the scientific literature and summarize the available data regarding the outcome disparities of African American women with uterine cancer.

METHODS

Literature on disparities in uterine cancer was systematically reviewed using the PubMed search engine. Articles from 1992 to 2012 written in English were reviewed. Search terms included endometrial cancer, uterine cancer, racial disparities, and African American.

RESULTS

Twenty-four original research articles with a total of 366,299 cases of endometrial cancer (337,597 Caucasian and 28,702 African American) were included. Compared to Caucasian women, African American women comprise 7% of new endometrial cancer cases, while accounting for approximately 14% of endometrial cancer deaths. They are diagnosed with later stage, higher-grade disease, and poorer prognostic histologic types compared to their Caucasian counterparts. They also suffer worse outcomes at every stage, grade, and for every histologic type. The cause of increased mortality is multifactorial. African American and white women have varying incidence of comorbid conditions, genetic susceptibility to malignancy, access to care and health coverage, and socioeconomic status; however, the most consistent contributors to incidence and mortality disparities are histology and socioeconomics. More robust genetic and molecular profile studies are in development to further explain histologic differences.

CONCLUSIONS

Current studies suggest that histologic and socioeconomic factors explain much of the disparity in endometrial cancer incidence and mortality between white and African American patients. Treatment factors likely contributed historically to differences in mortality; however, studies suggest most women now receive equal care. Molecular differences may be an important factor to explain the racial inequities. Coupled with a sustained commitment to increasing access to appropriate care, on-going research in biologic mechanisms underlying histopathologic differences will help address and reduce the number of African American women who disproportionately suffer and die from endometrial malignancy.

Symptomatic venous thromboembolism in Asian major trauma patients: incidence, presentation and risk factors

BACKGROUND

Trauma patients are known to be at increased risk of venous thromboembolism (VTE), and pulmonary embolism (PE) is one of the preventable causes of mortality in trauma patients. The incidence of VTE in Asian populations was believed to be lower than in Caucasians, but the recent literature suggests that this is not the case. The purpose of this study was to assess the incidence of VTE in Asian major trauma patients and to examine the manner of presentation, use of prophylaxis and risk factors for VTE. While other studies of VTE have addressed general and high-risk populations within Asia, our study is one of the few to examine Asian major trauma patients.

METHODS

Data for all patients with VTE were extracted from the Singapore General Hospital trauma database over a 10-year period from 1998 to 2007. Patient profiles and clinical factors were compared to patients without a diagnosis of VTE admitted with injuries in the same time period.

RESULTS

There were 8,615 patients entered into our database in this 10-year period. Thirty-four patients had VTE, with an overall incidence of 0.39 %. Thirteen patients had pulmonary embolism, an incidence of 0.15 %. Of note, 30 % of patients with deep vein thrombosis (DVT) presented with fever alone without limb symptoms. Almost all 34 patients who developed VTE had either head injury, a spinal cord injury or a pelvic/extremity injury. Eighteen patients had head injury, 22 patients sustained pelvic or extremity injury, and three patients had spinal cord injury with paraplegia. Head injury and spinal cord injury with neurologic sequelae were statistically significant risk factors for VTE (p < 0.05).

CONCLUSION

The incidence of symptomatic VTE in the Asian trauma population is no lower than in the West. The incidence found in this study is similar to the incidence of VTE according to a study using data from the American national trauma data bank using similar study methods and with a similar study population. It is also higher than the incidence in the literature for general post-surgical Asian patients. Fever was the presenting factor in some patients and screening for VTE should not be forgotten when assessing fever in the trauma patient. The strong association between head injury, spinal cord injury and VTE confirms that we should pay special attention to VTE prophylaxis for our patients with these injuries.

High sodium:potassium intake ratio increases the risk for all-cause mortality: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study

Increased dietary Na intake and decreased dietary K intake are associated with higher blood pressure. It is not known whether the dietary Na:K ratio is associated with all-cause mortality or stroke incidence and whether this relationship varies according to race. Between 2003 and 2007, the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort enrolled 30 239 black and white Americans aged 45 years or older. Diet was assessed using the Block 98 FFQ and was available on 21 374 participants. The Na:K ratio was modelled in race- and sex-specific quintiles for all analyses, with the lowest quintile (Q1) as the reference group. Data on other covariates were collected using both an in-home assessment and telephone interviews. We identified 1779 deaths and 363 strokes over a mean of 4·9 years. We used Cox proportional hazards models to obtain multivariable-adjusted hazard ratios (HR). In the highest quintile (Q5), a high Na:K ratio was associated with all-cause mortality (Q5 v. Q1 for whites: HR 1·22; 95 % CI 1·00, 1·47, P for trend = 0·084; for blacks: HR 1·36; 95 % CI 1·04, 1·77, P for trend = 0·028). A high Na:K ratio was not significantly associated with stroke in whites (HR 1·29; 95 % CI 0·88, 1·90) or blacks (HR 1·39; 95 % CI 0·78, 2·48), partly because of the low number of stroke events. In the REGARDS study, a high Na:K ratio was associated with all-cause mortality and there was a suggestive association between the Na:K ratio and stroke. These data support the policies targeted at reduction of Na from the food supply and recommendations to increase K intake.

Differences in cholesterol management among states in relation to health insurance and race/ethnicity across the United States

BACKGROUND

Across the United States, hyperlipidemia remains inadequately controlled and may vary across states according to differences in health insurance coverage and/or race/ethnicity.

OBJECTIVE

To examine relationships between states' health insurance and race/ethnicity characteristics with measures of hyperlipidemia management across the 50 U.S. states and the District of Columbia.

METHODS

Cross-validated, multiple linear regression modeling was used to analyze associations between states' health insurance patterns or proportions of racial minorities (from the 2010 U.S. Census data) and states' aggregate frequency of checking cholesterol within the previous 5 years or prescriptions written for lipid-lowering medications (from national survey and population-adjusted retail prescription data, respectively), with adjustments for age, sex, body mass index, race/ethnicity, and poverty.

RESULTS

In states with proportionately more uninsured, cholesterol levels are checked less often, but in states with proportionately more private, Medicare, or Medicaid coverage, providers are not necessarily more likely to check cholesterol or to write more prescriptions. In states with proportionately more African-Americans and/or Hispanics, cholesterol is more likely to be checked, but in states with more African-Americans, more prescriptions were written, whereas in states with more Hispanics, fewer statin prescriptions were written.

CONCLUSION

Variations across states in insurance and racial/ethnicity mix are associated with variations in hyperlipidemia management; less-insured states may be less effective whereas states with more private, Medicare, or Medicaid coverage may not be more effective. In states with proportionately more African-Americans vs. Hispanics, lipid medications may be prescribed differently. Our findings warrant further investigations.

Insurance type, not race, predicts mortality after pediatric trauma

BACKGROUND

In adult trauma, mortality varies with race and insurance status. In the elderly, insurance type has little impact on mortality after trauma and the influence of race is reduced. How race and insurance affect pediatric trauma requires further attention. We hypothesized that mortality after pediatric trauma is influenced by insurance type and not race.

METHODS

We reviewed all cases of blunt trauma in children ≤13 y requiring admission, using the National Trauma Data Bank Research Data Sets for 2007 and 2008. Exclusions included an Abbreviated Injury Score of 6 for any body region, dead on arrival, and missing data. Our primary outcome measure was in-hospital mortality.

RESULTS

We identified 831 Asian (1.2%), 10,592 black (15.5%), 45,173 white (66.2%), and 8498 Hispanic (12.5%) children, and 3161 children (4.6%) classified as other race. Mean age was 7.4 ± 4.5 y, 11.9% were uninsured, and overall in-hospital mortality was 1.4%. Multivariable modeling indicated that race was not associated with increased mortality (Asian versus white, adjusted odds ratio [AOR] 1.05, P = 0.88; black versus white, AOR 0.92, P = 0.42; Hispanic versus white, AOR 0.87, P = 0.26; and other race versus white, AOR 1.01, P = 0.96). In contrast, insurance status (any insurance versus no insurance, AOR 0.6, P < 0.01) and insurance type (private insurance versus no insurance, AOR 0.47, P < 0.01; Medicaid versus no insurance, 0.67, P < 0.01) predicted reduced mortality.

CONCLUSIONS

Insurance status and insurance type are important predictors of mortality after pediatric trauma while, in contrast, race is not.

Early Family Ties and Marital Stability Over 16 Years: The Context of Race and Gender

Spouses' emotional ties to family early in marriage are linked to marital outcomes, but little is known about how these ties affect marital stability and whether these effects vary by race and gender. The present study examines the links between emotional ties to family of origin and in-laws in the first year of marriage and marital stability over the first 16 years of marriage. Data were collected as part of a longitudinal study following Black American (n=199) and White American (n=174) married couples. Analyses revealed that perceptions of closeness to in-laws early in marriage were associated with odds of divorce over time, but the results varied by race and gender. Findings are discussed in terms of couples' ties to family early in marriage and the role that in-law bonds play for marital stability. We also offer insights for practitioners who provide premarital and marital education and counseling services to couples.

Racial and ethnic disparities in the treatment of unruptured thoracoabdominal aortic aneurysms in the United States

PURPOSE

Previous studies have found increased mortality in minority patients undergoing abdominal aortic aneurysm repair. The goal of this study was to identify racial and ethnic disparities in patients undergoing thoracoabdominal aortic aneurysm repair.

MATERIALS AND METHODS

We queried the Nationwide Inpatient Sample (2005-2009) using International Classification of Diseases, Ninth Revision, Clinical Modification codes for repair of unruptured thoracoabdominal aneurysms. The primary outcome was death. Secondary outcomes included postoperative complications. We performed multivariate analysis adjusting for age, gender, race, comorbidities (Charlson index), insurance type, and surgeon and hospital operative volumes and characteristics.

RESULTS

Overall, 1541 white, 207 black, and 117 Hispanic patients underwent thoracoabdominal aortic aneurysm repair. White patients tended to be older (P = 0.003), whereas black patients had a higher incidence of diabetes mellitus (P = 0.04). Black and Hispanic patients were less likely to have an elective admission (P < 0.001) and more likely to have repair performed at a hospital with a lower average annual surgical volume (P = 0.04). Postoperative complications were similar among the groups (P = 0.31). On multivariate analysis, increased mortality was independently associated with Hispanic ethnicity (relative ratio [RR], 2.57; 95% confidence interval [CI], 1.25-5.25; P = 0.01), cerebrovascular disease (RR, 1.88; 95% CI, 1.10-3.23; P = 0.02), and age (RR, 1.04; 95% CI, 1.01-1.07; P = 0.004).

CONCLUSIONS

Hispanic ethnicity is independently associated with increased mortality after repair of unruptured thoracoabdominal aneurysms. This finding was independent of preoperative comorbidities, postoperative complications, and surgeon and hospital operative volumes. Further studies are necessary to determine whether this mortality difference persists after the index hospitalization.

Corneal epithelial permeability: ethnic differences between Asians and non-Asians

PURPOSE

To ascertain whether a difference in the permeability of the corneal epithelium to fluorescein (Pdc) exists between Asians and non-Asians.

METHODS

From a multi-study database we extracted 632 records of baseline, open-eye Pdc measurements taken on both eyes of 176 subjects. Subjects were awake for a minimum of 4h before measurement, and were free of ocular disease and central corneal staining. Pdc was transformed by natural logarithm to better approximate normality for statistical tests.

RESULTS

The mean ln(Pdc) in the Asian group was significantly greater than in the non-Asian group [-2.34 ln(nm/s) vs. -2.58 ln(nm/s); p<0.001].

CONCLUSIONS

Compared with non-Asians, Asians exhibited a less negative ln(Pdc), which translates to a higher Pdc and a more permeable corneal epithelium. We speculate that this may be related to anatomic differences responsible for greater eyelid tension in Asians.

Effects of gender, disability, and age in the receipt of preventive services

PURPOSE OF THE STUDY

We extend research to examine relations between gender, disability, and age in the receipt of preventive services.

DESIGN AND METHODS

We pool Medical Expenditure Panel Survey data for years 2001-2007. Using logit models, we examine the relations between gender, disability, and age and the receipt of preventive services.

RESULTS

For most services, both women and men with disabilities had higher probabilities of receiving preventive services relative to those without disabilities. There was a pattern of more significant differences for men relative to women. Predicted probabilities for receipt of services were significantly higher among older adults relative to younger adults. A usual source of care was a significant predictor across services. For example, we estimate that adults aged 18-64 with a place as a usual source of care received 59% of recommended services, whereas those with a person as a source of care received 63% of services relative to 47% for those without a usual source of care. Among older adults, the predicted percentage of preventive services received for no usual source of care was 52% and that for a place or a person as a usual source of care were 71% and 76%, respectively. Across gender, disability, and age, receipt of a range of clinical preventive services is suboptimal.

IMPLICATIONS

Policy actions that may mitigate the differences we observed include mechanisms to support access to a usual source of care, financial incentives to enhance the receipt of preventive services, and implementation of community-based prevention services with attention to their linkage to clinical care.

Survival advantage in black versus white men with CKD: effect of estimated GFR and case mix

BACKGROUND

Black dialysis patients have significantly lower mortality compared with white patients, in contradistinction to the higher mortality seen in blacks in the general population. It is unclear whether a similar paradox exists in patients with non-dialysis-dependent chronic kidney disease (CKD), and if it does, what its underlying reasons are.

STUDY DESIGN

Historical cohort.

SETTING & PARTICIPANTS

518,406 white and 52,402 black male US veterans with non-dialysis-dependent CKD stages 3-5.

PREDICTOR

Black race.

OUTCOMES & MEASUREMENTS

We examined overall and CKD stage-specific all-cause mortality using parametric survival models. The effect of sociodemographic characteristics, comorbid conditions, and laboratory characteristics on the observed differences was explored in multivariable models.

RESULTS

During a median follow-up of 4.7 years, 172,093 patients died (mortality rate, 71.0 [95% CI, 70.6-71.3] per 1,000 patient-years). Black race was associated with significantly lower crude mortality (HR, 0.95; 95% CI, 0.94-0.97; P < 0.001). The survival advantage was attenuated after adjustment for age (HR, 1.14; 95% CI, 1.12-1.16), but was magnified after full multivariable adjustment (HR, 0.72; 95% CI, 0.70-0.73; P < 0.001). The unadjusted survival advantage of blacks was more prominent in those with more advanced stages of CKD, but CKD stage-specific differences were attenuated by multivariable adjustment.

LIMITATIONS

Exclusively male patients.

CONCLUSIONS

Black patients with CKD have lower mortality compared with white patients. The survival advantage seen in blacks is accentuated in patients with more advanced stages of CKD, which may be explained by changes in case-mix and laboratory characteristics occurring during the course of kidney disease.

Characterizing inflammatory breast cancer among Arab Americans in the California, Detroit and New Jersey Surveillance, Epidemiology and End Results (SEER) registries (1988-2008)

Introduction

Inflammatory breast cancer (IBC) is characterized by an apparent geographical distribution in incidence, being more common in North Africa than other parts of the world. Despite the rapid growth of immigrants to the United States from Arab nations, little is known about disease patterns among Arab Americans because a racial category is rarely considered for this group. The aim of this study was to advance our understanding of the burden of IBC in Arab ethnic populations by describing the proportion of IBC among different racial groups, including Arab Americans from the Detroit, New Jersey and California Surveillance, Epidemiology and End Results (SEER) registries.

Methods

We utilized a validated Arab surname algorithm to identify women of Arab descent from the SEER registries. Differences in the proportion of IBC out of all breast cancer and IBC characteristics by race and menopausal status were evaluated using chi-square tests for categorical variables, t-tests and ANOVA tests for continuous variables, and log-rank tests for survival data. We modeled the association between race and IBC among all women with breast cancer using hierarchical logistic regression models, adjusting for individual and census tract-level variables.

Results

Statistically significant differences in the proportion of IBC out of all breast cancers by race were evident. In a hierarchical model, adjusting for age, estrogen and progesterone receptor, human epidermal growth receptor 2, registry and census-tract level education, Arab-Americans (OR=1.5, 95% CI=1.2,1.9), Hispanics (OR=1.2, 95% CI=1.1,1.3), Non-Hispanic Blacks (OR=1.3, 95% CI=1.2, 1.4), and American Indians/Alaskans (OR=1.9, 95% CI=1.1, 3.4) had increased odds of IBC, while Asians (OR=0.6, 95% CI=0.6, 0.7) had decreased odds of IBC as compared to Non-Hispanic Whites.

Conclusions

IBC may be more common among certain minority groups, including Arab American women. Understanding the descriptive epidemiology of IBC by race may generate hypotheses about risk factors for this aggressive disease. Future research should focus on etiologic factors that may explain these differences.

Racial/Ethnic Variations in Colorectal Cancer Screening Self-Efficacy, Fatalism and Risk Perception in a Safety-Net Clinic Population: Implications for Tailored Interventions

Ethnic and racial minority groups in the U.S. receive fewer colorectal cancer (CRC) screening tests and are less likely to be up-to-date with CRC screening than the population as a whole. Access, limited awareness of CRC and barriers may, in part, be responsible for inhibiting widespread adoption of CRC screening among racial and ethnic minority groups. The purpose of this study was to examine the role of self-efficacy, fatalism and CRC risk perception across racial and ethnic groups in a diverse sample. This study was a cross-sectional analysis from baseline measures gathered on a group of patients recruited into a trial to track colorectal cancer screening in underserved adults over 50. Out of 470 Participants, 42% were non-Hispanic; 27% Hispanic and 28% non-Hispanic White. Hispanic and non-Hispanic Blacks were more likely to have fatalistic beliefs about CRC than non-Hispanic Whites. Non-Hispanic Blacks perceived higher risk of getting colon cancer. Self-efficacy for completing CRC screening was higher among Non-Hispanic Blacks than among Hispanics. Racial and ethnic differences in risk perceptions, fatalism and self-efficacy should be taken into consideration in future CRC interventions with marginalized and uninsured populations.

Erythropoiesis-stimulating Agent Use among Patients with Lupus Nephritis Approaching End-stage Renal Disease

Objectives

Little is known about erythropoiesis-stimulating agents (ESAs) utilization among lupus nephritis (LN) patients with incipient ESRD. We aimed to identify sociodemographic and clinical factors associated with ESA use among incident LN ESRD patients.

Methods

Among all individuals age ≥18 with incident ESRD from 1995-2008 in the U.S. Renal Data System (USRDS), we identified those with systemic lupus erythematosus (ICD-9 code 710.0) as the cause of ESRD. ESA use at ESRD onset was ascertained from the Medical Evidence Report. Year of onset, age, sex, race/ethnicity, medical insurance, employment status, residential region, clinical factors and comorbidities were considered potentially associated with ESA use in multivariable-adjusted logistic regression analyses.

Results

We identified 12,533 individuals with incident LN ESRD (1% of entire population). Of those, 4,288 (34%) received an ESA preceding ESRD. In multivariable-adjusted models, ESA users had higher serum albumin and hemoglobin concentrations, were more likely to be women, and to live in the Northeast. Conversely, Medicaid beneficiaries, the uninsured, unemployed, African Americans, Hispanics, and those with IV drug use, congestive heart failure and obesity had lower ESA use.

Conclusion

Among all U.S. patients and those with LN who developed ESRD, approximately one third received ESAs. Patient sex, race, age, medical insurance, residential region and clinical factors were significantly associated with ESA therapy. While there are no guidelines for ESA use in LN patients approaching ESRD, there has been wide sociodemographic variation, raising questions about ESA prescription practices.

Suicide prevention program for at-risk groups: pointers from an epidemiological study

OBJECTIVES

The aim of this paper is to identify at-risk groups for a focused suicide prevention program for Malaysia.

METHODS

Data from 20,552 persons aged 16 years and above (males 45.9%), was obtained using stratified, random sampling in a national survey of psychiatric morbidity using locally validated General Health Questionnaire (GHQ-28) which included questions on suicidal ideation.

RESULTS

The overall prevalence of suicidal ideation (SI) was 6.3%, CI 6.1-6.8 (n=1288). Logistic regression analysis was performed with age, ethnicity, gender, urban/rural residence, age group, marital status, household income, type of household, presence of chronic pain, social dysfunction, somatic, anxiety or depressive symptoms, obesity, and chronic medical illnesses as independent variables. Only Insomnia, Religion, Marital Status, Depression, Social Dysfunction and Anxiety were seen to be significant predictors. Prevalence of SI was significantly higher among Indians (11.0%, CI 9.5-12.5), especially those of the Hindu faith (12.2%, CI 10.5-14.0), Chinese (9.7%, CI 8.8-10.7) and those having depressive symptoms.

CONCLUSION

In a developing country with competing priorities, prudent allocation of resources requires focusing suicide prevention efforts on treating depression in vulnerable groups.

Fitting In: Segregation, Social Class, and the Experiences of Black Students at Selective Colleges and Universities

We analyzed qualitative data gathered at a selective urban university with a large black student body. We found that black students from integrated backgrounds welcomed the chance to establish friendships with same-race peers even though they were at ease in white settings, whereas students from segregated backgrounds saw same-race peers as a source of comfort and refuge from a white world often perceived as hostile. These contrasting perceptions set up both groups for shock upon matriculation. Students from an integrated background were better prepared academically and socially, but were unfamiliar with urban black culture and uncomfortable interacting with students of lower class standing. Students from a segregated background were surprised to find they had little in common with more affluent students from integrated backgrounds. Although both groups were attracted to campus for the same reason-to interact with a critical mass of same-race peers-their contrasting expectations produced a letdown as the realities of intraracial diversity set in.

Confounding factors affect the pathophysiology of eosinophilic esophagitis

Eosinophilic esophagitis is a newly diagnosed esophageal disease in adult and children. The clinical and pathological characteristics of this disease have been established and were recently summarized in the expert clinical guideline published in 2011. In spite of the wide knowledge accumulated on this disease, there are many areas where scientific data are missing, especially in regard to the disease's pathophysiology. Recent publications have suggested that other confounding factors modify the disease and may affect its clinical-phenotypic presentation. Those factors may include place of living, air pollution, race, genetic factors and other. In the present report we discussed and review those confounding factors, the new developments, and what direction we should go to further advance our knowledge of this disease.

Racial Disparities in Mental Health Outcomes After Psychiatric Hospital Discharge Among Individuals With Severe Mental Illness

Racial disparities in mental health outcomes have been widely documented in non-institutionalized community psychiatric samples, but few studies have specifically examined the effects of race among individuals with the most severe mental illnesses. A sample of 925 individuals hospitalized for severe mental illness were followed for a year after hospital discharge to examine the presence of disparities in mental health outcomes between African American and White individuals diagnosed with a severe psychiatric condition. Results from a series of individual growth curve models indicated that African American individuals with severe mental illness experienced significantly less improvement in global functioning, activation and anergia symptoms, and were less likely to return to work in the year following hospitalization. Racial disparities persisted after adjustment for sociodemographic and diagnostic confounders, and were largely consistent across gender, socioeconomic status, and psychiatric diagnosis. Implications for social work research and practice with minorities with severe mental illness are discussed.

The Impact of Race and Ethnicity, Immigration, and Political Context on Participation in American Electoral Politics

This study uses national survey data in federal election years during 1996-2004 to examine voter registration and voting. It shows that racial/ethnic disparities in socio-economic resources and rootedness in the community do not explain overall group differences in electoral participation. It contradicts the expectation from an assimilation perspective that low levels of Latino participation are partly attributable to the large share of immigrants among Latinos. In fact net differences show higher average Latino participation than previously reported. The study focuses especially on contextual factors that could affect collective responses of group members. Moving beyond past research, significant effects are found for the group's representation among office holders, voting regulations, and state policies related to treatment of immigrants.

The effects of expectancy violations on early attention to race in an impression-formation paradigm

Previous research has demonstrated that early attentional components of the event-related potential (ERP) reflect differential attention to race during person perception. There is also evidence that inconsistency between stereotypic information following impression formation leads to greater neural processing in later ERP components. However, research has not examined how expectancy violations following impression formation affect the early attentional processing of race. The current study examined this issue by leading White participants to form impressions of targets based on positive or negative behaviors associated with stereotypes about Blacks or Whites, with the purpose of creating an expectation of Black or White targets. Following each impression formation trial, a target face whose race either violated or confirmed this expectancy was displayed. Participants indicated whether this target could have performed the previous behavior. Results demonstrated that reaction times and early attentional components of the ERP varied as a function of the match between expectancy and the race of target faces, with stereotypic expectancy violating trials yielding longer reaction times and greater N1 and N2 amplitudes than expectancy-confirming trials. Implications for impression formation and person perception are discussed.

The use of race, ethnicity and ancestry in human genetic research

Post-Human Genome Project progress has enabled a new wave of population genetic research, and intensified controversy over the use of race/ethnicity in this work. At the same time, the development of methods for inferring genetic ancestry offers more empirical means of assigning group labels. Here, we provide a systematic analysis of the use of race/ethnicity and ancestry in current genetic research. We base our analysis on key published recommendations for the use and reporting of race/ethnicity which advise that researchers: explain why the terms/categories were used and how they were measured, carefully define them, and apply them consistently. We studied 170 population genetic research articles from high impact journals, published 2008–2009. A comparative perspective was obtained by aligning study metrics with similar research from articles published 2001–2004. Our analysis indicates a marked improvement in compliance with some of the recommendations/guidelines for the use of race/ethnicity over time, while showing that important shortfalls still remain: no article using ‘race’, ‘ethnicity’ or ‘ancestry’ defined or discussed the meaning of these concepts in context; a third of articles still do not provide a rationale for their use, with those using ‘ancestry’ being the least likely to do so. Further, no article discussed potential socio-ethical implications of the reported research. As such, there remains a clear imperative for highlighting the importance of consistent and comprehensive reporting on human populations to the genetics/genomics community globally, to generate explicit guidelines for the uses of ancestry and genetic ancestry, and importantly, to ensure that guidelines are followed.

Metropolitan influences on migration into poor and nonpoor neighborhoods

Data from the Panel Study of Income Dynamics and three decennial U.S. censuses are used to examine the influence of metropolitan-area characteristics on black and white households' propensity to move into poor versus nonpoor neighborhoods. We find that a nontrivial portion of the variance in the odds of moving to a poor rather to a nonpoor neighborhood exists between metropolitan areas. Net of established individual-level predictors of inter-neighborhood migration, black and white households are more likely to move to a poor or extremely poor tract rather than to a nonpoor tract in metropolitan areas containing many poor neighborhoods and a paucity of recently-built housing in nonpoor areas. Blacks are especially likely to move to a poor tract in metropolitan areas characterized by high levels of racial residential segregation and in which poor tracts have a sizeable concentration of blacks. White households are more likely to move to a poor than to a nonpoor tract in metropolitan areas that have comparatively few African Americans.

STRUCTURAL RACISM AND HEALTH INEQUITIES: Old Issues, New Directions

Racial minorities bear a disproportionate burden of morbidity and mortality. These inequities might be explained by racism, given the fact that racism has restricted the lives of racial minorities and immigrants throughout history. Recent studies have documented that individuals who report experiencing racism have greater rates of illnesses. While this body of research has been invaluable in advancing knowledge on health inequities, it still locates the experiences of racism at the individual level. Yet, the health of social groups is likely most strongly affected by structural, rather than individual, phenomena. The structural forms of racism and their relationship to health inequities remain under-studied. This article reviews several ways of conceptualizing structural racism, with a focus on social segregation, immigration policy, and intergenerational effects. Studies of disparities should more seriously consider the multiple dimensions of structural racism as fundamental causes of health disparities.

STRUCTURAL RACISM AND HEALTH INEQUITIES: Old Issues, New Directions

Racial minorities bear a disproportionate burden of morbidity and mortality. These inequities might be explained by racism, given the fact that racism has restricted the lives of racial minorities and immigrants throughout history. Recent studies have documented that individuals who report experiencing racism have greater rates of illnesses. While this body of research has been invaluable in advancing knowledge on health inequities, it still locates the experiences of racism at the individual level. Yet, the health of social groups is likely most strongly affected by structural, rather than individual, phenomena. The structural forms of racism and their relationship to health inequities remain under-studied. This article reviews several ways of conceptualizing structural racism, with a focus on social segregation, immigration policy, and intergenerational effects. Studies of disparities should more seriously consider the multiple dimensions of structural racism as fundamental causes of health disparities.

The logic of location: malaria research in colonial India, Darjeeling and Duars,1900-30

This article explores the scientific and entrepreneurial incentives for malaria research in the tea plantations of north Bengal in colonial India. In the process it highlights how the logic of 'location' emerged as the central trope through which medical experts, as well as colonial administrators and planters, defined malaria research in the region. The paper argues that the 'local' emerged as both a prerequisite of colonial governance as well as a significant component of malaria research in the field. Despite the ambiguities that such a project entailed, tropical medicine was enriched from a diverse understanding of local ecology, habitation, and structural modes of production. Nevertheless, the locality itself did not benefit from anti-malarial policy undertaken either by medical experts or the colonial state. This article suggests that there was a disjuncture between 'tropical medicine' and its 'field' that could not be accommodated within the colonial plantation system.

Kin connection: kin involvement while growing up and marriage in adulthood

Although previous research demonstrates the importance of the availability of marriageable men, earnings, and employment stability for racial differences in marriage, it also suggests that other factors likely contribute to this variation. This study investigates a new factor that might help to explain racial variation in marriage, the kinship group. To explore this possible connection, we examine the influence of parental kin involvement experienced during childhood and adolescence on marriage in adulthood using all three waves of the National Survey of Families and Households. While few of the measures of kin ties have significant effects on marriage, some measures were significantly related and the patterns of associations sometimes varied by race.

An ex-vivo study on the shaping parameters of two nickel-titanium rotary systems compared with hand instruments

 

INTRODUCTION

Rotary nickel-titanium (NiTi) instruments are thought to allow shaping of narrow, curved root canals more efficiently and more effectively than stainless steel hand instruments. However, the continued search for even more effective and safer instruments has resulted in new rotary systems being introduced on a regular basis. The aim of this study was to compare shaping parameters of RaCe and Mtwo NiTi rotary files with stainless steel K-Flexofile hand instrument.

MATERIALS AND METHODS

A total of 60 mandibular first molars with 20-40 degree of curvature in mesial root were divided in to three groups and each was prepared with one kind of instrument (RaCe, Mtwo, stainless steel K-Flexofile). Using pre and post-radiographs, canal curvature was measured, with the Schneider technique. Preparation time was recorded. For evaluating canal centering and transportation, the tooth was sectioned 3, 6 and 9 mm from the apex. Pre and post- preparation photographs were taken from mesiolingual canal. Data was statistically analyzed using One-way ANOVA and Chi-Square tests.

RESULTS

RaCe and Mtwo maintained canal curvature better than K-Flexofile (P<0.001). Mtwo prepared the canal in a shorter time (P<0.001).

CONCLUSION

Significant statistical difference was not found in the three canal sections between the various systems. RaCe resulted in significantly fewer canal aberrations and better centering ability.

RACIAL DISPARITIES IN HEALTH: How Much Does Stress Really Matter?

Despite the widespread assumption that racial differences in stress exist and that stress is a key mediator linking racial status to poor health, relatively few studies have explicitly examined this premise. We examine the distribution of stress across racial groups and the role of stress vulnerability and exposure in explaining racial differences in health in a community sample of Black, Hispanic, and White adults, employing a modeling strategy that accounts for the correlation between types of stressors and the accumulation of stressors in the prediction of health outcomes. We find significant racial differences in overall and cumulative exposure to eight stress domains. Blacks exhibit a higher prevalence and greater clustering of high stress scores than Whites. American-born Hispanics show prevalence rates and patterns of accumulation of stressors comparable to Blacks, while foreign-born Hispanics have stress profiles similar to Whites. Multiple stressors correlate with poor physical and mental health, with financial and relationship stressors exhibiting the largest and most consistent effects. Though we find no support for the stress-vulnerability hypothesis, the stress-exposure hypothesis does account for some racial health disparities. We discuss implications for future research and policy.

Racial and Ethnic Disparities in Education-Occupation Mismatch Status Among Immigrants in South Africa and the United States

In this study, a comparative-international approach is used to examine race-ethnic disparities in education-occupation mismatch status among immigrants. Using data from the USA and South Africa, this study finds that immigrants are most likely to be undereducated, or have less schooling for their jobs, when their racial characteristics are similar to those of the local racial majority. Black immigrants in South Africa and White immigrants in the USA are the most likely to be undereducated. Having racial characteristics similar to those of the local racial majority is associated with a lower likelihood of overeducation among immigrants.

Admixture mapping: from paradigms of race and ethnicity to population history

Admixture mapping is a whole genome association strategy that takes advantage of population history-or genetic ancestry-to map genes for complex diseases. However, because it uses racial/ethnic groupings to examine differential disease risk, admixture mapping raises ethical and social concerns. While there has been much theoretical commentary regarding the ethical and social implications of population-based genetic research, empirical data from stakeholders most closely involved with these studies is limited. One of the first admixture mapping studies carried out was a scan for Multiple Sclerosis (MS) risk factors in an African-American population. Applying qualitative research methods, we used this example to explore developing views, experiences and perceptions of the ethical and social implications of admixture mapping and other population-based research-their value, risks and benefits, and the future prospects of the field. Additionally, we sought to understand how social and ethical risks might be mitigated, and the benefits of this research optimized. We draw on in-depth, one-on-one interviews with leading population geneticists, genome scientists, bioethicists, and African-Americans with MS. Here we present our findings from this unique group of key informants and stakeholders.

Are Blacks and Hispanics Disproportionately Incarcerated Relative to Their Arrests? Racial and Ethnic Disproportionality Between Arrest and Incarceration

Do large racial and ethnic disparities in prison populations reflect systematic racial and policy discrimination in the criminal justice system, or do they reflect disproportionate involvement of blacks and Hispanics in "serious" or street crime? Our investigation of this question keys off the approach initiated by Alfred Blumstein is his pioneering studies on the topic. While yielding important findings, there are, however, substantial gaps in the empirical literature on the racial disproportionality issue. We attempt to fill those gaps by (1) using both data on prison admission as well as in-stock prison populations, (2) presenting more recent racially and ethnically disaggregated arrest and incarceration data from Pennsylvania for 2003-2007, and (3) including Hispanic offenders in our racial and ethnic disproportionality comparisons. Our results indicate, first, that the representation of blacks, whites, and Hispanics among offenders admitted to state prison and in the prison population corresponds closely to their representation in arrest statistics. Second, using arrests as a marker of violent offending, the overrepresentation of blacks among offenders admitted to state prisons occurs because they commit a disproportionate number of frequently imprisoned (i.e., violent) crimes. Third, for those offenses where there is a within-race difference between arrest and incarceration representation, Hispanics experience the greatest disadvantage. Fourth, failing to account for Hispanics in white and black estimates tends to inflate white proportions and deflate black proportions of arrests, admissions, and prison population estimates, masking the "true" black and white racial disproportionality. We conclude that while there is a need for continued concern with possible racial discrimination in justice system processing, this concern should not distract attention from what arguably is the more important matter-ameliorating the social environmental conditions that foster disproportionate minority (especially black) involvement in violent crime.

Racial disparities in lung cancer mortality in U.S. congressional districts, 1990-2001

The objective of this study was to detect statistically significant racial disparities in lung cancer mortality at the U.S. congressional district level. We applied absolute disparity statistics to mortality data from the National Center for Health Statistics (NCHS) for 1990-2001, mapped significant lung cancer mortality disparities by race and gender within U.S. congressional districts, and uncovered previously unreported disparities. The disparity statistics comparing black and white females revealed higher mortality rates for black females in the Midwestern U.S., and higher mortality rates for white females in the South-eastern U.S. Our methodology provides a spatial tool for guiding public health cancer control practices to monitor, target and reduce disparities.

Centering ability and dentin removal of rotary systems in curved root canals

INTRODUCTION

The aim of this study was to compare centering ability and dentin removal of three rotary systems in curved root canals of extracted teeth.

MATERIALS AND METHODS

Sixty root canals of mandibular first molars with curvatures ranging between 25-35(o) were divided into three groups of 20 teeth each. Based on pre-instrumentation radiographs that assessed the angle and the radius of canal curvatures, teeth with curvatures were equally spread between the three groups. The root canals were sectioned horizontally at two levels before preparation and then remounted onto the muffle. All root canals were prepared using a low-torque control motor with Mtwo or Medin or Race instruments. Cross sectional images were obtained before and after instrumentation. Cross-sectional area and centering ability were evaluated. The data were analyzed using the one-way ANOVA and Tukey tests.

RESULTS

Neither instrument fracture nor permanent deformation occurred during preparations. The best centering ability was obtained by Mtwo instruments compare to Race and Medin instruments. In the coronal and middle sections, Mtwo removed less dentin than Race and Medin; while the difference in the apical section was not significant.

CONCLUSION

Under the conditions of this study, the debridement of root canals was more conservative with Mtwo. The canals prepared with these instruments were better centered in all three regions of the root.

The role of african american ethnicity and metabolism in sentinel polychlorinated biphenyl congener serum levels

Polychlorinated biphenyls (PCBs) are environmental contaminants found in the serum of human populations across the globe. A small set of sentinel PCB congeners (IUPAC# 101, 118, 138, 153, and 180) commonly sought in human serum are often used as markers of exposure. The Chicago Great Lakes cohort of pregnant African American women was developed to study organochlorine exposure through Great Lakes resources in a pregnant African American population and their children. Comparison of PCB serum concentrations in women reporting mixed race/ethnicity within the cohort shows significant elevations of serum PCB 101 and 118 in women reporting exclusive African American ancestry.Incubations were performed using pooled human liver microsomes followed by individual recombinant human CYP isoform microsomes to identify whether the other sentinel congeners are metabolized by human CYP 450. In human liver microsome metabolism experiments with the sentinel PCB congeners (IUPAC# 101, 118, 138, 153, and 180), only PCB 101 metabolism produced an identifiable metabolite. However, a significant loss of parent compound was observed for PCB 118 incubations with human liver microsomes. The loss of PCB 101 and PCB 118 in microsome experiments indicates they are likely metabolized in human liver. Therefore, CYP 450 mediated metabolic differences may contribute to differences in serum concentrations by race/ethnicity.PCB metabolism has an important impact on toxicity. PCB metabolites have been shown to differ significantly in toxicity profiles relative to parent compounds. Biomonitoring studies of PCB serum levels have correlated with toxicity for the metabolizeable congeners such as PCB 101 and PCB 118. However, measureable amounts of metabolizeable parent congeners such as PCB 101 may not be detectable in the serum of study participants. Because PCB 118 is metabolized, but is also readily found in human serum, it may be a better marker of metabolism related PCB toxicity. Human specific PCB metabolism is difficult to characterize but has important pathophysiological ramifications and deserves further study.

Legitimating Racial Discrimination: Emotions, Not Beliefs, Best Predict Discrimination in a Meta-Analysis

Investigations of racial bias have emphasized stereotypes and other beliefs as central explanatory mechanisms and as legitimating discrimination. In recent theory and research, emotional prejudices have emerged as another, more direct predictor of discrimination. A new comprehensive meta-analysis of 57 racial attitude-discrimination studies finds a moderate relationship between overall attitudes and discrimination. Emotional prejudices are twices as closely related to racial discrimination as stereotypes and beliefs are. Moreover, emotional prejudices are closely related to both observed and self-reported discrimination, whereas stereotypes and beliefs are related only to self-reported discrimination. Implications for justifying discrimination are discussed.

Are jews smarter than everyone else?

The debate about “race” and “intelligence” seems to be never ending. The “special nature” of the intelligence ascribed to “Jews” has recently reappeared in an essay by one of the authors of the notorious study of race and intelligence – The Bell Curve. How this debate is constructed and what its implications are for the reappearance of “race” as a category in medical and biological science is at the core of this present essay.

Crohn’s disease in one mixed-race population in Brazil

AIM: To evaluate the classification and severity of Crohn's disease in different racial groups.

METHODS: Patients with Crohn’s disease from the outpatient clinic of the University Hospital Prof. Edgard Santos were enrolled in the study. This hospital is a reference centre for inflammatory bowel disease. Race was determined using self-identification. The Vienna's classification was applied for all subjects. The severity of Crohn's disease was determined according to the number of surgical procedures, hospital admissions in the last year and treatment with steroids and immunosuppressors. Statistical analysis was calculated using t test for means, χ² or F for proportions. A P value < 0.05 was considered to be significant.

RESULTS: Sixty-five patients were enrolled. Non-white patients were more frequently diagnosed with Crohn’s disease in the age less than 40 years than white patients. The behaviour of disease was similar in both groups with a high frequency of the penetrating form. There was a tendency for non-white patients to have a greater frequency of hospital admissions in the last year compared to white subjects. Non-whites also had a higher rate of colonic and upper gastrointestinal involvement, and were also more frequently on treatment with immunossupressors than white patients although this difference was not statistically significant.

CONCLUSION: Non-white patients with Crohn’s disease had an earlier diagnosis and appeared to have had a more severe disease presentation than white patients.

Correlation of N-myc downstream-regulated gene 1 expression with clinical outcomes of colorectal cancer patients of different race/ethnicity

AIM: To evaluate the role of N-myc downstream-regulated gene 1 (NDRG1) expression in prognosis and survival of colorectal cancer patients with different ethnic backgrounds.

METHODS: Because NDRG1 is a downstream target of p53 and hypoxia inducible factor-1α (HIF-1α), we examined NDRG1 expression together with p53 and HIF-1α by immunohistochemistry. A total of 157 colorectal cancer specimens including 80 from Japanese patients and 77 from US patients were examined. The correlation between protein expression with clinicopathological features and survival after surgery was analyzed.

RESULTS: NDRG1 protein was significantly increased in colorectal tumor compared with normal epithelium in both Japanese and US patient groups. Expression of NDRG1 protein was significantly correlated with lymphatic invasion, venous invasion, depth of invasion, histopathological type, and Dukes' stage in Japanese colorectal cancer patients. NDRG1 expression was correlated to histopathological type, Dukes' stage and HIF-1α expression in US-Caucasian patients but not in US-African American patients. Interestingly, Kaplan-Meier survival analysis demonstrated that NDRG1 expression correlated significantly with poorer survival in US-African American patients but not in other patient groups. However, in p53-positive US cases, NDRG1 positivity correlated significantly with better survival. In addition, NDRG1 expression also correlated significantly with improved survival in US patients with stages III and IV tumors without chemotherapy. In Japanese patients with stages II and III tumors, strong NDRG1 staining in p53-positive tumors correlated significantly with improved survival but negatively in patients without chemotherapy.

CONCLUSION: NDRG1 expression was correlated with various clinicopathological features and clinical outcomes in colorectal cancer depending on the race/ethnicity of the patients. NDRG1 may serve as a biological basis for the disparity of clinical outcomes of colorectal cancer patients with different ethnic backgrounds.

SEM Study of Root Canal Walls Cleanliness after Ni-Ti Rotary and Hand Instrumentation

INTRODUCTION

To compare the cleaning effectiveness of K3 and Race NiTi rotary systems with K-Flexo file instruments during the preparation of curved canals in extracted human teeth.

MATERIALS AND METHODS

A total of 50 root canals of mandibular and maxillary molars with curvatures ranging between 25º and 35 º were divided in three groups of 15 each and 5 as negative control groups. Canals were prepared using a low torque control motor in two rotary groups according to manufacturer's instructions. Conventional Step back with S.S K files was the preparation technique in third group. The amount of debris and smear layer was quantified on the basis of a numerical evaluation scale. The data were statistically analyzed using Chi-Square and Likelihood Ratio tests.

RESULTS

In general, no significant difference in terms of amount of debris were found among three groups, only in apical zones of Race and K-Flexo file groups a significant difference was detected (P=0.041). Race rotary system left significantly less smear layer than k-Flexo file in the middle (P=0.009) and apical thirds (P=0.012), respectively. K3 significantly achieved higher scores of cleanliness than K-Flexo file in apical third only (P=0.049). No significant difference between Race and K3 rotary groups for residual debris and formed smear layer was detected.

CONCLUSION

Obtaining higher scores of cleanliness in various regions of the canals, crown down technique and the use of rotary instrumentation seem to be superior to conventional hand instrumentation with step back technique .No significant difference between K3 with three radial lands and Race with three cutting edges in terms of debris and smear layer formation was detected.