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Uncontested categories: the use of race and ethnicity variables in nursing research.

Classifying human beings according to race and ethnicity may seem straightforward to some but it, in fact, belies a difficult process. No standard procedure exists for categorizing according to race and ethnicity, calling into question the variables' use in research. This article explores the use of race and ethnicity variables in the nursing research literature. Content analysis was conducted of a sample of 337 original research studies published in Nursing Research from the years 1952, 1955, and then every 5 years through to 2000. Of the 337 research articles reviewed, 167 mentioned race, ethnicity, or their 81 code words or phrases. Out of the 167 articles, 153 used race or ethnicity to describe the study sample, and 45 of the 167 articles included race or ethnicity as an element of data analysis. Throughout the sample, there was substantial inconsistency related to race and ethnicity categorization, meanings of the terms, and use of these variables. Specificity related to conceptual assumptions, definitions, and context was missing and, as a result, data interpretation and understanding are suspect. The integrity of nursing knowledge requires that nurse researchers recognize and address the difficulties inherent in using race and ethnicity in health research.

Bias↗

Changes of blood metabolites in horses after racing, with particular reference to uric acid.

Changes in concentration of a number of blood metabolites in 30 thoroughbred horses were recorded after an 1110 metre race. No significant changes occurred in blood urea or aspartate aminotransferase during the three hours after racing. Plasma sodium, potassium and calcium levels were increased immediately after racing but had returned to normal one hour after racing. Plasma phosphate showed a significant fall in concentration one hour after racing. Creatinine and lactic acid concentrations were elevated ten minutes after racing and although they subsequently decreased, the level of lactic acid was still significant one hour later. Uric acid levels were well above resting levels at ten minutes after racing but rose even more in the subsequent hour. Urinary uric acid levels were also elevated during this time. Three hours after racing some horses still had elevated plasma uric acid levels and all of them showed a significant rise in creatine phosphokinase. The possible physiological basis of these findings is discussed.

Animals↗

Pulmonary haemorrhage in standardbred horses after racing.

Endoscopic examinations of the upper respiratory tract were done on 92 of 314 Standardbred horses that raced one or more times at 4 consecutive, weekly race meetings. Although participation was voluntary, the characteristics of the population of horses examined were not statistically different from those of all horses that raced. No horse showed epistaxis, but 34 (32.4%) examinations of the trachea revealed blood that ranged from a trace in the tracheal mucus to large amounts scattered over the tracheal walls. Forty-four horses exhibited minor degrees of pharyngeal lymphoid hyperplasia, 2 had asynchronous movement of the left arytenoid cartilage and 15 had grains of sand in the respiratory tract. There was no association between bleeding and age, sex, distance of race, place in race or date of race. Mucus and mucopurulent material occurred less often after longer races and more often on the last 3 race nights.

Age Factors↗

Flat, hurdle and steeple racing: risk factors for musculoskeletal injury.

A retrospective case-control study was conducted to identify and quantify risk factors for serious musculoskeletal injury sustained at 4 Australian metropolitan racetracks. During the period of study (August 1988-July 1995) there were 196 cases from flat racing, 52 cases from hurdle racing and 53 cases from steeplechases. The incidences of fatal musculoskeletal injuries per start for flat, hurdle and steeple races were 0.06, 0.63 and 1.43% respectively. Logistic regression identified harder track surfaces, horses being older than age 3 years, one racecourse (Flemington) and jumping races as significant risk factors which increased the risk of musculoskeletal breakdown. The incidence of fatal musculoskeletal injuries for flat races at the 4 study tracks was similar to that reported in the UK but less than the USA. Death rates for hurdle and steeple races in the study population were higher than in the UK. Strategies to reduce the incidence of serious musculoskeletal injuries may include avoidance of excessively hard track surfaces through closer regulation of track moisture content; implementation of more rigorous prerace lameness examinations of horses, particularly older horses; and altering the design and number of jumps in hurdle and steeple races. The quantification of risk, as we have reported here, is the first step towards addressing the causes of musculoskeletal breakdown and should help in applying a reasoned approach to intervention measures that may be effective in reducing racing injuries.

Analysis of Variance↗

The interaction of aging and 10 years of racing on ultraendurance running performance.

The aim of this study was to examine the interaction between aging and 10 years of racing in endurance runners. Race-time data from 194 runners who had completed 10 consecutive 56-km ultramarathons were obtained. The runners were either 20.5 +/- 0.7, 30.0 +/- 1.0, 39.9 +/- 0.9, or 49.4 +/- 1.0 years old at their first race. Each runner's race speed was determined for each race over the 10 years. Data were analyzed using repeated-measures ANOVA, one-way ANOVA, and independent t tests and showed that performance improved and declined at greater rates for younger runners; younger runners had a greater capacity for improvement than older runners; approximately 4 years were required to reach peak racing speed, regardless of age; it was not possible to compete at peak speed for more than a few years; and the combined effects of 10 years of aging and racing neither improve nor worsen net performance. In conclusion, these data suggest that although these runners showed similar patterns of change in race speed over a 10-year period, the extent of change in performance was greater in younger than in older runners.

Adult↗

Lay understandings of race: cultural and genetic definitions.

OBJECTIVE: To examine lay understandings of race. METHOD: Fifteen focus groups were held in the southeastern United States from July to October of 2001. RESULTS: The lay understanding of race is multifactorial, conceptualizing race as defined in part by genetics and in part by culture. CONCLUSIONS: The multifactorial understanding of race used by lay people is important to geneticists for two reasons. First, within the multifactorial definition of race, genetic variation is interpreted as phenotypic differences among individuals. Second, racial differences are apparent in understandings of race. African-American participants held a more fluid understanding of race that included ideas of self-definition and culture, while European-Americans were more likely to rely on physical characteristics to understand race.

Adolescent↗

Explaining race differences in mortality among the Tennessee Medicare elderly: the role of physician services.

We investigated the impact of socioeconomic conditions, patterns of morbidity, and physician service utilization on race differences in rates of mortality, and mortality associated with specific diagnoses. Longitudinal data from the Center for Medicare and Medicaid Services (CMS) Physician Billing File data and the Medicare Enrollment Database (EDB) were analyzed to assess physician-diagnosed morbidity, health service use, and mortality, among the population of Medicare beneficiaries in Tennessee (N=665,887). Proportional hazards models were used to examine the effects of race, socioeconomic status, morbidity, and physician service utilization on mortality. Race differences in physician visits explain the largest portion of mortality differentials between African Americans and Whites. Race disparities in mortality associated with particular forms of morbidity are also mostly a function of differences in physician service use. Our examination suggested that race differences in patterns of physician service use principally explain race disparities in mortality. Further, race differences in the use of physician services were substantially responsible for race disparities in mortality associated with particular forms of morbidity.

Black or African American↗

To air is human: altitude illness during an expedition length adventure race.

OBJECTIVE: To calculate the incidence and prevalence of altitude illness (acute mountain sickness [AMS], high altitude pulmonary edema, and high altitude cerebral edema) during an expedition length adventure race and to determine factors contributing to its development as well as identify cases requiring medical treatment, withdrawal from the event, or both. METHODS: The Primal Quest Expedition Length Adventure Race was held in Colorado in July 2002. Sixty-two coed teams of four participated in the event. It began at an altitude of over 9500 feet, ascended to an altitude over 13,500 feet with a cumulative elevation gain of 69,400 feet, of which 40,000 feet occurred in the first 12 hours of the event. There was 138,800 total feet of altitude change during the event. All racers underwent a prerace medical assessment 24 hours before the start of the race and completed an Environmental Systems Questionnaire version 3-R (ESQ 3-R). Onsite medical staff provided treatment during the event. A standard medical encounter form was used to record all patient encounters including a presumed diagnosis and disposition. RESULTS: At the start of the race, the prevalence of altitude illness was 4.5%. The incidence of altitude illness requiring medical treatment during the race was 14.1% (AMS, 33 [13.3%]; high altitude pulmonary edema, 2 [.81%]) resulting in 4 (14.3%) of the 28 medical withdrawals from the race. There was no correlation between home altitude, prerace ESQ scores, and successful completion of the race. CONCLUSIONS: Altitude illness occurs among participants in expedition length adventure races and contributes significantly to withdrawal from the event.

Adult↗

The correspondence between interracial births and multiple-race reporting.

OBJECTIVES: Race-specific health statistics are routinely reported in scientific publications; most describe health disparities across groups. Census 2000 showed that 2.4% of the US population identifies with more than 1 race group. We examined the hypothesis that multiple-race reporting is associated with interracial births by comparing parental race reported on birth certificates with reported race in a national health survey. METHODS: US natality data from 1968 through 1998 and National Health Interview Survey data from 1990 through 1998 were compared, by year of birth. RESULTS: Overall multiple-race survey responses correspond to expectations from interracial births. However, there are discrepancies for specific multiple-race combinations. CONCLUSIONS: Projected estimates of the multiple-race population can be only partially informed by vital records.

Birth Certificates↗

Health and behavior risks of adolescents with mixed-race identity.

OBJECTIVES: This study compared the health and risk status of adolescents who identify with 1 race with those identifying with more than 1 race. METHODS: Data are derived from self-reports of race, using the National Longitudinal Study of Adolescent Health (Add Health), which provides a large representative national sample of adolescents in grades 7 through 12. Respondents could report more than 1 race. RESULTS: Mixed-race adolescents showed higher risk when compared with single-race adolescents on general health questions, school experience, smoking and drinking, and other risk variables. CONCLUSIONS: Adolescents who self-identify as more than 1 race are at higher health and behavior risks. The findings are compatible with interpreting the elevated risk of mixed race as associated with stress.

Adolescent↗

Effect of alpha-tocopheryl acetate supplementation on vitamin E concentrations in Greyhounds before and after a race.

OBJECTIVES: To determine effect of alpha-tocopherol supplementation on serum vitamin E concentrations in Greyhounds before and after a race. ANIMALS: 8 adult racing Greyhounds. PROCEDURE: Dogs were given 2 capsules of alpha-tocopheryl acetate (total, 680 units [0.5 g]) with food that contained < or = 15 mg of vitamin E/kg each morning for 7 days. Dogs were exercised in a 30 X 30-m grass paddock for 15 minutes twice a day and raced for 500 m twice a week. Blood samples were collected before and 5 minutes after a race, before supplementation was begun, and after 7 days of supplementation. Blood and diet samples were analyzed for tocopherols and alpha-tocopheryl acetate. RESULTS: Before supplementation, serum alpha-tocopherol concentration after racing (mean +/- SD, 6.7 +/- 2.4 mg/L ) was significantly lower than before racing (12.2 +/- 3.1 mg/L). After supplementation, alpha-tocopherol concentrations were significantly higher overall, although values obtained before (26.6 +/- 5.2 mg/L) and after (29.8 +/- 3.6 mg/L) racing were not significantly different. CONCLUSIONS AND CLINICAL RELEVANCE: Supplementation with alpha-tocopheryl acetate increased serum alpha-tocopherol concentrations and eliminated the decrease in alpha-tocopherol concentration that was detected after a race, which may decrease oxidation during exercise and improve performance or recovery.

Animals↗

Effect of increased dietary protein and decreased dietary carbohydrate on performance and body composition in racing Greyhounds.

OBJECTIVE: To determine effects of increased dietary protein and decreased dietary carbohydrate on hematologic variables, body composition, and racing performance in Greyhounds. ANIMALS: 8 adult Greyhounds. PROCEDURE: Dogs were fed a high-protein (HP; 37% metabolizable-energy [ME] protein, 33% ME fat, 30% ME carbohydrate) or moderate-protein (MP; 24% ME protein, 33% ME fat, 43% ME carbohydrate) extruded diet for 11 weeks. Dogs subsequently were fed the other diet for 11 weeks (crossover design). Dogs raced a distance of 500 m twice weekly. Rectal temperature, hematologic variables before and after racing, plasma volume, total body water, body weight, average weekly food intake, and race times were measured at the end of each diet period. RESULTS: When dogs were fed the MP diet, compared with the HP diet, values (mean +/- SD) differed significantly for race time (32.43 +/- 0.48 vs 32.61 +/- 0.50 seconds), body weight (32.8 +/- 2.5 vs 32.2 +/- 2.9 kg), Hct before (56 +/- 4 vs 54 +/- 6%) and after (67 +/- 3 vs 64 +/- 8%) racing, and glucose (131 +/- 16 vs 151 +/- 27 mg/dl) and triglyceride (128 +/- 17 vs 104 +/- 28 mg/dl) concentrations after racing. CONCLUSIONS AND CLINICAL RELEVANCE: Greyhounds were 0.18 seconds slower (equivalent to 0.08 m/s or 2.6 m) over a distance of 500 m when fed a diet with increased protein and decreased carbohydrate. Improved performance attributed to feeding meat to racing Greyhounds apparently is not attributable to increased dietary protein and decreased dietary carbohydrate.

Animal Feed↗

Association of high-speed exercise with racing injury in thoroughbreds.

OBJECTIVE: To determine the association between high-speed exercise and risk of injury while racing among Thoroughbreds in Kentucky. DESIGN: Matched case-control study. ANIMALS: 206 Thoroughbreds that sustained a musculoskeletal injury while racing and 412 Thoroughbreds that were not injured during the same races. PROCEDURE: Data regarding official timed workouts and races and the Beyer's numbers for the 3 races before the race during which injury occurred were extracted from past performance charts and compared between injured horses and control horses. RESULTS: For injured horses, cumulative distance of high-speed exercise during the 1- and 2-month periods prior to the race in which injury occurred was significantly less than that of control horses; for either period, a difference of 10 furlongs was associated with approximately 2-fold greater risk of injury. Beyer's numbers were significantly higher for injured horses than for control horses. These effects remained significant after adjusting for age and results of prerace physical inspection. CONCLUSIONS AND CLINICAL RELEVANCE: In Kentucky, injured horses had significantly less cumulative high-speed exercise than did control horses during the 1- and 2-month periods prior to the race in which injury occurred. These results differ from those observed in California. The association of injury with cumulative high-speed exercise appears to vary among regions in the United States.

Age Factors↗

Career racing performance in Thoroughbreds treated with prosthetic laryngoplasty for laryngeal neuropathy: 52 cases (1981-1989).

OBJECTIVE: To compare racing performance before and after prosthetic laryngoplasty for treatment of laryngeal neuropathy in inexperienced and experienced Thoroughbred racehorses. DESIGN: Retrospective study. ANIMALS: 52 Thoroughbred racehorses treated with prosthetic laryngoplasty for laryngeal neuropathy. PROCEDURE: Lifetime race records were analyzed by use of a verified regression model. Individual race records and hospital records were also reviewed. RESULTS: Experienced horses had a decline in performance, as measured by performance index, earnings percentage, and mean prediction error, during the 6-month period before prosthetic laryngoplasty. Performance improved after surgery, relative to performance in 1 to 4 races immediately before surgery, but did not attain previous baseline values for performance index and earnings percentage, although racing speed was restored to baseline values. Factors associated with failure to attain baseline levels of performance included other racing-related injuries and disorders, major complications of surgery, and age. Individually, however, many horses had long and successful careers after surgery. Performance of inexperienced horses after surgery was at least equal to that of experienced horses. CONCLUSIONS AND CLINICAL RELEVANCE: In addition to warning clients of the complications associated with prosthetic laryngoplasty, it may be prudent to provide a guarded prognosis for full restoration of racing performance in older horses, unless they are especially talented and are free of other racing-related problems.

Animals↗

Effects of racing and nontraining on plasma thyroid hormone concentrations in sled dogs.

OBJECTIVE: To determine the effects of racing and nontraining on plasma thyroxine (T4), free thyroxine (fT4), thyroid-stimulating hormone (TSH), and thyroglobulin autoantibody (TgAA) concentrations in sled dogs and compare results with reference ranges established for dogs of other breeds. DESIGN: Cross-sectional study. ANIMALS: 122 sled dogs. PROCEDURE: Plasma thyroid hormone concentrations were measured before dogs began and after they finished or were removed from the Iditarod Trail Sled Dog Race in Alaska and approximately 3 months after the race. RESULTS: Concentrations of T4 and fT4 before the race were less than the reference range for nonsled dogs in 26% and 18% of sled dogs, respectively. Immediately after racing, 92% of sled dogs had plasma T4 concentrations less than the reference range. Three months after the race, 25% of sled dogs had plasma T4 concentrations less than the reference range. For T4, fT4, TSH, and TgAA, significant differences were not detected in samples collected before the race versus 3 months later. CONCLUSIONS AND CLINICAL RELEVANCE: Plasma T4, fT4, and TSH concentrations decreased in dogs that complete a long distance sled dog race. Many clinically normal sled dogs have plasma T4 and fT4 values that are lower than the reference range for nonsled dogs. We suggest that the reference ranges for sled dogs are 5.3 to 40.3 nmol/L and 3.0 to 24.0 pmol/L for plasmaT4 and fT4 concentrations, respectively, and 8.0 to 370 mU/L for TSH.

Alaska↗

The effects of frusemide on racing times of Standardbred pacers.

Seven hundred and eighty-eight Standardbred pacers competing in 8378 races at one racetrack were analysed to determine the effects of the administration of prerace frusemide on racing times (RT). Frusemide was administered i.v. 4 h before the race to pacers diagnosed with exercise-induced pulmonary haemorrhage (EIPH). Of the pacers, starting in the 1997 racing season, 32.5% received prerace frusemide. This study demonstrated that administration of frusemide prior to racing significantly decreased RT. There was an overall significant decrease (P<0.00001) in RT of 0.67 s. The overall RT for horses, geldings, and females, were mean +/- s.e 117.91 +/- 0.06, 118.20 +/- 0.03 and 118.86 +/- 0.04, respectively. RT progressively decreased until age 6 and increased thereafter. Horses, geldings and females ran a mean of 0.46, 0.31 and 0.74 s faster, respectively, with prerace administration of frusemide. This decrease in RT following prerace administration was most pronounced in younger pacers. In this study, a greater percentage of older pacers received prerace frusemide; however, the effect of frusemide on RT was decreasing with age. Prerace venous acid-base screening was performed in 2729 of the pacers competing. Pennsylvania Harness Racing Commission Regulations disqualify Standardbreds from racing with a base excess of over 10 and 12 mmol/l for Standardbreds without and with prerace administration of frusemide. The prerace venous acid-base levels were not significantly related to RT and, for those Standardbreds also sampled following the race, there was no correlation between pre- and postrace acid-base status.

Acid-Base Equilibrium↗

Assessment of the efficacy of composite surgery for the treatment of dorsal displacement of the soft palate in a group of 53 racing Thoroughbreds (1990-1996).

REASONS FOR PERFORMING STUDY: There has been no objectively assessed case-control study of the efficacy of surgery to correct dorsal displacement of the soft palate (DDSP) previously reported. HYPOTHESIS: Composite surgery has a beneficial result on racing performance in horses affected with DDSP as compared to a matched control population. METHODS: Race records were obtained for 53 racing Thoroughbreds which underwent composite staphylectomy, sternothyrohyoideus myectomy and ventriculectomy for correction of idiopathic DDSP at the University of Bristol between 1990 and 1996. Each surgical case was matched for age, sex and training yard with 2 control horses. The racing performance, based on prize money won, of surgical cases and control horses were compared for 3 races run before and after the date of surgery. RESULTS: Ninety-two percent of the surgical cases returned to racing after surgery. There was a significant increase in earnings of the surgical group before and after surgery (P = 0.011), but there was no significant difference in earnings of the control group before and after the date of surgery (P = 0335). Sixty percent of the surgical group had higher earnings after surgery than before, compared to 40% of controls. When horses which underwent surgery were ranked relative to their 2 matched controls, surgical cases did not significantly change in rank (P = 033), whereas control horses significantly decreased in rank (P = 0.012). Additionally, horses within the surgical group were more likely (P < 0.01) to start in 3 post operative races than those in the control group. CONCLUSIONS AND POTENTIAL RELEVANCE: Composite surgery had a beneficial effect on racing performance of horses afflicted with idiopathic DDSP, and further studies to evaluate objectively the usefulness of other surgical techniques are warranted.

Animals↗

Racing performance after arthroscopic removal of apical sesamoid fracture fragments in Thoroughbred horses age < 2 years: 151 cases (1989--2002).

REASONS FOR PERFORMING STUDY: Studies on arthroscopic removal of apical proximal sesamoid fracture fragments in Thoroughbred (TB) horses age > or = 2 years have reported a high success rate. However, there are no reports documenting the racing prognosis of TB horses that undergo such surgery as weanlings or yearlings. OBJECTIVES: To describe the incidence of apical proximal sesamoid fractures in immature TB horses, age < 2 years and determine probability and quality of racing performance after arthroscopic removal of such fractures in 151 TB weanlings and yearlings. METHODS: The medical records of TB horses age < 2 years that underwent arthroscopic surgery for removal of apical proximal sesamoid fracture fragments were reviewed. Follow-up information was obtained from race records. Student's t tests were used to compare performance variables of operated racehorses to that of their maternal siblings. RESULTS: Ninety-two percent (139/151) of fractures occurred in the hindlimbs and 8% (11/151) in the forelimbs (fracture of both fore- and hindlimb, n = 1). Horses with forelimb fractures had a greatly reduced probability of racing (55%) compared to those with hindlimb fractures (86%). Overall, 84% of the horses raced post operatively and had performance records similar to that of their maternal siblings, 78% (787/1006) of which raced. CONCLUSIONS: Arthroscopic removal of apical proximal sesamoid fracture fragments in TB weanlings and yearlings carries an excellent prognosis for racing in horses with hindlimb fractures and a reduced prognosis in those with forelimb fractures. Medial fractures of the forelimb carry the worst prognosis. POTENTIAL RELEVANCE: The determination of prognosis increases knowledge on apical sesamoid bone fractures and potential for arthroscopic restoration of the ability to race; and enables the value of yearlings for subsequent sale to be established.

Age Factors↗