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Race and ethnicity in health research.

'Race' and 'ethnicity' are increasingly being used as variables in health research. However, studies have been mainly descriptive and have not been used to develop and evaluate strategies to improve health care. In part this reflects the poor analytical standards. The status of the concepts of 'race' and 'ethnicity' as research tools are rarely considered and there is poor consistency in terminology. This paper gives an overview of the research literature and raises questions about the validity of 'race' and 'ethnicity' as epidemiological variables. The tendency to collect routine ethnic data and include ethnic variables in an ad hoc and uncritical way in the United Kingdom and other countries may help transform minorities into mere statistical categories and produce data and findings which reinforce stereotypes. Multiculturalist ethnic health explanations also tend to displace more material explanations of health outcomes. It is concluded that more thought and care is needed before data are routinely categorized by ethnicity, or race or ethnicity are included as variables in research.

Epidemiologic Methods↗

[Horse racing and animal welfare].

Intensive strain of racing-horses during training and race is not an end in itself but should be understood from the social task to create exceptionally efficient horses. This roughness in sports obliges the responsible associations to issue rigorous regulations for the protection of horses. In this paper, some physical and psychical disorders of racing-horses are described. Improved keeping conditions as well as performance-adapted training methods will help to avoid defects. The aids being used during training and races are critically investigated on their effects according to the regulations on animal protection.

Animal Welfare↗

A proposed method for the identification of race in sub-adult skeletons: a geometric morphometric analysis of mandibular morphology.

The identification of biological race (ancestry) in skeletal material is an important aspect of forensic investigations. While techniques for race determination are well established for adult skeletons, identification of race in sub-adult specimens has not been widely addressed. The present study investigates racial differences in the mandibular morphology of sub-adult specimens using geometric morphometric analyses. One hundred and seventy-four mandibles from five morphologically distinct samples were digitized and subjected to general Procrustes analysis. Results showed significant morphological differences between the samples and obtained cross-validation results of over 70% accuracy in identification of unknown individuals using the complete mandible. It is suggested that these techniques could provide a method for the identification of race in sub-adult individuals.

Adolescent↗

The race concept in six regions: variation without consensus.

Race, once the central concept in physical anthropology worldwide, now varies in the degree of support it receives in different regions. We present the currently available information on the status of the concept in the United States, the Spanish language areas, Poland, Europe, Russia, and China. Rejection of race ranges from high to low with the highest rejection occurring among anthropologists in the United States (and Canada). Rejection of race is moderate in Europe, sizeable in Poland and Cuba, and lowest in Russia and China. A discussion on the scientific and contextual reasons influencing these variations is presented. The tension between scientific evidence and social influences varies from region to region. The methods used in the studies reported here included questionnaires and content analysis. Response rates to questionnaires were often around 50 percent (with exception of the Polish studies). We discuss reasons for the low rates. Although a uniform method of data gathering is desirable, it may not suit scientists working in different traditions of theory and research. We conclude that it is once again timely to discuss the race concept in international meetings where all scientific and political changes occurring throughout the world in recent past decades are taken into account.

Anthropology, Physical↗

Race-ethnic differences in the extent, prevalence, and progression of coronary calcium.

OBJECTIVE: To compare across four race-ethnic groups the baseline prevalence and extent of coronary calcium and the 7-year rate of progression in the extent of coronary calcium. DESIGN: The South Bay Heart Watch is a prospective cohort study designed to appraise the value of coronary calcium for predicting cardiovascular outcomes in asymptomatic adults with cardiac risk factors. Statistical analyses were conducted to evaluate ethnic differences in the prevalence, extent, and progression of coronary calcium among Caucasian, African-American, Hispanic, and Asian participants. SETTING: Population-based study. PATIENTS OR PARTICIPANTS: Between December 1990 and December 1992, 1289 participants without coronary heart disease underwent baseline risk factor screening and computed tomography for coronary calcification (Cohort 1). Seven years later, 828 (64%) participants returned for follow-up evaluation and re-scanning (Cohort 2). MAIN OUTCOME MEASURES: Prevalence, extent, and progression of coronary artery calcium. RESULTS: In Cohort 2, compared to Whites, African Americans had a lower prevalence of coronary calcium at baseline (P=.012) and follow-up (P=.005), smaller calcium scores at baseline (P=.005) and follow-up (P=.0004), and less progression (P=.001); Hispanics had a lower prevalence of coronary calcium at follow-up (P=.04) with smaller calcium scores (P=.011), and less progression (P=.009). In contrast, no differences were seen between Whites and Asian/Pacific Islanders. Race-ethnic differences in progression persisted after adjusting for risk factors and participation bias (P<.05). CONCLUSIONS: The present results lend further credence to the notion that race-ethnic differences exist in the prevalence and rate of progression of coronary calcification. The relationship between calcification and the incidence of coronary heart disease in these race-ethnic groups needs further exploration.

Aged↗

Race and transference in psychoanalysis and psychotherapy.

Given the enduring primacy of race in western cultures, it is always a factor in any psychotherapeutic situation. In this paper, the role of race in elucidating transference manifestations is explored. Vignettes and clinical narratives are used to illustrate the point that race can be a useful vehicle for the expression and elaboration of transferences of defence, of drive derivative and of object ties. Several factors are discussed which influence whether and to what degree race serves as a point of engagement for transference reactions.

Adaptation, Psychological↗

HIV/AIDS among minority races and ethnicities in the United States, 1999-2003.

BACKGROUND: During June 1981 to June 1982, 37% of more than 400 cases of AIDS reported to the CDC were in minority races and ethnicities. In 2003, 72% of the estimated 43,171 cases of AIDS diagnosed in the 50 states; District of Columbia; and U.S. dependencies, possessions and free nations were in minority races and ethnicities. METHODS: We analyzed HIV/AIDS data for 2000-2003 reported by the 32 states that have had confidential name-based reporting of HIV infection since 1999. For analysis of AIDS data, we used data for 1999-2003 reported by the 50 states and the District of Columbia. HIV/AIDS and AIDS data were statistically adjusted for reporting delays and redistribution of cases initially reported without risk factors. RESULTS: For all years, the numbers of HIV/AIDS and AIDS diagnoses were consistently higher among non-Hispanic blacks than among other races and ethnicities. In the 32 states with HIV reporting, the HIV/AIDS diagnosis rate in 2003 was 74 per 100,000 for blacks, 25 per 100,000 for Hispanics, 11 per 100,000 for American Indians/Alaska Natives, nine per 100,000 for whites, and seven per 100,000 for Asians/Pacific Islanders. The rates for persons living with HIV/AIDS at the end of 2003 were highest for blacks (765 per 100,000) and Hispanics (220 per 100,000). In the 50 states and the District of Columbia, AIDS diagnosis rates in 2003 were 58 per 100,000 for blacks, 20 per 100,000 for Hispanics, eight per 100,000 for American Indians/Alaska Natives, and four per 100,000 for Asians/Pacific Islanders. CONCLUSION: HIV/AIDS disproportionately affects minority races and ethnicities in the United States. To reduce rates of HIV/AIDS in these populations, effective and culturally appropriate prevention interventions must be developed and implemented.

Acquired Immunodeficiency Syndrome↗

The meaning of race in healthcare and research--part 2. Current controversies and emerging research.

The state of race today is complex and challenging. An article published in the preceding issue of this journal examined the history of race and its impact on health care. This article further examines the issue of race and health care as concerns arise regarding the relevance of genetics to health disparities. Pediatric nurses must examine the literature on race, as well as our own assumptions, and be clear about when and why we use racial categories and what they really mean.

Attitude of Health Personnel↗

Effect of race category redefinition on hypertension and hypercholesterolemia prevalence in the behavioral risk factor surveillance system, 1999 and 2001.

Race information in the United States is used to identify populations at risk for cardiovascular disease (CVD) or associated risk factors. Behavioral Risk Factor Surveillance System data from 1999 and 2001 were used to examine shifts in racial distributions and CVD risk factors after a multiracial category was added in 2001. We compared age-adjusted, weighted, race-specific prevalence estimates of self-reported high blood pressure (HBP) and high blood cholesterol (HBC) from 1999 and 2001 with descriptive statistics and 95% confidence intervals. The proportion of non-Hispanic Whites decreased significantly after the multiracial category was added. Overall, the prevalence of HBC did not significantly change, but HBP increased significantly, from 24.2% in 1999 to 25.6% in 2001 (P<.05). Among racial groups, only non-Hispanic Whites showed a statistically significant increase in HBP prevalence from 23.1% to 24.4% (P<.05); however, larger percentage increases in HBP were seen among non-Hispanic Asian/Pacific Islanders (3.5%) and non-Hispanic Blacks (1.6%). Among non-Hispanic Whites, when combining multiracial respondents whose preferred single race was non-Hispanic White, the prevalence of HBP was significantly higher in 2001 than in 1999. The race-specific prevalence of HBP and HBC was virtually unchanged, whether or not multiracial respondents were included in prevalence estimates. Observed HBP increases for non-Hispanic Whites were not caused by the addition of a multiracial category. In 2001, multiracial respondents had the second highest prevalence of HBP after non-Hispanic Blacks. To promote heart health, we must focus on the needs of this emerging multiracial group and on groups with increasing rates of HBP.

Adolescent↗

Age, race, and repeated prostate-specific antigen (PSA) test use in the National Health Interview Survey.

BACKGROUND: Prostate cancer is the second leading cause of cancer death in American men. Prostate-specific antigen (PSA) test use was examined in US men aged > or = 40 years to clarify the relationship with age and race. METHODS: The National Health Interview Survey (2000) collected information about PSA test use in a representative sample of the US population. This study examined whether men reported having had three or more PSA tests within the past five years by age and race subgroups. RESULTS: Prostate-specific antigen (PSA) test use rates were lowest in men aged 40-49 and highest in men aged 65-79. Receipt of three or more PSA tests within the past five years varied by age and race. Use was higher for African-American men, compared with White men aged 40-49; similar for African-American and White men aged 50-64; higher for White than African-American men aged 65-79; and similar for African-American and White men aged > or = 80. CONCLUSION: The PSA test use patterns showed variation by age and race subgroups, and these patterns are better understood when examining both variables at the same time.

Adult↗

Racing prognosis of horses following surgically repaired olecranon fractures.

Olecranon fracture is a common orthopedic problem in juvenile horses. Prognosis for complete fracture healing when various methods of internal fixation are used is good; however, the impact of olecranon fracture stabilization on the likelihood that foals will start on a racecourse is unknown. Medical records of foals undergoing internal fixation for an olecranon fracture were reviewed. The dam's foaling records were obtained and lifetime racing records were then retrieved for both the affected foals and 1 of their siblings. Twenty-two of 24 repaired fractures healed completely, subsequently, 16 of the foals started in at least 1 race. Statistical calculations suggest that when compared with their siblings, the occurrence of olecranon factures requiring internal fixation in juvenile racehorses will not significantly reduce the likelihood that they will race; however, the siblings had significantly more lifetime race starts and higher career earnings.

Animals↗

Association of race and breast cancer stage.

PURPOSE: To determine if breast cancer stage exhibits any significant variation between African Americans and white Americans. METHODS: We conducted a retrospective cohort study. Inclusion criteria required a diagnosis of breast cancer that was reported to the TriHealth tumor registry from 1991-2003. For each patient, we collected data on race; American Joint Committee on Cancer stage at diagnosis; and 12 potential confounding variables, including topography, morphology, laterality, age, menopausal age, smoking status, estrogen and progesterone receptor status, marital status, menopausal status, family history of breast cancer in a first-degree relative and insurance status. RESULTS: 5,751 patients (5,119 Caucasians, 632 African Americans) were eligible to be included in the study. African Americans were significantly younger, with a younger age of menopause, less family history of breast cancer, fewer positive estrogen and progesterone receptors, higher rate of cigarette smokers, more Medicaid insured, and more single and divorced individuals compared to Caucasian Americans (p < 0.05). Multivariate analysis found no difference between the races for stage 0, stage 2 and stage 4. African Americans had significantly less stage 1 (RR 0.80, 95% CI: 0.67-0.96), less combined stage 0 and 1 (RR 0.75, 95% CI: 0.63-0.89) and more combined stage 3 (RR 1.50 95% CI: 1.11-2.01). CONCLUSION: Although there was no difference among the races for topography, morphology and laterality of their breast cancers, African-American race is a predictor of more advanced stage at diagnosis.

Black or African American↗

Race effects.

1. One-year graft survival rates for cyclosporine-treated first cadaver donor transplants were 80% for 14,911 White recipients, 74% for 3,845 Blacks, 84% for 951 Asians, and 81% for 1,319 Hispanics reported to the UCLA Renal Transplant Registry between January 1984 and December 1991. 2. One-year graft survival rates for similar transplants reported to the UNOS Scientific Renal Transplant Registry between October 1987 and December 1991 were 83% for 10,518 Whites, 79% for 3,655 Blacks, 82% for 429 Asians, and 84% for 1,277 Hispanic recipients. 3. Transplant half-lives calculated after 6 months were 10 years for Asian recipients, 9 years for Whites, 6 years for Hispanics, and 4 years for Black recipients (UCLA Registry). 4. Patient survival was 93% and 85% at 1 and 3 years, respectively, for both Black and White recipients of first cadaver transplants. Patient survival was 94% and 89% at 1 and 3 years, respectively, for Asian and Hispanic recipients (UCLA Registry). 5. Asian recipients had significantly better graft survival than Whites (4% through 3 years, p less than 0.05). This high survival was not affected by donor race, although HLA-matching was remarkably better in Asian-to-Asian combinations than White-to-Asian, nor by whether the transplant was performed in the United States or Canada, or at other international centers (UCLA Registry). 6. The poor graft survival of Black recipients at 1 and 3 years was strongly influenced by age-dependent factors. Black recipients of either sex aged 16-30 had the poorest graft survival rates (UCLA Registry). 7. Blacks were sensitized more often than Whites (17 vs 15%, p less than 0.01). Even moderate sensitization reduced 1-year graft survival from 76% to 71% (p less than 0.05) in Blacks whereas there was no effect in recipients of other races. By contrast, broad sensitization did not affect 1-year graft survival in Hispanic recipients (UCLA Registry). 8. Blacks received more poorly HLA-matched transplants than recipients of other races. Only 2% received HLA-A,B-matched kidneys and 29% received completely HLA-A,B-mismatched transplants (p less than 0.01). More than 30% received transplants mismatched at 2 HLA-DR antigens (p less than 0.01) (UCLA Registry). 9. Although there were clear racial differences in the original diseases leading to end-stage renal disease, the recipient's race was a stronger predictor of graft outcome than disease (UCLA Registry).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

Recipient race does not influence waiting time for a cadaveric renal transplant--one organ procurement organization's experience.

There was no statistical significance to the differences in waiting time for cadaveric renal transplant by race. Whether for first transplant or second or greater, any differences in waiting time could not be accounted for by the recipient's race. CAUC made up 58% of the waiting list, 65% of the recipients, and 87% of the donors. The corresponding numbers for AA are: 38%, 29%, and 10%, respectively. More regional serum-sharing trays may be needed in order to expose recipients with high PRA to as many donors as possible in order to lessen their waiting time. It should be noted that fewer HLA mismatches occurred when donor and recipient race were identical. In light of this data, more study is needed to determine the relationship between donor and recipient race, corresponding HLA mismatches, and graft survival. If antigen-matching is found to increase graft survival, then an increase in minority donations will be required. Until that time, under the current allocation system and with the predominance of Caucasian donors, it is likely that Afro-Americans will continue to receive kidneys that have more HLA antigen mismatches than if Afro-Americans donated in numbers equivalent to their percentage of the waiting list.

Adult↗

Body composition and exercise in racing pigeons.

Exercise-related changes in body protein 'turnover' and in the absolute amounts of body protein were studied in racing pigeons. Whole body radioactivity was followed in racing and control (limited exercise) birds after protein labelling by the injection of 75Seselenomethionine. Because of re-utilisation of the label this does not give a true picture of body protein turnover but the comparative data suggested an increased turnover in racing compared to control birds. Carcase analysis on a group of pigeons demonstrated a water content for lean body mass of 72.7 per cent +/- 3.54. Lean body mass and exchangeable body potassium were used as indices of total body protein in a group of pigeons participating in an endurance race (15 + hours of flying). The results indicated that no body protein had been used as an energy source. These findings are compatible with the presence in pigeons of a small labile pool or pools of protein. The presence and characteristics of such pools remains to be determined.

Animal Nutritional Physiological Phenomena↗

The race effect.

1. One-year graft survival rates were 93% for recipients of HLA-identical sibling transplants in Blacks and Caucasians. One-year graft survival rates were lower in Blacks than Caucasians by 6% for parent donor, 8% for first cadaver, and 4% for cadaver donor retransplants between 1984 and 1989. 2. Although 1-year graft survival was consistently lower in Black recipients, there was no significant race difference when the recipient was over age 45 years. In transplants performed after 1986, there was no significant race difference when the recipient was over age 30 years. 3. Black recipients aged 15-30 years had the poorest 1-year graft survival at 64% each year between 1984 and 1988. One-year graft survival in comparable Caucasian recipients improved from 73-82% during this interval. The difference was greatest (18%) when comparing young Black and Caucasian males. 4. Caucasians had better early function than Blacks as judged from serum creatinine levels in the first 60 days. Fifty-two percent of Caucasians had excellent function (SCr less than 1.5 mg/dl) vs 37% of Blacks. Conversely, 22% of Blacks had SCr levels that never fell below 2.5 mg/dl vs 16% of Caucasians. There was no racial difference in early graft survival when transplants were stratified by function. The race effect became apparent after 6-12 months. 5. Long-term graft survival continues to differ dramatically between Black and Caucasian recipients. Transplant half-lives were consistently 4 years among Black and 7.5 years among Caucasian recipients of first cadaver transplants. Even comparing HLA-identical sibling transplants, the late loss rate in Blacks was double that in Caucasians. 6. The transplant center was an important factor in the race effect. Blacks transplanted at centers with overall high success rates had 79% 1-year graft survival, not significantly lower than that of Caucasian recipients. As the overall success rates declined at good and fair centers, the difference in 1-year graft survival between Black and Caucasian recipients increased from 8% to 12%. 7. The transplant center did not influence long-term graft survival in Black recipients. Transplant half-lives ranged from 4.9-3.9 years at excellent and fair centers, respectively. 8. The difference in graft survival between Caucasian and Black donors was primarily a center effect. In transplants to Caucasian recipients, there was no difference between Caucasian and Black donors at excellent and good centers, and a 16% difference at fair centers.

Adolescent↗

Race, socioeconomic status, and psychological distress: an examination of differential vulnerability.

Using data from a 1985 epidemiological survey of 2,115 adults in Florida, this research has two goals: it tests the proposition that race and SES jointly influence mental health, and it examines the contribution of undesirable life events and economic problems to psychological distress across SES groups. Using multiple indicators of SES and mental health, we found that the evidence for a model of joint influence of race and SES on mental health varied with the measures being used. The most general conclusion is that SES interacts with race to increase psychological symptoms of distress. Partitioning the sample into three SES categories (low, middle, high), we examined the contribution of stressors to the greater distress among lower-SES blacks compared to other blacks and lower-SES whites. Lower-SES blacks are more vulnerable than lower-SES whites to the impact of undesirable events, but they are less vulnerable than lower-SES whites to the impact of economic problems. Lower-SES blacks are more vulnerable than middle-SES blacks to the impact of both discrete events and economic problems. Limitations of the study indicate a need for future longitudinal studies with measures of coping resources and support networks to further our understanding of the race, social class and psychological distress relationship.

Adolescent↗

[Doping control in race horses].

Doping in performance horses is defined as the "illegal application of any substance, except normal diet, that might modify the natural and present capacities of the horse at the time of the race." The prohibition of doping is mainly based on the protection of animals. Doping can be performed with various aims: "doping to win" can be regarded as the classical method by mobilization of overphysiological capacities. Such positive doping may be classified as an acute form using psychomotoric stimulants, as a chronic form using anabolic hormones, and as a paradoxical form using small doses of neuroleptics or tranquilizers in excitable horses. In larger doses these sedatives are acting for "doping to loose" in a more subtle manner as compared to hypnotics. According to the doping regulations there is no difference between therapy and doping at the time of the race. Thus at the race all medications to restore normal performance have to be regarded as doping. This fact especially concerns the therapy of lamenesses with non-steroidal antiinflammatory drugs or local anesthetics. A particular problem is "inadvertent" doping due to unknown side effects, combinations of drugs, galenic supplements or food additives. Accidental doping may further be caused by the unawareness of elimination times. At the moment no exact withdrawing times can be defined due to the manifold interindividual variations at different levels of the pharmacokinetics. As a border-line case of doping the application of endogenous substances, like electrolytes or glucose, may be regarded. Though their parenteral application is prohibited prior to the race, only bicarbonate or "blood doping" may be considered to be effective as positive doping. Special doping methods are the use of "masking" substances or diuretics in order to make more difficult the detection of illegal drugs as well as physical doping procedures which are often hardly to define and which thus are only in part included in the doping regulations.

Anabolic Agents↗