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Age, sex, and race inequality in renal transplantation.

We calculated the chance of receiving a kidney transplant in the United States in 1983, and in the Midwest from 1979 through 1985, considering age, sex, and race. In the United States, 23,026 patients began long-term dialysis and 6112 (27%) received a kidney transplant. Transplant rates were 31% for men and 21% for women. White patients had a 30% rate and nonwhite patients a 20% rate. Patients less than 11 to 35 years old had an 85% rate vs a 3% rate for those older than 56 years. When race, age, and sex were analyzed together, nonwhite patients aged 21 to 45 years had only half the chance of receiving a transplant compared with white patients of the same age and sex. Women aged 46 to 60 years had less than half the chance of receiving a transplant when compared with men of the same age and race. These data show that there are age, sex, and race imbalances in the distribution of renal transplantation. We believe these imbalances only partially have a morally neutral biological, medical, social, and cultural explanation and that there should be a fairer distribution of kidney transplants.

Adult↗

Conceptual and methodological issues in the use of race as a variable: policy implications.

The history, reality, and prolonged effects of racial stratification and its supportive ideology in the United States require systematic study of the impact of racial perceptions in the health sphere and in every facet of American life (Berry 1965; Berreman 1985; Blackwell 1985). In this regard, the use of race as an independent variable in social research is, in principle, similar to the presumed explanatory power of other status characteristics such as class or economic position. Depending on which meaning is intended, the potential policy, health services, and sociopolitical outcomes could be diametrically opposed to one another. Far from being an esoteric subject among intellectuals, any definition of race has fundamental and practical extensions to cultural and political realities. Essentially, studies and discussions of racial similarities and differences in health matters, whether intended or not, go beyond statistical compilations and correlations and reflect norms, values, the country's common beliefs (Praeger 1982), and the structural positions of majority and minority groups. Presumably, these are among the reasons that racial categories are studied in social science. They are assumed to represent socially relevant and unique histories, experiences, and statuses which differentiate black and white Americans in particular. The risks in epidemiologic and in social science research involve the preoccupation with disparities in the health difficulties among them; the attribution of racial biology and genetic traits to virtually all health spheres; the assumed preponderance of disabling conditions for blacks; and the unrelenting focus on only two racial populations despite our having a multiethnic society (Wilkinson 1987). Since health behaviors are directly associated with a group's "way of life," they should be carefully scrutinized within relevant socio-environmental contexts as part of the scientific processes of discovery, for the underlying premises, ideological translations, and practical applications of their studies especially with respect to race-specific health research. It is likely that systematic probing beyond demographic or constitutional factors will enable social scientists and health researchers to discover that for certain behaviors (e.g., prevention), individual attributes such as race and sex--and even knowledge, roles, attitudes, and diets--may explain far less than will environmental hazards and basic structural variables such as the organization of the health care delivery system, availability of and access to care, ability to pay, provider patterns, diagnostic processes, institutional operations, and quality of care.(ABSTRACT TRUNCATED AT 400 WORDS)

Ethnicity↗

Nutritional management of horses competing in 160 km races.

A survey was taken of dietary management and training schedules of 54 horses competing in two 160 km endurance races. A total of 52 owners, representing 54 horses, responded to a questionnaire distributed prior to the races. Diet and training schedules were compared between horses that successfully completed the races and those that were eliminated for metabolic reasons. Horses that completed the races were 11.5 +/- 4 years old, weighed 429 +/- 4.5 kg and were ridden 61 +/- 32 km a week when training. Feed intake was reported as "free choice hay or pasture" by 34 of the respondents. Dry matter (DM) hay intake in these horses was estimated to be 3% body weight (kg) minus the kg DM of grain fed, assuming a maximum intake. They were fed 12.3 +/- 2.3 kg feed per day consisting of 10 +/- 2.3 kg hay and 2.3 +/- 1.4 kg of grain. Most had free access to salt and were fed 1 +/- 1 vitamin/mineral supplement per day. Based on Nutritional Research Council (NRC) values for nutrient content of the reported feeds, diets contained 60 +/- 5% total digestible nutrients (TDN), 12 +/- 2% crude protein, 27 +/- 4% crude fiber, 0.72 +/- 0.4% calcium and 0.29 +/- 0.06% phosphorus. Maximum caloric intake was estimated to be 31.9 Mcal per day. Ratios of nutrients fed per kilometer trained were: kg TDN/km = .14 +/- .08, kg crude protein/km trained = .03 +/- .02, and kg crude fiber/km trained = .06 +/- .04.(ABSTRACT TRUNCATED AT 250 WORDS)

Animal Nutritional Physiological Phenomena↗

Cardiopathology of sudden cardiac death in the race horse.

Twenty thoroughbred race horses were selected for postmortem cardiopathological study of sudden cardiac death; ten of the twenty horses died suddenly. In order to define accurately the morphological changes observed in these ten hearts, ten other thoroughbred race horses considered to have normal hearts were selected as a control group and studied by postmortem coronary angiography. Of the ten horses that died suddenly, eight were witnessed to have died either during or shortly after training or racing. The death was instantaneous except in one horse, which showed ventricular tachycardia and died 4.5 h after a race. The other two died unexpectedly in the stable at night. Pathologically, the horses that died suddenly generally showed multifocal myocardial lesions that were ischemic and fibrotic. These lesions were found in the atrial tissue close to the sinoatrial (SA) node and in the atrioventricular (AV) junction, including the upper portion of the interventricular septum. Such myocardial lesions were often associated with vascular changes including arterio- and/or arteriolosclerosis. Angiographically, the SA node appeared to be perfused by atrial branches of the left and right coronary arteries. One branch originating from the left coronary artery gave off a few branches into the AV junction. These pathological findings, mainly consisting of both atrial lesions and lesions in the AV junction, were similar to those observed in horses with either atrial fibrillation, SA block, or paroxysmal ventricular tachycardia. A finding of particular interest was the angiographic demonstration that the blood supply to the AV junction partly came from the SA node artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Wheelchair racing: an important modality in acute rehabilitation after paraplegia.

Sports rehabilitation has been proven effective with patients having spinal cord injury. This case discusses a man with T12/LI paraplegia who had acute rehabilitation augmented by competitive long distance wheelchair racing. Stress testing was used to evaluate cardiorespiratory fitness and to develop parameters whereby maximally efficient training could occur. Wheelchair modifications for racing were necessary. Competitive wheelchair racing was found valuable for this patient's physical, emotional and social rehabilitation. Patient involvement in racing has continued since discharge and the Boston Marathon was completed by wheelchair less than 1 year after onset of spinal cord injury.

Adult↗

Exercise-induced pulmonary hemorrhage in Thoroughbreds after racing and breezing.

Thoroughbred horses (n = 191) were examined with a flexible fiberoptic endoscope within 2 hours of racing on a dirt track; 147 (75.4%) had evidence of exercise-induced pulmonary hemorrhage (EIPH), and 13 (9.0%) had blood at the nostrils. Of 107 Thoroughbreds examined within the same period after breezing, 41 (38.3%) had evidence of EIPH. One horse (2.4%) of this group had blood at the nostrils. Statistical analysis of frequency data showed that a relationship existed between EIPH and the horse's age or distance raced or breezed. Relationship did not exist between EIPH and sex or finishing position. Thoroughbreds were also examined endoscopically after steeplechase, flat turf, and timber races; 67.7% (21/31), 14.3% (2/14), and 66.6% (2/3) of the horses in such races were EIPH-positive, respectively; and 14.3% (3/21), 0% (0/2), and 100% (2/2) of these EIPH-positive horses had blood at the nostrils. Of 32 breezing Thoroughbreds in a 3rd survey, 21 (65.5%) were EIPH-positive. None bled from the nostrils. Endoscopic findings of EIPH are repeatable in the horses, indicating that bleeding is not a random event.

Age Factors↗

Evolution of human races at the gene level.

Using gene frequency data for 62 protein loci and 23 blood group loci, we studied the genetic relationship of the three major races of man, Caucasoid, Negroid, and Mongoloid. Genetic distance data indicate that Caucasoid and Mongoloid are somewhat closer to each other than to Negroid. Analysis of restriction site data for mitochondrial DNA also shows the same genetic relationship. It seems that the Negroid and the Caucasoid-Mongoloid groups diverged about 110,000 +/- 34,000 years ago, whereas Caucasoid and Mongoloid diverged about 41,000 +/- 15,000 years ago. The genetic relationships of various races in each group of Caucasoid, Negroid, and Mongoloid were also studied. All European populations are genetically close to one another except the Lapps, whereas many African, Oceanian, and Amer-indian tribes show large extents of genetic differentiation. The major cause for this differentiation seems to be the bottleneck effect. The Polynesians, Micronesians, and Indonesians are more closely related to the Asian Mongoloids than to the Australoids in Australia and New Guinea. There are also indications that migration played an important role in forming the current genetic relationships among human races. The extent of genetic differentiation between human races is not always correlated with the degree of morphologic differentiation. The genetic differentiation at protein loci seems to occur largely by mutation, genetic drift, and isolation, whereas morphologic characters are apparently subject to stronger natural selection than "average protein loci."

Asian People↗

Conceptualizing race in economic models of medical utilization: a case study of community-based elders and the emergency room.

There is no consensus on the appropriate conceptualization of race in economic models of health care. This is because race is rarely the primary focus for analysis of the market. This article presents an alternative framework for conceptualizing race in health economic models. A case study is analyzed to illustrate the value of the alternative conceptualization. The case study findings clearly document the importance of model stratification according to race. Moreover, the findings indicate that empirical results are improved when medical utilization models are refined in a way that reflects the unique experiences of the population that is studied.

Black or African American↗

Effect of race on survival following in-hospital cardiopulmonary resuscitation.

BACKGROUND: Race has been shown to be a significant predictive factor in a number of treatment decisions and outcomes, including survival following out-of-hospital cardiopulmonary resuscitation (CPR). The goal of this study was to determine whether race is associated with the rate of survival to discharge following in-hospital CPR. METHODS: Consecutive adult patients undergoing attempted CPR at three teaching hospitals were identified. Demographic, clinical, and laboratory data from the time of admission, information about the resuscitation attempt, and the outcome of CPR were recorded for each patient. The characteristics of black and non-black patients were compared. Logistic regression was used to determine whether race was a significant independent predictor of CPR outcome. RESULTS: A total of 656 patients were identified. Black patients had a higher mean severity of illness as measured by the Acute Physiology and Chronic Health Evaluation (APACHE) III score, were more likely to have an initial rhythm of electromechanical dissociation or asystole, were less likely to have an admitting diagnosis of myocardial infarction or a history of coronary artery disease, and had a higher serum creatinine level, lower serum albumin value, and lower 24-hour urine output for the first 24 hours. There was no difference between black and nonblack patients regarding the rate of survival of the resuscitative effort itself. However, black patients were significantly less likely than nonblack patients to survive to discharge following resuscitation (Mantel-Haenszel odds ratio, 0.31; 95% confidence interval, 0.15 to 0.68). This relationship persisted after adjusting for potential confounders such as age, sex, initial cardiac rhythm, diagnosis of pneumonia, serum creatinine level, hospital, and APACHE III score. CONCLUSIONS: Black race is significantly associated with a lower rate of survival to discharge following in-hospital CPR. Further work is needed to explore this association in other settings; to examine the effect of other possible confounding variables, such as tobacco use, socioeconomic status, and marital status; and to further study the determinants of physician decision-making about resuscitation.

Adult↗

Race and sex differences in rates of invasive cardiac procedures in US hospitals. Data from the National Hospital Discharge Survey.

BACKGROUND: Lower rates of invasive cardiac procedures have been reported for blacks and women than for white men. However, few studies have adjusted for differences in the type of hospital of admission, insurance status, and disease severity. SETTING, DESIGN, AND PARTICIPANTS: Data from the National Hospital Discharge Survey were used to investigate race and sex differences in rates of cardiac catheterization, percutaneous transluminal coronary angioplasty, and coronary artery bypass surgery among 10,348 persons hospitalized for acute myocardial infarction. RESULTS: White men consistently had the highest procedure rates, followed by white women, black men, and black women. After matching for the hospital of admission and adjusting for age, in-hospital mortality, health insurance, and hospital transfer rates (with white men as the referent), the odds ratios for cardiac catheterization were 0.67 (95% confidence interval [CI], 0.51 to 0.87) for black men, 0.72 (95% CI, 0.63 to 0.83) for white women, and 0.50 (95% CI, 0.37 to 0.68) for black women. Similar race-sex differences were noted for percutaneous transluminal coronary angioplasty and coronary artery bypass surgery. CONCLUSIONS: Race and sex differentials in the rates of invasive cardiac procedures remained despite matching for the hospital of admission and controlling for other factors that influence procedure rates, suggesting that the race and sex of the patient influence the use of these procedures.

Adult↗

The concept of race in Health Services Research: 1966 to 1990.

OBJECTIVE: This study examined ways in which race/ethnicity has been conceptualized and used in the health services research literature as published in Health Services Research (HSR). DATA SOURCE: All articles published in HSR from its inception in 1966 to 1990. STUDY DESIGN: The analyses were restricted to U.S.-based empirical research on humans or in which human population characteristics are described. This study identifies the terms used for race and/or ethnicity, the frequency with which they occur, and the purposes for which they are utilized. PRINCIPAL FINDINGS: The study documents that race/ethnicity is widely used in the health services literature to stratify or adjust results and to describe the sample or population of the study. Terms used for race are seldom defined and race is frequently employed in a routine and uncritical manner to represent ill-defined social and cultural factors. CONCLUSIONS: Researchers and practitioners must give more careful attention to the conceptualization and measurement of race. An understanding of racial/ethnic differences in patterns of health service utilization will require efforts to catalog and quantify the specific social and cultural factors that are differentially distributed by racial and ethnic status.

Ethnicity↗

Race, intervening variables, and two components of low birth weight.

The low birth weight (LBW) gap between blacks and whites has remained largely unexplained in past research. Most previous research on the topic has focused on LBW as a single entity, and without using a causal framework for analysis. The present study examines the determinants of race differences in the two main components of LBW--preterm birth (PRETERM) and intrauterine growth retardation (IUGR)-within a partially causal framework that includes social and proximate explanatory variables. The data come from the 1988 National Survey of Family Growth. This study asks, first, through what intervening variables do race and other exogenous sociodemographic variables operate to raise the risk of these adverse pregnancy outcomes? Second, what are the determinants of the two components of LBW when all explanatory variables are included in the model? The findings reveal differences in how race (and other exogenous variables) act through downstream variables to affect PRETERM and IUGR, as well as differences in the net determinants of these pregnancy outcomes. The models are better able to account statistically for race differences in IUGR (which is explained by intervening sociodemographic, attitude, and behavior variables) than in PRETERM (which is explained partly by intervening health variables).

Adolescent↗

Race and survival from breast cancer: based on Cancer and Leukemia Group B trial 8541.

PURPOSE: The purpose of this research was to evaluate the prognostic significance of race and survival in stage II breast cancer among women treated with adjuvant chemotherapy in the Cancer and Leukemia Group B (CALGB) trial 8541. MATERIALS AND METHODS: A total of 1572 patients with node-positive breast cancer were entered in CALGB trial 8541. This study opened in January 1985 and randomized patients to receive "high-dose," "standard-dose," or "low-dose" adjuvant CAF (cyclophosphamide, doxorubicin, and fluorouracil) chemotherapy. Patients were stratified according to treatment of the primary lesion (mastectomy or breast conservation), menopausal status, number of positive lymph nodes, and estrogen-receptor status. Twelve percent of the patients entered in this study were African-American, 84% were white, and 4% were of other racial backgrounds. RESULTS: African-Americans and whites were evenly distributed on all three arms. In a univariate analysis, African-Americans were more likely to have a reduced survival and shorter time to relapse than other patients. Race was moderately associated with tumor size, receptor status, and type of surgery. In a multivariate analysis, after adjusting for the dose of chemotherapy, number of lymph nodes, estrogen-receptor status, and age, race was no longer of prognostic significance. DISCUSSION: After adjustment for other well-recognized prognostic factors, race appears to have no independent prognostic significance for survival from stage II breast cancer among women receiving adjuvant CAF chemotherapy.

Black People↗

Effect of racing on serum sodium and potassium concentrations and acid-base status of Alaskan sled dogs.

OBJECTIVE: To examine the effect of participation in a long-distance race on serum electrolyte concentrations, estimated exchangeable cation content, and acid-base status of Alaskan sled dogs. DESIGN: Prospective study. ANIMALS: 9 male and 5 female, sexually intact, physically fit Alaska sled dogs between 18 and 48 months old. PROCEDURE: Body weight was recorded, and blood samples were collected from dogs before, during, and after a 300-mile race. RESULTS: Serum sodium and potassium concentrations decreased during the race, as did serum total protein, albumin, and globulin concentrations and PCV. Effects on acid-base status were minimal. Body weight and estimated total exchangeable cation content in dogs also decreased significantly during the race. CLINICAL IMPLICATIONS: Prolonged running is associated with decreases in serum cation concentration and estimated total exchangeable cation content in dogs, as in human beings and horses. However, the mechanism of the decrease in serum cation concentration likely differs among species. Clinical abnormalities associated with cation depletion were not observed in the dogs in this study.

Acid-Base Equilibrium↗

Validation of a regression model for standardizing lifetime racing performances of thoroughbreds.

OBJECTIVE: To determine the relationship between prediction errors of a regression model of racing finish times and earnings or finish position; the relationship between standardized finish times, determined by use of this model, and earnings or finish position; and whether this model was valid when applied to data for horses that underwent surgical treatment. DESIGN: Survey. SAMPLE POPULATION: Records of 6,700 healthy Thoroughbreds racing in Louisiana and of 31 Thoroughbreds with idiopathic left laryngeal hemiplegia that underwent surgical treatment. PROCEDURE: Predicted and standardized finish times were calculated by use of the regression model for healthy horses, and the relationships between prediction error (actual--predicted finish time) and standardized finish times, and earnings and finish position, were examined. Then, the regression model was applied to data for horses with hemiplegia to determine whether the model was valid when used to calculate predicted and standardized finish times for lifetime performance data. RESULTS: Prediction error and standardized finish times were negatively correlated with earnings and positively correlated with finish position and, thus, appeared to be reliable measures of racing performance. The regression model was found to be valid when applied to lifetime performance records of horses with laryngeal hemiplegia. CLINICAL IMPLICATIONS: Prediction error and standardized finish times are measures of racing performance that can be used to compare performances among Thoroughbred racehorses across a variety of circumstances that would otherwise confound comparison.

Animals↗

Survival of beta and gamma races of Neotricula aperta snail intermediate hosts of Schistosoma mekongi in raw waters.

Beta and gamma races of Neotricula aperta were exposed to naturally raw waters of the Sirindhorn reservoir, Mun River and Mekong River in laboratory conditions and non supplement on food. Snails of two races could withstand well in variable qualities of water within 48 hours. The survival rates of N. aperta in three sources of raw water were 100% for the beta race and 97 to 100% for the gamma race.

Animals↗

Body fat distribution and race differences in apolipoprotein A1.

OBJECTIVE: This is the first study to assess the role of waist-to-hip ratio in explaining race differences in levels of serum apolipoprotein A1, a protective risk factor for atherosclerosis. METHODS: Linear regression analyses were used in a community-based survey of 3,043 adults (23.5% African-American) to assess associations of race, age, anthropometric measures, education, diabetes, blood pressure medication use, cigarette smoking, and leisure-time physical activity with apolipoprotein A1 levels. RESULTS: Higher apolipoprotein A1 levels were observed among African-American than among white adults (African-American men: +15.6 mg/dl than white men, African-American women: +3.1 mg/dl more than white women; p < 0.05). Waist-to-hip ratio and other variables did not account for race differences among men. African-American women had +8.6 mg/dl higher levels than white women after adjustment for differing distributions of waist-to-hip ratio, age, body mass index and education. Cigarette smoking, physical activity, and medical history accounted for no further differences among women. CONCLUSIONS: Higher levels of obesity indicators and lower educational attainment among African-American women reduced a potentially greater beneficial race difference in apolipoprotein A1. These findings also suggest that other environmental and biochemical factors may play roles in explaining the higher protective levels of apolipoprotein A1 observed among African-American children and adults.

Adipose Tissue↗

[Sled dog racing and animal welfare aspects].

Transport, housing and the dimensions of strain during training and race are important aspects of animal welfare. The race veterinarian has a great responsibility. He is responsible for the treatment of injured dogs and he has to give advice on all medical and animal welfare questions. The presence of the veterinarian during the entire race is very important. These veterinarians should have special knowledge of small animals and of sled dogs in particular. There should be health checks of sled dogs before and after racing similar to horse sport tournaments.

Animal Welfare↗