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At least 1,027 records · Page 57Linked to original sources
PubMed2000

Impact of socioeconomic status and race on clinical parameters of patients undergoing radical prostatectomy in an equal access health care system.

OBJECTIVES: To analyze the relationships among socioeconomic status (SES), race, and the clinical parameters of patients undergoing radical prostatectomy (RP) in an equal access health care system. METHODS: The Department of Defense Center for Prostate Disease Research longitudinal prostate cancer database from multiple military institutions was used to analyze the clinical, pathologic, and outcome data of 1058 patients with localized (Stage T2c or lower) prostate cancer and a preoperative prostate-specific antigen (PSA) level of 20 ng/mL or less who underwent RP between January 1987 and December 1997. Military rank (officer versus enlisted) was used as a surrogate measure of SES. RESULTS: The percentage of patients with pathologic Gleason grade 7 or greater prostate cancer was higher in enlisted (45%) than in officer (37%) patients (P = 0. 021). However, no difference was found between these groups with respect to pathologic stage or biochemical recurrence rates. African Americans presented at a younger age (P = 0.003), with a higher pretreatment PSA level (P = 0.001), and demonstrated higher biochemical recurrence rates than other ethnic groups (P = 0.037). The Cox proportional hazards analysis showed that a lower SES (P = 0.010) but not African American race (P = 0.696) was an independent predictor of a higher grade (Gleason grade 7 or higher) cancer. However, biochemical progression was more common in African American men (P = 0.035) and was not related to SES (P = 0.883). CONCLUSIONS: In an equal access health care system, patients of lower SES presented with higher grade prostate cancer at the time of RP. However, only African American race predicted biochemical progression after RP.

Age Factors↗
PubMed2003

The dual factor structure of self-rated MDQ hypomania: energized-activity versus irritable-thought racing.

BACKGROUND: Bipolar II is diagnosed in a clinically depressed patient by documenting history of hypomania. Therefore, it is of great significance for both clinical and research purposes to characterize the factor structure of hypomania. METHODS: Among consecutive depressive outpatients-126 major depressives and 187 bipolar II-diagnosed by the Structured Clinical Interview for DSM-IV (Clinician Version), 181 who had clinically recovered from depression were administered the Mood Disorder Questionnaire (MDQ of. Am. J. Psychiatry 157, 1873). The MDQ is a newly developed, psychometrically validated self-report screening instrument for bipolar spectrum disorders. It screens for lifetime history of manic/hypomanic symptoms by including yes/no items covering all DSM-IV symptoms of mania/hypomania. The MDQ symptom interrelationships were studied by principal component analysis with varimax rotation. RESULTS: Hypomanic symptoms occurring in >50% were racing thoughts, increased energy and social activity, and irritability. Factor analysis revealed two factors: 'Energized-Activity' (eigenvalue=3.1) and 'Irritability-Racing Thoughts' (eigenvalue=1.5). LIMITATIONS: Cross-sectional assessment. CONCLUSIONS: Self-assessment of past hypomanic symptoms by patients, during clinical remission from depression, revealed two independent hypomanic factors, neither of which comprised euphoria. Hypomanic behavior appears to be more fundamental for the diagnosis of hypomania than elated mood accorded priority in DSM-IV; of hypomanic moods, irritability had greater significance than elation. It would appear that self-report of euphoria is less likely when hypomanias are brief (>or=2 vs. >or=4 days). The main implication for busy clinical practice is that energized activity and irritable mood associated with racing thoughts represent the modal experiences of hypomania among bipolar II outpatients; euphoria is neither sensitive, nor pathognomonic, in the diagnosis of these patients. These conclusions accord with recommendations made many years ago for the diagnosis of hypomania among cyclothymic patients [. Am. J. Psychiatry 134, 1227].

Bipolar Disorder↗
PubMed2003

ARF after open-heart surgery: Influence of gender and race.

BACKGROUND: Both acute renal failure (ARF) and female sex are strongly associated with mortality after open-heart surgery. This study analyzes the effect of sex and race on the incidence of ARF after open-heart surgery and its influence on mortality. METHODS: A total of 24,660 patients underwent open-heart surgery at the Cleveland Clinic Foundation (Cleveland, OH) from 1993 to 2000. The primary outcome was ARF defined as ARF requiring dialysis, 50% or greater decline in glomerular filtration rate (GFR) not requiring dialysis, or 50% or greater decline in GFR relative to baseline or requirement of dialysis. The secondary outcome was all-cause hospital mortality. RESULTS: The overall frequency of ARF requiring dialysis after open-heart surgery was 1.82%. The frequency was greater in women (2.36%) than men (1.60%; P < 0.0001) and blacks (2.94%) than nonblacks (1.70%; P < 0.0001) by univariate analysis. By multivariate analysis, risk for ARF requiring dialysis in women was 1.61 (confidence interval [CI], 1.27 to 2.05; P < 0.0001), but race was not a risk factor. The overall postoperative mortality rate was 2.2%, and for patients with ARF requiring dialysis, it was 61.2% (women, 68.6% versus men, 56.5%; P = 0.01) with an odds ratio of 49.29, whereas in patients with ARF not requiring dialysis, it was 14.1% (women, 13.3% versus men 14.6%; P = 0.63) with an odds ratio of 7.18. CONCLUSION: Female sex is an independent risk factor for developing ARF after open-heart surgery. The influence of race on risk for ARF is less clear. Regardless of its definition, ARF is strikingly associated with a high risk for mortality.

Acute Kidney Injury↗
PubMed1994

Race, socioeconomic status, and the development of end-stage renal disease.

The reasons for the increased annual incidence of end-stage renal disease (ESRD) in blacks compared with whites are unclear, but may include lack of access to treatment of the causative disease, which likely relates closely to socioeconomic status (SES). End-stage renal disease rates for diabetic glomerulosclerosis, hypertensive nephrosclerosis, and glomerulonephritis were determined in the 9,390 black and white New York State residents who began treatment within the Medicare program between 1982 and 1988. The relationship between the incidence of ESRD, age, and SES, as measured by the race-specific median family income in the patient's zip code, was estimated using a series of logistic-regression models for 12 populations: three causes of renal failure by two races by two sexes. For whites, incidence rates of diabetic glomerulosclerosis and hypertensive nephrosclerosis were significantly negatively associated with declining SES for the 45 to 65 year and 25 to 55 year age groups, respectively. In contrast, there was no relationship between the incidence of these diseases and SES in blacks. For glomerulonephritis, effects of SES were minor for both races. Better access to treatment of diabetes and hypertension might well decrease the annual incidence of ESRD due to diabetic glomerulosclerosis and hypertensive nephrosclerosis in whites. If the SES measures used for blacks are adequate, predisposition to progressive renal damage in response to renal injury or environmental factors other than SES are stronger risk factors for ESRD than SES.

Adult↗
PubMed1992

Race and sex differences in the identification of candidates for renal transplantation.

The availability of renal transplantation to individuals with end-stage renal disease (ESRD) is an issue of considerable concern. The role of age, race, sex, socioeconomic status, illness severity, and comorbidity in determining access to this therapy remains unclear. We examined the influence of these factors on transplant candidacy in 8,315 patients receiving dialysis treatment for ESRD in North Carolina, South Carolina, and Georgia. We found important race-sex differences in the likelihood of being identified as a transplant candidate. These differences persisted after adjustment for other patient characteristics, including illness severity and certain comorbid conditions. Characteristics found to be positively associated with candidacy included age less than 30 years (P less than 0.00001), living with a spouse and children (P = 0.004), and employment status (P = 0.006). Characteristics and comorbid conditions that were negatively associated with candidacy included 8 years or less of formal education (P = 0.001), cancer (P = 0.0006), visual impairment (P = 0.006), congestive heart failure (P = 0.008), and peripheral vascular disease (P = 0.01). Compared with white males, after adjustment for these factors, the likelihood (95% confidence interval) of being identified as a transplant candidate was: white females, 0.88 (0.65 to 1.18); black males, 0.77 (0.59 to 0.99); and black females, 0.66 (0.51 to 0.87). We conclude that although socioeconomic and medical factors are strongly associated with transplant candidacy, these associations do not adequately explain the observed race-sex differences in transplant candidacy status.

Adolescent↗
PubMed2003

Inequalities in nonfatal work injury: the significance of race, human capital, and occupations.

Little research is conducted to examine the determinants of nonfatal injury on the job. In particular, this study stresses the importance of race, human capital, and occupational conditions in explaining nonfatal injury at work. It measures nonfatal work injury as an episode of work injury, using the data from the 1988 Occupational Health Supplement (1988 OHS) to the National Health Interview Survey (NHIS). First, this study confirms no association between race and nonfatal injury at work. Second, the findings show that human capital, expressed through education and work experience, is the crucial determinant of nonfatal injury at work. In general, workers of more years of schooling and more work experience encounter less nonfatal injury at work than their counterparts. Third, the results also demonstrate the significance of occupational conditions (occupational positions and work activity) for nonfatal injury at work. Specifically, workers in professional occupations experience less work injury than workers in production occupations, but more work injury than workers engaged in clerical jobs. Even after controlling for occupational positions, there is a significant correlation between work activity and nonfatal work injury. Our study is a first step towards the causation of nonfatal injury on the job in terms of race, human capital, and occupational conditions. Therefore, the next step of work injury study needs to consider the influence of the other important determinants on nonfatal injury at work.

Accidents, Occupational↗
PubMed1999

Implications of social class and race for urban public health policy making: a case study of HIV/AIDS and TB policy in Washington, DC.

This paper explores how social class and race affect the public health policy-making process in an urban area. Ethnographic methods were used to collect and analyze information about HIV/AIDS and tuberculosis policy-making by the Washington, DC Commission of Public Health, Kingdon's conceptual model of policy making was used to analyze and understand the process. The problems of HIV/AIDS and tuberculosis in the district have important social class dimensions that were not always made explicit, but were instead defined in terms of 'race' and 'place'. Social class considerations and racial politics shaped what policies were developed or not developed and implemented successfully or failed. This study, which has national and international implications, concludes that there is a need to improve our understanding of the complex social dimensions of public health problems; there needs to be more consideration of the politics of strategy formulation and how issues of social class and race affect this process; and public health needs to strengthen its constituency in order to build support for the successful development and implementation of policy.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Does race influence survival for esophageal cancer patients treated on the radiation and chemotherapy arm of RTOG #85-01?

PURPOSE: In reported retrospective non-randomized trials of treatment of esophageal carcinoma, blacks have a lower survival from esophageal cancer than whites. None of these studies has accounted for the extent of disease, or the methods and quality of treatment. We reviewed the data that included only patients treated on the chemoradiation arm of the RTOG-8501 esophageal carcinoma trial to see if there were differences in overall survival between black and white patients receiving the same standard of care. METHODS AND MATERIALS: One hundred-nineteen patients, 37 blacks and 82 whites were evaluated who met the criteria for receiving chemoradiation of 5000 cGy and four courses of Cisplatin (75 mg/m2) and Fluorouracil (1000 mg/m2 for 4 days). RESULTS: Blacks had squamous histology only, with 86% of blacks having weight loss of 10 lbs. or more compared to 56% of whites (p = 0.001). In addition, blacks had larger tumors and more difficulty eating (p = 0.010). Overall, there was no difference in the Kaplan-Meier median survival estimate by race (p = 0.2757). Only when we limited the analysis to the "squamous histology" subgroup, stratified according to age >70 vs. <70 years (p = 0.0002), and nodal status (p = 0.0177) in a Cox regression model analysis, did race appear to be a significant factor (p = 0.0012). However, using the entire database, the age effect was found to be a "bimodal" effect, wherein the "youngest" (< age 60 years) and "oldest" patients (age > 70 years) did poorly. Because of the dramatic differences in the age and histology distributions between blacks and whites, this issue could not be resolved in the subset of squamous only who received chemoradiation. CONCLUSIONS: The increasing incidence of adenocarcinoma among white patients without a corresponding increase of this histology in blacks reflects a difference in diet and or lifestyle compared to blacks that deserves additional study. When treated aggressively with chemoradiation, race did not appear to be a statistically significant factor for overall survival.

Adenocarcinoma↗
PubMed1998

Relationship between motion sickness, migraine and menstruation in crew members of a "round the world" yacht race.

The similarities between the symptoms reported by patients with migraine and those experienced by severely motion sick individuals raises the question of whether the two conditions involve common mechanisms. In women, attacks of migraine may follow the menstrual cycle, and anecdote suggests this may also be true of motion sickness. The aim of this study was to determine whether there was a cyclical pattern in the occurrence of migraine/headache and motion sickness among crew members of a "round the world" yacht race. The participants were asked to complete pre- and postrace questionnaires that related to their susceptibility to motion sickness and headache/migraine; additionally, the female subjects were asked for details about their menstrual cycle. During the race the subjects completed a logbook to record the occurrence of motion sickness (using a four-point scale), migraine/headache (including the type of headache), menstruation, medication consumption and duties aboard the yacht. Female sailors were found to be more prone to motion sickness than the males. Motion sickness was also found to be linked to time at sea, and subjects who suffered migraine during the race were also more susceptible to motion sickness. A distinct pattern was found in the occurrence of motion sickness and headache that related to the menstrual cycle, although motion sickness and headache did not generally occur together in most of the subjects. A cyclical pattern was not obvious for the male subjects.

Adult↗
PubMed2002

Nosological study of Borna disease virus infection in race horses.

To investigate the prevalence of diseases in the Borna disease virus (BDV) antibody positive race horses, we undertook seroepidemiological studies of BDV infection on 125 culled race horses in Hokkaido, Japan. The serological study disclosed the presence of antibodies only to BDV-p40 or -p24 in 19.2% (24/125) and 3.2% (4/125) of culled horses, respectively. Antibodies to both BDV-p40 and -p24 were found in 24.0% (30/125) of these horses. Of particular note was the finding that locomotorium disorders were detectable at a significantly higher rate in BDV antibody positive horses than that in the seronegative horses. These results imply that BDV infection may possibly contribute to an increase in the incidence rate of locomotorium disorders in race horses.

Animals↗
PubMed2003

Outcome of carotid endarterectomy in African Americans: is race a factor?

OBJECTIVE: African American patients have been underrepresented in large-scale trials of carotid endarterectomy (CEA). Thus the role of CEA in the treatment of extracranial carotid artery occlusive disease in black patients remains unclear. We undertook this study to determine the effect of black race on early and late outcome of CEA. METHODS: A retrospective review was performed of records for patients who underwent CEA from 1990 to 1999. Data on demographics, operative indications, hospital course, and long-term follow-up were obtained for each patient. Patients were stratified by race for comparison of perioperative course and late outcome. Risk factors were compared using chi(2) methods, and life table analysis was performed with Kaplan-Meier survival plots. RESULTS: One thousand forty-five CEA procedures were performed during the study period, 133 (13%) in black patients and 912 (87%) in white patients. Demographic risk factors were similar in both groups, except for hypertension (P =.003), diabetes (P <.001), and renal insufficiency (P =.03), which were more prevalent in blacks. Just over half of patients had symptoms at presentation, with equal racial distribution. The perioperative stroke and death rate was 3.3% (blacks, 5.3%; whites, 3.1%; P =.19). The 8-year actuarial ipsilateral stroke rate was 7% in patients without symptoms and 8% in patients with symptoms, with no racial variation. There was, however, a racial difference in the long-term "all strokes" rate (P =.002), regardless of vascular territory. This difference was largely due to the high late stroke rate in black patients with symptoms at presentation. A Cox proportional hazards analysis showed that only black race was a significant predictor of any stroke. CONCLUSIONS: CEA can be accomplished with acceptable morbidity and mortality in black patients with an expectation of similar protection from ipsilateral ischemic stroke as in white patients. Black patients, however, have a higher incidence of all strokes at long-term follow-up due to the higher risk of stroke in patients with symptoms of carotid bifurcation disease.

Adult↗
PubMed2002

Effects of age, race, gender, blood pressure, and estrogen on arterial compliance.

BACKGROUND: Although a variety of factors have been shown to influence vascular compliance in humans, few studies have been large enough to adequately assess the effects of age, race, gender, blood pressure (BP), and estrogen therapy. METHODS: As part of a long-term follow-up study, 272 subjects, 50% women, 26% African American, 71% currently hypertensive, ranging in age from 33 to 80 years were studied with noninvasive measures of vascular compliance by pulse wave analysis. RESULTS: A significant age-related decrease in large and small vessel compliance and increase in vascular resistance and impedance was seen in all hypertensive subjects and in normotensive women. The slope of the relationship was significantly steeper for women than for men. No effect of estrogen or race could be observed. In hypertensive subjects, pulse pressure exerted an effect similar to that of age. CONCLUSIONS: Studies of vascular compliance must consider a variety of demographic and physiologic factors including age, gender, and BP. Race and estrogen administration do not appear to contribute to the variables independent of the factors identified.

Adult↗
PubMed2001

Steering with the head. the visual strategy of a racing driver.

We studied the eye movements of a racing driver during high-speed practice to see whether he took in visual information in a different way from a normal driver on a winding road [1, 2]. We found that, when cornering, he spent most of the time looking close to, but not exactly at, the tangent points on the inside edges of the bends. Each bend was treated slightly differently, and there was a highly repeatable pattern to the way the track edge was viewed throughout each bend. We also found a very close relationship between the driver's head direction and the rate of rotation of the car 1 s later. We interpret these observations as indicating that the driver's gaze is not driven directly by tangent point location, as it is in ordinary driving. Instead, we propose that his head direction is driven by the same information that he uses to control steering and speed, namely his knowledge of the track and his racing line round it. If he directs his head at an angle proportional to his estimate of car rotation speed, this will automatically bring his head roughly into line with the tangent points of the bends. From this standardized position, he can use the expected movements of the tangent points in his field of view to verify, and if necessary modify, his racing line during the following second.

Automobile Driving↗
PubMed2001

The use of census data for determining race and education as SES indicators: a validation study.

PURPOSE: Little research has examined the validity of using census data to determine an individual's socio-economic status (SES), as measured by race and educational level. This study assessed the accuracy of using aggregate level data from United States Census Block Groups in determining race and education SES indicators in a cohort of women from North Carolina. METHODS: The study analyzed patient data from the Carolina Mammography Registry and 1990 United States Census in 21 North Carolina counties. Women (n = 39,546) were geocoded to their census block group and their block group characteristics (surrogate measures) were validated with their self-reported values on race and education. An analysis was performed to explore whether using these surrogate measures would affect measured associations with the self-reported values. RESULTS: Whites were accurately identified (84.8%) more consistently than Blacks (14.1%) regardless of their urban/rural status. Women without a high school diploma or equivalent were accurately identified (56.2%) more often than those with higher education levels (45.9%). Analyses using the surrogate measures were significantly different than the true values according to chi-square statistics. CONCLUSIONS: Use of census data to derive SES indicators tends to be more accurate for the majority than the minority population. Researchers must be sensitive to the ecologic fallacy when using aggregate level data such as the census to determine individual level characteristics.

Black or African American↗
PubMed2003

Sex-race differences in the relationship between obesity and asthma: the behavioral risk factor surveillance system, 2000.

PURPOSE: Although prospective data are limited, recent cross-sectional studies support obesity as a cause of asthma. They also suggest that the association is present only among women. Our analysis examines possible sex-race differences in the relationship between obesity and asthma. METHODS: We examined data from the 2000 Behavioral Risk Factor Surveillance System. To minimize diagnostic bias, the sample was limited to adults aged 18 to 34 years. All cases had doctor-diagnosis of asthma and ongoing symptoms. Multiple logistic regression was used to examine risk factors for current asthma vs. never having asthma. RESULTS: Obesity and asthma were more strongly related among women than men (test for interaction, p<0.01). Across increasing categories of body mass index (BMI), we observed a dose-response relationship among women (odds ratios: 0.9, 1.0 [reference], 1.0, 1.3, 1.5, 1.8, and 3.2) but only a non-significant increased risk in severely obese men (odd ratio: 2.0). In subgroup analyses, however, the obesity-asthma association was present in four of six sex-race/ethnicity subgroups, including black and Hispanic men. CONCLUSIONS: Although the obesity-asthma association is stronger among women than men, our analysis demonstrates a strong positive association among men from minority groups. These race-specific results may help explain some of the "inconsistencies" in prior studies.

Adolescent↗
PubMed1999

Is race a poor prognostic factor in breast cancer?

BACKGROUND: African American breast cancer patients have a higher mortality rate than their Caucasian counterparts. The purpose of this study was to evaluate whether race is a poor prognostic factor in breast cancer survival after multiple other prognostic factors are taken into account. STUDY DESIGN: The tumor registry data from two institutions between the years 1982 and 1995 were combined for the analysis. A total of 1,745 patients, including 1,297 African American and 448 Caucasian women, were available for analysis. Race, age, income, stage, histologic findings, type of operation, and treating institution were evaluated as possible key prognostic variables. RESULTS: In a univariate Cox proportional hazards regression analysis, African American patients with breast cancer were 1.27 times more likely to die than Caucasians when death from disease was measured (p = 0.01, 95% confidence interval 1.03 to 1.47). When all factors were included in a Cox regression analysis, only the stage of disease at diagnosis, age, and whether the patient had a therapeutic surgical treatment were statistically significant. Race, income, hospital, and histologic findings were not significant, although they were significant when used in a univariate analysis. CONCLUSIONS: Poor survival of African American breast cancer patients seems to be related to their advanced stage at presentation and young age. To improve survival in these women, efforts should be concentrated on aggressive screening at a young age to detect the disease at an earlier stage.

Adult↗
PubMed2003

School performance, race, and other correlates of sleep-disordered breathing in children.

OBJECTIVES: Childhood sleep-disordered breathing (SDB) has been associated with poor school performance. Both problems are common among African-American (AA) children, but potential confounders such as low socioeconomic status (SES) and obesity have not been well studied. METHODS: Children in second and fifth grades at six urban elementary schools were evaluated by teachers' ratings and year-end reading and math assessments. Risk for SDB was assessed with the validated parental Pediatric Sleep Questionnaire, and SES by qualification for school lunch assistance. RESULTS: Among 146 children whose parents completed surveys, risk for SDB was associated with AA race, low SES, and poor teacher ratings (P<0.01), but not assessment scores (P>0.1). In multiple regression models, poor school performance was consistently and independently predicted by low SES (P<0.01) but not by AA race or SDB risk. Risk for SDB was associated with low SES before, but not after body mass index (BMI) was taken into account. CONCLUSIONS: The SDB symptoms, AA race, and low SES all vary to some extent with poor school performance, but the only consistent and independent covariate of performance is SES. Risk for SDB is associated with low SES, perhaps because of a third variable, namely high BMI.

Black People↗
PubMed2005

Chromosomal phylogeny of Robertsonian races of the house mouse on the island of Madeira: testing between alternative mutational processes.

The ancestral karyotype of the house mouse (Mus musculus) consists of 40 acrocentric chromosomes, but numerous races exist within the domesticus subspecies characterized by different metacentric chromosomes formed by the joining at the centromere of two acrocentrics. An exemplary case is present on the island of Madeira where six highly divergent chromosomal races have accumulated different combinations of 20 metacentrics in 500-1000 years. Chromosomal cladistic phylogenies were performed to test the relative performance of Robertsonian (Rb) fusions, Rb fissions and whole-arm reciprocal translocations (WARTs) in resolving relationships between the chromosomal races. The different trees yielded roughly similar topologies, but varied in the number of steps and branch support. The analyses using Rb fusions/fissions as characters resulted in poorly supported trees requiring six to eight homoplasious events. Allowance for WARTs considerably increased nodal support and yielded the most parsimonious trees since homoplasy was reduced to a single event. The WART-based trees required five to nine WARTs and 12 to 16 Rb fusions. These analyses provide support for the role of WARTs in generating the extensive chromosomal diversification observed in house mice. The repeated occurrence of Rb fusions and WARTs highlights the contribution of centromere-related rearrangements to accelerated rates of chromosomal change in the house mouse.

Animals↗