2633 research outputs found
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Colonoscopist and Primary Care Physician Supply and Disparities in Colorectal Cancer Screening
No full textAbstract available at publisher's web site
Open Access: Greater Impact for Minority Health & Health Equity Research
No full textThis PowerPoint presentation provides history and information about Open Access and its impact on research and publishing. The presentation focuses on the Minority Health and Health Equity Archive's role in Open Access dissemination of research. Tools to facilitate Open Access are also discussed
Understanding Socioeconomic and Racial/Ethnic Status Disparities in Diet, Exercise, and Weight: Underlying Contextual Factors and Pathways
No full textNo abstract available
Records of Dr. John C. Cutler
No full text(From National Archives Press Release) From 1946-48, the U.S. Public Health Service (USPHS) Venereal Disease Research Laboratory (VDRL) and the Pan American Sanitary Bureau collaborated with several government agencies in Guatemala on U.S. National Institutes of Health-funded studies involving deliberate exposure of human subjects with bacteria that cause sexually transmitted diseases (STD). Guatemalan partners included the Guatemalan Ministry of Health, the National Army of the Revolution, the National Mental Health Hospital, and the Ministry of Justice. Studies were conducted under the on-site direction of John C. Cutler, MD in Guatemala City, under the supervision of R.C. Arnold MD and John F. Mahoney, MD of the USPHS VDRL in Staten Island, New York; the primary local collaborator was Dr. Juan Funes, chief of the VD control division of the Guatemalan Sanidad Publica. According to a “Syphilis Summary Report” and experimental logs in the archives, syphilis studies included Commercial Sex Workers, prisoners, and patients in the mental hospital. In the series of syphilis studies, a total of 696 subjects of individual experiments (some representing the same patients involved in several experiments) were exposed to infection (by sexual contact or inoculation)
Toward a fourth generation of disparities research to achieve health equity
No full textAchieving health equity, driven by the elimination of health disparities, is a goal of Healthy People 2020. In recent decades, the improvement in health status has been remarkable for the U.S. population as a whole. However, racial and ethnic minority populations continue to lag behind whites with a quality of life diminished by illness from preventable chronic diseases and a life span cut short by premature death. We examine a conceptual framework of three generations of health disparities research to understand (a) data trends, (b) factors driving disparities, and (c) solutions for closing the gap. We propose a new, fourth generation of research grounded in public health critical race praxis, utilizing comprehensive interventions to address race, racism, and structural inequalities and advancing evaluation methods to foster our ability to eliminate disparities. This new generation demands that we address the researcher's own biases as part of the research process
The impact of race/ethnicity on baseline characteristics and the burden of coronary atherosclerosis in the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial.
No full textOBJECTIVES: We aimed to test the impact of race/ethnicity on coronary artery disease (CAD) after adjusting for baseline risk factors.
BACKGROUND: Whether race/ethnicity remains an important determinant of the burden of CAD even among patients with long-standing type 2 diabetes (diabetes mellitus) and established CAD is unknown.
METHODS: Analysis of baseline data from the BARI 2D trial (January 1, 2001, to March 31, 2005) was performed. Myocardial jeopardy index (MJI) was evaluated by a blinded core angiographic laboratory. Multivariate regression analysis was performed to determine the independent association of race/ethnicity on the burden of CAD after adjusting for baseline risk factors. Data were collected from US and Canadian academic and community hospitals. The baseline analysis was performed on patients with long-standing diabetes and documented CAD with no prior revascularization at study entry (n = 1,331). The main outcome measure was MJI, which represents the percentage of myocardium jeopardized by significant lesions (≥50%). The secondary outcome measure was ≥2 lesions with ≥50% stenosis.
RESULTS: Risk factors varied significantly among racial/ethnic groups. Blacks were significantly more likely to be women, have no health insurance, be current smokers, have higher body mass index, have hypertension, have a longer duration of diabetes, a higher hemoglobin A(1c) level, and were more likely to be taking insulin. Their mean total, low-density lipid, and high-density lipid cholesterol levels were higher, whereas their triglycerides were lower than others. After controlling for baseline risk factors, blacks had a significantly lower burden of CAD; the adjusted MJI was 5.43 U lower (95% CI -9.13 to -1.72), and the adjusted number of lesions was 0.53 fewer (95% CI -0.88 to -0.18) in blacks compared to whites.
CONCLUSIONS: In the BARI 2D trial, self-reported race/ethnicity is associated with important differences in baseline risk factors and is a powerful predictor of the burden of CAD adjusting for such baseline differences. These findings may help direct medical intervention and resources and further investigation into the basis of racial/ethnic differences in CAD burden
Explaining Divergent Levels of Longevity in High-Income Countries
No full textDuring the last 25 years, life expectancy at age 50 in the United States has been rising, but at a slower pace than in many other high-income countries, such as Japan and Australia. This difference is particularly notable given that the United States spends more on health care than any other nation. Concerned about this divergence, the National Institute on Aging asked the National Research Council to examine evidence on its possible causes.
According to Explaining Divergent Levels of Longevity in High-Income Countries, the nation's history of heavy smoking is a major reason why lifespans in the United States fall short of those in many other high-income nations. Evidence suggests that current obesity levels play a substantial part as well. The book reports that lack of universal access to health care in the U.S. also has increased mortality and reduced life expectancy, though this is a less significant factor for those over age 65 because of Medicare access. For the main causes of death at older ages -- cancer and cardiovascular disease -- available indicators do not suggest that the U.S. health care system is failing to prevent deaths that would be averted elsewhere. In fact, cancer detection and survival appear to be better in the U.S. than in most other high-income nations, and survival rates following a heart attack also are favorable.
Explaining Divergent Levels of Longevity in High-Income Countries identifies many gaps in research. For instance, while lung cancer deaths are a reliable marker of the damage from smoking, no clear-cut marker exists for obesity, physical inactivity, social integration, or other risks considered in this book. Moreover, evaluation of these risk factors is based on observational studies, which -- unlike randomized controlled trials -- are subject to many biases
Mediating Impact of Social Capital and Human Capital on Employment Outcome among Single Women Who Use Welfare: A Structural Equation Model
No full textWith the passage of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) in 1996, Congress ended “welfare as we know it” and formally adopted a workfare approach. However, families continue to be trapped in the “low-wage ghetto”. Therefore, research is needed that investigates effective routes out of poverty. Studies have found that welfare recipients with higher educational attainment work more and earn significantly higher income than those with lower educational attainment. However, very little research exists around the relationship between social capital and labor force participation.
Four research questions guided this study: (1) How do demographic variables affect social capital and human capital among single women who use welfare? (2) How do social capital and human capital affect employment outcome? (3) Do social capital and human capital act as mediators between demographic variables and employment outcome? (4) How do macro-level variables (i.e., city unemployment rate and state TANF policy) affect employment outcome?
This study analyzed Wave 2 (2005-2007) data from the Making Connections Cross-Site Survey database. 1,428 women with no spouse/partner present in the household who indicated use of a TANF/welfare office in the last 12 months were selected for inclusion in the study sample. An exploratory factor analysis was conducted to extract factors that underlie the social capital construct and to identify the indicators that were associated with each of those factors. Five social capital factors emerged: support giving social capital, bonding social capital, bridging social capital, value sharing social capital, and support receiving social capital. Structural equation modeling was used to answer the major research questions in this study.
This study found that older participants had a lower level of human capital, support giving social capital, and support receiving social capital than their younger counterparts. Additionally, older recipients had a worse employment outcome. Human capital and support giving social capital were positively associated with employment outcome, meaning that a higher level of human capital and giving support to family and friends were associated with a better employment outcome. In contrast, receiving support from family and friends was associated with a worse employment outcome. Human capital, support giving social capital, and support receiving social capital were found to mediate the relationship between age and employment outcome. Furthermore, more generous state TANF policy was associated with a worse employment outcome. Finally, there was sufficient evidence that factor loadings differed across race/ethnicity, presence of child under the age of 6, and ownership of a vehicle.
This study has implications for policy, practice, and research. First, federal TANF policy should be amended to encourage the accumulation of human capital. Second, community participatory interventions are needed to increase social capital. Third, research is needed that will develop a measurement tool that can be tailored to measure social capital among low-income families. Longitudinal research is needed to examine the impact of social capital on employment in the long-term
Racial/Ethnic Disparities in Risk of Early Childhood Mortality Among Children With Congenital Heart Defects
No full textBACKGROUND: Infants with congenital heart defects (CHDs) have increased risk of childhood morbidity and mortality. However, little is known about racial/ethnic differences in early childhood mortality.
PATIENTS AND METHODS: We conducted a retrospective cohort study with data from the Texas Birth Defect Registry on 19 530 singleton, live-born infants with a CHD and born January 1, 1996, to December 31, 2003, to non-Hispanic (NH) white, NH black, and Hispanic women. Texas Birth Defect Registry data were linked to Texas death records and the National Death Index to ascertain deaths between January 1, 1996, and December 31, 2005. Kaplan-Meier survival estimates were computed, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated from multivariable Cox-proportional hazard regression models to determine the effect of maternal race/ethnicity on mortality for selected CHD phenotypes.
RESULTS: After adjusting for covariates, compared with NH white children, NH black children had increased early childhood mortality risk for transposition of the great arteries (HR: 2.04 [95% CI: 1.40–2.97]), tetralogy of Fallot (HR: 1.85 [95% CI: 1.09–3.12]), pulmonary valve atresia without ventricular septal defect (VSD) (HR: 2.60 [95% CI: 1.32–5.12]), VSD (HR: 1.56 [95% CI: 1.19–2.03]), and atrial septal defect (HR: 1.34 [95% CI: 1.08–1.66]). Hispanic children had higher mortality risk for pulmonary valve atresia without VSD (HR: 1.76 [95% CI: 1.06–2.91]) and hypoplastic left heart syndrome (HR: 1.51 [95% CI: 1.13–2.02]).
CONCLUSIONS: We provide evidence that supports racial/ethnic disparities in early childhood mortality among infants with CHDs. Identifying infants with the greatest risk of early childhood mortality will facilitate development of interventions and policies to mitigate these risks
Community-Based Participatory Research as Worldview or Instrumental Strategy: Is It Lost in Translation(al) Research?
No full textCommunity involvement in community-wide interventions is
important for a variety of scientific, ethical, and pragmatic reasons. However, the specific meaning of community involvement depends on the details of how it is enacted. Katz et al. outline an ambitious effort to blend the science of randomized controlled trials (RCTs) with the
processes of community-based participatory research (CBPR) in translational research. RCTs provide the science, while CBPR provides the processes of tailoring and implementation. Katz et al. offer a detailed example of how research might occur through the use of community portals and community health advisors as local advocates for the delivery of interventions. Their examples are rich and raise fundamental issues regarding the importance of CBPR
and the role of local participation in translational research more generally