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Journal of Immigrant and Minority Health Dec 2023Stigma reduces access to alcohol and other drug (AOD) support. This systematic review explored perceptions and experiences of stigma associated with AOD use among... (Review)
Review
Stigma reduces access to alcohol and other drug (AOD) support. This systematic review explored perceptions and experiences of stigma associated with AOD use among migrant and ethnic minority groups. Qualitative studies published in English were identified using six databases. Two reviewers screened and critically appraised articles using the Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies. Data were synthesised using best fit framework synthesis. Twenty-three studies were included. Stigma drivers and facilitators included stereotypes, socio-cultural norms, legal responses and precarious lived experiences. Stigma intersected with gender, citizenship, race and ethnicity and manifested though shame, exclusion, secondary stigma and discrimination in treatment. Outcomes and impacts included avoidance of services, emotional distress, isolation and loneliness. This review identified similar stigma experiences to other populations, however outcomes were complicated by precarious lived experiences and multiple stigmatised identities. Multi-level interventions are required to reduce AOD-related stigma for migrant and ethnic minority groups.
Topics: Humans; Ethnicity; Minority Groups; Ethnic and Racial Minorities; Transients and Migrants; Qualitative Research
PubMed: 36976449
DOI: 10.1007/s10903-023-01468-3 -
Drug and Alcohol Review Sep 2022The transgenerational impacts of colonisation-inclusive of dispossession, intergenerational trauma, racism, social and economic exclusion and marginalisation-places... (Review)
Review
ISSUES
The transgenerational impacts of colonisation-inclusive of dispossession, intergenerational trauma, racism, social and economic exclusion and marginalisation-places First Nations peoples in Australia at significant risk of alcohol and other drug (AOD) use and its associated harms. However, knowledge and evidence supporting community-based AOD treatment for First Nations adults is limited. Therefore, this review aimed to examine the impact and acceptability of community-based models of AOD support for First Nations adults in Australia.
APPROACH
A systematic search of the empirical literature from the past 20 years was conducted.
KEY FINDINGS
Seventeen studies were included. Nine studies evaluated the program's impact on substance use and 10 studies assessed program acceptability (two studies evaluated both). Only three out of nine studies yielded a statistically significant reduction in substance use. Acceptable components included cultural safety, First Nations AOD workers, inclusion of family and kin, outreach and group support. Areas for improvement included greater focus on holistic wrap-around psychosocial support, increased local community participation and engagement, funding and breaking down silos.
IMPLICATIONS
Culturally safe, holistic and integrated AOD outreach support led by First Nations peoples and organisations that involves local community members may support First Nations peoples experiencing AOD concerns. These findings may inform the (re)design and (re)development of community-based AOD services for First Nations peoples.
CONCLUSION
There is a limited evidence-base for community-based AOD programs for First Nations peoples. First Nations-led research that is controlled by and co-produced with First Nations peoples is necessary to extend our understanding of community-based programs within First Nations communities.
Topics: Adult; Australia; Health Services, Indigenous; Humans; Indigenous Peoples; Native Hawaiian or Other Pacific Islander
PubMed: 35546281
DOI: 10.1111/dar.13477 -
JAMA Pediatrics Jun 2022A previously reported prediction model included a child's race to estimate risk of urinary tract infection (UTI), but race-conscious medicine encourages investigating... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
A previously reported prediction model included a child's race to estimate risk of urinary tract infection (UTI), but race-conscious medicine encourages investigating how race is likely to be a proxy for other factors that should instead be used for risk prediction.
OBJECTIVES
To systematically review the available literature to evaluate the robustness of the association between race and UTI and to assess whether other variables could replace race as a variable in a previously developed prediction tool without adversely affecting its accuracy.
DATA SOURCE
MEDLINE was searched through May 28, 2021.
STUDY SELECTION
English-language studies that reported data on the prevalence of UTI according to race for children younger than 18 years were included.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers assessed studies for risk of bias and abstracted data. Random-effects models were used to pool odds ratios, and meta-regression was used to explore heterogeneity.
MAIN OUTCOMES AND MEASURES
Odds of UTI among non-Black children vs Black children.
RESULTS
Sixteen studies (17 845 children) were included. In the primary analysis, which included 11 studies, the pooled odds ratio of UTI among non-Black children was 2.44-fold higher (95% CI, 1.87-3.20) than among Black children. The corresponding odds ratio in studies with low or very low risk of bias was 4.84-fold higher (95% CI, 3.16-7.41; I2 = 0%) among non-Black children than among Black children. Replacing race with history of UTI and duration of fever resulted in a model with similar accuracy (training cohort: overall sensitivity, 96% [95% CI, 94%-98%]; overall specificity, 35% [95%, 32%-38%]; overall area under the receiver operating characteristic curve, 0.80 [95% CI, 0.77-0.82]; validation cohort: overall sensitivity, 97% [95% CI, 90%-100%]; overall specificity, 32% [95% CI, 26%-37%]; overall area under the receiver operating characteristic curve, 0.84 [95% CI, 0.77-0.92]).
CONCLUSIONS AND RELEVANCE
Although previous studies suggested that an association between race and UTI exists, because of the issues associated with the inclusion of race in decision models, we replaced the variable of race with history of UTI and duration of fever in a previously developed risk prediction model and found similar accuracy.
Topics: Child; Fever; Humans; Prevalence; ROC Curve; Urinary Tract Infections
PubMed: 35435935
DOI: 10.1001/jamapediatrics.2022.0700 -
Journal of Diabetes and Its... Sep 2021The consistency of cardiovascular risk reduction by antidiabetes medications across racial and ethnic groups remains unclear. The aim of this study was to analyze... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The consistency of cardiovascular risk reduction by antidiabetes medications across racial and ethnic groups remains unclear. The aim of this study was to analyze racial/ethnic patterns in the results of cardiovascular outcomes trials of antidiabetes medications in people with type 2 diabetes.
METHOD
PubMed and Cochrane library databases were searched from the inception dates to December 2020. Cardiovascular outcome trials in type 2 diabetes that randomized participants to antidiabetes medication or control treatment and reported results by race/ethnic groups or region were included.
RESULTS
A total of 19 studies were included in this meta-analysis. Among White participants, treatment with antidiabetes medications significantly decreased the risk of composite cardiovascular outcomes when compared with placebo treatment (OR = 0.88, 95% CI 0.83-0.94, p < 0.05). Among Asian participants, antidiabetes medications also significantly decreased the risk of composite cardiovascular outcomes when compared with control treatment (OR = 0.80, 95% CI 0.74-0.86, p < 0.05). A similar pattern was found when analyzing the effects of antidiabetes medications vs. control treatment in other racial/ethnic groups comprising mostly Hispanics and Pacific Islanders (OR = 0.87, 95% CI 0.78-0.98, p < 0.05). However, among Black participants, treatment with antidiabetes medications resulted in nominal but non-significant decreases in the composite cardiovascular outcomes when compared with control treatment (OR = 0.84, 95% CI 0.62-1.14, p = 0.26).
CONCLUSIONS
The present meta-analysis showed cardiovascular safety of antidiabetes medications in people with type 2 diabetes from all racial/ethnic groups studied; however, significant composite cardiovascular risk reductions were demonstrated only in White and Asian participants. To determine whether antidiabetes drugs confer consistent cardiovascular benefits in Black and other racial/ethnic participants requires more investigations in the future.
Topics: Asian People; Cardiovascular Diseases; Diabetes Mellitus, Type 2; Ethnicity; Hispanic or Latino; Humans; Hypoglycemic Agents; Racial Groups; White People
PubMed: 34266712
DOI: 10.1016/j.jdiacomp.2021.107980 -
Pathogens and Global Health Mar 2023Novel COVID-19 variants continue to endanger global public health. Increasing COVID-19 vaccination, healthcare-related preventative behaviors, and general knowledge...
Novel COVID-19 variants continue to endanger global public health. Increasing COVID-19 vaccination, healthcare-related preventative behaviors, and general knowledge rates are all critical in halting COVID-19 spread. We evaluated Asian American COVID-19 healthcare-related behaviors and knowledge, due to the dearth of knowledge in this area and the unique social factor of COVID-19 related discrimination; discriminatory acts during the pandemic may play a role in COVID-19 related behavior adherence. Following PRISMA-P protocol, we conducted a systematic review. The search strategy combined synonyms of health-care behaviors and knowledge. Reviewers synthesized key themes across articles and assessed studies utilizing modified Newcastle-Ottawa criteria. Of the 2,518 articles, 32 were selected. Asian Americans reported greater COVID-19 vaccination willingness and decreased COVID-19 testing relative to other racial groups. Common COVID-19 vaccination concerns included vaccination side effects, long-term safety, and distrust of COVID-19 information sources. Asian Americans had high COVID-19 preventative behavior rates including mask-wearing, handwashing, and social isolation compared to other ethnic groups. Asian Americans, conversely, had lower COVID-19-related healthcare knowledge and telemedicine adoption levels relative to other participants. This systematic review informs public health officials and clinicians of COVID-19 related healthcare knowledge and behaviors in the Asian American population. Equipped with this knowledge, public health officials can better target messaging about vaccine safety concerns to the Asian American community and recognize the importance of tailoring COVID-19 educational materials to the heterogeneous Asian American subpopulations. This systematic review also provides insight into the unique telemedicine challenges physicians may face when engaging with Asian American patients.
Topics: Humans; Asian; COVID-19; COVID-19 Testing; COVID-19 Vaccines; SARS-CoV-2; Telemedicine; Vaccination; Health Knowledge, Attitudes, Practice; Health Behavior
PubMed: 35892162
DOI: 10.1080/20477724.2022.2106110 -
Journal of Racial and Ethnic Health... Oct 2019Racial disparities in sepsis outcomes have been previously reported. However, recently, there have been inconsistencies in identifying which socioeconomic variables,... (Meta-Analysis)
Meta-Analysis
RATIONALE
Racial disparities in sepsis outcomes have been previously reported. However, recently, there have been inconsistencies in identifying which socioeconomic variables, such as race, account for these disparities. The objective of this study was to perform a systematic review in order to examine the impact of race on sepsis-attributable mortality.
METHODS
Systematic searches for English-language articles identified through MEDLINE, EBSCOhost, PubMed, ERIC, and Cochrane Library databases from 1960 to 1 February 2017. Included studies examined sepsis outcomes in the context of sepsis incidence and/or mortality. Two investigators independently extracted data and assessed study quality. The meta-analysis was performed in accordance with the Cochrane Collaboration guidelines.
RESULTS
Twenty-one studies adhered to the predefined selection criteria and were included in the review. Of the 21 studies, we pooled data from 6 studies comparing African American/Black race as a risk factor for sepsis-related mortality disparities (reference group being Caucasian/White). From the meta-analysis on these six studies, African American/Black race was found to have no statistical significant relationship with sepsis-related mortality (odds ratio 1.20, 95% CI, 0.81 to 1.77). Similar results were found for other races (Native Americans, Asians) and ethnicities (Hispanic/Latinos).
CONCLUSION
On the basis of available evidence from a limited number of observation retrospective studies, race alone cannot fully explain sepsis-related disparities, especially sepsis-attributable mortality.
Topics: Black or African American; Healthcare Disparities; Humans; Observational Studies as Topic; Racial Groups; Retrospective Studies; Sepsis; White People
PubMed: 31144133
DOI: 10.1007/s40615-019-00590-z -
Ear and HearingThe author's objective was to evaluate sex and race representation in temporal bone histopathology studies.
OBJECTIVES
The author's objective was to evaluate sex and race representation in temporal bone histopathology studies.
DESIGN
PubMed, Embase, Cochrane, Web of Science, and Scopus were searched for studies written in English examining temporal bone histopathology specimens from U.S.-based institutions from January 1, 1947, to September 1, 2021. Two authors then performed "snowballing" by reviewing references from the initial search and included the studies that fulfilled the inclusion criteria. For each study, the following information was collected: publication details, study design, funding, institution from where temporal bone specimens were procured, number of study specimens, and donor demographical information.
RESULTS
The authors found that out of 300 studies, 166 (55%) report sex while only 15 (5%) reported race information. Over the past 70 years, the ratio of studies reporting sex to those that do not has increased from 1.00 to 2.19 and the number of female temporal bone histopathology subjects relative to male has increased from 0.67 to 0.75. Over 90% of studies that do report this information feature participant racial compositions that do not reflect the diversity of the U.S. population.
CONCLUSIONS
Studies of temporal bone histopathology often do not report participant sex or race. The reporting of participant sex and the inclusion of specimens from female donors have both increased over time. However, temporal bone histopathology study cohorts are not representative of the racial diversity of the U.S. population. The otolaryngology community must strive to build temporal bone histopathology libraries that are representative of the diverse U.S. population.
Topics: Female; Humans; Male; Research Design; United States; Temporal Bone; Racial Groups; Sex
PubMed: 36763469
DOI: 10.1097/AUD.0000000000001340 -
JAMA Health Forum Jun 2024The five 1997 Office of Management and Budget races in the US include American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other...
IMPORTANCE
The five 1997 Office of Management and Budget races in the US include American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White, with Hispanic ethnicity. Despite the Affordable Care Act mandating Office of Management and Budget-based collecting and reporting standards, race and ethnicity publishing in medical journals is inconsistent, despite being necessary to achieve health equity.
OBJECTIVE
To quantify race and ethnicity reporting rates and calculate representation quotients (RQs) in published oncology clinical trials.
EVIDENCE REVIEW
In this systematic review, PubMed and Embase were queried for phase 2/3 clinical trials of the 6 most common noncutaneous solid cancers, published between January 1, 2012, and December 31, 2022, in 4 high-impact journals. Trial characteristics were recorded. The RQs for each race and ethnicity were calculated by dividing the percent of representation in each clinical trial publication by the percent of year-matched, site-specific incident cancers in the US, compared with Kruskal-Wallis tests with Bonferroni correction (BC). Reporting was compared between journal publications and ClinicalTrials.gov.
FINDINGS
Among 1202 publications evaluated, 364 met inclusion criteria: 16 JAMA, 241 Journal of Clinical Oncology, 19 Lancet, and 88 New England Journal of Medicine. Publications included 268 209 patients (171 132 women [64%]), with a median of 356 (IQR, 131-800) patients per publication. Reported race and ethnicity included American Indian or Alaska Native in 52 (14%) publications, Asian in 196 (54%), Black or African American in 215 (59%), Hispanic in 67 (18%), Native Hawaiian or Other Pacific Islander in 28 (8%), and White in 254 (70%). Median RQ varied across race (P < .001 BC), with 1.04 (IQR, 0.09-4.77) for Asian, 0.98 (IQR, 0.86-1.06) for White, 0.42 (IQR, 0.12-0.75) for Black or African American, and 0.00 (IQR, 0.00-0.00) for both American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander patients. Sensitivity analyses showed similar findings on subset analysis for US-only clinical trials. There was significantly less race and ethnicity reporting in the clinical trial publications compared with ClinicalTrials.gov documentation for American Indian or Alaska Native (14% vs 45%; P < .001 per McNemar χ2 test with continuity correction [MC]) and Native Hawaiian or Other Pacific Islander (8% vs 43%; P < .001 MC).
CONCLUSIONS AND RELEVANCE
While most phase 2/3 oncology clinical trials published in high-impact journals report race and ethnicity, most did not report American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander racial categories. Our findings support a call to action for consistent journal policies and transparent race and ethnicity reporting, in alignment with Affordable Care Act-concordant race and ethnicity federal reporting requirements.
Topics: Humans; Racial Groups; Clinical Trials, Phase III as Topic; Clinical Trials, Phase II as Topic; United States; Neoplasms; Ethnicity
PubMed: 38848090
DOI: 10.1001/jamahealthforum.2024.1388 -
Women's Health Issues : Official... 2011inadequate prenatal care and higher incidences of higher-risk behaviors and gestational diabetes, in addition to other significant determinants of health, place... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
inadequate prenatal care and higher incidences of higher-risk behaviors and gestational diabetes, in addition to other significant determinants of health, place aboriginal women at increased risk of adverse pregnancy outcomes. We conducted a systematic review and meta-analyses of pregnancy and neonatal outcomes among aboriginal women.
METHODS
we searched Medline, Embase, and CINAHL for English-language studies reporting rates of pregnancy and neonatal outcomes among aboriginal women. Data were extracted by three reviewers in duplicate. Study quality was assessed for biases in selection, exposure assessment, confounder adjustment, analyses, outcomes assessment, and attrition. Data were synthesized using random effect model. Subgroup analyses were performed based on the country of origin of the aboriginal women.
RESULTS
thirty-eight studies of low to moderate risk of biases were included. Adjustment for confounding factors was performed in eight studies. Unadjusted odds of low birth weight (LBW), preterm birth (PTB), stillbirth, neonatal and perinatal mortality were increased among infants born to aboriginal women. However, adjusted odds were only increased for PTB and stillbirths. Subgroup analyses revealed higher unadjusted odds of LBW, PTB, stillbirth, and neonatal and perinatal mortality among Australian aboriginals; PTB, macrosomia, stillbirth and neonatal and perinatal mortality among Canadian aboriginals, and PTB and neonatal mortality among American Indians and Alaskan Native women.
CONCLUSION
aboriginal women are at increased risk of adverse pregnancy outcomes especially PTB; however, future studies assessing confounders adjusted estimates are needed. Differences in outcomes exist based on the country of origin of aboriginal women, reasons for which should be investigated.
Topics: Adolescent; Adult; Australia; Canada; Female; Fetal Macrosomia; Gestational Age; Humans; Indians, North American; Infant Mortality; Infant, Low Birth Weight; Infant, Newborn; Maternal Age; Native Hawaiian or Other Pacific Islander; Pregnancy; Pregnancy Outcome; Premature Birth; Prenatal Care; Young Adult
PubMed: 21129997
DOI: 10.1016/j.whi.2010.08.005 -
The European Respiratory Journal Jun 2013The 2005 guidelines of the American Thoracic Society/European Respiratory Society recommend the use of race- and/or ethnic-specific reference standards for spirometry.... (Review)
Review
The 2005 guidelines of the American Thoracic Society/European Respiratory Society recommend the use of race- and/or ethnic-specific reference standards for spirometry. Yet definitions of the key variables of race and ethnicity vary worldwide. The purpose of this study was to determine whether researchers defined race and/or ethnicity in studies of lung function and how they explained any observed differences. Using the methodology of the systematic review, we searched PubMed in July 2008 and screened 10 471 titles and abstracts to identify potentially eligible articles that compared "white" to "other racial and ethnic groups". Of the 226 eligible articles published between 1922 and 2008, race and/or ethnicity was defined in 17.3%, with the proportion increasing to 70% in the 2000s for those using parallel controls. Most articles (83.6%) reported that "other racial and ethnic groups" have a lower lung capacity compared to "white"; 94% of articles failed to examine socioeconomic status. In the 189 studies that reported lower lung function in "other racial and ethnic groups", 21.8% and 29.4% of explanations cited inherent factors and anthropometric differences, respectively, whereas 23.1% of explanations cited environmental and social factors. Even though researchers sought to determine differences in lung function by race/ethnicity, they typically failed to define their terms and frequently assumed inherent (or genetic) differences.
Topics: Ethnicity; Europe; Humans; Lung Diseases; Pulmonary Medicine; Research Design; Respiratory Function Tests; Socioeconomic Factors; Spirometry; United States
PubMed: 22878881
DOI: 10.1183/09031936.00091612