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Journal of General Internal Medicine May 2008To better understand the causes of racial disparities in health care, we reviewed and synthesized existing evidence related to disparities in the "equal access" Veterans... (Review)
Review
OBJECTIVES
To better understand the causes of racial disparities in health care, we reviewed and synthesized existing evidence related to disparities in the "equal access" Veterans Affairs (VA) health care system.
METHODS
We systematically reviewed and synthesized evidence from studies comparing health care utilization and quality by race within the VA.
RESULTS
Racial disparities in the VA exist across a wide range of clinical areas and service types. Disparities appear most prevalent for medication adherence and surgery and other invasive procedures, processes that are likely to be affected by the quantity and quality of patient-provider communication, shared decision making, and patient participation. Studies indicate a variety of likely root causes of disparities including: racial differences in patients' medical knowledge and information sources, trust and skepticism, levels of participation in health care interactions and decisions, and social support and resources; clinician judgment/bias; the racial/cultural milieu of health care settings; and differences in the quality of care at facilities attended by different racial groups.
CONCLUSIONS
Existing evidence from the VA indicates several promising targets for interventions to reduce racial disparities in the quality of health care.
Topics: Black or African American; Healthcare Disparities; Hospitals, Veterans; Humans; Minority Groups; Patient Compliance; Prejudice; Surgical Procedures, Operative; United States; White People
PubMed: 18301951
DOI: 10.1007/s11606-008-0521-4 -
The Journal of Cardiovascular Nursing 2018Despite Korean Americans being one of the fastest growing immigrant groups in the United States, little is known about their cardiovascular health or cardiovascular... (Review)
Review
BACKGROUND
Despite Korean Americans being one of the fastest growing immigrant groups in the United States, little is known about their cardiovascular health or cardiovascular disease risk factors.
PURPOSE
The purpose of this report is to describe the prevalence of cardiovascular disease risks and their contributing factors in Korean Americans and recommend future directions for the development of cardiovascular disease prevention or management research to meet the unique needs of this ethnic group.
METHODS
We conducted a systematic review using databases of PubMed, CINAHL, PsycINFO, Web of Science, and the Cochrane Database of Systematic Reviews and identified 27 studies that reported the prevalence of cardiovascular disease or its risk factors in Korean Americans, published in English between 2000 and 2016.
RESULTS
We found high rates of unhealthy behaviors (eg, consumption of a high-sodium diet, physical inactivity, smoking) and risk factors (eg, hypertension, diabetes) for cardiovascular disease. Moreover, they were less likely to receive counseling about their diseases from healthcare providers and modify their lifestyle (eg, reduce their diet sodium intake, control their weight) to manage their diseases than were other ethnic populations. Individual-, interpersonal-, community-, and societal-level influences contributed to the high prevalence of cardiovascular risk factors.
CONCLUSIONS
Data on subgroups of Asian Americans indicate that Korean Americans have significant lifestyle-related cardiovascular disease risks, which could be a critical agenda for researchers and clinicians to better understand cardiovascular health disparities in the United States.
Topics: Asian; Cardiovascular Diseases; Health Behavior; Humans; Prevalence; Republic of Korea; United States
PubMed: 28525522
DOI: 10.1097/JCN.0000000000000417 -
Frontiers in Human Neuroscience 2022This meta-analysis investigated (1) whether ethnic minority and majority members have a neural inter-group bias toward each other, and (2) whether various ethnic groups...
INTRODUCTION
This meta-analysis investigated (1) whether ethnic minority and majority members have a neural inter-group bias toward each other, and (2) whether various ethnic groups (i.e., White, Black, and Asian) are processed in the brain differently by the other respective ethnicities.
METHODS
A systematic coordinate-based meta-analysis of functional magnetic resonance imaging (fMRI) studies was conducted using Web of Science, PubMed, and PsycINFO (altogether 50 datasets, = 1211, 50.1% female).
RESULTS
We found that ethnic minority members did not show any signs of neural inter-group bias (e.g., no majority-group derogation). Ethnic majority members, in turn, expressed biased responses toward minority (vs. majority) members in frontal, parietal, temporal, and occipital regions that are known to be involved in e.g., facial processing, attention, and perspective-taking. We also found differences in neural response patterns toward different ethnic groups (White, Black, and Asian); broadest biases in neural response patterns were evident toward Black individuals (in non-Black individuals). Heterogeneity was mostly minor or low.
DISCUSSION
Overall, the findings increase understanding of neural processes involved in ethnicity perception and cognition as well as ethnic prejudices and discrimination. This meta-analysis provides explanations for previous behavioral reports on ethnic discrimination toward minority groups.
PubMed: 36684846
DOI: 10.3389/fnhum.2022.1072345 -
Journal of the American Academy of... Apr 2024To examine the risk of anxiety disorders in offspring of parents with mood disorders. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To examine the risk of anxiety disorders in offspring of parents with mood disorders.
METHOD
We conducted a systematic review and meta-analysis. We searched 4 electronic databases (Medline, Embase, PsycINFO, and Web of Science [core collection]) to identify cross-sectional and cohort studies that examined the association between parental mood disorders (including bipolar disorder and unipolar depression) and risk of anxiety disorders in offspring. Pooled risk ratios (RRs) of overall and specific anxiety disorders were synthesized using a random effects model. Subgroup analyses and meta-regression were performed to identify moderation factors.
RESULTS
A total of 35 studies were included in the final analysis. Our results showed higher risks of all types of anxiety disorders in the offspring of parents with mood disorders (any anxiety disorder, RR = 1.82, 95% CI = 1.47-2.26), except for agoraphobia (RR = 1.08, 95% CI = 0.56-2.08), and with an especially elevated risk of panic disorder (RR = 3.07, 95% CI = 2.19-4.32). Subgroup analysis demonstrated no significant difference between the risks of anxiety disorders across the offspring of parents with bipolar disorder as opposed to unipolar depression. The absence of anxiety disorders in control parents, younger offspring age, and specific parent/offspring sex were associated with higher RRs for some anxiety disorders in offspring of parents with mood disorders.
CONCLUSION
Our findings suggest a robust relationship between parental mood disorders and offspring anxiety disorders, and highlight the potential value of prevention and early intervention for anxiety disorders in this context.
DIVERSITY & INCLUSION STATEMENT
We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.
STUDY PREREGISTRATION INFORMATION
Anxiety Disorders in Offspring of Parents with Mood Disorders: A Systematic Review; https://www.crd.york.ac.uk/prospero/; CRD42021215058.
Topics: Humans; Mood Disorders; Cross-Sectional Studies; Anxiety Disorders; Parents; Depressive Disorder; Child of Impaired Parents
PubMed: 37453607
DOI: 10.1016/j.jaac.2023.06.022 -
Journal of Perinatal Medicine Sep 2022The US preterm birth rate varies dramatically by race and ethnicity yet the racial and ethnic representation within studies evaluating 17-hydroxprogesterone caproate...
OBJECTIVES
The US preterm birth rate varies dramatically by race and ethnicity yet the racial and ethnic representation within studies evaluating 17-hydroxprogesterone caproate (17-P) for preterm birth prevention is unknown. The objectives of our study were to 1) examine the racial and ethnic representation of participants in 17-P preterm birth prevention studies, 2) evaluate adherence to the NIH race and ethnicity reporting guidelines and 3) compare racial and ethnic representation in research studies to national preterm birth incidence.
METHODS
We systematically reviewed US studies published between January 2000 and December 2019. Study participant's race and ethnicity were reported using descriptive statistics then compared to US 2017//2018 preterm birth data using Pearson's chi-square.
RESULTS
Eighteen studies met the inclusion criteria, 17 studies reported race, 11 studies reported ethnicity, and yet none of the studies followed the NIH criteria. Compared to 2017/2018 US preterm births, the proportion of black/African American study participants was significantly higher whereas the proportions of all other race categories were lower.
CONCLUSIONS
More detailed reporting of race and ethnicity is needed in 17-P literature. Black women appear to be well represented while other racial and ethnic groups may be understudied.
Topics: 17 alpha-Hydroxyprogesterone Caproate; 17-alpha-Hydroxyprogesterone; Caproates; Ethnicity; Female; Humans; Infant, Newborn; Premature Birth
PubMed: 36027908
DOI: 10.1515/jpm-2021-0425 -
Quality of Life Research : An... Jul 2023This study aimed to systematically identify, appraise, and summarize the psychometric properties of instruments used to measure the quality of dying and death in Asian... (Review)
Review
PURPOSE
This study aimed to systematically identify, appraise, and summarize the psychometric properties of instruments used to measure the quality of dying and death in Asian countries.
METHODS
The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) was closely followed. The literature was searched using the following keywords and their synonyms: "death and dying," "measurement," and "Asian country" in CINAHL, PubMed, PsycInfo, Web of Science, and Cochrane Library from inception to April 2021. Two reviewers independently screened titles and abstracts and reviewed the full text. Two other reviewers independently assessed the quality of the identified studies in three steps: methodological quality evaluation, good measurement properties evaluation, and quality of evidence evaluation.
RESULTS
This review retrieved 37,195 studies, of which seven were finally included. Four instruments that assessed the quality of dying and death in Asian countries were identified: the Good Death Inventory (GDI), the Good Death Scale (GDS), and two versions of the Quality of Dying and Death (QODD) Questionnaires. All included studies failed to evaluate all the recommended psychometric properties, and none of the instruments provided strong evidence of their quality among Asian populations. Overall, the grade of evidence quality for the GDI was moderate, the highest among all identified instruments.
CONCLUSION
The GDI is by far the most reliable instrument for assessing the quality of dying and death in Asian populations. A lack of validation studies in Asian and Western cultures, however, warrants caution when drawing conclusions from the GDI.
Topics: Humans; Asian; Consensus; Psychometrics; Quality of Life; Reproducibility of Results; Surveys and Questionnaires; Health Status; Death
PubMed: 36441382
DOI: 10.1007/s11136-022-03307-8 -
Journal of General Internal Medicine Jun 2021Data suggest that there were disparities in H1N1 vaccine uptake, and these may inform COVID-19 vaccination efforts. We conducted a systematic review to evaluate... (Review)
Review
BACKGROUND
Data suggest that there were disparities in H1N1 vaccine uptake, and these may inform COVID-19 vaccination efforts. We conducted a systematic review to evaluate disparities in H1N1 vaccine uptake, factors contributing to disparities, and interventions to reduce them.
METHODS
We searched English-language articles in MEDLINE ALL, PsycINFO, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials from database inception through May 8, 2020. Observational studies examining H1N1 vaccine uptake by race/ethnicity, socioeconomic status, rurality, and disability status in US settings were included. Two reviewers independently assessed study eligibility. Single-reviewer data abstraction was confirmed by a second reviewer. We conducted independent dual quality assessment, and collective strength of evidence assessment.
RESULTS
We included 21 studies. African American/Black, Latino, and low-socioeconomic status participants had disproportionately lower H1N1 vaccination rates (low- to moderate-strength evidence). However, Latinos were more likely than Whites to intend to be vaccinated, and African American/Blacks and participants with lower-socioeconomic status were just as likely to intend to be vaccinated as their White and higher-socioeconomic status counterparts (low-strength evidence). Vaccine uptake for other groups has been insufficiently studied. Factors potentially contributing to disparities in vaccine uptake included barriers to vaccine access, inadequate information, and concerns about vaccine safety and efficacy. Studies were largely cross-sectional. Many of the studies are a decade old and were conducted in the context of a different pandemic. The categorization of racial and ethnic groups was not consistent across studies and not all groups were well-studied.
DISCUSSION
Efforts to avoid disparities in COVID-19 vaccination uptake should prioritize vaccine accessibility and convenience in African American/Black, Latino, and low-SES communities; engage trusted stakeholders to share vaccine information; and address concerns about vaccine safety and efficacy.
PRIMARY FUNDING SOURCE
Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development.
PROTOCOL REGISTRATION
PROSPERO CRD42020187078.
Topics: COVID-19; COVID-19 Vaccines; Cross-Sectional Studies; Healthcare Disparities; Humans; Influenza A Virus, H1N1 Subtype; SARS-CoV-2; Vaccination
PubMed: 33791935
DOI: 10.1007/s11606-021-06715-7 -
Clinical Interventions in Aging 2015Alzheimer's disease (AD) is the most common form of dementia. Mutations in the genes encoding presenilin 1 (PSEN1), presenilin 2 (PSEN2), and amyloid precursor protein... (Review)
Review
Alzheimer's disease (AD) is the most common form of dementia. Mutations in the genes encoding presenilin 1 (PSEN1), presenilin 2 (PSEN2), and amyloid precursor protein have been identified as the main genetic causes of familial AD. To date, more than 200 mutations have been described worldwide in PSEN1, which is highly homologous with PSEN2, while mutations in PSEN2 have been rarely reported. We performed a systematic review of studies describing the mutations identified in PSEN2. Most PSEN2 mutations were detected in European and in African populations. Only two were found in Korean populations. Interestingly, PSEN2 mutations appeared not only in AD patients but also in patients with other disorders, including frontotemporal dementia, dementia with Lewy bodies, breast cancer, dilated cardiomyopathy, and Parkinson's disease with dementia. Here, we have summarized the PSEN2 mutations and the potential implications of these mutations in dementia-associated disorders.
Topics: Alzheimer Disease; Amyloid Precursor Protein Secretases; Amyloid beta-Peptides; Breast Neoplasms; Cardiomyopathy, Dilated; Dementia; Exons; Humans; Mutation; Parkinson Disease; Phenotype; Presenilin-2; Protein Isoforms; Racial Groups; Transcription, Genetic
PubMed: 26203236
DOI: 10.2147/CIA.S85808 -
Journal of Global Health Jun 2021People from racial minority groups in western countries experience disproportionate socioeconomic and structural determinants of health disadvantages. These... (Meta-Analysis)
Meta-Analysis
BACKGROUND
People from racial minority groups in western countries experience disproportionate socioeconomic and structural determinants of health disadvantages. These disadvantages have led to inequalities and inequities in health care access and poorer health outcomes. We report disproportionate disparities in prevalence, hospitalisation, and deaths from COVID-19 by racial minority populations.
METHODS
We conducted a systematic literature search of relevant databases to identify studies reporting on prevalence, hospitalisations, and deaths from COVID-19 by race groups between 01 January 2020 - 15 April 2021. We grouped race categories into Blacks, Hispanics, Whites and Others. Random effects model using the method of DerSimonian and Laird were fitted, and forest plot with respective ratio estimates and 95% confidence interval (CI) for each race category, and subgroup meta-regression analyses and the overall pooled ratio estimates for prevalence, hospitalisation and mortality rate were presented.
RESULTS
Blacks experienced significantly higher burden of COVID-19: prevalence ratio 1.79 (95% confidence interval (CI) = 1.59-1.99), hospitalisation ratio 1.87 (95% CI = 1.69-2.04), mortality ratio 1.68 (95% CI = 1.52-1.83), compared to Whites: prevalence ratio 0.70 (95% CI = 0.0.64-0.77), hospitalisation ratio 0.74 (95% CI = 0.65-0.82), mortality ratio 0.82 (95% CI = 0.78-0.87). Also, Hispanics experienced a higher burden: prevalence ratio 1.78 (95% CI = 1.63-1.94), hospitalisation ratio 1.32 (95% CI = 1.08-1.55), mortality ratio 0.94 (95% CI = 0.84-1.04) compared to Whites. A higher burden was also observed for Other race groups: prevalence ratio 1.43 (95% CI = 1.19-1.67), hospitalisation ratio 1.12 (95% CI = 0.89-1.35), mortality ratio 1.06 (95% CI = 0.89-1.23) compared to Whites. The disproportionate burden among Blacks and Hispanics remained following correction for publication bias.
CONCLUSIONS
Blacks and Hispanics have been disproportionately affected by COVID-19. This is deeply concerning and highlights the systemically entrenched disadvantages (social, economic, and political) experienced by racial minorities in western countries; and this study underscores the need to address inequities in these communities to improve overall health outcomes.
Topics: COVID-19; Health Status Disparities; Healthcare Disparities; Hospitalization; Humans; Mortality; Pandemics; Prevalence; SARS-CoV-2
PubMed: 34221360
DOI: 10.7189/jogh.11.05015 -
Journal of Foot and Ankle Research Jul 2022Ongoing colonisation produces inequity in healthcare delivery and inequality in healthcare outcomes for Aboriginal and Torres Strait Islander Peoples. As a consequence,... (Review)
Review
BACKGROUND
Ongoing colonisation produces inequity in healthcare delivery and inequality in healthcare outcomes for Aboriginal and Torres Strait Islander Peoples. As a consequence, within the domain of lower limb health, foot disease has severe impacts for First Nations Peoples. Central to developing culturally safe healthcare and driving positive foot health change for First Nations Peoples, is the need for health professionals to develop understanding of First Nations perspectives of foot health. The aim of this systematic review was to evaluate studies investigating Aboriginal and Torres Strait Islander Peoples' perceptions of foot and lower limb health.
METHODS
PubMeD, Ovid (Embase, Emcare, Medline), CINAHL, Informit Indigenous collection, and grey literature sources were searched to 23 July 2021. We included any published reports or studies that examined Aboriginal and Torres Strait Islander Peoples' perceptions of foot and lower limb health, or meanings of, or attitudes to, foot and lower limb health.
RESULTS
Four studies with a total of 1515 participants were included. Studies found that Aboriginal and Torres Strait Islander people self-assessed foot health with a demonstrated ability to perceive their feet as healthy relative to Western clinical measures of peripheral blood supply and neurological function. Footwear, including ill-fitting or lack of footwear was considered a contributing factor to reduced foot and lower limb health. Foot pain affected up to 60% of participants with up to 70% of foot pain untreated. Lack of access to culturally safe health care delivered by culturally capable health professionals was perceived to contribute to worse foot and lower limb health outcomes.
CONCLUSIONS
Aboriginal and Torres Strait Islander Peoples' perceptions of foot and lower limb health are influenced by multiple complex interrelated factors. The limited number of studies in this area indicates ongoing failings to consult First Nations Peoples regarding their own lower limb and foot health. It is therefore essential that healthcare service and cultural capability implementation is led by Aboriginal and Torres Strait Islander Peoples in co-design. Urgent need for further research that exemplifies design and delivery of culturally safe care is required.
Topics: Delivery of Health Care; Foot; Health Status; Humans; Lower Extremity; Native Hawaiian or Other Pacific Islander; Pain
PubMed: 35869536
DOI: 10.1186/s13047-022-00557-0