No Racial Disparity in Outcome Measures After Endovascular Treatment for Stroke in the Elderly.

BACKGROUND AND PURPOSE: Despite the lower rates of good outcomes and higher mortality in elderly patients, age does not modify the treatment effect of mechanical thrombectomy for large vessel occlusion strokes. We aimed to study whether racial background influences the outcome after mechanical thrombectomy in the elderly population. METHODS: We reviewed a prospectively maintained database of patients with acute ischemic stroke treated with mechanical thrombectomy from October 2010 through June 2020 to identify all consecutive patients with age ≥80 years and anterior circulation large vessel occlusion strokes. The patients were categorized according to their race as Black and White. Univariable and multivariable analyses were performed to define the predictors of 90-day modified Rankin Scale and mortality in the overall population and in each race separately. RESULTS: Among 2241 mechanical thrombectomy, a total of 344 patients (median [interquartile range]; age 85 [82-88] years, baseline National Institutes of Health Stroke Scale score of 19 [15-23], Alberta Stroke Program Early CT Score 9 [7-9], 69.5% females) were eligible for the analysis. White patients (n=251; 73%) had significantly lower median body mass index (25.37 versus 26.89, P=0.04) and less frequent hypertension (78.9% versus 90.3%, P=0.01) but more atrial fibrillation (64.5% versus 44.1%, P=0.001) compared with African Americans (n=93; 27%). Other clinical, imaging, and procedural characteristics were comparable between groups. The rates of symptomatic intracerebral hemorrhage, 90-day modified Rankin Scale score of 0 to 2, and mortality were comparable among both groups. On multivariable analysis, race was neither a predictor of 90-day modified Rankin Scale score of 0 to 2 (White race: odds ratio, 0.899 [95% CI, 0.409-1.974], P=0.79) nor 90-day mortality (White race: odds ratio, 1.368; [95% CI, 0.715-2.618], P=0.34). CONCLUSIONS: In elderly patients undergoing mechanical thrombectomy for acute ischemic stroke, there was no racial difference in terms of outcome.

Psicologia, Racismo e Antirracismo: segunda parte / Psicología, racismo y antirracismo: segunda parte / Psychology, Racism and Anti-racism: second part

Apresentamos os artigos publicados no dossiê Psicologia, Racismo e Antirracismo —Parte 2. As referências às questões raciais têm ganhado espaço no campo da Psicologia e os olhares sobre as questões raciais nessa ciência estão frequentemente presentes como aspectos específicos de teorias críticas, mas a depender do “lugar” que tais olhares ocupam dentro dessas teorias, os impactos e críticas para a própria Psicologia ganham dimensões que apontam para inclusões pontuais de algumas categoriais ou para revisões mais amplas e estruturais desse campo do co-nhecimento. Os artigos publicizados neste dossiê contribuem para interpelar a Psicologia que ao longo da história contribuiu para a reprodução do racismo, articulado com outras opressões e violências e apontam caminhos de mudança na área e revelam a necessidade de um giro an-tirracista na Psicologia. (AU)

We present the articles published in the dossier Psychology, Racism and Anti-Racism –Part 2. References to racial issues have gained space in the field of Psychology and the perspectives on racial issues in this science are often present as specific aspects of critical theories, but depending on the “place” that such perspectives occupy within these theories, the impacts, and criticisms for Psychology itself gain dimensions that point to punctual inclusions of some categories or to broader and more structural revisions of this field of knowledge. The articles published in this dossier contribute to questioning Psychology that throughout history has con-tributed to the reproduction of racism, articulated with other oppressions and violence, and point out ways of change in the area and reveal the need for an anti-racist turn in Psychology. (AU)

A contribuição dos estudos críticos da branquitude para compreensão do preconceito racial na psicologia social / La contribución de los estudios críticos del blanqueo a la comprensión del prejuicio racial en la psicología social / The contribution of critical whiteness studies to the understanding of racial prejudice in social psychology

Este artigo tem como objetivo apresentar as principais abordagens em que a psicologia social clássica norte-americana teorizou sobre o preconceito racial, o racismo e o antirracismo e, a partir delas, trazer os estudos críticos da branquitude como possibilidades para superar os limi-tes identificados nessa corrente, que ora apresenta um indivíduo fora da estrutura, ora a estru-tura sem indivíduos. Para isto, neste artigo definimos três abordagens propostas pela psicologia social norte-americana: teste de associação implícita; teoria do contato intergrupal e racismo aversivo; e emoções específicas. A partir daí mostramos como os estudos críticos da branquitu-de se apresentam como uma síntese entre essas duas posições opostas, que oscilam entre o in-divíduo e a estrutura. Nesta perspectiva, a estrutura se manifesta na própria experiência sub-jetiva do indivíduo, que se torna capaz de identificá-la em seu próprio campo experiencial. (AU)

The goal of this article is to present the main approaches through which classical North Amer-ican social psychology has theorized about racial prejudice, racism and antiracism, and on that basis present critical whiteness studies as possibilities to overcome the limits identified within these approaches, which presents us either with individuals outside the structure, or with a structure with no individuals. For that purpose, in this article we identify three main ap-proaches in North American social psychology: implicit association test; intergroup contact theory and aversive racism; and specific emotions. On that basis we show how critical white-ness studies may be presented as a synthesis between these two extremes, which oscillates between the individual and the structure. In this perspective, the structure is manifested in the individual’s subjective experience in the world, and thus identifiable in one’s own experi-ential field. (AU)

La articulación del racismo y la homofobia en los valores de la población europea / The articulation of racism and homophobia in the values of the European population

Racismo y homofobia representan dos grandes desafíos para las sociedades contemporáneas. El síndrome de enemistad grupal (SEG) y el homonacionalismo representan dos conceptos, apa-rentemente opuestos, para la comprensión de la relación entre racismo y homofobia. En este artículo analizamos esta relación en los valores de la población de Austria, Francia, España y Holanda, a partir de los datos de la European Values Study2017. Empleamos el método de la tipología estructural y articulada, con análisis de correspondencias y un análisis de clasifica-ción. Nuestros resultados confirman parcialmente la adecuación, tanto del SEG como del ho-monacionalismo, para explicar la relación entre el racismo y la homofobia. Por un lado, el ra-cismo resultó más elevado que la homofobia en todos los grupos. Por el otro, obtuvimos un grupo moderadamente racista y poco homófobo, otro racista y homófobo y sólo en un grupo muy minoritario se visualizaron tendencias hacia una sociedad genuinamente inclusiva. (AU)

Social research has identified racism and homophobia as two of the great challenges for con-temporary societies. The syndrome of group focused enmity (SGE) and homonationalism repre-sent two apparently opposite concepts in understanding the relationship between racism and homophobia. In this article we analyse this relationship considering the values of the popula-tion of Austria, France, Spain, and the Netherlands, based on data from the European Values Study 2017. We use the method of structural and articulated typology, with analysis of corre-spondences and classification analysis. Our results lead us to partially confirm the adequacy of both SEG and homonationalism to explain the relationship between racism and homophobia. On the one hand, racism was higher than homophobia in all groups. On the other hand, we ob-tained a moderately racist and slightly homophobic group, another racist and homophobic group and only in a very minority group tendencies towards a genuinely inclusive society were visualized. (AU)

Toward an Anti-Racist Approach to Biomedical and Neuroscience Research.

Racism is a threat to public health. Race is a sociopolitical construct that has been used for generations to create disparities in educational access, housing conditions, exposure to environmental contaminants, and access to health care. Collectively, these disparities have a negative impact on the health of non-white Americans. The National Institutes of Health (NIH) funds biomedical research, including basic neuroscience research, aimed at understanding the mechanisms and consequences of health and disease in Americans. NIH has recently acknowledged its own structural racism, the disadvantage this perpetuates in the biomedical research enterprise, and has announced its commitment to eliminating these disparities. Here, we discuss different rates of disease in U.S. citizens from different racial backgrounds. We next describe ways in which the biomedical research enterprise (1) has contributed to health disparities and (2) can contribute to the solving this problem. Based on our own scientific expertise, we use neuroscience in general and mental health/addiction disorders more specifically as examples of a broader issue. The NIH, including its neuroscience-focused Institutes, and NIH-funded scientists, including neuroscientists, should prioritize research topics that reflect the health conditions that affect all Americans, not just white Americans.

Ten-Year Trend in Age, Sex, and Racial Disparity in tPA (Alteplase) and Thrombectomy Use Following Stroke in the United States.

Background and Purpose: IV tPA (intravenous thrombolysis with alteplase) and mechanical thrombectomy (MT) utilization increased in acute ischemic stroke hospitalizations in the United States over the last decade. It is uncertain whether this increase occurred equally across all age, sex, and racial groups. Methods: Adult acute ischemic stroke hospitalizations (weighted n=4 442 657) contained in the 2008 to 2017 National Inpatient Sample were identified using International Classification of Diseases codes. Proportions of hospitalizations with IV tPA and MT were computed according to age, sex, and race. Joinpoint and multivariable-adjusted logistic regression models were used to evaluate trends over time. Results: Across this period, 32.4% of all hospitalizations were in patients ≥80 years, and 64.7% of these were women. IV tPA and MT use differed by age with highest proportion of utilization of both treatments in patients aged 18 to 39 years (IV tPA, 12.3%) and lowest percentage in patients aged ≥90 years (IV tPA, 7.9%). Utilization of both procedures increased over time in all age groups, but the pace of increase was faster in patients ≥90 years compared with patients aged 18 to 39 years (MT: odds ratio, 1.25 [95% CI, 1.20­1.35] per unit increase in year, P interaction <0.001). Frequency of utilization of IV tPA and MT was lower in Black patients compared with White patients in most age groups. Usage of both procedures increased over time in all races and after 2015, IV tPA utilization was >10% in all demographic subgroups except in Black patients 60 to 79 years and Black patients ≥80 years. Analysis of race-by-time interaction revealed the Black-vs-White treatment gaps for IV tPA (odds ratio, 1.02 [95% CI, 1.01­1.03]) and MT (odds ratio, 1.08 [95% CI,1.05­1.12]) declined over time (both P interaction <0.01). Sex-related differences in IV tPA use were noted, but this gap also declined over time. Conclusions: Age- and sex-related treatment gaps in IV tPA and MT reduced over the last decade. Racial disparity in IV tPA and MT utilization persists with particularly lower frequency of usage of both acute stroke treatments in Black patients compared with White patients, but race-associated treatment gaps also declined over time.

The Reality for Minorities Exploring Nurse Executive Leadership.

Practices to increase diversity in nursing have had little effect at the executive leadership level. Lack of diversity in leadership threatens efforts to improve patient care and reduce disparities. This article advocates for formal mentorship as an evidence-based pathway to expand diversity in nurse executive leadership.

Looking back on a life of unacknowledged privilege and a call to action.

The year 2020 provided a wake-up call about the role systemic racism plays in shaping our nation and shaping science. While hard work and great mentors helped bring me a long way from a farm in Minnesota, it's become much clearer that the privilege of being white and male and the accumulated advantages that began there played powerful roles. It's time for white scientists like me to listen, think, and take action.

Aggression, Escalation, and Other Latent Themes in Legal Intervention Deaths of Non-Hispanic Black and White Men: Results From the 2003‒2017 National Violent Death Reporting System.

Objectives. To investigate racial/ethnic differences in legal intervention‒related deaths using state-of-the-art topic modeling of law enforcement and coroner text summaries drawn from the 2003-2017 US National Violent Death Reporting System (NVDRS). Methods. Employing advanced topic modeling, we identified 8 topics consistent with dangerousness in death incidents in the NVDRS death narratives written by public health workers (PHWs). Using logistic regression, we then evaluated racial/ethnic differences in PHW-coded variables and narrative topics among 4981 males killed by legal intervention, while adjusting for age, county-level characteristics, and year. Results. Black, as compared with White, decedents were younger and their deaths were less likely to include PHW-coded mental health or substance use histories, weapon use, or positive toxicology for alcohol or psychoactive drugs, but more likely to include "gangs-as-an-incident-precipitant" coding. Topic modeling revealed less frequent thematic representation of "physical aggression" or "escalation" but more of "gangs or criminal networks" among Black versus White decedents. Conclusions. While Black males were more likely to be victims of legal intervention deaths, PHW-coded variables in the NVDRS and death narratives suggest lower threat profiles among Black versus similar White decedents. The source of this greater risk remains undetermined.

New Horizons-Addressing Healthcare Disparities in Endocrine Disease: Bias, Science, and Patient Care.

Unacceptable healthcare disparities in endocrine disease have persisted for decades, and 2021 presents a difficult evolving environment. The COVID-19 pandemic has highlighted the gross structural inequities that drive health disparities, and antiracism demonstrations remind us that the struggle for human rights continues. Increased public awareness and discussion of disparities present an urgent opportunity to advance health equity. However, it is more complicated to change the behavior of individuals and reform systems because societies are polarized into different factions that increasingly believe, accept, and live different realities. To reduce health disparities, clinicians must (1) truly commit to advancing health equity and intentionally act to reduce health disparities; (2) create a culture of equity by looking inwards for personal bias and outwards for the systemic biases built into their everyday work processes; (3) implement practical individual, organizational, and community interventions that address the root causes of the disparities; and (4) consider their roles in addressing social determinants of health and influencing healthcare payment policy to advance health equity. To care for diverse populations in 2021, clinicians must have self-insight and true understanding of heterogeneous patients, knowledge of evidence-based interventions, ability to adapt messaging and approaches, and facility with systems change and advocacy. Advancing health equity requires both science and art; evidence-based roadmaps and stories that guide the journey to better outcomes, judgment that informs how to change the behavior of patients, providers, communities, organizations, and policymakers, and passion and a moral mission to serve humanity.

Fifteen-year trends in self-reported racism and link with health and well-being of African Canadian adolescents: a secondary data analysis.

BACKGROUND: We assessed the prevalence and trends in racial discrimination among African Canadian adolescents in British Columbia. The association between racial discrimination and self-rated health, access to mental health services, substance use, suicidal thoughts and attempts, experience of extreme stress, among others were examined within the 2018 dataset. METHODS: Secondary analysis used the data collected from African Canadian adolescents (n = 2448) as part of the British Columbia Adolescent Health Surveys (2003-2018). We examined whether racial discrimination increased, decreased, or remained stable over time. We evaluated experiences of racial discrimination for all adolescents, and then disaggregated analyses for boys, girls, immigrant, and Canadian-born African adolescents. We used Rao-Scott's adjusted chi-square to test differences in racial discrimination and adjusted logistic regressions to test trends across survey years, widening or narrowing gaps in racial discrimination, as well as the link to health outcomes. RESULTS: Racial discrimination was significantly different across the survey years (Adjusted F = 4.60, p < .01), with the highest percentage of adolescents reporting past year racial discrimination in 2018 (29.9%) and the lowest percentage in 2013 (21.3%). Girls and immigrant African Canadian adolescents were more likely to have experienced racial discrimination. However, girls and Canadian-born adolescents had the highest odds of reporting racial discrimination in 2018 compared to 2003, AOR = 1.85, and 1.58, respectively. The findings reveal significant differences in the experiences of racial discrimination for boys and girls, as well as for immigrant and Canadian-born African adolescents. Significant differences were noted in the link between racial discrimination and self-rated health and engaging in behaviours that might expose them to health risks. The worst negative health outcomes were found for boys and immigrant African Canadian adolescents. CONCLUSION: The study suggests that more than 1 in 4 African Canadian adolescents in British Columbia report racial discrimination, which is an increasing trend in recent years. Those who reported racial discrimination also had the worst adverse health outcomes. There is a need for more public health action to reduce racism, create awareness about the negative health impacts, and provide better support for African Canadian adolescents.

Antiracist Praxis in Public Health: A Call for Ethical Reflections.

The Covid-19 pandemic has revealed myriad social, economic, and health inequities that disproportionately burden populations that have been made medically or socially vulnerable. Inspired by state and local governments that declared racism a public health crisis or emergency, the Anti-Racism in Public Health Act of 2020 reflects a shifting paradigm in which racism is considered a social determinant of health. Indeed, health inequities fundamentally rooted in structural racism have been exacerbated by the Covid-19 pandemic, which calls for the integration of antiracist praxis to promote ethical public health research processes. This commentary describes ways in which antiracist praxis-which emphasizes empowerment of traditionally marginalized populations-offers strategies to explicitly address power imbalance, stigmatization, and other consequences of structural racism in public health research.