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1.
JAMA Netw Open ; 7(4): e245091, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38573634

RESUMO

Importance: Differences in patient use of health information technologies by race can adversely impact equitable access to health care services. While this digital divide is well documented, there is limited evidence of how health care systems have used interventions to narrow the gap. Objective: To compare differences in the effectiveness of patient training and portal functionality interventions implemented to increase portal use among racial groups. Design, Setting, and Participants: This secondary analysis used data from a randomized clinical trial conducted from December 15, 2016, to August 31, 2019. Data were from a single health care system and included 6 noncancer hospitals. Participants were patients who were at least 18 years of age, identified English as their preferred language, were not involuntarily confined or detained, and agreed to be provided a tablet to access the inpatient portal during their stay. Data were analyzed from September 1, 2022, to October 31, 2023. Interventions: A 2 × 2 factorial design was used to compare the inpatient portal training intervention (touch, in-person [high] vs built-in video tutorial [low]) and the portal functionality intervention (technology, full functionality [full] vs a limited subset of functions [lite]). Main Outcomes and Measures: Primary outcomes were inpatient portal use, measured by frequency and comprehensiveness of use, and use of specific portal functions. A logistic regression model was used to test the association of the estimators with the comprehensiveness use measure. Outcomes are reported as incidence rate ratios (IRRs) for the frequency outcomes or odds ratios (ORs) for the comprehensiveness outcomes with corresponding 95% CIs. Results: Of 2892 participants, 550 (19.0%) were Black individuals, 2221 (76.8%) were White individuals, and 121 (4.2%) were categorized as other race (including African, American Indian or Alaska Native, Asian or Asian American, multiple races or ethnicities, and unknown race or ethnicity). Black participants had a significantly lower frequency (IRR, 0.80 [95% CI, 0.72-0.89]) of inpatient portal use compared with White participants. Interaction effects were not observed between technology, touch, and race. Among participants who received the full technology intervention, Black participants had lower odds of being comprehensive users (OR, 0.76 [95% CI, 0.62-0.91), but interaction effects were not observed between touch and race. Conclusions and Relevance: In this study, providing in-person training or robust portal functionality did not narrow the divide between Black participants and White participants with respect to their inpatient portal use. Health systems looking to narrow the digital divide may need to consider intentional interventions that address underlying issues contributing to this inequity. Trial Registration: ClinicalTrials.gov Identifier: NCT02943109.


Assuntos
Portais do Paciente , Grupos Raciais , Humanos , Pacientes Internados , Tato , Educação de Pacientes como Assunto
2.
Politics Life Sci ; 43(1): 99-131, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38567783

RESUMO

Recent research suggests that contemporary American society is marked by heightened hostile racial rhetoric, alongside increasing salience of White nationalists who justify an ideology of racial hierarchy with claims of biological superiority. Media coverage of such genetics research has often emphasized a deterministic (or causal) narrative by suggesting that specific genes directly increase negative outcomes and highlighting reported genetic differences between racial groups. Across two experimental studies, we examine the effect of the media's portrayal of scientific findings linking genes with negative health and behavioral outcomes on measures of racism. We find that deterministic genetic attributions for health and behavioral outcomes can lead to more negative racial out-group attitudes. Importantly, we also investigate potential interventions in the presentation of genetic science research. Our research has implications for understanding racial attitudes and racialized ideology in contemporary American politics, as well as for framing scientific communication in intergroup contexts.


Assuntos
Racismo , Humanos , Estados Unidos , Atitude , Grupos Raciais , Narração , Brancos
3.
Fam Med ; 56(3): 169-175, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38467005

RESUMO

BACKGROUND AND OBJECTIVES: Accreditation standards for MD- and DO-granting institutions require medical schools to recruit a diverse student body and educate students about diverse groups of patients. The minority tax is a summary of responsibilities assigned to racial and ethnic underrepresented faculty to achieve diversity, equity, and inclusion in medical institutions in addition to their typical academic workload. This article provides a narrative review of medical students' experiences of the minority tax and recommendations on how medical educators can support an equitable learning environment by eliminating the minority tax. METHODS: We searched the PubMed, Web of Science, and Scopus databases, Google Scholar, and medical society websites, blogs, and fora for terms, including minority tax, medical students, and undergraduate medical education. We included publications if they discussed the underrepresented in medicine medical students' experiences of the minority tax. RESULTS: Our search yielded six peer-reviewed original research articles and six publications of commentaries, opinion pieces, or news pieces. Students who were underrepresented in medicine reported spending more hours on diversity efforts compared with students who were not underrepresented; moreover, students reported that they had to sacrifice academic excellence in order to fulfill these additional diversity duties. CONCLUSIONS: The minority tax among medical students constitutes an unequitable and unjust barrier to career advancement, and it likely represents an early cause of attrition in the pipeline of underrepresented in medicine academic faculty. Medical educators can enact specific recommendations to eliminate or mitigate the minority tax experience for medical students.


Assuntos
Estudantes de Medicina , Humanos , Grupos Minoritários , Faculdades de Medicina , Grupos Raciais , Docentes de Medicina
4.
Cien Saude Colet ; 29(3): e05092023, 2024 Mar.
Artigo em Português, Inglês | MEDLINE | ID: mdl-38451645

RESUMO

This ecological study of time trends and multiple groups evaluated incompleteness in the race/colour field of Brazilian health information system records and the related time trend, 2009-2018, for the diseases and disorders most prevalent in the black population. The Romero and Cunha (2006) classification was applied in order to examine incompleteness using secondary data from Brazil's National Notifiable Diseases System, Hospital Information System and Mortality Information System, by administrative regions of Brazil, while percentage underreporting and time trend were calculated using simple linear regression models with Prais-Winsten correction (p-value<0.05). All records scored poorly except those for mortality from external causes (excellent), tuberculosis (good) and infant mortality (fair). An overall downward trend was observed in percentage incompleteness. Analysis by region found highest mean incompleteness in the North (30.5%), Northeast (33.3%) and Midwest (33.0%) regions. The Southeast and Northeast regions showed the strongest downward trends. The findings intended to increase visibility on the implications of the race/color field for health equity.


Propõe-se avaliar a incompletude e a tendência temporal do preenchimento do campo raça/cor das doenças e agravos mais prevalentes na população negra nos Sistemas de Informação em Saúde do Brasil, 2009-2018. Trata-se de estudo ecológico de tendência temporal e múltiplos grupos. Foi adotada a classificação de Romero e Cunha (2006) para análise da incompletude e utilizados dados secundários do Sistema Nacional de Agravos de Notificação, Sistema de Informações Hospitalares e Sistema de Informações sobre Mortalidade do Brasil e regiões brasileiras, calculada a proporção de subnotificação e a tendência temporal, utilizando o modelo de regressão linear simples, com correção Prais-Winsten (p-valor<0,05). Excetuando-se os registros de mortalidade por causas externas (excelente), tuberculose (bom) e mortalidade infantil (regular), todos os registros apresentaram escore ruim. Observou-se tendência decrescente da proporção de incompletude. A análise por região mostrou que as maiores médias de incompletude foram registradas na região Norte (30,5%), Nordeste (33,3%) e Centro-Oeste (33,0%). As regiões Sudeste e Nordeste foram as que mais apresentaram tendência decrescente. Os resultados visam ampliar a visibilidade acerca das implicações do preenchimento do campo raça/cor para a equidade em saúde.


Assuntos
Sistemas de Informação em Saúde , Sistemas de Informação Hospitalar , Humanos , População Negra , Brasil/epidemiologia , Grupos Raciais , Etnicidade
5.
Cien Saude Colet ; 29(3): e04882023, 2024 Mar.
Artigo em Português, Inglês | MEDLINE | ID: mdl-38451644

RESUMO

The present study aimed to investigate the association between racial iniquities and oral health status. This is a systematic review with a protocol registered on the Prospero Platform (CRD42021228417), with searches carried out in electronic databases and in gray literature. Our study identified 3,028 publications. After applying the eligibility criteria and risk of bias analysis, 18 studies were selected. The results indicate that individuals of black/brown race/skin color have unfavorable oral health conditions, mainly represented by self-rated oral health, tooth loss, caries, and periodontitis. The results showed racial iniquities in oral health in different countries, for all analyzed indicators, with a greater vulnerability of the black population.


O objetivo deste estudo é investigar a associação entre iniquidades raciais e condição de saúde bucal. Trata-se de revisão sistemática com protocolo cadastrado na plataforma prospero (CRD42021228417), com buscas realizadas em bases de dados eletrônicas e na literatura cinzenta. Identificou-se 3.028 publicações e após aplicação dos critérios de elegibilidade e análise do risco de vieses, 18 estudos foram selecionados. Os resultados indicam que indivíduos de raça/cor da pele preta/parda apresentam condições de saúde bucal desfavorável, representada principalmente pela autoavaliação de saúde bucal, perda dentária, cárie e periodontite. Os resultados evidenciaram iniquidades raciais em saúde bucal em diferentes países, para todos os indicadores analisados, com maior vulnerabilidade da população negra.


Assuntos
População Negra , Saúde Bucal , Humanos , Bases de Dados Factuais , Definição da Elegibilidade , Grupos Raciais
6.
Cien Saude Colet ; 29(3): e10202023, 2024 Mar.
Artigo em Português, Inglês | MEDLINE | ID: mdl-38451652

RESUMO

This ecological, time-trend study examined rates of homicide against women residing in Brazil, by state and race/colour, from 2016 to 2020, by performing. Multiple analysis by regression model on longitudinal data. During the study period, 20,405 homicides of women were recorded in Brazil. Standardised homicides rates were higher among black women (6.1/100,000) than among white women (3.4/100,000). From 2016 to 2020, rates decreased 25.2%, from 4.7 deaths per 100,000 women in 2016 to 3.5 in 2020, with a statistically significant downward trend among both black and white women. Statistically significant inverse relationships were found between female homicide rates and HDI, illiteracy rate and proportion of ill-defined causes. The average homicide rate decreased in 2019 and 2020, as compared with 2016. Despite the decreasing time trend in homicide rates for both black and white women, they differed substantially by race, with worse outcomes for black women.


O objetivo deste estudo é avaliar as taxas de homicídios contra mulheres residentes no Brasil, segundo unidades da federação e raça/cor, no período de 2016 a 2020. Trata-se de um estudo ecológico de tendência temporal. Foi realizada análise múltipla adotando-se modelo de regressão para dados longitudinais. No período, ocorreram no Brasil 20.405 homicídios de mulheres e as taxas padronizadas mostraram que as mulheres negras (6,1/100.000) apresentaram as maiores taxas, em comparação às brancas (3,4/100.000). O Brasil apresentou queda de 25,2% de 2016 a 2020. A taxa de homicídio variou de 4,7 mortes por 100 mil mulheres em 2016 para 3,5 em 2020, mas a tendência decrescente e estatisticamente significante foi observada nas taxas de mulheres negras e brancas. As variáveis IDH, taxa de analfabetismo e proporção de causas mal definidas apresentaram uma relação inversa e estatisticamente significante com as taxas de homicídio de mulheres. Nos anos de 2019 e 2020 houve uma diminuição da taxa média de homicídio em relação ao ano de 2016. Apesar do decrescimento na evolução temporal das taxas para negras e brancas, houve diferenças raciais importantes nos homicídios de mulheres, com piores resultados para as mulheres negras.


Assuntos
População Negra , Homicídio , Feminino , Humanos , Brasil/epidemiologia , Grupos Raciais , Etnicidade
7.
BMC Infect Dis ; 24(1): 287, 2024 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-38448806

RESUMO

BACKGROUND: Hepatitis C virus (HCV) infection is a major global concern, with Indigenous Peoples bearing the highest burden. Previous studies exploring HCV prevalence within Indigenous populations have predominantly used a pan-Indigenous approach, consequently resulting in limited availability of Métis-specific HCV data. The Métis are one of the three recognized groups of Indigenous Peoples in Canada with a distinct history and language. The Métis Nation of Ontario (MNO) is the only recognized Métis government in Ontario. This study aims to examine the prevalence of self-reported HCV testing and positive results among citizens of the MNO, as well as to explore the association between sociodemographic variables and HCV testing and positive results. METHODS: A population-based online survey was implemented by the MNO using their citizenship registry between May 6 and June 13, 2022. The survey included questions about hepatitis C testing and results, socio-demographics, and other health related outcomes. Census sampling was used, and 3,206 MNO citizens responded to the hepatitis C-related questions. Descriptive statistics and bivariate analysis were used to analyze the survey data. RESULTS: Among the respondents, 827 (25.8%, CI: 24.3-27.3) reported having undergone HCV testing and 58 indicated testing positive, resulting in a prevalence of 1.8% (CI: 1.3-2.3). Respondents with a strong sense of community belonging, higher education levels, and lower household income were more likely to report having undergone HCV testing. Among those who had undergone testing, older age groups, individuals with lower education levels, and retired individuals were more likely to test positive for HCV. CONCLUSION: This study is the first Métis-led and Métis-specific study to report on HCV prevalence among Métis citizens. This research contributes to the knowledge base for Métis health and will support the MNO's health promotion program and resources for HCV. Future research will examine the actual HCV incidence and prevalence among MNO citizens.


Assuntos
Hepacivirus , Hepatite C , Humanos , Idoso , Ontário/epidemiologia , Prevalência , Hepatite C/epidemiologia , Grupos Raciais
8.
MMWR Morb Mortal Wkly Rep ; 73(9): 204-208, 2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38451870

RESUMO

Social determinants of health (SDOH) are a broad array of social and contextual conditions where persons are born, live, learn, work, play, worship, and age that influence their physical and mental wellbeing and quality of life. Using 2022 Behavioral Risk Factor Surveillance System data, this study assessed measures of adverse SDOH and health-related social needs (HRSN) among U.S. adult populations. Measures included life satisfaction, social and emotional support, social isolation or loneliness, employment stability, food stability/security, housing stability/security, utility stability/security, transportation access, mental well-being, and health care access. Prevalence ratios were adjusted for age, sex, education, marital status, income, and self-rated health. Social isolation or loneliness (31.9%) and lack of social and emotional support (24.8%) were the most commonly reported measures, both of which were more prevalent among non-Hispanic (NH) American Indian or Alaska Native, NH Black or African American, NH Native Hawaiian or other Pacific Islander, NH multiracial, and Hispanic or Latino adults than among NH White adults. The majority of prevalence estimates for other adverse SDOH and HRSN were also higher across all other racial and ethnic groups (except for NH Asian) compared with NH White adults. SDOH and HRSN data can be used to monitor needed social and health resources in the U.S. population and help evaluate population-scale interventions.


Assuntos
Qualidade de Vida , Determinantes Sociais da Saúde , Adulto , Humanos , Estados Unidos/epidemiologia , Sistema de Vigilância de Fator de Risco Comportamental , Grupos Raciais , Havaí
9.
JAMA Netw Open ; 7(3): e243194, 2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38512251

RESUMO

Importance: Immigrant birthing people have lower rates of preterm birth compared with their US-born counterparts. This advantage and associated racial and ethnic disparities across the gestational age spectrum have not been examined nationally. Objective: To examine associations of maternal nativity, ethnicity, and race with preterm birth. Design, Setting, and Participants: This cohort study used birth certificates from the National Vital Statistics System to analyze in-hospital liveborn singleton births in the US between January 1, 2009, and December 31, 2018. Data were analyzed from January to June 2023. Exposure: Mutually exclusive nativity, ethnicity, and race subgroups were constructed using nativity (defined as US-born or non-US-born), ethnicity (defined as Hispanic or non-Hispanic), and race (defined as American Indian or Alaska Native, Asian, Black, Native Hawaiian or Other Pacific Islander, White, or other [individuals who selected other race or more than 1 race]). Main Outcomes and Measures: The primary outcome of interest was preterm birth. Modified Poisson and multinomial logistic regression models quantified relative risk (RR) of preterm birth overall (<37 weeks' gestation) and by gestational category (late preterm: 34-36 weeks' gestation; moderately preterm: 29-33 weeks' gestation; and extremely preterm: <29 weeks' gestation) for each maternal nativity, ethnicity, and race subgroup compared with the largest group, US-born non-Hispanic White (hereafter, White) birthing people. The RR of preterm birth overall and by category was also measured within each racial and ethnic group by nativity. Models were adjusted for maternal demographic and medical covariates, birth year, and birth state. Results: A total of 34 468 901 singleton live births of birthing people were analyzed, with a mean (SD) age at delivery of 28 (6) years. All nativity, ethnicity, and race subgroups had an increased adjusted risk of preterm birth compared with US-born White birthing people except for non-US-born White (adjusted RR, 0.85; 95% CI, 0.84-0.86) and Hispanic (adjusted RR, 0.98; 95% CI, 0.97-0.98) birthing people. All racially and ethnically minoritized groups had increased adjusted risks of extremely preterm birth compared with US-born White birthing people. Non-US-born individuals had a decreased risk of preterm birth within each subgroup except non-Hispanic Native Hawaiian or Other Pacific Islander individuals, in which immigrants had significantly increased risk of overall (adjusted RR, 1.07; 95% CI, 1.01-1.14), moderately (adjusted RR, 1.10; 95% CI, 0.92-1.30), and late (adjusted RR, 1.11; 95% CI, 1.02-1.22) preterm birth than their US-born counterparts. Conclusions and Relevance: Results of this cohort study suggest heterogeneity of preterm birth across maternal nativity, ethnicity, and race and gestational age categories. Understanding these patterns could aid the design of targeted preterm birth interventions and policies, especially for birthing people typically underrepresented in research.


Assuntos
Nascimento Prematuro , Adulto , Feminino , Humanos , Recém-Nascido , Estudos de Coortes , Etnicidade , Nascimento Prematuro/epidemiologia , Grupos Raciais
10.
JAMA ; 331(10): 861-865, 2024 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-38470384

RESUMO

Importance: Gummies, flavored vaping devices, and other cannabis products containing psychoactive hemp-derived Δ8-tetrahydrocannabinol (THC) are increasingly marketed in the US with claims of being federally legal and comparable to marijuana. National data on prevalence and correlates of Δ8-THC use and comparisons to marijuana use among adolescents in the US are lacking. Objective: To estimate the self-reported prevalence of and sociodemographic and policy factors associated with Δ8-THC and marijuana use among US adolescents in the past 12 months. Design, Setting, and Participants: This nationally representative cross-sectional analysis included a randomly selected subset of 12th-grade students in 27 US states who participated in the Monitoring the Future Study in-school survey during February to June 2023. Exposures: Self-reported sex, race, ethnicity, and parental education; census region; state-level adult-use (ie, recreational) marijuana legalization (yes vs no); and state-level Δ8-THC policies (regulated vs not regulated). Main Outcomes and Measures: The primary outcome was self-reported Δ8-THC and marijuana use in the past 12 months (any vs no use and number of occasions used). Results: In the sample of 2186 12th-grade students (mean age, 17.7 years; 1054 [48.9% weighted] were female; 232 [11.1%] were Black, 411 [23.5%] were Hispanic, 1113 [46.1%] were White, and 328 [14.2%] were multiracial), prevalence of self-reported use in the past 12 months was 11.4% (95% CI, 8.6%-14.2%) for Δ8-THC and 30.4% (95% CI, 26.5%-34.4%) for marijuana. Of those 295 participants reporting Δ8-THC use, 35.4% used it at least 10 times in the past 12 months. Prevalence of Δ8-THC use was lower in Western vs Southern census regions (5.0% vs 14.3%; risk difference [RD], -9.4% [95% CI, -15.2% to -3.5%]; adjusted risk ratio [aRR], 0.35 [95% CI, 0.16-0.77]), states in which Δ8-THC was regulated vs not regulated (5.7% vs 14.4%; RD, -8.6% [95% CI, -12.9% to -4.4%]; aRR, 0.42 [95% CI, 0.23-0.74]), and states with vs without legal adult-use marijuana (8.0% vs 14.0%; RD, -6.0% [95% CI, -10.8% to -1.2%]; aRR, 0.56 [95% CI, 0.35-0.91]). Use in the past 12 months was lower among Hispanic than White participants for Δ8-THC (7.3% vs 14.4%; RD, -7.2% [95% CI, -12.2% to -2.1%]; aRR, 0.54 [95% CI, 0.34-0.87]) and marijuana (24.5% vs 33.0%; RD, -8.5% [95% CI, -14.9% to -2.1%]; aRR, 0.74 [95% CI, 0.59-0.94]). Δ8-THC and marijuana use prevalence did not differ by sex or parental education. Conclusions and Relevance: Δ8-THC use prevalence is appreciable among US adolescents and is higher in states without marijuana legalization or existing Δ8-THC regulations. Prioritizing surveillance, policy, and public health efforts addressing adolescent Δ8-THC use may be warranted.


Assuntos
Dronabinol , Alucinógenos , Uso da Maconha , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Adulto , Feminino , Humanos , Masculino , Cannabis , Estudos Transversais , Fumar Maconha/epidemiologia , Fumar Maconha/legislação & jurisprudência , Uso da Maconha/epidemiologia , Uso da Maconha/legislação & jurisprudência , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia , Prevalência , Estudantes/estatística & dados numéricos , Autorrelato , Grupos Raciais/etnologia , Grupos Raciais/estatística & dados numéricos , Dronabinol/análogos & derivados
11.
JAMA Netw Open ; 7(3): e242961, 2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38506809

RESUMO

Importance: Despite the widely recognized importance of racial and ethnic concordance between patients and clinicians, there is a lack of studies on clinician diversity in medically underserved areas and whether it aligns with the changing demographic landscape. Objective: To assess trends in National Health Services Corps (NHSC) clinician diversity and racial and ethnic concordance between NHSC clinicians and the populations in underserved areas from before to after the 2009 NHSC expansion. Design, Setting, and Participants: This cross-sectional, population-based study compared trends in the diversity of NHSC clinicians practicing in health professional shortage areas (HPSAs) and the HPSA populations during 2003 to 2019 using the Health Resources and Services Administration's NHSC Field Strength Database and Area Health Resources Files. The analysis was performed from February through May 2023. Main Outcomes and Measures: Concordance was measured with an annual community representativeness ratio defined as the ratio of the proportions of same race or ethnicity NHSC clinicians to HPSA population. Results: There were a total of 41 180 clinicians practicing in HPSAs from 2003 to 2019; the median (IQR) age was 34 (30-41) years. Among 38 569 NHSC clinicians who reported gender, 28 444 (73.7%) identified as female and 10 125 (26.3%) identified as male. The average annual number of NHSC clinicians increased from 3357 in 2003 to 2008 to 9592 in 2009 to 2019. Before 2009, 1076 clinicians (5.3%) identified as Black, 9780 (48.6%) as Hispanic, 908 (4.5%) as other, and 8380 (41.6%) as White. During this period, concordance was low among non-Hispanic White and Black individuals due to clinician underrepresentation relative to the population, yet Hispanic clinicians were overrepresented. Following the 2009 NHSC expansion, the main change was the sharp decline in the proportion of Hispanic clinicians, to 1601 (13%) by 2019; while concordance was achieved for non-Hispanic White and Black individuals, Hispanic clinicians became underrepresented relative to population. The results held across 3 specialties: primary care, mental health care, and dental care. Conclusions and Relevance: This cross-sectional study of trends in racial and ethnic concordance found that while the NHSC expansion starting in 2009 improved clinician-population concordance for non-Hispanic White and Black individuals, it reversed a prior trend for Hispanic individuals among whom clinicians became underrepresented relative to the population. Targeted NHSC clinician recruitment efforts are needed to improve concordance for Hispanic individuals in underserved areas, especially given Hispanics' projected growth in the US.


Assuntos
Área Carente de Assistência Médica , Médicos , Populações Vulneráveis , Adulto , Feminino , Humanos , Masculino , Estudos Transversais , Hispânico ou Latino , Medicina Estatal , Grupos Raciais , Etnicidade , Médicos/estatística & dados numéricos
12.
PLoS One ; 19(3): e0298896, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38507346

RESUMO

Starch residue analysis was carried out on stone tools recovered from the bottom layer of the Anakena site on Rapa Nui (Easter Island). These deposits have been dated to AD 1000-1300 AD and so far, represent the earliest evidence of human settlement on this island. Twenty obsidian tools were analyzed. Analysis of 46 starch grains recovered from 20 obsidian tools from the earliest dated level of the Anakena site on Rapa Nui provides direct evidence for translocation of traditional crop plants at initial stages of the colonization of this island. The analysis of starch grains was based mainly on statistical methods for species identification but was complemented by visual inspection in some cases. Our results identify taxons previously unknown to have been cultivated on the island, such as breadfruit (Artocarpus altilis), Zingiber officinale (ginger), and starch grains of the Spondias dulcis and Inocarpus fagifer tropical trees. Additionally, starch grains of Colocasia esculenta (taro) and Dioscorea sp. (yam), both common species in Pacific agriculture, were identified. Furthermore, the presence of four American taxa Ipomoea batatas (sweet potato), Canna sp. (achira), Manihot esculenta (manioc), and Xanthosoma sp., was detected. The occurrence of Canna sp., M. esculenta, and Xanthosoma sp. starch grains suggests the translocation of previously not described South American cultivars into the Pacific. The detection of I. batatas from this site in Rapa Nui constitutes the earliest record of this cultigen in the Pacific. Our study provides direct evidence for translocation of a set of traditional Polynesian and South American crop plants at the initial stages of colonization in Rapa Nui.


Assuntos
Artocarpus , Dioscorea , Ipomoea batatas , Humanos , Amido , Grupos Raciais , Produtos Agrícolas , América do Sul
13.
Natl Vital Stat Rep ; 73(3): 1-9, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38536215

RESUMO

Objectives- This report presents infant mortality rates for selected maternal characteristics (prepregnancy body mass index, cigarette smoking during pregnancy, receipt of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits during pregnancy, timing of prenatal care, and source of payment for delivery) for the five largest maternal race and Hispanic-origin groups in the United States for combined years 2019-2021. Methods-Descriptive tabulations based on data from the linked birth/infant death files for 2019-2021 are presented. The linked birth/infant death file is based on birth and death certificates registered in all 50 states and the District of Columbia. Infant mortality rates are presented for each maternal race and Hispanic-origin group overall and by selected characteristics. Results-Infant mortality rates varied across the five largest maternal race and Hispanic-origin groups and by selected maternal characteristics. For most race and Hispanic-origin groups, mortality rates were higher among infants of women with prepregnancy obesity compared with those of women who were normal weight, and were higher for infants of women who smoked cigarettes during pregnancy, received late or no prenatal care, or were covered by Medicaid as the source of payment for delivery. Overall, mortality rates were higher for infants of women who received WIC during pregnancy, but results varied across race and Hispanic-origin groups. Mortality rates for the maternal characteristics examined were generally highest among infants of Black non-Hispanic and American Indian and Alaska Native non-Hispanic women and lowest for Asian non-Hispanic women.


Assuntos
Hispânico ou Latino , Mortalidade Infantil , Feminino , Humanos , Lactente , Gravidez , Etnicidade , Morte do Lactente , Estados Unidos/epidemiologia , Grupos Raciais
14.
Soc Sci Med ; 346: 116737, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38447335

RESUMO

Despite overwhelming evidence to the contrary, the concept of 'race' as a biological unit continues to persist in various scientific disciplines, notably in the field of medicine. This paper explores the persistence of 'race as biology' in medical research via examining select citational practices that have perpetuated this problematic concept. Citations serve as a cornerstone in scientific literature, signifying reliability and expert affirmation. By analyzing citation threads and historical patterns, we aim to shed light on the creation and perpetuation of false scientific truths and their impact on medical research, training, and practice. We focus on two prominent examples, eGFR and Spirometry, and trace key articles' citational histories, highlighting the flawed evidence in support of racial corrections in medical assessments. The eGFR equation incorporates 'race' as a factor based on the erroneous belief that Black individuals have higher muscle mass than white individuals. Our analysis reveals that key cited sources for this belief lack robust and well-developed datasets. Similarly, Spirometry measurements incorporate racial correction factors, relying on questionable evidence dating back to the Civil War era. Citations serve as a cornerstone in scientific literature, signifying reliability and expert affirmation. They play a crucial role in shaping theoretical positions and validating data and assumed knowledge. Evaluating citation threads and key articles consistently referenced over time can reveal how falsehoods and erroneous assertions are constructed and maintained in scientific fields. This study underscores the need for critical examination of citational practices in medical research and urges a shift toward a more cautious approach when citing sources that support 'race as biology.' The paper calls for a reevaluation of pedagogical approaches and assigned readings in medical education to prioritize an anti-racist perspective in future research endeavors.


Assuntos
Algoritmos , Grupos Raciais , Espirometria , Humanos , Reprodutibilidade dos Testes
16.
J Am Heart Assoc ; 13(7): e031313, 2024 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-38529656

RESUMO

There are now abundant data demonstrating disparities in acute stroke management and prognosis; however, interventions to reduce these disparities remain limited. This special report aims to provide a critical review of the current landscape of disparities in acute stroke care and highlight opportunities to use implementation science to reduce disparities throughout the early care continuum. In the prehospital setting, stroke symptom recognition campaigns that have been successful in reducing prehospital delays used a multilevel approach to education, including mass media, culturally tailored community education, and professional education. The mobile stroke unit is an organizational intervention that has the potential to provide more equitable access to timely thrombolysis and thrombectomy treatments. In the hospital setting, interventions to address implicit biases among health care providers in acute stroke care decision-making are urgently needed as part of a multifaceted approach to advance stroke equity. Implementing stroke systems of care interventions, such as evidence-based stroke care protocols at designated stroke centers, can have a broader public health impact and may help reduce geographic, racial, and ethnic disparities in stroke care, although further research is needed. The long-term impact of disparities in acute stroke care cannot be underestimated. The consistent trend of longer time to treatment for Black and Hispanic people experiencing stroke has direct implications on long-term disability and independence after stroke. A learning health system model may help expedite the translation of evidence-based interventions into clinical practice to reduce disparities in stroke care.


Assuntos
Disparidades em Assistência à Saúde , Acidente Vascular Cerebral , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Hispânico ou Latino , Grupos Raciais , Prognóstico
17.
Popul Health Manag ; 27(2): 128-136, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38442304

RESUMO

Hip and knee replacement have been marked by racial and ethnic disparities in both utilization and postoperative adverse events among Medicare beneficiaries, but limited knowledge exists regarding racial and ethnic differences in joint replacement care among Medicaid beneficiaries. To close this gap, this study used Medicaid claims in 2018 and described racial and ethnic differences in the utilization and postoperative adverse events of elective joint replacements among Medicaid beneficiaries. Among the 2,260,272 Medicaid beneficiaries, 5987 had an elective joint replacement in 2018. Asian (0.05%, 95% confidence interval [CI]: 0.03%-0.07%) and Hispanic beneficiaries (0.12%, 95% CI: 0.07%-0.18%) received joint replacements less frequently than American Indian and Alaska Native (0.41%, 95% CI: 0.27%-0.55%), Black (0.33%, 95% CI: 0.19%-0.48%), and White (0.37%, 95% CI: 0.25%-0.50%) beneficiaries. Black patients demonstrated the highest probability of 90-day emergency department visits (34.8%, 95% CI: 32.7%-37.0%) among all racial and ethnic groups and a higher probability of 90-day readmission (8.0%, 95% CI: 6.9%-9.0%) than Asian (3.4%, 95% CI: 0.7%-6.0%) and Hispanic patients (4.4%, 95% CI: 3.4%-5.3%). These findings indicate evident disparities in postoperative adverse events across racial and ethnic groups, with Black patients demonstrating the highest probability of 90-day emergency department visits. This study represents an initial exploration of the racial and ethnic differences in joint replacement care among Medicaid beneficiaries and lay the groundwork for further investigation into contributing factors of the observed disparities.


Assuntos
Artroplastia do Joelho , Etnicidade , Disparidades em Assistência à Saúde , Grupos Raciais , Humanos , Medicaid , Estados Unidos , Aceitação pelo Paciente de Cuidados de Saúde , Complicações Pós-Operatórias/epidemiologia , Readmissão do Paciente/estatística & dados numéricos
18.
Gen Hosp Psychiatry ; 88: 23-29, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38452405

RESUMO

OBJECTIVE: A cluster randomized controlled trial (RCT) of two interventions for addressing perinatal depression treatment in obstetric settings was conducted. This secondary analysis compared treatment referral and participation among Minoritized perinatal individuals compared to their non-Hispanic white counterparts. METHODS: Among perinatal individuals with depression symptoms, we examined rates of treatment 1) referral (i.e., offered medications or referred to mental health clinician), 2) initiation (i.e., attended ≥1 mental health visit or reported prescribed antidepressant medication), and 3) sustainment (i.e., attended >1 mental health visit per study month or prescribed antidepressant medication at time of study interviews). We compared non-Hispanic white (NHW) (n = 149) vs. Minoritized perinatal individuals (Black, Asian, Hispanic/Latina, Pacific Islander, Native American, Multiracial, and white Hispanic/Latina n = 157). We calculated adjusted odds ratios (aOR) for each outcome. RESULTS: Minoritized perinatal individuals across both interventions had significantly lower odds of treatment referral (aOR = 0.48;95% CI = 0.27-0.88) than their NHW counterparts. There were no statistically significant differences in the odds of treatment initiation (aOR = 0.64 95% CI:0.36-1.2) or sustainment (aOR = 0.54;95% CI = 0.28-1.1) by race/ethnicity. CONCLUSIONS: Perinatal mental healthcare inequities are associated with disparities in treatment referrals. Interventions focusing on referral disparities across race and ethnicity are needed.


Assuntos
Depressão , Etnicidade , Disparidades em Assistência à Saúde , Grupos Raciais , Feminino , Humanos , Gravidez , Antidepressivos/uso terapêutico , Iniquidades em Saúde
19.
J AAPOS ; 28(2): 103870, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38460595

RESUMO

PURPOSE: To examine the prevalence of and factors associated with racial and ethnic reporting and trends in such reporting and to assess whether categories of race and ethnicity have been under- or over-represented in pediatric ophthalmology randomized control trials (RCTs) in the United States. METHODS: We systematically searched the literature on pediatric ophthalmology RCTs in high-impact factor ophthalmology journals published between 2000 and 2022. Logistic regression was used to assess parameters linked to race/ethnicity reporting; linear regression, to gauge the relationship between publication year and race/ethnicity reporting. The racial and ethnic composition of RCTs was contrasted with 2010 US census data by calculating percentage difference. RESULTS: Of 170 eligible articles, 89 (52.4%) included race/ethnicity data. Multivariable analysis showed that academic (OR = 12.19; 95% CI, 3.34-44.44) and government (OR = 3.91; 95% CI, 1.20-12.72) funding was linked to data reporting. During the study period, publication year and race/ethnicity reporting had a nonstatistically significant 1.0% annual increase (r = 0.29, P = 0.18). White participants were over-represented, with a percentage difference of 16.7% (95% CI, 11.8%-21.7%), whereas Hispanic individuals were under-represented, with a percentage difference of -7.6% (95% CI, -11.2% to -4.1%) compared to the 2010 US census data. CONCLUSIONS: Our results indicate a gradual rise in reported race and/or ethnicity in published pediatric ophthalmology RCTs, though not statistically significant, both in the United States and globally. Notably, under-representation of Hispanic, over-representation of White, and proportional representation of Black and Asian individuals were observed in US-based studies.


Assuntos
Etnicidade , Oftalmologia , Grupos Raciais , Criança , Humanos , Projetos de Pesquisa , Estados Unidos , Ensaios Clínicos Controlados Aleatórios como Assunto
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