Health Literacy (HL) & Health-Related Quality of Life (HRQL) Among Minority Men.

Health literacy remains a key factor in the continuance of health disparities in our society as health related quality of life can be negatively affected by limited health literacy. This study explores how limited health literacy among minority men, attending a community health fair, correlates with their health related quality of life. Findings reflect that minority men who possess lower levels of health literacy experience lower self-reported quality of life. Directions for healthcare providers, community health educators and future research approaches are provided.

Disparities in health-related Internet use among African American men, 2010.

Given the benefits of health-related Internet use, we examined whether sociodemographic, medical, and access-related factors predicted this outcome among African American men, a population burdened with health disparities. African American men (n = 329) completed an anonymous survey at a community health fair in 2010; logistic regression was used to identify predictors. Only education (having attended some college or more) predicted health-related Internet use (P < .001). African American men may vary in how they prefer to receive health information; those with less education may need support to engage effectively with health-related Internet use.

Pandemic Superimposed on Epidemic: Covid-19 Disparities in Black Americans.

Health and healthcare disparities are variances in the health of a population or the care rendered to a population. Disparities result in a disproportionately higher prevalence of disease or lower standard of care provided to the index group. Multiple theories exist regarding the genesis of this disturbing finding. The COVID-19 pandemic has had the unfortunate effect of amplifying health inequity in vulnerable populations. African Americans, who make up approximately 12% of the US population are reportedly being diagnosed with COVID-19 and dying at disproportionately higher rates. Viewed holistically, multiple factors are contributing to the perfect storm: 1) Limited availability of public testing, 2) A dramatic increase in low wage worker unemployment/health insurance loss especially in the service sector of the economy, 3) High rates of preexisting chronic disease states/reduced access to early healthcare and 4) Individual provider and structural healthcare system bias. Indeed, COVID-19 represents a pandemic superimposed on a historic epidemic of racial health inequity and healthcare disparities. Therapeutic solutions are not expected in the near term. Thus, identifying the genesis and magnitude of COVID-19's impact on African American communities is the requisite first step toward crafting an immediate well designed response. The mid and long term approach should incorporate population health based tactics and strategies.

Racial disparities in urologic health care.

In the United States, disparities in health care delivery and access are apparent between different racial and ethnic groups. Minorities, including African Americans, often suffer disproportionately from disease compared to Caucasians. In the urologic arena, this is apparent in urologic cancer screening, treatment choices, and survival, as well as in the arena of chronic kidney disease, transplant allocation, and transplant outcomes. Latino men also seem to be affected more often by erectile dysfunction than Caucasian counterparts. Disparities such as these have been identified as a problem in the delivery of health care in the United States, and resources have been allocated to help allay the disparity. Through organizations such as the Cleveland Clinic Minority Men's Health Center, policy initiatives, and increased cultural awareness by physicians, steps can be made to reduce and eliminate health care disparities.

A Contemporary Analysis of Outcomes and Modifiable Risk Factors of Ethnic Disparities in Kidney Transplantation.

OBJECTIVE: The aim of this study was to provide a contemporary analysis of longitudinal kidney transplant outcomes and to evaluate potential causes of ethnic disparities among African American (AA) and Caucasian American (CA) patients undergoing kidney transplantation at our institution. PATIENTS AND METHODS: 1400 patients were identified who underwent kidney transplantation from 2003 to 2013 from a large, academic institution in Cleveland, OH. Relevant recipient and donor demographic and clinical covariates were obtained from an institutional transplant database. Simple descriptive statistics and comparative survival analyses were performed to assess overall survival and graft survival. RESULTS: The final cohort was comprised of 341 AA and 1059 CA patients. AAs were less likely to receive a living donor transplant (27.6% vs. 57.2%, p < 0.001) compared to CAs. Overall patient survival did not significantly differ between the two groups even when stratified by ethnicity. However, AAs had a significantly lower rate of graft survival (p < 0.001). On stratified analysis, there was no difference in the rate of graft survival among AAs and CAs who received living donor grafts. On univariate analysis, AAs demonstrated higher rates of immunosuppression non-compliance and chronic rejection (both p < 0.05). On multivariate analysis, AA recipient ethnicity (HR 1.56, p = 0.047), recipient history of diabetes (HR 1.67, p < 0.001), and AA donor ethnicity (HR 1.56, p = 0.047) were significantly associated with graft failure. CONCLUSION: AAs undergoing deceased donor renal transplantation demonstrated lower graft survival compared to CAs. Conversely, this disparity did not exist among AAs undergoing living donor transplantation. AAs had higher rates of deceased donor transplantation, immunosuppression non-compliance, chronic rejection, and diabetes. Opportunities exist to use patient education, alternative immunosuppression regimens, and living transplantation to close the ethnic disparity in renal allograft survival.

Cultural Biases in Current Medical Practices with a Specific Attention to Orthopedic Surgery: a Review.

Due to the increasing diversity within the United States population, there is an ever-increasing need for increased education on cultural literacy and tolerance in medical schools and residency programs. The purpose of this article was to review how a person's culture can play a substantive role in effecting and influencing (1) medical diagnosis, (2) patient and health provider medical decision-making, (3) the patient's perception of disease, and (4) the doctor-patient relationships. Many of the decisions we make as orthopedic surgeons must account for the patient's cultural needs, as much of our work impacts patients' daily activities and function. When considering the patient's perception of disease, validated tools have been developed, such as the Patient-Specific Index, which can be used to assess the feelings, goals, and expectations of patients. Cultural competency should be a part of curricula at every level of medical education.

Kidney transplantation with sirolimus and mycophenolate mofetil-based immunosuppression: 5-year results of a randomized prospective trial compared to calcineurin inhibitor drugs.

BACKGROUND: We report the 5-year outcomes from a randomized prospective trial in primary adult renal allograft recipients, designed to evaluate calcineurin inhibitor (CNI)-free immunosuppression on kidney transplant function. METHODS: Sixty-one patients were randomized to either sirolimus (n=31) or cyclosporine (n=30) after basiliximab induction and mycophenolate mofetil (MMF) with steroids. Sirolimus was concentration controlled at 10-12 ng/mL for at least 6 months. RESULTS: After 5 years, sirolimus-MMF-steroids compared to cyclosporine-MMF-steroids provides similar patient survival (87.1 vs. 90%, P=0.681), acute rejection rates (12.9 vs. 23.3%, P=0.22), total cholesterol (209.1 vs. 204.3 mg/dL, P=0.973), urine protein/creatinine ratios (0.398 vs. 0.478 mg/dL, P=0.72), and overall medical and surgical morbidity (P=NS). Although unadjusted patient survival was similar, sirolimus based CNI-free patients had longer death censored graft survival (96.4 vs. 76.7%, P=0.0265), higher glomerular filtration rate (GFR) by the abbreviated Modified Diet in Renal Disease (66.7 vs. 50.7 cc/min, P=0.0075), and fewer graft losses from chronic allograft nephropathy. The Banff chronic scores at two years were strong predictors of 5-year GFR. At 5 years, there were six de novo (three solid organ, three skin) cancers in the CNI group and only two de novo (one skin, one leukemia, no solid organ) cancers in the sirolimus group (P=NS). CONCLUSIONS: This study of low to moderate risk patients demonstrates that excellent 5-year kidney transplant outcomes can be achieved without CNI drugs, when therapeutic drug monitoring of sirolimus is employed. The application of CNI drug avoidance protocols to high-risk recipients (retransplants, highly sensitized, etc.), extrarenal allograft recipients, or alternative drug regimens such as steroid or MMF elimination should be subjected to controlled trials.

Perceptions of Health-Related Quality of Life: A Minority Men's Perspective.

Health-related quality of life (HRQOL) measures among the African American populations have previously been inadequately studied. This study sought to further analyze the quality of life of African American men at the Cleveland Clinic Minority Men's Health Center and Cleveland Clinic Minority Men's Health Fair. Subjects were randomly selected at the Minority Health Fair and Minority Men's Health Center clinics over the duration of 2 weeks to participate in the anonymous survey with the help of independent surveyors. Convenience sampling was done at the Minority Men's Health Fair and at the Minority Men's Health Clinics. Participants were administered in-person Short Form-36 (SF-36v2). A total of 83 participants were surveyed, and the response rate from the surveyed population was 100%. The only exclusion criterion for the study was the refusal to participate ( n = 0). As compared with healthy U.S. norms, African American men reported lower HRQOL across six health domains: physical functioning (60.69 ± 2.82 vs. 84.2), general health (57.56 ± 2.41 vs. 72), social functioning (72.65 ± 3.17 vs. 83.3), role-emotional (55.89 ± 3.02 vs. 81.3), mental health (61.23 ± 2.34 vs. 74.7), and role-physical (62.5 ± 2.88 vs. 81). The largest difference between the health domains was reported in role limitations due to emotional problems (55.89 ± 3.02 vs. 81.3, 25.4). Marital analysis revealed clinically significant lower HRQOL in married African Americans as compared with nonmarried, statistically significant in physical functioning and physical health component ( p < .05). African Americans disproportionally face pervasive disparities in health, as supported by extensive quality of life impairment. No other study, to our knowledge, has used quality of life assessment in African Americans to quantitate how such disparities are affecting important domains in their lives.

Ex-vivo partial nephrectomy after living donor nephrectomy: Surgical technique for expanding kidney donor pool.

Renal transplantation has profound improvements in mortality, morbidity, and overall quality of life compared to renal replacement therapy. This report aims to illustrate the use of ex-vivo partial nephrectomy in a patient with a renal angiomyolipoma prior to living donor transplantation. The surgical outcomes of the donor nephrectomy and recipient transplantation are reported with 2 years of follow-up. Both the donor and recipient are healthy and without any significant comorbidities. In conclusion, urologic techniques such as partial nephrectomy can be used to expand the living donor pool in carefully selected and well informed transplant recipients. Our experience demonstrated a safe and positive outcome for both the recipient and donor, and is consistent with other reported outcomes in the literature.

Self-Rated Health and Health Care Access Associated With African American Men's Health Self-Efficacy.

Health self-efficacy, a measure of one's self-assurance in taking care of their own health, is known to contribute to a range of health outcomes that has been under examined among African American men. The purpose of this investigation was to identify and contextualize predictors of general health self-efficacy in this population. A cross-sectional sample of surveys from 558 African American was examined. These men were older than 18 years, could read and write English, and attended a hospital-based community health fair targeting minority men in 2011. The outcome of interest was health self-efficacy, which was assessed by asking, "Overall, how confident are you in your ability to take good care of your health?" Responses ranged from 1 ( not confident at all) to 5 ( completely confident). Covariates included age, self-rated health, health insurance status, having a regular physician, and being a smoker. The mean age of participants was 54.4 years, and 61.3% of participants indicated confidence in their ability to take good care of their health. Older age and being a smoker were inversely associated with the outcome. Good self-rated health, having health insurance, and having a regular doctor were positively associated with reports of health self-efficacy. Findings suggest that multiple points of connection to the health care system increase the likelihood of health self-efficacy for this sample and interventions to support older African American men who may evaluate their own health status as poor and who may face barriers to health care access are implicated.

Assessing Transplant Attitudes: Understanding Minority Men's Perspectives on the Multifarious Barriers to Organ Donation.

African Americans comprise 11 % of living organ donors, yet constitute 34 % of the kidney transplant waiting list. There are many barriers to organ donation among minorities that include decreased awareness of transplantation, cultural mistrust of the medical community, financial concerns, and fear of the transplant operation. This study investigates the societal misconceptions and demographic health factors that correlate with minority participation in organ and tissue donation. A 57 question Health and Wellness survey was designed to assess participants' demographic information, medical history, professional background, and opinions regarding organ transplantation. Participants were also asked to complete Quality Metric's Short Form-8 (SF-8) survey to assess physical health, mental health, and quality-of-life. Three hundred twenty-six surveys were administered to minority men. The majority of men were identified as African American, and 55 % were below the age of 40. Though 44 % of participants were willing to donate, only 27 % were registered as organ and tissue donors. Minorities who held misconceptions about organ donation-including the belief that they were too old or unhealthy to donate, for example-had lower general, physical, and mental health scores than those who did not (p = <0.0001). Minorities aware of the shortage for organs or who know a registered donor, an organ recipient, a dialysis patient, or someone on the waiting list were more willing to donate organs. Improving the general, physical, and mental health of minorities, coupled with an active educational outreach program, could result in a greater percentage of minorities registering and willing to be organ and tissue donors.

Race effects on pathological and functional outcomes after robotic partial nephrectomy in a single academic tertiary care center.

To explore the potential effects of race on pathological outcomes of renal tumor and on kidney function preservation in the patients undergoing robotic partial nephrectomy (RPN) at our center. Retrospective review of our institutional review board approved database for African-American (AA) patients undergoing RPN from 2006 to 2014 was performed. AA and non-AA groups were compared with regards to demographics, tumor characteristics, functional data and, oncological outcomes. For functional outcomes, groups were matched (1:1) in terms of age, preoperative estimated glomerular filtration rate (eGFR) and R.E.N.A.L score. From the total of 1005 patients, 84 were AA. Age and the tumor size were comparable between the two groups (2.7 vs. 3 cm; p = 0.29). Proportion of patients with papillary RCC was higher among AAs compared to non-AAs (43.3 vs. 19.4 %; p < 0.001). After matching AA patients with non-AA counterparts (1:1 matching), eGFR preservation at latest follow up after surgery was comparable between groups (84.3 vs. 85 %; p = 0.25). AA race (OR 3.62, p < 0.001), male gender (OR 2.05, p < 0.001) and low preoperative eGFR (OR 0.97, p < 0.001) were predictors of papillary RCC on multivariate analyses. The incidence of papillary RCC is higher in AA patients undergoing RPN. There was no difference in kidney function recovery after robotic partial nephrectomy in both AA and non-AA groups. AA race itself is not a significant factor in determining renal malignancy. Further studies are needed to clarify the impact of higher prevalence of papillary tumors in AA group in terms of long-term oncological and functional outcomes.

The effect of 2-gram versus 1-gram concentration controlled mycophenolate mofetil on renal transplant outcomes using sirolimus-based calcineurin inhibitor drug-free immunosuppression.

BACKGROUND: We performed a sequential study to determine the efficacy and side effects of low-dose (1 g) mycophenolate mofetil (MMF) in a CNI drug avoidance regimen including sirolimus/steroids. METHODS: A total of 260 kidney-only recipients were given basiliximab (232) or thymoglobulin (28) induction, and sirolimus/steroids. In addition, 160 recipients were begun on standard MMF 1 g twice daily (2-g group), while 100 recipients were begun on low-dose MMF 500 mg twice daily (1-g group). The 1-g recipients were concentration controlled to keep mycophenolic acid (MPA) C0 levels at 1.8-4 microg/ml. RESULTS: There were no statistically significant differences in demographics between the groups. At 6 months there were no significant differences between the 2-g and 1-g MMF groups in patient survival (96.8% vs. 96%), graft survival (92.5% vs. 95%), biopsy-confirmed and treated acute rejection (8.8% vs. 13%), or mean creatinine mg/dL (1.41+/-0.52 vs. 1.47+/-0.67), respectively. Mean MPA C0 levels microg/ml were (4.7 vs. 2.3) at 1 month, (4.1 vs. 3.1) at 3 months, and (3.9 vs. 2.4) at 6 months. There were no significant differences at 1, 3, or 6 months in mean WBC, HgB, or platelets, or wound complications. There were significant reductions in the number of patients reporting nausea-vomiting-dyspepsia (20.6% vs. 8%, P=0.007), diarrhea (34.3% vs. 20%, P=0.01), and abdominal pains (10.6% vs. 4%, P=0.05), between the 2-g and 1-g MMF groups, respectively. CONCLUSIONS: The use of concentration-controlled 1-g MMF results in comparable transplant outcomes with less GI toxicity during the first 6 months posttransplant in a CNI drug-free sirolimus based immunosuppressive regimen.

Financial hardship, unmet medical need, and health self-efficacy among African American men.

BACKGROUND: Health self-efficacy (the confidence to take care of one's health) is a key component in ensuring that individuals are active partners in their health and health care. The purpose of this study was to determine the association between financial hardship and health self-efficacy among African American men and to determine if unmet medical need due to cost potentially mediates this association. METHOD: Cross-sectional analysis was conducted using data from a convenience sample of African American men who attended a 1-day annual community health fair in Northeast Ohio (N = 279). Modified Poisson regression models were estimated to obtain the relative risk of reporting low health self-efficacy. After adjusting for sociodemographic characteristics, those reporting financial hardship were 2.91 times, RR = 2.91 (confidence interval [1.24, 6.83]; p < .05), more likely to report low health self-efficacy. When unmet medical need due to cost was added to the model, the association between financial hardship and low health self-efficacy was no longer statistically significant. CONCLUSION: Our results suggest that the association between financial hardship and health self-efficacy can be explained by unmet medical need due to cost. Possible intervention efforts among African American men with low financial resources should consider expanding clinical and community-based health assessments to capture financial hardship and unmet medical need due to cost as potential contributors to low health self-efficacy.

The impact of sirolimus, mycophenolate mofetil, cyclosporine, azathioprine, and steroids on wound healing in 513 kidney-transplant recipients.

BACKGROUND: The aim of this study was to determine whether there has been an increase in the incidence or severity of wound-healing complications that can be attributed to the introduction of newer immunosuppressive drugs. METHODS: Consecutive series of adult kidney-only transplant recipients were selected from our Unified Transplant Database backward from September 2002. There were 513 patients divided into groups on the basis of their maintenance immunosuppression given for at least the first 30 days posttransplant. Group I (152) was given sirolimus, mycophenolate mofetil, and prednisone (SRL/MMF/P) between March 2000 and September 2002; group II (168) was given cyclosporine A (CsA)/MMF/P between January 1999 and July 2002; and group III (193) was given azathioprine (AzA)/CsA/P between January 1993 and December 1997. A classification system for wound-healing problems was developed, and each of the three groups was analyzed by univariate and multivariate analysis. RESULTS: From groups III to II to I, there was a significant increase in mean age (42.4 vs. 49 years), percent of patients diabetic (17% vs. 29%), mean body mass index (BMI) (24.2 vs. 27.1 kg/m2), and percent BMI greater than 30 (13.5% vs. 27%). The cumulative percentage of all wound-healing problems between group I (19.7%) vs. group II (16.1%) and group III (15.6%) was not significantly different. The most significant risk factor was a recipient BMI greater than 30 (P=0.0012) and delayed graft function (P=0.0041). CONCLUSIONS: During a 10-year period marked by changing recipient demographics, the introduction of MMF and SRL did not result in a significant increase in transplant wound-healing complications. The most significant risk factor associated with transplant wound-healing complications remains body weight, which was the major influence for each of the immunosuppressive drug combinations described.

Renal transplantations in African Americans: a single-center experience of outcomes and innovations to improve access and results.

OBJECTIVE: To report a single-center 10-year experience of outcomes of kidney transplantation in African Americans (AAs) vs Caucasian Americans (CA) and to propose ways in which to improve kidney transplant outcomes in AAs, increased access to kidney transplantation, prevention of kidney disease, and acceptance of organ donor registration rates in AAs. METHODS: We compared outcomes of deceased donor (DD) and living donor (LD) renal transplantation in AAs vs CAs in 772 recipients of first allografts at our transplant center from January 1995 to March 2004. For DD and LD transplants, no significant differences in gender, age, body mass index, or transplant panel reactive antibody (PRA) existed between AA and CA recipients. RESULTS: Primary diagnosis of hypertension was more common in AA, DD, and LD recipients. Significant differences for DD transplants included Medicaid insurance in 23% AA compared with 7.0% CA (P<.0001) and more frequent diabetes mellitus type 2 in AAs (15% vs 4.1%, P=.0009). Eighty-three percent of AAs had received hemodialysis compared with 72% of CAs (P=.02). AAs endured significantly longer pretransplant dialysis (911±618 vs 682±526 days CA, P=.0006) and greater time on the waiting list (972±575 vs 637±466 days CA, P<0001). In DD renal transplants, AAs had more human leukocyte antigen (HLA) mismatches than CAs (4.1±1.4 vs 2.7±2.1, P<.0001). Mean follow-up for survivors was 7.1±2.5 years. Among LD transplants, graft survival and graft function were comparable for AAs and CAs; however, among DD transplants, graft function and survival were substantially worse for AAs (P=.0003). In both LD and DD transplants, patient survival was similar for AAs and CAs. CONCLUSION: Our data show that AAs receiving allografts from LDs have equivalent short- and long-term outcomes to CAs, but AAs have worse short- and long-term outcomes after DD transplantation. As such, we conclude that AAs should be educated about prevention of kidney disease, the importance of organ donor registration, the merits of LD over DD, and encouraged to seek LD options.

Social Determinants Associated with Colorectal Cancer Screening in an Urban Community Sample of African-American Men.

BACKGROUND: African-American men are disproportionately burdened with colorectal cancer (CRC). Research is scarce on the social determinants that may influence CRC screening as the primary strategy for early detection among African-American males. METHODS: African-American men over the age of 18 years (n = 558) were recruited from a community health fair and anonymously surveyed about their health and cancer screening behaviors. A social ecological theoretical framework was utilized to identify intrapersonal, interpersonal, organizational, and community predictors of CRC screening, which may be associated with social determinants of health and health behaviors. Analysis included correlations and logistic regression. RESULTS: The mean age of participants was 54.3 years with 85.8% of men being over 40 years of age. Regarding CRC screening: 50.5% (n = 282) of African-American male participants had received any type of CRC screening at any time. Positive predictors of CRC screening included: health insurance status, older age, having spoken with a health provider about family cancer risk, and having a regular doctor. However, employment status and poor self-rated health were negative predictors of the outcome. CONCLUSIONS: Social determinants of health, such as healthcare access and interactions with health systems, along with employment play a critical role in facilitating CRC screening completion in high-risk underserved populations such as African-American men.

Disparities in prostate cancer in African American men: what primary care physicians can do.

African American men have a higher incidence of prostate cancer than white men, and also a higher rate of death due to prostate cancer. Although both biologic and socioeconomic factors may be to blame, better screening in this population may help to close the gap.