Race

种族
  • 文章类型: Journal Article
    在美国,烧伤导致显著的发病率和死亡率。尽管人们越来越关注医疗保健中的种族和族裔差异,我们在理解这些差异对烧伤患者并发症的影响方面仍存在严重的知识差距.美国烧伤协会的国家烧伤存储库数据从2010年至2018年进行了审查。有关人口统计的信息,烧伤机制和严重程度,并发症,并记录临床结局.使用1:1倾向评分匹配和逻辑回归模型进行数据分析。使用卡方检验对西班牙裔和非西班牙裔患者进行了单独分析。在215,071名患者中,种族分布为65.16%的白人,19.13%黑色,2.18%亚洲人,0.74%美洲印第安人/阿拉斯加原住民,其他12.78%。火焰伤害是最常见的原因(35.2%),其次是烫伤(23.3%)。所有的比较都是参照白人群体进行的。黑人患者更容易死亡(OR:1.28;95CI:1.17-1.40),经验全部(OR:1.08;95CI:1.03-1.14),心血管(OR:1.24;95CI:1.08-1.43),或感染性(OR:1.64;95CI:1.40-1.91)并发症,并且不太可能经历气道并发症(OR:0.83;95CI:0.74-0.94)。美洲印第安人/阿拉斯加原住民患者更有可能出现任何并发症(OR:1.33;95CI:1.05-1.70)。所有少数民族都增加了住院时间。黑色,亚洲人,其他患者ICU住院时间较长。黑人患者的呼吸机持续时间更长。在82,775名患者中,24,075名患者被确定为西班牙裔,58,700名为非西班牙裔。在年龄方面,各组之间存在统计学上的显着差异,TBSA,2度烧伤的比例,3度烧伤的比例(p<0.01)。这些发现强调了需要进一步的工作来确定这些差异的病因,以改善所有患者的烧伤护理。
    Burn injury contributes to significant morbidity and mortality in the United States. Despite an increased focus on racial and ethnic disparities in healthcare, there remains a critical knowledge gap in our understanding of the effect of these disparities on complications experienced by burn patients. The American Burn Association\'s National Burn Repository data were reviewed from 2010-2018. Information regarding demographics, burn mechanism and severity, complications, and clinical outcomes were recorded. Data analysis was performed using 1:1 propensity-score-matching and logistic regression modeling. A separate analysis of Hispanic and non-Hispanic patients was performed using Chi squared tests. Among 215,071 patients, racial distribution was 65.16% white, 19.13% black, 2.18% Asian, 0.74% American Indian/Alaskan Native, and 12.78% other. Flame injuries were the most common cause (35.2%), followed by scald burns (23.3%). All comparisons were made in reference to the white population. Black patients were more likely to die (OR: 1.28; 95%CI: 1.17-1.40), experience all (OR: 1.08; 95%CI: 1.03-1.14), cardiovascular (OR: 1.24; 95%CI: 1.08-1.43), or infectious (OR: 1.64; 95%CI: 1.40-1.91) complications, and less likely to experience airway complications (OR: 0.83; 95%CI: 0.74-0.94). American Indian/Alaskan Native patients were more likely to experience any complication (OR: 1.33; 95%CI: 1.05-1.70). All minority groups had increased length of hospital stay. Black, Asian, and other patients had longer length of ICU stay. Black patients had longer ventilator duration. Among 82,775 patients, 24,075 patients were identified as Hispanic and 58,700 as non-Hispanic. Statistically significant differences were noted between groups in age, TBSA, proportion of 2nd degree burn, and proportion of 3rd degree burn (p<0.01). These findings highlight the need for further work to determine the etiology of these disparities to improve burn care for all patients.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    以明尼阿波利斯为中心的乔治·弗洛伊德谋杀案,明尼苏达,在关于美国种族不公正的对话中。我们利用明尼阿波利斯警察局的公开数据来分析个人,地理,自2016年以来,超过170,000名警察停止了时间模式。我们使用带有邻域聚类的广义估计方程,通过种族评估个人级别的人员和车辆搜索,直接解决警察活动中的邻里差异。明尼阿波利斯展示了种族不成比例的警务模式,与白人相比,黑人的搜索率更高。时间可视化表明,在乔治·弗洛伊德被谋杀后,警察停止了。此分析为美国主要大都市地区的警务状况提供了当代证据。
    The murder of George Floyd centered Minneapolis, Minnesota, in conversations on racial injustice in the US. We leverage open data from the Minneapolis Police Department to analyze individual, geographic, and temporal patterns in more than 170,000 police stops since 2016. We evaluate person and vehicle searches at the individual level by race using generalized estimating equations with neighborhood clustering, directly addressing neighborhood differences in police activity. Minneapolis exhibits clear patterns of disproportionate policing by race, wherein Black people are searched at higher rates compared to White people. Temporal visualizations indicate that police stops declined following the murder of George Floyd. This analysis provides contemporary evidence on the state of policing for a major metropolitan area in the United States.
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  • 文章类型: Journal Article
    背景:专业协会指南是基于证据的建议,旨在促进标准化护理和改善健康结果。在人们越来越认识到种族主义在塑造不公平的医疗保健提供方面所起的作用的同时,许多研究人员和从业者批评了现有的指导方针,特别是那些包括基于种族的建议。批评强调种族主义如何影响准则所依据的证据及其解释。然而,很少有人使用系统的方法来检查基于种族的建议。这篇综述探讨了高血压指南,一种影响美国近一半成年人的疾病,了解指南如何参考和制定与种族相关的建议。
    方法:对1977年至2022年之间发表的关于原发性高血压管理的所有专业指南的系统范围审查,以检查种族类别的使用和含义。
    结果:在符合纳入标准的37个指南中,我们确定了总共990个种族类别的提及.黑人和非洲/非洲裔美国人是指南中提到的主要种族类别(n=409)。指南作者在五个关键领域使用种族:描述高血压的患病率或病因;描述先前的高血压研究;描述高血压干预措施;社会风险和健康的社会决定因素;种族的复杂性。指南作者主要将种族类别用作生物学而不是社会结构。这些指南都没有讨论种族主义及其在延续高血压不平等中所起的作用。
    结论:高血压指南在很大程度上将种族视为一种独特而自然的类别,而不是面对医疗系统内外种族主义的长期历史。将种族正常化为一种生物学而非社会结构,未能解决种族主义是导致心血管健康不平等的关键决定因素。这些变化是必要的,以产生有意义的结构性解决方案,促进高血压教育的公平性,研究,和护理交付。
    BACKGROUND: Professional society guidelines are evidence-based recommendations intended to promote standardized care and improve health outcomes. Amid increased recognition of the role racism plays in shaping inequitable healthcare delivery, many researchers and practitioners have critiqued existing guidelines, particularly those that include race-based recommendations. Critiques highlight how racism influences the evidence that guidelines are based on and its interpretation. However, few have used a systematic methodology to examine race-based recommendations. This review examines hypertension guidelines, a condition affecting nearly half of all adults in the United States (US), to understand how guidelines reference and develop recommendations related to race.
    METHODS: A systematic scoping review of all professional guidelines on the management of essential hypertension published between 1977 and 2022 to examine the use and meaning of race categories.
    RESULTS: Of the 37 guidelines that met the inclusion criteria, we identified a total of 990 mentions of race categories. Black and African/African American were the predominant race categories referred to in guidelines (n = 409). Guideline authors used race in five key domains: describing the prevalence or etiology of hypertension; characterizing prior hypertension studies; describing hypertension interventions; social risk and social determinants of health; the complexity of race. Guideline authors largely used race categories as biological rather than social constructions. None of the guidelines discussed racism and the role it plays in perpetuating hypertension inequities.
    CONCLUSIONS: Hypertension guidelines largely refer to race as a distinct and natural category rather than confront the longstanding history of racism within and beyond the medical system. Normalizing race as a biological rather than social construct fails to address racism as a key determinant driving inequities in cardiovascular health. These changes are necessary to produce meaningful structural solutions that advance equity in hypertension education, research, and care delivery.
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  • 文章类型: Journal Article
    研究儿科精神卫生服务中的实践范围(SoP)法规与种族差异之间的关联。我们使用全国儿童健康调查(2016-2020年;n=33,790)来调查未满足的精神卫生保健需求和接受精神卫生药物的州之间的种族差异,其中有和没有为心理学家和护士从业者(NP)进行SoP扩展。我们的主要结果是(1)未满足的精神卫生保健需求和(2)接受精神卫生药物。我们使用逻辑回归与SoP扩展和种族/种族之间的相互作用项检查了SoP扩展对结果的异质治疗效果。我们估计了通过SoP扩展分层的两种结果的人口水平种族差异,以确定种族差异的差异。心理学家SoP扩展相关的未满足需求的减少比白人儿童大15.8个百分点(CI=-25.3,-6.2)。心理学家SoP扩张相关的药物增加为5.1个百分点(CI=。黑人儿童的分数为0.8,9.4),其他种族儿童的分数为5.6%(CI=0.5,10.8)。对于NPSoP扩增没有发现差异。在心理学家SoP扩展状态下,两种结果的种族差异较低,但在NPSoP状态下有所不同。扩大的SoP通常与儿童精神卫生保健获得方面的较低种族差异有关。
    To examine the association between scope-of-practice (SoP) regulations and racial disparities in pediatric mental health services. We used the National Survey of Children\'s Health (2016-2020; n = 33,790) to examine racial disparities in unmet mental health care needs and receipt of mental health medication between states with and without SoP expansions for psychologists and nurse practitioners (NP). Our primary outcomes were (1) unmet mental health care needs and (2) receipt of mental health medication. We examined heterogeneous treatment effects of SoP expansion on the outcomes using logistic regression with interaction terms between SoP expansion and race/ethnicity. We estimated population-level racial disparities for both outcomes stratified by SoP expansion to identify differences in racial disparities. The psychologist SoP expansion-associated reduction in unmet need was 15.8 percentage-points (CI= -25.3, -6.2) larger for Other-race children than for White children. The psychologist SoP expansion-associated increase in medication was 5.1%-points (CI=. 0.8, 9.4) larger for Black children and 5.6%-points (CI = 0.5, 10.8) for Other-race children. No differences were found for NP SoP expansion. Racial disparities in both outcomes were lower in psychologist SoP expansion states but varied in NP SoP states. Expanded SoP was generally associated with lower racial disparities in pediatric mental health care access.
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  • 文章类型: Journal Article
    我们研究了文化价值观,在美国,从众和育儿行为与儿童中期适应有关。白色,黑人和拉丁裔母亲(n=273),父亲(n=182)和他们的孩子(n=272)报告了父母的个人主义和集体主义,一致性值,父母的温暖,监测,家庭义务期望,以及儿童内化和外化行为。平均差异,对感兴趣的变量进行双变量相关和多元回归分析.父母的集体主义与家庭义务期望和父母的温暖有关。具有较高从众价值观的父亲对儿童的家庭义务有更高的期望。当拉丁裔家庭订阅个人主义价值观时,儿童的内在化和外在化行为更大。这些结果是在文化价值观的背景下讨论的,行为的保护和促进因素,和美国的种族/民族。
    We examined whether cultural values, conformity and parenting behaviours were related to child adjustment in middle childhood in the United States. White, Black and Latino mothers (n = 273), fathers (n = 182) and their children (n = 272) reported on parental individualism and collectivism, conformity values, parental warmth, monitoring, family obligation expectations, and child internalising and externalising behaviours. Mean differences, bivariate correlations and multiple regression analyses were performed on variables of interest. Collectivism in mothers and fathers was associated with family obligation expectations and parental warmth. Fathers with higher conformity values had higher expectations of children\'s family obligations. Child internalising and externalising behaviours were greater when Latino families subscribed to individualistic values. These results are discussed in the context of cultural values, protective and promotive factors of behaviour, and race/ethnicity in the United States.
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  • 文章类型: Journal Article
    背景:尽管临床试验中种族和民族代表性很重要,随着时间的推移,关于这些组房颤(AF)试验的纳入趋势的数据有限.
    目的:本研究的目的是检查当代房颤临床试验的特征,并评估其与种族和民族的关系。
    方法:我们对所有在ClinicalTrials.gov中注册的在受孕至2023年12月31日之间完成的房颤试验进行了系统搜索,并手动提取了种族/民族组成。我们按研究特点分层试验,包括影响因子,发布状态,资金来源,和位置。我们通过将非白人参与者的百分比除以非白人参与者在疾病人群中的百分比(PPR0.8-1.2表明比例代表)来计算参与患病率(PPR)。
    结果:我们确定了277项完成的房颤试验,包括1,933,441名成年人。非白人的中位数比例为12%(IQR:6-27),121(43.7%)设备聚焦,184项(66.4%)由工业界资助。只有36.1%的试验报告了全面的种族信息。总的来说,非白人参与者的代表性不足(PPR=0.511;P<0.001),包括黑人(PPR=0.263)和西班牙裔(PPR=0.337)参与者。非白人参与者的比例在2000年至2023年之间没有显着变化(11%vs9%;P=0.343)。
    结论:尽管意识更强,房颤临床试验中的种族/民族报告和非白种人组的代表性较差,并且随着时间的推移没有显著改善.这些发现需要额外的招募工作和新的招募政策,以确保在未来的AF临床试验中这些人口统计学亚组的充分代表。
    BACKGROUND: Despite the importance of racial and ethnic representation in clinical trials, limited data exist regarding the enrollment trends of these groups in atrial fibrillation (AF) trials over time.
    OBJECTIVE: The purpose of this study is to examine the characteristics of contemporary AF clinical trials and evaluate their association with race and ethnicity over time.
    METHODS: We performed a systematic search of all completed AF trials registered in ClinicalTrials.gov between conception to December 31, 2023 and manually extracted composition of race/ethnicity. We stratified trials by study characteristics, including impact factor, publication status, funding source, and location. We calculated the participation prevalence ratio (PPR) by dividing the percentage of non-White participants by the percentage of non-White participants among the disease population (PPR 0.8-1.2 suggests proportional representation) over time.
    RESULTS: We identified 277 completed AF trials encompassing a total of 1,933,441 adults, with a median proportion of non-White at 12% (IQR: 6-27), 121 (43.7%) device-focused, and 184 (66.4%) funded by industry. Only 36.1% of trials reported comprehensive race information. Overall, non-White participants were underrepresented (PPR = 0.511; P < 0.001), including Black (PPR = 0.263) and Hispanic (PPR = 0.337) participants. The proportion of non-White participants did not change significantly between 2000 and 2023 (11% vs 9%; P = 0.343).
    CONCLUSIONS: Despite greater awareness, race/ethnicity reporting and representation of non-White groups in AF clinical trials are poor and have not improved significantly over time. These findings demand additional recruitment efforts and novel recruitment policies to ensure adequate representation of these demographic subgroups in future AF clinical trials.
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  • 文章类型: Editorial
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  • 文章类型: Journal Article
    合成了来自近50年的注意力缺陷/多动障碍(ADHD)儿童和青少年治疗研究的人口统计学数据。综合搜索确定了组间设计的ADHD治疗研究,包括一个社会心理,循证治疗,并在美国进行。检查了126项研究,其中包括10,604名青年。人口统计学的报告各不相同,48%的研究(k=61)报告种族,73%(k=92)报告种族,80%(k=101)报告年龄(M年龄=8.81,SD=2.82),88%(k=111)报告性别。大多数参与者被确定为非西班牙裔/拉丁裔(15.99%西班牙裔/拉丁裔),白色(62.54%),和男孩(74.39%;24.47%的女孩)。自1970年代以来,ADHD治疗研究中的零青年被确定为中东/北非,0.1%是美洲印第安人/阿拉斯加原住民或夏威夷原住民太平洋岛民,1.77%是亚洲人,15.10%是黑人,3.14%是多种族。根据出版年份,女孩的比例,种族化的青年,随着时间的推移,ADHD治疗研究中包括的西班牙裔/拉丁裔青年也有所增加。女孩们,非二元和非顺性青年,年幼的孩子,青少年,西班牙裔/拉丁裔青年,在ADHD治疗研究中,除白人以外的所有种族群体的青年代表性不足。讨论了研究差距,并为儿童和青少年心理研究中的全面人口报告提供了建议。
    Demographic data from nearly 50 years of treatment research for children and adolescents with attention-deficit/hyperactivity disorder (ADHD) are synthesized. Comprehensive search identified ADHD treatment studies that were between-group designs, included a psychosocial, evidence-based treatment, and were conducted in the United States. One hundred and twenty-six studies that included 10,604 youth were examined. Reporting of demographics varied with 48% of studies (k = 61) reporting ethnicity, 73% (k = 92) reporting race, 80% (k = 101) reporting age (M age = 8.81, SD = 2.82), and 88% (k = 111) reporting gender. Most participants identified as non-Hispanic/Latine (15.99% Hispanic/Latine), White (62.54%), and boys (74.39%; 24.47% girls). Since the 1970s, zero youth in ADHD treatment studies identified as Middle Eastern/North African, 0.1% were American Indian/Alaskan Native or Native Hawaiian Pacific Islander, 1.77% were Asian, 15.10% were Black, and 3.14% were Multiracial. Based on publication year, the proportions of girls, racially minoritized youth, and Hispanic/Latine youth included in ADHD treatment research have increased over time. Girls, non-binary and non-cisgender youth, young children, adolescents, Hispanic/Latine youth, and youth from all racial groups other than White are underrepresented in ADHD treatment research. Research gaps are discussed, and recommendations for comprehensive demographic reporting in child and adolescent psychological research are provided.
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