American Race Research Articles

Characterizing apparent treatment resistant hypertension in the United States: insights from the All of Us Research Program.

Hypertension (HTN) remains a significant public health concern and the primary modifiable risk factor for cardiovascular disease, which is the leading cause of death in the United States. We applied our validated HTN computable phenotypes within the All of Us Research Program to uncover prevalence and characteristics of HTN and apparent treatment-resistant hypertension (aTRH) in United States. Within the All of Us Researcher Workbench, we built a retrospective cohort (January 1, 2008-July 1, 2023), identifying all adults with available age data, at least one blood pressure (BP) measurement, prescribed at least one antihypertensive medication, and with at least one SNOMED "Essential hypertension" diagnosis code. We identified 99 461 participants with HTN who met the eligibility criteria. Following the application of our computable phenotypes, an overall population of 81 462 were further categorized to aTRH (14.4%), stable-controlled HTN (SCH) (39.5%), and Other HTN (46.1%). Compared to participants with SCH, participants with aTRH were older, more likely to be of Black or African American race, had higher levels of social deprivation, and a heightened prevalence of comorbidities such as hyperlipidemia and diabetes. Heart failure, chronic kidney disease, and diabetes were the comorbidities most strongly associated with aTRH. β-blockers were the most prescribed antihypertensive medication. At index date, the overall BP control rate was 62%. All of Us provides a unique opportunity to characterize HTN in the United States. Consistent findings from this study with our prior research highlight the interoperability of our computable phenotypes.

Huck’s Voice versus Herd Mentality: The Good, the Bad, and the Evil

In Mark Twain's 1884 chef-d‘œuvre, The Adventures of Huckleberry Finn (HF), the voice of innocence—personified by Huck Finn—evolves as a graphic reflection of his unique social and ethical standing, portraying him as a nonconforming, Adam-like wanderer seeking refuge in nature and searching for a distinct identity. Employing literary theory, this article goes beyond exposing the moral bankruptcy and hypocrisy in an allegedly ‘civilized’ white society that purports to uphold high moral standards. Drawing on Nietzsche's doctrine of good vs. bad and good vs. evil, along with the psychological phenomenon of herd mentality, the article demonstrates how Huck's voice challenges and destabilizes orthodox linguistic conventions, societal norms, ethical constructs, and long-standing beliefs in the antebellum American South during the nineteenth century. Key findings reveal that such a unique voice can be seen as a profound critique of the antebellum South’s values, introducing a newfangled perspective on America's development of a distinctive identity and its quest to establish its own voice and literature after severing ties with Britain.

Outpatient vs. inpatient designation in total hip arthroplasty: can we predict who will require hospitalization?

Following removal of total hip arthroplasty (THA) from the inpatient only (IPO) list by the Center for Medicare Services (CMS), arthroplasty surgeons face increased pressure to perform procedures on an outpatient (OP) basis. The purposes of the present study were to compare patients booked for THA as OP who required conversion to IP status postoperatively, to patients who were booked as, and remained OP, and to identify factors predictive of conversion from OP to IP status. We retrospectively reviewed all patients who underwent a primary THA at our institution between January 1, 2020 and April 26, 2022. All patients included were originally scheduled for OP surgery and were separated based on conversion to IP status postoperatively. Multiple regression analyses were used to determine the significance of all perioperative variables. Modeling via binary logistic regressions were used to determine factors predictive of status conversion. Of 1,937 patients, 372 (19.2%) designated as OP preoperatively required conversion to IP status postoperatively. These patients had significantly higher facility discharge rates (P < 0.001) and 90-day readmission rates (P = 0.024). Patients aged 65 and older (P < 0.001), females (P < 0.001), patients with Black/African American race (P = 0.027), with a recovery room arrival time after 12pm (P < 0.001), with a BMI > 30kg/m2 (P = 0.001), and with a Charlson Comorbidity Index (CCI) ≥ 4 (P = 0.013) were Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation more likely to require conversion to IP designation. Marital status and time of procedure were also significant factors, as patients who were married (P < 0.001) and who were the first case of the day (P < 0.001) were less likely to be converted to IP. Several factors were identified which could help determine appropriate hospital designation status at the time of surgical booking to ultimately avoid insurance claim denials. These included BMI, certain demographic factors, CCI ≥ 4, and patients 65 or older. Retrospective Cohort Study.

Risk factors of undiagnosed and uncontrolled hypertension in primary care patients with hypertension: a cross-sectional study

BackgroundHypertension is a common heart condition in the United States (US) and severely impacts racial and ethnic minority populations. While the understanding of hypertension has grown considerably, there remain gaps in US healthcare research. Specifically, there is a lack of focus on undiagnosed and uncontrolled hypertension in primary care settings.AimThe present study investigates factors associated with undiagnosed and uncontrolled hypertension in primary care patients with hypertension. The study also examines whether Black/African Americans are at higher odds of undiagnosed and uncontrolled hypertension compared to White patients.MethodsA cross-sectional study was conducted using electronic health records (EHR) data from the University of Utah primary care health system. The study included for analysis 24,915 patients with hypertension who had a primary care visit from January 2020 to December 2020. Multivariate logistic regression assessed the odds of undiagnosed and uncontrolled hypertension.ResultsAmong 24,915 patients with hypertension, 28.6% (n = 7,124) were undiagnosed and 37.4% (n = 9,319) were uncontrolled. Factors associated with higher odds of undiagnosed hypertension included age 18–44 (2.05 [1.90–2.21]), Hispanic/Latino ethnicity (1.13 [1.03–1.23]), Medicaid (1.43 [1.29-1.58]) or self-pay (1.32 [1.13-1.53]) insurance, CCI 1-2 (1.79 [1.67-1.92]), and LDL-c ≥ 190 mg/dl (3.05 [1.41–6.59]). For uncontrolled hypertension, risk factors included age 65+ (1.11 [1.08–1.34]), male (1.24 [1.17–1.31]), Native-Hawaiian/Pacific Islander (1.32 [1.05-1.62]) or Black/African American race (1.24 [1.11-1.57]) , and self-pay insurance (1.11 [1.03-1.22]).ConclusionThe results of this study suggest that undiagnosed and uncontrolled hypertension is prevalent in primary care. Critical risk factors for undiagnosed hypertension include younger age, Hispanic/Latino ethnicity, very high LDL-c, low comorbidity scores, and self-pay or medicaid insurance. For uncontrolled hypertension, geriatric populations, males, Native Hawaiian/Pacific Islanders, and Black/African Americans, continue to experience greater burdens than their counterparts. Substantial efforts are needed to strengthen hypertension diagnosis and to develop tailored hypertension management programs in primary care, focusing on these populations.

Positive Trends in Racial Disparities for Head and Neck Microvascular Reconstructive Surgery.

To evaluate national trends in racial disparities for patients undergoing head and neck reconstructive surgery. Retrospective analysis using the 2008 to 2021 American College of Surgeons National Surgical Quality Improvement Program database. Patients receiving microvascular free tissue transfer were eligible for inclusion. Pediatric patients and those treated by non-otolaryngologists were excluded. Outcomes were analyzed with univariate and multivariable models. A total of 5831 head and neck free flap cases were analyzed, 4869 (83.5%) were White, 560 (9.6%) were Black or African American, and 402 (6.9%) were Asian, Native American, or other groups (ANAOG). The proportion of Black or African American patients and ANAOG patients undergoing free tissue transfer increased significantly over the time period (p = 0.047 and p = 0.010, respectively). However, there was a downtrend that started around 2017. In a multivariable model, Black or African American race was not associated with readmission (OR = 0.99 [95% CI 0.74, 1.31], p > 0.05), returning to the operating room (OR = 1.20 [95% CI 0.96, 1.49], p > 0.05), or any post-operative complication (OR = 0.83 [95% CI 0.68, 1.01], p > 0.05). There were also no significant associations found in the ANAOG population on multivariate analysis (p > 0.05 for all). The percentage of free tissue transfer performed in patients from minority backgrounds with head and neck cancer has been increasing in the United States. Outcomes after head and neck microvascular reconstruction are similar when stratified by race. However, racial disparities remain and further work is necessary to reduce these disparities. Level IV Laryngoscope, 2024.

Factors associated with change in activities of daily living performance in home health care patients with diabetes

Older adults with diabetes are at risk for impairments in activities of daily living (ADL) performance. Home health (HH) services help patients regain their ability to perform ADLs following hospitalization, but there may be disparities in ADL improvement. We aimed to identify factors associated with change in ADL performance from the start of HH care to discharge in HH patients with diabetes age ≥65. This secondary analysis used Outcome and Assessment Information Set-D data collected by a HH agency. The sample (n = 1350) had a mean age of 76.3 (SD 7.3). Black/African American race and bowel incontinence/ostomy were associated with less ADL improvement. The following factors were associated with greater ADL improvement: having a caregiver who needed training/support, surgical wounds, pain that interfered with activity, confusion, and better scores in prior functioning. Overall, most patients improved their ADL performance while receiving HH care, but there are disparities that should be addressed.

Longitudinal Transition of Symptom Cluster Profiles Among Community-Dwelling Older Adults With Heart Failure.

Older adults with heart failure experience clustered symptoms. However, little is known about how symptom clusters transition over time. This study aimed to (1) identify the longitudinal transition of symptom cluster profiles over 8 years and (2) examine the associations between demographic and clinical factors and the transition between symptom cluster profiles over time. We conducted a longitudinal secondary analysis of data from the Health and Retirement Study's 2008, 2012, and 2016 surveys. We included participants with heart failure in the core data sets and their proxy respondents in the exit data sets. We included demographic and clinical variables as well as six symptoms (fatigue, shortness of breath, pain, swelling, depressive symptoms, dizziness) through physical health interviews. We used latent transition analysis and multinominal regressions to determine longitudinal profiles and explored the association between demographic and clinical factors and membership in symptom cluster profiles. Among 690 participants, we found four symptom cluster profiles (high burden, low burden, distressing, and respiratory-depressive distress). Participants in the low burden at baseline had the highest probability of transitioning to the respiratory-depressive distress profile. Participants in the respiratory-depressive distress at 4 years had the highest probability of transitioning to the high burden profile. Male sex, Black/African American race, smoking, and comorbidities were associated with the increased odds of transiting from the low symptom burden to the high symptom burden profile. Symptom cluster profile memberships were stable over an 8-year period. However, symptom cluster profiles are changeable and deteriorate over time. Identifying predictive factors enables targeted interventions for those at highest risk.

Du Boisian sociology after Du Bois: Frazier, St Clair Drake, and the global and comparative study of race and empire

AbstractIn this paper, I focus on two thinkers who I contend can be read as Du Boisian sociologists: Franklin Frazier and John Gibbs St. Clair Drake. I argue that both Frazier and Drake are often (mis)represented as being ethnographic sociologists of racism in the American inner city who owe their intellectual training and lineage to the Chicago School. By contrast, I argue that Frazier and Drake, while interested in race in the American inner city, both viewed American racism as only one piece in a global jigsaw puzzle; both advocated for comparative and historical sociologies of race and empire which would highlight—to quote Frazier (1973, 339)—that although racism “in the United States has many unique features, it is […] a phase of a world process.” Excavating this world process, to both Frazier and Drake, necessarily entailed studying the global color line beyond its expression only in the United States. Frazier and Drake ought to be read, therefore, primarily as Du Boisian sociologists, not simply as parochial ethnographers of the inner city. The data for this paper come from the Du Bois, Frazier, and Drake papers housed in archives at the University of Massachusetts‐Amherst, Howard University, and the Schomburg Centre.

Work absence and productivity loss of patients undergoing a trial of spontaneous passage for ureteral stones.

Patients with ureteral stones are often managed with a spontaneous trial of passage. While cost effective, the current literature has not examined the effects of a trial of passage on patients' work productivity. In this study, we aim to characterize work absence and productivity losses in a cohort of patients undergoing a trial of passage for ureteral stones. Actively employed patients aged 18 to 64 and discharged from Duke emergency departments without surgical intervention for ureteral stones ≤ 10mm were contacted by phone four weeks after their presentation. Participants completed the Institute for Medical Technology Assessment Productivity Cost Questionnaire which assesses three domains: absenteeism - missed work; presenteeism -productivity when returning to work; and unpaid work - assistance with household work. Linear regression associated demographic and stone factors with productivity losses.109 patients completed the survey. In total, 67% of patients missed work, 46% had decreased productivity when returning to work, and 55% required assistance with unpaid work. 59% of patients with stones ≤ 5mm missed work versus 84% with stones > 5mm (p = 0.009). African American race (coefficient 23.68, 95% confidence interval 2.24-45.11, p = 0.031), first-time stone formers (coefficient 20.28, 95% confidence interval 2.50-38.07, p = 0.026), and patients with stones > 5mm (coefficient 25.34, 95% CI 5.25-45.44, p = 0.014) were associated with increased productivity losses. The majority of patients miss work while undergoing a trial of passage and many have decreased productivity when returning to work. This information may help counsel patients in emergency departments, especially first-time stone formers, and prevent return visits.

Identifying Factors Associated With Fast Visual Field Progression in Patients With Ocular Hypertension Based on Unsupervised Machine Learning.

We developed unsupervised machine learning models to identify different subtypes of patients with ocular hypertension in terms of visual field (VF) progression and discovered 4 subtypes with different trends of VF worsening. We then identified factors associated with fast VF progression. To identify ocular hypertension (OHT) subtypes with different trends of visual field (VF) progression based on unsupervised machine learning and to discover factors associated with fast VF progression. Cross-sectional and longitudinal study. A total of 3133 eyes of 1568 ocular hypertension treatment study (OHTS) participants with at least 5 follow-up VF tests were included in the study. We used a latent class mixed model (LCMM) to identify OHT subtypes using standard automated perimetry (SAP) mean deviation (MD) trajectories. We characterized the subtypes based on demographic, clinical, ocular, and VF factors at the baseline. We then identified factors driving fast VF progression using generalized estimating equation (GEE) and justified findings qualitatively and quantitatively. Rates of SAP mean deviation (MD) change. The LCMM model discovered four clusters (subtypes) of eyes with different trajectories of MD worsening. The number of eyes in clusters were 794 (25%), 1675 (54%), 531 (17%), and 133 (4%). We labeled the clusters as improvers (cluster 1), stables (cluster 2), slow progressors (cluster 3), and fast progressors (cluster 4) based on their mean of MD decline rate, which were 0.08, -0.06, -0.21, and -0.45dB/year, respectively. Eyes with fast VF progression had higher baseline age, intraocular pressure (IOP), pattern standard deviation (PSD) and refractive error (RE), but lower central corneal thickness (CCT). Fast progression was associated with being male, heart disease history, diabetes history, African American race, and stroke history. Unsupervised clustering can objectively identify OHT subtypes including those with fast VF worsening without human expert intervention. Fast VF progression was associated with higher history of stroke, heart disease and diabetes. Fast progressors were more from African American race, males, and had higher incidence of glaucoma conversion. Subtyping can provide guidance for adjusting treatment plans to slow vision loss and improve quality of life of patients with a faster progression course.

Medications that Regulate Gastrointestinal Transit Influence Inpatient Blood Glucose.

A multitude of factors affect a hospitalized individual's blood glucose (BG), making BG difficult to predict and manage. Beyond medications well established to alter BG, such as beta-blockers, there are likely many medications with undiscovered effects on BG variability. Identification of these medications and the strength and timing of these relationships has potential to improve glycemic management and patient safety. EHR data from 103,871 inpatient encounters over 8 years within a large, urban health system was used to extract over 500 medications, laboratory measurements, and clinical predictors of BG. Feature selection was performed using an optimized Lasso model with repeated 5-fold cross-validation on the 80% training set, followed by a linear mixed regression model to evaluate statistical significance. Significant medication predictors were then evaluated for novelty against a comprehensive adverse drug event database. We found 29 statistically significant features associated with BG; 24 were medications including 10 medications not previously documented to alter BG. The remaining five factors were Black/African American race, history of type 2 diabetes mellitus, prior BG (mean and last) and creatinine. The unexpected medications, including several agents involved in gastrointestinal motility, found to affect BG were supported by available studies. This study may bring to light medications to use with caution in individuals with hyper- or hypoglycemia. Further investigation of these potential candidates is needed to enhance clinical utility of these findings. This study uniquely identifies medications involved in gastrointestinal transit to be predictors of BG that may not well established and recognized in clinical practice.

Racial Disparities in Cancer Stage at Diagnosis and Survival for Adolescents and Young Adults

There are limited studies assessing stage at diagnosis and risk of death among all 5 federally defined races in the US among adolescent and young adult (AYA) patients with cancer. To identify racial disparities in stage at diagnosis and survival among AYA patients with cancer. This retrospective cohort study used data from a US national hospital-based oncology database on AYA patients, aged 15 to 39 years, with the 10 deadliest cancers among AYA patients who received a diagnosis from January 1, 2004, to December 31, 2017, with 6 months or more of follow-up. Analyses by race were categorized by the 5 federally defined races in the US: American Indian or Alaska Native, Asian, Black, Native Hawaiian or Other Pacific Islander, and non-Hispanic White (hereafter, White). White patients served as the majority reference group. Statistical analysis was performed from November 2022 to September 2023. The primary end points were late stage at diagnosis (logistic regression with adjusted odds ratios [AORs] and 95% CIs) and overall survival (log-rank tests and Cox proportional hazards regression with adjusted hazard ratios [AHRs] and 95% CIs). A total of 291 899 AYA patients (median age, 33 years [IQR, 28-37 years]; 186 549 female patients [64%]; 189 812 [65%] with stage I or II cancers) were evaluated. The cohort included 1457 American Indian or Alaska Native patients (1%), 8412 Asian patients (3%), 40 851 Black patients (14%), 987 Native Hawaiian or Other Pacific Islander patients (0.3%), and 240 192 White patients (82%). Cancers included breast (n = 79 195 [27%]), lymphoma (n = 45 500 [16%]), melanoma (n = 36 724 [13%]), testis (n = 31 413 [11%]), central nervous system (n = 26 070 [9%]), colon or rectum (n = 22 545 [8%]), cervix (n = 20 923 [7%]), sarcoma (n = 14 951 [5%]), ovary (n = 8982 [3%]), and lung (n = 5596 [2%]). Risk of late-stage diagnosis was higher for Asian (AOR, 1.20; 95% CI, 1.14-1.26), Black (AOR, 1.40; 95% CI, 1.36-1.43), and Native Hawaiian or Other Pacific Islander (AOR, 1.34; 95% CI, 1.16-1.55) patients compared with White patients. Overall survival differed by race for all cancer sites, except cancers of the central nervous system and ovary. Risk of death was higher for American Indian or Alaska Native (AHR, 1.15; 95% CI, 1.02-1.30), Black (AHR, 1.22; 95% CI, 1.19-1.26), and Native Hawaiian or Other Pacific Islander (AHR, 1.25; 95% CI, 1.09-1.44) patients but lower for Asian patients (AHR, 0.90; 95% CI, 0.85-0.95) compared with White patients. This cohort study of AYA patients suggests that stage at diagnosis and survival varied across races for the 10 deadliest AYA cancers. These results support the need for tailored interventions and informed public policy to achieve cancer care equity for all races.

Sociodemographic Differences in Perspectives on Postpartum Symptom Reporting.

The overall goal of this work is to create a patient-reported outcome (PRO) and decision support system to help postpartum patients determine when to seek care for concerning symptoms. In this case study, we assessed differences in perspectives for application design needs based on race, ethnicity, and preferred language. A sample of 446 participants who reported giving birth in the past 12 months was recruited from an existing survey panel. We sampled participants from four self-reported demographic groups: (1) English-speaking panel, Black/African American race, non-Hispanic ethnicity; (2) Spanish-speaking panel, Hispanic-ethnicity; (3) English-speaking panel, Hispanic ethnicity; (4) English-speaking panel, non-Black race, non-Hispanic ethnicity. Participants provided survey-based feedback regarding interest in using the application, comfort reporting symptoms, desired frequency of reporting, reporting tool features, and preferred outreach pathway for concerning symptoms. Fewer Black participants, compared with all other groups, stated that they had used an app for reporting symptoms (p = 0.02), were least interested in downloading the described application (p < 0.05), and found a feature for sharing warning sign information with friends and family least important (p < 0.01). Black and non-Hispanic Black participants also preferred reporting symptoms less frequently as compared with Hispanic participants (English and Spanish-speaking; all p < 0.05). Spanish-speaking Hispanic participants tended to prefer calling their professional regarding urgent warning signs, while Black and English-speaking Hispanic groups tended to express interest in using an online chat or patient portal (all p < 0.05) CONCLUSION: Different participant groups described distinct preferences for postpartum symptom reporting based on race, ethnicity, and preferred languages. Tools used to elicit PROs should consider how to be flexible for different preferences or tailored toward different groups.

Real-World Biomarker Test Ordering Practices in Non-Small Cell Lung Cancer: Interphysician Variation and Association With Clinical Outcomes.

Patients with metastatic or advanced non-small cell lung cancer (NSCLC) need biomarker testing, including, in most cases, anaplastic lymphoma kinase (ALK), epidermal growth factor receptor (EGFR), and PD-L1, to identify options for targeted therapies and to optimally incorporate immune checkpoint inhibitors into therapeutic regimens. We sought to examine real-world patterns of biomarker testing, quantify interphysician practice variation, and correlate testing with clinical outcomes. We extracted real-world data from a nationwide electronic health record-derived deidentified database from 17,165 patients diagnosed with advanced NSCLC between 2018 and 2021 and receiving care in the community setting. We analyzed data using descriptive analyses, fixed- and mixed-effects logistic regression models, and proportional hazard models. Only 67% of all 17,165 patients and 77% of patients with nonsquamous, metastatic NSCLC had ALK, EGFR, and PD-L1 testing within 90 days of diagnosis. Later diagnosis year (2019-2021 compared with 2018) was associated with higher rates of ALK, EGFR, and PD-L1 testing; stage IIIB/C disease (compared with stage IV), squamous histology, and Black or African American race were associated with lower rates. Interphysician variation was substantial with a median odds ratio between physicians (adjusted for patient factors) of 1.78 for ALK, EGFR, and PD-L1 testing. Patients with nonsquamous, metastatic NSCLC had significantly prolonged survival if tested with all three biomarkers (median, 364 days for all three v 180 for none of the three; hazard ratio, 0.67; P < .001). Rates of biomarker testing appear suboptimal with substantial interphysician variation. Testing correlates with improved survival, although causality cannot be proven from this study. Additional work is needed to address the underlying causes of suboptimal test ordering.

Differences in familiarity with oral immunotherapy among caregivers of White and Black children with food allergy

BackgroundPotential racial and ethnic disparities related to oral immunotherapy (OIT) have not been fully described among children with food allergy (FA). ObjectiveTo characterize the differences in attitudes toward, familiarity with, and utilization of OIT among non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic or Latino (H/L) caregivers of children with FA. MethodsSurveys were administered to the caregivers of children enrolled in Food Allergy Outcomes Related to White and African American Racial Differences, a prospective, multisite cohort of children with FA. The distribution of responses by caregiver-reported race and ethnicity was described using an analysis of variance for continuous outcomes and χ2 tests for categorical outcomes. A logistic regression model was used to determine associations between familiarity with OIT as a treatment option and various other covariates. ResultsThe NHB and H/L respondents were more frequently not familiar with OIT compared with NHW responders (54.3% and 62.5% vs 9.2%, P < .001). This finding remained true, even after adjusting for household income (odds ratio: 0.1, 95% CI: 0.1-0.4 for NHB participants and odds ratio: 0.1, 95% CI: 0.0-0.3 for H/L participants). NHB and H/L participants more frequently reported that they had never heard of OIT before the survey compared with NHW participants (76.7% and 50.0% vs 26.7%, P < .001). None of the NHB and H/L respondents initiated OIT compared with 14.8% of NHW participants (P < .001). ConclusionIn the Food Allergy Outcomes Related to White and African American Racial Differences cohort, familiarity with OIT was lower among caregivers of minoritized racial and ethnic groups, even after adjusting for household income.

Understanding the experiences of virtual race participants through the lens of mindfulness theory

ABSTRACT The development of digital technologies and innovations has contributed, in part, to the rise of virtual races. As a type of active leisure event, virtual races have the potential to overcome geographic constraints and attract more participants. To further our understanding of participants’ virtual race experiences, we adopted mindfulness theory to examine components that contributed to participants reporting a mindful experience or a mindless experience, respectively. Qualitative data were collected via photo-elicitation interviews with 20 informants who completed the 2020 Illinois Marathon Virtual Race in the United States. Findings showed that components that led to informants reporting a mindful experience included: 1) a self-created connection to place, 2) bounded creativity, and 3) an adaptive mindset, whilst components that led to informants reporting a mindless experience included 1) the absence of event formalities and 2) anchoring bias. Based on these findings, we developed a model of mindful/mindless virtual race experiences. Implications for active leisure event literature and mindfulness theory were discussed, along with practical recommendations for how event managers and participants can co-create a mindful virtual race experience.

Understanding delays to parathyroidectomy: A mixed-methods approach

BackgroundPatients from ethnic and racial minority groups with primary hyperparathyroidism may have greater time delays to curative parathyroidectomy. Contributing factors are unclear. MethodsThis was a sequential mixed-methods study. The quantitative phase was a retrospective chart review of adults with primary hyperparathyroidism who underwent parathyroidectomy between 2015 and 2020, collecting demographic and clinical data. Social vulnerability of the patients' residential area, measured with the Social Vulnerability Index, and relevant clinical time intervals were calculated. A multivariable analysis of factors associated with greater time intervals was performed. The qualitative phase involved semistructured interviews with endocrinologists, analyzed inductively for themes. ResultsOn chart review of 1,083 patients, the median age was determined to be 61 years and 856 (79%) were female. Six hundred twenty-eight (57.9%) were non-Hispanic White and 456 (42.1%) were Hispanic ethnicity or Asian, Pacific Islander, Black, Native American, Other or Unknown race. Patients of Hispanic ethnicity, or Asian or Pacific Islander, Black, Native American, Other or Unknown race were more likely than non-Hispanic White patients to live in the most socially vulnerable areas (19.3% vs 5.9%, P < .01) and had greater time intervals than non-Hispanic White patients between index hypercalcemia and first parathyroid hormone level, surgical referral, or parathyroidectomy (all P < .05). On multivariable analysis, age (coefficient 7.9, 95% CI 2.8–13.0) and living in the most socially vulnerable areas (coefficient 297.9, 95% CI 87–508.7) were associated with greater days between index hypercalcemia and parathyroidectomy. In the study's qualitative phase, identified themes for reasons for care delays included socioeconomic, nonsocioeconomic patient, and nonsocioeconomic nonpatient factors. ConclusionCare delays are driven by a combination of socioeconomic and nonsocioeconomic factors.

Examining the "White Health Advantage" Effect among Latinos in the United States.

There is consensus regarding the socio-political roots of the concept of race (and ethnicity) in the United States (US). However arbitrary, the US societal constructions of race have meant racial/ethnic minorities experience disproportionate health burdens. The present study examined the so-called "white health advantage" effect in a large sample of US respondents, comparing Latinos (non-White and White) with non-Latino Whites. This cross-sectional study used deidentified data from the Dynata Global COVID Symptoms map project, collected between July 7-14, 2020 (n = 135,075). A dichotomous health status variable was created with respondents answering yes/no to any COVID-19 symptoms (difficulty breathing, coughing, fatigue, fever, and loss of taste or smell). We included relevant predisposing (age, gender, number of children, race, ethnicity, marital status, and education) and enabling factors (housing conditions, income, employment status, business ownership, and number of cars owned - a proxy measure for wealth). Multivariate logistic regression models showed significant differences in health status (as measured by COVID-19 symptoms) when comparing Latinos (non-White, White) and non-Latino Whites. For instance, higher socioeconomic status had a protective effect only among non-Latino Whites. In turn, being married/living with a partner was only associated with COVID-19 symptoms among White Latinos, indicating that the apparent benefits of this "improving" socio-political location are somewhat limited. Our study found significant differences in COVID-19 symptoms when comparing Latinos (non-White, White) and non-Latino Whites. Our findings underscore the importance of further examining health outcomes by racial identities of US Latinos, which can help inform future health equity efforts.

Factors associated with lower quarter performance-based balance and strength tests: a cross-sectional analysis from the project baseline health study.

Physical performance tests are predictive of mortality and may screen for certain health conditions (e.g., sarcopenia); however, their diagnostic and/or prognostic value has primarily been studied in age-limited or disease-specific cohorts. Our objective was to identify the most salient characteristics associated with three lower quarter balance and strength tests in a cohort of community-dwelling adults. We applied a stacked elastic net approach on detailed data on sociodemographic, health and health-related behaviors, and biomarker data from the first visit of the Project Baseline Health Study (N = 2,502) to determine which variables were most associated with three physical performance measures: single-legged balance test (SLBT), sitting-rising test (SRT), and 30-second chair-stand test (30CST). Analyses were stratified by age (<65 and ≥65). Female sex, Black or African American race, lower educational attainment, and health conditions such as non-alcoholic fatty liver disease and cardiovascular conditions (e.g., hypertension) were consistently associated with worse performance across all three tests. Several other health conditions were associated with either better or worse test performance, depending on age group and test. C-reactive protein was the only laboratory value associated with performance across age and test groups with some consistency. Our results highlighted previously identified and several novel salient factors associated with performance on the SLBT, SRT, and 30CST. These tests could represent affordable, noninvasive biomarkers of prevalent and/or future disease in adult individuals; future research should validate these findings. ClinicalTrials.gov, identifier NCT03154346, registered on May 15, 2017.

Insidious racism and institutional constraints: evidence from national and local case studies in the United States

In recent years, researchers have become increasingly interested in educational and institutional strategies to limit or eradicate contemporary forms of racism in the United States. They have generally accepted that most people in the modern-day United States do not actually want to be racist, but the various legacies of oppression live on through American institutions, promote unconscious biases, and manifest in unintentionally racist behaviors. However, previous research has largely overlooked the interactive relationship specifically between insidious racists, and the institutions meant to limit and punish their intentional behavior. Insidious racists are conscious of their racist beliefs, they engage in intentional acts of racism, and yet, they hold value in not being deemed racist by American society. In this article I develop a framework of the varying institutional constraints associated with addressing insidious racism. I then deploy this framework on national and local case studies to highlight the contribution of this work. The national case study analyzes the institutional constraints that allowed for loan officers to engage in racist actions leading up to the Great Recession. The local case study analyzes institutional constraints that led to the deviant behavior and racist redistricting efforts coordinated by members of the Los Angeles City Council. Taken together, I show that institutional design and administrator ideologies determine the levels of insidious racism prevalent in a given institution.