Group Of Black Patients Research Articles

Cancer Survivorship: Religion in Meaning Making and Coping Among a Group of Black Prostate Cancer Patients in South Africa

The purpose of the study was to explore the role of religion in meaning making and coping among a group of black patients receiving some form of prostate cancer treatment at a public hospital in Limpopo Province, South Africa. A sample of 20 prostate cancer survivors, with ages ranging from 67 to 85 years (meanage = 76yrs; SD = 5.3) selected through purposive sampling. Data were collected through in-depth, semi-structured individual interviews and analysed using interpretative phenomenological analysis (IPA). The findings demonstrated that religion is an important factor in meaning making and coping by prostate cancer survivors. The findings suggest that healthcare practitioners need to pay close attention to the meanings that cancer patients assign to their illness to provide the appropriate care and support.

Survival Analysis of Demographic Factors Associated With 5+ Year Survival of Pancreatic Carcinoma.

BackgroundAlthough pancreatic cancer incidence is low at 13.1 per 100,000 people, this cancer is difficult to treat and carries a poor 5-year survival rate. Additionally, pancreatic cancer survival rates vary disproportionately based on age and race. The objective of this study was to evaluate the association between 5-year survival of pancreatic cancer and the basic demographic factors age, race, and sex.MethodsData were retrieved from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 18 database, spanning from 2000-2017, using SEER*Stat. SPSS was used to calculate descriptive statistics for vital status, age, race, and sex. Odds ratios with confidence intervals were calculated using Epi Info. Case data were used to conduct survival analysis by age, race, and sex using OriginPro.ResultsOut of a total of 118,581 cases, 79.3% were White (n = 106,887), 12.5% were Black (n = 16,866), 7.4% were Asian or Pacific Islander (n = 9,960), 0.6% were American Indian/Alaskan Native (n = 792), and 0.2% were unknown race (n = 321). The odds ratio (OR) of dying before reaching 5+ survival was lowest for the Asian or Pacific Islander group (OR = 0.70, 95% CI: 0.66 - 0.74), followed by the group of Black patients (OR = 1.07, 95% CI: 1.02 - 1.13), the White patients group (OR = 1.12, 95% CI: 1.08 - 1.17), and the American Indian/Alaskan Native group (OR = 1.12, 95% CI: 0.89 - 1.40). The largest age group was 65-69 years old, comprising 14.7% (n = 19,866) of the dataset. Probability of 5+ year survival for pancreatic cancer patients was highest for the age group 15-19 years (n = 74). In general, 5+ year survival probability declined with age. Risk of death before reaching 5+ year pancreatic cancer survival was slightly higher in men (OR = 1.03, 95% CI: 1.00 - 1.07), who comprised 50.9% (n = 68,628) of the dataset.DiscussionFindings from this study corroborate differences by age, race, and sex discussed in the literature. Differences in survival rates by race depart from some findings in literature documenting no significant differences in treatment outcome by race. Controlling for age in a future study in both race and sex survival probability analyses may be helpful. Further, stratifying by sex in survival probability analysis by race would be illuminating. In addition to survival analysis, regression modeling would be a useful next step.

Black patients sustain vision loss while White and South Asian patients gain vision following delamination or segmentation surgery for tractional complications associated with proliferative diabetic retinopathy.

PurposeThis retrospective comparative case series aims to determine whether patient ethnicity (White versus South Asian versus Black) is related to the outcome of surgical treatment for traction complications of severe proliferative diabetic retinopathy (PDR).SettingMoorfields Eye Hospital London, UK.MethodsAll patients who underwent vitrectomy with, delamination and/or segmentation for PDR over a 5-year period (2009-2014) were reviewed retrospectively. Patients were divided into White, South Asian or Black groups, and their age, gender, HbA1C and type of diabetes were recorded. A total of 484 patients (253 White, 117 South Asian, 114 Black) were included. Twenty-one patients were excluded due to inadequate documentation.OutcomesLogMAR Visual acuity (converted from Snellen) (VA), was recorded pre-operatively and ~6 months post surgery (range 5-8 months). Surgical outcome was classified according to the type and duration of tamponade required post-operatively.ResultsPre-operative VA and HbA1C values were similar across all three ethnic groups (P=0.64 and 0.569, respectively). Change in VA (mean±SD) was 0.41±0.78, 0.14±0.76 and -0.26±0.57 in White, South Asian and Black patient groups respectively (P<0.001). Multiple regression analysis showed that post-op VA was significantly related to race and pre-op VA only (both P<0.001). The Black patient group were more likely to require silicone oil tamponade (P<0.001) and long-term retention of silicone oil (P<0.001) than the White and South Asian patient groups.ConclusionsThis study demonstrates that Black patients on average lose vision following delamination surgery for traction complications of PDR while White and South Asian patients gain vision. The same group is also at higher risk of retaining silicone more than 6 months after surgery. This difference remains even when corrected for glycaemic control. The higher risk of visual loss and long-term retention of silicone oil in black patients requires further investigation. If these results are confirmed, surgeons should consider their patients' ethnicity before proceeding with surgical treatment of diabetic tractional detachment.

Stroke burden and risk factors during 1997-2008: Examining the effect of ethnicity and gender

Objective: Examine the effect of race and gender variation on the burden of stroke and associated risk factors among hospital-discharged patients. Materials and Methods: We examined Tennessee Hospital Discharge Database from 1997 to 2008 for patients (older than 20 years) discharged with a diagnosis of stroke. The number of stroke patients was 17,149 in 1997; 19,020 in 2003; and 17,010 in 2008. We also extracted data on cardiovascular risk factors for each patient. Age-adjusted prevalence of hospitalization for stroke per 100K for non-Hispanic white and black patient groups was developed per Center of Disease Control (CDC) procedures of at-risk population. Race- and gender-specific prevalence of stroke and associated cardiovascular risk factors among hospitalized patients were examined using multivariate logistic models. To examine consistency, we compared the two groups at three different points: 1997, 2003, and 2008 regarding the prevalence of stroke and their associated risk factors. Results: Our analyses revealed three major trends: (1) Age-adjusted stroke rate declined by 13.8% over a 12-year period (from 466.8 per 100,000 in 1997 to 402.2 per 100,000 in 2008). This decline occurred for both black and white patients. However, the white stroke rate declined by 19.8% (from 401.9 in 1997 to 322.2 in 2008), compared with only 13.7% among blacks (from 599.2 in 1997 to 517.3 in 2008). Additionally, throughout the 12-year period, although no significant gender differences were observed, the stroke rates among blacks remained consistently higher compared with whites (black:white rate ratios of 1.60 in 1997, 1.40 in 2003, and 1.60 in 2008). Logistic regression analysis revealed the four risk factors that consistently predicted stroke for both black and white patients in 1997, 2003, and 2008, namely, hypertension (HTN), diabetes mellitus (DM), high cholesterol, and cardiac arrhythmia. Conclusion : Aggressive management of two cardiovascular risk factors (HTN and DM) may subsequently reduce stroke health disparity and the burden of stroke hospitalization among blacks.

Randomised controlled trial of joint crisis plans to reduce compulsory treatment for people with psychosis: economic outcomes.

BackgroundCompulsory admission to psychiatric hospitals may be distressing, disruptive to patients and families, and associated with considerable cost to the health service. Improved patient experience and cost reductions could be realised by providing cost-effective crisis planning services.MethodsEconomic evaluation within a multi-centre randomised controlled trial comparing Joint Crisis Plans (JCP) plus treatment as usual (TAU) to TAU alone for patients aged over 16, with at least one psychiatric hospital admission in the previous two years and on the Enhanced Care Programme Approach register. JCPs, containing the patient's treatment preferences for any future psychiatric emergency, are a form of crisis intervention that aim to mitigate the negative consequences of relapse, including hospital admission and use of coercion. Data were collected at baseline and 18-months after randomisation. The primary outcome was admission to hospital under the Mental Health Act. The economic evaluation took a service perspective (health, social care and criminal justice services) and a societal perspective (additionally including criminal activity and productivity losses).FindingsThe addition of JCPs to TAU had no significant effect on compulsory admissions or total societal cost per participant over 18-months follow-up. From the service cost perspective, however, evidence suggests a higher probability (80%) of JCPs being the more cost-effective option. Exploration by ethnic group highlights distinct patterns of costs and effects. Whilst the evidence does not support the cost-effectiveness of JCPs for White or Asian ethnic groups, there is at least a 90% probability of the JCP intervention being the more cost-effective option in the Black ethnic group.InterpretationThe results by ethnic group are sufficiently striking to warrant further investigation into the potential for patient gain from JCPs among black patient groups.Trial RegistrationCurrent Controlled Trials ISRCTN11501328

Ethnic variations in pathways into early intervention services for psychosis

Ethnic variations have previously been identified in the duration of untreated psychosis (DUP) and pathways into psychiatric services. These have not been examined in the context of early intervention services, which may alter these trajectories. To explore ethnic differences in the nature and duration of pathways into early intervention services. In a naturalistic cohort study, data were collected for 1024 individuals with psychotic disorders accepted for case management by eight London early intervention services. Duration of untreated psychosis was prolonged in the White British group compared with most other ethnic groups. White British individuals were more likely to make contact with their general practitioner and less likely to be seen within emergency medical services. All Black patient groups were more likely than their White British counterparts to experience involvement of criminal justice agencies. Variations continue to exist in how and when individuals from different ethnic groups access early intervention services. These may account for disparities in DUP.

3* Spectrum of CFTR mutations in a group of black patients from South Africa: Identification of a novel large rearrangement

3* Spectrum of CFTR mutations in a group of black patients from South Africa: Identification of a novel large rearrangement

Absence of sympathetic overactivity in Afro-Caribbean hypertensive subjects studied by heart rate variability.

Black hypertensives present a greater prevalence of left ventricular hypertrophy and an increased mortality compared to white hypertensives. Differences in sympathetic activity might contribute to explain these racial differences in hypertension. Nevertheless, previous laboratory studies did not show any increase of sympathetic activity direct to the heart in black subjects. The aim of the present study was to investigate the cardiac sympatho-vagal balance in black and white hypertensives analysing heart rate variability, during the entire 24 h. We analysed Holter recordings of 52 essential hypertensive patients, who had never received antihypertensive treatment, 26 of whom were black and 26 were white. Consecutive series of 300 beats, with 150 beats overlapped (approximately 600 series/day), were considered for the analysis in time and frequency domain. The mean 24-h value of the power of the low frequency spectral component (0.04-0.15 Hz), expressed in normalised units, ie a marker of sympathetic modulation, was significantly lower in the group of black patients compared to whites (respectively 40.0 +/- 2.1 vs 53.6 +/- 3.6 nu, P < 0.01). Similar results were observed for the LF/HF ratio, an index of the sympatho-vagal balance (respectively 4.11 +/- 0.58 vs 5.98 +/- 0.79; P < 0.05). In a multiple linear regression analysis, considering diastolic blood pressure, left ventricular mass index, race and age as independent variables, only race (P < 0.002) and age (P < 0.01) could independently predict the normalised low frequency power or the LF/HF ratio, as dependent variables. The results of this study suggest some blunting of the cardiac sympathetic neural modulation in black hypertensives compared to white hypertensives, during the entire 24 h.

Trends in pulmonary embolism mortality in the US elderly population: 1984 through 1991.

This study determined race-, age- and sex-specific trends in 30-day pulmonary embolism mortality rates. Medicare beneficiaries with a primary or secondary discharge diagnosis of pulmonary embolism from 1984 to 1991 (n = 391,991) were examined. For a primary diagnosis of pulmonary embolism, mortality rates declined by 15.2% and 16.0%, respectively, for White male patients 65 to 74 years old and 75 years or older. There was a corresponding decline in mortality rates for White women. For a secondary diagnosis of pulmonary embolism, mortality rates declined by 14.7% and 9.8%, respectively, for White male patients 65 to 74 years old and 75 years or older. The White mortality rate declines revealed in this study did not translate, in all cases, to Black patient groups.

Racial differences in the histology, location, and risk factors of esophageal cancer.

Although esophageal cancer is uncommon in the united states, its high mortality rate and recent increased incidence make it an important malignancy. Because there appears to be significant racial variation in the types of esophageal cancer, we examined a group of black patients with esophageal cancer and compared their risk factors, histology, and location with those of a cohort of white patients with esophageal cancer seen during the same period. We retrospectively reviewed patients with esophageal cancer seen at three major hospitals in Atlanta, Georgia from January 1990 to April 1996. Patients of races other than white or black were excluded from this study, the esophagus was separated into upper, middle, and lower thirds by defined criteria. Of the eligible 234 patients, 129 were black and 105 were white. In blacks with esophageal cancer, squamous cell cancer was the predominant type (92%), and adenocarcinoma was infrequent in whites, adenocarcinoma was more common than squamous cell cancer (66% vs. 32%). Although Barrett's esophagus was distinctly uncommon, smoking and alcohol consumption were significantly more common in blacks. Only 43% of the patients with adenocarcinoma had evidence of barrett's esophagus, all adenocarcinomas were located in the lower third of the esophagus. There appear to be significant racial differences in the types, risk factors, and location of esophageal cancer. Adenocarcinoma and Barrett's esophagus are uncommon in blacks.

Health Beliefs of a Sample of Black Patients Attending a Specialized Medical Facility

Cross-cultural research has highlighted the influential role of health beliefs in shaping responses to health messages and subsequent health behaviour. Research into health behaviour constitutes an interdisciplinary field which studies personal attributes related to health maintenance, restoration and improvement and it embraces concepts related to biopsychosocial health care and behavioural medicine. Health behaviour research is in its infancy in Africa. Particularly in South Africa, where there is a high incidence of diseases requiring high technology medical intervention within a large spectrum of an underprivileged population, there is a need to gain more cross-cultural health behaviour knowledge that would permit the formulation of a health-care education programme specifically designed for local needs. Given this, this study investigated health beliefs amongst a group of black patients who required highly specialized medical treatment. The sample consisted of a random selection of black patients attending a university-affiliated specialized teaching hospital's out-patient clinic for ‘high-tech’ medical or surgical procedures. Results showed statistically significant differences between the health beliefs of rural and urbanized patients and the importance of religious concepts in health beliefs. Further, the patients' health beliefs related to health behaviour were influenced by several other variables including the interaction between socio-economic, cultural, environmental, and other factors. It is argued that, in order to introduce health behaviour changes, these complex sets of beliefs must be taken into account when health-care education programmes are designed.

Resting metabolic rate of esophageal carcinoma patients: a model for energy expenditure measurement in a homogenous cancer population

In cancer patients controversy exists as to the nature of changes in resting metabolic rate (RMR) and their contribution to cachexia. This study describes the fasting indirect calorimetry, and nutritional measurements made on a homogeneous group of Black patients with carcinoma of the esophagus. It compares them with a reference group. All cancer patients had localized disease and were markedly malnourished. They were on average 20 to 25% lighter than reference subjects. In the cancer patients, the triceps skinfold thickness (TSF) in mm and the hand grip strength in kg/m2, mean and SD, were, respectively, 7.3 +/- 2.8 and 28 +/- 6 for men and 12 +/- 5 and 22 +/- 3.5 for women, and were significantly lower than those of the reference subjects. Fat-free mass was calculated from the TSF measurements. In men with cancer RMR (6.06 MJ/day +/- 0.56) was significantly lower than the reference subjects values (7.07 MJ/day +/- 0.64) p = 0.002. In women with cancer RMR was on average 2 MJ/day less than in controls but this difference failed to reach significance. However, when expressed per kg fat free mass, or per kg body weight this difference is no longer apparent the RMR being 0.14 MJ/kg/fat free mass in both groups. Our interpretation is that there is no direct effect of the tumour on RMR and that energy expenditure changes are secondary to body composition changes.

A screening protocol for a prenatal population at risk for inherited hemoglobin disorders: Results of its application to a group of Southeast Asians and blacks

Several inherited hemoglobin disorders are present among certain racial subgroups of the United States population, particularly among blacks and Southeast Asians. Many of these disorders are unfamiliar to the obstetrician-gynecologist but may have important implications for care in pregnancy, including genetic counseling and prenatal diagnosis. A simple, effective screening tool was devised for detection of thalassemias and hemoglobinopathies in a prenatal clinic population. Use of the tool resulted in diagnosis of a hemoglobin disorder in 20% of a group of black patients; diagnoses included alpha-thalassemia trait, beta-thalassemia trait, hemoglobin C trait, hemoglobin S/C disease, hemoglobin S trait, sickle cell anemia, and hemoglobin Lepore. In a group of Southeast Asian patients, 39% had a hemoglobin disorder, including alpha-thalassemia trait, beta-thalassemia trait, hemoglobin E disease, and hemoglobin H disease. Implications for care are discussed.

Use of the Tourniquet During Surgery in Patients with Sickle Cell Hemoglobinopathies

Twenty-one patients carrying the sickle cell gene underwent 29 operative procedures using tourniquet-induced ischemia. No statistically increased incidence of complications occurred in the sickle cell group when compared with a control group of black patients who did not have the sickle cell trait, but who underwent similar operative procedures. There was no obvious contraindication to the use of the tourniquet in patients carrying the sickle cell gene.