1
|
Plante TB, Juraschek SP, Howard G, Howard VJ, Tracy RP, Olson NC, Judd SE, Kamin Mukaz D, Zakai NA, Long DL, Cushman M. Cytokines, C-Reactive Protein, and Risk of Incident Hypertension in the REGARDS Study. Hypertension 2024; 81:1244-1253. [PMID: 38487890 PMCID: PMC11095906 DOI: 10.1161/hypertensionaha.123.22714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/28/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Hypertension is a highly prevalent cardiovascular disease risk factor that may be related to inflammation. Whether adverse levels of specific inflammatory cytokines relate to hypertension is unknown. The present study sought to determine whether higher levels of IL (interleukin)-1β, IL-6, TNF (tumor necrosis factor)-α, IFN (interferon)-γ, IL-17A, and CRP (C-reactive protein) are associated with a greater risk of incident hypertension. METHODS The REGARDS study (Reasons for Geographic and Racial Difference in Stroke) is a prospective cohort study that recruited 30 239 community-dwelling Black and White adults from the contiguous United States in 2003 to 2007 (visit 1), with follow-up 9 years later in 2013 to 2016 (visit 2). We included participants without prevalent hypertension who attended follow-up 9 years later and had available laboratory measures and covariates of interest. Poisson regression estimated the risk ratio of incident hypertension by level of inflammatory biomarkers. RESULTS Among 1866 included participants (mean [SD] aged of 62 [8] years, 25% Black participants, 55% women), 36% developed hypertension. In fully adjusted models comparing the third to first tertile of each biomarker, there was a greater risk of incident hypertension for higher IL-1β among White (1.24 [95% CI, 1.01-1.53]) but not Black participants (1.01 [95% CI, 0.83-1.23]) and higher TNF-α (1.20 [95% CI, 1.02-1.41]) and IFN-γ (1.22 [95% CI, 1.04-1.42]) among all participants. There was no increased risk with IL-6, IL-17A, or CRP. CONCLUSIONS Higher levels of IL-1β, TNF-α, and IFN-γ, representing distinct inflammatory pathways, are elevated in advance of hypertension development. Whether modifying these cytokines will reduce incident hypertension is unknown.
Collapse
Affiliation(s)
- Timothy B. Plante
- Departments of Medicine (T.B.P., D.K.M., N.A.Z., M.C.), Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Stephen P. Juraschek
- Department of Medicine, Beth Israel Lahey Clinic/Harvard Medical School, Boston, MA (S.P.J)
| | - George Howard
- Departments of Biostatistics (G.H., S.E.J.), School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Virginia J. Howard
- Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Russell P. Tracy
- Pathology and Laboratory Medicine (R.P.T., N.C.O., N.A.Z., M.C.), Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Nels C. Olson
- Pathology and Laboratory Medicine (R.P.T., N.C.O., N.A.Z., M.C.), Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Suzanne E. Judd
- Departments of Biostatistics (G.H., S.E.J.), School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Debora Kamin Mukaz
- Departments of Medicine (T.B.P., D.K.M., N.A.Z., M.C.), Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Neil A. Zakai
- Departments of Medicine (T.B.P., D.K.M., N.A.Z., M.C.), Larner College of Medicine at the University of Vermont, Burlington, VT
- Pathology and Laboratory Medicine (R.P.T., N.C.O., N.A.Z., M.C.), Larner College of Medicine at the University of Vermont, Burlington, VT
| | - D. Leann Long
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC (D.L.L.)
| | - Mary Cushman
- Departments of Medicine (T.B.P., D.K.M., N.A.Z., M.C.), Larner College of Medicine at the University of Vermont, Burlington, VT
- Pathology and Laboratory Medicine (R.P.T., N.C.O., N.A.Z., M.C.), Larner College of Medicine at the University of Vermont, Burlington, VT
| |
Collapse
|
2
|
Williams MT, Holmes S, Zare M, Haeny A, Faber S. An Evidence-Based Approach for Treating Stress and Trauma due to Racism. COGNITIVE AND BEHAVIORAL PRACTICE 2023; 30:565-588. [PMID: 38037647 PMCID: PMC10686550 DOI: 10.1016/j.cbpra.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Racism can be stressful or even traumatizing. Psychological unwellness emerges out of the confluence of historical, cultural, and individual experiences, and resulting syndromes may or may not fit into a DSM-5 PTSD diagnostic framework. Although racial stress and trauma are common presentations in therapy, few therapists have the resources or training to treat these issues. Based on the empirical evidence to date, this article describes the essential components of treatment for racial stress and trauma from a cognitive-behavioral perspective, called the Healing Racial Trauma protocol. Each technique is described with reference to the literature supporting its use for racial stress and trauma, along with guidance for how therapists might implement the method with clients. Also provided is information about sequencing techniques for optimal outcomes. Critical therapist prerequisites for engaging in this work are also discussed, with an emphasis on an anti-racist, empathy-centered approach throughout.
Collapse
|
3
|
Bliton JN. Inefficiency in Delivery of General Surgery to Black Patients: A National Inpatient Sample Study. Surg J (N Y) 2023; 9:e123-e134. [PMID: 38197094 PMCID: PMC10730284 DOI: 10.1055/s-0043-1777811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2024] Open
Abstract
Background Racial disparities in outcomes among patients in the United States are widely recognized, but disparities in treatment are less commonly understood. This study is intended to identify treatment disparities in delivery of surgery and time to surgery for diagnoses managed by general surgeons-appendicitis, cholecystitis, gallstone pancreatitis, abdominal wall hernias, intestinal obstructions, and viscus perforations. Methods The National Inpatient Sample (NIS) was used to estimate and analyze disparities in delivery of surgery, type of surgery received, and timing of surgery. Age-adjusted means were compared by race/ethnicity and trends in treatment disparities were evaluated from 1993 to 2017. Linear modeling was used to measure trends in treatment and outcome disparities over time. Mediation analysis was performed to estimate contributions of all available factors to treatment differences. Relationships between treatment disparities and disparities in mortality and length of stay were similarly evaluated. Results Black patients were less likely to receive surgery for appendicitis, cholecystitis, pancreatitis, and hernias, and more likely to receive surgery for obstructions and perforations. Black patients experienced longer wait times prior to surgery, by 0.15 to 1.9 days, depending on the diagnosis. Mediation analysis demonstrated that these disparities are not attributable to the patient factors available in the NIS, and provided some insight into potential contributors to the observed disparities, such as hospital factors and socioeconomic factors. Conclusion Treatment disparities are present even with common indications for surgery, such as appendicitis, cholecystitis, and gallstone pancreatitis. Black patients are less likely to receive surgery with these diagnoses and must wait longer for surgery if it is performed. Surgeons should plan institution-level interventions to measure, explain, and potentially correct treatment disparities.
Collapse
Affiliation(s)
- John N. Bliton
- Department of Surgery, Jamaica Hospital Medical Center, Queens, New York
| |
Collapse
|
4
|
Lawrence SC, Lederer SE. Medical specimens and the erasure of racial violence: the case of Harriet Cole. MEDICAL HUMANITIES 2023; 49:457-467. [PMID: 36931722 PMCID: PMC10511999 DOI: 10.1136/medhum-2022-012514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
This article analyses the complex narrative of Harriet Cole, a 36-year-old African-American woman whose body was delivered to the anatomy department of Hahnemann Medical School in 1888. The anatomist Rufus B Weaver used her preserved remains to create a singular anatomical specimen, an intact extraction of the 'cerebro-spinal nervous system'. Initially anonymised, deracialised and unsexed, the central nervous system specimen endured for decades before her identity as a working-class woman of colour was reunited with her remains. In the 1930s, media accounts began to circulate that Harriet Cole had bequeathed her remains to the anatomist, a claim that continues to circulate uncritically in the biomedical literature today. Although we conclude that this is likely a confabulation that erased the history of violence to her autonomy and her dead body, the rhetorical possibility that Harriet Cole might have chosen to donate her body to the medical school reflects the racial, political and legal dimensions that influenced how and why the story of Harriet Cole's 'gift' served multiple purposes in the century and a half since her death.
Collapse
Affiliation(s)
| | - Susan E Lederer
- Medical History and Bioethics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| |
Collapse
|
5
|
Abstract
BACKGROUND History is a critical methodology that provides perspective on complex issues in health care today. METHOD This article draws on a selection of interdisciplinary scholarship on the history of nursing and health care, including work by scholars of color; lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ+) scholars; and disability studies scholars, to demonstrate the role of history in inclusive nursing education. RESULTS History provides critical perspective regarding how race, gender, class, sexuality, and disability have shaped the development of nursing and the health care system, affected who has been able to access education and careers in nursing, and influenced Americans' access to and experiences of health care. CONCLUSION History prepares nursing students to better understand the reasons for and implications of persistent health disparities and inequities in access to nursing education and health care services, providing them with knowledge to advocate for greater health equity and social justice during their nursing careers. [J Nurs Educ. 2022;61(8):469-475.].
Collapse
|
6
|
Walker VP, Williams DR. Restitution Through Equity-Focused Mentoring: A Solution to Diversify the Physician Workforce. Front Public Health 2022; 10:879181. [PMID: 35719651 PMCID: PMC9199986 DOI: 10.3389/fpubh.2022.879181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022] Open
Abstract
Minoritized and marginalized physicians who identify as Black, Latino/a/x and Native American (BLNA) remain unacceptably underrepresented in medicine. Multiple studies provide a compelling argument for prioritizing racial/ethnic diversification of the physician workforce to improve racial/ethnic physician-patient concordance and assist in achieving more equitable health outcomes. Despite a growing awareness for the tangible benefits of a diversified physician workforce, the number of physicians from minoritized and marginalized groups remains relatively stagnant or worsening in certain demographics. The 5:1 ratio of Black students and trainees to Black faculty exemplifies and exacerbates the increased risk for harmful isolation particularly experienced by many BLNA mentees. They too need and deserve the benefits produced by concordant racial/ethnic faculty mentoring and support. However, these demands on time, resources and bandwidth can lead to negative consequences for BLNA faculty engaged in these efforts by contributing to their emotional, mental and physical exhaustion. Given the perpetual paucity of BLNA physicians in academic medicine, immediate interventions to prevent attrition of BLNA faculty, trainees and students journeying along the physician career pathway are urgently needed. Requiring the implementation of mentoring programs explicitly focused on increasing the number of physicians from groups underrepresented in medicine must happen at every point of the education and training process.
Collapse
Affiliation(s)
- Valencia P Walker
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States.,Center for the Study of Racism, Social Justice and Health, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Dominique R Williams
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States.,Division of Primary Care, Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH, United States
| |
Collapse
|
7
|
Calhoun A, Genao I, Martin A, Windish D. Moving Beyond Implicit Bias in Antiracist Academic Medicine Initiatives. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:790-792. [PMID: 34907963 DOI: 10.1097/acm.0000000000004562] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The concept of implicit bias has arguably laid the groundwork for uncomfortable discussions surrounding race in academic medicine, but its effectiveness in changing racist behavior and systems remains unclear. Terms like implicit bias, while perhaps more palatable than other concepts to some, may result in confusion and divert time from meaningful reconceptualization and creation of effective antiracism initiatives. This Invited Commentary contends that the term implicit bias is inadequate for addressing racism because it is too broad; does not necessarily lead to a change in racist behaviors; assumes that racism is unconscious, aggressor-centered, and individual-focused; and implies that everyone suffers equally in a racist system. The authors illustrate why terms like implicit bias are inadequate in combatting racism in medicine and suggest alternate terminology to use while engaging in antiracism work in academic medicine.
Collapse
Affiliation(s)
- Amanda Calhoun
- A. Calhoun is an adult/child psychiatry resident, Yale Child Study Center, New Haven, Connecticut
| | - Inginia Genao
- I. Genao is the graduate medical education director for diversity and inclusion and associate professor of medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Andrés Martin
- A. Martin is the Riva Ariella Ritvo Professor, Yale Child Study Center, and medical director, Children's Psychiatric Inpatient Service, Yale-New Haven Children's Hospital, New Haven, Connecticut
| | - Donna Windish
- D. Windish is associate professor of medicine and program director, General Internal Medicine Medical Education Fellowship, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
8
|
Hamilton R, Ciccarelli O. Multiple Sclerosis Incidence in Black Patients: It Is Time to Do Away With a Racial Medical Myth. Neurology 2022; 98:739-740. [PMID: 35483903 DOI: 10.1212/wnl.0000000000200309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/10/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Roy Hamilton
- From the Department of Neurology (R.H.), University of Pennsylvania, Philadelphia; Queen Square MS Centre (O.C.), Department of Neuro-Inflammation, University College London Queen Square Institute of Neurology; and NIHR University College London Hospitals Biomedical Research Centre (O.C.), UK
| | - Olga Ciccarelli
- From the Department of Neurology (R.H.), University of Pennsylvania, Philadelphia; Queen Square MS Centre (O.C.), Department of Neuro-Inflammation, University College London Queen Square Institute of Neurology; and NIHR University College London Hospitals Biomedical Research Centre (O.C.), UK
| |
Collapse
|
9
|
Hanson C, Samson K, Anderson-Berry AL, Slotkowski RA, Su D. Racial disparities in caesarean delivery among nulliparous women that delivered at term: cross-sectional decomposition analysis of Nebraska birth records from 2005-2014. BMC Pregnancy Childbirth 2022; 22:329. [PMID: 35428241 PMCID: PMC9013155 DOI: 10.1186/s12884-022-04666-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/28/2022] [Indexed: 11/21/2022] Open
Abstract
Background Previous studies suggest higher rates of caesarean section among women who identify as racial/ethnic minorities. The objective of this study was to understand factors contributing to differences in caesarean rates across racial and ethnic groups. Methods Data was collected from 2005 to 2014 Nebraska birth records on nulliparous, singleton births occurring on or after 37 weeks gestation (n = 87,908). Risk ratios (RR) and 95% confidence intervals (CI) for caesarean were calculated for different racial and ethnic categories, adjusting for maternal age, marital status, county of residence, education, insurance status, pre-pregnancy BMI, and smoking status. Fairlie decomposition technique was utilized to quantify the contribution of individual variables to the observed differences in caesarean. Results In the adjusted analysis, relative to non-Hispanic (NH) White race, both Asian-NH (RR 1.21, 95% CI 1.14, 1.28) and Black-NH races (RR 1.13, 95% CI 1.08, 1.19) were associated with a significantly higher risk for caesarean. The decomposition analysis showed that among the variables assessed, maternal age, education, and pre-pregnancy BMI contributed the most to the observed differences in caesarean rates across racial/ethnic groups. Conclusion This analysis quantified the effect of social and demographic factors on racial differences in caesarean delivery, which may guide public health interventions aimed towards reducing racial disparities in caesarean rates. Interventions targeted towards modifying maternal characteristics, such as reducing pre-pregnancy BMI or increasing maternal education, may narrow the gap in caesarean rates across racial and ethnic groups. Future studies should determine the contribution of physician characteristics, hospital characteristics, and structural determinants of health towards racial disparities in caesarean rates.
Collapse
|
10
|
Gee GC, Morey BN, Bacong AM, Doan TT, Penaia CS. Considerations of Racism and Data Equity Among Asian Americans, Native Hawaiians, And Pacific Islanders in the Context of COVID-19. CURR EPIDEMIOL REP 2022; 9:77-86. [PMID: 35342687 PMCID: PMC8932682 DOI: 10.1007/s40471-022-00283-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/22/2022]
Abstract
Purpose of Review The COVID-19 pandemic has revealed the importance of considering social determinants of health, including factors such as structural racism. This review discusses some of the evidence that triangulates on this issue, including data from hate crime statistics, social media analysis, and survey-based research. It also examines the data needs for Asian Americans, Native Hawaiian, and Pacific Islander (NHPI) communities. Recent Findings The available data provides evidence that the pandemic has contributed to an increase in anti-Asian sentiment and discriminatory incidents. Many reports have surfaced showing a surge in anti-Chinese discrimination, which has "spilled over" into other Asian communities. Research is beginning to emerge to show that such discrimination may also impact health issues such as psychological distress. Given prior research, we would expect many more studies to emerge in the future. Also, the pandemic has illustrated the major gaps in data available to disentangle the health and social concerns facing Asian Americans and NHPI communities. Significant issues include the lack of systematic reporting of data for these communities both across states, and even among agencies within a state; erroneous aggregation of Asians with NHPIs; and censoring of data. These gaps and issues contribute to bias that obscures objective data and amplifies health inequalities. Summary The COVID-19 pandemic has had a negative impact on the well-being of Asian American and NHPI communities. It is critical to provide disaggregated data, not only so that we can have accurate reporting, but also to ensure data and health equity.
Collapse
Affiliation(s)
- Gilbert C. Gee
- Department of Community Health Sciences, University of California Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA USA
| | - Brittany N. Morey
- Department of Health, Society, & Behavior, Program in Public Health, University of California Irvine, 653 E. Peltason Dr., Anteater Instruction and Research Building (AIRB) 2022, Irvine, CA USA
| | - Adrian M. Bacong
- Department of Community Health Sciences, University of California Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA USA
| | - Tran T. Doan
- Department of Health Management and Policy, University of Michigan, 1415 Washington Heights, Ann Arbor, MI USA
| | - Corina S. Penaia
- Asian Pacific Islander Forward Movement, 905 East 8th Street, Los Angeles, CA USA
- Department of Health Policy and Management, University of California Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA USA
| |
Collapse
|
11
|
Ibrahim Z, Brown C, Crow B, Roumimper H, Kureshi S. The Propagation of Race and Racial Differences as Biological in Preclinical Education. MEDICAL SCIENCE EDUCATOR 2022; 32:209-219. [PMID: 35186437 PMCID: PMC8814266 DOI: 10.1007/s40670-021-01457-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 06/14/2023]
Abstract
Modern scientific research has demonstrated that race is a social construct rather than a biological construct. Yet, medical education research suggests that medical faculty still sometimes characterize race and racial differences as biological during lectures. To explore this dynamic, we reviewed (1) how race is presented in the preclinical curriculum of an undergraduate medical institution and (2) how preclinical faculty both define race and attribute disparate health outcomes to race. In part 1 of the study, the authors conducted a retrospective summative content analysis of all first-year preclinical lectures during the 2018-2019 academic year. In part 2, the authors administered a survey to preclinical faculty on the understanding of race, and responses were assessed through conventional content analysis. A number of faculty suggested a biological basis for racial differences during lectures, though survey results suggested that the majority characterize race as a social construct. Faculty knowledge of race and racial differences as a social construct was not reflected in the majority of the curricular analysis. Instead, the lectures showed that faculty predominantly discussed race without context (e.g., as a standalone epidemiological statistic or an unexplained factor of risk, diagnosis, prognosis, or treatment), or with a biological context. We conclude that there is a discrepancy between preclinical faculty knowledge of race and the presentation of race and racial differences in lectures. This discrepancy has implications on medical education. We offer possible explanations for this discrepancy as well as resources for preclinical faculty development to bridge this gap.
Collapse
Affiliation(s)
- Zara Ibrahim
- Georgetown University School of Medicine, Washington, D.C USA
| | - Claire Brown
- Georgetown University School of Medicine, Washington, D.C USA
| | - Brendan Crow
- Georgetown University School of Medicine, Washington, D.C USA
| | | | - Sarah Kureshi
- Family Medicine Academic Department, Georgetown University School of Medicine, Washington, D.C USA
| |
Collapse
|
12
|
Frontline yet at the back of the queue – improving access and adaptations to CBT for Black African and Caribbean communities. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
This paper focuses on the Black minority ethnic population (Black British, Black African, Black Caribbean) and uses the term BME in reference to this group. Only 6.2% of BME people access psychological intervention for common mental disorders. In provision of cognitive behavioural therapy (CBT) the diversity in global majority populations1 requires culturally specific informed and responsive approaches. The Improving Access to Psychological Therapies (IAPT) programme needs to be accountable, culturally congruent and strategic, to ensure accessibility and improve outcomes for BME people. According to the Mental Health Foundation (2019), a higher percentage of Black, Asian and other minority ethnic populations (BAME) are diagnosed with common, severe and complex mental health disorders. Despite the weight of literature on this, little has changed. The NHS Implementation Plan outlines trajectories for increased access and reduced attrition within mental health services, addressing inequalities for BAME populations.
Evidence-based guidance and audits for provision of culturally sensitive and adapted therapies are presented in the pioneering (IAPT) BAME Positive Practice Guide (PPG). However, there are no funding arrangements or formal integrated frameworks to support implementation. The COVID-19 global pandemic and the high-profile death of George Floyd tragically exposed and highlighted the consequences of systemic racism. Understanding of the importance of service and clinical anti-racist practice is imperative for CBT therapists. Implementation of the BAME PPG audit tool ensures review of race equity in access, engagement, adaptation and workforce within IAPT and other mental health services. This could transform lives.
Key learning aims
(1)
To understand the barriers (individual, societal and systemic) to accessing psychological therapies such as CBT and the impact on CBT treatment outcomes specifically for black minority ethnic (BME) populations.
(2)
To recognise barriers to implementation of formal frameworks for equitable access to psychological therapies such as CBT for BME communities.
(3)
To assist services and therapists to implement evidence-based learning, on cultural adaptations, to address barriers in access, retention and completion of CBT.
(4)
To provide examples of services that have taken successful actions to address the issues identified in the earlier points.
Collapse
|
13
|
Benton R. Unconscious bias and how clinicians can address racial inequities in medicine. JAAPA 2021; 34:51-53. [PMID: 34031316 DOI: 10.1097/01.jaa.0000751000.53855.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Roxanna Benton
- Roxanna Benton practices in pediatrics at Val Verde Regional Medical Center in Del Rio, Tex. The author has disclosed no potential conflicts of interest, financial or otherwise
| |
Collapse
|
14
|
Abstract
Integrating the story of a young Freud's racial trauma with a novel application of the concept of moral injury has led to a realization and conceptual formulation during the pandemic uprisings of the mental construct of Black Rage as an adaptation to oppression trauma. As formulated here, Black Rage exists in a specific dynamic equilibrium as a compromise formation that is a functional adaptation for oppressed people of color who suffer racial trauma and racial degradation, an adaptation that can be mobilized for the purpose of defense or psychic growth. Black Rage operates as a mental construct in a way analogous to the structural model [corrected], in which mental agencies carry psychic functions. The concept of Black Rage is crucial to constructing a theoretical framework for a psychology of oppression and transgenerational transmission of trauma. Additionally, in the psychoanalytic theory on oppression suggested here, a developmental line is formulated for the adaptive function of Black Rage in promoting resilience in the face of oppression trauma for marginalized people.
Collapse
|
15
|
Abstract
Covid-19 has infected thousands and killed hundreds in prisons, jails, and immigration detention facilities across the United States. Responding to this crisis, leading medical researchers have called for expanding opportunities for people in prison to participate in vaccine trials. These calls, like current regulations, focus on individualized risk assessments around consent, coercion, and harm, while ignoring the unnaturalness of deprivation conditions in U.S. prisons. We need new frameworks of analysis that refocus on structural, rather than individual, risk assessments. Integrating structural perspectives-including skepticism of claims of scarcity, avoidance of representational distortions, and attention to institutional agency-into our existing, overly individualistic frameworks might permit the design of more ethical research projects involving people who are incarcerated. Still, the unnatural deprivations of incarceration might be so great that research subjects might need to be removed from prison entirely in order to ethically participate in research.
Collapse
|
16
|
Gwenzi W, Rzymski P. When silence goes viral, Africa sneezes! A perspective on Africa's subdued research response to COVID-19 and a call for local scientific evidence. ENVIRONMENTAL RESEARCH 2021; 194:110637. [PMID: 33373609 PMCID: PMC7837055 DOI: 10.1016/j.envres.2020.110637] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/13/2020] [Accepted: 12/16/2020] [Indexed: 05/17/2023]
Abstract
By mid-September 2020, over 1.33 million confirmed COVID-19 cases and 32 thousand deaths had been reported in Africa. Global research on COVID-19 went 'viral' with a record 3487 research contributions comprising of 2062 journal papers and 1425 preprints published within the first three months following the outbreak of COVID-19. Surprisingly, the silence of the African research community has been unprecedented - contributing a paltry 0.6% (22 contributions), a figure nearly matched by Colombia (18 publications). Until now, a comprehensive perspective on the reasons for this subdued research response, and COVID-19 themes critical to Africa has been missing. We posit that while a milieu of factors accounts for this silence, unprecedented research opportunities exist to support COVID-19 decision and policy formulation in Africa. The subdued response reflects weak research systems, characterized by deep-rooted challenges, including severe lack of research expertise, funding, and infrastructure, coupled with poor working conditions. Hence, Africa's contribution to research on infectious diseases, including COVID-19, remains weak. Perceptions and attitudes among researchers and policy-makers on COVID-19, and the role of science in decision and policy-making also exist. Moreover, COVID-19 and earlier severe acute respiratory syndromes are considered as 'imported diseases' originating from outside Africa. Thus, notions may exist that the control methods will come from outside Africa through 'technology-transfer' or 'capacity-building'. Yet local COVID-19 research is needed to address knowledge gaps, including; (1) potential novel transmission of SARS-CoV-2, (2) adaption of generic COVID-19 control measures to suit African settings, (3) occurrence and persistence of SARS-CoV-2 in solid waste, wastewaters, on-site sanitation systems, and drinking water, and (4) the 'human factor' including the role of gender, perceptions, myths, attitudes, and religious beliefs in the transmission and control of COVID-19. Therefore, there is a need to: (1) strengthen local research capacity and evaluation systems, (2) consider biosafety and ethical issues, (3) initiate cross-disciplinary research and global collaboration on COVID-19, and (4) integrate science communication in COVID-19 programs.
Collapse
Affiliation(s)
- Willis Gwenzi
- Biosystems and Environmental Engineering Research Group, Department of Soil Science and Agricultural Engineering, Faculty of Agriculture, University of Zimbabwe, P.O.Box MP 167, Mount Pleasant, Harare, Zimbabwe.
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, Rokietnicka 8, 60-806, Poznań, Poland; Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), Poznań, Poland
| |
Collapse
|
17
|
Altschuler S, Maddock Dillon E. Humanities in the Time of Covid: The Humanities Coronavirus Syllabus. ISLE: INTERDISCIPLINARY STUDIES IN LITERATURE AND ENVIRONMENT 2021. [PMCID: PMC7928897 DOI: 10.1093/isle/isaa192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
18
|
Rzymski P, Mamzer H, Nowicki M. The Main Sources and Potential Effects of COVID-19-Related Discrimination. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1318:705-725. [PMID: 33973207 DOI: 10.1007/978-3-030-63761-3_39] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The outbreak of a new coronavirus disease (COVID-19), which appeared in late 2019 and eventually resulted in the announcement of a pandemic by the World Health Organization, led to global fear and panic as well as the spread of false information and fake news from different sources. As a result, a sharp increase in prejudice, discrimination, and xenophobia against different groups of people was observed in different geographical locations. This chapter presents the psychological and social sources of stereotypes and prejudices that take forms in the COVID-19 pandemic. These sources can be located in psychosocial processes, such as (i) socially generated and reinforced fears; (ii) human responses to stress induced by certain types of stimuli; (iii) sense of helplessness based on the lack of control over reality; (iv) psychological responses reinforced by conformism (crowd psychology); and (v) the stigmatization process. The chapter also presents the main groups of increased risk of experiencing prejudice and discrimination during the COVID-19 pandemic (Asians, health-care workers, COVID-19 patients, and their relatives). Moreover, it provides a documented example of such behaviors. The groups at higher risk of more adverse effects of COVID-19 due to pre-pandemic discrimination are also discussed. Finally, initiatives taken to mitigate the discrimination associated with COVID-19 are presented, as well as the recommendations and good practices for preventing these behaviors during future outbreaks and for limiting discrimination against COVID-19 until the disease can be contained.
Collapse
Affiliation(s)
- Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, Poznań, Poland. .,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Poznań, Poland.
| | - Hanna Mamzer
- Faculty of Sociology Adam Mickiewicz University, Szamarzewskiego 89 c, 60-568, Poznań, Poland
| | - Michał Nowicki
- Chair of Histology and Embryology, Poznan University of Medical Sciences, Poznań, Poland
| |
Collapse
|
19
|
Loeb TB, Ebor MT, Smith-Clapham AM, Chin D, Novacek DM, Hampton-Anderson JN, Norwood-Scott E, Hamilton AB, Brown AF, Wyatt GE. How Mental Health Professionals Can Address Disparities in the Context of the COVID-19 Pandemic. ACTA ACUST UNITED AC 2020; 27:60-69. [PMID: 34025223 DOI: 10.1037/trm0000292] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The Coronavirus 2019 (COVID-19) pandemic is an unparalleled crisis, yet also a unique opportunity for mental health professionals to address and prioritize mental and physical health disparities that disproportionately impact marginalized populations. Black, Indigenous, and People of Color (BIPOC) have long experienced structural racism and oppression, resulting in disproportionately high rates of trauma, poverty, and chronic diseases that span generations and are associated with increased COVID-19 morbidity and mortality rates. The current pandemic, with the potential of conferring new trauma exposure, interacts with and exacerbates existing disparities. To assist mental health professionals in offering more comprehensive services and programs for those who have minimal resources and the most profound barriers to care, four critical areas are highlighted as being historically problematic and essential to address: (a) recognizing psychology's role in institutionalizing disparities; (b) examining race/ethnicity as a critical variable; (c) proactively tackling growing mental health problems amidst the COVID-19 crisis; and (d) understanding the importance of incorporating historical trauma and discrimination in research and practice. Recommendations are provided to promote equity at the structural (e.g., nationwide, federal), professional (e.g., the mental health professions), and individual (e.g., practitioners, researchers) levels.
Collapse
Affiliation(s)
- Tamra Burns Loeb
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Megan T Ebor
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Amber M Smith-Clapham
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Dorothy Chin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Derek M Novacek
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095.,Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA, 90073
| | - Joya N Hampton-Anderson
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA, 30322
| | - Enricka Norwood-Scott
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Alison B Hamilton
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095.,Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA, 90073
| | - Arleen F Brown
- Division of General Internal Medicine and Health Services Research (GIM and HSR), University of California Los Angeles, CA, USA, 90095.,Division of GIM and HSR, Olive View-UCLA Medical Center, Sylmar, CA, USA, 91342
| | - Gail E Wyatt
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| |
Collapse
|
20
|
Kuno G. The Absence of Yellow Fever in Asia: History, Hypotheses, Vector Dispersal, Possibility of YF in Asia, and Other Enigmas. Viruses 2020; 12:E1349. [PMID: 33255615 PMCID: PMC7759908 DOI: 10.3390/v12121349] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 01/11/2023] Open
Abstract
Since the recent epidemics of yellow fever in Angola and Brazil as well as the importation of cases to China in 2016, there has been an increased interest in the century-old enigma, absence of yellow fever in Asia. Although this topic has been repeatedly reviewed before, the history of human intervention has never been considered a critical factor. A two-stage literature search online for this review, however, yielded a rich history indispensable for the debate over this medical enigma. As we combat the pandemic of COVID-19 coronavirus worldwide today, we can learn invaluable lessons from the historical events in Asia. In this review, I explore the history first and then critically examine in depth major hypotheses proposed in light of accumulated data, global dispersal of the principal vector, patterns of YF transmission, persistence of urban transmission, and the possibility of YF in Asia. Through this process of re-examination of the current knowledge, the subjects for research that should be conducted are identified. This review also reveals the importance of holistic approach incorporating ecological and human factors for many unresolved subjects, such as the enigma of YF absence in Asia, vector competence, vector dispersal, spillback, viral persistence and transmission mechanisms.
Collapse
Affiliation(s)
- Goro Kuno
- Centers for Disease Control and Prevention, Formerly Division of Vector-Borne Infectious Diseases, Fort Collins, CO 80521, USA
| |
Collapse
|
21
|
Johnson-Agbakwu CE, Ali NS, Oxford CM, Wingo S, Manin E, Coonrod DV. Racism, COVID-19, and Health Inequity in the USA: a Call to Action. J Racial Ethn Health Disparities 2020; 9:52-58. [PMID: 33197038 PMCID: PMC7668281 DOI: 10.1007/s40615-020-00928-y] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/27/2020] [Accepted: 11/10/2020] [Indexed: 12/14/2022]
Abstract
The current national COVID-19 mortality rate for Black Americans is 2.1 times higher than that of Whites. In this commentary, we provide historical context on how structural racism undergirds multi-sector policies which contribute to racial health inequities such as those highlighted by the COVID-19 pandemic. We offer a concrete, actionable path forward to address structural racism and advance health equity for Black Americans through anti-racism, implicit bias, and cultural competency training; capacity building; community-based participatory research (CBPR) initiatives; validated metrics for longitudinal monitoring of efforts to address health disparities and the evaluation of those interventions; and advocacy for and empowerment of vulnerable communities. This necessitates a multi-pronged, coordinated approach led by clinicians; public health professionals; researchers; social scientists; policy-makers at all governmental levels; and local community leaders and stakeholders across the education, legal, social service, and economic sectors to proactively and systematically advance health equity for Black Americans across the USA.
Collapse
Affiliation(s)
- Crista E Johnson-Agbakwu
- Southwest Interdisciplinary Research Center (SIRC), Arizona State University, Phoenix, AZ, USA. .,Obstetrics and Gynecology, Valleywise Health, University of Arizona College of Medicine, Phoenix, AZ, USA. .,Creighton University School of Medicine, Phoenix, AZ, USA. .,District Medical Group, Phoenix, AZ, USA.
| | - Nyima S Ali
- Obstetrics and Gynecology, Valleywise Health, University of Arizona College of Medicine, Phoenix, AZ, USA.,Creighton University School of Medicine, Phoenix, AZ, USA.,District Medical Group, Phoenix, AZ, USA
| | - Corrina M Oxford
- Maternal Fetal Medicine/Critical Care Medicine, NewYork-Presbyterian Hospital, Clinical Obstetrics and Gynecology-Weill Cornell Medical College, Cornell University, New York City, NY, USA
| | | | - Emily Manin
- Southwest Interdisciplinary Research Center (SIRC), Arizona State University, Phoenix, AZ, USA
| | - Dean V Coonrod
- Obstetrics and Gynecology, Valleywise Health, University of Arizona College of Medicine, Phoenix, AZ, USA.,Creighton University School of Medicine, Phoenix, AZ, USA.,District Medical Group, Phoenix, AZ, USA
| |
Collapse
|
22
|
Braun L. Race Correction and Spirometry: Why History Matters. Chest 2020; 159:1670-1675. [PMID: 33263290 DOI: 10.1016/j.chest.2020.10.046] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/13/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022] Open
Abstract
In recent months, medical institutions across the United States redoubled their efforts to examine the history of race and racism in medicine, in classrooms, in research, and in clinical practice. In this essay, I explore the history of racialization of the spirometer, a widely used instrument in pulmonary medicine to diagnose respiratory diseases and to assess eligibility for compensation. Beginning with Thomas Jefferson, who first noted racial difference in what he referred to as "pulmonary dysfunction," to the current moment in clinical medicine, I interrogate the history of the idea of "correcting" for race and how researchers explained difference. To explore how race correction became normative, initially just for people labeled "black," I examine visible and invisible racialized processes in scientific practice. Over more than two centuries, as ideas of innate difference hardened, few questioned the conceptual underpinnings of race correction in medicine. At a moment when "race norming" is under investigation throughout medicine, it is essential to rethink race correction of spirometric measurements, whether enacted through the use of a correction factor or through the use of population-specific standards. Historical analysis is central to these efforts.
Collapse
Affiliation(s)
- Lundy Braun
- Departments of Pathology and Laboratory Medicine and Africana Studies, Brown University, Providence, RI.
| |
Collapse
|
23
|
Krishnan L, Ogunwole SM, Cooper LA. Historical Insights on Coronavirus Disease 2019 (COVID-19), the 1918 Influenza Pandemic, and Racial Disparities: Illuminating a Path Forward. Ann Intern Med 2020; 173:474-481. [PMID: 32501754 PMCID: PMC7298913 DOI: 10.7326/m20-2223] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is exacting a disproportionate toll on ethnic minority communities and magnifying existing disparities in health care access and treatment. To understand this crisis, physicians and public health researchers have searched history for insights, especially from a great outbreak approximately a century ago: the 1918 influenza pandemic. However, of the accounts examining the 1918 influenza pandemic and COVID-19, only a notable few discuss race. Yet, a rich, broader scholarship on race and epidemic disease as a "sampling device for social analysis" exists. This commentary examines the historical arc of the 1918 influenza pandemic, focusing on black Americans and showing the complex and sometimes surprising ways it operated, triggering particular responses both within a minority community and in wider racial, sociopolitical, and public health structures. This analysis reveals that critical structural inequities and health care gaps have historically contributed to and continue to compound disparate health outcomes among communities of color. Shifting from this context to the present, this article frames a discussion of racial health disparities through a resilience approach rather than a deficit approach and offers a blueprint for approaching the COVID-19 crisis and its afterlives through the lens of health equity.
Collapse
Affiliation(s)
- Lakshmi Krishnan
- The Johns Hopkins University School of Medicine, Johns Hopkins Department of History of Medicine, and Johns Hopkins Center for Medical Humanities and Social Medicine, Baltimore, Maryland (L.K.)
| | - S Michelle Ogunwole
- The Johns Hopkins University School of Medicine and Johns Hopkins Center for Health Equity, Baltimore, Maryland (S.M.O.)
| | - Lisa A Cooper
- The Johns Hopkins University School of Medicine, Johns Hopkins Center for Health Equity, and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (L.A.C.)
| |
Collapse
|
24
|
Jean-Baptiste CO, Green T. Commentary on COVID-19 and African Americans. The numbers are just a tip of a bigger iceberg. SOCIAL SCIENCES & HUMANITIES OPEN 2020; 2:100070. [PMID: 34173501 PMCID: PMC7572051 DOI: 10.1016/j.ssaho.2020.100070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/15/2020] [Accepted: 10/04/2020] [Indexed: 01/19/2023]
|