Kwonho Jeong

Perceived Discrimination in Health Care and Health Status in a Racially Diverse Sample

Background:Despite the surge of recent research on the association between perceived discrimination and health-related outcomes, few studies have focused on race-based discrimination encountered in health care settings. This study examined the prevalence of such discrimination, and its association with health status, for the 3 largest race/ethnic groups in the United States. Methods:Data were drawn from the 2004 Behavioral Risk Factor Surveillance System survey. The primary variables were perceived racial discrimination in health care and self-reported health status. Multivariable logistic regression was used to compare the prevalence of perceived discrimination for whites, African Americans, and Hispanics, and to examine the association between perceived discrimination and health status, controlling for sex, age, income, education, health care coverage, affordability of medical care, racial salience, and state. Results:Perceived discrimination was reported by 2%, 5.2%, and 10.9% of whites, Hispanics, and African Americans, respectively. Only the difference between African Americans and whites remained significant in adjusted analyses [odds ratio (OR) = 3.22, 95% confidence interval (CI) = 2.46–4.21]. Racial/ethnic differences in perceived discrimination depended on income, education, health care coverage, and affordability of medical care. Perceived discrimination was associated with worse health status for the overall sample (OR = 1.71, 95% CI = 1.35–2.16). Stratified analyses revealed that this relationship was significant for whites (OR = 2.00, 95% CI = 1.45–2.77) and African Americans (OR = 1.95, 95% CI = 1.39–2.73), but not for Hispanics (OR = 0.55, 95% CI = 0.24–1.22). Conclusions:Perceived racial discrimination in health care is much more prevalent for African Americans than for whites or Hispanics. Furthermore, such discrimination is associated with worse health both for African Americans and for whites.

Physical Activity Measured by the SenseWear Armband in Women With Rheumatoid Arthritis

Background Individuals with rheumatoid arthritis (RA) often are sedentary and have an increased risk of developing comorbid conditions. Women with RA are more likely to experience challenges in maintaining an active lifestyle over their life span than men with RA or people who are healthy. As the benefits of physical activity (PA) are well known, measuring PA accurately in this population is important. Objectives The purposes of this study were: (1) to characterize PA as measured with the SenseWear Armband (SWA) in women with RA and (2) to determine the measurement time frame to obtain consistent estimates of PA and daily energy expenditure (EE) in women with RA. Design This was a cross-sectional study. Methods Participants wore the SWA for 7 days. Measurements of daily total energy expenditure (TEE), physical activity energy expenditure (PAEE) during activities at or above 1 metabolic equivalent (MET) level (PAEE≥1MET), PAEE during activities at or above 2 METs (PAEE≥2METs), PAEE during activities at or above 3 METs (PAEE≥3METs), and number of steps were obtained. Results Fifty-three women participated. Complete data were obtained for 47 participants (89%). Daily usage of the SWA was 98% of the time (23:31 hours/24 hours). Means (SD) were 2,099 (340) kcal/d for TEE, 1,050 (331) kcal/d for PAEE≥1MET, 642 (309) kcal/d for PAEE≥2METs, 239 (178) kcal/d for PAEE≥3METs, and 7,260 (2,710) for number of steps. Results of intraclass correlation coefficient analyses and multiple linear regressions indicated that 2 days were needed to reliably estimate TEE; 3 days for PAEE≥1MET, PAEE≥2METs, and number of steps; and 4 days for PAEE≥3METs. Limitations The sample was composed of well-educated women with RA who had mild to moderate difficulty performing daily activities. Conclusion The SWA may be useful to quantify PA in women with RA and to monitor effectiveness of interventions aiming to increase PA levels. Minimizing the number of days necessary for data collection will reduce the individuals burden and may improve adherence in studies of PA behaviors.

Coronary atherosclerosis and cardiovascular mortality in hemophilia

Although mortality in individuals with hemophilia is 2- to 3-fold higher than the general population, ischemic heart disease mortality is 50–80% lower than the general population [1–5]. Moreover, hemophilia carriers whose factor VIII levels are low, but not deficient, also appear to have low death rates of ischemic cardiac disease [6]. Elevated circulating factor VIII levels [7], as well as fibrinogen [8] and von Willebrand factor [9], are considered risk factors for cardiovascular disease. Yet, it is possible that low factor VIII levels may reduce the likelihood of clot formation, even in the presence of cardiovascular risk factors, such as smoking or elevated cholesterol, and, thereby, decrease coronary thrombosis and myocardial infarction in individuals with hemophilia.

Perceived Discrimination in Health Care and Use of Preventive Health Services

ObjectiveTo examine the relationship between perceived discrimination and preventive health care utilization.Design and ParticipantsCross-sectional analysis using the 2004 Behavioral Risk Factor Surveillance System “Reactions to Race” module (N = 28,839).MeasurementsOutcomes were self-reported utilization of seven preventive health services. Predictors included perceived negative and positive racial discrimination (vs. none) while seeking health care in the past year. Multivariable models adjusted for additional patient characteristics.Main ResultsIn unadjusted models, negative discrimination was significantly associated with less utilization of mammogram, pap test, PSA test, blood stool test, and sigmoidoscopy/colonoscopy (ORs = 0.53–0.73, p < .05), but not flu or pneumococcal vaccines (ORs = 0.76 and 0.84). Positive discrimination was significantly associated with more utilization of all services (ORs = 1.29–1.58, p < .05) except pap test (OR = 0.94). In adjusted models, neither negative nor positive discrimination was predictive of utilization, except for PSA test (positive discrimination OR = 1.33, p < .05).ConclusionsPerceived racial discrimination in health care does not independently predict preventive health care utilization.

The Relationship Between Shift Work, Sleep, and Cognition in Career Emergency Physicians

OBJECTIVES The 24-hour physician coverage of the emergency department (ED) requires shift work, which can result in desynchronosis and cognitive decline. We measured changes in cognition and sleep disturbance in attending emergency physicians (EPs) before and after day and overnight shifts. METHODS Thirteen EPs were tested before and after day and overnight shifts using the Paced Auditory Serial Addition Test (PASAT), the University of Southern California Repeatable Episodic Memory Test (REMT), the Trail Making Test (TMT), and the Stroop Color-Word Test. Sleep quality and fatigue were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Chalder Fatigue Questionnaire (CFQ). Saliva samples were collected from each physician immediately before and after day shifts and night shifts for neurohormonal assays. RESULTS Significantly fewer words were recalled on the REMT after both day (-2.4, 95% confidence interval [CI] = -4.4 to -0.4) and overnight shifts (-4.6, 95% CI = -6.4 to -2.8). There was a significant postshift increase in words recalled from the last third of the REMT list after overnight shifts (6.6, 95% CI = 2.8 to 10.4). Sleep quality was worse in EPs (mean PSQI = 4.8, SD ± 2.5) compared to the normal population, with 31% of subjects reporting poor sleep quality. Postshift fatigue was correlated with the perceived difficulty of the shift. Salivary cortisol and melatonin demonstrated diurnal variation consistent with normal circadian rhythms. Morning cortisol peak was decreased or delayed in samples from physicians after a night shift. CONCLUSIONS These data indicate that short-term memory appears to decline after day and overnight shifts and confirms the high incidence of disturbed sleep in this population.

Impact of Season and Diet on Vitamin D Status of African American and Caucasian Children

Seasonal variation of vitamin D status and adequacy of dietary vitamin D and impact of race on maintaining vitamin D sufficiency was assessed in 140 healthy 6- to 12-year-old African American (AA) and Caucasian (C) children residing in Pittsburgh, Pennsylvania during summer and winter. Vitamin D insufficiency was not rare in either group (AA vs C, summer, 17.2% vs 14.3%, nonsignificant; winter, 34.1% vs 32.5%, nonsignificant) despite a mean dietary intake of vitamin D above the American Academy of Pediatrics (AAP) recommended intake (400 IU/d; AA vs C, summer, 421 vs 456 IU/d, nonsignificant; winter, 507 vs 432 IU/d, nonsignificant). Race/season and dietary vitamin D were predictors of serum 25-hydroxyvitamin D [25(OH)D] concentrations. However, dietary vitamin D influenced 25(OH)D only in Caucasians during winter. Current AAP recommended daily intake for vitamin D is inadequate for maintaining vitamin D sufficiency in children.

An Interactive Text Message Intervention to Reduce Binge Drinking in Young Adults: A Randomized Controlled Trial with 9-Month Outcomes

Background Binge drinking is associated with numerous negative consequences. The prevalence and intensity of binge drinking is highest among young adults. This randomized trial tested the efficacy of a 12-week interactive text message intervention to reduce binge drinking up to 6 months after intervention completion among young adults. Methods and Findings Young adult participants (18–25 y; n = 765) drinking above the low-risk limits (AUDIT-C score >3/4 women/men), but not seeking alcohol treatment, were enrolled from 4 Emergency Departments (EDs) in Pittsburgh, PA. Participants were randomized to one of three conditions in a 2:1:1 allocation ratio: SMS Assessments + Feedback (SA+F), SMS Assessments (SA), or control. For 12 weeks, SA+F participants received texts each Thursday querying weekend drinking plans and prompting drinking limit goal commitment and each Sunday querying weekend drinking quantity. SA+F participants received tailored feedback based on their text responses. To contrast the effects of SA+F with self-monitoring, SA participants received texts on Sundays querying drinking quantity, but did not receive alcohol-specific feedback. The control arm received standard care. Follow-up outcome data collected through web-based surveys were provided by 78% of participants at 3- months, 63% at 6-months and 55% at 9-months. Multiple imputation-derived, intent-to-treat models were used for primary analysis. At 9-months, participants in the SA+F group reported greater reductions in the number of binge drinking days than participants in the control group (incident rate ratio [IRR] 0.69; 95% CI .59 to.79), lower binge drinking prevalence (odds ratio [OR] 0.52; 95% CI 0.26 to 0.98]), less drinks per drinking day (beta -.62; 95% CI -1.10 to -0.15) and lower alcohol-related injury prevalence (OR 0.42; 95% CI 0.21 to 0.88). Participants in the SA group did not reduce drinking or alcohol-related injury relative to controls. Findings were similar using complete case analyses. Conclusions An interactive text-message intervention was more effective than self-monitoring or controls in reducing alcohol consumption and alcohol-related injury prevalence up to 6 months after intervention completion. These findings, if replicated, suggest a scalable approach to help achieve sustained reductions in binge drinking and accompanying injuries among young adults. Trial Registration ClinicalTrials.gov NCT01688245

Perceived Racial Discrimination in Health Care: A Comparison of Veterans Affairs and Other Patients

OBJECTIVES We compared rates of perceived racial discrimination in health care settings for veteran and nonveteran patients and for veterans who used the Veterans Affairs health care system and those who did not. METHODS Data were drawn from the 2004 Behavioral Risk Factor Surveillance System. We used logistic regression to examine whether perceived racial discrimination in health care was associated with veteran status or use of Veterans Affairs health care, after adjusting for patient characteristics. RESULTS In this sample of 35,902 people, rates of perceived discrimination were equal for veterans and nonveterans (3.4% and 3.5%, respectively; crude odds ratio [OR] = 1.00; 95% confidence interval [CI] = 0.77, 1.28; adjusted OR = 0.92; 95% CI = 0.66, 1.28). Among veterans (n = 3420), perceived discrimination was more prevalent among patients who used Veterans Affairs facilities than among those who did not (5.4% vs 2.7%; OR = 2.08; 95% CI = 1.04, 4.18). However, this difference was not significant after adjustment for patient characteristics (OR = 1.30; 95% CI = 0.54, 3.13). CONCLUSIONS Perceived racial discrimination in health care was equally prevalent among veterans and nonveterans and among veterans who used the Veterans Affairs health care system and those who did not.

Serum Neutrophil Gelatinase-Associated Lipocalin Predicts Survival After Resuscitation From Cardiac Arrest.

Objectives:In the first days after cardiac arrest, accurate prognostication is challenging. Serum biomarkers are a potentially attractive adjunct for prognostication and risk stratification. Our primary objective in this exploratory study was to identify novel early serum biomarkers that predict survival after cardiac arrest earlier than currently possible. Design:Prospective, observational study. Setting:A single academic medical center. Subjects:Adult subjects who sustained cardiac arrest with return of spontaneous circulation. Intervention:None. Measurements and Main Results:We obtained blood samples from each subject at enrollment, 6, 12, 24, 48, and 72 hours after return of spontaneous circulation. We measured the serum levels of novel biomarkers, including neutrophil gelatinase–associated lipocalin, high-mobility group protein B1, intracellular cell adhesion molecule-1, and leptin, as well as previously characterized biomarkers, including neuron-specific enolase and S100B protein. Our primary outcome of interest was survival-to-hospital discharge. We compared biomarker concentrations at each time point between survivors and nonsurvivors and used logistic regression to test the unadjusted associations of baseline clinical characteristics and enrollment biomarker levels with survival. Finally, we constructed a series of adjusted models to explore the independent association of each enrollment biomarker level with survival. A total of 86 subjects were enrolled. Enrollment levels of high-mobility group protein B1, neutrophil gelatinase–associated lipocalin, and S100B were higher in nonsurvivors than survivors. Enrollment leptin, neuron-specific enolase, and intracellular cell adhesion molecule-1 levels did not differ between nonsurvivors and survivors. The discriminatory power of enrollment neutrophil gelatinase–associated lipocalin level was the greatest (c-statistic, 0.78 [95% CI, 0.66–0.90]) and remained stable across all time points. In our adjusted models, enrollment neutrophil gelatinase–associated lipocalin level was independently associated with survival even after controlling for the development of acute kidney injury, and its addition to clinical models improved overall predictive accuracy. Conclusions:Serum neutrophil gelatinase–associated lipocalin levels are strongly predictive of survival-to-hospital discharge after cardiac arrest.

A checklist is associated with increased quality of reporting preclinical biomedical research: A systematic review

Irreproducibility of preclinical biomedical research has gained recent attention. It is suggested that requiring authors to complete a checklist at the time of manuscript submission would improve the quality and transparency of scientific reporting, and ultimately enhance reproducibility. Whether a checklist enhances quality and transparency in reporting preclinical animal studies, however, has not been empirically studied. Here we searched two highly cited life science journals, one that requires a checklist at submission (Nature) and one that does not (Cell), to identify in vivo animal studies. After screening 943 articles, a total of 80 articles were identified in 2013 (pre-checklist) and 2015 (post-checklist), and included for the detailed evaluation of reporting methodological and analytical information. We compared the quality of reporting preclinical animal studies between the two journals, accounting for differences between journals and changes over time in reporting. We find that reporting of randomization, blinding, and sample-size estimation significantly improved when comparing Nature to Cell from 2013 to 2015, likely due to implementation of a checklist. Specifically, improvement in reporting of the three methodological information was at least three times greater when a mandatory checklist was implemented than when it was not. Reporting the sex of animals and the number of independent experiments performed also improved from 2013 to 2015, likely from factors not related to a checklist. Our study demonstrates that completing a checklist at manuscript submission is associated with improved reporting of key methodological information in preclinical animal studies.