Racial differences in neurocognitive outcomes post-stroke: The impact of healthcare variables

AbstractObjectives:The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke.Methods:One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age:M=56.4;SD=12.6; education:M=13.7;SD=2.5; 50% male; years post-stroke: 1–18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale.Results:An independent samplesttest indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score:M=37.63;SD=11.67) than Whites (Fluid T-score:M=42.59,SD=11.54;p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p&lt;.001 andp=.02, respectively) and significantly mediated racial differences on neurocognitive impairment.Conclusions:We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences. (JINS, 2017,23, 640–652)</jats:p

Measurement of the xx- and Q2Q^2-Dependence of the Asymmetry A1A_1 on the Nucleon

We report results for the virtual photon asymmetry $A_1$ on the nucleon from new Jefferson Lab measurements. The experiment, which used the CEBAF Large Acceptance Spectrometer and longitudinally polarized proton ($^{15}$NH$_3$) and deuteron ($^{15}$ND$_3$) targets, collected data with a longitudinally polarized electron beam at energies between 1.6 GeV and 5.7 GeV. In the present paper, we concentrate on our results for $A_1(x,Q^2)$ and the related ratio $g_1/F_1(x,Q^2)$ in the resonance and the deep inelastic regions for our lowest and highest beam energies, covering a range in momentum transfer $Q^2$ from 0.05 to 5.0 GeV$^2$ and in final-state invariant mass $W$ up to about 3 GeV. Our data show detailed structure in the resonance region, which leads to a strong $Q^2$--dependence of $A_1(x,Q^2)$ for $W$ below 2 GeV. At higher $W$, a smooth approach to the scaling limit, established by earlier experiments, can be seen, but $A_1(x,Q^2)$ is not strictly $Q^2$--independent. We add significantly to the world data set at high $x$, up to $x = 0.6$. Our data exceed the SU(6)-symmetric quark model expectation for both the proton and the deuteron while being consistent with a negative $d$-quark polarization up to our highest $x$. This data setshould improve next-to-leading order (NLO) pQCD fits of the parton polarization distributions.Comment: 7 pages LaTeX, 5 figure