Black Infant Deaths Point to Flaw in U.S. Health Care System

In a recent interview on The Daily Show, TV host Jon Stewart asked Fox political commentator Bill O’Reilly: “Does white privilege exist?” O’Reilly denied the existence of white privilege but conceded that as a collective, blacks carry more of a burden than whites

Sagging Pants Does Not Equate to Sagging Values

I teach a class in the DeVos Sport Business Management graduate program at the For years I’ve debated the issue of people wearing sagging pants with anyone who cared to listen. I’ve hesitated to speak publicly for fear people would think I was condoning the style of dress. For the record, I believe style is a matter of personal expression

An Ecological Analysis Of Social And Economic Influences On Black And White Infant Mortality Risk In Orange County, Fl

Black health disparities are a salient public health issue with blacks in every socioeconomic level at a greater health disadvantage than their white counterparts. In particular, disparity in infant mortality rates between blacks and whites have widened in recent decades to differentials never before experienced in the United States. Social ecologists investigating the myriad of individual and environmental risk factors have failed to fully account for the persistent differential. This study examines the relationships between individual and environmental influences on the health risk experienced by blacks, whites, as well as the differential between the two populations. This multi-level analysis was conducted using five-year aggregate data centering on the 2000 decennial census (1998 - 2002) as the most recent census data available. During the study period, the 193 census tracts in Orange County, Florida, experienced 504 infant deaths which included 242 black and 241 white infant deaths. Using the infant mortality target rate developed for Healthy People 2000 as the ―normal‖ infant mortality rate, risk was calculated as the percentage of deviation from the ―normal‖. A rate was also calculated to demonstrate the difference between black and white percent deviations from the ―normal‖. Structural equation modeling was used to examine the relationship between socioeconomic influences (Socioeconomic Disadvantage), social risk factors (Social Disorganization), and behavioral risk factors (Poor Behavioral Choices) using a latent variable approach based on a conceptual model which integrated the social determinants of health framework and conflict theory. iv In this study, an inverse association was found between socioeconomic disadvantage and infant mortality risk for black infants. This finding is contradictory to the expected finding and may have been due to multicollinearity or the operationalization of the endogenous study variable for black infant mortality risk. Thus, this study highlights the complexity of unraveling the interrelationship between social and economic risk factors. The results of this study demonstrate the importance of the latent variable approach in public health research as well as the need to broaden the approach to selecting indicators. This study concludes with specific policy recommendations aimed at improving the health outcomes of vulnerable populations using the social determinants of health framework

Examining the Impact of Institutional Racism in Black Residentially Segregated Communities

This article identifies institutional racism as a form of oppression that contributes to the social and economic disadvantaged experienced by Blacks in residentially segregated communities. The authors highlight the existence of social, economic, environmental and political influences as contributors to disparate outcomes experienced in economically disadvantaged black communities. Through the lens of the social determinants of health, inequalities in health, housing, and the criminal justice system are examined as powerful indicators of disparate outcomes for Blacks isolated in segregated communities across the U.S. Specific policy implications are presented to address the context in which disparate outcomes occur

#BlackLivesMatter – So Keep the Conversation Going

#BlackLivesMatter has become part of a symbolic movement with a powerful message. First tweeted on April 11, 2012, following the shooting death of Trayvon Martin, #BlackLivesMatter began trending heavily during protests after the death of Michael Brown in Ferguson, Mo. Three years later, it remains relevant

The Future Will Require Learning How to Exist in a Multicultural Society

Why should I have to tell my sons to respect the police

Broad Changes Are Needed to Move Toward Social Harmony

I wonder if the need for workplace-diversity initiatives is an indicator of an underlying societal issue? If so, could a more comprehensive approach to diversity serve as a catalyst for social transformation

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention