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38 Cards in this Set

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Whitehall Study
survey of British Civil Service Employees
all have the same access to same health care
found that conditional probability of deaths were lowest for those who had the least stressful (administrative) jobs, highest for those who had the highest stress job(clerical)
found that diastolic blood pressure was much higher for low grade workers, even at home, although comparable at work
Alameda County asthma study
AA children in the county have the highest asthma hospitalization rates in the state
correlated to high traffic areas
those well below FPL mostly live in medium to high traffic areas
Latinos and Blacks less likely to live in low traffic area, more likely to live in medium traffic
Lemelin study
Lemelin study of artery thickness in men and women
measured: childhood SEP, adult SEP and average neighborhood SEP
measured thickness of the lining of the carotid artery via ultrasound
results:
in men:
childhood SEP and adult SEP counted
in women:
childhood SEP
adult SEP
neighborhood SEP mattered
Thurston study
Race/SES and intimal thickness
examined students age 14-16
recorded their race and SES
asked them to self report their position in the social hierarchy
3 yrs later they measured thickness of the lining of the carotid artery
results:
AA subjects had higher intima thickness than whites
lower SES also had higher intima thickness
AA subjects were generally of a lower SES than white subjects
Brunners Model of Heart Disease
Brunners Model of Heart Disease (explains differences in health status by social class)
illness caused by unhealthy behaviors
tissue damage due directly to chronic stress
key risk variable: control over work environment
increased fibrogen lebvels associated with low grade workers
Stringhini study
Stringhini study of SEP with Health Behaviors/Mortality
evaluated health behaviors of Whitehall participants
then looked at association between occ status and all cause mortality controlling and not controlling for these factors
risk reduced significant when controlling for health behaviors
Pensola study
if born and stayed in high SES, then lowest mortality
if born into low SES and stayed in low SES then highest mortality
if born into high SES and moved into low SES, mortality only slightly higher than those of high SES
if born into low SES and moved into high SES, mortality similar to those of low SES
conclusion: childhood SES is a major factor in health outcomes
Roux study
Roux study of neighborhood and heart disease
residents of disadvantaged neighborhoods had a higher risk of disease than residents of advantaged neighborhoods
men: neighborhood has greater effect than own income
Cohen Cold Study
association between strength of social networks and illness
injected men and women with the cold
strength of social networks outside the lab affected the chances of getting a cold inside the lab
those with stronger social networks got less sick
Kawachi study
-residents in poor neighborhoods are less likely to report regular social support
-increasing social capital can increase health
-bowling alone hypothesis: those without social capital, can result adverse health affects
-can work the other way in low income neighborhoods (seeking social capital from gangs, etc)
Lee and Koenig
human beings from throughout the world share a similar genome
human beings share 99 percent of their DNA
biologically different races do not exist
the differences in genetic material do not translate to social group difference
Rosenberg article
Rosenberg article
although little variation, determined that the number of genetically distinct groups varried from 2-6 with analysis of only microsattelites
identified six main genetic clusters
four of the clusters correspond to major geographic regions that associated with races
using SNPs
there are 7 genetically different groups
difference explained by higher mutation rates in microsattelites
the findings of Rosenberg were only valid in areas of low migration and low intermarriage
little admixture
therefore little validity in the US
Goodman article
human variation is continuous
variation is nonconcordant
within group variation is much greater than variation between races
there is no consistent way to classify race
no clarity as to what race is/is not
Perez Stable study
Perez Stable study Nicotine Metabolism and Intake in Black and White Smokers
both groups smoked similar numbers of cigarettes but blacks had a higher baseline cotine level than whiters
blacks smoke more menthols than whites
enables them to enhale more deeply
menthol has a cooling effect for lungs
differntial marketing to blacks
78 percent of blacks smoke menthols, only 5 percent whites
Lieberman study
Lieberman et. al study on Colon Polyps
flawed bc didnt control for SES
black men and women have a higher incidnce and mortality from colon cancer
blacks develop it at a younger age
risk factors for colon cancer are influenced by race and SES
low fruit and veggies
lack of physical activity
alcohol consumption
tobacco use
Exner
Exner study on ACE inhibitors and differential results
ace inhibitor enalpril is associated with significant reduction in the risk of hospitalization for whites only.
no significant improvement for blacks
Sloan Study Longevity
followed two populations
black and white civil war vets
black and white US residents alive in 92
controlled for age, occupation and education
although there was a decrease in mortality overall, the black white disparity still existed
Williams study of MDD
Williams study Depressive Disorder
found that dd was highest for whites, then caribbean blacks and then AAs
fewer than half of AA who met the criteria received therapy
Acevedo Garcia study
Acevedo Garcia LBW and Race/Ethnic Status
foreign born status has a protective effect against LBQ
black and hispanic women
adverse effect in Asians
no effect on whites
Lozano study
ashtma in AA children more ER visits, fewer office visits with a physician for primary care
Rosenstreich study
Rosenstreich Cockroach Allergy
neighbor hood 30 percent or more lived below the poverty level
all children had asthma
children who had allergies to cockroaches and lived in high cockroach pops had more hospitalization
children with cockroaches in their bedroom are sicker than those without
black children more likely to live in res segregated areas
GENERAL NOTE: SES is controlled for in VA studies since all have access to same care, also in medicare studies
GENERAL NOTE: SES is controlled for in VA studies since all have access to same care, also in medicare studies
Krieger and Sidney study
Krieger and Sidney
examioned assoociation between blood pressure and self reported experiences of racial discrimination
found that blacks had higher pressure than whites
80% of blacks report having experienced racial discrimination
Cykert study
Cykert study
why dont many patients get surgery, especially AA
a total of 437 patients with biopsy proven or probably early stage lung cancer
assessed their sentiments toward doctors, cancer,etc
outcome measure: surgery within in four months
four characteristics of less likely to get surgery
perceptions of worse communication iwth physician
less patient certainty in the accuracy of the diagnosis
a lack of a regualar source of care
pre-existing illnesses that make surgery more risky
after controlling for theses factos, there was not a higher refusal rate by race
physician's role: implicit bias
Margolis study
patients frequently voice concern that air exposure during lung cancer surger might cause the turmor to spread
several AA patients asserted that this beleif was common in the AA community
objective: to asses the prevalence of this belief
38% of individuals beleived that air exposure causes turmor spread
however blacks believed this more than whites
Peterson VA study
he VA study
examined the records of all vets that showed up in emergency room of VA hospital because of heart attack
asked whter the race of the patient was associated with wheter the patient was given a certain treatment
back patients less likely to receive cardiac catheterization
less likely to receive CABG, angioplasty
less likely to receive any revacularization
for those who survived, quality of life because of the surgery was sig better for whites
weer these differences only because of the quality of VA health care
follow up study was the Dike Univerversity study
calculated the same rates- rates of CABG, Angioplasty, etc
black patients were less like to get angioplasty and CABG
Meta analysis on Racial/ethnic differences in cardiac care-Kaiser family
results:
-AA less likely than whites to receive diagnostic treatment/revascularization
-these differences remained even after controlling for SES
Knox Todd studies
-both examined the likelihood of minorities to receive pain medication for bone fractures
Skinner study
Total knee replacement
-calculated rate of surgery for medicare beneficiaries
-rate of surgery varies along age, race, sex and geographic lines
Meta analysis on Racial/ethnic differences in cardiac care-Kaiser family
results:
-AA less likely than whites to receive diagnostic treatment/revascularization
-these differences remained even after controlling for SES
Knox Todd studies
-both examined the likelihood of minorities to receive pain medication for bone fractures
Skinner study
Total knee replacement
-calculated rate of surgery for medicare beneficiaries
-rate of surgery varies along age, race, sex and geographic lines
Schulman study
-used actors who read a script
-saw the rates that physicians recommended cardiac catheterization
-found both gender and racial bias
-know followup study
van Ryn study
-patient perception study
-controlled for SES
-asked physician what their perception of the patient was (high SES black/ low SES black/high SES white/low SES white)
-showed a clear racial bias
four types of racial bias
-conscious
-institutionalized
-statistical (Lane study)
-unconcious (Sabin study)
Lane study
child abuse
*less important to know
-doctors filed child abuse reports more frequently for non white patients than for white patients when a child comes in with an injury
-suggests lower threshold of suspicion for minority children
-examined Medicaid v private insurance--took SES into account and racial differences persisted
Sabin study
Physician bias based on physcians background
*less important to know
-implicit association test
-medical doctors showed an implicit positive association for white faces than black faces
-however, black MDs did not show pos association for either
Chen study
Racial Differences in Cardiac catheterization
-both black and white doctors--black patients had lower rates of cardiac catheterization
-suggests patient apprehension or white patients may be overusing
-study controlled for SES factors