BACKGROUND

The realities of the 21 st century have forced the public health profession to reconsider traditional approaches, apply new technologies appropriately and diversify sources of support. Recognition of social, economic and behavioral influences in disease prevention has highlighted the need to facilitate complex, individual behavior change and community participation. Resource allocation away from social programs has made it necessary to be creative in the search for and allocation of scarce resources. In response to these challenges, there is a need for creative approaches to public health research and practice that maximize existing resources, ensure timely responses to public health crises, build on established knowledge and enhance community participation.

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This study represents the nation’s first systematic investigation of racial and ethnic differences in medical care for patients with work-related injuries and illnesses. Though previous evidence and anecdotal accounts have suggested that such differences exist, the use of a nationally representative sample from the NAMCS has allowed us to identify and quantify specific variations in care involving procedures and treatments commonly administered in an ambulatory setting. Our analyses have controlled for covari-ables, including age, gender and geographical location, which have not been taken into consideration in previously published investigations of social disparities in occupational health.

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Bivariate Statistics

Approximately 2.4% of ambulatory care visits were for work-related conditions (1,179 of 48,054 visits in the NAMCS sample). Of the work-related visits, 11.9% were made by African-American patients and 18.7% involved Hispanic patients. Vis its by African-American patients represented a slightly greater proportion of visits for care of work-related conditions than for nonwork-related conditions in the NAMCS sample (11.9% vs. 10.9%). Visits by Hispanic patients accounted for a much greater proportion of visits for care of work-related conditions than for nonwork-related conditions in the NAMCS sample (18.7% vs. 9.6%).

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After controlling for age, gender, region and MSA status (Table 4), African-American patients receiving care for work-related conditions were found to be more than four times as likely as whites to receive mental health counseling (OR=4.60, CI: 2.03-10.44) and were 65% more likely than whites to receive physical therapy (OR=1.65, CI: 1.12-2.44). They were less than half as likely as whites to be seen by a nurse (RN or LPN) during the visit (OR=0.44, CI: 0.21-0.95). Consistent with the initial bivariate analysis, African Americans were found to be less likely than whites to see a physician (OR=0.42, CI: 0.131.37) and to have their blood pressure measured during the visit (OR=0.65, CI: 0.37-1.15), but the adjusted odds ratios for those associations were not quite statistically significant at p<0.05.

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Data and Sample
The National Ambulatory Medical Care Survey (NAMCS) is a nationally representative survey of physicians providing office-based ambulatory medical care in the United States. The survey has been conducted annually since 1973 by the National Center for Health Statistics (NCHS) of the U.S. Centers for Disease Control and Prevention. The target universe of the NAMCS includes ambulatory visits made to offices of nonfederally employed physicians, excluding visits made in hospital-based settings and care provided by anesthesiologists, radiologists and pathologists. Each physician is asked to complete a patient record for a random sample of visits occurring during a randomly assigned one-week period. Information is recorded by the physician regarding the patient’s demographic characteristics, symptoms, diagnosis and the medical services, tests, medications and procedures provided during the visit. In addition, supplementary information about the physician’s practice is collected by NCHS investigators. The NAMCS does not obtain information concerning the patient’s employment status, work history, medical care costs or the outcomes of care.
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Considerable progress has been made in identifying distinctive patterns of medical care among racial and ethnic groups in the general healthcare setting. However, relatively little is known about how medical care for workers suffering occupational injuries or illnesses varies according to patients’ race and ethnicity. In this article, we report the results of an exploratory analysis of a nationally representative sample of office-based medical visits to provide descriptive information about characteristic patterns of ambulatory care for treatment of work-related conditions among African-American and white patients and among patients of Hispanic and non-Hispanic ethnicity.

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Possible Explanations for G894T Genotype Effects

Existing data in certain models of hypertension have shown that a relative or absolute defect in the production of NO by NOS is associated with various degrees of end-organ involvement in response to hemodynamic workload. Since NO may participate in the hypertrophic growth of the myocardium independently of its effect on Blood Pressure, it is tempting to speculate that a defect in the eNOS/NO pathway linked to the 894T allelic variant could account for the observed association with LVM. The possibility that such an association may reflect linkage disequilibrium of G894T polymorphism with another functional allelic variation within the eNOS gene locus or other genetic cofactors in the regulation of eNOS needs to be further examined in future studies. In this respect, it is worth noting that individuals who were homozygous for this rare 894T allele also carried other common “wild-type” alleles within the eNOS gene, including “bb” of 27-bp repeat in intron 4 or “TT” of T C in the promoter region. None of these common alleles showed any significant association with LVM. While our data provide indirect preliminary evidence to support the relative contribution of this rare allelic polymorphism in exon 7 (G894T) of the eNOS gene to the underlying susceptibility to LV hypertrophic process in this early stage of the development of hypertension, the biological correlates of the conservative Asp-to-Glu substitution in codon 298 of the eNOS gene are not well-known. Likewise, this G894T variant has been implicated in the development of several Cardiovascular disorders in which NO bioactivity is impaired, such as hypertension. In the present study, plasma levels of NO metabolites did not vary significantly among carriers of 894T allele compared to 894G allele-bearing subjects in the absence of a nitrate-controlled diet. It is possible that the absence of a nitrate-controlled diet may have masked the detection of true differences in NO metabolites across the genotypes. …..Click here to read more