Geographic Location May Help Explain Why Hispanics Face Disparities in Kidney Transplantation

 

• Hispanics were just as likely as non-Hispanic whites to be put on the kidney transplant waitlist.
• Once waitlisted, Hispanics were less likely to receive a transplant from a deceased donor. This disparity was largely explained by differences in patient blood type and regional variability of organ supply among organ procurement organizations across the country.

More than 70,000 Americans are placed on the waitlist for a kidney transplant, but fewer than 18,000 receive a transplant per year.

Newswise — Washington, DC (October 10, 2013) — In the United States, Hispanics with kidney failure are less likely than non-Hispanic whites to receive a kidney transplant largely due to their blood type and because of where they live, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The findings highlight the need to implement new deceased donor organ allocation policies that distribute organs over wider geographic areas to help reduce barriers to transplantation for Hispanics.

Hispanics represent the largest minority group in the United States and have an increased risk for developing kidney failure compared with non-Hispanic whites. Prior studies have shown that Hispanics were less likely to be placed on the transplant waiting list, experienced longer waiting times, or were less likely to receive a kidney transplant compared with non-Hispanic whites. Cristina Maria Arce, MD (now at The Ohio State University Wexner Medical Center) and her former colleagues at Stanford University School of Medicine sought to study these issues further by analyzing data from the US Renal Data System, the national registry of individuals with kidney failure. The investigators identified 417,801 Caucasians who initiated dialysis from 1995 to 2007 and were followed through 2008.

Among the major findings:
• Hispanics were just as likely as non-Hispanic whites to be put on the kidney transplant waitlist.
• Once waitlisted, Hispanics were 21% less likely to receive a transplant from a deceased donor. But this disparity was largely explained by differences in patient blood type and regional variability of organ supply among organ procurement organizations across the country.

“The main barriers after placement on the waitlist include the tendency for Hispanics to reside in regions with organ procurement organizations characterized by longer median waiting times as well as the higher likelihood for Hispanics to have blood type O, which further complicates organ allocations due to fewer ABO-compatible deceased donors,” explained Dr. Arce. “To overcome the geographic disparities that Hispanics encounter in the path to transplantation, organ allocation policy revisions are needed to improve donor organ equity.”

Study co-authors include Benjamin A. Goldstein, PhD, Aya A. Mitani, Colin R. Lenihan, and Wolfgang C. Winkelmayer, MD, ScD.

Disclosures: Wolfgang Winkelmayer reports having served as a scientific advisor or consultant to Affymax, Amgen, Bayer, Fibrogen, and GlaxoSmithKline.

The article, entitled “Differences in Access to Kidney Transplantation between Hispanic and non-Hispanic Whites by Geographic Location in the United States,” will appear online at http://cjasn.asnjournals.org/ on October 10, 2013, doi: 10.2215/CJN01560213.

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Founded in 1966, and with more than 14,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

Teaching and learning as Professor H

 

 with 8.7 million views and counting - was produced by a group of students who wanted to have fun with Hafensteiner general chemistry class. Prof. H, as it is called Hafensteiner, agreed to give students five minutes (15 didn't) at the beginning of the first class of the year. Someone posing as Hafensteiner established in the law (non-cellular and not portable) and warned them of the high failure rate, at the same time destroy their hopes of entering medical school. Once the fear had set, the real Prof. H appeared, demanded to know who was the charlatan and assumed control of the intruder, to the relieved applause of his students.

Prof. H uses that moment to emphasize the difference between the stereotyped concept of the experience of the University Science and his class.

"Introducing and taunts from some very common at the beginning of the class fears, I was able to clarify things," said Hafensteiner. "My class is structured so that they can have success."

Even before the start of the first Conference, it is immediately apparent to newcomers Hafensteiner general chemistry class is different to everything they had in high school. For starters, instead of the typical students from 20 to 30 in a high school classroom, Prof. H class has ten times as many.

Hafensteiner is that their students are making a massive transition from high school aware - where there may be a lot of hand through their courses - to the University of Rochester, where they hope to identify the resources needed to tackle the problems alone.

And Hafensteiner perfectly understands that many of his students have a chemical good experience in high school, even with lots of hand in a smaller class.

"Ninety -nine percent of students who say that they hated secondary chemistry actually admit that you liked the teacher, that has nothing to do with the material," Hafensteiner said. "The challenge is to give students the opportunity to appreciate the science."

Prof. H uses many tools and strategies adopted by other teachers. Works hard to learn the names of the students, applies the material life for every day of course, cool in their classes each semester and employs > clickers to obtain immediate feedback from the students in class discussions and problems. But in the end, success of Hafensteiner as a teacher can reduce access.

"It is the type of teacher that is very accessible," said Sharath Koorathota, a former Professor of Hafensteiner and one of the producers of deception video Student Assistant. "He designed his lectures in a way that supports those who take chemistry for the first time, while it continues to defy everyone in the class."

Hafensteiner holds office three hours each week with anywhere from five to 15 students. Non-office hours as much as they are mini-clases that allow to see it approaching if students are grasping the material.

Prof. H is clearly making a difference. The University of Rochester last spring named Hafensteiner students association teacher of the year in the natural sciences, citing their support for the students and their "ability to feel young any kind".

"Yes, I can concentrate on making the three best students scientific fantastic," said Hafensteiner. "But if that's all what I did, chemical, as a discipline, he would die. One of the most valuable things I can do is make sure that all my students have an appreciation for the field".

Physical Attractiveness Impacts One's Memory

 — A study at Texas Christian University in Fort Worth has found that the attractiveness of others can have an impact on how much we lie or misrepresent and to the extent that we believe those lies/misrepresentations.

For example, Harry gets a call from a political polling organization and is asked for his opinion of the Patient Protection and Affordable Care Act. He gives it the lowest possible rating. A few weeks later, Harry meets an attractive woman named Sally online. During their conversation, Sally mentions that she answered the same question by the same polling organization and expressed high approval of Obamacare. She then asks “What approval rating did you give Obamacare when they asked you?”

This question poses a dilemma for Harry. Should he tell the truth or should he shade the truth? To the extent that Harry finds Sally very attractive and is motivated to create a positive impression, he might shade the truth about his past behavior by claiming to have expressed at least moderate approval of Obamacare. What, if any, effect would this misrepresentation have on Harry’s memory for how he actually answered on the day he was contacted by the polling organization?

“What we know is that people will embellish or distort facts when telling stories, which causes them to oftentimes remember the lies more so than the truth,” said Charles Lord, professor of psychology at Texas Christian University in Fort Worth. “Research has also showed us that people tell others what they want to hear. In this case, Harry will lie to impress Sally, and he is also more likely to fool himself into believing the lie.”

Researchers asked single individuals if they agreed or disagreed with instituting “comprehensive mandatory exams” for graduating seniors using a 1-10 scale. A total of 44 individuals did not want to institute mandatory exams. Those respondents were then led to believe they would be meeting a member of the opposite sex who wanted to institute mandatory exams by scoring those a nine on the survey. They also were shown a photo of this person and asked to report on a 1-7 scale if they found their partner “physically attractive and wanted to get along with and make a good impression on this partner.”

Participants were then asked to complete a profile to be sent to their partner before an in-person meeting answering the same question about “comprehensive mandatory exams.” Researchers found there was a correlation between the attractiveness of the partner and those warming to the idea of “comprehensive mandatory exams.”

Researchers then retested students with some of the same questions they had taken two weeks earlier by asking respondents to remember what they had said in the initial survey.

“Participants with relatively attractive potential partners remembered giving more positive initial survey responses than participants with relatively unattractive potential partners,” said Lord.

Researchers then tested 117 additional undergraduate students letting them see profile pictures and foreknowledge of how those students responded. They were told they would be partnered with these individuals later in the course. Findings showed that people with perceived “attractive partners” aligned their views more closely with the partner than those with unattractive partners.

“In both experiments we found that knowing the other person’s positive evaluation in advance led participants to misrepresent their own previous evaluations, and this misrepresentation, in turn, altered memories for participants’ own actual past actions,” said Lord.

Sara E. Brady, assistant professor at Charleston Southern University in Charleston, SC is also a lead author on the paper.

These findings appear in the forthcoming edition of the Journal of Social Cognition.