To see a comprehensive list of all of Dr. Charles Modlin’s publications and research, please look here:

Culturally competent methods to promote organ donation rates among African-Americans using venues of the Bureau of Motor Vehicles

More than one-third of the minority population of African-Americans (AAs) in the US are in need of renal transplantation but end up on the waiting list with few options for living donor transplantation. The lack of a suitable living donor is due to high rates of cardiovascular disease, diabetes, and hypertension. To solve this organ shortage and increase the acceptance of organ donation among AAs, a collaborative outreach curriculum was developed to improve attitudes, behaviors, and willingness toward organ donation. This was seen among minority populations who were encountered at specific Ohio Bureau of Motor Vehicles Deputy Registrar License Agencies (BMV or DMV) in collaboration with Organ Procurement Organization. In order to influence minorities to sign up as an organ donor, they need trust, awareness of the need, and communication in a culturally sensitive manner. The 4-month-long Organ Donor Registry Promotion Outreach contest was made to educate possible donors and to increase organ donation through promotional outreach initiates, flyers, pamphlets, and others. The function of the BMV workers was to monitor potential organ registries on willingness to register as a donor via computer databases. The top three BMVs were monitored: 1813 Wade Park in Cleveland, Ohio; 4705 Lorain, Ohio; and 4726 Amherst, Ohio. The percentage of donor registry was recorded for each location and documented initial pre-contest averages, pre-contest goals, contest average that surpassed the goals, highest percentage of registry, and post-contest overall percentage. Overall, the three locations increased dramatically in organ donation registry that predominately served minority communities. This success in community education showed the promotion of awareness regarding the need for organ donation, trust-building, and culturally competent communication. By changing the attitudes and behaviors towards organ donation among minority communities, registration rates of AA organ donor registries have increased. This method is the best way to continue this trend.

Racial disparities in urologic health care

Although all races and ethnicities of our human breed are equal in rights and importance, there are still several health disparities that fall on minorities compared to Caucasians, such as kidney diseases, hypertension, prostate cancer, bladder cancer, and erectile dysfunction. Also, there are differences in care for minorities, such as longer waiting time for transplants.  The reason for this could be due to a lack of cultural competency, lack of diversity in health care workforce, and lack of nutritional factors for minorities.  However, solutions such as training in cultural competency and reaching out to minorities, a model for reducing health disparities through NIH funding, and a model for elimination of racial disparities in urological health can create an impact on improving healthcare provided to all races.

Renal transplantations in African Americans: A Single-center experience of outcomes and innovations to improve access and results

African Americans develop ESRD at greater rates than Caucasians and receive a lower amount of kidney transplants. African Americans with ESRD should seek help and ask for an early referral for kidney transplantation. They should also look up information and be educated about ESRD so they know what issues that are facing.

Simultaneous vs. sequential laparoscopic bilateral native nephrectomy and renal transplantation

Simultaneous single incision bilateral native nephrectomy and renal transplantation in 11 patients were compared to 7 recipients who underwent staged laparoscopic bilateral nephrectomy followed by kidney transplantation. Over 60% of patients who had simultaneous bilateral native nephrectomy and kidney transplantation required an additional surgical procedure. A safe and feasible alternative to kidney transplantation is laparoscopic bilateral nephrectomy.

Laparoscopic donor nephrectomy gene expression

In a study, twelve kidneys were compared with each other: six before surgical manipulation and six several hours after the kidneys were removed after the laparoscopic donor nephrectomy was exposed to CO2 pneumoperitoneum. When compared, the two groups revealed differences on 865 of 1380 expressed genes. These genes, involved with key cell processes, show altered renal transcriptome due to the exposure to CO2 pneumoperitoneum and laparoscopic surgery, with upregulation of ischemia and injury associated genes.

Disparities in prostate cancer in African American men: What primary care physicians can do

At present, African American men exhibit significantly higher rates of prostate cancer than non-Hispanic white men. As well, prostate cancers in African American men tend to be more lethal. While research has shown that specific genomic sequences associated with prostate disease are more prevalent among men of African descent, this predisposition likely works synergistically with systematic disparities in clinical care to produce the observed gap in prostate cancer occurrence and lethality. Primary care physicians may be able to address this issue by increasing the amount of screening and preventative care they administer to men of this demographic.

Racial Health Care Disparities in Urology

At present, disparities in disease incidence, morbidity and mortality along ethnic and socio-economic lines are a major issue in health care. These disparities likely have root in various interconnected factors including biological predisposition, cultural incompetency on the parts of health care providers, and mistrust in health care institutions within ethnic minority demographics.

Within the discipline of urology, disparities of this nature are especially evident.

African American men exhibit the highest occurrence of prostate cancer in the world, two thirds higher than that of their Caucasian American counterparts. As well, prostate cancer among African men tends to be more biologically aggressive, and African American patients suffering from metastatic prostate cancer have poorer prognoses and quality of life than white patients.

PSA testing, the primary pre-biopsy screening technique for detecting prostate cancer, has different predictive capacity in African American patients than white patients, as African American men, with or without prostate cancer, exhibit consistently higher levels of serum PSA than white men. This difference in PSA level remains true in patients who have undergone radical prostatectomies as treatment for prostate cancer; however, race does not appear to be a significant factor in biochemical recurrence rates.

Much of the disparity in prostate cancer occurrence and severity may be due to differences in screening. African American men are less likely to be examined for prostate cancer than white men because of poor communication and cultural divides separating health care providers from African American patients.

Ethnic minority demographics also show higher occurrences of kidney failure, Native Americans and African Americans being particularly affected. This may be tied to characteristically higher rates of hypertension in these populations, which likely has root in socioeconomic factors including diet and access to health care. Unfortunately, despite comprising nearly a third of patients awaiting kidney transplants, black patients are less likely to receive donor kidneys, largely due to low numbers of African American cadaveric and living donors. Many believe that the organ allocation system should be adjusted to address this problem.

For African American patients who do receive kidney transplants, organ rejection is a statistically greater issue than for those who are white. This necessitates the use of larger amounts of immunosuppressant drugs in African American transplant recipients, thus increasing their risk of developing drug related issues such as post-transplant diabetes.

Studies have also shown racial disparities in both testicular and bladder cancer. Black subjects have been shown to have lower rates of bladder cancer than white counterparts, but with greater risk of death following cystectomy. In the case of testicular cancer, black men exhibit lower occurrence, but with greater risk of mortality and more advanced stage cancer at diagnosis. Researchers determined that this is due to lack of education and reduced access to health care within the demographic, not biological predisposition.

Much must be done to address the issue of racial disparities in urological health. Several national agencies have already taken action, the NIH being one of them. It is mandated that any study funded by the NIH must include minority test subjects and yield information specifically regarding differences in results by race. Alongside national edicts like this, health care professionals must become more culturally aware and better equip themselves to communicate with patients of ethnic backgrounds. As well, better awareness of urological health issues such as kidney failure and prostate cancer within minority communities would help in reducing disparities in these areas.

In an effort to eliminate racial disparities in urological health, the Cleveland Clinic established the Glickman Urological Institute’s Minority Men’s Health Center. Through an integrated program of clinical care and interdisciplinary research, the center aims to not only treat urological diseases, but to connect underserved patients to additional care in hopes that it may lessen the health care gap between Caucasian Americans and minorities.

AUA Update Services Volume 26, 2007, Lesson 19



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