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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A major challenge in the United States is to narrow the gap in the excess morbidity and mortality rates of minority populations. This article presents a synthesis of the 15-year results of a collaborative program between the Johns Hopkins Medical Institutions and an African-American community with the highest rates of premature disease and death in Maryland. The program began with an efficacious disease prevention clinical trial with patients and ended with effective population approaches. We transferred key components to community ownership and formally trained community health workers who provided health promotion counseling, monitoring, linkage, and referral services. Results indicated significant decreases in morbidity and mortality as a result of improved control of hypertension. This program has begun to decrease the health status gap in an African-American population and has demonstrated long-term sustainability. Current joint activities are directed at several major causes of excess morbidity and mortality, including smoking, obesity, hyperlipidemia, and hypertension, and at plans for programs to control diabetes, substance abuse, and breast and cervical cancer.
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PMID:Narrowing the gap in health status of minority populations: a community-academic medical center partnership. 141 34

Current blood pressure data for healthy newborn infants consist primarily of single measurements of systolic and diastolic pressure in the first 48 hours of life. The purpose of this study was to determine if blood pressure levels are stable or are changing during the first few days of life. To determine blood pressure level and trend, indirect blood pressure was measured on day 1 through day 3 of life in all infants admitted to the well newborn nursery at Hahnemann University Hospital in Philadelphia. Systolic pressure correlated significantly with birthweight on day 1 of life (P less than .03). Repeated measures analysis of variance demonstrated a significant increase in both systolic and diastolic pressures over the first 72 hours of life (P less than .001). There was no difference in blood pressure among racial groups (black, Hispanic, white, Asian). In healthy newborns, there was no correlation of blood pressure with maternal conditions: toxemia, diabetes, substance abuse. These data demonstrate that blood pressure correlates with birthweight in well newborns. There is, however, a significant progressive increase in both systolic and diastolic blood pressure over the first 3 days of life, regardless of birthweight or maternal conditions.
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PMID:Blood pressure patterns in the first three days of life. 191 20

It is projected that the proportion of black Americans, American Indians, Asian Americans, and Hispanic Americans entering the ESRD program will continue to increase. Despite the increase in the average age of the ESRD population, the minorities entering the ESRD program are much younger. The major risk factors of ESRD--hypertension, diabetes, and glomerulonephritis--are affecting these minorities at a higher rate and in varying combinations. High prevalence and severity of hypertension followed by diabetes mellitus are the major risk factors in blacks, especially black women. Heroin and HIV nephropathies, tied to the epidemic of illicit drug abuse, have a major impact on young black men. The high prevalence of diabetes and the epidemic of glomerulonephritis in certain tribes are the major risk factors in American Indians. Hypertension and diabetes are the risk factors for the rapidly increasing Asian American population, especially for the elderly segment of this population. Diabetes predominates as the risk factor for the rapidly growing Hispanic American population, a group that needs to be identified separately within the ESRD program. Diabetes and hypertension are treatable, and adequate control can prevent progression of renal failure. However, with minority groups, it is difficult to fully implement the measures necessary to achieve this control. Outreach programs are necessary not only to provide medical treatment but to include instruction in socioeconomic and educational strategies. Programs that will seek out these patients and treat them should also educate them about their diet, about the detrimental effects of alcohol and smoking, and about the danger of substance abuse. Ultimately, these programs may be much cheaper than supporting a rapidly increasing ESRD program.
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PMID:End stage renal disease in minorities. 192 May 1

Alcohol and drug use in adolescents with diabetes mellitus was assessed by an anonymous self-administered questionnaire with verification by urine drug screening. Approximately 50% of these adolescents report having tried alcohol and 25% report ongoing use. Almost 25% have tried drugs of abuse and 5% report ongoing use. One of 97 consecutive urine specimens was positive for marijuana. In general, the frequency of alcohol and drug use was less than expected based on other studies of different clinical groups of patients in the same age range. Patients with diabetes who reported drug use or who reported they live in an environment of substance abuse had poorer diabetes control than patients who did not.
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PMID:Alcohol and drug use in teenagers with diabetes mellitus. 200 46

As a result of decreases in maternal mortality and infectious diseases, women's life expectancy has increased rapidly in this century and is expected to reach 83 years by the year 2000. However, there are a large number of chronic conditions that negatively affect the quality of life of women today: urinary tract infection, menstrual cycle disorders, hypertension, diabetes, osteoporosis, arthritis, eating disorders, substance abuse, and mental depression. Although women's life expectancy is 7.5 years greater than that of men, the morbidity rates are significantly higher for women. As women continue to enter the labor force in large numbers, questions are being raised regarding the physical and psychological hazards of jobs traditionally considered to be women's work, the risks associated with jobs that are physically demanding or involve exposure to toxic substances, and the association between pregnancy outcome and employment. Further research is needed on the effects of multiple role stress on women's health. Another recent trend has been the feminization of poverty: 2/3 of all US adults classified as poor are women. The lack of financial resources has a detrimental effect on nutrition, access to health care, and other preventive behaviors. Yet another social change related to women's health is the increasing number of elderly in the population. Women comprise 72% of the elderly poor, and over 80% of all retiring female workers do not have pension benefits. Access to, availability of, and payment for health care are problems for elderly women. It is important that research address the physiologic, psychosocial, and economic factors that together affect women's health status.
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PMID:Changing factors and changing needs in women's health care. 351 29

When challenged by complex medical and social conditions, local providers must participate in information exchanges, resource sharing, continuing education, and service coordination. A community exchange system, flexible enough to share and adapt new knowledge, and able to provide continuing multidisciplinary training and education across different practice settings, was established for the prevention and treatment of HIV/AIDS in East Harlem, New York City. The HIV/AIDS community exchange system supports linkages among disciplines within a medical center, communication among the local community-based organizations, and networks between the two settings. The system, as a model, is applicable to complex socio-medical problems such as diabetes, substance abuse, violence, tuberculosis, or geriatrics.
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PMID:Linking frontline work and state-of-the-art knowledge: a community exchange system. 762 98

Heroin-associated nephropathy (HAN), a complication of intravenous heroin abuse, was initially recognized at Kings County Hospital in Brooklyn, NY, in the early 1970s. Our recent experience indicates that after a steady incidence of new cases of HAN throughout the mid-1980s, a sharp decrease in incidence of new cases occurred starting in 1989. We sought to explore possible explanations for what amounts to disappearance of a previously prevalent disease. By means of retrospective analysis of a hospital-specific registry of new cases of end-stage renal disease (ESRD) at Kings County Hospital in Brooklyn, incidence curves from 1981 through 1993 for new cases of HAN, diabetes-induced renal disease, and human immunodeficiency virus-associated nephropathy were constructed. From hospital computer records, the number of admissions directly related to opioid abuse were extracted and charted. Unpublished surveillance records of the New York State Office of Alcoholism and Substance Abuse Services as well as reports from the New York City Department of Health, Office of AIDS Surveillance and the US Department of Justice Drug Enforcement Administration were used to determine the pattern of change in the prevalence of heroin abuse. Additionally, we used analysis of "street" heroin by the Drug Enforcement Administration to draw curves detailing drug cost and purity in New York City. There were no new cases of ESRD due to HAN for the years 1991 through 1993. The rates for new cases of ESRD due to diabetes and hypertension remained relatively constant throughout this interval.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Disappearance of uremia due to heroin-associated nephropathy. 774 21

Objective of the paper was to determine the fetal heart rate (FHR) changes that occur in preterm fetuses whose mothers have suffered antepartum bleeding, versus uncomplicated controls. Over a 12-year span, 91 patients with significant antenatal bleeding (bleeding requiring inhospital observation) were examined and compared to 75 controls with uncomplicated normal pregnancies. None of the women were in labor and all were evaluated at 25-37 weeks' gestation. Excluded were: patients with any other complication (i.e., premature rupture of membranes, intrauterine growth retardation, diabetes, hypertension, collagen vascular disease, postuterine surgery, substance abuse and twins). Analysis of the FHR tracings included baseline heart rate, long-term FHR variability, and number and amplitude of FHR accelerations in 20-min segments. There was no difference in baseline heart rate in the preterm fetuses of pregnancies complicated by antepartum bleeding versus controls. However, the parameters associated with FHR reactivity (number of accelerations in 20 min, and amplitude of accelerations) were higher to a statistically significant degree in fetuses of pregnancies complicated by antenatal bleeding than in controls. Fetuses of mothers suffering antenatal bleeding exhibited significant higher rates of reactive FHR patterns at earlier gestational ages than did controls. In conclusion, there is a significant increase in FHR reactivity in pregnancies in which significant antenatal bleeding occurs, suggesting a probable acceleration in fetal central nervous system maturation in these fetuses.
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PMID:Antenatal bleeding and fetal heart rate. 789 Feb 47

By the year 2000, Hispanics will outnumber African Americans and become the majority minority. Statistics reveal that health problems of the three main groups of Hispanics in the United States (Mexican Americans, Puerto Ricans, and Cubans) include diabetes, injuries and violence, substance abuse, HIV/AIDS, limited access to health care, and many other problems shared by the poor and disenfranchised. The health care provider may intervene with Hispanic clients and communities in culturally sensitive ways such as viewing culture as an enabler rather than a resistant force, incorporating cultural beliefs into the plans of care, stressing familialism, taking the time for "pleasant conversation," refraining from harsh criticism, and involving the community in preventive health care programs. Such interventions require providers who are knowledgeable about the culture, customs, beliefs, and language of the Hispanics within their practice area. Health care providers also need to be alert to and active in health care policy making that will improve access to health care for the growing Hispanic population.
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PMID:Providing culturally sensitive health care to Hispanic clients. 793 59

Epidemiologic data suggest that obsessive-compulsive disorder is the fourth most common mental disorder, after phobias, substance abuse and depression, and is nearly as common as asthma and diabetes mellitus. The understanding of obsessive-compulsive disorder and its treatment have significantly improved over the past decade. Positron emission tomographic scanning has demonstrated characteristic changes in the cerebral metabolism of patients with obsessive-compulsive disorder. Selective serotonin reuptake inhibitors have been shown to alleviate the symptoms of this disorder. Treatment of obsessive-compulsive disorder includes drug therapy, behavior therapy and family therapy. The family physician can play a key role in recognizing the clinical markers of obsessive-compulsive disorder and negotiating a treatment plan that significantly lessens the psychosocial morbidity associated with it.
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PMID:Obsessive-compulsive disorder: a concealed diagnosis. 815 2


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