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Query: UMLS:C0020538 (hypertension)
 170,190 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

In 1989, researchers at the University of Washington, Division of Adolescent Medicine, described the multifactorial risks of pregnancy for adolescents engaged in prostitution activities. Factors identified as placing this population at particular risk were transience, substance abuse, violence, sexually transmitted diseases, inadequate (or no) medical care, and poor nutrition. The relationship between such risks in the pregnant adolescent and poor birth outcome has been widely demonstrated. In this follow-up study, we describe the birth outcomes of 54 of the original sample of 61 prostituting adolescents who delivered infants between November 1987 and November 1989 in Seattle, Washington. The data were collected by retrospective chart review. Maternal factors evaluated were 1) age 2) ethnic group 3) substance abuse history 4) number of prenatal visits 5) maternal complications and 6) parity. The infant inpatient charts were reviewed for the following characteristics: 1) birth weight 2) occipitofrontal head circumference 3) length 4) Apgar scores and 5) neonatal complications. Results indicated high rates of maternal and infant complications with respect to: preterm birth (22%), precipitous delivery (15%), pregnancy-induced hypertension (16%), positive toxicology screens (28%), meconium staining (30%), infant hypertonicity (30%), and small for gestational age infants (14.5%).
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PMID:Birth outcomes of prostituting adolescents. 177 90

Because hypertension is a "silent" disease process, compliance with therapy is always a problem. In the inner city, where socioeconomic factors such as poverty, illiteracy, and substance abuse raise additional barriers to effective health care, poor compliance with antihypertensive regimens can reach epidemic proportions--as it did in our clinic in the early 1970s. After identifying the major causes of poor compliance in our patients, we instituted measures that led directly to greatly improved compliance and control, among them the expansion of clinic hours, the expediting of laboratory services, and the training of nurse-therapists to assume many of the responsibilities of running the clinic. In recent years a number of new antihypertensive agents have been introduced, and these new drugs have afforded patients better blood pressure control through less complex drug regimens with fewer serious side effects. Indeed, we observed a strong correlation between patient compliance and the administration of agents with longer dosing intervals and improved side effects profiles. This observation led us to consider whether transdermal clonidine--which requires weekly, rather than daily, administration--might not be an especially effective means of controlling blood pressure in inner-city patients. To test this hypothesis, we enrolled 20 patients, all of them blacks, in a pilot study of this unique delivery system. Blood pressure was adequately controlled in all 18 patients who completed the study, and patients were uniformly enthusiastic about this alternative to daily dosing. As a result, compliance with this mode of therapy was excellent.
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PMID:Improving compliance in an inner-city hypertensive patient population. 186 27

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

Two hundred two poor, mainly black women were studied to assess the effects of selected social, behavioral, and biologic factors on birth weight. A path analysis was used to model hypotheses about the interrelationships among these variables. Six sociocultural factors had direct paths to quality of prenatal care: amount of insurance, delay in telling others about the pregnancy, attitudes toward health professionals, month of gestation in which the pregnancy was suspected, perception of the importance of prenatal care, and initial attitude toward the pregnancy. Together, these factors accounted for 64% of the variance in the quality of prenatal care received. Four variables had direct paths to birth weight: month in which the pregnancy was suspected, quality of prenatal care, hypertension, and substance abuse, which together accounted for 13% of the variance in birth weight. The key findings were the relative impact that the quality of prenatal care, especially the source of care, had on birth weight, and the potential for improving birth outcomes by addressing the negative effects of underlying social factors.
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PMID:Quality of prenatal care; selected social, behavioral, and biomedical factors; and birth weight. 231 79

The values and experience of physicians as adolescents can effect their care of adolescent patients. Eighty residents were studied using extensive personal data gathered from a structured interview, a questionnaire of perceived clinical skills, and a videotape with a simulated patient. A "values" and "risk-taking during adolescence" score was constructed and related to the resident's perceived skills for and attitudes about adolescent health care. Residents with higher values scores (more conservative) were more likely to be pediatric than internal medicine residents and less likely to prescribe birth control pills to an adolescent. Residents with higher risk-taking scores considered themselves more skilled in dealing with substance abuse and sexually transmitted diseases and in recognizing psychologic problems. Values or risk-taking scores were not related to the resident's perceived skill in areas such as evaluating hypertension or performing Tanner staging. These data suggest that certain values and experiences may be influential in the physician's ability and approach to dealing with certain issues related to adolescent health care.
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PMID:Physicians' values and experience during adolescence. Their effect on adolescent health care. 333 70

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

Homelessness may be the leading social problem in the United States in the mid 1980s. While there may be anywhere from 250,000 to three million homeless persons, few empirically based published studies are available concerning the correlates of mental and physical health status among the homeless. Los Angeles, where the present study was conducted, has been designated by the U.S. Department of Housing and Urban Development to have one of the largest homeless populations (34,000-50,000) in the U.S. The current study is based on 269 in-depth interviews with homeless men and women in Los Angeles County, California. The homeless were found to be younger, better educated and disproportionately non-white compared to the profiles of the skidrow homeless of the past decades. Nearly half the men were veterans of military services, including 30% who were veterans of the Vietnam War. Respiratory infections and hypertension were the most prevalent health problems. The data suggest that a large segment of the homeless persons were depressed, 15.6% reported lifetime prevalence of hospitalization for emotional or nervous problems, and 12.6% reported hospitalization for substance abuse disorders. Multiple regression was utilized to test the validity of a perceived health status index as measured among the homeless and to identify the correlates of health. The health index reflect primarily an affliction by a chronic disease, the severity of an acute condition, the duration of depressed mood, and the alcoholism symptomatology. Length of unemployment, education, gender, and number of nights spent in a shelter were the best predictors of poor health in this population. Evidence from this study, as well as others, suggests that efforts should be made to avoid using the term homeless metaphorically. The causes of homelessness are multiple and complex and the resulting subgroups among the homeless population have different problems which require a variety of strategies to meet their needs.
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PMID:Perceived health status among the new urban homeless. 360 89

Reductions in publicly funded prenatal care programs in 1981 to 1984 resulted in an increase in unregistered patient deliveries from 7.8% to 14.9% of births at University of California San Diego Medical Center. To assess the economic and perinatal impact of the increasing number of deliveries of women without prenatal care, 100 consecutive patients with fewer than three prenatal visits were studied. Each "no care" patient was matched by age, parity, and week of delivery with a control patient who received care in a state-funded perinatal project (Comprehensive Perinatal Program). Maternal antenatal risk factors were equally distributed between the two groups when maternal age, parity, history of substance abuse, prior preterm delivery, hypertension, and abortion were compared. Maternal obstetric outcomes were similar, including cesarean section rate and incidence of postpartum fever and hemorrhage. However, neonates delivered of women receiving no care experienced significantly greater morbidity than the neonates of women in the Comprehensive Perinatal Program, including an increased incidence of premature rupture of the membranes and preterm delivery (13% versus 2%, p less than 0.05), low birth weight (21% versus 6% less than 2500 gm, p less than 0.002), and intensive care unit admissions (24% versus 10%, p less than 0.005). When the total inpatient hospital charges were tabulated for each mother-baby pair, the cost of perinatal care for the group receiving no care ($5168 per pair) was significantly higher than the cost for patients in the Comprehensive Perinatal Program ($2974 per pair, p less than 0.001) including an antenatal charge of $600 in the Comprehensive Perinatal Program. The excess cost for delivery of 400 women receiving no care per year in the study hospital was $877,600. These results suggest that extension of prenatal care programs to medically indigent women is likely to result in a net reduction in perinatal morbidity and health care expenditures.
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PMID:The perinatal and economic impact of prenatal care in a low-socioeconomic population. 394

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


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