Journal of the Association for Academic Minority Physicians : the official publication of the Association for Academic Minority Physicians最新文献

Background: Studies show an increase in right-sided adenomas and cancers. In African Americans, a near equal distribution of right- and left-sided colorectal adenomas and cancers or even a predominance of right-sided adenomas and cancers has been shown. This study evaluated the location of both colorectal polyps and cancers in self-identified African Americans evaluated at Howard University Hospital.

Methods: A retrospective chart review of endoscopic records and the computerized tumor registry at Howard University Hospital for self-identified African Americans with polyps on colonoscopy and colorectal cancer diagnosed and/or treated between January 1, 1993 and December 31, 1999 was carried out. Polyps and cancers were documented as being right sided, left sided, both right and left sided, and unspecified when the location of the lesion was not documented.

Results: Eight hundred and thirty-seven patients had adenomas removed from 1993 to 1999, of which 36.3% had right-sided and 42% had left-sided adenomas. Three hundred and twenty patients were diagnosed and/or treated for colorectal cancer from 1993 to 1999, of whom 44.2% had right-sided and 46.7% had left-sided cancers.

Conclusion: Our study revealed near equal distribution of right- and left-sided colorectal adenomas and cancers in African Americans. Colonoscopy as opposed to sigmoidoscopy appears to be the appropriate modality for screening African Americans at average risk for colorectal cancer.

Objective: To examine physician factors associated with ovarian cancer screening.

Methods: Postal questionnaires to Maryland primary care physicians. Bivariate tests for statistical significance used X-Square and Student's t tests. Multivariate analysis and logistic regression were used to analyze responses based on specialty type, gender, and work experience.

Results: Fifty-six percent of the 375 were male, 44%, females; 33%, OB/GYN; and 67%, family/internal medicine (FM/IM). The mean age was 47 and the mean number of years in practice was 16. OB/GYNs provided more ovarian cancer counseling, OR 2.64 (CI 1.55, 4.48) and were more likely to respond correctly to knowledge questions--i.e., reduction of ovarian cancer risk with oral contraceptive (OCP) use than IM/FM, OR 8.57 (CI 3.54, 20.8). Overall, there were few gender differences in approach to evaluation, but male physicians were less likely to be aware of the relationship of OCP use to ovarian cancer risk than females, OR 0.48 (CI 0.25, 0.91). IF/FM physicians were less likely to order CA-125 for patients (of any age) based upon symptoms of bloating or physical examination alone. OB/GYN physicians, OR 4.77 (2.73, 8.34) and physicians with > 15 years in practice, OR 2.79 (1.46, 5.35) attended more meetings on ovarian cancer than non OB/GYNs or those with less experience. Although 74% indicated access to the Internet, just 16% to 26% used the Internet for cancer information; OB/GYNs used the Internet less frequently than FM/IMs, OR 0.53 (0.28, 0.97).

Conclusions: Specialty was more predictive of knowledge, approach to evaluation, and counseling than gender or experience.

While the computer-based patient record (CPR) is considered essential technology for improving efficiency and quality of health care, the high cost of CPR implementation has been a major barrier to widespread acceptance of these systems. This paper describes a framework to evaluate the costs and benefits of implementing CPR systems in outpatient clinical settings. Return on investment (ROI), a measurement of the difference between the costs of and benefits from an investment, is one method to evaluate the economic implications of CPR. The major costs in acquiring a CPR system include the costs of hardware, software, networking, ongoing maintenance, installation and training, and opportunity costs. Benefits of CPR systems include improved productivity by reducing resource utilization or improving revenues; improved quality by providing convenient access to information at the point of care, computerized physician-order entry and decision support systems; and intangible benefits that can not be simply quantified in monetary terms, such as enhanced data capture and access, enhanced business management and improved legal and regulatory compliance. We believe that understanding the ROI framework will enable physicians to make informed strategic decisions regarding purchase and implementation of CPR systems in their practices.

Objective: The purpose of this study is to describe change in the prevalence of overweightness over time in a cohort of youth with a family history of cardiovascular disease and to determine whether changes in adiposity were influenced in this group by ethnicity, gender, socioeconomic status (SES), or interactions among these factors.

Methods: Two hundred and fifty-three subjects with an average age of 8.8 years +/- 2.0 (SD) at the initial visit and 16.0 years +/- 1.8 SD at follow-up were included in the study. Measures of general adiposity, central adiposity, and peripheral adiposity were obtained at both the initial and follow-up visits. Overweight was defined as having a body mass index (BMI) > the 95th percentile; at risk for overweight was defined as having a BMI between the 85th and 95th percentile for age and gender.

Results: The prevalence of overweight among the study group remained stable at about 22%, while the prevalence of at risk for being overweight increased from 8.7% to 17.4%. Nearly 40% of all the participants had a BMI > 85th percentile at follow-up. Lower SES youth demonstrated the largest increases in BMI, standardized BMI, sum of skinfold thickness, waist circumference, and triceps skinfold thickness.

Conclusions: The prevalence of youth at risk for being overweight increases during late childhood and adolescence. Effectively focused primary prevention efforts are needed for at-risk youth to prevent the later development of adiposity-related morbidity.

Percutaneous endoscopic gastrostomy (PEG), a safe and effective procedure, is an alternative to open gastrostomy. There are two techniques of placing PEG tubes. One technique consists of a pull-string Ponsky-Gauderer type gastrostomy and the other a push-over-wire Sachs-Vine type gastrostomy. After the gastrostomy tube is positioned, a repeat endoscopy is performed to determine optimal placement of the PEG tube. The purpose of this study was to determine the necessity of a repeat endoscopy to determine the optimal positioning of the PEG tube. Charts of 132 patients who underwent a PEG procedure between July 1, 1994 and September 30, 1996 were reviewed. Specifically, we assessed whether the endoscopist changed the position of the bumper during repeat endoscopy after PEG placement. PEG was performed successfully in 125 of 132 adult patients. Of 125 patients, the endoscope was reintroduced after PEG in 110 patients. A minor adjustment was defined as repositioning of the bumper by < or = 1.0 cm and a major adjustment as > 1.0 cm. The endoscopist made no adjustment in initial placement of the gastrostomy tube bumpers in 102 of 110 patients (93%). A minor adjustment was made in 5 patients (4%), and a major adjustment was made in 3 patients (3%). Therefore, in 102 of 110 patients (93%), initial placement of the gastrostomy tube bumpers was felt to be adequate, and repeat endoscopy was not necessary. Thus, repeat endoscopy is not routinely required to assess the proper positioning of the internal bumper. Repeat endoscopy should be at the discretion of the endoscopist if there is suspicion of improper positioning of the bumper along the gastric mucosa.

The emergence of multidrug resistant (MDR) strains of Mycobacterium tuberculosis (MDR-TB) represents a serious worldwide threat to the health of mankind. Approximately 2 billion persons are infected with Mycobacterium tuberculosis, and 8.8 million new cases of tuberculosis occur annually, with over 50,000 attributable deaths each week! Drug resistance is either acquired with the initial infection (from a host harboring resistant tubercle bacilli) or develops during treatment with antituberculous chemotherapeutic agents because of poor patient compliance or inadequate/inappropriate treatment regimens. The epidemiology of tuberculosis and drug resistance is reviewed; the likelihood of the development of resistance and the molecular mechanisms of resistance to each drug are also discussed. Principles of prevention of nosocomial transmission, use of involuntary detention, and drug treatment approaches for MDR-TB are discussed, and the potential roles of surgery and novel therapies (phenothiazines, suicide genes) are presented.

The existence of disparities in health has gained national attention. While racial disparities in health have been documented for decades, "health disparities research" has not been described or defined. Health disparities may occur in categories such as racial/ethnic, age, and in geographic categories such as rural/urban, as well as in socioeconomic status. This paper, using the documented racial disparities in cancer for blacks and whites, presents a framework and model for documenting disparities, designing and conducting health disparities research, and applying the results of this research to reduce or eliminate disproportionate rates. The model consists of four components: 1. Surveillance 2. Explanatory Research 3. Intervention Research: Development and Evaluation 4. Translation/Application of Research Results. This model is presented to assist researchers in systematically addressing health disparities through well designed, well conducted, and well applied research. The Special Populations Cancer Research Networks are an 18 member national network of grants that focus on cancer disparities research, community awareness and participatory research, increased accrual of minorities to clinical trials, and training of minority investigators. The primary objective of the University of Maryland School of Medicine's grant is to reduce cancer rate disparities in underserved communities.

The HIV/AIDS epidemic is dramatically affecting adolescents. Although it is estimated that 50% of new HIV infections in the United States is among people under 25 years of age, adolescents seek HIV counseling and testing services at a much lower rate than adults. Furthermore, many HIV-infected adolescents remain unaware of their status and do not seek health care. As HIV identification remains the most important gap in the efforts to control the spread of the HIV epidemic among youths, there is an increasing need to implement creative strategies to attract youths to HIV screening services. This article describes the implementation of an innovative HIV/AIDS social marketing campaign designed to attract at-risk urban adolescents to youth-friendly HIV counseling and testing services and link them to comprehensive health care. In addition, the article describes the key elements of the social marketing initiative: 1) designing a meaningful message, 2) attaining audience credibility, and 3) mobilizing the community.

Islam is the fastest growing religion in the United States. African Americans make up the largest part of the Muslim community in America, and they are also the individuals at greatest risk for contracting HIV. With the objective of understanding the impact of religious and cultural beliefs on HIV risk behaviors, this article reviews the literature on HIV and AIDS in Muslim communities in America. While no specific data exists regarding HIV seroprevalence or the risk factors for transmission of HIV in specifically American Muslim communities, the available information is presented describing American Muslims' attitudes and beliefs regarding HIV. Furthermore, in order to help clinicians improve the delivery of HIV preventive services to members of these communities, Islamic doctrine is described in relation to the three main risk factors for acquiring HIV: sexual activity, drug use and perinatal transmission. American Muslims make up a diverse population which have unique needs regarding prevention of HIV and AIDS. These needs must be more fully investigated and understood in order to minimize rates of HIV transmission in these rapidly growing communities.

Severe obesity is associated with multiple comorbidities and is refractory to dietary management with or without behavioral or drug therapies. There are a number of surgical procedures for the treatment of morbid obesity, including purely gastric restrictive, a combination of malabsorption and gastric restriction or primary malabsorption. The purely gastric restrictive procedures, including vertical banded gastroplasty and laparoscopic adjustable silicone gastric banding, do not provide adequate weight loss. African-American patients do especially poorly after the banding procedure with the loss of only 11% of excess weight in one study. Gastric bypass (GBP) is associated with the loss of 66% of excess weight at 1 to 2 years after surgery, 60% at 5 years and 50% at 10 years. For unknown reasons, African-American patients lose significantly less weight than Caucasians after GBP. There is a risk of micronutrient deficiencies after GBP, including iron deficiency anemia in menstruating women, vitamin B12, and calcium deficiencies. Prophylactic supplementation of these nutrients is necessary. Recurrent vomiting after bariatric surgery may be associated with a severe polyneuropathy and must be aggressively treated with endoscopic dilatation before this complication is allowed to develop. The malabsorptive procedures include the partial biliopancreatic bypass (BPD) and BPD with duodenal switch (BPD/DS). The BPD appears to cause severe protein-calorie malnutrition in American patients; the BPD/DS may be associated with less malnutrition. Weight loss failure after GBP does not respond to tightening a dilated gastrojejunal stoma or reducing the size of the gastric pouch. These patients may require conversion to a malabsorptive distal GBP, similar to the BPD. However, because of the risk of severe protein-calorie malnutrition and calcium deficiency BPD should be reserved for patients with severe obesity comorbidity. The risk of death following bariatric surgery is between 1% and 2% in most series but is significantly higher in patients with respiratory insufficiency of obesity. In most patients, surgically induced weight loss will correct hypertension, type II diabetes mellitus, sleep apnea, obesity hypoventilation syndrome, gastroesophageal reflux, venous stasis disease, urinary incontinence, female sexual hormone dysfunction, pseudotumor cerebri, degenerative joint disease pains, as well as improved self-image and employability.