Federal Poverty Guidelines Research Articles

Diabetes in urban african americans. III. Management of type II diabetes in a municipal hospital setting

Management of type II diabetes is difficult, particularly in urban populations with limited resources and access to care. To evaluate the effectiveness of structured care delivered by non-physician providers, patients were studied prospectively for 6 months in a municipal hospital diabetes clinic. The population was approximately 90% African American and had median known diabetes duration of approximately 1 year, 54% had incomes below the Federal Poverty Guideline. Primary management was provided by nurse-practitioners and dietitians, and primary outcome measures were hemoglobin A1c (HbA1c), fasting plasma glucose, and changes in body weight. Responses were analyzed in 325 new patients returning for visits at 2, 4, 6, and 12 months; metabolic profiles at presentation were similar to those of subjects who missed intervening visits. Lean patients largely continued on pharmacologic therapy and improved HbA1c from 9.4% to 7.4% at 2 months (P < 0.001), remained stable through 6 months, then rose to 7.9% at 1 year. Obese patients (71%) received dietary instruction. Weaning of pharmacologic therapy was attempted for the first 2 months, resulting in a decline of HbA1c from 9.6% to 8.0% (P < 0.001), with 70% treated with diet alone. In the obese, HbA1c continued to decrease through 6 months (7.7%). Thereafter, providers saw patients at their own discretion and intensified therapy as needed. Although by 1 year, HbA1c had risen to only 8.2%, some patients required reinstitution of pharmacologic therapy; 59% were on diet alone. While 52% lost 4 lb or more (mean 9.3) by 2 months, little additional weight was lost. Interestingly, glycemic control was improved both in those who lost > or = 8.5 lb in the first 2 months (HbA1c 9.6% to 8.1% at 12 months), and in those who gained weight (HbA1c 10.2% to 8.2%). In the obese patients using pharmacologic agents at presentation, 35% were able to discontinue oral agents or insulin by 1 year, with good glycemic control (HbA1c < 8%). For patients who were initially on diet alone, a fasting plasma glucose > 177 mg/dL predicted the need for pharmacologic therapy with 97% certainty. In urban African American patients, nonpharmacologic management of type II diabetes substantially improves metabolic control; decreases in HbA1c are comparable in those who do and do not lose weight. Therapy managed by nonphysician providers can be an effective cornerstone of diabetes care in this socioeconomically disadvantaged population.

Poverty and Psychiatric Status

We assessed the effect of poverty on psychiatric status using two waves of New Haven (Conn) Epidemiologic Catchment Area data. Poverty was defined using federal poverty guidelines; psychiatric status was assessed by the Diagnostic Interview Schedule (DIS). When examining the course of healthy respondents at the first interview, respondents in poverty had a twofold-increased risk (controlling for demographic factors) for an episode of at least one DIS/DSM-III Axis I psychiatric disorder. Rates of most specific psychiatric disorders were comparably higher for respondents meeting poverty criteria compared with those not in poverty, although these differences were not always statistically significant. The effects of poverty did not differ by sex, age, race, or history of psychiatric episodes.

Success Against the Odds: Effective Education of Inner-City Youth in a New York City Public High School

Emerging statistics on Black Americans, over the last decade, indicate that the economic and social progress of the race, on the whole, is travelling down a negative road of racial genocide and that steps must be taken now to stop this encroaching tragedy. Almost 30 percent of all Black-American families are now living below the federal poverty guideline, compared with 8 percent of white families. The national infant mortality rate is 50 percent higher among Blacks than among whites, and in New York City, with the advent of the drug crack, infant deaths have increased by 20 percent. One third of Black New Yorkers between the ages of 5 and 19 years are victims of homicide; nationally, the leading cause of death for Black men between the ages of 16 and 34 is murder. Nationally, Blacks account for 24 percent of all AIDS cases. Half the female AIDS victims are Black; two of three infants born with AIDS are Black. Of the fifty thousand women in New York City who are infected with the AIDS virus, 80 percent are Black or Hispanic. More Blacks than whites are afflicted with heart disease, cancer, and cirrhosis. Blacks have hypertension and strokes at twice the rate of whites. Approximately 70 percent of poor Black families are headed by women. Over 57 percent of Black births are out of wedlock. Since 1981, unwed motherhood has replaced marital breakup as the leading cause for welfare eligibility.'

Students do make a difference.

Nursing students and faculty in community health may often overhear a community health nurse or clinic personnel in an agency grumble, Those student nurses are so much trouble. On hearing such negative comments and complaints, one may well ask whether students contribute anything of value to agencies or clients. Further, one may wonder if students are worth the time and effort spent on them by community health nurses. As members of the community health nursing faculty at Arizona State University, we pursued answers to these questions. During a semester at our clinical agencies, 80 students make approximately 4,000 home visits (see Table 1). They have a small caseload, usually between 3 and 5 families per student, but cumulatively, their efforts reduce the heavy workload of the community health nurses in the agencies. Almost 100% of the clients seen by students fall below the federal poverty guidelines and include chronically ill individuals, families with young children and newborns, pregnant women and ...