Nonblack Men Research Articles

Reactions to ethnic deviance: The role of backlash in racial stereotype maintenance.

Backlash effects are social and economic penalties for counterstereotypical behavior (Rudman & Phelan, 2008). Five experiments support a model of the role of backlash in racial stereotype maintenance from the standpoint of perceivers and actors (Rudman & Fairchild, 2004). In Experiment 1, perceivers sabotaged Asians and Whites for succeeding in counterstereotypical domains, thereby preventing their future success. In Experiment 2, a White rapper suffered prejudice and economic discrimination, relative to a Black rapper, and prejudice mediated discrimination. Further, actors threatened by backlash for achievement in cross-racial domains responded to success in ways that bolster ethnic stereotypes. For example, Black men and women who feared backlash for academic skill (Experiment 3), and non-Black (Experiment 4) and non-White (Experiment 5) men who experienced backlash for cross-racial achievement, resorted to defensive strategies that preserve racial stereotypes (e.g., refusing to publicize and pursue counterstereotypical talents). Implications for cultural stereotype maintenance are discussed.

Disparity in outcomes of surgical revascularization for limb salvage. Race and gender are synergistic determinants of vein graft failure and limb loss. Nguyen LL, Hevelone N, Rogers SO, Bandyk DF, Clowes AW, Moneta GL, Lipsitz S, Conte MS. Circulation. 2009; 119: 123–130.

The primary objective of this study was to examine in a post hoc secondary analysis, the interaction of race and gender as they affect graft patency, limb salvage and mortality among patients enrolled in the Project of Ex Vivo Vein Graft Engineering via Transfection III (PREVENT III). PREVENT III was a randomized controlled trial, designed to test the efficacy of edifoligide versus placebo in patients undergoing vein bypass for critical limb ischemia (CLI). PREVENT III enrolled 1404 patients, > 18 years of age with CLI (defined as arterial insufficiency with gangrene, a non-healing ischemic ulcer or rest pain) undergoing vein bypass graft surgery, across 83 North American centres. The primary outcome measure for PREVENT III was time to occurrence of non-technical graft failure resulting in either graft revision or major amputation at 12 months post enrolment. Graft failure was assessed with angiographic or ultrasound surveillance and clinical follow-up at multiple intervals for up to 1 year. For this post hoc study, data from the PREVENT III trial were analysed as an observational cohort for the effect of race and gender on vascular endpoints and patient outcomes. For this analysis, race was dichotomized ('black' versus 'non-black') and race and gender were analysed in individual (dichotomized) and combined groups (black men, black women, non-black men, non-black women). Graft and limb-related endpoints consisted of primary patency (graft patency without intervention), primary assisted patency (graft patency after preventive intervention of a stenosis), secondary patency (graft patency after intervention on a thrombosed graft), major amputation (transtibial or higher) and composite outcomes including amputation-free survival and amputation/revision-free survival. Univariate analysis (using ANOVA and Fisher's exact test) examined the association of race/gender groups with patient demographic characteristics and co-morbidities. Univariate logistic regression models examined the relationship of patient characteristics and 30-day peri-operative variables to clinical endpoints. Cox proportional-hazard models were used for 1-year outcomes for graft patency, limb salvage and patient mortality. Propensity score modelling was used to control for 16 covariates (including demographic variables, technical factors, selected co-morbidities and medications) to allow multivariable analysis of the associations and interactions between race and gender with outcomes. Propensity score adjustments nested covariates into the primary outcomes models to analyse the effects of the four combinations of race and gender. Of the 1404 patients enrolled in PREVENT III, 249 black patients (118 women and 131 men) were included. The overall peri-operative (30-day) mortality was 2.7% and no differences were observed between race and gender groups. Although black race and gender were not individually associated with primary patency at 30 days, the subgroup of black men were at increased risk of graft failure at 30 days compared to non-black men (hazard ratio [HR] = 2.96, 95% CI: 1.72-6.06, p < 0.01) and this difference persisted even after adjustments for high-risk grafts (odds ratio [OR] = 3.03, 95% CI: 1.29-7.12, p = 0.01). At 1 year, no significant differences were observed in mortality or primary patency rates among race and gender groups; however, black patients experienced reduced secondary patency compared to non-black patients (HR = 1.49, 95% CI: 1.08-2.06, p = 0.02) and limb salvage (HR = 2.02, 95% CI: 1.27-3.20, p < 0.01). Propensity score models indicated that this disparity was more pronounced among black women (secondary patency HR = 2.02, 95% CI: 1.27-3.20, p < 0.01; major amputation HR = 2.38, 95% CI: 1.18-4.83, p < 0.02). No significant differences were seen between race and gender subgroups in patient survival, amputation-free survival or amputation/revision-free survival. No differences were observed in mortality or primary patency at 30 days or at 1 year among individual and combined race/gender groups. Black patients, especially black women, were found to have worse secondary patency and limb salvage outcomes after vein bypass surgery for CLI.

Increased Low Density Lipoprotein and Increased Likelihood of Positive Prostate Biopsy in Black Americans

Differences in prostate cancer incidence, grade and stage at diagnosis, and survival in black vs nonblack men are well documented. Recent studies indicate that lipids may have a role in oncogenesis, including that of prostate cancer. We investigated the relationship between circulating lipids in black and nonblack patients, and newly diagnosed prostate cancer. The study population included consecutive patients who underwent prostate biopsy for increased prostate specific antigen and/or abnormal digital rectal examination at Atlanta Veterans Affairs Medical Center. Age, race, prostate specific antigen, prostate volume, body mass index, family history, high and low density lipoprotein, triglyceride and cholesterol lowering medications were included in data analysis. A total of 1,775 men with complete information were included in data analysis. A total of 521 black and 451 white men had positive biopsies. Using 100 mg/dl or less as the referent the adjusted OR reflecting the association of low density lipoprotein and prostate cancer diagnosis in black men was 1.49 (95% CI 1.04-2.13, p = 0.031), 1.51 (95% CI 0.96-2.39, p = 0.076) and 3.24 (95% CI 1.59-6.92, p = 0.002) for low density lipoprotein greater than 100 to 130, greater than 130 to 160 and greater than 160 mg/dl, respectively. Corresponding results in nonblack men showed no significant association. Increased serum low density lipoprotein is associated with an increased likelihood of prostate cancer diagnosis in black men but not in nonblack men. This association is strongest in the highest low density lipoprotein risk category. The reasons for the racial differences are unknown but may include genetic, dietary or other environmental factors.

PCV83 GENDER DISPARITIES IN THE UTILIZATION OF MYOCARDIAL PERFUSION IMAGING

• Our findings are consistent with the overall trend seen in the literature: the averaged rate of yearly increase (over 8 years) in the use of imaging stress tests was about 1.5 times higher in non-black men than in women or in black men in one observation; similarly, men were significantly more likely than women to receive an exercise stress test across all age strata in another study (all p<0.009)

Abstract 3727: Meeting Quality of Care Goals for Hypercholesterolemia: Understanding Deficiencies for Women and Black Men Compared With Non-Black Men

BACKGROUND: CAD risk reduction requires maintaining LDL cholesterol (LDL) below NCEP goals. We examined time to LDL control for women and black men versus non-black men and examined the role of demographic, clinical, or health care factors in observed differences. METHODS: Among 35,165 patients at 6 academic primary care practices from 1/1/03 to 2/8/05, we used electronic medical records to identify 11,536 patients at increased risk of CAD due to hypertension (HTN) and age (&gt;45 if male and &gt;55 if female) and an LDL from 1/1/00 to 2/28/05. For 6,497 patients (56%), the last LDL was high (i.e., ≥130 mg/dl or high risk ≥100 mg/dl) before or at the start of our timeframe. We studied 5,146 patients with 2+ visits after that LDL and complete data. Hazard ratios (HR) for the outcome - LDL control - came from survival (Cox) models with censoring 6 months after the last visit or the study end if no LDL control. Models adjust for demographics (age, income, insurance), clinical factors (discordant comorbidities such as asthma, concordant comorbidities such as CAD, smoking, obesity, LDL level), health care (N of HTN drugs, visits/month, provider gender, race, type, annual patient workload), and time from high LDL to next visit in study timeframe. RESULTS: 47% of the cohort had LDL control within two years. Median days (d) to LDL control were: 456 d for non-black men (N=1,058); 627 d for non-black women (N=1,563); 698 d for black men (N=1,114); and 828 d for black women (N=2,164) (p&lt;0.001). Compared to non-black men, adjusted HRs of LDL control were still lower for: non-black women (0.73, CI 0.64–0.82), black men (0.73, 0.63–0.85), and black women (0.59, CI 0.51–0.67). LDL control was positively associated with discordant comorbidities, anti-HTN drugs, age 61–80 vs &lt;50, and shorter time from high LDL to next visit. Low income, Medicaid/uninsured vs commercial insured, and very high baseline LDL were negatively associated. CONCLUSIONS: Among HTN patients at increased risk of CAD, time to LDL control was significantly longer for all women and black men than non-black men and not due to many patient and health care factors. Access to and acceptance/persistence with lipid-lowering medication likely contribute to these important disparities in CAD risk reduction.

Distribution of creatine kinase in the general population: Implications for statin therapy

Eligible subjects with mildly elevated serum creatine kinase (CK) activity are often excluded before randomization in statin trials, but patients may potentially be misclassified as having hyperCKemia when inappropriate reference limits are used. Little information is usually given regarding how reference limit data were established, although evidence suggests that the variation of CK activity in the general population is wider than reflected in reference intervals in current use. We determined reference intervals for serum CK according to National Committee on Clinical Laboratory Standards/Nordic Reference Interval Project guidelines, in a stratified random sample of the population, including 1444 individuals, aged 34 to 60 years, after 3 days of rest. Participants were mainly of white European (n = 503), South Asian (n = 292), or African descent (n = 580). The calculated upper reference limits (97.5th percentile) for nonblack and black women and men were 2 to 5 times higher than recommended by the assay manufacturer. Respectively 13% of the white Europeans, 23% of South Asians, and 49% of the black people had serum CK activities above the manufacturer-provided limits. The variation in CK activity within the population is wider than previously suggested in smaller, nonrandom samples, and relatively high values occur frequently in all subgroups studied after rest. Therefore, we infer that upward adjustment of the upper reference limit is necessary for all population subgroups studied. The use of appropriately established reference intervals may improve the use of statins and particularly benefit the control of dyslipidemia in those with relatively high baseline CK activity.

Differences in cardiac stress testing by sex and race among Medicare beneficiaries

Although there is a wide literature demonstrating sex and race differences in the receipt of invasive cardiac tests and treatments, much less is known about the influence of such characteristics on receipt of a stress test, the first event in the diagnostic/treatment cascade for many patients. We explored the influence of patient characteristics on receipt of a stress test, with special attention to sex and race. We performed a nested case-control study of Medicare beneficiaries who were aged 66 years and older during 1999-2001 and were free of cardiac diagnoses and procedures for at least 1 year. Cases were recipients of a stress test. Cases were younger, less likely to be female or black, but more likely to live in high-income, highly educated, and urban areas than controls. Nonblack men were more likely to receive a stress test than women and black men, controlling for age, area characteristics, and clinical characteristics (odds ratio for nonblack men compared with black women 1.71). These results were not explained by physician visit frequency. Efforts at minimizing disparities in cardiac care must attend to what is, for many patients, the entry into the cardiac care system: the stress test. Our findings suggest that simple "access," as measured by physician visit frequency, is not a rate-limiting factor.

Long-term Glycemic Control and Postoperative Infectious Complications

Good preoperative glycemic control (hemoglobin A(1c) [HbA(1c)] levels <7%) is associated with decreased postoperative infections. Retrospective observational study using Veterans Affairs National Surgical Quality Improvement Program data from the Veterans Affairs Connecticut Healthcare System from January 1, 2000, through September 30, 2003. Veterans Affairs Connecticut Healthcare System, a tertiary referral center and major university teaching site. Six hundred forty-seven diabetic patients underwent major noncardiac surgery during the study period; 139 were excluded because the HbA(1c) levels were more than 180 days prior to surgery; 19 were excluded for other reasons; 490 diabetic patients were analyzed. The study patients were predominantly nonblack men with a median age of 71 years. Primary outcomes were infectious complications, including pneumonia, wound infection, urinary tract infection, or sepsis. Bivariate analysis was used first to determine the association of each independent variable (age, race, diabetic treatment, American Society of Anesthesiologists classification, Activities of Daily Living assessment, elective vs emergent procedure, wound classification, operation length, and HbA(1c) levels) with outcome. Factors significant at P<.05 were used in a multivariable logistic regression model. In the multivariable model, age, American Society of Anesthesiologists class, operation length, wound class, and HbA(1c) levels were significantly associated with postoperative infections. Emergency/urgent cases and dependence in Activities of Daily Living were significant in bivariate analysis but failed to reach statistical significance in the multivariable model. An HbA(1c) level of less than 7% was significantly associated with decreased infectious complications with an adjusted odds ratio of 2.13 (95% confidence interval, 1.23-3.70) and a P value of .007. Good preoperative glycemic control (HbA(1c) levels <7%) is associated with a decrease in infectious complications across a variety of surgical procedures.

Temporal trends in the utilization of diagnostic testing and treatments for cardiovascular disease in the United States, 1993-2001.

Rates of invasive testing and treatment for coronary artery disease have increased over time. Less is known about trends in the utilization of noninvasive cardiac testing for coronary artery disease. The objective of this study was 2-fold: to explore temporal trends in the utilization of noninvasive and invasive cardiac services in relation to changes in the prevalence of cardiac disease, and to examine whether temporal increases have been targeted to potentially underserved populations. We performed an annual cross-sectional population-based study of Medicare patients from 1993 to 2001. We identified stress testing, cardiac catheterization, and revascularization procedures, as well as hospitalizations for acute myocardial infarction, during each year and calculated population-based rates for each using the total fee-for-service Medicare population as the denominator and adjusting for age, gender, and race. We observed marked growth in the utilization rates of cardiac services over time, with relative rates nearly doubling for most services. Acute myocardial infarction hospitalization rates have remained stable over the study period. Although rates of all procedures except coronary artery bypass increased in all subgroups, differences in rates of cardiac testing and treatment between nonblack men and other subgroups persisted over time. Temporal increases in the use of noninvasive and invasive cardiac services are not explained by changes in disease prevalence and have not succeeded in narrowing preexisting treatment differences by gender and race. Such increases, although conferring benefit for some, may expose others to risk and cost without benefit.

Screening for prostate cancer in high risk populations.

Black men and men with a family history of prostate cancer are at higher risk for this disease and may have an earlier age of onset. Consequently, screening at a younger age has been recommended for high risk men, however, there are limited data on actual screening results in young, high risk populations. In men 50 years old or older we compared screening results in 1,224 black men, 1,227 men with a positive family history and 63 men who were both with those of 15,964 nonblack men with no known family history. In high risk men in their forties we also evaluated the percent with abnormal screening tests, the positive predictive value of screening tests, cancer detection rates and the prognostic features of tumors detected. In men 50 years old or older prostate cancer detection rates were 6.4% for controls compared with 10.3%, 10.5% and 17.5%, respectively, for the high risk groups. Among high risk men screened in their forties 8% had suspicious screening tests and approximately 55% who underwent a biopsy had cancer detected. Of tumors detected 80% were organ confined and all but 1 were of moderate Gleason grade 5 years old or older. Only 1 tumor (7%) fulfilled the published criteria for a possibly harmless cancer. Black men and men with a family history of prostate cancer are at a 75% to 80% higher risk for prostate cancer. On initial screening of high risk men in their fourth decade only 8% have positive screening tests; however, approximately 55% of these men have tumors, most of which are medically important with favorable prognostic features.

Race and survival of men treated for prostate cancer on radiation therapy oncology group phase III randomized trials.

We assessed the impact of race on survival in men treated with external beam radiotherapy with or without hormonal therapy for localized prostate cancer in Radiation Therapy Oncology Group randomized trials. Between 1975 and 1992, 2,048 men were treated for clinically localized prostate cancer in 1 of 4 consecutive prospective phase III randomized trials. After excluding nonblack and nonwhite men 2,012 remained for analysis. Patients were included in this analysis if they were deemed evaluable and eligible for the trial, and followup information and centrally reviewed pathological results were available. Short-term hormonal therapy consisted of goserelin acetate and flutamide administered 2 months before and during radiotherapy. Long-term hormonal therapy consisted of adjuvant goserelin acetate, which was generally given for 2 years or more. Pretreatment prostate specific antigen (PSA) findings were available in 430 cases (21%), including 213 treated with radiotherapy alone, 60 treated with short-term hormonal therapy and 157 on long-term hormonal therapy. Mean pretreatment PSA was 68.8 and 35.2 ng./ml. in black and white patients, respectively. Cox proportional hazards models were used to identify the impact of previously defined risk groups on overall and disease specific survival. Multivariate analysis was done for the significance of race using a stratified Cox model. Median followup in patients treated in early and late studies exceeded 11 and 6 years, respectively. On univariate analysis black race was associated with lower overall and disease specific survival (p = 0.04, RR = 1.24 and p = 0.016, RR = 1.41, respectively). After adjusting for risk group and treatment type (with or without short-term or long-term hormonal therapy) race was no longer associated with outcome (p >0.05). The trend for a persistent difference in survival was likely due to the higher tumor burden in black men, as reflected in higher PSA. As previously reported, tumor grade (Gleason score), palpation T stage, lymph node status, pretreatment PSA and treatment type are major predictors of overall and disease specific survival. We noted no evidence that race has independent prognostic significance in patients treated for prostate cancer in Radiation Therapy Oncology Group prospective randomized trials.

Dietary patterns and prostate cancer risk in the National Health and Nutrition Examination Survey Epidemiological Follow-up Study cohort.

Ecological studies implicate a "Western" diet in prostate cancer development, but whether dietary patterns measured in individuals are associated with risk has not been studied previously. We examined this issue using prospective data from the nationally representative United States Health Examination Epidemiological Follow-up Study. Among 3,779 men followed from 1982-84 to 1992, 136 incident cases were identified. Using principal component analysis on responses to a 105-item dietary questionnaire, the following three distinct patterns were identified: a vegetable-fruit pattern; a red meat-starch pattern characterized by red meats, potatoes, cheese, salty snacks, and desserts; and a Southern pattern characterized by such foods as cornbread, grits, sweet potatoes, okra, beans, and rice. In adjusted proportional hazards models, prostate cancer risk was not associated with the vegetable-fruit or red meat-starch pattern, but higher intake of the Southern pattern showed a reduction in risk (3rd versus 1st tertile relative risk, 0.6; 95% confidence interval, 0.4-1.1; trend P = 0.08) that approached statistical significance. The inverse association was observed in black and non-black men and was not attributable to intake of any individual foods or nutrients. A Southern dietary pattern may reflect a history of living in the South and serve as an integrative marker of sunlight exposure and protection through 1,25-dihydroxyvitamin D production. Further evaluation and better characterization of the pattern would offer more information on potentially beneficial features of the diet or its associated lifestyle.

Economic distress and cause‐of‐death patterns for black and non‐black men in Chicago: Reconsidering the relevance of classic epidemiological transition theory

The mortality disadvantage of African Americans is well documented, but previous studies have not considered its implications for population theory in the general case of industrialized nation states with high levels of income inequality. This paper examines the relevance of classic epidemiological theory to the extremes of income and mortality observed in Chicago, one of America's most racially divided cities. We analyze cause-specific death rates for black and non-black male populations residing in Chicago's community areas by using linked data from the 1990 Census and from 1989-1991 individual death certificates. The same cause-of-death patterns explain much of the mortality of black and non-black men. These two major structures include one, degenerative diseases, the other, "tough-living" causes (accidents, homicides, and liver disease). Community socioeconomic status is strongly related to tough-living deaths within each racial group, and to degenerative deaths for African Americans. Black men's tough-living mortality is much greater than non-blacks', but their younger age structure suppresses their degenerative death rates. Aggregate unemployment and social disorganization account for the most salient disparities in mortality across racial groups. This patterning of mortality along a socioeconomic continuum supports epidemiological theory and extends its applicability to highly unequal populations within industrialized countries.

Race and Survival of Men Treated for Prostate Cancer on Radiation Therapy Oncology Group Phase III Randomized Trials

We assessed the impact of race on survival in men treated with external beam radiotherapy with or without hormonal therapy for localized prostate cancer in Radiation Therapy Oncology Group randomized trials. Between 1975 and 1992, 2,048 men were treated for clinically localized prostate cancer in 1 of 4 consecutive prospective phase III randomized trials. After excluding nonblack and nonwhite men 2,012 remained for analysis. Patients were included in this analysis if they were deemed evaluable and eligible for the trial, and followup information and centrally reviewed pathological results were available. Short-term hormonal therapy consisted of goserelin acetate and flutamide administered 2 months before and during radiotherapy. Long-term hormonal therapy consisted of adjuvant goserelin acetate, which was generally given for 2 years or more. Pretreatment prostate specific antigen (PSA) findings were available in 430 cases (21%), including 213 treated with radiotherapy alone, 60 treated with short-term hormonal therapy and 157 on long-term hormonal therapy. Mean pretreatment PSA was 68.8 and 35.2 ng./ml. in black and white patients, respectively. Cox proportional hazards models were used to identify the impact of previously defined risk groups on overall and disease specific survival. Multivariate analysis was done for the significance of race using a stratified Cox model. Median followup in patients treated in early and late studies exceeded 11 and 6 years, respectively. On univariate analysis black race was associated with lower overall and disease specific survival (p = 0.04, RR = 1.24 and p = 0.016, RR = 1.41, respectively). After adjusting for risk group and treatment type (with or without short-term or long-term hormonal therapy) race was no longer associated with outcome (p >0.05). The trend for a persistent difference in survival was likely due to the higher tumor burden in black men, as reflected in higher PSA. As previously reported, tumor grade (Gleason score), palpation T stage, lymph node status, pretreatment PSA and treatment type are major predictors of overall and disease specific survival. We noted no evidence that race has independent prognostic significance in patients treated for prostate cancer in Radiation Therapy Oncology Group prospective randomized trials.

Screening for Prostate Cancer in High Risk Populations

Black men and men with a family history of prostate cancer are at higher risk for this disease and may have an earlier age of onset. Consequently, screening at a younger age has been recommended for high risk men, however, there are limited data on actual screening results in young, high risk populations. In men 50 years old or older we compared screening results in 1,224 black men, 1,227 men with a positive family history and 63 men who were both with those of 15,964 nonblack men with no known family history. In high risk men in their forties we also evaluated the percent with abnormal screening tests, the positive predictive value of screening tests, cancer detection rates and the prognostic features of tumors detected. In men 50 years old or older prostate cancer detection rates were 6.4% for controls compared with 10.3%, 10.5% and 17.5%, respectively, for the high risk groups. Among high risk men screened in their forties 8% had suspicious screening tests and approximately 55% who underwent a biopsy had cancer detected. Of tumors detected 80% were organ confined and all but 1 were of moderate Gleason grade 5 years old or older. Only 1 tumor (7%) fulfilled the published criteria for a possibly harmless cancer. Black men and men with a family history of prostate cancer are at a 75% to 80% higher risk for prostate cancer. On initial screening of high risk men in their fourth decade only 8% have positive screening tests; however, approximately 55% of these men have tumors, most of which are medically important with favorable prognostic features.

Decreasing mortality from pulmonary embolism in the United States, 1979-1996

Mortality trends and patterns for pulmonary embolism may yield clues to its aetiology. Previous investigations had identified several mortality contrasts in pulmonary embolism mortality among US residents. These findings had been made in the context of a trend of increasing rates during 1962-1984. Annual age-specific and age-adjusted pulmonary embolism mortality rates for US residents during 1979-1996 were compiled from the US National Center for Health Statistics web site. These data were analysed for mortality contrasts and trends. For all racial-gender groups, age-adjusted mortality declined throughout the period. The greatest rate of decline was found among black men, followed by (in decreasing order) black women, white men, other men, white women, and other women. In 1996, the previously observed demographic contrasts of blacks experiencing the highest pulmonary embolism mortality, followed by whites and then others, and the male rate being higher than the female one were still present despite this decline. Age-specific mortality from pulmonary embolism in the US during 1996 also mirrored that reported for the 1970s, with mortality increasing during the life span (the risk of death doubling with each decade of life). Specifically, the annual age-adjusted pulmonary embolism mortality rate in 1996 for white men was 2.4 per 100 000 persons; white women, 2.3 per 100 000 persons; black men, 6.0 per 100 000 persons; black women, 4.8 per 100 000 persons; non-black non-white men, 1.0 per 100 000 persons; and non-black non-white women, 0.7 per 100 000 persons. Mortality from pulmonary embolism in the US declined significantly during 1979-1996. Several demographic contrasts, particularly an excess among men, continue to exist.

Effect of Hydrochlorothiazide on the Pharmacokinetics and Pharmacodynamics of the Angiotensin II Blocker Irbesartan

The primary objective of this study was to assess the effect of hydrochlorothiazide on the pharmacokinetics of irbesartan in patients with mild-to-moderate hypertension. In addition, this study compared the pharmacodynamic and tolerability profiles of irbesartan administered both alone and in combination with hydrochlorothiazide. The study consisted of a placebo lead-in period (period A) to establish the stability of blood pressure (seated diastolic blood pressure 95 to 110mm Hg), a 7-day, single-blind treatment period (irbesartan 150mg every day) (period B), and a 7-day, double-blind treatment period [irbesartan 150mg every day plus either placebo (n = 18) or hydrochlorothiazide 25mg every day (n = 18)] (period C). Non-Black men and women 45 to 65 years of age with hypertension were included. The pharmacokinetic profile [maximum concentration of irbesartan in plasma (Cmax), time taken to reach Cmax (tmax), and the area under the plasma concentration versus time curve during a dosage interval (AUCtau)] of irbesartan was unaffected by the addition of hydrochlorothiazide. Mean changes in 24-hour AUC values for seated blood pressures from day 7 of period B to day 7 of period C were significantly lower in patients treated with irbesartan plus hydrochlorothiazide compared with those of patients treated with irbesartan plus placebo. Plasma angiotensin II levels, plasma renin activity, and urinary excretion of sodium, chloride and potassium were significantly increased, whereas urinary aldosterone and creatinine excretion remained unchanged with concomitant hydrochlorothiazide administration.

Rates of and factors associated with self-reported prior HIV testing among adult medical patients in an inner city emergency department in the Bronx, New York City.

We studied the rates of and factors associated with self-reported prior human immunodeficiency virus (HIV) testing in adult patients visiting an emergency department (ED) in the Bronx, New York City. A total of 1,744 consecutive noncritical adult medical emergency patients responded to a standardized interview administered by ED physicians. The interview included questions pertaining to demographic characteristics, prior HIV testing, and HIV risk behaviors. On multivariate analysis, female gender, younger age, history of weight loss, injecting drug use (IDU), syphilis, and genital herpes were all associated with increased reported prior testing rates. Race (i.e., black race) was an independent predictor of increased rates among male subjects; comparatively low rates were reported by patients with a first language other than English, patients lacking medical insurance, and highly sexually active, nonblack men. Increased HIV testing rates were reported by subjects with recognized HIV risk behaviors in a New York City ED population; however, substantial proportions of subjects at risk had not been tested. Programs of HIV testing and counseling need to include older, uninsured, and non-English-speaking segments of the population who engage in high-risk behaviors.

Market Structure and Racial and Gender Discrimination:

Abstract.The Annual Equal Employment Opportunity Reports and Current Population Survey files are used to examine employment and earnings by race and gender in the telecommunications industry following changes in the industry's affirmative action guidelines and following the divestiture of the American Telephone and Telegraph Company. Nonblack minority men were the only underrepresented group to experience marked employment gains as managers and professional. The relative employment probability of other underrepresented workers remained similar to the levels experienced during the implementation of affirmative action guidelines. Earnings differentials did decline for minority men and white women in the telecommunications industry. However, this finding is only unique to black men as the earnings pattern for white women and nonblack minority men mirror that found for these groups nationally.

Epidermoid cyst of the testis: a critical analysis.

Our experience with 163 patients (11 from our institution) with simple epidermoid cyst of the testis was analysed. The lesion is nearly as common as interstitial cell tumour of the testis. In its simple form it is a benign lesion that usually appears as a solitary, asymptomatic, testicular, 2-cm mass in non-black young men (usually 20 to 40 years of age). It has been suspected on circumstantial clinical evidence in a few patients (17.5%) who have been successfully treated by simple enucleation. In the majority, however, fear of looking for a zebra in a herd of horses or not thinking of zebras at all has led to radical orchiectomy. None of the 80 patients followed up for a maximum of 37 years has suffered any ill effects.