Faculty Bibliography

OBJECTIVE: The relationship between appointment-keeping behavior, medication adherence (ADH), and systolic and diastolic blood pressure (SBP and DBP) was assessed in 153 hypertensive African Americans followed in a community-based practice. METHODS: ADH was assessed with a self-report questionnaire. BP was obtained from electronic medical records and appointment attendance was determined from the log of all appointments made during the 12-month study period. Nonadherence rates were compared across appointment attendance categories with chi-square. Logistic regression was used to assess the relationship between ADH and appointment attendance, whereas multivariate analysis of covariance (MANCOVA) was used to examine the relationship between appointment attendance and BP. RESULTS: Twenty-five percent of patients (87% women, mean age 52 years) did not miss any appointments, 44% missed 1-30%, and 31% missed greater than 30%. Adjusted nonadherence rates were similar for all 3 categories (70%, 66%, and 65%, respectively, p = 0.88) as were adjusted mean SBP and DBP in the MANCOVA model, [F (4, 218) = 1.13, p = .34]. Logistic regression analysis did not indicate a significant relationship between appointment attendance and ADH. CONCLUSIONS: Appointment-keeping behavior was not related to ADH or BP among hypertensive African Americans. It should not be used as a proxy for ADH in this patient population

The current study investigated the relationship between trait forgiveness and cardiovascular reactivity (CVR) and recovery in 99 normotensive participants (mean age=33.8). Cardiovascular parameters were obtained at 2-minute intervals during a 10-minute baseline period and a 20-minute recovery period, and at 1-minute intervals during a 4-minute anger recall task and a 4-minute serial subtraction task without harassment. Participants filled out a self-report measure of forgiveness prior to the laboratory procedure. Although forgiveness was not related to CVR, higher levels of trait forgiveness were predictive of lower diastolic blood pressure (DBP) at baseline (p<.02) and faster DBP recovery (p<.003). Findings suggest that forgiveness may be related to overall reductions in blood pressure levels and may aid in cardiovascular recovery from stress. The results also provide preliminary evidence that forgiveness may impact cardiovascular health not through a myocardial or vascular pathway, but through another mechanism

He had no lasting effects from the earlier incident and was ''fully recovered'' from the seizure he suffered about 2 p.m. Monday, the court said, adding that the chief justice had undergone ''a thorough neurological evaluation, which revealed no cause for concern.'' Christopher Burke, a spokesman for Penobscot Bay Medical Center, told The Associated Press, ''It's my understanding he's fully recovered.'' In an interview on Monday evening, Dr. David J. Langer, the director of cerebrovascular neurosurgery at St. Luke's-Roosevelt, Beth Israel and Long Island College Hospital, said that medical care after such a seizure should include ''a good M.R.I., CAT scan and EEG.'' All these tests are available at the Penobscot Bay Medical Center, according to the hospital's Web site

Methods to assess uncertainty in the estimated population attributable risk (PAR) by calculating 95 per cent confidence intervals (CIs) are not readily available in software for complex sample surveys. Using the Bonferroni inequality, a simple method to obtain CIs for the PAR is developed. The method is demonstrated using a simulation in a (2 x 2) table as well as a cohort study to calculate CIs for PAR of coronary heart disease death (using proportional hazards regression). This article demonstrates a straightforward, theoretically valid method of determining CIs for the PAR. Using this method, researchers analysing complex surveys can routinely provide a population perspective and a valid measure of the uncertainty for these estimates.

Two sets of studies by Dr. Comstock in the 1940s and '50s had a critical impact on the federal government's response to tuberculosis. One set led public health officials to reject the tuberculosis vaccine known as BCG, which had been under consideration for routine use among American children. Dr. Comstock attributed the discrepancies among the trials to variations in different strains of the BCG vaccine and a lack of standard manufacturing techniques. Later, genetics studies documented that there was no uniformity among BCG vaccines, said Richard E. Chaisson, a tuberculosis researcher at Johns Hopkins. In the trial, Dr. Comstock and his family took INH themselves to convince the participants of his belief in the therapy's safety, Mr. Chaisson said. After the trial, Dr. Comstock returned and gave INH to those who had received the placebo

The most celebrated example of such discordant findings involved Andrew Speaker, the Atlanta lawyer who caused an international health scare after traveling to Europe in May with what was believed to be extensively drug-resistant tuberculosis, known as XDR. This month, Speaker's doctors downgraded his type of tuberculosis to multidrug-resistant, or MDR, after repeating tests that initially gave a different result. The overwhelming majority of tuberculosis cases are caused by bacterial strains that yield to the standard, or first-line, anti- TB drugs. Newer, second-line drugs are used if a strain of tuberculosis is MDR or XDR, which are resistant to the first-line drugs. If tuberculosis strains are not tested for drug resistance as soon as they are found in a patient, the problem may be detected too late to permit a cure. Reliable tests to determine resistance to first-line drugs were developed when the drugs were first marketed about a half-century ago. Fewer resistance tests exist for the newer, second-line drugs needed to treat MDR and XDR tuberculosis, and many of them are difficult to perform

The overwhelming majority of tuberculosis cases are caused by bacterial strains that yield to the standard, or first-line, anti-TB drugs. Newer, second-line drugs are used if a strain of tuberculosis is MDR or XDR, which are resistant to the first-line drugs. If tuberculosis strains are not tested for drug resistance as soon as they are found in a patient, the problem may be detected too late to permit a cure. ''But no laboratory test for any disease is 100 percent,'' said one member of the panel, Dr. Karin Weyer of the South African Medical Research Council. ''Labs often have problems and can and do make mistakes,'' Dr. Weyer said. The panel also recommended using molecular tests to detect rifampicin resistance as a proxy for MDR tuberculosis. Use of such tests could reliably determine XDR in less than two months, compared with the several months that are often needed now, Dr. Weyer said. Standard tests take weeks to complete because tuberculosis bacteria grow slowly

In the trial, [George Comstock] and his family took INH themselves to convince the participants of his belief in the therapy's safety, Chaisson said. After the trial, Comstock returned and gave INH to those who had received the placebo. Comstock attributed the discrepancies among the trials to variations in different strains of the BCG vaccine and a lack of standard manufacturing techniques. Later, genetics studies documented that there was no uniformity among BCG vaccines, said Richard Chaisson, a tuberculosis researcher at Johns Hopkins

Before the screening, Mr. [Bush] sent a letter to the House speaker, Nancy Pelosi, Democrat of California, and the president pro tem of the Senate, Senator Robert C. Byrd, Democrat of West Virginia, in which he invoked Section 3 of the 25th Amendment of the Constitution in transferring power to Mr. [Dick Cheney]. Afterward, he sent another letter declaring, ''I am presently able to resume the discharge of the constitutional powers and duties of the office of the president of the United States.'' Mr. [Scott M. Stanzel] said Mr. Bush was in ''good humor'' and planned to take a bicycle ride later in the day

After Mr. Speaker arrived at National Jewish on May 31 following his widely publicized journey, his doctors were unanimous in recommending surgery in July. A major factor is that a review in 2004 of 15 years' experience in treating resistant tuberculosis at National Jewish found that ''the most important single variable we had associated with favorable outcome was resectional surgery.'' In discussions among the doctors, surgery was ''a gray zone call,'' Dr. [Michael D. Iseman] said in an interview. ''One day I could go argue for it, the next day against it,'' he said. In the best of circumstances, Mr. Speaker could go home to Atlanta as soon as in two to three weeks, Dr. Iseman said. But, he added, ''his situation is so public health delicate that he and we and the authorities in Georgia may wish to treat him here a little bit longer, just so we can assure everyone in the community that he does not have positive cultures.''