Faculty Bibliography

BACKGROUND: Randomized clinical trials have demonstrated that strict blood pressure (BP) control in diabetes reduces cardiovascular morbidity and mortality. Previous observational studies have confirmed that hypertension is inadequately controlled in the general population of the United States. In this study we evaluated the prevalence and determinants of severe, sustained, uncontrolled hypertension in a national cohort of persons with diabetes. METHODS: We identified 64,105 veterans from the national Veterans Administration diabetes registry for whom BP, survey, laboratory, and medication data were available. Using mean BP from three visits in fiscal year 2000, we determined the prevalence of sustained BP readings >/=160/100, >/=140/90, or >/=130/80 mm Hg. We determined predictors of the three thresholds using demographic variables, self-reported medical comorbidities, estimated glomerular filtration rate, and number of BP-lowering medications. RESULTS: Over a mean interval of 131.0 days (+/-81.4), we found that 6,347 (9.9%) of the 64,105 veterans with diabetes had mean BP >/=160/100 mm Hg. Similarly 25,924 (40.4%) had a mean BP >/=140/90 mm Hg, and 38,296 (59.7%) had a mean BP >/=130/80 mm Hg. Independent predictors of mean BP >/=160/100 mm Hg included age, ethnicity, education level, cardiovascular comorbidities, alcohol use, and number of BP-lowering medications. CONCLUSIONS: Administrative databases can be used to identify patients with sustained uncontrolled hypertension within health care systems. Our findings suggest important patient-level factors that can be targeted for quality improvement programs in diabetes

Osteoporosis is a serious national and global public health problem, but data on bone health are limited for Asian women living in the U.S., the majority of whom are Chinese. For this study, we measured bone mineral density (BMD) by dual energy X-ray densitometry (DXA) at the lumbar spine and hip region in 300 immigrant Chinese women, ages 40-90 y, living in New York City. We also collected demographic and health data, information about knowledge and care for osteoporosis, and anthropometric measures, and estimated calcium intake from the women. In our sample, 55% had osteoporosis and 38% had low bone mass (osteopenia). Older age, lower body mass index (BMI), and shorter height were associated with lower BMD at all sites. Years lived in the U.S. and number of children were also associated with lower BMD of the lumbar spine. Chinese women who emigrated from Mainland China had lower BMD at the lumbar spine and femoral neck than Chinese women who emigrated from Hong Kong, after adjusting for potential confounders. Both groups of immigrant women had lower BMD at all sites than a national sample of U.S. Caucasian women. Although the women in our study had generally poor knowledge about osteoporosis, most could identify at least one food rich in calcium. The large number of immigrant Chinese women in New York City with osteoporosis calls for major efforts to increase awareness, prevention, diagnosis, and treatment of this condition in this susceptible population.

There is a new help-you-sleep kid on the block -- Lunesta. Like its older cousins, Ambien and Sonata, Lunesta is a hypnotic sleep drug that is not addictive and does not require larger and larger doses. Ambien and Sonata revolutionized the treatment of insomnia because they can be taken without fear of physical dependence, though they may be somewhat habit forming. Lunesta may have an advantage for people who have trouble maintaining sleep, because it has a six-hour half-life. Two other sleeping pills are in late-stage clinical trials

BACKGROUND: To establish international standards for medical schools, an appropriate panel of experts must decide on performance standards. A pilot test of such standards was set in the context of a multidimensional (multiple-choice question examination, objective structured clinical examination, faculty observation) examination at 8 leading schools in China. METHODS: A group of 16 medical education leaders from a broad array of countries met over a 3-day period. These individuals considered competency domains, examination items, and the percentage of students who could fall below a cut-off score if the school was still to be considered as meeting competencies. This 2-step process started with a discussion of the borderline school and the relative difficulty of a borderline school in achieving acceptable standards in a given competency domain. Committee members then estimated the percentage of students falling below the standard that is tolerable at a borderline school and were allowed to revise their ratings after viewing pilot data. RESULTS: Tolerable failure rates ranged from 10% to 26% across competency domains and examination types. As with other standard-setting exercises, standard deviations from initial to final estimates of the tolerable failure rates fell, but the cut-off scores did not change significantly. Final, but not initial cut-off scores were correlated with student failure rates (r = 0.59, P = 0.03). DISCUSSION: This paper describes a method to set school-level outcome standards at an international level based on prior established standard-setting methods. Further refinement of this process and validation using other examinations in other countries will be needed to achieve accurate international standards.

Despite an observed decrease in overall cancer death rates in the USA, immigrant minorities continue to experience disproportionately higher cancer incidence and mortality rates. Thirteen focus groups were conducted in the Haitian, English-Speaking Caribbean, Latino, Korean, and Chinese communities of New York City to better understand their health-seeking behaviors with respect to cancer prevention, screening, and treatment. Focus groups addressed the degree to which cultural, linguistic, and systematic barriers impact these behaviors and explored methods to support salutary behaviors. Findings underscored that, while there are many similarities across immigrant groups, there are significant variations between the immigrant groups to necessitate a tailored community-based approach. The prevalent misinformation observed among all groups warrants the prompt development of culturally competent programs for cancer control with immigrant minorities

This paper presents the General Ethnic Discrimination Scale, an 18-item measure of perceived ethnic discrimination that can be used in health research with any ethnic group. The 1569 participants (half college students, half community adults) completed the General Ethnic Discrimination scale and measures of cigarette smoking and of psychiatric symptoms. Results revealed that the General Ethnic Discrimination subscales model the latent construct of perceived ethnic discrimination equally well for Blacks, Latinos, Asians, and Whites. Discrimination was strongly related to psychiatric symptoms and to current cigarette smoking for ethnic minorities and Whites alike, but such relationships were stronger for ethnic minorities. Minorities who experienced frequent discrimination were 2.3 times more likely than their low-discrimination counterparts to be smokers. This 5th grade reading-level scale takes 10 min to complete and has sufficient, initial psychometric integrity for use in clinical and community health studies

After three years, 93 percent of the older kidneys that scored favorably functioned well, a rate comparable to kidneys from younger donors. Among older transplanted kidneys that were not biopsied, the rate was 72 percent. In the United States, of the estimated 60,000 patients who await kidney transplants each year, 16,000 receive a kidney. In 2003, 12 percent of kidneys from donor bodies were discarded, chiefly because of the donor's age and the quality and size of the kidneys. Dr. [Edward Cole], who has been a research partner with Dr. [Giuseppe Remuzzi] of Italy, said that one possible problem is that while the lists for older kidneys have been short, ''the more we publicize their potential benefits, the more people will sign up for them, the longer the lists will be'' and ''if you do more double kidneys,'' there will be fewer recipients

In the fall of 2005, the purchase of hand sanitizers was up almost tenfold. I'm sure this is a response to the fear of getting bird flu -- a way to reassure yourself that you are doing something to protect yourself. I would never discourage hand cleansing, but keep in mind that any quick remedy for bird flu fears also reinforces the notion that bird flu is almost here, when there is no evidence to support this. The same is true for avoiding poultry. It may make some people feel safer for a brief moment, but it also reinforces the misconception that our poultry supply is at risk. The chances of an infected human bringing bird flu to the United States on a plane are practically nonexistent, simply because there are so few cases of human bird flu. But even if someone brought bird flu here, it would not spread because there is no human-to-human transmission with bird flu in its current state. It is very unlikely that a live bird will pass bird flu to North America, though bird smugglers do exist and Pacific flyway birds can occasionally make it across Siberia to Alaska. It is far more likely that some chilled or frozen poultry containing H5N1 will arrive here, mislabeled or smuggled from Asia. In that case, the virus would be destroyed as soon as the poultry was cooked, and the virus would not be transmitted to humans or other animals