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Background: Obese African American women under-appraise their body mass index (BMI) classification and report fewer weight loss attempts than women who accurately appraise their weight status. This cross-sectional study examined whether physician-informed weight status could predict weight self-perception and weight self-regulation strategies in obese women., Methods: A convenience sample of 118 low-income women completed a survey assessing demographic characteristics, comorbidities, weight self-perception, and weight self-regulation strategies. BMI was calculated during nurse triage. Binary logistic regression models were performed to test hypotheses., Results: The odds of obese accurate appraisers having been informed about their weight status were six times greater than those of under-appraisers. The odds of those using an "approach" self-regulation strategy having been physician-informed were four times greater compared with those using an "avoidance" strategy., Discussion: Physicians are uniquely positioned to influence accurate weight self-perception and adaptive weight self-regulation strategies in underserved women, reducing their risk for obesity-related morbidity.

Background: Self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) have been proven effective in improving hemoglobin A1c (HbA1c) and in reducing hypoglycemia in patients with type 1 diabetes mellitus (T1DM). It is not clear, however, if CGM provides further efficacy and safety benefits beyond SMBG in the management of T1DM., Methods: MEDLINE (1966-November 2009), COCHRANE REGISTRY (all years), and EMBASE (1980-November 2009), and article bibliographies were searched for randomized controlled trials (RCTs) investigating the use of CGM in patients with T1DM, with clinical outcomes, including HbA1c and hypoglycemia and/or hyperglycemia., Results: Fourteen RCTs met eligibility criteria [n = 1188 patients, 97.4% with T1DM, age 29.0 ± 14.3 years, diabetes duration 11.7 ± 7.0 years, and baseline HbA1c 8.3 ± 0.8% (mean ± standard deviation)]. Compared with SMBG, the use of CGM was associated with a greater reduction in HbA1c [-0.3% (confidence interval: 0.4, -0.2), p < .0001]. The number of hypoglycemic events was not significantly different between the CGM and SMBG groups (0.52 ± 0.52 versus 0.52 ± 0.63 events/day, p = .5), but duration of hypoglycemia was shorter for the CGM group (75 ± 39 versus 89 ± 19 min/day), with an incremental reduction of hypoglycemia duration of -15.2 min/day, p < .0001. Continuous glucose monitoring also resulted in a shorter duration of hyperglycemia than SMBG (172 ± 125 versus 217 ± 152 min/day, p = .04)., Conclusions: The use of CGM is associated with improvement in metabolic control in T1DM, with significant short- and long-term reductions in HbA1c and reduction in the duration of periods of hypoglycemia and hyperglycemia versus SMBG., (© 2012 Diabetes Technology Society.)

The Morehouse School of Medicine (MSM) Research Centers in Minority Institutions (RCMI) Center of Excellence in Clinical and Translational Research has developed a research web-portal to foster research development and collaborations. We describe the role of focus groups (FG). Research faculty and staff were organized into three groups by research interest. Each FG discussion had five steps: Brainstorming, Reporting, Card-sorting, Priority-setting, and Discussions. Integration of top priorities across each FG culminated in a final priority-setting step. Each FG generated 45 to 50 unique ideas during brainstorming that were categorized into 10 to 12 unique categories. Final priority-setting captured six top items for the initial design of the portal: ability to identify researchers working on similar research; common data management tools; access to clinical trials information; participant recruitment tools; secure access to research databases; and financial support. Focus groups allowed for a discovery period that generated common themes for the design and customization of the web-portal.

Background and Aims: The metabolic syndrome (MetS) is a clustering of cardio-metabolic risk factors for cardiovascular disease. It is important to identify individuals with the MetS early and initiate interventions long before adverse conditions occur. Our previous studies found that missing or incomplete data that should be entered into the electronic health record (EHR) by nursing staff could lead to the under-diagnosis of the MetS. This study aimed to determine whether a five-component intervention to improve EHR data entry would increase the completeness of data, particularly height, weight, and blood pressure, needed to diagnose the MetS., Design: Quasi-experimental design with pre-test, intervention, and post-test sessions., Setting: Two family medicine residency training clinics serving mainly African-American patients in Atlanta, Georgia, United States., Subjects and Methods: Four nurses and four certified medical assistants attended pre-test, intervention, and post-test sessions. Data of 279 patients at pre-test and 246 patients at post-test were collected and analysed. The pre-test and post-test data completion rates of data entry were compared using rates and Wald chi(2)-test., Main Outcome Measures: Rate of patients with information documented in the EHR on blood pressure, weight, and height at pre-test and post-test., Results: There was a statistically significant increase in the recording of height from pre-test to post-test (46.6% versus 96.7%, P <0.001) and the recording of blood pressure from pre-test to post-test (96.8% versus 99.2%, P <0.05)., Conclusions: The intervention led to an improvement in the entry of pertinent EHR data among nurses and medical assistants in this primary care setting. This increase improved the ability to identify patients who met the criteria for the MetS.

Background: The incidence of and mortality from invasive pneumococcal disease are significantly higher in children with sickle cell disease than in the general pediatric population. The objective of this population-based study was to assess the effect of pneumococcal conjugate vaccine on rates of invasive pneumococcal disease among children with sickle cell disease., Patients and Methods: Records, including the history of pneumococcal conjugate vaccine administration, of 1247 children born after 1983 residing in metropolitan Atlanta, Georgia, with confirmed hemoglobinopathies were linked to an active surveillance database for invasive pneumococcal disease for the period of January 1, 1995, through January 1, 2003. The incidence of invasive pneumococcal disease and the percentage of rate reduction were estimated before and after pneumococcal conjugate vaccine licensure. Survival analysis was used to estimate the effect of pneumococcal conjugate vaccine on invasive pneumococcal disease rates while accounting for herd immunity., Results: A significant decline in invasive pneumococcal disease in children with sickle cell disease < or = 10 years of age was noted after pneumococcal conjugate vaccine licensure, from 1.7 infections per 100 person-years (1995-2000) to 0.5 infections per 100 person-years (2001-2002), which represents a 68% reduction. The effectiveness of > or = 1 dose of pneumococcal conjugate vaccine was estimated by crude analysis to be 84.5% and by stratified survival analysis to be 81.4% when controlling for the presence of herd immunity in the 2 years after pneumococcal conjugate vaccine licensure. Serotype 6A invasive pneumococcal disease represented 36% of invasive pneumococcal disease before pneumococcal conjugate vaccine licensure and 0% after pneumococcal conjugate vaccine licensure, suggesting a protective effect against this pneumococcal conjugate vaccine-related serotype., Conclusions: Invasive pneumococcal disease significantly decreased in children with sickle cell disease < or = 10 years of age after pneumococcal conjugate vaccine licensure. Pneumococcal conjugate vaccine was effective even when controlling for herd immunity. Extending guideline recommendations for catch-up vaccination beyond 4 years of age should be considered.

Background: Increased C-reactive protein (CRP) concentration and insulin resistance (IR) are associated with increased rates of adverse cardiovascular events. We sought to examine the relationship of CRP with surrogate measures of IR among nondiabetic adults in the US., Methods: We conducted analyses using data from the National Health and Nutrition Examination Survey 1999-2002. We analyzed a nationally representative sample of 2514 men and nonpregnant women age > or = 20 years who were non-Hispanic white, non-Hispanic black, or Mexican American., Results: After adjustment for age, sex, race/ethnicity, smoking status, systolic blood pressure, and serum concentrations of HDL cholesterol, LDL cholesterol, and triglyceride, CRP was significantly associated with 10 IR measures (all P values <0.01). The strength of the association attenuated after further adjustment for waist circumference (change in adjusted regression coefficients ranging from 60.0% to 75.1%). The association of CRP with each IR surrogate was similar (standardized regression coefficient ranges from 0.06 to 0.09). The association of CRP (>3 vs <1 mg/L) with the homeostasis model for assessment of IR (> or = 75th vs <75th percentile) was statistically significant among people with a body mass index > or = 30 kg/m(2) (odds ratio, 2.6; 95% CI, 1.3-5.1) or with a body mass index <25 kg/m(2) (odds ratio, 2.5; 95% CI, 1.5-4.2)., Conclusions: CRP was significantly associated with the surrogate measures of IR among nondiabetic adults. Obesity may play an important role in the association of CRP with IR in this nationally representative sample.

Objectives: This study's objectives were to determine the national prevalence of anemia in pregnancy (AIP) in the United States, compare racial differences in the prevalence, compare the AIP risk factor profiles between non-Hispanic whites and non-Hispanic blacks, and to analyze the associations between AIP and some maternal and fetal/neonatal complications between whites and blacks., Methods: The data used were from the United States natality data files (1995 through 2000), which included 23,654,695 live births. All mothers diagnosed with AIP, defined as hemoglobin-concentration < 10 g/dl, were included. The cohorts were analyzed in two groups. The "whole group" (WG) comprised all women in the data set who had anemia status reported. The "low-risk group" (LRG) comprised women with low-risk factors for AIP. Race was determined by mothers' skin colors and racial self-identifications. Logistic regression was used to explore associations between race and AIP while controlling for other covariates., Results: The national prevalence of AIP among the general population was 21.55/1,000 among the WG and 11.51/1,000 among the LRG. Among the WG, the prevalence of AIP was two times higher among non-Hispanic blacks (35.38/1,000) than among non-Hispanic whites (18.02/1,000). Among the LRG, the prevalence was 1.94 times higher among non-Hispanic blacks (20.44/1,000) than among non-Hispanic whites (10.63/1,000). The other risk factor profiles for AIP were similar among the races. Many serious maternal and fetal/neonatal complications occurred more frequently among anemic patients when compared with non-anemic patients., Conclusions: The results of this study showed that black race was significantly associated with higher risk of AIP. The other risk factor profiles of AIP were significantly similar between whites and blacks. This study also confirmed that AIP was significantly associated with some serious maternal and fetal/neonatal complications. The findings of this study indicate that race is an important risk factor of AIP.

Introduction: Disparities in health care are maintained by three primary factors: 1) patient factors which include multiple risk factors and comorbidities; 2) healthcare practitioner factors comprising inconsistent application of practice guidelines due to a limited database of clinical trials of effective therapies in African Americans and other underrepresented minorities; and 3) barriers in the healthcare delivery system resulting in poor access to care. The Morehouse School of Medicine Community Physicians' Network (CPN) was established to address disparities in health care by focusing on provider-specific strategies., Objectives: To: 1) use disease-specific registries to identify treatment gaps and facilitate quality improvement processes among CPN practices; 2) develop practice-specific and guideline-based educational messages to promote quality care; 3) engage and train CPN-physicians for participation in approved NIH, other government, and industry-supported clinical protocols; and 4) develop a data repository of all CPN-sponsored clinical trials that include significant numbers of African Americans and other underrepresented minorities., Methods: The disease-specific outpatient registries will have the following features: 1) data structures and data elements will use standard database codes and a data dictionary; 2) HIPPA-compliant data abstraction and data transfer tool; 3) baseline chart review to establish practice patterns and provide practice-specific feedback; 4) annual update of registry; 5) data registry and repository maintained on Morehouse School of Medicine's secure servers; 6) registry publications will include only aggregate data, without identification of contributing practices; 7) an electronic medical records platform will be encouraged as the ultimate data management tool for CPN practices. In addition, up to three continuing medical education (CME) programs each year will feature national speakers and promote evidence-based practice guidelines., Results: Eighty-five primary care and subspecialty practices are actively enrolled in CPN with a total of 385,000 annual outpatient visits. The makeup of insurance status is: HMO/PPO (45%); Medicare only (19%); Medicare HMO (11%); Medicare plus (8%); Medicaid (6%); Uninsured (11%)., Conclusions: The Community Physicians' Network will address specific gaps in the health care of African-American and other minority patients by promoting quality care among its members and by facilitating participation in approved clinical trial protocols. The unique academic community partnership is consistent with the NIH roadmap goal of eliminating healthcare disparities.

This cross-sectional study sought to determine the prevalence of cognitive impairment among African-American patients with congestive heart failure (CHF). We studied 100 African-American CHF patients (aged 55-87 years) in New York Heart Association classes II-IV, who are enrolled in an ongoing, randomized, controlled trial, evaluating the effectiveness of a telemonitoring intervention to improve access to ambulatory care for heart failure patients. These CHF patients were recruited from an inner-city practice, rural physician practices and an urban physician practice in Atlanta. The Mini-Mental Status Examination (MMSE) was used to measure cognition. Cognitive impairment was defined as a MMSE score of less than 24. The crude prevalence of cognitive impairment was 10% in this population of African Americans with CHF. The results of multivariate logistic regression analysis indicated an increase in odds of cognitive impairment with increasing age [odds ratio (OR) = 1.10 and 95% confidence interval, 1.00-1.20; p=0.042]. There was no significant relationship between cognitive impairment and gender, education status, depression and severity of CHF. This study indicates that cognitive impairment is relatively prevalent among African Americans with CHF, but lower than previously reported among Caucasians with CHF.

Purpose: Before implementing a new prevention curriculum, the authors assessed the prevention practices and attitudes of community family physicians in North Carolina who precepted third-year family medicine clerkship students., Method: An 18-item questionnaire was mailed to 165 preceptors during the 1995-96 academic year. The questionnaire explored the preceptors' levels of preparation to counsel patients, the types of prevention services they offered, and their levels of success in modifying patients' behaviors. The survey was re-sent to non-respondents., Results: The response rate was 70% (n = 112); of these 75% were men and 55% had graduated after 1987. Over 60% of the preceptors "almost always" offered services in smoking cessation, exercise, diet and nutrition, and age-specific services (range 62-86%). Over 50% felt "very prepared" to counsel patients regarding smoking cessation, sexually transmitted diseases, depression, exercise, alcohol use, and age-specific services (range 53-74%). However, the preceptors in this study felt pessimistic about their success in getting patients to change their behaviors. Preceptors who had graduated more recently offered more preventive services for smoking cessation, alcohol use, and illicit drugs than did earlier graduates., Discussion: Although North Carolina preceptors were pessimistic about their success in changing patients' behaviors regarding prevention, they were confident about their knowledge and skills to provide these services. This information was used to modify a prevention curriculum for third-year medical students.

Purpose: To determine whether students' performances in a pre-admission program predicted whether participants would (1) apply to medical school, (2) get accepted, and (3) graduate., Method: Using prospectively collected data from participants in the University of North Carolina at Chapel Hill's Medical Education Development Program (MEDP) and data from the Association of American Colleges Student and Applicant Information Management System, the author identified 371 underrepresented minority (URM) students who were full-time participants and completed the program between 1984 and 1989, prior to their acceptance into medical school. Logistic regression analysis was used to determine whether MEDP performance significantly predicted (after statistically controlling for traditional predictors of these outcomes) the proportions of URM participants who applied to medical school and were accepted, the timeliness of graduating, and the proportion graduating. Odds ratios with 95% confidence intervals were calculated to determine the associations between the independent and outcome variables., Results: In separate logistic regression models, MEDP performance predicted the study's outcomes after statistically controlling for traditional predictors with 95% confidence intervals., Conclusions: Pre-admission programs with similar outcomes can improve the diversity of the physician workforce and the access to health care for underrepresented minority and economically disadvantaged populations.

The association between the percent change in first-year and total underrepresented minority student enrollment and the presence of preadmission programs at Liaison Committee on Medical Education (LCME) accredited medical schools was assessed before and during successful legal and legislative challenges to affirmative action. The percent change in under-represented minority student enrollment was determined by comparing enrollment data for the academic years 1993-94 and 1996-97. Schools were categorized as having either a negative or positive percent change in their enrollment of underrepresented minority students. Logistic regression was used to determine the association of the percent change in under-represented minority student enrollment and the presence of a preadmission program while controlling for schools' financial support and the presence of postbaccalaureate programs. Fifty-six percent of the included medical schools had preadmission programs. Schools with a positive percent change were significantly more likely to have preadmission programs compared with schools with a negative percent change. There was no association between the presence of preadmission programs and the percent change in total enrollment. These results indicate that the presence of preadmission programs is positively associated with increases in first-year underrepresented minority student enrollment during the successful challenges to affirmative actions.

This article investigates the possible effects of minority status, presence of a Minority Affairs Office or Student National Medical Association (SNMA) Chapter, level of indebtedness, and number of years (4 to 5) to complete medical school on specialty choice of minority medical students. The 5-year experiences of 20 medical schools in the southern region (including three in Puerto Rico) were examined via a questionnaire. Information was sought for African Americans, Afro-Caribbean, Mexican American, other minority, and nonminority students. Minority graduates entered the specialities of internal medicine, pediatrics, and family medicine in far greater numbers than any other speciality. Also, the percentage of minorities who entered these fields was greater than the percentage of non-minorities. Conversely, minorities were significantly underrepresented in the surgical subspecialties and radiology. Additional study is needed to further examine the medical school experience for indications of why the clustering in primary care specialities occurs. Moreover, while most schools had some kind of minority affairs organization, few were active in the writing of the Dean's letter. Other suggestions to assure adequate minority representation across specialties include early exposure to the different specialties and subspecialties for minority students, a mentorship program with practicing physicians, and stronger recruitment of minorities into underrepresented specialties.

Black medical students perceived significantly more stressors than white medical students in a predominantly white medical school environment (P=0.001). Black medical students perceived fewer social supports than white medical students, but not significantly fewer (P=0.224). There was no significant difference between mean systolic and diastolic blood pressure levels for the low and high stress groups (P=0.302 and 0.844, respectively). The total degree of perceived stressors did not predict systolic and diastolic blood pressure when controlling for potential confounders (0.050.25 and 0.1

This longitudinal study of medical students assessed the relationship between their mental and social well-being, the discrepancy between their expectations and the reality of the learning environment, and social support, after controlling for baseline characteristics that may affect students' perceptions. Finding, at the end of the first year, that the quality of the learning environment was better than expected was positively associated with social well-being but negatively associated with mental well-being. Finding less stress than expected was positively associated with both mental and social well-being. Social support had only a direct positive association with social well-being. There was a suggestion, although it was not statistically significant, of a negative association between social support and mental well-being and a positive interaction between social support and students' perception of the environment's quality. These findings suggest that stressors and mediators of stress may show specificity for health outcomes.

Transcutaneous electrical nerve stimulation (TENS) has been reported to reduce the use of narcotic analgesic medication for pain relief in the postoperative period. This study compares the use of narcotic analgesics and the occurrence of postoperative complications in 205 patients who underwent gastric bypass surgery for control of obesity. Seventy-four patients used TENS for postoperative pain relief. The control group comprised 131 patients who did not use TENS. There were no statistically significant differences in the use of narcotic analgesic medication and the occurrence of postoperative complications between the experimental group and the control group.