Posted by James
Table 1 outlines the demographic characteristics of the study sample. The median duration of hypertension was eight years with median hypertension treatment duration of six years. Blood pressure data were available on 81 patients, of whom 60% had uncontrolled hypertension [defined as systolic blood pressure of 140 mm hg or diastolic blood pressure of 90 mm hg]. Regarding comorbidity, most patients had no comorbid illness, 26% had diabetes, while fewer than 6% had heart disease, cerebrovascular disease, peripheral vascular disease, or renal failure.
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Posted by James
Design
Several methods have been proposed for eliciting patients’ expectations, including use of self-administered questionnaires, semistructured interviews, and focus groups. We conducted a qualitative study using in-depth, open-ended individual interviews to elicit expectations of blood pressure treatment in a group of hypertensive African-American patients.
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Posted by James
INTRODUCTION
African Americans have the highest prevalence of hypertension in the United States, and they experience higher rates of hypertension-related adverse outcomes, such as stroke and renal disease, compared to European Americans. Such high rates of hypertension-related adverse outcomes may be explained, in part, by the higher rates of uncontrolled hypertension noted in African Americans compared to European Americans. While some investigators have suggested that these racial disparities in adverse outcomes may be due to poorer medication adherence noted in African Americans compared to European Americans, others have attributed them to the lay beliefs about the meaning, causes, and treatment of hypertension in this population. The beliefs patients have may underlie how they construct their own models or understanding of their illness with such models often differing from traditional biomedical beliefs held by physicians. Such discordance may, in turn, lead to poor clinical outcomes. For example, in a clinic-based study of older hypertensive African-American women in Louisiana, Heurtin-Roberts and colleagues identified two models of hypertension—a traditional biomedical model where hypertension was perceived to be a chronic disease that requires lifelong treatment and a nonbiomedical model where hypertension was perceived to be an acute, hyperactive, nervous disease that occurs in exacerbations and frequently leads to increased pressure in the blood. The authors further demonstrated that patients with nonbiomedical models of hypertension had poorer compliance and blood pressure control compared to those with biomedical models.
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Posted by James
DISCUSSION
In this study, 68% of the physicians had low bone mass (12% had osteoporosis and 56% had osteopenia). We are unable to identify similar, published data on bone mass in a cohort of physicians; thus, this is a unique study. The results of NHANES III showed that the prevalence of low bone mass increases with age. In the general population, the prevalence of reduced bone mass in women 50-59 years old was 37% but increased to 87% among women 80 years and older. Our study revealed that osteoporosis was present in 33% of the cohorts in both the age group from 30-39 years old and the >60 years old group. This may be explained by the number of subjects in these two groups. These were the two largest age groups. It is difficult to compare NHANES III data with the data of this physician study. Our cohort was younger (mean age of 42 years old). Twenty-five percent of the group was under the age of 39 years. We are unable to find data on a young group with which to compare our data. Also, this study is a pilot study done on the population in an urban hospital with few Caucasian physicians. The National Osteoporosis Risk Assessment study (NORA), the largest recently reported study of osteoporosis tablet that included minority women, showed that the risk of osteoporosis was 1.56 times greater for Asian women, 1.31 times greater for Hispanic women and 45% lower for African-American women, compared to Caucasian women. Other studies of minority groups showed that the risk for osteoporosis is low in African Americans. Our study was not designed to evaluate low bone mass density in various ethnic groups. However, in this study, more low bone mass density was evident in African Americans and Asians than in other ethnic groups. The Asians and African physicians had the largest percentage of persons with osteopenia (61%); they had no one with osteoporosis. For the Asians, the osteopenia may reflect the early start of osteoporosis (their mean age was 48 years), or it may be secondary to nutritional or genetic factors, or to a combination of age, nutrition, and genetic factors. Studies show that the peak bone mass attained at the end of adolescence is one of the principal factors that determines bone mass later in life. The finding of osteopenia in this group of young adult physicians strongly suggests that with continuous loss of bone mass they will progress to osteoporosis at a later age. One study indicated that Japanese women had lower peak bone mass than white non-Hispanic women. It may be that the Asian physicians studied had decreased peak bone mass. It should also be noted that in our study, one out of the 31 Asians was a strict vegetarian, and 10% of the 31 were lactovegetarians.
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Posted by James
There were no differences between the physicians’ baseline age and sex demographics (Table 1). African Americans were the largest group studied (32%; 14 men, 18 women). The Asians were the next largest group (31%; 14 men, 17 women). The African group (18%) had 14 men and four women, whereas the Caribbean group (16%) had seven men and nine women. Also, there were two Caucasian men and one Hispanic man.
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Posted by James
A total of 100 staff physicians were enrolled in the study. There were 52 men and 48 women with an age range of 27-79 years (mean 43.40±14.3). The study population was composed of the following groups: African (n=18), African-American (n=32), Asian (n=31), Caribbean (n=16), Caucasian (n=2) and Hispanic (n=l). The exclusion criteria included current pregnancy, history of hyperthyroidism, liver disease, kidney disease, and persons taking medications or recreational drugs that affect bone metabolism. Signed informed consent was obtained for each participant. This study was approved by the Howard University Institutional Review Board.
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Posted by James
INTRODUCTION
Osteoporosis is a group of skeletal disorders characterized by low bone mass and microarchitectural disruption of bone tissue that leads to fractures. Based on the results of bone densitometry, the World Health Organization (WHO) study group defined osteoporosis as a bone mass greater than 2.5 standard deviation (SD) below peak bone mass (T-score) and osteopenia as 1 SD to 2.5 SD below peak bone mass. More than 10 million Americans have osteoporosis, and another 18 million have osteopenia. The prevalence of osteoporosis drug and osteopenia differs between men and women. Approximately 56% of women in the United States >50 years of age have osteopenia, and 16% have osteoporosis. Low bone mass, expressed clinically as bone mineral density, varies by race and ethnicity. It is more common in Caucasian women (17% have osteoporosis, and 42% have osteopenia) than in other ethnic groups. African-American women, for example, reportedly have a low prevalence of osteoporosis and osteopenia (8%> and 28%>, respectively).
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