Posted by James
Study Population
The study population consisted of 28 adult males from the city of Jos and 44 adult Fulani males from Magama Gumau, a hamlet situated approximately 60 km east of Jos. The Jos subjects, which consisted primarily of individuals from the Hausa, Igbo, Yoruba, and Berom ethnic groups, were recruited from among the staff of the Jos University Teaching Hospital and their relatives. Individuals with a history of tobacco use or who had an upper respiratory infection in the previous six weeks were excluded from the study. Data were collected on location between June and August of 2002, which coincides with the rainy season in Nigeria. Informed consent was obtained for all subjects. The study was approved by the University of New Mexico School of Medicine Human Research Review Committee and the Jos University Teaching Hospital Human Ethics Committee.
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Posted by James
INTRODUCTION
The Fulani are seminomadic herders of the western Sahel whose culture and economy are centered on their cattle. Adult Fulani men have a highly active lifestyle because of their constant trekking to obtain pasture and water for their cattle. In a previous study of the cattle Fulani of the Jos plateau of central Nigeria, we found that active herdsmen in the age range of 16 to 40 years were characteristically very lean: their fat-free mass (FFM) averaged 87.3%, while their fat content was relatively low at 12.7%. In addition, the caloric intake of the Fulani men was surprisingly low (1,668 kCal), especially in light of the physically demanding nature of their work. With regard to diet, more than half of their caloric intake was derived from fat, of which more than half again was accounted for by saturated fatty acids.
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Posted by James
We elicited expectations of treatment in 93 hypertensive African-American patients followed in a primary care practice. This is the only study, to our knowledge, that explored expectations of blood pressure treatment in this patient population. Our findings indicate that patients had multiple, varied expectations of their blood pressure treatment that were grouped into three major categories and the theme underlying these categories was role identification, such that patients attributed specific roles or functions in the course of treatment to themselves (patient’s role), to their physicians (physician’s role), and to their medications (medication effects). Contrary to previous beliefs, the majority of patients actually expected to follow their physidans’ recommendations, such as taking their medications, being proactive in their care, and seeking prognostic information. They expected their physicians to serve as sources of information; they wanted their physicians to educate them about the side effects of their medications as well as their mechanism of action; and they expected appropriate physiologic response from medications, such as blood pressure lowering and prevention of complications.
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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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