J Natl Med Assoc
-
Opioid abuse and addiction have increased in frequency in the United States over the past 20 years. In 2009, an estimated 5.3 million persons used opioid medications nonmedically within the past month, 200000 used heroin, and approximately 9.6% of African Americans used an illicit drug. Racial and ethnic minorities experience disparities in availability and access to mental health care, including substance use disorders. ⋯ However, restrictive federal regulations and stigmatization of opioid addiction and treatment have limited the availability of methadone. The opioid partial agonist-antagonist buprenorphine/naloxone combination has proven an effective alternative. This article reviews the literature on differences between buprenorphine and methadone regarding availability, efficacy, safety, side-effects, and dosing, identifying resources for enhancing the effectiveness of medication-assisted recovery through coordination with behavioral/psychological counseling, embedded in the context of recovery-oriented systems of care.
-
Controlled Clinical Trial
Increasing knowledge of cardiovascular risk factors among African Americans by use of community health workers: the ABCD community intervention pilot project.
African Americans have higher rates of cardiovascular disease (CVD) and poorer outcomes compared to others. The American Diabetes Association and the National Diabetes Education Program have promoted use of the ABC approach (glycated hemoglobin A1c, blood pressure, cholesterol) for identifying and controlling the leading indicators of CVD risk. In the present study, researchers added a D factor, for depression, because this disorder is common and also predictive of CVD risk and of control of diabetes. ⋯ The only significant difference in clinical measures reflected a worsening of HbA1c levels in the control group; the CHW intervention group showed a slight improvement. Participants also learned self-management skills, such as taking blood pressure, measuring glucose, and reading labels. Nevertheless, more longitudinal research and a larger sample size are needed to confirm the impact of CHWs in community settings to change factors associated with CVD risk.
-
Comparative Study
Characterization of metabolically unhealthy overweight/obese African American women: significance of insulin-sensitive and insulin-resistant phenotypes.
Obesity is often associated with high cardiovascular disease risk factors. Obesity is common in African American women. We investigated the characteristics of metabolically healthy and metabolically unhealthy overweight/obese African American women based on the presence of insulin resistance. ⋯ We concluded that: (1) despite obesity, metabolically healthy African American women appear to be less prone to type 2 diabetes and cardiovascular disease and (2) in view of the higher prevalence of metabolic syndrome, metabolically unhealthy African American women should be targeted for primary prevention of type 2 diabetes and cardiovascular disease.
-
Recent studies have shown that hypertension is inversely correlated with bone mineral density (BMD) as determined by dual energy x-ray absorptiometery (DXA) in different ethnic groups. But in most published studies, either the sample size was small or the study was limited by different measurement methods. These limitations leave this association controversial and inconclusive. The current study utilizes a sample of African American females referred for clinical screening of osteoporosis in our center to find out if any association of high blood pressure and BMD in this ethnic group exists. The secondary endpoint was to determine the effect of thiazide diuretics on BMD of the elderly African American females because, theoretically, thiazides are considered to have a positive impact on BMD. ⋯ Hypertension in elderly African American females aged at least 65 years was not found to be correlated with low BMD at either the lumbar spine (L1-L4) or both femoral necks when confounding factors were taken into consideration. Mean BMD of the hypertensive cohort taking thiazide diuretics was found lower at the lumbar spine as compared to the hypertensive patients not taking thiazide diuretics.
-
Cardiovascular disease continues to be the leading cause of death in the United States and African Americans are disproportionately affected. Cardiovascular disease risk factors such as obesity, hypertension, family history of heart disease, and physical inactivity are often higher in African American young adults. The aim of the current study was to assess cardiovascular disease risk factors at a historically black college and university (HBCU) in North Carolina. ⋯ There is an urgent need to intervene among African American college students and address behavioral risk factors for cardiovascular disease. Such interventions may have a major impact on their overall and future health outcomes. Strategies to be employed need to focus on the integration of culturally appropriate healthy lifestyle programs into the curriculum and university health centers. Consultations with stakeholders for ideas and resources should be encouraged.