J Natl Med Assoc
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Comparative Study
Cardiovascular disease in African American women: a health care disparities issue.
To review the current status of cardiovascular disease (CVD) in African American women compared to Caucasian women in regards to 4 categories of CVD: coronary artery disease (CAD), hypertension, stroke, and congestive heart failure (CHF), and to call attention to the need to place more emphasis on the need to increase awareness of CVD as the greatest killer of African American females in the United States. ⋯ African American women are at exceptional risk for CVD, and more recognition of this fact as well as greater awareness of the problem should be promulgated and distributed by means of public education programs. Physicians who treat black patients also need to be encouraged to be more aggressive in their efforts to detect patients at risk and to initiate therapy early on in the course of CVD in this sub-population.
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The purpose of this study was to determine factors associated with cervical cancer screening compliance and noncompliance among Chinese, Korean, Vietnamese, and Cambodian women aged 18 years and older. ⋯ Compliance with cervical cancer screening guidelines among Asian American women can be enhanced significantly by providing culturally and linguistically appropriate educational and early intervention programs.
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Breast cancer mortality has declined, yet disease outcomes have not improved equally across populations. Disparities may initiate early in the continuum of care, in health behavior patterns, and screening practices. We examined variations in mammography, exercise, fruit and vegetable intake, alcohol consumption, and body mass index (BMI, kg/m2) by age and race in a diverse sample of clinic patients. ⋯ New intervention models that link health behavior information with screening messages in clinical settings may be important in reducing breast cancer risk and mortality.
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Congenital malformations are the major cause of infant mortality in the United States, but their contribution to overall racial disparity--a major public health concern--is poorly understood. We sought to estimate the contribution of a congenitally acquired central nervous system lesion, Dandy-Walker Syndrome (DWS), to black-white disparity in infant mortality. ⋯ DWS has one of the largest black-white disparities in postneonatal survival. This underscores the importance of evaluating racial disparities in infant mortality by specific conditions in order to formulate targeted interventions to reduce disparities.
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Comparative Study
Computed tomography imaging in the management of headache in the emergency department: cost efficacy and policy implications.
To evaluate the economic impact and diagnostic utility of computed tomography (CT) in the management of emergency department (ED) patients presenting with headache and nonfocal physical examinations. ⋯ Our results indicate that emergent CT imaging of nonfocal headache yields a low percentage of positive clinically significant results, and has limited cost efficacy. Since the use of CT for imaging patients with headache in the ED is widespread, the economic implications are considerable. Health policy reforms are indicated to better direct utilization in these patients.