J Natl Med Assoc
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Comparative Study
Enrollment of sudden cardiac death victims into a limited cardiac autopsy study in the emergency department.
The lack of balanced recruitment for racial and ethnic groups in research protocols is an important ethical issue. African Americans have a history of forced participation, unethical research, and unwilling human dissection/demonstration that leads to a lack of participation in clinical research. ⋯ We have screened 14 and enrolled 10 African Americans with sudden death (95% CI 0.41-0.91). By addressing the concerns of the African-American community and involving qualified input in the planning stages of the study we have been able to significantly improve the recruitment rate for this important population subgroup.
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Relatively high serum albumin levels compared to low levels have been associated with reduced cardiovascular mortality and coronary heart disease and stroke incidence. The nature of these associations remains undefined. Therefore, widely accepted criteria of Bradford Hill were used to assess the likelihood that the association is a causal one. ⋯ Favoring a causal association are lack of temporal ambiguity in cohort studies, consistency of findings among studies and biologically plausible mechanisms. Not favoring a causal association are lack of specificity of the association, and inconsistency among age-, sex-groups. Further studies are needed to elucidate mechanisms for the effect of serum albumin on incidence of cardiovascular disease and death.
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There are four categories of causes responsible for the majority of injuries in youth 10-19 years of age: 1) motor vehicle traffic; 2) violence (intra-familial, extra-familial, self, pregnancy-related); 3) recreational; and 4) occupational. This article presents data from the National Center for Health Statistics mortality data and the National Pediatric Trauma Registry morbidity data. Nationwide, the pediatric injury death rate is highest among adolescents 15-19 years of age. ⋯ Injuries related to recreation include drowning and sports injuries. Preventive strategies may include proper supervision and risk reduction with respect to use of alcohol/drugs. The data presented support the use of primary prevention to achieve the most effective, safe community interventions targeting adolescents.
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Cardiovascular disease mortality rates have dropped significantly over the past several decades, but a shift has occurred over time in the geographic patterns of both coronary heart disease (CHD) and stroke mortality. This article describes these patterns and discusses how they vary by sex, race, age, and over time. Death certificate information for Health Service Areas (HSAs) in 1988-1992 was used to analyze the geographic patterns of CHD and stroke death rates by race, sex, and age. ⋯ Over time, rates have declined for both CHD and stroke, but regional differences in the rates of change give the appearance of a southwesternly movement of high heart disease rate clusters and a breakup of the "Stroke Belt." Further research is needed to elucidate the cause of regional variation in CHD and stroke mortality. Similar geographic patterns of high rates of CHD and stroke in the southeastern United States may reflect common risk factors. This knowledge can be used to help develop appropriate interventions to target these high-rate areas in the Mississippi and Ohio River valleys.
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Multicenter Study Comparative Study
Childhood-onset systemic lupus erythematosus: a comparative study of African Americans and Latin Americans.
This study compared the clinical and serologic features in two different ethnic groups of patients with childhood-onset systemic lupus erythematosus (SLE). One hundred seventy-one SLE patients comprised the study population; 61 (55 girls and 6 boys) were African American with age at onset of 13 +/- 2.9 years, and 110 (97 girls and 13 boys) were Latin American (Colombian) with age at onset of 13 +/- 3.2 years. ⋯ In addition, there was a higher frequency of anti-dsDNA, anti-Sm, anti-RNP, and anti-Ro positivity among African-Americans compared with Latin-American patients. These results suggest the presence of ethnic differences in the clinical expression of SLE.