J Natl Med Assoc
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This study evaluates the impact of health insurance as a substitute for social class on tumor location, presentation, stage, grade, and age-adjusted survival in an African-American population. Patients were stratified by insurance into two groups: group 1 (private insurance and Medicare parts A & B) and group 2 (Medicaid, Medical Charity, self-pay, uninsured, or unemployed). A total of 212 patients were evaluated. ⋯ The type of health insurance did not significantly affect age-adjusted survival. However, age and stage at presentation were positive predictors of age-adjusted survival. Higher socioeconomic status was associated with group 1 health insurance.
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The damage control laparotomy is an advancement in the management of massively injured trauma victims. Mortality for this group of patients remains high but some can be saved using staged abdominal reconstruction for trauma. Massive liver injuries, pelvic trauma, and retroperitoneal injury are some of the indications for this approach. ⋯ It must be emphasized that abdominal packing must not be used without repairing major vascular injuries. Premature packing and inadequate packing also should be avoided. This staged approach to abdominal trauma is not a panacea; however, improved trauma care is possible if this technique is used carefully.
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Comparative Study
Major salivary gland flow rates in young and old, generally healthy African Americans and whites.
Saliva is essential to maintain and preserve oral health. Previous studies of primarily white populations demonstrated that salivary gland flow rates are age-stable in healthy adults, but there are little data on African Americans of different ages. The purpose of this study was to determine if there is a relationship between age, gender, and race in unstimulated and stimulated parotid and submandibular salivary gland flow rates and to evaluate subjective responses to questions regarding salivary dysfunction. ⋯ The results indicate, in general, that objective and subjective measurements of major salivary gland flow rates are independent of age, gender, and race. Further studies are required using larger populations. These results suggest that signs and symptoms of dry mouth in the elderly regardless of race or gender should not be considered a normal sequela of aging.
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The records of 163 penetrating trauma patients who required surgery in a 36-month period between 1988 and 1990 were reviewed. Those patients with head trauma were excluded. Thirty patients were identified as having: similar Injury Severity Scores (ISS), received at least 8 L of crystalloid, and received at least 4 units of packed red blood cells during the first 24 hours after admission. ⋯ Nonsurvivors also had lower hemoglobin levels (7.84 +/- 1 versus 9.1 +/- 2.3) and platelet counts (134.2 +/- 14.1 versus 188.6 +/- 6.3) than survivors. In addition, nonsurvivors demonstrated greater incidence of three major risk factors than did the survivors: hypothermia (75% versus 41%), acidosis (100% versus 27%), and coagulopathy (62% versus 4.5%). Therapeutic measures to limit these risk factors for increased mortality may maximize the chance of survival in these patients.
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A sample of African-American and white young adults were classified as having multiple sex partners or one sexual partner. Subjects with multiple sexual partners were more likely to use drugs and practice risky sexual behaviors such as having anal intercourse, having sexual experiences with a prostitute, and having a history of gonorrhea (P < .001) and genital warts (P < .01). Additional analyses were conducted to determine African-American versus white differences in risky sexual behaviors. ⋯ Finally, the results from discriminant analysis indicate that a large number of variables significantly discriminate between subjects who engage in risky sexual behaviors and those who do not. Although there is some similarity in the variables for African Americans and whites, there was tremendous variability between the ethnic groups in the factors that predict risky behaviors. These findings are discussed with reference to the need to develop HIV/AIDS prevention programs for African Americans that are based on data derived from African-American populations rather than from black versus white comparison studies.