Showing papers in "Journal of The National Medical Association in 1988"

Garlic Revisited: Therapeutic for the Major Diseases of Our Times?

Abstract: Garlic may play an invaluable role in the prevention and therapy of the major causes of death. Anecdotal, basic, and clinical research data are confirming the efficacy of this herb in the treatment of hyperlipemia, cancer, heavy-metal intoxication, infectious diseases, hypertension, free-radical damage, and immune deficiency states. Garlic's broad antimicrobial spectra and its ability to modulate immunity may play a strategic role in the acquired immunodeficiency syndrome pandemic. A review of the literature supports a greater scrutiny of this herb's therapeutic potential.

The help-seeking behavior of black Americans. A summary of findings from the National Survey of Black Americans

Abstract: In 1977, the National Institute of Mental Health funded the National Survey of Black Americans (NSBA). The NSBA was an omnibus, nationally representative sample (N = 2,107) of adult black Americans that explored numerous issues relevant to black quality of life. One topic that has received much attention is where blacks go for help during periods of crisis. This article provides a brief summary of NSBA findings on the use of informal help, professional help, and insurance coverage. Suggestions for future research directions for those interested in the help-seeking behavior of black Americans are provided.

The relationship of isolated sleep paralysis and panic disorder to hypertension.

Abstract: An hypothesis is proposed that there exists a subgroup of African-American hypertensive patients whose hypertension could have been prevented by the early detection and treatment of easily recognizable symptoms that signal the initiation of the pathophysiologic processes that lead to essential hypertension. A pilot study of 31 patients with elevated blood pressure revealed that 41.9 percent had isolated sleep paralysis, 35.5 percent had panic attacks, and 9.7 percent had panic disorder. These proposed hyperadrenergic phenomena may be related to the development of hypertension in certain individuals.

Drug Abuse Among Medical Students at a Nigerian University: Part 1. Prevalence and Pattern of Use

Abstract: Using a structured pro forma, 728 out of 775 medical undergraduates at a Nigerian university were surveyed for the prevalence and pattern of drug use. An operational definition of substance abuse was made, and 28 percent of students fell within that criterion. Male abusers (81 percent) exceeded female abusers (19 percent). Substances most commonly abused were alcohol (60 percent), minor tranquilizers (48 percent), tobacco (35 percent), and narcotics (29 percent), particularly codeine. Only 11 percent abused cannabis. While most students were polydrug users, there was a low frequency of daily drug use. A general lifetime (occasional use) prevalence of substance use of 56 percent was found. Drugs consumed on a daily basis were alcohol (2 percent) and tobacco (6 percent). The prevalence of drug use was highest among the fourth and final year students. The majority of students were occasional abusers; there was no evidence of physical dependence.

Morbidity in obese and nonobese patients following gynecologic surgery for cancer.

Abstract: Meager information exists regarding the morbidity of cancer surgery in obese patients, and it is generally assumed that surgery in the obese patient is attended with increased complications over those found in nonobese patients. A retrospective evaluation was undertaken at the Louisiana State University Medical Center to ascertain the morbidity of cancer surgery among 97 patients. In comparing the obese with the nonobese group of patients, the former was more often found to have complications of postoperative wound disorders that frequently required secondary operations, and a greater incidence of diabetes. The risk of postoperative complications among obese patients undergoing cancer surgery did not otherwise appear to be greater than that of nonobese patients.

Lung function in sickle cell hemoglobinopathy patients compared with healthy subjects.

Abstract: Previous studies of lung function tests performed on patients with sickle cell disease have shown a restrictive ventilatory defect, usually a diffusion defect, and mild hypoxia at rest. The present study was undertaken to explain the pathophysiology of these changes and to extend these studies to include functional measurements not reported previously. Lung function studies were performed at rest and during treadmill walking on 66 patients with sickle cell anemia and on 16 healthy control subjects. Patients had restrictive ventilatory defects, decreased lung compliance, and uneven ventilation-perfusion ratios. These abnormalities caused an increased alveolar-arterial oxygen tension difference that caused hypoxemia. The diffusion defects were because of the sickle cell disease. Carboxyhemoglobin levels were increased in patients with sickle cell disease. This increase may be caused by a combination of factors, including increased cigarette smoking, hemolysis, and preferential survival of red blood cells that contain carbon monoxide and which do not sickle. During treadmill walking, the patients with sickle cell disease showed a decreased work tolerance caused by impaired oxygen delivery. The anaerobic threshold is reached sooner in patients with sickle cell disease and may also account for the limitations in work capacity of these patients.

Need for victimization screening in a black psychiatric population

Abstract: Recent reports indicate that violence toward others is a major public health problem in the black community; however, there are very few empirical studies that delineate the severity of the problem. In an effort to add to the meager data on violence in the black community, the authors compiled the results of a victimization screening form obtained from a black outpatient psychiatric population. Recommendations are made that black psychiatric populations be screened for histories of victimization, as victimization is common in this population group and will have a significant impact on treatment.

Anorectal abscess and fistula-in-ano.

Abstract: The etiology of anorectal abscess and fistula-in-ano is discussed. The anatomy, which is vital to the understanding and treatment of the above, is reviewed, with two of the more common classifications of fistula-in-ano presented. The different methods of treating each are discussed, and some of the common complications of the procedure are listed. A true understanding of the disease process and anatomy is needed before treatment of fistulous abscesses is begun, but, with it, successful outcomes will occur in most cases.

Anger Expression and Life Stress Among Blacks: Their Role in Physical Health

Abstract: This study examines the relationship between anger expression and life stress in a nationally representative sample of black adults. Recent research of mostly white subjects has shown that anger-hostility, one of the components of the Type A behavioral pattern, is an important predictor of health problems. The findings of the present inquiry indicate that anger-hostility is an important predictor of life stress, and that people with higher levels of anger conflict are more likely to experience negative life events. Moreover, negative life events and anger are shown to be independent predictors of health problems among blacks. The implications of these results for future studies of the health of black Americans are discussed.

Long-term effects of a lifestyle-change obesity treatment program with minorities.

Abstract: Obesity and a sedentary lifestyle places Americans in general, and minorities in particular, at risk for a number of chronic health problems: cardiovascular and cerebrovascular disease, diabetes, and hypertension, to name a few. It is therefore concluded that walking or other energy-expending activities and a sensible diet are not only an efficient weight-loss approach, but the most effective long-term weight maintenance approach available to date. Moreover, the potential for enhanced psychological well-being, increased health benefits, and reduced risk factors is also far greater with diet and exercise than with diet alone. Practitioners concerned with improving the overall health status of obese minorities would be well advised to remember that dieting is a depriving experience, while walking and other aerobic activities can be an exhilarating experience that gives the obese individual another degree of freedom.

The need for victimization screening in a poor outpatient medical population.

Abstract: Recent reports indicate that violence toward others is a major public health problem in the black community; however, there are few empirical studies that delineate the severity of the problem. The authors have compiled the results of a victimization screening form obtained from a poor outpatient medical population. These results are compared with a similar survey performed on a poor outpatient psychiatric population. Recommendations are made that poor medical populations should be screened for histories of victimization, because early identification of patients at risk may reduce their chances of future victimization.

Behavior and development patterns in children born to heroin-addicted and methadone-addicted mothers

Abstract: This paper reviews the literature regarding the development of children up to age 6 years who were born to mothers addicted to heroin or methadone. These children are compared with children born to nonaddicted mothers to determine whether there were any differences between the two groups related to maternal drug addiction. This paper discusses the obstetrical and medical complications associated with maternal drug addiction and their effects on the prognosis of the infant at delivery.

Stevens-Johnson Syndrome: A Review of the Literature

Abstract: Stevens-Johnson syndrome is both a physically and psychologically devastating disease. This paper primarily deals with the physiological complications of the disease process, but the psychological trauma often associated with such an initially disfiguring disease leaves wounds that are not visible. Constant support of both the patient and the nursing staff is necessary to relieve some of the anxiety associated with this syndrome. Education and reassurance should be as much a part of the treatment process as drug therapy.Although minimal drug therapy is required in the treatment of Stevens-Johnson syndrome, early aggressive management is necessary. Treatment should include management of pain and fluid losses as well as supportive care of the respiratory and ocular complications. It is essential that nutrition be maintained and that treatment of infections is appropriate to the identified cultures. Antacids, H(2) receptor antagonists, or both have proven beneficial in the prevention or reduction of gastrointestinal ulcers. Most important, however, is psychological support of the patient.

The wandering bullet.

Abstract: The phenomenon of bullet embolization has been documented in various organs or major organ systems. A case report of a gunshot wound injury to the left hemithorax with penetration of the esophagus and embolization to the stomach is presented. Diagnostic evaluation and therapy are discussed.

Sexual contacts of intravenous drug abusers: implications for the next spread of the AIDS epidemic.

Abstract: A scarcity of knowledge exists regarding the sexual behavior of intravenous drug abusers (IVDAs) despite their potential role in the heterosexual transmission of acquired immunodeficiency syndrome (AIDS). Using a standardized questionnaire of drug and sexual practices, 96 patients enrolled in methadone maintenance treatment in New York City were interviewed anonymously.Over one half of the 767 sexual contacts reported by this sample were non-IVDAs. Male IVDAs, compared with female IVDAs, reported a significantly greater percentage of heterosexual non-IVDA contacts (P < .001). Participating in needle-sharing behavior or being younger than 35 years of age was also associated with a significant probability (P < .001) of having a non-drug-using sex partner. Female IVDAs, as compared with male IVDAs, were at greater risk for human immunodeficiency virus (HIV) infection from sexual contacts with male IVDAs and their own parenteral drug use. Black and Hispanic IVDAs, in contrast to white IVDAs, reported a statistically insignificant greater percentage of non-IVDA sex partners.These findings suggest that aggressive health education campaigns targeted for IVDAs and sexually active female non-IVDAs are sorely needed to reduce HIV-exposing sexual behaviors, especially in communities where intravenous drug use is prevalent.

Alcohol increases mortality in murine head injury.

Abstract: Head injury is a major factor in the mortality of traumatized patients, accounting for about 50 percent of the resulting fatalities. Alcohol intoxication is frequently (25 to 50 percent) associated with head injuries. This study was undertaken to investigate the effects of alcohol on head trauma in a standardized animal model. Swiss Webster mice (25 ± 2 g) were given intraperitoneally 0.2 mL of either saline or 50 percent ethanol in saline. Thirty minutes later, under light ether anesthesia, severe concussion was produced by dropping a 39.5-g lead weight from a height of 30 cm. The trauma was centered on the midskull by channeling the weight through a vertical tube, 1.2 cm in diameter. Animals were observed daily for eight days. Among the controls, 12 of 12 mice, (100 percent) survived for four days and 8 of 12 (67 percent) survived eight days. In the alcohol recipients, there were 10 of 21 survivors (48 percent) at four days and only one survivor (5 percent) at eight days. This study clearly demonstrates that alcohol increases the lethality of standardized head trauma in mice. The mechanism by which alcohol modifies the effects of craniocerebral trauma remains to be elucidated.

Teenage pregnancy: issues, interventions, and direction.

Abstract: The positive health trends and overall improvement in health status among the US population cause health professionals, human service providers, educators, and policy makers to be encouraged about the fitness of our nation. When taking a closer look at these trends and related changes, however, a dilemma exists among a portion of our population that cannot be dismissed. While the health status of the US population as a whole has steadily improved over the past decades, such progress has not been sustained for adolescents. In fact, adolescence (15 to 21 years of age) is the only age group in which mortality rates have increased over the past decade.One of the principal threats to adolescent health is unwanted pregnancy. More than one million teenage pregnancies occur each year in the United States, 75 percent of which are unintended. Teenage pregnancy is a multifaceted problem that requires multifaceted intervention. It is not just the pregnant teenager's problem either, but may involve up to three generations of family members and a host of other significant relationships. The impact and cost to society can become staggering.If such a great proportion of these pregnancies are unintended, what steps can be taken to offer acceptable and accessible alternatives to adolescents? An assessment of the magnitude of this problem, its impact on the family and society, and the measures implemented to date reveal a major challenge facing our policy makers, health and human service providers, and concerned citizenry.

Treating the black female alcoholic: clinical observations of black therapists.

Abstract: Empirical observations from a decade of treating economically deprived black female alcoholics at the Lincoln Community Health Center in Durham, North Carolina, indicate that recognition of the social and cultural determinants of alcoholism is crucial to treatment. Scrutiny of the approach suggests that the psychopathology of these patients was inextricably intertwined with issues of racism, unemployment, poverty, and substandard housing. It is concluded that a comprehensive health care approach that utilizes the input of a black female therapist as the case manager has distinct advantages.

Review of primary tumors of the diaphragm.

Abstract: A case report of a man with a huge, left-sided diaphragmatic rhabdomyosarcoma is presented. The mass was attached to the lung, pericardium, left phrenic nerve, sternum, and chest wall. Enbloc resection of the tumor was done with primary repair of the diaphragmatic defect. Only three reported cases of primary diaphragmatic rhabdomyosarcoma were found in the literature.

Alcohol and drug taking among medical students at a Nigerian university campus: Part 2. Sociodemographic factors of etiologic significance.

Abstract: In a survey of Nigerian undergraduate medical students, alcohol and drug users were classified as frequent users, casual users, and nonusers. Place of residence during session and family structure recorded no significant contribution to the development of substance abuse. Male sex, poor performance on examinations, drug taking among close friends and peers, and a family background of lower socioeconomic status emerged as sociodemographic factors correlating positively with the presence of substance abuse. Health education, controlled distribution of drugs and alcohol, stringent regulatory provisions against their use, and a permanent Commission on Substance Abuse with full judicial powers are suggested as measures that may help control the abuse of psychoactive substances and the hazard they pose to public health.

Co-factors, host susceptibility, and AIDS: an argument for stress.

Abstract: Acquired immune deficiency syndrome (AIDS) is perhaps the most serious communicable public-health disease of modern society. The human and societal devastation associated with this disease is tremendous. To date, a retrovirus (HTLV-III) has been implicated in the etiology of AIDS. There remains several critical questions, however, that only a more eclectic approach, certainly with a social science input, can more adequately address. Such questions have to deal with, for example, why are there differential out-comes regarding initiation, progress, and severity of AIDS? Realizing this need, this paper argues for the possible co-factor contribution of stress to host immune suppression and, ultimately, host susceptibility to the AIDS virus and its associated outcomes. A conceptual sociopsychophysiologic model of the entire stress process, ie, from onset, reaction up to and including effect, is presented and discussed. Within the context of the model, stress is viewed as a physiologic reaction and stressors are viewed as initiators of the stress process. The possible stress-AIDS experience is discussed using the model as a conceptual guiding tool. The paper concludes with the need for health educators to educate the general public, at-risk groups, and the medical and associated professions about the nature of stress, or in short, how best to cope with and manage stress within the context of available resources.

Black Americans' perceptions of cancer. A study utilizing the Health Belief Model.

Abstract: The purpose of this study was to determine black adults' knowledge and perceptions of cancer by utilizing the Health Belief Model. The subjects were obtained by randomly selecting 11 churches from a list of 33. There were 769 black adults who responded to the survey (64 percent response rate). Mean age of respondents was 44.3 years, SD = 14.7. Only 29 percent were able to correctly identify all seven of the American Cancer Society warning signs; 13 percent were unable to identify any warning signs. One in four believed it was likely they would develop cancer sometime in their life, and 42 percent believed blacks were more susceptible to cancer than whites. Forty-one percent believed most people who get cancer will die from it. Perceived barriers to treatment included cost and pain. A large number of significant differences (P < .01) were found when responses were examined in relation to the sex, educational level, and age of the subjects.

An ethnomedical analysis of hypertension among Detroit Afro-Americans.

Abstract: To analyze Afro-American ethnomedical beliefs and practices concerning disease and health care, the author investigated the health-care-seeking behavior among 285 Afro-Americans and 178 Euro-Americans in the Detroit metropolitan area with respect to hypertension. Hypertension was chosen because more than 60 million individuals in the United States have elevated blood pressure (140/90 mmHg or greater).QUANTITATIVE AND QUALITATIVE DATA REVEALED FIVE THEMES ASSOCIATED WITH HYPERTENSION: (1) degree of activity and responsibility, (2) individual and familial moral strength, (3) naturalistic causation, (4) family, folk, or personal care, and (5) physical and spiritual balance. In addition to these ethnohealth and ethnocaring modes, the decisive sociocultural factors in the utilization of the health screening were (1) the health beliefs of the extended lay network, (2) the type of health facility, (3) the lifestyle and behavioral patterns of Detroiters from 1910 to the present, and (4) the adherence to traditional Afro-American cultural beliefs. Once health care professionals recognize the multitude of factors that affect health-care-seeking behavior among Afro-Americans, many health care issues can be resolved.

Postictal pulmonary edema and hemoptysis.

Abstract: Neurogenic, or postictal, pulmonary edema is a rare complication of grand mal seizures. At present, the etiology of this disorder is complex and not understood fully. This report describes a case of a young man who was previously healthy, but who subsequently developed acute pulmonary edema after a grand mal seizure. The patient presented with gross hemoptysis, which has not been described previously in this disorder. The pathogenesis, diagnosis, and treatment of neurogenic pulmonary edema are discussed.

Heart rate of black and white youths aged 12-17 years: associations with blood pressure and other cardiovascular risk factors.

Abstract: Correlates of heart rate were investigated in youths aged 12 to 17 years examined in the United States National Health Examination Survey. Heart rate decreased with age in boys but no consistent trend appeared in girls. Girls had higher heart rates than boys. Blacks had heart rates 6 to 12 beats per minute lower than whites of the same age and sex. Multiple regression analysis showed the effect of race to be independent of multiple other variables. Regression analyses within sex-race groups identified the following independent correlates of heart rate: white boys, age, systolic blood pressure, and body temperature; black boys, age, body temperature, subscapular skinfold, and systolic blood pressure; white girls, systolic blood pressure, body temperature, cigarette smoking; black girls, body temperature. Correlations of two heart rate measurements 28 to 53 months apart (median 44 months) ranged from r = 0.21 to r = 0.30. Although expanded blood volume and lower sympathetic tone in blacks have been hypothesized, further longitudinal studies are needed to explain the differences in heart rates between races and sexes and their relationship to hypertension in adulthood.

Sexual Victimization of Boys: An Ongoing Study of an Adolescent Medicine Clinic Population

Abstract: An ongoing clinical research project on sexual victimization of boys was begun in 1982 The study population is boys aged 12 to 21 years attending an adolescent medicine clinic for reasons other than having been sexually abused More recently, comparison populations have been obtained from a sexual abuse clinic, from an adolescent medicine clinic for girls, and from a group of adolescent sexual offenders

Black American Attitudes Toward Organ Donation and Transplantation

Abstract: One hundred eleven black Americans were surveyed on various issues related to organ donation. The majority of respondents were indecisive on key issues, suggesting a lack of sufficient knowledge of and exposure to the many aspects of this procedure. Many of the individuals surveyed were familiar with the urgent need for transplantable organs, although most were unaware of the even more critical need for transplantable organs from the black population. Less than one third of the respondents stated that they would either be willing to donate their own organs or those of a relative. Even fewer would be willing to donate the organs of a child or an incompetent. The study group favored making donated organs available to individuals with the greatest need rather than reserving them for members of specific groups. Most indicated they would be willing to “share” organs donated by US citizens with noncitizens. The overwhelming majority objected to the commercialization of organs. In selecting recipients for organs, respondents accorded the highest priority to medical need and to those recipients who have spent the greatest time on waiting lists. Ability to pay was rejected as an appropriate criterion. The results of this survey made clear the need for educating blacks on issues related to organ donation and to improve channels of communication between the transplant community and the black population.

Sarcoidosis in the United States—1968 to 1984: Hospitalization and Death

Abstract: In order to provide national data on the epidemiology of sarcoidosis in the United States, data from the National Center for Health Statistics were examined for the period 1968 to 1984. Sarcoidosis appeared among the diagnoses of over 20,000 hospital discharges in recent years. It was mentioned on 605 death certificates in 1982, and as underlying cause of death on 339. In blacks, rates of hospital discharge with the diagnosis were eight times those of whites in 1981, and death rates were 20 times those of whites at ages 15 to 44 years. Women had higher rates than men. Both hospitalization and mortality data may give distorted pictures of this frequently mild or asymptomatic condition. Furthermore, no information was available on the percentage of diagnoses confirmed by biopsy, or on severity of disease in hospitalized patients. Race-specific hospital discharge rates must be interpreted with caution in this survey. Nevertheless, patterns were generally consistent with studies of prevalence and incidence. Further descriptive and analytic studies of the epidemiology of sarcoidosis are needed to help identify modifiable risk factors and possible causes.