On the preservation of health Barondess, Jeremiah A
JAMA : the journal of the American Medical Association,
2005-Dec-21, Letnik:
294, Številka:
23
Journal Article
Urban health: a look out our windows Fleischman, Alan R; Barondess, Jeremiah A
Academic medicine,
12/2004, Letnik:
79, Številka:
12
Journal Article
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Approximately 80% of Americans live in cities or immediately adjacent communities. Such urban environments are complex amalgams of people of disparate backgrounds, economic status, and expectations, ...with extraordinary disparities in health status and outcomes between groups just blocks apart. Urban health as a framing paradigm is of recent vintage and offers a perspective on health and disease that integrates clinical medicine and public health and draws on the social and political sciences to seek understanding of the impact of cities on the health of populations and individuals. Ironically, disparate outcomes and increased mortality among poor minority populations in cities are not primarily related to the consequences of the urban epidemics of drugs and violence but rather are due to the increased prevalence and severity of common diseases such as asthma, cardiovascular disease, diabetes, and kidney disease. Several factors may be responsible for such disparities, including stress, racism, perceptions of deprivation, economic inequalities, and lack of access to quality health care. It is time for leaders in medical education and health care delivery to focus on the populations that surround their institutions in order to study urban health and meet the challenge of caring for all the residents of our cities.
Osteoporosis is characterized by both a low bone mass and a disruption of the architectural arrangement of bone tissue, leading to decreased skeletal strength and increased fracture risk. Although ...there are well‐known ethnic differences in bone mass and fracture risk, little is known about possible ethnic differences in bone structure. Therefore, we studied cross‐sectional geometry in the hip in a sample of postmenopausal black and white women in order to investigate ethnic differences that might contribute to differences in bone strength and ultimately hip fracture risk. We recruited 371 postmenopausal black and white women who were entering the Women's Health Initiative (WHI) clinical trials in Detroit. Bone density measurements of the proximal femur were done by dual‐energy X‐ray absorptiometry (DXA) using a Hologic 1000 Plus bone densitometer. The DXA data were used for hip structure analysis, which treats the entire proximal femur as a continuous curved beam from the proximal shaft to the femoral neck. This permits the analysis of cross‐sectional geometric properties in two narrow regions corresponding to thin (5 mm) cross‐sectional slabs seen on edge. The results indicate significant ethnic differences in bone density, cross‐sectional geometry, and dimensional variables. Specifically, the black women have a significantly higher bone density in both locations (10.1% and 4.1% for the neck and shaft, respectively); greater cross‐sectional geometric properties in the neck (ranging from 6.1% to 11.6%), but a smaller endocortical diameter in the neck (3.6%). There are fewer significant differences in cross‐sectional geometry in the shaft location. Our data suggest that the spatial distribution of bone is arranged in the femoral neck to resist greater loading in black women compared with white women.
There are known black‐white differences in bone density measured by DXA but less is known about bone architecture. We compared cross‐sectional geometric properties of the proximal femur in U.S. black ...(n = 86) and white (n = 151) and South African black (n = 60) and white (n = 48) postmenopausal women. Results are consistent with greater bone strength in the black groups in both countries.
Introduction: There are well‐known ethnic differences in bone density, but little is known about ethnic differences in bone architecture between U.S. and South African blacks and whites.
Materials and Methods: We compared bone density and cross‐sectional geometric properties of the proximal femur in 237 U.S. black (n = 86) and white (n = 151) and 108 South African black (n = 60) and white (n = 48) postmenopausal women. The proximal femur (neck, intertrochanteric region, and proximal shaft regions of interest) was measured with DXA and further analyzed with a hip structural analysis program. For each region, BMD, cross‐sectional area, outer diameter, section modulus, endosteal diameter, average cortical thickness, and the buckling ratio were estimated.
Results and Conclusions: In the femoral neck, in both countries, the blacks had narrower endosteal diameters (mean difference, 2.6% and 5.1% in U.S. and South African women, respectively), thicker cortices (9.3% and 11.0%), and a lower buckling ratio (11.6% and 15.2%) despite a similar outer diameter. In the intertrochanteric region, the whites had a greater outer diameter (2.2% and 3.0% in U.S. and South African women, respectively), lower cross‐sectional area (4.8% and 7.2%), and a higher buckling ratio (7.6% and 3.6%). There are fewer differences in the shaft. Compared with South African whites, U.S. whites had wider (mean difference 2.9%) femoral necks and a greater section modulus (6.4%) in the shaft. U.S. whites also had greater cross‐sectional area in both the neck and shaft (5.2% and 4.6%, respectively). The U.S. blacks had significantly greater outer diameters, cross‐sectional areas, endosteal diameters, and section moduli in the neck region compared with South African blacks. Our observations are consistent with greater bone strength in the black groups in both countries, and they also suggest that there are fewer differences between the same ethnic groups in the two countries than there are between different ethnic groups within a country.
Patient-physician covenant Crawshaw, R; Rogers, D E; Pellegrino, E D ...
JAMA : the journal of the American Medical Association,
1995-May-17, Letnik:
273, Številka:
19
Journal Article
Difficulties in funding promising young researchers at the outset of their careers have led to efforts to find new kinds of sources of support. In the past four years the municipal administration in ...New York City has funded a program to help support new junior research faculty in the city's research-intensive institutions. Under the aegis of the New York Academy of Medicine a program has been designed that provides support for research proposals that are peer-reviewed and competitively awarded. As measured by the quality of the submitted proposals, progress toward realizing the scientific goals of each, and additional research funding received, the program has been a success, and should be considered for replication by other municipalities.
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