Associations of Abdominal Fat With Perceived Racism and Passive Emotional Responses to Racism in African American Women

Objectives. An excess in abdominal fat may predispose African American women to chronic health conditions such as diabetes and cardiovascular disease. Because stress may increase body fat in the center-body region, we used the waist-to-hip ratio (WHR) to examine associations between excess abdominal fat and perceived racism (a chronic stressor) and daily stress. Passive emotional responses to perceived racism, hypothesized to have particularly adverse effects, were also examined

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Altered pituitary hormone response to naloxone in hypertension development.

Endogenous opioid regulation of blood pressure is altered during stress in young adults at risk for hypertension. We studied the effects of the opioid antagonist naloxone on the secretion of corticotropin and /3-endorphin during psychological stress in young adults with mildly elevated casual arterial pressures. Naloxone-induced secretion of both corticotropin and 0-endorphin was significantly diminished in persons at enhanced risk for hypertension compared with the low blood pressure control group. Results suggest that opioidergic inhibition of anterior pituitary function is altered in hypertension development. {Hypertension 1989;14:636-644) Endogenous opioids interact with circulatorycontrol nuclei at several distinct anatomicsites, including adrenal medullae and periph-eral sympathetic ganglia,1-2 nucleus tractus soli-tarius,3 and hypothalamic paraventricular nuclei.4-5 This multiplicity of pathways results in pressor or depressor actions of opioid antagonists, depending on the dose, site of action, behavioral state, and the species under investigation.6-8 Recent work with the stereospecific opioid antagonist naloxone sug

Factors Considered Important at the End of Life by Patients, Family, Physicians, and Other Care Providers

Context A clear understanding of what patients, families, and health care practitioners view as important at the end of life is integral to the success of improving care of dying patients. Empirical evidence defining such factors, however, is lacking. Objective To determine the factors considered important at the end of life by patients, their families, physicians, and other care providers. Design and Setting Cross-sectional, stratified random national survey conducted in March-August 1999. Participants Seriously ill patients (n = 340), recently bereaved family (n = 332), physicians (n = 361), and other care providers (nurses, social workers, chaplains, and hospice volunteers; n = 429). Main Outcome Measures Importance of 44 attributes of quality at the end of life (5-point scale) and rankings of 9 major attributes, compared in the 4 groups. Results Twenty-six items consistently were rated as being important (>70% responding that item is important) across all 4 groups, including pain and symptom management, preparation for death, achieving a sense of completion, decisions about treatment preferences, and being treated as a "whole person." Eight items received strong importance ratings from patients but less from physicians (P<.001), including being mentally aware, having funeral arrangements planned, not being a burden, helping others, and coming to peace with God. Ten items had broad variation within as well as among the 4 groups, including decisions about life-sustaining treatments, dying at home, and talking about the meaning of death. Participants ranked freedom from pain most important and dying at home least important among 9 major attributes. Conclusions Although pain and symptom management, communication with one's physician, preparation for death, and the opportunity to achieve a sense of completion are important to most, other factors important to quality at the end of life differ by role and by individual. Efforts to evaluate and improve patients' and families' experiences at the end of life must account for diverse perceptions of quality.Sociolog

SOCIAL CORRELATES OF THE CHRONIC STRESS OF PERCEIVED RACISM AMONG BLACK WOMEN

Objectives: This study describes the perceptions of racism, passive and active responses to this psychosocial stressor, and it examines socioeconomic correlates of perceived racism in an economically diverse population of Black women. Methods: The Telephone-Administered Perceived Racism Scale was administered to 476 Black women, aged 36 to 53 years, who were randomly selected from a large health plan. Results: The percentage of respondents who reported personally experiencing racism in the past five years ranged from 66% to 93%, depending on the specific item asked. When respondents were asked about racism toward Blacks as a group, perceptions of racism were even higher. For example, 68% ‘‘agreed’’ or ‘‘strongly agreed’’ that they had personally experienced being followed or watched while shopping because of their race, and 93 reported that Blacks in general experience this form of discrimination. Strong emotional responses to racism were often reported, and though more respondents (41%) reported experiencing very strong active emotions including anger, a substantial group (16%) reported experiencing very strong passive emotions such as powerlessness. Higher education was associated with higher perceived racism, while growing up in a middle income or well-off family was associated with lower perceived racism and reduced likelihood of passive responses to racism. Conclusions: The high prevalence of perceived racism in this study population warrants further examination of this stressor as a potential determinant of racial health disparities. Higher education and income do not appear to protect women from experiencing racism and feeling hopeless or powerless in response

Patterns and stability of cardiovascular responses to variations of the cold pressor test

Test‐retest reliabilities and patterns of heart rate and blood pressure responses were examined using variations in the cold pressor test in 113 normotensive white college men. Comparisons were made of stimulus site (forehead vs. foot) and bodily posture (seated vs. supine) across four separate groups of men. The stability of cardiovascular responses was examined over a 2‐week test‐retest interval. Different cardiovascular response patterns emerged as a function of stimulation site and posture. Systolic and diastolic blood pressure increases were accompanied by bradycardia in the forehead cold pressor task but by tachycardia in the foot cold pressor task. Systolic blood pressure increases were larger for foot than for forehead stimulation. Heart rate increases were larger for supine than for seated men. Effects on response were independent of postural differences at baseline, and there were no stimulation site by posture interactions. The cardiovascular responses to stimulation did not attenuate across sessions in any experimental condition but were more reliable for foot than for forehead stimulation and for supine than for seated posture. Short‐term stability for changes to the task approached that for baseline and task and was higher than has been reported elsewhere