Race and Ethnic Differences in the Associations between Cardiovascular Diseases, Anxiety, and Depression in the United States

Introduction: Although cardiovascular diseases and psychiatric disorders are linked, it is not yet known if such links are independent of comorbid medical diseases and if these associations depend on race and ethnicity. This study aimed to determine if the associations between cardiovascular diseases with general anxiety disorder (GAD) and major depressive episode (MDE) are independent of comorbid medical diseases and if these links differ among African Americans, Caribbean Blacks, and Non-Hispanic Whites. Methods: This cross-sectional study enrolled African American, Caribbean Black, and Non-Hispanic White adults who had participated in the National Survey of American Life (NSAL), 2001 - 2003. Data on socio-economics (age, sex, and education level) were collected. Self-reported physician diagnosed cardiovascular diseases (heart disease, atherosclerosis, hypertension, and stroke) and chronic medical conditions (peptic ulcer, cancer, diabetes, liver disease, kidney disease, asthma, other chronic respiratory diseases, sickle cell anemia, and glaucoma) were measured. The 12-month GAD and MDE were measured using the Composite International Diagnostic Interview (CIDI). Logistic regressions were fitted to data to determine if the associations between cardiovascular diseases and 12-month GAD and 12-month MDE are independent of socio-economic status and comorbid chronic medical diseases across race and ethnic groups. Results: Above and beyond other medical conditions, heart disease and atherosclerosis were associated with 12-month GAD among Caribbean Blacks, but not African Americans or non-Hispanic Whites. Hypertension was associated with 12-month MDE among African Americans, and heart disease was associated with 12-month MDE among Caribbean Blacks. None of the cardiovascular diseases were associated with 12-month MDE among non-Hispanic Whites, while all the other medical conditions were controlled. Conclusion: Our study showed race and ethnicity may be associated with specific patterns of comorbidity between cardiovascular diseases and 12-month MDE and GAD. By other words, the link between psychiatric disorders and cardiovascular diseases may depend on race and ethnicity. More research is needed to explore the behavioral and mental health profile of individuals with heart disease based on race and ethnicity. Race and ethnicity should inform mental health evaluation of patients with cardiovascular diseases

Association between Heart Disease and Subjective Health in Ten North, Middle, and South American Countries

Introduction: This study was conducted to compare 10 American countries for the association between self-reported physician diagnosis of heart disease and subjective health above and beyond the effect of socio-economic factors. Methods: With a cross-sectional design, this study used data from Research on Early Life and Aging Trends and Effects (RELATE). The study included adults from 10 American countries including Costa Rica, Puerto Rico, United States, Mexico, Argentina, Barbados, Brazil, Chile, Cuba, and Uruguay. Outcome was self-rated health, independent variable was self-reported physician diagnosis of heart disease, while age, gender, and socio-economics (education and income) were control variables. Country-specific logistic regressions were used for data analysis. Results: Although the effects of age, gender, education, and income, were inconsistent, with no exception, in all countries, heart disease was associated with poor subjective health. In Costa Rica, income modified the effect of heart disease on subjective health. In the US, age and gender modified the effect of heart disease on subjective health. Conclusion: Although the effect of heart disease on well-being was consistent across all north American countries, this effect seemed to depend on various demographic and socio-economic factors in various countries

Drug Injection to Sites other than Arm: A Study of Iranian Heroin Injectors.

For almost all injecting drug users (IDUs), the first site of injection is the arm. Years after injection, IDUs may shift to using other sites for intravenous (IV) access. Although injection to sites other than the arm is associated with higher risks, literature is limited regarding this behavior. We aimed to determine the prevalence and associated factors of using IV access points other than the arm among a national sample of IDUs in Iran. Data came from the National Drug Dependence Survey, 2007, which had enrolled 863 IDUs with at least one daily injection. Data on socio-demographics, pattern of drug use, and injection-related behaviors were entered into a logistic regression to determine predictors of injection to sites other than the arm. From all participants, 54.8% reported current injection sites in areas other than the arm. The other injection sites were the femoral venous sinus (17.0%), followed by the groin (14.5%) and neck (11.5%). Logistic regression revealed that living alone [odds ratio (OR) = 1.789, 95% confidence interval (CI) = 1.218-2.629], being Sunni (OR = 3.475, 95% CI = 1.775-6.801), having higher family income (OR = 1.002, 95% CI = 1.001-1.003), higher age at first drug use (OR = 1.039, 95% CI = 1.009-1.069), longer injection duration (OR = 1.071, 95% CI = 1.041-1.102), and more injection frequency (OR = 1.255, 95% CI = 1.072-1.471) were associated with higher likelihood of using injection sites other than the arm. Using sites other than the arm for IV injection is linked to socio-demographics, drug use data, and injection-related characteristics that can be used by policy makers. This information can be used for harm reduction planning

Fear of Neighborhood Violence During Adolescence Predicts Development of Obesity a Decade Later: Gender Differences Among African Americans

Background: African American youth are more likely than other racial and ethnic groups to be obese. African American youth are also more likely to live in disadvantaged neighborhoods which increase their victimization, observation, and fear of violence. Objectives: This study tested if victimization, observation, and fear of violence in the neighborhood during adolescence predict trajectory of body mass index (BMI) in the 3rd decade of life in African Americans. Patients and Methods: Data came from an 18-year community-based cohort. We used multi-group latent growth curve modeling for data analysis, considering neighborhood violence at age 15 (i.e. victimization, observation, and fear) as predictors, and the linear slope for the average change in BMI from age 21 to 32 as the outcome, with age and socioeconomic status (i.e. intact family and parental employment) as covariates. Results: Fear of neighborhood violence at age 15 was predictive of an increase in BMI from age 21 to 32 among female but not male African Americans. Victimization and observation of violence at age 15 did not predict BMI change from age 21 to 32 among female or male African Americans. Conclusions: Fear of neighborhood violence is a contributing factor to increased risk of obesity for female African American youth who live in disadvantaged areas. This finding has implications for prevention of obesity among African American women who are at highest risk for obesity in the United States. Initiatives that enhance neighborhood safety are critical strategies for obesity prevention among African American women

Nausea and vomiting after general anesthesia with halothane or isoflurane A double blind randomized trial

Background: Postoperative nausea and vomiting (PONV) is potentially dangerous and causes morbidity and excessive costs to the patients. Prior investigators have reported controversies about halothane- and isoflurane-induced PONV, thus, the present study was conducted to compare these two drugs. Materials and methods: 80 candidates for elective minor orthopedic surgery were randomly allocated into two groups, halothane (n= 40) and isoflurane (n=40). Confounding factors including sex, age, duration of surgery, NPO, history of general anesthesia, history of PONV, drugs, and history of disease were recorded in a questionnaire. PONV was assessed at three occasions (recovery, 3- and 6-hour post operative). Results: PONV was reported in 4 (10%) and 3 (7.5%) patients in halothane and isoflurane groups, respectively (NS). None of the patients suffered PONV 3- or 6-hour post operative. Conclusions: Results revealed that the incidence of PONV can be hold low, with an aggressive control of risk factors, in addition, halothane or isoflurane seems to have no preference from this aspect to each other

Family satisfaction from point of view of diabetic and non-diabetic pares

Background: Family satisfaction in subpopulations referred to the endocrine clinic including diabetic and non diabetic patients and their spouses are compared in the present study. This study also assesses the correlation between family satisfaction and variables such as age, sex, educational level, economic status, type of diabetes, duration of the disease, type of therapy and dosage of drugs. A comparison of the frequency of sexual dysfunction between diabetics and non-diabetic pairs was also done. Methods: In this case- control study, 400 subjects were selected as simplified non-randomized method from outpatients referred to the Shahre Kord endocrine clinic in 2002. We assigned samples to group I (diabetic patients, n=100), group II (diabetic patients spouses, n=100), group III (non-diabetic patients, n=100) and group IV (non-diabetic patients spouses, n=100). Groups I and II were similar in sex, socioeconomic status and educational level. GRIMS family relationship questionnaire was used to evaluate family satisfaction. Results: Family satisfaction for diabetics in comparison with non-diabetics (P=0.05), diabetics in comparison with their spouses (P=0.003), and non-diabetics in comparison with their spouses (p=0.002) were significantly less. There was no significant difference between family satisfaction in diabetic and non-diabetic patients spouses (p>0.05). Relative frequency of sexual dysfunction was 76 and 29 and relative frequency of decreased libido was 32 an 12, in diabetic and non-diabetic couples, respectively. Family satisfaction was less in patients with diabetes type I and whom using higher dosage of drugs. Conclusion: This study emphasized on the attention to the family as a part of approach to the diabetic patients. According to our results, it is recommended to focus the most attention in this field to the patients with type I diabetes and who consume more amounts of drugs

Importance of Socioeconomic, Clinical, and Psychological Factors on Health-related Quality of Life in Adolescents After Kidney Transplant

Objectives: Health-related quality of life after kidney transplant in adolescents is a major concern; nevertheless, there is a paucity of data on the variables that have an effect on it. This study evaluated the extent to which socioeconomic, clinical, and psychological characteristics explain the variance in the health-related quality of life of adolescent Iranian kidney transplant recipients. Materials and Methods: Into a hierarchical regression analysis, the cross-sectional socioeconomic, clinical, and psychological characteristics were entered among 55 adolescent Iranian kidney transplant recipients. Results: The relative predictive power of socioeconomic, clinical, and psychological variables with respect to health-related quality of life was 21.8% (P = .088), 21.2% (P = .014), and 27.6% (P = .001). Conclusions: Psychological factors had a greater relative predictive power in postrenal transplant health-related quality of life of adolescents than did the socioeconomic and clinical characteristics. Further research should target to improve the health-related quality of life in adolescent kidney recipients by psychological intervention

Contextual Effects of Ethnicity, Gender, and Place on Depression; Case Study of War Related Stress for Kurdish Women

Contextual factors such as ethnicity, gender, place, and their intersections determine the social condition that populations and individuals live in. As a result, environmental stressors that shape exposures, and also resilience and vulnerabilities are specific to the population. This emphasizes the role of the intersection of such contextual factors in studying psychosocial causes of depression. The aim of this case study is to review the role of war related stress as a unique environmental cause of depression among Kurdish women who live in the Middle East. First, we reviewed the literature on the direct effects of ethnicity, gender, place, and their intersections on depression. Then we discussed the contextual (indirect) effects of these factors in modifying the effect of (resilience and vulnerability to) risk factors of depression. Then we reviewed the evidence highlighting the role of war related stress as a unique social cause of depression among Kurd women. We hope this paper provides an example of how social causes of depression depend on intersections of ethnicity, gender, and place. We argue that depression should be seen as a condition, with population specific causes and consequences. We also believe that ethnicity, gender, and place help clinicians and public health officials to better approach depression within populations. Contextual factors should not be undermined in approaching depression across population groups. In this view, context not only determines the exposure to the risk and protective factors, it also changes the vulnerability and resilience to them. Thus we need to better understand how ethnicity, gender, place, and their intersections modify separate, additive, and multiplicative effects of risk and protective factors on depression

Drug Use among Iranian Drivers Involved in Fatal Car Accidents

Background: Although the problem of substance use among drivers is not limited to certain parts of the world, most epidemiological reports on this topic have been published from industrial world. Aim: To investigate pattern of drug use among Iranian drivers who were involved in fatal road accidents. Methods: This study enrolled 51 Iranian adults who were involved in fatal vehicle accidents and were imprisoned thereafter. Data came from a national survey of drug abuse that was done among Iranian prisoners. The survey collected data at the entry to seven prisons in different regions of the country during a 4-month period in 2008. Self-reported lifetime, last year, and last month drug use was measured. Commercial substance screening tests were applied to detect recent substance use (opioids, cannabinoids, methamphetamines, and benzodiazepines). Results: The commercial substance screening test showed three distinct patterns of recent illicit drug use: opioids (37.3%), cannabinoids (2.0%), opioids and cannabinoids (13.7%). 29.4% were also positive for benzodiazepines. The substance use screening test detected 23.5% of participants who had used drugs but did not disclose any substance use. Conclusion: Opioids are the most common illicit drugs being used by Iranian drivers who are involved in fatal car accidents. The high rate of substance use prior to fatal car accidents in Iran advocates for the need for drug use control policies and programs as major strategies for injury prevention in Iran. There is also a need for substance screening among all drivers involved in fatal car accidents in Iran, as more than 20% of users may not disclose substance use

Racial Discrimination in Health Care Is Associated with Worse Glycemic Control among Black Men but Not Black Women with Type 2 Diabetes

BackgroundA growing body of research suggests that racial discrimination may affect the health of Black men and Black women differently.AimsThis study examined Black patients with diabetes mellitus (DM) in order to test gender differences in (1) levels of perceived racial discrimination in health care and (2) how perceived discrimination relates to glycemic control.MethodsA total of 163 Black patients with type 2 DM (78 women and 85 men) provided data on demographics (age and gender), socioeconomic status, perceived racial discrimination in health care, self-rated health, and hemoglobin A1c (HbA1c). Data were analyzed using linear regression.ResultsBlack men reported more racial discrimination in health care than Black women. Although racial discrimination in health care was not significantly associated with HbA1c in the pooled sample (b = 0.20, 95% CI = −0.41 −0.80), gender-stratified analysis indicated an association between perceived discrimination and higher HbA1c levels for Black men (b = 0.86, 95% confidence intervals (CI) = 0.01–1.73) but not Black women (b = −0.31, 95% CI = −1.17 to −0.54).ConclusionPerceived racial discrimination in diabetes care may be more salient for glycemic control of Black men than Black women. Scholars and clinicians should take gender into account when considering the impacts of race-related discrimination experiences on health outcomes. Policies should reduce racial discrimination in the health care