Creating research capacity through a tribally based institutional review board.

Tribal groups work tirelessly to maintain sovereignty rights, preserving and upholding tribal authority and protection over their land, people, businesses, and health. Moreover, the conduct of health science research by outsiders has had its share of an unethical, misguided, and abusive past. Tribally based institutional review boards (IRBs) are addressing these issues in an effort to control new health science research, set their own research agenda, and protect their people in the same spirit as has been accomplished through the perpetuation of sovereignty rights. We describe the success of a tribally based IRB at creating new capacity for health research and enhanced levels of trust, including bidirectional cultural education between academic researchers and tribal IRB committee members.

Acute monarthritis: diagnosis and management.

The diagnosis for an acute monarthritis may still be elusive, even after an extensive initial evaluation. For example, what should be done for a patient who has a paucity of extra-articular findings on physical examination and an inflammatory synovial fluid with negative Gram's stain, cultures, and crystals? Conservative management is always prudent. Assume the joint is infected and treat as such until proven otherwise, because infection carries the highest morbidity and mortality of all the common acute monarthopathies.

Racial differences in the prevalence of vertebral fractures in older men: the Baltimore Men's Osteoporosis Study.

Older black men have higher adjusted bone mineral density (BMD) and a lower adjusted rate of decline in hip BMD than older white men. There are few published data on the prevalence of morphometric vertebral fractures in older white men and no published data for older black men. The study's objective was to estimate the prevalence of vertebral fractures in older men and explore differences in prevalence between older white and black men. Subjects included five hundred forty-two men (415 white and 127 black) aged 65 and above (mean age of 74.0+/-5.7 years) participating in the longitudinal component of the Baltimore Men's Osteoporosis Study. Radiographs of the thoracic and lumbar spine were obtained using standard protocols and read for the presence of vertebral deformities using binary semiquantitative techniques. Quantitative morphometry was performed and vertebral fractures were defined using the Melton-Eastell method. BMD was measured at the femoral neck, total hip and lumbar spine. Participants also completed self- and interviewer-administered questionnaires and underwent standardized clinical examinations. One or more vertebral fractures were present in 30 of 514 men with available radiographs: estimated prevalence 5.8% (95% confidence intervals [CI]: 4.0, 8.3%). Prevalence was significantly higher in white than black men, 7.3% vs 0.9% (Fishers' exact p =0.01): age-adjusted odds ratio=8.3 (95% CI: 1.1, 62.5). Among white men, there was no significant difference in age-adjusted femoral neck or total hip BMD or frequency or severity of back pain between men with and without vertebral fractures. In conclusion, older white men have a higher prevalence of vertebral fractures than older black men. This may be related to differences in BMD between these groups.

Racial differences in rate of decline in bone mass in older men: the Baltimore men's osteoporosis study.

UNLABELLED: Older black men have higher adjusted BMD than older white men. Using data from a longitudinal cohort study of older men followed for a mean of 18.8 +/- 6.5 (SD) months, we found that older black men have a higher rate of decline in femoral neck and total hip BMD and femoral neck BMAD than older white men. INTRODUCTION: Older black men have higher adjusted BMD compared with older white men. The difference in BMD may be caused by having attained higher peak bone mass as young adults and/or having a slower rate of decline in bone mass as adults. There are few published longitudinal data on change in bone mass in older white men and no published data for older black men. MATERIALS AND METHODS: Three hundred forty-nine white men and 119 black men 65 of age (mean age, 75 +/- 5.7 and 72 +/- 5.6 years, respectively) who participated in the longitudinal component of the Baltimore Men's Osteoporosis Study returned for a second visit after a mean of 18.8 +/- 6.5 (SD) months and were not taking medications used to treat low bone mass at either visit. BMD was measured at the femoral neck and total hip by Hologic-certified technicians using a QDR 2000 at the baseline visit (V1) and QDR 4500 at the first follow-up visit (V2). Participants also completed self-administered and interviewer-administered questionnaires and underwent standardized clinic examinations. Bone mineral apparent density (BMAD) at the femoral neck was calculated as an estimate of volumetric BMD. Annual crude and multiple variable adjusted percent changes in BMD and BMAD were calculated. RESULTS: In univariate analyses, black men had lower percent decline in femoral neck and total hip BMD and femoral neck BMAD than white men. In addition, older age at baseline, lower baseline weight, current smoking, and lower baseline BMD were associated with greater percent decline per year in femoral neck BMD; older age at baseline, current smoking, and lower baseline BMD were associated with greater percent decline per year in total hip BMD; and older age at baseline and lower baseline femoral neck BMAD were associated with greater percent decline per year in femoral neck BMAD. Racial differences in bone loss persisted in multiple variable models that controlled for other factors associated with change in BMD and BMAD. CONCLUSIONS: Older black men seem to lose bone mass at a slower rate than older white men. These differences in the rate of bone loss may account, in part, for the racial disparities in BMD and BMAD and risk of osteoporotic fractures among older men.

Racial differences in bone mineral density in older men.

UNLABELLED: Studies have examined factors related to BMD in older white, but not black, men. We measured BMD in older white and black men and examined factors related to racial differences in BMD. Black men had significantly higher adjusted BMD at all sites. These results may explain, in part, the lower incidence of fractures in older black men. INTRODUCTION: Several studies have examined factors associated with bone mineral density (BMD)in older men. None, however, have had sufficient numbers of black men to allow for meaningful comparisons by race. MATERIALS AND METHODS: A total of 503 white and 191 black men aged 65 and older(75.1 +/- 5.8 and 72.2 +/- 5.7 years, respectively) were recruited from the Baltimore metropolitan area. All men completed a battery of self-administered questionnaires, underwent a standardized examination, and had BMD measured at the femoral neck, lumbar spine, and total body. Data were analyzed using multiple variable linear regression models, adjusted for potential confounding variables; two-way interactions with main effects were included in models where appropriate. RESULTS: Black men had significantly higher adjusted BMD at the femoral neck (difference 0.09 [95% CI: 0.07, 0.12] mg/cm2), lumbar spine (0.07 [0.04, 0.10] mg/cm2), and total body (0.06 [0.03, 0.08] mg/cm2) than white men. CONCLUSIONS: Older black men have significantly higher BMD than older white men, even after adjustment for factors associated with BMD. These differences, especially at the femoral neck, may explain the reduced incidence of hip fracture in black compared with white men.

Evidence for aerobic insufficiency in women with systemic Lupus erythematosus.

OBJECTIVE: To determine if fatigue is associated with diminished aerobic capacity in women with systemic lupus erythematosus (SLE). METHODS: Eighteen women (age 35 +/- 9 years) with mild SLE (Systemic Lupus Activity Measure = 3.1 +/- 2.1) and 16 healthy but sedentary controls (age 38 +/- 8 years) completed peak treadmill exercise tests to determine aerobic capacity and Fatigue Severity Scales to quantify the severity of fatigue. Measures of oxygen consumption (VO(2)) were recorded during the treadmill tests. RESULTS: Peak VO(2) was lower in patients with SLE (19.2 +/- 4.4 ml/kg/minute) as compared with controls (27.4 +/- 4.7 ml/kg/minute) and expected values (30.7 +/- 3.1 ml/kg/minute; P < 0.0006 versus controls and P < 0.0001 versus expected). Functional aerobic impairment was observed in 14 of the 18 patients with SLE. In patients with SLE, ventilatory threshold, a marker for the onset of lactic acidemia, was observed at the lowest energy requirement for instrumental activities of daily living. Peak VO(2) in the patients with SLE was similar to the highest energy requirements for instrumental activities of daily living, leaving little or no reserve for more intense occupational and recreational activities. Peak VO(2) was significantly higher (P < 0.0001) than the activity of daily living requirements in controls, providing a substantial energy reserve. Fatigue severity score (FSS) was 5.0 +/- 1.4 in patients with SLE, with 14 of the 18 patients having scores above 4.0, a score indicating that fatigue severity limited physical activity. Of the 14, 12 had functional aerobic impairment. An FSS of greater than 4.0 was not observed in controls (mean = 2.5 +/- 0.7). CONCLUSION: In women with SLE, aerobic capacity was diminished to levels that were insufficient for engaging in activities of daily living and below those expected to result from physiologic deconditioning. This functional aerobic impairment was strongly correlated with the perception of severe, activity-limiting fatigue.