Impact of a Culturally Sensitive Health Self-Empowerment Workshop Series on Health Behaviors/Lifestyles, BMI, and Blood Pressure of Culturally Diverse Overweight/Obese Adults.

OBJECTIVE: Examine the impact of the Health Self-Empowerment Theory-based, culturally sensitive Health Self-Empowerment (HSE) Workshop Series to Modify and Prevent Obesity on levels of health promoting (health-smart) behaviors, motivators of and barriers to these behaviors, health promoting lifestyle variables, and health status indicators (Body Mass Index [BMI] and blood pressure) among a culturally diverse sample of overweight/obese adults from mostly low income households. DESIGN: 153 overweight/obese adults participated in an Immediate Treatment (IT) Group (n = 100) or a Waitlist Control (WC) Group (n = 53). RESULTS: Post-intervention, the IT Group compared to the WC Group reported (a) significantly higher engagement in physical activity and healthy eating, (b) significantly less intake of calories, total fat, transfat, saturated fat, sugar, and added sugar, (c) significantly higher motivators for engaging in two of four specific health-smart behaviors, (d) significantly lower barriers to engaging in three of four specific health-smart behaviors, and (e) significantly lower BMI and systolic blood pressure. CONCLUSION: The HSE Workshop Series may be an effective intervention for treating and preventing obesity among diverse low-income adults - individuals who often perceive/experience limited power over their health. Health care providers, particularly physicians, have important health empowerment roles in this intervention.

Promoting heart health: an HBCU collaboration with the Living Heart Foundation and the National Football League Retired Players Association.

INTRODUCTION: Cardiovascular disease continues to be the leading cause of death in the United States and African Americans are disproportionately affected. Cardiovascular disease risk factors such as obesity, hypertension, family history of heart disease, and physical inactivity are often higher in African American young adults. The aim of the current study was to assess cardiovascular disease risk factors at a historically black college and university (HBCU) in North Carolina. METHODS: A collaborative partnership was established that included Living Heart Foundation, the NFL Retired Players Association and a HBCU. Ninety-one students (77 females and 14 males) aged 18 to 55 years (mean, 24 y, SD = 9 y) were recruited via dissemination of flyers, brochures, mass e-mailing, and announcements. Demographic and medical history data were collected. Stata version 10.1 was used for all analyses. RESULTS: Fifty-three percent of the participants reported having experienced a chronic health condition, 32% were overweight (body mass index [BMI], 25-29.9 kg/m2) and 31% obese (BMI > or = 30 kg/m2). Five percent of females and 23% of males had high-density lipoprotein cholesterol of 40 mg/dL or less, indicative of a risk for developing heart disease. CONCLUSION: There is an urgent need to intervene among African American college students and address behavioral risk factors for cardiovascular disease. Such interventions may have a major impact on their overall and future health outcomes. Strategies to be employed need to focus on the integration of culturally appropriate healthy lifestyle programs into the curriculum and university health centers. Consultations with stakeholders for ideas and resources should be encouraged.

Aspiration of foreign bodies in adults with personality disorders: impact on diagnosis and recurrence.

Most cases of foreign-body aspiration are accidental events in children, whereas the majority of adults will have neurological dysfunction, trauma, alcohol abuse, or psychological disorders. Much has been written about psychiatric patients engaging in self-mutilation such as cutting and burning, but little is recorded about deliberate aspiration of objects in these patients, who clinically can be separated into 4 groups: (1) malingering, (2) psychosis, (3) pica, and (4) personality disorders. The immediate psychological gain for these patients is unclear, as the act is insidious with no evidence of intentional harm or immediate danger. Thus, they are considered as being parasuicidal events designed to diminish other psychological processes. Aspirated objects that are not immediately dislodged by coughing, choking, or gagging require surgical intervention. Most of these patients usually come to the attention of a psychiatrist, but such intervention does not prevent recurrences. We discuss a schizophrenic patient who aspirated multiple coins while under psychiatric treatment for prior episodes of aspiration of coins, ingestion of objects, and insertion of others in his urethra and rectum, while also reviewing some of the diagnostic and therapeutic challenges inherent in the management of these patients.

Creating a segregated medical profession: African American physicians and organized medicine, 1846-1910.

An independent panel of experts, convened by the American Medical Association (AMA) Institute for Ethics, analyzed the roots of the racial divide within American medical organizations. In this, the first of a 2-part report, we describe 2 watershed moments that helped institutionalize the racial divide. The first occurred in the 1870s, when 2 medical societies from Washington, DC, sent rival delegations to the AMA's national meetings: an all-white delegation from a medical society that the US courts and Congress had formally censured for discriminating against black physicians; and an integrated delegation from a medical society led by physicians from Howard University. Through parliamentary maneuvers and variable enforcement of credentialing standards, the integrated delegation was twice excluded from the AMA's meetings, while the all-white society's delegations were admitted. AMA leaders then voted to devolve the power to select delegates to state societies, thereby accepting segregation in constituent societies and forcing African American physicians to create their own, separate organizations. A second watershed involved AMA-promoted educational reforms, including the 1910 Flexner report. Straightforwardly applied, the report's population-based criterion for determining the need for phySicians would have recommended increased training of African American physicians to serve the approximately 9 million African Americans in the segregated south. Instead, the report recommended closing all but 2 African American medical schools, helping to cement in place an African American educational system that was separate, unequal, and destined to be insufficient to the needs of African Americans nationwide.

Segregation, civil rights, and health disparities: the legacy of African American physicians and organized medicine, 1910-1968.

Between 1910 and 1968, the National Medical Association (NMA) repeatedly clashed with the American Medical Association (AMA) over the latter organization's racial bars to membership and other health policy issues. The NMA, founded in 1895 as a nonexclusionary medical society to provide a voice for disenfranchised black physicians and patients, struggled in its early years, during which AMA leadership took scant notice of it. But skirmishes ensued over such actions as stigmatizing racial labels in the AMA's American Medical Directory, which, beginning in 1906, listed all U.S. physicians but designated African Americans with the notation col. The NMA also repeatedly asked the AMA to take action against overt racial bars on blacks' membership in its constituent state and county societies. During the civil rights era, African American physicians received no AMA support in seeking legal remedies to hospital segregation. And the NMA and AMA found themselves opposed on other policy issues, including Medicaid and Medicare. These differences eventually catalyzed a series of direct confrontations. The 1965 AMA meeting in New York City, for example, was protested by about 200 NMA-led picketers. The NMA's quest for racial equality in medicine was supported by some other medical organizations, such as the Medical Committee for Human Rights. In 1966, the AMA House voted to amend the AMA Constitution and Bylaws, giving its Judicial Council (now the Council on Ethical and Judicial Affairs) the authority to investigate allegations of discrimination. This paved the way for a subsequent era of increasing cooperation and understanding.

African American physicians and organized medicine, 1846-1968: origins of a racial divide.

Like the nation as a whole, organized medicine in the United States carries a legacy of racial bias and segregation that should be understood and acknowledged. For more than 100 years, many state and local medical societies openly discriminated against black physicians, barring them from membership and from professional support and advancement. The American Medical Association was early and persistent in countenancing this racial segregation. Several key historical episodes demonstrate that many of the decisions and practices that established and maintained medical professional segregation were challenged by black and white physicians, both within and outside organized medicine. The effects of this history have been far reaching for the medical profession and, in particular, the legacy of segregation, bias, and exclusion continues to adversely affect African American physicians and the patients they serve.

There is no scientific rationale for race-based research.

For centuries, the colonial governments used a combination of race and ethnic characteristics to subjugate and control people of color, and scientists of the day provided evidence of the "natural order of things" to support national policies of domination, segregation and control. There have been many examples of events in the past 70 years to suggest that achievements by ethnic peoples are not genetically determined and that race and ethnicity are merely terms to describe external features, language, culture, social mores and folklore. BiDil was the first drug in this country approved by the FDA for use in a single "race" after a clinical trial that enrolled only members of that race. Thus arose the question of the efficacy of doing race-based research in humans. In order for this kind of research to have any scientific basis, each individually defined or self-declared race would have to have a 100% pure gene pool, and the data show that the gene pool among whites, blacks and Hispanics in America is very heterogeneous. This makes for far greater similarities among U.S. citizens than any perceived differences, and genomic science has failed to support the concept of racial categories in medicine. Scientists involved with the first mapping of the human genome have noted that there is no basis in the genetic code for race. That being the case, there appears to be no justification for race-based research among human beings.

Charity Hospital: from the beginning to either a new beginning or the end.

Through epidemics, wars, hurricanes, pirates and politics, Charity Hospital has served the indigent population of New Orleans and Louisiana since May 10, 1736 as the second oldest continuing public hospital in the country following Bellevue in New York City, which opened six weeks earlier on March 31, 1736. The first Charity facility was financed by the estate of boat builder Jean Louis, whose will recorded, "a sale shall be made of all that remains, which, together with my small lot, I bequeath to serve in perpetuity to the founding of a hospital for the sick of the City of New Orleans...".