Associations between race, lifecourse socioeconomic position and prevalence of diabetes among US women and men: results from a population-based panel study.

BACKGROUND: Few studies have examined the degree to which racial disparities in the development of diabetes are accounted by differences in lifecourse socioeconomic position (SEP). We assessed the association between race, lifecourse SEP measures and prevalence of diabetes in a representative US sample of black and white adults. METHODS: A generalised estimating equations approach was used with a sample of 3497 adults from the Americans' Changing Lives study. Sex-specific models were calculated to compute prevalence ratios (PR) for associations of race and SEP with self-reported diagnoses of diabetes. RESULTS: For men, childhood and adult SEP were unrelated to diabetes, and adjustment for lifecourse SEP had little effect on the excess diabetes in blacks (PR=1.56, 95% CI 1.11 to 2.21). Adjustment for measures of lifecourse SEP reduced the PR for the association between race and diabetes in women from 1.96 (95% CI 1.52 to 2.54) to 1.40 (95% CI 1.04 to 1.87) with the respondent's education responsible for most of the reduction in the association. However, diabetes was also inversely associated with father's education, and low SEP throughout the lifecourse was associated with a nearly threefold increase in diabetes (PR=2.89, 95% CI 2.10 to 3.99). CONCLUSIONS: Racial disparities in diabetes existed among both men and women, but lifecourse SEP was related to diabetes only among women. The pathway and cumulative hypotheses for lifecourse SEP effects on diabetes may be especially salient for women.

Combined asymptomatic congenital anterior and posterior deficiency of the atlas.

Atlas anomalies in terms of clefts and aplasia are rare. They can sometimes simulate fractures and need further evaluation. Imaging in terms of CT and MR can help resolve diagnostic confusion and also outline associated neurological involvement. A rare anomaly of anterior and posterior atlas arch, previously unclassified, is presented.

Caregivers' attitudes toward their family members' participation in Alzheimer disease research: implications for recruitment and retention.

Current levels of participation in Alzheimer disease (AD) research are inadequate, particularly among nonwhites. This study was conducted to examine caregivers' attitudes toward their family members' participation in AD research. Six focus group interviews were conducted with 38 white and 12 African-American caregivers of participants enrolled in clinical research projects. Both white and African-American families participated in research to help their care recipients and future generations, receive support from the clinical and research staff, and obtain feedback about patient status and research results. Among white caregivers, primary barriers to participation in research included the potential for no direct benefit, problems with the procedures and tests involved, lack of time and resources, and difficulty accepting the diagnosis. Among African-American caregivers, primary barriers included general skepticism about the research process and firmly established attitudes about medical treatment and help seeking that serve as disincentives to research participation. To maximize the perceived benefits of research participation, potential participants should have access to regular personal contact with staff, information about health status changes in the care recipient, and the short-term and long-term results of the research studies in which they are participants. In addition, researchers should be sensitive to the concerns that may serve as barriers to participation, particularly among African Americans.

Prevalence of positive preoperative pregnancy testing in teenagers scheduled for orthopedic surgery.

The pregnancy status of female teenagers presenting for orthopaedic surgery is often unknown. Anesthetics may have teratogenic or abortive effects. The authors report the results of a screening program for unrecognized pregnancy in 532 female teenagers presenting for orthopaedic surgery. Five patients with a positive urine human chorionic gonadotropin test were identified, for a prevalence of 1 positive result in 106 patients tested (0.9%). Surgery was cancelled in each case.

Familial torticollis with polydactyly: manifestation in three generations.

Familial transmission of congenital muscular torticollis (CMT) has been reported in the literature, and postaxial polydactyly has been frequently reported in familial cases, but, to our knowledge, familial CMT with postaxial polydactyly has not been described. In this article, we report a rare case of CMT with postaxial polydactyly in 3 generations of a family and suggest an autosomal-dominant pattern of inheritance in these cases.

Exploring race variations in aging and personal control.

OBJECTIVES: The purpose of this study is twofold: (a) to see whether the association between age and perceived control is the same for Blacks as well as Whites; and (b) to see if education, health, income, social support, cognitive function, and religion account for the relationship between age and control in the same way for Blacks and Whites. METHODS: Data for this study come from the first wave of the Americans' Changing Lives panel study. Complete data are available for 357 Black and 2,792 White individuals. Respondents were asked questions about their feelings of control, health status, income, social support, cognitive function, religious participation, and demographic information. RESULTS: The findings suggest that age has an inverse and nonlinear association with feelings of control. Moreover, this relationship is similar for Blacks and Whites. The data further reveal that, across all age groups, Blacks report a lower sense of control than Whites. Less education, less income, greater cognitive impairments, and more religiosity are associated with a lower sense of control. These factors, along with health and social support, account for 69% of the association between age and control, with no differences according to race. DISCUSSION: These results show that lower levels of control are associated with older age in both Blacks and Whites, and that racial disparities in feelings of control persist across all age groups. This suggests that Blacks may be at a particular disadvantage in the face of the increasing challenges of aging.

The Antley-Bixler syndrome: two new cases.

The Antley-Bixler syndrome is a rare multiple congenital anomaly with a high mortality rate. The characteristic manifestations include craniosynostosis, radiohumeral synostosis, midface hypoplasia, joint contractures and arachnodactyly. We report two new cases of this syndrome and address the diagnostic features, associated malformations, inheritance patterns, prenatal findings, and briefly review the literature.

Giving social support to others, socioeconomic status, and changes in self-esteem in late life.

OBJECTIVE: The purpose of this study was twofold: (1) to see if providing emotional support to others bolsters the self-esteem of older adults over time; and (2) to assess whether the salubrious effects of helping others are more likely to be enjoyed by high socioeconomic status (SES) elders. METHODS: Interviews were conducted with a nationally representative sample of older adults at three points in time: 1992-1993, 1996-1997, 1998-1999. Complete data are available for 511 elderly people. During each round of interviews, respondents were asked how often they provided emotional support to their social network members. Information on the self-esteem of older support providers was also gathered at each point in time. RESULTS: Initially, the findings revealed that helping others tends to bolster the self-esteem of all study participants regardless of their SES standing. However, these benefits began to taper off for lower SES elders during the course of the study. By the third wave of interviews, the salutary effects of helping others were evident only among older adults in upper SES levels. DISCUSSION: The results highlight the dynamic nature of the helping process and underscore the importance of taking SES into account when studying the effects of assisting others in late life.

Role-specific feelings of control and mortality.

The purpose of this study is to examine the impact of 2 different measures of personal control on mortality in late life. The 1st reflects control over the 3 roles that are most important to elderly study participants. The 2nd is a global measure that assesses control over life as a whole. Data provided by a nationwide survey of older adults (N = 884) indicate that feelings of control over the single most important role significantly reduce the odds of dying. In contrast, control over the 2nd and 3rd most important roles are not related to mortality, nor are feelings of control over life as a whole. The theoretical implications of these findings are discussed.

The cerebro-costo-mandibular syndrome: 9-year follow-up of a case.

Cerebro-costo-mandibular syndrome (CCMS) is a rare multiple congenital anomaly with a low survival rate. There are few reports of long-term survival in this condition. We describe the findings and management of a 9-year-old survivor of CCMS, outline the importance of early intervention and multidisciplinary team approach. The child presented in the neonatal period in respiratory distress with classical features of the syndrome. Aggressive initial respiratory management was later followed up with an integrated multidisciplinary team approach. He has been carefully followed up for nine years now, illustrating well, the course of the syndrome.

Secondary fractures associated with external fixation in pediatric femur fractures.

Sixty-six femur fractures sustained by children ages 4-14 years and treated with external fixation were reviewed retrospectively to assess factors influencing the incidence of refracture. The total rate of secondary fracture was 12% (eight patients) including five recurrent fractures at the original fracture site and three fractures through the pin sites. After removal of the external fixator, five patients refractured at the original fracture site and one patient fractured through a pin tract. Two patients fractured at pin sites while the fixator was still in place. Multivariate linear-regression analysis showed no correlation between the incidence of refracture and fracture pattern, percentage of bone fragment contact after fixator application, type of external fixator, or dynamization. A statistically significant association (p < 0.05) was found between the number of cortices demonstrating bridging callus [on both anteroposterior (AP) and lateral views] at the time of fixator removal and the rate of refracture. Fractures showing fewer than three cortices of bridging callus had a three (33%) in nine rate of refracture, whereas fractures with three or four cortices of bridging callus had a two (4%) of 57 rate of refracture.

Comparison of morphine patient-controlled analgesia with and without ketorolac for postoperative analgesia in pediatric orthopedic surgery.

The purpose of this prospective, randomized, double-blind, placebo-controlled clinical study was to determine whether the administration of intravenous ketorolac, coadministered with morphine patient-controlled analgesia (PCA), demonstrates an opioid-sparing effect, provides improved analgesia, and reduces the incidence of opioid-induced side effects in children after orthopedic surgery. The findings of enhanced analgesia with decreased opioid use suggest that coadministration of ketorolac with morphine PCA is beneficial for the treatment of pain in children after orthopedic surgery.

Displaced odontoid fracture in a 9-month-old child.

A 9-month-old child sustained a displaced odontoid fracture in a motor vehicle accident. She was treated with closed reduction and a Minerva cast for 6 weeks, followed by a collar for an additional 2 weeks. At 5-year follow-up, she had made a complete recovery with solid union, no deformity, and no instability.

C-arm manipulation using a sterile disposable lamp handle.

Portable C-arm fluoroscopy is often used in the operating room. We describe a sterile technique that enables the physician to position the C-arm without requiring the use of a sterile drape.

Humerus shaft fractures in young children: accident or abuse?

We performed a retrospective review of 34 humerus shaft fractures (HSFs) in children younger than 3 years to determine the frequency of child abuse in young children with this injury. Data were obtained from hospital records (including previous and subsequent emergency, clinic, and inpatient notes), radiographs, and county childprotective services. Cases were reviewed independently by four physicians and were classified as probable abuse, probable not abuse, and indeterminate. Only 18% were classified as probable abuse. The history and findings other than the fracture itself were critical in establishing cause. Neither age nor fracture pattern is pathognomonic of abuse, but suspicion should remain high. A detailed history, complete physical examination, and appropriate radiographic investigation are required in every case either to make the diagnosis of abuse or to avoid the trauma of a false accusation.

Musculoskeletal coccidioidomycosis. A review of 25 cases.

Coccidioidomycosis is a fungal infection endemic to the southwestern United States. Musculoskeletal involvement is rare, and there are few reports with clear recommendations regarding treatment. The purpose of this study was to review a series of 25 patients with musculoskeletal coccidioidomycosis and to assess their outcomes with respect to presentation and treatment. There were 36 lesions among the 25 patients, 8 located in the spine, with the remainder distributed throughout the body. Seventeen patients had a delay in diagnosis of more than 1 month. Eight patients had an elevated white blood cell count, and 10 had an elevated sedimentation rate. Only 7 of the patients had an overt pneumonia before the musculoskeletal presentation. Twenty-four patients underwent formal irrigation and debridement and 22 patients had at least 1 course of Amphotericin B. The average followup after the initiation of treatment was 3.5 years, ranging from 2 to 10 years. Seven patients had recurrent lesions that required further surgical intervention, 4 of whom had a delay in diagnosis of more than 1 month. There were 3 deaths. All surviving patients were free of disease at final followup.

Technique for securing guide wires in cannulated screw systems.

Cannulated screw guide wires may be inadvertently removed while using the cannulated drill or tap. We describe a simple technique for securing the guide wire during drilling and tapping.