Association between change in systolic blood pressure and cognitive decline among elderly Mexican Americans: data from the Hispanic established population for epidemiology study of the elderly.

The longitudinal association between the rate of change in blood pressure and cognitive decline was examined in an area probability sample from a population-based survey of elderly Mexican Americans, 65 years of age or older obtained in 1993--1994, 1995--1996, 1998--1999, and 2000--2001 (n = 2859). The sample was divided into two groups at baseline: hypertensives had a systolic blood pressure (SBP) > or = 140 mm Hg, a diastolic blood pressure (DBP) > or = 90 mm Hg, or indicated a prior diagnosis of hypertension, and the normotensive group. Cognition was indexed by the Mini-Mental State Examination (MMSE). Neither SBP nor DBP at baseline predicted cognitive decline. However, the mean slope for SBP in the normotensive group showed an increase of 4.55mm Hg (increase from Time 1 to Time 2 was 123mm Hg to 132 mm Hg) and was significant in a regression model predicting cognitive decline even after adjusting for covariates. These findings suggest an association between increasing SBP and cognitive decline for normotensive elderly in this study population.

Impact of Generalist Physician Initiatives on Residency Selection.

OBJECTIVE: To compare the residency selection choices of students who experienced courses resulting from generalist physician initiatives to choices made by students prior to the implementation of those courses and to describe the characteristics of students selecting primary care residencies. BACKGROUND: In the fall of 1994 a first year Community Continuity Experience course was initiated and in the summer of 1995 a third year Multidisciplinary Ambulatory Clerkship was begun at the University of Texas Medical Branch in Galveston. These courses were inserted into the curriculum to enhance and promote primary care education. DESIGN/METHODS: We examined the residency selections of cohorts of graduating medical students before (1992-1996) and after (1997-1999) the implementation of the primary care courses. Survey information on career preferences at matriculation and in the fourth year of medical school were available for students graduating after the programs began. We compared the career preferences and characteristics of those students who selected a primary care residency to those who did not. RESULTS: Prior to the implementation of the programs, 45%(425/950) of students graduating selected primary care residencies compared to 45% (210/465) of students participating in the programs (p=0.88). At matriculation, 45% of students had listed a primary care discipline as their first career choice. Among the students who had indicated this degree of primary care interest 61% ended up matching in a primary care discipline. At year 4, 31% of students indicated a primary care discipline as their first career choice and 92% of these students matched to a primary care residency. By univariate analysis, minority students (53%) were more likely to select a primary care residency than non-minority students (40%); students in the two lowest grade point average quartiles (55% and 50%) selected primary care residencies compared to 37% and 38% of students in the top 2 quartiles; and students who stated that income potential had little or no impact on their choice were more likely to select a primary care residency (48%) than those who said income potential was important (37%). CONCLUSIONS: We observed no significant trend towards higher proportions of graduating students selecting primary care discipline residencies as a result of implementing courses that emphasized primary care. Those students expressing an interest in a primary care discipline at their entrance into medical school were more likely to select a primary care residency. A more significant impact on graduating students interested in primary care may be made through the medical student selection process than by altering the curriculum.