青年缺血性卒中患者的基因突变

缺血性卒中是一种多基因遗传性疾病 ,并由多种危险因素叠加而致发病 ,其发病率和致残率均较高。遗传因素对于青年人缺血性卒中的影响作用较大。文章对与青年人缺血性卒中有关的血小板相关基因、凝血 /纤溶基因、脂代谢基因、同型半胱氨酸代谢基因等作了综述。     

青年卒中的病因和危险因素

研究发现，青年卒中的发病率有逐渐增高的趋势，但其病因和危险因素极为复杂。文章对该领域的国内外临床研究进展进行了综述。     

The Hispanic Paradox: Race/Ethnicity and Nativity,Immigrant Enclave Residence and Cognitive Impairment Among Older US Adults

Hispanics, and particularly foreign‐born Mexican Americans, have been shown to fare better across a range of health outcomes than might be expected given the generally higher levels of socioeconomic disadvantage in this population, a phenomena termed the “Hispanic Paradox”. Previous research on social disparities in cognitive aging, however, has been unable to address both race/ethnicity and nativity (REN) in a nationally‐representative sample of US adults leaving unanswered questions about potentially “paradoxical” advantages of Mexican ethnic‐origins and the role of nativity, socioeconomic status (SES), and enclave residence. We employ biennial assessments of cognitive functioning to study prevalent and incident cognitive impairment (CI) within the three largest US REN groups: US‐born non‐Hispanic whites (US‐NHW), US‐born non‐Hispanic blacks (US‐NHB), US‐born Mexican Americans (US‐MA), and foreign‐born Mexican Americans (FB‐MA). Data come from a nationally‐representative sample of community‐dwelling older adults in the Health and Retirement Study linked with the 2000 Census and followed over 10 years (N = 8,433). Large disadvantages in prevalent and incident CI were observed for all REN minorities respective to US‐born non‐Hispanic whites. Individual and neighborhood SES accounted substantially for these disadvantages and revealed an immigrant advantage: FB‐MA odds of prevalent CI were about half those of US‐NHW and hazards of incident CI were about half those of US‐MA. Residence in an immigrant enclave was protective of prevalent CI among FB‐MA. The findings illuminate important directions for research into the sources of cognitive risk and resilience and provide guidance about CI screening within the increasingly diverse aging US population.     

Racial and Ethnic Differences in Preferences for End-of-Life Treatment

BACKGROUND  Studies using local samples suggest that racial minorities anticipate a greater preference for life-sustaining treatment when faced with a terminal illness. These studies are limited by size, representation, and insufficient exploration of sociocultural covariables. OBJECTIVE  To explore racial and ethnic differences in concerns and preferences for medical treatment at the end of life in a national sample, adjusting for sociocultural covariables. DESIGN  Dual-language (English/Spanish), mixed-mode (telephone/mail) survey. PARTICIPANTS  A total of 2,847 of 4,610 eligible community-dwelling Medicare beneficiaries age 65 or older on July 1, 2003 (62% response). MEASUREMENTS  Demographics, education, financial strain, health status, social networks, perceptions of health-care access, quality, and the effectiveness of mechanical ventilation (MV), and concerns and preferences for medical care in the event the respondent had a serious illness and less than 1 year to live. RESULTS  Respondents included 85% non-Hispanic whites, 4.6% Hispanics, 6.3% blacks, and 4.2% “other” race/ethnicity. More blacks (18%) and Hispanics (15%) than whites (8%) want to die in the hospital; more blacks (28%) and Hispanics (21.2%) than whites (15%) want life-prolonging drugs that make them feel worse all the time; fewer blacks (49%) and Hispanics (57%) than whites (74%) want potentially life-shortening palliative drugs, and more blacks (24%, 36%) and Hispanics (22%, 29%) than whites (13%, 21%) want MV for life extension of 1 week or 1 month, respectively. In multivariable analyses, sociodemographic variables, preference for specialists, and an overly optimistic belief in the effectiveness of MV explained some of the greater preferences for life-sustaining drugs and mechanical ventilation among non-whites. Black race remained an independent predictor of concern about receiving too much treatment [adjusted OR = 2.0 (1.5–2.7)], preference for dying in a hospital [AOR = 2.3 (1.6–3.2)], receiving life-prolonging drugs [1.9 (1.4–2.6)], MV for 1 week [2.3 (1.6–3.3)] or 1 month’s [2.1 (1.6–2.9)] life extension, and a preference not to take potentially life-shortening palliative drugs [0.4 (0.3–0.5)]. Hispanic ethnicity remained an independent predictor of preference for dying in the hospital [2.2 (1.3–4.0)] and against potentially life-shortening palliative drugs [0.5 (0.3–0.7)]. CONCLUSIONS  Greater preference for intensive treatment near the end of life among minority elders is not explained fully by confounding sociocultural variables. Still, most Medicare beneficiaries in all race/ethnic groups prefer not to die in the hospital, to receive life-prolonging drugs that make them feel worse all the time, or to receive MV. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users. Source of support: Funding was provided by the National Institute on Aging (NIA) grant P01 AG19783 and the Robert Wood Johnson Foundation 050488. Dr. Barnato was supported by NIA career-development grant K08 AG021921.     

Effectiveness of the AUDIT-C as a Screening Test for Alcohol Misuse in Three Race/Ethnic Groups

Summary Background  The Alcohol Use Disorders Identification Test—Consumption (AUDIT-C) is a brief validated screen for risky drinking and alcohol abuse and dependence (alcohol misuse). However, the AUDIT-C was validated in predominantly White populations, and its performance in different racial/ethnic groups is unclear. Objective  To evaluate the validity of the AUDIT-C among primary care patients from the predominant racial/ethnic subgroups within the United States: White, African American, and Hispanic. Design  Cross-sectional interview validation study. Participants  1,292 outpatients from an academic family practice clinic in Texas (90% of randomly sampled eligible). Measurements and Main Results  Race/ethnicity was self-reported. Areas under the receiver operating curve (AuROCs) evaluated overall AUDIT-C performance in the 3 racial/ethnic groups compared to diagnostic interviews for alcohol misuse. AUDIT-C sensitivities and specificities at recommended screening thresholds were compared across racial/ethnic groups. AuROCs were greater than 0.85 in all 3 groups, with no significant differences across racial/ethnic groups in men (P = .43) or women (P = .12). At previously recommended cut points, there were statistically significant differences by race in AUDIT-C sensitivities but not specificities. In women, the sensitivity was higher in Hispanic (85%) than in African-American (67%; P = .03) or White (70%; P = .04) women. In men, the sensitivity was higher in White (95%) than in African-American men (76%; P = .01), with no significant difference from Hispanic men (85%; P = .11). Conclusions  The overall performance of the AUDIT-C was excellent in all 3 racial/ethnic groups as reflected by high AuROCs. At recommended cut points, there were significant differences in the AUDIT-C’s sensitivity but not in specificity across the 3 racial/ethnic groups. Electronic supplementary material  The online version of this article (doi: ) contains supplementary material, which is available to authorized users.     

Pregnancy and Race/Ethnicity as Predictors of Motivation for Drug Treatment

While drug use during pregnancy represents substantial obstetrical risks to mother and baby, little research has examined motivation for drug treatment among pregnant women. We analyzed data collected between 2000 and 2007 from 149 drug-using women located in Baltimore, Maryland. We hypothesized that pregnant drug-using women would be more likely than non-pregnant drug-using women to express greater motivation for treatment. Also, we explored race/ethnicity differences in motivation for treatment. Propensity score analysis was used to match a sample of 49 pregnant drug-using women with 100 non-pregnant drug-using women. The first logistic regression model indicated that pregnant women were more than four times as likely as non-pregnant women to express greater motivation for treatment. The second logistic regression analysis indicated a significant interaction between pregnancy status and race/ethnicity, such that white pregnant women were nearly eight times as likely as African-American pregnant women to score higher on the motivation for treatment measure. These results suggest that African-American pregnant drug-using women should be targeted for interventions that increase their motivation for treatment.     

Patent Foramen Ovale and Stroke: Prognosis and Treatment in Young Adults

A patent foramen ovale (PFO) is found with increased frequency in patients with stroke of undetermined origin but the significance and therapeutic implications of this observation remain unclear. Several lines of evidence suggest a role for the PFO in stroke pathophysiology for some cryptogenic stroke patients, such as those whose PFO is accompanied by a prothrombotic state, atrial septal aneurysm, or lower extremity/pelvic DVT. Diagnostic evaluation of the patient with cryptogenic stroke and PFO is directed at identifying these subgroups. Appropriate therapy for primary and secondary stroke prevention in a subject with a PFO remains unclear given current uncertainties as to the pathophysiological significance of PFO. Additional studies are needed, such as those focused on lower extremity veins or the cardiac interatrial septum, to guide therapy in specific stroke subpopulations.     

High-Risk Drinking Among Young Adults: The Influence of Race and College Enrollment

This secondary data analysis of the 2001 National Household Survey on Drug Abuse examines the influence of individual, interpersonal, and contextual social risk and protective factors on high risk drinking, focusing on the influence of minority status and college enrollment among 5,895 young adults. Hierarchical regression predicted 39.4% of the variance in high-risk drinking. Being male, increased risk-taking behavior, being older, and higher numbers of friends getting drunk all positively influenced high-risk drinking, and disapproval of daily drinking reduced high-risk drinking. Interaction effects showed all significant variables to be more influential for Whites than Blacks, including college attendance.     

Gender and Racial/Ethnic Disparities in the Impact of HIV Prevention Programming in Substance Abuse Treatment

Objective: The objective of the study was to evaluate the capacity of HIV prevention programs offered in substance abuse treatment to reduce HIV-related risk behavior for women and men and for Black, Latino, and White groups. Methods: Prospective data was collected at intake, discharage, and 12 months post-treatment from 1992 to 1997 for the National Treatment Improvement Evaluation Study with a sample consisting of 3,142 clients from 59 service delivery units: 972 females, 1,870 males, 1,812 Blacks, 486 Latinos, and 844 Whites. Results: Study findings show that receipt of HIV prevention programming as part of substance abuse treatment services resulted in reductions in HIV-related risk behavior for the sample overall and for women as well as men. However, although Blacks received more prevention services than Latinos and Whites, the significant positive effect of HIV services on reduced HIVrisk behavior held only for Whites. Conclusions: Racial/ethnic disparities exist in the capacity for HIV prevention programming offered as part of substance abuse treatment to reduce HIV-risk behavior. The findings highlight the need for the development of culturally competent service delivery strategies to enhance the impact of these services for all groups.     

Race and ethnicity impact on the maximum proliferative response in peripheral blood lymphocytes from HIV-seropositive individuals

The effects of race and ethnicity on immunological function have not been fully studied in patients infected with HIV-1. To study such differences, 54 patients on virally suppressive highly active antiretroviral therapy (HAART) with CD4 counts >200 cells/microL had their peripheral blood lymphocytes (PBL) evaluated for response to recall antigen. Significant differences were found in the maximum responses for PBL from black individuals compared with those from white individuals, and the differences were highly significant when responses for African-Americans were compared with those for white-Hispanics. These findings support work delineating ethnicity and race as significant variables to be taken into account when looking at vaccination strategies and responsiveness to therapeutic pharmacological interventions.     

Race/ethnicity and patient satisfaction

OBJECTIVE: To determine whether an established patient satisfaction scale commonly used in the primary care setting is sufficiently sensitive to identify racial/ethnic differences in satisfaction that may exist; to compare a composite indicator of overall patient satisfaction with a 4-item satisfaction scale that measures only the quality of the direct physician-patient interaction. DESIGN: Real-time survey of patients during a primary care office visit. SETTING: Private medical offices in a generally affluent area of northern California. PARTICIPANTS: Five hundred thirty-seven primary care patients selected at random from those entering a medical office. MAIN OUTCOME MEASURES: Patient satisfaction using 1) a composite, 9-item satisfaction scale (VSQ-9); and 2) a 4-item subset of that scale that measures only satisfaction with direct physician care. RESULTS: The 9-item, composite scale identified no significant difference in patient satisfaction between white and nonwhite patients, after controlling for patient demographics and other aspects of the visit. The 4-item, physician-specific scale indicated that nonwhite patients were less satisfied than white patients with their direct interaction with the physicians included in the study (P 相似文献   

Racial/Ethnic Differences in Multiple Self-Care Behaviors in Adults with Diabetes

Objective To assess racial/ethnic differences in multiple diabetes self-care behaviors. Design Cross-sectional study. Participants 21,459 participants with diabetes in the 2003 Behavioral Risk Factor Surveillance survey. Measurements The study assessed self-care behaviors including physical activity, fruits/vegetables consumption, glucose testing, and foot examination, as well as a composite of the 4 self-care behaviors across racial/ethnic groups. Multiple logistic regression was used to assess the independent association between race/ethnicity, the composite variable, and each self-care behavior controlling for covariates. STATA was used for statistical analysis. Results Overall, 6% engaged in all 4 self-care behaviors, with a range of 5% in non-insulin users to 8% in insulin users. Blacks were less likely to exercise (OR 0.63, 95% CI 0.51, 0.79), while Hispanics and “others” were not significantly different from whites. Hispanics (OR 0.64, 95% CI 0.49, 0.82) and others (OR 0.69, 95% CI 0.49, 0.96) were less likely to do home glucose testing, while blacks were not significantly different from whites. Blacks (OR 1.42, 95% CI 1.12, 1.80) were more likely to do home foot examinations, while Hispanics and others were not significantly different from whites. Blacks (OR 0.56, 95% CI 0.36, 0.87) were less likely to engage in all 4 behaviors, while Hispanics and others were not significantly different from whites. There were no significant racial/ethnic differences in fruit and vegetable consumption. Conclusions Few patients engage in multiple self-care behaviors at recommended levels, and there are significant racial/ethnic differences in physical activity, dietary, and foot care behaviors among adults with diabetes. Potential Financial Conflicts of Interest: The authors do not have any conflicts of interest to report.     

Race/Ethnicity and Risk of AIDS and Death Among HIV-infected Patients with Access to Care

BACKGROUND  Prior studies evaluating racial/ethnic differences in responses to antiretroviral therapy (ART) among HIV-infected patients have not adequately accounted for many potential confounders, and few have included Hispanic patients. OBJECTIVE  To identify racial/ethnic differences in ART adherence, and risk of AIDS and death after ART initiation for HIV patients with similar access to care. DESIGN  Retrospective cohort study. PARTICIPANTS  4,686 HIV-infected patients (66% White, 20% Black, and 14% Hispanic) initiating ART and who were enrolled in an integrated healthcare system. MEASUREMENTS  Main outcomes evaluated were ART adherence, new AIDS clinical events, and all-cause mortality. The potential confounding effects of demographics, socioeconomic status, ART parameters, HIV disease stage, and other clinical parameters were considered in multivariable models. RESULTS  Adjusted mean adherence levels were higher among White (70.1%; ref) compared with Black (64.2%; P < 0.001) and Hispanic patients (65.2%; P < 0.001). Adjusted hazard ratios (HR) for the risk of new AIDS events (White patients as reference) were 1.3 (P = 0.09) for Black and 0.9 (P = 0.64) for Hispanic patients. The adjusted HR for AIDS comparing Hispanic to Black patients was 0.7 (P = 0.11). Hispanic patients had fewer deaths compared with other racial/ethnic groups, particularly cancer and cardiovascular-related. However, adjusted HRs for death were 1.2 (P = 0.37) and 0.9 (P = 0.62) for Black and Hispanic patients, respectively, compared with White patients and 0.9 (P = 0.63) for Hispanic compared with Black patients. Adjustment for adherence did not change inferences for AIDS or death. CONCLUSIONS  In the setting of similar access to care, we did not observe a disparity for the risk of clinical events for racial/ethnic minorities, despite lower ART adherence. This material was presented at the 4th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, Sydney, Australia, July 22–25, 2007 (#WEPEB107). This research was supported by a Community Benefit grant from Kaiser Permanente Northern California and grant number K01AI071725 from the NIAID.     

Race/ethnicity and asthma management among adults presenting to the emergency department

We investigated whether racial/ethnic disparities exist in asthma management among 1785 adults requiring emergency department (ED) treatment. In this multicentre study, non‐Hispanic blacks with increased chronic asthma severity were only as likely (P > 0.05) as non‐Hispanic whites or Hispanics to utilize controller medications or see asthma specialists before ED presentation and to be prescribed recommended inhaled corticosteroids at ED discharge. Improved ED education on evidence‐based chronic disease management is needed to address continuing race/ethnicity‐based asthma disparities.