Researchers identify stroke predictors in black patients

WINSTON-SALEM, N.C. – Predictors of atrial fibrillation (AF or afib) might offer physicians a better way to prevent stroke in blacks, according to a new study done by researchers at Wake Forest University School of Medicine.

AF is an irregular and often rapid heart rate that commonly causes poor blood flow to the body, as well as symptoms of heart palpitations, shortness of breath and weakness. Despite low reported prevalence of AF – one of the major risk factors for stroke – in black patients, they suffer strokes five times more often than white patients and die from them two times more often.

That paradox might result from limitations in the methods (electrocardiograms (ECG) or self-report) used to detect AF, said Elsayed Z. Soliman, M.D., M.Sc. M.S., associate director of the Epidemiological Cardiology Research Center (EPICARE) at the School of Medicine and lead author of the study.

Elsayed Z. Soliman, M.D., M.Sc. M.S., associate director of the Epidemiological Cardiology Research Center (EPICARE) at the School of Medicine and lead author of the study.

"The limitations stem from the fact that AF is intermittent in at least 30 percent of patients, and most patients are not aware if they have AF or not," Soliman said. "Trying to detect AF using an ECG, or simply counting on patients to know if they have it, leads to under-diagnosis of the condition most of the time. Our research suggests that being proactive in predicting it may be a better approach." The study appears in the current issue of Stroke, the peer-reviewed journal of the American Heart Association and American Stroke Association. An electrocardiogram is a diagnostic tool that measures and records the electrical activity of the heart. Interpretation of an ECG report allows diagnosis of a wide range of heart conditions from minor to life threatening.

Doctors use ECGs to diagnose AF, and therefore assess the risk of stroke in different patients. However, ECG reports of AF have not been as useful for identifying black patients at high risk. While black patients suffer more ischemic strokes than white patients, their ECG results do not indicate AF as often.

For the study, researchers reviewed ECG data from the Atherosclerosis Risk in Communities (ARIC) study supported by the National Heart, Lung and Blood Institute. More than 15,000 people in North Carolina, Mississippi, Minnesota and Maryland participated in the study during the 1980s and 90s.

Researchers found that, while ECG reports of AF were significantly less in black participants than in whites, black participants ultimately suffered more ischemic strokes. However, the analysis uncovered that ECGs on black participants revealed a higher rate of predictors of future AF than did the ECGs of the white participants. These ECG predictors of AF (P-wave terminal force, P-wave duration, P-wave area and PR duration) represent electrical activity within the upper two chambers of heart, or atria, which are the sources of blood clots that cause stroke if AF occurs. These ECG predictors of AF were strongly predictive of strokes and AF in blacks and whites, so researchers believe their existence could be considered as presence – or future presence – of AF.

"With the blacks having more abnormal ECG predictors of AF, as the results showed, there is a possibility that blacks might actually have a higher prevalence of AF than previous studies have picked up on," Soliman said. "Blacks may have more "intermittent" AF, the difficult type of AF to detect, which could be the reason why previous studies underestimated AF diagnosis more in blacks."

Soliman added that physicians, knowing this, should use the ECG to evaluate black patients' risk of stroke by determining if the patient has certain predictors of AF, instead of the condition itself. If so, the patients may be able to be treated with blood thinners as if they have AF. It is a treatment adjustment that could help prevent stroke, however further investigation into the subject is needed, he said.

"P-wave terminal force in the ECG may provide a strong independent predictor for incidence stroke and AF in clinical practice," Soliman said.

"For the physician evaluating black patients for the risk of stroke, these results show that you cannot think AF is less common in this population," Soliman said.

Soliman said that the next step in research on this subject is to do a long-term ECG study to confirm the hypothesis that AF, especially intermittent AF, has been under-diagnosed in blacks.

"We need further studies using long-term ECG recording – 48 hours to 72 hours – or event monitors to detect AF" he said. "The cost of these tests on population studies has always been an obstacle. However, with the results of this study, it may be worth it." ###

Co-authors on the study are Ronald J. Prineas, M.D., Ph.D., L. Douglas Case, Ph.D., Zhu-ming Zhang, M.D. and David C. Goff Jr., M.D., Ph.D., all of the Division of Public Health Sciences at the Wake Forest University School of Medicine.

Media Relations Contacts: Jessica Guenzel, jguenzel@wfubmc.edu, (336) 716-3487; Bonnie Davis, bdavis@wfubmc.edu, (336) 716-4977; or Shannon Koontz, shkoontz@wfubmc.edu, (336) 716-4587

Wake Forest University Baptist Medical Center (www.wfubmc.edu) is an academic health system comprised of North Carolina Baptist Hospital, Brenner Children's Hospital, Wake Forest University Physicians, and Wake Forest University Health Sciences, which operates the university's School of Medicine and Piedmont Triad Research Park.

The system comprises 1,056 acute care, rehabilitation and long-term care beds and has been ranked as one of "America's Best Hospitals" by U.S. News & World Report since 1993. Wake Forest Baptist is ranked 32nd in the nation by America's Top Doctors for the number of its doctors considered best by their peers. The institution ranks in the top third in funding by the National Institutes of Health and fourth in the Southeast in revenues from its licensed intellectual property.

Contact: Jessica Guenzel jguenzel@wfubmc.edu 336-716-3487 Wake Forest University Baptist Medical Center

Research finds perceived warmth, 'babyfaceness' positive characteristics for black CEOs

Study examined physical characteristics as a predictor of obtaining and maintaining leadership roles

Evanston, Ill. (April 30, 2009) – As President Barack Obama commemorates his 100th day as the country's first black commander-in-chief, a new study by Kellogg School of Management researchers examines the intersection of race and power in corporate America. While many traits of successful leaders transcend racial or ethnic bounds, this study sought to focus on one particular facet of blacks' ascensions to power: the physical characteristics of so-called "babyfaces," and their influence on perception and achievement.

"The Teddy Bear Effect: Does babyfaceness benefit Black CEOs?" will appear in a forthcoming issue of Psychological Science and is co-authored by Robert Livingston and Nicholas Pearce of the Kellogg School.

Robert Livingston. MANAGEMENT & ORGANIZATIONS. Assistant Professor of Management and Organizations

Searching for traits common to black CEOs who have successfully navigated treacherous cultural and corporate terrain, the researchers demonstrate that babyfaces – and perceived warmer physical appearances and personality traits – can benefit black CEOs and act as disarming mechanisms within the social hierarchy. Black CEOs categorized as having a babyface tend to be at the helm of more prestigious corporations than black CEOs who have a more mature appearance.

"Prior research has shown babyface-type traits are a liability for those striving for a leadership role because they undermine perceptions of competence, but these studies focused on white males," said Livingston, lead author and assistant professor of management and organizations at the Kellogg School of Management. "Because a babyface is disarming, we hypothesized that it would provide an advantage to black leaders who have a history of being stigmatized as too threatening to occupy positions of high power."

Methodology

Non-black women and men were shown 40 headshot photos of black men and white women and men. Though the faces were not recognized by participants, all were current or former CEOs of Fortune 500 companies.

Participants were asked to rate how babyfaced, how attractive, and also how old, each person appeared. They also rated each in terms of perceived personality traits. For example, how warm did a person appear? How competent would they be as a leader? Participants were then asked to use those same personality criteria to rate, in general, how they perceive blacks and whites. Finally, participants guessed how much money each person earned.

Rev. Nicholas Pearce

Babyface Definition

The researchers have identified several traits associated with "babyfaceness" including a rounder face, larger forehead, smaller nose, larger ears and fuller, pouty lips. Despite these individual features, babyface is a "gestalt" or whole that is easily recognizable by people. Babyfaceness is an attribute that generalizes across regions, ethnicities, gender and even species, as identified by social psychologists. There is a universal, evolutionary response to babies across all cultures because infants require special care, attention, and nurturing in order to survive.

This adaptive response to infants is over-generalized to adults who have features that resemble babies. The result is that babyfaced adults are treated differently compared with maturefaced adults: babyfaced adults are considered more warm, innocent and trustworthy.

The hypothesis of the current study was that babyfaceness could serve as a "disarming mechanism" that would attenuate the fear, hostility and aggression typically associated with black males. Thus babyfaceness would facilitate the ascension of black males but not white males.

Results

Babyface features had a clear influence on professional achievement, both perceived and real. Black CEOs were rated as being more babyfaced, and having warmer personalities, than whites.

The more babyfaced the black CEO, the more he was also thought to earn. In terms of real, not just perceived, earnings and achievement, the more babyfaced the black CEO, the more prestigious was the company he actually led, reflected by both Fortune 500 ranking and annual corporate revenue. These perceived and real professional benefits were correlated with physical appearance, not to perceptions of age, which was not found to be linked to babyfaceness.

Livingston pointed out that while the 10 black CEO faces were considered warmer than the white faces, blacks as a group were considered less warm than whites overall. Thus, the visual influence of babyfaceness clearly shifted perception, and the playing field. He said, "To function effectively as an African American male in the U.S. it helps to have a disarming mechanism." A disarming mechanism is a physical or behavioral trait, noted Livingston, that eases perceptions of threat—it signals to whites that they do not have a reason to fear this particular black individual. Babyfaceness is but one example: political conservatism, style of speech or dress, smiling behavior, or even a Harvard education might also serve a similar disarming function.

The research notes disarming mechanisms, like warmth, are only necessary for groups that are perceived to be hostile or threatening by default. Prior research has shown warmth to be counterproductive for white male leaders and women leaders. "Female leaders are already 'disarmed' because of traditional caregiver roles and stereotypes," said Livingston. "Women leaders must prove to be strong and assertive, frequently at the expensive of being perceived as lacking warmth." The implication is that black leaders may have to adopt a gentler leadership style compared with white males who can get angry or pound their fists in order to accomplish leadership objectives.

Beyond the Babyface

While facial features may present natural advantages or obstacles to some, other behavioral traits can be developed and used by most anyone. "There are other mechanisms thought to help minorities function and achieve without stoking envy, resentment, fear," said Livingston. "For example, some point to Former U.S. Secretary of State Condoleeza Rice as someone who internalizes shared ideology with the dominant group, and is therefore seen as non-threatening." Livingston adds that although Barack Obama does not possess all of the typical features associated with babyfaceness per se, he does have a disarming appearance. "Big ears or a simple smile can disarm one's appearance from suggested perceptions of threat that might otherwise be associated with black males. This could serve to increase the appeal of the president or even one of Hollywood's most successful actors—Will Smith," he said. ###

• To read the full article or speak with Kellogg School of Management professor Robert Livingston, e-mail Meg Washburn at m-washburn@kellogg.northwestern.edu
• To learn more about the Association of Psychological Science, visit www.psychologicalscience.org.
• To learn more about the Kellogg School of Management, visit www.kellogg.northwestern.edu.

Contact: Meg Washburn m-washburn@kellogg.northwestern.edu 847-491-5446 Association for Psychological Science

New Medicare policy may pose risks to black kidney patients

Policy change could discourage dialysis centers from accepting African-American patients

A change in Medicare reimbursement policy could make it more difficult for African Americans with kidney disease to access dialysis services, suggests a study in an upcoming issue of the Journal of the American Society of Nephrology (JASN). "The change in payment policy may disadvantage a substantial group of dialysis patients," comments Areef Ishani, MD (University of Minnesota).

Under the new policy, the Centers for Medicare & Medicaid Services (CMS) will make a single payment to dialysis units to cover both dialysis and injectable medications, which were previously reimbursed separately.

Areef Ishani, M.D., M.S.

African American dialysis patients have more problems with anemia (low hemoglobin) than white patients and thus may require more treatment with costly erythropoiesis stimulating agents (ESAs) to raise hemoglobin levels. On analysis of 12,000 patients starting dialysis during 2006, the researchers confirmed that African Americans had lower initial hemoglobin levels when starting hemodialysis compared to white patients.

Also, the average required dose of ESAs over the first two months on dialysis was eleven percent higher in African American patients.

Since dialysis centers will no longer be reimbursed for the higher ESA doses, the researchers are concerned that the new policy could create a "financial disincentive" to accept African Americans. "The CMS has suggested that the new reimbursement scheme will adjust for a variety of factors," according to Dr. Ishani. "If race is not included as a payment adjuster, African American patients could be disadvantaged by this policy change."

The study is limited in that it included only patients who were over age 67 at the start of dialysis and had Medicare as their primary insurance source. Also, it only looked at ESA use during the first two months on dialysis.

Dr. Ishani consults for the Chronic Disease Research Group. Haifeng Guo; Thomas Arneson, MD; Lih-Wen Mau, PhD; Suying Li, PhD; and Stephan Dunning are employed by the Chronic Disease Research Group. David Gilbertson, PhD and Allan Collins, MD have received consulting fees from Amgen. ###

The study appears online at jasn.asnjournals.org/ doi 10.1681/ASN.2008080853.

Founded in 1966, the American Society of Nephrology (ASN) is the world's largest professional society devoted to the study of kidney disease. Comprised of 11,000 physicians and scientists, ASN continues to promote expert patient care, to advance medical research, and to educate the renal community. ASN also informs policymakers about issues of importance to kidney doctors and their patients. ASN funds research, and through its world-renowned meetings and first-class publications, disseminates information and educational tools that empower physicians.

Contact: Shari Leventhal sleventhal@asn-online.org 202-416-0658 American Society of Nephrology

One hundred days of African-American history

Looking back at President Barack Obama's first 100 days

On November 4, 2008, Barack Obama became the answer to a question that will eventually end up on an African American studies test: Who was the nation's first African American president?

But now that the confetti has blown away and the Inauguration has come and gone, what have the first 100 Days of President Obama's Administration meant to the African American community?

That is the question that will be answered during A Conference Call: A 100 Day Assessment of the Obama Presidency From an African American Perspective, a symposium being held from May 1st through 3rd in Temple University's Anderson Hall, 1114 Berks Street, and Beury Hall, 1901 N. 13th Street.

The symposium, which is co-sponsored by the Center for African American Research and Public Policy at Temple University and the Philadelphia Community Institute of Africana Studies,

will look at the impact that the first 100 days of the Obama Presidency has had on the African American community in terms of the economy, the criminal justice system, and foreign relations through an African American historical perspective.

In addition to looking at the Obama presidency, the symposium will also focus on the discipline of Black History itself as it celebrates its 40th Anniversary. As the first institution to offer a doctorate in Black History, Temple is uniquely qualified to provide this view.

The discussion begins Friday night by investigating how President Obama's election has affected African American politics and political thought. Among the confirmed panelists are poet and activist Amiri Baraka, Ron Walters, director of the African American Leadership Center at the University of Maryland and Kenneth Lawrence, Temple University's senior vice president for Government, Community and Public Affairs. This discussion will be held from 5:30 p.m. to 7:30 p.m. in Anderson Hall, room 13.

Starting the discussion with politics makes sense because there are few political stories in the African American community bigger than the Obama Presidency, said Nathaniel Norment, director of Temple's Center for African American Research and Public Policy and chair of the African American Studies Department.

"We are experiencing a unique and historical political reality with the election of President Barack Obama," Norment said. "African Americans must seize this time to develop strategic economic and political actions that will empower our communities. The conference provides an opportunity to begin this work."

On Saturday, the conference continues with a panel discussion on the evolution of Black Studies from its inception at San Francisco University in the late 1960s to the present day and whether or not it is still relevant in the Age of Obama.

Among those expected to attend this discussion are John Bracey Jr., professor in the W.E.B DuBois Department of African American Studies at the University of Massachusetts-Amherst; Jimmy Garrett, one of the founders of the first Black Studies Department at San Francisco State; Rosemari Mealy, an activist and former member of the Black Panther Party who has studied the place of women within the party and is best known for her book detailing the meeting of Malcolm X and Fidel Castro; and Charles Jones, president of the National Council of Black Studies. This discussion will be held at 10:30 a.m. in room 160 Beury Hall.

In addition to the two plenary sessions, there will be a variety of working groups that will discuss some of the issues that the Obama Administration has tackled during the first 100 Days and whether or not the needs of African Americans have been addressed. Topics such as communications and media, the Labor movement, and Veterans Affairs will be discussed with the help of panelists and facilitators including Henry Nicholas, president of the National Union of Hospital and Healthcare Employees (1199-C), Linn Washington, associate professor in Temple's Department of Journalism and columnist for the Philadelphia Tribune, and Temple poet-in-residence and activist Sonia Sanchez. ###

For more information on A Conference Call: A 100 Day Assessment of the Obama Presidency From an African American Perspective, please contact Denise Clay at 215-204-6522 (office); 215-900-3337(mobile) or denise.clay@temple.edu.

Contact: Denise Clay denise.clay@temple.edu 215-204-6522 Temple University

More African-Americans die from causes that can be prevented or treated

Two-thirds of the difference between death rates among African Americans and Caucasians are now due to causes that could be prevented or cured, according to a new study appearing in the Journal of Epidemiology and Community Health. The study, "Black-White Differences in Avoidable Mortality in the United States, 1980-2005," found that death from preventable or treatable conditions represented half of all deaths for individuals under age 65 and accounted for nearly 70 percent of the black-white mortality difference.

"People should not be dying prematurely from stroke, hypertension, diabetes, colon cancer, appendicitis or the flu. Our study shows that while much progress has been made, our health care system is still failing to meet the very basic needs of some Americans.

Many disparities can be conquered by focusing more on public policies that promote prevention and by ensuring that all Americans have access to good quality health care," said James Macinko, who conducted the research as a Robert Wood Johnson Foundation Health & Society Scholar at the University of Pennsylvania. He is the lead author of the study.

The major reason for the black-white mortality gap—representing about 30 percent of the gap for men and 42 percent for women—is due to conditions that have effective treatments, the study found. Disparities were most pronounced for conditions or diseases for which deaths can be prevented, such as diabetes, stroke, infectious and respiratory diseases, preventable cancers, and circulatory diseases like hypertension.

The conditions analyzed included premature deaths from common infectious diseases, cervical cancers, appendicitis, maternal deaths, hypertension, stroke, diabetes, peptic ulcers and traffic accidents, all of which could be avoided through medical care or health policy changes. The study suggests that the reinforcement of policies that improve access to quality medical care will be important to reducing death disparities.

"As the nation turns its attention to health care reform, we now know that much can be done to reduce racial and ethnic health care disparities and to improve the health care for all Americans," said Macinko. "We also have a lot to learn from other health care systems that measure performance based on preventable deaths."

To analyze the death disparity among African Americans and Caucasians, the scholar used "avoidable mortality," a commonly used measure of health system performance in Europe. It is defined as premature death under age 65 from conditions responsive to medical care, changes in public policy, or behaviors. Over the last decade, avoidable mortality has declined less rapidly in the United States than in other industrialized nations.

"Avoidable mortality gives us one way to assess the shortcomings of our health care system, particularly in the area of prevention," said Irma T. Elo, Ph.D., co-author on the report and an associate professor of sociology at the University of Pennsylvania. "It can help to identify where preventable disparities are greatest and aid in directing resources to where they can improve the health of vulnerable populations." ###

Elo also serves as an affiliated-faculty member for the RWJF Health & Society Scholars Program at the University of Pennsylvania.

The RWJF Health & Society Scholars Program is designed to build the nation's capacity for research, leadership and policy change to address the broad range of factors that affect health. Information about the RWJF Health & Society Scholars Program, including application information, can be found at www.healthandsocietyscholars.org.

Contact: Jennifer Combs jcombs@iqsolutions.com 240-221-4256 RWJF Health & Society Scholars Program

Study of neighborhoods points to modifiable factors, not race, in cancer disparities

While cities have shown considerable racial disparities in cancer survival, those racial disparities virtually disappear among smaller populations, such as neighborhoods within that city. The finding comes from a new analysis published in the May 15, 2009 issue of CANCER, a peer-reviewed journal of the American Cancer Society. The study examined breast and prostate cancer survival rates at different geographic levels, and the results suggest that there are significant societal factors at the root of cancer-related racial disparities.

Previous research has shown that considerable health disparities exist relating to race, ethnicity, geographic location, and other factors. While researchers have been striving to understand the causes of such disparities in survival from some cancers, including cancers of the breast and prostate, the potential roles of innate factors, such as genetic differences, versus modifiable factors, such as socioeconomic differences, remain unclear.

Jaymie R. Meliker, Ph.D.

Researchers led by Jaymie Meliker, Ph.D. of Stony Brook University investigated if these disparities remained among different population sizes—for example whether disparities seen in counties persisted in cities and even neighborhoods. They studied regions in Michigan, drawing from the Michigan Cancer Surveillance Program, which compiled information from 1985-2002 on 124,218 breast cancer and 120,615 prostate cancer patients.

The team's goal was to conduct an analysis of racial disparities in cancer survival at different geographic scales. As the geographic scale decreases, the population becomes more homogenous in terms of socioeconomic status and other characteristics, such as proximity to medical screening facilities. Therefore, the researchers hypothesized that if racial disparities diminished when smaller geographic areas were analyzed, modifiable factors, not biology, may be responsible for the disparity.

The study revealed that whites experienced significantly higher survival rates for prostate and breast cancer compared with blacks throughout much of southern Michigan when large geographic regions were analyzed. However, when the investigators analyzed smaller geographic regions, such as legislative districts and community-defined neighborhoods, disparities diminished or virtually disappeared.

"When racial disparities vanish in small geographic areas, it suggests that modifiable factors are responsible for apparent racial disparities observed at larger geographic scales," the authors write. These modifiable factors could include socioeconomic factors, differences in tumor stage, differences in treatment and the presence of additional health conditions. It is unclear which of these are important, but this study's findings suggest that genetic factors are not likely to play a large role in disparities of survival from prostate and breast cancer. ###

Article: "Breast and prostate cancer survival in Michigan: can geographic analyses assist in understanding racial disparities?" Jaymie R. Meliker, Pierre Goovaerts, Geoffrey M. Jacquez, Gillian A. AvRuskin, and Glenn Copeland. CANCER; Published Online: April 13, 2009 (DOI: 10.1002/cncr.24251); Print Issue Date: May 15, 2009.

Contact: Greg Filiano at gfiliano@notes.cc.sunysb.edu. David Sampson American Cancer Society david.sampson@cancer.org . Claire Greenwell American Cancer Society claire.greenwell@cancer.org 404-417-5883 American Cancer Society

Consuming a little less salt could mean fewer deaths

For every gram of salt that Americans reduce in their diets daily, a quarter of a million fewer new heart disease cases and over 200,000 fewer deaths would occur over a decade, researchers said at the American Heart Association's 49th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.

These results were derived from a validated computer-simulation of heart disease among U.S. adults.

"A very modest decrease in the amount of salt — hardly detectable in the taste of food — can have dramatic health benefits for the U.S.," said Kirsten Bibbins-Domingo, Ph.D., M.D., M.A.S., lead author of the study and an assistant professor of Medicine and of Epidemiology at the University of California, San Francisco. "It was a surprise to see the magnitude of the impact on the population, given the very small reductions in salt that we were modeling."

Kirsten Bibbins-Domingo, Ph.D., M.D. Current position: Assistant Professor in Residence of Medicine, Epidemiology and Biostatistics

A 3-gram–a-day reduction in salt intake (about 1200 mg of sodium) would result in 6 percent fewer cases of new heart disease, 8 percent fewer heart attacks, and 3 percent fewer deaths. Even larger health benefits are projected for African Americans, who are more likely to have high blood pressure and whose blood pressure may be more sensitive to salt. Among African Americans, new heart disease cases would be reduced by 10 percent, heart attacks by 13 percent and deaths by 6 percent. For years, ample evidence has linked salt intake to high blood pressure and heart disease. Yet, salt consumption among Americans has risen by 50 percent and blood pressure has risen by nearly the same amount since the 1970s, according to researchers.

Currently, Americans eat 9-12 grams of salt per day (or 3600-4800 mg of sodium. This amount is far in excess than recommended by most health organizations (5-6 grams/day of salt or 2000-2400 mg sodium). Each gram of salt contains 0.4 grams of sodium.

"It's clear that we need to lower salt intake, but individuals find it hard to make substantial cuts because most salt comes from processed foods, not from the salt shaker," Bibbins-Domingo said. "Our study suggests that the food industry and those who regulate it could contribute substantially to the health of the nation by achieving even small reductions in the amount of salt in these processed foods."

To estimate the benefit of making small reductions in salt intake, the investigators used the Coronary Heart Disease Policy Model, a computer simulation of heart disease in the U.S. adult population. The model can be used to evaluate the impact of policy changes on the health of the nation, and has previously been used to project the future of heart disease in the United States given the current rate of childhood obesity, Bibbins-Domingo said.

The researchers used the model to estimate the impact of an immediate reduction of daily salt intake by 0𔃄 grams on the incidence of cardiovascular disease and deaths between 2010�. In that period, the model suggests that more than 800,000 life-years could be saved for each gram of salt lowered. Larger reductions would have greater benefits, with a 6 gram reduction resulting in 1.4 million fewer heart disease cases, 1.1 million fewer deaths and over 4 million life-years saved.

Because the majority of salt in the diet comes from prepared and packaged foods, the results of the study reveal the need for regulatory changes or voluntary actions by the food industry to make achievable changes in heart health, Bibbins-Domingo said.

The researchers are planning to assess the cost-effectiveness of various interventions already being used to reduce salt consumption in other countries, including industry collaborations, regulations and labeling changes.

Co-authors are: Glenn M. Chertow, M.D., M.P.H.; Andrew E. Moran, M.D., M.A.S.; Pamela G. Coxson, Ph.D.; and Lee Goldman, M.D., M.P.H. Individual author disclosures are available on the abstract.

The study was funded by the University of California, San Francisco Clinical and Translational Sciences Institute Strategic Opportunities for Support intramural grant. ###

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events.

The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.

Editor's note: The American Heart Association recommends healthy American adults should reduce their sodium intake to less than 2300 mg (about 1 teaspoon) per day. Americans consume up to 75 percent of their sodium from processed foods like tomato sauce, soups, condiments, canned foods and prepared mixes. The FDA and USDA state that an individual food that has the claim "healthy" must not exceed 480 mg sodium per reference amount. "Meal type" products must not exceed 600 mg sodium per labeled serving size. For more information visit: www.americanheart.org/presenter.

Contact: Karen Astle karen.astle@heart.org 214-706-1392 American Heart Association

Elderly blacks and whites are not getting the same care for lung cancer

HOUSTON – (April 13, 2009) – When it comes to the treatment of lung cancer in the elderly, blacks are less likely to get chemotherapy or surgery than whites, according to a new study by epidemiologists at The University of Texas School of Public Health that appears in the May 15 issue of CANCER, a peer-reviewed journal of the American Cancer Society.

The investigators found that lung cancer treatment disparities between blacks and whites were just as large in 2002, as they were in the early 1990s, despite efforts to address inequalities in medical treatment. In fact, the gap between blacks and whites is more pronounced among women, older patients or people in the poorest socioeconomic quartile.

To remedy the situation, the authors wrote, “Efforts should focus on providing appropriate quality treatment and educating blacks on the value of having these treatments to reduce these disparities in receipt of treatment.”

UT School of Public Health researchers Dale Hardy, Ph.D., and Xianglin Du., M.D., Ph.D.

The researchers conducted a retrospective study of 83,101 seniors who were enrolled in Medicare between 1991 and 2002 and diagnosed with non-small cell lung cancer. Medicare is the official federal health insurance for people 65 years of age or more and those with disabilities. Lung cancer is the leading cause of death from all types of cancers in the United States with an estimated 161,840 deaths in 2008.

Non-small cell lung cancer accounts for nearly 90 percent of lung cancer.

“We thought the disparity would have narrowed,” said Dale Hardy, Ph.D., lead author and research associate at the UT School of Public Health. “We were surprised that the gap is still there.”

Hardy now plans to analyze the impact of this treatment disparity on patient outcomes.

In their analysis, the investigators found that blacks with early stage lung cancer were 37 percent less likely than whites to receive surgery and 42 percent less likely to receive chemotherapy. Researchers found no significant difference between blacks and whites when it came to people receiving radiation for advanced stage cancer.

During the advanced stages of cancer, blacks were 57 percent less likely to receive chemotherapy than whites.

Factors contributing to the treatment disparities, according to the researchers, could include blacks being less likely than whites to receive recommendations for surgery and more likely to refuse recommendations for surgical treatments.

Xianglin Du., M.D., Ph.D., an associate professor of epidemiology at the UT School of Public Health, was senior author. Other UT School of Public Health contributors include: Chih-Chin Liu, graduate student; Rui Xia, graduate student; Wenyaw Chan, Ph.D., professor of biostatistics; Arica White, predoctoral fellow; and Keith Burau, Ph.D., associate professor of biostatistics. Janice N. Cormier, M.D., associate professor of surgical oncology and biostatistics at The University of Texas M. D. Anderson Cancer Center, also collaborated on the study.

The study is titled “Racial Disparities and Treatment Trends in a Large Cohort of Elderly Black and White Patients with Nonsmall Cell Lung Cancer.” The study was supported by a grant from the Agency for Healthcare Research and Quality.

Media Contact: Robert Cahill Robert.Cahill@uth.tmc.edu Media Hotline: 713-500-3030

Why do blacks with advanced kidney disease live longer than whites?

Blacks more likely to progress to end stage disease, whites more likely to die before kidney failure

Blacks in the United States are more likely to require dialysis and develop end stage renal disease (ESRD) than whites, but they also live longer than whites once they reach later stages of kidney disease. A study of this phenomenon will appear in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN).

Csaba P. Kovesdy, MD (Salem VA Medical Center), John E. Anderson, MD, Stephen F. Derose, MD, and Kamyar Kalantar-Zadeh, MD, PhD (University of California Los Angeles), investigated by comparing 298 black and 945 white male patients with moderate and advanced chronic kidney disease (CKD) who were not on dialysis and who were treated within the Veteran Health Administration (VA) System.

"Studying patients with non-dialysis dependent CKD is important to determine the reasons behind the higher incidence of ESRD in blacks in order to address the root causes of this discrepancy," said Dr. Kovesdy. Conducting the study within the VA System allowed the researchers to analyze a group of patients in which blacks and whites had similar access to health care.

The investigators found that the rates of kidney function decline were similar in blacks and whites, but blacks were less likely to die once they reached moderate to advanced kidney disease.

The lower death rates in black patients with later stages of disease were mainly due to a lower prevalence of cardiovascular disease; the higher incidence of ESRD was explained by clinical characteristics such as lower initial kidney function.

The authors' suspect that lower death rates among blacks with moderate to advanced kidney disease is due to higher death rates among blacks in earlier stages of kidney disease. Blacks who survive earlier stages have fewer health issues (such as cardiovascular disease) than whites. This would explain why blacks had better survival rates than whites among the VA patients. "These survival discrepancies are quite different from what is seen in the general population, where black Americans typically experience higher mortality and lower life expectancy than whites," said Dr. Kovesdy. "More research is needed to explain these differences and to alleviate the racial and ethnic discrepancies in health outcomes in the US," he added. ###

Some of this material was presented at the American Society of Nephrology Renal Week 2008, Philadelphia, PA. This study is supported by grant 1R01DK078106-01 to Dr. Kovesdy and Dr. Kalantar-Zadeh. The study authors reported no financial disclosures.

The article, entitled "Outcomes Associated with Race in Males with Non-Dialysis Dependent CKD," will appear online at cjasn.asnjournals.org/ on April 15, 2009, doi 10.2215/CJN.06031108.

ASN is a not-for-profit organization of 11,000 physicians and scientists dedicated to the study of nephrology and committed to providing a forum for the promulgation of information regarding the latest research and clinical findings on kidney diseases. ASN publishes the Journal of the American Society of Nephrology (JASN), the CJASN, and the Nephrology Self-Assessment Program (NephSAP). In January 2009, the Society will launch ASN Kidney News, a newsmagazine for nephrologists, scientists, allied health professionals, and staff.

Contact: Shari Leventhal sleventhal@asn-online.org 202-416-0658 American Society of Nephrology

Image 2: CDC's Diabetes Program - Data & Trends

Patient preferences play role in racial disparities in rheumatoid arthritis treatment

New study examined whether African-American and white patients with RA differ in how they make trade-offs between risks and benefits related to treatment

Racial disparities in the delivery of healthcare occur even among insured populations with access to care. This suggests that some of the differences in health care utilization among different racial groups may be due to patient preferences. Rheumatoid arthritis (RA) treatment decisions are frequently complex, requiring multiple trade-offs between symptom relief, long-term reduction of disability, adverse events and serious complications. A new study examined whether African American and white patients with RA differ in how they make trade-offs between risks and benefits related to treatment. The study was published in the April issue of Arthritis Care & Research (www3.interscience.wiley.com/journal/77005015/).

Led by Dr. Liana Fraenkel of Yale University, researchers examined how 136 RA patients made trade-offs about specific treatment characteristics related to commonly used RA drugs. These included benefits such as the chance of remission or symptom improvement, and risks such as side effects and theoretical risk of cancer. They analyzed how patients made trade-offs in treatment decisions to determine how respondents value specific characteristics.

The results showed that there were significant differences in the ways that African American and white patients evaluated treatment characteristics. African American patients, who comprised 49 percent of the study sample, attached greater importance to the risk of toxicity, particularly for rare, serious adverse events, and less importance to the likelihood of benefit than white patients. For example, African Americans assigned the greatest importance to the theoretical risk of cancer, whereas white patients were most concerned with the likelihood of remission and halting radiographic progression.

Until now, it has been widely believed that differences in treatment by race can be corrected by changes in either health care providers or the health care system. This is because research on health care disparities has largely focused on access to care, lack of insurance, quality of care due to unconscious practitioner bias and social factors.

Although the Institute of Medicine's model of health disparities includes an acknowledgement that these may be due in part to differences in preferences of care, few studies have tested this notion and racial/cultural differences in risk/benefit perception remain an under-researched field.

"Our study is important because, to the best of our knowledge, this is the first study to formally assess whether risk preference for therapy is one of the potential explanations of the lower use among African Americans of more effective, although more risky, therapy for a chronic disabling disease," the authors state. They point out that disparate models of health and illness may lead to disparate patient preferences, as well as limited communication during clinical visits.

The study showed that African Americans were significantly more risk averse than their white counterparts, which the authors theorize may be due to "cultural risk aversion for gains." This type of risk aversion is based on a learned distrust or low expectations of the healthcare system that arise when a subgroup observes significant gains in lifespan, economic prosperity and power of the larger culture, but does not experience these gains even though they live in the same country or culture.

The authors conclude: "Given these results, physicians should confirm that patients have accurate expectations regarding the natural history and treatment of their disease, and ensure that patient preferences are based on an informed assessment of the pros and cons related to available treatment options." ###

Article: "Understanding Why Rheumatoid Arthritis Patient Treatment Preferences Differ By Race," Florina Constantinescu, Suzanne Goucher, Arthur Weinstein, Wally Smith, Liana Fraenkel, Arthritis & Rheumatism (Arthritis Care & Research), April 2009.

Contact: Sean Wagner medicalnews@bos.blackwellpublishing.com 781-388-8550 Wiley-Blackwell

Image: Rheumatoid Arthritis

Increase in p53 mutation linked to advanced colorectal cancer in blacks

PHILADELPHIA – Researchers have identified a possible genetic cause for increased risk for a more advanced form of colorectal cancer in blacks that leads to shorter survival, according to data published in Clinical Cancer Research, a journal of the American Association for Cancer Research.

Understanding the relationship between molecular defects and differences in colorectal cancer incidence, aggressiveness and clinical outcomes is important in individualizing the treatment and in eliminating racial disparities.

"Several studies have identified a disparity between African-Americans and whites for colorectal cancer. What this study does is pinpoint a possible genetic cause," said Upender Manne, Ph.D., associate professor in the Department of Pathology at the University of Alabama at Birmingham.

For the current study, Manne and colleagues analyzed 137 colorectal adenocarcinomas from African-American patients and 236 colorectal adenocarcinomas from non-Hispanic whites. Researchers assessed these carcinomas for p53 mutations and genotyped for codon 72 polymorphisms.

Overall, whites and African-Americans had a similar rate of p53 mutations. However, the frequency of the Pro72 allele was higher in blacks at 17 percent compared with 7 percent among whites. By contrast, the Arg72 allele frequency was higher in whites at 36 percent than in African-Americans, where the frequency was 19 percent.

representation of a complex between DNA and the protein p53

Presence of the Pro72 allele in blacks was associated with a more than two-fold increase in mortality due to colorectal cancer. "This paper shows that in a subset of patients with the Pro72 allele, and the susceptibility to p53 mutations may be a possible molecular explanation for the racial disparity," said Manne. ### The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, AACR is the world's oldest and largest professional organization dedicated to advancing cancer research. The membership includes more than 28,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and 80 other countries. The AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants.

The AACR Annual Meeting attracts more than 17,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care. The AACR publishes five major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; and Cancer Epidemiology, Biomarkers & Prevention.

The AACR's most recent publication and its sixth major journal, Cancer Prevention Research, is dedicated exclusively to cancer prevention, from preclinical research to clinical trials. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.

Contact: Jeremy Moore Jeremy.moore@aacr.org 267-646-0557 American Association for Cancer Research

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American Geographical Society awards honor Matthew Alexander Henson, on April 15 at UD

The American Geographical Society's awards ceremony on Wednesday, April 15, at the University of Delaware will honor past and present polar explorers - of this planet and of Mars.

Also recognized will be the researchers who oversaw the gargantuan task of relocating the society's library, described as "the largest privately owned geographical research collection in the western hemisphere," from New York to Wisconsin in the 1970s.

The public is invited to attend the ceremony, which begins at 7:30 p.m. at the Louise and David Roselle Center for the Arts. Register online at this Web page.

The ceremony will be Webcast live at this site and made available as a podcast after the event at the UD podcast Web site.

The lecture also will be simulcast into the University of Delaware's virtual world in Second Life, at this location. You must have an avatar in Second Life to visit using this link. Cullum Geographical Medal The Cullum Geographical Medal, "for those who distinguish themselves by geographical discoveries or in the advancement of geographical science,

" will be presented to Peter Smith, principal investigator of the Phoenix Mars Mission, and be awarded posthumously to Matthew Henson, the African American explorer who accompanied Commander Robert Peary on the 1909 expedition to the North Pole.

Born in Charles County, Md., Henson became an adventurer early in life, going to sea at the age of 12 as a cabin boy aboard a merchant ship. In 1887, while working as a stock clerk in Washington, D.C., he met Peary, then a U.S. Navy lieutenant, who offered him a job as his valet on a surveying expedition in Nicaragua. Peary was so impressed by Henson's skills and knowledge that he asked him to join him on his arctic adventures over the next two decades, culminating in the 1909 expedition to the North Pole.

Peary repeatedly acknowledged that he could not have reached the top of the world-a feat many believe to have been accomplished on April 6, 1909 - without Henson, who learned all he could from the native Inuit people, including their language, how to build a camp and repair sledges, drive a dog team, make fur clothing, and hunt.

Although Henson's role went largely unacknowledged at the time, later in life he was awarded honorary degrees by Howard University and Morgan College, given lifetime membership in the Explorers Club, and honored at the White House by President Eisenhower. In 1951, he signed the AGS Fliers' and Explorers' Globe at a lavish ceremony in New York's Waldorf Astoria Hotel. Upon his death in 1955, Henson was buried in Woodlawn Cemetery in New York City. In 1988, he was re-interred as a hero, at Arlington National Cemetery alongside Peary.

Leila Savoy Adrade, Henson's great-great grandniece, will accept the Cullum Medal on his behalf. Deirde C. Stam of the Palmer School of Library and Information Science, Long Island University, will offer remarks about Henson's life and accomplishments. In February, Stam republished Henson's 1912 autobiographical account of his North Pole journey. Issued through the Explorers Club of New York, the 2009 edition contains a wealth of new information about Henson.

Peter Smith, senior research scientist at the University of Arizona's Lunar and Planetary Laboratory, led NASA's Phoenix Mars Mission. The Phoenix Mars Lander, the first in NASA's Scout class, was launched on August 4, 2007, and touched down in the Martian arctic on May 25, 2008, to search the soil of the Red Planet for the building blocks of life.

During five months of operations, the probe confirmed the presence of frozen water just below the planet's surface, found minerals that form in liquid water, identified potential nutrients in the soil, and observed snow in the atmosphere. Phoenix's cameras captured more than 25,000 pictures, from grand landscapes to nanoscale images using the first atomic force microscope ever used outside Earth.

Throughout the mission, which ended in November 2008, Smith and his team controlled the lander from the University of Arizona's Science Operations Center, working closely with NASA's Jet Propulsion Laboratory in Pasadena, Calif., and Lockheed Martin Space Systems in Denver. An international assembly of scientific institutes in Canada, Denmark, Finland, Germany, and Switzerland also was involved.

Smith will deliver a public lecture on Thursday, April 16, at 7:30 p.m. at the Center for the Arts. Register for the free event at this Web site.

Samual F. B. Morse Medal

The Samuel Finley Breese Morse Medal, "for the encouragement of geographical research," will be presented to Barbara Borowiecki, professor emerita of geography, and William Roselle, director (retired) of the Golda Meir Library, at the University of Wisconsin-Milwaukee.

Borowiecki made the initial suggestion that the AGS Library in New York be moved to UW-Milwaukee. Used by researchers around the world, the library today numbers more than 1.2 million items, including maps and atlases, books and periodicals, LANDSAT images, photographs, and globes.

She and Roselle prepared a detailed feasibility study that was used to generate support for the project. The pair oversaw many of the details of the library's relocation from uptown Manhattan to Milwaukee, a distance of nearly 1,000 miles. The move took place from July 26 through Sept. 12, 1978, in 16 full-size moving vans.

On Friday, April 17, Roselle will describe "the moving experience" in the Department of Geography's seminar series. The talk will begin at 3:30 p.m. in Room 127 Memorial Hall. A reception will follow.

Borowiecki, a distinguished geomorphologist and horsewoman, was born and raised in Warsaw, Poland. She was a member of the Polish Underground during World War II. Her family immigrated to the United States in the 1940s. After receiving an engineering degree at Indiana University, she enrolled at the University of Wisconsin to pursue her doctorate in geography. Her research and teaching career at UW-Milwaukee focused on eolian and Pleistocene geomorphology and European regional geography.

Roselle, a native of Pennsylvania, received his B.A. from Thiel College and M.L.S. from the University of Pittsburgh. Prior to entering librarianship, he served two years in the U.S. Army and taught at the Milton Hershey School. He held posts at the Pennsylvania State University and the University of Iowa before going to the University of Milwaukee-Wisconsin, where he served two decades as professor and director of the Golda Meir Library. He is the brother of David Roselle, University of Delaware president emeritus.

The award ceremony will include brief remarks by each recipient and be followed by a reception, where Stam and Roselle will sign copies of their books.

Together, the award ceremony and public lecture mark the culmination of the University of Delaware's William S. Carlson International Polar Year Events, celebrating UD's president from 1946-1950, who was an Arctic explorer, and the University's significant polar research in the world's fourth International Polar Year, which began in March 2007 and concluded in April 2009. ###

Contact: Tracey Bryant tbryant@udel.edu 302-831-8185 University of Delaware

Making the list -- disparities in kidney transplant waiting lists

Blacks in poor neighborhoods suffer greatest inequality

You might expect that living close to a clinic that specializes in transplanting organs would put you at an advantage if you needed a new kidney. According to an upcoming study in the Journal of the American Society Nephrology (JASN), you would be wrong. The study found that distance from a patient's home to the nearest transplant facility has no bearing on whether an individual is placed on the transplant waiting list. However, the research identified other factors associated with disparities in waitlisting, including neighborhood poverty.

Access to kidney transplants is not equal for all patients, particularly when comparing patients of different races.

Caption: This is Rachel Patzer, MPH, from Emory University. Credit: N/A. Usage Restrictions: None.

To understand this disparity, Rachel Patzer, MPH, Sandra Amaral, MD, and their colleagues at Emory University in Atlanta analyzed data from 1998 to 2002 of 35,346 patients in Georgia, North Carolina, and South Carolina who had end-stage renal disease (ESRD). They found that black patients were less likely than whites to be placed on the kidney transplant waiting list, and this disparity was not associated with the distance to the nearest transplant center. They also found that as neighborhood poverty increased, the likelihood of being placed on the waiting list decreased for blacks compared with whites. "We found the most striking disparity in the poorest neighborhoods, where blacks were 57% less likely to be waitlisted for transplantation than whites," said Patzer.

The researchers offer several potential explanations for these racial disparities. Social, behavioral, cultural, and biologic factors may play a role, as could patient preferences (black patients have been shown to be less likely to want a transplant).

"Exploring the role of these factors in the observed racial differences in waitlisting outcomes is important in developing effective solutions for improving equality in access to healthcare," said senior author William McClellan, MD. Dr. Amaral adds, "Our study suggests that poverty also needs to be considered as an influential factor in these racial differences. Constructing future interventions that reach out to poorer communities may be one approach to mitigate racial disparity in transplantation." ###

Caption: This is William McClellan, M.D., from Emory University. Credit: N/A. Usage Restrictions: None.

The authors report no financial disclosures.

The article, entitled "Neighborhood Poverty and Racial Disparities in Kidney Transplant Waitlisting," will appear online at jasn.asnjournals.org/ on Wednesday, April 1, 2009, doi 10.1681/ASN.2008030335.

Founded in 1966, the American Society of Nephrology (ASN) is the world's largest professional society devoted to the study of kidney disease. Comprised of 11,000 physicians and scientists, ASN continues to promote expert patient care, to advance medical research, and to educate the renal community. ASN also informs policymakers about issues of importance to kidney doctors and their patients. ASN funds research, and through its world-renowned meetings and first-class publications, disseminates information and educational tools that empower physicians.

Contact: Shari Leventhal, sleventhal@asn-online.org 202-416-0658. American Society of Nephrology

African Burial Ground PHOTO ESSAY

Return to the Past to Build the Future. GSA’s African Burial Ground project began in 1991, when, during excavation work for a new federal office building, workers discovered the skeletal remains of the first of more than 400 men, women and children. Further investigation revealed that during the 17th and 18th centuries, free and enslaved Africans were buried in a 6.6 acre burial ground in lower Manhattan outside the boundaries of the settlement of New Amsterdam, which would become New York. Over the decades, the unmarked cemetery was covered over by development and landfill.

Managed by GSA, the overall project is a testimonial to a positive and collaborative partnership between many parties, including the Department of the Interior’s National Park Service, the U.S. Army Corps of Engineers, the Advisory Council on Historic Preservation, Howard University, the Schomburg Center for Research in Black Culture, and the African American community.

Today the site is a National Monument featuring a distinctive memorial that commemorates and communicates the story of the African Burial Ground—the single-most important, historic urban archaeological project undertaken in the United States.

The African Burial Ground National Monument, located at the corners of Duane and Elk Streets in lower Manhattan, is operated by the National Park Service. For directions to the site and more information, go to www.nps.gov/afbg The memorial is open Monday through Sunday 9:00 a.m. until 5:00 p.m. except Thanksgiving, Christmas, and New Years Day.

The African Burial Ground Visitor Center is located in the adjacent Ted Weiss Federal Building at 290 Broadway. The hours of operation are Monday thorough Friday, 9 a.m. to 5 p.m. except for federal holidays. For more information please contact: African Burial Ground National Monument National Park Service 290 Broadway New York, NY 10007 Phone 212-637-2019.

For more information on the U.S. General Services Administration, please go to www.gsa.gov This website contains information on GSA’s African Burial Ground project, the memorial, artwork, interpretive center, reinterment ceremony, scientific reports and more. africanburialground.gov

It has been estimated that as many as 200 burials may remain undisturbed on this site. Scientific analysis of the remains indicate that the remains found at 290 Broadway, are indeed of African origin or descent. Artifacts were found in and around the human remains. Some have been positively identified as relating to a specific individual.

All resources related to the ABG, including DNA samples, have been inventoried and stored in accordance with federal regulations and accepted professional standards. The government will select a long-term repository when all current research has been completed.

Access to these materials for future research will be determined on a case-by-case basis by appropriately qualified professionals.

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1 in 7 US teens is vitamin D deficient

Weill Cornell Medical College study finds prevalence highest among African-Americans

NEW YORK -- One in seven American adolescents is vitamin D deficient, according to a new study by researchers in the Department of Public Health at Weill Cornell Medical College. The findings are published in the March issue of the journal Pediatrics and were presented at the Pediatric Academic Societies' Annual Meeting in May 2008.

In children, vitamin D deficiency can interfere with bone mineralization, leading to rickets. In adults, it is linked to cardiovascular disease, cancer, diabetes, immune dysfunction and hypertension.

The study employs a new definition of vitamin D deficiency recommended by a group of scientists attending the 13th Workshop Consensus for Vitamin D Nutritional Guidelines in 2007. These experts collectively proposed that the minimum acceptable serum vitamin D level be raised from 11 nanograms per milliliter (ng/mL) to at least 20 ng/mL.

D3 cholecalciferol

Using the newer criteria, the study finds more than half of African-American teens are vitamin D deficient. Girls had more than twice the risk of deficiency compared with boys. And overweight teens had nearly double the risk of their normal-weight counterparts. "These are alarming findings. We need to do a better job of educating the public on the importance of vitamin D, and the best ways to get it. To meet minimum nutritional requirements teens would need to consume at least four glasses of fortified milk daily or its dietary equivalent.

Other foods rich in vitamin D include salmon, tuna, eggs and fortified cereals. A vitamin supplement containing 400 IU of vitamin D is another alternative," says Dr. Sandy Saintonge, assistant professor of clinical pediatrics and assistant professor of clinical public health at Weill Cornell Medical College, and a pediatric emergency physician at New York Hospital Queens, a member of the NewYork-Presbyterian Hospital Healthcare System. "We should also consider a national fortification strategy, perhaps including routine supplementation and monitoring of serum levels, but more research is needed to determine optimal vitamin D levels."

Of the specific findings, the authors were particularly concerned about the role of weight in deficiency. "Because vitamin D is stored in body fat, simply increasing the dosage of vitamin D may not be effective in overweight adolescents," notes senior author Dr. Linda M. Gerber, professor of public health in the Division of Biostatistics and Epidemiology and professor of epidemiology in medicine at Weill Cornell Medical College. "As the prevalence of childhood obesity increases, vitamin D deficiency may increase as well. In this group, appropriate nutrition could solve both problems."

Another concern is the increased risk of deficiency in girls, some of whom may become pregnant during adolescence. The authors note that a lack of vitamin D may increase maternal risk of preeclampsia and gestational diabetes and may be associated with reduced bone mineralization in the offspring.

Data was obtained from National Health and Nutrition Examination Survey III, a cross-sectional survey administered to a nationally representative sample of persons aged 2 months and older. Analyses were restricted to 2,955 participants aged 12 to 19.

The study was co-authored by Dr. Heejung Bang, associate professor of biostatistics in public health at Weill Cornell Medical College.

###

Weill Cornell Medical College

Weill Cornell Medical College, Cornell University's medical school located in New York City, is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine, locally, nationally and globally. Weill Cornell, which is a principal academic affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum that integrates the teaching of basic and clinical sciences, problem-based learning, office-based preceptorships, and primary care and doctoring courses.

Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research in areas such as stem cells, genetics and gene therapy, geriatrics, neuroscience, structural biology, cardiovascular medicine, transplantation medicine, infectious disease, obesity, cancer, psychiatry and public health -- and continue to delve ever deeper into the molecular basis of disease in an effort to unlock the mysteries of the human body in health and sickness.

In its commitment to global health and education, the Medical College has a strong presence in places such as Qatar, Tanzania, Haiti, Brazil, Austria and Turkey. Through the historic Weill Cornell Medical College in Qatar, the Medical College is the first in the U.S. to offer its M.D. degree overseas.

Weill Cornell is the birthplace of many medical advances -- including the development of the Pap test for cervical cancer, the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the first clinical trial of gene therapy for Parkinson's disease, the first indication of bone marrow's critical role in tumor growth, and most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. For more information, visit www.med.cornell.edu.

Contact: Lezlie Greenberg leg2003@med.cornell.edu 212-821-0560 New York- Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College

Exposure to family violence compromises physical and mental health of older women

New Rochelle, NY, March, 2009—Older African American women exposed to high levels of family violence during their lifetimes are at significantly greater risk of poor health status, according to a report in the current issue of Journal of Women's Health, a peer-reviewed journal published by Mary Ann Liebert, Inc. (www.liebertpub.com). This report is available free online at www.liebertpub.com/jwh

Higher lifetime exposure among older African American women to family violence, which may include intimate partner violence and elder maltreatment, is linked to worse physical and mental health, regardless of when the exposure occurred. Anuradha Paranjape, MD, MPH, Nancy Sprauve-Holmes, MPH, John Gaughan, PhD, and Nadine Kaslow, PhD, from Temple University School of Medicine (Philadelphia, PA) and Emory University School of Medicine (Atlanta, GA), used a survey to assess lifetime family violence levels, including physical violence, emotional, financial, and sexual abuse, neglect, and coercion, among 158 African American women 50 years of age or older attending ambulatory medicine clinics at a large inner-city public hospital in the southeastern U.S. The authors also gathered measures of the women's physical and mental health status.

In the article entitled, "Lifetime Exposure to Family Violence: Implications for the Health Status of Older African American Women," the authors conclude that a holistic approach to caring for older African American women should include greater awareness by clinicians of current and past violence exposure and the negative effects it may have on the health status of these women.

"This study provides further evidence of the enduring harmful effects that family violence can have on both mental and physical health, and in particular it highlights the association between such exposure and the health of older African American women," says Susan G. Kornstein, MD, Editor-in-Chief of Journal of Women's Health, and Executive Director of the Virginia Commonwealth University Institute for Women's Health, Richmond, VA. ###

Journal of Women's Health, published monthly, is a core multidisciplinary journal dedicated to the diseases and conditions that hold greater risk for or are more prevalent among women, as well as diseases that present differently in women. Under the leadership of Editor-in-Chief Susan G. Kornstein, MD, and Deputy Editor Wendy S. Klein, MD, of the Virginia Commonwealth University Institute for Women's Health, Richmond, VA, the Journal covers the latest advances and clinical applications of new diagnostic procedures and therapeutic protocols for the prevention and management of women's healthcare issues. Journal of Women's Health is the Official Journal of the American Medical Women's Association (AMWA; www.amwa-doc.org).

Mary Ann Liebert, Inc. (www.liebertpub.com), is a privately held, fully integrated media company known for establishing authoritative peer-reviewed journals in many promising areas of science and biomedical research, including Obesity Management, Breastfeeding Medicine, Thyroid, Metabolic Syndrome and Related Disorders, and Diabetes Technology and Therapeutics. Its biotechnology trade magazine, Genetic Engineering & Biotechnology News (GEN), was the first in its field and is today the industry's most widely read publication worldwide. A complete list of the firm's 60 journals, books, and newsmagazines is available at www.liebertpub.com

Mary Ann Liebert, Inc. 140 Huguenot Street, New Rochelle, NY 10801 www.liebertpub.com Phone: (914) 740-2100 (800) M-LIEBERT Fax (914) 740-2110

JOURNAL OF WOMEN’S HEALTH Volume 18, Number 2, 2009 In PDF format.

Contact: Amy Gleason Quarshie agleason@liebertpub.com 914-740-2149 Mary Ann Liebert, Inc./Genetic Engineering News

Genomic variations in African-American and white populations

Deletions, duplications or rearrangements of genomic regions in the human genomes produce differences in gene copy numbers, referred to as copy number variations (CNV). Those variations account for a substantial portion of human genetic diversity, and in a few cases, have been associated with behavioural traits or increased susceptibility to disease. A study published today in the open access journal BMC Genetics, describes a CNV map of the African American genome, and compares frequencies of CNVs between African American and white American/European populations.

Joseph P McElroy and colleagues from the Department of Neurology, University of California at San Francisco, recruited African Americans from 28 States and used their genomes to draw CNV comparisons with the White dataset. "To the best of our knowledge, this is the first detailed map of copy number variations in African Americans. Understanding the distributions of CNVs in a population is a first step to addressing their role in disease".

The authors employed an array of over 500,000 sequences whose position in the human genome is already known due to single nucleotide polymorphisms.

They first analysed the interaction of 50 blood samples of healthy African American females with this gene chip platform, and then used the results as a reference to assess copy number variation in samples from a further 385 African Americans, and an additional set of samples from 435 White individuals. In total, 1362 CNVs were detected in African Americans and 1972 in the White cohort. Across most of the genome, the frequency of CNVs did not differ greatly between the two populations. However, there were two duplications, one on chromosome 15, and one on chromosome 17, whose frequency varied markedly between the two groups.

The research team discovered that the duplication in chromosome 17 (region 17q21) is present in 45% of White but only in 8% of African American individuals. Another independent study has implicated the same region in mental retardation caused by a deletion due to duplication. Among the deleted genes, two of them, CRHR1 (corticitropin releasing hormone receptor 1) and MAPT (microtubule-associated protein tau), were previously associated with some neurological disorders. These two genes are not contained within the 17q21 region of CNV duplication, but map very close to it.

According to McElroy, "It would be good to know if the CNV duplication of the region might have an effect on the expression of these genes, which in turn could result in neurological disease. It is also interesting to find out whether the type of mental retardation associated with this locus is more common in Whites than in Africans or African Americans. If this is true, then it might be one of the first reported diseases with differing ethnic frequencies due to CNVs." ###

1. Research article, Copy number variation in African Americans Joseph P McElroy, Mathew R Nelson, Stacy J Caillier and Jorge R Oksenberg, BMC Genetics (in press)

During embargo, article available upon request via the media contact

2. BMC Genetics is an open access journal publishing original peer-reviewed research articles in all aspects of inheritance and variation in individuals and among populations. BMC Genetics (ISSN 1471-2156) is indexed/tracked/covered by PubMed, MEDLINE, BIOSIS, CAS, Scopus, EMBASE, Zoological Record, Thomson Reuters (ISI) and Google Scholar.

3. BioMed Central (http://www.biomedcentral.com/) is an STM (Science, Technology and Medicine) publisher which has pioneered the open access publishing model. All peer-reviewed research articles published by BioMed Central are made immediately and freely accessible online, and are licensed to allow redistribution and reuse. BioMed Central is part of Springer Science+Business Media, a leading global publisher in the STM sector.

Contact: Charlotte Webber charlotte.webber@biomedcentral.com 44-782-531-7342 BioMed Central