Health and Racial Disparities: Importance of Accurate and Reliable Ethnicity, Race, and Language Data

Introduction: Accurate demographic data are essential to identify and monitor differences, trends, and changes in diabetes-related conditions between Hispanics and non-Hispanic Blacks (NHBs). It also provides pertinent information to reduce health and racial disparities among English- and Spanish-speakers. Method: The study's design was a quantitative cross-sectional one. Electronic medical record (EMR) and survey data of the same sample were compared. Descriptive statistics were computed for ethnicity, preferred language, and physiological data. Frequency and percentages were calculated for each continuous and categorical variable. Chi-square was calculated to compare physiological variables by ethnicity and language. Results: During a 5-month period (September 2021-February 2022), 106 individuals from New York City with diabetes took part in this study. Among Hispanics, most from the EMR identified as Other (82.4%), whereas from the survey, most identified as White (57.1%). More Hispanics (19%) and Spanish speakers (18%) had high triglyceride levels compared to NHBs (2%) and English speakers (3%). Conclusion: Ensuring that demographic data are accurate can better inform programs. Because Hispanics and Spanish speakers had the highest triglyceride levels, diabetes programs need to include information on cardiovascular disease and must be available in Spanish, to further reduce risk factors, improve health outcomes, and promote health equity among these populations.

National Institutes of Health R-series Grants portfolio of racism and healthcare, 2017-2022

BACKGROUND

Any form of racism in healthcare is an unacceptable barrier to receiving equitable and quality care, further contributing to health disparities among populations. For these reasons, it is critical to have a better understanding on the amount of research and scientific advances of funded projects aimed at racism in healthcare. An examination of the distribution of R-series funded research by the National Institutes of Health (NIH) on racism in healthcare during a 5-year fiscal year (FY) period (2017-2022) was conducted by the study team.

METHODS

This cross-sectional study used publicly available data from the NIH RePORTER (Research Portfolio Online Reporting Tools: Expenditures and Results) for research project grants awarded on racism and healthcare during the FYs of 2017 to 2022. The number of R-series NIH funded projects on racism in healthcare were examined, including the abstract and public health relevance statement, number of publications, spending category, fiscal start and end dates, total amount of funding each year, funding agency/center(s), and type of funding opportunity announcements. Descriptive statistics were performed on the data by the research team.

RESULTS

There were a total of 93 R-series grants funded during the FYs of 2017 to 2022. Most of the grants were R01s (77.4%); focused primarily on racism at the system-wide level (68.8%), and on patients (64.5%); the largest racial and ethnic minority group reported were African/American/Black (20.4%); and close to 40% did not report race or ethnicity. None of the grants focused in internalized racism, which is at the individual -level. From the FYs of 2017 to 2022, 0.07% of all NIH research funding was awarded to racism in healthcare.

CONCLUSION

The findings of this study showed the need for continued funding and of the need of more research on racism in healthcare, that potentially can reduce health disparities and inequities.

What Are the English to Spanish Translation Methods Used on Written Health-Related Information?

Objective: This systematic review was conducted to examine methods and tools used to translate written health-related information from English to Spanish. Methods: The design of this study was a systematic review. This review search was of all published articles up to July 2022. Three databases were used: CINAHL Plus, MEDLINE, and PubMed. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis flowchart was used in the systematic review. Results: A total of 17 articles were used in the analysis. Six (35.3%) of the articles used a machine and human translation method, and eight (47%) used Google Translate as the machine translation tool. The screening, full-text review, and data extraction were done using the Covidence software. Discussions: As translating health-related information accurately is crucial, using metrics or standardizing one is urgently needed. Nursing implications: This review highlights that in addition to a lack of standardized metrics, there currently is no criterion on the qualifications or credentials required by individuals who translate written information from English to Spanish, allowing anyone to do so. This is concerning because it is critical that Spanish speakers and those with limited English proficiency receive linguistically accurate and appropriate resources that allow them to improve their health literacy and promote health.

COVID-19 survey among NYC non-Hispanic Black and Hispanic/Latino adults with diabetes

OBJECTIVES

To better understand the knowledge, practice, importance, awareness, usefulness, and confidence of non-Hispanic Black and English- and Spanish-speaking Hispanic/Latino adults with diabetes.

DESIGN

A descriptive cross-sectional survey study design was used and descriptive statistics was conducted.

SAMPLE

Non-Hispanic Black and Hispanic/Latino adults with diabetes were recruited from three New York City public hospitals.

MEASUREMENTS

A one-time survey was delivered via email, text message or over the phone.

RESULTS

Of the 96 participants, 47.9% were Hispanic/Latino and 52.1% were non-Hispanic Black individuals; 43.8% of the surveys were completed in Spanish and 56.3% in English; 41.7% were female and 58.3% male; 77.1% preferred to complete the survey via the telephone, 14.6% through email, and 8.3% via text message. Chi-square findings showed, 90.6% knew mask wearing prevented COVID-19; 96.9% knew that covering the nose and mouth during mask wearing is needed, 93.8% wore a mask, and 92.8% felt it important or very important to wear a mask to prevent the spread of COVID-19. For social distancing, 88.5% knew it prevented the spread of COVID-19, 93.8% practiced it, and 95.8% felt it important or very important.

CONCLUSION

In having a better understanding of the knowledge and practices of COVID-19 among non-Hispanic Black and Hispanic populations with diabetes, the development of culturally and linguistically tailored community-based mitigation strategies can be developed that are aimed at improving the preparedness of these groups for the next emerging infectious disease, such as COVID-19.

Demographics, A1C Testing, and Medication Use of Mexican Americans and Mexicans With Diabetes

Purpose

The purpose of this study is to investigate diabetes rates among Mexicans 20 years and older living in the United States and Mexico in 2012 and 2016.

Methods

The national sample was the National Health and Nutrition Examination Survey (NHANES) 2011-2012, NHANES 2015-2016, Mexican National Health and Nutrition Survey 2012 (ie, Encuesta Nacional de Salud y Nutrición 2012 [ENSANUT 2012]), and ENSANUT de Medio Camino 2016 (ENSANUT-MC 2016). Sex, age, A1C testing, and medication use (insulin, oral hypoglycemic agents, and both) were examined among participants.

Results

Most participants in study were female (50.7%, 53.9%, and 57.2%) and were younger (61 years, 57 years, and 60 years). A1C testing was conducted more in the United States (69.6% and 82.6%) than in Mexico (9.5% and 15.1%). More Mexicans (73.1% and 67.8% vs 54.9% and 54.9%) were using oral hypoglycemic agents, while more Mexican Americans used insulin (12.6% and 11.6% vs 6.3% and 11.1%) and used both insulin and oral hypoglycemic agents (17.1% and 15.8% vs 6.6% and 8.7%).

Conclusions

By examining and highlighting the diabetes mellitus practices and standardization of A1C testing, providers will be able to better understand and address the rising rates of diabetes in the United States and Mexico while driving practice and policy changes.

Literature Review on Diabetes Internet-based Spanish-Language Information

BACKGROUND

Diabetes is a growing epidemic that is affecting Hispanics in high rates.

INTRODUCTION

Although Hispanics use the internet for health-related informational and educational purposes, there is a lack of information available in the Spanish-language.

METHODS

A review was conducted to examine the literature on internet-based, Spanish-language, diabetes focused information. One search was conducted using three different databases (i.e. CINAHL, MEDLINE, and PubMed). The search used the keywords diabetes, internet, and Spanish, and was based on published articles from January 1, 2005 to June 30, 2016.

RESULTS

Of the 46 articles reviewed, one was a duplicate, and 41 were eliminated. These findings show a lack of data and research on Spanish-language, internet-based diabetes informational and educational sites.

CONCLUSION

Qualitative and quantitative studies are needed to develop and examine Spanish-language diabetes internet sites and the health-related impact they have on Hispanics who prefer Spanishlanguage sites.

Health effectiveness of community health workers as a diabetes self-management intervention

OBJECTIVE

To evaluate the health effectiveness of community health workers among three groups (intervention, attentional control and control groups) of Hispanic adults with uncontrolled (HbA1c >8%) type 2 diabetes mellitus.

METHODS

This was a randomized clinical trial involving 180 English- and Spanish-speaking Hispanic individuals with uncontrolled type 2 diabetes mellitus, 40-74 years of age, who received diabetes care at an outpatient, public, urban hospital. Repeated-measures analysis of variance was used to evaluate the effect of time and group on the primary outcome measure and secondary outcomes. Group differences in the percentage of participants achieving at least 1% reduction in HbA1c levels were assessed using chi-square tests.

RESULTS

Patients' ages ranged from 44 to 74 years, 40% were male, 97% preferred Spanish and seven Spanish-speaking countries were identified as country of origin. Relative to the control and attentional control groups, the intervention group showed greater HbA1c reduction from baseline to 12 months and was the group with the highest percentage of participants showing 1% or more HbA1c reduction.

CONCLUSION

Integration of community health workers improved disease control for patients with type 2 diabetes mellitus during the intervention phase. Peer-driven/interactive ways to sustain diabetes control need to be explored.

Diabetes Training for Community Health Workers

BACKGROUND

A 2.5-month diabetes education training for community health workers (CHWs) was developed, implemented, and evaluated.

METHODS

Training methods used included case studies, role-playing, and lectures. Exams were used throughout the training for its evaluation. Teaching was delivered by different ways: a one day American Diabetes Association (ADA) course; a five day Diabetes Self-Management Program (DSMP); Conversation Maps; and a series of seven National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) diabetes education booklets.

RESULTS

Qualitative and quantitative evaluative methods were used during and after the training. The CHWs' diabetes knowledge was evaluated by a pre- and post-test Diabetes Knowledge Questionnaire (DKQ). The post-test was conducted one week after completing the training. The findings showed that the diabetes knowledge of the CHWs increased.

CONCLUSIONS

Diabetes competencies and evaluative tools need to be developed specific for CHWs as a way to standardize all CHW diabetes trainings.

Understanding diabetes self-management behaviors among Hispanics in New York City

Diabetes mellitus is a public health concern disproportionately affecting Hispanics. Because Hispanics are greatly affected by a high prevalence of diabetes, a qualitative study was conducted, which explored how Hispanics understand, perceive, and experience behavioral change and how they maintain such change while managing their diabetes. Twenty Caribbean (Dominican and Puerto Rican) Hispanic adults with diabetes, who were either English- or Spanish-speaking, participated in the study. Twenty individual interviews were conducted, audiotaped, and transcribed and translated. Structured questions were used in the interviews which covered the meaning of certain terms (e.g., healthy eating, exercise), motivators and barriers to changing behaviors related to diabetes management, and a question to explore ways nurses can assist them in changing behaviors. Content analysis was used to analyze the text of the interviews. Three themes (diabetes management, behavior change, and nurse's role) emerged from the data, including apparent gaps in the participants' perception of adapting their cultural foods into healthier dietary habits.

General literacy and health literacy in Dominicans with diabetes

Dominicans are one of the fastest growing Hispanic subgroups in the United States, and they are greatly affected by type 2 diabetes. Health literacy and general literacy are critical components in diabetes self-management given that type 2 diabetes is a disease that relies heavily on a person having the skills needed to actively participate in their diabetes care. Three PubMed searches were conducted using search words Dominicans, Hispanics, diabetes, type 2 diabetes, diabetes education, health literacy, and literacy. These searches were based on published articles completed from January 2000 to May 2012. There were 14 articles reviewed. Eight articles were eliminated from the 3 literature searches. These findings show a lack of data and research on Dominicans with diabetes and on health literacy and general literacy among this Hispanic subgroup. Qualitative and quantitative studies are urgently needed to examine diabetes in Dominicans and the impact health literacy and general literacy have on diabetes health outcomes in this Hispanic subgroup.

Mentoring Hispanic undergraduate and graduate research assistants: building research capacity in nursing

BACKGROUND

This article discusses and describes the experiences of five Hispanic bilingual (English and Spanish) research assistants (RAs) who were undergraduate and graduate nursing students and who were part of a research team.

METHOD

A capacity-building framework was used, which has six guiding principles: a whole-system approach; accommodating diversity; reducing barriers to participation; enabling collaboration; mentoring; and facilitating networking. In addition, mentorship and peer learning were essential components of building research capacity.

RESULTS

Reflections of the five RAs highlighting how these principles were applied are described. The experiences of the five Hispanic RAs and the outcomes of the projects are also described.

CONCLUSION

These experiences demonstrate the importance of involving undergraduate and graduate nursing students in research, which can build research capacity and increase the number of Hispanic nurses in the workforce.

Prevalence of normoglycemic, prediabetic and diabetic A1c levels

AIM: To investigate normoglycemic, prediabetic and diabetic A1c levels in those with prediabetes; and prediabetic and diabetic A1c levels in those with non-prediabetes.

METHODS: The National Health and Nutritional Examination Survey (NHANES) 2007-2008 and NHANES 2009-2010 were utilized to examine and compare trends and differences among five different ethnic groups (Mexican Americans, Other Hispanics, Non-Hispanic Whites, Non-Hispanic Blacks, Other/Multi-racials) with normoglycemic, prediabetic and diabetic A1c levels with self-reported prediabetes and prediabetic and diabetic A1c levels in those with self-reported non-prediabetes. Sample participants of the five ethnic groups were limited to those 20 years of age and older, who had completed the diabetes questionnaire and had A1c measured. Descriptive statistics were computed for all variables. χ² were performed on all five ethnic groups to examine significant differences of normoglycemic, prediabetic and diabetic A1c levels in those with self-reported prediabetes, and prediabetic and diabetic A1c levels in those with self-reported non-prediabetes.

RESULTS: This study demonstrates that of the five different ethnic groups from NHANES 2007-2008 to NHANES 2009-2010, Non-Hispanic Whites (6.5% increase) and Non-Hispanic Blacks (0.2% increase) were the only two groups with an increase in the number of self-reported prediabetes. Although the overall percentage of Mexican Americans who self-reported prediabetes had remained the same (5%) from NHANES 2007-2008 to NHANES 2009-2010, χ² analysis showed significant differences when examining the different ranges of A1c levels (normoglycemic, prediabetic and diabetic). Among Mexican Americans who self-reported prediabetes, normoglycemic (P = 0.0001) and diabetic (P = 0.0001) A1c levels from NHANES 2007-2008 to NHANES 2009-2010. For Non-Hispanic Whites who self-reported prediabetes, prediabetic (P = 0.0222); and diabetic (P≤ 0.0001) A1c levels from NHANES 2007-2008 to NHANES 2009-2010. For Non-Hispanic Blacks who self-reported prediabetes, there were significant differences (P = 0.0001) for all A1c levels (normoglycemic, prediabetic and diabetic A1c levels). For Other/Multi-racials with self-reported prediabetes there was significant differences in those with normoglycemic (P = 0.0104) and diabetic (P = 0.0067) A1c levels from NHANES 2007-2008 to NHANES 2009-2010. For all combined ethnic groups who self-reported not having prediabetes (non-prediabetes), 19.9% of those in NHANES 2007-2008 and 22.4% in the NHANES 2009-2010 showed to have prediabetic A1c levels. When separately examining each of the five ethnic groups who self-reported not having prediabetes, all showed an increase in those with prediabetic A1c levels from NHANES 2007-2008 to NHANES 2009-2010. Through χ² analysis, all five ethnic groups who self-reported not having prediabetes showed significant differences (P < 0.0001) in all A1c levels (normoglycemic, prediabetic and diabetic) from NHANES 2007-2008 to NHANES 2009-2010.

CONCLUSION: The findings highlight the need of prediabetes awareness and of education in the community as ways to reduce the number of people with prediabetes.

Knowledge, perceptions, and experiences of Dominicans with diabetes

Dominicans, one of the fastest growing Hispanic subgroups in New York City (NYC), have a high rate of diabetes. A qualitative study exploring Dominicans' knowledge, perceptions, and experiences in managing their diabetes was conducted. There were a total of 40 participants who were Spanish speaking Dominicans, 40-74 years of age, diagnosed with diabetes and NYC residents. Four focus groups were conducted in Spanish, which were recorded and then transcribed into English. Content analysis was used to analyze the text of the focus groups. Different themes emerged from the data, with apparent gaps in diabetes knowledge and of awareness of risk for diabetes complications.

Teaching home care electronic documentation skills to undergraduate nursing students

Although there is general consensus that nursing students need knowledge and significant skill to document clinical findings electronically, nursing faculty face many barriers in ensuring that undergraduate students can practice on electronic health record systems (EHRS). External funding supported the development of an educational innovation through a partnership between a home care agency staff and nursing faculty. Modules were developed to teach EHRS skills using a case study of a homebound person requiring wound care and the Medicare-required OASIS documentation system. This article describes the development and implementation of the module for an upper-level baccalaureate nursing program located in New York City. Nursing faculty are being challenged to develop creative and economical solutions to expose nursing students to EHRSs in nonclinical settings.

Sequencing of Lp-PLA2-encoding PLA2G7 gene in 2000 Europeans reveals several rare loss-of-function mutations

Elevated plasma levels of lipoprotein-associated phospholipase A₂ (Lp-PLA2) activity have been shown to be associated with increased risk of coronary heart disease and an inhibitor of this enzyme is under development for the treatment of that condition. A Val279Phe null allele in this gene, that may influence patient eligibility for treatment, is relatively common in East Asians but has not been observed in Europeans. We investigated the existence and functional effects of low frequency alleles in a Western European population by re-sequencing the exons of PLA2G7 in 2000 samples. In all, 19 non-synonymous single-nucleotide polymorphisms (nsSNPs) were found, 14 in fewer than four subjects (minor allele frequency <0.1%). Lp-PLA2 activity was significantly lower in rare nsSNP carriers compared with non-carriers (167.8±63.2 vs 204.6±41.8, P=0.01) and seven variants had enzyme activities consistent with a null allele. The cumulative frequency of these null alleles was 0.25%, so <1 in 10 000 Europeans would be expected to be homozygous, and thus not potentially benefit from treatment with an Lp-PLA2 inhibitor.

Key elements of large survey data sets

One low-cost area of research that nurses typically do not consider is to perform secondary analyses of large federal or state health care data sets. These data sets contain vast amounts of existing data that otherwise would be difficult and expensive to gather, thereby enabling research which is economically feasible and which potentially has wide implications and applications. Large survey data may be free and easy to access, but that does not mean that retrieving the raw data, examining the manuals for the survey, and conducting the secondary analysis is simple or easy. To analyze the data accurately, it is essential that nurse researchers fully understand all key elements of the data set survey chosen, as well as how to prepare and manage the data. In a time of limited funding and resources, and of numerous health concerns in all age groups across different races and ethnicities, nurse researchers need to utilize the many venues that contain rich and vast amounts of data such as large data sets.

Diabetes risk factors in Mexican Americans with diabetes

Diabetes and diabetes-related risk factors increase the risk of diabetes complications, particularly if the disease is controlled poorly. Three diabetes risk factors were examined in this study: obesity (body mass index), hypertension (systolic blood pressure and diastolic blood pressure), and hyperlipidemia (cholesterol and triglyceride). The Hispanic Health and Nutrition Examination Survey (1982-1984), the National Health and Nutrition Examination Survey (NHANES) 1999-2000, and NHANES 2001-2002 were utilized to examine and compare trends and differences in diabetes-related risk factor variables in Mexican Americans with diabetes.

Meeting the linguistic needs of urban communities

In a collaborative effort to address the linguistic disparities within communities, an urban public university, school of nursing (SON), and a certified home healthcare (HHC) agency partnered in an Influenza Initiative. Undergraduate nursing students provided individual health screenings, education, and materials on the importance of influenza vaccination. In order to address the linguistic needs of the New York City (NYC) residents the nursing students, many of who were bilingual, served as translators for non-English speaking Spanish, Chinese, Russian, and Ukraine NYC residents.

Absence of association of asporin polymorphisms and osteoarthritis susceptibility in US Caucasians

OBJECTIVE

An association between osteoarthritis (OA) and functional polymorphisms in the aspartic acid (d) repeat of the asporin (ASPN) gene was reported in Japanese and Han Chinese populations. The aim of this study was to assess the association of variants in the ASPN gene with the presence of radiographic hand and/or knee OA in a US Caucasian population.

METHODS

Ten single nucleotide polymorphisms (SNPs) within the ASPN gene were genotyped in 775 affected siblings with radiographically confirmed hand and/or knee OA, and the allelic, genotypic and haplotypic association results were examined.

RESULTS

One variant (SNP RS7033979) showed nominal evidence of association with both hand OA (P=0.042) and knee OA (P=0.032). Four additional SNPs showed nominal evidence of association with knee OA only. These associations were only observed with genotypic tests; the corresponding allelic and haplotype tests did not corroborate the single-point association results.

CONCLUSION

These data suggest that polymorphisms within ASPN are not a major influence in susceptibility to hand or knee OA in US Caucasians.

Acute bacterial meningitis among children, in Manhiça, a rural area in Southern Mozambique

INTRODUCTION

Acute bacterial meningitis (ABM) is one of the most severe diseases in Sub-Saharan Africa. Although data for the continent is very limited, more than one million cases are estimated per year, with mortality and life-long sequelae occurring in 50% of these cases.

METHODS

As part of the clinical management of children admitted to the Manhiça District Hospital, information on cases of ABM was recorded. We analysed data from June 1998 to November 2003.

RESULTS

During the study period, 475 cerebrospinal-fluid (CSF) samples were collected from 20,173 children <15 years of age admitted to hospital. Culture results confirmed 71 (15%) cases of ABM. The most prevalent bacterial aetiologies were Streptotoccus pneumoniae (pneumococcus, n=31), Haemophilus influenzae (n=13) and Neisseria meningitis (n=8). Other important bacteria were Streptococcus sp. (n=7), Salmonella sp. (n=4) and Staphylococcus aureus (n=3). Crude incidence rates of ABM and pneumococcal meningitis were 20/100,000 and 10/100,000 children-year-at-risk, respectively. Incidences were more than three times higher in the <1 year age group. Overall case fatality rate was 36%, and was highest for H. influenzae and pneumococcal meningitis (55% and 45%, respectively, p=0.044). Pneumococcal susceptibility was 81% for oxacillin and 93% for chloramphenicol. For H. influenzae isolates, susceptibility was 54% for ampicillin and 62% for chloramphenicol.

CONCLUSIONS

S. pneumoniae and H. influenzae are the main aetiologies responsible for the high burden of morbidity and mortality associated with ABM in rural Mozambique. These findings are important to evaluate treatment guidelines and potential impact of control measures.

Community as Client: Reaching an Underserved Urban Community and Meeting Unmet Primary Health Care Needs

In a collaborative effort to address the health disparities within 1 urban underserved community, the Hunter-Bellevue School of Nursing, Hunter College, and the Mount Sinai Medical Center organized a health fair. Nursing faculty worked side by side with undergraduate nursing students to offer several health promotion activities, screening, and educational sessions for residents of East Harlem, New York. In addition, nursing students provided individual patient education on nutrition, hand washing hygiene, medication review, and glucometer usage. Educational materials on lifestyle issues (sample meals, maintaining normal blood glucose, blood pressure, cholesterol levels, and smoking cessation) were provided. To help bridge the gap between health education and health promotion activities, nursing students, many of whom were bilingual, served as translators for non-English speaking Spanish and Chinese residents. In addition to the new professional partnerships developed, new clinical placements for nursing students were established.

Intermittent treatment for malaria and anaemia control at time of routine vaccinations in Tanzanian infants: a randomised, placebo-controlled trial

BACKGROUND

Clinical malaria and severe anaemia are major causes of paediatric hospital admission and death in many malaria-endemic settings. In the absence of an effective and affordable vaccine, control programmes continue to rely on case management while attempting the large-scale deployment of insecticide-treated nets. We did a randomised, placebo-controlled trial to assess the efficacy and safety of intermittent sulphadoxine-pyrimethamine treatment on the rate of malaria and severe anaemia in infants in a rural area of Tanzania.

METHODS

We randomly assigned 701 children living in Ifakara, southern Tanzania, sulphadoxine-pyrimethamine or placebo at 2, 3, and 9 months of age. All children received iron supplementation between 2 and 6 months of age. The intervention was given alongside routine vaccinations delivered through WHO's Expanded Program on Immunisation (EPI). The primary outcome measures were first or only episode of clinical malaria, and severe anaemia in the period from recruitment to 1 year of age. Morbidity monitoring through a hospital-based passive case-detection system was complemented by cross-sectional surveys at 12 and 18 months of age. Results were expressed in terms of protective efficacy (100 [1-hazard ratio]%) and analysis was by intention to treat.

FINDINGS

40 children dropped out (16 died, 11 migrated, 12 parents withdrew consent, and one for other reasons). Intermittent sulphadoxine-pyrimethamine treatment was well tolerated and no drug-attributable adverse events were recorded. During the first year of life, the rate of clinical malaria (events per person-year at risk) was 0.15 in the sulphadoxine-pyrimethamine group versus 0.36 in the placebo group (protective efficacy 59% [95% CI 41-72]), and the rate of severe anaemia was 0.06 in the sulphadoxine-pyrimethamine group versus 0.11 in the placebo group (50% [8-73]). Serological responses to EPI vaccines were not affected by the intervention.

INTERPRETATION

This new approach to malaria control reduced the rate of clinical malaria and severe anaemia by delivering an available and affordable drug through the existing EPI system. Data are urgently needed to assess the potential cost-effectiveness of intermittent treatment in areas with different patterns of malaria endemicity.

Histopathologic findings in the liver of rheumatoid arthritis patients treated with long-term bolus methotrexate

Twenty-three patients with severe rheumatoid arthritis were treated with oral methotrexate (MTX) for more than 10 years. MTX was given as a bolus of 5-15 mg/week; the total cumulative dose ranged from 4,690 mg to 10,230 mg. Liver biopsies were performed on 21 of the patients to assess possible fibrosis and cirrhosis. Grade I histopathologic changes were found in 13 of the 21 biopsy samples, grade II changes were found in 3, and grade IIIA changes (mild fibrosis) were found in 5 specimens. None of the biopsy samples showed cirrhosis. Repeat biopsies were performed on the 5 patients with grade IIIA changes while they were still taking MTX. No progression of the fibrosis was noted. Two of the 5 samples, however, were graded IIIB because of portal and perilobular inflammation. Our findings support the premise that prolonged administration of oral MTX, when given as a weekly bolus at a low dose, does not cause cirrhosis or severe fibrosis in the rheumatoid arthritis patient who does not abuse alcohol.

beta-Endorphin, immunological and biochemical changes in synovial fluid in rheumatic disorders

In 120 patients with rheumatic disorders concomitant assays of serum and synovial fluid were done for acute phase reactants, immunoglobulins and the neuropeptide beta-endorphin. One-third of the patients with rheumatoid disease demonstrated synovial fluid levels of endorphin to be several-fold higher than serum levels, while in two-thirds the opposite results were found. These changes are discussed as adaptive or defense mechanisms. The synovial membrane is postulated to synthesize beta-endorphin.

Serum beta-endorphin in rheumatic disorders

Serum beta-endorphin levels have been determined in patients with a wide variety of rheumatic disorders as well as a group of healthy men and women controls. Normal levels of endorphin have been found in patients with juvenile rheumatoid arthritis. Patients with rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus, gout, ankylosing spondylitis, pseudogout and psoriatic arthritis have diminished levels of endorphins. Speculation is offered to explain these changes. Perturbations in endorphins are postulated to be part of the organism's protective mechanism in inflammatory arthritis.