Education differentials by race and ethnicity in the diagnosis and management of hypercholesterolemia: a national sample of U.S. adults (NHANES 1999-2002).

OBJECTIVES: To examine education differentials in screening, awareness, treatment and control of hypercholesterolemia overall and in 3 race/ethnic groups. METHODS: We analyzed data for a nationally representative sample of 8,429 men and women ages 20 to 85 years, self-reported as white, black, Mexican American, or other race/ethnicity, who participated in the National Health and Nutrition Examination Survey from 1999-2002. RESULTS: Participants with < high school education were 2.5 times less likely than participants with > or = high school education to have been screened for hypercholesterolemia, after adjusting for age and gender (odds ratio: 0.4, 95 % confidence interval: 0.3-0.5, and similar across race/ethnic group). Multivariable models for awareness, treatment and control showed no significant trends associated with education after adjusting for age, gender, race and comorbidities. CONCLUSIONS: Higher education significantly increased the odds of being screened for hypercholesterolemia overall and within each race/ethnic group. Education differentials were strongest for hypercholesterolemia screening, and weak or no longer apparent for subsequent steps of awareness, treatment and control. Focusing public health policy on increasing screening for individuals with low education might greatly improve their chances of preventing or mitigating morbidity related to hypercholesterolemia and subsequent cardiovascular disease.

Encouraging geriatric medicine fellows to write review articles: a description of our experience.

Medical education in the United States develops many skills, but writing is not usually one of them. At the UCLA Multicampus Division of Geriatrics, we recently instituted a project that attempts to provide the opportunity for each of our Geriatric Medicine fellows to write and publish a review article. We report our experiences of the first 3 years of this program in an effort to share our successes, our shortcomings and our impressions.

Education, income and ethnic differences in cumulative biological risk profiles in a national sample of US adults: NHANES III (1988-1994).

Data from the nationally representative US National Health and Nutrition Examination Survey (NHANES) III cohort were used to examine the hypothesis that socio-economic status is consistently and negatively associated with levels of biological risk, as measured by nine biological parameters known to predict health risks (diastolic and systolic blood pressure, pulse, HDL and total cholesterol, glycosylated hemoglobin, c-reactive protein, albumin and waist-hip ratio), resulting in greater cumulative burdens of biological risk among those of lower education and/or income. As hypothesized, consistent education and income gradients were seen for biological parameters reflecting cardiovascular, metabolic and inflammatory risk: those with lower education and income exhibiting greater prevalence of high-risk values for each of nine individual biological risk factors. Significant education and income gradients were also seen for summary indices reflecting cumulative burdens of cardiovascular, metabolic and inflammatory risks as well as overall total biological risks. Multivariable cumulative logistic regression models revealed that the education and income effects were each independently and negatively associated with cumulative biological risks, and that these effects remained significant independent of age, gender, ethnicity and lifestyle factors such as smoking and physical activity. There were no significant ethnic differences in the patterns of association between socio-economic status and biological risks, but older age was associated with significantly weaker education and income gradients.

Rheumatic diseases in the elderly: assessing chronic pain.

This article discusses the assessment of chronic pain in older patients. First, the epidemiology and impact of chronic pain in the elderly are addressed. Next, common barriers to pain assessment are reviewed. An effective approach to pain assessment in the older patient is described, including the important pearls of history-taking and the physical examination, as well as recommendations for the evaluation of functional status and psychosocial well-being. The article concludes with a review of multidimensional and unidimensional pain assessment tools, and a discussion of methods for pain assessment in the cognitively impaired.

An unintended consequence: fatal amiodarone pulmonary toxicity in an older woman.

Amiodarone pulmonary toxicity represents the most serious adverse reaction from amiodarone use. It remains underdiagnosed and can have a variable presentation. The elderly population is at increased risk for amiodarone pulmonary toxicity. Thus, clinicians should prescribe the lowest dosage possible in the elderly and have a low threshold to discontinue the amiodarone for anyone with unexplained fatigue, dyspnea, cough, or weight loss. We present the case of an 89-year-old female who presented with a several month history of fatigue and recent development of dyspnea on exertion and a dry cough. She had been taking amiodarone for 1 year secondary to atrial fibrillation. Chest x-ray and chest CT revealed multilobar airway opacities. An infectious work-up was negative and a transbronchial biopsy revealed prominent intra-alveolar foamy macrophages, consistent with amiodarone pulmonary toxicity. Despite the prompt discontinuation of her amiodarone and a trial of intravenous steroids, the patient succumbed to respiratory failure. The risk factors, clinical presentation, diagnosis, treatment, and prevention of amiodarone pulmonary toxicity are discussed.

Rheumatic diseases in the elderly: assessing chronic pain.

This article will discuss the assessment of chronic pain in older patients. First, the epidemiology and impact of chronic pain in the elderly will be addressed. Next, common barriers to pain assessment will be reviewed. An effective approach to pain assessment in the older patient will then be described, including important pearls for history-taking and the physical examination, as well as recommendations for the evaluation of functional status and psychosocial well-being. The article will conclude with a review of multidimensional and unidimensional pain assessment tools and a discussion of methods for pain assessment in the cognitively impaired.