Racial disparities in the treatment of endometrial intraepithelial neoplasia in postmenopausal women.

Disparities in endometrial cancer has increased during the past decade with Black women more likely to be diagnosed at a later stage and have higher mortality. The majority of research has been focused on cultural barriers, socioeconomic status, lack of access to care, comorbidities, and tumor histology to explain these disparities. Limited studies have been conducted on the disparity in the treatment of endometrial intraepithelial neoplasia(EIN). We sought to analyze the differences in treatment used in the management of postmenopausal women with EIN to evaluate whether race/ethnicity is a contributing factor. An IRB approved retrospective study was conducted amongst women at a single institution diagnosed with EIN. Ethnicity/race was defined as non-Hispanic White, non-Hispanic Black, Hispanic, and Asian. Demographic and clinical data was extracted. Multivariable logistic regression was used to examine the association between ethnicity/race and treatment, adjusted for age, BMI, and underlying medical conditions such as cardiovascular disease and diabetes. In total, 254 patients were analyzed. A significant association between ethnicity/race and treatment with non-Hispanic Black women less likely to be treated with surgical management compared to non-Hispanic White women (OR = 0.326, 95 %CI 0.129-0.827, p = 0.026). Importantly, after adjusting for clinical risk factors(age, BMI, CVD, diabetes), non-Hispanic Black women remained at an increased risk of not undergoing surgical intervention (OR = 0.333, 95 % CI 0.125-0.882, p = 0.027). Future research is imperative to evaluate the root cause of this disparity in the healthcare system.

The pediatrician and early intervention for the developmentally disabled or handicapped child.

New federal legislation involving infants at risk for handicaps and their families, in the form of Public Law 99-457, will rely on interaction between pediatricians and other professionals to maximize health and social benefits. Involvement in early identification and remediation of infants at risk is a role well suited to the primary care pediatrician. Early Intervention Programs offer remediation and enhancement of development for children at biologic or environmental risk. Pediatricians should be alert to screen, identify, and assess children who may be helped by Early Intervention Programs. The primary care pediatrician should work with children who have these problems, help coordinate care, and serve as an advocate for the child and family.

Breast-feeding by employed mothers: a reasonable accommodation in the work place.

A nonprofit voluntary community hospital, the Hunterdon Medical Center, has made a commitment to encourage breast-feeding among employees. In support of this commitment, arrangements were made for time off during the work day for nursing mothers to pump their breasts. An electric breast pump in a suitably accessible location and supportive professional advice were offered. Among those who chose to nurse their babies, it was found that mothers nursed for longer times and were more likely to continue nursing after return to employment when this program was available.

Physiologic and behavioral responses to companion animals.

There is a set of behavioral and physiologic responses to companion animals that can be reliably observed under both experimental and natural conditions. These responses indicate that contact with companion animals can be an effective means of reducing stress.

Social interaction and blood pressure. Influence of animal companions.

The effect of the presence of a friendly animal on children's blood pressures and heart rates while resting and their cardiovascular responses to verbalization were examined. The presence of the dog resulted in lower blood pressures both while the children (N = 38) were resting and while they were reading. The effect of the presence of the dog was greater when the dog was present initially than when it was introduced in the second half of the experiment. We speculate that the animal causes the children to modify their perceptions of the experimental situation and the experimenter by making both less threatening and more friendly. This study provides insight into the use of pets as adjuncts in psychotherapy.

Blood pressure changes while talking.

Using a noninvasive automatic device to rapidly and repeatedly measure blood pressure, a striking relationship was found between talking and an increase in blood pressure and heart rate. This finding was demonstrated in a variety of experimental settings (the laboratory, medical clinic, classroom and home) in both children and adults and in both normotensive and hypertensive individuals. A significant positive correlation was also observed between the level of resting pressure and the magnitude of increase in pressure while talking. These findings point toward an important link between human communication and blood pressure control that has previously been overlooked. They also suggest a new conceptual approach to the understanding and treatment of hypertension.