Neural rim area declines with increased intraocular pressure in urban Americans.

OBJECTIVE: To determine intraocular pressure (IOP)-related differences in the neural rim area among urban Americans without known optic nerve disease. DESIGN: Population-based prevalence study conducted in 16 cluster areas in East Baltimore, Md. PARTICIPANTS: A population-based sample of 1521 black and 1851 white individuals aged 40 years and older without evidence of optic nerve disease. MAIN OUTCOME MEASURE: Intraocular pressure-related differences in neural rim area, neural rim area-to-disc area ratio, and cup-to-disc ratio. RESULTS: We analyzed optic disc photographs using the Imagenet system (Topcon Instrument Corp of America, Paramus, NJ). After adjusting for age and disc area, white Americans had a 6% decrease in neural rim area for every 10-mm Hg increase in IOP (P = .0001). In black Americans, there was a quadratic relationship between neural rim area and IOP, with little decline with IOP up to approximately 17 mm Hg, after which neural rim area declined significantly with higher IOP (P = .001). Similarly, the neural rim area-to-disc area ratio decreased and the vertical cup-to-disc ratio increased with increasing IOP in both black and white Americans. CONCLUSIONS: The higher the level of IOP, the smaller was the amount of neural rim tissue in the optic disc for both black and white Americans. However, the relationship between IOP and neural rim area was different in whites and blacks.

Race-, age-, gender-, and refractive error-related differences in the normal optic disc.

OBJECTIVE: To determine race-, age-, gender-, and refractive error-related differences in the size and topography of the optic disc in healthy Americans. DESIGN: Population-based study. SETTING: Eastern and southeastern health districts of Baltimore, Md. PARTICIPANTS: A population-based sample of 4877 non-institutionalized black and white individuals aged 40 years or older without evidence of optic nerve disease. MAIN OUTCOME MEASURE: Race-, age-, gender-, and refractive error-related differences in optic disc measurements: disc area, neural rim area, cup area, cup-to-disc ratio, and neural rim area-to-disc area ratio. RESULTS: We analyzed simultaneous stereoscopic optic disc photographs from 3387 (1534 black and 1853 white) of the 4877 healthy individuals using an image analyzer (Topcon Image Analyzer, Topcon Instrument Corporation, Paramus, NJ). A total of 1490 individuals were excluded owing to the absence of good-quality images from either eye. The image analyzer defined the cup margin 150 microns below the surface of the disc margin. On average, blacks had significantly larger disc areas (blacks, 2.94 mm2; whites, 2.63 mm2), larger cup areas (blacks, 1.04 mm2; whites, 0.71 mm2), larger cup-to-disc ratios (blacks, 0.56; whites, 0.49), similar neural rim areas (blacks, 1.90 mm2; whites, 1.92 mm2), and smaller neural rim area-to-disc area ratios (blacks, 0.66; whites, 0.74) compared with whites. There were no age-related differences in any of the disc measurements. Male subjects had 2% to 3% larger optic discs compared with female subjects. No association between refractive error and any of the optic disc measurements studied was detected. CONCLUSIONS: Racial differences in the normal optic disc are present among urban Americans, and these differences must be considered in evaluation of the optic disc for glaucoma and other optic neuropathies. Among the individuals in our study, all of whom were 40 years of age or older, no progressive age-related decline in neural rim area was detectable. Neither gender nor refractive error were associated with any significant differences in the size and topography of the normal optic disc.

A clinical trial to improve high blood pressure care in young urban black men: recruitment, follow-up, and outcomes.

This randomized trial recruited and followed underserved, inner-city, hypertensive (HTN), young black men and investigated whether a nurse-community health worker team in combination with usual medical care (SI) increased entry into care and reduced high blood pressure (HBP), in comparison to usual medical care (UC) alone. Emergency department records, advertising, and BP screenings identified potential participants with HBP. Telephone calls and personal contacts tracked enrollees. Of 1391 potential participants, 803 (58%) responded to an invitation to be screened and scheduled a visit. Of these, 528 (66%) kept an appointment, 207 (35%) were BP eligible, and 204 (99%) consented to enroll. At 12 months 91% of men were accounted for and 85.8% (adjusted for death, in jail, or moved away) were seen. Mean BP changed from 153(16)/98(10) to 152(19)/94(11) mm Hg in the SI group and 151(18)/98(11) to 147(21)/92(14) mm Hg in the UC group (P = NS). High rates of participation are attainable in this population; however, culturally acceptable ways of delivering HBP care are needed.

Development of fetal movement--fetal heart rate coupling from 20 weeks through term.

This study documents the development of fetal heart rate (FHR) change in response to fetal movement (FM) in healthy fetuses from 20 weeks' gestational age through term. Thirty-one fetuses received 50 min of Doppler-based monitoring at 20, 24, 28, 32, 36 and 38-39 weeks. FHR and FM were continuously digitized. A coupling index was computed as the percentage of FMs associated with increases in FHR of 5 beats/min or more within -5 or +15 s of movement onset. The latency between FM onset and FHR change was also computed, as were the amplitude and duration of all movements. FM and FHR became more integrated with advancing gestation. Coupling increased and the latency between FM and FHR changes decreased. Maternal age, blood pressure and fetal sex did not affect FM-FHR coupling, but fetuses of women who reported greater stress in their daily lives and had faster heart rates displayed reduced coupling. These data suggest that the development of FM-FHR coupling reflects the development of the central nervous system during gestation, and that development may be affected by maternal factors.

Risk of foot complications in long-term diabetic patients with and without ESRD: a preliminary study.

OBJECTIVE: The purpose of this preliminary study was to generate hypotheses for future research about the relationship between ESRD and foot complications in patients with long-term diabetes. DESIGN: A cross-sectional prevalence study was conducted comparing a sample of long-term diabetic patients with ESRD to a sample of long-term diabetic patients without ESRD. SAMPLE/SETTING: A convenience sample of 132 patients with long-term diabetes (> 15 years), with (N = 60) and without (N = 72) ESRD, was selected from ambulatory care settings and dialysis units. METHODS: Data were collected by chart audit, structured interview, and physical examination. RESULTS: Foot complications were greater in individuals with diabetes and ESRD (25%) than in diabetic individuals without ESRD (10%) (p = 0.02). Neither neuropathy, past or current smoking, race, gender, nor age were significantly associated with current foot complications (either current infection, ulcer, gangrene, or amputation). CONCLUSIONS: Research is needed to better understand foot complications in persons with long-term diabetes and ESRD so that the effectiveness of nursing and medical interventions to stabilize or prevent foot complications can be evaluated.

Fetal neurobehavioral development.

The ontogeny of fetal autonomic, motoric, state, and interactive functioning was investigated longitudinally in a sample of 31 healthy fetuses from 20 weeks through term. Fetal heart rate and movement data were collected during 50 min of doppler-based fetal monitoring at 6 gestational ages. Measures of fetal heart rate and variability, activity level and vigor, behavioral state, and reactivity were derived from these digitized data. Weighted least squares analyses were conducted to model the developmental patterns and to examine the role of maternal and fetal covariates. With advancing gestation, fetuses displayed slower heart rate, increased heart rate variability, reduced but more vigorous motor behavior, coalescence of heart rate and movement patterns into distinct behavioral states, and increasing cardiac responsivity to stimulation. Male fetuses were more active than female fetuses, and greater maternal stress appraisal was associated with reduced fetal heart variability. An apparent period of neurobehavioral transition exists between 28 and 32 weeks. Fetal research methods are evaluated.

Adolescent childbearing revisited: the age of inner-city mothers at delivery is a determinant of their children's self-sufficiency at age 27 to 33.

OBJECTIVES: Data from recent interviews with 1758 inner-city children, born between 1960 to 1965 and followed with their mothers in the Pathways to Adulthood Study to age 27 to 33 years, were used to address two related questions. 1) Is maternal age, across the reproductive age range, a determinant of child's adult outcome? and 2) Do covariates of maternal age at delivery reduce or eliminate the effect of maternal age on child's adult outcome? METHODS: An intergenerational life course model of development identified significant maternal and child characteristics at birth associated with the child's self-sufficient outcomes in adulthood: education (more than or equal to a high school diploma); financial independence of public support; and delay of first birth until age 20 or older. Bivariate and multiple logistic regression techniques were used to identify independent relationships between dependent and independent variables and to adjust the outcomes to compensate for the effect of possible confounding of maternal age at delivery by maternal education, parity, poverty status, and the child's race and gender. RESULTS: Each covariate was independently associated with maternal age at delivery. Adjustment for their effects reduced, but did not eliminate, the association between maternal age at birth and the child's outcome at age 27 to 33 years. As a group, children of the oldest mothers (>/=25 years of age) had the most favorable outcomes, and those of teenage mothers (<20 years of age) had the least favorable outcomes; 22% of daughters and 6% of sons of the oldest mothers versus 38% and 18%, respectively, of the youngest mothers became teenage parents. CONCLUSION: The mother's age at delivery is an independent determinant of the child's adult status.