Positive and negative consequences of a military deployment.

This study determined the perception by 951 U.S. Army soldiers of positive and negative consequences of a peacekeeping deployment to Bosnia. Seventy-seven percent reported some positive consequences, 63% reported a negative consequence, and 47% reported both. Written comments were also provided. Of the 951 soldiers, 478 wrote at least one positive comment and 403 at least one negative comment. Single soldiers were more likely than married soldiers to report positive consequences (82% vs. 72%). Married soldiers were more likely than single soldiers to report negative consequences (70% vs. 55%). Positive consequences included making additional money, self-improvement, and time to think. Negative consequences included the military chain of command, being away from home, and deterioration of marital/significant other relationships.

Aspirin and ticlopidine for prevention of recurrent stroke in black patients: a randomized trial.

CONTEXT: Blacks are disproportionately affected by stroke, and they are about 2 times more likely than most other individuals in the United States to die of or experience stroke. OBJECTIVE: To determine the efficacy and safety of aspirin and ticlopidine to prevent recurrent stroke in black patients. DESIGN, SETTING, AND PATIENTS: Randomized, double-blind, investigator-initiated, multicenter trial of 1809 black men and women who recently had a noncardioembolic ischemic stroke and who were recruited between December 1992 and October 2001 from 62 academic and community hospitals in the United States and followed up for up to 2 years. INTERVENTION: A total of 902 patients received 500 mg/d of ticlopidine and 907 received 650 mg/d of aspirin. MAIN OUTCOME MEASURES: Recurrent stroke, myocardial infarction, or vascular death was the composite primary end point (according to intention-to-treat analysis). The secondary outcome was fatal or nonfatal stroke. RESULTS: The blinded phase of the study was halted after about 6.5 years when futility analyses revealed a less than 1% probability of ticlopidine being shown superior to aspirin in the prevention of the primary outcome end point. The primary outcome of recurrent stroke, myocardial infarction, or vascular death was reached by 133 (14.7%) of 902 patients assigned to ticlopidine and 112 (12.3%) of 907 patients assigned to aspirin (hazard ratio, 1.22; 95% confidence interval, 0.94-1.57). Kaplan-Meier curves for time to event for the primary outcome did not differ significantly (P =.12 by log-rank test). Kaplan-Meier curves for time to the secondary outcome of fatal or nonfatal stroke approached a statistically significant reduction favoring aspirin over ticlopidine (P =.08 by log-rank test). The frequency of laboratory-determined serious neutropenia was 3.4% for patients receiving ticlopdine vs 2.2% for patients receiving aspirin (P =.12) and 0.3% vs 0.2% for thrombocytopenia, respectively (P =.69). One ticlopidine-treated patient developed thrombocytopenia, which was thought to be a case of possible thrombotic thrombocytopenia purpura, and recovered after therapy with plasmapheresis. CONCLUSIONS: During a 2-year follow-up, we found no statistically significant difference between ticlopidine and aspirin in the prevention of recurrent stroke, myocardial infarction, or vascular death. However, there was a nonsignificant trend for reduction of fatal or nonfatal stroke among those in the aspirin group. Based on these data and the risk of serious adverse events with ticlopidine, we regard aspirin as a better treatment for aspirin-tolerant black patients with noncardioembolic ischemic stroke.

The Black Seventh-Day Adventist exploratory health study.

African Americans are at high risk for stroke and dementia. Modifications of lifestyle, however, might lower this risk. The Seventh-Day Adventist (SDA) Church encourages both spiritual adherence and a healthy lifestyle. Members are encouraged to exercise and are discouraged from smoking, drinking alcoholic or caffeinated beverages, or eating meat. The present study describes an exploratory project in 2 Black SDA congregations (N = 82) designed to characterize the lifestyle, dietary, and spiritual health habits of these congregations, and to test the feasibility of collecting such information in the Black SDA community at large. Three separate data collection methods are described and evaluated. Data demonstrate that the sample differs significantly from the African-American community at large in dietary, lifestyle, and spiritual health habits. The Black SDA community represents a unique opportunity to test the effects of diet, lifestyle, and spirituality on risk for stroke and dementia.