Review of the Captain America Graphic Novel 'TRUTH: Red, White and Black' Focusing on Parallels with the Infamous USPHS Syphilis Study at Tuskegee.

This review presents the first detailed presentation of the parallelism between the Tuskegee Syphilis Study and the Captain America graphic novel 'TRUTH: Red, White and Black', published as a graphic novel by Marvel Comics in 2004 as a paperback, and then in 2009 as a hardcover. First written, published and distributed monthly in 2003 as pre-sequel seven comic book series to tell the story of the origins of the WWII superhero Captain America. In 2003, Marvel Comics chose to tell a 'very dark story' to explain the origins of Captain America, a half century after the initial introduction of Captain America as a WWII action hero in 1940. By detailing-for the first time-nine parallel aspects between these two storylines, this review demonstrates how Marvel Comics brought the tragic Tuskegee Syphilis Study story into the popular press, thus reaching an audience far beyond traditional bioethics academicians. This review is intended to stimulate and guide classroom discussions on the ethical issues at the core of the infamous Tuskegee Syphilis Study allowing bioethical issues to be made more accessible to the general public, via school curriculums, by the use of graphic novels.

Seat belt use among Hispanic ethnic subgroups of national origin.

OBJECTIVE: Findings from over a dozen studies of Hispanic/white disparities in seat belt use have been inconsistent, variably revealing that seat belt use prevalence among Hispanics is higher, lower, or comparable to use among non-Hispanics. In contrast to previous studies, this study investigates disparities in seat belt use by Hispanic subgroups of national origin. METHODS: Data from the US Fatality Analysis Reporting System were used to compare seat belt use among 60 758 non-Hispanic whites and 6879 Hispanics (Mexican American (MA), n = 5175; Central American/South American (CASA), n = 876; Puerto Rican (PR), n = 412; Cuban (CU), n = 416) killed in crashes from 1999-2003. Logistic regression was used to adjust for age, gender, seat belt law, seat position, urban/rural region, and income. RESULTS: Overall adjusted odds ratios for seat belt use among Hispanic subgroups, relative to non-Hispanic whites, were 1.04 (95% confidence interval (CI) 0.85 to 1.28) for CUs, 1.17 (95% CI 0.95 to 1.44) for PRs, 1.33 (95% CI 1.25 to 1.42) for MAs, and 1.66 (95% CI 1.44 to 1.91) for CASAs. Relative to their non-Hispanic white counterparts, odds ratios among MA and CASA Hispanics were highest for men, younger age groups, drivers, primary law states, rural areas, and lower income quartiles. CONCLUSION: Among all Hispanic subgroups, seat belt use was at least as prevalent as among non-Hispanic whites. In the CASA and MA subgroups, which have the most rapidly growing subpopulations of immigrants, seat belt use was significantly more common than among whites.

Environmental health and antisocial behavior: implications for public policy.

Antisocial behavior persists as a preeminent public policy issue in the United States. A more critical assessment of both the policies and the programs designed to address this problem is necessary, and new risk factors for antisocial behavior need to be investigated. Sufficient evidence exists to hypothesize that exposure to neurotoxins may be a risk factor for antisocial behavior. Neurotoxins such as lead have been demonstrated to affect the cognitive development of children, and impaired cognition is accepted as a risk factor for antisocial behavior. Little consideration has been given, however, to the possible link between neurotoxins and human behavior. This paper presents a biologically and socially plausible justification for this association, reviews the supporting evidence, and emphasizes the need for additional investigation of the phenomenon. Elucidation of this risk factor may lead to new strategies for preventing or mitigating antisocial behaviors among youth and adults.

Enhancing oral and systemic health.

Much published research documents continuing racial and ethnic disparities in health, particularly for African Americans, which apply to both oral and systemic diseases. Current research suggests biologically plausible associations between oral and systemic diseases; however, clear cause-and-effect relationships have not been substantiated. Some researchers and health care providers have noted anecdotal associations between oral and systemic health, as well as compounding adverse effects of oral and systemic diseases and dysfunctions. Historically, African American physicians, dentists, and pharmacists have bonded together under one organizational umbrella to combat discrimination, prejudice, and racism directed at them and their patient populations. This coming together has resulted in a more comprehensive clinical, behavioral, economic, and public health decision-making process related to the general health and well-being of their patient populations, such as maximizing health care visits, treatment plans, reimbursements, and oral and systemic health care follow-ups. According to the 1985 Secretary's Task Force Report, the six causes of excess deaths among African Americans were: cardiovascular disease and stroke; cancer; diabetes; cirrhosis; homicide and accidents; and infant mortality. In 1991, HIV/AIDS became the seventh cause of excess deaths. This article summarizes salient information about cardiovascular diseases, diabetes, cancer, and the social and behavioral factors related to oral and systemic health.

Factors affecting environmental awareness among Head Start families in Mississippi.

BACKGROUND: Socioeconomic and racial/ethnic disparities in health status in the United States may be attributed in part to environmental injustice and differential exposure to environmental hazards among low-income and/or minority populations. However, the environmental justice movement has historically focused on equity in the siting of point-source polluting facilities, giving little attention to environmental hazards and environmental awareness at the level of the individual household. METHODS: Heads of 763 low-income households participating in Head Start programs in 20 counties of the Mississippi Delta region were surveyed regarding their education, the physical environment of their home and workplace, sources of food and water, awareness of local polluting sites/facilities, knowledge of government agencies, and behaviors that may affect their health or impact their local environment. Survey results were compared to demographic, socioeconomic, and environmental quality indicators. RESULTS: Significant associations existed between both education and race/ethnicity and the responses of survey participants. Being African American was more commonly associated with poor quality-of-life indicators such as renting substandard older homes and living in close proximity to areas of unfavorable watershed quality. Higher education was more commonly and positively associated with indicators of heightened environmental awareness and increased political empowerment. No association was observed between race/ethnicity and the prevalence of polluting facilities. However, a significant association existed between race/ethnicity and indicators of environmental quality/integrity. CONCLUSIONS: Environmental health education interventions that target individual households may be a useful mechanism for increasing the access of low-income communities to government health resources and reducing adverse health effects from the environment. However, racial/ethnic disparities in education and health remain an important consideration.

Environmental health and African Americans: challenges and opportunities.

Demographic shifts and other social and economic forces as well as the increasing concerns about environmental determinants of disease and dysfunction have focused more attention on the disproportionate burden of environmental risk on blacks and other minorities. This article reviews these developments and identifies related challenges and opportunities confronting the medical community in the prevention of environmentally provoked disease among black Americans.

The concept of race and health status in America.

Race is an unscientific, societally constructed taxonomy that is based on an ideology that views some human population groups as inherently superior to others on the basis of external physical characteristics or geographic origin. The concept of race is socially meaningful but of limited biological significance. Racial or ethnic variations in health status result primarily from variations among races in exposure or vulnerability to behavioral, psychosocial, material, and environmental risk factors and resources. Additional data that capture the specific factors that contribute to group differences in disease must be collected. However, reductions in racial disparities in health will ultimately require change in the larger societal institutions and structures that determine exposure to pathogenic conditions. More attention needs to be given to the ways that racism, in its multiple forms, affects health status. Socio-economic status is a central determinant of health status, overlaps the concept of race, but is not equivalent to race. Inadequate attention has been given to the range of variation in social, cultural, and health characteristics within and between racial or ethnic minority populations. There is a growing emphasis, both within and without the Federal Government, on the collection of racial or ethnic identifiers in health data systems, but noncoverage of the Asian and Pacific Islander population, Native Americans, and subgroups of the Hispanic population is still a major problem. However, for all racial or ethnic groups, we need not only more data but better data. We must be more active in directly measuring the health-related aspects of belonging to these social categories.

Arginine metabolism in the salivary glands of protein-deficient rats and its potential association with the oral microflora.

Salivary glands and their secretions play key roles in the prevention of dental diseases. The antibacterial and physicochemical properties of saliva are compromised in chronic malnutrition. The present study has examined the possibility that some malnutrition-induced changes in salivary gland function are potentially capable of promoting growth and metabolic activities of pathogenic oral microorganisms. Compared to well-fed controls, rats fed a 3% protein diet for 18 days showed a significant reduction (p < 0.001) in the submandibular gland arginase (L-arginine amidinohydrolase, EC 3.5.3.1) activity. Associated with the latter finding was a marked increase (+85%) in the glandular level of free arginine, this basic amino acid accounting for 12.2% of the total essential amino acids as compared with a figure of only 4.6% for the controls. The total free amino acid pool in whole saliva was relatively unaffected by malnutrition, but the levels of the basic amino acids arginine and histidine were marginally increased. Many oral bacterial species, some of which are dominant plaque microorganisms, utilize the arginine deiminase (EC 3.5.3.6) pathway. Thus, increased availability of free arginine from salivary glands offers a plausible explanation for the frequently reported observation of differential overgrowth of several potentially pathogenic microorganisms including some mutants streptococci in protein-deficient laboratory animals and may well apply to similar findings in malnourished populations in Third World countries.

Induction of tamoxifen-dependent rat mammary tumors.

We have observed previously that animals given tamoxifen (TAM) and the carcinogen dimethylbenzanthracene develop exclusively hormone-independent tumors. Since our data implied that the TAM-associated tumors were different from control tumors, we undertook studies to examine the role of TAM in the induction and growth of these tumors. Following cessation of TAM administration, almost one-third [29.0 +/- 1.7% (SEM)] of the tumors regressed and more tumors appeared. Resumption of TAM administration resulted in regrowth of some tumors and regression of the new tumors. These studies demonstrate that some of the TAM-associated tumors are actually dependent upon TAM for growth, while the appearance of new tumors suggests that TAM does not totally prevent tumor formation but may only delay it.

Survey of graduates of the Epidemic Intelligence Service as an approach to enhancing ethnic diversity among the nation's epidemiologists.

A survey was conducted to improve the recruitment, training, and retention of epidemiologists in the Epidemic Intelligence Service (EIS) Program of the Centers for Disease Control. The authors compared minority graduates of the program and nonminority graduates in several areas: reasons for application, degree of satisfaction, appropriateness of preparation for epidemiologic practice, and current professional activities. A closed-ended questionnaire was mailed to all 87 minority graduates from the program during the period 1970-88, and to 172 randomly selected nonminority graduates. Of 259 graduates surveyed, 234 or 90.3 percent returned the questionnaire--89.6 percent of minority graduates and 90.7 percent of nonminority graduates. Virtually all graduates were satisfied with their EIS experience (95.2 percent), have encouraged others to apply (96.1 percent), and are the most frequent sources of initial contact of prospective officers (38.2 percent). Most EIS graduates (71.2 percent) were still working in epidemiology. Compared with the nonminority graduates, the minority graduates were more likely to be women and to be single. Minority graduates were less likely than non minorities to hold academic appointments (44.2 percent versus 60.0 percent) and less likely to work in academic settings as their primary job (11.5 percent versus 18.7 percent). At the same time, minority graduates were more likely to have learned of the EIS Program from academic advisors (32.1 percent versus 19.4 percent). Graduates express high levels of satisfaction with the EIS Program and continue to practice epidemiology following graduation. Few differences between the minority and nonminority graduates were found. Because fewer minority graduates are in academic settings to serve as mentors or role models, alternative recruitment methods must be developed to sustain a high level of interest among minority groups in the EIS Program.

Violence: a challenge to the public health community.

In the past 2 years, cities have reported skyrocketing rates of violence, crime, and abusive behavior including intrafamilial homicides. Of the 1838 homicide deaths last year among teenagers between the ages of 15 and 19, 71% involved the use of a firearm. Among black males in the same age group, 82% of the deaths were associated with guns. Since 1968, homicide has been among the leading causes of death for black teenagers. These and large volumes of other data clearly indicate that violence and abusive behavior is a compelling public health problem.

Congenital palpebral lipoblastoma. First report of a case.

Lipoblastoma, an uncommon benign tumor of adipose tissue, occurs in infants and young children. Anatomic sites usually involved include extremities, neck, trunk, retroperitoneum, and mediastinum. To our knowledge, no cases involving the eyelids have previously been reported. Its clinical presentation and appearance are not distinctive; diagnosis and differentiation from other lipocytic tumors are achieved via routine light-microscopic studies. Lipoblastoma is composed of fat cells exhibiting a broad spectrum of differentiation. Simple excision suffices as treatment.

Assessment of feature size abnormalities using receiver operating characteristic analysis.

The ability of an observer to detect variations in size of a geometrical image feature have been investigated using receiver operating characteristic (ROC) analysis. Three types of image were constructed using computer graphics: disc-shaped targets of variable radius, model chest radiographs showing a variable heart diameter and model arterial angiograms with variable vessel width. Five factors were investigated: observer experience, variation of detectability with theoretical signal-to-noise ratio, the prior probability of the presence of an abnormality, viewing distance, and uncertainty in the location of an abnormality. In all but one experiment, excellent agreement was found between measured detectabilities and the predictions of signal detection theory, providing an initial practice session was included for each observer. No significant variation in detectability was found using six different prior probabilities and two different viewing distances, and the reduction in detectability for a four-alternative location task was in good agreement with theoretical predictions. The high statistical efficiencies found for the detection of geometrical signals suggest that the levels of observer "internal" noise arising from decision-making processes during an ROC experiment are very low.