Thursday, April 26, 2007
agressie
Road rage and fruit flies pp581 - 582
The genetic basis of aggression may be conserved from lobsters
to humans. A new study uses the genetics of Drosophila melanogaster
to explore the underlying neurochemical mechanisms.
Anne F Simon and David E Krantz
10.1038/ng0507-581
http://ealerts.nature.com/cgi-bin24/DM/y/edjL0SwmaM0HjQ0BRQu0EN
The genetic basis of aggression may be conserved from lobsters
to humans. A new study uses the genetics of Drosophila melanogaster
to explore the underlying neurochemical mechanisms.
Anne F Simon and David E Krantz
10.1038/ng0507-581
http://ealerts.nature.com/cgi-bin24/DM/y/edjL0SwmaM0HjQ0BRQu0EN
atrium fibrillatie
Treatment for Atrial Fibrillation and Flutter
Solvay Pharmaceuticals Files Tedisamil, a New Cardiometabolic Product for the Treatment of Atrial Fibrillation and Atrial Flutter
BRUSSELS, Belguim, April 25, 2007--Solvay announced today that its dossier for intravenous tedisamil (intended brand name: Pulzium IV), a new chemical entity coming from Solvay Pharmaceuticals R&D laboratories, has been filed for approval by the US Food and Drug Administration (FDA) as well as by the authorities of European Union countries. This means that the formal processing and review have begun.
The regulatory submission is based on safety and efficacy studies that evaluated Pulzium IV for the rapid conversion of recent onset atrial fibrillation or atrial flutter to normal sinus rhythm in more than 1000 patients with symptomatic atrial fibrillation or flutter. Pulzium IV is a class III anti-arrhythmic drug which blocks multiple potassium channels.
“We believe that Pulzium IV represents a valuable treatment option for cardiologists treating patients with recent onset atrial fibrillation or flutter. Used as a 30 minute intravenous infusion, it converts atrial flutter or fibrillation back to sinus rhythm and becomes a worthwhile addition to the other cardiometabolic treatments we offer”, said Claus Steinborn, Executive Vice President R&D of Solvay Pharmaceuticals.
Solvay Pharmaceuticals Files Tedisamil, a New Cardiometabolic Product for the Treatment of Atrial Fibrillation and Atrial Flutter
BRUSSELS, Belguim, April 25, 2007--Solvay announced today that its dossier for intravenous tedisamil (intended brand name: Pulzium IV), a new chemical entity coming from Solvay Pharmaceuticals R&D laboratories, has been filed for approval by the US Food and Drug Administration (FDA) as well as by the authorities of European Union countries. This means that the formal processing and review have begun.
The regulatory submission is based on safety and efficacy studies that evaluated Pulzium IV for the rapid conversion of recent onset atrial fibrillation or atrial flutter to normal sinus rhythm in more than 1000 patients with symptomatic atrial fibrillation or flutter. Pulzium IV is a class III anti-arrhythmic drug which blocks multiple potassium channels.
“We believe that Pulzium IV represents a valuable treatment option for cardiologists treating patients with recent onset atrial fibrillation or flutter. Used as a 30 minute intravenous infusion, it converts atrial flutter or fibrillation back to sinus rhythm and becomes a worthwhile addition to the other cardiometabolic treatments we offer”, said Claus Steinborn, Executive Vice President R&D of Solvay Pharmaceuticals.
Friday, April 20, 2007
AF cardiac death
Cardiac Arrhythmias
Currently, the two major areas of cardiac arrhythmias research in the Division of Cardiology are:
Atrial Fibrillation
Sudden Cardiac Death
Atrial fibrillation back to top
A normal, healthy heart typically beats rhythmically and at a predictable rate. However, in some individuals, often those who have underlying heart disease, the heart beats arrhythmically: either too quickly (a condition called tachycardia) or too slowly (called bradycardia). These heart rhythm abnormalities can occur in the upper chambers of the heart (the atria) or the lower chambers (the ventricles).
Atrial fibrillation is the most common sustained cardiac arrhythmia seen in the cardiologist's office. Affecting more than two million Americans, this condition may be associated with symptoms such as palpitations and shortness of breath as well as an increased risk of blood clots and stroke, as well as congestive heart failure in some patients.
Today, there are numerous options for the management of atrial fibrillation, including medications, implantable atrial defibrillators, the surgical maze procedure, or minimally invasive, catheter-based procedures such as radiofrequency ablation. Unfortunately, most do not offer a cure and all have significant limitations.
Research under way within the Division of Cardiology is focused on finding new, more effective, and safer non-pharmacological treatments for atrial fibrillation, including several novel catheter-based approaches. Through the Massachusetts General Hospital Cardiovascular Research Center, the division's research is also aimed at better understanding the possible role of genetics in atrial fibrillation with the long-term goal of developing preventive strategies and new, more targeted therapies.
One of the latest treatments for atrial fibrillation is pulmonary vein catheter ablation. This therapy aims to isolate the underlying triggers of the arrhythmia (the foci) within muscle of the pulmonary veins leading to the atria and ablate (destroy) their connections using radiofrequency (electrical) current delivered via a catheter. In properly selected patients, this therapy can sometimes eliminate or significantly reduce the frequency and duration of episodes of atrial fibrillation. Yet the procedure is complex and lengthy, and is not without some risks, such as narrowing (stenosis) of the pulmonary veinsand, rarely, stroke, even when performed by the most experienced clinicians.
Investigators within the Division of Cardiology are currently conducting research in experimental models aimed at further improving the outcomes for patients undergoing pulmonary vein catheter ablation for atrial fibrillation.
One new approach under investigation is cryothermal ablation, which uses cold energy rather than radiofrequency (electrical) energy to ablate the foci of atrial fibrillation. The results to date indicate that this approach is not only very effective, but may also be less apt to stimulate clot formation and potential stroke. Further research is necessary, but it is anticipated that clinical (human) trials evaluating cryothermal ablation for the treatment of atrial fibrillation willbegin within the near future.
Another potential new strategy for the treatment of atrial fibrillation currently under investigation in the Division of Cardiology uses another new energy source the diode laser. This low-powered laser, which is housed in a balloon and introduced into the pulmonary veins via a catheter, produces a radial (360 degree) lesion [click here for an image of the laser]. This new approach will soon be evaluated in multi-center clinical trials at Massachusetts General Hospital and the Mayo Clinic.
Investigators at MGH are also looking at the possibility of using intraoperative magnetic resonance imaging (MRI) for pulmonary vein catheter ablation. This sophisticated technology, which has revolutionized the treatment of patients with brain tumors, enables physicians to view the operative field in three dimensions, in real time, and with unprecedented detail while avoiding the use of X-rays.
In addition to investigating new treatment strategies, investigators in the Division of Cardiology are striving to determine whether there is a genetic component to lone, or isolated, atrial fibrillation. This form of atrial fibrillation, which affects about one-third of patients, occurs in individuals with no known heart disease.
By studying large populations and families with this disorder, the division's researchers are attempting to find the common gene or genes that cause or predispose someone to develop lone atrial fibrillation. If a genetic marker is found to play a key role in this condition, this information could be used to develop preventive strategies and/or highly targeted therapeutic agents. In collaboration with their colleagues in the Cardiovascular Research Center, researchers are also doing early work in experimental models using gene therapy for atrial fibrillation.
Sudden cardiac death back to top
Every year, sudden cardiac death (also called cardiac arrest) claims the lives of approximately 350,000 people in the United States, about one-third of whom have no prior history of heart disease or obvious symptoms. Sudden cardiac death is usually caused by the most serious forms of cardiac arrhythmia, called ventricular tachycardia or fibrillation, in which rapid electrical activity causes the ventricles to beat very rapidly and, in the case of ventricular fibrillation, to lose all coordinated contraction. Because the ventricles are unable to pump blood effectively at these high rates, the blood pressure falls and patients lose consciousness. Unless cardiopulmonary resuscitation is administered immediately, an individual with ventricular fibrillation will die from cardiac arrest.
Research initiatives under way in the Division of Cardiology are investigating ventricular arrhythmias (both ventricular fibrillation and ventricular tachycardias) from a number of different angles, from prevention to new treatments.
One investigator is conducting long-term epidemiological (population-based) research involving thousands of patients to determine which factors including diet, exercise, and other lifestyle choices increase the risk of sudden cardiac death. The results of this research will ultimately elucidate some of the major risk factors for this common cause of death, making it possible for people to make healthy lifestyle decisions that may reduce their risk of sudden cardiac death.
In a related project, an investigator is evaluating the potential protective effects of omega-3 fatty acids, which are found in fish oil, among patients with a history of life-threatening cardiac arrhythmias who have an implantable defibrillator. Earlier research in experimental models has demonstrated that fish oil is protective against ventricular tachycardia and ventricular fibrillation. The results of this multi-center trial, which will continue for several more years, will help shed more light on the potential role of omega-3 fatty acids in the prevention of a leading cause of death in the developed world.
Researchers in the Division of Cardiology are also evaluating new approaches to the treatment of ventricular tachycardia. In one investigation, which is being conducted in collaboration with researchers in Prague, investigators are employing sophisticated new non-contact, non-fluoroscopic (non X-ray) three dimensional mapping systems in an effort to more accurately isolate cardiac scar tissue that may contribute to ventricular tachycardia. The goal of this substrate-based approach is to be able to more accurately isolate and ablate the border zones of scar tissue from which these abnormal rhythms originate in order to reduce the recurrence rates seen with conventional ablation techniques. In addition, researchers are also beginning to evaluate the use of alternative energy sources, such as cryothermal and diode laser energy, for the treatment of ventricular tachycardia, much as they are doing in the treatment of atrial fibrillation.
Yet another avenue of research is epicardial ablation for the treatment of some ventricular tachycardias and, perhaps in the future, atrial fibrillation as well. In this approach, which is currently being tested in experimental models, catheters are introduced into the heart's pericardial (outer surface) space via a catheter, rather than into the heart through major veins or arteries. It is anticipated that this approach, while currently technically more challenging to perform than existing treatments, may pose a lower risk of clots and stroke.
The preceding is an overview of research of arrhythmias under way in the Division of Cardiology. It is not intended as a complete listing of all current research initiatives in these areas.
Currently, the two major areas of cardiac arrhythmias research in the Division of Cardiology are:
Atrial Fibrillation
Sudden Cardiac Death
Atrial fibrillation back to top
A normal, healthy heart typically beats rhythmically and at a predictable rate. However, in some individuals, often those who have underlying heart disease, the heart beats arrhythmically: either too quickly (a condition called tachycardia) or too slowly (called bradycardia). These heart rhythm abnormalities can occur in the upper chambers of the heart (the atria) or the lower chambers (the ventricles).
Atrial fibrillation is the most common sustained cardiac arrhythmia seen in the cardiologist's office. Affecting more than two million Americans, this condition may be associated with symptoms such as palpitations and shortness of breath as well as an increased risk of blood clots and stroke, as well as congestive heart failure in some patients.
Today, there are numerous options for the management of atrial fibrillation, including medications, implantable atrial defibrillators, the surgical maze procedure, or minimally invasive, catheter-based procedures such as radiofrequency ablation. Unfortunately, most do not offer a cure and all have significant limitations.
Research under way within the Division of Cardiology is focused on finding new, more effective, and safer non-pharmacological treatments for atrial fibrillation, including several novel catheter-based approaches. Through the Massachusetts General Hospital Cardiovascular Research Center, the division's research is also aimed at better understanding the possible role of genetics in atrial fibrillation with the long-term goal of developing preventive strategies and new, more targeted therapies.
One of the latest treatments for atrial fibrillation is pulmonary vein catheter ablation. This therapy aims to isolate the underlying triggers of the arrhythmia (the foci) within muscle of the pulmonary veins leading to the atria and ablate (destroy) their connections using radiofrequency (electrical) current delivered via a catheter. In properly selected patients, this therapy can sometimes eliminate or significantly reduce the frequency and duration of episodes of atrial fibrillation. Yet the procedure is complex and lengthy, and is not without some risks, such as narrowing (stenosis) of the pulmonary veinsand, rarely, stroke, even when performed by the most experienced clinicians.
Investigators within the Division of Cardiology are currently conducting research in experimental models aimed at further improving the outcomes for patients undergoing pulmonary vein catheter ablation for atrial fibrillation.
One new approach under investigation is cryothermal ablation, which uses cold energy rather than radiofrequency (electrical) energy to ablate the foci of atrial fibrillation. The results to date indicate that this approach is not only very effective, but may also be less apt to stimulate clot formation and potential stroke. Further research is necessary, but it is anticipated that clinical (human) trials evaluating cryothermal ablation for the treatment of atrial fibrillation willbegin within the near future.
Another potential new strategy for the treatment of atrial fibrillation currently under investigation in the Division of Cardiology uses another new energy source the diode laser. This low-powered laser, which is housed in a balloon and introduced into the pulmonary veins via a catheter, produces a radial (360 degree) lesion [click here for an image of the laser]. This new approach will soon be evaluated in multi-center clinical trials at Massachusetts General Hospital and the Mayo Clinic.
Investigators at MGH are also looking at the possibility of using intraoperative magnetic resonance imaging (MRI) for pulmonary vein catheter ablation. This sophisticated technology, which has revolutionized the treatment of patients with brain tumors, enables physicians to view the operative field in three dimensions, in real time, and with unprecedented detail while avoiding the use of X-rays.
In addition to investigating new treatment strategies, investigators in the Division of Cardiology are striving to determine whether there is a genetic component to lone, or isolated, atrial fibrillation. This form of atrial fibrillation, which affects about one-third of patients, occurs in individuals with no known heart disease.
By studying large populations and families with this disorder, the division's researchers are attempting to find the common gene or genes that cause or predispose someone to develop lone atrial fibrillation. If a genetic marker is found to play a key role in this condition, this information could be used to develop preventive strategies and/or highly targeted therapeutic agents. In collaboration with their colleagues in the Cardiovascular Research Center, researchers are also doing early work in experimental models using gene therapy for atrial fibrillation.
Sudden cardiac death back to top
Every year, sudden cardiac death (also called cardiac arrest) claims the lives of approximately 350,000 people in the United States, about one-third of whom have no prior history of heart disease or obvious symptoms. Sudden cardiac death is usually caused by the most serious forms of cardiac arrhythmia, called ventricular tachycardia or fibrillation, in which rapid electrical activity causes the ventricles to beat very rapidly and, in the case of ventricular fibrillation, to lose all coordinated contraction. Because the ventricles are unable to pump blood effectively at these high rates, the blood pressure falls and patients lose consciousness. Unless cardiopulmonary resuscitation is administered immediately, an individual with ventricular fibrillation will die from cardiac arrest.
Research initiatives under way in the Division of Cardiology are investigating ventricular arrhythmias (both ventricular fibrillation and ventricular tachycardias) from a number of different angles, from prevention to new treatments.
One investigator is conducting long-term epidemiological (population-based) research involving thousands of patients to determine which factors including diet, exercise, and other lifestyle choices increase the risk of sudden cardiac death. The results of this research will ultimately elucidate some of the major risk factors for this common cause of death, making it possible for people to make healthy lifestyle decisions that may reduce their risk of sudden cardiac death.
In a related project, an investigator is evaluating the potential protective effects of omega-3 fatty acids, which are found in fish oil, among patients with a history of life-threatening cardiac arrhythmias who have an implantable defibrillator. Earlier research in experimental models has demonstrated that fish oil is protective against ventricular tachycardia and ventricular fibrillation. The results of this multi-center trial, which will continue for several more years, will help shed more light on the potential role of omega-3 fatty acids in the prevention of a leading cause of death in the developed world.
Researchers in the Division of Cardiology are also evaluating new approaches to the treatment of ventricular tachycardia. In one investigation, which is being conducted in collaboration with researchers in Prague, investigators are employing sophisticated new non-contact, non-fluoroscopic (non X-ray) three dimensional mapping systems in an effort to more accurately isolate cardiac scar tissue that may contribute to ventricular tachycardia. The goal of this substrate-based approach is to be able to more accurately isolate and ablate the border zones of scar tissue from which these abnormal rhythms originate in order to reduce the recurrence rates seen with conventional ablation techniques. In addition, researchers are also beginning to evaluate the use of alternative energy sources, such as cryothermal and diode laser energy, for the treatment of ventricular tachycardia, much as they are doing in the treatment of atrial fibrillation.
Yet another avenue of research is epicardial ablation for the treatment of some ventricular tachycardias and, perhaps in the future, atrial fibrillation as well. In this approach, which is currently being tested in experimental models, catheters are introduced into the heart's pericardial (outer surface) space via a catheter, rather than into the heart through major veins or arteries. It is anticipated that this approach, while currently technically more challenging to perform than existing treatments, may pose a lower risk of clots and stroke.
The preceding is an overview of research of arrhythmias under way in the Division of Cardiology. It is not intended as a complete listing of all current research initiatives in these areas.
Wednesday, April 18, 2007
bloeddruk verlagers (antihypertensiva)
Geneesmiddelen tegen hoge bloeddruk.
Middelen tegen hoge bloeddruk worden antihypertensiva genoemd.
In her verleden werd bij hoge bloeddruk meestal begonnen met een beta-blocker al of niet tegelijk met een plaspil.
Beta-blockers
Beta-blockers blokkeren de werking van de zenuwen die op het einde zogenaamde beta uiteinden hebben. Deze uiteinden beïnvloeden het hartrhytme. Door nu deze uiteinden te blokkeren hebben beta blockers een matigend effect op het hart. Het hart gaat wat langzamer kloppenen de bloeddruk wordt erdoor verlaagd, Atenolol is een bekende beta-blocker maar er zijn er veel meer, meestal eindigen ze op lol.( metoprelol timolol enz.) Om uitgebreide informatie vul in op Google: beta blockers Wikipedia.
Sinds 2006 zijn de beta blockers minder in de balanstelling. Er zijn beter middelen op de markt gekomen. Langdurig gebruik van beta blockers kan vooral bij oudere mensen diabetes 2 tot gevolg hebben.
Plasmiddelen
Middelen om het vocht beter uit het lichaam te verwijderen heten diuretica.
Meestal gebruikt men de middelen die thiazides genoemd worden. Ze bevorderen de uitscheiding van zout (NaCl), maar ook van Kalium.Gewoon NaCl krijgen we via het keukenzout voldoende binnen, maar kalium vaak veel minder. Er kan dan een verlaagd Kalium gehalte in het bloed komen. Ook verhogen ze soms het urine-zuur in het bloed omdat dat minder wordt afgescheiden met de urine en dat kan weer jicht veroorzaken.
Men kan een thiazide met een ACE remmer in een tablet doen. De ACE remmer zorgt ervoor dat kalium minder wordt uitgescheiden. De werkingen heffen ellkaar dan op. Het voorbeeld dat je me liet zien is zo een voorbeeld van een combinatie van plasmiddel en een ACE remmer.
Dat is daarom een goed middel bij verhoogde bloeddruk, dat overeenkomt met de moderne opvattingen over dit onderwerp.
Door het verlies van vocht dat met de plaspillen bereikt wordt krijg je minder druk in de bloedvaten.
ACE remmers
ACE remmers blokkeren het Angiotensin Converting Enzym (ACE) . Angiotensin doet de spiertjes rond de bloedvaten contraheren en het gevolg is bloeddruk stijging. Om angiotensin te maken heeft het lichaam een enzym nodig. Dat enzym wordt nu door de ACE remmers geblokkeerd. Vandaar de naam Angiotensin converting enzym inhibitors. Het enzym dat de grondstof converts ( verandert) in angiotensin wordt geremd ( inhibitor)
De ACE remmers zijn tegenwoordig de “drugs of first choice”. Dit heeft er mee te maken dat de drukverlaging aan de arm gemeten goed overeenkomt met de druk in de vaten rond het hart en dat is met beta-blockers minder het geval.
Calsiumchannel blockers
Calciumchannel blockers zij middelen die de calcium channel proteins blokkeren. De calcium channel proteins zijn eiwitten ( proteins) die een soort kanaaltjes vormen waardoor Calcium ionen in de hartspier kunnen dringen.( potentiaal verschillen neutraliseren) Calcium ionen zijn nodig voor spiercontractie, zowel de hartspier als de bloedvat spiertjes. Minder contractie betekent minder druk. Bij oudere mensen zouden Calsium blokkers wel eens averechts kunnen werken omdat bij oudere mensen vanzelf al verlies van calcium channel proteins aanwezig zijn. Als je dan nog Calium channel blokkers gaat toedienen kan Atrium fibrilleren het gevolg zijn. Dit is nog maar alleen bij proefdieren aangetoond. Bij atrium fibrilatie geeft de zogenaamde sinus in de rechter boezem van het hart niet een op zich zelf staande prikkel af, die de boezems doet samentrekken en zo het bloed naar de kamers stuwt, maar prikkel trilt als het ware en dat geeft minder gelijkmatige contracties. Er kunnen zo eiwitsliertjes ontstaan die herseninfarcten kunnen veroorzaken. Men moet dan bloedverdunners nemen, in dit geval anticoagulantia, die dus het coaguleren van de eiwitten tegen gaan. Men neemt dan coumarine derivaten zoals syntron (acenocoumarol). In de Angelsaksische landen wordt Warfarin gebruikt maar dat komt op hetzelfde neer. Het zijn Vitamine K inhibitors. Vitamine K is nodig om het bloed te laten coaguleren. Omdat afhankelijk van de voeding het vitamine K kan variëren moet men naar de thrombose dienst bij herhaling bloed leten nemen om te kijken of de dosering wellicht moet worden aangepast.
Aspirine werkt anders. Het zorgt ervoor dat de bloedplaatjes niet aan elkaar gaan plakken en korstjes vormen.Deze samenklonteringen van bloedplaatjes kunnen makkelijk infarcten veroorzaken. Ook zogenaamde TIA's kunnen ontstaan ( Transient Ischemic Attacks). De Tia's zijn kleinere propjes vandaar voorbijgaand (transient) Ischemic is eigenlijk zonder bloed, maar wordt hier gebruikt om aan te geven dat het propjes zijn en geen bloedingen. Het nadeel van de vitamine K remmers is dat ze wel zeer goed werken tegen het ontstaan van bloedstolseltjes maar ook eerder bloedingen kunnen veroorzaken. Aspirine werkt iets minder tegen het vormen van propjes, maar geeft minder bloedingen.
Als je meer wilt weten zoek dan bij Google, en vul het betreffend middel in plus wikipedia.
Middelen tegen hoge bloeddruk worden antihypertensiva genoemd.
In her verleden werd bij hoge bloeddruk meestal begonnen met een beta-blocker al of niet tegelijk met een plaspil.
Beta-blockers
Beta-blockers blokkeren de werking van de zenuwen die op het einde zogenaamde beta uiteinden hebben. Deze uiteinden beïnvloeden het hartrhytme. Door nu deze uiteinden te blokkeren hebben beta blockers een matigend effect op het hart. Het hart gaat wat langzamer kloppenen de bloeddruk wordt erdoor verlaagd, Atenolol is een bekende beta-blocker maar er zijn er veel meer, meestal eindigen ze op lol.( metoprelol timolol enz.) Om uitgebreide informatie vul in op Google: beta blockers Wikipedia.
Sinds 2006 zijn de beta blockers minder in de balanstelling. Er zijn beter middelen op de markt gekomen. Langdurig gebruik van beta blockers kan vooral bij oudere mensen diabetes 2 tot gevolg hebben.
Plasmiddelen
Middelen om het vocht beter uit het lichaam te verwijderen heten diuretica.
Meestal gebruikt men de middelen die thiazides genoemd worden. Ze bevorderen de uitscheiding van zout (NaCl), maar ook van Kalium.Gewoon NaCl krijgen we via het keukenzout voldoende binnen, maar kalium vaak veel minder. Er kan dan een verlaagd Kalium gehalte in het bloed komen. Ook verhogen ze soms het urine-zuur in het bloed omdat dat minder wordt afgescheiden met de urine en dat kan weer jicht veroorzaken.
Men kan een thiazide met een ACE remmer in een tablet doen. De ACE remmer zorgt ervoor dat kalium minder wordt uitgescheiden. De werkingen heffen ellkaar dan op. Het voorbeeld dat je me liet zien is zo een voorbeeld van een combinatie van plasmiddel en een ACE remmer.
Dat is daarom een goed middel bij verhoogde bloeddruk, dat overeenkomt met de moderne opvattingen over dit onderwerp.
Door het verlies van vocht dat met de plaspillen bereikt wordt krijg je minder druk in de bloedvaten.
ACE remmers
ACE remmers blokkeren het Angiotensin Converting Enzym (ACE) . Angiotensin doet de spiertjes rond de bloedvaten contraheren en het gevolg is bloeddruk stijging. Om angiotensin te maken heeft het lichaam een enzym nodig. Dat enzym wordt nu door de ACE remmers geblokkeerd. Vandaar de naam Angiotensin converting enzym inhibitors. Het enzym dat de grondstof converts ( verandert) in angiotensin wordt geremd ( inhibitor)
De ACE remmers zijn tegenwoordig de “drugs of first choice”. Dit heeft er mee te maken dat de drukverlaging aan de arm gemeten goed overeenkomt met de druk in de vaten rond het hart en dat is met beta-blockers minder het geval.
Calsiumchannel blockers
Calciumchannel blockers zij middelen die de calcium channel proteins blokkeren. De calcium channel proteins zijn eiwitten ( proteins) die een soort kanaaltjes vormen waardoor Calcium ionen in de hartspier kunnen dringen.( potentiaal verschillen neutraliseren) Calcium ionen zijn nodig voor spiercontractie, zowel de hartspier als de bloedvat spiertjes. Minder contractie betekent minder druk. Bij oudere mensen zouden Calsium blokkers wel eens averechts kunnen werken omdat bij oudere mensen vanzelf al verlies van calcium channel proteins aanwezig zijn. Als je dan nog Calium channel blokkers gaat toedienen kan Atrium fibrilleren het gevolg zijn. Dit is nog maar alleen bij proefdieren aangetoond. Bij atrium fibrilatie geeft de zogenaamde sinus in de rechter boezem van het hart niet een op zich zelf staande prikkel af, die de boezems doet samentrekken en zo het bloed naar de kamers stuwt, maar prikkel trilt als het ware en dat geeft minder gelijkmatige contracties. Er kunnen zo eiwitsliertjes ontstaan die herseninfarcten kunnen veroorzaken. Men moet dan bloedverdunners nemen, in dit geval anticoagulantia, die dus het coaguleren van de eiwitten tegen gaan. Men neemt dan coumarine derivaten zoals syntron (acenocoumarol). In de Angelsaksische landen wordt Warfarin gebruikt maar dat komt op hetzelfde neer. Het zijn Vitamine K inhibitors. Vitamine K is nodig om het bloed te laten coaguleren. Omdat afhankelijk van de voeding het vitamine K kan variëren moet men naar de thrombose dienst bij herhaling bloed leten nemen om te kijken of de dosering wellicht moet worden aangepast.
Aspirine werkt anders. Het zorgt ervoor dat de bloedplaatjes niet aan elkaar gaan plakken en korstjes vormen.Deze samenklonteringen van bloedplaatjes kunnen makkelijk infarcten veroorzaken. Ook zogenaamde TIA's kunnen ontstaan ( Transient Ischemic Attacks). De Tia's zijn kleinere propjes vandaar voorbijgaand (transient) Ischemic is eigenlijk zonder bloed, maar wordt hier gebruikt om aan te geven dat het propjes zijn en geen bloedingen. Het nadeel van de vitamine K remmers is dat ze wel zeer goed werken tegen het ontstaan van bloedstolseltjes maar ook eerder bloedingen kunnen veroorzaken. Aspirine werkt iets minder tegen het vormen van propjes, maar geeft minder bloedingen.
Als je meer wilt weten zoek dan bij Google, en vul het betreffend middel in plus wikipedia.
Tuesday, April 17, 2007
SCHIZOFRENIE
Comment: Over the decades, numerous neuropsychological difficulties have been described in patients with schizophrenia. What we call schizophrenia is a diverse group of syndromes that affect different patients in sundry ways. If all of these researchers had studied the same patients, we might have learned the extent to which this astounding array of deficits occurs concurrently and how specific phenomenologic features correlate with specific biologic findings.
An editorialist who attempts to make sense of this dizzying diversity of findings points out that all of the authors make good cases that their findings are due to uncorrected pathology rather than to medication effects. He hypothesizes that a single underlying pathology might affect different brain regions, as occurs in stroke patients. If so, clinical differences among patients might indicate individual variation in brain areas vulnerable to these underlying processes. Researchers could test this interesting idea by searching for more-fundamental common processes, e.g., whether these various neuroimpairments are associated with specific brain protein abnormalities.
— Joel Yager, MD
Published in Journal Watch Psychiatry April 13, 2007
An editorialist who attempts to make sense of this dizzying diversity of findings points out that all of the authors make good cases that their findings are due to uncorrected pathology rather than to medication effects. He hypothesizes that a single underlying pathology might affect different brain regions, as occurs in stroke patients. If so, clinical differences among patients might indicate individual variation in brain areas vulnerable to these underlying processes. Researchers could test this interesting idea by searching for more-fundamental common processes, e.g., whether these various neuroimpairments are associated with specific brain protein abnormalities.
— Joel Yager, MD
Published in Journal Watch Psychiatry April 13, 2007
Monday, April 09, 2007
statins
Statin drugs lower respiratory death risk
POSTED: 5:56 p.m. EDT, April 9, 2007
Story Highlights
• People on statins had lower death risk from emphysema, chronic bronchitis
• Statins patients also had a lower risk of dying from influenza or pneumonia
• Study supports theory that statins might help patients with H5N1 avian influenza
• Statins, including Lipitor, Lipitor, Pravachol, Zocor, are world's best-selling drugs
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WASHINGTON (Reuters) -- People who use statin drugs are less likely to die of influenza and chronic bronchitis, according to a study that shows yet another unexpected benefit of the cholesterol-lowering medications.
Their study of more than 76,000 people showed that those who had taken statins for at least 90 days had a much lower risk of dying from chronic obstructive pulmonary disease or COPD, the technical name for emphysema and chronic bronchitis.
Patients on statins also had a lower risk of dying from influenza or pneumonia, the researchers reported Monday.
Statins -- which include Pfizer Inc.'s $10 billion-a-year Lipitor, Bristol-Myers Squibb Co.'s Pravachol and Merck and Co. Inc.'s Zocor -- are the world's best-selling drugs, taken by millions to reduce the risk of heart attack.
The new study supports a theory proposed last year that statin drugs might help patients with H5N1 avian influenza, which some studies suggest kills by causing an immune system overreaction called a cytokine storm.
Floyd Frost of the Lovelace Respiratory Research Institute in Albuquerque, New Mexico, and colleagues analyzed their institute's database of medical records from several health maintenance organizations.
They looked at incidence of influenza and pneumonia and of COPD, and then cross-checked to see which patients were also taking statins.
"This study found a dramatically reduced risk of death from COPD among statin users and a significantly reduced risk of death from influenza/pneumonia," the researchers wrote in their report, published in the journal Chest.
"These findings suggest that moderate-dose statin use reduces the risk of influenza/pneumonia death and strongly suggest that statins reduce the risk of COPD death."
In 2006, researchers in Canada reported that statins act against sepsis, a dangerous blood infection, and a 2005 study found the death rate was 64 percent lower in pneumonia patients who had been taking statins.
Buying time?
Experts say a pandemic of some sort of influenza is inevitable.
The H5N1 avian influenza sweeping countries in Asia and also affecting Europe and Africa is considered the most likely candidate. So far it has rarely infected people, but has killed 170 people out of 285 known to have been infected.
Experts generally agree that an effective vaccine would take months to formulate and perhaps years to make enough doses to cover the world. There is also a shortage of antiviral drugs.
Statins might buy some time, Frost's team wrote.
"Even if statins are not able to significantly reduce the risk of death from avian influenza, their use could significantly extend the time between disease onset and death," they wrote.
"This additional survival time could increase the effectiveness of anti-influenza drugs, providing a longer time to reduce mortality risks."
Last July, Dr. David Fedson, a retired corporate expert on vaccination, cited studies that suggested statins might calm down immune response. The drugs are known to affect the insides of blood vessels, but their full mechanism of action is not fully understood.
POSTED: 5:56 p.m. EDT, April 9, 2007
Story Highlights
• People on statins had lower death risk from emphysema, chronic bronchitis
• Statins patients also had a lower risk of dying from influenza or pneumonia
• Study supports theory that statins might help patients with H5N1 avian influenza
• Statins, including Lipitor, Lipitor, Pravachol, Zocor, are world's best-selling drugs
Adjust font size:
Decrease fontDecrease font
Enlarge fontEnlarge font
WASHINGTON (Reuters) -- People who use statin drugs are less likely to die of influenza and chronic bronchitis, according to a study that shows yet another unexpected benefit of the cholesterol-lowering medications.
Their study of more than 76,000 people showed that those who had taken statins for at least 90 days had a much lower risk of dying from chronic obstructive pulmonary disease or COPD, the technical name for emphysema and chronic bronchitis.
Patients on statins also had a lower risk of dying from influenza or pneumonia, the researchers reported Monday.
Statins -- which include Pfizer Inc.'s $10 billion-a-year Lipitor, Bristol-Myers Squibb Co.'s Pravachol and Merck and Co. Inc.'s Zocor -- are the world's best-selling drugs, taken by millions to reduce the risk of heart attack.
The new study supports a theory proposed last year that statin drugs might help patients with H5N1 avian influenza, which some studies suggest kills by causing an immune system overreaction called a cytokine storm.
Floyd Frost of the Lovelace Respiratory Research Institute in Albuquerque, New Mexico, and colleagues analyzed their institute's database of medical records from several health maintenance organizations.
They looked at incidence of influenza and pneumonia and of COPD, and then cross-checked to see which patients were also taking statins.
"This study found a dramatically reduced risk of death from COPD among statin users and a significantly reduced risk of death from influenza/pneumonia," the researchers wrote in their report, published in the journal Chest.
"These findings suggest that moderate-dose statin use reduces the risk of influenza/pneumonia death and strongly suggest that statins reduce the risk of COPD death."
In 2006, researchers in Canada reported that statins act against sepsis, a dangerous blood infection, and a 2005 study found the death rate was 64 percent lower in pneumonia patients who had been taking statins.
Buying time?
Experts say a pandemic of some sort of influenza is inevitable.
The H5N1 avian influenza sweeping countries in Asia and also affecting Europe and Africa is considered the most likely candidate. So far it has rarely infected people, but has killed 170 people out of 285 known to have been infected.
Experts generally agree that an effective vaccine would take months to formulate and perhaps years to make enough doses to cover the world. There is also a shortage of antiviral drugs.
Statins might buy some time, Frost's team wrote.
"Even if statins are not able to significantly reduce the risk of death from avian influenza, their use could significantly extend the time between disease onset and death," they wrote.
"This additional survival time could increase the effectiveness of anti-influenza drugs, providing a longer time to reduce mortality risks."
Last July, Dr. David Fedson, a retired corporate expert on vaccination, cited studies that suggested statins might calm down immune response. The drugs are known to affect the insides of blood vessels, but their full mechanism of action is not fully understood.
Statin drugs lower respiratory death risk
POSTED: 5:56 p.m. EDT, April 9, 2007
Story Highlights
• People on statins had lower death risk from emphysema, chronic bronchitis
• Statins patients also had a lower risk of dying from influenza or pneumonia
• Study supports theory that statins might help patients with H5N1 avian influenza
• Statins, including Lipitor, Lipitor, Pravachol, Zocor, are world's best-selling drugs
Adjust font size:
Decrease fontDecrease font
Enlarge fontEnlarge font
WASHINGTON (Reuters) -- People who use statin drugs are less likely to die of influenza and chronic bronchitis, according to a study that shows yet another unexpected benefit of the cholesterol-lowering medications.
Their study of more than 76,000 people showed that those who had taken statins for at least 90 days had a much lower risk of dying from chronic obstructive pulmonary disease or COPD, the technical name for emphysema and chronic bronchitis.
Patients on statins also had a lower risk of dying from influenza or pneumonia, the researchers reported Monday.
Statins -- which include Pfizer Inc.'s $10 billion-a-year Lipitor, Bristol-Myers Squibb Co.'s Pravachol and Merck and Co. Inc.'s Zocor -- are the world's best-selling drugs, taken by millions to reduce the risk of heart attack.
The new study supports a theory proposed last year that statin drugs might help patients with H5N1 avian influenza, which some studies suggest kills by causing an immune system overreaction called a cytokine storm.
Floyd Frost of the Lovelace Respiratory Research Institute in Albuquerque, New Mexico, and colleagues analyzed their institute's database of medical records from several health maintenance organizations.
They looked at incidence of influenza and pneumonia and of COPD, and then cross-checked to see which patients were also taking statins.
"This study found a dramatically reduced risk of death from COPD among statin users and a significantly reduced risk of death from influenza/pneumonia," the researchers wrote in their report, published in the journal Chest.
"These findings suggest that moderate-dose statin use reduces the risk of influenza/pneumonia death and strongly suggest that statins reduce the risk of COPD death."
In 2006, researchers in Canada reported that statins act against sepsis, a dangerous blood infection, and a 2005 study found the death rate was 64 percent lower in pneumonia patients who had been taking statins.
Buying time?
Experts say a pandemic of some sort of influenza is inevitable.
The H5N1 avian influenza sweeping countries in Asia and also affecting Europe and Africa is considered the most likely candidate. So far it has rarely infected people, but has killed 170 people out of 285 known to have been infected.
Experts generally agree that an effective vaccine would take months to formulate and perhaps years to make enough doses to cover the world. There is also a shortage of antiviral drugs.
Statins might buy some time, Frost's team wrote.
"Even if statins are not able to significantly reduce the risk of death from avian influenza, their use could significantly extend the time between disease onset and death," they wrote.
"This additional survival time could increase the effectiveness of anti-influenza drugs, providing a longer time to reduce mortality risks."
Last July, Dr. David Fedson, a retired corporate expert on vaccination, cited studies that suggested statins might calm down immune response. The drugs are known to affect the insides of blood vessels, but their full mechanism of action is not fully understood.
POSTED: 5:56 p.m. EDT, April 9, 2007
Story Highlights
• People on statins had lower death risk from emphysema, chronic bronchitis
• Statins patients also had a lower risk of dying from influenza or pneumonia
• Study supports theory that statins might help patients with H5N1 avian influenza
• Statins, including Lipitor, Lipitor, Pravachol, Zocor, are world's best-selling drugs
Adjust font size:
Decrease fontDecrease font
Enlarge fontEnlarge font
WASHINGTON (Reuters) -- People who use statin drugs are less likely to die of influenza and chronic bronchitis, according to a study that shows yet another unexpected benefit of the cholesterol-lowering medications.
Their study of more than 76,000 people showed that those who had taken statins for at least 90 days had a much lower risk of dying from chronic obstructive pulmonary disease or COPD, the technical name for emphysema and chronic bronchitis.
Patients on statins also had a lower risk of dying from influenza or pneumonia, the researchers reported Monday.
Statins -- which include Pfizer Inc.'s $10 billion-a-year Lipitor, Bristol-Myers Squibb Co.'s Pravachol and Merck and Co. Inc.'s Zocor -- are the world's best-selling drugs, taken by millions to reduce the risk of heart attack.
The new study supports a theory proposed last year that statin drugs might help patients with H5N1 avian influenza, which some studies suggest kills by causing an immune system overreaction called a cytokine storm.
Floyd Frost of the Lovelace Respiratory Research Institute in Albuquerque, New Mexico, and colleagues analyzed their institute's database of medical records from several health maintenance organizations.
They looked at incidence of influenza and pneumonia and of COPD, and then cross-checked to see which patients were also taking statins.
"This study found a dramatically reduced risk of death from COPD among statin users and a significantly reduced risk of death from influenza/pneumonia," the researchers wrote in their report, published in the journal Chest.
"These findings suggest that moderate-dose statin use reduces the risk of influenza/pneumonia death and strongly suggest that statins reduce the risk of COPD death."
In 2006, researchers in Canada reported that statins act against sepsis, a dangerous blood infection, and a 2005 study found the death rate was 64 percent lower in pneumonia patients who had been taking statins.
Buying time?
Experts say a pandemic of some sort of influenza is inevitable.
The H5N1 avian influenza sweeping countries in Asia and also affecting Europe and Africa is considered the most likely candidate. So far it has rarely infected people, but has killed 170 people out of 285 known to have been infected.
Experts generally agree that an effective vaccine would take months to formulate and perhaps years to make enough doses to cover the world. There is also a shortage of antiviral drugs.
Statins might buy some time, Frost's team wrote.
"Even if statins are not able to significantly reduce the risk of death from avian influenza, their use could significantly extend the time between disease onset and death," they wrote.
"This additional survival time could increase the effectiveness of anti-influenza drugs, providing a longer time to reduce mortality risks."
Last July, Dr. David Fedson, a retired corporate expert on vaccination, cited studies that suggested statins might calm down immune response. The drugs are known to affect the insides of blood vessels, but their full mechanism of action is not fully understood.
pulse pressure 2
Gary F. Mitchell, M.D., of Cardiovascular Engineering Inc., Waltham, Mass., and colleagues examined the association between pulse pressure and the development of AF. The study included 5,331 participants of the Framingham Heart Study who were age 35 years and older and initially free from AF (median [midpoint] age, 57 years; 55 percent women).
During an average of 16 years of follow-up, 363 men and 335 women developed AF with a median time-to-event of 12 years after pulse pressure assessment. The researchers found that after adjusting for age and sex, a 20 mm Hg increase in pulse pressure was associated with a 34 percent increase in the risk for developing AF. The association between pulse pressure and AF remained significant after further adjusting for average arterial pressure and clinical risk factors for AF; each 20 mm Hg increase in pulse pressure was associated with a 24 percent increase in the risk for developing AF. In contrast, average arterial pressure was not associated with increased risk for developing AF.
Cumulative 20-year AF incidence rates were 5.6 percent for pulse pressure of 40 mm Hg or less (25th percentile) and 23.3 percent for pulse pressure greater than 61 mm Hg (75th percentile).
"In summary, we have shown that increased pulse pressure, a simple and readily accessible if somewhat indirect measure of arterial stiffness, is likely an important risk factor for development of AF in a community-based sample. Arterial stiffness increases with advancing age, even in a relatively healthy sample. However, increased arterial stiffness with advancing age is not inevitable and appears to be modifiable [such as by reducing various cardiovascular disease risk factors]. As a result, increased arterial stiffness may represent a major modifiable risk factor for development of AF."
"Given the aging of the population, further research is needed to determine whether interventions aimed at reducing pulse pressure or preventing the increase in pulse pressure with advancing age effectively reduce the incidence of AF. In light of the variable and often substantial increase in pulse pressure that accompanies advancing age, lifestyle modifications or therapy aimed specifically at reducing or limiting the increase in pulse pressure with advancing age may markedly reduce the substantial and rapidly growing incidence of AF in our aging society," the authors write.
###
(JAMA. 2007;297:709-715.)
During an average of 16 years of follow-up, 363 men and 335 women developed AF with a median time-to-event of 12 years after pulse pressure assessment. The researchers found that after adjusting for age and sex, a 20 mm Hg increase in pulse pressure was associated with a 34 percent increase in the risk for developing AF. The association between pulse pressure and AF remained significant after further adjusting for average arterial pressure and clinical risk factors for AF; each 20 mm Hg increase in pulse pressure was associated with a 24 percent increase in the risk for developing AF. In contrast, average arterial pressure was not associated with increased risk for developing AF.
Cumulative 20-year AF incidence rates were 5.6 percent for pulse pressure of 40 mm Hg or less (25th percentile) and 23.3 percent for pulse pressure greater than 61 mm Hg (75th percentile).
"In summary, we have shown that increased pulse pressure, a simple and readily accessible if somewhat indirect measure of arterial stiffness, is likely an important risk factor for development of AF in a community-based sample. Arterial stiffness increases with advancing age, even in a relatively healthy sample. However, increased arterial stiffness with advancing age is not inevitable and appears to be modifiable [such as by reducing various cardiovascular disease risk factors]. As a result, increased arterial stiffness may represent a major modifiable risk factor for development of AF."
"Given the aging of the population, further research is needed to determine whether interventions aimed at reducing pulse pressure or preventing the increase in pulse pressure with advancing age effectively reduce the incidence of AF. In light of the variable and often substantial increase in pulse pressure that accompanies advancing age, lifestyle modifications or therapy aimed specifically at reducing or limiting the increase in pulse pressure with advancing age may markedly reduce the substantial and rapidly growing incidence of AF in our aging society," the authors write.
###
(JAMA. 2007;297:709-715.)
Pulse Pressure
The study included 7,830 white and African American adults age 30 to 74 that took part in the Second National Health and Nutrition Examination Survey (NHANES II) from 1976 to 1992. All of the participants were free of an obvious heart disease. Blood pressure was measured three times at enrollment. Of the 1,588 participants who died, 582 died of cardiovascular disease.
Dr. Guallar and his colleagues studied the effects of high systolic and diastolic blood pressure simultaneously and found a direct and consistent correlation between increased systolic blood pressure and an increased risk of death from cardiovascular disease and for all other causes among all of the study participants. Increased diastolic pressure over 80 mm Hg was also associated with an increased risk of death. However, for people under 65, the risk of death remained the same for diastolic reading of 80 mm Hg or lower. For participants over 65 years of age, the risk of death increased with low diastolic pressure.
The researchers found a complex association between pulse pressure and mortality. Increasing pulse pressure caused by increased systolic pressure was associated with an increased risk of mortality. Increased pulse pressure caused by increased diastolic pressure could be associated with increased risk, decreased risk, and no change in the risk of mortality.
"Pulse pressure alone, without appropriate attention to systolic and diastolic blood pressure components, is an inadequate indicator of mortality risk," said Dr. Guallar.
Dr. Guallar and his colleagues studied the effects of high systolic and diastolic blood pressure simultaneously and found a direct and consistent correlation between increased systolic blood pressure and an increased risk of death from cardiovascular disease and for all other causes among all of the study participants. Increased diastolic pressure over 80 mm Hg was also associated with an increased risk of death. However, for people under 65, the risk of death remained the same for diastolic reading of 80 mm Hg or lower. For participants over 65 years of age, the risk of death increased with low diastolic pressure.
The researchers found a complex association between pulse pressure and mortality. Increasing pulse pressure caused by increased systolic pressure was associated with an increased risk of mortality. Increased pulse pressure caused by increased diastolic pressure could be associated with increased risk, decreased risk, and no change in the risk of mortality.
"Pulse pressure alone, without appropriate attention to systolic and diastolic blood pressure components, is an inadequate indicator of mortality risk," said Dr. Guallar.
Afro-Americans
The Failure of Youth
Williams' account of Negro youth growing up with little knowledge of their fathers, less of their fathers' occupations, still less of family occupational traditions, is in sharp contrast to the experience of the white child. The white family, despite many variants, remains a powerful agency not only for transmitting property from one generation to the next, but also for transmitting no less valuable contracts with the world of education and work. In an earlier age, the Carpenters, Wainwrights, Weavers, Mercers, Farmers, Smiths acquired their names as well as their trades from their fathers and grandfathers. Children today still learn the patterns of work from their fathers even though they may no longer go into the same jobs.
White children without fathers at least perceive all about them the pattern of men working.
Negro children without fathers flounder — and fail.
Not always, to be sure. The Negro community produces its share, very possibly more than its share, of young people who have the something extra that carries them over the worst obstacles. But such persons are always a minority. The common run of young people in a group facing serious obstacles to success do not succeed.
A prime index of the disadvantage of Negro youth in the United States is their consistently poor performance on the mental tests that are a standard means of measuring ability and performance in the present generation.
There is absolutely no question of any genetic differential: Intelligence potential is distributed among Negro infants in the same proportion as among Icelanders or Chinese or any other group. American society, however, impairs the Negro potential. The statement of the HARYOU report that "there is no basic disagreement over the fact that central Harlem students are performing poorly in school"39 may be taken as true of Negro slum children throughout the United States.
Eighth grade children in central Harlem have a median IQ of 87.7, which means that perhaps a third of the children are scoring at levels perilously near to those of retardation. IQ declines in the first decade of life, rising only slightly thereafter.
The effect of broken families on the performance of Negro youth has not been extensively measured, but studies that have been made show an unmistakable influence.
Martin Deutch and Bert Brown, investigating intelligence test differences between Negro and white 1st and 5th graders of different social classes, found that there is a direct relationship between social class and IQ. As the one rises so does the other: but more for whites than Negroes. This is surely a result of housing segregation, referred to earlier, which makes it difficult for middle class Negro families to escape the slums.
The authors explain that "it is much more difficult for the Negro to attain identical middle or upper middle class status with whites, and the social class gradations are less marked for Negroes because Negro life in a caste society is considerably more homogeneous than is life for the majority group."40
Therefore, the authors look for background variables other than social class which might explain the difference: "One of the most striking differences between the Negro and white groups is the consistently higher frequency of broken homes and resulting family disorganization in the Negro group."41
Further, they found that children from homes where fathers are present have significantly higher scores than children in homes without fathers.
The influence of the father's presence was then tested within the social classes and school grades for Negroes alone. They found that "a consistent trend within both grades at the lower SES [social class] level appears, and in no case is there a reversal of this trend: for males, females, and the combined group, the IQ's of children with fathers in the home are always higher than those who have no father in the home."42
The authors say that broken homes "may also account for some of the differences between Negro and white intelligence scores."43
The scores of fifth graders with fathers absent were lower than the scores of first graders with fathers absent, and while the authors point out that it is cross sectional data and does not reveal the duration of the fathers' absence, "What we might be tapping is the cumulative effect of fatherless years."44
This difference in ability to perform has its counterpart in statistics on actual school performance. Nonwhite boys from families with both parents present are more likely to be going to school than boys with only one parent present, and enrollment rates are even lower when neither parent is present.
When the boys from broken homes are in school, they do not do as well as the boys from whole families. Grade retardation is higher when only one parent is present, and highest when neither parent is present.
The loneliness of the Negro youth in making fundamental decisions about education is shown in a 1959 study of Negro and white dropouts in Connecticut high schools.
Only 29 percent of Negro male dropouts discussed their decision to drop out of school with their fathers, compared with 65 percent of the white males (38 percent of the Negro males were from broken homes). In fact, 26 percent of the Negro males did not discuss this major decision in their lives with anyone at all, compared with only 8 percent of white males.
A study of Negro apprenticeship by the New York State Commission Against Discrimination in 1960 concluded:
"Negro youth are seldom exposed to influences which can lead to apprenticeship. Negroes are not apt to have relatives, friends, or neighbors in skilled occupations. Nor are they likely to be in secondary schools where they receive encouragement and direction from alternate role models. Within the minority community, skilled Negro 'models' after whom the Negro youth might pattern himself are rare, while substitute sources which could provide the direction, encouragement, resources, and information needed to achieve skilled craft standing are nonexistent."45
Delinquency and Crime
The combined impact of poverty, failure, and isolation among Negro youth has had the predictable outcome in a disastrous delinquency and crime rate.
In a typical pattern of discrimination, Negro children in all public and private orphanages are a smaller proportion of all children than their proportion of the population although their needs are clearly greater.
On the other hand Negroes represent a third of all youth in training schools for juvenile delinquents.
It is probable that at present, a majority of the crimes against the person, such as rape, murder, and aggravated assault are committed by Negroes. There is, of course, no absolute evidence; inference can only be made from arrest and prison population statistics. The data that follow [chart not reproduced] unquestionably are biased against Negroes, who are arraigned much more casually than are whites, but it may be doubted that the bias is great enough to affect the general proportions.
Again on the urban frontier the ratio is worse: 3 out of every 5 arrests for these crimes were of Negroes.
In Chicago in 1963, three-quarters of the persons arrested for such crimes were Negro; in Detroit, the same proportions held.
In 1960, 37 percent of all persons in Federal and State prisons were Negro. In that year, 56 percent of the homicide and 57 percent of the assault offenders committed to State institutions were Negro.
The overwhelming number of offenses committed by Negroes are directed toward other Negroes: the cost of crime to the Negro community is a combination of that to the criminal and to the victim.
Some of the research on the effects of broken homes on delinquent behavior recently surveyed by Thomas F. Pettigrew in A Profile of the Negro American is summarized below, along with several other studies of the question.
Mary Diggs found that three-fourths — twice the expected ratio — of Philadelphia's Negro delinquents who came before the law during 1948 did not live with both their natural parents.46
In predicting juvenile crime, Eleanor and Sheldon Glueck also found that a higher proportion of delinquent than nondelinquent boys came from broken homes. They identified five critical factors in the home environment that made a difference in whether boys would become delinquents: discipline of boy by father, supervision of boy by mother, affection of father for boy, affection of mother for boy, and cohesiveness of family.
In 1952, when the New York City Youth Board set out to test the validity of these five factors as predictors of delinquency, a problem quickly emerged. The Glueck sample consisted of white boys of mainly Irish, Italian, Lithuanian, and English descent. However, the Youth Board group was 44 percent Negro and 14 percent Puerto Rican, and the frequency of broken homes within these groups was out of proportion to the total number of delinquents in the population.47
"In the majority of these cases, the father was usually never in the home at all, absent for the major proportion of the boy's life, or was present only on occasion."
(The final prediction table was reduced to three factors: supervision of boy by mother, discipline of boy by mother, and family cohesiveness within what family, in fact, existed, but was, nonetheless, 85 percent accurate in predicting delinquents and 96 percent accurate in predicting nondelinquents.)
Researchers who have focussed [sic] upon the "good" boy in high delinquency neighborhoods noted that they typically come from exceptionally stable, intact families.48
Recent psychological research demonstrates the personality effects of being reared in a disorganized home without a father. One study showed that children from fatherless homes seek immediate gratification of their desires far more than children with fathers present.49 Others revealed that children who hunger for immediate gratification are more prone to delinquency, along with other less social behavior.50 Two psychologists, Pettigrew says, maintain that inability to delay gratification is a critical factor in immature, criminal, and neurotic behavior.51
Finally, Pettigrew discussed the evidence that a stable home is a crucial factor in counteracting the effects of racism upon Negro personality.
"A warm, supportive home can effectively compensate for many of the restrictions the Negro child faces outside of the ghetto; consequently, the type of home life a Negro enjoys as a child may be far more crucial for governing the influence of segregation upon his personality than the form the segregation takes — legal or informal, Southern or Northern."52
A Yale University study of youth in the lowest socioeconomic class in New Haven in 1950 whose behavior was followed through their 18th year revealed that among the delinquents in the group, 38 percent came from broken homes, compared with 24 percent of nondelinquents.53
The President's Task Force on Manpower Conservation in 1963 found that of young men rejected for the draft for failure to pass the mental tests, 42 percent of those with a court record came from broken homes, compared with 30 percent of those without a court record. Half of all the nonwhite rejectees in the study with a court record came from broken homes.
An examination of the family background of 44,448 delinquency cases in Philadelphia between 1949 and 1954 documents the frequency of broken homes among delinquents. Sixty two percent of the Negro delinquents and 36 percent of white delinquents were not living with both parents. In 1950, 33 percent of nonwhite children and 7 percent of white children in Philadelphia were living in homes without both parents. Repeaters were even more likely to be from broken homes than first offenders.54
The Armed Forces
The ultimate mark of inadequate preparation for life is the failure rate on the Armed Forces mental test. The Armed Forces Qualification Test is not quite a mental test, nor yet an education test. It is a test of ability to perform at an acceptable level of competence. It roughly measures ability that ought to be found in an average 7th or 8th grade student. A grown young man who cannot pass this test is in trouble.
Fifty six percent of Negroes fail it.
This is a rate almost four times that of the whites.
The Army, Navy, Air Force, and Marines conduct by far the largest and most important education and training activities of the Federal Government, as well as provide the largest single source of employment in the nation.
Military service is disruptive in some respects. For those comparatively few who are killed or wounded in combat, or otherwise, the personal sacrifice is inestimable. But on balance service in the Armed Forces over the past quarter-century has worked greatly to the advantage of those involved. The training and experience of military duty itself is unique, the advantages that have generally followed in the form of the G.I. Bill, mortgage guarantees, Federal life insurance, Civil Service preference, veterans hospitals, and veterans pensions are singular, to say the least.
Although service in the Armed Forces is at least nominally a duty of all male citizens coming of age, it is clear that the present system does not enable Negroes to serve in anything like their proportionate numbers. This is not a question of discrimination. Induction into the Armed Forces is based on a variety of objective tests and standards, but these tests nonetheless have the effect of keeping the number of Negroes disproportionately small.
In 1963 the United States Commission on Civil Rights reported that "A decade ago, Negroes constituted 8 percent of the Armed Forces. Today... they continue to constitute 8 percent of the Armed Forces."55
In 1964 Negroes constituted 11.8 percent of the population, but probably remain at 8 percent of the Armed Forces.
The significance of Negro under representation in the Armed Forces is greater than might at first be supposed. If Negroes were represented in the same proportions in the military as they are in the population, they would number 300,000 plus. This would be over 100,000 more than at present (using 1964 strength figures). If the more than 100,000 unemployed Negro men were to have gone into the military the Negro male unemployment rate would have been 7.0 percent in 1964 instead of 9.1 percent.
In 1963 the Civil Rights Commission commented on the occupational aspect of military service for Negroes. "Negro enlisted men enjoy relatively better opportunities in the Armed Forces than in the civilian economy in every clerical, technical, and skilled field for which the data permit comparison."56
There is, however, an even more important issue involved in military service for Negroes. Service in the United States Armed Forces is the only experience open to the Negro American in which he is truly treated as an equal: not as a Negro equal to a white, but as one man equal to any other man in a world where the category "Negro" and "white" do not exist. If this is a statement of the ideal rather than reality, it is an ideal that is close to realization. In food, dress, housing, pay, work — the Negro in the Armed Forces is equal and is treated that way.
There is another special quality about military service for Negro men: it is an utterly masculine world. Given the strains of the disorganized and matrifocal family life in which so many Negro youth come of age, the Armed Forces are a dramatic and desperately needed change: a world away from women, a world run by strong men of unquestioned authority, where discipline, if harsh, is nonetheless orderly and predictable, and where rewards, if limited, are granted on the basis of performance.
The theme of a current Army recruiting message states it as clearly as can be: "In the U.S. Army you get to know what it means to feel like a man."
At the recent Civil Rights Commission hearings in Mississippi a witness testified that his Army service was in fact "the only time I ever felt like a man."
Yet a majority of Negro youth (and probably three quarters of Mississippi Negroes) fail the Selective Service education test and are rejected. Negro participation in the Armed Forces would be less than it is, were it not for a proportionally larger share of voluntary enlistments and reenlistments. (Thus 16.3 percent of Army sergeants are Negro.)
Alienation
The term alienation may by now have been used in too many ways to retain a clear meaning, but it will serve to sum up the equally numerous ways in which large numbers of Negro youth appear to be withdrawing from American society.
One startling way in which this occurs is that the men are just not there when the Census enumerator comes around.
According to Bureau of Census population estimates for 1963, there are only 87 nonwhite males for every 100 females in the 30-to-34-year age group. The ratio does not exceed 90 to 100 throughout the 25-to-44-year age bracket. In the urban Northeast, there are only 76 males per 100 females 20-to-24-years of age, and males as a percent of females are below 90 percent throughout all ages after 14.
There are not really fewer men than women in the 20-to-40 age bracket. What obviously in involved is an error in counting: the surveyors simply do not find the Negro man. Donald J. Bogue and his associates, who have studied the Federal count of the Negro man, place the error as high as 19.8 percent at age 28; a typical error of around 15 percent is estimated from age 19 through 43.57 Preliminary research in the Bureau of the Census on the 1960 enumeration has resulted in similar conclusions, although not necessarily the same estimates of the extent of the error. The Negro male can be found at age 17 and 18. On the basis of birth records and mortality records, the conclusion must be that he is there at age 19 as well.
When the enumerators do find him, his answers to the standard questions asked in the monthly unemployment survey often result in counting him as "not in the labor force." In other words, Negro male unemployment may in truth be somewhat greater than reported.
The labor force participation rates of nonwhite men have been falling since the beginning of the century and for the past decade have been lower than the rates for white men. In 1964, the participation rates were 78.0 percent for white men and 75.8 percent for nonwhite men. Almost one percentage point of this difference was due to a higher proportion of nonwhite men unable to work because of long-term physical or mental illness; it seems reasonable to assume that the rest of the difference is due to discouragement about finding a job.
If nonwhite male labor force participation rates were as high as the white rates, there would have been 140,000 more nonwhite males in the labor force in 1964. If we further assume that the 140,000 would have been unemployed, the unemployment rate for nonwhite men would have been 11.5 percent instead of the recorded rate of 9 percent, and the ratio between the nonwhite rate and the white rate would have jumped from 2:1 to 2.4:1.
Understated or not, the official unemployment rates for Negroes are almost unbelievable.
The unemployment statistics for Negro teenagers — 29 percent in January 1965 — reflect lack of training and opportunity in the greatest measure, but it may not be doubted that they also reflect a certain failure of nerve.
"Are you looking for a job?" Secretary of Labor Wirtz asked a young man on a Harlem street corner. "Why?" was the reply.
Richard A. Cloward and Robert Ontell have commented on the withdrawal in a discussion of the Mobilization for Youth project on the lower East Side of New York.
"What contemporary slum and minority youth probably lack that similar children in earlier periods possessed is not motivation but some minimal sense of competence.
"We are plagued, in work with these youth, by what appears to be a low tolerance for frustration. They are not able to absorb setbacks. Minor irritants and rebuffs are magnified out of all proportion to reality. Perhaps they react as they do because they are not equal to the world that confronts them, and they know it. And it is the knowing that is devastating. Had the occupational structure remained intact, or had the education provided to them kept pace with occupational changes, the situation would be a different one. But it is not, and that is what we and they have to contend with."58
Narcotic addiction is a characteristic form of withdrawal. In 1963, Negroes made up 54 percent of the addict population of the United States. Although the Federal Bureau of Narcotics reports a decline in the Negro proportion of new addicts, HARYOU reports the addiction rate in central Harlem rose from 22.1 per 10,000 in 1955 to 40.4 in 1961.59
There is a larger fact about the alienation of Negro youth than the tangle of pathology described by these statistics. It is a fact particularly difficult to grasp by white persons who have in recent years shown increasing awareness of Negro problems.
The present generation of Negro youth growing up in the urban ghettos has probably less personal contact with the white world than any generation in the history of the Negro American.60
Until World War II it could be said that in general the Negro and white worlds live, if not together, at least side by side. Certainly they did, and do, in the South.
Since World War II, however, the two worlds have drawn physically apart. The symbol of this development was the construction in the 1940's and 1950's of the vast white, middle and lower middle class suburbs around all the Nation's cities. Increasingly the inner cities have been left to Negroes — who now share almost no community life with whites.
In turn, because of this new housing pattern — most of which has been financially assisted by the Federal government — it is probable that the American school system has become more, rather than less segregated in the past two decades.
School integration has not occurred in the South, where a decade after Brown v. Board of Education only 1 Negro in 9 is attending school with white children.
And in the North, despite strenuous official efforts, neighborhoods and therefore schools are becoming more and more of one class and one color.
In New York City, in the school year 1957-58 there were 64 schools that were 90 percent of [sic] more Negro or Puerto Rican. Six years later there were 134 such schools.
Along with the diminution of white middle class contacts for a large percentage of Negroes, observers report that the Negro churches have all but lost contact with men in the Northern cities as well. This may be a normal condition of urban life, but it is probably a changed condition for the Negro American and cannot be a socially desirable development.
The only religious movement that appears to have enlisted a considerable number of lower class Negro males in Northern cities of late is that of the Black Muslims: a movement based on total rejection of white society, even though it emulates whites more.
In a word: the tangle of pathology is tightening.
Previous
Williams' account of Negro youth growing up with little knowledge of their fathers, less of their fathers' occupations, still less of family occupational traditions, is in sharp contrast to the experience of the white child. The white family, despite many variants, remains a powerful agency not only for transmitting property from one generation to the next, but also for transmitting no less valuable contracts with the world of education and work. In an earlier age, the Carpenters, Wainwrights, Weavers, Mercers, Farmers, Smiths acquired their names as well as their trades from their fathers and grandfathers. Children today still learn the patterns of work from their fathers even though they may no longer go into the same jobs.
White children without fathers at least perceive all about them the pattern of men working.
Negro children without fathers flounder — and fail.
Not always, to be sure. The Negro community produces its share, very possibly more than its share, of young people who have the something extra that carries them over the worst obstacles. But such persons are always a minority. The common run of young people in a group facing serious obstacles to success do not succeed.
A prime index of the disadvantage of Negro youth in the United States is their consistently poor performance on the mental tests that are a standard means of measuring ability and performance in the present generation.
There is absolutely no question of any genetic differential: Intelligence potential is distributed among Negro infants in the same proportion as among Icelanders or Chinese or any other group. American society, however, impairs the Negro potential. The statement of the HARYOU report that "there is no basic disagreement over the fact that central Harlem students are performing poorly in school"39 may be taken as true of Negro slum children throughout the United States.
Eighth grade children in central Harlem have a median IQ of 87.7, which means that perhaps a third of the children are scoring at levels perilously near to those of retardation. IQ declines in the first decade of life, rising only slightly thereafter.
The effect of broken families on the performance of Negro youth has not been extensively measured, but studies that have been made show an unmistakable influence.
Martin Deutch and Bert Brown, investigating intelligence test differences between Negro and white 1st and 5th graders of different social classes, found that there is a direct relationship between social class and IQ. As the one rises so does the other: but more for whites than Negroes. This is surely a result of housing segregation, referred to earlier, which makes it difficult for middle class Negro families to escape the slums.
The authors explain that "it is much more difficult for the Negro to attain identical middle or upper middle class status with whites, and the social class gradations are less marked for Negroes because Negro life in a caste society is considerably more homogeneous than is life for the majority group."40
Therefore, the authors look for background variables other than social class which might explain the difference: "One of the most striking differences between the Negro and white groups is the consistently higher frequency of broken homes and resulting family disorganization in the Negro group."41
Further, they found that children from homes where fathers are present have significantly higher scores than children in homes without fathers.
The influence of the father's presence was then tested within the social classes and school grades for Negroes alone. They found that "a consistent trend within both grades at the lower SES [social class] level appears, and in no case is there a reversal of this trend: for males, females, and the combined group, the IQ's of children with fathers in the home are always higher than those who have no father in the home."42
The authors say that broken homes "may also account for some of the differences between Negro and white intelligence scores."43
The scores of fifth graders with fathers absent were lower than the scores of first graders with fathers absent, and while the authors point out that it is cross sectional data and does not reveal the duration of the fathers' absence, "What we might be tapping is the cumulative effect of fatherless years."44
This difference in ability to perform has its counterpart in statistics on actual school performance. Nonwhite boys from families with both parents present are more likely to be going to school than boys with only one parent present, and enrollment rates are even lower when neither parent is present.
When the boys from broken homes are in school, they do not do as well as the boys from whole families. Grade retardation is higher when only one parent is present, and highest when neither parent is present.
The loneliness of the Negro youth in making fundamental decisions about education is shown in a 1959 study of Negro and white dropouts in Connecticut high schools.
Only 29 percent of Negro male dropouts discussed their decision to drop out of school with their fathers, compared with 65 percent of the white males (38 percent of the Negro males were from broken homes). In fact, 26 percent of the Negro males did not discuss this major decision in their lives with anyone at all, compared with only 8 percent of white males.
A study of Negro apprenticeship by the New York State Commission Against Discrimination in 1960 concluded:
"Negro youth are seldom exposed to influences which can lead to apprenticeship. Negroes are not apt to have relatives, friends, or neighbors in skilled occupations. Nor are they likely to be in secondary schools where they receive encouragement and direction from alternate role models. Within the minority community, skilled Negro 'models' after whom the Negro youth might pattern himself are rare, while substitute sources which could provide the direction, encouragement, resources, and information needed to achieve skilled craft standing are nonexistent."45
Delinquency and Crime
The combined impact of poverty, failure, and isolation among Negro youth has had the predictable outcome in a disastrous delinquency and crime rate.
In a typical pattern of discrimination, Negro children in all public and private orphanages are a smaller proportion of all children than their proportion of the population although their needs are clearly greater.
On the other hand Negroes represent a third of all youth in training schools for juvenile delinquents.
It is probable that at present, a majority of the crimes against the person, such as rape, murder, and aggravated assault are committed by Negroes. There is, of course, no absolute evidence; inference can only be made from arrest and prison population statistics. The data that follow [chart not reproduced] unquestionably are biased against Negroes, who are arraigned much more casually than are whites, but it may be doubted that the bias is great enough to affect the general proportions.
Again on the urban frontier the ratio is worse: 3 out of every 5 arrests for these crimes were of Negroes.
In Chicago in 1963, three-quarters of the persons arrested for such crimes were Negro; in Detroit, the same proportions held.
In 1960, 37 percent of all persons in Federal and State prisons were Negro. In that year, 56 percent of the homicide and 57 percent of the assault offenders committed to State institutions were Negro.
The overwhelming number of offenses committed by Negroes are directed toward other Negroes: the cost of crime to the Negro community is a combination of that to the criminal and to the victim.
Some of the research on the effects of broken homes on delinquent behavior recently surveyed by Thomas F. Pettigrew in A Profile of the Negro American is summarized below, along with several other studies of the question.
Mary Diggs found that three-fourths — twice the expected ratio — of Philadelphia's Negro delinquents who came before the law during 1948 did not live with both their natural parents.46
In predicting juvenile crime, Eleanor and Sheldon Glueck also found that a higher proportion of delinquent than nondelinquent boys came from broken homes. They identified five critical factors in the home environment that made a difference in whether boys would become delinquents: discipline of boy by father, supervision of boy by mother, affection of father for boy, affection of mother for boy, and cohesiveness of family.
In 1952, when the New York City Youth Board set out to test the validity of these five factors as predictors of delinquency, a problem quickly emerged. The Glueck sample consisted of white boys of mainly Irish, Italian, Lithuanian, and English descent. However, the Youth Board group was 44 percent Negro and 14 percent Puerto Rican, and the frequency of broken homes within these groups was out of proportion to the total number of delinquents in the population.47
"In the majority of these cases, the father was usually never in the home at all, absent for the major proportion of the boy's life, or was present only on occasion."
(The final prediction table was reduced to three factors: supervision of boy by mother, discipline of boy by mother, and family cohesiveness within what family, in fact, existed, but was, nonetheless, 85 percent accurate in predicting delinquents and 96 percent accurate in predicting nondelinquents.)
Researchers who have focussed [sic] upon the "good" boy in high delinquency neighborhoods noted that they typically come from exceptionally stable, intact families.48
Recent psychological research demonstrates the personality effects of being reared in a disorganized home without a father. One study showed that children from fatherless homes seek immediate gratification of their desires far more than children with fathers present.49 Others revealed that children who hunger for immediate gratification are more prone to delinquency, along with other less social behavior.50 Two psychologists, Pettigrew says, maintain that inability to delay gratification is a critical factor in immature, criminal, and neurotic behavior.51
Finally, Pettigrew discussed the evidence that a stable home is a crucial factor in counteracting the effects of racism upon Negro personality.
"A warm, supportive home can effectively compensate for many of the restrictions the Negro child faces outside of the ghetto; consequently, the type of home life a Negro enjoys as a child may be far more crucial for governing the influence of segregation upon his personality than the form the segregation takes — legal or informal, Southern or Northern."52
A Yale University study of youth in the lowest socioeconomic class in New Haven in 1950 whose behavior was followed through their 18th year revealed that among the delinquents in the group, 38 percent came from broken homes, compared with 24 percent of nondelinquents.53
The President's Task Force on Manpower Conservation in 1963 found that of young men rejected for the draft for failure to pass the mental tests, 42 percent of those with a court record came from broken homes, compared with 30 percent of those without a court record. Half of all the nonwhite rejectees in the study with a court record came from broken homes.
An examination of the family background of 44,448 delinquency cases in Philadelphia between 1949 and 1954 documents the frequency of broken homes among delinquents. Sixty two percent of the Negro delinquents and 36 percent of white delinquents were not living with both parents. In 1950, 33 percent of nonwhite children and 7 percent of white children in Philadelphia were living in homes without both parents. Repeaters were even more likely to be from broken homes than first offenders.54
The Armed Forces
The ultimate mark of inadequate preparation for life is the failure rate on the Armed Forces mental test. The Armed Forces Qualification Test is not quite a mental test, nor yet an education test. It is a test of ability to perform at an acceptable level of competence. It roughly measures ability that ought to be found in an average 7th or 8th grade student. A grown young man who cannot pass this test is in trouble.
Fifty six percent of Negroes fail it.
This is a rate almost four times that of the whites.
The Army, Navy, Air Force, and Marines conduct by far the largest and most important education and training activities of the Federal Government, as well as provide the largest single source of employment in the nation.
Military service is disruptive in some respects. For those comparatively few who are killed or wounded in combat, or otherwise, the personal sacrifice is inestimable. But on balance service in the Armed Forces over the past quarter-century has worked greatly to the advantage of those involved. The training and experience of military duty itself is unique, the advantages that have generally followed in the form of the G.I. Bill, mortgage guarantees, Federal life insurance, Civil Service preference, veterans hospitals, and veterans pensions are singular, to say the least.
Although service in the Armed Forces is at least nominally a duty of all male citizens coming of age, it is clear that the present system does not enable Negroes to serve in anything like their proportionate numbers. This is not a question of discrimination. Induction into the Armed Forces is based on a variety of objective tests and standards, but these tests nonetheless have the effect of keeping the number of Negroes disproportionately small.
In 1963 the United States Commission on Civil Rights reported that "A decade ago, Negroes constituted 8 percent of the Armed Forces. Today... they continue to constitute 8 percent of the Armed Forces."55
In 1964 Negroes constituted 11.8 percent of the population, but probably remain at 8 percent of the Armed Forces.
The significance of Negro under representation in the Armed Forces is greater than might at first be supposed. If Negroes were represented in the same proportions in the military as they are in the population, they would number 300,000 plus. This would be over 100,000 more than at present (using 1964 strength figures). If the more than 100,000 unemployed Negro men were to have gone into the military the Negro male unemployment rate would have been 7.0 percent in 1964 instead of 9.1 percent.
In 1963 the Civil Rights Commission commented on the occupational aspect of military service for Negroes. "Negro enlisted men enjoy relatively better opportunities in the Armed Forces than in the civilian economy in every clerical, technical, and skilled field for which the data permit comparison."56
There is, however, an even more important issue involved in military service for Negroes. Service in the United States Armed Forces is the only experience open to the Negro American in which he is truly treated as an equal: not as a Negro equal to a white, but as one man equal to any other man in a world where the category "Negro" and "white" do not exist. If this is a statement of the ideal rather than reality, it is an ideal that is close to realization. In food, dress, housing, pay, work — the Negro in the Armed Forces is equal and is treated that way.
There is another special quality about military service for Negro men: it is an utterly masculine world. Given the strains of the disorganized and matrifocal family life in which so many Negro youth come of age, the Armed Forces are a dramatic and desperately needed change: a world away from women, a world run by strong men of unquestioned authority, where discipline, if harsh, is nonetheless orderly and predictable, and where rewards, if limited, are granted on the basis of performance.
The theme of a current Army recruiting message states it as clearly as can be: "In the U.S. Army you get to know what it means to feel like a man."
At the recent Civil Rights Commission hearings in Mississippi a witness testified that his Army service was in fact "the only time I ever felt like a man."
Yet a majority of Negro youth (and probably three quarters of Mississippi Negroes) fail the Selective Service education test and are rejected. Negro participation in the Armed Forces would be less than it is, were it not for a proportionally larger share of voluntary enlistments and reenlistments. (Thus 16.3 percent of Army sergeants are Negro.)
Alienation
The term alienation may by now have been used in too many ways to retain a clear meaning, but it will serve to sum up the equally numerous ways in which large numbers of Negro youth appear to be withdrawing from American society.
One startling way in which this occurs is that the men are just not there when the Census enumerator comes around.
According to Bureau of Census population estimates for 1963, there are only 87 nonwhite males for every 100 females in the 30-to-34-year age group. The ratio does not exceed 90 to 100 throughout the 25-to-44-year age bracket. In the urban Northeast, there are only 76 males per 100 females 20-to-24-years of age, and males as a percent of females are below 90 percent throughout all ages after 14.
There are not really fewer men than women in the 20-to-40 age bracket. What obviously in involved is an error in counting: the surveyors simply do not find the Negro man. Donald J. Bogue and his associates, who have studied the Federal count of the Negro man, place the error as high as 19.8 percent at age 28; a typical error of around 15 percent is estimated from age 19 through 43.57 Preliminary research in the Bureau of the Census on the 1960 enumeration has resulted in similar conclusions, although not necessarily the same estimates of the extent of the error. The Negro male can be found at age 17 and 18. On the basis of birth records and mortality records, the conclusion must be that he is there at age 19 as well.
When the enumerators do find him, his answers to the standard questions asked in the monthly unemployment survey often result in counting him as "not in the labor force." In other words, Negro male unemployment may in truth be somewhat greater than reported.
The labor force participation rates of nonwhite men have been falling since the beginning of the century and for the past decade have been lower than the rates for white men. In 1964, the participation rates were 78.0 percent for white men and 75.8 percent for nonwhite men. Almost one percentage point of this difference was due to a higher proportion of nonwhite men unable to work because of long-term physical or mental illness; it seems reasonable to assume that the rest of the difference is due to discouragement about finding a job.
If nonwhite male labor force participation rates were as high as the white rates, there would have been 140,000 more nonwhite males in the labor force in 1964. If we further assume that the 140,000 would have been unemployed, the unemployment rate for nonwhite men would have been 11.5 percent instead of the recorded rate of 9 percent, and the ratio between the nonwhite rate and the white rate would have jumped from 2:1 to 2.4:1.
Understated or not, the official unemployment rates for Negroes are almost unbelievable.
The unemployment statistics for Negro teenagers — 29 percent in January 1965 — reflect lack of training and opportunity in the greatest measure, but it may not be doubted that they also reflect a certain failure of nerve.
"Are you looking for a job?" Secretary of Labor Wirtz asked a young man on a Harlem street corner. "Why?" was the reply.
Richard A. Cloward and Robert Ontell have commented on the withdrawal in a discussion of the Mobilization for Youth project on the lower East Side of New York.
"What contemporary slum and minority youth probably lack that similar children in earlier periods possessed is not motivation but some minimal sense of competence.
"We are plagued, in work with these youth, by what appears to be a low tolerance for frustration. They are not able to absorb setbacks. Minor irritants and rebuffs are magnified out of all proportion to reality. Perhaps they react as they do because they are not equal to the world that confronts them, and they know it. And it is the knowing that is devastating. Had the occupational structure remained intact, or had the education provided to them kept pace with occupational changes, the situation would be a different one. But it is not, and that is what we and they have to contend with."58
Narcotic addiction is a characteristic form of withdrawal. In 1963, Negroes made up 54 percent of the addict population of the United States. Although the Federal Bureau of Narcotics reports a decline in the Negro proportion of new addicts, HARYOU reports the addiction rate in central Harlem rose from 22.1 per 10,000 in 1955 to 40.4 in 1961.59
There is a larger fact about the alienation of Negro youth than the tangle of pathology described by these statistics. It is a fact particularly difficult to grasp by white persons who have in recent years shown increasing awareness of Negro problems.
The present generation of Negro youth growing up in the urban ghettos has probably less personal contact with the white world than any generation in the history of the Negro American.60
Until World War II it could be said that in general the Negro and white worlds live, if not together, at least side by side. Certainly they did, and do, in the South.
Since World War II, however, the two worlds have drawn physically apart. The symbol of this development was the construction in the 1940's and 1950's of the vast white, middle and lower middle class suburbs around all the Nation's cities. Increasingly the inner cities have been left to Negroes — who now share almost no community life with whites.
In turn, because of this new housing pattern — most of which has been financially assisted by the Federal government — it is probable that the American school system has become more, rather than less segregated in the past two decades.
School integration has not occurred in the South, where a decade after Brown v. Board of Education only 1 Negro in 9 is attending school with white children.
And in the North, despite strenuous official efforts, neighborhoods and therefore schools are becoming more and more of one class and one color.
In New York City, in the school year 1957-58 there were 64 schools that were 90 percent of [sic] more Negro or Puerto Rican. Six years later there were 134 such schools.
Along with the diminution of white middle class contacts for a large percentage of Negroes, observers report that the Negro churches have all but lost contact with men in the Northern cities as well. This may be a normal condition of urban life, but it is probably a changed condition for the Negro American and cannot be a socially desirable development.
The only religious movement that appears to have enlisted a considerable number of lower class Negro males in Northern cities of late is that of the Black Muslims: a movement based on total rejection of white society, even though it emulates whites more.
In a word: the tangle of pathology is tightening.
Previous
African American
Robin M. Williams, Jr. in a study of Elmira, New York:
"Only 57 percent of Negro adults reported themselves as married-spouse present, as compared with 78 percent of native white American gentiles, 91 percent of Italian-American, and 96 percent of Jewish informants. Of the 93 unmarried Negro youths interviewed, 22 percent did not have their mother living in the home with them, and 42 percent reported that their father was not living in their home. One third of the youth did not know their father's present occupation, and two-thirds of a sample of 150 Negro adults did not know what the occupation of their father's father had been. Forty percent of the youths said that they had brothers and sisters living in other communities: another 40 percent reported relatives living in their home who were not parents, siblings, or grandparent."38
"Only 57 percent of Negro adults reported themselves as married-spouse present, as compared with 78 percent of native white American gentiles, 91 percent of Italian-American, and 96 percent of Jewish informants. Of the 93 unmarried Negro youths interviewed, 22 percent did not have their mother living in the home with them, and 42 percent reported that their father was not living in their home. One third of the youth did not know their father's present occupation, and two-thirds of a sample of 150 Negro adults did not know what the occupation of their father's father had been. Forty percent of the youths said that they had brothers and sisters living in other communities: another 40 percent reported relatives living in their home who were not parents, siblings, or grandparent."38
Sunday, April 08, 2007
negro family structure
There are two reasons. First, the racist virus in the American blood stream still afflicts us: Negroes will encounter serious personal prejudice for at least another generation. Second, three centuries of sometimes unimaginable mistreatment have taken their toll on the Negro people. The harsh fact is that as a group, at the present time, in terms of ability to win out in the competitions of American life, they are not equal to most of those groups with which they will be competing. Individually, Negro Americans reach the highest peaks of achievement. But collectively, in the spectrum of American ethnic and religious and regional groups, where some get plenty and some get none, where some send eighty percent of their children to college and others pull them out of school at the 8th grade, Negroes are among the weakest.
The most difficult fact for white Americans to understand is that in these terms the circumstances of the Negro American community in recent years has probably been getting worse, not better.
Indices of dollars of income, standards of living, and years of education deceive. The gap between the Negro and most other groups in American society is widening.
The fundamental problem, in which this is most clearly the case, is that of family structure. The evidence — not final, but powerfully persuasive — is that the Negro family in the urban ghettos is crumbling. A middle class group has managed to save itself, but for vast numbers of the unskilled, poorly educated city working class the fabric of conventional social relationships has all but disintegrated. There are indications that the situation may have been arrested in the past few years, but the general post war trend is unmistakable. So long as this situation persists, the cycle of poverty and disadvantage will continue to repeat itself.
The thesis of this paper is that these events, in combination, confront the nation with a new kind of problem. Measures that have worked in the past, or would work for most groups in the present, will not work here. A national effort is required that will give a unity of purpose to the many activities of the Federal government in this area, directed to a new kind of national goal: the establishment of a stable Negro family structure.
This would be a new departure for Federal policy. And a difficult one. But it almost certainly offers the only possibility of resolving in our time what is, after all, the nation's oldest, and most intransigent, and now its most dangerous social problem. What Gunnar Myrdal said in An American Dilemma remains true today: "America is free to chose whether the Negro shall remain her liability or become her opportunity."
The most difficult fact for white Americans to understand is that in these terms the circumstances of the Negro American community in recent years has probably been getting worse, not better.
Indices of dollars of income, standards of living, and years of education deceive. The gap between the Negro and most other groups in American society is widening.
The fundamental problem, in which this is most clearly the case, is that of family structure. The evidence — not final, but powerfully persuasive — is that the Negro family in the urban ghettos is crumbling. A middle class group has managed to save itself, but for vast numbers of the unskilled, poorly educated city working class the fabric of conventional social relationships has all but disintegrated. There are indications that the situation may have been arrested in the past few years, but the general post war trend is unmistakable. So long as this situation persists, the cycle of poverty and disadvantage will continue to repeat itself.
The thesis of this paper is that these events, in combination, confront the nation with a new kind of problem. Measures that have worked in the past, or would work for most groups in the present, will not work here. A national effort is required that will give a unity of purpose to the many activities of the Federal government in this area, directed to a new kind of national goal: the establishment of a stable Negro family structure.
This would be a new departure for Federal policy. And a difficult one. But it almost certainly offers the only possibility of resolving in our time what is, after all, the nation's oldest, and most intransigent, and now its most dangerous social problem. What Gunnar Myrdal said in An American Dilemma remains true today: "America is free to chose whether the Negro shall remain her liability or become her opportunity."
Saturday, April 07, 2007
zie origineel (Afro- Americans)
The Black Family: 40 Years of Lies
Kay S. Hymowitz
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Read through the megazillion words on class, income mobility, and poverty in the recent New York Times series “Class Matters” and you still won’t grasp two of the most basic truths on the subject: 1. entrenched, multigenerational poverty is largely black; and 2. it is intricately intertwined with the collapse of the nuclear family in the inner city.
By now, these facts shouldn’t be hard to grasp. Almost 70 percent of black children are born to single mothers. Those mothers are far more likely than married mothers to be poor, even after a post-welfare-reform decline in child poverty. They are also more likely to pass that poverty on to their children. Sophisticates often try to dodge the implications of this bleak reality by shrugging that single motherhood is an inescapable fact of modern life, affecting everyone from the bobo Murphy Browns to the ghetto “baby mamas.” Not so; it is a largely low-income—and disproportionately black—phenomenon. The vast majority of higher-income women wait to have their children until they are married. The truth is that we are now a two-family nation, separate and unequal—one thriving and intact, and the other struggling, broken, and far too often African-American.
So why does the Times, like so many who rail against inequality, fall silent on the relation between poverty and single-parent families? To answer that question—and to continue the confrontation with facts that Americans still prefer not to mention in polite company—you have to go back exactly 40 years. That was when a resounding cry of outrage echoed throughout Washington and the civil rights movement in reaction to Daniel Patrick Moynihan’s Department of Labor report warning that the ghetto family was in disarray. Entitled “The Negro Family: The Case for National Action,” the prophetic report prompted civil rights leaders, academics, politicians, and pundits to make a momentous—and, as time has shown, tragically wrong—decision about how to frame the national discussion about poverty.
To go back to the political and social moment before the battle broke out over the Moynihan report is to return to a time before the country’s discussion of black poverty had hardened into fixed orthodoxies—before phrases like “blaming the victim,” “self-esteem,” “out-of-wedlock childbearing” (the term at the time was “illegitimacy”), and even “teen pregnancy” had become current. While solving the black poverty problem seemed an immense political challenge, as a conceptual matter it didn’t seem like rocket science. Most analysts assumed that once the nation removed discriminatory legal barriers and expanded employment opportunities, blacks would advance, just as poor immigrants had.
Conditions for testing that proposition looked good. Between the 1954 Brown decision and the Civil Rights Act of 1964, legal racism had been dismantled. And the economy was humming along; in the first five years of the sixties, the economy generated 7 million jobs.
Yet those most familiar with what was called “the Negro problem” were getting nervous. About half of all blacks had moved into the middle class by the mid-sixties, but now progress seemed to be stalling. The rise in black income relative to that of whites, steady throughout the fifties, was sputtering to a halt. More blacks were out of work in 1964 than in 1954. Most alarming, after rioting in Harlem and Paterson, New Jersey, in 1964, the problems of the northern ghettos suddenly seemed more intractable than those of the George Wallace South.
Moynihan, then assistant secretary of labor and one of a new class of government social scientists, was among the worriers, as he puzzled over his charts. One in particular caught his eye. Instead of rates of black male unemployment and welfare enrollment running parallel as they always had, in 1962 they started to diverge in a way that would come to be called “Moynihan’s scissors.” In the past, policymakers had assumed that if the male heads of household had jobs, women and children would be provided for. This no longer seemed true. Even while more black men—though still “catastrophically” low numbers—were getting jobs, more black women were joining the welfare rolls. Moynihan and his aides decided that a serious analysis was in order.
Convinced that “the Negro revolution . . . , a movement for equality as well as for liberty,” was now at risk, Moynihan wanted to make several arguments in his report. The first was empirical and would quickly become indisputable: single-parent families were on the rise in the ghetto. But other points were more speculative and sparked a partisan dispute that has lasted to this day. Moynihan argued that the rise in single-mother families was not due to a lack of jobs but rather to a destructive vein in ghetto culture that could be traced back to slavery and Jim Crow discrimination. Though black sociologist E. Franklin Frazier had already introduced the idea in the 1930s, Moynihan’s argument defied conventional social-science wisdom. As he wrote later, “The work began in the most orthodox setting, the U.S. Department of Labor, to establish at some level of statistical conciseness what ‘everyone knew’: that economic conditions determine social conditions. Whereupon, it turned out that what everyone knew was evidently not so.”
But Moynihan went much further than merely overthrowing familiar explanations about the cause of poverty. He also described, through pages of disquieting charts and graphs, the emergence of a “tangle of pathology,” including delinquency, joblessness, school failure, crime, and fatherlessness that characterized ghetto—or what would come to be called underclass—behavior. Moynihan may have borrowed the term “pathology” from Kenneth Clark’s The Dark Ghetto, also published that year. But as both a descendant and a scholar of what he called “the wild Irish slums”—he had written a chapter on the poor Irish in the classic Beyond the Melting Pot—the assistant secretary of labor was no stranger to ghetto self-destruction. He knew the dangers it posed to “the basic socializing unit” of the family. And he suspected that the risks were magnified in the case of blacks, since their “matriarchal” family had the effect of abandoning men, leaving them adrift and “alienated.”
Kay S. Hymowitz
RESPOND
Read through the megazillion words on class, income mobility, and poverty in the recent New York Times series “Class Matters” and you still won’t grasp two of the most basic truths on the subject: 1. entrenched, multigenerational poverty is largely black; and 2. it is intricately intertwined with the collapse of the nuclear family in the inner city.
By now, these facts shouldn’t be hard to grasp. Almost 70 percent of black children are born to single mothers. Those mothers are far more likely than married mothers to be poor, even after a post-welfare-reform decline in child poverty. They are also more likely to pass that poverty on to their children. Sophisticates often try to dodge the implications of this bleak reality by shrugging that single motherhood is an inescapable fact of modern life, affecting everyone from the bobo Murphy Browns to the ghetto “baby mamas.” Not so; it is a largely low-income—and disproportionately black—phenomenon. The vast majority of higher-income women wait to have their children until they are married. The truth is that we are now a two-family nation, separate and unequal—one thriving and intact, and the other struggling, broken, and far too often African-American.
So why does the Times, like so many who rail against inequality, fall silent on the relation between poverty and single-parent families? To answer that question—and to continue the confrontation with facts that Americans still prefer not to mention in polite company—you have to go back exactly 40 years. That was when a resounding cry of outrage echoed throughout Washington and the civil rights movement in reaction to Daniel Patrick Moynihan’s Department of Labor report warning that the ghetto family was in disarray. Entitled “The Negro Family: The Case for National Action,” the prophetic report prompted civil rights leaders, academics, politicians, and pundits to make a momentous—and, as time has shown, tragically wrong—decision about how to frame the national discussion about poverty.
To go back to the political and social moment before the battle broke out over the Moynihan report is to return to a time before the country’s discussion of black poverty had hardened into fixed orthodoxies—before phrases like “blaming the victim,” “self-esteem,” “out-of-wedlock childbearing” (the term at the time was “illegitimacy”), and even “teen pregnancy” had become current. While solving the black poverty problem seemed an immense political challenge, as a conceptual matter it didn’t seem like rocket science. Most analysts assumed that once the nation removed discriminatory legal barriers and expanded employment opportunities, blacks would advance, just as poor immigrants had.
Conditions for testing that proposition looked good. Between the 1954 Brown decision and the Civil Rights Act of 1964, legal racism had been dismantled. And the economy was humming along; in the first five years of the sixties, the economy generated 7 million jobs.
Yet those most familiar with what was called “the Negro problem” were getting nervous. About half of all blacks had moved into the middle class by the mid-sixties, but now progress seemed to be stalling. The rise in black income relative to that of whites, steady throughout the fifties, was sputtering to a halt. More blacks were out of work in 1964 than in 1954. Most alarming, after rioting in Harlem and Paterson, New Jersey, in 1964, the problems of the northern ghettos suddenly seemed more intractable than those of the George Wallace South.
Moynihan, then assistant secretary of labor and one of a new class of government social scientists, was among the worriers, as he puzzled over his charts. One in particular caught his eye. Instead of rates of black male unemployment and welfare enrollment running parallel as they always had, in 1962 they started to diverge in a way that would come to be called “Moynihan’s scissors.” In the past, policymakers had assumed that if the male heads of household had jobs, women and children would be provided for. This no longer seemed true. Even while more black men—though still “catastrophically” low numbers—were getting jobs, more black women were joining the welfare rolls. Moynihan and his aides decided that a serious analysis was in order.
Convinced that “the Negro revolution . . . , a movement for equality as well as for liberty,” was now at risk, Moynihan wanted to make several arguments in his report. The first was empirical and would quickly become indisputable: single-parent families were on the rise in the ghetto. But other points were more speculative and sparked a partisan dispute that has lasted to this day. Moynihan argued that the rise in single-mother families was not due to a lack of jobs but rather to a destructive vein in ghetto culture that could be traced back to slavery and Jim Crow discrimination. Though black sociologist E. Franklin Frazier had already introduced the idea in the 1930s, Moynihan’s argument defied conventional social-science wisdom. As he wrote later, “The work began in the most orthodox setting, the U.S. Department of Labor, to establish at some level of statistical conciseness what ‘everyone knew’: that economic conditions determine social conditions. Whereupon, it turned out that what everyone knew was evidently not so.”
But Moynihan went much further than merely overthrowing familiar explanations about the cause of poverty. He also described, through pages of disquieting charts and graphs, the emergence of a “tangle of pathology,” including delinquency, joblessness, school failure, crime, and fatherlessness that characterized ghetto—or what would come to be called underclass—behavior. Moynihan may have borrowed the term “pathology” from Kenneth Clark’s The Dark Ghetto, also published that year. But as both a descendant and a scholar of what he called “the wild Irish slums”—he had written a chapter on the poor Irish in the classic Beyond the Melting Pot—the assistant secretary of labor was no stranger to ghetto self-destruction. He knew the dangers it posed to “the basic socializing unit” of the family. And he suspected that the risks were magnified in the case of blacks, since their “matriarchal” family had the effect of abandoning men, leaving them adrift and “alienated.”
fish oil
Fish oil bolsters statin reduction of coronary events
30 March 2007
The fish oil eicosapentaenoic acid (EPA) could offer extra cardioprotection in people taking statins, a study from Japan reveals.
Mitsuhiro Yokoyama (Kobe University Graduate School of Medicine, Japan) and colleagues report a 19% relative reduction in major coronary events among hypercholesterolemic patients taking EPA in addition to a statin compared with those taking a statin alone.
Epidemiologic and clinical evidence shows that increased intake of long-chain n-3 polyunsaturated fatty acids - especially EPA and docosahexanoic acid (DHA), which are found in fish and fish oil - protects against mortality from coronary artery disease.
Yokohama and team examined whether adding EPA to conventional statin treatment could yield an incremental benefit in patients in the Japan EPA Lipid Intervention Study (JELIS).
The study included 18,645 patients with a total cholesterol level of ≥6.5 mmol/l (251 mg/dl) who were randomly assigned to receive either 1800 mg EPA daily on top of a statin, or a statin alone. All patients received either 10 mg pravastatin or 5 mg simvastatin. This was increased to 20 mg or 10 mg, respectively, if a patient's lipid levels remained uncontrolled at the lower dose.
After a mean follow-up period of 4.6 years, the primary endpoint of any major coronary event, including sudden cardiac death, fatal and nonfatal myocardial infarction, and other nonfatal events occurred in 262 (2.8%) of the patients who took EPA compared with 324 (3.5%) of those who took a statin only.
This translated into a hazard ratio (HR) of 0.81 for the primary endpoint in EPA-treated patients relative to the statin-only group (p=0.011). The benefit was not tied to low-density lipoprotein cholesterol levels, the authors note in The Lancet.
Unstable angina and nonfatal coronary events were also significantly less frequent in the EPA group, at respective HRs of 0.76 (p=0.014) and 0.81 (p=0.015). Sudden cardiac death and coronary death rates did not differ significantly between the groups, however.
Further analysis showed that patients with a history of coronary artery disease (CAD) who took EPA also had a 19% lower relative risk of the primary endpoint than those who took a statin only (8.7% vs 10.7%, HR=0.81; p=0.048).
Among those with no history of CAD, there was an 18% reduction in the primary endpoint with EPA, but this was not a significant difference (1.4% vs 1.7%).
"The beneficial effects of EPA could have stemmed from many biological effects that lead to the attenuation of thrombosis, inflammation, and arrhythmia in addition to a reduction of triglycerides," say Yokoyama et al.
The researchers caution that because the patients were exclusively Japanese, they cannot generalize the results to other populations.
"We need to investigate whether EPA is effective for prevention of major coronary events in hypercholesterolemic patients without or with CAD in other countries," they conclude.
Lancet 2007; 369: 1090-1098
© Copyright Current Medicine Group Ltd, 2006
30 March 2007
The fish oil eicosapentaenoic acid (EPA) could offer extra cardioprotection in people taking statins, a study from Japan reveals.
Mitsuhiro Yokoyama (Kobe University Graduate School of Medicine, Japan) and colleagues report a 19% relative reduction in major coronary events among hypercholesterolemic patients taking EPA in addition to a statin compared with those taking a statin alone.
Epidemiologic and clinical evidence shows that increased intake of long-chain n-3 polyunsaturated fatty acids - especially EPA and docosahexanoic acid (DHA), which are found in fish and fish oil - protects against mortality from coronary artery disease.
Yokohama and team examined whether adding EPA to conventional statin treatment could yield an incremental benefit in patients in the Japan EPA Lipid Intervention Study (JELIS).
The study included 18,645 patients with a total cholesterol level of ≥6.5 mmol/l (251 mg/dl) who were randomly assigned to receive either 1800 mg EPA daily on top of a statin, or a statin alone. All patients received either 10 mg pravastatin or 5 mg simvastatin. This was increased to 20 mg or 10 mg, respectively, if a patient's lipid levels remained uncontrolled at the lower dose.
After a mean follow-up period of 4.6 years, the primary endpoint of any major coronary event, including sudden cardiac death, fatal and nonfatal myocardial infarction, and other nonfatal events occurred in 262 (2.8%) of the patients who took EPA compared with 324 (3.5%) of those who took a statin only.
This translated into a hazard ratio (HR) of 0.81 for the primary endpoint in EPA-treated patients relative to the statin-only group (p=0.011). The benefit was not tied to low-density lipoprotein cholesterol levels, the authors note in The Lancet.
Unstable angina and nonfatal coronary events were also significantly less frequent in the EPA group, at respective HRs of 0.76 (p=0.014) and 0.81 (p=0.015). Sudden cardiac death and coronary death rates did not differ significantly between the groups, however.
Further analysis showed that patients with a history of coronary artery disease (CAD) who took EPA also had a 19% lower relative risk of the primary endpoint than those who took a statin only (8.7% vs 10.7%, HR=0.81; p=0.048).
Among those with no history of CAD, there was an 18% reduction in the primary endpoint with EPA, but this was not a significant difference (1.4% vs 1.7%).
"The beneficial effects of EPA could have stemmed from many biological effects that lead to the attenuation of thrombosis, inflammation, and arrhythmia in addition to a reduction of triglycerides," say Yokoyama et al.
The researchers caution that because the patients were exclusively Japanese, they cannot generalize the results to other populations.
"We need to investigate whether EPA is effective for prevention of major coronary events in hypercholesterolemic patients without or with CAD in other countries," they conclude.
Lancet 2007; 369: 1090-1098
© Copyright Current Medicine Group Ltd, 2006
Beta blockers
Beta blockers over-used in elderly with uncomplicated hypertension
2 April 2007
Elderly patients with uncomplicated hypertension are too often prescribed beta blockers as first-line therapy, according to a study of patients in Ontario, Canada.
Beta blockers were prescribed as initial therapy to one in 10 such patients who did not have any other compelling indication for beta blocker use, such as heart failure, myocardial infarction (MI), or angina, over the period 1994-2002.
This occurred despite explicit recommendations not to use the drugs as initial therapy being in place over the entire period, N Campbell (University of Calgary, Toronto, Canada) and colleagues note.
Large randomized controlled trials and meta-analyses have shown that beta blockers are less effective for the prevention of cardiovascular events in elderly hypertensive patients than diuretics, angiotensin receptor blockers, and calcium channel blockers, Campbell and colleagues explain in the Journal of Human Hypertension.
The researchers studied the prevalence of prescribing beta blockers as initial therapy in Ontario residents aged 66 years or older who received a new prescription for an antihypertensive agent between July 1994 and March 2002.
The researchers excluded patients who had a comorbid indication for a beta blocker. Of 194,761 eligible patients, 25,485 (13%) were prescribed a beta-blocker as their first antihypertensive therapy.
By looking at the annual population-adjusted prescribing rates, the authors found that there was a 27% increase in beta blocker prescriptions for newly treated hypertension over the study period. The publication in 1998 of a large meta-analysis showing beta blockers to be less effective in the elderly than other antihypertensive agents appeared to have no impact on this trend.
Initiation with a beta blocker became less common with increasing age. For example, the prescribing rate was 14% among 66-69-year-olds versus 10% of patients aged 85 years or more, with an odds ratio (OR) of 1.67.
Other factors associated with being prescribed a beta blocker included being male (OR=1.06 vs women), residence in a long-term care facility (OR=1.19 vs living in the community), and having lower socioeconomic statue (OR=1.07 for lowest vs highest quintile).
"Greater efforts are required to educate physicians to select other drugs for initial therapy in older patients with uncomplicated hypertension," the authors conclude.
In an accompanying editorial, S Bangalore and F Messerli (Columbia University, New York, USA) commented that the study is "an eye opener for those of us who were under the impression that beta blocker prescriptions in elderly hypertensive patients had diminished."
They noted that some other national and international guidelines continued their endorsement for beta blocker use in hypertension during the study period, and high-profile studies regarding their benefits in MI patients and those undergoing non-cardiac surgery were published.
"It is therefore not surprising that physicians in Canada and elsewhere continued prescribing beta blockers for hypertension," they wrote.
"Efforts should be made to educate the people, physicians and the guideline committee."
J Hum Hypertens 2007; 21: 271-275
2 April 2007
Elderly patients with uncomplicated hypertension are too often prescribed beta blockers as first-line therapy, according to a study of patients in Ontario, Canada.
Beta blockers were prescribed as initial therapy to one in 10 such patients who did not have any other compelling indication for beta blocker use, such as heart failure, myocardial infarction (MI), or angina, over the period 1994-2002.
This occurred despite explicit recommendations not to use the drugs as initial therapy being in place over the entire period, N Campbell (University of Calgary, Toronto, Canada) and colleagues note.
Large randomized controlled trials and meta-analyses have shown that beta blockers are less effective for the prevention of cardiovascular events in elderly hypertensive patients than diuretics, angiotensin receptor blockers, and calcium channel blockers, Campbell and colleagues explain in the Journal of Human Hypertension.
The researchers studied the prevalence of prescribing beta blockers as initial therapy in Ontario residents aged 66 years or older who received a new prescription for an antihypertensive agent between July 1994 and March 2002.
The researchers excluded patients who had a comorbid indication for a beta blocker. Of 194,761 eligible patients, 25,485 (13%) were prescribed a beta-blocker as their first antihypertensive therapy.
By looking at the annual population-adjusted prescribing rates, the authors found that there was a 27% increase in beta blocker prescriptions for newly treated hypertension over the study period. The publication in 1998 of a large meta-analysis showing beta blockers to be less effective in the elderly than other antihypertensive agents appeared to have no impact on this trend.
Initiation with a beta blocker became less common with increasing age. For example, the prescribing rate was 14% among 66-69-year-olds versus 10% of patients aged 85 years or more, with an odds ratio (OR) of 1.67.
Other factors associated with being prescribed a beta blocker included being male (OR=1.06 vs women), residence in a long-term care facility (OR=1.19 vs living in the community), and having lower socioeconomic statue (OR=1.07 for lowest vs highest quintile).
"Greater efforts are required to educate physicians to select other drugs for initial therapy in older patients with uncomplicated hypertension," the authors conclude.
In an accompanying editorial, S Bangalore and F Messerli (Columbia University, New York, USA) commented that the study is "an eye opener for those of us who were under the impression that beta blocker prescriptions in elderly hypertensive patients had diminished."
They noted that some other national and international guidelines continued their endorsement for beta blocker use in hypertension during the study period, and high-profile studies regarding their benefits in MI patients and those undergoing non-cardiac surgery were published.
"It is therefore not surprising that physicians in Canada and elsewhere continued prescribing beta blockers for hypertension," they wrote.
"Efforts should be made to educate the people, physicians and the guideline committee."
J Hum Hypertens 2007; 21: 271-275
