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Biomedical subjects

M N Hill

Publications and source records attributed to M N Hill.

At least 19 recordsLinked to original sources
PubMed2005

Is there a role for the endocannabinoid system in the etiology and treatment of melancholic depression?

With advances in basic and clinical neuroscience, many gaps have appeared in the traditional monoamine theory of depression that have led to reformulation of the hypotheses concerning the neurobiology of depression. The more recent hypotheses suggest that melancholic depression is characterized by central glucocorticoid resistance that results in hypercortisolemia, which in turn leads to down-regulation of neurotrophins and subsequent neurodegeneration. Examining the neurobiology of depression from this perspective suggests that the endocannabinoid system may play a role in the etiology of melancholic depression. Specifically, pharmacological and genetic blockade of the cannabinoid CB1 receptor induces a phenotypic state that is analogous to melancholic depression, including symptoms such as reduced food intake, heightened anxiety, increased arousal and wakefulness, deficits in extinction of aversive memories and supersensitivity to stress. These similarities between melancholic depression and an endocannabinoid deficiency become more interesting in light of recent findings that endocannabinoid activity is down-regulated by chronic stress and possibly increased by some antidepressant regimens. We propose that an endocannabinoid deficiency may underlie some of the symptoms of melancholic depression, and that enhancement of this system may ultimately be a novel form of pharmacotherapy for treatment-resistant depression.

Animals↗
PubMed2001

Attenuated myocardial vasodilator response in patients with hypertensive hypertrophy revealed by oxygenation-dependent magnetic resonance imaging.

BACKGROUND: Oxygen (O(2)) homeostasis is central to myocardial tissue functioning, and increased O(2) demand is thought to be satisfied by a vasodilatory mechanism that results in increased blood and O(2) delivery. We applied blood oxygenation level-dependent (BOLD) MRI in conjunction with vasodilatory stress to index the ability to augment intramyocardial oxygenation in hypertensive hypertrophy, the primary cause of heart failure. METHODS AND RESULTS: Nine healthy controls and 10 hypertensive subjects with moderate-to-severe hypertrophy underwent imaging on a 1.5 T clinical scanner. The dipyridamole-induced change in the apparent transverse relaxation rate, R2*, which correlates with hemoglobin oxygenation, was -5.4+/-2.2 s(-1) (95% CI, -4.0 to -6.8 s(-1)) in controls compared with -1.7+/-1.4 s(-1) (95% CI, -0.8 to -2.6 s(-1)) in hypertensive patients (P=0.0003). CONCLUSIONS: Patients with hypertensive hypertrophy demonstrate an impaired ability to increase intramyocardial oxygenation during vasodilatory stress, as indexed by BOLD MRI. The capacity to image vascular function with BOLD MRI may advance the understanding of the development of ventricular dysfunction in hypertension.

Adult↗
PubMed2001

Cardiovascular disease risk factors in Korean American elderly.

An in-depth cardiovascular risk factor assessment was carried out in a sample of 205 Korean American elderly in Maryland, consisting of 75 males and 130 females aged 60 to 89 years (mean age = 69.9 +/- 6.5 years). Six risk factors were assessed in each participant: high blood pressure, current smoking, high blood cholesterol, overweight, sedentary lifestyle, and diabetes. The findings of this cross-sectional study suggested that high blood pressure was the leading cardiovascular disease risk factor among Korean American elderly (71%), followed by high blood cholesterol (53%), overweight (43%), sedentary life style (24%), diabetes (18%), and smoking (7%). Two thirds of the sample had multiple cardiovascular disease risk factors. The pattern of prevalence and risk factors that was observed was consistent with the distribution of multiple risk factors in that the combination of high blood pressure, high blood cholesterol, and overweight was most common in Korean American elderly (62%). These findings indicate that culturally relevant and salient strategies are needed to reduce multiple risk factors in this population.

Aged↗
PubMed2001

Obesity and approaches to weight in an urban African-American community.

OBJECTIVES: To describe the prevalence of obesity, associated factors, and current approaches to weight in an inner city African-American community. DESIGN: In-home survey by community health interviewers. SETTING: Baltimore, Maryland. PARTICIPANTS: 2196 community residents identified in a probability sample of census blocks. MAIN OUTCOME MEASURES: Self-reported height and weight and calculated Body Mass Index (BMI), category of BMI, and stated weight goals. RESULTS: Sixty percent of participants were overweight (BMI> or =25 kg/m2), and 31% were obese (BMI> or =30 kg/m2). In multivariate analysis, women, those earning $15,000-30,000, and those aged 45-60 were more likely to be obese; less likely to be obese were smokers, daily drinkers, and those with "good" or "excellent" health. Sixty-one percent of obese participants reported trying to lose weight, while 36% of normal weight participants were trying to gain weight. Of those trying to lose weight, 35% were using recommended approaches, and 26% received "the professional help they needed to control their weight." CONCLUSIONS: Although obesity was prevalent, few were using recommended weight loss strategies and a significant minority of normal weight participants were trying to gain weight, indicating a need for improved weight management and obesity prevention in the African-American community.

Adolescent↗
PubMed2000

Awareness, perception, and knowledge of heart disease risk and prevention among women in the United States. American Heart Association Women's Heart Disease and Stroke Campaign Task Force.

CONTEXT: One of 2 women in the United States dies of heart disease or stroke, yet women are underdiagnosed and undertreated for these diseases and their risk factors. Informed decisions to prevent heart disease and stroke depend on awareness of risk factors and knowledge of behaviors to prevent or detect these diseases. OBJECTIVE: Assess (1) knowledge of risks of heart disease and stroke and (2) perceptions of heart disease and its prevention among women in the United States. DESIGN AND SETTING: Telephone survey conducted in 1997 of US households, including an oversample of African American and Hispanic women. PARTICIPANTS: One thousand respondents 25 years or older; 65.8% white, 13.0% African American, and 12.6% Hispanic. MAIN OUTCOME MEASURES: Knowledge of heart disease and stroke risks, perceptions of heart disease, and knowledge of symptoms and preventive measures. RESULTS: Only 8% of the respondents identified heart disease and stroke as their greatest health concerns; less than 33% identified heart disease as the leading cause of death. More women aged 25 to 44 years identified breast cancer as the leading cause of death than women 65 years or older. Women aged 25 to 44 years indicated they were not well informed about heart disease and stroke. Although 90% of the women reported that they would like to discuss heart disease or risk reduction with their physicians, more than 70% reported that they had not. CONCLUSIONS: Most women do not perceive that heart disease is a substantial health concern and report that they are not well informed about their risk. Age influenced knowledge to a greater extent than ethnicity. Programs directed at young women that address the effects of lifestyle behaviors on long-term health are needed. Better communication between physicians and patients is also warranted.

Adult↗
PubMed2000

Barriers to hypertension care and control.

Despite clinical trial evidence and public health data documenting the benefits of controlling hypertension in individuals and populations, implementation in practice is less than optimal. Barriers to hypertension care and control are remarkably persistent and continue to impede improvement in rates of awareness, treatment, and control. Barriers have been identified at the patient, provider, health care organization, and community levels. At every level, knowledge, attitudes, values, and beliefs can impede the evidence-based recommended behaviors needed to lower blood pressure and sustain lowering over time. Numerous new studies provide data that reinforce the need for culturally sensitive interventions at each level.

Black or African American↗
PubMed2000

Spot urinary albumin-creatinine ratio predicts left ventricular hypertrophy in young hypertensive African-American men.

Hypertensive patients with target organ damage are at increased cardiovascular risk, and should be treated most aggressively. The association between urinary albumin excretion and left ventricular hypertrophy (LVH) in prior studies is inconsistent, and has not been described using a single, random spot urine specimen. Therefore, we evaluated the association between the urinary albumin creatinine ratio (ACR) and left ventricular (LV) mass and also tested the hypothesis that a simple random, single-void urine ACR would identify high risk young, hypertensive, African-American men. We measured echocardiographic LV mass and a random spot urinary ACR in 109 untreated, hypertensive, young, inner city, African-American men. The mean age was 41 +/- 6 years and the mean blood pressure (BP) was 157 +/- 19/107 +/- 13 mm Hg. Microalbuminuria (ACR 30 to 300 mg/g) was present in 22% of subjects. The ACR is higher in the men with LVH than in the men without LVH (P < .05). Increased ACR is a predictor of increased LV mass index (P < .003) using multiple linear regression. An ACR >30 mg/g has a sensitivity of 33% and a specificity of 82% for the diagnosis of echocardiographic LVH. In conclusion, elevated random spot ACR is a marker of increased LV mass, independent of BP, in young urban African-American men with hypertension, and may help to determine the aggressiveness of antihypertensive therapy in this high-risk group.

Adolescent↗
PubMed2000

The contexts of adherence for African Americans with high blood pressure.

The contexts of adherence for African Americans with high blood pressure African American men between the ages of 18 and 49 years have the lowest rates of awareness, treatment and control of high blood pressure (HBP) of all age/race/gender groups in the United States. A qualitative study was done to gain an understanding of urban black males' experiences of living with HBP. In-depth semi-structured interviews were conducted with 19 black males. The interviews explored perceptions of health, health problems and priorities, and concerns of daily living that influenced appointment keeping and medication taking. The sample was a subset of 309 men participating in a 3-year clinical trial to improve HBP control in an inner city African-American population. Content analysis of transcribed interviews identified the following themes and related concerns: (a) personal contexts: meaning of health, high blood pressure and treatments; (b) social context: living as a young black male in an urban environment; and (c) cultural context of relating: patient-provider relationship can make a difference. Influencing participants' responses were: interpreting symptoms; adjusting medication taking; protecting personal privacy; allocating limited resources; dealing with addiction; and feeling cared for by a health care provider. Adherence appeared to be multifaceted and changing depending upon: the men's social, economic and personal circumstances; empathetic and non-judgemental assistance from providers; financial concerns and employment; and drug addiction. Findings are useful in refining high blood pressure interventions.

Adaptation, Psychological↗
PubMed2000

Development and testing of the Hill-Bone Compliance to High Blood Pressure Therapy Scale.

The Hill-Bone Compliance to High Blood Pressure Therapy Scale assesses patient behaviors for three important behavioral domains of high blood pressure treatment: 1) reduced sodium intake; 2) appointment keeping; and 3) medication taking. This scale is comprised of 14 items in three subscales. Each item is a four point Likert type scale. The content validity of the scale was assessed by a relevant literature review and an expert panel, which focused on cultural sensitivity and appropriateness of the instrument for low literacy. Internal consistency reliability and predictive validity of the scale were evaluated using two community based samples of hypertensive adults enrolled in clinical trials of high blood pressure care and control. The standardized alpha for the total scale were 0.74 and 0.84, and the average interitem correlations of the 14 items were 0.18 and 0.28, respectively. The construct and predictive validity of the scale was assessed by factor analysis and by testing of theoretically derived hypotheses regarding whether the scale demonstrated consistent and expected relationships with related variables. In this study, high compliance scale scores predicted significantly lower levels of blood pressure and blood pressure control. Moreover, high compliance scale scores at the baseline were significantly associated with blood pressure control at both baseline and at follow up in the two independent samples. This brief instrument provides a simple method for clinicians in various settings to use to assess patients' self reported compliance levels and to plan appropriate interventions.

Adult↗
PubMed2000

Community health survey in an urban African-American neighborhood: distribution and correlates of elevated blood pressure.

While considerable improvements have been made over the last 30 years in hypertension (HTN) awareness, treatment, and control, a recent reversal of these trends has been documented with African-American adults, particularly among those continuing to suffer from uncontrolled hypertension and its adverse consequences. This paper presents data from a cross-sectional representative survey of the health status of an urban African-American community. The study was designed in partnership with community leadership to improve HTN care and control. The baseline survey was a face-to-face interview (including blood pressure [BP] measurements) of 2,196 adults residing in randomly selected blocks in the Sandtown-Winchester neighborhood in Baltimore City. These sample data were compared with national data from the NHANES III survey, and demonstrated similar awareness of hypertension. However, hypertension control rates among treated hypertensives were significantly lower in the study community (28%) than in the national survey (44%). Compared with normotensive individuals, those with HTN were significantly older, had less education, were less likely to be employed, and had lower annual incomes. Individuals with HTN were also significantly more likely to rate their health as poor/fair, to report a history of heart disease, stroke, diabetes, kidney disease, obesity, high cholesterol, and lack of exercise, as well as to be at greater risk of alcoholism or alcohol problems. Hypertensive individuals (88% with reported prior history, 12% newly detected) were significantly more likely to have a usual source of care, have seen a health professional in the last 12 months, and to be extremely satisfied with the provider; however, 20% of individuals with hypertension reported no health insurance. These data indicate the need for focused interventions to enhance hypertension maintenance of care and adherence to treatment.

Adult↗
PubMed2000

Comprehensive hypertension care in young urban black men: an example of a program of nursing research that integrates genetic science, clinical interventions, and patient outcomes.

Black Americans have the highest rate of hypertension in the world. The well-known consequences of this condition include stroke, heart failure, and renal disease. The causes, care, and control of hypertension, especially among the underserved and understudied group of young urban black men, require more comprehensive models of health care delivery and an understanding of the gene-gene and gene-environment interactions influencing blood pressure.

Adolescent↗
PubMed2000

Prevalence and factors associated with high blood pressure in Korean Americans.

This study, conducted from October 1998 to February 1999, included a cross-sectional epidemiological survey administered to Korean Americans (KAs) living in Maryland (N = 761). One third (32%) of participants had high blood pressure (HPB: SBP > or = 140 mm Hg and/or DBP > or = 90 mm Hg or were on hypertension medication). HBP was more common among males (35%) than females (30%) and those who were aged 50 years or older (53%) compared to those who were less than 50 years old (12%). The prevalence of HBP in Maryland KAs was found to be much higher than in other Americans (24%) and in their counterparts in Korea (22% overall: 29% in males, 11% in females). Only 40% of the hypertensive KAs were taking HBP medication, and 74% of those did not have controlled HBPs. Further, multivariate logistic analyses were conducted to estimate the relative biobehavioral risk factors related to hypertension. Several significant risk factors were identified, including family history of HBP, gender, level of education, level of acculturation, regular exercise, and being overweight. Findings from this study indicate that culturally relevant approaches to prevention and treatment of HBP are urgently needed to address the HBP problem in Korean Americans.

Adolescent↗
PubMed1999

Symptoms of Raynaud's phenomenon in an inner-city African-American community: prevalence and self-reported cardiovascular comorbidity.

The objective of this study was to determine the prevalence of symptoms and the morbidity associated with Raynaud's phenomenon (RP) among African Americans. A total of 2196 randomly selected residents of an inner-city community, in Baltimore, completed a health-assessment survey. Symptoms of RP consisted of cold sensitivity plus cold-induced white or blue digital color change. One third (n = 703) reported cold sensitivity and 14% (n = 308) reported digital color change; 84 residents with symptoms of RP were identified, yielding an overall prevalence rate of 3.8% (95% confidence interval [CI] 3.0-4.6). RP was associated with poor or fair health status (odds ratio [OR] = 1.82, CI 1.18-2.81), heart disease (OR = 2.32, CI 1.39-3.87), and stroke (OR = 2.20, CI 1.17-4.15), after adjustment for age, gender, and physician-diagnosed arthritis. The prevalence of symptoms of RP in this African-American community is comparable to published reports from other populations. These community-based data suggest that identification of RP among African Americans should raise consideration of possible comorbidity, particularly cardiovascular disease.

Adult↗
PubMed1999

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

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

Adult↗
PubMed1999

Barriers to hypertension care and control in young urban black men.

Barriers to high blood pressure (HBP) care and control have been reported in the literature for > 30 years. Few reports on barriers, however, have focused on the young black man with HBP, the age/sex/race group with the highest rates of early severe and complicated HBP and the lowest rates of awareness, treatment, and control. In a randomized clinical trial of comprehensive care for hypertensive young urban black men, factors potentially associated with care and control were assessed at baseline for the 309 enrolled men. A majority of the men encountered a variety of barriers including economic, social, and lifestyle obstacles to adequate BP care and control, including no current HBP care (49%), risk of alcoholism (62%), use of illicit drugs (45%), social isolation (47%), unemployment (40%), and lack of health insurance (51%). Having health insurance (odds ratio = 7.20, P = .00) and a negative urine drug screen (odds ratio = .56, P = .04) were significant predictors of being in HBP care. Low alcoholism risk and employment were identified as significant predictors of compliance with HBP medication-taking behavior. Men currently using illicit drugs were 2.64 times less likely to have controlled BP compared with their counterparts who did not use illicit drugs, and men currently taking HBP medication were 63 times more likely have controlled BP compared with men not taking HBP medication. Comprehensive interventions are needed to address socioeconomic and lifestyle issues as well as other barriers to care and treatment, if HBP care is to be salient and effective in this high risk group.

Adult↗
PubMed1998

My transformation as a leader in cardiovascular nursing.

Several themes emerged as I reviewed my career and development as a leader in cardiovascular nursing. An inherent part of my personality is to analyze situations, identify needed action, and figure out appropriate solutions. I recognized that gaining expert knowledge, wise mentors, and constructive critique were essential if I was to develop the skill to make meaningful contributions. My greatest role satisfaction comes from facilitating the intersection of nursing with other disciplines and coaching and mentoring others. Volunteering in the American Heart Association has provided me with many opportunities, an extensive network, and invaluable friendships.

Cardiovascular Diseases↗