CLINICAL LEPTOSPIROSIS IN HAWAII.
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In the Cruzan case, the U.S. Supreme Court acknowledged the patient's right to refuse treatment but limited the decision-making involvement of the family when the patient's wishes are unknown. A study of 118 graduating physicians at the John A. Burns School of Medicine revealed their most significant clinical experience involving an ethical dilemma during their 3rd and 4th years was their involvement with families in the decision to discontinue treatment for terminal patients. These findings underscore the need for a focus on this issue in the curriculum.
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Although several studies have examined differences in daily blood pressure variability between African-American and Caucasian groups in the United States, little is known about the blood pressure variation of other ethnic groups. This study examined the effects of emotional state, setting, posture, and ethnicity on the ambulatory blood pressure of female health care workers (nurses and nurse's aides) from 2 ethnic groups: Filipino-Americans (N = 38) and Caucasians (N = 22). Ambulatory blood pressure measurements were obtained at 15-min intervals during a typical work day. Participants reported in a diary their setting (work or home), posture, mood, and specific activity at each measurement. The effects of these factors and ethnicity were examined using analysis of variance (ANOVA). The results show that for all subjects blood pressure was higher at work (P < 0.05), while standing (P < 0.05), during reports of negative moods (anxiety, anger, or sadness) (P < 0.05), and while engaging in activities such as interacting with fellow staff members at work and "washing up" at home. However, the Filipino-American women reported negative moods more frequently than their Caucasian counterparts (P < 0.05), had a greater proportion of readings taken while standing at work, and reacted differently than the Caucasian women to some specific activities; for instance, their blood pressure was not elevated when doing household chores. These results suggest that the extent of blood pressure variation in daily life may depend upon cognitive processes which are influenced by the cultural background and emotional state of the individual. They further suggest that ethnicity has an important impact on blood pressure variation.
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