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At least 1,009 records · Page 56Linked to original sources
PubMed2006

Reperfusion of acute myocardial infarction in North Carolina emergency departments (RACE): study design.

Despite the accumulation of almost 2 decades of data in support of rapid reperfusion therapy for ST-segment elevation myocardial infarction (STEMI), the United States healthcare system still faces serious challenges in providing reperfusion to all eligible patients in a timely fashion. American College of Cardiology/American Heart Association guidelines call for systematic interventions aimed at improving both the proportion of patients receiving reperfusion and the timeliness of treatment. We designed a project (RACE) that incorporates standardized protocols and integrated systems for treatment and timely transfer (when appropriate) of patients with STEMI in 5 geographic regions in North Carolina. The RACE project was created by an alliance between national and regional professional societies, a local payer, the pharmaceutical, and healthcare providers, including emergency medical services, emergency medicine, cardiology, and hospital administrations. The main outcomes of interest are rates of reperfusion and time to treatment. Collected data will also provide important insights into barriers to timely reperfusion. The goal of the RACE project is to provide a model for improving the care of patients with STEMI by identifying those features associated with significant improvement, as well as those imposing significant barriers to appropriate therapy.

Angioplasty, Balloon, Coronary↗
PubMed2005

Influence of the randomized trials, AFFIRM and RACE, on the management of atrial fibrillation in two University Medical Centers.

The results of the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) and the Rate Control Versus Electrical Cardioversion for Persistent Atrial Fibrillation (RACE) study were presented in March 2002. These large studies showed no benefit of a rhythm-control strategy over a rate-control strategy in managing atrial fibrillation (AF). Cardioversion and atrioventricular junctional ablation are forms of rhythm control and rate control, respectively. The numbers of cardioversions and atrioventricular junctional ablations performed at the University of Virginia and the Medical College of Virginia during the 52 months before AFFIRM and RACE results were released and the 21 months afterward were compared. From January 1998 to March 2002, monthly averages of 31 +/- 8 elective cardioversions and 6 +/- 3 atrioventricular junctional ablations were performed; from April 2002 to December 2003, the monthly averages were 21 +/- 6 cardioversions (p = 0.001) and 9 +/- 3 ablations (p = 0.001). AF management changed at these institutions shortly after the RACE and AFFIRM results were released.

Atrial Fibrillation↗
PubMed2005

Outcomes by race and etiology of patients with left ventricular systolic dysfunction.

Previous studies have shown that blacks have worse long-term outcomes than whites who have systolic heart failure. The reasons for these racial differences remain unclear. We investigated the effect of race and etiology of heart failure on outcomes of patients who had left ventricular (LV) systolic dysfunction. We studied records of 1,977 patients (27% black) who underwent cardiac catheterization who had New York Heart Association class II to IV symptoms and a LV ejection fraction <40%. Adjusted Cox's proportional hazards regression models were examined for the end points of mortality, rehospitalization, and a composite of the 2. Black versus white patients were younger (median age 56 vs 63 years, p <0.01), more often were women (49% vs 33%, p <0.01), had diabetes (37% vs 31%, p = 0.02), and hypertension (75% vs 56%, p <0.01). Black patients were less likely to have significant coronary artery disease by angiography (41% vs 69%, p <0.01). Race was not an independent predictor of mortality (hazard ratio 1.09, 95% confidence interval 0.93 to 1.28, p = 0.27). After adjusted survival curves were stratified by race and etiology, the estimates indicated that among those patients who had nonischemic LV dysfunction, blacks appeared to have worse survival than whites. Thus, we found no racial differences in the long-term mortality risk of patients who had symptomatic LV systolic dysfunction. In conclusion, after stratifying by ischemic and nonischemic etiologies, we found decreased survival in blacks who had a nonischemic etiology compared with whites. There were no racial differences in rehospitalization between patients who had ischemic LV systolic dysfunction and those who did not.

Adult↗
PubMed2003

Race-mixing and science in the United States.

Scientific racism was widely used as a justification to oppose race-mixing in the United States. Historians have justly criticized this abuse of science, but have overlooked some of the important ways in which science was used in the 1930s and 1940s to overturn scientific racism and opposition to race-mixing. Of particular importance was the cultural anthropology of Franz Boas and the evolutionary biology of Theodosius Dobzhansky, which supplied arguments against racism and fundamentally altered the scientific understanding of race.

Anthropology, Cultural↗
PubMed2004

The influence of age, gender, and race on the prevalence of depression in heart failure patients.

OBJECTIVES: The goal of this study was to determine the prevalence of depression in an out-patient heart failure (HF) population; its relationship to quality of life (QOL); and the impact of gender, race, and age. BACKGROUND: Most studies of depression in HF have evaluated hospitalized patients (a small percentage of the population) and have ignored the influence of various patient characteristics. Although reported depression rates among hospitalized patients range from 13% to 77.5%, out-patient studies have been small, have reported rates of 13% to 42%, and have not adequately accounted for the impact of age, race, or gender. METHODS: A total of 155 patients with stable New York Heart Association functional class II, III, and IV HF and an ejection fraction <40% were given questionnaires to assess QOL and depression. These included the Medical Outcomes Study Short Form, the Minnesota Living with Heart Failure questionnaire, and the Beck Depression Inventory (BDI). Depression was defined as a score on the BDI of > or =10. RESULTS: A total of 48% of the patients scored as depressed. Depressed patients tended to be younger than non-depressed patients. Women were more likely (64%) to be depressed than men (44%). Among men, blacks (34%) tended to have less depression than whites (54%). Depressed patients scored significantly worse than non-depressed patients on all components of both the questionnaires measuring QOL. However, they did not differ in ejection fraction or treatment, except that depressed patients were significantly less likely to be receiving beta-blockers. CONCLUSIONS: Depression is common in patients with HF, with age, gender, and race influencing its prevalence in ways similar to those observed in the general population. These data suggest that pharmacologic or non-pharmacologic treatment of depression might improve the QOL of HF patients.

Adrenergic beta-Antagonists↗
PubMed2005

Design and demonstration of a dynamometric horseshoe for measuring ground reaction loads of horses during racing conditions.

Because musculoskeletal injuries to racehorses are common, instrumentation for the study of factors (e.g. track surface), which affect the ground reaction loads in horses during racing conditions, would be useful. The objectives of the work reported by this paper were to (1) design and construct a novel dynamometric horseshoe that is capable of measuring the complete ground reaction loading during racing conditions, (2) characterize static and dynamic measurement errors, and (3) demonstrate the usefulness of the instrument by collecting example data during the walk, trot, canter, and gallop for a single subject. Using electrical resistance strain gages, a dynamometric horseshoe was designed and constructed to measure the complete ground reaction force and moment vectors and the center of pressure. To mimic the load transfer surface of the hoof, the shape of the surface contacting the ground was similar to that of the solar surface of the hoof. Following static calibration, the measurement accuracy was determined. The root mean squared errors (RMSE) were 3% of full scale for the force component normal to the hoof and 9% for force components in the plane of the hoof. The dynamic calibration determined that the natural frequency with the full weight of a typical horse was 1744 Hz. Example data were collected during walking on a ground surface and during trotting, cantering, and galloping on a treadmill. The instrument successfully measured the complete ground reaction load during all four gaits. Consequently the dynamometric horseshoe is useful for studying factors, which affect ground reaction loads during racing conditions.

Animals↗
PubMed2003

The influence of gender and race on physicians' pain management decisions.

This study set out to examine whether gender or race influences physicians' pain management decisions in a national sample of 712 (414 men, 272 women) practicing physicians. Medical vignettes were used to vary patient gender and race experimentally while holding symptom presentation constant. Treatment decisions were assessed by calculating maximum permitted doses of narcotic analgesic (hydrocodone) prescribed for initial pain treatment and for follow-up care. No overall differences by patient gender or race were found in decisions to treat or in maximum permitted doses. However, for persistent back pain, female physicians prescribed lower doses of hydrocodone, especially to male patients. For renal colic, lower doses were prescribed to black versus white patients when the patient was female, whereas the reverse was true when patients were male. These findings challenge a fairly extensive literature suggesting that physicians treat women and minorities less aggressively for their pain, and results offer further evidence that pain treatment decisions are influenced physician gender.

Adult↗
PubMed2005

Comparative analysis of autogenous infrainguinal bypass grafts in African Americans and Caucasians: the association of race with graft function and limb salvage.

OBJECTIVE: African Americans (AAs) are at risk for developing diabetes mellitus and atherosclerosis. Whether race influences the results of infrainguinal arterial reconstruction is unclear. The purpose of this study was to compare the results of autogenous infrainguinal bypasses in AAs and Caucasians to determine the association of race with graft function and limb salvage. METHODS: This was a retrospective, comparative cohort study of AA and Caucasian patients who had undergone autogenous infrainguinal bypass surgery. Only single-limb bypasses in each patient cohort were considered in this analysis. In patients who had undergone bilateral lower limb bypasses, the first limb bypass was chosen as the index bypass procedure. RESULTS: From January 1985 to December 2003, 1459 autogenous infrainguinal bypasses were performed in 1459 patients for lower limb ischemia. Within this group, 89 AA patients/vein grafts formed the study cohort. The control group comprised 1370 Caucasian patients/vein grafts. Compared with the Caucasian cohort, AA patients were significantly younger (median age, 65 vs 70 years, respectively; P = .001) and predominantly female (57% vs 41%, respectively; P = .002). AA patients also had a higher prevalence of diabetes mellitus, hypertension, cerebrovascular disease, congestive heart failure, and dialysis-dependent renal failure. More AA than Caucasian patients presented with gangrene (34% vs 16%, respectively; P = .001), and more underwent bypass surgery for limb salvage indications (91% vs 81%, respectively; P = .01). The venous conduit used was predominantly the greater saphenous vein (AA, 83%; Caucasian, 85%), and the site of distal anastomosis was at the tibial/pedal level in 67% of AA and 61% of Caucasian patients. Overall morbidity (AA, 28%; Caucasian, 23%) and 30-day mortality (AA, 3%; Caucasian, 3%) were similar. Thirty-day graft failure was significantly greater in AAs than Caucasians (12% vs 5%, respectively; P = .003). The overall 5-year primary graft patency (+/-SE) was significantly worse in AA patients (AA, 52% +/- 6%; Caucasian, 67% +/- 2%; P = .009). The 5-year limb salvage rate (+/-SE) was also significantly worse in AA patients (AA, 81% +/- 5%; Caucasian, 90% +/- 1%; P = .04). With the Cox proportional hazard model, significant risk factors associated with primary graft failure were AA race, age younger than 65 years, female sex, secondary reconstructions, tibial bypasses, and critical limb ischemia. Significant risk factors associated with limb loss were age younger than 65 years, female sex, absence of coronary disease, presence of critical limb ischemia, and secondary reconstructions. CONCLUSIONS: Autogenous infrainguinal bypass surgery in AAs is associated with poorer primary graft patency and limb salvage rates compared with those of Caucasians. This may partially account for the higher rate of limb loss in AA patients with peripheral arterial occlusive disease.

Black or African American↗
PubMed2005

Functional decline in lower-extremity peripheral arterial disease: associations with comorbidity, gender, and race.

PURPOSE: To identify comorbidities associated with increased rates of functional decline in persons with lower-extremity peripheral arterial disease (PAD). We also determined whether female sex and black race were associated with greater functional decline than male sex and white race, respectively, in PAD. METHODS: Three-hundred ninety-seven men and women with PAD were followed prospectively for a median of 36 months. The presence of comorbid illnesses was determined with medical record review, patient report, medications, laboratory values, and a primary care physician questionnaire. Functional outcomes, measured annually, included the 6-minute walk, usual-paced and fast-paced 4-meter walking speed, and summary performance score. The summary performance score is a composite measure of lower-extremity functioning (score range, 0 to 12; 12 = best). RESULTS: Adjusting for known and potential confounders, PAD patients with pulmonary disease had a significantly greater average annual decline in 6-minute walk performance of -34.02 ft/y (95% confidence interval [CI], -60.42 to -7.63; P = .012), rapid-paced 4-meter walk speed of -0.028 m/s/y (95% CI, -0.054 to -0.001; P = .042), and summary performance score of -0.460/y (95% CI, -0.762 to -0.157; P = .003) compared with those without pulmonary disease. PAD patients with spinal stenosis had a greater average annual decline in 6-minute walk performance of -77.4 ft/y (95% CI, -18.9 to -35.8; P < .001) and usual-paced 4-meter walking velocity of -0.045 m/s/y (95% CI, -0.081 to -0.009; P = .014) compared with participants without spinal stenosis. CONCLUSION: At 3-year follow-up, pulmonary disease and spinal stenosis were each associated with a significant decline in functioning among persons with PAD. In contrast, female sex and black race were not associated with functional decline among persons with PAD.

Aged↗
PubMed2004

Unloading the trunk: neurasthenia, CFS and race.

The aetiologies of both chronic fatigue syndrome (CFS) and its predecessor neurasthenia, have been linked to technological advances in 'developed' countries. This paper discusses how this has led to a form of race thinking within discussions about fatigue which has persisted for more than a century. We review the historical development of this race thinking from neurasthenia to CFS and describe how it is manifested in both the lay- and medical literature. We also review the epidemiological literature on CFS and ethnicity to better understand the relatively low percentage of non-white patients seen in tertiary referral clinics for CFS. The aim of this paper is to act as a starting point for a debate on race and CFS.

Diagnosis, Differential↗
PubMed2006

Literacy, race, and PSA level among low-income men newly diagnosed with prostate cancer.

OBJECTIVES: Among men with newly diagnosed prostate cancer, prostate-specific antigen (PSA) levels are higher and the cancer stage more advanced for African Americans than for whites. An earlier study found that after adjustment for literacy, race was no longer a significant predictor of advanced stage at presentation. We investigated whether, after adjusting for literacy, race was a significant independent predictor of greater PSA levels among men with newly diagnosed prostate cancer. METHODS: Consecutive patients with newly diagnosed prostate cancer from four outpatient care facilities in Chicago were interviewed and given a literacy assessment (n = 308). The PSA level at diagnosis was obtained from the medical charts. Logistic regression models were used to identify predictors of high PSA levels (greater than 20 ng/mL) at presentation. RESULTS: African-American men were three times more likely to have low literacy skills (sixth grade or less: 22.9% versus 7.1%; P <0.001) than were white men. In turn, men with low literacy skills were more than twice as likely to have a PSA level greater than 20 ng/mL at diagnosis (33.3% versus 13.5%; P = 0.009). On multivariate analyses, significant predictors of high PSA levels included low literacy (adjusted odds ratio 2.5, 95% confidence interval 1.5 to 4.2) and older age (age 65 to 74 years, adjusted odds ratio 2.6, 95% confidence interval 2.1 to 3.1 versus older than 74 years, adjusted odds ratio 3.4, 95% confidence interval 1.8 to 6.6), but not African-American race. CONCLUSIONS: In the current era in which PSA testing is common, low literacy may be an important and potentially overlooked factor associated with higher PSA levels at prostate cancer diagnosis among African-American and white men.

Aged↗
PubMed2002

Hospital transfer of patients with acute myocardial infarction: the effects of age, race, and insurance type.

BACKGROUND: Many factors precipitate the transfer of patients hospitalized for acute myocardial infarction, including clinical status and the need for diagnostic testing and therapeutic interventions not available at the admitting hospital. The objectives of this study were to assess the frequency of transfer to another hospital and to determine whether nonmedical factors, such as age, sex, race, and insurance status, are associated with transfer. METHODS: We conducted a prospective study of patients with acute myocardial infarction who were enrolled in the National Registry of Myocardial Infarction 2 from June 1994 through March 1998. The Registry involves 1674 hospitals in the United States. All patients survived to the time of hospital discharge or until transfer. Multivariable logistic regression models, with transfer as the outcome variable, were developed for the entire sample, as well as for subgroups determined by the interventional capabilities of the admitting hospital. RESULTS: Of 537,283 patients with acute myocardial infarction, 152,310 (28%) were transferred to another hospital after admission. After adjustment for differences in clinical and hospital characteristics, factors that were most associated with a reduced odds of transfer included older age (odds ratio [OR] = 0.43; 95% confidence interval [CI]: 0.42 to 0.44 for those aged >75 vs. <65 years), African-American race (OR = 0.69; 95% CI: 0.67 to 0.71 for African Americans vs. whites), and Medicaid/self-pay insurance status (OR = 0.68; 95% CI: 0.66 to 0.70 for Medicaid/self-pay vs. commercial insurance). These effects were most apparent for patients admitted to hospitals without full invasive diagnostic and therapeutic capabilities, but persisted to some extent among those admitted to hospitals with full invasive services. CONCLUSION: Our findings suggest that nonmedical factors, including age, race, and insurance type, affect decisions regarding the transfer of patients hospitalized with acute myocardial infarction. As only a minority of the nation's hospitals offers a full range of cardiovascular diagnostic and therapeutic procedures, these findings reinforce ongoing concerns about disparities in access to health care services for some patients.

Age Factors↗
PubMed2003

Side effects of opioids during short-term administration: effect of age, gender, and race.

OBJECTIVE: Little is known about risk factors that increase the risk of development of opioid side effects. Our objective was to evaluate the effect of the type of opioid, age, gender, and race on the incidence of side effects from short-term opioid use. METHODS: A secondary analysis of a retrospective cohort study in 35 community-based and tertiary hospitals was done. There were 8855 black or white subjects aged 16 years and older. Patients received meperidine (INN, pethidine), morphine, or fentanyl as part of their treatment. Measurements were made to assess the presence of nausea and vomiting and respiratory depression. RESULTS: Of the patients, 26% had nausea and vomiting and 1.5% had respiratory depression after opioid administration. After adjustment for opioid dose, route of administration, age, gender, and race, meperidine produced less nausea and vomiting (odds ratio [OR] = 0.7; 95% confidence interval [CI], 0.5-0.8) and less respiratory depression (OR = 0.6; 95% CI, 0.2-0.9) than morphine. The risk of respiratory depression increased with age. Compared with patients aged between 16 and 45 years, those aged between 61 and 70 years had 2.8 times the risk of development of respiratory depression (95% CI, 1.2-6.6); those aged between 71 and 80 years had 5.4 times the risk (95% CI, 2.4-11.8); and those aged older than 80 years had 8.7 times the risk (95% CI, 3.8-20.0). Men had less nausea and vomiting than women (OR = 0.5; 95% CI, 0.4-0.6). White subjects had more nausea and vomiting than black subjects (OR = 1.4; 95% CI, 1.1-1.7). CONCLUSIONS: Meperidine produced fewer side effects than morphine during short-term use. The risk of respiratory depression increases substantially after 60 years of age. Women have nausea and vomiting more often than men. The effect of race deserves further investigation.

Adolescent↗
PubMed1986

Time-related changes in the plasma concentrations of prolactin, gonadotropins, sex hormone-binding globulin, and certain steroid hormones in female runners after a long-distance race.

Running is associated with an increase in plasma concentrations of certain anterior pituitary hormones and adrenal steroids. This study reports such increases after a marathon race. Six trained female runners, 26 to 42 years old, participated in a marathon race. Fasting (resting) blood samples were collected a few weeks before the race (baseline) and immediately (0 hour), 1 hour, and 4 hours after the run. The data were analyzed with the use of two-way analyses of variance (F-test), paired t-test, and Page's test. At 0 hour, compared with baseline, significant increases were observed in the plasma concentrations of testosterone (T), dehydroepiandrosterone sulfate (DHEA-S), cortisol (F), free T index (T/SHBG), and prolactin (PRL). At 1 hour, levels of these steroid hormones and PRL declined, some significantly. At 4 hours, levels of all hormones except DHEA-S returned to baseline. No significant changes were observed in concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and sex hormone-binding globulin (SHBG), as evaluated by F-test. Running-associated changes in plasma hormonal concentrations revert to baseline in four hours, although DHEA-S may take a little longer.

Adult↗
PubMed1999

What are the requirements for medical cover at motor racing circuits?

Motor racing is perceived as a dangerous sport but few data are available on the incidence and nature of injuries sustained. The medical service requirement at one regional motor racing circuit was assessed by determining the incidence of injuries, the medical interventions required and the need for hospital referral and admission over a 5-year period. Five hundred and twenty-one patients, including support staff and spectators, attended the medical centre, of whom 14% were referred to hospital and 4% required admission. Each competitor had a 4% chance of requiring on-circuit medical attention, 0.6% chance of hospital referral and 0.17% chance of admission per race. Most major accidents involved more than two drivers. Twenty sustained major trauma including five pelvic fractures and two intraabdominal haemorrhages. Emergency intervention included intubation and ventilation in five. There were three deaths from a total of 9000 competitors (mortality rate 0.033%). This study shows that despite the nature of the sport, the mortality rate remains low with prompt skilled medical intervention. Medical personnel should include those competent in dealing with minor medical complaints as well as those with advanced airway management and resuscitation skills. Although national motor sport guidelines recommend a minimum of two attending doctors this would have been insufficient for multivehicle accidents.

Athletic Injuries↗
PubMed2000

Race and gender differences in cord blood lipoproteins.

Race and gender differences in lipoproteins and apolipoproteins have repeatedly been demonstrated in adults. The same disparities have been observed in children of different race and gender, implying that these differences may be influenced by genetic factors. To further explore this hypothesis, cord blood concentrations of both lipoproteins and apolipoproteins were examined in black and white neonates of both sexes. Results were controlled for the observed effects of gestational age and growth parameters. Similar patterns of lipoprotein differences to those observed in adults and children were also detected between black and white, and between male and female neonates. These findings support the concept that the aetiology of the difference in lipoprotein concentration observed between race and gender groups includes a significant genetic component.

Apolipoproteins↗
PubMed1997

Variation in the incidence of uterine leiomyoma among premenopausal women by age and race.

OBJECTIVE: To quantify the incidence of uterine leiomyoma confirmed by hysterectomy, ultrasound, or pelvic examination according to age and race among premenopausal women. METHODS: From September 1989 through May 1993, 95,061 premenopausal nurses age 25-44 with intact uteri and no history of uterine leiomyoma were followed to determine incidence rates of uterine leiomyoma. The self-reported diagnosis was confirmed in 93% of the medical records obtained for a sample of cases. Using pooled logistic regression, we estimated relative risks (RRs) of uterine leiomyoma according to race and examined whether adjustment for other potential risk factors could explain the variation in the race-specific rates. RESULTS: During 327,065 woman-years, 4181 new cases of uterine leiomyoma were reported. The incidence rates increased with age, and the age-standardized rates of ultrasound- or hysterectomy-confirmed diagnoses per 1000 woman-years were 8.9 among white women and 30.6 among black women. After further adjustment for marital status, body mass index, age at first birth, years since last birth, history of infertility, age at first oral contraceptive use, and current alcohol consumption, the rates among black women were significantly greater for diagnoses confirmed by ultrasound or hysterectomy (RR 3.25; 95% confidence interval [CI] 2.71, 3.88) and by hysterectomy (RR 1.82; 95% CI 1.17, 2.82) compared with rates among white women. We observed similar RRs when the cohort was restricted to participants who reported undergoing a screening physical examination within the 2 years before baseline. CONCLUSION: A higher prevalence of known risk factors did not explain the excess rate of uterine leiomyoma among premenopausal black women.

Adult↗
PubMed1998

An empiric evaluation of the Institute of Medicine's pregnancy weight gain guidelines by race.

OBJECTIVE: To examine associations between pregnancy weight gain outside and within ranges recommended by the Institute of Medicine and birth weight by both prepregnant body mass index (BMI) and race-ethnicity. METHODS: Mean birth weight and incidence of term low birth weight (LBW, less than 2500 g) and high birth weight (more than 4500 g) were compared across BMI-pregnancy weight gain-race-ethnicity strata. Subjects were 173,066 white, black, and Hispanic low-income pregnant women attending prenatal nutrition programs between 1990 and 1993. RESULTS: Among low and average BMI women (all race-ethnicity groups), weight gain within Institute of Medicine ranges resulted in significant LBW reductions; further LBW reductions at gains beyond Institute of Medicine ranges were offset by increasing high birth weight risk. Among women of high and obese BMI, LBW trends were less pronounced; thus, the benefit of gaining within the Institute of Medicine range was less apparent. Although blacks in every BMI-weight gain category had lower mean birth weights than white women, gaining in the upper end of the Institute of Medicine ranges did not provide a consistent LBW reduction for black women; adjusted LBW odds ratios and 95% confidence intervals for gains in the upper relative to the lower half of the Institute of Medicine range were 1.3 (0.8, 2.1), 0.7 (0.5, 1.03), 0.3 (0.2, 0.8), and 1.3 (0.7, 2.5) for black women of low, average, high, and obese BMI, respectively. CONCLUSION: Institute of Medicine pregnancy weight gain ranges recommended for low and average BMI women appear reasonable, but recommendations for high and obese BMI women require further evaluation. The recommendation that black women in all BMI groups strive for gains toward the upper ends of the ranges is not supported clearly by these data.

Adult↗