International Genetics


Nursing in the Community

Research Briefs
Around & About

Within the past few years, Harlem has experienced decreased infant mortality rates but Harlem adults die more from smoking-related heart diseases and cancer compared with average New Yorkers.

These were among the findings of the Harlem UpClose Chartbook, a compilation of research conducted during the past 10 years by researchers at the Harlem Health Promotion Center (HHPC) of the Mailman School of Public Health and elsewhere. Additionally, the chartbook contains profiles of community leaders and programs involved in health promotion activities.

More than 200 people attended a forum revealing the findings of the Harlem UpClose Chartbook, a study examining the health status of its residents. Participants included, from left, Dr. Alwyn Cohall, principal investigator and director of the Harlem Health Promotion Center (HHPC) in the Mailman School of Public Health; Dr. Cheryl Healton, president and CEO of the American Legacy Foundation and past director of the Center for Applied Public Health at Mailman; Dr. Allan Rosenfield, Mailman dean and former HHPC principal investigator; and Dr. Edward Healton, senior vice president and medical director, National Rehabilitation Hospital in Washington, D.C., and former medical director of Harlem Hospital.

The Harlem Household Study, one of the chartbook's main data sources, surveyed approximately 700 Harlem adults to assess their health status and their health-compromising and health-seeking behaviors. The study, conducted between 1992 and 1994, resulted in several papers published by Columbia researchers within the past six years.

The researchers performed the household study in response to a 1990 New England Journal of Medicine paper, which concluded African-American men living in Harlem were less likely to reach age 65 than men in Bangladesh. Drs. Colin McCord and Harold P. Freeman, both of whom were at Harlem Hospital at the time, conducted the NEJM study.

In an effort to educate and inform the community about the chartbook findings, on Oct. 24, the HHPC and its Community Advisory Board sponsored a forum. More than 200 participants attended the event at Windows Over Harlem, including Dr. Allan Rosenfield, Mailman dean (HHPC principal investigator from 1991-2000); Dr. Alwyn Cohall, current principal investigator and HHPC director; Anthony Tassi, a mayoral health policy adviser; and former mayor David Dinkins.

One of the chartbook's findings shows infant mortality is an area where Harlem is improving, with rates declining by 26.7 percent from 1999 to 2000. Among the reasons for the improvement, according to the report, is better care for premature babies, lowered drug use during pregnancy, and increased prenatal care access. However, community rates remain higher than the rest of New York City.

The report also found tobacco use among Central Harlem adults is almost double that of the national average. Analysis of household study data suggests smokers in Harlem make fewer attempts to quit, which may be due to a lack of smoking cessation programs. Harlem residents also have higher death rates from smoking-related heart disease and cancer than average New Yorkers.

Chartbook data suggest a need for focused and continued attention to the health of this community. The report's release is intended to spark dialogue among community groups and policy-makers toward the development and implementation of health promotion goals for Harlem.

Breast density, not a woman's age or hormonal status, is the most important factor affecting the ability of mammography to detect tumors, according to new research findings by P&S radiologists. The researchers also say ultrasound may be a good adjunct method to detect cancers in dense breast tissue.

The study, led by Dr. Thomas Kolb, assistant professor of clinical radiology, found that mammography could detect 99 percent of cancers in fatty breasts but only 48 percent in dense breasts. The study was published in the October issue of Radiology.

Dense breasts, which are more prevalent in younger women, have a higher proportion of fibrous tissue and milk glands and ducts than fat. In a mammogram, breasts appear white and cancer also looks white. Breasts with a higher proportion of fat appear dark. Approximately 66 percent of premenopausal women have dense breasts, as do 50 percent of postmenopausal women who take hormones and 25 percent who do not.

In the study of 27,825 consecutive screening sessions, Dr. Kolb used mammography and physical examination to screen 11,130 women with no symptoms of breast cancer. Women with dense breasts, about half the study population, also were screened with ultrasound. The researchers found that the addition of ultrasound testing in women with dense breasts could increase the detection of all breast cancers from 74 percent to 97 percent.

Women with fatty breasts were not screened with ultrasound, since preliminary data showed the technique did not reveal any cancers not previously detected by mammography.

"All women with dense breasts can benefit from having ultrasound screening in addition to their mammogram," Dr. Kolb says. "But additional studies are needed before I would recommend it as the standard of care."

—Susan Conova

Because mercury can cause nervous system damage, medications with mercury-based preservatives may cause neurodevelopmental problems in fetuses and infants. But research to date about the deleterious effects has been inconclusive.

Despite the ambiguous data, the potential risk to babies led the American Academy of Pediatrics and the Institute of Medicine during the past four years to advocate for the removal of mercury-based substances as preservatives from pediatric vaccines. Now companies that manufacture pediatric vaccines use mercury-free chemicals.

Aware of the change in pediatric vaccine policy and the trend to remove mercury from medications, Dr. James D. Auran, associate professor of clinical ophthalmology at P&S, told colleagues at the American Academy of Ophthalmology's annual meeting on Oct. 23 about the need to eliminate mercury in eye medications. Pregnant women who use the medications may pass the mercury through their blood to the fetus, he says. Infants may also consume mercury from mother's milk. Babies and small children also may receive mercury directly from eye medications prescribed to treat their eye problems.

The amount of mercury in eye medications is minimal and probably not harmful but Dr. Auran argues that mercury-based preservatives should be replaced because newer, more effective preservatives now are available. He plans to publish a paper about the topic and will speak again about it at the Association for Research in Vision and Ophthalmology's annual meeting in April 2003.

A few years ago, 25 eye medications contained mercury. Today, 15 eye medications, approximately 10 percent of all eye medications, contain the element. Recently, class action lawsuits against drug companies have alleged a connection between mercury in children's vaccines and childhood autism and mercury in dental fillings of pregnant women and autism in their children.

—Matthew Dougherty