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Harris LK, Berry DC, Cortés YI. Psychosocial factors related to Cardiovascular Disease Risk in Young African American Women: a systematic review. ETHNICITY & HEALTH 2022; 27:1806-1824. [PMID: 34668802 PMCID: PMC9018871 DOI: 10.1080/13557858.2021.1990218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE African American women are exposed to multiple adverse psychosocial factors, including racism, discrimination, poverty, neighborhood stress, anxiety, and depression. The impact of these psychosocial factors on cardiovascular disease (CVD) risk in women during early adulthood is limited. This review aims to summarize and synthesize the recent literature on psychosocial factors related to CVD risk in young African American women. METHODS We conducted a comprehensive search of the literature in PubMed, APA PsycINFO, and CINAHL. We systematically reviewed the literature for studies examining associations between psychosocial factors (e.g. racism, discrimination, neighborhood stress, anxiety) and CVD risk factors (e.g. body mass index [BMI], blood pressure, diabetes) in African American women age 19-24 years. Eligible studies measured at least one psychosocial factor, a CVD risk factor, and included young adult African American women (age 19-24) or reported sex-stratified analyses. RESULTS We identified nine studies that met our inclusion criteria: six cross-sectional and three longitudinal studies. Of these, eight studies reported that psychosocial factors (i.e. perceived stress, racial discrimination, internalized racism, depression) are related to higher BMI and blood pressure. The majority of studies were conducted among college students or had a small sample size (<200). The quality of six studies was rated as excellent; the remainder were good and fair. CONCLUSIONS Findings from this review suggest that exposure to adverse psychosocial factors may be related to increased CVD risk in early adulthood (age 19-24) in African American women. However, larger prospective analyses are necessary to examine these associations.
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Affiliation(s)
- Latesha K. Harris
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diane C. Berry
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yamnia I. Cortés
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Gender differences in prevalence of myocardial infarction in rural West Texans. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 30:385-397. [PMID: 35402143 DOI: 10.1007/s10389-020-01262-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Heart disease is the leading cause of death in the United States. Incidence rates of myocardial infarction (MI) in rural West Texas signify a lack of effective, risk-specific prevention programs. The purpose of this study was to identify gender-specific risk factors for MI in rural West Texans. Subjects and methods Hospital patient data for those with and without a history of MI were obtained from the Project FRONTIER database for rural West Texas counties. We used statistical software, such as SPSS, R, and WinBUGS to detect and understand the nature of MI risk factors. Statistical methods including t-tests, Chi-squared, logistic regression, and a Bayesian approach were utilized to analyze data. Results MI significant risk factors obtained for females were systolic blood pressure (p = 0.002), diastolic blood pressure (p = 0.004), pulse (p = 0.015), and smoking (p = 0.002). For males, these were glucose (p = 0.022), age (p = 0.050), body fat (p = 0.034), and smoking (p = 0.017). The mean risk parameter followed a normal distribution, while the precision parameter depicted skew for both sexes. Conclusions Gender-specific differences in MI risk factors exist, and incorporating such variables can guide relevant policymaking to reduce MI incidence in rural West Texans.
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San Diego ERN, Ahuja NA, Johnson BM, Leak CL, Relyea G, Lewis JC, French N, Harmon BE. Prevalence of Cardiovascular Disease Risk Factors by Key Demographic Variables Among Mid-South Church Leaders from 2012 to 2017. JOURNAL OF RELIGION AND HEALTH 2021; 60:1125-1140. [PMID: 33389434 DOI: 10.1007/s10943-020-01135-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 06/12/2023]
Abstract
Cardiovascular disease (CVD) risk factors were examined among church leaders (n = 2309) who attended Mid-South United Methodist Church annual meetings between 2012 and 2017 using repeated cross-sectional data. There was a significant increase in body mass index (BMI) (b = 0.24, p = 0.001) and significant decreases in blood pressure (systolic: b = - 1.08, p < 0.001; diastolic: b = - 0.41, p = 0.002), total cholesterol (b = - 1.76, p = 0.001), and blood sugar (b = - 1.78, p = 0.001) over time. Compared to Whites, a significant increase was seen in BMI (b = 1.14, p = 0.008) among participants who self-identified as "Other," and a significant increase was seen in blood pressure (systolic: b = 1.36, p = 0.010; diastolic: b = 1.01, p = 0.004) among African Americans over time. Results indicate BMI and blood pressure are important CVD risk factors to monitor and address among church leaders, especially among race/ethnic minority church leaders.
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Affiliation(s)
- Emily Rose N San Diego
- Division of Social and Behavioral Sciences, The University of Memphis School of Public Health, Memphis, TN, USA
| | - Nikhil A Ahuja
- Division of Social and Behavioral Sciences, The University of Memphis School of Public Health, Memphis, TN, USA
| | - Brandi M Johnson
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Cardella L Leak
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - George Relyea
- Division of Epidemiology, Biostatistics and Environmental Health, The University of Memphis School of Public Health, Memphis, TN, USA
| | - Jonathan C Lewis
- Mission Integration Division, Methodist Le Bonheur Healthcare, Memphis, TN, USA
| | - Niels French
- Mission Integration Division, Methodist Le Bonheur Healthcare, Memphis, TN, USA
| | - Brook E Harmon
- Division of Social and Behavioral Sciences, The University of Memphis School of Public Health, Memphis, TN, USA.
- Department of Nutrition and Healthcare Management, Appalachian State University, 1179 State Farm Rd, Leon Levine Hall Room 575, Boone, NC, 28607, USA.
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Cheng KJG, Sun Y, Monnat SM. COVID-19 Death Rates Are Higher in Rural Counties With Larger Shares of Blacks and Hispanics. J Rural Health 2020; 36:602-608. [PMID: 32894612 DOI: 10.1111/jrh.12511] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE This study compared the average daily increase in COVID-19 mortality rates by county racial/ethnic composition (percent non-Hispanic Black and percent Hispanic) among US rural counties. METHODS COVID-19 daily death counts for 1,976 US nonmetropolitan counties for the period March 2-July 26, 2020, were extracted from USAFacts and merged with county-level American Community Survey and Area Health Resource File data. Covariates included county percent poverty, age composition, adjacency to a metropolitan county, health care supply, and state fixed effects. Mixed-effects negative binomial regression with random intercepts to account for repeated observations within counties were used to predict differences in the average daily increase in the COVID-19 mortality rate across quartiles of percent Black and percent Hispanic. FINDINGS Since early March, the average daily increase in the COVID-19 mortality rate has been significantly higher in rural counties with the highest percent Black and percent Hispanic populations. Compared to counties in the bottom quartile, counties in the top quartile of percent Black have an average daily increase that is 70% higher (IRR = 1.70, CI: 1.48-1.95, P < .001), and counties in the top quartile of percent Hispanic have an average daily increase that is 50% higher (IRR = 1.50, CI: 1.33-1.69, P < .001), net of covariates. CONCLUSION COVID-19 mortality risk is not distributed equally across the rural United States, and the COVID-19 race penalty is not restricted to cities. Among rural counties, the average daily increase in COVID-19 mortality rates has been significantly higher in counties with the largest shares of Black and Hispanic residents.
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Affiliation(s)
- Kent Jason G Cheng
- Social Science Department, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York
| | - Yue Sun
- Sociology Department, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York
| | - Shannon M Monnat
- Sociology Department, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York
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Affiliation(s)
| | - Vanita Sood
- Andrew Weil Center for Integrative Medicine, University of Arizona, Tucson, Arizona
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Scott J, Dardas L, Sloane R, Wigington T, Noonan D, Simmons LA. Understanding Social Determinants of Cardiometabolic Disease Risk in Rural Women. J Community Health 2020; 45:1-9. [PMID: 31372797 DOI: 10.1007/s10900-019-00710-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Women living in rural America experience significant disparities in cardiometabolic diseases warranting research to aid in understanding the contextual factors that underlie the rural and urban disparity and in planning effective primary prevention interventions. While research has established a general understanding of cardiometabolic risks individually, the combination or bundling of these risk behaviors is not clearly understood. The purpose of this study is to explore the association of social determinants of health on obesity and adiposity related cardiometabolic disease risk among rural women. Data were from the multi-state Rural Families Speak about Health Study. A total of 399 women were included in the analyses. Data were collected using a self-administered questionnaire on women's demographics, economic stability, education, and health and healthcare. Food insecurity, education, healthcare access and comprehension health literacy were associated with higher obesity and adiposity-related cardiometabolic risk. Health behaviors, tobacco use and physical activity were not associated with higher cardiometabolic risk in this sample of rural women. This is one of the first studies to focus on multiple social determinants of health and cardiometabolic risk in rural American women. Understanding combinations of risk behaviors can assist health care providers and community health professionals in tailoring multiple health behavior change interventions to prevent cardiometabolic disease among rural women. The findings support a focus on community and societal level factors may be more beneficial for improving the cardiometabolic health of rural women.
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Affiliation(s)
- Jewel Scott
- Duke University School of Nursing, 307 Trent Drive, DUMC, Box 3322, Durham, NC, 27710, USA.
| | - Latefa Dardas
- Community Mental Health Nursing Department, The University of Jordan School of Nursing, Amman, Jordan
| | - Richard Sloane
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, 27710, USA
| | | | - Devon Noonan
- Duke University School of Nursing, 307 Trent Drive, DUMC, Box 3322, Durham, NC, 27710, USA
| | - Leigh Ann Simmons
- Department of Human Ecology, University of California, One Shields Avenue, 2323 Hart Hall, Davis, CA, 95616, USA
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Thompson SC, Nedkoff L, Katzenellenbogen J, Hussain MA, Sanfilippo F. Challenges in Managing Acute Cardiovascular Diseases and Follow Up Care in Rural Areas: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E5126. [PMID: 31847490 PMCID: PMC6950682 DOI: 10.3390/ijerph16245126] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 12/11/2022]
Abstract
This narrative review explores relevant literature that is related to the challenges in implementing evidence-based management for clinicians in rural and remote areas, while primarily focussing on management of acute coronary syndrome (ACS) and follow up care. A targeted literature search around rural/urban differences in the management of ACS, cardiovascular disease, and cardiac rehabilitation identified multiple issues that are related to access, including the ability to pay, transport and geographic distances, delays in patients seeking care, access to diagnostic testing, and timely treatment in an appropriate facility. Workforce shortages or lack of ready access to relevant expertise, cultural differences, and complexity that arises from comorbidities and from geographical isolation amplified diagnostic challenges. Given the urgency in management of ACS, rural clinicians must act quickly to achieve optimal patient outcomes. New technologies and quality improvement approaches enable better access to rapid diagnosis, as well as specialist input and care. Achieving an uptake of cardiac rehabilitation in rural and remote settings poses challenges that may reduce with the use of alternative models to centre-based rehabilitation and use of modern technologies. Expediting improvement in cardiovascular outcomes and reducing rural disparities requires system changes and that clinicians embrace attention to prevention, emergency management, and follow up care in rural contexts.
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Affiliation(s)
- Sandra C. Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, P.O. Box 109, Geraldton 6531, Australia;
| | - Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, M431, 35 Stirling Highway, Perth 6009, Australia; (L.N.); (J.K.); (F.S.)
| | - Judith Katzenellenbogen
- School of Population and Global Health, The University of Western Australia, M431, 35 Stirling Highway, Perth 6009, Australia; (L.N.); (J.K.); (F.S.)
| | - Mohammad Akhtar Hussain
- Western Australian Centre for Rural Health, The University of Western Australia, P.O. Box 109, Geraldton 6531, Australia;
- Menzies Institute for Medical Research, University of Tasmania, 15-17 Liverpool Street, Hobart, Tasmania 7000, Australia
| | - Frank Sanfilippo
- School of Population and Global Health, The University of Western Australia, M431, 35 Stirling Highway, Perth 6009, Australia; (L.N.); (J.K.); (F.S.)
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Soumerai SB, Koppel R. Instrumental variables: The power of wishful thinking vs the confounded reality of comparative effectiveness research. Health Serv Res 2019; 54:537-542. [PMID: 30864150 DOI: 10.1111/1475-6773.13129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Stephen B Soumerai
- Harvard Medical School Department of Population Medicine and Harvard Pilgrim Health Care, Boston, Massachusetts
| | - Ross Koppel
- Department of Biomedical Informatics, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biomedical Informatics, University at Buffalo (SUNY), Buffalo, New York
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Corbie-Smith G, Wiley-Cene C, Bess K, Young T, Dave G, Ellis K, Hoover SM, Lin FC, Wynn M, McFarlin S, Ede J. Heart Matters: a study protocol for a community based randomized trial aimed at reducing cardiovascular risk in a rural, African American community. BMC Public Health 2018; 18:938. [PMID: 30064398 PMCID: PMC6069773 DOI: 10.1186/s12889-018-5802-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 07/04/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND African Americans living in the rural south have the highest prevalence of cardiovascular disease (CVD) risk in the United States. Given this geographic and racial disparity, intervention implementation needs to be evaluated for effectiveness and feasibility with African Americans in the rural south. METHODS The trial developed out of a community-based participatory research partnership, Project GRACE, and community partners who are collaborators throughout the study. Heart Matters is a randomized stepped wedge trial that will assess the effectiveness of a 12-month behavioral change intervention adapted from PREMIER, an evidence-based treatment targeting multiple CVD risk factors. 140 participants will be recruited through 8 community- or faith-based organizations to participate in the intervention. Through matched pair randomization, organizations will be randomized to begin immediately after baseline data collection (Arm 1) or delayed 6 months (Arm 2). Data collection will occur at baseline, 6, 12, and 18 months. The primary outcome is change in body weight. In addition to assessing effectiveness, the study will also evaluate process and feasibility outcomes through quantitative and qualitative data collection. DISCUSSION This study will contribute to CVD prevention research and likely have a positive impact on the rural, African American community where the trial occurs. Our study is unique in its use of community partnerships to develop, implement, and evaluate the intervention. We expect that this approach will enhance the feasibility of the trial, as well as future dissemination and sustainability of the intervention. TRIAL REGISTRATION Clinical Trials, NCT02707432 . Registered 13 March 2016.
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Affiliation(s)
| | | | - Kiana Bess
- University of North Carolina School of Medicine, Chapel Hill, USA
| | - Tiffany Young
- University of North Carolina School of Medicine, Chapel Hill, USA
| | - Gaurav Dave
- University of North Carolina School of Medicine, Chapel Hill, USA
| | - Katrina Ellis
- University of North Carolina School of Medicine, Chapel Hill, USA
| | | | - Feng-Chang Lin
- University of North Carolina School of Medicine, Chapel Hill, USA
| | - Mysha Wynn
- Project Momentum, Inc., Rocky Mount, USA
| | | | - Jamie Ede
- University of North Carolina School of Medicine, Chapel Hill, USA
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An Approach to Integrating Health Disparities within Undergraduate Biomedical Engineering Education. Ann Biomed Eng 2017; 45:2703-2715. [PMID: 28849321 DOI: 10.1007/s10439-017-1903-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/11/2017] [Indexed: 12/25/2022]
Abstract
Health disparities are preventable differences in the incidence, prevalence and burden of disease among communities targeted by gender, geographic location, ethnicity and/or socio-economic status. While biomedical research has identified partial origin(s) of divergent burden and impact of disease, the innovation needed to eradicate health disparities in the United States requires unique engagement from biomedical engineers. Increasing awareness of the prevalence and consequences of health disparities is particularly attractive to today's undergraduates, who have undauntedly challenged paradigms believed to foster inequality. Here, the Department of Biomedical Engineering at The City College of New York (CCNY) has leveraged its historical mission of access-and-excellence to integrate the study of health disparities into undergraduate BME curricula. This article describes our novel approach in a multiyear study that: (i) Integrated health disparities modules at all levels of the required undergraduate BME curriculum; (ii) Developed opportunities to include impacts of health disparities into undergraduate BME research projects and mentored High School summer STEM training; and (iii) Established health disparities-based challenges as BME capstone design and/or independent entrepreneurship projects. Results illustrate the rising awareness of health disparities among the youngest BMEs-to-be, as well as abundant undergraduate desire to integrate health disparities within BME education and training.
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Bansal N, Katz R, Robinson-Cohen C, Odden MC, Dalrymple L, Shlipak MG, Sarnak MJ, Siscovick DS, Zelnick L, Psaty BM, Kestenbaum B, Correa A, Afkarian M, Young B, de Boer IH. Absolute Rates of Heart Failure, Coronary Heart Disease, and Stroke in Chronic Kidney Disease: An Analysis of 3 Community-Based Cohort Studies. JAMA Cardiol 2017; 2:314-318. [PMID: 28002548 PMCID: PMC5832350 DOI: 10.1001/jamacardio.2016.4652] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). Understanding the relative contributions of cardiovascular disease event types to the excess burden of cardiovascular disease is important for developing effective strategies to improve outcomes. Objective To determine absolute rates and risk differences of incident heart failure (HF), coronary heart disease (CHD), and stroke in participants with vs without CKD. Design, Setting and Participants We pooled participants without prevalent cardiovascular disease from 3 community-based cohort studies: the Jackson Heart Study, Cardiovascular Health Study, and Multi-Ethnic Study of Atherosclerosis. The Jackson Heart Study was conducted between 2000 and 2010, the Cardiovascular Health Study was conducted between 1989 and 2003, and the Multi-Ethnic Study of Atherosclerosis was conducted between 2000 and 2012. Exposures Chronic kidney disease was defined as estimated glomerular filtration rate less than 60 mL/min/1.73 m2, calculated using the combined creatinine-cystatin C CKD-Epidemiology Collaboration Equation. Main Outcomes and Measures Poisson regression was used to calculate incidence rates (IRs) and risk differences of adjudicated incident HF, CHD, and stroke, comparing participants with vs without CKD. Results Among 14 462 participants, the mean (SD) age was 63 (12) years, 59% (n = 8533) were women, and 44% (n = 6363) were African American. Overall, 1461 (10%) had CKD (mean [SD] estimated glomerular filtration rate, 49 [10] mL/min/1.73 m2). Unadjusted IRs for participants with and without CKD, respectively, were 22.0 (95% CI, 19.3-24.8) and 6.2 (95% CI, 5.8-6.7) per 1000 person-years for HF; 24.5 (95% CI, 21.6-27.5) and 8.4 (95% CI, 7.9-9.0) per 1000 person-years for CHD; and 13.4 (95% CI, 11.3-15.5) and 4.8 (95% CI, 4.4-5.3) for stroke. Adjusting for demographics, cohort, hypertension, diabetes, hyperlipidemia, and tobacco use, risk differences comparing participants with vs without CKD (per 1000 person-years) were 2.3 (95% CI, 1.2-3.3) for HF, 2.3 (95% CI, 1.2-3.4) for CHD, and 0.8 (95% CI, 0.09-1.5) for stroke. Among African American and Hispanic participants, adjusted risk differences comparing participants with vs without CKD for HF were 3.5 (95% CI, 1.5-5.5) and 7.8 (95% CI, 2.2-13.3) per 1000 person-years, respectively. Conclusions and Relevance Among 3 diverse community-based cohorts, CKD was associated with an increased risk of HF that was similar in magnitude to CHD and greater than stroke. The excess risk of HF associated with CKD was particularly large among African American and Hispanic individuals. Efforts to improve health outcomes for patients with CKD should prioritize HF in addition to CHD prevention.
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Affiliation(s)
- Nisha Bansal
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle
| | - Ronit Katz
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle
| | | | - Michelle C Odden
- College of Public Health and Human Services, Oregon State University, Corvallis
| | - Lorien Dalrymple
- Division of Nephrology, University of California, Davis, San Francisco
| | | | - Mark J Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | | | - Leila Zelnick
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, University of Washington, Seattle
| | - Bryan Kestenbaum
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle
| | - Adolfo Correa
- Department of Medicine and Pediatrics, University of Mississippi Medical Center, Jackson
| | - Maryam Afkarian
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle
| | - Bessie Young
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle9Puget Sound Veterans Affairs Administration, Washington, DC
| | - Ian H de Boer
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle9Puget Sound Veterans Affairs Administration, Washington, DC
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Cordasco KM, Mengeling MA, Yano EM, Washington DL. Health and Health Care Access of Rural Women Veterans: Findings From the National Survey of Women Veterans. J Rural Health 2016; 32:397-406. [PMID: 27466970 DOI: 10.1111/jrh.12197] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/06/2016] [Accepted: 06/24/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Disparities in health and health care access between rural and urban Americans are well documented. There is evidence that these disparities are mirrored within the US veteran population. However, there are few studies assessing this issue among women veterans (WVs). METHODS Using the 2008-2009 National Survey of Women Veterans, a population-based cross-sectional national telephone survey, we examined rural WVs' health and health care access compared to urban WVs. We measured health using the Medical Outcomes Study Short-Form (SF-12); access using measures of regular source of care (RSOC), health care utilization, and unmet needs; and barriers to getting needed care. FINDINGS Rural WVs have significantly worse physical health functioning compared to urban WVs (mean physical component score of 43.6 for rural WVs versus 47.2 for urban WVs; P = .007). Rural WVs were more likely to have a VA RSOC (16.4% versus 10.6%; P = .009) and use VA health care (21.7% versus 12.9%; P < .001), and had fewer non-VA health care visits compared with urban WVs (mean 4.2 versus 5.9; P = .021). They had similar overall numbers of health care visits (mean 5.8 versus 7.1; P = .11 ). Access barriers were affordability for rural WVs and work release time for urban WVs. Rural WVs additionally reported that transportation was a major factor affecting health care decisions. CONCLUSIONS Our findings demonstrate VA's crucial role in addressing disparities in health and health care access for rural WVs. As VA continues to strive to optimally meet the needs of all WVs, innovative care models need to account for their high health care needs and persistent barriers to care.
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Affiliation(s)
- Kristina M Cordasco
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, California.
- Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California.
- Department of Medicine, University of California Geffen School of Medicine, Los Angeles, California.
| | - Michelle A Mengeling
- VA Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City, Iowa
- Veterans Rural Health Resource Center - Iowa City, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, California
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, California
- Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Department of Medicine, University of California Geffen School of Medicine, Los Angeles, California
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Afkarian M, Katz R, Bansal N, Correa A, Kestenbaum B, Himmelfarb J, de Boer IH, Young B. Diabetes, Kidney Disease, and Cardiovascular Outcomes in the Jackson Heart Study. Clin J Am Soc Nephrol 2016; 11:1384-1391. [PMID: 27340284 PMCID: PMC4974894 DOI: 10.2215/cjn.13111215] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/18/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Blacks have high rates of cardiovascular disease and mortality. Diabetes and CKD, risk factors for cardiovascular mortality in the general population, are common among blacks. We sought to assess their contribution to cardiovascular disease and mortality in blacks. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This observational cohort study was of 3211 participants in the Jackson Heart Study (enrolled 2000-2004). Rates of incident stroke, incident coronary heart disease, and cardiovascular mortality were quantified in participants with diabetes, CKD (eGFR<60 ml/min per 1.73 m(2), urine albumin-to-creatinine ratio ≥30 mg/g, or both), or both through 2012, with a median follow-up of 6.99 years. RESULTS Four hundred fifty-six (14.2%) participants had only diabetes, 257 (8.0%) had only CKD, 201 (6.3%) had both, and 2297 (71.5%) had neither. Diabetes without CKD was associated with excess risks of incident stroke, incident coronary heart disease, and cardiovascular mortality after adjustment for demographic and clinical covariates, including prevalent cardiovascular disease (excess incidence rates, 2.6; 95% confidence interval, 0.5 to 4.7; 2.6; 95% confidence interval, 0.3 to 4.8; and 2.4; 95% confidence interval, 0.4 to 4.3 per 1000 person-years, respectively). CKD without diabetes was associated with comparable nonsignificant excess risks for incident stroke and coronary heart disease (2.5; 95% confidence interval, -0.1 to 5.2 and 2.4; 95% confidence interval, -0.8 to 5.5 per 1000 person-years, respectively) but a larger excess risk for cardiovascular mortality (7.3; 95% confidence interval, 3.0 to 11.5 per 1000 person-years). Diabetes and CKD together were associated with greater excess risks for incident stroke (13.8; 95% confidence interval, 5.3 to 22.3 per 1000 person-years), coronary heart disease (12.8; 95% confidence interval, 4.9 to 20.8 per 1000 person-years), and cardiovascular mortality (14.8; 95% confidence interval, 7.2 to 22.3 per 1000 person-years). The excess risks associated with the combination of diabetes and CKD were larger than those associated with established risk factors, including prevalent cardiovascular disease. CONCLUSIONS The combination of diabetes and kidney disease is associated with substantial excess risks of cardiovascular events and mortality among blacks.
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Affiliation(s)
- Maryam Afkarian
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington
| | - Ronit Katz
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington
| | - Nisha Bansal
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington
| | - Adolfo Correa
- Jackson Heart Study, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi; and
| | - Bryan Kestenbaum
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington
| | - Jonathan Himmelfarb
- Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington
| | - Ian H. de Boer
- Kidney Research Institute, Division of Nephrology, Veterans Affairs Puget Sound, University of Washington, Seattle, Washington
| | - Bessie Young
- Kidney Research Institute, Division of Nephrology, Veterans Affairs Puget Sound, University of Washington, Seattle, Washington
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Building Collaborative Health Promotion Partnerships: The Jackson Heart Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010025. [PMID: 26703681 PMCID: PMC4730416 DOI: 10.3390/ijerph13010025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 10/23/2015] [Accepted: 11/09/2015] [Indexed: 01/13/2023]
Abstract
Building Collaborative Health Promotion Partnerships: The Jackson Heart Study. Background: Building a collaborative health promotion partnership that effectively employs principles of community-based participatory research (CBPR) involves many dimensions. To ensure that changes would be long-lasting, it is imperative that partnerships be configured to include groups of diverse community representatives who can develop a vision for long-term change. This project sought to enumerate processes used by the Jackson Heart Study (JHS) Community Outreach Center (CORC) to create strong, viable partnerships that produce lasting change. Methods: JHS CORC joined with community representatives to initiate programs that evolved into comprehensive strategies for addressing health disparities and the high prevalence of cardiovascular disease (CVD). This collaboration was made possible by first promoting an understanding of the need for combined effort, the desire to interact with other community partners, and the vision to establish an effective governance structure. Results: The partnership between JHS CORC and the community has empowered and inspired community members to provide leadership to other health promotion projects. Conclusion: Academic institutions must reach out to local community groups and together address local health issues that affect the community. When a community understands the need for change to respond to negative health conditions, formalizing this type of collaboration is a step in the right direction.
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Newman AB, Avilés-Santa ML, Anderson G, Heiss G, Howard WJ, Krucoff M, Kuller LH, Lewis CE, Robinson JG, Taylor H, Treviño RP, Weintraub W. Embedding clinical interventions into observational studies. Contemp Clin Trials 2015; 46:100-105. [PMID: 26611435 DOI: 10.1016/j.cct.2015.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/18/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
Abstract
Novel approaches to observational studies and clinical trials could improve the cost-effectiveness and speed of translation of research. Hybrid designs that combine elements of clinical trials with observational registries or cohort studies should be considered as part of a long-term strategy to transform clinical trials and epidemiology, adapting to the opportunities of big data and the challenges of constrained budgets. Important considerations include study aims, timing, breadth and depth of the existing infrastructure that can be leveraged, participant burden, likely participation rate and available sample size in the cohort, required sample size for the trial, and investigator expertise. Community engagement and stakeholder (including study participants) support are essential for these efforts to succeed.
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Affiliation(s)
- Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, A527 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
| | - M Larissa Avilés-Santa
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, 6701 Rockledge Drive, Suite 10018, Bethesda, MD 20892-7936, USA.
| | - Garnet Anderson
- Fred Hutchinson Cancer Research Center, Public Health Sciences Division, 1100 Fairview Ave N, M3-A410, PO Box 19024, Seattle, WA 98109, USA.
| | - Gerardo Heiss
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 137 E Franklin St, Ste 306, Chapel Hill, NC 27514-3628, USA.
| | - Wm James Howard
- Medstar Health Research Institute, Medstar Washington Hospital Center, Department of Internal Medicine, Rm. 6A 126, 110 Irving St. NW, Washington, DC 20010, USA.
| | - Mitchell Krucoff
- Departments of Medicine and Cardiology, Duke University Medical Center, 508 Fulton Street, Room A3006, Durham, NC 27705, USA.
| | - Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N. Bellefield Avenue, Room 550, Pittsburgh, PA 15213, USA.
| | - Cora E Lewis
- University of Alabama School of Medicine, Division of Preventive Medicine, Medical Towers 614, 1717 11th Avenue South, Birmingham, AL 35205, USA.
| | - Jennifer G Robinson
- Department of Epidemiology, University of Iowa, 145 North Riverside Drive, S455 CPBH, Iowa City, IA 52242, USA.
| | - Herman Taylor
- Jackson Heart Study, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
| | - Roberto P Treviño
- Social and Health Research Center, 1302 South Saint Mary's Street, San Antonio, TX 78210, USA.
| | - William Weintraub
- Center for Heart & Vascular Health, Christiana Care Health System, 4755 Ogletown-Stanton Road, Suite 1070, Newark, DE 19713, USA.
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Cloos P. [The racialization of public health in the United States : the possibility that the concept be allowed to die out]. Glob Health Promot 2015; 19:68-75. [PMID: 24801319 DOI: 10.1177/1757975911432358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Résumé Aux États-Unis, une intensification de l’usage de la race en santé publique a récemment été notée ; une idée qui est pourtant controversée dans les sciences. La race a été vue dans ce contexte comme un objet de discours entre pouvoirs et savoirs, un objet qui se réfère au corps devenu au cours des derniers siècles un site discursif pour représenter la différence. Cet article s’appuie sur une analyse de documents de la santé publique parus aux États-Unis et issus de bureaux fédéraux et d’une importante revue spécialisée dans le domaine sanitaire, qui ont été publiés entre 2001 et 2009. Cette étude a analysé la manière dont la race est représentée, produite comme objet de connaissance et régulée par les pratiques discursives dans ces documents. Les résultats décrivent deux processus enchevêtrés, la racialisation et la sanitarisation, qui concourent à reformuler l’idée de race. Le premier est un ensemble d’opérations qui visent à identifier, à situer et à opposer les sujets et les groupes à partir de labels standardisés. La sanitarisation assure la traduction des groupes racialisés en termes de maladies, de comportements, de vie ou de mort. Ces pratiques aboutissent à la caractérisation et à la formation d’objets racialisés et sanitarisés et à des stéréotypes ; un ensemble d’opérations qui a tendance à naturaliser la différence. La racialisation apparaît également tiraillée entre un pouvoir sur la vie et un droit de laisser mourir. Enfin, cette étude propose aux acteurs de la santé publique de sortir des frontières imposées par le discours racialisant.
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Affiliation(s)
- Patrick Cloos
- Faculté des arts et des sciences, École de service social, Université de Montréal, Montréal, Canada
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Hauenstein EJ, Glick DF, Kane C, Kulbok P, Barbero E, Cox K. A Model to Develop Nurse Leaders for Rural Practice. J Prof Nurs 2014; 30:463-73. [DOI: 10.1016/j.profnurs.2014.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Indexed: 12/29/2022]
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Khare MM, Koch A, Zimmermann K, Moehring PA, Geller SE. Heart smart for women: a community-based lifestyle change intervention to reduce cardiovascular risk in rural women. J Rural Health 2014; 30:359-68. [PMID: 24576081 DOI: 10.1111/jrh.12066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Cardiovascular disease (CVD) is the leading cause of death for rural women in the United States. Lifestyle change interventions in group settings focused on increasing physical activity and improving nutrition have been shown to help reduce the risk for CVD. This paper describes the implementation and evaluation of Heart Smart for Women (HSFW), a 12-week lifestyle behavior change intervention to reduce CVD risk for women in the rural southernmost 7 counties (S7) of Illinois. METHODS The HSFW evidence-based lifestyle intervention was delivered by a trained facilitator in 12 weekly 1-hour sessions to groups of women in the rural S7 region of Illinois. Dietary and physical activity assessments were collected at baseline, postintervention, and 1 year. Clinical measurements were taken at baseline, 6 months and 1 year. Data were analyzed for change in behavioral and clinical outcomes over time. FINDINGS In total, 162 women completed HSFW in 13 communities across the S7 region. HSFW participants showed improvement in dietary and physical activity indicators at the end of the 12-week intervention, but only increases in vegetable consumption and physical activity were sustained over 1 year. A decrease in total cholesterol was observed at 6 months but not maintained at 1 year. CONCLUSIONS HSFW led to short-term, moderate changes in nutrition and physical activity in rural women, but some health improvements were not sustained at 1 year. These findings suggest that more intensive follow-up maybe required to help maintain long-term behavior change, especially in rural areas where women are geographically dispersed.
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Affiliation(s)
- Manorama M Khare
- Department of Family and Community Medicine, University of Illinois College of Medicine at Rockford, Rockford, Illinois; Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, Illinois
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Kulshreshtha A, Goyal A, Dabhadkar K, Veledar E, Vaccarino V. Urban-rural differences in coronary heart disease mortality in the United States: 1999-2009. Public Health Rep 2014; 129:19-29. [PMID: 24381356 DOI: 10.1177/003335491412900105] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Coronary heart disease (CHD) mortality has declined in the past few decades; however, it is unclear whether the reduction in CHD deaths has been similar across urbanization levels and in specific racial groups. We describe the pattern and magnitude of urban-rural variations in CHD mortality in the U.S. METHODS Using data from the National Center for Health Statistics, we examined trends in death rates from CHD from 1999 to 2009 among people aged 35-84 years, in each geographic region (Northeast, Midwest, West, and South) and in specific racial-urbanization groups, including black and white people in large and medium metropolitan (urban) areas and in non-metropolitan (rural) areas. We also examined deaths from early-onset CHD in females aged <65 years and males aged <55 years. RESULTS From 1999 to 2009, there was a 40% decline in age-adjusted CHD mortality. The trend was similar in black and white people but was more pronounced in urban than in rural areas, resulting in a crossover in 2007, when rural areas began showing a higher CHD mortality than urban areas. White people in large metropolitan areas had the largest decline (43%). Throughout the study period, CHD mortality remained higher in black people than in white people, and, in the South, it remained higher in rural than in urban areas. For early-onset CHD, the mortality decline was more modest (30%), but overall trends by urbanization and region were similar. CONCLUSION Favorable national trends in CHD mortality conceal persisting disparities for some regions and population subgroups (e.g., rural areas and black people).
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Affiliation(s)
- Ambar Kulshreshtha
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA ; Emory University School of Medicine, Department of Family and Preventive Medicine, Atlanta, GA
| | - Abhinav Goyal
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA ; Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA
| | - Kaustubh Dabhadkar
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA ; Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA
| | - Emir Veledar
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA ; Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA
| | - Viola Vaccarino
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA ; Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA
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Vasiljevic Z, Krljanac G, Davidovic G, Panic G, Radovanovic S, Mickovski N, Srbljak N, Markovic-Nikolic N, Curic-Petkovic S, Panic M, Cenko E, Manfrini O, Martelli I, Koller A, Badimon L, Bugiardini R. Gender differences in case fatality rates of acute myocardial infarction in Serbia. Eur Heart J Suppl 2014. [DOI: 10.1093/eurheartj/sut012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Della LJ, Smith SE, Best L, D'Silva MU. What's Hoppin' in Hoptown?: Examining Fruit and Vegetable Consumption Among Hopkinsville's African American Community. KENTUCKY JOURNAL OF COMMUNICATION 2014; 33:5-24. [PMID: 35002546 PMCID: PMC8741168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Cardiovascular disease is a concern nationwide and disproportionately impacts African Americans residing in the American South. However, this condition can be assuaged by consuming a diet of fruits and vegetables. Utilizing the social ecological model, this study explored the community, interpersonal, and intrapersonal factors that predict fruit and vegetable consumption in Hopkinsville, Kentucky, a small rural city which possesses one of the largest populations of African Americans in the state. Using data from social transect walks and a formative research survey (N=174), this study also sought to discover the best methods to communicate with Hopkinsvillians to improve their diets. Results show that despite some barriers (i.e., cost of quality foods, perceived lack of access to fresh food stores), Hopkinsvillians tend to view fruit and vegetable consumption positively. In addition, family and friends provide interpersonal support to those wanting to eat healthier. The study reveals that communicators must consider all levels of the social ecological model to produce effective health messages.
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Affiliation(s)
- Lindsay J Della
- Department of Communication at the University of Louisville, 308E Strickler Hall, Louisville, KY 40292
| | - Siobhan E Smith
- Department of Communication at the University of Louisville, 310 Strickler Hall, Louisville, KY 40292
| | - Latrica Best
- Department of Pan-African Studies and Department of Sociology at the University of Louisville, 435 Strickler Hall Louisville, KY 40292
| | - Margaret U D'Silva
- Department of Communication at the University of Louisville, 310 Strickler Hall, Louisville, KY 40292
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The impact of Japan's 2004 postgraduate training program on intra-prefectural distribution of pediatricians in Japan. PLoS One 2013; 8:e77045. [PMID: 24204731 PMCID: PMC3813669 DOI: 10.1371/journal.pone.0077045] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 09/06/2013] [Indexed: 11/19/2022] Open
Abstract
Objective Inequity in physician distribution poses a challenge to many health systems. In Japan, a new postgraduate training program for all new medical graduates was introduced in 2004, and researchers have argued that this program has increased inequalities in physician distribution. We examined the trends in the geographic distribution of pediatricians as well as all physicians from 1996 to 2010 to identify the impact of the launch of the new training program. Methods The Gini coefficient was calculated using municipalities as the study unit within each prefecture to assess whether there were significant changes in the intra-prefectural distribution of all physicians and pediatricians before and after the launch of the new training program. The effect of the new program was quantified by estimating the difference in the slope in the time trend of the Gini coefficients before and after 2004 using a linear change-point regression design. We categorized 47 prefectures in Japan into two groups: 1) predominantly urban and 2) others by the definition from OECD to conduct stratified analyses by urban-rural status. Results The trends in physician distribution worsened after 2004 for all physicians (p value<.0001) and pediatricians (p value = 0.0057). For all physicians, the trends worsened after 2004 both in predominantly urban prefectures (p value = 0.0012) and others (p value<0.0001), whereas, for pediatricians, the distribution worsened in others (p value = 0.0343), but not in predominantly urban prefectures (p value = 0.0584). Conclusion The intra-prefectural distribution of physicians worsened after the launch of the new training program, which may reflect the impact of the new postgraduate program. In pediatrics, changes in the Gini trend differed significantly before and after the launch of the new training program in others, but not in predominantly urban prefectures. Further observation is needed to explore how this difference in trends affects the health status of the child population.
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Assessment of Risk Factor for Cardiovascular Disease Using Heart Rate Variability in Postmenopausal Women: A Comparative Study between Urban and Rural Indian Women. ISRN CARDIOLOGY 2013; 2013:858921. [PMID: 23936672 PMCID: PMC3725838 DOI: 10.1155/2013/858921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/18/2013] [Indexed: 11/17/2022]
Abstract
Cardiovascular diseases are important causes of morbidity and mortality in postmenopausal women. A major determinant of cardiovascular health is the status of autonomic nervous system and assessment of Heart Rate Variability (HRV). Heart Rate Variability is a noninvasive and sensitive technique to evaluate cardiovascular autonomic control. Reduced HRV is an independent risk factor for the development of heart disease. This study evaluated the risk factors for cardiovascular diseases using HRV, between urban and rural Indian postmenopausal women ranging in age from 40 to 75 years. Findings of the analysis of HRV have showed that the total power which reflects overall modulation of cardiac autonomic activity (759 ± 100 versus 444 ± 65), the absolute power of high frequency which is surrogate of cardiovagal activity (247 ± 41 versus 163 ± 45), and low frequency that reflects cardiac sympathetic activity (205 ± 26 versus 127 ± 18) were significantly higher in urban women than that of their rural counterparts. Further, among the anthropometric measures, waist circumference was significantly correlated with indices of HRV. The study concludes that rural Indian women are associated with an additional risk beyond that of ageing and postmenopausal status when compared to the urban women. The higher central obesity could be the contributing factor for developing higher risk for cardiovascular disease among the rural women.
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Goldner M, Hale TM, Cotten SR, Stern MJ, Drentea P. The intersection of gender and place in online health activities. JOURNAL OF HEALTH COMMUNICATION 2013; 18:1235-1255. [PMID: 23886026 DOI: 10.1080/10810730.2013.778364] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study examines how rurality and gender are related to online health activities. Rural women face greater health risks and yet have access to a weaker health system infrastructure, which has resulted in a health disadvantage. New health information technologies may ameliorate some of these disparities; thus, the authors examine the relevance of gender and place in going online to search for health information, buy medicines, participate in health-related support groups, communicate with physicians, or maintain a personal health record. Analyzing data from the National Cancer Institute's 2007 Health Information National Trends Survey, the authors found that the relations between rurality and gender vary, depending on the specific type of online health activity, and that gender may be a more salient factor than rurality in determining whether individuals engage in particular types of online health activities. This study contributes to the literature by examining how gender and place are related to online health activities, a combined area neglected in past research, and advancing research on gender and technology. This research highlights the importance of expanding high-speed access in rural locations, increasing technological and health literacy, and tailoring the Internet to specific populations.
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Affiliation(s)
- Melinda Goldner
- a Department of Sociology , Union College , Schenectady , New York , USA
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Ford CD. Building from within: pastoral insights into community resources and assets. Public Health Nurs 2013; 30:511-8. [PMID: 24579711 DOI: 10.1111/phn.12048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore perceptions of community pastors regarding the extent of community resources and assets in a rural, Southern, African American community. DESIGN AND SAMPLE Utilizing a qualitative, descriptive design, interviews were conducted with six African American pastors. MEASURES Interviews were conducted using a semi-structured interview guide based on an assets-oriented approach. RESULTS Pastors discussed various resources and assets, probable within the community that may be considered as support for program development. Key themes included: (1) community strengths, (2) community support, and (3) resources for a healthy lifestyle. The church was identified, throughout the interviews, as a primary source of strength and support for community members. CONCLUSIONS In this study of African American pastors, various perceptions of community resources were identified. Findings indicate that a sample, rural, Southern, African American community has a wealth of resources and assets, but additional resources related to health promotion are still necessary to produce optimal results. Specific programs to prevent chronic conditions such as cardiovascular disease can provide an effective means for addressing related health disparities. Programs implemented through churches can reach large numbers of individuals in the community and provide an important source of sustainable efforts to improve the health of African Americans.
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Tonks SA, Makwana S, Salanitro AH, Safford MM, Houston TK, Allison JJ, Curry W, Estrada CA. Quality of diabetes mellitus care by rural primary care physicians. J Rural Health 2012; 28:364-71. [PMID: 23083082 DOI: 10.1111/j.1748-0361.2012.00410.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore the relationship between degree of rurality and glucose (hemoglobin A1c), blood pressure (BP), and lipid (LDL) control among patients with diabetes. METHODS Descriptive study; 1,649 patients in 205 rural practices in the United States. Patients' residence ZIP codes defined degree of rurality (Rural-Urban Commuting Areas codes). Outcomes were measures of acceptable control (A1c < = 9%, BP < 140/90 mmHg, LDL < 130 mg/dL) and optimal control (A1c < 7%, BP < 130/80 mmHg, LDL < 100 mg/dL). Statistical significance was set at P < .008 (Bonferroni's correction). FINDINGS Although the proportion of patients with reasonable A1c control worsened by increasing degree of rurality, the differences were not statistically significant (urban 90%, large rural 88%, small rural 85%, isolated rural 83%; P = .10); mean A1c values also increased by degree of rurality, although not statistically significant (urban 7.2 [SD 1.6], large rural 7.3 [SD 1.7], small rural 7.5 [SD 1.8], isolated rural 7.5 [SD 1.9]; P = .16). We observed no differences between degree of rural and reasonable BP or LDL control (P = .42, P = .23, respectively) or optimal A1c or BP control (P = .52, P = .65, respectively). Optimal and mean LDL values worsened as rurality increased (P = .08, P = .029, respectively). CONCLUSIONS In patients with diabetes who seek care in the rural Southern United States, we observed no relationship between degree of rurality of patients' residence and traditional measures of quality of care. Further examination of the trends and explanatory factors for relative worsening of metabolic control by increasing degree of rurality is warranted.
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Affiliation(s)
- Stephen A Tonks
- The University of Alabama, Birmingham, Alabama 35294-3407, USA
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Khare MM, Carpenter RA, Huber R, Bates NJ, Cursio JF, Balmer PW, Nolen KN, Hudson H, Shippee SJ, Loo RK. Lifestyle Intervention and Cardiovascular Risk Reduction in the Illinois WISEWOMAN Program. J Womens Health (Larchmt) 2012; 21:294-301. [DOI: 10.1089/jwh.2011.2926] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Manorama M. Khare
- Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, Illinois
| | | | | | - Nancy J. Bates
- Evaluation and Tracking Program, Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, Illinois
| | - John F. Cursio
- Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, Illinois
| | - Pamela W. Balmer
- Office of Women's Health, Illinois Department of Public Health, Springfield, Illinois
| | - Kristen N. Nolen
- Illinois Tobacco-Free Communities Program, Illinois Department of Public Health, Springfield, Illinois
| | - Heather Hudson
- Office of Women's Health, Illinois Department of Public Health, Springfield, Illinois
| | - Sara J. Shippee
- Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, Illinois
| | - Ryan K. Loo
- Spectrum Consulting, Health Policy Research Division, Lawrenceville, Georgia
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Is Francophone Language Status Associated With Differences in the Health Services Use of Rural Nova Scotians? Canadian Journal of Public Health 2012. [DOI: 10.1007/bf03404071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Clark CR, Coull B, Berkman LF, Buring JE, Ridker PM. Geographic variation in cardiovascular inflammation among healthy women in the Women's Health Study. PLoS One 2011; 6:e27468. [PMID: 22102899 PMCID: PMC3213140 DOI: 10.1371/journal.pone.0027468] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 10/17/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Geographic variation in traditional cardiovascular disease (CVD) risk factors has been observed among women in the US. It is not known whether state-level variation in cardiovascular inflammation exists or could be explained by traditional clinical risk factors and behavioral lifestyle factors. METHODS AND RESULTS We used multilevel linear regression to estimate state-level variation in inflammatory biomarker patterns adjusted for clinical and lifestyle characteristics among 26,029 women free of CVD. Participants derived from the Women's Health Study, a national cohort of healthy middle-aged and older women. Inflammatory biomarker patterns (plasma levels of high-sensitivity C-reactive protein (hsCRP), soluble intercellular adhesion molecule-1 (sICAM-1), and fibrinogen) were compared to state-level patterns of traditional CVD risk factors and global risk scores. We found that all three inflammatory biomarkers exhibited significant state-level variation including hsCRP (lowest vs. highest state median 1.3 mg/L vs. 2.7 mg/L, unadjusted random effect estimate 1(st) to 99(th) percentile range for log hsCRP 0.52, p<.001), sICAM-1 (325 ng/ml vs. 366ng/ml, unadjusted random effect estimate 1(st) to 99(th) percentile range 0.44, p<.001), and fibrinogen (322 mg/dL vs. 367 mg/dL, unadjusted random effect estimate 1(st) to 99(th) percentile range 0.41, p = .001). Neither demographic, clinical or lifestyle characteristics explained away state-level effects in biomarker patterns. Southern and Appalachian states (Arkansas, West Virginia) had the highest inflammatory biomarker values. Regional geographic patterns of traditional CVD risk factors and risk scores did not completely overlap with biomarkers of inflammation. CONCLUSIONS There is state-level geographic variation in inflammatory biomarkers among otherwise healthy women that cannot be completely attributed to traditional clinical risk factors or lifestyle characteristics. Future research should aim to identify additional factors that may explain geographic variation in biomarkers of inflammation among healthy women.
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Affiliation(s)
- Cheryl R Clark
- Division of General Medicine and Primary Care, Brigham and Women's-Faulkner Hospitalist Program, Harvard Medical School, Boston, Massachusetts, United States of America.
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Flessner MF, Wyatt SB, Akylbekova EL, Coady S, Fulop T, Lee F, Taylor HA, Crook E. Prevalence and awareness of CKD among African Americans: the Jackson Heart Study. Am J Kidney Dis 2009; 53:238-47. [PMID: 19166799 PMCID: PMC2668959 DOI: 10.1053/j.ajkd.2008.08.035] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 08/29/2008] [Indexed: 12/27/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) leads to end-stage renal disease and is a growing epidemic throughout the world. In the United States, African Americans have an incidence of end-stage renal disease 4 times that of whites. STUDY DESIGN Cross-sectional to examine the prevalence and awareness of CKD in African Americans. SETTING & PARTICIPANTS Observational cohort in the Jackson Heart Study (JHS). PREDICTOR CKD was defined as an estimated glomerular filtration rate less than 60 mL/min/1.73 m(2), the presence of albuminuria, or dialysis therapy. OUTCOMES & MEASUREMENTS Data from the JHS were analyzed. Medical history, including disease awareness and drug therapy, anthropometric measurements, and serum and urine samples, were obtained from JHS participants at the baseline visit. Associations between CKD prevalence and awareness and selected demographic, socioeconomic, health care access, and disease status parameters were assessed by using logistic regression models. RESULTS The prevalence of CKD in the JHS was 20%; CKD awareness was only 15.8%. Older participants had a greater prevalence, but also were more aware of CKD. Hypertension, diabetes, cardiovascular disease, hypercholesterolemia, hypertriglyceridemia, increasing age and waist circumference, and being single or less physically active were associated with CKD. Only advancing CKD stage was associated with awareness. LIMITATIONS Cross-sectional assessment, single urine measurement. CONCLUSIONS The JHS has a high prevalence and low awareness of CKD, especially in those with less severe disease status. This emphasizes the need for earlier diagnosis and increased education of health care providers and the general population.
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Affiliation(s)
- Michael F Flessner
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA.
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Hemsing N, Greaves L. Women, environments and chronic disease: shifting the gaze from individual level to structural factors. ENVIRONMENTAL HEALTH INSIGHTS 2009; 2:127-35. [PMID: 21572841 PMCID: PMC3091340 DOI: 10.4137/ehi.s989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Chronic heart and respiratory diseases are two of the leading causes of morbidity and mortality affecting women. Patterns of and disparities in chronic diseases between sub-populations of women suggest that there are social as well as individual level factors which enhance or impede the prevention or development of chronic respiratory and cardiovascular diseases. By examining the sex, gender and diversity based dimensions of women's lung and heart health and how these overlap with environmental factors we extend analysis of preventive health beyond the individual level. We demonstrate how biological, environmental and social factors interact and operate in women's lives, structuring their opportunities for health and abilities to prevent or manage chronic cardiovascular and respiratory diseases. METHODS This commentary is based on the findings from two evidence reviews, one conducted on women's heart health, and another on women's lung health. Additional literature was also reviewed which assessed the relationship between environmental factors and chronic heart and lung diseases. This paper explores how obesogenic environments, exposure to tobacco smoke, and the experience of living in deprived areas can affect women's heart and respiratory health. We discuss the barriers which impede women's ability to engage in physical activity, consume healthy foods, or avoid smoking, tobacco smoke, and other airborne contaminants. RESULTS Sex, gender and diversity clearly interact with environmental factors and shape women's promotion of health and prevention of chronic respiratory and cardiovascular diseases. The environments women live in structure their opportunities for health, and women navigate these environments in unique ways based on gender, socioeconomic status, race/ethnicity and other social factors. DISCUSSION Future research, policy and programs relating to the prevention of chronic disease need to move beyond linear individually-oriented models and address these complexities by developing frameworks and interventions which improve environmental conditions for all groups of women. Indeed, in order to improve women's health, broad social and economic policies and initiatives are required to eliminate negative environmental impacts on women's opportunities for health.
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Affiliation(s)
- Natalie Hemsing
- Tobacco Research Coordinator, British Columbia Centre of Excellence for Women’s Health, Vancouver, British Columbia, Canada
| | - Lorraine Greaves
- Executive Director, British Columbia Centre of Excellence for Women’s Health, Vancouver, British Columbia, Canada
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Ford CD, Kim MJ, Dancy BL. Perceptions of hypertension and contributing personal and environmental factors among rural Southern African American women. Ethn Dis 2009; 19:407-413. [PMID: 20073141 PMCID: PMC2827201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE This study aimed to describe the perceptions of Southern, rural, African American women regarding personal and environmental factors that affect their hypertension. DESIGN A purposive sample of 25 African American women aged 40-74 years, who lived in rural Alabama, participated in seven Talking Circles for 60 minutes. RESULTS Most felt that hypertension was a "common occurrence" and that it was "typical in the African American community." They associated hypertension with stroke and heart attacks and referred to hypertension as the "silent killer." Barriers to following the treatment plan were low income, high medical expenses, and lack of insurance. Barriers to medication were cost, dislike for taking medication, running out of medication, side effects, forgetting, and being tired; and barriers to exercise were being tired, busy schedule, and safety. Walking paths, fitness centers, or malls to walk around were not available in all communities, and not all sidewalks were well-lit, limiting their walking exercise opportunities after work hours. Healthcare facilities were accessible, but it was easier to get an appointment and receive respect from healthcare providers if the women had money or insurance. Blood pressure monitors were available in their homes, at grocery stores and at Wal-Mart. No church health programs were available, but some churches had nurses on duty who offered blood pressure and cholesterol screening; however, no medication was provided. Grocery stores were accessible, and they had a flea market with fresh fruits and vegetables. Social environment/support by families and friends for persons with hypertension was not always positive. CONCLUSION The findings of this study indicate that personal and environmental factors play important roles in hypertensive status. The modified ecological framework used in this study may help us explore perspectives of family members and friends regarding their support for persons with hypertension. More serious efforts and resources need to be made available for preventive measures of hypertension in this population.
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Affiliation(s)
- Cassandra D Ford
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL 35487-0358, USA.
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Smith KB, Humphreys JS, Wilson MGA. Addressing the health disadvantage of rural populations: How does epidemiological evidence inform rural health policies and research? Aust J Rural Health 2008; 16:56-66. [DOI: 10.1111/j.1440-1584.2008.00953.x] [Citation(s) in RCA: 330] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Eudy RL. Infant mortality in the Lower Mississippi Delta: geography, poverty and race. Matern Child Health J 2008; 13:806-13. [PMID: 18278546 DOI: 10.1007/s10995-008-0311-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Accepted: 01/21/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objectives of this study were to explore regional, economic and racial disparities in infant mortality rates between geographic sub-regions within the eight states containing the Delta and to test hypotheses that regional disparities would decrease over time while county poverty level and racial composition would remain significant predictors of infant mortality rates. STUDY DESIGN The study used secondary data analysis of county level rates, including descriptive statistics, hierarchical multiple regression with interaction effects and linear multiple regression. Models testing the impact of sub-regional geographic differences, percent of poverty, percent of black population and interaction effects were conducted at three time periods, the late 1970s, late 1980s and late 1990s. RESULTS In the first time period, regional differences, percent of poverty, percent of black population and the interaction of region and poverty were all predictive of infant mortality (R(2) = 0.31, P < 0.0001). In the subsequent time periods, only percent of poverty and percent of black population were significant predictors (R(2) = 0.20, P < 0.0001 and R(2) = 0.26, P < 0.0001). CONCLUSIONS During the late 1970s and early 1980s, region, poverty and racial composition of counties all played an important part in predicting life chances for infants born in these eight states. Furthermore, Central Delta infants in counties with poverty levels of 30% or greater were significantly more likely to die than infants in other areas with the same rates of poverty, even after controlling for racial composition. The impact of regional differences was no longer significant at the ends of the subsequent two decades. Both medical and policy changes during these decades may have contributed to the decreased impact of region. However, both poverty and racial composition continue as important factors, accounting for more variance in the late 1990s than a decade before.
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Affiliation(s)
- Ruth L Eudy
- Health Policy and Management, UAMS College of Public Health, 4301 W. Markham St., Little Rock, AR 72206, USA.
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Abstract
BACKGROUND Cardiovascular disease is the number one cause of mortality and morbidity among women in the United States, resulting in 25,000 deaths annually. Despite this high mortality figure, most women survive. Although evidence suggests that depression is common after myocardial infarction (MI), there are limited data on how depression impacts women's recovery after their first event. The purpose of this study was to describe the relationship between depression and quality of life in women after a first MI. METHOD A convenience sample of 27 women (mean age = 60.7 years) with first MI completed the study. Depression was measured using the Beck Depression Inventory, and quality of life was measured using the Short Form-36. RESULTS The mean (SD) depression score was 9.4 (5.5), indicating mild to moderate depression. Depression had a significant negative correlation with the mental component summary of the Short Form-36 (r = -0.72, P = .0005) but not the physical component summary (r = -0.191, P = .360). In addition, subjects reported lower scores on 3 of the 8 Short Form-36 subscales when compared with national norms of persons experiencing a recent MI. IMPLICATIONS Many women continue to report mild to severe depression after MI, and depression seems to be related to some aspects of quality of life. Screening for depression and treating if symptoms are significant is one intervention for improving quality of life after MI.
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Affiliation(s)
- Mary L White
- McAuley School of Nursing, University of Detroit-Mercy, Detroit, Mich and Doctoral Student, Wayne State University, Detroit, MI, USA.
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Ziembroski JS, Breiding MJ. The cumulative effect of rural and regional residence on the health of older adults. J Aging Health 2006; 18:631-59. [PMID: 16980633 DOI: 10.1177/0898264306291440] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study considers whether rural status or living in a particular region of the United States has effects on mental and physical health. The analyses examine whether there are independent and interactive effects of rural status and region of residence on health, beyond individual level factors related to poverty. METHODS Ordinary least squares (OLS) regression models are used to examine the relationships between rural and regional residence and health across three time periods. RESULTS Negative health effects of rural residence were found only in the South region. Positive health effects of rural residence were found only in the Midwest region. There are no observed health risks associated with rural or regional residence across group. DISCUSSION The results indicate a cumulative risk of rural and Southern residence for older men and women. Living in a rural place in the midwestern United States seems to provide unique sources of health benefits.
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Bravo KJ. ALOHA to Women s Heart Disease. J Cardiovasc Nurs 2006; 21:E21-3. [PMID: 16699352 DOI: 10.1097/00005082-200605000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article describes the American Heart Association, ALOHA program. ALOHA is a multidisciplinary approach to helping lay people and clinicians determine the best course of action for managing cardiac risk factors in women. ALOHA, an acronym that stands for designated interventions based on individualized assessment of patients, along with the Framingham risk assessment calculator, allows health care providers with their patients to individualize treatment for heart disease and management of risk factors.
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King KM, Thomlinson E, Sanguins J, LeBlanc P. Men and women managing coronary artery disease risk: Urban–rural contrasts. Soc Sci Med 2006; 62:1091-102. [PMID: 16115710 DOI: 10.1016/j.socscimed.2005.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2004] [Accepted: 07/13/2005] [Indexed: 11/21/2022]
Abstract
People's beliefs about health and making lifestyle changes associated with risk reduction and disease prevention can vary based on their gender and ethnocultural affiliation. Our objective was to describe and explain how gender and ethnocultural affiliation influence the process that people undergo when faced with making lifestyle changes related to their coronary artery disease (CAD) risk. A series of grounded theory studies were undertaken in Alberta, Canada, with men and women from five ethnocultural groups diagnosed with CAD. Here, we describe the cultural aspects associated with urban- and rural-living in 42 Euro-Celtic men and women. Data were collected through semi-structured, audio-recorded interviews and analysed using constant comparative methods. The core variable that emerged through the process was 'meeting the challenge'. There were three phases to the process of managing CAD risk: pre-diagnosis/event, liminal self, and living with CAD. Intra-personal, inter-personal, extra-personal, and socio-demographic factors influenced the participants' capacity to meet the challenge of managing their CAD risk. The influence of these factors was either direct or indirect through the intertwined elements of the participants' knowledge about CAD and perceived extent of necessary change. Each element of this process was influenced by the participants' gender and culture (urban- versus rural-living). When healthcare providers understand and work with the gender- and ethnoculturally based components that influence people's appraisal of their cardiac health and their decision-making, appropriate secondary prevention interventions and positive health outcomes are more likely to follow.
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Affiliation(s)
- Kathryn M King
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4.
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Eberhardt MS, Pamuk ER. The importance of place of residence: examining health in rural and nonrural areas. Am J Public Health 2004; 94:1682-6. [PMID: 15451731 PMCID: PMC1448515 DOI: 10.2105/ajph.94.10.1682] [Citation(s) in RCA: 384] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We examined differences in health measures among rural, suburban, and urban residents and factors that contribute to these differences. Whereas differences between rural and urban residents were observed for some health measures, a consistent rural-to-urban gradient was not always found. Often, the most rural and the most urban areas were found to be disadvantaged compared with suburban areas. If health disparities are to be successfully addressed, the relationship between place of residence and health must be understood.
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Affiliation(s)
- Mark S Eberhardt
- National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Rd, Rm 6421, Hyattsville, MD 20782, USA.
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Carty RM, Al-Zayyer W, Arietti LL, Lester AS. International rural health needs and services research: a nursing and midwifery response. J Prof Nurs 2004; 20:251-9. [PMID: 15343499 DOI: 10.1016/j.profnurs.2004.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As the importance of evidence-based practice in global health care increases, the need for constant, accurate feedback from those in practice is critical, yet the requirement to rapidly obtain and disseminate data on a global basis is a challenge for all health professionals. The Internet allows for global participation in data collection that dramatically streamlines the traditional survey process. This new paradigm applies to surveys that are short, issue focused, and time sensitive. The Global Network of World Health Organization (WHO) Collaborating Centres for Nursing and Midwifery Development used a sample of international nurses in 70 countries to identify the worldwide rural health issues of WHO priority health needs, treatment modalities, health care interventions, and providers, as well as the current state of rural health research on a global level. This article presents the results of the survey regarding rural health needs and nursing and midwifery's response to them internationally, demonstrates Internet data collection, and shows how this research paradigm can help establish an evidence base for nursing practice.
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Affiliation(s)
- Rita M Carty
- Global Network of WHO Collaborating Centres for Nursing and Midwifery Development, College of Nursing and Health Science, George Mason University, 4400 University Drive, Fairfax, VA 22030, USA.
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Crook ED, Clark BL, Bradford STJ, Golden K, Calvin R, Taylor HA, Flack JM. From 1960s Evans County Georgia to present-day Jackson, Mississippi: an exploration of the evolution of cardiovascular disease in African Americans. Am J Med Sci 2003; 325:307-14. [PMID: 12811227 DOI: 10.1097/00000441-200306000-00002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiovascular disease (CVD) is the No. 1 cause of mortality in the United States and it disproportionately affects African Americans. However, there are earlier reports that African Americans had significantly less CVD than whites. This racial discrepancy in CVD rates was noticed primarily for coronary heart disease (CHD). This issue was examined in the Evans County (Georgia) Cardiovascular Disease Study conducted in the 1960s. It showed that African American men had significantly lower rates of CHD than white men. Over the last couple of decades, the rates of CVD have been declining. However, the rate of decline of CVD in African Americans has not been equal to that seen in whites, such that African Americans now have a disproportionate share of CVD in the United States. In the 1990s, the Jackson Heart Study was designed to explore the reasons for the current racial discrepancy. This articles reviews the findings of the Evans County Study and explores various hypotheses for why CVD in African Americans has evolved from a disease from which African Americans may have been "protected" to one in which they shoulder a disproportionate burden.
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Affiliation(s)
- Errol D Crook
- Department of Medicine, Wayne State University School of Medicine and John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan 48302, USA.
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