Knowledge of heart attack and stroke symptomology: a cross-sectional comparison of rural and non-rural US adults

<p>Abstract</p> <p>Background</p> <p>Understanding the signs and symptoms of heart attacks and strokes are important not only in saving lives, but also in preserving quality of life. Findings from recent research have yielded that the prevalence of cardiovascular disease risk factors are higher in rural populations, suggesting that adults living in rural locales may be at higher risk for heart attack and/or stroke. Knowledge of heart attack and stroke symptomology as well as calling 911 for a suspected heart attack or stroke are essential first steps in seeking care. This study sought to examine the knowledge of heart attack and stroke symptoms among rural adults in comparison to non-rural adults living in the U.S.</p> <p>Methods</p> <p>Using multivariate techniques, a cross-sectional analysis of an amalgamated multi-year Behavioral Risk Factor Surveillance Survey (BRFSS) database was performed. The dependent variable for this analysis was low heart attack and stroke knowledge score. The covariates for the analysis were: age, sex, race/ethnicity, annual household income, attained education, health insurance status, having a health care provider (HCP), timing of last routine medical check-up, medical care deferment because of cost, self-defined health status and geographic locale.</p> <p>Results</p> <p>The weighted n for this study overall was 103,262,115 U.S. adults > =18 years of age. Approximately 22.0% of these respondents were U.S. adults living in rural locales. Logistic regression analysis revealed that those U.S. adults who had low composite heart attack and stroke knowledge scores were more likely to be rural (OR = 1.218 95%CI 1.216-1.219) rather than non-rural residents. Furthermore, those with low scores were more likely to be: male (OR = 1.353 95%CI 1.352-1.354), >65 years of age (OR = 1.369 95%CI 1.368-1.371), African American (OR = 1.892 95%CI 1.889-1.894), not educated beyond high school (OR = 1.400 955CI 1.399-1.402), uninsured (OR = 1.308 95%CI 1.3-6-1.310), without a HCP (OR = 1.216 95%CI 1.215-1.218), and living in a household with an annual income of < $50,000 (OR = 1.429 95%CI 1.428-1.431).</p> <p>Conclusions</p> <p>Analysis identified clear disparities between the knowledge levels U.S. adults have regarding heart attack and stroke symptoms. These disparities should guide educational endeavors focusing on improving knowledge of heart attack and stroke symptoms.</p

A population-based cross-sectional study of health service deficits among U.S. adults with depressive symptoms

BACKGROUND: Depression is a psychiatric condition that affects approximately one in five U.S. adults in their lifetime. No study that we know of has examined depressive symptoms and health service deficits in rural compared with non-rural populations. Four factors constitute the variable health service deficits: did not have health insurance, did not have a healthcare provider, deferred medical care because of cost and did not have a routine medical exam, all within the last 12 months. The aim of this study was to ascertain the prevalence of health service deficits in rural versus non-rural adults with depressive symptoms. Examining depressive symptoms by health service deficits is important because it allows us to approximate those with the condition who might not be receiving care for it. By analyzing national, population-based data, this study sought to fill in some important epidemiological gaps regarding depressive symptoms and health service deficits. METHODS: For this analysis the population of interest was U.S. adults identified as currently having depressive symptoms using the PHQ-8 criteria. Behavior Risk Factor Surveillance Survey 2006 data were used in this analysis. Health service deficits was the primary dependent variable. Multivariate logistic regression analysis was performed to examine health service deficits experienced by adults with depression controlling for socioeconomic status, race and ethnicity and geographic locale (rural or non-rural). RESULTS: Logistic regression analysis yielded that U.S. adults currently having depressive symptoms who were of low socioeconomic status, Hispanic ethnicity, or living in a rural locale were more likely to have at least one health service deficit. CONCLUSION: Analyzing data collected by a large surveillance system such as BRFSS, allows for an analysis incorporating an array of covariates not available from clinically-based data such as electronic health records. By identifying clinically depressed U.S. adults who also have at least one health service deficit, we were able to ascertain those most likely not receiving care for this debilitating condition. We believe community pharmacists are well suited to assist in connecting depressed, vulnerable populations with appropriate and needed care. This care would be best provided by an inter-professional team led by a primary care provider

Neurotrophins Regulate Bone Marrow Stromal Cell IL-6 Expression through the MAPK Pathway

The host's response to infection is characterized by altered levels of neurotrophins and an influx of inflammatory cells to sites of injured tissue. Progenitor cells that give rise to the differentiated cellular mediators of inflammation are derived from bone marrow progenitor cells where their development is regulated, in part, by cues from bone marrow stromal cells (BMSC). As such, alteration of BMSC function in response to elevated systemic mediators has the potential to alter their function in biologically relevant ways, including downstream alteration of cytokine production that influences hematopoietic development.In the current study we investigated BMSC neurotrophin receptor expression by flow cytometric analysis to determine differences in expression as well as potential to respond to NGF or BDNF. Intracellular signaling subsequent to neurotrophin stimulation of BMSC was analyzed by western blot, microarray analysis, confocal microscopy and real-time PCR. Analysis of BMSC Interleukin-6 (IL-6) expression was completed using ELISA and real-time PCR.BMSC established from different individuals had distinct expression profiles of the neurotrophin receptors, TrkA, TrkB, TrkC, and p75(NTR). These receptors were functional, demonstrated by an increase in Akt-phosphorylation following BMSC exposure to recombinant NGF or BDNF. Neurotrophin stimulation of BMSC resulted in increased IL-6 gene and protein expression which required activation of ERK and p38 MAPK signaling, but was not mediated by the NFkappaB pathway. BMSC response to neurotrophins, including the up-regulation of IL-6, may alter their support of hematopoiesis and regulate the availability of inflammatory cells for migration to sites of injury or infection. As such, these studies are relevant to the growing appreciation of the interplay between neurotropic mediators and the regulation of hematopoiesis

Ablation of VLA4 in multiple myeloma cells redirects tumor spread and prolongs survival

Multiple myeloma (MM) is a cancer of bone marrow (BM) plasma cells, which is increasingly treatable but still incurable. In 90% of MM patients, severe osteolysis results from pathological interactions between MM cells and the bone microenvironment. Delineating specific molecules and pathways for their role in cancer supportive interactions in the BM is vital for developing new therapies. Very Late Antigen 4 (VLA4, integrin

Collisionality and safety factor scalings of H-mode energy transport in the MAST spherical tokamak

A factor of 4 dimensionless collisionality scan of H-mode plasmas in MAST shows that the thermal energy confinement time scales as BτE,th ∝ ν-0.82±0.1*e. Local heat transport is dominated by electrons and is consistent with the global scaling. The n

Hadron Spectra for Semileptonic Heavy Quark Decay

We calculate the leading perturbative and power corrections to the hadronic invariant mass and energy spectra in semileptonic heavy hadron decays. We apply our results to the $B$ system. Moments of the invariant mass spectrum, which vanish in the parton model, probe gluon bremsstrahlung and nonperturbative effects. Combining our results with recent data on $B$ meson branching ratios, we obtain a lower bound $\bar\Lambda>410\,{\rm MeV}$ and an upper bound $m_b^{\rm pole}<4.89\,$GeV. The Brodsky-Lepage-Mackenzie scale setting procedure suggests that higher order perturbative corrections are small for bottom decay, and even tractable for charm decay.Comment: 24 pages, uses REVTeX, 5 EPS figures embedded with epsf.sty, slightly modified version to appear in Phys. Rev.

Invisible Z-Boson Decays at e+e- Colliders

The measurement of the invisible Z-boson decay width at e+e- colliders can be done "indirectly", by subtracting the Z-boson visible partial widths from the Z-boson total width, or "directly", from the process e+e- -> \gamma \nu \bar{\nu}. Both procedures are sensitive to different types of new physics and provide information about the couplings of the neutrinos to the Z-boson. At present, measurements at LEP and CHARM II are capable of constraining the left-handed Z\nu\nu-coupling, 0.45 <~ g_L <~ 0.5, while the right-handed one is only mildly bounded, |g_R| <= 0.2. We show that measurements at a future e+e- linear collider at different center-of-mass energies, \sqrt{s} = MZ and \sqrt{s}s ~ 170 GeV, would translate into a markedly more precise measurement of the Z\nu\nu-couplings. A statistically significant deviation from Standard Model predictions will point toward different new physics mechanisms, depending on whether the discrepancy appears in the direct or the indirect measurement of the invisible Z-width. We discuss some scenarios which illustrate the ability of different invisible Z-boson decay measurements to constrain new physics beyond the Standard Model

Aerodynamic investigations of ventilated brake discs.

The heat dissipation and performance of a ventilated brake disc strongly depends on the aerodynamic characteristics of the flow through the rotor passages. The aim of this investigation was to provide an improved understanding of ventilated brake rotor flow phenomena, with a view to improving heat dissipation, as well as providing a measurement data set for validation of computational fluid dynamics methods. The flow fields at the exit of four different brake rotor geometries, rotated in free air, were measured using a five-hole pressure probe and a hot-wire anemometry system. The principal measurements were taken using two-component hot-wire techniques and were used to determine mean and unsteady flow characteristics at the exit of the brake rotors. Using phase-locked data processing, it was possible to reveal the spatial and temporal flow variation within individual rotor passages. The effects of disc geometry and rotational speed on the mean flow, passage turbulence intensity, and mass flow were determined. The rotor exit jet and wake flow were clearly observed as characterized by the passage geometry as well as definite regions of high and low turbulence. The aerodynamic flow characteristics were found to be reasonably independent of rotational speed but highly dependent upon rotor geometry

Phenomenology of the 1/mQ1/m_Q Expansion in Inclusive BB and DD Meson Decays

We apply a recent theoretical analysis of hadronic observables in inclusive semileptonic heavy hadron decays to the phenomenology of $B$ and $D$ mesons. Correlated bounds on the nonperturbative parameters $\bar\Lambda$ and $\lambda_1$ are derived by considering data from $B$ decays and, independently, data from $D$ decays. The two sets of bounds are found to be consistent with each other. The data from $B$ decays are then are used to extract a lower limit on the CKM matrix element $|V_{cb}|$. We address the issue of the convergence of the perturbative expansions used in the analysis, and compare our bounds on $\bar\Lambda$ and $\lambda_1$ to lattice and QCD sum rule results. Finally, we argue that a comparison of the analyses of $D$ and $D_s$ decays provides evidence for the applicability of parton-hadron duality in the semileptonic decay of charmed hadrons.Comment: 18 pages, 3 embedded figures, uses REVTeX and epsf.sty; this is the slightly revised version to appear in Physical Review