Estimating alcohol-related premature mortality in san francisco: use of population-attributable fractions from the global burden of disease study

<p>Abstract</p> <p>Background</p> <p>In recent years, national and global mortality data have been characterized in terms of well-established risk factors. In this regard, alcohol consumption has been called the third leading "actual cause of death" (modifiable behavioral risk factor) in the United States, after tobacco use and the combination of poor diet and physical inactivity. Globally and in various regions of the world, alcohol use has been established as a leading contributor to the overall burden of disease and as a major determinant of health disparities, but, to our knowledge, no one has characterized alcohol-related harm in such broad terms at the local level. We asked how alcohol-related premature mortality in San Francisco, measured in years of life lost (YLLs), compares with other well-known causes of premature mortality, such as ischemic heart disease or HIV/AIDS.</p> <p>Methods</p> <p>We applied sex- and cause-specific population-attributable fractions (PAFs) of years of life lost (YLLs) from the Global Burden of Disease Study to 17 comparable outcomes among San Francisco males and females during 2004-2007. We did this in three ways: Method 1 assumed that all San Franciscans drink like populations in developed economies. These estimates were limited to alcohol-related harm. Method 2 modified these estimates by including several beneficial effects. Method 3 assumed that Latino and Asian San Franciscans drink alcohol like populations in the global regions related to their ethnicity.</p> <p>Results</p> <p>By any of these three methods, alcohol-related premature mortality accounts for roughly a tenth of all YLLs among males. Alcohol-related YLLs among males are comparable to YLLs for leading causes such as ischemic heart disease and HIV/AIDS, in some instances exceeding them. Latino and black males bear a disproportionate burden of harm. Among females, for whom estimates differed more by method and were smaller than those for males, alcohol-related YLLs are comparable to leading causes which rank somewhere between fifth and fourteenth.</p> <p>Conclusions</p> <p>Alcohol consumption is a major contributor to premature mortality in San Francisco, especially among males. Interventions to avert alcohol-related harm in San Francisco should be taken at the population level and deserve the same attention that is given to other major risk factors, such as smoking or obesity.</p

Transformative undergraduate science courses for non-majors at a historically black institution and at a primarily white institution

We investigated curricular and pedagogical innovations in undergraduate science courses for non-science majors at a Historically Black Institution (HBI) and a Primarily White Institution (PWI). The aims were to improve students’ understanding of science, increase their enthusiasm towards science by connecting their prior experience and interest to the science content, and recruit students, especially from underrepresented groups, to science teacher education. Both courses were developed with the same fundamental principles of teaching for all and connection to student interests. We report on the way we used students’ interest to increase their enthusiasm towards science and how the instructors established linkages between science and teaching, while introducing their students to scientific research (reading the literature, writing mini-research reports and presenting the data in poster presentations). We discuss the way that the PWI and HBI instructors customized their courses to take into consideration the characteristics of the students’ population taking the courses. We assessed our progress in achieving our goals by using researchers’ observations, the instructors’ perspective, students’ feedback, and a reliable and valid survey. Our major insight was that the instructors’ perception of their roles within their contexts (HBI or PWI) mediated the way they designed, implemented, and assessed their learners

Dementia Patient Suffering and Caregiver Depression

Cross-sectional and longitudinal analyses were carried out to assess the relationship between dementia patient suffering, caregiver depression, and antidepressant medication use in 1222 dementia patients and their caregivers. We assessed the prevalence of 2 types of patient suffering, emotional and existential distress, and examined their independent associations with caregiver depression and antidepressant medication use when controlling for sociodemographic characteristics of caregivers and patients, cognitive and physical disability of the patient, the frequency of patient memory problems and disruptive behaviors, and the amount of time spent caring for the patient. Multiple linear regression models showed that both aspects of perceived patient suffering independently contribute to caregiver depression (emotional distress: β = 1.24; P < 0.001; existential distress: β = 0.66; P < 0.01) whereas only existential suffering contributes to antidepressant medication use: odds ratio = 1.25 95% confidence interval, 1.10–1.42; P < 0.01. In longitudinal analyses, increases in both types of suffering were associated with increases in caregiver depression (emotional distress: β = 1.02; P < 0.01; existential distress: β = 0.64; P < 0.01). This is the first study to show in a large sample that perceived patient suffering independently contributes to family caregiver depression and medication use. Medical treatment of patients that maintain or improve memory but do not address suffering may have little impact on the caregiver. Alzheimer disease patient suffering should be systematically assessed and treated by clinicians