Health Promotion Behaviors of Rural Women with Heart Failure

The purpose of this study was to predict the influence of socioecological factors, including social support, barriers to HPB, perceived health status, and demographic variables on the health promotion behaviors (HPB) of rural women with heart failure (HF). A descriptive correlational design was used with a convenience sample of 45 older rural women with HF. Instruments to assess social support, barriers to health promotion, perceived health, and demographic data were utilized. Multiple regression was used to identify sociological influences on HPB, indicating that a significant variance in HPB was predicted by two variables: (1) New York Heart Association classification level (negative association), and (2) a history of diabetes mellitus (DM). Measures of social support, barriers to HPB, and perceived health status were not found to be predictive of HPB

Distance and Access to Health Care for Rural Women with Heart Failure

Background and Research Objective: Heart Failure (HF) is a disease state requiring ongoing and specialized health care. For persons living in rural areas, access to care may be delayed or difficult as best due to the distance involved. Distance to obtain health care can be further confounded by such issues as weather and lack of transportation. To further understand these issues, a sample of women diagnosed with HF and living in rural upstate New York was studied to explicate the impact of distance and weather on access to health care. Sample and Method: A convenience sample of 45 women living in upstate New York diagnosed with HF was studied to assess the impact of distance and the associated issues on accessing health care. Mileage to primary care and specialty care was quantified. Frequencies for associated issues such as the need for emergency care, weather, and the ability to drive were measured. Results and Conclusions: The mean distance to obtain primary care was 6.4 miles, while the mean distance to obtain cardiology care was 32.6 miles. However, only 50% of the sample actually sought ongoing care from a cardiologist. When assessing the impact of weather or distance on access to health care, no significant influences were found. However, with increasing age, weather was shown to approach significance (p=. 059). These findings further illustrate the ongoing issues experienced by rural dwellers when accessing health care for HF

The challenges of data collection in rural dwelling samples

Data collection in rural areas presents unique problems that impact the research process and thus the outcomes of the research. Some of the issues that must be accounted for include utilization of appropriate tools when studying rural dwelling persons, location of appropriate participants, rural health issues, environmental barriers, and ethical considerations. Researchers must be aware of these unique problems and issues and consider the impact of these issues on the integrity of the data

ARC Newsletter May 2017

https://digitalcommons.lasalle.edu/arc_newsletter/1004/thumbnail.jp

Substantially more children receiving antidepressants see a specialist than reported by Jack et al.

We would like to draw attention to evidence of substantial bias in the article published in this journal by Jack et al. (BMC Med 18:1-12, 2020). They provide an analysis of antidepressant prescribing to children and young people (CYP; ages 5 to 17) in primary care in England and reported that only 24.7% of CYP prescribed SSRIs for the first time were seen by a child and adolescent psychiatrist—contrary to national guidelines. We believe that their analysis is based on incomplete data that misses a large proportion of specialist mental health contacts. This is because the dataset Jack et al. used to capture specialist mental health contact—The Hospital Episode Statistics (HES) dataset—has poor coverage, as most CYP mental health services do not submit data. We demonstrate the level of underreporting with an analysis of events in a large primary care dataset where there has been a record of definite contact with CYP mental health services. We report that as many as three quarters of specialist CYP contacts with mental health specialists are missed in the HES dataset, indicating that the figure presented by Jack et al. is substantially wrong

Logical Step-Indexed Logical Relations

Appel and McAllester's "step-indexed" logical relations have proven to be a simple and effective technique for reasoning about programs in languages with semantically interesting types, such as general recursive types and general reference types. However, proofs using step-indexed models typically involve tedious, error-prone, and proof-obscuring step-index arithmetic, so it is important to develop clean, high-level, equational proof principles that avoid mention of step indices. In this paper, we show how to reason about binary step-indexed logical relations in an abstract and elegant way. Specifically, we define a logic LSLR, which is inspired by Plotkin and Abadi's logic for parametricity, but also supports recursively defined relations by means of the modal "later" operator from Appel, Melli\`es, Richards, and Vouillon's "very modal model" paper. We encode in LSLR a logical relation for reasoning relationally about programs in call-by-value System F extended with general recursive types. Using this logical relation, we derive a set of useful rules with which we can prove contextual equivalence and approximation results without counting steps

An Ethnographic Study of Students' Views of Group Work

Poster with the results of a collaborative ethnographic study of students' views of group work. The study was conducted within the framework of the anthropology course 810.21: Research Design and Ethnographic Methods (Spring 2011) taught by Dr. Mark Moritz

Thoracoscopic Left Atrial Appendage Clipping: a multicenter cohort analysis

Objectives: This study sought to document the closure rate, safety, and stroke rate after thoracoscopic left atrial appendage (LAA) clipping. Background: The LAA is the main source of stroke in patients with atrial fibrillation, and thoracoscopic clipping may provide a durable and safe closure technique. Methods: The investigators studied consecutive patients undergoing clipping as part of a thoracoscopic maze procedure in 4 referral centers (the Netherlands and the United States) from 2012 to 2016. Completeness of LAA closure was assessed by either computed tomography (n = 100) or transesophageal echocardiography (n = 122). The primary outcome was complete LAA closure (absence of residual LAA flow and pouch <10 mm). The secondary outcomes were 30-day complications; the composite of ischemic stroke, hemorrhagic stroke, or transient ischemic attack; and all-cause mortality. Results: A total of 222 patients were included, with a mean age of 66 ± 9 years, and 68.5% were male. The mean CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65 to 74 years, sex category [female]) score was 2.3 ± 1.0. Complete LAA closure was achieved in 95.0% of patients. There were no intraoperative or clip-related complications, and the overall 30-day freedom from any complication rate was 96.4%. The freedom from cerebrovascular events after surgery was 99.1% after median follow-up of 20 months (interquartile range: 14 to 25 months; 369 patient-years of follow-up), and overall survival was 98.6%. The observed rate of cerebrovascular events after LAA clipping was low (0.5 per 100 patient-years). Conclusions: LAA clipping during thoracoscopic ablation is a feasible and safe technique for closure of the LAA in patients with atrial fibrillation. The lower than expected rate of cerebrovascular events after deployment was likely multifactorial, including not only LAA closure, but also the effect of oral anticoagulation and rhythm control

Assessing the carcinogenic potential of low-dose exposures to chemical mixtures in the environment: the challenge ahead.

Lifestyle factors are responsible for a considerable portion of cancer incidence worldwide, but credible estimates from the World Health Organization and the International Agency for Research on Cancer (IARC) suggest that the fraction of cancers attributable to toxic environmental exposures is between 7% and 19%. To explore the hypothesis that low-dose exposures to mixtures of chemicals in the environment may be combining to contribute to environmental carcinogenesis, we reviewed 11 hallmark phenotypes of cancer, multiple priority target sites for disruption in each area and prototypical chemical disruptors for all targets, this included dose-response characterizations, evidence of low-dose effects and cross-hallmark effects for all targets and chemicals. In total, 85 examples of chemicals were reviewed for actions on key pathways/mechanisms related to carcinogenesis. Only 15% (13/85) were found to have evidence of a dose-response threshold, whereas 59% (50/85) exerted low-dose effects. No dose-response information was found for the remaining 26% (22/85). Our analysis suggests that the cumulative effects of individual (non-carcinogenic) chemicals acting on different pathways, and a variety of related systems, organs, tissues and cells could plausibly conspire to produce carcinogenic synergies. Additional basic research on carcinogenesis and research focused on low-dose effects of chemical mixtures needs to be rigorously pursued before the merits of this hypothesis can be further advanced. However, the structure of the World Health Organization International Programme on Chemical Safety 'Mode of Action' framework should be revisited as it has inherent weaknesses that are not fully aligned with our current understanding of cancer biology