Appalachian Coalfield Delegation Position Paper on Sustainable Energy

Appalachian grassroots groups(with support provided by the DataCenter) release a scathing report on the impact of coal mining to the United Nations Commission on Sustainable Development. The Delegation created an historic moment with its powerful stories and diverse outreach. Alliances were forged and the civil society discourse on energy, particularly what is sustainable energy and who gets to define it, has been challenged. Their answer---"it comes from the people!" As most government officials continue to ignore the atrocities of mountain top removal, coal sludge impoundments, and underground injections of sludge, it is up to the people of the Appalachian coal fields to let the world know the harsh realities of an economy built on seemingly cheap electricity

Epidemiology and Management of Depression Following Coronary Heart Disease Diagnosis in Women

Coronary heart disease (CHD) and depression are both highly prevalent in women. Importantly, depression is associated with significantly elevated morbidity and mortality in women with CHD. There are intriguing speculations about biological mechanisms underlying this association, such as endothelial dysfunction, subclinical atherosclerosis, inflammation, and autonomic dysregulation. Social and behavioral mechanisms, such as lack of social support and physical inactivity, have also been shown to play important roles. Unfortunately, many randomized clinical trials of counseling and pharmacologic interventions for depression in patients with CHD have failed to improve cardiovascular outcomes, and in fact have raised the possibility that interventions might be harmful in women. Several recent trials of new treatment strategies, however, have been more effective in improving depressive symptoms and quality of life and deserve further investigation. In this review, we summarize recent findings with regards to the epidemiology, etiology, diagnosis, and management of depression in women diagnosed with CHD

The association of posttraumatic stress disorder and quality of life during the first year after acute coronary syndrome

Acute coronary syndrome [ACS, including unstable angina (UA) or myocardial infarction (MI)] events can be psychologically traumatic experiences for patients given their unpredictable, sudden onset and life-threatening nature [1]. Although posttraumatic stress disorder (PTSD) is commonly associated with index events of war or assault, PTSD is also associated with life-threatening illness and in particular ACS with approximately 12% of patients developing PTSD [1] and [2]. PTSD due to ACS has a multitude of consequences, including increased risk of ACS recurrence and mortality [3] and [4] in addition to PTSD itself being a debilitating psychiatric condition. Sufferers of PTSD are burdened by symptoms that include re-experiencing the traumatic event via intrusive thoughts, flashbacks, or nightmares; avoiding reminders of the index event; persistent negative alterations in cognition and mood; or physiologic hyperarousal. As such, ACS-induced PTSD is likely associated with substantial detriment in quality of life (QOL). However, few studies have measured this association, and no study has investigated it among a general ACS population or longitudinally. Rather, prior studies were composed of ACS patients only in intensive care units (ICUs) or among armed-services veterans [5], [6] and [7] or are notable for limitations such as cross-sectional designs [5] and [7]

Blood Pressure Reactivity to an Anger Provocation Interview Does Not Predict Incident Cardiovascular Disease Events: The Canadian Nova Scotia Health Survey (NSHS95) Prospective Population Study

We examined the association between blood pressure (BP) reactivity to an anger provocation interview and 10-year incident CVD events in 1,470 adults from the population-based 1995 Nova Scotia Health Survey (NSHS95). In an unadjusted model, those in the highest decile of systolic BP reactivity were more than twice as likely to have an incident CVD event compared to those in the decile with no reactivity (HR = 2.33, 95% CI = 1.15 – 4.69, P = 0.02). However, after adjusting for age and sex, and then also for Framingham risk score, body mass index, and education, this relationship was attenuated and not statistically significant. Diastolic BP reactivity was not associated with CVD incidence in any model. Individual differences in BP reactivity to a laboratory-induced, structured anger provocation interview may not play a major role in clinical CVD endpoints

Is vitamin D deficiency a risk factor for ischemic heart disease in patients with established cardiovascular disease? 10-year follow-up of the Nova Scotia Health Survey

Recent studies have reported that low serum vitamin D levels are associated with a variety of diseases, including cardiovascular disease and in particular ischemic heart disease (IHD). Possible mechanisms underlying this association include increased inflammation, reninangiotensin system upregulation, insulin resistance, altered lipid metabolism, and altered vascular smooth muscle growth and function that lead to hypertension, diabetes, dyslipidemia and atherosclerosis.[1][2] However, few longitudinal studies have explored the association between vitamin D levels and incident IHD. A nested case-control study of male health care professionals found an approximately doubled risk of incident myocardial infarction associated with lower vitamin D levels.[3] Other studies have identified trends between vitamin D levels and incident myocardial infarction but no statistically significant associations, [4][5][6] at least in part due to small sample sizes or short follow-up

Vitamin D Supplementation for Depressive Symptoms: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVE: The aim of this study was to review the effects of vitamin D supplementation on depressive symptoms in randomized controlled trials. Although low vitamin D levels have been observationally associated with depressive symptoms, the effect of vitamin D supplementation as an antidepressant remains uncertain. METHODS: MEDLINE, CINAHL, AMED, PsycINFO, Scopus, The Cochrane Library, and references of included reports (through May 2013) were searched. Two independent reviewers identified and extracted data from randomized trials that compared the effect of vitamin D supplementation on depressive symptoms to a control condition. Two additional reviewers assessed study quality using The Cochrane Risk of Bias Tool. Seven trials (3191 participants) were included. RESULTS: Vitamin D supplementation had no overall effect on depressive symptoms (standardized mean difference [SMD], 0.14; 95% confidence interval [CI], -0.33 to 0.05, p = .16), although considerable heterogeneity was observed. Subgroup analysis showed that vitamin D supplementation for participants with clinically significant depressive symptoms or depressive disorder had a moderate, statistically significant effect (2 studies: SMD, -0.60; 95% CI, -1.19 to -0.01; p = .046), but a small, nonsignificant effect for those without clinically significant depression (5 studies: SMD, -0.04; 95% CI, -0.20 to 0.12; p = .61). Most trials had unclear or high risk of bias. Studies varied in the amount, frequency, duration, and mode of delivery of vitamin D supplementation. CONCLUSIONS: Vitamin D supplementation may be effective for reducing depressive symptoms in patients with clinically significant depression; however, further high-quality research is needed

Hypertension: an unstudied potential risk factor for adverse outcomes during continuous flow ventricular assist device support

In end-stage heart failure, left ventricular assist devices (LVADs) represent an exciting new frontier in which post-device implantation survival approaches that of heart transplant. However, expansion of this technology is still limited by complications that impact morbidity and mortality. Thus, it is essential to identify and optimize modifiable predictors of poor outcomes. One such predictor may be hypertension (HTN). Not only may chronic HTN as a traditional cardiovascular risk factor be present during long-term LVAD support, but HTN may also contribute to device malfunction or device-associated complications. Although current guidelines identify blood pressure (BP) control as important to outpatient continuous flow (CF) LVAD management, there is no evidence base to support these guidelines. Indeed, our comprehensive literature search did not identify any studies that evaluated post-device implantation HTN as a potential predictor of adverse CF-LVAD outcomes. HTN among CF-LVAD patients is likely a relatively unstudied factor because of difficulties using standard noninvasive techniques to measure BP in the setting of reduced pulsatile flow. Fortunately, recent research has elucidated the meaning of Doppler BP measurements and validated a slow-cuff deflation system for BP measurements in the setting of CF-LVAD support. Therefore, CF-LVAD researchers and clinicians may (1) consider potential mechanisms relating HTN to poor outcomes, (2) realize that HTN management is a stated goal despite scarce evidence, and (3) utilize the new reliable and valid methods for outpatient BP measurement that make research and management possible. It is critical and now feasible that research on HTN in the CF-LVAD patient population move forward

Association Between Learning Environment Interventions and Medical Student Well-being: A Systematic Review

Importance: Concerns exist about the current quality of undergraduate medical education and its effect on students' well-being. Objective: To identify best practices for undergraduate medical education learning environment interventions that are associated with improved emotional well-being of students. Data Sources: Learning environment interventions were identified by searching the biomedical electronic databases Ovid MEDLINE, EMBASE, the Cochrane Library, and ERIC from database inception dates to October 2016. Studies examined any intervention designed to promote medical students' emotional well-being in the setting of a US academic medical school, with an outcome defined as students' reports of well-being as assessed by surveys, semistructured interviews, or other quantitative methods. Data Extraction and Synthesis: Two investigators independently reviewed abstracts and full-text articles. Data were extracted into tables to summarize results. Study quality was assessed by the Medical Education Research Study Quality Instrument (MERQSI), which has a possible range of 5 to 18; higher scores indicate higher design and methods quality and a score of 14 or higher indicates a high-quality study. Findings: Twenty-eight articles including at least 8224 participants met eligibility criteria. Study designs included single-group cross-sectional or posttest only (n = 10), single-group pretest/posttest (n = 2), nonrandomized 2-group (n = 13), and randomized clinical trial (n = 3); 89.2% were conducted at a single site, and the mean MERSQI score for all studies was 10.3 (SD, 2.11; range, 5-13). Studies encompassed a variety of interventions, including those focused on pass/fail grading systems (n = 3; mean MERSQI score, 12.0), mental health programs (n = 4; mean MERSQI score, 11.9), mind-body skills programs (n = 7; mean MERSQI score, 11.3), curriculum structure (n = 3; mean MERSQI score, 9.5), multicomponent program reform (n = 5; mean MERSQI score, 9.4), wellness programs (n = 4; mean MERSQI score, 9.0), and advising/mentoring programs (n = 3; mean MERSQI score, 8.2). Conclusions and Relevance: In this systematic review, limited evidence suggested that some specific learning environment interventions were associated with improved emotional well-being among medical students. However, the overall quality of the evidence was low, highlighting the need for high-quality medical education research

2010 YCAP Needs Assessment Report

This report outlines the Yamhill Community Action Partnership (YCAP) areas of need, strength, and improvement. Low income and unemployed individuals receive significant support through YCAP programs, including transportation, housing, and bill pay assistance. YCAP programs were assessed during the spring of 2010 through a client survey

A test of the diathesis-stress model in the emergency department: Who develops PTSD after an acute coronary syndrome?

Most acute coronary syndrome (ACS) patients first present to the emergency department (ED). Patients who present to overcrowded EDs develop more posttraumatic stress disorder (PTSD) symptoms due to the ACS than do patients who present to less crowded EDs, but no research has indicated whether some patients may be more vulnerable to the effects of ED crowding than others. In an observational cohort study, we tested whether depressed patients developed more ACS-induced PTSD symptoms under conditions of ED overcrowding than patients who had never been depressed. We conducted psychiatric interviews for current and past depression in 189 ACS patients admitted through the ED within a week of hospitalization, and screened for PTSD symptoms 1 month later using the Impact of Events Scale-Revised. The sum of ED admissions for the 12 h prior to and 12 h after each participant's admission was categorized into tertiles for analysis. In a 3 (ED crowding tertile) by 3 (never, past, current depression) analysis of covariance adjusted for demographic and clinical factors, we found significant effects for ED crowding, depression status, and their interaction (all p's < .05). Mean PTSD scores were significantly higher (p = .005) for participants who were currently depressed and were treated during times of high ED crowding [25.38, 95% CI = 16.18–34.58], or had a history of depression [10.74, 95% CI = 6.86–14.62], relative to all other participants, who scored 5.6 or less. These results suggest that depressed ACS patients may be most vulnerable to the stress-inducing effects of ED crowding