Design of a Novel Intervention Model to Address Cardiovascular Health Disparities in the Rural Underserved Community of Phillips County Arkansas.

Devastating health-related disparities driven by an entanglement of factors disproportionately impact the underserved, low-wealth, and minority community of Phillips county (PC) in the Arkansas Delta Region (ADR). Cardiovascular disease continues to increase with widespread consequences on the local economy, health care systems, and population. Health care and community-based systems have been unsuccessful in reducing out-of-hospital cardiac death, particularly in the ADR, for many reasons.

Dyad training protocols and the development of a motor sequence representation.

The purpose of the experiment was to determine the extent to which observation and the inter-trial dialogue in a dyad training protocol enhance the development of a movement sequence representation. The task was to reproduce a 1300ms spatial-temporal pattern of elbow extension/flexion movements. An inter-manual transfer design with a retention test and two effector transfer tests was used.

Predictors of 30-Day Return Following an Emergency Department Visit for Older Adults.

Older adults who are discharged following emergency department evaluation are at increased risk for functional decline and health care utilization, and are likely to benefit from close follow-up and additional care services. Understanding factors associated with a return emergency department visit within 30 days among older fee-for-service Medicare beneficiaries discharged to the community may assist in identifying patients at greatest need for interventions. Predictors from Medicare data and public sources were evaluated in a retrospective data analysis of North and South Carolina residents (2011-2012) aged ≥ 65 years using Cox regression proportion hazards ratios (HR) and 95% confidence intervals (CI) for time-to-30-day return events.

The influence of eye-movements on the development of a movement sequence representation during observational and physical practice.

An experiment was conducted to examine the development of a movement sequence representation and the role of eye-movements during observational and physical practice. The task was to reproduce a 1300ms spatial-temporal pattern of a sequence of elbow flexions and extensions. An inter-manual transfer design with a retention and two effector transfer tests (contralateral limb) was used.

Magnifying visual target information and the role of eye movements in motor sequence learning.

An experiment investigated the influence of eye movements on learning a simple motor sequence task when the visual display was magnified. The task was to reproduce a 1300 ms spatial-temporal pattern of elbow flexions and extensions. The spatial-temporal pattern was displayed in front of the participants.

Utilization of acute care among patients with ESRD discharged home from skilled nursing facilities.

Background And Objectives: Older adults with ESRD often receive care in skilled nursing facilities (SNFs) after an acute hospitalization; however, little is known about acute care use after SNF discharge to home.

Design, Setting, Participants, & Measurements: This study used Medicare claims for North and South Carolina to identify patients with ESRD who were discharged home from a SNF between January 1, 2010 and August 31, 2011. Nursing Home Compare data were used to ascertain SNF characteristics.

The role of eye movements in motor sequence learning.

An experiment that utilized a 16-element movement sequence was designed to determine the impact of eye movements on sequence learning. The participants were randomly assigned to two experimental groups: a group that was permitted to use eye movements (FREE) and a second group (FIX) that was instructed to fixate on a marker during acquisition (ACQ). A retention test (RET) was designed to provide a measure of learning, and two transfer tests were designed to determine the extent to which eye movements influenced sequence learning.

Comparative effectiveness of follow-up imaging approaches in pancreatic cancer.

Aim: Although PET imaging is sometimes used in follow-up of pancreatic cancer, evidence regarding comparative effectiveness of PET and older imaging modalities is limited.

Patients & Methods: Linked cancer registry and Medicare claims data were analyzed to examine patterns of imaging and effects on treatment patterns and survival among newly diagnosed pancreatic cancer patients from 2003 to 2007.

Results: 12% of patients received PET during follow-up.

A satisfaction survey of current medicines used for migraine therapy in China: is Chinese patent medicine effective compared with Western medicine for the acute treatment of migraine?

Objective: To investigate the patient satisfaction with medications commonly used for migraine therapy in patients seen in headache clinic in China with emphasis on the evaluation of Chinese patent medicine (CPM) in relieving acute migraine attack.

Methods: Patients admitted at headache clinics in the neurological departments of four hospitals during April to October 2011 were enrolled in the investigation. The questionnaire was designed based on the validation of a diagnostic questionnaire for a population-based survey in China in 2009.

Restarting the cycle: incidence and predictors of first acute care use after nursing home discharge.

Objectives: To describe the time to first acute care use (e.g., emergency department (ED) use without hospitalization or rehospitalization) for older adults discharged to home after receiving postacute care in skilled nursing facilities (SNFs); to identify predictors of first acute care use.

The Million Hearts initiative: applying the ABCS of healthy hearts in North Carolina.

Cardiovascular disease (CVD) is the leading cause of death in the United States. The goal of the national Million Hearts initiative is to prevent 1 million heart attacks and strokes by 2017 by promoting evidence-based preventive care and treatments for CVD. North Carolina has ongoing services and investments that will contribute to the success of this initiative.

Impact of distance to a urologist on early diagnosis of prostate cancer among black and white patients.

Purpose: We examined whether an increased distance to a urologist is associated with a delayed diagnosis of prostate cancer among black and white patients, as manifested by higher risk disease at diagnosis.

Materials And Methods: North Carolina Central Cancer Registry data were linked to Medicare claims for patients with incident prostate cancer diagnosed in 2004 to 2005. Straight-line distances were calculated from the patient home to the nearest urologist.

A randomized, one-year clinical trial comparing the efficacy of topiramate, flunarizine, and a combination of flunarizine and topiramate in migraine prophylaxis.

Objectives: The objective of this study was to observe the efficacy, safety, and side effects of a combination of flunarizine plus topiramate compared with either flunarizine and or toparamate alone for migraine prophylaxis.

Methods: Out of 150 patients with migraine recruited into the study and randomly assigned to one of three conditions, 126 completed the trial in their group: flunarizine (39), topiramate (44), and flunarizine plus topiramate (43). Patient information was assessed at enrollment and at follow-up visits at the end of months 1-3, 6, 9, and 12.

Relation of ventricular premature complexes to heart failure (from the Atherosclerosis Risk In Communities [ARIC] Study).

Analogous to rapid ventricular pacing, frequent ventricular premature complexes (VPCs) can predispose over time to cardiomyopathy and subsequent heart failure (HF). We examined the association of frequent VPCs with HF incidence in a population-based cohort, free of HF and coronary heart disease at baseline. At study baseline (1987 to 1989), ≥1 VPC on a 2-minute rhythm electrocardiographic strip was seen in 5.

National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005-2006.

Background: The national prevalence and patterns of food allergy (FA) in the United States are not well understood.

Objective: We developed nationally representative estimates of the prevalence of and demographic risk factors for FA and investigated associations of FA with asthma, hay fever, and eczema.

Methods: A total of 8203 participants in the National Health and Nutrition Examination Survey 2005-2006 had food-specific serum IgE measured to peanut, cow's milk, egg white, and shrimp.

Neurosteroids and self-reported pain in veterans who served in the U.S. Military after September 11, 2001.

Objective: Nearly half of Operation Enduring Freedom/Operation Iraqi Freedom veterans experience continued pain post-deployment. Several investigations report analgesic effects of allopregnanolone and other neurosteroids in animal models, but few data are currently available focusing on neurosteroids in clinical populations. Allopregnanolone positively modulates GABA(A) receptors and demonstrates pronounced analgesic and anxiolytic effects in rodents, yet studies examining the relationship between pain and allopregnanolone in humans are limited.

Premature ventricular complexes and the risk of incident stroke: the Atherosclerosis Risk In Communities (ARIC) Study.

Background And Purpose: Premature ventricular complexes (PVCs) on a 2-minute electrocardiogram are a common, largely asymptomatic finding associated with increased risk of coronary heart disease and death. They may reflect atherosclerosis or other pathogenic pathways that predispose to arrhythmias and stroke.

Methods: We conducted a prospective evaluation of the Atherosclerosis Risk In Communities Study cohort (n=14,783) of middle-aged men and women to assess whether the presence of PVCs at study baseline (1987 to 1989) influenced the risk of incident stroke through December 31, 2004.

After the collaborative is over: what sustains quality improvement initiatives in primary care practices?

Background: Multisite quality improvement (QI) initiatives, often known as collaboratives, involving primary care practices such as community health centers, academic practices, and managed care groups have been reported. Yet relatively little is known about the sustainability of these QI initiatives after the initial project, and frequently its funding, has ended. A series of practice characteristics that constitute critical elements for QI sustainability activities, as described in a Sustainability Pyramid Model, were proposed.

Novel relationship of serum cholesterol with asthma and wheeze in the United States.

Background: Cholesterol exerts complex effects on inflammation. There has been little investigation of whether serum cholesterol is associated with asthma, an inflammatory airways disease with great public health impact.

Objective: To determine relationships between levels of 3 serum cholesterol measures (total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], and non-HDL-C) and asthma/wheeze in a sample representative of the US population.

Comparative effectiveness of beta-blockers in elderly patients with heart failure.

Background: Whether beta-blockers (BBs) other than carvedilol, metoprolol succinate, and bisoprolol fumarate (evidence-based beta-blockers [EBBBs]) improve survival in patients with heart failure (HF) is unknown. We compared the effectiveness of EBBBs vs non-EBBBs on survival.

Methods: Our study population included North Carolina residents at least 65 years old who were eligible for Medicare and Medicaid with pharmacy benefits and had had at least 1 hospitalization for HF during the period 2001 through 2004.

Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting: Intervention in Older Persons with Acute Coronary Syndrome-Part II.

This is Part II of a two-part article on treatment of acute coronary syndrome in the older population. Part I (published in the October issue of Clinical Geriatrics) analyzed the differential utilization of invasive therapies with respect to age and heart disease. Part II summarizes information from the literature on acute coronary syndrome outcomes from invasive treatments (percutaneous coronary interventions or coronary artery bypass grafting) among older persons.

Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting: Intervention in Older Persons with Acute Coronary Syndrome-Part I.

This is Part I of a two-part article on treatment of acute coronary syndrome in the older population. Part I analyzes the differential utilization of invasive therapies with respect to age and heart disease. Part II (to be published in the next issue of Clinical Geriatrics) will summarize information from the literature on acute coronary syndrome outcomes from invasive treatments (percutaneous coronary interventions or coronary artery bypass grafting) among older persons.