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State level correlations between high heart attack and stroke symptomology knowledge scores and CVD risk factors and mortality rates

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Health 2013年第10期5卷 1634-1640页

作者： mary nawal lutfiyya Krista L. Huot Maria L. Amaro Michael F. Akers Michael Swanoski College of Pharmacy Ambulatory Care Residency Program University of Minnesota Minneapolis USA Essentia Health System Ambulatory Care Pharmacy Services Duluth USA Essential Institute of Rural Health Duluth USA

Introduction: In 2008, cardiovascular disease (CVD) accounted for one in three deaths in the United States. Epidemiological analyses suggest that two or more risk factors are the indicator of high risk and/or poor CVD outcomes. Knowledge of heart attack and stroke symptomology has been the focus of much research based on the assumption that accurate identification of an event is critical to reducing time to treatment. There is a paucity of research showing a clear association between knowledge of heart attack and stroke symptomology, risk factors, and mortality rates. In this study, we hypothesized that high stroke and heart attack symptomology knowledge scores would correspond to lower stroke or CVD mortality rankings as well as to a lower prevalence of two or more CVD risk factors. Methods: State was the unit of analysis used to examine data from two different sources and combined into a customized database. The first source was a multiyear Behavioral Risk Factor Surveillance Survey (BRFSS) heart attack and stroke symptom knowledge module database. CVD and stroke mortality data used came from the American Heart Association’s (AHA) 2012 Heart Disease and Stroke Statistics Update. Spearman’s Rho was the test statistic. Results: A moderate negative correlation was found between high heart attack and stroke symptom knowledge scores and the percentage of adults with two or more CVD or stroke risk factors. Likewise, a similar correlation resulted from the two variables, high heart attack and stroke symptoms knowledge score and CVD mortality rank. Conclusions: This study demonstrated a significant relationship between high heart attack and stroke symptom knowledge and lower CVD mortality rates and lower prevalence of two or more CVD risk factors at the state level. Our findings suggest that it is important to continue education efforts regarding heart attack and stroke symptom knowledge. Pharmacists are one group of health care providers who could enhance the needed publ

关键词： Knowledge of Heart Attack and Stroke Symptomology CVD Risk Factors Stroke Mortality CVD Mortality

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Population-based study of health service deficits in US adults with depression: Does chronic disease co-morbidity and/or rural residency make a difference?

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Health 2013年第4期5卷 774-782页

作者： Andrine Lemieux Daniel M. Saman M. nawal lutfiyya Essentia Institute of Rural Health Division of Research Duluth USA

Introduction: Rural residents are at higher risk for a depressive disorder than their non-rural counterparts. Recent research has indicated that co-morbidities are also associated with depression. Health service deficits (HSDs) is an analytic concept that facilitates the examination of how a population uses health services relevant to their condition. A HSD is present when, over the preceding 12 months, an individual has had no health insurance, no specified health care provider, deferred medical care due to cost, or did not have a routine medical exam. Research has shown a high prevalence of HSDs in populations with individual chronic conditions. No study that we know of has examined if there is an association between the constellation of chronic conditions of depression and the co-morbidities of asthma, arthritis, and diabetes, with HSDs. Methods: 2011 Behavioral Risk Factor Surveillance Survey (BRFSS) data were analyzed to identify important dimensions of the epidemiology of depression by ascertaining whether there were differences in the prevalence of health service deficits in rural versus non-rural adults with depression and at least one additional chronic disease (arthritis, asthma, or diabetes). Data analyses entailed both bivariate and multivariate techniques. All analyses were performed on weighted data. Results: Logistic regression analysis performed using the presence of at least one HSD as the dependent variable yielded that for US adults with lifetime depression those who were African American, Hispanic and other/multiracial in comparison to Caucasian had higher odds of having at least one health service deficit. Low socioeconomic status (SES) and middle SES in comparison to high SES were also risk factors for US adults with lifetime depression having at least one HSD. Rural residency in comparison to non-rural residency also emerged as an independent risk factor (for US adults with lifetime depression having at least one HSD. Chronic disease, however,

关键词： Health Service Deficits for Depression and Other Co-Morbidities BRFSS Surveillance Data

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Prevalence of daily or near daily aspirin use by US adults with diabetes: A cross-sectional study using a multi-year national database

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Health 2012年第6期4卷 297-303页

作者： Michael F. Akers M. nawal lutfiyya Maria L. Amaro Michael T. Swanoski Ambulatory Care Residency Program College of Pharmacy University of Minnesota Minneapolis USA Essentia Institute of Rural Essentia Institute of Rural Health Duluth USA Duluth USA

Introduction: For persons with diabetes, cardiovascular disease is the major cause of morbidity and mortality that is reflected in a two-to- four times greater risk for both heart disease and stroke when compared to adults without diabetes. Although not without controversy, diabetes and cardiovascular disease (CVD) management guidelines in the US recommend the use of once-daily aspirin. This epidemiological study was undertaken to fill the knowledge gap regarding the prevalence of daily or near daily aspirin use for US age-appropriate adults with diabetes. Methods: Using bivariate and multivariate techniques, a cross-sectional analysis of an amalgamated database using 2005, 2007, and 2009 Behavioral Risk Factor Surveillance Survey data was performed. The dependent variable for this analysis was daily or near daily aspirin use. The population of interest was US adults, men >= 45 - 79 and women >= 55 - 79 years of age. Results: Overall the prevalence of daily or near daily aspirin use by age-appropriate US adults with diabetes was 62.5%;it was 41.0% for similar non-diabetic adults. Logistic regression analysis yielded that age-appropriate adults, of both genders, with diabetes taking daily or near daily aspirin were more likely to be: physically active, male, live in rural locales, not have a health care provider, have deferred medical care because of cost, have an elevated BMI, a smoker, and have hypertension. Conclusion: It was determined that the age-appropriate use of aspirin in the US adult population with diabetes is underutilized. The role of the pharmacist through- out the continuum of care is one way to improve appropriate aspirin use in patients with diabetes.

关键词： Aspirin Use CVD Prevention Diabetes Practice Guidelines

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Cross-sectional population based study examining the impact of children with asthma on US rural families

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Health 2013年第2期5卷 351-359页

作者： Laura C. Palombi May nawal lutfiyya Kathryn J. Pederson David R. Simmons Darin J. Steenerson Kenzie G. Hohman Krista Huot Ambulatory Care Residency Program College of Pharmacy University of Minnesota Minneapolis USA Essentia Health Acute Care Pharmacy Residency Duluth USA Essentia Health System Ambulatory Care Pharmacy Services Duluth USA Essentia Institute of Rural Health Duluth USA

Introduction: Approximately 7.1 million US children have asthma. The burden of asthma is disproportionate with ruralUSpopulations experiencing a higher prevalence of the disease. Rural populations experience additional disparities regarding health care access, job availability, and daily living resources. Hence, the family impact of having a child with asthma may be influenced by geographic locale. This impact could be a result of health insurance tied to employment, out of pocket costs, and health care provider availability. Few studies have assessed the impact a child’s asthma has on a family. This study sought to answer the question: What is the impact of children with asthma on US rural families? Methods: Multivariate techniques were performed to examine a single year of data from two connected population-based datasets, the 2007-2008 National Survey of Children’s Health and the 2009-2010 Children with Special Health Care Needs Survey. Children with current asthma defined the study population for both datasets. A logistic regression model was performed for each database. The dependent variable for the first model was child in family currently has asthma, for the second it was rural children with current asthma. Results: The first logistic regression model confirmed that rural children were more likely to have asthma than non-rural children. The second logistic regression model yielded that rural families with a child diagnosed with asthma had greater odds of: not having health insurance, having a parent who stopped working, avoided a job change, or experienced financial problems because of the child’s health. Conclusions: This study demonstrated that rural families experience a disproportionate financial hardship as a result of their child’s asthma. Pharmacist intervention in asthma care in rural areas has the potential to decrease the financial burden for a family while also improving a child’s health.

关键词： Asthma Family Burden Children with Asthma Rural Children with Asthma NSCH Data CSHCNS Data

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Cross-sectional population based study ascertaining the characteristics of US rural adults with mental health concerns who perceived a stigma regarding mental health issues

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Health 2013年第4期5卷 695-702页

作者： Kathryn J. Pederson M. nawal lutfiyya Laura C. Palombi David R. Simmons Darin J. Steenerson Kenzie G. Hohman Krista L. Huot Essentia Health Acute Care Pharmacy Residency Duluth USA Essentia Health System Ambulatory Care Pharmacy Services Duluth USA Essentia Institute of Rural Health Duluth USA University of Minnesota College of Pharmacy Ambulatory Care Residency Program Minneapolis USA

Introduction: Mental health is an important component of overall health. Mental illness is a leading cause of morbidity and mortality in the US and is associated with chronic diseases such as heart disease, diabetes, and arthritis. In the US, most people with mental health issues or disorders remain untreated. Epidemiological studies have identified rural residents as being at greater risk for health disparities;as a result, rural residents are a vulnerable population in terms of mental health and mental health care. Research has demonstrated that perceived stigma can be a significant barrier to rural residents seeking mental health care. This study examined the research question: What are the characteristics of US rural adults with mental health concerns who perceived stigma? Methods: 2007 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed using bivariate and multivariate techniques to answer the research question. 2007 BRFSS data were used because in that year non-institutionalized US adults in 37 states and territories were queried about their attitudes toward mental illness. BRFSS is a random digit telephone survey that uses a complex multi-stage sampling approach and subsequently a weighting factor is calculated for application to the data in order to ensure that they are representative of the US population based on the most recent census data. Only weighted data were analyzed. Results: Logistic regression analysis revealed that rural adults reporting mental health concerns who perceived stigma regarding mental health were more likely to be unemployed seeking work or not working and not seeking work, military veterans, or to have deferred medical care because of cost. They were also more likely to not have a health care provider and to rarely or never feel supported emotionally. Conclusions: Support systems may render people with mental health issues less vulnerable to perceiving stigma, thus assisting with removing stigma as a barrier to car

关键词： BRFSS Surveillance Data Rural Mental Health Perceived Stigma of Mental Health Issues

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