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Hypertension Awareness, Treatment and Control in Working Aged American Adults: Analysis of Data from the National Health and Nutrition Examination Survey 2011-2020
No full textHypertension (HTN) is a highly prevalent chronic health condition and a leading cause of premature death in American adults. Preventing and controlling HTN at younger ages is necessary to prevent long term health problems. Research related to HTN outcomes and age frequently centers on older adults and less is known on the determinants of HTN in working aged adults. Serial cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES) (2011 to 2020) was performed. The primary objectives of the study were to examine and provide contemporary estimates of HTN outcomes in working age adults (aged 20 to 64) including assessment of: (1) trends in HTN awareness, treatment and control across NHANES cycles; (2) the socio-ecological factors associated with HTN awareness, treatment and control; (3) examination of the moderating effect of age on the association between HTN awareness and treatment; and (4) assessment of the mediating effect of HTN awareness on the relationship between age and HTN treatment. The prevalence of HTN awareness was stable over time in the total sample from 57.5% in 2011-2012 to 56.9% in 2017-2020 (ptrend=0.082). The prevalence of HTN treatment was also stable across consecutive cycles of NHANES with a prevalence of 81.7% in 2011-2012 and a prevalence of 81.2% in 2017-2020 (ptrend=0.838). There was also no statistically significant trend in HTN control in the overall population over time (ptrend=0.056) but a statistically significant negative trend was noted in HTN control in those reporting HTN treatment (prevalence difference: -1.8, ptrend=0.031). Significant trends were noted by subgroup. Women had a negative decline in HTN awareness and HTN treatment over time (ptrend =0.006 and ptrend \u3c 0.001, respectively). A decline in HTN treatment was also noted in men (ptrend \u3c 0.001). Notably, a negative trend was also observed in younger adults (aged 20 to 39) in HTN treatment and HTN control in those reporting HTN treatment (ptrend =0.009 and ptrend =0.005, respectively). Compared to adults aged 60 to 64, this younger age group was less likely to report HTN awareness (adjusted Prevalence Ratio (aPR)=0.55 [95% Confidence Interval (CI), 0.49-0.60]), HTN treatment (aPR=0.82 [95% CI, 0.76-0.88]), and HTN control (aPR=0.27 [95%CI, 0.21-0.35]). Men were less likely to have HTN control compared to women (aPR=0.86 [95% CI, 0.75-0.98]). Other notable findings include that participants reporting availability of a usual source of care were 64% more likely to report HTN awareness (aPR=1.64 [95% CI, 1.44-1.86]), 83% more likely to report HTN treatment (aPR=1.83 [95% CI, 1.56-2.14]) and were almost three times as likely to have HTN control (aPR=2.93 [95% CI, 1.96-4.40]), compared to participants with no usual source of care. The relationship between HTN awareness and HTN treatment was modified by age on the additive scale for younger adults both with HTN awareness (aPR 0.81, [95% CI 0.69-0.95]) and without HTN awareness (aPR 0.86, 95% CI 0.74-0.99]) compared to participants aged 60 to 64 with HTN awareness. In conclusion, HTN awareness, treatment and control have declined in certain subgroups and HTN metrics differ substantially by age and sex. Access to a usual source of care was highly correlated with a higher prevalence of HTN treatment and control. Lastly, on the additive scale, age moderated the relationship between HTN awareness and treatment in younger adults. These findings highlight the need to improve HTN awareness, treatment and control in younger adults and men, and to arrest the decline in HTN awareness and treatment in women. Further research is necessary to evaluate the upstream factors contributing to the decline in the awareness, treatment and control of HTN and the lack of responsiveness to HTN awareness in young adults
The Role of Regulatory RNAs in the Progression and Development of Prostate Fibrosis
No full textAutopsy examinations revealed that benign prostate hyperplasia (BPH) histologically affects 80-90% of men in their 70s and older. Due to the prostate\u27s unique position surrounding the urethra, BPH contributes to lower urinary tract dysfunction (LUTD). LUTD is characterized by painful urination and can lead to acute urinary retention, which significantly impacts the quality of life of patients. Our lab previously uncovered prostate fibrosis as an unexplored pathobiology associated with LUTD. A key attribute of fibrosis is the excessive production of extracellular matrix (ECM), triggered by inflammatory cytokines such as interleukin-4 (IL-4) and interleukin-13 (IL-13). In contrast to conventional approaches focusing on signal transduction-mediated regulation of ECM production, our novel strategy centers on understanding how regulatory RNAs control translation of ECM proteins. Regulatory RNAs include microRNA (miRNA) that bind to the 3\u27 UTR of target mRNA to inhibit translation. Also, circular RNA (circRNA) that acts as a miRNA sponge, creating a double-negative effect to alleviate translation inhibition. These investigations aim to unveil how regulatory RNAs could be utilized by profibrotic cytokines to increase ECM protein production, contributing to fibrosis in the lower urinary tract. Through microarray analysis and RNA sequencing, we have determined differentially expressed circRNAs and miRNAs. The expression levels of identified miRNA and circRNA were validated through Quantitative Reverse Transcriptase Polymerase Chain Reaction (RT-qPCR). Leveraging our knowledge of ECM protein transcripts, circRNAs, miRNAs of interest and their potential complementary binding, a preliminary competing endogenous RNA network was established. From the ceRNA network, we identified multiple circRNAs and miRNAs of interest for future explorational studies. Future research will concentrate on further validating the roles of these RNAs and exploring their potential as therapeutic targets
Better Light than Never: A New Radiative Mechanism for Observing Binary Black Holes
Get PDFBlack holes are notoriously elusive, they are impossible to observe directly, and cur- rent methods of extracting information from behind their cosmic camouflage are both limited in number and experimentally difficult. The scope of this investigation is to ex- plore a proposed novel radiative mechanism for active similar mass binary black holes, affording new observational methods to investigate frequency inspirals of BH mergers. The explored mechanism is a result of each BH’s accretion of the surrounding plasma, creating voids that orbit throughout the plasma. The significant results described in this thesis include expressions for the frequency, power radiated per unit solid angle, and average power radiated for the quadrupolar radiation of our system
A Quartet of Consequence: Randolph, Rustin, Baker & Levison & The Movement They Made
Get PDFThe historiography of the civil rights movement has been dominated by a debate over the proper placement of the historian’s lens. Should it provide a top/down view concentrating on high profile leaders like Martin Luther King, Jr., or should it have a bottom/up focus that zeroes in on courageous grassroots leaders? Some historians have argued for a both/and approach with perspective on both the leaders at the top and at the bottom and how they interacted. What has been missing from this debate is the decisive impact made by networks of leaders who set aside their own narrow interests to form powerful partnerships that advanced the movement. These leaders are the antithesis of the turf conscious activists who see coalitions as transactional zero sum games. An inside/out view can sharpen the historian’s lens so that the crucial contributions of these networks can come into focus. Four civil rights leaders formed a network that propelled the movement forward at pivotal points. A. Philip Randolph, Bayard Rustin, Ella Baker, and Stanley Levison have each been studied individually. What has been missed is the way their collaboration magnified their impact. Critically, the whole was greater than the sum of the parts. Each brought assets lacked by the other three so that when they worked together their collective impact on the movement was profound. Although the work of these four was often done years before the spotlight began to shine or was accomplished quietly off-stage, their fingerprints are on many milestones of the movement. The Montgomery Bus Boycott, the launch of the Southern Christian Leadership Conference, and the 1963 March on Washington might have turned out differently or not have landed with such impact had it not been for this Quartet of Consequence and how they worked together
Coping with the Complexity of the Changing Character of War: Toward a New Paradigm of Adaptive Peace
Get PDFThe world has entered a period of heightened geopolitical instability that is compounded by climate change and the emergence of new technologies. The number of conflicts and related deaths are increasing. Dramatic failures in Afghanistan and elsewhere show that the mainstream approach to peace and conflict is no longer effective. The aim of this article is to contribute to re-thinking peace and security in two ways. First, by explaining why trying to influence complex social change process with a determined-design approach is self-defeating. Second, by introducing adaptive peace theory as a normative and functional approach to ending violent conflicts and sustaining peace in specific contexts, that is aimed at navigating the complexity inherent in trying to nudge societal change processes toward peace, without causing harm
Highlights of the Annual Report of the Cohort 3 TPSID Model Demonstration Projects (Year 3, 2022–2023)
Get PDFThis Highlights document was created with data from the Annual Report of the Cohort 3 TPSID Model Demonstration Projects (Year 3, 2022-2023) for those who are interested in the most critical statistics from the report, or are sharing with a broad audience. It features bold graphics and brief summaries of program and student data, including exit and post-exit outcomes
CBT-I Training For the Mental Health Clinician to Deliver Evidence-Based Treatment to Address Impaired Sleep Quality in a Correctional Facility
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Description of the Problem: Insomnia significantly impacts mental and physical well-being, with long-term health effects and considerable healthcare costs. While pharmacological treatments offer temporary relief for some, they do not always provide lasting solutions.
Available Knowledge: A PRISMA-guided literature review found that training programs for cognitive-behavioral therapy for insomnia (CBT-I) are effective in increasing knowledge and confidence for addressing impaired sleep.
Aim and Objectives: This project aimed to enhance mental health clinicians\u27 ability to assess and treat impaired sleep, focusing on implementing a tailored CBT-I educational initiative in a correctional facility.
Intervention: This project implemented evidence-based CBT-I training for mental health clinicians at a Boston correctional facility to address sleep issues among incarcerated adults. Pre-assessments and final surveys gauged clinicians\u27 confidence and knowledge in CBT-I, while bi-weekly huddles gathered feedback on training effectiveness.
Evaluation of Intervention: The output measures included data from frequency and proportion of mental health clinicians who participated in a face-to-face training, who participated in bi-weekly huddles, who showed an increase in knowledge and confidence and survey results completed by the mental health clinicians about feasibility, applicability, and value added.
Results: The project ran from August 2023 to March 2024. Initially, all eight clinicians began training, but only five remained. Bi-weekly feedback huddles had participation rates ranging from 50% to 88%. Although 63% reported increased knowledge and confidence, it did not meet the 85% target. Participants had varied perceptions of the initiative\u27s value, feasibility, and applicability, indicating mixed feedback.
Discussion: This project aimed to enhance mental health clinicians\u27 skills in addressing impaired sleep among incarcerated individuals through a tailored CBT-I program. Clinicians reported increased knowledge and confidence over weeks 4, 8, and 12. Feedback indicated that 73% found the project valuable, 60% found it feasible, and 53% saw its relevance in correctional settings, with no negative responses. The project supports the use of Orem\u27s theory when considering non-pharmacological interventions in correctional sleep care, demonstrating CBT\u27s effectiveness in managing sleep issues
Increasing Colorectal Cancer Screening Rates in Adults Aged 45-49 at an Urban FQHC: A Quality Improvement Project
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Background: The United States Preventive Services Task Force (USPSTF) now recommends that colorectal screening begins at age 45 rather than 50. The purpose of this QI project was to improve colorectal cancer screening rates in adults to prevent diagnosis, promote earlier detection, and reduce mortality from colorectal cancer.
Local Problem: This QI project was completed at a large urban federally qualified health center (FQHC) that served a diverse and underserved population. Its colorectal cancer screening rate for adults aged 45 to 49 was low compared to older adults (50-75) and national standards.
Methods: A literature review identified technology-based outreach as the best evidenced-based intervention for the project site. The Plan-Develop-Study-Act (PDSA) cycle was used to guide the development and implementation of this project.
Intervention: Patients aged 45 to 49 seen in the last 12 months who were due for colorectal cancer screening and had email or cell phone contact information received a message from a patient-engagement platform inviting them to select a colorectal cancer screening option. These selections were then reviewed and ordered by their primary care providers.
Results: 396 patients were outreached. 44 patients responded to the message and 50% of patients who requested a screening successfully completed the stool-based test or connected with a gastroenterologist within three months. Greater than 50% of providers were satisfied with project implementation and supported similar outreach in the future.
Conclusion: Technology-based outreach improved colorectal cancer screening in adults aged 45-49. Future projects should be focused on multipronged approaches to increase screening rates
Latinos in Massachusetts Selected Areas: West Springfield
Get PDFThis is a publication of the Mauricio Gastón Institute for Latino Community Development and Public Policy
Post-Memory of the War Experience as a Child of a Demobilized Soldier: Reflections on Embodied Military Experience
Get PDFPost-Memory of the War Experience as a Child of a Demobilized Soldier: Reflections on Embodied Military Experience. Volume 36, Issue 2 of the New England Journal of Public Policy