scholarly journals Racial differences in follow-up of abnormal mammography findings among economically disadvantaged women

Cancer ◽  
2009 ◽  
Vol 115 (24) ◽  
pp. 5788-5797 ◽  
Author(s):  
Swann A. Adams ◽  
Emily R. Smith ◽  
James Hardin ◽  
Irene Prabhu-Das ◽  
Jeanette Fulton ◽  
...  
Keyword(s):  
Racial Differences ◽  
Economically Disadvantaged ◽  
Disadvantaged Women ◽  
Abnormal Mammography

scholarly journals Adherence to Accelerometer Protocols Among Women From Economically Disadvantaged Neighborhoods

2011 ◽  
Vol 8 (5) ◽  
pp. 699-706 ◽  
Author(s):  
Patricia A. Sharpe ◽  
Sara Wilcox ◽  
Laura J. Rooney ◽  
Donna Strong ◽  
Rosie Hopkins-Campbell ◽  
...  
Keyword(s):  
Physical Activity ◽  
Economically Disadvantaged ◽  
Population Group ◽  
Community Based ◽  
Activity Data ◽  
Daily Diaries ◽  
Cultural Considerations ◽  
Disadvantaged Populations ◽  
Disadvantaged Women

Background:Objective measurement of physical activity with accelerometers is a challenging task in community-based intervention research. Challenges include distribution of and orientation to monitors, nonwear, incorrect placement, and loss of equipment. Data collection among participants from disadvantaged populations may be further hindered by factors such as transportation challenges, competing responsibilities, and cultural considerations.Methods:Research staff distributed accelerometers and provided an orientation that was tailored to the population group. General adherence strategies such as follow-up calls, daily diaries, verbal and written instructions, and incentives were accompanied by population-specific strategies such as assisting with transportation, reducing obstacles to wearing the accelerometer, tailoring the message to the participant population, and creating a nonjudgmental environment.Results:Sixty women asked to wear the Actigraph GT1M returned the accelerometer, and 57 of them provided sufficient data for analysis (at least 10 hours a day for a minimum of 4 days) resulting in 95% adherence to the protocol. Participants wore the accelerometers for an average of 5.98 days and 13.15 hours per day.Conclusions:The high accelerometer monitoring adherence among this group of economically disadvantaged women demonstrates that collection of high-quality, objective physical activity data from disadvantaged populations in field-based research is possible.

scholarly journals Enrolling Incident Caregivers and Matched Controls From a Nationwide Epidemiological Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 658-658
Author(s):  
David Roth ◽  
William Haley ◽  
Orla Sheehan ◽  
J David Rhodes ◽  
Virginia Howard
Keyword(s):  
Blood Sample ◽  
Epidemiological Study ◽  
Racial Differences ◽  
Family Caregiving ◽  
Regards Study

Abstract Participants in the national Reasons for Geographic and Racial Differences in Stroke (REGARDS) study were asked about family caregiving responsibilities at enrollment (2003-2007). Among the 88% of participants who were not caregivers at enrollment, 1,229 reported becoming caregivers before a follow-up interview 12 years later. The Caregiving Transitions Study screened these participants and enrolled 251 as incident caregivers. All reported 5 or more hours of care per week, provided assistance with at least one ADL or IADL, and were caregivers for at least 3 months before a 2nd blood sample was obtained in the REGARDS study. A total of 251 noncaregiving control participants who reported no caregiving responsibilities over this 12-year period were also enrolled. Each control was matched to a caregiver on age (+ 5 years), sex, race, other demographics, and baseline (pre-caregiving) health variables. Descriptive analyses confirm the unique comparability of the samples compared to previous caregiving studies.

Abstract 021: Higher Levels of Ideal Cardiovascular Health Are Associated With Lower Risk of Incident Type 2 Diabetes Mellitus Among Individuals With Normal Fasting Glucose but Not Impaired Fasting Glucose: The Reasons for Geographic and Racial Differences in Stroke Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Joshua J Joseph ◽  
Aleena Bennett ◽  
Justin B Echouffo Tcheugui ◽  
Valery S Effoe ◽  
James Odei ◽  
...  
Keyword(s):  
Racial Differences ◽  
Impaired Fasting Glucose ◽  
Lower Risk ◽  
Cardiovascular Health ◽  
Fasting Glucose ◽  
Glycemic Status ◽  
Ideal Cardiovascular Health ◽  
Normal Fasting Glucose ◽  
Prevention Of Diabetes

Aims/hypothesis: Ideal cardiovascular health (ICH) is associated with lower risk of incident diabetes, but whether this association varies by baseline glycemia (normal [<100 mg/dL] vs. impaired fasting glucose [100-125 mg/dL]) remains to be clarified. We assessed the incidence of diabetes based on American Heart Association (AHA) ICH components stratified by glycemic status to determine whether ICH is more effective for primordial or primary prevention of diabetes among middle-aged and older adults. Methods: This study included 7,662 non-Hispanic whites and African Americans from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study without prevalent diabetes at baseline (2003-2006), who completed the follow-up exam (2013-2016). Participants were categorized as having ideal, intermediate or poor cardiovascular health, as defined by the AHA 2020 Impact Goals, based on baseline ICH components (total cholesterol, blood pressure, dietary intake, tobacco use, physical activity and body-mass index (BMI)). We categorized participants based on their total number of components that were ideal (0-1 “poor”, 2-3 “intermediate”, and 4+ “ideal”). Incident rate ratios (IRR) were calculated using modified poisson regression adjusting for age, sex, education, income, race, alcohol use, estimated glomerular filtration rate, urine albumin:creatinine ratio and high-sensitivity C-reactive protein. After confirming significant interactions with multiplicative interaction terms and application of likelihood ratio test, we stratified by glycemic status (normal vs. impaired fasting glucose). Results: Among REGARDS participants (mean age 63.0 [SD 8.4] years, 56% female, 26% African American), there were 560 incident diabetes cases (median follow-up 9.5 years). Overall, those with 2-3 and 4+ ICH components vs. 0-1 components had 31% (IRR 0.69; 95% CI 0.61, 0.79) and 71% lower (IRR 0.29; 95% CI 0.20, 0.42) risk of diabetes, respectively. Among 5,930 participants with normal fasting glucose, these risks were 36% (IRR 0.64; 95% CI 0.52, 0.79) and 80% lower (IRR 0.20; 95% CI 0.10, 0.37), while among 1,732 participants with baseline impaired fasting glucose these risks were 8% (IRR 0.92; 95% CI 0.80,1.07) and 13% lower (IRR 0.87; 95% CI 0.58,1.30) (p for interaction by baseline glucose status <0.0001). Conclusions/interpretation: Meeting an increasing number of ideal levels of dietary intake, physical activity, smoking, blood pressure, cholesterol and BMI was associated with a dose-dependent lower risk of diabetes for individuals with normal fasting glucose but not impaired fasting glucose. This suggests the AHA 2020 guidelines may be more effective for primordial versus primary prevention of diabetes among middle-aged and older adults.

Abstract P323: Pulse Pressure and Incident Acute Coronary Heart Disease Events in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Stephen P Glasser ◽  
Daniel L Halberg ◽  
Charles Sands ◽  
Paul Muntner ◽  
Monika Safford
Keyword(s):  
Risk Factors ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Racial Differences ◽  
Pulse Pressure ◽  
Proportional Hazards ◽  
Linear Trend ◽  
Cox Proportional Hazards ◽  
Cvd Risk

Background: Increased attention has been given to pulse pressure (PP) as a potential independent risk factor of cardiovascular disease. We examined the relationship between PP and incident acute coronary heart disease (CHD). Methods: We used data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) national cohort study of 30,239 black and white participants aged 45 years or older and enrolled between 2003 and 2007. Baseline data included a 45-minute interview and in-home visit during which blood pressure was assessed and recorded as the average of two measurements obtained after a 5 minute seated rest. PP (SBP-DBP) was classified into 4 groups (<45, 45-54, 54.1-64, >64.1 mmHg). Telephone follow-up occurred every six months for self or proxy-reported suspected events, triggering medical record retrieval and adjudication by experts. Cox-proportional hazards models examined the association of incident CHD with PP groups, adjusting for socio-demographic and clinical risk factors. Results: This analysis included 22,909 participants free of CHD at baseline, with mean age 64.7±9.4 years; 40.4%were black, 44.6% were male and they experienced a total of 515 incident CHD events over a mean 3.4 yrs of follow-up (maximum 6 years). In unadjusted analyses, compared with PP<45 mmHg, each higher PP group had incrementally higher hazard ratios (HR) for incident CHD (HR 1.28 {95% CI 1.02-1.60}, 2.05 {1.63-2.56}, 3.82 {3.08-4.74}, p<0.001 for linear trend). This relationship persisted after fully adjusting including SBP for the highest PP group (HR 0.96 {0.75-1.21}, 1.12 {0.86-1.46}, 1.51 {1.09-2.10}, p trend <0.0001). Conclusions: High PP was associated with incident CHD, even when accounting for SBP and numerous other CVD risk factors.

Abstract 183: Depressive Symptoms and Incident Stroke in Black and White Participants in the REGARDS Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Audrey L Austin ◽  
Michael G Crowe ◽  
Martha R Crowther ◽  
Virginia J Howard ◽  
Abraham J Letter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Depressive Symptoms ◽  
Racial Differences ◽  
Stroke Risk ◽  
Depression Scale ◽  
Stroke Incidence ◽  
Blacks And Whites ◽  
The Impact

Background and Purpose: Research suggests that depression may contribute to stroke risk independent of other known risk factors. Most studies examining the impact of depression on stroke have been conducted with predominantly white cohorts, though blacks are known to have higher stroke incidence than whites. The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke in blacks and whites, and determine whether depressive symptomatology was differentially predictive of stroke among blacks and whites. Methods: The REasons for Geographic and Racial Differences in Stroke (REGARDS), is a national, population-based longitudinal study designed to examine risk factors associated with black-white and regional disparities in stroke incidence. Among 30,239 participants (42% black) accrued from 2003-2007, excluding those lacking follow-up or data on depressive symptoms, 27,557 were stroke-free at baseline. As of the January 2011 data closure, over an average follow-up of 4.6 years, 548 incident stroke cases were verified by study physicians based on medical records review. The association between baseline depressive symptoms (assessed via the Center for Epidemiological Studies Depression scale, 4-item version) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographic factors (age, race, and sex), stroke risk factors (hypertension, diabetes, smoking, atrial fibrillation, and history of heart disease), and social factors (education, income, and social network). Results: For the total sample, depressive symptoms were predictive of incident stroke. The association between depressive symptoms and stroke did not differ significantly based on race (Wald X 2 = 2.38, p = .1229). However, race-stratified analyses indicated that the association between depressive symptoms and stroke was stronger among whites and non-significant among blacks. Conclusions: Depressive symptoms were an independent risk factor for incident stroke among a national sample of blacks and whites. These findings suggest that assessment of depressive symptoms may warrant inclusion in stroke risk scales. The potential for a stronger association in whites than blacks requires further study.

Abstract P515: Comparison of Dietary Measures Association With Incident Type 2 Diabetes: The Reasons for Geographic and Racial Differences in Stroke (regards) Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Stephanie Tison ◽  
April P Carson ◽  
James M Shikany ◽  
Keith Pearson ◽  
George Howard ◽  
...  
Keyword(s):  
Racial Differences ◽  
Mediterranean Diet ◽  
Dietary Patterns ◽  
Dietary Pattern ◽  
A Priori ◽  
Incident Diabetes ◽  
A Posteriori ◽  
Regards Study ◽  
Diet Score

Background: Previous studies have investigated the association of dietary patterns with risk of diabetes, but have not compared a priori and a posteriori dietary scores in the same diverse population. The objective of this study was to evaluate a priori and a posteriori dietary patterns associations with incident diabetes in the REGARDS study. Methods: This study included 8,875 Black and White adults with available dietary data, without diabetes (defined as fasting glucose>=126 mg/dL, random glucose>=200 mg/dL, or use of diabetes medications) at baseline (2003-2007), and with follow-up (2013-2016) status of diabetes. Dietary patterns were examined by quintile and included a posteriori Plant-based and Southern, as well as a priori scores of Mediterranean Diet Score, Dietary Approaches to Stop Hypertension (DASH) Diet Score, Dietary Inflammatory Index (DII) and Dietary Inflammation Score (DIS). Modified Poisson regression was used to obtain risk ratios for incident diabetes with models adjusted for total energy intake, demographics, and lifestyle factors. Results: The mean (SD) age at baseline was 63.2 (8.5) years, 27.1% were Black, 56.2% were female, and 11.7% had incident diabetes at follow-up. Adherence to the Southern dietary pattern was positively associated with incident diabetes for all models (figure). After adjustment for demographic factors, the highest quintiles of DII and DIS were associated with incident diabetes and the highest quintiles of DASH scores were protective of development of incident diabetes. Conclusion: The Southern dietary pattern derived in REGARDS showed the strongest association with incident diabetes of all the dietary scores and of the a priori scores the DIS showed the strongest association with incident diabetes. The lack of association in adjusted models with the Mediterranean Diet and Plant-based pattern show these scores to be less pertinent. The DIS demonstrates food based dietary inflammation as one of the potential pathways for incident diabetes.

Abstract 14088: Pro-neurotensin/neuromedin N is Associated With Incident Metabolic Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Charles D Nicoli ◽  
April P Carson ◽  
Timothy B Plante ◽  
Leann Long ◽  
Leslie A McClure ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Glycemic Control ◽  
Racial Differences ◽  
Density Lipoprotein ◽  
Fatty Acid Uptake ◽  
Acid Uptake ◽  
High Systolic Blood Pressure ◽  
Neuromedin N

Introduction: The tridecapeptide neurotensin increases dietary fatty acid uptake and is implicated in insulin resistance in animal models and—through plasma levels of its stable precursor pro-neurotensin/neuromedin N (pro-NT/NMN)—with human diabetes mellitus, obesity, and cardiovascular disease. We evaluated the association of pro-NT/NMN with incident metabolic syndrome (MetS). Methods: This analysis included a subcohort of 2,770 Black and White participants without prevalent MetS at baseline (2003-2007) from the REasons for Geographic And Racial Differences in Stroke study who had fasting plasma pro-NT/NMN measured by immunoassay and completed a second assessment from 2013-2016. Incident MetS was defined as ≥3 harmonized criteria at follow-up: impaired glycemic control, high systolic blood pressure, high triglycerides, low high-density lipoprotein (HDL), and increased waist circumference. Four sequential weighted logistic regression models were fitted to incident MetS overall and for each criterion separately, incorporating demographic factors, metabolic risk factors, HOMA-IR, and diet scores. Results: Over mean 9.4 (standard deviation [SD] 1.0) years follow up, 564 participants developed MetS. Median [IQR] plasma pro-NT/NMN was 160 [118-218] pmol/L. In the overall group, higher log pro-NT/NMN was associated with incidence of lower HDL (odds ratio [OR] per SD pro-NT/NMN 1.16, 95% confidence interval [CI] 1.00-1.35) and impaired glycemic control (1.25, 95% CI 1.11-1.40), but not other MetS components. Each SD higher log pro-NT/NMN was associated with a 22% increased odds of incident MetS, adjusted for demographics (Table); this was not significant when controlling for HOMA-IR in all but the White subgroup (race p -interaction 0.05). No differences by sex were observed. Conclusions: Higher neurotensin likely augments insulin resistance to increase odds of incident metabolic syndrome through impaired glycemic control and lower HDL.

scholarly journals Sensor-as-a-Service: Convergence of Sensor Analytic Point Solutions (SNAPS) and Pay-A-Penny-Per-Use (PAPPU) Paradigm as a Catalyst for Democratization of Healthcare in Underserved Communities

Diagnostics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 22 ◽  
Author(s):  
Victoria Morgan ◽  
Lisseth Casso-Hartmann ◽  
David Bahamon-Pinzon ◽  
Kelli McCourt ◽  
Robert G. Hjort ◽  
...  
Keyword(s):  
Low Income ◽  
Economically Disadvantaged ◽  
Technology Development ◽  
Point Of Care ◽  
Diagnostic Tools ◽  
Marginalized Communities ◽  
Community Environment ◽  
Service Convergence ◽  
The Social

In this manuscript, we discuss relevant socioeconomic factors for developing and implementing sensor analytic point solutions (SNAPS) as point-of-care tools to serve impoverished communities. The distinct economic, environmental, cultural, and ethical paradigms that affect economically disadvantaged users add complexity to the process of technology development and deployment beyond the science and engineering issues. We begin by contextualizing the environmental burden of disease in select low-income regions around the world, including environmental hazards at work, home, and the broader community environment, where SNAPS may be helpful in the prevention and mitigation of human exposure to harmful biological vectors and chemical agents. We offer examples of SNAPS designed for economically disadvantaged users, specifically for supporting decision-making in cases of tuberculosis (TB) infection and mercury exposure. We follow-up by discussing the economic challenges that are involved in the phased implementation of diagnostic tools in low-income markets and describe a micropayment-based systems-as-a-service approach (pay-a-penny-per-use—PAPPU), which may be catalytic for the adoption of low-end, low-margin, low-research, and the development SNAPS. Finally, we provide some insights into the social and ethical considerations for the assimilation of SNAPS to improve health outcomes in marginalized communities.

scholarly journals Incremental Benefit-Cost of MOMCare: Collaborative Care for Perinatal Depression Among Economically Disadvantaged Women

2017 ◽  
Vol 68 (11) ◽  
pp. 1164-1171 ◽  
Author(s):  
Nancy K. Grote ◽  
Gregory E. Simon ◽  
Joan Russo ◽  
Mary Jane Lohr ◽  
Kathy Carson ◽  
...  
Keyword(s):  
Collaborative Care ◽  
Economically Disadvantaged ◽  
Perinatal Depression ◽  
Incremental Benefit ◽  
Disadvantaged Women ◽  
Benefit Cost
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