The Association between Educational Attainment and Patterns of Emergency Department Utilization among Adults with Sickle Cell Disease.

PURPOSE: Patients with low educational attainment may be at increased risk for unplanned health care utilization. This study aimed to determine what factors are related to emergency department (ED) visits in hopes of guiding treatments and early interventions. METHODS: At two medical centers in the Mid-Atlantic United States, 258 adults with sickle cell disease aged 19-70 years participated in a retrospective study where we examined whether education level is independently associated with ED visits after accounting for other socioeconomic status (SES) variables, such as pain and disease severity and psychosocial functioning. RESULTS: The data showed that patients without a high school education visited the ED three times as frequently as patients with post secondary education. Controlling for poverty and employment status decreased the effect of education on ED visits by 33.24 %. Further controlling for disease severity and/or psychosocial functioning could not account for the remaining association between education and ED visits, suggesting that education is independently associated with potentially avoidable emergency care. CONCLUSIONS: Early interventions addressing disparities in academic performance, especially for those children most at risk, may lead to improved long-term health outcomes in this population.

The effects of neuroticism and extraversion on cardiovascular reactivity during a mental and an emotional stress task.

UNLABELLED: Evidence suggests that physiological reactivity to mental and emotional stress may be influenced by personality traits. OBJECTIVES: This study aimed to examine the relationship between, emotionally based personality traits, Neuroticism (N) and Extraversion (E), and cardiovascular reactivity (CVR) during mental arithmetic (MA) and anger recall (AR). METHODS: Heart rate, blood pressure, cardiac output and total peripheral resistance were measured in 114 Singaporean male patrol officers from the Singapore Police Force while they performed MA and AR tasks. N and E were assessed using the NEO PI-R. RESULTS: Higher N was associated with lower DBP and TPRI reactivity during MA as compared to lower N, but higher TPRI reactivity during AR. Lower E scores were associated with heightened CVR while higher E scores were associated with lower CVR. For SBP and HR, E was associated with a reduction in reactivity across tasks; whereas, for DBP and TPRI this reduction was found only during AR. CONCLUSION: In this population, N had differential effects on CVR depending upon the nature of the stress task, cognitive or emotional. However, higher E was consistently linked to lower CVR during stress tasks and appeared to influence how individuals express and cope with anger.