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Objective The aim of this study is to compare the prevalence of hypertension (HTN) in pre-clinical (first- and second-year) medical students at Lincoln Memorial University to that of the United States population and identify risk factors in this group. Materials and Methods Students from the DeBusk College of Osteopathic Medicine completed a survey that queried age, gender, tobacco use, alcohol consumption, diet, aerobic exercise, mental health, social support, amount of sleep per night, and past medical history. Omron BP710N (Omron 3 series) sphygmomanometers were used to measure blood pressures in the left arm. Waist circumference was measured around the umbilicus. HTN stages were defined under the 2017 ACC/AHA guidelines. Univariate, binominal, and multinomial regression analyses of risk factors were performed using SPSS v22.0 with α = 0.05. Results Of the 213 students surveyed, 49.8% (106/213) were males, 49.3% (105/213) were females, and 0.9% (2/213) declined to reveal their gender. The mean age of the sample was 25.8 years (SD = 2.75 years) and the range was between 21 and 37 years. Under the 2017 ACC/AHA guidelines, 36.6% (78/213) were normotensive; 16.4% (35/213) had elevated blood pressure; 29.1% (62/213) had stage 1 HTN; and 17.8% (38/213) had stage 2 HTN. A multinomial logistic regression model was significant, χ 2(9) = 82.934, p < 0.001, explained 34.9% (Nagelkerke R2) of the variance in HTN, and correctly classified 50.2% of cases. In comparison to normotensive females, normotensive males are 2.81 times more likely (95% CI: 1.04-7.61; p = 0.042) to develop stage 2 HTN; increasing waist circumference by 1 cm in normotensive students was associated with a 10% increase (95% CI: 1.06-1.15; p < 0.001) in developing stage 2 HTN; and sleeping <6 hours per night was associated with 4.33 times increased (95% CI: 1.52-12.34; p = 0.006) likelihood of developing stage 2 HTN with respect to normotensive students who sleep for 6-8 hours a night. Conclusion Our sample of medical students has a 2.4 times higher prevalence of stage 2 HTN readings in comparison to adults aged 18-39 according to the 2015-2016 national CDC hypertension prevalence report. Risk factors including male gender and sleeping less than 6 hours per night are significant predictors of elevated and stage 2 HTN. Waist circumference is predictive of stage 1 HTN and stage 2 HTN. Additional studies should be conducted to increase the sample size in order to better assess the prevalence of stage 2 HTN in American medical students.
RESUMEN
Relevance Although the seasonal flu vaccine remains the most effective way to prevent the spread of influenza and reduce its associated mortalities, the proportion of individuals receiving the vaccine continues to be an issue in various communities across the United States. The attitudes of residents who live in Sneedville, a small town in a rural northeastern Tennessee, were surveyed. Objective(s) To determine the barriers to influenza vaccination in Sneedville, Tennessee and contribute to the literature on why some rural communities across the United States show low influenza vaccination rates. Materials and Methods Door-to-door convenience sampling was conducted in Sneedville, TN. Participants were asked to complete a survey consisting of --three yes or no demographic questions (one with an option to further elaborate) and nine opinion questions based on a five-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = undecided, 4 = agree, 5 = strongly agree). Participants were not provided any additional details pertaining to the Likert scale questions and were given the option to skip the Likert scale questions. These questions were chosen to gauge the potential structural, socioeconomic, belief, and provider-related barriers to vaccination. Two-tailed independent t-tests were used to compare the Likert scale means for each of the nine opinion questions in those that received the influenza vaccine and those who did not. Univariate analysis was conducted to assess difference in the distribution of Likert responses in vaccinators compared to non-vaccinators. Results This project surveyed 172 residents of which 60.5% (104/172) indicated that they did not receive the influenza vaccine for the 2017-2018 flu season. Compared to individuals who vaccinate against the flu, individuals who do not vaccinate against the flu believe the flu shot is not worthwhile and believe the flu shot has a greater chance to make them sick. Conclusions This study finds that structural, socioeconomic, and provider-related barriers are not the underlying cause of the low influenza vaccination rates in this rural area. Instead, public opinion on influenza vaccination seems to be the reason for the disparity.