Biocultural and social determinants of ill health and early mortality in a New Mexican paediatric autopsy sample.

RESULTS.: Hispanic children have higher odds of growth stunting than non-Hispanic White children. Native American children die younger and have higher odds of respiratory diseases and porous lesions than Hispanic and non-Hispanic Whites. Rural/urban location does not significantly impact age at death, but housing type does. Individuals who lived in trailers/mobile homes had earlier ages at death. When intersections between housing type and housing location are considered, children who were poor and from impoverished areas lived longer than those who were poor from relatively well-off areas. CONCLUSIONS.: Children's health is shaped by factors outside their control. The children included in this study embodied experiences of social and ELS and did not survive to adulthood. They provide the most sobering example of the harm that social factors (structural racism/discrimination, socioeconomic, and political structures) can inflict.

Rural Population Health and Aging: Introduction to the Special Issue.

This special issue of the Journal of Rural Social Sciences (JRSS) focuses on rural population health and aging. It showcases the work of scholars from several backgrounds and social science disciplines to advance knowledge in a critical field of investigation. Assembled through an open call for submissions coordinated through the National Institute on Aging (NIA) funded Interdisciplinary Network on Rural Population Health and Aging (INRPHA), the collection of articles helps inform a more nuanced understanding of the factors associated with rural places, which often have different health outcomes and aging patterns than their urban counterparts. The authors achieve this through application of innovative analytical strategies used with a combination of data sources. This introductory essay provides background and an overview of the four articles, followed by discussion of future opportunities to advance an agenda for rural population health and aging research.

Rural Population Health and Aging: Toward a Multilevel and Multidimensional Research Agenda for the 2020s.

The unique health and aging challenges of rural populations often go unnoticed. In fact, the rural United States is home to disproportionate shares of older and sicker people, there are large and growing rural-urban and within-rural mortality disparities, many rural communities are in population decline, and rural racial/ethnic diversity is increasing.Yet rural communities are not monolithic, and although some rural places are characterized by declining health, others have seen large improvements in population health. We draw on these realities to call for new research in five areas.First, research is needed to better describe health disparities between rural and urban areas and, because rural places are not monolithic, across rural America. Second, research is needed on how trends in rural population health and aging are affecting rural communities. Third, research is needed on the ways in which economic well-being and livelihood strategies interact with rural health and aging. Fourth, we need to better understand the health implications of the physical and social isolation characterizing many rural communities. Finally, we argue for new research on the implications of local natural environments and climate change for rural population health and aging.

Prognostic value of late gadolinium enhancement in clinical outcomes for hypertrophic cardiomyopathy.

OBJECTIVES: The objective of this study was to perform a systematic review and meta-analysis of the predictive value of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) for future cardiovascular events and death in hypertrophic cardiomyopathy (HCM). BACKGROUND: The utility of LGE for detecting myocardial fibrosis is well established. The prognostic value of LGE in HCM has been described in several studies, but controversy exists given the limited power of these studies to predict future events. METHODS: We searched multiple databases including PubMed for studies of LGE in HCM that reported selected clinical outcomes (cardiovascular mortality, sudden cardiac death [SCD], aborted SCD, and heart failure death). We performed a systematic review of the literature and meta-analysis to determine pooled odds ratios for these clinical events. RESULTS: Four studies evaluated 1,063 patients over an average follow-up of 3.1 years. The pooled prevalence of LGE was 60%. The pooled odds ratios (OR) demonstrate that LGE by CMR correlated with cardiac death (pooled OR: 2.92, 95% confidence interval [CI]: 1.01 to 8.42; p = 0.047), heart failure death (pooled OR: 5.68, 95% CI: 1.04 to 31.07; p = 0.045), and all-cause mortality (pooled OR: 4.46, 95% CI: 1.53 to 13.01; p = 0.006), and showed a trend toward significance for predicting sudden death/aborted sudden death (pooled OR: 2.39, 95% CI: 0.87 to 6.58; p = 0.091). CONCLUSIONS: Late gadolinium enhancement by CMR has prognostic value in predicting adverse cardiovascular events among HCM patients. There are significant relationships between LGE and cardiovascular mortality, heart failure death, and all-cause mortality in HCM. Additionally, LGE and SCD/aborted SCD displayed a trend toward significance. The assessment of LGE by CMR has the potential to provide important information to improve risk stratification in HCM in clinical practice.

Did H1N1 influenza prevention messages reach the vulnerable population along the Mississippi Gulf Coast?

OBJECTIVE: To identify the primary sources of information utilized by a vulnerable population during the 2009 influenza pandemic and examine disease prevention behaviors related to reports of local H1N1 influenza transmission. DESIGN: Cross-sectional study. SETTING: Between May 2009 and December 2009, face-to-face interviews were conducted in towns located in 3 Mississippi counties along the Gulf Coast. PARTICIPANTS: Two hundred sixteen residents of the Mississippi Gulf Coast were interviewed. MAIN OUTCOME MEASURES: Analysis of the interview results described awareness of the influenza outbreak/pandemic and sources of information about the situation. Chi-square tests were used to examine differences in reported disease-preventive behaviors taken by Mississippi Gulf Coast residents before and after H1N1 influenza transmission was confirmed locally. RESULTS: Most subjects were aware of H1N1 influenza at the time of interview (n = 212; 98%). Television (n = 145; 69%), newspaper (n = 40; 19%), and the Internet (n = 19; 9%) were the most common sources of information regarding H1N1 influenza. Hand hygiene (n = 85; 41%) was the most reported preventive measure adopted by study subjects and increased following the confirmation of the first H1N1 influenza cases in Harrison County (χ= 4.46, p= 0.04). CONCLUSIONS: The Centers for Disease Control and Prevention's emphasis on providing health information about H1N1 primarily through the Internet may not have been effective in reaching the public. Provision of health messages through various mediums, especially television, may better inform the public of disease-related prevention messages during a developing influenza pandemic.

Challenges to accessing pediatric health care in the Mississippi delta: a survey of emergency department patients seeking nonemergency care.

BACKGROUND: Increases in hospital emergency department use have been driven by insured patients with problems accessing primary care services. Access problems are especially pronounced in rural communities with health professional shortages. This qualitative study explored reasons for nonurgent pediatric emergency department use in the Mississippi Delta. METHOD: Using a community-based participatory research framework, a semistructured survey was administered face-to-face in a hospital emergency department waiting room with parents/caregivers who brought their children. Interviews were done over 144 hours in 2-hour blocks covering regular "business hours" and "after hours" (evenings/weekends). Open-ended items allowed qualitative data to be gathered describing reasons for emergency department use and perceptions of urgency of the visit in the parents'/caregivers' own words. RESULTS: There were 112 children, with a response rate of 87%. The mean child age was 5.7 years; 52% were male; 95% were African American and 5% white; 80.6% had Medicaid/SCHIP, 7.8% commercial, and 3.9% other insurance; 7.8% were uninsured. Most (88%) had a usual source of pediatric care. Only 24.3% tried to obtain care before emergency department visit; 23.2% said their children required "urgent" care. Mean distance from home to usual source of care was 10 miles. Ten percent cited transportation as a barrier to keeping health care appointments; 5.5% cited insurance or cost. Families who used the emergency department during evening/weekends were significantly more likely to have cited clinic hours of operation as a reason care was not sought previously than were "business hours" users, who emphasized convenience. CONCLUSION: Nonurgent pediatric emergency department use could be reduced by extending clinic hours, adding a walk-in service, and making transportation more available.

Calcitriol modulation of cardiac contractile performance via protein kinase C.

Vitamin D(3) deficiency enhances cardiac contraction in experimental studies, yet paradoxically this deficiency is linked to congestive heart failure in humans. Activated vitamin D(3) (1alpha,25-dihydroxyvitamin D(3)) or calcitriol, decreases peak force and activates protein kinase C (PKC) in isolated perfused hearts. However, the direct influence of this hormone on adult cardiac myocyte contractile function is not well understood. Our aim is to investigate whether 1alpha,25-dihydroxyvitamin D(3) acutely modulates contractile function via PKC activation in adult rat cardiac myocytes. Sarcomere shortening and re-lengthening were measured in electrically stimulated myocytes isolated from adult rat hearts, and the vitamin D(3) response (10(-10) to 10(-7) M) was compared to shortening observed under basal conditions. Maximum changes in sarcomere shortening and relaxation were observed with 10(-9) M 1alpha,25-dihydroxyvitamin D(3). This dose decreased peak shortening, and accelerated contraction and relaxation rates within 5 min of administration, and changes in the Ca(2+) transient contributed to the peak shortening and relaxation effects. The PKC inhibitor, bis-indolylmaleimide (500 nM) largely blocked the acute influence of the most potent dose (10(-9) M) on contractile function. While peak shortening and shortening rate returned to baseline within 30 min, there was a sustained acceleration of relaxation that continued over 60 min. Phosphorylation of the Ca(2+) regulatory proteins, phospholamban, and cardiac troponin I correlated with the accelerated relaxation observed in response to acute application of 1alpha,25-dihydroxyvitamin D(3). Accelerated relaxation continued to be observed after chronic addition of 1alpha,25-dihydroxyvitamin D(3) (e.g. 2 days), yet this sustained increase in relaxation was not associated with increased phosphorylation of phospholamban or troponin I. These results provide evidence that 1alpha,25-dihydroxyvitamin D(3) directly modulates adult myocyte contractile function, and protein kinase C plays an important signaling role in the acute response. Phosphorylation of key Ca(2+) regulatory proteins by this kinase contributes to the enhanced relaxation observed in response to acute, but not chronic calcitriol.