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Prevalence of Cholesterol Screening and High Blood Cholesterol Among Adults — United States, 2005, 2007, and 2009
Prevalence of Cholesterol Screening and High Blood Cholesterol Among Adults — United States, 2005, 2007, and 2009
Source: Morbidity and Mortality Weekly Report (CDC)
High blood cholesterol is a leading risk factor in the development of atherosclerosis and coronary heart disease (CHD) (1,2). The risks associated with high blood cholesterol can be reduced by screening and early intervention (3). Current clinical practice guidelines provide evidenced-based standards for detection, treatment, and control of high blood cholesterol (4). Healthy People 2020 monitors national progress related to screening and controlling high blood cholesterol through the National Health Interview Survey and the National Health and Nutrition Examination Survey (NHANES). State-level estimates of self-reported cholesterol screening and high blood cholesterol prevalence are available using Behavioral Risk Factor Surveillance System (BRFSS) data. To assess recent trends in the percentage of adults aged ≥18 years who had been screened for high blood cholesterol during the preceding 5 years, and the percentage among those who had been screened within the previous 5 years and who were ever told they had high blood cholesterol, CDC analyzed BRFSS data from 2005, 2007, and 2009. The results of that analysis showed that the percentage of adults reporting having been screened for high blood cholesterol within the preceding 5 years increased overall from 72.7% in 2005 to 76.0% in 2009. In addition, the percentage who had ever been told they had high cholesterol increased from 33.2% to 35.0%. Both self-reported screening and high cholesterol varied by state and sociodemographic subgroup. To reach the Healthy People 2020 target for cholesterol screening, public health practitioners should emphasize the importance of screening, especially among younger adults, men, Hispanics, and persons with lower levels of education.
Adults experiencing mental illness have higher rates of certain chronic physical illnesses
A new report shows that adults (aged 18 and older) who had a mental illness in the past year have higher rates of certain physical illnesses than those not experiencing mental illness. According to the report by the Substance Abuse and Mental Health Services Administration (SAMHSA), adults aged 18 and older who had any mental illness, serious mental illness, or major depressive episodes in the past year had increased rates of high blood pressure, asthma, diabetes, heart disease, and stroke.For example, 21.9 percent of adults experiencing any mental illness (based on the diagnostic criteria specified in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)) in the past year had high blood pressure. In contrast, 18.3 percent of those not experiencing any mental illness had high blood pressure. Similarly, 15.7 percent of adults who had any mental illness in the past year also had asthma, while only 10.6 percent of those without mental illness had this condition.Adults who had a serious mental illness (i.e., a mental illness causing serious functional impairment substantially interfering with one or more major life activities) in the past year also evidenced higher rates of high blood pressure, asthma, diabetes, heart disease and stroke than people who did not experience serious mental illnesses.Adults experiencing major depressive episodes (periods of depression lasting two weeks or more in which there were significant problems with everyday aspects of life such as sleep, eating, feelings of self-worth, etc.) had higher rates of the following physical illnesses than those without past-year major depressive episodes: high blood pressure (24.1 percent vs. 19.8 percent), asthma (17.0 percent vs. 11.4 percent), diabetes (8.9 percent vs. 7.1 percent), heart disease (6.5 percent vs. 4.6 percent), and stroke (2.5 percent vs. 1.1 percent).
+ Full Report (PDF)
Programs Addressing Psychological Health and Traumatic Brain Injury Among U.S. Military Servicemembers and Their Families
Programs Addressing Psychological Health and Traumatic Brain Injury Among U.S. Military Servicemembers and Their Families
Source: RAND Corporation
Over the last decade, U.S. military forces have been engaged in extended conflicts that are characterized by increased operational tempo, most notably in Iraq and Afghanistan. While most military personnel cope well across the deployment cycle, many will experience difficulties handling stress at some point; will face psychological health challenges, such as post-traumatic stress disorder or major depression; or will be affected by the short- and long-term psychological and cognitive consequences of a traumatic brain injury (TBI). Over the past several years, the Department of Defense (DoD) has implemented numerous programs that address various components of psychological health along the resilience, prevention, and treatment continuum and focus on a variety of clinical and nonclinical concerns. This comprehensive catalog of programs currently sponsored or funded by DoD to address psychological health and TBI provides overviews and detailed descriptions of 211 programs, along with a description of how programs relate to other available resources and care settings. It also provides recommendations for clarifying the role of programs, examining gaps in routine service delivery that could be filled by programs, and reducing implementation barriers. Barriers include inadequate funding and resources, concerns about the stigma associated with receiving psychological health services, and inability to have servicemembers spend adequate time in programs. The authors found that there is significant duplication of effort, both within and across branches of service. As each program develops its methods independently, it is difficult to determine which approaches work and which are ineffective. Recommendations include strategic planning, centralized coordination, and information-sharing across branches of service, combined with rigorous evaluation. Programs should be evaluated and tracked in a database, and evidence-based interventions should be used to support program efforts.
Trust for America’s Health Releases Healthier Americans for a Healthier Economy
Trust for America’s Health Releases Healthier Americans for a Healthier Economy
Source: Trust for America
Trust for America’s Health (TFAH) released a new report, Healthier Americans for a Healthier Economy, featuring six case studies focused on the relationship between health and economic development. The report examines how health affects the ability of states, cities and towns to attract and retain employers, and how workplace and community wellness programs help improve productivity and reduce health spending.
“High rates of chronic diseases, like diabetes and heart disease, are among the biggest drivers of U.S. health care costs and they are harming our nation’s productivity,” said Jeff Levi, PhD, Executive Director of TFAH, and Chair of the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. “Workplace wellness and community prevention programs are a win-win way to make a real difference in improving our health and bottom line all at once.”
According to the report, more than half of all Americans currently live with one or more chronic disease, including heart disease, stroke, diabetes and cancer. High rates of these diseases, which in many cases are preventable, are associated with increasing health care costs.
The case studies in the report feature first-hand accounts from business executives, elected officials and public health leaders in Minnesota, Texas, Nashville, Indiana, San Diego and Hernando, Mississippi, where employers and communities are making the connection between improving health and improving the economy.
Transition of Care for Acute Stroke and Myocardial Infarction Patients: From Hospitalization to Rehabilitation, Recovery, and Secondary Prevention
Transition of Care for Acute Stroke and Myocardial Infarction Patients: From Hospitalization to Rehabilitation, Recovery, and Secondary Prevention (PDF)
Source: Agency for Healthcare Research and Quality
A total of 62 articles representing 44 studies were included for data abstraction. Transition of care interventions were grouped into four categories: (1) hospital-initiated support for discharge was the initial stage in the transition of care process, (2) patient and family education interventions were started during hospitalization but were continued at the community level, (3) community-based models of support followed hospital discharge, and (4) chronic disease management models of care assumed the responsibility for long-term care. Early supported discharge after stroke was associated with reduced total hospital length of stay without adverse effects on functional recovery, and specialty care after MI was associated with reduced mortality. Because of several methodological shortcomings, most studies did not consistently demonstrate that any specific intervention resulted in improved patient- or system-based outcomes. Some studies included more than one intervention, which made it difficult to determine the effect of individual components on clinical outcomes. There was inconsistency in the definition of what constituted a component of transition of care compared to “standard care.” Standard care was poorly defined, and nearly all studies were underpowered to demonstrate a statistical benefit. The endpoints varied greatly from study to study. Nearly all the studies were single-site based, and most (26 of 44) were conducted in countries with national health care systems quite different from that of the U.S., therefore limiting their generalizability.
Apixaban versus Warfarin in Patients with Atrial Fibrillation
Apixaban versus Warfarin in Patients with Atrial Fibrillation
Source: New England Journal of Medicine
In patients with atrial fibrillation, apixaban was superior to warfarin in preventing stroke or systemic embolism, caused less bleeding, and resulted in lower mortality. (Funded by Bristol-Myers Squibb and Pfizer; ARISTOTLE ClinicalTrials.gov number, NCT00412984.)
Incident cognitive impairment is elevated in the stroke belt: The REGARDS Study
Incident cognitive impairment is elevated in the stroke belt: The REGARDS Study
Source: Annals of Neurology
Regional disparities in cognitive decline mirror regional disparities in stroke mortality, suggesting shared risk factors for these adverse outcomes. Efforts to promote cerebrovascular and cognitive health should be directed to the Stroke Belt. ANN NEUROL 2011
The Reasons for Geographic and Racial Differences in Stroke (REGARDS) study is an epidemiological study following a cohort of US adults for stroke and cognitive decline. In reports from REGARDS, self-reported stroke symptoms in the absence of diagnosed stroke were considered as potential markers of ischemic changes. Such symptoms, reported by 18% of REGARDS participants,1 were associated with a 24% increased risk of prevalent cognitive impairment after controlling for age, sex, race, education, and region of residence.2 Decrements in cognitive function may serve in some cases as a proxy for unrecognized small strokes,2 a notion that is supported by demonstrated associations between magnetic resonance imaging-defined silent brain infarcts, cognitive deficits, and incident dementia.3–7 It is not known, however, whether incidence of cognitive impairment is elevated in the Stroke Belt region of the United States, a region of the southeastern United States first described in 1965 as having 50% higher stroke mortality rates than the remaining United States.8 Centers for Disease Control and Prevention state statistics from 2000 to 2006 reveal that among adults aged 35 years and older, age-adjusted annual rates of stroke mortality in the 8 Stroke Belt states were, on average, 125 per 100,000, compared to an average rate of 96 per 100,000 in the remaining 40 contiguous states and the District of Columbia.9 During the same period, age-adjusted stroke hospitalization rates among Medicare beneficiaries aged 65 years and older followed a similar pattern of higher concentration in the Stroke Belt.9
It is plausible that incidence of cognitive impairment might be elevated in the Stroke Belt due to subclinical strokes and cerebrovascular disease as well as to precursor or concomitant risk factors for both stroke and cognitive impairment, such as hypertension, diabetes, kidney disease, and metabolic syndrome.10–16 The purpose of the present analysis from the REGARDS study was to examine incident impairment in cognitive screening status in the southern Stroke Belt region relative to the remaining 40 contiguous states. Among participants who had intact cognitive screening status at baseline and no history of stroke, we predicted regional differences in incident cognitive impairment that reflect well-documented regional differences in stroke incidence and mortality. Specifically, we hypothesized that there would be greater occurrence of incident impairment in cognitive screening performance in the Stroke Belt relative to the rest of the United States.
