bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vagal Enhancement as Evidence of Residual Ischemia After Inferior Myocardial Infarction
Authors: KAWASAKI TATSUYA , AKAKABE YOSHIKI , YAMANO MICHIYO , MIKI SHIGEYUKI , KAMITANI TADAAKI , KURIBAYASHI TOSHIRO , MATSUBARA HIROAKI , SUGIHARA HIROKI 
Published: December 2008

Background: Acute inferior myocardial infarction (MI) often induces transient sinus bradycardia through vagal enhancement, known as Bezold‐Jarisch reflex, which is explained by preferential distribution of vagal nerve in the inferior wall. We examined vagal activity in relation to the occurrence of residual ischemia in patients with old inferior MI and assessed its diagnostic usefulness.
Methods: Exercise myocardial scintigraphy was performed in 15 patients with old inferior MI, 19 angina pectoris (AP) patients with inferior ischemia but no MI, and 32 control subjects who had no evidence of cardiac disease. We analyzed the connection of residual ischemia in old MI with ST‐segment response to exercise and with vagal activity as determined by coefficient of component variance of high frequency (CCVHF).
Results: Exercise‐induced percentage change in CCVHF was higher in patients with old MI and residual ischemia (18.8 ± 13.5%) and AP (5.5 ± 9.7%) than old MI but no residual ischemia (–24.1 ± 4.9%) or control (–22.8 ± 4.5%, P = 0.006). Percentage change in CCVHF > –5% had a good diagnostic value for the detection of residual ischemia in patients with old inferior MI with sensitivity of 83%, specificity of 89%, accuracy of 87%, and positive likelihood ratio of 7.50, which was higher than that of ST‐segment depression (67%, 50%, 56%, and 1.33).
Conclusions: Vagal enhancement was associated with residual ischemia in old inferior MI as well as inferior AP. Measurement of CCVHF is useful in improving the diagnostic reliability of exercise electrocardiography in patients with old inferior MI.
Diagnosis of Paroxysmal Atrial Fibrillation in Patients with Implanted Pacemakers: Relationship to Symptoms and Other Variables
Authors: QUIRINO GIANLUCA , GIAMMARIA MASSIMO , CORBUCCI GIORGIO , PISTELLI PAOLO , TURRI ELENA , MAZZA ANTONIO , PERUCCA ANTONELLO , CHECCHINATO CATIA , DALMASSO MAURIZIO , BAROLD S. SERGE 
Published: December 2008

Background: Atrial fibrillation (AF) is not always accompanied by clear‐cut symptoms and symptoms suggestive of AF may not correspond to a genuine AF episode. The study prospectively evaluated the burden of asymptomatic AF episodes in pacemaker patients (for sick sinus syndrome) with a history of documented paroxysmal AF.
Methods: Consecutive patients were enrolled and implanted with dual‐chamber pacemakers equipped with diagnostic features for AF monitoring. Each patient was instructed about typical AF symptoms and was asked to keep a detailed log of symptoms. Stored pacemaker data were analyzed using only AF episodes >30 s.
Results: The mean follow‐up was 16 ± 6 months and 102 patients were enrolled (73 ± 7 years, 59 M). Thirteen patients (13%) dropped out with the development of permanent AF and their data were discarded. Twenty‐three patients (26%) without device‐stored AF episodes all reported at least one annotated AF episode. There were 1,245 device‐stored AF episodes in 66 (74%) out of 89 patients. Patients reported 1,141 episodes of AF‐related symptoms. Only 240 (21%) corresponded to a genuine device‐stored AF event. The sensitivity and positive predictive value of symptoms to detect AF were respectively 19% and 21%. Episode duration, rate increase at the onset of the arrhythmia, heart disease, or antiarrhythmic drug therapy showed no statistically significant differences comparing symptomatic and asymptomatic episodes.
Conclusions: Many pacemaker patients with paroxysmal AF can develop AF‐like symptoms in the absence of device‐stored AF. AF‐related symptoms have low sensitivity and low positive predictive value in patients with permanent pacemakers.
Combination of Doxazosin and Sildenafil Exerts an Additive Relaxing Effect Compared with Each Compound Alone on Human Cavernosal and Prostatic Tissue
Authors: Oger Stéphanie , Behr-Roussel Delphine , Gorny Diane , Lecoz Olivier , Lebret Thierry , Denoux Yves , Faix Antoine , Leriche Albert , Wayman Chris , Alexandre Laurent , Giuliano François 
Published: December 2008

ABSTRACT

Introduction
Phosphodiesterase 5 inhibitors (PDE5) such as sildenafil are first-line treatment for erectile dysfunction (ED). Alpha1 (α1)-adrenoceptor antagonists such as doxazosin are indicated for the treatment of patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). ED and LUTS/BPH are conditions that are often associated. Accordingly, α1-adrenoceptor antagonists and PDE5 inhibitors will be often prescribed in real life setting together.

Aim
To evaluate the effects of the combination of sildenafil and doxazosin on human cavernosal and prostatic tissue.

Methods
Prostatic and erectile tissues were obtained from nine to 12 patients, respectively. Patients underwent cystoprostatectomy for infiltrating bladder cancer or penile surgery for penile implant, congenital curvature or Peyronie’s disease.

Main Outcome Measures
In organ baths, prostatic and cavernosal strips were submitted to either concentration-response curves (CRC) to phenylephrine (Phe) or norepinephrine (NE), respectively, in presence of vehicle, sildenafil (10−6 M, 10−5 M), doxazosin (10−8 M, 3.10−8 M, or 10−7 M), or a combination of both. Continuous electrical field stimulation (EFS; 32 Hz, 5 ms, 5 seconds, 300 mA) was performed on prostatic strips which were incubated with sildenafil 10−6 M or vehicle before the successive addition of doxazosin (10−7 M, 10−6 M) or vehicle. Cavernosal strips were pre-incubated with doxazosin (10−9 M, 10−8 M) or vehicle, then CRC to sildenafil were constructed on NE (3.10−6 M) precontracted cavernosal strips.

Results
Combination of sildenafil and doxazosin exerted a greater relaxing effect on CRC to Phe or NE compared with each compound alone in both tissues. Sildenafil significantly enhanced the relaxing effect of doxazosin on EFS-induced contractions in prostatic strips. Doxazosin significantly increased the ability of sildenafil to inhibit NE-induced contractions in cavernosal strips.

Conclusions
Sildenafil and doxazosin reduced adrenergic tone of prostatic and cavernosal smooth muscle and their combination provided a significant benefit when targeting relaxation of both tissues. These experiments provide support for further clinical evaluation of the sildenafil and doxazosin combination in ED patients with LUTS/BPH.
Sustaining the Rural Workforce: Nursing Perspectives on Worklife Challenges
Authors: Hunsberger Mabel , Baumann Andrea , Blythe Jennifer , Crea Mary 
Published: December 2008

ABSTRACT:
Context: Concerns have been raised about the sustainability of health care workforces in rural settings. According to the literature, rural nurses’ work satisfaction varies with the resources and supports available to respond to specific challenges. Given the probable effects of stressors on retention, it is essential to understand the unique requirements of nurses in rural practice environments. Purpose: To investigate whether nurses receive the resources and supports necessary to meet the challenges of rural practice. Methods: Semi‐structured interviews were conducted with 21 managers and 44 staff nurses in 19 selected rural hospitals in Ontario, Canada. The interviews were taped and transcripts interpreted through a thematic analysis. Major worklife themes were identified and analyzed within a healthy work environment model based on the work of Kristensen. Findings: Three interrelated dimensions of the model were relevant to workforce sustainability: the balance between demands and the resources of the person, the level of social support, and the degree of influence. The availability of resources and supports affected whether the nurses perceived challenges as stimulating or overwhelming. Deficits interfered with practice and the well‐being of the nurses and patients. Conclusions: The nurses felt frustrated and powerless when they lacked resources, support, and influence to manage negative situations. Strategies to achieve workforce sustainability include resources to reduce stress in the workplace, education to meet the needs of new and experienced nurses, and offering of employment preferences to the workforce. Addressing resources, support, and influence of rural nurses is essential to alleviate workplace challenges and sustain the rural nursing workforce.
Trends in the Rehabilitation Therapist Workforce in Underserved Areas: 1980‐2000
Authors: Wilson Richard D. , Lewis Steven A. , Murray Patrick K. 
Published: December 2008

ABSTRACT:
Context: There is little information about how increases in the rehabilitation therapist workforce have been distributed over the nation. There is evidence that rural areas continue to face a shortage of trained rehabilitation providers. There has also been little attention to therapist distribution in non‐rural settings where health professionals are in short supply. Purpose: To assess the change in the distribution of rehabilitation therapists in 1980, 1990, and 2000 across counties with different levels of health professional shortages and the difference between metropolitan and non‐metropolitan counties. Methods: A trend analysis of cross‐sectional data of employment of physical therapists, occupational therapists, and speech‐language pathologists from 1980 to 2000 by county, relative to population, was done. The groups were stratified by shortage area, partial shortage area, and non‐shortage counties and metropolitan and non‐metropolitan counties. Findings: There is a maldistribution of rehabilitation therapists in the United States. Although the absolute differences have remained the same or, in most instances, have increased, the relative change was greatest in the shortage areas and non‐metropolitan areas. If the trends in the relative changes continue, the absolute differences may begin to narrow. Conclusions: This study provides evidence that there are maldistributions of rehabilitation therapists in traditionally underserved areas. It is unclear if these maldistributions represent a shortage of rehabilitation therapists. Continued monitoring of the rehabilitation therapist workforce and the determination of the optimal supply should be undertaken in the future.
Exploring the Temperament and Character Traits of Rural and Urban Doctors
Authors: Eley Diann , Young Louise , Przybeck Thomas R. 
Published: December 2008

ABSTRACT:
Context: Australia shares many dilemmas with North America regarding shortages of doctors in rural and remote locations. This preliminary study contributes to the establishment of a psychobiological profile for rural doctors by comparing temperament and character traits with an urban cohort. Purpose: The aim was to compare the individual levels and combinations of temperament (mildly heritable and stable) and character (developmental and modifiable) traits of rural and urban general practitioners (GPs). Methods: Rural (n = 120) and urban (n = 94) GPs completed a demographic questionnaire and the TCI‐R 140 to identify levels of the 7 basic dimensions of temperament and character. These are Novelty Seeking (NS), Harm Avoidance (HA), Reward Dependence (RD), Persistence (PS), Self‐Directedness (SD), Cooperativeness (CO), and Self‐Transcendence (ST). Findings: Preliminary results show rural GPs were higher in the temperament traits of NS and lower in HA compared with the urban sample. All female GPs were higher in RD and CO compared with all males, and all older GPs (over 55 years) were lower in RD compared with all younger GPs. Conclusions: This preliminary work may be the precursor to a new approach for the recruitment and retention of rural doctors through a greater awareness of personality traits conducive to the rural workforce. Further work may help inform appropriate policies to attract and retain this workforce and be a useful adjunct to the counseling of students interested in rural medicine by providing a better understanding of “what it takes” to be a rural doctor.
Childhood Conduct Problems and Other Early Risk Factors in Rural Adult Stimulant Users
Authors: Kramer Teresa L. , Han Xiaotong , Leukefeld Carl , Booth Brenda M. , Edlund Carrie 
Published: December 2008

ABSTRACT:
Context: Understanding childhood risk factors associated with adult substance use and legal problems is important for treatment and prevention. Purpose: To examine the relationship of early substance use, conduct problems before age 15, and family history of substance abuse on adult outcomes in rural, stimulant users. Methods: Adult cocaine and methamphetamine users (N = 544) in rural Arkansas and Kentucky were interviewed. Data were analyzed using both bivariate analyses and multiple logistic and log‐linear regression models, with dependent variables being any substance abuse/dependence, stimulant abuse/dependence, total number of arrests since age 18 and days incarcerated since age 18. Findings: One third reported 3 or more conduct disorder problems prior to age 15; half reported initiation of substances (excluding alcohol) before age 15; and 60% reported family history of substance problems. All 3 variables were associated with adult substance abuse/dependence but only the latter two were associated with stimulant abuse/dependence. Conclusions: This study highlights early risk factors for adult substance abuse/dependence among rural stimulant users.
Rates of Physical Activity Among Appalachian Adolescents in Ohio
Authors: Hortz Brian , Stevens Emily , Holden Becky , Petosa R. Lingyak 
Published: December 2008

ABSTRACT:
Purpose: The purpose of this study was to describe the physical activity behavior of high school students living in the Appalachian region of Ohio. Methods: A cross‐sectional sample of 1,024 subjects from 11 schools in Appalachian Ohio was drawn. Previously validated instruments were used to measure physical activity behavior over 7 days. Findings: Appalachian adolescents fell short of recommended levels of activity. They reported high rates of sedentary behavior by 9th grade. Appalachian adolescents may be acquiring sedentary behaviors earlier than adolescents living in other regions. Low rates of activity make this population particularly at risk for the health consequences associated with inactivity.
Do Older Rural and Urban Veterans Experience Different Rates of Unplanned Readmission to VA and Non‐VA Hospitals?
Authors: Weeks William B. , Lee Richard E. , Wallace Amy E. , West Alan N. , Bagian James P. 
Published: December 2008

ABSTRACT:
Context: Unplanned readmission within 30 days of discharge is an indicator of hospital quality. Purpose: We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non‐VA hospitals than their urban counterparts. Methods: We used the combined VA/Medicare dataset to examine 3,513,912 hospital admissions for older veterans that occurred in VA or non‐VA hospitals between 1997 and 2004. We calculated 30‐day readmission rates and odds ratios for rural and urban veterans, and we performed a logistic regression analysis to determine whether living in a rural setting or initially using the VA for hospitalization were independent risk factors for unplanned 30‐day readmission, after adjusting for age, sex, length of stay of the index admission, and morbidity. Findings: Overall, rural veterans had slightly higher 30‐day readmission rates than their urban counterparts (17.96% vs 17.86%; OR 1.006, 95% CI: 1.0004, 1.013). For both rural‐ and urban‐dwelling veterans, readmission after using a VA hospital was more common than after using a non‐VA hospital (20.7% vs 16.8% for rural veterans, 21.2% vs 16.1% for urban veterans). After adjusting for other variables, readmission was more likely for rural veterans and following admission to a VA hospital. Conclusions: Our findings suggest that VA should consider using the unplanned readmission rate as a performance metric, using the non‐VA experience of veterans as a performance benchmark, and helping rural veterans select higher performing non‐VA hospitals.
Factors Associated with Iowa Rural Hospitals' Decision to Convert to Critical Access Hospital Status
Authors: Li Pengxiang , Ward Marcia M. , Schneider John E. 
Published: December 2008

ABSTRACT:
Context: The Balanced Budget Act (BBA) of 1997 allowed some rural hospitals meeting certain requirements to convert to Critical Access Hospitals (CAHs) and changed their Medicare reimbursement from prospective to cost‐based. Some subsequent CAH‐related laws reduced restrictions and increased payments, and the number of CAHs grew rapidly. Purpose: To examine factors related to hospitals' decisions to convert and time to CAH conversion. Methods: Eighty‐nine rural hospitals in Iowa were characterized and observed from 1998 to 2005. Cox proportional hazards models were used to identify the determinants of time to CAH conversion. Findings: T‐test and one‐covariate Cox regression indicated that, in 1998, Iowa rural hospitals with more staffed beds, discharges, and acute inpatient days, higher operating margin, lower skilled swing bed days relative to acute days, and located in relatively high density counties were more likely to convert later or not convert before 2006. Multiple Cox regression with baseline covariates indicated that lower number of discharges and average length of stay (ALOS) were significant after controlling all other covariates. Conclusion: Iowa rural hospitals' decisions regarding CAH conversion were influenced by hospital size, financial condition, skilled swing bed days relative to acute days, length of stay, proportion of Medicare acute days, and geographic factors. Although financial concerns are often cited in surveys as the main reason for conversion, lower number of discharges and ALOS are the most prominent factors affecting rural hospitals' decision on when to convert.
Electronic Patient Registries Improve Diabetes Care and Clinical Outcomes in Rural Community Health Centers
Authors: Pollard Cecil , Bailey Kelly A. , Petitte Trisha , Baus Adam , Swim Mary , Hendryx Michael 
Published: December 2008

ABSTRACT:
Context: Diabetes care is challenging in rural areas. Research has shown that the utilization of electronic patient registries improves care; however, improvements generally have been described in combination with other ongoing interventions. The level of basic registry utilization sufficient for positive change is unknown. Purpose: The goal of the current study was to examine differential effects of basic registry utilization on diabetes care processes and clinical outcomes according to level of registry use in a rural setting. Methods: Patients with diabetes (N = 661) from 6 Federally Qualified Health Centers in rural West Virginia were entered into an electronic patient registry. Data from pre‐ and post‐registry were compared among 3 treatment and control groups that had different levels of registry utilization: low, medium, or high (for example, variations in the use of registry‐generated progress notes examined at the point‐of‐care and in the accuracy of registry‐generated summary reports to track patients' care). Data included care processes (annual exams, screens to promote wellness, education, and self‐management goal‐setting) and clinical outcomes (HbA1c, LDL, HDL, cholesterol, triglycerides, blood pressure). Findings: The registry assisted in significantly improving 12 of 13 care processes and 3 of 6 clinical outcomes (HbA1c, LDL, cholesterol) for patients exposed to at least medium levels of registry utilization, but not for the controls. For example, the percent of patients who had received an annual eye exam at follow‐up was 11%, 34%, and 38% for the low, medium, and high utilization groups, respectively; only the latter groups improved. Conclusions: As an initial step to achieving control of diabetes, basic registry utilization may be sufficient to drive improvements in provider‐patient care processes and in patient outcomes in rural clinics with few resources.
Racial Differences in HPV Knowledge, HPV Vaccine Acceptability, and Related Beliefs Among Rural, Southern Women
Authors: Cates Joan R. , Brewer Noel T. , Fazekas Karah I. , Mitchell Cicely E. , Smith Jennifer S. 
Published: December 2008

ABSTRACT:
Context: Because cervical cancer mortality in the United States is twice as high among black women as white women and higher in rural areas, providing human papillomavirus (HPV) vaccine to rural black adolescents is a high priority. Purpose: To identify racial differences in knowledge and attitudes about HPV, cervical cancer, and the HPV vaccine that may influence uptake of the vaccine. Methods: We interviewed women (91 black and 47 white) living in a rural area of the Southern United States in 2006. Analyses controlled for socioeconomic status, age, and recruitment location. Findings: More white respondents had heard of HPV than had black respondents (57% vs 24%, P < .001), and whites had higher HPV knowledge (42% vs 29% correct responses, P < .05). Blacks were less likely than whites to think that cervical cancer would be a serious threat to their daughters' health (75% vs 96%, P < .001). More blacks than whites thought the ideal age to receive the vaccine was 17 years or older (63% vs 40%, P < .05). Blacks reported lower intentions to vaccinate their daughters than whites (M = 4.14 vs 4.55, P < .05 in unadjusted analyses, but not statistically significant in adjusted analyses). Conclusions: Black and white respondents had different awareness, knowledge, and beliefs related to the HPV vaccine. Communication‐based interventions to maximize uptake of the HPV vaccine in the rural, Southern United States may need different messages for black parents of adolescent girls.
Health Care Utilization Among Migrant Latino Farmworkers: The Case of Skin Disease
Authors: Feldman Steven R. , Vallejos Quirina M. , Quandt Sara A. , Fleischer Alan B. , Schulz Mark R. , Verma Amit , Arcury Thomas A. 
Published: December 2008

ABSTRACT:
Context: Skin diseases are common occupational illnesses for migrant farmworkers. Farmworkers face many barriers in accessing health care resources. Purpose: Framed by the Health Behavior Model, the purpose of this study was to assess health care utilization for skin disease by migrant Latino farmworkers. Methods: Three hundred and four migrant and seasonal Latino farmworkers in North Carolina were enrolled in a longitudinal study of skin disease and health care utilization over a single agricultural season. Self‐reported and dermatologist‐diagnosed skin condition data were collected at baseline and at up to 4 follow‐up assessments. Medical visit rates were compared to national norms. Findings: Self‐reported skin problems and diagnosed skin disease were common among farmworkers. However, only 34 health care visits were reported across the entire agricultural season, and none of the visits were for skin diseases. Nevertheless, self‐treatment for skin conditions was common, including use of non‐prescription preparations (63%), prescription products (9%), and home remedies (6%). General medical office visits were reported in 3.2% of the assessments, corresponding to 1.6 office visits per person year. Conclusions: The migrant farmworker population consists largely of young men who make little use of clinic services. Skin conditions are very common among these workers, but use of medical services for these conditions is not common. Instead, farmworkers rely primarily on self‐treatment. Clinic‐based studies of farmworker skin conditions will not account for most injury or disease in this population and have the potential for biased estimates.