Purpose: The purposes of this study were to translate current knowledge regarding cardiovascular risk factors, screening, and prevention to a disparate population of women and to ascertain the cardiovascular health status and risk factors in a sample of minority and underserved Appalachian women.Data sources: Demographic data were collected from a voluntary sample of women from a disparate population living in Appalachian Tennessee. A coronary risk profile recorded family health history, personal health history, and lifestyle habits affecting risk for cardiovascular disease. Physiologic measurements included body mass index, blood pressure, fasting glucose, cholesterol levels, ankle brachial index, and carotid artery stenosis.Conclusions: Women in Appalachia Tennessee from a disparate population have high risks for heart disease and stroke. This is a critical time to address any modifiable risk factors and aggressively treat underlying cardiovascular diseases such as hypertension and hypercholesterolemia.Implications for practice: Nurse practitioners (NPs) often provide primary care to women who may not be aware of their cardiovascular risks or actual disease. NPs can ensure that their practice incorporates primary and secondary cardiovascular prevention through screening, individual health education, and aggressive evidence-based treatment plans for women.

BACKGROUND: Neuronal remodeling in human heart disease is not well understood. METHODS: Stellate ganglia from patients with cardiomyopathy (CMY) and refractory ventricular arrhythmias undergoing cardiac sympathetic denervation (n = 8), and from organ donors with normal hearts (n = 8) collected at the time of organ procurement were compared. Clinical data on all subjects were reviewed. Electron microscopy (EM), histologic, and immunohistochemical assessments of neurotransmitter profiles, glial activation and distribution, and lipofuscin deposition, a marker of oxidative stress, were quantified. RESULTS: In CMY specimens, lipofuscin deposits were larger, and present in more neurons (26.3% ± 6.3% vs. 16.7% ± 7.6%, P < 0.043), than age-matched controls. EM analysis revealed extensive mitochondrial degeneration in CMY specimens. T cell (CD3+) infiltration was identified in 60% of the CMY samples, with one case having large inflammatory nodules, while none were identified in controls. Myeloperoxidase-immunoreactive neutrophils were also identified at parenchymal sites distinct from inflammatory foci in CMY ganglia, but not in controls. The adrenergic phenotype of pathologic samples revealed a decrease in tyrosine hydroxylase staining intensity compared with controls. Evaluation of cholinergic phenotype by staining for the vesicular acetylcholine transporter revealed a low but comparable number of cholinergic neurons in ganglia from both groups and demonstrated that preganglionic cholinergic innervation was maintained in CMY ganglia. S100 staining (a glial cell marker) demonstrated no differences in glial distribution and relationship to neurons; however, glial activation demonstrated by glial fibrillary acidic protein (GFAP) staining was substantially increased in pathologic specimens compared with controls. CONCLUSIONS: Stellate ganglia from patients with CMY and arrhythmias demonstrate inflammation, neurochemical remodeling, oxidative stress, and satellite glial cell activation. These changes likely contribute to excessive and dysfunctional efferent sympathetic tone, and provide a rationale for sympathectomy as a treatment for arrhythmias in this population. FUNDING: This work was made possible by support from NIH grants HL125730 to OAA, GM107949 to DBH, and HL084261 and OT2OD023848 to KS.

The accumulation of pro-inflammatory macrophages in the inflamed vascular wall is a critical step in atherogenesis. The mechanism of macrophage retention within the site of inflammation is not understood yet. High adhesion that prevents macrophage migration is one of the potential mechanisms. Previous research in our laboratory showed that integrin αDβ2 is upregulated on pro-inflammatory macrophages, promotes macrophage retention, and contributes to atherogenesis. However, a key ligand for αDβ2 within the tissue is yet to be identified, since αDβ2 does not interact with major ECM proteins, collagens, and laminins. We recently found that during acute inflammation, the oxidation of docosahexaenoic acid (DHA) leads to the generation of end product carboxyethylpyrrole (CEP), which forms an adduct with fibrinogen and albumin via ε-amino group of lysines. There is evidence that macrophages adhere to CEP-modified albumin in αDβ2-dependent manner. We continued the advancement of the proposed hypothesis that non-conserved, basic amino acids of integrin αDβ2 located near the MIDAS site of the I-domain are responsible for binding to CEP. αD I-domain and generated I-domain mutants: H272(D), K297(Q) and K309(N) were used to map the ligand binding site between integrin and CEP. Using site-directed mutagenesis, mutant αD I-domains were generated with minimal amino acid substitutions. Protein-protein binding reveals that the generated mutation of K297(Q) on the I-domain demonstrates the strong reduction of binding, while H272(D) and K309(N) did not have a significant effect on integrin binding properties. Therefore, lysine 297 located in I-domain of integrin αD, is a critical amino acid for αDβ2 binding to CEP-modified proteins. The identification of a binding site for CEP-modified proteins within αDβ2 will help to develop a blocking reagent for the treatment of the inflammatory component of atherosclerosis.

Cardiovascular disease (CVD) is the leading cause of death worldwide. The risks for women increase at the onset of menopause. A central feature in CVD patients is excessive sympathetic stimulation of beta-adrenergic receptors (β-ARs). Both clinical and animal studies show that estrogen loss and age exacerbate cardiac β-AR signaling and contractile function. We, therefore, examined the hypothesis that prolonged estrogen deficiency followed by chronic sympathetic injury worsens left ventricular cardiac function in the aged female heart. Bilateral ovariectomy (OVX) or SHAM surgery was performed in female mice at 2.5 months of age and infused with Isoproterenol (ISO; 400μg/kg/h) at 12 months (12M) post OVX for 3 days to induce chronic sympathetic stimulation. Transthoracic two-dimensional M-mode echocardiography was used to measure left ventricular (LV) wall thickness and left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD), percent fractional shortening (%FS), and ejection fraction (EF). Animal body weight was measured to calculate the heart-body ratio, followed by the removal of the heart, left lung, and uterus during euthanasia. Tissue samples were treated with wheat germ agglutinin staining to measure cardiac myocyte cross-sectional area (hypertrophy). Results show that prolonged ovariectomy increased mortality in mice treated with ISO post-ovariectomy (OVX +ISO) compared to the SHAM+ISO group. Echocardiography imaging demonstrated a smaller systolic diameter and increased contractility in the ISO and ISO+OVX groups. OVX, ISO, and ISO+OVX treatment had a significant decrease in LVESD versus SHAM and OVX groups. The LVEDD resulted in a significant decrease with ISO treatment compared to the SHAM group, and no significant difference was observed between the OVX and ISO+OVX groups compared to the SHAM. Percent FS presented a significant increase in cardiac function in OVX, ISO, and ISO+OVX groups compared to the SHAM. There was an increased %FS in the ISO+OVX compared to the OVX group, and no significant difference between the ISO+OVX and ISO treatment groups. Percent EF significantly increased in the OVX, ISO, and ISO+OVX treatment groups from the SHAM and OVX group, and no significant difference between the ISO+OVX and ISO treatment groups. OVX increased left ventricular mass compared to SHAM. While ISO treatment did not increase LV mass ISO+OVX treatment group significantly increased in LV mass when compared to the ISO treatment group. There was no significant difference in the left ventricular mass between the ISO+OVX vs. OVX group. There was no significant difference in cardiac myocyte cross-sectional area in the SHAM, OVX vs ISO groups. There was however a significant increase in myocyte cross-sectional area in the ISO+OVX group compared to OVX treatment and ISO groups. The results presented here show that estrogen loss impairs left ventricular cardiac function and increases remodeling in response to β-AR stimulation and that prolonged estrogen loss may blunt the sympathetic response in the heart. These results highlight the importance of the long-term effects of estrogen loss during menopause in the treatment and management of heart disease.

Magister Public Health - MPH / Non-communicable diseases (NCD) continue to rise globally, causing significant morbidity and mortality. Low and medium-income countries (LMIC) such as South Africa are the worst affected because of an existing burden of infectious diseases and general poverty in the population. In South Africa, NCDs were responsible for 57.8% of total deaths in 2017, surpassing group 1 diseases (30.7%) that include tuberculosis and HIV/AIDS. Studies have shown that early detection of NCDs and interventions to reduce NCDs' risk significantly prevent suffering and further loss of lives. Workplace health promotion and healthy university concepts are widely being implemented globally to promote health at workplaces and institutions of higher learning. The study aimed to determine the prevalence of selected non-communicable disease risk factors and to assess the risk of cardiovascular disease among administrative staff at the University of the Western Cape (UWC), South Africa, using secondary data collected in 2011.

Background: Obesity is a significant healthcare problem in modern American society. It has led to decreased longevity of employees and decreased productivity in day-to-day duties of healthcare workers. There are more negative attributes to obesity than positive, regardless of the race affected. One of the leading causes of death in 2012 was cardiovascular disease. Due to poor dietary choices, the promotion of sedentary lifestyle has led to complications of obesity such as high blood pressure and diabetes. Major improvements can be made within a community that acknowledges the risks of obesity and seeks to implement preventive programs. Increasing one’s physical activity and implementing healthier dietary choices leads to a reduction in cardiovascular diseases. Purpose: The purpose of this quality improvement project was to develop an evidence-based obesity prevention program for the healthcare facility staff to increase physical activity within the workplace. Theoretical Framework: Health Belief Model Theory. Methods: The investigator used a quasi-experimental approach using a pretest/posttest design. Results: The results of the data analysis revealed positive perception changes in acceptance to the implementation of physical activity in the workplace. Within two weeks of the project completion, the investigator noted a 69.23 percent increase in the implementation of physical activity in the work and home setting, and an 84.62% change in the manner individuals made food choices, with a median percentage rate of 96.2 for awareness of obesity, overweight health status, and cardiovascular disease risk factors. Conclusion: The evidence-based worksite obesity prevention initiative provides support and acceptance for the implementation of physical activity in the work setting.

Magister Public Health - MPH / South Africa has the largest burden of HIV in the world with 7.9 million people living with HIV and 4.4 million registered on antiretroviral therapy (ART) in 2017. KwaZulu-Natal is hardest hit by the HIV epidemic with a prevalence of 27% among adults aged 15 to 49 years old. With the widespread ART uptake, the spectrum of HIV related admissions in hospitals has changed over the last decade. Hypertension, diabetes, cardiovascular disease, and renal failure have become significant reasons for inpatient care. Increased life expectancy, rising non-communicable diseases (NCDs) and easier access to ART have played a significant change in the landscape of inpatients as compared to the pre-ART era. To provide integrated healthcare to the patient, it is necessary to understand the prevalence and patterns of HIV comorbidities for efficient and effective service delivery to HIV patients at facility-level.

No description available.

Doctor Educationis / Background: South Africa has the largest burden of HIV in the world with 7.9 million people living with HIV and 4.4 million registered on antiretroviral therapy (ART) in 2017. KwaZuluNatal is hardest hit by the HIV epidemic with a prevalence of 27% among adults aged 15 to 49 years old. With the widespread ART uptake, the spectrum of HIV related admissions in hospitals has changed over the last decade. Hypertension, diabetes, cardiovascular disease, and renal failure have become significant reasons for inpatient care. Increased life expectancy, rising non-communicable diseases (NCDs) and easier access to ART have played a significant change in the landscape of inpatients as compared to the pre-ART era. To provide integrated healthcare to the patient, it is necessary to understand the prevalence and patterns of HIV comorbidities for efficient and effective service delivery to HIV patients at facility-level. Aim: The current study aimed to describe the prevalence and patterns of HIV-related comorbidities in adult hospital admissions in iLembe, KwaZulu-Natal. Methodology: A retrospective, cross-sectional survey was conducted of all adult HIV-related admissions between 1st October and 31st December 2019. Clinical and demographic characteristics were extracted from admission and discharge records, and laboratory data was collected via the National Health Laboratory Services using Labtrack. Summative and inferential analyses were done using SPSS v 23.

No description available.