Background: Few studies have explored changing patterns of alcohol consumption among young females and differences based on race/ethnicity. Objective: This study examined differences in alcohol consumption between black and white undergraduate females and compared trends in three different measures of alcohol consumption over a 10-year period from 2004 to 2014. Methods: The CORE Alcohol and Drug Survey was used to collect data from female undergraduates attending a public university in the northeastern USA. Classes were randomly selected into the sample; class acceptance was 68% and student participation was 96%. The chi-square test examined differences between groups and the Cochrane Armitage Test for Trend assessed changes over time. Results: In 2014, for every measure of alcohol consumption examined, a significantly larger percentage of white females engaged in the behavior compared to black females. Trend analysis from 2004 to 2014 demonstrated a narrowing of this gap. Controlling for age, any alcohol use in past 30 days and binge drinking in the past 2 weeks increased significantly for black females 21 years or older. Any alcohol use in the past 30 days decreased significantly for white females under 21 years. Conclusion: These findings introduce many questions which should be explored through additional research.

The purpose of this study was to examine the prevalence, correlates and predictors of depression and anxiety disorders (generalized anxiety disorder and panic disorder) among a national sample of U.S. graduate students. In recent decades, depression and anxiety disorders have become increasingly prevalent on college campuses; however, few studies have explored the factors that lead to these illnesses among graduate students. To address this knowledge gap and inform campus mental health programming, this epidemiological study was conducted using secondary data collected from graduate students (N=4477) in 2010 as part of the national Healthy Minds Study. Demographic and social factors and lifestyle and health-related behaviors were used to predict screening positive for depression and/or anxiety disorders, as measured by the Patient Health Questionnaire (PHQ), a validated and reliable screening instrument. Statistical analyses were conducted, including cross tabulation and multiple regression. Prevalence testing results showed that 14% screened positive for depression, which included major depression and other depressive disorder, and 9.5% screened positive for anxiety disorders, which included generalized anxiety disorder and panic disorder. About 19% screened positive for either depression or anxiety disorders, and 4.4% screened positive for both mental illnesses. These findings indicate these mental illnesses may be as prevalent among graduate students as they are among undergraduates, and perhaps more prevalent than among the U.S. general population. In logistic regression modeling, the strongest predictors of screening positive included: a) having a sexual orientation other than heterosexual; b) being single, divorced or widowed; c) having financial problems when growing up; and d) experiencing discrimination. The strongest protector was exercising three or more times per week. The results of this study have important implications for university health promotion programs, which have largely ignored graduate students. Universities are in a unique position to identify and intervene before mental health problems occur or become serious, but are largely missing this opportunity when it comes to graduate students.

Community-based participatory research (CBPR) is a collaborative methodology that uniquely involves stakeholders in all stages of the research process. CBPR has been widely utilized in the field of public health, but not widely employed with college populations. This study utilized CBPR methods within a college community to gain insight into excessive alcohol consumption. Six student researchers planned and carried out a rigorous qualitative study at a public university in the Northeast region of the United States. A total of 48 undergraduate participants were recruited for focus groups that were facilitated by two student researchers, and transcribed and analyzed using thematic analysis methods. Students’ reasons for drinking alcohol were focused within the themes of inclusion, habitual default, and the student development process. Social media, strict policy/enforcement, and student’s desire to avoid responsibility led to increased risk and consequences related to drinking. Students recommended late night transportation and a Good Samaritan policy as strategies to improve student safety. This study led to student advocacy and policy change directed at improving student’s health and safety and demonstrated that CBPR methods show promise for engaging students and producing meaningful data.

OBJECTIVE:This study examined alcohol consumption patterns and trends at a public university in the Northeast from 2002 to 2008.PARTICIPANTS:Stratified random sampling was used to select undergraduate students enrolled in courses during spring semesters in 2002, 2004, 2006, and 2008.METHODS:Data were collected during regularly scheduled classes for 4 measures of alcohol consumption and 5 demographic categories using the Core Alcohol and Drug Survey.RESULTS:Four groups showed significant increases in both frequency and volume of alcohol consumption-students who were female, over 21 years of age or over, living off-campus, or performing well academically. There were no decreasing trends for any demographic group. These results differ from national college health surveys, which have shown alcohol use remaining steady during this period.CONCLUSIONS:Campus-specific trend data can provide unique perspectives and guide programming efforts. These trends suggest a need for new intervention strategies on this campus.

Background Telemonitoring, the use of communication technology to monitor clinical status, is gaining attention as a strategy to improve the care of patients with heart failure. A system of frequent monitoring could alert clinicians to early heart failure decompensation, providing the opportunity for intervention before patients become severely ill and require hospitalization. Moreover, patients' participation in a daily monitoring program could have a favorable effect on their health behaviors. The literature on telemonitoring for heart failure, however, is quite limited. Methods and Materials Telemonitoring to Improve Heart Failure Outcomes (Tele-HF) is a randomized, controlled, trial designed to compare an automated, daily symptom, and self-reported weight monitoring intervention with usual care in reducing (all-cause) hospital readmissions and mortality among patients recently hospitalized with decompensated heart failure. The intervention will be implemented and all outcomes will be assessed over a 6-month period. The purpose of the intervention is to collect information about symptoms, clinical status and weight and to engage participants in their own self-care. Participants are recruited from general cardiology, heart failure specialty, and primary care practices across the United States. Conclusions The results of this study may inform future policy decisions regarding implementation of telemonitoring in treatment of heart failure.

Background— Fewer than half of patients with ST-elevation acute myocardial infarction (STEMI) are treated within guideline-recommended door-to-balloon times; however, little information is available about the approaches used by hospitals that have been successful in improving door-to-balloon times to meet guidelines. We sought to characterize experiences of hospitals with outstanding improvement in door-to-balloon time during 1999–2002. Methods and Results— We performed a qualitative study using in-depth interviews (n=122) with clinical and administrative staff at 11 hospitals that were participating with the National Registry of Myocardial Infarction and had median door-to-balloon times of ≤90 minutes during 2001–2002, representing substantial improvement since 1999. Data were organized with the use of NUD-IST 4 (Sage Publications Software) and were analyzed by the constant comparative method of qualitative data analysis. Eight themes characterized hospitals’ experiences: commitment to an explicit goal to improve door-to-balloon time motivated by internal and external pressures; senior management support; innovative protocols; flexibility in refining standardized protocols; uncompromising individual clinical leaders; collaborative teams; data feedback to monitor progress and identify problems and successes; and an organizational culture that fostered resilience to challenges or setbacks in improvement efforts. Conclusions— Several themes characterized the experiences of hospitals that had achieved notable improvements in their door-to-balloon times. By distilling the complex and diverse experiences of organizational change into its essential components, this study provides a foundation for future efforts to elevate clinical performance in the hospital setting.

BACKGROUNDPrompt reperfusion treatment is essential for patients who have myocardial infarction with ST-segment elevation. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon time) during primary percutaneous coronary intervention should be 90 minutes or less. However, few hospitals meet this objective. We sought to identify hospital strategies that were significantly associated with a faster door-to-balloon time.METHODSWe surveyed 365 hospitals to determine whether each of 28 specific strategies was in use. We used hierarchical generalized linear models and data on patients from the Centers for Medicare and Medicaid Services to determine the association between hospital strategies and the door-to-balloon time.RESULTSIn multivariate analysis, six strategies were significantly associated with a faster door-to-balloon time. These strategies included having emergency medicine physicians activate the catheterization laboratory (mean reduction in door-to-balloon time, 8.2 minutes), having a single call to a central page operator activate the laboratory (13.8 minutes), having the emergency department activate the catheterization laboratory while the patient is en route to the hospital (15.4 minutes), expecting staff to arrive in the catheterization laboratory within 20 minutes after being paged (vs. >30 minutes) (19.3 minutes), having an attending cardiologist always on site (14.6 minutes), and having staff in the emergency department and the catheterization laboratory use real-time data feedback (8.6 minutes). Despite the effectiveness of these strategies, only a minority of hospitals surveyed were using them.CONCLUSIONSSeveral specific hospital strategies are associated with a significant reduction in the door-to-balloon time in the management of myocardial infarction with ST-segment elevation.

OBJECTIVES We sought to recommend an approach for minimizing preventable delays in door-to-balloon time on the basis of experiences in top-performing hospitals nationally.BACKGROUND Prompt percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI) significantly reduces mortality and morbidity; however, door-to-balloon times often exceed the 90-min guideline set forth by the American College of Cardiology (ACC) and the American Heart Association (AHA).METHODS We conducted a qualitative study using in-depth interviews (n = 122) of hospital staff at hospitals (n = 11) selected as top performers based on data from the National Registry of Myocardial Infarction from January 2001 to December 2002. We used the constant comparative method of qualitative data analysis to synthesize best practices across the hospitals.RESULTS Top performers were those with median door-to-balloon times of <= 90 min for their most recent 50 PCI cases through December 2002 and the greatest improvement in median door-to-balloon times during the preceding four-year period 1999 to 2002. Several critical innovations are described, including use of pre-hospital electrocardiograms (ECGs) to activate the catheterization laboratory, allowing emergency physicians to activate the catheterization laboratory, and substantial interdisciplinary collaboration throughout the process. In the ideal approach, door-to-balloon time is 60 min for patients transported by paramedics with a pre-hospital ECG and 80 min for patients who arrive without paramedic transport and a pre-hospital ECG.CONCLUSIONS Hospitals can achieve the recommended ACC/AHA guidelines for door-to-balloon time with specific process design efforts. However, the recommended best practices involve extensive interdisciplinary collaboration and will likely require explicit strategies for overcoming barriers to organizational change. (c) 2005 by the American College of Cardiology Foundation.

Alterations in cerebral blood flow (CBF) are implicated in the etiology of portal-systemic encephalopathy. We hypothesized that CO2 reactivity of the cerebral circulation may be impaired in subjects with chronic liver disease (CLD) who also had subclinical portal-systemic encephalopathy (SPSE). We compared the relationship between PETCO2 and cerebral blood flow velocity in 10 patients with CLD with those of 10 healthy control subjects. Middle cerebral artery mean blood flow velocity (MCAMFV) was measured using transcranial Doppler during rest, hyperventilation, and hypoventilation. The degree of SPSE was quantified by using psychometric testing. Patients with CLD had poorer psychometric test scores compared with control subjects. Patients with CLD had lower PETCO2, MCAMFV, and blood pressure values and higher heart rates, differing from control subjects in all ventilation states. However, CO2 reactivity, the rate of change in MCAMFV to changes in ventilation (expressed as percent change in CBF velocity per mm Hg change in PETCO2) was similar for both groups (4.6% +/- 0.6% vs 4.2% +/- 0.5% for patients with CLD versus control subjects, P = 0.15). Implications: Psychometric test scores in patients with chronic liver disease revealed subclinical impairment compared with control subjects. Transcranial Doppler measurements of middle cerebral artery blood flow with varying PETCO2 were conducted, but the CO2 response of patients with liver disease was within the range of control subjects. (Anesth Analg 1998;86:1005-9)