The purpose of this study was to explore faith-based leaders' perceptions regarding provision of mental health services among their congregants and within the African American community. Previous ...research suggests that formal mental health services are less utilized by African Americans, however church leaders have historically provided congregants with informalized faith-based mental health services (Allen, Davey & Davey, 2010). An analysis of de-identified data on a sample of 246 African American ministry leaders was conducted. Findings suggested that most congregant leaders were able to recognize when individuals desired or were in need of a higher level of mental health services, rather than the usual services they are typically offered through prayer and counseling. A lower percentage of faith-based leaders had knowledge of mental health disorders and wanted to collaborate with others to increase health and wellness amongst congregants. The findings also suggest that faith-based pastors and leaders are more inclined to refer congregants to mental health professionals when the presenting crisis is beyond their scope of expertise and education.
Objective: The purpose of this study is to examine the relationship between social network member college expectations of Black students and the college expectations and college attendance of the ...students. Methods: This study conducted secondary analysis of the nationally representative data from the Educational Longitudinal Study of 2002. Selected variables were recoded into binary variables and binary logistic regression was conducted on the independent and control variables and the dependent variables of student college expectations and student college attendance. Results: Some of the independent variables were found to be predictors of student college expectations and college attendance. Conclusions: Members of Black students’ social networks should strive to espouse positive expectations for them. Discussion and suggestions for future research are provided.
Abstract only Background: In patients with cryptogenic stroke (CS), a patent foramen ovale (PFO) can be incidental or pathogenic. The Risk of Paradoxical Embolism (RoPE) score has been developed to ...determine the likelihood that a PFO is pathogenic or incidental using clinical variables. We hypothesize that echocardiographic features and conditions promoting paradoxical embolism differ between patients with pathogenic and incidental PFOs. Methods: The International PFO Consortium collects clinical, radiological and echocardiographic data of patients with CS and PFO. In the original RoPE score, a value of 0-6 was classified as a low RoPE score and 7-10 as a high score. Since information on cortical versus deep stroke location (one of the items on the RoPE score) was not available, we used two alternative approaches to stratify for PFO pathogenicity. In a first approach, we used a 9-point score and lowered the cut-off for dichotomization by 1 point (RoPE score 0-5 vs 6-9). In a second approach, patients with a RoPE score of 6 were excluded since they could either be classified as low or high RoPE score depending on stroke location. The associations between RoPE stratum and echocardiographic features (atrial septal aneurysm (ASA), right-to-left shunt (RLS) at rest and large RLS) as well as conditions promoting paradoxical embolism (deep vein thrombosis (DVT), pulmonary embolism (PE) and Valsalva maneuver (VM) were studied. Results: We analyzed 1044 CS patients with a PFO. Average age was 55 (SD 16) and 635 patients (61%) were male. Preceding VM was more frequent in patients with a high vs low RoPE score in both analyses: 11% vs 5% (OR: 2.1 95%CI 1.3-4.3) and 10% vs 5% (OR: 2.0 95%CI 1.2-3.6). The distribution of ASA (35% vs 34% and 32% vs 34%, in the first and the second analysis respectively), RLS at rest (28% vs 28% and 29% vs 28%), large RLS (67% vs 66% and 65% vs 66%), PE (2% vs 2% and 1% vs 2%), and DVT (4% vs 4% and 3% vs 4%) did not differ by RoPE stratum. Conclusion: In patients with CS, preceding VM was significantly associated with pathogenic PFO, while echocardiographic features or conditions promoting paradoxical embolism were not. The formation of a significant right-to-left pressure gradient at the atrial septum level appears to play a substantial role in the pathogenicity of PFO.
Abstract only Background: A patent foramen ovale (PFO) discovered in patients with cryptogenic stroke (CS) may be incidental or pathogenic. Recently, a Risk of Paradoxical Embolism (RoPE) score has ...been proposed to stratify patients by their PFO pathogenicity. Based on this score, the probability that a PFO is incidental (rather than pathogenic) increases with advancing age, deep stroke location, or the presence of cardiovascular risk factors (RF). Given that RF accumulate at a later age in women than in men, we hypothesize that there are gender differences in the variables used for RoPE score calculation. Methods: The distribution of RF (history of hypertension, diabetes or stroke/TIA, current smoking, and age categories as defined in the original RoPE score publication) was compared by sex in the entire cohort of 1044 CS patients as well as within the groups with low (0-5) and high (7-10) RoPE scores (due to lacking information on cortical versus deep stroke location, we excluded all patients with a RoPE score of 6, since they could be either classified with low or high RoPE score depending on stroke location). Furthermore, for each patient we calculated the age impact ratio (AIR): the points assigned for the corresponding age category divided by the RoPE score. Gender comparisons of AIR were drawn in the entire cohort and within the RoPE score strata. Results: Average age was 55.5 years and 635 patients (61%) were male. In the entire cohort, the distribution of age categories and RF as well as AIR did not differ between men and women. In the higher RoPE stratum (PFO likely pathogenic), women were younger than men (median, 38 years vs 45 years, P=0.036). The distribution of RF and the AIR did not differ between sexes. In the lower PFO stratum (PFO likely incidental), men were younger than women (median, 62 years vs 66 years, P=0.011). The AIR was lower in women than in men (mean, 0.24 vs 0.29, P=0.013). There were no gender differences in the distribution of RF. Conclusions: There are significant gender differences in age among patients with CS and PFO, with women being younger than men in the higher RoPE stratum and vice versa in the lower RoPE stratum. More women than men are classified as having an incidental PFO because of their advancing age rather than the accumulation of RF.
Abstract only Background and purpose: Recurrent ischemic stroke in patients with CS and PFO has been proposed as a marker of increased risk for paradoxical embolism. It is unclear, whether the excess ...risk is driven by specific features of the PFO (right-to-left shunt (RLS) size, RLS at rest, associated atrial septum aneurysm (ASA)) or the presence of vascular risk factors (vRF). We compare the prevalence of vRF, TEE features, and baseline medications in PFO patients with first-ever versus multiple CS. Methods: From September 2008 to March 2013, the International PFO Consortium enrolled 993 patients with ischemic stroke or transient ischemic attack (TIA) and newly diagnosed PFO. In this analysis of baseline data, we included 386 patients with first-ever CS and no radiological evidence of prior cerebral ischemia (first-ever CS group, mean age, 52y) as well as 71 patients with recurrent CS and multiple ischemic lesions on CT and/or MRI (multiple CS group, mean age, 59y). Patients with TIA as index event, those with first-ever CS but additional “silent” ischemic lesions on imaging as well as those with recurrent CS without radiological findings of prior cerebral ischemia were excluded. We used nonparametric tests for independent samples and the Bonferroni correction for multiple comparisons. Results: Age > 55y (63% vs. 44%, P=0.001), hypertension (52% vs. 30%, P=0.001), hyperlipidemia (64% vs. 44%, P=0.003), and coronary artery disease (15% vs. 3%, P=0.001) were significantly more frequent in the multiple CS than in the first-ever CS group. The frequencies of male gender, current smoking, diabetes, migraine with or without aura, associated ASA, RLS size, and RLS at rest did not differ between groups. At baseline, patients with multiple CS were more likely to be on antiplatelets (50% vs. 18%), antihypertensive (51% vs. 22%) or lipid lowering drugs (44% vs. 10%, P=0.001 for each comparison) than patients with first-ever CS. The frequency of anticoagulant treatment did not differ between groups. Conclusions: In patients with CS, vRF but not specific PFO features were associated with recurrent cerebral ischemic events. The ongoing prospective part of the International PFO Consortium will likely shed light upon the role of vRF control for secondary stroke prevention in patients with PFO.
How Big is the Hole? Alexander, Thomas H.; Collins, Lester B.; Harrison, Preston E. ...
Journal for vascular ultrasound,
12/2015, Letnik:
39, Številka:
4
Journal Article
Recenzirano
Transcranial Doppler (TCD) with agitated saline injection and transesophageal echocardiography (TEE) are used to evaluate cryptogenic stroke and transient ischemic attack (TIA) patients for patent ...foramen ovale (PFO). The role of the PFO may be to serve as a passageway for emboli from the peripheral venous system to the brain ( Figure 1 ). Alternatively, thrombi may form in situ at the PFO, especially with a concurrent atrial septal aneurysm. Blood coagulopathies can also contribute to clot formation. Clearly, the mere presence of a PFO cannot explain stroke in any given individual. Secondary stroke prevention includes anticoagulation or endovascular closure or both. Management controversies still exist. Regardless, sensitive and specific diagnostic procedures form the bedrock of our understanding. TCD is equal or superior in its sensitivity to the presence of any right-to-left shunt compared with echocardiography.
1
Insurance carriers generally require a registered vascular technologist perform the technical portion of the TCD-PFO test.
The purpose of this study was to explore faith-based leaders’ perceptions regarding provision of mental health services among their congregants and within the African American community. Previous ...research suggests that formal mental health services are less utilized by African Americans, however church leaders have historically provided congregants with faith-based mental health services (Allen, Davey & Davey, 2010). A secondary analysis of de-identified data on a sample of 246 African American ministry leaders was conducted. Findings suggested that most congregant leaders were able to recognize when individuals inconspicuously desired more of an evidence-based approach to mental health care, rather than the current offering of biblical expertise. A lower percentage of faith-based leaders had knowledge of mental health disorders and wanted to collaborate with others to increase health and wellness. The findings also suggest that faith-based pastors and leaders have a desire to address issues related to mental health in collaboration with mental health professionals, such as social workers and other community partners.
Background and Purpose
Transesophageal echocardiography (TEE) is used and accepted as a method for detecting right-to-left cardiac shunts, most commonly caused by patent foramen ovale (PFO). ...Transcranial Doppler (TCD) is an accepted alternative test involving the injection of agitated saline with a timed and gauged Valsalva maneuver. Controversy exists about the exact role of PFO in patients with cryptogenic stroke and the resultant therapeutic alternatives; however, there is no controversy about the need to accurately detect the PFO.
Methods
We reviewed the records of 264 consecutive patients referred for TCD with the diagnosis of cryptogenic stroke or transient ischemic attack.
Results
A total of 89 (33.7%) patients had a positive TCD test for PFO; 39 went on to have TEE studies. A total of 19 of the TEE results failed to confirm the PFO (48.7%). TEE in the East Texas Region is routinely performed by the use of conscious sedation, which requires the supervising cardiologist to compress the abdomen to simulate Valsalva.
Conclusion
In the East Texas region, transcranial Doppler is superior to transesophageal echocardiography for the detection of right-to-left shunt in stroke patients, presumably because of the Valsalva limiting effect of intravenous sedation routinely given during the latter procedure.
