Systematic review of current trends of cardiovascular disease (CVD) and association between health insurance coverage and CVD mortality among women aged 60--65 in Texas in 2000--2011

Cardiovascular disease (CVD) is highly preventable, yet it is a leading cause of death among women in Texas. The primary goals of this research were to examine past and current trends of CVD, as well as identify whether there is an association between the insurance coverage and mortality from CVD among women aged 60–65 in Texas between 2000 and 2011. ^ The systematic review of the research is based on the guidelines and recommendations set by the Centre for Reviews and Dissemination for conducting reviews in health care. Over 47 citations of peer-reviewed articles from Ovid MEDLINE and PubMed databases and five websites were identified, of which 7 studies met inclusion criteria for the first systematic review to examine the trends of CVD in Texas. Ten citations of peer-reviewed articles from Ovid MEDLINE and PubMed databases and five web sites were reviewed for the second systematic review (to study the association between insurance coverage and cardiovascular health among Texas women 60–64 years of age), of which 3 studies met inclusion criteria and were included in the research. The results of the study highlighted key gaps in the existing literature and important areas for the further research, as well as determined directions for future public health CVD prevention programs in Texas. ^ Based on the conducted research, the major determinants of premature mortality among women attributed to cardiovascular disease are based on individual level characteristics, more specifically sex, age, race/ethnicity, and education. The results indicate that African American and non-Hispanic white women are more likely to have higher CVD mortality rates than Hispanic women due to higher prevalence of cardiac risk factors. The data also shows higher levels of mortality from CVD in the southeastern United States, with Texas ranking as the third state with the highest prevalence of CVD among women. According to the Texas Department of State Health Services, there are approximately 56,000 deaths caused by CVD annually in Texas, which represents about one death every ten minutes. Coronary artery disease and stroke were the causes of 31.2 percent of all female deaths in Texas in 2009, meaning that approximately 68 women die from any form of cardiac disease in Texas each day. ^ The data of the reviewed studies indicate that women' lack of health insurance was significantly associated with a higher prevalence of cardiovascular disease. The uninsured women were more likely to be unaware of their risk factors and more likely to have undiagnosed diabetes—a co-morbidity factor of CVD. One of the studies also reports strong correlation between state rates of uninsured and lower rates of preventive care. Given these strong correlations, those who were chronically uninsured were at a higher risk of mortality than the insured, due to prolonged periods of time without basic access to preventive and medical care. ^ Suggested recommendations to decrease CVD mortality rates in Texas are consistent with the existing literature and include state policy development that addresses elimination of health disparities, consideration of potential benefits of universal health coverage by the legislative policymakers, and maintenance of solid partnerships between public health agencies and hospitals to educate on, diagnose, and treat CVD among the female population in Texas. ^

Patient-centered medical home technology effects on hypertension and diabetes control

Background: Hypertension and Diabetes is a public health and economic concern in the United States. The utilization of medical home concepts increases the receipt of preventive services, however, do they also increase adherence to treatments? This study examined the effect of patient-centered medical home technologies such as the electronic health record, clinical support system, and web-based care management in improving health outcomes related to hypertension and diabetes. Methods: A systematic review of the literature used a best evidence synthesis approach to address the general question " Do patient-centered medical home technologies have an effect of diabetes and hypertension treatment?" This was followed by an evaluation of specific examples of the technologies utilized such as computer-assisted recommendations and web-based care management provided by the patient's electronic health record. Ebsco host, Ovid host, and Google Scholar were the databases used to conduct the literature search. Results: The initial search identified over 25 studies based on content and quality that implemented technology interventions to improve communication between provider and patient. After further assessing the articles for risk of bias and study design, 13 randomized controlled studies were chosen. All of the studies chosen were conducted in various primary care settings in both private practices and hospitals between the years 2000 and 2007. The sample sizes of the studies ranged from 42 to 2924 participants. The mean age for all of the studies ranged from 56 to 71 years. The percent women in the studies ranged from one to 78 percent. Over one-third of the studies did not provide the racial composition of the participants. For the seven studies that did provide information about the ethnic composition, 64% of the intervention participants were White. All of the studies utilized some type of web-based or computer-based communication to manage hypertension or diabetes care. Findings on outcomes were mixed, with nine out of 13 studies showing no significant effect on outcomes examined, and four of the studies showing significant and positive impact on health outcomes related to hypertension or diabetes Conclusion: Although the technologies improved patient and provider satisfaction, the outcomes measures such as blood pressure control and glucose control were inconclusive. Further research is needed with diverse ethnic and SES population to investigate the role of patient-centered technologies on hypertension and diabetes control. Also, further research is needed to investigate the effects of innovative medical home technologies that can be used by both patients and providers to increase quality of communication concerning adherence to treatments.^

Black/white disparities in infant mortality rates in the U.S.: A quality of care perspective

The infant mortality rate for non-Hispanic Black infants in the U.S. is 13.63 deaths per 1,000 live births while the IMR for non-Hispanic White persons in the U.S. is 5.76 deaths per 1,000 live births. Black women are 2 times as likely as White women to deliver preterm infants and Black women are 2 times as likely as White women to deliver low birth weight infants (weighing less than 2,500 grams at birth). Differential underlying risk factors among mothers of different racial/ethnic groups for delivering pre-term and low birth weight infants have been historically accepted as the cause of racial disparities in IMRs. However, differential underlying risk status may not be the only major causative factor. Differential or unequal access to and provision of care is widely speculated to be a leading contributing factor to the wide racial disparity in infant mortality.2 This paper conducts a systematic review of existing literature investigating racial disparities in obstetrical care provided by healthcare practitioners to evaluate whether inequities in healthcare services provided to pregnant mothers and their neonates exist. The search terms "racial disparities obstetrical care," "racial differences quality of prenatal care," and "infant mortality racial disparities" were entered into the EBSCO Medline, Ovid Medline, PubMed, and Academic Search Complete databases, and articles between years 1990–2011 were selected for abstract review. The only articles included were those that used statistical methods to assess whether racial inequalities were present in the obstetrical services provided to pregnant women. My literature search returned 5 articles. Four of the five studies yielded significant racial differences in obstetrical care. However, the one study that used a large, nationally representative valid sample did not represent significant differences. Thus, this review provides initial evidence for racial disparities in obstetrical care, but concludes that more studies are needed in this area. Not all of the studies reviewed were consistent in the use and measurement of services, and not all studies were significant. The policy and public health implications of possible racial disparities in obstetrical care include the need to develop standard of care protocols for ALL obstetrical patients across the United States to minimize and/or eliminate the inequities and differences in obstetrical services provided.^

Factors associated with contraception use among postpartum or parenting Latina adolescents: A systematic review

Despite advances in effective and long-acting contraceptive methods and the introduction into health care that an initial unplanned pregnancy allows, repeat unplanned pregnancy continues to affect Hispanic adolescents at a rate higher than that of non-Hispanic whites. The current study was undertaken to identify and categorize factors associated with uptake of long acting contraception (implant or intrauterine devices) or consistent use of highly effective methods (injectable DMPA, ring, patch, or pills), among Hispanic/Latina teens who have previously given birth. ^ I searched Ovid Medline, Pubmed, CINAHL, PsychINFO, POPLINE and Scopus, and reference lists for studies in English, ≥1980, of original data from the United States on factors related to initiation, maintenance, or discontinuation of contraceptive methods in postpartum or parenting adolescent females. I then identified articles that specified the inclusion of Hispanics/Latinas in the study population and either reported findings specific to race/ethnicity or used race/ethnicity as an independent variable in analyses of contributing factors. I then extracted data for each study and categorized independent variables as predisposing, enabling, or reinforcing following the PRECEDE model.1 Factors found to be associated with contraception use or non-use were combined to create a logic model of risk. ^ Of 9 eligible studies, one solely addressed initiation; one, initiation and maintenance; two, initiation and discontinuation; three, maintenance; and two, maintenance and discontinuation. There was some overlap in the studies' assessments of maintenance and discontinuation and the author(s) often did not distinguish between the two. Nearly all (k=7) were prospective observational studies with convenience samples and bivariate analyses (k=6). One study was initially a quasi-experimental design but became a prospective cohort due to extremely high attrition. Sociodemographic characteristics and predisposing factors were studied frequently, as were reinforcing factors; enabling factors were discussed infrequently and only in studies involving focus groups or interviews. Due to a paucity of research, a consensus of factors found consistently to influence the contraception behavior of postpartum Latina teens could not be established for the overall population nor for cultural subgroups. Future research is needed that focuses on postpartum/parenting Latina teens, with subgroup identification and differentiation, to determine the prevalent and pertinent predisposing, enabling, and reinforcing factors related to effective contraception initiation and maintenance.^

Influenza vaccination as a primary or secondary prevention for cardiovascular diseases: A systematic review of the literature

Background: Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality worldwide. CVD mainly comprise of coronary heart disease and stroke and were ranked first and fourth respectively amongst leading causes of death in the United States. Influenza (flu) causes annual outbreaks and pandemics and is increasingly recognized as an important trigger for acute coronary syndromes and stroke. Influenza vaccination is an inexpensive and effective strategy for prevention of influenza related complications in high risk individuals. Though it is recommended for all CVD patients, Influenza vaccine is still used at suboptimal levels in these patients owing to prevailing controversy related to its effectiveness in preventing CVD. This review was undertaken to critically assess the effectiveness of influenza vaccination as a primary or secondary prevention method for CVD. ^ Methods: A systematic review was conducted using electronic databases OVID MEDLINE, PUBMED (National Library of Medicine), EMBASE, GOOGLE SCHOLAR and TRIP (Turning Research into Practice). The study search was limited to peer-reviewed articles published in English language from January 1970 through May 2012. The case control studies, cohort studies and randomized controlled trials related to influenza vaccination and CVD, with data on at least one of the outcomes were identified. In the review, only population-based epidemiologic studies in all ethnic groups and of either sex and with age limitation of 30 yrs or above, with clinical CVD outcomes of interest were included. ^ Results: Of the 16 studies (8 case control studies, 6 cohort studies and 2 randomized controlled trials) that met the inclusion criteria, 14 studies reported that there was a significant benefit in u influenza vaccination as primary or secondary prevention method for preventing new cardiovascular events. In contrary to the above findings, two studies mentioned that there was no significant benefit of vaccination in CVD prevention. ^ Conclusion: The available body of evidence in the review elucidates that vaccination against influenza is associated with reduction in the risk of new CVD events, hospitalization for coronary heart disease and stroke and as well as the risk of death. The study findings disclose that the influenza vaccination is very effective in CVD prevention and should be encouraged for the high risk population. However, larger and more future studies like randomized control trials are needed to further evaluate and confirm these findings. ^

Complications of misoprostol and other abortion induction methods in the developing world: A systematic review

OBJECTIVE: To systematically review published literature to examine the complications associated with the use of misoprostol and compare these complications to those associated with other forms of abortion induction. ^ DATA SOURCES: Studies were identified through searches of medical literature databases including Medline (Ovid), PubMed (NLM), LILACS, sciELO, and AIM (AFRO), and review of references of relevant articles. ^ STUDY SELECTION AND METHODS: A descriptive systematic review that included studies reported in English and published before December 2012. Eligibility criteria included: misoprostol (with or without other methods) and any other method of abortion in a developing country, as well as quantitative data on the complication of each method. The following is information extracted from each study: author/year, country/city, study design/study sample, age range, setting of data collection, sample size, the method of abortion induction, the number of cases for each method, and the percentage of complications with each method. RESULTS: A total of 4 studies were identified (all in Latin America) describing post-abortion complications of misoprostol and other methods in countries where abortion is generally considered unsafe and/or illegal. The four studies reported on a range of complications including: bleeding, infection, incomplete abortion, intense pelvic pain, uterine perforation, headache, diarrhea, nausea, mechanical lesions, and systemic collapse. The most prevalent complications of misoprostol-induced abortion reported were: bleeding (7-82%), incomplete abortion (33-70%), and infection (0.8-67%). The prevalence of these complications reported from other abortion methods include: bleeding (16-25%), incomplete abortion (15-82%), and infection (13-50%). ^ CONCLUSION: The literature identified by this systematic review is inadequate for determining the complications of misoprostol used in unsafe settings. Abortion is considered an illicit behavior in these countries, therefore making it difficult to investigate the details needed to conduct a study on abortion complications. Given the differences between the reviewed studies as well as a variety of study limitations, it is not possible to draw firm conclusions about the rates of specific-abortion related complications.^

Notable College Experiences Through Original Still Photography

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Fuentes latinas de The rape of Lvcrece, de Shakespeare

Este artículo se consagra a una comparación entre el temprano poema de Shakespeare, The Rape of Lvcrece, y sus dos principales fuentes latinas, Ab Vrbe Condita, de Tito Livio y los Fasti, de Ovidio. Anticipándose a la penetración del dramaturgo en sus personajes trágicos, Shakespeare da una aguda descripción de las psicomaquias de Tarquino y de Lucrecia. En el caso del primero, al revelar la lucha interior a propósito de la ética y las consecuencias de sus acciones. En el caso de la segunda, cuando Lucrecia analiza el horror de su vergüenza y los modos de purificarse. En ambos casos Shakespeare opera dramáticamente con sus fuentes, suprimiendo algunos detalles y enriqueciendo significativamente su narración. Existe una complicación adicional en cuanto precede al poema un Argumento que sigue de cerca la historia de Tito Livio. Sin embargo, paradójicamente, el poema se desvía de su mismo argumento en algunos puntos fundamentales

La historia de amor de la Sibila y las dinámicas narrativas de Metamorfosis 14

El episodio del encuentro entre Eneas y la Sibila de Cumas en Metamorfosis 14.102157 forma parte de la "Eneida ovidiana", aquella sección del poema (13.62314.608) en la cual se narran las aventuras de Eneas desde su partida de Troya hasta su asentamiento definitivo en el suelo itálico. En este trabajo proponemos un análisis del pasaje teniendo en cuenta aquellos rasgos que permiten estudiarlo en relación con las demás historias de amor del poema. Emplearemos para ello las categorías de "repetición", "continuidad narrativa" y "cierre" enunciadas por S. Wheeler en Narrative Dynamics in Ovid's Metamorphoses (2000).

La apoteosis en las Metamorfosis de Ovidio : Función estructural y valor semántico

El objeto de este trabajo ha sido estudiar el motivo de la apoteosis con el fin de descubrir de qué manera se integra positivamente en la representación de las Metamorfosis. Se intenta trascender interpretaciones denigratorias o irónicas del motivo. El estudio consta de dos partes. En el primer capítulo de la primera parte, "La apoteosis en la estructura de las Metamorfosis", se demuestra con un análisis intratextual la importancia que tiene el relato de la creación del hombre como sanctius animal, considerada paradigmática, en el estudio del motivo de la apoteosis. El segundo capítulo insiste en la dimensión intertextual, recordando la influencia estructural de dos modelos poéticos de las Metamorfosis de Ovidio, Hesíodo y la Égloga 6 de Virgilio, para una representación que comienza en la creación del hombre y termina en la apoteosis del poeta. La introducción a la segunda parte, "Valor semántico de la apoteosis", pone el acento en tres aspectos esenciales para el estudio de la apoteosis. En primer lugar, la idea de "lectura", i.e., la trascendencia latente del motivo de la apoteosis y de la idea de estirpe a lo largo de la obra. Se propone, en segundo lugar, el concepto de "mitologización" como una forma de examinar la apropiación que hace el poeta del mito historizado y del mito con alusión augustea. Esa apropiación tendrá como fin destacar el aspecto literatio de las historias y ejercerá un papel fundamental en la construcción de una gfigura de poeta que, mediante la apoteosis por su obra, se eleva por sobre las figuras de filósofo y de político. Su tratamiento en este trabajo, pues, se debe al hecho de que está ligado, en último término, con el motivo de la apoteosis. Dado que el estudio tiene como punto de partida la relación entre el sanctius animal, paradigma de la creación del hombre, y la apoteosis, se ha elegido examinar detalladamente aquellas apoteosis en que aparece una alusión explícita a la parte mortal o a la parte inmortal, i.e., las de Ino y Melicertes, Hércules, Eneas, Glauco, Rómulo, Hersilia, César, Augusto y Ovidio. Se incluyen, de todas maneras, otras referencias y apoteosis relevantes. La alusión a la imagen de la pars, siguiendo una de las denominaciones con más trascendencia formal en la obra, remite a la creación del hombre divino semine y a partir de semina caeli, aspecto que se estudia en el primer capítulo de la primera parte y se retoma en el análisis de cada apoteosis. La conclusión del trabajo es que el motivo de la apoteosis sólo puede inteligirse a la luz del final, en el que se representa la apoteosis del poeta. Al margen de la mitologización que opera en las historias con valor histórico y augusteo, Ovidio se ha preocupado por mantener, aunque sólo sea en forma referencial, el sentido de las apoteosis con el fin de desplegar toda su significación en la apoteosis final. Inversamente, el valor completo del motivo en el cierre de la obra exige aceptar su significación a lo largo de la obra. En el final, el poeta, un poeta Romanus en la medida en que su obra será leída donde se extienda la Romana potentia, se revela como el auténtico sanctius animal referido en la creación.

'Muerte de Narciso', poema-umbral del orbe lezamiano

Este trabajo contempla la presencia de los subtextos de los Narcisos de Valéry y Ovidio, así como las poéticas de Garcilaso y Góngora en "Muerte de Narciso" de José Lezama Lima. En este primer poema publicado Lezama diseña su linaje colocando a Garcilaso como la figura emblemática del poeta y expone sus diferencias con respecto a Valéry y Góngora. A pesar de la distancia entre este texto y la noción de "era imaginaria" que Lezama construye posteriormente, nuestra lectura halla vínculos que permiten trazar en "Muerte de Narciso" una era imaginaria que traza el inicio de la poética lezamiana.

Ecos ovidianos en una adaptación de Eurípides : Hécuba Triste de Pérez de Oliva

Hécuba triste de Pérez de Oliva, considerada una de las primeras traducciones a lengua vernácula de una tragedia griega, es una adaptación peculiar de la Hécuba de Eurípides que incorpora notables cambios, algunos de ellos por influencia de otras tragedias griegas. En este trabajo estudiamos varios motivos utilizados por Oliva que remiten a otros textos, entre los que destacan obras relacionadas directa o indirectamente con Ovidio.

¿Fue Ovidio un poeta latino de la Edad de Plata?

Este artículo busca establecer cómo las características más sobresalientes de las Metamorfosis de Ovidio, consideradas por muchos estudiosos como el modelo por excelencia de los poetas latinos del siglo I d.C. no resultan tan influyentes en la praxis poética de los autores neronianos y flavianos. Aun considerando los numerosos paralelismos formales y estilísticos existentes en estos autores, tal como el uso de la paradoja, la sobreexplicitación visual y la acumulación de detalles, resulta claro que el propósito y el uso de los diferentes topoi literarios que estos poetas hacen son completamente distintos. Un análisis de los motivos de la nekya y la tempestad en Ovidio, Lucano, Silio Itálico, Valerio Flaco y Estacio muestra cuánto más a menudo los poetas latinos del siglo I d.C. recurren a la obra de Virgilio que a la de Ovidio

La apoteosis en las Metamorfosis de Ovidio : Función estructural y valor semántico

El objeto de este trabajo ha sido estudiar el motivo de la apoteosis con el fin de descubrir de qué manera se integra positivamente en la representación de las Metamorfosis. Se intenta trascender interpretaciones denigratorias o irónicas del motivo. El estudio consta de dos partes. En el primer capítulo de la primera parte, "La apoteosis en la estructura de las Metamorfosis", se demuestra con un análisis intratextual la importancia que tiene el relato de la creación del hombre como sanctius animal, considerada paradigmática, en el estudio del motivo de la apoteosis. El segundo capítulo insiste en la dimensión intertextual, recordando la influencia estructural de dos modelos poéticos de las Metamorfosis de Ovidio, Hesíodo y la Égloga 6 de Virgilio, para una representación que comienza en la creación del hombre y termina en la apoteosis del poeta. La introducción a la segunda parte, "Valor semántico de la apoteosis", pone el acento en tres aspectos esenciales para el estudio de la apoteosis. En primer lugar, la idea de "lectura", i.e., la trascendencia latente del motivo de la apoteosis y de la idea de estirpe a lo largo de la obra. Se propone, en segundo lugar, el concepto de "mitologización" como una forma de examinar la apropiación que hace el poeta del mito historizado y del mito con alusión augustea. Esa apropiación tendrá como fin destacar el aspecto literatio de las historias y ejercerá un papel fundamental en la construcción de una gfigura de poeta que, mediante la apoteosis por su obra, se eleva por sobre las figuras de filósofo y de político. Su tratamiento en este trabajo, pues, se debe al hecho de que está ligado, en último término, con el motivo de la apoteosis. Dado que el estudio tiene como punto de partida la relación entre el sanctius animal, paradigma de la creación del hombre, y la apoteosis, se ha elegido examinar detalladamente aquellas apoteosis en que aparece una alusión explícita a la parte mortal o a la parte inmortal, i.e., las de Ino y Melicertes, Hércules, Eneas, Glauco, Rómulo, Hersilia, César, Augusto y Ovidio. Se incluyen, de todas maneras, otras referencias y apoteosis relevantes. La alusión a la imagen de la pars, siguiendo una de las denominaciones con más trascendencia formal en la obra, remite a la creación del hombre divino semine y a partir de semina caeli, aspecto que se estudia en el primer capítulo de la primera parte y se retoma en el análisis de cada apoteosis. La conclusión del trabajo es que el motivo de la apoteosis sólo puede inteligirse a la luz del final, en el que se representa la apoteosis del poeta. Al margen de la mitologización que opera en las historias con valor histórico y augusteo, Ovidio se ha preocupado por mantener, aunque sólo sea en forma referencial, el sentido de las apoteosis con el fin de desplegar toda su significación en la apoteosis final. Inversamente, el valor completo del motivo en el cierre de la obra exige aceptar su significación a lo largo de la obra. En el final, el poeta, un poeta Romanus en la medida en que su obra será leída donde se extienda la Romana potentia, se revela como el auténtico sanctius animal referido en la creación.

'Muerte de Narciso', poema-umbral del orbe lezamiano

Este trabajo contempla la presencia de los subtextos de los Narcisos de Valéry y Ovidio, así como las poéticas de Garcilaso y Góngora en "Muerte de Narciso" de José Lezama Lima. En este primer poema publicado Lezama diseña su linaje colocando a Garcilaso como la figura emblemática del poeta y expone sus diferencias con respecto a Valéry y Góngora. A pesar de la distancia entre este texto y la noción de "era imaginaria" que Lezama construye posteriormente, nuestra lectura halla vínculos que permiten trazar en "Muerte de Narciso" una era imaginaria que traza el inicio de la poética lezamiana.