BackgroundUnderstanding the signs and symptoms of heart attacks and strokes are important not only in saving lives, but also in preserving quality of life. Findings from recent research have yielded that the prevalence of cardiovascular disease risk factors are higher in rural populations, suggesting that adults living in rural locales may be at higher risk for heart attack and/or stroke. Knowledge of heart attack and stroke symptomology as well as calling 911 for a suspected heart attack or stroke are essential first steps in seeking care. This study sought to examine the knowledge of heart attack and stroke symptoms among rural adults in comparison to non-rural adults living in the U.S.MethodsUsing multivariate techniques, a cross-sectional analysis of an amalgamated multi-year Behavioral Risk Factor Surveillance Survey (BRFSS) database was performed. The dependent variable for this analysis was low heart attack and stroke knowledge score. The covariates for the analysis were: age, sex, race/ethnicity, annual household income, attained education, health insurance status, having a health care provider (HCP), timing of last routine medical check-up, medical care deferment because of cost, self-defined health status and geographic locale.ResultsThe weighted n for this study overall was 103,262,115 U.S. adults > =18 years of age. Approximately 22.0% of these respondents were U.S. adults living in rural locales. Logistic regression analysis revealed that those U.S. adults who had low composite heart attack and stroke knowledge scores were more likely to be rural (OR = 1.218 95%CI 1.216-1.219) rather than non-rural residents. Furthermore, those with low scores were more likely to be: male (OR = 1.353 95%CI 1.352-1.354), >65 years of age (OR = 1.369 95%CI 1.368-1.371), African American (OR = 1.892 95%CI 1.889-1.894), not educated beyond high school (OR = 1.400 955CI 1.399-1.402), uninsured (OR = 1.308 95%CI 1.3-6-1.310), without a HCP (OR = 1.216 95%CI 1.215-1.218), and living in a household with an annual income of < $50,000 (OR = 1.429 95%CI 1.428-1.431).ConclusionsAnalysis identified clear disparities between the knowledge levels U.S. adults have regarding heart attack and stroke symptoms. These disparities should guide educational endeavors focusing on improving knowledge of heart attack and stroke symptoms.

Objective. To implement a longitudinal research experience in the form of an embedded mini-fellowship in a first-postgraduate year (PGY1) residency program. Design. In September 2011, a research module was initiated and research meetings were established on a recurrent basis throughout the residency so that residents would have protected time for academic work. The research module was structured around lecture seminars, statistical analysis workshops, and works-in-progress sessions. Assessment. Two residents completed the initial module and worked on multiple research projects. The projects were assessed by the lead faculty member on the research module based on established learning objectives for the module. The 3 completed research projects were presented at national meeting poster sessions. Five papers were submitted to scholarly journals for peer review. Residents were able to submit their final required project manuscripts just 4 months after beginning the research module. Conclusion. Formalizing the research efforts of PGY1 residents by establishing a research module with protected time ensured residents worked steadily toward established deadlines and met the objectives of the module.

BackgroundDepression is a psychiatric condition that affects approximately one in five U.S. adults in their lifetime. No study that we know of has examined depressive symptoms and health service deficits in rural compared with non-rural populations. Four factors constitute the variable health service deficits: did not have health insurance, did not have a healthcare provider, deferred medical care because of cost and did not have a routine medical exam, all within the last 12 months. The aim of this study was to ascertain the prevalence of health service deficits in rural versus non-rural adults with depressive symptoms. Examining depressive symptoms by health service deficits is important because it allows us to approximate those with the condition who might not be receiving care for it. By analyzing national, population-based data, this study sought to fill in some important epidemiological gaps regarding depressive symptoms and health service deficits.MethodsFor this analysis the population of interest was U.S. adults identified as currently having depressive symptoms using the PHQ-8 criteria. Behavior Risk Factor Surveillance Survey 2006 data were used in this analysis. Health service deficits was the primary dependent variable. Multivariate logistic regression analysis was performed to examine health service deficits experienced by adults with depression controlling for socioeconomic status, race and ethnicity and geographic locale (rural or non-rural).ResultsLogistic regression analysis yielded that U.S. adults currently having depressive symptoms who were of low socioeconomic status, Hispanic ethnicity, or living in a rural locale were more likely to have at least one health service deficit.ConclusionAnalyzing data collected by a large surveillance system such as BRFSS, allows for an analysis incorporating an array of covariates not available from clinically-based data such as electronic health records. By identifying clinically depressed U.S. adults who also have at least one health service deficit, we were able to ascertain those most likely not receiving care for this debilitating condition. We believe community pharmacists are well suited to assist in connecting depressed, vulnerable populations with appropriate and needed care. This care would be best provided by an inter-professional team led by a primary care provider.

With involvement in two wars over the past decade, there has been a documented increase in depression prevalence and suicide incidence among U.S. military veterans. Because higher proportions of veterans come from rural communities, access to care may be an issue when behavioral health care is needed. Although the Veterans Administration has expanded health services in rural areas, this has not always resulted in increased service utilization. This study examined the prevalence of depression and associated health service deficits (HSDs) for rural versus nonrural U.S. military veterans. Using bivariate and multivariate techniques, 2006 Behavioral Risk Factor Surveillance System data were analyzed. Bivariate analysis revealed that rural veterans had greater odds of having at least one HSD, being currently depressed as measured by the Personal Health Questionnaire-8, and having lifetime depression. Logistic regression analysis confirmed that rural veterans had higher odds of both current and lifetime depression than nonrural veterans when controlling for socioeconomic status and race/ethnicity. Additionally, logistic regression analysis also revealed that rural veterans with current depression had higher odds of being Hispanic or Other/Multiracial than Caucasian, not employed for wages than employed for wages, <65 years of age, and reported having at least one HSD.

Introduction: Mental health is an important component of overall health. Mental illness is a leading cause of morbidity and mortality in the US and is associated with chronic diseases such as heart disease, diabetes, and arthritis. In the US, most people with mental health issues or disorders remain untreated. Epidemiological studies have identified rural residents as being at greater risk for health disparities; as a result, rural residents are a vulnerable population in terms of mental health and mental health care. Research has demonstrated that perceived stigma can be a significant barrier to rural residents seeking mental health care. This study examined the research question: What are the characteristics of US rural adults with mental health concerns who perceived stigma? Methods: 2007 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed using bivariate and multivariate techniques to answer the research question. 2007 BRFSS data were used because in that year non-institutionalized US adults in 37 states and territories were queried about their attitudes toward mental illness. BRFSS is a random digit telephone survey that uses a complex multi-stage sampling approach and subsequently a weighting factor is calculated for application to the data in order to ensure that they are representative of the US population based on the most recent census data.Only weighted data were analyzed. Results: Logistic regression analysis revealed that rural adults reporting mental health concerns who perceived stigma regarding mental health were more likely to be unemployed seeking work or not working and not seeking work, military veterans, or to have deferred medical care because of cost. They were also more likely to not have a health care provider and to rarely or never feel supported emotionally. Conclusions: Support systems may render people with mental health issues less vulnerable to perceiving stigma, thus assisting with removing stigma as a barrier to care. Pharmacist may play a role as support in communities, especially where access to health care providers may be limited.