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1.
Health Place ; 87: 103257, 2024 May.
Article in English | MEDLINE | ID: mdl-38696876

ABSTRACT

BACKGROUND: Neighborhood physical environments may influence cardiometabolic health, but prior studies have been inconsistent, and few included long follow-up periods. METHODS: Changes in cardiometabolic risk factors were measured for up to 14 years in 2830 midlife women in the Study of Women's Health Across the Nation, a multi-ethnic/racial cohort of women from seven U.S. sites. Data on neighborhood food retail environments (modified Retail Food Environment Index) and walkability (National Walkability Index) were obtained for each woman's residence at each follow-up. Data on neighborhood access to green space, parks, and supermarkets were available for subsets (32-42%) of women. Models tested whether rates of change in cardiometabolic outcomes differed based on neighborhood characteristics, independent of sociodemographic and health-related covariates. RESULTS: Living in more (vs. less) walkable neighborhoods was associated with favorable changes in blood pressure outcomes (SBP: -0.27 mmHg/year, p = 0.002; DBP: -0.22 mmHg/year, p < 0.0001; hypertension status: ratio of ORs = 0.79, p < 0.0001), and small declines in waist circumference (-0.09 cm/year, p = 0.03). Small-magnitude associations were also observed between low park access and greater increases in blood pressure outcomes (SBP: 0.37 mmHg/year, p = 0.003; DBP: 0.15 mmHg/year, p = 0.04; hypertension status: ratio of ORs = 1.16, p = .04), though associations involving DBP and hypertension were only present after adjustment for sociodemographic variables. Other associations were statistically unreliable or contrary to hypotheses. CONCLUSION: Neighborhood walkability may have a meaningful influence on trajectories of blood pressure outcomes in women from midlife to early older adulthood, suggesting the need to better understand how individuals interact with their neighborhood environments in pursuit of cardiometabolic health.


Subject(s)
Cardiometabolic Risk Factors , Residence Characteristics , Walking , Women's Health , Humans , Female , Middle Aged , Walking/statistics & numerical data , United States , Residence Characteristics/statistics & numerical data , Neighborhood Characteristics , Blood Pressure/physiology , Adult , Environment Design , Waist Circumference , Risk Factors , Cardiovascular Diseases/epidemiology
2.
J Am Coll Cardiol ; 83(14): 1310-1321, 2024 Apr 09.
Article in English | MEDLINE | ID: mdl-38569760

ABSTRACT

BACKGROUND: Transcatheter pulmonary valve replacement (TPVR) with the self-expanding Harmony valve (Medtronic) is an emerging treatment for patients with native or surgically repaired right ventricular outflow tract (RVOT) pulmonary regurgitation (PR). Limited data are available since U.S. Food and Drug Administration approval in 2021. OBJECTIVES: In this study, the authors sought to evaluate the safety and short-term effectiveness of self-expanding TPVR in a real-world experience. METHODS: This was a multicenter registry study of consecutive patients with native RVOT PR who underwent TPVR through April 30, 2022, at 11 U.S. CENTERS: The primary outcome was a composite of hemodynamic dysfunction (PR greater than mild and RVOT mean gradient >30 mm Hg) and RVOT reintervention. RESULTS: A total of 243 patients underwent TPVR at a median age of 31 years (Q1-Q3: 19-45 years). Cardiac diagnoses were tetralogy of Fallot (71%), valvular pulmonary stenosis (21%), and other (8%). Acute technical success was achieved in all but 1 case. Procedural serious adverse events occurred in 4% of cases, with no device embolization or death. Hospital length of stay was 1 day in 86% of patients. Ventricular arrhythmia prompting treatment occurred in 19% of cases. At a median follow-up of 13 months (Q1-Q3: 8-19 months), 98% of patients had acceptable hemodynamic function. Estimated freedom from the composite clinical outcome was 99% at 1 year and 96% at 2 years. Freedom from TPVR-related endocarditis was 98% at 1 year. Five patients died from COVID-19 (n = 1), unknown causes (n = 2), and bloodstream infection (n = 2). CONCLUSIONS: In this large multicenter real-world experience, short-term clinical and hemodynamic outcomes of self-expanding TPVR therapy were excellent. Ongoing follow-up of this cohort will provide important insights into long-term outcomes.


Subject(s)
Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Pulmonary Valve Insufficiency , Pulmonary Valve , Humans , Adult , Pulmonary Valve/surgery , Heart Valve Prosthesis Implantation/adverse effects , Cardiac Catheterization/adverse effects , Treatment Outcome , Pulmonary Valve Insufficiency/surgery , Pulmonary Valve Insufficiency/etiology , Registries , Prosthesis Design , Retrospective Studies
3.
Health Place ; 82: 103033, 2023 Jul.
Article in English | MEDLINE | ID: mdl-37141837

ABSTRACT

PURPOSE: To examine whether longitudinal exposure to neighborhood socioeconomic vulnerability influences blood pressure changes throughout midlife in a racially, ethnically, and geographically-diverse cohort of women transitioning through menopause. METHODS: We used longitudinal data on 2738 women (age 42-52 at baseline) living in six United States cities from The Study of Women's Health Across the Nation. Residential histories, systolic blood pressures (SBP), and diastolic blood pressures (DBP) were collected annually for ten years. We used longitudinal latent profile analysis to identify patterns of neighborhood socioeconomic vulnerability occurring from 1996 to 2007 in participant neighborhoods. We used linear mixed-effect models to determine if a woman's neighborhood profile throughout midlife was associated with blood pressure changes. RESULTS: We identified four unique profiles of neighborhood socioeconomic vulnerability - differentiated by residential socioeconomic status, population density, and vacant housing conditions - which remained stable across time. Women residing in the most socioeconomically vulnerable neighborhoods experienced the steepest increase in annual SBP growth by 0.93 mmHg/year (95% CI: 0.65-1.21) across ten-year follow-up. CONCLUSIONS: Neighborhood socioeconomic vulnerability was significantly associated with accelerated SBP increases throughout midlife among women.


Subject(s)
Residence Characteristics , Women's Health , Humans , Female , United States , Adult , Middle Aged , Blood Pressure , Longitudinal Studies , Social Class
4.
Subst Use Misuse ; 56(9): 1363-1373, 2021.
Article in English | MEDLINE | ID: mdl-34085586

ABSTRACT

Beer remains the greatest source of per capita alcohol consumption in the United States, and increasing market availability and consumer demand for higher alcohol has meaningful public health consequences. Objectives: To determine whether apparent alcohol intake from beer changed among households over time, we used nationally-representative US Nielsen Consumer Panel purchasing data from 2004 to 2014, and incorporated information on percent alcohol by volume (ABV) to compute the number of standard drinks of alcohol consumed from beer as a result. Methods: We queried external data sources (e.g. official manufacture, consumer beer-related websites) to obtain beer-specific ABVs, merged this information with Nielsen consumer-level data, and calculated the average rate of beer and standard drink consumption per household per year. We used joinpoint regression to estimate annual percentage changes and annual absolute changes in intake over time, with separate piecewise linear segments fit between years if a significant deviation in trend was detected. Results: Higher alcohol content beer consumption increased steadily across the decade, accounting for 9.6% of total intake in 2004 compared to 21.6% of total intake by 2014. Standard drink intake from beer declined sharply post-2011 by 3.04% annually (95% CI: -5.93, -0.06) or by 4.52 standard drinks (95% CI: -8.69, -0.35) yearly - coinciding with several beer industry transitions, market share fluctuations, and consumer preference changes for beer occurring around that time. Conclusions: Despite consistent increases in higher alcohol content beer intake across the decade, households do not appear to be consuming more standard drinks of alcohol from beer as a result.Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1928208 .


Subject(s)
Alcohol Drinking , Beer , Alcohol Drinking/epidemiology , Alcoholic Beverages , Commerce , Ethanol , Family Characteristics , Humans , United States/epidemiology
5.
Prog Community Health Partnersh ; 14(1): 109-115, 2020.
Article in English | MEDLINE | ID: mdl-32280128

ABSTRACT

BACKGROUND: The Greater Pittsburgh Community Food Bank (GPCFB) developed the Green Grocer mobile food market to address limited access to fresh, affordable food options in local communities. GPCFB and researchers from the University of Pittsburgh established a partnership for Green Grocer implementation and evaluation, including application of geospatial techniques to help identify locations of stops for Green Grocer. OBJECTIVES: We used geospatial analyses to identify locations in Allegheny County with limited food access as potential stops for the Green Grocer mobile food market. METHODS: Using census, county, city, and public health data, we conducted a spatial overlay analysis based on five key metrics: poverty/income rates, Supplemental Nutrition Assistance Program (SNAP) use, obesity rates, grocery/supermarket access, and mass transit access. We first defined our base target areas by finding the intersection of tracts with high rates of poverty, SNAP use, and obesity. To obtain our final recommended target neighborhoods, we then calculated the symmetric difference between these base target areas and areas of low grocery access and transit use. RESULTS: As identified from our overlay analysis, six neighborhoods became the targeted pilot sites for Green Grocer. These particular communities had higher poverty rates than Pittsburgh, Allegheny County, and Pennsylvania averages. A separate pilot evaluation was conducted after the initial sites were selected to examine additional population characteristics and to help determine any modifications to the program. CONCLUSIONS: Geospatial overlay analysis identified key locations to help the GPCFB target allocation of fresh food and produce. When used in tandem with other programmatic information and processes, this data-driven approach was essential in the development and identification of distribution of resources.


Subject(s)
Food Supply/methods , Residence Characteristics/statistics & numerical data , Spatial Analysis , Community-Based Participatory Research , Community-Institutional Relations , Food Assistance/statistics & numerical data , Humans , Obesity/epidemiology , Pennsylvania/epidemiology , Poverty/statistics & numerical data , Socioeconomic Factors , Universities/organization & administration
6.
Health Equity ; 2(1): 375-383, 2018.
Article in English | MEDLINE | ID: mdl-30582097

ABSTRACT

Purpose: In November 2015, Greater Pittsburgh Community Food Bank implemented a pilot phase of the Green Grocer mobile market, a program aimed at improving access to locally sourced fresh foods in low-resource neighborhoods. We conducted an evaluation of this pilot phase. Methods: We conducted baseline surveys of residents in six neighborhoods that received Green Grocer in the pilot phase to understand the food environment, including perceptions of fresh food availability, and another survey of Green Grocer consumers to evaluate their experiences and satisfaction. We measured respondent intake of fruit and vegetable in the terms of days per week and servings per day. We used Poisson regression with cluster-robust standard errors to model the average change in produce consumption pre-post intervention. Results: Residents of select communities observed meaningful improvements in intake. After covariate adjustment, Homewood residents observed an average 13% increase in vegetable intake (days/week) rates post-Green Grocer (p=0.04). Clairton residents also showed marked increases, with an average 20% increase in vegetable intake (servings/day) (p=0.049). After 6 months, declines in produce purchase from discount stores and supercenters were observed alongside increases in procurement from Green Grocer, farmer's markets, gardens, and other sources. Conclusion: Our preliminary work provides support that this mobile market serving under-resourced areas was valued by consumers and showed increases in vegetable consumption in several neighborhoods. When scaled-up, this program had the potential to reduce geographically-based food and health disparities.

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