Four out of five people in the United States live within an hour's drive of a hospital equipped to treat acute stroke – yet very few get recommended treatment, according to research presented at the American Stroke Association's International Stroke Conference 2014.
Of the more than 370,000 Medicare stroke claims for 2011 that researchers examined:
These treatments are most likely available at designated stroke centers, where a team of providers are trained to quickly diagnose and treat strokes.
“If a patient suspects they are having a stroke, they need to call 9-1-1 immediately and get to the nearest stroke center as soon as possible, which might mean bypassing another hospital that isn't set up to deliver the necessary therapy,” said Opeolu Adeoye, M.D., M.S., the study's lead author and associate professor of emergency medicine and neurosurgery at the University of Cincinnati.
“We strongly suggest that patients go to the hospital by ambulance, that they or whoever is with them ask to go to a stroke center and ask for tPA.” The study found that within an hour's driving time:
Within an hour by air:
In 2011, 60 percent of U.S. hospitals didn't administer tPA. These hospitals discharged about 1 in 5 of all stroke patients.
“Every 15-minute delay in getting treatment increases the odds of that patient not being able to go home,” Adeoye said. “Calling 9-1-1 is best if a stroke is suspected because paramedics should know which hospitals are stroke centers and can alert the stroke team in advance of the patient's arrival, all of which saves time.”
For additional information on stroke warning signs, visit http://powertoendstroke.org/stroke-recognize.html .
FALLS CHURCH, Va. – Older firefighters who are chronically exposed to heat stress on the job could be more heat resilient over time.
A recent study published in the December issue of the Journal of Occupational and Environmental Hygiene (JOEH) found that older firefighters may be able to tolerate more challenging or arduous work environments before they feel affected by the heat, compared to non-heat-exposed workers who would need to stop work prematurely.
“We found that the firefighters experienced reduced subjective feelings of thermal and cardiovascular strain during exercise compared to the non-firefighters, potentially indicative of greater heat resilience in firefighters due to the nature of their occupation,” said study investigator Glen P. Kenny, PhD, a professor at the School of Human Kinetics at the University of Ottawa in Ontario, Canada.
The researchers examined a group of older, physically active non-firefighters and firefighters, approximately 51 years old, during intermittent exercise in two heat stress conditions, to investigate the potential thermal, cardiovascular and hydration effects of repeated occupational heat stress.
While Kenny and his colleagues found no differences in the level of thermal and cardiovascular strain between the older heat-exposed firefighters and non-heat-exposed older workers, the non-heat-exposed workers felt more heat stressed relative to the older firefighters and felt that the work performed was physically more challenging.
“If you have older workers who work in the heat, they are in a better position to handle working in the heat as compared to their non-heat-exposed counterparts,” said Kenny. “If they can better handle the heat stress, they can better perform challenging tasks without putting themselves at greater risks of injuries caused by impairments in mental function, alertness, concentration, motor dexterity and coordination.”
Prior to this study, physiological strain had been examined in young and middle-aged firefighters during live firefighting and simulated drills, but the responses of older and more experienced firefighters had not previously been investigated.
“Our discovery is especially important given recent findings that aging can decrease an individual's ability to dissipate heat and therefore work in hot environments,” added Kenny.
CHICAGO – Elevated blood pressure as young as age 18 is a warning sign of cardiovascular disease developing later in life and the time to begin prevention, according to a large national Northwestern Medicine study.
That's decades earlier than clinicians and patients generally start thinking about heart disease risk.
The study also found distinct blood pressure patterns from ages 18 to 55 that reveal people at high risk for calcification of coronary arteries – a marker for heart disease – by middle age.
Also known as hardening of the arteries, these calcium deposits can narrow coronary arteries and increase heart attack risk.
The 25-year study is the first to identify different long-term patterns of blood pressure levels and resulting cardiovascular risk.
“This shows that your blood pressure in young adulthood can impact your risk for heart disease later in life,” said Norrina Allen, lead study author and assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine. “We can't wait until middle age to address it. If we can prevent their blood pressure from increasing earlier in life we can reduce their risk of future heart attacks and stroke.”
More than 33 percent of U.S. adults have hypertension. Currently, the clinical approach is to evaluate blood pressure risk in middle or older age and not consider how it may have changed or increased with age.
The paper will be published Feb. 4 in the Journal of the American Medical Association.
Tracking the long-term patterns in blood pressure starting in young adulthood will more accurately identify individuals at risk for heart disease. It also will enable earlier and more effective prevention, scientists said.
“If we see someone who is 25 or 30 and they fall into one of these patterns, we can predict where they'll be later in middle age,” Allen said. “Then we can prescribe lifestyle changes such as increased physical activity or a better diet that can prevent them from developing hypertension and a higher risk of disease.”
“In people with higher blood pressure, earlier intervention with lifestyle and with medication, when needed, is important,” noted senior author Donald Lloyd-Jones, M.D., chair of preventive medicine at Feinberg and a cardiologist at Northwestern Memorial Hospital. “Although blood pressure can be quickly lowered with medication, the damage to the heart and blood vessels that is caused by time spent with elevated blood pressure tends to remain. We can't put the horse all the way back in the barn.”
The study used data from 4,681 participants in the Coronary Artery Risk Development in Young Adults Study from baseline years 1985-1986 through 25 years of follow-up. The participants (black and white men and women) were 18 to 25 years old when the study began and from four urban sites including Chicago, Birmingham, Minneapolis, and Oakland.
The highest risk group had elevated blood pressure compared to their peers at age 18, but it was still within the range considered normal; this tended to develop into hypertension by middle age. They were four times more likely to have coronary artery calcification.
The study identified five patterns in blood pressure from young adulthood to middle age:
Groups with elevated or increasing blood pressure were at the highest risk for developing calcification of coronary arteries.
The study also found African Americans and smokers were more likely to experience rapid increases in blood pressure during middle age, placing them at higher risk of heart disease.
SAN FRANCISCO – This week the U.S. Environmental Protection Agency (EPA) announced over $3 million in grants to research institutions to better understand how chemicals interact with biological processes and how these interactions may lead to altered brain development.
The studies are focused on improving EPA’s ability to predict the potential health effects of chemical exposures.
The University of California, Davis (UC Davis) is one of the four grantees to receive $800,000 to conduct research on developmental neurotoxicity.
“This research will transform our understanding of how exposure to chemicals during sensitive lifestages affects the development of the brain,” said Lek Kadeli, acting assistant administrator for EPA’s Office of Research and Development. “By better predicting whether chemicals have the potential to impact health and human development, these grants will not only advance the science necessary to improve chemical safety but protect the well being and futures of children in this nation.”
From the project, UC Davis will conduct research to demonstrate how the thyroid hormone (TH), which is responsible for neurodevelopment, is affected by toxic chemicals.
Research will also provide insight into which parts of the neurodevelopment systems are susceptible to disruption, and improve assessments used to show impact to human health.
In addition to UC Davis, other recipients include: North Carolina State University in Raleigh, N.C., The University of Georgia in Athens, Ga., and the Sanford-Burnham Medical Research Institute in La Jolla, Calif.
These grants focus on developing better adverse outcome pathways (AOPs), which are models that predict the connection between exposures and the chain of events that lead to an unwanted health effect.
AOPs combine vast amounts of data from different sources to depict the complex interactions of chemicals with biological processes, and then extend this information to explain an adverse health effect.
EPA expects to use the knowledge gained from this research to develop efficient and cost-effective models to better predict if and how exposure to environmental chemicals may lead to developmental neurotoxicity.
These awards are advancing the science and technological capability to model and predict how chemicals behave when they come into contact with biological systems.
This improved understanding supports the agency’s mission of protecting human health and the environment and amplifies the impact of its chemical safety research efforts.
EPA’s chemical safety research is accelerating the pace of chemical screening, helping to protect vulnerable populations and species, developing solutions for more sustainable chemicals and using computational science to understand the relationship between chemical exposures and health outcomes.
For more information about these awards visit http://epa.gov/ncer/adversepath ,
For more information on EPA’s National Research Program on Chemical Safety, visit http://www.epa.gov/research/chemicalscience/ .