Diseases Commons^™

Humanizing Mathematical Biology Research And Education, Carrie Diaz Eaton, Ognyan Simeonov

Annual Symposium on Biomathematics and Ecology Education and Research

No abstract provided.

Diabetes-Related Bias In Electronic Health Records And International Classification Of Diseases., Mihail Zilbermint

Journal of Community Hospital Internal Medicine Perspectives

Diabetes mellitus is a chronic health condition that affects the body's ability to convert food into energy. People living with diabetes, as well as doctors and hospitals, struggle to handle the challenge. Among these challenges is that the field of diabetology is filled with bias. People living with diabetes will say that “diabetes does not define them,” yet they often refer to themselves as “diabetics.” Doctors are frequently “trained” to call people “diabetics,” and I am one of them. Psychological consequences associated with diabetes and obesity bias and stigma have been previously reported studied. People with diabetes may experience stigma …

Understanding The Mental Health Impact And Needs Of Public Healthcare Professionals During Covid-19 In Pakistan : A Qualitative Study, Waqas Hameed, Anam Shahil Feroz, Bilal Iqbal Avan, Bushra Khan, Zafar Fatmi, Noreen Afzal, Hussain Jafri, Mansoor Ali Wassan, Sameen Siddiqi

Community Health Sciences

Objectives: A dearth of qualitative studies constrains in-depth understanding of health service providers' perspectives and experiences regarding the impact of COVID-19 on their mental health. This study explored the mental health impact and needs of of public sector healthcare workers during COVID-19 who working in secondary-level and tertiary-level healthcare settings of Pakistan.
Design: An exploratory qualitative study.
Setting: Twenty-five secondary-level and eight tertiary-level public hospitals of Sindh and Punjab provinces of Pakistan.
Participants: In-depth interviews were conducted with 16 health service providers and 40 administrative personnel. Study data were analysed on NVivo V.11 using the conventional content analysis technique.
Results: …

Living With Multiple Sclerosis As A Former Marathon Runner: Impact Of Attitude And Past Behaviour On Self-Care Maintenance And Perseverance, Michael Stephanou

Patient Experience Journal

As healthcare professionals, we have a duty to promote the wellbeing of individuals living with chronic diseases and this could be accomplished through the establishment of self-care strategies that are both collaborative and self-directed. Insight into the complex behaviours and backgrounds of individuals who show initiative in dealing with chronic disease could help achieve this by revealing drivers of health-seeking and engaging behaviours. Therefore, by deducing the complex interactions between attitude, past experiences and disease outlook, broader patient welfare could be championed through the implementation of targeted interventions which promote self-care in chronic disease. This article aims to explore these …

Covid-19, Nutrition, And Gender: An Evidence-Informed Approach To Gender-Responsive Policies And Programs, Anna Kalbarczyk, Noora-Lisa Aberman, Bregje S M Van Asperen, Rosemary Morgan, Zulfiqar Ahmed Bhutta, Bianca Carducci, Rebecca Heidkamp, Saskia Osendarp, Neha Kumar, Anna Lartey

Department of Paediatrics and Child Health

In addition to the direct health impacts of COVID-19, government and household mitigation measures have triggered negative indirect economic, educational, and food and health system impacts, hitting low-and middle-income countries the hardest and disproportionately affecting women and girls. We conducted a gender focused analysis on five critical and interwoven crises that have emerged because of the COVID-19 crisis and exacerbated malnutrition and food insecurity. These include restricted mobility and isolation; reduced income; food insecurity; reduced access to essential health and nutrition services; and school closures. Our approach included a theoretical gender analysis, targeted review of the literature, and a visual …

Cost Analysis Of Implementing An Exercise Program For Fall And Fracture Prevention In Older Adults On Proton Pump Inhibitor Therapy, Thomas Adam Wichelmann, Nhan Dang, David H. Kruchko, Sufyan Abdulmujeeb, Eli D. Ehrenpreis

Journal of Patient-Centered Research and Reviews

Purpose: Falls have significant financial impact. Proton pump inhibitor (PPI) therapy is associated with an increased risk of falls and fractures. Exercise programs have been shown to decrease risk of falls in the elderly population and are recommended by the U.S. Preventive Services Task Force for patients over age 65 to reduce falls. Our study aimed to explore the potential financial benefit of implementing three different Centers for Disease Control and Prevention-recommended exercise-based interventions for fall prevention (Tai Chi, Stepping On, and Otago Exercise Program) in ≥ 65-year-old patients on PPI therapy.

Methods: A Markov model was developed to predict …

The Development And Initial Validation Of The Promis®+Hf-27 And Promis+Hf-10 Profiles, Faraz S Ahmad, Kathryn L Jackson, Susan E Yount, Nan E Rothrock, Michael A Kallen, Leilani Lacson, Karl Y Bilimoria, Abel N Kho, Raja Kannan Mutharasan, Peter A Mccullough, Jeffrey Bruckel, Savitri Fedson, Stephen E Kimmel, David T Eton, Kathleen L Grady, Clyde W Yancy, David Cella

Center for Medical Ethics and Health Policy Staff Publications

Aims: Heart failure (HF) is a common and morbid condition impacting multiple health domains. We previously reported the development of the PROMIS®-Plus-HF (PROMIS+HF) profile measure, including universal and HF-specific items. To facilitate use, we developed shorter, PROMIS+HF profiles intended for research and clinical use.

Methods and results: Candidate items were selected based on psychometric properties and symptom range coverage. HF clinicians (n = 43) rated item importance and clinical actionability. Based on these results, we developed the PROMIS+HF-27 and PROMIS+HF-10 profiles with summary scores (0-100) for overall, physical, mental, and social health. In a cross-sectional sample (n = 600), we …

A Qualitative Exploration Of Social Support In Males And Females Experiencing Issues With Infertility., Maya Pinzon, Shawna Rotoli

Rowan-Virtua School of Osteopathic Medicine Departmental Research

INTRODUCTION: The purpose of this study was to qualitatively investigate and compare male and female experiences of infertility in the context of social support.

METHODS: A Qualtrics survey (Qualtrics, Provo, Utah, United States) was posted to online fertility support groups and the responses were thematically analyzed. Only participants that completed the qualitative component of the survey were included in the study. Responses were subsequently thematically analyzed.

RESULTS: A sample of 110 participants (13 males and 97 females) were included in the present study. Thematic analyses revealed that isolation and loneliness, stigma, sentiments of misunderstanding, insensitive reactions, and others' unhelpful attempts …

Does Crime Trigger Genetic Risk For Type 2 Diabetes In Young Adults? A G X E Interaction Study Using National Data, Fangqi Guo, Kathleen Mullan Harris, Jason D. Boardman, Jennifer W. Robinette

Psychology Faculty Articles and Research

Background

Living in neighborhoods perceived as disordered exacerbates genetic risk for type 2 diabetes (T2D) among older adults. It is unknown whether this gene-neighborhood interaction extends to younger adults. The present study aims to investigate whether crime, an objectively measured indicator of neighborhood disorder, triggers genetic risk for T2D among younger adults, and whether this hypothesized triggering occurs through exposure to obesity.

Methods

Data were from the Wave I (2008) National Longitudinal Study of Adolescent to Adult Health. A standardized T2D polygenic score was created using 2014 GWAS meta-analysis results. Weighted mediation analyses using generalized structural equation models were conducted …

Wastewater-Informed Public Health Intervention Playbook

Sustain Magazine

As the SARS-CoV-2 pandemic quickly spread from country to country and continent to continent in 2020, governments and scientists needed a way to track COVID-19 through populations in order to position public health interventions in the most impactful locations. Having a decision-based risk framework may help to guide policy creation that could minimize or prevent possible outbreaks and surges of infection within communities. The University of Louisville in partnership with Louisville’s Department of Public Health and Wellness tested this strategy in 2021 and 2022. This Wastewater-Informed Public Health Intervention Playbook describes the decisions and actions of that academic and public …

Possible Gender Differences In The Level Of Perceived Social Support In Couples Who Are Experiencing Issues With Infertility., Maya Pinzon, Shawna Rotoli

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Objective The purpose of this study is to examine whether there are gender differences in the level of perceived social support in couples experiencing issues with fertility. Methods A total of 938 participants aged 18-47 years, with self-reported issues of infertility, were evaluated using the Multidimensional Scale of Perceived Social Support (MSPSS) which comprises three subscales which correspond with distinct sources of social support: significant other (SO), family, and friends. Differences between sexes for total score and for all subscale scores were subsequently analyzed using SPSS Statistics (IBM Corp, Armonk, USA). Results Mean total scores and scores on all subscales …

An Evaluation Of Covid-19 Vaccination Rates Of The Patients At The Kentucky Racing Health Services Center, Aditya Mehta, Dedra Hayden

The Cardinal Edge

COVID-19 vaccines have been widely available to the U.S. public since early 2021. However, vaccination rates still vary considerably across geographical areas and different populations. The objective of this study was to research overall vaccination rates against COVID-19 for Latinx patients at the Kentucky Racing Health Services Center (KRHSC). Vaccination and booster data was collected from June to December 2021 for all unique patients visiting the center. It was initially hypothesized that these rates of vaccination and booster doses for the KRHSC patients would be lower than the data reported by Kentucky and Jefferson County. After a retrospective review, the …

Associations Between Cannabis, Psychosis, And Schizophrenia In Adolescents, Lauren Moment

Academic Leadership Journal in Student Research

The effects of cannabis use on the brain, mind, and body have been studied for decades. The developing brain, particularly the adolescent and young adult brain, undergoes critical development that makes it especially susceptible to the effects of cannabis use. Among the adverse effects of cannabis use in adolescence and young adulthood, psychosis and psychotic disorders (e.g., schizophrenia) have been examined. The association of cannabis use with schizophrenia was first elucidated in a Swedish study of army conscripts. Specifically, conscripts reported their cannabis use exposure and were followed longitudinally to assess the emergence of schizophrenia. The authors found that those …

Social Media Impact Of Articles Published By Dermatology Residents During Medical School: Cross-Sectional Study, Austin Huang, Harrison Zhu, Kelvin Zhou, R Parker Kirby, Nina Dasari, Gianmarco A Calderara, Kathryn Cordova, Ryan Sorensen, Anshul Bhatnagar, Soo Jung Kim

Faculty, Staff and Students Publications

BACKGROUND: The Altmetric score (AS) is a novel measure of publication impact that is calculated by the number of mentions across various social media websites. This method may have advantages over traditional bibliometrics in the context of research by medical students.

OBJECTIVE: This study aimed to determine whether dermatology matriculants who graduated from higher-ranked medical schools published more articles with greater impact (ie, a higher AS) than those from lower-ranked institutions.

METHODS: A PubMed search for articles published by dermatology residents who started medical school in 2020 was conducted. Demographic information and Altmetric data were collected, and medical schools were …

Post Covid-19 Cognitive Impairment In A Patient With Bipolar Disorder, Nilanjana Dutta, Raghav Gupta, Dr. M Kishor Mbbs, Md

Digital Journal of Clinical Medicine

COVID-19 has caused widespread health conditions, psychological and social distress among people and there is evidence that shows profound neuropsychiatric complications during acute and post-recovery phases of the infection. Cognitive impairment occurring after COVID-19 infection can be explained by various mechanisms, including persistent systemic inflammation, direct viral invasion, alteration in the blood-brain barrier, and cerebrovascular endothelial injury.There are few studies that have explored the impact of COVID-19 on pre-existing psychiatric conditions. This case report highlights the temporal association of cognitive impairment with COVID-19 and the need for cognitive assessment and management in post-COVID-19 patients with pre-existing psychiatric conditions.

In Vivo Measurement Of Intradiscal Pressure Changes Related To Thrust And Non-Thrust Spinal Manipulation In An Animal Model: A Pilot Study, William R Reed, Michael A K Liebschner, Carla R Lima, Harshvardhan Singh, Christopher P Hurt, Daniel F Martins, James M Cox, Maruti R Gudavalli

Faculty, Staff and Students Publications

BACKGROUND: The intervertebral disc is a known back pain generator and is frequently the focus of spinal manipulative therapy evaluation and treatment. The majority of our current knowledge regarding intradiscal pressure (IDP) changes related to spinal manual therapy involves cadaveric studies with their inherent limitations. Additional in vivo animal models are needed to investigate intervertebral disc physiological and molecular mechanisms related to spinal manipulation and spinal mobilization treatment for low back disorders.

METHODS: Miniature pressure catheters (Millar SPR-1000) were inserted into either the L4-L5 or L5-L6 intervertebral disc of 3 deeply anesthetized adult cats (Oct 2012-May 2013). Changes in IDP …

Heterogeneity In The Prevalence Of Premature Hypertension Among Asian American Populations Compared With White Individuals: A National Health Interview Survey Study, Sina Kianoush, Mahmoud Al Rifai, Anwar T Merchant, Xiaoming Jia, Zainab Samad, Aneil Bhalla, Ayesha Khan, Dongshan Zhu, Salim Virani

Faculty, Staff and Students Publications

BACKGROUND: Differences in prevalence of risk factors such as hypertension may explain heterogeneity in cardiovascular risk across Asian American populations.

METHODS: We used National Health Interview Survey (NHIS) data from 2006 to 2018 among White, Chinese, Asian Indian, Filipino, and 'other Asians' (Japanese, Korean, and Vietnamese). Unadjusted and adjusted odds ratios (aOR) with 95% confidence intervals were reported using logistic regression models for the association between race and self-reported premature hypertension (ageold). Models were adjusted for sex, education, body mass index, smoking status, diabetes, and coronary heart disease.

RESULTS: We studied 99,864 participants with history of hypertension (mean age, 59.3 …

Problems And Suggestions On Covid-19’S Quarantine And Isolation From Perspective Of Spatial Organization, Wei Sun, Fengjun Jin

Bulletin of Chinese Academy of Sciences (Chinese Version)

Quarantine and isolation are effective means to prevent transmission of COVID-19, but the problems arised during the period of quarantine and isolation are worth pondering. This article first streamlines five types of problems during the recent period of quarantine and isolation. Based on a brief review of related research on domestic and international literature, the article argues that it will be a suitable approach to carry out research from the perspective of spatial organization combined with the concept of systems theory. Then, it explores the reasons of the aforementioned problems from the objective laws of spatial organization and systems theory. …

Association Between Social Vulnerability Index And Cardiovascular Disease: A Behavioral Risk Factor Surveillance System Study, Vardhmaan Jain, Mahmoud Al Rifai, Safi U Khan, Ankur Kalra, Fatima Rodriguez, Zainab Samad, Yashashwi Pokharel, Arunima Misra, Laurence S Sperling, Jamal S Rana, Waqas Ullah, Ankit Medhekar, Salim S Virani

Faculty, Staff and Students Publications

Background Social and environmental factors play an important role in the rising health care burden of cardiovascular disease. The Centers for Disease Control and Prevention developed the Social Vulnerability Index (SVI) from US census data as a tool for public health officials to identify communities in need of support in the setting of a hazardous event. SVI (ranging from a least vulnerable score of 0 to a most vulnerable score of 1) ranks communities on 15 social factors including unemployment, minoritized groups status, and disability, and groups them under 4 broad themes: socioeconomic status, housing and transportation, minoritized groups, and …

A Large-Scale Genome-Wide Gene-Gene Interaction Study Of Lung Cancer Susceptibility In Europeans With A Trans-Ethnic Validation In Asians, Ruyang Zhang, Sipeng Shen, Yongyue Wei, Ying Zhu, Yi Li, Jiajin Chen, Jinxing Guan, Zoucheng Pan, Yuzhuo Wang, Meng Zhu, Junxing Xie, Xiangjun Xiao, Dakai Zhu, Yafang Li, Demetrios Albanes, Maria Teresa Landi, Neil E Caporaso, Stephen Lam, Adonina Tardon, Chu Chen, Stig E Bojesen, Mattias Johansson, Angela Risch, Heike Bickeböller, H-Erich Wichmann, Gadi Rennert, Susanne Arnold, Paul Brennan, James D Mckay, John K Field, Sanjay S Shete, Loic Le Marchand, Geoffrey Liu, Angeline S Andrew, Lambertus A Kiemeney, Shan Zienolddiny-Narui, Annelie Behndig, Mikael Johansson, Angela Cox, Philip Lazarus, Matthew B Schabath, Melinda C Aldrich, Juncheng Dai, Hongxia Ma, Yang Zhao, Zhibin Hu, Rayjean J Hung, Christopher I Amos, Hongbing Shen, Feng Chen, David C Christiani

Faculty, Staff and Students Publications

INTRODUCTION: Although genome-wide association studies have been conducted to investigate genetic variation of lung tumorigenesis, little is known about gene-gene (G × G) interactions that may influence the risk of non-small cell lung cancer (NSCLC).

METHODS: Leveraging a total of 445,221 European-descent participants from the International Lung Cancer Consortium OncoArray project, Transdisciplinary Research in Cancer of the Lung and UK Biobank, we performed a large-scale genome-wide G × G interaction study on European NSCLC risk by a series of analyses. First, we used BiForce to evaluate and rank more than 58 billion G × G interactions from 340,958 single-nucleotide polymorphisms …

Histomonosis In Turkeys – Factors Influencing Transmission, Pathogenesis, And The Search For Prophylactic Or Therapeutic Compounds, Thainá Landim De Barros

Graduate Theses and Dissertations

The incidence of histomonosis has been increasing in poultry since the ban of prophylactic and therapeutic compounds. Histomonosis is caused by the protozoa Histomonas meleagridis. The objective of this dissertation was to investigate factors impacting the pathogenesis and transmission of histomonosis and to evaluate compounds that could potentially prevent or reduce the severity of histomonosis in turkeys. In the first study, the effect of sodium chlorate and sodium nitrate on reducing histomonads growth was tested in vitro and added to a basal turkey diet. A decrease in the growth of histomonads in vitro was observed, but no in vivo effect …

Intestinal Microbiota Analysis Of Broiler Chickens Under Necrotic Enteritis Challenge And Tributyrin Supplementation, Taylor Nicole Mckinney

Graduate Theses and Dissertations

Poultry is a staple protein source for most of the planet. Until recently, antibiotic growth promoters (AGPs) were used to prevent illnesses in commercial chicken production. Currently, this is not possible due to regulations and consumer concern, but without such a preventative, diseases like necrotic enteritis (NE) have reemerged, posing a threat to bird health, and ultimately, our food source. Necrotic enteritis is a severe gastrointestinal disease caused by the gram-positive pathogen, Clostridium perfringens. Clinical features of this disease are diarrhea, intestinal lesions, and death, with a high transmission rate. In a subclinical form, growth performance is diminished and is …

Enhancing Physician Perspectives Of Skilled Occupational Therapy Services For Patients With Rheumatoid Arthritis, Valerie S. Trinidad

Department of Occupational Therapy Entry-Level Capstone Projects

This Capstone Project, with a focus in research, sought to identify a relationship between self-reported functional performance and participation restriction as described by satisfaction with one’s execution or participation in a described occupation. A correlational study design was employed under the mentorship of Dr. Thomas Decker, EdD, OTD, OTR/L who oversaw all IRB processes, documentation, study development and deployment, as well as co-authored and provided mentorship for creation of a publishable manuscript of this project. The established Health Assessment Questionnaire Disability Index (HAQ-DI) and the newer Keele Assessment of Participation (KAP) were the two outcome measures of focus for surveying …

Ketamine For Acute Pain After Trauma: The Kapt Randomized Controlled Trial, Thaddeus J Puzio, James Klugh, Michael W Wandling, Charles Green, Julius Balogh, Samuel J Prater, Christopher T Stephens, Paulina B Sergot, Charles E Wade, Lillian S Kao, John A Harvin

Faculty, Staff and Student Publications

BACKGROUND: Evidence for effective pain management and opioid minimization of intravenous ketamine in elective surgery has been extrapolated to acutely injured patients, despite limited supporting evidence in this population. This trial seeks to determine the effectiveness of the addition of sub-dissociative ketamine to a pill-based, opioid-minimizing multi-modal pain regimen (MMPR) for post traumatic pain.

METHODS: This is a single-center, parallel-group, randomized, controlled comparative effectiveness trial comparing a MMPR to a MMPR plus a sub-dissociative ketamine infusion. All trauma patients 16 years and older admitted following a trauma which require intermediate (IMU) or intensive care unit (ICU) level of care are …

The Impact Of Hpv Vaccine Narratives On Social Media: Testing Narrative Engagement Theory With A Diverse Sample Of Young Adults, Amy E. Leader, Michelle Miller-Day, Rikishi T. Rey, Preethi Selvan, Anne E. Pezalla, Michael L. Hecht

Communication Faculty Articles and Research

Rates of human papillomavirus (HPV) infection are highest in young adults, who can be vaccinated against HPV if they were not vaccinated as adolescents. Since young adults increasingly access health information on social media, we tested the impact of a social media campaign with narrative-based health information on intentions related to HPV vaccination. We also aimed to understand which ads resonated most with young adults and led to higher survey completion rates. We created social media posts featuring videos promoting HPV vaccination. We launched a sponsored ad campaign on Facebook to reach young women, ages 18–26, across the country. Participants …

Evaluating Social Support And T2d Risk Factors Among Members Of Rural-Dwelling Grandparent-Headed Households, Brittany L. Smalls, Abebola Adegboyega, Kelly Nb Palmer, Jennifer Hatcher

Journal of Appalachian Health

Purpose: This study examines the associations of social support and type 2 diabetes (T2D) risk factors among members of rural-dwelling, grandparent-headed households (GHH).

Methods: Prospective data were collected from rural-dwelling members of GHH with no known diagnosis of T2D. Data collected on family characteristics, T2D clinical risk factors, and social support were assessed.

Results: Sixty-six grandparents and 72 grandchildren participated in the study. The average age and HbA1Cs were 59.4 years and 6.2% ± 1.4 for grandparents and 11.8 years and 4.9% ± 0.6 for grandchildren. Most grandparents were found to have prediabetes or undiagnosed diabetes. The number of people …

Gis Automated Delineation And Analysis Of Cancer Service Areas In The United States, Changzhen Wang

LSU Doctoral Dissertations

Delineating a meaningful and reliable geographic unit pertaining to cancer care is essential in examining geographic variations in cancer care for better analysis, management, and planning. Public health researchers have devoted great efforts to defining various service areas, which; however, lack scientific rigor or are unrepresentative of the highly specialized cancer care markets, and their methods have become obsolete in the era of big data and high geo-computation. This study develops the “Spatially Constrained Leiden (ScLeiden)” method, a network community detection algorithm in Geographic Information Systems (GIS), and applies it to delineate a series of coherent cancer service …

The Lived Experience Of Postpartum Anxiety During Covid-19: A Hermeneutic Phenomenological Study, Walker Ladd Phd, Jenny De Decker

The Qualitative Report

The experience of pregnancy and postpartum anxiety disorders results in adverse birth outcomes and the disrupted development of infants and children. Since the COVID-19 Pandemic, the Centers for Disease Control and Prevention (CDC) has designated pregnant and postpartum women as more vulnerable to COVID-19 (CDC, 2021), and perinatal mood and anxiety disorders rates have increased. However, research regarding the lived experience of women with postpartum anxiety (PPA) during a global pandemic remains lacking. Using van Manen’s hermeneutic phenomenological research method, we interviewed eight women self-identifying as having had PPA during the COVID-19 pandemic. Analysis revealed five themes describing the lived …

United States Healthcare Burden Of Pediatric Functional Gastrointestinal Pain Disorder Hospitalizations From 2002 To 2018, John M Hollier, Jason L Salemi, Robert J Shulman

Faculty, Staff and Students Publications

BACKGROUND: The healthcare burden of pediatric functional gastrointestinal pain disorders (FGIDs) is unclear. Our study aimed to characterize the burden of these hospitalizations in the United States (US).

METHODS: We utilized the US National Inpatient Sample from 2002 to 2018 to capture pediatric hospitalizations (ages 4 to 18 years old) with a primary discharge diagnosis of abdominal pain, constipation, irritable bowel syndrome, dyspepsia, abdominal migraine, cyclic vomiting syndrome, or fecal incontinence. We calculated the FGID hospitalization prevalence rate, length of stay (LOS), and inflation-adjusted costs annually and assessed for statistically significant trend changes using joinpoint analyses.

KEY RESULTS: 22.3 million …

Psychological Well-Being In Childhood And Cardiometabolic Risk In Middle Adulthood: Findings From The 1958 British Birth Cohort, Julia K. Boehm, Farah Qureshi, Laura D. Kubzansky

Psychology Faculty Articles and Research

Childhood adversity is linked to poor cardiometabolic outcomes, but less is known about positive childhood factors. Using data from 4,007 members of the 1958 British Birth Cohort, we investigated whether children with greater psychological well-being had lower adulthood cardiometabolic risk. At age 11, participants wrote essays about their future. Two judges rated each essay for nine psychological well-being items (Finn’s r = .82–.91), which were combined into a standardized overall score (Cronbach’s α = .91). When participants reached age 45, nurses assessed their blood pressure, heart rate, lipids, glycosylated hemoglobin, fibrinogen, and C-reactive protein, which were standardized and summed for …