Objective People with serious mental illness (SMI) die at least 11 years earlier than the general U.S. population, on average, due largely to cardiovascular disease (CVD). Disparities in CVD morbidity and mortality also occur among some U.S. racial and ethnic minorities. The combined effect of race/ethnicity and SMI on CVD-related risk factors, however, remains unclear. To address this gap, we conducted a critical literature review of studies assessing the prevalence of CVD risk factors (overweight/obesity, diabetes mellitus, metabolic syndrome, hypercholesterolemia, hypertension, cigarette smoking, and physical inactivity) among U.S. racial/ethnic groups with schizophrenia-spectrum and bipolar disorders. Methods and Results We searched MEDLINE and PsycINFO for articles published between 1986 and 2013. The search ultimately yielded 40 articles. There was great variation in sampling, methodology, and study populations. Results were mixed, though there was some evidence for increased risk for obesity and diabetes mellitus among African Americans, and to a lesser degree for Hispanics, compared to non-Hispanic Whites. Sex emerged as an important possible effect modifier of risk, as women had higher CVD risk among all racial/ethnic subgroups where stratified analyses were reported. Conclusions Compared to general population estimates, there was some evidence for an additive risk for CVD risk factors among racial/ethnic minorities with SMI. Future studies should include longitudinal assessment, stratification by sex, subgroup analyses to clarify the mechanisms leading to potentially elevated risk, and the evaluation of culturally appropriate interventions to eliminate the extra burden of disease in this population.

Higher teen crash rates occurred in jurisdictions with EHSST, as in our prior study. This study contributes to and extends existing data on preventable teen crashes and high school start times.

BACKGROUND Actigraphic data during simulated participant movements were evaluated to differentiate among patient behavior states. METHODS Arm and leg actigraphic data were collected on 30 volunteers who simulated 3 behavioral states (calm, restless, agitated) for 10 minutes; counts of observed participant movements (head, torso, extremities) were documented. RESULTS The mean age of participants was 34.7 years, and 60% were female. Average movement was significantly different among the states (P < .0001; calm [mean = .48], restless [mean = 2.16], agitated [mean = 3.75]). Mean actigraphic measures were significantly different among states for both arm (P < .0001; calm [mean = 6.8], restless [mean = 28.5], agitated [mean = 52.6]) and leg (P < .0001; calm [mean = 3.5], restless [mean = 18.7], agitated [mean = 37.7]). CONCLUSION Distinct levels of behavioral states were successfully simulated. Actigraphic data can provide an objective indicator of patient activity over a variety of behavioral states, and these data may offer a standard for comparison among these states.

Background: Fibromyalgia (FMS) is a chronic pain syndrome characterized by fatigue and non-restorative sleep. Over 75% of individuals with FMS complain of fatigue and poor sleep. Purpose: The primary aim of this study was to compare 25 women with and 25 women without FMS, on fatigue; autonomic nervous system activity; perceived stress; sleep quality; and immune function. All participants complained of poor sleep, and had been referred to a sleep center for evaluation. The secondary aim was to explore the relationships among those variables within each group and compare those relationships between groups. Methods: A single stage cross-sectional design was used. Results: The FMS group reported greater fatigue, worse sleep, and more autonomic symptoms than the non-FMS group; they evidenced higher tumor necrosis factor alpha (TNF-α) levels. Non-FMS participants with obstructive sleep apnea (OSA) had higher interleukin 1-beta (IL-1β) values than the FMS group. In the FMS group, fatigue was positively correlated with stress, autonomic symptoms, and TNF-α; stress was positively correlated with autonomic symptoms; apnea-hypopnea index (AHI) was negatively correlated with IL-1β levels and total arousals. In the non-FMS group, fatigue was positively correlated with sleep quality; both variables were positively correlated with IL-1β. IL-1β was also positively correlated with TNF-α. Conclusions: Variables that were correlated in the FMS group differed from those in the non-FMS group, except for the correlation of total arousals with AHI.

Nurse researchers explored the history of Mary Breckenridge’s Frontier Nursing Service (FNS) during the years 1925 to 1965, to elicit how her experience could inform present day concerns regarding universal access to healthcare. A historical biographical approach informed by critical theory was selected as the methodology. As historical research tends to generate large volumes of data, concept mapping was selected to collect, reduce, organize and interpret data. Additionally, concept mapping can assist researchers to agree on meaning as seen in interrelationships of the data. The final aggregate concept map is a graphic, visual representation of the outcome of this historical research process. The researchers in this study found concept mapping to be an ideal tool for reducing and managing data, visualizing interconnectedness of the data and viewing significant concepts in relation to the whole. The results of this study found the FNS to be a powerful exemplar of a successful healthcare delivery system that had a major impact on the health of the residents in one of poorest regions in the country. Mary Breckenridge was able to mobilize public support and creatively generate resources, to initiate and maintain a community-based healthcare program.