Wake Forest University

About: Wake Forest University is a education organization based out in Winston-Salem, North Carolina, United States. It is known for research contribution in the topics: Population & Diabetes mellitus. The organization has 21499 authors who have published 48731 publications receiving 2246027 citations. The organization is also known as: Wake Forest College.

Disparities in stroke incidence contributing to disparities in stroke mortality

Abstract: Stroke mortality rates declined dramatically in the 20th century, yielding 1 of the top 10 public health achievements of that era.1 Despite this, rates have remained consistently higher among blacks than any other race/ethnic group in the United States.2–5 This disparity in stroke mortality is largest at younger ages; at age 45 years, the mortality rate is 3 times higher for blacks than whites, with a decreasing racial disparity with increasing age: by age 85 years the difference is no longer apparent.2–4,6 There are also substantial geographic disparities in stroke mortality with higher rates in the southeastern United States, termed the “stroke belt.” First identified in 1965, excess stroke mortality rates in this region have existed since at least 1940 and have persisted.6–8 A 153-county region including the coastal plain of North Carolina, South Carolina, and Georgia is referred to as the “stroke buckle” due to even higher stroke mortality than the rest of the stroke belt.9 Because the stroke belt and buckle contain counties with very high stroke mortality rates and counties with average or even low stroke mortality, the overall stroke mortality is approximately 20% higher in the stroke belt than rest of the nation, with rates in the stroke buckle approximately 40% higher than rest of the nation.6–9 In the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS), the black-white disparity in stroke mortality was primarily due to higher stroke incidence among blacks, with little contribution of case fatality, the other potential contributor to disparities in stroke mortality.10 National racial and geographic disparities in stroke mortality are documented based on death certificates through the national vital statistics system. National data on stroke incidence based on validated stroke events are not available. The goal of this report was to describe black-white and geographic differences in stroke incidence in a national population-based cohort and assess if the pattern and magnitude of stroke incidence rates mirror the disparities in stroke mortality.

Incidence and Prevalence of Dementia in the Cardiovascular Health Study

Abstract: Objectives: To estimate the incidence and prevalence of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) in the Cardiovascular Health Study (CHS) cohort. Design: Longitudinal cohort study using prospectively and retrospectively collected data to evaluate dementia. Setting: Four U.S. communities. Participants: There were 3,602 CHS participants, including 2,865 white and 492 African-American participants free of dementia, who completed a cranial magnetic resonance image between 1992 and 1994 and were followed for an average of 5.4 years. Measurements: Dementia was classified by neurologist/psychiatrist committee review using neuropsychological tests, neurological examinations, medical records, physician questionnaires, and proxy/informant interviews. Demographics and apolipoprotein E (APOE) genotype were collected at baseline. Incidence by type of dementia was determined using National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for AD and Alzheimer's Disease Diagnostic and Treatment Center's State of California criteria for VaD. Results: Classification resulted in 227 persons with prevalent dementia at entry into the study and 480 incident cases during follow-up. Incidence rates of dementia scaled to age 80 were 34.7 per 1,000 person-years for white women, 35.3 for white men, 58.8 for African-American women, and 53.0 for African-American men. Sex differences were not significant within race. Adjusted for age and education, racial differences were only of borderline significance and may have been influenced by ascertainment methodology. Rates differed substantially by educational attainment but were only significant for whites. Those with the APOE ɛ4 allele had an incidence rate at age 80 of 56.4, compared with 29.6 for those without this allele (P<.001). In whites, type-specific incidence at age 80 was 19.2 for AD versus 14.6 for VaD. These rates were 34.7 and 27.2 for African Americans. At termination of observation, women had only a slightly higher prevalence of dementia (16.0%) than men (14.7%). Conclusion: Sex and racial differences were not found, and VaD was higher than reported in other studies. These data provide new estimates of dementia incidence in a community sample for projection of future burden.

Understanding the control of Pseudomonas aeruginosa alginate synthesis and the prospects for management of chronic infections in cystic fibrosis

Abstract: Decades of research have been dedicated to the study of the opportunistic pathogen Pseudomonas aeruginosa, a Gram-negative, environmental bacterium that secretes the exopolysaccharide alginate during chronic lung infection of cystic fibrosis (CF) patients. Although P. aeruginosa utilizes a variety of factors to establish a successful infection in the lungs of CF patients, alginate has stood out as one of the best-studied prognostic indicators of chronic lung infection. While the genetics, biosynthesis and regulation of alginate are well understood, questions still remain concerning its role in biofilm development and its potential as a therapeutic target. The purpose of this review is to provide a brief summary of alginate biosynthesis and regulation, and to highlight recent discoveries in the areas of alginate production, biofilm formation and vaccine design. This information is placed in context with a proposed P. aeruginosa infectious pathway, highlighting avenues for the use of existing therapies as well as the potential for novel agents to reduce or eliminate chronic infections in CF patients.