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Introduction Hypertension affects 5–10% of pregnancies in the United States. Chronic hypertension during pregnancy can have a significant impact on maternal and neonatal outcomes, especially in rural populations. Pregnancies complicated by hypertension are currently managed through frequent clinic visits or extended hospital stays. Cellular-enabled remote patient monitoring devices provide an alternative treatment method for women in rural areas. Research Aim This study aimed to measure the feasibility of and patient satisfaction with using an integrated model of cellular-enabled remote patient monitoring devices for blood pressure supported by a 24/7 nurse call center. Methods In a mixed methods pilot study, twelve women with chronic hypertension during pregnancy were given cellular-enabled BodyTrace™ blood pressure cuffs and weight scales. Participants’ blood pressures were continuously monitored by a nurse call center. Participants completed a survey and a brief semi-structured interview after two weeks. Results Participants scored low on stress and anxiety with mean scores of 5.45 (SD = 3.56) and 8.09 (SD 3.62), respectively. Participants scored high on behavioral intention, system usability, and perceived benefits with mean scores of 8.73 (SD = 2.53), 75.91 (SD = 23.70), and 19.64 (SD = 5.92), respectively. Participants perceived benefits to using the device, including increased monitoring by health professionals, increased self-awareness, decreased number of clinic visits, and convenience of use. Perceived disadvantages included higher readings when compared to clinical readings. Discussion Cellular-enabled remote patient monitoring devices for blood pressure are a valuable tool for managing treatment of pregnancies complicated by hypertension.

The present water shutoff crisis in Detroit, which has deepened with the spread of COVID-19, exists within an historical context of decades-old government-sanctioned racial residential segregation ...

To determine the frequency and risk factors for non-home discharge (NHD) and its association with clinical outcomes and quality of life (QOL) at 1 year following cardiac surgery in patients with ischemic mitral regurgitation (IMR).Discharge disposition was evaluated in 552 patients enrolled in trials of severe or moderate IMR. Patient and in-hospital factors associated with NHD were identified using logistic regression. Subsequently, association of NHD with 1-year mortality, serious adverse events (SAEs), and QOL was assessed.NHD was observed in 30% (154/522) with 25% (n = 71/289) in moderate and 36% (n = 83/233) in patients with severe IMR (unadjusted P = .006), a difference not significant after including age (5-year change: adjusted odds ratio [adjOR], 1.52; 95% confidence interval [CI], 1.35-1.72; P .001), diabetes (adjOR, 1.94; 95% CI, 1.27-2.94; P = .002), and previous heart failure (adjOR, 1.64; 95% CI, 1.06-2.52; P = .03). Odds of NHD were increased for patients with postoperative SAEs (adjOR, 1.85; 95% CI, 1.19-2.86; P = .01) but not based on type of cardiac surgery. Greater rates of death and SAEs were observed in NHD patients at 1 year: adjusted hazard ratio, 4.29 (95% CI, 2.14-8.59; P .001) and adjusted rate ratio, 1.45 (95% CI, 1.03-2.02; P = .03), respectively. QOL did not differ significantly between groups.NHD is common following surgery for IMR, influenced by older age, diabetes, previous heart failure, and postoperative SAEs. These patients may be at greater risk of death and subsequent SAEs after discharge. Discussion of NHD with patients may have important implications for decision-making and guiding expectations following cardiac surgery.

Objective: The purpose of this research is to geographically model airborne lead emission concentrations and total lead deposition in the Detroit Metropolitan Area (DMA) from 2006 to 2013. Further, this study characterizes the racial and socioeconomic composition of recipient neighborhoods and estimates the potential for IQ (Intelligence Quotient) loss of children residing there. Methods: Lead emissions were modeled from emitting facilities in the DMA using AERMOD (American Meteorological Society/Environmental Protection Agency Regulatory Model). Multilevel modeling was used to estimate local racial residential segregation, controlling for poverty. Global Moran’s I bivariate spatial autocorrelation statistics were used to assess modeled emissions with increasing segregation. Results: Lead emitting facilities were primarily located in, and moving to, highly black segregated neighborhoods regardless of poverty levels—a phenomenon known as environmental injustice. The findings from this research showed three years of elevated airborne emission concentrations in these neighborhoods to equate to a predicted 1.0 to 3.0 reduction in IQ points for children living there. Across the DMA there are many areas where annual lead deposition was substantially higher than recommended for aquatic (rivers, lakes, etc.) and terrestrial (forests, dunes, etc.) ecosystems. These lead levels result in decreased reproductive and growth rates in plants and animals, and neurological deficits in vertebrates. Conclusions: This lead-hazard and neighborhood context assessment will inform future childhood lead exposure studies and potential health consequences in the DMA.