School Notes: School of Public Health
May/June 2009

Older women live longer than men after first "mini stroke"

Elderly women who suffer a first "mini-stroke" are less likely than men of the same age to be readmitted to a hospital, new research has found. Transient ischemic attack (TIA) is known as a mini-stroke because it produces stroke-like symptoms but no lasting damage. TIA is often considered a harbinger of more serious health problems, including full-fledged strokes, coronary artery disease, and even death. Almost one in ten TIA patients are readmitted to the hospital within a month after the initial event and half are readmitted within a year. The study reviewed records on more than 122,000 patients, 65 and older, who were hospitalized with a TIA in 2002. Follow-up research showed fewer women were readmitted for stroke or coronary artery disease, and women had lower mortality rates after an initial TIA. The findings could help to improve care and outcomes for men and women, said Judith H. Lichtman, an associate professor in the division of chronic disease epidemiology.

High-stress jobs can take a toll on employee's family

The daily stress of a high-pressure career can adversely affect the mental health of a worker's spouse. This work-related "spillover" from an unhappy mate can be as significant to a spouse's mental well-being as his or her own physical and mental health. Associations between spouses in areas such as education and intelligence have long been established. Research also has shown that some couples have similar mental health outcomes, but it is difficult to show whether the similarity is based on "spillovers" from one another or because they are exposed to many of the same environmental and social conditions. Jason M. Fletcher, an assistant professor in the division of health policy and administration, found that spillover is potentially significant. The study isolated the role that workplace conditions have on the mental health of an employee's spouse. Future research will seek to quantify the magnitude of the spillover effect.

New prevention strategy may significantly reduce HIV infections

The risk of HIV infection in high-risk populations may be substantially reduced by an antiretroviral drug treatment currently being tested in clinical trials. The study examined the costs and benefits of giving antiretroviral drug regimens to high-risk populations in order to protect them from HIV infection, a prevention strategy known as pre-exposure prophylaxis (PrEP). Investigators created a mathematical model that focused on homosexual men of a mean age of 34. They estimated that PrEP would reduce lifetime HIV infection risk in these populations from 44 percent to 25 percent while increasing their mean survival rate from 39.9 to 40.7 years. A. David Paltiel, a professor in the division of health policy administration, said the model is the first to establish performance benchmarks of the clinical, epidemiologic, and economic potential of PrEP.