Recruitment, Retention, and Future Direction for a Heart Health Education and Risk Reduction Intervention Led by Community Health Workers in an African American Majority City

Heart disease is a leading cause of death for African Americans. A community-academic partnership cross-trained community health workers to engage African American adults in a 6-month heart health education and risk reduction intervention. We conducted a one-group feasibility study using a one group (pre-posttest) design. A total of 100 adults were recruited from 27 zip codes in an African American majority city through community-based organizations (46%), churches (36%), and home visits (12%). Ninety-six percent were African American; 55% were female, 39% were male, and 6% were transgender. Their mean age was 44.6 years (SD=15.9). Ninety-two percent had health insurance. Seventy-six percent of participants averaged blood pressure (BP) readings\u3e130/80 mmHg. Eleven percent of participants had a 30% or higher probability of developing cardiovascular disease in the next 10 years. Six-month follow-up was completed with 96% of participants. There were statistically significant increases in knowledge and in perception of personal risk for heart disease. However, slightly more participants (n=77, 80.2%) had BP\u3e130/80 mmHg. The Community Advisory Group recommended expanding the intervention to 12 months and incorporating telehealth with home BP monitoring. Limited intervention duration did not meet longer term objectives such as better control of high BP and sharing risk reduction planning with primary care providers

Lifestyle as a predictor of health status and the use of health services.

The purpose of this dissertation was to investigate the relationships among selected aspects of lifestyle, health status and health care utilization. The lifestyle factors examined in this study were current and former smoking behavior, alcohol consumption, life stress, nutritional status, sedentariness, and obesity. Health status was measured as a subjective rating of general health. Utilization was operationalized in four separate measures: illness-related physician visits, preventive physician visits, total physician visits, and hospitalization. Using data collected from a probability sample of Michigan households, the proposed relationships were examined through a series of correlational, multiple regression and path analyses. Pearsonian correlation analysis revealed that each of the lifestyle factors is significantly correlated with health status. A regression of health status on the lifestyle factors simultaneously showed that only five of the predictors were significant at the.05 level. Namely, current smoking behavior, excessive alcohol consumption, life stress, sedentariness, and obesity were all observed to be negatively associated with self-assessed health status. In turn, self-assessed health status was found to be the major predictor of the use of health care services. Individuals rating their health as poor made more illness, preventive, and total physician visits and were more likely to be hospitalized than were individuals rating their health as good. In addition to assessing the indirect effect of the lifestyle factors on utilization via health status, the direct effect of these factors on utilization were also evaluated. While results varied among the four utilization models, in general, the lifestyle factors were found to have significant direct relationships with the measures of utilization, even after controlling for health status. This supports the proposition that utilization behavior is affected not only by health status, but also by individual health behavior.Ph.D.Health Services Organization and PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/105850/1/9226848.pdfDescription of 9226848.pdf : Restricted to UM users only

Urban rage in Bronzeville: Social commentary in the poetry of Gwendolyn Brooks, 1945-1960

Gwendolyn Brooks, Poet Laureate of Illinois, earned fame when she was awarded the Pulitzer Prize (1950) for her second book of poetry, Annie Allen (1949). Brooks used the poetic language and the traditional prosodic devices of the English poets and earned wide acclaim for her poetic expertise. However, by doing so, she also became the literary target of a chorus of dissident voices: a cultural contingency accused her of directing her writing to a white audience and ignoring her own Black community, while a critical coterie viewed her work as unduly obscure and complex because of her use of inverted syntax, extreme wordplay, and highly allusive images. In the midst of the tensions created by such controversial analyses of Brooks' early work, little attention has been directed to illuminating its social content. Yet, the reality is that since Brooks published her first book of poetry, A Street in Bronzeville (1945), her voice of social consciousness has been consistent and clear. In this study I explicate Brooks' poetry from the perspective of the social commentary in the two works listed above and in her third book of poetry, The Bean Eaters (1960).The thematic structures and poetic techniques in Brooks' poetry reflect her immersion in the multiple literary traditions of white poets like William Shakespeare, John Milton, Robert Frost, John Donne, Emily Dickinson, and T. S. Eliot. Yet her deft expressiveness in early poems like the "Gay Chaps at the Bar" sonnet series is especially ironic since, thematically, she re-defines the form; rather than borrowing the associative attributes of a melodiously elevated lyric, Brooks' sonnets sing of the somber strains of Black soldiers of World War II who are fighting a dual battle: one for patriotism and one against racism.An analysis of the historical aftermaths of the Post-Depression Era, World War II, and the Civil Rights Movement, against their literary counterparts in the Harlem Renaissance (1920's and 30's) and the Black Arts Movement (1960's), provides an apt juxtaposition of the works of Langston Hughes for the regional sensibility he shares with Brooks; Sterling Brown, for his expertise with the ballad form, and Margaret Walker, as one of Brooks' few Black female poetic peers of the day. Finally, I align the use of history, language, allusion, and social commentary in the works of Melvin Tolson and Robert Hayden, with the social and poetic articulation inherent in Brooks' early works. The three-fold theoretical methodology I use to illuminate the social commentary in Brooks' poetry is historical, formal, and feminist.U of I OnlyETDs are only available to UIUC Users without author permissio

The Importance of Taking a History of Over-the-Counter Medication Use: A Brief Review and Case Illustration of “PRN” Antihistamine Dependence in a Hospitalized Adolescent

Over-the-counter (OTC) and prescription medication abuse has been rapidly increasing, yet publications on OTC abuse in adolescents are limited. We present a brief literature review and a novel report of antihistamine dependence emerging after admission in an adolescent, subsequently treated with naltrexone. This case highlights the need to take a thorough history of OTC, herbal, and prescription drug use from parents and patients separately and repeatedly, at initial presentation, and again if withdrawal symptoms emerge. General strategies for combating OTC and prescription abuse are given

Prejunctional muscarinic inhibitory control of acetylcholine release in the human isolated detrusor: involvement of the M(4) receptor subtype

1. Experiments were carried out in human detrusor strips to characterize muscarinic receptor subtypes involved in the prejunctional regulation of acetylcholine (ACh) release from cholinergic nerve terminals, and in the postjunctional smooth muscle contractile response. 2. In detrusor strips preincubated with [(3)H]-choline, electrical field stimulation (600 pulses) delivered in six trains at 10 Hz produced a tritium outflow and a contractile response. In the presence of 10 μM paraoxon (to prevent ACh degradation) the tritium outflow was characterized by HPLC analysis as [(3)H]-ACh (76%) and [(3)H]-choline (24%). 3. Electrically-evoked [(3)H]-ACh release was abolished by tetrodotoxin (TTX: 300 nM) and unaffected by hexamethonium (10 μM), indicating a postganglionic event. It was reduced by physostigmine (100 nM) and the muscarinic receptor agonist, muscarone (10 nM–1 μM), and enhanced by atropine (0.1–100 nM). These findings indicate the presence of a muscarinic negative feedback mechanism controlling ACh release. 4. The effects of various subtype-preferring muscarinic receptor antagonists were evaluated on [(3)H]-ACh release and muscle contraction. The rank potency (−log EC(50)) orders at pre- and postjunctional level were: atropine ⩾4-diphenyl-acetoxy-N-piperidine (4-DAMP)>mamba toxin 3 (MT-3)>tripitramine>para-fluorohexahydrosiladiphenidol (pF-HHSiD)⩾methoctramine⩾pirenzepine>tripinamide, and atropine⩾4-DAMP>pF-HHSiD>>pirenzepine=tripitramine>tripinamide>methoctramine>>MT-3, respectively. 5. The comparison of pre- and post-junctional potencies and the relationship analysis with the affinity constants at human cloned muscarinic receptor subtypes indicates that the muscarinic autoreceptor inhibiting ACh release in human detrusor is an M(4) receptor, while the receptor involved in muscular contraction belongs to the M(3) subtype.