Effectiveness of a short video-based educational intervention on factors related to clinical trial participation in adolescents and young adults: a pre-test/post-test design

Abstract Background Poor clinical trial enrollment continues to be pervasive and is especially problematic among young adults and youth, and among minorities. Efforts to address barriers to enrollment have been predominantly focused on adult diseased populations. Because older adults may already have established attitudes, it is imperative to identify strategies that target adolescents and young adults. The purpose of this study was to test the effectiveness of an educational video on factors related to clinical trial participation among a healthy adolescent and young adult population. Methods Participants completed a 49-item pre-test, viewed a 10-min video, and completed a 45-item post-test to assess changes in attitudes, knowledge, self-efficacy, receptivity to, and intention to participate (primary outcome) in clinical trials. Descriptive statistics, paired samples t-tests, and Wilcoxon signed-rank tests were conducted. Results The final analyses included 935 participants. The mean age was 20.7 years, with almost 70% aged 18 to 20 years. The majority were female (73%), non-Hispanic (92.2%), white (70%), or African American (20%). Participants indicated a higher intention to participate in a clinical trial (p < 0.0001) and receptivity to hearing more about a clinical trial (p < 0.0001) after seeing the video. Intention to participate (definitely yes and probably yes) increased by an absolute 18% (95% confidence interval 15–22%). There were significant improvements in attitudes, knowledge, and self-efficacy scores for all participants (p < 0.0001). Conclusions The results of this study showed strong evidence for the effectiveness of a brief intervention on factors related to participation in clinical trials. This supports the use of a brief intervention, in a traditional educational setting, to impact the immediate attitudes, knowledge, self-efficacy, and intention to participate in clinical trial research among diverse, healthy adolescents and young adults.https://deepblue.lib.umich.edu/bitstream/2027.42/146769/1/13063_2018_Article_3097.pd

Accessing Young Black Stroke Survivors for Secondary Prevention

ABSTRACT Background- Stroke rates and risk factors may be increasing in young adults aged 18-64, especially black individuals. We sought to identify whether young high risk stroke survivors could be found at community health centers. Methods- This was a cross-sectional analysis of the National Ambulatory Medical Care Survey from 2006-2011. We used chi-square analyses, t-tests, and proportions to compare and describe stroke survivor visits at community health centers and private offices. Results- Young stroke survivor visits comprise 48% of stroke survivor visits at community health centers compared to 31% of stroke survivor visits at the private office setting. Among young stroke survivors cared for at community health centers, 47% were black individuals compared to 14% at a private office setting. The prevalence of hypertension and cigarette smoking was higher in young stroke survivors at the community health center. Conclusions- The community health center is a setting to access young black stroke survivors. Stroke prevention and preparedness interventions should be considered at community health centers

Relationship of Self-Determination Theory Constructs and Physical Activity and Diet in a Mexican American Population in Nueces County, Texas

Due to disparities in stroke risk among U.S. Hispanics, the need for culturally tailored, theory based effective health behavior change interventions persists. The purpose of this study was to examine self-determination theory (SDT) constructs related to cardiovascular disease (CVD) risk factors in a predominantly Mexican American population. The Stroke Health and Risk Education (SHARE) project was a cluster-randomized, faith-based behavioral intervention trial that enrolled Mexican Americans (MAs) and non-Hispanic whites (NHWs) from Catholic Churches in Nueces County, Texas. Data regarding SDT constructs and dietary and physical activity behaviors were collected via computer-assisted interviews using standardized instruments at the baseline assessment. Of the 801 subjects who consented, 760 completed baseline interviews. After eliminating cases with missing data, 733 participants (617 MA and 116 NHW) were included in the analyses. Participants were predominantly Mexican American (84%) and female (64%), and had a median age of 53 years. There were no significant ethnic differences in any of the baseline SDT scale scores with the exception of higher autonomous motivation scores for exercise among MAs (7.00 vs. 6.67, p = 0.01). Demographic differences in mean SDT scale scores were identified for sex, age, and income. Perceived competence and autonomous motivation were both significant predictors of diet and physical activity behaviors. This study increases our understanding of SDT constructs relative to diet and physical activity in a large, predominantly Mexican American sample. The results indicate that SDT is an appropriate framework to address CVD behavioral risk factors in a predominantly Hispanic population

Creating New β-Globin-Expressing Lentiviral Vectors by High-Resolution Mapping of Locus Control Region Enhancer Sequences.

Hematopoietic stem cell gene therapy is a promising approach for treating disorders of the hematopoietic system. Identifying combinations of cis-regulatory elements that do not impede packaging or transduction efficiency when included in lentiviral vectors has proven challenging. In this study, we deploy LV-MPRA (lentiviral vector-based, massively parallel reporter assay), an approach that simultaneously analyzes thousands of synthetic DNA fragments in parallel to identify sequence-intrinsic and lineage-specific enhancer function at near-base-pair resolution. We demonstrate the power of LV-MPRA in elucidating the boundaries of previously unknown intrinsic enhancer sequences of the human β-globin locus control region. Our approach facilitated the rapid assembly of novel therapeutic βAS3-globin lentiviral vectors harboring strong lineage-specific recombinant control elements capable of correcting a mouse model of sickle cell disease. LV-MPRA can be used to map any genomic locus for enhancer activity and facilitates the rapid development of therapeutic vectors for treating disorders of the hematopoietic system or other specific tissues and cell types

Sleep‐disordered breathing and poststroke outcomes

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150527/1/ana25515_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150527/2/ana25515.pd

Ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage.

OBJECTIVE: To explore ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage. DESIGN: Population-based surveillance. SETTING: Corpus Christi, Texas. PATIENTS: All cases of intracerebral hemorrhage in the community of Corpus Christi, TX were ascertained as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Medical records were reviewed for do-not-resuscitate orders. Unadjusted and multivariable logistic regression were used to test for associations between ethnicity and do-not-resuscitate orders, both overall ( any do-not-resuscitate ) and within 24 hrs of presentation ( early do-not-resuscitate ), adjusted for age, gender, Glasgow Coma Scale, intracerebral hemorrhage volume, intraventricular hemorrhage, infratentorial hemorrhage, modified Charlson Index, and admission from a nursing home. A total of 270 cases of intracerebral hemorrhage from 2000-2003 were analyzed. Mexican-Americans were younger and had a higher Glasgow Coma Scale than non-Hispanic whites. Mexican-Americans were half as likely as non-Hispanic whites to have early do-not-resuscitate orders in unadjusted analysis (odds ratio 0.45, 95% confidence interval 0.27, 0.75), although this association was not significant when adjusted for age (odds ratio 0.61, 95% confidence interval 0.35, 1.06) and in the fully adjusted model (odds ratio 0.75, 95% confidence interval 0.39, 1.46). Mexican-Americans were less likely than non-Hispanic whites to have do-not-resuscitate orders written at any time point (odds ratio 0.37, 95% confidence interval 0.23, 0.61). Adjustment for age alone attenuated this relationship although it retained significance (odds ratio 0.49, 95% confidence interval 0.29, 0.82). In the fully adjusted model, Mexican-Americans were less likely than non-Hispanic whites to use do-not-resuscitate orders at any time point, although the 95% confidence interval included one (odds ratio 0.52, 95% confidence interval 0.27, 1.00). CONCLUSIONS: Mexican-Americans were less likely than non-Hispanic whites to have do-not-resuscitate orders after intracerebral hemorrhage although the association was attenuated after adjustment for age and other confounders. The persistent trend toward less frequent use of do-not-resuscitate orders in Mexican-Americans suggests that further study is warranted

Validation of thermal-mechanical modeling of stainless steel forgings

A constitutive model for recrystallization has been developed within the framework of an existing dislocation-based rate and temperature-dependent plasticity model. The theory has been implemented and tested in a finite element code. Material parameters were fit to data from monotonic compression tests on 304L steel for a wide range of temperatures and strain rates. The model is then validated by using the same parameter set in predictive thermal-mechanical simulations of experiments in which wedge forgings were produced at elevated temperatures. Model predictions of the final yield strengths compare well to the experimental results

Reply

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109317/1/ana24280.pd

Prevalence and Course of Depression During the First Year After Mild to Moderate Stroke

Background: This study examined the prevalence and longitudinal course of depression during the first year after mild to moderate stroke. Methods and Results: We identified patients with mild to moderate ischemic stroke or intracerebral hemorrhage (National Institutes of Health Stroke Scale score <16) and at least 1 depression assessment at 3, 6, or 12 months after stroke (n=648, 542, and 533, respectively) from the Brain Attack Surveillance in Corpus Christi project (2014–2016). Latent transition analysis was used to examine temporal profiles of depressive symptoms assessed by the 8‐item Patient Health Questionnaire between 3 and 12 months after stroke. Mean age was 65.6 years, 49.4% were women, and 56.7% were Mexican Americans. The prevalence of depression after stroke was 35.3% at 3 months, decreased to 24.9% at 6 months, and remained stable at 25.7% at 12 months. Approximately half of the participants classified as having depression at 3 or 6 months showed clinical improvement at the next assessment. Subgroups with distinct patterns of depressive symptoms were identified, including mild/no symptoms, predominant sleep disturbance and fatigue symptoms, affective symptoms, and severe/all symptoms. A majority of participants with mild/no symptoms retained this symptom pattern over time. The probability of transitioning to mild/no symptoms was higher before 6 months compared with the later period, and severe symptoms were more likely to persist after 6 months compared with the earlier period. Conclusions: The observed dynamics of depressive symptoms suggest that depression after stroke tends to persist after 6 months among patients with mild to moderate stroke and should be continually monitored and appropriately managed