Finding Food: Characterizing Food Coping Strategies Among Food Pantry Clients In The High Country

Though starvation seldom occurs in the United States, many individuals do suffer from food insecurity, which exists when access to adequate and safe food is limited or uncertain, or when such food cannot be accessed in socially acceptable ways (Ramaduria, Sharf, & Sharkey, 2012). Previous research has identified that food insecurity is exacerbated for rural residents, as they are 12–15% more likely to be food insecure (Ramaduria, Sharf, & Sharkey, 2012). To combat the hardships caused by food insecurity, individuals may turn to a multitude of practices or behaviors to maintain an adequate food supply for themselves and their households, also known as food coping strategies. This research is necessary due to the gaps in the literature that do not address rural food coping strategies, and the fact that food insecurity is a major public health concern. In 2010, 86% of all health care spending was being used for people with one or more chronic medical conditions, with obesity alone costing the United States 147 billion dollars in 2008 (Centers for Disease Control and Prevention, 2016). Interventions are needed to address food access, insecurity, and coping strategies among low-income populations to help relieve these problems

Association Between Rural Background and Physical Therapist Practice Location

Purpose/Hypothesis To examine the association between physical therapists’ rural background and their decision to practice in a rural setting. We hypothesized that years of rural upbringing and size of hometown would be related to rural practice. Number of Subjects 257 physical therapists who graduated from one of two physical therapy programs in the Western United States between 2000 and 2020. Materials and Methods A survey was emailed to 19 physical therapy schools consisting of questions regarding participants’ background, demographics, and job history. We collected total number of years of practice and total years of rural practice. Length of practice varied, so we calculated a rural practice proportion (RPP) for each subject and used Pearson correlation to determine the association between years of rural upbringing and the RPP. To examine the association between size of hometown and practice in any rural setting, a Spearman correlation was conducted. Additionally, multivariate logistic regression was used to explore potential effects of several factors on the likelihood of rural practice. iv Results Alumni from two physical therapy programs housed at two institutions, the University of Nevada, Las Vegas (UNLV) (199) and the University of Colorado, Boulder (49) submitted 257 surveys. There were weak positive correlations between years of rural upbringing and RPP (r = .374, n = 152, p\u3c .001) and between size of hometown and size of current practice location (r= .332, N = 225, 0 \u3c0.001). A weak positive correlation existed between size of hometown and practice in any rural setting (r = .154, N = 234, p = .018), with smaller hometown correlating with rural practice. In our unadjusted models, several factors including completion of a rural clinical experience, partner’s rurality, and being from smaller towns were found to affect the likelihood of practicing in a rural setting (p \u3c .05). However, in an adjusted model, only partners’ rurality was found to significantly increase the likelihood of practicing in a rural setting (p = .012). Conclusions Among survey respondents, those with more years of rural upbringing were more likely to have practiced in rural settings. Physical therapists from smaller sized hometowns showed increased odds of having worked in rural settings compared to those from urban areas. Lastly, physical therapists with partners from rural areas were more likely to have worked in rural areas versus those with partners from urban areas. Clinical Relevance Additional research is warranted to understand the intrinsic and extrinsic factors that increase the likelihood of physical therapists practicing in rural settings. Academic physical therapy programs v can consider recruiting students from rural areas and providing opportunities for rural clinical experiences since these appear to be related to rural practice. Programs are encouraged to partner with rural communities and clinical partners to enhance their understanding of the unique health care needs of these communities that are amenable to physical therapy intervention. Academic physical therapy programs, state boards of physical therapy, and the American Physical Therapy Association (APTA) should collaborate to create new and leverage existing databases to describe physical therapist practice patterns across the professional career cycle

Assessing agricultural risk management using historic crop insurance loss data over the Ogallala Aquifer

Much of the agricultural production in the Ogallala Aquifer region relies on groundwater for irrigation. In addition to declining water levels, weather and climate-driven events affect crop yields and revenues. Crop insurance serves as a risk management tool to mitigate these perils. Here, we seek to understand what long-term crop insurance loss data can tell us about agricultural risk management in the Ogallala. We assess patterns and trends in crop insurance loss data from the U.S. Department of Agriculture Risk Management Agency. Indemnities, or insurance payments, totaled $22 billion from 1989–2017 for the 161 counties that overlie the Ogallala Aquifer. We focused on the top ten weather and climate-driven causes of crop loss for the Ogallala, which comprised at least 92% of total indemnities. Drought, hail, and heat were the leading causes of crop loss for the region, and varied over space and time. For example, drought is a significant cause of loss across all seasons, while hail is more prevalent in the spring and summer. Spatially heterogeneous patterns emerged showing larger hail indemnities in the northern Ogallala versus larger drought indemnities in the southern portion. We performed a Mann-Kendall trend analysis of county-level annual loss cost values (the ratio of indemnities to liabilities). Drought and excess moisture showed significant increasing loss cost trends in the western counties of the Ogallala. In contrast, hail showed significant decreasing trends in the northern and eastern portions. These results suggest the northern counties of the Ogallala may perceive hail as a greater risk, and may be better equipped to handle drought losses as compared with the southern Ogallala. Crop insurance loss data play a role in integrating long-term trends with near-term management practices, and providing relevant risk information in producers’ operational to tactical decision making processes

Telemedicine Facilitates CHF Home Health Care for Those with Systolic Dysfunction

An estimated 5 million Americans have congestive heart failure (CHF) and one in five over the age of 40 will develop CHF. There are numerous examples of CHF patients living beyond the years normally expected for people with the disease, usually attributed to taking an active role in disease management. A relatively new alternative for CHF outpatient care is telemedicine and e-health. We investigated the effects of a 6-week in-home telemedicine education and monitoring program for those with systolic dysfunction on the utilization of health care resources. We also measured the effects of the unit 4.5 months after its removal (a total of 6 months post introduction of the unit into the home). Concurrently, we assessed participants' perceptions of the value of having a telemedicine unit. Participants in the telemedicine group reported weighing more times a week with less variability than did the control group. Telemedicine led to a reduction in physician and emergency department visits and those in the experimental group reported the unit facilitating self-care, though this was not significantly different from the control group (possibly due to small sample size). These findings suggest a possibility for improvement in control of CHF when telemedicine is implemented. Our review of the literature also supports the role of telemedicine in facilitating home health care and self-management for CHF patients. There are many challenges still to be addressed before this potential can be reached and further research is needed to identify opportunities in telemedicine

The study design and rationale of the randomized controlled trial: translating COPD guidelines into primary care practice

Background: Chronic obstructive pulmonary disease (COPD) is a progressive, debilitating disease associated with significant clinical burden and is estimated to affect 15 million individuals in the US. Although a large number of individuals are diagnosed with COPD, many individuals still remain undiagnosed due to the slow progression of the disorder and lack of recognition of early symptoms. Not only is there under-diagnosis but there is also evidence of sub-optimal evidence-based treatment of those who have COPD. Despite the development of international COPD guidelines, many primary care physicians who care for the majority of patients with COPD are not translating this evidence into effective clinical practice. Method/Design This paper describes the design and rationale for a randomized, cluster design trial (RCT) aimed at translating the COPD evidence-based guidelines into clinical care in primary care practices. During Phase 1, a needs assessment evaluated barriers and facilitators to implementation of COPD guidelines into clinical practice through focus groups of primary care patients and providers. Using formative evaluation and feedback from focus groups, three tools were developed. These include a computerized patient activation tool (an interactive iPad with wireless data transfer to the spirometer); a web-based COPD guideline tool to be used by primary care providers as a decision support tool; and a COPD patient education toolkit to be used by the practice team. During phase II, an RCT will be performed with one year of intervention within 30 primary care practices. The effectiveness of the materials developed in Phase I are being tested in Phase II regarding physician performance of COPD guideline implementation and the improvement in the clinically relevant outcomes (appropriate diagnosis and management of COPD) compared to usual care. We will also examine the use of a patient activation tool - ‘MyLungAge’ - to prompt patients at risk for or who have COPD to request spirometry confirmation and to request support for smoking cessation if a smoker. Discussion Using a multi-modal intervention of patient activation and a technology-supported health care provider team, we are testing the effectiveness of this intervention in activating patients and improving physician performance around COPD guideline implementation. Trial registration ClinicalTrials.gov, NCT0123756

Clinically significant depressive symptoms are prevalent in people with extremely short prognoses - A systematic review

Context: Currently, systematic evidence of prevalence of clinically significant depressive symptoms in people with extremely short prognoses is not available to inform its global burden, assessment, and management. Objectives: To determine the prevalence of clinically significant depressive symptoms in people with advanced life-limiting illnesses and extremely short prognoses (range of days to weeks). Methods: A systematic review and meta-analysis (random effects model) were performed (PROSPERO: CRD42019125119). MEDLINE, Embase, PsycINFO, CINAHL, and CareSearch were searched for studies (1994-2019). Data were screened for prevalence of clinically significant depressive symptoms (assessed using validated depression-specific screening tools or diagnostic criteria) of adults with advanced life-limiting illnesses and extremely short prognoses (defined by survival or functional status). Quality assessment was performed using the Joanna Briggs Institute Systematic Reviews Checklist for Prevalence Studies for individual studies, and Grading of Recommendations Assessment, Development and Evaluation (GRADE) across studies. Results: Thirteen studies were included. The overall pooled prevalence of clinically significant depressive symptoms in adults with extremely short prognoses (n = 10 studies; extremely short prognoses: N = 905) using depression-specific screening tools was 50% (95%CI: 29%-70%; I2 = 97.6%). Prevalence of major and minor depression were 10% (95%CI: 4%-16%) and 5% (95%CI: 2%-8%), respectively. Major limitations included high heterogeneity, selection bias and small sample sizes in individual studies. Conclusions: Clinically significant depressive symptoms were prevalent in people with advanced life-limiting illnesses and extremely short prognoses. Clinicians need to be proactive in the recognition and assessment of these symptoms to allow for timely intervention

Decision-making in livestock biosecurity practices amidst environmental and social uncertainty: Evidence from an experimental game

Livestock industries are vulnerable to disease threats, which can cost billions of dollars and have substantial negative social ramifications. Losses are mitigated through increased use of disease-related biosecurity practices, making increased biosecurity an industry goal. Currently, there is no industry-wide standard for sharing information about disease incidence or on-site biosecurity strategies, resulting in uncertainty regarding disease prevalence and biosecurity strategies employed by industry stakeholders. Using an experimental simulation game, with primarily student participants, we examined willingness to invest in biosecurity when confronted with disease outbreak scenarios. We varied the scenarios by changing the information provided about 1) disease incidence and 2) biosecurity strategy or response by production facilities to the threat of disease. Here we show that willingness to invest in biosecurity increases with increased information about disease incidence, but decreases with increased information about biosecurity practices used by nearby facilities. Thus, the type or context of the uncertainty confronting the decision maker may be a major factor influencing behavior. Our findings suggest that policies and practices that encourage greater sharing of disease incidence information should have the greatest benefit for protecting herd health

Curable sexually transmitted infections among women with HIV in sub-Saharan Africa

OBJECTIVES: Sexually transmitted infections (STIs) cause significant morbidity among women with HIV and increase HIV transmission. We estimated the prevalence of four STIs among women with HIV in sub-Saharan Africa (SSA) and compared prevalence among women with and without HIV. DESIGN: Systematic review and meta-analysis. METHODS: We searched for studies published 1 January 1999 to 19 December 2019 reporting prevalence of gonorrhea, chlamydia, trichomoniasis, or Mycoplasma genitalium among women with HIV in SSA. We excluded studies conducted in high-risk groups (e.g. female sex workers). We extracted data on laboratory-confirmed STIs among women with HIV, and when included, among women without HIV. We estimated pooled prevalence for each STI among women with HIV using inverse variance heterogeneity meta-analysis, compared prevalence to women without HIV, and examined the influences of region, clinical setting, and pregnancy status in subgroup analyses. RESULTS: We identified 3756 unique records; 67 studies were included in the meta-analysis. Prevalence of gonorrhea, chlamydia, trichomoniasis, and M. genitalium was 3.5, 4, 15.6, and 10.2%, respectively. Chlamydia prevalence was lower in Eastern (2.8%) than in Southern (12.5%) and West/Central (19.1%) Africa combined. Prevalence of chlamydia and trichomoniasis was higher among pregnant (8.1%, 17.6%) than nonpregnant (1.7%, 12.3%) women. All STIs were more prevalent among women with than without HIV (relative risks ranging 1.54-1.89). CONCLUSION: STIs are common among women with HIV in SSA, and more common among women with than without HIV. Integrated STI and HIV care could substantially impact STI burden among women with HIV, with potential downstream impacts on HIV transmission

Older persons’ and their caregivers’ perspectives and experiences of research participation with impaired decision-making capacity: A scoping review

Background and Objectives: Human research ethics statements support equitable inclusion of diverse groups. Yet older people are under-represented in clinical research, especially those with impaired decision-making capacity. The aim of this study was to identify perspectives and experiences of older persons and their caregivers of research participation with impaired decision-making capacity. Research Design and Methods: Scoping review of literature and online sources in January-February 2019 (updated June 2020) according to Joanna Briggs Institute methodology and PRISMA Extension for Scoping Reviews. English-language peer-reviewed research articles and Australian online narratives were included. Data were tabulated and narratively synthesized. Results: From 4171 database records and 93 online resources, 22 articles (2000-2019, 82% United States, 16 first authors) and one YouTube webinar (2018) were initially included; updated searches yielded an additional article (2020) and YouTube webinar (2020). Studies were heterogeneous in terminology, methods and foci, with hypothetical scenarios, quantitative analyses and examination of proxy consent predominating. Participants (n=7331) were older persons (71%), caregivers of older persons with dementia/cognitive impairment (23%) and older persons with dementia/cognitive impairment (6%). Synthesis identified two themes: willingness to participate and decision-making approaches. Discussion and Implications: Research participation by older persons with dementia may be optimized through reducing risks and burdens and increasing benefits for participants, greater consumer input into study development, and shared and supported decision-making. Older persons’ and caregivers’ perspectives and experiences of research participation with impaired decision-making capacity require investigation in a greater range of countries and conditions other than dementia, and dissemination through more varied media