A Comparative Analysis of Registered Nurse Demand in Tennessee Rural and Urban Hospitals and Nursing Homes

The purpose of this study was to compare Registered Nurse (RN) current and future demand between Tennessee rural and urban licensed hospitals and nursing homes. Comparisons of Registered Nurse demand by principal duty or position and by educational level were also undertaken. The educational level of RNs was examined using the proportion of RNs at each of five educational levels: diploma, associate, baccalaureate, master\u27s, and doctorate. The variables examined were 1988 and 1989 vacancy rates and proportion of budgeted positions, change in vacancy rates and proportions from 1988 to 1989, projected changes in positions and proportions from 1988 to 1992 and to 1995. Nurse administrators from one hundred fifty four hospitals (63% response rate) and two hundred twelve nursing homes (72% response rate) were surveyed for responses about current and future RN demand. This study is a secondary analysis of data that were collected as a part of a larger research project conducted by the Tennessee Board of Regents Task Force on Nurse Supply and Demand. The findings were that rural hospitals had significantly higher vacancy rates for total nurse positions in 1988 and general duty positions in 1989. Urban hospital administrators reported higher vacancy rates for RN positions at the diploma level and projected significantly greater changes in clinical specialist and master\u27s level positions for 1992 and 1995. Rural hospitals had a higher proportion of associate degree nurses in 1989, and urban hospitals had a higher percentage of master\u27s prepared RNs for 1988 and 1989. Urban hospitals projected a greater change in the proportion of RNs at the doctoral level for 1995. Rural nursing homes projected higher numbers of associate degree nurses for 1992 and 1995. The major conclusion was that the nursing shortage in Tennessee hospitals was more severe than that reported on the national level and greater in rural hospitals. The shortage in Tennessee nursing homes was reported to be much less acute than the national shortage, and the critical shortages were limited to a few facilities, both rural and urban

Effectiveness of tailored lifestyle interventions, using web-based and print-mail, for reducing blood pressure among rural women with prehypertension: main results of the Wellness for Women: DASHing towards Health clinical trial.

Background Lifestyle modification is recommended for management of prehypertension, yet finding effective interventions to reach rural women is a public health challenge. This community-based clinical trial compared the effectiveness of standard advice to two multi-component theory-based tailored interventions, using web-based or print-mailed delivery, in reducing blood pressure among rural women, ages 40–69, with prehypertension. Methods 289 women with prehypertension enrolled in the Wellness for Women: DASHing towards Health trial, a 12-month intervention with 12-month follow-up. Women were randomly assigned to groups using a 1:2:2 ratio, comparing standard advice (30-minute counseling session) to two interventions (two 2-hour counseling sessions, 5 phone goal-setting sessions, strength-training video, and 16 tailored newsletters, web-based or print-mailed). Linear mixed model methods were used to test planned pairwise comparisons of marginal mean change in blood pressure, healthy eating and activity, adjusted for age and baseline level. General estimating equations were used to examine the proportion of women achieving normotensive status and meeting health outcome criteria for eating and activity. Results Mean blood pressure reduction ranged from 3.8 (SD = 9.8) mm Hg to 8.1 (SD = 10.4) mm Hg. The 24-month estimated marginal proportions of women achieving normotensive status were 47% for web-based, and 39% for both print-mailed and standard advice groups, with no group differences (p = .11 and p = .09, respectively). Web-based and print-mailed groups improved more than standard advice group for waist circumference (p = .017 and p = .016, respectively); % daily calories from fat (p = .018 and p = .030) and saturated fat (p = .049 and p = .013); daily servings of fruit and vegetables (p = .008 and p \u3c .005); and low fat dairy (p \u3c .001 and p = .002). Greater improvements were observed in web-based versus standard advice groups in systolic blood pressure (p = .048) and estimated VO2max (p = .037). Dropout rates were 6% by 6-months, 11.4% by 24 months, with no differences across groups. Conclusions Rural women with prehypertension receiving distance-delivery theory-based lifestyle modifications can achieve a reduction of blood pressure and attainment of normotensive status

User Engagement Associated with Web-Intervention Features to Attain Clinically Meaningful Weight Loss and Weight Maintenance in Rural Women

Objective: Purely web-based weight loss and weight-loss maintenance interventions show promise to influence behavior change. Yet, little is known about user engagement with features of web-based interventions that predict clinically meaningful weight loss (≥5% bodyweight loss). This study examines level of website feature engagement with the likelihood of attaining ≥5% bodyweight loss after 6 and 18 months participation in a web-based intervention, among rural women at high risk of obesity-related diseases and disability. Methods: In this secondary analysis of clinical trial data of 201 rural women, we examined weight change and user engagement, measured as clicks on specific web-based intervention features (messaging and self-tracking), as associated with clinically meaningful weight loss (baseline to 6 months) and weight-loss maintenance (6 to 18 months). Results: Generalized estimating equations, adjusted for age, intervention group, and intervention phase, revealed high engagement with messaging predicted whether women achieved ≥5% weight loss at 6 months and at 18 months. There was no effect of self-tracking. Conclusions: Being engaged with messages was associated with attaining clinically meaningful short-term and longer-term weight loss. This trial is registered with NCT01307644

Associations of Cardiorespiratory Fitness and Fatness with Metabolic Syndrome in Rural Women with Prehypertension

This study investigated the associations of fitness and fatness with metabolic syndrome in rural women, part of a recognized US health disparities group. Methods. Fitness, percentage body fat, BMI, and metabolic syndrome criteria were assessed at baseline in 289 rural women with prehypertension, ages 40–69, enrolled in a healthy eating and activity communitybased clinical trial for reducing blood pressure. Results. Ninety (31%) women had metabolic syndrome, of which 70% were obese by BMI (≥30 kg/m2), 100% by percentage body fat (≥30%), and 100% by revised BMI standards (≥25 kg/m2) cited in current literature. Hierarchical logistic regression models, adjusted for age, income, and education, revealed that higher percentage body fat (P \u3c 0.001) was associated with greater prevalence of metabolic syndrome. Alone, higher fitness lowered the odds of metabolic syndrome by 7% (P \u3c 0.001), but it did not lower the odds significantly beyond the effects of body fat. When dichotomized into “fit” and “unfit” groups, women categorized as “fat” had lower odds of metabolic syndrome if they were “fit” by 75% and 59%, for percentage body fat and revised BMI, respectively. Conclusion. Among rural women with prehypertension, obesity and fitness were associated with metabolic syndrome. Obesity defined as ≥25 kg/m2 produced results more consistent with percentage body fat as compared to the ≥30 kg/m2 definition

Erratum to ‘‘Associations of Cardiorespiratory Fitness and Fatness with Metabolic Syndrome in Rural Women with Prehypertension’’

In the original paper, the authors discovered a computer coding error that resulted in 33 of the women’s ages being incorrectly recorded. All analyses were repeated for this paper using the corrected age dataset, as all our logistic regression analyses in the published paper were adjusted for age.The repeated analyses, using the corrected dataset, lead to minor changes that needed to be reported to the results in the published paper. These corrections did not change the conclusion of the published paper.The authors apologize for any inconvenience

Associations of Cardiorespiratory Fitness and Fatness with Metabolic Syndrome in RuralWomen with Prehypertension

This study investigated the associations of fitness and fatness with metabolic syndrome in rural women, part of a recognized US health disparities group. Methods. Fitness, percentage body fat, BMI, and metabolic syndrome criteria were assessed at baseline in 289 rural women with prehypertension, ages 40–69, enrolled in a healthy eating and activity communitybased clinical trial for reducing blood pressure. Results. Ninety (31%) women had metabolic syndrome, of which 70% were obese by BMI (≥30 kg/m2), 100% by percentage body fat (≥30%), and 100% by revised BMI standards (≥25 kg/m2) cited in current literature. Hierarchical logistic regression models, adjusted for age, income, and education, revealed that higher percentage body fat (P \u3c 0.001) was associated with greater prevalence of metabolic syndrome. Alone, higher fitness lowered the odds of metabolic syndrome by 7% (P \u3c 0.001), but it did not lower the odds significantly beyond the effects of body fat. When dichotomized into “fit” and “unfit” groups, women categorized as “fat” had lower odds of metabolic syndrome if they were “fit” by 75% and 59%, for percentage body fat and revised BMI, respectively. Conclusion. Among rural women with prehypertension, obesity and fitness were associated with metabolic syndrome. Obesity defined as ≥25 kg/m2 produced results more consistent with percentage body fat as compared to the ≥30 kg/m2 definition

Obesity and Physical Function in Rural Women who enroll in a Lifestyle Modification Intervention for Reducing Blood Pressure

Purpose: Rural women have high prevalence of obesity and prehypertension. Obesity, if associated with poor physical function, may have implications for applying activity guidelines for women volunteering for lifestyle modification. This study examined associations of body mass index (BMI) and percent body fat with measures of 1-mile walk time, post-walk perceived exertion, and 10-repetition chair stands in rural women ages 40-69. Methods: Cross-sectional baseline data were collected using standardized methods from 289 rural women with prehypertension who volunteered for a lifestyle clinical trial for reducing blood pressure. ANOVAs and linear regression were used for analysis. Results: With exception of the chair stands measure across categories of BMI, group differences were noted in all measures across categories of BMI and percent body fat, with women in the two highest categories demonstrating the poorest performance. These two body composition measures were significant predictors for 1-mile walk-time and 10-repetition chair stands, after controlling for confounding variables. Conclusions: Poorer scores were observed in performance-based measures in women with higher BMI and percent body fat, though mean scores were above thresholds for functional limitation. Physical performance needs to be assessed and addressed by physical therapists when providing lifestyle interventions for overweight and obese women

Associations of cardiorespiratory fitness and fatness with metabolic syndrome in rural women with prehypertension.

BACKGROUND: This study investigated the associations of fitness and fatness with metabolic syndrome in rural women, part of a recognized US health disparities group. METHODS: Fitness, percentage body fat, BMI, and metabolic syndrome criteria were assessed at baseline in 289 rural women with prehypertension, ages 40-69, enrolled in a healthy eating and activity community-based clinical trial for reducing blood pressure. RESULTS: Ninety (31%) women had metabolic syndrome, of which 70% were obese by BMI (≥30 kg/m²), 100% by percentage body fat (≥30%), and 100% by revised BMI standards (≥25 kg/m²) cited in current literature. Hierarchical logistic regression models, adjusted for age, income, and education, revealed that higher percentage body fat (P \u3c 0.001) was associated with greater prevalence of metabolic syndrome. Alone, higher fitness lowered the odds of metabolic syndrome by 7% (P \u3c 0.001), but it did not lower the odds significantly beyond the effects of body fat. When dichotomized into fit and unfit groups, women categorized as fat had lower odds of metabolic syndrome if they were fit by 75% and 59%, for percentage body fat and revised BMI, respectively. CONCLUSION: Among rural women with prehypertension, obesity and fitness were associated with metabolic syndrome. Obesity defined as ≥25 kg/m² produced results more consistent with percentage body fat as compared to the ≥30 kg/m² definition

Feasibility of mHealth technology use among a sample of isolated rural men at high risk for cardiovascular disease

Purpose/Hypothesis: Isolated rural men are considered a health disparities group at high risk for cardiovascular disease. The increasing availability of technologies for self-monitoring for healthy eating, activity and weight loss (ie mHealth) may show promise for engaging rural men in lifestyle modification. This study investigated the feasibility of men from rural isolated areas to use a fitness monitor with text messaging support over a 3- week period. The study examined the men’s daily monitor use for tracking activity and eating, and assessed via written survey, their perspectives about mHealth. Number of Subjects: Twelve men, ages 40 to 69, from a US Department of Agriculture defined isolated rural area, participated. These men were a purposive sample originally recruited to participate in a focus group about their perceptions of the utility of mHealth. The men (50.9 6 8.6 yrs) had a baseline BMI of 25 to 44 kg/m2 (34.8 6 6.6 kg/m2). Eligibility included having cell/smartphones capable of sending/ receiving text messages, access to a computer, willing to use a fitness monitor and have research personnel access the men’s logs. Materials/Methods: Men participated in 2 visits at a community center located within 70 miles of their residence, at baseline and 3 weeks. Assessments included baseline health histories and vital sign biomarkers. The men received training using the fitness monitor with supporting technologies (cell/ smartphone and computer) and were asked to wear the monitor daily for 3 weeks. Men received 1–3 text messages/day for 3 weeks for reminders, education and motivation for self-monitoring. At visit 2, men completed post-intervention surveys about their fitness monitoring. Descriptive data were used for analysis. Results: Men were overweight (n 5 3) or obese (n 5 9) and most (9/12) were hypertensive with only four being treated with medications. One man was hypertensive stage 2 under no treatment and another was pre-hypertensive. Nine of 12 men wore the monitor during all 21 days, two wore it 9 and 15 days respectively and one lost the monitor. Survey data of the 12 men revealed seven checking their step count more than 5 times/day, 6 reported using the associated smart phone app and seven used the optional sleep log feature. Eleven of 12 men manually entered food into the log and most (9/12) did this on $15 days. Ten men indicated the log was helpful in learning about eating; though only 3 indicated it was easy to log food. All men reported reading reminder and motivational text messages sent during the study and 11 plan to continue using the fitness monitor. Conclusions: Men were not well managed for blood pressure or overweight/obesity. Both the log records and the survey results indicated that using fitness monitors was feasible and acceptable among this population. Clinical Relevance: Using mHealth appears feasible as an action-oriented tool for therapists to recommend for lifestyle self-monitoring in isolated rural men. The findings reinforce the important role of therapists in routinely assessing vital signs and making referrals as appropriate

Health and Appearance Reasons for Weight Loss as Predictors of Long-Term Weight Change

This study investigated whether women\u27s initial reasons (health, appearance to others, or appearance to self) for wanting to lose weight influenced their weight change over a 30-month web-based intervention. Multilevel modeling with 1416 observations revealed that only appearance in relation to one\u27s self was a significant (negative) predictor. Women highly motivated to lose weight to improve their appearance in relation to themselves gained weight at 30 months, whereas those not motivated for this reason achieved clinically significant weight loss. Results suggest examining participants\u27 initial reasons for weight loss as an important component of intervention failure or success