The Use of Gesture in Self-Initiated Self-Repair Sequences by Persons with Non-Fluent Aphasia

This study examines the relationship between types of gestures and instances of self-initiated self-repair (SISR) used by persons with non-fluent aphasia (NFA), which is a type of aphasia characterized by stilted speech or signing (Papathanasiou et al., 2013), in interactions with clinicians. Conversation repairs in this study are assessed using the framework of Conversation Analysis (CA), which is an approach for describing, analyzing, and understanding social interaction (Sidnell, 2010). Previous linguistic studies have demonstrated a distinct preference for the use of gesture during a repair by persons with aphasia (Goodwin, 1995; Klippi, 2015; Wilkinson, 2013). This study draws more conclusive generalizations than previous studies about the types of gesture used in successful and unsuccessful SISR by persons with NFA through the use of the AphasiaBank corpus. Results show that there does not appear to be a connection between the overall frequencies of gesture used by persons with NFA during a phase of the repair mechanism as compared to other phases in the repair mechanism. Additionally, there is a slight tendency in this dataset for persons with NFA to have more successful repairs when they use gesture during the initiation and reparable portions of the repair mechanism

Nurse Led Community Health Worker Lay Leader Model

In America’s Health Rankings 2018 Annual Report, Kentucky ranked 45 out of 50 in the nation’s healthiest states, signifying the poor overall health of the state.1 Additional statistics show that rural areas of Kentucky, especially the Appalachian region, face some of the highest rates of health disparities in the state and nation. Associated social, environmental, and health risk factors in this population further complicate matters, resulting in a higher prevalence of chronic diseases. Although chronic diseases can cause serious complications, most disease risk factors can be prevented or controlled. Evidence-based self-management education models, such as the Chronic Disease Self-Management Program (CDSMP), Diabetes Self-Management Program (DSMP), and Walk With Ease, may provide a solution to address the growing chronic disease epidemic. In these programs, participants receive self-management education for a variety of chronic diseases, including diabetes and arthritis, to improve and manage their health conditions. Led and trained by registered nurses, community health workers (CHWs) incorporate these self-management programs into the communities they serve and provide a supportive role by interacting with participants before, during, and after each session to aid in successful completion rates and improved health outcomes. One such CHW program, Kentucky Homeplace, has been providing self-management education since its inception in 1994, and began integrating CDSMP, DSMP, and Walk With Ease into the community in 2015

The Impact of COVID-19 on Smoking Cessation Motivation and Lung Cancer Screening in Quitline Clients

https://openworks.mdanderson.org/sumexp23/1044/thumbnail.jp

Kentucky’s Primary Care Workforce Shortages 2016 - 2025 and Recommendations for Increasing the Production of Primary Care Physicians for Kentucky

An excerpt from the executive summary: Kentucky and the nation face severe shortages of primary care (PC) physicians. PC physicians are essential to cost-effective healthcare. Kentucky ranks 40th among the United States in its PC physician workforce per 100,000 people, with 2,696 practicing PC physicians statewide. The purposes of this white paper are to: Present up-to-date data and information about the primary care workforce in Kentucky Describe current trainee pipelines that supply new primary care physicians to Kentucky Recommend strategies and tactics for improving the primary care physician workforc

Automated Reminders to Promote Radon Testing in a Lung Cancer Case Control Study

One of the four pilot projects of the Lung Cancer Initiative sponsored by the Department of Defense measures radon levels in the participants homes. Radon exposure is the second leading cause of Lung Cancer. The case-control study has a targeted accrual of 1800 with a case-control ratio of 1:4. The long-term radon kits remain in the home for 90 days and the participants are asked to mail the test kit to the company for analysis. In order to maximize the test kit return rate, reminder calls to the participants occurred 90 days after the home visit

Screening for Hearing Loss in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Importance: Hearing loss is common in older adults and associated with adverse health and social outcomes. Objective: To update the evidence review on screening for hearing loss in adults 50 years or older to inform the US Preventive Services Task Force. Data Sources: MEDLINE, Cochrane Library, EMBASE, and trial registries through January 17, 2020; references; and experts; literature surveillance through October 8, 2020. Study Selection: English-language studies of accuracy, screening, and interventions for screen-detected or newly detected hearing loss. Data Extraction and Synthesis: Dual review of abstracts, full-text articles, and study quality. Meta-analysis of screening test accuracy studies. Main Outcomes and Measures: Quality of life and function, other health and social outcomes, test accuracy, and harms. Results: Forty-one studies (N = 26386) were included, 18 of which were new since the previous review. One trial enrolling US veterans (n = 2305) assessed the benefits of screening; there was no significant difference in the proportion of participants experiencing a minimum clinically important difference in hearing-related function at 1 year (36%-40% in the screened groups vs 36% in the nonscreened group). Thirty-four studies (n = 23228) evaluated test accuracy. For detecting mild hearing loss (>20-25 dB), single-question screening had a pooled sensitivity of 66% (95% CI, 58%-73%) and a pooled specificity of 76% (95% CI, 68%-83%) (10 studies, n = 12637); for detecting moderate hearing loss (>35-40 dB), pooled sensitivity was 80% (95% CI, 68%-88%) and pooled specificity was 74% (95% CI, 59%-85%) (6 studies, n = 8774). In 5 studies (n = 2820) on the Hearing Handicap Inventory for the Elderly-Screening to detect moderate hearing loss (>40 dB), pooled sensitivity was 68% (95% CI, 52%-81%) and pooled specificity was 78% (95% CI, 67%-86%). Six trials (n = 853) evaluated amplification vs control in populations with screen-detected or recently detected hearing loss over 6 weeks to 4 months. Five measured hearing-related function via the Hearing Handicap Inventory for the Elderly; only 3 that enrolled veterans (n = 684) found a significant difference considered to represent a minimal important difference (>18.7 points). Few trials reported on other eligible outcomes, and no studies reported on harms of screening or interventions. Conclusions and Relevance: Several screening tests can adequately detect hearing loss in older adults; no studies reported on the harms of screening or treatment. Evidence showing benefit from hearing aids on hearing-related function among adults with screen-detected or newly detected hearing loss is limited to studies enrolling veterans

A Case-Control Study of Trace-Element Status and Lung Cancer in Appalachian Kentucky

Appalachian Kentucky (App KY) leads the nation in lung cancer incidence and mortality. Trace elements, such as As, have been associated with lung cancers in other regions of the country and we hypothesized that a population-based study would reveal higher trace element concentrations in App KY individuals with cancer compared to controls. Using toenail and drinking water trace element concentrations, this study investigated a possible association between lung cancer incidence and trace-element exposure in residents of this region. This population-based case-control study had 520 subjects, and 367 subjects provided toenail samples. Additionally, we explored the relationship between toenail and fingernail trace-element concentrations to determine if fingernails could be used as a surrogate for toenails when patients are unable to provide toenail samples. We found that, contrary to our initial hypothesis, trace element concentrations (Al, As, Cr, Mn, Co, Fe, Ni, Cu, Se, and Pb) were not higher in cancer cases than controls with the exception of Zn where concentrations were slightly higher in cases. In fact, univariate logistic regression models showed that individuals with lower concentrations of several elements (Al, Mn, Cr, and Se) were more likely to have lung cancer, although only Mn was significant in multivariate models which controlled for confounding factors. While drinking water concentrations of Al, Cr and Co were positively related to cancer incidence in univariate models, only Co remained significant in multivariate models. However, since the drinking water concentrations were extremely low and not reflected in the toenail concentrations, the significance of this finding is unclear. We also found that fingernail concentrations were not consistently predictive of toenail concentrations, indicating that fingernails should not be used as surrogates for toenails in future studies

Screening for Eating Disorders in Adolescents and Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force

Importance: Eating disorders are associated with adverse health and social outcomes. Objective: To review the evidence on screening for eating disorders in adolescents and adults to inform the US Preventive Services Task Force. Data Sources: MEDLINE, Cochrane Library, PsycINFO, and trial registries through December 19, 2020; surveillance through January 1, 2022. Study Selection: English-language studies of screening test accuracy, randomized clinical trials (RCTs) of screening or interventions for eating disorders in populations with screen-detected or previously untreated eating disorders (trials limited to populations who are underweight were ineligible). Data Extraction and Synthesis: Dual review of abstracts, full-text articles, and study quality. Meta-analysis of test accuracy studies and intervention trials. Main Outcomes and Measures: Test accuracy, eating disorder symptom severity, quality of life, depression, and harms. Results: Fifty-seven studies were included (N = 10 773); 3 (n = 1073) limited to adolescents (mean or median age, 14-15 years). No study directly evaluated the benefits and harms of screening. Seventeen studies (n = 6804) evaluated screening test accuracy. The SCOFF questionnaire (cut point ≥2) had a pooled sensitivity of 84% (95% CI, 74% to 90%) and pooled specificity of 80% (95% CI, 65% to 89%) in adults (10 studies, n = 3684). Forty RCTs (n = 3969) evaluated interventions for eating disorders; none enrolled a screen-detected population. Lisdexamfetamine for binge eating disorder (4 RCTs; n = 900) was associated with larger reductions in eating disorder symptom severity on the Yale-Brown Obsessive Compulsive Scale modified for binge eating (YBOCS-BE) than placebo (pooled mean difference, -5.75 [95% CI, -8.32 to -3.17]). Two RCTs (n = 465) of topiramate for binge eating disorder found larger reductions in YBOCS-BE scores associated with topiramate than placebo, from -6.40 (95% CI, -8.16 to -4.64) to -2.55 (95% CI, -4.22 to -0.88). Nine pharmacotherapy trials (n = 2006) reported on harms. Compared with placebo, lisdexamfetamine was associated with higher rates of dry mouth, headache, and insomnia, and topiramate was associated with higher rates of paresthesia, taste perversion, confusion, and concentration difficulty. Twenty-four trials (n = 1644) assessed psychological interventions. Guided self-help for binge eating disorder improved eating disorder symptom severity more than control (pooled standardized mean difference, -0.96 [95% CI, -1.26 to -0.67]) (5 studies, n = 391). Evidence on other interventions was limited. Conclusions and Relevance: No studies directly assessed the benefits and harms of screening. The SCOFF questionnaire had adequate accuracy for detecting eating disorders among adults. No treatment trials enrolled screen-detected populations; guided self-help, lisdexamfetamine, and topiramate were effective for reducing eating disorder symptom severity among referred populations with binge eating disorder, but pharmacotherapies were also associated with harms

A Systematic Review of Patient- and Family-Level Inhaled Corticosteroid Adherence Interventions in Black/African Americans

Background: Inhaled corticosteroid (ICS) adherence rates are suboptimal among adult black/African Americans. Comprehensive studies characterizing the effectiveness and the methodological approaches to the development of interventions to improve ICS adherence in adult black/African Americans have not been performed. Objectives: Conduct a systematic review of patient/family-level interventions to improve ICS adherence in adult black/African Americans. Methods: We searched MEDLINE, EMBASE, Web of Science, and CINAHL from inception to August 2017 for English-language US studies enrolling at least 30% black/African Americans comparing patient/family-level ICS adherence interventions with any comparator. Two investigators independently selected, extracted data from, and rated risk of bias. We collected information on intervention characteristics and outcomes, and assessed whether studies were informed by behavior theory, stakeholder engagement, or both. Results: Among 1661 abstracts identified, we reviewed 230 full-text articles and identified 4 randomized controlled trials (RCTs) and 1 quasi-experimental (pre-post design) study meeting criteria. Study participants (N range, 17-333) varied in mean age (22-47 years), proportion black/African Americans studied (71%-93%), and sex (69%-82% females). RCTs evaluated problem-solving classes, self-efficacy training, technology-based motivational interviewing program, and the use of patient advocates. The RCT testing self-efficacy training was the only intervention informed by both behavior theory and stakeholder engagement. All 4 RCTs compared interventions with active control and rated as medium risk of bias. No RCTs found a statistically significant improvement in adherence. Conclusions: Few studies assessing asthma adherence interventions focused on adult black/African-American populations. No RCTs demonstrated improved ICS adherence in participants. Future studies that are informed by behavior change theory and stakeholder engagement are needed