Native American Weight Loss Movement: Pilot Test of a Culturally Tailored Weight Loss Program for American Indians

American Indians (AIs) have higher rates of obesity than other racial/ethnic groups, placing them at heightened risk for cardiovascular diseases, diabetes, and certain cancers. Culturally appropriate weight loss interventions may be the key to reducing risk. The most successful program used in AI communities has been the Diabetes Prevention Program (DPP), which limits enrollment to individuals with a clinical diagnosis of pre-diabetes. The purpose of this pilot project was to modify and culturally tailor a weight loss intervention to AI communities in Kansas to improve weight loss related behaviors among those who do not qualify for the DPP. The Native American Weight Loss Movement (NAWLM) was developed from 2012-2014 using an iterative process with 4 sequential modifications to the program. Group 1 received a slightly modified version of the DPP that was originally tailored to African Americans. Each group received an improved program based on modifications from the previous group. Our analysis shows 36.1% (95% CI: 25.7, 47.5) of all participants (n=72) lost weight; a majority (63.9%, 95% CI: 52.8-75.0) maintained weight, gained weight, or dropped out. Among individuals who completed the program (n=34), 76.5% lost weight (95% CI: 61.4, 91.5). These individuals lost an average of 2.98% body weight (95% CI: 1.58, 4.37), with 6 participants losing \u3e7% body weight. While most participants who completed the program lost weight, more research is needed to determine factors that discourage drop-out and promote behavioral changes. NAWLM shows promise as a weight loss program for AIs who do not qualify for the DPP

Diabetes and Tooth Loss in a National Sample of Dentate Adults Reporting Annual Dental Visits

IntroductionPeriodontal disease has been associated with tooth loss and reported as more prevalent among people with diabetes than among those without diabetes. Having an annual dental examination is a national goal of Healthy People 2010. Our objective was to examine whether an association exists between diabetes and tooth loss among a population reporting an annual dental visit.MethodsWe used data from the 2004 Behavioral Risk Factor Surveillance System to examine the association between self-reported diabetes and tooth removal due to decay or periodontal disease among 155,280 respondents reporting a dental visit within the past year. We calculated prevalence estimates, odds ratios, and 95% confidence intervals. Multiple logistic regression allowed for adjustment.ResultsThe overall prevalence of tooth removal among the people in the study was 38.3%. People with diabetes had a significantly higher prevalence of tooth removal. In a multivariable model adjusting for selected covariates, respondents with diabetes were 1.46 times as likely (95% CI, 1.30–1.64) to have at least one tooth removed than respondents without diabetes. A stronger association between diabetes and tooth loss was observed among people in the younger age groups than among those in the older age groups.ConclusionEven among people reporting a recent dental visit, diabetes was independently associated with tooth loss. Multidisciplinary efforts are needed to raise awareness of the risk of tooth loss among younger people with diabetes. Good oral hygiene as well as annual dental examinations are important for preventing tooth loss

Communities organizing to promote equity: engaging local communities in public health responses to health inequities exacerbated by COVID-19–protocol paper

BackgroundThe COVID-19 pandemic has disproportionately impacted rural and under-resourced urban communities in Kansas. The state’s response to COVID-19 has relied on a highly decentralized and underfunded public health system, with 100 local health departments in the state, few of which had prior experience engaging local community coalitions in a coordinated response to a public health crisis.MethodsTo improve the capacity for local community-driven responses to COVID-19 and other public health needs, the University of Kansas Medical Center, in partnership with the Kansas Department of Health and Environment, will launch Communities Organizing to Promote Equity (COPE) in 20 counties across Kansas. COPE will establish Local Health Equity Action Teams (LHEATs), coalitions comprised of community members and service providers, who work with COPE-hired community health workers (CHWs) recruited to represent the diversity of the communities they serve. CHWs in each county are tasked with addressing unmet social needs of residents and supporting their county’s LHEAT. LHEATs are charged with implementing strategies to improve social determinants of health in their county. Monthly, LHEATs and CHWs from all 20 counties will come together as part of a learning collaborative to share strategies, foster innovation, and engage in peer problem-solving. These efforts will be supported by a multilevel communications strategy that will increase awareness of COPE activities and resources at the local level and successes across the state. Our mixed methods evaluation design will assess the processes and impact of COPE activities as well as barriers and facilitators to implementation using aspects of both the Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) models.DiscussionThis protocol is designed to expand community capacity to strategically partner with local public health and social service partners to prioritize and implement health equity efforts. COPE intentionally engages historically resilient communities and those living in underserved rural areas to inform pragmatic strategies to improve health equity

Fast and Accurate Resonance Assignment of Small-to-Large Proteins by Combining Automated and Manual Approaches

The process of resonance assignment is fundamental to most NMR studies of protein structure and dynamics. Unfortunately, the manual assignment of residues is tedious and time-consuming, and can represent a significant bottleneck for further characterization. Furthermore, while automated approaches have been developed, they are often limited in their accuracy, particularly for larger proteins. Here, we address this by introducing the software COMPASS, which, by combining automated resonance assignment with manual intervention, is able to achieve accuracy approaching that from manual assignments at greatly accelerated speeds. Moreover, by including the option to compensate for isotope shift effects in deuterated proteins, COMPASS is far more accurate for larger proteins than existing automated methods. COMPASS is an open-source project licensed under GNU General Public License and is available for download from http://www.liu.se/forskning/foass/tidigare-foass/patrik-lundstrom/software?l=en. Source code and binaries for Linux, Mac OS X and Microsoft Windows are available.Funding Agencies|Swedish Research Council [Dnr. 2012-5136]</p

Understanding Medication Adherence in Patients with Limited English Proficiency

Introduction. Approximately 41.6% of the US population who speak a language other than English (20% over all) and have limited English proficiency (LEP) status.1 Health outcomes for patients with LEP status or who are language discordant (speak a different language than their clinicians) have been studied in several settings, including the hospital and outpatient, with results widely demonstrating that these patients have worse outcomes when a professional interpreter is not used consistently. 2,3 The aim of this study was to investigate the impact of preferred language and language discordance on medication adherence. Methods. Data were collected via review of pharmacy-acquired medication profiles for three primary language cohorts: Nepali, Spanish, and English. Total Days of Adherence, Adherence Ratio, and Maximum Days Non-adherent were calculated and compared between language groups. We examined these statistics for regular and long-acting insulin, metformin and ACE inhibitors, testing for differences between language groups and those who experienced greater vs less than the median value for language concordant clinical encounters. Results. The most adherent group over all (highest adherence-ratio) were the Nepali-speaking, but the results showed high variability across outcomes and medications. Conclusions. After adjustment and stratification for greater vs lesser language concordant patient visit experience, we found that language-spoken plays an important role in the clinical encounter, and that LEP patients could have improved outcomes in their adherence to medications by having providers who speak their language or use an interpreter

Refugee and migrants' involvement in participatory spaces in a US practice‐based research network study: Responding to unanticipated priorities

Abstract Background Refugees and migrants face suboptimal involvement in spaces for primary healthcare decision‐making. Given the rising numbers of resettled refugees and migrants in primary care settings in the United States, there is an urgent need for patient‐centred outcome research in practice‐based research networks (PBRNs) with diverse ethnolinguistic communities. This study explored whether researchers, clinicians and patients would achieve consensus on (1) a common set of clinical problems that were applicable across a PBRN and (2) potential clinical interventions to address those problems to inform a patient‐centred outcomes research (PCOR) study in a similar research network. Methods In this qualitative participatory health research study, patients from diverse ethnolinguistic communities and clinicians from seven practices in a US PBRN discussed preferences for PCOR responsive to patients and the clinicians who serve them in language‐discordant settings. Researchers and an advisory panel that included patients and clinicians from each participating practice held regular advisory meetings to monitor progress on project milestones and solve emerging problems. Participants took part in 10 sessions using Participatory Learning in Action and the World Café methods to identify and prioritise their ideas, using questions set for them by the advisory panel. Data were analysed based on principles of qualitative thematic content analysis. Results Participants identified common barriers in language‐discordant healthcare settings, principally patient‐clinician communication barriers and suggestions to overcome these barriers. A key finding was an unanticipated consensus about the need for attention to healthcare processes rather than a clinical research priority. Negotiation with research funders enabled further analysis of potential interventions for care processes to improve communication and shared decision‐making in consultations and the practice as a whole. Conclusion PCOR studies should examine interventions for improving communication between patients from diverse ethnolinguistic communities and primary care staff if the sorts of harms experienced by patients experiencing language‐discordant healthcare are to be reduced or prevented. Flexibility and responsiveness from funders to unanticipated findings are key structural supports for participatory health research in primary care clinical settings with this population and others who experience marginalisation and exclusion. Patient or Public Contribution Patients and clinicians participated in the study both in the formulation of the study question, data collection, analysis and dissemination of these results; consented to their individual participation; and reviewed early drafts of the manuscript

A Symposium On Sense of Place In Appalachia - Part 2

A symposium on the sense of place in Appalachia held at Morehead State University in October of 1987. The symposium includes presentations from: Joyce LeMaster on the Sense of Place in the Dollmaker Joseph Connelly on Affirming Place in the Winter People Bob Reiman on the Sense of Place in Central Appalachia William Turner on the Sense of Place among Blacks Judy Lewis on Appalachia in Mass Media Homer Marcum on I\u27m a Lovely Kentuckia