Effectiveness of a Faith-placed Cardiovascular Health Promotion Intervention for Rural Adults

Introduction: Cardiovascular disease (CVD) is the leading cause of mortality in the US. Further, rural US adults experience disproportionately high CVD prevalence and mortality compared to non-rural. Cardiovascular risk-reduction interventions for rural adults have shown short-term effectiveness, but long-term maintenance of outcomes remains a challenge. Faith organizations offer promise as collaborative partners for translating evidence-based interventions to reduce CVD. Methods: We adapted and implemented a collaborative, faith-placed, CVD risk-reduction intervention in rural Illinois. We used a quasi-experimental, pre-post design to compare changes in dietary and physical activity among participants. Intervention components included Heart Smart for Women (HSFW), an evidence-based program implemented weekly for 12 weeks followed by Heart Smart Maintenance (HSM), implemented monthly for two years. Participants engaged in HSFW only, HSM only, or both. We used regression and generalized estimating equations models to examine changes in outcomes after one year. Results: Among participants who completed both baseline and one-year surveys (n = 131), HSFW+HSM participants had significantly higher vegetable consumption (p = .007) and combined fruit/vegetable consumption (p = .01) compared to the HSM-only group at one year. We found no differences in physical activity. Conclusion: Improving and maintaining CVD-risk behaviors is a persistent challenge in rural populations. Advancing research to improve our understanding of effective translation of CVD risk-reduction interventions in rural populations is critical

Relationships Among Depression, Anxiety, and Insomnia Symptoms in Perinatal Women Seeking Mental Health Treatment

Background: Depression and anxiety symptoms are commonly experienced by women during the perinatal period. Changes in sleep and sleep quality are typical throughout pregnancy and early postpartum. However, little is known about relationships between insomnia symptoms and psychiatric symptoms in perinatal women. The objective of the present study is to characterize the burden of insomnia symptoms in perinatal women seeking outpatient psychiatric treatment and to examine relationships between insomnia and symptoms of depression and anxiety. Methods: Data from 257 pregnant or postpartum women who sought outpatient psychiatric treatment at a university hospital-affiliated clinic were extracted from an existing clinical management database. Data included validated self-report measures assessing insomnia (Insomnia Severity Index [ISI]), mood (Edinburgh Postnatal Depression Scale [EPDS]), and generalized anxiety (Penn State Worry Questionnaire [PSWQ]). Results: Fifty-two percent of women reported symptoms of insomnia, 75% reported symptoms of depression, and 61% reported symptoms of generalized anxiety. After controlling for PSWQ, the partial correlation between EPDS and ISI was 0.15 and 0.37 for pregnant and postpartum women, respectively. After controlling for EPDS, the partial correlation between PSWQ and ISI was 0.20 and 0.12 for pregnant and postpartum women, respectively. Women with clinically significant ISI scores had significantly higher odds for reporting symptoms consistent with depression (odds ratio [OR] 7.7) and generalized anxiety (OR 2.55) compared to women with lower ISI scores. Conclusions: Insomnia symptoms affected a significant proportion of the perinatal women in this sample. These symptoms are linked to symptoms of depression and anxiety in treatment-seeking pregnant and postpartum women. Perinatal women seen in psychiatric treatment settings should be routinely screened for sleep problems.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90453/1/jwh-2E2010-2E2371.pd

Advancing marine reserve science : from field experiments to marine conservation planning tools

This dissertation focuses on science relevant to the design and implementation of marine reserves. The chapters explore a range of topics related to among-site variation in population, community, and ecosystem dynamics. My results demonstrate the value and feasibility of integrating this knowledge into more comprehensive conservation and management approaches. While the threats facing the oceans are serious, we in the scientific community have considerable information and tools to contribute to the development and implementation of solutions. In Chapter 2, I report on the effects of conspecific density on multiple traits of the intertidal barnacle Balanus glandula. The primary effects of increased density were enhanced survival and higher reproductive rates. My results provide a strategy for evaluating the relative importance of positive vs. negative intraspecific interactions when implementing reserves. In Chapter 3, my co-authors and I investigated how variation in nearshore primary productivity influenced survival, growth, and reproduction in B. glandula. We found strong evidence for bottom-up (i.e. productivity) forcing of barnacle population dynamics. One site produced substantially more larvae than the others, demonstrating the importance of among-site variability. Our findings advance understanding of bottom-up influences on marine populations, and demonstrate the value of embedding reserves within a network. In Chapter 4, my co-authors and I used benthic habitat data from the Florida Keys to show how a computer-based siting tool could be used to help design reserve networks. We found that many different combinations of sites produced satisfactory networks, and highlighted areas as potential conservation priorities. Our work was the first marine application of this tool and provided a starting point for applications in California and Australia. In Chapter 5, I report on a synthesis of marine conservation planning cases globally. I found that the majority occurred in North and Central America, were based on biogeographic boundaries, and that biodiversity conservation was the primary objective. One of the most striking findings was the paucity of well-documented cases. My results suggested that planners consider knowledge of marine populations, communities, and ecosystems important when identifying priorities, but that they do not have clear guidelines for how to integrate this information appropriately

Violence against Women Raises Risk of Cervical Cancer

Background: An emerging literature suggests that violence against women (VAW), particularly sexual violence, may increase the risk of acquiring a sexually transmitted infection (STI) and, therefore, may be associated with cervical cancer development. The purpose of this cross-sectional analysis was to determine if women who had experienced violence had higher prevalence rates of invasive cervical cancer. Methods: Women aged 18–88 who joined the Kentucky Women’s Health Registry (2006–2007) and completed a questionnaire were included in the sample. Multivariate logistic regression analyses were used to adjust odds ratio (OR) for confounders (e.g., age, education, current marital status, lifetime illegal drug use, and pack-years of cigarette smoking). Results: Of 4732 participants with no missing data on violence, cervical cancer, or demographic factors, 103 (2.1%) reported ever having cervical cancer. Adjusting for demographic factors, smoking, and illegal drug use, experiencing VAW was associated with an increased prevalence of invasive cervical cancer (adjusted OR [aOR]¼2.6, 95% CI¼1.7-3.9). This association remained significant when looking at three specific types of VAW: intimate partner violence (IPV) (aOR¼2.7, 95% CI¼1.8-4.0), adult exposure to forced sex (aOR¼2.6, 95% CI¼1.6-4.3), and child exposure to sexual abuse (aOR¼2.4, 95% CI¼1.4-4.0). Conclusions: Rates of cervical cancer were highest for those experiencing all three types of VAW relative to those never experiencing VAW. Because VAW is common and has gynecological health effects, asking about VAW in healthcare settings and using this information to provide tailored healthcare may improve women’s health outcomes

Small Food Store Retailers’ Willingness to Implement Healthy Store Strategies in Rural North Carolina

Access to supermarkets is lacking in many rural areas. Small food stores are often available, but typically lack healthy food items such as fresh produce. We assessed small food store retailer willingness to implement 12 healthy store strategies to increase the availability, display, and promotion of healthy foods and decrease the availability, display, and promotion of tobacco products. Interviews were conducted with 55 small food store retailers in three rural North Carolina counties concurrently with store observations assessing current practices related to the strategies. All stores sold low-calorie beverages, sugar-sweetened beverages, candy and cigarettes. Nearly all sold smokeless tobacco and cigars/cigarillos, and 72% sold e-cigarettes. Fresh fruits were sold at 30.2% of stores; only 9.4% sold fresh vegetables. Retailers reported being most willing to stock skim/low-fat milk, display healthy snacks near the register, and stock whole wheat bread. About 50% were willing to stock at least three fresh fruits and three fresh vegetables, however only 2% of stores currently stocked these foods. Nearly all retailers expressed unwillingness to reduce the availability of tobacco products or marketing. Our results show promise for working with retailers in rural settings to increase healthy food availability in small food stores. However, restrictions on retail tobacco sales and marketing may be more feasible through local tobacco control ordinances, or could be included with healthy foods ordinances that require stores to stock a minimum amount of healthy foods

Sociodemographic Disparities in Proximity of Schools to Tobacco Outlets and Fast-Food Restaurants

Objectives. To examine the association of school sociodemographic characteristics with tobacco outlet and fast-food restaurant availability near schools in a national study

Stroke impact on mortality and psychologic morbidity within the Childhood Cancer Survivor Study.

BackgroundPoor socioeconomic and health-related quality of life (HRQOL) outcomes in survivors of childhood cancer can lead to distress and overall negatively impact the lives of these individuals. The current report has highlighted the impact of stroke and stroke recurrence on mortality, psychological HRQOL, and socioeconomic outcomes within the Childhood Cancer Survivor Study (CCSS).MethodsThe CCSS is a retrospective cohort study with longitudinal follow-up concerning survivors of pediatric cancer who were diagnosed between 1970 and 1986. Mortality rates per 100 person-years were calculated across 3 periods: 1) prior to stroke; 2) after first stroke and before recurrent stroke; and 3) after recurrent stroke. Socioeconomic outcomes, the standardized Brief Symptoms Inventory-18, the Medical Outcomes Study 36-Item Short Form Health Survey, and the CCSS-Neurocognitive Questionnaire also were assessed.ResultsAmong 14,358 participants (median age, 39.7 years), 224 had a stroke after their cancer diagnosis (single stroke in 161 patients and recurrent stroke in 63 patients). Based on 2636 deaths, all-cause late mortality rates were 0.70 (95% CI, 0.68-0.73) prior to stroke, 1.03 (95% CI, 0.73-1.46) after the first stroke, and 2.42 (95% CI, 1.48-3.94) after the recurrent stroke. Among 7304 survivors, those with stroke were more likely to live with a caregiver (single stroke odds ratio [OR], 2.3 [95% CI, 1.4-3.8]; and recurrent stroke OR, 5.3 [95% CI, 1.7-16.8]) compared with stroke-free survivors. Stroke negatively impacted task efficiency (single stroke OR, 2.4 [95% CI, 1.4-4.1] and recurrent stroke OR, 3.3 [95% CI, 1.1-10.3]) and memory (single stroke OR, 2.1 [95% CI, 1.2-3.7]; and recurrent stroke OR, 3.5 [95% CI, 1.1-10.5]).ConclusionsStroke and stroke recurrence are associated with increased mortality and negatively impact HRQOL measures in survivors of pediatric cancer

Des Moines Area Community College Creative Writing Contest 1976-2001

Award-Winning Works For the Academic Year · 2000-2001https://openspace.dmacc.edu/creativewriting/1002/thumbnail.jp

A window of opportunity for abatacept in RA: is disease duration an independent predictor of low disease activity/remission in clinical practice?

The objective of the study was to examine whether disease duration independently predicts treatment response among biologic-naive patients with rheumatoid arthritis (RA) initiating abatacept in clinical practice. Using the Corrona RA registry (February 2006-January 2015), biologic-naive patients with RA initiating abatacept with 12-month (+/-3 months) follow-up and assessment of disease activity (Clinical Disease Activity Index [CDAI]) at initiation and at 12 months were identified. The primary outcome was mean change in CDAI (DeltaCDAI) from baseline to 12 months. Secondary outcomes at 12 months included achievement of low disease activity (LDA; CDAI 10 years, n = 79). Increased disease duration was associated with older age (p = 0.047), and the median number of prior conventional disease-modifying antirheumatic drugs used was lowest in the 0- to 2-year duration group (p \u3c 0.001). Mean DeltaCDAI (SE) ranged from -10.22 (1.19) for 0-2 years to -4.63 (1.38) for \u3e 10 years. In adjusted analyses, shorter disease duration was significantly associated with greater mean DeltaCDAI (p = 0.015) and greater likelihood of achieving LDA (p = 0.048). In biologic-naive patients with RA initiating abatacept, earlier disease (shorter disease duration) was associated with greater DeltaCDAI and likelihood of achieving LDA