Cancer Awareness in Alternative Settings: Lessons Learned and Evaluation of the Barbershop Men’s Health Project

Prostate and colorectal cancer are two of the leading causes of cancer deaths among African American men. This study describes lessons learned from the development, implementation and evaluation of a culturally appropriate, barbershop-based intervention to improve prostate and colorectal cancer screening awareness among African American men. Working with an Advisory Panel of shop owners, barbers, and cancer survivors, local barbers were recruited and trained as Community Health Advisors to educate, motivate, and assist their clients in becoming more knowledgeable about prostate and colorectal cancer. Survey results reveal increases in prostate and colorectal cancer knowledge and self-reported screening among participants. Lessons learned include the need for adequate project staffing and the appropriate role of the barber as a Community Health Advisor. Findings from this study suggest that barbershops are a promising setting for reaching African American men and could be used to target additional conditions that disproportionately impact this community

Multiple uncontrolled conditions and blood pressure medication intensification: an observational study

Abstract Background Multiple uncontrolled medical conditions may act as competing demands for clinical decision making. We hypothesized that multiple uncontrolled cardiovascular risk factors would decrease blood pressure (BP) medication intensification among uncontrolled hypertensive patients. Methods We observed 946 encounters at two VA primary care clinics from May through August 2006. After each encounter, clinicians recorded BP medication intensification (BP medication was added or titrated). Demographic, clinical, and laboratory information were collected from the medical record. We examined BP medication intensification by presence and control of diabetes and/or hyperlipidemia. 'Uncontrolled' was defined as hemoglobin A1c ≥ for diabetes, BP ≥ 140/90 mmHg (≥ 130/80 mmHg if diabetes present) for hypertension, and low density lipoprotein cholesterol (LDL-c) ≥ 130 mg/dl (≥ 100 mg/dl if diabetes present) for hyperlipidemia. Hierarchical regression models accounted for patient clustering and adjusted medication intensification for age, systolic BP, and number of medications. Results Among 387 patients with uncontrolled hypertension, 51.4% had diabetes (25.3% were uncontrolled) and 73.4% had hyperlipidemia (22.7% were uncontrolled). The BP medication intensification rate was 34.9% overall, but higher in individuals with uncontrolled diabetes and uncontrolled hyperlipidemia: 52.8% overall and 70.6% if systolic BP ≥ 10 mmHg above goal. Intensification rates were lowest if diabetes or hyperlipidemia were controlled, lower than if diabetes or hyperlipidemia were not present. Multivariable adjustment yielded similar results. Conclusions The presence of uncontrolled diabetes and hyperlipidemia was associated with more guideline-concordant hypertension care, particularly if BP was far from goal. Efforts to understand and improve BP medication intensification in patients with controlled diabetes and/or hyperlipidemia are warranted.http://deepblue.lib.umich.edu/bitstream/2027.42/78266/1/1748-5908-5-55.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78266/2/1748-5908-5-55.pdfPeer Reviewe

Alabama Veterans Rural Health Initiative: A Preliminary Evaluation of Unmet Health Care Needs

The Alabama Veterans Rural Health Initiative aims to better understand the health care needs, health status, and barriers to care for rural veterans. Following extensive community outreach, Veteran Community Outreach Health Workers assessed 203 veterans residing in rural counties of Alabama who either: 1) had never enrolled in VA health services, or 2) had not used those services in at least two years. While 71.4 percent of participants reported having utilized non-VHA primary care within the past year, 33.5 percent reported an inability or delay in obtaining needed health care for one or more services: primary care, specialty care, mental health care, addictions treatment, dental care, or prescription medication. The most commonly cited barrier was cost. Among all participants, 56 percent screened positive for at least one Axis I mental disorder. Rurally residing, non-VHA utilizing veterans appear to have fairly good access to primary care, but need dental care, prescription medication, and mental health care

A Retrospective Cohort Study of the Potency of lipid-lowering therapy and Race-gender Differences in LDL cholesterol control

<p>Abstract</p> <p>Background</p> <p>Reasons for race and gender differences in controlling elevated low density lipoprotein (LDL) cholesterol may be related to variations in prescribed lipid-lowering therapy. We examined the effect of lipid-lowering drug treatment and potency on time until LDL control for black and white women and men with a baseline elevated LDL.</p> <p>Methods</p> <p>We studied 3,484 older hypertensive patients with dyslipidemia in 6 primary care practices over a 4-year timeframe. Potency of lipid-lowering drugs calculated for each treated day and summed to assess total potency for at least 6 and up to 24 months. Cox models of time to LDL control within two years and logistic regression models of control within 6 months by race-gender adjust for: demographics, clinical, health care delivery, primary/specialty care, LDL measurement, and drug potency.</p> <p>Results</p> <p>Time to LDL control decreased as lipid-lowering drug potency increased (P < 0.001). Black women (N = 1,440) received the highest potency therapy (P < 0.001) yet were less likely to achieve LDL control than white men (N = 717) (fully adjusted hazard ratio [HR] 0.66 [95% CI 0.56-0.78]). Black men (N = 666) and white women (N = 661) also had lower adjusted HRs of LDL control (0.82 [95% CI 0.69, 0.98] and 0.75 [95% CI 0.64-0.88], respectively) than white men. Logistic regression models of LDL control by 6 months and other sensitivity models affirmed these results.</p> <p>Conclusions</p> <p>Black women and, to a lesser extent, black men and white women were less likely to achieve LDL control than white men after accounting for lipid-lowering drug potency as well as diverse patient and provider factors. Future work should focus on the contributions of medication adherence and response to treatment to these clinically important differences.</p

Study protocol for the recreational stimulation for elders as a vehicle to resolve delirium superimposed on dementia (Reserve For DSD) trial

<p>Abstract</p> <p>Background</p> <p>Delirium is a state of confusion characterized by an acute and fluctuating decline in cognitive functioning. Delirium is common and deadly in older adults with dementia, and is often referred to as delirium superimposed on dementia, or DSD. Interventions that treat DSD are not well-developed because the mechanisms involved in its etiology are not completely understood. We have developed a theory-based intervention for DSD that is derived from the literature on cognitive reserve and based on our prior interdisciplinary work on delirium, recreational activities, and cognitive stimulation in people with dementia. Our preliminary work indicate that use of simple, cognitively stimulating activities may help resolve delirium by helping to focus inattention, the primary neuropsychological deficit in delirium. Our primary aim in this trial is to test the efficacy of Recreational Stimulation for Elders as a Vehicle to resolve DSD (RESERVE- DSD).</p> <p>Methods/Design</p> <p>This randomized repeated measures clinical trial will involve participants being recruited and enrolled at the time of admission to post acute care. We will randomize 256 subjects to intervention (RESERVE-DSD) or control (usual care). Intervention subjects will receive 30-minute sessions of tailored cognitively stimulating recreational activities for up to 30 days. We hypothesize that subjects who receive RESERVE-DSD will have: decreased severity and duration of delirium; greater gains in attention, orientation, memory, abstract thinking, and executive functioning; and greater gains in physical function compared to subjects with DSD who receive usual care. We will also evaluate potential moderators of intervention efficacy (lifetime of complex mental activities and APOE status). Our secondary aim is to describe the costs associated with RESERVE-DSD.</p> <p>Discussion</p> <p>Our theory-based intervention, which uses simple, inexpensive recreational activities for delivering cognitive stimulation, is innovative because, to our knowledge it has not been tested as a treatment for DSD. This novel intervention for DSD builds on our prior delirium, recreational activity and cognitive stimulation research, and draws support from cognitive reserve theory.</p> <p>Trial registration</p> <p>ClinicalTrials.gov identifier: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01267682">NCT01267682</a></p

RELATIONS OF BLACK MOTHERS’ AND DAUGHTERS’ BODY FATNESS, PHYSICAL ACTIVITY BELIEFS AND BEHAVIOR

Objectives: 1) Examine the association between Black mothers’ and daughters’ body fatness, physical activity (PA) beliefs and levels of PA, and daughters’ PA behavior; 2) determine whether family sociodemographic factors influence these relationships. Design and Setting: Cross-sectional; Black girls recruited from elementary schools in a low socioeconomic area. Data collected at the Georgia Prevention Institute. Participants: 133 Black girls (8–12 years of age) and their mothers (24–66 years of age). Analyses: Spearman correlations, regressions. Outcome Measures: Body mass index (BMI) as a measure of body fatness. Moderate and vigorous PA collected from a 7-d recall. Beliefs about PA collected from questionnaires. Results: There was a positive relation between mothers’ and daughters’ BMI (rs50.34, P,.0001). Mothers’ and daughters’ PA beliefs were positive but not significantly related. A significant inverse relation was seen between vigorous PA (rs520.16, P,.05); and a nonsignificant correlation between moderate PA (rs50.05). Mothers’ body fatness, PA beliefs and behavior did not predict daughters’ PA. The BMI association was stronger when spouse lived in household (P,.01). Daughters’ BMI was lower (P,.05) and intent to be active higher (P,.05) when more people lived in the household. Family income accentuated the relation of mothers’ belief in the usefulness of PA and daughters’ PA physical outcomes beliefs (P5.1). Mothers’ age and education had no significant influence on daughters’ PA beliefs and behaviors. Conclusion: Mothers and daughters believed PA to have beneficial outcomes. Mothers’ body fatness, PA beliefs and behaviors were not associated with daughters’ PA. Family income and structure appeared to influence these relationships

A 24-month evaluation of amalgam and resin-based composite restorations:Findings from The National Dental Practice-Based Research Network

BACKGROUND: Knowing which factors influence restoration longevity can help clinicians make sound treatment decisions. The authors analyzed data from the National Dental Practice-Based Research Network to identify predictors of early failures of amalgam and resin-based composite (RBC) restorations. METHODS: This prospective cohort study gathered information from clinicians and offices participating in the network. Clinicians completed a baseline data collection form at the time of restoration placement, and annually thereafter. Data collected included patient factors, practice factors, and dentist factors, and were analyzed using mixed-model logistic regression. RESULTS: A total of 226 practitioners followed 6,218 direct restorations in 3,855 patients; 386 restorations failed (6.6 percent) during the mean follow-up period of 23.7 (SD 8.8) months. The number of tooth surfaces restored at baseline predicted subsequent restoration failure; large restorations were over 4 times more likely to fail. Material was not significantly associated with longevity; neither was tooth type. Patient age was highly associated with failure (p<0.0001). The failure rate for children was 5 percent, compared to 12 percent in persons 65 years old or older. Dentist gender and practice workload were significantly associated with restoration longevity. CONCLUSIONS: In this prospective cohort study, these factors significantly predicted an increased failure rate for amalgam and RBC restorations: older patient age and a higher number of surfaces restored at baseline, with other key baseline variables taken into account. Material choice was not significantly predictive in these early results. CLINICAL IMPLICATIONS: Understanding risk factors for early restoration failure may lead to more-effective patient care