Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA.

Background: Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas. Methods: Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3%) and urban (30.9%) areas. Multivariable logistic analyses compared trip characteristics by rurality designation. Results: Rural (37.2%) and urban (41.2%) participants used services more frequently for dialysis than for any other medical concern. Older age and personal accompaniment were more common and wheel chair use was less common for rural trips. The mean cost per trip was greater for rural users (difference of $2910 per trip), which was attributed to the greater distance per trip in rural areas. Conclusions: Among a sample who were eligible for subsidized NEMT and who utilized this service, rural trips tended to be longer and, therefore, higher in cost. Over 50% of trips were made for dialysis highlighting the need to address prevention and, potentially, health service improvements for rural dialysis patients

Comparative effectiveness of diabetes self-management education and support intervention strategies among adults with type 2 diabetes in Texas

BackgroundWith approximately 1-in-10 Texas estimated to be living with Type 2 Diabetes Mellitus (T2DM), and the steadily rising healthcare costs associated with non-managed T2DM, efforts are needed to help patients manage their diabetes and avoid costly health consequences. While many diabetes self-management interventions and solutions exist to improve health among people living with T2DM, less is known about the relative effectiveness of these interventions based on their delivery format and when used in combination. The purpose of this study was to identify the effectiveness of three intervention modalities to reduce hemoglobin A1c (A1c) among Texans with T2DM living in rural and urban settings.MethodsA three-arm randomized controlled trial (RCT) was conducted from November 2020 through March 2022. The three modalities included: (1) asynchronous virtual education and support program with one-on-one follow-up counseling [i.e., virtual Making Moves with Diabetes (vMMWD)]; (2) technology-based education and support (i.e., TBES); and (3) combined modality where participants sequentially received vMMWD and TBES (i.e., combined). Data were collected at baseline and again at 3- and 6-month follow-up. Using an intent-to-treat analysis, constrained longitudinal data analysis models were fitted to identify and compare changes in A1c over time.ResultsFindings demonstrate the positive effects of all three intervention modalities (i.e., vMMWD, TBES, and combined) to significantly reduce A1c among participants. Longitudinal analyses identified that initial reductions in A1c at 3-month follow-up were sustained at 6-month follow-up. Findings were consistent among rural- and urban-residing participants.ConclusionThis RCT highlights the universal benefits of self-paced virtual diabetes self-management interventions to reduce A1c among Texans with unmanaged T2DM. Such low-cost interventions may be widely applicable for different settings and populations

Identifying Factors Associated with Participation in T1D Support Program for Young Adults

Objective: Type 1 diabetes (T1D) has been shown to have a significant and stressful impact on an individual’s transition into young adulthood. Young adults are often experiencing new levels of independence and decision-making at this time. Insufficient research has been conducted on the use and impact of T1D support programs tailored to young adults in relation to the emotional impacts of the disease, access to programming, and desired outcomes of programs. his study assesses awareness, utilization, and emotional needs of T1D support programs tailored to young adults. Research Design and Methods: A cross-sectional analysis was performed on surveys collected through specific groups on Facebook (n=529). Logistic regression was used to assess factors associated with participation in T1D support programs. Results: Approximately 41% of participants had been involved in a program or activity for young adults. he average age was 24 (range 18-30) with females being overrepresented (85%). Individuals who attended a T1D support program for young adults were more likely to disagree that: 1) their T1D keeps them from having a normal life; 2) they feel their T1D controls their life; 3) they feel their T1D takes up too much mental/physical energy; or 4) they need more peer-to-peer support with T1D. Conclusion: The indings highlight the importance for T1D support programs for young adults and the unique needs of a population with T1D. T1D support programs should be considered in combination with clinical support to better prepare individuals as they transition into young adulthood

Geographic variations in access and utilization of cancer screening services: examining disparities among American Indian and Alaska Native Elders

Despite recommendations for cancer screening for breast and colorectal cancer among the Medicare population, preventive screenings rates are often lower among vulnerable populations such as the small but rapidly growing older American Indian and Alaska Native (AIAN) population. This study seeks to identify potential disparities in the availability of screening services, distance to care, and the utilization of cancer screening services for Medicare beneficiaries residing in areas with a higher concentration of AIAN populations. Using the county (n =3,225) as the level of analysis, we conducted a cross-sectional analysis of RTI International’s Spatial Impact Factor Data (2012) to determine the level of disparities for AIAN individuals. The outcomes of interest include: the presence of health care facilities in the county, the average distance in miles to the closest provider of mammography and colonoscopy (analyzed separately) and utilization of screening services (percent of adults aged 65 and older screened by county). Counties with higher concentrations of AIAN individuals had greater disparities in access and utilization of cancer screening services. Even after adjusting for income, education, state of residence, population 65 and older and rurality, areas with higher levels of AIAN individuals were more likely to see disparities with regard to health care services related to mammograms (p ≤ .05; longer distance, lower screening) and colonoscopies (p ≤ .05; longer distance, lower screening). These findings provide evidence of a gap in service availability, utilization and access facing areas with higher levels of AIAN individuals throughout the US. Without adequate resources in place, these areas will continue to have less access to services and poorer health which will be accelerated as the population of older adults grows. Keywords: American Indian; Alaska Native; Cancer; Rural; Disparities; Ecological analysisThe open access fee for this work was funded through the Texas A&M University Open Access to Knowledge (OAK) Fund

Chronic disease self-management education courses: utilization by low-income, middle-aged participants

BACKGROUND: Individuals living in lower-income areas face an increased prevalence of chronic disease and, oftentimes, greater barriers to optimal self-management. Disparities in disease management are seen across the lifespan, but are particularly notable among middle-aged adults. Although evidence-based Chronic Disease Self-management Education courses are available to enhance self-management among members of this at-risk population, little information is available to determine the extent to which these courses are reaching those at greatest risk. The purpose of this study is to compare the extent to which middle-aged adults from lower- and higher-income areas have engaged in CDSME courses, and to identify the sociodemographic characteristics of lower-income, middle aged participants. METHODS: The results of this study were produced through analysis of secondary data collected during the Communities Putting Prevention to Work: Chronic Disease Self-Management Program initiative. During this initiative, data was collected from 100,000 CDSME participants across 45 states within the United States, the District of Columbia, and Puerto Rico. RESULTS: Of the entire sample included in this analysis (19,365 participants), 55 people lived in the most impoverished counties. While these 55 participants represented just 0.3% of the total study sample, researchers found this group completed courses more frequently than participants from less impoverished counties once enrolled. CONCLUSION: These results signal a need to enhance participation of middle-aged adults from lower-income areas in CDSME courses. The results also provide evidence that can be used to inform future program delivery choices, including decisions regarding recruitment materials, program leaders, and program delivery sites, to better engage this population

Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA

Background: Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas. Methods: Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3%) and urban (30.9%) areas. Multivariable logistic analyses compared trip characteristics by rurality designation. Results: Rural (37.2%) and urban (41.2%) participants used services more frequently for dialysis than for any other medical concern. Older age and personal accompaniment were more common and wheel chair use was less common for rural trips. The mean cost per trip was greater for rural users (difference of $2910 per trip), which was attributed to the greater distance per trip in rural areas. Conclusions: Among a sample who were eligible for subsidized NEMT and who utilized this service, rural trips tended to be longer and, therefore, higher in cost. Over 50% of trips were made for dialysis highlighting the need to address prevention and, potentially, health service improvements for rural dialysis patients

Prevalence and Mortality of Heart Disease and Related Conditions: Disparities affecting the South, Rural Areas, and American India, and Alaska Natives

Across the U.S., major health inequities persist across several social and structural determinants of health. In this brief, we explored the intersection of these social and structural determinants across major diseases and disease-related mortality. The likelihood of stroke, angina or coronary heart disease, and heart attack (myocardial infarction) was significantly higher in the South and for American Indian or Alaska Native individuals as compared to White individuals. Rural areas of the South experienced high rates of mortality for multiple years related to congestive heart failure, ischemic heart disease, and stroke and cerebrovascular disease. Stroke and cerebrovascular disease mortality were highest in the South as compared to all other regions. Major declines were identified in mortality rates for ischemic heart disease over time (2006-2016). Both region and rurality were critical in assessing mortality with major variation in rates of mortality across each. Major inequities identified in this brief can serve as targets for policymakers in terms of providing additional resources to help reduce the burden of disease facing at-risk populations, particularly rural residents, residents of the South, and American Indians and Alaska Natives.Federal Office of Rural Health Policy (FORHP), Heath Resources and Service Administration (HRSA

Measures of organizational characteristics associated with adoption and/or implementation of innovations: A systematic review

Abstract Background This paper identifies and describes measures of constructs relevant to the adoption or implementation of innovations (i.e., new policies, programs or practices) at the organizational-level. This work is intended to advance the field of dissemination and implementation research by aiding scientists in the identification of existing measures and highlighting methodological issues that require additional attention. Methods We searched for published studies (1973–2013) in 11 bibliographic databases for quantitative, empirical studies that presented outcome data related to adoption and/or implementation of an innovation. Included studies had to assess latent constructs related to the “inner setting” of the organization, as defined by the Consolidated Framework for Implementation Research. Results Of the 76 studies included, most (86%) were cross sectional and nearly half (49%) were conducted in health care settings. Nearly half (46%) involved implementation of evidence-based or “best practice” strategies; roughly a quarter (26%) examined use of new technologies. Primary outcomes most often assessed were innovation implementation (57%) and adoption (34%); while 4% of included studies assessed both outcomes. There was wide variability in conceptual and operational definitions of organizational constructs. The two most frequently assessed constructs included “organizational climate” and “readiness for implementation.” More than half (55%) of the studies did not articulate an organizational theory or conceptual framework guiding the inquiry; about a third (34%) referenced Diffusion of Innovations theory. Overall, only 46% of articles reported psychometric properties of measures assessing latent organizational characteristics. Of these, 94% (33/35) described reliability and 71% (25/35) reported on validity. Conclusions The lack of clarity associated with construct definitions, inconsistent use of theory, absence of standardized reporting criteria for implementation research, and the fact that few measures have demonstrated reliability or validity were among the limitations highlighted in our review. Given these findings, we recommend that increased attention be devoted toward the development or refinement of measures using common psychometric standards. In addition, there is a need for measure development and testing across diverse settings, among diverse population samples, and for a variety of types of innovations

Brain-Derived Neurotrophic Factor Ameliorates Brain Stem Cardiovascular Dysregulation during Experimental Temporal Lobe Status Epilepticus

Background: Status epilepticus (SE) is an acute, prolonged epileptic crisis with a mortality rate of 20–30%; the underlying mechanism is not completely understood. We assessed the hypothesis that brain stem cardiovascular dysregulation occurs during SE because of oxidative stress in rostral ventrolateral medulla (RVLM), a key nucleus of the baroreflex loop; to be ameliorated by brain-derived neurotrophic factor (BDNF) via an antioxidant action. Methodology/Principal Findings: In a clinically relevant experimental model of temporal lobe SE (TLSE) using Sprague-Dawley rats, sustained hippocampal seizure activity was accompanied by progressive hypotension that was preceded by a reduction in baroreflex-mediated sympathetic vasomotor tone; heart rate and baroreflex-mediated cardiac responses remained unaltered. Biochemical experiments further showed concurrent augmentation of superoxide anion, phosphorylated p47 phox subunit of NADPH oxidase and mRNA or protein levels of BDNF, tropomyosin receptor kinase B (TrkB), angiotensin AT1 receptor subtype (AT1R), nitric oxide synthase II (NOS II) or peroxynitrite in RVLM. Whereas pretreatment by microinjection bilaterally into RVLM of a superoxide dismutase mimetic (tempol), a specific antagonist of NADPH oxidase (apocynin) or an AT1R antagonist (losartan) blunted significantly the augmented superoxide anion or phosphorylated p47 phox subunit in RVLM, hypotension and the reduced baroreflex-mediated sympathetic vasomotor tone during experimental TLSE, pretreatment with a recombinant human TrkB-Fc fusion protein or an antisense bdn