Physical Activity and Acculturation among U.S. Latinas of Childbearing Age

The majority of Latinas of childbearing age is not sufficiently active; a significant health disparity, and is at-risk for deleterious health consequences. The study’s objectives were to explore how acculturation and factors associated with acculturation affect engagement in Physical Activity (PA) among Latinas. Based on data (2008-2011 NHIS; n=7,278), multinomial logistic models were employed to predict odds of adherence to 2008 CDCPA Guidelines. Among 3,386,680 U.S. Latinas, 18 to 47 years, 58.9% (SE=0.0073) met neither aerobic nor muscle strengthening recommendations, after controlling for poverty, income, marital status and competing obligations. Less acculturated Latinas, (Spanish-preferring), were less likely to engage in PA than English-preferring counterparts (OR=0.57, p\u3c0.01). Spanish-preferring foreign-born Latinas have substantially smaller odds of meeting PA guidelines than U.S.-born English-preferring Latinas (OR=0.3, p\u3c0.001). Puerto Ricans and Dominican immigrants are least likely to meet guidelines. Latinas are not homogeneous. Country of origin and acculturation should be considered in future PA interventions

"Concordance between comorbidity data from patient self-report interviews and medical record documentation"

<p>Abstract</p> <p>Background</p> <p>Comorbidity is an important adjustment measure in research focusing on outcomes such as health status and mortality. One recurrent methodological issue concerns the concordance of comorbidity data obtained from different reporting sources. The purpose of these prospectively planned analyses was to examine the concordance of comorbidity data obtained from patient self-report survey interviews and hospital medical record documentation.</p> <p>Methods</p> <p>Comorbidity data were obtained using survey interviews and medical record entries from 525 hospitalized Acute Coronary Syndrome patients. Frequencies and descriptive statistics of individual and composite comorbidity data from both sources were completed. Individual item agreement was evaluated with simple and weighted kappas, Spearman Rho coefficients for composite scores.</p> <p>Results</p> <p>On average, patients reported more comorbidities during their patient survey interviews (mean = 1.78, SD = 1.99) than providers had documented in medical records (mean = 1.27, SD = 1.43). Higher proportions of positive responses were obtained from self-reports compared to medical records for all conditions except congestive heart failure and renal disease. Older age and higher depressive symptom levels were significantly associated with poorer levels of data concordance.</p> <p>Conclusion</p> <p>These results demonstrate that survey comorbidity data from ACS patients may not be entirely concordat with medical record documentation. In the absence of a gold standard, it is possible that hospital records did not include all pre-admission comorbidities and these patient survey interview methods may need to be refined. Self-report methods to facilitate some patients' complete recall of comorbid conditions may need to be refined by health services researchers.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov NCT00416026.</p

Accuracy and usefulness of BMI measures based on self-reported weight and height: findings from the NHANES & NHIS 2001-2006

<p>Abstract</p> <p>Background</p> <p>The Body Mass Index (BMI) based on self-reported height and weight ("self-reported BMI") in epidemiologic studies is subject to measurement error. However, because of the ease and efficiency in gathering height and weight information through interviews, it remains important to assess the extent of error present in self-reported BMI measures and to explore possible adjustment factors as well as valid uses of such self-reported measures.</p> <p>Methods</p> <p>Using the combined 2001-2006 data from the continuous National Health and Nutrition Examination Survey, discrepancies between BMI measures based on self-reported and physical height and weight measures are estimated and socio-demographic predictors of such discrepancies are identified. Employing adjustments derived from the socio-demographic predictors, the self-reported measures of height and weight in the 2001-2006 National Health Interview Survey are used for population estimates of overweight & obesity as well as the prediction of health risks associated with large BMI values. The analysis relies on two-way frequency tables as well as linear and logistic regression models. All point and variance estimates take into account the complex survey design of the studies involved.</p> <p>Results</p> <p>Self-reported BMI values tend to overestimate measured BMI values at the low end of the BMI scale (< 22) and underestimate BMI values at the high end, particularly at values > 28. The discrepancies also vary systematically with age (younger and older respondents underestimate their BMI more than respondents aged 42-55), gender and the ethnic/racial background of the respondents. BMI scores, adjusted for socio-demographic characteristics of the respondents, tend to narrow, but do not eliminate misclassification of obese people as merely overweight, but health risk estimates associated with variations in BMI values are virtually the same, whether based on self-report or measured BMI values.</p> <p>Conclusion</p> <p>BMI values based on self-reported height and weight, if corrected for biases associated with socio-demographic characteristics of the survey respondents, can be used to estimate health risks associated with variations in BMI, particularly when using parametric prediction models.</p

Changes in practice patterns affecting in-hospital and post-discharge survival among ACS patients

BACKGROUND: Adherence to clinical practice guidelines for the treatment of specific illnesses may result in unexpected outcomes, given that multiple therapies must often be given to patients with diverse medical conditions. Yet, few studies have presented empirical evidence that quality improvement (QI) programs both change practice by improving adherence to guidelines and improve patient outcomes under the conditions of actual practice. Thus, we focus on patient survival, following hospitalization for acute coronary syndrome in three successive patient cohorts from the same community hospitals, with a quality improvement intervention occurring between cohorts two and three. METHODS: This study is a comparison of three historical cohorts of Acute Coronary Syndrome (ACS) patients in the same five community hospitals in 1994–5, 1997, 2002–3. A quality improvement project, the Guidelines Applied to Practice (GAP), was implemented in these hospitals in 2001. Study participants were recruited from community hospitals located in two Michigan communities during three separate time periods. The cohorts comprise (1) patients enrolled between December 1993 and April 1995 (N = 814), (2) patients enrolled between February 1997 and September 1997 (N = 452), and (3) patients enrolled between January 14, 2002 and April 13, 2003 (N = 710). Mortality data were obtained from Michigan's Bureau of Vital Statistics for all three patient cohorts. Predictor variables, obtained from medical record reviews, included demographic information, indicators of disease severity (ejection fraction), co-morbid conditions, hospital treatment information concerning most invasive procedures and the use of ace-inhibitors, beta-blockers and aspirin in the hospital and as discharge recommendations. RESULTS: Adjusted in-hospital mortality showed a marked improvement with a HR = 0.16 (p < 0.001) comparing 2003 patients in the same hospitals to those 10 years earlier. Large gains in the in-hospital mortality were maintained based on 1-year mortality rates after hospital discharge. CONCLUSION: Changes in practice patterns that follow recommended guidelines can significantly improve care for ACS patients. In-hospital mortality gains were maintained in the year following discharge

Relationship of Adult and Child Dietary Intakes in Michigan and Implications for Programming Region-Wide

Healthful dietary intakes are crucial for stemming the current childhood obesity epidemic. We examined the dietary intakes of 392 Michigan children aged 1–12 years. About 70% and 58% of children ate fruits and vegetables, respectively, each day; 26% drank sugar-sweetened beverages; and 31% ate with a television on. Children\u27s vegetable intakes were significantly and moderately correlated with their parents\u27 vegetable intakes (r = .34–.38), but their fruit intakes were more related to their grandparents\u27 fruit intakes (r = .31). Due to the relative representativeness of our sample and similarities in eating patterns across the region, Extension professionals may consider our study findings when designing tailored nutrition education programs for families in the midwestern United States

Changes in practice patterns affecting in-hospital and post-discharge survival among ACS patients

Abstract Background Adherence to clinical practice guidelines for the treatment of specific illnesses may result in unexpected outcomes, given that multiple therapies must often be given to patients with diverse medical conditions. Yet, few studies have presented empirical evidence that quality improvement (QI) programs both change practice by improving adherence to guidelines and improve patient outcomes under the conditions of actual practice. Thus, we focus on patient survival, following hospitalization for acute coronary syndrome in three successive patient cohorts from the same community hospitals, with a quality improvement intervention occurring between cohorts two and three. Methods This study is a comparison of three historical cohorts of Acute Coronary Syndrome (ACS) patients in the same five community hospitals in 1994–5, 1997, 2002–3. A quality improvement project, the Guidelines Applied to Practice (GAP), was implemented in these hospitals in 2001. Study participants were recruited from community hospitals located in two Michigan communities during three separate time periods. The cohorts comprise (1) patients enrolled between December 1993 and April 1995 (N = 814), (2) patients enrolled between February 1997 and September 1997 (N = 452), and (3) patients enrolled between January 14, 2002 and April 13, 2003 (N = 710). Mortality data were obtained from Michigan's Bureau of Vital Statistics for all three patient cohorts. Predictor variables, obtained from medical record reviews, included demographic information, indicators of disease severity (ejection fraction), co-morbid conditions, hospital treatment information concerning most invasive procedures and the use of ace-inhibitors, beta-blockers and aspirin in the hospital and as discharge recommendations. Results Adjusted in-hospital mortality showed a marked improvement with a HR = 0.16 (p Conclusion Changes in practice patterns that follow recommended guidelines can significantly improve care for ACS patients. In-hospital mortality gains were maintained in the year following discharge.</p