Racial/Ethnic and social class differences in preventive care practices among persons with diabetes

BACKGROUND: Diabetes is the sixth leading cause of death in the United States. Persons with diabetes are at increased risk for serious complications including CVD, stroke, retinopathy, amputation, and nephropathy. Minorities have the highest incidence and prevalence of diabetes and related complications compared to other racial groups. Preventive care practices such as smoking cessation, eye examinations, feet examinations, and yearly checkups can prevent or delay the incidence and progression of diabetes related complications. The purpose of this study was to examine racial/ethnic differences in diabetes preventive care practices by several socio-demographic characteristics including social class. METHODS: Data from the Behavioral Risk Factor Surveillance Survey for 1998–2001 were used for analyses. The study population consisted of persons who indicated having diabetes on the BRFSS, 35 yrs and older, and Non-Hispanic Black, non-Hispanic White, or Hispanic persons. Logistic regression was used in analyses. RESULTS: Contrary to our hypotheses, Blacks and Hispanics engaged in preventive care more frequently than Whites. Whites were less likely to have seen a doctor in the previous year, less likely to have had a foot exam, more likely to smoke, and less likely to have attempted smoking cessation. Persons of lower social class were at greatest risk for not receiving preventive care regardless of race/ethnicity. Persons with no health care coverage were twice as likely to have not visited the doctor in the previous year and twice as likely to have not had an eye exam, 1.5 times more likely to have not had a foot exam or attempted smoking cessation. CONCLUSION: This study showed that persons of lower social class and persons with no health insurance are at greatest risk for not receiving preventive services

Jury Instructions: A Bibliography. Part II: Criminal Jury Instructions

Pattern jury instructions are used by trial judges to explain the law to jurors in language that they can understand and that provide consistency from one trial to another. This criminal jury instructions bibliography of 169 entries is a companion to a previous bibliography on civil jury instructions. An index to acronyms for both criminal and civil jury instructions is also included

Fluidized Bed Steam Reforming Mineralization for High Organic and Nitrate Waste Streams for the Global Nuclear Energy Partnership

Waste streams that may be generated by the Global Nuclear Energy Partnership (GNEP) Advanced Energy Initiative may contain significant quantities of organics (0-53 wt%) and/or nitrates (0-56 wt%). Decomposition of high nitrate streams requires reducing conditions, e.g. organic additives such as sugar or coal, to reduce the NO{sub x} in the off-gas to N{sub 2} to meet the Clean Air Act (CAA) standards during processing. Thus, organics will be present during waste form stabilization regardless of which GNEP processes are chosen, e.g. organics in the feed or organics for nitrate destruction. High organic containing wastes cannot be stabilized with the existing HLW Best Developed Available Technology (BDAT) which is HLW vitrification (HLVIT) unless the organics are removed by preprocessing. Alternative waste stabilization processes such as Fluidized Bed Steam Reforming (FBSR) operate at moderate temperatures (650-750 C) compared to vitrification (1150-1300 C). FBSR converts organics to CAA compliant gases, creates no secondary liquid waste streams, and creates a stable mineral waste form that is as durable as glass. For application to the high Cs-137 and Sr-90 containing GNEP waste streams a single phase mineralized Cs-mica phase was made by co-reacting illite clay and GNEP simulated waste. The Cs-mica accommodates up to 30% wt% Cs{sub 2}O and all the GNEP waste species, Ba, Sr, Rb including the Cs-137 transmutation to Ba-137. For reference, the cesium mineral pollucite (CsAlSi{sub 2}O{sub 6}), currently being studied for GNEP applications, can only be fabricated at {ge} 1000 C. Pollucite mineralization creates secondary aqueous waste streams and NO{sub x}. Pollucite is not tolerant of high concentrations of Ba, Sr or Rb and forces the divalent species into different mineral host phases. The pollucite can accommodate up to 33% wt% Cs{sub 2}O

The Association between Optimism and Serum Antioxidants in the Midlife in the United States Study

Objective Psychological and physical health are often conceptualized as the absence of disease, but less research addresses positive psychological and physical functioning. For example, optimism has been linked with reduced disease risk and biological dysfunction, but very little research has examined associations with markers of healthy biological functioning. Thus, we investigated the association between two indicators of positive health: optimism and serum antioxidants. Methods The cross-sectional association between optimism and antioxidant concentrations was examined in 982 men and women from the Midlife in the United States study. Primary measures included self-reported optimism (assessed with the revised Life Orientation Test) and serum concentrations of nine different antioxidants (carotenoids and Vitamin E). Regression analyses examined the relationship between optimism and antioxidant concentrations in models adjusted for demographics, health status, and health behaviors. Results For every standard deviation increase in optimism, carotenoid concentrations increased by 3–13% in age-adjusted models. Controlling for demographic characteristics and health status attenuated this association. Fruit and vegetable consumption and smoking status were identified as potential pathways underlying the association between optimism and serum carotenoids. Optimism was not significantly associated with Vitamin E. Conclusions Optimism was associated with greater carotenoid concentrations and this association was partially explained by diet and smoking status. The direction of effects cannot be conclusively determined. Effects may be bidirectional given that optimists are likely to engage in health behaviors associated with more serum antioxidants, and more serum antioxidants are likely associated with better physical health that enhances optimism

Subjective Well-Being and Cardiometabolic Health: An 8-11 Year Study of Midlife Adults

Objective: Individuals who are satisfied and experience frequent positive emotions tend to have reduced risk for coronary heart disease (CHD). However, conflicting evidence exists and little research has investigated whether well-being is associated with early-warning indicators of biological risk that precede CHD. We investigated whether life satisfaction and positive emotions longitudinally predicted reduced risk of incident cardiometabolic conditions and healthier cardiometabolic risk scores, which may provide insight into underlying mechanisms and novel prevention targets. Methods: Initially healthy men and women (N=754–854) reported their baseline life satisfaction and positive emotions. During follow-up, presence of manifest cardiometabolic conditions was assessed and a separate cardiometabolic risk score was constructed from eight biomarkers. Poisson and linear regression analyses tested whether life satisfaction and positive emotionswere associated with reduced incident disease risk and lower cardiometabolic risk scores 8–11 years later. Results: Life satisfaction and positive emotions were each prospectively associated with reduced risk of manifest conditions, controlling for demographics and family history of CHD. Associations were attenuated for positive emotions after adjusting for depressive symptoms and for life satisfaction after adjusting for health behaviors. Life satisfactionwas associated with lower cardiometabolic risk scores until adding health behaviors, but positive emotions were not (regardless of the included covariates). Conclusion: Well-being, particularly life satisfaction, is associated with reduced risk for incident cardiometabolic conditions in minimally-adjusted models. However, accounting for underlying behavioral pathways attenuates the association. Low levels of life satisfaction (but not positive emotions) may also provide early warning of cardiometabolic risk prior to disease development

Report of the panel on the land surface: Process of change, section 5

The panel defined three main areas of study that are central to the Solid Earth Science (SES) program: climate interactions with the Earth's surface, tectonism as it affects the Earth's surface and climate, and human activities that modify the Earth's surface. Four foci of research are envisioned: process studies with an emphasis on modern processes in transitional areas; integrated studies with an emphasis on long term continental climate change; climate-tectonic interactions; and studies of human activities that modify the Earth's surface, with an emphasis on soil degradation. The panel concluded that there is a clear requirement for global coverage by high resolution stereoscopic images and a pressing need for global topographic data in support of studies of the land surface

Maternity waiting homes and traditional midwives in rural Liberia

ObjectiveMaternity waiting homes (MWHs) can reduce maternal morbidity and mortality by increasing access to skilled birth attendants (SBAs). The present analysis was conducted to determine whether MWHs increase the use of SBAs at rural primary health clinics in Liberia; to determine whether traditional midwives (TMs) are able to work with SBAs as a team and to describe the perceptions of TMs as they engage with SBAs; and to determine whether MWHs decrease maternal and child morbidity and mortality.MethodsThe present analysis was conducted halfway through a large cohort study in which 5 Liberian communities received the intervention (establishment of an MWH) and 5 Liberian communities did not (control group). Focus groups were conducted to examine the views of TMs on their integration into health teams.ResultsCommunities with MWHs experienced a significant increase in team births from baseline to post‐intervention (10.8% versus 95.2%, P < 0.001), with greater TM engagement. Lower rates of maternal and perinatal death were reported from communities with MWHs.ConclusionThe reduction in morbidity and mortality indicates that the establishment of MWHs is an effective strategy to increase the use of SBAs, improve the collaboration between SBAs and TMs, and improve maternal and neonatal health.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135181/1/ijgo114.pd

Innovation and expansion in the breadth of programs and services

Given that students will be unequally prepared for college, we can assume that there will always be a need for developmental education in some form. Even the debates about mainstreaming developmental education still recognize the need for some kind of integrated, expanded support services such as study skills courses and learning centers to support all students. Whatever the focus—integrated services or separate programs— the fact is that work needs to continue to provide innovative and expanded versions of developmental education in the future. The breadth of programs in developmental education is far-ranging, from inclusive English as a Second Language (ESL) programs to federally funded academic support and bridge programs like TRIO’s Upward Bound and Talent Search programs. It is important to examine the ways that these programs presently serve students, as well as continuing to identify the best locations and configurations for these programs. A deeper consideration of the relationship of these programs to each other, and how they fit under the umbrella of developmental education, is a key issue in the future