Demographics and Cardiovascular Risk Factors in a Bi-ethnic Church-based Intervention: Baseline Results of the Stroke Health and Risk Education (SHARE) project

Objectives: Hispanics have a higher incidence of cardiovascular disease (CVD) than non-Hispanic whites (NHWs). Despite proven benefits in other minority populations, few interventions have been conducted in partnership with Churches with substantial Hispanic membership. In this context, we describe the baseline demographics and CVD risk factors among participants of a bi-ethnic Catholic Church-based CVD prevention trial. Methods: The Stroke Health and Risk Education (SHARE) project was a cluster-randomized, multi-component, faith-based, behavioral intervention that enrolled Mexican Americans (MAs) and NHWs from Catholic Churches in Corpus Christi, Texas. Strategies to ensure MA recruitment included bilingual staff and materials and partnership with Catholic Churches and prominent parishioners for assistance in recruiting. Primary outcomes were health behaviors: sodium intake, fruit and vegetable intake, and physical activity. The proportion of participants whose intake of sodium, fruits, vegetables, and physical activity met all guideline recommendations at baseline was calculated. Results: A total of 755 baseline interviews were conducted in MAs (84%) and NHWs (16%) from 10 Churches. The median age was 52 (IQR 43-64) years and 64% of participants were female. Few participants met dietary guideline recommendations for fruit (7.7%), vegetable (16.7%) or sodium intake (33.3%) while the majority (74%) met guideline recommendations for physical activity. Only 0.4% of participants met all four recommendations for diet and physical activity. There were no ethnic differences in sodium or fruit intake or physical activity. MAs consumed fewer cups of vegetables than NHWs (1.36 vs. 1.75, p Conclusions: Partnering with bi-ethnic Catholic Churches is an opportunity to enroll MAs and participants with vascular risk factors. Both MAs and NHWs rarely met all four recommendations for diet and physical activity, substantiating the need for CVD prevention interventions in similar populations

Body-worn camera perceptions of southwest Florida citizens and police officers

The purpose of this study explored if police officers wearing body-worn cameras contributed to an increased perception of safety among community members. Further emphasis centered on community support of body-worn cameras, officers who deployed the technology, and perceived trust of citizens geared at improving relations between police and the community. The current study set out to provide an evaluation of police body-worn cameras and their perceived safety impact on citizens (n=166). Perceptions of police officers (n=200) supporting the cameras were also examined in the sampling. A One-Same Binomial Test proved ninety-one percent of citizen respondents believed the cameras would enhance safety between officers and the public while objectively documenting police-citizen encounters. Public support for police deploying body-worn cameras exists. Officers who support the wearing of body-worn cameras in the performance of an assigned work shift favored 65% while the remaining 35% of respondents did not. Lastly, 58% of officers either “agree” or “strongly agree” that body-worn cameras are capable of improving documentation between their encounters with the public. Results of the researcher’s hypothesis concluded there is no difference supporting the use of body-worn cameras between citizens and police. Proven to fit into a larger progression of research, future studies are recommended to increase the generalizibility of the study and expand same to other regions of the country while considering an increased sample population

Understanding fragmentation of prostate cancer survivorship care

BACKGROUND: Cancer survivors are particularly prone to the effects of a fragmented health care delivery system. The implications of fragmented cancer care across providers likely include greater spending and worse quality of care. For this reason, the authors measured relations between increasing fragmentation of cancer care, expenditures, and quality of care among prostate cancer survivors. METHODS: A total of 67,736 patients diagnosed with prostate cancer between 1992 and 2005 were identified using Surveillance, Epidemiology, and End Results (SEER)‐Medicare data. Using the Herfindahl‐Hirschman Index and a measure of the average number of prostate cancer providers over time, patients were sorted into 3 fragmentation groups (low, intermediate, and high). The authors then examined annual per capita survivorship expenditures and a measure of quality (ie, repetitive prostate‐specific antigen [PSA] testing within 30 days) according to their fragmentation exposure using multinomial logistic regression. RESULTS: Patients with highly fragmented cancer care tended to be younger, white, and of higher socioeconomic status (all P < .001). Prostate cancer survivorship interventions were most common among patients with the highest fragmentation of care across providers ( P < .001). After adjustment for clinical characteristics and prostate cancer survivorship interventions, higher degrees of fragmentation continued to be associated with repetitive PSA testing (13.6% for high vs 7.0% for low fragmentation; P < .001) and greater spending, particularly among patients not treated with androgen deprivation therapy. CONCLUSIONS: Fragmented prostate cancer survivorship care is expensive and associated with potentially unnecessary services. Efforts to improve care coordination via current policy initiatives, electronic medical records, and the implementation of cancer survivorship tools may help to decrease fragmentation of care and mitigate downstream consequences for prostate cancer survivors. Cancer 2011;. © 2011 American Cancer Society. Fragmented prostate cancer survivorship care is expensive and associated with potentially unnecessary services. Efforts to improve care coordination via current policy initiatives, electronic medical records, and the implementation of cancer survivorship tools may help to decrease fragmentation of care and mitigate downstream consequences for prostate cancer survivors.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91344/1/26601_ftp.pd

Continuing Clinical Research During Shelter‐in‐Place

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162767/2/ana25840_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162767/1/ana25840.pd

Reply

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106672/1/ana24034.pd

Choosing Wisely: Highest‐cost tests in outpatient neurology

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98329/1/ana23865.pd

Symptom burden and information needs in prostate cancer survivors: a case for tailored longâ term survivorship care

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134216/1/bju13329_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134216/2/bju13329.pd

Accessing Young Black Stroke Survivors for Secondary Prevention

ABSTRACT Background- Stroke rates and risk factors may be increasing in young adults aged 18-64, especially black individuals. We sought to identify whether young high risk stroke survivors could be found at community health centers. Methods- This was a cross-sectional analysis of the National Ambulatory Medical Care Survey from 2006-2011. We used chi-square analyses, t-tests, and proportions to compare and describe stroke survivor visits at community health centers and private offices. Results- Young stroke survivor visits comprise 48% of stroke survivor visits at community health centers compared to 31% of stroke survivor visits at the private office setting. Among young stroke survivors cared for at community health centers, 47% were black individuals compared to 14% at a private office setting. The prevalence of hypertension and cigarette smoking was higher in young stroke survivors at the community health center. Conclusions- The community health center is a setting to access young black stroke survivors. Stroke prevention and preparedness interventions should be considered at community health centers

Missed Opportunities in Preventing Hospital Readmissions: Redesigning Post‐Discharge Checkup Policies

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147049/1/poms12858.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147049/2/poms12858_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147049/3/poms12858-sup-0001-AppendixS1.pd

The accuracy of surrogate decision makers: informed consent in hypothetical acute stroke scenarios

Abstract Background Over one third of stroke patients have cognitive or language deficits such that they require surrogate consent for acute stroke treatment or enrollment into acute stroke trials. Little is known about the agreement of stroke patients and surrogates in this time-sensitive decision-making process. We sought to determine patient and surrogate agreement in 4 hypothetical acute stroke scenarios. Methods We performed face to face interviews with ED patients at an academic teaching hospital from June to August 2011. Patients and the surrogates they designated were asked to make decisions regarding 4 hypothetical stroke scenarios: 2 were treatment decisions; 2 involved enrollment into a clinical trial. Percent agreement was calculated as measures of surrogate predictive ability. Results A total of 200 patient/surrogate pairs were interviewed. Overall patient/surrogate percent agreement was 76.5%. Agreement for clinical scenarios ranged from 87% to 96% but dropped to 49%-74% for research scenarios. Conclusions Surrogates accurately predict patient preferences for standard acute stroke treatments. However, the accuracy decreases when predicting research participation suggesting that the degree of surrogate agreement is dependent on the type of decision being made. Further research is needed to more thoroughly characterize surrogate decision-making in acute stroke situations.http://deepblue.lib.umich.edu/bitstream/2027.42/112377/1/12873_2013_Article_190.pd