Knowledge, Attitudes, Behaviors, and Beliefs about Chronic Kidney Disease in Indiana’s Minority Communities: A Community-Based Survey

The purpose of this report is to detail the findings of the study ‘Knowledge, Attitudes, Behaviors, And Beliefs about Chronic Kidney Disease in Indiana Minority Communities,’ undertaken as a collaboration between Indiana Minority Health Coalition, Inc. (IMHC) and the Butler University College of Pharmacy and Health Sciences (BUCOPHS). The purpose of the study was to understand knowledge of and beliefs about Chronic Kidney Disease (CKD) among racial/ethnic minorities in Indiana, to learn how these populations would like to receive information about CKD, to understand the factors associated with higher levels of CKD awareness, to estimate the proportion of people with risk factors who have been screened for CKD, and to determine the characteristics associated with people who have been screened. CKD, the ninth leading cause of death in the United States, is a major public health issue in Indiana. Just over 1 in 5 deaths in Indiana are due to kidney disease, a figure higher than the 14% national average. CKD is especially problematic for racial/ethnic minorities, who are more likely to get the disease, and at earlier ages. They also progress more quickly to End Stage Renal Disease (ESRD), the final stage of CKD, treatable only by lifelong dialysis or kidney transplant. Treatment comes with high costs in terms of public and private money as well as patients’ suffering. Nearly one quarter of the US Medicare budget ($24 billion) is spent caring for people with ESRD. Early detection and treatment of CKD are essential to stopping disease progression, which is irreversible. Most people with CKD are undiagnosed and undertreated, leading to complications and progression of the disease. Diabetes, hypertension, and family history of kidney disease are the most significant CKD risk factors, and it is recommended that adults with any of these should be screened. Very little is known about knowledge, attitudes, behaviors and beliefs regarding CKD in Indiana’s racial/ethnic minority communities. Because of this, a collaborative, community-based survey project was undertaken by IMHC and the BUCOPHS. Information on socio-demographics (including self-identified race/ethnicity); health status; healthcare access and utilization; CKD screening, knowledge and attitudes toward health,CKD and screening; and preferences for receiving health information were included. The survey was translated in several languages (Spanish, Burmese, Hakka Chin, and Falam Chin) and the translations were verified by native-speaking community members. IMHC engaged 15 community partners in 22 Indiana counties to administer the surveys. Community partners were oriented to the project and trained in survey administration, and surveys were conducted between November 2012 and February 2013. Surveys from 1,465 eligible respondents were received and scanned into a data base. Survey results were analyzed collaboratively by BUCOPHS and IMHC. Respondents represented four major racial/ethnic groups: African Americans (59%), Hispanic/Latinos (22%), American Indians/Alaskan Natives (11%), and Asian/Pacific Islanders (8%). Forty-four percent were male, and ages ranged from 18 to 92 years (average= 40 years), 20% were born outside of the United States, and 85% spoke English as their primary language. Most (84%) were in good, very good, or excellent health, and the most commonly reported health conditions were high blood pressure (36%), diabetes or arthritis (both 16%), and asthma or obesity (both 14%). Most (70%) had health insurance and a regular healthcare provider (61%), but 25% reported that they were not able to see a provider in the prior year because of cost. Being older, having higher self-rated health, being employed, higher educational attainment, having health insurance, being Hispanic/Latino, and reporting high blood pressure, diabetes, or kidney disease were all associated with more knowledge and awareness of CKD, while being Burmese and not being able to see a provider because of cost were related to less knowledge and awareness. Just over one quarter (29%) of those reporting at least one risk factor had been screened. Increased knowledge and attitude toward kidney disease, having high blood pressure or kidney disease, and having a regular healthcare provider were associated with having been screened among those with risk factors. Respondents preferred to get information in the form of brochures (66%), the internet (57%) or on television (37%); from a doctor (87%), nurse (40%), or family member (37%); at a doctor’s office or clinic (76%), or hospital or health fair (both 58%). This study’s most critical finding is that only a small minority (28.7%) of those requiring screening actually report that they had been screened for kidney disease. The findings, however, indicate many opportunities to improve knowledge and behaviors among the state’s extremely vulnerable racial/ethnic populations; indeed, they demonstrate that increasing knowledge is an important factor in encouraging at-risk people to undergo screening. It is apparent that all minority populations need, and wish to receive, information on CKD, and that access to screening should be increased. Adoption of provisions of the Affordable Care Act in the next few years, with its emphasis on prevention and establishment of medical homes, may help in promoting screening. It is apparent that communities need to provide education on the causes and consequences of kidney disease, as well as the importance of prevention and screening for those at risk for CKD. Communities should encourage people to establish and maintain medical homes, relationships with primary care providers who can manage their health conditions and help patients navigate through the healthcare system. Communities need to engage healthcare providers in CKD education. Community-appropriate educational materials, especially brochures and possibly DVDs, need to be developed. It is critical that information be easily understood by those with low education, as they are particularly vulnerable to CKD risk. Education about kidney function and disease is required for adults of all ages. Although respondents may not be representative of all racial/ethnic minority residents of Indiana and information was obtained directly from respondents rather than medical records (and thus subject to memory lapses and misunderstanding), this study lays the foundations to improve kidney health in Indiana’s health-vulnerable racial/ethnic minority communities

Effectiveness of Inactivated Influenza Vaccine Among Nursing Home Residents During an Influenza Type A (H3N2) Epidemic

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111257/1/j.1532-5415.1999.tb04574.x.pd

Concepts of Health in Older Urban African American Women with Chronic Health Conditions: A Focus Group Study

The purpose of this report is to relate the findings of the study ‘Concepts of Health in Older Urban African American Women with Chronic Health Conditions.’ This investigation, undertaken at the request of the Indiana Minority Health Coalition, Inc. (IMHC) is collaboration between IMHC, Butler University College of Pharmacy and Health Sciences, and the community partner, the Black Nurses Association of Indianapolis, Inc. (BNA). The purpose of the study is to gain an understanding of the ways older African American women from medically underserved areas of Indianapolis characterize the various parts of the concept of health; how they understand and interpret the determinants of health status; and to understand how they assess health. Researchers decided to hold focus groups of African American women from Indianapolis ages 50 years and older who had at least one diagnosis of a chronic illness. The Principal Investigator created a moderator’s guide for the focus group. All research partners met to review and redesign the guide to make sure that it was appropriate and would be effective in stimulating discussion to address the three specific aims. The groups, one of currently employed women, two of residents of senior/disabled housing, one group of members of a community church, and one mixed-recruitment group, were held in community settings. Participants received $25.00 gift cards for their involvement. Major findings are that women view ‘health’ as a concept that includes many elements: physical health, mental/emotional health, ability to function through day-to-day activities, and spiritual health. These components work together to produce a state of wholeness or well-being. ‘Health’ is determined through interplay between influences that operate on many levels: the personal, the interpersonal, and the immediate and social/political environment. Specific determinates include health behaviors, state of mind, stress, relationship with God, and the aging process. Women speak at length about their relationship with institutions of healthcare. They express problems in communicating with their healthcare providers, feeling that they are not treated as unique individuals, and they often express distrust of providers. Participants assess their own health through paying attention to their own physical symptoms, their state of mind, and their energy level. Medications are named as determinants of health and markers of health status. Women assess health of their families and friends through observation, intuition, and communication. These women act as facilitators of health status and behaviors for their family members and others in the community. Women are well aware of the importance of positive health behaviors, especially diet and exercise, and they feel strong senses of control over their health. As these women envision ‘health’ as involving many concepts and levels, interventions need to address issues beyond the physical, involving women actively through relationships within communities. Public health professionals need to work with these women in a respectful and collaborative manner. Issues that need further exploration are interplay between mental and physical health through the aging process, patient-provider communication, and women’s understanding of medications in maintaining and improving health

The relative efficacy of trivalent live attenuated and inactivated influenza vaccines in children and adults

In the United States, two types of vaccines are recommended for the prevention of influenza: an intranasal live attenuated influenza vaccine (LAIV) for eligible individuals aged 2–49 years and unadjuvanted injectable trivalent inactivated vaccines (TIV) for eligible individuals aged ≥6 months. Several recent studies have compared the efficacy of the 2 vaccines in children and adults. In children 6 months to 18 years of age, each of the four comparative studies of LAIV and TIV demonstrated that LAIV was more protective. In individuals 17–49 years of age, most comparative studies have demonstrated that LAIV and TIV were similarly efficacious or that TIV was more efficacious. However, LAIV was shown to be more protective than TIV in new military recruits of all ages, and placebo-controlled studies in adults in 1997–1998 suggested that LAIV was more protective against the mismatched A/H3N2 strain. The relative efficacy of LAIV and TIV among young adults may vary depending on the specific population and the antigenic match between the vaccines and circulating strains. In adults 60 years of age and older, limited data suggest that the two vaccines are similarly effective. In children and adults, studies also suggest that the relative efficacy of LAIV versus TIV may increase when measured against more severe illness. Additional research comparing LAIV and TIV is needed in adults and would also be valuable in older children and adolescents. Studies should examine the role of pre-existing immunity as well as vaccine impact on influenza illness of varying severity

Influenza transmission in a cohort of households with children: 2010-2011

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Current status of live attenuated influenza vaccine in the United States for seasonal and pandemic influenza

A live attenuated influenza vaccine (LAIV) is currently approved in the United States for the prevention of influenza in individuals 2–49 years of age. This article summarizes the available data describing the safety and efficacy of LAIV for the prevention of influenza in both children and adults. LAIV is administered as an intranasal spray and has been shown to provide high levels of efficacy against influenza illness caused by both matched and mismatched strains in children and adults. In studies comparing LAIV and inactivated influenza vaccine in children, LAIV recipients experienced 35–53% fewer cases of culture-confirmed influenza illness caused by antigenically matched strains. Protection through a second influenza season against antigenically matched strains has also been seen in children. In adults, definitive comparative studies of LAIV and inactivated vaccine have not been conducted and no statistically significant differences in efficacy have been demonstrated. The most common adverse reactions with LAIV include runny nose/nasal congestion in all age groups, fever >100°F in children, and sore throat in adults. Formulations of LAIV against pandemic influenza strains, including H5N1, H9N2, and H7N3, are currently being tested in preclinical and phase I clinical studies

Adaptation of the Psychological Behavioral Acculturation Scale to a Community of Urban-based Mexican Americans in the United States

Objective: To report the psychometric properties of the Psychological-Behavioral Acculturation Scale (P-BAS), a tool gauging behavioral and psychological acculturation after adapting it through formative research to people of Mexican origin in the United States. Methods: We analyzed data from adapted P-BAS questionnaires in the TalaSurvey study, using standard methods to establish internal consistencies (Cronbach’s alpha), construct validity, and ascertain if the value orientation profile differed by ethnic group. Results: In 2012-13, 505 respondents (mean age 45.2 ±14.1, 56% female) participated: 250 European Americans (EA) and 255 people of Mexican origin (MA). Conclusions: Although internal consistencies of 15 value orientation measures were occasionally low, overall results were encouraging. A weighted combination of value orientation scores strongly discriminated between EA and MA. Additionally, the pattern of relationships among MAs identified between acculturation scores and the validity contrasts supported the construct validity of the proposed dual framework. The trend was particularly evident for most behavioral variables

Effect of prolonged HAART on oral colonization with Candida and candidiasis

BACKGROUND: Progressive cell-mediated immunodeficiency with decrease of CD4+ lymphocyte count to less than or equal to 200 cells/mm(3 )is a major risk factor for colonization with Candida species and development of candidiasis. Oropharyngeal candidiasis may occur in up to 90% of human immunodeficiency virus (HIV)-infected patients during the course of the disease. This study is to determine the effect of prolonged highly active antiretroviral therapy (HAART) on oropharyngeal colonization with Candida species and oral candidiasis. METHODS: A prospective, longitudinal follow-up study in HIV-infected patients receiving HAART. RESULTS: The mean CD4+ count increased from 232.5 to 316 cells/mm(3 )and the proportion of patients whose CD4+ count less than 200 cells/mm(3 )decreased from 50.0% to 28.9% (p = 0.0003) in patients receiving HAART for at least 2 years. The prevalence of oral candidiasis decreased from 10.6% to 2.1% (p = 0.004). The decrease in Candida colonization was less impressive, falling from 57.8% to 46.5 % (p = 0.06). Of the 142 patients enrolled in at least two surveys, 48 (33.8%) remained colonized with Candida and 42 (29.6%) remained negative. In the remaining 52 patients, 34 switched from culture positive to negative, and an increase in CD4+ lymphocytes was noted in 91.2% of them. Among the 18 patients who switched from culture negative to positive, 61.1% also demonstrated an increase in CD4+ lymphocyte count (p = 0.01). CONCLUSION: These findings indicate that HAART is highly effective in decreasing oral candidiasis in association with a rise in CD4+ lymphocyte counts, but only marginally effective in eliminating Candida from the oropharynx