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de Groot M, Shubrook J, Schwartz F, Hornsby WG, Pillay Y, Saha C. Program ACTIVE II: Design and Methods for a Multi-Center Community-Based Depression Treatment for Rural and Urban Adults with Type 2 Diabetes. ACTA ACUST UNITED AC 2015; 1. [PMID: 27500279 PMCID: PMC4974010 DOI: 10.16966/2380-5544.108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective Depression affects one in four adults with type 2 diabetes (T2DM) and is associated with worsened diabetes complications, increased health care costs and early mortality. Rural and low-income urban areas, including the Appalachian region, represent an epicenter of the T2DM epidemic. Program ACTIVE II is a comparative effectiveness treatment trial designed to test whether a combination of cognitive behavioral therapy (CBT) and community-based exercise (EXER) will offer greater improvements in diabetes and depression outcomes compared to individual treatment approaches and usual care (UC). The secondary aims are to assess changes in cardiovascular risk factors across groups and to conduct a cost-effectiveness analysis of predicted incidence of cardiovascular complications across groups. Methods The study is a 2-by-2 factorial randomized controlled trial consisting of 4 treatment groups: CBT alone, EXER alone, combination of CBT and EXER, and UC. Adults with T2DM for > 1 year and who meet DSM-IVTR criteria for Major Depressive Disorder (MDD) are eligible to participate at two rural Appalachian sites (southeastern Ohio and West Virginia) and one urban site (Indianapolis). This type II behavioral translation study uses a community-engaged research (CEnR) approach by incorporating community fitness centers and mental health practices as interventionists. Conclusions This is the first study to evaluate the comparative effectiveness of combined CBT and exercise in the treatment of depression using community-based intervention delivery. This approach may serve as a national model for expanding depression treatment for patients with T2DM.
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Affiliation(s)
| | | | - Frank Schwartz
- Ohio University Heritage College of Osteopathic Medicine, USA
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152
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Accessible Transportation, Geographic Elevation, and Masticatory Ability Among Elderly Residents of a Rural Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:7199-207. [PMID: 26132474 PMCID: PMC4515650 DOI: 10.3390/ijerph120707199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/08/2015] [Accepted: 06/18/2015] [Indexed: 11/17/2022]
Abstract
Given that public transportation networks are often worse in rural areas than in urban areas, rural residents who do not drive can find it difficult to access health-promoting goods, services, and resources related to masticatory ability. Moreover, geographical location, assessed by elevation, could modify this association. The aim of this study was to test whether the association between access to transportation and masticatory ability varied by elevation. Data were collected from a cross-sectional study conducted in Mizuho and Iwami counties, Japan. Objective masticatory ability was evaluated using a test gummy jelly and elevation was estimated by the geographic information systems according to the participant’s address. After excluding subjects with missing data, 672 subjects (Mizuho = 401 and Iwami = 271) were analyzed. After adjustment for potential confounders, being a driver was not significantly associated with masticatory ability among elderly people living at low elevation (≤313 m) in Mizuho county. However, after the same adjustment, being a driver remained significantly associated with increased masticatory ability among elderly at high elevations. Similar findings were observed in Iwami county. Accessible transportation was significantly associated with increased mastication ability in elderly people living at high elevations, but not in those living at low elevations.
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153
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Ferrah N, Obieta A, Ibrahim JE, Odell M, Yates M, Loff B. Inequity in health: older rural driving and dementia. Inj Prev 2015; 22:292-6. [PMID: 26091882 DOI: 10.1136/injuryprev-2015-041601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/26/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Noha Ferrah
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Victoria, Australia
| | - Alfredo Obieta
- Sub-acute Services, Ballarat Health Services, Ballarat, Australia
| | - Joseph Elias Ibrahim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia Sub-Acute Services, Ballarat Health Services, Ballarat, Australia
| | - Morris Odell
- Clinical Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Mark Yates
- Sub-acute Services, Ballarat Health Services and Deakin Clinical School at Ballarat Health Services, Australia
| | - Bebe Loff
- Michael Kirby Centre For Public Health and Human Rights, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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154
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Douthit N, Kiv S, Dwolatzky T, Biswas S. Exposing some important barriers to health care access in the rural USA. Public Health 2015; 129:611-20. [PMID: 26025176 DOI: 10.1016/j.puhe.2015.04.001] [Citation(s) in RCA: 552] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 03/11/2015] [Accepted: 04/09/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To review research published before and after the passage of the Patient Protection and Affordable Care Act (2010) examining barriers in seeking or accessing health care in rural populations in the USA. STUDY DESIGN This literature review was based on a comprehensive search for all literature researching rural health care provision and access in the USA. METHODS Pubmed, Proquest Allied Nursing and Health Literature, National Rural Health Association (NRHA) Resource Center and Google Scholar databases were searched using the Medical Subject Headings (MeSH) 'Rural Health Services' and 'Rural Health.' MeSH subtitle headings used were 'USA,' 'utilization,' 'trends' and 'supply and distribution.' Keywords added to the search parameters were 'access,' 'rural' and 'health care.' Searches in Google Scholar employed the phrases 'health care disparities in the USA,' inequalities in 'health care in the USA,' 'health care in rural USA' and 'access to health care in rural USA.' After eliminating non-relevant articles, 34 articles were included. RESULTS Significant differences in health care access between rural and urban areas exist. Reluctance to seek health care in rural areas was based on cultural and financial constraints, often compounded by a scarcity of services, a lack of trained physicians, insufficient public transport, and poor availability of broadband internet services. Rural residents were found to have poorer health, with rural areas having difficulty in attracting and retaining physicians, and maintaining health services on a par with their urban counterparts. CONCLUSIONS Rural and urban health care disparities require an ongoing program of reform with the aim to improve the provision of services, promote recruitment, training and career development of rural health care professionals, increase comprehensive health insurance coverage and engage rural residents and healthcare providers in health promotion.
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Affiliation(s)
- N Douthit
- Medical School for International Health, Ben Gurion University, Beer Sheva, Israel
| | - S Kiv
- Medical School for International Health, Ben Gurion University, Beer Sheva, Israel
| | - T Dwolatzky
- Medical School for International Health, Ben Gurion University, Beer Sheva, Israel
| | - S Biswas
- Ben Gurion University, Beer Sheva, Israel.
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155
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Weaver A, Capobianco J, Ruffolo M. Systematic review of EBPs for SMI in rural America. JOURNAL OF EVIDENCE-INFORMED SOCIAL WORK 2015; 12:155-65. [PMID: 25661891 DOI: 10.1080/15433714.2013.765815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This systematic review of the implementation of evidence-based practices (EBPs) for adults with severe mental illnesses (SMI) in rural mental health settings examined peer-reviewed literature, grey literature, and public information. Included articles had to report implementation efforts of EBP(s) for SMI in rural settings or adaptations for rural service delivery. Only three peer-reviewed articles and two publicly available reports met inclusion criteria. Findings suggest little attention is focused on studying factors affecting implementation of EBPs for SMI in rural areas. Adaptations are occurring in rural settings, though rarely documented or tested; their impact on fidelity and consumer outcomes is unclear.
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Affiliation(s)
- Addie Weaver
- a Curtis Research Center, University of Michigan School of Social Work , Ann Arbor , Michigan , USA
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156
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Understanding shortages of sufficient health care in rural areas. Health Policy 2014; 118:201-14. [DOI: 10.1016/j.healthpol.2014.07.018] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 07/07/2014] [Accepted: 07/25/2014] [Indexed: 11/22/2022]
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157
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Elderly breast and colorectal cancer patients' clinical course: patient and contextual influences. Med Care 2014; 52:809-17. [PMID: 25119954 DOI: 10.1097/mlr.0000000000000180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The social and medical environments that surround people are each independently associated with their cancer course. The extent to which these characteristics may together mediate patients' cancer care and outcomes is not known. METHODS Using multilevel methods and data, we studied elderly breast and colorectal cancer patients (level I) within urban social (level II: ZIP code tabulation area) and health care (level III: hospital service area) contexts. We sought to determine (1) which, if any, observable social and medical contextual attributes were associated with patient cancer outcomes after controlling for observable patient attributes, and (2) the magnitude of residual variation in patient cancer outcomes at each level. RESULTS Numerous patient attributes and social area attributes, including poverty, were associated with unfavorable patient cancer outcomes across the full clinical cancer continuum for both cancers. Health care area attributes were not associated with patient cancer outcomes. After controlling for observable covariates at all 3 levels, there was substantial residual variation in patient cancer outcomes at all levels. CONCLUSIONS After controlling for patient attributes known to confer risk of poor cancer outcomes, we find that neighborhood socioeconomic disadvantage exerts an independent and deleterious effect on residents' cancer outcomes, but the area supply of the specific types of health care studied do not. Multilevel interventions targeted at cancer patients and their social areas may be useful. We also show substantial residual variation in patient outcomes across social and health care areas, a finding potentially relevant to traditional small area variation research methods.
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158
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Mallow JA, Theeke LA, Barnes ER, Whetsel T, Mallow BK. Using mHealth Tools to Improve Rural Diabetes Care Guided by the Chronic Care Model. ONLINE JOURNAL OF RURAL NURSING AND HEALTH CARE 2014; 14:43-65. [PMID: 26029005 DOI: 10.14574/ojrnhc.v14i1.276] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Used as an integrated tool, mHealth may improve the ability of healthcare providers in rural areas to provide care, improve access to care for underserved populations, and improve biophysical outcomes of care for persons with diabetes in rural, underserved populations. Our objective in this paper is to present an integrated review of the impact of mHealth interventions for community dwelling individuals with type two diabetes. MATERIALS AND METHODS A literature search was performed using keywords in PubMed to identify research studies which mHealth technology was used as the intervention. RESULTS AND DISCUSSION Interventions using mHealth have been found to improve outcomes, be cost effective, and culturally relevant. mHealth technology that has been used to improve outcomes include: seeking out health information via the web, access to appointment scheduling and medication refills, secure messaging, computerized interventions to manage a chronic condition, use of a personal health record, use of remote monitoring devices, and seeking support from others with similar health concerns through social networks. CONCLUSION Using the validated Chronic Care Model to translate what is known about mHealth technology to clinical practice has the potential to improve the ability of healthcare providers in rural areas to provide care, improve access to care for underserved populations, and improve biophysical outcomes of care for persons with diabetes in rural underserved populations. While these approaches were effective in improving some outcomes, they have not resulted in the establishment of the necessary electronic infrastructure for a sustainable mobile healthcare delivery model.
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159
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Green BQ, Jones K, Milofsky C. Implementing the Affordable Care Act in Central Pennsylvania. J Rural Health 2014; 31:4-6. [PMID: 24803427 DOI: 10.1111/jrh.12075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Brandn Q Green
- Place Studies Initiative of the Bucknell Environmental Center, Bucknell University, Lewisburg, Pennsylvania
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160
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Winans-Mitrik RL, Hula WD, Dickey MW, Schumacher JG, Swoyer B, Doyle PJ. Description of an intensive residential aphasia treatment program: rationale, clinical processes, and outcomes. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 23:S330-S342. [PMID: 24687159 DOI: 10.1044/2014_ajslp-13-0102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The purpose of this article is to describe the rationale, clinical processes, and outcomes of an intensive comprehensive aphasia program (ICAP). METHOD Seventy-three community-dwelling adults with aphasia completed a residentially based ICAP. Participants received 5 hr of daily 1:1 evidence-based cognitive-linguistically oriented aphasia therapy, supplemented with weekly socially oriented and therapeutic group activities over a 23-day treatment course. Standardized measures of aphasia severity and communicative functioning were obtained at baseline, program entry, program exit, and follow-up. Results were analyzed using a Bayesian latent growth curve model with 2 factors representing (a) the initial level and (b) change over time, respectively, for each outcome measure. RESULTS Model parameter estimates showed reliable improvement on all outcome measures between the initial and final assessments. Improvement during the treatment interval was greater than change observed across the baseline interval, and gains were maintained at follow-up on all measures. CONCLUSIONS The rationale, clinical processes, and outcomes of a residentially based ICAP have been described. ICAPs differ with respect to treatments delivered, dosing parameters, and outcomes measured. Specifying the defining components of complex interventions, establishing their feasibility, and describing their outcomes are necessary to guide the development of controlled clinical trials.
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Abstract
Transportation barriers are often cited as barriers to healthcare access. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes. However, the significance of these barriers is uncertain based on existing literature due to wide variability in both study populations and transportation barrier measures. The authors sought to synthesize the literature on the prevalence of transportation barriers to health care access. A systematic literature search of peer-reviewed studies on transportation barriers to healthcare access was performed. Inclusion criteria were as follows: (1) study addressed access barriers for ongoing primary care or chronic disease care; (2) study included assessment of transportation barriers; and (3) study was completed in the United States. In total, 61 studies were reviewed. Overall, the evidence supports that transportation barriers are an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured. Additional research needs to (1) clarify which aspects of transportation limit health care access (2) measure the impact of transportation barriers on clinically meaningful outcomes and (3) measure the impact of transportation barrier interventions and transportation policy changes.
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162
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Mallow JA, Theeke LA, Barnes ER, Whetsel T. Examining Dose of Diabetes Group Medical Visits and Characteristics of the Uninsured. West J Nurs Res 2014; 37:1033-61. [PMID: 24709853 DOI: 10.1177/0193945914529190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Type 2 diabetes is a significant problem for the uninsured. Diabetes Group Medical Visits (DGMVs) have been reported to improve outcomes. However, it is not known if the increased workload of the health care team to treat and educate patients at multiple visits has an impact on patient functioning and well-being. The aim of this study was to explore the impact of dose of DGMVs on biophysical outcomes of care in uninsured persons with diabetes. No significant correlations were found between number of DGMVs attended and biophysical outcomes of care. However, the majority of patients attended two or less DGMVs in 1 year. Dose of DGMVs did not impact outcomes and may not be enough to assure attendance. Involving patients to construct patient-centered interventions may decrease the treatment burden faced by both patients and providers. In addition, such interventions should be aimed at understanding reasons for low attendance, particularly in rural impoverished adults.
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163
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Yikilkan H, Gorpelioglu S, Aypak C, Uysal Z, Ariman OO. Differences between rural and urban primary care units in Turkey: implications on residents' training. J Family Med Prim Care 2014; 2:15-9. [PMID: 24479037 PMCID: PMC3894020 DOI: 10.4103/2249-4863.109935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Context: Family practice training takes place at primary care based training centers linked to Education and Research State Hospitals in Turkey. There is a discussion if these units are adequate to train primary care staff and if the patients of these units reflect the applicants of primary care. Aims: The aim of our study is to investigate the demographic characteristics, the effect of distance on primary care utilization, and most common diagnosis of the patients who applied to two different outpatient clinics: One urban and one rural. Settings and Design: Study was conducted from the electronic health records of the patients applied to outpatient clinics of Ankara Diskapi Yildirim Beyazit Training and Research Hospital Department of Family Medicine between 1 January and 31 December 2009. Results: Total number of patients applied to both of the outpatient clinics was 34,632 [urban clinic: 16.506 (47.7%), rural clinic: 18.126 (52.3%)]. Leading three diagnoses were upper respiratory tract infection (URTI), general medical examination (GME), and hypertension (HT) in the most common 10 diagnosis. Conclusion: In our study, the rural outpatient clinic is regarded as a primary care unit in the neighborhood of living area and the urban clinic as close to working environment. We found statistically meaningful differences in most common diagnosis, gender, age, and consultation time between the rural and urban clinics. According to our results, family practitioners’ field training should take place at different primary care units according to sociodemographic characteristics of each country.
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Affiliation(s)
- Hulya Yikilkan
- Department of Family Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey ; Department of Family Medicine, University of Antwerp, Antwerp, Belgium
| | - Suleyman Gorpelioglu
- Department of Family Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Cenk Aypak
- Department of Family Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Zekai Uysal
- Department of Family Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Osman O Ariman
- Department of Family Medicine, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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164
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Russell DJ, Humphreys JS, Ward B, Chisholm M, Buykx P, McGrail M, Wakerman J. Helping policy-makers address rural health access problems. Aust J Rural Health 2014; 21:61-71. [PMID: 23586567 DOI: 10.1111/ajr.12023] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2012] [Indexed: 11/28/2022] Open
Abstract
This paper provides a comprehensive review of the key dimensions of access and their significance for the provision of primary health care and a framework that assists policy-makers to evaluate how well policy targets the dimensions of access. Access to health care can be conceptualised as the potential ease with which consumers can obtain health care at times of need. Disaggregation of the concept of access into the dimensions of availability, geography, affordability, accommodation, timeliness, acceptability and awareness allows policy-makers to identify key questions which must be addressed to ensure reasonable primary health care access for rural and remote Australians. Evaluating how well national primary health care policies target these dimensions of access helps identify policy gaps and potential inequities in ensuring access to primary health care. Effective policies must incorporate the multiple dimensions of access if they are to comprehensively and effectively address unacceptable inequities in health status and access to basic health services experienced by rural and remote Australians.
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Affiliation(s)
- Deborah J Russell
- School of Rural Health, Monash University, Centre of Research Excellence in Rural and Remote Primary Health Care, Bendigo, Victoria, Australia.
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165
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Patient Safety in Outpatient Care. PATIENT SAFETY 2014. [DOI: 10.1007/978-1-4614-7419-7_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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166
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Mallow JA, Theeke LA, Barnes ER, Whetsel T, Mallow BK. Free Care Is Not Enough: Barriers to Attending Free Clinic Visits in a Sample of Uninsured Individuals with Diabetes. ACTA ACUST UNITED AC 2014; 4:912-919. [PMID: 25767743 PMCID: PMC4354849 DOI: 10.4236/ojn.2014.413097] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Free care does not always lead to improved outcomes. Attendance at free clinic appointments is unpredictable. Understanding barriers to care could identify innovative interventions. The purpose of this study was to examine patient characteristics, biophysical outcomes, and health care utilization in uninsured persons with diabetes at a free clinic. A sample of 3139 patients with at least one chronic condition was identified and comparisons were made between two groups: those who attended all scheduled appointments and those who did not. Geographic distance to clinic and multiple chronic conditions were identified as barriers to attendance. After one year, missing more than one visit had a positive correlation with increased weight, A1C, and lipids. Additionally, patients who missed visits had higher blood pressure, depression scores, and numbers of medications. Future research should further enhance understanding of barriers to care, build knowledge of how social and behavioral determinants contribute to negative outcomes in the context of rurality. Innovative methods to deliver more frequent and intensive interventions will not be successful if they are not accessible to patients.
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Affiliation(s)
- Jennifer A Mallow
- School of Nursing, West Virginia University, Morgantown, West Virginia, USA
| | - Laurie A Theeke
- School of Nursing, West Virginia University, Morgantown, West Virginia, USA
| | - Emily R Barnes
- School of Nursing, West Virginia University, Morgantown, West Virginia, USA
| | - Tara Whetsel
- School of Nursing, West Virginia University, Morgantown, West Virginia, USA
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167
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Suarez EC, Schramm-Sapyta NL. Race differences in the relation of vitamins A, C, E, and β-carotene to metabolic and inflammatory biomarkers. Nutr Res 2013; 34:1-10. [PMID: 24418240 DOI: 10.1016/j.nutres.2013.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 10/04/2013] [Accepted: 10/07/2013] [Indexed: 12/14/2022]
Abstract
Using archival data, we conducted a secondary analysis to examine race differences in the relation of serum vitamins A, C, E and β-carotene to insulin resistance (IR), fasting insulin and glucose, high sensitivity C-reactive protein (hs-CRP), and leukocyte count in 176 non-smoking, healthy, white, and African American (AA) adults aged 18 to 65 years (48% women, 33% AA). We hypothesized that micronutrient concentrations would be associated with early risk markers of cardiometabolic diseases in a race-dependent manner. Fasting blood samples were analyzed for micronutrients, insulin, glucose, hs-CRP, and leukocyte count. Insulin resistance was estimated using the homeostatic model assessment. After adjusting for age, body mass index, gender, educational level, use of vitamin supplements, alcohol intake, leisure time physical activity, menopausal status, and total cholesterol, we observed that β-carotene was significantly associated with insulin resistance and fasting insulin in a race-dependent manner. Among AA, lower β-carotene levels were associated with higher estimates of insulin resistance and fasting insulin; whereas, these same associations were not significant for whites. Race also significantly moderated the relation of vitamin C to leukocyte count, with lower vitamin C being associated with higher leukocyte count only in AA but not whites. For all subjects, lower β-carotene was associated with higher hs-CRP. In AA, but not whites, lower levels of β-carotene and vitamin C were significantly associated with early risk markers implicated in cardiometabolic conditions and cancer. Whether or not lower levels of micronutrients contribute uniquely to racial health disparities is a worthwhile aim for future research.
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Affiliation(s)
- Edward C Suarez
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC.
| | - Nicole L Schramm-Sapyta
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
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168
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Palmer NRA, Geiger AM, Lu L, Case LD, Weaver KE. Impact of rural residence on forgoing healthcare after cancer because of cost. Cancer Epidemiol Biomarkers Prev 2013; 22:1668-76. [PMID: 24097196 PMCID: PMC3833446 DOI: 10.1158/1055-9965.epi-13-0421] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Routine follow-up care is recommended to promote the well-being of cancer survivors, but financial difficulties may interfere. Rural-urban disparities in forgoing healthcare due to cost have been observed in the general population; however, it is unknown whether this disparity persists among survivors. The purpose of this study was to examine rural-urban disparities in forgoing healthcare after cancer due to cost. METHODS We analyzed data from 7,804 cancer survivors in the 2006 to 2010 National Health Interview Survey. Logistic regression models, adjusting for sociodemographic and clinical characteristics, were used to assess rural-urban disparities in forgoing medical care, prescription medications, and dental care due to cost, stratified by age (younger: 18-64, older: 65+). RESULTS Compared with urban survivors, younger rural survivors were more likely to forgo medical care (P < 0.001) and prescription medications (P < 0.001) due to cost; older rural survivors were more likely to forgo medical (P < 0.001) and dental care (P = 0.05). Rural-urban disparities did not persist among younger survivors in adjusted analyses; however, older rural survivors remained more likely to forgo medical [OR = 1.66, 95% confidence interval (CI) = 1.11-2.48] and dental care (OR = 1.54, 95%CI = 1.08-2.20). CONCLUSIONS Adjustment for health insurance and other sociodemographic characteristics attenuates rural-urban disparities in forgoing healthcare among younger survivors, but not older survivors. Financial factors relating to healthcare use among rural survivors should be a topic of continued investigation. IMPACT Addressing out-of-pocket costs may be an important step in reducing rural-urban disparities in healthcare, especially for older survivors. It will be important to monitor how healthcare reform efforts impact disparities observed in this vulnerable population.
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Affiliation(s)
- Nynikka R A Palmer
- Authors' Affiliations: Social Science and Health Policy, Epidemiology and Prevention, Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina; Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Science, National Cancer Institute, Rockville, Maryland
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Bell RA, Arcury TA, Ip E, Grzywacz JG, Nguyen H, Kirk JK, Saldana S, Quandt SA. Correlates of physician trust among rural older adults with diabetes. Am J Health Behav 2013; 37:660-6. [PMID: 23985289 PMCID: PMC3761406 DOI: 10.5993/ajhb.37.5.10] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine the demographic, health and diabetes management correlates of physician trust in a rural, multiethnic population with diabetes. METHODS 563 older (≥ 60 years) African American, American Indian and White adults completed in-home surveys, including the 11-item General Trust in Physicians Scale. RESULTS Higher trust scores were seen among: older (>75) participants (p < .01), those with fewer (<3) chronic health conditions (p < .01), and those who adhered to physical activity (p < .05) and dilated eye exam (p < .01) guidelines; the latter remained significant (eye exam, p = .019) or approached significance (physical activity, p = .051) after adjustment for potential confounders. CONCLUSIONS Physician trust may influence patient adherence to diabetes management recommendations. Efforts should be made to build trust in the patient-provider relationship to enhance patient outcomes.
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Affiliation(s)
- Ronny A Bell
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Grose J, Freeman J, Marsden J. Service delivery for people with hereditary spastic paraparesis living in the South West of England. Disabil Rehabil 2013; 36:907-13. [DOI: 10.3109/09638288.2013.824032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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171
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Abstract
Addiction appointment no-shows adversely impact clinical outcomes and healthcare productivity. During 2007-2010, 67 treatment organizations in the Strengthening Treatment Access and Retention program were asked to reduce their no-show rates by using practices taken from no-show research and theory. These treatment organizations reduced outpatient no-show rates from 37.4% to 19.9% (p = .000), demonstrated which practices they preferred to implement, and which practices were most effective in reducing no-show rates. This study provides an applied synthesis of addiction treatment no-show research and suggests future directions for no-show research and practice.
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Affiliation(s)
- Todd Molfenter
- University of Wisconsin-Madison, Madison, Wisconsin 53706, USA.
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172
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Altizer K, Quandt SA, Grzywacz JG, Bell RA, Sandberg J, Arcury TA. Traditional and commercial herb use in health self- management among rural multiethnic older adults. J Appl Gerontol 2013; 32:387-407. [PMID: 24991081 PMCID: PMC4076146 DOI: 10.1177/0733464811424152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study analyzes the role of traditional and commercial herbs in older adults’ health self-management based on Leventhal’s Self-Regulatory Model conceptual framework. Sixty-two African American and White adults age 65 and older completed qualitative interviews describing the forms of herbs currently being used, sources of information about them, interpretations of health (acute symptoms or chronic conditions) that led to their use, and the initiation and suspension of use. Traditional herbs are native to the region or have been traditionally cultivated, usually taken raw or boiled to produce tea, and used for treating mild symptoms. Commercial herbs are prepared as pills, extracts, or teas; they are purchased at local stores or ordered by catalog or Internet and used for health promotion, illness prevention, or treatment of chronic conditions. Herbs are widely used among older adults; this analysis differentiates the types of herbs they use and their reasons for herbs use.
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Affiliation(s)
- Kathryn Altizer
- Department of Family and Community Medicine, Wake Forest School of Medicine
| | - Sara A. Quandt
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine
| | - Joseph G. Grzywacz
- Department of Family and Community Medicine, Wake Forest School of Medicine
| | - Ronny A. Bell
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine
| | - Joanne Sandberg
- Department of Family and Community Medicine, Wake Forest School of Medicine
| | - Thomas A. Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine
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173
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Bell RA, Grzywacz JG, Quandt SA, Neiberg R, Lang W, Nguyen H, Altizer KP, Arcury TA. Medical skepticism and complementary therapy use among older rural African-Americans and Whites. J Health Care Poor Underserved 2013; 24:777-87. [PMID: 23728044 PMCID: PMC3830528 DOI: 10.1353/hpu.2013.0052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE This study documents demographic, health, and complementary therapy (CT) correlates of medical skepticism among rural older adults. METHODS Older (≥65 years) African Americans and Whites in rural North Carolina (N=198) were interviewed. Medical skepticism was assessed using the four items from the Medical Expenditure Survey. Bivariate associations between medical skepticism and demographic and health characteristics and CT use were assessed, and independent effects on CT use. FINDINGS Positive responses to medical skepticism questions ranged from 19.7% (can overcome illness without help) to 59.6% (believes own behavior determines their health). Medical skepticism indicators were associated with few demographic and health characteristics, and one CT category. CONCLUSIONS This study shows a high degree of medical skepticism among rural older adults, but limited associations with demographic and health characteristics and CT use. Further research is needed to understand relationships of attitudes towards conventional care and CT use in this population.
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Affiliation(s)
- Ronny A Bell
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston- Salem, NC 27157, USA.
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174
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Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. J Community Health 2013. [PMID: 23543372 DOI: 10.1007/s10900‐013‐9681‐1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Transportation barriers are often cited as barriers to healthcare access. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes. However, the significance of these barriers is uncertain based on existing literature due to wide variability in both study populations and transportation barrier measures. The authors sought to synthesize the literature on the prevalence of transportation barriers to health care access. A systematic literature search of peer-reviewed studies on transportation barriers to healthcare access was performed. Inclusion criteria were as follows: (1) study addressed access barriers for ongoing primary care or chronic disease care; (2) study included assessment of transportation barriers; and (3) study was completed in the United States. In total, 61 studies were reviewed. Overall, the evidence supports that transportation barriers are an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured. Additional research needs to (1) clarify which aspects of transportation limit health care access (2) measure the impact of transportation barriers on clinically meaningful outcomes and (3) measure the impact of transportation barrier interventions and transportation policy changes.
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Affiliation(s)
- Samina T Syed
- Section of Endocrinology, Diabetes and Metabolism, University of Illinois at Chicago, 1819 W. Polk Street, M/C 640, Chicago, IL 60612, USA.
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175
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Weaver KE, Geiger AM, Lu L, Case LD. Rural-urban disparities in health status among US cancer survivors. Cancer 2013; 119:1050-7. [PMID: 23096263 PMCID: PMC3679645 DOI: 10.1002/cncr.27840] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/20/2012] [Accepted: 08/13/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although rural residents are more likely to be diagnosed with more advanced cancers and to die of cancer, little is known about rural-urban disparities in self-reported health among survivors. METHODS The authors identified adults who had a self-reported history of cancer from the National Health Interview Survey (2006-2010). Rural-urban residence was defined using US Census definitions. Logistic regression with weighting to account for complex sampling was used to assess rural-urban differences in health status after accounting for differences in demographic characteristics. RESULTS Of the 7804 identified cancer survivors, 20.8% were rural residents. This translated to a population of 2.8 million rural cancer survivors in the United States. Rural survivors were more likely than urban survivors to be non-Hispanic white (P < .001), to have less education (P < .001), and to lack health insurance (P < .001). Rural survivors reported worse health in all domains. After adjustment for sex, race/ethnicity, age, marital status, education, insurance, time since diagnosis, and number of cancers, rural survivors were more likely to report fair/poor health (odds ratio, 1.39; 95% confidence interval, 1.20-1.62), psychological distress (odds ratio, 1.23; 95% confidence interval, 1.00-1.50), ≥2 noncancer comorbidities (odds ratio, 1.15; 95% confidence interval, 1.01-1.32), and health-related unemployment (odds ratio, 1.66; 95% confidence interval, 1.35-2.03). CONCLUSIONS The current results provide the first estimates of the proportion and number of US adult cancer survivors who reside in rural areas. Rural cancer survivors are at greater risk for a variety of poor health outcomes, even many years after their cancer diagnosis, and should be a target for interventions to improve their health and well being.
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Affiliation(s)
- Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
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176
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Pesut B, Laberge C, Sawatzky R, Mallinson J, Rush K. Understanding the landscape: promoting health for rural individuals after tertiary level cardiac revascularization. J Rural Health 2013; 29:88-96. [PMID: 23289659 DOI: 10.1111/j.1748-0361.2012.00427.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this pilot study was to describe the needs and experiences of rural individuals commuting to an urban center for percutaneous coronary intervention (PCI). METHODS Data were analyzed from a "Patient Adherence and Satisfaction Survey" conducted by telephone as part of a quality improvement focus, and supplemented with in-depth semi-structured interviews with rural patients following PCI. FINDINGS Both urban and rural patients after PCI experienced few complications, had made some attempts to reduce tobacco usage, and were highly satisfied with explanations of their treatment and their overall treatment experience. Patients in rural settings were more likely to experience chest pain at least rarely following their surgery than people in urban settings (P < .05). Data on participation in cardiac rehabilitation (CR) showed no significant differences between urban and rural dwellers. Four themes emerged from the interviews: standards of care during treatment; transportation; local resources and community support; and lifestyle changes. Although patients were highly satisfied with standards of care during acute treatment, there were unmet needs in relation to transportation and lifestyle changes. CONCLUSION Transitions between rural communities and urban centers and rural adaptations of secondary prevention programs require more attention in health service delivery. Further research is required to better understand potential variations in chest pain patterns between urban and rural residents.
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Affiliation(s)
- Barbara Pesut
- School of Nursing, University of British Columbia, Kelowna, British Columbia, Canada.
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177
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Hamano T, Kimura Y, Takeda M, Yamasaki M, Isomura M, Nabika T, Shiwaku K. Effect of environmental and lifestyle factors on hypertension: Shimane COHRE study. PLoS One 2012; 7:e49122. [PMID: 23152860 PMCID: PMC3494668 DOI: 10.1371/journal.pone.0049122] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 10/07/2012] [Indexed: 11/19/2022] Open
Abstract
Background In recent years there has been increasing evidence of an association between residential remoteness and hypertension (HTN); however, no study has examined the effects of residential remoteness-lifestyle associations on HTN. The objective of this study was to evaluate the effects of residential remoteness, as measured by road network distance and elevation, and lifestyle associations, including access to daily products as a measure of car use, on HTN in a rural region in Japan. Method This is a cross-sectional population based study. We analyzed data from the Shimane COHRE study conducted from 2006 to 2009 in the rural mountainous regions of Japan. After excluding missing data, we conducted a logistic regression analysis of the data for 1,348 individuals and examined the effects of residential remoteness and lifestyle associations, including road network distance, elevation and access to daily products as a measure of car use, on the prevalence of HTN. Principal Findings In participants without access to car use, the odds ratios for self-reported HTN (i.e. taking antihypertensive medication) were significantly increased in those living in moderate (odds ratio (OR): 2.21, 95% confidence interval (CI): 1.19–4.08) and far (OR: 2.55, 95% CI: 1.00–6.51) road distances, whereas there were no significant associations in participants with access to car use. There were no significant associations between elevation and HTN for participants either with or without access to car transportation. Conclusions Our findings show that specific residential remoteness-hypertension associations vary according to access to daily products as a measure of car use in a rural mountainous area of Japan. These results advance the understanding and importance of considering residential environment, “where people live,” in establishing health policy.
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Affiliation(s)
- Tsuyoshi Hamano
- Center for Community-Based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, Izumo, Japan
- Department of Environmental and Preventive Medicine, Shimane University School of Medicine, Izumo, Japan
- * E-mail:
| | - Yoshinari Kimura
- Department of Geography, Graduate School of Literature and Human Sciences, Osaka City University, Osaka, Japan
| | - Miwako Takeda
- Center for Community-Based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, Izumo, Japan
- Department of Environmental and Preventive Medicine, Shimane University School of Medicine, Izumo, Japan
| | - Masayuki Yamasaki
- Center for Community-Based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, Izumo, Japan
- Department of Environmental and Preventive Medicine, Shimane University School of Medicine, Izumo, Japan
| | - Minoru Isomura
- Center for Community-Based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, Izumo, Japan
- Department of Functional Pathology, Shimane University School of Medicine, Izumo, Japan
| | - Toru Nabika
- Center for Community-Based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, Izumo, Japan
- Department of Functional Pathology, Shimane University School of Medicine, Izumo, Japan
| | - Kuninori Shiwaku
- Center for Community-Based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, Izumo, Japan
- Department of Environmental and Preventive Medicine, Shimane University School of Medicine, Izumo, Japan
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178
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Kollannoor-Samuel G, Vega-López S, Chhabra J, Segura-Pérez S, Damio G, Pérez-Escamilla R. Food insecurity and low self-efficacy are associated with health care access barriers among Puerto-Ricans with type 2 diabetes. J Immigr Minor Health 2012; 14:552-62. [PMID: 22101725 DOI: 10.1007/s10903-011-9551-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Racial/ethnic minorities are disproportionately affected by barriers to health care access and utilization. The primary objective was to test for an independent association between household food insecurity and health care access/utilization. In this cross-sectional survey, 211 Latinos (predominantly, Puerto-Ricans) with type 2 diabetes (T2D) were interviewed at their homes. Factor analyses identified four barriers for health care access/utilization: enabling factor, doctor access, medication access and forgetfulness. Multivariate logistic regression models examined the association between each of the barrier factors and food insecurity controlling for sociodemographic, cultural, psychosocial, and diabetes self-care variables. Higher food insecurity score was a risk factor for experiencing enabling factor (OR = 1.46; 95% CI = 1.17-1.82), medication access (OR = 1.26; 95 CI% = 1.06-1.50), and forgetfulness (OR = 1.22; 95 CI% = 1.04-1.43) barriers. Higher diabetes management self-efficacy was protective against all four barriers. Other variables associated with one or more barriers were health insurance, perceived health, depression, blood glucose, age and education. Findings suggest that addressing barriers such as food insecurity, low self-efficacy, lack of health insurance, and depression could potentially result in better health care access and utilization among low income Puerto-Ricans with T2D.
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179
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Su D, Pratt W, Salinas J, Wong R, Pagán JA. Rural-urban differences in health services utilization in the US-Mexico border region. J Rural Health 2012; 29:215-23. [PMID: 23551652 DOI: 10.1111/j.1748-0361.2012.00445.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Evaluate the association between driving distance to the US-Mexico border and rural-urban differences in the use of health services in Mexico by US border residents from Texas. METHODS Data for this study come from the Cross-Border Utilization of Health Care Survey, a population-based telephone survey conducted in the Texas border region in spring 2008. Driving distances to the border were estimated from the nearest border crossing station using Google Maps. Outcome measures included medication purchases, physician visits, dentist visits, and inpatient care in Mexico during the 12 months prior to the survey. A series of adjusted logit models were estimated after controlling for relevant confounding factors. FINDINGS The average driving distance to the nearest border crossing station among rural respondents was 4 times that of urban respondents (42.0 miles vs 10.3 miles [P < .001]). Rural respondents were more likely to be dissatisfied than urban respondents with the health care provided on the US side of the border, yet they were less likely to use health services in Mexico. Driving distance to the border largely explained the observed rural-urban differences in medication purchases from Mexico. In the case of inpatient care, however, rural respondents reported a higher utilization rate than urban respondents and this rural-urban difference became more pronounced after adjusting for the effect of driving distance to the border. CONCLUSIONS Dissatisfaction with US health care services in rural communities in the US-Mexico border region seems to be compounded by the lack of access to health care services in Mexico due to travel distance constraints.
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Affiliation(s)
- Dejun Su
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA.
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180
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Silver D, Blustein J, Weitzman BC. Transportation to clinic: findings from a pilot clinic-based survey of low-income suburbanites. J Immigr Minor Health 2012; 14:350-5. [PMID: 22512007 DOI: 10.1007/s10903-010-9410-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Health care policymakers have cited transportation barriers as key obstacles to providing health care to low-income suburbanites, particularly because suburbs have become home to a growing number of recent immigrants who are less likely to own cars than their neighbors. In a suburb of New York City, we conducted a pilot survey of low income, largely immigrant clients in four public clinics, to find out how much transportation difficulties limit their access to primary care. Clients were receptive to the opportunity to participate in the survey (response rate = 94%). Nearly one-quarter reported having transportation problems that had caused them to miss or reschedule a clinic appointment in the past. Difficulties included limited and unreliable local bus service, and a tenuous connection to a car. Our pilot work suggests that this population is willing to participate in a survey on this topic. Further, since even among those attending clinic there was significant evidence of past transportation problems, it suggests that a population based survey would yield information about substantial transportation barriers to health care.
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Affiliation(s)
- Diana Silver
- Steinhardt School of Culture, Education and Human Development, New York University, New York, NY 10003, USA.
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181
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Arcury TA, Grzywacz JG, Ip EH, Saldana S, Nguyen HT, Bell RA, Kirk JK, Quandt SA. Social integration and diabetes management among rural older adults. J Aging Health 2012; 24:899-922. [PMID: 22764154 DOI: 10.1177/0898264312449186] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe diabetes management behaviors and social integration among older adults, and delineate the associations of social integration with diabetes management behaviors. METHOD Interview data from 563 African American, American Indian, and White participants (age 60+) from eight south central North Carolina counties selected using a site-based procedure. Statistical analysis comprises descriptive statistics, bivariate analysis, and multivariate analysis. RESULTS Participants had high levels of social integration and largely adhered to diabetes management behaviors (glucose monitoring, checking feet, maintaining diet, formal exercise program, health provider monitoring A1C and examining feet). Social integration was associated with several behaviors; social network size, particularly other relatives seen and spoken with on the telephone, was associated with provider A1C monitoring and foot examinations. DISCUSSION Social integration had small but significant associations with diabetes management behaviors. This analysis suggests specific mechanisms for how social integration influences the effect of disease on disability.
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Affiliation(s)
- Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine NC, Winston-Salem, NC 27157-1084, USA.
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182
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Wilson DM, Thomas R, Kovacs Burns KK, Hewitt JA, Osei-Waree J, Robertson S. Canadian rural-urban differences in end-of-life care setting transitions. Glob J Health Sci 2012; 4:1-13. [PMID: 22980372 PMCID: PMC4776943 DOI: 10.5539/gjhs.v4n5p1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 06/12/2012] [Indexed: 12/04/2022] Open
Abstract
Few studies have focused on the care setting transitions that occur in the last year of life. A three part mixed-methods study was conducted to gain an understanding of the number and implications or impact of care setting transitions in the last year of life for rural Canadians. Provincial health services utilization data, national online survey data, and local qualitative interview data were analyzed to gain general and specific information for consideration. Rural Albertans had significantly more healthcare setting transitions than urbanites in the last year of life (M=4.2 vs 3.3). Online family respondents reported 8 moves on average occurred for family members in the last year of life. These moves were most often identified (65%) on a likert-type scale as “very difficult,” with the free text information revealing these trips were often emotionally painful for themselves and physically painful for their ill family member. Eleven informants were then interviewed until data saturation, with constant-comparative data analysis conducted for a more in-depth understanding of rural transitions. Moving from place to place for needed care in the last year of life was identified as common and concerning for rural people and their families, with three data themes developing: (a) needed care in the last year of life is scattered across many places, (b) travelling is very difficult for terminally-ill persons and their caregivers, and (c) local rural services are minimal. These findings indicate planning is needed to avoid unnecessary end-of-life care setting transitions and to make needed moves for essential services in the last year of life less costly, stressful, and socially disruptive for rural people and their families.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, Canada.
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183
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Silver D, Blustein J, Weitzman BC. Transportation to clinic: findings from a pilot clinic-based survey of low-income suburbanites. J Immigr Minor Health 2012. [PMID: 22512007 DOI: 10.1007/s10903‐010‐9410‐0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Health care policymakers have cited transportation barriers as key obstacles to providing health care to low-income suburbanites, particularly because suburbs have become home to a growing number of recent immigrants who are less likely to own cars than their neighbors. In a suburb of New York City, we conducted a pilot survey of low income, largely immigrant clients in four public clinics, to find out how much transportation difficulties limit their access to primary care. Clients were receptive to the opportunity to participate in the survey (response rate = 94%). Nearly one-quarter reported having transportation problems that had caused them to miss or reschedule a clinic appointment in the past. Difficulties included limited and unreliable local bus service, and a tenuous connection to a car. Our pilot work suggests that this population is willing to participate in a survey on this topic. Further, since even among those attending clinic there was significant evidence of past transportation problems, it suggests that a population based survey would yield information about substantial transportation barriers to health care.
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Affiliation(s)
- Diana Silver
- Steinhardt School of Culture, Education and Human Development, New York University, New York, NY 10003, USA.
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184
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Popejoy LL, Galambos C, Moylan K, Madsen R. Challenges to Hospital Discharge Planning for Older Adults. Clin Nurs Res 2012; 21:431-49. [DOI: 10.1177/1054773812436373] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hospital discharge planning for older adults is an essential component to successful transitional care and will become increasingly important as hospitals face financial penalties for avoidable readmissions. This study reports a cross-sectional descriptive web-based survey study about challenges to discharge planning experienced by hospitals in the Midwestern state of Missouri. Problems identified by respondents included difficulties finding placement for patients requiring ventilator care, hemodialysis, chemotherapy, radiation therapy, wound vacuums, or who have mental health care needs. In general, urban hospitals reported more problems with finding postacute discharge destinations for patients than did rural hospitals. It is essential that nursing homes, residential care facilities, and home health agencies be adequately reimbursed to manage complex patients. It may be equally important to identify ways to develop critical assessment and care management skills that are needed in postacute staff to increase the likelihood that patients will be accepted at the time of hospital discharge.
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185
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Parker J, Jackson L, Dykeman M, Gahagan J, Karabanow J. Access to harm reduction services in Atlantic Canada: Implications for non-urban residents who inject drugs. Health Place 2012; 18:152-62. [DOI: 10.1016/j.healthplace.2011.08.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 07/22/2011] [Accepted: 08/25/2011] [Indexed: 11/28/2022]
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186
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Sharkey JR, Johnson CM, Dean WR. Relationship of household food insecurity to health-related quality of life in a large sample of rural and urban women. Women Health 2012; 51:442-60. [PMID: 21797678 DOI: 10.1080/03630242.2011.584367] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The authors examined the associations of household food insecurity and other characteristics with fair-to-poor general health, poor physical health, and frequent mental distress among 1,367 rural and urban women in Texas. The 2006 Brazos Valley Community Health Assessment provided data on demographic characteristics, economic risk factors, health-related quality of life, household food insecurity, and geographic residence. Multivariable logistic regression models were estimated for the three health-related quality of life measures: fair-to-poor health, poor physical health, and frequent mental distress, adjusting for confounding variables. Having less than 12 years of education, not being employed full-time, and being household food insecure were independently significantly associated with increased odds for all health-related quality of life outcomes. Rural residence and being nonwhite were associated with fair-to-poor general health, but not physical or mental health. Results from the separate urban and rural models indicated that household food insecurity was associated with fair-to-poor general health among rural women, not among urban women. Poverty and being nonwhite were also associated with increased odds of reporting fair-to-poor general health, but were significant only among urban women. These results emphasize the need for health promotion and policy efforts to consider household food access and availability as part of promoting healthful food choices and good physical and mental health among women, especially rural women.
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Affiliation(s)
- Joseph R Sharkey
- Program for Research in Nutrition and Health Disparities, School of Rural Public Health, Texas A&M Health Science Center, College Station, USA.
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187
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Access to emerging technologies and telehealth intervention modality preferences in rural patients. HEALTH AND TECHNOLOGY 2011. [DOI: 10.1007/s12553-011-0009-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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188
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Tan MY, Magarey JM, Chee SS, Lee LF, Tan MH. A brief structured education programme enhances self-care practices and improves glycaemic control in Malaysians with poorly controlled diabetes. HEALTH EDUCATION RESEARCH 2011; 26:896-907. [PMID: 21715653 DOI: 10.1093/her/cyr047] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We assessed the effectiveness of a brief structured diabetes education programme based on the concept of self-efficacy on self-care and glycaemic control using single-blind study design. One hundred and sixty-four participants with poorly controlled diabetes from two settings were randomized using computer-generated list into control (n = 82) and intervention (n = 82) groups, of which 151 completed the study. Monthly interventions over 12 weeks addressed the self-care practices of diet, physical activity, medication adherence and self-monitoring of blood glucose (SMBG). These self-care practices were assessed at Weeks 0 and 12 using pre- and post-questionnaires in both groups together with glycated haemoglobin A1c (HbA1c) and diabetes knowledge. In the intention-to-treat analysis (n = 164), the intervention group improved their SMBG (P = <0.001), physical activity (P = 0.001), HbA1c (P = 0.03), diabetes knowledge (P = <0.001) and medication adherence. At Week 12, HbA1c difference adjusted for SMBG frequency, medication adherence and weight change remained significant (P = 0.03) compared with control group. For within group comparisons, diabetes knowledge (P = <0.001), HbA1c level (P = <0.001), SMBG (P = <0.001) and medication adherence (P = 0.008) improved from baseline in the intervention group. In the control group, only diabetes knowledge improved (P = <0.001). These findings can contribute to the development of self-management diabetes education in Malaysia.
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Affiliation(s)
- M Y Tan
- Department of Nursing, Damai Medical and Heart Clinic, Melaka 75300, Malaysia.
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189
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Lin YJ, Tian WH, Chen CC. Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan. Health Policy 2011; 103:236-43. [PMID: 21920621 DOI: 10.1016/j.healthpol.2011.08.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 08/10/2011] [Accepted: 08/25/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aims to investigate the relationship between the level of urbanization and the utilization of outpatient services under the National Health Insurance (NHI) program in Taiwan. METHODS We adopted a two-part model using data from the 2001 National Health Interview Survey (NHIS) and the 2001 National Health Insurance Research Database (NHIRD) in Taiwan. Data for a total of 20,640 individuals were obtained for subsequent analysis in this study. RESULTS The results of the first part, the contact analysis, indicate that individuals residing in areas with lower urbanization levels are less likely to use outpatient services compared to those residing in areas with the highest urbanization levels. The second part of the frequency analysis revealed that, for those individuals that had previously utilized outpatient services, those residing in areas with lower urbanization levels tended to utilize outpatient services less than individuals residing in areas with higher levels of urbanization. CONCLUSIONS Our empirical results show that differences between urbanization levels are a major contributory factor associated with the probability and frequency of outpatient utilization in Taiwan.
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Affiliation(s)
- Yen-Ju Lin
- Department of Public Finance and Taxation, National Taichung Institute of Technology, Taiwan
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190
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Arcury TA, Chen H, Savoca MR, Anderson AM, Leng X, Bell RA, Quandt SA. Ethnic variation in oral health and social integration among older rural adults. J Appl Gerontol 2011; 32:302-23. [PMID: 23788829 DOI: 10.1177/0733464811420428] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This analysis examines the associations of oral health with social integration among ethnically diverse (African American, American Indian, White) rural older adults. Data are from a cross-sectional survey of 635 randomly selected community-dwelling adults aged 60+. Measures include self-rated oral health, number of teeth, number of oral health problems, social engagement, and social network size. Minority elders have poorer oral health than do White older adults. Most rural elders have substantial social engagement and social networks. Better oral health (greater number of teeth) is directly associated with social engagement, whereas the relationship of oral health to social network size is complex. The association of oral health with social engagement does not differ by ethnicity. Poorer oral health is associated with less social integration among African American, American Indian, and White elders. More research on the ways oral health affects the lives of older adults is warranted.
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Affiliation(s)
- Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, NC, USA
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191
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Stoller EP, Grzywacz JG, Quandt SA, Bell RA, Chapman C, Altizer KP, Arcury TA. Calling the doctor: a qualitative study of patient-initiated physician consultation among rural older adults. J Aging Health 2011; 23:782-805. [PMID: 21311048 PMCID: PMC3130826 DOI: 10.1177/0898264310397045] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Guided by Leventhal's self-regulatory model and Cockerham's theory of health lifestyles, we explore two questions regarding physician consultation among elderly rural adults: What symptom characteristics prompt patient-initiated physician consultation? Do participants' accounts of responses to symptoms, including the decision to consult a physician, incorporate descriptions of change over time? METHOD We analyze data from semistructured in-depth interviews with 62 older rural adults. RESULTS Accounts of decisions to initiate contact with physicians support prior research. Some symptoms encouraged immediate consultation; others prompted periods of monitoring and lay management. Physicians were most often contacted if changes were new, unusually severe, persisted or worsened, or failed to respond to lay treatment. DISCUSSION We characterize participants' responses to symptoms as bricolages to highlight their construction from available materials. Incorporating the integrating concept of bricolage and Cockerham's emphasis on both general dispositions and symptom-specific responses represents an important extension of Leventhal's conceptualization of illness behavior, including patient-initiated physician consultation.
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Affiliation(s)
- Eleanor Palo Stoller
- Research Professor, Department of Sociology, Box 7808, Wake Forest University, Winston-Salem, NC 27109, (336) 643-0973
| | - Joseph G. Grzywacz
- Associate Professor, Department of Family and Community Medicine, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, North Carolina 27157-1084, (336) 716-2237
| | - Sara A. Quandt
- Professor, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1063, (336) 716-6015
| | - Ronny A. Bell
- Professor, Department of Epidemiology and Prevention, Division of Public Health Sciences; Director, Maya Angelou Center for Health Equity, Wake Forest University Health Sciences, Medical Center Blvd, Winston-Salem, NC 27157-1063, (336) 716-9736
| | - Christine Chapman
- Project Manager, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest university School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1063, (336) 713-4340
| | - Kathryn P. Altizer
- Associate Project Manager, Department of Family and Community Medicine, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1084, (336) 716-1839
| | - Thomas A. Arcury
- Professor and Vice Chair for Research, Department of Family and Community Medicine; Director, Center for Worker Health, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1084, (336) 716-9438
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192
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Zullig LL, Jackson GL, Provenzale D, Griffin JM, Phelan S, van Ryn M. Transportation: a vehicle or roadblock to cancer care for VA patients with colorectal cancer? Clin Colorectal Cancer 2011; 11:60-5. [PMID: 21803001 DOI: 10.1016/j.clcc.2011.05.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 04/26/2011] [Accepted: 05/06/2011] [Indexed: 01/30/2023]
Abstract
BACKGROUND Patients must have transportation to the treatment site before they can access appropriate cancer care. This article describes factors associated with patients experiencing transportation-related barriers to accessing cancer care. PATIENTS AND METHODS The Cancer Care Assessment & Responsive Evaluation Studies (C-CARES) questionnaire was mailed to Veterans Affairs (VA) patients with colorectal cancer (CRC) during the fall of 2009. Eligible patients were diagnosed at any VA facility in 2008, they were men, and alive at the time of the mailing. A total of 1409 surveys were returned (approximately 67% response rate). To assess transportation barriers, patients were asked how often it was difficult to get transportation to or from treatment. Symptoms were assessed using validated Patient-Reported Outcomes Measurement Information System (PROMIS) scales for fatigue, pain, and depression. Multivariate logistic regression was used to examine determinants of transportation barriers. RESULTS A minority of respondents (19%) reported transportation barriers. Patients experiencing pain (OR, 1.04; 95% CI, 1.02-1.06) had greater odds of transportation barriers than patients without this symptom. Patients who reported no primary social support (OR, 6.13; 95% CI, 3.10-12.14) or nonspousal support (OR, 2.00; 95% CI, 1.40-2.87) were more likely to experience transportation barriers than patients whose spouses provided social support. DISCUSSION Patients with uncontrolled pain or less social support have greater odds of transportation barriers. The directional association between social support, symptoms, and transportation cannot be determined in this data. CONCLUSION Inquiring about accessible transportation should become a routine part of cancer care, particularly for patients with known risk factors.
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Affiliation(s)
- Leah L Zullig
- Durham Veterans Affairs Medical Center, Center for Health Services Research in Primary Care, NC 27705, USA.
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193
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Harris JK, Cyr J, Carothers BJ, Mueller NB, Anwuri VV, James AI. Referrals among cancer services organizations serving underserved cancer patients in an urban area. Am J Public Health 2011; 101:1248-52. [PMID: 21566039 DOI: 10.2105/ajph.2010.300017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Significant racial, socioeconomic, and geographic disparities exist nationwide in cancer screenings, treatments, and outcomes. Differences in health and social service provision and utilization may contribute to or exacerbate these disparities. We evaluated the composition and structure of a referral network of organizations providing services to underserved cancer patients in an urban area in 2007. We observed a need for increased awareness building among provider organizations, broader geographic coverage among organizations, and increased utilization of tobacco cessation and financial assistance services.
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Affiliation(s)
- Jenine K Harris
- Center for Tobacco Policy Research, Washington University, St Louis, MO, USA.
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194
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Astell-Burt T, Flowerdew R, Boyle PJ, Dillon JF. Does geographic access to primary healthcare influence the detection of hepatitis C? Soc Sci Med 2011; 72:1472-81. [DOI: 10.1016/j.socscimed.2011.02.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 12/07/2010] [Accepted: 02/06/2011] [Indexed: 12/27/2022]
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195
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Jackson LA, Unruh A, Donahue M. Living in a Rural Community Is Good for Your Health … Or Is It? Young Women Talk About Rural Living and Their Emotional and Mental Health. ACTA ACUST UNITED AC 2011. [DOI: 10.7870/cjcmh-2011-0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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196
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Wang JY, Bennett K, Probst J. Subdividing the digital divide: differences in internet access and use among rural residents with medical limitations. J Med Internet Res 2011; 13:e25. [PMID: 21371989 PMCID: PMC3221347 DOI: 10.2196/jmir.1534] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 11/15/2010] [Accepted: 11/15/2010] [Indexed: 12/02/2022] Open
Abstract
Background Access to health care is often contingent upon an individual’s ability to travel for services. Certain groups, such as those with physical limitations and rural residents, have more travel barriers than other groups, reducing their access to services. The use of the Internet may be a way for these groups to seek care or information to support their health care needs. Objective The purpose of this study was to examine Internet use among those whose are, for medical reasons, limited in their ability to travel. We also examined disparities in Internet use by race/ethnicity and rural residence, particularly among persons with medical conditions. Methods We used data from the 2001 National Household Travel Survey (NHTS), a nationally representative sample of US households, to examine Internet use among individuals with medical conditions, rural residents, and minority populations. Internet use was defined as any use within the past 6 months; among users, frequency of use and location of use were explored. Control variables included sociodemographics, family life cycle, employment status, region, and job density in the community. All analyses were weighted to reflect the complex NHTS sampling frame. Results Individuals with medical conditions were far less likely to report Internet use than those without medical conditions (32.6% vs 70.3%, P < .001). Similarly, rural residents were less likely to report Internet access and use than urban residents (59.7% vs 69.4%, P < .001). Nationally, 72.8% of white respondents, versus 65.7% of persons of “other” race, 51.5% of African Americans, and 38.0% of Hispanics reported accessing the Internet (P < .001). In adjusted analyses, persons with medical conditions and minority populations were less likely to report Internet use. Rural-urban differences were no longer significant with demographic and ecological characteristics held constant. Conclusions This analysis confirmed previous findings of a digital divide between urban and rural residents. Internet use and frequency was also lower among those reporting a medical condition than among those without a condition. After we controlled for many factors, however, African Americans and Hispanics were still less likely to use the Internet, and to use it less often, than whites. Policy makers should look for ways to improve the access to, and use of, the Internet among these populations.
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Affiliation(s)
- Jong-Yi Wang
- Department and Graduate Institute of Health Services Administration, China Medical University, No.91 Hsueh-Shih Road, Taichung, Taiwan
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197
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Hightow-Weidman LB, Smith JC, Valera E, Matthews DD, Lyons P. Keeping them in "STYLE": finding, linking, and retaining young HIV-positive black and Latino men who have sex with men in care. AIDS Patient Care STDS 2011; 25:37-45. [PMID: 21162690 DOI: 10.1089/apc.2010.0192] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Young men who have sex with men (YMSM) of color are at particularly increased risk for HIV infection compared to white MSM. National data highlight the need to link YMSM of color to care to improve their overall health and stem further infections, yet, there is limited data on interventions and clinical outcomes focused on engaging and retaining youth, specifically HIV-infected YMSM of color in care. To address the medical care needs of this underserved population, in 2005, the Health Research and Services Administration (HRSA) created the YMSM of Color Initiative. Utilizing a social marketing campaign targeting youth and members of their sexual and social networks, testing and outreach on college campuses and within the broader community, and a tightly linked medical-social support network, we created STYLE (Strength Through Youth Livin' Empowered), a novel intervention that sought to diagnose, engage, and retain HIV-positive black and Latino YMSM in HIV primary care services. Over a 3-year period, 81 men were either newly diagnosed or reengaged in care. Overall, 63% of the cohort was retained in clinical care; defined as attending at least one medical visit every 4 months. Compared to the 3 years prior to STYLE, the odds ratio for whether or not someone attended a clinic visit was 2.58 (95% confidence interval [CI] 1.34-4.98) if enrolled in STYLE. We conclude that compared to a pre-STYLE cohort, STYLE was an effective intervention that increased HIV diagnoses, provided efficient and timely engagement in care for both those newly diagnosed and those who had fallen out of care and improved overall retention.
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Affiliation(s)
- Lisa B. Hightow-Weidman
- Division of Infectious Diseases, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Justin C. Smith
- Department of Health Behavior and Health Education, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erik Valera
- Division of Infectious Diseases, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Derrick D. Matthews
- Department of Health Behavior and Health Education, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Patrick Lyons
- Division of Infectious Diseases, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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198
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Abstract
BACKGROUND the associations between transportation, driving and successful ageing are as yet poorly understood. As longitudinal studies are the best methodology for clarifying associations and relationships between health, ageing and environmental factors, we sought to determine how transportation is incorporated into longitudinal studies, and which aspects are assessed. METHODS of 55 longitudinal studies on ageing on the National Institute on Aging register, online survey instruments, where available, were scrutinised for references to transport. Where unavailable, principal investigators were contacted by mail/email/phone and asked to forward questions on transportation and driving. Questions were classified into (i) systems, (ii) resources, (iii) transport satisfaction and (iv) mobility needs. RESULTS of 55 studies, we could review 36 questionnaires (28 personal replies, 9 accessible online survey instruments). Sixteen had no reference to driving or transportation, 20 (61%) had public transport components and 12 (31%) included questions about driving. Questions covered systems (17), transportation needs (12), transportation resources (11) and transportation satisfaction (4). CONCLUSION transport is under-represented in ongoing longitudinal studies, with emphases on public transport, systems and resources, rather than driving and satisfaction. Future waves of studies could usefully review their survey instruments to better measure older people's preferences on transport options and satisfaction.
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Affiliation(s)
- Mairead Bartley
- Centre for Ageing, Neuroscience and the Humanities, Trinity College, Dublin, Ireland
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199
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Smith ML, Ahn SN, Sharkey JR, Horel S, Mier N, Ory MG. Successful Falls Prevention Programming for Older Adults in Texas. J Appl Gerontol 2010. [DOI: 10.1177/0733464810378407] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study assessed health-related changes of participants attending A Matter of Balance/Volunteer Lay Leader (AMOB/VLL) model falls-prevention program for older adults based on their residential location. Data were examined from 1,482 older Texans enrolled in AMOB/VLL over a 2-year period and assessed at baseline and postintervention. Results indicate participants significantly increased falls efficacy by an average of 14.4% ( p < .01), reduced activity interference due to their health by an average of 6.5% ( p < .01), and decreased the number of days limited from usual activity by an average of 28.2% ( p < .05). Regression models show that rural participants, despite entering and exiting the program with lower health status, report greater rates of positive change for falls efficacy and health interference compared with their urban counterparts. Findings contribute to the understanding of geographic variation with falls-prevention program outcomes.
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Affiliation(s)
- Matthew Lee Smith
- Texas A&M Health Science Center School of Rural Public Health, College Station
| | - Sang Nam Ahn
- Texas A&M Health Science Center School of Rural Public Health, College Station
| | - Joseph R. Sharkey
- Texas A&M Health Science Center School of Rural Public Health, College Station
| | - Scott Horel
- Texas A&M Health Science Center School of Rural Public Health, College Station
| | - Nelda Mier
- Texas A&M Health Science Center South Texas Center, McAllen
| | - Marcia G. Ory
- Texas A&M Health Science Center School of Rural Public Health, College Station
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200
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McGwin G, Khoury R, Cross J, Owsley C. Vision impairment and eye care utilization among Americans 50 and older. Curr Eye Res 2010; 35:451-8. [PMID: 20465437 PMCID: PMC3592495 DOI: 10.3109/02713681003664931] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Few studies have provided population-based estimates of the vision impairment, eye disease and eye care in the United States. Using data from the Behavioral Risk Factor Surveillance System (BRFSS) this study reports the overall and age-race-specific prevalence of self-reported vision impairment, eye diseases, and eye care utilization among older adults. METHODS Between 2005 and 2008 residents aged 50 and older in 17 states responded to BRFSS questions concerning difficulty with distance and near vision-related tasks, self-reported eye diseases and reported eye care insurance and service utilization. RESULTS The overall prevalence of difficulty with distance and near vision was 16.6 and 32.8%, respectively with no meaningful change with increasing age. The prevalence of cataract, glaucoma, and macular degeneration was 19.6%, 6.4, and 5.8%; all of which increased dramatically with age. Nearly 69% of Whites and Blacks and 65% of Hispanics visited an eye care provider in the past year. Overall, among the approximately one-third of participants who did not visit an eye care provider in the past year, half indicated that they did not have any reason to go and 20% cited it was due to cost/insurance. CONCLUSION The continued and expanding use of the BRFSS Visual Impairment and Access to Eye Care module represents a unique opportunity to obtain population-based estimates of vision impairment, eye disease and perhaps most uniquely, eye care utilization. Moreover, the integration of this and other BRFSS modules will provide researchers the opportunity to evaluate the relationship between these estimates and other measures of health status and health care utilization. However, the self-reported nature of the BRFSS data is an important limitation that must be considered when interpreting the results.
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Affiliation(s)
- Gerald McGwin
- Department of Epidemiology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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