Older, hypertensive, and hypercholesterolemic fairgoers visit more booths and differ in their health concerns at a community health fair

Health risks and changes in self-efficacy following community health screening of adults with serious mental illnesses

Physical health screenings were conducted by researchers and peer wellness specialists for adults attending publicly-funded community mental health programs. A total of 457 adults with serious mental illnesses attended health fairs in 4 U.S. states and were screened for 8 common medical co-morbidities and health risk factors. Also assessed were self-reported health competencies, medical conditions, and health service utilization. Compared to non-institutionalized U.S. adults, markedly higher proportions screened positive for obesity (60%), hypertension (32%), diabetes (14%), smoking (44%), nicotine dependence (62%), alcohol abuse (17%), drug abuse (11%), and coronary heart disease (10%). A lower proportion screened positive for hyperlipidemia (7%). Multivariable random regression analysis found significant pre- to post-screening increases in participants’ self-rated abilities for health practices, competence for health maintenance, and health locus of control. Screening identified 82 instances of undiagnosed diabetes, hypertension or hyperlipidemia, and 76 instances where these disorders were treated but uncontrolled. These results are discussed in the context of how this global public health approach holds promise for furthering the goal of integrating health and mental health care.

The reach and rationale for community health fairs

Latinos living in the USA account for one third of the uninsured population and face numerous cultural, linguistic, and financial barriers to accessing healthcare services. Community health fairs have developed to address the unmet need for no- and low-cost services that target prevention and education among underserved communities. The current research describes an ongoing effort in a community in Southern California and examines the barriers to health care among participants registering to receive free breast health screenings, one of the major services offered at a 2010 health fair. A total of 186 adult Latina women completed a brief questionnaire assessing their healthcare utilization and self-reported barriers to engaging in preventive and screening services. Approximately two thirds of the participants reported never receiving or having more than 2 years passing since receiving a preventive health check-up. Participants identified cost (64.5%) and knowledge of locations for services (52.3%) as the primary barriers to engaging in routine healthcare services. Engaging with health professionals represents a leading way in which adults obtain health information; health fairs offering cancer health screenings represent a culturally appropriate venue for increased cancer health equity. Implications of the current research for future health fairs and their role in community cancer education are discussed.

Health screening dialouges

Nurses can play an important role in community-based health screenings, which are a practical resource to empower people living with mental and substance use disorders to make positive lifestyle changes. The experiences, struggles, and strengths of screening participants provides insights for nurses to engage people in health and wellness dialogues.

Increasing access to cholesterol screening in rural communities catalyzes cardiovascular disease prevention

PURPOSE

Despite increasing frequency, little evidence guides cholesterol screening in less traditional health care settings, such as rural health fairs.

METHODS

The Miller School of Medicine Department of Community Service (DOCS) is a student-run organization providing free basic health care to underserved South Florida communities. We retrospectively reviewed all new patients seen at 2007 DOCS rural fairs to describe their low-density lipoprotein (LDL) and high-density lipoprotein (HDL) values. In addition, we assessed if patient characteristics were associated with cholesterol abnormalities and whether patients with abnormalities who returned to a subsequent fair in 2008 or 2009 improved their cholesterol.

FINDINGS

Of 252 patients, 145 (58%) had an LDL cholesterol over 129 mg/dL and 61 (24%) had an HDL cholesterol below 40 mg/dL or 50 mg/dL for males and females, respectively. Baseline LDL cholesterol was not associated with body-mass index (BMI), age over 60 years, gender, healthy lifestyle habits, or insurance status. Of 36 patients with elevated LDL cholesterol and a follow-up screening, 24 (67%) reduced their LDL cholesterol by at least 16 mg/dL though reductions were not associated with BMI reduction, and 22 (61%) increased their HDL cholesterol by at least 5 mg/dL, trending with BMI reduction.

CONCLUSIONS

Cholesterol screening at rural fairs can identify a high proportion of patients with abnormal cholesterol, including those who might not be considered at high risk. Although this may catalyze favorable cholesterol changes, the lack of an association with weight loss suggests patients seek additional medical care, which should be considered before offering cholesterol screening at fairs.

Thyroid disease awareness is associated with high rates of identifying subjects with previously undiagnosed thyroid dysfunction

BACKGROUND

Conventional screening for hypothyroidism is controversial. Although hypothyroidism is underdiagnosed, many organizations do not recommend screening, citing low disease prevalence in unselected populations. We studied attendees at a thyroid health fair, hypothesizing that certain patient characteristics would enhance the yield of testing.

METHODS

We carried out an observational study of participants at a Michigan health fair that focused on thyroid disease. We collected patient-reported symptoms and demographics by questionnaire, and correlated these with the TSH values obtained through the health fair.

RESULTS

794 of 858 health fair attendees participated. Most were women, and over 40% reported a family history of thyroid disease. We identified 97 (12.2%) participants with previously unknown thyroid dysfunction. No symptom or combination of symptoms discriminated between hypothyroid and euthyroid individuals. Hypothyroid and euthyroid participants in the health fair reported each symptom with a similar prevalence (p > 0.01), a prevalence which was very high. In fact, when compared with a previously published case-control study that reported symptoms, the euthyroid health fair participants reported a higher symptom prevalence (range 3.9% to 66.3%, mean 31.5%), than the euthyroid individuals from the case-control study (range 2% to 54%, mean 17.4%).

CONCLUSIONS

A high proportion of previously undiagnosed thyroid disease was identified at this health fair. We initially hypothesized symptoms would distinguish between thyroid function states. However, this was not the case in this health fair screening population. The prevalence of reported symptoms was similar and high in both euthyroid and hypothyroid participants. Because attendees were self-selected, it is possible that this health fair that focused on thyroid disease attracted participants specifically concerned about thyroid health. Despite the lack of symptom discrimination, the much higher prevalence of hypothyroidism in this study (12%) compared with the general population (<2%) suggests that screening may be appropriate and effective in certain circumstances such as thyroid health fairs.

Lessons learned from a black and minority health fair's 15-month follow-up counseling

BACKGROUND

Little is known about the impact of community health fairs on participants' health knowledge, literacy, attitudes, or behaviors. Few health fairs have provided followup services for participants.

OBJECTIVE

To evaluate the short-term (baseline) and long-term (10-month follow-up) health effects of exposure to the Indiana Black and Minority Health Fair (BMHF) and to assess the impact of personalized 15-month follow-up health counseling sessions for the BMHF participants who agreed to the sessions.

METHODS

A prospective panel study design was utilized with a pre-post test in addition to a cross-sectional survey design.

RESULTS

Although few behavioral changes were observed between the baseline and the precounseling 10-month follow-up, more people perceived themselves as overweight (68.1% vs 65.3%, p < .01) and fewer people watched TV/videos 4 hours or more on a usual weekday (25.6% vs 47.0%, p <.001) than 10 months before. After the 15-month follow-up health counseling sessions, the intervention group reported substantial and meaningful improvements in self-reported general health status, health status compared to 6 months earlier, percentage of overweight or obese people, choosing leaner meats over those higher in fat, snacking while watching TV or videos, and placing a high priority on exercise when planning a schedule.

CONCLUSIONS

A follow-up component to the health fair is not only necessary but also in demand for improving health literacy and healthy outcomes for participants. Efforts should be made to transform health fair encounters from episodic experiences to long-term educational experiences that spur individuals to make the necessary changes to enhance their health.

Improving access to comprehensive injury risk assessment and risk factor reduction in older adult populations

Preventing injuries in older populations (aged 50-86 years) is more complex than in younger populations because of frailty, comorbidities, polypharmacy, and physical and cognitive functional limitations. To improve accessibility and delivery of comprehensive, focused injury prevention, we developed a model incorporating applicable features of our national children's program with additional elements to address challenges of older populations. The older adult injury prevention model addresses gaps in prevention by improving access to risk factor screening, safety devices, education, counseling, medical care, and referrals.