A. Scott LaJoie

Facilitators and Barriers to Self-management of Type 2 Diabetes Among Urban African American Adults Focus Group Findings

Purpose The purpose of this study was to identify facilitators and barriers to self-management of type 2 diabetes mellitus (T2DM) among urban African American adults. Methods Thirty-eight African American adults with T2DM were recruited from 1 of 3 health care agencies in a midsized city in the southeastern United States. Qualitative data were obtained using focus groups, wherein each participant engaged in a 60- to 90-minute audio-recorded session. Focus group data were transcribed and analyzed using Atlas ti 6 ® data analysis software. Demographic and medical history information was also collected. Results Factors relating to external locus of control primarily facilitated adherence to T2DM self-management behaviors. Support from family, peers, and health care providers positively influenced adherence behaviors by providing cues to action, direct assistance, reinforcement, and knowledge. Internal factors were primarily described as barriers to self-management behaviors and included fears associated with glucose monitoring, lack of self-control over dietary habits, memory failure, and perceived lack of personal control over diabetes. Conclusions African Americans perceived external factors as facilitators of their T2DM management behaviors and internal factors as barriers to self-management. Further research is necessary to design and test interventions that capitalize on the external facilitators while helping African Americans to overcome perceived barriers identified in this study.

Health information and risk behaviors among lesbian, gay, and bisexual college students

Purpose: To describe differences in alcohol use, marijuana use, and smoking behaviors between lesbian, gay, and bisexual (LGB) and heterosexual college students, and determine whether there was a difference in the health information each group received. Data sources: A random sample of 3000 college students aged 18–24 years who were currently enrolled at a southeastern metropolitan university on a full‐time basis were invited to participate. The final sample (n= 772) consisted of heterosexuals (n= 731) and LGB (n= 41) college students. Gay and bisexual men (n= 20) and lesbian and bisexual women (n= 21) were compared to heterosexual college students. Conclusions: Lesbian/bisexual women were 4.9 times more likely to smoke, 10.7 times more likely to drink, and 4.9 times more likely to use marijuana than heterosexual women. Gay/bisexual men did not significantly differ from heterosexual men. There was no difference in the health information on alcohol and drug prevention the groups received. Gay/bisexual men were less likely (p= .02) compared to heterosexual men to have received tobacco prevention information. Implications for practice: Advanced practice nurses must ensure that every patient receives preventive services and anticipatory guidance at every visit. LGB clients in particular need health assessments and interventions appropriate to their individual risk profiles.

Determining the sensitivity and specificity of common diagnostic tests for carpal tunnel syndrome using latent class analysis.

Background: The accuracy of a diagnostic test used to classify a patient as having disease or being disease-free is a valuable piece of information to be used by the physician when making treatment decisions. If a standard reference test is available, determining the sensitivity and specificity of a new test is straightforward. However, if that reference test is incorrectly assumed to be perfectly sensitive and specific, the errors of the reference test can result in an underestimation of the accuracy of the test being evaluated. Latent class analysis can be applied to determine the sensitivity and specificity of a new test when no standard exists. Methods: Latent class analysis was used to determine the accuracy rates of three commonly used measures of carpal tunnel syndrome: Tinel’s sign, Phalen’s test, and the nerve conduction velocity test. Data included 162 wrists from 81 patients seeking treatment for symptoms associated with carpal tunnel syndrome. Results: Tinel’s sign and Phalen’s test were both highly sensitive (0.97 and 0.92, respectively) and specific (0.91 and 0.88, respectively). The sensitivity and specificity of the nerve conduction velocity test were 0.93 and 0.87, respectively. Conclusion: Estimates of the sensitivity and specificity of these common tests for carpal tunnel syndrome support their widespread clinical use.

Relaxation Response and Resiliency Training and Its Effect on Healthcare Resource Utilization.

Background Poor psychological and physical resilience in response to stress drives a great deal of health care utilization. Mind-body interventions can reduce stress and build resiliency. The rationale for this study is therefore to estimate the effect of mind-body interventions on healthcare utilization. Objective Estimate the effect of mind body training, specifically, the Relaxation Response Resiliency Program (3RP) on healthcare utilization. Design Retrospective controlled cohort observational study. Setting: Major US Academic Health Network. Sample: All patients receiving 3RP at the MGH Benson-Henry Institute from 1/12/2006 to 7/1/2014 (n = 4452), controls (n = 13149) followed for a median of 4.2 years (.85–8.4 yrs). Measurements: Utilization as measured by billable encounters/year (be/yr) stratified by encounter type: clinical, imaging, laboratory and procedural, by class of chief complaint: e.g., Cardiovascular, and by site of care delivery, e.g., Emergency Department. Subgroup analysis by propensity score matched pre-intervention utilization rate. Results At one year, total utilization for the intervention group decreased by 43% [53.5 to 30.5 be/yr] (p <0.0001). Clinical encounters decreased by 41.9% [40 to 23.2 be/yr], imaging by 50.3% [11.5 to 5.7 be/yr], lab encounters by 43.5% [9.8 to 5.6], and procedures by 21.4% [2.2 to 1.7 be/yr], all p < 0.01. The intervention group’s Emergency department (ED) visits decreased from 3.6 to 1.7/year (p<0.0001) and Hospital and Urgent care visits converged with the controls. Subgroup analysis (identically matched initial utilization rates—Intervention group: high utilizing controls) showed the intervention group significantly reduced utilization relative to the control group by: 18.3% across all functional categories, 24.7% across all site categories and 25.3% across all clinical categories. Conclusion Mind body interventions such as 3RP have the potential to substantially reduce healthcare utilization at relatively low cost and thus can serve as key components in any population health and health care delivery system.

Prehabilitation and Quality of Life Three Months after Total Knee Arthroplasty: A Pilot Study

Knee osteoarthritis (OA), which affects over 27 million Americans, decreases the individuals quality of life through decreasing mobility, deconditioning, reducing functional ability, and increasing knee pain. The present aim was to assess whether such patients engaging in exercise prior to surgery (“prehabilitation”; preoperative exercise intervention) rate higher quality of life 3 mo. after their surgery compared with ratings by patients who did not engage in prehabilitation. Standard populations consist of OA patients that do not participate in any preoperative exercise programs, such as a prehabilitation exercise intervention. 18 knee osteoarthritis patients were randomly assigned to a control or a prehabilitation group. The latter group participated in an exercise intervention three times per week, once at home and twice at the physical therapy lab, for 8 wk. prior to their surgery. The control group participated in their usual preoperative care prescribed by the physician for all patients. Eight health-related quality of life domains were assessed at 3 mo. post surgery. These preliminary findings suggest efficacy of prehabilitation in facilitating quality of life of total knee arthroplasty (TKA) patients 3 mo. after surgery.

Gender Differences in Diabetes Self-Management Among African American Adults

The rising incidence of diabetes complications among African Americans is a major health concern. Few studies have addressed gender differences in diabetes self-management in this population. The purpose of this study was to determine whether gender differences in facilitators and barriers to self-management exist among African American adults with type 2 diabetes. Thirty-eight participants were recruited from community agencies and each participated in one of seven audio-recorded focus group sessions. Regular health care visits, positive outlook, prioritization of health, and independence facilitated self-management behaviors in men, whereas acceptance of diabetes was a facilitator for women. Lack of time at work, lack of family support, and lack of knowledge were barriers for men, whereas lack of finances, embarrassment, negative outlook, perceived lack of disease control, and adverse effects of medications were barriers for women. Further research is necessary to design and test gender-specific tailored interventions to improve diabetes self-management in this population.

Undressing "health fashion": an examination of health-cause clothing and accessories.

Today, fashion items such as rubber wristbands in various colors, pink ribbons, and red dresses represent different health-related causes and can be seen frequently across demographic groups. Complete with pithy slogans (e.g., “Go Red for Women”), these items are part of a larger “health fashion” trend—one that involves wearing, using, and displaying health-cause clothing and accessories. In this article, the authors explore recent interest in “health fashion,” examining in particular its origins, effectiveness, and implications.

Intention to seek mental health treatment for adolescent girls: Comparison of predictors in mothers and daughters

PROBLEM To examine predictors of intention to seek mental health treatment for adolescent girls in mothers and daughters. METHODS In this cross-sectional study, mothers and adolescent daughters (n = 71) completed measures of behavioral attitudes, subjective norms, perceived behavioral control, and intention to seek mental health treatment for the adolescent daughter. FINDINGS Behavioral attitude and perceived behavioral control predicted intention to seek mental health treatment among mothers. Behavioral attitude predicted intention among daughters. There were no associations between mothers and daughters on study variables. CONCLUSIONS To promote shared decision making and engagement in mental health treatment, clinicians may target interventions to the mothers perceived behavioral control and behavioral attitudes of daughters and mothers. Based upon study results, clinicians should promote shared decision making and concordance between mothers and daughters on attitudes toward mental health treatment.

Influencers and preference predictors of HPV vaccine uptake among US male and female young adult college students

Objective The purpose of the study was to assess the knowledge, attitudes and beliefs of male and female college students in Kentucky about HPV associated diseases and vaccines, and to determine which parameters predicted self-reported uptake of HPV vaccination. Materials and methods A self-selected cross-sectional sample of college students completed an evidence-based online survey. Results Of approximately 1200 potential respondents, 585 completed the survey. The average age was 20.6 (SD 3.15) and 78% were female; 84% of the population had had one or more sexual partners. Concern for HPV vaccine safety and potential need for boosters did not significantly deter vaccine uptake. Likewise, knowledge about HPV associated cancers was not predictive of vaccine uptake. On the other hand, parental influence for vaccination was a strong predictor for vaccine uptake (aOR = 5.32, 2.71–13.03), and free vaccine nearly doubled the likelihood of being vaccinated (aOR 1.90, 1.05–3.41). In addition, the strong preference for the respondents partner to be HPV vaccinated predicted vaccine uptake (aOR = 4.04, 95% CI: 2.31–7.05), but the lack of preference for partner vaccination predicted an unvaccinated self (aOR = 0.50, 0.27–0.93). Conclusions HPV vaccination has been successful in young adult college students in Kentucky. Young adults prefer their partners to be HPV vaccinated regardless of whether they themselves are vaccinated. Parental influence and free vaccine were positive predictors for vaccine uptake in this population.

Cost-effectiveness of Strategies for Offering Influenza Vaccine in the Pediatric Emergency Department

Importance Influenza is a significant public health burden, causing morbidity and mortality in children, yet vaccination rates remain low. Vaccination in the pediatric emergency department (PED) setting may be beneficial but, to date, has not been proven to be cost-effective. Objective To compare the cost-effectiveness of 4 strategies for PED-based influenza vaccine: offering vaccine to all patients, only to patients younger than 5 years, only to high-risk patients (all ages), or to no patients. Design, Setting, and Participants Using commercial decision analysis software, a cost-effectiveness analysis was performed from January 1, 2016, to June 1, 2017, to compare influenza vaccine strategies at a tertiary, urban, freestanding PED with an estimated 60 000 visits per year among a hypothetical cohort of children visiting the above PED during influenza season. Sensitivity analyses estimated the effect of uncertainties across a variety of input variables (eg, influenza prevalence, vaccine price and effectiveness, and costs of complications). Main Outcomes and Measures The primary outcomes were cost and incremental cost-effectiveness ratio in dollars per influenza case averted. Secondary outcomes included total societal costs, hospitalizations and deaths averted, and quality-adjusted life-years gained. Results Offering influenza vaccine to all eligible patients has the lowest cost, at