Carl V. Tyler

Screening for Osteoporosis in Community-Dwelling Adults with Mental Retardation.

Osteoporosis screening of adults ages 40 to 60 who attended community-based adult training centers was conducted utilizing dual-energy X-ray absorptiometry (DEXA) measurements of the calcaneus. Valid measurements were obtained on 107 individuals, a response rate of 94%. One fifth of the sample (21%) had osteoporosis and 34% had osteopenia. On multiple regression analysis, the most significant predictors of BMD were Down syndrome, mobility status, and race. Future studies involving larger samples of middle-age adults with mental retardation/developmental disabilities will clarify the need and optimum age for osteoporosis screening.

Mental illness and use of screening mammography among Medicaid beneficiaries.

BACKGROUND Disparities in receipt of preventive services by people with mental illness have been documented previously. However, whether these disparities extend to screening mammography among individuals experiencing comparable barriers to accessing care has not been examined fully. PURPOSE To determine whether disparities exist in receipt of screening mammography between women with and without mental illness enrolled in Medicaid, a program with documented potential to reduce healthcare disparities. METHODS Receipt of screening mammography was examined among women aged 50-64 years enrolled in Ohios Medicaid program during the years 2002-2008 (n=130,088). Receipt of annual screening mammography was examined among those with at least one screening mammography during the study period. Mental illness was identified through diagnostic, service, and pharmacotherapy codes (n=61,661). RESULTS Compared to women without mental illness, more women with mental illness received at least one screening mammography during the study period (31.7% vs 38.1%, p<0.001). However, after adjusting for potential confounders, including the presence of comorbid conditions and length of enrollment in Medicaid, women with mental illness were 32% less likely to undergo at least one screening mammography (AOR=0.68, 95% CI=0.66, 0.70). Among those who received at least one screening mammography, fewer women with mental illness received screening mammography on an annual basis (5.9% vs 12.7%, p<0.001; AOR=0.53, 95% CI=0.49, 0.56). For all beneficiaries, each year of enrollment in Medicaid increased the likelihood of screening mammography use by at least 50%. CONCLUSIONS Medicaid beneficiaries with mental illness constitute a particularly vulnerable population for suboptimal breast cancer screening.

Caring for adults with mental retardation: survey of family practice residency program directors.

In their core curriculum guidelines, the Society of Teachers of Family Medicine has recognized the importance of training family physicians in caring for persons with mental retardation. We mailed surveys to all family practice residency directors in the United States, questioning them about experiences and methods used to teach residents about health care needs of adults with mental retardation and the importance of this education. We found that 84% of programs provide residents with one or more experiences, and 60% instruct residents in this area. Most directors ranked this education as very important or important. There was no relationship between type or age of residency program and likelihood that residents were educated about mental retardation. The importance of this education is discussed.

Analyzing excess mortality from cancer among individuals with mental illness

The objective was to compare patterns of site‐specific cancer mortality in a population of individuals with and without mental illness.

Barriers to supplemental calcium use among women in suburban family practice: A report from the Cleveland Clinic Ambulatory Research Network (CleAR-eN)

Background: The majority of adult women in the United States fail to meet daily calcium intake recommendations. This study was undertaken to (1) identify predictors of calcium supplement use versus non-use, (2) understand barriers to calcium supplementation, and (3) determine the potential impact of physician recommendation on calcium supplement use. Methods: Surveys were self-administered by 185 women, ages 20 to 64, presenting consecutively for care at 6 suburban community-based family medicine practices within the Cleveland Clinic Ambulatory Research Network (CleAR-eN). We compared demographic characteristics, health beliefs, and health behaviors of those women who reported never using calcium supplements with those who presently took calcium supplements. Women who never took calcium were also queried about reasons for non-use and whether physician recommendation would influence their adoption of calcium supplementation. Results: Multivitamin use, self-perceived risk of osteoporosis, and age were independent predictors of calcium supplement use. Leading barriers for never-users were lack of knowledge about the need/importance of increasing calcium intake, lack of motivation to start supplements, and the belief that their dietary calcium intake alone was sufficient. Ninety-six percent of never-users reported that they would consider taking a calcium supplement if recommended by their physician. Conclusions: Many patient-identified barriers to calcium supplementation seem amenable to focused and brief office-based interventions that could increase the number of women meeting calcium intake guidelines.

Environmental health and developmental disabilities: a life span approach.

Prenatal and childhood environmental exposures are an underrecognized primary cause of intellectual and other developmental disabilities. In addition, individuals with established disabilities are vulnerable to further harm from subsequent environmental exposures. In individuals with communicative impairment or limited ability to independently escape from hazards, these subsequent exposures, too, may occur undetected or untreated. This article introduces the subject of environmental health and developmental disabilities throughout the life span. In particular, we focus on ways that families, communities, and health professionals can prevent both primary and secondary disabilities through better awareness of common environmental health issues.

The Palmore Facts on Aging Quiz: Are We Using It Correctly?

Abstract This study assessed geriatric medical educators on the Facts on Aging Quiz (Version 2) (FAQ2) and the relationship of personal or professional characteristics to these scores. A survey with FAQ2 and demographics was administered to attendees at a national geriatric conference. Data from 79 respondents revealed 44% female, mean age of 44 years old, 8.9 years working in geriatrics, and 82% of patient populations 65 years of age or older. The mean and median FAQ2 score was 15 out of 25, with no observable pattern of missed items and no personal or professional characteristics significantly related to FAQ2. Our survey suggests that geriatric medical educators may have knowledge deficits in areas addressed by FAQ2 and that this instrument may not be suited for evaluative use in medical education.

Community-engagement strategies of the developmental disabilities practice-based research network (DD-PBRN).

There is often a rich but untold history of events that occur and relationships that form before a practice-based research network (PBRN) is launched. This is particularly the case in PBRNs that are community based and comprise partnerships outside of the health care system. In this article we summarize an organizational “prenatal history” before the birth of a PBRN devoted to people with developmental disabilities. Using a case study approach, this article describes the historic events that preceded and fostered the evolution of this PBRN and contrasts how the processes leading to the creation of this multistakeholder, community-based PBRN differ from those of typical academic/clinical practice PBRNs. We propose potential advantages and complexities inherent to this newest iteration of PBRNs.

Calcium supplement use by African American women

INTRODUCTION Inadequate calcium intake is more common among women belonging to racial and ethnic minorities. This study examined the patterns and characteristics associated with calcium supplement use or nonuse among African American women, and the potential impact of physician recommendation on calcium supplementation. METHODS African American women aged 19 to 65, attending community outreach activities sponsored by a multispecialty academic medical center in northeastern Ohio, completed a calcium supplement survey. Survey items included demographic and bone health-related information, and rationale for calcium supplement use or nonuse. RESULTS Of 160 respondents, 14% of women regularly took calcium supplements, 16% were former users, and 70% never used calcium supplements. Characteristics associated with calcium use status included age, multivitamin use, and marital status. Few African American women recall discussions with their doctors about calcium intake. Most who formerly took calcium supplements and most who had never taken them were willing to do so if recommended by their physician. DISCUSSION Calcium supplement use among African American women in this study was low. However, many of the barriers to calcium supplement use by African American women appear remediable through brief calcium intake counseling by their physician.