Cynthia Herrick

Persistent Pain in Frail Older Adults After Hip Fracture Repair

Objectives: To identify factors associated with persistent hip pain in elderly hip fracture patients with physical frailty.

Enhancing Workplace Wellness Efforts to Reduce Obesity: A Qualitative Study of Low-Wage Workers in St Louis, Missouri, 2013-2014

Introduction The objective of this study was to examine workplace determinants of obesity and participation in employer-sponsored wellness programs among low-wage workers. Methods We conducted key informant interviews and focus groups with 2 partner organizations: a health care employer and a union representing retail workers. Interviews and focus groups discussed worksite factors that support or constrain healthy eating and physical activity and barriers that reduce participation in workplace wellness programs. Focus group discussions were transcribed and coded to identify main themes related to healthy eating, physical activity, and workplace factors that affect health. Results Although the union informants recognized the need for workplace wellness programs, very few programs were offered because informants did not know how to reach their widespread and diverse membership. Informants from the health care organization described various programs available to employees but noted several barriers to effective implementation. Workers discussed how their job characteristics contributed to their weight; irregular schedules, shift work, short breaks, physical job demands, and food options at work were among the most commonly discussed contributors to poor eating and exercise behaviors. Workers also described several general factors such as motivation, time, money, and conflicting responsibilities. Conclusion The workplace offers unique opportunities for obesity interventions that go beyond traditional approaches. Our results suggest that modifying the physical and social work environment by using participatory or integrated health and safety approaches may improve eating and physical activity behaviors. However, more research is needed about the methods best suited to the needs of low-wage workers.

Outside the Exam Room: Policies for Connecting Clinic to Community in Diabetes Prevention and Treatment

The public health burden and racial/ethnic, sex, and socioeconomic disparities in obesity and in diabetes require a population-level approach that goes beyond provision of high-quality clinical care. The Robert Wood Johnson Foundation’s Commission to Build a Healthier America recommended 3 strategies for improving the nation’s health: 1) invest in the foundations of lifelong physical and mental well-being in our youngest children; 2) create communities that foster health-promoting behaviors; and 3) broaden health care to promote health outside the medical system. We present an overview of evidence supporting these approaches in the context of diabetes and suggest policies to increase investments in 1) adequate nutrition through breastfeeding and other supports in early childhood, 2) community and economic development that includes health-promoting features of the physical, food, and social environments, and 3) evidence-based interventions that reach beyond the clinical setting to enlist community members in diabetes prevention and management.

Prenatal counseling on type 2 diabetes risk, exercise, and nutrition affects the likelihood of postpartum diabetes screening after gestational diabetes

ObjectiveScreening rates for type 2 diabetes after a pregnancy with gestational diabetes are inadequate. We aimed to determine how prenatal counseling on exercise, nutrition, and type 2 diabetes risk affects postpartum screening for diabetes.MethodsUsing Pregnancy Risk Assessment Monitoring System data from Colorado (2009–2011) and Massachusetts (2012–2013), we performed multivariable logistic regression to examine the relationship between prenatal counseling and postpartum screening.ResultsAmong 556 women, prenatal counseling was associated with increased postpartum diabetes screening, after adjusting for age; parity; and receipt of Women, Infants, and Children (WIC) benefits (adjusted odds ratio (AOR) 3.0 [95% CI 1.4–6.5]). This effect was modified by race/ethnicity. Primiparity (AOR 2.2 [95% CI 1.2–4.1]) and advanced maternal age (AOR 2.2 [95% CI 1.2–3.8]) were associated with increased screening, and receiving WIC benefits was associated with decreased screening (AOR 0.5 [95% CI 0.3–0.9]).ConclusionsIn women with gestational diabetes, culturally appropriate counseling on future diabetes risk, nutrition, and exercise may enhance postpartum diabetes screening.