J.J. Brennan

Childhood movement skills: predictors of physical activity in Anglo American and Mexican American adolescents?

Abstract We assessed the relationship between young childrens movement skills and their physical activity in early adolescence. Balance, agility, eye-hand coordination, and skinfold thicknesses in 207 Mexican American and Anglo American children (104 boys, 103 girls) were measured at ages 4, 5, and 6 years. Habitual physical activity was assessed at the age of 12 years by two interviewer-administered 7-day recalls. Ethnic differences in movement skills were not found. Young girls were better at jumping and balancing, and young boys were better at catching. Tracking of skills was low, and childrens early childhood skills were not related to their physical activity 6 years later. Further studies involving additional movement skills and other populations are recommended to determine if enhanced movement skills in children promote subsequent physical activity.

Acculturation, Parent–Child Acculturation Differential, and Chronic Disease Risk Factors in a Mexican-American Population

Acculturation is typically defined in terms of individual responses to a dominant culture. In the present study, we examined the effects of different levels of acculturation among family members. Specifically, we looked at the health and risk behavior in Mexican-American children as related to a variety of psychosocial predictors, especially the differences in orientation toward Mexican- and Anglo-American cultures between them and their parents. Mother and child pairs (n = 106) noted their orientation toward both Anglo and Mexican cultures. Children’s dietary and sedentary behaviors, tobacco and alcohol use (and susceptibility to use), and depressive symptoms were also measured. Males were more likely to be sedentary and consume higher levels of total fat and saturated fat, whereas girls reported higher levels of depression. Anglo-oriented youth consumed lower levels of calories from fat but also more alcohol than did their Mexican-oriented counterparts. The latter was particularly the case among those children who were relatively more Anglo oriented than were their parents. Parent–child acculturation differential in terms of the differences in Mexican orientation, in comparison, predicted susceptibility to tobacco use. However, the sum of the absolute values of these two differences predicted only lifetime alcohol use, and in a counter-intuitive direction. This familial measure of acculturation shows some promise, but additional formative research is needed to operationalize this construct.

Changes and tracking of physical activity across seven years in Mexican-American and European-American mothers.

ABSTRACT Longitudinal changes in physical activity among 129 Mexican-American (mean age 30.8; SD = 5.6) and 97 European-American (mean age 31.2; SD = 5.4) women were studied. Two physical activity recall interviews were administered at baseline and 7 years later. At baseline, European-American women reported more vigorous leisure activity (p <.005) than Mexican-Americans, and Mexican-Americans reported more moderate work activity (p <.02) than European-Americans. Virtually all components of physical activity increased significantly over the 7 years. Pearson tracking correlations for total energy expenditure were about r = 0.30. The finding that both groups increased physical activity over time was unexpected and was unrelated to a reduction in the number of preschool children in the homes over time.

A Conceptual Model for Faculty Development in Academic Medicine: The Underrepresented Minority Faculty Experience

In May 2010, the Association of American Medical Colleges reported that nonwhite professors have a lower promotion rate than white professors. A cohort of 30 underrepresented minority (URM) junior faculty who participated in a structured faculty development program at a public, research-intensive, academic medical center were followed in a 10-year longitudinal study. This paper reports on the career status of 12 of the 30 URM faculty who were eligible for promotion during this period. Ninety-two percent (11/12) of URM faculty eligible for promotion were promoted to associate professor. When asked what factors contributed to their success, these URM faculty identified access and support of senior faculty mentors, peer networking, professional skill development, and knowledge of institutional culture. A faculty development program that addresses these components can promote the success of URM faculty in academic medicine.

Application of the MASCC and CISNE Risk-Stratification Scores to Identify Low-Risk Febrile Neutropenic Patients in the Emergency Department

Study objective: Although validated risk‐stratification tools have been used to send low‐risk febrile neutropenic patients home from clinic and inpatient settings, there is a dearth of research evaluating these scores in the emergency department (ED). We compare the predictive accuracy of the Multinational Association for Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) scores for patients with chemotherapy‐induced febrile neutropenia and presenting to the ED. Methods: We conducted a retrospective cohort study to evaluate all patients with febrile neutropenia (temperature ≥38°C [100.4°F], absolute neutrophil count <1,000 cells/&mgr;L) who presented to 2 academic EDs from June 2012 through January 2015. MASCC and CISNE scores were calculated for all subjects, and each visit was evaluated for several outcome variables, including inpatient length of stay, upgrade in level of care, clinical deterioration, positive blood culture results, and death. Descriptive statistics are reported and continuous variables were analyzed with Wilcoxon rank sum. Results: During our study period, 230 patients presented with chemotherapy‐induced febrile neutropenia. The CISNE score identified 53 (23%) of these patients as low risk and was highly specific in the identification of a low‐risk cohort for all outcome variables (98.3% specific, 95% confidence interval [CI] 89.7% to 99.9%; positive predictive value 98.1%, 95% CI 88.6% to 99.9%). Median length of stay was shorter for low‐risk versus high‐risk CISNE patients (3‐day difference; P<.001). The MASCC score was much less specific (54.2%; 95% CI 40.8% to 67.1%) in the identification of a low‐risk cohort. Conclusion: Our results suggest that the CISNE score may be the most appropriate febrile neutropenia risk‐stratification tool for use in the ED.

Binational Care-Seeking Behavior and Health-Related Quality of Life Among HIV-Infected Latinos in the U.S.-Mexico Border Region

&NA; Although binational health care–seeking is common among HIV‐infected Latinos living near the U.S.‐Mexico border, information is lacking on whether regional indicators of health access are associated with Health‐Related Quality of Life (HRQL). This study examined health care–seeking behaviors across four HRQL domains (emotional well‐being, cognitive functioning, physical functioning, and pain) using linear regression. HIV‐infected Latinos (n = 239) were recruited from U.S. community clinics situated near the border shared by California with Mexico. In general, the Spanish‐speaking (81%) and male‐dominant (84%) population had positive indicators of HRQL. AIDS diagnosis predicted poorer HRQL (cognitive functioning, physical functioning, and pain), as did receipt of traditional medications and/or herbs in Mexico (physical functioning and pain). Staying for 1 or more months in Mexico in the past year was associated with higher cognitive functioning and less pain. Border‐related factors were inconsistently implicated in HRQL measures. Improved understanding of complementary and alternative medicine usage by HIV‐infected Latinos is warranted.

Lengths of stay for involuntarily held psychiatric patients in the ED are affected by both patient characteristics and medication use

BACKGROUND Psychiatric patients experience longer treatment times (length of stay [LOS]) in the emergency department (ED) compared to nonpsychiatric patients. Although patients on involuntary mental health holds are relatively understudied, common wisdom would hold that times for these patients can only be affected by addressing systems issues because they are not free to leave. The objective of this study was to determine whether both selected ED and patient-specific factors were associated with longer LOS. We hypothesized that nonmodifiable factors (age, sex, agitation, presentation during evenings/nights, presentation during weekends, suicidal ideation) would prolong LOS but that potentially modifiable factors (such as use of medication) would reduce LOS. METHODS A historical cohort of patients (January 1, 2009-August 16, 2010) placed on involuntary mental health holds was studied in 2 general EDs. A regression model was used to calculate the effects of modifiable and nonmodifiable factors on LOS. RESULTS Six hundred forty patient visits met all inclusion/exclusion criteria. Longer LOSs were significantly associated with suicidal ideation, use of antipsychotics, and use of benzodiazepines, although agitation did not predict longer LOSs. Longer LOSs were also longer with presentation on the weekends. CONCLUSIONS Lengths of stay for patients on involuntary mental health holds are associated with several factors outside the control of the typical ED clinician such as the ability to clear holds quickly due to day of week or placement of the hold for suicidal ideation. Lengths of stay are also increased by factors within the control of the typical ED clinician, such as administration of calming medication.

Cultural Adaptation of a Nutrition Education Curriculum for Latino Families to Promote Acceptance

Researchers who work with Latino populations contend that genetics, culture, immigration, and social and environmental conditions influence eating and activity behaviors in Latino families. 6 Thus, these factors should inform the processes and resources used to adapt a health education program from one United States population segment to another. The purpose of this paper is to describe how an existing nutrition education program was adapted for Latino families and to report indicators of its acceptability. To achieve a good fit, several components were considered in all aspects of the program, including both surface modifications, such as bilingual-bicultural educators, material translation, and incentive selections, as well as deep-structure characteristics of culture such as common values and culturally appropriate mealtime practices.

Supporting Positive Living and Sexual Health (SPLASH): A Clinician and Behavioral Counselor Risk-Reduction Intervention in a University-Based HIV Clinic

Effective HIV prevention interventions with HIV-positive persons are paramount to stemming the rate of new infections. This paper describes an HIV-clinic-based demonstration project aimed at decreasing patient HIV-transmission risk behaviors and sexually transmitted infections. Systematic, computer-assisted assessment of patient risk aided primary care providers in delivering prevention messages. Patients at greater risk were referred to an HIV Prevention Specialist for behavioral counseling. Patients completed a computerized behavioral staging assessment to self-identify risk behaviors and readiness to change behaviors and counseling messages were individually tailored based on computer assessment. Challenges to project implementation: primary care provider buy-in, patient privacy concerns during risk assessment, and low participation in behavioral counseling. Forty-six percent of persons completing a risk assessment (2,124) were at risk for HIV transmission. Of 121 patients who scheduled counseling appointments, 42% completed at least one session. Despite challenges, successful implementation of a clinic-based prevention intervention is feasible, particularly with attention to patient and provider concerns.

Inpatient Readmissions and Emergency Department Visits within 30 Days of a Hospital Admission

Introduction Inpatient hospital readmissions have become a focus for healthcare reform and cost-containment efforts. Initiatives targeting unanticipated readmissions have included care coordination for specific high readmission diseases and patients and health coaching during the post-discharge transition period. However, little research has focused on emergency department (ED) visits following an inpatient admission. The objective of this study was to assess 30-day ED utilization and all-cause readmissions following a hospital admission. Methods This was a retrospective study using inpatient and ED utilization data from two hospitals with a shared patient population in 2011. We assessed the 30-day ED visit rate and 30-day readmission rate and compared patient characteristics among individuals with 30-day inpatient readmissions, 30-day ED discharges, and no 30-day visits. Results There were 13,449 patients who met the criteria of an index visit. Overall, 2,453 (18.2%) patients had an ED visit within 30 days of an inpatient stay. However, only 55.6% (n=1,363) of these patients were admitted at one of these 30-day visits, resulting in a 30-day all-cause readmission rate of 10.1%. Conclusion Approximately one in five patients presented to the ED within 30 days of an inpatient hospitalization and over half of these patients were readmitted. Readmission measures that incorporate ED visits following an inpatient stay might better inform interventions to reduce avoidable readmissions.