Joan Walsh

Prospective Study of Etiologic Agents of Acute Gastroenteritis Outbreaks in Child Care Centers

OBJECTIVE To investigate the etiology of outbreaks of acute gastroenteritis (AGE) in children attending childcare centers (CCCs) in North Carolina between October 2005 and March 2007. STUDY DESIGN In this prospective study of outbreaks of AGE in CCCs, stool specimens from symptomatic children and environmental surface swabs were tested for adenovirus group F, astrovirus, norovirus (NoV), rotavirus group A, and sapovirus using real-time and conventional reverse transcription-polymerase chain reaction assays, and viruses were genotyped by sequencing. RESULTS A total of 29 AGE outbreaks were evaluated, of which 13 (45%) were caused by a single virus, including rotavirus group A (17%), NoV (10%), astrovirus (10%), and sapovirus (7%). Multiple viruses were detected in 3 outbreaks (10%). Environmental swabs from 13 of 22 outbreaks (59%) tested positive for at least 1 virus and confirmed the findings of the same virus in the fecal specimens for 10 of the outbreaks (45%). CONCLUSIONS This study confirms that viruses are major causes of AGE outbreak in CCCs. Our finding of widespread environmental contamination during such outbreaks suggests the need to study the effectiveness of current surface disinfectants against multiple gastroenteritis viruses in CCCs.

Health behavior changes in white and African American prostate cancer survivors

Prostate cancer prognosis may be improved by healthy behaviors; however, little is known regarding whether prostate cancer survivors make health behavior changes after diagnosis, and there are no data on racial/ethnic differences. This study explored patterns of and factors that influence healthy behavior changes in diet, physical activity, and dietary supplement use among whites and African Americans (n = 30) aged 45 to 70 years, approximately 1 year after diagnosis with localized prostate cancer. Data were collected by telephone using semistructured qualitative interviews. The mean participant age was 59.6 years, 77% had attended college, 87% were married, and 22% were retired. Most (58%) had improved their diet since diagnosis, defined as eating more fruits/vegetables and less fat. Although 77% reported regular use of at least 1 dietary supplement before diagnosis, several discontinued use after diagnosis. Sixty-seven percent exercised regularly before diagnosis, and most of these (75%) continued after diagnosis; however, time and health constraints were barriers. Physician recommendation and family support strongly influenced positive changes. Except for more postdiagnosis dietary improvements in African Americans, there were few racial differences in patterns/motives for behavior changes. Most respondents were motivated to maintain and/or adopt healthy behavioral changes after diagnosis. Nurses/physicians are encouraged to inform their prostate cancer patients about the benefits of healthy eating and regular exercise and about the absence of scientific evidence regarding the benefits/risks of most supplements, particularly herbal formulations.

Quality of Life Following Radiofrequency Ablation of Dysplastic Barrett’s Esophagus

BACKGROUND AND STUDY AIMS The impact of the diagnosis and treatment of dysplastic Barretts esophagus on quality of life (QoL) is poorly understood. This study assessed the influence of dysplastic Barretts esophagus on QoL and evaluated whether endoscopic treatment of dysplastic Barretts esophagus with radiofrequency ablation (RFA) improves QoL. PATIENTS AND METHODS We analyzed changes in QoL in the AIM Dysplasia Trial, a multicenter study of patients with dysplastic Barretts esophagus who were randomly allocated to RFA therapy or a sham intervention. We developed a 10-item questionnaire to assess the influence of dysplastic Barretts esophagus on QoL. The questionnaire was completed by patients at baseline and 12 months. RESULTS 127 patients were randomized to RFA (n = 84) or sham (n = 43). At baseline, most patients reported worry about esophageal cancer (71 % RFA, 85 % sham) and esophagectomy (61 % RFA, 68 % sham). Patients also reported depression, impaired QoL, worry, stress, and dissatisfaction with the condition of their esophagus. Of those randomized, 117 patients completed the study to the 12-month end point. Compared with the sham group, patients treated with RFA had significantly less worry about esophageal cancer ( P=0.003) and esophagectomy ( P =0.009). They also had significantly reduced depression ( P=0.02), general worry about the condition of their esophagus ( P≤0.001), impact on daily QoL ( P=0.009), stress ( P=0.03), dissatisfaction with the condition of their esophagus ( P≤0.001), and impact on work and family life ( P=0.02). CONCLUSIONS Inclusion in the treatment group of this randomized, sham-controlled trial of RFA was associated with improvement in disease-specific health-related quality of life. This improvement appears secondary to a perceived decrease in the risk of cancer.

Promoting fruit and vegetable consumption among members of Black Churches, Michigan and North Carolina, 2008-2010

Introduction Evidence-based health promotion programs that are disseminated in community settings can improve population health. However, little is known about how effective such programs are when they are implemented in communities. We examined community implementation of an evidence-based program, Body and Soul, to promote consumption of fruits and vegetables. Methods We randomly assigned 19 churches to 1 of 2 arms, a colon cancer screening intervention or Body and Soul. We conducted our study from 2008 through 2010. We used the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to evaluate the program and collected data via participant surveys, on-site observations, and interviews with church coordinators and pastors. Results Members of 8 churches in Michigan and North Carolina participated in the Body and Soul program. Mean fruit and vegetable consumption increased from baseline (3.9 servings/d) to follow-up (+0.35, P = .04). The program reached 41.4% of the eligible congregation. Six of the 8 churches partially or fully completed at least 3 of the 4 program components. Six churches expressed intention to maintain the program. Church coordinators reported limited time and help to plan and implement activities, competing church events, and lack of motivation among congregation members as barriers to implementation. Conclusions The RE-AIM framework provided an effective approach to evaluating the dissemination of an evidence-based program to promote health. Stronger emphasis should be placed on providing technical assistance as a way to improve other community-based translational efforts.

Rape-Related HIV Risk Concerns Among Recent Rape Victims

A sample of 62 recent rape victims who had received postrape medical care were interviewed an average of 6 weeks after being raped (M = 37.3 days, SD = 19.3 days) to examine fear or concern about contracting HIV as a result of rape. Fifty-seven of the 62 women (91.9%) reported some degree of initial fear or postrape concern about contracting HIV as a result of the rape, and 45 of the 62 women (72.6%) reported that theywere extremely fearful or concerned about contracting HIV. Women who were extremely fearful or concerned about contracting HIV were more likely to have been raped by a stranger. Reported fear/concern was not simply a function of current intensity of intrusive or avoidance symptoms of post-traumatic stress disorder. Fifty-one women (82.3%) wanted more information about HIV at postrape medical treatment visits

Cluster Randomized Trial of a Church-Based Peer Counselor and Tailored Newsletter Intervention to Promote Colorectal Cancer Screening and Physical Activity Among Older African Americans

Action Through Churches in Time to Save Lives (ACTS) of Wellness was a cluster randomized controlled trial developed to promote colorectal cancer screening and physical activity (PA) within urban African American churches. Churches were recruited from North Carolina (n = 12) and Michigan (n = 7) and were randomized to intervention (n = 10) or comparison (n = 9). Intervention participants received three mailed tailored newsletters addressing colorectal cancer screening and PA behaviors over approximately 6 months. Individuals who were not up-to-date for screening at baseline could also receive motivational calls from a peer counselor. The main outcomes were up-to-date colorectal cancer screening and Metabolic Equivalency Task (MET)-hours/week of moderate–vigorous PA. Multivariate analyses examined changes in the main outcomes controlling for church cluster, gender, marital status, weight, and baseline values. Baseline screening was high in both intervention (75.9%, n = 374) and comparison groups (73.7%, n = 338). Screening increased at follow-up: +6.4 and +4.7 percentage points for intervention and comparison, respectively (p = .25). Baseline MET-hours/week of PA was 7.8 (95% confidence interval [6.8, 8.7]) for intervention and 8.7 (95% confidence interval [7.6, 9.8]) for the comparison group. There were no significant changes (p = .15) in PA for intervention (−0.30 MET-hours/week) compared with the comparison (−0.05 MET-hours/week). Among intervention participants, PA increased more for those who participated in church exercise programs, and screening improved more for those who spoke with a peer counselor or recalled the newsletters. Overall, the intervention did not improve PA or screening in an urban church population. These findings support previous research indicating that structured PA opportunities are necessary to promote change in PA and churches need more support to initiate effective peer counselor programs.

Date and Acquaintance Rape: Development and Validation of a Set of Scales

At least 85% of rapes and attempted rapes of college women are perpetrated by nonstrangers, and more than 50% occur on dates. This study developed a set of scales measuring college womens susceptibility to date and acquaintance rape (DAR). Preliminary DAR scales and three convergent/discriminant validity scales were included in a questionnaire completed by 374 dormitory residents. Three reliable DAR scales emerged: Perceived Vulnerability, Self-Efficacy, and Self-Determination, as well as one marginally reliable scale: Victim-Blaming. Five of six predicted correlations between pairs of DAR scales were supported. Three of five hypothesized correlations between DAR scales and convergent/discriminant validity scales were supported. The DAR scales show promise as measures of womens susceptibility to DAR and as useful tools in rape prevention education.

Tailoring Health Interventions: An Approach for Working with African American Churches to Reduce Cancer Health Disparities

African Americans continue to experience disproportionately high rates of mortality and morbidity due to cancer. Understanding the issues, addressing the causes, and improving survival rates among African Americans will require a composite of strategies. Approaches that address the unique barriers, beliefs, and concerns of African Americans are needed.