Karen Peters

The effect of giving global coronary risk information to adults: a systematic review.

BACKGROUND Global coronary heart disease (CHD) risk estimation (ie, a quantitative estimate of a patients chances of CHD calculated by combining risk factors in an empirical equation) is recommended as a starting point for primary prevention efforts in all US adults. Whether it improves outcomes is currently unknown. METHODS To assess the effect of providing global CHD risk information to adults, we performed a systematic evidence review. We searched MEDLINE for the years 1980 to 2008, Psych Info, CINAHL, and the Cochrane Database and included English-language articles that met prespecified inclusion criteria. Two reviewers independently reviewed titles, abstracts, and articles for inclusion and assessed study quality. RESULTS We identified 20 articles, reporting on 18 unique fair or good quality studies (including 14 randomized controlled studies). These showed that global CHD risk information alone or with accompanying education increased the accuracy of perceived risk and probably increased intent to start therapy. Studies with repeated risk information or risk information and repeated doses of counseling showed small significant reductions in predicted CHD risk (absolute differences, -0.2% to -2% over 10 years in studies using risk estimates derived from Framingham equations). Studies providing global risk information at only 1 point in time seemed ineffective. CONCLUSIONS Global CHD risk information seems to improve the accuracy of risk perception and may increase intent to initiate CHD prevention among individuals at moderate to high risk. The effect of global risk presentation on more distal outcomes is less clear and seems to be related to the intensity of accompanying interventions.

Sources of attrition in a church-based exercise program for older African-Americans.

Among 123 older African Americans recruited into a church-based exercise program, 43% had dropped out within four months. Compared to those who did not drop out, drop outs had lower levels of education, energy to do activities, energy to exercise, and self-ratings of health, all based on measures taken before the class. Over half of those who dropped out cited non-exercise related health problems, and 17% caregiver responsibilities. Of those who dropped out, half said they would continue to exercise and 32% said they intended to start within the next six months.

Meeting the needs of rural populations through interdisciplinary partnerships.

Summary: This article describes the organization and outcomes of a Rural Health Outreach Initiative (RHOI) designed to increase collaboration between the medical education and health care delivery sectors to imrove the quality of health care delivery and health outcomes in rural communities. Two inter-related partnership strategies were utilized in rural communities to address the health and social service needs of rural populations. The partnerships were created through the efforts of a rural health professions education program located in a community-based medical school. The two partnership models were implemented at the same time and target the same rural populations. Both strategies relied upon interdisciplinary collaborations to achieve their goals and outcomes. One strategy involved the creation of partnerships among rural medical students and the projects they initiate, using the model of community oriented primary care (COPC). The second strategy involved the establishment of partnerships by a variety of rural, community-based entities that resulted from a three-year Health Resources and Services Administration Rural Health Outreach grant that supported a “mini-grant” program. This article summarizes the process and results of these innovative collaborations that occurred at two levels: (1) between health and service institutions representing multiple disciplines and (2) between academic institutions and local communities. Specific attention is given to projects that resulted from the work of the partnerships that address the needs of older adults residing in the rural communities. The two strategies are compared and implications for the success of similar efforts are discussed.

Physical activity and cognitive functioning: Translating research to practice with a public health approach

A growing body of research, from retrospective cross‐sectional studies to randomized clinical trials, suggests that physical activity among the elderly has positive effects on a wide range of physiologic systems and tissues, including the cardiovascular, immune, and endocrine systems, and even cognitive functioning. The latter is particularly relevant to the management of Alzheimers disease and other forms of dementia. There is increasing support that the positive effects of physical activity on cognitive functioning have been obtained at the primary (cognitively healthy older adults), secondary (persons with some loss of cognitive functioning to mild cognitive impairment), and tertiary (older adults with significant cognitive impairment) prevention levels. However, there are several specific components and potential roles for physical activity in the field of cognitive health and functioning that have not been addressed. Moreover, we argue that a population‐based public health perspective is needed as efforts to investigate the physical activity/cognitive health relationship are developed and disseminated for large‐scale implementation. This perspective discusses some of the problems that might be faced when translating basic research findings into public health practice for cognitive impairment and/or dementia in older adults and addresses how some of these problems might be overcome.

Health information preferences among Hispanic/Latino immigrants in the U.S. rural Midwest.

We investigated whether length of residence and other socio-demographic factors affect how rural Hispanic/Latino immigrants in the U.S. prefer to receive general health information. As part of a federally-funded participatory research project, we surveyed 894 adult Hispanics who were recruited through schools, community-based organizations (CBO) and faith-based organizations (FBO) in six rural communities of Illinois. Data suggest that workshops in Spanish at community settings are the most preferred health information strategy and home visits the least. Preference for these two strategies decreased significantly in the second generation, while preference for mailed printed materials increased. We further explored the role of length of residence in the U.S. on ‘in-person’ and ‘impersonal’ health information preferences controlling for other relevant socio-demographic factors finding that first generation and less educated Hispanic immigrants’ prefer ‘in-person’ strategies. These findings suggest that rural health organizations and practitioners should implement not only culturally-appropriate but also acculturation-sensitive approaches to address Hispanic/Latino immigrants’ specific health information needs.

Developing the Evidence Base to Inform Best Practice: A Scoping Study of Breast and Cervical Cancer Reviews in Low- and Middle-Income Countries

Background Breast and cervical cancers have emerged as major global health challenges and disproportionately lead to excess morbidity and mortality in low- and middle-income countries (LMICs) when compared to high-income countries. The objective of this paper was to highlight key findings, recommendations, and gaps in research and practice identified through a scoping study of recent reviews in breast and cervical cancer in LMICs. Methods We conducted a scoping study based on the six-stage framework of Arskey and O’Malley. We searched PubMed, Cochrane Reviews, and CINAHL with the following inclusion criteria: 1) published between 2005-February 2015, 2) focused on breast or cervical cancer 3) focused on LMIC, 4) review article, and 5) published in English. Results Through our systematic search, 63 out of the 94 identified cervical cancer reviews met our selection criteria and 36 of the 54 in breast cancer. Cervical cancer reviews were more likely to focus upon prevention and screening, while breast cancer reviews were more likely to focus upon treatment and survivorship. Few of the breast cancer reviews referenced research and data from LMICs themselves; cervical cancer reviews were more likely to do so. Most reviews did not include elements of the PRISMA checklist. Conclusion Overall, a limited evidence base supports breast and cervical cancer control in LMICs. Further breast and cervical cancer prevention and control studies are necessary in LMICs.

Building Capacity for Heart Disease and Stroke Prevention Research: The Cardiovascular Health Intervention Research and Translation Network

The Centers for Disease Control and Preventions Division for Heart Disease and Stroke Prevention created the Prevention Research Centers (PRCs) Cardiovascular Health Intervention Research and Translation Network (CHIRTN) in 2005 to develop partnerships and create a research agenda that addresses cardiovascular health promotion. Six participating universities with expertise in heart disease and stroke prevention research collaborate with their PRC partner communities and other partners to (a) conduct demonstration research projects and (b) identify gaps in knowledge and make recommendations for future research to address those gaps. This report describes the structure and current efforts of the CHIRTN. The goal of these efforts is to promote cardiovascular health for Americans, particularly underserved, at-risk populations.

The instructional impact of the American Medical Association's Older Drivers Project online curriculum.

The Older Drivers Project (ODP) of the American Medical Association has provided evidence-based training for clinicians since 2003. More than 10,000 physicians and other professionals have been trained via an authoritative manual, the Physicians Guide to Assessing & Counseling Older Drivers, and an associated continuing medical education five-module curriculum offered formally by multidisciplinary teams from 12 U.S. States from 2003 to 2008. An hour-long, online version was piloted with medical residents and physicians (N = 259) from six academic and physician office sites from 2010 to 2011. Pre/postsurveys were completed. Most rated the curriculum of high quality and relevant to their practice. A majority (88%) reported learning a new technique or tool, and 89% stated an intention to incorporate new learning into their daily clinical practice. More than one half (62%) reported increased confidence in addressing driving. This transition from in-person to online instruction will allow the ODP to reach many more clinicians, at all levels of training, in the years to come.

Implications of the aging process: opportunities for prevention in the farming community.

ABSTRACT This paper provides an overview of the demographic trends in aging, and of the process of aging and its implications on physical and mental health, with special reference to farmers. Agriculture employs more workers age 55 and over than any other industry (22.9% in agriculture versus 13.6% for all industries). Aging is an intricate process with inevitable physiological and physical impacts on the various body systems. These changes in the older farmer community are highlighted, along with preventive measures that can be adopted by farmers to maximize life span and quality of life. The farmer community can acquire knowledge about maintenance of workplace safety, preservation of good health, and prevention of chronic diseases that compromise healthy aging.

Impact of Telephone Reinforcement and Negotiated Contracts on Behavioral Predictors of Exercise Maintenance in Older Adults with Osteoarthritis

OBJECTIVES To examine the impact of telephone reinforcement (TR) on predictors of physical activity (PA) maintenance in older adults with osteoarthritis. METHODS Mixed effects modeling was conducted of data from a randomized PA trial that used negotiated maintenance contracts, supplemented by TR, to test impact of TR on barriers, decisional balance, and stage of change at multiple points in time. RESULTS Participants who were referred to a PA program and received TR improved the most in barriers and decisional balance. Participants who negotiated a tailored maintenance contract but did not receive TR improved the most in stage. CONCLUSIONS TR appears to positively affect perceptions around engagement, whereas negotiation positively impacts PA behavior. Further research should examine the effectiveness of specific PA maintenance strategies.