Search

This study compared the quality of survey data collected from Mechanical Turk (MTurk) workers and college students. Three groups of participants completed the same survey. "MTurk" respondents completed the survey as paid workers using the Mechanical Turk crowdsourcing platform. "Student Online" respondents also completed the survey online after having been recruited in class. Finally, "Student Paper-and-Pencil" respondents completed the survey on paper in a classroom setting. Validity checks embedded in the survey were designed to gauge participants' haste and carelessness in survey completion. MTurk respondents were significantly more likely to fail validity checks by contradicting their own answers or simply completing the survey too quickly. Student groups showed fewer careless mistakes and longer completion times. The MTurk sample tended to be older, more educated, and more ethnically diverse than student samples. Results suggest that researchers should pay special attention to the use of validity checks when recruiting MTurk samples.

In the past, juvenile gang researchers have focused primarily on the characteristics of gangs and the prevalence of gangs in communities and schools. One of the greatest limitations of this research, however, surrounds the lack of agreement on the definition of a gang and, consequently, the prevalence of gangs in the community and in schools. In this paper, we attempt to provide a new method to (1) define a gang, from a triangulation of the perspectives of law enforcement, school principals, and gang researchers and (2) estimate the prevalence of gangs in schools in a three-state region. We determine that the type of definition used dramatically impacts estimates of the prevalence of gangs in schools. The limitations and implications of this finding for school administrators and law enforcement are also discussed. In the past, juvenile gang researchers have focused primarily on the characteristics of gangs and the prevalence of gangs in communities and schools. One of the greatest limitations of this research, however, surrounds the lack of agreement on the definition of a gang and, consequently, the prevalence of gangs in the community and in schools. In this paper, we attempt to provide a new method to (1) define a gang, from a triangulation of the perspectives of law enforcement, school principals, and gang researchers and (2) estimate the prevalence of gangs in schools in a three-state region. We determine that the type of definition used dramatically impacts estimates of the prevalence of gangs in schools. The limitations and implications of this finding for school administrators and law enforcement are also discussed. (Contains 2 tables and 3 notes.)

This paper presents information on re-developing an outcome evaluation for a state-funded program providing service coordination utilizing wraparound to youth with severe emotional disturbance (SED) and their families. Originally funded by the Robert Wood Johnson Foundation, the Kentucky IMPACT program has existed statewide since 1990. Changing data needs and limitations of the original evaluation required revamping the program's data collection system. The new evaluation uses the extant knowledge base to improve: (1) design, (2) measures, and (3) utility. A pre-post design with multiple follow-ups provides the framework for data collection. An ecological framework provides a conceptual structure for selecting measures focusing on both the service recipients and their environment. Data collection via a personal digital assistant (PDA) ensures utility of the data for both consumers and researchers. Issues ranging from conceptualization to implementation of the project as well as lessons learned are discussed. (Contains 1 table and 1 figure.)

This paper describes a research partnership conducted between Jefferson County (Ky.) Public Schools, the University of Louisville, and the University of Kentucky. The aim of the partnership was to share resources while meeting the different institutions' needs in areas such as research and recruitment. Although effective district and university collaboration means linking different entities, it is argued that this is not an unattainable goal. The objective of this article is to stimulate and promote greater interest in research partnerships that ultimately will reap benefits for students at all levels. (Contains 1 figure.)

Technology use is widespread in the lives of children and families, and parents and caregivers express concern about children's safety and development in relation to technology use. Children's librarians have a unique role to play in guiding the technology use of children and families, yet little is known about how public library programs facilitate children's digital literacy. This study sought to uncover librarians' purposes for using technology in programs with young children as well as the supporting factors and barriers they encountered in attempting to do so. Findings reveal 10 purposes for integrating technology into public library storytime programs and 15 factors across four dimensions that facilitate and/or inhibit its inclusion. If librarians are to embrace the media mentor role with confidence and the necessary knowledge and skills required of the task, much greater attention should be devoted to the responsibility and more support in the way of professional development and resources is necessary. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? People admitted to psychiatric facilities have high rates of tobacco use and hospitalizations present an opportunity for patients to have conversations about tobacco use treatment., Clinicians may believe that people with mental illnesses are not interested in quitting or that they do not understand the importance of treatment., Positive attitudes towards tobacco treatment, viewing that participating in treatment is normal care, and feeling that one is quite able to participate in such treatment predicts intentions to participate in treatment, which, in turn, predicts actual participation., What does this paper add to existing knowledge? Psychiatric patients who use tobacco use report poor prior involvement with tobacco treatment., Positive attitudes towards, encouraging opinions of other people about, and having a sense of control over taking part in tobacco treatment increases plans to engage in treatment., Having a sense of control in taking part in tobacco treatment is strongly associated with prior experiences with evidence-based treatment., What are the implications for practice? Because psychiatric hospitalizations are an opportunity for addressing tobacco use and treatment, clinicians should be prepared to support willing patients, especially those with prior substance use histories., Support should include providing them with information regarding tobacco treatment options during their hospital stay and ways that they can continue to receive care after discharge., Clinicians should be promoters of pro-tobacco treatment attitudes and supporting patients' sense of control over participating in treatment during hospitalization., Abstract Introduction Hospitalized tobacco users with mental illnesses ( MI) may face several barriers to stopping smoking. However, motivational factors that affect the intention to engage in tobacco treatment have been shown to predict actual engagement. Aim To use the Theory of Planned Behavior to assess intentions to and prior experiences of engaging in evidence-based tobacco treatment among hospitalized individuals with MI. Method A cross-sectional survey was conducted among 115 patients in a state psychiatric hospital. Multivariate analyses were used to examine associations with the intentions and prior experiences of engaging in tobacco treatment. Results After controlling for demographic and smoking history, attitudes, subjective norms and perceived behavioural control towards engaging in tobacco treatment were significantly associated with intentions towards treatment engagement. Only higher scores on perceived behavioural control and lower education levels were associated with reported prior experiences of tobacco treatment. Discussion The low prior treatment engagement scores, but relatively higher intention to engage scores among participants suggests the need for deliberate support for evidence-based tobacco treatment during psychiatric hospitalizations. Implications for practice Clinician training in tobacco treatment can promote self-efficacy to engage patients while supporting patients' control so that tobacco treatment is an expected component of psychiatric care. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate factors influencing one's decision to become a live kidney donor under the framework of sociotechnical systems, by expanding the focus to include larger organizational influences and technological considerations. Semi-structured interviews were conducted with live kidney donors who donated through University of Louisville Health, Trager Transplant Center, a mid-scale transplant program, in the years 2017 through 2019. The interview transcripts were analyzed for barriers and facilitators to live kidney donation within a sociotechnical system. The most salient facilitators included: having an informative, caring, and available care team; the absence of any negative external pressure toward donating; donating to a family or friend; and the ability to take extra time off work for recovery. The most recurrent barriers included: short/medium-term (<1 year) negative health impacts because of donation; the need to make minor lifestyle changes (e.g., less alcohol consumption) after donation; and mental health deterioration stemming from the donation process. The sociotechnical systems framework promotes a balanced system comprised of social, technical, and environmental subsystems. Assessing the facilitators and barriers from the sociotechnical system perspective revealed the importance of and opportunities for developing strategies to promote integration of technical subsystem, such as social media apps and interactive AI platforms, with social and environmental subsystems to enable facilitators and reduce barriers effectively. [ABSTRACT FROM AUTHOR]

In 1997, the Medicare Rural Hospital Flexibility Grant Program created the Critical Access Hospital (CAH) Program as a response to the financial distress of rural hospitals. It was believed that this program would reduce the rate of rural hospital closures and improve access to health care services in rural communities. The objective of this paper is to analyze the economic impact of the CAH Program on Kentucky's communities. Both an economic input-output model and a quasi-experimental control group method are used in this research paper. While the analysis using the input-output model uses data from the year 2006, the analysis using the quasi-experimental control group method uses data from 1989 to 2006. The results indicate that the rural counties where a CAH was adopted did appear to benefit in economic terms relative to those that did not have a CAH. [ABSTRACT FROM AUTHOR]

Rural Appalachian Kentucky adolescents are less likely to receive age-appropriate vaccinations compared with other populations and these low vaccination rates represent a major public health risk. This study investigates parental acceptance of adolescent vaccinations by examining their knowledge, attitudes, and behaviors related to vaccinating their adolescents with both state required and recommended vaccines. Using the integrated behavioral model as a guiding framework, the researchers conducted 21 in-depth interviews with parents of 11-18-year-old children in Appalachian Kentucky. Three salient findings emerged. First, knowledge was not strongly related to a parent's behavior, as both vaccinating parents and non-vaccinating parents expressed varying degrees of accurate knowledge. Second, attitudes emerged as an important predictor of behavior, such that parents with positive preventive health attitudes had the desire to protect their children's future through vaccination, indicating risk protection behavior could precede knowledge acquisition. Third, opinion leaders in the community served as important motivators for parents vaccinating their children, contributing to the knowledge-attitude-practice gap in that their influence seemed to be enough to drive behavior. The paper concludes with a discussion of the findings and appropriate communication strategies to use with parents of adolescents and local healthcare providers in order to improve both state required and recommended vaccination rates. The implications from this study could provide insights for designing similar interventions in other underserved, rural areas. [ABSTRACT FROM AUTHOR]

Background: Recent shifts to telemedicine and remote patient monitoring demonstrate the potential for new technology to transform health systems; yet, methods to design for inclusion and resilience are lacking.Objective: The aim of this study is to design and implement a participatory framework to produce effective health care solutions through co-design with diverse stakeholders.Methods: We developed a design framework to cocreate solutions to locally prioritized health and communication problems focused on cancer care. The framework is premised on the framing and discovery of problems through community engagement and lead-user innovation with the hypothesis that diversity and inclusion in the co-design process generate more innovative and resilient solutions. Discovery, design, and development were implemented through structured phases with design studios at various locations in urban and rural Kentucky, including Appalachia, each building from prior work. In the final design studio, working prototypes were developed and tested. Outputs were assessed using the System Usability Scale as well as semistructured user feedback.Results: We co-designed, developed, and tested a mobile app (myPath) and service model for distress surveillance and cancer care coordination following the LAUNCH (Linking and Amplifying User-Centered Networks through Connected Health) framework. The problem of awareness, navigation, and communication through cancer care was selected by the community after framing areas for opportunity based on significant geographic disparities in cancer and health burden resource and broadband access. The codeveloped digital myPath app showed the highest perceived combined usability (mean 81.9, SD 15.2) compared with the current gold standard of distress management for patients with cancer, the paper-based National Comprehensive Cancer Network Distress Thermometer (mean 74.2, SD 15.8). Testing of the System Usability Scale subscales showed that the myPath app had significantly better usability than the paper Distress Thermometer (t63=2.611; P=.01), whereas learnability did not differ between the instruments (t63=-0.311; P=.76). Notable differences by patient and provider scoring and feedback were found.Conclusions: Participatory problem definition and community-based co-design, design-with methods, may produce more acceptable and effective solutions than traditional design-for approaches. [ABSTRACT FROM AUTHOR]

Though COVID-19 has had sweeping implications, many immigrant groups in the United States have been disproportionately affected. The purpose of the present study is to explore the impact of COVID-19 on immigrant communities and how local immigrant-serving organizations (ISOs) have responded during the pandemic. The authors conducted in-depth qualitative interviews with executive directors and program coordinators of 31 ISOs and health clinics in Kentucky, North Carolina, and South Carolina. Findings highlight the needs of immigrants and refugees during the pandemic, including economic burden, lack of information, and limited access to testing and treatment for COVID-19. The authors find that ISOs have responded to these needs by providing basic supports, partnering with other local organizations to channel needed resources to immigrant communities, and collaborating with state-level entities to improve outreach, testing, and treatment. The authors also identify mechanisms that enabled the organizations to make nimble accommodations during the pandemic as well as the burden and compromises that these organizations have experienced. The authors argue that ISOs represent an important aspect of safety nets available for immigrants and provide insights into how other organizations can prepare for public health crises like COVID-19 in the future. [ABSTRACT FROM AUTHOR]

Background: Cancer care delivery approaches to address financial toxicity among cancer patients are not well- established, especially in rural communities. Objectives: To identify healthcare staff perspectives of financial toxicity experienced by cancer patients and to examine staff- and systems-level cancer care delivery approaches for addressing financial toxicity, with a focus on rural cancer survivors in Kentucky. Methods: We conducted key informant interviews using a semistructured interview guide with cancer center staff who provided financial navigation and/or assistance to oncology patients and their caregivers at 15 cancer centers in Kentucky. Results: Findings from this study revealed several key factors related to the availability and accessibility of cancer care delivery approaches at patient, staff, and system levels for reducing financial toxicity and improving access to care for rural and urban cancer survivors. Participants perceived high financial toxicity among cancer patients, especially in rural regions, related to the high cost of cancer care, as well the patients' limited ability to engage in cost-of-care conversations, low cost-related health literacy, and challenges in navigating cancer care. The availability of trained financial navigators/counselors dedicated solely to assisting the cancer patient population was limited, as was the use of standardized and proactive screening methods for financial toxicity. While in-house and external financial assistance programs were frequently tapped into, there were limitations in the navigators' ability to provide cost estimates based on insurance coverage and in assisting patients with applying for health insurance. Gaps in cancer care delivery approaches to reduce financial toxicity of patients included enhanced transportation options, additional financial navigation staff, early assessment of patient financial barriers and concerns, increased cost transparency, and enhanced cost-of-care conversations between patients and clinicians. Conclusion: Establishing sustainable oncology-designated financial navigation roles is imperative to expanding patient support and improving health and financial outcomes of cancer patients. Future research is needed to gather evidence that informs programs targeted at mitigating financial toxicity of cancer patients in rural communities. [ABSTRACT FROM AUTHOR]

Importance and Contribution of this Study: Variability exists in the passage of SARS-COV-2 IgG from asymptomatic COVID-19 mothers to their newly born infants. Awareness of SARS-COV-2 IgG may contribute to the management of asymptomatic RT PCR COVID-19 positive pregnant women, their newborns, and future vaccination practices. Objective: Characterize COVID testing results of asymptomatic COVID-19 positive pregnant women and their infants. Our assumption/hypothesis maintained that all infants born to asymptomatic COVID-19 positive mothers would have detectable SARS-CoV-2 specific IgG. Study Design: Retrospective chart review. Clinical demographics/COVID-19 testing of maternal/infant dyads were reviewed/collected for reporting purposes. Setting: Center for Women and Infants (CWI), University of Louisville Hospital, Louisville, KY. Participants: Asymptomatic COVID-19 positive pregnant women/infant dyads admitted to the CWI between June 2020 to February 2021. Results: 36 COVID-19 positive asymptomatic mother/37 infant dyads (one set of twins) reviewed. 38% of the mother/infant dyads were positive for SARS-CoV-2 IgG, while 27% of mother/infant dyads were negative for IgG. A COVID-19 positive mother of twins was IgG negative, but both twins were positive. Two mothers in this study group had developed significant COVID-19 disease at 28w4d gestation and 34w0d gestation. Both required intensive care but recovered, and their pregnancies were maintained until 37w4d and 39w3d gestation, respectively. By the time of delivery, both mothers had negative COVID-19 RT PCR testing, but both infants were positive for SARS-CoV-2 IgG antibodies. COVID-19 RT PCR testing on both of these infants at 24 and 48 hours of age was negative. Conclusion: SARS-CoV-2 IgG is passively transferred to the infant during pregnancy of asymptomatic positive COVID-19 mothers however appears variable and/or possibly based on the ability of IgG detection with current testing. Further investigation of the immune system's response to the SARS-CoV-2 virus during pregnancy can direct future management/treatment during pregnancy, especially in the wake of vaccination for the virus during pregnancy and emerging variants. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the relationship between school nurse presence and graduation rates, absenteeism, and American College Test (ACT) scores. A state-wide survey of all public high schools was undertaken (participation rate of 99.1%). Survey data obtained from individual high schools provided information on the employment status of school nurses. In addition to nurse presence determined by the survey, open-access electronic databases were used to determine graduation rates, absenteeism, ACT scores, money spent per pupil, gender, race–ethnicity proportion, and incarceration data. Study findings showed a possible relationship between students attending schools with a full-time nurse and significantly higher graduation rates, lower absenteeism, and higher ACT scores. The study results suggest that school nurses may contribute not just to health outcomes but to improved academic and economic outcomes as well. Of course, future work is needed to confirm these assertions. [ABSTRACT FROM AUTHOR]

Bystander-based violence prevention interventions have shown efficacy to reduce dating violence and sexual violence acceptance at the individual level yet no large randomized controlled trial (RCT) has evaluated this effect at the high-school level and over time. This rigorous cluster-randomized controlled trial addresses this gap by evaluating intervention effectiveness at both school and individual levels. Kentucky high schools were randomized to intervention or control conditions. In intervention schools educators provided school-wide 'Green Dot' presentations and bystander training with student popular opinion leaders. Each spring from 2010 to 2014; 73,044 students completed anonymous surveys with no missing data on relevant outcomes. Dating violence and sexual violence acceptance were the primary outcomes for this analysis. At the school level, slopes from linear mixed models using averaged school-level dating violence acceptance (condition-time, p < 0.001) and sexual violence acceptance (condition-time interaction, p < 0.001) differed indicating a significant reduction in the violence acceptance in the intervention relative to control schools over time and specifically in years 3 and 4 when 'Green Dot' was fully implemented. Analyses based on student's self-reported receipt of 'Green Dot' training by condition confirmed the school level finding of significant reductions in both dating violence and sexual violence acceptance in years 3 and 4 for both males and females. In this RCT we find evidence that the bystander-based violence prevention intervention 'Green Dot' works, as hypothesized and as implemented, to reduce acceptance of dating violence and sexual violence at the school and individual levels. [ABSTRACT FROM AUTHOR]

High rates of child welfare practitioner turnover remain a national problem with significant consequences. Title IV-E education and training programs prepare child welfare practitioners for this line of work with the intent that they will create long term careers. This study analyzed qualitative data from a 2016 statewide electronic survey launched to obtain frontline child welfare practitioner feedback about workforce turnover and assist the agency in retention efforts. Practitioner insight resulted in 189 responses specifically related to improving the state’s Title IV-E supported education and training program-the “Academy.” A qualitative thematic analysis identified three main themes: making it more realistic and hands on (n = 104), needing additional training and specific content (n = 45), and feeling overwhelmed with the experience (n = 40). Practitioner feedback illustrated the existing tensions with using a blended model to educate and train the workforce. Implications for Title IV-E education and training partnerships are discussed. [ABSTRACT FROM AUTHOR]

Purpose:Traumatic brain injury (TBI) is prevalent in Kentucky and comes with a high cost in care and quality of life for individuals and caregivers affected. Many people living with the condition of TBI have unmet needs. Research among people living with TBI in rural areas is limited. The purposes of this study were to (1) increase understanding of the lived experience of people with TBI and caregivers in rural regions of Kentucky across the continuum of their care and (2) provide their perspectives on barriers and facilitators of optimal function and well-being. Methods:A qualitative descriptive interview study was conducted by a multidisciplinary team. Content analysis was completed with data-derived coding and iterative modifications to analysis, coalescing codes into categories and themes. Results:Thirteen people with TBI and six caregivers participated in the interview. Categories that emerged in analysis included the experiences under each locus of care; themes included relationships, functional competence, and participation in meaningful activity. Conclusion:Relationships represented both barriers and facilitators of well-being. Major unmet needs persisted in terms of medical problems, support for caregivers, community linkages, and participation in meaningful activities. Recommendations are made regarding avenues for addressing unmet needs.Implications for RehabilitationPeople with TBI are living with chronic conditions and may need intensive rehabilitation after the injury and intermittent rehabilitation throughout life to develop and maintain functional competence.Rehabilitation providers need to understand the unique aspects of the rural home environment to which a patient will be discharged (e.g., mountainous terrain, lack of transportation, dimensions of home) and communicate with rural providers directly.Rehabilitation providers need additional focus on improving patient’s and caregiver’s abilities to advocate for themselves.Patients with TBI should be referred to vocational rehabilitation as soon as possible to make the transition to meaningful activity at home more of a possibility. [ABSTRACT FROM AUTHOR]

Purpose: Papanicolau (Pap) screenings disparities exist for immigrant women in the United States. This study sought to have an understanding of factors influencing Pap screening among sub-Saharan African immigrant women. Method: This is a qualitative descriptive study. Women were recruited from the community and by word of mouth following institutional review board approval. Data were gathered through in-depth focus group and demographic questionnaires. Interview sessions were digitally recorded and transcribed verbatim. Transcripts were analyzed for themes. Findings: Twenty-two women aged 24 to 65 years were interviewed. Barriers to screening included low knowledge of screening, cost, cultural beliefs, fear and communication issues. Motivators to improve Pap use include provider’s recommendations, enlightenment, and family support. Discussion: Interventions addressing the barriers peculiar to this population may alleviate these barriers and improve Pap screening use in this population. Providers have the opportunity to influence screening attitudes of African-born women by providing awareness and patient-targeted interventions. [ABSTRACT FROM AUTHOR]

Objective The study examined the relationship between exposure to e-cigarette advertising and e-cigarette use by pregnancy status, including use of flavored e-cigarette products, among women of childbearing age. Design A cross-sectional, correlational design was used. Subjects Female current or former tobacco users in Central and Eastern Kentucky, 18-45 years old ( N = 194, 52% pregnant). Measures Demographics, pregnancy status, cigarette and e-cigarette use, and exposure to e-cigarette advertising. Results Younger age, white non-Hispanic race, and greater exposure to e-cigarette advertising were associated with a higher likelihood of ever using e-cigarettes ( p < .05 for each variable). Pregnancy was not associated with ever use ( p = .11). Younger age was associated with use of flavored e-cigarettes ( p = .0027). Among e-cigarette users, those who used flavored products were more likely to have seen advertisements or information about e-cigarettes on social media, compared to those who used unflavored e-cigarettes only ( p = .016). Conclusion There is a link between advertising exposure and ever use of e-cigarettes. Pregnancy status is not significantly associated with ever use. Use of flavored e-cigarettes is associated with younger age. E-cigarette users with greater exposure to advertising on social media were more likely to use flavored products. [ABSTRACT FROM AUTHOR]

Background: Hemodialysis (HD) patients have high hospitalization rates. This nonrandomized trial tested the effect of a bundle of renal-specific "Right TraC™" strategies on 30-day all-cause readmission rates and, secondarily, 90-day readmissions and overall admissions among HD patients.Methods: Twenty-six Fresenius clinics in West Virginia, Ohio, and Kentucky participated in the interventions. Eighteen matched clinics served as controls; intervention clinics also served as their own controls. We deployed the intervention in 3 incremental phases focused on patient information exchange, post-hospital follow-up, and telephonic case management. Thirty-day hospital readmissions per patient year (ppy) were calculated by dividing the total number of readmissions within 30 days of index admission by the total number of patient-years in baseline (2012) and remeasurement (2014) periods. We also compared readmission rates from 2010 to 2015. We used repeated measures Poisson regression to compare outcomes between groups and time periods.Results: From 2012 to 2014, 30-day all-cause readmissions ppy declined for Right TraC clinics (from 0.88 to 0.66 [p < 0.001]; for controls, from 0.73 to 0.61 [p = 0.16]). Difference in change between groups was nonsignificant (p = 0.26). Overall admissions ppy declined: for Right TraC clinics from 2.51 to 1.97 (p < 0.001); for controls from 2.14 to1.92 (p = 0.21); difference in change between groups was significant (p = 0.01). For 2010, 2011, and 2012, Right TraC clinic 30-day readmissions ppy were unchanged: 0.89, 1.00, 0.88 (p = 0.61 and p = 0.49); they declined to 0.66 (p < 0.001) in 2014 (intervention year); rose to 0.70 (p = 0.06) in 2015 (interventions discontinued).Conclusion: We conclude that Right TraC interventions may have been helpful in reducing hospital readmission rates. [ABSTRACT FROM AUTHOR]

Aims: To describe correlations and agreement between salivary and serum B-type natriuretic peptide (BNP), C-reactive protein (CRP), interleukin (IL)-6, and IL-10 and determine which biomarkers predict worse functional class in patients with heart failure (HF). Methods: Serum and saliva were collected from 75 hospitalized patients with HF (57 ± 12 years, 43% female, New York Heart Association [NYHA] Classes I [4%], II [43%], and III [53%]). Oral inflammation was rated as good, fair, or poor. Spearman’s ρ and Bland–Altman were used to determine correlations and agreement of the salivary and serum forms of each biomarker. Logistic regressions were used to determine which biomarkers predicted worse NYHA functional class, controlling for depression, body mass index, smoking, and oral inflammation. Results: Median biomarker concentrations were as follows: BNP (serum 361 pg/ml, saliva 9 pg/ml), CRP (serum 13 ng/ml, saliva 25.6 ng/ml), IL-6 (serum 19.3 pg/ml, saliva 10.5 pg/ml), and IL-10 (serum 64.1 pg/ml, saliva 4.7 pg/ml). There was a moderate-to-strong correlation for serum–salivary CRP, weak correlation for serum–salivary IL-6, and no correlations for serum–salivary BNP and IL-10. The Bland–Altman test showed good salivary–serum agreement for all biomarkers, but as serum concentrations rose, salivary measures underestimated serum levels. Visible oral inflammation was the only predictor of worse NYHA class. [ABSTRACT FROM AUTHOR]

Adults spend a significant amount of time at work making the worksite a convenient venue for participation in health-promotion activities. This research project examined participants’ perceptions of gaining knowledge and changing health behavior practices as a result of knowledge gained through participation in health-promotion activities provided at the worksite. The worksite health-promotion activities were offered as a result of an innovative collaboration effort between nursing faculty in an academic setting and a community partner in the private sector. The findings demonstrate that participation in health-promotion activities at the worksite can result in increased knowledge and changes in health behavior practices as a result of knowledge gained. [ABSTRACT FROM PUBLISHER]

Purpose: The purpose of this study was to determine if increased frequency of telephone contact immediately following diabetes self-management education (DSME) impacts improvements in A1C levels versus routine telephone follow-up. Methods: This study used a quasi-experimental design consisting of a control group (n = 30) who received routine follow-up (1 telephone call 4–6 weeks after DSME class completion) and an intervention group (n = 26) who received an average of 5 telephone calls over a 3-month period following DSME. Participants were obtained from an outpatient diabetes education program assoctiated with a large urban health care system. Results: Most participants were female, White, with the average age of 57.2 years (SD = 14.1). Preintervention A1C levels ranged from 6.5% to 14.3%, whereas postintervention A1C levels ranged from 5.2% to 13.6%. There was significant improvement in A1C levels for both the intervention and the control groups. However, no statistically significant difference in A1C change scores was found between the groups. Sixty percent of the control group participants had post-A1C levels below 7% compared to 54% of the intervention group. Increased telephone contact was associated with A1C reductions, although this relationship was not statistically significant. Conclusions: This study demonstrated that A1C reductions can occur with either frequency of telephone follow-up. The diabetes educator should evaluate the telephone follow-up needs of each DSME participant to support his or her diabetes self-management success. [ABSTRACT FROM AUTHOR]

This study describes the decision-making processes home healthcare personnel (HHP) use to manage their personal health and safety when managing hazards in client homes. A professionally diverse national sample of 68 HHP participated in individual semi-structured interviews and focus group discussions, and described their decision making and strategies for hazard management in their work environments. HHP described 353 hazard management dilemmas within 394 specifically identified hazards, which were clustered within three broader categories: electrical/fire, slip/trip/lift, and environmental exposures. HHP described multiple types of “making do” decisions for hazard management solutions in which perceived and actual resource limitations constrained response options. A majority of hazard management decisions in the broader hazards categories (72.5%, 68.5%, and 63.5%, respectively) were classifiable as less than optimal. These findings stress the need for more support of HHPs, including comprehensive training, to improve HHP decision making and hazard management strategies, especially in context of resource constraints. [ABSTRACT FROM AUTHOR]

The number of farmers’ markets in the United States is growing. Although there are tools to analyze food availability at grocery stores, corner stores, and convenience stores, little research exists about the availability of food types at farmers’ markets. This research developed an audit tool to measure the food environment at farmers’ markets in rural and urban food environments and examined its psychometric properties, including face validity, interrater reliability, and discriminant validity. The Farmers’ Market Audit Tool was reviewed by content experts, revised, and then tested in six farmers’ markets by researchers across three states in 2013, including Kentucky, North Carolina, and Montana. Seven food categories were developed, including vegetables, fruits, meats, cheeses, eggs, grains, and samples. Interrater reliability was high within farmers’ market across states. As expected, discriminant validity indicated a systematic disagreement within and between states due to seasonality and ability to grow different types of food across different farmers’ markets. The total scores assessing the healthfulness of each farmers’ market was 38 (range = 28-50). Using the Farmers’ Market Audit Tool at farmers’ markets is a reliable and valid method to capture the availability of food offerings. [ABSTRACT FROM AUTHOR]

The purpose of this qualitative study is to understand changing illicit drug use patterns in rural Appalachia since a new formulation of OxyContin® was released with the goal of deterring diversion and misuse. Participants ( n = 25) from a longitudinal study of rural drug users ( N = 192) were approached to participate in semistructured qualitative interviews between April and June 2011. The primary finding is that the majority of participants switched from using the original formulation OxyContin to immediate-release oxycodone. We discuss the implications and limitations of these findings. [ABSTRACT FROM AUTHOR]

The major national innovation of the Affordable Care Act (ACA) is the insurance exchange or health insurance marketplace (HIM). We begin by briefly reviewing the ACA's chief features and detailing its HIM provisions. Section two explores the policy history of exchanges, beginning with Clinton's proposals and Massachusetts' Connector and concluding by contrasting the House-passed bill with one national exchange and the Senate bill with state-based exchanges. The Senate bill became the ACA. The evolution of policy ideas about exchanges suggests three critical conditions for a successful exchange: commodification (of insurance products), competition (between insurers), and communication (to potential buyers and the public about insurance). The penultimate section compares the rollout of the state-run Kentucky exchange and the federally facilitated exchange in North Carolina in light of what we will call the 3 Cs. The conclusion reflects more widely upon the unique form that the pro- competition or deregulatory strategy has taken in health policy. [ABSTRACT FROM AUTHOR]

Context: Whereas guidelines about return-to-play (RTP) after concussion have been published, actual prognoses remain elusive. Objective: To develop probability estimates for time until RTP after sport-related concussion. Design: Descriptive epidemiology study. Setting: High school. Patients or Other Participants: Injured high school varsity, junior varsity, or freshman athletes who participated in 1 of 13 interscholastic sports at 7 area high schools during the 2007-2009 academic years. Intervention(s): Athletic trainers employed at each school collected concussion data. The athletic trainer or physician on site determined the presence of a concussion. Athlete-exposures for practices and games also were captured. Main Outcome Measure(s): Documented concussions were categorized by time missed from participation using severity outcome intervals (same-day return, 1- to 2-day return, 3- to 6-day return, 7- to 9-day return, 10- to 21-day return, >21-day return, no return [censored data]). We calculated Kaplan- Meier time-to-event probabilities that included censored data to determine the probability of RTP at each of these time intervals. Results: A total of 81 new concussions were documented in 478775 athlete-exposures during the study period. After a new concussion, the probability of RTP (95% confidence interval) was 2.5% (95% confidence interval = 0.3, 6.9) for a 1- to 2-day return, 71.3% (95% confidence interval = 59.0, 82.9) for a 7- to 9-day return, and 88.8% (95% confidence interval = 72.0, 97.2) for a 10- to 21-day return. Conclusions: For high school athletes, RTP within the first 2 days after concussion was unlikely. After 1 week, the probability of return rose substantially (approximately 71%). Prognostic indicators are used to educate patients about the likely course of disease. Whereas individual symptoms and recovery times vary, prognostic time-to-event probabilities allow clinicians to provide coaches, parents, and athletes with a prediction of the likelihood of RTP within certain timeframes after a concussion. [ABSTRACT FROM AUTHOR]

Prognostic utility of MEGA was evaluated on a sample of 969 male and female youth without history of sexually-related probation or parole violation. Six month follow-up of 334 (34 %) found a new sexually-related probation or parole violation occurred in 28 (8.4 %). ROC findings showed Risk Scale significantly ( p < .001) predictive of a new violation (AUC = .71 [95 % CI = .62 to .80]). MEGA Risk Scale scores added incremental prognostic utility over demographic variables ( p < 0.001) and resulted in a net reclassification improvement of 31.5 %. Contravention for youth ages 4 to 12 was defined as new reports of sexually abusive behaviors in three or more different locations, or sexual behaviors that included oral, anal, vaginal, direct skin to skin contact, and/or penetration. Post-hoc analysis found 8 youth (21 %) experienced these outcomes. Risk Scale was significantly predictive (AUC = .77 [95 % C.I. = .60 to .96; p = 0.016]). [ABSTRACT FROM AUTHOR]

Elevated suicide mortality rates have been reported for farmers and for the elderly. Very little literature exists that looks at the health of older minority farmers. This mixed-method study describes older African-American farmers ( N = 156) in the contexts of active coping, personal satisfaction from farm work, and attachment to their farmland to provide insight into the psychosocial dimensions of their mental health. Findings show that the farmers have positive perspectives on work and farm future, and strong attachment to the land. Differences were noted by gender. Nurses can use these findings to frame culturally appropriate strategies for aging farmers to maximize positive outcomes. [ABSTRACT FROM AUTHOR]

The purpose of this article is to describe how the print media portrays secondhand smoke and smoke-free policy in rural communities. Baseline print media clips from an ongoing 5-year study of smoke-free policy development in 40 rural communities were analyzed. The authors hypothesized that community population size would be positively associated with media favorability toward smoke-free policy. Conversely, pounds of tobacco produced and adult smoking prevalence would be negatively associated with media favorability. There was a positive correlation between population size and percentage of articles favorable toward smoke-free policy. The authors did not find a correlation between adult smoking or tobacco produced and media favorability toward smoke-free policy, but we did find a positive relationship between tobacco produced and percentage of pro-tobacco articles and a negative relationship between adult smoking prevalence and percentage of articles about health/comfort. Implications for targeting pro-health media in rural communities as well as policy-based initiatives for tobacco control are discussed. [ABSTRACT FROM PUBLISHER]

This study reports on the use of Concept Mapping to delineate a conceptual framework germane to the planning and initial formation of tri-county rural diabetes coalition in a southeast US community. The focus of the tricounty coalition is to reduce diabetes-related inequalities in vulnerable populations. After a review of pertinent literature on community coalitions, this article explicates Concept Mapping processes utilized to plan and organize the formation of a coalition, offers analyses of the results, and discusses implications for current and future practices pertaining to community coalition work. [ABSTRACT FROM AUTHOR]

The article presents the findings of a cross-sectional study which determines if a core battery of clinical tests used to diagnose shoulder injuries should be taught to allied health professionals. The study reveals that at least 1 test was used for each of the 9 injuries listed, and at least 50% of respondents used 25 clinical tests. It shows that the total number of special tests used by each surgeon for each condition ranged from 7 to 19 tests.

Human papillomavirus (HPV) vaccination coupled with routine Papanicolaou (Pap) tests can prevent pervasive HPV infections causing cervical cancer. However, both HPV vaccination rates and Pap testing rates in Appalachian Kentucky are lower among all age groups than the rest of the United States. We recruited 19 young women residing in Appalachian Kentucky from university-based and rural clinical settings for group and individual interviews. After considering an integrated behavioral framework, we illustrate these women’s perspectives by detailing five themes, including (a) experiential beliefs pose barriers to performing behaviors, (b) three vaccine doses complicate vaccination intention, (c) women have misunderstandings about HPV and the HPV vaccination function, (d) normative influences cue action (and inaction), and (e) specific environmental and contextual barriers exist to performing cervical cancer prevention behaviors in Appalachian Kentucky. These findings related to cervical cancer prevention in Appalachian Kentucky have implications for health-message design and clinical practice. [ABSTRACT FROM PUBLISHER]

Classification systems are available to subgroup patients with acute//nonspecific low back pain (LBP) to determine interventions. The use of classification systems by physical therapists (PT) has little published evidence. The aims of this study were to understand the process PTs use when assessing and determining interventions for patients with acute//nonspecific LBP in outpatient settings and what classification systems, if any, are used in clinical practice. Qualitative methods were used to investigate the decision-making process PTs use when managing patients with LBP. Semi-structured interviews focused on the decision-making process of examination and intervention selection for patients with LBP. Findings were verified through member checking, triangulation, and audit trail. Thirteen PTs were included in the study. Four decision-making preferences emerged from the data: 1) identifying the root cause, 2) eclectic approach, 3) experience-based management, and 4) evidence-based management. Experience, education, and other aspects of the PTs' backgrounds influenced their preferred decision-making style, and use of resources, such as classification systems, varied broadly. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the psychometric properties of the Functional Social Support Questionnaire (FSSQ) in pregnant women. A secondary analysis of data from 186 low-income pregnant women in their third trimester was conducted to assess the internal consistency reliability, dimensionality, and concurrent validity of the FSSQ. Cronbach's alpha was .83. Factor analysis supported the unidimensionality of the FSSQ. Correlations with the Interpersonal Support Evaluation List (ISEL) and the Center for Epidemiologic Studies-Depression Scale (CES-D) supported concurrent and construct validity. This secondary analysis provided evidence of the psychometric soundness of the FSSQ in this sample. [ABSTRACT FROM AUTHOR]

The purpose of this exploratory study was to describe factors that contribute to successful postpartum smoking abstinence among women who quit smoking during pregnancy. Research questions addressed the primary motivators and lifestyle characteristics of women who do not return to postpartum smoking. Participants were recruited from a feasibility study (N = 16) based on their ability to remain smoke free for at least 6 months following delivery. Individual interviews were analyzed using content analysis strategies. Women’s narratives described the process of postpartum smoking abstinence. Four themes emerged: (a) child’s health as the primary motivator, (b) demanding a smoke-free home or environment, (c) smoking perception changes from one of primarily comfort to one of disgust, and (d) viewing abstinence as a lifelong change. Clinical implications include educating families about the effects of smoke-free environments on the health of their children while redirecting smoking habits with healthy behaviors. [ABSTRACT FROM PUBLISHER]

Principles of grounded theory guided a qualitative analysis of the occupational nature of late-life parenting among four grand- or great-grandmothers raising grandchildren and four typical age mothers. Semi-structured interview and video of in-home childcare routines furnished data relevant to understand how custodial grandmothers re-engage in the parental role after age 60 despite contextual barriers and age-related limitations. When presented with the situation to care, grandmothers activate prior role competencies and enfold the child into existing routines with only subtle contextual adaptations. Findings conceptualize the strength of prior experience as grandmothers make wise use of routine to meet the physical demands and energy challenges posed by late-life parenting. [ABSTRACT FROM AUTHOR]