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Background. This study examined the association between selected sociodemographic, health, and built environmental factors and walking behaviors of middle-aged and older overweight/obese adults. Methods. Subjective data were obtained from surveys administered to community-dwelling overweight/obese adults aged ≥50 years residing in four Texas cities from October 2013 to June 2014, along with objective data on neighborhood walkability (Walk Score™). Multivariate logistic regression identified factors predicting the odds of walking the recommended ≥150 minutes per week for any purpose. Results. Of 253 participants, the majority were non-Hispanic white (81.8%), married (74.5%), and male (53.4%) and reported an annual income of ≥$50,000 (65.5%). Approximately, half were employed (49.6%) or had at least a college degree (51.6%). Walking the recommended ≥150 minutes per week for any purpose (n=57, 22.5%) was significantly associated with having at least a college degree (OR=5.55, 95% CI = 1.79–17.25), having no difficulty walking a quarter of a mile (OR=5.18, 95% CI = 1.30–20.83), and being unemployed (OR=3.25, 95% CI = 1.18–8.93) as well as perceived presence of sidewalks/protected walkways (OR=3.56, 95% CI = 1.10–11.50) and perceived absence of distracted drivers in the neighborhood (OR=4.08, 95% CI = 1.47–11.36). Conclusion. Addressing neighborhood conditions related to distracted drivers and pedestrian infrastructure may promote walking among middle-aged and older overweight/obese individuals. [ABSTRACT FROM AUTHOR]

Introduction: Primary care providers (PCPs) are strategically positioned to communicate with their overweight/obese patients about positive behavioral changes to improve health and functioning. Demographic and behavioral correlates of receiving a recommendation for more physical activity (PA) from a PCP by overweight/obese patients were assessed.Methods: Community-dwelling adults aged ≥50 years from four Texas cities who were seen by a family physician in a primary care clinic were surveyed from October 2013 to June 2014. Multivariate logistic regression predicted the likelihood of receiving a PA recommendation from a PCP, controlling for sociodemographic factors, health conditions, and walking behaviors. The analysis was conducted in 2016.Results: Of the total 388 participants (survey response rate, 6.8%), 30.1% were obese, 55.4% were female, and most were non-Hispanic white (82.9%), married (75.6%), or reported an annual household income of ≥$50,000 (66.8%). Receipt of a PA recommendation from a PCP (n=151, 38.9%) was significantly correlated with reporting poor to fair health (OR=7.33, 95% CI=2.6, 20.32), obesity (OR=2.95, 95% CI=1.69, 5.14), having only a little or some difficulty walking for a quarter of a mile (OR=2.94, 95% CI=1.41, 5.88), not walking the recommended ≥150 minutes for any purpose (OR=2.60, 95% CI=1.25, 5.38), and being employed (OR=2.11, 95% CI=1.13. 3.94).Conclusions: PCPs seem to be targeting obese, inactive individuals with poor to fair health, populations traditionally not encouraged to be more physically active. These findings are consistent with the current trend in medical care to recommend positive lifestyle changes to a broader range of the population. [ABSTRACT FROM AUTHOR]

Background Diabetes self-care by patients has been shown to assist in the reduction of disease severity and associated medical costs. We compared the effectiveness of two different diabetes selfcare interventions on glycemic control in a racially/ethnically diverse population. We also explored whether reductions in glycated hemoglobin (HbA1c) will be more marked in minority persons. Methods We conducted an open-label randomized controlled trial of 376 patients with type 2 diabetes aged =18 years and whose last measured HbA1c was =7.5% (=58 mmol/mol). Participants were randomized to: 1) a Chronic Disease Self-Management Program (CDSMP; n = 101); 2) a diabetes self-care software on a personal digital assistant (PDA; n = 81); 3) a combination of interventions (CDSMP + PDA; n = 99); or 4) usual care (control; n = 95). Enrollment occurred January 2009-June 2011 at seven regional clinics of a university-affiliated multispecialty group practice. The primary outcome was change in HbA1c from randomization to 12 months. Data were analyzed using a multilevel statistical model. Results Average baseline HbA1c in the CDSMP, PDA, CDSMP + PDA, and control arms were 9.4%, 9.3%, 9.2%, and 9.2%, respectively. HbA1c reductions at 12 months for the groups averaged 1.1%, 0.7%, 1.1%, and 0.7%, respectively and did not differ significantly from baseline based on the model (P = .771). Besides the participants in the PDA group reporting eating more high-fat foods compared to their counterparts (P < .004), no other significant differences were observed in participants' diabetes self-care activities. Exploratory subanalysis did not reveal any marked reductions in HbA1c for minority persons but rather modest reductions for all racial/ethnic groups. Conclusions Although behavioral and technological interventions can result in some modest improvements in glycemic control, these interventions did not fare significantly better than usual care in achieving glycemic control. More research is needed to understand how these interventions can be most effective in clinical practice. The reduction in HbA1c levels found in our control group that received usual care also suggests that good routine care in an integrated healthcare system can lead to better glycemic control. [ABSTRACT FROM AUTHOR]

Objective: To determine whether there are any age-related disparities in the frequency of provision of counseling and education for diabetes care in a large HMO in Central Texas.Methods: EMR search from 13 primary care clinics on patients aged ≥18 years (n=1300) who had been diagnosed with type 2 diabetes.Results: There were no significant age differences in the frequency of provision of counseling about HBGM, diet, smoking or diabetes education. However, there were significant age differences in the provision of exercise counseling. Patients aged ≥75 were significantly less likely to have been provided exercise counseling than those aged <65 (adjusted OR=0.60; 95% CI=0.37-0.98). The mean HbA1c for patients aged ≥75 and 65-74 were significantly lower than that of patients aged <65 (8.9 vs. 9.0 vs. 9.7; P<0.001).Conclusion: While age-related variations in self-management protocols were not found, the provision of formal diabetes education was low (29.4%). The persistence of key risk factors in later life (e.g., obesity) underscores the need for better self-management protocols for older adults.Practice Implications: Additional efforts on strategies to increase counseling about lifestyle habits and diabetes self-management care by appropriate health care providers is needed. Diabetes counseling should be individually tailored in older population. [ABSTRACT FROM AUTHOR]

Although diabetes management remains an important problem, little is known about the effectiveness of employing emerging information technologies to enhance self-management strategies in order to improve diabetes care and patient outcomes. This report reviews the use of a community-based participatory research (CBPR) approach with user feedback to understand the feasibility of introducing the personal digital assistant (PDA) as a self-management tool for diabetes management. We focused on problem identification, intervention selection, and methodological issues. Both physician and patient perspectives are addressed. A search of electronic medical records helped to identify diabetes as a major clinical issue for primary care physicians in an integrated group practice. Physicians subsequently identified technological innovations as a promising tool to enhance patient outcomes. User feedback data confirmed the usefulness of using PDAs to assist patients to keep track of their appointments, physical activity, dietary intake, medication use, and daily blood glucose readings. While those with more computer experience caught on quicker, even some of those with limited computer experience were able to draw some benefit. Needed adaptations for greater success with this technological innovation in a wider range of patients were identified. Implementation of new technological approaches in disease management can benefit from a CBPR framework that addresses factors affecting both physician and patient acceptance and uptake. [ABSTRACT FROM AUTHOR]

Abstract: Background : Cervical cancer screening guidelines were created to help healthcare professionals in appropriate screening utilizing the PAP test. However, significant variation in cervical cancer screening among primary care physicians has been noted. Knowledge of the awareness of and adherence to cervical cancer screening guidelines by primary care physicians will help determine how best to disseminate and educate these physicians regarding the guidelines in hopes of reducing unnecessary screening and improving screening for under screened populations. Methods : A cross-sectional, mailed survey involving Family Medicine (FP), Community Internal Medicine (CIM), and Obstetrics/Gynecology (OB) physicians practicing in a large University-affiliated, multi-specialty group practice associated with an 186,000-member HMO in Central Texas (n = 177) was conducted in 2001–2002. Results : Most physicians performed PAP testing (50.4%). PAP screening was noted to vary significantly by specialty (P < 0.0001). All OBs were aware of at least one published guideline, compared to 96% of FPs and 91% of CIMs (P < 0.05). A wide variation was reported regarding adherence to published guidelines. In addition, there was significant intraspecialty variation regarding adherence to the physicians'' own specialty''s guidelines. Conclusions : While most physicians in the primary care setting perform PAP tests and are aware of published guidelines for PAP screening, adherence to the published guidelines varies considerably even in the same clinical setting. [Copyright &y& Elsevier]

Objectives: To assess physicians' responses to written feedback on medication discrepancies found with their elderly ambulatory patients. Design: Cross-sectional survey. Setting: Four clinics of a large university-affiliated, multispecialty group practice associated with a 186,000-member health maintenance organization. Participants: Patients aged 65 and older (n=202) and their family physicians (n=32). Measurements: Medication discrepancies and physicians' responses to written feedback on letters and adhesive labels containing a list of patients' actual medications. Results: A medication discrepancy was identified with 171 of 202 patients (84.7%). They resulted from patients not taking charted medications (52.9%), patients taking medications that were not charted (34.3%), or difference in dosage and/or schedule (12.8%). The medications involved were mostly complementary/alternative (28.3%), respiratory/allergy (15.1%), and analgesics (14.1%). The majority of physicians reported that the letters (93.8%) and accompanying labels (90.6%) were helpful to them. Half of the physicians reported filing the letters in patients' charts, whereas the other half discarded them. The majority (93.8%) also perceived the labels as an additional benefit to their practice and placed them in patients' charts to be used to correct patients' medications. Receptivity to the feedback was unrelated to physician age group, sex, years in practice, or clinic of practice. Conclusion: Although medication discrepancies are common in elderly ambulatory patients, their family physicians appreciate assistance in correcting these discrepancies, although potential problems, such as cultural or organizational resistance to the open disclosure of medication discrepancies in medical records due to associated legal ramifications, may need to be resolved. [ABSTRACT FROM AUTHOR]

Summary: Objectives:: The objectives of this study were to assess patients’ willingness to use e-mail to obtain specific test results, assess their expectations regarding response times, and identify any demographic trends. Methods:: A cross-sectional survey of primary care patients was conducted in 19 clinics of a large multi-specialty group practice associated with an 186,000-member Health Maintenance Organization. The outcome measures were proportion of patients with current e-mail access, their willingness to use it for selected general clinical services and to obtain specific test results, and their expectations of timeliness of response. Results:: The majority of patients (58.3%) reported having current e-mail access and indicated strong willingness to use it for communication. However, only 5.8% reported having ever used it to communicate with their physician. Patients were most willing to use e-mail to obtain cholesterol and blood sugar test results, but less willing to use it to obtain brain CT scan results. Patients’ expectations of timeliness were generally very high, particularly for high-stakes tests such as brain CT scan. Significant differences of willingness and expectations were found by age group, education, and income. Conclusions:: These findings indicate that most patients are willing to use e-mail to communicate with their primary care providers even for specific test results and that patients will hold providers to high standards of timeliness regarding response. The implication is that integration of e-mail communications into primary care ought to assure prompt and accurate patient access to a plethora of specific clinical services. [Copyright &y& Elsevier]

Background. Although current recommendations advocate screening persons 50 years of age or older for colorectal cancer (CRC), actual screening practice is highly variable among primary care physicians (PCPs). Knowledge of the factors that influence whether or not screening is offered during a clinic visit is essential to develop effective screening strategies.Methods. A cross-sectional telephone survey of one in four randomly selected patients aged 50 years or older (n = 400) attending a primary care clinic within an integrated health care system in central Texas was conducted. A survey of all PCPs (n = 32) at the practice sites was also administered.Results. The visit type was an important determinant of whether CRC screening was discussed, with most discussion occurring during visits for physicals (P < 0.0001). This finding was corroborated by the physician survey. Patient age and education were also associated with a higher likelihood of having been offered CRC screening (P = 0.009 and 0.014, respectively). Patient race, gender, primary language, PCP, or clinics attended were not significantly associated with the discussion of CRC screening.Conclusions. Discussions regarding CRC screening are most likely to occur during preventive care visits. Thus, facilitating preventive visits especially for the elderly represents an opportunity to improve CRC screening rates in primary care practice. [Copyright &y& Elsevier]

Objectives: Introducing new ideas such as complementary and alternative medicine (CAM) and evidence based medicine (EBM) to medical students early in their education may help to nurture their interest. This study evaluated the effectiveness of teaching CAM using EBM principles and assessed changes in student perceived knowledge, attitudes, and skills following a new curriculum on CAM. Design: A before-and-after evaluation using a one-page, anonymous questionnaire. Setting and subjects: All third year students of a state, public medical school in Texas. Intervention: A new curriculum comprising interactive sessions on CAM, EBM, and basic principles of epidemiology and biostatistics. Outcome measures: Changes in student-perceived knowledge, attitudes, and skills. Results: Of 67 students, complete data were obtained for 54 (81%). The majority reported that the new instruction in CAM (98%), EBM (96%), biostatistics (91%), and epidemiology (87%) would be of some benefit in their future work. Significant changes were reported in the areas of appraising a clinical trial (p < 0.0001), critiquing the medical literature (p < 0.01), and the appropriateness of integrating EBM and CAM in the medical school curriculum (/9 < 0.05). There were modest increases in the mean responses on their skill level in reading/understanding the medical literature (3.40 3.52), comfort level in reading the medical literature (3.53 3.67), and preparedness in designing a research study (2.12 2.39) based on a five point Likert scale, although not statistically significant. Conclusions: Medical students could be effectively taught CAM using EBM principles. In addition, a short, interactive curriculum on an important topic has a positive impact on medical students' desires to acquire new knowledge. This... [ABSTRACT FROM AUTHOR]

OBJECTIVE: Many health care providers and patients are exploring the feasibility of using E-mail to address a variety of medical issues. We wanted to determine the proportion of our patient population with E-mail access, determine their willingness to use this technology to expedite communication with health care providers, and assess their expectations of response times. STUDY DESIGN: A cross-sectional, in-person prevalence survey. POPULATION Patients (n=950) with scheduled appointments to see a primary care provider in 6 of 18 family practice clinics in a large health care delivery system in central Texas. OUTCOMES MEASURED: The proportion of patients with E-mail access, their willingness to use it, and their expectations regarding the timeliness of responses to their E-mail queries about selected clinical services. RESULTS: Overall, 54.3% of the patients reported having E-mail access, with significant variation among the 6 clinics (33%-75%). Reported areas of strongest desire for using E-mail were to request prescription refills (90%), for nonurgent consultations (87%), and to obtain routine laboratory results or test reports (84%). Patients' expectations regarding the timeliness of responses to their E-mail queries varied by clinical service. For laboratory results, their expectations were: less than 9 hours, 21%; 9 to 24 hours, 53%; and more than 24 hours, 26%. CONCLUSIONS: Most patients attending family practice clinics in central Texas have E-mail access and indicate they would use it to request prescription refills, for nonurgent consultations, and to obtain routine laboratory results or test reports. Regardless of sex or race, patients have high expectations that these tasks can be completed within a relatively short time. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to determine the incidence, hospital charges, and correlates associated with inpatient treatment of child maltreatment related injuries. Methods: The data were based on the 1995 Pennsylvania Hospital Discharge Data which included all Pennsylvania acute care hospitals that reported child maltreatment discharges. Per capita hospital discharge rates were computed for children discharged with child maltreatment related injuries according to selected variables. Odds ratios for child maltreatment related injury hospitalizations were also computed. Results: A total of 348 maltreated injured children ages 0-19 years were discharged from Pennsylvania hospitals in 1995, representing an incidence rate of 10.8 per 100,000 persons. The total hospital charges for child maltreatment related injury discharges amounted to over $5.4 million, of which Medicaid alone paid for 45%. Compared to a random sample of non-maltreated injured children (n = 1052), maltreated injured children were found to be significantly younger, more likely to be females, and more likely to be Black. Child maltreatment related injury hospitalizations were more likely to be urgent and via physician referral or transfer from other health care facility. Maltreated injured children were three times as likely to die as other children. Conclusions: These findings indicate that injury from child maltreatment is a major cause of hospitalization of young children 5 years and younger and represents a significant cost to publicly financed health care. While hospital discharge data can be used for population-based surveillance of child maltreatment related trauma, there is need for improvement in the surveillance of these injuries. [ABSTRACT FROM AUTHOR]

Objectives. This study examined correlates of injury in a cohort of women who were partners of men enrolled in batterer treatment programs. Methods. Cross-sectional data of 670 pairs of battered women and their partners were analyzed. Prevalence rates of women's self-reports of injury due to their partners' abusive behavior were computed and compared by couples' demographic and behavioral characteristics. Results. Men's use of severe tactics of abuse was the characteristic most significantly associated with injury (odds ratio = 15.47; 95% confidence interval = 9.02, 26.55). Conclusion. Our findings underscore the need to obtain information on the specific tactics used by couples to settle their disputes during universal screening by practitioners. [ABSTRACT FROM AUTHOR]

Reviews successful interventions for transport and home injuries in developing countries. Injury interventions developed in developed countries; Guide to injury control efforts in developing countries.

Injuries have now become a recognizable public health problem in developing Countries. However, no definite policies regarding their surveillance and control are yet available in most of these countries. This paper, using Ghana as a prototype, examines the need for policy and action which has been accentuated in recent times by public outcry. The paper also provides some recommendations to solve this problem: the urgent need to initiate programs such as needs assessment, the establishment of a surveillance system for injuries at various levels of health services, creation of public awareness and provision of health education, and the institution of simple first-aid measures. Specific policies regarding injuries from motor vehicle accidents and fires are also given. [ABSTRACT FROM AUTHOR]

The article offers information on the safety injury interventions devices such as using of seat belt. Topics discussed observational survey of seat belt use by vehicle occupants; findings of the prevalence of homes with inadequate smoke alarm protection from residential fires; and information on the helmet use as successful safety device.

An editorial is presented on the dangers associated with the use of mobile phones while walking or driving which can result in injuries. It talks about the use of mobiles on the road can be dangerous for the passers-by and also for the motorists. It tells about the use of social media while crossing the road, watching videos or clicking pictures.

An introduction is presented in which the editor discusses articles in the issue on topics including geographical information systems; analytical methods to inform injury control; and the joinpoint regression analytical method to evaluate traffic public health policies in Chile.

The prevalence and risk factors for childhood burn-related physical impairments and disabilities in Ghana were determined with data from mothers of burned children. Of 650 identified burns, 113 (17.4%) resulted in physical impairments; 5 (1%) resulted in physical disabilities. After multivariate adjustment, the odds of developing burn-related physical impairments were increased by burns with protracted healing (odds ratio [OR] = 5.80), burns to the head/neck (OR = 3.44), burns involving skin removal (OR = 3.04), and wound infection (OR = 2.03) and decreased by first aid (OR = 0.51) and maternal education (OR = 0.54). Education on the proper care of burns may prevent burn-related physical impairments. The results also underscore the link between maternal education and child morbidity. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including epidemiology of drowning to safety education around bodies of water; drowning burden in lakeside districts of Uganda; and drowning preventive efforts on other age groups.

An introduction to the journal is presented in which the editor discusses the report on the knowledge, attitudes, and practices of healthcare professionals on childhood unintentional injuries in Cairo, Egypt.

The author reflects on how the various methods available for the estimation of injury rates and risks from existing databases are limited by methodological and data quality issue. He references an article by R. Alexandrescu, SJ O'Brien and FE Lecky where they took a critical examination of the methodological approaches in the measurement of injury incident rates and recommended for the development of new methodological approaches to constructing or estimating injury rates.

The author reflects on the impact of improvement in poison prevention in reducing the rates of childhood unintentional poisoning. He mentions the systematic reviews of primary studies about the occurrence of childhood poisoning in home. It says that potential increase on risk of childhood poisoning happens at the age of one to three years old. The author provides suggestions on how to prevent poisoning.

The article offers information on the Safety 2016 World Injury Conference which will be held in Tampere, Finland.

An introduction is presented in which the editor discusses various reports within the issue on topics including children's injuries sustained from outdoor activities, the epidemiology of unintentional child injuries in the South East Asia Region, and paediatric head injuries.

An introduction is presented in which the editor discusses reports within the issue on topics including identification of child abuse in emergency department (ED) in Australia, substance use in ED in South Africa, and snowboarders injured in a terrain park and presented to an ED in Alberta, Canada.

Editorial. Addresses injury prevention for people with disabilities. How risks can be minimized without unduly restricting activities; Mechanics behind why the risk of injury for people with impairments, disabilities or other special healthcare needs is multiplied exponentially; Details of injury prevention, a multidisciplinary science of averting damage to body tissues by identifying the host, agent, and environmental factors that interact to create the risk of injury.

A letter to the editor is presented about the standardization of statewide hospitalized injury morbidity reports in the U.S.

Background: Diabetes self-care by patients has been shown to assist in the reduction of disease severity and associated medical costs. We compared the effectiveness of two different diabetes self-care interventions on glycemic control in a racially/ethnically diverse population. We also explored whether reductions in glycated hemoglobin (HbA1c) will be more marked in minority persons.Methods: We conducted an open-label randomized controlled trial of 376 patients with type 2 diabetes aged ≥18 years and whose last measured HbA1c was ≥7.5% (≥58 mmol/mol). Participants were randomized to: 1) a Chronic Disease Self-Management Program (CDSMP; n = 101); 2) a diabetes self-care software on a personal digital assistant (PDA; n = 81); 3) a combination of interventions (CDSMP + PDA; n = 99); or 4) usual care (control; n = 95). Enrollment occurred January 2009-June 2011 at seven regional clinics of a university-affiliated multi-specialty group practice. The primary outcome was change in HbA1c from randomization to 12 months. Data were analyzed using a multilevel statistical model.Results: Average baseline HbA1c in the CDSMP, PDA, CDSMP + PDA, and control arms were 9.4%, 9.3%, 9.2%, and 9.2%, respectively. HbA1c reductions at 12 months for the groups averaged 1.1%, 0.7%, 1.1%, and 0.7%, respectively and did not differ significantly from baseline based on the model (P = .771). Besides the participants in the PDA group reporting eating more high-fat foods compared to their counterparts (P < .004), no other significant differences were observed in participants' diabetes self-care activities. Exploratory sub-analysis did not reveal any marked reductions in HbA1c for minority persons but rather modest reductions for all racial/ethnic groups.Conclusions: Although behavioral and technological interventions can result in some modest improvements in glycemic control, these interventions did not fare significantly better than usual care in achieving glycemic control. More research is needed to understand how these interventions can be most effective in clinical practice. The reduction in HbA1c levels found in our control group that received usual care also suggests that good routine care in an integrated healthcare system can lead to better glycemic control.Trial Registration: Clinicaltrials.gov Identifier: NCT01221090. [ABSTRACT FROM AUTHOR]

Rationale Neighborhood safety is important for older adults’ health and wellbeing, but there has not been a synthesis in the literature of what is currently known about this construct. Objectives This systematic literature review, following the PRISMA guidelines, focuses on identifying neighborhood safety factors associated with health-related outcomes and behaviors of older adults in the U.S. Methods A search was conducted in 2014 via Academic Search Complete, CINAHL, Embase, MEDLINE, SportDis, and Transportation Databases. Based on our inclusion and exclusion criteria, we identified thirty-two articles for review. Results Sixteen studies examined health outcomes such as health status, mental health, physical function, morbidity/mortality, and obesity; the other sixteen studies focused on health behaviors, such as physical activity and walking. Four domains of neighborhood safety were identified: overall/general neighborhood safety; crime-related safety; traffic-related safety; and proxies for safety (e.g., vandalism, graffiti). Overall/general neighborhood safety appeared most relevant to mental health and physical function. Traffic-related safety was most pertinent to physical activity, while crime-related safety was more consistently associated with mental health and walking. While all safety variables were significantly associated with mental health, no significant associations were found for obesity. We also found that specific measures or constructs of safety were not applied consistently across the examined studies, making it difficult to compare the results. Conclusion This review identified several important gaps in the existing studies dealing with neighborhood safety-health relationships among older adults. Further studies are needed that examine the different roles of multidimensional neighborhood safety in promoting the community health, not only in the U.S., but globally. [ABSTRACT FROM AUTHOR]

The authors examined the responses of 63 primary care physicians to diabetes clinical protocols (DCPs) for the management of type II diabetes (T2DM). We measured physician demographics, current diabetes patient loads, and responses to DCPs (physician attitudes, physician familiarity, and physician recommendation of DCPs) using a 20-question electronic survey. Results of the survey indicate that primary care physicians may be unfamiliar with the benefits of diabetes clinical protocols for the self-management of T2DM. Given the importance of diabetes self-management education in controlling T2DM, those interested in implementing DCPs should address the beliefs and attitudes of primary care physicians. [ABSTRACT FROM AUTHOR]

Despite increasing recognition of injury as a major public health problem worldwide, it has received limited attention and resources. This lack of attention is most notable in low-income countries. As part of efforts to develop coordinated injury control activities in Africa, a round table session was held at the Third International Conference on Injury Prevention and Control in Melbourne, Australia. The aims of the forum were to provide injury control researchers from Africa the opportunity to come together and reflect on issues of injury control in Africa, to deliberate on strategies of getting African governments to show more interest in injury control, and to solicit more assistance from the international donor community. Participants from Ghana, Kenya, South Africa and Zimbabwe presented the magnitude of the injury burden in their respective countries, reflected on current research efforts and highlighted the preventive efforts being undertaken. The forum made many recommendations including several regarding specific actions required of African governments, individual researchers and donor agencies. [ABSTRACT FROM AUTHOR]

Objective: To assess self‐reported financial strain and persistence in asking treatment‐ and medication‐related questions in relation to medication nonadherence. Method: Data were analysed from a cross‐sectional study of adults with diabetes, hypertension or both in central Texas in 2013. Measures of medication nonadherence in the past 12 months, financial strain and patients' persistence in asking treatment‐ and medication‐related questions were identified. Medication nonadherence resulting from cost, transportation or work was compared with medication nonadherence resulting from other reasons. Binary and multinomial regression models were fitted to identify factors associated with medication nonadherence among the respondents. Key findings: In the bivariate model, medication nonadherence from any cause was significantly associated with financial strain, not asking questions about treatments or medications, and all demographic characteristics. However, in the multinomial model, medication nonadherence resulting from cost, work or transportation was only associated with not asking medication‐related question about financial strain, lack of health insurance, age and gender. This was true for nonadherence resulting from other reasons except that ethnicity was significant while gender was not. Conclusions: While removing financial strain could aid medication adherence, clinicians should also encourage patients to be persistent in asking questions about their medications until they understand the purpose for taking them. Our findings have implications for empowering patients to be more proactive in enhancing their adherence to medications. [ABSTRACT FROM AUTHOR]

Background and Objectives Fear of falling is a substantial barrier to walking and has been associated with increased fall risks. This study examines neighborhood environmental risk factors related to fear of outdoor falling in middle-aged and older adults. Research Design and Methods A total of 394 participants aged 50 years or older living independently in the community were recruited between 2013 and 2014 from an integrated health care network serving Central Texas. Fear of outdoor falling and perceived neighborhood environmental variables were assessed using self-reported questionnaires. Logistic regression identified perceived neighborhood environmental variables associated with fear of outdoor falling. Results Sixty-nine (17.9%) of 385 participants reported having a fear of outdoor falling. Compared to those who did not report a fear of outdoor falling, those who reported having a fear of outdoor falling were more likely to be adults aged 65 years or older (odds ratio [OR] = 2.974, 95% confidence interval [CI] = 1.247–7.094), be female (OR = 4.423, 95% CI = 1.830–10.689), have difficulty with walking for a quarter of a mile (OR = 2.761, 95% CI = 1.124–6.782), and have had a fall in the past year (OR = 4.720, 95% CI = 1.472–15.137). Among the neighborhood environmental characteristics examined, low traffic speed on streets (OR = 0.420, 95% CI = 0.188–0.935), drainage ditches (OR = 2.383, 95% CI = 1.136–5.000), and broken sidewalks (OR = 3.800, 95% CI = 1.742–8.288) were associated with the odds of having a fear of outdoor falling. Discussion and Implications In addition to the individual factors, findings from this study suggest the importance of addressing the environmental risk factors in identifying and reducing fear of outdoor falling among middle-aged and older adults. [ABSTRACT FROM AUTHOR]

Objective To determine physician perspectives about direct notification of normal and abnormal test results. Methods We conducted a cross-sectional survey at five clinical sites in the US and Australia. The US-based study was conducted via web-based survey of primary care physicians and specialists between July and October 2012. An identical paper-based survey was self-administered between June and September 2012 with specialists in Australia. Results Of 1417 physicians invited, 315 (22.2%) completed the survey. Two-thirds (65.3%) believed that patients should be directly notified of normal results, but only 21.3% were comfortable with direct notification of clinically significant abnormal results. Physicians were more likely to endorse direct notification of abnormal results if they believed it would reduce the number of patients lost to follow-up (OR = 4.98, 95%CI = 2.21–1.21) or if they had personally missed an abnormal test result (OR = 2.95, 95%CI = 1.44–6.02). Conversely, physicians were less likely to endorse if they believed that direct notification interfered with the practice of medicine (OR = 0.39, 95%CI = 0.20–0.74). Conclusion Physicians we surveyed generally favor direct notification of normal results but appear to have substantial concerns about direct notification of abnormal results. Practice implications Widespread use of direct notification should be accompanied by strategies to help patients manage test result abnormalities they receive. [ABSTRACT FROM AUTHOR]

The objective was to assess the impacts of diabetes self-management programs on productivity-related indirect costs of the disease. Using an employer's perspective, this study estimated the productivity losses associated with: (1) employee absence on the job, (2) diabetes-related disability, (3) employee presence on the job, and (4) early mortality. Data were obtained from electronic medical records and survey responses of 376 adults aged ≥18 years who were enrolled in a randomized controlled trial of type 2 diabetes self-management programs. All study participants had uncontrolled diabetes and were randomized into one of 4 study arms: personal digital assistant (PDA), chronic disease self-management program (CDSMP), combined PDA and CDSMP, and usual care (UC). The human-capital approach was used to estimate lost productivity resulting from 1, 2, 3, and 4 above, which are summed to obtain total productivity loss. Using robust regression, total productivity loss was modeled as a function of the diabetes self-management programs and other identified demographic and clinical characteristics. Compared to subjects in the UC arm, there were no statistically significant differences in productivity losses among persons undergoing any of the 3 diabetes management interventions. Males were associated with higher productivity losses (+$708/year; P<0.001) and persons with greater than high school education were associated with additional productivity losses (+$758/year; P<0.001). Persons with more than 1 comorbid condition were marginally associated with lower productivity losses (-$326/year; P=0.055). No evidence was found that the chronic disease management programs examined in this trial affect indirect productivity losses. ( Population Health Management 2014;17:112-120) [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study compared time-to-hospitalization among subjects enrolled in different diabetes self-management programs (DSMP). We sought to determine whether the interventions delayed the occurrence of any acute event necessitating hospitalization. Methods: Electronic medical records (EMR) were obtained for 376 adults enrolled in a randomized controlled trial (RCT) of Type 2 diabetes (T2DM) self-management programs. All study participants had uncontrolled diabetes and were randomized into either: personal digital assistant (PDA), Chronic Disease Self-Management Program (CDSMP), combined PDA and CDSMP (COM), or usual care (UC) groups. Subjects were followed for a maximum of two years. Time-to-hospitalization was measured as the interval between study enrollment and the occurrence of a diabetes-related hospitalization. Results: Subjects enrolled in the CDSMP-only arm had significantly prolonged time-to-hospitalization (Hazard ratio: 0.10; p =0.002) when compared to subjects in the control arm. Subjects in the PDA-only and combined PDA and CDSMP arms showed no improvements in comparison to the control arm. Conclusion: CDSMP can be effective in delaying time-to-hospitalization among patients with T2DM. Practice implications: Reducing unnecessary healthcare utilization, particularly inpatient hospitalization is a key strategy to improving the quality of health care and lowering associated health care costs. The CDSMP offers the potential to reduce time-to-hospitalization among T2DM patients. [Copyright &y& Elsevier]

Purpose: This study explored the impact of personal digital assistant (PDA) features, users' perceptions, and other factors that may have hindered PDA acceptability and usability as technology advances in e-health diabetes self-management.Study Design and Results: An ongoing study on PDA usage is set within the context of the advancements of Web 2.0 for type 2 diabetes mellitus (T2DM) self-management e-interventions. Advancements in technology as it relates to the future of T2DM mobile applications are discussed as possible deterrents of PDA acceptability and usability.Conclusions: This case study illustrates the importance of addressing factors that may impede the adoption of electronic devices intended for sustained health behavior change. Recognizing the importance of individual perception within the context of rapid technological advancements is imperative for designing future health interventions. Incorporating electronic devices that individuals are more inclined to utilize, such as smartphones, as the platform for health interventions is a promising strategy to improve acceptability and usability, allowing researchers to more accurately assess the health benefits of self-management programs. [ABSTRACT FROM AUTHOR]

Purpose: In this study, we developed and field tested the Medication Error and Adverse Drug Event Reporting System (MEADERS)-an easy-to-use, Web-based reporting system designed for busy office practices.Methods: We conducted a 10-week field test of MEADERS in which 220 physicians and office staff from 24 practices reported medication errors and adverse drug events they observed during usual clinical care. The main outcomes were (1) use and acceptability of MEADERS measured with a postreporting survey and interviews with office managers and lead physicians, and (2) distributions of characteristics of the medication event reports.Results: A total of 507 anonymous event reports were submitted. The mean reporting time was 4.3 minutes. Of these reports, 357 (70%) included medication errors only, 138 (27%) involved adverse drug events only, and 12 (2.4%) included both. Medication errors were roughly equally divided among ordering medications, implementing prescription orders, errors by patients receiving the medications, and documentation errors. The most frequent contributors to the medication errors and adverse drug events were communication problems (41%) and knowledge deficits (22%). Eight (1.6%) of the reported events led to hospitalization. Reporting raised staff and physician awareness of the kinds of errors that occur in office medication management; however, 36% agreed or strongly agreed that the event reporting "has increased the fear of repercussion in the practice." Time pressure was the main barrier to reporting.Conclusions: It is feasible for primary care clinicians and office staff to report medication errors and adverse drug events to a Web-based reporting system. Time pressures and a punitive culture are barriers to event reporting that must be overcome. Further testing of MEADERS as a quality improvement tool is warranted. [ABSTRACT FROM AUTHOR]

The article reports on the study concerning the New Ambulatory Care Medication Error and Adverse Drug Event Reporting System (MEADERS). The study concludes that it is practical for the primary care professionals to report the locations through MEADERS. Details on the MEADERS's design principles and event reporting form, study setting, and data analysis are discussed.