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Cardiovascular disease (CVD) is the leading cause of death for Hispanic women in the United States. In 2001, the Illinois Department of Public Health received funding from the Centers for Disease Control and Prevention to implement the enhanced WISEWOMAN program (IWP) to address the disproportionate CVD risk among uninsured and underinsured women enrolled in the Illinois Breast and Cervical Cancer Early Detection Program. This paper presents the results of the Spanish-language arm of the IWP. Spanish speaking IWP participants were recruited from two sites, and randomized into either the minimum intervention (MI) or the enhanced intervention (EI) group. Both groups received CVD risk factor screening and educational handouts. The EI group also received an integrated 12-week nutrition and physical activity lifestyle change intervention. Of the 180 Spanish-speaking immigrants in this sample, 90 (50 %) received the EI and 90 (50 %) received the MI. At baseline there were no significant differences between group demographics or clinical values. At post-intervention, the EI group showed improvements in fat intake, fiber intake, moderate intensity physical activity, and total physical activity. At 1 year only the change in fiber intake remained. A significant improvement was also seen in body mass index (BMI) at the 1-year follow-up. The IWP Spanish-language arm was moderately successful in addressing risk factors for CVD in this population. The behavior changes that sustained up to a year were an increase in fiber intake and a decrease in BMI. [ABSTRACT FROM AUTHOR]

Annual fecal occult blood testing (FOBT) has the potential to reduce colorectal cancer mortality, but in practice it is challenging to complete FOBT every year. Repeat FOBT adherence may be especially low in community health center (CHC) settings, where many patients face barriers to annual FOBT completion. We conducted a retrospective cohort analysis to investigate adherence to annual FOBT in an urban CHC network that serves a predominantly Spanish-speaking, uninsured adult patient population. This study used data from the two-year period between January 2010 and December 2011, and included adults aged 50-74 who completed a screening FOBT with a negative result during the first 6 months of 2010. We examined whether each patient completed a second FOBT between 9 and 18 months after the initial negative FOBT, and tested whether repeat FOBT adherence was associated with patient characteristics or the number of clinic visits after the initial negative FOBT. Only 69 of 281 included patients completed repeat FOBT (24.6 % adherence), and none of 62 patients (0 %) with 0 clinic visits completed repeat FOBT. We detected no significant differences in adherence by age, sex, preferred language, insurance status, or number of chronic conditions. In multivariable regression, the adjusted relative risk of repeat FOBT was 1.66 (95 % CI 1.09-2.54; p = 0.02) among patients with 3 or more clinic visits (referent: patients with 1-2 visits). The observed low rate of adherence greatly diminishes the effectiveness of FOBT in reducing CRC mortality. Findings demonstrate the need for systems-based interventions that increase adherence without requiring face-to-face encounters. [ABSTRACT FROM AUTHOR]

The purpose of this study is to evaluate the health status of the homeless population who utilize a free clinic. The study specifically aims to compare the prevalence of asthma, diabetes, tuberculosis, mental health disorders, sexually transmitted diseases, sinus problems, and hepatitis among the homeless population. Investigators collected data from paper medical records during patient visits from 2004 to 2009. Diagnosed health conditions among the homeless population were compared to the general clinic users using logistic regression. There were several similarities between the general clinic and homeless population, however, the homeless population had statistically significant ( p < 0.05) outcomes for diagnosed cases of tuberculosis, hepatitis, anxiety, and bipolar disorders. Prevalence of diabetes, sinus problems, asthma, diabetes, and depression were similar among both populations. The odds ratios among hepatitis, tuberculosis, STDs, bipolar disorder and anxiety disorder indicated the homeless had a significantly greater risk of developing hepatitis, tuberculosis, and bipolar disorder. This study adds to the literature by illustrating the characteristics of the homeless population who utilize the free health clinic and their medical conditions. Previous studies have shown the free clinic clients have a lower level of health than the general population. This study finds that the homeless clients of a free clinic have an even worse level of health than the general clinic clients. This research can contribute to the improvement of the healthcare delivery system in providing access to needed health care services for the homeless population. [ABSTRACT FROM AUTHOR]

The purpose of this study is to develop an intervention to help women meet weight gain goals during pregnancy. From 2007 to 2008, pregnant women were recruited at a clinic in Chicago. Intervention participants received an educational pamphlet at their first prenatal visit. At follow up visits, provider counseling was encouraged via a weight gain trend graph and targeted feedback checklist. The primary outcome was the total weight gained over the course of prenatal care. We analyzed 57 intervention group participants and 109 controls. Demographic composition was similar between the groups except for parity. Patients in the intervention group and routine care group gained similar weight (24.5 + 13.5 lb vs. 25.3 + 14.0 lb, P = 0.71). After controlling for baseline weight, the intervention was associated with 4.6 pounds lower follow-up weight ( P = 0.029). After controlling for baseline BMI and other covariates, participants who received the intervention were only 34% as likely to gain weight exceeding IOM guidelines ( P = 0.009). This pilot prenatal care obesity prevention project was associated with lower weight gain in pregnancy. The feedback checklist, weight gain graph, and educational pamphlet on weight gain proved to be favorable components of this project and merit further examination in a larger intervention trial. [ABSTRACT FROM AUTHOR]

The number of medically uninsured people in the United States rose from 46 million in 2008 to an astonishing 50.7 million in 2009. This population is unable to seek medical care due, in part, to the decrease in employment-based health insurance and the increase in the cost of health care. Free health clinics exist to ensure access to health care by providing a safety net for underserved populations, ultimately decreasing health disparities among people of different socioeconomic statuses. The purpose of this study was to determine the demographic characteristics of the uninsured people who utilized a free health clinic and the purpose for their visits. Investigators gathered information from over 2,000 hand-written medical records to determine whether the demographic characteristics and health conditions of the uninsured differed from the general population. While there was no predominate medical condition in this population, special attention is needed to the prevention of smoking and obesity among the uninsured. This uninsured population had a significantly higher rate of smoking ( P < 0.01) and obesity ( P < 0.05) than the general population. In addition to treatment for medical conditions, 1 in 4 patients came for a physical exam. This study adds to the literature by describing characteristics of a free clinic population and their medical conditions. This research can contribute to the improvement of a health care delivery system that is challenged in providing access to medical care by low-income and uninsured populations. [ABSTRACT FROM AUTHOR]