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BackgroundThe benefits of physical activity for cancer survivors are well documented. However, few older cancer survivors are engaged in regular physical activity. Mobile technologies may be an effective method to deliver physical activity promotion programs for older cancer survivors. iCanFit, a mobile-enabled Web-based app, was developed based on formative research and usability testing. This app includes interactive features of physical activity, goal setting and tracking, and receiving personalized visual feedback. ObjectiveThe aim of this study is to pilot test the initial efficacy of iCanFit. MethodsOlder cancer survivors (N=30) were recruited online through our collaborative partnership with a cancer survivor's organization. After the participants completed an online baseline survey, they were asked to use the iCanFit website. Instructional videos on how to use the web app were available on the website. Participants were asked to complete a follow-up survey 2-3 months later. Participants’ physical activity, quality of life, and their experience with iCanFit were measured. ResultsA total of 30 participants completed the baseline survey, and 26 of them (87%, 26/30) also completed a follow-up survey 2-3 months later. The median age of participants was 69 years (range 60-78). Participants’ quality of life and engagement in regular physical activity improved significantly after the use of iCanFit. Participants indicated a general affinity towards the key function “Goals” in iCanFit, which motivated continued activity. They also provided suggestions to further improve the app (eg, adding a reminder functionality, easier or alternative ways of entering activities). ConclusionThe interactive Web-based app iCanFit has demonstrated initial efficacy. Even though our study was limited by a small sample size, convenience sampling, and a short follow-up period, results suggest that using mobile tools to promote physical activity and healthy living among older cancer survivors holds promise. Next steps include refining iCanFit based on users’ feedback and developing versatile functionality to allow easier physical activity goal setting and tracking. We also call for more studies on developing and evaluating mobile and web apps for older cancer survivors.

A community-based survey of children aged 0 to 5 years in Ghana found that of 650 childhood burns, 5.4 percent were purposefully inflicted. Perpetrators were mostly friends (43 percent), siblings (37 percent), and traditional healers (6 percent). Healers inflicted burns on children who were comatose after convulsions. (Author/DB)

BackgroundThere is a growing recognition of the importance of lifestyle behavior change for health promotion and disease prevention, as well as the concomitant influence of patient–physician communication on effective behavior change. Mobile technology is increasingly being recognized as an important and efficient tool to collect patients’ health behavior data and facilitate patient–physician communication. ObjectiveThe aim of this study was to assess the feasibility of an iPod touch-based health behavior assessment (HBA) tool in enhancing patient–physician collaborative goal-setting for health promotion in primary care. MethodsA total of 109 patients from three primary care clinics in central Texas completed a brief HBA, which was programmed on an iPod touch device. An instant feedback report was generated for the patient and their physician simultaneously to facilitate collaborative goal-setting. Within approximately 7 days of the HBA, the patients were phoned for a follow-up survey for their feedback on the iPod touch–based HBA and resultant patient–physician communication. ResultsPatients were able to complete an HBA on the iPod touch with ease. Among those who completed the follow-up survey (n=83), 30% (25/83) reported that their physicians discussed the HBA report with them, while 29% (24/83) established behavior change goals with them. More than 90% (75/83) of the patients reported positive experiences with the iPod touch–based HBA. ConclusionsIt is feasible to use mobile tools for HBA in the primary care setting. The HBA also facilitated patient–physician communication on behavior change. However, more research is needed on the effectiveness of large scale dissemination of mobile-based HBA technology on health communication and behavior change for preventing or managing lifestyle-related chronic conditions, such as obesity, diabetes, cancer, or heart diseases.

BackgroundIntegrating online weight-loss programs into the primary care setting could yield substantial public health benefit. Little is known about primary care providers’ perspectives on online weight-loss programs. ObjectiveTo assess primary care providers’ perspectives on online weight-loss programs. MethodsWe conducted focus group discussions with providers in family medicine, internal medicine, and combined internal medicine/pediatrics in Texas and Pennsylvania, USA. Open-ended questions addressed their experience with and attitudes toward online weight-loss programs; useful characteristics of existing online weight-loss programs; barriers to referring patients to online weight-loss programs; and preferred characteristics of an ideal online weight-loss program. Transcripts were analyzed with the grounded theory approach to identify major themes. ResultsA total of 44 primary care providers participated in 9 focus groups. The mean age was 45 (SD 9) years. Providers had limited experience with structured online weight-loss programs and were uncertain about their safety and efficacy. They thought motivated, younger patients would be more likely than others to respond to an online weight-loss program. According to primary care providers, an ideal online weight-loss program would provide—at no cost to the patient—a structured curriculum addressing motivation, psychological issues, and problem solving; tools for tracking diet, exercise, and weight loss; and peer support monitored by experts. Primary care providers were interested in receiving reports about patients from the online weight-loss programs, but were concerned about the time required to review and act on the reports. ConclusionsPrimary care providers have high expectations for how online weight-loss programs should deliver services to patients and fit into the clinical workflow. Efforts to integrate online weight-loss programs into the primary care setting should address efficacy and safety of online weight-loss programs in clinic-based populations; acceptable methods of sending reports to primary care providers about their patients’ progress; and elimination or reduction of costs to patients.

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.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0277-9536(96)00051-2 Byline: Samuel N. Forjuoh (1), Guohua LI (2) Abstract: Injury is recognized as an increasing public health problem in developing countries. Extensive research on injury control has been conducted in the U.S. and other industrialized countries in the past several decades, but research is still in its infancy in developing countries. In this paper, successful interventions for transport and home injuries are reviewed in the context of the developing country setting. The aim is to evaluate injury interventions developed in the industrialized countries and identify those likely to be usable in developing countries. The evaluation criteria used include the efficacy of the interventions, as well as their affordability, feasibility and sustainability. The review demonstrates that while several interventions are available in the field of injury prevention for developing countries to import, caution should be taken in doing this. The use of automobile safety seat belts, bicyclist and motorcyclist helmets, speed limits, laws banning the sale of alcohol at lorry parks, pedestrian crossing signs, adequate roadway lighting, separation of pedestrians from vehicles, conspicuity-enhancement measures, simple safety equipment, and poison prevention packaging should be seriously considered by developing countries to reduce the morbidity and mortality from transport and home injuries. Since injury prevention may often require a blend of several interventions due to the multifactorial nature of the causes of injury, interventions that appear to be most effective are those with multidimensional strategies including education, legislation and environmental modification. This review should serve as a useful guide to injury control efforts in developing countries which must grapple with limited resources and low levels of education. Author Affiliation: (a) Department of Emergency Medicine and Center for Injury Research and Control, University of Pittsburgh, 230 McKee Place, Suite 400, Pittsburgh, PA 15213-2582, U.S.A. (b) Department of Emergency Medicine and Center for Injury Research and Policy, Johns Hopkins University, Baltimore, MD 21218, U.S.A.

Intentional (inflicted) injury to children through bums has been studied and mentioned extensively in the literature, although much less so in developing countries. A community-based survey of children aged 0-5 years in the Ashanti Region of Ghana found that of 650 childhood bums, 35 (5.4%) were purposefully inflicted. The perpetrators were mostly friends (43%) and siblings (37%) of the victims, and traditional healers (6%) who inflicted these bums to children who were comatose after convulsions. Intentional bums were more likely to be inflicted by flame (OR = 3.87, 95% CI = 1.52-10.0), and contact with a hot object (OR = 1.66, 95% CI = .62-4.44) than through scalding, the most common cause of bums in this region. Other patterns of intentional bums included the absence of any adult, bums covering < 3-5% of body surface area, and increased rate of wound infection. These findings contrast with the pattern of intentional bums seen in other countries, notably developed ones. Even though these inflicted bums were minor, it is important that doctors working in this setting become aware of their presence and that traditional healers and the general public be educated about the appropriate treatment for childhood convulsions.

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]

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]

Waldenström macroglobulinemia is a rare disorder affecting about 1400 people annually in the United States. This case report reviews from a primary care provider's perspective the initial presentation of a patient who complained of fatigue and dizziness that ultimately led to hospital admission with a diagnosis of Waldenström macroglobulinemia. The referral to hematology/oncology prompting the bone marrow biopsy that led to the diagnosis highlights the important role of the primary care provider in the initial workup, coordination among specialists, and overall management of patients with rare disorders. [ABSTRACT FROM AUTHOR]

Background: Regular physical activity (PA) is a major factor in maintaining health in aging populations. This study examines the influences of sociodemographic, health, and environmental characteristics on older adults' walking behaviors, and the role physicians can play in promoting physical activity.Methods: Online and paper surveys (n = 272) were distributed to community-dwelling older (age ≥ 60) adults from a large integrated healthcare system in two counties in Central Texas. Descriptive statistics were utilized to characterize participant's walking behaviors and places. Multivariate logistic regression was employed to predict being: 1) a frequent walker (i.e., walking at least three times a week); and 2) meeting the Centers for Disease Control and Prevention (CDC) PA recommendation through walking (i.e., walking ≥150 min per week), while considering sociodemographic, health, and environmental factors.Results: Individuals had a median age of 69 years, were of both genders (50.37 % female), and were primarily non-Hispanic White (84.87 %). While the majority (59.55 %) walked at least three times a week, only 27.86 % walked ≥150 min a week. Factors associated with a lower likelihood of being frequent walkers included experiencing poor mental health in the past month (OR = 0.345, 95 % CI = 0.185-0.645) and residing in areas with low or moderate (versus high) perceived neighborhood cohesion (OR = 0.471, 95 % CI = 0.228-0.974), while those in Census Tracts reflecting populations with a lower median age were more likely to report frequent walking behavior (OR = 1.799, 95 % CI = 1.034-3.131). Factors associated with a lower likelihood of meeting the CDC PA recommendation included being 60-69 years (versus 70 years or older) (OR = 0.538, 95 % CI = 0.290-0.997), experiencing poor mental health in the past month (OR = 0.432, 95 % CI = 0.198-0.944), and lacking social support for walking (OR = 0.383, 95 % CI = 0.154-0.957).Conclusion: Given the health benefits, PA promotion must be seen as a national responsibility. In particular, physicians have a major role to play in communicating the importance of PA to their older patients and making discussions about strategies for overcoming barriers to walking an integral part of their clinical encounter with these patients. [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]