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A sample of 175 veterans' scores on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; Randolph, 1998) was examined to investigate the factor structure of this scale. First, we attempted to replicate a five-factor model to reflect the five Index Scores of the RBANS (immediate memory, visuospatial/constructional, language, attention, and delayed memory) from the 12 individual subtests, using confirmatory factor analysis (CFA). We were unable to identify a five-factor structure of the RBANS. The RBANS subtests were then subjected to an exploratory factor analysis with a maximum likelihood extraction and orthogonal rotation to determine a new dimensional model. Results indicated a two-factor structure that can roughly be described as memory and visuospatial function. CFA of this new structure indicated an adequate fit for this sample. Findings suggest that it may be appropriate to place more emphasis on the individual subtest scores than the index scores during interpretation.

To assess the usefulness of three sources (faith-based organizations (FBOs), health system, and community) for recruitment of African Americans with type 2 diabetes to a randomized controlled trial (RCT).African Americans with type 2 diabetes were recruited to a diabetes self-management program at four FBO sites. An observational study of a multifaceted recruitment strategy to enroll subjects in the RCT that evaluated the effectiveness of a diabetes self-management program and the effect of recruitment source on retention after enrollment. Self-administered demographic surveys and weekly class attendance records were collected.Of 184 interested individuals, 109 (59.2%) were enrolled. Of those enrolled, 60.6% recruited through the health system, 13.8% FBOs, and 19.2% the community. The highest yield was achieved through the health system. However, for both the intervention (I) and control (C) groups, respectively, participants recruited from FBOs (85.7% I; 62.5% C) were more likely to attend four or more sessions than those from the health system (75.0% I; 43.3% C) and community (55.6% I; 25.0% C). Despite similar class size, participants in the intervention group (74.5%; n = 41) were more likely to attend four or more of the seven classes than those in the delayed intervention (control group) (40.7%; n = 22).The findings suggest that African American adults with diabetes can be successfully recruited and retained in a racially targeted RCT conducted in FBOs. Key elements to consider are the use of a multifaceted approach for participant recruitment, particularly the benefit of health system physician involvement in recruitment since the highest yield was achieved through health system providers, and importance of site location for retention.

The objective of this study was to determine whether racial differences in patterns of asthma care persist in a healthcare environment when financial barriers to health care are minimized. The study cohort consisted of African-American (AA) and Caucasian (C) patients, 18-50 years old, enrolled in a large HMO and hospitalized for asthma in 1993-1995. Baseline and 1-year follow-up data were collected from the HMO computerized database. Of the 193 patients in the cohort, 124 (65.3%) were AA and 67 (34.7%) were C. AAs were younger (mean = 36.2, SD = 9.9) than Cs (mean = 39.4, SD = 9.1), had a lower median household income, and made more asthma-related emergency department (ED) visits (45.2%) than Cs (22.4%) during the 1 year after the initial hospitalization (all p values0.001). During the same time period, Cs made more asthma-related primary care (70.2%) and allergy/pulmonary visits (38.8%) than AAs (47.6% and 27%, respectively). Although there were no significant racial differences in the rehospitalization rate, AA Medicaid contract patients (32%) had more rehospitalizations for asthma than AA regular contract patients (15.8%). These differential patterns in the use of asthma-related healthcare in this study indicate that the provision of health insurance alone is not sufficient to promote optimal levels of asthma management by all beneficiaries. Asthma education programs targeted for low-income AA patients may improve inappropriate healthcare use patterns.

Individuals who direct units providing biostatistical services in the area of health care frequently encounter a number of issues and problems common to this setting. To facilitate the exchange of ideas and solutions, we conducted a survey of leaders of groups providing biostatistical services in health care research settings throughout the United States and Canada. The survey included information regarding the organizational structures, salary ranges, sources of funding, computer resources, and operational concerns of these units. Respondents identified recruitment of qualified biostatisticians, inadequate institutional funding, lack of coauthorship on collaborative manuscripts, and inadequate time for independent research as major issues. Possible solutions and recommendations regarding these issues were discussed at a meeting of the heads of 19 units participating in the survey. This group, the Heads of Units of Biostatistics (HUBS), continues to meet biannually to discuss these common concern...