Search

Objective: This study tested whether initial weight change (WC), self‐weighing, and adherence to the expected WC trajectory predict longer‐term WC in an underserved primary‐care population with obesity. Methods: Data from the intervention group (n = 452; 88% women; 74% Black; BMI 37.3 kg/m2 [SD: 4.6]) of the Promoting Successful Weight Loss in Primary Care in Louisiana trial were analyzed. Initial (2‐, 4‐, and 8‐week) percentage WC was calculated from baseline clinic weights and daily at‐home weights. Weights were considered adherent if they were on the expected WC trajectory (10% at 6 months with lower [7.5%] and upper [12.5%] bounds). Linear mixed‐effects models tested whether initial WC and the number of daily and adherent weights predicted WC at 6, 12, and 24 months. Results: Percentage WC during the initial 2, 4, and 8 weeks predicted percentage WC at 6 (R2 = 0.15, R2 = 0.28, and R2 = 0.50), 12 (R2 = 0.11, R2 = 0.19, and R2 = 0.32), and 24 (R2 = 0.09, R2 = 0.11, and R2 = 0.16) months (all p < 0.01). Initial daily and adherent weights were significantly associated with WC as individual predictors, but they only marginally improved predictions beyond initial weight loss alone in multivariable models. Conclusions: These results highlight the importance of initial WC for predicting long‐term WC and show that self‐weighing and adherence to the expected WC trajectory can improve WC prediction. [ABSTRACT FROM AUTHOR]

Purpose: To determine the effect of common components of primary care-based colorectal cancer (CRC) screening interventions on fecal occult blood test (FOBT) completion "within" rural and urban community clinics, including: (1) physician's spoken recommendation, (2) providing information or education about FOBTs, and (3) physician providing the FOBT kit; to determine the relative effect of these interventions; and to compare the effect of each intervention between rural and urban clinics. Methods: We conducted structured interviews with patients aged 50 years and over receiving care at community clinics that were noncompliant with CRC screening. Self-report of ever receiving a physician's recommendation for screening, FOBT information or education, physician providing an FOBT kit, and FOBT completion were collected. Findings: Participants included 849 screening-eligible adults; 77% were female and 68% were African American. The median age was 57; 33% lacked a high school diploma and 51% had low literacy. In multivariable analysis, all services were predictive of rural participants completing screening (physician recommendation: P= 0.002; FOBT education: P= 0.001; physician giving FOBT kit: P less than 0.0001). In urban clinics, only physician giving the kit predicted FOBT completion (P less than 0.0001). Compared to urban patients, rural patients showed a stronger relationship between FOBT completion and receiving a physician recommendation (risk ratio [RR]: 5.3 vs 2.1; P= 0.0001), receiving information or education on FOBTs (RR: 3.8 vs 1.9; P= 0.0002), or receiving an FOBT kit from their physician (RR: 22.3 vs 10.1; P= 0.035). Conclusions: Participants who receive an FOBT kit from their physician are more likely to complete screening.

The purpose of this study was to determine whether an in-service for public health nurses (PHNs) and accompanying educational materials could improve vaccine risk/benefit communication. The content and timing of vaccine communication were recorded during 246 pre-and 217 post-intervention visits in two public health immunization clinics. Pre-/postintervention comparisons showed PHN communication of severe side effects (13% vs. 44%, p less than 0.0001) and their management (29% vs. 60%, p less than 0.0001) increased. There was no significant change in discussion of vaccine benefits (48% vs. 51%) or common side effects (91% vs. 92%),screening for contraindications (71% vs. 77%), or distribution of written information (89% vs. 92%). More parents initiated vaccine questions postintervention (27% vs. 39%,p less than 0.01) and were more satisfied with vaccine-risk communication (8.1 vs. 8.9 on a 10-point scale, p less than 0.01). Average vaccine communication time increased from 16 to 22 seconds (p less than 0.01). (Contains 3 tables and 1 note.)

Using data from the Louisiana Department of Public Health, we explored the spatial relationships between the Social Vulnerability Index (SVI) and COVID-19-related vaccination and mortality rates. Publicly available COVID-19 vaccination and mortality data accrued from December 2020 to October 2021 was downloaded from the Louisiana Department of Health website and merged with the SVI data; geospatial analysis was then performed to identify the spatial association between the SVI and vaccine uptake and mortality rate. Bivariate Moran's I analysis revealed significant clustering of high SVI ranking with low COVID-19 vaccination rates (1.00, p < 0.001) and high smoothed mortality rates (0.61, p < 0.001). Regression revealed that for each 10% increase in SVI ranking, COVID-19 vaccination rates decreased by 3.02-fold (95% CI = 3.73–2.30), and mortality rates increased by a factor of 1.19 (95% CI = 0.99–1.43). SVI values are spatially linked and significantly associated with Louisiana's COVID-19-related vaccination and mortality rates. We also found that vaccination uptake was higher in whites than in blacks. These findings can help identify regions with low vaccination rates and high mortality, enabling the necessary steps to increase vaccination rates in disadvantaged neighborhoods. [ABSTRACT FROM AUTHOR]

We examined knowledge of Alzheimer's disease and related dementias (ADRD), resources, and research opportunities among older African American (AA) and Caucasian caregivers. A mixed methods design integrated qualitative (focus group) and quantitative (survey) data from Northwest Louisiana. Eight focus groups (59 adults, 92% female, 78% AA, 25% rural) revealed limited knowledge. Quantitative findings from 117 ADRD caregivers (83% female, 72% AA, 30% limited heath literacy, 27% low income) indicated participants obtained information from providers (54%), friends and relatives (32%), and the internet (37%). Barriers to care were cost (24%) and lack of family agreement (17%). Few families used adult daycare (8%) or support groups (28%). Concerns about research participation were violation of privacy (30%) and fear of patient distress (27%). Distrust of doctors was minimal (3%). Findings did not vary by race. There is a need for clear, literacy-appropriate information about ADRD, caregiver resources, and clinical trials. [ABSTRACT FROM AUTHOR]

Purpose: The majority of colorectal cancer (CRC) research using the fecal immunochemical test (FIT) has studied short‐term screening results in predominantly urban areas. The purpose of this study was to evaluate the effectiveness of 2 outreach strategies embedded in a health literacy intervention on repeat CRC screening in rural community clinics. Methods: A 2‐arm randomized controlled trial was conducted in 4 rural clinics in Louisiana. During a regularly scheduled clinic visit, participants ages 50–75 received a FIT kit and brief educational intervention. Participants were randomized to receive an automated call or a personal call by a prevention counselor after 4 weeks and 8 weeks if FIT kits were not returned. In year 2, materials were mailed, and follow‐up calls were conducted as in year 1. The primary outcome was repeat FIT—the return of the FIT kit in both years. Participants: Of 568 eligible participants, 55% were female, 67% were African American, and 39% had low health literacy. Findings: Repeat FIT rates were 36.5% for those receiving the automated call and 33.6% for those receiving a personal call (P =.30). No annual FITs were returned in 30% of participants, while only 1 FIT was returned by 35% of participants (31% only year 1 and 4% only year 2). Conclusion: Sustaining CRC screening with FIT is challenging in rural clinics. A lower cost automated call was just as effective as the personal call in promoting repeat annual screening. However, more intensive strategies are needed to improve long‐term FIT screening among rural participants. [ABSTRACT FROM AUTHOR]

The mean absolute weight difference between the ILI and UC groups was 2.5 kg (CI, 0.2 to 4.8 kg; I P i = 0.030) lower among food-insecure patients than food-secure patients. I Objective: i To examine via post hoc analysis whether food security status modified patient responses to a high-intensity, lifestyle-based intervention for weight loss. [Extracted from the article]