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Background and objectivesFatigue is a common complaint and shares many risk factors with falls, yet the independent contribution of fatigue on fall risk is unclear. This study's primary aim was to assess the association between fatigue and prospective fall risk in 5642 men aged 64-100 enrolled in the Osteoporotic Fractures in Men Study (MrOS). The secondary aim was to examine the association between fatigue and recurrent fall risk.Research design and methodsFatigue was measured at baseline using the Medical Outcomes Study (short form) single-item question "During the past four weeks, how much of the time did you feel energetic?" Responses were then classified: higher fatigue = "none," "a little," or "some" of the time and lower fatigue = "a good bit," "most," or "all" of the time. We assessed falls using triannual questionnaires. Fall risk was examined prospectively over 3 years; recurrent falling was defined as at least 2 falls within the first year. Generalized estimating equations and multinomial logistic regression modeled prospective and recurrent fall risk as a function of baseline fatigue status, adjusted for demographics, medications, physical activity, and gait speed.ResultsMen with higher (26%) versus lower baseline fatigue were older (75.1 ± 6.2 vs 73.2 ± 5.7 years), 24% less active, and had worse physical function (gait speed = 1.09 ± 0.24 vs 1.24 ± 0.21 m/s), all p < .0001. Within 1 year, 25.4% (n = 1409) had fallen at least once, of which 47.4% (n = 668) were recurrent fallers. Men with higher versus lower fatigue had 25% increased fall risk (relative risk = 1.25, 95% CI: 1.14-1.36) over 3 years follow-up, but had 50% increased odds of recurrent falling (odds ratio = 1.50, 95% CI: 1.22-1.85) within the first year.Discussion and implicationsFatigue is an important risk factor of falling independent of established risk factors. Reductions in fatigue (ie, increased energy) may lessen the burden of falls in older men and provide a novel avenue for fall risk intervention.

Background: Disparities in breast and cervical cancer screening by socioeconomic status persist in the United States. It has been suggested that social support may facilitate screening, especially among women of low socioeconomic status. However, at present, it is unclear whether social support enables mammogram and Pap test compliance. Purpose: This study examines the association between social support and compliance with mammogram and Pap test screening guidelines, and whether social support provides added value for women of low education. Method: Data were from a countywide 2009-2010 population-based survey, which included records of 2,588 women 40 years and older (mammogram) and 2,123 women 21 to 65 years old (Pap test). Compliance was determined using the guidelines in effect at the time of data collection. Results: Social support was significantly related to mammogram (adjusted odds ratio = 1.43; 95% confidence interval [1.16, 1.77]) and Pap test (adjusted odds ratio = 1.71; 95% confidence interval [1.27, 2.29]) compliance after controlling for age, race, having a regular health care provider, and insurance status. The interaction between social support and education had a significant effect on Pap test compliance only among women younger than 40; the effect was not significant for mammogram compliance. Conclusion: Social support is associated with breast and cervical cancer screening compliance. The association between education and cancer screening behavior may be moderated by social support; however, results hold only for Pap tests among younger women. Practitioners and researchers should focus on interventions that activate social support networks as they may help increase both breast and cervical cancer screening compliance among women with low educational attainment.

While there is research on survivors of domestic violence in India and the United States (U.S.), little is known about the sociocultural factors related to domestic violence among Hindu Asian Indian immigrant women (AIIW) in the U.S. The objectives of this study were to a) test the feasibility of conducting domestic violence research among Hindu AIIW; b) investigate domestic violence prevalence and correlations with other characteristics; and c) test the cultural appropriateness of completed measures on social support, acculturation status, and domestic violence. Over 50% of respondents had experienced abuse, often perpetrated by family. Participants had high levels of social support and acculturation, regardless of their abuse status. Participants were receptive to this research, suggesting that domestic violence research among Hindu AIIW is feasible. High prevalence of violence among Hindu AIIW suggests they are at high risk for experiencing abuse; lack of variability in social support and acculturation scale responses suggest the need to further test instruments among Hindu AIIW. [ABSTRACT FROM AUTHOR]

Background. Little is known about vaccine intention behavior among patients recovering from a medically attended acute respiratory infection. Methods. Adults ≥ 18 years old with an acute respiratory infection in the 2014-2015, 2015-2016, and 2016-2017 influenza seasons were tested for influenza and completed surveys. Across seasons, unvaccinated participants were grouped into those who intended to receive the influenza vaccine in the following season (vaccine intention) and those who did not (no vaccine intention). In 2016-2017, participants were asked the reasons for their vaccination behavior. Results. Of the 837 unvaccinated participants, 308 (37%) intended to be vaccinated the next season. The groups did not differ in demographic or overall health factors. In logistic regression, non-Whites, those reporting wheezing or nasal congestion, and those receiving an antiviral prescription were more likely to be in the vaccine intention group. That group was significantly more likely to cite perceived behavioral control reasons for not being vaccinated (forgot), while the no vaccine intention group was significantly (p <.001) more likely to report knowledge/attitudinal reasons (side effects). Conclusion. Because influenza vaccine is given annually, adults must make a conscious decision to receive the vaccine each year. Understanding the factors related to vaccination behavior and intent can help shape interventions to improve influenza vaccination rates. A medical visit at the time of an acute respiratory illness, especially one in which the provider suspects influenza, as evidenced by an antiviral prescription, is an ideal opportunity to recommend influenza vaccine in the next season, to prevent a similar experience. [ABSTRACT FROM AUTHOR]

Utilization and perceived benefits of hospice may vary across populations. In a population-based survey, we examined the prevalence of hospice utilization, caregiver sociodemographic characteristics, and quality and complexity of end-of-life (EOL) care, as reported by community caregivers to people who died in the prior year. The 2009 to 2010 Allegheny County, PA Behavioral Risk Factor Surveillance System Health Survey, a population-based telephone survey of 5442 adult residents, included an 8-item EOL caregiver module. Overall, 7.8% (95% confidence interval = 7.0-8.6) of respondents reported having arranged or provided care for a close friend/family member who died in the previous 12 months. Caregivers of decedents who utilized hospice reported positive quality outcomes and greater involvement in care. Utilization of hospice services was associated with beneficial outcomes at EOL, but with increased involvement of EOL caregivers. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare simulation supports educational opportunities while maintaining patient safety. To reduce costs and increase the availability of training, a randomized controlled study evaluated central venous catheter (CVC) insertion training in the simulation laboratory with nonphysician competent facilitators (NPCFs) as instructors., Method: A group of learners naive to central line placement participated in a blended curriculum consisting of interactive online materials and simulation-based training. Learners were randomized to training with NPCFs or attending physician faculty. The primary outcome was simulated CVC insertion task performance, graded with a validated checklist by blinded physician reviewers. Learner knowledge and satisfaction were also evaluated. Analysis was conducted using noninferiority testing., Results: Eighty-five students, 11 attending physicians, and 7 NPCFs voluntarily participated. Noninferiority testing of the difference in CVC insertion performance between NPCF-trained learners versus physician-trained learners found no significant difference [rejecting the null hypothesis of inferiority using an 8% noninferiority margin (P < 0.01)]. In addition, there was no difference found between the 2 groups on pre/post knowledge scores, self-reported learner comfort, course satisfaction, or instructor satisfaction., Conclusions: An introductory CVC curriculum can be taught to novice learners by carefully trained and supported NPCFs and achieve skill and knowledge outcomes similar to learners taught by physicians.