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Background Older cancer survivors, faced with both age- and treatment-related morbidity, are at increased and premature risk for physical function limitations. Physical performance is an important predictor of disability, quality of life, and premature mortality, and thus is considered an important target of interventions designed to prevent, delay, or attenuate the physical functional decline. Currently, low-cost, valid, and reliable methods to remotely assess physical performance tests that are self-administered by older adults in the home-setting do not exist, thus limiting the reach, scalability, and dissemination of interventions. Objective This paper will describe the rationale and design for a study to evaluate the accuracy, reliability, safety, and acceptability of videoconferencing and self-administered tests of functional mobility and strength by older cancer survivors in their own homes. Methods To enable remote assessment, participants receive a toolkit and instructions for setting up their test course and communicating with the investigator. Two standard gerontologic performance tests are being evaluated: the Timed Up and Go test and the 30-second chair stand test. Phase 1 of the study evaluates proof-of-concept that older cancer survivors (age ≥60 years) can follow the testing protocol and use a tablet PC to communicate with the study investigator. Phase 2 evaluates the criterion validity of videoconference compared to direct observation of the two physical performance tests. Phase 3 evaluates reliability by enrolling 5-10 participants who agree to repeat the remote assessment (without direct observation). Phase 4 enrolls 5-10 new study participants to complete the remote assessment test protocol. Feedback from participants in each phase is used to refine the test protocol and instructions. Results Enrollment began in December 2019. Ten participants completed the Phase 1 proof-of-concept. The study was paused in mid-March 2020 due to the COVID-19 pandemic. The study is expected to be completed by the end of 2020. Conclusions This validity and reliability study will provide important information on the acceptability and safety of using videoconferencing to remotely assess two tests of functional mobility and strength, self-administered by older adults in their homes. Videoconferencing has the potential to expand the reach, scalability, and dissemination of interventions to older cancer survivors, and potentially other older adults, especially in rural areas. Trial Registration ClinicalTrials.gov NCT04339959; https://clinicaltrials.gov/ct2/show/NCT04339959 International Registered Report Identifier (IRRID) DERR1-10.2196/20834

This parallel-group, randomized controlled pilot study examined daily meditation in a diverse sample of older adults with postherpetic neuralgia. Block randomization was used to allocate participants to a treatment group (n = 13) or control group (n = 14). In addition to usual care, the treatment group practiced daily meditation for six weeks. All participants completed questionnaires at enrollment in the study, two weeks later, and six weeks after that, at the study's end. Participants recorded daily pain and fatigue levels in a diary, and treatment participants also noted meditation practice. Results at the 0.10 level indicated improvement in neuropathic, affective, and total pain scores for the treatment group, whereas affective pain worsened for the control group. Participants were able to adhere to the daily diary and meditation requirements in this feasibility pilot study.

BACKGROUND: The unintentional death rate from falls is higher among American Indians from the US Southwest than from other regions in the country. The Zuni Pueblo is a geographically isolated, rural American Indian community located in western New Mexico. Education and screening for falls risk is lacking in this community and may be needed to reduce falls and falls-related illness and death. COMMUNITY CONTEXT: Building on a 17-year relationship with the Zuni Health Initiative, meetings were held with Zuni tribal leadership, staff from the Zuni Senior Center and Zuni Home Health Services, members of the Zuni Comprehensive Community Health Center, Indian Health Service, and Zuni community health representatives (CHRs) to discuss elder falls in the community. Existing infrastructure, including CHRs who were already trained and certified in diabetes education and prevention, provided support for the study. METHODS: Tribal leadership agreed that CHRs would be trained to administer the Centers for Disease Control and Prevention's (CDC's) Stay Independent checklist to assess falls risk. They administered the checklist during one-on-one interviews in Shiwi (Zuni native language), English, or both to a convenience sample of 50 Zuni elders. OUTCOMES: Mean age of participants was 72 (standard deviation, 7.4) years, and 78% were women. Fifty-two percent reported at least 1 fall during the past year; 66% scored 4 or more on the CDC Stay Independent checklist, indicating elevated risk for falls. CHRs reported that the checklist was easy to administer and culturally accepted by the elder participants. INTERPRETATION: This study broadened the Zuni Health Initiative to include falls risk screening. Self-reported falls were common in this small sample, and the incidence was significantly higher than the national rate. These results highlight the need for community engagement, using culturally acceptable falls screening, to promote falls education and implement falls prevention programs. Language: en

To investigate the baseline associations between body composition, cardiorespiratory fitness, physical activity, family history of type 2 diabetes, metabolic syndrome and impaired fasting glucose (IFG) among 200 asymptomatic urban Native American women aged 18-40 years participating in a diabetes prevention intervention.Participants without diabetes who self-identified as Native American were recruited from the general urban community into a randomized controlled trial. Inclusion criteria included not being pregnant and willingness to stay in the urban area for 2 years. From June 2002 to June 2004, baseline measures were taken and included fasting serum glucose, insulin, and lipids, body mass index (BMI), waist circumference, percent body fat, submaximal predicted cardiorespiratory fitness, and self-reported leisure physical activity and family history of type 2 diabetes.Most participants were overweight or obese (mean BMI = 29.4 +/- 6.3 kg/m(2); mean percent body fat = 41.2% +/- 6.2%). Fifty-five (27.5%) had metabolic syndrome and 42 (21%) had IFG. Stepwise logistic regression indicated that BMI (odd ratio [OR] = 1.24; p0.001) and a family history of type 2 diabetes (OR = 4.96; p = 0.008) were significantly associated with metabolic syndrome. BMI (OR = 1.13; p = 0.003) was strongly positively associated with IFG. After adjusting for BMI, age (OR = 1.08; p = 0.021) was positively, and high-density lipoprotein cholesterol (HDL-C; OR = 0.93; p = 0.008) and cardiorespiratory fitness (OR = 0.36; p = 0.046) were inversely significantly associated with IFG.BMI, cardiorespiratory fitness, and physical activity levels are important variables to modify when attempting to reduce the prevalence of metabolic syndrome and IFG among young, asymptomatic Native American women. This information can be used to design effective diabetes prevention interventions.

Introduction Medical care for older adults is often quite complex, as individuals may have multiple health concerns that require medications, therapy, and a variety of treatment modalities. Medical conditions are often associated with psychosocial, cultural, cognitive, nutritional, financial and functional issues. To achieve positive health outcomes, care for older adults must be coordinated and comprehensive, and this often requires effective interprofessional collaboration. This means that health professional students need to learn how to provide care that exemplifies good communication, collaboration, and teamwork. In addition, there is increasing awareness that competence in geriatric care needs to be improved for almost all health care team members through enhanced training programs. Methods This case study is designed to be used with a team of any mix of interprofessional health care students and one standardized patient as a stand-alone activity or as a part of a larger interprofessional course. The standardized patient encounter utilizes three documents: the standardized patient script, the introduction, and the physical exam and laboratory findings. Each team is instructed to develop a team-oriented care plan based on the script, introduction, and the team assessment. Instructor assessment tools are also included with this resource. Results In order to determine if we are meeting our course and activity objectives, we collect pre- and postsurvey data on geriatric and interprofessional team perceptions. At the conclusion of the course the students complete a team effectiveness survey. Student written feedback on the course has consistently commented that the standardized patient assessments are the best portion of the course. Their feedback has also indicated that they feel more confident with evaluating geriatric patients and working as an interprofessional team. The students also learn more about each other's professional roles. Discussion This course has led to development of curricular changes and additional patient care services. Interprofessional faculty teaching together in this course led to the development of additional coordinated interprofessional clinical patient care service at the university's senior health primary care clinic. Additional service learning is now also being provided to under-served geriatric populations in the community. The occupational therapy program is now developing a geriatric curricular track that would include this course as a required element.

The acceptance of age-appropriate cancer screening as an integral part of primary care has grown among physicians over the past decade. We conducted a mailed survey of all primary care physicians in New Mexico in order to better understand their current cancer screening practices. We found a high rate of self-reported screening, particularly for prostate and colorectal cancer. The screening rates were influenced only slightly by the introduction of evidence-based guidelines, with younger physicians and those with university affiliations more likely to follow recommendations. Female physicians and obstetrician-gynecologists endorsed breast and cervical cancer screening among all age groups and were less likely to follow recommendations for less frequent screening in women as they age. Since a physician's practice beliefs influence his/her attitude toward testing, tailoring education by physician specialty may be more effective than using generic messages in encouraging compliance with the most recent evidence-based guidelines.

Introduction Public health nurses (PHNs) often serve as primary care providers, yet few studies have examined their practice patterns in the early detection of breast and cervical cancer. Methods We conducted a cross-sectional survey of all PHNs (N = 1,894) employed by the county health departments of North Carolina in July 1993 to describe the predictors of their performance of breast and cervical cancer early detection. The main outcome measures were self-report of cancer prevention and screening services provided for their adult clients, nursing self-confidence for counseling clients about cancer prevention, and training experience. Self-confidence for counseling clients about cancer prevention was measured by asking whether a nurse had sufficient knowledge to educate clients about cancer prevention as well as by obtaining nursing perception of the quality of their clinical skills. Results The response rate was 78%. Final sample consisted of 1,369 PHNs, after exclusion of 101 nurse practitioners. Nurses reported high performance rates of cancer screening, although self-rating of the quality of their clinical skills was often low. However, nurses who reported having higher quality clinical skills or who reported having sufficient knowledge to educate clients were significantly more likely to report a greater frequency of performing cancer screening and counseling. This self-confidence and performance association was independent of nursing certification to perform screening, job classification, education, knowledge, or continuing education coursework. Conclusions Self-confidence is a significant predictor of PHNs’ reported performance of cancer screening and counseling. Further studies to verify whether self-report predicts actual performance of cancer early detection are needed.

This study discusses the findings from a survey of the knowledge, attitudes, and clinical practice regarding cancer prevention and early detection of 101 nurse practitioners (NPs) working in the 87 county public health departments in North Carolina. Results show that nurse practitioners provide breast and cervical cancer screening services for most women over age 40 but are less likely to provide other types of cancer prevention, such as smoking cessation counseling or education about diet and cancer. NPs tended to rate their clinical skills in providing cancer screening as excellent but rate their skills in educating clients about cancer risk lower. Most NPs were interested in practice related to cancer control, especially learning more about the latest recommendations on cancer. However, in this study they indicated the least interest in learning more about smoking cessation methods or cancer prevention issues for men. These findings suggest that NPs in public health need further education and skills training related to cancer control, in addition to breast and cervical cancer screening.

OBJECTIVE: To compare three approaches for improving compliance with influenza and pneumococcal vaccination of elderly patients. DESIGN: Randomized controlled trial using three parallel group practices at a public urban teaching hospital. SETTING: Public teaching hospital. SUBJECTS: All patients 65 years of age and older (n = 1202) seen by resident physicians (n = 66) attending three ambulatory medical practices from October 1, 1989 to March 31, 1990. INTERVENTIONS: All three provider groups received intensive education in immunization standards. The control group received no further intervention. Staff in the second group offered education to patients at their visits. In the third group, the prevention team, a flowsheet was used, patient education offered, and staff had their tasks redefined to facilitate compliance; for vaccinations, eg, nurses could vaccinate independent of MD initiative. MEASUREMENTS AND MAIN RESULTS: Medical records were reviewed for the 1202 patients seen, including 756 patients seen during both the 1988-89 and 1989-90 influenza seasons, to determine documented offering and receipt of vaccinations. During the intervention period (1989-90), influenza vaccinations were offered significantly more frequently to prevention team patients (68.3%) than to patients in either the patient education (50.4%) or control (47.6%) groups (P = 0.006), even after adjusting for the patients' prior vaccination status, age, gender, race, and high-risk co-morbidity and for physicians' level of training. Likewise, pneumococcal vaccinations were offered more frequently to previously unvaccinated prevention team patients (28.3%) than to patient education (6.5%) or control (5.4%) group patients (P = 0.001), even after adjusting for the factors using multivariate analysis. Compliance rates did not differ between patient education and control subjects for either vaccine. Pre-intervention physician surveys documented higher perceived than actual compliance for both vaccines, with 89.0% and 52.8% of physicians believing that they complied with influenza and pneumococcal vaccination guidelines, respectively. CONCLUSIONS: The results of this trial provide strong support for organizational changes that involve non-physician personnel to enhance vaccination rates among older adults.

Background American Indians experience high rates of type 2 diabetes. The impact of low-intensity interventions on diabetes risk among young American Indian women is unknown. Design Randomized controlled trial. Setting/Participants Community-based; participants were 200 young urban American Indian women who were block-randomized on fasting blood glucose (FBG) into intervention and control groups. Inclusion criteria included self-reported identity, aged 18–40 years, not pregnant, willingness to stay in urban area for 2 years, and not having type 2 diabetes. Measures were taken at baseline, 6, 12, and 18 months. Data were gathered in 2002–2006 and analyzed in 2006–2007. Intervention Five discussion group sessions (one meeting per month for 5 months) were held focusing on healthful eating, physical activity, goal-setting, and social support. Main Outcome Measures Primary outcomes included dietary fat and vegetable consumption and self-reported physical activity. Secondary outcomes included cardiorespiratory fitness, insulin sensitivity, blood pressure, lipid profiles, percent body fat, BMI, intake of fruit, total sugar and sweetened beverages, FBG, and television viewing. Results Mean vegetable and fruit intake increased significantly more in the intervention group than in the control group over time (group by visit interaction, p =0.02 and p =0.002, respectively). Both groups had significant increases in percent body fat and decreases in waist circumference, insulin sensitivity, blood cholesterol, LDL, television viewing, and total intakes of energy, saturated fat, sugar, and sweetened beverages. Conclusions A culturally influenced, low-intensity lifestyle intervention can improve self-reported intakes of vegetables and fruit over 18 months in young, urban American Indian women. Trial Registration NCT00438126

Introduction Use of complementary and alternative medicine (CAM) for chronic conditions has increased in recent years. There is little information, however, on CAM use among adults with clinic-confirmed diagnoses, including arthritis, who are treated by primary care physicians. Methods To assess the frequency and types of CAM therapy used by Hispanic and non-Hispanic white women and men with osteoarthritis, rheumatoid arthritis, or fibromyalgia, we used stratified random selection to identify 612 participants aged 18–84 years and seen in university-based primary care clinics. Respondents completed an interviewer-administered survey in English or Spanish. Results Nearly half (44.6%) of the study population was of Hispanic ethnicity, 71.4% were women, and 65.0% had annual incomes of less than $25,000. Most (90.2%) had ever used CAM for arthritis, and 69.2% were using CAM at the time of the interview. Current use was highest for oral supplements (mainly glucosamine and chondroitin) (34.1%), mind-body therapies (29.0%), and herbal topical ointments (25.1%). Fewer participants made current use of vitamins and minerals (16.6%), herbs taken orally (13.6%), a CAM therapist (12.7%), CAM movement therapies (10.6%), special diets (10.1%), or copper jewelry or magnets (9.2%). Those with fibromyalgia currently used an average of 3.9 CAM therapies versus 2.4 for those with rheumatoid arthritis and 2.1 for those with osteoarthritis. Current CAM use was significantly associated with being female, being under 55 years of age, and having some college education. Conclusion Hispanic and non-Hispanic white arthritis patients used CAM to supplement conventional treatments. Health care providers should be aware of the high use of CAM and incorporate questions about its use into routine assessments and treatment planning.

Issues related to women’s health, and particularly to menopause, have been major priorities over the past decade for agencies of the U.S. Department of Health and Human Services (DHHS). In order to prevent morbidity and mortality in perimenopausal and postmenopausal women, an unprecedented concentration of resources and attention has been directed toward menopause. This has included funding of new research to elucidate the menopausal transition and to prevent morbidity, as well as support of studies of associated pharmacological, clinical, and epidemiological aspects and prevention research.

This study discusses the findings from two surveys of 459 nurses working in public health about their knowledge and perception of counseling and clinical skills related to breast and cervical cancer control. The first survey was conducted in 1993 before professional education efforts with the Breast and Cervical Cancer Control Program (BCCCP) began in North Carolina. The second survey was carried out in 1996. The results show a significant increase from 1993 to 1996 in recognition of increasing age, nulliparity, late childbearing, and family history as risk factors for breast cancer, and for smoking and early age at first sexual intercourse as risk factors for cervical cancer. Nurses' skills were more likely to be rated as excellent or very good in 1996 as compared with ratings in 1993 for educating women about mammography, performing a clinical breast examination, teaching breast self-examination by demonstration, performing a Papanicolaou (Pap) smear and bimanual examination, and counseling women about abnormal Pap tests. Nurses who took a BCCCP-sponsored adult physical assessment course were more likely to know correct risk factors for breast and cervical cancer, and to show improvement in teaching breast self-examination, performing a Pap smear, and counseling women about abnormal Pap tests.

Over 600,000 hysterectomies are performed each year in the United States, the majority of which are to improve quality of life for perimenopausal women. Hysterectomy rates for common conditions differ between African American and white women, and African American women undergo surgery at a younger age for most diagnoses. Many hysterectomies are accompanied by elective oophorectomy, and hormone replacement therapy (HRT) is commonly used, especially among women experiencing surgical menopause, despite questions about its long-term benefits and risks. Despite the high rates of hysterectomy in the United States, little is known about how women make decisions regarding this surgery and, in particular, how ethnic and cultural factors may influence these decisions. This article provides a review of what is currently known about the epidemiology of hysterectomy, oophorectomy, and HRT use and identifies gaps in knowledge about women's decision making, with a special focus on ethnic variations and cultural influences, issues addressed by the Ethnicity, Needs, and Decisions of Women (ENDOW) project.

Physicians play an important role in recommending and doing cancer screening for their patients. In 1991, the North Carolina Department of Environment, Health and Natural Resources and the Centers for Disease Control and Prevention conducted a survey to determine the counseling and referral practices of primary care physicians practicing in North Carolina. Physicians were asked to report the percentage of patients in various age groups that they recommended receive a clinical breast examination, referral for mammography screening, or a Pap test and at what intervals they recommended each study. They were also asked their perceived barriers to cervical cancer screening. Obstetrician-gynecologists recommended annual Pap smear screening more frequently than did physicians in other specialties for patients of all ages. For mammography, variation existed for recommended screening intervals for all specialties by patient age (35 to 39 years, 40 to 49 years, 50 to 64 years, and over age 65). Recommendations for mammography also differed significantly according to physicians' age and sex. The medical community and the public need a consistent and clear message to promote effective screening maneuvers.

Purpose This pilot study compared usual care alone with usual care plus meditation in relation to anxiety, depression, pain, and quality of life in community-dwelling older adults with postherpetic neuralgia (PHN). PHN may occur after shingles, and has been described as one of the most intractable neuropathic pain disorders. Older adults develop PHN more often than younger adults. Mindfulness meditation, found to be beneficial in the management of some chronic pain conditions, has not been specifically examined in older adults with PHN.

This article describes training programs instituted in 1992 by the North Carolina Breast and Cervical Cancer Control Program (BCCCP) to improve skills of public health nurses in breast and cervical cancer education and clinical services. Public health nurses traditionally serve as primary health care providers in medically underserved communities and are the main providers of BCCCP services. The training programs were evaluated by a statewide survey of public health nurses in 1996. The authors discuss the findings of this survey, its limitations, and the goals it has led the authors to set for improving the education program in the future.

Background: To compare three approaches for improving compliance with breast cancer screening in older Methods: Randomized controlled trial using three parallel group practices at a public hospital. Subjects included women aged 65 years and older (n=803) who were seen by residents (n=66) attending the ambulatory clinic from October 1, 1989, through March 31, 1990. All provider groups received intensive education in breast cancer screening. The control group received no further intervention. Staff in the second group offered education to patients at their visit. In addition, flowsheets were used in the "Prevention Team" group and staff had their tasks redefined to facilitate compli Results: Medical records were reviewed to determine documented offering/receipt of clinical breast examination and mammography. A subgroup of women without previous clinical breast examination (n=540) and without previous mammography (n=471) were analyzed to determine the effect of the intervention. During the intervention period, women without a previous clinical breast examination were offered an examination significantly more often in the Prevention Team group than in the control group, adjusting for age, race, and comorbidity and for physicians' gender and training level. The patients in the Prevention Team group were offered clinical breast examination (31.5%) more frequently than those in the patient education or control groups, but this was not significant after adjusting for the above covariates. Likewise, mammography was offered more frequently to patients in the Prevention Team and in the patient education group than to patients in the control group, after adjusting for the factors above using logistic regression. Conclusions: The results provide support for patient education and organizational changes that involve nonphysician personnel to enhance breast cancer screening among older women, particularly those without previous screening. (Arch Intern Med. 1995;155:717-722)