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Vinay K Cheruvu,1 Lorriane A Odhiambo,1 Dana S Mowls,2 Melissa D Zullo,1 Abdi T Gudina1 1Department of Biostatistics, Environmental Health Sciences, and Epidemiology, College of Public Health, Kent State University, Kent, OH, 2Department of Biostatistics & Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA Abstract: Findings from studies that examined the association between health-related ­quality of life (HRQOL) and smoking status among COPD patients have been mixed. Moreover, factors associated with current smoking in COPD patients and differences by sex have not been fully elucidated. Data from the 2011 and 2012 Behavioral Risk Factor Surveillance System was used in this study. Four HRQOL indicators were examined in this study: general health, physical health, mental health, and activity limitations. General health was dichotomized into two groups: “excellent/very good/good” and “fair/poor”, and the other three HRQOL indicators were dichotomized into

Purpose: Lack of knowledge contributes to disparate outcomes among Americans with asthma or chronic obstructive pulmonary disease (COPD). This study assessed the impact of an educational intervention on disease knowledge and management in Black Americans with asthma or COPD., Design: Pre-post study design with 9-month follow-up., Setting: Urban church community., Subjects: Black American adults (N = 38) with self-reported asthma (18) and COPD (20), of which 76.3% (N = 29) completed the intervention., Intervention: The Asthma COPD (ACOPD) Workshop consisted of three 1-hour classes focused on disease knowledge and management behaviors (physical activity, nutrition, and avoiding triggers) delivered in 16 sessions over six months., Measures: Knowledge questionnaire., Analysis: McNemar's tests for paired proportions., Results: Knowledge of disease concepts increased post-intervention, then decreased at the 9-month follow-up. There was a significant difference in the proportion of participants that provided correct answers to questions about 'two diseases that constitute COPD' ( P = .04), 'main cause of COPD' ( P = .01), 'written action plan' ( P = .04), and 'untrue statement about asthma,' ( P = .02)., Conclusion: The ACOPD Workshop increased knowledge of basic disease concepts, risk factors, and management. Regular delivery of educational sessions in the community can support knowledge retention and practice of healthy behaviors., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Sedentary behavior is a public health threat with extensive health burden on society. High levels of sedentary behavior have been associated with cardiovascular diseases, diabetes, obesity, and cancer. Individuals working in desk-related occupations are more likely to be sedentary for most of the day. Health researchers have responded by implementing and promoting interventions and wellness programs in work environments to reduce this behavior. This study examined the feasibility and experience of using the DeskCycle to reduce sedentary behavior among female workers in an academic office environment., Methods: This was an intervention study where participants used the DeskCycle in two consecutive eight-week phases and uploaded DeskCycle use data daily. A questionnaire was administered after week 2 and week 8 (pre-post) of DeskCycle use in each phase to assess dimensions of feasibility, including an open-ended question for user experience., Results: The participants (N = 78) had an average age of 44.4 (±11.3) years and were primarily non-Hispanic White (88.5%). DeskCycle daily use varied from Phase I: 84% to 64.9% (weeks 1-7), and 49.4% in week 8, to Phase II: 73.5% to 52.2% (week 1-7), and 40.2% in week 8. In Phase I, 96.6% (week 2) and 87% (week 8) agreed that the DeskCycle decreased sedentary behavior, and in Phase II, 74.3% (week 2) and 76.9% (week 8) agreed. The analysis of open-ended responses found challenges with the desk set up, cycling interfering with typing, and thinking critically, as barriers to DeskCycle use, while enjoying cycling and cycling improving mood were reported as facilitators., Conclusions: Using a DeskCycle in an academic office environment to reduce sedentary behavior is feasible in female office workers. Consideration should be given to the type of tasks performed while cycling., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Odhiambo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Post-intensive care syndrome-family (PICS-F) is a constellation of adverse psychological symptoms experienced by family members of critically ill patients during and after acute illness. Cognitive behavioral therapy delivered using smartphone technology is a novel approach for PICS-F symptom self-management., Objective: To determine the efficacy of smartphone delivery of cognitive behavioral therapy in reducing the prevalence and severity of PICS-F symptoms in family members of critically ill patients., Methods: The study had a randomized controlled longitudinal design with control and intervention groups composed of family members of patients admitted to 2 adult intensive care units. The intervention consisted of a mental health app loaded on participants' personal smartphones. The study time points were upon enrollment (within 5 days of intensive care unit admission; time 1), 30 days after enrollment (time 2), and 60 days after enrollment (time 3). Study measures included demographic data, PICS-F symptoms, mental health self-efficacy, health-related quality of life, and app use., Results: The study sample consisted of 60 predominantly White (72%) and female (78%) family members (30 intervention, 30 control). Anxiety and depression symptom severity decreased significantly over time in the intervention group but not in the control group. Family members logged in to the app a mean of 11.4 times (range, 1-53 times) and spent a mean of 50.16 minutes (range, 1.87-245.92 minutes) using the app., Conclusions: Delivery of cognitive behavioral therapy to family members of critically ill patients via a smartphone app shows some efficacy in reducing PICS-F symptoms., (©2023 American Association of Critical-Care Nurses.)

Objective: To evaluate the effectiveness of the DeskCycle in reducing sedentary behavior among female office workers at an educational institution., Methods: This was a randomized control trial with a crossover design (N = 80). The intervention was conducted in two 8-week phases and included the DeskCycle and an informational handout with benefits and suggestions about the frequency of use. The primary outcome was weekly average nonsedentary time. Secondary outcomes included weight and mood., Results: DeskCycle users reported significantly higher weekly average nonsedentary time compared with nonusers (phase I: 402.3 ± 72.4 vs 169.3 ± 17.5, P < 0.00; phase II: 282 ± 45 vs 216 ± 23, P = 0.00). There were no significant differences in weight or mood., Conclusions: The DeskCycle is effective in reducing sedentary behavior, suggesting workers in sedentary office occupations could integrate it into their workday, where possible, to prevent negative health outcomes., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 American College of Occupational and Environmental Medicine.)

Asthma, and chronic obstructive pulmonary disease (COPD) are significant health problems that have disparate effects on many Americans. Misdiagnosis and underdiagnosis are common and lead to ineffective treatment and management. This study assessed the feasibility of applying a two-step case-finding technique to identify both COPD and adult asthma cases in urban African American churches. We established a community-based partnership, administered a cross-sectional survey in step one of the case-finding technique and performed spirometry testing in step two. A total of 219 surveys were completed. Provider-diagnosed asthma and COPD were reported in 26% (50/193) and 9.6% (18/187) of the sample. Probable asthma (13.9%), probable COPD (23.1%), and COPD high-risk groups (31.9%) were reported. It is feasible to establish active case-finding within the African American church community using a two-step approach to successfully identify adult asthma and COPD probable cases for early detection and treatment to reduce disparate respiratory health outcomes., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Family members of intensive care unit (ICU) patients are at risk for post-intensive care syndrome- family (PICS-F), including symptoms of anxiety, depression, and posttraumatic stress. Cognitive behavioral therapy is the first-line nonpharmacologic treatment for many psychological symptoms and has been successfully delivered by use of mobile technology for symptom self-management., Objectives: To determine the feasibility of delivering cognitive behavioral therapy through a smartphone app to family members of critically ill patients., Methods: This was a prospective longitudinal cohort study with a consecutive sample of patients admitted to 2 adult ICUs and their family members. The control group period was followed by the intervention group period. The intervention consisted of a mobile health app preloaded on a smartphone provided to family members. The study time points were enrollment (within 5 days of ICU admission), 30 days after admission, and 60 days after admission. Study measures included demographic data, app use, satisfaction with the app, mental health self-efficacy, and measures of PICS-F symptoms., Results: The study sample consisted of 49 predominantly White (92%) and female (82%) family members (24 intervention, 25 control). Smartphone ownership was 88%. Completion rates for study measures were 92% in the control group and 79% in the intervention group. Family members logged in to the app a mean of 18.58 times (range 2-89) and spent a mean of 81.29 minutes (range 4.93-426.63 minutes) using the app., Conclusions: The study results confirm the feasibility of implementing app-based delivery of cognitive behavioral therapy to family members of ICU patients., (©2021 American Association of Critical-Care Nurses.)

Background: Family members of critically ill patients experience symptoms of postintensive care syndrome-family (PICS-F), including anxiety, depression, and posttraumatic stress disorder. Postintensive care syndrome-family reduces the quality of life of the families of critically ill patients and may impede the recovery of such patients. Cognitive behavioral therapy has become a first-line nonpharmacological treatment of many psychological symptoms and disorders, including anxiety, depression, and posttraumatic stress. With regard to managing mild-to-moderate symptoms, the delivery of cognitive behavioral therapy via mobile technology without input from a clinician has been found to be feasible and well accepted, and its efficacy rivals that of face-to-face therapy., Objective: The purpose of our pilot study is to examine the efficacy of using a smartphone mobile health (mHealth) app to deliver cognitive behavioral therapy and diminish the severity and prevalence of PICS-F symptoms in family members of critically ill patients., Methods: For our pilot study, 60 family members of critically ill patients will be recruited. A repeated-measures longitudinal study design that involves the randomization of participants to 2 groups (the control and intervention groups) will be used. The intervention group will receive cognitive behavioral therapy, which will be delivered via a smartphone mHealth app. Bandura's social cognitive theory and an emphasis on mental health self-efficacy form the theoretical framework of the study., Results: Recruitment for the study began in August 2020. Data collection and analysis are expected to be completed by March 2022., Conclusions: The proposed study represents a novel approach to the treatment of PICS-F symptoms and is an extension of previous work conducted by the research team. The study will be used to plan a fully powered randomized controlled trial., Trial Registration: ClinicalTrials.gov NCT04316767; https://clinicaltrials.gov/ct2/show/NCT04316767., International Registered Report Identifier (irrid): DERR1-10.2196/30813., (©Amy B Petrinec, Joel W Hughes, Melissa D Zullo, Cindy Wilk, Richard L George. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 04.08.2021.)

Purpose: Older adults who use postacute care (PAC) after hospitalization for myocardial infarction (MI) are often overlooked as cardiac rehabilitation (CR) candidates because of physical limitations. This research describes the impact of functional status and PAC, including inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), or home health care (HHC), on CR initiation in Medicare beneficiaries discharged from the hospital following an index MI., Methods: The Chronic Condition Warehouse database of Medicare beneficiaries discharged to PAC following index MI in 2008 (n = 63 092) was used for this retrospective study. Functional status at PAC discharge was described as dependent, needed assistance, needed supervision, or independent. Logistic regression examined factors associated with CR initiation., Results: CR was initiated by 3% and 21% of beneficiaries discharged from PAC as dependent or independent, respectively. Beneficiaries who were dependent, needed assistance, or needed supervision were 78% (95% CI, 0.18-0.28), 60% (0.32-0.49), and 51% (0.41-0.57) less likely to initiate CR compared with independent beneficiaries. Those who had used IRF were 40% more likely to initiate CR compared with those who had used HHC, with no difference observed between those who had used SNF compared with HHC., Conclusions: Functional status at PAC discharge was strongly associated with CR initiation. Beneficiary initiation of CR was at proportions corresponding to the level of independence. Beneficiaries discharged from PAC as independent initiated CR at rates slightly higher than non-PAC users, and those discharged from IRF were more likely to initiate CR. These findings are promising and more targeted recruitment from PAC may increase CR initiation and completion, resulting in continued improvement in functional status.

Background: Researchers have been advocating for a new weight-inclusive paradigm that focuses on health rather than weight. One important component of this model is intuitive eating. Although registered dietitian nutritionists (RDNs) are the nation's food and nutrition experts, RDNs' knowledge of and attitudes toward intuitive eating and use of traditional or restrictive strategies are unknown., Objective: The purpose of this study was to characterize RDNs' knowledge of and attitudes toward an intuitive eating lifestyle and describe use of traditional weight management and nonrestrictive lifestyle practices with clients., Design: This was a cross-sectional study., Participants: A validated survey was distributed using online survey software to 88,834 RDNs., Results: There were 18,622 respondents who completed the survey (25%). The majority of RDNs were knowledgeable about intuitive eating, answering 71% of items correctly. The majority of RDNs had a positive view on each attitude item. RDNs who work in weight management reported using nonrestrictive/intuitive eating practices more than traditional/restrictive practices. RDNs who were women (P<0.001), had advanced education (P<0.001), worked in a private practice setting (P<0.001), completed at least one certificate of training in weight management (P<0.001), had more experience in weight management counseling (P<0.001), and had greater intuitive eating knowledge (P<0.001) were more likely to report greater use of nonrestrictive/intuitive eating practices., Conclusions: This study provides evidence that RDNs are using an intuitive eating approach more often than traditional weight management practices., (Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Purpose: On the basis of several small studies, depression is often considered a barrier to cardiac rehabilitation (CR) enrollment and program completion. The purpose of this research was to examine the association between depression diagnosis and participation in CR in a large sample of Medicare beneficiaries with recent myocardial infarction (MI)., Methods: This was a retrospective study of Medicare beneficiaries with an MI during 2008 (N = 158 991). CR enrollment was determined by the Carrier and Outpatient files using the Healthcare Common Procedure Coding System #93797 or #93798. Depression diagnosis was obtained from the International Classification of Diseases, Ninth Revision (ICD-9) codes in the Medicare Provider Analysis and Review (MEDPAR), Outpatient and Carrier Files. The association between depression diagnosis and CR attendance was evaluated using multivariable logistic regression., Results: Overall, 14% (n = 22 735) of the study population attended CR within 1 year of MI diagnosis. Twenty-eight percent (n = 43 827) had a diagnosis of depression, with 96% of cases documented before enrollment in CR. Twenty-eight percent with a diagnosis of depression compared with 9% without depression attended CR. In adjusted analysis, patients with depression were 3.9 (99% CI, 3.7-4.2) times more likely to attend CR compared with those without depression. Program completion (≥25 sessions) was more common in those with depression (56%) than in those without (35%) (P < .001)., Conclusions: Diagnosis of depression in Medicare beneficiaries was strongly associated with attending CR and attending more sessions of CR compared with those without depression. Depression is not a barrier to CR participation after MI in Medicare beneficiaries.

Objective: The purpose of the present study was to develop and assess the construct validity of a tool to measure knowledge, attitudes and practices of registered dietitians/nutritionists (RD/N) regarding an intuitive eating lifestyle., Design: Cross-sectional study design that utilized a survey administered to a random sample and remaining full population of RD/N., Setting: A national survey conducted via online survey software., Subjects: A random sample of 10 % of all RD/N in the USA (n 8834) was invited to participate. Survey completion rate was 22·2 % (n 1897). After initial validation, the survey was distributed to the remaining 90 % of RD/N to confirm validation., Results: After removing items with insufficient factor loadings, results were consistent with a four-factor solution: (i) knowledge of intuitive eating; (ii) attitudes towards intuitive eating; (iii) traditional and restrictive practices; and (iv) non-restrictive and intuitive eating practices. Confirmatory factor analysis provided further evidence of the validity of the four factors and the factors had strong reliability., Conclusions: Unlike the hypothesized three-factor solution (knowledge, attitudes and practices), validation analysis revealed that the survey measures knowledge of intuitive eating, attitudes towards intuitive eating, use of traditional and restrictive weight-management practices, and use of non-restrictive and intuitive eating practices. With the landscape of weight management and health promotion undergoing a shift towards a health centred, size acceptance approach, this instrument will provide valuable information regarding the current knowledge, attitudes and practices of RD/N and other health promotion professionals.

The purpose of this community-based study was to assess the prevalence of chronic diseases among 18-65 year old Bhutanese refugee women resettled in Northeast Ohio, United States (US). A Nepali-language questionnaire was administered in a face-to-face mode. Anthropometric measurements included height, weight, and hip and waist circumferences. The overall prevalence (95 % confidence interval) of self-reported hypertension, diabetes, asthma, heart disease, and cancer were 15.3 % (9.2-23.4), 6.4 % (2.3-10.9), 5.5 % (2.0-11.5), 2.7 % (0.6-7.8), and 1.8 % (0.2-6.4), respectively. Overweight/obesity was observed in 64.8 % of the women; 69.5 and 74.1 % had waist circumference >80 cm and waist-to-hip ratio ≥85, respectively. Length of time in the US was not associated with the prevalence of the chronic conditions. This study suggests chronic conditions may be significant health issues among US resettled Bhutanese refugees and a larger population-based study to confirm the findings is warranted.

To address surgical complications, the World Health Organization (WHO) developed the Safe Surgery Saves Lives Checklist. With the foundation of the WHO's checklist, a robotic-specific checklist (RORCC) was developed using standardized content and face validity methods. The RORCC was implemented in a high volume gynecological (GYN) specialty group using minimally invasive robotic-assisted surgery. Data were abstracted from patients undergoing GYN procedures from four GYN surgeons at an urban, community hospital during November 16, 2010 to May 15, 2011 (pre-RORCC) n = 89 and from the period May 16, 2011 to November 16 2011 (post-RORCC) n = 121. Thirty-day readmissions pre-checklist and post-checklist were 12 and 5, respectively, which is a significant (p = 0.02) reduction. The duration of surgery was not significantly affected (p = 0.40) with pre-RORCC surgery time at 110.1 (35.7) min versus post-RORCC surgery time at 112.9 (37.4) min. This study demonstrated the feasibility of integrating an electronic, interactive, and robotic-specific checklist for gynecologic robotic-assisted surgery which resulted in a significant reduction in readmissions at the 30-day without significantly impacting operating room times.

The video capsule endoscopy is an accurate tool to investigate the entire small bowel. Currently, the nurse actively participates in the procedure from patient preparation to the video download, whereas a gastroenterologist interprets the endoscopic findings. However, few studies recently showed high accuracy of nurses in detecting lesions in the small bowel on video capsule endoscopy recordings. This prospective study aimed to assess the ability of experienced and trained nurses in detecting small bowel lesions as compared with gastroenterologists. Forty-six consecutive video capsule endoscopy procedures were analyzed. Overall, the nurse evaluation was highly (95.6%) accurate in detecting small bowel lesions, with a 100% concordance with the gastroenterologist for the relevant findings. In addition, the absence of lesions was confirmed by the endoscopist in all cases classified as negative by the nurse. Data of this study found that trained nurses, with a large experience in endoscopic features, correctly identified small bowel lesions on video capsule endoscopy recordings. Therefore, a trained nurse may accurately select the thumbnails of all mucosal irregularities that may be faster reviewed by the endoscopist for a final diagnosis.

Introduction: In 2011, the Centers for Disease Control and Prevention for the first time ever collected nationally representative prevalence data on chronic obstructive pulmonary disease (COPD), spirometry diagnosis, and healthcare utilization factors related to COPD. This research reports on that data and describes characteristics of adults with COPD who reported diagnosis by spirometry compared to those who did not report diagnosis by spirometry. Variables examined included basic elements of healthcare utilization such as emergency room visits, hospitalization or personal physician utilization., Methods: This is a cross-sectional study using novel data from the 2011 Behavioral Risk Factor Surveillance System COPD Module. Weighted multivariable logistic regression examined factors associated with (n = 13,484) and without spirometry (n = 3,131)., Results: Spirometry to diagnose COPD was reported by 78% of adults and increased with age. In multivariable modeling, spirometry was more likely in: Black, non-Hispanic compared to white non-Hispanic; current and former compared to never smokers; adults with co-morbidity including asthma, depression, and cardiovascular disease; adults with a doctor; and those who had been to emergency room/hospital for COPD. Those less likely to receive a spirometry were: Hispanic and reported exercise in the past 30 days., Conclusions: This study identified that adults diagnosed with COPD without a spirometry tended to be Hispanic, younger, healthier, and had less utilization of medical resources. This study is a first step in understanding the potential impact of COPD diagnosis made without spirometry.

Study Objective: To measure the safety culture in the robotics surgery operating room before and after implementation of the Robotic Operating Room Computerized Checklist (RORCC)., Design: Prospective study., Subjects: Gynecology surgical staff (n = 32)., Setting: An urban community hospital., Interventions: The Safety Attitudes Questionnaire domains examined were teamwork, safety, job satisfaction, stress recognition, perceptions of management, and working conditions. Questions and domains were described using percent agreement and the Cronbach alpha. Paired t-tests were used to describe differences before and after implementation of the checklist., Measurements and Main Results: Mean (SD) staff age was 46.7 (9.5) years, and most were women (78%) and worked full-time (97%). Twenty respondents (83% of nurses, 80% of surgeons, 66% of surgical technicians, and 33% of certified registered nurse anesthetists) completed the Safety Attitudes Questionnaire; 6 were excluded because of non-matching identifiers. Before RORCC implementation, the highest quality of communication and collaboration was reported by surgeons and surgical technicians (100%). Certified registered nurse anesthetists reported only adequate levels of communication and collaboration with other positions. Most staff reported positive responses for teamwork (48%; α = 0.81), safety (47%; α = 0.75), working conditions (37%; α = 0.55), stress recognition (26%; α = 0.71), and perceptions of management (32%; α = 0.52). No differences were observed after RORCC implementation., Conclusion: Quality of communication and collaboration in the gynecology robotics operating room is high between most positions; however, safety attitude responses are low overall. No differences after RORCC implementation and low response rates may highlight lack of staff support., (Copyright © 2014. Published by Elsevier Inc.)

Only half of adults with chronic obstructive pulmonary disease (COPD) report a smoking quit attempt in the past year. Adults with COPD have frequent encounters with the healthcare system that are opportunities for health behavior interventions that support quit attempts. The purpose of this research was to examine individual- and clinical-level factors associated with smoking quit attempts in adults with COPD. Cross-sectional data were from the 2011 Behavioral Risk Factor Surveillance System. Race-stratified, weighted logistic regression examined factors associated with quit attempt among current smokers with COPD. Overall, quit attempt was reported by 65% (95% confidence interval (CI): 61.9, 67.5) of adults and was more likely among blacks than whites (p < 0.0001). Among whites with COPD quit attempt was associated with: Female gender (adjusted odds ratio (AOR) = 1.3; CI: 1.0, 1.7), exercise (AOR = 2.0; CI: 1.5, 2.5), and medications for COPD (AOR = 1.6; CI: 1.3, 2.2). Among black adults with COPD quit attempt was associated with: Having a partner (AOR = 4.5; CI: 1.3, 15.0), exercise (AOR = 3.7; CI: 1.6, 8.7), spirometry (AOR = 9.5; CI: 3.2, 28.7), and having a personal doctor (AOR = 6.4; CI: 1.8, 22.5). Individual and clinical-factors associated with quit attempt varied by race. These findings suggest an impact of the healthcare system that supports quit attempts in blacks but not whites with COPD.

Introduction: Influenza vaccination rates are low in adults with chronic obstructive pulmonary disease (COPD). A diagnostic breathing test in adults with COPD may increase vaccination rates; however, research has not demonstrated this relationship. The purpose of this research was to determine if adults with COPD diagnosed by a breathing test were more likely to have had an influenza vaccination during the past 12 months when compared to those with COPD diagnosed without a breathing test., Methods: This was a cross-sectional study using data from the 2011 Behavioral Risk Factor Surveillance System. Logistic regression examined the relationship between influenza vaccination among adults with COPD diagnosed with a breathing test (n = 13,201) compared to those diagnosed without a breathing test (n = 3,108), after controlling for all potential confounders., Results: Overall, 49% of respondents with COPD received an influenza vaccination within the past 12 months and 78% reported their COPD was diagnosed by a breathing test. The prevalence of influenza vaccination in the past 12 months was greater in those with COPD diagnosed by a breathing test (53%) compared to those diagnosed without a breathing test (36%). In adjusted analysis, adults with COPD who had a breathing test were 31% (confidence interval 1.1, 1.6) more likely to have received an influenza vaccination in the past 12 months compared to those without a breathing test., Discussion: A diagnostic breathing test for COPD was associated with increased likelihood of having had an influenza vaccination in the past 12 months. This may be an indicator of the relationship between knowledge of lung function and the need for preventative care, a sign of quality healthcare, or good health-seeking behaviors in patients with COPD. This research is the first to use a nationally representative sample to suggest that spirometry diagnosis of COPD may increase rates of influenza vaccination.

Accreditation criteria by the Council on Education for Public Health (CEPH) state that prior to graduation, Masters of Public Health (MPH) students must demonstrate the application of knowledge and skills through a practice experience, commonly called the "Practicum." The purpose of this research was to review those MPH Practicum requirements. Practicum guidelines from US-based schools of public health that were accredited as of October 2011 were reviewed. Data on each Practicum's level of coordination, timing, and credit and contact hours as well as information about written agreements, preceptors, and how the Practicum was graded were collected. Seventy-four Practicums in 46 accredited schools of public health were reviewed. The majority (85 %) of accredited schools controlled the Practicum at the school-level. Among the Practicums reviewed, most did not require completion of any credit hours or the MPH core courses (57 and 74 %, respectively) prior to starting the Practicum; 82 % required written agreements; 60 % had stated criteria for the approval of preceptors; and 76 % required students to submit a product for grading at the conclusion of the Practicum. The results of this research demonstrate that the majority of accredited schools of public health designed Practicum requirements that reflect some of the criteria established by CEPH; however, issues related to timing, credit and contact hours, and preceptor qualifications vary considerably. We propose that a national dialogue begin among public health faculty and administrators to address these and other findings to standardize the Practicum experience for MPH students.

Background: After hospitalization for a cardiac event, older adults are frequently discharged to a skilled nursing facility (SNF) for postacute care. The American Association of Cardiopulmonary Rehabilitation recommends that cardiac care be integrated into procedures at SNFs., Objective: We undertook this research to describe the characteristics of patients in SNFs after a cardiac event and the cardiac care delivered at SNFs., Methods: A dual approach included (1) a retrospective medical record review of consecutive patients admitted to 2 hospital-based SNFs after a cardiac event (n = 80), and (2) surveys from healthcare professionals (n = 21) working in these facilities., Results: Thirty-two percent of patients were not candidates for cardiac rehabilitative interventions because they had been rehospitalized, discharged to long-term care facilities, or manifested contraindications to exercise. No standard assessment of exercise tolerance was evident, and although 70% of patients were discharged home, cardiac-specific discharge education was seldom evident. Healthcare professionals in SNFs reported that standard procedures for cardiac care services were lacking., Conclusion: The integration of cardiac care into SNFs is important to ensure the safety of therapy and improve the transition of patients from SNFs to outpatient cardiac rehabilitation programs., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The purpose of this pilot study was to test the initial efficacy, feasibility, and safety of a specially designed postacute care transitional rehabilitation intervention for cardiac patients. Cardiac Transitional Rehabilitation Using Self-Management Techniques (Cardiac TRUST) is a family-focused intervention that includes progressive low-intensity walking and education in self-management skills to facilitate recovery following a cardiac event. Using a randomized two-group design, exercise self-efficacy, steps walked, and participation in an outpatient cardiac rehabilitation (CR) program were compared in a sample of 38 older adults (17 Cardiac TRUST, 21 usual care). At discharge from postacute care, the intervention group trended toward higher levels of self-efficacy for exercise outcomes than the usual care group. During the 6 weeks following discharge, the intervention group had greater attendance in outpatient CR and a trend toward more steps walked during the first week. The feasibility of the intervention was better for the home health care participants than for those in the skilled nursing facility. The provision of CR during postacute care has the potential to bridge the gap in transitional services from hospitalization to outpatient CR for these patients at high risk for future cardiac events. Further evidence of the efficacy of Cardiac TRUST is warranted., (Copyright 2011, SLACK Incorporated.)

The World Health Organization estimated alcohol consumption in Uganda to be one of the highest in the world. We examined alcohol consumption among Ugandan women prior to and after learning of pregnancy. We developed a screening algorithm using factors that predicted alcohol consumption in this study. In 2006, we surveyed 610 women attending antenatal care at the national referral hospital in Kampala, Uganda about consumption of traditional and commercial alcoholic beverages before and after learning of pregnancy. Predictors of alcohol consumption during pregnancy were examined and a practical screening algorithm was developed for use in antenatal clinics. One hundred eighty women (30%) drank alcohol at least monthly before learning of their pregnancy. Among these women, almost one-third reported usual consumption of at least one beverage type at quantities that equal binging levels for women. Overall, 151 women (25%) consumed alcohol after learning of pregnancy. Commercial beverages, particularly beer, were consumed more often than traditional drinks. A two-stage screening algorithm asking women about their religion, male partner or friends' drinking, and any lifetime drinking predicted self-reported consumption of alcohol during pregnancy with 97% sensitivity and 89% specificity. Alcohol consumption among pregnant Ugandan women attending antenatal care is high. A feasible screening algorithm can help providers target education and counseling to women who are likely drinking during pregnancy. Given the preference for commercial alcoholic beverages, it is recommended that labels be placed prominently on bottled alcoholic beverages warning of the adverse effects of consuming alcohol during pregnancy.

Background: It has been hypothesized that exposure to exogenous estrogens may be associated with endometriosis and uterine myomas. We sought to investigate the association between heavy metals which have been shown to be hormonally active and these disorders using data from the National Health and Nutrition Examination Survey, 1999-2002., Methods: Women aged 20-49 years who had data on metals and the outcomes of interest, were premenopausal and neither pregnant nor breastfeeding were eligible (n = 1425). Lead, cadmium and mercury were measured in whole blood. Diagnosis of outcomes was based upon self-report. Logistic regression was used to examine the association between tertiles of heavy metals and disease adjusting for age, race/ethnicity, use of birth control pills prior to diagnosis and smoking status at diagnosis., Results: A dose-response association between cadmium and endometriosis was observed [tertile 2 versus 1: adjusted odds ratio (OR) = 1.94, 95% confidence interval (CI): 0.73-5.18; tertile 3 versus 1: adjusted OR = 3.39, 95% CI 1.37-8.40]. This association persisted in subanalyses: (i) limiting analysis to women diagnosed in the past 10 years and (ii) limiting analysis to women diagnosed since last pregnancy, although limited by sample size., Conclusions: These results must be interpreted with caution given the cross-sectional study design. The observed association between cadmium and endometriosis deserves further investigation in properly designed studies.