Browsing by Author "Chumbler, Neale"

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    Building a “Better Life”: The Transformative Effects of Adolescent Pregnancy and Parenting
    (Sage, 2015-01) Cherry, Colleen O'Brien; Chumbler, Neale; Bute, Jennifer J.; Huff, Amber; Department of Communication Studies, School of Liberal Arts
    Adolescent pregnancy is often described as a major concern in public health and is associated with negative outcomes for educational and career attainment. Our objective was to compare the future aspirations of pregnant and parenting adolescents and identify social or structural barriers that they experience in their daily lives using journal entries from pregnant and parenting adolescents. The journals, which served as primary data sources, were completed by 52 multi-ethnic pregnant and parenting adolescents aged 15 to 19 in Indiana. Both pregnant and parenting adolescents aspired to provide a “better life” for their children that included finishing school and obtaining a career. An emergent theme is that the experience of pregnancy and parenting is transformative and may invoke a positive refocusing of life aspirations for educational and career attainment. However, social stigma and barriers exist that make achieving educational and employment opportunities difficult. The study findings indicate that pregnant and parenting adolescents need strong social support networks and practical tools to help harness their motivation and transcend social and material barriers to achieve their goals and aspirations.
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    Diagnosing and managing sleep apnea in patients with chronic cerebrovascular disease: a randomized trial of a home-based strategy
    (Springer, 2017-07) Bravata, Dawn M.; McClain, Vincent; Austin, Charles; Ferguson, Jared; Burrus, Nicholas; Miech, Edward J.; Matthias, Marianne S.; Chumbler, Neale; Ofner, Susan; Foresman, Brian; Sico, Jason; Vaz Fragoso, Carlos A.; Williams, Linda S.; Agarwal, Rajiv; Concato, John; Yaggi, H. Klar; Department of Medicine, IU School of Medicine
    Background Obstructive sleep apnea is common and associated with poor outcomes after stroke or transient ischemic attack (TIA). We sought to determine whether the intervention strategy improved sleep apnea detection, obstructive sleep apnea (OSA) treatment, and hypertension control among patients with chronic cerebrovascular disease and hypertension. Methods In this randomized controlled strategy trial intervention, patients received unattended polysomnography at baseline, and patients with OSA (apnea-hypopnea index ≥5 events/h) received auto-titrating continuous positive airway pressure (CPAP) for up to 1 year. Control patients received usual care and unattended polysomnography at the end of the study, to identify undiagnosed OSA. Both groups received 24-h blood pressure assessments at baseline and end of the study. “Excellent” CPAP adherence was defined as cumulative use of ≥4 h/night for ≥70% of the nights. Results Among 225 randomized patients (115 control; 110 intervention), 61.9% (120/194) had sleep apnea. The strategy successfully diagnosed sleep apnea with 97.1% (102/105) valid studies; 90.6% (48/53, 95% CI 82.7–98.4%) of sleep apnea was undiagnosed among control patients. The intervention improved long-term excellent CPAP use: 38.6% (22/57) intervention versus 0% (0/2) control (p < 0.0001). The intervention did not improve hypertension control in this population with well-controlled baseline blood pressure: intervention, 132.7 mmHg (±standard deviation, 14.1) versus control, 133.8 mmHg (±14.0) (adjusted difference, −1.1 mmHg, 95% CI (−4.2, 2.0)), p = 0.48). Conclusions Patients with cerebrovascular disease and hypertension have a high prevalence of OSA. The use of portable polysomnography, and auto-titrating CPAP in the patients’ homes, improved both the diagnosis and the treatment for sleep apnea compared with usual care but did not lower blood pressure.