Browsing by Subject "chronic disease"
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Item The availability, price and quality of food items in diverse food retail outlets(Office of the Vice Chancellor for Research, 2011-04-08) Mushi-Brunt, Christina; Virgil, Kisha; Agbonhese, JoyDespite large-scale, nationwide health promotion efforts, researchers continue to report socioeconomic and racial disparities in the prevalence of chronic disease, including diabetes, cardiovascular disease, obesity and certain cancers. One possible explanation for these disparities may be found in examining the retail food environment in which healthy food choices are made by individuals. The local food environment can strongly influence the dietary choices made by individuals. Low-income residents have reported factors such as limited access to health food options and the high cost and low quality of the available food items within their communities as important barriers to consuming a healthy diet. Recent studies have shown direct correlations between a healthy diet and access to retail food outlets such as supermarkets and grocery stores. However, there are few studies that have directly assessed the availability, price and quality of foods sold in diverse types of food retail outlets and identified differences between and among the various types of outlets. Fewer still are studies that have identified these food item characteristics based on recommendations specific to cancer prevention. This study identifies the availability, price and quality of foods recommended by the American Cancer Society for a healthy diet in the food retail outlets of Marion County, Indiana and determines if differences exist in these characteristics between and within store types and community deprivation. In 2010 144 food retail outlets (supermarkets, grocery stores, convenience stores, gas stations, and ethnic grocers) were assessed through direct observation by trained researchers using a validated food retail outlet audit tool. Food items included fresh, frozen and canned produce; dry goods; fresh meats; dairy; and refrigerated foods. The price of specific food items with each food category was assessed. Quality was assessed for fresh produce category only. The environmental characteristics of the stores, including cleanliness, safety features, and the presence of health promotion message (e.g. 5-a-Day for Better Health logo) was also assessed. Each food retail outlet was characterized as being in a “high deprivation” or “low deprivation” community. Type of community was determined from a composite of socioeconomic characteristics using 2000 census block group data. This presentation provides a summary of key research findings and highlights suggested translation of the research findings into health promotion practice and policy. Funding support for this study was provided by the Indiana University American Cancer Society Institutional Research Grant. Census data work completed with the assistance of Shawn Hoch, IU School of Medicine.Item Comprehensive Strategy for Evaluation of Clinical Health Coaches in Chronic Disease Management(Office of the Vice Chancellor for Research, 2016-04-08) Randolph, Courtney; Maxey, Hannah L.; Mullen, CodyPurpose: As chronic disease rises to the top of morbidity and mortality causes in the United States, improving chronic disease management, particularly at healthcare administration and patient engagement levels, becomes a rising public health concern. Clinical Health Coaches (CHCs) are an innovative role in primary care settings, collaborating with patients to improve patient outcomes. There is a need for best practices guidelines of the CHC role, as there is currently no standardized training program. Iowa Chronic Care Consortium (ICCC) developed a CHC training program which is being implemented in an Indiana Rural Health Association pilot program. This study seeks to develop an evaluation tool for ICCC training and its effectiveness in chronic disease management. Methods: An extensive literature review was performed on previous evaluations of similar health coach role implementation in chronic disease management. ICCC training was completed to further understand the training program. Results: A collaboration of the chronic care model and ICCC’s proposed CHC model was determined to be the most appropriate tool for evaluation. From these models, 5 key domains were identified including: patient engagement, self-management support, patient experience, patient satisfaction, and delivery system design. This comprehensive approach will allow for both qualitative and quantitative analysis. Discussion & Implications: These survey tools will be administered to both patients and CHCs as a part of an evaluation of ICCC training and its effectiveness. As a result of this study, the CHC program could be expanded to more primary care settings to improve health outcomes in chronic disease patients. Learning objectives: Design an evaluation tool for clinical health coach training in chronic disease management. Evaluate the effectiveness of clinical health coach implementation in chronic disease management in a primary care setting.Item COVID-19 and Type 1 Diabetes: Addressing Concerns and Maintaining Control(ADA, 2021-09) DiMeglio, Linda A.; Pediatrics, School of MedicineThe worldwide outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been an unprecedented pandemic. Early on, even as the signs and symptoms of coronavirus disease 2019 (COVID-19) were first characterized, significant concerns were articulated regarding its potential impact on people with chronic disease, including type 1 diabetes. Information about the basic and clinical interrelationships between COVID-19 and diabetes has rapidly emerged. Initial rapid reports were useful to provide alerts and guide health care responses and initial policies. Some of these have proven subsequently to have durable findings, whereas others lacked scientific rigor/reproducibility. Many publications that report on COVID-19 and “diabetes” also have not distinguished between type 1 and type 2 (1). Available evidence now demonstrates that people with type 1 diabetes have been acutely affected by COVID-19 in multiple ways. This includes effects from limited access to health care, particularly during lockdown periods, and increased morbidity/mortality in infected adults with type 1 diabetes compared with peers without diabetes.Item Development of patient-centric linguistically tailored psychoeducational messages to support nutrition and medication self-management in type 2 diabetes: a feasibility study(Dove Press Ltd, 2014-10-07) Bartlett Ellis, Rebecca J.; Connor, Ulla; Marshall, James; School of NursingPurpose: This study evaluated the feasibility of developing linguistically tailored educational messages designed to match the linguistic styles of patients segmented into types with the Descriptor™, and to determine patient preferences for tailored or standard messages based on their segments. Patients and methods: Twenty patients with type 2 diabetes (T2DM) were recruited from a diabetes health clinic. Participants were segmented using the Descriptor™, a language-based questionnaire, to identify patient types based on their control orientation (internal/external), agency (high/low), and affect (positive/negative), which are well studied constructs related to T2DM self-management. Two of the seven self-care behaviors described by the American Association of Diabetes Educators (healthy eating and taking medication) were used to develop standard messages and then linguistically tailored using features of the six different construct segment types of the Descriptor™. A subset of seven participants each provided feedback on their preference for standard or linguistically tailored messages; 12 comparisons between standard and tailored messages were made. Results: Overall, the tailored messages were preferred to the standard messages. When the messages were matched to specific construct segment types, the tailored messages were preferred over the standard messages, although this was not statistically significant. Conclusion: Linguistically tailoring messages based on construct segments is feasible. Further - more, tailored messages were more often preferred over standard messages. This study provides some preliminary evidence for tailoring messages based on the linguistic features of control orientation, agency, and affect. The messages developed in this study should be tested in a larger more representative sample. The present study did not explore whether tailored messages were better understood. This research will serve as preliminary evidence to develop future studies with the ultimate goal to design intervention studies to investigate if linguistically tailoring com - munication within the context of patient education influences patient knowledge, motivation, and activation toward making healthy behavior changes in T2DM self-management.Item Evidence for Long-Term Impact of Pasos Adelante: Using a Community-Wide Survey to Evaluate Chronic Disease Risk Modification in Prior Program Participants(MDPI, 2013-10) Carvajal, Scott C.; Miesfeld, Noelle; Chang, Jean; Reinschmidt, Kerstin M.; de Zapien, Jill Guernsey; Fernandez, Maria L.; Rosales, Cecilia; Staten, Lisa K.; Social and Behavioral Sciences, School of Public HealthEffective community-level chronic disease prevention is critical to population health within developed and developing nations. Pasos Adelante is a preventive intervention that aims to reduce chronic disease risk with evidence of effectiveness in US-Mexico residing, Mexican origin, participants. This intervention and related ones also implemented with community health workers have been shown to improve clinical, behavioral and quality of life indicators; though most evidence is from shorter-term evaluations and/or lack comparison groups. The current study examines the impact of this program using secondary data collected in the community 3–6 years after all participants completed the program. A proportional household survey (N = 708) was used that included 48 respondents who indicated they had participated in Pasos. Using propensity score matching to account for differences in program participants versus other community residents (the program targeted those with diabetes and associated risk factors), 148 natural controls were identified for 37 matched Pasos participants. Testing a range of behavioral and clinical indicators of chronic disease risk, logistic regression models accounting for selection bias showed two significant findings; Pasos participants were more physically active and drank less whole milk. These findings add to the evidence of the effectiveness of Pasos Adalente and related interventions in reducing chronic disease risk in Mexican-origin populations, and illustrate the use of innovative techniques for using secondary, community-level data to complement prior evaluation research.Item Impact of Sex and Antihypertensive Medication on Global Cognition in Primary Care Older Adults(Oxford, 2022-11) de la Colina, Adrian Noriega; Vasiliadis, Helen-Maria; Berbiche, Djamal; Bherer, Louis; Girouard, Helene; Kaushal, Navin; Health Sciences, School of Health and Human SciencesHypertension is one of the strongest modifiable risk factors for the development of cognitive impairment and dementia. However, there are conflicting reports regarding which class of antihypertensive medication is the best for reducing the risk of cognitive decline. The objective of this study is to determine whether sex determines the pharmacological therapy that is the most effective in preserving cognitive outcomes. This study examined 1607 participants from the ESA Services Study, a longitudinal survey of older adults over 65 years old in Quebec-Canada. They were examined for the Mini-Mental State Examination(MMSE) at baseline (T1) and followed up three (T2) and four years after (T3). Hypertensive women had the highest mean MMSE score at each time point (T1 28.591 (SE .064); T2 28.282 (SE .118); T3 28.524 (SE.119)), while hypertensive men had the worst (T1 28.038(SE.070); T2 27.694(SE.125); 27.809(SE.128)). Women taking angiotensin II receptor antagonists (ARBs) showed the highest MMSE scores (p<.003), and men taking diuretics and other antihypertensives had the lowest MMSE scores(p<.001) after a 3-year follow-up. Combination therapy of two or three antihypertensives drugs was associated with higher scores in women at T1 and T2 (p<.001). In men, taking three antihypertensives showed a sharp decrease in MMSE scores from T1 to T3 (p<.001). Sex differences in global cognition outcomes in older adults are in part due to the heterogeneity in effects related to the type and number of antihypertensive drugs used. Effective antihypertensive treatment should consider the impact of sex to optimize the effect of pharmacological interventions on cognition.Item Pasos Adelante: The Effectiveness of a Community-based Chronic Disease Prevention Program(2005-01) Staten, Lisa K.; Scheu, Linda L.; Bronson, Dan; Peña, Veronica; Elenes, JoJeanBackground Implementing programs that target primary prevention of chronic diseases is critical for at-risk populations. Pasos Adelante, or “Steps Forward,” is a curriculum aimed at preventing diabetes, cardiovascular disease, and other chronic diseases in Hispanic populations. Pasos Adelante is adapted from the National Heart, Lung, and Blood Institute’s cardiovascular disease prevention curriculum, Su Corazón, Su Vida, and includes sessions on diabetes and community advocacy and incorporates walking clubs. Context The Pasos Adelante curriculum was implemented in two Arizona, United States-Sonora, Mexico border counties. Key issues in these communities are safety, access to recreational facilities, climate, and cultural beliefs. Methods Pasos Adelante is a 12-week program facilitated by community health workers. The program includes interactive sessions on chronic disease prevention, nutrition, and physical activity. Evaluation of the program included pre-curriculum and postcurriculum questionnaires with self-reported measures of physical activity and dietary patterns. Approximately 250 people participated in the program in Yuma and Santa Cruz counties. Consequences Postprogram evaluation results demonstrate a significant increase in moderate to vigorous walking among participants and shifts in nutritional patterns. Interpretation The Pasos Adelante program demonstrates that an educational curriculum in conjunction with the support of community health workers can motivate people in Arizona/Sonora border communities to adopt healthy lifestyle behaviors.Item Structural and Contextual Patterns in Family Health History Knowledge among African American Adults: A Mixed-Methods Social Network Analysis Study(INSNA, 2019) Hood, Sula M.; Golembiewski, Elizabeth H.; Sow, Hadyatoullaye; Benbow, Kyle; Prather, Jeremy; Robison, Lisa D.; Martin-Hagler, Elisabeth; Social and Behavioral Sciences, School of Public HealthBackground: Family health history is a strong risk factor for many chronic diseases. Ethnic minorities have been found to have a low awareness of their family health history (FHH), which may pose a contributing factor to health disparities. Purpose: The purpose of this mixed-methods social network analysis study was to identify structural and contextual patterns in African American adults’ FHH knowledge based on interpersonal communication exchanges with their family members. Methods: African American adults completed individually administered family network interviews. Participants’ 3-generation family pedigree served as a visual aid to guide their interview. Our primary outcome of interest for this analysis was whether a family member was reported as someone who talks to the participant about their own (i.e., the family member’s) health, which we refer to as a “personal health informant.” To contextualize quantitative findings, participants were asked to describe how they learned about the health history of the relatives they identified during their interview. Results: Participants (n=37) reported an average family network size of 29.4 relatives (SD = 15.5; Range = 10-67). Each participant, on average, named 17% of their familial network as personal health informants. Multivariate regression results showed that participants were more likely to name an alter as a personal health informant if the alter was female (OR = 2.14, p = 0.0519), from the maternal side of the participant’s family (OR = 1.12, p = 0.0006), had one or more chronic health conditions (OR = 2.41, p = 0.0041), was someone who has discussions with the participant about the participant’s health (OR = 16.28, p < 0.0001), was a source of family health information (OR = 3.46, p = 0.0072), and was someone whose health the participant helps to monitor or track (OR = 5.93, p = 0.0002). Complementary qualitative findings indicate that FHH knowledge is facilitated by open, direct communication among relatives. Personal health informants were described as disclosing information for the purposes of informing others for preventive purposes and for gaining social support. Participants also learned about FHH via other methods, including direct observation, during caretaking, and following a relative’s death. Conclusions: Communication and disclosure practices is an important determinant of African Americans’ FHH knowledge. More culturally and contextually meaningful public health efforts are needed to promote family health history sharing, especially regarding paternal family health history, siblings, and extended relatives.Item Understanding Traumatic Brain Injury in the Primary Care Setting(Office of the Vice Chancellor for Research, 2016-04-08) Gano, Laura; Kean, Jacob; Renshaw, Scott E.; Hernandez, Ruben; Willis, DeAnnaBackground: TBI is being re-conceptualized as a chronic disease causative agent rather than as a single, acute event. This study examined how familiar family medicine physicians (PCPs) are with TBI and their level of confidence in treating TBI sequelae likely to be seen in primary care. We also examined PCP attitudes regarding care for post-acute mild TBI and moderate/severe TBI in primary care and how recently the respondent had cared for a mild TBI and/or moderate/severe TBI patient. Methods: The study featured a mixed methods study design. A survey was administered on paper and electronically. A semi-structured qualitative interview guide was developed based upon survey responses. Descriptive statistics were calculated. Results: Most respondents associated neurological symptoms/conditions as TBI sequelae: irritability, 100.0%, fatigue, 98.0%; insomnia, 88.2%, depression, 98.0%, headaches, 98.0%, anxiety, 80.4%. Two-thirds (66.7%) identified epilepsy as a condition associated with TBI. Just over one-half associated tinnitus (51.0%) or loss of libido (52.9%) with TBI while only one-third (33.3%) associated incontinence with TBI. Most physicians felt confident treating depression (84.0%), anxiety (82.4%), headache (80.4%) and insomnia (76.0%). Physicians felt less confident in treating fatigue (68.0%), irritability (68.0%), incontinence (51.2%) and loss of libido (50.0%). The least amount of confidence was claimed in treating epilepsy (37.5%) and tinnitus (36.4%). All respondents (100.0%) believed that a PCP can manage post-acute mild TBI (concussion) care while 52.0% agreed that a PCP can manage post-acute care for moderate/severe TBI. Only one respondent (2.0%) had never cared for a mild TBI patient. Most (70.6%) had cared for a moderate/severe TBI patient within the past two years while 5.9% had cared for one of these patients more than a year ago. Nearly twenty percent (19.7%) had never cared for a moderate/severe TBI patient and 3.9% were unsure if they had.