Incidence and prevalence of epilepsy among older U.S. Medicare beneficiaries.

OBJECTIVE: To determine the prevalence and incidence of epilepsy among U.S. Medicare beneficiaries aged 65 years old and over, and to compare rates across demographic groups. METHODS: We performed a retrospective analysis of Medicare administrative claims for 2001-2005, defining prevalent cases as persons with ≥1 claim with diagnosis code 345.xx (epilepsy) or 2 or more with diagnosis code 780.3x (convulsion) ≥1 month apart, and incident cases as prevalent cases with 2 years immediately before diagnosis without such claims. Prevalence and incidence rates were calculated for the years 2003-2005 using denominators estimated from a 5% random sample of Medicare beneficiaries. Results were correlated with gender, age, and race. RESULTS: We identified 282,661 per year on average during 2001-2005 (a total of 704,243 unique cases overall), and 62,182 incident cases per year on average during 2003-2005. Average annual prevalence and incidence rates were 10.8/1,000 and 2.4/1,000. Overall, rates were higher for black beneficiaries (prevalence 18.7/1,000, incidence 4.1/1,000), and lower for Asians (5.5/1,000, 1.6/1,000) and Native Americans (7.7/1,000, 1.1/1,000) than for white beneficiaries (10.2/1,000, 2.3/1,000). Incidence rates were slightly higher for women than for men, and increased with age for all gender and race groups. CONCLUSIONS: Epilepsy is a significant public health problem among Medicare beneficiaries. Efforts are necessary to target groups at higher risk, such as minorities or the very old, and to provide the care necessary to reduce the negative effects of epilepsy on quality of life.

The role of availability as a moderator of family fruit and vegetable consumption.

The public health objective to improve the diet of Americans includes increasing the consumption of fruits and vegetables (F&V). The availability of F&V in the home has been suggested but not confirmed as one environmental factor that influences the types and quantities of F&V eaten by family members. Using a model of parental and child influences on a child's intake of F&V, the authors investigated F&V availability as a moderating variable for the relationships between the model constructs and how the relationships might change with varying levels of F&V availability. Path analysis and multigroup structural equation modeling were the analytic tools. Results indicated that homes with more F&V available had a richer and generally stronger set of motivating factors for parent and child F&V consumption than homes with low F&V availability. Findings have implications for parental involvement in interventions to enhance the diet of fourth-grade children.

Cancer prevention in rural primary care. An academic-practice partnership.

BACKGROUND: Cancer screening rates are particularly low among poor, minority, and rural women, those segments of the population with the highest cancer mortality risk. Therefore, targeted strategies to increase screening in these population groups are needed. METHODS: This paper describes a partnership between the University of Alabama at Birmingham (UAB) and Family HealthCare of Alabama, a nonprofit health care agency, initiated to promote cancer control and prevention in a predominantly low-income, African-American population in rural western Alabama. The partnership has collaborated in the development of two research proposals designed specifically to evaluate cancer control strategies within the context of routine health care delivery. RESULTS: The UAB/Family HealthCare partnership is conducting two randomized treatment outcome studies funded by the National Cancer Institute to evaluate theory-based patient management strategies to promote patient adherence to screening recommendations for cervical cancer and breast cancer. CONCLUSIONS: The success of this academic-practice partnership can be seen in the funded research projects, the enhancement of preventive services in rural primary care, and in the potential to disseminate theory-based cancer control strategies throughout an extended primary care network.

Motivational interviewing to improve adherence to a behavioral weight-control program for older obese women with NIDDM. A pilot study.

OBJECTIVE: The aim of this randomized pilot study was to examine whether the addition of motivational interviewing strategies to a behavioral obesity intervention enhances adherence and glucose control in older obese women with NIDDM. RESEARCH DESIGN AND METHODS: Twenty-two older obese women (41% black) with NIDDM were randomly assigned to 1) a standard 16-week group behavioral weight-control program that provided instruction in diet, exercise, and behavioral modification or 2) the same group behavioral program with three individualized motivational interviewing sessions added. RESULTS: The motivational group attended significantly more group meetings (13.3 vs. 8.9), completed significantly more food diaries (15.2 vs. 10.1), and recorded blood glucose significantly more often (46.0 vs. 32.2 days) than the standard group. Further, participants in the motivational group had significantly better glucose control post-treatment (9.8 vs. 10.8%). Although both groups demonstrated significant weight loss, no differences were apparent between groups. CONCLUSIONS: These results suggest that augmenting a standard behavioral treatment program for obese women with NIDDM with a motivational interviewing component may significantly enhance adherence to program recommendations and glycemic control. Preliminary data warrant further investigation with larger samples and a longer follow-up.