Predictive value of a comprehensive atrial assessment with cardiac magnetic resonance in non-ischemic cardiomyopathy: keep it simple.

Cardiac magnetic resonance (CMR) can provide a multi-parametric evaluation of left atrial (LA) size and function. A complete CMR-based LA assessment might improve the risk stratification of patients with non-ischemic dilated cardiomyopathy (DCM). We performed a comprehensive CMR-based evaluation of LA size and function, in order to assess the prognostic impact of specific LA parameters in DCM. Secondary analysis of a prospective registry (UHSM-CMR study, NCT02326324) including 648 consecutive patients with DCM and CMR evaluation of LA area and LA length. Of these, 456 had complete LA assessment covering reservoir, conduit and booster pump function and including LA reservoir strain evaluated with feature tracking. The heart failure (HF) endpoint included HF hospitalizations, HF death and heart transplant. The arrhythmic endpoint included ventricular arrhythmias (VA) (sustained or treated by implantable defibrillator) and sudden death (SD). At median follow-up of 23 months, 34 patients reached the HF endpoint; in a multivariable model including NYHA class and LVEF, LA length had incremental predictive value. LA length ≥ 69 mm was the best cut-off to predict HF events (adjusted HR 2.3, p = 0.03). Among the 456 patients with comprehensive LA assessment, only LA length was independently associated with the HF endpoint after adjusting for LVEF and NYHA class. By contrast, no LA parameter independently predicted the arrhythmic risk. In DCM patients, LA length is an independent predictor of HF events, showing stronger association than other more complex parameters of LA function. No atrial parameter predicts the risk of VA and SD.

CDC's DELTA FOCUS Program: Identifying Promising Primary Prevention Strategies for Intimate Partner Violence.

According to 2011 data, nearly one in four women and one in seven men in the United States experience severe physical violence by an intimate partner, creating a public health burden requiring population-level solutions. To prevent intimate partner violence (IPV) before it occurs, the CDC developed Domestic Violence Prevention Enhancements and Leadership Through Alliances, Focusing on Outcomes for Communities United with States to identify promising community- and societal-level prevention strategies to prevent IPV. The program funds 10 state domestic violence coalitions for 5 years to implement and evaluate programs and policies to prevent IPV by influencing the environments and conditions in which people live, work, and play. The program evaluation goals are to promote IPV prevention by identifying promising prevention strategies and describing those strategies using case studies, thereby creating a foundation for building practice-based evidence with a health equity approach.

How can Primary Care Physicians Best Support Contraceptive Decision Making? A Qualitative Study Exploring the Perspectives of Baltimore Latinas.

OBJECTIVES: U.S. Latinas experience disproportionately high rates of unintended pregnancy and low rates of consistent contraception use. Not well known are Latinas' perspectives about how primary care physicians (PCPs) might facilitate or deter contraceptive decision making. The theory of planned behavior has been used previously to explain contraceptive behaviors. This study used the theory of planned behavior as a guide to help describe Latinas' perspectives regarding specific factors that influence their contraceptive decision making and to describe their perspectives about the role of PCPs in the decision making. STUDY DESIGN AND METHODS: We conducted focus groups (n = 3) and interviews (n = 8) of Latinas ages 15 to 24 years, recruited from urban primary care sites in Baltimore, Maryland. Concepts from the theory of planned behavior were used to develop a coding scheme and guide identification of themes. RESULTS: Sixteen Latinas participated; all were immigrants. THEMES: The desire to avoid unintended pregnancy is dominant and, not surprisingly, is the main driver of contraceptive intentions. The role of PCPs in contraceptive decision making is to build strong patient relationships through heightened communication and trust. PCPs should develop trust and foster communication by using a shared decision-making approach in contraceptive counseling. Religious norms rarely operate as barriers to contraceptive use, yet positive reinforcement from family, friends, and schools is viewed as supportive. CONCLUSIONS AND IMPLICATIONS: For this group of young, immigrant Latinas, there is a pervasive desire for effective communication and trusting relationships with PCPs. Findings suggest that providers can facilitate contraceptive decision making for this population by using a shared decision-making approach to contraceptive counseling.

Teaching retirement financial literacy in an undergraduate gerontology classroom: broadening the concept of the tripod or three-legged stool of retirement income utilizing active learning.

The three-legged stool concept is widely used in gerontological and geriatric education as an explanation on how one should fiscally approach his or her retirement. Financial managers, planners, retirees, business owners, even the Social Security Administration uses this metaphor of fiscal soundness in retirement planning. Gerontologists are moving away from the "tripod of retirement income" and "three-legged stool" term, as more often market work is needed for financial security. This activity focuses on the tripod or three-legged stool concepts of retirement planning using active learning, allowing the students to work collaboratively in a group, reflect upon the activity, and most importantly have fun. The game also allows for an expansion of the tripod concepts into the four pillars of economic security, broaching the use of personal assets and the possible need for longer employment. Game scenarios also emphasize macro- and microlevel forces, such as race, gender, health status, education, or marital status, which can influence timing of retirement or the level of retirement income available. The authors include instructions on how to set up the learning experience including worksheets, as well as reflection questions posed throughout the process.

Social Security and divorce or death benefits storyboard (S(2)D(2)BS): an interactive participant learning exercise.

Using the concept of an interactive or living storyboard, the author discusses the use of seven case narratives constructed for the sole purpose of teaching introductory gerontology or geriatric students about the distribution of Social Security benefits after spousal death. Additional information is included pertaining to Social Security benefits payable to divorced persons after the death of the former spouse, including the status of married same-sex couples. Narratives include representations of a male breadwinner model couple, a two-earner couple who have similar/dissimilar earnings prior to retirement, a divorced couple with a remarriage after a death, a gay couple with and without children, and a female primary breadwinner couple. Updated information from the Social Security Administration, as well as information on game preparation, scripts, and debriefing questions are included.

Is depression associated with contraceptive motivations, intentions, and use among a sample of low-income Latinas?

BACKGROUND: Latinas in the United States experience high rates of unintended pregnancy and low rates of contraception use, yet reasons are not completely understood. Depression is common among pregnant and nonpregnant Latinas; its influence on contraceptive motivations, intentions, and use is understudied. OBJECTIVES: We sought to 1) describe Latinas' contraceptive motivations, intentions, and use; 2) use structural equation modeling to test associations between depression and contraceptive self-efficacy/motivations/intentions/use; and 3) determine whether associations differ by pregnancy status. METHODS: This cross-sectional study included Latinas ages 15 to 45 recruited from an urban Federally Qualified Health Center in Baltimore, Maryland. Structured surveys were used to collect data regarding depressive symptoms measured using the PHQ-9. All other constructs were measured with previously validated questions. Constructs included contraceptive self-efficacy, positive and negative contraceptive motivations (perceived advantages and disadvantages of using contraception), contraceptive intentions to begin or continue contraception use, and contraceptive methods currently used. RESULTS: Among pregnant Latinas, depression was associated with negative motivations (ß = 0.16; p < .05), negative motivations were associated with intentions (ß = -0.22; p < .01), and contraceptive self-efficacy was associated with intentions (ß = 0.43; p < .001). Among nonpregnant Latinas, contraceptive self-efficacy was associated with intentions (ß = 0.78; p < .001) and intentions were associated with use (ß = 0.40; p < .05). CONCLUSIONS: Among pregnant Latinas, negative motivations intervene in the association between depression and contraceptive intentions. For nonpregnant Latinas, intentions intervene in the association between self-efficacy and contraceptive use. This study underscores the importance of depression screening during pregnancy and encourages practitioners to target contraceptive motivations to improve contraceptive use.

Toward the development of microbial indicators for wetland assessment.

Wetland assessment tools are being developed and employed in wetland monitoring and conservation based on physical, chemical and biological characterization. In wetland biological assessment, various ecological functions have been described by biological traits of an entire species pool that adapts to different types of wetland environments. Since microorganisms play a key role in wetland biogeochemical processes and respond quickly to environmental disturbances, this review paper describes the different macro indicators used in wetland biological monitoring and expands the potential use of microbial indicators in wetland assessment and management. Application of molecular microbial technologies paves the path to an integrated measure of wetland health conditions. For example, the ratio of ammonia-oxidizing archaeal and bacterial populations has been proposed to serve as a microbial indicator of wetland nutrient conditions. The microbial indicators coupled with physical, chemical and other biological parameters are vital to the development of multi-metric index for measuring wetland health conditions. Inclusion of microbial indicators will lead to a more comprehensive wetland assessment for wetland restoration and management practices.

Perspectives on Latino lay health promoter programs: Maryland, 2009.

OBJECTIVES: We examined common barriers and best practices in the design, implementation, monitoring, and evaluation of Latino lay health promoter programs. METHODS: Ten lay health promoter program coordinators serving Maryland Latinos were recruited in 2009 through snowball sampling for in-depth semistructured interviews with a bilingual and bicultural researcher. Program coordinators were asked about recruitment, selection, training, and supervision; key program elements; and evaluation. Analyses were conducted to identify common themes. RESULTS: Respondents had worked up to 13 years in programs focused on such areas as awareness of healthy lifestyles and reducing risk of illness. Coordinators looked for Latino leaders with team-building skills and a desire to help the community. Six programs compensated promoters with stipends; 4 paid an hourly wage. Promoters were usually trained in monthly meetings that actively engaged them. Most programs conducted site visits, practice sessions, and performance evaluations. CONCLUSIONS: Our findings indicate that successful health promoter programs require needs assessments, formation of a target population advisory board, identification of appropriate promoters, and a significant amount of training. These findings can be used to guide future programs in the identification, recruitment, and training of health promoters as well as in program monitoring.

Perspectives on cancer health disparities in West Virginia.

"Perspectives on Cancer Health Disparities in West Virginia" provides an overview of the factors that lead to health disparities in general, to the burden of breast and other cancers in our state, and highlights the deep-rooted values and characteristics that will help communities and their partners achieve parity.

From high tech to high touch: integrating community voices in mobile mammography outreach.

Providing mobile screening mammography services across the state of West Virginia (WV) presents unique challenges. The ability of new machines to screen for breast cancer is modern medicine at its best. The use of the mobile unit, "Bonnie's Bus", holds promise for getting this high tech equipment to women in rural areas of West Virginia where it is most needed. Cancer detected in early stages is more treatable and women have a better chance of becoming survivors. The key to the program's success resides with the women who come for the screening, the extension network of community members who help set up and assist women to access the screening system, and community health care providers who care for the women if cancer is found. Linking "community voices" with the programs funded under the WV Komen grant screening programs provides a winning solution for West Virginia and the women served by Bonnie's Bus. Information obtained from five focus groups of 58 community leaders and women residing in rural WV was used to develop the mobile program. Building upon established relationships with the West Virginia Breast and Cervical Cancer Screening Program (WV BCCSP) coordinators and providers, outreach and information gleaned from WV communities, is being used to develop community partnerships based on mutual trust and respect to advance the common goal of decreasing breast cancer related illness and death in West Virginia women.

Addressing the challenges of Latino health research: participatory approaches in an emergent urban community.

BACKGROUND: Challenges to recruitment of Latinos in health research may include language, cultural and communication barriers, trust issues, heterogeneity of legal status, and a high percent of uninsured when compared to the US population. This paper highlights the community-based participatory research (CBPR) process and expands on the applicability of these principles to Latino communities. METHODS: We review steps taken and describe lessons learned in using a participatory approach to broadly assess and address the health of urban-dwelling Latinos in Baltimore, Maryland, through the adaptation of CBPR principles. FINDINGS: We identified health priorities, access barriers, and community resources (eg, Latin American trained nurses who were not currently working in the health field, immigrant networks) using a participatory approach. Suggestions for improving trust, research participation, and access to care ranged from not collecting data on legal status, and regular attendance and presentations of ongoing research at community provider meetings, to referral to free or low-cost health care services at screening events. CONCLUSION: Despite growing interest in CBPR, limited guidance exists on how to apply CBPR principles to conduct health research among Latinos. Incorporating a participatory process can help address Latino community concerns, enrich quality and relevance of research, and empower community members.

Human papillomavirus (HPV) vaccine availability, recommendations, cost, and policies among health departments in seven Appalachian states.

Telephone interviews of health department personnel in six states and review of an immunization database from one state were conducted to assess human papillomavirus (HPV) vaccine availability, recommendations, cost, policies, and educational materials in health departments in seven Appalachian states. Most (99.1%) health departments (n=234) reported receiving patient requests for the HPV vaccine, and only two (1%) health departments reported that they did not provide the vaccine for patients. HPV vaccine supply was reported to not meet the demand in 10.5% (24/228) of health departments due to high costs. Level (state, region, county) at which policy about the HPV vaccine was determined, vaccine recommendations, costs, and available educational materials varied among states. This study documented variation in vaccine availability, recommendations, cost, policies, and educational materials in Appalachian health departments that could significantly affect vaccine distribution. Findings highlight the need for more comprehensive and consistent policies that maximize accessibility of the HPV vaccine to women, especially those in underserved areas.

Latin American-trained nurse perspective on Latino health disparities.

This study seeks the unique perspective of Latin-American-trained nurses on barriers and strategies to improve the health of Baltimore's Latino community. Individual in-depth interviews are conducted in Spanish with one male and seven female nurses recruited by Baltimore's Latino Providers Network. Audiotaped home interview transcripts are manually reviewed for common themes. Strategies include professional medical interpreters, workshops on the U.S. health care system, media campaign on affordable/bilingual care sources, licensing foreign-trained nurses, and outreach clinics linked to trusted community-based organizations. Findings can be used to develop culturally appropriate programs to better administer health care to Latino communities.

Maximizing resilience through diverse levels of inquiry: Prevailing paradigms, possibilities, and priorities for the future.

The study of resilience has two core characteristics: it is fundamentally applied in nature, seeking to use scientific knowledge to maximize well-being among those at risk, and it draws on expertise from diverse scientific disciplines. Recent advances in biological processes have confirmed the profound deleterious effects of harsh caregiving environments, thereby underscoring the importance of early interventions. What remains to be established at this time is the degree to which insights on particular biological processes (e.g., involving specific brain regions, genes, or hormones) will be applied in the near future to achieve substantial reductions in mental health disparities. Aside from biology, resilience developmental researchers would do well to draw upon relevant evidence from other behavioral sciences as well, notably anthropology as well as family, counseling, and social psychology. Scientists working with adults and with children must remain vigilant to the advances and missteps in each others' work, always ensuring caution in conveying messages about the "innateness" of resilience or its prevalence across different subgroups. Our future research agenda must prioritize reducing abuse and neglect in close relationships; deriving the "critical ingredients" in effective interventions and going to scale with these; working collaboratively to refine theory on the construct; and responsibly, proactively disseminating what we have learned about the nature, limits, and antecedents of resilient adaptation across diverse at-risk groups.

Extracurricular involvement among affluent youth: a scapegoat for "ubiquitous achievement pressures"?

It has been suggested that over-scheduling of upper-class youth might underlie the high distress and substance use documented among them. This assumption was tested by considering suburban 8th graders' involvement in different activities along with their perceptions of parental attitudes toward achievement. Results indicated negligible evidence for deleterious effects of high extracurricular involvement per se. Far more strongly implicated was perceived parent criticism for both girls and boys as well as the absence of after-school supervision. Low parent expectations connoted significant vulnerability especially for boys. The findings indicate that at least among early adolescents, converging scientific and media reports may have scapegoated extracurricular involvements, to some degree, as an index of ubiquitous achievement pressures in affluent communities.

Care management, dementia care and specialist mental health services: an evaluation.

OBJECTIVE: To evaluate a model of intensive case management for people with dementia based in a community-based mental health service for older people. METHOD: Quasi-experimental design. Individuals in one community team setting received case management and were compared with those in a similar team without such a service. Forty-three matched pairs were identified. Eligible older people and their carers were interviewed at uptake and again at 6 and 12 months. RESULTS: The impact of the scheme upon placement occurred in the second year at the end of which 51% of the experimental group remained at home compared with 33% of the comparison group. For the experimental group significant improvements in the social contacts of older people were noted; a decrease in the stress of their carers was observed, together with a reduction in their input to the care of the client; and there were significant improvements on ratings of overall need reduction, aspects of daily living and level of risk. Differences between the two groups based on service receipt showed higher costs for the experimental group. DISCUSSION: The benefits to older people and their carers confirms previous findings that the most effective case management interventions are those targeted on a highly specific client group. Issues which influence the cost-effectiveness of intensive case management are discussed. The benefits of locating this service within a specialist mental health team are explored in the context of current initiatives to promote greater service integration between health and social services.