Clinical and Demographic Profiles of Home Care Patients With Alzheimer's Disease and Related Dementias: Implications for Information Transfer Across Care Settings.

Home health care (HHC) clinicians serving individuals with Alzheimer's disease and related dementias (ADRD) do not always have information about the person's ADRD diagnosis, which may be used to improve the HHC plan of care. This retrospective cohort study examined characteristics of 56,652 HHC patients with varied documentation of ADRD diagnoses. Data included clinical assessments and Medicare claims for a 6-month look-back period and 4-year follow-up. Nearly half the sample had an ADRD diagnosis observed in the claims either prior to or following the HHC admission. Among those with a prior diagnosis, 63% did not have it documented on the HHC assessment; the diagnosis may not have been known to the HHC team or incorporated into the care plan. Patients with ADRD had heightened risk for adverse outcomes (e.g., urinary tract infection and aspiration pneumonia). Interoperable data across health care settings should include ADRD-specific elements about diagnoses, symptoms, and risk factors.

Clinical Assessment of Concussion and Persistent Post-Concussive Symptoms for Neurologists.

PURPOSE OF REVIEW: Concussion produces a variety of signs and symptoms. Most patients recover within 2-4 weeks, but a significant minority experiences persistent post-concussive symptoms (PPCS), some of which may be from associated cervical or persistent neurologic sub-system (e.g., vestibular) dysfunction. This review provides evidence-based information for a pertinent history and physical examination of patients with concussion. RECENT FINDINGS: The differential diagnosis of PPCS is based on the mechanism of injury, a thorough medical history and concussion-pertinent neurological and cervical physical examinations. The concussion physical examination focuses on elements of autonomic function, oculomotor and vestibular function, and the cervical spine. Abnormalities identified on physical examination can inform specific forms of rehabilitation to help speed recovery. Emerging data show that there are specific symptom generators after concussion that can be identified by a thorough history, a pertinent physical examination, and adjunct tests when indicated.

Effect of Stroke Education Pamphlets vs a 12-Minute Culturally Tailored Stroke Film on Stroke Preparedness Among Black and Hispanic Churchgoers: A Cluster Randomized Clinical Trial.

IMPORTANCE: Black individuals and Hispanic individuals are less likely to recognize stroke and call 911 (stroke preparedness), contributing to racial/ethnic disparities in intravenous tissue plasminogen activator use. OBJECTIVE: To evaluate the effect of culturally tailored 12-minute stroke films on stroke preparedness vs the usual care practice of distributing stroke education pamphlets. DESIGN, SETTING, AND PARTICIPANTS: Cluster randomized clinical trial between July 26, 2013, and August 16, 2018, with randomization of 13 black and Hispanic churches located in urban neighborhoods to intervention or usual care. In total, 883 congregants were approached, 503 expressed interest, 375 completed eligibility screening, and 312 were randomized. Sixty-three individuals were ineligible (younger than 34 years and/or did not have at least 1 traditional stroke risk factor). INTERVENTIONS: Two 12-minute stroke films on stroke preparedness for black and Hispanic audiences. MAIN OUTCOMES AND MEASURES: The primary outcome was the Stroke Action Test (STAT), assessed at baseline, 6 months, and 12 months. RESULTS: In total, 261 of 312 individuals completed the study (83.7% retention rate). Most participants were female (79.1%). The mean (SD) age of participants was 58.57 (11.66) years; 51.1% (n = 159) were non-Hispanic black, 48.9% (n = 152) were Hispanic, and 31.7% (n = 99) had low levels of education. There were no significant end-point differences for the STAT at follow-up periods. The mean (SD) baseline STAT scores were 59.05% (29.12%) correct for intervention and 58.35% (28.83%) correct for usual care. At 12 months, the mean (SD) STAT scores were 64.38% (26.39%) correct for intervention and 61.58% (28.01%) correct for usual care. Adjusted by education, a post hoc subgroup analysis revealed a mean (SE) intervention effect of 1.03% (0.44%) (P = .02) increase per month in the low-education subgroup (about a 10% increase in 12 months). In the high-education subgroup, the mean (SE) intervention effect was -0.05% (0.30%) (P = .86). Regarding percentage correct, the low-education intervention subgroup improved from 52.4% (7 of 21) to 66.7% (14 of 21) compared with the other subgroups. CONCLUSIONS AND RELEVANCE: No difference was observed in stroke preparedness at 12 months in response to culturally tailored 12-minute stroke films or conventional stroke education pamphlets. Additional studies are required to confirm findings from a post hoc subgroup analysis that suggested a significant education effect. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01909271.

Hip Hop HEALS: Pilot Study of a Culturally Targeted Calorie Label Intervention to Improve Food Purchases of Children.

OBJECTIVES: We explored the effect of a culturally targeted calorie label intervention on food purchasing behavior of elementary school students. METHOD: We used a quasi-experimental design with two intervention schools and one control school to assess food purchases of third through fifth graders at standardized school food sales before and after the intervention (immediate and delayed) in schools. The intervention comprised three 1-hour assembly-style hip-hop-themed multimedia classes. RESULTS: A mean total of 225 children participated in two baseline preintervention sales with and without calorie labels; 149 children participated in immediate postintervention food sales, while 133 children participated in the delayed sales. No significant change in purchased calories was observed in response to labels alone before the intervention. However, a mean decline in purchased calories of 20% (p < .01) and unhealthy foods (p < .01) was seen in immediately following the intervention compared to baseline purchases, and this persisted without significant decay after 7 days and 12 days. CONCLUSION: A 3-hour culturally targeted calorie label intervention may improve food-purchasing behavior of children.

Tailored approaches to stroke health education (TASHE): study protocol for a randomized controlled trial.

BACKGROUND: Stroke is a leading cause of adult disability and mortality. Intravenous thrombolysis can minimize disability when patients present to the emergency department for treatment within the 3 - 4½ h of symptom onset. Blacks and Hispanics are more likely to die and suffer disability from stroke than whites, due in part to delayed hospital arrival and ineligibility for intravenous thrombolysis for acute stroke. Low stroke literacy (poor knowledge of stroke symptoms and when to call 911) among Blacks and Hispanics compared to whites may contribute to disparities in acute stroke treatment and outcomes. Improving stroke literacy may be a critical step along the pathway to reducing stroke disparities. The aim of the current study is to test a novel intervention to increase stroke literacy in minority populations in New York City. DESIGN AND METHODS: In a two-arm cluster randomized trial, we will evaluate the effectiveness of two culturally tailored stroke education films - one in English and one in Spanish - on changing behavioral intent to call 911 for suspected stroke, compared to usual care. These films will target knowledge of stroke symptoms, the range of severity of symptoms and the therapeutic benefit of calling 911, as well as address barriers to timely presentation to the hospital. Given the success of previous church-based programs targeting behavior change in minority populations, this trial will be conducted with 250 congregants across 14 churches (125 intervention; 125 control). Our proposed outcomes are (1) recognition of stroke symptoms and (2) behavioral intent to call 911 for suspected stroke, measured using the Stroke Action Test at the 6-month and 1-year follow-up. DISCUSSION: This is the first randomized trial of a church-placed narrative intervention to improve stroke outcomes in urban Black and Hispanic populations. A film intervention has the potential to make a significant public health impact, as film is a highly scalable and disseminable medium. Since there is at least one church in almost every neighborhood in the USA, churches have the ability and reach to play an important role in the dissemination and translation of stroke prevention programs in minority communities. TRIAL REGISTRATION: NCT01909271 ; July 22, 2013.

Hip Hop Stroke: Study Protocol for a Randomized Controlled Trial to Address Stroke Literacy.

OBJECTIVE: Stroke is the fifth leading cause of death and the leading cause of serious long-term adult disability in the US. Acute stroke treatments with intravenous thrombolysis and endovascular therapy are proven to reduce disability, however a critical limitation on their effectiveness is the narrow time window for administration, which is 4.5 hours and 6 hours respectively from the onset of symptoms. Our overarching goal is to reduce pre-hospital delays to acute stroke treatments in economically disadvantaged minority communities where the greatest delays exist, using Hip Hop Stroke. METHODS: Hip Hop Stroke (HHS) is a school-based, child-mediated, culturally-tailored stroke communication multimedia intervention developed using validated models of behavior change and designed to improve stroke literacy (knowledge of stroke symptoms, the urgent need to call 911, and prevention measures) of 4th, 5th and 6th grade students and their parents residing in poor urban communities. Children in the intervention arm will receive the HHS intervention, while those in the attentional control arm will receive standardized nutrition education based on the USDA's MyPyramid program. Children will be trained and motivated to share stroke information with their parents or other adult caregiver. Both children and parents will complete a stroke knowledge assessment at baseline, immediately following the program, and at 3-months post-program. The primary outcome is the effect of the child mediation on parental stroke literacy. CONCLUSION: Stroke literate children, a captive audience in school systems, may represent a viable channel for spreading stroke information into households of poor urban communities where mass media stroke campaigns have shown the lowest penetration. These children may also call 911 when witnessing a stroke in their homes or communities. The HHS program may highlight the potential role of children in the chain of stroke recovery as a strategy for reducing prehospital delays to acute stroke treatment.

Motivational factors and future life plans of orthodontic residents in the United States.

INTRODUCTION: The purposes of this study were to investigate factors influencing career choice and identify future life plans of orthodontic residents in the United States. METHODS: Program chairs and directors of all 65 orthodontic residency programs in the United States were contacted by e-mail and telephone for permission to e-mail their residents and invite them to take part in on online survey. A total of 335 residents from 37 programs were invited to complete an anonymous 57-item questionnaire in May 2007. Data were categorized, and basic statistics including chi-square comparative analyses were performed. RESULTS: A total of 136 (40.60%) residents completed the survey. A "passion for orthodontics" emerged as the most important factor (20.29%) influencing the decision to pursue orthodontics as a career, followed by "intellectual stimulation or challenge" (18.12%). Most residents decided to become an orthodontist before they were in dental school (44.93%). Most residents (89.05%) plan to engage in private practice, and only 2 intend to pursue primarily an academic career. The average resident debt was $165,226 at the end of their program. CONCLUSIONS: The decision to become an orthodontist is often made early in life, before dental school, and a passion for orthodontics is the motivational factor. Residents plan to enter private practice and not pursue a career in academia. The current shortage of academics and orthodontic researchers will not be resolved from the current pool of orthodontic residents. A possible solution to the academic crisis is to change the selection criteria in programs to accept orthodontic residents who develop a passion for orthodontics while in dental school or to recruit primary researchers and teachers to the specialty. Residents plan to practice in an urban setting. Rural and underserviced areas will probably continue to experience shortages of orthodontists in the future.

A comparison of the costs and patient acceptability of professionally applied topical fluoride foam and varnish.

OBJECTIVES: In Canada and the United States, professionally applied topical fluorides (PATF) are usually applied as a gel or foam. However, fluoride varnish has also been found to be effective for caries prevention and may be a preferred method because less time is required and fluoride exposure can be better controlled. The goal of this study was to compare the costs and patient acceptability of two methods of PATF (foam and varnish). METHODS: The study population was a convenience sample of high-risk children from the York Region and the city of Hamilton, Ontario, Canada, who had been identified as requiring fluoride therapy (n = 256). Children received from dental hygienists either fluoride foam applied in trays or fluoride varnish painted on tooth surfaces. An observer recorded the time to perform each procedure, adverse outcomes, and the satisfaction of children with treatment. RESULTS: The varnish technique took significantly less time compared to foam (5.81 vs 7.86 minutes; P < .0001). Significant differences between procedure times were found in all age groups, but the largest difference was for children aged 3-6 years (5.22 vs 8.61 minutes; P < .0001). Signs of gagging were observed in a lower proportion of participants who received varnish (3.8% vs 15.1%; P < .01), and this difference was largest for children aged 3-6 years (2.6% vs 29.7%; P < .01). The cost per varnish application, for children aged 3-6 years, was substantially less after labor costs were considered (dollar 3.43 vs dollar 4.43, CDN). CONCLUSIONS: Varnish applications were found to take less time and resulted in fewer signs of discomfort. These results support the use of fluoride varnish in caries prevention programs, especially for younger children.