Building Capacity Among Laity: A Faith-Based Health Ministry Initiative.

A systematic review of topic-specific faith-based health programs determined that health outcomes can be improved though faith-based health interventions. A university research team, in partnership with the Kansas United Methodist Church and a United Methodist philanthropy, facilitated planning and development of a statewide initiative to increase the capacity of laity-led health ministry teams. The purpose of this paper is to describe the processes utilized to design and implement an initiative to increase capacity for laity-led comprehensive health ministry among Kansas United Methodist Church congregations and to share the key elements of the initiative.

Tobacco-free policies at worksites in Kansas.

BACKGROUND: This study sought to examine the relationship between tobacco-free policies at worksites to worksite demographics such as company size and geographic location. METHODS: Worksites participating in a worksite wellness workshop were asked to complete a worksite wellness instrument, which provided an assessment of their wellness practices already in place in the worksite, including the degree to which tobacco-free policies were in place at the worksite. RESULTS: At a bivariate level, those more likely to have tobacco-free policies included: urban employers (76.8% versus 50% rural employers, p = 0.0001); large employers (> = 250 employees) (74.3% versus 43.1% small employers (<50 employees), p = 0.0003); and schools (69.4%) and hospitals (61.5%) (versus 35.5%, agricultural/ manufacturing employers, p = 0.0125). At the multivariate level, rural employers (AOR = 0.47, 95% CI 0.23, 0.95) and small employers (AOR = 0.34, 95% CI 0.16, 0.71) had decreased odds, compared to their urban and large employer counterparts, of having tobacco-free policies. CONCLUSIONS: Rural and smaller employers are less likely to have tobacco-free policies than their urban and large counterparts.

Prevalence of diabetes and pre-diabetes in Kansas.

OBJECTIVE: The study objective was to determine the prevalence of diabetes and prediabetes among rural and urban populations in Kansas. RESEARCH DESIGN AND METHODS: This study utilized 2009 BRFSS data and included 18,912 respondents. Participants were identified through a stratified random sample of adult Kansans, living in a non-institutionalized setting, and with access to a land-based telephone line. Analyses were conducted using SAS to provide descriptive statistics for groups based on diabetes status. A logistic regression was conducted to explore significant variables associated with the likelihood of diabetes. RESULTS: Diabetes prevalence was lower among urban (11.8%) populations than rural (12.7%) areas of Kansas, but the inverse was true for pre-diabetes (3.7% urban, 3.1% in rural). Lower income and lower levels of educational attainment were associated with increased rates of diabetes and pre-diabetes, with the highest prevalence levels overall found among rural Latinos (19.3%) and urban African Americans (22.9%). Multivariate regression suggests that age, income, ethnicity, education, sex, rural vs urban status, and race all served as significant predicators of diabetes, net of other factors. CONCLUSIONS: Rural residents were more likely than urban residents to report having diabetes, whereas urban residents were more likely than rural residents to report having pre-diabetes. Although rural vs urban status played a significant role in the model's predicative ability for diabetes and pre-diabetes diagnosis, increased age was by far the most significant factor in diabetes and pre-diabetes diagnosis.

Emergency preparedness training and response among community health centers and local health departments: results from a multi-state survey.

Due to their access to medically underserved and vulnerable populations, community health centers (CHCs) can play an essential role in emergency response. CHCs often fill this role in partnership with other local health resources, such as local health departments (LHD). Little research has been done to understand the success of these partnerships as it relates to emergency planning and emergency response. This study compares CHC and LHD personnel regarding past, present, and future collaborative preparedness and response activities. Surveys were distributed electronically to 1,265 clinical and clerical staff at LHDs and CHCs in 23 states who met the study criteria. Of the 522 respondents, 287 (55%) reported having engaged in collaborative preparedness activities in general, with CHCs more likely to report partnering than LHDs. LHDs were more likely than CHCs to report taking part in specific preparedness activities, such as planning activities (91, 79%), (chi(2)(1, N = 280) = 7.395, P < 0.05), mass dispensing drill/exercises (65, 42%), (chi(2)(1, N = 279) = 14.019, P < 0.001), and communication drill/exercises (69, 47%), (chi(2)(1, N = 280) = 13.059, P < 0.001). This study suggests that collaborations between CHCs and LHDs in general are occurring, but these general collaboration are not being translated into participation in functional drills or exercises. Additional efforts to ensure a more comprehensive partnership between CHCs and LHDs in emergency preparedness are warranted.

Health behaviors and conditions of persons with epilepsy: a bivariate analysis of 2006 BRFSS data.

Using amalgamated Behavioral Risk Factor Surveillance System (BRFSS) data from nine states in 2006, this study examined the differences in demographics, health conditions, health behaviors, and quality of life among persons with active epilepsy (PWAE) and persons with a lifetime prevalence of epilepsy (PWLE), compared with persons without epilepsy (PWOE). Frequencies for PWAE, PWLE, and PWOE by selected health behaviors, health conditions, quality of life, and demographic variables were produced. Differences between persons with and without epilepsy were analyzed. Results indicated smoking and unemployment rates were significantly higher among PWLE/PWAE than among PWOE. PWLE/PWAE were also less likely than PWOE to report advanced educational attainment, and more likely to report suffering physical, mental, or emotional limitations that affected their activities in some way. Hispanics were less likely to report a lifetime or active prevalence of epilepsy than people without epilepsy. PWLE/PWAE report several differences in demographics, health conditions, health behaviors, and quality of life compared to people without epilepsy.

Exercise and epilepsy: a survey of Midwest epilepsy patients.

Obesity and lack of physical activity are an increasing problem. In addition to common barriers to physical activity, people with epilepsy also face fear of exercise-induced seizures, medication side effects, and, often, confusing advice regarding the safety of exercise. To explore barriers faced by people with epilepsy, we mailed a survey to 412 adult patients with epilepsy from an epilepsy center in Kansas. Survey items assessed patients' exercise habits, attitudes regarding exercise, and barriers to exercise. Forty-seven percent completed the survey. Most respondents reported that they did exercise, though most did so 3 or fewer days per week and at light intensity. Respondents who reported seizures as a barrier to exercise did not exercise with less frequency or intensity than those who did not report seizures as a barrier, but these respondents reported greater fear of seizures. Patient-specific education about the benefits of exercise needs to be initiated by physicians.

Pediatric emergency preparedness training: are we on a path toward national dissemination?

BACKGROUND: Emergency preparedness training is crucial for all health professionals, but the physiologic, anatomic, and psychologic differences between children and adults necessitates that health professionals receive training specific to pediatric emergencies. Before a standardized, nationally disseminated pediatric curriculum can be developed or endorsed, evidence-based evaluations of short- and long-term outcomes need to be conducted. METHODS: A review of literature was conducted to identify developed courses and any evaluation of these courses. RESULTS: Much has been published that supports the need for pediatric emergency preparedness, and many resources have been developed. However, very little literature presents evaluations of training courses. DISCUSSION: To achieve evidence-based pediatric emergency preparedness training, existing training programs must be evaluated, standardized training guidelines need to be developed, and critical components of pediatric disaster response need to be captured in the academic literature.

The National Training Strategy for emergency preparedness: collective lessons learned.

Seven distinct National Training Strategy programs were developed to meet the needs of the nation's community healthcare providers. Data on barriers and challenges, lessons learned, and best practices of the seven programs were collected from unpublished grant reports written by National Training Strategy awardees. Commonly reported themes were reviewed and compiled into these collective lessons learned.

Evaluation of mental health emergency preparedness among health professionals.

The purpose of this study was to identify if health professionals report an increase in mental health preparedness abilities with having only two mental health components as part of a 2-day preparedness training conference. At each of three conferences, identical pretraining and posttraining surveys were administered to conference participants. A 3-month follow-up survey was administered to respondents who volunteered to complete them. At pretraining, respondents (n = 603) reported generally greater mental health preparedness abilities than non-mental health preparedness abilities. This trend continued at posttraining (n = 490) and at 3 months posttraining (n = 195). Participants reported significantly increased mental health preparedness abilities at immediate posttraining and at 3 months posttraining from pretraining. This current study suggests that even when mental health items are included as a secondary component of disaster preparedness training, significant and meaningful growth in participants' confidence in their abilities can occur.

Early Success Is Vital in Minimal Worksite Wellness Interventions at Small Worksites.

INTERVENTION: In an effort to increase physical activity, 15 workplaces participated in a minimal-contact 10,000-steps-a-day program sponsored by the Sedgwick County Health Department in 2007 and 2008. Pedometers were provided to measure participants' weekly steps for the 10-week intervention. METHOD: Participants were defined as those who completed the preregistration survey and logged at least 1 week of results. Registrants were defined as those who completed a registration survey but did not log any weekly results. The primary dependent variable was whether or not participants achieved weekly success, as measured by achieving at least 70,000 steps in a week. A secondary dependent variable was participants' number of steps each week during the weeks they logged results. Repeated measures logistic regression analysis was conducted to identify factors associated with weekly success. RESULTS: Of the 2,515 registrants, 1,292 (51%) were participants. The average number of weeks of participation for this 10-week intervention was 5.6 weeks (SD = 3.4). Those from small employers (n < 750) were more likely (OR = 2.0) than those from large organizations (n > 750) to become participants. Participants who achieved at least 70,000 steps in the first week of the intervention were 7.3 times more likely than participants who walked less than 70,000 steps in the first week to achieve 70,000 steps each week for all 10 weeks. CONCLUSIONS: Results from implementing a minimal-contact 10,000-step intervention can be maximized by targeting small worksites and supporting employees to achieve 70,000 steps in their first week.

Does availability of expanded point-of-care services improve outcomes for rural diabetic patients?

AIMS: The purpose of this study was to assess compliance with American Diabetes Association screening recommendations at Salina Family Healthcare (SFHC) in Salina, Kansas, a large rural town, and to evaluate the impact of point-of-care (POC) dilated eye exams for uninsured patients. POC exams are those performed in the location where patients are treated. METHODS: There were 462 type II diabetic (DM2) patients seen at SFHC in 2009 and 537 DM2 patients seen in 2010. A chart review of all patients with DM2 was done to assess rates of recommended screening exams, including dilated eye exams and foot exams. RESULTS: In 2009/2010 urine microalbumin was checked in 57%/75% of DM2 patients. HbA1c and low density lipoprotein (LDL) levels at goal were 46%/48% and 58%/58%, respectively. 47%/67% of DM@ patients received foot exams and 21%/30% received eye exams. In 2009, 23% of the 155 uninsured diabetic patients at SFHC received a dilated eye exam. The following year, after implementation of on-site ophthalmologic services, rates of dilated eye exams increased 1.6 fold to 37% of the 196 uninsured patients. CONCLUSIONS: SFHC performed similarly to national rates on some diabetic screening exams, but there is room for improvement in all recommended screening exams. The implementation of a novel approach to increasing dilated eye exam rates indicates that expanded POC services can improve outcomes for diabetic patients.

A large-scale points-of-dispensing exercise for first responders and first receivers in Nassau County, New York.

Points of dispensing (PODs) are vital for responding to events that require mass chemoprophylaxis, such as bioterrorist attacks or pandemic influenza. This article evaluates the operational success of a large-scale dispensing drill for first responders and first receivers, focusing on differences in functioning of PODs by practice discipline and POD model. PODs were operated by either first responders (EMS, fire, or police) or first receivers (hospitals). Facilities could operate a centralized POD model, a decentralized POD model, or a combination, or "hybrid," model. Evaluation consisted of having evaluators at every POD, conducting a survey of POD individuals, and reviewing retrospectively the medications dispensed during the drill. Throughput counts, satisfaction with POD functioning, and errors in medication dispensing at each site are reported by practice discipline and facility model. During the drill, 23 PODs successfully processed more than 4,000 individuals. Centralized PODs and first responder facilities had faster throughput times than hybrid and hospital facilities, but hospital facilities had a lower incidence of medication error. Nominal differences in patient satisfaction were found. Assessing a combination of throughput, medical errors, and patient satisfaction with first responders and first receivers as points of dispensing can provide valuable insight into the feasibility of providing chemoprophylaxis to first responders and first receivers in advance of POD operations for the general public.

Factors predicting individual emergency preparedness: a multi-state analysis of 2006 BRFSS data.

Disasters pose a very real threat to every individual in the United States. One way to mitigate the threat of disasters is through personal preparedness, yet numerous studies indicate that individual Americans are not prepared for a disaster. This study attempted to identify the factors most likely to predict individual disaster preparedness. We used 2006 Behavioral Risk Factor Surveillance System (BRFSS) data from the 5 states that included the optional general preparedness module. Respondents were defined as being "prepared" if they were deficient in no more than 1 of the 6 actionable preparedness measures included on the BRFSS. Analyses were conducted comparing preparedness rates based on medical and demographic factors. Using logistic regression, a predictive model was constructed to identify which factors most strongly predicted an individual's likelihood of being prepared. Although 78% of respondents reported feeling prepared for a disaster, just 45% of respondents were actually prepared by objective measures. Factors predicting an increased likelihood of preparedness included feeling "well prepared" (OR 9.417), having a disability or health condition requiring special equipment (OR 1.298), being 55 to 64 years old (OR 1.794), and having an annual income above $50,000 (OR 1.286). Among racial and ethnic minorities, an inability to afford medical care in the previous year (OR .581) was an important factor in predicting a decreased likelihood of being prepared. This study revealed a pervasive lack of disaster preparedness overall and a substantial gap between perceived and objective preparedness. Income and age were important predictors of disaster preparedness.

Emergency preparedness training for veterinarians: prevention of zoonotic transmission.

Natural zoonotic outbreaks can cause widespread devastation, and several zoonoses can be transmitted as agents of bioterrorism. Although veterinarians can be vital in controlling the transmission of zoonotic diseases, many lack knowledge about their roles in emergency response and about zoonoses. A training session titled "Prevention of Zoonotic Disease Transmission" was provided for New York veterinarians. The training was evaluated using pre-training, post-training, and follow-up surveys, which measured increase in and retention of knowledge. Seventy-five (75) veterinary professionals participated in the training, and 91% responded on pre- and post-training surveys. The percentage of respondents who correctly answered the objective knowledge questions increased from pre-training to post-training. Furthermore, follow-up surveys demonstrated that participants were able to retain much of the information from the training session. Very little research has been found that evaluates a similar training event. As knowledge increases, additional training conferences could benefit veterinarians and supplement this research. The results of the pre-training, post-training, and follow-up surveys indicate that veterinary professionals' knowledge of zoonoses can be significantly improved after receiving training; participants found the training to be useful and requested additional training, indicating that veterinary professionals have a desire to learn about emergency preparedness topics.

Influenza vaccine coverage and presenteeism in Sedgwick County, Kansas.

The likelihood of persons working while ill, a practice known as "presenteeism," must be assessed when making preparations for pandemic influenza. A questionnaire was distributed to evaluate various health care professionals' past presenteeism, future intent to work with an influenza-like illness (ILI), and vaccination status. Of the respondents who reported that they would call in sick, 47% reported previously working with an ILI. Overall, males were more likely than females to have been vaccinated, to haved stayed at work when ill, and to have previously worked with an ILI. Because limiting the spread of influenza depends on community action, knowing a community's attitudes and behaviors can help target educational and preparedness efforts.

Regional Health System Response to the 2007 Greensburg, Kansas, EF5 Tornado.

BACKGROUND: On May 4, 2007 an EF5 tornado hit the rural community of Greensburg, KS, destroying 95% of the town and resulting in 12 fatalities. METHODS: Data was requested from the emergency medical services units that initially responded and the regional hospitals that received people injured in the tornado within 24 hours following the tornado. Requested data included patient age and sex, and injury severity score or ICD-9 codes. Critical mortality, or the number of deaths of critically injured patients, was also calculated. RESULTS: The extensive damage caused by the tornado effectively destroyed the infrastructure of the community and created enormous challenges for emergency medical services responders, who were unable to record any triage data. Area hospitals treated 90 patients, who had an average injury severity score of 6.4. Age was found to be related to injury severity, but no relationship between sex and injury severity was found. Critical mortality was found to be 18% for this event. CONCLUSIONS: Injury severity score has seldom been used to analyze natural disasters, especially tornadoes, although such analysis is helpful for understanding the magnitude of the disaster, comparing to other disasters, and preparing for future incidents. Advanced warning and personal preparedness are important factors in reducing tornado-related injuries and deaths.