Operative treatment of adolescent clavicle fractures with an intramedullary clavicle pin.

BACKGROUND: Adolescent clavicle fractures have traditionally been treated nonoperatively; however, recent literature in adults has shown improved outcomes with operative treatment of displaced and shortened clavicle fractures. It has been suggested that these results may translate to adolescents. This study presents an initial look at outcomes for operative treatment of displaced midshaft clavicle fractures in adolescents using an intramedullary clavicle pin. METHODS: Seventeen adolescent patients treated for a displaced, shortened midshaft clavicle fracture with an intramedullary clavicle pin between November 2007 and August 2009 were evaluated. Preoperative displacement, fracture union, and complications were reviewed, and shoulder scores were determined using the patient self-report section of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. RESULTS: Fracture union occurred in all 17 patients by 12 weeks. Average patient age was 15.8 years and ranged from 13 to 18 years. All but 2 implants were electively removed. The most common postoperative complaint was prominent hardware, which resolved after elective removal. There were no infections and only 1 patient reported decreased sensation at the incision site. Ten patients returned the American Shoulder and Elbow Surgeons form at an average time of 16.6 months after surgery. The average pain score was 44.2 of a possible 50 points. The average functional score was 44.3 of a possible 50 points. No patients reported severe difficulty with work activities and only 1 patient reported severe difficulty with sporting activities. CONCLUSIONS: Operative treatment with an intramedullary clavicle pin seems to be a safe and effective treatment method for displaced midshaft clavicle fractures in adolescents. LEVEL OF EVIDENCE: Therapeutic level IV.

Self-reported and clinical measurement of three chronic disease risks among low-income women in West Virginia.

BACKGROUND: This study assessed the validity of several self-reported cardiovascular risk factors among low-income women aged 40-64 years in West Virginia. METHODS: A cross-sectional survey was conducted of 733 women participating in the Well Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) project in West Virginia to examine agreement between self-report and clinical screenings in the prevalence of risk factors related to coronary heart disease (CHD). Women participating in the study were interviewed face-to-face before administration of clinical screenings that assessed height, weight, Quetelet's index, high blood pressure (systolic > or =140 mm Hg or diastolic > or =90 mm Hg), and elevated total cholesterol concentrations (> or =200 mg/dL and > or =240 mg/dL). RESULTS: The overall results showed high sensitivity and specificity for each of the risk factors examined; for overweight/obesity, the sensitivity was 96% and specificity was 93%; for cholesterol > or =240 mg/dL, sensitivity was 85% and specificity was 67%; for hypertension, sensitivity was 77% and specificity was 86%. Using a threshold value of > or =240 mg/dL for hypercholesterolemia led to higher sensitivity but a lower specificity than for a value of > or =200 mg/dL. CONCLUSIONS: This study found that among low-income women at higher risk for cardiovascular disease (CVD), self-reported values for high body mass index (BMI), hypercholesterolemia, and hypertension were well correlated with clinical measures, as indicated by high sensitivity values. Thus, self-reported values can be used for surveillance, targeted screenings, and health promotion activities, including lifestyle changes.

Perceived barriers to physical activity according to stage of change and body mass index in the west virginia wisewoman population.

PURPOSE: Low-income Appalachian women aged 40-64 years are an understudied population relative to physical activity barriers. To inform a cardiovascular risk factor intervention targeting this population through the West Virginia WISEWOMAN program, we determined at baseline participants' perceptions about the presence of 6 barriers to physical activity and respective differences according to stage of readiness for change (SOC). METHODS: Low-income women aged 40-64 who had participated in a state cancer screening program were recruited through 13 clinics. Participants were interviewed at clinics using a health risk/behavioral survey that included questions about barriers to and SOC for physical activity. Weight, height, and waist circumference were measured. PRINCIPAL FINDINGS: Baseline screening was completed by 733 women; 84% were overweight (body mass index [BMI] 25-29.9 [24.1%]) or obese (BMI > or = 30 [59.8%]). The prevalence of barriers was greatest for lack of support (52.4%) and lack of willpower (50.8%); lack of time was reported by only 30.1%. On chi(2) test, significant differences were revealed across SOC for time (p = .026), don't need more physical activity (p = .003), and willpower (p < 001); and for time (p = .006) and don't need more (p < .000) across BMI categories. Time increased from precontemplation (21.1%) to maintenance (35%). Obese participants reported time less frequently (25.7%) than participants of normal weight (40.2%). CONCLUSIONS: Lack of willpower and support-not time-seem to be the dominant physical activity barriers in the West Virginia WISEWOMAN population. Interventions targeting willpower in early SOC and in obese participants may be promising toward increasing physical activity.

Effectiveness of a nutrition intervention with rural low-income women.

OBJECTIVES: To evaluate Cookin' Up Health, a computer-based interactive nutrition intervention. METHODS: After randomization to intervention and control groups, 262 women in rural clinics in West Virginia completed both a baseline and 3-month follow-up survey. RESULTS: Compared to the control group, the intervention group had significantly improved scores on knowledge of dietary fats, food label reading, and readiness to eat 5 fruits and vegetables a day and foods lower in fat. CONCLUSIONS: This brief interactive nutrition intervention shows potential as a strategy to begin the process of change, but follow-up may be needed for actual behavior change to occur.

Cookin' Up Health: developing a nutrition intervention for a rural Appalachian population.

Cookin' Up Health is a culturally targeted and individualized tailored nutrition intervention using a computer-based interactive format. Using a cooking show theme, the program demonstrates step-by-step meal preparation emphasizing healthy selection and portion control. Focus groups were conducted with women in two rural counties in West Virginia to guide the development of the intervention. Women felt more susceptible to heart disease because the changing role of women creates more stress and less time; weight loss was a greater motivator for dietary change than was preventing heart disease; social support is a barrier and facilitator for dietary change; cultural heritage and the way women were raised were major barriers to making health changes as adults; convenience and the cost of eating healthier were major factors when trying to make changes in diet; and women did not feel confident in their ability to maintain dietary changes.

Correlates of physical activity in a community sample of older adults in Appalachia.

Although much has been learned about the global determinants of physical activity in adults, there has been a lack of specific focus on gender, age, and urban/rural differences. In this church-based community sample of Appalachian adults (N = 1,239), the primary correlates of physical activity included age, gender, obesity, and self-efficacy. Overall, 42% of all participants and 31% of adults age 65 years or older met recommended guidelines for physical activity, which suggests that most participants do not engage in adequate levels of physical activity. Of participants who met physical activity guidelines, the most common modes of moderate and vigorous activity were walking briskly or uphill, heavy housework or gardening, light strength training, and biking. These particular activities that focus on building self-efficacy might be viable targets for intervention among older adults in rural communities.

Knowledge and perceptions of diabetes in an Appalachian population.

INTRODUCTION: Qualitative research on knowledge and perceptions of diabetes is limited in the Appalachian region, where social, economic, and behavioral risk factors put many individuals at high risk for diabetes. The aim of this study was to gain a culturally informed understanding of diabetes in the Appalachian region by 1) determining cultural knowledge, beliefs, and attitudes of diabetes among those who live in the region; 2) identifying concerns and barriers to care for those with diabetes; and 3) determining the barriers and facilitators to developing interventions for the prevention and early detection of diabetes in Appalachia. METHODS: Thirteen focus groups were conducted in 16 counties in West Virginia in 1999. Seven of the groups were composed of persons with diabetes (n = 61), and six were composed of community members without diabetes (n = 40). Participants included 73 women and 28 men (n = 101). RESULTS: Findings show that among this population there is lack of knowledge about diabetes before and after diagnosis and little perception that a risk of diabetes exists (unless there is a family history of diabetes). Social interactions are negatively affected by having diabetes, and cultural and economic barriers to early detection and care create obstacles to the early detection of diabetes and education of those diagnosed. CONCLUSION: Public health education and community-level interventions for primary prevention of diabetes in addition to behavior change to improve the management of diabetes are needed to reduce the health disparities related to diabetes in West Virginia.