Cardiovascular Disease Risk in Rural Adults: A Pilot Intervention Study Using Registered Nurse/Community Health Worker Teams.

BACKGROUND: Cardiovascular disease (CVD) risk reduction programs led by a nurse/community health worker team are effective in urban settings. This strategy has not been adequately tested in rural settings. OBJECTIVE: A pilot study was conducted to examine the feasibility of implementing an evidence-based CVD risk reduction intervention adapted to a rural setting and evaluate the potential impact on CVD risk factors and health behaviors. METHODS: A 2-group, experimental, repeated-measures design was used; participants were randomized to a standard primary care group (n = 30) or an intervention group (n = 30) where a registered nurse/community health worker team delivered self-management strategies in person, by phone, or by videoconferencing. Outcomes were measured at baseline and at 3 and 6 months. A sample of 60 participants was recruited and retained in the study. RESULTS: In-person (46.3%) and telephone (42.3%) meetings were used more than the videoconferencing application (9%). Mean change at 3 months differed significantly between the intervention and control groups for CVD risk (-1.0 [95% confidence interval (CI), -3.1 to 1.1] vs +1.4 [95% CI, -0.4 to 3.3], respectively), total cholesterol (-13.2 [95% CI, -32.1 to 5.7.] vs +21.0 [95% CI, 4.1-38.1], respectively), and low-density lipoprotein (-11.5 [95% CI, -30.8 to 7.7] vs +19.6 [95% CI, 1.9-37.2], respectively). No between-group differences were seen in high-density lipoprotein, blood pressure, or triglycerides. CONCLUSIONS: Participants receiving the nurse/community health worker-delivered intervention improved their risk CVD profiles, total cholesterol, and low-density lipoprotein levels at 3 months. A larger study to explore the intervention impact on CVD risk factor disparities experienced by rural populations is warranted.

Vicarious Experience to Affect Physical Activity in Women: A Randomized Control Trial.

People compare themselves to others for self-evaluation, practical information, and motivation for healthy behaviors. The effect of active peer models on comparative thinking is unknown. The purpose of this 12-week, randomized, two-group pilot study was to evaluate the effect of a workplace peer modeling intervention on self-efficacy, motivation, and comparative thinking. The attention control group (ACG; n = 24) received general health information. The intervention group (n = 26) met with active peer models, received an exercise prescription and information. No significant group by time interaction effects were found. Comparisons on ability (how well am I doing), opinions (what should I think or believe), future self (think about my future), and modeling (be like someone else) all increased in the intervention group (n = 21) but decreased in the ACG (n = 22). Active peer models may support physical activity behavior change through specific lines of comparative thinking.

Adapting an Evidence-Based Cardiovascular Disease Risk Reduction Intervention to Urban American Indians.

PURPOSE: Using the RE-AIM framework, the primary purpose of this qualitative study was to conduct focus groups to identify areas for future adaptation of an evidence-based cardiovascular disease (CVD) risk intervention (COACH) developed for an urban primary care setting to urban American Indian (AI)-serving settings. METHODS: This qualitative study involved conducting three focus groups with 31 urban AI patients with two or more CVD risk factors to maximize reach and efficacy of COACH. The patients had not yet participated in an adapted COACH program. RESULTS: Findings from the focus groups indicate that a culturally adapted CVD risk reduction program modeled after COACH would be acceptable among urban AI populations. Recommendations for cultural adaptation include a need for images of AI people, traditional AI exercise activities and AI foods, information on the portion sizes of traditional foods, and expanded information on tobacco use and resources. CONCLUSION: With cultural adaptations, the COACH program can be pilot-tested in urban AI-serving primary care settings to address health concerns and behaviors that affect cardiovascular health outcomes.

Impact of Yoga on Inflammatory Biomarkers: A Systematic Review.

BACKGROUND: Many chronic conditions, including heart disease, cancer, and rheumatoid arthritis, are associated with underlying chronic inflammatory processes. Literature reviews have analyzed a variety of integrative therapies and their relationships with chronic inflammation. This systematic review is unique in reporting solely on yoga's relationship with inflammation. Its purpose was to synthesize current literature examining the impact of yoga interventions on inflammatory biomarkers in adults with chronic inflammatory-related disorders. METHOD: Searches of several electronic databases were conducted. Inclusion criteria were (a) English language, (b) sample age >18 years old, (c) yoga interventions involving postures with or without yoga breathing and/or meditation, and (d) measured inflammatory biomarkers. RESULTS: The final review included 15 primary studies. Of these, seven were rated as excellent and eight as average or fair. There was considerable variability in yoga types, components, frequency, session length, intervention duration, and intensity. The most common biomarkers measured were interleukin-6 ( n = 11), C-reactive protein ( n = 10), and tumor necrosis factor ( n = 8). Most studies reported positive effects on inflammatory biomarkers ( n = 11) from baseline to post yoga intervention. Analysis of the dose showed higher total dose (>1,000 min) resulted in greater improvements in inflammation. CONCLUSION: This review suggests that yoga can be a viable intervention to reduce inflammation across a multitude of chronic conditions. Future studies with detailed descriptions of yoga interventions, measurement of new and well-established inflammatory biomarkers, and larger sample sizes are warranted to advance the science and corroborate results.

Feasibility and Effect of a Peer Modeling Workplace Physical Activity Intervention for Women.

Most working women do not meet current guidelines for physical activity (PA). A 12-week pilot study tested a workplace, peer modeling PA intervention. Inactive female employees from a health system were randomized to an attention control group (ACG; n = 26) or an intervention group (IG; n = 26). The ACG received health information. The IG participated in six group sessions with an active peer model and received an exercise prescription and PA information. Pre and post measures were PA (ActiGraph), Estimated VO2max (cycle ergometer), resting heart rate (HR), glucose and lipids, and cardiovascular risk. Using hierarchical linear modeling, no significant group by time effects were found. Although PA increased in both groups, F( df = 1) = 11.4, p = .002, the IG had greater improvements in fitness (VO2max, HR) and cardiovascular risk (total cholesterol, triglyceride, low density lipoprotein [LDL], calculated risk score) compared with ACG. Results support repeating this intervention in a fully powered study.

Perceptions of a Peer Modeling Workplace Physical Activity Intervention for Women.

A workplace physical activity (PA) study tested a novel use of peers to deliver the intervention. Peer models provided vicarious experience for living physically active lifestyles to a group of inactive women. The purpose of this study was to describe participants' perceptions of the peer modeling intervention. Nine women from the intervention group ( n = 26) participated in a 90-minute focus group. Qualitative description using thematic analysis was used to identify themes from the focus group transcript. Two themes about the intervention were "I am left wanting more" and "focus on food." Two themes about the peer models were "real people" and "it is doable." Focus group participants perceived the peer modeling PA intervention favorably; however, they desired more attention to healthy eating and more time with peer models. Replication of the study accounting for themes identified by focus group participants is needed to strengthen the peer modeling intervention.

Seasonal Work and Cardiovascular Risk Factors in Farmers.

BACKGROUND: Cardiovascular disease is the leading cause of death and hospitalization in the rural United States. Midwestern farmers are integral to rural communities, but little is known about the effect of occupational variability of seasonal work and technology use on their cardiovascular disease risk. AIMS: This study describes the relationships of health behaviors and cardiovascular disease risk in 40 Midwestern farmers during peak and off-peak farming seasons. METHODS: Objectively measured physical activity and self-report of demographics, diet, and health-related quality of life were collected during each farming season. RESULTS AND CONCLUSIONS: Farmers in this study were physically active, ate consistent diets, and reported high health status ratings throughout the year. Cardiovascular disease risk was positively correlated with age and body mass index (P < .01), and half of young and middle-age farmers reported anxiety and depression problems. Cardiovascular disease risk reduction interventions for farmers should address both physical and emotional aspects of farming.

Couples' Experiences With Healthy Lifestyle Behaviors After Cardiac Rehabilitation.

PURPOSE: Many cardiac patients discontinue heart-healthy eating and physical activity (PA) behaviors in the months following cardiac rehabilitation (CR). Involving the spouse in CR with the patient may be 1 strategy to increase the maintenance of these behaviors after CR. Assisting patients and spouses with the maintenance of healthy eating and PA behavior following CR begins with a better understanding of the couple-focused factors, impacting their experiences with these behaviors. The purpose of this study was to qualitatively examine couple-focused facilitators and barriers to maintaining changes in healthy eating and PA behavior from the perspectives of both cardiac patients and their spouses following phase 2 CR. METHODS: A purposive sample of 11 couples (patients undergoing postcoronary artery bypass graft surgery and their spouses) were selected from a larger randomized control trial. Semistructured, in-person interviews were conducted with patients and their spouses separately following CR. Data were analyzed using line-by-line coding to identify facilitator and barrier themes. RESULTS: Two couple-focused barrier themes emerged: unnegotiated situations and unshared behaviors. Two couple-focused facilitator themes emerged: supportive exchanges and partnerships. CONCLUSION: These findings will help guide interventions targeting changes in diet and PA behavior in both patients and their spouses through minimizing unnegotiated situations, fostering supportive exchanges, and creating a partnership for the couple to work together on shared diet and PA goals. Targeting both patients and their spouses may be an innovative and effective way to intervene to increase adherence to healthy eating and PA behaviors post-CR.

Impact of change to a concept-based baccalaureate nursing curriculum on student and program outcomes.

The purpose of this study was to compare selected baccalaureate program outcomes for a traditional, specialty-based curriculum (TC) to a concept-based curriculum (CBC). Outcomes included NCLEX-RN licensure pass rates, graduation rates, national assessment of critical thinking, and program satisfaction. Student self-efficacy for performing nursing activities also was measured to assess the impact of the curriculum change on student confidence. The sample included 240 students enrolled in the two curricula during the last semester of the two baccalaureate nursing curricula. The TC sample (n = 104) included three cohort graduating classes, and the CBC sample (n = 136) included two cohort graduating classes. Findings indicated few differences on outcomes between the two curricula. Lack of a negative impact on program outcomes observed in this study may encourage other nursing colleges to implement newer curriculum models. Further study is needed on ways to evaluate the impact of curriculum change.

Symptom management strategies used by elderly patients after coronary artery bypass surgery.

The purpose of this secondary analysis was to describe symptom management strategies used by elderly patients (n = 236) 3 and 6 weeks after coronary artery bypass surgery (CABS). Three weeks after surgery, the most frequently used strategies were rest to manage shortness of breath (53%) and fatigue (53%), medications for incision pain (24%), and repositioning for swelling (35%) and sleep disturbance (18%). Overall, fewer patients experiencing sleep disturbances (39%), incision pain (39%), swelling (46%), and appetite problems (17%) reported using a strategy to manage their symptom. Nurses must assist patients in symptom identification and problem solving to accomplish effective symptom management.