Research interests, experience, and training of Community Health Workers: a mixed Method Approach.

The Affordable Care Act includes a call for community health care workers (CHWs) to be integrated into health care delivery systems to improve health care quality. In recent years, there have been increasing calls for community-based participatory research (CBPR) and patient-centered outcomes research (PCOR), as such types of research hold much potential for identifying interventions to reduce health and health care disparities. Yet, little is known about the research training, knowledge, experience, and even interest of CHWs in these types of research or in health research in general (HR). Thus, the purposes of this study include determining if there are differences between participating CHWs (N = 202) in their levels of training, knowledge, experience, and interest in relation to CBPR, PCOR and HR. Findings suggest that certified CHWs, as compared to non-certified CHWs, have significantly higher knowledge levels across all three types of research (ß = 1.3, p = .007). Additionally, participants had significantly higher knowledge of HR compared to CBPR (ß = 0.5, p = .015), but not higher than their knowledge of PCOR (p > .5). Qualitative data analyses performed to determine research areas of interest among the participating CHWs resulted in eighteen major research interest themes. Examples of these major themes are chronic illness (n = 95), health promotion (n = 39), healthcare services and administration (n = 30), mental health (n = 29), and research evaluation and methodology (n = 26). Together, the findings suggest that though CHWs have an interest in a wide range of health research areas, they could benefit from research trainings tailored to their responsibilities and interests.

Views of diverse primary care patients on the roles of healthcare providers and staff and the influence of other variables in their weight management.

The prevalence of overweight/obesity is disproportionately higher among racial/ethnic minority and low-income patients. The purpose of this study was to survey racially diverse, low-income patients regarding their experiences with and desires regarding their providers' involvement in weight management. Adult patients (N = 529), including mostly African American (42.7%), White (44.6%) and low-income (55.5% with incomes <$30 000) patients from 7 Patient-Centered Medical Homes voluntarily completed a brief anonymous survey while waiting to see their providers. Only 19.8% of the patients said that their primary care provider frequently or very frequently talked with them about their weight. Older patients as compared to younger patients, as well as males compared to females, were more likely to have their primary care provider talk to them about their diet and physical activity during the last year. It was also found that 56.9% of the patients were interested in getting help from their doctor to connect with resources for weight management in their community. African American patients, as compared to White patients, were more interested in getting such help. These results suggest that there is a need to establish healthcare policies and training in primary care settings that are designed to ensure that primary care providers routinely talk with all of their patients, including their female and older patients, about their weight and weight management services. Additionally, primary care administrators need to play an increased role in identifying, developing, and advocating for affordable weight management services, particularly in African American and low-income communities.

The effect of chronic ammonia exposure on acute-phase proteins, immunoglobulin, and cytokines in laying hens.

Ammonia (NH3) is a potential health hazard to both humans and animals, causing local and systemic low-grade inflammation based on its levels and exposure durations. The objective of this study was to examine the effects of 45 wk of exposure to 30 ppm NH3 on the concentrations of acute-phase proteins, immunoglobulins, and cytokines in laying hens. At 18 wk of age, a group of Hy-Line W-36 hens was randomly assigned to 4-hen cages. These cages were evenly divided between 2 environmentally controlled chambers. At 25 wk of age, one chamber was maintained continuously with fresh air (NH3 < 5 ppm; control group) and the other one was injected with NH3 and controlled at 30 ppm (NH3 group) for 45 wk. At 70 wk of age, blood and spleen samples (n = 8 per treatment) were collected for analyses of immunological parameters. No significant differences were observed in plasma levels of albumin, complement components (C)-3 and C-4, immunoglobulin (Ig)M, IgA and IgG, interleukin (IL)-6, IL-10, or interferon gamma in the NH3 group compared to control group. Compared to control hens, NH3 exposed hens had higher plasma levels of α-1-acid glycoprotein (24%) and tumor necrosis factor alpha (54%) and higher mRNA expression of IL-1ß (47%) and IL-6 (62.5%) in the spleen. These results indicated that hens may have the capability to adapt to chronic effects of moderate levels of NH3. Future studies should explore acute effects of NH3 at higher levels on hen health and welfare.

Fis1 deficiency selects for compensatory mutations responsible for cell death and growth control defects.

Genetic mutations affecting mitochondrial fission and fusion proteins cause human neurological disorders, but are assumed to be well tolerated in yeast. The conserved mitochondrial fission protein Dnm1/Drp1 is required for normal mitochondrial division, but also promotes cell death in mammals and yeast. Fis1, an outer mitochondrial membrane-anchored receptor for Dnm1/Drp1, also can promote cell death in mammals, but appears to have prosurvival activity in yeast. Here we report that deletion of the FIS1 gene in yeast consistently results in acquisition of a secondary mutation that confers sensitivity to cell death. In several independently derived FIS1 knockouts, tiling arrays and genomic sequencing identified the secondary mutation as a premature termination in the same stress-response gene, WHI2. The WHI2 mutation rescues the mitochondrial respiratory defect (petite formation) caused by FIS1 deficiency, but also causes a failure to suppress cell growth during amino-acid deprivation. Thus, loss of Fis1 drives the selection for specific compensatory mutations that confer defective growth control and cell death regulation, characteristic of human tumor cells. The important long-term survival function of Fis1 that is compensated by WHI2 mutation appears to be independent of fission factor Dnm1/Drp1 and its adaptor Mdv1, but may be mediated through a second adaptor Caf4, as WHI2 is also mutated in a CAF4 knockout.

Self-regulation predictors of medication adherence among ethnically different pediatric patients with renal transplants.

OBJECTIVE: To predict medication adherence among ethnically different pediatric patients with renal transplants between the ages of 6 and 20 years old, using self-regulation variables including motivation, perceived control and responsibility, and perceived support. METHODS: Twenty-six African American children and 42 Caucasian children were verbally administered the Self-Regulation of Medication Adherence Battery to assess their (1) motivation to be medication adherent, (2) perceived control of and responsibility for medication adherence, and (3) perceived support of medication adherence from their primary caregiver. Four measures were used to assess medication adherence: self-ratings, nephrologists' ratings, cyclosporine levels, and pill count/refill histories. RESULTS: For the African American patients, regression analyses revealed that responses to motivation and perceived control questions that focused on self-efficacy were unique predictors of medication adherence as rated by their primary nephrologist. For the Caucasian patients, one motivation question regarding how often they forget to take their medication predicted their self-reported adherence. CONCLUSIONS: Facilitating their beliefs that they can regularly take their medications may help promote medication adherence among African American children with renal transplants, whereas for Caucasian children, providing cues and reminders to take their medications may help. We discuss implications of the results for multimodal assessment of medication adherence and for ethnic group-specific medication adherence research and interventions.

Reproductive responses of beef heifers after concurrent administration of vaccines, anthelmintic and progestogen.

A study was conducted to determine whether concurrent administration of vaccines for reproductive diseases and an anthelmintic, given immediately prior to estrus synchronization with a progestogen, would affect subsequent estrous response and fertility in beef heifers. Two hundred ninety-five yearling crossbred beef heifers on 3 ranches in Oregon and Kansas were assigned to 1 of 2 treatments. Control heifers were vaccinated and dewormed 30 d prior to the anticipated breeding. Treated heifers received the same vaccination and deworming products 9 d prior to breeding. All heifers in both groups were treated with norgestomet (Syncro-Mate-B) for 9 d to synchronize estrus. The administered vaccine consisted of modified live virus for infectious bovine rhinotracheitis, parainfluenza and bovine viral diarrhea, with 5-way bacterin for leptospirosis and bacterin for vibriosis. Heifers were also administered ivermectin or fenbendazole for deworming. Heifers exhibiting synchronized estrus were artificially inseminated and subsequently exposed to fertile bulls. Pregnancy status was determined at a later date by palpation per rectum. Vaccination and deworming at the time of treatment with progestogen compared with immunizing and deworming 30 d prior to breeding did not impair the expression of behavioral estrus. The percentage of treated heifers conceiving to AI or natural service did not differ from that of the respective control heifers. These data suggest that vaccination, deworming and synchronization of estrus with norgestomet can be performed simultaneously without any detrimental effects upon occurrence of behavioral estrus or fertility.

An investigation of factors associated with fluid adherence among hemodialysis patients: a self-efficacy theory based approach.

This research tested the hypothesis that fluid adherence (i.e. mean weekend interdialysis fluid weight gain) among adult chronic hemodialysis patients would have significant associations with fluid adherence efficacy expectation, fluid adherence outcome expectation, and fluid adherence motivation. The association of these variables with patients' medical characteristics was also examined. Results provide partial support for the hypothesis. Fluid adherence efficacy expectation was found to be a significant predictor of mean weekend interdialysis fluid weight gain (fluid adherence). Patients with higher fluid adherence efficacy expectations had lower mean weekend interdialysis fluid weight gains. However, fluid adherence outcome expectation and fluid adherence motivation were not found to be significant predictors of fluid adherence. Results also revealed that certain of the investigated medical characteristics were significantly associated with mean weekend interdialysis fluid weight gain and fluid adherence efficacy expectation. Implications for studying and modifying fluid adherence among hemodialysis patients are discussed.

Family behavior, adaptation, and treatment adherence of pediatric nephrology patients.

In this exploratory study we investigated the relationships among family behavior variables (e.g., family expressiveness), adaptive functioning skills, maladaptive behavior, and adherence to treatment in pediatric renal failure patients. The study included 22 pediatric outpatients with renal failure who had not yet received dialysis or transplantation (RF) and their parents, and 12 pediatric outpatients with kidney transplants (TX) and their parents. For the RF patients, significant correlations were found between some of their adaptive functioning skills and measures of their medication adherence, diet adherence, and clinic appointment adherence; however, for the TX patients significant correlations were found only between some of their adaptive functioning skills and measures of their medication adherence. For the RF patients only, some measures of their family behavior were significantly correlated with measures of their medication adherence and diet adherence. Additionally, some measures of the RF patients' family behavior were significantly related to their communication skills, socialization skills, overall adaptive functioning skills, and maladaptive behavior. For the TX patients, only their socialization skill level was significantly correlated with one measure of their family behavior. It is concluded that facilitation of adaptive and physical functioning among renal pediatric patients likely requires multidimensional training and/or counselling interventions with the children and their families, and that some of the content and/or emphasis of this training likely needs to differ for RF patients versus TX patients.

The impact of a confusion technique on hypnotic responsivity in low-susceptible subjects.

The present study investigated the hypothesis that a confusion technique would produce greater hypnotic responsiveness for subjects who responded minimally to a standard hypnotic induction. Ten subjects who scored in the low range of hypnotic susceptibility on the HGSHS:A (scores of 0-4) participated in a confusion induction session. Hypnotic responsiveness was measured by several scales: the Harvard Group Scale of Hypnotic Susceptibility (HGSHS:A), a Depth Estimate (DE), and the Inventory Scale of Hypnotic Depth (ISHD). Qualitative data was collected via a follow-up interview. Collectively, the results did not support the hypothesis that a confusion technique is more effective than a standard induction for low-susceptible subjects. Implications for future research will be discussed.

Nurses' attitudes, nurse-patient interactions and adherence to treatment by hemodialysis patients.

Relationships among fluid intake and dietary-adherence of 29 hemodialysis patients, nurses' attitudes (liking-disliking) toward these patients, and selected nurses' and patients' verbalizations during hemodialysis treatment were explored. No significant associations were found. Nurses may be facilitating positive solutions to all patients' health care problems rather than admonishing those whom they dislike and/or who do not adhere to treatment.

Quality of life of patients on in-center hemodialysis versus continuous ambulatory peritoneal dialysis.

This study compared chronic hemodialysis and CAPD patients on several quality of life variables: dietary adherence, self-esteem, hope, wellbeing, marital happiness, perceived control over life, marital status, number of emotional support persons, and participation in social, recreational, and work activities. Statistically significant differences in the quality of life variables due to treatment modality or demographic variables were not found. However, CAPD patients did engage in significantly more social and recreational activity, though not more work activity, than did hemodialysis patients. It is noted that 73% of the CAPD patients were Caucasian and that 72% of the hemodialysis patients were of black origin. Similarly skewed racial compositions in preceding research comparing patients on CAPD and hemodialysis suggest that 1. choice of treatment is occurring on the basis of some set of patient characteristics, or 2. systematic assignment is occurring on the basis of race, sex, and/or education. However, given no significant race/demography differences for variables used in this research, it appears that quality of life across racially different groups of hemodialysis and CAPD patients is comparable.

The evaluation of isoxsuprine hydrochloride for the treatment of navicular disease: a double blind study.

A randomised double-blind clinical trial of 28 horses was undertaken to evaluate the efficacy of isoxsuprine hydrochloride at four different doses:- 0.0 mg/kg bodyweight (bwt) (placebo), 0.6 mg/kg bwt, 1.2 mg/kg bwt and 1.8 mg/kg bwt for treatment of navicular disease. The results showed that horses treated with isoxsuprine hydrochloride (N = 22) responded significantly with respect to clinical assessment score (P less than 0.01) when compared with the control group (N = 6). Furthermore, there were no dose-related differences in the responses of the horses treated with increasing levels of isoxsuprine. No correlation was found between radiological evidence of the extent of navicular disease and severity of lameness or response to treatment.

Long-term nurse-patient interactions: factors in patient compliance or noncompliance to the dietary regimen.

Noncompliance to treatment regimens is a widespread, costly problem. The present study examines nurse-patient interactions as factors in compliance/noncompliance to the hemodialysis dietary regimen. Several research studies have evidenced these interactions to be central to patient compliance. However, no research has been reported that has controlled for the nature of the treatment regimen; rather, practitioners' interactions with patients who are being treated for a variety of disorders have been examined. An interaction-process-analysis technique was used to code the verbal behaviors that occur during treatment between 38 hemodialysis outpatients with chronic renal disease and the nurses who provide their treatment. These verbal interactions were analyzed in relation to levels of dietary compliance/noncompliance of patients and length of nursing tenure. It was found that emotionally positive and negative responses by nurses were both positively associated with noncompliance to the dietary regimen; however, treatment-related responses by nurses were not associated with compliance/noncompliance level. With regard to length of nursing tenure, it was found that emotionally positive and negative responses by patients were positively associated with nursing tenure and that treatment-related questions by nurses were negatively associated with nursing tenure.

Alzheimer's disease: an olfactory connection?

The density and distribution of senile plaques and neurofibrillary tangles were examined in the olfactory bulbs and tracts, amygdala and hippocampus of 28 patients with Alzheimer's disease, 13 with Down's syndrome and 60 non-demented patients of age range 6-84 years. In all three patient groups comparisons of incidence and severity over the three areas showed the amygdala to be the most commonly and most severely affected area by senile plaques, the hippocampus by neurofibrillary tangles, and the olfactory bulbs and tracts to be the least affected by both. These findings are discussed in relationship to the possibility that the olfactory tracts might provide a portal of entry to the brain for any putative pathogenic agent(s) that might be responsible for the induction of senile plaques and/or neurofibrillary tangles.

The topographic distribution of senile plaques and neurofibrillary tangles in the brains of non-demented persons of different ages.

The incidence and severity of senile plaques (SP) and neurofibrillary tangles (NFT) were examined in six areas of brain in 60 non-demented patients of age range 6-84 years. Thirty-two patients showed neither SP nor NFT in any region (30 of these were under 65 years of age), 15 patients showed both SP and NFT in one or more regions (14 were over 60 years of age), 11 patients aged 21-84 years showed NFT only in one or more areas and two patients showed SP alone and only in the amygdala. Overall comparison of number and severity showed the greatest severity of SP within the amygdala in most instances, whereas NFT were found in most instances and at greatest severity within the hippocampus. The reason for this apparent vulnerability of these areas of brain to SP and NFT formation may lie with their connections with the outside world via the olfactory bulbs and tract. This pathway may thus provide an entry point to the brain for pathogenic agent(s) that may induce, either directly or indirectly, pathological processes that ultimately lead to SP and NFT formation.

Assessment-based group counseling to address concerns of chronic hemodialysis patients.

A Dialysis Patient Concerns Inventory (DPCI) was administered to 15 chronic hemodialysis outpatients by their nurses to assess concerns related to being a hemodialysis patient. This direct information from patients rather than experts in the field was used to construct a group counseling program to address these and other concerns later acknowledged by patients once group counseling began. Components of the counseling program, how the program was implemented, its effects, and factors important in effective program implementation with nurse involvement are discussed. It was concluded that it is important for nurses to play key roles in group counseling to address patients' concerns. It is also important for such counseling to be based on structured assessment of specific concerns reported from patients. Furthermore, it was concluded that group counseling should be planned and executed in ways that actively involve patients and that allow patients to participate for skill development and for life enhancement, rather than to get help with personal problems--a motivator that is often stigmatized.