Association between Loneliness and Depression among Community-Dwelling Older Women Living Alone in South Korea: The Mediating Effects of Subjective Physical Health, Resilience, and Social Support.

Social isolation and loneliness are the key risk factors for depression in late life. Older adults living alone and socially isolated are at greater risk for physical and mental health. This study aims to examine the mediating effects of subjective physical health, resilience, and social support on the association between loneliness and depression among the elderly female population living alone in South Korea. We included a total of 308 older women aged 60 years or older who live alone in a medium-sized city in South Korea. The survey data was collected using the validated survey instruments between November 2015 and April 2016. A parallel mediation model was performed to investigate whether physical health, resilience, and social support had mediating effects on the association of loneliness with depression. The findings of this study showed that loneliness was directly and indirectly associated with depression through its association with the subjective physical health, resilience, and social support among the older female population living alone. Our results suggest the importance of supporting community-based programs to improve physical and mental health of the elderly people as a way to minimize the level of loneliness and prevent depression.

COVID-19 and communication: A sentiment analysis of US state governors' official press releases.

OBJECTIVES: This study examines the contents of official communication from United States governors' offices related to the COVID-19 pandemic to assess patterns in communication and to determine if they correlate with trends for COVID cases and deaths. METHODS: We collected text data for all COVID-19 related press releases between March 1 and December 31, 2020 from the US governors' office websites in all 50 states. An automated parsing and sentiment analyzer assessed descriptive statistics and trends in tone, including positivity and negativity. RESULTS: We included a total of 7,720 press releases in this study. We found that both positive and negative sentiments were homogenous across states at the beginning of the pandemic but became heterogeneous as the pandemic evolved. The same trend applied to the frequency and tone of press releases. Sentiments across states were overall positive with a small level of negativity. We observed a reactive official communication to the evolution of the number of COVID-19 cases rather than responsive or preventive. CONCLUSIONS: The findings of both positivity and negativity in press communications suggest that the effect of discounted importance was present in official communications. Our findings support a state-dependent optimal communication frequency and tone, agreeing with the curvilinear communication model of organizational theory and implying that feedback cycles between government officials and public response should be shortened to rapidly maximize communication efficacy during the pandemic. Future research should identify and evaluate the drivers of the large differences in communication tone across states and validate the reactive characteristics of COVID-19 official communications.

A Cost-Effectiveness Analysis of a Community Health Worker Led Asthma Education Program in South Texas.

Purpose: This paper examines the cost-effectiveness of an asthma-related education program. Materials and Methods: Using a pre and post approach, the paper calculates first changes in cost due to variations in outcome (from baseline to follow-up). We also estimate cost-effectiveness ratios for each of the eight outcomes (numbers of asthma attacks, hospital, and ER visits, and physical and emotional health, and activity levels of both children and family members). Results: The intervention saved the household around $36 per day. Cost-effectiveness ratios ranged between less than $2.2 for children and family members' physical and emotional health, and activity levels to between $4.1 and $82.8 for asthma attacks and hospital visits. Cost-benefit results showed minimal benefit due to conservative estimates. We could not quantify the economic value of physical and emotional health improvement seen based on the measures. Conclusion: Cost savings and ratios suggest that such a program could reduce health disparities due to improved knowledge, decreasing exposure to asthma triggers, enhancing health outcomes, and improving the quality of life of the children with asthma and their whole family.

Comparison of LACE and HOSPITAL Readmission Risk Scores for CMS Target and Nontarget Conditions.

This study evaluated the utility and performance of the LACE index and HOSPITAL score with consideration of the type of diagnoses and assessed the accuracy of these models for predicting readmission risks in patient cohorts from 2 large academic medical centers. Admissions to 2 hospitals from 2011 to 2015, derived from the Vizient Clinical Data Base and regional health information exchange, were included in this study (291 886 encounters). Models were assessed using Bayesian information criterion and area under the receiver operating characteristic curve. They were compared in CMS diagnosis-based cohorts and in 2 non-CMS cancer diagnosis-based cohorts. Overall, both models for readmission risk performed well, with LACE performing slightly better (area under the receiver operating characteristic curve 0.73 versus 0.69; P ≤ 0.001). HOSPITAL consistently outperformed LACE among 4 CMS target diagnoses, lung cancer, and colon cancer. Both LACE and HOSPITAL predict readmission risks well in the overall population, but performance varies by salient, diagnosis-based risk factors.

Pediatric asthma hospitalization: individual and environmental characteristics of high utilizers in South Texas.

Objective: Few studies have examined factors affecting the high frequency of hospitalization for pediatric asthma. This study identifies individual and environmental characteristics of children with asthma from a low-income community with a high number of hospitalizations.Methods: The study population included 902 children admitted at least once to a children's hospital in South Texas because of asthma from 2010 to 2016. The population was divided into three groups by utilization frequency (high: ≥4 times, medium: 2-3 times, or low: 1 time). Individual-level factors at index admission and environmental factors were included for the analysis. Unadjusted and adjusted multivariate ordered logistic regression models were applied to identify significant characteristics of high hospital utilizers.Results: The high utilization group comprised 2.4% of total patients and accounted for substantial hospital resource utilization: 10.8% of all admissions and 13.5% of days stayed in the hospital. Patients in the high utilization group showed longer length of stay (LOS) and shorter time between admissions on average than the other two groups. The multivariate ordered logistic regression models revealed that age of 5-11 years (OR = 0.57, 95%CI = 0.35-0.93), longer LOS (2 days: OR = 1.80, 95%CI = 1.15-2.84; ≥3 days: OR = 3.38, 95%CI = 2.10-5.46), warm season at index admission (OR = 1.49, 95%CI = 1.01-2.20), and higher average ozone level in children's residential neighborhoods (OR = 1.78, 95%CI = 1.01-3.14) were significantly associated with a higher number of asthma hospitalizations.Conclusions: The findings suggest the importance of monitoring high hospital utilizers and establishing strategies for such patients based on their characteristics to reduce repeated hospitalizations and to increase optimal use of hospital resources.

Evaluation of Healthy South Texas Asthma Program on improving health outcomes and reducing health disparities among the underserved Hispanic population: using the RE-AIM model.

BACKGROUND: In the United States, childhood asthma prevalence is higher among low-income communities and Hispanic populations. Previous studies found that asthma education could improve health and quality of life, especially in vulnerable populations lacking healthcare access. This study aims to describe Healthy South Texas Asthma Program (HSTAP), an evidence-based asthma education and environmental modification program in South Texas, and evaluate its associations with health-related outcomes among Hispanic children with asthma and their families. METHODS: The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) planning and evaluation framework was used as an overarching tool to evaluate the impact of the HSTAP. This educational program included 451 children with asthma and their families living in South Texas, an impoverished area at the Texas-Mexico border. The program consisted of (a) the asthma education (2-h) for children with asthma provided by Respiratory Therapy students at the children's schools and (b) the home visit Asthma and Healthy Homes education and walk-through sessions (at baseline and 3 months) for parents and two follow-up visits (6 and 9-12 months later) led by community health workers. The education was provided in either English or Spanish between September 2015 and August 2020 as part of the Healthy South Texas Initiative. A pre-and post-test design was implemented to assess the differences in health outcomes, knowledge, and behaviors using standardized self-reported surveys as reported by parents. Analyses included primary descriptive analyses, generalized estimating equation models, the Wilcoxon signed-rank test, and the McNemar test. RESULTS: The HSTAP was significantly associated with improved individual-level outcomes on the frequency of asthma-related respiratory symptoms, including shortness of breath, chest tightness, coughing, and sleep difficulty, among children with asthma, as well as an enhanced asthma knowledge in their family. This study also showed significant associations with children's school attendance and participation in physical activities and family social events and decreased families' worry about their asthma management. CONCLUSIONS: The RE-AIM model was a helpful framework to assess the HSTAP on all its components. The results suggest that participation in an asthma education and environmental modification program was associated with improved individual-level health conditions and reduced health disparities among children with asthma in low-income communities.

Validating Visual Stimuli of Nature Images and Identifying the Representative Characteristics.

This study fills a void in the literature by both validating images of nature for use in future research experiments and examining which characteristics of these visual stimuli are found to be most representative of nature. We utilized a convenience sample of university students to assess 129 different nature images on which best represented nature. Participants (n = 40) viewed one image per question (n = 129) and were asked to rate images using a 5-point Likert scale, with the anchors "best represents nature" (5) and "least represents nature" (1). Average ratings across participants were calculated for each image. Canopies, mountains, bodies of water, and unnatural elements were identified as semantic categories of interest, as well as atmospheric perspectives and close-range views. We conducted the ordinary least squares (OLS) regression and the ordered logistic regression analyses to identify semantic categories highly representative of nature, controlling for the presence/absence of other semantic categories. The results showed that canopies, bodies of water, and mountains were found to be highly representative of nature, whereas unnatural elements and close-range views were inversely related. Understanding semantic categories most representative of nature is useful in developing nature-centered interventions in behavioral performance research and other neuroimaging modalities. All images are housed in an online repository and we welcome the use of the final 10 highly representative nature images by other researchers, which will hopefully prompt and expedite future examinations of nature across multiple research formats.

Assessing Patient Needs During Natural Disasters: Mixed Methods Analysis of Portal Messages Sent During Hurricane Harvey.

BACKGROUND: Patient portals play an important role in connecting patients with their medical care team, which improves patient engagement in treatment plans, decreases unnecessary visits, and reduces costs. During natural disasters, patients' needs increase, whereas available resources, specifically access to care, become limited. OBJECTIVE: This study aims to examine patients' health needs during a natural crisis by analyzing the electronic messages sent during Hurricane Harvey to guide future disaster planning efforts. METHODS: We explored patient portal use data from a large Greater Houston area health care system focusing on the initial week of the Hurricane Harvey disaster, beginning with the date of landfall, August 25, 2017, to August 31, 2017. A mixed methods approach was used to assess patients' immediate health needs and concerns during the disruption of access to routine and emergent medical care. Quantitative analysis used logistic regression models to assess the predictive characteristics of patients using the portal during Hurricane Harvey. This study also included encounters by type (emergency, inpatient, observation, outpatient, and outpatient surgery) and time (before, during, and after Hurricane Harvey). For qualitative analysis, the content of these messages was examined using the constant comparative method to identify emerging themes found within the message texts. RESULTS: Out of a total of 557,024 patients, 4079 (0.73%) sent a message during Hurricane Harvey, whereas 31,737 (5.69%) used the portal. Age, sex, race, and ethnicity were predictive factors for using the portal and sending a message during the natural disaster. We found that prior use of the patient portal increased the likelihood of portal use during Hurricane Harvey (odds ratio 13.688, 95% CI 12.929-14.491) and of sending a portal message during the disaster (odds ratio 14.172, 95% CI 11.879-16.907). Having an encounter 4 weeks before or after Hurricane Harvey was positively associated with increased use of the portal and sending a portal message. Patients with encounters during the main Hurricane Harvey week had a higher increased likelihood of portal use across all five encounter types. Qualitative themes included: access, prescription requests, medical advice (chronic conditions, acute care, urgent needs, and Hurricane Harvey-related injuries), mental health, technical difficulties, and provider constraints. CONCLUSIONS: The patient portal can be a useful tool for communication between patients and providers to address the urgent needs and concerns of patients as a natural disaster unfolds. This was the first known study to include encounter data to understand portal use compared with care provisioning. Prior use was predictive of both portal use and message sending during Hurricane Harvey. These findings could inform the types of demands that may arise in future disaster situations and can serve as the first step in intentionally optimizing patient portal usability for emergency health care management during natural disasters.

Factors Affecting Adoption of a Technology-Based Tool for Diabetes Self-Management Education and Support Among Adult Patients with Type 2 Diabetes in South Texas.

PURPOSE: The purpose of this study is to describe a novel computerized diabetes education tool and explore factors influencing self-selection and use among primarily Hispanic patients diagnosed with type 2 diabetes in south Texas. METHODS: Study participants included 953 adult patients with type 2 diabetes enrolled in a diabetes education program between July 1, 2016, and June 30, 2017. Participants were asked to choose either a new technology-based diabetes education tool with a touch-screen device or a traditional face-to-face education method. Multivariate logistic regression analysis was applied to identify factors associated with adopting the computerized diabetes education tool among the patients. RESULTS: When comparing technology-based tool adopters and nonadopters, several demographic and health-related factors differentiated technology use in bivariate analyses. The multivariate logistic regression model showed that Hispanic patients were less likely to choose a technology-based tool. Patients who perceived their health status as excellent/good were more likely to adopt the technologic education method than those with fair/poor perceived health status. A1C level was negatively associated with self-selection of technology. CONCLUSIONS: Specific demographic and health-related characteristics are significant contributing factors to patients' adoption of a technology-based diabetes education tool. Health care providers can utilize these findings to target and refer specific patients to a computerized diabetes education tool for more effective diabetes care and to optimize technology adoption success.

Cross-sectional study to measure household water insecurity and its health outcomes in urban Mexico.

OBJECTIVE: To assess the links between structural and household determinants of household water insecurity and test three water insecurity measures against self-reported diarrhoea, dengue fever and perceived stress in the middle-income and low-income urban areas of Torreón, Mexico. DESIGN: Cross-sectional household survey conducted in two waves (rainy and dry seasons). PARTICIPANTS: 500 households selected via multistage cluster sample in selected communities. Socioeconomic status determined the selection of participant neighbourhoods; five were identified in low socioeconomic status neighbourhoods and five in low-medium socioeconomic status neighbourhoods. We examine how the context of urban water provision is related to a new cross-culturally valid Household Water Insecurity Experiences (HWISE) Scale. PRIMARY OUTCOME MEASURES: The HWISE Scale, self-reported diarrhoea, dengue fever and the Perceived Stress Scale. RESULTS: Water system intermittency (adjusted OR (AOR) 3.96, 95% CI 2.40 to 6.54, p<0.001), unpredictability (AOR 2.24, 95% CI 1.34 to 3.74, p=0.002) and the dry season (AOR 3.47, 95% CI 2.18 to 5.52, p<0.001) were structural correlates of the HWISE Scale. This study also found that the HWISE Scale was associated with two health outcomes, self-reported diarrhoea (AOR 1.09, 95% CI 1.03 to 1.15, p=0.002) and perceived stress (ß=0.28, SE=0.07, t=4.30, p<0.001), but not self-reported dengue fever (AOR 1.02, 95% CI 0.98 to 1.06). A 3-item hygiene subscore and a 3-item water worry subscore were also both positively associated with self-reported diarrhoea and perceived stress. CONCLUSION: Short-form screeners of water insecurity may be useful for assessing certain health risks by lay survey workers in settings with limited healthcare resources, particularly in lieu of more expensive microbiological tests that require specialised training and facilities.

Diabetes Education Desert: Regional Disparity Between Diabetes Prevalence and Diabetes Self-Management Education Programs in Texas.

Diabetes is a major chronic disease that was the seventh leading cause of death in the United States in 2017. Although diabetes self-management education (DSME) programs have been implemented to promote patients' self-management skills, the disease continues to grow and some regions have a heavier burden of diabetes diagnoses than others. Focusing on the unbalanced diabetes prevalence across counties, this study aims to identify regional distribution of diabetes education programs in Texas counties, and explore whether diabetes prevalence is worse in certain counties that are geographically isolated from DSME programs. Data from the Centers for Disease Control and Prevention, American Diabetes Association, and American Association of Diabetes Educators were analyzed using ESRI ArcGIS software. When the authors geocoded 167 DSME programs in Texas, it was found that 47 programs (28.7%) were concentrated in 1 single county, and only 49 counties (19.3%) of the total counties (n = 254) had at least 1 DSME program. It also was revealed that the 25 counties (10%) with the highest diabetes prevalence had only 4 DSME programs (2.4%), indicating that there are still marginalized areas with no access to diabetes education programs. Considering the distance from each county's center to the nearest DSME program and diabetes prevalence, 3 counties were identified as diabetes education deserts. When designing, implementing, and evaluating strategies to reduce the burden of diabetes, policy makers and health care providers should account for the existing regional disparity in diabetes education and its impact on diabetes prevalence.

Assessing Impact of Household Intervention on Indoor Air Quality and Health of Children with Asthma in the US-Mexico Border: A Pilot Study.

Few studies have investigated household interventions to enhance indoor air quality (IAQ) and health outcomes in relatively low-income communities. This study aims to examine the impact of the combined intervention with asthma education and air purifier on IAQ and health outcomes in the US-Mexico border area. An intervention study conducted in McAllen, Texas, between June and November 2019 included 16 households having children with asthma. The particulate matter (PM2.5) levels were monitored in the bedroom, kitchen, and living room to measure the IAQ for 7 days before and after the intervention, respectively. Multiple surveys were applied to evaluate changes in children's health outcomes. The mean PM2.5 levels in each place were significantly improved. Overall, they significantly decreased by 1.91 µg/m3 on average (p < 0.05). All surveys showed better health outcomes; particularly, quality of life for children was significantly improved (p < 0.05). This pilot study suggests that the combined household intervention might improve IAQ in households and health outcomes for children with asthma and reduce health disparities in low-income communities. Future large-scale studies are needed to verify the effectiveness of this household intervention to improve IAQ and asthma management.

Effect of Ambient Air Pollution on Hospital Readmissions among the Pediatric Asthma Patient Population in South Texas: A Case-Crossover Study.

Few studies have evaluated the association between ambient air pollution and hospital readmissions among children with asthma, especially in low-income communities. This study examined the short-term effects of ambient air pollutants on hospital readmissions for pediatric asthma in South Texas. A time-stratified case-crossover study was conducted using the hospitalization data from a children's hospital and the air pollution data, including particulate matter 2.5 (PM2.5) and ozone concentrations, from the Centers for Disease Control and Prevention between 2010 and 2014. A conditional logistic regression analysis was performed to investigate the association between ambient air pollution and hospital readmissions, controlling for outdoor temperature. We identified 111 pediatric asthma patients readmitted to the hospital between 2010 and 2014. The single-pollutant models showed that PM2.5 concentration had a significant positive effect on risk for hospital readmissions (OR = 1.082, 95% CI = 1.008-1.162, p = 0.030). In the two-pollutant models, the increased risk of pediatric readmissions for asthma was significantly associated with both elevated ozone (OR = 1.023, 95% CI = 1.001-1.045, p = 0.042) and PM2.5 concentrations (OR = 1.080, 95% CI = 1.005-1.161, p = 0.036). The effects of ambient air pollutants on hospital readmissions varied by age and season. Our findings suggest that short-term (4 days) exposure to air pollutants might increase the risk of preventable hospital readmissions for pediatric asthma patients.

Regional Disparity in Asthma Prevalence and Distribution of Asthma Education Programs in Texas.

Objectives: To identify the distribution of asthma education programs that are currently active in Texas and examine whether there is a geographical disparity between asthma prevalence and locations of asthma education programs in the Public Health Regions (PHRs) of Texas. Methods: The data for adult asthma prevalence in PHRs was obtained from the Texas Department of State and Health Services (DSHS) 2015 Texas Behavioral Risk Factor Surveillance System (BRFSS) Public Use Data File. The Geographic Information System (GIS) program was used to show the distribution of asthma education programs and visually identify the isolated areas for asthma education programs on the maps. To examine the areas covered by the asthma education programs, we illustrated 50 miles and 70 miles of buffer zones from each program by proximity (multiple ring buffer) functions in GIS. Results: We identified that 27 asthma education programs are active in Texas as of July 2019. The analysis showed that PHRs 1, 2, and 7 had the highest rate of asthma prevalence but had fewer asthma education programs. Also, the distribution of asthma education programs is concentrated around major cities, leading to a regional imbalance between asthma prevalence and locations of asthma education programs. The central and western areas of Texas proved to be marginalized areas for asthma education programs, particularly PHRs 2 and 9 because they may not be covered by the buffer zones of 70 miles from any asthma education programs. Discussion. This study revealed the marginalized regions in Texas lacking asthma education programs. The findings could help policymakers and health care professionals enhance opportunities to develop asthma education programs using different venues in isolated areas and prioritize these regions, for funds, to establish new asthma education programs.

Bariatric Surgery in End-Stage Heart Failure: Feasibility in Successful Attainment of a Target Body Mass Index.

INTRODUCTION: Orthotopic heart transplantation (OHT) is contraindicated in morbidly obese patients with end-stage heart failure (HF), for whom cardiac allograft is the only means for long-term survival. Bariatric surgery may allow them to achieve target body mass index (BMI) for OHT METHODS: From 4/2014 to 12/2018, 26 morbidly obese HF patients who did not meet BMI eligibility criteria for OHT underwent laparoscopic bariatric surgery. Outcomes of interest were median difference in BMI, number of patients achieving target BMI for OHT, and 30-day mortality. RESULTS: Median age was 49 (IQR 14) years, and 13 (50%) were women. HF was mainly systolic (15 patients, 58%). The median LVEF was 27% (IQR 37%). At the time of bariatric surgery, 12 (46%) patients had mechanical circulatory support: 2 (8%) concomitant left ventricular assist device (LVAD) placements, 8 (31%) LVAD already-in-place, and 2 (8%) intra-aortic balloon pumps. There was no 30-day mortality, but one mortality on postoperative day 48. Over a median follow-up of 6 months (range 0-36 months, IQR 17), there was a significant reduction in BMI (p<0.0001). The median postoperative BMI was 36.7 (IQR 8.7), compared to preoperative median BMI of 42.7 (IQR 9.4). Target BMI of < 35 was achieved in 11 (42%) patients. Three patients (12%) have undergone OHT. CONCLUSION: Bariatric surgery in end-stage HF is feasible and results in a high number of patients achieving target BMI, increasing their probability of undergoing OHT. The presence of a LVAD should not preclude these patients from undergoing a bariatric intervention.

Association between Ambient Air Pollution and Hospital Length of Stay among Children with Asthma in South Texas.

Although hospital length of stay (LOS) has been identified as a proxy measure of healthcare expenditures in the United States, there are limited studies investigating the potentially important association between outdoor air pollution and LOS for pediatric asthma. This study aims to examine the effect of ambient air pollution on LOS among children with asthma in South Texas. It included retrospective data on 711 children aged 5-18 years old admitted for asthma to a pediatric tertiary care hospital in South Texas between 2010 and 2014. Air pollution data including particulate matter (PM2.5) and ozone were collected from the U.S. Centers for Disease Control and Prevention. The multivariate binomial logistic regression analyses were performed to determine the association between each air pollutant and LOS, controlling for confounders. The regression models showed the increased ozone level was significantly associated with prolonged LOS in the single- and two-pollutant models (p < 0.05). Furthermore, in the age-stratified models, PM2.5 was positively associated with LOS among children aged 5-11 years old (p < 0.05). In conclusion, this study revealed a concerning association between ambient air pollution and LOS for pediatric asthma in South Texas.

An exploration of community partnerships, safety-net hospitals, and readmission rates.

OBJECTIVE: To compare hospital-community partnerships among safety-net hospitals relative to non-safety-net hospitals, and explore whether hospital-community partnerships are associated with reductions in readmission rates. DATA SOURCES: Data from four nationwide hospital-level datasets for 2015-2016, including American Hospital Association (AHA) annual survey, Hospital Inpatient Prospective Payment System (IPPS) data, CMS Hospital Compare, and County Health Rankings National (CHRN) data. STUDY DESIGN: We first examined how safety-net hospitals partner with nine different community providers, and how the overall and individual partnership patterns differ from those in non-safety-net hospitals. We then explored their association with 30-day readmission rates by diagnosis and hospital wide. DATA COLLECTION/EXTRACTION METHODS: We included 1979 hospitals across 50 US states. PRINCIPAL FINDINGS: Safety-net hospitals were more engaged in hospital-community partnerships, especially with local public health, local governments, social services, nonprofits, and insurance companies, relative to their non-safety-net peers. However, we found that such partnerships were not significantly related to reductions in readmission rates. The findings indicated that merely partnering with various community organizations may not be associated with readmission rate reduction. CONCLUSIONS: Before promoting partnerships with various community organizations for its own sake, further prospective, longitudinal, and evidence-based guidance derived from the study of hospital-community partnerships is needed to make meaningful recommendations aimed at readmission rate reduction in safety-net hospitals.

Association between life-style behaviors and health outcomes in Adventist and non-Adventist adolescents in Mexico: a pilot study.

BACKGROUND: Identifying lifestyle-related health predictors affecting adolescent behaviors is a matter of interest and study for diverse audiences, including the religious sphere. The Adventist religion recommends their followers to adopt a healthy diet, adequate rest, physical activity, sufficient water intake, and non-use of addictive substances such as alcohol, tobacco, and drugs, as well as fostering faith and hope to give meaning to life. METHODS: A cross-sectional and observational study was conducted among adolescent students aged 13 to 19 years old in Montemorelos City, Nuevo León, Northern Mexico, between September 14, 2017 and February 13, 2018. This study included 363 Mexican adolescents, consisting of 202 Adventists and 161 non-Adventists. The binomial logistic regression analysis was performed to examine the relationships between religious affiliation and life-style behaviors and evaluate the effect of life-style behaviors on health outcomes by religious affiliation. Age, gender, type of residence, and place of birth were controlled. RESULTS: We found that Adventist adolescents were more likely to be watching TV for 2 h or less per day (p < 0.001), have enough sleeping time for 7 h or more (p < 0.001), go to bed early at 11 o'clock or before (p < 0.001), and have breakfast (p = 0.006) than non-Adventist adolescents significantly. It indicates that Adventist students are more likely to have healthier life-style behaviors than non-Adventist students. The multiple binomial regression models showed that in the group of Adventist adolescents sporting activity and hours watching TV were significantly associated with obesity risk (p = 0.001) and risky eating patterns (p = 0.044), respectively, controlling for age, gender, type of residence, and place of birth. No relationship was found between life-style behaviors and health outcomes in non-Adventist adolescents. CONCLUSIONS: Religious affiliation could serve as a predictor of healthy behaviors among adolescents. This study concluded that Adventist adolescents are more likely to have a healthier lifestyle behavior than non-Adventist adolescents and various health-related behaviors were specifically identified among Adventist participants.

Effects of the home-based educational intervention on health outcomes among primarily Hispanic children with asthma: a quasi-experimental study.

BACKGROUND: Childhood asthma is a significant health issue with 8.3% prevalence in the U.S. Its prevalence is particularly higher among low-income communities in the Texas-Mexico border region, as they often lack access to clinical care and health insurance. This study examines the impact of a home-based education led by Community Health Workers (CHWs) on health outcomes for asthmatic, predominantly Hispanic children in these communities. METHODS: The study was a quasi-experimental design to learn the effectiveness of the asthma home-based education by comparing changes of health outcomes between baseline and follow-up of intervention and control groups. This study enrolled 290 participants, consisting of 130 in the intervention group and 160 in the control group. The educational intervention led by the CHWs referenced the Asthma and Healthy Homes curriculum and contents of the Seven Principles of Healthy Homes. The multiple linear regression analysis was conducted to estimate the associations between the intervention and each health outcome. RESULTS: When comparing the intervention group with the control group, the intervention group showed a significantly greater decrease in asthma attacks than the control group (p = 0.049). Although all of the five Children's Health Survey for Asthma (CHSA) scores showed significant improvements between baseline and follow-up in both groups, we found that increases of CHSA scores in the intervention group were higher than the control group except for emotional health of children (EC) score. The multiple linear regression models demonstrated that the mean changes in asthma attacks (p = 0.036) and emotional health of families (EF) score (p = 0.038) were significantly better in the intervention group than the control group, adjusting for children's age of diagnosis, household income, use of steroids, family history of allergy, and type of insurance. CONCLUSIONS: This study concluded that the home-based education by CHWs effectively improve health outcomes among children in communities lacking access to medical resources. The findings suggest the importance of the home-based education program in promoting emotional and medical care for children and their families in low-income communities like those in the Texas-Mexico border region.

How Leading Hospitals Operationalize Evidence-Based Readmission Reduction Strategies: A Mixed-Methods Comparative Study Using Systematic Review and Survey Design.

Although various interventions targeted at reducing hospital readmissions have been identified in the literature, little is known about actual operationalization of such evidence-based interventions. This study conducted a systematic review and a survey of key informants in 2 leading hospitals, Houston Methodist (HM) and MD Anderson Cancer Center (MDACC), to compare and contrast the most cited evidence-based interventions in the current literature with interventions reported by those hospitals. The authors found that both hospitals followed evidence-based practices reported as successful in the literature. Both hospitals have implemented interventions for inpatient settings, and the timing of interventions was very similar. Major implementation differences observed for post-discharge interventions focused on collaboration. It also was found that HM was more likely than MDACC to use medication reconciliation in outpatient (P = .018) and discharge planning for community/home patients (P = .032). Results will provide hospital professionals with insights for implementing the most effective interventions to reduce readmissions.