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1.
Obesity (Silver Spring) ; 28(3): 510-520, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31984668

RESUMEN

OBJECTIVE: Rural black communities bear a disproportionate burden of obesity. To increase reach among underserved groups, community-based weight loss and maintenance interventions are crucial. METHODS: The Diabetes Prevention Program (DPP) was adapted for rural black adults of faith to create The Wholeness, Oneness, Righteousness, Deliverance (WORD) trial, a group-based, community health worker-delivered weight loss intervention. A Weight Loss Only arm (16 sessions) was compared with a Weight Loss + Maintenance arm (16 + 12 sessions) in a cluster randomized controlled trial of 31 churches (n = 440). Weight and related behaviors were assessed at 0, 6, 12, and 18 months. RESULTS: The WORD produced weight loss from baseline to 6 months (percentage body weight change -2.47 [-3.13 to -1.80]). Among those who lost 5% of their baseline weight, there was a statistical trend of lower weight regain in the Weight Loss + Maintenance arm compared with control. Maintenance arm participants reported higher activity at 12 months. There were no between-arm differences at 18 months. CONCLUSIONS: The WORD produced weight loss from baseline to 6 months on par with that produced by other DPP adaptations for black communities, including adaptations using health professionals. Weight regain was also consistent with that reported in prior literature. Continuing sessions as part of the church's mission may foster adoption of DPP-based weight loss programs.

2.
Prog Community Health Partnersh ; 12(2): 173-177, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30270227

RESUMEN

BACKGROUND: Community subcontracts are an essential component of community-engaged research, particularly community-based participatory research (CBPR). However, several barriers have limited community-based organizations' (CBOs) ability to serve as subcontractors on research grants. This article describes the barriers and strategies to implementing community subcontracts through a case study of the implementation of one federal grant. LESSONS LEARNED: Specific lessons learned at the CBO level, budget-creation level, and university-level are described to overcome barriers in executing community subcontracts in community-engaged research. CONCLUSIONS: We call for institutional changes to facilitate equitable resource sharing in community-engaged research.


Asunto(s)
Investigación Participativa Basada en la Comunidad/organización & administración , Asignación de Recursos/métodos , Investigación Participativa Basada en la Comunidad/métodos , Relaciones Comunidad-Institución , Servicios Contratados/métodos , Servicios Contratados/organización & administración , Humanos , Desarrollo de Programa/métodos , Asignación de Recursos/organización & administración , Estados Unidos , Universidades/organización & administración
3.
J Behav Med ; 39(4): 687-93, 2016 08.
Artículo en Inglés | MEDLINE | ID: mdl-27017335

RESUMEN

This paper evaluated long-term associations between psychosocial factors and premature mortality among women with suspected coronary artery disease (CAD). We tracked total mortality events over a median 9.3 years in a cohort of 517 women [baseline mean age = 58.3 (11.4) years]. Baseline evaluations included coronary angiography, psychosocial testing, and CAD risk factors. Measures included the Spielberger Trait Anxiety Scale, Beck Depression Inventory, self-rated health, and Social Network Index. Cox regression analysis was used to assess relationships. Covariates included age, CAD risk factors, and CAD severity. BDI scores (HR 1.09, 95 % CI 1.02-1.15), STAI scores (HR .86, 95 % CI .78-.93), and very good self-rated health (relative to the poor self-rated health group; HR .33, 95 % CI .12-.96) each independently predicted time to mortality outcomes in the combined model. SNI scores (HR .91, 95 % CI .81-1.06) and other self-rated health categories (i.e., fair, good, and excellent categories) were not significant mortality predictors after adjusting for other psychosocial factors. These results reinforce and extend prior psychosocial research in CAD populations.


Asunto(s)
Ansiedad/psicología , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/mortalidad , Depresión/psicología , Isquemia Miocárdica/mortalidad , Anciano , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/psicología , Femenino , Humanos , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico por imagen , Isquemia Miocárdica/psicología , National Heart, Lung, and Blood Institute (U.S.) , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Índice de Severidad de la Enfermedad , Estados Unidos
4.
Contemp Clin Trials ; 40: 63-73, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25461496

RESUMEN

BACKGROUND: The positive effects of weight loss on obesity-related risk factors diminish unless weight loss is maintained. Yet little work has focused on the translation of evidence-based weight loss interventions with the aim of sustaining weight loss in underserved populations. Using a community-based participatory approach (CBPR) that engages the strong faith-based social infrastructure characteristic of rural African American communities is a promising way to sustain weight loss in African Americans, who bear a disproportionate burden of the obesity epidemic. OBJECTIVES: Led by a collaborative community-academic partnership, The WORD aims to change dietary and physical activity behaviors to produce and maintain weight loss in rural, African American adults of faith. DESIGN: The WORD is a randomized controlled trial with 450 participants nested within 30 churches. All churches will receive a 16-session core weight loss intervention. Half of the churches will be randomized to receive an additional 12-session maintenance component. METHODS: The WORD is a cultural adaptation of the Diabetes Prevention Program, whereby small groups will be led by trained church members. Participants will be assessed at baseline, 6, 12, and 18 months. A detailed cost-effectiveness and process evaluation will be included. SUMMARY: The WORD aims to sustain weight loss in rural African Americans. The utilization of a CBPR approach and the engagement of the faith-based social infrastructure of African American communities will maximize the intervention's sustainability. Unique aspects of this trial include the focus on weight loss maintenance and the use of a faith-based CBPR approach in translating evidence-based obesity interventions.


Asunto(s)
Afroamericanos , Sobrepeso/terapia , Religión , Población Rural , Pérdida de Peso , Índice de Masa Corporal , Investigación Participativa Basada en la Comunidad , Conducta Cooperativa , Dieta , Ejercicio , Femenino , Conductas Relacionadas con la Salud , Estado de Salud , Humanos , Difusión de la Información , Masculino , Obesidad/etnología , Obesidad/prevención & control , Sobrepeso/etnología , Proyectos de Investigación , Factores Socioeconómicos
5.
Am J Med ; 127(9): 840-7, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24769297

RESUMEN

BACKGROUND: Dietary habits and depression are associated with cardiovascular disease risk. Patients with depression often report poor eating habits, and dietary factors may help explain commonly observed associations between depression and cardiovascular disease. METHODS: From 1996 to 2000, 936 women were enrolled in the Women's Ischemia Syndrome Evaluation at 4 US academic medical centers at the time of clinically indicated coronary angiography and then assessed (median follow-up, 5.9 years) for adverse outcomes (cardiovascular disease death, heart failure, myocardial infarction, stroke). Participants completed a protocol including coronary angiography (coronary artery disease severity) and depression assessments (Beck Depression Inventory scores, antidepressant use, and depression treatment history). A subset of 201 women (mean age, 58.5 years; standard deviation, 11.4) further completed the Food Frequency Questionnaire for Adults (1998 Block). We extracted daily fiber intake and daily servings of fruit and vegetables as measures of dietary habits. RESULTS: In separate Cox regression models adjusted for age, smoking, and coronary artery disease severity, Beck Depression Inventory scores (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01-1.10), antidepressant use (HR, 2.4; 95% CI, 1.01-5.9), and a history of treatment for depression (HR, 2.4; 95% CI, 1.1-5.3) were adversely associated with time to cardiovascular disease outcomes. Fiber intake (HR, 0.87; 95% CI, 0.78-0.97) and fruit and vegetable consumption (HR, 0.36; 95% CI, 0.19-0.70) were associated with a decreased time to cardiovascular disease event risk. In models including dietary habits and depression, fiber intake and fruit and vegetable consumption remained associated with time to cardiovascular disease outcomes, whereas depression relationships were reduced by 10% to 20% and nonsignificant. CONCLUSIONS: Among women with suspected myocardial ischemia, we observed consistent relationships among depression, dietary habits, and time to cardiovascular disease events. Dietary habits partly explained these relationships. These results suggest that dietary habits should be included in future efforts to identify mechanisms linking depression to cardiovascular disease.


Asunto(s)
Depresión/complicaciones , Conducta Alimentaria , Insuficiencia Cardíaca/etiología , Isquemia Miocárdica/etiología , Accidente Cerebrovascular/etiología , Adulto , Anciano , Encuestas sobre Dietas , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/prevención & control , Insuficiencia Cardíaca/psicología , Humanos , Persona de Mediana Edad , Infarto del Miocardio/etiología , Infarto del Miocardio/mortalidad , Infarto del Miocardio/prevención & control , Infarto del Miocardio/psicología , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/mortalidad , Isquemia Miocárdica/psicología , Modelos de Riesgos Proporcionales , Factores de Riesgo , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/psicología
6.
J Rural Health ; 30(3): 284-91, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24575972

RESUMEN

PURPOSE: Racial and geographic disparities in human immunodeficency virus (HIV) are dramatic and drug use is a significant contributor to HIV risk. Within the rural South, African Americans who use drugs are at extremely high risk. Due to the importance of religion within African American and rural Southern communities, it can be a key element of culturally-targeted health promotion with these populations. Studies have examined religion's relationship with sexual risk in adolescent populations, but few have examined specific religious behaviors and sexual risk behaviors among drug-using African American adults. This study examined the relationship between well-defined dimensions of religion and specific sexual behaviors among African Americans who use cocaine living in the rural southern United States. METHODS: Baseline data from a sexual risk reduction intervention for African Americans who use cocaine living in rural Arkansas (N = 205) were used to conduct bivariate and multivariate analyses examining the association between multiple sexual risk behaviors and key dimensions of religion including religious preference, private and public religious participation, religious coping, and God-based, congregation-based, and church leader-based religious support. FINDINGS: After adjusting individualized network estimator weights based on the recruitment strategy, different dimensions of religion had inverse relationships with sexual risk behavior, including church leadership support with number of unprotected vaginal/anal sexual encounter and positive religious coping with number of sexual partners and with total number of vaginal/anal sexual encounters. CONCLUSION: Results suggest that specific dimensions of religion may have protective effects on certain types of sexual behavior, which may have important research implications.


Asunto(s)
Afroamericanos , Trastornos Relacionados con Cocaína/epidemiología , Religión , Conducta Sexual , Adolescente , Adulto , Anciano , Arkansas/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Asunción de Riesgos , Salud Rural , Población Rural , Encuestas y Cuestionarios
7.
J Phys Act Health ; 11(7): 1408-14, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24368673

RESUMEN

BACKGROUND: The effect of volunteer lay leaders on availability and sustainability of strength-training programs for older adults has not been well explored. We describe implementation of the StrongWomen strength training program by the Arkansas Cooperative Extension Service, and report on the relationship between delivery approach (agent-led, lay-led, or combination of agent- and lay-led) and program access and sustainability. METHODS: All state Extension agents (n = 66) were surveyed on program implementation, continuance, and use of lay leaders. Program records were used to identify the number of trained lay leaders. Regression models were used to examine the relationship between delivery approach and group availability. RESULTS: Counties using lay leaders had twice as many groups as counties using only agents. There was a significant, positive relationship between the number of lay leaders and the number of groups. Counties using lay leaders were 8.3 times more likely to have continuing groups compared with counties not using lay leaders. CONCLUSIONS: Program continuance was significantly and positively associated with lay leader use. Lay delivery expanded access to strength training programs and increased the likelihood that programs would continue. This approach can be used to increase access to and sustainability of strength training programs, particularly in resource-constrained areas.


Asunto(s)
Comunicación en Salud/métodos , Liderazgo , Entrenamiento de Resistencia/métodos , Salud Rural/educación , Adulto , Anciano , Arkansas , Femenino , Recursos en Salud , Humanos , Masculino , Población Rural , Voluntarios
8.
Res Aging ; 36(1): 22-39, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25651599

RESUMEN

Senior centers are ideal locations to deliver evidence-based health promotion programs to the rapidly growing population of older Americans to help them remain healthy and independent in the community. However, little reported research is conducted in partnership with senior centers; thus, not much is known about barriers and facilitators for senior centers serving as research sites. To fill this gap and potentially accelerate research within senior centers to enhance translation of evidence-based interventions into practice, the present study examined barriers and facilitators of senior centers invited to participate in a cluster-randomized controlled trial. Primary barriers to participation related to staffing and perceived inability to recruit older adult participants meeting research criteria. The primary facilitator was a desire to offer programs that were of interest and beneficial to seniors. Senior centers are interested in participating in research that provides benefit to older adults but may need assistance from researchers to overcome participation barriers.


Asunto(s)
Proyectos de Investigación , Centros para Personas Mayores , Investigación en Medicina Traslacional , Anciano , Anciano de 80 o más Años , Arkansas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto
9.
J Womens Health (Larchmt) ; 22(9): 724-32, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23992103

RESUMEN

BACKGROUND: Black women are less likely to be evaluated and treated for anginal symptoms, despite a higher premature cardiac mortality rate compared to white women. Our objective was to compare angina symptoms in black versus white women regarding (1) angina symptoms characterization; (2) relationship with obstructive coronary artery disease (CAD); and (3) relationship with subsequent mortality. METHODS: A cohort of 466 women (69 black and 397 white) undergoing coronary angiography for suspected ischemia and without prior history of CAD completed symptom checklists. Four symptom clusters (CHEST, UPPER, STOMACH, and TYPICAL TRIGGERS) were derived by factor analysis. All angiograms were analyzed by core lab. Mortality data over 10 years were obtained from National Death Index. RESULTS: (1) Black women had lower mean CHEST cluster scores (0.60±0.30 vs. 0.73±30, p=0.002), but higher STOMACH scores (0.41±0.25 vs. 0.30±0.25, p=0.011) than white women. (2) Prevalence and severity of CAD did not differ in black and white women and was not predicted by symptom cluster scores. (3) All-cause mortality rates were 24.9% in blacks versus 14.5% in whites, p=0.007; and cardiovascular mortality 22.5% vs.8.8%, p=0.001. Symptom clusters were not predictive of adverse events in white women. However, black women with a low TYPICAL score had significantly higher mortality compared to those with a high TYPICAL score (43% vs. 10%, p=0.006). CONCLUSIONS: Among women undergoing coronary angiography, black women report fewer chest-related and more stomach-related symptoms, regardless of presence or severity of CAD, and these racial symptom presentation differences are linked with the more adverse prognosis observed in the black women. Atypical symptom presentation may be a barrier to appropriate and timely diagnosis and treatment and contribute to poorer outcomes for black women.


Asunto(s)
Angina de Pecho/etnología , Enfermedad de la Arteria Coronaria/etnología , Adulto , Grupo de Ascendencia Continental Africana/estadística & datos numéricos , Anciano , Angina de Pecho/diagnóstico , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Análisis Factorial , Femenino , Humanos , Estimación de Kaplan-Meier , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiología , National Heart, Lung, and Blood Institute (U.S.) , Prevalencia , Análisis de Regresión , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Estados Unidos/epidemiología
10.
Int J Cardiol ; 168(3): 2335-40, 2013 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-23410495

RESUMEN

BACKGROUND: Anxiety is common among patients presenting with suspected coronary artery disease (CAD). In a sample of women with signs and symptoms of ischemia, we examined three anxiety markers as predictors of CAD endpoints including: 1) cardiac symptom indicators; 2) angiographic CAD severity; and 3) healthcare utilization (cardiac hospitalizations and 5-year cardiovascular [CVD] healthcare costs). METHODS: Participants completed a baseline protocol including coronary angiogram, cardiac symptoms, psychosocial measures and a median 5.9-year follow-up to track hospitalizations. We calculated CVD costs based on cardiac hospitalizations, treatment visits, and CVD medications. Anxiety measures included anxiolytic medication use, Spielberger Trait Anxiety Inventory (STAI) scores, and anxiety disorder treatment history. RESULTS: The sample numbered 514 women with anxiety measure data and covariates (mean age=57.5 [11.1]). One in five (20.4%) women reported using anxiolytic agents. Anxiety correlated with cardiac symptom indicators (anxiolytic use with nighttime angina and nitroglycerine use; STAI scores and anxiety disorder treatment history with nighttime angina, shortness of breath, and angina frequency). Anxiety disorder treatment history (but not STAI scores or anxiolytics) predicted less severe CAD. Anxiolytic use (but not STAI scores or anxiety disorder treatment history) predicted hospitalizations for chest pain and coronary catheterization (HRs=2.0, 95% CIs=1.1-4.7). Anxiety measures predicted higher 5-year CVD costs (+9.0-42.7%) irrespective of CAD severity. CONCLUSIONS: Among women with signs and symptoms of myocardial ischemia, anxiety measures predict cardiac endpoints ranging from cardiac symptom severity to healthcare utilization. Based on these findings, anxiety may warrant greater consideration among women with suspected CAD.


Asunto(s)
Ansiedad/etiología , Angiografía Coronaria/métodos , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Isquemia Miocárdica/complicaciones , Aceptación de la Atención de Salud , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico por imagen , National Heart, Lung, and Blood Institute (U.S.) , Inventario de Personalidad , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Síndrome , Factores de Tiempo , Estados Unidos
11.
Gerontologist ; 53(1): 162-71, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22936536

RESUMEN

PURPOSE OF THE STUDY: Lay health educators (LHEs) offer great promise for facilitating the translation of evidence-based health promotion programs to underserved areas; yet, there is little guidance on how to train LHEs to implement these programs, particularly in the crucial area of empirically validated obesity interventions. DESIGN AND METHODS: This article describes experiences in recruiting, training, and retaining 20 LHEs who delivered a 12-month evidence-based behavioral lifestyle intervention (based on the Diabetes Prevention Program) in senior centers across a rural state. A mixed method approach was used which incorporated collecting the folllowing: quantitative data on sociodemographic characteristics of LHEs; process data related to training, recruitment, intervention implementation, and retention of LHEs; and a quantitative program evaluation questionnaire, which was supplemented by a qualitative program evaluation questionnaire. Descriptive statistics were calculated for quantitative data, and qualitative data were analyzed using content analysis. RESULTS: The training program was well received, and the LHEs effectively recruited participants and implemented the lifestyle intervention in senior centers following a structured protocol. IMPLICATIONS: The methods used in this study produced excellent long-term retention of LHEs and good adherence to intervention protocol, and as such may provide a model that could be effective for others seeking to implement LHE-delivered health promotion programs.


Asunto(s)
Técnicos Medios en Salud/educación , Educadores en Salud/educación , Promoción de la Salud/métodos , Obesidad/terapia , Pérdida de Peso , Programas de Reducción de Peso/métodos , Adulto , Medicina Basada en la Evidencia , Femenino , Educadores en Salud/psicología , Humanos , Estilo de Vida , Masculino , Área sin Atención Médica , Evaluación de Programas y Proyectos de Salud , Investigación Cualitativa , Servicios de Salud Rural , Población Rural , Encuestas y Cuestionarios
12.
J Aging Health ; 25(1): 97-118, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23248351

RESUMEN

OBJECTIVE: To determine whether a cognitive intervention delivered by lay health educators (LHEs) in senior centers was effective in improving cognition in obese older adults. METHODS: This cluster randomized trial was conducted in 16 senior centers from which 228 senior adults were recruited. The centers were randomized to either the cognitive intervention or a control, weight-loss intervention. The primary outcome variable, cognitive function, was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). RESULTS: Analyses of RBANS indices as continuous variables did not indicate significant differences between arms. However, after adjusting for baseline delayed memory, gender, and baseline body mass index, seniors in the cognitive intervention arm had a 2.7 times higher odds of a reliable improvement (clinically significant) in delayed memory from baseline as compared to those in the control intervention (95% CI, 1.3-5.6, p = .011). The intervention effect was not significant for the proportion showing reliable improvement in immediate memory or in attention. Attendance at the 12-session program was high with an average of 83% (67%-92%) sessions attended and 87% of participants in the cognitive arm indicating they would recommend the program. DISCUSSION: Cognitive interventions can be effectively delivered in the community by LHEs.


Asunto(s)
Cognición/fisiología , Terapia Cognitivo-Conductual/métodos , Servicios de Salud Comunitaria/organización & administración , Servicios de Salud para Ancianos/organización & administración , Obesidad/terapia , Servicios de Salud Rural/organización & administración , Programas de Reducción de Peso/métodos , Anciano , Arkansas , Análisis por Conglomerados , Práctica Clínica Basada en la Evidencia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Pruebas Neuropsicológicas , Evaluación de Programas y Proyectos de Salud
13.
Psychosom Med ; 74(3): 263-70, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22434916

RESUMEN

BACKGROUND: There is overlap among psychosocial predictors of cardiovascular disease (CVD). The usefulness of combining psychosocial variables as risk markers for CVD needs investigation. METHODS: Participants were 493 women in the NHLBI WISE study. Multivariate combination of Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Social Network Index (SNI), and Cook-Medley hostility subscales was evaluated, and principal components analysis also conducted. Relationships of composite psychosocial risk markers to CVD events and risk factors were assessed. RESULTS: The multivariate block of SNI, Cook-Medley Hostile Affect subscale, STAI, and BDI predicted CVD events (χ(2) = 27.8, df = 6, p < .001). Scalewise factor analysis revealed 2 factors: negative affectivity (NA) and hostility (explained variance, 45.6% and 17.1%, respectively). NA was associated with BMI (ß [SE] = 0.18 [0.09], p = .04), hostility with metabolic syndrome (exp(ß) = 0.60 [0.28], p = .04). Both factors were associated with blood pressure (BP): NA with SBP (ß = 2.53 [1.04], p = .02) and DBP (ß = 1.66 [0.60], p = .02); hostility with SBP (ß = 2.72 [1.13], p = .02) and DBP (ß = 1.83 [0.65], p = .005). Neither factor predicted CVD events. Original scales predicted CVD events: lower SNI (HR = 0.74, CI = 0.57-0.96), lower Hostile Affect (HR = 0.80, CI = 0.56-1.03), and higher BDI (HR = 1.33, CI = 1.08-1.74). CONCLUSIONS: In women with suspected ischemia, multivariate combination of psychosocial risk markers predicts CVD events; derived psychosocial factors were associated with CVD risk factors but not events. Measuring common variance among psychosocial variables may be a useful research strategy.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/psicología , Apoyo Social , Salud de la Mujer/estadística & datos numéricos , Ira , Presión Sanguínea/fisiología , Índice de Masa Corporal , Angiografía Coronaria , Interpretación Estadística de Datos , Métodos Epidemiológicos , Femenino , Hostilidad , Humanos , Síndrome Metabólico/epidemiología , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico por imagen , Isquemia Miocárdica/epidemiología , National Heart, Lung, and Blood Institute (U.S.) , Determinación de la Personalidad/estadística & datos numéricos , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Estrés Psicológico/epidemiología , Estados Unidos/epidemiología
14.
J Womens Health (Larchmt) ; 21(2): 133-9, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-21988550

RESUMEN

BACKGROUND: Modifiable risk factors for cardiovascular disease (CVD) account for much of the variability in CVD outcomes and are also related to psychosocial variables. There is evidence that depression can undermine the treatment and advance the progression of CVD risk factors, suggesting that CVD risk factor relationships with CVD events may differ among those with depression. METHODS: This study tracked CVD events and mortality over a median of 5.9 years among a prospective cohort of 620 women (mean age 59.6 years [11.6]) completing a diagnostic protocol including coronary angiography and CVD risk factor assessment. Depressive symptoms were assessed using the Beck Depression Inventory (BDI). The study outcome was combined cardiovascular mortality and events. RESULTS: Over the follow-up interval, 16.1% of the sample experienced one or more of the cardiovascular outcomes. In separate Cox regression models adjusting for age, education history, ethnicity, and coronary angiogram scores, we observed statistically significant CVD risk factor × BDI score interactions for diabetes, smoking, and waist-hip ratio factors. Simple effect analyses indicated that diabetes and smoking status were more strongly associated with cardiovascular outcomes among participants with lower BDI scores, whereas waist-hip ratio values predicted outcomes only among those with higher BDI scores. CONCLUSIONS: These results suggest that the relationship between modifiable CVD risk factors and CVD outcomes may vary with depression status in clinical samples of women. This evidence augments prior research by demonstrating that depression may influence CVD risk jointly with or independent of CVD risk factors. It also provides further support for the inclusion of depression assessment in cardiovascular clinic settings.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/psicología , Trastorno Depresivo/epidemiología , Trastorno Depresivo/etiología , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/mortalidad , Comorbilidad , Trastorno Depresivo/diagnóstico , Femenino , Humanos , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Fumar/epidemiología , Fumar/psicología , Estados Unidos/epidemiología
15.
Prev Chronic Dis ; 8(6): A146, 2011 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-22005639

RESUMEN

BACKGROUND: African Americans and rural residents are disproportionately affected by obesity. Innovative approaches to address obesity that are sensitive to the issues of rural African Americans are needed. Faith-based and community-based participatory approaches show promise for engaging racial/ethnic minorities to change health outcomes, but few faith-based weight loss interventions have used a community-based participatory approach. COMMUNITY CONTEXT: A faith-based weight loss intervention in the Lower Mississippi Delta arose from a 5-year partnership between academic and community partners representing more than 30 churches and community organizations. METHODS: Community and academic partners translated the 16 core sessions of the Diabetes Prevention Program for rural, church-going African American adults. The feasibility of the lay health advisor-led delivery of the 16-week (January-May 2010), 16-session, adapted intervention was assessed in 26 participants from 3 churches by measuring recruitment, program retention, implementation ease, participant outcomes, and program satisfaction. OUTCOME: Twenty-two of 26 participants (85%) provided 16-week follow-up data. Lay health advisors reported that all program components were easy to implement except the self-monitoring component. Participants lost an average of 2.34 kg from baseline to 16-week follow-up, for a mean weight change of -2.7%. Participants reported enjoying the spiritual and group-based aspects of the program and having difficulties with keeping track of foods consumed. The intervention engaged community partners in research, strengthened community-academic partnerships, and built community capacity. INTERPRETATION: This study demonstrates the feasibility of delivering this adapted intervention by lay leaders through rural churches.


Asunto(s)
Terapia Conductista/métodos , Medicina Basada en la Evidencia/métodos , Educación en Salud , Estilo de Vida , Curación Mental , Obesidad/rehabilitación , Población Rural , Adulto , Afroamericanos , Estudios de Factibilidad , Estudios de Seguimiento , Humanos , Morbilidad/tendencias , Obesidad/etnología , Resultado del Tratamiento , Estados Unidos , Pérdida de Peso
16.
Am J Prev Med ; 41(4): 385-91, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-21961465

RESUMEN

BACKGROUND: Older adults have high obesity rates and respond well to evidence-based weight-loss programs, such as the Diabetes Prevention Program (DPP) Lifestyle intervention. The goal of this study was to determine whether a translation of the DPP Lifestyle program delivered by lay health educators and conducted in senior centers is effective in promoting weight loss among older adults. DESIGN: An RCT with older adults nested within senior centers. Senior centers identified lay health educators to receive training and deliver the intervention program at the senior center. Senior centers were randomized to DPP Lifestyle program or an attention control intervention (cognitive training). SETTING/PARTICIPANTS: Senior centers (N=15) located throughout Arkansas. Participants (N=228) were obese (BMI=34.5±4.9) older (aged 71.2±6.6 years) adults able to engage in moderate exercise. Follow-up data were collected at 4 months on 93% of the original cohort between February 2009 and July 2010. INTERVENTIONS: A 12-session translation of the Diabetes Prevention Program Lifestyle behavioral weight-control program delivered in group sessions by trained lay health educators. MAIN OUTCOME MEASURES: Body weight was assessed by digital scale. Percentage weight loss from baseline and proportion achieving ≥5% and ≥7% weight loss were examined. Analyses were completed in March 2011. RESULTS: Participants attending senior centers randomized to Lifestyle lost a significantly greater percentage of baseline weight (3.8%, 95% CI=2.9%, 4.6%) than those in the control senior centers (0.2%, 95% CI= -0.6%, -0.9%) after adjusting for baseline BMI and gender (p<0.001). Among participants attending senior centers offering the Lifestyle program, 38% lost ≥5% of baseline weight compared with 5% in the control arm (p<0.001). Similarly, significantly more participants (24%) in Lifestyle senior centers lost ≥7% than did control participants (3%, p=0.001). CONCLUSIONS: A behavioral lifestyle weight-loss intervention delivered by a lay health educator offers a promising vehicle for translation of evidence-based obesity treatment programs in underserved areas. TRIAL REGISTRATION: This study is registered at Clinicaltrials.govNCT01377506.


Asunto(s)
Promoción de la Salud/organización & administración , Estilo de Vida , Obesidad/terapia , Pérdida de Peso , Programas de Reducción de Peso/métodos , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Difusión de Innovaciones , Medicina Basada en la Evidencia , Femenino , Educadores en Salud , Humanos , Masculino
17.
Psychosom Med ; 72(6): 549-55, 2010 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-20410246

RESUMEN

OBJECTIVE: To determine the association between self-rated health and major cardiovascular events in a sample of women with suspected myocardial ischemia. Previous studies showed that self-rated health is a predictor of objective health outcomes, such as mortality. METHOD: At baseline, 900 women rated their health on a 5-point scale ranging from poor to excellent as part of a protocol that included quantitative coronary angiography, cardiovascular disease (CVD) risk factor assessment, cardiac symptoms, psychotropic medication use, and functional impairment. Participants were followed for a maximum of 9 years (median, 5.9 years) to determine the prevalence of major CVD events (myocardial infarction, heart failure, stroke, and CVD-related death). RESULTS: A total of 354 (39.3% of sample) participants reported their health as either poor or fair. After adjusting for demographic factors, CVD risk factors, and coronary artery disease severity, women who rated their health as poor (hazard ratio, 2.1 [1.1-4.2]) or fair (hazard ratio, 2.0 [1.2-3.6]) experienced significantly shorter times to major CVD events compared with women who rated their health as excellent or very good. Further adjustment for functional impairment, however, attenuated the self-rated health relationships with major CVD events. CONCLUSIONS: Among women with suspected myocardial ischemia, self-rated health predicted major CVD events independent of demographic factors, CVD risk factors, and angiogram-defined disease severity. However, functional impairment seemed to explain much of the self-rated health association. These results support the clinical utility of self-rated health scores in women and encourage a multidimensional approach to conceptualizing these measures.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/mortalidad , Indicadores de Salud , Estado de Salud , Encuestas y Cuestionarios , Enfermedades Cardiovasculares/diagnóstico , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/mortalidad , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/mortalidad , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/epidemiología , Infarto del Miocardio/mortalidad , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiología , Isquemia Miocárdica/mortalidad , National Heart, Lung, and Blood Institute (U.S.) , Probabilidad , Modelos de Riesgos Proporcionales , Factores de Riesgo , Clase Social , Factores Socioeconómicos , Resultado del Tratamiento , Estados Unidos , Salud de la Mujer
18.
Prev Chronic Dis ; 6(4): A123, 2009 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-19754999

RESUMEN

INTRODUCTION: Maintaining a healthy and productive workforce is essential for employers in public and private sectors. Poor nutrition and obesity contribute to chronic diseases and influence health care costs and productivity. Research indicates that eating a healthy diet is associated with lower body mass index and reduced risk for developing chronic disease. METHODS: The Arkansas Department of Health implemented the Healthy Employee Lifestyle Program to encourage wellness among state health employees. During the pilot year, participants completed a health risk assessment at baseline and again after 1 year that assessed diet and physical activity, other health risk factors, and readiness to make behavioral changes. Participants were encouraged to eat healthfully, participate in regular exercise, report health behaviors using a Web-based reporting system, accumulate points for healthy behaviors, and redeem points for incentives. Differences in participants' (n = 214) reported dietary behaviors between baseline and follow-up were assessed using chi2 analyses and tests of symmetry. RESULTS: Consumption of sweets/desserts, fats, protein, grains, processed meats, and dairy did not differ significantly from baseline to follow-up. However, at follow-up more participants reported eating 3 or more fruits and vegetables per day than at baseline and being in the action and maintenance stages of readiness to change for eating 5 or more fruits and vegetables per day and for eating a diet low in fat. CONCLUSION: Further study is needed to examine physical activity and other health risk factors to determine whether the program merits a broader dissemination.


Asunto(s)
Dieta/normas , Promoción de la Salud/organización & administración , Arkansas , Conducta Alimentaria , Frutas , Conductas Relacionadas con la Salud , Humanos , Proyectos Piloto , Verduras
19.
Arch Gen Psychiatry ; 66(5): 499-507, 2009 May.
Artículo en Inglés | MEDLINE | ID: mdl-19414709

RESUMEN

CONTEXT: Symptoms of depression and cardiovascular disease (CVD) overlap substantially. Differentiating between dimensions of depressive symptoms may improve our understanding of the relationship between depression and physical health. OBJECTIVE: To compare symptom dimensions of depression as predictors of cardiovascular-related death and events among women with suspected myocardial ischemia. DESIGN: Cohort study of women with suspected myocardial ischemia who underwent evaluation at baseline for a history of cardiovascular-related problems, depressive symptoms using the Beck Depression Inventory, and coronary artery disease severity via coronary angiography. Principal components analyses (PCAs) of the Beck Depression Inventory items were conducted to examine differential cardiovascular prognosis according to symptom dimensions of depression. SETTING: The Women's Ischemia Syndrome Evaluation (WISE), a multicenter study sponsored by the National Heart, Lung, and Blood Institute to assess cardiovascular function using state-of-the-art techniques in women referred for coronary angiography to evaluate chest pain or suspected myocardial ischemia. PARTICIPANTS: Five hundred fifty women (mean [SD] age, 58.4 [11.2] years) enrolled in the WISE study and followed up for a median of 5.8 years. MAIN OUTCOME MEASURES: Cardiovascular-related mortality and events (stroke, myocardial infarction, and congestive heart failure). RESULTS: When a 3-factor structure from PCA was used, somatic/affective (hazards ratio, 1.35; 95% confidence interval, 1.04-1.74) and appetitive (1.42; 1.21-1.68) but not cognitive/affective (0.89; 0.70-1.14) symptoms predicted cardiovascular prognosis in adjusted multivariate Cox regression analysis. When a 2-factor structure from PCA was used, adjusted results indicated that somatic (hazards ratio, 1.63; 95% confidence interval, 1.28-2.08) but not cognitive/affective (0.87; 0.68-1.11) symptoms predicted worse prognosis. CONCLUSIONS: In a sample of women with suspected myocardial ischemia, somatic but not cognitive/affective depressive symptoms were associated with an increased risk of cardiovascular-related mortality and events. These results support the need to research dimensions of depression in CVD populations and have implications for understanding the connection between depression and CVD.


Asunto(s)
Depresión/diagnóstico , Isquemia Miocárdica/psicología , National Heart, Lung, and Blood Institute (U.S.) , Salud de la Mujer , Adulto , Anciano , Enfermedades Cardiovasculares/mortalidad , Causas de Muerte , Estudios de Cohortes , Depresión/mortalidad , Depresión/psicología , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Isquemia Miocárdica/mortalidad , Inventario de Personalidad/estadística & datos numéricos , Análisis de Componente Principal , Pronóstico , Psicometría/estadística & datos numéricos , Factores de Riesgo , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/mortalidad , Trastornos Somatomorfos/psicología , Tasa de Supervivencia , Síndrome , Estados Unidos
20.
J Womens Health (Larchmt) ; 18(4): 443-50, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19361310

RESUMEN

BACKGROUND: Although extensive research has been conducted on both smoking and low exercise capacity alone, few studies have examined the joint impact or interaction of these two risk factors. We examined the joint and interactive effects of smoking and self-reported exercise capacity on subsequent clinical events (heart failure, myocardial infarction [MI], stroke, and cardiovascular-related mortality) among women with suspected myocardial ischemia. METHODS: At baseline (1996-1999), 789 women completed angiographic testing of coronary artery disease (CAD) severity and provided self-report information about their smoking history and exercise capacity as well as demographic and other risk factor data. Incidence of clinical events among the women was tracked for a median of 5.9 years; this analysis was conducted in 2008. RESULTS: In an adjusted survival analysis, women with a positive smoking history and self-reported low exercise capacity had the greatest risk of experiencing a clinical event (HR = 7.7, 95% CI 2.3, 25.5), followed by women with a positive smoking history and self-reported high exercise capacity (HR = 6.9, 95% CI 2.0, 24.6) and those with a negative smoking history and self-reported low exercise capacity (HR = 4.9, 95% CI 1.5, 15.8), relative to women with a negative smoking history and self-reported high exercise capacity. Additional analyses revealed a significant interaction between smoking history and exercise capacity, such that (1) women with a positive smoking history did not experience an additional significantly greater risk due to low exercise capacity, unlike those with a negative smoking history, and (2) all women experienced a significantly greater risk due to a positive smoking history regardless of their exercise capacity. CONCLUSIONS: Among women with suspected myocardial ischemia, the combined protective health effects of self-reported high exercise capacity and a negative smoking history remained significant after controlling for preexisting CAD severity and other established risk factors. These findings highlight the importance of studying behavioral risk factors in combination.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Ejercicio , Isquemia Miocárdica , Aptitud Física , Fumar , Anciano , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Persona de Mediana Edad , Factores de Riesgo , Índice de Severidad de la Enfermedad , Análisis de Supervivencia
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