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1.
Prev Chronic Dis ; 15: E10, 2018 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-29346062

RESUMO

BACKGROUND: Prolonged television viewing time, a marker of sedentary activity, is independently associated with increased all-cause mortality; however, this association has rarely been studied in African Americans. The objective of our study was to examine the association between television viewing time and mortality among African Americans by using data from the Jackson Heart Study (JHS). METHODS: We studied 5,289 participants from the JHS study who reported television viewing time (h/day) in the JHS baseline questionnaire from 2000 through 2004. Using multivariable Cox regression models adjusted for age, sex, smoking, alcohol use, physical activity, nutrition, prevalent coronary heart disease, chronic kidney disease, diabetes, and hypertension, we computed hazard ratios to examine the association between television viewing time (≤2 h/day, 2-4 h/day, and ≥4 h/day) and mortality. RESULTS: Participants had a mean age of 55 years, and 64% were women. After a median follow-up of 9.9 years (interquartile range, 9.0-10.7), 615 deaths occurred (data analysis conducted in 2017). Hazard ratios for mortality were 1.08 (0.86-1.37) for television time of 2 to 4 hours per day and 1.48 (95% CI: 1.19-1.83) for television time of greater than or equal to 4 hours per day when compared with those who watched television less than 2 hours per day (P trend = .002). When we restricted analyses to those who performed leisure-time activities, the hazard ratios for mortality were 1.10 (95% CI, 0.84-1.45) for television viewing of 2 to 4 hours per day and 1.45 (95% CI, 1.13-1.86) for more than 4 hours per day compared with the less than 2 hours per day. CONCLUSION: Our findings suggest that greater television viewing time, even among those who perform leisure-time physical activities, is associated with increased all-cause mortality among African Americans. Thus, it may serve as an indicator of a sedentary lifestyle with potential for intervention.


Assuntos
Afro-Americanos/estatística & dados numéricos , Exercício , Tempo de Tela , Comportamento Sedentário , Televisão/estatística & dados numéricos , Adulto , Idoso , Causas de Morte , Feminino , Nível de Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Mississippi , Vigilância da População , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Autorrelato
2.
J Holist Nurs ; 36(2): 147-158, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29172896

RESUMO

PURPOSE: Explore the feasibility of a Tai Chi intervention to improve musculoskeletal pain, emotion, cognition, and physical function in individuals with posttraumatic stress disorder. DESIGN: Two-phase, one-arm quasi-experimental design. METHOD: Phase 1: 11 participants completed one Tai Chi session, feasibility questionnaire, and were offered participation in Phase 2, a 12-week Tai Chi intervention. Ten participants participated in Phase 2. Pain intensity, interference, physical function scales, an emotional battery, and cognition tests were used for pre- and postintervention outcome measures. Paired t tests and thematic analysis were used for analysis. FINDINGS: In Phase 1, most felt Tai Chi would benefit health (90.9%) and expressed interest in continuing Tai Chi (6.73 out of 7). Phase 2 results showed improvement in fear-affect (raw t = -2.64, p = .03; age adjusted t = -2.90, p = .02), fear-somatic arousal (raw t = -2.53, p = .035), List Sorting Working Memory (raw t = 2.62, p = .031; age adjusted t = 2.96, p = .018), 6-Minute Walk Test ( t = 3.541, p = .008), and current level of Pain Intensity ( t = -4.00, p = .004). CONCLUSIONS: Tai Chi is an acceptable, holistic treatment to individuals with musculoskeletal pain and posttraumatic stress disorder. It may reduce pain, improve emotion, memory, and physical function.


Assuntos
Dor Crônica/terapia , Transtornos de Estresse Pós-Traumáticos/terapia , Tai Ji/normas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/terapia , Manejo da Dor/métodos , Manejo da Dor/normas , Projetos Piloto , Qualidade de Vida/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários , Tai Ji/métodos
3.
Psychol Serv ; 14(2): 214-220, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28481607

RESUMO

Communicating health care preferences in advance, so that wishes can be honored if the person becomes unable to participate in decision-making, is especially important for vulnerable populations such as homeless veterans. Hospitals are required to inform patients of their rights to document their preferences, but completion rates for advance directives are low. Conceptualizing advance health care planning as a series of health behavior steps emphasizing communication is recommended for improving engagement in advance health care planning. The authors used program evaluation data from psychoeducational groups with 288 homeless veterans to learn about their previous experience with different steps of advance health care planning and their personal goals for future steps. Results revealed a significant discrepancy between what these veterans reported they have done and information available to health care providers in the medical record: Only 26% had an advance directive in the medical record, but 70% reported they had thought about the care they would want, and almost half reported they had talked with a trusted other or named someone to make decisions for them. The most frequent goal endorsed by veterans attending groups was discussing advance health care planning with family or trusted others and/or naming someone to be a decision maker. These findings indicate a need for improved communication and documentation of veteran preferences about emergency and end of life care. Results are also consistent with interventions tailored to varying readiness for different steps of advance health care planning. (PsycINFO Database Record


Assuntos
Planejamento Antecipado de Cuidados , Diretivas Antecipadas , Pessoas em Situação de Rua , Relações Médico-Paciente , Veteranos , Adulto , Idoso , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
4.
Prev Med ; 100: 95-100, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28414066

RESUMO

The purpose of this study was to compare the relationship of diet quality, physical activity, and environmental factors with body mass index (BMI) maintenance in African American adults. We analyzed data from 4041 participants in the Jackson Heart Study, a prospective cohort study based in Jackson, Mississippi. Exposures were baseline American Heart Association diet quality score, American Heart Association physical activity categories, the built environment, the food environment, and neighborhood safety. The outcome was weight maintenance or loss (no BMI increase ≥1.0kg/m2) versus weight gain (BMI increased ≥1.0kg/m2) over a mean of 5.0years. We found that 63% of participants maintained or lost weight and 37% gained weight. In multivariable analyses, ideal diet quality was associated with a 6% greater likelihood of BMI maintenance (incidence rate ratio [IRR] 1.06, 95% confidence interval [CI]: 1.03, 1.10). Living in an unsafe neighborhood was associated with a 2% lower likelihood of BMI maintenance (IRR 0.98, 95% CI: 0.96, 0.99), as was poor built environment (IRR 0.98, 95% CI: 0.97, 0.998). Physical activity and poor food environment were not associated with BMI maintenance. In conclusion, among African American adults in Jackson, Mississippi, high quality diet was the strongest factor associated with BMI maintenance.


Assuntos
Índice de Massa Corporal , Peso Corporal , Dieta/estatística & dados numéricos , Afro-Americanos/estatística & dados numéricos , Planejamento Ambiental/estatística & dados numéricos , Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mississippi , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários
5.
J Aging Res ; 2017: 4653635, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28261500

RESUMO

Background/Objectives. Balance problems are well-established modifiable risk factors for falls, which are common in older adults. The objective of this study was to establish the efficacy of a Wii-Fit interactive video-game-led physical exercise program to improve balance in older Veterans. Methods. A prospective randomized controlled parallel-group trial was conducted at Veterans Affairs Medical Center. Thirty community dwelling Veterans aged 68 (±6.7) years were randomized to either the exercise or control groups. The exercise group performed Wii-Fit program while the control group performed a computer-based cognitive program for 45 minutes, three days per week for 8-weeks. The primary (Berg Balance Scale (BBS)) and secondary outcomes (fear of falling, physical activity enjoyment, and quality of life) were measured at baseline, 4 weeks, and 8 weeks. Results. Of 30 randomized subjects, 27 completed all aspects of the study protocol. There were no study-related adverse events. Intent-to-treat analysis showed a significantly greater improvement in BBS in the exercise group (6.0; 95% CI, 5.1-6.9) compared to the control group (0.5; 95% CI, -0.3-1.3) at 8 weeks (average intergroup difference (95% CI), 5.5 (4.3-6.7), p < 0.001) after adjusting for baseline. Conclusion. This study establishes that the Wii-Fit exercise program is efficacious in improving balance in community dwelling older Veterans. This trial is registered with ClinicalTrials.gov Identifier NCT02190045.

6.
Hypertension ; 69(3): 421-427, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28137988

RESUMO

There is limited empirical evidence to support the protective effects of physical activity in the prevention of hypertension among African Americans. The purpose of this study was to examine the association of physical activity with incident hypertension among African Americans. We studied 1311 participants without hypertension at baseline enrolled in the Jackson Heart Study, a community-based study of African Americans residing in Jackson, Mississippi. Overall physical activity, moderate-vigorous physical activity, and domain-specific physical activity (work, active living, household, and sport/exercise) were assessed by self-report during the baseline examination (2000-2004). Incident hypertension, assessed at examination 2 (2005-2008) and examination 3 (2009-2013), was defined as the first visit with systolic/diastolic blood pressure ≥140/90 mm Hg or self-reported antihypertensive medication use. Over a median follow-up of 8.0 years, there were 650 (49.6%) incident hypertension cases. The multivariable-adjusted hazard ratios (95% confidence interval) for incident hypertension comparing participants with intermediate and ideal versus poor levels of moderate-vigorous physical activity were 0.84 (0.67-1.05) and 0.76 (0.58-0.99), respectively (P trend=0.038). A graded, dose-response association was also present for sport/exercise-related physical activity (Quartiles 2, 3, and 4 versus Quartile 1: 0.92 [0.68-1.25], 0.87 [0.67-1.13], 0.75 [0.58-0.97], respectively; P trend=0.032). There were no statistically significant associations observed for overall physical activity, or work, active living, and household-related physical activities. In conclusion, the results of the current study suggest that regular moderate-vigorous physical activity or sport/exercise-related physical activity may reduce the risk of developing hypertension in African Americans.


Assuntos
Afro-Americanos , Pressão Sanguínea/fisiologia , Exercício/fisiologia , Hipertensão/fisiopatologia , Vigilância da População , Medição de Risco/métodos , Feminino , Humanos , Hipertensão/etnologia , Incidência , Masculino , Pessoa de Meia-Idade , Mississippi/epidemiologia , Estudos Retrospectivos , Fatores de Risco
7.
J Pain Symptom Manage ; 53(1): 1-4, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27876636

RESUMO

CONTEXT: The Measuring What Matters initiative of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association identified documentation of a surrogate decision maker as one of the top 10 quality indicators in the acute hospital and hospice settings. OBJECTIVES: To better understand the potential implementation of this Measuring What Matters quality measure #8, Documentation of Surrogate in outpatient primary care settings by describing primary care patients' self-reported identification and documentation of a surrogate decision maker. METHODS: Examination of patient responses to self-assessment questions from advance health care planning educational groups conducted in one medical center primary care clinic and seven community-based outpatient primary care clinics. We assessed the concordance between patient reports of identifying and naming a surrogate decision maker and having completed an advance directive (AD) with presence of an AD in the electronic medical record. RESULTS: Of veterans without a documented AD on file, more than half (66%) reported that they had talked with someone they trusted and nearly half (52%) reported that they had named someone to communicate their preferences. CONCLUSIONS: Our clinical project data suggest that many more veterans may have initiated communications with surrogate decision makers than is evident in the electronic medical record. System changes are needed to close the gap between veterans' plans for a surrogate decision maker and the documentation available to acute care health care providers.


Assuntos
Planejamento Antecipado de Cuidados , Tomada de Decisões , Registros Eletrônicos de Saúde , Veteranos , Diretivas Antecipadas , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Indicadores de Qualidade em Assistência à Saúde , Autorrelato
8.
Prev Med ; 90: 216-22, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27473665

RESUMO

Physical inactivity is an independent risk factor for many diseases. Most research has focused on individual-level factors for physical activity (PA), but evidence suggests that neighborhood is also important. We examined baseline data collected between 2000 and 2004 from 5236 participants in the Jackson Heart Study to determine the effects of neighborhood on 2 types of PA: Active Living (AL), and Sports and Exercise (Sport) in an all-African American cohort. Participants were georeferenced and data from individual baseline questionnaires and US Census were analyzed using descriptive, bivariate, and multilevel models. In both types of PA, neighborhood factors had an independent and additive effect on AL and Sport. Living in an urban (p=0.003) or neighborhood with a higher percentage of residents with less than a high school education (p<0.001) was inversely associated with AL. There was an inverse interaction effect between individual and lower neighborhood education (p=0.01), as well as between age and urban neighborhoods (p=0.02) on AL. Individual level education (OR=1.30) and per capita income (OR=1.07) increased the odds of moderate-to-high sports. Future studies should focus on what contextual aspects of urban or less educated neighborhoods are influential in determining PA, as well as longitudinal multilevel analyses of neighborhood effects on PA.


Assuntos
Afro-Americanos/estatística & dados numéricos , Exercício , Características de Residência/estatística & dados numéricos , Esportes , Estudos Transversais , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Mississippi , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários
10.
Int J Behav Nutr Phys Act ; 13: 31, 2016 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-26928285

RESUMO

BACKGROUND: Previous studies have reported conflicting results as to whether an association exists between sedentary time and cardiovascular disease (CVD) risk among African Americans. These studies, however, were limited by lack of consideration of sedentary behavior in leisure versus non-leisure settings. To elucidate this relation, we investigated the associations of television (TV) viewing time and occupational sitting with carotid intima-media thickness (CIMT), a subclinical atherosclerosis measure, in a community-based sample of African Americans. METHODS: We studied 3410 participants from the Jackson Heart Study, a single-site, community-based study of African Americans residing in Jackson, MS. CIMT was assessed by ultrasonography and represented mean far-wall thickness across right and left sides of the common carotid artery. TV viewing time, a measure of leisure sedentary behavior, and occupational sitting, a measure of non-leisure sedentary behavior, were assessed by questionnaire. RESULTS: In a multivariable regression model that included physical activity and CVD risk factors, longer TV viewing time (2-4 h/day and >4 h/day) was associated with greater CIMT (adjusted mean ± SE difference from referent [<2 h/day] of 0.009 ± 0.008 mm for 2-4 h/day, and 0.028 ± 0.009 mm for >4 h/day; P-trend =0.001). In contrast, more frequent occupational sitting ('sometimes' and 'often/always') was associated with lower CIMT (adjusted mean ± SE difference from referent ['never/seldom']:-0.021 ± 0.009 mm for 'sometimes', and-0.018 ± 0.008 mm for 'often/always'; P-trend = 0.042). CONCLUSIONS: Longer TV viewing time was associated with greater CIMT, while occupational sitting was associated with lower CIMT. These findings suggest the role of sedentary behaviors in the pathogenesis of CVD among African Americans may vary by whether individuals engage in leisure versus non-leisure sedentary behaviors.


Assuntos
Afro-Americanos/estatística & dados numéricos , Aterosclerose/epidemiologia , Comportamento Sedentário/etnologia , Espessura Intima-Media Carotídea , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mississippi/epidemiologia
11.
Fed Pract ; 33(8): 44-47, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30766199

RESUMO

The overall quality of life of older veterans living in a rural area improved by participating in a patient-centric, home-based walking program.

12.
Clin Nutr ; 35(3): 679-84, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-25971658

RESUMO

BACKGROUND & AIMS: Type 2 diabetes (DM) disproportionally affects African Americans. Data on the association between egg consumption and risk of DM are sparse. We sought to examine whether egg consumption is associated with the prevalence and incidence of DM among African Americans. METHODS: We analyzed baseline data from 4568 participants of the Jackson Heart Study. Egg consumption was obtained using a food frequency questionnaire designed for this population. We used generalized estimating equations to calculate adjusted prevalence ratios of DM and Cox regression to estimate hazard ratios of DM with corresponding 95% confidence intervals (CI). RESULTS: The average age was 55 ± 13 years and 64% of subjects were women. The median frequency of egg consumption was 2/week for men and 1/week for women. The prevalence of DM was 22% overall (21% of men and 23% of women). Multivariable adjusted prevalence ratio [PR (95% CI)] for DM were: 1.00 (ref), 1.14 (0.90-1.44), 1.33 (1.04-1.70), 1.33 (1.06-1.68), 1.26 (0.99-1.61), and 1.52 (1.17-1.97) for egg consumption of <1/month, 1-3/month, 1/week, 2/week, 3-4/week, and 5+/week, respectively, p for linear trend 0.0024. Corresponding multivariable adjusted hazard ratios were 1.00 (ref), 0.88 (0.65-1.19), 0.94 (0.68-1.30), 0.91 (0.66-1.25), 1.11 (0.81-1.52), and 1.17 (0.81-1.70), respectively, during a mean follow up of 7.3 years (p for linear trend 0.22). CONCLUSIONS: While egg consumption was positively associated with prevalent DM, prospective analysis did not show an association of egg intake with incidence of DM among African Americans.


Assuntos
Diabetes Mellitus Tipo 2/etiologia , Ovos/efeitos adversos , Adulto , Afro-Americanos , Idoso , Estudos de Coortes , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/prevenção & controle , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mississippi/epidemiologia , Cooperação do Paciente/etnologia , Prevalência , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Autorrelato , Fatores Sexuais
13.
J Epidemiol Community Health ; 70(2): 187-94, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26417003

RESUMO

BACKGROUND: Using Jackson Heart Study data, we examined associations of multiple measures of perceived discrimination with health behaviours among African-Americans (AA). METHODS: The cross-sectional associations of everyday, lifetime and burden of discrimination with odds of smoking and mean differences in physical activity, dietary fat and sleep were examined among 4925 participants aged 35-84 years after adjustment for age and socioeconomic status (SES). RESULTS: Men reported slightly higher levels of everyday and lifetime discrimination than women and similar levels of burden of discrimination as women. After adjustment for age and SES, everyday discrimination was associated with more smoking and a greater percentage of dietary fat in men and women (OR for smoking: 1.13, 95% CI 1.00 to 1.28 and 1.19, 95% CI 1.05 to 1.34; mean difference in dietary fat: 0.37, p<0.05 and 0.43, p<0.01, in men and women, respectively). Everyday and lifetime discrimination were associated with fewer hours of sleep in men and women (mean difference for everyday discrimination: -0.08, p<0.05 and -0.18, p<0.001, respectively; and mean difference for lifetime discrimination: -0.08, p<0.05 and -0.24, p<0.001, respectively). Burden of discrimination was associated with more smoking and fewer hours of sleep in women only. CONCLUSIONS: Higher levels of perceived discrimination were associated with select health behaviours among men and women. Health behaviours offer a potential mechanism through which perceived discrimination affects health in AA.


Assuntos
Afro-Americanos/psicologia , Comportamentos Relacionados com a Saúde , Discriminação Social , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mississippi , Estresse Psicológico , Inquéritos e Questionários
14.
Curr Obes Rep ; 4(3): 363-70, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26627494

RESUMO

This review considers a variety of perspectives on overweight and obesity (OW/obesity), including measurement and classification; prevalence and changes in prevalence in recent years; genetic, biological, medical, individual, and social correlates of OW/obesity; and treatment approaches. Despite increased attention, OW/obesity is escalating in prevalence worldwide, and the causes are exceedingly complex. A range of innovative studies, including basic research on gut microflora, dietary composition, pharmacologic interventions, and surgical procedures, is generating findings with potential for future prevention and treatment of OW/obesity. Social system changes such as school programs and the awareness of the roles of personal, family, health provider, and cultural experiences related to OW/obesity have also gained traction for vital prevention and treatment efforts over the past decade.


Assuntos
Índice de Massa Corporal , Dieta , Estilo de Vida , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Saúde Pública , Humanos , Obesidade/etiologia , Sobrepeso/etiologia , Prevalência , Fatores de Risco , Fatores Socioeconômicos
15.
Mil Med ; 180(10): 1027-33, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26444464

RESUMO

The Veterans Health Administration's MOVE! Program is the largest health care-delivered weight loss intervention in the United States. As a referring clinician's perceptions and knowledge of health programs may impact implementation, examining perceptions of MOVE! may inform improvements to this and other programs. This study investigated primary care clinician perceptions of MOVE! (n = 754, 50% nurses). Perceived effectiveness ratings were highest for groups with 11 to 25 group members (p < 0.01) and for a combined lecture and support group format (p = 0.026), though session length and several other aspects of delivery were not associated with perceptions of effectiveness. MOVE! staff also rated the program as more effective than did other clinicians (p < 0.01). Many respondents lacked knowledge about program specifics, especially those not involved with MOVE! delivery (vs. those directly involved; p < 0.01). These findings indicate that variety in group size and format is related to perceptions of MOVE! effectiveness. Also, clinicians not involved with MOVE! may lack knowledge about the program and underestimate its effectiveness, which could negatively affect referral likelihood or enthusiasm expressed to referred patients. Findings highlight opportunities for clarifying perceptions of a weight control program among clinicians in a large health care system.


Assuntos
Promoção da Saúde , Obesidade/reabilitação , Médicos/psicologia , Inquéritos e Questionários , United States Department of Veterans Affairs/estatística & dados numéricos , Saúde dos Veteranos , Perda de Peso/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Médicos/normas , Estados Unidos , Veteranos
16.
Psychiatr Serv ; 66(3): 265-71, 2015 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-25727114

RESUMO

OBJECTIVE: The aim of this study was to test whether gender moderates intervention effects in the Coordinated Anxiety Learning and Management (CALM) intervention, a 12-month, randomized controlled trial of a collaborative care intervention for anxiety disorders (panic disorder, generalized anxiety disorder, posttraumatic stress disorder, and social anxiety disorder) in 17 primary care clinics in California, Washington, and Arkansas. METHODS: Participants (N=1,004) completed measures of symptoms (Brief Symptom Inventory [BSI]) and functioning (mental and physical health components of the 12-Item Short Form [MCS and PCS] and Healthy Days, Restricted Activity Days Scale) at baseline, six, 12, and 18 months. Data on dose, engagement, and beliefs about psychotherapy were collected for patients in the collaborative care group. RESULTS: Gender moderated the relationship between treatment and its outcome on the BSI, MCS, and Healthy Days measures but not on the PCS. Women who received collaborative care showed clinical improvements on the BSI, MHC, and Healthy Days that were significantly different from outcomes for women in usual care. There were no differences for men in collaborative care compared with usual care on any measures. In the intervention group, women compared with men attended more sessions of psychotherapy, completed more modules of therapy, expressed more commitment, and viewed psychotherapy as more helpful. CONCLUSIONS: These findings contribute to the broader literature on treatment heterogeneity, in particular the influence of gender, and may inform personalized care for people seeking anxiety treatment in primary care settings.


Assuntos
Transtornos de Ansiedade/terapia , Comportamento Cooperativo , Atenção Primária à Saúde/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Adolescente , Adulto , Idoso , Arkansas , California , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Fatores Sexuais , Resultado do Tratamento , Washington , Adulto Jovem
17.
Prev Med ; 74: 111-6, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25712326

RESUMO

OBJECTIVES: The aim of this study is to assess the prevalence and changes over time of ideal Life's Simple Seven (LSS) in African-Americans. METHODS: Prospective cohort of 5301 African-Americans from the Jackson Heart Study (JHS) from 2000 to 2013. Each of the LSS metrics was categorized as poor, intermediate, or ideal. RESULTS: Among men, the prevalence of having 0, 1, 2, 3, 4, 5, 6, and 7 ideal LSS was 3.3%, 23.0%, 33.5%, 24.7%, 11.6%, 3.6%, 0.3%, and 0%, respectively. Corresponding values for women were 1.7%, 26.3%, 33.1%, 22.8%, 11.9%, 3.7%, 0.6%, and 0%. Prevalence of ideal diet was 0.9%. The proportions of those meeting LSS ideal recommendations for cholesterol and fasting glucose declined from the first through third JHS visits across all age groups, whereas prevalence of ideal BMI declined only in participants <40 years at a given visit. Prevalence of ideal blood pressure did not change over time and being ideal on physical activity improved from the first [18.3% (95% CI: 17.3% to 19.3%)] to third visit [24.8% (95% CI: 23.3% to 26.3%)]. CONCLUSIONS: Our data show a low prevalence of ideal LSS (especially diet, physical activity, and obesity) in the JHS and a slight improvement in adherence to physical activity recommendations over time.


Assuntos
Afro-Americanos/estatística & dados numéricos , Doenças Cardiovasculares/etnologia , Comportamentos Relacionados com a Saúde/etnologia , Hipertensão/complicações , Atividade Motora/fisiologia , Obesidade/complicações , Adulto , Idoso , Glicemia/análise , Índice de Massa Corporal , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Colesterol/sangue , Dieta/efeitos adversos , Dieta/etnologia , Dieta/estatística & dados numéricos , Feminino , Humanos , Hipertensão/etnologia , Masculino , Pessoa de Meia-Idade , Mississippi/epidemiologia , Avaliação Nutricional , Obesidade/etnologia , Preparações Farmacêuticas/administração & dosagem , Preparações Farmacêuticas/classificação , Prevalência , Estudos Prospectivos , Fatores de Risco , Fumar/efeitos adversos , Fumar/etnologia , Fatores Socioeconômicos
18.
Am J Hypertens ; 28(7): 900-8, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25499058

RESUMO

BACKGROUND: The disproportionate rates of cardiovascular disease in African Americans may, in part, be due to suboptimal assessment of blood pressure (BP) with clinic BP measurements alone. To date, however, the prevalence of masked hypertension in African Americans has not been fully delineated. The purpose of this study was to evaluate masked hypertension prevalence in a large population-based sample of African Americans and examine its determinants and association with indices of target organ damage (TOD). METHODS: Clinic and 24-hour ambulatory BP monitoring were conducted in 972 African Americans enrolled in the Jackson Heart Study. Common carotid artery intima-media thickness, left ventricular mass index, and the urinary albumin:creatinine excretion ratio were evaluated as indices of TOD. RESULTS: Masked hypertension prevalence was 25.9% in the overall sample and 34.4% in participants with normal clinic BP. All indices of TOD were significantly higher in masked hypertensives compared to sustained normotensives and were similar between masked hypertensives and sustained hypertensives. Male gender, smoking, diabetes, and antihypertensive medication use were independent determinants of masked hypertension in multivariate analyses. CONCLUSIONS: In this population-based cohort of African Americans, approximately one-third of participants with presumably normal clinic BP had masked hypertension when BP was assessed in their daily environment. Masked hypertension was accompanied by a greater degree of TOD in this cohort.


Assuntos
Afro-Americanos , Pressão Sanguínea , Hipertensão Mascarada/etnologia , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Monitorização Ambulatorial da Pressão Arterial , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/etnologia , Doenças das Artérias Carótidas/fisiopatologia , Artéria Carótida Primitiva/diagnóstico por imagem , Espessura Intima-Media Carotídea , Diabetes Mellitus/etnologia , Progressão da Doença , Feminino , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/etnologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Nefropatias/diagnóstico , Nefropatias/etnologia , Nefropatias/fisiopatologia , Modelos Logísticos , Masculino , Hipertensão Mascarada/diagnóstico , Hipertensão Mascarada/tratamento farmacológico , Hipertensão Mascarada/fisiopatologia , Pessoa de Meia-Idade , Mississippi/epidemiologia , Análise Multivariada , Razão de Chances , Prevalência , Fatores de Risco , Fatores Sexuais , Fumar/efeitos adversos , Fumar/etnologia
19.
Prim Health Care Res Dev ; 16(2): 147-56, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24589352

RESUMO

BACKGROUND: Overweight and obesity are growing problems for primary care. Although effective weight management programs exist, these programs experience significant attrition, which limits effectiveness. OBJECTIVES: This study examined provider and staff perceptions of attrition from the Veterans Health Administration MOVE!(®) Weight Management Program as an initial step toward understanding attrition from primary care-based programs. PARTICIPANTS: MOVE!(®) clinicians, primary care providers, and other staff members who interacted with patients about participating in MOVE!(®) (n=754) from Department of Veterans Affairs medical centers throughout the United States. Respondents were predominantly female (80.8%), Caucasian (79.2%), and trained as nurses (L.P.N., R.N., or N.P.; 50%). MEASURE: Participants completed a web-mediated survey; items assessed agreement with personal and programmatic reasons for dropout, and allowed respondents to indicate the number one reason for dropout in an open-ended format. This survey was adapted from an existing tool designed to capture patient perceptions. RESULTS: Respondents indicated that veterans experienced practical barriers to attendance (eg, transportation and scheduling difficulties) and desire for additions to the program (eg, a live exercise component). Low motivation was the primary factor identified by respondents as associated with dropout, particularly as noted by MOVE!(®) clinicians (versus other providers/staff; P<0.01). CONCLUSIONS: These findings suggest that programmatic changes, such as adding additional meeting times or in-session exercise time, may be of benefit to MOVE!(®). In addition, increasing the use of techniques such as Motivational Interviewing among providers who refer patients to MOVE!(®) may improve participant engagement in MOVE!(®) and other primary care-based weight management programs. Further research is needed to effectively identify those likely to withdraw from weight management programs before achieving their goals, and the reasons for withdrawal.


Assuntos
Atitude do Pessoal de Saúde , Sobrepeso/terapia , Cooperação do Paciente/psicologia , Atenção Primária à Saúde/métodos , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Veteranos/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sobrepeso/psicologia , Cooperação do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos , United States Department of Veterans Affairs , Perda de Peso
20.
Prev Med ; 57(6): 855-9, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24096141

RESUMO

OBJECTIVE: To examine the relationship between pedometer-measured step count data and the Metabolic Syndrome (MetS) in African American adults. METHOD: 379 African American adults (mean age 60.1 years; 60% female) enrolled in the Jackson Heart Study (Jackson, MS) from 2000 to 2004 provided sufficient pedometer data for inclusion in this analysis. MetS was classified according to the International Diabetes Federation Task Force on Epidemiology and Prevention. RESULTS: Using steps/day categorized as tertiles (<3717 (referent), 3717-6238, >6238), participants taking 3717-6238 (Odds Ratio (OR)(95% Confidence Interval (CI))=0.34 (0.19, 0.61)) and >6238 steps/day (OR(95% CI)=0.43 (0.23, 0.78)) had lower odds of having MetS compared to participants in the lowest tertile. Using previously suggested steps/day cut-points (<2500 (referent), 2500-4999, 5000-7499, ≥7500), the odds of having MetS were lower for participants taking 2500-4999 (OR(95% CI)=0.32 (0.14, 0.72)), 5000-7499 (OR(95% CI)=0.22 (0.09, 0.53)), and >7500 (OR(95% CI)=0.26 (0.11, 0.65)) steps/day compared to those taking <2500 steps/day. CONCLUSION: Compared to lower levels, higher levels of steps/day are associated with a lower prevalence of MetS in this older African American population.


Assuntos
Afro-Americanos/estatística & dados numéricos , Síndrome Metabólica/epidemiologia , Caminhada/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mississippi/epidemiologia , Atividade Motora , Fatores de Risco
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