Evaluation of the effectiveness of a problem-solving intervention addressing barriers to cardiovascular disease prevention behaviors in 3 underserved populations: Colorado, North Carolina, West Virginia, 2009.

INTRODUCTION: In low-income and underserved populations, financial hardship and multiple competing roles and responsibilities lead to difficulties in lifestyle change for cardiovascular disease (CVD) prevention. To improve CVD prevention behaviors, we adapted, pilot-tested, and evaluated a problem-solving intervention designed to address barriers to lifestyle change. METHODS: The sample consisted of 81 participants from 3 underserved populations, including 28 Hispanic or non-Hispanic white women in a western community (site 1), 31 African-American women in a semirural southern community (site 2), and 22 adults in an Appalachian community (site 3). Incorporating focus group findings, we assessed a standardized intervention involving 6-to-8 week group sessions devoted to problem-solving in the fall of 2009. RESULTS: Most sessions were attended by 76.5% of participants, demonstrating participant adoption and engagement. The intervention resulted in significant improvement in problem-solving skills (P < .001) and perceived stress (P < .05). Diet, physical activity, and weight remained stable, although 72% of individuals reported maintenance or increase in daily fruit and vegetable intake, and 67% reported maintenance or increase in daily physical activity. CONCLUSION: Study results suggest the intervention was acceptable to rural, underserved populations and effective in training them in problem-solving skills and stress management for CVD risk reduction.

Mediterranean Milk Ladder: Integrating a Healthy Eating Plan While Reintroducing Cow's Milk.

The process of gradually reintroducing food allergens into an individual's diet is referred to as a food allergen "ladder", and the most recent edition of the original Milk Allergy in Primary (MAP) Care Guidelines, as well as the International Milk Allergy in Primary Care (IMAP), includes a shortened, improved, and international version with specific recipes, indicating the exact milk protein content, as well as the duration of heating and the temperature for each step of the ladder. Food allergen ladders are being used increasingly in clinical practice. The aim of this study was to develop a Mediterranean milk ladder based on the principles of the Mediterranean eating pattern. The protein content delivered in a portion of the final food product in each step of the ladder in the Mediterranean version corresponds to that provided in the IMAP ladder. Different recipes for the various steps were provided to increase acceptability and variety. Quantification of the total milk protein, casein content, and beta-lactoglobulin by Enzyme-linked immunosorbent assay (ELISA) could detect the gradual increase in concentrations, but the accuracy of the method was affected by the presence of the other ingredients in the mixtures. When developing the Mediterranean milk ladder, a key consideration was to reduce the amount of sugar by using limited amounts of brown sugar and substituting sugar with fresh fruit juice or honey for children aged older than one year. The proposed Mediterranean milk ladder includes principles of (a) healthy eating based on the Mediterranean diet and (b) the acceptability of foods across different age groups.

Perceptions of cardiovascular health in underserved communities.

INTRODUCTION: Cardiovascular disease is the leading cause of deaths and illnesses in US adults, and the prevalence is disproportionately high in underserved populations. In this study, we assessed respondents' understanding of context-specific differences in knowledge and perceptions of disease, risk, and prevention in 6 underserved communities, with the longer-term goal of developing appropriate interventions. METHODS: Thirty-nine small-group sessions and 14 interviews yielded data from 318 adults. Each site's researchers coded, analyzed, and extracted key themes from local data. Investigators from all sites synthesized results and identified common themes and differences. RESULTS: Themes clustered in 3 areas (barriers to cardiovascular health, constraints related to multiple roles, and suggestions for effective communications and programs). Barriers spanned individual, social and cultural, and environmental levels; women in particular cited multiple roles (eg, competing demands, lack of self-care). Programmatic suggestions included the following: personal, interactive, social context; information in language that people use; activities built around cultural values and interests; and community orientation. In addition, respondents preferred health-related information from trusted groups (eg, AARP), health care providers (but with noticeable differences of opinion), family and friends, and printed materials. CONCLUSION: Interventions to decrease barriers to cardiovascular health are needed; these strategies should include family and community context, small groups, interactive methods, culturally sensitive materials, and trusted information sources. New-immigrant communities need culturally and linguistically tailored education before receiving more substantive interventions.

Understanding administrative coding of emergency department visits for unspecified acute allergic reactions.

AIM: Emergency department (ED) visits for food-related acute allergic reactions enable estimation of temporal trends in food allergy prevalence. To use this approach in New Zealand requires an understanding of the proportion of ED visits coded as 'anaphylaxis, unspecified' or 'allergy, unspecified' that are food-related allergic reactions. METHOD: We reviewed all ED presentations of children, coded as 'anaphylaxis, unspecified' or 'allergy, unspecified', from 1988-2011 to the Auckland City Hospital ED. Charts were reviewed independently by two investigators to determine agreement on categorisation of presentations as being food-related acute allergic reactions. We compared ED presentation rates in different time intervals using rate ratios (RR) and 95% confidence intervals (CI). RESULTS: Sixty-five (29%) of the 221 ED presentations given a discharge code of 'anaphylaxis, unspecified' or 'allergy, unspecified', were a food-related allergic reaction. Inter-observer agreement was very good (kappa >0.80). The ED presentation rate with food-related allergic reactions in 2004-2011 was 98% higher than in 1988-1995 (RR=1.98, 95%CI 1.10-3.72). By contrast, ED presentation rates for non-food-related allergic reactions did not change over these years. CONCLUSION: ED presentations for food-related allergic reactions are identifiable from within ED presentations coded as 'anaphylaxis, unspecified' or 'allergy, unspecified'. ED presentations for food-related allergic reactions have increased over time in Auckland.