Fewer thromboembolic events after implementation of a venous thromboembolism risk stratification tool.

BACKGROUND: Deep venous thrombosis and pulmonary embolus are leading preventable causes of death after surgery. Venous thromboembolism (VTE) prophylaxis management guidelines, with evidenced-based recommendations, are available in the literature. However, over 40% of "at-risk" surgical patients fail to receive appropriate VTE prophylaxis. Decision support-based interventions to reduce venous thromboembolic events were explored. METHODS: A venous thromboembolic risk stratification tool embedded in the electronic medical record, Epic, linking risk category to venous thromboembolic prophylaxis order sets was created, implemented, and analyzed for general surgery patients. Logistic regression analysis was used to compare rates of venous thromboembolic events before and after the intervention, controlling for age, gender, race, body mass index, inpatient status, transfer status, elective/emergent case status, American Society of Anesthesiologists classification, and wound classification. RESULTS: Venous thromboembolic events in the preintervention and postintervention periods were 55 (1.25%) and 12 (0.64%), respectively (P = 0.033). All-cause mortality events decreased after intervention from 49 (1.12%) to 14 (0.75%; P = 0.187). Multivariable analyses show that the risk of a venous thromboembolic event after intervention was half (odds ratio = 0.532; 95% confidence interval, 0.284-0.997; P = 0.049) as likely compared to that in the preintervention period. From 2012 to 2015, our institution moved from the ninth decile (poor) to the first decile (best) for the incidence of venous thromboembolic events among 760 National Surgical Quality Improvement Program hospitals across the nation. CONCLUSIONS: Postoperative thromboembolic events decreased after implementation of a VTE risk stratification tool, linking risk category to venous thromboembolic prophylaxis order sets, embedded in the electronic medical record, Epic.

Nutritional status and socio-ecological factors associated with overweight/obesity at a rural-serving US-Mexico border university.

INTRODUCTION: Globesity (the global epidemic of obesity), like undernutrition at the opposite end of the malnutrition spectrum, affects virtually all age and socioeconomic groups in developed and developing countries. Genetics, comorbid diseases and lifestyle factors have been associated with obesity and weight gain for college students. Little is known about obesity and lifestyle factors of campus students and employees located in rural areas. The purpose of this study was to examine the prevalence of overweight/obesity and socioecological elements of the obesogenic environment at a rural-serving US-Mexico border university. METHODS: Data were collected using a cross-sectional, convenience sample by anasynchronous electronic survey submitted to approximately 23 000 students, faculty and staff on the main campus of New Mexico State University. Self-reported anthropometric indicators were used as proxy measures of nutritional status. Factors analyzed include the prevalence overweight/obesity from calculated body mass index (BMI) and self-identified body image in the contexts of sex, age, ethnicity, role at the university (student or employee) and residence. Body mass index categories were analyzed for associations with reported prevalence of stress indicators such as clinically diagnosed anxiety or depression, and major diseases such as diabetes, hypertension, heart disease, cancer and stroke. RESULTS: A total of 3962 completed surveys were analyzed. Self-reported respondent rates (n = 3962) of overweight and obese individuals (47.2%) were less than those reported for the state (60.7%) in a 2010 national survey. When BMI was analyzed by sex, there was a significant difference (p = 0.003) between males and females. More males were overweight and obese than females. When BMI and BMI categories were assessed by age, ethnicity, role at the university and residence, each variable was found to have statistically significant differences. CONCLUSION: No one demographic or socioecological factor appears to have a predominant role in predicting obesity in the participants studied at this rural-serving university. The authors conclude that levels of overweight and obesity are multifactorial and should be addressed with more holistic actions. These findings suggest that future studies should look more closely at stressors in the environment as well as culturally acceptable versus ideal notions of weight and corpulence. Study findings also suggest that early intervention will be critical to reducing levels of overweight/obesity and associated complications as the population ages. Finally, this study provides evidence for health educators and policy makers to go beyond exercise and calories in/out to develop educational materials that can cross many barriers of culture, age, ethnicity, educational level, residence and body image.

Diabetes and stress: an anthropological review for study of modernizing populations in the US-Mexico border region.

INTRODUCTION: Diabetes is a growing worldwide problem, characterized by considerable ethnic variation and being particularly common in modernizing populations. Modernization is accompanied by a variety of stressful sociocultural changes that are believed to increase the risk of diabetes. Unfortunately, there is little accurate knowledge about impact of stress on the risk of diabetes in the US-Mexico border area. METHODS: Literature searches were performed in PubMed and Google Scholar to identify anthropological studies on stress and diabetes. Snowball and opportunistic sampling were used to expand the identified literature. In total, 30 anthropological studies were identified concerning the role of stress and modernization on diabetes among Indigenous peoples. This article reviews the available information regarding stress and diabetes in different populations from various anthropological perspectives. RESULTS: Four different concepts of stress were indentified: physiological, psychological, psychosocial and nutritional stress. Unlike physiological and nutritional theories of diabetes, psychological and psychosocial theories of stress and disease lack etiological specificity. No study addressed all four concepts of stress and few studies addressed more than two concepts. Most studies concerned nutritional stress and the developmental origins of diabetes. Most studies were conducted on the Pima Indians of Arizona and Mexico. All four stress concepts have some evidence as determinants of diabetes. CONCLUSION: These theoretical concepts and ethnographic results can provide the basis for developing comprehensive research protocols and public health intervention targeted at diabetes. A comprehensive view of stress can potentially explain the high prevalence of diabetes in developing countries and among Indigenous peoples. These results can be used to inform public health interventions aimed at reducing diabetes in the US-Mexico border region or similar areas, help identify at-risk individuals, and guide health education and promotion.

Pandemic flu knowledge among dormitory housed university students: a need for informal social support and social networking strategies.

INTRODUCTION: The declaration of a Phase 6 pandemic of influenza A (H1N1) by the World Health Organization in June 2009, triggered the activation of preparedness responses worldwide. During 2009 spring and fall, many US universities actuated their emergency pandemic preparedness plans. This article describes a research study that used a modified community based participatory research (CBPR) approach between August and November 2009 at New Mexico State University's main Las Cruces campus to determine influenza (pandemic influenza A (H1N1) 2009 and seasonal influenza knowledge, attitudes, and health communication (informal support networks and social networking) strategies specifically related to influenza among dormitory housed (on-campus living) undergraduate students. The goal was to produce data for use in the university's pandemic illness/disaster preparedness and response plans. METHODS: Following activation of the university's campus-wide efforts to educate students about pandemic flu, university community partners were asked for input regarding information for flu preparedness for the university's undergraduate students. Student participants were recruited for the present study from those housed in four campus dormitories. A purposive convenience sample was used to collect survey data from 175 students during the peak week of reported flu cases on campus. Each participant was given an anonymous, face-to-face, self-administered survey and 167 surveys were able to be analyzed. A χ² goodness of fit test was used to determine whether observed proportions of categorical variables differed from hypothesized proportions. RESULTS: Four categorical data were analyzed by topics: (1) demographics; (2) flu awareness; (3) flu immunization knowledge and practices; and (4) communication and health information practices. The average age was 19.6 years (SD = 1.8), with no significant differences by sex (86 males and 76 females, 5 undisclosed) or race/ethnicity (57 White, 43 Hispanic, 44 Other). All questions were tested with χ² against sex, race, and dormitory; however, only three questions revealed statistically significant differences by any of these demographic categories. CONCLUSIONS: Sex, race, age, and dormitory were demonstrated to have little impact on H1N1 health practices and knowledge. Three-quarters of students surveyed demonstrated awareness of the pandemic 2009 H1N1 flu. Despite public health and university health education campaigns, approximately 25% were not aware of the virus. Most students stated that they knew someone who had flu during the year, even if they had not. Students did not perceive (60%) dormitory living to be a greater health risk, even though the proximal distance among students diminishes by sharing bathrooms and sleeping quarters. Three main factors affected the students' knowledge, attitudes and behaviors: faculty attitudes and influenza knowledge; low levels of flu like illnesses at the university; and the utilization of health education strategies inconsistent with the mechanisms students use to gain health information (informal support networks and electronic social networking). Failure to utilize these student information mechanisms may result in less than optimal health education effectiveness. Health educators should ensure that identifiable intermediaries (eg faculty) understand and assist in health education efforts. However, the incidence of H1N1 at this university was relatively low, which may have affected the research results.

Predictors of access to healthcare: what matters to rural Appalachians?

OBJECTIVE: Lack of access to healthcare is frequently cited as a primary reason for health disparities globally, especially in poor, rural areas such as Appalachia in the U.S. This study examined predictors of perceived access to healthcare among residents in a poor, medically underserved, rural Appalachian community. METHODS: The study was guided by the revised behavioral model of healthcare services utilization. Self-reported survey data were obtained from a convenience sample of 921 residents in rural Tennessee. RESULTS: The majority of respondents in this study did not perceive access to healthcare to be a problem in their community. Financial factors, health status, and associated social factors negatively affected only a small number respondents' perceptions of access to healthcare. CONCLUSIONS: Despite the presence of multiple factors previously shown to affect access to healthcare, the majority of respondents in this study did not perceive access to healthcare to be a problem in their community. Results of this study suggest that to understand an individual's passage through the healthcare system, the contextual aspects of healthcare utilization, should be added to coverage, services, timeliness, and workforce as a fifth component of access to healthcare. Assessing perceived need and associated cultural factors that affect individuals' concepts of health and wellness represent important areas for future exploration to explain observed health disparities. Additionally, findings showed that having sufficient quality and quantity of healthcare professionals and services in a community or region may be necessary, but not sufficient to explain health disparities and the underlying reasons why individuals choose or choose not to seek health services.