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Zagt AC, Bos N, Bakker M, de Boer D, Friele RD, de Jong JD. A scoping review into the explanations for differences in the degrees of shared decision making experienced by patients. PATIENT EDUCATION AND COUNSELING 2024; 118:108030. [PMID: 37897867 DOI: 10.1016/j.pec.2023.108030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVES In order to improve the degree of shared decision making (SDM) experienced by patients, it is necessary to gain insight into the explanations for the differences in these degrees. METHODS A scoping review of the literature on the explanations for differences in the degree of SDM experienced by patients was conducted. We assessed 21,329 references. Ultimately, 308 studies were included. The explanations were divided into micro, meso, and macro levels. RESULTS The explanations are mainly related to the micro level. They include explanations related to the patient and healthcare professionals, the relationship between the patient and the physician, and the involvement of the patient's relatives. On the macro level, explanations are related to restrictions within the healthcare system such as time constraints, and adequate information about treatment options. On the meso level, explanations are related to the continuity of care and the involvement of other healthcare professionals. CONCLUSIONS SDM is not an isolated process between the physician and patient. Explanations are connected to the macro, meso, and micro levels. PRACTICE IMPLICATIONS This scoping review suggests that there could be more focus on explanations related to the macro and meso levels, and on how explanations at different levels are interrelated.
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Affiliation(s)
- Anne C Zagt
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands.
| | - Nanne Bos
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Max Bakker
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Dolf de Boer
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Roland D Friele
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; Tranzo Scientifc Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000 LE Tilburg, the Netherlands
| | - Judith D de Jong
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; CAPHRI, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
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2
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Pourat N, Lu C, Chen X, Zhou W, Hoang H, Sripipatana A. Weight management practices of health center providers in the United States. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:304-313. [PMID: 36942770 DOI: 10.1080/17538068.2023.2189378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND We examined weight management counseling practices of Health Resources and Services Administration-funded health center (HC) providers for patients with overweight (POW) and obesity (POB) status, focusing on weight-related conditions, risk factors, and health care utilization. METHOD We used a nationally representative cross-sectional survey of HC patients and multilevel generalized structural equation logistic regression models to assess the association of provider counseling practices for POW and POB and by three obesity classes. Dependent variables included being told by the HC provider that weight was a problem, receiving a diet or exercise recommendation, referral to a nutritionist, or receiving weight loss prescriptions. Independent variables included weight-related conditions such as diabetes and hypertension, risk factors such as smoking, and health service utilization such as five or more primary care visits. RESULTS All POB classes had higher odds of receiving all five counseling interventions than POW. Patients with diabetes and high cholesterol had higher odds of diet recommendations (OR = 1.8) and nutritionist referrals (OR = 2.3), while patients with cardiovascular disease had higher odds of nutritionist referral (OR = 2.0) and receiving weight loss prescriptions (OR = 2.6). Respondents with POB class III and diabetes had higher odds of receiving exercise recommendations (OR = 3.4), while POB class 1 and had hypertension had lower odds of nutritionist referral (OR = 0.3). CONCLUSIONS Variations in HC primary care providers' weight management counseling practices between POW and POB present missed opportunities for consistent practice and early intervention. Assessing providers' counseling practices for patients with comorbid conditions is essential to the successful management of the obesity crisis.
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Affiliation(s)
- Nadereh Pourat
- UCLA Center for Health Policy Research, Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Connie Lu
- UCLA Center for Health Policy Research, Los Angeles, CA, USA
| | - Xiao Chen
- UCLA Center for Health Policy Research, Los Angeles, CA, USA
| | - Weihao Zhou
- UCLA Center for Health Policy Research, Los Angeles, CA, USA
| | - Hank Hoang
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Alek Sripipatana
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, MD, USA
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3
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Eskridge W, Cryer DR, Schattenberg JM, Gastaldelli A, Malhi H, Allen AM, Noureddin M, Sanyal AJ. Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis: The Patient and Physician Perspective. J Clin Med 2023; 12:6216. [PMID: 37834859 PMCID: PMC10573476 DOI: 10.3390/jcm12196216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
Diagnosing and managing metabolic dysfunction-associated steatotic liver disease (MASLD) remains a major challenge in primary care due to lack of agreement on diagnostic tools, difficulty in identifying symptoms and determining their cause, absence of approved pharmacological treatments, and limited awareness of the disease. However, prompt diagnosis and management are critical to preventing MASLD from progressing to more severe forms of liver disease. This highlights the need to raise awareness and improve understanding of MASLD among both patients and physicians. The patient perspective is invaluable to advancing our knowledge of this disease and how to manage it, as their perspectives have led to the growing recognition that patients experience subtle symptoms and that patient-reported outcomes should be incorporated into drug development. This review and expert opinion examine MASLD and metabolic dysfunction-associated steatohepatitis from the patient and physician perspective from pre-diagnosis to diagnosis and early care, through to progression to advanced liver damage. Specifically, the paper dives into the issues patients and physicians experience, and, in turn, what is required to improve diagnosis and management, including tips and tools to empower patients and physicians dealing with MASLD.
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Affiliation(s)
| | | | - Jörn M. Schattenberg
- Metabolic Liver Research Program, Department of Medicine, University Medical Center of the Johannes Gutenberg University, 155131 Mainz, Germany
| | - Amalia Gastaldelli
- Cardiometabolic Risk Laboratory, Institute of Clinical Physiology, Italian National Research Council CNR, 00133 Pisa, Italy
| | - Harmeet Malhi
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55901, USA
| | - Alina M. Allen
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55901, USA
| | - Mazen Noureddin
- Fatty Liver Program, Karsh Division of Gastroenterology and Hepatology, Cedar Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Arun J. Sanyal
- Stravitz-Sanyal Institute of Liver Disease and Metabolic Health, VCU School of Medicine and Health System and Division of Gastroenterology, Department of Internal Medicine, VCU School of Medicine, Richmond, VA 23298, USA
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4
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Hyer S, Davis JW, Slowik JL, Dove-Medows E, Giurgescu C. A mixed methods systematic review of midwives' clinical practices related to prenatal care of women with obesity. Midwifery 2023; 121:103653. [PMID: 36907010 PMCID: PMC10147579 DOI: 10.1016/j.midw.2023.103653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/13/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Maternal obesity has been related to adverse maternal and infant outcomes. It is a persistent challenge of midwifery care worldwide and can present clinical challenges and complications. This review sought to identify evidence on the practice patterns of midwives related to prenatal care of women with obesity. METHODS The databases Academic Search Premier, APA PsycInfo, CINAHL PLUS with Full Text, Health Source: Nursing/Academic Edition, and MEDLINE were searched November 2021. Search terms included weight, obesity, practices, and midwives. Inclusion criteria included quantitative, qualitative, and mixed method studies that addressed practice patterns of midwives related to prenatal care of women with obesity published in peer-reviewed journals, written in English. The recommended Joanna Briggs Institute approach to mixed methods systematic reviews was followed e.g. study selection, critical appraisal, data extraction, and a convergent segregated method of data synthesis and integration. RESULTS Seventeen articles from 16 studies were included. The quantitative evidence showed a lack of knowledge, confidence, and support for midwives that would facilitate adequate management of pregnant women with obesity while the qualitative evidence revealed that midwives desire a sensitive approach to discussing obesity and the risks associated with maternal obesity. DISCUSSION Quantitative and qualitative literature report consistent individual and system-level barriers to implementing evidence-based practices. Implicit bias training, midwifery curriculum updates, and the use of patient centered care models may help overcome these challenges.
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Affiliation(s)
- Suzanne Hyer
- College of Nursing, University of Central Florida, 12201 Research Parkway, Suite 300, Orlando, FL, USA.
| | - Jean W Davis
- College of Nursing, University of Central Florida, 12201 Research Parkway, Suite 300, Orlando, FL, USA
| | - Jordan Lee Slowik
- College of Nursing, University of Central Florida, 12201 Research Parkway, Suite 300, Orlando, FL, USA
| | - Emily Dove-Medows
- School of Nursing, University of Michigan, 500 S State St, Ann Arbor, MI, USA
| | - Carmen Giurgescu
- College of Nursing, University of Central Florida, 12201 Research Parkway, Suite 300, Orlando, FL, USA
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5
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Croskey O, Clark MK. Individualized diet conversation in primary care: A pilot intervention. Nurse Pract 2023; 48:38-46. [PMID: 36975749 DOI: 10.1097/01.npr.0000000000000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Most primary care providers do not routinely discuss nutrition and diet with their patients, largely due to lack of time, inadequate resources, and perceived complexity of the topic. This article describes development and implementation of a brief protocol for systematically assessing and discussing diet during routine primary care visits to increase the frequency of these conversations and improve patient health outcomes. METHODS The authors developed a protocol for assessing both nutrition and stage of change as well as a guide for engaging in patient-led conversations about nutrition. The protocol was modeled after Screening, Brief Intervention, and Referral to Treatment and informed by the Dietary Guidelines for Americans, the Transtheoretical Model of Behavior Change, and principles of motivational interviewing. It was implemented over three months at a rural health clinic staffed by one NP. RESULTS The protocol and conversation guide were easy to use with minimal training and seamlessly incorporated into clinic workflow. The likelihood of making diet changes increased significantly following the diet conversation, with persons who initially scored lower in readiness to change ultimately reporting significantly greater increases. CONCLUSION A protocol for assessing diet and engaging patients in a stage of change-appropriate diet conversation can be efficiently integrated into a single primary care visit and increase patients' intent to change their diet. Further investigation is needed to evaluate the protocol more completely and in multiple clinics.
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Chu YT, Huang RY, Chen TTW, Lin WH, Tang JT, Lin CW, Huang CH, Lin CY, Chen JS, Kurtz-Rossi S, Sørensen K. Effect of health literacy and shared decision-making on choice of weight-loss plan among overweight or obese participants receiving a prototype artificial intelligence robot intervention facilitating weight-loss management decisions. Digit Health 2022; 8:20552076221136372. [PMID: 36353693 PMCID: PMC9638535 DOI: 10.1177/20552076221136372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Implementation of artificial intelligence (AI) in medical decision-making is
still in early development. We developed an AI robot intervention prototype with
a health literacy-friendly interface that uses interactive voice response (IVR)
surveying to assist in decision-making for weight loss. The weight-specific
health literacy instrument (WSHLI) and Shared Decision-Making Questionnaire
(SDMQ) were used to measure factors influencing weight-loss decisions. Factors
associated with participants choosing to lose weight were analyzed using
logistic regression, and factors influencing the selection of specific
weight-loss plans were examined with one-way analysis of variance. Our study
recruited 144 overweight or obese adults (69.4% women, 58.3% with body mass
index (BMI) ≥ 24). After interacting with the AI robot, 78% of the study
population made the decision to lose weight. SDMQ score was a significant factor
positively influencing the decision for weight-loss (odds ratio [OR]: 2.16, 95%
confidence interval [CI]: 1.09–4.29, p = 0.027). Individuals
who selected self-monitored lifestyle modification (mean ± SD: 11.52 ± 1.95) had
significantly higher health literacy than those who selected dietician-assisted
plan (9.92 ± 2.30) and physician-guided treatment (9.60 ± 1.52) (both
p = 0.001). The study results demonstrated that our
prototype AI robot can effectively encourage individuals to make decisions
regarding weight management and that both WSHLI and SDMQ scores affect the
choice of weight-loss plans.
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Affiliation(s)
- Yi-Tang Chu
- Department of Holistic Medicine, E-Da Hospital, Kaohsiung, Taiwan
- Department of Family and Community Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Ru-Yi Huang
- Department of Holistic Medicine, E-Da Hospital, Kaohsiung, Taiwan
- Department of Family and Community Medicine, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Tara Tai-Wen Chen
- Department of Family and Community Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Wei-Hsuan Lin
- Department of Family and Community Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - James TaoQian Tang
- Department of Family and Community Medicine, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Chi-Wei Lin
- Department of Family and Community Medicine, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chi-Hsien Huang
- Department of Family and Community Medicine, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Sheng Chen
- Department of Medical Research, E-Da Hospital, Kaohsiung, Taiwan
| | - Sabrina Kurtz-Rossi
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA
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7
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Taylor PC, Van de Laar M, Laster A, Fakhouri W, Quebe A, de la Torre I, Jain S. Call for action: incorporating wellness practices into a holistic management plan for rheumatoid arthritis-going beyond treat to target. RMD Open 2021; 7:e001959. [PMID: 34893537 PMCID: PMC8666892 DOI: 10.1136/rmdopen-2021-001959] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/23/2021] [Indexed: 01/07/2023] Open
Abstract
This expert opinion article explores the strategy of adopting a holistic approach to the management of rheumatoid arthritis (RA) by incorporating the wellness practices of exercise, optimised sleep, optimised nutrition, mindfulness, social connectedness and positive emotions into the management plan. The aim is to attain optimal health for each patient beyond that achievable by limiting disease management to pharmacological treatment to attain the lowest achievable composite scores of disease activity, as recommended with the current treat-to-target approach, and addressing the recent recognition of pain control as a key patient-reported outcome. Incorporating wellness practices into a busy clinical setting requires creativity and customisation based on the individual practice setting and the individual needs of each patient. Such practices can help people living with RA to achieve optimum wellness through the introduction of measures-according to individual need-designed to improve the aspects of life most impacted for that person, thereby complementing treat-to-target and pain control strategies with pharmacological agents. Clinicians must consider wellness practices in addition to treat-to-target pharmacological agents for the holistic management of people with RA.
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Affiliation(s)
- Peter C Taylor
- Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK
| | - Mart Van de Laar
- Transparency in Healthcare B.V, University of Twente, Hengelo, The Netherlands
| | - Andrew Laster
- Arthritis & Osteoporosis Consultants of the Carolinas, Charlotte, North Carolina, USA
| | | | - Amanda Quebe
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Saundra Jain
- School of Nursing, The University of Texas at Austin, Austin, Texas, USA
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Shaikh F, Wynne R, Castelino RL, Inglis SC, Ferguson C. Effectiveness of Direct Oral Anticoagulants in Obese Adults With Atrial Fibrillation: A Systematic Review of Systematic Reviews and Meta-Analysis. Front Cardiovasc Med 2021; 8:732828. [PMID: 34692784 PMCID: PMC8531486 DOI: 10.3389/fcvm.2021.732828] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/13/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia. Obesity is an independent risk factor for AF. Anticoagulants have been strongly recommended by all international guidelines to prevent stroke. However, altered pathophysiology in obese adults may influence anticoagulant pharmacology. Direct oral anticoagulants (DOACs) in the context of obesity and AF have been examined in recent systematic reviews. Despite the similarities in included studies, their results and conclusions do not agree. Methods and Results: The protocol for this review was registered with PROSPERO (CRD42020181510). Seven key electronic databases were searched using search terms such as “atrial fibrillation,” “obese,*” “overweight,” “novel oral anticoagulant,” “direct oral anticoagulant,” “DOAC,” “NOAC,” “apixaban,” dabigatran,” “rivaroxaban,” and “edoxaban” to locate published and unpublished studies. Only systematic reviews with meta-analyses that examined the effect of DOACs in overweight or obese adults with AF, published in the English language, were included. A total of 9,547 articles were initially retrieved. After removing the duplicates, title and abstract review and full-text review, five articles were included in the systematic review. From these only RCTs were included in the meta-analyses. There was disagreement within the published systematic reviews on DOACs in obesity. The results from our meta-analysis did not show any significant difference between all body mass index (BMI) groups for all outcomes at both 12 months and for the entire trial duration. Non-significant differences were seen among the different types of DOACs. Conclusion: There was no difference between the BMI classes in any of the outcomes assessed. This may be due to the limited number of people in the trial that were in the obese class, especially obese class III. There is a need for large prospective trials to confirm which DOACs are safe and efficacious in the obese class III adults and at which dose.
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Affiliation(s)
- Fahad Shaikh
- Western Sydney Nursing and Midwifery Research Centre, Western Sydney University & Western Sydney Local Health District, Blacktown, NSW, Australia
| | - Rochelle Wynne
- Western Sydney Nursing and Midwifery Research Centre, Western Sydney University & Western Sydney Local Health District, Blacktown, NSW, Australia.,School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
| | - Ronald L Castelino
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Pharmacy Department, Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW, Australia
| | - Sally C Inglis
- Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Sydney, NSW, Australia
| | - Caleb Ferguson
- Western Sydney Nursing and Midwifery Research Centre, Western Sydney University & Western Sydney Local Health District, Blacktown, NSW, Australia
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Sánchez Urbano RE, Paredes A, Vargas Chambi FR, Guedes Ruela P, Olivares DEV, Souza Pereira BT, Pacheco SOS, Pacheco FJ. Reception of Dietary and Other Health-Related Lifestyle Advice to Address Non-communicable Diseases in a Primary Care Context: A Mixed-Method Study in Central Argentina. Front Nutr 2021; 8:622543. [PMID: 33585541 PMCID: PMC7873357 DOI: 10.3389/fnut.2021.622543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
An effective way to address risk factors for non-communicable chronic diseases (NCD) and reduce healthcare costs is by using sound health-related advice (HRA) to promote healthy lifestyle habits. In Argentina, however, few studies have examined the context in which HRA is communicated and undertaken by patients at the primary care level. In this study, we assessed the reception of HRA using a mixed-method approach in a central area of Argentina. A total of 1,044 participants from the community were contacted and sociodemographic characteristics, health-related lifestyle factors, and medical history were collected. A calendar with health messages was provided to participants and its usage was assessed after 1 year. Additionally, semi-structured interviews were conducted with 34 patients attending a local primary healthcare center. The results show that HRA was given more frequently to individuals with higher mean age, lower educational level, and to females. Participants with a chronic health condition are at a higher chance of receiving advice to reduce salt intake and maintain a healthy weight. Dietary advice is offered along with other lifestyle recommendations. The use of alcohol and tobacco is usually addressed together. HRA was primarily received in the context of an NCD diagnosis and advice was directed, especially, to risky behaviors. The HRA to increase the intake of fruits and vegetables was mentioned less frequently. Patients at the healthcare center greatly appreciated receiving an HRA, especially when given in a tailored, written, and detailed form, and acknowledged its importance to prevent or control a chronic health condition as part of the medical treatment but showed concern regarding the ability to fully incorporate the advice. Lifestyle recommendations are highly appreciated by patients but are still underutilized since they are offered mostly in the context of illness. The health calendar was shown to be useful to complement health intervention programs at the community level. The findings of our study underscore the acknowledged value of HRA by participants to tackle the risk factors of chronic diseases. If properly used HRA constitutes a simple and highly valued tool to help address patient's needs to prevent and control NCD in Argentina.
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Affiliation(s)
- Raúl E Sánchez Urbano
- Center for Health Sciences Research, School of Medicine and Health Sciences, Universidad Adventista del Plata, Libertador San Martín, Argentina
| | - Ariel Paredes
- Center for Health Sciences Research, School of Medicine and Health Sciences, Universidad Adventista del Plata, Libertador San Martín, Argentina
| | - Frank R Vargas Chambi
- Center for Health Sciences Research, School of Medicine and Health Sciences, Universidad Adventista del Plata, Libertador San Martín, Argentina
| | - Pedro Guedes Ruela
- Center for Health Sciences Research, School of Medicine and Health Sciences, Universidad Adventista del Plata, Libertador San Martín, Argentina
| | - David E V Olivares
- Center for Health Sciences Research, School of Medicine and Health Sciences, Universidad Adventista del Plata, Libertador San Martín, Argentina
| | - Benicio T Souza Pereira
- Center for Health Sciences Research, School of Medicine and Health Sciences, Universidad Adventista del Plata, Libertador San Martín, Argentina
| | - Sandaly O S Pacheco
- Center for Health Sciences Research, School of Medicine and Health Sciences, Universidad Adventista del Plata, Libertador San Martín, Argentina.,Institute for Food Science and Nutrition, Universidad Adventista del Plata, Libertador San Martín, Argentina
| | - Fabio J Pacheco
- Center for Health Sciences Research, School of Medicine and Health Sciences, Universidad Adventista del Plata, Libertador San Martín, Argentina.,Institute for Food Science and Nutrition, Universidad Adventista del Plata, Libertador San Martín, Argentina
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10
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Gibson B, Simonsen S, Jensen JD, Yingling L, Schaefer J, Sundaresh V, Zhang Y, Altizer R. Mobile Virtual reality vs. Mobile 360 Video to Promote Enrollment in the Diabetes Prevention Program Amongst Hispanic Adults (Preprint). JMIR Diabetes 2020; 7:e26013. [PMID: 35297771 PMCID: PMC8972104 DOI: 10.2196/26013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 09/30/2021] [Accepted: 01/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background Hispanic adults are at increased risk of developing type 2 diabetes. The Diabetes Prevention Program (DPP) reduces the risk of developing type 2 diabetes; however, the rate of enrollment is very low. Objective The goal of this pilot project was to determine whether presenting brief motivational mobile videos in virtual reality vs 360° video has differential effects on risk perceptions and enrollment in the DPP. Methods Adults with prediabetes were recruited at a clinic serving a low-income Hispanic community. After consenting, the participants completed a baseline survey that collected information about demographics and risk perceptions. All participants then viewed 2 videos. Per random assignment, the videos were presented either using the participant’s smartphone alone (360° video) or were viewed with their smartphone in a virtual reality (VR) cardboard headset. Two weeks later, a follow-up survey collected measures of enrollment in the DPP, risk perceptions, health literacy, the importance of contextual factors related to the decision of whether to enroll in the DPP (eg, distance to the class), and qualitative feedback on the interventions. We used logistic regression to determine whether enrollment in the DPP differed by intervention mode, while accounting for health literacy and contextual factors related to the DPP. We used unpaired t tests to examine differences in change in risk perceptions between groups. Paired t tests were used to examine within-subject changes in risk perceptions. Results A total of 116 participants provided complete data. Most participants were middle-aged (mean age 44.6 years; SD 11.9) Hispanic (114/116), female (79/116), with low health literacy (mean score 12.3/20; SD 3.4). Enrollment in the DPP was 44/116 (37.9%) overall but did not differ by group (odds ratio for enrolling in VR group 1.78, 95% CI 0.75-4.3; P=.19). Individuals who rated the distance needed to travel to attend the DPP as more important were less likely to enroll in the DPP (odds ratio 0.56, 95% CI 0.33-0.92; P=.03). Risk perceptions did not differ by group (mean change in 360° video group -0.07, mean change in VR group 0.03, t=0.6, P=.54) and did not change within subjects (mean 0.02, t=0.21, P=.83). Participant feedback suggested that the videos are emotionally engaging and educational. Conclusions The videos presented in 360° video and mobile VR had equal efficacy in promoting enrollment in the DPP. Future work to rigorously evaluate this intervention, its mechanism of action, and potential moderators of the efficacy are discussed.
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Affiliation(s)
- Bryan Gibson
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Sara Simonsen
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Jakob D Jensen
- Department of Communication, University of Utah, Salt Lake City, UT, United States
| | - Leah Yingling
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Julia Schaefer
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Vishnu Sundaresh
- Department of Endocrinology, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Yue Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Roger Altizer
- Therapeutic Games and Applications Lab, University of Utah, Salt Lake City, UT, United States
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Critchlow N, Rosenberg G, Rumgay H, Petty R, Vohra J. Weight assessment and the provision of weight management advice in primary care: a cross-sectional survey of self-reported practice among general practitioners and practice nurses in the United Kingdom. BMC FAMILY PRACTICE 2020; 21:111. [PMID: 32552861 PMCID: PMC7304118 DOI: 10.1186/s12875-020-01184-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/09/2020] [Indexed: 12/26/2022]
Abstract
Background Although primary care settings provide a large-scale and high-reach opportunity for weight management and obesity prevention, the proportion of adults in the United Kingdom (UK) who report receiving weight management advice is limited. This study examines the self-reported frequency of assessing weight and providing weight management advice by General Practitioners (GPs) and Practice Nurses (PNs) working in primary care in the UK, and differences by practitioner characteristics. Methods Cross-sectional survey with GPs and PNs in the UK (n = 2020), conducted January–March 2017. A mock consultation exercise assessed what factors led to calculating a patient’s Body Mass Index (BMI) and whether weight management advice was given after determining the patient had an obese BMI. For all patients, practitioners were asked how often they calculated BMI, how often they gave weight management advice to patients with an obese BMI, and how often they utilised different advice or referral options (each: Always/Often vs. Less often/Never). Binary logistic regressions examined whether frequency of assessing weight and providing advice was associated with practitioner characteristics. Results In the mock consultation, physical cues (40%) were most likely to prompt calculation of BMI, and half of practitioners (56%) provided weight management advice after determining the patient had an obese BMI, with GPs less likely to do so than PNs (Odds Ratio [OR] = 0.59, 95% CI: 0.47–0.75). Half of practitioners (58%) said they calculated the BMI of all patients Always/Often, with GPs less likely to do so than PNs (OR = 0.27, 95% CI: 0.21–0.34). Three quarters (78%) said they provided weight management advice to patients with an obese BMI Always/Often, with GPs less likely to do so than PNs (OR = 0.63, 95% CI: 0.47–0.85). Weight management advice was provided more frequently than referrals, particularly suggesting increased physical activity (93%) and diet modification (89%). Conclusions Consistent with previous research, the findings suggest that opportunities to provide weight management advice in primary care, including to patients with an obese BMI, are potentially missed. Future research should test alternative mechanisms to increase weight assessment and advice provision, examine the effectiveness of advice frequently given, and seek solutions to reported barriers for providing weight management advice.
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Affiliation(s)
- Nathan Critchlow
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK. .,Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, UK.
| | - Gillian Rosenberg
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
| | - Harriet Rumgay
- Cancer Intelligence, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
| | - Robert Petty
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
| | - Jyotsna Vohra
- Cancer Policy Research Centre, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
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12
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Valero-Elizondo J, Aneni EC, Osondu CU, Grandhi GR, Virani SS, Nasir K. Gaps in provider lifestyle counseling and its adherence among obese adults with prediabetes and diabetes in the United States. Prev Med 2019; 129:105815. [PMID: 31454663 DOI: 10.1016/j.ypmed.2019.105815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/18/2019] [Accepted: 08/20/2019] [Indexed: 11/16/2022]
Abstract
Obesity is an epidemic affecting about 40% of the US adult population. Tracking with the obesity epidemic is an increase in the prevalence of diabetes and pre-diabetes. Both pre-diabetes and diabetes are often coexistent with obesity and contribute to an increased total and cardiovascular disease related morbidity and mortality. Lifestyle modification is usually the first step in management among individuals with obesity and/or pre-diabetes or diabetes, but remains an unfulfilled potential by healthcare providers to promote healthier lifestyles in obese patients. We aimed to describe the current patterns of lifestyle counseling (diet, physical activity, and weight loss) and their adherence by patients with obesity in the US using the National Health Interview Survey, 2016-2017. We analyzed these patterns among individuals with pre-diabetes and diabetes. We found that, regardless of pre-diabetes or diabetes status, almost 1 in 3 individuals with mild obesity (BMI ≥ 30 & < 35) and 1 in 4 with severe obesity (BMI ≥ 35) reported lack of lifestyle counseling from healthcare providers regarding diet or physical activity, and 2 in 3 individuals with any level of obesity reported lack of referral/counsel concerning weight loss programs. Lifestyle counseling and its compliance among obese adults from a contemporary dataset in the US is still suboptimal. This study highlights the gaps in the implementation of the AHA/ACC 2013 guidelines on management of obesity among adults particularly among those with metabolic disease, who would derive the greatest benefit.
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Affiliation(s)
- Javier Valero-Elizondo
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, United States of America. https://twitter.com/jvaleromd
| | - Ehimen C Aneni
- Yale University School of Medicine, Division of Cardiovascular Medicine, New Haven, CT, United States of America.
| | - Chukwuemeka U Osondu
- Baptist Health South Florida, Miami, FL, United States of America. https://twitter.com/droz09
| | - Gowtham R Grandhi
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, United States of America. https://twitter.com/gowthyharsha
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America; Baylor College of Medicine, Houston, TX, United States of America. https://twitter.com/virani_md
| | - Khurram Nasir
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, United States of America; Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, United States of America. https://twitter.com/khurramn1
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13
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Greaney ML, Cohen SA, Ward-Ritacco CL, Riebe D. Rural-Urban Variation in Weight Loss Recommendations Among US Older Adults with Arthritis and Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060946. [PMID: 30884784 PMCID: PMC6466170 DOI: 10.3390/ijerph16060946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/07/2019] [Accepted: 03/13/2019] [Indexed: 12/11/2022]
Abstract
Purpose: Weight loss is advantageous for individuals with obesity and arthritis. Therefore, this study was conducted to determine if there are differences by rural-urban status among older adults with these conditions who reported being advised by a health care provider to lose weight for arthritis or to ameliorate arthritis symptoms. Methods: A cross-sectional analysis of 2011 Behavioral Risk Factor Surveillance System (BRFSS) data. Respondents reported if they had been diagnosed with arthritis and if they received a provider weight loss recommendation (WLR). The analytic sample was limited to older adults aged 60⁻79 living in the five states that administered the examined BRFSS arthritis module who had body mass index ≥ 30 kg/m² and reported having arthritis (n = 2920). The respondent's county of residence was linked to the corresponding county-level population density from the US Decennial Census to determine rural-urban status. A generalized linear model examined the association between receipt of a WLR and population density, controlling for demographics. Results: The sample was 83.6% white, 57.8% female, and 63.2% received a WLR. Respondents from more urban counties were more likely to receive a WLR (p value for trend <0.001). Additionally, older respondents, men, individuals with less than a high school education, and whites had a decreased likelihood of receiving a WLR. Conclusions: The analysis identified notable rural-urban differences with respondents in more urban counties being more likely to receive a WLR. Furthermore, there were differences in those who received a WLR by age, sex, and education. Reasons for these differences should be explored.
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Affiliation(s)
- Mary L Greaney
- Health Studies, University of Rhode Island, 25 West Independence Way, Kingston, RI 02881, USA.
| | - Steven A Cohen
- Health Studies, University of Rhode Island, 25 West Independence Way, Kingston, RI 02881, USA.
| | - Christie L Ward-Ritacco
- Department of Kinesiology, University of Rhode Island, 25 West Independence Way, Kingston, RI 02881, USA.
| | - Deborah Riebe
- Department of Kinesiology, University of Rhode Island, 25 West Independence Way, Kingston, RI 02881, USA.
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14
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Walsh K, Grech C, Hill K. Health advice and education given to overweight patients by primary care doctors and nurses: A scoping literature review. Prev Med Rep 2019; 14:100812. [PMID: 30805277 PMCID: PMC6374522 DOI: 10.1016/j.pmedr.2019.01.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 01/08/2023] Open
Abstract
Health advice for overweight patients in primary care has been a focus of obesity guidelines. Primary care doctors and nurses are well placed to provide evidence based preventive health advice. This literature review addressed two research questions: ‘When do primary care doctors and nurses provide health advice for weight management?’ and ‘What health advice is provided to overweight patients in primary care settings?’ The study was conducted in the first half of 2018 and followed Arksey and O'Malley (2005) five stage framework to conduct a comprehensive scoping review. The following databases were searched: Emcare, Ovid, Embase, The Cochrane library, Proquest family health, Health source (nursing academic), Joanna Briggs Institute EBP database, Medline, PubMed, Rural and remote, Proquest (nursing and allied health) and TRIP using search term parameters. Two hundred and forty-eight (248) articles were located and screened by two reviewers. Twenty-three research papers met the criteria and data were analysed using a content analysis method. The results show that primary care doctors and nurses are more likely to give advice as BMI increases and often miss opportunities to discuss weight with overweight patients. Body Mass Index (BMI) is often wrongly categorised as overweight, when in fact it is in the range of obese, or not recorded and when health advice is given, it can be of poor quality. Few studies on this topic included people under 40 years, practice nurses as the focus and those with a BMI of 25–29.9 without a risk factor. A ‘toolkit’ approach to improve advice and adherence to evidence based guidelines should be explored in future research.
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Affiliation(s)
- Kristina Walsh
- School of Nursing and Midwifery, the University of South Australia, Australia
| | - Carol Grech
- School of Nursing and Midwifery, the University of South Australia, Australia
| | - Kathy Hill
- School of Nursing and Midwifery, the University of South Australia, Australia
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15
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Glenister K, Opie CA, Wright J. Preferred language regarding overweight and obesity in general practice: a survey of predominantly rural Australian adults. Aust J Prim Health 2018; 24:391-397. [DOI: 10.1071/py18023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/28/2018] [Indexed: 11/23/2022]
Abstract
Discussions regarding overweight may be infrequent in Australian general practice. General practitioners (GPs) may find these discussions difficult to initiate if they are unsure of the language to use, or if patients would find it acceptable to be weighed. Overweight and obesity are more prevalent in rural areas than in metropolitan areas, and strategies to address the health risks associated with these conditions need to be tailored to rural communities. The aims of this study were to identify the language preferred by an Australian adult sample with a range of body sizes, to assess acceptability of routine weight measurement by GPs, and to assess potential influence of gender, body size and rurality on these preferences. A questionnaire was distributed through the authors’ informal networks using email and social media. Australian adults were eligible to participate. Respondents (n=771) were predominantly female, health professionals and resided in rural areas. The preferred language was weight neutral (‘weight’) or linked to health (‘your weight may be damaging your health’, ‘you are above your healthy weight range’). Preferred language appeared to be influenced by gender and body size but not rurality. Most respondents (76%) would find it acceptable to be weighed regularly by their GP.
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Banerjee ES, Herring SJ, Hurley K, Puskarz K, Yebernetsky K, LaNoue M. Determinants of Successful Weight Loss in Low-Income African American Women: A Positive Deviance Analysis. J Prim Care Community Health 2018; 9:2150132718792136. [PMID: 30084705 PMCID: PMC6081755 DOI: 10.1177/2150132718792136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We set out to investigate the behaviors of low-income African American women who successfully lost weight. METHODS From an urban, academic, family medicine practice, we used a mixed methods positive deviance approach to evaluate 35 low-income African American women who were obese and lost at least 10% of their maximum weight, and maintained this loss for 6 months, comparing them with 36 demographically similar control participants who had not lost weight. Survey outcomes included demographics and behaviors that were hypothesized to be related to successful weight loss. Interviews focused on motivations, barriers, and what made weight loss successful. Survey data were analyzed using t tests and linear regression for continuous outcomes and chi-square tests and logistic regression for categorical outcomes. Interviews were analyzed using a modified approach to grounded theory. RESULTS In adjusted analyses, women in the positive deviant group were more likely to be making diet changes compared with those women who did not lose at least 10% of their initial body weight. Major themes from qualitative analyses included ( a) motivations (of health, appearance, quality of life, family, and epiphanies), ( b) opportunity (including time and support), ( c) adaptability. CONCLUSIONS The findings of this study may be useful in developing motivational interviewing strategies for primary care providers working with similar high-risk populations.
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Affiliation(s)
- Elaine Seaton Banerjee
- Thomas Jefferson University, Philadelphia, PA, USA
- Lehigh Valley Health Network, Allentown, PA, USA
| | | | - Katelyn Hurley
- Thomas Jefferson University, Philadelphia, PA, USA
- ACT.md, Boston, MA, USA
| | | | - Kyle Yebernetsky
- Thomas Jefferson University, Philadelphia, PA, USA
- Geisinger Health System, Danville, PA, USA
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