Community-Engaged Research With Latino Dementia Caregivers: Overcoming Challenges in Community Advisory Board Development

BACKGROUND AND OBJECTIVES

Latinos caring for a person with Alzheimer's disease and related dementias (ADRD) have the highest prevalence of caregiving. Yet, they are less likely to benefit from evidence-based interventions given their continued underrepresentation in ADRD-related research. Community advisory boards (CABs) have the potential to address barriers to research for underrepresented communities; however, there are complexities to establishing and sustaining CABs. This article describes how our work addressed challenges in CABs related to unbalanced power relations, language barriers, the value of time, and low research knowledge and health literacy.

RESEARCH DESIGN AND METHODS

Nine Latino CAB members, including older Latino caregivers, were trained in a comprehensive program designed to increase knowledge about health research methods and ethics, cognitive health, and cultural adaptation methods. Members completed pre- and post-training measures of Alzheimer's disease knowledge, attitudes, and beliefs toward research, and a satisfaction survey.

RESULTS

Results from the satisfaction questionnaire indicated that the program was well received. CAB members increased their knowledge regarding the management of behavioral and psychological symptoms of dementia and dementia-associated risk factors and treatment. Positive changes in members' attitudes toward research included increased willingness to participate in trials and subject protection measures.

DISCUSSION AND IMPLICATIONS

Formalized training in research conduct and ethics and health literacy is a promising strategy to reduce challenges in establishing and maintaining CABs and can also optimize CAB impact to address gaps in older Latino ADRD caregiving research.

Measurement Reactivity in a Randomized Clinical Trial Using Self-Reported Data

PURPOSE

The objective of this article is to describe how self-monitoring contributed to measurement reactivity in a randomized clinical trial (RCT). The implications of measurement reactivity on self-monitoring and suggestions for minimizing its effect will be discussed.

DESIGN

The study involved a secondary data analysis of responses from 145 participants who completed a 12-month long RCT. The original sample consisted of 202 community-living adults with long-term indwelling urinary catheters.

METHODS

The data analyzed were from the participants' brief responses to the final study question concerning their perceived study participation value. The data were discussed and coded iteratively until three researchers reached consensus. At the end, each item was recoded into eight categories and minor codes.

FINDINGS

Our belief that the calendar was the probable cause of reactivity was not fully supported as the control group also learned about paying attention to urinary catheter problems by the questions asked through the seven bimonthly interviews.

CONCLUSIONS

The calendar and interview questions were reactive by increasing participants' self-monitoring of catheter problems. Specifically, the frequent interviews exposed participants to catheter-related concerns and provided them with ideas as to how to better manage them.

CLINICAL RELEVANCE

This article provides insight related to the internal validity threat of measurement reactivity in RCTs and gives suggestions to reduce its effects.

The validity of classic symptoms and chest radiographic configuration in predicting pulmonary tuberculosis

OBJECTIVE

Patients admitted to the pulmonary isolation service to rule out tuberculosis (TB) were prospectively studied to identify predictors of smear-positive TB.

METHODS

History of symptoms--cough, sputum production, fever, weight loss, night sweats, hemoptysis, anorexia, and dyspnea; medical history--TB, tuberculin skin test (TST) status, TB contact; and social factors--crowding index, history of incarceration or living in a shelter, and employment status were obtained in face-to-face interviews. Chest x-rays (CXRs) were scored as typical, atypical, or negative. Serial morning sputa were collected.

RESULTS

Complete data were collected on 101 patients; 44 had pulmonary TB; 33 patients were smear positive and considered infectious; 11 patients were smear negative but culture positive. There was no difference between TB and non-TB patients with respect to HIV status and social risk factors. Significant differences were found between patients who were smear positive for TB and smear negative with respect to cough, sputum, and typical CXR (79%, 76%, and 79% sensitivity, respectively). Eleven patients without TB had an atypical CXR and denied cough, sputum, and weight loss. Only one patient with TB presented this way.

CONCLUSION

Even in high-risk populations, symptoms of cough, sputum, weight loss for less than 2 weeks, and the absence of a typical CXR are strong negative predictors for TB.

Tularemia from a cat bite: case report and review of feline-associated tularemia

We report the case of a 63-year-old man who developed ulceroglandular tularemia complicated by pneumonia following a cat bite. A review of the literature revealed 51 cases of cat-related tularemia reported since 1928. Details of 15 cases (including the present case) were available and analyzed. If, following feline contact, patients develop pneumonia or if patients with skin and soft-tissue infection fail to respond to therapy with penicillin, physicians should be alerted to the possibility of tularemia. A greater awareness of this complication following a cat bite or cat scratch is important for recognizing this uncommon infection.