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Hughes MC, Vernon E, Egwuonwu C, Afolabi O. Measuring decision aid effectiveness for end-of-life care: A systematic review. PEC Innov 2024; 4:100273. [PMID: 38525314 PMCID: PMC10957449 DOI: 10.1016/j.pecinn.2024.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/26/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024]
Abstract
Objective To systematically review research analyzing the effectiveness of decision aids for end-of-life care, including how researchers specifically measure decision aid success. Methods We conducted a systematic review synthesizing quantitative, qualitative, and mixed-methods study results using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Four databases were searched through February 18, 2023. Inclusion criteria required articles to evaluate end-of-life care decision aids. The review is registered under PROSPERO (#CRD42023408449). Results A total of 715 articles were initially identified, with 43 meeting the inclusion criteria. Outcome measures identified included decisional conflict, less aggressive care desired, knowledge improvements, communication improvements, tool satisfaction, patient anxiety and well-being, and less aggressive care action completed. The majority of studies reported positive outcomes especially when the decision aid development included International Patient Decision Aid Standards. Conclusion Research examining end of life care decision aid use consistently reports positive outcomes. Innovation This review presents data that can guide the next generation of decision aids for end-of-life care, namely using the International Patient Decision Aid Standards in developing tools and showing which tools are effective for helping to prevent the unnecessary suffering that can result when patients' dying preferences are unknown.
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Affiliation(s)
- M. Courtney Hughes
- School of Health Studies, Northern Illinois University, Wirtz Hall 209, DeKalb, IL 60115, USA
| | - Erin Vernon
- Department of Economics, Seattle University, Pigott 522, Seattle, WA 98122, USA
| | - Chinenye Egwuonwu
- School of Health Studies, Northern Illinois University, Wirtz Hall 209, DeKalb, IL 60115, USA
| | - Oluwatoyosi Afolabi
- School of Health Studies, Northern Illinois University, Wirtz Hall 209, DeKalb, IL 60115, USA
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Brewer A, Hughes MC, Patel KN. Impact of Repeated Reimbursement Penalties on Hospital Total Quality Scores. J Patient Saf 2024; 20:198-201. [PMID: 38197907 DOI: 10.1097/pts.0000000000001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVES The incidence of hospital-acquired conditions (HACs) is a serious public health issue with implications ranging from patient morbidity and mortality to negative financial impacts on patients and health care systems. Despite substantial efforts to address and reduce HACs, research into the effect of quality improvement programs is inconclusive. This study seeks to better understand the relationship between repeated reimbursement penalties and improvement in HAC quality scores. METHODS A quantitative comparative analysis of U.S. health care data was conducted. Data on quality outcomes and hospital characteristics were sourced from the Hospital-Acquired Condition Reduction Program from fiscal years 2018 and 2019 and the Centers for Medicare & Medicaid Services Inpatient Prospective Payment System impact files, respectively. RESULTS In total, 3123 U.S. hospitals were analyzed to compare differences between total HAC scores of hospitals with and without penalties in consecutive years. Hospitals with repeated penalties had significantly greater improvement in scores ( t497.262 = -13.00, P < 0.001), and the impact was greatest in small hospitals (<100 beds). Repeated penalties had a smaller impact on disproportionate share hospitals (Cohen d = 0.73). Among all hospitals, the effect of repeated penalties was large (Cohen d = 0.75). CONCLUSIONS This study suggests that repeated penalties can improve quality scores in U.S. hospitals. However, the effect may be exaggerated for smaller hospitals and those that serve patient populations with a relatively higher socioeconomic status. The reason disproportionate share hospitals did not show as much improvement as nondisproportionate hospitals may be because hospitals serving vulnerable populations often have fewer resources.
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Affiliation(s)
- Alice Brewer
- From the College of Health and Human Sciences, Northern Illinois University, DeKalb, Illinois
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Chung K, Hughes MC, Koushkaki SR, Risberg MR, Alcantara M, Amico JM. Hospice Capacity to Provide General Inpatient Care: Emergency Department Utilization and Live Discharge Among Cancer Patients. Am J Hosp Palliat Care 2024; 41:63-72. [PMID: 37088870 DOI: 10.1177/10499091231170598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
General inpatient (GIP) hospice care is used only minimally for hospice patients, and more than a quarter of Medicare hospice facilities do not provide GIP care. To determine the impact of hospices' capacity to provide on emergency department use during hospice enrollment and live discharge from hospice, we used Surveillance, Epidemiology, and End Results-Medicare linked data and CMS Provider of Services data from 2007 to 2013 from ten states and two metropolitan regions. Grouping hospices into three GIP care provision categories: 1) no-GIP; 2) GIP-contract; and 3) GIP-IHF where hospices directly provide GIP care in their own inpatient hospice facility (IHF), we built a multilevel logistic model that accounted for unobserved hospice characteristics. Nearly 9% of the study sample received GIP care, of which 82% received such care in the last week of discharge. GIP-IHF hospices had lower live discharge rates than no-GIP hospices (AOR: .61; 95% CI: .47-.79; P < .001) and GIP-contract hospices (AOR: .84; 95% CI: .70-1.00; P < .05). Similarly, GIP-contract hospices were also associated with a decreased risk of live discharge, compared to no-GIP hospices (AOR: .76; CI: .62-.92; P < .05). There was no difference in emergency department use between no-GIP hospices and hospices with such capacity. Our results suggest that hospices capable of providing GIP care have lower live discharge rates than their counterparts. However, the fact that GIP care tends to be provided too close to death limits its effectiveness in preventing avoidable emergency department use.
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Affiliation(s)
- Kyusuk Chung
- Department of Health Sciences, California State University Northridge, Northridge, CA, USA
| | - M Courtney Hughes
- Northern Illinois University, School of Health Studies, DeKalb, IL, USA
| | | | - Mia Richelle Risberg
- Department of Health Sciences, California State University Northridge, Northridge, CA, USA
| | - Michelle Alcantara
- Department of Health Sciences, California State University Northridge, Northridge, CA, USA
| | - Jennifer M Amico
- Kaiser Foundation Hospitals, Medical Group Administration, Woodland Hills, CA, USA
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Liu Y, Hughes MC, Baumbach A, Derain L. An online intervention to improve the health and well-being of informal caregivers of individuals with Alzheimer's disease: A pilot study. PEC Innov 2023; 3:100229. [PMID: 37929051 PMCID: PMC10623357 DOI: 10.1016/j.pecinn.2023.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Abstract
Objective Describe an intervention to improve the health and well-being of informal caregivers of individuals with Alzheimer's disease (AD) and present pilot program findings. Methods Participants (N = 31, mean age = 45.7) were randomly assigned to one of two conditions: an online synchronous didactic lesson and peer support session series or an asynchronous didactic only session series. Outcome variables included physical health, nutrition intake, and stress. One-way ANOVA was conducted to examine the effects of the intervention. The least significant difference (LSD) post hoc test was used to analyze the difference pattern between means. Results Participants in both conditions reported healthier dietary behavior and lower level of stress from pre-intervention to the post-intervention. These effects were not maintained at one-month follow up. Conclusion An online educational intervention may improve the health and well-being of informal caregivers of people with AD. Further research is necessary to determine which specific intervention components to include and what strategies may help participants maintain improved health behaviors. Innovation This program focused on the health and well-being of informal caregivers of individuals with AD rather than on emphasizing how caregivers can perform their caregiving duties better. The intervention was provided in an underserved lower-income, rural area.
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Affiliation(s)
- Yujun Liu
- School of Family and Consumer Sciences, Northern Illinois University, 1425 W. Lincoln Hwy, DeKalb, IL 815-753-1301, United States of America
| | - M. Courtney Hughes
- School of Health Studies, Northern Illinois University, DeKalb, IL, United States of America
| | - Abby Baumbach
- School of Family and Consumer Sciences, Northern Illinois University, DeKalb, IL, United States of America
| | - Lily Derain
- School of Nursing, Northern Illinois University, DeKalb, IL, United States of America
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Fang D, Guo L, Hughes MC, Tan J. Dynamic Patterns and Modeling of Early COVID-19 Transmission by Dynamic Mode Decomposition. Prev Chronic Dis 2023; 20:E95. [PMID: 37884317 PMCID: PMC10625432 DOI: 10.5888/pcd20.230089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION Understanding the transmission patterns and dynamics of COVID-19 is critical to effective monitoring, intervention, and control for future pandemics. The aim of this study was to investigate the spatial and temporal characteristics of COVID-19 transmission during the early stage of the outbreak in the US, with the goal of informing future responses to similar outbreaks. METHODS We used dynamic mode decomposition (DMD) and national data on COVID-19 cases (April 6, 2020-October 9, 2020) to model the spread of COVID-19 in the US as a dynamic system. DMD can decompose the complex evolution of disease cases into linear combinations of simple spatial patterns or structures (modes) with time-dependent mode amplitudes (coefficients). The modes reveal the hidden dynamic behaviors of the data. We identified geographic patterns of COVID-19 spread and quantified time-dependent changes in COVID-19 cases during the study period. RESULTS The magnitude analysis from the dominant mode in DMD showed that California, Louisiana, Kansas, Georgia, and Texas had higher numbers of COVID-19 cases than other areas during the study period. States such as Arizona, Florida, Georgia, Massachusetts, New York, and Texas showed simultaneous increases in the number of COVID-19 cases, consistent with data from the Centers for Disease Control and Prevention. CONCLUSION Results from DMD analysis indicate that certain areas in the US shared similar trends and similar spatiotemporal transmission patterns of COVID-19. These results provide valuable insights into the spread of COVID-19 and can inform policy makers and public health authorities in designing and implementing mitigation interventions.
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Affiliation(s)
- Dehong Fang
- Department of Mechanical Engineering, Northern Illinois University, 1425 W Lincoln Hwy, DeKalb, IL 60115
| | - Lei Guo
- School of Interdisciplinary Health Professions, Northern Illinois University, DeKalb, Illinois
| | - M Courtney Hughes
- School of Health Studies, Northern Illinois University, DeKalb, Illinois
| | - Jifu Tan
- Department of Mechanical Engineering, Northern Illinois University, DeKalb, Illinois
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Hughes MC, Vernon E, Hainstock A. The effectiveness of community-based palliative care programme components: a systematic review. Age Ageing 2023; 52:afad175. [PMID: 37740895 PMCID: PMC10517647 DOI: 10.1093/ageing/afad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND There is evidence that community-based palliative care programmes can improve patient outcomes and caregiver experiences cost-effectively. However, little is known about which specific components within these programmes contribute to improving the outcomes. AIM To systematically review research that evaluates the effectiveness of community-based palliative care components. DESIGN A systematic mixed studies review synthesising quantitative, qualitative and mixed-methods study findings using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PROSPERO: ID # CRD42022302305. DATA SOURCES Four databases were searched in August 2021 (CINAHL, Web of Science, ProQuest Federated and PubMed including MEDLINE) and a close review of included article references. Inclusion criteria required articles to evaluate a single, specific component of a community-based palliative care programme either within an individual programme or across several programmes. RESULTS Overall, a total of 1,674 articles were identified, with 57 meeting the inclusion criteria. Of the included studies, 21 were qualitative, 25 were quantitative and 11 had mixed methods. Outcome measures consistently examined included patient/caregiver satisfaction, hospital utilisation and home deaths. The components of standardised sessions (interdisciplinary meetings about patients), volunteer engagement and early intervention contributed to the success of community-based palliative care programmes. CONCLUSIONS Certain components of community-based palliative care programmes are effective. Such components should be implemented and tested more in low- and middle-income countries and key and vulnerable populations such as lower-income and marginalised racial or ethnic groups. In addition, more research is needed on the cost-effectiveness of individual programme components.
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Affiliation(s)
- M Courtney Hughes
- Department of Public Health, Northern Illinois University, DeKalb, IL 60115, USA
| | - Erin Vernon
- Department of Economics, Seattle University, Seattle, WA 98122, USA
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Maas CCHM, Kent DM, Hughes MC, Dekker R, Lingsma HF, van Klaveren D. Performance metrics for models designed to predict treatment effect. BMC Med Res Methodol 2023; 23:165. [PMID: 37422647 PMCID: PMC10329397 DOI: 10.1186/s12874-023-01974-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 06/10/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Measuring the performance of models that predict individualized treatment effect is challenging because the outcomes of two alternative treatments are inherently unobservable in one patient. The C-for-benefit was proposed to measure discriminative ability. However, measures of calibration and overall performance are still lacking. We aimed to propose metrics of calibration and overall performance for models predicting treatment effect in randomized clinical trials (RCTs). METHODS Similar to the previously proposed C-for-benefit, we defined observed pairwise treatment effect as the difference between outcomes in pairs of matched patients with different treatment assignment. We match each untreated patient with the nearest treated patient based on the Mahalanobis distance between patient characteristics. Then, we define the Eavg-for-benefit, E50-for-benefit, and E90-for-benefit as the average, median, and 90th quantile of the absolute distance between the predicted pairwise treatment effects and local-regression-smoothed observed pairwise treatment effects. Furthermore, we define the cross-entropy-for-benefit and Brier-for-benefit as the logarithmic and average squared distance between predicted and observed pairwise treatment effects. In a simulation study, the metric values of deliberately "perturbed models" were compared to those of the data-generating model, i.e., "optimal model". To illustrate these performance metrics, different modeling approaches for predicting treatment effect are applied to the data of the Diabetes Prevention Program: 1) a risk modelling approach with restricted cubic splines; 2) an effect modelling approach including penalized treatment interactions; and 3) the causal forest. RESULTS As desired, performance metric values of "perturbed models" were consistently worse than those of the "optimal model" (Eavg-for-benefit ≥ 0.043 versus 0.002, E50-for-benefit ≥ 0.032 versus 0.001, E90-for-benefit ≥ 0.084 versus 0.004, cross-entropy-for-benefit ≥ 0.765 versus 0.750, Brier-for-benefit ≥ 0.220 versus 0.218). Calibration, discriminative ability, and overall performance of three different models were similar in the case study. The proposed metrics were implemented in a publicly available R-package "HTEPredictionMetrics". CONCLUSION The proposed metrics are useful to assess the calibration and overall performance of models predicting treatment effect in RCTs.
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Affiliation(s)
- C C H M Maas
- Department of Public Health, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
| | - D M Kent
- Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, USA
| | - M C Hughes
- Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, USA
| | - R Dekker
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - H F Lingsma
- Department of Public Health, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - D van Klaveren
- Department of Public Health, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
- Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, USA
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Hughes MC, ScheckLong D, Chung K. Hearing Aid Loan Program for Hearing Loss at the End of Life. J Soc Work End Life Palliat Care 2023; 19:182-189. [PMID: 37368863 DOI: 10.1080/15524256.2023.2229038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
This article describes a hearing aid loan program to provide free amplification devices for patients at the end of life to help them communicate more effectively at this critical time. It includes steps for establishing such a program, addressing challenges, and the role of the informal caregiver throughout the intervention. Healthcare professionals and social workers are encouraged to develop similar programs and use the information here as helpful suggestions to consider for their programs.
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Affiliation(s)
- M Courtney Hughes
- School of Health Studies, Northern Illinois University, DeKalb, Illinois, USA
| | - Diane ScheckLong
- Allied Health and Communicative Disorders, Northern Illinois University, DeKalb, Illinois, USA
| | - King Chung
- Allied Health and Communicative Disorders, Northern Illinois University, DeKalb, Illinois, USA
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Hughes MC, Afrin S, Hamlish T. Effectiveness of Skill-Building Interventions for Informal Caregivers of Adults with Cancer: a Systematic Review. J Cancer Educ 2023; 38:390-397. [PMID: 36372814 DOI: 10.1007/s13187-022-02236-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 05/20/2023]
Abstract
Over 19 million people worldwide were diagnosed with cancer in 2020. Informal caregivers of adults with cancer play an important role in helping their loved ones with cancer yet often receive little support in developing the necessary skills for caregiving. A systematic review of skill-building interventions for informal caregivers of adults with cancer was conducted across three electronic databases for academic articles published through February 2022. PRISMA reporting guidelines were followed throughout this review, the Mixed Methods Appraisal Tool was used to assess study quality, and results were summarized in a narrative synthesis. The main components of skill-building interventions examined include caregiving preparedness, communication, and self-care. Nine of the 11 included articles showed that interventions effectively built skills for informal caregivers. The articles reviewed had a wide variety of intervention strategies, outcome measures, and study designs. Two of the 11 articles mentioned vulnerable and key groups, and no studies were performed in low- and middle-income countries. Findings generally support implementing skill-building interventions for informal caregivers of adults with cancer; however, further research is necessary to determine the most effective approaches for improving caregiver skills and reaching vulnerable and key populations.
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Affiliation(s)
- M Courtney Hughes
- School of Health Studies, Northern Illinois University, DeKalb, IL, 60115, USA.
| | - Sadia Afrin
- School of Health Studies, Northern Illinois University, DeKalb, IL, 60115, USA
| | - Tamara Hamlish
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, 60607, USA
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Hughes MC, Gray JA, Kim J. The Perspective of Administrators of Intellectual Disability Organizations on the COVID-19 Pandemic. J Intellect Disabil 2023; 27:206-220. [PMID: 35037499 PMCID: PMC9939914 DOI: 10.1177/17446295211062400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To learn about the challenges, policies, and needed resources to serve people with intellectual disability and protect staff during the COVID-19 pandemic. From the perspective of intellectual disability service providers. METHODS We conducted in-depth qualitative interviews with 16 intellectual disability organization administrators throughout Illinois, USA from November 2020 through February 2021. We coded and analyzed the data using thematic analysis. RESULTS Three major themes emerged: (1) COVID-19 caused considerable challenges to people with intellectual disability and staff and service providers, (2) intellectual disability organizations reinvented service provisions in response to COVID-19 challenges, and (3) the interrelatedness of intellectual disability organizations, public policies, and community entities became evident. CONCLUSIONS Exhibiting responsiveness to needs and developing innovative solutions were strategies championed by intellectual disability organizations during the pandemic. Fostering collaboration with community entities may assist these organizations in navigating pandemic challenges and developing resilient infrastructure for future environmental threats.
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Affiliation(s)
| | | | - Jinsook Kim
- School of Health Studies, Northern Illinois
University, DeKalb, IL, USA
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11
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Baumbach A, Hughes MC, Derain L, Liu Y. Parenting style in childhood and attitudes toward caregiving in adulthood: a qualitative study. Home Health Care Serv Q 2023; 42:54-68. [PMID: 36047603 DOI: 10.1080/01621424.2022.2118096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This study aims to explore how relationships with parents during childhood can influence an individual's attitude toward caregiving later in life. The qualitative data came from 47 respondents who care for adult loved ones, with a caregiver mean age of 46.7. The respondents reflected on their recent experience of providing care for their loved ones and how experiences with their caregivers growing up may have influenced their caregiving attitudes. Using a codebook thematic analysis, themes were generated linking childhood experiences to current attitudes toward caregiving. Themes included reciprocating good care, performing obligatory care, and stopping the generational transference of negative care. For most participants, providing quality care for adult loved ones happened regardless of whether the one's childhood experiences with caregivers were positive or negative. Knowledge about the impact of childhood experiences can help health professionals develop interventions to support family caregivers that consider childhood experiences with parents.
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Affiliation(s)
- Abby Baumbach
- School of Family and Consumer Sciences, Northern Illinois University, DeKalb, Illinois, USA
| | - M Courtney Hughes
- School of Health Studies, Northern Illinois University, DeKalb, Illinois, USA
| | - Lily Derain
- School of Nursing, Northern Illinois University, DeKalb, Illinois, USA
| | - Yujun Liu
- School of Family and Consumer Sciences, Northern Illinois University, DeKalb, Illinois, USA
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Liu Y, Wang H, Hughes MC. Health Behaviors, Financial Difficulties, and Depressive Symptoms Among Older Adults Across Gender and Race During the COVID-19 Pandemic. Gerontol Geriatr Med 2023; 9:23337214231192820. [PMID: 37565025 PMCID: PMC10411279 DOI: 10.1177/23337214231192820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/12/2023] Open
Abstract
Background: COVID-19 deeply affected the health and well-being of older adults. This study examines health behavior change and the interrelationships between health behaviors, financial difficulties, and depressive symptoms among older adults across gender and race during the pandemic. Methods: Using Rounds 1, 5, and 10 of the National Health and Aging Trends Study (NHATS) linked with the NHATS COVID-19 dataset, our sample included Medicare beneficiaries aged 65 or older in the U.S. (N = 3,118). We modeled the interrelationships between health behaviors, financial difficulties, and depressive symptoms using a structural equation model. Results: Female participants reported less walking, more changes in eating habits, less sleeping, and less alcohol consumption during the pandemic than before the pandemic compared to male participants. Compared to White, Non-White participants showed higher proportions of experiencing financial difficulties, less walking, less vigorous activity, and changes in time spent eating and sleeping during than before the pandemic. Financial difficulties was positively associated with depressive symptoms and sedentary behavior. Active behavior was negatively associated with depressive symptoms, while sedentary behavior was positively associated with more depressive symptoms. Discussion: Health professionals should consider health behaviors and financial difficulties when intervening on depressive symptoms experienced by older adults since the pandemic.
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Affiliation(s)
- Yujun Liu
- Northern Illinois University, DeKalb, USA
| | - Heng Wang
- Rush University Medical Center, Chicago, IL, USA
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Baumbach A, Hughes MC, Derain L, Liu Y. EFFECTS OF PARENTING STYLE IN CHILDHOOD ON MENTAL HEALTH OUTCOMES OF CAREGIVING IN ADULTHOOD: A QUALITATIVE ANALYSIS. Innov Aging 2022. [PMCID: PMC9770731 DOI: 10.1093/geroni/igac059.2548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The life course perspective suggests that caregivers of aging parents bring their histories of relationships with aging parents, such as childhood maltreatment, to the care environment. These histories would then impact the dynamics and consequences of caregiving. However, there is a lack of research on the impact of childhood parental interactions on adult relationships with aging parents, particularly in the context of caregiving. The study aims to understand how relationships with caregivers while growing can impact an individual's role as a caregiver later in life. The qualitative study included 47 adult family caregiver survey respondents who care for their parents, with a mean age of 46.7, ranging from 20 to 79 years old. The respondents were asked to reflect on their recent experience of providing care for their loved ones and how experiences with their caregiver growing up may have influenced their current relationship dynamic. The researchers used Dedoose V.9.0.17 to perform a codebook thematic analysis. Themes from the survey analysis linking childhood to current experience included reciprocating good care, performing obligatory care, and stopping the generational transference of negative care. When focusing on specific parental genders when receiving care in childhood, levels of presence and affection stood out as important aspects of their father’s caregiving. Themes associated with maternal caregiving included good relationships, strained relationships, and nurturing. Knowledge about the impact of childhood experiences can help program designers develop interventions to help lessen caregiver burdens that consider childhood care receiving experiences and the challenges and opportunities they present.
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Affiliation(s)
- Abby Baumbach
- Northern Illinois University, DeKalb, Illinois, United States
| | | | - Lily Derain
- Northern Illinois University, DeKalb, Illinois, United States
| | - Yujun Liu
- Northern Illinois University, Naperville, Illinois, United States
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Liu Y, Zhao Y, Hughes MC. HEALTH BEHAVIORS AND MENTAL HEALTH OUTCOMES OF INFORMAL CAREGIVERS DURING THE COVID-19 PANDEMIC. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.2553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Differences exist in health behaviors and mental health outcomes between spouse and adult children caregivers and between caregivers of individuals with or without dementia. We aimed to examine the change in health behaviors and mental health outcomes of informal caregivers of older adults during the COVID-19 pandemic and explore disparities based on caregiver relationship and care recipient. Using the 2020 National Health and Aging Trends Study (NHATS) COVID-19 supplement for Family Members and Friends, our sample included adult family or friend caregivers of Medicare beneficiaries aged 65 or older in the US (N = 2,062). We used ANOVA and two-way ANCOVA to assess the effects of the pandemic, caregiver relationship type, and care recipient condition (dementia vs. non-dementia) on seven health behaviors and two mental health outcomes. We performed all post hoc analyses using Bonferroni corrections controlling the covariates age, gender, marital status, education, and self-reported health of the caregiver. Compared to before the pandemic and to spouse caregivers, adult children caregivers reported: 1) significantly less time walking and significantly more time watching TV or online programs, and 2) a significantly higher level of emotional distress and depressive symptoms. Compared to caregivers for people without dementia, those who provide care for people with dementia experienced less sleep and a higher level of depressive symptoms during the pandemic than before the pandemic. Health professionals should consider the impact of COVID-19 and the vulnerability of adult children caregivers and caregivers of individuals with dementia when designing and delivering health and wellness programs.
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Affiliation(s)
- Yujun Liu
- Northern Illinois University , Naperville, Illinois , United States
| | - Yuxin Zhao
- Booz Allen Hamilton , Washington, District of Columbia , United States
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Faghani A, Guo L, Wright ME, Hughes MC, Vaezi M. Construction and case study of a novel lung cancer risk index. BMC Cancer 2022; 22:1275. [PMID: 36474178 PMCID: PMC9724373 DOI: 10.1186/s12885-022-10370-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE This study constructs a lung cancer risk index (LCRI) that incorporates many modifiable risk factors using an easily reproducible and adaptable method that relies on publicly available data. METHODS We used meta-analysis followed by Analytic Hierarchy Process (AHP) to generate a lung cancer risk index (LCRI) that incorporates seven modifiable risk factors (active smoking, indoor air pollution, occupational exposure, alcohol consumption, secondhand smoke exposure, outdoor air pollution, and radon exposure) for lung cancer. Using county-level population data, we then performed a case study in which we tailored the LCRI for use in the state of Illinois (LCRIIL). RESULTS For both the LCRI and the LCRIIL, active smoking had the highest weights (46.1% and 70%, respectively), whereas radon had the lowest weights (3.0% and 5.7%, respectively). The weights for alcohol consumption were 7.8% and 14.7% for the LCRI and the LCRIIL, respectively, and were 3.8% and 0.95% for outdoor air pollution. Three variables were only included in the LCRI: indoor air pollution (18.5%), occupational exposure (13.2%), and secondhand smoke exposure (7.6%). The Consistency Ratio (CR) was well below the 0.1 cut point. The LCRIIL was moderate though significantly correlated with age-adjusted lung cancer incidence (r = 0.449, P < 0.05) and mortality rates (r = 0.495, P < 0.05). CONCLUSION This study presents an index that incorporates multiple modifiable risk factors for lung cancer into one composite score. Since the LCRI allows data comprising the composite score to vary based on the location of interest, this measurement tool can be used for any geographic location where population-based data for individual risk factors exist. Researchers, policymakers, and public health professionals may utilize this framework to determine areas that are most in need of lung cancer-related interventions and resources.
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Affiliation(s)
- Ali Faghani
- grid.261128.e0000 0000 9003 8934College of Engineering and Engineering Technology, Northern Illinois University, DeKalb, IL USA
| | - Lei Guo
- grid.261128.e0000 0000 9003 8934School of Interdisciplinary Health Professions, Northern Illinois University, DeKalb, IL USA
| | - Margaret E. Wright
- grid.185648.60000 0001 2175 0319University of Illinois Cancer Center, Chicago, IL USA
| | - M. Courtney Hughes
- grid.261128.e0000 0000 9003 8934School of Health Studies, Northern Illinois University, DeKalb, IL USA
| | - Mahdi Vaezi
- grid.261128.e0000 0000 9003 8934College of Engineering and Engineering Technology, Northern Illinois University, DeKalb, IL USA
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Guo L, Wright ME, Osias MC, Vaezi M, Hughes MC. Creation and Evaluation of the Illinois Cancer Risk Index as a Predictor of Four Common Cancers. Prev Chronic Dis 2022; 19:E75. [DOI: 10.5888/pcd19.220104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Lei Guo
- School of Interdisciplinary Health Professions, Northern Illinois University, DeKalb, Illinois
| | | | - Meredith C. Osias
- School of Health Studies, Northern Illinois University, DeKalb, Illinois
| | - Mahdi Vaezi
- Department of Engineering Technology, Northern Illinois University, DeKalb, Illinois
| | - M. Courtney Hughes
- School of Health Studies, Northern Illinois University, DeKalb, Illinois
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Hughes MC, Spana E, Cada D. Developing a Needs Assessment Process to Address Gaps in a Local System of Care. Community Ment Health J 2022; 58:1329-1337. [PMID: 35072911 PMCID: PMC8785380 DOI: 10.1007/s10597-022-00940-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 01/08/2022] [Indexed: 12/03/2022]
Abstract
Early diagnosis and access to behavioral health services can improve the health outcomes for young children suffering from mental illness. Often, children and their families' behavioral health needs are not met due to a broken local system of care. Developing a deep understanding of the situation by exploring all stakeholders' needs across a community in conjunction with a comprehensive review of the existing scientific literature prepared one rural midwestern county to build a better local system of care. This study's unique aspects include visual mapping using art in focus groups and close collaboration between a public mental health board, academic faculty, student researchers, local behavioral health organizations, and schools. Major themes found about the existing barriers were dysfunctional patterns in families, lack of resources, reliance on the school system, and lack of access to healthcare professionals. Other communities can use this approach as a model for a local needs assessment.
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Affiliation(s)
- M Courtney Hughes
- School of Health Studies, Northern Illinois University, Wirtz Hall 209, DeKalb, IL, 60115, USA.
| | - Ethan Spana
- School of Health Studies, Northern Illinois University, Wirtz Hall 209, DeKalb, IL, 60115, USA
| | - Deanna Cada
- DeKalb County Community Mental Health Board, 2500 N Annie Glidden Rd, DeKalb, IL, 60115, USA
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Faghani A, Hughes MC, Vaezi M. Association of anti-contagion policies with the spread of COVID-19 in United States. J Public Health Res 2022; 11. [PMID: 35332753 PMCID: PMC8991027 DOI: 10.4081/jphr.2022.2748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/10/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The outbreak of a novel coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or COVID-19, raised worldwide concern. The present study investigates the association between anti-contagion policies and the spread of COVID-19 across the United States. DESIGN AND METHODS We selected the most frequently implemented COVID-19 anti-contagion policies in all the U.S. states issued from 29 February 2020. Accordingly, we modified an epidemiological model and combined it with a comprehensive statistical analysis to evaluate the policies' individual and overall likely impact. RESULTS For the first time, a novel index, evaluates the associations between policy implementation and COVID-19 spread at both statewide and national levels. Our results indicate that governmental policies requiring mask use, businesses social distancing, and quarantining travelers may be most effective for controlling COVID-19 spread. Simultaneously, widespread orders like school closure and safer-at-home that can be particularly disruptive to the economy and social fabric of society may be unnecessary given their lack of association with reducing infection. CONCLUSIONS The absence of any COVID-19 vaccines during the first several months of its pandemic necessitated using governmental policies to help stop the spread of this disease. Our index showed the association between implemented policies and COVID-19 spread, highlighting the specific policies with the greatest association - mandatory quarantine upon entering a state, businesses implementing social distancing, and mandatory mask use - and those with less association like school closure and safer-at-home orders. This study provided evidence to inform policy choices for the current global crisis and future pandemics.
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Affiliation(s)
- Ali Faghani
- College of Engineering and Engineering Technology, Northern Illinois University, DeKalb, IL.
| | | | - Mahdi Vaezi
- College of Engineering and Engineering Technology, Northern Illinois University, DeKalb, IL.
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19
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Liu Y, Hughes MC, Baumbach A. Parenting Style in Childhood and Mental Health Outcomes of Caregiving in Middle and Later Adulthood. Innov Aging 2021. [PMCID: PMC8681260 DOI: 10.1093/geroni/igab046.2984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives. This study examined the association between remembered parenting style of both mothers and fathers in childhood and mental health outcomes of caregiving in middle and later adulthood. Methods. Data were from the Midlife in the United States (MIDUS) study, a national survey that included 7,108 participants aged 24 to 75 years at baseline. The sample analyzed in the current study included 244 MIDUS participants who had given personal care to their mothers or fathers for one month or more during the last 12 months in the second and third waves. Parenting style variables, which included maternal/paternal affection and maternal/paternal discipline, were from the first wave; mental health outcome variables, which included emotional distress, depressive symptoms, and life satisfaction, were from the second and third waves. Multiple regression and multilevel modeling were applied using R. Results. Maternal affection was negatively associated with emotional distress. Paternal affection was negatively associated with depressive symptoms. The associations between maternal/paternal discipline and mental health outcomes were not significant. Among the caregivers who provided care for parents, those who had mothers with high affection in childhood experienced a lower level of emotional distress, those who had fathers with high affection experienced a lower level of depressive symptoms in middle and later adulthood. Discussion. Our findings have advanced the understanding of the long-term consequences of parenting style in childhood on mental health outcomes among family caregivers in later life. The results have implications in the development of interventions focusing on mental health outcomes among family caregivers.
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Affiliation(s)
- Yujun Liu
- Northern Illinois University, Naperville, Illinois, United States
| | | | - Abby Baumbach
- Northern Illinois University, DeKalb, Illinois, United States
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20
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Hughes MC, Perry SF. Does blood flow limit acute hypoxia performance in larval zebrafish (Danio rerio)? J Comp Physiol B 2021; 191:469-478. [PMID: 33580284 DOI: 10.1007/s00360-020-01331-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/22/2020] [Accepted: 11/18/2020] [Indexed: 01/21/2023]
Abstract
Oxygen uptake (ṀO2) in larval zebrafish prior to maturation of the gill relies on cutaneous O2 transfer. Under normoxic conditions, rates of cutaneous O2 transfer are unaffected by haemoglobin availability but are diminished in fish lacking a functional circulatory system, suggesting that internal convection is critically involved in setting the resting ṀO2 in zebrafish larvae, even when relying on cutaneous O2 transfer. The reliance of ṀO2 on blood circulation led to the first objective of the current study, to determine whether loss of internal convection would reduce acute hypoxia performance (as determined by measuring critical PO2; Pcrit) in larval zebrafish under conditions of moderate hypoxia (PO2 = 55 mmHg) at 28.5 and 34 °C. Internal convection was eliminated by preventing development of blood vessels using morpholino knockdown of vascular endothelial growth factor (VEGF); these fish are termed VEGF morphants. Breathing frequency (fV) and heart rate (fH) also were measured (at 28.5 °C) to determine whether any detriment in performance might be linked to cardiorespiratory dysfunction. Although ṀO2 was reduced in the VEGF morphants, there was no significant effect on Pcrit at 28.5 °C. Raising temperature to 34 °C resulted in the VEGF morphants exhibiting a higher Pcrit than the shams, suggesting an impairment of hypoxia tolerance in the morphants at the higher temperature. The usual robust increase in fV during hypoxia was absent or attenuated in VEGF morphants at 4 and 5 days post fertilization (dpf), respectively. Resting fH was reduced in the VEGF morphants and unlike the sham fish, the morphants did not exhibit hypoxic tachycardia at 4 or 5 dpf. The number of cutaneous neuroepithelial cells (presumptive O2 chemoreceptors) was significantly higher in the VEGF morphants and thus the cardiorespiratory impairment in the morphants during hypoxia was unlikely related to inadequate peripheral O2 sensing.
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Affiliation(s)
- M C Hughes
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N6N5, Canada
| | - S F Perry
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N6N5, Canada.
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Abstract
There is a disproportionate burden of illness and death among racial/ethnic minorities related to COVID-19. The importance of reaching groups suffering the most with resources such as advance directive guidance, telehealth, and culturally sensitive education materials is vital to providing quality, inclusive care. A crisis presents an opportunity to unite and problem-solve to help avoid the dire consequences facing inaction. In this way, inclusive responses by hospices, social workers, other community partners during the COVID-19 pandemic can help reach and alleviate the pain of those groups most afflicted. We offer hospice inclusion strategies that align with general pandemic response trends that may lead to greater hospice inclusion beyond this public health emergency.
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Affiliation(s)
- M Courtney Hughes
- School of Health Studies, Northern Illinois University , DeKalb, Illinois , USA
| | - Erin Vernon
- Albers School of Business and Economics, Seattle University , Seattle, Washington, USA
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22
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Hughes MC, Vernon E, Kowalczyk M, Basco-Rodillas M. US hospices' approach to racial/ethnic minority inclusion: a qualitative study. BMJ Support Palliat Care 2021:bmjspcare-2020-002680. [PMID: 33574023 DOI: 10.1136/bmjspcare-2020-002680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine hospices' approaches to improving the current racial/ethnic hospice utilisation disparity. METHODS During June and July 2020, we conducted in-depth, semistructured interviews with 22 hospice leaders from across the USA. The interviews focused on inclusive strategy approaches. We analysed the data using qualitative methods. RESULTS Multiple themes emerged about racial/ethnic minority inclusion strategies: (1) hospices tailor strategies to the local communities they serve; (2) improvement involves addressing social determinants of health that extend beyond end-of-life care; (3) costs of strategies are not a primary concern and the benefits are worth the costs; and (4) hospices want to do more to improve their efforts. CONCLUSIONS Hospices want to improve racial/ethnic minority inclusion and can take specific action steps to educate community members about hospice and provide an environment within hospice care that is welcoming to all. Hospice-targeted programmes and policies that facilitate language translation, diversity in staffing, enhanced community outreach, and leadership and staff collaboration regarding inclusion may help hospices achieve success in their efforts toward racial/ethnic minority inclusion.
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Affiliation(s)
- M Courtney Hughes
- School of Health Studies, Northern Illinois University, DeKalb, Illinois, USA
| | - Erin Vernon
- Albers School of Business and Economics, Seattle University, Seattle, Washington, USA
| | - Monica Kowalczyk
- School of Health Studies, Northern Illinois University, DeKalb, Illinois, USA
| | - Marlon Basco-Rodillas
- Albers School of Business and Economics, Seattle University, Seattle, Washington, USA
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Hughes MC, Liu Y, Baumbach A. Impact of COVID-19 on the Health and Well-being of Informal Caregivers of People with Dementia: A Rapid Systematic Review. Gerontol Geriatr Med 2021; 7:23337214211020164. [PMID: 34104687 PMCID: PMC8170284 DOI: 10.1177/23337214211020164] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/06/2021] [Indexed: 01/04/2023] Open
Abstract
Background: In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or COVID-19, raised worldwide concern. Since then, the COVID-19 pandemic has negatively influenced health and wellness across the globe and caused nearly three million deaths. This study focuses on informal caregivers of people with dementia, a disease that affects about 50 million older adults worldwide and requires much caregiving support. Objective: Examine the current literature on the impact of COVID-19 on the health and well-being of informal caregivers for people with dementia. Method: This rapid review was conducted across five electronic databases for quantitative and qualitative articles published through March 15, 2021. Results: The 10 studies included in this review reported quantitative descriptive data from across the globe; however, no studies existed from the U.S. or East Asia countries. All of the studies examined the psychological rather than physical impact of COVID-19 and highlighted risk and protective factors in the areas of psychosocial (resilience, neuropsychiatric, and social isolation), sociodemographic (gender and education), and environmental (home confinement, living arrangement, and dementia stage). Conclusion: COVID-19 has had a considerable negative impact on the psychological well-being of informal caregivers of people with dementia, namely causing more depression and anxiety than pre-pandemic.
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Affiliation(s)
| | - Yujun Liu
- Northern Illinois University,
DeKalb, IL, USA
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24
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Hughes MC, Vernon E, Kowalczyk M, Zhou H. Experiences of caregivers and hospice leaders with telehealth for palliative care: a mixed methods study. Ann Palliat Med 2021; 11:2302-2313. [DOI: 10.21037/apm-21-3899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/10/2022] [Indexed: 11/06/2022]
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25
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Bellissimo CA, Delfinis LJ, Hughes MC, Turnbull PC, Gandhi S, DiBenedetto SN, Rahman F, Tadi P, Amaral C, Dehghani A, Quadrilatero J, Schlattner U, Perry CGR. Correction: Muscle health in a mouse model of Duchenne muscular dystrophy can be partially improved by restoring mitochondrial creatine metabolism. Appl Physiol Nutr Metab 2020; 46:190. [PMID: 33356880 DOI: 10.1139/apnm-2020-1066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- C A Bellissimo
- School of Kinesiology & Health Science, Muscle Health Research Centre, York University, Toronto, ON M3J 1P3, Canada
| | - L J Delfinis
- School of Kinesiology & Health Science, Muscle Health Research Centre, York University, Toronto, ON M3J 1P3, Canada
| | - M C Hughes
- School of Kinesiology & Health Science, Muscle Health Research Centre, York University, Toronto, ON M3J 1P3, Canada
| | - P C Turnbull
- School of Kinesiology & Health Science, Muscle Health Research Centre, York University, Toronto, ON M3J 1P3, Canada
| | - S Gandhi
- School of Kinesiology & Health Science, Muscle Health Research Centre, York University, Toronto, ON M3J 1P3, Canada
| | - S N DiBenedetto
- School of Kinesiology & Health Science, Muscle Health Research Centre, York University, Toronto, ON M3J 1P3, Canada
| | - F Rahman
- Faculty of Applied Health Sciences, Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - P Tadi
- School of Kinesiology & Health Science, Muscle Health Research Centre, York University, Toronto, ON M3J 1P3, Canada
| | - C Amaral
- School of Kinesiology & Health Science, Muscle Health Research Centre, York University, Toronto, ON M3J 1P3, Canada
| | - A Dehghani
- School of Kinesiology & Health Science, Muscle Health Research Centre, York University, Toronto, ON M3J 1P3, Canada
| | - J Quadrilatero
- Faculty of Applied Health Sciences, Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - U Schlattner
- Laboratory of Fundamental and Applied Bioenergetics, and SFR Environmental and Systems Biology, University of Grenoble Alpes, Grenoble, France
| | - C G R Perry
- School of Kinesiology & Health Science, Muscle Health Research Centre, York University, Toronto, ON M3J 1P3, Canada
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Affiliation(s)
- M Courtney Hughes
- School of Health Studies, Northern Illinois University, DeKalb, Illinois, USA
| | - Yihui Elina Tang
- Department of Marketing, Northern Illinois University, DeKalb, Illinois, USA
| | - Shupei Yuan
- Department of Communication, Northern Illinois University, DeKalb, Illinois, USA
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27
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McCulloch E, Cuckler A, Valdes E, Hughes MC. Effectiveness of Online Training and Supervisor Feedback on Safe Eating and Drinking Practices for Individuals With Developmental Disabilities. Intellect Dev Disabil 2020; 58:111-125. [PMID: 32240050 DOI: 10.1352/1934-9556-58.2.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dysphagia is common in individuals with developmental disabilities. Little research exists on the impact of trainings aimed at improving Direct Care Staff's (DCS) use of safe eating and drinking practices. This article presents two studies using pre-and postexperimental design, evaluating online training to improve DCSs' knowledge and ability to identify nonadherence to diet orders. A pilot study (n = 18) informed improvements to the intervention. The follow-up study (n = 64) compared those receiving training with those receiving training plus supervisor feedback. There was no significant difference between groups after training. Both groups increased in knowledge and identification of nonadherence to diet orders. Online training may be an effective tool for training DCS in safe eating and drinking practices.
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Affiliation(s)
- Emaley McCulloch
- Emaley McCulloch, Relias Institute; Audra Cuckler, Easter Seals; Elise Valdes, Relias Institute; and M. Courtney Hughes, Northern Illinois University
| | - Audra Cuckler
- Emaley McCulloch, Relias Institute; Audra Cuckler, Easter Seals; Elise Valdes, Relias Institute; and M. Courtney Hughes, Northern Illinois University
| | - Elise Valdes
- Emaley McCulloch, Relias Institute; Audra Cuckler, Easter Seals; Elise Valdes, Relias Institute; and M. Courtney Hughes, Northern Illinois University
| | - M Courtney Hughes
- Emaley McCulloch, Relias Institute; Audra Cuckler, Easter Seals; Elise Valdes, Relias Institute; and M. Courtney Hughes, Northern Illinois University
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Hughes MC, Vernon E. "We Are Here to Assist All Individuals Who Need Hospice Services": Hospices' Perspectives on Improving Access and Inclusion for Racial/Ethnic Minorities. Gerontol Geriatr Med 2020; 6:2333721420920414. [PMID: 32490039 PMCID: PMC7238442 DOI: 10.1177/2333721420920414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/08/2020] [Accepted: 03/23/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Racial/ethnic minority populations in the United States are less likely to utilize hospice services nearing their end of life, potentially diminishing their quality of care while also increasing medical costs. Objective: Explore the minority hospice utilization gap from the hospice perspective by examining perceived barriers and facilitators as well as practices and policies. Method: Qualitative surveys were conducted with 41 hospices across the United States. Qualitative data analysis included performing a limited content analysis, including the identification of themes and representative quotations. Results: Commonly reported barriers to hospice care for racial/ethnic minorities included culture/beliefs, mistrust of the medical system, and language barriers. A major theme pertaining to successful minority hospice enrollment was an inclusive culture that provided language services, staff cultural training, and a diverse staff. Another major theme was the importance of community outreach activities that extended beyond the medical community and forming relationships with churches, racial/ethnic minority community leaders, and Native American reservations. Conclusion: The importance of incorporating a culture of inclusivity by forming committees, providing language services, and offering culturally competent care emerged in this qualitative study. Building strong external relationships with community groups such as churches is a strategy used to increase racial/ethnic minority utilization of hospice.
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Hughes MC, Vernon E. Closing the Gap in Hospice Utilization for the Minority Medicare Population. Gerontol Geriatr Med 2019; 5:2333721419855667. [PMID: 31276019 PMCID: PMC6598325 DOI: 10.1177/2333721419855667] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 03/10/2019] [Accepted: 04/04/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Medicare spends about 20% more on the last year of life for Black and Hispanic people than White people. With lower hospice utilization rates, racial/ethnic minorities receive fewer hospice-related benefits such as lesser symptoms, lower costs, and improved quality of life. For-profit hospices have higher dropout rates than nonprofit hospices, yet target racial/ethnic minority communities more through community outreach. This analysis examined the relationship between hospice utilization and for-profit hospice status and conducted an economic analysis of racial/ethnic minority utilization. Method: Cross-sectional analysis of 2014 Centers for Medicare & Medicaid Services (CMS), U.S. Census, and Hospice Analytics data. Measures included Medicare racial/ethnic minority hospice utilization, for-profit hospice status, estimated cost savings, and several demographic and socioeconomic variables. Results: The prevalence of for-profit hospices was associated with significantly increased hospice utilization among racial/ethnic minorities. With savings of about $2,105 per Medicare hospice enrollee, closing the gap between the White and racial/ethnic minority populations would result in nearly $270 million in annual cost savings. Discussion: Significant disparities in hospice use related to hospice for-profit status exist among the racial/ethnic minority Medicare population. CMS and state policymakers should consider lower racial/ethnic minority hospice utilization and foster better community outreach at all hospices to decrease patient costs and improve quality of life.
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Affiliation(s)
- M Courtney Hughes
- Northern Illinois University, DeKalb, USA.,Relias Institute, Morrisville, NC, USA
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Hughes MC, Baker TA, Kim H, Valdes EG. Health behaviors and related disparities of insured adults with a health care provider in the United States, 2015-2016. Prev Med 2019; 120:42-49. [PMID: 30639668 DOI: 10.1016/j.ypmed.2019.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 12/31/2018] [Accepted: 01/08/2019] [Indexed: 11/26/2022]
Abstract
Health care providers are in a unique position to address patients' health behaviors and social determinants of health, factors like income and social support that can significantly impact health. There is a need to better understand the risk behaviors of a population that providers may counsel (i.e., those who are insured and have a provider.) Using the 2015 and 2016 CDC's Behavioral Risk Factor Surveillance System, we examine the prevalence of health behaviors and the existence of disparities in health behaviors based on social determinants among American adults. Our sample included noninstitutionalized adults aged 18 to 64 years, in the U.S. (N > 300,000). We used multivariate logistic regression analysis to assess the independent effects of income, education, sex, race, and metropolitan status on nine key health behaviors. Among adults with insurance and a provider (n > 200,000): 1) rates of engaging in poor health behaviors ranged from 6.4% (heavy drinking) to 68.1% (being overweight or obese), 2) rural residence, lower income, and lower education were associated with decreased clinical preventive services, 3) lower income and lower education were associated with lifestyle-related risks, and 4) being black was associated with receiving more cancer screenings, no influenza vaccination, inadequate physical activity, and being overweight or obese. Insured adults, with a provider, are not meeting recommended guidelines for health behaviors. Significant disparities in health behaviors related to social factors exist among this group. Health care providers and organizations may find it helpful to consider these poor health behaviors and disparities when determining strategies to address SDOH.
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Affiliation(s)
- M Courtney Hughes
- School of Health Studies, Northern Illinois University, Wirtz Hall 209, DeKalb, IL 60115, USA.
| | - Tamara A Baker
- Department of Psychology, University of Kansas, 454 Fraser Hall, Lawrence, KS 66045, USA; Gerontology Program, University of Kansas, 3091 Dole, Lawrence, KS 66045, USA.
| | - Hansol Kim
- Gerontology Program, University of Kansas, 3091 Dole, Lawrence, KS 66045, USA.
| | - Elise G Valdes
- Relias Institute, 111 Corning Road, Suite 250, Cary, NC 27518, USA.
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Webb PM, Ibiebele TI, Hughes MC, Beesley J, van der Pols JC, Chen X, Nagle CM, Bain CJ, Chenevix-Trench G. Folate and related micronutrients, folate-metabolising genes and risk of ovarian cancer. Eur J Clin Nutr 2011; 65:1133-40. [PMID: 21629268 DOI: 10.1038/ejcn.2011.99] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVE Folates are essential for DNA synthesis and methylation, and thus may have a role in carcinogenesis. Limited evidence suggests folate-containing foods might protect against some cancers and may partially mitigate the increased risk of breast cancer associated with alcohol intake, but there is little information regarding ovarian cancer. Our aim was to evaluate the role of folate and related micronutrients, polymorphisms in key folate-metabolising genes and environmental factors in ovarian carcinogenesis. SUBJECTS/METHODS Participants in the Australian Ovarian Cancer Study (1363 cases, 1414 controls) self-completed risk factor and food-frequency questionnaires. DNA samples (1638 cases, 1278 controls) were genotyped for 49 tag single-nucleotide polymorphisms (SNPs) in the methylene tetrahydrofolate reductase (MTHFR), methionine synthase (MTR) and MTR reductase (MTRR) genes. Logistic regression models were used to generate adjusted odds ratios and 95% confidence intervals. RESULTS We saw no overall association between the intake of folate, B vitamins or other methyl donors and ovarian cancer risk, although increasing folate from foods was associated with reduced risk among current smokers (P(trend)=0.03) and folic acid intake was associated with borderline significant increased risks among women who consumed ≥1 standard alcoholic drinks/day (odds ratio (OR)=1.64; 95% confidence interval (CI) 1.05-2.54, P(trend)=0.05). Two SNPs (rs7365052, rs7526063) showed borderline significant inverse associations with ovarian cancer risk; both had very low minor allele frequencies. There was little evidence for interaction between genotype and micronutrient intake or for variation between different histological subtypes of ovarian cancer. CONCLUSIONS Our data provide little evidence to support a protective role for folate in ovarian carcinogenesis but suggest further evaluation of the joint effects of folic acid and alcohol is warranted.
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Affiliation(s)
- P M Webb
- Gynaecological Cancers Group, Queensland Institute of Medical Research, Herston, Brisbane, Australia.
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Hughes MC, Yette EM, Hannon PA, Harris JR, Tran NM, Reid TR. Promoting tobacco cessation via the workplace: opportunities for improvement. Tob Control 2011; 20:305-8. [PMID: 21377998 DOI: 10.1136/tc.2010.041038] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Little research exists on the prevalence of evidence-based tobacco cessation practices in workplaces, employer promotion of state-sponsored quitlines and predictors of these practices. METHODS Cross-sectional analysis of the 2008 Healthy Worksite Survey, a telephone survey administered to Washington employers with 50 or more employees (n=693). The objectives were to describe workplaces' implementation of evidence-based tobacco cessation practices and identify key predictors of implementation in order to highlight opportunities for interventions. RESULTS Among these employers, 38.6% promoted quitting tobacco, and 33.8% offered insurance coverage for cessation medications and counselling, 27.5% referred no-smoking violators to cessation services, and 5.7% included the state-sponsored quitline in health promotion messages. Larger workplaces and workplaces with a wellness staff, committee or coordinator had greater insurance coverage for tobacco cessation, communications promoting tobacco cessation, and promotion of the state-sponsored quitline (p<0.01). Workplaces with a wellness staff, committee or coordinator referred more violators of no-smoking policies to cessation services (p<0.01). CONCLUSIONS In Washington State workplaces do little to promote tobacco cessation by their employees. The lack of tobacco cessation promoting practices at small businesses, restaurants and bars, and businesses without wellness personnel indicates an opportunity for finding and reaching current smokers at businesses with limited resources. By adopting inexpensive prevention efforts, such as promoting the state-sponsored tobacco cessation quitline, employers can help employees quit smoking and, thereby, assist in improving employee health and lower medical costs.
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Affiliation(s)
- M Courtney Hughes
- Department of Health Services, The University of Washington, Box 354804, Seattle, WA 98195, USA.
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Abstract
Purpose. To examine the prevalence of health behaviors, including clinical preventive services and lifestyle risk behaviors, among insured workers and to determine whether disparities in health behaviors based on demographic factors exist among this group. Design. Cross-sectional analysis of 2004–2005 Behavioral Risk Factor Surveillance System data. Setting. United States. Subjects. A representative sample of noninstitutionalized employed and insured adults aged 18 to 64 years (139,738 in 2004 and 159,755 in 2005). Measures. Self-reported clinical preventive services utilization and lifestyle-related behaviors, as well as multiple logistic regression analyses assessing the independent effects of demographic and access variables on health behaviors. Results. Among insured workers, rates of not using recommended clinical preventive services ranged from 8.5% (cervical cancer screening) to 73.9% (influenza vaccination). Rates for engaging in lifestyle-related risks ranged from 5.5% (heavy drinking) to 77.1% (inadequate fruit-vegetable consumption). In multivariate analyses, lower income, lower education, cost as a barrier to health care, and no health care provider were associated with significantly decreased clinical preventive services utilization (p < .01). Lower education and no health care provider were associated with lifestyle-related risks (p < .01). Conclusions. Working insured adults are not meeting recommendations for health behaviors. Significant disparities in health behaviors related to socioeconomic status exist among this group. Employers and insurers should consider these poor health behaviors and disparities when designing insurance benefits addressing clinical preventive services utilization and workplace health promotion programs addressing lifestyle-related behaviors.
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Affiliation(s)
- M. Courtney Hughes
- M. Courtney Hughes, PhD, MS; Peggy A. Hannon, PhD, MPH; Jeffrey R. Harris, MD, MPH, MBA; and Donald L. Patrick, PhD, MSPH, were all with the Department of Health Services, University of Washington School of Public Health and Community Medicine, Seattle, at the time of the study
| | - Peggy A. Hannon
- M. Courtney Hughes, PhD, MS; Peggy A. Hannon, PhD, MPH; Jeffrey R. Harris, MD, MPH, MBA; and Donald L. Patrick, PhD, MSPH, were all with the Department of Health Services, University of Washington School of Public Health and Community Medicine, Seattle, at the time of the study
| | - Jeffrey R. Harris
- M. Courtney Hughes, PhD, MS; Peggy A. Hannon, PhD, MPH; Jeffrey R. Harris, MD, MPH, MBA; and Donald L. Patrick, PhD, MSPH, were all with the Department of Health Services, University of Washington School of Public Health and Community Medicine, Seattle, at the time of the study
| | - Donald L. Patrick
- M. Courtney Hughes, PhD, MS; Peggy A. Hannon, PhD, MPH; Jeffrey R. Harris, MD, MPH, MBA; and Donald L. Patrick, PhD, MSPH, were all with the Department of Health Services, University of Washington School of Public Health and Community Medicine, Seattle, at the time of the study
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Hughes MC, Patrick DL, Hannon PA, Harris JR, Ghosh DL. Understanding the decision-making process for health promotion programming at small to midsized businesses. Health Promot Pract 2009; 12:512-21. [PMID: 19843701 DOI: 10.1177/1524839909349162] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study explores the decision-making process for implementing and continuing health promotion programs at small to midsized businesses to inform health promotion practitioners and researchers as they market their services to these businesses. Qualitative interviews are conducted with 24 employers located in the Pacific Northwest ranging in size from 75 to 800 employees, with the majority having between 100 and 200 employees. Small to midsized employers depend most on company success-related factors rather than on humanitarian motives when deciding whether to adopt workplace health promotion programs. They rely heavily on health insurers for health promotion and desire more information about the actual costs and cost-benefits of programs. To increase health promotion adoption at small to midsized businesses, health promotion practitioners should appeal to overall company success-related factors, use the insurance channel, and target their information to both human resource personnel and senior management.
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Affiliation(s)
- M Courtney Hughes
- Health Promotion Research Center, University of Washington School of Public Health and Community Medicine, Seattle, Washington, USA.
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Abstract
Due to the growing knowledge about the role of specific fatty acids in health and disease, dietary intake measurements of individual fatty acids or classes of fatty acids are becoming increasingly important. The objective of this study was to evaluate the ability of the Nambour FFQ to estimate intakes of specific fatty acids, particularly PUFA. The study population was a sub-sample of adult participants in a randomised controlled trial of beta-carotene and sunscreen in the prevention of skin cancer (n 43). Dietary intake was assessed by a self-administered FFQ and a weighed food record (WFR). Non-fasting blood samples were collected and analysed for plasma phospholipid fatty acids. Median intakes on the FFQ were generally higher than the WFR except for the n-3 PUFA groups, where the FFQ estimated higher intakes. Correlations between the FFQ and WFR were moderate (r 0 x 32-0 x 59) except for trans fatty acids (r 0 x 03). Correlations between each of the dietary assessment methods and the plasma phospholipids were poor for all fatty acids other than the PUFA. Using the methods of triads approach, the FFQ validity coefficients for total n-3 fatty acids, total long chain n-3 fatty acids, EPA, arachidonic acid, docosapentaenoic acid and DHA were 0 x 50, 0 x 63, 0 x 45 and 0 x 62 and 0 x 62, respectively. For most fatty acids, the FFQ adequately estimates group mean fatty acid intakes and can adequately rank individuals; however, the ability of this FFQ to estimate trans fatty acids was poor.
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Affiliation(s)
- S A McNaughton
- School of Population Health, University of Queensland, Herston, Australia.
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Abstract
OBJECTIVE To investigate the association between total alcohol intake and intake of different types of alcoholic beverages in relation to the risk of basal cell (BCC) and squamous cell (SCC) carcinoma of the skin. DESIGN Prospective cohort study. SETTING Follow-up data from a community-based skin cancer study in Australia. SUBJECTS Randomly selected sample of 1360 adult residents of the township of Nambour who completed a food frequency questionnaire in 1992 and were monitored for BCC and SCC until 31 December 2002. RESULTS No significant association was found between overall BCC or SCC risk and total alcohol intake, or intake of beer, white wine, red wine or sherry and port. However, among those with a prior skin cancer history, there was a significant doubling of risk of SCC for above-median consumption of sherry and port (multivariable adjusted relative risk 2.46, 95% confidence interval 1.06-5.72) compared with abstainers. CONCLUSIONS There are no associations between first occurrence of skin cancers and alcoholic beverage consumption. People with a history of skin cancer who consume above-average quantities of sherry or port may be at a raised risk of SCC, although replication of these findings in different study populations is needed to confirm this possible role of specific alcoholic beverages in secondary keratinocytic skin cancer risk.
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Affiliation(s)
- T M R Ansems
- Cancer and Population Studies Group, Queensland Institute of Medical Research, Queensland, Australia
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Hughes RG, Sharp DS, Hughes MC, Akau'ola S, Heinsbroek P, Velayudhan R, Schulz D, Palmer K, Cavalli-Sforza T, Galea G. Environmental influences on helminthiasis and nutritional status among Pacific schoolchildren. Int J Environ Health Res 2004; 14:163-177. [PMID: 15203448 DOI: 10.1080/0960312042000218589] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This paper describes a study undertaken to: (1) determine the prevalence of Ascaris lumbricoides, Trichuris trichiura and hookworm infections and nutritional status among Pacific Island school children; (2) identify factors influencing helminthiasis; (3) identify interventions to improve school health. A total of 3,683 children aged 5-12 years attending 27 primary schools in 13 Pacific Island countries were surveyed along with school environmental data. Stool samples were collected from 1996 children (54.2%) and analysed for ova and helminths. Total prevalence of helminthiasis was 32.8%. Anaemia prevalence was 12.4%. Children with helminthiasis and anaemia were found to be 8.7 times more likely to be stunted and 4.3 times more likely to be underweight than non-anaemic and non-infected children. Four significant environmental influences on helminthiasis were identified: (1) an inadequate water supply; (2); availability of a school canteen; (3) regular water/sanitation maintenance regimes; and (4) overcrowded classrooms. Helminthiasis was found to be strongly associated with anaemia, stunting and underweight and environmental influences identified. Although mass anti-helminthic drug administrations (MDA) have been taking place, reinfection is common as drug therapy alone is not enough. Programme effectiveness depends upon upgrading school environments to include an adequate water supply, controlled food preparation/provision, well-maintained water/sanitation facilities and class sizes of 30 students or less.
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Affiliation(s)
- R G Hughes
- Nutrition Program, Australian Centre for International & Tropical Health & Nutrition, University of Queensland, Brisbane, Australia.
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Clemens NA, Bebchuk W, Beitman BD, Blinder BJ, Gabbard GO, Goin MK, Hughes MC, Kay J, Kimmich RA, Lazar SG, Reiss D, Szigethy EM, Tasman A. Disputing psychiatry's redefinition. Am J Psychiatry 1997; 154:1633-5. [PMID: 9356592 DOI: 10.1176/ajp.154.11.1633] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Hughes MC. Critical care nursing for the patient with a spinal cord injury. Crit Care Nurs Clin North Am 1990; 2:33-40. [PMID: 2357313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Knowledge of the dynamics of spinal cord injury to anticipate the myriad of physiologic and psychological complications is essential for effective interventions to achieve optimal patient outcomes. Continuous expert nursing care must be provided to ensure that the patient survives life-threatening events and to facilitate optimal adaptation of the patient and family during this enormous emotional upheaval of their lives. Given the devastating effects of a spinal cord injury, the critical care nurse faces one of the most complex and potentially rewarding challenges of his or her career.
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Hughes MC, Goldman BL, Snyder NF. Hyperactivity and the attention deficit disorder. Am Fam Physician 1983; 27:119-26. [PMID: 6858813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The attention deficit disorder is a clinical syndrome manifested by inattention, impulsivity and hyperactivity beginning before age seven and persisting for at least six months. The family physician plays a key role in consolidating the observations of parents and teachers with the findings on medical evaluation. The physician also initiates the comprehensive treatment program with counseling and stimulant medication, and coordinates the use of special education, mental health and other resources as needed.
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Abstract
Children hospitalized with psychogenic abdominal pain and the children's families are discussed from the perspective of a child psychiatrist working within the pediatric hospital. Psychosocial and emotional difficulties for the child and parents are noted as families use somatic symptoms to deal with psychic distress. Principles for management are emphasized, utilizing a comprehensive team approach by physicians, nurses, and other health professionals. Through constructive use of hospitalization and informed follow-up, these children and their parents can be helped toward symptomatic improvement and a more meaningful understanding and resolution of their underlying emotional difficulties.
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