1
|
Hernandez R, Pyatak EA, Vigen CLP, Jin H, Schneider S, Spruijt-Metz D, Roll SC. Understanding Worker Well-Being Relative to High-Workload and Recovery Activities across a Whole Day: Pilot Testing an Ecological Momentary Assessment Technique. Int J Environ Res Public Health 2021; 18:10354. [PMID: 34639654 PMCID: PMC8507775 DOI: 10.3390/ijerph181910354] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 11/21/2022]
Abstract
Occupational health and safety is experiencing a paradigm shift from focusing only on health at the workplace toward a holistic approach and worker well-being framework that considers both work and non-work factors. Aligned with this shift, the purpose of this pilot study was to examine how, within a person, frequencies of high-workload and recovery activities from both work and non-work periods were associated with same day well-being measures. We analyzed data on 45 workers with type 1 diabetes from whom we collected activity data 5-6 times daily over 14 days. More frequent engagement in high-workload activities was associated with lower well-being on multiple measures including higher stress. Conversely, greater recovery activity frequency was mostly associated with higher well-being indicated by lower stress and higher positive affect. Overall, our results provide preliminary validity evidence for measures of high-workload and recovery activity exposure covering both work and non-work periods that can inform and support evaluations of worker well-being.
Collapse
Affiliation(s)
- Raymond Hernandez
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (E.A.P.); (C.L.P.V.); (S.C.R.)
| | - Elizabeth A. Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (E.A.P.); (C.L.P.V.); (S.C.R.)
| | - Cheryl L. P. Vigen
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (E.A.P.); (C.L.P.V.); (S.C.R.)
| | - Haomiao Jin
- Dornsife Center for Economic & Social Research, University of Southern California, Los Angeles, CA 90089, USA; (H.J.); (S.S.); (D.S.-M.)
| | - Stefan Schneider
- Dornsife Center for Economic & Social Research, University of Southern California, Los Angeles, CA 90089, USA; (H.J.); (S.S.); (D.S.-M.)
| | - Donna Spruijt-Metz
- Dornsife Center for Economic & Social Research, University of Southern California, Los Angeles, CA 90089, USA; (H.J.); (S.S.); (D.S.-M.)
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
| | - Shawn C. Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA; (E.A.P.); (C.L.P.V.); (S.C.R.)
| |
Collapse
|
2
|
Schepens Niemiec SL, Vigen CLP, Martínez J, Blanchard J, Carlson M. Long-Term Follow-Up of a Lifestyle Intervention for Late-Midlife, Rural-Dwelling Latinos in Primary Care. Am J Occup Ther 2021; 75:7502205020p1-7502205020p11. [PMID: 33657344 PMCID: PMC7929605 DOI: 10.5014/ajot.2021.042861] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Indexed: 11/30/2022] Open
Abstract
Importance: Rural-dwelling Latinos are an underresourced population in need of accessible and effective wellness programs. Objective: To evaluate patients’ long-term health-related outcomes after lifestyle intervention. Design: An uncontrolled pilot trial assessing change in health from pretreatment to long-term follow-up (12 mo after intervention completion, no contact) and from posttreatment to long-term follow-up. Setting: Rural, community-based primary care. Participants: Latino and Hispanic safety-net primary care patients, ages 50 to 64 yr. Intervention: A culturally tailored, 4-mo lifestyle intervention co-led by occupational therapy practitioners and Latino community health workers that features telehealth and in-home sessions covering topics such as healthy eating and navigating health care. Outcomes and Measures: Self-reported and physiological outcomes: symptom–well-being (primary), stress, sleep disturbance, social satisfaction, physical activity, patient activation, blood pressure, and weight. Exit interviews addressed health experiences and intervention impact on participants’ lives. Results: Participants (N = 27) demonstrated clinically significant pretreatment to long-term follow-up benefits in all symptom–well-being dimensions (Cohen’s d ≥ 0.8, p ≤ .004), with additional gains from posttreatment to long-term follow-up (d ≥ 0.4, p ≤ .05). Significant improvements from pre- to posttreatment in systolic blood pressure, stress, and social role and activity satisfaction were maintained at long-term follow-up. No changes were observed in weight, physical activity, or diastolic blood pressure. Participants described the intervention’s sustained positive effect on their wellness. Conclusions and Relevance: A lifestyle intervention led by occupational therapy practitioners and community health workers in a primary care context has potential to achieve long-term health benefits in rural-dwelling, late-midlife Latinos. What This Article Adds: This study reveals that rural, late-midlife Latinos showed long-lasting improvements in psychological and physical health after finishing a program that helped them make healthy lifestyle choices. This finding supports the unique contribution of occupational therapy in primary care settings.
Collapse
Affiliation(s)
- Stacey L Schepens Niemiec
- Stacey L. Schepens Niemiec, PhD, OTR/L, is Associate Professor of Research, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles;
| | - Cheryl L P Vigen
- Cheryl L. P. Vigen, PhD, is Associate Professor of Research, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Jenny Martínez
- Jenny Martínez, OTD, OTR/L, BCG, is Associate Professor, Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA
| | - Jeanine Blanchard
- Jeanine Blanchard, PhD, OTR/L, is Project Manager, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Mike Carlson
- Mike Carlson, PhD, is Professor of Research, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| |
Collapse
|
3
|
González JL, Prabhakar R, Marks J, Vigen CLP, Shukla J, Bannister B. Reducing the Pain Behind Opioid Prescribing in Primary Care. Pain Med 2020; 21:1377-1384. [PMID: 32022892 DOI: 10.1093/pm/pnz365] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the efficacy of a comprehensive approach aimed at reducing opioid prescribing in an internal medicine resident clinic. DESIGN Retrospective observational study. SETTING Internal medicine primary care resident clinic at a large urban academic medical center. SUBJECTS All patients receiving opioid prescriptions from the primary care clinic. METHODS We reviewed pharmacy dispensing data for two hospital-affiliated pharmacies for resident primary care patients filling opioid prescriptions between July 2016 and July 2018. We instituted a comprehensive set of interventions that included resident education, limiting supervision of encounters for long-term opioid therapy (LTOT) to a fixed set of faculty champions, and providing alternate modalities for pain control. We calculated the change in number of opioid prescriptions dispensed, number of patients receiving opioid prescriptions, morphine milligram equivalents (MMEs) dispensed, and average per-patient daily MMEs dispensed. RESULTS We observed an average monthly reduction of 2.44% (P < 0.001) in the number of prescriptions dispensed and a 1.83% (P < 0.001) monthly reduction in the number of patients receiving prescriptions. Over the two-year period, there was a 74.3% reduction in total MMEs prescribed and a 66.5% reduction in the average MMEs prescribed per patient. CONCLUSIONS Our findings demonstrate a significant reduction in opioid prescribing after implementation of a comprehensive initiative. Although our study was observational in nature, we witnessed a nearly threefold decrease in opioid prescribing compared with national trends. Our results offer important insights for other primary care resident clinics hoping to engender safe prescribing practices and curb high-dose opioid prescribing.
Collapse
Affiliation(s)
- José Luis González
- University of Southern California, Los Angeles, California.,LAC+USC Medical Center, Los Angeles, California.,USC Gehr Family Center for Health Systems Science, University of Southern California, Los Angeles, California
| | - Radhika Prabhakar
- University of Southern California, Los Angeles, California.,LAC+USC Medical Center, Los Angeles, California
| | - Jennifer Marks
- University of Southern California, Los Angeles, California.,LAC+USC Medical Center, Los Angeles, California
| | - Cheryl L P Vigen
- University of Southern California, Los Angeles, California.,Biostatistics, Epidemiology, and Research Design (BERD), University of Southern California, Los Angeles, California.,Southern California Clinical and Translational Science Institute (SC CTSI)
| | | | | |
Collapse
|
4
|
Pyatak EA, Carlson M, Vigen CLP, Blanchard J, Niemiec SS, Sideris J, Baranek GT. Contextualizing the Positive Effects of the Well Elderly 2 Trial: A Response to Schelly and Ohl (2019). Am J Occup Ther 2020; 73:7306205100p1-7306205100p11. [PMID: 31891349 DOI: 10.5014/ajot.2019.038752] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE A recent reanalysis of data from the Well Elderly (WE) 2 study purportedly indicated that the intervention did not achieve clinically meaningful or statistically significant effects; this article addresses these criticisms. OBJECTIVE To contextualize the WE 2 study as targeting a nonclinical population and demonstrate that the intervention produced substantively important, statistically significant effects. DESIGN Secondary analysis of WE 2 intervention-based pre-post change scores. SETTING The original trial occurred primarily in senior centers and senior housing facilities in greater Los Angeles. PARTICIPANTS Independent-living older adults (N = 324) who were assessed before and after intervention. INTERVENTION The WE intervention, a version of the Lifestyle Redesign® (LR) approach, was administered by occupational therapists over 6 mo by means of group and individual sessions. OUTCOMES AND MEASURES The 36-item Short Form Health Survey, the Life Satisfaction Index-Z, and the Center for Epidemiologic Studies Depression Scale. RESULTS The WE intervention was associated with statistically significant improvement on 10 of 12 outcome variables that were examined. CONCLUSIONS AND RELEVANCE Because the WE intervention was hypothesized to reduce age-related decline and followed a population-oriented approach, the expectation that average results would be clinically meaningful was inappropriate. The intervention produced positive effects across a wide array of outcome domains. In settings in which clinical meaningfulness is an appropriate index of intervention outcomes, evidence suggests that LR produces effects that are clinically meaningful. As an evidence-based intervention, LR should be considered useful both in population-oriented contexts and in addressing discrete health conditions. WHAT THIS ARTICLE ADDS Valid analyses demonstrate that the positive experimental effects of the WE 2 study are, in fact, genuine and cost-effective, and LR in clinically oriented contexts has produced statistically significant, clinically meaningful results. Clearly and accurately representing the evidence base of occupational therapy in prevention and chronic care is of critical importance to advance the field as a whole.
Collapse
Affiliation(s)
- Elizabeth A Pyatak
- Elizabeth A. Pyatak, PhD, OTR/L, CDE, FAOTA, is Associate Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles; .,E. A. Pyatak and M. Carlson contributed equally to the conceptualization and writing of this article and should be considered co-first authors
| | - Mike Carlson
- Mike Carlson, PhD, is Professor of Research, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Cheryl L P Vigen
- Cheryl L. P. Vigen, PhD, is Associate Professor of Research, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Jeanine Blanchard
- Jeanine Blanchard, PhD, OTR/L, is Project Manager, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Stacey Schepens Niemiec
- Stacey Schepens Niemiec, PhD, OTR/L, is Assistant Professor of Research, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - John Sideris
- John Sideris, PhD, is Professor of Research, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Grace T Baranek
- Grace T. Baranek, PhD, OTR/L, FAOTA, is Associate Dean, Chair, and Mrs. T. H. Chan Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| |
Collapse
|
5
|
Pyatak E, King M, Vigen CLP, Salazar E, Diaz J, Schepens Niemiec SL, Blanchard J, Jordan K, Banerjee J, Shukla J. Addressing Diabetes in Primary Care: Hybrid Effectiveness-Implementation Study of Lifestyle Redesign ® Occupational Therapy. Am J Occup Ther 2019; 73:7305185020p1-7305185020p12. [PMID: 31484021 DOI: 10.5014/ajot.2019.037317] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
IMPORTANCE Primary health care is rapidly developing as an occupational therapy practice area. Yet, to date, little evidence supports occupational therapy's feasibility and efficacy in primary care settings. OBJECTIVE To report on the implementation and preliminary clinical outcomes of a Lifestyle Redesign® (LR)-occupational therapy (LR-OT) diabetes management intervention in a primary care clinic. DESIGN Patients were randomized to be offered LR-OT or to a no-contact comparison group (data not reported). We assessed implementation outcomes using mixed methods. SETTING Safety-net primary care clinic. PARTICIPANTS Clinic providers and staff; English- or Spanish-speaking clinic patients ages 18-75 yr with diabetes and a current hemoglobin A1c (HbA1c) ≥ 9.0%. INTERVENTION Eight 1-hr individual sessions of LR-OT focused on diabetes management. OUTCOMES AND MEASURES Clinical and health behavior outcomes were assessed via electronic medical record (EMR) review and self-report surveys of patients receiving LR-OT at initial evaluation and discharge. We assessed implementation outcomes (acceptability, appropriateness, feasibility, fidelity, efficiency, and timeliness) using patient and staff surveys, interviews, focus groups, and observations. RESULTS Seventy-three patients were offered LR-OT: 51 completed one or more sessions, and 38 completed the program. Clinical outcomes among program completers indicate beneficial changes in HbA1c, diabetes self-care, and health status. Implementation challenges included a need for patient and staff education, securing adequate workspace, and establishing a referral process. Factors contributing to implementation success included strong buy-in from clinic leadership, colocation, and shared EMR documentation. CONCLUSIONS AND RELEVANCE LR-OT is a feasible approach to enhancing service delivery and clinical outcomes in primary care. WHAT THIS ARTICLE ADDS This study provides insight into factors that may create challenges or contribute to the success of implementing occupational therapy services within primary health care settings. In addition, this study provides preliminary evidence of occupational therapy's effectiveness in improving clinical outcomes among ethnically diverse, low-income patients with diabetes in a safety-net primary care setting.
Collapse
Affiliation(s)
- Elizabeth Pyatak
- Elizabeth Pyatak, PhD, OTR/L, CDE, is Associate Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles;
| | - Maggie King
- Maggie King, MA, OTR/L, is Doctorate of Occupational Therapy Resident, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Cheryl L P Vigen
- Cheryl L. P. Vigen, PhD, is Associate Professor of Research, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Elia Salazar
- Elia Salazar, MPH, is Project Specialist, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Jesus Diaz
- Jesus Diaz, OTD, OTR/L, is Associate Professor of Research, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Stacey L Schepens Niemiec
- Stacey L. Schepens Niemiec, PhD, OTR/L, is Assistant Professor of Research, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Jeanine Blanchard
- Jeanine Blanchard, PhD, OTR/L, is Project Manager, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Katie Jordan
- Katie Jordan, OTD, OTR/L, is Associate Chair of Occupational Therapy Clinical Services, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Josh Banerjee
- Josh Banerjee, MD, is Associate Medical Director for Transitions of Care, Los Angeles County+University of Southern California Medical Center, Los Angeles County Department of Health Services, Los Angeles, CA
| | - Jagruti Shukla
- Jagruti Shukla, MD, is Director of Primary Care, Los Angeles County+University of Southern California Medical Center, Los Angeles County Department of Health Services, Los Angeles, CA
| |
Collapse
|
6
|
Vigen CLP, Carandang K, Blanchard J, Sequeira PA, Wood JR, Spruijt-Metz D, Whittemore R, Peters AL, Pyatak EA. Psychosocial and Behavioral Correlates of A1C and Quality of Life Among Young Adults With Diabetes. Diabetes Educ 2018; 44:489-500. [PMID: 30295170 DOI: 10.1177/0145721718804170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The purpose of this study was to evaluate relationships between behavioral and psychosocial constructs, A1C, and diabetes-dependent quality of life (DQoL) among low-socioeconomic status, ethnically diverse young adults with diabetes. METHODS Using baseline data of 81 participants in the Resilient, Empowered, Active Living (REAL) randomized controlled trial, behavioral, cognitive, affective, and experiential variables were correlated with A1C and DQoL while adjusting for demographic characteristics, and these relationships were examined for potential effect modification. RESULTS The data indicate that depressive symptoms and satisfaction with daily activities are associated with both A1C and DQoL, while diabetes knowledge and participation in daily activities are associated with neither A1C nor DQoL. Two constructs, diabetes distress and life satisfaction, were associated with DQoL and were unrelated to A1C, while 2 constructs, self-monitoring of blood glucose and medication adherence, were associated with A1C but unrelated to DQoL. These relationships were largely unchanged by adjusting for demographic characteristics, while numerous effect modifications were found. CONCLUSION The data suggest that when tailoring interventions, depressive symptoms and satisfaction with daily activities may be particularly fruitful intervention targets, as they represent modifiable risk factors that are associated with both A1C and DQoL.
Collapse
Affiliation(s)
- Cheryl L P Vigen
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Kristine Carandang
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Jeanine Blanchard
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Paola A Sequeira
- Department of Pediatrics, University of Southern California, Los Angeles, California
| | - Jamie R Wood
- Children's Hospital Los Angeles, Los Angeles, California
| | - Donna Spruijt-Metz
- Dornsife Center for Economic and Social Research, University of Southern California, Los Angeles, California
| | | | - Anne L Peters
- Division of Endocrinology, University of Southern California, Beverly Hills, California
| | - Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| |
Collapse
|
7
|
Pyatak EA, Carandang K, Vigen CLP, Blanchard J, Diaz J, Concha-Chavez A, Sequeira PA, Wood JR, Whittemore R, Spruijt-Metz D, Peters AL. Occupational Therapy Intervention Improves Glycemic Control and Quality of Life Among Young Adults With Diabetes: the Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) Randomized Controlled Trial. Diabetes Care 2018; 41:696-704. [PMID: 29351961 PMCID: PMC5860833 DOI: 10.2337/dc17-1634] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/17/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the efficacy of a manualized occupational therapy (OT) intervention (Resilient, Empowered, Active Living with Diabetes [REAL Diabetes]) to improve glycemic control and psychosocial well-being among ethnically diverse young adults with low socioeconomic status (SES) who have type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODS Eighty-one young adults (age 22.6 ± 3.5 years; hemoglobin A1c [HbA1c] = 10.8%/95 mmol/mol ± 1.9%/20.8 mmol/mol) were randomly assigned to the REAL Diabetes intervention group (IG) or an attention control group (CG) over 6 months. IG participants received biweekly sessions guided by a manual composed of seven content modules; CG participants received standardized educational materials and biweekly phone calls. Blinded assessors collected data at baseline and 6 months. The primary outcome was HbA1c; secondary outcomes included diabetes self-care, diabetes-related quality of life (QOL), diabetes distress, depressive symptoms, and life satisfaction. Change scores were analyzed using Wilcoxon rank sum tests. RESULTS Intent-to-treat analyses showed that IG participants showed significant improvement in HbA1c (-0.57%/6.2 mmol/mol vs. +0.36%/3.9 mmol/mol, P = 0.01), diabetes-related QOL (+0.7 vs. +0.15, P = 0.04), and habit strength for checking blood glucose (+3.9 vs. +1.7, P = 0.05) as compared with CG participants. There was no statistically significant effect modification by sex, ethnicity, diabetes type, recruitment site, or SES. No study-related serious adverse events were reported. CONCLUSIONS The REAL Diabetes intervention improved blood glucose control and diabetes-related QOL among a typically hard-to-reach population, thus providing evidence that a structured OT intervention may be beneficial in improving both clinical and psychosocial outcomes among individuals with diabetes.
Collapse
Affiliation(s)
- Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Kristine Carandang
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Cheryl L P Vigen
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Jeanine Blanchard
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Jesus Diaz
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Alyssa Concha-Chavez
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Paola A Sequeira
- Department of Pediatrics, University of Southern California, Los Angeles, CA
| | - Jamie R Wood
- Children's Hospital Los Angeles, Los Angeles, CA
| | | | - Donna Spruijt-Metz
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA
| | - Anne L Peters
- Division of Endocrinology, University of Southern California, Beverly Hills, CA
| |
Collapse
|
8
|
Schepens Niemiec SL, Blanchard J, Vigen CLP, Martínez J, Guzmán L, Fluke M, Carlson M. A Pilot Study of the ¡Vivir Mi Vida! Lifestyle Intervention for Rural-Dwelling, Late-Midlife Latinos: Study Design and Protocol. OTJR (Thorofare N J) 2018. [PMID: 29514544 DOI: 10.1177/1539449218762728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 11/16/2022]
Abstract
Older, rural-dwelling Latinos face multiple health disparities. We describe the protocol of a pilot study of a community health worker-occupational therapist-led lifestyle program, ¡Vivir Mi Vida! ( ¡VMV!), designed for delivery in primary care and adapted for late-midlife, Latino rural-living patients. Using mixed methods, we collected feasibility, acceptability, and preliminary efficacy data on ¡VMV!. Forty 50- to 64-year-old Latinos participated in a 16-week lifestyle intervention led by a community health worker-occupational therapist team. We conducted pre- and post-intervention assessments to evaluate the efficacy of ¡VMV! in improving psychosocial and clinical health outcomes. Focus groups and interviews were held post-intervention with participants and key stakeholders to assess feasibility and acceptability. This is the first trial designed to evaluate a lifestyle intervention that includes collaboration between occupational therapists and community health workers within primary care. The detailed description of methodology promotes research transparency and reproducibility of a community health worker-occupational therapist-led lifestyle intervention.
Collapse
Affiliation(s)
| | | | | | | | - Laura Guzmán
- 1 University of Southern California, Los Angeles, USA
| | - Michelle Fluke
- 2 Antelope Valley Partners for Health, Lancaster, CA, USA
| | - Mike Carlson
- 1 University of Southern California, Los Angeles, USA
| |
Collapse
|
9
|
Pyatak EA, Sequeira PA, Vigen CLP, Weigensberg MJ, Wood JR, Montoya L, Ruelas V, Peters AL. Clinical and Psychosocial Outcomes of a Structured Transition Program Among Young Adults With Type 1 Diabetes. J Adolesc Health 2017; 60:212-218. [PMID: 27889401 PMCID: PMC5253301 DOI: 10.1016/j.jadohealth.2016.09.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 03/16/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE We identified and treated young adults with type 1 diabetes who had been lost to follow-up during their transfer from pediatric to adult care, comparing their clinical, psychosocial, and health care utilization outcomes to participants receiving continuous care (CC) throughout the transition to adult care. METHODS Individuals in their last year of pediatric care (CC group, n = 51) and individuals lost to follow-up in the transfer to adult care ("lapsed care" [LC] group, n = 24) were followed prospectively for 12 months. All participants were provided developmentally tailored diabetes education, case management, and clinical care through a structured transition program. RESULTS At baseline, LC participants reported lapses in care of 11.6 months. Compared with CC participants, they had higher hemoglobin A1C (A1C; p = .005), depressive symptoms (p = .05), incidence of severe hypoglycemia (p = .005), and emergency department visits (p = .004). At 12-month follow-up, CC and LC participants did not differ on the number of diabetes care visits (p = .23), severe hypoglycemia (no events), or emergency department visits (p = .22). Both groups' A1C improved during the study period (CC: p = .03; LC: p = .02). LC participants' depressive symptoms remained elevated (p = .10), and they reported a decline in life satisfaction (p = .007). There was greater loss to follow-up in the LC group (p = .04). CONCLUSIONS Our study suggests that, for young adults with a history of lapses in care, a structured transition program is effective in lowering A1C, reducing severe hypoglycemia and emergency department utilization, and improving uptake of routine diabetes care. Loss to follow-up and psychosocial concerns remain significant challenges in this population.
Collapse
Affiliation(s)
- Elizabeth A. Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St., CHP-133, Los Angeles, California, 90089-9003
| | - Paola A. Sequeira
- Department of Pediatrics, University of Southern California, 2020 Zonal Ave, IRD 127, Los Angeles, Ca 90033
| | - Cheryl L. P. Vigen
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St., CHP-133, Los Angeles, California, 90089-9003
| | - Marc J. Weigensberg
- Department of Pediatrics, University of Southern California, 2020 Zonal Ave, IRD 127, Los Angeles, Ca 90033
| | - Jamie R. Wood
- Children’s Hospital of Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, United States
| | - Lucy Montoya
- Keck School of Medicine, University of Southern California, 150 N. Robertson Blvd, Suite 210, Beverly Hills, CA 90211, United States
| | - Valerie Ruelas
- Keck School of Medicine, University of Southern California, 150 N. Robertson Blvd, Suite 210, Beverly Hills, CA 90211, United States
| | - Anne L. Peters
- Keck School of Medicine, University of Southern California, 150 N. Robertson Blvd, Suite 210, Beverly Hills, CA 90211, United States
| |
Collapse
|
10
|
Abstract
OBJECTIVE In this study, we systematically reviewed the effectiveness of educational interventions falling within the scope of occupational therapy practice for people with rheumatoid arthritis (RA). These interventions included disease education, joint protection and energy conservation, psychosocial techniques, pain management, and a combination category. METHOD Two databases, MEDLINE and CINAHL, and select journals were searched for randomized controlled trials published between January 2002 and June 2015. Qualitative synthesis was used for between-study comparisons. RESULTS Twenty-two studies, with approximately 2,600 participants, were included. The interventions were found to have strong evidence for constructs that dealt with increasing coping with pain and fatigue as well as maintaining positive affect. There was limited or no evidence supporting the effectiveness of these interventions on most other measured constructs. CONCLUSION Interventions in which a combination of educational techniques is used may complement pharmacological therapies in the care of people with RA. Future research is needed to identify specific mechanisms of change.
Collapse
Affiliation(s)
- Kristine Carandang
- Kristine Carandang, OTR/L, is PhD Candidate, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles;
| | - Elizabeth A Pyatak
- Elizabeth A. Pyatak, PhD, OTR/L, CDE, is Assistant Professor, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Cheryl L P Vigen
- Cheryl L. P. Vigen, PhD, is Research Assistant Professor, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| |
Collapse
|
11
|
Grimminger PP, Shi M, Barrett C, Lebwohl D, Danenberg KD, Brabender J, Vigen CLP, Danenberg PV, Winder T, Lenz HJ. TS and ERCC-1 mRNA expressions and clinical outcome in patients with metastatic colon cancer in CONFIRM-1 and -2 clinical trials. Pharmacogenomics J 2011; 12:404-11. [PMID: 21788964 DOI: 10.1038/tpj.2011.29] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
To validate established cutoff levels of thymidylate synthase (TS) and excision repair cross-complementing (ERCC-1) intratumoral mRNA expressions in tumor samples from metastatic colorectal cancer (mCRC) patients treated with PTK787/ZK222584 (PTK/ZK). From 122 samples of patients with mCRC enrolled in CONFIRM-1 (Colorectal Oral Novel Therapy for the Inhibition of Angiogenesis and Retarding of Metastases) or CONFIRM-2, mRNA was isolated of microdissected formalin-fixed paraffin-embedded samples and quantitated using TaqMan-based technology. Existing TS and ERCC-1 cutoff levels were tested for their prognostic value in first-line and second-line therapy. TS expression was associated with overall survival (OS) in first-line, but not second-line therapy. ERCC-1 was associated with OS in patients treated with first-line and second-line FOLFOX4. In first-line FOLFOX4, combination of high TS and/or high ERCC-1 was associated with shorter OS. A correlation was observed between ERCC-1 expression and benefit from PTK/ZK+FOLFOX4 treatment. TS and ERCC-1 expression is associated with clinical outcome in mCRC. Baseline TS and ERCC-1 levels may allow the selection of patients who benefit from FOLFOX4 chemotherapy.
Collapse
Affiliation(s)
- P P Grimminger
- Department of Molecular Biology and Biochemistry, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|