Non-Medical Characteristics Affect Referral for Advanced Heart Failure Services: a Retrospective Review

BACKGROUND

Patients with advanced heart failure (AHF) are extensively evaluated before heart transplantation or left ventricular assist device (LVAD) eligibility. Patients are assessed for medical need and psychosocial or economic factors that may affect success post-treatment. For patients to be evaluated, however, they first must be referred. This study investigated social and economic factors affecting AHF referral, specialist visits, or treatment.

METHODS

Patients with heart failure (n = 24,258) were reviewed at one large hospital system over 4 years. Independent variables age, sex, marital status, race/ethnicity, preferred language, smoking, and insurance status were assessed for the outcomes of referral, clinic visit, and treatment by Chi-square and ANOVA. In-house and 1-year mortality were evaluated by logistic regression, and time-to-event was assessed by the Cox proportional hazards model.

RESULTS

Younger (HR 0.934, 95% CI 0.925-0.943), male (HR 2.216, 95% CI 1.544-3.181), and publicly insured (HR 1.298 [95% CI 1.038, 1.623]) patients were more likely to be referred, while unmarried (HR 0.665, 95% CI 0.488-0.905) and smoking (HR 0.549, 95% CI 0.389-0.776) patients had fewer referrals. Younger, married, and nonsmoking patients were more likely to have a clinic visit. Younger age, White race, and Hispanic/Latino ethnicity were associated with receiving a heart transplant, and LVAD recipients were more likely Hispanic/Latino ethnicity. Advanced age, Hispanic/Latino ethnicity, and smoking were associated with 1-year mortality after heart failure diagnosis.

CONCLUSIONS

Disparities in access exist before evaluation for AHF therapies. Improving access at the levels of referral and evaluation is a necessary step toward achieving equity in organ allocation.

Acute Effects of Ice Hockey on Hip Range of Motion, Strength, and Pelvic Tilt in Competitive Male Players

BACKGROUND

Ice hockey players are at high risk for hip and groin injury. Several risk factors have been identified or proposed, including lower hip rotation range of motion (ROM), lower hip adductor strength, lower ratio of hip adductor to abductor strength, and lower pelvic tilt angle. It is not known how these risk factors change acutely with ice hockey participation.

HYPOTHESIS

Acute exposure to ice hockey will result in a reduction in ROM, strength, and pelvic tilt angle in competitive male players.

STUDY DESIGN

Controlled cohort study.

LEVEL OF EVIDENCE

Level 3.

METHODS

Risk factors for hip and groin injury, including isometric hip adductor strength at 0° of flexion, the ratio of hip adductor to abductor strength, total hip rotation passive ROM in supine, and the resting pelvic tilt angle, were assessed immediately before, immediately after, and 24 hours after an ice hockey exposure in 42 competitive male ice hockey players. Rating of perceived exertion (RPE) was collected to identify the intensity of the exposure.

RESULTS

There was a significant decrease in total hip rotation ROM (-7.32°, P < 0.01 (-3.91, -10.70)) and hip adductor strength (-4.41 kg, P < 0.01 (-2.81, -6.00) immediately after the exposure, and a significant decrease in total hip rotation ROM (-18.54°, P < 0.01 (-14.35, -22.73)), hip adductor strength (-6.56 kg, P < 0.01 (-4.58, -8.61)), and the ratio of hip adductor to abductor strength (-0.12, P < 0.01 (-0.21, -0.45)) 24 hours after. There was no significant change in pelvic tilt found in this study immediately after or 24 hours after. There was a moderate relationship between changes in hip adductor strength and changes in the ratio of hip adductor to abductor strength (r = 0.433, P < 0.01). RPE was not significantly correlated to any of the changes observed.

CONCLUSION

Risk factors for hip and groin injury in ice hockey players are modifiable after a single ice hockey exposure.

CLINICAL RELEVANCE

The identified fluctuation of injury risk factors for hip and groin injury in ice hockey players has implications for injury risk profiling, rehabilitation, and return-to-competition decision-making.

Methods of Current Practice: Qualitative Analysis of Intervention Strategies Utilized by Vaccine Waiver Educators in Michigan

By enacting administrative rule 325.176 (12), Michigan added a vaccine education component as a precondition to granting vaccine waivers to vaccine-hesitant parents wishing to file a nonmedical vaccine exemption for their school-aged child. The purpose of the study was to identify best practices for reaching vaccine-hesitant parents during face-to-face vaccine education sessions conducted by vaccine waiver educators in Michigan. This study utilized qualitative descriptive content analysis of semi-structured phone interviews with vaccine waiver educators from local health departments (LHDs) in Michigan. Participants were vaccine waiver educators who were employed by a local health department in Michigan and had conducted at least 30 vaccine waiver education sessions. Strategies, resources, and techniques identified by educators as beneficial included using and providing information from a variety of sources, compiling their own educational materials, creating a positive experience, holding personalized sessions, and streamlining exemption and vaccination sessions. However, unexpected themes that emerged from the interviews revealed that vaccine waiver educators need additional training in discussing vaccine ingredients with parents, handling religious vaccine exemption requests, and assessing the role of schools. Implementing successful vaccine education interventions targeting vaccine-hesitancy is crucial to public health. Charging LHDs with overseeing vaccine education via a face-to-face discussion is a novel intervention strategy, the effective implementation of which may inform vaccine education intervention nationwide and may even be translated into international contexts and prove useful to current COVID-19 vaccination efforts.

The Association Between Fear of Falling and Fall Prevention Interventions Offered by an Occupational Therapist in a Geriatric Primary Care Setting

Date Presented 4/1/2017

This study demonstrates that occupational therapy fall prevention interventions are beneficial for improving quality of care as part of a coordinated care team within a primary care setting and should further be examined in expanded populations, settings, and interventions.

Primary Author and Speaker: Lydia Royeen

Contributing Authors: Kieran J. Fogarty, Brenda Koverman

The development of a standards-based national curriculum framework for regulatory food safety training in the United States

In response to the recognized need for a training system to support an integrated food safety system in the U.S., the International Food Protection Training Institute (IFPTI) in Battle Creek, Michigan, designed a career-spanning curriculum framework. IFPTI collaborated with a national curriculum team consisting of regulatory officials and university academics. The curriculum framework encompasses and organizes existing professional development for the estimated 45,000 federal, state, and local food regulators in the U.S. into efficient, standards-driven learning paths. This article describes the development process leading to an integrated national food protection training curriculum framework.

Exploration of commonalities and variations in health related beliefs across four Latino subgroups using focus group methodology: implications in care for Latinos with type 2 diabetes

Latinos, now the largest U.S. ethnic minority, have a high risk for type 2 diabetes. The Latino population is a heterogeneous group of individuals from many countries with a variety of beliefs and cultures. The purpose of this study was to explore similarities and differences in beliefs and attitudes related to health and healthcare practices across our Latino subgroups (Mexican, Colombian, Puerto Rican, and Mayan). The study used a qualitative research design employing focus groups and participant questionnaires. Data analysis revealed four themes: 1) View of health; 2) Access to care; 3) Acculturation; and 4) Stress and worry.

Shoulder injuries in US high school baseball and softball athletes, 2005-2008

OBJECTIVE

The objective of this study was to determine factors that are involved in shoulder injury rates among high school athletes who participate in organized baseball and softball.

METHODS

Baseball- and softball-related injury data were collected during the 2005-2008 academic years from approximately 74 nationally representative high schools via High School Reporting Information Online.

RESULTS

Certified athletic trainers reported 91 baseball shoulder injuries and 40 softball shoulder injuries during 528147 and 399522 athlete exposures, respectively. The injury rate was 1.72 injuries per 10000 athlete exposures for baseball and 1.00 injuries per 10000 athlete exposures for softball. Muscle strain/incomplete tears were the most common injuries in both baseball (30.8%) and softball (35.0%). In practices, throwing, not including pitching, caused more than half of softball injuries (68.2%) as compared with competition injuries (23.5%; injury proportion ratio [IPR]: 2.90 [95% confidence interval (CI): 1.17-7.15]; P = .015), whereas pitching was the most common mechanism in causing shoulder injuries during baseball practice (41.9%) compared with competitions (25.6%; IPR: 1.64 [95% CI: 0.88-3.04]; P = .17). Eighty-one percent of the baseball shoulder injuries and 82.5% of the softball shoulder injuries were new. Ten percent of baseball athletes and 5.3% of softball athletes sustained injuries that required surgery (IPR: 1.40 [95% CI: 0.32-6.10]; P = .93). Injuries that were sustained while the athlete was on the pitcher's mound were significantly more likely to result in surgery than any other field position (IPR: 2.64 [95% CI: 1.65-4.21]; P = .0061). Injured baseball players were more than twice as likely to be pitchers.

CONCLUSIONS

Although rates and patterns of shoulder injuries are similar between baseball and softball players, injury rates and patterns differ between field positions within each sport, as well as by injury severity and the athletes' year in school.

Validating the utility of the Spanish version of the American Diabetes Association Risk Test

The American Diabetes Association (ADA) Risk Test, often used for decisions to blood glucose screen or not, lacks studies reporting the reliability or validity for the Spanish version of the tool. The objective of this study is to further validate the utility of the Spanish version of the ADA's Risk Test for Latino Populations. A convenience sample of 316 Latinos participated in this study. A positive but weak statistical correlation was found between blood glucose and the Risk Test score (.138), suggesting low reliability and validity of the Spanish version of the instrument. Two internal consistency estimates of reliability techniques were computed for the Risk Test for diabetes scale items, indicating low reliability.

A national, geographic database of CDC-funded HIV prevention services: development challenges and potential applications

Background

From 2000–2002, the Centers for Disease Control and Prevention (CDC) funded a study that was designed to improve the information available to program planners about the geographic distribution of CDC-funded HIV prevention services provided by community-based organizations (CBOs). Program managers at CDC recognized the potential of a geographic information system (GIS) to organize and analyze information about HIV prevention services and they made GIS a critical component of the study design. The primary objective of this study was to construct a national, geographically-referenced database of HIV prevention services provided by CDC-funded CBOs. We designed a survey instrument to collect information about the geographic service areas where CBOs provided HIV prevention services, then collected data from CBOs that received CDC funding for these services during fiscal year 2000. We developed a GIS database to link questionnaire responses with GIS map layers in a manner that would incorporate overlapping geographies, risk populations and prevention services. We collected geographic service area data in two formats: 1) geopolitical boundaries and 2) geographic distance.

Results

The survey response rate was 70.3%, i.e. 1,020 of 1,450 community-based organizations responded. The number of HIV prevention programs administered by each CBO ranged from 1 to 23. The survey provided information about 3,028 prevention programs, including descriptions of intervention types, risk populations, race and ethnicity, CBO location and geographic service area. We incorporated this information into a large GIS database, the HIV Prevention Services Database. The use of geopolitical boundaries provided more accurate results than geographic distance. The use of a reference map with the questionnaire improved completeness, accuracy and precision of service area data.

Conclusion

The survey instrument design and database development procedures that we used for this study successfully met our objective. The development of the HIV Prevention Services Database for CDC is an important step toward the implementation of a spatial decision support system. Due to the costs involved in a nationwide survey such as this, we recommend that future data collection efforts use Web-based survey methodologies that incorporate interactive maps.

Vaccine coverage levels after implementation of a middle school vaccination requirement, Florida, 1997-2000

OBJECTIVE

Little information is available about the effectiveness of school entry vaccination requirements at the middle school level. This study examined coverage levels among students entering seventh grade in Florida following implementation of a school entry vaccination requirement in 1997.

METHODS

The authors analyzed county-specific vaccination coverage levels (three doses of hepatitis B vaccine, a second dose of measles, mumps, and rubella [MMR] vaccine, and a booster dose of tetanus and diphtheria toxoids [Td]) among students entering public and private schools in Florida from 1997 through 2000. In 1998, a survey of all county health departments was conducted, and the resulting data were linked to county-specific vaccination rates.

RESULTS

During the 1997-1998 school year, the first year the requirement went into effect, at school entry 121,219 seventh-grade students (61.8%) were fully vaccinated, 72,275 seventh grade students (36.9%) lacked one or more doses of vaccine but were considered in process, 1,817 were non-compliant (0.9%), and 763 had medical or religious exemptions (0.4%). In the 2000-2001 school year, the proportions of students reported fully vaccinated at school entry had increased to 66%. Most of this change was related to an increase in hepatitis B coverage. There was a significant inverse relationship between the proportion of students fully vaccinated and the size of the county's seventh grade population.

CONCLUSIONS

The seventh grade vaccination entry requirement was associated with sustained high levels of vaccination coverage. Passing a school entry vaccination requirement appears may be sufficient to increase coverage, but other strategies may be required to achieve full immunization of middle school students.

An exploration of attitudes on sexuality at a northeastern urban university

This study was conducted to assess the prevalence of scores on homophobia among 104 college students at a northeastern urban university. Participants reported their attitudes regarding homosexuals and homosexual behavior on Hudson and Rickett's Index of Homophobia. The 33 men indicated more negative attitudes about homosexuals and homosexual situations than the 71 women.

Assessing variability of HIV transmission attitudes and behaviors at an urban northeastern university

Teenagers in the United States are one of the populations whose HIV infection rates are increasing most rapidly. This study was designed to measure college students' knowledge of HIV transmission methods using Kittleson and Venglarcik's HIV Transmission Survey. Participants (N= 167) were divided into two groups, 99 students from a rural background and 68 students from an urban background. Students from an urban background were significantly more knowledgeable about documented HIV transmission modes than students from a rural background. Men were significantly less aware of documented HIV transmission modes than women. These results suggest that education about AIDS needs to be improved. The current educational procedures do not properly inform students in a fashion which exhibits the true risk of infection and those behaviors which increase risk. Fifteen years after the discovery of the HIV virus students are still largely unaware that they are at risk for contracting a fatal disease.