Assessing the Effectiveness of Professional Development Training on Autism and Culturally Responsive Practice for Educators and Practitioners in Ethiopia.

This study examines the effect of professional development training on educators' and practitioners' knowledge of Autism and the use of culturally responsive practices. Using a single group, pre-post design, data was gathered from 34 educators and health professionals (i.e., teachers, counselors, psychologists, therapists, therapeutic care workers, social workers, and nurses) in Ethiopia. A week-long training covering ASDs and culturally responsive evidence-based training was provided to participants. Results showed significant improvement in participants' knowledge about ASD symptoms, nature, characteristics, as well as intervention selection. Participants' use of culturally informed approaches, in their area of professional service, showed a high level of participants' knowledge and low-level use of culturally responsive practices, policies, and procedures. Recommendations for addressing cultural factors impacting the diagnosis and treatment-seeking approaches to ASD in Africa are provided.

Association between obesity and therapeutic goal attainment in patients with concomitant hypertension and dyslipidemia.

BACKGROUND: Obesity is associated with cardiovascular risk factors such as hypertension, dyslipidemia, and diabetes mellitus, as well as cardiovascular diseases. OBJECTIVES: To evaluate demographic, diagnostic, and treatment characteristics of patients with concomitant hypertension and dyslipidemia, stratified by body mass index and the attainment of blood pressure (BP) and lipid targets in obese versus nonobese patients. METHODS: This retrospective study used data from GE Centricity Electronic Medical Records database (2004-2011) of a primary care physician group. Patients aged ≥ 18 years and having concomitant hypertension and dyslipidemia were categorized based on their body mass index: normal weight (≤ 24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥ 30.0 kg/m2). Blood pressure and lipid goal attainments were based on Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and National Cholesterol Education Program Adult Treatment Panel III guidelines, respectively. RESULTS: A total of 9086 patients with concomitant hypertension and dyslipidemia were identified and categorized as normal weight (n = 1256), overweight (n = 3058) and obese (n = 4772). Patients who were obese were younger (< 65 years); were more likely to have diabetes mellitus (P < 0.001); had higher baseline BP and triglyceride levels and lower levels of high-density lipoprotein cholesterol (P < 0.05); and were more likely to be prescribed antihypertensives and antilipemic agents (P < 0.001). In multivariate analyses, obese patients were significantly more likely to fail to attain BP (odds ratio = 1.562, P < 0.001) and dual BP and low-density lipoprotein cholesterol (odds ratio = 1.193, P = 0.023) goals. CONCLUSIONS: Obesity appears to be an independent risk factor for the failure to attain BP and dual BP and low-density lipoprotein cholesterol goals in patients with concomitant hypertension and dyslipidemia. These findings suggest that future research is needed to determine the underlying link between obesity and failure to attain these goals.

Impact of invalidation and trust in physicians on health outcomes in fibromyalgia patients.

INTRODUCTION: Patients with fibromyalgia have reported experiencing discouragement, rejection, suspicion, and stigma during their encounters with health care professionals. The impact of these experiences on health outcomes has not been extensively examined. The aim of this study was to assess fibromyalgia patients' self-reported quality of life (QoL) and pain based on the following: perceptions of physician attitudes, trust in physicians, perceptions of medical professionals, type of treatment, and various demographic variables. METHOD: An online survey was advertised in the electronic newsletter of the National Fibromyalgia and Chronic Pain Association and data were collected in February 2013. A new scale was developed to measure patient perceptions of physician attitudes. Patients' trust in physicians, patients' perceptions of medical professionals, and QoL were measured using the following standardized scales: Trust in Physician Scale, Illness Invalidation Inventory (3*I), and Quality of Life Scale-16 (QOLS-16). RESULTS: The survey resulted in 670 usable responses. The Patient Perceptions of Physician Attitudes Scale showed high internal consistency and convergent validity (Cronbach α = 0.91). Factor analysis of the Trust in Physician scale, 3*I, and QOLS-16 showed a 1-dimensional structure. Invalidation, use of complementary and alternative medicine, income, age, and marital status were significant predictors of QoL (P < .001). Trust in physician, income, education, and number of referrals to health care providers were significant predictors of pain (P < .001). CONCLUSIONS: Invalidation, trust in physician, and use of complementary medicine can have significant impact on QoL and pain in fibromyalgia. Further research in more representative fibromyalgia samples may help confirm findings.

Factors associated with primary hip arthroplasty after hip fracture.

OBJECTIVES: To determine patient, clinical, and hospital factors associated with receiving total hip arthroplasty (THA) and hemiarthroplasty (HA) in the United States. STUDY DESIGN: Retrospective, cross-sectional study. METHODS: Hospital discharge records with a principal diagnosis of hip fracture and primary hip arthroplasty or no surgery were identified from the 2009 Nationwide Inpatient Sample data set of the Healthcare Cost and Utilization Project. Patient (age, sex, race, income, payer), clinical (comorbidities, severity, fracture type), hospital (region, location, teaching status, bed size, ownership), and outcome (receipt of THA or HA) variables were extracted and weighted for the analyses. Univariate and multivariate analysis were conducted and significance was set at P < .05. RESULTS: A total of 92,861, 15,489, and 9863 discharges occurred for HA, no surgery, and THA, respectively. Compared with no surgery, THA or HA was significantly more likely in patients who were aged > 50 years, white, and female; had > $39,000 income; lived in a medium-metro or noncore county; had comorbidities (anemia, hypertension); and had intracapsular fracture. THA or HA was significantly more likely in urban, privately owned hospitals with > 249 beds. Compared with no surgery, THA was significantly more likely in nonteaching hospitals, the Northeast region, and in private insurance or self-pay patients with moderate to severe fractures; HA was more likely in teaching hospitals, in the South and West, and in Medicare patients with minor fractures. CONCLUSIONS: Similarities and differences in patient, clinical, and hospital factors associated with surgical treatments of hip fracture warrant the attention of providers and payers.