Factors Associated with Beneficiary Outcomes from Community Health Programs in Predominantly Low-Income African American Communities in Mississippi USA.

BACKGROUND: Community health programs (CHPs) can improve the conditions of disadvantaged populations through direct health and support services. OBJECTIVE: We examine factors associated with two CHP beneficiary outcomes including program needs being met and satisfaction in the low-income and predominantly African American cities of Belzoni and Jackson in Mississippi, USA. METHODS: A retrospective and cross-sectional design is implemented using chi squared tests and regression analysis of 108 survey responses from a convenience sample. RESULTS: Chi-squared test results associate program meeting needs with gender, participation, efforts towards financial success, and financial condition. Satisfaction is also associated with age, marital status, gender, years at address, degree of participation, ethnicity, efforts at financial success, and financial condition. Equally, logistic regression analysis associates satisfaction with marital status, gender, years at address, age group, ethnicity, education, and efforts at financial success. DISCUSSION AND CONCLUSIONS: The negative relationship between participation in program activities and satisfaction, and the large size of participants (42-57%) who are less likely to report satisfaction with services, calls for an investigation of the causes of low levels of satisfaction. Immediate and long-term improvements needed to strengthen the fit between CHP services and beneficiary needs in Belzoni and Jackson are recommended.

(Re)defining their place at the table: Frank discussions by adults with disabilities on contemporary self-advocacy.

Adults with disabilities have long been at the forefront of disability advocacy in the United States. Grounded in the tenets of radical disability studies and principles of disability justice, this study explored the lived experiences of 12 adults with disabilities, including intellectual disability and developmental disabilities, with a particular focus on self-advocacy. Two focus groups were primary data sources. Three participants and one university-based researcher analyzed the data collaboratively. Iterative data collection and analysis yielded 8 primary codes and 22 subcodes. We discuss a subset of our findings, focusing on three major themes. The findings illuminated how adults with disabilities conceptualised self-advocacy expansively, including self, other, and the collective. Participants also described problems they faced advocating. Finally, adults with disabilities shared solutions to inequities at individual, group, and societal levels. This project illustrates the importance of centering adults with disabilities in research and policy with implications for future thought.

Community study to uncover the full spectrum of rheumatic heart disease in Uganda.

OBJECTIVE: Estimates of the prevalence of rheumatic heart disease (RHD) in many endemic countries are limited to samples of children attending schools, which generate an incomplete picture of disease burden in communities. The present study conducted household-based RHD screening in a representative community in Gulu district, Uganda. METHODS: Members of households identified through a two-stage cluster-sampling approach between the ages of 5 years and 50 years were invited to undergo limited cardiac testing with a handheld echocardiogram to assess for the presence of RHD. Suspicious cases underwent confirmatory echocardiogram with a fully functional machine. RESULTS: Of the 2453 community members screened, 2.45% (95% CI 1.87% to 3.14%) showed echocardiographic evidence of RHD with 1.26% (95% CI 0.860% to 1.79%) having definite RHD. The overall prevalence of RHD among participants <20 years was 2.52% (95% CI 1.78% to 3.45%), with a borderline prevalence of 1.97% (95% CI 1.33% to 2.82%) and a definite prevalence of 0.544% (95% CI 0.235% to 1.07%). Prevalence rates among youth increased with age and peaked in the age group of 16-20 years. The overall adult prevalence (>20 years) of RHD was 2.34% (95% CI 1.49% to 3.49%). The majority of definite cases were mild (81%) and marked by mitral regurgitation and associated morphological valve changes (71%). CONCLUSION: Our data reveal a high prevalence of undiagnosed RHD within an endemic community and fill a critical gap in RHD epidemiology in African adults.

A phenomenological study of romantic love for women in late life.

Romantic love in late life is often beneficial, though not without challenges. Financial concerns and objections of adult children can interfere with a late-life individual's decision to commit to a romantic relationship. In this study, the experience of romantic love for women who enter committed relationships in later life was examined. Fourteen women between the ages of 65 and 84 who had lived the experience of romantic love in late life were interviewed. By using Moustakas's qualitative Transcendental Phenomenological method, several themes emerged to provide a description of the phenomena. These themes included openness to experience, attraction, commitment, adjournment, and generativity. According to the findings of this study, women in late life who form committed romantic love relationships negate the physical and emotional effects of loneliness brought about by bereavement or single status in late-life women. In addition, this study found these women were attracted to partners to fulfill their needs for love, esteem, spiritual connection, and self-actualization.

The Differential Effects of Human Immunodeficiency Virus and Hepatitis C Virus on Bone Microarchitecture and Fracture Risk.

Background: Human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected individuals have a significantly greater osteoporotic fracture risk than HIV-monoinfected persons, despite the fact that HIV/HCV coinfection has not been associated with lower bone mineral density (BMD) than HIV or HCV alone. To evaluate if changes in bone microarchitecture, measured by trabecular bone score (TBS), could explain these differences, we performed a prospective, cross-sectional cohort study of virologically suppressed HIV-infected subjects, untreated HCV-infected subjects, HIV/HCV-coinfected subjects, and uninfected controls. Methods: We enrolled 532 male subjects: 57 HIV/HCV coinfected, 174 HIV infected, 123 HCV infected, and 178 controls. We conducted analysis of covariance comparing BMD and TBS between groups, controlling for age, race, body mass index, and smoking. We used linear regression to evaluate predictors of BMD and TBS and evaluated the effects of severity of HCV infection and tenofovir disoproxil fumarate use. Results: Despite both infections being associated with decreased BMD, only HCV, but not HIV, was associated with lower TBS score. Also, HIV/HCV-coinfected subjects had lower TBS scores than HIV-monoinfected, HCV-monoinfected, and uninfected subjects. Neither the use of TDF or HCV viremia nor the severity of HCV liver disease was associated with lower TBS. Conclusions: HCV infection is associated with microarchitectural changes at the lumbar spine as assessed by the low TBS score, suggesting that microstructural abnormalities underlie some of the higher fracture risk in HCV infection. TBS might improve fracture risk prediction in HCV infection.

Circadian Phase-Shifting Effects of Bright Light, Exercise, and Bright Light + Exercise.

Limited research has compared the circadian phase-shifting effects of bright light and exercise and additive effects of these stimuli. The aim of this study was to compare the phase-delaying effects of late night bright light, late night exercise, and late evening bright light followed by early morning exercise. In a within-subjects, counterbalanced design, 6 young adults completed each of three 2.5-day protocols. Participants followed a 3-h ultra-short sleep-wake cycle, involving wakefulness in dim light for 2h, followed by attempted sleep in darkness for 1 h, repeated throughout each protocol. On night 2 of each protocol, participants received either (1) bright light alone (5,000 lux) from 2210-2340 h, (2) treadmill exercise alone from 2210-2340 h, or (3) bright light (2210-2340 h) followed by exercise from 0410-0540 h. Urine was collected every 90 min. Shifts in the 6-sulphatoxymelatonin (aMT6s) cosine acrophase from baseline to post-treatment were compared between treatments. Analyses revealed a significant additive phase-delaying effect of bright light + exercise (80.8 ± 11.6 [SD] min) compared with exercise alone (47.3 ± 21.6 min), and a similar phase delay following bright light alone (56.6 ± 15.2 min) and exercise alone administered for the same duration and at the same time of night. Thus, the data suggest that late night bright light followed by early morning exercise can have an additive circadian phase-shifting effect.

Circadian rhythms of psychomotor vigilance, mood, and sleepiness in the ultra-short sleep/wake protocol.

Despite its advantages as a chronobiological technique, the ultra-short sleep/wake protocol remains underutilized in circadian rhythm research. The purpose of this study was to examine circadian rhythms of psychomotor vigilance (PVT), mood, and sleepiness in a sample (n=25) of healthy young adults while they adhered to a 3 h ultra-short sleep/wake protocol. The protocol involved 1 h sleep intervals in darkness followed by 2 h wake intervals in dim light, repeated for 50-55 h. A 5 min PVT test was conducted every 9 h with the standard metrics of mean reaction time (RT; RT(mean)), median RT (RT(med)), fastest 10% of responses (RT(10fast)), and reciprocal of the 10% slowest responses (1/RT(10slow)). Subjective measures of mood and sleepiness were assessed every 3 h. A cosine fit of intra-aural temperature, assessed three times per wake period, established the time of the body temperature minimum (T(min)). Mood, sleepiness, and PVT performances were expressed relative to individual means and compared across eight times of day and twelve 2 h intervals relative to T(min). Significant time-of-day and circadian patterns were demonstrated for each of the PVT metrics, as well as for mood and sleepiness. Most mood subscales exhibited significant deterioration in day 2 of the protocol without alteration of circadian pattern. However, neither sleepiness nor performance was worse on the second day of observation compared to the first day. These data provide further support for the use of the ultra-short sleep/wake protocol for measurement of circadian rhythms.

Circadian variation in swim performance.

Previous findings of time-of-day differences in athletic performance could be confounded by diurnal fluctuations in environmental and behavioral "masking" factors (e.g., sleep, ambient temperature, and energy intake). The purpose of this study was to examine whether there is a circadian rhythm in swim performance that is independent of these masking factors. Experienced swimmers (n = 25) were assessed for 50-55 consecutive hours in the laboratory. The swimmers followed a 3-h "ultra-short" sleep-wake cycle, involving 1 h of sleep in darkness and 2 h of wakefulness in dim light, that was repeated throughout the observation. The protocol distributes behavioral and environmental masking factors equally across the 24-h period. Each swimmer was scheduled to perform six maximal-effort 200-m swim trials that were distributed equally across eight times of day (n = 147 trials). Each trial was separated by 9 h. A cosine fit of intra-aural temperature data established the time of the lowest body temperature (Tmin). Swim performances were z-transformed and compared across the eight times of day and across twelve 2-h intervals relative to Tmin. Analysis of covariance, controlling for trial number, revealed a significant (P < 0.001) pattern in swim performance relative to environmental and circadian times of day. Performance peaked 5-7 h before Tmin (approximately 2300) and was worst from 1 h before to 1 h after Tmin (approximately 0500). Mean swim performance was 169.5 s; circadian variation from peak to worst performance was 5.8 s. These data suggest a circadian rhythm in athletic performance independent of environmental and behavioral masking effects.