Empowerment, Leadership, and Sustainability in a Faith-Based Partnership to Improve Health.

Community-based participatory research is a noted approach for improving community health and reducing health disparities. Community partnerships can serve as a catalyst for change in public health efforts. This article will apply empowerment theory and sustainability principles to an existing faith-based partnership. BRANCH Out is a partnership among 13 African American churches, the City of Milwaukee Health Department - Community Nutrition, and the Medical College of Wisconsin. The partnership goal was to change inaccurate perceptions, knowledge and negative attitudes, and behaviors about chronic disease and promote healthy youth leadership. Faith-based empowerment can occur at the individual, organizational, and community level. BRANCH Out demonstrates how partnerships can be sustained in multiple ways. The partnership also highlights the unique contributions of churches to community health outcomes.

Assessing the readiness of a school system to adopt food allergy management guidelines.

IMPORTANCE: The prevalence of potentially fatal food allergies in school-aged children is rising. It is important for schools to have a food allergy management policy and an emergency action plan for each affected student. OBJECTIVE: To examine the current status of food allergy guideline and/or policy implementation and adoption in a large school system in southeastern Wisconsin. DESIGN: A 24-item anonymous electronic survey was developed and completed by school principals and administrators in the Archdiocese of Milwaukee School System (approximately 125 schools) in southeastern Wisconsin. RESULTS: One in 4 responding schools reported no guidelines or policy. Schools that reported having students with special needs due to food allergy were more likely to have a local food allergy policy compared to schools that did not report having students with food allergy special needs (OR 6.3, 1.5-26, P = 0.01). Schools with food allergy guidelines/policies were 3.5 times more likely to require student individual action plans than schools with no guidelines or policies (OR 3.5, 1.00-12.2, P = 0.05). CONCLUSIONS: Gaps in evidence-based food allergy policy implementation were found in this school system. Schools with food-allergic children with special needs were more likely to have guidelines/policy, however, they were not more likely to require emergency action plans. The majority of schools (66, 90%) reported interest in receiving further information or training on food allergy management.

Empowerment, Leadership, and Sustainability in a Faith-Based Partnership to Improve Health.

Community-based participatory research is a noted approach for improving community health and reducing health disparities. Community partnerships can serve as a catalyst for change in public health efforts. This article will apply empowerment theory and sustainability principles to an existing faith-based partnership. BRANCH Out is a partnership among 13 African American churches, the City of Milwaukee Health Department-Community Nutrition, and the Medical College of Wisconsin. The partnership goal was to change inaccurate perceptions, knowledge and negative attitudes, and behaviors about chronic disease and promote healthy youth leadership. Faith-based empowerment can occur at the individual, organizational, and community level. BRANCH Out demonstrates how partnerships can be sustained in multiple ways. The partnership also highlights the unique contributions of churches to community health outcomes.

A randomized trial of peer-delivered self-management support for hypertension.

BACKGROUND: Peer-led interventions to improve chronic disease self-management can improve health outcomes but are not widely used. Therefore, we tested a peer-led hypertension self-management intervention delivered at regular meetings of community veterans' organizations. METHODS: We randomized 58 organizational units ("posts") of veterans' organizations in southeast Wisconsin to peer-led vs. professionally delivered self-management education. Volunteer peer leaders at peer-led posts delivered monthly presentations regarding hypertension self-management during regular post meetings. Volunteer post representatives at seminar posts encouraged post members to attend 3 didactic seminars delivered by health professionals at a time separate from the post meeting. Volunteers in both groups encouraged members to self-monitor using blood pressure cuffs, weight scales, and pedometers. Our primary outcome was change in systolic blood pressure (SBP) at 12 months. RESULTS: We measured SBP in 404 participants at baseline and in 379 participants at 12 months. SBP decreased significantly (4.4mm Hg; P < 0.0001) overall; the decrease was similar in peer-led and seminar posts (3.5mm Hg vs. 5.4mm Hg; P = 0.24). Among participants with uncontrolled BP at baseline, SBP decreased by 10.1mm Hg from baseline to 12 months but was again similar in the 2 groups. This pattern was also seen at 6 months and with diastolic blood pressure. CONCLUSIONS: Our peer-led educational intervention was not more effective than didactic seminars for SBP control. Although peer-led educational programs have had important impacts in a number of studies, we did not find our intervention superior to a similar intervention delivered by healthcare professionals. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT00571038.

Evaluation of a peer-led hypertension intervention for veterans: impact on peer leaders.

Volunteer peer leaders (PLs) benefit from their involvement in health interventions but we know little about how they compare with other non-PL volunteers or with the intervention recipients themselves. We randomized 58 veterans' service organizations' posts (e.g. VFW) to peer- versus professionally led self-management support interventions. Our primary research questions were whether hypertensive PLs changed over the course of the project, whether they changed more than hypertensive volunteers who were not randomized to such a role [i.e. post representatives (PRs)] and whether they changed more than the intervention recipients with respect to health knowledge, health beliefs and health outcomes from baseline to 12 months. After the intervention, PLs provided open-ended feedback and participated in focus groups designed to explore intervention impact. Hypertensive PLs improved their systolic blood pressure and hypertension knowledge and increased their fruit/vegetable intake and pedometer use. We found no differences between PLs and PRs. PLs improved knowledge and increased fruit/vegetable intake more than intervention recipients did; they provided specific examples of personal health behavior change and knowledge acquisition. Individuals who volunteer to be peer health leaders are likely to receive important benefits even if they do not actually take on such a role.

The development and validation of the hypertension evaluation of lifestyle and management knowledge scale.

Hypertension knowledge is an integral component of the chronic care model. A valid scale to assess hypertension knowledge and self-management skills is needed. The hypertension evaluation of lifestyle and management (HELM) scale was developed as part of a community-based study designed to improve self-management of hypertension. Participants included 404 veterans with hypertension. Literature review and an expert panel were used to identify required skills. Items were generated and pilot tested in the target population. Validity was assessed through comparisons of performance with education, health numeracy, print numeracy, patient activation and self-efficacy, and hypertension control. The HELM knowledge scale had 14 items across 3 domains: general hypertension knowledge, lifestyle and medication management, and measurement and treatment goals. Scores were positively associated with education (0.28, P<.0001), print health literacy (0.21, P<.001), health numeracy (0.17, P<.001), and patient activation (0.12, P=.015) but no association was found with diastolic or systolic blood pressure. The HELM knowledge scores increased following the educational intervention from baseline (mean, 8.7; standard deviation, 2.2) to 12-month follow-up (mean, 9.2, standard deviation, 2.2; P<.001). We conclude that the HELM provides a valid measure of the knowledge required for patients to take an active role in the chronic disease management of hypertension.

Location and organizational features: what type of veteran communities participate in health programs?

BACKGROUND: Research shows that community-based membership organizations are effective partners in health promotion activities; however, most community organizations do not participate in such partnerships. There is little research regarding the geographical and organizational characteristics associated with participation. OBJECTIVE: We examined the factors associated with community-based veterans service organization (VSO) units' decision to participate in a health promotion project. METHODS: We collected location and organizational characteristics regarding 218 VSO units asked to participate in POWER, a partnership to improve hypertension self-management skills between the Medical College of Wisconsin, the Milwaukee Veterans Affairs Medical Center (VAMC) and Wisconsin branches of the American Legion, Veterans of Foreign Wars (VFW), Vietnam Veterans of America, and National Association of Black Veterans. We tested the association of these characteristics with participation using chi-square and Fisher's exact tests for categorical variables, and analysis of variance and the Kruskal-Wallis test for continuous variables. We used multivariable logistic regression to identify factors independently associated with participation. RESULTS: In bivariable analyses, likelihood of participation was positively associated with increasing membership (p < .001), meeting attendance (p < .001), publication of an organizational newsletter (p < .001), presence of a women's auxiliary (p = .02), and location within 44 miles of the VAMC (p = .047). On multivariable analysis, only meeting attendance and census tract-level educational attainment predicted participation. CONCLUSIONS: Greater membership sizes, meeting attendance, and more group resources might be important factors for researchers to consider when initiating community-based health and wellness programs.

Veterans service organization engagement in 'POWER,' a peer-led hypertension intervention.

OBJECTIVES: The purpose of this study was to determine the influence of program factors on participant engagement in POWER, a peer-led intervention designed to reduce hypertension, increase hypertension knowledge, and improve other relevant health behaviors, such as diet and exercise, among US veterans involved in veterans service organizations throughout Southeastern Wisconsin. METHODS: Two hundred and nineteen hypertensive members from 58 VSOs participated in a year-long peer-led intervention designed to improve hypertension knowledge, disease self-management behaviors, and health outcomes. This study represents a qualitative evaluation of post and participant engagement in this intervention. We triangulated data collected via three qualitative approaches (observations, focus groups, and in-depth interviews) from intervention posts to derive a model of engagement. RESULTS: Our findings indicate that discrete characteristics of the peer leaders, post members, posts, and the intervention itself contributed to intervention engagement. DISCUSSION: We make suggestions for future research studies, particularly as related to understanding how peer leader identities and cultural norms within VSOs might contribute to peer-led health intervention success.

Engaging community-based veterans' organizations in health promotion programs.

Community organizations, such as churches, clubs, and senior centers, can be important locations for health programs. However, little is known about the organizational factors that influence participation and engagement in health programs. To learn more, we evaluated a community-based program designed to help US military veterans better manage their high blood pressure. The program involved training a pair of veterans to deliver health-related presentations at their local units. We found that factors such as larger meeting attendance size, rural location, age diversity, and member enthusiasm were positively associated with both a willingness to participate and a high level of engagement in program activities.

Strong Rural Communities Initiative (SRCI) program: challenges in promoting healthier lifestyles.

BACKGROUND: The Strong Rural Communities Initiative (SRCI) was created to address the health needs of rural Wisconsin communities through a multifaceted partnership that included the Medical College of Wisconsin (MCW), University of Wisconsin School of Medicine and Public Health (UWSMPH), the Rural Health Development Council (RHDC), and hospitals, public health departments, and businesses in 6 rural communities in Wisconsin. The SRCI provided a broad framework of leadership to assist each of the 6 rural communities in developing and implementing new, collaborative interventions that addressed the specific health needs of the community. METHODS: Separate assessments were conducted for the communities that partnered with each respective medical school and focused on the processes of community collaboration and partnership function. Assessment approaches included formative and outcome evaluation. RESULTS: Each community independently reported positive outcomes associated with the partnership process and various aspects of community collaboration, including the successes and health impacts of the workplace wellness programs implemented. Assessment data also revealed challenges related to conducting effective community-academic partnerships. CONCLUSIONS: The SRCI was established to execute statewide programs in rural communities with the goal to improve the health of people living in those communities. We have gained applicable knowledge regarding the types of challenges that exist in establishing a rural-based community research network between academic partners and community leaders.

Ethical challenges in a randomized controlled trial of peer education among veterans service organizations.

Efforts to increase community members' involvement in research may create novel ethical challenges. We describe an ongoing randomized trial of a peer-delivered intervention to encourage hypertension self-management. Community members serving as peer leaders participate in subject recruitment, the informed consent process, and intervention. We describe our experience with several ethical issues that may arise when conducting research in similar settings: (1) coercion of community members, by the community, to participate either as leaders or as study subjects; (2) threats to the privacy of health information; and (3) conflict between peer leaders' roles as community members and study team members.

Preliminary description of the feasibility of using peer leaders to encourage hypertension self-management.

BACKGROUND: Despite consensus that effective treatment of hypertension reduces morbidity and mortality, control rates remain relatively low. This report describes key features of a peer support program designed to motivate individuals to improve self-management of hypertension. METHODS: We recruited Veterans of Foreign Wars posts in southeastern Wisconsin and trained members of these posts to be peer health leaders over a period of 18 months. The curriculum covered information important to blood pressure control, as well as peer educator skills. During this time, the peer leaders presented educational materials and encouraged self-monitoring of blood pressure at post meetings. Surveys and focus groups were conducted to evaluate the adoption of the program at the posts. RESULTS: After a series of informational mailings and visits to veteran posts, 15 posts and 27 peer leaders volunteered to participate. Fourteen posts (93%) continued active participation throughout the study period, as did 24 peer leaders. Peer leaders reported that they gained health knowledge, skills, and confidence to perform as informational resources at their posts, resulting in greater levels of health support among post members. CONCLUSION: The partnership of health care professional, medical school, and veteran service organization successfully organized and maintained a community-based, peer-led program to promote healthy behaviors among Wisconsin's armed services veterans. Community physicians should be familiar with programs of this type as chronic disease self-management grows in appeal in our communities and increasing numbers of veterans return from armed service duty.

Enzymatic deprotection of the cephalosporin 3'-acetoxy group using Candida antarctica lipase B.

Cephalosporins remain one of the most important classes of antibiotics. A useful site for derivatization involves generation of and chemistry at the 3'-hydroxymethyl position. While 3'-acetoxymethyl-substituted cephalosporins are readily available, deacetylation to access the free 3'-hydroxymethyl group is problematic when the carboxylic acid is protected as an ester. Herein we report that this important transformation has been efficiently accomplished using Candida antarctica lipase B. Although this transformation is difficult to carry out using chemical methods, the enzymatic deacetylation has been successful on gram scale, when the cephalosporin is protected as either the benzhydryl or tert-butyl esters and on the corresponding sulfoxide and sulfone of the tert-butyl ester.

Peptides selected for the protein nanocage pores change the rate of iron recovery from the ferritin mineral.

Pores regulate access between ferric-oxy biomineral inside and reductants/chelators outside the ferritin protein nanocage to control iron demineralization rates. The pore helix/loop/helix motifs that are contributed by three subunits unfold independently of the protein cage, as observed by crystallography, Fe removal rates, and CD spectroscopy. Pore unfolding is induced in wild type ferritin by increased temperature or urea (1-10 mM), a physiological urea range, 0.1 mM guanidine, or mutation of conserved pore amino acids. A peptide selected for ferritin pore binding from a combinatorial, heptapeptide library increased the rate of Fe demineralization 3-fold (p<0.001), similarly to a mutation that unfolded the pores. Conjugating the peptide to Desferal (desferrioxamine B mesylate), a chelator in therapeutic use, increased the rates to 8-fold (p<0.001). A second pore binding peptide had the opposite effect and decreased the rate of Fe demineralization 60% (p<0.001). The peptides could have pharmacological uses and may model regulators of ferritin demineralization rates in vivo or peptide regulators of gated pores in membranes. The results emphasize that small peptides can exploit the structural plasticity of protein pores to modulate function.

Maternal and perinatal morbidity associated with classic and inverted T cesarean incisions.

OBJECTIVE: To estimate the maternal and perinatal morbidity associated with cesarean delivery involving the upper uterine segment compared with that of low transverse cesarean delivery. METHODS: A 19-year review of a perinatal database and the relevant charts was used to determine the maternal and perinatal morbidity associated with low transverse cesarean, classic cesarean, and inverted "T" cesarean deliveries. RESULTS: Over the 19 years, 1980-1998, there were 19,726 cesarean deliveries: low transverse cesarean, 19,422 (98.5%); classic cesarean, 221 (1.1%); and inverted T cesarean, 83 (0.4%). As a proportion of all cesarean deliveries, the rates of low transverse cesarean and classic cesarean have remained stable, whereas the rate of inverted T cesarean has risen from 0.2% to 0.9%. Maternal morbidity (puerperal infection, blood transfusion, hysterectomy, intensive care unit admission, death) and perinatal morbidity (stillborn fetus, neonatal death, 5 minute Apgar less than 7, intensive care) were significantly higher in classic cesarean compared to low transverse cesarean. Some maternal morbidity (puerperal infection, blood transfusion) and perinatal morbidity (5 minute Apgar less than 7, intensive care) were also significantly higher for inverted T cesarean compared to low transverse cesarean. CONCLUSION: Classic cesarean section has a higher maternal and perinatal morbidity than inverted T cesarean and much higher than low transverse cesarean. There is no increased maternal or perinatal morbidity if an attempted low transverse incision has to be converted to an inverted "T" incision compared to performing a classic cesarean section.

Serum and urine metal levels in patients with metal-on-metal surface arthroplasty.

The resurgence of metal-on-metal articulating surfaces for hip arthroplasty has also heightened concerns about the degree and magnitude of metal particle generation and the accompanying increase in circulating metal ion concentrations. In this study, we measured the concentration of chromium in serum and urine and the concentration of cobalt in serum in twenty-five patients with modern metal-on-metal surface arthroplasty of the hip in a prospective manner. The results showed that the mean post-operative chromium in serum levels were 22-fold, 23-fold and 21-fold higher at 3, 6 and 12 months post-operative, respectively, than pre-operative levels. The mean post-operative cobalt in serum levels were 8-fold, 7-fold and 6-fold higher at 3, 6 and 12 months post-operative, respectively, than pre-operative levels. The mean post-operative chromium in urine levels were 9-fold, 10-fold and 14-fold higher at 3, 6 and 12 months post-operative, respectively, than pre-operative levels. The values seen in this study with the current generation of surface arthroplasties are: (a) lower than those seen in an earlier generation of surface arthroplasties; (b) in the same range as those observed in association with metal-on-metal conventional total hip replacements, which typically have smaller head sizes; (c) higher than values observed in patients with conventional metal-on-polyethylene articulating couples.