Impact of a rural interprofessional health professions summer preceptorship educational experience on participants' attitudes and knowledge.

BACKGROUND: A six-week rural interprofessional health professions summer preceptorship provided an interprofessional training experience (IPE) for upper level baccalaureate and post-baccalaureate/graduate level health professions students in Dixon, Illinois, USA. There are three distinct yet complementary components of this forty hours per week summer preceptorship: Numerous interprofessional clinical shadowing experiences, a community service-learning project carried out as a team and weekly classroom sessions. This study assesses knowledge and attitude changes about IPE among students who participated in this Rural Interprofessional Health Professions Summer Preceptorship between 2006 and 2011. METHODS: Fifty-two students over the six program years were asked to complete an identical pre-/post-questionnaire. The questionnaire included scales on seven topics, two of which addressed knowledge and attitudes about IPE: (i) Understanding of their own and other professions' work roles and (ii) Perceived ability to work effectively in interprofessional teams and make use of skills of other professions. Fifty of the fifty two (96.1%) students completed both the pre- and post-tests. RESULTS: Positive changes from the pre- to the post-tests were observed for the scales that related to interaction with other professions and assessment of their professional skills and students' understanding of the roles of other professions. Pre- versus post-preceptorship students also reported greater experience working as a member of an interprofessional team and an increase in their support for interprofessional education within a rural setting being required for all health professions students. CONCLUSION: A rural interprofessional health professions summer preceptorship that includes preceptor shadowing, a community service-learning project and classroom work proved to be an effective approach to developing interprofessional health care teams, increasing the knowledge and skills of participating students and creating positive attitudes toward interactions with other professions.

Rural older adults' mental health: status and challenges in care delivery.

INTRODUCTION: Health disparities remain a challenge in rural populations, with mental health care especially challenging as the proportion of older adults continues to increase worldwide. This study examined the mental health service needs of, and use by, independently living rural older adults, with a focus on depression. METHODS: Older adults (≥ 50 years) were asked to complete a survey. RESULTS: There were 150 respondents: 29% were between the ages of 50 and 64 years and 71% were 65 years and older. On a composite variable, 23.3% were at-risk for depression. One-half to two-thirds reported awareness of local mental health services, but nearly three-quarters never used these. Barriers to effective treatment of depression included stress, healthcare costs, and denial/fear of depression. There was an 'avoidance' factor in depression diagnosis and management. CONCLUSION: Older adults in rural communities experiencing depression pose a problem. Strategies are needed to overcome multiple barriers to effective diagnosis and treatment. There is a need to better understand the role of stress in older adults' lives. It is especially important for primary care providers and the local community to organize resources to allow for more time to be spent with older adults with mental health problems.

Noni juice improves serum lipid profiles and other risk markers in cigarette smokers.

Cigarette smoke-induced oxidative stress leads to dyslipidemia and systemic inflammation. Morinda citrifolia (noni) fruit juice has been found previously to have a significant antioxidant activity. One hundred thirty-two adult heavy smokers completed a randomized, double blind, placebo-controlled clinical trial designed to investigate the effect of noni juice on serum cholesterol, triglyceride, low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), high-sensitivity C-reactive protein (hs-CRP), and homocysteine. Volunteers drank noni juice or a fruit juice placebo daily for one month. Drinking 29.5 mL to 188 mL of noni juice per day significantly reduced cholesterol levels, triglycerides, and hs-CRP. Decreases in LDL and homocysteine, as well increases in HDL, were also observed among noni juice drinkers. The placebo, which was devoid of iridoid glycosides, did not significantly influence blood lipid profiles or hs-CRP. Noni juice was able to mitigate cigarette smoke-induced dyslipidemia, an activity associated with the presence of iridoids.

Morinda citrifolia (noni) reduces cancer risk in current smokers by decreasing aromatic DNA adducts.

Quantitative determination of aromatic DNA adducts in peripheral blood lymphocytes (PBLs) of current smokers is an useful surrogate biomarker for the evaluation of environmental carcinogen exposure or chemopreventive intervention. In this study, we examined the impact of Tahitian Noni Juice (TNJ) on the aromatic DNA adducts of PBLs, before and after a 1-mo intervention, using (32)P postlabeling assay. Of 283 enrolled, 203 smokers completed the trial. Aromatic DNA adducts levels in all participants were significantly reduced by 44.9% (P < 0.001) after drinking 1 to 4 oz of TNJ for 1 mo. Dose-dependent analyses of aromatic DNA adduct levels showed reductions of 49.7% (P < 0.001) in the 1-oz TNJ group and 37.6% (P < 0.001) in the 4-oz TNJ group. Gender-specific analyses resulted in no significant differences in the 4-oz TNJ groups. Interestingly, the 1-oz TNJ group showed a reduction of 43.1% (P < 0.001) in females compared with 56.1% (P < 0.001) in males. The results suggest that drinking 1 to 4 oz of TNJ daily may reduce the cancer risk in heavy cigarette smokers by blocking carcinogen-DNA binding or excising DNA adducts from genomic DNA.

Antioxidant activity of noni juice in heavy smokers.

BACKGROUND: Noni (Morinda citrifolia) juice has demonstrated antioxidant activity in vitro and in vivo. To evaluate this activity in humans, noni juice from Tahiti (TNJ) was evaluated in a 30 day, double-blind, and placebo controlled clinical trial with 285 current heavy smokers. Research participants were randomly assigned to three daily treatment groups: 118 mL placebo, 29.5 mL TNJ, and 118 mL TNJ. Plasma superoxide anion radicals (SAR) and lipid hydroperoxide (LOOH) levels were measured pre and post-intervention. RESULTS: After 30 days, mean SAR decreased from 0.26 +/- 0.14 to 0.19 +/- 0.10 micromol/mL in the 29.5 mL dose group (P < 0.01) and from 0.26 +/- 0.22 to 0.18 +/- 0.11 micromol/mL in the 118 mL dose group (P < 0.001). LOOH levels decreased from 0.53 +/- 0.19 to 0.40 +/- 0.10 micromol/mL in the 29.5 mL dose group (P < 0.001) and from 0.55 +/- 0.21 to 0.40 +/- 0.14 micromol/mL in the 118 mL dose group (P < 0.001). No significant reductions in SAR or LOOH levels were observed in the placebo group. CONCLUSION: The results suggest an antioxidant activity from noni juice in humans exposed to tobacco smoke, thereby replicating the results found previous chemical and in vivo tests.

A comparison of quality of care indicators in urban acute care hospitals and rural critical access hospitals in the United States.

OBJECTIVE: Two recent Institute of Medicine reports highlight that the quality of healthcare in the US is less than what should be expected from the world's most extensive and expensive healthcare system. This may be especially true for critical access hospitals since these smaller rural-based hospitals often have fewer resources and less funding than larger urban hospitals. The purpose of this paper was to compare quality of hospital care provided in urban acute care hospitals to that provided in rural critical access hospitals. DESIGN: Cross-sectional study analyzing secondary Hospital Compare data. T-test statistics were computed on weighted data to ascertain if differences were statistically significant (P=0.01). SETTING: Centers for Medicare and Medicaid Services hospitals. PARTICIPANTS: US Acute Care and Critical Access hospitals. MAIN OUTCOME MEASURES: Differences between urban acute care hospitals and rural critical access hospitals on quality care indicators related to acute myocardial infarction, heart failure and pneumonia. RESULTS: For 8 of the 12 hospital quality indicators the differences between urban acute care and rural critical access hospitals were statistically significant (P=0.01). In seven instances these differences favored urban hospitals. One indicator related to pneumonia favored rural hospitals CONCLUSIONS: Although this study focused on only three disease states, these are among the most common clinical conditions encountered in inpatient settings. The findings suggested that there may be differences in quality in rural critical access hospitals and urban acute care hospitals and support the need for future studies addressing disparities between urban acute care and rural critical access hospitals.