A Statewide Approach to Falls Prevention: Widespread Implementation of A Matter of Balance in North Carolina, 2014-2019.

This study showcases the statewide strategies used to implement and sustain an evidence-based fall prevention program, A Matter of Balance (MOB) in North Carolina between 2014 and 2019. Statewide program implementation and data collection support strategies are detailed. The mostly White (not Hispanic/Latino), female participants were 75 years old on average. Pre- and post-self-reported assessments included demographic, health status, quality of life, and falls-related metrics. Survey responses were scaled and analyzed. Statistically significant improvements (p < .05) across health status measurements, times fallen, and falls resulting in injury were observed. These results offer a model for effective statewide implementation of the MOB program to reduce falls among older adults in community settings with support from a statewide resource center.

Challenges in the Medical and Surgical Management of Chronic Inflammatory Bowel Disease.

Inflammatory bowel disease patients will likely come to the surgeon's attention at some point in their course of disease, and they present several unique anatomic, metabolic, and physiologic challenges. Specific and well-recognized complications of chronic Crohn disease and ulcerative colitis are presented as well as an organized and evidence-based approach to the medical and surgical management of such disease sequelae. Topics addressed in this article include intestinal fistula and short bowel syndrome, pouch complications, and deep venous thrombosis with emphasis placed on optimization of the patient's physiologic state for best outcomes.

Impact of multiple caregiving roles on elevated depressed mood in early-stage breast cancer patients and same-age controls.

The effect of caregiving roles on risk of elevated depressed mood over 12 months was examined in early-stage (0-IIA) breast cancer patients and same-aged women without breast cancer. Women were interviewed 4-6 weeks, 6 months, and 12 months following definitive surgical treatment (patients) or routine screening mammogram (controls). The Center for Epidemiologic Studies-Depression Scale was administered at each interview and dichotomized for analysis (<16 [little/no depressed mood] vs. >or=16 [elevated depressed mood]). Participants were categorized as having no caregiving responsibilities, caregiving for children or other persons, or caregiving for both children and others (multiple caregiving roles). Two multivariable marginal logistic regression models with repeated measures were fit (one each for patients and controls) to examine the effect of caregiving roles on elevated depressed mood, using generalized estimating equations to account for intra-individual correlations. Of 1096 participants (mean age 58; 76% white), 1019 with caregiving data were included in the analysis. Compared with baseline, patients with multiple caregiving roles (23/521 patients) were at increased risk of elevated depressed mood at 6 months (adjusted odds ratio [aOR], 7.20; 95% confidence interval [CI], 1.17-44.46; P = 0.034), and controls with multiple caregiving roles (15/498 controls) were at decreased risk of elevated depressed mood at 12-month follow-up (aOR, 0.12; 95% CI, 0.02-0.97; P = 0.047). Patients with multiple caregiving roles were more likely while controls were less likely to report elevated depressed mood over time, suggesting a need to identify patients with multiple caregiving roles early during their treatment.

Validity of large-deformation high dimensional brain mapping of the basal ganglia in adults with Tourette syndrome.

The basal ganglia and thalamus may play a critical role for behavioral inhibition mediated by prefrontal, parietal, temporal, and cingulate cortices. The cortico-basal ganglia-thalamo-cortical loop with projections from frontal cortex to striatum, then to globus pallidus or to substantia nigra pars reticulata, to thalamus and back to cortex, provides the anatomical substrate for this function. In-vivo neuroimaging studies have reported reduced volumes in the thalamus and basal ganglia in individuals with Tourette Syndrome (TS) when compared with healthy controls. However, patterns of neuroanatomical shape that may be associated with these volume differences have not yet been consistently characterized. Tools are being developed at a rapid pace within the emerging field of computational anatomy that allow for the precise analysis of neuroanatomical shape derived from magnetic resonance (MR) images, and give us the ability to characterize subtle abnormalities of brain structures that were previously undetectable. In this study, T1-weighted MR scans were collected in 15 neuroleptic-naïve adults with TS or chronic motor tics and 15 healthy, tic-free adult subjects matched for age, gender and handedness. We demonstrated the validity and reliability of large-deformation high dimensional brain mapping (HDBM-LD) as a tool to characterize the basal ganglia (caudate, globus pallidus and putamen) and thalamus. We found no significant volume or shape differences in any of the structures in this small sample of subjects.

Knowledge, beliefs, practices, blood pressure and blood glucose control in women with diabetes mellitus [abstract]

OBJECTIVE: To determine the knowledge, beliefs, practices, blood pressure and blood glucose control among women with diabetes mellitus attending a specialist medical clinic. METHOD: A 43-item pre-tested questionnaire was administered to a purposive sample of 28 (26.4 percent) of women attending the University Hospital of the West Indies Diabetes Clinic in May/June 2001. Weight (wt), height (ht), blood pressure (BP), fasting blood glucose (FBG) and two hour post-prandial blood glucose (2hpp), diet and activity were recorded. Body mass index (BMI, wt/ht2) was calculated. RESULTS: Median age of 57 years, range, 21-85 years; median time since diagnosis was 14.5 years, range, 0.5-51 years. Only 27 percent of patients had BP controlled to ó135/85 mm/Hg. There was an association between systolic BP and BMI (r= 0.43, p<0.05). The majority of the patients were inactive, overweight or obese: median BMI, 30.3 kg/m2. The majority did not follow a diabetic diet and had no recent contact with a dietitian. There was an association between reported intake of sucrose and 2hpp (r= 0.75, p<0.001). The majority (82 percent) did not take alcohol; 14 percent smoked cigarettes. Only 28.6 percent were controlled to FBG ó 8 mmol/l and 2 hpp ó10 mmol/l. Sixty-seven percent of the patients were on insulin; 21.3 percent used a glucometer. Medications were missed a median of two days per month. There were inverse associations between years since diagnosis and number of days per month that medications were missed (r= -0.39, p<0.05) and knowledge scores and age (r= -0.47, p<0.01). There were associations between knowledge, practice and educational level (p<0.01). The doctor was the main source of information. The majority reported having had ECG (57 percent), blood cholesterol and renal function tests (64 percent) in the past year. The majority (57 percent) reported never having had a foot examination; 32 percent reported never having had an eye examination. CONCLUSION: The majority of these patients were inactive and obese with limited control of blood glucose and blood pressure. Although fairly compliant with medication, there was little adherence to therapeutic guidelines regarding diet, exercise and maintenance of normal weight. Closer attention should be given to foot and eye examinations for early detection of complications. Closer monitoring and counselling of patients in these areas is recommended. (AU)

Satisfaction among patients attending a specialist medical clinic

OBJECTIVE: To determine the level of satisfaction among patients attending the Cardiac Specialists Clinic at the University Hospital of the West Indies (UHWI), Mona. METHOD: A 25-item pre-tested questionnaire was administered to a purposive sample (n=39), men (n=10) and women (n=29), 43.3 percent of a total population (n=90) attending the clinic in May and June 2001. Their median age was 59 years, range 31-90 years. RESULTS: There were no significant differences between the responses of the men and the women. Respondents travelled a median of eight miles, range 2-183 miles, to attend the clinic, and waited for a median of four hours, range 1-8 hours, before receiving attention. They had attended the clinic a median of four times. Despite this, they reported a high level of satisfaction with all categories of hospital personnel (median rating: 8/10). They, however, rated the caring behaviour of the physicians significantly higher than that of nurses (z=3.2, p<0.001). The majority (71.8 percent) regarded the clinic fees as "reasonable". Fifty percent were eligible for the Drugs for the Elderly Programme but only 21.5 percent were on it. This programme is not offered at the UHWI hospital pharmacy. Only two persons rated the overall facilities as "excellent". They all would recommend the services of the clinics to friends and relatives for "good treatment from knowledgeable doctors and nurses" and "cleanliness of the surroundings". CONCLUSION: Overall, patients were satisfied with the services. The waiting time and time taken to find the dockets were the areas of greatest concern. (AU)

Impact on blood pressure control of a six month intervention project

The aim of this study is to evaluate the impact of a six-month structured education programme on blood pressure (BP) control in patients with uncontrolled hypertension. All patients attending the Specialist Hypertension Clinic, University Hospital of the West Indies (UHWI), between January 4 and March 29, 1999, with blood pressure >140/90 mmHg (n=80), were randomly divided into Group 1, cases (n=42) and Group 2, controls (n=38). A 40-item pretested questionnaire, administered at the baseline and final visits of both groups, elicited demographic, lifestyles and knowledge data. Group 1 attending monthly structured interventions for six months. Except for diastolic blood pressure among male controls, disatolic blood pressure and systolic blood pressure were significantly reduced at the end of the intervention period (p < 0.01). Knowledge improved among the male patients (p < 0.01). Among the female patients, acitivity scores were significantly increased (p < 0.01), weight ( p < 0.05) and BMI (p < 0.05) were significantly reduced. There were no differences in these variables among the controls. This intervention had a benefit in blood pressure control.(Au)

Risk factors for sexually transmitted diseases among females adolescents

OJBECTIVE: To explore the risk factors involved in the occurence of sexually transmitted diseases (STDs) among female adolescents. METHODS: A 38-item pretested questionnaire was administered to a purposive sample of 28 female adolescents, aged 16-19.9 years, diagnosed with more than one sexually transmitted disease, attending the Comprehensive Health Centre, Kingston, Jamaica. Information regarding their socio-demographic characteristics, sex education, sexual behaviour and knowledge of safer sex practices was analysed using SPSS Version 6.13. RESULTS: The median age of their first sexual experience, initiation of alcohol consumption and smoking was 15 years. Sixty-one per cent had one or two children and/or were pregnant. Their reports behaviour was inconsistent with the high scores obtained in the knowledge of safer sex practices. Four of them had HIV. Fifty-seven per cent were unable to say what were their STD diagnosis. Fifty-four per cent had three or more partners, 62 percent consumed alcoholic drinks and 25 smoked cigarettes/marijuana. They seldom used condoms. There was an inverse association between their age at first sexual experience and their number of reported partners (p<.05). CONCLUSION: The early initiation of unprotected sexual activity and substance use in this group of adolescents, the low rate of condom use and the history of multiple partners are a cause for concern. Their apparent knowledge of safer sex practices did not appear to influence their risky behaviour.(Au)

Jamaican nurses' perception of their work experiences with foreign nurses

OBJECTIVE: To explore the perception of Jamaican nurses regarding their work experiences with nurses from Cuba, Nigeria and Ghana. METHOD: A 24-item pretested self-administered questionnaire was distributed to 30 Registered Nurses working with foreign nurses on five selected wards at Kingston Public Hospital. Twenty-three nurses (77 percent) completed the questionnaire. Data were analysed using SPSS Version 6.13. RESULTS: In terms of clinical performance, ability to communicate with patients and staff and pleasant work attitude, the nurse rated those from Ghana highest, followed by Nigerians and Cubans (p<0.001). The majority (91 percent) of the respondents were concerned about the cost of recruiting foreign nurses, some of whom they perceived to be lazy and incompetent. They felt that Jamaican nurses should be treated better by improving salaries and benefits. Sixty-one per cent suggested that the benefits to foreign nurses surpassed their own. CONCLUSION: Nurses from Ghana were the most popular with Jamaican nurses. The cost of improving salaries and benefits to retain Jamaican nurses should be weighed against the cost of recruiting foreign nurses to work in Jamaica.(Au)

Impact on blood pressure control of a six-month intervention project

OBJECTIVE: to evaluate the impact of a structured education programme on blood pressure (BP) control in patients with uncontrolled hypertension. METHODS: All patients attending the Specialist Hypertension Clinic, University Hospital of the West Indies, Kingston, Jamaica, between January 4 and March 29,1999, with blood pressure > 140/90 mmHg (n = 80), were randomly divided into Group 1, cases (n = 42) and Group 2, controls (n =38). Group 1 attended monthly structured intervention programmes for six months: blood pressure and weight monitoring, video presentations, group and individual counselling. A 40-item pre-tested questionnaire, administered at the baseline and final visits of both groups, elicited demographic, lifestyle and knowledge data. Both groups kept their usual clinic appointments. RESULTS: Except for diastolic blood pressure among male controls, diastolic blood pressure and systolic blood pressure were significantly reduced at the end of the intervention period (p < 0.01). Knowledge improved significantly among the male patients (P<0.01). Among the female cases, activity scores were significantly increased (p<0.01), weight (p<0.05) and body mass index (p<0.05) were significantly reduced. There were no differences in these variables among the controls. CONCLUSION: This intervention may have a benefit in blood pressure control.(Au)

A comparison of labour and delivery outcomes in mothers induced with cytotec or pitocin

OBJECTIVE: To compare the labour and delivery outcomes among mothers induced with cytotec (misoprostol) and those induced with pitocin (oxytocin) in a retrospective study. METHODS: A stratified random sample of 40 patient records of 20 mothers induced with cytotec (Group 1) and 20 with pitocin (Group 2), was selected from the records of all of the mothers (n = 148) who had induction of labour at Victoria Jubilee Hospital, Kingston, Jamaica, in March 2000. The groups were matched for age, parity and gestation. Mothers with hypertension, diabetes mellitus, sickle cell disease and multiple pregnancies were excluded. A pretested 27-item checklist, based on the standard labour and delivery records, included a list of possible antepartum, intrapartum and immediate postpartum complications and length of hospital stay. SPSS version 7.5 was used for data analysis. RESULTS: There were no significant differences in total time of labour, blood pressure, blood loss, pre- and post-induction foetal heart rates, apgar scores and length of hospital stay. Two mothers in the cytotec group had uterine hyperstimulation and were delivered by Caesarean section. Four babies in the cytotec group and three in the pitocin group were admitted for special care. CONCLUSION: Althoygh the outcome variables for mothers induced with cytotec and those induced with pitocin were similar, the two cases of uterine hyperstimulation in the cytotec group suggest caution in the use of cytotec for the induction of labour. (Au)

Impact of a six-month intervention project on blood pressure control: preliminary report

OBJECTIVES: To describe the characteristics of uncontrolled hypertensive clients attending the specialist hypertension clinic at the University Hospital of the West Indies. To evaluate the effect of a six-month structured education programme on blood pressure (BP) control in these clients. METHOD: All clients attending the clinic between January 4 and March 29, 1999, with blood pressure >140/90 mmHg (n=80), were divided into Group 1, cases (n=42) and Group 2, controls (n=38). Blood pressure (BP), weight (wt), height (ht), waist (W) and hip (H) circumferences were measured and Body Mass Index (BMI) and W/H ratio calculated. Group 1 attended monthly structured interventions: BP and wt monitoring, videos, group and individual counselling for six months. A 40 item pretested questionnaire, administered to both groups, collected demographic, lifestyle, knowedge and medication data at baseline and at the end of six months. RESULTS: Mean BMI for men was 27.2 (95 percent CI, 25.7-29.6); mean BMI for women was 30.9 (95 percent CI, 26.1-35.7). Although the majority of both men and women recognized diet, inactivity and overweight as contributing to high blood pressure. Reported medication compliance was good with a mean of only 4 days missed per month. In men, there were associations between BMI and WWHR, p<0.05, BMI and diastolic BP and a negative association between BMI and activity level, p<0.05. Following the intervention, BP was reduced overall, p<0.01, except for diastolic BP in male controls. Knowledge improved among the male cases p<0.01. In the female cases activity scores were higher, p<0.001; Wt and BMI, were lower than at baseline, p<0.05. There was no difference in these variables among the controls. CONCLUSION: Structured education and monitoring interventions with personalised counselling in life style management and weight reduction may be an important part of therapy for clients.(Au)

Topical use of Papaya in chronic skin ulcer therapy in Jamaica

The objective of the study was to determine the prevalence of the use of the fruit (papaya) or Carica papaya as topical ulcer dressings by registered nurses in the Spanish Town Hospital (STH), Kingston Public Hospital (KPH) and the University Hospital of the West Indies (UHWI), Jamaica. A ten-item pre-tested self-administered questionnaire was distributed to 285 randomly selected registered nurses at the UHWI, KPH and STH. There was a 72 percent response rate. The prevalence of topical papaya use among the respondents was 75 percent. Comments from the users of papaya suggested that topical application of the unripe fruit promoted desloughing, granulation and healing and reduced odour in chronic skin ulcers. It was cost effective. Papaya was considered to be more effective than other topical applications in the treatment of chronic ulcers. There was some difficulty in preparation of the fruit and occasionally a standardised procedure but there were no reports of wound infection from its use. Papaya is widely used by nurses as a form of dressing for chronic ulcers and there is need for standardisation of its preparation and application.(Au)