Improving Care Transitions: An Academic Service Partnership to Achieve Coordination of Care Using Students as Health Coaches.

To avoid penalty through the Hospital Readmission Reduction Program, an academic practice partnership, Health Transitions Alliance, was formed with the local university, resulting in adoption of an innovative transitional care model. Key to the model was a health coach who operationalized transition care to the home setting. Health coaches, interns in their last semester of college, used motivational interviewing to help patients set disease management goals. As a result of this model, the readmission rate for program participants in the initial 7 months was reduced by 72%.

Cultural influences on safety and health education among Vietnamese fishermen.

Every ethnic group has its own cultural background and history that influences how it views health behaviors. By virtue of their work history, many Vietnamese have pursued the fishing industry when migrating to the United States. Even though the fishing trades are among the most dangerous jobs in the world, there has been little attention in the literature to the significant role that culture plays in the expression and experience of occupational health practices among Vietnamese shrimp fishermen. Three focus group sessions were conducted to identify factors that hinder or facilitate receptivity to available training and to guide culturally appropriate content. Participants were recruited using purposive sampling among various Vietnamese shrimp fishermen communities in Texas. Utilizing a series of open-ended questions, sessions were conducted in their native language among owners/captains/deckhands; support infrastructure--adult family members and religious/community leaders; and industry management and insurance representatives. Translations of transcribed documents were compared with simultaneous translations to ensure thematic consistency. Conducting hands-on training among Vietnamese by experienced fishermen, specifically targeting captains, was considered key to safety culture on the vessels. Findings of the study support that training should occur in a variety of formats (hands-on), but should be periodic, current, practical, convenient, taught in the primary language of the audience by an experienced individual, culminate in a certificate of completion, and target captains first. These findings illustrate the importance of considering cultural factors in the design of workplace interventions that focus on changes in safety and occupational health behaviors.

Evaluation of a school-based train-the-trainer intervention program to teach first aid and risk reduction among high school students.

BACKGROUND: Farming is a hazardous occupation posing health risks from agricultural exposures for the farm owner and family members. First Aid for Rural Medical Emergencies (F.A.R.M.E.) was developed to support a train-the-trainer (TTT) program to prepare high school students to teach first aid skills and risk reduction through peer interaction. This study was designed to evaluate the educational effectiveness for first aid skill development and awareness of safety issues and injury prevention impacting agricultural communities. METHODS: Forty-three agricultural science students from a rural high school participated in the study. A quasi-experimental design was used to evaluate knowledge acquisition and anticipatory action among groups: those participating in training and a comparison group with no training. The intervention group included 27 participants trained as first aid peer instructors using the F.A.R.M.E. manual, return demonstration, case scenario facilitation training, and teaching evaluation sessions. The effectiveness of the program was evaluated using triangulated data. Independent t test analyses were conducted on post-test scores to evaluate the knowledge acquisition and anticipatory action scores between groups. Focus group sessions assessed attitudes, experiences, and values held following the intervention of teaching peers. RESULTS: Results indicate that the intervention group scored significantly higher on anticipatory action (t = 2.23, p = .03) but not knowledge acquisition (t = 1.37, p = .18). Focus group data suggest that the TTT format bolstered confidence in teaching, confirmed that teens enjoy learning from teens, and fostered pride in team work. CONCLUSIONS: The F.A.R.M.E. TTT resulted in a theory and evidence-based intervention that can be implemented in a school setting to promote knowledge and skill acquisition of first aid and injury prevention among rural high school students.

Graduate nursing online orientation course: transitioning for success.

Graduate nursing students beginning their graduate education often lack technological preparedness when beginning the journey in a virtual e-learning environment. These gaps in preparedness include lack of understanding course delivery, accessing resources remotely, participating in asynchronous course activities, and use of emerging health care technologies. This article describes an educational innovative online orientation course that simulates course activities so that students get a true perspective of what e-learning entails. With enhanced education through the accelerated learning modules, students became proficient with distance education, which promotes success in an online master's of science in nursing program.

Self-reported back pain among farm women in southeast Louisiana.

This cross-sectional survey details the incidence and predictors of self-reported back pain among farm women from southeastern Louisiana. The sample was obtained from a preexisting data set of a cross-sectional randomized sample of farm women who participated in the Louisiana Farm Family Injury Prevention and Health Initiative research project. The Haddon Injury Model was used as the conceptual framework. Approximately one fourth of the women in the sample reported back pain in the past year. The major findings from logistic regression analysis were that women reported back pain if they were hauling animals to market and had physical health conditions. Implications for nursing practice include assessing the risk of back pain among farm women and providing client education that includes the importance of compliance with recommended health screenings for early detection and treatment of physical health conditions associated with back pain.

Behavior change, environmental hazards and respiratory protection among a southern farm community.

The agricultural industry ranks as one of the most dangerous in terms of occupational deaths and injuries. A wide variety of respiratory illnesses can result from the exposure to grain and organic dusts and working in animal confinement facilities and barns. This article analyzes the Transtheoretical Model of Change for implications relevant to health promotion and education. This study explored differences of perception of occupational health, environmental exposures, and stages of change consistent with the readiness to take action and the confidence to act toward respiratory health among farmers who report respiratory symptoms with physical activity and those who do not. A convenience sample of 123 farm owners and agricultural employees recruited from community-based agricultural events in southeast and central Louisiana completed three surveys: (a) Health Risk and Environmental Assessment; (b) Identification of Respiratory Mask Use; (c) Stage of Awareness and Preventive Respiratory Health; and demographic information. Subjects performed pulmonary function tests including three Forced Vital Capacity (FVC) maneuvers while connected to a Renaissance spirometer. Even though the majority of subjects rated themselves in action stage of change, subjects reported using respiratory protective devices less than 10% of the time. No significant differences were found in environmental exposures. Using chi-square analysis, those farmers who reported breathlessness were significantly more likely to report fatigue, chest pain, and dizziness. Those farmers who report breathlessness are significantly less likely to perceive respiratory health as important compared to other occupational illnesses/conditions. There is a need for additional studies to further examine the relationship between respiratory symptoms, exposure risks, and behavior change theory.

My father's experience with macular degeneration: implications for the home healthcare nurse.

Macular degeneration has become a problem of substantial proportions for older adults. This article can help the home health nurse gain a greater understanding of macular degeneration and therefore be more effective in the home setting. The addition of vision rehabilitation also can prolong older adults' independent years and enhance their satisfaction with life. Using Parse's human-becoming theory as a theoretical framework, the home health nurse can coparticipate in the older adult's experience of living and thus enhance the probability that the last years will be a rewarding time of life.

The impact of farm lifestyle and health characteristics: cervical cancer screening among southern farmwomen.

BACKGROUND: Rural residence, access to healthcare facilities, and multiple roles of farmwomen may pose barriers to cervical cancer screening among women living in southern farm states. OBJECTIVES: To compare the proportion of women failing to obtain cervical cancer screening in three Southern states to state-level Behavioral Risk Factor Surveillance System (BRFSS) data and to identify factors contributing to cervical cancer screening and detection behaviors. METHODS: A cross-sectional study design was used. Data were collected using several Farm Family Health and Injury Prevention surveys via telephone interviews in three southern states. Farmwomen (N = 2,324) from three states comprised the sample on Pap testing. Data were used from summary reports of the BRFSS for each state to compare the proportion of farmwomen >or=18 years of age who had failed to obtain a Pap test within the past 3 years to failure to obtain Pap tests statewide. Multiple logistic regression analyses were conducted to examine the predictors of failure to obtain early screening. RESULTS: Pap testing did not meet Healthy People 2010 target goal of 90%. Farm lifestyle predicting failure to obtain cervical cancer screening included having a house on the farm and engaging in no off-farm work and minimal involvement in farm tasks. The risk of failing to obtain Pap testing increased with age and decreased with education. The only health access variable contributing to failure to obtain Pap testing was women with no insurance. Positive preventive risk factors contributing to compliance with up-to-date status were previous mammogram and previous breast exam. Being married was a positive risk factor. DISCUSSION: Although the failure to obtain Pap testing in Texas was comparable to state BRFSS rates, failure to obtain Pap testing rates in Kentucky and Louisiana were at least 6% greater for farmwomen than women living in the state. Farmwomen, a subgroup of the rural population, have unique barriers to obtaining screening services. Geographical isolation and minimal role involvement on the farm may contribute to the likelihood that women are not seeking cervical cancer screening.

Potential exposure to hazardous work activities: tractor usage among farmwomen.

Farmwomen are often an unacknowledged workforce, leading to a lack of targeted safety interventions. This study examined the involvement and work patterns of 665 women in Texas and 657 women in Louisiana who were 18 years old and older and whose family participated in farming operations. Surveys were used to gather specific data regarding tractor work patterns, tractor knowledge, sources of information about tractors, and demographic information in two southern states in which cattle and dairy were the major agricultural commodity. Among the sample of 1,322 women, 577 (43.6%) reported driving tractors at least one day a year. This subset was used to describe characteristics of tractors and tractor-related activities. Findings indicate that women learn to drive tractors in their 20s, use husbands as the primary source of their information about tractors, engage in a wide variety of farm activities including bush-hogging and plowing, and acknowledge knowing an average or less than an average amount about driving tractors. Women most often reported driving between 1 to 12 days/year (n = 321, 55.6%). When examining patterns of ROPS-equipped tractor use, women were 1.47 times more likely to drive a tractor without ROPS or enclosed when driving less than 12 days a year as opposed to 13-103 days/year or greater than 104 days/year. The results of this study support the need for health care professionals and safety specialists to design appropriate interventions that target women to become more knowledgeable regarding the injury risks associated with farm work while driving tractors.

Occupational risky business: injury prevention behaviors of farm women and children.

On farms in the United States, there are approximately 100 fatal and 32,800 nonfatal injuries annually in children 19 years and younger (United States Department of Labor, 1999). Up to 40% of nonfatally injured children are left with permanent disabilities. The impact of injury and death on children associated with farming in the United States is substantial. Research suggests that modeling of health behaviors may be an effective technique for the socialization of children's health behaviors. The purpose of this study is twofold. First, the study describes the participation and use of protective farm equipment or practices by the caregiver and the child. The second purpose is to compare the practices of the caregivers and the children in relation to the use of protective farm equipment and practices. Descriptive and categorical data analysis methods were used to examine the associations of 177 pairs of caregivers and children and their use of protective equipment and preventative behaviors. Greater than 50% of the children under the age of 7 had handled or touched livestock, as well as rode as passengers on tractors. Many children in all age categories had ridden in the back of pick-up trucks. Modeling of the prevention behavior by the caregivers did parallel the use of the equipment by the children. However, the opposite also was true; if the caregiver did not use the equipment, neither did the child.

Adiponectin responses to continuous and progressively intense intermittent exercise.

PURPOSE: Adiponectin is a recently discovered adipocyte protein that is lower in patients with coronary artery disease and in Type II diabetics who have insulin resistance. Regular exercise is known to be a preventative factor in the development of atherosclerosis and Type II diabetes. Acute exercise increases insulin sensitivity; however, it also increases beta-adrenergic and glucocorticoid activities that may suppress adiponectin expression. Two experiments were conducted to determine whether acute exercise affects adiponectin concentrations. METHODS: In the first experiment, six healthy male subjects completed 30 min of heavy continuous running exercise at 79% of VO (2max). In the second experiment, well-trained runners completed strenuous intermittent exercise consisting of treadmill running at 60, 75, 90, and 100% VO (2max). A resting control trial for the second experiment was also conducted. RESULTS: Glucose and insulin were not altered significantly in the first experiment, but both increased significantly (P < 0.05) in the second experiment. A significant increase (P < 0.05) in adiponectin in the first experiment was no longer significant after correction for plasma volumes shifts. In the second experiment, there were significant (P < 0.05) changes in adiponectin concentrations over time but not a significant difference between adiponectin responses in exercise and control trials. CONCLUSIONS: The data suggest that 30 min of heavy continuous running or more strenuous intermittent running does not stimulate an increase in production and release of adiponectin, and small increases in adiponectin concentrations resulting from the exercise may be attributed to normal plasma volume shifts.

Nonfatal injury experiences among women on family farms.

Agricultural injury occurrence was determined among 1,096 working farm women in Texas and Louisiana. The 1-year cumulative incidence was 4.8%. Lower extremities were the body parts most frequently injured. The leading external causes were contact with foreign object, followed by falls and overdoing/ lifting. The seasonal pattern of injury was consistent with warm weather. The factors predictive of increased injury risk in multiple logistic regression included large animal farm type, greater time commitment, recurrent or persistent back conditions or weakness during the previous 12 months, hauling goods to market, and driving a tractor more than 52 days per year. Most women consulted a physician as a result of the injury. Resolving the problem of preventable farm-related injuries will require a major and coordinated effort aimed not only at farm women themselves but also at multiple variables that profoundly affect the underlying conditions and behaviors that lead to farm-related injuries.

Depressive symptoms in farm women: effects of health status and farming lifestyle characteristics, behaviors, and beliefs.

A multitude of responsibilities, environmental and social influences, and stressors place farm women at high risk for depressive symptoms. This cross sectional survey design study examines demographic, health status, and farm lifestyle characteristics, behaviors and beliefs as risk factors contributing to depressive symptoms among farm women in southeast Louisiana. The study was conducted in a stratified, random sample of 657 women 18 years and older. Factors predictive of depressive symptoms in adjusted logistic regression included those who experience poor health, perceive hazards associated with farming, experience recent farm-related injuries and engage in farming over longer periods of time. These findings help target interventions toward women at risk for depressive symptoms.