Where Have They Gone? Recruiting and Retaining Older Rural Research Participants.

ISSUE: Rural-dwelling elderly have been shown to suffer from health disparities when compared to the general population. Research involving these individuals is important, and to have meaningful results, sample sizes must be adequate. Recruiting and retaining these individuals pose significant challenges. CONTEXT: Nurse researchers in the rural northwestern United States conducted a 4-part educational intervention aimed at increasing general and complementary and alternative health care literacy of older rural dwellers. Significant challenges were faced in both recruiting and retaining participants over the 6-month study period. Despite careful planning and community selection, the team had to double the number of communities in which they carried out the project to meet recruitment goals. Retention was also a challenge. Of 127 participants initially enrolled in the study, only 52 remained to the end. LESSONS LEARNED: Challenges of recruiting and retaining are complex and compounded when the target population is rural, older and the study is longitudinal. Recruitment challenges included reaching older adults, offering a compelling program, and offering it in an acceptable format at a convenient time and place. A variety of outreach activities were conducted including in-person presentations, advertising or public interest stories in local newspapers or radio stations, and flyers on bulletin boards in restaurants, clinics, churches, community centers, and libraries. A project champion, an individual well known and connected within the community and committed to the success of the proposed study, is a major asset. Retention strategies included developing relationships with the participants and maintaining contact with them over the course of the study through such mechanisms as appointment cards, e-mail or regular mail, telephone reminders, and thank you cards. Oversampling was important as factors beyond the control of the researcher occurred; for example, illness, death, family crises, unexpected relocations, and weather events that prevented travel to scheduled research events.

Be Wise: A complementary and alternative medicine health literacy skill-building programme.

BACKGROUND: Health literacy has been found to be the strongest predictor of health status; and without adequate health literacy, consumers may not understand/adequately evaluate the myriad of choices available. Older rural residents tend to use self-prescribed complementary and alternative medicine (CAM) therapies and glean information about these therapies primarily by word of mouth/media. OBJECTIVES: The purpose of this article is to describe the Be Wise health literacy skill building programme and the participants' evaluation of the programme. DESIGN: The programme involved four sessions delivered over 7 weeks at seniors' centres in rural communities. METHOD: Data were collected initially (N = 127), at the end of the sessions (N = 67) and after 5 months (N = 52). SETTING: Participants were primarily rural Caucasian women, mean age 76 years, and most had an associate/baccalaureate degree. RESULTS: Questions were worded to ascertain satisfaction with the programme, usefulness of the information provided, willingness to recommend the programme, and the likelihood of using the programme. All scores were most favourable ranging from 3.35 to 4.41 on a 5-point scale. A question regarding the usefulness of the Be Wise programme in managing health received at mean score of 3.55 on a 5-point scale. Written comments on the questionnaires were overwhelmingly favourable. CONCLUSION: Delivering programmes to older adults in small rural communities has special challenges and rewards. Participants were enthusiastic about learning more about making informed health care choices. There is a compelling need for continued programme development and long-term outcomes evaluation.

Community-based Skill Building Intervention to Enhance Health Literacy Among Older Rural Adults.

The purpose of this article is to report the outcomes of a skill building intervention to improve general health literacy and health literacy about complementary and alternative therapies (CAM) among older rural adults. The intervention was implemented in eight rural communities. Descriptive statistics and general linear modeling were used for analysis. A total of 127 older adults completed the initial session and Time 1 questionnaire, 67 (51%) completed the intervention sessions and Time 2 questionnaire, and 52 (40.9%) completed the Time 3 questionnaire five months later. CAM health literacy scores and scores on one general health literacy measure were significantly higher at Time 2 compared to Time 1 and 3. The decline in scores over time suggests a need for continuing strategies to support older adults' health literacy. Assisting older adults to make safe health care choices is a critical role for investigators, nurses, and other health care providers.

Psychometric evaluation of the MSU CAM health literacy scale.

BACKGROUND/PURPOSE: The rise in the use of alternative health care approaches (CAM) increases the need for adequate health literacy. The MSU Health Literacy Scale was developed to measure CAM health literacy. Psychometric evaluation of the scale is presented in this article. METHODS: A test retest design was utilized and data from this instrument evaluation research project were used to explore the validity and several forms of reliability of the MSU Health Literacy Scale. The data analysis was based on the scores of 241 individuals at the T1 data collection and the scores of 188 at the T2 administration of the instrument. RESULTS: There were significant correlations between the MSU CAM Health Literacy Scale and Newest Vital Sign (r = 0.330 p = .000) and with a single question health literacy measure (r = .255 (p = .000). Cronbach's alphas were adequate for each administration of the scale (T1 = .774 and T2 = .754). The correlation of scores between the T1 administration and the T2 administration were significant (r = .696 (p = .000). CONCLUSIONS: This psychometric evaluation provides confirmation of convergent validity and stable reliability. The scale can be used in future research and clinical endeavors.

Bee SAFE, a Skill-Building Intervention to Enhance CAM Health Literacy: Lessons Learned.

The purpose is to describe a feasibility study of a skill-building intervention to enhance health literacy about complementary and alternative (CAM) therapies among older rural adults and share lessons learned. A study was designed to examine the feasibility of an intervention to enhance CAM health literacy. The theme was "Bee SAFE" for Be a wise user of CAM, Safety, Amount, From where, and Effect. Modules were presented face to face and by webinar with older adults at a senior center in one small rural community. The team achieved its purpose of designing, implementing, and evaluating the intervention and assessing if it could be implemented in a rural community. The implementation challenges encountered and lessons learn are discussed. By improving CAM health literacy, older rural adults with chronic health conditions can make well-reasoned decisions about using CAM for health promotion and illness management. The goal is to implement the Bee SAFE intervention in other rural communities; thus team members were attentive to lessons to be learned before investing time, effort, and expense in the larger intervention. It is hoped that the lessons learned can be instructive to others planning projects in rural communities.

RN Perceptions of a Newly Adopted Electronic Health Record.

OBJECTIVE: The purpose of this study was to understand nurses' perceptions of a newly adopted electronic health record (EHR). BACKGROUND: As use of EHRs in hospital settings increases, leaders prepare staff members for change. There is limited information about impacts of EHR adoption on RNs using EHRs at the point of care. METHODS: Clinical RNs were surveyed about 3 domains (ease of use, usefulness, and attitude) before and after implementation of an EHR. A small subset of nurses was interviewed for a deeper understanding of perceptions associated with this change. RESULTS: One year after adoption, nurses believed that the EHR did not improve patient care, the learning curve was steep, and they had lower confidence using the EHR than anticipated. Nurses commented on both their frustration and optimism about EHRs. CONCLUSIONS: This study provides insight into RNs' perceptions of an EHR, providing important information for nursing administrators.

Instrument to measure health literacy about complementary and alternative medicine.

BACKGROUND AND PURPOSE: Health literacy is an essential skill for today's health care consumers. The growth in use of complementary and alternative medicine (CAM) adds to the complexity of being sufficiently health literate. The purpose of this article is to describe the initial psychometric evaluation of the "Montana State University (MSU) CAM Health Literacy Scale," a newly developed instrument to measure an individual's health literacy about CAM. METHODS: Exploratory factor analyses, reliabilities, and conceptual considerations were used. RESULTS: The outcome is a 21-item instrument with Cronbach's alpha of .753 and 42.27% explained variance. Convergent validity assessments revealed weak but significant correlations between the scale and measures of general health literacy. CONCLUSIONS: The MSU CAM Health Literacy Scale has promise for use in future research and clinical endeavors.

The Montana State University conceptual model of complementary and alternative medicine health literacy.

This article aims to present and describe a model of complementary and alternative medicine (CAM) health literacy. The model is the conceptual basis for CAM health literacy, which is operationally defined as the information about CAM needed to make informed self-management decisions regarding health. Improving health literacy is a national priority, and widespread use of CAM has added to the complexity of this task. There are no currently available models or measures of health literacy regarding CAM. The authors developed the model using an iterative process of deriving concepts, constructs, and empirical indicators from the literature and the author's prior work, review and critique by experts, and revision. The model of CAM health literacy can serve as the basis for future research on the use and efficacy of CAM and the constructs and concepts within it can be used to identify points of intervention for research or for clinical practice. It is anticipated that the model will have scientific and clinical application for assessing health literacy in other self care decision-making situations.

Viral sequestration of antigen subverts cross presentation to CD8(+) T cells.

Virus-specific CD8(+) T cells (T(CD8+)) are initially triggered by peptide-MHC Class I complexes on the surface of professional antigen presenting cells (pAPC). Peptide-MHC complexes are produced by two spatially distinct pathways during virus infection. Endogenous antigens synthesized within virus-infected pAPC are presented via the direct-presentation pathway. Many viruses have developed strategies to subvert direct presentation. When direct presentation is blocked, the cross-presentation pathway, in which antigen is transferred from virus-infected cells to uninfected pAPC, is thought to compensate and allow the generation of effector T(CD8+). Direct presentation of vaccinia virus (VACV) antigens driven by late promoters does not occur, as an abortive infection of pAPC prevents production of these late antigens. This lack of direct presentation results in a greatly diminished or ablated T(CD8+) response to late antigens. We demonstrate that late poxvirus antigens do not enter the cross-presentation pathway, even when identical antigens driven by early promoters access this pathway efficiently. The mechanism mediating this novel means of viral modulation of antigen presentation involves the sequestration of late antigens within virus factories. Early antigens and cellular antigens are cross-presented from virus-infected cells, as are late antigens that are targeted to compartments outside of the virus factories. This virus-mediated blockade specifically targets the cross-presentation pathway, since late antigen that is not cross-presented efficiently enters the MHC Class II presentation pathway. These data are the first to describe an evasion mechanism employed by pathogens to prevent entry into the cross-presentation pathway. In the absence of direct presentation, this evasion mechanism leads to a complete ablation of the T(CD8+) response and a potential replicative advantage for the virus. Such mechanisms of viral modulation of antigen presentation must also be taken into account during the rational design of antiviral vaccines.

Validated protocol for FoxP3 reveals increased expression in type 1 diabetes patients.

BACKGROUND: FoxP3 has become a key identifier of regulatory T cells. Investigators have used a variety of antibodies and methods for detecting FoxP3 by flow cytometry. To standardize FoxP3 antibody staining for use in clinical trial samples, we tested various antibodies from different vendors, cell preparation protocols and fix/perm reagents, and cell isolation procedures. Using this optimized staining protocol, we evaluated clinical specimens from patients with multiple sclerosis (MS) or type 1 diabetes. METHODS: FoxP3 antibodies from eBioscience (236A/E7 and PCH101) and BioLegend (206D) were evaluated along with their respective methods and fix/perm reagents for preparation and staining of FoxP3 for flow cytometry. Fresh washed blood and frozen or fresh PBMC were evaluated. Upon optimization of the protocol, clinical samples (frozen PBMC) from patients with MS or type 1 diabetes and healthy control donors were evaluated with the BioLegend antibody. RESULTS: Clone 206D from BioLegend yielded optimal staining and the fix/perm reagents from both eBioscience and BioLegend were comparable. Data were also comparable between cells separated by Ficoll (fresh or frozen) and washed blood samples, allowing this protocol to be applicable to different types of samples. We validated this protocol using clinical samples and saw a significant increase in FoxP3 expression in the patients with type 1 diabetes but not in the MS. CONCLUSIONS: The results from this study will allow the assessment of FoxP3 by flow cytometry on samples from clinical sites that are analyzed in real time on fresh blood or frozen PBMC.

A Survey of Hospices Use of Complementary Therapy.

As people live longer with chronic illnesses, the need for hospice services will increase. Complementary therapies have been shown to increase ease, relieve pain, and improve quality of life; all relevant for people with chronic illness at the end of their lives. The first aim of this study was to identify complementary therapy services available to, and provided for, clients receiving hospice care in Nevada and Montana. The second aim was to identify differences in those therapies for urban and rural hospice clients. Using a descriptive survey design, data were collected from surveys sent to all hospice administrators in Nevada and Montana (N=54). A 50% (n=27) response rate was obtained. Most (70.4%, n=19) of the participating hospices offered complementary therapy; slightly more than half (52.9%, n=9) provided the services for less than 25% of their clients. No significant differences were found between rural and urban hospices.

Complementary therapy and older rural women: who uses it and who does not?

BACKGROUND: Despite the growing use of complementary therapy by consumers in the United States, very little is known about the factors associated with the use of these therapies among older rural women. OBJECTIVE: The aim of this study was to answer the following research question using data from a portion of a larger study: What factors predict the use of complementary therapy among older rural women? METHODS: Data were collected by telephone interview from a random sample of older residents of 19 rural towns in Montana and North Dakota. Interviews were conducted using a guide that included questions about the use of allopathic and complementary healthcare and related issues such as health status, health problems, and reasons for seeking care. A direct logistic regression analysis was performed on the use of complementary or alternative medicine (CAM) as outcome and eight potential predictors. Data from 156 women were included in this analysis. RESULTS: A total of 25.6% (n=40) of the women reported using CAM in the recent past. Rural women most likely to use CAM were those who were fairly well educated, not currently married, and in their early older years. They had one or more significant chronic illnesses and lower health-related quality of life due to emotional concerns. DISCUSSION: By improving the existing understanding of who is or is not likely to use CAM, the results of this study can be used in giving comprehensive care for rural women, including all healthcare practices, self-care and practitioner provided, and complementary and conventional.

Cross-priming utilizes antigen not available to the direct presentation pathway.

CD8+ T cells play a crucial role in protective immunity to viruses and tumours. Antiviral CD8+ T cells are initially activated by professional antigen presenting cells (pAPCs) that are directly infected by viruses (direct-priming) or following uptake of exogenous antigen transferred from virus-infected or tumour cells (cross-priming). In order to efficiently target each of these antigen-processing pathways during vaccine design, it is necessary to delineate the properties of the natural substrates for either of these antigen-processing pathways. In this study, we utilized a novel T-cell receptor (TCR) transgenic mouse to examine the requirement for both antigen synthesis and synthesis of other cellular factors during direct or cross-priming. We found that direct presentation required ongoing synthesis of antigen, but that cross-priming favoured long-lived antigens and did not require ongoing antigen production. Even after prolonged blockade of protein synthesis in the donor cell, cross-priming was unaffected. In contrast, direct-presentation was almost undetectable in the absence of antigen neosynthesis and required ongoing protein synthesis. This suggests that the direct- and cross-priming pathways may utilize differing pools of antigen, an observation that has far-reaching implications for the rational design of vaccines aimed at the generation of protective CD8+ T cells.

Health care choices: complementary therapy, chronic illness, and older rural dwellers.

PURPOSE: To better understand elderly rural dwellers use of complementary and alternative therapies (CAM), perception of efficacy, and their sources of information. METHOD: Ten participants between ages 60 and 80 years were interviewed by telephone. Qualitative analysis for content and themes was done. FINDINGS: Self-directed practices such as vitamin, mineral, and herbal supplements, taken to compensate for perceived dietary deficiencies, were cited most frequently. Therapies used included biofeedback, massage, chiropractic, and podiatry. Information was obtained from the physician or nurse practitioner and supplemented with material from other sources. CONCLUSIONS: Respondents were discriminating users of the products they selected and were satisfied with the results, although they did not always have accurate understanding of the effects of the supplement or therapy. IMPLICATIONS: Health professionals need to have knowledge about CAM and to include questions about use during patient encounters. Providers must take time to answer questions and provide user friendly information.

Complementary therapy use among older rural adults.

OBJECTIVE: Explore use, cost, and satisfaction with the quality and effectiveness of complementary therapy among older rural adults. DESIGN: Descriptive survey. SAMPLE: A random sample of 325 older adults from rural communities throughout Montana and North Dakota. MEASUREMENTS: Participants were interviewed by telephone. RESULTS: Only 57 participants (17.5%) had used complementary providers and most sought this care for chronic problems, heard about providers through word-of-mouth information, and were satisfied with the care. A total of 35.7% (116) used self-directed complementary practices and most used these practices for health promotion, heard about them through informal sources, and found them to be at least somewhat helpful. Of the 325 participants, 45.2% (147) used some form of complementary care, e.g., providers, self-directed practices, or both. Participants used as much complementary care as is found in national studies. Most spent relatively little out-of-pocket for complementary care. CONCLUSIONS: Understanding the health care choices that older rural residents make, including complementary health care, is paramount for a comprehensive approach to meeting their health care needs.

Influence of biosolids compost on the bradyrhizobial genotypes recovered from cowpea and soybean nodules.

The interaction of biosolids compost application to soil and bradyrhizobial genotypes recovered from nodules was examined. Among 170 isolates, seven genotypes were recovered from soils receiving either no biosolids application or rates of 73 or 146 Mg/ha for three successive years. With the exception of one genotype, the distribution of the bacterial genotypes recovered from nodules was interrelated with the level of biosolids. Two of the genotypes nodulated both soybean and cowpea. Because soybean-nodulating bradyrhizobia were not recovered from control plots, it is possible that they had been introduced together with the biosolids compost application.

Improving the management of breathlessness using a clinical effectiveness programme.

Breathlessness represents a significant problem for the person with advanced cancer. Uncontrolled breathlessness ranks highly in terms of uncomfortable symptoms experience, causing pain and distress to the patient and resulting in significant anxiety to their carers. The key to the provision of effective care lies in the informed application of the nursing process, underpinned by a sound knowledge base in relation to the nursing management of breathlessness. Theoretical knowledge enables nursing staff to offer appropriate interventions for the management of breathlessness in collaboration with other members of the multidisciplinary team. This article will discuss the cause and management of breathlessness in the person with advanced cancer; the discussion focuses on the application of research-based interventions and the evaluation of clinical outcomes in a UK clinical governance context.

Efectos de la suspensión del rociamiento residual y del paludismo importado en el control de la malaria en Estados Unidos / Effects of suspended residual spraying and of imported malaria on malaria control in the USA

The activities of the National Malaria Eradication Program, a cooperative campaign inaugurated in July 1947 by the United States Public Health Service and certain State and local health agencies, are outlined. Control operations reached their maximal level in 1948, when 1,364,950 dwellings in 13 "malarious" States were sprayed with residual DDT, and the percentage of mosquito control achieved was 83.2

In 1950, only 2,227 cases of malaria were reported as compared with 16,203 in 1947 and 9,797 in 1948. But the return of infected servicemen from Korea caused a temporary increase in the incidence in 1951 and 1952, when the totals were 5,600 and 7,023, respectively. In 1953, however, only 559 civilian cases were reported; of the cases appraised, 28 were of local origin, and, of these, at least 24 are known to have been infected in 1952

The Public Health Service ceased active participation in the Program in 1951, but continued to give technical advice. At the same time, State authorities received Federal support in activating malaria surveillance-and-prevention programs. More selective anti-anopheline activities have replaced residual insecticide spraying, which is now carried out in only a few isolated areas. It is believed that these measures have prevented imported malaria from increasing the diminishing incidence of primary indigenous cases in the USA(AU)