A Policy Analysis of Mandatory Obstructive Sleep Apnea Screening in the Trucking Industry.

Obstructive sleep apnea (OSA) is a chronic condition characterized by occlusion of the upper airway during sleep resulting in daytime sleepiness. Drivers with OSA are at a two- to sevenfold increase in risk of motor vehicle crashes (MVCs). Approximately, 13% to 28% of commercial motor vehicle drivers (CMVDs) are thought to have OSA. Obstructive sleep apnea is a significant issue in the transportation industry. Currently, The Federal Motor Carrier Safety Association (FMCSA) does not mandate OSA screening. Federal regulations only specify that CMVDs be free of "respiratory dysfunction" that would impair driving. Untreated OSA is a public safety concern. The purpose of this article is to use Bardach's eightfold policy analysis approach to examine policy options related to OSA screening in the trucking industry.

Family history of stroke among African Americans and its association with risk factors, knowledge, perceptions, and exercise.

BACKGROUND: African Americans are at greater risk for stroke than whites are; however, it is unclear what role family history of stroke (FHS) plays in the adoption of healthier lifestyles among African Americans. OBJECTIVE: The aim of this study was to compare modifiable risk factors, knowledge of stroke risk factors, perceived threat of stroke, perceived control of stroke, and exercise behaviors and intentions in African Americans with a FHS and those without a FHS. METHODS: A cross-sectional study was conducted with rural African Americans aged 19 to 54 years participating in a mobile health clinic. Participants' stroke knowledge, perceptions of risk, exercise history and intent, physiologic data, and health history were collected. RESULTS: Participants (N = 66) had a mean (SD) age of 43.3 (9.4) years and were mostly women, high school graduates, and unemployed. Participants with a FHS (n = 33) did not differ on average number of risk factors from those without a FHS. However, participants with a FHS were more likely to report a history of hypertension than were those without. There were no significant differences between groups in stroke knowledge, perceived threat and perceived control, or recent exercise performance, although participants with a FHS had significantly lower future intentions to exercise than did those without a FHS. CONCLUSIONS: Family history of stroke was common in this sample; however, it did not translate into better understanding of stroke or better exercise behaviors and intentions. More can be done to identify African Americans with a FHS, especially those with multiple risk factors, to educate them about the significance of FHS while promoting lifestyle change and self-management.

Hypertension education and screening in African American churches.

A major disparity among African Americans is undiagnosed and uncontrolled hypertension. This exploratory study examined hypertension education and screening activities of 45 African American churches. A cross-sectional telephone survey was used to interview church representatives with knowledge of their church's health activities. Most churches (87%) offered at least 1 activity and 40% offered all 4 (i.e., screenings, materials, talks, health-fairs) within 2 years of the interview. Larger churches and those with an active health ministry offered more activities. More information about resources, program ideas, and collaborators was desired. Research is needed to examine factors that act as barriers and facilitators to implementing church based programs and to examine the effectiveness of these programs in reducing hypertension.

Metabolic syndrome in African Americans: views on making lifestyle changes.

This study explores African American adults' understanding of metabolic syndrome (MetS) and their motivations for making lifestyle changes. African Americans have a greater risk for components of MetS, such as hypertension. Three focus groups were conducted with African American adults (n = 11) with MetS. Content analysis revealed five themes: Threat of Poor Health, Building Trust With Providers, Gaining Social Support, Seeking Culturally Acceptable Alternatives, and Getting on Track and Staying on Track. Lifestyle interventions for African Americans with MetS need to focus on building trust, developing self-monitoring skills, social support, and identifying low-cost/convenient opportunities for physical activity.

Implantable cardioverter defibrillator storm: nursing care issues for patients and families.

Implantable cardioverter defibrillators (ICDs) are being used for primary and secondary prevention of life-threatening cardiac arrhythmias, and evidence suggests that increased use is likely in the future. ICD storm, the delivery of two or more shocks within 24 hours, occurs in 10% to 20% of patients who have ICDs and can have long-lasting psychological and physical consequences. An understanding of the factors associated with ICD storm, relevant assessment, and patient and family teaching and counseling can help clinicians to better meet the needs of patients who have experienced ICD storm.