Abstract P453: Keep Your Heart Healthy: Engaging Medical Students to Reduce Cardiovascular Disease Risk in Low Income Communities

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
David A Klein ◽  
Allison L Ducharme-Smith ◽  
Jasmine Rassiwala ◽  
Nilay S Shah ◽  
Claudia L Leung ◽  
...  

Background: Cardiovascular diseases (CVD) are largely preventable yet remain leading causes of morbidity and mortality in Chicago, especially in minority neighborhoods. Hypothesis: Medical schools can engage students to conduct community CVD screening and consultation to reduce risks in low income Chicago communities with high CVD mortality rates. Objectives: Keep Your Heart Healthy (KYHH) initiative is a collaboration of the Feinberg School of Medicine, Chicago Department of Public Health, and community partners. The KYHH pilot aims to engage medical students to determine current CVD risks through screening and consultation in primarily Hispanic (Humboldt Park) and African American (North Lawndale) Chicago communities. We report on the pilot: August 1, 2013 to date. Methods: A total of 54 medical students volunteered, including 26% of the first-year class. A convenience sample of adults was recruited by community health workers. Medical student volunteers, trained by Feinberg faculty, conducted interviews to assess CVD risk by participant self report, measured body weight and blood pressure, and provided brief, personalized counseling based on the American Heart Association’s “Life’s Simple 7.” Participants with blood pressure ≥ 140/90 were referred to their primary care providers or a Federally Qualified Health Center. Randomly selected participants provided post-event survey feedback. Results: At 17 events, students (mean = 8) screened 650 participants in Humboldt Park (further data n=329 at time of submission) and 119 participants in North Lawndale. Demographics (Humboldt Park vs North Lawndale) were as follows: race/ethnicity (82% Latino vs 94% African American); age (63% vs 54% 40-65 years old); gender (62% vs 75% women). Self-reported CVD risk factors included cigarette smoking (31% vs 21%), diabetes (33% vs 17%), hypertension (47% vs 34%), and prior heart attack (8% vs 7%) or stroke (5% vs 1%). Obesity (42% vs 57%) and uncontrolled hypertension (20% vs 23%) rates were high. Humboldt Park and North Lawndale participants rarely (19% vs 15%) or sometimes (41% vs 43%) ate fruit/vegetables, and sometimes (42% vs 50%) or often (20% vs 22%) ate high-salt foods. Participants often lacked insurance or a usual source of care (32% vs 34%). The most common participant-identified goals were achieving a healthier body weight (51% vs 42%) or diet (41% vs 34%). Of 131 participants who provided post-event feedback, 95% indicated they learned something new about their heart health, 92% made goals to improve it, 99% indicated they understood their own personal risks, and 99% indicated they would recommend the screening to others. Conclusion: CVD risk factor burden is high in low income Chicago communities. KYHH is a model for engaging medical students to advance community health by conducting personalized screening and consultation. Early efforts have been well received by community residents.

2018 ◽  
Vol 9 ◽  
pp. 215013271879213 ◽  
Author(s):  
Elaine Seaton Banerjee ◽  
Sharon J. Herring ◽  
Katelyn Hurley ◽  
Katherine Puskarz ◽  
Kyle Yebernetsky ◽  
...  

Objective: We set out to investigate the behaviors of low-income African American women who successfully lost weight. Methods: From an urban, academic, family medicine practice, we used a mixed methods positive deviance approach to evaluate 35 low-income African American women who were obese and lost at least 10% of their maximum weight, and maintained this loss for 6 months, comparing them with 36 demographically similar control participants who had not lost weight. Survey outcomes included demographics and behaviors that were hypothesized to be related to successful weight loss. Interviews focused on motivations, barriers, and what made weight loss successful. Survey data were analyzed using t tests and linear regression for continuous outcomes and chi-square tests and logistic regression for categorical outcomes. Interviews were analyzed using a modified approach to grounded theory. Results: In adjusted analyses, women in the positive deviant group were more likely to be making diet changes compared with those women who did not lose at least 10% of their initial body weight. Major themes from qualitative analyses included ( a) motivations (of health, appearance, quality of life, family, and epiphanies), ( b) opportunity (including time and support), ( c) adaptability. Conclusions: The findings of this study may be useful in developing motivational interviewing strategies for primary care providers working with similar high-risk populations.


2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Vanessa Brcic ◽  
Caroline Eberdt ◽  
Janusz Kaczorowski

Objective. The goal of this pilot study was to develop and field-test questions for use as a poverty case-finding tool to assist primary care providers in identifying poverty in clinical practice. Methods. 156 questionnaires were completed by a convenience sample of urban and rural primary care patients presenting to four family practices in British Columbia, Canada. Univariate and multivariate logistic regression analyses compared questionnaire responses with low-income cut-off (LICO) levels calculated for each respondent. Results. 35% of respondents were below the “poverty line” (LICO). The question “Do you (ever) have difficulty making ends meet at the end of the month?” was identified as a good predictor of poverty (sensitivity 98%; specificity 60%; OR 32.3, 95% CI 5.4–191.5). Multivariate analysis identified a 3-item case-finding tool including 2 additional questions about food and housing security (sensitivity 64.3%; specificity 94.4%; OR 30.2, 95% CI 10.3–88.1). 85% of below-LICO respondents felt that poverty screening was important and 67% felt comfortable speaking to their family physician about poverty. Conclusions. Asking patients directly about poverty may help identify patients with increased needs in primary care.


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Gina P LUNDBERG ◽  
Telisa Spikes ◽  
Ijeoma Isiadinso ◽  
Puja K Mehta

Background: The socioeconomic determinants of health (SEDoH) are contributors to the widening health disparities between White and AA women. Low income is a key contributor to poor cardiovascular (CV) health. Limited data exists on socioeconomic characteristics of African American (AA) women attending community blood pressure (BP) screenings. Objective: To examine whether income is related to BP in AA women attending community health screenings. Methods: AA women (n=972) attending community health screenings in metro Atlanta were evaluated from 2015 to 2019. Sociodemographics, health histories, point of care lipids, and BP were collected. Hypertension (HTN) was defined as systolic BP (SBP) >130 or diastolic BP (DBP) > 80 mmHg. Descriptive statistics, chi-square, and OLS linear regression were used to examine SEDoH and BP after adjusting for age, body mass index (BMI), smoking, and lipids. Results: Mean age was 51±14.1 years, mean SBP 132±19.6 mmHg and DBP 82±12 mmHg. In the unadjusted regression model, income of $48K-$96K (ß=4.1, se=2.0, p=<.04) was associated with a higher SBP compared to those earning $96K and above. After adjusting for covariates, income groups <$24K (ß=7.0, se=2.7, p=.01), $24K-$48K (ß=4.6, se=2.3, p=.05), & $48K-$96K (ß=5.5, se=2.1, p=.01) were associated with a higher SBP. Age (ß=.52, se=.05, p=<.001), BMI (ß=.53, se=.10, p=<.001), current smoking (ß=7.7, se=3.5, p=.03) and total cholesterol (ß=1.0, se=.04, p=.02) were the only covariates significantly associated with increased SBP. Income of $48K-$96K (ß=2.7, se=1.4, p=.05) and current smoking (ß=5.1, se=2.3, p=.03) were associated with a higher DBP in the fully adjusted models. Conclusions: Middle-aged AA women have higher prevalence of HTN, even those with higher incomes. Understanding CV risks and SEDoH, between high and low levels of income, is essential to improving culturally appropriate care. Community based BP screenings targeting both low and middle income AA women are needed to identify AA women with HTN and reduce CV events.


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jason J Sico ◽  
Edward J Miech ◽  
Teresa M Damush ◽  
Ava B Keating ◽  
Gregory W Arling ◽  
...  

Introduction: Many patients with TIA/minor stroke do not achieve goal blood pressure their cerebrovascular event, thereby remaining at high risk for future events. Understanding the influence of contextual factors associated with post-event hypertension management may inform future intervention studies. Methods: As part of a national, observational study of TIA/minor stroke care across the Veterans Health Administration (VHA), in-person site visits were conducted at participating VHA medical centers in 2014-15. Semi-structured interviews were used to elicit provider perspectives about local practices related to the care of TIA/minor stroke patients. Study team members systematically applied codes transcribed files using qualitative, categorical, and quantitative descriptive codebooks. Investigators used Thematic Content Analysis and mixed-methods matrix displays to analyze coded data, generate, and then validate findings. Results: Seventy interviews were obtained from staff at 14 sites. Several contextual factors appeared to influence post-event hypertension care delivery for patients after a TIA/minor stroke. Neurologists reported that they perceived no direct responsibility for managing post-event blood pressure and were uncertain whether recommendations regarding blood pressure management were being implemented in primary care. Primary care providers expressed hesitancy about titrating antihypertensive medications post-event, citing concerns about permissive hypertension. Providers also reported that poor blood pressure control was not as salient to patients as symptoms, leading some patients to not adhere to their antihypertensives or not feel a sense of urgency in seeking prompt medical attention. VHA facilities did not have protocols to guide providers in the treatment of post-TIA/minor stroke hypertension, with centers expressing little compulsion to develop them. Conclusions: Multiple contextual factors at the provider- and system-levels were identified as barriers to achieving post-cerebrovascular event hypertension control; these data have informed the design of a recently funded vascular risk factor intervention.


2021 ◽  
Author(s):  
Tengfei Su ◽  
Mac Jackson ◽  
Keaton Sacry ◽  
Karl Kingsley MPH

BACKGROUND Over the past few decades, a growing trend of overweight and obesity has emerged among the pediatric population. This is a cause of significant concern as these are significantly correlated to other negative oral and systemic health outcomes over time. Although measurement of body mass index (BMI) is common among pediatric physicians and primary care providers, few studies have explored the feasibility of BMI measurement and analysis from pediatric dental providers. OBJECTIVE The primary objective of this study was to compile and analyze pediatric BMI measurements taken from a pediatric dental school patient population. METHODS This study was a retrospective analysis of previously collected data of pediatric patients between 2012 and 2019 (N=451), which was reviewed and approved by the Institutional Review Board (IRB). Descriptive statistics and trend analysis were compiled to determine the trends in pediatric BMI over time. RESULTS Nearly equal percentages of females and males were represented in the study (P=0.432), with the overwhelming majority identified as racial/ethnic minorities (84.5%), P=0.0075. These data revealed that pediatric BMI increased significantly from 25.6 in 2012 to 31.3 in 2018 (22.1%), P=0.031. No significant differences between males and females were observed (P=0.4824) or between minority and non-minority patients (P=0.8288). CONCLUSIONS This study provides significant novel temporal information regarding pediatric BMI among this low-income, minority patient population and highlights the need for expanding the dental school (and pediatric dental residency) curriculum to include more topics related to measuring and tracking overweight and obese children and the most appropriate methods for use in the pediatric dental office.


2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Manjula Venkataraghavan ◽  
Padma Rani ◽  
Lena Ashok ◽  
Chythra R. Rao ◽  
Varalakshmi Chandra Sekaran ◽  
...  

PurposePhysicians who are primary care providers in rural communities form an essential stakeholder group in rural mobile health (mHealth) delivery. This study was exploratory in nature and was conducted in Udupi district of Karnataka, India. The purpose of this study is to examine the perceptions of rural medical officers (MOs) (rural physicians) regarding the benefits and challenges of mobile phone use by community health workers (CHWs).Design/methodology/approachIn-depth interviews were conducted among 15 MOs belonging to different primary health centers of the district. Only MOs with a minimum five years of experience were recruited in the study using purposive and snowball sampling. This was followed by thematic analysis of the data collected.FindingsThe perceptions of MOs regarding the CHWs' use of mobile phones were largely positive. However, they reported the existence of some challenges that limits the potential of its full use. The findings were categorized under four themes namely, benefits of mobile phone use to CHWs, benefits of mobile phone-equipped CHWs, current mobile phone use by CHWs and barriers to CHWs' mobile phone use. The significant barriers reported in the CHWs' mobile phone use were poor mobile network coverage, technical illiteracy, lack of consistent technical training and call and data expense of the CHWs. The participants recommend an increased number of mobile towers, frequent training in mobile phone use and basic English language for the CHWs as possible solutions to the barriers.Originality/valueStudies examining the perceptions of doctors who are a primary stakeholder group in mHealth as well as in the public health system scenario are limited. To the authors’ knowledge, this is one of the first studies to examine the perception of rural doctors regarding CHWs' mobile phone use for work in India.


Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Caleigh Smith ◽  
Vanessa Rivera ◽  
Jean Joscar Victor ◽  
Lookens Pierre ◽  
Fabyola Preval ◽  
...  

Background: Cardiovascular disease is the leading cause of mortality among Haitian adults, and hypertension (HTN) is the most important CVD risk factor, as in other resource-poor countries. The majority of Haitians have never been screened for hypertension and access to clinic-based services is limited. Methods: Twenty-eight Haitian community health workers (CHW) conducted household-based HTN screening within a population-based longitudinal cohort study of 3,000 adults in metropolitan Port-au-Prince. Randomly selected GPS locations across census blocks were selected in proportion to the estimated population of each block. One household at each waypoint was selected systematically and CHW collected household information and conducted three blood pressure measurements the same day on all adult household members (≥ 18 years) present at the time of the survey using AHA guidelines. Adults with HTN were referred to the GHESKIO clinic for repeat BP measurement and treatment. Results: Between March and September 2019, 585 households provided verbal consent for surveys and BP screening (97% response rate). These households had a total of 2542 people (1777 adults) with the median number of adults per household being 3 (IQR 2-4; range 1-9). A total of 913 adults (51%) were present at the time of survey, and all agreed to blood pressure screening. The majority were women (70%) with a median age of 36 years (IQR 27-52). Hypertension prevalence (SBP > 140 and/or DBP > 90) was 25.3% (15.5% Stage I, 9.8% Stage II). Figure 1 reports HTN prevalence by age group (18-30, 31-45, 46-60, >60) and by sex, with HTN increasing by age group but without significant variation by sex. Conclusion: Community blood pressure screening is feasible and highly acceptable in Port-au-Prince, Haiti. Preliminary results show high rates of HTN among a population with limited access to screening, diagnosis and treatment. Further research is urgently needed to design linkage to care strategies and effective treatment interventions to curb the HTN epidemic in Haiti.


Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3377-3386
Author(s):  
Alma Viviana Silva Guerrero ◽  
Jenny Setchell ◽  
Annick Maujean ◽  
Michele Sterling

Abstract Objectives Neck pain remains highly prevalent and costly worldwide. Although reassurance has been recommended as a first line of treatment, specific advice on the best ways to provide reassurance has not been provided due to lack of evidence. Pain symptoms and experiences differ between patients with whiplash-associated disorder (WAD) and those with nontraumatic neck pain (NTNP). The aims of this study were to 1) identify and compare the concerns, fears, and worries of patients with WAD and NTNP; and 2) determine if patients believe their concerns are addressed by primary care providers. Methods These questions were investigated through an online survey, with a convenience sample of 30 participants with NTNP and 20 with WAD. Results A thematic analysis of survey responses resulted in the following seven themes related to common concerns, and two regarding how well concerns were addressed. Common concerns expressed by both groups shared four themes: 1) further structural damage, 2) psychological distress, 3) concerns about the future, and 4) hardships that eventuate. Theme 5), pain/disability is long term, was specific to WAD. Themes 6), pain is current or reoccurring, and 7), interference with daily life, were specific to NTNP. Regarding how well patient concerns were addressed, two overarching themes were common to both conditions: 1) concerns were addressed, with both groups sharing the subthemes “successful treatment,” “reassurance,” and “trust”; and 2) concerns were not addressed, where all subthemes were shared with the exception of two unique to NTNP. Conclusions This detailed comparison provides information about neck pain patients’ concerns and fears, while providing health practitioners support for selecting strategies to promote reassurance appropriately for individual patient needs. Our findings from patients’ perspectives enhance the understanding for providing reassurance for neck pain as proposed by our analysis.


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