Barriers to diabetes self-management education programs in underserved rural Arkansas: implications for program evaluation.
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BACKGROUND: Diabetes prevalence has reached epidemic proportions. Diabetes self-management education (DSME) has been shown to improve preventive care practices and clinical outcomes. In this study, we discuss the barriers faced during the implementation of DSME programs in medically underserved rural areas of Arkansas. CONTEXT: Arkansas is a rural state, with most southeastern counties experiencing a shortage of health care professionals. The Arkansas Diabetes Prevention and Control Program and its partners established 12 DSME programs in underserved counties with a high prevalence of diabetes. METHODS: DSME programs were delivered by a registered nurse and a dietitian who provided 10 to 13 hours of education to each program participant. Baseline, 6-month, and year-end data were collected on preventive care practices, such as daily blood glucose monitoring, foot examination, systolic and diastolic blood pressure, and glycosylated hemoglobin level, among the participants in newly established DSME programs. CONSEQUENCES: Of the 12 DSME programs established, 11 received American Diabetes Association recognition. The number of participants in the DSME programs increased 138% in 1 year, from 308 in February 2003 to 734 in March 2004. Preventive care practices improved: daily blood glucose monitoring increased from 56% to 67% of participants, and daily foot examinations increased from 63% to 84% of participants. Glycosylated hemoglobin decreased by an average of 0.5 units per participant who completed the program. However, many anticipated and a few unanticipated barriers during the implementation of the program could not be overcome because of the lack of an evaluation plan. INTERPRETATION: Although results point to potential benefits of preventive care practices among DSME participants, interpretation of findings was limited by sample size. Sample size limitations are traced to barriers to assessing program outcome. Program evaluation should be integrated into the planning phase to ensure adequate measures of program effectiveness. (+info)
Using relationship styles based on attachment theory to improve understanding of specialty choice in medicine.
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BACKGROUND: Patient-provider relationships in primary care are characterized by greater continuity and depth than in non-primary care specialties. We hypothesized that relationship styles of medical students based on attachment theory are associated with specialty choice factors and that such factors will mediate the association between relationship style and ultimately matching in a primary care specialty. METHODS: We determined the relationship styles, demographic characteristics and resident specialty match of 106 fourth-year medical students. We assessed the associations between 1) relationship style and specialty choice factors; 2) specialty choice factors and specialty match, and 3) relationship style and specialty match. We also conducted mediation analyses to determine if factors examined in a specialty choice questionnaire mediate the association between relationship style and ultimately matching in a primary care specialty. RESULTS: Prevalence of attachment styles was similar to that found in the general population and other medical school settings with 59% of students rating themselves as having a secure relationship style. Patient centeredness was directly associated, and career rewards inversely associated with matching in a primary care specialty. Students with a self-reliant relationship style were significantly more likely to match in a non-primary care specialty as compared to students with secure relationship style (OR = 5.3, 95% CI 1.8, 15.6). There was full mediation of the association between relationship style and specialty match by the specialty choice factor characterized by patient centeredness. CONCLUSION: Assessing relationship styles based on attachment theory may be a potentially useful way to improve understanding and counsel medical students about specialty choice. (+info)
Overweight among students in grades K-12--Arkansas, 2003-04 and 2004-05 school years.
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Prevalence of overweight among children nearly doubled from 1976-1980 to 1999-2002 in the United States. During 1999-2002, approximately 65% of adults aged > or =20 years were overweight or obese, according to the National Health and Nutrition Examination Survey (NHANES). Among persons aged 6-19 years during the same period, 31% were overweight or at risk for overweight. In 2003, the Youth Risk Behavior Surveillance (YRBS) survey indicated that 27% of high school students were overweight or at risk for overweight. Among adolescents with a body mass index (BMI) at or above the 95th percentile, approximately 50% will become obese adults, and 70% will become obese or overweight adults. Although NHANES and YRBS provide population-based, cross-sectional state and national samples, no studies reflect a national or statewide longitudinal cohort assessment of childhood and adolescent obesity. The American Academy of Pediatrics (AAP) and the Institute of Medicine recommend annual assessments of BMI as a strategy for preventing and combating childhood obesity. In 2003, Arkansas implemented a multifaceted statewide initiative to reduce and prevent overweight among children. A key aspect of this initiative (Act 1220) is the mandated annual statewide BMI assessments of all Arkansas public school students with confidential reporting of results to parents. This report describes the results of this large-scale population screening, which indicated that, during the 2003--04 and 2004--05 school years, 38% of Arkansas students were overweight or at risk for overweight. This finding suggests a more severe problem than that reported for other states. Because rates of childhood and adolescent obesity in certain areas might be higher than anticipated, health policy decisions that address health outcomes and cost of care should be based on state-specific, population-based data. (+info)
A 30-month evaluation of the effects on the cost and utilization of proton pump inhibitors from adding omeprazole OTC to drug benefit coverage in a state employee health plan.
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OBJECTIVE: On March 1, 2004, the state employee health plan began covering omeprazole OTC (over the counter) at a $5 copayment. Reimbursement to pharmacy providers for omeprazole OTC increased by $10.50 per claim, from $2.50 to a $13 dispensing fee. Initially, neither generic omeprazole prescription (Rx) nor brand omeprazole Rx was covered because omeprazole OTC was available in the same strength as the Rx products at a lower cost, but an omeprazole OTC shortage necessitated coverage of generic omeprazole Rx at a $10 copay. The objective of this study was to evaluate the long-term financial impact of a drug benefit policy change on a mid-size state employee health plan and its beneficiaries associated with the addition to coverage of omeprazole OTC. METHODS: The pharmacy claims database for the employee benefits division (EBD) was used to examine utilization and cost data for beneficiaries who received proton pump inhibitors (PPIs). Pharmacy claims for the 30-month period for dates of service from December 1, 2002, through May 31, 2005, were extracted from the database, yielding a preperiod of 15 months and a postpolicy change period of 15 months. RESULTS: In the 15-month postperiod, the number of PPI claims per member per month (PMPM) decreased by 3.9%, but the days of PPI therapy PMPM increased from 1.71 to 1.82 (6.4%). Price as measured by the allowed charge per day of drug therapy decreased from $4.25 to $2.74 (35.6%) despite an increase of $1.89 (76%) in the average dispensing paid per PPI claim to pharmacies, from $2.49 to $4.38. The average beneficiary copayment decreased by $0.50 (2.0%) per PPI claim, from $25.06 in the preperiod to $24.56 per claim in the postperiod. Therefore, the net heath plan cost for PPIs decreased by $2.20 PMPM (37.6%) during the 15-month postperiod, from $5.84 to $3.64 PMPM, producing savings of $4,207,350, or annualized savings of $3,365,880, in this employee benefit plan of 127,495 members. CONCLUSION: A change in policy to include coverage of omeprazole OTC and an increase in pharmacy reimbursement for omeprazole OTC resulted in 38% net savings to a state employee health plan. The large difference in drug acquisition cost between omeprazole OTC and the other Rx-only PPIs made it possible to implement a program intervention that provided financial benefit to pharmacists, beneficiaries, and the drug plan sponsor despite a 6% increase in PPI utilization. (+info)
Ruminal in situ disappearance kinetics of nitrogen and neutral detergent insoluble nitrogen from common crabgrass forages sampled on seven dates in northern Arkansas.
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Southern crabgrass (Digitaria ciliaris [Retz.] Koel.) is often an undesirable species in field and forage crops, but visual observations suggest that livestock prefer it to many other summer forages. The objectives of this study were to assess the nutritive value of crabgrass sampled weekly between July 11 and August 22, 2001 and then to determine ruminal in situ disappearance kinetics of N and neutral detergent insoluble N (NDIN) for these forages. A secondary objective was to compare these kinetic estimates for crabgrass with those of alfalfa (Medicago sativa L.), bermudagrass (Cynodon dactylon [L.] Pers.), and or-chardgrass (Dactylis glomerata L.) as control hays. All kinetic evaluations were conducted with 5 ruminally cannulated Gelbvieh x Angus x Brangus steers (383 +/- 22.7 kg). Concentrations of N for crabgrass decreased linearly (P < or = 0.002) across sampling dates for leaf, stem, and whole-plant tissues. Conversely, percentages of the total N pool within NDIN and ADIN fractions generally increased over sampling dates in mostly linear patterns. For crabgrass, the immediately soluble portion of the total N pool (fraction A; overall mean = 54.6% of N) was greater (P < 0.001) than for all control hays. Crabgrass exhibited a more rapid N disappearance rate (overall mean = 0.093/h; expressed as a proportion disappearing/h) than that of bermudagrass (0.046/h; P < 0.001), but the disappearance rate for alfalfa N (0.223/h) was considerably faster (P < 0.001) than for crabgrass. The effective ruminal disappearance of N was greater (P < 0.001) for crabgrass (overall mean = 85.4%) than for the alfalfa (83.3%), bermudagrass (72.3%), or orchardgrass (76.0%) control hays. For alfalfa, the ruminal disappearance rate of NDIN (0.150/h) was more rapid (P < 0.001) than for crabgrass (overall mean = 0.110/h); however, the disappearance rate for crabgrass was faster than that for bermudagrass (0.072/h; P < 0.001) or for orchardgrass (0.098/h; P = 0.010). Effective ruminal disappearance of NDIN was greater (P < 0.001) for crabgrass (overall mean = 72.0%) than for the bermudagrass (69.0%) or alfalfa hays (50.5%), but there was no difference (P = 0.865) between crabgrass and orchardgrass (72.1%). Although crabgrass forages exhibited concentrations of total N that were comparable with those of alfalfa and rates of ruminal N disappearance that were < 50% of those for the alfalfa hay control, improvements in N use efficiency relative to alfalfa are questionable because of the excessively large Fraction A for crabgrass. (+info)
FDA research: the foundation for sound regulatory decisions.
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The National Center for Toxicological Research (NCTR) plays a critical role in the Food and Drug Administration's mission to promote and protect public health. (+info)
Comment on "Ivory-billed woodpecker (Campephilus principalis) persists in continental North America".
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We reanalyzed video presented as confirmation that an ivory-billed woodpecker (Campephilus principalis) persists in Arkansas (Fitzpatrick et al., Reports, 3 June 2005, p. 1460). None of the features described as diagnostic of the ivory-billed woodpecker eliminate a normal pileated woodpecker (Dryocopus pileatus). Although we support efforts to find and protect ivory-billed woodpeckers, the video evidence does not demonstrate that the species persists in the United States. (+info)
Morbidity surveillance after Hurricane Katrina--Arkansas, Louisiana, Mississippi, and Texas, September 2005.
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Hurricane Katrina made landfall on the U.S. Gulf Coast on August 29, 2005. Thousands of Gulf Coast residents evacuated and dispersed across the country, moving into hotels, private homes, and evacuation centers (ECs) in 30 states and the District of Columbia (DC). One goal of public health responders was to identify and prevent hurricane-related morbidity and mortality among affected populations, especially among those with limited access to health care and those who were living in crowded conditions. This report summarizes the challenges of conducting national surveillance after Hurricane Katrina, focusing on the role of CDC in coordinating surveillance and consolidating and interpreting morbidity data from jurisdictions that used diverse surveillance approaches. Aggregate morbidity data that were reported through Arkansas, Louisiana, Mississippi, and Texas to CDC during September 1-22, 2005 (before the Gulf Coast landfall of Hurricane Rita on September 24) are presented from ECs and health-care facilities (HCFs) that served affected populations in these states. Chronic diseases and injuries were the most common conditions reported by ECs and HCFs, respectively. To better prepare for future large-scale disasters with widespread impact, public health agencies and other partners are actively working to establish standardized guidelines and tools for morbidity surveillance. These guidelines will facilitate the interpretation and exchange of health information among multiple jurisdictions and public and private agencies during a disaster response to identify outbreaks and monitor health concerns. (+info)