Fluid management with a simplified conservative protocol for the acute respiratory distress syndrome*.

Objectives: In the Fluid and Catheter Treatment Trial (FACTT) of the National Institutes of Health Acute Respiratory Distress Syndrome Network, a conservative fluid protocol (FACTT Conservative) resulted in a lower cumulative fluid balance and better outcomes than a liberal fluid protocol (FACTT Liberal). Subsequent Acute Respiratory Distress Syndrome Network studies used a simplified conservative fluid protocol (FACTT Lite). The objective of this study was to compare the performance of FACTT Lite, FACTT Conservative, and FACTT Liberal protocols.

Can an Internet-based health risk assessment highlight problems of heart disease risk factor awareness? A cross-sectional analysis.

Background: Health risk assessments are becoming more popular as a tool to conveniently and effectively reach community-dwelling adults who may be at risk for serious chronic conditions such as coronary heart disease (CHD). The use of such instruments to improve adults' risk factor awareness and concordance with clinically measured risk factor values could be an opportunity to advance public health knowledge and build effective interventions.

Objective: The objective of this study was to determine if an Internet-based health risk assessment can highlight important aspects of agreement between respondents' self-reported and clinically measured CHD risk factors for community-dwelling adults who may be at risk for CHD.

Creating a tipping point: Texas obesity policy actions in review, 2000-2010.

This paper discusses the historical context and current challenges of obesity prevention and control initiatives in Texas to understand how the obesity epidemic has been addressed by multiple interacting stakeholders over the past decade. By reviewing state reports and interviewing key decision makers, this paper chronicles recent efforts in Texas by highlighting health policy initiatives and champions who helped to create the foundation for obesity prevention and control. The findings outline the sentinel policy approaches that were implemented by public/private sector partnerships over the last decade, as well as the public figures that have been singular champions in creating the momentum for these changes.

The utility of rural and underserved designations in geospatial assessments of distance traveled to healthcare services: implications for public health research and practice.

Health disparities research in rural populations is based on several common taxonomies identified by geography and population density. However, little is known about the implications of different rurality definitions on public health outcomes. To help illuminate the meaning of different rural designations often used in research, service delivery, or policy reports, this study will (1) review the different definitions of rurality and their purposes; (2) identify the overlap of various rural designations in an eight-county Brazos Valley region in Central Texas; (3) describe participant characteristic profiles based on distances traveled to obtain healthcare services; and (4) examine common profile characteristics associated with each designation.

Health and health care utilization among obese and diabetic baby boomers and older adults.

Purpose: Examine how sociodemographic, health, behavioral, and health care utilization factors are associated with being obese or having diabetes among baby boomers and older adults.

Design: Cross-sectional data were drawn from the 2007-2008 National Health and Nutrition Examination Survey.

Setting: United States.

Advanced practice nurses and program evaluation: can solicitation of an e-mail address lead to longitudinal selection bias?

Objectives: To identify if survey respondents providing an e-mail address for program evaluation represent a risk of longitudinal selection bias.

Methods: A survey was administered to advanced practice nurses after a chronic disease self-management presentation. Chi-square statistics and logistic regression were used to identify variables associated with successful solicitation of an e-mail address.

Disparity of risk-adjusted inpatient outcomes among African American and white patients hospitalized with community-acquired pneumonia.

The objectives of this study were to examine the associations between inpatient pneumonia outcomes, health care factors, and sociodemographics with an emphasis on race. African American and white patients from the 2008 National Hospital Discharge Survey who were admitted to nonprofit and for-profit hospitals with a principal diagnosis of pneumonia were sampled (n=1924). Three outcomes were measured: length of hospital stay, discharge to home, and deceased at discharge.

College students' perceived disease risk versus actual prevalence rates.

Objective: To compare college students' perceived disease risk with disease prevalence rates.

Methods: Data were analyzed from 625 college students collected with an Internet-based survey. Paired t-tests were used to separately compare participants' perceived 10-year and lifetime disease risk for 4 diseases: heart disease, cancer, diabetes, and overweight/obesity.

Correlates of chronic disease and patient-provider discussions among middle-aged and older adult males: Implications for successful aging and sexuality.

Objective: Effective erectile dysfunction (ED) treatments and cardiovascular disease (CVD) and diabetes risk assessments are available, but require patient-provider communication. The present study explored this issue using 2010 National Social Life, Health and Aging Project data for males age 57 years and older (n = 1011).

Methods: Multinomial logistic regression was performed to compare factors associated with being without CVD/diabetes (39.

The association of physical activity, sedentary behaviors, and body mass index classification in a cross-sectional analysis: are the effects homogenous?

Background: While much is known about the benefits of physical activity (PA) and the consequence of sedentary behaviors relative to body mass index (BMI), little is known about the homogeneity of these effects across individuals. The goal of this study was to determine if PA and sedentary behaviors have the same effect on individuals of all BMI classifications.

Methods: Data from a community health assessment were analyzed and a sample was selected to include respondents who self-reported a chronic disease associated with obesity (n = 2,840).

Advanced practice nurses' perspectives on the use of health optimization strategies for managing chronic disease among older adults in different care settings: pushing the boundaries of self-management programs.

This study examines the intention of advanced practice nurses (APNs) to utilize health optimization programs (HOPs) for addressing clients' chronic disease in various work settings (i.e., nursing homes or other care settings).

Quality of primary care processes for individuals with chronic diseases associated with the metabolic syndrome: a comparative study.

Aim: The aim of this study is to investigate whether individuals diagnosed with chronic diseases associated with the metabolic syndrome (MetS) receive favorable quality of care processes in the primary care setting relative to other individuals with and without chronic diseases.

Background: Data from the 2010 Brazos Valley Health Status Assessment (BVHSA) (n = 3964) were analyzed. Individuals diagnosed with chronic diseases that are collectively associated with a diagnosis of MetS, namely obesity, diabetes, high cholesterol, and hypertension, were characterized as a group (ie, analytic sample, n = 168).

Perceived risk of developing diabetes in early adulthood: beliefs about inherited and behavioral risk factors across the life course.

This study aimed to determine how college students perceive their risk of developing diabetes over their life course, with specific emphasis on their beliefs about the influence of inherited versus behavioral risk factors. A bivariate ordered probit regression model was used to simultaneously predict perceived risk for 10-year absolute risk of diabetes and lifetime absolute risk of diabetes. Ten-year and lifetime absolute risk were both increased when the respondent self-identified with a race/ethnicity other than non-Hispanic white (β = 0.

Provenge: revolutionary technology or ethical bust?

Sipuleucel-T (known by the trade name, "Provenge") is the first prostate cancer vaccine approved by the Food and Drug Administration (FDA), and represents a new type of cancer therapy termed, Autologous Cellular Immunotherapy (ACT). This therapy has been described as a revolution in technology by clinicians and researchers alike. However, policy-makers and health economists question the efficacy of such treatment given its costs, while mainstream media often bemoan Provenge as yet another example of a healthcare system gone awry.

The influence of episodic mood disorders on length of stay among patients admitted to private and non-profit hospitals with alcohol dependence syndrome.

Episodic mood disorders are often associated with alcohol dependence. Few studies have explored the contribution of episodic mood disorders to length of stay among those hospitalized with alcohol dependence syndrome. Filling this research gap could improve care for patients while minimizing hospital utilization costs.

Increasing uptake of Gardasil among American adolescents: comparisons with the history of Hepatitis B vaccination.

Objectives: This paper identifies differences in the uptake rate of Gardasil and contrasts Gardasil uptake rate with the history of Hepatitis B vaccination.

Methods: A targeted review of peer-reviewed journals and industry commentary was conducted. New trends were calculated and figures created based on secondary data.

Assessing costs and potential returns of evidence-based programs for seniors.

The authors describe the customary tools used by health services researchers to conduct economic evaluations of health interventions. Recognizing the inherent challenges of these tools for utilization in contemporary public health practice, we recommend a practical cost-benefit analysis (PCBA) to allow public health practitioners to assess the economic merits of their existing public health programs. The PCBA estimates what health effects and corresponding medical cost avoidance would be required to support the costs associated with implementing a community-based prevention program.

Associations between health care factors and self-reported health status among individuals with diabetes: results from a community assessment.

To identify the influence of select health care variables on self-reported physical and mental health status of individuals with diabetes. Data from the 2006 Brazos Valley Health Status Assessment (BVHSA) were analyzed. Aspects of health care were defined through exploratory factor analysis.

Hypercholesterolemia in youth: opportunities and obstacles to prevent premature atherosclerotic cardiovascular disease.

Treatment of hypercholesterolemia in youth is predicated on the knowledge that we can identify those youth with this atherosclerotic risk factor most likely to develop premature cardiovascular disease. Unfortunately, this is not the case. Before we can adequately address appropriate lipid-lowering therapies in this special population, we must address and resolve current barriers related to screening and diagnosis.