Feasibility of a Web-Based Training System for Peer Community Health Advisors in Cancer Early Detection Among African Americans

We describe the feasibility of a Web-based portal for training peer community health advisors (CHAs). We conducted a community-based implementation trial in African American churches between 2012 and 2014. The Web-based portal allows CHAs to log in and view 13 training videos, preparing them to deliver 3 cancer early detection workshops in their churches. Of 8 churches, 6 completed the training, each certifying 2 CHAs. These CHAs took an average of 26 days to complete the training, requiring little technical assistance. Additional technical assistance was required to implement the workshops. The Web-based system appears to be a feasible method for training lay individuals for the CHA role and has implications for increasing the reach of evidence-based interventions.It has been well documented that many evidence-based health promotion interventions fail to achieve further implementation or use in the communities they are intended to serve.1 Such interventions, without intentional effort, do not disseminate themselves into practice.2 Interest in dissemination and implementation research is growing. Consistent with Rabin et al.,3 we use the term dissemination to refer to the active process of spreading evidence-based interventions to a particular audience using planned approaches and the term implementation to refer to the processes of integrating evidence-based interventions within a setting. We use the phrase dissemination and implementation to refer to the broader field in general.Previous dissemination and implementation research has mainly focused on health care settings. More research is needed to identify optimal ways to translate research evidence into practice, including interventions in community settings that use community-based participatory methods.4 This includes research on successful implementation of interventions serving culturally and ethnically diverse populations.2 Peer health educators are viewed as a promising strategy to achieve this goal.5 Volunteer laypeople, such as those used in the community health advisor (CHA) model, have been used worldwide to promote health.6 This model for community health promotion recognizes that CHAs are cultural insiders and trusted sources of information and can help increase access to health care while naturally building capacity in the community for sustained positive health outcomes.6–10     

Validity and reliability of a pediatric patient classification instrument

OBJECTIVES:

to assess the construct validity and reliability of the Pediatric Patient Classification Instrument.

METHODS:

correlation study developed at a teaching hospital. The classification involved 227 patients, using the pediatric patient classification instrument. The construct validity was assessed through the factor analysis approach and reliability through internal consistency.

RESULTS:

the Exploratory Factor Analysis identified three constructs with 67.5% of variance explanation and, in the reliability assessment, the following Cronbach''s alpha coefficients were found: 0.92 for the instrument as a whole; 0.88 for the Patient domain; 0.81 for the Family domain; 0.44 for the Therapeutic procedures domain.

CONCLUSIONS:

the instrument evidenced its construct validity and reliability, and these analyses indicate the feasibility of the instrument. The validation of the Pediatric Patient Classification Instrument still represents a challenge, due to its relevance for a closer look at pediatric nursing care and management. Further research should be considered to explore its dimensionality and content validity.     

Association of cardiovascular risk factors with the different presentations of acute coronary syndrome

OBJECTIVE:

to identify the relationship between different presentations of acute coronary syndrome and cardiovascular risk factors among hospitalized individuals.

METHOD:

cross-sectional study performed in a teaching hospital in São Paulo, in the State of São Paulo (SP). Socio-demographic, clinical and anthropometric data of 150 individuals hospitalized due to acute coronary syndrome were collected through interviews and review of clinical charts. Association between these data and the presentation of the syndrome were investigated.

RESULTS:

there was a predominance of ST segment elevation acute myocardial infarction. There was significant association of systemic hypertension with unstable angina and high values of low density lipoprotein with infarction, without influence from socio-demographic characteristics.

CONCLUSION:

arterial hypertension and high levels of low-density lipoprotein were associated with different presentations of coronary syndrome. The results can provide support for health professionals for secondary prevention programs aimed at behavioural changing.     

Tuberculosis care: an evaluability study

OBJECTIVE:

to verify whether the tuberculosis control program (TCP) is evaluable and to examine the feasibility of building an evaluation model in apriority municipality for the control of tuberculosis.

METHOD:

this evaluability study was conducted in a municipality in northeastern Brazil. For data collection, documental analysis and interviews with key informants were performed. For indicator validation, the nominal group technique was adopted.

RESULTS:

the details of TCP were described, and both the logical model and the classification framework for indicators were developed and agreed up on, with the goal of characterizing the structural elements of the program, defining the structure and process indicators, and formulating the evaluation questions.

CONCLUSION:

TCP is evaluable. Based on logical operational analysis, it was possible to evaluate the adequacy of the program goals for the control of tuberculosis. Therefore, the performance of a summative evaluation is recommended, with a focus on the analysis of the effects of tuberculosis control interventions on decreasing morbidity and mortality.     

Increase in hippocampal theta oscillations during spatial decision making

The processing of spatial and mnemonic information is believed to depend on hippocampal theta oscillations (5–12 Hz). However, in rats both the power and the frequency of the theta rhythm are modulated by locomotor activity, which is a major confounding factor when estimating its cognitive correlates. Previous studies have suggested that hippocampal theta oscillations support decision‐making processes. In this study, we investigated to what extent spatial decision making modulates hippocampal theta oscillations when controlling for variations in locomotion speed. We recorded local field potentials from the CA1 region of rats while animals had to choose one arm to enter for reward (goal) in a four‐arm radial maze. We observed prominent theta oscillations during the decision‐making period of the task, which occurred in the center of the maze before animals deliberately ran through an arm toward goal location. In speed‐controlled analyses, theta power and frequency were higher during the decision period when compared to either an intertrial delay period (also at the maze center), or to the period of running toward goal location. In addition, theta activity was higher during decision periods preceding correct choices than during decision periods preceding incorrect choices. Altogether, our data support a cognitive function for the hippocampal theta rhythm in spatial decision making. © 2014 The Authors Hippocampus Published by Wiley Periodicals, Inc.     

Perceiving nonverbal behavior: Neural correlates of processing movement fluency and contingency in dyadic interactions

Despite the fact that nonverbal dyadic social interactions are abundant in the environment, the neural mechanisms underlying their processing are not yet fully understood. Research in the field of social neuroscience has suggested that two neural networks appear to be involved in social understanding: (1) the action observation network (AON) and (2) the social neural network (SNN). The aim of this study was to determine the differential contributions of the AON and the SNN to the processing of nonverbal behavior as observed in dyadic social interactions. To this end, we used short computer animation sequences displaying dyadic social interactions between two virtual characters and systematically manipulated two key features of movement activity, which are known to influence the perception of meaning in nonverbal stimuli: (1) movement fluency and (2) contingency of movement patterns. A group of 21 male participants rated the “naturalness” of the observed scenes on a four‐point scale while undergoing fMRI. Behavioral results showed that both fluency and contingency significantly influenced the “naturalness” experience of the presented animations. Neurally, the AON was preferentially engaged when processing contingent movement patterns, but did not discriminate between different degrees of movement fluency. In contrast, regions of the SNN were engaged more strongly when observing dyads with disturbed movement fluency. In conclusion, while the AON is involved in the general processing of contingent social actions, irrespective of their kinematic properties, the SNN is preferentially recruited when atypical kinematic properties prompt inferences about the agents' intentions. Hum Brain Mapp 35:1362–1378, 2014. © 2013 Wiley Periodicals, Inc.     

Impulsiveness in chronic hepatitis C patients

Objective

The objective was to investigate impulsiveness among chronic hepatitis C (CHC) patients and its association with sociodemographic, clinical and psychopathological factors.

Method

Ninety-one CHC individuals were enrolled in a cross-sectional study at a Brazilian public university-based outpatient’s service for infectious diseases. They were assessed using the Barrat Impulsiveness Scale, Brief Fatigue Inventory, Beck Depression Inventory and Hamilton Anxiety Scale. Structured psychiatric interview was performed according to the Mini International Neuropsychiatric Interview. Multivariate analysis was performed according to linear stepwise forward regression.

Results

The total score of impulsiveness according to BIS in studied population was 64.6±9.8. The scores for the nonplanning, cognitive–attentional and motor domains were 23.8±5, 19.4±2.9 and 21.4±5, respectively. Impulsiveness was associated with lower educational level, current interferon-α (IFN) use, attention-deficit/hyperactivity disorder, alcohol use disorder, mixed anxiety and depressive disorder, specific phobia, bipolar spectrum disorders and anxiety symptoms. During IFN treatment, impulsiveness was also associated with suicide risk.

Conclusion

Impulsiveness was frequent in CHC patients and was associated with several psychopathological alterations. Impulsiveness management should be considered when attending CHC patients.     

The benefits of a high-intensity aquatic exercise program (HydrOS) for bone metabolism and bone mass of postmenopausal women

This study aimed to evaluate the 24-week effects of a high-intensity aquatic exercise program on bone remodeling markers and bone mass of postmenopausal women. In this randomized, controlled trial we studied 108 women (58.8 ± 6.4 years), randomized into Aquatic Exercise Group (AEG), n = 64, performing 24 weeks of aquatic exercises, and Control Group (CG), n = 44, sedentary. They had their fasting morning blood sample collected for the measures of intact parathyroid hormone (iPTH), procollagen type 1 amino-terminal propeptide (P1NP) and carboxy-terminal cross-linking telopeptide of type I collagen (CTx). Bone mass was measured by dual-energy X-ray absorptiometry before and after the intervention. Participants of both groups received a daily supplementation of 500 mg of elementary calcium and 1,000 IU of vitamin D (cholecalciferol). Results showed an augment in bone formation marker (P1NP) only in the AEG (15.8 %; p = 0.001), and although both groups experienced significant enhancements in bone resorption marker (CTx), this increase was less considerable in the AEG (15 % in the AEG and 29 % in the CG). IPTH was increased by 19 % in the CG (p = 0.003) at the end. The femoral trochanter BMD presented a 1.2 % reduction in the CG (p = 0.009), whereas in the AEG no change was observed (p = 0.069). The proposed aquatic exercise program was efficient in attenuating bone resorption raise and enhancing bone formation, which prevented the participants in the AEG from reducing the femoral trochanter BMD, as happened in the CG.