Development and Feasibility of a Community-Based,Culturally Flexible Colorectal Cancer Prevention Program

Comprehensive cancer centers are an important community resource for cancer prevention education in their catchment areas. Colorectal cancer remains one of the most commonly diagnosed cancers in the United States, making prevention a priority. Colorectal cancer prevention targets include lifestyle modifications that are influenced by cultural norms, such as diet change, physical activity and screening behavior. Cancer centers must tailor prevention efforts to multiethnic catchment areas. This paper describes the development and feasibility of a comprehensive cancer center’s approach to community-based colorectal cancer prevention in Houston, Texas, specifically targeting Hispanic and Asian populations. Sites were recruited through a city-wide network of partnerships between the community relations department in the hospital and community organizations. The program consisted of three workshop-style classes per community site. Each class had a similar overall structure, but cultural and site-specific adaptations were made for each group. A total of 33 classes were taught at nine distinct community sites to 1054 participants over 9 months. This program structure may be adapted for the future dissemination of other cancer prevention tools to communities in the area.     

Risky Driving Behaviors for Older Adults: Differences by Veteran’s Status

Veterans are at an increased risk of being injured or killed in motor vehicle crashes, potentially due to their proclivity to engage in risky driving behaviors. However, most research in this area has focused on driving behaviors of veterans who have recently returned home after deployment. No research has focused on risky driving behaviors of older veterans (aged 65 or older) and if risky driving behaviors extend beyond the time period immediately following return from deployment. The purpose of this research is to determine if differences exist in risky driving behaviors of veterans and non-veterans aged 65 or older. This study used data from the 2011 National Health and Aging Trend Study (NHATS), a nationally representative, longitudinal survey of community-dwelling, Medicare beneficiaries aged 65 or older. Binary logistic regression analyses were conducted in 2017 to determine if veteran’s status was predictive of specific risky driving behaviors. Veteran’s status was found to be predictive of specific driving behaviors for adults aged 65 and older, with non-veterans significantly more likely than veterans to: not currently drive; avoid driving at night; avoid driving alone; avoid driving on busy roads or highways; and avoid driving in bad weather. The results of this study highlight the need to further understand the effects of veteran’s status on risky driving behaviors among older adults, specifically, whether veteran’s status compounds driving-related risks associated with aging-related physical and mental changes.     

A Descriptive Analysis of a Community Clinic Providing Hepatitis C Treatment to Poor and Uninsured Patients

This study describes clinical characteristics of poor and uninsured patients living with hepatitis C virus (HCV) who received care from a multidisciplinary HCV clinic, reports treatment completion and cure rates, and estimates the cost of HCV medications provided at no cost to uninsured patients. A retrospective chart review was performed and identified 69 uninsured HCV patients who received medical care at Mercy Health Center, a small non-profit community clinic, between January 2008 and March 2015. Three-fourths of the patients were unemployed, a third had multiple HCV exposures, nearly half acquired HCV due to illicit drug use, and more than half had active psychiatric disorders. Of those who received HCV treatment, 81% completed treatment and 85% were achieved virological cure. The multidisciplinary community clinic provided >?$1.4 million of HCV antivirals at no cost to uninsured patients. Findings suggest a multidisciplinary community clinic comprised of a social worker, pharmacist, gastroenterologist, nurse, nurse practitioner, psychologist, and dietitian can help patients achieve HCV treatment completion and cure rates comparable to traditional physician-led clinics, and successfully manage uninsured and underserved HCV patients—who are often regarded as “difficult-to-treat” patients. Public health social workers and other health professionals are encouraged to advocate for treatment and care of poor and uninsured patients living with HCV in health agencies and health systems, otherwise population-wide reductions in HCV morbidity and mortality will not be realized.     

Scope of Knowledge About Zika Among Women in US–Mexico Border Communities

Maternal Zika virus infection (ZIKV) has serious health consequences for unborn offspring. Knowledge about prevention is critical to reducing risk, yet what women in the high-risk US–Mexico border region know about protecting themselves and their babies from ZIKV is mostly unknown. This study aimed to assess knowledge of ZIKV among pregnant and inter-conception women and to identify sources of information that might address knowledge gaps. Clients in five federally-funded, border region Healthy Start programs (N?=?326) were interviewed in late 2016 about their knowledge of ZIKV prevention methods and whether they believed themselves or their babies to be at risk. Sources of information about ZIKV and demographic characteristics were also measured. Chi square tests identified important associations between variables; adjusted odds ratios (AOR) and 95% confidence intervals for knowledge and beliefs were calculated. Among the 305 women aware of ZIKV, 69.5% could name two ways to prevent infection. Only 16.1% of women named using condoms or abstaining from sex as a prevention method. While 75.3% heard about ZIKV first from TV/radio, just 9.5% found the information helpful. Women who received helpful information from health care providers had greater odds of knowing two prevention methods (AOR?=?2.0; 1.1–3.7), when to test for ZIKV (AOR?=?5.2; 2.1–13.2), and how long to delay pregnancy after infection in a male partner (AOR?=?1.9; 1.1–3.2). Those who said web-based and social media sources were helpful had greater odds of knowing when to test for ZIKV (AOR?=?2.8; 1.3–6.3). Results can inform messaging for safe pregnancy and ZIKV prevention.     

Perception of Community on Attachment and Resilience According to Closing of Hospitals

This study includes a comparison analysis of how community resilience and its influence factor of community attachment were changed before and after the closing of the hospital in the rural community. In order to analyze the influence factors of healthcare and medical vulnerability on community resilience, as well as the mean difference from before and after the closing of the hospital, this study conducted matching sample t test, hierarchical regression analysis, difference in differences (DID) analysis. The results indicate that community attachment consists of such factors as closeness, preference, affective bond, and identity, and they showed significance in confidence. It showed that resilience and community attachment are lower after closing than before closing. Moreover, as a result of DID analysis where the variation of community attachment affects community resilience, closeness together with closeness had an influence on the community resilience. It needs to expand public projects to improve the settlement environment of the basic local government, and in particular, it should consider various support measures to overcome vulnerabilities in the healthcare and medical sector.     

Use of Evidence-Based Interventions and Implementation Strategies to Increase Colorectal Cancer Screening in Federally Qualified Health Centers

While colorectal cancer (CRC) screening rates have been increasing in the general population, rates are considerably lower in Federally Qualified Health Centers (FQHCs), which serve a large proportion of uninsured and medically vulnerable patients. Efforts to screen eligible patients must be accelerated if we are to reach the national screening goal of 80% by 2018 and beyond. To inform this work, we conducted a survey of key informants at FQHCs in eight states to determine which evidence-based interventions (EBIs) to promote CRC screening are currently being used, and which implementation strategies are being employed to ensure that the interventions are executed as intended. One hundred and forty-eight FQHCs were invited to participate in the study, and 56 completed surveys were received for a response rate of 38%. Results demonstrated that provider reminder and recall systems were the most commonly used EBIs (44.6%) while the most commonly used implementation strategy was the identification of barriers (84.0%). The mean number of EBIs that were fully implemented at the centers was 2.4 (range 0–7) out of seven. Almost one-quarter of respondents indicated that their FQHCs were not using any EBIs to increase CRC screening. Full implementation of EBIs was correlated with higher CRC screening rates. These findings identify gaps as well as the preferences and needs of FQHCs in selecting and implementing EBIs for CRC screening.     

Motives for Filing a False Allegation of Rape

The list of motives by Kanin (1994) is the most cited list of motives to file a false allegation of rape. Kanin posited that complainants file a false allegation out of revenge, to produce an alibi or to get sympathy. A new list of motives is proposed in which gain is the predominant factor. In the proposed list, complainants file a false allegation out of material gain, emotional gain, or a disturbed mental state. The list can be subdivided into eight different categories: material gain, alibi, revenge, sympathy, attention, a disturbed mental state, relabeling, or regret. To test the validity of the list, a sample of 57 proven false allegations were studied at and provided by the National Unit of the Dutch National Police (NU). The complete files were studied to ensure correct classification by the NU and to identify the motives of the complainants. The results support the overall validity of the list. Complainants were primarily motivated by emotional gain. Most false allegations were used to cover up other behavior such as adultery or skipping school. Some complainants, however, reported more than one motive. A large proportion, 20% of complainants, said that they did not know why they filed a false allegation. The results confirm the complexity of motivations for filing false allegations and the difficulties associated with archival studies. In conclusion, the list of Kanin is, based on the current results, valid but insufficient to explain all the different motives of complainants to file a false allegation.     

Will biomarker-based diagnosis of Alzheimer’s disease maximize scientific progress? Evaluating proposed diagnostic criteria

A recently published framework for the diagnosis of Alzheimer’s disease (AD) in research studies would allow diagnosis on the sole basis of two biomarkers (β-amyloid and pathologic tau), even in people with no objective or subjective memory or cognitive changes. This revision will have substantial implications for future Alzheimer’s research, and the changes should be rigorously evaluated before widespread adoption. We propose three principles for evaluating any revision to diagnostic frameworks for AD: (1) does the revision improve the validity of the diagnosis; (2) does the revision improve the reliability or reduce the expense of the diagnosis; and (3) will the revision foster innovative and rigorous research across populations. The new diagnostic framework is unlikely to achieve any of these goals. Instead, it has the potential to handicap future researchers, and slow progress towards identifying effective strategies to prevent or treat AD.