Characteristics of Women Lost to Follow-Up in Cardiovascular Community Health Interventions: Findings from the Sister to Sister Campaign

Community-based interventions (CBI) have been targeted as a potential means of tackling cardiovascular disease in women. However, there have been mixed results in terms of their impact on health, with at least some of this being attributed to high attrition rates. This study explores factors that may be contributing to the low retention of women in cardiovascular CBIs. In 2009, Sister to Sister, a national organization that sponsors community health fairs, provided free cardiovascular health screenings for a total of 9,443 women nationwide. All participants were invited to enroll in a 1 year, survey-based observational study to assess the effectiveness of these community health screenings. Of these 9,443 women, 5.9 % actively participated in the follow-up study. Participants were more likely to have health insurance (75.5 vs. 65.3 %, p < 0.001), have an annual income above 75,000 dollars (26.7 vs. 19.7 %, p < 0.001), and identify themselves as white (50.0 vs. 31.5 %, p < 0.001). They were also more likely to have hypertension (32.1 vs. 27.4 %, p = 0.018) and metabolic syndrome (35.7 vs. 20.4 %, p < 0.001). Our results suggest that white, affluent women with health insurance and cardiovascular risk factors are more likely to engage in CBIs that require longitudinal assessment. This study gives insight into the demographics, socioeconomic status, and cardiovascular comorbidities of women who participate in cardiovascular CBIs. The results may prove to be useful in understanding the biopsychosocial barriers to participation in CBIs in order to develop more effective interventions in the future.     

Toward a model of person-environment congruence: Development of the EPPIS

The Person Environment (P-E) Congruence model represents an approach to understanding the impact of the environment on the well-being and adjustment of the elderly which may also provide information for the development of intervention programs at individual, group and/or institutional levels. Assessment of P-E congruence, or fit between the person and his/her environment, was operationalized in two studies through the development of the Environmental Perception, Preference and Importance Scale (EPPIS). The EPPIS provides scales to assess environmental perceptions, individual environmental preferences and the important or salience of the environment on 15 empirically derived, commensurate dimensions. In a third study, the four-month test-retest reliability of the overall P-E congruence score of the EPPIS, defined as the absolute difference between the perceived and preferred environment weighted by importance, was 78 while the unweighted model reliability was 76. Also, the 15 dimensions of the EPPIS were observed to be significant predictors of well-being. It was proposed that the EPPIS may be used both to determine areas of intervention which the elderly themselves feel are important and as a means to evaluate the effectiveness of interventions intended to reduce P-E incongruence and increase psychological well-being.     

Resident and staff perceptions of latitude of choice in elderly institutionalized men

Ninety-nine elderly institutionalized males, selected equally from three decades, completed measures of: their personal, perceived latitude of choice (LOC) in activities of daily living; self-concept; and life satisfaction. One hundred staff, of both sexes, estimated how the typical or “average” V.A. domiciliary resident would respond to the LOC meaure. Mean resident LOC scores were found to be significantly related to life satisfaction but not to self-concept. This supports the thesis that latitude of choice, or personal autonomy, is related to well-being and that the LOC measure may be a useful tool in the development and evaluation of interventions aimed at improving resident well-being. Significant relationships between resident age and the importance of daily activities, self-concept and life satisfaction were also observed although there were no age differences in the resident data for the LOC, importance or choice measures. In comparing staff attributed and resident perceived latitude of choice, significant differences were found. Examination of response patterns to the specifically listed activities of daily living also revealed significant staff-resident differences. Therefore, any attempt to intervene in the environment to increase the personal autonomy or control of residents, and hence their well-being, must deal with such staff-resident differences and with staff misperceptions of what is and is not important to residents. Interventions should be targeted at specific activities viewed by a majority of residents as restricted and insofar as practical, interventions should be individually tailored.     

Neural coding of nociceptive stimuli—from rat spinal neurones to human perception

Translational studies are key to furthering our understanding of nociceptive signalling and bridging the gaps between molecules and pathways to the patients. This requires use of appropriate preclinical models that accurately depict outcome measures used in humans. Whereas behavioural animal studies classically involve reports related to nociceptive thresholds of, for example, withdrawal, electrophysiological recordings of spinal neurones that receive convergent input from primary afferents permits investigation of suprathreshold events and exploration of the full-range coding of different stimuli. We explored the central processing of nociceptive inputs in a novel parallel investigation between rats and humans. Using radiant laser pulses, we first compared the electrophysiological responses of deep wide dynamic range and superficial nociceptive-specific neurones in the rat dorsal horn with human psychophysics and cortical responses. Secondly, we explored the effects of spatial summation using laser pulses of identical energy and different size. We observed 3 main findings. Firstly, both rodent and human data confirmed that neodymium–yttrium aluminium perovskite laser stimulation is a nociceptive-selective stimulus that never activates Aβ afferents. Secondly, graded laser stimulation elicited similarly graded electrophysiological and behavioural responses in both species. Thirdly, there was a significant degree of spatial summation of laser nociceptive input. The remarkable similarity in rodent and human coding indicates that responses of rat dorsal horn neurones can translate to human nociceptive processing. These findings suggest that recordings of spinal neuronal activity elicited by laser stimuli could be a valuable predictive measure of human pain perception.     

Cholera Vaccination in Urban Haiti

Successful and sustained efforts have been made to curtail the major cholera epidemic that occurred in Haiti in 2010 with the promotion of hygiene and sanitation measures, training of health personnel and establishment of treatment centers nationwide. Oral cholera vaccine (OCV) was introduced by the Haitian Ministry of Health as a pilot project in urban and rural areas. This paper reports the successful OCV pilot project led by GHESKIO Centers in the urban slums of Port-au-Prince where 52,357 persons received dose 1 and 90.8% received dose 2; estimated coverage of the at-risk community was 75%. This pilot study demonstrated the effort, community mobilization, and organizational capacity necessary to achieve these results in a challenging setting. The OCV intervention paved the way for the recent launching of a national cholera vaccination program integrated in a long-term ambitious and comprehensive plan to address Haiti''s critical need in water security and sanitation.