Nonpurging binge eaters versus nonbinge eaters and treatment retention for adult obesity

Dropout from obesity treatment has been a major factor associated with weight control failure, with few reliable predictors of dropouts or completers. Previous studies have tended to treat obese people as a homogeneous group with standard behavior modification-based interventions. Current research indicates there may be subgroups within the obese population, binge eaters and nonbinge eaters, who have different dropout rates. Current studies also recommend focusing on the subset of this subgroup that does not engage in purging (vomiting, laxative abuse, or excessive exercise) to compensate for binge eating. This research uses a secondary dataset (N = 156) from a prospective study in which participants were randomized to a Food Dependency (FD) and a Behavioral Self-Management (BSM) group for weight reduction. Criteria for subjects in the original study included (1) scoring higher on the existing Binge Eating Scale (BES) in order to ensure enrollment of more binge eaters and (2) no compensatory purging behavior for binge eating. Subjects were then reclassified in this study as binge eaters or nonbinge eaters using the more stringent proposed 1994 DSM-IV criteria for Binge Eating Disorder (BED). Subjects were followed for dropout. Variables studied were binge status, age at obesity onset, age at study baseline, class instructor, number of previous weight loss attempts, race, marital status, body mass index (BMI kg/m$\sp2$), type of intervention, work status, educational level, and social support. Stepwise backward regression Cox survival analysis indicated binge status had a consistent, statistically significant protective effect on dropout in which binge eaters were half as likely to dropout versus nonbinge eaters (p = 0.04). Cox proportional hazards analysis indicated no statistical difference in dropout by type of intervention (FD, p = 0.13; BSM, p = 0.80) when controlling for binge status. All other variables did not reach significance, which is consistent with the literature. Implications of these findings suggest that (1) the proposed 1994 DSM-IV criteria for BED is a more useful classification that the existing DSM-III-R criteria, and (2) the identification of subgroups among obese subjects is an important step in dropout and weight loss intervention research. Future research can confirm this finding. ^

Food intake in nonpurging obese women who binge eat before and after a behavioral weight loss program

Little is known about the impact of behavioral programs to decrease binge eating in obese persons who do not purge. This study was conducted to compare the amount of change in the reduction of binge days and selected nutrients in women who had joined a behavioral weight loss program. Forty-six women in the behavioral self management (BSM) group and thirty-six women in the Wait List Control (WLC) groups completed seven day food records at baseline and six months. These records were analyzed for calories, percentage of calories from protein, carbohydrate, fat and dietary fiber/ 1000 calories and were marked as "binge" or "nonbinge" days. Foods were also divided into 12 food groups but only six contributing to fat intake were chosen for analysis: dairy; fat; grains and starchy vegetables; meat, fish, and poultry; meat, fish, and poultry combinations; snacks and desserts. At six months, there was no difference in the amount of change in any of the selected nutrients between the BSM and WLC groups or in the amount of change within each food group except in the meat, fish, and poultry combination and in the snacks and desserts groups because both groups experienced similar changes at six months. Binge and nonbinge day nutrient analysis by BSM and WLC showed that at baseline and six months within the BSM group, calories increased significantly on binge days. Within the WLC group at six months, percentage of calories from protein was significantly decreased on binge days.^ The significant finding of this study was the reduction in the amount of change in the number of binge days at six months between the BSM and WLC groups ($-$2.2 versus $-$1.1 respectively). These data suggest that behavioral programs can successful reduce binge days, but that significant change in food intake may require more intensive treatment. ^

A STUDY OF THE RELATIONSHIP BETWEEN SELF-ASSESSMENT AND CLINICAL EVALUATION OF HEARING STATUS

The relationship was explored between a subjective measure of hearing status, derived from a functional self-assessment expressed in terms of ability to hear and understand spoken words, and a comparable objective measure of hearing status, obtained from a speech reception test. The Augmentation Survey of the Health and Nutrition Examination Survey of the National Center for Health Statistics provided the necessary data for a sample of 3059 adults. Using chi-square tests for the subsample with the highest level of objectively assessed hearing status, favorable subjective assessments were found to be significantly associated with higher income, lower age group, higher level of educational attainment, greater psychological adjustment, fewer symptoms of depression, and higher self-ratings of overall health. In a linear regression with self-assessment of hearing status as the dependent variable, less than one-quarter of the variation could be explained by objective status and the six explanatory variables.^

Evaluation of web-based resources for HIV+ youth

Given current rates of the Human Immunodeficiency Virus (HIV) in youth ages 15–24, comprehensive care is imperative in order to manage the virus and to prevent further transmission. In the past decade, the Internet has become an immensely popular source for information, including health information. Due to the increase in Internet use for this purpose, the assessment of the quality, accuracy, and timeliness of health information on the Internet is necessary since the information delivered may not be current or accurate. The purpose of this study was to determine the quantity and quality of websites containing health information and resources directed specifically towards HIV positive youth. Three general search terms, “HIV + teens”, “HIV teens info”, and “HIV infected teens,” were searched using the current top three search engines: Google, Yahoo!, and MSN/Bing. The first hundred hits of each search were then categorized by type of website. The examination of the search results yielded 7 sites that met the inclusion criteria. These sites were consequently evaluated on functionality and content using an adapted version of a pre-existing instrument. The functionality analysis revealed that no websites that contained self management information were dedicated specifically to HIV positive youth. The content analysis showed that the sites chosen for evaluation were mostly consistent with the guidelines provided by the Department of Health and Human Services. The most discussed topics in the sites included the importance of safer sexual behavior, HIV counseling, partner notification, safer behavior choices, such as condom use, and mental health. These results highlight the need for the development of accessible websites that contain accurate information targeting youth infected with HIV. This study provides a snapshot of the available web-based resources and health information for HIV positive youth, and is relevant for health educators, care providers, researchers, and others intervening with HIV+ youth. ^

Formalizing a Conceptual Framework of Work Domain Knowledge

Background: The failure rate of health information systems is high, partially due to fragmented, incomplete, or incorrect identification and description of specific and critical domain requirements. In order to systematically transform the requirements of work into real information system, an explicit conceptual framework is essential to summarize the work requirements and guide system design. Recently, Butler, Zhang, and colleagues proposed a conceptual framework called Work Domain Ontology (WDO) to formally represent users’ work. This WDO approach has been successfully demonstrated in a real world design project on aircraft scheduling. However, as a top level conceptual framework, this WDO has not defined an explicit and well specified schema (WDOS) , and it does not have a generalizable and operationalized procedure that can be easily applied to develop WDO. Moreover, WDO has not been developed for any concrete healthcare domain. These limitations hinder the utility of WDO in real world information system in general and in health information system in particular. Objective: The objective of this research is to formalize the WDOS, operationalize a procedure to develop WDO, and evaluate WDO approach using Self-Nutrition Management (SNM) work domain. Method: Concept analysis was implemented to formalize WDOS. Focus group interview was conducted to capture concepts in SNM work domain. Ontology engineering methods were adopted to model SNM WDO. Part of the concepts under the primary goal “staying healthy” for SNM were selected and transformed into a semi-structured survey to evaluate the acceptance, explicitness, completeness, consistency, experience dependency of SNM WDO. Result: Four concepts, “goal, operation, object and constraint”, were identified and formally modeled in WDOS with definitions and attributes. 72 SNM WDO concepts under primary goal were selected and transformed into semi-structured survey questions. The evaluation indicated that the major concepts of SNM WDO were accepted by 41 overweight subjects. SNM WDO is generally independent of user domain experience but partially dependent on SNM application experience. 23 of 41 paired concepts had significant correlations. Two concepts were identified as ambiguous concepts. 8 extra concepts were recommended towards the completeness of SNM WDO. Conclusion: The preliminary WDOS is ready with an operationalized procedure. SNM WDO has been developed to guide future SNM application design. This research is an essential step towards Work-Centered Design (WCD).

Texas laboratory healthcare workforce: Meeting the needs in 2015

The purpose of this research was to study groups of students and young professionals in the clinical laboratory science field using exploratory discovery and inductive logic regarding the attitudes of four groups in Texas: (1) 3rd and 4th year college biology students, (2) students currently enrolled in Clinical Laboratory Science/Clinical Laboratory Technician (CLS/CLT) programs, (3) young CLS/CLT professionals (1-2 years post education), and (4) mid-career CLS/CLTs (4-10 years post education). It was also a comparative study looking at these four groups and their attitudes and perception regarding: career selection factors and legislative incentive measures which might attract individuals to an allied health care career, the field of practice and factors needed to keep individuals in the chosen field of practice. ^ The study found that the career is attractive to individuals who enjoy laboratory work and find the various areas in which to choose to work very attractive. Government programs offering grants/scholarships or loan forgiveness programs offered by health care institutions would be beneficial in attracting students to study in the clinical laboratory sciences. Students are unsure if there is a viable career ladder associated with the field and are anticipating the possibility of going on to other fields in the future. ^ While young and mid-career professionals share many of the same points of view on some aspects (skills used, trends) of the CLS/CLT profession there were a few areas were opinions diverged; perceptions of the field itself and if they plan to remain in the profession for the next 5 years. The mid-career professionals had a much more negative outlook on the profession (low salary, no visible career ladder, lack of respect from other health care professionals) and only a small number plan to be in the field within the next 5 years. ^ The lower salaries in the profession as compared to other similar health care careers, lack of a career ladder and lack of respect from laboratory and institutional management and other health care providers are critical missing pieces to the retention of CLS/CLT professionals. ^

Academic medical centers: A framework for strategic repositioning

This study sought to understand the elements affecting the success or failure of strategic repositioning efforts by academic medical centers (AMC). The research question was: What specific elements in the process appear to be most important in determining the success or failure of an AMC.s strategic repositioning? Where success is based on the longterm sustainability of the new position.^ "An organization's strategic position is its perceptual location relative to others" (Gershon, 2003). Hence, strategic repositioning represents a shift from one strategic position within an environment to another (H. Mintzberg, 1987a). A deteriorating value proposition coupled with an unsustainable national health care financing system is forcing AMCs to change their strategic position. Where the value proposition is defined as the health outcome per dollar spent. ^ AMCs are of foundational importance to our health care system. They educate our new physicians, generate significant scientific breakthroughs, and care for our most difficult patients. Yet, their strategic, financial and business acumen leaves them particularly vulnerable in a changing environment. ^ After a literature review revealed limited writing on this subject, the research question was addressed using three separate but parallel exploratory case study inquiries of AMCs that recently underwent a strategic repositioning. Participating in the case studies were the Baylor College of Medicine, the University of Texas M. D. Anderson Cancer Center, and the University of Texas Medical Branch.^ Each case study consisted of two major research segments; a thorough documentation review followed by semi-structured interviews of selected members of their governance board, executive and faculty leadership teams. While each case study.s circumstances varied, their response to the research question, as extracted through thematic coding and analysis of the interviews, had a high degree of commonality.^ The results identified managing the strategic risk surrounding the repositioning and leadership accountability as the two foundational elements of success or failure. Metrics and communication were important process elements. They both play a major role in managing the strategic repositioning risk communication loop. Sustainability, the final element, was the outcome sought.^ Factors leading to strategic repositioning included both internal and external pressures and were primarily financial or mission based. Timing was an important consideration as was the selection of the strategic repositioning endpoint.^ In conclusion, a framework for the strategic repositioning of AMCs was offered that integrates the findings of this study; the elements of success, the factors leading to strategic repositioning, and the risk communication loop. ^

Patient-centered medical home technology effects on hypertension and diabetes control

Background: Hypertension and Diabetes is a public health and economic concern in the United States. The utilization of medical home concepts increases the receipt of preventive services, however, do they also increase adherence to treatments? This study examined the effect of patient-centered medical home technologies such as the electronic health record, clinical support system, and web-based care management in improving health outcomes related to hypertension and diabetes. Methods: A systematic review of the literature used a best evidence synthesis approach to address the general question " Do patient-centered medical home technologies have an effect of diabetes and hypertension treatment?" This was followed by an evaluation of specific examples of the technologies utilized such as computer-assisted recommendations and web-based care management provided by the patient's electronic health record. Ebsco host, Ovid host, and Google Scholar were the databases used to conduct the literature search. Results: The initial search identified over 25 studies based on content and quality that implemented technology interventions to improve communication between provider and patient. After further assessing the articles for risk of bias and study design, 13 randomized controlled studies were chosen. All of the studies chosen were conducted in various primary care settings in both private practices and hospitals between the years 2000 and 2007. The sample sizes of the studies ranged from 42 to 2924 participants. The mean age for all of the studies ranged from 56 to 71 years. The percent women in the studies ranged from one to 78 percent. Over one-third of the studies did not provide the racial composition of the participants. For the seven studies that did provide information about the ethnic composition, 64% of the intervention participants were White. All of the studies utilized some type of web-based or computer-based communication to manage hypertension or diabetes care. Findings on outcomes were mixed, with nine out of 13 studies showing no significant effect on outcomes examined, and four of the studies showing significant and positive impact on health outcomes related to hypertension or diabetes Conclusion: Although the technologies improved patient and provider satisfaction, the outcomes measures such as blood pressure control and glucose control were inconclusive. Further research is needed with diverse ethnic and SES population to investigate the role of patient-centered technologies on hypertension and diabetes control. Also, further research is needed to investigate the effects of innovative medical home technologies that can be used by both patients and providers to increase quality of communication concerning adherence to treatments.^

Understanding treatment-related symptoms, symptom management techniques, and symptom management self-efficacy in a sample of non-muscle invasive bladder cancer patients

The current literature available on bladder cancer symptom management from the perspective of the patients themselves is limited. There is also limited psychosocial research specific to bladder cancer patients and no previous studies have developed and validated measures for bladder cancer patients’ symptom management self-efficacy. The purpose of this study was to investigate non-muscle invasive bladder cancer patients’ health related quality of life through two main study objectives: (1) to describe the treatment related symptoms, reported effectiveness of symptom-management techniques, and the advice a sample of non-muscle invasive bladder cancer patients would convey to physicians and future patients; and (2) to evaluate Lepore’s symptom management self-efficacy measure on a sample of non-muscle invasive bladder cancer patients. Methods. A total of twelve (n=12) non-muscle invasive bladder cancer patients participated in an in-depth interview and a sample of 46 (n=4) non-muscle invasive bladder cancer patients participated in the symptom-management self-efficacy survey. Results. A total of five symptom categories emerged for the participants’ 59 reported symptoms. Four symptom management categories emerged out of the 71 reported techniques. A total of 62% of the participants’ treatment related symptom-management techniques were reported as effective in managing their treatment-related symptoms. Five advice categories emerged out of the in-depth interviews: service delivery; medical advice; physician-patient communication; encouragement; and no advice. An exploratory factor analysis indicated a single-factor structure for the total population and a multiple factor structure for three subgroups: all males, married males, and all married participants. Conclusion. These findings can inform physicians and patients of effective symptom-management techniques thus improving patients’ health-related quality of life. The advice these patients’ impart can improve service-delivery and patient education.^