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Ann Ward

Publications and source records attributed to Ann Ward.

9 recordsLinked to original sources
PubMed2006

Community-based coalitions' capacity for sustainable action: the role of relationships.

Given both the importance and difficulty of promoting community-based public health coalitions, their capacity for sustainable action merits systematic examination. The current study addresses this need, focusing specifically on the relational dimension of capacity, that is, how relationships both among members and with external actors affect coalition-level activity. The context is a multimethod comparative case study of two rural cancer control coalitions. The authors began by using quantitative and qualitative data to characterize relational capacity in each coalition and then assessed the association between coalition-level relational capacity and level of subsequent interventions. The more active coalition had a more inclusive relational structure than did its less active counterpart but also placed less emphasis on personal friendships. The authors conclude that coalitions' relational structures are measurable and that this dimension of capacity may affect sustainable capacity for health promotion.

Appalachian Region↗
PubMed2005

Evaluation of outcome after immediate breast reconstruction: prospective comparison of four methods.

BACKGROUND: Little is known about the association among different methods to assess outcome following breast reconstruction. The aim of this study was to comprehensively compare four distinct methods of outcome evaluation following immediate breast reconstruction. METHODS: There were 102 women who were prospectively evaluated: 46 patients had submuscular implants, and 56 patients had implant-assisted latissimus dorsi breast reconstruction. The mean patient age at the time of operation was 46 years (range, 22 to 72 years), with a mean follow-up of 18 months (range, 12 to 24 months). All patients were evaluated using geometric measurements, photographs, linear analogue scores, and a quality-of-life questionnaire. The Wilcoxon signed rank test, Spearman's correlation, and factor analysis statistics were used. RESULTS: Transverse breast width, vertical breast height, sternal notch-nipple, midclavicular line-nipple, nipple-inframammary crease, midline-nipple, internipple, and intermammary measurements were reproducible and reliable. Median differences of absolute vertical and horizontal differences were less than 1 cm and were associated with high levels of patient satisfaction. Assessors asked to score photographs without being specifically requested to consider shape, cleavage, or symmetry would focus mainly on vertical and horizontal differences. There was a high correlation between surgeon and patient linear analogue scores. Quality-of-life questionnaires provide valuable information on body image, physical effects, and continued cancer worry. Factor analyses failed to identify components to compress data fields to obtain equivalent information from fewer questions. CONCLUSIONS: Evaluation of immediate breast reconstruction is complex. Cumbersome data collection has to be balanced against practical variables that individual units can collect to evaluate outcome for audit and research.

Adult↗
PubMed2003

Serum concentrations of lipids, vitamin d metabolites, retinol, retinyl esters, tocopherols and selected carotenoids in twelve captive wild felid species at four zoos.

Serum concentrations of several nutrients were measured in 12 captive wild felid species including caracal (Felis caracal), cheetah (Acinonyx jubatus), cougar (Felis concolor), fishing cat (Felis viverrinus), leopard (Panthera pardus), lion (Panthera leo), ocelot (Felis pardalis), pallas cat (Felis manul), sand cat (Felis margarita), serval (Felis serval), snow leopard (Panthera uncia) and tiger (Panthera tigris). Diet information was collected for these animals from each participating zoo (Brookfield Zoo, Fort Worth Zoo, Lincoln Park Zoological Gardens and North Carolina Zoological Park). The nutritional composition of the diets at each institution met the probable dietary requirements for each species except for the pallas cat. Blood samples were collected from each animal (n = 69) and analyzed for lipids (total cholesterol, triacylglycerides, HDL cholesterol and LDL cholesterol), vitamin D metabolites [25-hydroxycholecalciferol (25(OH)D) and 1,25-dihydroxycholecalciferol (1,25(OH)(2)D)], vitamin A (retinol, retinyl stearate and retinyl palmitate), vitamin E (alpha- and gamma-tocopherol) and selected carotenoids. Species differences were found for all except triacylglycerides and 1,25(OH)(2)D. Genus differences were found for retinol, retinyl palmitate, retinyl stearate, gamma-tocopherol and beta-carotene. Circulating nutrient concentrations for many of the species in this study have not been reported previously and most have not been compared with the animals' dietary intakes. The large number of animals analyzed provides a substantial base for comparing the serum nutrient concentrations of healthy animals, for both wild and captive exotic species.

Animal Nutritional Physiological Phenomena↗
PubMed2003

Immediate breast reconstruction using biodimensional anatomical permanent expander implants: a prospective analysis of outcome and patient satisfaction.

Immediate breast reconstruction is offered to the majority of women requiring a mastectomy for cancer treatment. Improvements in implant technology have seen the evolution of shaped, fixed-volume implants and permanent expanders. The theoretical benefits of biodimensional anatomical expander implants include better reconstructed breast form, the potential for achieving this at a single procedure, and the avoidance of a contralateral procedure as a result of improved ipsilateral cosmesis. The aim of the present study was to assess outcome after immediate breast reconstruction using the McGhan 150 permanent expander implant. A total of 107 consecutive patients (129 breast reconstructions) were studied over a 30-month period; 49 patients (68 reconstructions) had submuscular implant placement alone, and 58 patients (61 reconstructions) had an implant in conjunction with a latissimus dorsi flap. The mean patient age was 47 years (range, 22 to 72 years) and the mean follow-up was 18 months (range, 6 to 40 months). Outcome was assessed in the following four ways: geometric measurements, evaluation of photographs by four independent observers, linear numerical analogue scale, and a quality-of-life questionnaire. Geometric measurements after surgery showed median differences that were highly consistent with good symmetry. Transverse breast width difference between breasts was 0.35 cm, vertical breast height difference was 0.8 cm, sternal notch-to-nipple distance difference was 0.6 cm, midclavicular line-to-nipple distance difference was 0.5 cm, nipple-to-inframammary crease distance difference was 0.5 cm, midline-to-nipple distance difference was 0 cm, and projection difference was 0 cm. Photographic assessment by four observers who evaluated shape, cleavage, symmetry, and overall outcome produced correlation values of 0.73 to 0.81. More than 75 percent of each of these parameters was scored as good or excellent. A numerical analogue scale (from 1 to 10) assessing overall result by the surgeon and patient revealed good (7 to 8) or excellent (9 to 10) scores in 83 and 82 percent of respondents, respectively. Quality-of-life data showed that 81 and 88 percent of women felt "a little" or "not at all" less feminine, respectively, and 88 percent were satisfied with the appearance of their breasts. A total of 88 percent of women would also choose the same reconstructive procedure if faced with the same cancer diagnosis. Complication rates were low; infections occurred in 6.2 percent of reconstructions, hematoma occurred in 1.6 percent, and implant loss occurred in 3.9 percent. Only 24 of 107 patients (22 percent) elected to have a synchronous contralateral breast adjustment, and four of 107 (4 percent) chose to have a subsequent procedure for symmetry. Biodimensional expander implants used in immediate breast reconstruction are associated with high levels of patient and surgeon satisfaction. Optimum breast form can be achieved during a single operation with a low incidence of complications.

Adult↗
PubMed2002

Unaltered insulin sensitivity after resistance exercise bout by postmenopausal women.

PURPOSE: The major aims of this study were to determine whether a single session of resistance exercise would alter insulin sensitivity, glucose effectiveness, and C-peptide response to glucose challenge in a group of previously sedentary, postmenopausal women. METHODS: Ten postmenopausal women (aged 57.5 +/- 1.6 yr) were studied. Each participant underwent two frequently sampled intravenous glucose tolerance tests (FSIVGTT): without prior exercise (no exercise), and postexercise (15 h after a session of resistance exercise: three sets of 10 repetitions performed at 50%, 75%, and 100% of 10-repetition maximum for 7 exercises). Insulin sensitivity and glucose effectiveness were determined according to Bergman's minimal model procedure. In addition, C-peptide concentration and glucose disappearance were measured. RESULTS: There was no significant difference between trials for insulin sensitivity, glucose effectiveness, glucose disappearance, or area under the curve (AUC) for glucose or insulin during the glucose challenge. AUC for C-peptide tended (P = 0.059) to be 10% higher in the postexercise versus no exercise trial, and C-peptide values were significantly (P < or = 0.02) higher at several time points (60, 70, 140, and 180 min) during the postexercise compared with no exercise trial. CONCLUSIONS: In contrast to previously reported results with young men and women after a single bout of endurance exercise, insulin sensitivity was unaltered by a single session of resistance exercise in postmenopausal women. Higher plasma C-peptide values concomitant with unchanged insulin values provide evidence that resistance exercise may have induced a slightly higher insulin secretion and a proportional increase in insulin clearance.

Area Under Curve↗
PubMedDate not supplied

A pilot study of group exercise training (GET) for women with primary breast cancer: feasibility and health benefits.

Evidence is accumulating for physical activity as an effective, well-tolerated, highly rewarding complementary behavioral intervention for enhancing quality of life (QOL) as well as fitness among individuals with chronic and even terminal illnesses. However, relatively few studies have examined the feasibility and potential health benefits of supervised, structured exercise programs for sedentary women with primary breast cancer. Forty women over the age of 45 with primary breast cancer participated in a course of group exercise training (GET) delivered in a structured format three times per week for 16 weeks. GET emphasizes physical activities that promote aerobic fitness, strength, and flexibility. Assessments of fitness/vigor and QOL were conducted prior to, during, and upon completion of the program. Results demonstrated that GET was feasible, safe, and well-tolerated. Moreover, the participants experienced significant health benefits over the course of the intervention in multiple dimensions of fitness/vigor (aerobic capacity, strength, flexibility) as well as QOL (increased positive affect, decreased distress, enhanced well-being, and improved functioning). Discussion highlights the need for inclusion of physical activity programs in comprehensive, complementary treatment regimes for breast cancer patients.

Adaptation, Psychological↗
PubMedDate not supplied

Tracing the evolution of pluralism in community-based coalitions.

In this study, a crisis of leadership succession led to greater subsequent pluralism by the previously less inclusive coalition. Substantial tension existed between both coalitions and the federally funded Appalachia Cancer Network, especially around its evidence-based mission. The fact that this tension occurred even at the more locally inclusive site indicates that pluralism may vary across levels within the same coalition. This article contributes to theory by exploring how coalitions evolve over time across community boundaries, as well as to management practice by yielding guidance about how to build inclusive organizations.

Appalachian Region↗
PubMedDate not supplied

Effect of community coalition structure and preparation on the subsequent implementation of cancer control activities.

PURPOSE: The purpose of this paper is to identify factors within a three-phase community coalition development model that influence short-term success in cancer control coalitions based on the cumulative number of educational and screening activities conducted by the coalitions. DESIGN: This study was a nonrandomized community intervention trial involving four autonomous, independently funded multistate projects aimed at using coalitions to increase cancer screening and early detection. SETTING: The study was conducted in medically underserved, rural counties of Appalachia. SUBJECTS: Sixty-three coalitions involved 1725 members representing 71 counties within 10 states. Intervention. A network of local and regional community cancer control coalitions throughout rural Appalachia delivered culturally sensitive cancer control messages to women, with the long-term goal of increasing the early detection of breast cancer ANALYSIS: County-level coalitions were the unit of analysis for this study. Multiple linear regression was used to determine if three classes of variables corresponding to the developmental history of coalitions--formation, preparation for implementation, and implementation--were associated with the number of educational and screening activities conducted by the coalitions. RESULTS: The presence of a paid coordinator and formal organizational structure were both strongly associated with the number of activities conducted, accounting for 71% of the variability in coalition activities. Other variables positively associated with number of activities were the preparation of written community assessments and the modification of implementation plans. The same factors (structure, written plans) were associated with activities in coalitions without paid organizers (r2 = .57), as was the number of meetings. However, such coalitions produced an average of only 2.2 activities vs. 21.7 activities in coalitions with paid coordinators. CONCLUSION: The ALIC study would seem to indicate that community-based coalitions with paid coordinators and formal structures are capable of generating significantly higher levels of activity than those without either a paid coordinator or formal structure.

Appalachian Region↗