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Biomedical subjects

Doyle M Cummings

Publications and source records attributed to Doyle M Cummings.

14 recordsLinked to original sources
PubMed2007

Children at risk: the association between perceived weight status and suicidal thoughts and attempts in middle school youth.

BACKGROUND: Suicide is one of the most common causes of death among young people. A report from the US Surgeon General called for strategies to prevent suicide, including increasing public awareness of suicide and risks factors, and enhancing research to understand risk and protective factors. Weight perception has been linked to depression and poor self-esteem in adolescents. The purpose of this study was to examine the relationship between perceived weight status and suicidal thoughts and actions by gender in middle school youth. METHODS: All public middle school students in 4 eastern North Carolina counties presented, and with parental permission (n = 5174), completed the Youth Risk Behavior Survey: Middle School Questionnaire. The 3 dependent variables were self-reported thinking, planning, and attempting suicide. Bivariate analyses describe suicidal thoughts and actions; multiple logistic regression models examined the relationship between weight description and suicidal thoughts and actions controlling for age, race, household composition, grades on report cards, and parents' education. RESULTS: Significantly more females than males reported thinking (26% vs 19%), planning (12% vs 9%), and attempting (11% vs 8%) suicide. For females, those who perceived themselves as overweight were significantly more likely to report suicidal thoughts and actions; while for males, perceptions of overweight and underweight were significantly associated with suicidal thoughts and actions. CONCLUSIONS: Controlling for personal and family characteristics, perceived weight status was significantly associated with suicidal thoughts and actions in middle school boys and girls.

Adolescent↗
PubMed2006

Combining serum biomarkers: the association of C-reactive protein, insulin sensitivity, and homocysteine with cardiovascular disease history in the general US population.

BACKGROUND: Elevated levels of serum biomarkers such as C-reactive protein (CRP) and homocysteine have been independently associated with cardiovascular risk. However, the prevalence of concurrent elevations of these biomarkers in the general population is unknown, as is their association with cardiovascular disease (CVD). METHODS: Data from adults (n = 4900) in the National Health and Nutrition Examination Survey were used to investigate the relationship between combinations of serum biomarkers of inflammation (CRP), atherosclerosis (homocysteine), and insulin sensitivity [homeostatic model assessment (HOMA) fasting insulin] and CVD. Using SUDAAN, logistic regression models were constructed to examine the relationships between elevated serum biomarkers (CRP, homocysteine, HOMA, or insulin), singly or in combination, and having a history of heart failure, myocardial infarction (MI), stroke, or any CVD, while controlling for age, race, sex, obesity, smoking, cholesterol level, diabetes history, hypertension history, exercise level, and dietary fiber intake. RESULTS: After adjustment for covariates, there was a significant relationship between concomitant elevations of CRP plus homocysteine and a history of MI [odds ratio (OR) 2.21], heart failure (OR 2.14), and any CVD (OR 1.87) that was stronger than the relationship between individual biomarkers alone and a history of CVD. In addition, combinations of elevated CRP plus HOMA and CRP plus insulin, remained significantly related to having a history of any CVD. CONCLUSION: Recent scientific evidence and the present findings demonstrate the possibility for improving cardiovascular risk stratification through the concurrent evaluation of multiple biomarkers. In particular, these findings demonstrate the need to evaluate the combination of CRP and homocysteine prospectively as predictors of CVD.

Adolescent↗
PubMed2006

Comparison of self-reported and measured height and weight in eighth-grade students.

The goal of this study was to evaluate the relationships between self-reported and measured height, weight, and body mass index (BMI) in a sample of eighth-grade students. The study population consisted of eighth-grade students in eastern North Carolina who completed a cross-sectional survey, self-reported their height and weight, and had their height and weight measured (N = 416). Fifty-nine percent of the sample was male; 42% African American, 46% white, and 12% other races. Mean self-reported weight (62.9 kg) was significantly lower than mean measured weight (64.4 kg). Mean self-reported BMI (22.8 kg/m2) was significantly lower than mean measured BMI (23.3 kg/m2). Race and BMI category were significantly associated with reporting errors. Specifically, African American and white students were significantly less likely to under-report their height compared to other race students. African American students were more likely to underestimate their weight compared to other race students. BMI was more likely to be underestimated in African American and white students compared to other race students. Students who were at risk for overweight and those that were overweight were more likely to underestimate their weight and BMI than students who were normal weight. Approximately 17% of students were misclassified in BMI categories when self-reported data were used. The results indicate that eighth-grade students significantly underestimate their weight, but on average provide valid estimates of their height. Race and measured BMI category influence this discrepancy. School-based research that addresses the prevalence of obesity in adolescents should utilize measured height and weight when feasible.

Adolescent↗
PubMed2006

Health care disparities in postmenopausal women referred for DXA screening.

BACKGROUND: Racial disparities have been identified in a number of areas in clinical medicine. Limited data are available on osteoporosis screening rates between races. We assessed the racial distribution in Dual Energy X-ray Absorptiometry (DXA) screening rates among African American and Caucasian women referred from our primary care clinics. METHODS: We obtained DXA results during the years 1998-2002 for all 546 women ages >50 years referred for bone mineral density (BMD) testing from a primary care population. We compared the DXA screening rates between African American and Caucasian women with the racial demographics of the referring primary care clinic population. RESULTS: African American women represented 45.9% and Caucasian women 51.7% of our primary care clinic population. Yet, only 14.5% (n=79) of the DXA screened women were African American, while 82.8% (n=452) were Caucasian. Age and recognized risk factors only explained a small portion of this difference. In women 65 years and older with universal screening recommendations, 19.4% (n=46) of the screened women were African American, and 80.6% (n=191) were Caucasian. The prevalence of osteoporosis was similar in both populations, 21.5% and 20.1% for African American and Caucasian women, respectively. CONCLUSIONS: Significantly fewer African American women had BMD screening even though national guidelines do not differentiate by race. The large disparity between the proportion of African American and Caucasian women screened calls for more equitable BMD screening among races.

Absorptiometry, Photon↗
PubMed2005

Confronting disparities in diabetes care: the clinical effectiveness of redesigning care management for minority patients in rural primary care practices.

CONTEXT: Diabetes mellitus and its complications disproportionately affect minority citizens in rural communities, many of whom have limited access to comprehensive diabetes management services. PURPOSE: To explore the efficacy of combining care management and interdisciplinary group visits for rural African American patients with diabetes mellitus. METHODS: In the intervention practice, an advanced practice nurse visited the practice weekly for 12 months and facilitated diabetes education, patient flow, and management. Patients participated in a 4-session group visit education/support program led by a nurse, a physician, a pharmacist, and a nutritionist. The control patients in a separate practice received usual care. FINDINGS: Median hemoglobin A1c (HbA1c) was not significantly different at baseline in the intervention and control groups but was significantly different at the end of the 12-month follow-up period (P < .05). In the intervention group, median HbA1c at baseline was 8.2 +/- 2.6%, and median HbA1c at an average follow-up of 11.3 months was 7.1 +/- 2.3%, (P < .0001). In the control group, median HbA1c increased from 8.3 +/- 2.0% to 8.6 +/- 2.4% (P < .05) over the same time period. In the intervention group, 61% of patients had a reduction in HbA1c, and the percentage of patients with a HbA1c of less than 7% improved from 32% to 45% (P < 05). CONCLUSIONS: These findings suggest that a redesigned care management model that combines nurse-led case management with structured group education visits can be successfully incorporated into rural primary care practices and can significantly improve glycemic control.

Adult↗
PubMed2004

Prevalence of hyperinsulinemia and clinical correlates in overweight children referred for lifestyle intervention.

Although not well documented in the literature, there is growing evidence that overweight children may develop hyperinsulinemia. Children (n=171) with a body mass index greater than the 85th percentile for age using the Centers for Disease Control and Prevention growth charts for children were recruited through primary care physician offices for a lifestyle change intervention. Laboratory measurements were obtained. About 30% of these children were identified as hyperinsulinemic, using an insulin-to-glucose ratio of > or =33% or a serum insulin > or =25 microU/mL. When compared with non-hyperinsulinemic children, there were significant differences in cardiovascular risk factors. Dietetics professionals providing medical nutrition therapy to overweight children need to be aware of dietary and physical activity recommendations for individuals with marked hyperinsulinemia.

Adolescent↗
PubMed2003

Descriptive meta-evaluation. Case study of an interdisciplinary curriculum.

This article describes an example of meta-evaluation in an educational setting. The meta-evaluation examined an evaluation of a community-based, interdisciplinary curriculum. The Program Evaluation Standards (PES), divided into the categories of utility, feasibility, propriety, and accuracy, provided a framework for the meta-evaluation. Utility standards address the information needs of intended users. Feasibility refers to the extent to which an evaluation is realistic, prudent, diplomatic, and frugal. Propriety refers to the properness of an evaluation in terms of meeting legal and ethical obligations. Accuracy pertains to the trustworthiness of evaluation data. Use of the PES as a framework for descriptive meta-evaluation of a single case illustrated the breadth of issues involved in curriculum evaluation and their interrelatedness. Furthermore, the PES helped to reveal strengths and weaknesses that served as starting points for further improvement of the evaluation.

Curriculum↗
PubMed2003

C-reactive protein, antiinflammatory drugs, and quality of life in diabetes.

BACKGROUND: C-reactive protein (CRP) is an important biological marker of inflammation that has been linked to cardiovascular disease. The extent to which the inflammatory processes associated with elevated CRP concentrations impair physical functioning and quality of life, and whether this is modulated by hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) and aspirin, which have been shown to lower CRP concentrations, is unclear. OBJECTIVE: To determine whether an association exists between CRP concentrations and health-related quality of life among patients with diabetes, and to determine whether the association is affected by use of statins and nonsteroidal antiinflammatory drugs (NSAIDs). METHODS: A trained interviewer collected self-reported information regarding demographics, health-related quality of life (SF-12), and medication use, and a nurse collected a blood sample from 86 adult subjects with type 2 diabetes mellitus who were part of a larger population-based survey. The serum was analyzed for CRP using a highly sensitive assay. RESULTS: In simple bivariate analysis, there was a significant inverse relationship between CRP and the physical health component score of health-related quality of life (Spearman correlation coefficient [r] = -0.26; p = 0.025). For subjects on statins (r = -0.44; p = 0.02; n = 27), this relationship persisted, while for patients on NSAIDs or aspirin (r = -0.21; p = 0.17; n = 44), no relationship was observed. Similar findings were observed with self-rated health alone as an outcome variable. However, stepwise linear regression revealed no consistent relationship between CRP and health-related quality of life (i.e., standardized SF-12 physical component score) when demographic variables, disease duration, glucose control, serum creatinine, smoking, and medication use were controlled for. CONCLUSIONS: In multivariate regression modeling, the initial inverse relationship between CRP and health-related quality of life was lost, suggesting that other covariates are responsible for this association. While statins and NSAIDs may impact CRP or health-related quality of life independently, they do not appear to modulate a relationship between these factors.

Analysis of Variance↗
PubMed2002

Strategies used by interdisciplinary rural health training programs to assure community responsiveness and recruit practitioners.

In this article, the strategies used by five US rural interdisciplinary training grant programs to respond to local needs and to promote recruitment in rural communities are described. The programs provide training to 17 health care disciplines and serve disadvantaged Hispanic, African-American, Amish, Native American, and Anglo populations. Four programs are based in academic institutions; one is based in a community health center. The programs provide services to the rural communities through individual clinical or case management services, population-level interventions, and collaborative research. All programs use specific mechanisms (e.g. case conferences or participation in local coalitions) to facilitate collaboration with residents and to link student activities with community or individual needs. Unique strategies include the use of problem-based learning and community health workers on the interdisciplinary team to increase responsiveness. The programs also provide educational support to students while they work in the rural communities. Finally, the primary strategy used to promote recruitment is the training experience in rural communities. The programs also appear to indirectly improve the environment of rural practice.

Case Management↗
PubMed2002

Disparities in mammography screening in rural areas: analysis of county differences in North Carolina.

The extent to which targeted mammography programs have impacted women in rural areas is not well defined. We investigated mammography screening rates among 843 women age 50 and over from a population-based sample in four predominantly rural eastern North Carolina counties. We examined age, race, education level, county of residence, health insurance, and the self-reported completion of mammography in the past year using contingency tables and logistic regression. African American females aged 65 years or older had the lowest reported mammography rates (42%), while white females aged 50 to 64 had the highest rates (58%). Uninsured women and those with less education were less likely to have received a mammogram. Logistic regression demonstrated that age, education, and health insurance were significant predictors of mammography completion. A county-level analysis revealed that three counties had similar rates and one county had substantially lower rates. A higher-than-expected rate of screening-mammography completion among African American women was noted in one predominantly rural county served by a breast cancer screening program. Logistic regression analysis confirmed that county was a significant predictor for mammography completion. In separate regressions run by race, county remained a significant predictor for African American women but not for white women. Differences in mammography screening appear to persist in some predominantly rural areas and are related to age, race, education, and health insurance. Programs that target hard-to-reach women with efforts tailored specifically to their needs may be effective in reducing persistent racial differences.

Black or African American↗
PubMedDate not supplied

Feasibility and effectiveness of system redesign for diabetes care management in rural areas: the eastern North Carolina experience.

PURPOSE: Redesigning the system of care for the management of patients with type 2 diabetes mellitus has not been well studied in rural communities with a significant minority population and limited health care resources. This study assesses the feasibility and potential for cost-effectiveness of restructuring care in rural fee-for-service practices for predominantly minority patients with diabetes mellitus. METHODS: This was a feasibility study of implementing case management, group visits, and electronic registry in 5 solo or small group primary care practices in rural North Carolina. The subjects were 314 patients with type 2 diabetes mellitus (mean age = 61 years; 72% African American; 54% female). An advanced practice nurse visited each practice weekly for 12 months, provided intensive diabetes case management, and facilitated a 4-session group visit educational program. An electronic diabetes registry and visit reminder systems were implemented. RESULTS: There was an improvement in the percentage of patients achieving diabetes management goals and an improvement in productivity and billable encounters. The percentage of patients with a documented self-management goal increased from 0% to 42%, a currently documented lipid panel from 55% to 76%, currently documented aspirin use from 25% to 37%, and currently documented foot examination from 12% to 54%. The average daily encounter rate improved from 20.17 to 31.55 on intervention days. CONCLUSIONS: A redesigned care delivery system that uses case management with structured group visits and an electronic registry can be successfully incorporated into rural primary care practices and appears to significantly improve both care processes and practice productivity.

Diabetes Mellitus↗
PubMedDate not supplied

Outpatient colonoscopy by rural family physicians.

PURPOSE: Five percent of family physicians offer colonoscopy services, either in the office or the hospital, often in rural areas that have no gastroenterologist. Two previous large series have shown the quality and safety of colonoscopy performed by family physicians. The purpose of this study was to verify these findings in an outpatient setting, as well as to obtain patient satisfaction data. METHODS: Data were obtained from 731 colonoscopies performed between 1996 and 2001 in a rural Virginia family practice. These data included patients' age and sex, indications for the procedure, drug dosages for sedation, cecal intubation rates, pathologic findings, complications, and referral correlation findings compared with the original examination. A patient satisfaction survey was done. RESULTS: The adenoma detection rate was 27.2% for men and 21.4% for women older than age 50 years. Six adenocarcinomas and 5 large (>2 cm) villous adenomas were detected, and the patients were referred for definitive surgical resection. A total of 29 patients (4%) were referred: 10 to colorectal surgery and 19 to gastroenterology for resection of large polyps. Correlation of findings at referral with the initial examination was excellent. Cecal intubation rates increased from 89.5% from 1996-1998 to 94.6% from 1999-2001. Minor sedation complications occurred in 5 cases (<1%), and patients responded to supportive care. A high degree of satisfaction was reported by patients, with a mean satisfaction score of 8.8 on a scale from 1 to 10. CONCLUSIONS: Colonoscopy can be performed safely and competently by properly trained family physicians in an outpatient setting with a high degree of patient satisfaction.

Adult↗