Biomedical subjects

Kelly R Evenson

Publications and source records attributed to Kelly R Evenson.

46 records · Page 3Linked to original sources

PubMedDate not supplied

Ability of laypersons to use the Cincinnati Prehospital Stroke Scale.

OBJECTIVE: Early stroke recognition optimizes patients' opportunities to benefit from therapeutic options. Prehospital stroke recognition is suboptimal. If 9-1-1 dispatchers used stroke-identification tools, prehospital stroke recognition might occur more rapidly and accurately. The Cincinnati Prehospital Stroke Scale (CPSS) is a brief, effective tool used by emergency medical services and hospital personnel to identify stroke. The study's goal was to determine whether laypersons could be instructed to use the CPSS over the telephone. METHODS: Adult visitors (laypersons) to a tertiary care emergency department were enrolled. Using a mock patient, laypersons were instructed to use the CPSS via telephone by an investigator simulating a 9-1-1 dispatcher. The patient randomly portrayed clinically normal and abnormal patient types. The layperson's ability to convey CPSS instructions to the patient and relay findings to the investigator was scored. RESULTS: Seventy laypersons were enrolled (35 each for normal and abnormal patient types). Average age was 48 years, 63% were female, and 40% never attended college. Facial droop and speech instructions were administered with 100% accuracy. Arm drift instructions were administered with 99% accuracy. Layperson accuracies for interpreting findings were 93% for facial droop, 93% for arm drift, and 97% for speech. Overall, stroke symptoms were detected with 94% sensitivity (95% CI 87, 100) and 83% specificity (95% CI 70, 95). CONCLUSION: Laypersons correctly administered and interpreted the CPSS when directed to do so over the telephone by a trained investigator. These findings suggest that the CPSS may be a useful tool in early prehospital detection of stroke by dispatchers.

Emergency Medical Services↗

PubMedDate not supplied

Calling emergency medical services for acute stroke: a study of 9-1-1 tapes.

OBJECTIVE: To obtain a better understanding of how stroke events are communicated to 9-1-1 telecommunicators, and how telecommunicators and emergency medical services (EMS) personnel respond to such calls. METHODS: The authors identified 104 patients with a hospital discharge diagnosis of stroke or transient ischemic attack who were transported to hospital by ambulance in two North Carolina counties during 1999 and 2000. Ambulance call reports were abstracted and linked to 9-1-1 call center audiotapes, which were transcribed and verified. RESULTS: Of the 104 calls, 44 were made by medical personnel, 38 by a family member, eight by a bystander or neighbor, five undetermined, and three by other nonmedical personnel. In only six instances (6%) was the call placed by the patient. The most common symptoms reported were altered mental status (40%), trouble walking (32%), impaired speech (27%), and abnormal breathing (27%). Although the word "stroke" was often used (45%), 9-1-1 telecommunicators classified the calls as a stroke in only 31% of cases. However, in the majority of cases (79%), paramedics were dispatched at the highest priority. The median time from dispatch of EMS to patient arrival at the hospital was 41 minutes, approximately half of which was spent at the scene. CONCLUSION: Although typical stroke symptoms are commonly described, calls are often not classified as "strokes" by telecommunicators. Nevertheless, because of the symptoms reported during the calls, the majority of cases are treated as high priority by telecommunicators.

Aged↗

PubMedDate not supplied

Directed use of the Cincinnati Prehospital Stroke Scale by laypersons.

BACKGROUND: The Cincinnati Prehospital Stroke Scale (CPSS) is a three-item examination that has been effective in the identification of stroke victims by health care professionals. However, assessment of the patient earlier in the chain of care, specifically by a 9-1-1 telecommunicator, may improve stroke outcomes. OBJECTIVES: To modify the CPSS for over-the-phone administration and to assess whether untrained adults can follow the CPSS instructions, identify deficits in stroke survivors, and return these findings to an investigator. METHODS: One hundred nonpatient visitors to an academic tertiary care emergency department were recruited. Each participant was brought to a room with a stroke survivor possessing unresolved symptoms from a previous stroke. The participant was telephoned by an investigator and led through administering the CPSS to the stroke survivor. The investigator noted whether the participant accurately administered CPSS instructions and whether normal or abnormal findings were returned. RESULTS: Participants correctly administered CPSS directions 98% of the time. For facial weakness, the sensitivity of the participants' assessments was 74% and the specificity was 94%. For arm weakness, the sensitivity was 97% and the specificity was 72%. For speech deficits, the sensitivity was 96% and the specificity was 96%. CONCLUSIONS: Untrained adults can use the CPSS to accurately identify stroke symptoms and can relay these findings to an investigator. Telecommunicator administration of the CPSS may allow for expedited prehospital triage of the stroke patient and delivery of resources in a timely manner and, given the limited time window for efficacious treatment, may lead to improved patient outcome.

Emergency Medical Service Communication Systems↗

PubMedDate not supplied

Statewide prevalences of concern about enough food, 1996-1999.

OBJECTIVE: Food insecurity is defined as not having access at all times to enough food for an active and healthy life-style. A Healthy People 2010 objective is to increase food security and reduce the risk of hunger for all households. The objective of this study was to characterize the prevalence of concern about enough food and its association with other sociodemographic and health characteristics at the state level. METHODS: Adult respondents participating in the Behavioral Risk Factor Surveillance System survey provided information on concern about enough food from nine states from 1996 through 1999. RESULTS: Overall, the prevalence of concern about enough food ranged from 3.1% to 11.8% for individual states. Across states, low household income was the strongest predictor of concern about enough food. The odds of being concerned about enough food were generally higher among respondents who were female, younger, and without health care coverage. The odds were generally lower among those reporting excellent or very good general health and among non-Hispanic whites. CONCLUSION: Food security scales could be used at the state level to track progress for the Healthy People 2010 objective of reducing food insecurity and hunger across American households.

Adolescent↗

PubMedDate not supplied

Five-year changes in North Carolina outpatient cardiac rehabilitation.

PURPOSE: The purpose of this study was to describe cardiac rehabilitation programming, barriers to participation, and reasons for dropout in North Carolina from a program director's perspective and to compare those results with those of a similar statewide survey conducted 5 years earlier. METHODS: In 1999 and 2004, a survey was mailed to all North Carolina program directors of outpatient cardiac rehabilitation programs. The response rate was 85% (61/72) in 1999 and 79% (61/77) in 2004. RESULTS: More than 85% of North Carolinians older than 40 years lived within a 15-mile buffer of an outpatient cardiac rehabilitation program in 2004. Most programs were staffed with personnel trained in nursing, exercise physiology, and nutrition in 1999 and 2004. Women and African Americans remained disproportionately underrepresented as participants in the program for both years. In 2004, approximately one third of cardiac rehabilitation programs reported having a referral to rehabilitation on the hospital discharge plan for myocardial infarction and coronary artery bypass surgery. In 1999 and 2004, the most frequently reported barrier to participation remained financial, followed by lack of interest or motivation and workplace conflicts. Work conflicts, lack of interest, and comorbidities were the most frequently reported reasons for dropping out from cardiac rehabilitation programs in both 1999 and 2004. CONCLUSIONS: Increasing participation in cardiac rehabilitation programs by addressing barriers at multiple levels may facilitate greater patient participation. This statewide survey could be used in other states as a surveillance tool, to track changes in rehabilitation over time from a program director's perspective.

Ambulatory Care Facilities↗

PubMedDate not supplied

Neighborhood environment, access to places for activity, and leisure-time physical activity in a diverse North Carolina population.

PURPOSE: To examine associations between perceived neighborhood characteristics, access to places for activity, and leisure-time physical activity. DESIGN: Cross-sectional telephone survey. SETTING: Cabarrus, Henderson, Pitt, Robeson, Surry, and Wake counties in North Carolina. SUBJECTS: Population-based sample of 1796 adults at least 18 years of age residing in the six counties. MEASURES: The 133-item questionnaire assessed self-reported leisure-time physical activity and perceptions of neighborhood characteristics (sidewalks, trails, heavy traffic, streetlights, unattended dogs, and safety from crime) and general access to places for physical activity. RESULTS: Trails, streetlights, and access to places were positively associated with engaging in any leisure activity: unadjusted odds ratio (OR) (95% confidence interval [CI]); 1.62 (1.09-2.41), 1.57 (1.14-2.17), and 2.94 (1.91-4.52), respectively. Trails and access to places were positively associated with engaging in the recommended amount of leisure activity: 1.49 (1.00-2.22), and 2.28 (1.30-4.00), respectively). In multivariable logistic regression modeling including environmental factors and demographics, access to places was associated with any activity (2.23 [1.44-3.44]) and recommended activity (2.15 [1.23-3.77]), and trails were associated with recommended activity (1.51 [1.00-2.28]). CONCLUSION: Certain neighborhood characteristics, particularly trails, and access to places for physical activity may be associated with leisure activity levels. In this study, perceived neighborhood environmental factors and access to places for physical activity were strongly associated with race, education, and income.

Adolescent↗

PubMedDate not supplied

Availability of school physical activity facilities to the public in four U.S. communities.

PURPOSE: This study documents the public availability of school physical activity facilities, reasons facilities were not made available to the public, and the barriers and benefits associated with having facilities available. DESIGN: Cross-sectional. SETTING: All schools located in four geographic locations (Washington County, Maryland; northwest suburbs of Minneapolis, Minnesota; Jackson, Mississippi; and Forsyth County, North Carolina). SUBJECTS: The survey was completed by 289 school representatives for a response rate of 82.3% (289/351 schools). For the nonrespondents, 61 of 62 schools were visited to obtain information on outdoor facilities. MEASURES: Information on indoor and outdoor physical activity facilities available to the public was collected for all schools (public, private, and colleges) using a telephone survey. Site visits were made to schools that did not participate in the survey to collect information on outdoor facilities only. RESULTS: The schools in the four geographic areas owned a wide range and number of physical activity facilities for their students. For the schools, 27% had no indoor facilities and 11% had no outdoor facilities. Private schools and colleges were less likely to have indoor or outdoor facilities compared to public schools. Outdoor facilities were available more often to the public than indoor facilities overall, across sites, and by school type (public, private, college). Among the 313 schools with outdoor facilities, 240 (77%) allowed at least some public use, and among the 210 schools with indoor facilities, 134 (64%) allowed at least some public use. Some reasons that facilities were not made available included: for student use only, supervision and personnel requirements, safety concerns, insurance, liability, and a private or church-owned status. The most common benefits of allowing the public to use the facilities included providing a space to keep youth active and good publicity for the school. CONCLUSION: These findings suggest that safety, insurance, and liability concerns are barriers that need to be addressed with schools before indoor and outdoor facilities can be made available to the public. Furthermore, emphasizing the benefits that we found, such as providing a space to keep youth active and good publicity for the school, would also be important.

Community Participation↗

PubMedDate not supplied

Workers' perceptions about worksite policies and environments and their association with leisure-time physical activity.

PURPOSE: To estimate the employed population's exposure to perceived worksite policies and environments hypothesized to promote physical activity and to determine their relationship to leisure-time physical activity. DESIGN: Cross-sectional, random-digit-dial telephone survey. SETTING: Community. SUBJECTS: Employed adults (n = 987) in six North Carolina counties. MEASURES: Outcomes included any leisure-time physical activity, recommended physical activity, and work-break physical activity. Perceived worksite policies and environments included on-site fitness facility at work, safe place to walk outside work, paid time for activity, subsidized health-club membership, and flexible work schedule. ANALYSIS: Descriptive statistics were used to describe the study population and exposure to perceived worksite policies and environments. Multivariable logistic regression was used to evaluate relationships between perceived worksite policies and environments and physical activity, controlling for age, race, sex, educational status, disability, and general health status. RESULTS: Various supportive worksite policies and environments were reported by 15% to 56% of employed participants. Associations between perceived worksite policies and environments and physical activity were strongest for having paid time for non-work-related physical activity, an on-site fitness facility at work, and subsidies for health clubs. Recommended activity was not associated with perceived worksite policies and environments. CONCLUSION: Worksite policies and environments are promising factors for future study in physical activity promotion. Studies should evaluate these relationships in other populations and explore measurement error in self-reported worksite policies and environments.

Adolescent↗

PubMedDate not supplied

Measurement of perceived school climate for active travel in children.

OBJECTIVES: To describe the development of an original scale that measures perceived school climate for active travel in fourth- and fifth-grade girls and boys. METHODS: The data were analyzed using confirmatory factor analysis (CFA) to provide evidence of factorial validity, factorial invariance, and construct validity. RESULTS: The CFA supported the fit of a 3-factor (encouragement, praise, and importance) correlated model for the school climate for active travel measure. This hierarchical model was invariant between sex and across a 7-month time period, and initial evidence for construct validity was provided. CONCLUSIONS: School climate for active travel is a measurable construct, and preliminary evidence suggests relationships with more support for active travel from friends and family.

Attitude↗

PubMedDate not supplied

Scale development for perceived school climate for girls' physical activity.

OBJECTIVES: To test an original scale assessing perceived school climate for girls' physical activity in middle school girls. METHODS: Confirmatory factor analysis (CFA) and structural equation modeling (SEM). RESULTS: CFA retained 5 of 14 original items. A model with 2 correlated factors, perceptions about teachers' and boys' behaviors, respectively, fit the data well in both sixth and eighth graders. SEM detected a positive, significant direct association of the teacher factor, but not the boy factor, with girls' self-reported physical activity. CONCLUSIONS: School climate for girls' physical activity is a measurable construct, and preliminary evidence suggests a relationship with physical activity.

Adolescent↗