Lower Odds Of Participation Research Articles

Long-term patient outcomes from a multidisciplinary cardiac rehabilitation programme with integrated nurse specialist support: A retrospective cohort study

BackgroundCardiac rehabilitation programmes, while demonstrating benefits, face challenges in universal adoption, particularly in New Zealand. This study evaluates the long-term impact of cardiac rehabilitation participation and attendance on survival and readmission rates in the Auckland Health District. ObjectiveTo examine the impact of patient participation in nurse-led lifestyle rehabilitation and physiotherapy exercise rehabilitation on key outcomes, including all-cause mortality, and all-cause, cardiac-specific, and kidney disease readmission rates. DesignRetrospective cohort study. SettingAuckland Health District, New Zealand. Participants3331 patients registered in the Auckland cardiac rehabilitation programme between 2016 and 2020. MethodsData analysis included examining associations between attendance at nurse-led lifestyle and physiotherapy-led exercise sessions and outcomes at 12, 24 months, and 2022 year-end, including all-cause mortality, all-cause readmission, and cardiac-specific readmission rates. Analysis methods included survival analysis, Cox proportional regression, and logistic binary regression, controlling for confounders using propensity score weights and baseline factors. Results1363 (40.9 %) patients attended at least one lifestyle rehabilitation session (average 5.0 ± 2.9 sessions), 1121 (33.7 %) patients attended at least one exercise rehabilitation session (average 6.8 ± 7.4 sessions), and 649 (19.5 %) patients attended at least one lifestyle and one exercise rehabilitation session. Increased likelihood of participation in rehabilitation was explained by ethnicity, while current and historical tobacco use, history of heart failure, receiving an angiogram, PCI, or other treatment such as medical management or implantable devices were associated with lower odds of participation. Participation in rehabilitation (average 7.9 ± 6.1 sessions) was associated with a higher mean survival estimate (7.6 years vs. 6.4 years, p < 0.001) while Cox proportional hazard regression, controlling for baseline factors and propensity score weights showed that a single session of rehabilitation attended had a 2.1 % decreased risk of mortality (hazard ratio = 0.98, 95 % CI: 0.96 to 0.99, p = 0.29). The cumulative hazard ratio for average attendance (7.9 ± 6.1 sessions) was 0.85 (95 % CI: 0.83 to 0.86, p < 0.001) indicating a 15 % decreased risk of mortality during follow-up. 20 % lower kidney disease readmission rates were observed among participants over the next 24 months (p < 0.05). However, no differences in all-cause or cardiac-specific readmission rates were observed. ConclusionsThe study supports the effectiveness of cardiac rehabilitation in improving long-term survival for Auckland Health District patients. The positive impact of nurse-led interventions and integrated support throughout the cardiac rehabilitation process highlights the need for translating this model to other health districts in New Zealand to optimise patient care and outcomes.

Impact of patient demographics and neighborhood socioeconomic variables on clinical trial participation patterns for NHL

AbstractPrior studies have demonstrated that certain populations including older patients, racial/ethnic minority groups, and women are underrepresented in clinical trials. We performed a retrospective analysis of patients with non-Hodgkin lymphoma (NHL) seen at MD Anderson Cancer Center (MDACC) to investigate the association between trial participation, race/ethnicity, travel distance, and neighborhood socioeconomic status (nSES). Using patient addresses, we ascertained nSES variables on educational attainment, income, poverty, racial composition, and housing at the census tract (CT) level. We also performed geospatial analysis to determine the geographic distribution of clinical trial participants and distance from patient residence to MDACC. We examined 3146 consecutive adult patients with NHL seen between January 2017 and December 2020. The study cohort was predominantly male and non-Hispanic White (NHW). The most common insurance types were private insurance and Medicare; only 1.1% of patients had Medicaid. There was a high overall participation rate of 30.5%, with 20.9% enrolled in therapeutic trials. In univariate analyses, lower participation rates were associated with lower nSES including higher poverty rates and living in crowded households. Racial composition of CT was not associated with differences in trial participation. In multivariable analysis, trial participation varied significantly by histology, and participation declined nonlinearly with age in the overall, follicular lymphoma, and diffuse large B-cell lymphoma (DLBCL) models. In the DLBCL subset, Hispanic patients had lower odds of participation than White patients (odds ratio, 0.36; 95% confidence interval, 0.21-0.62; P = .001). In our large academic cohort, race, sex, insurance type, and nSES were not associated with trial participation, whereas age and diagnosis were.

Impact of Patient Demographics and Neighborhood Socioeconomic Variables on Clinical Trial Participation Patterns for Non-Hodgkin Lymphoma at a Major Academic Institution

Background: There have been tremendous advancements in Non-Hodgkin Lymphoma (NHL) therapies and outcomes in large part due to clinical trials. Prior studies have demonstrated that certain populations including the elderly, certain racial and/or ethnic minority groups, and women are underrepresented in cancer clinical trials. Better understanding of how social context impacts clinical trial enrollment will allow us to better design tailored interventions to address barriers to clinical trial participation. We performed a retrospective analysis of patients with NHL seen at MD Anderson Cancer Center (MDACC) to systematically investigate the association between clinical trial participation patterns and sociodemographic context measured by neighborhood socioeconomic factors based on place of residence. Examining our practice patterns may then inform strategies to enhance trial recruitment of underrepresented groups. Methods: We examined 3448 patients, age ≥18 years with a diagnosis of NHL seen at MDACC between January 2017 and December 2020. Using patient address, geolocation software and American Community Survey (2015 - 2020) and 2020 census data available through data.Census.gov we ascertained 35 neighborhood level socioeconomic status (nSES) variables corresponding to each census tract including the domains of educational attainment, neighborhood median income, poverty, crowding, race composition and home values. We performed descriptive analysis to understand the demographics of the total populations and those enrolled in clinical trials. We performed univariate analysis of clinical trial enrollment patterns by sex, race, age, histology type, insurance type and nSES variables using 2-sample t-test and Mann-Whitney tests (MHT). Using exhaustive variable selection based upon minimizing the Akaike Information Criteria, including 2-way interactions, we found the set of variables that generated an optimal generalized additive logistic regression model for incidence of participation in clinical trials. We repeated this procedure for the diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) subgroups. We adjusted alpha 0.05/3=0.017 as the criteria for significance in these models to address multiple testing. Results: We excluded 130 patients with international patient addresses and 427 patients without complete address information. and found no significant difference in baseline characteristic or clinical trial enrollment between the 572 excluded patients and the study cohort of 2943 patients. The study population was 59% male, 74.6% Non-Hispanic white (NHW), 13.2% Hispanic, 6.1% black, 3.7% Asian; 29.5% had DLBCL, 22% FL, 13.2% mantle cell, 9% marginal zone, 8.3% T-cell, and 6.5% high grade B cell lymphoma. The most common insurance was managed care 47% and Medicare 45.7%; 2.5% of patients were self-pay, 1.2% had Medicaid, and 2.1% had other government insurance. There was a high overall clinical trial participation rate of 30.5% with 20.9% enrolled in therapeutic trials and participation differed by diagnosis (Table). In univariate analyses, lower participation rates were associated with lower nSES including: increasing % of populations living below poverty level, increasing % living in crowded households, increasing % above age 25 years with less than high school diploma, and decreasing median household income. Racial composition of census tract was not associated with differences in clinical trial participation. Participation did not differ by insurance type. In multivariable analysis, incidence of participation declined nonlinearly with age in the overall, FL, and DLBCL models. In the DLBCL subset Hispanic patients had lower odds of participation than Whites (odds ratio 0.34, p=0.0003). No nSES variable predicted clinical trial participation in these models. Conclusion: In a large academic cohort, age and diagnosis not race, gender, insurance type, or nSES were independent predictors of trial participation. One major limitation to the generalizability of these results is the select patient population seen at our institution are relatively well insured. Examination of multi-center datasets including community practices when underinsured patients received care and evaluation of interventions to influence access to clinical trials are needed. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Facilitators and barriers to participation in health mothers’ groups in improving maternal and child health and nutrition in Nepal : A mixed-methods study

BackgroundIn Nepal, Health Mother’s Groups (HMG) are women’s group-based programmes for improving maternal and child health. However, they remain underutilised with only 27% of reproductive-aged women participating in an HMG meeting in 2016. This study aimed to understand the facilitators and barriers to HMG meeting participation.MethodsWe conducted a convergent mixed-methods study using cross-sectional quantitative data from the 2016 Nepal Demographic and Health Survey and primary data collected via 35 in-depth interviews and eight focus group discussions with 1000-day women and their family members, female community health volunteers (FCHVs) and health facility staff in two geographies of Nepal, Kaligandaki and Chapakot. Quantitative data were analysed using logistic regression and qualitative data using deductive coding. The results were triangulated and thematically organised according to the socio-ecological model (SEM).ResultsFacilitators and barriers emerged across individual, interpersonal and community levels of the SEM. In the survey, women with more children under five years of age, living in a male-headed household, or in rural areas had increased odds of HMG participation (p < 0.05) while belonging to the Janajati caste was associated with lower odds of participation (p < 0.05). Qualitative data helped to explain the findings. For instance, the quantitative analysis found women’s education level associated with HMG participation (p < 0.05) while the qualitative analysis showed different ways women’s education level could facilitate or hinder participation. Qualitative interviews further revealed that participation was facilitated by women’s interest in acquiring new knowledge, having advanced awareness of the meeting schedule and venue, and engagement with health workers or non-government organisation staff. Participation was hindered by the lack of meeting structure and work obligations during the agricultural season.ConclusionsTo improve women’s participation in HMGs in Nepal, it is necessary to address factors at the SEM’s individual, interpersonal, and community levels, such as enhancing FCHV literacy, providing advance notice of the meeting schedule, upgrading the meeting venues and reducing women’s workload through family support, particularly during agricultural season. These improvements are essential for strengthening effective implementation of HMG meetings and similar women’s group-based platforms, and for ultimately improving maternal and child health in Nepal.

Understanding the participation of breast screening among women born in predominantly Muslim countries living in Victoria, Australia from record-linkage data.

BackgroundEarly detection of breast cancer can improve survival rates and decrease mortality rates. This study investigates whether there are significant differences in participation in breast screening among women born in Muslim countries compared to women born in Non-Muslim countries and Australia.MethodsScreening data from January 1st, 2000 to December 31st, 2013 from the Breast Screen Victoria Registry (BSV) was linked with hospital records from the Victorian Admitted Episodes Dataset (VAED). Countries having more than 50% of their population as Muslim were categorised as Muslim countries. Age adjusted rates were calculated for women born in Muslim and Non-Muslim countries and compared with the Australian age adjusted rates. Logistic regression assessed the association between screening status and other factors which include country of birth, marital status, age and socio-economic status.ResultsWomen born in Muslim countries (Odds Ratio (OR) = 0.70, 95%CI = 0.68–0.72) and in other Non-Muslim countries (OR = 0.87, 95%CI = 0.86–0.88) had lower odds of participation in breast screening than Australian born women. Women aged 60–64 years (OR = 1.42, 95%CI = 1.40–1.44) had higher odds of participation in the BreastScreen program than 50–54 age group.ConclusionThis study provides valuable insights to understanding breast screening participation among women born in Muslim countries residing in Victoria. This population level study contributes to the broader knowledge of screening participation of women born in Muslim countries, an understudied population group in Australia and across the world. This study has implications for breast screening programs as it highlights the need for culturally sensitive approaches to support breast screening participation among women born in Muslim countries.

A population-based study of invitation to and participation in clinical trials among women with early-stage breast cancer.

Although many studies clearly demonstrate disparities in cancer clinical trial enrollment, there is a lack of consensus on potential causes. Furthermore, virtually nothing is known about associations between patients' decision-making style and their participation in clinical trials. Women with newly diagnosed, stage 0-II breast cancer reported to the Georgia and Los Angeles County Surveillance, Epidemiology, and End Results (SEER) registries in 2013-2014 were surveyed approximately seven months after diagnosis. We investigated two primary outcome variables: (1) invitation to participate in a clinical trial, (2) participation in a clinical trial. We evaluated bivariate associations using Chi-squared tests and used multivariable logistic regression models to investigate associations between patient variables, including decision-making style, and the primary outcomes. 2578 patients responded (71% response rate); 30% were > age 65, 18% were black, 18% were Latina, 29% had ≤ high school education. 10% of patients reported invitation to participate in a clinical trial; 5% reported participation in a clinical trial. After adjustment younger age, receipt of chemotherapy or radiation, disease stage, and a more rational (versus more intuitive) decision-making style were associated with a higher odds of invitation to participate. Being married was associated with a higher odds of participation; having an annual family income ≥ $40,000 was associated with a lower odds of participation. 10% of patients reported invitation to participate in a clinical trial, and half of these reported participation. Invitation to participate varied by age and decision-making style, and participation varied by marital status and income.

School and Community Involvement of Adolescents With Chronic Health Conditions

PurposeTo investigate associations between chronic health conditions and participation in school and community activities at age 15 years. MethodsSecondary analysis of data from an urban U.S. birth cohort study was conducted to investigate associations between chronic health conditions and participation in specific types of school and community activities. Logistic regression was used to adjust for potentially confounding factors. ResultsOver one third of the teens had a chronic health condition. Having a chronic developmental or behavioral health condition (vs. no chronic developmental or behavioral health condition) was associated with lower odds of participation in sports (odds ratio [OR], .714; 95% confidence interval [CI], .577–.883), volunteer activities (OR, .751; 95% CI, 0.611–.924), and any activities (OR, .690; 95% CI, .516–.921), after adjusting for potential confounders. The associations for having a chronic physical health condition were less consistent. ConclusionsChronic developmental or behavioral conditions of teens are negatively associated with school and community participation, particularly sports and volunteering, both of which can substantially enhance their development. Schools can play a role in promoting participation by offering activities designed for students with disabilities that may also include typical students or by referring families to such activities in the community. Clinicians can play a role by educating families about the benefits of extracurricular activities, providing information about laws and regulations requiring schools and other organizations to provide accommodations, and linking families to activities and programs in their community.

Understanding the participation in cervical screening of Muslim women in Victoria, Australia from record-linkage data

BackgroundPrevention of cervical cancer through screening can significantly decrease incidence and mortality from the disease. This study investigates whether there are significant differences in participation in screening among women born in Muslim countries compared to women born in Non-Muslim countries and Australia. MethodsScreening data from Jan 2000 to Dec 2013 from the Victorian Cervical Cytology Registry (VCCR) was linked probabilistically with hospital records containing country of birth information from the Victorian Admitted Episodes Dataset (VAED). Countries with more than 50 % of their population Muslim were categorised as Muslim countries. Age adjusted rates were calculated for women born in Muslim and Non-Muslim countries and compared with the Australian age adjusted rates. Logistic regression assessed the association between screening status and other factors which include principal diagnosis, country of birth, marital status, age and socio-economic status. ResultsWomen born in Muslim countries (OR = 0.77, 95% CI = 0.75–0.78) and in other Non-Muslim countries (OR = 0.83, 95% CI = 0.82–0.84) had lower odds of participation in screening than Australian born women. Women born in Muslim countries (OR = 0.71, 95% CI = 0.69–0.74) and in other Non- Muslim countries (OR = 0.71, 95% CI = 0.69–0.72) admitted to the hospital for perinatal reasons had lower odds of participation in screening than Australian born women. ConclusionsFuture screening programs should incorporate ethnic diversity of the population, particularly Muslim immigrant community. There is also a need to focus on improving screening among older Muslim women.

Factors Influencing Participation Of Healthy Volunteers In Clinical Trials: Findings From A Cross-Sectional Study In Delhi, North India.

PurposeTo identify the specific motivations that drive healthy volunteers to consent for their participation in clinical studies. Additionally, the study aimed to document the socio-demographic determinants of participation in the trial related solely to the intention of securing financial gains.Patients and methodsThis cross-sectional study was conducted among subjects who participated as healthy volunteers in clinical trials conducted by Contract Research Organizations (CROs) of Delhi. Pre-tested, validated semi-structured questionnaires were used to collect baseline socio-demographic data, information about factors motivating participation in clinical trials, and pattern of utilisation of money received against participation in the trial. Logistic regression analysis was done to determine the factors that influenced participation in the trial related purely to the motive of securing financial gains.ResultsA total of 400 participants were selected. The majority of the volunteers (77.5%) reported that their sole reason for participating in clinical trials was for monetary gain. Around a tenth of the volunteers participated with the intent to advance scientific knowledge and another 4.5% participated due to benefits of free medical check-ups. Participants in the age group of 29–38 years, those that were married, those residing in an urban slum, male participants, those with a high number of dependent family members (ie, 5 to 8), and those earning less than 5000 INR (71 USD) a month had higher odds of participating in a clinical trial purely for the financial benefits. Those educated till intermediate and above had lower odds of participation in the trial due to monetary benefits.ConclusionOur study shows that healthy volunteers in Delhi consider participation in clinical trials mainly because of the prospect of financial reward. More research is needed to inform judgments around the ethics of providing financial rewards and enrollment of healthy research volunteers.

Predictors of Patient Participation and Completion of Home-Based Cardiac Rehabilitation in the Veterans Health Administration for Patients With Coronary Heart Disease

Traditional, facility-based cardiac rehabilitation (CR) is vastly underutilized in the United States. The Veterans Health Administration (VA) has developed new home-based cardiac rehabilitation (HBCR) programs to address this issue. However, the characteristics of patients who choose HBCR are unknown. We sought to determine predictors of participation and completion of HBCR at the San Francisco VA (SFVA). We evaluated patients hospitalized for ischemic heart disease between 2013 and 2016 at SFVA. Logistic regression models were used to identify predictors of participation and completion of HBCR. In 724 patients with ischemic heart disease who were eligible for CR between 2013 and 2016, 314 (43%) enrolled in HBCR. Older age was associated with lower odds of participation in HBCR (odds ratio [OR] 0.84; p <0.01). Additionally, patients with coronary artery bypass grafting (CABG) were twice as likely as those with percutaneous coronary intervention to participate in HBCR (OR 2.03; 95% confidence interval 1.40, 2.97). In HBCR participants, 48% (150/314) completed ≥9 sessions. Patients with CABG were twice as likely as those with percutaneous coronary intervention to complete the HBCR program (OR 2.02; 95% confidence interval 1.18, 3.44). There were no differences in participation or completion rates by gender, race, ethnicity, or rurality. Our study showed that the SFVAMC HCBR program achieved a 43% participation rate, well above the VA average of 13%. There were no disparities by gender, race, or rurality in terms of participation and adherence. CABG as the indication for CR was the most significant predictor of participation and completion of HBCR.

The association between distance to public amenities and cardiovascular risk factors among lower income Singaporeans.

Existing evidence on the association between built environment and cardiovascular disease (CVD) risk factors focused on the general population, which may not generalize to higher risk subgroups such as those with lower socio-economic status (SES). We examined the associations between distance to 5 public amenities from residential housing (public polyclinic, subsidized private clinic, healthier eatery, public park and train station) and 12 CVD risk factors (physical inactivity, medical histories and unhealthy dietary habits) among a study sample of low income Singaporeans aged ≥ 40 years (N = 1972). Using data from the Singapore Heart Foundation Health Mapping Exercise 2013–2015, we performed a series of logistic mixed effect regressions, accounting for clustering of respondents in residential blocks and multiple comparisons. Each regression analysis used the minimum distance (in km) between residential housing and each public amenity as an independent continuous variable and a single risk factor as the dependent variable, controlling for demographic characteristics. Increased distance (geographical inaccessibility) to a train station was significantly associated with lower odds of participation in sports whereas greater distance to a subsidized private clinic was associated with lower odds of having high cholesterol diagnosed. Increasing distance to park was positively associated with higher odds of less vegetable and fruits consumption, deep fried food and fast food consumption in the preceding week/month, high BMI at screening and history of diabetes, albeit not achieving statistical significance. Our findings highlighted potential effects of health-promoting amenities on CVD risk factors in urban low-income setting, suggesting gaps for further investigations.

Unit Nonresponse in a Population-Based Study of Prostate Cancer.

Low unit response rates can increase bias and compromise study validity. Response rates have continued to fall over the past decade despite all efforts to increase participation. Many factors have been linked to reduced response, yet relatively few studies have employed multivariate approaches to identify characteristics that differentiate respondents from nonrespondents since it is hard to collect information on the latter. We aimed to assess factors contributing to enrollment of prostate cancer (PCa) patients. We combined data from the North Carolina-Louisiana (LA) PCa Project’s LA cohort, with additional sources such as US census tract and LA tumor registry data. We included specific analyses focusing on blacks, a group often identified as hard to enroll in health-related research. The ability to study the effect of Hurricane Katrina, which occurred amidst enrollment, as a potential determinant of nonresponse makes our study unique. Older age (≥ 70) for blacks (OR 0.65) and study phase with respect to Hurricane Katrina for both races (OR 0.59 for blacks, OR 0.48 for whites) were significant predictors of participation with lower odds. Neighborhood poverty for whites (OR 1.53) also was a significant predictor of participation, but with higher odds. Among blacks, residence in Orleans parish was associated with lower odds of participation (OR 0.33) before Katrina. The opposite occurred in whites, with lower odds (OR 0.43) after Katrina. Our results overall underscore the importance of tailoring enrollment approaches to specific target population characteristics to confront the challenges posed by nonresponse. Our results also show that recruitment-related factors may change when outside forces bring major alterations to a population's environment and demographics.

Factors affecting student participation in extra-curricular activities: A comparison between two Middle Eastern dental schools.

ObjectiveThis study was conducted to assess the level of participation of dental undergraduate students in extracurricular activities (ECAs) and the factors affecting this participation.MethodsThe study included dental students enrolled in undergraduate programs at the Faculty of Dentistry, Alexandria University, Egypt, and the College of Dentistry, University of Dammam, Saudi Arabia. A questionnaire was developed to collect background information about students, their participation in ECAs, and time allocated for these activities. Students were asked about their perceptions of the relationship between ECAs and academic studies, and their reasons for participating in and satisfaction with ECAs.ResultsThe study included 199 students from Alexandria and 146 students from Dammam, with response rates of 99.5% and 73%, respectively. The percentages of those reporting ECA participation were 27.1% and 43.8%, respectively, mostly in community service, sports, and social activities. About 60% of students did not think that ECAs affected their studies, although the perceived difficulty of balancing ECAs and academics was associated with lower odds of participation (odds ratio = 0.51). Most students participated in ECAs to socialize and make friends, and the majority was dissatisfied with school-organized ECAs (52% and 59%, respectively). Gender and/or perceived relation between ECAs and academic studies affected actual participation in ECAs in one school but not the other.ConclusionsECA participation among these students was low. Gender and perception of ECAs in relation to academic studies affected ECA participation differently in the two schools. Better planning and management of ECAs that incorporate students’ preferences and reasons for participation is needed. Gender issues and the relationship between ECAs and academic performance should be addressed in relation to school and social characteristics.

Correlates of Self-Reported Physical Activity at 3 and 12 Months Postpartum.

Postpartum women are encouraged to participate in ≥ 150 min/week of moderate-intensity aerobic activity, but few women achieve this recommendation. This study sought to identify factors associated with participation in physical activity after pregnancy. We examined correlates of any self-reported moderate-to-vigorous physical activity (MVPA) (≥ 10 min/week across all modes) and any recreational MVPA (≥ 10 min/week) among women enrolled in the Pregnancy, Infection, and Nutrition Postpartum study at 3 months postpartum (n = 667) and at 12 months postpartum (n = 530). Potential correlates were identified according to the socioecological framework. At 3 and 12 months postpartum, lower odds of participation in any MVPA were associated with lower education, breastfeeding, and minimal emotional support. Low exercise self-efficacy, receipt of advice about physical activity, and warmer seasons were associated with higher odds of any MVPA. For recreational MVPA, lower odds of participation were associated with unmarried status, lower education, employment, low income, preeclampsia, and minimal emotional support. Involvement in child/adult care activities, transportation MVPA, and warmer seasons were associated with higher odds of recreational MVPA. These findings suggest that several modifiable intrapersonal and interpersonal factors are associated with postpartum MVPA and should be considered when developing interventions to help women maintain or increase MVPA after pregnancy.

Abstract P436: Correlates of Physical Activity at 3- and 12-Months Postpartum

Background: Participation in at least 150 minutes/week of moderate-intensity aerobic activity is suggested for postpartum women. However, few women engage in these recommended levels of physical activity after pregnancy. To inform the development of interventions aimed at maintaining or increasing physical activity in the postpartum period, it is important to understand which factors are associated with postpartum physical activity. Methods: We examined the correlates of self-reported moderate to vigorous physical activity (MVPA) at 3- and 12-months postpartum among a cohort of women in the Pregnancy, Infection, and Nutrition Postpartum study. Women self-reported the frequency, duration, and mode of MVPA. Potential correlates were identified according to the socioecological framework and included sociodemographics, behavioral characteristics, non-recreational modes of MVPA (assessed only for recreational MVPA), reproductive history, infant care, psychosocial factors, and barriers to MVPA. Logistic regression models with GEE were used to identify correlates of any MVPA (≥10 minutes/week across all modes of activity) and any recreational MVPA (≥10 minutes/week) among women at 3-months (n=667) and 12-months (n=530) postpartum. Results: At both time points, lower odds of participation in any MVPA were associated with lower education, breastfeeding, depression, and minimal emotional support. Low confidence in exercise ability, receipt of advice about physical activity, and warmer seasons were associated with higher odds of participation in any MVPA. Associations varied by time point for two correlates. Low poverty and odds of any MVPA were negatively associated at 3-months and positively associated at 12-months postpartum. History of preeclampsia and odds of any MVPA were positively associated at 3-months and negatively associated at 12-months postpartum. For recreational MVPA at both time points, lower odds of participation were associated with unmarried status, lower education, employment, low poverty, history of preeclampsia, and minimal emotional support. Involvement in child/adult care activities and warmer seasons were associated with higher odds of participation in any recreational MVPA. Associations varied by time point for two correlates. Transportation MVPA and odds of any recreational MVPA were positively associated at 3-months and negatively associated at 12-months postpartum. Moderate stress and odds of any recreational MVPA were negatively associated at 3-months and positively associated at 12-months postpartum. Conclusion: These findings suggest that there are several modifiable factors associated with participation in MVPA in the postpartum period. Selected associations varied by time point. This information should be considered when developing interventions to help women maintain or increase physical activity following pregnancy.

Biospecimen repositories: are blood donors willing to participate?

Sponsored by the National Heart, Lung, and Blood Institute, the Retrovirus Epidemiology Donor Studies (REDS-I/-II) have conducted epidemiologic, laboratory, and survey research on volunteer blood donors. Some studies request additional permission to store biospecimens for future studies. The representativeness and applicability of studies performed using repositories may be reduced by low participation rates. Demographics from subjects consenting to participate in the 2007 REDS-II Leukocyte Antibodies Prevalence Study (LAPS) repository were compared to "study-only" subjects. Data from the 1998 REDS-I survey of donor opinion regarding storage and use of biospecimens were also explored. Overall, 91% of LAPS subjects agreed to participate in the repository. Odds of repository participation were lower among African American and Hispanic donors, 35- to 44-year-olds, donors who had not completed high school, and donors from one geographic location, regardless of other variables. Survey data from 1998 revealed that 97% of respondents approved of long-term storage of biospecimens, although only 87% indicated that they would personally participate. Many respondents would require notification or their permission be obtained before participation. Minority respondents would require permission or notification more often and were less certain they would personally participate in a repository. Blood donors are quite willing to participate in biospecimen repositories. Regional differences and lower odds of participation in the minority blood donor population may result in a reduced number of biospecimens available for study and a decreased ability to definitely answer specific research questions in these populations.

Association of Workload of On-Call Medical Interns With On-Call Sleep Duration, Shift Duration, and Participation in Educational Activities

Further restrictions in resident duty hours are being considered, and it is important to understand the association between workload, sleep loss, shift duration, and the educational time of on-call medical interns. To assess whether increased on-call intern workload, as measured by the number of new admissions on-call and the number of previously admitted patients remaining on the service, was associated with reductions in on-call sleep, increased total shift duration, and lower likelihood of participation in educational activities. Prospective cohort study of medical interns at a single US academic medical center from July 1, 2003, through June 24, 2005. Of the 81 interns, 56 participated (69%), for a total of 165 general medicine inpatient months resulting in 1100 call nights. On-call sleep duration, estimated by wrist watch actigraphy; total shift duration, measured from paging logs; and participation in educational activities (didactic lectures or bedside teaching), measured by experience sampling method via a personal digital assistant. Mean (SD) sleep duration on-call was 2.8 (1.5) hours and mean (SD) shift duration was 29.9 (1.7) hours. Interns reported spending 11% of their time in educational activities. Early in the academic year (July to October), each new on-call admission was associated with less sleep (-10.5 minutes [95% confidence interval {CI}, -16.8 to -4.2 minutes]; P < .001) and a longer shift duration (13.2 minutes [95% CI, 3.2-23.3 minutes]; P = .01). A higher number of previously admitted patients remaining on the service was associated with a lower odds of participation in educational activities (odds ratio, 0.82 [95% CI, 0.70-0.96]; P = .01]. Call nights during the week and early in the academic year were associated with the most sleep loss and longest shift durations. In this study population, increased on-call workload was associated with more sleep loss, longer shift duration, and a lower likelihood of participation in educational activities.

Participation in pediatric epidemiologic research: The SEARCH for Diabetes in Youth Study experience

Background We evaluated the association of demographic and clinical characteristics with participation in an epidemiologic study of diabetes mellitus among youth. Methods SEARCH for Diabetes in Youth is a multicenter study of physician-diagnosed diabetes in youth under the age of 20 comprising a surveillance and a cohort component. At each center, we enumerated all prevalent cases of diabetes in 2001 ( n = 6266) and all incident cases between 2002 and 2004 ( n = 3668). After confirmation of eligibility and validation, we invited each case to complete a survey and participate in a study visit. Here we evaluate how age, sex, race, and diabetes type are associated with participation in the survey and study visit. Results Among prevalent cases, participation in the survey was 68% and 41% in the study visit. Among 2002 to 2004 incident cases, participation varied for the survey (76%, 81%, and 82%) and study visit (52%, 60%, and 60%). In multivariate logistic regression analyses among all incident cases, older age was associated with a lower odds of participation in the study visit (15–17 vs. < 10 years: OR 0.5, 95% CI 0.4–0.7; 18–19 vs. < 10 years: OR 0.3, 95% CI 0.2–0.5), as was having type 2 diabetes vs. type 1 diabetes (OR 0.5, 95% CI 0.4–0.7) and being of African American race vs. non-Hispanic White (OR 0.6, 95% CI 0.4–0.8). Results were very similar among prevalent cases. Conclusions Elucidating the relationship between individual characteristics and participation is essential for evaluating nonresponse bias, correcting for it, and for planning and implementing recruitment strategies.