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            "title": "Health Status and Transitions in Cohabiting Relationships of American Young Adults",
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                    "firstName": "Brandon",
                    "lastName": "Wagner"
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            "abstractNote": "Objective: This study examines whether individual health predicts cohabiters' union transitions to marriage in American young adults. Background: Associations between health and subsequent marital transitions are well documented, but less is known about how health influences transitions of cohabiting relationships. As cohabitation has become a common relationship experience, understanding how health may influence cohabiters' union transitions is an important component of how health shapes relationship exposures more broadly. Method: Data were taken from Waves III and IV of the National Longitudinal Study of Adolescent to Adult Health, including the supplemental collection of relationship partners conducted during Wave III. Competing-risk regressions for the transition of cohabiting unions to marriage were estimated in two samples: individuals and a smaller sample of cohabiting couples with information from both partners. Results: Healthier cohabiters are more likely to marry than are their less healthy counterparts, but only women's health is significantly associated with the transition to marriage. In the dyadic sample with information from both partners, the significant association between the female partner's health and the transition to marriage is robust to male partner characteristics, including health. Conclusion: Health is an important predictor of cohabitation transitions in early adulthood, but these transitions may only be sensitive to the female partner's health.",
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            "place": "",
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            "version": 49,
            "itemType": "journalArticle",
            "title": "The Diabetes Family Behavior Checklist: A Psychometric Evaluation",
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                {
                    "creatorType": "author",
                    "firstName": "Adam B.",
                    "lastName": "Lewin"
                },
                {
                    "creatorType": "author",
                    "firstName": "Gary R.",
                    "lastName": "Geffken"
                },
                {
                    "creatorType": "author",
                    "firstName": "Amanda D.",
                    "lastName": "Heidgerken"
                },
                {
                    "creatorType": "author",
                    "firstName": "Danny C.",
                    "lastName": "Duke"
                },
                {
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                    "firstName": "Wendy",
                    "lastName": "Novoa"
                },
                {
                    "creatorType": "author",
                    "firstName": "Laura B.",
                    "lastName": "Williams"
                },
                {
                    "creatorType": "author",
                    "firstName": "Eric A.",
                    "lastName": "Storch"
                }
            ],
            "abstractNote": "The Diabetes Family Behavior Checklist (DFBC) assesses supportive and non-supportive parental behavior specific to diabetes management via parent and child reports. The DFBC was administered to 133 children with type 1 diabetes (T1D) and their caregivers. Subsequent analysis verified the two-factor structure of the DFBC corresponding to positive and negative support behaviors. Internal consistency was high for DFBC scores. Moderate to strong correlations with other measures of diabetes-specific familial behaviors, adherence, and metabolic control support the validity of the DFBC. Clinical application of the DFBC is discussed.",
            "publicationTitle": "Journal of Clinical Psychology in Medical Settings",
            "publisher": "",
            "place": "",
            "date": "2005-12",
            "volume": "12",
            "issue": "4",
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            "DOI": "10.1007/s10880-005-7817-x",
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            "ISSN": "1068-9583, 1573-3572",
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            "shortTitle": "The Diabetes Family Behavior Checklist",
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                    "firstName": "Lindsay S.",
                    "lastName": "Mayberry"
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                {
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                    "firstName": "Chandra Y.",
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            "abstractNote": "We used a mixed-methods approach to explore the relationships between participants' perceptions of family members' diabetes self-care knowledge, family members' diabetesspecific supportive and nonsupportive behaviors, and participants' medication adherence and glycémie control (AlC). Adults with type 2 diabetes participated in focus group sessions that discussed barriers and facilitators to diabetes management (n = 45) and/or completed surveys (n = 61) to collect demographic information, measures of diabetes medication adherence, perceptions of family members' diabetes self-care knowledge, and perceptions of family members' diabetes-specific supportive and nonsupportive behaviors. Most recent AlC was extracted from the medical record. Perceiving family members were more knowledgeable about diabetes was associated with perceiving family members performed more diabetes-specific supportive behaviors, but was not associated with perceiving family members performed fewer nonsupportive behaviors. Perceiving family members performed more nonsupportive behaviors was associated with being less adherent to one's diabetes medication regimen, and being less adherent was associated with worse glycémie control. In focus groups, participants discussed family member support and gave examples of family members who were informed about diabetes but performed sabotaging or nonsupportive behaviors. Participant reports of family members' nonsupportive behaviors were associated with being less adherent to one's diabetes medication regimen. Participants emphasized the importance of instrumental help for diabetes self-care behaviors and reported that nonsupportive family behaviors sabotaged their efforts to perform these behaviors. Interventions should inform family members about diabetes and enhance their motivation and behavioral skills around not interfering with one's diabetes self-care efforts.",
            "publicationTitle": "Diabetes Care",
            "publisher": "",
            "place": "",
            "date": "Jun 2012",
            "volume": "35",
            "issue": "6",
            "section": "",
            "partNumber": "",
            "partTitle": "",
            "pages": "1239-45",
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            "creatorSummary": "Schafer et al.",
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            "version": 47,
            "itemType": "journalArticle",
            "title": "Supportive and Nonsupportive Family Behaviors: Relationships to Adherence and Metabolic Control in Persons with Type I Diabetes",
            "creators": [
                {
                    "creatorType": "author",
                    "firstName": "Lorraine C.",
                    "lastName": "Schafer"
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                {
                    "creatorType": "author",
                    "firstName": "Kevin D.",
                    "lastName": "McCaul"
                },
                {
                    "creatorType": "author",
                    "firstName": "Russell E.",
                    "lastName": "Glasgow"
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            ],
            "abstractNote": "The Diabetes Family Behavior Checklist (DFBC) was administered to 54 adults and 18 adolescents (<19 yr of age) with insulin-dependent diabetes mellitus (IDDM). Subjects and family members completed parallel forms of the DFBC at initial and 6-mo follow-up home interviews. During each of these periods, adherence was assessed via self-report, 1 wk of self-monitoring, and 24-h dietary recalls. The results showed reliable differences between adolescents and adults. More negative interactions with family members were reported by adolescents and their family members, and adolescents were in poorer metabolic control. For adults but not adolescents, negative DFBC scores were prospectively predictive of poorer regimen adherence over the 6-mo interval for measures of glucose testing, insulin injection, and dietary adherence. In addition, higher negative DFBC scores for adults were marginally associated with higher HbA1 levels (P < 0.10). We conclude that the DFBC is a promising measure of family interaction related specifically to the IDDM regimen and that, for adults, higher levels of nonsupportive family behaviors may be related to reduced regimen adherence and poor control.",
            "publicationTitle": "Diabetes Care",
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            "date": "1986/03/01",
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            "shortTitle": "Supportive and Nonsupportive Family Behaviors",
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            "itemType": "journalArticle",
            "title": "Disparities in obesity among rural and urban residents in a health disparate region",
            "creators": [
                {
                    "creatorType": "author",
                    "firstName": "Jennie L.",
                    "lastName": "Hill"
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                {
                    "creatorType": "author",
                    "firstName": "Wen",
                    "lastName": "You"
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                {
                    "creatorType": "author",
                    "firstName": "Jamie M.",
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            "abstractNote": "The burden of obesity and obesity-related conditions is not borne equally and disparities in prevalence are well documented for low-income, minority and rural adults in the United States. The current literature on rural versus urban disparities is largely derived from national surveillance data which may not reflect regional nuances. There is little practical research that supports the reality of local service providers such as county health departments that may serve both urban and rural residents in a given area. Conducted through a community-academic partnership, the primary aim of this study is to quantify the current levels of obesity (BMI), fruit and vegetable (FV) intake and physical activity (PA) in a predominately rural health disparate region. Secondary aims are to determine if a gradient exists within the region in which rural residents have poorer outcomes on these indicators compared to urban residents.\nPMID: 25297840",
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            "creatorSummary": "Joynt KE et al.",
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            "version": 41,
            "itemType": "journalArticle",
            "title": "QUality of care and patient outcomes in critical access rural hospitals",
            "creators": [
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                    "creatorType": "author",
                    "name": "Joynt KE"
                },
                {
                    "creatorType": "author",
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            "abstractNote": "Context Critical access hospitals (CAHs) play a crucial role in the US rural safety net. Current policy efforts have focused primarily on helping these small, isolated hospitals remain financially viable to ensure access for individuals living in rural areas in the United States; however, little is known about the quality of care they provide or the outcomes their patients achieve.Objectives To examine the quality of care and patient outcomes at CAHs and to understand why patterns of care might differ for CAHs vs non-CAHs.Design, Setting, and Patients A retrospective analysis in 4738 US hospitals of Medicare fee-for-service beneficiaries with acute myocardial infarction (AMI) (10 703 for CAHs vs 469 695 for non-CAHs), congestive heart failure (CHF) (52 927 for CAHs vs 958 790 for non-CAHs), and pneumonia (86 359 for CAHs vs 773 227 for non-CAHs) who were discharged in 2008-2009.Main Outcome Measures Clinical capabilities, performance on processes of care, and 30-day mortality rates, adjusted for age, sex, race, and medical comorbidities.Results Compared with other hospitals (n = 3470), 1268 CAHs (26.8%) were less likely to have intensive care units (380 [30.0%] vs 2581 [74.4%], P < .001), cardiac catheterization capabilities (6 [0.5%] vs 1654 [47.7%], P < .001), and at least basic electronic health records (80 [6.5%] vs 445 [13.9%], P < .001). The CAHs had lower performance on processes of care than non-CAHs for all 3 conditions examined (concordance with Hospital Quality Alliance process measures for AMI, 91.0% [95% CI, 89.7%-92.3%] vs 97.8% [95% CI, 97.7%-97.9%]; for CHF, 80.6% [95% CI, 79.2%-82.0%] vs 93.5% [95% CI, 93.3%-93.7%]; and for pneumonia, 89.3% [95% CI, 88.6%-90.0%] vs 93.7% [95% CI, 93.6%-93.9%]; P < .001 for each). Patients admitted to CAHs had higher 30-day mortality rates for each condition than those admitted to non-CAHs (for AMI: 23.5% vs 16.2%; adjusted odds ratio [OR], 1.70; 95% confidence interval [CI], 1.61-1.80; P < .001; for CHF: 13.4% vs 10.9%; adjusted OR, 1.28; 95% CI, 1.23-1.32; P < .001; and for pneumonia: 14.1% vs 12.1%; adjusted OR, 1.20; 95% CI, 1.16-1.24; P < .001).Conclusion Compared with non-CAHs, CAHs had fewer clinical capabilities, worse measured processes of care, and higher mortality rates for patients with AMI, CHF, or pneumonia.",
            "publicationTitle": "JAMA",
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        "version": 40,
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            "creatorSummary": "MacDowell et al.",
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            "version": 40,
            "itemType": "journalArticle",
            "title": "A national view of rural health workforce issues in the USA",
            "creators": [
                {
                    "creatorType": "author",
                    "firstName": "M",
                    "lastName": "MacDowell"
                },
                {
                    "creatorType": "author",
                    "firstName": "M",
                    "lastName": "Glasser"
                },
                {
                    "creatorType": "author",
                    "firstName": "M",
                    "lastName": "Fitts"
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                {
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                    "firstName": "K",
                    "lastName": "Nielsen"
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                    "firstName": "M",
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            "abstractNote": "Introduction\nRegional or state studies in the USA have documented shortages of rural physicians and other healthcare professionals that can impact on access to health services. The purpose of this study was to determine whether rural hospital chief executive officers (CEOs) in the USA report shortages of health professions and to obtain perceptions about factors influencing recruiting and retention.\n\nMethods\nA nationwide US survey was conducted of 1031 rural hospital CEOs identified by regional/state Area Health Education Centers. A three-page survey was sent containing questions about whether or not physician shortages were present in the CEO’s community and asking about physician needs by specialty. The CEOs were also asked to assess whether other health professionals were needed in their town or within a 48 km (30 mile) radius. Analyses from 335 respondents (34.4%) representative of rural hospital CEOs in the USA are presented.\n\nResults\nPrimary care shortages based on survey responses were very similar to the pattern for all rural areas in the USA (49% vs 52%, respectively). The location of respondents according to ZIP code rurality status was similar to all rural areas in the USA (moderately rural, 29.3% vs 27.6%, respectively), and 69.1 % were located in highly rural ZIP codes (vs 72.4% of highly rural ZIP codes for all USA). Physician shortages were reported by 75.4% of the rural CEOs, and 70.3% indicated shortages of two or more primary care specialties. The most frequently reported shortage was family medicine (FM, 58.3%) followed by general internal medicine (IM, 53.1%). Other reported shortages were: psychiatry (46.6%); general surgery (39.9%); neurology (36.4%); pediatrics (PEDS, 36.2%); cardiology (35%); and obstetrics-gynecology (34.4%). The three most commonly needed allied health professions were registered nurses (73.5%), physical therapists (61.2%) and pharmacists (51 %). The percentage of CEOs reporting shortages of two or more primary care specialties (FM, IM or PEDS) was 70.3% nationally, with no statistically significant regional variation (p = .394), while higher for the New England through Virginia region (83.9%) than for all other regions. The CEOs reported the highest specialty care shortages for psychiatry (46.6%) followed by general surgery (39.9%), neurology (36.4%), cardiology (35.0%) and obstetrics-gynecology (34.4%;). Major specialty shortages varied among regions and only for neurology and cardiology were regional differences statistically significant (p < .05). Marked variation between need for healthcare professionals were reported ranging from approximately 73% for registered nurses (RNs) to 16% for health educators. Reporting of need for RNs in rural areas was nearly 74% nationally and 35% reported a need for nurse practitioners. Differences for both RNs and nurse practitioners were not statistically significant among regions. Nationally, approximately 30% of CEOs reported a shortage of licensed practical nurses, which differed significantly among regions (p = .006). There was variation in physical therapist shortages among regions (p = 001), with 61.2% of CEOs reporting shortages nationally. Regional variation pattern was observed for pharmacists (p = .004) with approximately 50% of rural CEOs reporting a need for pharmacists nationally. The association between CEOs’ reported shortages of two or more primary care doctors and their indication of the need for other health professionals was statistically significant for nurse practitioners, physician assistants, pharmacists, and dentists. The recruitment and retention attributes deemed to be of greatest importance were: (1) healthcare is a major part of the local economy; (2) community is a good place for family; (3) doctors are well-respected and supported; and (4) people in the community are friendly and supportive of each other. These were remarkably similar across 6 US geographic regions.\n\nConclusions\nSimilarities in shortages and attributes influencing recruitment across regions suggest that major policy and program interventions are needed to develop a rural health professions workforce that will enable the benefits of recent US health reform insurance coverage to be realized. Substantial and targeted programs to increase rural healthcare professionals are needed.",
            "publicationTitle": "Rural and remote health",
            "publisher": "",
            "place": "",
            "date": "2010",
            "volume": "10",
            "issue": "3",
            "section": "",
            "partNumber": "",
            "partTitle": "",
            "pages": "1531",
            "series": "",
            "seriesTitle": "",
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            "journalAbbreviation": "Rural Remote Health",
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                    "lastName": "Kim"
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                    "lastName": "Tak"
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                    "firstName": "Jeehye",
                    "lastName": "Im"
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            "publicationTitle": "Journal of Korean Medical Science",
            "publisher": "",
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    {
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        "version": 37,
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            "creatorSummary": "Murimi and Harpel",
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        "data": {
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            "version": 37,
            "itemType": "journalArticle",
            "title": "Practicing Preventive Health: The Underlying Culture Among Low-Income Rural Populations",
            "creators": [
                {
                    "creatorType": "author",
                    "firstName": "Mary W.",
                    "lastName": "Murimi"
                },
                {
                    "creatorType": "author",
                    "firstName": "Tammy",
                    "lastName": "Harpel"
                }
            ],
            "abstractNote": "Context: Health disparities on the basis of geographic location, social economic factors and education levels are well documented. However, even when health care services are available, there is no guarantee that all persons will take preventive health measures. Understanding the cultural beliefs, practices, and lifestyle choices that determine utilization of health services is an important factor in combating chronic diseases. Purpose: The purpose of this study was to investigate personal, cultural, and external barriers that interfered with participating in a community-based preventive outreach program that included health screening for obesity, diabetes, heart diseases, and hypertension when cost and transportation factors were addressed. Methods: Six focus groups were conducted in a rural community of Louisiana. Focus groups were divided into 2 categories: participants and nonparticipants. Three focus groups were completed with Dubach Health Outreach Project (DUHOP) participants and 3 were completed with nonparticipants. The focus group interviews were moderated by a researcher experienced in focus group interviews; a graduate student assisted with recording and note-taking during the sessions. Findings: Four main themes associated with barriers to participation in preventive services emerged from the discussions: (1) time, (2) low priority, (3) fear of the unknown, and (4) lack of companionship or support. Health concerns, free services, enjoyment, and free food were identified as motivators for participation. Conclusions: The findings of this study indicated that the resulting synergy between low-income status and a lack of motivation regarding health care prevention created a complicated practice of health care procrastination, which resulted in unnecessary emergency care and disease progression. To change this practice to proactive disease prevention and self care, a concerted effort will need to be implemented by policy makers, funding agents, health care providers, and community leaders and members.",
            "publicationTitle": "The Journal of Rural Health",
            "publisher": "",
            "place": "",
            "date": "June 1, 2010",
            "volume": "26",
            "issue": "3",
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            "partNumber": "",
            "partTitle": "",
            "pages": "273-282",
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            "DOI": "10.1111/j.1748-0361.2010.00289.x",
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            "url": "http://onlinelibrary.wiley.com/doi/10.1111/j.1748-0361.2010.00289.x/abstract",
            "accessDate": "2014-09-07T22:43:28Z",
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            "shortTitle": "Practicing Preventive Health",
            "language": "en",
            "libraryCatalog": "Wiley Online Library",
            "callNumber": "",
            "rights": "© 2010 National Rural Health Association",
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            "dateAdded": "2014-09-07T22:43:28Z",
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