Since 1975, the prevalence of obesity has nearly tripled around the world. In 2016, 39% of adults, or 1.9 billion people, were considered overweight, and 13% of adults, or 650 million people, were considered obese. Furthermore, Cardiovascular disease remains to be the leading cause of death for adults in the United States, with 655,000 people dying from related conditions and consequences each year. Including fiber in one’s dietary regimen has been shown to greatly improve health outcomes in regards to these two areas of health. However, not much literature is available on the effects of corn-based fiber, especially detailing the individual components of the grain itself. The purpose of this preliminary study was to test the differences in influence on both LDL-cholesterol and triglycerides between treatments based on whole-grain corn flour, refined corn flour, and 50% refined corn flour + 50% corn bran derived from whole grain cornmeal (excellent fiber) in healthy overweight (BMI ≥ 25.0 kg/m2) adults (ages 18 - 70) with high LDL cholesterol (LDL ≥ 120mg/dL). 20 participants, ages 18 - 64 (10 males, 10 females) were involved. Data was derived from blood draws taken before and after each of the three treatments as well as before and after each treatment’s wash out periods. A general linear model was used to assess the effect of corn products on circulating concentrations of LDL-cholesterol and triglycerides. From the model, it was found that the whole-grain corn flour and the 50% refined corn flour + 50% corn bran drive from whole grain cornmeal treatments produced a higher, similar benefit in reductions in LDL-cholesterol. However, the whole grain flour, refined flour, and bran-based fiber treatments did not influence the triglyceride levels of the participants throughout this study. Further research is needed to elucidate the effects of these fiber items on cardiometabolic disease markers in the long-term as well as with a larger sample size.
Methods: An academic detailing session was provided by the Florida Department of Health in Broward County to primary care providers (PCPs) at a private clinic in the Southeastern US. The Conceptual Model of Nursing and Population Health (CMNPH) and the Promoting Action on Research Implementation in Health Services Framework (PARIHS) were used as guides for project design and evidence-based practice implementation. There were five participants in the academic detailing session including: a physician, a physician assistant (PA), and three medical students. PCP PrEP knowledge, attitudes, and behaviors were measured using pre and post intervention surveys. PrEP prescription, HIV/Sexually Transmitted Infection (STI) screening, and HIV testing were measured using aggregate data queries for the time periods of four and eight weeks before and four and eight weeks after the educational intervention. No personal identifying information was obtained.
Results: Pre and post surveys were analyzed using Wilcoxon signed rank testing to examine differences between matched pairs of ordinal data. Significant PrEP screening and HIV/STI testing were analyzed pre and post intervention using paired t tests to compare pre and post intervention practices. Significant differences were found in the results (Z = 2.03, 1.84, and 1.83 respectively, p > 0.1) The academic detailing intervention significantly improved knowledge, attitudes, and behaviors of primary care providers and medical students regarding PrEP. The mean of active qualifying ICD 10 codes prior to the intervention versus post intervention were 5 (sd = 5.64) vs. 4.2 (sd = 4.87) respectively. No significant difference was found between active ICD 10 codes for patient visits before compared to after the intervention (t (9) = 1.12, p>.1).
Conclusions: This project found that academic detailing improved provider self-reported knowledge, attitudes, and behaviors regarding PrEP. However, self-reported survey scores were not correlated with changes in clinical practice based on ICD 10 codes. Additional clinical implications may include fostering clinical outreach and cooperation between the county health department and local primary care clinics. Further research is needed on the effects of PrEP academic detailing on clinical practice.