Publications by authors named "Gail Bellamy"

14 Publications

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Medical Residents' and Practicing Physicians' e-Cigarette Knowledge and Patient Screening Activities: Do They Differ?

Health Serv Res Manag Epidemiol 2016 Jan-Dec;3:2333392816678493. Epub 2016 Nov 28.

Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine in Tallahassee, Tallahassee, FL, USA.

Purpose: The purpose of this study was to compare medical residents and practicing physicians in primary care specialties regarding their knowledge and beliefs about electronic cigarettes (e-cigarettes). We wanted to ascertain whether years removed from medical school had an effect on screening practices, recommendations given to patients, and the types of informational sources utilized.

Methods: A statewide sample of Florida primary care medical residents (n = 61) and practicing physicians (n = 53) completed either an online or paper survey, measuring patient screening and physician recommendations, beliefs, and knowledge related to e-cigarettes. χ tests of association and linear and logistic regression models were used to assess the differences within- and between-participant groups.

Results: Practicing physicians were more likely than medical residents to believe e-cigarettes lower cancer risk in patients who use them as an alternative to cigarettes ( = .0003). Medical residents were more likely to receive information about e-cigarettes from colleagues ( = .0001). No statistically significant differences were observed related to e-cigarette knowledge or patient recommendations.

Conclusions: Practicing primary care physicians are accepting both the benefits and costs associated with e-cigarettes, while medical residents in primary care are more reticent. Targeted education concerning the potential health risks and benefits associated with the use of e-cigarettes needs to be included in the current medical education curriculum and medical provider training to improve provider confidence in discussing issues surrounding the use of this product.
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http://dx.doi.org/10.1177/2333392816678493DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266463PMC
November 2016

Rural Healthy People 2020: New Decade, Same Challenges.

J Rural Health 2015 7;31(3):326-33. Epub 2015 May 7.

Department of Health Policy & Management, Texas A&M School of Public Health, College Station, Texas.

Purpose: The health of rural America is more important than ever to the health of the United States and the world. Rural Healthy People 2020's goal is to serve as a counterpart to Healthy People 2020, providing evidence of rural stakeholders' assessment of rural health priorities and allowing national and state rural stakeholders to reflect on and measure progress in meeting those goals. The specific aim of the Rural Healthy People 2020 national survey was to identify rural health priorities from among the Healthy People 2020's (HP2020) national priorities.

Methods: Rural health stakeholders (n = 1,214) responded to a nationally disseminated web survey soliciting identification of the top 10 rural health priorities from among the HP2020 priorities. Stakeholders were also asked to identify objectives within each national HP2020 priority and express concerns or additional responses.

Findings And Conclusions: Rural health priorities have changed little in the last decade. Access to health care continues to be the most frequently identified rural health priority. Within this priority, emergency services, primary care, and insurance generate the most concern. A total of 926 respondents identified access as the no. 1 rural health priority, followed by, no. 2 nutrition and weight status (n = 661), no. 3 diabetes (n = 660), no. 4 mental health and mental disorders (n = 651), no. 5 substance abuse (n = 551), no. 6 heart disease and stroke (n = 550), no. 7 physical activity and health (n = 542), no. 8 older adults (n = 482), no. 9 maternal infant and child health (n = 449), and no. 10 tobacco use (n = 429).
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http://dx.doi.org/10.1111/jrh.12116DOI Listing
July 2016

Post-Discharge Adverse Events Among Urban and Rural Patients of an Urban Community Hospital: A Prospective Cohort Study.

J Gen Intern Med 2015 Aug 31;30(8):1164-71. Epub 2015 Mar 31.

Department of Family Medicine & Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, 48201, USA,

Background: There has been little research to examine post-discharge adverse events (AEs) in rural patients discharged from community hospitals.

Objective: We aimed to determine the rate of post-discharge AEs, classify the types of post-discharge AEs, and identify risk factors for post-discharge AEs in urban and rural patients.

Design: This was a prospective cohort study of patients at risk for post-discharge adverse events from December 2011 through October 2012.

Patients: Six hundred and eighty-four patients who were under the care of hospitalist physicians and were being discharged home, spoke English, and could be contacted after discharge, were admitted to the medical service. Patients were stratified as urban/rural using zip code of residence. Rural patients were oversampled to ensure equal enrollment of urban and rural patients.

Main Measures: The main outcome of the study was post-discharge AEs based on structured telephone interviews, health record review, and adjudication by two blinded, trained physicians using a previously established methodology.

Results: Over 28% of 684 patients experienced post-discharge AEs, most of which were either preventable or ameliorable. There was no difference in the incidence of post-discharge AEs in urban versus rural patients (ARR 1.04 95% CI 0.82-1.32 ), but post-discharge AEs were associated with hypertension, type 2 diabetes mellitus, and number of secondary discharge diagnoses only in urban patients.

Conclusions: Post-discharge AEs were common in both urban and rural patients and many were preventable or ameliorable. Potentially different risk factors for AEs in urban versus rural patients suggests the need for further research into the underlying causes. Different interventions may be required in urban versus rural patients to improve patient safety during transitions in care.
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http://dx.doi.org/10.1007/s11606-015-3260-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4510218PMC
August 2015

Rural Healthy People 2010, 2020, and beyond: the need goes on.

Fam Community Health 2011 Apr-Jun;34(2):182-8

Blue Cross and Blue Shield of Florida Center for Rural Health Research and Policy, Florida State University College of Medicine, Tallahassee, FL 32306-4300, USA.

Rural Healthy People 2010 represented the first effort to specifically include small and rural communities in the Healthy People movement to improve the health of Americans. Rural Healthy People 2010 set rural-specific health priority areas, documented what is known about health in rural areas, identified rural best practice programs/interventions, and promoted rural health services research and researchers. Over the last decade Rural Healthy People 2010 has provided policy makers, rural providers, and rural communities with a valuable resource for planning and policy making. Sustaining the Rural Healthy People project in collaboration with the broader Healthy People 2020 effort will provide an important infrastructure for improving rural health.
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http://dx.doi.org/10.1097/FCH.0b013e31820dea1cDOI Listing
July 2011

Bypassing the local rural hospital for outpatient procedures.

J Rural Health 2009 ;25(2):174-81

Department of Family Medicine and Rural Health, Florida State University College of Medicine, Tallahassee, FL 32306-4300, USA.

Purpose: To assess the amount of local rural hospital outpatient department (HOPD) bypass for outpatient procedures.

Methods: We analyzed data on colonoscopies and upper gastrointestinal endoscopies performed in the state of Florida over the period 1997-2004.

Findings: Approximately, 53% of colonoscopy and 45% of upper gastrointestinal endoscopy patients bypassed their local rural hospital for treatment at either a free-standing ambulatory surgical center (ASC) or a nonlocal hospital outpatient department. Independent predictors of bypass included risk-adjusted severity of the patient's medical condition, insurance status, and race. Patients treated in ASCs were predominately healthier, white and commercially insured. Nonlocal HOPDs tend to treat a sicker cohort of patients who were publicly insured or under managed care.

Conclusions: The results indicate that patients who bypass their local HOPD to an ASC differ from those bypassing to a nonlocal HOPD, and that patient factors influencing bypass for outpatient procedures differ from those influencing inpatient bypass. From a policy perspective, as procedures continue to migrate from the inpatient to the outpatient setting, bypassing the local rural hospital for treatment elsewhere could create conditions that negatively impact rural hospital operations.
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http://dx.doi.org/10.1111/j.1748-0361.2009.00214.xDOI Listing
January 2010

Bypass of local primary care in rural counties: effect of patient and community characteristics.

Ann Fam Med 2008 Mar-Apr;6(2):124-30

Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.

Purpose: This national study sought information from rural patients (1) to assess the prevalence of bypass, a pattern of seeking health care outside the local community; (2) to examine the impact of locally available primary care physicians (PCPs) and hospital size on the odds of bypass; and (3) to identify patient demographic and geographic factors associated with bypass. This study also ascertained the reasons patients give for bypass and their suggestions for how hospitals can retain patients locally.

Methods: We analyzed data from a 2005 telephone survey of 1,264 adults, aged 18 years or older, who lived within 20 miles of 25 randomly selected Critical Access Hospitals and were linked with a Health Professional Shortage Area and 2004 census data. Respondents were asked about demographic characteristics, travel time and distance to local hospitals, and insurance status, as well as for suggestions of what local hospitals could do to retain patients.

Results: Overall, 32% of respondents bypassed local primary care; the rate ranged from 9% to 66% across the Critical Access Hospital service areas. Factors associated with bypass included age, education, marital status, satisfaction with the local hospital, admission to a hospital in the past 12 months, hospital size, and local density of PCPs. Compared with residents in areas with a higher density of PCPs (=3,500 residents per PCP), residents in areas with a low density (>4,500 residents per PCP) were more likely to bypass local care (odds ratio, 1.58; 95% confidence interval, 1.02-2.46). Lack of specialty care and limited services were most frequently mentioned as reasons why patients bypassed local hospitals.

Conclusions: The sizable variation in bypass rates among this sample of Critical Access Hospital service areas suggests that strategies to reduce bypass behavior should be directed at the local community or facility level. Changing rural residents' perception of their local care, helping them gain a better understanding of the function of primary care, and increasing the number of PCPs might help hospitals retain patients and rural communities stay healthy.
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http://dx.doi.org/10.1370/afm.794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2267422PMC
April 2008

Genomic imprinting and the expression of affect in Angelman syndrome: what's in the smile?

J Child Psychol Psychiatry 2007 Jun;48(6):571-9

School of Psychology, University of Birmingham, UK.

Background: Kinship theory (or the genomic conflict hypothesis) proposes that the phenotypic effects of genomic imprinting arise from conflict between paternally and maternally inherited alleles. A prediction arising for social behaviour from this theory is that imbalance in this conflict resulting from a deletion of a maternally imprinted gene, as in Angelman syndrome (AS), will result in a behavioural phenotype that should evidence behaviours that increase access to maternally provided social resources (adult contact).

Method: Observation of the social behaviour of children with AS (n = 13), caused by a deletion at 15q11-q13, and a matched comparison group (n = 10) was undertaken for four hours in a socially competitive setting and the effect of adult attention on child behaviours and the effect of child smiling on adult behaviours evaluated using group comparisons and observational lag sequential analyses.

Results: The AS group smiled more than the comparison group in all settings, which had different levels of adult attention, and more when the level of adult attention was high. Smiling by children with AS evoked higher levels of adult attention, eye contact and smiling both than by chance and in comparison to other children and this effect was sustained for 30 s to 50 s. Smiling by children with AS was frequently preceded by child initiated contact toward the adult.

Discussion: The results are consistent with a kinship theory explanation of the function of heightened levels of sociability and smiling in Angelman syndrome and provide support for an emotion signalling interpretation of the mechanism by which smiling accesses social resources. Further research on other behaviours characteristic of Angelman and Prader-Willi syndromes warrant examination from this perspective.
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http://dx.doi.org/10.1111/j.1469-7610.2007.01736.xDOI Listing
June 2007

Patient bypass behavior and critical access hospitals: implications for patient retention.

J Rural Health 2007 ;23(1):17-24

West Virginia University Institute for Health Policy Research, Charleston, WVA, USA.

Purpose: To assess the extent of bypass for inpatient care among patients living in Critical Access Hospital (CAH) service areas, and to determine factors associated with bypass, the reasons for bypass, and what CAHs can do to retain patients locally.

Methods: Six hundred and forty-seven subjects, aged 18 years and older, who had been admitted to a hospital for inpatient care in the past 12 months and lived within 15-20 miles of 25 randomly selected CAHs were surveyed by phone during the period from early February through late July 2005. Survey questions included demographic characteristics, general health status, travel time/distance to health care, questions on satisfaction with local health services, bypass behavior, and solicited suggestions on how local hospitals could retain patients locally.

Findings: About 60% of surveyed patients bypassed their local CAHs for inpatient care including 16% who were referred to another facility by the local CAH/health care providers and would use the local hospital if needed services were available. Bypass rates ranged from 16% to 70% across the sampled CAHs. Factors associated with bypass included age, income, satisfaction with the local hospital, and traveling distance/time. Lack of specialty care, limited services, and the quality/reputation of local services/doctors were most frequently mentioned as reasons why patients bypass local CAHs.

Conclusions: The bypass rate for sampled CAHs is considerably higher than the 20%-50% bypass rates documented in the literature for all hospitals in general using discharge/administrative data. The sizeable variation in bypass rates across CAHs suggests that the appropriate response/fix should come from the facility/community levels.
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http://dx.doi.org/10.1111/j.1748-0361.2006.00063.xDOI Listing
April 2007

Getting from here to there: evaluating West Virginia's rural nonemergency medical transportation program.

J Rural Health 2003 ;19 Suppl:397-406

West Virginia Institute for Health Policy Research, 3110 MacCorkle Ave, SE, Charleston, WV 25302, USA.

With funding from the 21st Century Challenge Fund, the West Virginia Rural Health Access Program created Transportation for Health, a demonstration project for rural nonemergency medical transportation. The project was implemented in 3 sites around the state, building on existing transportation systems--specifically, a multicounty transit authority, a joint senior center/transit system, and a senior services center. An evaluation of the project was undertaken to answer 3 major questions: (1) Did the project reach the population of people who need transportation assistance? (2) Are users of the transportation project satisfied with the service? (3) Is the program sustainable? Preliminary results from survey data indicate that the answers to questions 1 and 2 are affirmative. A break-even analysis of all 3 sites begins to identify programmatic and policy issues that challenge the likelihood of financial sustainability, including salary expenses, unreimbursed mileage, and reliance on Medicaid reimbursement.
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http://dx.doi.org/10.1111/j.1748-0361.2003.tb01060.xDOI Listing
October 2003

Unique advocacy opportunities for rural public health agencies.

J Rural Health 2002 ;18(3):388-91

University of Kentucky Center for Rural Health, Hazard 41701, USA.

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http://dx.doi.org/10.1111/j.1748-0361.2002.tb00902.xDOI Listing
September 2002

Rural healthy people 2010: identifying rural health priorities and models for practice.

J Rural Health 2002 ;18(1):9-14

Southwest Rural Health Research Center, School of Rural Public Health, Texas A&M University System Health Science Center, Bryan, 77802, USA.

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http://dx.doi.org/10.1111/j.1748-0361.2002.tb00869.xDOI Listing
July 2002