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Constantine, Norman A., Carmen R. Nevarez, Michael Miller, and Paula Hamilton. "Statewide Policy Advocacy Intervention in California." Californian Journal of Health Promotion 4, no. 3 (September 1, 2006): 10–22. http://dx.doi.org/10.32398/cjhp.v4i3.1953.
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California has made substantial progress since 1991 in reducing its teen birth rate, and its rate reduction now leads the nation. Yet more than 50,000 Californian teens continue to give birth each year, and many more became pregnant. And due to changing demographics and the recent reversal in the last decade’s poverty rate declines, California’s improvements are at risk. The No Time for Complacency (NTFC) initiative is a policy advocacy intervention designed to promote effective statewide teen pregnancy prevention policy and funding in California. This initiative employs legislative-district data analysis to provide a politically compelling organization of teen birth data, cost analyses to heighten the societal relevance of teen births, policy analysis to identify promising and effective state policies, and media advocacy to focus attention on these issues in all regions of the state. The process and results described show how it was possible to achieve impacts on state-level health policy and program funding.
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Fries, James F., Harry Harrington, Robert Edwards, Louis A. Kent, and Nancy Richardson. "Randomized Controlled Trial of Cost Reductions from a Health Education Program: The California Public Employees' Retirement System (PERS) Study." American Journal of Health Promotion 8, no. 3 (January 1994): 216–23. http://dx.doi.org/10.4278/0890-1171-8.3.216.
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Purpose. This study evaluated the cost trend reduction from a health promotion program. Design. A randomized 12-month trial comparing claims data was conducted. Additional studies, utilizing quasi-experimental designs, analyzed changes in health habits and changes in costs estimated by self-report. Subjects. All active California Public Employees' Retirement System (PERS) employees (21,170), non-Medicare eligible retirees (8,316), and retirees with Medical Supplement coverage (25,416) administered by Blue Shield of California were included. Intervention. The program consisted of mailed health risk assessments at six- or 12-month intervals, with individualized reports and recommendation letters sent to participants emphasizing and encouraging change, self-management materials emphasizing self-care when appropriate, and quarterly newsletters. Passive participants received printed materials only. Measures. Health risks were based upon self-report; summary scores were computed by modified Framingham algorithms. Self-report cost data were estimated from reported doctor visits, hospital days, and days sick or confined to home. Claims data were those paid by Blue Shield of California. Results. The program was associated with: 1) reduction in health risk scores at 12 months, (p<.001), 2) reduction of subject reported medical utilization from baseline (p<.05), and 3) decrease in claims cost growth relative to controls (p=.03). Annual claims costs were approximately $3.2 to $8.0 million less than expected had costs for the experimental participants increased at the same rate as the control group. Discussion. Results suggest that appropriately designed health promotion programs can reduce health risks and at the same time reduce the medical care claims cost trend.
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Bruvold, William H. "A Meta-Analysis of the California School-Based Risk Reduction Program." Journal of Drug Education 20, no. 2 (June 1990): 139–52. http://dx.doi.org/10.2190/7crh-5r8t-mhr6-6ud7.
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Parriott, Andrea, James G. Kahn, Haleh Ashki, Adam Readhead, Pennan M. Barry, Alex J. Goodell, Jennifer Flood, and Priya B. Shete. "Modeling the Impact of Recommendations for Primary Care–Based Screening for Latent Tuberculosis Infection in California." Public Health Reports 135, no. 1_suppl (July 2020): 172S—181S. http://dx.doi.org/10.1177/0033354920927845.
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Objective Targeted testing and treatment of persons with latent tuberculosis infection (LTBI) is a critical component of the US tuberculosis (TB) elimination strategy. In January 2016, the California Department of Public Health issued a tool and user guide for TB risk assessment (California tool) and guidance for LTBI testing, and in September 2016, the US Preventive Services Task Force (USPSTF) issued recommendations for LTBI testing in primary care settings. We estimated the epidemiologic effect of adherence to both recommendations in California. Methods We used an individual-based Markov micro-simulation model to estimate the number of cases of TB disease expected through 2026 with baseline LTBI strategies compared with implementation of the USPSTF or California tool guidance. We estimated the risk of LTBI by age and country of origin, the probability of being in a targeted population, and the probability of presenting for primary care based on available data. We assumed 100% adherence to testing guidance but imperfect adherence to treatment. Results Implementation of USPSTF and California tool guidance would result in nearly identical numbers of tests administered and cases of TB disease prevented. Perfect adherence to either recommendation would result in approximately 7000 cases of TB disease averted (40% reduction compared with baseline) by 2026. Almost all of this decline would be driven by a reduction in the number of cases among non–US-born persons. Conclusions By focusing on the non–US-born population, adherence to LTBI testing strategies recommended by the USPSTF and the California tool could substantially reduce the burden of TB disease in California in the next decade.
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Molitor, Fred, Celeste Doerr, John Pugliese, and Lauren Whetstone. "Three-year trends in dietary behaviours among mothers, teenagers and children from SNAP-Ed (Supplemental Nutrition Assistance Program–Education) eligible households across California." Public Health Nutrition 23, no. 1 (November 20, 2019): 3–12. http://dx.doi.org/10.1017/s1368980019003197.
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AbstractObjective:To examine trends from 2015 to 2017 in dietary behaviours and diet quality among low-income mothers, teenagers and children.Design:Cross-sectional telephone surveys using a validated 24 h dietary assessment.Setting:Randomly sampled households with incomes ≤185 % of the US federal poverty level across California.Participants:Survey participants were 13 247 mothers (≥18 years), 3293 teenagers (12–17 years) and 6043 children (5–11 years). Respondents were mostly Latino.Results:Over the 3-year study period, consumption of fruits and vegetables with and without 100 % fruit juice increased (P ≤ 0·05) by at least 0·3 cups/d for mothers, teenagers and children. Intake of water also increased (P ≤ 0·001) by more than 1 cup/d for mothers and children and 2 cups/d for teenagers. Sugar-sweetened beverage (SSB) consumption was unchanged over the 3 years. Overall diet quality, as assessed by the Healthy Eating Index-2015, improved (P ≤ 0·01) for mothers, teenagers and children. Covariates for the fifteen regression models (three age groups by five outcome variables) included race/ethnicity, age, education for mothers, and gender for teenagers and children.Conclusions:The observed increases in fruit and vegetable intake and improvements in overall diet quality during the 3-year period suggest that low-income Californians may have lowered their risk of preventable diseases. However, more intense or strategic SSB-reduction interventions are required. Regional- or state-level, population-based surveillance of dietary behaviours is useful for public health nutrition policy and programme decision making, and can be used to assess potential trends in future negative health outcomes and related costs associated with poor dietary behaviours within at-risk populations.
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D’Addario, Lia, Tony Kuo, and Brenda Robles. "Do knowledge about sodium, health status by self-report, and having hypertension predict sodium consumption behaviors among Southern California hospital employees?" Translational Behavioral Medicine 11, no. 6 (March 23, 2021): 1254–63. http://dx.doi.org/10.1093/tbm/ibaa148.
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Lay Summary A major problem in the United States is the overconsumption of high sodium foods. These foods often put people at higher risk of hypertension, heart disease, and stroke. Recent public health efforts have tackled this problem by making it easier to select/purchase healthier, lower sodium foods in different settings. Hospital employees are one such group that has been the focus of these interventions. Presently, little is known about what explains sodium-related dietary behaviors among hospital employees. To address this gap, we used data from a survey of hospital staff who were exposed to sodium reduction interventions in the workplace to examine how their knowledge, attitudes, and self-reported health status affected their sodium consumption. A key finding was being in “good health” and having the belief that salt intake matters for health predicted decreased sodium consumption among the survey participants. These and other study findings provide context and insights into ways in which further sodium reduction could be achieved among at-risk hospital employees.
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Wild, Laura E., William B. Patterson, Roshonda B. Jones, Jasmine F. Plows, Paige K. Berger, Claudia Rios, Jennifer L. Fogel, Michael I. Goran, and Tanya L. Alderete. "Risk of Micronutrient Inadequacy among Hispanic, Lactating Mothers: Preliminary Evidence from the Southern California Mother’s Milk Study." Nutrients 13, no. 9 (September 18, 2021): 3252. http://dx.doi.org/10.3390/nu13093252.
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Micronutrients are dietary components important for health and physiological function, and inadequate intake of these nutrients can contribute to poor health outcomes. The risk of inadequate micronutrient intake has been shown to be greater among low-income Hispanics and postpartum and lactating women. Therefore, we aimed to determine the risk of nutrient inadequacies based on preliminary evidence among postpartum, Hispanic women. Risk of micronutrient inadequacy for Hispanic women (29–45 years of age) from the Southern California Mother’s Milk Study (n = 188) was assessed using 24 h dietary recalls at 1 and 6 months postpartum and the estimated average requirement (EAR) fixed cut-point approach. Women were considered at risk of inadequate intake for a nutrient if more than 50% of women were consuming below the EAR. The Chronic Disease Risk Reduction (CDRR) value was also used to assess sodium intake. These women were at risk of inadequate intake for folate and vitamins A, D, and E, with 87.0%, 93.4%, 43.8%, and 95% of women consuming less than the EAR for these nutrients, respectively. Lastly, 71.7% of women consumed excess sodium. Results from this preliminary analysis indicate that Hispanic women are at risk of inadequate intake of important micronutrients for maternal and child health.
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ROCHELEAU, J. P., P. MICHEL, L. R. LINDSAY, M. DREBOT, A. DIBERNARDO, N. H. OGDEN, A. FORTIN, and J. ARSENAULT. "Emerging arboviruses in Quebec, Canada: assessing public health risk by serology in humans, horses and pet dogs." Epidemiology and Infection 145, no. 14 (September 28, 2017): 2940–48. http://dx.doi.org/10.1017/s0950268817002205.
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SUMMARYPeriodic outbreaks of West Nile virus (WNV), Eastern equine encephalitis virus (EEEV) and to a lesser extent, California serogroup viruses (CSGV), have been reported in parts of Canada in the last decade. This study was designed to provide a broad assessment of arboviral activity in Quebec, Canada, by conducting serological surveys for these arboviruses in 196 horses, 1442 dogs and 485 humans. Sera were screened by a competitive enzyme linked immunosorbent assay and positive samples confirmed by plaque reduction neutralisation tests. The percentage of seropositive samples was 83·7%, 16·5%, 7·1% in horses, 18·8%, 0·6%, 0% in humans, 11·7%, 3·1%, 0% in adult dogs and 2·9%, 0·3%, 0% in juvenile dogs for CSGV, WNV and EEEV, respectively. Serological results in horses and dogs appeared to provide a meaningful assessment of risk to public health posed by multiple arboviruses.
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Nyamathi, Adeline, Benissa Salem, Cathy J. Reback, Steven Shoptaw, Catherine M. Branson, Faith E. Idemundia, Barbara Kennedy, Farinaz Khalilifard, Mary Marfisee, and Yihang Liu. "Correlates of Hepatitis B Virus and HIV Knowledge Among Gay and Bisexual Homeless Young Adults in Hollywood." American Journal of Men's Health 7, no. 1 (August 8, 2012): 18–26. http://dx.doi.org/10.1177/1557988312456068.
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Homeless gay and bisexual (G/B) young men have multiple risk factors that increase their risk of contracting hepatitis B virus (HBV) and human immunodeficiency virus (HIV). This study used baseline information from structured instruments to assess correlates of knowledge to HIV and HBV infection from 267 young (18-39 year old) G/B active methamphetamine, cocaine, and crack-using homeless men enrolled in a longitudinal trial. The study is designed to reduce drug use and improve knowledge of hepatitis and HIV/AIDS in a community center in Hollywood, California. Regression modeling revealed that previous hepatitis education delivered to G/B men was associated with higher levels of HIV/AIDS and hepatitis knowledge. Moreover, higher HIV/AIDS knowledge was associated with combining sex and drinking alcohol. Associations with hepatitis B knowledge was found among G/B men who were engaging in sex while under the influence of marijuana, who were receiving support from non–drug users, and who had been homeless in the last 4 months. Although being informed about HIV/AIDS and hepatitis did not preclude risky sexual and drug use behavior, knowledge about the dangers of concurrent sex with substance use is important. As higher levels of knowledge of hepatitis was associated with more moderate drug use, early access to testing and teaching harm reduction strategies remain critical to reduce exposure and infection of HBV and HIV in this population.
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Jule, Janet G. "Workplace Safety: A Strategy for Enterprise Risk Management." Workplace Health & Safety 68, no. 8 (June 1, 2020): 360–65. http://dx.doi.org/10.1177/2165079920916654.
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Background: Injury and illness incidence rates continue to be higher in healthcare facilities than in the manufacturing environment despite improvement efforts implemented by various organizations. The prevention of workplace injury and illness is a challenge for facilities due to reasons including exposure to body fluids, infectious diseases, and patient handling activities. The purpose of this project was to reduce workplace safety-related incidents and prevent employee injuries through leadership involvement in employment of preventive, directive, and corrective controls. Methods: A tertiary medical center in California experienced 114 accepted injury claims in 1 year. As a response to the problem, the medical center developed a safety management system consisting of a process for engagement between leadership and staff members/employees to increase accountability and reduce injury risks. Findings: The medical center achieved a 59% reduction from 114 to 67 injury claims over a period of 2 years and a two-point increase in engagement scores from both leaders and staff members. Conclusion/Application to Practice: The development of a safety culture starts with leadership behavior, establishment of clear safety processes, and hazard mitigation activities. Workplace safety is a shared responsibility between frontline staff managers and leadership within an organization. Senior leaders must serve as role models to promote a speak-up culture to support safe work practices.
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Nichols, Hazel B., Til Stürmer, Valerie S. Lee, Chelsea Anderson, Jean S. Lee, Janise M. Roh, Kala Visvanathan, Hyman Muss, and Lawrence H. Kushi. "Breast Cancer Chemoprevention in an Integrated Health Care Setting." JCO Clinical Cancer Informatics, no. 1 (November 2017): 1–12. http://dx.doi.org/10.1200/cci.16.00059.
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Purpose National guidelines encourage counseling high-risk women about pharmacologic breast cancer risk reduction. We evaluated the use of integrated health care data to identify and characterize breast cancer chemoprevention use. Chemoprevention included US Food and Drug Administration–approved use of tamoxifen and raloxifene and off-label use of aromatase inhibitors (AIs). Patients and Methods Using electronic medical and pharmacy records (EMRs) in the Kaiser Permanente Northern California health care system, we sampled cancer-free women age 35 to 69 years who used tamoxifen, raloxifene, exemestane, anastrozole, or letrozole from 2005 to 2013. Risk-benefit profiles were calculated for tamoxifen and raloxifene using published indices. The proportion of days covered was calculated from pharmacy records to assess adherence. Results Among 90 chemoprevention users (confirmed with EMR review from a sample of 371 women), 74% used tamoxifen, 11% used raloxifene, and 13% used an AI. For tamoxifen and raloxifene users, the risk-benefit index indicated 23% of women had insufficient evidence that benefits would outweigh risks. For all agents, adherence decreased from an average proportion of days covered of 75% at 1 year to 67% at 5 years. Automated EMR searches identified breast cancer chemoprevention users with 60% positive predictive value overall and 75% for tamoxifen after post hoc modifications. Conclusion Our study contributes to an emerging picture of breast cancer chemoprevention use in real-world settings, where evidence of net benefit is not uniform and nonadherence is common. Among breast cancer chemoprevention agents, our automated selection best performed for tamoxifen use. We also identified off-label use of AIs for chemoprevention, suggesting that expansion of risk-benefit indices to include AIs is warranted.
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Garcia, Erika, Robert Urman, Kiros Berhane, Rob McConnell, and Frank Gilliland. "Effects of policy-driven hypothetical air pollutant interventions on childhood asthma incidence in southern California." Proceedings of the National Academy of Sciences 116, no. 32 (July 22, 2019): 15883–88. http://dx.doi.org/10.1073/pnas.1815678116.
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Childhood asthma is a major public health concern and has significant adverse impacts on the lives of the children and their families, and on society. There is an emerging link between air pollution, which is ubiquitous in our environment, particularly in urban centers, and incident childhood asthma. Here, using data from 3 successive cohorts recruited from the same 9 communities in southern California over a span of 20 y (1993 to 2014), we estimated asthma incidence using G-computation under hypothetical air pollution exposure scenarios targeting nitrogen dioxide (NO2) and particulate matter <2.5 μm (PM2.5) in separate interventions. We reported comparisons of asthma incidence under each hypothetical air pollution intervention with incidence under the observed natural course of exposure; results that may be more tangible for policymakers compared with risk ratios. Model results indicated that childhood asthma incidence rates would have been statistically significantly higher had the observed reduction in ambient NO2 in southern California not occurred in the 1990s and early 2000s, and asthma incidence rates would have been significantly lower had NO2 been lower than what it was observed to be. For example, compliance with a hypothetical standard of 20 ppb NO2 was estimated to result in 20% lower childhood asthma incidence (95% CI, −27% to −11%) compared with the exposure that actually occurred. The findings for hypothetical PM2.5 interventions, although statistically significant, were smaller in magnitude compared with results for the hypothetical NO2 interventions. Our results suggest a large potential public health benefit of air pollutant reduction in reduced incidence of childhood asthma.
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Scheier, Lawrence M., Michael D. Newcomb, and Rodney Skager. "Risk, Protection, and Vulnerability to Adolescent Drug Use: Latent-Variable Models of Three Age Groups." Journal of Drug Education 24, no. 1 (March 1994): 49–82. http://dx.doi.org/10.2190/2mjd-y7uk-anym-vk3a.
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Much research has focused on the relationships between risk factors and adolescent drug use (DU). Less is known regarding the role of protective factors and how they may inoculate youth from initiating or escalating their DU. Using latent-variable modeling and a risk factor method, we examined the cross-sectional role of risk and protective factors in predicting teenage DU for three age groups, separately by gender. Data are from a biannual statewide survey of California students. A Vulnerability latent construct was reflected in three unit-weighted indexes: risk for initiation to DU, risk for problem DU, and protection from DU. A Polydrug Use construct was reflected in eight measures of alcohol and drug use. Structural equation models revealed that for all age/gender groups, Vulnerability was strongly related to Polydrug Use as well as having specific effects on the DU measures. Effects between Vulnerability and DU were more numerous for seventh and eleventh grade than ninth grade students. Ninth grade females had the fewest effects overall. Number of specific effects between protection and DU remained stable with increasing age. Results underscore two important foci for prevention: 1) the importance of considering age-related developmental phenomena in the overall context of DU prevention; and 2) that programs continue to emphasize risk reduction, while simultaneously developing and reinforcing protective agents.
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Clavijo, Stephanie, Matthew Herrmann, and Katya Corado. "997. The Purview Paradox: PrEP Utilization at a Major Southern California County Teaching Hospital and Affiliated Clinics." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S527—S528. http://dx.doi.org/10.1093/ofid/ofaa439.1183.
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Abstract Background According to the Centers for Disease Control (CDC), PrEP coverage in the United States was approximately 18% in 2018 and 21.9% in California. We predict that PrEP prescription is lower at Harbor-UCLA Medical Center (HUMC) and affiliated clinics within Los Angeles County Department of Health Services. Methods A retrospective chart review of HIV-negative patients with ICD-10 coded diagnoses of sexually transmitted infections (STIs) or high-risk sexual behavior was performed across various medical specialties at HUMC and affiliated clinics in 2018. Documentation of sexual behavior risk reduction counseling, PrEP discussion and prescription was reviewed from electronic medical records for each encounter. Descriptive statistics and analysis were completed in STATA Version 16.1, StataCorp LLC. Results The sample included 250 individual patients, all with indications for PrEP. Of those, 47.2% identified as Latinx and 27.2% Black. Table 1 shows 74% of patients identified as heterosexual whereas 9.2% identified as gay, and 4.4% bisexual. Of the 250 individual patients, 87 (34.8%) returned for a 2nd visit, 35 (14.0%) for a third, and 9 (3.6%) for a 4th visit, for a total of 381 encounters. Of the total encounters, 49.3% had sexual behavior risk reduction counseling, 7.3% had discussions about PrEP with their provider, and only 2.1% were newly prescribed PrEP (Table 2). Of the 2.1% new PrEP prescriptions, 1.8% were prescribed by family medicine providers with no new prescriptions by OB/GYN or acute care providers. Only 25% of new PrEP prescriptions were female patients. A positive test for an STI occurred in 45.1% of total encounters while high risk sexual behavior was identified in 54.9% of encounters (Table 3). Table 1: First Encounter Demographics (N=250 Individual Patients) Table 2: Primary Outcomes by Specialty (N=381 Total Encounters) Table 3: Sexually Transmitted Infections Frequency (N=381 Total Encounters) Conclusion Our findings demonstrate that the percent of individuals newly prescribed PrEP (2.1%) at HUMC and affiliated clinics is less than that reported nationally and in California. This suggests that municipal health systems fall short in PrEP usage, notably for structurally vulnerable populations such as racial minorities as well as heterosexual females. Ending racial/ethnic disparities in HIV and in PrEP coverage not only requires educating specialty providers on PrEP, but also addressing structural racism and identifying structural barriers to care in vulnerable communities. Disclosures All Authors: No reported disclosures
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Lee, Jinhyung, and Sung J. Choi. "Hospital Productivity After Data Breaches: Difference-in-Differences Analysis." Journal of Medical Internet Research 23, no. 7 (July 6, 2021): e26157. http://dx.doi.org/10.2196/26157.
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Background Data breaches are an inevitable risk to hospitals operating with information technology. The financial costs associated with data breaches are also growing. The costs associated with a data breach may divert resources away from patient care, thus negatively affecting hospital productivity. Objective After a data breach, the resulting regulatory enforcement and remediation are a shock to a hospital’s patient care delivery. Exploiting this shock, this study aimed to investigate the association between hospital data breaches and productivity by using a generalized difference-in-differences model with multiple prebreach and postbreach periods. Methods The study analyzed the hospital financial data of the California Office of Statewide Health Planning and Development from 2012 to 2016. The study sample was an unbalanced panel of hospitals with 2610 unique hospital-year observations, including general acute care hospitals. California hospital data were merged with breach data published by the US Department of Health and Human Services. The dependent variable was hospital productivity measured as value added. The difference-in-differences model was estimated using fixed effects regression. Results Hospital productivity did not significantly differ from the baseline for 3 years after a breach. Data breaches were not significantly associated with a reduction in hospital productivity. Before a breach, the productivity of hospitals that experienced a data breach maintained a parallel trend with control hospitals. Conclusions Hospital productivity was resilient against the shocks from a data breach. Nonetheless, data breaches continue to threaten hospitals; therefore, health care workers should be trained in cybersecurity to mitigate disruptions.
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Velasquez, Susan, Andrea Bauchowitz, David Pyo, and Megan Pollock. "Implementation of a specialized program to treat violence in a forensic population." CNS Spectrums 25, no. 5 (March 11, 2020): 571–76. http://dx.doi.org/10.1017/s1092852919001883.
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A shift within state psychiatric hospitals toward serving a predominantly forensic population has resulted in increased violent incidents within those settings. Thus, addressing criminogenic needs in addition to mental illness is an important paradigm shift. Relying on seclusion or restraint as the primary mechanisms to address violence interferes with the provision of effective care to patients struggling with aggressive behaviors. Implementing new treatment programs aimed at reducing violence in forensic inpatient settings is warranted. This article focuses on the step-by-step process of developing such a specialized treatment program within the California Department of State Hospitals. Leadership within this hospital system collaborated with labor unions and other stakeholders to obtain funding to create a novel treatment environment. This treatment program includes a ward design aimed to improve safety and delivers treatment based on the Risk Needs Responsivity Model. Treatment is guided by violence risk assessment and primarily focused on addressing criminogenic needs. The selection of treatments with a focus on violence reduction is discussed.
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Wang, Liang, and Ke-Sheng Wang. "Age Differences in the Association of Severe Psychological Distress and Behavioral Factors with Heart Disease." Psychiatry Journal 2013 (2013): 1–9. http://dx.doi.org/10.1155/2013/979623.
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Few studies have examined the risk factors of serious psychological distress (SPD) and behavioral factors for heart disease separately stratified as young (18–44 years), middle aged (45–64 years), and elderly (65 years or older). A total of 3,540 adults with heart disease and 37,703 controls were selected from the 2005 California Health Interview Survey. Data were weighted to be representative and adjusted for potential undercoverage and nonresponse biases. Multiple logistic regression models were used to estimate the associations of the factors with heart disease at different ages. The prevalence of SPD was 8% in cases and 4% in controls, respectively. For young adults, SPD and higher federal poverty level (FPL) were associated with an increased risk of heart disease while for middle-aged adults, SPD, past smoking, lack of physical activity, obesity, male, and unemployment were associated with an increased risk of heart disease. In addition, SPD, past smoking, lack of physical activity, obesity, male, unemployment, White, and lower FPL were associated with an increased risk of heart disease in elderly. Our findings indicate that risk factors for heart disease vary across all ages. Intervention strategies that target risk reduction of heart disease may be tailored accordingly.
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Filipe, João A. N., Richard C. Cobb, Maëlle Salmon, and Christopher A. Gilligan. "Management Strategies for Conservation of Tanoak in California Forests Threatened by Sudden Oak Death: A Disease-Community Feedback Modelling Approach." Forests 10, no. 12 (December 3, 2019): 1103. http://dx.doi.org/10.3390/f10121103.
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We use a new modelling approach to predict the cumulative impact of Phytophthora ramorum on the dynamic distribution of tanoak (Notholithocarpus densiflorus) and other tree species in coastal-Californian forest-communities. We explore the effectiveness of disease-management strategies for the conservation of tanoak at stand level. Forest resources are increasingly threatened by emerging pathogens such as P. ramorum, a generalist that kills hosts and has altered ecosystems in the USA and Europe. In coastal California, P. ramorum has the greatest impact on tanoak through leaf sporulation and lethal bole infections, but also sporulates on the common overstory-tree bay laurel (Umbellularia californica) without significant health impact. Such epidemiological differences impede host-species coexistence and challenge pathogen management. For most disease-impacted natural systems, however, empirical evidence is still insufficient to identify effective and affordable pathogen-control measures for retaining at-risk host populations. Yet, landscape-scale tree mortality requires swift actions to mitigate ecological impacts and loss of biodiversity. We apply a mathematical model of the feedback between disease and forest-community dynamics to assess the impacts of P. ramorum invasion on tanoak under stand-scale disease-management strategies by landowners aiming to retain tanoak and slow disease progression: (1) removal of inoculum through reduction of bay laurel abundance; (2) prevention of tanoak infection through chemical protection (acting epidemiologically like a vaccine); and (3) a combination strategy. The model results indicate that: (1) both bay laurel removal and tanoak protection are required to help maintain tanoak populations; (2) treatment effectiveness depends on forest composition and on threshold criteria; (3) sustainable tanoak conservation would require long-term follow-up of preventive treatments; (4) arresting basal sprouting upon tree removal may help to reduce inoculum. These findings suggest potential treatments for specific forest conditions that could be tested and implemented to reduce P. ramorum inoculum and disease and to conserve tanoak at stand level.
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Haseeb, Yasmeen A. "A Review of Obstetrical Outcomes and Complications in Pregnant Women after Bariatric Surgery." Sultan Qaboos University Medical Journal [SQUMJ] 19, no. 4 (December 22, 2019): 284. http://dx.doi.org/10.18295/squmj.2019.19.04.003.
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Bariatric surgery (BS) is a novel treatment for weight reduction with longer lasting health benefits. This review aimed to summarise the available evidence regarding the fetomaternal outcomes and the most common challenges and complications in pregnancies following BS. Google Scholar (Google LLC, Mountain View, California, USA) and PubMed<sup>®</sup> (National Library of Medicine, Bethesda, Maryland, USA) databases were searched for articles published until December 2018. A total of 64 articles were included in this review and results showed that BS mitigates the risk of gestational diabetes mellitus, hypertensive disorders in pregnancy and fetal macrosomia. However, it can also have detrimental effects on fetomaternal health. There is paucity of data regarding small for gestational age intrauterine growth restriction, premature rupture of membranes and longterm effects on the children born to women who underwent BS.Keywords: Bariatric Surgery; Nutritional Deficiencies; Obesity; Pregnancy; Surgical Injuries.
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Schepens Niemiec, Stacey L., Jeanine Blanchard, Cheryl Vigen, Jenny Martínez, and Mike Carlson. "FEASIBILITY OF A TELEHEALTH-DELIVERED LIFESTYLE INTERVENTION FOR LATE-MIDLIFE LATINOS LIVING IN RURAL CALIFORNIA." Innovation in Aging 3, Supplement_1 (November 2019): S141—S142. http://dx.doi.org/10.1093/geroni/igz038.511.
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Abstract Late-midlife Latinos (50–64 years old) living in rural regions experience significant health disparities, oftentimes exacerbated by limited access to healthcare services. In a previous pilot study, we observed psychosocial, behavioral, and cardiometabolic health improvements sustained over 12-months in late-midlife Latinos who participated in ¡Vivir Mi Vida! (¡VMV!), a culturally tailored lifestyle intervention led by a Latino community health worker (promotor) and occupational therapist team. For the present study, we assessed the feasibility of telehealth-delivered ¡VMV! modules. Participants (N=10) received an abbreviated three-week version of ¡VMV! consisting of an in-person promotor-led orientation and two one-hour telehealth sessions. Telehealth opinions/experiences were assessed at baseline and follow-up using study-specific questionnaires and by interview. Patient-identified health quality was measured pre-post intervention using the Measure Yourself Medical Outcome Profile (MYMOP2) and a single-item stress index. Participants generally agreed that telehealth session quality was equivalent to in-person sessions, and demonstrated confidence in their ability to communicate freely with the promotor and actively participate in telehealth sessions. We observed significant improvements in nearly all MYMOP2 components and a trend in stress reduction. The intervening promotor reflected that telehealth ¡VMV! extended healthcare to patients impacted by risk factors such as geographic isolation, lack of available services, and hesitancy to access in-person services due to fear of discrimination or deportation. Participants provided highly positive feedback, highlighting the practicality and convenience of the telehealth program. Feasibility of delivering ¡VMV! via telehealth to late-midlife rural-dwelling Latinos and its potential for positive effect was supported.
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Clements-Nolle, Kristen, Robert Guzman, and Susan G. Harris. "Sex trade in a male-to-female transgender population: psychosocial correlates of inconsistent condom use." Sexual Health 5, no. 1 (2008): 49. http://dx.doi.org/10.1071/sh07045.
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Background: Research suggests that because of economic necessity, many male-to-female (MTF) transgender individuals trade sex for money, drugs, housing, and other things they may need. To date, no studies have quantitatively assessed psychosocial correlates of condom use with this population. Methods: We conducted a cross sectional study with 190 MTF transgender individuals involved in sex trade in San Francisco, California. Multivariate logistic regression was used to determine factors independently associated with inconsistent condom use during receptive anal sex with exchange partners. Results: About one fifth of our participants reported inconsistent condom use during receptive anal sex in the past 6 months. In the multivariate model, low self-esteem [adjusted odds ratio (AOR) = 3.09; 95% confidence interval (CI) (1.28, 7.47)], a history of forced sex or rape [AOR = 2.91; 95% CI (1.06, 8.01)], and use of crack-cocaine [AOR = 2.59; 95% CI (1.09, 6.13)] were independently associated with inconsistent condom use. Conclusions: Our findings highlight an urgent need for multilevel risk reduction interventions for MTF transgender individuals involved in sex trade. Such interventions will be most effective if they address the psychosocial context of sexual risk taking by focusing on issues such as low self-esteem, sexual violence, and illicit drug use.
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Conly, JM, and BL Johnston. "Physical Plant Design and Engineering Controls to Reduce Hospital-Acquired Infections." Canadian Journal of Infectious Diseases and Medical Microbiology 17, no. 3 (2006): 151–53. http://dx.doi.org/10.1155/2006/390985.
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The importance of the environment as a reservoir for microorganisms implicated in disease transmission in the hospital setting has been increasingly recognized, especially with respect to dialysis units, ventilation in specialized areas, and the proper use of disinfectants (1). Inherent within the environmental setting is the importance of physical plant design. Several studies have underscored the importance of optimizing design standards to maximize patient and health care worker (HCW) safety, including the prevention of hospital-acquired infections in patients (2-6). Ulrich et al (7) recently completed an evidence-based review, entitled'The role of the physical environment in the hospital of the 21st century: A once-in-a-lifetime opportunity', for the Center for Health Design in California (USA), which was funded by the Robert Wood Johnson Foundation. Ulrich and colleagues identified over 600 studies that examined the hospital environment and its effects on staff effectiveness, patient safety, patient and family stress, quality and costs. They suggested that one of the important elements in improving patient safety is the reduction of the risk of hospital-acquired infections through improved facility design.
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Osibogun, Olatokunbo, Oluseye Ogunmoroti, Martin Tibuakuu, Eve-Marie Benson, and Erin D. Michos. "Sex differences in the association between ideal cardiovascular health and biomarkers of cardiovascular disease among adults in the United States: a cross-sectional analysis from the multiethnic study of atherosclerosis." BMJ Open 9, no. 11 (November 2019): e031414. http://dx.doi.org/10.1136/bmjopen-2019-031414.
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ObjectivesThis study investigated the sex differences in the associations between ideal cardiovascular health (CVH), measured by the American Heart Association’s Life’s Simple 7 metrics, and cardiovascular disease (CVD)-related biomarkers among an ethnically diverse cohort of women and men free of clinical CVD at baseline.SettingWe analysed data from the Multi-Ethnic Study of Atherosclerosis conducted in six centres across the USA (Baltimore, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles, California; New York, New York; and St Paul, Minnesota).ParticipantsThis is a cross-sectional study of 5379 women and men, aged 45–84 years old. Mean age (SD) was 62 (10), 52% were women, 38% White, 11% Chinese American, 28% Black and 23% Hispanic.Primary measuresThe seven metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure and blood glucose) were each scored as 0 points (poor), 1 point (intermediate) or 2 points (ideal). The total CVH score ranged from 0 to 14. The CVD-related biomarkers studied were high-sensitivity C-reactive protein, D-dimer, fibrinogen, homocysteine, high-sensitivity cardiac troponin T, N-terminal pro B-type natriuretic peptide (NT-proBNP) and interleukin 6. We examined the association between the CVH score and each biomarker using multivariable linear regression, adjusting for age, race/ethnicity, education, income and health insurance status.ResultsHigher CVH scores were associated with lower concentrations of all biomarkers, except for NT-proBNP where we found a direct association. There were statistically significant interactions by sex for all biomarkers (p<0.001), but results were qualitatively similar between women and men.ConclusionA more favourable CVH score was associated with lower levels of multiple CVD-related biomarkers for women and men, except for NT-proBNP. These data suggest that promotion of ideal CVH would have similarly favourable impact on the reduction of biomarkers of CVD risk for both women and men.
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SANTILLANA FARAKOS, SOFIA M., RÉGIS POUILLOT, GORDON R. DAVIDSON, RHOMA JOHNSON, INSOOK SON, NATHAN ANDERSON, and JANE M. VAN DOREN. "A Quantitative Risk Assessment of Human Salmonellosis from Consumption of Walnuts in the United States." Journal of Food Protection 82, no. 1 (December 26, 2018): 45–57. http://dx.doi.org/10.4315/0362-028x.jfp-18-233.
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ABSTRACT We assessed the risk of human salmonellosis from consumption of shelled walnuts in the United States and the impact of 0- to 5-log reduction treatments for Salmonella during processing. We established a baseline model with Salmonella contamination data from 2010 to 2013 surveys of walnuts from California operations to estimate baseline prevalence and levels of Salmonella during preshelling storage and typical walnut processing stages, considered U.S. consumption data, and applied an adapted dose-response model from the Food and Agriculture Organization and the World Health Organization to evaluate risk of illness per serving and per year. Our baseline model predicted 1 case of salmonellosis per 100 million servings (95% confidence interval [CI], 1 case per 3 million to 1 case per 2 billion servings) of walnuts untreated during processing and uncooked by consumers, resulting in an estimated 6 cases of salmonellosis per year (95% CI, <1 to 278 cases) in the United States. A minimum 3-log reduction treatment for Salmonella during processing of walnuts eaten alone or as an uncooked ingredient resulted in a mean risk of <1 case per year. We modeled the impact on risk per serving of three atypical situations in which the Salmonella levels were increased by 0.5 to 1.5 log CFU per unit pretreatment during processing at the float tank or during preshelling storage or posttreatment during partitioning into consumer packages. No change in risk was associated with the small increase in levels of Salmonella at the float tank, whereas an increase in risk was estimated for each of the other two atypical events. In a fourth scenario, we estimated the risk per serving associated with consumption of walnuts with Salmonella prevalence and levels from a 2014 to 2015 U.S. retail survey. Risk per serving estimates were two orders of magnitude larger than those of the baseline model without treatment. Further research is needed to determine whether this finding reflects variability in Salmonella contamination across the supply or a rare event affecting a portion of the supply.
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Lin, Jody L., Joseph Rigdon, Keith Van Haren, MyMy Buu, Olga Saynina, Jay Bhattacharya, Douglas K. Owens, and Lee M. Sanders. "Gastrostomy Tubes Placed in Children With Neurologic Impairment: Associated Morbidity and Mortality." Journal of Child Neurology 36, no. 9 (March 22, 2021): 727–34. http://dx.doi.org/10.1177/08830738211000179.
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Background: Gastrostomy tube (G-tube) placement for children with neurologic impairment with dysphagia has been suggested for pneumonia prevention. However, prior studies demonstrated an association between G-tube placement and increased risk of pneumonia. We evaluate the association between timing of G-tube placement and death or severe pneumonia in children with neurologic impairment. Methods: We included all children enrolled in California Children’s Services between July 1, 2009, and June 30, 2014, with neurologic impairment and 1 pneumonia hospitalization. Prior to analysis, children with new G-tubes and those without were 1:2 propensity score matched on sociodemographics, medical complexity, and severity of index hospitalization. We used a time-varying Cox proportional hazard model for subsequent death or composite outcome of death or severe pneumonia to compare those with new G-tubes vs those without, adjusting for covariates described above. Results: A total of 2490 children met eligibility criteria, of whom 219 (9%) died and 789 (32%) had severe pneumonia. Compared to children without G-tubes, children with new G-tubes had decreased risk of death (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.39-0.55) but increased risk of the composite outcome (HR 1.21, CI 1.14-1.27). Sensitivity analyses using varied time criteria for definitions of G-tube and outcome found that more recent G-tube placement had greater associated risk reduction for death but increased risk of severe pneumonia. Conclusion: Recent G-tube placement is associated with reduced risk of death but increased risk of severe pneumonia. Decisions to place G-tubes for pulmonary indications in children with neurologic impairment should weigh the impact of severe pneumonia on quality of life.
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Ramal, Edelweiss, Andrea Champlin, and Khaled Bahjri. "Impact of a Plant-Based Diet and Support on Mitigating Type 2 Diabetes Mellitus in Latinos Living in Medically Underserved Areas." American Journal of Health Promotion 32, no. 3 (May 14, 2017): 753–62. http://dx.doi.org/10.1177/0890117117706793.
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Purpose: To determine the impact that a high-fiber, low-fat diet, derived from mostly plant-based sources, when coupled with support has upon self-management of type 2 diabetes mellitus in Latinos from medically underserved areas (MUAs). Design: Experimental randomized controlled community pilot study. Setting: Three community clinics in MUAs located within San Bernardino County, California. Participants: Thirty-two randomly assigned Latinos with A1C greater than 6.4: 15 control and 17 experimental. Intervention: Participants completed a 5-week education program. Researchers provided follow-up support for 17 randomly assigned experimental group participants through focus groups held at participating clinics—1, 3, and 6 months posteducation. Measures: Changes in fat and fiber consumption were measured using a modified Dietary Screener for Mexican Americans. Self-management was measured through the Self-Efficacy for Exercise Scale and Diabetes Quality of Life Measure. Analysis: Baseline characteristics for both groups were analyzed using independent t tests and χ2 tests. A 2-way repeated-measures analysis of variance was used to analyze biometric data between baseline and 6 months for both groups. Results: Mean A1C levels decreased from baseline to 6 months for both groups: control, μ1 = 9.57, μ2 = 9.49; experimental, μ1 = 8.53, μ2 = 7.31. Conclusion: The experimental group demonstrated a statistically significant reduction in mean A1C levels ( P = .002) when compared to the control group.
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Vinogradoff, Breanne, Giselle Pereira Pignotti, Marcelle Dougan, and John Gieng. "Association of Food Pharmacy Participation with Type II Diabetes Mellitus Risk Factors." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 292. http://dx.doi.org/10.1093/cdn/nzaa043_143.
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Abstract Objectives Food insecurity poses a public health threat in a number of concerning ways, including increased risk of Type 2 Diabetes Mellitus (T2DM). A number of safety-net resource sites in the US are working to address this complex relationship through the disbursal of medically tailored food to clients with T2DM, sometimes referred to as a “food pharmacy”. Our study aimed to determine if participation by food insecure individuals in a food pharmacy affected clinical markers of T2DM status or risk, namely glycated hemoglobin (HbA1c), fasting blood glucose (FBG), or body mass index (BMI). Methods We conducted a retrospective study of data from a food pharmacy run by a safety-net healthcare clinic in California. Data from January 2016 through May 2019 were analyzed. Patients with T2DM were referred to the food pharmacy by clinic physicians. After referral, patients could pick up boxes of diabetes appropriate food (contents were determined by program staff and varied based on food availability) once a week. Results from participant's successive biomedical tests were recorded by clinic staff. Participants with a baseline measurement of HbA1c, FBG, or BMI within ±11 days of food pharmacy referral and at least one subsequent measurement of the same variable qualified for inclusion (n = 161). Participation rate was defined as the proportion of food pickup opportunities attended by each individual. Spearman correlation analysis, t-tests, and analyses of variance were conducted to determine the association between program participation on HbA1c, FBG, and BMI. Results At 24 months, increased food pharmacy participation correlated with a reduction in BMI (r = –0.39, P = 0.03, n = 29). As compared with those who participated below the median rate, the “high participation” group had a lower mean BMI at 24 months (34.6 ± 9.1 vs 29.1 ± 4.9 kg/m2, P = 0.05). Mean HbA1c was lower at 18 months as compared to baseline (9.1 ± 2.3 vs 8.2 ± 1.8%, P = 0.04). However, HbA1c and FBG were not correlated with participation rate. Conclusions This study found higher food pharmacy participation rates are associated with reductions in BMI, but not HbA1c or FBG. Food pharmacies may need to reevaluate their treatment model if they are to effectively target T2DM in food insecure individuals. Funding Sources None.
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Bayen, Eleonore, Shirley Nickels, Glen Xiong, Julien Jacquemot, Raghav Subramaniam, Pulkit Agrawal, Raheema Hemraj, Alexandre Bayen, Bruce L. Miller, and George Netscher. "Reduction of Time on the Ground Related to Real-Time Video Detection of Falls in Memory Care Facilities: Observational Study." Journal of Medical Internet Research 23, no. 6 (June 17, 2021): e17551. http://dx.doi.org/10.2196/17551.
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Background Lying on the floor for a long period of time has been described as a critical determinant of prognosis following a fall. In addition to fall-related injuries due to the trauma itself, prolonged immobilization on the floor results in a wide range of comorbidities and may double the risk of death in elderly. Thus, reducing the length of Time On the Ground (TOG) in fallers seems crucial in vulnerable individuals with cognitive disorders who cannot get up independently. Objective This study aimed to examine the effect of a new technology called SafelyYou Guardian (SYG) on early post-fall care including reduction of Time Until staff Assistance (TUA) and TOG. Methods SYG uses continuous video monitoring, artificial intelligence, secure networks, and customized computer applications to detect and notify caregivers about falls in real time while providing immediate access to video footage of falls. The present observational study was conducted in 6 California memory care facilities where SYG was installed in bedrooms of consenting residents and families. Fall events were video recorded over 10 months. During the baseline installation period (November 2017 to December 2017), SYG video captures of falls were not provided on a regular basis to facility staff review. During a second period (January 2018 to April 2018), video captures were delivered to facility staff on a regular weekly basis. During the third period (May 2018 to August 2018), real-time notification (RTN) of any fall was provided to facility staff. Two digital markers (TUA, TOG) were automatically measured and compared between the baseline period (first 2 months) and the RTN period (last 4 months). The total number of falls including those happening outside of the bedroom (such as common areas and bathrooms) was separately reported by facility staff. Results A total of 436 falls were recorded in 66 participants suffering from Alzheimer disease or related dementias (mean age 87 years; minimum 65, maximum 104 years). Over 80% of the falls happened in bedrooms, with two-thirds occurring overnight (8 PM to 8 AM). While only 8.1% (22/272) of falls were scored as moderate or severe, fallers were not able to stand up alone in 97.6% (247/253) of the cases. Reductions of 28.3 (CI 19.6-37.1) minutes in TUA and 29.6 (CI 20.3-38.9) minutes in TOG were observed between the baseline and RTN periods. The proportion of fallers with TOG >1 hour fell from 31% (8/26; baseline) to zero events (RTN period). During the RTN period, 76.6% (108/141) of fallers received human staff assistance in less than 10 minutes, and 55.3% (78/141) of them spent less than 10 minutes on the ground. Conclusions SYG technology is capable of reducing TOG and TUA while efficiently covering the area (bedroom) and time zone (nighttime) that are at highest risk. After 6 months of SYG monitoring, TOG was reduced by a factor of 3. The drastic reduction of TOG is likely to decrease secondary comorbid complications, improve post-fall prognosis, and reduce health care costs.
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Barber, Claire E. H., Deborah A. Marshall, Nanette Alvarez, G. B. John Mancini, Diane Lacaille, Stephanie Keeling, J. Antonio Aviña-Zubieta, et al. "Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel Using a Novel Online Process." Journal of Rheumatology 42, no. 9 (July 15, 2015): 1548–55. http://dx.doi.org/10.3899/jrheum.141603.
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Objective.Patients with rheumatoid arthritis (RA) have a high risk of premature cardiovascular disease (CVD). We developed CVD quality indicators (QI) for screening and use in rheumatology clinics.Methods.A systematic review was conducted of the literature on CVD risk reduction in RA and the general population. Based on the best practices identified from this review, a draft set of 12 candidate QI were presented to a Canadian panel of rheumatologists and cardiologists (n = 6) from 3 academic centers to achieve consensus on the QI specifications. The resulting 11 QI were then evaluated by an online modified-Delphi panel of multidisciplinary health professionals and patients (n = 43) to determine their relevance, validity, and feasibility in 3 rounds of online voting and threaded discussion using a modified RAND/University of California, Los Angeles Appropriateness Methodology.Results.Response rates for the online panel were 86%. All 11 QI were rated as highly relevant, valid, and feasible (median rating ≥ 7 on a 1–9 scale), with no significant disagreement. The final QI set addresses the following themes: communication to primary care about increased CV risk in RA; CV risk assessment; defining smoking status and providing cessation counseling; screening and addressing hypertension, dyslipidemia, and diabetes; exercise recommendations; body mass index screening and lifestyle counseling; minimizing corticosteroid use; and communicating to patients at high risk of CVD about the risks/benefits of nonsteroidal antiinflammatory drugs.Conclusion.Eleven QI for CVD care in patients with RA have been developed and are rated as highly relevant, valid, and feasible by an international multidisciplinary panel.
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Quader, Zerleen S., Lixia Zhao, Lisa J. Harnack, Christopher D. Gardner, James M. Shikany, Lyn M. Steffen, Cathleen Gillespie, Alanna Moshfegh, and Mary E. Cogswell. "Self-Reported Measures of Discretionary Salt Use Accurately Estimated Sodium Intake Overall but not in Certain Subgroups of US Adults from 3 Geographic Regions in the Salt Sources Study." Journal of Nutrition 149, no. 9 (June 10, 2019): 1623–32. http://dx.doi.org/10.1093/jn/nxz110.
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ABSTRACT Background Excess sodium intake can increase blood pressure, and high blood pressure is a major risk factor for cardiovascular disease. Accurate population sodium intake estimates are essential for monitoring progress toward reduction, but data are limited on the amount of sodium consumed from discretionary salt. Objectives The aim of this study was to compare measured sodium intake from salt added at the table with that estimated according to the Healthy People 2020 (HP 2020) methodology. Methods Data were analyzed from the 2014 Salt Sources Study, a cross-sectional convenience sample of 450 white, black, Asian, and Hispanic adults living in Alabama, Minnesota, and California. Sodium intake from foods and beverages was assessed for each participant through the use of 24-h dietary recalls. Estimated sodium intake from salt used at the table was assessed from self-reported frequency and estimated amounts from a previous study (HP 2020 methodology). Measured intake was assessed through the use of duplicate salt samples collected on recall days. Results Among all study participants, estimated and measured mean sodium intakes from salt added at the table were similar, with a nonsignificant difference of 8.9 mg/d (95% CI: −36.6, 54.4 mg/d). Among participants who were non-Hispanic Asian, Hispanic, had a bachelor's degree or higher education, lived in California or Minnesota, did not report hypertension, or had normal BMI, estimated mean sodium intake was 77–153 mg/d greater than measured intake (P < 0.05). The estimated mean sodium intake was 186–300 mg/d lower than measured intake among participants who were non-Hispanic black, had a high school degree or less, or reported hypertension (P < 0.05). Conclusions The HP 2020 methodology for estimating sodium consumed from salt added at the table may be appropriate for the general US adult population; however, it underestimates intake in certain population subgroups, particularly non-Hispanic black, those with a high school degree or less, or those with self-reported hypertension. This study was registered at clinicaltrials.gov as NCT02474693.
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Odisho, Anobel Y., John L. Gore, and Ruth Douglas Etzioni. "Beyond classical risk adjustment: Socioeconomic status and hospital performance in urologic oncology." Journal of Clinical Oncology 35, no. 6_suppl (February 20, 2017): 526. http://dx.doi.org/10.1200/jco.2017.35.6_suppl.526.
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526 Background: Safety-net hospitals care for more patients of lower socioeconomic status (SES) than non-safety-net hospitals and may be disproportionately punished under readmission risk adjustment models that do not incorporate (SES). We developed a readmission risk adjustment framework incorporating SES to assess impact of SES on safety-net hospital rankings for patients undergoing major surgery for urologic malignancies. Methods: Quasi-experimental design using California Office of Statewide Health Planning and Development data from 2007-2011. Subjects included all patients undergoing radical cystectomy for bladder cancer (n = 3,771), partial nephrectomy (n = 5,556), and radical nephrectomy (n = 13,136) for kidney cancer. Unadjusted hospital rankings and predicted rankings under a base model, which simulated the Medicare Hospital Readmissions Reduction Program model, were compared with predicted rankings under models incorporating socioeconomic status. Socioeconomic status was derived from a multifactorial neighborhood score at the ZIP code level calculated from US Census data. The main outcome measures were hospital rankings based on 30-day all-cause readmission rate and differences between model predicted rankings. Results: For all procedures, the addition of socioeconomic status, geographic, and hospital factors changed the overall hospital rankings significantly compared with the base model (p < 0.01), with the exception of socioeconomic status in radical cystectomy (p = 0.07) and socioeconomic status and rural factors in partial nephrectomy (p = 0.12). For radical nephrectomy and partial nephrectomy, the addition of socioeconomic status and hospital factors significantly improved the mean ranking of safety-net hospitals and improved the ratio of observed relative to expected rankings (p < 0.01). For radical cystectomy there was no significant change in rankings with the addition of socioeconomic status, rural status, or hospital factors. Conclusions: Adding socioeconomic status to existing Medicare readmission risk adjustment models leads to significant changes in hospital rankings, with a differential impact on safety-net hospitals.
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Boadway, BT, J. MacPhail, and C. Jacobson. "Ontario Medical Association Position Paper on Health Effects of Ground-Level Ozone, Acid Aerosols and Particulate Matter." Canadian Respiratory Journal 5, no. 5 (1998): 367–84. http://dx.doi.org/10.1155/1998/285495.
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This review of the evidence of the health effects of air pollutants focuses on research conducted in Ontario. Seven key Ontario studies are cited. These findings are highly significant for people living in the Great Lakes basin (and particularly the Windsor-Quebec corridor), where high levels of certain air pollutants (eg, ground-level ozone and ultra-fine particles) occur more frequently than in other parts of Canada. The issue is a serious one, requiring an integrated and comprehensive approach by many stakeholders, including the active involvement of organized medicine. It is important that the health effects of these air pollutants are understood. Governments must act to reduce emission levels through statue and regulation bolstered by noncompliance penalties.The findings of research have included the following: in a Toronto study, a 2% to 4% excess of respiratory deaths were attributable to pollutant levels; children living in rural Ontario communities with the highest levels of airborne acids were significantly more likely to report at least one episode of bronchitis, as well as to show decreases in lung function; and have been linked to increases in pollutants, emergency room visits and hospitalizations in Ontario.Every Ontarian is affected by air pollutants, although he or she may be unaware of the asymptomatic effects such as lung and bronchial inflammation. This health problem is preventable; while physicians know of the adverse health impacts of air pollution and they are concerned, individually they now focus on the treatment of symptoms. The major recommendations of the report are as follows:* Enactment of more stringent sulphur and nitrogen oxide emission limits, including a provincewide sulphur dioxide reduction of 75% from current cap levels, and the maximum allowable nitrogen oxides emission limits of 6000 tonnes annually from Ontario Hydro.* New transportation sector emission limits that should include California-level standards for light and heavy duty vehicles, reductions from off-road engines, an expanded vehicle inspection and maintenance program, and tougher standards for sulphur-in-fuel content.* Petitioning the United States Environmental Protection Agency administrator under Section 115 of the United States Clear Air Act to require reductions in the American emission of sulphur dioxide and nitrogen oxides, which damage the health of Canadian residents and their environment.* Physician advice to patients about the risks of smog exposure, physician support for more health effects research on air pollution, and physician promotion of the development of air pollution-related health education materials.The recommendations discussed in this paper will, if acted upon, lead to a significant reduction in the overall burden of illness from air pollutants, especially in children and the elderly. These recommendations have been selected from a review of recommendations made by various authorities, and are those that the OMA feels a particular responsibility to support.
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Bailie, Jason, Alia Westphal, Angela Basham, Juan Lopez, Melissa Caswell, and Ida Babakhanyan. "A-118 Efficacy of Computerized Cognitive Rehabilitation Programs in Treating Warfighters with a History of Mild Traumatic Brain Injury." Archives of Clinical Neuropsychology 36, no. 6 (August 30, 2021): 1168. http://dx.doi.org/10.1093/arclin/acab062.136.
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Abstract Background Computerized cognitive rehabilitation programs (CCRP) have gained popularity in recent years. The objective of this study was to investigate the efficacy of CCRP in military personnel with a prior mTBI. Methods 21 active-duty service members with a history of mTBI were enrolled in the randomized clinical trial. Participants completed one of two CCRPs (Lumosity or the University of California Riverside Brain Game Center). Primary dependent variable was the Key Behavioral Change Inventory (KBCI) with eight scales: Inattention, Impulsivity, Unawareness of problems, Apathy, Interpersonal difficulty, Communication problems, Somatic difficulties, and Emotional adjustment. Other variables included age, education, number of mTBIs, years since last mTBI, total lifetime years of repetitive head injury (RHI). Results There was a significant reduction in Somatic Difficulties post-treatment (p = 0.029) with trends towards reductions on Inattention (p = 0.077) and Apathy (p = 0.064). 19/21 (90%) of participants had improvement in at least one KBCI scale (i.e., at least one point change), 14/21 (66%) had 3 or more scales improved, and 7/21 (67%) had 5 or more scales improved. Total number of scales improved was correlated with years since TBI (rho = 0.38, p = 0.044) and years of RHI (rho = 0.459, p = 0.018). Conclusions CCRP had modest efficacy in improving persistent symptoms following a mTBI. Fewer years since mTBI and fewer number of years of RHI were associated with better treatment response.
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Shortreed, Susan M., and Gregory E. Simon. "Using predictive analytics to improve pragmatic trial design." Clinical Trials 17, no. 4 (March 10, 2020): 394–401. http://dx.doi.org/10.1177/1740774520910367.
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Clinical trials embedded in health systems can randomize large populations using automated data sources to determine trial eligibility and assess outcomes. The suicide prevention outreach trial used real-world data for trial design and randomized 18,868 individuals in four health systems using patient-reported thoughts of death or self-harm (Patient Health Questionnaire item 9). This took 3.5 years. We consider if using predictive analytics, that is, suicide risk estimates based on prediction models, could improve trial “efficiency.” We used data on mental health outpatient visits between 1 January 2009 and 30 September 2017 in seven health systems (HealthPartners; Henry Ford Health System; and Colorado, Hawaii, Northwest, Southern California, and Washington Kaiser Permanente regions). We used a suicide risk prediction model developed in these same systems. We compared five trial designs with different eligibility criteria: a response of a 2 or 3 on Patient Health Questionnaire item 9, a response of a 3, suicide risk score above 90th, 95th, or 99th percentile. We compared the sample that met each criterion, 90-day suicide attempt rate following first eligible visit, and necessary sample sizes to detect a 15%, 25%, and 35% relative reduction in the suicide attempt rate, assuming 90% power, for each eligibility criterion. Our sample included 24,355,599 outpatient visits. Despite wide-spread use of Patient Health Questionnaire, 21,026,985 (86.3%) visits did not have a recorded Patient Health Questionnaire. Of the 2,928,927 individuals in our sample, 109,861 had a recorded Patient Health Questionnaire item 9 response of a 2 or 3 over the study years with a 1.40% 90-day suicide attempt rate and 50,047 had a response of a 3 (suicide attempt rate 1.98%). More patients met criteria requiring a certain risk score or higher: 331,273 had a 90th percentile risk score or higher (suicide attempt rate: 1.36%); 182,316 a 95th percentile or higher (suicide attempt rate 2.16%), and 78,655 a 99th percentile or higher (suicide attempt rate: 3.95%). Eligibility criterion of a Patient Health Questionnaire item 9 response of a 2 or 3 would require randomizing 44,081 individuals (40.2% of eligible population in our sample); eligibility criterion of a 3 would require 31,024 individuals (62.0% of eligible population). Eligibility criterion of a suicide risk score of 90th percentile or higher would require 45,675 individuals (13.8% of eligible population), 95th percentile 28,699 individuals (15.7% of eligible population), and 99th percentile 15,509 (19.7% of eligible population). A suicide risk prediction calculator could improve trial “efficiency”; identifying more individuals at increased suicide risk than relying on patient-report. It is an open scientific question if individuals identified using predictive analytics would respond differently to interventions than those identified by more traditional means.
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Smith, Toby O., Jack R. Dainty, Esther Williamson, and Kathryn R. Martin. "Association between musculoskeletal pain with social isolation and loneliness: analysis of the English Longitudinal Study of Ageing." British Journal of Pain 13, no. 2 (September 20, 2018): 82–90. http://dx.doi.org/10.1177/2049463718802868.
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Introduction: Musculoskeletal pain is a prevalent health challenge for all age groups worldwide, but most notably in older adults. Social isolation is the consequence of a decrease in social network size with a reduction in the number of social contacts. Loneliness is the psychological embodiment of social isolation and represents an individual’s perception of dissatisfaction in the quality or quantity of their social contacts. This study aims to determine whether a relationship exists between musculoskeletal pain and social isolation and loneliness. Methods: A cross-sectional analysis of the English Longitudinal Study of Ageing (ELSA) cohort was undertaken. ELSA is a nationally representative sample of the non-institutionalised population of individuals aged 50 years and over based in England. Data were gathered on social isolation through the ELSA Social Isolation Index, loneliness through the University of California, Los Angeles (UCLA) Loneliness Scale and musculoskeletal pain. Data for covariates included physical activity, depression score, socioeconomic status, access to transport and demographic characteristics. Logistic regression analyses were undertaken to determine the relationship between social isolation and loneliness with pain and the additional covariates. Results: A total of 9299 participants were included in the analysis. This included 4125 (44.4%) males, with a mean age of 65.8 years. There was a significant association where social isolation was lower for those in pain (odd ratio (OR): 0.87; 95% confidence intervals (CI): 0.75 to 0.99), whereas the converse occurred for loneliness where this was higher for those in pain (OR: 1.15; 95% CI: 1.01 to 1.31). Age, occupation, physical activity and depression were all associated with increased social isolation and loneliness. Conclusion: People who experience chronic musculoskeletal pain are at greater risk of being lonely, but at less risk of being socially isolated. Health professionals should consider the wider implications of musculoskeletal pain on individuals, to reduce the risk of negative health implications associated with loneliness from impacting on individual’s health and well-being.
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Doyle, A. E., J. Wozniak, T. E. Wilens, A. Henin, L. J. Seidman, C. Petty, R. Fried, L. M. Gross, S. V. Faraone, and J. Biederman. "Neurocognitive impairment in unaffected siblings of youth with bipolar disorder." Psychological Medicine 39, no. 8 (December 11, 2008): 1253–63. http://dx.doi.org/10.1017/s0033291708004832.
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BackgroundThere is growing evidence for the familiality of pediatric bipolar disorder (BPD) and its association with impairments on measures of processing speed, verbal learning and ‘executive’ functions. The current study investigated whether these neurocognitive impairments index the familial risk underlying the diagnosis.MethodSubjects were 170 youth with BPD (mean age 12.3 years), their 118 non-mood-disordered siblings and 79 non-mood-disordered controls. Groups were compared on a battery of neuropsychological tests from the Wechsler Intelligence Scales, the Stroop Color Word Test, the Wisconsin Card Sorting Test (WCST), the Rey–Osterrieth Complex Figure (ROCF), an auditory working memory Continuous Performance Test (CPT) and the California Verbal Learning Test – Children's Version (CVLT-C). Measures were factor analyzed for data reduction purposes. All analyses controlled for age, sex and attention-deficit/hyperactivity disorder (ADHD).ResultsPrincipal components analyses with a promax rotation yielded three factors reflecting: (1) processing speed/verbal learning, (2) working memory/interference control and (3) abstract problem solving. The CPT working memory measure with interference filtering demands (WM INT) was only administered to subjects aged ⩾12 years and was therefore analyzed separately. BPD youth showed impairments versus controls and unaffected relatives on all three factors and on the WM INT. Unaffected relatives exhibited impairments versus controls on the abstract problem-solving factor and the WM INT. They also showed a statistical trend (p=0.07) towards worse performance on the working memory/interference control factor.ConclusionsNeurocognitive impairments in executive functions may reflect the familial neurobiological risk mechanisms underlying pediatric BPD and may have utility as endophenotypes in molecular genetic studies of the condition.
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Lagana, Michele, Erin Elizabeth Hahn, Joanne E. Schottinger, Susan E. Kutner, and Mark B. Littlewood. "The Kaiser Permanente Breast Cancer Survivorship National Clinical Algorithm: Regional variation in implementation processes/strategies within an integrated health care system." Journal of Clinical Oncology 34, no. 7_suppl (March 1, 2016): 104. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.104.
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104 Background: Kaiser Permanente (KP) is an integrated healthcare system providing comprehensive services to over 10 million members. The KP Interregional Breast Care Leaders, a multidisciplinary clinician group, developed a comprehensive evidence/consensus-based algorithm for breast cancer survivors, the KP Breast Cancer Survivorship National Clinical Algorithm (BCSNCA). The BCSNCA is intended to reduce variation in medical and psychosocial surveillance and improve outcomes by providing guidance to locally implemented survivorship programs, ie, recommendations for surveillance, late effects management, and risk reduction. As a quality improvement project, we evaluated regional/ facility level implementation. Methods: Qualitative data on BCSNCA implementation was collected from key informant interviews with oncology providers for 20 sites in 6 regions: Georgia, Colorado, Hawaii, Southern (KPSC) and Northern California (KPNC), and Mid-Atlantic, and by attending BCSNCA meetings. Implementation activities were recorded, categorized, and compared to BCSNCA. Results: Facilities in 3 regions implemented discrete BCSNCA components: Northwest and Georgia facilities implemented dedicated survivorship clinics; a KPSC facility piloted a nurse navigator standardized psychosocial assessment; KPNC implemented local guidelines, similar to the BCSNCA. One region has not implemented; Georgia implemented all BCSNCA components. There is variation within each region. Implementation drivers include available resources, competing QI priorities/leadership preferences, and adaptability of extant programs. Conclusions: We found variation between and within regions. The BCSNCA content accommodates variation in implementation, guided by a complex set of factors, including resource availability, leadership preferences, and local organizational goals. Even in integrated systems, the need for locally driven guideline adaptation is critical. Next step: assessment of BCSNCA components on patient-level outcomes.
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Lamorey, Suzanne. "Risk Reduction Education." Remedial and Special Education 31, no. 2 (July 31, 2009): 87–96. http://dx.doi.org/10.1177/0741932509338342.
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Jay, Melanie, Stephanie L. Orstad, Soma Wali, Judith Wylie-Rosett, Chi-Hong Tseng, Victoria Sweat, Sandra Wittleder, Suzanne B. Shu, Noah J. Goldstein, and Joseph A. Ladapo. "Goal-directed versus outcome-based financial incentives for weight loss among low-income patients with obesity: rationale and design of the Financial Incentives foR Weight Reduction (FIReWoRk) randomised controlled trial." BMJ Open 9, no. 4 (April 2019): e025278. http://dx.doi.org/10.1136/bmjopen-2018-025278.
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IntroductionObesity is a major public health challenge and exacerbates economic disparities through employment discrimination and increased personal health expenditures. Financial incentives for weight management may intensify individuals’ utilisation of evidence-based behavioural strategies while addressing obesity-related economic disparities in low-income populations. Trials have focused on testing incentives contingent on achieving weight loss outcomes. However, based on social cognitive and self-determination theories, providing incentives for achieving intermediate behavioural goals may be more sustainable than incentivising outcomes if they enhance an individual’s skills and self-efficacy for maintaining long-term weight loss. The objective of this paper is to describe the rationale and design of the Financial Incentives foR Weight Reduction study, a randomised controlled trial to test the comparative effectiveness and cost-effectiveness of two financial incentive strategies for weight loss (goal directed vs outcome based) among low-income adults with obesity, as well as compared with the provision of health behaviour change resources alone.Methods and analysisWe are recruiting 795 adults, aged 18–70 years with a body mass index ≥30 kg/m2, from three primary care clinics serving residents of socioeconomically disadvantaged neighbourhoods in New York City and Los Angeles. All participants receive a 1-year commercial weight loss programme membership, self-monitoring tools (bathroom scale, food journal and Fitbit Alta HR), health education and monthly check-in visits. In addition to these resources, those in the two intervention groups can earn up to $750 over 6 months for: (1) participating in an intensive weight management programme, self-monitoring weight and diet and meeting physical activity guidelines (goal-directed arm); or (2) a ≥1.5% to ≥5% reduction in baseline weight (outcome-based arm). To maximise incentive efficacy, we incorporate concepts from behavioural economics, including immediacy of payments and framing feedback to elicit regret aversion. We will use generalised mixed effect models for repeated measures to examine intervention effects on weight at 6, 9 and 12 months.Ethics and disseminationHuman research protection committees at New York University School of Medicine, University of California Los Angeles (UCLA) David Geffen School of Medicine and Olive-View–UCLA Medical Center granted ethics approval. We will disseminate the results of this research via peer-reviewed publications, conference presentations and meetings with stakeholders.Trial registration numberNCT03157713.
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Morales, Celina, and Pimbucha Rusmevichientong. "Dietary Salt-Related Knowledge, Attitude, Behaviors, and Hypertension in a Rural Northern Thailand Population." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 870. http://dx.doi.org/10.1093/cdn/nzaa053_075.
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Abstract Objectives The objectives of this study were to examine the dietary salt-related knowledge, attitudes, and behaviors associated with the prevalence of hypertension among adults residing in rural Northern Thailand. Methods A cross-sectional study utilizing convenience sampling was administered in San Pa Tong District, Chiang Mai, Thailand. The one-on-one interview was conducted to assess subject's knowledge, attitudes, and behaviors relating to their dietary salt intake. Various food frequencies for foods high in salt were also measured. Each subject's blood pressure was measured twice before and after the interview. A logistic regression model was used in the analysis to determine potential hypertension risk factors. Results A total of 403 adults participated in the study. A majority of participants were female (73.2%), and the average age was 62.5 years old. Half of participants reported a family history of hypertension and 32% of participants were hypertensive. The major results from the logistic regression model indicated positive attitudes towards decreasing salt intake lead to a lower chance of becoming hypertensive (OR = 0.934). However, a family history of high blood pressure (OR = 1.417), a higher knowledge score about foods high in salt (OR = 1.254), daily use of Monosodium Glutamate (MSG) in food preparation (OR = 1.959) and buying outside food to eat at home (OR = 5.692) lead to a higher chance of becoming hypertensive. Conclusions Our findings suggest higher knowledge does not decrease the chance of becoming hypertensive. However, there is a positive association between hypertension and dietary salt-related behaviors among adults living in rural Thai communities. More specifically, salt-reduction interventions should focus on promoting home-cooked meal preparation with lower salt substitutes to MSG. Funding Sources NIMHD Minority Health and Health Disparities Research Training Program (MHRT), California State University, Fullerton (Department of Public Health) and Chiang Mai University (Department of Community Medicine).
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Tobin, L. Thomas, Fred Turner, James F. Goodfellow, and Brian L. Stoner. "California at Risk: Where Do We Go from Here?" Earthquake Spectra 8, no. 1 (February 1992): 17–34. http://dx.doi.org/10.1193/1.1585668.
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In 1986, the state of California embarked on a comprehensive earthquake hazard reduction program described in California at Risk: Reducing Earthquake Hazards 1987-1992. This Program identifies hazard reduction efforts for existing development, emergency response, future development, recovery planning, education, and research. The goal is to reduce the state's earthquake hazards significantly by the year 2000. This paper reviews the development of the Program, the state's progress toward hazard reduction, seismic safety legislation and refinements in the Program's second five years.
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Heckman, Carolyn, Yong Lin, Mary Riley, Yaqun Wang, Trishnee Bhurosy, Anna Mitarotondo, Baichen Xu, and Jerod Stapleton. "Association Between State Indoor Tanning Legislation and Google Search Trends Data in the United States From 2006 to 2019: Time-Series Analysis." JMIR Dermatology 4, no. 1 (April 9, 2021): e26707. http://dx.doi.org/10.2196/26707.
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Background Exposure to ultraviolet radiation from the sun or indoor tanning is the cause of most skin cancers. Although indoor tanning has decreased in recent years, it remains most common among adolescents and young adults, whose skin is particularly vulnerable to long-term damage. US states have adopted several types of legislation to attempt to minimize indoor tanning among minors: a ban on indoor tanning among all minors, a partial minor ban by age (eg, <14 years), or the requirement of parental consent or accompaniment for tanning. Currently, only 6 US states have no indoor tanning legislation for minors. Objective This study investigated whether internet searches (as an indicator of interest) related to indoor tanning varied across US states by the type of indoor tanning legislation, using data from Google Trends from 2006 to 2019. Methods We conducted a time-series analysis of Google Trends data on indoor tanning from 2006 to 2019 by US state. Time-series linear regression models were generated to assess the Google Trends data over time by the type of indoor tanning legislation. Results We found that indoor tanning search rates decreased significantly for all 50 states and the District of Columbia over time (P<.01). The searches peaked in 2012 when indoor tanning received marked attention (eg, indoor tanning was banned for all minors by the first state—California). The reduction in search rates was more marked for states with a complete ban among minors compared to those with less restrictive types of legislation. Conclusions Our findings are consistent with those of other studies on the association between indoor tanning regulations and attitudinal and behavioral trends related to indoor tanning. The main limitation of the study is that raw search data were not available for more precise analysis. With changes in interest and norms, indoor tanning and skin cancer risk among young people may change. Future studies should continue to determine the impact of such public health policies in order to inform policy efforts and minimize risks to public health.
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Stout, Natasha K., Grace M. Lee, Anastasiia S. Weiland, Caleb S. Chen, Syma Rashid, Raveena D. Singh, Thomas Tjoa, et al. "Cost Savings Associated With Decolonization of Postdischarge MRSA Carriers: Results From the CLEAR Randomized Trial." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s28—s29. http://dx.doi.org/10.1017/ice.2020.506.
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Background: Greater than 10% of hospitalized MRSA carriers experience serious MRSA infection in the year following discharge. Prevention opportunities have primarily focused on hospital stays; however postdischarge interventions have the potential to reduce morbidity, mortality and healthcare costs. The CLEAR trial found a 30% hazard reduction in postdischarge MRSA infections among patients who had inpatient MRSA cultures and were given postdischarge decolonization (5 days twice-a-month for 6 months) relative to hygiene education alone. We conducted a cost analysis of the CLEAR intervention to quantify the economic implications and understand the value of adopting this MRSA decolonization strategy. Methods: We constructed a decision model to estimate the one-year healthcare utilization and costs associated with postdischarge decolonization relative to hygiene education. Trial results for MRSA infection risk and downstream outcomes (including outpatient and emergency room visits, hospitalizations, related nursing home stays, and postdischarge antibiotics) were used to parameterize the model. Other medical care and prescription drug costs were based on Medicare Fee Schedules, Red Book and the literature. Patient out-of-pocket costs and time costs associated with subsequent infections were from a survey of trial participants experiencing infection (n=405). All costs were reported in 2019 US dollars. The analysis was conducted using healthcare system and societal perspectives. Sensitivity analyses were conducted on key parameters. Results: Among a hypothetical cohort of 1,000 hospitalized MRSA carriers, we estimated that a postdischarge decolonization intervention versus hygiene education would result in at least 36 fewer subsequent MRSA infections (130 vs 93 of 1,000, respectively) and >40 fewer MRSA-attributable healthcare events including 32 hospitalizations and 6 postdischarge nursing home visits over the course of a year. Assuming an intervention cost of $185 per individual, the program would result in an overall cost savings of $469,000 per 1,000 MRSA carriers undergoing decolonization. This translates to an overall savings of $13,200 per infection averted and $9,000 per infection averted from the healthcare system perspective. Even assuming a lower infection rate or a less effective intervention (15% reduction in infections vs 30% in the CLEAR trial), or a more expensive (up to $653 per patient) intervention, a decolonization program would still result in cost-savings for society, the healthcare system and patients. Conclusions: In addition to health benefits of preventing infections, postdischarge decolonization of MRSA carriers yields substantial savings to society and the healthcare system. Future recommendations for reducing postdischarge MRSA-related disease among MRSA carriers should consider routine decolonization at hospital discharge.Funding: This study was supported by a grant from the AHRQ Healthcare-Associated Infections Program (R01HS019388) and by the University of California Irvine Institute for Clinical and Translational Science, which was funded by a grant from the NIH Clinical and Translational Sciences Award program (UL1 TR000153).Disclosures: Dr. Huang reports conducting clinical studies in which participating nursing homes and hospitals received donated products from Stryker (Sage Products), Mölnlycke, 3M, Clorox, Xttrium Laboratories, and Medline. Ms. Singh reports conducting clinical studies in which participating nursing homes and hospitals received donated products from Stryker (Sage Products), 3M, Clorox, Xttrium Laboratories, and Medline. Dr. Rashid, conducting clinical studies in which participating nursing homes and hospitals received donated products from Stryker(Sage Products), Clorox, and Medline. Dr. McKinnell reports receiving grant support to his institution from Melinta Therapeutics, and fees for serving as a research investigator from Lightship, conducting clinical studies in which participating nursing homes and hospitals received donated products from Stryker (Sage Products), 3M, Clorox, Xttrium Laboratories and Medline, and serving as cofounder of Expert Stewardship. Dr. Miller reports receiving grant support from Gilead Sciences, Merck, Abbott, Cepheid, Genentech, Atox Bio, and Paratek Pharmaceuticals, grant support and fees for serving on an advisory board from Achaogen and grant support, consulting fees, and fees for serving on an advisory board from Tetraphase and conducting clinical studies in which participating nursing homes and hospitals received donated products from Stryker (Sage Products), 3M, Clorox, Xttrium Laboratories, and Medline.
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Johns, David P., and Richard Tinning. "Risk Reduction: Recontexualizing Health As a Physical Education Curriculum." Quest 58, no. 4 (November 2006): 395–409. http://dx.doi.org/10.1080/00336297.2006.10491890.
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Glanz, Karen. "Nutrition education for risk factor reduction and patient education: A review." Preventive Medicine 14, no. 6 (November 1985): 721–52. http://dx.doi.org/10.1016/0091-7435(85)90069-6.
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Cowell, Susan. "Emerging Risk Factors for Acquired Immune Deficiency Syndrome and Risk Reduction Education." Journal of American College Health 34, no. 5 (April 1986): 216–19. http://dx.doi.org/10.1080/07448481.1986.9938938.
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Coleman, Karen J., Heidi Fischer, David E. Arterburn, Douglas Barthold, Lee J. Barton, Anirban Basu, Anita Courcoulas, et al. "Effectiveness of Gastric Bypass Versus Gastric Sleeve for Cardiovascular Disease: Protocol and Baseline Results for a Comparative Effectiveness Study." JMIR Research Protocols 9, no. 4 (April 6, 2020): e14936. http://dx.doi.org/10.2196/14936.
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Background When compared with conventional weight loss strategies, bariatric surgery results in substantially greater durable weight loss and rates of disease remission. Objective The ENGAGE CVD (Effectiveness of Gastric Bypass versus Gastric Sleeve for Cardiovascular Disease) cohort study aimed to provide population-based, comprehensive, rigorous evidence for clinical and policy decision making regarding the choice between gastric bypass and gastric sleeve for overall cardiovascular disease (CVD) risk reduction, risk factor remission, and safety. Methods The cohort had 22,095 weight loss surgery patients from a large integrated health care system in Southern California assembled from 2009 to 2016 who were followed up through 2018. Bariatric surgery patients were followed up for the length of their membership in the health care system. Of the patients who had at least five years of follow-up (surgery between 2009 and 2013), 85.86% (13,774/16,043) could contribute to the outcome analyses for the ENGAGE CVD cohort. Results Patients in the ENGAGE CVD cohort were 44.6 (SD 11.4) years old, mostly women (17,718/22,095; 80.19%), with 18.94% (4185/22,095) non-Hispanic black and 41.80% (9235/22,095) Hispanic, and had an average BMI of 44.3 (SD 6.9) kg/m2 at the time of surgery. When compared with patients who did not contribute data to the 5-year outcome analysis for the ENGAGE CVD cohort (2269/16,043; 14.14%), patients who contributed data (13,774/16,043; 85.86%) were older (P=.002), more likely to be women (P=.02), more likely to be non-Hispanic white (P<.001), more likely to have had an emergency department visit in the year before surgery (P=.006), less likely to have a mental illness before surgery (P<.001), and more likely to have had a CVD event at any time before surgery (P<.001). Conclusions This study had one of the largest populations of gastric sleeve patients (n=13,459). The 5-year follow-up for those patients who had surgery between 2009 and 2013 was excellent for a retrospective cohort study at 85.86% (13,774/16,043). Unlike almost any study in the literature, the majority of the ENGAGE CVD cohort was racial and ethnic minority, providing a rare opportunity to study the effects of bariatric surgery for different racial and ethnic groups, some of whom have the highest rates of severe obesity in the United States. Finally, it also used state-of-the-art statistical and econometric comparative effectiveness methods to mimic the effect of random assignment and control for sources of confounding inherent in large observational studies. International Registered Report Identifier (IRRID) RR1-10.2196/14936
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Phillips, Karran A., David H. Epstein, Mustapha Mezghanni, Massoud Vahabzadeh, David Reamer, Daniel Agage, and Kenzie L. Preston. "Smartphone Delivery of Mobile HIV Risk Reduction Education." AIDS Research and Treatment 2013 (2013): 1–9. http://dx.doi.org/10.1155/2013/231956.
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We sought to develop and deploy a video-based smartphone-delivered mobile HIV Risk Reduction (mHIVRR) intervention to individuals in an addiction treatment clinic. We developed 3 video modules that consisted of a 10-minute HIVRR video, 11 acceptability questions, and 3 knowledge questions and deployed them as a secondary study within a larger study of ecological momentary and geographical momentary assessments. All 24 individuals who remained in the main study long enough completed the mHIVRR secondary study. All 3 videos met our a priori criteria for acceptability “as is” in the population: they achieved median scores of ≤2.5 on a 5-point Likert scale; ≤20% of the individuals gave them the most negative rating on the scale; a majority of the individuals stated that they would not prefer other formats over video-based smartphone-delivered one (allP<0.05). Additionally, all of our video modules met our a priori criteria for feasibility: ≤20% of data were missing due to participant noncompliance and ≤20% were missing due to technical failure. We concluded that video-based mHIVRR education delivered via smartphone is acceptable, feasible and may increase HIV/STD risk reduction knowledge. Future studies, with pre-intervention assessments of knowledge and random assignment, are needed to confirm these findings.
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Foster, Saralyn, Christian Vazquez, Catherine Cubbin, Amy Nichols, Rachel Rickman, and Elizabeth Widen. "Characterizing the Impact of Breastfeeding and Socioeconomic Status on Maternal Weight Change From Pregnancy to Ten Years Postpartum." Current Developments in Nutrition 5, Supplement_2 (June 2021): 746. http://dx.doi.org/10.1093/cdn/nzab046_043.
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Abstract Objectives Breastfeeding is a potentially modifiable factor associated with less postpartum weight retention; however, in the United States women with lower socioeconomic status (SES) are less likely to initiate breastfeeding and, therefore, may be at higher risk for long-term weight retention. We sought to describe associations between duration of breastfeeding with postpartum weight retention and later BMI, and to determine whether associations varied by SES. Methods Maternal and infant data (n = 2144 dyads) are from the Geographic Research on Wellbeing survey (GROW), a follow-up study of California's annual statewide-representative Maternal and Infant Health Assessment. Pre-pregnancy BMI was obtained from self-report; at 4–10y postpartum, breastfeeding history and self-reported body weight were collected. Multivariable linear regression was used to examine associations between breastfeeding and long-term maternal body size. SES was calculated as a composite score of % federal poverty threshold plus education and was dichotomized. Results Overall, mean prepregnancy BMI was 24.9 kg/m,2 while long-term weight retention 4–10 y postpartum was 4.0 kg. The sample average breastfeeding duration was 8.5 months with 61% meeting the World Health Organization (WHO) recommendations for 6 months of breastfeeding. In adjusted models, compared to women who did not meet recommendations, women who met WHO recommendations had slightly lower long-term postpartum weight retention (b = −1.06 kg, CI: −1.93, −0.25, p = 0.01) and a small reduction in BMI (b = −0.4 kg/m,2 95% CI −0.74, −0.08; p = 0.02). Compared to higher SES women, fewer lower SES women ever breastfed (89% vs 74%, p < .0001) or met WHO recommendations (70% vs 51%, p < .0001). Lower SES women had higher prepregnancy BMI (25.9kg/m2 vs 23.5, p < .0001), and had greater long-term weight retention 4–10 y postpartum (5.68kg vs. 1.83, p < .0001). In SES stratified adjusted models, there were no differences in associations between breastfeeding with long-term weight retention or BMI. Conclusions Breastfeeding was associated with long term maternal postpartum weight status. Six months of breastfeeding was associated with lower long-term postpartum weight retention and lower BMI at 4–10 years postpartum, and effects did not vary by socioeconomic status. Funding Sources CDPH, UCSF.
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Males, Mike. "Youth Health Services, Development Programs, and Teenage Birth Rates in 55 California Cities." Californian Journal of Health Promotion 4, no. 1 (March 1, 2006): 46–57. http://dx.doi.org/10.32398/cjhp.v4i1.732.
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Many advocacy groups depict sexuality education, abstinence education, health services, and development services to teenagers as pivotal factors in their birth rates. Data from California’s 55 largest cities for 1990-2002 allow regression analyses of the associations between levels of health and development services to youth, socioeconomic factors such as poverty, and environmental factors such adult birth rates on rates of and changes in births to teenage mothers. The analysis found teenage birth rates vary 30-fold from California’s richest to poorest city. Socioeconomic and environmental factors, chiefly adult birth rates and youth poverty rates, are associated with nearly 90% of the variance in teen birth rates. Contrary to assertions by many advocates, lower-income teens have greater access to health, sexuality education, and development services, and the availability of these services is not associated with lower rates of or greater reductions over time in teenage birth rates.