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1
Friedricks, William, and Edward Leo Lyman. "San Bernardino: The Rise and Fall of a California Community." Journal of American History 84, no. 4 (March 1998): 1537. http://dx.doi.org/10.2307/2568178.
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Holzhauser, Elizabeth, Patti Herring, and Susanne Montgomery. "Integrating Academia with Community-Based Health Practices: The San Bernardino County Community-Based Pediatric Vision Outreach System." Public Health Reports 117, no. 2 (March 2002): 197–200. http://dx.doi.org/10.1093/phr/117.2.197.
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Dolan, Tom, Brian D. Christens, and Cynthia Lin. "Combining Youth Organizing and Youth Participatory Action Research to Strengthen Student Voice in Education Reform." Teachers College Record: The Voice of Scholarship in Education 117, no. 13 (April 2015): 153–70. http://dx.doi.org/10.1177/016146811511701303.
Повний текст джерелаАнотація:
Community organizing processes seek to address community issues of mutual concern through cycles of relationship development, research, action, and evaluation led by people directly affected by the issues at stake. This chapter examines a community organizing effort in San Bernardino, California, that has built power to address issues in schools and the broader community. This organizing effort, which has involved leadership by hundreds of youth, has achieved numerous changes in programs and policies that have increased educational, recreational, and employment opportunities for young people. In this chapter, we examine the youth organizers’ deepening use of (a) organizing research and (b) youth participatory action research (YPAR). We compare these two types of research in a community organizing context and highlight the ways that each type of research has contributed to successes in collective action.
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Huhn, Arianna, and Annika Anderson. "Promoting Social Justice through Storytelling in Museums." Museum and Society 19, no. 3 (November 1, 2021): 351–68. http://dx.doi.org/10.29311/mas.v19i3.3775.
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In 2018 the Anthropology Museum at California State University San Bernardino (USA) opened an exhibition entitled In|Dignity. The collaborative endeavour combined social science techniques, documentary photography, and theatre performances to present first person narratives of 43 community members. Participants represented marginalized demographics and intersectional identities that extended far beyond standardized approaches to ‘diversity’. Their stories provided an intimate look into experiences of discrimination, microaggressions, harassment, exclusion, and other affronts to self-worth and barriers to community belonging. This article argues that connecting individuals through telling and listening to stories is a valid strategy to promote social justice. In|Dignity provides one case study of a museum using the narrative form and the processes of exhibition development to disrupt power hierarchies, uplift community concerns, and promote human dignity.
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Arthur, Kristen N., Synnøve F. Knutsen, Rhonda Spencer-Hwang, David Shavlik, and Susanne Montgomery. "Health-Predictive Social-Environmental Stressors and Social Buffers Are Place Based: A Multilevel Example From San Bernardino Communities." Journal of Primary Care & Community Health 10 (January 2019): 215013271983562. http://dx.doi.org/10.1177/2150132719835627.
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Significant evidence demonstrates the powerful effects social determinants have on health-related perceptions, behaviors, and health outcomes. However, these factors are often studied out of context, despite the acknowledgement that social determinants of health are place based. This research aimed to demonstrate that health-related perceptions are dependent on where one lives. Via a community-based participatory study, participants were randomly selected from 3 residential regions varying distances from a freight railyard (nearest n = 300, middle n = 338, farthest n = 327), all mostly low-income, predominately Latino areas. Interview-administered surveys with adults were collected by bilingual trained community members (87% response) in English/Spanish. Adjusted-logistic regression models assessed residential region as a predictor of stressors (perceptions of community safety, community noise disturbance, health care access, food insecurity) and buffers (3 neighborhood cohesion variables), after adjusting for household income, race/ethnicity, gender, and age. Each region experienced a unique amalgam of stressors and buffers. In general, the region closest to the railyard experienced more stressors (odds ratio [OR] = 1.58; 95% CI 1.12-2.20) and less buffers (OR = 0.69; 95% CI 0.49-0.96) than the region furthest from the railyard. More than half of participants in each region reported 2 or more stressors and 2 or more buffers. In this seemingly homogenous study population, place remained important in spite of traditionally used socioeconomic factors, such as household income and race/ethnicity. Social determinants of health should be studied with regard to their environmental context, which will require interdisciplinary collaboration to improve multilevel research methods. Including the study of social buffers will also promote sustainable, positive change to reduce health disparities.
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Abdul-Mutakabbir, Jacinda, Samuel Casey, Veatrice Jews, Andrea King, Kelvin Simmons, Bridgette Peteet, Juan Carlos Belliard, Michael Hogue, and Ricardo Peverini. "475. The Utility of Community-Academic Partnerships in Promoting the Equitable Delivery of COVID-19 Vaccines in Black Communities." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S339. http://dx.doi.org/10.1093/ofid/ofab466.674.
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Abstract Background In the U.S., non-Hispanic Black individuals are disproportionately represented amongst COVID-19 mortalities. The COVID-19 vaccines are poised to change this outcome; however, inequitable access and decades of medical mistreatment have resulted in healthcare mistrust and an associated low uptake within this group. Loma Linda University (LLU) houses the largest mass vaccination site in San Bernardino County (SBC) California; nevertheless, there has been a perpetual low representation of Black vaccinees. To increase the number of Black persons vaccinated, a selected team at LLU leveraged a community-academic partnership model to address vaccine hesitancy and increase access to the COVID-19 vaccines. The objective of this study was to evaluate the number of Black persons vaccinated in community settings compared to the mass clinic. Methods LLU developed a tiered approach to increase COVID-19 vaccinations within Black SBC communities. The first tier engaged faith leaders with the academic community in disseminating COVID-19 health information, the second included culturally representative LLU healthcare professionals in the delivery of COVID-19 educational webinars, and the third was to conduct low barrier, remote-site vaccination clinics, within targeted Black communities. Following these efforts, we compared the number of Black individuals vaccinated in the LLU mass clinic to those vaccinated in the community remote-site clinics. Results The remote-site COVID-19 vaccination clinics commenced in February 2021. From February 1 until April 30, 2021, 24,808 individuals were vaccinated in the LLU mass clinic with a first dose (Pfizer or Moderna) or single dose (Janssen) of a COVID-19 vaccine, however, only 908 (3.7%) were Black vaccinees. Contrastingly, the LLU remote site clinics vaccinated 1,542 individuals with a first or single dose of a COVID-19 vaccine. Of those vaccinees, 675 (44%) were Black. Conclusion The multi-tiered community approach (remote-site vaccination clinics) resulted in a necessary overrepresentation of Black vaccinees, previously underrepresented in the LLU traditional mass vaccination clinic effort (44% vs. 3.7%, respectively). Further research is warranted to examine the key elements to increase vaccinations amongst minoritized groups. COVID-19 Vaccination Comparisons Between Models This table includes data from the Loma Linda University Mass Vaccination Clinic and the Remote-Site Vaccination Efforts compared to the San Bernardino County Demographics Disclosures All Authors: No reported disclosures
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SPITZER, BRIAN W., and ALEXANDER L. WILD. "Effects of tree mortality caused by a bark beetle outbreak on the ant community in the San Bernardino National Forest." Ecological Entomology 38, no. 5 (June 3, 2013): 439–47. http://dx.doi.org/10.1111/een.12031.
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Abdul-Mutakabbir, Jacinda C., Cristie Granillo, Bridgette Peteet, Alex Dubov, Susanne B. Montgomery, Jasmine Hutchinson, Samuel Casey, Kelvin Simmons, Alex Fajardo, and Juan Carlos Belliard. "Rapid Implementation of a Community–Academic Partnership Model to Promote COVID-19 Vaccine Equity within Racially and Ethnically Minoritized Communities." Vaccines 10, no. 8 (August 20, 2022): 1364. http://dx.doi.org/10.3390/vaccines10081364.
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Coronavirus disease 2019 (COVID-19) has highlighted inequities in mortalities and associated illnesses among non-Hispanic Black and Hispanic/Latino individuals. Immunization against COVID-19 is critical to ending the pandemic, especially within racial and ethnically minoritized communities. However, vaccine hesitancy and institutional mistrust in these communities, resulting from decades of mistreatment, structural racism, and barriers to vaccination access, have translated into low vaccination uptake. Trustworthy relationships with healthcare professionals and partnerships with faith and community leaders are critical to increasing vaccination rates within these minoritized communities. Loma Linda University researchers collaborated with local faith and community organizations in San Bernardino County, CA, to rapidly implement a three-tiered approach to increase the vaccination rates within non-Hispanic Black and Hispanic/Latino communities. This community–academic partnership model provided over 1700 doses of the COVID-19 vaccine within these vaccine-hesitant, targeted minoritized communities. As over 100,000 individuals are diagnosed with COVID-19 daily and updated vaccines targeting variants of the Omicron strain are expected to rollout in the coming months, the development of sustainable programs aimed at increasing vaccine uptake within vulnerable communities are of the utmost importance.
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Curry, Michael, Allen Lipscomb, Wendy Ashley, and David McCarty-Caplan. "Black Barbershops: Exploring Informal Mental Health Settings Within the Community." Journal of Humanities and Social Sciences Studies 4, no. 1 (February 5, 2022): 60–69. http://dx.doi.org/10.32996/jhsss.2022.4.1.6.
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The barbershop is a landmark in the Black community, providing a site for cultural exchange, discussion forums and a point of psychological connection for African American men. Barbershops offer safe spaces for culturally responsive engagement, discourse, and guidance without stigma. Researchers and service providers have utilized Black barbershops for physical health outreach, understanding Black masculinity, exploring intersections of sexuality, and informal mental health support. The Black barbershop offers a nuanced, culturally relevant perspective of African American men, which is valuable to current and future human service providers, educators, and stakeholders in formulating effective interventions and practices with Black men. Utilizing video voice participatory action research (PAR) qualitative methodology, this study explored the experiences of African American (or Black) men using community barbershops as informal mental health care settings. The study explored the experiences of ten (N = 10) African American men, ages 18-75, from either the San Bernardino County or Los Angeles County areas who utilized Black barbershops as informal mental health care settings. The results suggested that African American men were willing to embark on conversations about their mental health within their barbershops, reporting that these experiences yielded them significant psychological, emotional, and social well-being. The authors recommend future collaboration efforts to join with existing informal mental healthcare settings such as Black barbershops to support community-based, culturally relevant healing spaces for African American men.
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Pfeiffer, Jane, Hong Li, Maybelline Martez, and Tim Gillespie. "The Role of Religious Behavior in Health Self-Management: A Community-Based Participatory Research Study." Religions 9, no. 11 (November 13, 2018): 357. http://dx.doi.org/10.3390/rel9110357.
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Prevalence of chronic disease, mental health problems, and risk behaviors in San Bernardino (SB) County reflect some of the worst health outcomes in the State of California and the United States. Using the Integrated Theory of Health Behavior Change (ITHBC) as the theoretical framework, this community-based participatory research (CBPR) study aimed to determine how religious self-regulation skills and ability, and religious behaviors, jointly affect health promotion behaviors among socio-economically challenged residents of southwest SB County, California. A convenience sample of adult residents (N = 261) completed a series of inventories to measure the relationship between modified ITHBC constructs of religious self-regulation skills, religious self-management behaviors, and health outcomes. Structural Equation Modeling (SEM) analysis was conducted to validate the strong positive effect of religious self-regulation skills and ability on how frequently individuals engage in both organized and non-organized religious activities. Results also indicated a significant positive impact of religious behaviors towards healthy eating behaviors. However, without the engagement in religious activities, high religious self-regulation skills and ability inhibited the likelihood of healthy food intake. This faith-related theoretical model provides an avenue for faith-based organizations’ capacity for contributing to community health promotion.
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Valenzuela, Kathleen Louise, Jennifer Veltman, and April Wilson. "447. COVID-19 Prevalence Among COVID-19 Exposed Health Care Workers at a Tertiary Care Center in San Bernardino County, Ca." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S291—S292. http://dx.doi.org/10.1093/ofid/ofaa439.640.
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Abstract Background We studied the prevalence of positive SARS-CoV2 antibody and positive SARS-CoV2 antigen among high risk health care workers at Loma Linda University Health System (LLUHS) who voluntarily obtained SARS-CoV2 antibody testing, and if indicated, antigen testing. The study determined that there is a significant decrease in the prevalence of SARS-CoV2 antigen among employees at LLUH compared to the community. Methods Employee Health and Occupational Medicine offered antibody testing to employees who were considered high risk, primarily working in the Coronavirus Disease 19 (COVID-19) designated units. We tested 658 subjects’ serum for the presence of IgM and IgG antibodies via the Nirmidas Qualitative SARS-CoV2 test. 29 subjects with a positive antibody test were subsequently tested for the presence of serum SARS-CoV2 antigen via PCR. Results There were 31 subjects who tested positive for IgM or IgG antibodies. 11 subjects had positive IgM with negative IgG. 3 subjects had negative IgM with positive IgG. 15 patients had positive IgM and positive IgG. 2 subjects had positive IgM with negative IgG, were subsequently retested, and then found to have positive IgM and positive IgG. Of those 31 subjects with a positive antibody test, 2 were not tested for the COVID-19 antigen, 1 had an inconclusive test, 23 tested negative, and 5 tested positive. Of those 5 positive for the antigen, 2 had symptoms and 3 did not report symptoms or did not use the symptom questionnaire. The community prevalence of positive SARS-CoV2 antigen in San Bernardino is 0.37%, as of June 16. The prevalence of positive SARS-CoV2 antigen among LLUH employees is 0.03% and the prevalence of positive antibody is 0.18%. The value of z is -7.3206, p is < .00001. Thus, the result is significant at p < .01. Conclusion The results of this testing supports the efficacy of the early protective measures that LLUHS implemented in preparation for the pandemic. Such protective measures include: mandated face masks, symptoms screening, testing for SARS-CoV2 antibody or antigen on patients admitted, a dedicated COVID-19 section of the emergency department as well as inpatient units, etc. Given the statistical significance of this study, the protective bundle can be used as a template for preventative measures for future pandemics. Disclosures All Authors: No reported disclosures
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Durand, Casey P., Genevieve F. Dunton, Donna Spruijt-Metz, and Mary Ann Pentz. "Does Community Type Moderate the Relationship between Parent Perceptions of the Neighborhood and Physical Activity in Children?" American Journal of Health Promotion 26, no. 6 (July 2012): 371–80. http://dx.doi.org/10.4278/ajhp.100827-quan-290.
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Purpose. To examine whether residing in a community designed to promote physical activity moderates the relationship between parent perceptions of the neighborhood and general physical activity or active commuting to school in their children. Design. Cross-sectional. Setting. San Bernardino County, California. Subjects. Three hundred sixty-five families (one parent and one child in grades four through eight). Eighty-five reside in a smart growth community designed to be more conducive to physical activity. Measures. Parent perceptions assessed using the Neighborhood Environment Walkability Scale (NEWS). General child physical activity was measured using accelerometers, and active commuting was self-reported by children. Analysis. Two sets of regressions were performed: one for general physical activity, and one for active commuting. Separate models were run in the two sets for each of the 14 NEWS factors, while controlling for demographics. Results. For general physical activity, walking infrastructure, lack of cul-de-sacs, and social interaction had significant main effect associations (p ≤ .05). No factors were moderated by community. The relationships between active commuting to school and perceived crime, traffic hazards, hilliness, physical barriers, cul-de-sac connectivity, aesthetics, and walking infrastructure were significant for those in the smart growth community only (p ≤ .05). Conclusions. Living in an activity-friendly environment is associated with positive relationships between parent perceptions and active commuting behaviors in children. Future interventions should account for both the perceived neighborhood environment and available physical activity infrastructure.
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Noblezada, Mary Mar P., and Wilfredo L. Campos. "Chaetognath assemblages along the Pacific Coast and adjacent inland waters of the Philippines: relative importance of oceanographic and biological factors." ICES Journal of Marine Science 69, no. 3 (January 20, 2012): 410–20. http://dx.doi.org/10.1093/icesjms/fsr209.
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Abstract Noblezada, M. M. P., and Campos, W. L. 2012. Chaetognath assemblages along the Pacific Coast and adjacent inland waters of the Philippines: relative importance of oceanographic and biological factors. – ICES Journal of Marine Science, 69: 410–420. When studying plankton distribution, it is necessary to investigate the biology of the target organisms and the surrounding physical environment. Station and species groupings are only useful if they provide insight into the environmental associations of the species in the group. The study covers two geographic regions: the Pacific Coast (Bicol Shelf) and inland waters (San Bernardino Strait, Ticao Pass, Sibuyan, and Visayan Seas) of the Philippines. Comprehensive information is provided on chaetognath assemblages and distribution within the regions. The findings are integrated with oceanographic conditions and phenomena that define the characteristics of the subareas and consideration given to how these conditions affect chaetognath ecology. A comparison is also provided of the community structure of the two regions, and the possible use of chaetognaths as indicator species of water mass movement and oceanographic phenomena explored. In all, 28 284 specimens were examined, and 33 species from 17 genera were identified. Chaetognath distributions, abundance, and community structure were analysed using dissimilarity indices and multiple regression. The results show that the distribution of chaetognaths agrees well with the movement of oceanic water from the Pacific into the central part of the archipelago.
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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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McCarthy, Maureen A. "The Role of Psychology in a Liberal Arts Education: An Interview with Diane F. Halpern." Teaching of Psychology 32, no. 2 (April 2005): 132–35. http://dx.doi.org/10.1207/s15328023top3202_10.
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Diane F. Halpern is the Past-President of the American Psychological Association (APA) and Director of the Berger Institute for Work, Family, and Children and Professor of Psychology at Claremont McKenna College. Her earlier appointments include professor of psychology, Chair and Dean of Undergraduate Studies at California State University, San Bernardino. Her teaching, service to psychology, and research have been recognized with many awards, including the 2002 Outstanding Teaching Award from the Western Psychological Association, Wang Family Excellence Award, American Psychological Foundation Award for Distinguished Teaching, Distinguished Career Contributions to Education and Training, G. Stanley Hall Lecture, and the Outstanding Professor Award from California State University-Statewide. Maureen McCarthy is the Director of Precollege and Undergraduate Programs for the APA. She provides leadership and management oversight of programs and initiatives to enhance the teaching and learning of psychology in high schools, community colleges, and undergraduate programs; coordinates programs with initiatives of national organizations, projects, and agencies that share the mission of enhancing teaching and faculty development; and initiates research pertaining to needs, achievements, and characteristics of undergraduate psychology. Effective spring 2005, she became a faculty member at Kennesaw State University, where she teaches experimental psychology and research methods.
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Mcclure, D., H. Engelke, and S. Mackintosh. "(P1-48) Rethinking the “Disaster Club” as a Student Interest Group on a Health Professions Campus." Prehospital and Disaster Medicine 26, S1 (May 2011): s114. http://dx.doi.org/10.1017/s1049023x11003803.
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Disaster preparedness and response requires an integrated response by all aspects of the health professions. The most successful outcome can occur when interprofessional cooperation exists between community, first responders, and the many facets of health professions. At Western University Health Sciences we have replaced our interprofessional disaster club with a disaster focused element in several other health professional interest clubs. The primary coordination is centered in the Public Health Club which is composed of students from many of our medical colleges. The public health club mirrors our community disaster response in that preventive medicine and preparedness lies in our public health program. Public health interest such as rabies prevention and education on world rabies they are centered in our public health club with support from our faculty expertise in public health. Educational components such as wilderness medicine fit well into the human emergency and critical care student group. Both human and veterinary emergency and critical care student group's natural interest lies in triage and first response. Student interest groups or clubs that focus on community outreach in medicine, nursing, dentistry and veterinary shelter medicine have a take the lead in emergency sheltering for vulnerable populations. Using the model presented here, disaster preparedness is promoted as routine extensions of daily professional endeavors. By building upon student interest groups we can build a culture of connectivity across the professions. Extending student club supported training endeavors to the community surrounding can allow the disaster responder community to meet on neutral ground. Western University Health Sciences is uniquely situated in Los Angeles County and our faculty and students reside in neighboring Orange Riverside and San Bernardino counties. At a private health professions university, our focus is to provide educational opportunities in a real-world setting which is integrated with community.
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Ebersole, Tela, and Anabelle Alfaro Obando. "Knowledge and beliefs about the Red Cross: Perspectives of community members and Red Cross workers in San Ramón, Alajuela, Costa Rica." UNED Research Journal 8, no. 1 (June 10, 2016): 41–48. http://dx.doi.org/10.22458/urj.v8i1.1221.
Повний текст джерелаАнотація:
In Costa Rica, the Red Cross provides most pre-hospital emergency care and transport. Very few studies have investigated extra-hospital emergency care in Costa Rica so this study aimed to fill this gap through interviews with community members, surveys of Red Cross workers and volunteers, and observations of the daily functioning of the Red Cross Committee in San Ramón, Alajuela, Costa Rica. Over the course of 7 weeks of observation at the Red Cross office of San Ramón, 136 interviews and surveys were collected. The study found a well-equipped organization that provides many emergency and non-emergency services for the community. People, mostly over 45 years old, interviewed at the Red Cross were more likely to believe that the community uses the Red Cross’s services rationally than people interviewed at other locations. Community members and Red Cross workers strongly differed in whether or not the community uses the services appropriately; community members felt that they did, while Red Cross workers felt that the usage was often inappropriate and for non-emergency cases, which would be better suited to a clinic. Educating the public about appropriate use of Red Cross services would save money and resources for true emergencies.
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Parker, Lynsey Karen, Jeremiah Johnson, John Grant, Pradeepa Vennam, Rajashi Parikh, Chao-Jung Chien, and Ralph Morris. "Ozone Trends and the Ability of Models to Reproduce the 2020 Ozone Concentrations in the South Coast Air Basin in Southern California under the COVID-19 Restrictions." Atmosphere 13, no. 4 (March 26, 2022): 528. http://dx.doi.org/10.3390/atmos13040528.
Повний текст джерелаАнотація:
The current U.S. emission control requirements for on-road motor vehicles are driven by the ozone problem in the South Coast Air Basin (SoCAB) in southern California. Based on ozone modeling performed for Air Quality Management Plans (AQMPs), the SoCAB ozone attainment plan requires large (>80%) amounts of emission reductions in oxides of nitrogen (NOx) from current levels with more modest (~40%) controls on Volatile Organic Compounds (VOC). The shelter in place orders in response to the 2020 COVID-19 pandemic resulted in an immediate reduction in emissions, but instead of ozone being reduced, in 2020 the SoCAB saw some of the highest observed ozone levels in decades. We used the abrupt emissions reductions from 2019 to 2020 caused by COVID-19 to conduct a dynamic model evaluation of the Community Multiscale Air Quality (CMAQ) model to evaluate whether the models used to develop ozone control plans can correctly simulate the ozone response to the emissions reductions. Ozone modeling was conducted for three scenarios: 2019 Base, 2020 business-as-usual (i.e., without COVID reductions), and 2020 COVID. We found that modeled ozone changes between 2019 and 2020 were generally consistent with the observed ozone changes. We determined that meteorology played the major role in the increases in ozone between 2019 and 2020; however, the reduction in NOX emissions also caused ozone increases in Los Angeles County and into western San Bernardino County, with more widespread ozone decreases further to the east.
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Miller, George, Stephen Randolph, and Jan E. Patterson. "Responding to Simulated Pandemic Influenza in San Antonio, Texas." Infection Control & Hospital Epidemiology 29, no. 4 (April 2008): 320–26. http://dx.doi.org/10.1086/529212.
Повний текст джерелаАнотація:
Objective.To describe the results of a simulation study of the spread of pandemic influenza, the effects of public health measures on the simulated pandemic, and the resultant adequacy of the surge capacity of the hospital infrastructure and to investigate the adequacy of key elements of the national pandemic influenza plan to reduce the overall attack rate so that surge capacity would not be overwhelmed.Design.We used 2 discrete-event simulation models: the first model simulates the contact and disease transmission process, as affected by public health interventions, to produce a stream of arriving patients, and the second model simulates the diagnosis and treatment process and determines patient outcomes.Setting.Hypothetical scenarios were based on the response plans, infrastructure, and demographic data of the population of San Antonio, Texas.Results.Use of a mix of strategies, including social distancing, antiviral medications, and targeted vaccination, may limit the overall attack rate so that demand for care would not exceed the capacity of the infrastructure. Additional simulations to assess social distancing as a sole mitigation strategy suggest that a reduction of infectious community contacts to half of normal levels would have to occur within approximately 7 days.Conclusions.Under ideal conditions, the mix of strategies may limit demand, which can then be met by community surge capacity. Given inadequate supplies of vaccines and antiviral medications, aggressive social distancing alone might allow for the control of a local epidemic without reliance on outside support.
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Schell, Micheal T., Anthony Barcia, Austin L. Spitzer, and Hobart W. Harris. "Pancreaticoduodenectomy: Volume is not Associated with Outcome within an Academic Health Care System." HPB Surgery 2008 (January 29, 2008): 1–6. http://dx.doi.org/10.1155/2008/825940.
Повний текст джерелаАнотація:
Hypothesis. Smaller and lower-volume hospitals can attain surgical outcomes similar to high-volume centers if they incorporate the expertise and health care pathways of high-volume centers. Setting. The academic tertiary care center, Moffit-Long Hospital (ML); the community-based Mount Zion Hospital (ZION); the San Francisco County General Hospital (SFGH); and the Veterans Affairs Medical Center of San Francisco (VAMC). Patients. 369 patients who underwent pancreaticoduodenectomy between October 1989 and June 2003 at the University of California, San Francisco (UCSF) affiliated hospitals. Interventions. Pancreaticoduodenectomy. Design. Retrospective chart review. To correct for the potentially confounding effect of small case volumes and event rates, data for SFGH, VAMC, and ZION was combined (Small Volume Hospital Group; SVHG) and compared against data for ML. Main Outcome Measures. Complication rates; three-year and five-year survival rates. Results. The average patient age and health, as determined by ASA score, were similar between ML and the SVHG. The postoperative complication rate did not differ significantly between ML and the SVGH (58.8% versus 63.1%). Patients that experienced a complication averaged 2.5 complications in both groups. The perioperative mortality rate was 4% for patients undergoing pancreaticoduodenectomy at either ML or the SVGH. Although the 3-year survival rate for patients with adenocarcinoma of the pancreas was nearly twice as high at ML (31.2% versus 18.3% at SVHG), there was no significant difference in the 5-year survival rates (19% at ML versus 18.3% at SVHG). Conclusions. Low-volume hospitals can achieve similar outcomes to high-volume tertiary care centers provided they import the expertise and care pathways necessary for improved results.
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Sobo, Elisa. "A Model Protocol for Applying Anthropology in Rapid Health Services Evaluations." Practicing Anthropology 25, no. 2 (April 1, 2003): 39–42. http://dx.doi.org/10.17730/praa.25.2.u17g513627w57552.
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In 1998, California launched Healthy Families/Medi-Cal for Children (HF/MCC). HF/MCC provides low- and no-cost insurance to low-income children. Six million dollars was budgeted for culturally appropriate outreach and enrollment activities and 72 community-based organizations (CBOs) were contracted to carry these out. The contracts were performance based and required measurable outcomes, such as successful enrollments, to increase local public awareness and generate enrollment in HF/MCC. Children's Hospital San Diego was hired (through the San Diego State Foundation) to evaluate the CBOs' performance. This article describes the fortuitous incorporation of a qualitative anthropological component. The protocol developed might be applied in other rapid health services evaluation contexts, especially when other members of the evaluation team (or the sponsors) have not yet been convinced of the usefulness of the qualitative approach.
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Noyola, Daniel E., M. Lourdes Padilla-Ruiz, M. Guadalupe Obregón-Ramos, Patricia Zayas, and Beatriz Pérez-Romano. "Parvovirus B19 infection in medical students during a hospital outbreak." Journal of Medical Microbiology 53, no. 2 (February 1, 2004): 141–46. http://dx.doi.org/10.1099/jmm.0.05417-0.
Повний текст джерелаАнотація:
From March to May 2002, a parvovirus B19 (B19) outbreak was identified at a general hospital that serves as a teaching facility for the Universidad Autónoma de San Luis Potosí, Mexico. Medical students attending the hospital presented with symptoms suggestive of B19 infection. Previous studies have suggested that apparent hospital-related B19 outbreaks may be a reflection of B19 infection in the community. A study was undertaken to assess whether exposure to the hospital was a risk factor for B19 infection and to determine to what extent medical students were infected during this outbreak. The incidence of B19 infection in medical students attending the teaching hospital during the outbreak (n = 211) was determined and compared to students not attending the hospital (n = 96). To assess if a community-wide outbreak had occurred, 80 blood donors were also evaluated for the presence of B19 antibodies. Acute B19 infection was identified in 40 of 119 (33.6 %) susceptible students attending the hospital and in 20 of 47 (42.6 %) susceptible students not attending the hospital. The frequency of acute infection among susceptible blood donors was lower (9.5 %) than in students, but higher than the rate expected during non-epidemic periods. Most infections (68.3 %) were asymptomatic. Symptoms reported by infected subjects were not specific for B19 infection. Only 11.7 % of subjects with acute infection fulfilled the clinical surveillance definition used to detect cases during the outbreak. In conclusion, hospital exposure was not associated to increased risk of B19 infection among medical students. Medical students may be at increased risk for acquiring and transmitting B19 infection during outbreaks.
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Evelyn, Angelia. "Reviewer Acknowledgements." Applied Finance and Accounting 3, no. 1 (January 23, 2017): 94. http://dx.doi.org/10.11114/afa.v3i1.2179.
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Applied Finance and Accounting [AFA] would like to acknowledge the following reviewers for their assistance with peer review of manuscripts for this issue. Many authors, regardless of whether AFA publishes their work, appreciate the helpful feedback provided by the reviewers. Their comments and suggestions were of great help to the authors in improving the quality of their papers. Each of the reviewers listed below returned at least one review for this issue.Reviewers for Volume 3, Number 1 Abdelaziz Hakimi, University of Jendouba, TunisiaAdam Zaremba, Poznań University of Economics, PolandAnastasia Kopaneli, University of Patras, GreeceAndrey Kudryavtsev, The Max Stern Yezreel Valley Academic College, IsraelArash Riasi, University of Delaware, USAAugustine Akhidime, Benson Idahosa University, NigeriaDesti Kannaiah, James Cook University, SingaporeFeng Jui Hsu, National Taichung Univ. of Sci. & Tech., TaiwanGheorghe Morosan, Stefan Cel Mare Univ. Suceava Romania, RomaniaIoan Bogdan Robu, Alexandru Ioan Cuza University of Iasi, RomaniaJames Estes, California State University San Bernardino, USAKesseven Padachi, University of Technology, MauritiusLasse Oulasvirta, University of Tampere, FinlandLuca Sensini, University of Salerno, ItalyMarco Muscettola, Independent researcher, ItalyMazurina Mohd Ali, Universiti Teknologi Mara, MalaysiaMohamed Jalloh, Eco. Community of West African States, NigeriaMojeed Idowu John Odumeso-Jimoh, Noble Integrated Resources & Management, NigeriaNicoleta Radneantu, Romanian – American University, RomanianNikolay Patonov, European Polytechnical University, BulgariaNoriaki Okamoto, Rikkyo University, JapanPeibiao Zhao, Nanjing University of Science & Technology, ChinaSawsan Saadi Halbouni, Canadian University Dubai, UAEVineet Chouhan, Sir Padampat Singhania University, IndiaWilson E. Herbert, Bingham University, NigeriaYu Peng Lin, University of Detroit Mercy, USA Angelia EvelynEditorial AssistantOn behalf of,The Editorial Board of Applied Finance and AccountingRedfame Publishing9450 SW Gemini Dr. #99416Beaverton, OR 97008, USAE-mail: afa@redfame.comURL: http://afa.redfame.com
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Simkin, Samantha Kaye, Stuti L. Misra, Malcolm Battin, Charles N. J. McGhee, and Shuan Dai. "Prospective observational study of universal newborn eye screening in a hospital and community setting in New Zealand." BMJ Paediatrics Open 3, no. 1 (January 2019): bmjpo—2018–000376. http://dx.doi.org/10.1136/bmjpo-2018-000376.
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ObjectiveEarly detection of ocular abnormalities in newborn infants is essential for timely diagnosis and treatment. This study aimed to assess wide-field digital imaging for universal newborn eye screening (UNES) to determine the prevalence of ocular abnormalities, including retinal haemorrhages, in newborn infants in New Zealand.DesignProspective ocular screening study of infants.SettingA public hospital maternity ward and a community birth centre in Auckland, New Zealand.PatientsA total of 350 infants were enrolled in UNES, those with birth weight <1250 g or gestational age <30 weeks were excluded.MethodsWide-field digital images of the external eye and retina were captured by RetCam (Natus Medical, San Carlos, California, USA) and reviewed by an ophthalmologist via an established telemedicine methodology.Main outcome measuresDetection of ocular abnormalities, including retinal haemorrhages. Correlation between haemorrhages and maternal, obstetric and neonatal factors.ResultsA total of 346 infants completed screening (median age 2 days). Retinal haemorrhages were present in 50 cases (14.5%), two cases exhibited persistent retinal haemorrhages at 6-week follow-up. A significant increase in the odds of retinal haemorrhages was present for vaginal delivery compared with caesarean section. Other ocular abnormalities, including congenital cataract and optic nerve hypoplasia, were present in 1.4% of infants.ConclusionsOcular abnormalities were detected by UNES including congenital cataract and optic nerve hypoplasia. However, retinal haemorrhages, significantly associated with delivery modality, were the most common abnormality detected. The majority of retinal haemorrhages resolved spontaneously.
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Lien, Tsung-Chi, Laurie Covarrubias, Alice Ip, Harlan Husted, Emi Suzuki, and Chokechai Rongkavilit. "109. Develop and Implement a Novel Pediatric Antimicrobial Stewardship Program in a Non-Freestanding Children’s Hospital Located in an Adult-Centered Community Hospital in San Joaquin Valley, California." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S168—S169. http://dx.doi.org/10.1093/ofid/ofab466.311.
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Abstract Background A pediatric-specific antimicrobial stewardship program (Ped ASP) has been shown to optimize antimicrobial use, improve patient outcomes, and reduce healthcare expenditures in this population. Opportunities and challenges exist when developing a Ped ASP for a children’s hospital within an adult-centered medical center primarily due to mixed infrastructure. The objective of this study is to provide process and outcome data of a new Ped ASP in a non-freestanding children’s hospital within an adult-centered tertiary hospital. Methods A pediatric infectious disease physician and four pediatric pharmacists designed a Ped ASP utilizing direct and indirect patient care activities to optimize pediatric antimicrobial use in 21 bed-pediatric services within a 685-bed, adult-centered medical center. Implemented in 2020, Ped ASP activities include thrice weekly chart reviews followed by handshake rounds and quarterly reviews of documented interventions. The Ped ASP team also developed policies, education, and other resources to further guide appropriate antimicrobial use, in collaboration with the adult team. Results Ped ASP was initiated on general pediatric (PED) and pediatric intensive care (PICU) units. In 2020, a total of 286 charts were reviewed with 199 antibiotic interventions provided, including optimization of antimicrobial selection (23%), IV-to-PO conversion (15%), and antimicrobial dosage adjustment (13%). Annual average antibiotic length and days of therapy per 1000 patient-days were 241 and 290 respectively in PED, and 388 and 432 in PICU. The overall trend from 2020 to 2021 decreased in PED but increased in PICU (Fig. 1). The ratio of narrow to broad spectrum antibiotic use increased for both PED and PICU (Fig. 2). Simultaneously, a pediatric-specific antibiogram, extended-infusion protocol of beta-lactams, and neonatal sepsis treatment algorithm were developed and implemented. Antibiotic Days of Therapy per 1000 Patient Days Ratio of Narrow: Broad Spectrum Antibiotic Usage Conclusion A Ped ASP was successfully developed in a non-freestanding children’s hospital. Continual metrics served as an important tool to identify areas for improvement. Future goals include expansion of Ped ASP to other service lines, enhanced ASP education and development of additional pediatric antimicrobial treatment pathways. Disclosures All Authors: No reported disclosures
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Campos Mangas, M. C., and M. A. Ruiz Feliu. "Judicialized treatment in severe mental disorder." European Psychiatry 26, S2 (March 2011): 768. http://dx.doi.org/10.1016/s0924-9338(11)72473-7.
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IntroductionInvoluntary outpatient treatment (IOT) is a form of involuntary treatment applied in the community, which seeks to ensure adherence to treatment in patients suffering from severe mental illness, unaware of disease and in which abandonment of treatment poses a high risk of relapse, with the development of disruptive and violent behavior, and repeated hospitalizations (usually involuntary) and frequent emergencies.In 1997 was the first time was implemented in the province of Guipúzcoa, Spain.ObjectivesPerform an analysis of IOT in two mental health centers of San Sebastian.MethodsRetrospective descriptive study. The sample comprised all patients who are on involuntary outpatient treatment in two mental health centers in San Sebastian, from 2009 until June 2010.The collection of information is conducted through a review of the patient’s medical history, analyzing the following demographic and clinical data: age, sex, psychiatric diagnosis, evolution of the disease, number of hospital admissions and care in emergenciesResultsA sample population of 42 patients. 58% are male and 42% female. The average patient age is 48 years. The youngest person is 18 years and 81 years older.The years of evolution of the illness range from 2 to 25 years, with an average of 12 years. The average hospital admissions per patient is 4.For diagnosis, schizophrenia is the most common mental disorder. In second place: delusional disorder, bipolar disorder and schizoaffective disorder.ConclusionsIOT is most often applied to people with schizophrenia which have severe relapses with violent behavior or noncompliance.
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Lamers, Susanna, David Nolan, Yvette Simone McCarter, Chad Neilsen, Rebecca Rose, Christopher Rodriguez, and Stephanie Cross. "Using Whole-Genome Sequencing to Improve Surveillance Measures: Case Study of Methicillin-Resistant Staphylococcus aureus (MRSA) in a Florida Hospital." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s505—s506. http://dx.doi.org/10.1017/ice.2020.1186.
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Background: The CDC considers methicillin-resistant Staphylococcus aureus (MRSA) one of the most important hospital-acquired infections (HAIs) in the United States. However, infection control departments (ICDs) often rely on subjective data to determine whether multiple MRSA cases are a true outbreak and whether the hospital is responsible (community- vs hospital-acquired). Objective: Our objective was to determine whether whole-genome sequencing (WGS) of MRSA provided new insights into on transmission dynamics at large, inner-city hospital in Jacksonville, Florida. Methods: Over a 4-month period, MRSA samples were obtained from 44 infected patients at 3 campuses within a single hospital system. Limited nonpatient identifying information was obtained, including date of collection, campus, unit, reason for admission, and days post admission (DPA) of MRSA diagnosis. Whole-genome sequences were generated using the Illumina platform. Raw reads were processed, and genetic distances were calculated and used to identify genetically linked bacterial infections using FoxSeq version 1.0 software. Results: Based on their length of stay, 10 patients were reported by the ICD as obtaining an HAI. Three distinct “episodes” were evident in which >5 MRSA cases were observed within a 3–5-day period. Genomic analysis identified 5 clusters of linked infections: 4 clusters contained 2 patients and another contained 3. Of these clusters, only 1 contained multiple cases that were reported as HAIs; however, because these case were separated by 2 weeks, it is unlikely that they came from a source in the hospital. The results suggest that HAIs were overreported and that most MRSA present in the hospital likely came from community sources. Conclusions: WGS provided clear evidence that temporally clustered MRSA cases do not imply an outbreak is occurring. Furthermore, ongoing detection of the same community-acquired infections over several months is indicative of a shared source outside of the hospital, which could be uncovered through examination of clinical records. Considering the implications of HAIs, best approaches to combat them should include identifying their sources. As molecular surveillance approaches to infection control are rapidly becoming easier and less expensive, the methods can be used to bring objective clarity to the ICD.Funding: NoneDisclosures: Susanna L. Lamers reports salary from BioInfoExperts and contract research for the NIH, the University of California - San Francisco, and UMASS Medical School.
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Covington, Matthew F., Donna L. Agan, Yang Liu, John O. Johnson, and David J. Shaw. "Teaching Cost-Conscious Medicine: Impact of a Simple Educational Intervention on Appropriate Abdominal Imaging at a Community-Based Teaching Hospital." Journal of Graduate Medical Education 5, no. 2 (June 1, 2013): 284–88. http://dx.doi.org/10.4300/jgme-d-12-00117.1.
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Abstract Background Rising costs pose a major threat to US health care. Residency programs are being asked to teach residents how to provide cost-conscious medical care. Methods An educational intervention incorporating the American College of Radiology appropriateness criteria with lectures on cost-consciousness and on the actual hospital charges for abdominal imaging was implemented for residents at Scripps Mercy Hospital in San Diego, CA. We hypothesized that residents would order fewer abdominal imaging examinations for patients with complaints of abdominal pain after the intervention. We analyzed the type and number of abdominal imaging studies completed for patients admitted to the inpatient teaching service with primary abdominal complaints for 18 months before (738 patients) and 12 months following the intervention (632 patients). Results There was a significant reduction in mean abdominal computed tomography (CT) scans per patient (1.7–1.4 studies per patient, P < .001) and total abdominal radiology studies per patient (3.1–2.7 studies per patient, P = .02) following the intervention. The avoidance of charges solely due to the reduction in abdominal CT scans following the intervention was $129 per patient or $81,528 in total. Conclusions A simple educational intervention appeared to change the radiologic test-ordering behavior of internal medicine residents. Widespread adoption of similar interventions by residency programs could result in significant savings for the health care system.
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Sicignano, Claudia, Lorenzo Diana, Rossella Marmo, and Francesco Polverino. "Abandoned places, complexes and parts of cities. Regeneration and enhancement of monumental hospitals in the historic centre of Naples." VITRUVIO - International Journal of Architectural Technology and Sustainability 7, no. 1 (June 29, 2022): 78–91. http://dx.doi.org/10.4995/vitruvio-ijats.2022.17489.
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Even before Covid-19 although in the very center of the old town and historic center of Naples there were abandoned buildings and complexes, uninhabited and unused for decades. The cause is attributed to multiple reasons such as functional obsolescence, failure to adapt to intervening European standards in terms of hospital construction, technological facilities to standards, etc. The health crisis which strongly affected European societies revealed the fragilities of our healthcare systems. In Italy, a large number of COVID-19 patients congested hospitals while the continuity of essential services was interrupted at the expense of other needs. At the same time, the process of abandonment of historic buildings affects different monumental hospitals, such as the “San Giacomo degli Incurabili” and the “Carlo Forlanini” in Rome, or the “Gesù e Maria” Hospital, “San Gennaro dei Poveri” and the “Santa Maria del Popolo degli Incurabili” in Naples. This paper reports three case studies of Neapolitan historical hospitals regeneration proposals with the goal of strengthening the existing community healthcare system and developing energy efficiency and seismic improvement strategies in the spirit of sustainable development. Leveraging the flexibility of monumental hospitals, the proposed light retrofit interventions restore the historial healthcare functional destination ensuring also the reuse of such an heritage. The current research delineates an approach to the recovery and enhancement for social and cultural purposes of unused and abandoned historical hospitals. This approach can positively affect the quality of life of citizens and the use of health services, while recovering historical cultural heritage buildings.
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Vilke, Gary M., Alan M. Smith, Barbara M. Stepanski, Leslie Upledger Ray, Patricia A. Murrin, and Theodore C. Chan. "Impact of the San Diego County Firestorm on Emergency Medical Services." Prehospital and Disaster Medicine 21, no. 5 (October 2006): 353–58. http://dx.doi.org/10.1017/s1049023x00004003.
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AbstractBackground:In October 2003, San Diego County, California, USA, experienced the worst firestormin recent history. During the firestorm, public health leaders implemented multiple initiatives to reduce its impact on community health using health updates and news briefings. This study assessed the impact of patients with fire-related complaints on the emergency medical services (EMS) system during and after the firestorm.Methods:A retrospective review of a prehospital database was performed for all patients who were evaluated by advanced life support (ALS) ambulance personnel after calling the 9-1-1 emergency phone system for direct, fire related complaints from 19 October 2003 through 30 November 2003 in San Diego County. The study location has an urban, suburban, rural, and remote resident population of approximately three million and covers 4,300 square miles (2,050 km2). The prehospital patient database was searched for all patients with a complaint that was related directly to the fires. Charts were abstracted for data, including demographics, medical issues, treatments, and disposition status.Results:During the firestorm, fire consumed >380,000 acres (>938,980 hectares), including 2,454 residences and 785 outbuildings, and resulted in a total of 16 fatalities. Advanced life support providers evaluated 138 patients for fire related complaints. The majority of calls were for acute respiratory complaints. Other complaints included burns, trauma associated with evacuation or firefighting, eye injuries, and dehydration. A total of 78% of the injuries were mild. Twenty percent of the victims were firefighters, most with respiratory complaints, eye injuries, or injuries related to trauma. A total of 76% of the patients were transported to the hospital, while 10% signed out against medical advice.Conclusion:Although the firestorm had the potential to significantly impact EMS, pre-emptive actions resulted in minimal impact to emergency departments and the prehospital system. However, during the event, therewere a number of lessons learned that can be used in future events.
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Rizzo, Kyle R., Sarah H. Yi, Erin P. Garcia, Matt Zahn, and Erin Epson. "Reduction in Clostridium difficile infection rates following a multifacility prevention initiative in Orange County, California: A controlled interrupted time series evaluation." Infection Control & Hospital Epidemiology 40, no. 8 (May 24, 2019): 872–79. http://dx.doi.org/10.1017/ice.2019.135.
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AbstractObjective:To evaluate the Orange County Clostridium difficile infection (CDI) prevention collaborative’s effect on rates of CDI in acute-care hospitals (ACHs) in Orange County, California.Design:Controlled interrupted time series.Methods:We convened a CDI prevention collaborative with healthcare facilities in Orange County to reduce CDI incidence in the region. Collaborative participants received onsite infection control and antimicrobial stewardship assessments, interactive learning and discussion sessions, and an interfacility transfer communication improvement initiative during June 2015–June 2016. We used segmented regression to evaluate changes in monthly hospital-onset (HO) and community-onset (CO) CDI rates for ACHs. The baseline period comprised 17 months (January 2014–June 2015) and the follow-up period comprised 28 months (September 2015–December 2017). All 25 Orange County ACHs were included in the CO-CDI model to account for direct and indirect effects of the collaborative. For comparison, we assessed HO-CDI and CO-CDI rates among 27 ACHs in 3 San Francisco Bay Area counties.Results:HO-CDI rates in the 15 participating Orange County ACHs decreased 4% per month (incidence rate ratio [IRR], 0.96; 95% CI, 0.95–0.97; P < .0001) during the follow-up period compared with the baseline period and 3% (IRR, 0.97; 95% CI, 0.95–0.99; P = .002) per month compared to the San Francisco Bay Area nonparticipant ACHs. Orange County CO-CDI rates declined 2% per month (IRR, 0.98; 95% CI, 0.96–1.00; P = .03) between the baseline and follow-up periods. This decline was not statistically different from the San Francisco Bay Area ACHs (IRR, 0.97; 95% CI, 0.95–1.00; P = .09).Conclusions:Our analysis of ACHs in Orange County provides evidence that coordinated, regional multifacility initiatives can reduce CDI incidence.
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Hill, V., K. Bruner, G. Maciaz, L. Saucedo, L. Catzoela, R. Ramirez, W. J. Jacobs, et al. "Successful Implementation of Clinical Information Technology." Applied Clinical Informatics 06, no. 04 (2015): 698–715. http://dx.doi.org/10.4338/aci-2015-06-soa-0067.
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SummaryObjectives: To identify and describe the most critical strategic and operational contributors to the successful implementation of clinical information technologies, as deployed within a moderate sized system of U.S. community hospitals.Background and Setting: CHRISTUS Health is a multi-state system comprised of more than 350 services and 60 hospitals with over 9 000 physicians. The Santa Rosa region of CHRISTUS Health, located in greater San Antonio, Texas is comprised of three adult community hospital facilities and one Children’s hospital each with bed capacities of 142–180. Computerized Patient Order Entry (CPOE) was first implemented in 2012 within a complex market environment. The Santa Rosa region has 2 417 credentialed physicians and 263 mid-level allied health professionals.Methods: This report focuses on the seven most valuable strategies deployed by the Health Informatics team in a large four hospital CHRISTUS region to achieve strong CPOE adoption and critical success lessons learned. The findings are placed within the context of the literature describing best practices in health information technology implementation.Results: While the elements described involved discrete de novo process generation to support implementation and operations, collectively they represent the creation of a new customer-centric service culture in our Health Informatics team, which has served as a foundation for ensuring strong clinical information technology adoption beyond CPOE.Conclusion: The seven success factors described are not limited in their value to and impact on CPOE adoption, but generalize to – and can advance success in – varied other clinical information technology implementations across diverse hospitals. A number of these factors are supported by reports in the literature of other institutions’ successful implementations of CPOE and other clinical information technologies, and while not prescriptive to other settings, may be adapted to yield value elsewhere.
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Abdelmonem, M., T. Yu, J. Scot, R. Bandak, V. Davis, V. Javaherchian, G. Hatten, and M. Gines. "A Rare Case of Babesia microti in San Francisco East Bay." American Journal of Clinical Pathology 154, Supplement_1 (October 2020): S129. http://dx.doi.org/10.1093/ajcp/aqaa161.282.
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Abstract Introduction/Objective Babesia microti, a zoonotic intraerythrocytic parasite, is the primary etiological agent of human Babesiosis in the United States. Human infections range from subclinical illness to severe disease resulting in death, with symptoms being related to host immune status. Despite advances in our understanding and management of B. microti, the incidence of infection in the United States has increased. Therefore, research focused on eradicating disease and optimizing clinical management is essential. Here we review this remarkable organism, with emphasis on the clinical, diagnostic, and therapeutic aspects of human disease. Methods A 71-year-old Asian man presented to the emergency department in our San Francisco East Bay community hospital in July 2019 with complaints of high fever and chills for the last five days. The patient is a resident of Taiwan. He was visiting his daughter in New Jersey where he worked in her garden. He came to California to visit his son when he noted feelings of excessive tiredness, muscle aches, and headache. He also described a decrease in appetite and nausea with vomiting and diarrhea. Results His chest x-ray showed increased diffuse bilateral pulmonary infiltrate. He has a history of coronary artery disease post stent placement in 2011 and history of benign prostatic hypertrophy post transurethral resection of the prostate (TURP) On physical exam, He was febrile (103.1°F) and scleral icterus was identified. Laboratory workup revealed findings suggestive of hemolysis including increased LDH (401 U/L) and increased unconjugated bilirubin (1.7 mg/dL), critically low platelets and white blood cells of (32 and 2.9), while hemoglobin & hematocrit values in the normal range (13. g/dL & 36.8%, respectively). Elevated liver enzymes were also noted; AST 72 U/L and ALT 59 U/L. Upon examination of the blood smear, Malaria -like organisms were detected, and Maltese cross forms were also visible in the red blood cells. Those findings were also seen using Giemsa stain and were confirmed at the Alameda county lab. PCR was also positive for Babesia microti. Investigation for concurrent infection with Ehrlichia chaffeensis, Anaplasma phagocytophilum and Borrelia burgdorferi was negative. Conclusion This case highlights the importance of timely and effective collaboration between the laboratory staff and clinicians.
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Cona, Andrea, Alessandro Tavelli, Andrea Renzelli, Benedetta Varisco, Francesca Bai, Daniele Tesoro, Alessandro Za, et al. "Incidence, Risk Factors and Impact on Clinical Outcomes of Bloodstream Infections in Patients Hospitalised with COVID-19: A Prospective Cohort Study." Antibiotics 10, no. 9 (August 24, 2021): 1031. http://dx.doi.org/10.3390/antibiotics10091031.
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With the aim of describing the burden and epidemiology of community-acquired/healthcare-associated and hospital-acquired bloodstream infections (CA/HCA-BSIs and HA-BSIs) in patients hospitalised with COVID-19, and evaluating the risk factors for BSIs and their relative impact on mortality, an observational cohort study was performed on patients hospitalised with COVID-19 at San Paolo Hospital in Milan, Italy from 24 February to 30 November 2020. Among 1351 consecutive patients hospitalised with COVID-19, 18 (1.3%) had CA/HCA-BSI and 51 (3.8%) HA-BSI for a total of 82 episodes of BSI. The overall incidence of HA-BSI was 3.3/1000 patient-days (95% CI 2.4–4.2). Patients with HA-BSI had a longer hospital stay compared to CA/HCA-BSI and no-BSI groups (27 (IQR 21–35) vs. 12 (7–29) vs. 9 (5–17) median-days, p < 0.001) but a similar in-hospital mortality (31% vs. 33% vs. 25%, p = 0.421). BSI was not associated with an increased risk of mortality (CA/HCA-BSI vs. non-BSI aOR 1.27 95% CI 0.41–3.90, p = 0.681; HA-BSI vs. non-BSI aOR 1.29 95% CI 0.65–2.54, p = 0.463). Upon multivariate analysis, NIMV/CPAP (aOR 2.09, 95% CI 1.06–4.12, p = 0.034), IMV (aOR 5.13, 95% CI 2.08–12.65, p < 0.001) and corticosteroid treatment (aOR 2.11, 95% CI 1.06–4.19, p = 0.032) were confirmed as independent factors associated with HA-BSI. Development of HA-BSI did not significantly affect mortality. Patients treated with corticosteroid therapy had double the risk of developing BSI.
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Jones, Jessica Trevino, Manuel Ricardo Espinoza-Gutarra, Sushanth Kakarla, Michelle Janania Martinez, David Gregorio, Prathibha Surapaneni, Michael Mader, and Zohra Nooruddin. "Veterans Treated with R-CHOP for Diffuse Large B Cell Lymphoma Compared to Neighboring Hospital: An Interesting Discovery for Treatment Outcomes." Blood 132, Supplement 1 (November 29, 2018): 3604. http://dx.doi.org/10.1182/blood-2018-99-119667.
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Abstract BACKGROUND: Diffuse Large B cell Lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL). Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) remains the standard of care for most advanced stage DLBCL. There is limited outcome data in DLBCL in Veteran population. Having unique health care access, our goal was to study basic characteristics of Veterans with DLBCL and to assess and compare treatment responses to similar patient population. METHODS: With IRB approval, we performed a retrospective analysis of DLBCL patients (n=55) who received R-CHOP at the VA Audie Murphy Hospital in San Antonio, Texas from 2007-2017. We compared the Veteran patients with DLBCL who received R-CHOP to Insured Community Setting ICS (n=58) and uninsured patients UCS (n=24) from 2007-2017 in the same zip code. Only patients who started and completed their care with respective institutions were included in this study. Rates of neutropenia, and use of hematopoietic support either pre-emptively or after infection were measured for VA patients. Other variables studied included LDH, stage, HIV status, age, time from definitive diagnosis to first R-CHOP treatment (TDT), treatment response (CR, PR, PD), relapse date, and morbidity/mortality. Similar variables were compared for patients at neighboring community stetting. Outcomes were compared based on health care access - Veterans (VA) vs Insured Community Setting (ICS) vs Uninsured Community Setting (UCS). Frequency among variables and predictive analysis were evaluated by the FREQ and NPAR1WAY procedures in SAS 9.4 using the Chi-squared Test of Independence and the Cochran-Mantel-Haenszel test. RESULTS The median age of diagnosis was 64.5 years (yrs.), 57 yrs. and 58 yrs. for the VA patients, ICS and UCS patients respectively. TDT for VA vs ICS vs UCS was 20 days vs. 22 days vs. 21.5 days (p=0.66). VA patients had a higher rate of stage III/IV disease at 78% compared to ICS 53% and UCS 43% (p=0.0033). Accounting for the higher rate of Stage III/IV cancers in the VA population, there was a higher failure rate of 40 % among VA patients vs 18 % for ICS vs 20 % for UCS to initial chemotherapy(p=0.034). CONCLUSION Our comparison data of VA patients with DLBCL receiving R-CHOP to a neighboring community setting show similar TDT. Response to initial treatment was inferior in Veteran population as compared to patient population with similar demographics and having similar TDT. Also, in comparing VA patients to uninsured patients, VA patients still have worse outcomes for treatment of DLBCL with R- CHOP. Older patient population, advanced stage and multiple co-morbidities are the possible contributing factors for difference in treatment outcomes for DLBCL in the VA community. Disclosures No relevant conflicts of interest to declare.
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Bove, Riley, Tanuja Chitnis, Bruce AC Cree, Mar Tintoré, Yvonne Naegelin, Bernard MJ Uitdehaag, Ludwig Kappos, et al. "SUMMIT (Serially Unified Multicenter Multiple Sclerosis Investigation): creating a repository of deeply phenotyped contemporary multiple sclerosis cohorts." Multiple Sclerosis Journal 24, no. 11 (August 29, 2017): 1485–98. http://dx.doi.org/10.1177/1352458517726657.
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Background: There is a pressing need for robust longitudinal cohort studies in the modern treatment era of multiple sclerosis. Objective: Build a multiple sclerosis (MS) cohort repository to capture the variability of disability accumulation, as well as provide the depth of characterization (clinical, radiologic, genetic, biospecimens) required to adequately model and ultimately predict a patient’s course. Methods: Serially Unified Multicenter Multiple Sclerosis Investigation (SUMMIT) is an international multi-center, prospectively enrolled cohort with over a decade of comprehensive follow-up on more than 1000 patients from two large North American academic MS Centers (Brigham and Women’s Hospital (Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women’s Hospital (CLIMB; BWH)) and University of California, San Francisco (Expression/genomics, Proteomics, Imaging, and Clinical (EPIC))). It is bringing online more than 2500 patients from additional international MS Centers (Basel (Universitätsspital Basel (UHB)), VU University Medical Center MS Center Amsterdam (MSCA), Multiple Sclerosis Center of Catalonia-Vall d’Hebron Hospital (Barcelona clinically isolated syndrome (CIS) cohort), and American University of Beirut Medical Center (AUBMC-Multiple Sclerosis Interdisciplinary Research (AMIR)). Results and conclusion: We provide evidence for harmonization of two of the initial cohorts in terms of the characterization of demographics, disease, and treatment-related variables; demonstrate several proof-of-principle analyses examining genetic and radiologic predictors of disease progression; and discuss the steps involved in expanding SUMMIT into a repository accessible to the broader scientific community.
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Adams-Sapper, Sheila, Binh An Diep, Francoise Perdreau-Remington, and Lee W. Riley. "Clonal Composition and Community Clustering of Drug-Susceptible and -Resistant Escherichia coli Isolates from Bloodstream Infections." Antimicrobial Agents and Chemotherapy 57, no. 1 (November 12, 2012): 490–97. http://dx.doi.org/10.1128/aac.01025-12.
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ABSTRACTMultidrug-resistantEscherichia colistrains belonging to a single lineage frequently account for a large proportion of extraintestinalE. coliinfections in many parts of the world. However, limited information exists on the community prevalence and clonal composition of drug-susceptibleE. colistrains. Between July 2007 and September 2010, we analyzed all consecutively collected Gram-negative bacterial isolates from patients with bloodstream infection (BSI) admitted to a public hospital in San Francisco for drug susceptibility and associated drug resistance genes. TheE. coliisolates were genotyped forfimHsingle nucleotide polymorphisms (SNPs) and multilocus sequence types (MLSTs). Among 539 isolates,E. coliaccounted for 249 (46%); 74 (30%) of them were susceptible to all tested drugs, and 129 (52%) were multidrug resistant (MDR). Only five MLST genotypes accounted for two-thirds of theE. coliisolates; the most common were ST131 (23%) and ST95 (18%). Forty-seven (92%) of 51 ST131 isolates, as opposed to only 8 (20%) of 40 ST95 isolates, were MDR (P< 0.0001). The Simpson's diversity index for drug-susceptible ST genotypes was 87%, while the index for MDR ST genotypes was 81%. ST95 strains were comprised of fourfimHtypes, and one of these (f-6) accounted for 67% of the 21 susceptible isolates (P< 0.003). A large proportion (>70%) of both MDR and susceptibleE. coliBSI isolates represented community-onset infections. These observations show that factors other than the selective pressures of antimicrobial agents used in hospitals contribute to community-onset extraintestinal infections caused by clonal groups ofE. coliregardless of their drug resistance.
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Patel, Devika, Siavash Sarlati, Patrick Martin-Tuite, Joshua Feler, Lara Chehab, Michael Texada, Ruben Marquez, et al. "Designing an Information and Communications Technology Tool With and for Victims of Violence and Their Case Managers in San Francisco: Human-Centered Design Study." JMIR mHealth and uHealth 8, no. 8 (August 24, 2020): e15866. http://dx.doi.org/10.2196/15866.
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Background Violence is a public health problem. Hospital-based violence intervention programs such as the San Francisco Wraparound Project (WAP) have been shown to reduce future violent injury. The WAP model employs culturally competent case managers who recruit and enroll violently injured patients as clients. Client acceptance of the WAP intervention is variable, and program success depends on streamlined, timely communication and access to resources. High rates of smartphone usage in populations who are at risk for violent reinjury create an opportunity to design a tailored information and communications technology (ICT) tool to support hospital-based violence intervention programs. Objective Current evidence shows that ICT tools developed in the health care space may not be successful in engaging vulnerable populations. The goal of this study was to use human-centered design methodology to identify the unique communication needs of the clients and case managers at WAP to design a mobile ICT. Methods We conducted 15 semi-structured interviews with users: clients, their friends and families, case managers, and other stakeholders in violence intervention and prevention. We used a human-centered design and general inductive approach to thematic analysis to identify themes in the qualitative data, which were extrapolated to insight statements and then reframed into design opportunities. Wireframes of potential mobile ICT app screens were developed to depict these opportunities. Results Thematic analysis revealed four main insights that were characterized by the opposing needs of our users. (1) A successful relationship is both professional and personal. Clients need this around the clock, but case managers can only support this while on the clock. (2) Communications need to feel personal, but they do not always need to be personalized. (3) Healing is a journey of skill development and lifestyle changes that must be acknowledged, monitored, and rewarded. (4) Social networks need to provide peer support for healing rather than peer pressure to propagate violence. These insights resulted in the following associated design opportunities: (1) Maximize personal connection while controlling access, (2) allow case managers to personalize automated client interactions, (3) hold clients accountable to progress and reward achievements, and (4) build a connected, yet confidential community. Conclusions Human-centered design enabled us to identify unique insights and design opportunities that may inform the design of a novel and tailored mobile ICT tool for the WAP community.
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Lin, Janet Y., Renee King, Naina Bhalla, and Caroline Brander. "Assessment of Prehospital Care and Disaster Preparedness in a Rural Guatemala Clinic." Prehospital and Disaster Medicine 26, no. 1 (February 2011): 27–32. http://dx.doi.org/10.1017/s1049023x10000063.
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AbstractIntroduction: In October 2005, Hurricane Stan impacted Central America, causing severe damage to Guatemala. The main objectives of this study are to report on the effects of Hurricane Stan in rural Guatemala, to assess the responses of a rural clinic during and after the storm, and to identify ways in which the clinic can better prepare for future disasters. The clinic is located in Catarina, San Marcos, Guatemala. Roughly 400–500 patients are attended to each week at the clinic.Methods: Survey data were obtained during a two-week period using a convenience sample of people at the clinic and in the surrounding community.Results: The major medical problems after the impact of Hurricane Stan included fungal infections, upper respiratory infections, diarrhea, and emotional problems. The most needed supplies included food, electricity, home repair, potable water, communication, and clothing. In the immediate aftermath of event, 61% of the participants could not get to a hospital; however, most did not require medical assistance.Conclusions: Hurricane Stan had a devastating effect on the San Marcos region of Guatemala. While the clinic could have served as a resource center and a base, it was not prepared to address the community's health needs after the hurricane as there were no previous plans in place for disaster response for the clinic or for the community. Next steps include developing a preparedness plan to utilize the clinic as a local resource center , in the event that the planned national disaster responses are delayed or unable to reach the affected area.
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Wyte-Lake, DPT, MPH, Tamar, Susan Schmitz, MAIDP, Cosme Torres-Sabater, RN, MEP, CHCM, and Aram Dobalian, PhD, JD. "Case study of VA Caribbean Healthcare System’s community response to Hurricane Maria." Journal of Emergency Management 19, no. 8 (September 1, 2021): 189–99. http://dx.doi.org/10.5055/jem.0536.
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Background: Hurricane Maria, which hit Puerto Rico in 2017, catastrophically impacted infrastructure and severely disrupted medical services. The US Department of Veterans Affairs Caribbean Healthcare System (VA CHCS), which serves approximately 67,000 patients and has most of its facilities on the island of Puerto Rico, was able to successfully maintain operations after the hurricane. As a part of the larger VA system, VA CHCS also has a mission to support “national, state, and local emergency management, public health, safety and homeland security efforts.” The objective of this study is to better understand the ways VA and its facilities meet this mission by exploring how VA CHCS acted as a community resource following Hurricane Maria.Methods: This study investigated experiences of five employees in critical emergency response positions for VA CHCS, Veterans Integrated Service Networks (VISN) 8, and the Office of Emergency Management. All respondents were interviewed from March to July 2019. Data were collected via semistructured interviews exploring participants’ experiences and knowledge about VA’s activities provided to the community of Puerto Rico following Hurricane Maria. Data were analyzed using thematic and in vivo coding methods. Results: All respondents underscored VA’s primary mission after a disaster was to maintain continuity of care to Veterans, while concomitantly describing the role of VA in supporting community recovery. Three major themes emerged: continuity of operations for the San Juan VA Medical Center (VAMC) and its affiliated outpatient clinics, provision of services as a federal partner, and services provided directly to the Puerto Rican community.Discussion: Recent disasters have revealed that coordinated efforts between multidisciplinary agencies can strengthen communities’ capacity to respond. This case example demonstrates how a VA hospital not only continued serving its patients but, with the support from the greater VA system, also filled a wide variety of requests and resource gaps in the community. Building relationships with local VAMCs can help determine how VA could be incorporated into emergency management strategies. In considering the strengths community partners can bring to bear, a coordinated regional response would benefit from involving VA as a partner during planning.
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Kraushaar, Vit, Pam Daily Kirley, Ashley Coates, and Arthur Reingold. "690. Bacterial Coinfections Among Adults Hospitalized with Community-Associated Influenza, 2016–2017." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S249. http://dx.doi.org/10.1093/ofid/ofy210.697.
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Abstract Background Influenza and bacterial coinfection are associated with increased symptom severity and worse health outcomes. We used data from the population based Influenza Hospitalization Surveillance Network (FluSurv-Net) California site to describe adult influenza hospitalizations with and without bacterial coinfections and evaluate the risk of severe disease. Methods We included data from adults hospitalized with laboratory confirmed influenza during the 2016/2017 influenza season who resided in San Francisco, Alameda or Contra Costa counties and had a bacterial culture performed ≤ 3 days after admission. We excluded records for healthcare facility-associated influenza. Univariate analyses were used to describe demographics, clinical characteristics and outcomes. Multivariate logistic regression was used to evaluate the effect of bacterial coinfection as a risk factor for severe outcome, defined as admission to an intensive care unit (ICU) or death during hospitalization. Results Among 2,029 adult influenza hospitalizations, 102 had ≥1 positive bacterial cultures. There were 119 bacterial isolates from blood (58), respiratory sites (60), and joint fluid (1). The most frequent blood isolates were Streptococcus pneumoniae (11), and Staphylococcus aureus (10). The most frequent respiratory isolates were S. aureus (30) and S. pneumoniae (7). Coinfected persons were younger (median age 71 vs. 78), and more likely to have past or current alcohol abuse or immunosuppression. Coinfected patients were more likely to be admitted to an ICU (45% vs. 15%) or die (16.0% vs. 3.6%). The median length of hospital stay was twice as long for coinfected patients (6 days vs. 3). In multivariate analyses, bacterial coinfection (aOR, 4.49; 95% CI, 2.99–6.72), chronic lung disease (aOR, 1.52; 95% CI, 1.18–1.95) and cardiovascular disease (aOR, 1.48; 95% CI, 1.15–1.90) were associated with a severe outcome. Conclusion Bacterial coinfection was associated with a four-fold higher risk of ICU admission and death during hospitalization. This study highlights the need for clinicians to maintain a high index of suspicion for the presence of bacterial coinfection among patients with influenza requiring hospitalization. Disclosures All authors: No reported disclosures.
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Dixit, Niharika, Piera Wong, Robin McBride, Ditas Hernandez, and Barbara Cicerelli. "Survivorship care plans in safety net: Bridging the barriers." Journal of Clinical Oncology 36, no. 7_suppl (March 1, 2018): 68. http://dx.doi.org/10.1200/jco.2018.36.7_suppl.68.
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68 Background: Survivorship care plans (SCPs) are considered an important tool in survivorship care. SCP should include treatment summaries and follow up care plans and are intended to improve survivorship care. Despite the institute of medicine (IOM) recommendation regarding SCPs, the uptake has been low in community cancer centers. The safety net hospitals face additional challenges to SCPs including patient who may have low health literacy and limited English proficiency. In addition, resources and personnel constraints can be important barriers for implementation of SCPs. Methods: Zuckerberg San Francisco General Hospital is a safety net hospital in the City and County of San Francisco. We created SCPs for breast cancer survivors, as it is our largest group of cancer survivors. Patients, who were within 5 years of completion of treatment with curative intent for breast cancer were candidates for receiving SCPs. We used ASCO survivorship template to create a survivorship care plan. ASCO breast cancer SCP was discussed in the focus groups and modified to match the needs of our patients. SCP committee and patient advisory board evaluated the SCP prior to a pilot of the SCPs in the clinic. We piloted the SCPs initially in English and Spanish to assess feedback from clinic providers. After requested modifications SCP was then translated in to simplified Chinese. The SCP delivery was embedded in the clinic flow and was done at time of routine clinic visit to reduce the burden of additional visits. Results: 104/175 eligible patients have already received the SCP over one year period. All providers in the clinic participated in delivery of SCPs. Conclusions: SCP in multiple languages can be implemented successfully in safety net setting in a patient population with low health literacy and limited English proficiency. Availability in multiple languages, provider buy–in and embedding SCPs in clinic flow appears to be important factors in implementation. We are evaluating the optimal process of SCP delivery with an ongoing randomized pilot study of SCPs with and without navigation with breast cancer related quality of life and self-efficacy measures. We are also evaluating the usefulness of SCPs in meeting the informational needs of primary care providers.
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Izano, Monika A., Lara J. Cushing, Jue Lin, Stephanie M. Eick, Dana E. Goin, Elissa Epel, Tracey J. Woodruff, and Rachel Morello-Frosch. "The association of maternal psychosocial stress with newborn telomere length." PLOS ONE 15, no. 12 (December 10, 2020): e0242064. http://dx.doi.org/10.1371/journal.pone.0242064.
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Background Telomere length in early life predicts later length, and shortened telomere length among adults and children has been linked to increased risk of chronic disease and mortality. Maternal stress during pregnancy may impact telomere length of the newborn. Methods In a diverse cohort of 355 pregnant women receiving prenatal and delivery care services at two hospitals in San Francisco, California, we investigated the relationship between self-reported maternal psychosocial stressors during the 2nd trimester of pregnancy and telomere length (T/S ratio) in newborn umbilical cord blood leukocytes. We examined financial strain, food insecurity, high job strain, poor neighborhood quality, low standing in one’s community, experience of stressful/traumatic life events, caregiving for a dependent family member, perceived stress, and unplanned pregnancy. We used linear regression and Targeted Minimum Loss-Based Estimation (TMLE) to evaluate the change in the T/S ratio associated with exposure to each stressor controlling for maternal age, education, parity, race/ethnicity, and delivery hospital. Results In TMLE analyses, low community standing (-0.09; 95% confidence interval [CI]-0.19 to 0.00) and perceived stress (-0.07; 95% CI -0.15 to 0.021 was marginally associated with shorter newborn telomere length, but the associations were not significant after adjusting for multiple comparisons. All linear regression estimates were not statistically significant. Our results also suggest that the association between some maternal stressors and newborn telomere length varies by race/ethnicity and infant sex. Conclusions This study is the first to examine the joint effect of multiple stressors during pregnancy on newborn TL using a flexible modeling approach.
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Chapwell, Clair. "Bring on the health economists: time for a rigorous evaluation of senior participative arts." Working with Older People 18, no. 1 (March 4, 2014): 4–9. http://dx.doi.org/10.1108/wwop-11-2013-0028.
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Purpose – As our elderly population increases, scheduled to rise by 61 per cent in the next 20 years, a national panic has set in about what to do. Antidepressant use is on the rise, and the figures for loneliness and depression skyrocketing. So far, so normal and so very disheartening. The purpose of this paper is to make a radical plea to change our thinking about how the lives of our senior citizens are lived: bring on the health economists, and let us put some serious funding into studying the effects of participative arts on the lives of older people. Design/methodology/approach – This year the author was awarded a Winston Churchill Fellowship to study participative arts for older people in the USA. The author interviewed Professor Julene Johnson of University of California San Francisco, about “Community of Voices” an ambitious, well-funded five year programme which is launching 12 one-year choirs with low income, non-singers, after which findings will be rigorously tested. Findings – In the USA, proper evaluation of participative arts is being taken seriously as a means of whittling down massive Medicare costs. There is evaluation going on in the UK, but much of it is flawed, usually down to cost. Evaluations generally consist of questionnaires filled in by participants. Findings centre around the psychological arena, rather than physical aspects (balance, hospital visits). Originality/value – It is imperative that one starts thinking about participative arts for seniors in a scientific and serious way. The alternative – roomfuls of elders on antidepressants (the UK's antidepressant use was up 23 per cent between 2010 and 2011) does not bear thinking about.
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Valencia Cuevas, Diego José. "Factores biológicos, socioambientales y clínico radiológicos asociados a neumonía adquirida en la comunidad en menores de 5 años en un hospital público del Perú." Salud Uninorte 38, no. 01 (May 5, 2022): 193–207. http://dx.doi.org/10.14482/sun.38.1.616.241.
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Introducción: La Neumonía Adquirida en la Comunidad (NAC) es una patología inflamatoria que daña la vía respiratoria baja, generalmente de etiología infecciosa. Afecta el parénquima pulmonar produciendo alteración en la hematosis alveolar, ocasionando hipoxemia progresiva. Objetivo: Determinar cómo los factores biológicos, socioambientales, clínico radiológicos y analíticos se asocian al desarrollo de NAC en menores de 5 años hospitalizados en un Hospital Público del Perú durante el año 2019. Materiales y Métodos: Estudio observacional, retrospectivo, analítico, tipo casos y controles. El tamaño muestral se realizó mediante muestreo aleatorio simple, no pareado, obteniendo 71 casos y 71 controles en el Servicio de Pediatría del Hospital San José durante el año 2019. Resultados: El sexo masculino predominó en los pacientes con NAC (54.9%); pero no hubo asociación significativa entre este sexo y NAC (OR: 1.67 IC: 0.86-3.23, p: 0.13). Los resultados estadísticamente significativos asociados a NAC fueron lactancia materna no efectiva (OR: 6.85, IC 95%: 3.18-14.75) y antecedente de enfermedades respiratorias (OR: 5.41, IC 95%: 2.58-11.34) Conclusiones: Los factores biológicos, lactancia materna no efectiva y antecedente de enfermedades respiratorias se encuentran asociados a NAC en menores de 5 años.
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Kung, Michael S., Andrea Lozano, Vicente J. Covas, Lorena Rivera-González, Yllen Y. Hernández-Blanco, Yaritza Diaz-Algorri, and Sandra Chinapen. "Assessing Medical Students’ Knowledge of the Deaf Culture and Community in Puerto Rico: A Descriptive Study." Journal of Medical Education and Curricular Development 8 (January 2021): 238212052199232. http://dx.doi.org/10.1177/2382120521992326.
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Background: Effective communication between health care professionals and Deaf and Hard of Hearing (D&HH) patients remains a challenge. Literature regarding health professionals’ knowledge of the D&HH community and their barriers toward health care access is limited in Puerto Rico and suggests a need for research. Therefore, this descriptive study aims to evaluate future physician’s knowledge about the Deaf culture and community in a student cohort at San Juan Bautista School of Medicine (SJBSM), with the objective of guiding our results toward improving our curriculum. Methods: Medical students answered a survey to evaluate their knowledge of D&HH patients. The survey consisted of 3 parts testing awareness, exposure, and knowledge of the Deaf community. Responses from the Knowledge section were graded using an answer key, and correct answers were added to create an overall continuous sum score per participant, with higher scores meaning higher knowledge. Participants were also asked to write in possible issues deaf patients may face when hospitalized, apart from communication problems. All data were recorded and used for descriptive analysis. Results: 158 (68%) medical students participated. 63% reported exposure to D&HH people, and 80% were aware of the Deaf culture. 21% of students answered to have attended an American Sign Language (ASL) class, and 86% expressed interest in taking an ASL class. The overall percentage of correct answers from all the medical groups evaluated was 39%, with increasing percent knowledge as medical student year increased. The most frequently listed problem by respondents that deaf patients may face when hospitalized was dealing with an emergency in the hospital, such as the fire alarm. Conclusion: Students from clinical years (MSIII & MSIV) showed a better understanding of the Deaf culture than students in pre-clinical years (MSI & MSII). Nevertheless, the knowledge was limited in all groups. The information generated is not only valuable for our school but the healthcare community as well. The literature related to Deaf culture, particularly in the medical setting in Puerto Rico, is limited. Therefore, there exists a need to continue investigating ways to improve medical students’ education of the Deaf culture and community.
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Westgard, Christopher Michael, Natalia Rivadeneyra, and Patricia Mechael. "mHealth tool to improve community health agent performance for child development: study protocol for a cluster-randomised controlled trial in Peru." BMJ Open 9, no. 11 (November 2019): e028361. http://dx.doi.org/10.1136/bmjopen-2018-028361.
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IntroductionCultivating child health and development creates long-term impact on the well-being of the individual and society. The Amazon of Peru has high levels of many risk factors that are associated with poor child development. The use of ‘community health agents’ (CHAs) has been shown to be a potential solution to improve child development outcomes. Additionally, mobile information and communication technology (ICT) can potentially increase the performance and impact of CHAs. However, there is a knowledge gap in how mobile ICT can be deployed to improve child development in low resource settings.Methods and analysisThe current study will evaluate the implementation and impact of a tablet-based application that intends to improve the performance of CHAs, thus improving the child-rearing practices of caregivers and ultimately child health and development indicators. The CHAs will use the app during their home visits to record child health indicators and present information, images and videos to teach key health messages. The impact will be evaluated through an experimental cluster randomised controlled trial. The clusters will be assigned to the intervention or control group based on a covariate-constrained randomisation method. The impact on child development scores, anaemia and chronic malnutrition will be assessed with an analysis of covariance. The secondary outcomes include knowledge of healthy child-rearing practices by caregivers, performance of CHAs and use of health services. The process evaluation will report on implementation outcomes. The study will be implemented in the Amazon region of Peru with children under 4. The results of the study will provide evidence on the potential of a mHealth tool to improve child health and development indicators in the region.Ethics and disseminationThe study received approval from National Hospital ‘San Bartolome’ Institutional Ethics Committee on 8 November 2018 (IRB Approval #15463–18) and will be disseminated via peer-reviewed publications.Trial registration numberISRCTN43591826.
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A, laRoche, Arredondo B, Devito A, Bailey A, Mizuki B, Boettcher A, Brickell E, and Sawyer J. "A-01 Dementia Care Ecosystem: Health Care Utilization at Six Months." Archives of Clinical Neuropsychology 35, no. 6 (August 28, 2020): 791. http://dx.doi.org/10.1093/arclin/acaa068.01.
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Abstract Objective This study implemented the University of California, San Francisco (UCSF) Care Ecosystem Program, a Persons with Dementia (PWD)- and Caregiver (CG)-centered model of dementia care designed to improve quality of life and reduce the cost of care associated with emergency department (ED) visits and hospitalizations. Method Community-dwelling PWD and CGs at a southern regional medical system who had a diagnosis of dementia and at least one hospitalization or ED visit in the previous 12 months were prospectively enrolled in a mixed method study. These dyads (N = 54) completed monthly visits for six months, including behavior management, financial and advanced care planning, caregiver well-being, and navigating community and healthcare resources. PWD were predominantly Caucasian (70.4%; 30% African American) and female (53.7%), with an average age of 80.26 (SD = 6.99). CGs were demographically similar, but younger [M(SD) = 66.18(12.89)]. Results ED utilization decreased by 41% (51 visits in 6 months prior to enrollment vs. 30 visits post enrollment); [pre-M(SD) = 0.94(1.57); post-M(SD) = 0.56(1.11); 95% Confidence Interval − 0.09—0.86; t = 1.64, p > .05; Cohen’s d = 0.28]. On a paired samples t-test, there was a small effect despite not reaching statistical significance. Hospitalizations decreased by 43% (30 in 6 months prior to enrollment, 17 post enrollment); [pre-M(SD) = 0.56(1.09); post-M(SD) = 0.31(0.77); 95% Confidence Interval − 0.03—0.51; t = 1.79, p > .05; Cohen’s d = .26]. Again, there was a small effect despite not reaching statistical significance. Conclusions Preliminary results suggested a trend toward reduced hospital utilization. Future analysis on cost savings and other benefits of this type of program will be crucial to sustainability.
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Holmen, Jenna, Bryanna Cikesh, Lindsay Kim, and Art Reingold. "2325. Relationship Between Neighborhood Census-Tract-Level Poverty and Respiratory Syncytial Virus Infection in hospitalized Adults in the San Francisco Bay area, CA 2015–2017." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S798. http://dx.doi.org/10.1093/ofid/ofz360.2003.
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Abstract Background In the United States, respiratory syncytial virus (RSV) is a leading cause of admission for adults with respiratory illness. In adults > 50 years of age, it accounts for up to 12% of medically-attended acute respiratory illnesses and has a case fatality proportion of ~6–8%. Poverty can have an important influence on health. Few studies have evaluated the relationship of RSV incidence and poverty level, and no identified studies have evaluated this relationship among adults. We evaluated the incidence of RSV-associated hospitalizations in adults in the San Francisco Bay Area, CA by census-tract-level poverty. Methods Medical record data abstraction was conducted for all adults with a laboratory-confirmed RSV infection who were admitted to a hospital within the 3 counties comprising the catchment area (Alameda, Contra Costa, and San Francisco counties) during the 2015–2016 and 2016–2017 RSV seasons. Patient addresses were geocoded to their corresponding census-tract (CT). Census tracts were divided into four levels of poverty based on American Community Survey data of percentage of people living below the poverty level: 0–4.9%, 5–9.9%, 10-–9.9%, and ³20%. Incidence rates were calculated by dividing the number of RSV cases in each CT poverty-level (numerator) by the number of adults living in each CT poverty level (denominator), as determined from the 2010 US census, and standardized for age. Results There were 526 RSV case-patients with demographic characteristics as outlined in Table 1. The highest incidence of RSV-associated hospitalization was in CTs associated with the highest levels of poverty (>20%). However, the second highest incidence of RSV-associated hospitalization occurred among adults living in CTs with <5% poverty (Figure 1 and Table 2). Conclusion The incidence rate of RSV-associated hospitalization in adults appears to be positively correlated with highest census-tract level of poverty; however, there is a high incidence among adults living in the lowest poverty census-tracts. Disclosures All authors: No reported disclosures.
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McGann, Patrick T., Margarida Muhongo, Elizabeth McGann, Vysolela de Oliveira, Brigida Santos, and Russell E. Ware. "Successful Outcomes Of An Infant Sickle Cell Clinic In Luanda, Angola." Blood 122, no. 21 (November 15, 2013): 2934. http://dx.doi.org/10.1182/blood.v122.21.2934.2934.
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Abstract Background Sickle cell anemia (SCA) is a significant, under recognized contributor to global childhood mortality, especially in sub-Saharan Africa. Early diagnosis is critical to enable timely access to care and education, before severe and life-threatening complications develop in the first year of life. Unfortunately, such early and comprehensive care remains largely unavailable for many infants across Africa. In an attempt to reduce the high early mortality associated with SCA, an infant SCA clinic was developed and implemented in the capital city of Luanda, Angola. We describe the early experiences and successful outcomes for infants enrolled in this clinic. Methods Infants were enrolled in the clinic if the diagnosis of SCA was made in the first year of life. The clinic was established in the major public pediatric hospital in Angola, Hospital Pediátrico David Bernardino (HPDB). The vast majority of enrolled infants were diagnosed by newborn screening at local maternity hospitals, while some were diagnosed due to clinical suspicion or known family history. Initial clinic visit included intake of demographics such as contact information, family history, and details of basic housing conditions. A dried bloodspot was collected and the diagnosis of SCA was confirmed by isoelectric focusing. All families received sickle cell education and confirmed infants received penicillin prophylaxis (125 mg by mouth twice per day), pneumococcal vaccination series (Prevnar-13), and an insecticide-treated mosquito net for malaria prophylaxis. Results In the first twenty months of the HPDP Infant SCA clinic, 301 infants were enrolled. Eighty-one percent (244/301) were identified through the associated newborn screening program, while the remaining fifty-seven infants presented due to clinical symptoms or known family history. Families live in the urban and poverty-stricken Luanda. The average household has 6.4 people with 2.8 people per bedroom. Only 34.2% of families reported access to water within their household. Despite poverty and difficult housing situations, continued follow-up was extraordinarily high at 97.3%. After the initial visit, only eight families (2.7%) chose not to follow-up – four preferred faith or traditional healing techniques, and four chose follow-up care at a private clinic. With a concentrated effort to track and enable timely follow-up care, there were zero babies truly “lost to follow-up.” For the 167 babies who are now at least one year of age, the calculated infant mortality rate (under 1 year of age) is 6.6%, which compares favorably to the nationally reported infant mortality rate for all children (9.8%). Upon reviewing the 11 deaths, in nearly all cases the families sought appropriate medical care as instructed, and most deaths were likely preventable if appropriate and timely emergency care were available in the community. Conclusions Early mortality associated with SCA can be significantly reduced through early diagnosis and access to care and education, even in countries with few health resources such as Angola. These experiences with a newborn clinic in the urban city of Luanda demonstrate that simple, lifesaving care is feasible and that follow-up and survival is excellent. Although the survival in this Angolan cohort was even better than the national infant mortality rate, the few deaths illustrate gaps in the understanding of emergency SCA care among the healthcare community. It is critical to include education and training of healthcare professionals at all levels of care in any national strategy, so that children with SCA can be promptly triaged and adequately treated for emergent and life-threatening complications. Disclosures: No relevant conflicts of interest to declare.