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Gnanapragasam SN, Tinch-Taylor R, Scott HR, Hegarty S, Souliou E, Bhundia R, Lamb D, Weston D, Greenberg N, Madan I, Stevelink S, Raine R, Carter B, Wessely S. Multicentre, England-wide randomised controlled trial of the 'Foundations' smartphone application in improving mental health and well-being in a healthcare worker population. Br J Psychiatry 2023; 222:58-66. [PMID: 36040419 PMCID: PMC10895508 DOI: 10.1192/bjp.2022.103] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/27/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Healthcare workers (HCWs) have faced considerable pressures during the COVID-19 pandemic. For some, this has resulted in mental health distress and disorder. Although interventions have sought to support HCWs, few have been evaluated. AIMS We aimed to determine the effectiveness of the 'Foundations' application (app) on general (non-psychotic) psychiatric morbidity. METHOD We conducted a multicentre randomised controlled trial of HCWs at 16 NHS trusts (trial registration number: EudraCT: 2021-001279-18). Participants were randomly assigned to the app or wait-list control group. Measures were assessed at baseline, after 4 and 8 weeks. The primary outcome was general psychiatric morbidity (using the General Health Questionnaire). Secondary outcomes included: well-being; presenteeism; anxiety; depression and insomnia. The primary analysis used mixed-effects multivariable regression, presented as adjusted mean differences (aMD). RESULTS Between 22 March and 3 June 2021, 1002 participants were randomised (500:502), and 894 (89.2%) followed-up. The sample was predominately women (754/894, 84.3%), with a mean age of 44⋅3 years (interquartile range (IQR) 34-53). Participants randomised to the app had a reduction in psychiatric morbidity symptoms (aMD = -1.39, 95% CI -2.05 to -0.74), improvement in well-being (aMD = 0⋅54, 95% CI 0⋅20 to 0⋅89) and reduction in insomnia (adjusted odds ratio (aOR) = 0⋅36, 95% CI 0⋅21 to 0⋅60). No other significant findings were found, or adverse events reported. CONCLUSIONS The app had an effect in reducing psychiatric morbidity symptoms in a sample of HCWs. Given it is scalable with no adverse effects, the app may be used as part of an organisation's tiered staff support package. Further evidence is needed on long-term effectiveness and cost-effectiveness.
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Affiliation(s)
- Sam N. Gnanapragasam
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK and South London and Maudsley NHS Foundation Trust, UK
| | - Rose Tinch-Taylor
- Department of Biostatistics and Health Informatics and King's Clinical Trials Unit, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK
| | - Hannah R. Scott
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Siobhan Hegarty
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Emilia Souliou
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Rupa Bhundia
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Danielle Lamb
- Department of Applied Health Research, University College London, UK
| | - Danny Weston
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Neil Greenberg
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas’ NHS Foundation Trust, UK
| | - Sharon Stevelink
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics and King's Clinical Trials Unit, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
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Population attributable fraction estimates of cardiovascular diseases in different blood pressure levels in a large-scale cross-sectional study: a focus on prevention strategies and treatment coverage. Blood Press Monit 2023; 28:1-10. [PMID: 36606475 DOI: 10.1097/mbp.0000000000000612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Hypertension is one of the major modifiable risk factors in developing cardiovascular diseases (CVD). Hence, we aimed to ascertain age- and sex-specific population attributable fraction (PAF) for CVD in different blood pressure levels to implement efficient preventive strategies at the population level. METHODS Participants' data were obtained from the Iranian stepwise approach for surveillance of noncommunicable disease risk factors (STEPs) survey to calculate PAF in four subsequent phases. In phase 0, PAF was measured, irrespective of the diagnosis status. In phase 1, the theoretical minimum range of 115 ≤SBP less than 130 mmHg was considered as the low-risk and measurements equal to or higher than 130 mmHg as the high-risk group. Across phase 2, patients were divided into normal and hypertensive groups based on the American College of Cardiology/American Heart Association guideline. In phase 3, patients were divided into two categories based on treatment coverage. RESULTS A total number of 27 165 participants aged ≥25 years had valid blood pressure measurements and were enrolled. Phase 0: PAF generally had an upward trend with age advancing. Phase 1: participants with BP ≥130 mmHg comprised the largest PAF, extending from 0.31 (0.25-0.37) in older male individuals to 0.85 (0.79-0.91) in younger females. Phase 2: higher values were found in younger ages for hypertension. Phase 3 represented that attributable fractions among hypertensive patients who received treatment were much lower than drug-naïve hypertensive participants. CONCLUSION Our study enlightens the necessity for implementing effective screening strategies for the younger generation and providing adequate access to antihypertensive medications for the low-risk population.
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Deady M, Glozier N, Calvo R, Johnston D, Mackinnon A, Milne D, Choi I, Gayed A, Peters D, Bryant R, Christensen H, Harvey SB. Preventing depression using a smartphone app: a randomized controlled trial. Psychol Med 2022; 52:457-466. [PMID: 32624013 DOI: 10.1017/s0033291720002081] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is evidence that depression can be prevented; however, traditional approaches face significant scalability issues. Digital technologies provide a potential solution, although this has not been adequately tested. The aim of this study was to evaluate the effectiveness of a new smartphone app designed to reduce depression symptoms and subsequent incident depression amongst a large group of Australian workers. METHODS A randomized controlled trial was conducted with follow-up assessments at 5 weeks and 3 and 12 months post-baseline. Participants were employed Australians reporting no clinically significant depression. The intervention group (N = 1128) was allocated to use HeadGear, a smartphone app which included a 30-day behavioural activation and mindfulness intervention. The attention-control group (N = 1143) used an app which included a 30-day mood monitoring component. The primary outcome was the level of depressive symptomatology (PHQ-9) at 3-month follow-up. Analyses were conducted within an intention-to-treat framework using mixed modelling. RESULTS Those assigned to the HeadGear arm had fewer depressive symptoms over the course of the trial compared to those assigned to the control (F3,734.7 = 2.98, p = 0.031). Prevalence of depression over the 12-month period was 8.0% and 3.5% for controls and HeadGear recipients, respectively, with odds of depression caseness amongst the intervention group of 0.43 (p = 0.001, 95% CI 0.26-0.70). CONCLUSIONS This trial demonstrates that a smartphone app can reduce depression symptoms and potentially prevent incident depression caseness and such interventions may have a role in improving working population mental health. Some caution in interpretation is needed regarding the clinical significance due to small effect size and trial attrition.Trial Registration Australian and New Zealand Clinical Trials Registry (www.anzctr.org.au/) ACTRN12617000548336.
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Affiliation(s)
- Mark Deady
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Nicholas Glozier
- Central Clinical School, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Rafael Calvo
- School of Electrical and Information Engineering, University of Sydney, Sydney, NSW, Australia
- Dyson School of Design Engineering, Imperial College London, London, UK
| | - David Johnston
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Andrew Mackinnon
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - David Milne
- School of Systems Management and Leadership, Faculty of Engineering and IT, University of Technology Sydney, Sydney, NSW, Australia
| | - Isabella Choi
- Central Clinical School, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Aimee Gayed
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Dorian Peters
- School of Electrical and Information Engineering, University of Sydney, Sydney, NSW, Australia
- Leverhulme Centre for the Future of Intelligence, University of Cambridge, Cambridge, UK
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Helen Christensen
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Samuel B Harvey
- Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Kwon SC, Wyatt LC, Kum SS, Zanowiak JM, Kim SS, Yi SS, Min D, Lee L, Islam NS. Evaluation of a Diabetes Prevention Intervention for Korean American immigrants at Risk for Diabetes. Health Equity 2022; 6:167-177. [PMID: 35402771 PMCID: PMC8985525 DOI: 10.1089/heq.2021.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose Despite the small but growing number of studies documenting the increasing prevalence of diabetes among Korean Americans, no culturally adapted interventions have been developed for Korean Americans at risk for diabetes. We evaluate the efficacy of a culturally tailored lifestyle intervention among Korean American immigrants at risk for diabetes in New York City (NYC). Methods Korean Americans at risk for diabetes were recruited into a culturally adapted, community health worker (CHW) intervention in NYC. Treatment group participants received 6 group sessions and 10 follow-up phone calls from CHWs over the 6-month period. Control participants received only the first session. Study outcomes included changes in weight, body mass index (BMI), blood pressure, physical activity (PA) and PA behaviors, nutrition behaviors, and diabetes knowledge. Paired t-tests and chi-square tests assessed group differences for each group for each outcome measure. Results The treatment group reported significant positive changes in recommended weekly PA, PA self-efficacy, PA barriers, nutrition self-efficacy, diabetes knowledge, weight, BMI, and systolic blood pressure compared with control participants. Generalized estimated equations models for repeated measures assessed change across time while adjusting for study arm, time point, and the interaction between study arm and time point. The intervention effect was significant for weekly moderate and vigorous PA, recommended weekly PA, PA self-efficacy, and diabetes knowledge. Conclusions Results suggest that a culturally adapted lifestyle intervention for Korean American immigrants at risk for diabetes have the potential to improve behaviors associated with cardiovascular disease outcomes and diabetes prevention. Further research among Korean Americans is warranted.
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Affiliation(s)
- Simona C. Kwon
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Laura C. Wyatt
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | | | - Jennifer M. Zanowiak
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Sara S. Kim
- Korean Community Services of Metropolitan New York, New York, New York, USA
| | - Stella S. Yi
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Deborah Min
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Linda Lee
- Korean Community Services of Metropolitan New York, New York, New York, USA
| | - Nadia S. Islam
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
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Bruckner T, Das A, Singh P, Boden-Albala B. SARS-CoV-2: An Empirical Investigation of Rose's Population-based Logic. Epidemiology 2021; 32:807-810. [PMID: 34347688 PMCID: PMC8478111 DOI: 10.1097/ede.0000000000001405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Geoffrey Rose's paper "Sick Individuals, Sick Populations" highlights the counterintuitive finding that the largest share of morbidity arises from populations engaging in low- to moderate-risk behavior. Scholars refer to this finding as the prevention paradox. We examine whether this logic applies to SARS-CoV-2 infected persons considered low to moderate risk. METHODS We conducted a population-representative survey and sero-surveillance study for SARS-CoV-2 among adults in Orange County, California. Participants answered questions about health behaviors and provided a finger-pin-prick sample from 10 July to 16 August 2020. RESULTS Of the 2979 adults, those reporting low- and moderate-risk behavior accounted for between 78% and 92% of SARS-CoV-2 infections. Asymptomatic individuals, as well as persons with low and moderate scores for self-reported likelihood of having had SARS-CoV-2, accounted for the majority of infections. CONCLUSIONS Our findings support Rose's logic, which encourages public health measures among persons who self-identify as unlikely to have SARS-CoV-2. See video abstract at, http://links.lww.com/EDE/B860.
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Affiliation(s)
- Tim Bruckner
- From the Program in Public Health, University of California, Irvine, CA
- Center for Population, Inequality, and Policy, University of California, Irvine, CA
| | - Abhery Das
- From the Program in Public Health, University of California, Irvine, CA
| | - Parvati Singh
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH
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Sniderman AD, Thanassoulis G, Wilkins JT, Furberg CD, Pencina M. Sick Individuals and Sick Populations by Geoffrey Rose: Cardiovascular Prevention Updated. J Am Heart Assoc 2019; 7:e010049. [PMID: 30371337 PMCID: PMC6404899 DOI: 10.1161/jaha.118.010049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Allan D Sniderman
- 1 Royal Victoria Hospital McGill University Health Centre Montreal Quebec Canada
| | - George Thanassoulis
- 1 Royal Victoria Hospital McGill University Health Centre Montreal Quebec Canada
| | - John T Wilkins
- 2 Department of Medicine (Cardiology) and Preventive Medicine Northwestern University Chicago IL
| | - Curt D Furberg
- 3 Public Health Sciences Wake Forest University Winston-Salem NC
| | - Michael Pencina
- 4 Duke Clinical Research Institute Duke University School of Medicine Durham NC
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7
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Bobić B, Villena I, Stillwaggon E. Prevention and mitigation of congenital toxoplasmosis. Economic costs and benefits in diverse settings. Food Waterborne Parasitol 2019; 16:e00058. [PMID: 32095628 PMCID: PMC7034037 DOI: 10.1016/j.fawpar.2019.e00058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 11/27/2022] Open
Abstract
Congenital toxoplasmosis (CT), the result of a primary infection of pregnant women with Toxoplasma gondii which was transmitted to the fetus, may result in mild to deep injuries occurring in the newborn or later in its development or in adolescence. The visual and cognitive impairment that can result imposes substantial economic costs on the individual and society. Numerous observational studies favor the conclusion that, with preventive measures currently available, it is possible to reduce the incidence of infections in pregnant women, the incidence of fetal infection by preventing transplacental transmission, and the gravity of injury in infected newborns. Treatment of infected newborns can also reduce the severity of consequences and the frequency of their occurrence later in life. Prevention programs, however, are applied in only a few countries; in most countries implementation of a national prevention program has not been considered or has been thought to be too expensive. This article lists the methods of prevention of CT and describes existing national prevention programs in France and Austria. It analyzes the economic costs and benefits of maternal screening for CT prevention and mitigation for society and for health systems. The economic feasibility of implementing national screening in low-prevalence, high-cost countries is illustrated with the example of the United States. New diagnostic tools are discussed and the implication of lower costs is considered, for countries with well-established screening programs as well as those with inadequate prenatal care networks.
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Affiliation(s)
- Branko Bobić
- Institute for Medical Research, University of Belgrade, Centre of Excellence for Food- and Vector-borne Zoonoses, National Reference Laboratory for Toxoplasmosis, Serbia
| | - Isabelle Villena
- EA 7510, UFR Médecine, University Reims Champagne-Ardenne, National Reference Center on Toxoplasmosis, Hospital Reims, France
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8
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Kwon SC, Rideout C, Patel S, Arista P, Tepporn E, Lipman J, Kunkel S, Le DQ, Chin KK, Trinh-Shevrin C. Improving Access to Healthy Foods for Asian Americans, Native Hawaiians, and Pacific Islanders: Lessons Learned from the STRIVE Program. J Health Care Poor Underserved 2016; 26:116-36. [PMID: 25981093 DOI: 10.1353/hpu.2015.0063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) experience a large burden from certain chronic disease-related risk factors. The STRIVE Program funded four AANHPI community-based organizations (CBOs) to implement culturally adapted community gardens and farmers' markets to increase access to healthy foods. Key CBO informant interviews were conducted to understand processes and lessons learned.
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Chiolero A, Paradis G, Paccaud F. The pseudo-high-risk prevention strategy. Int J Epidemiol 2015; 44:1469-73. [DOI: 10.1093/ije/dyv102] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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10
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Integrated preclinical cardiovascular prevention: a new paradigm to face growing challenges of cardiovascular disease. Am J Cardiovasc Drugs 2015; 15:163-70. [PMID: 25894618 DOI: 10.1007/s40256-015-0114-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cardiovascular disease (CVD) still represents the leading cause of mortality and morbidity worldwide. Despite considerable improvements in the prognosis of CVD and the significant reduction of CVD mortality obtained during the past half century, patients developing CVD, even though satisfactorily treated, still carry coronary artery disease and remain at risk for advanced CVD. Thus, the healthcare and socioeconomic burden linked to CVD remains high. As a result, more effective CVD prevention strategies remain crucial. 'Population strategies' and 'high-risk' approaches both have limitations and have often been viewed as alternative solutions. This persistent dualism could be overcome with the promotion of integrated prevention strategies based on a systematic evaluation of the total risk of disease, at both a population and an individual level. New approaches are also needed to reach people earlier in the course of the vascular disease and, possibly, to prevent risk factors and reduce CVD clinical manifestation.
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Trinh-Shevrin C, Nadkarni S, Park R, Islam N, Kwon SC. Defining an integrative approach for health promotion and disease prevention: a population health equity framework. J Health Care Poor Underserved 2015; 26:146-63. [PMID: 25981095 PMCID: PMC4530990 DOI: 10.1353/hpu.2015.0067] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Eliminating health disparities in racial/ethnic minority and underserved populations requires a paradigm shift from biomedical approaches that are disease-focused to a health equity framework that aims to achieve optimal health for all by targeting social and structural determinants of health. We describe the concepts and parallel approaches that underpin an integrative population health equity framework and present the experience of NYU Center for the Study of Asian American Health (CSAAH) in applying the framework to guide its work. Applying an integrative framework has deepened our community engagement efforts, our understanding of the multi-level contextual factors that influence health, and our capacity to advance health equity for Asian American communities through action-oriented research and policy. This framework and experience is applicable to researchers and community members working with other underserved populations.
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Affiliation(s)
- Chau Trinh-Shevrin
- NYU Center for the Study of Asian American Health, NY, NY
- NYU Department of Population Health, NYU School of Medicine, NY, NY
| | - Smiti Nadkarni
- NYU Center for the Study of Asian American Health, NY, NY
- NYU Department of Population Health, NYU School of Medicine, NY, NY
| | - Rebecca Park
- NYU Center for the Study of Asian American Health, NY, NY
- NYU Department of Population Health, NYU School of Medicine, NY, NY
| | - Nadia Islam
- NYU Center for the Study of Asian American Health, NY, NY
- NYU Department of Population Health, NYU School of Medicine, NY, NY
| | - Simona C. Kwon
- NYU Center for the Study of Asian American Health, NY, NY
- NYU Department of Population Health, NYU School of Medicine, NY, NY
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12
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Patel S, Kwon S, Arista P, Tepporn E, Chung M, Ko Chin K, Rideout C, Islam N, Trinh-Shevrin C. Using evidence-based policy, systems, and environmental strategies to increase access to healthy food and opportunities for physical activity among Asian Americans, Native Hawaiians, and Pacific Islanders. Am J Public Health 2015; 105 Suppl 3:S455-8. [PMID: 25905839 DOI: 10.2105/ajph.2015.302637] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Recent initiatives have focused on the dissemination of evidence-based policy, systems, and environmental (EBPSE) strategies to reduce health disparities. Targeted, community-level efforts are needed to supplement these approaches for comparable results among Asian Americans and Native Hawaiians and Pacific Islanders (NHPIs).The STRIVE Project funded 15 Asian American and NHPI community-based organizations (CBOs) to implement culturally adapted strategies. Partners reached more than 1.4 million people at a cost of $2.04 per person. CBOs are well positioned to implement EBPSE strategies to reduce health disparities.
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Affiliation(s)
- Shilpa Patel
- Shilpa Patel, Simona Kwon, Catlin Rideout, Nadia Islam, and Chau Trinh-Shevrin are with the Center for the Study of Asian American Health, Department of Population Health, NYU School of Medicine, New York, NY. Pedro Arista, Ed Tepporn, Marianne Chung, and Kathy Ko Chin are with the Asian & Pacific Islander American Health Forum, San Francisco, CA
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Cerdá M, Tracy M, Ahern J, Galea S. Addressing population health and health inequalities: the role of fundamental causes. Am J Public Health 2014; 104 Suppl 4:S609-19. [PMID: 25100428 DOI: 10.2105/ajph.2014.302055] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES As a case study of the impact of universal versus targeted interventions on population health and health inequalities, we used simulations to examine (1) whether universal or targeted manipulations of collective efficacy better reduced population-level rates and racial/ethnic inequalities in violent victimization; and (2) whether experiments reduced disparities without addressing fundamental causes. METHODS We applied agent-based simulation techniques to the specific example of an intervention on neighborhood collective efficacy to reduce population-level rates and racial/ethnic inequalities in violent victimization. The agent population consisted of 4000 individuals aged 18 years and older with sociodemographic characteristics assigned to match distributions of the adult population in New York City according to the 2000 U.S. Census. RESULTS Universal experiments reduced rates of victimization more than targeted experiments. However, neither experiment reduced inequalities. To reduce inequalities, it was necessary to eliminate racial/ethnic residential segregation. CONCLUSIONS These simulations support the use of universal intervention but suggest that it is not possible to address inequalities in health without first addressing fundamental causes.
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Affiliation(s)
- Magdalena Cerdá
- Magdalena Cerdá, Melissa Tracy, and Sandro Galea are with the Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY. Jennifer Ahern is with the Department of Epidemiology, University of California, Berkeley
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MacLeod KE, Satariano WA, Ragland DR. The Impact of Health Problems on Driving Status among Older Adults. JOURNAL OF TRANSPORT & HEALTH 2014; 1:86-94. [PMID: 25664238 PMCID: PMC4318249 DOI: 10.1016/j.jth.2014.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE This study assesses the impact of health problems on driving status (current driver vs. ex-driver) among older adults to identify which of those health problems have the greatest individual and population impact on driving cessation. METHODS Data were from baseline and 5 year follow-up waves of a longitudinal survey of adults age 55 years and older (N=1,279). The impact of several health problems on driving status was assessed using a relative risk ratio and a population attributable risk percent. Analyses controlled for age, gender, and the presence of additional baseline health problems. RESULTS Many health conditions were not associated with driving cessation. Functional limitations, cognitive function, and measures of vision were significant predictors of driving cessation. Self-care functional limitations were associated with the highest risk for driving cessation, while visual function was associated with the highest attributable risks. DISCUSSION In order to effectively address healthy aging and mobility transitions, it is important to consider the implications of targeting individuals or populations who are most at risk for driving cessation. The risk ratio is relevant for evaluating individuals; the attributable risk is relevant for developing interventions in populations.
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Affiliation(s)
- Kara E. MacLeod
- Safe Transportation Research and Education Center,
University of California at Berkeley, 2614 Dwight Way, Berkeley, CA 94720-7374,
USA
- School of Public Health, University of California at
Berkeley, Berkeley, CA 94720-7374, USA
- Corresponding author.
, (1) 510-642-4049
| | - William A. Satariano
- School of Public Health, University of California at
Berkeley, Berkeley, CA 94720-7374, USA
| | - David R. Ragland
- Safe Transportation Research and Education Center,
University of California at Berkeley, 2614 Dwight Way, Berkeley, CA 94720-7374,
USA
- School of Public Health, University of California at
Berkeley, Berkeley, CA 94720-7374, USA
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15
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A population approach to transportation planning: reducing exposure to motor-vehicles. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2013; 2013:916460. [PMID: 23840236 PMCID: PMC3694553 DOI: 10.1155/2013/916460] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 04/26/2013] [Accepted: 05/21/2013] [Indexed: 11/18/2022]
Abstract
Transportation planning and public health have important historical roots. To address common challenges, including road traffic fatalities, integration of theories and methods from both disciplines is required. This paper presents an overview of Geoffrey Rose's strategy of preventive medicine applied to road traffic fatalities. One of the basic principles of Rose's strategy is that a large number of people exposed to a small risk can generate more cases than a small number exposed to a high risk. Thus, interventions should address the large number of people exposed to the fundamental causes of diseases. Exposure to moving vehicles could be considered a fundamental cause of road traffic deaths and injuries. A global reduction in the amount of kilometers driven would result in a reduction of the likelihood of collisions for all road users. Public health and transportation research must critically appraise their practice and engage in informed dialogue with the objective of improving mobility and productivity while simultaneously reducing the public health burden of road deaths and injuries.
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Abstract
The term 'population health' is part of the natural evolution of the science of epidemiology. With the recognition of the importance of a life-course approach to help understand health along with the recognition of the importance of the wider determinants of health, epidemiology requires new techniques and thinking. 'Population health' recognizes that to improve oral health, then the determinants have to be tackled. These include both those that may be described as belonging to the environment and those influenced by the care system. The key issue for policy development is the need to recognize that with globalization and the extended time frame to undertake research, partnerships will be a key necessity to help ensure success in addressing inequalities and overall levels of health.
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Affiliation(s)
- Paul Batchelor
- Dental Health Services Leadership and Management Programme, Faculty of General Dental Practice (UK), Royal College of Surgeons, London, UK.
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17
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Lewis G, Kirkham H, Duncan I, Vaithianathan R. How Health Systems Could Avert ‘Triple Fail’ Events That Are Harmful, Are Costly, And Result In Poor Patient Satisfaction. Health Aff (Millwood) 2013; 32:669-76. [DOI: 10.1377/hlthaff.2012.1350] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Geraint Lewis
- Geraint Lewis ( ) is chief data officer of the National Health Service, in London, England
| | - Heather Kirkham
- Heather Kirkham is a manager in the Clinical Outcomes and Analytics Department at Walgreens, in Deerfield, Illinois
| | - Ian Duncan
- Ian Duncan is the vice president in the Clinical Outcomes and Analytics Department at Walgreens
| | - Rhema Vaithianathan
- Rhema Vaithianathan is a senior research fellow at Sim Ki Boon Institute, Singapore Management University, and director of the Centre for Applied Research in Economics, University of Auckland, in New Zealand
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18
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Quantile regression for hypothesis testing and hypothesis screening at the dawn of big data. Epidemiology 2012; 23:665-7. [PMID: 22872112 DOI: 10.1097/ede.0b013e318261f7be] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Koepsell TD, Zatzick DF, Rivara FP. Estimating the population impact of preventive interventions from randomized trials. Am J Prev Med 2011; 40:191-8. [PMID: 21238868 PMCID: PMC3042774 DOI: 10.1016/j.amepre.2010.10.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 09/07/2010] [Accepted: 10/11/2010] [Indexed: 01/04/2023]
Abstract
Growing concern about the limited generalizability of trials of preventive interventions has led to several proposals concerning the design, reporting, and interpretation of such trials. This paper presents an epidemiologic framework that highlights three key determinants of population impact of many prevention programs: the proportion of the population at risk who would be candidates for a generic intervention in routine use, the proportion of those candidates who are actually intervened on through a specific program, and the reduction in incidence produced by that program among recipients. It then describes how the design of a prevention trial relates to estimating these quantities. Implications of the framework include the following: (1) reach is an attribute of a program, whereas external validity is an attribute of a trial, and the two should not be conflated; (2) specification of a defined target population at risk is essential in the long run and merits greater emphasis in the planning and interpretation of prevention trials; (3) with due attention to sampling frame and sampling method, the process of subject recruitment for a trial can yield key information about quantities that are important for assessing its potential population impact; and (4) exclusions during subject recruitment can be conceptually separated into intervention-driven, program-driven, and trial-design-driven exclusions, which have quite different implications for trial interpretation and for estimating population impact of the intervention studied.
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Affiliation(s)
- Thomas D Koepsell
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA.
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