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Jones JR, Gottlieb D, McMurry AJ, Atreja A, Desai PM, Dixon BE, Payne PRO, Saldanha AJ, Shankar P, Solad Y, Wilcox AB, Ali MS, Kang E, Martin AM, Sprouse E, Taylor DE, Terry M, Ignatov V, Mandl KD. Real world performance of the 21st Century Cures Act population-level application programming interface. J Am Med Inform Assoc 2024; 31:1144-1150. [PMID: 38447593 PMCID: PMC11031206 DOI: 10.1093/jamia/ocae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/02/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE To evaluate the real-world performance of the SMART/HL7 Bulk Fast Health Interoperability Resources (FHIR) Access Application Programming Interface (API), developed to enable push button access to electronic health record data on large populations, and required under the 21st Century Cures Act Rule. MATERIALS AND METHODS We used an open-source Bulk FHIR Testing Suite at 5 healthcare sites from April to September 2023, including 4 hospitals using electronic health records (EHRs) certified for interoperability, and 1 Health Information Exchange (HIE) using a custom, standards-compliant API build. We measured export speeds, data sizes, and completeness across 6 types of FHIR. RESULTS Among the certified platforms, Oracle Cerner led in speed, managing 5-16 million resources at over 8000 resources/min. Three Epic sites exported a FHIR data subset, achieving 1-12 million resources at 1555-2500 resources/min. Notably, the HIE's custom API outperformed, generating over 141 million resources at 12 000 resources/min. DISCUSSION The HIE's custom API showcased superior performance, endorsing the effectiveness of SMART/HL7 Bulk FHIR in enabling large-scale data exchange while underlining the need for optimization in existing EHR platforms. Agility and scalability are essential for diverse health, research, and public health use cases. CONCLUSION To fully realize the interoperability goals of the 21st Century Cures Act, addressing the performance limitations of Bulk FHIR API is critical. It would be beneficial to include performance metrics in both certification and reporting processes.
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Affiliation(s)
- James R Jones
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02215, United States
| | - Daniel Gottlieb
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02215, United States
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115, United States
| | - Andrew J McMurry
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02215, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, United States
| | - Ashish Atreja
- Department of Health Innovation Technology, UC Davis Health, Rancho Cardova, CA 95670, United States
| | - Pankaja M Desai
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, United States
| | - Brian E Dixon
- Department of Health Policy and Management, Fairbanks School of Public Health, Indiana University, Indianapolis, IN 46202, United States
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN 46202, United States
| | - Philip R O Payne
- Department of Medicine, Washington University in St Louis, St Louis, MO 63110, United States
| | - Anil J Saldanha
- Department of Health Innovation, Rush University Medical Center, Chicago, IL 60612, United States
| | - Prabhu Shankar
- Department of Health Innovation Technology, UC Davis Health, Rancho Cardova, CA 95670, United States
- Department of Public Health Sciences, UC Davis Health, Davis, CA 95817, United States
| | - Yauheni Solad
- Department of Health Innovation Technology, UC Davis Health, Rancho Cardova, CA 95670, United States
| | - Adam B Wilcox
- Department of Medicine, Washington University in St Louis, St Louis, MO 63110, United States
| | - Momeena S Ali
- Department of Health Innovation Technology, UC Davis Health, Rancho Cardova, CA 95670, United States
| | - Eugene Kang
- Department of Health Innovation Technology, UC Davis Health, Rancho Cardova, CA 95670, United States
| | - Andrew M Martin
- Department of Technical Services, Regenstrief Institute, Indianapolis, IN 46202, United States
| | | | - David E Taylor
- Department of Technical Services, Regenstrief Institute, Indianapolis, IN 46202, United States
| | - Michael Terry
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02215, United States
| | - Vladimir Ignatov
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02215, United States
| | - Kenneth D Mandl
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02215, United States
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115, United States
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VanInsberghe D, McBride DS, DaSilva J, Stark TJ, Lau MSY, Shepard SS, Barnes JR, Bowman AS, Lowen AC, Koelle K. Genetic drift and purifying selection shape within-host influenza A virus populations during natural swine infections. PLoS Pathog 2024; 20:e1012131. [PMID: 38626244 PMCID: PMC11051653 DOI: 10.1371/journal.ppat.1012131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/26/2024] [Accepted: 03/16/2024] [Indexed: 04/18/2024] Open
Abstract
Patterns of within-host influenza A virus (IAV) diversity and evolution have been described in natural human infections, but these patterns remain poorly characterized in non-human hosts. Elucidating these dynamics is important to better understand IAV biology and the evolutionary processes that govern spillover into humans. Here, we sampled an IAV outbreak in pigs during a week-long county fair to characterize viral diversity and evolution in this important reservoir host. Nasal wipes were collected on a daily basis from all pigs present at the fair, yielding up to 421 samples per day. Subtyping of PCR-positive samples revealed the co-circulation of H1N1 and H3N2 subtype swine IAVs. PCR-positive samples with robust Ct values were deep-sequenced, yielding 506 sequenced samples from a total of 253 pigs. Based on higher-depth re-sequenced data from a subset of these initially sequenced samples (260 samples from 168 pigs), we characterized patterns of within-host IAV genetic diversity and evolution. We find that IAV genetic diversity in single-subtype infected pigs is low, with the majority of intrahost Single Nucleotide Variants (iSNVs) present at frequencies of <10%. The ratio of the number of nonsynonymous to the number of synonymous iSNVs is significantly lower than under the neutral expectation, indicating that purifying selection shapes patterns of within-host viral diversity in swine. The dynamic turnover of iSNVs and their pronounced frequency changes further indicate that genetic drift also plays an important role in shaping IAV populations within pigs. Taken together, our results highlight similarities in patterns of IAV genetic diversity and evolution between humans and swine, including the role of stochastic processes in shaping within-host IAV dynamics.
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Affiliation(s)
- David VanInsberghe
- Department of Microbiology and Immunology, Emory University, Atlanta, Georgia, United States of America
- Department of Biology, Emory University, Atlanta, Georgia, United States of America
| | - Dillon S. McBride
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Juliana DaSilva
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Thomas J. Stark
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Max S. Y. Lau
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Samuel S. Shepard
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John R. Barnes
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Andrew S. Bowman
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Anice C. Lowen
- Department of Microbiology and Immunology, Emory University, Atlanta, Georgia, United States of America
- Emory Center of Excellence for Influenza Research and Response (Emory-CEIRR), Atlanta, Georgia, United States of America
| | - Katia Koelle
- Department of Biology, Emory University, Atlanta, Georgia, United States of America
- Emory Center of Excellence for Influenza Research and Response (Emory-CEIRR), Atlanta, Georgia, United States of America
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Meador M, Sachdev N, Anderson E, Roy D, Bay RC, Becker LH, Lewis JH. Self-Measured Blood Pressure Monitoring During the COVID-19 Pandemic: Perspectives From Community Health Center Clinicians. J Healthc Qual 2024; 46:109-118. [PMID: 38150376 PMCID: PMC10901219 DOI: 10.1097/jhq.0000000000000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
ABSTRACT The early period of the COVID-19 pandemic necessitated a rapid increase in out-of-office care. To capture the impact from COVID-19 on care for patients with hypertension, a questionnaire was disseminated to community health center clinicians. The extent, types, and causes of care delays and disruptions were assessed along with adaptations and innovations used to address them. Clinician attitudinal changes and perspectives on future hypertension care were also assessed. Of the 65 respondents, most (90.8%) reported their patients with hypertension experienced care delays or disruptions, including lack of follow-up, lack of blood pressure assessment, and missed medication refills or orders. To address care delays and disruptions for patients with hypertension, respondents indicated that their health center increased the use of telehealth or other technology, made home blood pressure devices available to patients, expanded outreach and care coordination, provided medication refills for longer periods of time, and used new care delivery options. The use of self-measured blood pressure monitoring (58.5%) and telehealth (43.1%) was identified as the top adaptations that should be sustained to increase access to and patient engagement with hypertension care; however, barriers to both remain. Policy and system level changes are needed to support value-based care models that include self-measured blood pressure and telehealth.
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McMurry AJ, Gottlieb DI, Miller TA, Jones JR, Atreja A, Crago J, Desai PM, Dixon BE, Garber M, Ignatov V, Kirchner LA, Payne PRO, Saldanha AJ, Shankar PRV, Solad YV, Sprouse EA, Terry M, Wilcox AB, Mandl KD. Cumulus: A federated EHR-based learning system powered by FHIR and AI. medRxiv 2024:2024.02.02.24301940. [PMID: 38370642 PMCID: PMC10871375 DOI: 10.1101/2024.02.02.24301940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Objective To address challenges in large-scale electronic health record (EHR) data exchange, we sought to develop, deploy, and test an open source, cloud-hosted app 'listener' that accesses standardized data across the SMART/HL7 Bulk FHIR Access application programming interface (API). Methods We advance a model for scalable, federated, data sharing and learning. Cumulus software is designed to address key technology and policy desiderata including local utility, control, and administrative simplicity as well as privacy preservation during robust data sharing, and AI for processing unstructured text. Results Cumulus relies on containerized, cloud-hosted software, installed within a healthcare organization's security envelope. Cumulus accesses EHR data via the Bulk FHIR interface and streamlines automated processing and sharing. The modular design enables use of the latest AI and natural language processing tools and supports provider autonomy and administrative simplicity. In an initial test, Cumulus was deployed across five healthcare systems each partnered with public health. Cumulus output is patient counts which were aggregated into a table stratifying variables of interest to enable population health studies. All code is available open source. A policy stipulating that only aggregate data leave the institution greatly facilitated data sharing agreements. Discussion and Conclusion Cumulus addresses barriers to data sharing based on (1) federally required support for standard APIs (2), increasing use of cloud computing, and (3) advances in AI. There is potential for scalability to support learning across myriad network configurations and use cases.
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Affiliation(s)
- Andrew J. McMurry
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Daniel I. Gottlieb
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA
| | - Timothy A. Miller
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - James R. Jones
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA
| | - Ashish Atreja
- Department of Health Information Technology, UC Davis Health, Rancho Cordova, CA
| | - Jennifer Crago
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN
| | - Pankaja M. Desai
- Department of Internal Medicine, Rush University Medical Center, Chicago IL
| | - Brian E. Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN
- Department of Health Policy and Management, Fairbanks School of Public Health, Indiana University, Indianapolis, IN
| | - Matthew Garber
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA
| | - Vladimir Ignatov
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA
| | | | - Philip R. O. Payne
- Department of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Anil J. Saldanha
- Department of Health Innovation, Rush University Medical Center, Chicago, IL
| | - Prabhu R. V. Shankar
- Department of Health Information Technology, UC Davis Health, Rancho Cordova, CA
- Department of Public Health Sciences, UC Davis Health, Davis , CA
| | - Yauheni V. Solad
- Department of Health Information Technology, UC Davis Health, Rancho Cordova, CA
| | | | - Michael Terry
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA
| | - Adam B. Wilcox
- Department of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Kenneth D. Mandl
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA
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Smid MC, Vaughn P, Nowicki CC, Goodman DA, Zaharatos J, Campbell KA. Consensus pregnancy-related criteria for suicide and unintentional overdoses using a Delphi process. Arch Womens Ment Health 2024; 27:109-125. [PMID: 37770631 PMCID: PMC11000257 DOI: 10.1007/s00737-023-01375-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
Suicide and unintentional overdose are leading manners of preventable death during and within a year of pregnancy. Recently, the Utah Maternal Mortality Review Committee (MMRC) developed 10 criteria to guide pregnancy-related classification of these deaths. Our objective was to (1) evaluate if consensus could be reached across experts in maternal mortality review when applying criteria to the determination of pregnancy-relatedness in mock MMRC case evaluation and (2) assess how additional case information shifted participants' determination of pregnancy-relatedness in these mock cases. We used a modified Delphi process to evaluate criteria for pregnancy-related suicides and unintentional overdose. The study team developed base case scenarios to reflect the 10 proposed criteria. Base scenarios varied in timing of death (prenatal or delivery, early postpartum (<6 months), late postpartum (6-12 months)) and level of additional information available (e.g., informant interviews, social media posts). Consensus in favor of a criterion was met when ≥75% of participants identified a case as pregnancy-related in at least 1 scenario. Fifty-eight participants, representing 48 MMRCs, reviewed scenarios. Of 10 proposed criteria, 8 reached consensus. Overall, participants classified 19.4% of base case scenarios as pregnancy-related, which increased to 56.8% with additional information. Pregnancy-related classification changed across timing of death and with availability of additional information (prenatal or delivery 27.7% versus 84.6%; early postpartum 30.0% versus 58.3%; late postpartum 0.0% versus 25.0%, respectively). We identified consensus supporting the application of 8 standardized criteria in MMRC determinations of pregnancy-relatedness among suicide and unintentional overdose deaths.
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Affiliation(s)
- Marcela C Smid
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, USA.
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Porcia Vaughn
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - David A Goodman
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julie Zaharatos
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristine A Campbell
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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Valvi N, McFarlane T, Allen KS, Gibson PJ, Dixon BE. Identification of Hypertension in Electronic Health Records Through Computable Phenotype Development and Validation for Use in Public Health Surveillance: Retrospective Study. JMIR Form Res 2023; 7:e46413. [PMID: 38150296 PMCID: PMC10782284 DOI: 10.2196/46413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/21/2023] [Accepted: 11/07/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Electronic health record (EHR) systems are widely used in the United States to document care delivery and outcomes. Health information exchange (HIE) networks, which integrate EHR data from the various health care providers treating patients, are increasingly used to analyze population-level data. Existing methods for population health surveillance of essential hypertension by public health authorities may be complemented using EHR data from HIE networks to characterize disease burden at the community level. OBJECTIVE We aimed to derive and validate computable phenotypes (CPs) to estimate hypertension prevalence for population-based surveillance using an HIE network. METHODS Using existing data available from an HIE network, we developed 6 candidate CPs for essential (primary) hypertension in an adult population from a medium-sized Midwestern metropolitan area in the United States. A total of 2 independent clinician reviewers validated the phenotypes through a manual chart review of 150 randomly selected patient records. We assessed the precision of CPs by calculating sensitivity, specificity, positive predictive value (PPV), F1-score, and validity of chart reviews using prevalence-adjusted bias-adjusted κ. We further used the most balanced CP to estimate the prevalence of hypertension in the population. RESULTS Among a cohort of 548,232 adults, 6 CPs produced PPVs ranging from 71% (95% CI 64.3%-76.9%) to 95.7% (95% CI 84.9%-98.9%). The F1-score ranged from 0.40 to 0.91. The prevalence-adjusted bias-adjusted κ revealed a high percentage agreement of 0.88 for hypertension. Similarly, interrater agreement for individual phenotype determination demonstrated substantial agreement (range 0.70-0.88) for all 6 phenotypes examined. A phenotype based solely on diagnostic codes possessed reasonable performance (F1-score=0.63; PPV=95.1%) but was imbalanced with low sensitivity (47.6%). The most balanced phenotype (F1-score=0.91; PPV=83.5%) included diagnosis, blood pressure measurements, and medications and identified 210,764 (38.4%) individuals with hypertension during the study period (2014-2015). CONCLUSIONS We identified several high-performing phenotypes to identify essential hypertension prevalence for local public health surveillance using EHR data. Given the increasing availability of EHR systems in the United States and other nations, leveraging EHR data has the potential to enhance surveillance of chronic disease in health systems and communities. Yet given variability in performance, public health authorities will need to decide whether to seek optimal balance or declare a preference for algorithms that lean toward sensitivity or specificity to estimate population prevalence of disease.
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Affiliation(s)
- Nimish Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, United States
- Department of Nutrition and Health Science, College of Health, Ball State University, Muncie, IN, United States
| | - Timothy McFarlane
- Indiana Family and Social Services Administration, Indianapolis, IN, United States
| | - Katie S Allen
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, United States
- Department of Health Policy & Management, Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
| | | | - Brian Edward Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, United States
- Department of Health Policy & Management, Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
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7
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Doyle JD, Garg S, O'Halloran AC, Grant L, Anderson EJ, Openo KP, Alden NB, Herlihy R, Meek J, Yousey‐Hindes K, Monroe ML, Kim S, Lynfield R, McMahon M, Muse A, Spina N, Irizarry L, Torres S, Bennett NM, Gaitan MA, Hill M, Cummings CN, Reed C, Schaffner W, Talbot HK, Self WH, Williams D. Performance of established disease severity scores in predicting severe outcomes among adults hospitalized with influenza-FluSurv-NET, 2017-2018. Influenza Other Respir Viruses 2023; 17:e13228. [PMID: 38111901 PMCID: PMC10725795 DOI: 10.1111/irv.13228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 12/20/2023] Open
Abstract
Background Influenza is a substantial cause of annual morbidity and mortality; however, correctly identifying those patients at increased risk for severe disease is often challenging. Several severity indices have been developed; however, these scores have not been validated for use in patients with influenza. We evaluated the discrimination of three clinical disease severity scores in predicting severe influenza-associated outcomes. Methods We used data from the Influenza Hospitalization Surveillance Network to assess outcomes of patients hospitalized with influenza in the United States during the 2017-2018 influenza season. We computed patient scores at admission for three widely used disease severity scores: CURB-65, Quick Sepsis-Related Organ Failure Assessment (qSOFA), and the Pneumonia Severity Index (PSI). We then grouped patients with severe outcomes into four severity tiers, ranging from ICU admission to death, and calculated receiver operating characteristic (ROC) curves for each severity index in predicting these tiers of severe outcomes. Results Among 8252 patients included in this study, we found that all tested severity scores had higher discrimination for more severe outcomes, including death, and poorer discrimination for less severe outcomes, such as ICU admission. We observed the highest discrimination for PSI against in-hospital mortality, at 0.78. Conclusions We observed low to moderate discrimination of all three scores in predicting severe outcomes among adults hospitalized with influenza. Given the substantial annual burden of influenza disease in the United States, identifying a prediction index for severe outcomes in adults requiring hospitalization with influenza would be beneficial for patient triage and clinical decision-making.
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Affiliation(s)
- Joshua D. Doyle
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDCAtlantaGeorgiaUSA
- Epidemic Intelligence Service, CDCAtlantaGeorgiaUSA
| | - Shikha Garg
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDCAtlantaGeorgiaUSA
| | - Alissa C. O'Halloran
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDCAtlantaGeorgiaUSA
| | - Lauren Grant
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDCAtlantaGeorgiaUSA
| | - Evan J. Anderson
- Emory University School of MedicineAtlantaGeorgiaUSA
- Atlanta Veterans Affairs Medical CenterAtlantaGeorgiaUSA
| | - Kyle P. Openo
- Emory University School of MedicineAtlantaGeorgiaUSA
- Atlanta Veterans Affairs Medical CenterAtlantaGeorgiaUSA
- Georgia Emerging Infections Program, Georgia Department of HealthAtlantaGeorgiaUSA
| | - Nisha B. Alden
- Colorado Department of Public Health and EnvironmentDenverColoradoUSA
| | - Rachel Herlihy
- Colorado Department of Public Health and EnvironmentDenverColoradoUSA
| | - James Meek
- Connecticut Emerging Infections ProgramYale School of Public HealthNew HavenConnecticutUSA
| | - Kimberly Yousey‐Hindes
- Connecticut Emerging Infections ProgramYale School of Public HealthNew HavenConnecticutUSA
| | | | - Sue Kim
- Communicable Disease Division, Michigan Department of Health and Human ServicesLansingMichiganUSA
| | - Ruth Lynfield
- Minnesota Department of HealthSaint PaulMinnesotaUSA
| | | | - Alison Muse
- New York State Department of HealthAlbanyNew YorkUSA
| | - Nancy Spina
- New York State Department of HealthAlbanyNew YorkUSA
| | | | - Salina Torres
- New Mexico Department of HealthAlbuquerqueNew MexicoUSA
| | - Nancy M. Bennett
- University of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Maria A. Gaitan
- University of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Mary Hill
- Salt Lake County Health DepartmentSalt Lake CityUtahUSA
| | - Charisse N. Cummings
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDCAtlantaGeorgiaUSA
| | - Carrie Reed
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDCAtlantaGeorgiaUSA
| | | | - H. Keipp Talbot
- Vanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Wesley H. Self
- Vanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Derek Williams
- Vanderbilt University School of MedicineNashvilleTennesseeUSA
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Sumner KM, Masalovich S, O'Halloran A, Holstein R, Reingold A, Kirley PD, Alden NB, Herlihy RK, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Monroe ML, Leegwater L, Henderson J, Lynfield R, McMahon M, McMullen C, Angeles KM, Spina NL, Engesser K, Bennett NM, Felsen CB, Lung K, Shiltz E, Thomas A, Talbot HK, Schaffner W, Swain A, George A, Rolfes MA, Reed C, Garg S. Severity of influenza-associated hospitalisations by influenza virus type and subtype in the USA, 2010-19: a repeated cross-sectional study. Lancet Microbe 2023; 4:e903-e912. [PMID: 37769676 PMCID: PMC10872935 DOI: 10.1016/s2666-5247(23)00187-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Influenza burden varies across seasons, partly due to differences in circulating influenza virus types or subtypes. Using data from the US population-based surveillance system, Influenza Hospitalization Surveillance Network (FluSurv-NET), we aimed to assess the severity of influenza-associated outcomes in individuals hospitalised with laboratory-confirmed influenza virus infections during the 2010-11 to 2018-19 influenza seasons. METHODS To evaluate the association between influenza virus type or subtype causing the infection (influenza A H3N2, A H1N1pdm09, and B viruses) and in-hospital severity outcomes (intensive care unit [ICU] admission, use of mechanical ventilation or extracorporeal membrane oxygenation [ECMO], and death), we used FluSurv-NET to capture data for laboratory-confirmed influenza-associated hospitalisations from the 2010-11 to 2018-19 influenza seasons for individuals of all ages living in select counties in 13 US states. All individuals had to have an influenza virus test within 14 days before or during their hospital stay and an admission date between Oct 1 and April 30 of an influenza season. Exclusion criteria were individuals who did not have a complete chart review; cases from sites that contributed data for three or fewer seasons; hospital-onset cases; cases with unidentified influenza type; cases of multiple influenza virus type or subtype co-infection; or individuals younger than 6 months and ineligible for the influenza vaccine. Logistic regression models adjusted for influenza season, influenza vaccination status, age, and FluSurv-NET site compared odds of in-hospital severity by virus type or subtype. When missing, influenza A subtypes were imputed using chained equations of known subtypes by season. FINDINGS Data for 122 941 individuals hospitalised with influenza were captured in FluSurv-NET from the 2010-11 to 2018-19 seasons; after exclusions were applied, 107 941 individuals remained and underwent influenza A virus imputation when missing A subtype (43·4%). After imputation, data for 104 969 remained and were included in the final analytic sample. Averaging across imputed datasets, 57·7% (weighted percentage) had influenza A H3N2, 24·6% had influenza A H1N1pdm09, and 17·7% had influenza B virus infections; 16·7% required ICU admission, 6·5% received mechanical ventilation or ECMO, and 3·0% died (95% CIs had a range of less than 0·1% and are not displayed). Individuals with A H1N1pdm09 had higher odds of in-hospital severe outcomes than those with A H3N2: adjusted odds ratios (ORs) for A H1N1pdm09 versus A H3N2 were 1·42 (95% CI 1·32-1·52) for ICU admission; 1·79 (1·60-2·00) for mechanical ventilation or ECMO use; and 1·25 (1·07-1·46) for death. The adjusted ORs for individuals infected with influenza B versus influenza A H3N2 were 1·06 (95% CI 1·01-1·12) for ICU admission, 1·14 (1·05-1·24) for mechanical ventilation or ECMO use, and 1·18 (1·07-1·31) for death. INTERPRETATION Despite a higher burden of hospitalisations with influenza A H3N2, we found an increased likelihood of in-hospital severe outcomes in individuals hospitalised with influenza A H1N1pdm09 or influenza B virus. Thus, it is important for individuals to receive an annual influenza vaccine and for health-care providers to provide early antiviral treatment for patients with suspected influenza who are at increased risk of severe outcomes, not only when there is high influenza A H3N2 virus circulation but also when influenza A H1N1pdm09 and influenza B viruses are circulating. FUNDING The US Centers for Disease Control and Prevention.
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Affiliation(s)
- Kelsey M Sumner
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Svetlana Masalovich
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alissa O'Halloran
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel Holstein
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Arthur Reingold
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | | | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, CA, USA
| | - Rachel K Herlihy
- Colorado Department of Public Health and Environment, Denver, CA, USA
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA
| | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA
| | - Evan J Anderson
- Department of Medicine and Depatment of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA, USA; Veterans Affairs Medical Center, Atlanta, GA, USA
| | - Kyle P Openo
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA; Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA, USA; Veterans Affairs Medical Center, Atlanta, GA, USA
| | | | - Lauren Leegwater
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Justin Henderson
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | | | | | | | - Kathy M Angeles
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, NM, USA
| | - Nancy L Spina
- New York State Department of Health, Albany, NY, USA
| | | | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Christina B Felsen
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Krista Lung
- Ohio Department of Health, Columbus, OH, USA
| | - Eli Shiltz
- Ohio Department of Health, Columbus, OH, USA
| | | | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Ashley Swain
- Salt Lake County Health Department, Salt Lake City, UT, USA
| | - Andrea George
- Salt Lake County Health Department, Salt Lake City, UT, USA
| | - Melissa A Rolfes
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carrie Reed
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shikha Garg
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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9
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VanInsberghe D, McBride DS, DaSilva J, Stark TJ, Lau MS, Shepard SS, Barnes JR, Bowman AS, Lowen AC, Koelle K. Genetic drift and purifying selection shape within-host influenza A virus populations during natural swine infections. bioRxiv 2023:2023.10.23.563581. [PMID: 37961583 PMCID: PMC10634741 DOI: 10.1101/2023.10.23.563581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Patterns of within-host influenza A virus (IAV) diversity and evolution have been described in natural human infections, but these patterns remain poorly characterized in non-human hosts. Elucidating these dynamics is important to better understand IAV biology and the evolutionary processes that govern spillover into humans. Here, we sampled an IAV outbreak in pigs during a week-long county fair to characterize viral diversity and evolution in this important reservoir host. Nasal wipes were collected on a daily basis from all pigs present at the fair, yielding up to 421 samples per day. Subtyping of PCR-positive samples revealed the co-circulation of H1N1 and H3N2 subtype IAVs. PCR-positive samples with robust Ct values were deep-sequenced, yielding 506 sequenced samples from a total of 253 pigs. Based on higher-depth re-sequenced data from a subset of these initially sequenced samples (260 samples from 168 pigs), we characterized patterns of within-host IAV genetic diversity and evolution. We find that IAV genetic diversity in single-subtype infected pigs is low, with the majority of intra-host single nucleotide variants (iSNVs) present at frequencies of <10%. The ratio of the number of nonsynonymous to the number of synonymous iSNVs is significantly lower than under the neutral expectation, indicating that purifying selection shapes patterns of within-host viral diversity in swine. The dynamic turnover of iSNVs and their pronounced frequency changes further indicate that genetic drift also plays an important role in shaping IAV populations within pigs. Taken together, our results highlight similarities in patterns of IAV genetic diversity and evolution between humans and swine, including the role of stochastic processes in shaping within-host IAV dynamics.
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Affiliation(s)
- David VanInsberghe
- Department of Microbiology and Immunology, Emory University, Atlanta, GA, 30322
- Department of Biology, Emory University, Atlanta, GA, 30322
| | - Dillon S. McBride
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH 43210
| | - Juliana DaSilva
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA
| | - Thomas J. Stark
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA
| | - Max S.Y. Lau
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, 30322
| | - Samuel S. Shepard
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA
| | - John R. Barnes
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA
| | - Andrew S. Bowman
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH 43210
| | - Anice C. Lowen
- Department of Microbiology and Immunology, Emory University, Atlanta, GA, 30322
- Emory Center of Excellence for Influenza Research and Response (Emory-CEIRR)
| | - Katia Koelle
- Department of Biology, Emory University, Atlanta, GA, 30322
- Emory Center of Excellence for Influenza Research and Response (Emory-CEIRR)
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10
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Jones JR, Gottlieb D, McMurry AJ, Atreja A, Desai PM, Dixon BE, Payne PRO, Saldanha AJ, Shankar P, Solad Y, Wilcox AB, Ali MS, Kang E, Martin AM, Sprouse E, Taylor D, Terry M, Ignatov V, Mandl KD. Real World Performance of the 21st Century Cures Act Population Level Application Programming Interface. medRxiv 2023:2023.10.05.23296560. [PMID: 37873390 PMCID: PMC10593080 DOI: 10.1101/2023.10.05.23296560] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Objective To evaluate the real-world performance in delivering patient data on populations, of the SMART/HL7 Bulk FHIR Access API, required in Electronic Health Records (EHRs) under the 21st Century Cures Act Rule. Materials and Methods We used an open-source Bulk FHIR Testing Suite at five healthcare sites from April to September 2023, including four hospitals using EHRs certified for interoperability, and one Health Information Exchange (HIE) using a custom, standards-compliant API build. We measured export speeds, data sizes, and completeness across six types of FHIR resources. Results Among the certified platforms, Oracle Cerner led in speed, managing 5-16 million resources at over 8,000 resources/min. Three Epic sites exported a FHIR data subset, achieving 1-12 million resources at 1,555-2,500 resources/min. Notably, the HIE's custom API outperformed, generating over 141 million resources at 12,000 resources/min. Discussion The HIE's custom API showcased superior performance, endorsing the effectiveness of SMART/HL7 Bulk FHIR in enabling large-scale data exchange while underlining the need for optimization in existing EHR platforms. Agility and scalability are essential for diverse health, research, and public health use cases. Conclusion To fully realize the interoperability goals of the 21st Century Cures Act, addressing the performance limitations of Bulk FHIR API is critical. It would be beneficial to include performance metrics in both certification and reporting processes.
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Affiliation(s)
- James R Jones
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA
| | - Daniel Gottlieb
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA
| | - Andrew J McMurry
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Ashish Atreja
- Department of Health Innovation Technology, UC Davis Health, Rancho Cardova, CA
| | - Pankaja M Desai
- Department of Internal Medicine, Rush University Medical Center, Chicago IL
| | - Brian E Dixon
- Department of Health Policy & Management, Fairbanks School of Public Health, Indiana University, Indianapolis, IN
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN
| | - Philip R O Payne
- Department of Medicine, Washington University in St Louis, St Louis, MO
| | - Anil J Saldanha
- Department of Health Innovation, Rush University Medical Center, Chicago IL
| | - Prabhu Shankar
- Department of Health Innovation Technology, UC Davis Health, Rancho Cardova, CA
- Department of Public Health Sciences, UC Davis Health, Davis, CA
| | - Yauheni Solad
- Department of Health Innovation Technology, UC Davis Health, Rancho Cardova, CA
| | - Adam B Wilcox
- Department of Medicine, Washington University in St Louis, St Louis, MO
| | - Momeena S Ali
- Department of Health Innovation Technology, UC Davis Health, Rancho Cardova, CA
| | - Eugene Kang
- Department of Health Innovation Technology, UC Davis Health, Rancho Cardova, CA
| | - Andrew M Martin
- Department of Technical Services, Regenstrief Institute, Indianapolis, IN
| | | | - David Taylor
- Department of Technical Services, Regenstrief Institute, Indianapolis, IN
| | - Michael Terry
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA
| | - Vladimir Ignatov
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA
| | - Kenneth D Mandl
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
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11
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Nasuti L, Andrews B, Li W, Wiltz J, Hohman KH, Patanian M. Using latent class analysis to inform the design of an EHR-based national chronic disease surveillance model. Chronic Illn 2023; 19:675-680. [PMID: 35505590 PMCID: PMC10515457 DOI: 10.1177/17423953221099043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/10/2022] [Indexed: 11/17/2022]
Abstract
The Multi-state EHR-based Network for Disease Surveillance (MENDS) developed a pilot electronic health record (EHR) surveillance system capable of providing national chronic disease estimates. To strategically engage partner sites, MENDS conducted a latent class analysis (LCA) and grouped states by similarities in socioeconomics, demographics, chronic disease and behavioral risk factor prevalence, health outcomes, and health insurance coverage. Three latent classes of states were identified, which inform the recruitment of additional partner sites in conjunction with additional factors (e.g. partner site capacity and data availability, information technology infrastructure). This methodology can be used to inform other public health surveillance modernization efforts that leverage timely EHR data to address gaps, use existing technology, and advance surveillance.
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Affiliation(s)
- Laura Nasuti
- National Association of Chronic Disease Directors, Decatur, USA
| | - Bonnie Andrews
- National Association of Chronic Disease Directors, Decatur, USA
| | - Wenjun Li
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, USA
| | - Jennifer Wiltz
- Office of the Director, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Miriam Patanian
- National Association of Chronic Disease Directors, Decatur, USA
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12
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Fandetti SM, Dahl AA, Webster C, Bably MB, Coffman MJ, Racine EF. Healthy Food Policies Documented in University Food Service Contracts. Int J Environ Res Public Health 2023; 20:6617. [PMID: 37623200 PMCID: PMC10454280 DOI: 10.3390/ijerph20166617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/07/2023] [Accepted: 08/19/2023] [Indexed: 08/26/2023]
Abstract
In the United States, there is an opportunity to improve the nutritional health of university students through the campus food environment. This project used a content analysis approach to investigate whether healthy food standards and policies were incorporated into the contract agreements between North Carolina (NC) public universities and their food service management companies. Food service contracts were collected from 14 NC public universities using food service management companies on campus. Each contract was evaluated using the 35-item North Carolina Food Service Policy Guidelines Assessment to examine four elements of the campus food environment: Beverages, Packaged Snacks, Prepared Foods, and Other (e.g., strategic placement of healthier food). Five university food service contracts incorporated no North Carolina Food Service Policy Guidelines, three university contracts included one to five guidelines, and six university contracts included six to nine guidelines. Altogether, 13 of the 35 guidelines were incorporated into at least one university food service contract. This project presents a cost and time-effective assessment method for determining if evidence-based nutrition guidelines have been included in university food service contracts. This approach and findings may lead to contract revisions to improve the campus food environment and, subsequently, the nutritional health of college populations.
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Affiliation(s)
- Stacy M. Fandetti
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, USA; (A.A.D.); (C.W.); (M.B.B.)
| | - Alicia Anne Dahl
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, USA; (A.A.D.); (C.W.); (M.B.B.)
| | - Caitlan Webster
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, USA; (A.A.D.); (C.W.); (M.B.B.)
| | - Morium Barakat Bably
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, USA; (A.A.D.); (C.W.); (M.B.B.)
| | - Maren J. Coffman
- School of Nursing, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, USA;
| | - Elizabeth F. Racine
- Texas A&M AgriLife Research, Texas A&M University, 1380 A and M Circle, El Paso, TX 79927, USA;
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13
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Parker JJ, Simon C, Bendelow A, Bryan M, Smith RA, Kortsmit K, Salvesen von Essen B, Williams L, Dieke A, Warner L, Garfield CF. Fathers, Breastfeeding, and Infant Sleep Practices: Findings From a State-Representative Survey. Pediatrics 2023; 152:e2022061008. [PMID: 37325869 PMCID: PMC10900127 DOI: 10.1542/peds.2022-061008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVES To assess infant breastfeeding initiation and any breastfeeding at 8 weeks and safe sleep practices (back sleep position, approved sleep surface, and no soft objects or loose bedding ["soft bedding"]) by select paternal characteristics among a state-representative sample of fathers with new infants. METHODS Pregnancy Risk Assessment Monitoring System (PRAMS) for Dads, a novel population-based cross-sectional study, surveyed fathers in Georgia 2-6 months after their infant's birth. Fathers were eligible if the infant's mother was sampled for maternal PRAMS from October 2018 to July 2019. RESULTS Of 250 respondents, 86.1% reported their infants ever breastfed and 63.4% reported breastfeeding at 8 weeks. Initiation and breastfeeding at 8 weeks were more likely to be reported by fathers who reported wanting their infant's mother to breastfeed than those who did not want her to breastfeed or had no opinion (adjusted prevalence ratio [aPR] = 1.39; 95% confidence interval [CI], 1.15-1.68; aPR = 2.33; 95% CI, 1.59-3.42, respectively) and fathers who were college graduates than those with ≤high school diploma (aPR = 1.25; 95% CI, 1.06-1.46; aPR = 1.44; 95% CI, 1.08-1.91, respectively). Although about four-fifths (81.1%) of fathers reported usually placing their infants to sleep on their back, fewer fathers report avoiding soft bedding (44.1%) or using an approved sleep surface (31.9%). Non-Hispanic Black fathers were less likely to report back sleep position (aPR = 0.70; 95% CI, 0.54-0.90) and no soft bedding (aPR = 0.52; 95% CI, 0.30-0.89) than non-Hispanic white fathers. CONCLUSIONS Fathers reported suboptimal infant breastfeeding rates and safe sleep practices overall and by paternal characteristics, suggesting opportunities to include fathers in promotion of breastfeeding and infant safe sleep.
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Affiliation(s)
- John James Parker
- Family and Child Health Innovations Program, Smith Child Health Outcomes, Research and Evaluation Center
- Departments of Pediatrics
- Medicine, Northwestern University's Feinberg School of Medicine, Chicago, Illinois
| | - Clarissa Simon
- Family and Child Health Innovations Program, Smith Child Health Outcomes, Research and Evaluation Center
| | - Anne Bendelow
- Data Analytics and Reporting, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Michael Bryan
- Georgia Department of Public Health, Department of Epidemiology, Atlanta, Georgia
| | - Ruben A Smith
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Katherine Kortsmit
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | | | - Letitia Williams
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Ada Dieke
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Lee Warner
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia
| | - Craig F Garfield
- Family and Child Health Innovations Program, Smith Child Health Outcomes, Research and Evaluation Center
- Departments of Pediatrics
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14
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Meador M, Bay RC, Anderson E, Roy D, Allgood JA, Lewis JH. Using the Practical Robust Implementation and Sustainability Model (PRISM) to Identify and Address Provider-Perceived Barriers to Optimal Statin Prescribing and Use in Community Health Centers. Health Promot Pract 2023; 24:776-787. [PMID: 35603709 PMCID: PMC10336706 DOI: 10.1177/15248399221088592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Statins are an important but underutilized therapy to prevent cardiovascular events, particularly in high-risk patients. To increase use of statin therapy in high-risk patients, the Centers for Disease Control and Prevention funded a project led by the National Association of Community Health Centers to discover reasons for statin underuse in health centers and identify possible leverage points, particularly among vulnerable and underserved patients. The project further sought to develop training and educational materials to improve statin prescribing for and acceptance in eligible high-risk patients. As a first step, investigators implemented a questionnaire to clinical providers (n = 45) at health centers participating in the project to obtain their perspective on barriers to optimal statin use. We used the practical robust implementation and sustainability model (PRISM) domains to frame the overall project and guide the development of our questionnaire. This paper summarizes top perceived barriers to patient and health system/provider statin initiation and sustainment, as well as facilitators to prescribing, using PRISM as an organizing framework. Our questionnaire yielded important suggestions related to public awareness, education materials, health information technology (HIT)/data solutions, and clinical guidelines as key factors in optimizing statin use. It also informed the design of patient education resources and provider training tools. Future directions include using the full application of the PRISM implementation science model to assess how well our educational and training resources help overcome barriers to statin use in high-risk patients, including evaluating how key contextual factors influence successful implementation.
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Affiliation(s)
- Margaret Meador
- National Association of Community Health Centers, Bethesda, MD, USA
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15
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Farr SL, Downing KF, Tepper NK, Oster ME, Glidewell MJ, Reefhuis J. Reproductive Health of Women with Congenital Heart Defects. J Womens Health (Larchmt) 2023; 32:132-137. [PMID: 36757282 PMCID: PMC10680443 DOI: 10.1089/jwh.2022.0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
This report provides an overview of the unique reproductive health issues facing women with congenital heart defects (CHDs) and of the clinical care and professional guidelines on contraception, preconception care, and pregnancy for this population. It describes Centers for Disease Control and Prevention (CDC) activities related to surveillance of reproductive health issues among females with CHDs. It also describes CDC's work bringing awareness to physicians who provide care to adolescents and women with CHDs, including obstetrician/gynecologists, about the need for lifelong cardiology care for their patients with CHDs.
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Affiliation(s)
- Sherry L Farr
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karrie F Downing
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Naomi K Tepper
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew E Oster
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa J Glidewell
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennita Reefhuis
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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16
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Ragavan MI, Risser L, Duplessis V, DeGue S, Villaveces A, Hurley TP, Chang J, Miller E, Randell KA. The Impact of the COVID-19 Pandemic on the Needs and Lived Experiences of Intimate Partner Violence Survivors in the United States: Advocate Perspectives. Violence Against Women 2022; 28:3114-3134. [PMID: 34859721 PMCID: PMC9163202 DOI: 10.1177/10778012211054869] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We explored the challenges and lived experiences of intimate partner violence (IPV) survivors during the COVID-19 pandemic by interviewing 53 U.S.-based IPV advocates between June and November 2020. Advocates described how the COVID-19 pandemic limited survivors' abilities to meet their basic needs. The pandemic was also described as being used by abusive partners to perpetrate control and has created unique safety and harm reduction challenges. IPV survivors experienced compounding challenges due to structural inequities. IPV must be considered by local, state, and federal governments when developing disaster planning policies and practices, including in the context of pandemics.
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Affiliation(s)
- Maya I Ragavan
- Division of General Academic Pediatrics, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren Risser
- Division of Adolescent and Young Adult Medicine, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Sarah DeGue
- Division of Violence Prevention, National Center for Injury Prevention and Control, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrés Villaveces
- Division of Violence Prevention, National Center for Injury Prevention and Control, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tammy P Hurley
- Child Welfare, Trauma, and Resilience Initiatives, 3192American Academy of Pediatrics, Itasca, IL, USA
| | - Judy Chang
- Department of Obstetrics, Gynecology & Reproductive Sciences, and Internal Medicine, Magee-Women's Hospital, Pittsburgh, PA, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Kimberly A Randell
- Division of Pediatric Emergency Medicine, Children's Mercy Kansas City, Kansas City, MO, USA
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Liebhart JL, Goodman AB, Lindros J, Krafft C, Cook SR, Baker A, Hassink SG. Key Predictors of Primary Care Providers' Self-Efficacy in Caring for Children with Overweight or Obesity. Acad Pediatr 2022; 22:1158-1166. [PMID: 35247645 PMCID: PMC10291564 DOI: 10.1016/j.acap.2022.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Self-efficacy is a crucial factor in enabling pediatric primary care providers (PCPs) to deliver recommended care to children with overweight and obesity. This study, conducted with a large, national sample of PCPs, aimed to identify key factors, which may contribute to PCP self-efficacy for obesity-related care, from a list of previously reported barriers and facilitators. METHODS A national random sample of American Academy of Pediatrics members was surveyed in 2017 (analytic n = 704). Factor analysis was used to identify self-efficacy variables from relevant indicators and assess fit. Multivariable linear regression analyses were conducted to identify key predictors of PCP self-efficacy from reported facilitators or barriers to care, including characteristics of the PCP, practice, community, and payment systems. RESULTS Two PCP self-efficacy variables were identified: health risk assessment and patient-centered counseling. Both were positively predicted by relevant training, the belief that pediatricians play an important role in obesity, and awareness of barriers to payment for dietitians or weight management programs. Both were negatively predicted by a perceived lack of available PCP time for counseling and inadequacy of available referral resources to assist with treatment. Additional predictors of counseling self-efficacy included PCP beliefs that they are paid for treatment (+) and that patients/families lack time for healthy behaviors (-). Electronic health record clinical decision supports or registries and patient social disadvantage were not predictive. CONCLUSIONS Results suggest multiple potential roles and strategies for local and national organizations seeking to facilitate improvements to PCP self-efficacy in caring for children with overweight and obesity.
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Affiliation(s)
- Janice L Liebhart
- Institute for Healthy Childhood Weight, American Academy of Pediatrics (JL Liebhart, J Lindros, A Baker, and SG Hassink), Itasca, Ill.
| | - Alyson B Goodman
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention (AB Goodman), Atlanta, Ga
| | - Jeanne Lindros
- Institute for Healthy Childhood Weight, American Academy of Pediatrics (JL Liebhart, J Lindros, A Baker, and SG Hassink), Itasca, Ill
| | - Catherine Krafft
- Golisano Children's Ambulatory Care Facility, University of Rochester Medical Center (C Krafft and SR Cook), Rochester, NY
| | - Stephen R Cook
- Golisano Children's Ambulatory Care Facility, University of Rochester Medical Center (C Krafft and SR Cook), Rochester, NY
| | - Alison Baker
- Institute for Healthy Childhood Weight, American Academy of Pediatrics (JL Liebhart, J Lindros, A Baker, and SG Hassink), Itasca, Ill
| | - Sandra G Hassink
- Institute for Healthy Childhood Weight, American Academy of Pediatrics (JL Liebhart, J Lindros, A Baker, and SG Hassink), Itasca, Ill
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Calabrese T, Corcoran P, Limjuco S, Bernardi C, Plattos A, LeBlanc TT, Woolf A. An Innovative Approach to Increase Lead Testing by Pediatricians in Children, United States, 2019-2021. Am J Public Health 2022; 112:S647-S650. [PMID: 36179291 PMCID: PMC9528656 DOI: 10.2105/ajph.2022.307084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 09/03/2023]
Abstract
Opportunities for lead exposure are common in the United States. The American Academy of Pediatrics, in collaboration with the Centers for Disease Control and Prevention, launched the Increasing Capacity for Blood Lead Testing Extension for Community Healthcare Outcomes (ECHO) project to educate pediatricians on the importance of testing children for lead exposure and to assess practice behavior change. We found that two weeks to one month after receiving training, more than 80% of participants reported increased lead testing and practice changes. Our results support use of the ECHO model as a mechanism for practice change. (Am J Public Health. 2022;112(S7):S647-S650. https://doi.org/10.2105/AJPH.2022.307084).
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Affiliation(s)
- Trisha Calabrese
- Shannon Limjuco, Peter Corcoran, Trisha Calabrese, Cassandra Bernardi, and Alyse Plattos are with the American Academy of Pediatrics, Itasca, IL. Tanya Telfair LeBlanc is with the Lead Poisoning Prevention and Surveillance Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA, and is also a guest editor for this supplement issue. Alan Woolf is with the Harvard Medical School, Boston, MA
| | - Peter Corcoran
- Shannon Limjuco, Peter Corcoran, Trisha Calabrese, Cassandra Bernardi, and Alyse Plattos are with the American Academy of Pediatrics, Itasca, IL. Tanya Telfair LeBlanc is with the Lead Poisoning Prevention and Surveillance Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA, and is also a guest editor for this supplement issue. Alan Woolf is with the Harvard Medical School, Boston, MA
| | - Shannon Limjuco
- Shannon Limjuco, Peter Corcoran, Trisha Calabrese, Cassandra Bernardi, and Alyse Plattos are with the American Academy of Pediatrics, Itasca, IL. Tanya Telfair LeBlanc is with the Lead Poisoning Prevention and Surveillance Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA, and is also a guest editor for this supplement issue. Alan Woolf is with the Harvard Medical School, Boston, MA
| | - Cassandra Bernardi
- Shannon Limjuco, Peter Corcoran, Trisha Calabrese, Cassandra Bernardi, and Alyse Plattos are with the American Academy of Pediatrics, Itasca, IL. Tanya Telfair LeBlanc is with the Lead Poisoning Prevention and Surveillance Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA, and is also a guest editor for this supplement issue. Alan Woolf is with the Harvard Medical School, Boston, MA
| | - Alyse Plattos
- Shannon Limjuco, Peter Corcoran, Trisha Calabrese, Cassandra Bernardi, and Alyse Plattos are with the American Academy of Pediatrics, Itasca, IL. Tanya Telfair LeBlanc is with the Lead Poisoning Prevention and Surveillance Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA, and is also a guest editor for this supplement issue. Alan Woolf is with the Harvard Medical School, Boston, MA
| | - Tanya Telfair LeBlanc
- Shannon Limjuco, Peter Corcoran, Trisha Calabrese, Cassandra Bernardi, and Alyse Plattos are with the American Academy of Pediatrics, Itasca, IL. Tanya Telfair LeBlanc is with the Lead Poisoning Prevention and Surveillance Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA, and is also a guest editor for this supplement issue. Alan Woolf is with the Harvard Medical School, Boston, MA
| | - Alan Woolf
- Shannon Limjuco, Peter Corcoran, Trisha Calabrese, Cassandra Bernardi, and Alyse Plattos are with the American Academy of Pediatrics, Itasca, IL. Tanya Telfair LeBlanc is with the Lead Poisoning Prevention and Surveillance Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA, and is also a guest editor for this supplement issue. Alan Woolf is with the Harvard Medical School, Boston, MA
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Renov V, Risser L, Berger R, Hurley T, Villaveces A, DeGue S, Katz A, Henderson C, Premo K, Talis J, Chang JC, Ragavan M. The impact of the COVID-19 pandemic on child protective services caseworkers and administrators. Child Abuse Negl 2022; 130:105431. [PMID: 34953611 PMCID: PMC8665526 DOI: 10.1016/j.chiabu.2021.105431] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/25/2021] [Accepted: 12/02/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND The COVID-19 pandemic has impacted children and young people experiencing child abuse and neglect. Child Protective Services (CPS) has played an important role in supporting children and families during the COVID-19 pandemic. Few studies to-date have evaluated the impact of the pandemic on CPS caseworkers and administrators in the United States. OBJECTIVES We conducted interviews to explore CPS caseworkers' and administrators' experiences working and serving families during the pandemic. METHODS Participants were U.S.-based CPS caseworkers and administrators. We conducted semi-structured virtual interviews with participants and used an inductive thematic analysis approach. RESULTS We conducted 37 interviews. Participants discussed how the COVID-19 pandemic has changed the way they conduct investigations and provide services to families in the CPS system. Several services were adapted to occur virtually, providing challenges and unique opportunities. Participants also described the personal barriers they faced during the pandemic, including working remotely, experiencing burnout, and challenges obtaining personal protective equipment. Finally, participants shared creative solutions they engaged in to support children and families during the COVID-19 pandemic, including expanding collaborations with other community-based organizations. DISCUSSION This study suggests the important role that CPS has played during the pandemic and challenges individual CPS workers felt, in terms of both experiencing burnout and difficulty obtaining personalized protective equipment. Inclusion of the CPS system in emergency preparedness planning for future pandemics or natural disasters will ensure continuation of these vital services.
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Affiliation(s)
- Veronica Renov
- Pediatric Emergency Medicine, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224, United States of America.
| | - Lauren Risser
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA 15213, United States.
| | - Rachel Berger
- Division of Child Advocacy, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, United States of America.
| | - Tammy Hurley
- Child Welfare, Trauma, and Resilience Initiatives, American Academy of Pediatrics, 345 Park Blvd. Itasca, IL 60413, United States.
| | - Andrés Villaveces
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, S106-10, Atlanta, GA 30341, United States.
| | - Sarah DeGue
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, S106-10, Atlanta, GA 30341, United States.
| | - Abigail Katz
- Futures Without Violence, 101 Montgomery Street, San Francisco, CA, 94129, United States.
| | - Cynterria Henderson
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA 15213, United States.
| | - Kelly Premo
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA 15213, United States.
| | - Janine Talis
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA 15213, United States.
| | - Judy C Chang
- Department of Obstetrics, Gynecology & Reproductive Sciences, and Internal Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, United States.
| | - Maya Ragavan
- Division of General Academic Pediatrics, University of Pittsburgh, 3420 Fifth Avenue, Pittsburgh, PA 15213, United States.
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Rahman MM, Johnson C, Whyte M, Ewell J, Cope AB, Chandler Y, Bennett TS, Gray T, Gruber D, Peterman TA. Electronic Messaging for Gonorrhea and Chlamydia Test Result Notification, Improving Treatment and Patient Satisfaction. Sex Transm Dis 2022; 49:257-261. [PMID: 34813578 PMCID: PMC10214497 DOI: 10.1097/olq.0000000000001584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Approximately 20% of chlamydia (CT) and gonorrhea (GC) cases in Louisiana are diagnosed at Parish Health Units. Patient notification of CT and GC test results involves nurses' phone calls and letters to positive patients, which is time-consuming and inefficient. METHODS In December 2018, electronic results notification was implemented in Caddo Parish Health Unit using Chexout software to notify enrolled patients via text or email when test results are ready to view in a patient portal. We compared the timeliness of GC/CT results notification and treatment pre-Chexout (December 2017 to November 2018) and post-Chexout (December 2018 to November 2019) implementation. A random sample of patients was interviewed to assess acceptability. RESULTS During December 2018 to November 2019, 5432 patients were tested for CT/GC, 3924 (72%) enrolled in Chexout, and notifications were sent to 3884 (99%). Among CT-positives, 472 of 568 (83%) viewed results in the portal compared with 2451 of 3356 (73%) CT-negatives. Among GC-positives, 300 of 353 (85%) viewed results compared with 2657 of 3571 (74%) GC-negatives. Treatment success for CT improved from 493 of 670 (74%) to 506 of 568 (89%), and for GC, from 332 of 409 (81%) to 325 of 353 (92%). Mean time to treatment decreased for CT (13.4-10.7 days) and GC (11.3-9.2 days). Enrolled patients found Chexout notification satisfactory in 168 of 169 (99%) and easy to use in 130 of 141 (92%). Reasons for declining electronic notification included lack of personal cell phone for 55 of 86 (64%) and confidentiality concerns for 42 of 86 (49%). CONCLUSIONS Electronic messaging decreased time to notification and increased treatment success. Nurses spent less time notifying patients leaving more time for patient care.
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Affiliation(s)
- Mohammad M. Rahman
- Louisiana Department of Health- STD/HIV/Hepatitis Program, New Orleans, LA
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Chaquetta Johnson
- Louisiana Department of Health- STD/HIV/Hepatitis Program, New Orleans, LA
| | - Martha Whyte
- Louisiana Department of Health – Office of Public Health, Caddo Parish, LA
| | - Joy Ewell
- Louisiana Department of Health- STD/HIV/Hepatitis Program, New Orleans, LA
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Anna B. Cope
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
- North Carolina Department of Health and Human Services, Raleigh, NC
| | - Yolanda Chandler
- Louisiana Department of Health – Office of Public Health, Caddo Parish, LA
| | - Tammy S. Bennett
- Louisiana Department of Health – Bureau of Family Health, New Orleans, LA
| | - Terri Gray
- Louisiana Department of Health- STD/HIV/Hepatitis Program, New Orleans, LA
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - DeAnn Gruber
- Louisiana Department of Health – Bureau of Infectious Diseases, New Orleans, LA
| | - Thomas A. Peterman
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Gagnon KW, Bifulco L, Robinson S, Furness B, Lentine D, Anderson D. Qualitative inquiry into barriers and facilitators to transforming primary care for lesbian, gay, bisexual and transgender people in US federally qualified health centres. BMJ Open 2022; 12:e055884. [PMID: 35177460 PMCID: PMC8860040 DOI: 10.1136/bmjopen-2021-055884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Health systems must rapidly move knowledge into practice to address disparities impacting sexual and gender minority (SGM) patients. This qualitative study explores barriers and facilitators that arose during an initiative to improve care for SGM patients in federally qualified health centres (FQHCs) from the perspectives of FQHC staff. DESIGN Cross-sectional qualitative content analysis, using a general inductive approach, of secondary data from transcripts of intervention events offered to FQHC staff and semistructured interviews with staff and FQHC leadership during the intervention. SETTING 10 FQHCs from nine states in the USA. PARTICIPANTS FQHC quality improvement (QI) and clinical care staff, and leaders at each FQHC. INTERVENTIONS The transforming care for lesbian, gay, bisexual and transgender people QI initiative combined two evidence-based programmes, Learning Collaborative (LC) and Project Extension for Community Healthcare Outcomes (ECHO), to assist primary care health centres in developing capacity to identify SGM patients, monitor their health and care, and improve disparities. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was identification of barriers and facilitators to implementing initiatives to improve care for SGM patients. The secondary outcome was clarification of how intervention participants used Project ECHO sessions versus LC meetings to obtain information that influenced implementation of the initiative at their FQHC. RESULTS Barriers and facilitators mapped to two major themes: 'Clinical' (patients' health, wellness, and available treatment) and Health Systems and Institutional Culture (FQHC operations, and customs and social institutions within the FQHCs and in the external environment). Common 'Clinical' inquiries were for assistance with behavioural health, pre-exposure prophylaxis and transgender hormone therapy. Prevalent facilitators included workflow change and staff training, while adapting electronic health records for data collection, decision support and data extraction was the most prevalent barrier. CONCLUSIONS Project ECHO and LC provided complimentary forums to explore clinical and operational changes needed to improve care for SGM at FQHCs.
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Affiliation(s)
- Kelly W Gagnon
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Weitzman Institute, Community Health Center Inc, Middletown, Connecticut, USA
- Center for LGBT Health Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lauren Bifulco
- Weitzman Institute, Community Health Center Inc, Middletown, Connecticut, USA
| | - Sarafina Robinson
- Weitzman Institute, Community Health Center Inc, Middletown, Connecticut, USA
| | - Bruce Furness
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- HIV/AIDS, Hepatitis, STD and TB Administration, District of Columbia Department of Health, Washington, District of Columbia, USA
| | - Daniel Lentine
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daren Anderson
- Weitzman Institute, Community Health Center Inc, Middletown, Connecticut, USA
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Garfield CF, Simon CD, Stephens F, Castro Román P, Bryan M, Smith RA, Kortsmit K, Salvesen von Essen B, Williams L, Kapaya M, Dieke A, Barfield W, Warner L. Pregnancy Risk Assessment Monitoring System for Dads: A piloted randomized trial of public health surveillance of recent fathers' behaviors before and after infant birth. PLoS One 2022; 17:e0262366. [PMID: 35061783 PMCID: PMC8782358 DOI: 10.1371/journal.pone.0262366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/22/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Becoming a father impacts men's health and wellbeing, while also contributing to the health and wellbeing of mothers and children. There is no large-scale, public health surveillance system aimed at understanding the health and behaviors of men transitioning into fatherhood. The purpose of this study was to describe piloted randomized approaches of a state-based surveillance system examining paternal behaviors before and after their infant's birth to better understand the health needs of men and their families during the transition to parenthood. METHODS During October 2018-July 2019, 857 fathers in Georgia were sampled 2-6 months after their infant's birth from birth certificates files and surveyed via mail, online or telephone, in English or Spanish, using two randomized approaches: Indirect-to-Dads and Direct-to-Dads. Survey topics included mental and physical health, healthcare, substance use, and contraceptive use. FINDINGS Weighted response rates (Indirect-to-Dads, 33%; Direct-to-Dads, 31%) and population demographics did not differ by approach. Respondents completed the survey by mail (58%), online (28%) or telephone (14%). Among 266 fathers completing the survey, 55% had a primary care physician, and 49% attended a healthcare visit for themselves during their infant's mother's pregnancy or since their infant's birth. Most fathers were overweight or had obesity (70%) while fewer reported smoking cigarettes (19%), binge drinking (13%) or depressive symptoms (10%) since their infant's birth. CONCLUSIONS This study tests a novel approach for obtaining population-based estimates of fathers' perinatal health behaviors, with comparable response rates from two pragmatic approaches. The pilot study results quantify a number of public health needs related to fathers' health and healthcare access.
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Affiliation(s)
- Craig F. Garfield
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Division of Hospital Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago and Stanley Manne Children’s Research Institute, Chicago, Illinois, United States of America
- Family and Child Health Innovations Program, Ann & Robert H. Lurie Children’s Hospital of Chicago and Stanley Manne Children’s Research Institute, Chicago, Illinois, United States of America
| | - Clarissa D. Simon
- Family and Child Health Innovations Program, Ann & Robert H. Lurie Children’s Hospital of Chicago and Stanley Manne Children’s Research Institute, Chicago, Illinois, United States of America
| | - Fay Stephens
- Georgia Department of Public Health, Department of Epidemiology, Atlanta, Georgia, United States of America
| | - Patricia Castro Román
- Georgia Department of Public Health, Department of Epidemiology, Atlanta, Georgia, United States of America
| | - Michael Bryan
- Georgia Department of Public Health, Department of Maternal and Child Health Epidemiology, Atlanta, Georgia, United States of America
| | - Ruben A. Smith
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia, United States of America
| | - Katherine Kortsmit
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia, United States of America
| | - Beatriz Salvesen von Essen
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia, United States of America
| | - Letitia Williams
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia, United States of America
| | - Martha Kapaya
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia, United States of America
| | - Ada Dieke
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia, United States of America
| | - Wanda Barfield
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia, United States of America
| | - Lee Warner
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia, United States of America
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Uong S, Tomedi LE, Gloppen KM, Stahre M, Hindman P, Goodson VN, Crandall C, Sklar D, Brewer RD. Screening for Excessive Alcohol Consumption in Emergency Departments: A Nationwide Assessment of Emergency Department Physicians. J Public Health Manag Pract 2022; 28:E162-E169. [PMID: 33729185 PMCID: PMC10431951 DOI: 10.1097/phh.0000000000001286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess current screening practices for excessive alcohol consumption, as well as perceived barriers, perceptions, and attitudes toward performing this screening among emergency department (ED) physicians. DESIGN A brief online assessment of screening practices for excessive drinking was disseminated electronically to a representative panel of ED physicians from November 2016 to January 2017. Descriptive statistics were calculated on the frequency of alcohol screening, factors affecting screening, and attitudes toward screening. SETTING An online assessment was sent to a national panel of ED physicians. PARTICIPANTS A panel of ED physicians who volunteered to be part of the American College of Emergency Physicians Emergency Medicine Practice Research Network survey panel. MAIN OUTCOME MEASURE The primary outcome measures were the percentage of respondents who reported screening for excessive alcohol consumption and the percentage of respondents using a validated excessive alcohol consumption screening tool. RESULTS Of the 347 ED physicians evaluated (38.6% response rate), approximately 16% reported "always/usually," 70% "sometimes," and 14% "never" screening adult patients (≥18 years) for excessive alcohol use. Less than 20% of the respondents who screened for excessive drinking used a recommended screening tool. Only 10.5% of all respondents (15.4% "always," 9.5% "sometimes" screened) received an electronic health record (EHR) reminder to screen for excessive alcohol use. Key barriers to screening included limited time (66.2%) and treatment options for patients with drinking problems (43.1%). CONCLUSIONS Only 1 in 6 ED physicians consistently screened their patients for excessive drinking. Increased use of EHR reminders and other systems interventions (eg, electronic screening and brief intervention) could help improve the delivery of screening and follow-up services for excessive drinkers in EDs.
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Affiliation(s)
- Stephen Uong
- Council of State and Territorial Epidemiologists, Atlanta, Georgia (Mr Uong and Ms Goodson); ECHO Institute (Dr Tomedi) and Department of Emergency Medicine (Drs Sklar and Crandall), University of New Mexico, Albuquerque, New Mexico; Injury and Violence Prevention Section, Minnesota Department of Health, St Paul Minnesota (Dr Gloppen); Forecasting and Research Division, Washington Office of Financial Management, Olympia, Washington (Dr Stahre); Lifecourse Epidemiology & Genomics Division, Michigan Department of Health and Human Services, Lansing, Michigan (Mr Hindman); and Alcohol Program, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Brewer)
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Todd JV, Collins NV, Oakley J, Menza T, Barber M, Kasarskis I, Weresch A, Morgan S, Jellison J, Mishra N, Pérez A, Karki S. Automating Case Reporting of Chlamydia and Gonorrhea to Public Health Authorities in Oregon Clinics. Sex Transm Dis 2022; 49:38-42. [PMID: 34618780 PMCID: PMC10258727 DOI: 10.1097/olq.0000000000001507] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Optimizing sexually transmitted disease (STD) reporting to state public health authorities is important to reduce incidence and manage outbreaks of STDs. Electronic laboratory reporting (ELR) is the standard through which local clinics report STDs to state public health authority. Electronic case reporting (eCR) is an alternative approach which automates transmission of case reports to public health jurisdictions using electronic health record (EHR) data. METHODS Working with 3 community health centers in Oregon between February 3, 2020 and May 15, 2020, we piloted an automated eCR approach for gonorrhea (GC) and chlamydia (CT) from these clinics to the Oregon Health Authority. We compared the eCR approach to the existing ELR approach to determine completeness of case reporting for GC/CT. RESULTS A total of 365 eCRs from 206 unique patients were generated. Among 154 instances where the case detection logic was satisfied for CT, 37% (54 instances) were based on the presence of a diagnosis and 63% (97 instances) were based on laboratory data. Among 232 instances where logic was satisfied for GC, 44% (102 instances) reflected a diagnosis and 56% (130 instances) reflected laboratory results. Data completeness was uniformly equal or higher for eCRs versus ELRs. CONCLUSIONS The eCR approach was successful in identifying CT and GC cases and provided a more complete set of information to assist public health authorities when compared with ELRs. Electronic case reporting has the potential to automate and relieve staff burden on an important reporting requirement for clinical providers.
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Affiliation(s)
- Jonathan V. Todd
- OCHIN, Inc
- School of Public Health, Oregon Health and Science University – Portland State University, Portland, OR
| | | | | | - Timothy Menza
- Division of Infectious Diseases, Oregon Health and Science University, Portland
- Public Health Division, Oregon Health Authority, Salem, OR
| | | | | | | | | | - Jim Jellison
- Public Health Informatics Institute, Decatur, GA
| | - Ninad Mishra
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Alejandro Pérez
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Saugat Karki
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Esser MB, Sherk A, Subbaraman MS, Martinez P, Karriker-Jaffe KJ, Sacks JJ, Naimi TS. Improving Estimates of Alcohol-Attributable Deaths in the United States: Impact of Adjusting for the Underreporting of Alcohol Consumption. J Stud Alcohol Drugs 2022; 83:134-144. [PMID: 35040769 PMCID: PMC8819896 DOI: 10.15288/jsad.2022.83.134] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 05/21/2021] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE Self-reported alcohol consumption in U.S. public health surveys covers only 30%-60% of per capita alcohol sales, based on tax and shipment data. To estimate alcohol-attributable harms using alcohol-attributable fractions, accurate measures of total population consumption and the distribution of this drinking are needed. This study compared methodological approaches of adjusting self-reported survey data on alcohol consumption to better reflect sales and assessed the impact of these adjustments on the distribution of average daily consumption (ADC) levels and the number of alcohol-attributable deaths. METHOD Prevalence estimates of ADC levels (i.e., low, medium, and high) among U.S. adults who responded to the 2011-2015 Behavioral Risk Factor Surveillance System (BRFSS; N = 2,198,089) were estimated using six methods. BRFSS ADC estimates were adjusted using the National Alcohol Survey, per capita alcohol sales data (from the Alcohol Epidemiologic Data System), or both. Prevalence estimates for the six methods were used to estimate average annual alcohol-attributable deaths, using a population-attributable fraction approach. RESULTS Self-reported ADC in the BRFSS accounted for 31.3% coverage of per capita alcohol sales without adjustments, 36.1% using indexed-BRFSS data, and 44.3% with National Alcohol Survey adjustments. Per capita sales adjustments decreased low ADC prevalence estimates and increased medium and high ADC prevalence estimates. Estimated alcohol-attributable deaths ranged from approximately 91,200 per year (BRFSS unadjusted; Method 1) to 125,200 per year (100% of per capita sales adjustment; Method 6). CONCLUSIONS Adjusting ADC to reflect total U.S. alcohol consumption (e.g., adjusting to 73% of per capita sales) has implications for assessing the impact of excessive drinking on health outcomes, including alcohol-attributable death estimates.
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Affiliation(s)
- Marissa B. Esser
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adam Sherk
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | | | | | - Katherine J. Karriker-Jaffe
- Alcohol Research Group, Public Health Institute, Emeryville, California
- RTI International—Berkeley Office, Berkeley, California
| | | | - Timothy S. Naimi
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
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Abstract
Housing is considered a core social determinant of health (SDH) through mechanisms such as the quality, affordability, and location of the home. However, few nationally representative studies examine these mechanisms simultaneously with child health and healthcare use. To determine the associations between home quality and child health, a series of logistic regression analyses was employed using the Survey of Income and Program Participation (SIPP). The 2014 SIPP sample is a multistage, stratified sample of 53,070 housing units from 820 sample areas designed to represent the civilian, noninstitutionalized population of the United States. The analytic sample included 12,964 children aged 2-14 years. Poor housing quality was defined as whether the home had holes in the floor, cracks in the ceiling, plumbing issues, and/or pest problems. Outcome measures included child health status, number of medical visits, and hospitalizations. The results indicated that poor housing quality was associated with poorer health (OR = 1.16, 95% CI = 1.05-1.27) and a greater number of medical visits (OR = 1.11, 95% CI = 1.03, 1.20) after controlling for number of persons per household, neighborhood safety, nonmetropolitan status, parent's ability to afford housing-related expenses, and other SDH. Future work investigating and intervening on the SDH in children could specifically include the quality and contexts in which homes are situated.
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Affiliation(s)
- Samantha J Boch
- College of Nursing, 2650University of Cincinnati, OH, USA
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, OH, USA
| | - Deena J Chisolm
- Department of Pediatrics, Ohio State University College of Medicine, OH, USA
- Abigail Wexner Research Institute at Nationwide Children's Hospital, OH, USA
| | - Jennifer W Kaminski
- National Center on Birth Defects and Developmental Disabilities, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kelly J Kelleher
- Department of Pediatrics, Ohio State University College of Medicine, OH, USA
- Abigail Wexner Research Institute at Nationwide Children's Hospital, OH, USA
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VanNasdale DA, Jones-Jordan LA, Hurley MS, Shelton ER, Robich ML, Crews JE. Association between Vision Impairment and Physical Quality of Life Assessed Using National Surveillance Data. Optom Vis Sci 2021; 98:1063-1069. [PMID: 34570033 PMCID: PMC8505137 DOI: 10.1097/opx.0000000000001773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 05/04/2021] [Indexed: 11/27/2022] Open
Abstract
SIGNIFICANCE Physically unhealthy days assessments in national health surveillance datasets represent a useful metric for quantifying quality-of-life differences in those with and without vision impairment. Disproportionately poorer physical health in the visually impaired population provides further rationale for the inclusion of vision care in multidisciplinary approaches to chronic disease management. PURPOSE This study aimed to assess the association between vision impairment and health-related quality of life using data from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System. METHODS Data from each of the 50 states were extracted from the 2017 Behavioral Risk Factor Surveillance System data set. Self-report of difficulty seeing was used to categorize visually impaired versus nonvisually impaired populations. Self-report number of physically unhealthy days in the previous 30 days was used to quantify quality of life. The number of unhealthy days was calculated for the visually impaired and nonvisually impaired cohorts for each state. The ratio of the number of physically unhealthy days in the visually impaired versus nonvisually impaired population was calculated for each state and for different age cohorts. RESULTS Mean numbers of physically unhealthy days among persons with and without severe vision impairment across all states were 10.63 and 3.68 days, respectively, and demonstrated considerable geographic variability. Mean ratios of physically unhealthy healthy days in the visually impaired versus the nonvisually impaired population were 2.91 in the 18- to 39-year-old cohort, 2.87 in the 40- to 64-year-old cohort, and 2.16 in the ≥65-year-old cohort. CONCLUSIONS National surveillance data demonstrate a greater number of physically unhealthy days in the visually impaired population, indicating a need to improve our understanding of causes that lead to reduced physical health among those with vision impairment. Additional research is needed to better understand how individuals perceive vision as part of their overall health.
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Affiliation(s)
| | | | - Megan S. Hurley
- The Ohio State University College of Optometry, Columbus, Ohio
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Strasser S, Stauber C, Shrivastava R, Riley P, O’Quin K. Collective insights of public-private partnership impacts and sustainability: A qualitative analysis. PLoS One 2021; 16:e0254495. [PMID: 34283847 PMCID: PMC8291689 DOI: 10.1371/journal.pone.0254495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 06/29/2021] [Indexed: 11/18/2022] Open
Abstract
The global Coronavirus or COVID-19 pandemic exposed the weakness of healthcare systems including laboratory systems and is a call to action for unprecedented collaboration and partnerships to deal with the global crisis. The United States (U.S.) President’s Emergency Plan for AIDS Relief (PEPFAR) establishes the global HIV/AIDS treatment agenda in alignment with the UNAIDS 90-90-90 treatment targets to achieve epidemic control related to enhanced testing, treatment, and viral suppression. A strategic PEPFAR priority area recognizes that large-scale collective efforts and sharing of resources bear greater potential impact for lasting change than any single organization or entity can achieve alone. An important vehicle utilized within the global public health context is the public-private partnership (PPP) model whereby multiple international organizations forge unified project charters to collectively reach mutually agreed goals. While touted as an ideal mechanism to synthesize resources and maximize gain in numerous applications, little is known from a seasoned stakeholder perspective regarding PPP implementation and sustainability issues. The purpose of this research is to holistically examine perceptions of PPP model sustainability related to inputs and impacts among a collective network of stakeholders experienced with PEPFAR workforce development, laboratory-system strengthening project implementation. Interviews were conducted with frontline stakeholders from public and private sector organizations based in the US and select PEPFAR-supported priority countries. Analysis revealed three dominant themes: PPP impacts, keys of successful collaboration, and logistical challenges and opportunities to enhance sustainability of PPP outcomes in the future.
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Affiliation(s)
- Sheryl Strasser
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Christine Stauber
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Ritu Shrivastava
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Patricia Riley
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Karen O’Quin
- Department of Sustainable Development, Region Värmland, Karlstad, Sweden
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Rodela K, Wiggins N, Maes K, Campos-Dominguez T, Adewumi V, Jewell P, Mayfield-Johnson S. The Community Health Worker (CHW) Common Indicators Project: Engaging CHWs in Measurement to Sustain the Profession. Front Public Health 2021; 9:674858. [PMID: 34239855 PMCID: PMC8258143 DOI: 10.3389/fpubh.2021.674858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/17/2021] [Indexed: 11/21/2022] Open
Abstract
Despite progress in documenting the outcomes of Community Health Worker interventions, the lack of standardized measures to assess CHW practice has made it difficult for programs to conduct reliable evaluations, and impossible to aggregate data across programs and regions, impeding commitment to sustainable, long-term financing of CHW programs. In addition, while CHWs have sometimes been involved as data collectors, they have seldom been engaged as full partners in all stages of evaluation and research. This manuscript details the current work being done by the CI Project, demonstrating how CHWs are able to contribute to the integrity, sustainability, and viability of CHW programs through the collaborative development and adoption of a set of common process and outcome constructs and indicators for CHW practice and CHW program implementation.
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Affiliation(s)
- Keara Rodela
- Immigrant and Refugee Community Organization, Portland, OR, United States
| | - Noelle Wiggins
- Wiggins Health Consulting LLC, Portland, OR, United States
| | - Kenneth Maes
- Director, Applied Anthropology Graduate Program, School of Language, Culture and Society, Oregon State University, Corvallis, OR, United States
| | | | - Victoria Adewumi
- Manchester City Health Department, Manchester, NH, United States
| | - Pennie Jewell
- Nottawaseppi Huron Band of the Potawatomi, Fulton, MI, United States
| | - Susan Mayfield-Johnson
- School of Health Professions, University of Southern Mississippi, Hattiesburg, MS, United States
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Rembert JH, Zometa CS, O'Carroll PW, Licier AL, McPhillips-Tangum C, Hale PM. Using the Collaborative Requirements Development Methodology to Build Laboratory Capacity for Timely Diagnosis During the Zika Epidemic in Puerto Rico. J Public Health Manag Pract 2021; 27:E143-E150. [PMID: 32011597 PMCID: PMC9059220 DOI: 10.1097/phh.0000000000001130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In 2016, Puerto Rico became the focal point of the Zika epidemic, with more than 36 000 laboratory-confirmed cases before August. The Puerto Rico Department of Health (PRDH) responded by providing tests to symptomatic and asymptomatic pregnant women. The increased demand for Zika testing placed unprecedented strain on the laboratory capacity and information management processes used within the PRDH. The PRDH recognized the need to have an updated informatics system that securely manages, stores, and transmits digital data. The Centers for Disease Control and Prevention funded the Public Health Informatics Institute to collaborate with the PRDH to assess and improve the informatics capability to respond to the ongoing Zika virus transmission in Puerto Rico. APPROACH The team employed a 4-component approach to assess the informatics system and improve the information management processes for laboratory testing and reporting of arboviral diseases (Zika, chikungunya, and dengue). The method consisted of a (1) needs assessment, (2) business process analysis and requirements definition, (3) vendor analysis, and (4) solution implementation. RESULTS The needs assessment determined that the PRDH's procedures for arbovirus testing and reporting were highly complex and paper-based and thus did not maximize the use of existing technology. The solution was to build a Web portal. The business process analysis yielded information to create a map of the flow of specimens, an arbovirus context diagram, and more than 200 requirements. The requirements identified in this process guided the design and creation of the Web portal. DISCUSSION This report describes the process to build a Web portal to enhance laboratory testing and electronic reporting of Zika cases during the 2016 epidemic in Puerto Rico. We demonstrate the utility of applying the Collaborative Requirements Development Methodology, a proven informatics method, to the development of a Web portal for managing arboviruses in a health department.
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Affiliation(s)
- Juneka H Rembert
- The Public Health Informatics Institute at the Task Force for Global Health, Decatur, Georgia (Ms Rembert, Dr O'Carroll, and Ms Hale); Puerto Rico Department of Health, San Juan, Puerto Rico (Ms Licier); CMT Consulting, LLC, Lakewood, Ohio (Ms McPhillips-Tangum); and Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Zometa)
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Eisenberg Y, Vanderbom KA, Harris K, Herman C, Hefelfinger J, Rauworth A. Evaluation of the Reaching People with Disabilities through Healthy Communities Project. Disabil Health J 2021; 14:101061. [PMID: 33516725 DOI: 10.1016/j.dhjo.2021.101061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND People with disabilities experience disparities in chronic diseases, such as obesity, heart disease, and diabetes, in disproportionate numbers. Research suggests that healthy communities initiatives that work to implement policy, systems and environmental (PSE) changes can help reduce these disparities by improving access to healthy choices for community residents with disabilities. However, healthy communities efforts to implement PSE changes are often not inclusive of people with disabilities. OBJECTIVE The purpose of this paper is to evaluate the implementation of an Inclusive Healthy Communities Model that was designed to reach people with disabilities through inclusive PSE changes. METHODS Professionals from local public health agencies and disability organizations in 10 diverse communities worked to infuse disability inclusion into PSE changes promoting healthy living. Data on PSE implementation was collected and coded into categories to describe the nature of the inclusive PSEs. RESULTS Communities implemented 507 inclusive PSEs, 466 of which were environmental changes, 25 systems changes, and 16 policy changes. A large majority of PSEs were related to improving the built environment to facilitate access to public spaces, such as parks, playgrounds, and community gardens. Many communities also implemented policy and systems changes related to the addition of inclusion into existing policies, community plans, and ongoing training of staff. CONCLUSION Integrating disability inclusion into traditional healthy communities efforts can facilitate improved access and opportunity for healthy living among people with disabilities. This pilot project has implications for public health workforce training, current practices, and PSE development with interdisciplinary teams and multisectoral coalitions.
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Affiliation(s)
- Yochai Eisenberg
- Department of Disability and Human Development, University of Illinois at Chicago, 1640 W. Roosevelt Rd. M/C 626, Chicago, IL 60608, USA.
| | - Kerri A Vanderbom
- University of Alabama at Birmingham/Lakeshore Research Collaborative, 4000 Ridgeway Dr., Birmingham, AL 35209, USA.
| | - Karma Harris
- National Association of Chronic Disease Directors, 325 Swanton Way, Atlanta, GA 30030 USA.
| | - Casey Herman
- National Center on Health Physical Activity and Disability/Lakeshore Foundation, 4000 Ridgeway Dr., Birmingham, AL 35209, USA
| | - Jennie Hefelfinger
- National Association of Chronic Disease Directors, 325 Swanton Way, Atlanta, GA 30030 USA.
| | - Amy Rauworth
- National Center on Health Physical Activity and Disability/Lakeshore Foundation, 4000 Ridgeway Dr., Birmingham, AL 35209, USA.
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Townsend JS, Jones MC, Jones MN, Waits AW, Konrad K, McCoy NM. A Case Study of Early-Onset Colorectal Cancer: Using Electronic Health Records to Support Public Health Surveillance on an Emerging Cancer Control Topic. J Registry Manag 2021; 48:4-11. [PMID: 34170890 PMCID: PMC9231638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Electronic health records (EHRs) are increasingly being used to support public health surveillance, including in cancer, where many population-based registries can now accept electronic case reporting. Using EHRs to supplement cancer registry data provides the opportunity to examine in more detail emerging issues in cancer control, such as the increasing incidence rates of early onset colorectal cancer (CRC). The purpose of this study was to evaluate the feasibility of a public health organization partnering with a health system to examine risk factors for early-onset CRC in a community cancer setting, and to further understand challenges with using EHRs to address emerging topics in cancer control. We conducted a mixed-methods evaluation using key informant interviews with public health practitioners, researchers, and registry staff to generate insights on how using EHRs and partnering with health systems can improve chronic disease surveillance and cancer control. A data quality assessment of variables representing risk factors for CRC and other clinical characteristics was conducted on all CRC patients diagnosed in 2016 at the participating cancer center. The quantitative assessment of the EHR data revealed that, while most chronic health conditions were well documented, around 25% of CRC patients were missing information on body mass index, alcohol, and tobacco use. Key informants offered ideas and ways to overcome challenges with using EHR data to support chronic disease surveillance. Their recommendations included the following activities: engaging EHR vendors in the development of standards, taking leadership roles on workgroups to address emerging technological issues, participating in pilot studies and task forces, and negotiating with EHR vendors so that clinical decision support tools built to support public health initiatives are freely available to all users of those EHRs. Although using EHR data to support public health efforts is not without its challenges, it soon could be an important part of chronic disease surveillance and cancer control.
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Affiliation(s)
- Julie S. Townsend
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Amy W. Waits
- Northside Hospital Cancer Institute, Atlanta, Georgia
| | | | - Natasha M. McCoy
- National Association of Chronic Disease Directors, Decatur, Georgia
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Beasley LO, King C, Esparza I, Harnden A, Robinson LR, So M, Morris A, Silovsky JF. Understanding Initial and Sustained Engagement of Spanish-Speaking Latina Mothers in the Legacy for Children Program™: A Qualitative Examination of a Group-Based Parenting Program. Early Child Res Q 2021; 54:99-109. [PMID: 34737489 PMCID: PMC8563015 DOI: 10.1016/j.ecresq.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Culturally congruent parenting programs delivered during early childhood have the potential to support diverse families. Legacy for Children™ (Legacy) is a group-based prevention program designed to promote child development by reinforcing sensitive, responsive mother-child relationships, building maternal self-efficacy, and fostering peer networks of support among mothers living in poverty (Perou et al., 2012). The Legacy program was translated and culturally adapted for Spanish-speaking Latina mothers and their infants (hereafter referred to as Latina mothers) with a feasibility trial conducted to determine the cultural congruency of the adaptation. Feasibility results were positive with no previous studies validating the adapted Legacy Spanish language program (Legacy Spanish). The current manuscript focuses on understanding factors of engagement of the culturally adapted model. Specifically, we examined the factors that were perceived to have enhanced or hindered both initial and sustained engagement in the adapted Legacy Spanish program for Latina mothers. Individual interviews were conducted with Latina mothers (N=26) who attended the Legacy Spanish program. We used a template approach within NVivo 11© software to identify broad themes in Latina mothers' responses. Themes emerged regarding the importance of using home-based recruitment strategies and pairing verbal information with written brochures to foster initial engagement. Sustained engagement themes focused on the provision of support from other Latina mothers in the Legacy group and the relationships with the group leaders. Having group leaders who were perceived as genuine, kind, positive, "good" at teaching, and persistent emerged as themes that facilitated initial and ongoing engagement. Barriers to engagement centered primarily on logistics rather than characteristics of the program itself. Thus, Latina mothers attributed importance to aspects of the curriculum, logistics, and implementation with respect to program engagement. Application of similar engagement strategies could enhance the success of early childhood parenting programs and linkages with early educational programming.
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Affiliation(s)
- Lana O Beasley
- Oklahoma State University, 340 Human Sciences, Stillwater, OK 74078
- University of Oklahoma Health Sciences Center, 1100 NE 13 St., Oklahoma City, OK 73117
| | - Corie King
- University of Oklahoma Health Sciences Center, 1100 NE 13 St., Oklahoma City, OK 73117
| | - Irma Esparza
- University of Oklahoma Health Sciences Center, 1100 NE 13 St., Oklahoma City, OK 73117
| | - Angela Harnden
- University of Oklahoma Health Sciences Center, 1100 NE 13 St., Oklahoma City, OK 73117
| | - Lara R Robinson
- Child Development Studies Team, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341
| | - Marvin So
- Child Development Studies Team, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341
| | - Amanda Morris
- Oklahoma State University, 340 Human Sciences, Stillwater, OK 74078
| | - Jane F Silovsky
- University of Oklahoma Health Sciences Center, 1100 NE 13 St., Oklahoma City, OK 73117
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Seagle EE, Montour J, Lee D, Phares C, Jentes ES. Health screening results of Cubans settling in Texas, USA, 2010-2015: A cross-sectional analysis. PLoS Med 2020; 17:e1003233. [PMID: 32797047 PMCID: PMC7428019 DOI: 10.1371/journal.pmed.1003233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 07/15/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Protecting the health of refugees and other migrant populations in the United States is key to ensuring successful resettlement. Therefore, to identify and address health concerns early, the US Centers for Disease Control and Prevention (CDC) recommends a domestic medical examination (screening for infectious and noninfectious diseases/conditions) shortly after arrival in the US. However, because refugee/migrant populations often have differing health patterns from one another and the US population, the collection and analysis of health information is key to developing population-specific clinical guidelines to guide the care of resettled individuals. Yet little is known regarding the health status of Cubans resettling in the US. Among the tens of thousands of Cuban migrants who have resettled in the US, some applied as refugees in Cuba, some applied for parole (a term used to indicate temporary US admission status for urgent humanitarian reasons or reasons of public benefit under US immigration law) in Cuba, and others applied for parole status after crossing the border. These groups were eligible for US government benefits to help them resettle, including a domestic medical examination. We reviewed health differences found in these examinations of those who were determined to be refugees or parolees in Cuba and those who were given parole status after arrival. METHODS AND FINDINGS We conducted a retrospective cross-sectional analysis of the Texas Department of State Health Services database. Cubans who arrived from 2010 to 2015 and received a domestic medical examination in Texas were included. Those granted refugee/parolee status in Cuba were listed in federal databases for US-bound refugees/parolees; those who were paroled after arrival were not listed. Overall, 2,189 (20%) obtained either refugee or parolee status in Cuba, and 8,709 (80%) received parolee status after arrival. Approximately 62% of those who received parolee status after arrival at the border were male, compared with 49% of those who obtained prior refugee/parolee status in Cuba. Approximately one-half (45%) of those paroled after arrival were 19-34 years old (versus 26% among those who obtained refugee/parolee status in Cuba). Separate models were created for each screening indicator as the outcome, with entry route as the main exposure variable. Crude and adjusted prevalence ratios were estimated using PROC GENMOD procedures in SAS 9.4. Individuals paroled after arrival were less likely to screen positive for parasitic infections (9.6% versus 12.2%; adjusted prevalence ratio: 0.79, 0.71-0.88) and elevated blood lead levels (children ≤16 years old, 5.2% versus 12.3%; adjusted prevalence ratio: 0.42, 0.28-0.63). Limitations include potential disease misclassification, missing clinical information, and cross-sectional nature. CONCLUSIONS Within-country variations in health status are often not examined in refugee populations, yet they are critical to understand granular health trends. Results suggests that the health profiles of Cuban Americans in Texas differed by entry route. This information could assist in developing targeted screenings and health interventions.
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Affiliation(s)
- Emma E. Seagle
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Applied Epidemiology Fellowship Program, Council of State and Territorial Epidemiologists, Atlanta, Georgia, United States of America
| | - Jessica Montour
- Texas Refugee Health Program, Texas Department of State Health Services, Austin, Texas, United States of America
| | - Deborah Lee
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Christina Phares
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Emily S. Jentes
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
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So M, Rojo ALA, Robinson LR, Hartwig SA, Lee ARH, Beasley LO, Silovsky JF, Morris AS, Titchener KS, Roblyer MZ. Parent engagement in an original and culturally adapted evidence-based parenting program, Legacy for Children™. Infant Ment Health J 2020; 41:356-377. [PMID: 32275084 PMCID: PMC7322668 DOI: 10.1002/imhj.21853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Legacy for Children™ (Legacy) is an evidence-based program focused on promoting sensitive, responsive parenting for socioeconomically disadvantaged families. Legacy has recently been culturally and linguistically adapted for Spanish-monolingual Latino families and is being piloted in partnership with an early childhood education program. We conducted a mixed methods study to identify barriers and facilitators to engagement, using program monitoring data sources from both participant and group leader perspectives. We conducted qualitative analyses of open-ended data to identify distinct barriers (e.g., employment challenges, health-related challenges and appointments) and facilitators (e.g., other mothers in group, interest in program topics) to engagement that emerged across English and Spanish language curriculum versions; curriculum-specific barriers and facilitators were also documented. We interpret these findings in light of quantitative data on measures of engagement, showing that participants in the Spanish curriculum evidenced comparable levels of parent-group leader relationship quality relative to the English group, and higher levels of parent's group support/connectedness and overall satisfaction. These results offer promising considerations for optimizing families' engagement in parenting programs in the context of early care and education settings.
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Affiliation(s)
- Marvin So
- Child Development Studies Team, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341
- Oak Ridge Institute for Science and Education, 1299 Bethel Valley Rd, Oak Ridge, TN 37830
| | - Ana L. Almeida Rojo
- Child Development Studies Team, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341
- Oak Ridge Institute for Science and Education, 1299 Bethel Valley Rd, Oak Ridge, TN 37830
| | - Lara R. Robinson
- Child Development Studies Team, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341
| | - Sophie A. Hartwig
- Child Development Studies Team, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341
- Oak Ridge Institute for Science and Education, 1299 Bethel Valley Rd, Oak Ridge, TN 37830
| | - Akilah R. Heggs Lee
- Child Development Studies Team, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341
- Oak Ridge Institute for Science and Education, 1299 Bethel Valley Rd, Oak Ridge, TN 37830
| | - Lana O. Beasley
- Oklahoma State University, 700 N. Greenwood Ave., Main Hall 1110, Tulsa, OK 74106
- Oklahoma University Health Sciences Center, 1100 NE 13th St., Oklahoma City, OK 73117
| | - Jane F. Silovsky
- Oklahoma University Health Sciences Center, 1100 NE 13th St., Oklahoma City, OK 73117
| | - Amanda S. Morris
- Oklahoma State University, 700 N. Greenwood Ave., Main Hall 1110, Tulsa, OK 74106
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Treat AE, Sheffield Morris A, Hays-Grudo J, Williamson AC. The impact of positive parenting behaviors and maternal depression on the features of young children's home language environments. J Child Lang 2020; 47:382-400. [PMID: 31741432 DOI: 10.1017/s030500091900062x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study investigated the associations between maternal depression when infants were 3 to 11 months old (M = 6 months), and positive parenting behaviors when children were between 12 and 22 months (M = 17 months) and the home language environment assessed when children were 18 to 28 months old (M = 23.5 months) in a sample of 29 low-income mother-child dyads. After controlling for maternal education, only teaching behaviors remained a moderate and significant predictor of adult word counts. Observed teaching behaviors significantly predicted conversational turns and marginally predicted child vocalizations; effects sizes were small. Encouraging behaviors were a small and significant predictor of conversational turns and a marginally significant predictor of adult word counts. Maternal depression was a moderate and significant predictor of children's vocal productivity scores and a small, marginal predictor of conversational turns. These findings have important implications for parenting and children's language outcomes.
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Boch SJ, Taylor DM, Danielson ML, Chisolm DJ, Kelleher KJ. 'Home is where the health is': Housing quality and adult health outcomes in the Survey of Income and Program Participation. Prev Med 2020; 132:105990. [PMID: 31954138 PMCID: PMC7024670 DOI: 10.1016/j.ypmed.2020.105990] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/13/2019] [Accepted: 01/12/2020] [Indexed: 11/22/2022]
Abstract
Nearly a quarter of the homes in the United States were considered unhealthy or inadequate, but whether these housing characteristics have direct effects on health or whether they are driven by other contextual housing and neighborhood characteristics remains unclear. The purpose of this study was to quantify the independent associations between poor housing quality and adult health outcomes, adjusting for socioeconomic factors (e.g. income to poverty ratio, food insecurity) and other contextual housing characteristics (e.g. rental status, number of people per household, unsafe neighborhood). Using in-person household interview data from wave 1 of the 2014 Survey of Income and Program Participation (SIPP), a secondary analysis was performed using a series of logistic regression models. The 2014 SIPP sample is a multistage stratified sample of 53,070 housing units designed to represent the civilian, noninstitutionalized population of the United States (N = 55,281 adults ages 18 and older). Our results indicate that each additional poor housing characteristic was associated with poorer health status (OR: 1.17, CI [1.11, 1.23]), higher medical utilization (OR: 1.11 CI: [1.06, 1.16]), and a higher likelihood of hospitalization (OR: 1.07, CI [1.02, 1.12]). Non-housing-related government assistance, food security, and safe neighborhoods only partially explained associations between housing quality and health outcomes. Evaluating current local, state, and federal policy on housing quality standards may help determine if these standards decrease the number of Americans residing in inadequate homes or result in improvements in health and reductions in healthcare costs. Simply put, the home is where [we suggest] the health is.
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Affiliation(s)
- Samantha J Boch
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Danielle M Taylor
- Health and Disability Statistics Branch, U.S. Census Bureau, Suitland, MD, USA
| | - Melissa L Danielson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Deena J Chisolm
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Kelly J Kelleher
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
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Rambo-Martin BL, Keller MW, Wilson MM, Nolting JM, Anderson TK, Vincent AL, Bagal UR, Jang Y, Neuhaus EB, Davis CT, Bowman AS, Wentworth DE, Barnes JR. Influenza A Virus Field Surveillance at a Swine-Human Interface. mSphere 2020; 5:e00822-19. [PMID: 32024713 PMCID: PMC7002310 DOI: 10.1128/msphere.00822-19] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/07/2020] [Indexed: 12/20/2022] Open
Abstract
While working overnight at a swine exhibition, we identified an influenza A virus (IAV) outbreak in swine, Nanopore sequenced 13 IAV genomes from samples we collected, and predicted in real time that these viruses posed a novel risk to humans due to genetic mismatches between the viruses and current prepandemic candidate vaccine viruses (CVVs). We developed and used a portable IAV sequencing and analysis platform called Mia (Mobile Influenza Analysis) to complete and characterize full-length consensus genomes approximately 18 h after unpacking the mobile lab. Exhibition swine are a known source for zoonotic transmission of IAV to humans and pose a potential pandemic risk. Genomic analyses of IAV in swine are critical to understanding this risk, the types of viruses circulating in swine, and whether current vaccines developed for use in humans would be predicted to provide immune protection. Nanopore sequencing technology has enabled genome sequencing in the field at the source of viral outbreaks or at the bedside or pen-side of infected humans and animals. The acquired data, however, have not yet demonstrated real-time, actionable public health responses. The Mia system rapidly identified three genetically distinct swine IAV lineages from three subtypes, A(H1N1), A(H3N2), and A(H1N2). Analysis of the hemagglutinin (HA) sequences of the A(H1N2) viruses identified >30 amino acid differences between the HA1 of these viruses and the most closely related CVV. As an exercise in pandemic preparedness, all sequences were emailed to CDC collaborators who initiated the development of a synthetically derived CVV.IMPORTANCE Swine are influenza virus reservoirs that have caused outbreaks and pandemics. Genomic characterization of these viruses enables pandemic risk assessment and vaccine comparisons, though this typically occurs after a novel swine virus jumps into humans. The greatest risk occurs where large groups of swine and humans comingle. At a large swine exhibition, we used Nanopore sequencing and on-site analytics to interpret 13 swine influenza virus genomes and identified an influenza virus cluster that was genetically highly varied to currently available vaccines. As part of the National Strategy for Pandemic Preparedness exercises, the sequences were emailed to colleagues at the CDC who initiated the development of a synthetically derived vaccine designed to match the viruses at the exhibition. Subsequently, this virus caused 14 infections in humans and was the dominant U.S. variant virus in 2018.
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Affiliation(s)
| | - Matthew W Keller
- Oak Ridge Institute of Science and Education (ORISE), Oak Ridge, Tennessee, USA
| | - Malania M Wilson
- Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Jacqueline M Nolting
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Tavis K Anderson
- National Animal Disease Center, Agricultural Research Service (ARS), U.S. Department of Agriculture (USDA), Ames, Iowa, USA
| | - Amy L Vincent
- National Animal Disease Center, Agricultural Research Service (ARS), U.S. Department of Agriculture (USDA), Ames, Iowa, USA
| | | | - Yunho Jang
- Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Elizabeth B Neuhaus
- Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - C Todd Davis
- Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Andrew S Bowman
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, Ohio, USA
| | - David E Wentworth
- Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - John R Barnes
- Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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Boundy EO, Fisher Boyd A, Hamner HC, Belay B, Liebhart JL, Lindros J, Hassink S, Frintner MP. US Pediatrician Practices on Early Nutrition, Feeding, and Growth. J Nutr Educ Behav 2020; 52:31-38. [PMID: 31759892 PMCID: PMC10168016 DOI: 10.1016/j.jneb.2019.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Assess pediatrician practices around growth and nutrition for children under 2 years. DESIGN 2017 cross-sectional survey of a national random sample of the American Academy of Pediatrics members. SETTING US. PARTICIPANTS Practicing primary care pediatricians and residents (n = 698). MAIN OUTCOME MEASURES World Health Organization growth chart use, solid food introduction recommendations, healthy behaviors discussion. ANALYSIS Descriptive statistics were calculated for nutrition-related questions. McNemar tests compared recommendations on the introduction of different solid foods at <6 months; chi-square tests of independence examined outcomes by pediatrician and practice characteristics. RESULTS Most respondents (82.2%) reported using the World Health Organization growth charts at all well visits. Nearly half (45.3%) recommended solid food introduction at 6 months; 48.2% recommended <6 months. Cereals were more frequently recommended at <6 months than fruits/vegetables or meats (P <.001). Topics most frequently discussed were limiting juice (92.3%), and sugar-sweetened beverages (92.0%), avoiding restrictive and permissive food practices (30.7%), and avoiding food as a reward (29.1%) were least discussed. Pediatricians in hospital/clinic settings discussed healthy behaviors less than group or solo/2-physician practices. CONCLUSIONS AND IMPLICATIONS For children under 2 years, most pediatricians reported using recommended growth charts and discussing healthy behaviors. Fewer discussed responsive feeding topics. Results for guiding solid food introduction were mixed. Continued efforts to support pediatricians' work could improve the implementation of recommended practices.
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Affiliation(s)
- Ellen O'Neal Boundy
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
| | | | - Heather C Hamner
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Brook Belay
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Janice L Liebhart
- American Academy of Pediatrics, Institute for Healthy Childhood Weight, Itasca, IL
| | - Jeanne Lindros
- American Academy of Pediatrics, Institute for Healthy Childhood Weight, Itasca, IL
| | - Sandra Hassink
- American Academy of Pediatrics, Institute for Healthy Childhood Weight, Itasca, IL
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Jones WK, Hahn RA, Parrish RG, Teutsch SM, Chang MH. Male Mortality Trends in the United States, 1900-2010: Progress, Challenges, and Opportunities. Public Health Rep 2020; 135:150-160. [PMID: 31804898 PMCID: PMC7119244 DOI: 10.1177/0033354919893029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Male mortality fell substantially during the past century, and major causes of death changed. Building on our recent analysis of female mortality trends in the United States, we examined all-cause and cause-specific mortality trends at each decade from 1900 to 2010 among US males. METHODS We conducted a descriptive study of age-adjusted death rates (AADRs) for 11 categories of disease and injury stratified by race (white, nonwhite, and, when available, black), the excess of male mortality over female mortality ([male AADR - female AADR]/female AADR), and potential causes of persistent excess of male mortality. We used national mortality data for each decade. RESULTS From 1900 to 2010, the all-cause AADR declined 66.4% among white males and 74.5% among nonwhite males. Five major causes of death in 1900 were pneumonia and influenza, heart disease, stroke, tuberculosis, and unintentional nonmotor vehicle injuries; in 2010, infectious conditions were replaced by cancers and chronic lower respiratory diseases. The all-cause excess of male mortality rose from 9.1% in 1900 to 65.5% in 1980 among white males and a peak of 63.7% in 1990 among nonwhite males, subsequently falling among all groups. CONCLUSION During the last century, AADRs among males declined more slowly than among females. Although the gap diminished in recent decades, exploration of social and behavioral factors may inform interventions that could further reduce death rates among males.
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Affiliation(s)
- Wanda K. Jones
- Office of Research Integrity, Office of the Assistant Secretary for Health, US Department of Health and Human Services, Rockville, MD, USA
| | - Robert A. Hahn
- Community Guide Branch, Office of Public Health Scientific Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Steven M. Teutsch
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California Public Health Institute, Los Angeles, CA, USA
- UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Man-Huei Chang
- Office of the Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
This study builds upon a project that developed clinical criteria to identify undiagnosed hypertension patients "hiding in plain sight" (HIPS) by examining patient characteristics to understand whether there are disparities in hypertension diagnosis. We examined electronic health record demographic data for patients identified by the HIPS criteria and subgroups at 3 Missouri health centers. Identified patients who returned for a follow-up visit and were subsequently diagnosed with hypertension tended to be older, black/African American, uninsured, and classified as having obesity. Younger, white, healthy weight females were less likely to be diagnosed. These findings point to exploring possible biases/other nonclinical factors in hypertension diagnosis.
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Affiliation(s)
- Margaret Meador
- Correspondence: Margaret Meador, MPH, National Association of Community Health Centers, 7501 Wisconsin Ave Ste 1100W, Bethesda, MD 20814 ()
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Abstract
Public health workforce size and composition have been difficult to accurately determine because of the wide variety of methods used to define job title terms, occupational categories, and worker characteristics. In 2014, a preliminary consensus-based public health workforce taxonomy was published to standardize the manner in which workforce data are collected and analyzed by outlining uniform categories and terms. We summarize development of the taxonomy's 2017 iteration and provide guidelines for its implementation in public health workforce development efforts. To validate its utility, the 2014 taxonomy was pilot tested through quantitative and qualitative methods to determine whether further refinements were necessary. Pilot test findings were synthesized, themed by axis, and presented for review to an 11-member working group drawn from the community of experts in public health workforce development who refined the taxonomy content and structure through a consensus process. The 2017 public health workforce taxonomy consists of 287 specific classifications organized along 12 axes, intended for producing standardized descriptions of the public health workforce. The revised taxonomy provides enhanced clarity and inclusiveness for workforce characterization and will aid public health workforce researchers and workforce planning decision makers in gathering comparable, standardized data to accurately describe the public health workforce.
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Affiliation(s)
- Angela J Beck
- Center of Excellence in Public Health Workforce Studies, University of Michigan School of Public Health, Ann Arbor, Michigan (Drs Beck and Boulton); Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Coronado); and Columbia University Medical Center, New York, New York (Dr Merrill)
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Rolfes MA, Flannery B, Chung JR, O’Halloran A, Garg S, Belongia EA, Gaglani M, Zimmerman RK, Jackson ML, Monto AS, Alden NB, Anderson E, Bennett NM, Billing L, Eckel S, Kirley PD, Lynfield R, Monroe ML, Spencer M, Spina N, Talbot HK, Thomas A, Torres SM, Yousey-Hindes K, Singleton JA, Patel M, Reed C, Fry AM. Effects of Influenza Vaccination in the United States During the 2017-2018 Influenza Season. Clin Infect Dis 2019; 69:1845-1853. [PMID: 30715278 PMCID: PMC7188082 DOI: 10.1093/cid/ciz075] [Citation(s) in RCA: 192] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/22/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The severity of the 2017-2018 influenza season in the United States was high, with influenza A(H3N2) viruses predominating. Here, we report influenza vaccine effectiveness (VE) and estimate the number of vaccine-prevented influenza-associated illnesses, medical visits, hospitalizations, and deaths for the 2017-2018 influenza season. METHODS We used national age-specific estimates of 2017-2018 influenza vaccine coverage and disease burden. We estimated VE against medically attended reverse-transcription polymerase chain reaction-confirmed influenza virus infection in the ambulatory setting using a test-negative design. We used a compartmental model to estimate numbers of influenza-associated outcomes prevented by vaccination. RESULTS The VE against outpatient, medically attended, laboratory-confirmed influenza was 38% (95% confidence interval [CI], 31%-43%), including 22% (95% CI, 12%-31%) against influenza A(H3N2), 62% (95% CI, 50%-71%) against influenza A(H1N1)pdm09, and 50% (95% CI, 41%-57%) against influenza B. We estimated that influenza vaccination prevented 7.1 million (95% CrI, 5.4 million-9.3 million) illnesses, 3.7 million (95% CrI, 2.8 million-4.9 million) medical visits, 109 000 (95% CrI, 39 000-231 000) hospitalizations, and 8000 (95% credible interval [CrI], 1100-21 000) deaths. Vaccination prevented 10% of expected hospitalizations overall and 41% among young children (6 months-4 years). CONCLUSIONS Despite 38% VE, influenza vaccination reduced a substantial burden of influenza-associated illness, medical visits, hospitalizations, and deaths in the United States during the 2017-2018 season. Our results demonstrate the benefit of current influenza vaccination and the need for improved vaccines.
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Affiliation(s)
- Melissa A Rolfes
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brendan Flannery
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessie R Chung
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alissa O’Halloran
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University Health Science Center College of Medicine, Temple
| | | | | | - Arnold S Monto
- University of Michigan School of Public Health, Ann Arbor
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver
| | - Evan Anderson
- Georgia Emerging Infections Program, Atlanta VA Medical Center, Emory University, New York
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, New York
| | | | - Seth Eckel
- Michigan Department of Health and Human Services, Lansing
| | | | | | | | | | - Nancy Spina
- New York State Emerging Infections Program, New York State Department of Health, Albany
| | | | | | | | | | - James A Singleton
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Manish Patel
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carrie Reed
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
In 2014, the Centers for Disease Control and Prevention (CDC) commissioned the Urban Indian Health Institute (UIHI) to coordinate a multifaceted national evaluation plan for Good Health and Wellness in Indian Country (GHWIC), CDC's largest investment in chronic disease prevention for American Indians and Alaska Natives (AI/ANs). GHWIC is a collaborative agreement among UIHI, CDC, tribal organizations, and individual tribes. In collaboration, UIHI and CDC drew upon an indigenous framework, prioritizing strength-based approaches for documenting program activities, to develop a 3-tiered evaluation model. The model incorporated locally tailored metrics, adherence to tribal protocols, and cultural priorities. Ultimately, federal requirements and data collection processes were aligned with tribal strengths and bidirectional learning was promoted. We describe how UIHI worked with tribal recipients, tribal health organizations, Tribal Epidemiology Centers, and CDC to develop and implement the model on the basis of an indigenous framework of mutual trust and respect.
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Affiliation(s)
- Thomas J Lawrence
- Seattle Indian Health Board, Urban Indian Health Institute, 611 12th Ave S, Seattle, WA 98144.
| | - Rosalina D James
- Seattle Indian Health Board, Urban Indian Health Institute, Seattle, Washington
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Sedani A, Stover D, Coyle B, Wani RJ. Assessing Workplace Health and Safety Strategies, Trends, and Barriers through a Statewide Worksite Survey. Int J Environ Res Public Health 2019; 16:ijerph16142475. [PMID: 31336749 PMCID: PMC6678341 DOI: 10.3390/ijerph16142475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/26/2019] [Accepted: 07/09/2019] [Indexed: 11/16/2022]
Abstract
Chronic diseases have added to the economic burden of the U.S. healthcare system. Most Americans spend most of their waking time at work, thereby, presenting employers with an opportunity to protect and promote health. The purpose of this study was to assess the implementation of workplace health governance and safety strategies among worksites in the State of Nebraska, over time and by industry sector using a randomized survey. Weighted percentages were compared by year, industry sector, and worksite size. Over the three study periods, 4784 responses were collected from worksite representatives. Adoption of workplace health governance and planning strategies increased over time and significantly varied across industry sector groups. Organizational safety policies varied by industry sector and were more commonly reported than workplace health governance and planning strategies. Time constraints were the most common barrier among worksites of all sizes, and stress was reported as the leading employee health issue that negatively impacts business. Results suggest that opportunities exist to integrate workplace health and safety initiatives, especially in blue-collar industry sectors and small businesses.
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Affiliation(s)
- Ami Sedani
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Derry Stover
- Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, NE 68509, USA.
| | - Brian Coyle
- Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, NE 68509, USA
| | - Rajvi J Wani
- Division of Public Health, Nebraska Department of Health and Human Services, Lincoln, NE 68509, USA
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Brabson LA, Herschell AD, Kolko DJ, Mrozowski SJ. Associations Among Job Role, Training Type, and Staff Turnover in a Large-Scale Implementation Initiative. J Behav Health Serv Res 2019; 46:399-414. [PMID: 30607527 PMCID: PMC8006068 DOI: 10.1007/s11414-018-09645-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Staff turnover is problematic for behavioral health agencies implementing evidence-based practices (EBPs), which are costly and time-consuming. The current study examined the association between EBP training methods and turnover and explored predictors of turnover for different types of staff. Participants (100 clinicians, 50 supervisors, 50 administrators) were randomized to one of three training conditions for an EBP. Results indicated low annual rates of turnover for clinicians, supervisors, and administrators. However, contrary to hypothesis, no statistically significant differences were found in rates of turnover across training conditions. Partially consistent with prior research, organizational climate was a significant predictor of supervisor and administrator turnover at 24 months, but was not a significant predictor of clinician turnover. Implications and future directions for research are discussed.
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Affiliation(s)
- Laurel A Brabson
- Department of Psychology, West Virginia University, 1124 Life Sciences Building, P.O. Box 6040, Morgantown, WV, 26506-6040, USA.
| | - Amy D Herschell
- Department of Psychology, West Virginia University, 1124 Life Sciences Building, P.O. Box 6040, Morgantown, WV, 26506-6040, USA
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - David J Kolko
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, USA
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McGinty MD, Binkin N, Arrazola J, Israel MN, Juliano C. Epidemiology Workforce Capacity in 27 Large Urban Health Departments in the United States, 2017. Public Health Rep 2019; 134:386-394. [PMID: 31211646 PMCID: PMC6598134 DOI: 10.1177/0033354919856935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The Council of State and Territorial Epidemiologists (CSTE) has periodically assessed the epidemiological capacity of states since 2001, but the data do not reflect the total US epidemiology capacity. CSTE partnered with the Big Cities Health Coalition (BCHC) in 2017 to assess epidemiology capacity in large urban health departments. We described the epidemiology workforce capacity of large urban health departments in the United States and determined gaps in capacity among BCHC health departments. METHODS BCHC, in partnership with CSTE, modified the 2017 State Epidemiology Capacity Assessment for its 30 member departments. Topics in the assessment included epidemiology leadership, staffing, funding, capacity to perform 4 epidemiology-related Essential Public Health Services, salary ranges, hiring requirements, use of competencies, training needs, and job vacancies. RESULTS The 27 (90%) BCHC-member health departments that completed the assessment employed 1091 full-time equivalent epidemiologists. All or nearly all health departments provided epidemiology services for programs in infectious disease (n = 27), maternal and child health (n = 27), preparedness (n = 27), chronic diseases (n = 25), vital statistics (n = 25), and environmental health (n = 23). On average, funding for epidemiology activities came from local (47%), state (24%), and federal (27%) sources. Health departments reported needing a 40% increase from the current number of epidemiologists to achieve ideal epidemiology capacity. Twenty-five health departments reported substantial-to-full capacity to monitor health problems, 21 to diagnose health problems, 11 to conduct evaluations, and 9 to perform applied research. CONCLUSIONS Strategies to meet 21st century challenges and increase substantial-to-full epidemiological capacity include seeking funds from nongovernmental sources, partnering with schools and programs of public health, and identifying creative solutions to hiring and retaining epidemiologists.
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Affiliation(s)
| | - Nancy Binkin
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Jessica Arrazola
- Council of State and Territorial Epidemiologists, Atlanta, GA, USA
| | - Mia N. Israel
- Council of State and Territorial Epidemiologists, Atlanta, GA, USA
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Arrazola J, Israel MN, Binkin N. Applied Epidemiology Workforce Growth and Capacity Challenges: The Council of State and Territorial Epidemiologists 2017 Epidemiology Capacity Assessment. Public Health Rep 2019; 134:379-385. [PMID: 31161923 PMCID: PMC6598145 DOI: 10.1177/0033354919849887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To better understand the current status and challenges of the state public health department workforce, the Council of State and Territorial Epidemiologists (CSTE) assessed the number and functions of applied public health epidemiologists at state health departments in the United States. METHODS In 2017, CSTE emailed unique online assessment links to state epidemiologists in the 50 states and the District of Columbia (N = 51). The response rate was 100%. CSTE analyzed quantitative data (27 questions) on funding, the number of current and needed epidemiologists, recruitment, retention, perceived capacity, and training. CSTE coded qualitative data in response to an open-ended question that asked about the most important problems state epidemiologists face. RESULTS Most funding for epidemiologic activities came from the federal government (mean, 77%). State epidemiologists reported needing 1199 additional epidemiologists to achieve ideal capacity but noted challenges in recruiting qualified staff members. Respondents cited opportunities for promotion (n = 45, 88%), salary (n = 41, 80%), restrictions on merit raises (n = 36, 70%), and losses to the private or government sector (n = 33, 65%) as problems for retention. Of 4 Essential Public Health Services measured, most state epidemiologists reported substantial-to-full capacity to monitor health status (n = 43, 84%) and diagnose and investigate community health problems (n = 47, 92%); fewer respondents reported substantial-to-full capacity to conduct evaluations (n = 20, 39%) and research (n = 11, 22%). CONCLUSIONS Reliance on federal funding negatively affects employee retention, core capacity, and readiness at state health departments. Creative solutions for providing stable funding, developing greater flexibility to respond to emerging threats, and enhancing capacity in evaluation and applied research are needed.
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Affiliation(s)
- Jessica Arrazola
- Council of State and Territorial Epidemiologists, Atlanta, GA, USA
| | - Mia N. Israel
- Council of State and Territorial Epidemiologists, Atlanta, GA, USA
| | - Nancy Binkin
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
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Volerman A, Toups M, Hull A, Dennin M, Kim TY, Ignoffo S, Sharp LK, Press VG. Assessing children's readiness to carry and use quick-relief inhalers. J Allergy Clin Immunol Pract 2019; 7:1673-1675.e2. [PMID: 30529064 PMCID: PMC6511305 DOI: 10.1016/j.jaip.2018.11.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Affiliation(s)
| | | | | | | | - Tae Yeon Kim
- University of Chicago Pritzker School of Medicine,
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DeSisto CL, Kroelinger CD, Estrich C, Velonis A, Uesugi K, Goodman DA, Pliska E, Akbarali S, Rankin KM. Application of an Implementation Science Framework to Policies on Immediate Postpartum Long-Acting Reversible Contraception. Public Health Rep 2019; 134:189-196. [PMID: 30699303 PMCID: PMC6410478 DOI: 10.1177/0033354918824329] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Implementation science provides useful tools for guiding and evaluating the integration of evidence-based interventions with standard practice. The objective of our study was to demonstrate the usefulness of applying an implementation science framework-the Consolidated Framework for Implementation Research (CFIR)-to increase understanding of implementation of complex statewide public health initiatives, using the example of Medicaid immediate postpartum long-acting reversible contraception (LARC) policies. METHODS We conducted semistructured telephone interviews with the 13 state teams participating in the Immediate Postpartum LARC Learning Community. We asked teams to describe the implementation facilitators, barriers, and strategies in 8 focus areas of the Learning Community. We audio-recorded and transcribed interviews and then coded each interview according to the domains and constructs (ie, theoretical concepts) of the CFIR. RESULTS Cosmopolitanism (ie, networking with external organizations) was the most frequently coded construct of the framework. A related construct was networks and communications (ie, the nature and quality of social networks and formal and informal communications in an organization). Within the construct of cost, state teams identified barriers that were often unable to be overcome. Trialability (ie, ability to test the intervention on a small scale) and engaging champions (ie, attracting and involving persons who dedicate themselves to supporting the intervention in an organization) were among the most salient constructs of the framework and were the sources of many implementation strategies. CONCLUSIONS State leaders and program staff members may benefit from considering the CFIR domains and constructs in the planning, implementation, and evaluation of complex statewide public health initiatives.
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Affiliation(s)
- Carla L. DeSisto
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Charlan D. Kroelinger
- Division of Reproductive Health, Field Support Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA, USA
| | - Cameron Estrich
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Alisa Velonis
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Keriann Uesugi
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - David A. Goodman
- Division of Reproductive Health, Maternal Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA, USA
| | - Ellen Pliska
- Association of State and Territorial Health Officials, Arlington, VA, USA
| | - Sanaa Akbarali
- Association of State and Territorial Health Officials, Arlington, VA, USA
| | - Kristin M. Rankin
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
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