Search

This study examined how lifetime stress exposure and race are associated with first-birth intendedness, and whether these associations differ based on stress exposure timing. Greater lifetime stress exposure was related to increased first-birth intendedness for black women but was unrelated or even associated with decreased first-birth intendedness for white women, depending on stress exposure timing. These effects were robust while controlling for age, partner status, household income, and education, and they differed based on the timing of participants’ stress exposure. These data thus provide evidence that first-birth intendedness is influenced by both lifetime stress exposure and race in the United States. [ABSTRACT FROM AUTHOR]

Objective: The National Early Care and Education Learning Collaboratives (ECELC) Project aims to promote healthy physical activity and nutrition environments, policies and practices in early care and education (ECE) programmes across multiple states. The present pilot study sought to assess changes to the physical activity and nutrition practices in a sub-sample of ECE programmes participating in the ECELC using the Environment and Policy Assessment and Observation (EPAO). Additionally, it sought to compare results with the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC).Design: Quasi-experimental pre-post pilot study where paired-sample t tests examined changes to physical activity and nutrition practices from pre-assessment to post-assessment (P<0·05). Pearson correlation coefficients examined change scores from EPAO compared with NAP SACC with statistical significance set at a two-sided α level of P<0·10 to account for sample size.Setting: The study occurred among ECE programmes.Subjects: Pre-school classrooms in nineteen ECE programmes across four US states were observed.Results: EPAO data demonstrated an increase in total score from pre-assessment to post-assessment (150 (sd 30) to 176 (sd 35)). NAP SACC change scores demonstrated little relationship with EPAO domain change scores, with exceptions in Nutrition Policy and Physical Activity Policy (r=-0·4 and -0·6, respectively).Conclusions: The overall improvements reported through the EPAO suggest participation in the ECELC resulted in changes in critical nutrition- and physical activity-related practices. However, considerable differences in data reported using the NAP SACC compared with the EPAO suggest subjective data should be interpreted with caution and objective measurement should be used when feasible. [ABSTRACT FROM AUTHOR]

The goal of the U.S. Department of Agriculture’s Supplemental Nutrition Assistance Program (SNAP) is to assist food insecure households by providing federally allocated funds to increase purchasing power and ultimately achieve a more nutritious diet; however, working poor households tend to be underserved by SNAP. This study identified factors associated with SNAP participation in a nationally representative sample of the working poor (adults with household incomes ≤ 130% of the poverty level who worked 27 or more weeks during the year). Data were from the 2012 American Community Survey. Multivariable logistic regression was used to examine independent factors associated with SNAP participation. Adjusting for all other factors and state of residence, those more likely to participate in SNAP included those who were women; younger; non-Hispanic black or Hispanic; separated/divorced; less educated; U.S. citizens; English-speaking; disabled; with no health insurance; on government health plan; moved within the past year; lived in household with no access to a vehicle; paid more for electricity; multigenerational; and those who had at least one child member or one or more elderly members (P < .05, for each). SNAP outreach and policy may be more effective by targeting the working poor, specifically segments of the population who are less likely to participate in SNAP. [ABSTRACT FROM PUBLISHER]

The article discusses research regarding rural grocery storeowners' perceptions of their communities, their business practices, and factors that influence their sustainability and the ability to support healthy food choices in Nebraska as of 2016. According to the article, storeowners reported on strategies that they employ to remain competitive by focusing on customer service and product quality. The public health aspects of obesity in America are examined, along with small U.S. stores.

An estimated 78% of Hispanics in the United States (US) are overweight or obese. Household food insecurity, a condition of limited or uncertain access to adequate food, has been associated with obesity rates among Hispanic adults in the US. However, the Hispanic group is multi-ethnic and therefore associations between obesity and food insecurity may not be constant across Hispanic country of origin subgroups. This study sought to determine if the association between obesity and food insecurity among Hispanics is modified by Hispanic ancestry across low-income (≤200% of poverty level) adults living in California. Data are from the cross-sectional 2011-12 California Health Interview Survey (n = 5498). Rates of overweight or obesity (BMI ≥ 25), Calfresh receipt (California's Supplemental Nutrition Assistance Program), and acculturation were examined for differences across subgroups. Weighted multiple logistic regressions examined if household food insecurity was significantly associated with overweight or obesity and modified by country of origin after controlling for age, education, marital status, country of birth (US vs. outside of US), language spoken at home, and Calfresh receipt (P < .05). Significant differences across subgroups existed for prevalence of overweight or obesity, food security, Calfresh receipt, country of birth, and language spoken at home. Results from the adjusted logistic regression models found that food insecurity was significantly associated with overweight or obesity among Mexican-American women (β (SE) = 0.22 (0.09), p = .014), but not Mexican-American men or Non-Mexican groups, suggesting Hispanic subgroups behave differently in their association between food insecurity and obesity. By highlighting these factors, we can promote targeted obesity prevention interventions, which may contribute to more effective behavior change and reduced chronic disease risk in this population. [ABSTRACT FROM AUTHOR]

Backpack programs across the United States distribute easy-to-prepare foods in a backpack to potentially food-insecure students on Fridays to help reduce weekend hunger. This study used Healthy Eating Index 2010 (HEI-2010) to assess foods provided in Montana backpack programs. Healthy Eating Index 2010 measures compliance with the 2010 Dietary Guidelines and is a tool to assess the diet quality of foods provided in supplemental food assistance programs. We hypothesized that HEI-2010 scores would be of average dietary quality. One randomly selected menu was collected from each Montana backpack program (n = 5) from the 2011-2012 academic year. Each food provided was analyzed for diet quality using HEI-2010 to obtain component and total scores. Descriptive statistics and t tests were calculated to assess whether mean HEI-2010 component scores and total scores differed significantly ( P < .05) from the maximum scores. The mean total score for HEI-2010 was significantly lower than the maximum score of 100 (58.65; SD, 15.59; P = .004). Analysis resulted in significantly lower mean scores for total vegetables (2.26; SD, 1.37; P = .011), greens and beans (0; SD, 0; P < .001), fatty acids (0; SD, 0; P < .001), and sodium (3.90; SD, 2.52; P = .006). Dietary quality of backpack programs may further improve with information sharing between programs about the availability of specific food group items. To better suit children's nutritional needs and increase HEI-2010 scores, researchers, practitioners, and the food industry should identify food options for the backpack program that are easy to prepare, appealing, and affordable. [ABSTRACT FROM AUTHOR]

Asthma is the leading chronic illness in children, affecting about 4.8 million children in the United States. Recent reports indicate a lack of asthma educational resources for rural school health nurses to use in their practice. This article describes the development of the My Asthma Coloring Book© educational tool for children and their families living in rural communities. My Asthma Coloring Book© was developed to provide asthma information in a short-story format for children with asthma. The coloring book content is described, including its utilization as part of the A+ Asthma Rural Partnership research project funded by the National Institute of Nursing Research (RO1NR05062-01). [ABSTRACT FROM AUTHOR]

Examines the relationship between the Wide Range Achievement Test 3 and Wechsler Individual Achievement Test for a sample of children with learning disabilities in two rural school districts in the United States. Testing of children to determine school placements; Usefulness of information in assessing tests as measures of reading, arithmetic and spelling.

This article begins by discussing the recent emergence in the United States of women's health as a major public policy issue. The central question posed in the article is, How can the public's and government's interest in women's health be used to maximize health benefits for all women? Two arenas of women's health, childbearing and heart disease, are explored to further our understand of the possible costs and benefits to women of being a priority within the national public policy agenda. Three factors are proposed as crucial for maximizing women's health benefits within the current health policy climate: (a) broadening the definition of health benefits, (b) involving more women in the process of determining the hierarchy of health needs, and (c) involving more women in both the research and clinical aspects of medicine. [ABSTRACT FROM AUTHOR]

Immigration policy under the Trump Administration has relied on local officials and local information to fulfill federal policy goals of high-volume deportation. It has embroiled states and localities and inspired impassioned objection from many impacted localities. This intensification of federal deportation has compelled states, towns, and cities to define their relationships with their immigrant communities of color, federal deportation policy, and immigration law. This is nowhere more true than in Oregon. Oregon's response has been to unravel the strands of federal deportation policy that had over time become enmeshed in state, local, and private institutions. This Article, drafted in the crucible of an intensive upper-level immigration course, takes a deep dive into Oregon's efforts to shake off the tendrils of federal deportation policy. Why might it be worthwhile to follow the trail of immigrant inclusion in Oregon? Understanding the genesis of inclusive immigrant policies in this jurisdiction reveals that inclusionary policies have a deep-rooted history that long precedes the current administration's pronouncements. As a case study, Oregon's decades-long effort to disentangle itself from the divisiveness of federal immigration policy sheds valuable light on the process by which local jurisdictions build local policies to foster the kind of inclusion of immigrant communities of color seen as critical to local prosperity. [ABSTRACT FROM AUTHOR]

Introduction A primary mission of the U.S. Centers for Disease Control and Prevention's (CDC) is promoting immunization against seasonal influenza. As with most education efforts, CDC's influenza-related communications are often informed by formative research. Methods A qualitative meta-analysis of 29 unpublished, primarily qualitative CDC-sponsored studies related to flu and flu vaccination knowledge, attitudes and beliefs (KABs). The studies, undertaken between 2000 and 2013, involved focus groups, in-depth interviews, message testing and surveys. Some involved health care professionals, while others involved members of the public, including sub-populations at risk for severe illness. Findings The themes that emerged suggested progress in terms of KABs related to influenza and influenza vaccination, but also the persistence of many barriers to vaccine acceptance. With respect to the public, recurring themes included limited understanding of influenza and immunization recommendations, indications of greater sub-group recognition of the value of flu vaccination, continued resistance to vaccination among many, and overestimation of the effectiveness of non-vaccine measures. Seven cognitive facilitators of vaccination were identified in the studies along with six cognitive barriers. For health care providers, the analysis suggests greater knowledge and more favorable beliefs, but many misperceptions persist and are similar to those held by the public. KABs often differed by type or category of health care provider. Conclusions The themes identified in this qualitative analysis illustrate the difficulty in changing KABs related to influenza and influenza vaccine, particularly on the scope and scale needed to greatly improve uptake. Even with an influenza pandemic and more vaccine options available, public and some health care provider perceptions and beliefs are difficult and slow to change. This meta-analysis does, however, provide important insights from previously unpublished information that can help those who are promoting influenza vaccination to health care providers, the general public and specific populations within the general population. [ABSTRACT FROM AUTHOR]

Beginning December 6, 2021, all international air passengers boarding flights to the United States were required to show either a negative result from a SARS-CoV-2 viral test taken ≤1 day before departure or proof of recovery from COVID-19 within the preceding 90 days (1). As of June 12, 2022, predeparture testing was no longer mandatory but remained recommended by CDC (2,3). Various modeling studies have estimated that predeparture testing the day before or the day of air travel reduces transmission or importation of SARS-CoV-2 by 31%-76% (4-7). Postarrival SARS-CoV-2 pooled testing data from CDC's Traveler-based Genomic Surveillance program were used to compare SARS-CoV-2 test results among volunteer travelers arriving at four U.S. airports during two 12-week periods: March 20-June 11, 2022, when predeparture testing was required, and June 12-September 3, 2022, when predeparture testing was not required. In a multivariable logistic regression model, pooled nasal swab specimens collected during March 20-June 11 were 52% less likely to be positive for SARS-CoV-2 than were those collected during June 12-September 3, after adjusting for COVID-19 incidence in the flight's country of origin, sample pool size, and collection airport (adjusted odds ratio [aOR] = 0.48, 95% CI = 0.39-0.58) (p<0.001). These findings support predeparture testing as a tool for reducing travel-associated SARS-CoV-2 transmission and provide important real-world evidence that can guide decisions for future outbreaks and pandemics., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Benjamin H. Rome, Siyao Lisa Li, Thomas W.S. Aichele, and Robert C. Morfino are employed by Ginkgo Bioworks and own Ginkgo Bioworks employee stocks or restricted stock units (RSU) grants. Ezra T. Ernst is employed by XWELL and owns XWELL employee stocks or RSU grants. No other potential conflicts of interest were disclosed.

Purpose: The purpose of the Oncology Care Model (OCM) is to improve quality and reduce cost through practice transformation. A foundational tenant is to reduce avoidable emergency room (ER) visits and hospitalizations. In anticipation of being an OCM participant, we instituted a multidimensional campaign designed to meet these objectives., Methods: Prior actions included establishment of phone triage unit, after-hours and weekend calls, and institution of weekend urgent care., Results: On the basis of data from the Chronic Condition Warehouse, as provided by the Centers for Medicare and Medicaid Services, we were successful at reducing the acute care admissions rate by 16%. During the baseline period extending from Jan 2016-Mar 2016, the hospital admission rate was 27 per patient, per quarter, at an average cost per admission event of $11,122, translating to an inpatient cost per patient, per quarter, of $3,003. In the year one reporting period of July 2016-July 2017, the hospital admission rate declined to 22.6 per patient, per quarter, at an average cost per admission event of $11,106, translating to an inpatient cost per patient, per quarter, of $2,505. OCM patient survey scores improved. In addition, at Oncology Hematology Care, we achieved improved results compared with the risk-adjusted national averages for the following measures: readmissions (4.9 v 5.6 per 100 patients, respectively), ER use (17 v 18.6 per 100 patients, respectively), and observation stays (2.7 v 3.6 per 100 patients, respectively)., Conclusion: By implementing a cost-efficient, reproducible, and scalable campaign targeting ER avoidance and hospitalizations, we were able to decrease hospital admissions. Reported Medicare savings amounted to nearly $798,000 in inpatient cost per quarter over 1,600 patients.

We assessed the consumer food environment in rural areas by using the Nutrition Environment Measures Survey for Stores (NEMS-S) to measure the availability, price, and quality of fruits and vegetables. We randomly selected 20 grocery stores (17 rural, 3 urban) in 12 Montana counties using the 2013 US Department of Agriculture's rural-urban continuum codes. We found significant differences in NEMS-S scores for quality of fruits and vegetables; of 6 possible points, the mean quality score was 4.5; of rural stores, the least rural stores had the highest mean quality scores (6.0). Intervention strategies should aim to increase fruit and vegetable quality in rural areas.

Nurses at the Well-Being Institute, a community-based nursing outreach clinic in Detroit, Michigan, located 75 women living with HIV, mental illness, and substance abuse who were lost to follow-up at their HIV medical clinic as part of a nursing research study. Women who had been scheduled for an appointment in the last 4 months but who had missed that appointment were considered "lost to follow-up" in the HIV clinic. The purpose of the research was to study factors related to health care access in women not participating in regular health care for their HIV infection. Women were randomly assigned to two study groups. Women assigned to "care as usual" study group (n = 37) received no additional services beyond study interviews for 1 year. Women assigned to the "nursing intervention" group (n = 38) were provided with nursing services designed to facilitate their return to and continued connection with their HIV clinic. Findings showed that factors related to the women's vulnerability, such as mental illness and drug use, were more related to their use of expensive health care services such as hospital emergency departments or hospital inpatient admissions than was assignment to either the "nursing intervention" or "care as usual" study groups. Two case studies describing the cost of care for 2 of the multiply diagnosed women in the study is presented. The women differed on whether they had stable housing and were accessing care for their mental illness.

Status epilepticus (SE) has an annual incidence exceeding 100,000 cases in the United States alone, of which more than 20% result in death. Thus, increased awareness of presentation, etiologies, and treatment of SE is essential in the practice of critical care medicine. This review discusses current definitions of SE, as well as its clinical presentation and classification. The recent literature on epidemiology is reviewed, including morbidity and mortality data. An overview of the systemic pathophysiologic effects of SE is presented. Finally, significant studies on the treatment of acute SE and refractory SE are reviewed, including the use of anticonvulsants, such as benzodiazepines, and other drugs.