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The article provides an overview of and commentary on the last chapter of Cheit’s book, The Witch-Hunt Narrative: Politics, Psychology and the Sexual Abuse of Children. The chapter is divided into two sections called “Recent Developments” and “The Legacy of the Witch-Hunt Narrative.” We respond to the key assertions in each of those sections, providing discussion points of agreement and disagreement with Cheit, and note some areas Cheit does not cover, including important advances in the aftermath of the witch-hunt narrative (WHN). The article takes the position that there is cause for optimism with these advances in systems responses, child forensic interviewing research, and multidisciplinary team and training approaches; some of these advances are related to the WHN. The conclusion warns of the need to be vigilant about continuing Cheit’s work, we suggest this could take place in six key areas: (a) enhanced teacher training, (b) improved court responses to child sexual abuse (CSA) victims, (c) expanded use of Extended Forensic Interviews so that the complex cases (children with disabilities, children from multi problem households) might be thoroughly considered for prosecution, (d) broadened focus on CSA validation, recovery, and prevention, (e) engaged multistate research on the actual occurrence of day care CSA allegations, and (f) expanded efforts to educate the public and potential jury pools about the nuances of CSA prosecution, and the illusion of toughness in how we respond to convicted offenders. Cheit’s detailed research enables us to see where we came from, and what else needs to be done to understand the legacy of the WHN. [ABSTRACT FROM AUTHOR]

This is the first study to investigate how college students in the U.S. with problematic Internet use perceive the role the Internet plays within their families of origin. The sample included 27 U.S. university students who self-identified as excessive Internet users. Participants reported spending more than 25 hours a week on the Internet on non-school or non-work-related activities and reported Internet-associated health and/or psychosocial problems. This study provides descriptive statistics from participants' completion of two problematic Internet use measures (i.e., Young's Diagnostic Questionnaire and the Compulsive Internet Use Scale) and reports findings from four focus groups. Three themes emerged from the focus groups: (1) family connectedness, (2) family conflict/family disconnection, and (3) family Internet overuse. The findings of this study are a first step toward the design of effective interventions for problematic Internet use among U.S. college students and serve to inform clinical practice and health policy in this area. [ABSTRACT FROM AUTHOR]

This article describes a study that investigated whether child welfare--involved youths' school engagement affected delinquency after controlling for peer deviance, caregiver closeness, and attention deficit hyperactivity disorder (ADHD). This study used data from 461 11- to 17-year-olds who had substantiated child maltreatment investigations and participated in Wave 1 of the second National Survey of Child and Adolescent Well-Being (NSCAW II). Because there were low rates of delinquency among NSCAW II participants, a negative binomial regression was conducted. The study found that school engagement had a significant effect even after controlling for peer deviance, caregiver closeness, and ADHD. Results also showed that peer deviance increased the count of delinquent acts, whereas caregiver closeness protected against deviance. This study demonstrates the role schools play as a prosocial influence among maltreated youths. Results from this study illuminate key targets for prevention and intervention strategies. [ABSTRACT FROM AUTHOR]

Studies have identified high rates and severe consequences of Internet Addiction/Pathological Internet Use (IA/PIU) in university students. However, most research concerning IA/PIU in U.S. university students has been conducted within a quantitative research paradigm, and frequently fails to contextualize the problem of IA/PIU. To address this gap, we conducted an exploratory qualitative study using the focus group approach and examined 27 U.S. university students who self-identified as intensive Internet users, spent more than 25 hours/week on the Internet for non-school or non-work-related activities and who reported Internet-associated health and/or psychosocial problems. Students completed two IA/PIU measures (Young’s Diagnostic Questionnaire and the Compulsive Internet Use Scale) and participated in focus groups exploring the natural history of their Internet use; preferred online activities; emotional, interpersonal, and situational triggers for intensive Internet use; and health and/or psychosocial consequences of their Internet overuse. Students’ self-reports of Internet overuse problems were consistent with results of standardized measures. Students first accessed the Internet at an average age of 9 (SD = 2.7), and first had a problem with Internet overuse at an average age of 16 (SD = 4.3). Sadness and depression, boredom, and stress were common triggers of intensive Internet use. Social media use was nearly universal and pervasive in participants’ lives. Sleep deprivation, academic under-achievement, failure to exercise and to engage in face-to-face social activities, negative affective states, and decreased ability to concentrate were frequently reported consequences of intensive Internet use/Internet overuse. IA/PIU may be an underappreciated problem among U.S. university students and warrants additional research. [ABSTRACT FROM AUTHOR]

Child neglect, which is the most common form of maltreatment in the United States, has been repeatedly linked to an increased risk of delinquency. However, the existing literature lacks studies that simultaneously investigate how distinct types of neglect differentially influence delinquency among child welfare involved-youth. In addition, few studies of the relationship between neglect and delinquency include measures of ADHD, peer deviance or community violence, even though these variables have been strongly associated with delinquency. This study uses data from 784 11 to 17 year old youth who participated in Wave I of the Second National Survey of Child and Adolescent Wellbeing (NSCAW II) to examine whether supervisory neglect, physical neglect and parental substance abuse affect delinquency after controlling for ADHD, peer deviance, exposure to community violence, and out-of-home placements. We conducted a negative binomial regression to account for the low rates of delinquency among NSCAW II participants. We did not find significant main effects for supervisory neglect, physical neglect or parental substance abuse. Our study found that as youth age the count of delinquency acts increases. Black and Hispanic youth had higher counts of delinquency than youth with White, multi-racial, or “other” racial identities. Youth in out-of-home care had nearly double the rate of delinquency. Youth with more deviant peer affiliations and youth who had been exposed to community violence engaged in more delinquent behaviors. Our findings underscore the importance of the environment surrounding the youth, and the peers with whom the youth affiliates. [ABSTRACT FROM AUTHOR]

This study explored patterns of violent delinquent behaviors using latent class analysis (LCA). The study sample consisted of 1,013 11- to 17-year-olds who participated in Wave 1 of the second National Survey of Child and Adolescent Well-Being (NSCAW II). LCA was used to identify distinct patterns of violent delinquent behavior among youth involved in the child welfare system. The study found a model consisting of the two following classes: violent and normative. The study also examined how exposure to domestic violence, youths’ mental health, and youths’ substance abuse function as characteristics of the latent classes. Results showed members of the violent class were significantly more likely to report clinically significant depression and substance abuse. Racial differences did exist, showing members of the violent class were more likely to be Black than members of the normative class. The study found no differences on whether members of each class had been physically or sexually abused, experienced physical neglect, been exposed to domestic violence, or having a substance abusing parent, or a substantiated child maltreatment investigation. Results from this study could illuminate opportunities for prevention and intervention resources. [ABSTRACT FROM AUTHOR]

Abstract: This study used latent class analysis (LCA) to explore whether patterns of substance use and illegal behaviors among emerging adults, 18 to 28years old, differ depending on whether they have a prior history in foster care. The study sample, consisting of 316 respondents who had previously been in foster care and 14,301 respondents without a foster care history, was drawn from the third wave of the National Longitudinal Study of Adolescent Health. A multiple-group LCA compared former foster youth to their peers in the general population. The following four classes were identified: illegal behaviors, substance use, illegal behaviors with problematic substance use and normative behaviors. Most of the differences between the groups were not statistically significant. However, within the illegal behavior class former foster youth were less likely to have bought, sold, or held stolen goods; injured someone in a fight so that she or he needed medical attention; to have sold drugs; and to have been drunk at school or work. Additionally, in the illegal behaviors with problematic substance use class emerging adults in the general population were more likely to have used cocaine. Within the normative behaviors class, former foster youth were more likely to be current smokers, and to have injured someone in a fight so that he or she required medical attention. Within the substance use class, emerging adults from the general population were more likely to have taken place in a fight where one group fought another. Additional statistically significant, but very small differences were also identified. [Copyright &y& Elsevier]

Abstract: Objectives: This article is a systematic review of the effectiveness of three practices for reducing blood culture contamination rates: venipuncture, phlebotomy teams, and prepackaged preparation/collection (prep) kits. Design and methods: The CDC-funded Laboratory Medicine Best Practices Initiative systematic review methods for quality improvement practices were used. Results: Studies included as evidence were: 9 venipuncture (vs. versus intravenous catheter), 5 phlebotomy team; and 7 prep kit. All studies for venipuncture and phlebotomy teams favored these practices, with meta-analysis mean odds ratios for venipuncture of 2.69 and phlebotomy teams of 2.58. For prep kits 6 studies'' effect sizes were not statistically significantly different from no effect (meta-analysis mean odds ratio 1.12). Conclusions: Venipuncture and the use of phlebotomy teams are effective practices for reducing blood culture contamination rates in diverse hospital settings and are recommended as evidence-based “best practices” with high overall strength of evidence and substantial effect size ratings. No recommendation is made for or against prep kits based on uncertain improvement. [Copyright &y& Elsevier]

Abstract: Objectives: This is the first systematic review of the effectiveness of barcoding practices for reducing patient specimen and laboratory testing identification errors. Design and methods: The CDC-funded Laboratory Medicine Best Practices Initiative systematic review methods for quality improvement practices were used. Results: A total of 17 observational studies reporting on barcoding systems are included in the body of evidence; 10 for patient specimens and 7 for point-of-care testing. All 17 studies favored barcoding, with meta-analysis mean odds ratios for barcoding systems of 4.39 (95% CI: 3.05–6.32) and for point-of-care testing of 5.93 (95% CI: 5.28–6.67). Conclusions: Barcoding is effective for reducing patient specimen and laboratory testing identification errors in diverse hospital settings and is recommended as an evidence-based “best practice.” The overall strength of evidence rating is high and the effect size rating is substantial. Unpublished studies made an important contribution comprising almost half of the body of evidence. Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry (CDC/ATSDR). [Copyright &y& Elsevier]

In 2006, the United States Centers for Disease Control and Prevention (CDC) recommended expanded and routine use of single-session rapid HIV tests in all health care settings to increase the proportion of persons who learn their HIV status. Limited empiric information is available regarding the costs of rapid testing and pre- and posttest counseling in health care settings. We surveyed 45 U.S. hospitals during 2005 through 2006 to assess the costs associated with rapid testing and counseling. Cost analyses were conducted from the provider (hospital) perspective, and results were expressed in year 2006 U.S. dollars. The mean per-test cost of rapid HIV testing and counseling was $48.07 for an HIV-negative test and $64.17 for a preliminary-positive test. Pre- and posttest counseling costs accounted for 38.4% of the total cost of rapid testing for HIV-negative patients. Counseling costs were significantly correlated with overall test costs. Many hospitals contained overall test costs by limiting time spent in pre- and posttest counseling or by using lower-paid personnel for counseling activities or both. Counseling costs constituted a significant proportion of the overall costs of rapid testing and counseling activities at study hospitals. Our data provide useful baseline data before implementation of the CDC's 2006 recommendations. Costs can be reduced by limiting time spent in pre- and posttest counseling or by using lower-paid personnel for counseling activities or both. [ABSTRACT FROM AUTHOR]

The article discusses how to promote self management in patients with chronic illnesses in the U.S. It states that the patient must participate actively in the care process. The first step is to set an agenda with the patient for the visit, then apply the ask-tell-ask technique to help tailor information to the patient's needs. It suggests to encourage patients to set realistic goals for changing their health behavior and ask him to repeat back important information to ensure understanding.

The US Centers for Disease Control and Prevention recommends the expanded use of rapid HIV antibody tests in community settings to increase the proportion of persons who are aware of their HIV status. The cost of providing rapid testing services in these settings is not known. We conducted a cost survey of non-profit community clinics and community-based organizations (CBOs). The final study sample for the cost analyses included 28 community clinics and seven CBOs that offered rapid HIV testing, all of which used OraSure's OraQuick oral fluid assay. Overall, the mean per-client rapid testing cost was $36.68 for HIV-negative clients (2006 dollars, provider perspective) and $44.22 for preliminary-positive clients. Personnel costs accounted for 55.6% of overall testing costs for negative clients and 63.2% for preliminary-positive clients. This study contributes unique empirical data about the costs of OralQuick rapid testing that can be used by clinic and CBO directors to assess the economic impact of implementing rapid testing at their sites. The findings also could be used to inform discussions regarding national and local HIV testing policies. [ABSTRACT FROM AUTHOR]

Chronic kidney disease affects approximately 19 million adult Americans, and its incidence is increasing rapidly. Diabetes and hypertension are the underlying causes in most cases of chronic kidney disease. Evidence suggests that progression to kidney failure can be delayed or prevented by controlling blood sugar levels and blood pressure and by treating proteinuria. Unfortunately, chronic kidney disease often is overlooked in its earliest, most treatable stages. Guidelines from the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) recommend estimating glomerular filtration rate and screening for albuminuria in patients with risk factors for chronic kidney disease, including diabetes, hypertension, systemic illnesses, age greater than 60 years, and family history of chronic kidney disease. The glomerular filtration rate, calculated by using a prediction equation, detects chronic kidney disease more accurately than does the serum creatinine level alone; the glomerular filtration rate also is used for disease staging. In most clinical situations, analysis of random urine samples to determine the albumin-creatinine or protein-creatinine ratio has replaced analysis of timed urine collections. When chronic kidney disease is detected, an attempt should be made to identify and treat the specific underlying condition(s). The KDOQI guidelines define major treatment goals for all patients with chronic kidney disease. These goals include slowing disease progression, detecting and treating complications, and managing cardiovascular risk factors. Primary care physicians have an important role in detecting chronic kidney disease early, in instituting measures to slow disease progression, and in providing timely referral to a nephrologist. [ABSTRACT FROM AUTHOR]

Presents the findings of the U.S. Task Force on Community Preventive Services on the effectiveness of firearms laws in preventing violence, including violent crimes, suicides, and unintentional injury as of October 2003. Firearm laws that were evaluated; Review and summary of the findings; Lack of evidence to determine the effectiveness of any of the firearm laws in preventing violent outcomes.

Examines the nonparametric testable restrictions of Pareto-efficient bargaining behavior within a household in the United States. Treatment of household as a single utility-maximizing agent; Use of semialgebraic theory to derive nonparametric testable restrictions of household behavior; Alternative to the basic unitary model of household behavior.

Examines the persistence of urban deprivation in Wichita, Kansas in the 1970s. Changes in spatial distribution of various deprivation indicators within the city; Social and economic characteristics of areas most affected by changes; Areas that deteriorated in relation to the rest of the city; Concentrations of the city's underclass.

An essay is presented on the emerging landscapes of movement and logistics in the U.S. It describes the distribution landscapes at urban, regional and continental scale in order to examine the relationship between infrastructure and settlement. It proposes that together with entertainment, leisure-tourism, and science & technology research and development, distribution is a basis for new settlements and is participating new urban ensembles.

The purpose of this article is to develop and test a model of political influence on regulation that incorporates both the competing interests of elected officials and the relevant institutional constraints. To do this, we focus on one channel of political influence: the appointment of agency leaders to a multimember regulatory board. The model has two stages: first, a bargaining stage between the president and Senate in which they choose a target policy; and second, the appointments stage in which they attempt to implement this target by choosing the median board member. The model's empirical leverage arises because elected officials can replace board members only when seats on the board become available through term expiration or resignation. This yields specific predictions about how and whether each appointment will change policy. We apply the model to the NLRB. The empirical results, investigating all appointments to the NLRB from 1949 until 1988, fit our theory remarkably well. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To conduct a systematic review of the evidence available in support of automated notification methods and call centers and to acknowledge other considerations in making evidence-based recommendations for best practices in improving the timeliness and accuracy of critical value reporting. Design and methods: This review followed the Laboratory Medicine Best Practices (LMBP) review methods (Christenson, et al. 2011). A broad literature search and call for unpublished submissions returned 196 bibliographic records which were screened for eligibility. 41 studies were retrieved. Of these, 4 contained credible evidence for the timeliness and accuracy of automatic notification systems and 5 provided credible evidence for call centers for communicating critical value information in in-patient care settings. Results: Studies reporting improvement from implementing automated notification findings report mean differences and were standardized using the standard difference in means (d =0.42; 95% CI=0.2–0.62) while studies reporting improvement from implementing call centers generally reported criterion referenced findings and were standardized using odds ratios (OR=22.1; 95% CI=17.1–28.6). Conclusions: The evidence, although suggestive, is not sufficient to make an LMBP recommendation for or against using automated notification systems as a best practice to improve the timeliness of critical value reporting in an in-patient care setting. Call centers, however, are effective in improving the timeliness of critical value reporting in an in-patient care setting, and meet LMBP criteria to be recommended as an “evidence-based best practice.” Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry (CDC/ATSDR). [Copyright &y& Elsevier]

Overview: This report presents the results of a systematic review of the effectiveness and economic efficiency of disease management and case management for people with diabetes and forms the basis for recommendations by the Task Force on Community Preventive Services on the use of these two interventions. Evidence supports the effectiveness of disease management on glycemic control; on screening for diabetic retinopathy, foot lesions and peripheral neuropathy, and proteinuria; and on the monitoring of lipid concentrations. This evidence is applicable to adults with diabetes in managed care organizations and community clinics in the United States and Europe. Case management is effective in improving both glycemic control and provider monitoring of glycemic control. This evidence is applicable primarily in the U.S. managed care setting for adults with type 2 diabetes. Case management is effective both when delivered in conjunction with disease management and when delivered with one or more additional educational, reminder, or support interventions. [Copyright &y& Elsevier]

Purpose: Genomic screening for Lynch syndrome (LS) could prevent colorectal cancer (CRC) by identifying high-risk patients and instituting intensive CRC screening. We estimated the cost-effectiveness of a population-wide LS genomic screening vs family history-based screening alone in an unselected US population., Methods: We developed a decision-analytic Markov model including health states for precancer, stage-specific CRC, and death and assumed an inexpensive test cost of $200. We conducted sensitivity and threshold analyses to evaluate model uncertainty., Results: Screening unselected 30-year-olds for LS variants resulted in 48 (95% credible range [CR] = 35-63) fewer overall CRC cases per 100,000 screened individuals, leading to 187 quality-adjusted life-years (QALYs; 95% CR = 123-260) gained at an incremental cost of $24.6 million (95% CR = $20.3 million-$29.1 million). The incremental cost-effectiveness ratio was $132,200, with an 8% and 71% probability of being cost-effective at $100,000 and $150,000 per QALY willingness-to-pay thresholds, respectively., Conclusion: Population LS screening may be cost-effective in younger patient populations under a $150,000 willingness-to-pay per QALY threshold and with a relatively inexpensive test cost. Further reductions in testing costs and/or the inclusion of LS testing within a broader multiplex screening panel are needed for screening to become highly cost-effective., Competing Interests: Conflict of Interest The authors declare no conflicts of interest., (Copyright © 2022 American College of Medical Genetics and Genomics. Published by Elsevier Inc. All rights reserved.)

Background: Previous research has documented that deviant peer affiliation (DP) and externalizing behavior problems (EXT) are highly related and often co-occur. However, the directionality of the association between DP and EXT remains debatable. In addition, few studies have examined the longitudinal effects of child maltreatment types on co-development of DP and EXT overtime. Therefore, this study examined the role of child maltreatment in predicting the co-development of DP and EXT., Methods: DP and EXT were assessed at ages 12, 14, and 16. DP was measured using 13 items from the modified version of the Youth Risk Behavior and Monitoring the Future Survey. EXT was measured using the Child Behavior Checklist. Each type of child maltreatment (birth to age 12) was assessed using the CPS substantiated cases., Results: The results indicated that, on average, DP increased over time, whereas EXT decreased over time. In addition, the initial levels of EXT were associated with the slope of DP. Conditional parallel-process latent growth curve modeling identified that physically abused adolescents had higher initial levels of DP and showed a slower increase in DP, while those who had been emotionally abused were associated with a steeper decrease in EXT., Conclusion: The findings offer several meaningful implications for practice. First, early assessment of and treatment for EXT may be helpful in preventing DP over time. In addition, practitioners could assess each type of maltreatment to tailor preventive interventions for early onset and ongoing development of DP and EXT., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Importance: Genomic screening for hereditary breast and ovarian cancer (HBOC) in unselected women offers an opportunity to prevent cancer morbidity and mortality, but the potential clinical impact and cost-effectiveness of such screening have not been well studied., Objective: To estimate the lifetime incremental incidence of HBOC and the quality-adjusted life-years (QALYs), costs, and cost-effectiveness of HBOC genomic screening in an unselected population vs family history-based testing., Design, Setting, and Participants: In this study conducted from October 27, 2017, to May 3, 2020, a decision analytic Markov model was developed that included health states for precancer, for risk-reducing mastectomy (RRM) and risk-reducing salpingo-oophorectomy (RRSO), for earlier- and later-stage HBOC, after cancer, and for death. A complimentary cascade testing module was also developed to estimate outcomes in first-degree relatives. Age-specific RRM and RRSO uptake probabilities were estimated from the Geisinger MyCode Community Health Initiative and published sources. Parameters including RRM and RRSO effectiveness, variant-specific cancer risk, costs, and utilities were derived from published sources. Sensitivity and scenario analyses were conducted to evaluate model assumptions and uncertainty., Main Outcomes and Measures: Lifetime cancer incidence, QALYs, life-years, and direct medical costs for genomic screening in an unselected population vs family history-based testing only were calculated. The incremental cost-effectiveness ratio (ICER) was calculated as the difference in cost between strategies divided by the difference in QALYs between strategies. Earlier-stage and later-stage cancer cases prevented and total cancer cases prevented were also calculated., Results: The model found that population screening of 30-year-old women was associated with 75 (95% credible range [CR], 60-90) fewer overall cancer cases and 288 QALYs (95% CR, 212-373 QALYs) gained per 100 000 women screened, at an incremental cost of $25 million (95% CR, $21 millon to $30 million) vs family history-based testing; the ICER was $87 700 (78% probability of being cost-effective at a threshold of $100 000 per QALY). In contrast, population screening of 45-year-old women was associated with 24 (95% CR, 18-29) fewer cancer cases and 97 QALYs (95% CR, 66-130 QALYs) gained per 100 000 women screened, at an incremental cost of $26 million (95% CR, $22 million to $30 million); the ICER was $268 200 (0% probability of being cost-effective at a threshold of $100 000 per QALY). A scenario analysis without cascade testing increased the ICER to $92 600 for 30-year-old women and $354 500 for 45-year-old women. A scenario analysis assuming a 5% absolute decrease in mammography screening in women without a variant was associated with the potential for net harm (-90 QALYs per 100 000 women screened; 95% CR, -180 to 10 QALYs)., Conclusions and Relevance: The results of this study suggest that population HBOC screening may be cost-effective among younger women but not among older women. Cascade testing of first-degree relatives added a modest improvement in clinical and economic value. The potential for harm conferred by inappropriate reduction in mammography among noncarriers should be quantified.

Head and neck cancers are challenging to study because of their relatively low incidence. A large, novel population of patients with head and neck cancers that has not been previously studied and distinct from the referral populations has been identified. The National Cancer Institute-funded Health Maintenance Organization Cancer Research Network is a consortium of 15 nonprofit research centers based in large, vertically integrated health care delivery organizations across the United States. They represent a geographically, racially, and socioeconomically diverse population. These community-based organizations provide care to approximately 10 million individuals and 57,692 patients with head and neck cancer. This pilot study and preliminary analysis seeks to demonstrate the potential this network holds as a resource for clinical cancer research and to identify it as a unique resource that allows for more detailed queries than are currently available to researchers., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.)

This study examined how incest, depression, parental drinking, relationship status, and living with parents affect patterns of substance use among emerging adults, 18 to 25 years old. The study sample included (n = 11,546) individuals who participated in Waves I, II, and III of the National Longitudinal Study of Adolescent Health (Add Health). The study used separate latent class analysis for males and females to determine how patterns of substance use clustered together. The study identified the following three classes of substance use: heavy, moderate, and normative substance use patterns. Multinomial logistic regression indicated that, for females only, incest histories also nearly doubled the risk of heavy-use class membership. In addition, experiencing depression, being single, and not living with parents serve as risk factors for males and females in the heavy-use group. Conversely, being Black, Hispanic, or living with parents lowered the likelihood of being in the group with the most substance use behaviors (i.e., heavy use). Findings highlight the need for interventions that target depression and female survivors of incest among emerging adults.

Wider adoption of evidence-based, health promotion practices depends on developing and testing effective dissemination approaches. To assist in developing these approaches, we created a practical framework drawn from the literature on dissemination and our experiences disseminating evidence-based practices. The main elements of our framework are 1) a close partnership between researchers and a disseminating organization that takes ownership of the dissemination process and 2) use of social marketing principles to work closely with potential user organizations. We present 2 examples illustrating the framework: EnhanceFitness, for physical activity among older adults, and American Cancer Society Workplace Solutions, for chronic disease prevention among workers. We also discuss 7 practical roles that researchers play in dissemination and related research: sorting through the evidence, conducting formative research, assessing readiness of user organizations, balancing fidelity and reinvention, monitoring and evaluating, influencing the outer context, and testing dissemination approaches.

Background and Objectives: Diabetic nephropathy (DN) is a multifactorial complication characterized by persistent proteinuria in susceptible individuals with type 1 and type 2 diabetes. Disease burden in people of Mexican-American descent is particularly high, but there are only a few studies that characterize genes for DN in this ethnic group. Two genes, carnosine dipeptidase 1 (CNDP1) and engulfment and cell motility 1 (ELMO1) previously showed association with DN in other ethnic groups. CNDP1 and ELMO1 were examined along with eight other genes that are less well characterized for DN in a new study of Mexican-Americans., Design, Setting, Participants, & Measurements: The target sample was patients of Mexican-American ancestry collected from three centers: 455 patients with DN and 437 controls with long-term diabetes but no incident nephropathy. Forty-two, 227, and 401 single nucleotide polymorphisms (SNPs) in CNDP1, ELMO1, and the other eight genes, respectively, were examined., Results: No region in CNDP1 or ELMO1 showed significant P values. Of the other eight candidate genes, an association of DN with a SNP pair, rs2146098 and rs6659783, was found in hemicentin 1 (HMCN1) (unadjusted P = 6.1 x 10(-5)). Association with a rare haplotype in this region was subsequently identified., Conclusions: The associations in CNDP1 or ELMO1 were not replicable; however, an association of DN with HMCN1 was found. Additional work at this and other loci will enable refinement of the genetic hypotheses regarding DN in the Mexican-American population to find therapies for this debilitating disease.

Universal, school-based programs, intended to prevent violent behavior, have been used at all grade levels from pre-kindergarten through high school. These programs may be targeted to schools in a high-risk area-defined by low socioeconomic status or high crime rate-and to selected grades as well. All children in those grades receive the programs in their own classrooms, not in special pull-out sessions. According to the criteria of the systematic review methods developed for the Guide to Community Preventive Services (Community Guide), there is strong evidence that universal, school-based programs decrease rates of violence among school-aged children and youth. Program effects were consistent at all grade levels. An independent, recently updated meta-analysis of school-based programs confirms and supplements the Community Guide findings.

This article describes a partnership between an academic center and community-based organizations for the purpose of improving the health of older adults. Three sequential randomized trials of interventions that have been conducted by this partnership, along with an effectiveness study of one of the interventions, are presented as evidence of the partnership's success. Characteristics of an effective partnership are highlighted; these include: (1) a shared vision and a commitment to achieving similar goals; (2) complementary expertise and resources; (3) a willingness to contribute time and effort on projects that are jointly undertaken; (4) regularly scheduled meeting times to review progress and barriers to progress; and (5) time spent getting to know each other on a personal level. The iterative nature of research and programming that is carried out as part of this partnership is described.