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UK Sure Start Children's Centres (SSCCs) aim to lessen behavioural disorders yet we lack evidence concerning how this is achieved. This study evaluates one possible mechanism: improved home learning environments (HLEs). Data come from a longitudinal study of 2568 families and children recruited at a mean age of 14 months from 117 SSCCs in England in 2012. Behavioural disorders were measured at 38 months via the Strengths and Difficulties Questionnaire. HLEs were measured at 14 and 38 months via parental interview. Families' use of SSCCs was measured via parental interview at 14, 22, and 38 months. This study suggests that the use of SSCCs is associated with fewer preschool behavioural disorders via intermediate changes to the quality of HLE's. Implications are discussed for social policies and for early years' professionals. [ABSTRACT FROM AUTHOR]

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. [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]

This project focused on the development of a clinical research council in a home health and hospice organization. Strengths of establishing a council included enhanced use of evidence-based practice, an increase in cross-discipline collaboration, and recruitment and retention. Council members evaluated their learning needs to establish a research education program. An organizational evaluation reviewed library and institutional review board access, system research departments, internal policies, electronic database, and clinical tools. Planning for sustainability included developing an organizing framework, creating community collaborations, and establishing a research pathway. [ABSTRACT FROM AUTHOR]

The article examines a survey to asses the effectiveness of Cooking Matters for Adults (CMA), a cooking-based nutrition education program for low-income adults. The need for the development of common metrics to advance cooking-based nutrition education programs was mentioned. The components of the survey include dietary patterns, sociodemographics and psychometrics. It was found that the CMA Survey may be useful for similar nutrition-based programs.

ObjectiveTo explore the feasibility of a workplace farmstand programme through the utilization of an online ordering system to build awareness for local food systems, encourage community participation, and increase local fruit and vegetable availability.DesignA 4-week pilot to explore feasibility of workplace farmstand programmes through a variety of outcome measures, including survey, mode of sale, weekly sales totals and intercept interviews.SettingA large private company in Sarpy County, Omaha, Nebraska, USA.SubjectsEmployees of the company hosting the farmstand programme.ResultsPre-programme, a majority of employees indicated that quality (95·4 %), variety (94·6 %) and cost of fruits and vegetables (86·4 %) were driving factors in their fruit and vegetable selection when shopping. The availability of locally or regionally produced fruits and vegetables was highly important (78·1 %). Participants varied in their definition of local food, with nearly half (49·2 %) reporting within 80·5 km (50 miles), followed by 160·9 km (100 miles; 29·5 %) and 321·9 km (200 miles; 12·1 %). Weekly farmstand purchases (both walk-ups and online orders) ranged from twenty-eight to thirty-nine employees, with weekly sales ranging from $US 257·95 to 436·90 for the producer. The mode of purchase changed throughout the pilot, with higher use of online ordering in the beginning and higher use of walk-up purchasing at the end.ConclusionsThe workplace farmstand pilot study revealed initial interest by both employees and a producer in this type of programme, helped to establish a sustained producer–employer relationship and led to additional opportunities for both the producer and employer. [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]

Background: Black and Hispanic stroke survivors experience higher rates of recurrent stroke than whites. This disparity is partly explained by disproportionately higher rates of uncontrolled hypertension in these populations. Home blood pressure telemonitoring (HBPTM) and nurse case management (NCM) have proven efficacy in addressing the multilevel barriers to blood pressure (BP) control and reducing BP. However, the effectiveness of these interventions has not been evaluated in stroke patients. This study is designed to evaluate the comparative effectiveness, cost-effectiveness and sustainability of these two telehealth interventions in reducing BP and recurrent stroke among high-risk Black and Hispanic stroke survivors with uncontrolled hypertension. Methods/Design: A total of 450 Black and Hispanic patients with recent nondisabling stroke and uncontrolled hypertension are randomly assigned to one of two 12-month interventions: 1) HBPTM with wireless feedback to primary care providers or 2) HBPTM plus individualized, culturally-tailored, telephone-based NCM. Patients are recruited from stroke centers and primary care practices within the Health and Hospital Corporations (HHC) Network in New York City. Study visits occur at baseline, 6, 12 and 24 months. The primary outcomes are within-patient change in systolic BP at 12 months, and the rate of stroke recurrence at 24 months. The secondary outcome is the comparative cost-effectiveness of the interventions at 12 and 24 months; and exploratory outcomes include changes in stroke risk factors, health behaviors and treatment intensification. Recruitment for the stroke telemonitoring hypertension trial is currently ongoing. Discussion: The combination of two established and effective interventions along with the utilization of health information technology supports the sustainability of the HBPTM+ NCM intervention and feasibility of its widespread implementation. Results of this trial will provide strong empirical evidence to inform clinical guidelines for management of stroke in minority stroke survivors with uncontrolled hypertension. If effective among Black and Hispanic stroke survivors, these interventions have the potential to substantially mitigate racial and ethnic disparities in stroke recurrence. [ABSTRACT FROM AUTHOR]

This paper presents a review of the family services that were offered by a sample of 121 English Sure Start Children’s Centres in 2011 and 2012. Children’s Centres are community based facilities that aim to improve outcomes for at-risk families and children through the delivery of a range of services largely aimed at families with young children. Services commonly offered include: health advice, childcare and early education, employment advice, informal drop-in facilities, and specialist support on parenting. This paper provides a snapshot of Children’s Centre service provision in 2011 and 2012 and documents the extent of change. A picture of broad stability was observed in the numbers of services that centres reported offering (from a list of 47 services grouped into 11 categories). However, some Children’s Centres also appeared to be changing the focus of the services that they provided. Some centres seemed to be shifting towards providing greater outreach (rather than parent-support) and services which were targeted (rather than universal). [ABSTRACT FROM PUBLISHER]

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. [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]

Objective: This study evaluated the effectiveness of adding EMDR to the routine treatment regimen of child therapists. Method: Thirty-nine child guidance center clients were randomly assigned to an experimental group that received EMDR plus the center's routine treatment package or a control group that received only the center's routine treatment package. Results: Analyses of variance found no significant differences in Child Behavior Checklist scores between groups. Subanalyses conducted for 33 clients with elevated pretest scores found moderate effect sizes that approached, but fell short of, statistical significance. Conclusions: These findings raise doubts about notions that EMDR produces rapid and dramatic improvements with children whose emotional and behavioral problems are not narrowly connected to a specific trauma and who require improvisational deviations from the standard EMDR protocol. Further research is needed in light of the special difficulties connected to implementing the EMDR protocol with clients like those in this study. [ABSTRACT FROM AUTHOR]

The article offers information on the Original Kings of County blog which was launched by the State University of New York and integrated into its emergency medicine program to promote resident engagement and schlolarship.

Objective This study explored the feasibility of using a 23-week subsidized community-supported agriculture program to increase access to and intake of vegetables among Federally Qualified Health Center patients. Methods Outcomes were measured using pre-post intervention surveys (n = 9). Process data were collected in post-intervention surveys and focus groups (n = 15). Results Most participants (77%) indicated that the program improved their health and all (100%) reported that they were eating a greater variety of vegetables because of their participation in the program. Three themes emerged from the focus groups: increased access to fresh and/or organic vegetables, improved diet quality, and the importance of social support during the program. Conclusions and Implications Linking subsided community-supported agriculture programs with Federally Qualified Health Centers has the potential to increase access to and intake of vegetables among low-income patients. However, further research is needed with a larger sample size and a more robust study design. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article about austerity cuts impacting disadvantaged families the most in the January 23, 2015 issue.

Background: Black and Hispanic stroke survivors experience higher rates of recurrent stroke than whites. This disparity is partly explained by disproportionately higher rates of uncontrolled hypertension in these populations. Home blood pressure telemonitoring (HBPTM) and nurse case management (NCM) have proven efficacy in addressing the multilevel barriers to blood pressure (BP) control and reducing BP. However, the effectiveness of these interventions has not been evaluated in stroke patients. This study is designed to evaluate the comparative effectiveness, cost-effectiveness and sustainability of these two telehealth interventions in reducing BP and recurrent stroke among high-risk Black and Hispanic stroke survivors with uncontrolled hypertension.Methods/design: A total of 450 Black and Hispanic patients with recent nondisabling stroke and uncontrolled hypertension are randomly assigned to one of two 12-month interventions: 1) HBPTM with wireless feedback to primary care providers or 2) HBPTM plus individualized, culturally-tailored, telephone-based NCM. Patients are recruited from stroke centers and primary care practices within the Health and Hospital Corporations (HHC) Network in New York City. Study visits occur at baseline, 6, 12 and 24 months. The primary outcomes are within-patient change in systolic BP at 12 months, and the rate of stroke recurrence at 24 months. The secondary outcome is the comparative cost-effectiveness of the interventions at 12 and 24 months; and exploratory outcomes include changes in stroke risk factors, health behaviors and treatment intensification. Recruitment for the stroke telemonitoring hypertension trial is currently ongoing.Discussion: The combination of two established and effective interventions along with the utilization of health information technology supports the sustainability of the HBPTM + NCM intervention and feasibility of its widespread implementation. Results of this trial will provide strong empirical evidence to inform clinical guidelines for management of stroke in minority stroke survivors with uncontrolled hypertension. If effective among Black and Hispanic stroke survivors, these interventions have the potential to substantially mitigate racial and ethnic disparities in stroke recurrence.Trial Registration: ClinicalTrials.gov NCT02011685 . Registered 10 December 2013. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to assess the sensitivity, specificity and time to results of mycobacterial growth indicator tube (MGIT) 960, microscopic observation drug susceptibility (MODS) assay and nitrate reductase assay (NRA) compared with the gold standard agar proportion method (PM), and to determine whether there is cross-resistance between older-generation fluoroquinolones and moxifloxacin. Methods Mycobacterium tuberculosis isolates from culture-confirmed tuberculosis patients from 2002 to 2007 were tested for ofloxacin (2 mg/L) resistance by PM and MGIT 960. All isolates from 2005 and 2006 were also tested by MODS and NRA. Ofloxacin-resistant isolates by PM were further tested by all four methods using ciprofloxacin, levofloxacin and moxifloxacin. For each ofloxacin-resistant isolate, two ofloxacin-susceptible isolates were tested against all three fluoroquinolones using all four methods. Results Of the 797 M. tuberculosis isolates, 19 (2.4%) were ofloxacin-resistant by PM. MGIT 960 had 100% sensitivity (95% CI, 83%–100%) and specificity (95% CI, 99.5%–100%). Of the 797 isolates, 239 were from 2005 to 2006 and 6 of these (2.5%) were resistant by PM. MODS had 100% sensitivity (95% CI, 61%–100%) and specificity (95% CI, 98%–100%). NRA had 100% sensitivity (95% CI, 61%–100%) and 98.7% specificity (95% CI, 96%–99.6%). The median time to results was shorter using MGIT 960 (8 days), MODS (6 days) or NRA (9 days) compared with PM (21 days) (P Conclusions MGIT 960, MODS and NRA are sensitive and specific and more rapid than PM for identifying fluoroquinolone resistance in M. tuberculosis. Ofloxacin resistance was associated with cross-resistance to ciprofloxacin, levofloxacin and moxifloxacin. [ABSTRACT FROM AUTHOR]