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71.
Cindy Weston Robin Page Kara Jones-Schubart Marvellous Akinlotan 《The Journal for Nurse Practitioners》2018,14(5):e101-e104
The purpose of this project was to increase access to cancer screening for underserved women while providing collaborative clinical experiences for family nurse practitioner (FNP) students. A FNP program, the School of Public Health, and a free clinic collaborated to provide well-woman visits that included breast and cervical cancer screening to low-income women. From 2015–2016, 83 women received well-woman exams, including 75 cervical cancer screenings and 47 referrals for mammography. Qualitative surveys revealed 95% satisfaction and 100% reported they would refer friends and family. Innovative collaboration improves access to cancer screening for low-income women while providing training for FNP students. 相似文献
72.
Development and evaluation of a treatment fidelity instrument for family‐based treatment of adolescent anorexia nervosa
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73.
Alison M. Darcy PhD Kathleen Kara Fitzpatrick PhD Stephanie M. Manasse BA Nandini Datta BS Megan Klabunde PhD Danielle Colborn PhD Vandana Aspen PhD Colleen Stiles‐Shields MA MS Zandre Labuschagne MA Daniel Le Grange PhD James Lock MD PhD 《The International journal of eating disorders》2015,48(5):487-493
74.
Kara Mitchell Tanya Halse Donna Kohlerschmidt Toby Bennett Cynthia Vanner Ewa King Kimberlee Musser Vincent Escuyer 《Public health reports (Washington, D.C. : 1974)》2015,130(6):623-631
Objective
The need for public health laboratories (PHLs) to prioritize resources has led to increased interest in sharing diagnostic services. To address this concept for tuberculosis (TB) testing, the New York State Department of Health Wadsworth Center and the Rhode Island State Health Laboratories assessed the feasibility of shared services for the detection and characterization of Mycobacterium tuberculosis complex (MTBC).Methods
We assessed multiple aspects of shared services including shipping, testing, reporting, and cost. Rhode Island State Health Laboratories shipped MTBC-positive specimens and isolates to Wadsworth Center. Average turnaround times were calculated and cost analysis was performed.Results
Testing turnaround times were similar at both PHLs; however, the availability of conventional drug susceptibility testing (DST) results for Rhode Island primary specimens and isolates were extended by approximately four days of shipping time. An extended molecular testing panel was performed on every specimen submitted from Rhode Island State Health Laboratories to Wadsworth Center, and the total cost per specimen at Wadsworth Center was $177.12 less than at Rhode Island State Health Laboratories, plus shipping. Following a mid-study review, Wadsworth Center provided testing turnaround times for detection (same day), species determination of MTBC (same day), and molecular DST (2.5 days).Conclusion
The collaboration between Wadsworth Center and Rhode Island State Health Laboratories to assess shared services of TB testing highlighted a successful model that may serve as a guideline for other PHLs. The provision of additional rapid testing at a lower cost demonstrated in this study could potentially improve patient management and result in significant cost and resource savings if used in similar models across the country.Public health laboratories (PHLs) are essential for disease prevention and control. They serve as a first line of defense by rapidly recognizing and averting the spread of communicable diseases. In addition, they play a critical role in providing specialized tests for low-incidence, high-risk diseases, such as tuberculosis (TB), rabies, and botulism.1 Due to recent economic constraints, many PHLs have suffered financial pressures, including budget and staffing cuts. In some cases, PHLs have reduced or eliminated certain tests, creating a potential risk to the public''s health. As an alternative to the discontinuation of services, one suggested approach was the investigation of shared services with other PHLs in different jurisdictions through testing directories and pilot projects with assistance and support from the Centers for Disease Control and Prevention (CDC) and the Association of Public Health Laboratories (APHL).2,3TB, which is caused by the bacteria Mycobacterium tuberculosis, is a disease for which PHLs play an important role by providing diagnostics that contribute to prevention. Despite an overall decline in cases, TB continues to be a significant burden on social, public health, and economic systems in the United States.4 Maintaining a comprehensive and efficient laboratory system is critical to the continued decline of TB rates and overall prevention and control of TB in the United States. However, providing comprehensive TB testing services is becoming increasingly expensive per case identified. Additionally, retaining technical proficiency remains a challenge, especially as many experienced personnel are lost to retirement and are difficult to replace.5In 2013, a total of 9,582 new TB cases were reported in the United States, with an incidence rate of 3.0 cases per 100,000 population. Only four states reported more than 500 cases of TB: California, Texas, New York, and Florida, accounting for half of all TB cases in the United States. The TB incidence rate in New York State (NYS) is 4.4 per 100,000 population.4 The overall number of TB cases in NYS has decreased slightly over time, while the number of drug-resistant TB (DR TB) cases has remained steady during the past five years. Additionally, the percentage of multidrug-resistant TB (MDR TB) cases in NYS has increased from 1.3% to 3.6% during the past five years.6 In contrast, the TB incidence rate in Rhode Island is 2.6 per 100,000 population, and the overall number of TB cases has remained constant; DR TB and MDR TB cases in Rhode Island are rare.4,7 Given the low number of TB-positive specimens received each year in Rhode Island State Health Laboratories, developing an extensive, increasingly molecular-based, testing program for TB may not be cost effective. In contrast, a high proportion of specimens received each year by the NYS Department of Health Wadsworth Center are Mycobacterium tuberculosis complex (MTBC) positive, including DR TB and MDR TB cases, and an extensive testing program has been implemented.We assessed the feasibility of shared services for the detection and characterization of MTBC between Wadsworth Center and Rhode Island State Health Laboratories during a 10-month time period. Multiple aspects critical to the implementation of shared services were examined, including shipping, testing, reporting, and cost. During this project, Wadsworth Center provided services to Rhode Island State Health Laboratories for rapid detection of MTBC, MTBC species identification, rapid detection of mutations associated with rifampin and isoniazid resistance, and conventional drug susceptibility testing (DST). Importantly, this partnership allowed Wadsworth Center to assess its ability to share its extended testing capabilities with another PHL, determine if the additional services provided were beneficial to patient treatment and outcomes, and identify any potential issues with this testing approach. 相似文献75.
Carolyn L. McCarty Kristina Angelo Karlyn D. Beer Katie Cibulskas-White Kim Quinn Sietske de Fijter Rick Bokanyi Eric St. Germain Karen Baransi Kevin Barlow Gwen Shafer Larry Hanna Kelly Spindler Elizabeth Walz Mary DiOrio Brendan R. Jackson Carolina Luquez Barbara E. Mahon Colin Basler Kathryn Curran Almea Matanock Kelly Walsh Kara Jacobs Slifka Agam K. Rao 《MMWR. Morbidity and mortality weekly report》2015,64(29):802-803
76.
Lu Shi Donglan Zhang Jeroen van Meijgaard Kara E. MacLeod Jonathan E. Fielding 《American journal of public health》2015,105(7):1460-1467
Objectives. We examined whether the interactions between primarily speaking English at home and community-level measures (median household income and immigrant composition) are associated with physical inactivity and obesity.Methods. We pooled the 2005 and 2007 Los Angeles County Health Survey data to construct a multilevel data set, with community-level median household income and immigrant density as predictors at the community level. After controlling for individual-level demographic variables, we included the respondent’s perceived community safety as a covariate to test the hypothesis that perceived public safety mediates the association between acculturation and health outcomes.Results. The interaction between community median household income and primarily speaking English at home was associated with lower likelihoods of physical inactivity (odds ratio [OR] = 0.644; 95% confidence interval [CI] = 0.502, 0.825) and obesity (OR = 0.674; 95% CI = 0.514, 0.882). These odds remained significant after we controlled for perceived community safety.Conclusions. Resources in higher-income areas may be beneficial only to residents fully integrated into the community. Future research could focus on understanding how linguistic isolation affects community-level social learning and access to resources and whether this differs by family-level acculturation.Immigrants face the challenge of assimilating into their host country while maintaining values, beliefs, and behaviors from their homelands. Both acculturation and ethnic identity can influence health, and the construct of acculturation has been included in more and more health studies.1,2 Despite long-standing sociocultural theories of behavior that suggest that one’s behavior is the result of a dynamic interplay between internal, individual-level factors and social-cultural context,3–6 few public health studies have explored this interaction.7 A critical review noted that studies of acculturation tend to
separate culture from the larger social structure and the dynamic social processes in which behavior and beliefs are generated, and to relegate consideration of the socio-economic challenges associated with immigration, poor English language skills, and poverty, to their effects as separate or confounding variables.8(p981)For an immigrant, the interaction between acculturation status and the larger social structure in the host society could be important for health, as an inadequate level of acculturation in some contexts might result in reduced access to resources. In particular, undocumented immigrants have no federal coverage of health care under the Affordable Care Act. Therefore, access to resources may differ by legal status. However, in some settings, ethnic identity may buffer and even be protective against public health challenges in the United States (e.g., immigrants may maintain their dietary customs, which often include more whole foods, despite the excessive availability of processed foods in the United States).9 From a methodological perspective, multilevel models can provide a better understanding of this kind of interaction, whereby community-level factors, individual-level acculturation, and the cross-level interaction effects between the two can all be included as regressors of the outcome variable. However, very few public health studies have considered the cross-level interaction between acculturation and community-level factors on health behaviors and health outcomes. In an attempt to fill this research gap, we used population-based survey data to explore the cross-level interaction between community-level factors (median household income and immigrant composition) and individual-level linguistic acculturation (language preference at home).This study includes 2 independent variables that have been infrequently considered in previous studies of immigrant health: community immigrant composition and perceived community safety. Among various community-level factors that could influence residents’ health outcomes, community immigrant composition has begun to receive academic attention.10 Aside from individual-level acculturation indicators such as language preference and place of birth, living in a community with a high proportion of immigrants may be an independent predictor of one’s level of acculturation since people who are less acculturated may choose to live in ethnic enclaves.11 Perceived community safety has been shown to be a strong predictor of individual-level health outcomes such as having a mental health disorder or being overweight.12–15 The causal pathways between an unsafe community and negative health outcomes such as obesity could operate through reduced physical activity16–20 or through stress, which can disrupt energy metabolism and food intake regulation.21–24Because acculturation has been shown to be associated with one’s perception of community safety25 and predicts many different health behaviors and health outcomes,1,2 it is likely that an individual’s level of acculturation could modify the impact of community-level factors on health outcomes. Because understanding of these causal mechanisms is still far from conclusive, a study of the interaction between individuals’ level of acculturation and community-level factors could help reveal the complex pattern of acculturation and health. From the perspective of public health interventions, a good understanding of acculturation, perceived safety, and health could inform intersectoral collaboration between public safety, K-12 (kindergarten through 12th grade) and adult education, immigrant services, and public health agencies. 相似文献
77.
Shelley A. Wiechman Kara McMullen Gretchen J. Carrougher Jame A. Fauerbach Colleen M. Ryan David N. Herndon Radha Holavanahalli Nicole S. Gibran Kimberly Roaten 《Archives of physical medicine and rehabilitation》2018,99(7):1311-1317
Objective
To identify important sources of distress among burn survivors at discharge and 6, 12, and 24 months postinjury, and to examine if the distress related to these sources changed over time.Design
Exploratory.Setting
Outpatient burn clinics in 4 sites across the country.Participants
Participants who met preestablished criteria for having a major burn injury (N=1009) were enrolled in this multisite study.Interventions
Participants were given a previously developed list of 12 sources of distress among burn survivors and asked to rate on a 10-point Likert-type scale (0=no distress to 10=high distress) how much distress each of the 12 issues was causing them at the time of each follow-up.Main Outcomes Measures
The Medical Outcomes Study 12-Item Short-Form Health Survey was administered at each time point as a measure of health-related quality of life. The Satisfaction With Appearance Scale was used to understand the relation between sources of distress and body image. Finally, whether a person returned to work was used to determine the effect of sources of distress on returning to employment.Results
It was encouraging that no symptoms were worsening at 2 years. However, financial concerns and long recovery time are 2 of the highest means at all time points. Pain and sleep disturbance had the biggest effect on ability to return to work.Conclusions
These findings can be used to inform burn-specific interventions and to give survivors an understanding of the temporal trajectory for various causes of distress. In particular, it appears that interventions targeted at sleep disturbance and high pain levels can potentially effect distress over financial concerns by allowing a person to return to work more quickly. 相似文献78.
79.
Kara E. Bischoff David L. ORiordan Kristyn Fazzalaro Anne Kinderman Steven Z. Pantilat 《Journal of pain and symptom management》2018,55(3):881-889
Context
Pain is a common and distressing symptom. Pain management is a core competency for palliative care (PC) teams.Objective
Identify characteristics associated with pain and pain improvement among inpatients referred to PC.Methods
Thirty-eight inpatient PC teams in the Palliative Care Quality Network entered data about patients seen between December 12, 2012 and March 15, 2016. We examined patient and care characteristics associated with pain and pain improvement.Results
Of patients who could self-report symptoms, 30.7% (4959 of 16,158) reported moderate-to-severe pain at first assessment. Over 40% of these patients had not been referred to PC for pain. Younger patients (P < 0.0001), women (P < 0.0001), patients with cancer (P < 0.0001), and patients in medical/surgical units (P < 0.0001) were more likely to report pain. Patients with pain had higher rates of anxiety (P < 0.0001), nausea (P < 0.0001), and dyspnea (P < 0.0001). Sixty-eight percent of patients with moderate-to-severe pain improved by the PC team's second assessment within 72 hours; 74.7% improved by final assessment. There was a significant variation in the rate of pain improvement between PC teams (P < 0.0001). Improvement in pain was associated with improvement in anxiety (OR = 2.9, P < 0.0001) and dyspnea (OR = 1.4, P = 0.03). Patients who reported an improvement in pain had shorter hospital length-of-stay by two days (P = 0.003).Conclusion
Pain is common among inpatients referred to PC. Three-quarters of patients with pain improve and improvement in pain is associated with other symptom improvement. Standardized, multisite data collection can identify PC patients likely to have marked and refractory pain, create benchmarks for the field, and identify best practices to inform quality improvement. 相似文献80.
Ceren Orhan Ozgun Kaya Kara Serap Kaya Turkan Akbayrak Mintaze Kerem Gunel Gül Baltaci 《Disability and rehabilitation》2018,40(1):10-20
Purpose: The aim of this study was to investigate the effects of connective tissue manipulation (CTM) and Kinesio Taping® (KT) on constipation and quality of life in children with cerebral palsy (CP).Method: This study was designed as a randomized controlled trial. Forty children diagnosed with chronic constipation based on Rome III criteria were randomly assigned to CTM group [6 females, 7 males; 8 y 6?mo (SD = 3y 4?mo)], KT group [7 female, 7 male; 8y 7?mo (SD =3y 5?mo)] or control group [6 female, 7 male; 8y 3?mo (SD = 3y 6?mo)]. All patients were assessed with 7-day bowel diaries, Bristol Stool Form Scale (BSFS), Visual Analog Scale (VAS), and Pediatric Quality of Life Inventory (PEDsQL). Kruskal-Wallis, Wilcoxon’s signed-rank, and Mann–Whitney U tests were used to determine intra-group and inter-group differences. The level of significance was p?0.05.Results: Among the CTM, KT, and control groups, there were statistically significant differences regarding the changes in defecation frequency (2.46, 3.00, 0.30, ES 1.16, p?0.001), duration of defecation (5.07, 5.35, 0.15, ES 2.37, p?=?0.003), BSFS (1.84, 2.14, 0.07, ES 0.91, p?0.001), VAS (4.83, 3.87, 0.23, ES 1.98, p?0.001), and PEDsQL total scores (7, 14, 8.36, ?0.85, ES 4.08, p?0.001).Conclusions: This study revealed that CTM and KT seem equally effective physiotherapy approaches for the treatment of pediatric constipation and these approaches may be added to bowel rehabilitation program.
- Implications for rehabilitation
CTM and KT have similar effectiveness in alleviating the constipation-related symptoms and improving quality of life in children with CP.
CTM and KT can be integrated into bowel rehabilitation programs.
Considering the characteristics of patients, these treatment options can be used as an alternative of each other by physiotherapists.