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News and training opportunities
Cool websites and reports on hot topics*
Interesting journal articles*
January 2017 HAPPY NEW YEAR!!!
News and training opportunities
December 19, 2016 - January 20, 2017. Free online training on factors that influence health literacy, the difference between literacy and health literacy, and the definition and application of health policy literacy, sponsored by the Health Policy Research Consortium. See http://myemail.constantcontact.com/The-Health-Policy-Literacy-training.html?soid=1119736475713&aid=004kGJH8_f0
January 11, 2017 1:30-2:30pm CST. Webinar will discuss the report "2017-2022 Health Care Preparedness and Response Capabilities” issued by the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. The report describes what the health care delivery system, including health care coalitions, hospitals, and emergency medical services have to do to effectively prepare for and respond to emergencies that impact the public’s health. Register at https://attendee.gotowebinar.com/register/7333189881354959107
January 11, 2017 1 – 2 pm CST: Webinar: Beyond the First Step: The Many Benefits of Walking and Walkability. Learn how individuals and organizations are harnessing the power of walking to create lasting positive change. See more information and register at http://americawalks.org/new-webinar-beyond-the-first-step-the-many-benefits-of-walking-and-walkability-january-11th-2017/
January 19, 2017 11 am – 3 pm CST: The Future of Care Delivery: Relentless Redesign is a free, live web event produced by NEJM Catalyst and hosted by Providence St. Joseph Health. Join health care leaders and researchers who will address critical aspects of health care delivery transformation. See http://join.catalyst.nejm.org/events/relentless-reinvention/register/?utm_source=nejmlist&utm_medium=email&utm_content=email1_nejm&utm_campaign=relentless-reinvention
February 15-17, 2017, San Antonio, TX. Communities Joined in Action conference. The theme is "Unleashing the power of communities: Achieving health, well-being, and equity.” For more information and to register, see http://www.cjaonline.net/2017-conference/
Cool websites and reports on hot topics*
Big Data and Analytics for Infectious Disease Research, Operations, and Policy: Proceedings of a Workshop. Participants discussed a range of topics including preventing, detecting, and responding to infectious disease threats using big data and related analytics; varieties of data; means to improve their collection, processing, utility, and validation; and approaches that can be learned from other sectors. Read it at https://www.nap.edu/catalog/23654/big-data-and-analytics-for-infectious-disease-research-operations-and-policy
Compendium of Publicly Available Datasets and Other Data-Related Resources, compiled by the National Partnership for Action to End Health Disparities. The Compendium compiles in one place descriptions of and links to 132 public datasets and resources that include information about health conditions and other factors that impact the health of minority populations. See https://www.minorityhealth.hhs.gov/NPA/Materials/FIHET_Data_Compendium_508_version_FINAL_11_28_2016.pdf
Drinking Water Action Plan. The EPA has released an action plan to increase safety and reliability of drinking water with six priority areas: clean water equity, increased transparency, reducing lead risks, addressing unregulated contaminants, strengthening source water protection, and advancing oversight for the Safe Drinking Water Act. Read it at https://www.epa.gov/sites/production/files/2016-11/documents/508.final_.usepa_.drinking.water_.action.plan_11.30.16.v0.pdf
The Ebola Epidemic in West Africa: Proceedings of a Workshop (2016). Workshop participants explored the Ebola epidemic from multiple perspectives, identified important questions about Ebola that remain unanswered, and sought to apply this understanding to the broad challenges posed by Ebola and other emerging pathogens, in order to prevent the international community from being taken by surprise once again in the face of these threats. Read it at https://www.nap.edu/catalog/23653/the-ebola-epidemic-in-west-africa-proceedings-of-a-workshop
From Treating the Ill to Preventing the Illness by Natalie Orenstein and Barbara Ray, sponsored by the Build Healthy Places Coalition. Hospitals and health systems explore community development partnerships to save lives and cut costs. See https://medium.com/bhpn-crosswalk/from-treating-the-ill-to-preventing-the-illness-902efdde20b1#.m9wqvep22
Holiday menus: healthy, thrifty holiday menus are provided by the USDA in their online newsletter, SNAP-Ed Connection. Each menu has vegetarian options. Recipes are included for celebrations throughout the year. See https://snaped.fns.usda.gov/recipes/healthy-thrifty-holiday-menus#December
Human Genome Resources: this portal, from the National Library of Medicine, provides access to genome visualization and analysis tools, BLAST, NCBI Genome Remapping Service, and molecular databases. See https://www.ncbi.nlm.nih.gov/projects/genome/guide/human/
Microreact, a free, real-time epidemic visualization and tracking platform has been used to monitor outbreaks of Ebola, Zika and antibiotic-resistant microbes. It was developed by the Wellcome Trust Sanger Institute and Imperial College London. This online epidemic tracking tool embraces open data and collective intelligence to understand outbreaks. See http://www.sanger.ac.uk/news/view/online-epidemic-tracking-tool-embraces-open-data-and-collective-intelligence-understand
Mortality in the United States, 2015, NCHS Data Brief No. 267, December 2016. Life expectancy for the U.S. population in 2015 was 78.8 years, a decrease of 0.1 year from 2014. Read about it at https://www.cdc.gov/nchs/data/databriefs/db267.pdf
Physical Activity for Children and Youth (2016 United States Report Card) by the National Physical Activity Plan Alliance. The primary goal of the 2016 U.S. Report Card is to assess levels of physical activity and sedentary behaviors in American children and youth, facilitators and barriers for physical activity, and health outcomes related to physical activity. See http://physicalactivityplan.org/projects/reportcard.html
Preventing Illicit Drug Use, presents highlights of a forum sponsored by GAO, summary released November 2016. This forum discussed common factors related to illicit drug use; strategies in the education, health care, and law enforcement sectors to prevent illicit drug use; and high priority areas for future action to prevent illicit drug use. Read hihglights at http://www.gao.gov/assets/690/680990.pdf?utm_medium=email&utm_source=govdelivery or the full report at http://www.gao.gov/products/GAO-17-146SP .
Social Determinants of Health and Selected HIV Care Outcomes among Adults with Diagnosed HIV Infection in 32 States and the District of Columbia, 2014. HIV Surveillance Supplemental Report 2016;21(No. 7), CDC, December 2016. This report examines the social determinants of health and linkage to HIV medical care, retention in care, and HIV viral suppression. See https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-21-7.pdf
Strategies for Encouraging Staff Wellness in Trauma-Informed Organizations, Menschner C, Maul A, Center for Health Care Strategies, December 2016. Securing time and resources for staff wellness is an essential element to trauma-informed care, because supporting staff well-being helps them provide high quality care. This brief outlines the impact of chronic work-related stress and provides examples of two organizations that prioritize staff wellness. See http://www.chcs.org/media/ATC-Staff-Wellness-121316_FINAL.pdf
Strengthening the Workforce to Support Community Living and Participation for Older Adults and Individuals with Disabilities: Proceedings of a Workshop (2016). Participants aimed to identify how the health care workforce can be strengthened to support both community living and community participation for adults with disabilities and older adults. This publication summarizes the presentations and discussions from the workshop. Read it at https://www.nap.edu/catalog/23656/strengthening-the-workforce-to-support-community-living-and-participation-for-older-adults-and-individuals-with-disabilities
Winnable Battles Final Report was issued by the CDC. The Winnable Battles process has been infused into the way state, tribal and local public health officials, policy makers and healthcare professionals identify, prioritize and take action to improve health outcomes in their communities. See https://www.cdc.gov/winnablebattles/report/
Youth with Autism: Roundtable Views of Services Needed During the Transition into Adulthood. GAO-17-109, October 18. GAO studied the services and supports transitioning youth with ASD need to attain their goals for adulthood, the characteristics of these services and supports, and how youth with ASD can be fully integrated into society. See highlights at http://www.gao.gov/assets/690/680524.pdf or read the full report at http://www.gao.gov/products/GAO-17-109
Interesting journal articles*
Association between the opening of retail clinics and low-acuity emergency department visits. Martsolf G, Fingar KR, Coffey R, et al. Ann Emerg Med. 2016 Nov 4. pii: S0196-0644(16)30998-2. doi: 10.1016/j.annemergmed.2016.08.462. [Epub ahead of print]
Study Objective: We assess whether the opening of retail clinics near emergency departments (ED) is associated with decreased ED utilization for low-acuity conditions. Methods: We used data from the Healthcare Cost and Utilization Project State Emergency Department Databases for 2,053 EDs in 23 states from 2007 to 2012. We used Poisson regression models to examine the association between retail clinic penetration and the rate of ED visits for 11 low-acuity conditions. Retail clinic "penetration" was measured as the percentage of the ED catchment area that overlapped with the 10-minute drive radius of a retail clinic. Rate ratios were calculated for a 10-percentage-point increase in retail clinic penetration per quarter. During the course of a year, this represents the effect of an increase in retail clinic penetration rate from 0% to 40%, which was approximately the average penetration rate observed in 2012. Results: Among all patients, retail clinic penetration was not associated with a reduced rate of low-acuity ED visits (rate ratio=0.999; 95% confidence interval=0.997 to 1.000). Among patients with private insurance, there was a slight decrease in low-acuity ED visits (rate ratio=0.997; 95% confidence interval=0.994 to 0.999). For the average ED in a given quarter, this would equal a 0.3% reduction (95% confidence interval 0.1% to 0.6%) in low-acuity ED visits among the privately insured if retail clinic penetration rate increased by 10 percentage points per quarter. Conclusion: With increased patient demand resulting from the expansion of health insurance coverage, retail clinics may emerge as an important care location, but to date, they have not been associated with a meaningful reduction in low-acuity ED visits.
Brain activation in high-functioning older adults and falls: Prospective cohort study Verghese J, Wang C, Ayers E, Izzetoglu M, Holtzer R. Neurology. 2016 Dec 7. pii: 10.1212/WNL.0000000000003421. [Epub ahead of print]
Objective: To determine whether brain activity over the prefrontal cortex measured in real time during walking predicts falls in high-functioning older adults. Method: We examined166 older persons (mean age 75 years, 51% women) enrolled in a prospective aging study. High-functioning status defined as the absence of dementia or disability with normal gait diagnosed by study clinicians. The magnitude of task-related changes in oxygenated hemoglobin levels over the prefrontal cortex was measured with functional near-infrared spectroscopy during motor (walking at normal pace) and cognitive (reciting alternate letters of the alphabet) single tasks and a dual-task condition (walking while reciting alternate letters of the alphabet). Incident falls were prospectively assessed over a 50-month study period. Results: Over a mean follow-up of 33.9 ± 11.9 months, 116 falls occurred. Higher levels of prefrontal cortical activation during the dual-task walking condition predicted falls (hazard ratio adjusted for age, sex, education, medical illnesses and general mental status 1.32, 95% confidence interval 1.03-1.70). Neither behavioral outcomes (velocity or letter rate) on the dual task nor brain activation patterns on the single tasks (normal walk or talk alone) predicted falls in this high-functioning sample. The results remained robust after accounting for multiple confounders and for cognitive status, slow gait, previous falls, and frailty. Conclusions: Prefrontal brain activity levels while performing a cognitively demanding walking condition predicted falls in high-functioning seniors. These findings implicate neurobiological processes early in the pathogenesis of falls.
Children's environmental health: homes of influence. Afzal B, Witherspoon NO, Trousdale K. Environ Health Perspect. 2016 Dec 1;124(12):A209-A213.
Over the past two decades, diverse stakeholder groups, representing various disciplines and perspectives (e.g., federal, state and local policy makers; nonprofit organizations; health professionals; and industry), have devoted considerable resources, expertise, and influence toward efforts that wittingly and unwittingly affect children’s environmental health. In this article, we refer to these groups as “homes of influence,” and we summarize the wide reach and potential impacts of these homes on childhood asthma, as one example that illustrates how these varied groups impact childhood health outcomes. We posit that diverse homes of influence can be most successful in effecting positive change when they understand and acknowledge their respective influences and work together to develop informed, preventive initiatives under the framework of recommendations called, “A Blueprint for Protecting Children’s Environmental Health: An Urgent Call to Action.” This published resource was developed by a panel of thought leaders and experts in the field of children’s environmental health to guide cross-sector collaboration efforts to proactively protect the environmental health of all children.
Correlates of receiving a recommendation for more physical activity from a primary care provider, Forjuoh SN, Lee C, Won J, et al. Am J Prev Med. 2016 Nov 24. pii: S0749-3797(16)30522-0. doi: 10.1016/j.amepre.2016.09.037
Introduction: Primary care providers (PCPs) are strategically positioned to communicate with their overweight/obese patients about positive behavioral changes to improve health and functioning. Demographic and behavioral correlates of receiving a recommendation for more physical activity (PA) from a PCP by overweight/obese patients were assessed. Methods: Community-dwelling adults aged ≥50 years from four Texas cities who were seen by a family physician in a primary care clinic were surveyed from October 2013 to June 2014. Multivariate logistic regression predicted the likelihood of receiving a PA recommendation from a PCP, controlling for sociodemographic factors, health conditions, and walking behaviors. The analysis was conducted in 2016. Results: Of the total 388 participants (survey response rate, 6.8%), 30.1% were obese, 55.4% were female, and most were non-Hispanic white (82.9%), married (75.6%), or reported an annual household income of ≥$50,000 (66.8%). Receipt of a PA recommendation from a PCP (n=151, 38.9%) was significantly correlated with reporting poor to fair health (OR=7.33, 95% CI=2.6, 20.32), obesity (OR=2.95, 95% CI=1.69, 5.14), having only a little or some difficulty walking for a quarter of a mile (OR=2.94, 95% CI=1.41, 5.88), not walking the recommended ≥150 minutes for any purpose (OR=2.60, 95% CI=1.25, 5.38), and being employed (OR=2.11, 95% CI=1.13. 3.94). Conclusions: PCPs seem to be targeting obese, inactive individuals with poor to fair health, populations traditionally not encouraged to be more physically active. These findings are consistent with the current trend in medical care to recommend positive lifestyle changes to a broader range of the population.
Current cigarette smoking among adults - United States, 2005-2015. Jamal A, King BA, Neff LJ, et al. MMWR Morb Mortal Wkly Rep. 2016 Nov 11;65(44):1205-1211.
Tobacco use is the leading cause of preventable disease and death in the United States, and cigarettes are the most commonly used tobacco product among U.S. adults (1,2). To assess progress toward achieving the Healthy People 2020 target of reducing the proportion of U.S. adults who smoke cigarettes to ≤12.0% (objective TU1.1),* CDC assessed the most recent national estimates of cigarette smoking prevalence among adults aged ≥18 years using data from the 2015 National Health Interview Survey (NHIS). The proportion of U.S. adults who smoke cigarettes declined from 20.9% in 2005 to 15.1% in 2015, and the proportion of daily smokers declined from 16.9% to 11.4%. However, disparities in cigarette smoking persist. In 2015, prevalence of cigarette smoking was higher among adults who were male; were aged 25-44 years; were American Indian/Alaska Native; had a General Education Development certificate (GED); lived below the federal poverty level; lived in the Midwest; were insured through Medicaid or were uninsured; had a disability/limitation; were lesbian, gay, or bisexual; or who had serious psychological distress. Proven population-based interventions, including tobacco price increases, comprehensive smoke-free laws, anti-tobacco mass media campaigns, and barrier-free access to tobacco cessation counseling and medications, are critical to reducing cigarette smoking and smoking-related disease and death among U.S. adults, particularly among subpopulations with the highest smoking prevalences.
Evidence of degraded representation of speech in noise, in the aging midbrain and cortex. Presacco A,,Simon JZ, Anderson S. J Neurophysiol. 2016 Nov 1;116(5):2346-2355.
Humans have a remarkable ability to track and understand speech in unfavorable conditions, such as in background noise, but speech understanding in noise does deteriorate with age. Results from several studies have shown that in younger adults, low-frequency auditory cortical activity reliably synchronizes to the speech envelope, even when the background noise is considerably louder than the speech signal. However, cortical speech processing may be limited by age-related decreases in the precision of neural synchronization in the midbrain. To understand better the neural mechanisms contributing to impaired speech perception in older adults, we investigated how aging affects midbrain and cortical encoding of speech when presented in quiet and in the presence of a single-competing talker. Our results suggest that central auditory temporal processing deficits in older adults manifest in both the midbrain and in the cortex. Specifically, midbrain frequency following responses to a speech syllable are more degraded in noise in older adults than in younger adults. This suggests a failure of the midbrain auditory mechanisms needed to compensate for the presence of a competing talker. Similarly, in cortical responses, older adults show larger reductions than younger adults in their ability to encode the speech envelope when a competing talker is added. Interestingly, older adults showed an exaggerated cortical representation of speech in both quiet and noise conditions, suggesting a possible imbalance between inhibitory and excitatory processes, or diminished network connectivity that may impair their ability to encode speech efficiently.
Health literacy and health information technology adoption: the potential for a new digital divide. Mackert M, Flynn AM, Champlin S, et al. J Med Internet Res 2016;18(10):e264
Background: Approximately one-half of American adults exhibit low health literacy and thus struggle to find and use health information. Low health literacy is associated with negative outcomes including overall poorer health. Health information technology (HIT) makes health information available directly to patients through electronic tools including patient portals, wearable technology, and mobile apps. The direct availability of this information to patients, however, may be complicated by misunderstanding of HIT privacy and information sharing. Objective: The purpose of this study was to determine whether health literacy is associated with patients’ use of four types of HIT tools: fitness and nutrition apps, activity trackers, and patient portals. Additionally, we sought to explore whether health literacy is associated with patients’ perceived ease of use and usefulness of these HIT tools, as well as patients’ perceptions of privacy offered by HIT tools and trust in government, media, technology companies, and health care. This study is the first wide-scale investigation of these interrelated concepts. Methods: Participants were 4974 American adults (n=2102, 42.26% male, n=3146, 63.25% white, average age 43.5, SD 16.7 years). Participants completed the Newest Vital Sign measure of health literacy and indicated their actual use of HIT tools, as well as the perceived ease of use and usefulness of these applications. Participants also answered questions regarding information privacy and institutional trust, as well as demographic items. Results: Cross-tabulation analysis indicated that adequate versus less than adequate health literacy was significantly associated with use of fitness apps (P=.02), nutrition apps (P<.001), activity trackers (P<.001), and patient portals (P<.001). Additionally, greater health literacy was significantly associated with greater perceived ease of use and perceived usefulness across all HIT tools after controlling for demographics. Regarding privacy perceptions of HIT and institutional trust, patients with greater health literacy often demonstrated decreased privacy perceptions for HIT tools including fitness apps (P<.001) and nutrition apps (P<.001). Health literacy was negatively associated with trust in government (P<.001), media (P<.001), and technology companies (P<.001). Interestingly, health literacy score was positively associated with trust in health care (P=.03). Conclusions: Patients with low health literacy were less likely to use HIT tools or perceive them as easy or useful, but they perceived information on HIT as private. Given the fast-paced evolution of technology, there is a pressing need to further the understanding of how health literacy is related to HIT app adoption and usage. This will ensure that all users receive the full health benefits from these technological advances, in a manner that protects health information privacy, and that users engage with organizations and providers they trust.
Identifying counties vulnerable to diabetes from obesity prevalence in the United States: a spatiotemporal analysis. Li X, Staudt A, Chien LC. Geospat Health. 2016 Nov 21;11(3):439. doi: 10.4081/gh.2016.439.
Clinical and epidemiological research has reported a strong association between diabetes and obesity. However, whether increased diabetes prevalence is more likely to appear in areas with increased obesity prevalence has not been thoroughly investigated in the United States (US). The Bayesian structured additive regression model was applied to identify whether counties with higher obesity prevalence are more likely clustered in specific regions in 48 contiguous US states. Prevalence data adopted the small area estimate from the Behavioral Risk Factor Surveillance System. Confounding variables like socioeconomic status adopted data were from the American Community Survey. This study reveals that an increased percentage of relative risk of diabetes was more likely to appear in Southeast, Northeast, Central and South regions. Of counties vulnerable to diabetes, 36.8% had low obesity prevalence, and most of them were located in the Southeast, Central, and South regions. The geographic distribution of counties vulnerable to diabetes expanded to the Southwest, West and Northern regions when obesity prevalence increased. This study also discloses that 7.4% of counties had the largest average in predicted diabetes prevalence compared to the other counties. Their average diabetes prevalence escalated from 8.7% in 2004 to 11.2% in 2011. This study not only identifies counties vulnerable to diabetes due to obesity, but also distinguishes counties in terms of different levels of vulnerability to diabetes. The findings can provide the possibility of establishing targeted surveillance systems to raise awareness of diabetes in those counties.
Impact of booster breaks and computer prompts on physical activity and sedentary behavior among desk-based workers: a cluster-randomized controlled trial. Taylor WC, Paxton RJ, Shegog R, et al. Prev Chronic Dis. 2016 Nov 17;13:E155. doi: 10.5888/pcd13.160231.
Introduction: The 15-minute work break provides an opportunity to promote health, yet few studies have examined this part of the workday. We studied physical activity and sedentary behavior among office workers and compared the results of the Booster Break program with those of a second intervention and a control group to determine whether the Booster Break program improved physical and behavioral health outcomes. Methods: We conducted a 3-arm, cluster-randomized controlled trial at 4 worksites in Texas from 2010 through 2013 to compare a group-based, structured Booster Break program to an individual-based computer-prompt intervention and a usual-break control group; we analyzed physiologic, behavioral, and employee measures such as work social support, quality of life, and perceived stress. We also identified consistent and inconsistent attendees of the Booster Break sessions. Results: We obtained data from 175 participants (mean age, 43 y; 67% racial/ethnic minority). Compared with the other groups, the consistent Booster Break attendees had greater weekly pedometer counts (P < .001), significant decreases in sedentary behavior and self-reported leisure-time physical activity (P < .001), and a significant increase in triglyceride concentrations (P = .02) (levels remained within the normal range). Usual-break participants significantly increased their body mass index, whereas Booster Break participants maintained body mass index status during the 6 months. Overall, Booster Break participants were 6.8 and 4.3 times more likely to have decreases in BMI and weekend sedentary time, respectively, than usual-break participants. Conclusion: Findings varied among the 3 study groups; however, results indicate the potential for consistent attendees of the Booster Break intervention to achieve significant, positive changes related to physical activity, sedentary behavior, and body mass index.
Infectious disease mortality trends in the United States, 1980-2014. Hansen V, Oren E, Dennis LK, Brown HE. JAMA. 2016 Nov 22;316(20):2149-2151.
From 1900 through 1996, mortality from infectious diseases declined in the United States, except for a 1918 spike due to the Spanish flu pandemic.1 Since 1996, major changes in infectious diseases have occurred, such as the introduction of human immunodeficiency virus (HIV)/AIDS and West Nile virus into the United States, advances in HIV/AIDS treatment, changes in vaccine perceptions, and increased concern over drug-resistant pathogens. We investigated trends in infectious disease mortality from 1980 through 2014 to capture these changes.
Longitudinal functional brain imaging study in early course schizophrenia before and after cognitive enhancement therapy. Keshavan MS, Eack SM, Prasad KM, Haller CS, Cho RY. Neuroimage. 2016 Nov 25. pii: S1053-8119(16)30678-4. doi: 10.1016/j.neuroimage.2016.11.060. [Epub ahead of print]
Objective: Schizophrenia is characterized by impaired -social and non social cognition both of which lead to functional deficits. These deficits may benefit from cognitive remediation, but the neural underpinnings of such improvements have not been clearly delineated. Methods: We conducted a functional magnetic resonance (fMRI) study in early course schizophrenia patients randomly assigned to cognitive enhancement therapy (CET) or enriched supportive therapy (EST) and treated for two years. Imaging data over three time points including fMRI blood oxygen level dependent (BOLD) data were acquired during performance of a cognitive control paradigm, the Preparing to Overcome Prepotency (POP) task, and functional connectivity data, were analyzed. Results: During the two years of treatment, CET patients showed a continual increase in BOLD activity in the right dorsolateral prefrontal cortex (DLPFC), whereas EST patients tended to show no change in prefrontal brain function throughout treatment. Increases in right DLPFC activity were modestly associated with improved neurocognition (β = .14, p = .041), but not social cognition. Functional connectivity analyses showed reduced connectivity between the DLPFC and the anterior cingulate cortex (ACC) in CET compared to EST over the two years of treatment, which was associated with neurocognitive improvement. Conclusions: These findings suggest that CET leads to enhanced neural activity in brain regions mediating cognitive control and increased efficiency in prefrontal circuits; such changes may be related to the observed therapeutic effects of CET on neurocognitive function.
Proportion of selected congenital heart defects attributable to recognized risk factors. Simeone RM, Tinker SC, Gilboa SM, et al. Ann Epidemiol. 2016 Dec;26(12):838-845.
Purpose: To assess the contribution of multiple risk factors for two congenital heart defects-hypoplastic left heart syndrome (HLHS) and tetralogy of Fallot (TOF). Methods: We used data from the National Birth Defects Prevention Study (1997-2011) to estimate average adjusted population attributable fractions for several recognized risk factors, including maternal prepregnancy overweight-obesity, pregestational diabetes, age, and infant sex. Results: There were 594 cases of isolated simple HLHS, 971 cases of isolated simple TOF, and 11,829 controls in the analysis. Overall, 57.0% of HLHS cases and 37.0% of TOF cases were estimated to be attributable to risk factors included in our model. Among modifiable HLHS risk factors, maternal prepregnancy overweight-obesity accounted for the largest proportion of cases (6.5%). Among modifiable TOF risk factors, maternal prepregnancy overweight-obesity and maternal age of 35 years or older accounted for the largest proportions of cases (8.3% and 4.3%, respectively). Conclusions: Approximately half of HLHS cases and one-third of TOF cases were estimated to be attributable to risk factors included in our models. Interventions targeting factors that can be modified may help reduce the risk of HLHS and TOF development. Additional research into the etiology of HLHS and TOF may reveal other modifiable risk factors that might contribute to primary prevention efforts.
Why do people work in public health? exploring recruitment and retention among public health workers. Yeager VA, Wisniewski JM, Amos K, Bialek R. J Public Health Manag Pract. 2016 Nov-Dec;22(6):559-66.
Context: The public health workforce is critical to the functioning of the public health system and protection of the population's health. Ensuring a sufficient workforce depends on effectively recruiting and retaining workers. Objective: This study examines factors influencing decisions to take and remain in jobs within public health, particularly for workers employed in governmental public health. Design: This cross-sectional study employed a secondary data set from a 2010 national survey of US public health workers. Participants: Survey respondents were included in this study if they responded to at least 1 survey item related to recruitment and retention. A total of 10 859 survey responses fit this criterion. Main Outcome Measures: Data examined demographics of public health workers and factors that influenced decisions to take jobs in and remain in public health. Results: Job security (β = 0.42; 95% confidence interval [CI], 0.28-0.56) and competitive benefits (β = 0.49; 95% CI, 0.28-0.70) were significantly and positively associated with governmental employees' decisions to take positions with their current employers compared with public health workers employed by other types of organizations. The same finding held with regard to retention: job security (β = 0.40; 95% CI, 0.23-0.57) and competitive benefits (β = 0.53; 95% CI, 0.24-0.83). Two personal factors, personal commitment to public service (β = 0.30; 95% CI, 0.17-0.42) and wanted a job in the public health field (β = 0.44; 95% CI, 0.18-0.69), were significantly and positively related to governmental employees deciding to remain with their current employers. Conclusions: It is important to recognize the value of competitive benefits for both current and potential employees. Public health agencies should maintain these if possible and make the value of these benefits known to policy makers or other agencies setting these benefit policies. Job security associated with governmental public health jobs also appears to offer public health an advantage in recruiting and retaining employees.
1. Beyond Schizophrenia: Living and Working with a Serious Mental Illness by Marjorie L. Baldwin.
2. Bringing Out the Best in People: How to Apply the Astonishing Power of Positive Reinforcement by Aubrey C. Daniels.
3. Children and Youth with Autism Spectrum Disorder (ASD) : Recent Advances and Innovations in Assessment, Education, and Intervention, edited by James K. Luiselli.
4. The Oxford Handbook of Positive Psychology and Disability, edited by Michael L. Wehmeyer.
5. Winning the Brain Game: Fixing the Seven Fatal Flaws of Thinking by Matthew E. May.
6. Zika: The Emerging Epidemic by Donald G. McNeil, Jr.
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