Program evaluation in public health

"Effective program evaluation is a systematic way to improve and account for public health actions by involving procedures that are useful, feasible, ethical, and accurate. The framework guides public health professionals in their use of program evaluation. It is a practical, nonprescriptive tool, designed to summarize and organize essential elements of program evaluation. The framework comprises steps in program evaluation practice and standards for effective program evaluation. Adhering to the steps and standards of this framework will allow an understanding of each program's context and will improve how program evaluations are conceived and conducted. Furthermore, the framework encourages an approach to evaluation that is integrated with routine program operations. The emphasis is on practical, ongoing evaluation strategies that involve all program stakeholders, not just evaluation experts. Understanding and applying the elements of this framework can be a driving force for planning effective public health strategies, improving existing programs, and demonstrating the results of resource investments." - p. 1The following CDC staff members prepared this report: Robert L. Milstein, Scott F. Wetterhall, in collaboration with CDC Evaluation Working Group MembersIncludes bibliographical references (p. 35-40).1049939

Guidelines for the identification and management of lead exposure in pregnant and lactating women

"Lead exposure during pregnancy and breastfeeding can result in lasting adverse health effects independent of lead exposure during other life stages. However, to date there has been limited guidance available for clinicians and the public health community regarding the screening and management of pregnant and lactating women exposed to high levels of lead. Recognizing the need for national recommendations, the Centers for Disease Control and Prevention and the Advisory Committee on Childhood Lead Poisoning Prevention convened a workgroup of recognized experts to review the existing evidence for adverse effects of past and current maternal lead exposure on maternal health and fertility and on the developing fetus, infant, and child in prenatal and postnatal states and to propose evidence-based strategies for intervention. These Guidelines for the Identification and Management of Lead Exposure in Pregnant and Lactating Women are based on scientific data and practical considerations regarding preventing lead exposure during pregnancy, assessment and blood lead testing during pregnancy, medical and environmental management to reduce fetal exposure, breastfeeding, and follow up of infants and children exposed to lead in utero. The guidelines also outline a research agenda that will provide crucial information for future efforts to prevent and treat lead exposure during pregnancy and lactation. Further research is needed for a better understanding of lead's effect on pregnancy outcomes and infant development; lead kinetics across the placenta and in breast milk and their relationship to long-term health effects; genetic susceptibility to damage from lead; as well as the pharmacokinetics, effectiveness, and safety of chelating agents in the pregnant woman. Research is also needed to address important clinical and public health needs including validation of risk questionnaires for pregnant women, optimal timing of blood lead testing, and effective strategies for identification and treatment of pica in pregnant women." - p. iPreface -- Executive summary -- Summary of public health actions based on maternal and infant blood lead levels -- Members of the Work Group on Lead and Pregnancy -- Acknowledgments -- Members of the Advisory Committee on Childhood Lead Poisoning Prevention -- Glossary . -- 1. Introduction -- 2. Adverse health effects of lead exposure in pregnancy -- 3. Biokinetics and biomarkers of lead in pregnancy and lactation -- 4. Distribution of BLLs, risk factors for and sources of lead exposure in pregnant and lactating women -- 5. Blood lead testing in pregnancy and early infancy -- 6. Management of pregnant and lactating women exposed to lead -- 7. Nutrition and lead in pregnancy and lactation -- 8. Chelation of pregnant women, fetuses, and newborn infants -- 9. Breastfeeding -- 10. Research, policy, and health education recommendations -- 11. Resources and referral information --edited by Adrienne S. Ettinger, Anne Guthrie Wengrovitz.Issued by the National Center for Environmental Health Division of Emergency and Environmental Health Services."CS2016857."Includes bibliographical references.Environmental HealthPrevention and ControlCurren

Prevalence of Risk Factors for Adverse Pregnancy Outcomes During Pregnancy and the Preconception Period—United States, 2002–2004

Objectives: To assess the prevalence of risk factors for adverse pregnancy outcome during the preconception stage and during pregnancy, and to assess differences between women in preconception and pregnancy. Methods: Data from the 2002 and 2004 Behavioral Risk Factor Surveillance System, United States, were used to estimate the prevalence of selected risk factors among women 18–44 in the preconception period (women who wanted a baby in the next 12 months, and were not using contraception, not sterile and not already pregnant) with women who reported that they were pregnant at the time of interview. Results: Major health risks were reported by substantial proportions of women in the preconceptional period and were also reported by many pregnant women, although pregnant women tended to report lower levels of risk than preconception women. For example, 54.5% of preconception women reported one or more of 3 risk factors (frequent drinking, current smoking, and absence of an HIV test), compared with 32.0% of pregnant women (p < .05). The difference in the prevalence of these three risk factors between preconception and pregnancy was significant for women with health insurance (52.5% in preconception vs. 29.4% in pregnancy, p < .05), but not for women without insurance (63.4% vs. 52.7%, p > .05). Conclusions: Women appear to be responding to messages regarding behaviors that directly affect pregnancy such as smoking, alcohol consumption and taking folic acid, but many remain unaware of the benefits of available interventions to prevent HIV transmission and birth defects. Although it appears that some women reduce their risk for adverse pregnancy outcomes after learning of their pregnancy, the data suggest that a substantial proportion of women do not. Furthermore, if such change occurs it is often too late to affect outcomes, such as birth defects resulting from alcohol consumption during the periconception period. Preconception interventions are recommended to achieve a more significant reduction in risk and further improvement in perinatal outcomes

Proficiency Testing of Viral Marker Screening in African Blood Centers - Seven African Countries, 2017.

A 2014 report evaluating accuracy of serologic testing for transfusion-transmissible viruses at African blood center laboratories found sensitivities of 92%, 87%, and 90% for detecting infections with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV), respectively (1). Following substantial investments in national blood transfusion service (NBTS) laboratories, in 2017 investigators tested proficiency at 84 blood center laboratories (29 NBTS and 55 non-NBTS) in seven African countries. A blinded panel of 25 plasma samples was shipped to each participating laboratory for testing with their usual protocols based on rapid diagnostic tests (RDTs) (2) and third and fourth generation enzyme immunoassays (EIA-3 and EIA-4). Sensitivity and specificity were estimated using separate regression models that clustered assays by laboratory and adjusted for assay type and NBTS laboratory status. Mean specificities were ≥95% for all three viruses; however, mean sensitivities were 97% for HIV-positive, 76% for HBV-positive, and 80% for HCV-positive samples. Testing sensitivities for all viruses were high when EIA-3 assays were used (≥97%). Lower sensitivities for HBV-positive samples and HCV-positive samples were associated with assay types other than EIA-3, used primarily by non-NBTS laboratories. Proficiency for HIV testing has improved following international investments, but proficiency remains suboptimal for HBV and HCV testing. In sub-Saharan African blood centers, the quality of rapid tests used for HBV and HCV screening needs to be improved or their use discouraged in favor of EIA-3 tests

Recommendations to improve preconception health and health care -- United States: a report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care

"This report provides recommendations to improve both preconception health and care. The goal of these recommendations is to improve the health of women and couples, before conception of a first or subsequent pregnancy. Since the early 1990s, guidelines have recommended preconception care, and reviews of previous studies have assessed the evidence for interventions and documented the evidence for specific interventions. CDC has developed these recommendations based on a review of published research and the opinions of specialists from the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. The 10 recommendations in this report are based on preconception health care for the U.S. population and are aimed at achieving four goals to 1) improve the knowledge and attitudes and behaviors of men and women related to preconception health; 2) assure that all women of childbearing age in the United States receive preconception care services (i.e., evidence-based risk screening, health promotion, and interventions) that will enable them to enter pregnancy in optimal health; 3) reduce risks indicated by a previous adverse pregnancy outcome through interventions during the interconception period, which can prevent or minimize health problems for a mother and her future children; and 4) reduce the disparities in adverse pregnancy outcomes. The recommendations focus on changes in consumer knowledge, clinical practice, public health programs, health-care financing, and data and research activities. Each recommendation is accompanied by a series of specific action steps and, when implemented, can yield results within 2-5 years. Based on implementation of the recommendations, improvements in access to care, continuity of care, risk screening, appropriate delivery of interventions, and changes in health behaviors of men and women of childbearing age are expected to occur. The implementation of these recommendations will help achieve Healthy People 2010 objectives. The recommendations and action steps are a strategic plan that can be used by persons, communities, public health and clinical providers, and governments to improve the health of women, their children, and their families. Improving preconception health among the approximately 62 million women of childbearing age will require multistrategic, action-oriented initiatives" - p. 1Introduction -- -- Preconception Health and Care -- Healthy People 2000/2010 Objectives for Improving Preconception Health and Guidelines for Preconception Care -- Preconception Risks Associated with Adverse Pregnancy Outcomes -- Preconception Prevention and Intervention -- -- Context and Frame Work for Recommendations -- How the Recommendations were Developed -- Recommendations to Improve Preconception Health -- Recommendations -- Conclusion References -- Appendix: External Partner Organizationsprepared by Kay Johnson, Samuel F. Posner, Janis Biermann , Jose\ucc? F. Cordero, Hani K. Atrash, Christopher S. Parker, Sheree Boulet, Michele G. Curtis."April 21, 2006."Cover title."The material in this report originated in the National Center on Birth Defects and Developmental Disabilities, Jose\ucc? F. Cordero, MD, Director; and the Office of Program Development, Hani K. Atrash, MD, Associate Director; and the National Center for Chronic Disease Prevention and Health Promotion, Janet Collins, PhD, Director, and the Division of Reproductive Health, John Lehnherr, Director. " - p. 1Also available via the World Wide Web.Includes bibliographical references (p. 16-21)

Early Identification of Type 2 Diabetes: Policy should be aligned with health systems strengthening

This article does not have an abstract

Predicting and explaining transtheoretical model stage transitions in relation to condom-carrying behaviour

Objectives: The stages of change component of the transtheoretical model has been applied to safe sex behaviours in cross-sectional analyses, but have not yet been subject to prospective analysis. It was predicted that: (a) cross-sectional analyses would demonstrate good discrimination between the stages of change, (b) prospective analyses would allow for the identification of predictors of stage transitions, and (c) implementation intentions would explain progression from the preparation stage. Design: This study employed an experimental longitudinal design. Participants were randomly assigned to the experimental (implementation intention) or control conditions and completed questionnaires at baseline and at 2-months follow up. Methods: 525 adolescents who were broadly representative of the UK population completed questionnaires at baseline and follow up (n = 393) measuring: demographic variables, stage of change, theory of planned behaviour constructs, anticipated regret and moral norm in relation to condom carrying behaviour. The experimental condition completed a self-generated implementation intention to carry condoms at the end of the baseline questionnaire. Results: Discriminant function analyses indicated that the stages of change could be accurately discriminated from one another cross-sectionally and that, longitudinally, the measured variables were able to predict transitions between most stages. Implementation intentions caused people to progress from the preparation stage. Conclusions: Transitions between most stages were reliably predicted thereby providing potential targets for intervention. The brief implementation intention intervention was effective and could easily be utilised and expanded to encompass a broader range of sexual health behaviours.</p

Indirect estimation of a discrete-state discrete-time model using secondary data analysis of regression data

Multi-state models of chronic disease are becoming increasingly important in medical research to describe the progression of complicated diseases. However, studies seldom observe health outcomes over long time periods. Therefore, current clinical research focuses on the secondary data analysis of the published literature to estimate a single transition probability within the entire model. Unfortunately, there are many difficulties when using secondary data, especially since the states and transitions of published studies may not be consistent with the proposed multi-state model. Early approaches to reconciling published studies with the theoretical framework of a multi-state model have been limited to data available as cumulative counts of progression. This paper presents an approach that allows the use of published regression data in a multi-state model when the published study may have ignored intermediary states in the multi-state model. Colloquially, we call this approach the Lemonade Method since when study data give you lemons, make lemonade. The approach uses maximum likelihood estimation. An example is provided for the progression of heart disease in people with diabetes. Copyright © 2009 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63056/1/3599_ftp.pd