Interrupted Progress: Forty Years of Child Poverty

In the last forty years since the beginning of the war on poverty, the condition of poor children has improved and the percentage of children living in poverty has declined. Children and their families made the greatest gain when there was a good economy and an increase in government supports. But when such investments shrink, as they have in recent years, progress is impeded. Temporary Assistance to Needy Families (TANF) must be reauthorized by Congress. The legislation now under discussion does not encourage states to replicate programs that have increased work and family income and helped children

Deborah Weinstein to Mr. Meredith (1 October 1962)

https://egrove.olemiss.edu/mercorr_pro/1339/thumbnail.jp

Transferring Water and Climate Resilience Lessons from Australia\u27s Millennium Drought to Southern California

Southern California and Southern Australia are two regions of the world which share many climatic, socioeconomic and demographic characteristics that lend themselves to meaningful exchanges of knowledge and innovations. With the benefit of Australia’s documented experiences, California can learn what solutions worked and did not work in Australia, potentially avoiding major pitfalls. While some changes in California are already underway, many opportunities – and challenges – still remain. California’s policymakers and residents can adopt and adapt the most fitting solutions from Australia’s experience. California, and especially Southern California, can use these to appropriately and effectively respond to the extremes of our long-term water and climate crises. In doing so, we will put California on a better path towards resilience as we navigate the challenges of drought, flood and extreme heat forecast to increase in our future. In October 2014, TreePeople and The Energy Coalition co-organized and co-led a delegation of policymakers and elected officials from throughout California to the Australian cities of Melbourne and Adelaide. These cities implemented innovative water management solutions during the Millennium Drought that helped to drought-proof their water supplies and increase resilience in anticipation of a changing climate. The goals of this delegation were to show California water leaders first-hand the drought and climate response initiatives that Adelaide and Melbourne employed and to focus on transferring and implementing viable approaches in California. This article highlights the key lessons learned from this research and provides recommendations for how Southern California can best approach transferring these lessons

Factors Associated with Persistence with Teriparatide Therapy: Results from the DANCE Observational Study

Purpose. Determine patient-reported reasons for discontinuation with teriparatide. Methods. Patients taking teriparatide in a multicenter, prospective, and observational study were given three questionnaires: baseline, follow-up questionnaire 1 (QF1, 2 to 6 months), and follow-up questionnaire 2 (QF2, 12 months). Discontinuation reported at QF1 and QF2 was defined as “early” and “late,” respectively, and remaining patients were considered persistent. Cochran-Armitage trend test was used to identify factors associated with discontinuation. Results. Side effects, concern about improper use, injection difficulties, and several patient-perceived physician issues were associated with early discontinuation. Low patient-perceived importance of continuing treatment, side effects, difficulty paying, and low patient-perceived physician knowledge were associated with late discontinuation. The most common specific reasons selected for discontinuing treatment were “concerns about treatment outweighing the benefits” (n = 53) and “difficulty paying” (n = 47). Conclusions. Persistence with teriparatide is dependent on managing side effects, addressing financial challenges, proper training, and obtaining support from the healthcare provider

Effect of daily chlorhexidine bathing on hospital-acquired infection

BACKGROUND Results of previous single-center, observational studies suggest that daily bathing of patients with chlorhexidine may prevent hospital-acquired bloodstream infections and the acquisition of multidrug-resistant organisms (MDROs). METHODS We conducted a multicenter, cluster-randomized, nonblinded crossover trial to evaluate the effect of daily bathing with chlorhexidine-impregnated washcloths on the acquisition of MDROs and the incidence of hospital-acquired bloodstream infections. Nine intensive care and bone marrow transplantation units in six hospitals were randomly assigned to bathe patients either with no-rinse 2% chlorhexidine– impregnated washcloths or with nonantimicrobial washcloths for a 6-month period, exchanged for the alternate product during the subsequent 6 months. The incidence rates of acquisition of MDROs and the rates of hospital-acquired bloodstream infections were compared between the two periods by means of Poisson regression analysis. RESULTS A total of 7727 patients were enrolled during the study. The overall rate of MDRO acquisition was 5.10 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P=0.03), the equivalent of a 23% lower rate with chlorhexidine bathing. The overall rate of hospital-acquired bloodstream infections was 4.78 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P=0.007), a 28% lower rate with chlorhexidine-impregnated washcloths. No serious skin reactions were noted during either study period. CONCLUSIONS Daily bathing with chlorhexidine-impregnated washcloths significantly reduced the risks of acquisition of MDROs and development of hospital-acquired bloodstream infections. (Funded by the Centers for Disease Control and Prevention and Sage Products; ClinicalTrials.gov number, NCT00502476.

Use of Medicare claims to rank hospitals by surgical site infection risk following coronary artery bypass graft surgery

ObjectiveTo evaluate whether longitudinal insurer claims data allow reliable identification of elevated hospital surgical site infection (SSI) rates.DesignWe conducted a retrospective cohort study of Medicare beneficiaries who underwent coronary artery bypass grafting (CABG) in US hospitals performing at least 80 procedures in 2005. Hospitals were assigned to deciles by using case mix-adjusted probabilities of having an SSI-related inpatient or outpatient claim code within 60 days of surgery. We then reviewed medical records of randomly selected patients to assess whether chart-confirmed SSI risk was higher in hospitals in the worst deciles compared with the best deciles.ParticipantsFee-for-service Medicare beneficiaries who underwent CABG in these hospitals in 2005.ResultsWe evaluated 114,673 patients who underwent CABG in 671 hospitals. In the best decile, 7.8% (958/12,307) of patients had an SSI-related code, compared with 24.8% (2,747/11,068) in the worst decile ([Formula: see text]). Medical record review confirmed SSI in 40% (388/980) of those with SSI-related codes. In the best decile, the chart-confirmed annual SSI rate was 3.2%, compared with 9.4% in the worst decile, with an adjusted odds ratio of SSI of 2.7 (confidence interval, 2.2-3.3; [Formula: see text]) for CABG performed in a worst-decile hospital compared with a best-decile hospital.ConclusionsClaims data can identify groups of hospitals with unusually high or low post-CABG SSI rates. Assessment of claims is more reproducible and efficient than current surveillance methods. This example of secondary use of routinely recorded electronic health information to assess quality of care can identify hospitals that may benefit from prevention programs

Cost Effectiveness of Internet Interventions: Review and Recommendations

10.1007/s12160-009-9131-6Annals of Behavioral Medicine38140-45ABME