A Multisite Evaluation of Pediatric Asthma-Related Treatment in Accordance to the 2007 National Heart, Lung and Blood Institute Expert Panel Report — 3 Guidelines

Background: To determine if Georgia-based healthcare providers who received continuing education on pediatric asthma as described by 2007 National Heart, Lung, and Blood Institute Expert Panel Report – 3 guidelines demonstrated improvements in asthma-related treatment. Methods: We used a multi-site, cross-sectional design. Data were collected via surveys administered to healthcare providers and via randomized medical chart abstractions. Chart abstraction occurred at 12 months prior to intervention (n = 149); one month post-intervention (n = 208); and three months post-intervention (n = 123). Results: Substantial improvements were observed among the providers who used pre/post bronchodilator spirometry (5% at baseline, 12% at one month, and 19% at three months), and there was a significant increase in the number of patients being advised to improve conditions at home or school to avoid asthma triggers (9% at baseline, 43% at one month, and 37% at three months). However, prescription of preventive medications and patients being taught proper medication/spacer technique by providers decreased from baseline to three-months (69% vs 55% and 41% vs 27%, respectively). Providers’ self-reported barriers and patient load were consistently associated with poorer treatment outcomes. Healthcare providers who received continuing education on NHLBI - EPR 3 guidelines demonstrated an increase in spirometry use and in advising patients on improving home and school conditions. While these findings are useful, provider-reported barriers such as time, organizational, and insurance barriers prevent providers from effectively systematically incorporating all of the EPR 3 guidelines. Conclusions: Internal efforts to address clinical barriers combined with continued education may result in improvements in pediatric asthma-related treatment outcomes

The Effect of a Nutrition Intervention on Parents Living in a Rural Georgia Community

Background: Childhood obesity is a concern for public health organizations. Nearly one in four children living in rural communities are obese, and children living in rural Georgia communities are no exception. For rural communities, prevention efforts are needed to address challenges to reducing childhood obesity. The objective of the present effort was to increase the knowledge of parents in a rural community of the benefits of fruit and vegetable consumption and other healthy options. Methods: The “We Can Energize Families” curriculum, developed by the National Heart, Lung, and Blood Institute was implemented in a rural Georgia community. Pender’s Health Promotion Model, which encompasses the theory of persons taking a self-management approach in their health lifestyle, provided the framework. Participating in the study were 21 parents who had at least one child between the ages of 9-13. Outcome measures, adapted from the 16 measures relevant to the original “We Can Energize Families” objectives, were assessed, incorporating measures related to energy balance, portion size, healthy eating, physical activity, and screen time. Paired-T tests were used to evaluate increases in parents’ knowledge of the benefits of consumption of fruits and vegetables. Statistical significance was determined at p \u3c 0.05. Results: There were improvements in 9 of the 16 measures, including knowledge of research and energy balance; attitudes regarding energy balance, portion size, and healthy eating; and behaviors regarding healthy eating, healthy food, physical activity, and screen time. However, improvements were not evident for behaviors related to portion size, knowledge or attitudes pertaining to physical activity, or attitudes regarding screen time. Conclusions: Particularly in rural communities, parents can contribute to prevention of childhood obesity. The present results demonstrate increases in knowledge of the importance of eating nutrient-dense foods and incorporating fruits and vegetables into daily diets

Estimating the Number of Heterosexual Persons in the United States to Calculate National Rates of HIV Infection

<div><p>Background</p><p>This study estimated the proportions and numbers of heterosexuals in the United States (U.S.) to calculate rates of heterosexually acquired human immunodeficiency virus (HIV) infection. Quantifying the burden of disease can inform effective prevention planning and resource allocation.</p><p>Methods</p><p>Heterosexuals were defined as males and females who ever had sex with an opposite-sex partner and excluded those with other HIV risks: persons who ever injected drugs and males who ever had sex with another man. We conducted meta-analysis using data from 3 national probability surveys that measured lifetime (ever) sexual activity and injection drug use among persons aged 15 years and older to estimate the proportion of heterosexuals in the United States population. We then applied the proportion of heterosexual persons to census data to produce population size estimates. National HIV infection rates among heterosexuals were calculated using surveillance data (cases attributable to heterosexual contact) in the numerators and the heterosexual population size estimates in the denominators.</p><p>Results</p><p>Adult and adolescent heterosexuals comprised an estimated 86.7% (95% confidence interval: 84.1%-89.3%) of the U.S. population. The estimate for males was 84.1% (CI: 81.2%-86.9%) and for females was 89.4% (95% CI: 86.9%-91.8%). The HIV diagnosis rate for 2013 was 5.2 per 100,000 heterosexuals and the rate of persons living with diagnosed HIV infection in 2012was 104 per 100,000 heterosexuals aged 13 years or older. Rates of HIV infection were >20 times as high among black heterosexuals compared to white heterosexuals, indicating considerable disparity. Rates among heterosexual men demonstrated higher disparities than overall population rates for men.</p><p>Conclusions</p><p>The best available data must be used to guide decision-making for HIV prevention. HIV rates among heterosexuals in the U.S. are important additions to cost effectiveness and other data used to make critical decisions about resources for prevention of HIV infection.</p></div

Adult and adolescent heterosexuals living with diagnosed HIV infection- United States, 2012.

<p>*Number of cases attributable to heterosexual contact, statistically adjusted to account for reporting delays and missing risk factor information, but not for incomplete reporting.</p><p>^†Per 100,000 heterosexuals.</p><p>^§ Hispanics/Latinos may be of any race.</p><p>^¶ Other race includes American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, unknown race/ethnicity, and multiple races.</p><p>** Relative standard error >30% for meta-analysis estimate of the population proportion heterosexual for this group.</p><p>Note. Data include persons age 13 years and older with a diagnosis of HIV infection regardless of stage of disease at diagnosis. CI = confidence interval</p

Diagnoses of HIV infection among adult and adolescent heterosexuals, by selected characteristics—United States, 2013.

<p>*Number of cases attributable to heterosexual contact, statistically adjusted to account for reporting delays and missing risk factor information, but not for incomplete reporting.</p><p>^†Per 100,000 heterosexuals.</p><p>^§ Hispanics/Latinos may be of any race.</p><p>^¶ Other race includes American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, unknown race/ethnicity, and multiple races.</p><p>** Relative standard error >30% for meta-analysis estimate of the population proportion heterosexual for this group.</p><p>Note. Data include persons age 13 years and older with a diagnosis of HIV infection regardless of stage of disease at diagnosis. CI = confidence interval</p

Estimated proportion of heterosexual persons in the United States, by sex, race/ethnicity, and age group--meta-analysis of 3 national surveys^*.

<p>*Surveys used in the meta-analysis: General Social Survey (2010); NHANES = National Health and Nutrition Examination Survey (2009–2010); NSFG = National Survey of Family Growth (2006–2010). See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133543#pone.0133543.t001" target="_blank">Table 1</a> for description of each survey.</p><p>^† Relative Standard Error (RSE) = 30–49%.</p><p>CI = confidence interval.</p

Estimated proportion of heterosexual persons in the United States, by survey and combined by meta-analysis.

<p>* I² = 81.1; Q = 10.6, p = 0.005</p><p>^† I² = 88.1; Q = 16.8, p <0.001</p><p>^§ I² = 91.6; Q = 23.7, p < 0.001. CI = confidence interval. GSS = General Social Survey (2010); NHANES = National Health and Nutrition Examination Survey (2009–2010); NSFG = National Survey of Family Growth (2006–2010). See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133543#pone.0133543.t001" target="_blank">Table 1</a> for description of each survey.</p><p>Estimated proportion of heterosexual persons in the United States, by survey and combined by meta-analysis.</p

Description of 3 national household surveys of the non-institutionalized population of the United States used in meta-analysis.

<p>* Interview method is for the sexual and drug use behavior questions.</p><p>^† Question wording includes all questions used to determine heterosexual (ever had sex with opposite sex partner, did not ever inject drugs, did not ever have sex with same-sex partner [males]). Note that for NSFG the questions on injection drug use were not used.</p><p>^§ Analyses were limited to those aged 18–69 years to match the upper age limit of NHANES.</p><p>^¶ Data were available for respondents aged 14–69 years. Analyses were limited to those aged 15–69 years to match the lower age limit of NSFG.</p><p>CAPI = Computer-Assisted Personal Interview; ACASI = Audio, Computer-Assisted Self Interview</p