Ebola: Working Through Fear

Ebola: Working Through Fea

The Importance of Early Brain Development

N/

Perinatal Health and School Trajectories

Perinatal Health and School Trajectorie

Addressing Childhood Obesity in Georgia: Past, Present, and Future

The Trust for America\u27s Health ranks Georgia 17th (16.5%) in the nation for childhood obesity prevalence among youth aged 10-17 years. Georgia has a long history of addressing childhood obesity at the state, regional, and local levels. This report outlines the historical efforts in childhood obesity in Georgia from the mid-1990’s to the present, summarizes current childhood obesity prevention and management strategies, and provides childhood obesity-related data relevant to the current strategies

Addressing Childhood Obesity in Georgia: Past, Present, and Future

Background: The Trust for America\u27s Health ranks Georgia 17th (16.5%) in the nation for childhood obesity prevalence among youth aged 10-17 years. Georgia has a long history of addressing childhood obesity at the state, regional, and local levels. This report outlines the historical efforts in childhood obesity in Georgia from the mid-1990’s to the present, summarizes current childhood obesity prevention and management strategies, and provides childhood obesity-related data relevant to the current strategies. Methods: Childhood obesity-related efforts in Georgia from 1996 to the present are documented, along with how these efforts led to the creation of Georgia Shape. The Georgia Shape Childhood Obesity Prevention Initiative, created by Governor Nathan Deal in 2012, established a statewide, 10-year plan of action to address childhood obesity. It convenes more than 125 governmental, philanthropic, academic and business community partners quarterly to work towards reducing the incidence of childhood obesity and overweight in Georgia. Evidence supporting the Georgia Shape objectives is described, along with current program and policy efforts that may allow achievement of its goal of having 69% of Georgia’s children in a healthy weight range by the year 2023. Results: Georgia\u27s obesity rate for low-income, 2- to 4-year old children has decreased. Over the 2013-2015 school years, there has been no increase in BMI at the population level among school age children and youth, and the percentage of boys and girls with increased aerobic capacity has improved. Future efforts should focus on middle and high school students; engaging and educating parents of young children; and state policies that support safe, daily physical activity and access to healthy, local food. Conclusions: A long history of childhood obesity activities in Georgia has led to a strategic plan of action, with contributions from many stakeholders. These efforts aim to reduce the prevalence of childhood overweight and obesity in Georgia over 10 years

Integrating food and language nutrition to reach Georgia’s children in early care and education environments

Background: Educational attainment and health are mutually reinforcing outcomes. Good health supports children in the achievement of academic milestones, such as grade-level reading, and is associated with higher socio-economic status, longer life expectancy, and lower lifelong chronic disease. Improving health outcomes and increasing the potential for high educational attainment is necessary for reducing disparities, improving population health, and reducing morbidity. Early childhood and associated settings present opportunities to address lifelong health. Methods: To guide the development of programs to reach large numbers of children, we reviewed the literature associated with interventions during early childhood to promote healthy food consumption patterns and language development—“food and language nutrition.” Results: Identified in the systematic review were 12 articles. A recurrent theme was the social-ecological model, widely used in the studies identified through the literature review. Conclusions: The findings suggest a theoretical framework and key considerations that could guide the development of integrated interventions to improve food and language nutrition. With these findings, the authors propose a conceptual model and outline a public health program to address food and language nutrition together in early care settings in the state of Georgia, with the potential for application in other geographic areas

Drivers of potentially avoidable emergency admissions in Ireland: an ecological analysis

Background: Many emergency admissions are deemed to be potentially avoidable in a well-performing health system. Objective: To measure the impact of population and health system factors on county-level variation in potentially avoidable emergency admissions in Ireland over the period 2014–2016. Methods: Admissions data were used to calculate 2014–2016 age-adjusted emergency admission rates for selected conditions by county of residence. Negative binomial regression was used to identify which a priori factors were significantly associated with emergency admissions for these conditions and whether these factors were also associated with total/other emergency admissions. Standardised incidence rate ratios (IRRs) associated with a 1 SD change in risk factors were reported. Results: Nationally, potentially avoidable emergency admissions for the period 2014–2016 (266 395) accounted for 22% of all emergency admissions. Of the population factors, a 1 SD change in the county-level unemployment rate was associated with a 24% higher rate of potentially avoidable emergency admissions (IRR: 1.24; 95% CI 1.04 to 1.41). Significant health system factors included emergency admissions with length of stay equal to 1 day (IRR: 1.20; 95% CI 1.11 to 1.30) and private health insurance coverage (IRR: 0.92; 95% CI 0.89 to 0.96). The full model accounted for 50% of unexplained variation in potentially avoidable emergency admissions in each county. Similar results were found across total/other emergency admissions. Conclusion: The results suggest potentially avoidable emergency admissions and total/other emergency admissions are primarily driven by socioeconomic conditions, hospital admission policy and private health insurance coverage. The distinction between potentially avoidable and all other emergency admissions may not be as useful as previously believed when attempting to identify the causes of regional variation in emergency admission rates

An interrupted time-series analysis of the impact of emergency department reconfiguration on regional emergency department trolley numbers in Ireland from 2005 to 2015

Objectives: To understand the impact of emergency department (ED) reconfiguration on the number of patients waiting for hospital beds on trolleys in the remaining EDs in four geographical regions in Ireland using time-series analysis. Setting: EDs in four Irish regions; the West, North-East, South and Mid-West from 2005 to 2015. Participants: All patients counted as waiting on trolleys in an ED for a hospital bed in the study hospitals from 2005 to 2015. Intervention: The system intervention was the reconfiguration of ED services, as determined by the Department of Health and Health Service Executive. The timing of these interventions varied depending on the hospital and region in question. Results: Three of the four regions studied experienced a significant change in ED trolley numbers in the 12-month post-ED reconfiguration. The trend ratio before and after the intervention for these regions was as follows: North-East incidence rate ratio (IRR) 2.85 (95% CI 2.04 to 3.99, p<0.001), South IRR 0.68 (95% CI 0.51 to 0.89, p=0.006) and the Mid-West IRR 0.03 (95% 1.03 to 2.03, p=0.03). Two of these regions, the South and the Mid-West, displayed a convergence between the observed and expected trolley numbers in the 12-month post-reconfiguration. The North-East showed a much steeper increase, one that extended beyond the 12-month period post-ED reconfiguration. Conclusions: Findings suggest that the impacts of ED reconfiguration on regional level ED trolley trends were either non-significant or caused a short-term shock which converged on the pre-reconfiguration trend over the following 12 months. However, the North-East is identified as an exception due to increased pressures in one regional hospital, which caused a change in trend beyond the 12-month post reconfiguration

Case fatality ratios for serious emergency conditions in the Republic of Ireland: a longitudinal investigation of trends over the period 2002-2014 using joinpoint analysis

Background: In the past decade, the Republic of Ireland has undertaken significant reconfiguration programmes to improve emergency services. During this time the public healthcare system experienced a large real decrease in resources. This study assesses national and regional population outcomes over the period 2002–2014, and whether changes coincide with system reconfiguration and the financial restrictions imposed by the 2008 recession. Methods: Case fatality ratios (CFRs) were constructed for emergency conditions for 2002–2014. Total emergency conditions and individual condition trends were analysed nationally using joinpoint analysis. National results informed the investigation of trends at a regional and county level using an inverse standard error weighted generalised linear model with a log link to construct funnel plots. County-level CFRs were compared for the first and last 3 years of the period to further investigate the changes to county results over the 13 year period, specifically in comparison to the national-level CFR. Results: Nationally, there was an annual fall in CFRs (2.1%). The decline was faster from 2002 to 2007 (annual percentage change = − 3.4; 95% CI-4.4, − 2.4), compared to 2007–2014 (annual percentage change = − 1.2; 95% CI -1.9, − 0.5). The South-East had a lower rate of decrease and the West had a higher rate. Cross sectional analysis of two periods (2002–2004 and 2012–2014) showed high consistency in the counties performance relative to the national CFR in both periods. Conclusion: Change in the national trend coincided with the onset of economic stress on the public health system. Attributing the decline in CFR improvement to economic factors is weakened by the uneven nature of the trend change. No distinct pattern of change was identified among regions which underwent substantial reconfiguration of emergency services

The Effects of Volume Versus Intensity of Long-Term Voluntary Exercise on Physiology and Behavior in C57/Bl6 Mice

Cardiovascular exercise (CVE) is associated with healthy aging and reduced risk of disease in humans, with similar benefits seen in animals. Most rodent studies, however, have used shorter intervention periods of a few weeks to a few months, begging questions as to the effects of longer-term, or even life-long, exercise. Additionally, most animal studies have utilized a single exercise treatment group – usually unlimited running wheel access – resulting in large volumes of exercise that are not clinically relevant. It is therefore incumbent to determine the physiological and cognitive/behavioral effects of a range of exercise intensities and volumes over a long-term period that model a lifelong commitment to CVE. In the current study, C57/Bl6 mice remained sedentary or were allowed either 1, 3, or 12 h of access to a running wheel per day, 5 days/weeks, beginning at 3.5–4 months of age. Following an eight-month intervention period, animals underwent a battery of behavioral testing, then euthanized and blood and tissue were collected. Longer access to a running wheel resulted in greater volume and higher running speed, but more breaks in running. All exercise groups showed similarly reduced body weight, increased muscle mass, improved motor function on the rotarod, and reduced anxiety in the open field. While all exercise groups showed increased food intake, this was greatest in the 12 h group but did not differ between 1 h and 3 h mice. While exercise dose-dependently increased working memory performance in the y-maze, the 1 h and 12 h groups showed the largest changes in the mass of many organs, as well as alterations in several behaviors including social interaction, novel object recognition, and Barnes maze performance. These findings suggest that long-term exercise has widespread effects on physiology, behavior, and cognition, which vary by “dose” and measure, and that even relatively small amounts of daily exercise can provide benefits