It is Now Up to the Courts: Forensic Science in Criminal Courts: Ensuring Scientific Validity of Feature-Comparison Methods

It is Now Up to the Courts: Forensic Science in Criminal Courts: Ensuring Scientific Validity of Feature-Comparison Method

Discover Wellness: A Worksite Wellness Program for Higher Education

Sixty percent of adults in the United States suffer from chronic disease. Worksite wellness programs that target at-risk populations have positive health benefits. Discover Wellness: Find a Healthier You (DW) is a worksite wellness program intended to improve the higher education employee health by providing an opportunity for participants to learn and practice healthy behaviors. The purpose of this study was to evaluate DW program impact on employee behavior change to reduce chronic disease risk. This study employed a pretest-posttest quasi-experimental design that assessed self-efficacy and health behaviors of employees of a state university in the northeast United States. Participants experienced significant improvement in stress (t23 = -31.602, p < 0.001), nutrition (t21 = -36.313, p < 0.001), physical activity (t22 = -34.380, p < 0.001), and sleep (t23 = -18.450, p < 0.001). Additionally, anecdotes from participants revealed themes of comradery and reflection on health behaviors

Primary care physicians' use of the 5 A's to counsel adolescents about alcohol use

Background: Despite reductions in underage drinking in the United States since the 1980s, adolescent alcohol use remains a significant burden to public health. Multiple clinical guidelines recommend screening, brief intervention, and referral to treatment (SBIRT) for adult alcohol misuse in primary care, but there is no consensus about this practice with adolescents. Furthermore, it is unknown to what degree physicians use the 5 A's model in addressing adolescent alcohol use. Objectives: To review the literature regarding the efficacy of screening and brief intervention for adolescent alcohol use in primary care settings and to use secondary data to describe physicians' use of the 5 A's (Ask, Advise, Assess, Assist, Arrange) for adolescent alcohol use in primary care. Methods: For the systematic review, I searched the MEDLINE and CINAHL databases through February 2015 for experimental or observational studies examining both screening and brief intervention with average-risk 11-18 year-olds in primary care clinics. I abstracted data and assessed the quality of each study. This literature review informed the secondary data analysis, in which we audio recorded 540 adolescent well and chronic care visits with 49 primary care physicians. We identified visits in which alcohol was discussed, and conversations were analyzed for use of the 5 A's. Results: Four articles were included in the systematic review, two rated "fair" in overall quality, and two "poor." Only one intervention reduced adolescent alcohol use; two found increases in drinking behavior and one found no effect. In the audio-recorded visits, physicians and patients discussed alcohol in 61% of visits. In 64% of these, physicians used one or more of the 5 A's. In none of the visits were all 5 A's used. Physicians were most likely to Ask and Advise about alcohol use. Few Assessed, Assisted, and Arranged. Asking drinkers clear, non-leading questions was associated with increased likelihood of reporting alcohol use to physicians. Conclusions: Evidence about the use of SBIRT for adolescent alcohol use in primary care is unclear and of poor to fair quality. Few physicians addressed all of the 5 A's when counseling adolescents about alcohol use. Effective methods are needed to increase the quality of physician screening and counseling for underage drinking. Further examination of such interventions and systematic review of their use in other clinical settings or among higher-risk populations may be warranted in order to determine how to best use clinical time and resources to reduce alcohol-related morbidity and mortality among adolescents.Master of Public Healt