Adaptation reconceptualized: "retrofitting" ongoing organizational activities with essential elements of evidence-based interventions

http://deepblue.lib.umich.edu/bitstream/2027.42/134544/1/13012_2015_Article_948.pd

The Influence of Setting on Care Coordination for Childhood Asthma

Asthma affects 7.1 million children in the United States, disproportionately burdening African American and Latino children. Barriers to asthma control include insufficient patient education and fragmented care. Care coordination represents a compelling approach to improve quality of care and address disparities in asthma. The sites of The Merck Childhood Asthma Network Care Coordination Programs implemented different models of care coordination to suit specific settings—school district, clinic or health care system, and community—and organizational structures. A variety of qualitative data sources were analyzed to determine the role setting played in the manifestation of care coordination at each site. There were inherent strengths and challenges of implementing care coordination in each of the settings, and each site used unique strategies to deliver their programs. The relationship between the lead implementing unit and entities that provided (1) access to the priority population and (2) clinical services to program participants played a critical role in the structure of the programs. The level of support and infrastructure provided by these entities to the lead implementing unit influenced how participants were identified and how asthma care coordinators were integrated into the clinical care team.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113262/1/MCAN_Settings_Manuscript_20150708.docxhttp://deepblue.lib.umich.edu/bitstream/2027.42/113262/3/MCAN_Settings_Manuscript_20150708.pdfDescription of MCAN_Settings_Manuscript_20150708.docx : Main ArticleDescription of MCAN_Settings_Manuscript_20150708.pdf : Main Article with Title Page and Abstrac

Heterogeneity of Childhood Asthma Among Hispanic Children: Puerto Rican Children Bear a Disproportionate Burden

OBJECTIVES. To estimate differences in asthma prevalence among Hispanic subgroups and non-Hispanic children living in the United States and to explore the association between these differences and risk factors. METHODS. Weighted logistic regression analyses of merged 1997 to 2001 National Health Interview Survey data were used to estimate the prevalence of asthma diagnosis and asthma attacks in a sample of 46511 children (age: 2–17 years) living in the 50 states and the District of Columbia. RESULTS. Puerto Rican children had the highest prevalence of lifetime asthma (26%) and recent asthma attacks (12%), compared with non-Hispanic black children (16% and 7%, respectively), non-Hispanic white children (13% and 6%, respectively), and Mexican children (10% and 4%, respectively). Adjustment for asthma risk factors did not change these comparisons appreciably. Compared with non-Hispanic white children, the adjusted odds ratios (ORs) for a lifetime asthma diagnosis were 2.33 (95% confidence interval [CI]: 1.90–2.84) for Puerto Rican children, 1.16 (95% CI: 1.04–1.29) for non-Hispanic black children, and 0.90 (95% CI: 0.79–1.03) for Mexican children. Birthplace influenced the association between ethnicity and lifetime asthma diagnosis differently for Puerto Rican and Mexican children. Compared with United States-born non-Hispanic white children with United States-born parents, the adjusted ORs were 1.95 (95% CI: 1.48–2.57) for Puerto Rican children in families with the child and parent(s) born in the 50 states/District of Columbia and 2.50 (95% CI: 1.51–4.13) for island-born Puerto Rican children with island-born parents. The corresponding adjusted ORs for Mexican children were 1.05 (95% CI: 0.90–1.22) for families born in the 50 states/District of Columbia and 0.43 (95% CI: 0.29–0.64) for those born in Mexico. The results were similar for recent asthma attacks. CONCLUSIONS. The appreciably higher asthma morbidity rates experienced by Puerto Rican children cannot be explained by sociodemographic and other risk factors measured in the National Health Interview Survey. The heterogeneity of asthma among Hispanic subgroups should be considered in developing effective public health prevention and intervention strategies

Reputación corporativa y ventaja competitiva en una empresa privada de telecomunicaciones del distrito de Ate, periodo 2021

La presente investigación tuvo como objetivo determinar si existe relación entre la reputación corporativa y ventaja competitiva en una empresa privada de telecomunicaciones del distrito de Ate, año 2021. Esta investigación es de tipo cuantitativo, correlacional, no experimental y de corte transversal; con una muestra inicial calculada de 368 colaboradores, donde se lograron realizar 328 encuestas, descartando 51 de ellas con la pregunta control, quedando como final 277. Se utilizó como instrumento encuestas de tipo escala de Likert, relacionadas con las dimensiones de la variable reputación corporativa: atractivo emocional, servicios, capacidad administrativa y responsabilidad social, y para la variable ventaja competitiva: liderazgo en costos, enfoque y diferenciación. Para la estadística del estudio, se utilizó la herramienta SPSS, versión 25. Asimismo, se utilizó el coeficiente de Rho de Spearman para ambas variables, por la cual se obtuvo una prueba de normalidad de 0.080 para la reputación corporativa y 0.129 para la ventaja competitiva. Con los resultados se determinó que existe una relación positiva y directa entre la reputación corporativa y la ventaja competitiva, con un Rho de Spearman de 0.826 y un p valor de 0.000, denotando una relación entre las variables de la investigación y, logrando así determinar el objetivo general de la investigación.The objective of this investigation was to determine if there is a relationship between corporate reputation and competitive advantage in a private telecommunications company in the Ate district, in 2021. This investigation is quantitative, correlational, non-experimental, and cross-sectional; with an initial sample of 368 employees, where 328 surveys were carried out, discarding 51 of them with the control question, leaving 277 as the final one. Likert scale surveys were used as an instrument, related to the dimensions of the corporate reputation variable: emotional attractiveness, services, administrative capacity and social responsibility, and for the variable competitive advantage: cost leadership, focus and differentiation. For the statistics of the study, the SPSS tool, version 25, was used. Likewise, Spearman's Rho coefficient was used for both variables, for which a normality test of 0.080 was obtained for corporate reputation and 0.129 for competitive advantage. With the results, it was determined that there is a positive and direct relationship between corporate reputation and competitive advantage, with a Spearman's Rho of 0.826 and a p value of 0.000, denoting a relationship between the research variables and thus determining the overall objective of the research

Asthma mortality in U.S. Hispanics of Mexican, Puerto Rican and Cuban Heritage, 1990-1995

We used national vital statistics data for 1990 through 1995 to examine both national and regional age-adjusted asthma mortality rates for U.S. Hispanics of Mexican, Cuban, and Puerto Rican heritage, as well as for non-Hispanic whites and non-Hispanic blacks. Nationally, Puerto Ricans had an age-adjusted annual asthma mortality rate of 40.9 per million, followed by Cuban-Americans (15.8 per million) and Mexican-Americans (9.2 per million). In comparison, non-Hispanic whites had an age-adjusted annual asthma mortality rate of 14.7 per million and non-Hispanic blacks had a rate of 38.1 per million. Age-adjusted asthma mortality for Puerto Ricans was highest in the Northeast (47.8 per million); this region accounted for 81% of all asthma deaths among Puerto Ricans in the United States. In the U.S., Puerto Ricans had the highest asthma mortality rates among Hispanics, followed by Cuban-Americans and Mexican-Americans. In addition, among Hispanic national groups, mortality rates were consistently higher in the Northeast than the Midwest, South, or West regions. These results further support that Hispanics do not represent a uniform, discrete group in terms of health outcomes, and that further public health research and interventions should take Hispanic national origin into account. Homa DM, Mannino DM, Lara M. Asthma mortality in U.S. Hispanics of Mexican, Puerto Rican, and Cuban heritage, 1990–1995

Impact of a school-level intervention on leisure-time physical activity levels on school grounds in under-resourced school districts

Even the best school physical education programs fall short of providing enough physical activity (PA) to meet students’ PA guidelines thus increasing PA at other times throughout the school day could help students meet recommended PA levels. Unstructured leisure-time periods during the school day represent an opportunity to promote PA, particularly among students in underserved school districts. Between 2014 and 2018, we partnered with 14 elementary and 5 secondary schools in low-income Latino communities to increase students’ leisure time moderate to vigorous physical activity (MVPA). Schools received consultation and technical assistance on their wellness policy, and some created wellness committees. Schools selected 1–2 PA/nutrition promotion activities for the academic year. Following the System for Observing Play and Leisure Activity in Youth protocol, we conducted a pre- vs. post- analysis of observations of school time student PA (levels of MVPA, energy expenditure, proportion of areas in which games and sports were prominent) in 4936 pre-intervention play areas and 4404 post-intervention areas before school, during lunch recess, and after school. We utilized linear and logistic regression analyses to test pre/post changes in these dependent variables using school area characteristics, period of observation, and temperature as covariates. Following our intervention, MVPA levels before school, during lunch recess, and after school increased significantly from 19.8% at baseline to 25.6% among elementary girls and from 25.4% to 33.2% among elementary boys. Decomposition of these effects suggested that the benefits were partially mediated by increased adult playground supervision. We did not observe any significant changes in PA levels among secondary school girls or boys. Our school-level intervention aimed at promoting PA was associated with modest but meaningful increases in leisure-time PA among elementary, but not secondary, school students. The effects were attributable in part to increased adult supervision on the playground

Reconsidering reviews: the role of scoping reviews in digital medicine and pediatrics

Digital health is a rapidly developing field which is positioned to transform the manner in which healthcare is delivered, especially amongst adolescents and young adults. In order to assess the efficacy of novel medical devices, clinicians and researchers often turn to the literature for guidance. Randomized control trials and the systematic reviews and meta-analyses that they inform are considered to be at the top of the evidence hierarchy. While they are excellent tools to identify and to summarize the best available evidence to answer a specific research question, they are poorly equipped to provide a more expansive understanding of the body of relevant literature in a timely manner. In this letter we discuss the utility of the scoping review, an underutilized style of academic writing designed to map key concepts in a body of literature. This method is ideal when reporting on the fast-paced field of digital medicine, as it allows for rapid synthesis of the available literature