The Diabetes Primary Prevention Initiative interventions focus area: A case study and recommendations

Background: In 2005, CDC began the Diabetes Primary Prevention Initiative Interventions Focus Area (DPPI-IFA), which funded fıve state Diabetes Prevention and Control Programs (DPCPs) to translate diabetes primary prevention trials into real-world settings by developing and implementing a framework for state-level diabetes primary prevention. Purpose: The purpose of this case study, conducted in 2007, was to describe DPPI-IFA implementation, including facilitators and challenges to the initiative. Methods: Case studies of the fıve DPCPs in the DPPI-IFA involving site visits with key informant interviews of state staff and partners and archival record collection. Results: Partners recruited for DPPI-IFA activities included local or state public health agencies (three of fıve DPCPs); regional or state nonprofıt organizations (fıve DPCPs); businesses or employers (three DPCPs); and healthcare organizations (four DPCPs). The DPCPs implemented a variety of interventions in three main domains: diabetes primary prevention and prediabetes awareness, screening activities and lifestyle interventions, and prediabetes-related health policy efforts. Preliminary outcomes are described at the individual and organization/partnership levels. Results suggest the importance of utilizing preexisting partnerships to extend work into diabetes prevention, providing even small amounts of funding to partners, and prior program planning for diabetes prevention. Challenges for the DPPI-IFA included recruiting participants, establishing links with providers to obtain diagnostic testing for people screened for prediabetes, and offering a lifestyle intervention. Conclusions: The DPPI-IFA represents a unique effort by state public health programs in the translation of diabetes primary prevention trials into real-world settings. The experiences of the DPPI-IFA programs offer valuable lessons for future community-based diabetes prevention initiatives, especially regarding the need to strengthen clinical–community partnerships for referral of people with prediabetes to evidence-based lifestyle programs

Age-Related Disparities in Trauma Center Access for Severe Head Injuries Following the Release of the Updated Field Triage Guidelines

Objective: In 2006, the American College of Surgeons’ Committee on Trauma and the Center for Disease Control released field triage guidelines with special consideration for older adults. Additional considerations for direct transport to a Level I or II trauma center (TC) were added in 2011, reflecting perceived undertriage to TCs for older adults. We examined whether age-based disparities in TC care for severe head injury decreased following introduction of the 2011 revisions. Methods: A pre-post design analyzing the 2009 and 2012 Healthcare Cost and Utilization Project State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) with multivariable logistic regressions considered changes in (1) the trauma designation of the emergency department where treatment was initiated and (2) transfer to a TC following initial treatment at a non-TC. Results: Compared with adults aged 18–44 years, after multivariable adjustment, in both years TC care was less likely for adults aged 45–64 years (OR: 0.76 in 2009 and 0.74 in 2012), aged 65–84 years (OR: 0.61 and 0.59), and aged 85+ years (OR: 0.53 and 0.56). Between 2009 and 2012, the likelihood of TC care increased for all age groups, with the largest increase among those aged 85+ years (OR = 1.18), which was statistically different (p = .02) from the increase among adults aged 18–44 years (OR = 1.12). The analysis of transfers yielded similar results. Conclusions: Although patterns of increased TC treatment for all groups with severe head trauma indicate improvements, age-based disparities persisted

Assessing the Nation's Progress Toward Elimination of Disparities in Health Care

The Agency for Healthcare Research and Quality submitted the first annual National Healthcare Disparities Report to Congress in December, 2003. This first report will provide a snapshot of the state of racial, ethnic, and socioeconomic disparities in access and quality of care in America. It examines disparities in the general population and within the Agency’s priority populations. While focused on extant data, the first report will form the foundation for future versions, which examines causes of disparities and shape solutions to the problem. As patient advocates and agents of change, primary care physicians play a critical role in efforts to eliminate disparities in health care. Continuing participation by primary care physicians in the development and refinement of the National Healthcare Disparities Report is essential.https://onlinelibrary.wiley.com/doi/full/10.1111/j.1525-1497.2004.30221.

\u3csup\u3e1\u3c/sup\u3eH, \u3csup\u3e15\u3c/sup\u3eN, \u3csup\u3e13\u3c/sup\u3eC and \u3csup\u3e13\u3c/sup\u3eCO Assignments and Secondary Structure Determination of Basic Fibroblast Growth Factor Using 3D Heteronuclear NMR Spectroscopy

The assignments of the 1H, 15N, 13CO, and 13C resonances of recombinant human basic fibroblast growth factor (FGF-2), a protein comprising 154 residues and with a molecular mass of 17.2 kDa, is presented based on a series of three-dimensional triple-resonance heteronuclear NMR experiments. These studies employ uniformly labeled 15N- and 15N-/13C-labeled FGF-2 with an isotope incorporation \u3e95% for the protein expressed in E. coli. The sequence-specific backbone assignments were based primarily on the interresidue correlation of Cα, Cβ, and Hα to the backbone amide 1H and 15N of the next residue in the CBCA(CO)NH and HBHA(CO)NH experiments and the intraresidue cor-relation of Cα, Cβ, and Hα to the backbone amide 1H and 15N in the CBCANH and HNHA experi-ments. In addition, Cα and Cβ chemical shift assignments were used to determine amino acid types. Sequential assignments were verified from carbonyl correlations observed in the HNCO and HCACO experiments and Cα correlations from the HNCA experiment. Aliphatic side-chain spin sys-tems were assigned primarily from H(CCO)NH and C(CO)NH experiments that correlate all the aliphatic 1H and 13C resonances of a given residue with the amide resonance of the next residue. Additional side-chain assignments were made from HCCH-COSY and HCCH-TOCSY experiments. The secondary structure of FGF-2 is based on NOE data involving the NH, Hα, and Hβ protons as well as 3JHNHα coupling constants, amide exchange, and 13Cα and 13Cβ secondary chemical shifts. It is shown that FGF-2 consists of 11 well-defined antiparallel β-sheets (residues 30–34, 39–44, 48–53, 62–67, 71–76, 81–85, 91–94, 103–108, 113–118, 123–125, and 148–152) and a helix-like structure (residues 131–136), which are connected primarily by tight turns. This structure differs from the refined X-ray crystal structures of FGF-2, where residues 131–136 were defined as β-strand XI. The discovery of the helix-like region in the primary heparin-binding site (residues 128–138) instead of the β-strand conformation described in the X-ray structures may have important implications in understanding the nature of heparin–FGF-2 interactions. In addition, two distinct conformations exist in solution for the N-terminal residues 9–28. This is consistent with the X-ray structures of FGF-2, where the first 17–19 residues were ill defined

Compiling The Evidence: The National Healthcare Disparities Reports

Disparities in health care have been described extensively in the literature. The next step in resolving this national problem is to develop the necessary infrastructure for monitoring and tracking disparities. The congressionally mandated National Healthcare Disparities Report begins to build this infrastructure. The 2003 report addressed many of the methodological challenges inherent in measuring disparities. The recently released 2004 report continues the process by summarizing the status of U.S. health care disparities and beginning to track changes over time. Both reports emphasize the need to integrate activities to reduce disparities and to improve the quality of health care

Age-Related Disparities in Trauma Center Access for Severe Head Injuries Following the Release of the Updated Field Triage Guidelines

Objective: In 2006, the American College of Surgeons’ Committee on Trauma and the Center for Disease Control released field triage guidelines with special consideration for older adults. Additional considerations for direct transport to a Level I or II trauma center (TC) were added in 2011, reflecting perceived undertriage to TCs for older adults. We examined whether age-based disparities in TC care for severe head injury decreased following introduction of the 2011 revisions. Methods: A pre-post design analyzing the 2009 and 2012 Healthcare Cost and Utilization Project State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) with multivariable logistic regressions considered changes in (1) the trauma designation of the emergency department where treatment was initiated and (2) transfer to a TC following initial treatment at a non-TC. Results: Compared with adults aged 18–44 years, after multivariable adjustment, in both years TC care was less likely for adults aged 45–64 years (OR: 0.76 in 2009 and 0.74 in 2012), aged 65–84 years (OR: 0.61 and 0.59), and aged 85+ years (OR: 0.53 and 0.56). Between 2009 and 2012, the likelihood of TC care increased for all age groups, with the largest increase among those aged 85+ years (OR = 1.18), which was statistically different (p = .02) from the increase among adults aged 18–44 years (OR = 1.12). The analysis of transfers yielded similar results. Conclusions: Although patterns of increased TC treatment for all groups with severe head trauma indicate improvements, age-based disparities persisted

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Includes bibliographical references (p. 19).Mode of access: Internet