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

Bone mineral density and the subsequent risk of cancer in the NHANES I follow-up cohort

BACKGROUD: Bone mineral density (BMD) is a marker of long-term estrogen exposure. BMD measurement has been used in this context to investigate the association of estrogen with breast cancer risk in three cohorts. In order to assess further BMD as a predictor of estrogen related cancer risk, the association of BMD with colorectal and corpus uteri cancer was investigated in the NHANES I Epidemiologic Followup Study (NHEFS) cohort along with breast cancer and prostate cancer. METHODS: Participants were members of the NHEFS cohort who had BMD measurement in 1974–1975. Age, race, and BMI adjusted rate ratios and 95% confidence intervals were calculated for incidence of cancers of the corpus uterus, breast, colorectum, prostate, and of osteoporosis and hip fracture related to baseline BMD. RESULTS: Data were available for 6046 individuals. One hundred cases of breast cancer, 94 prostate cancers, 115 colorectal cancers, 29 uterine cancers, 110 cases of hip fracture and 103 cases of osteoporosis were reported between 1974 and 1993. Hip fracture and osteoporosis were both significantly inversely associated with BMD. Uterine cancer was positively associated (p = 0.005, test for linear trend) and colorectal cancer negatively associated (p = 0.03) with BMD. No association was found between elevated BMD and incidence of breast cancer (p = 0.74) or prostate cancer (p = 0.37) in the overall cohort, although a weak association was seen between BMD and subsequent breast cancer incidence when BMD was measured in post-menopausal women (p = 0.04). CONCLUSION: The findings related to cancers of the uterus and colorectum as well as the weak association of BMD with breast cancer strengthen the use of BMD as a marker of estrogen exposure and cancer risk

ED visits for AMI, Stroke, ACS & COPD after the Statewide Smoking Ban in Cook Co., IL

ObjectiveTo utilize ED chief complaint data obtained from syndromic surveillance to quantify the effect of the Illinois smoking ban on acute myocardial infarction (AMI), acute coronary syndrome (ACS), stroke, and chronic obstructive pulmonary disease (COPD) related ED visits in adults in Cook County, IL.IntroductionTobacco use is the leading global cause of preventable death, killing more than five million people per year [1]. In addition, exposure to secondhand smoke is estimated to kill an additional 600,000 people globally each year [1]. In 1986, the US Surgeon General’s Report declared secondhand smoke to be a cause of lung cancer in healthy nonsmokers [2].The first law restricting smoking in public places was enacted in 1973 in Arizona that followed the 1972 Surgeon General’s Report providing awareness of the negative health effects associated with the exposure to air pollution from tobacco smoke [3]. Smoke-free laws were slowly enacted after this time point with most occurring after the year 2000 [4].In July 2007, the Smoke Free Illinois Act (SB0500, Public Act 095-0017) was passed in IL [5]. The ban went into effect on Jan 1, 2008 and Illinois joined 22 other states in prohibiting smoking in virtually all public places and workplaces including offices, theaters, museums, libraries, schools, commercial establishments, retail stores, bars, private clubs, and gaming facilities [5-6].While many studies have examined the effect of smoking bans on hospitalizations, this study would be the first to examine the effect of the comprehensive smoking ban in IL on ED visits by utilizing chronic disease categories created with ED chief complaint data captured by syndromic surveillance [7]. The author hypothesizes that the comprehensive smoking ban in IL significantly reduced the ED visits associated with AMI, ACS, stroke, and COPD in adults in Cook County, IL.MethodsED visits with chief complaints consistent with categories for AMI, ACS, stroke and COPD captured by the Cook Co. Dept. of Public Health local instance of ESSENCE from Jan 1, 2006 – Dec 31, 2013 were included in the analysis. Proc Genmod with a log link and negative binomial distribution was utilized for the analysis. All data was aggregated at the monthly level. The total number of ED visits of the health effect of interest was the dependent variable. The total ED visits during the same period of time, was used as the offset variable, sub-grouped by age and gender where appropriate. A binary variable was utilized to capture the effect of the time period after the implementation of the statewide smoking ban; 0 for before the ban and 1 for after the ban. When examining the effect of the statewide ban, Cook Co. as an entirety was examined as well as ED visits stratified by zip codes that already had a smoking ban in place at that time point and those that did not, and stratifying by urban (Chicago) vs. suburban Cook Co. Seasonality was addressed by including month, month squared and month cubed in the model. Influenza was addressed by including a binary variable to indicate when influenza was occurring in the area based on percent influenza-like-illness ED visits that were occurring above the threshold for the area during that time period. Age and gender were also evaluated as confounders and effect modifiers. SAS 9.4 was utilized to perform the analyses.ResultsResults are presented in Table 1. Reductions of ED visits after the smoking ban implementation were seen in AMI and ACS disease categories for the overall adjusted model, at 3% and 3.5% respectively. Stroke associated ED visits were not affected by the smoking ban. COPD associated ED visits were not reduced immediately by the smoking ban, but did have a significant reduction 6 months after implementation of the ban at 3.6%. Stronger effects were seen in individuals 70 years and older, females, the urban population, and zip codes without a prior ban for AMI, ACS, and COPD.ConclusionsAn immediate, significant reduction in ED visits associated with AMI and ACS was associated with the IL statewide smoking ban in Cook Co., IL. COPD associated ED visits were significantly reduced 6 months after the ban implementation. The effect was greater in individuals 70 years and older, females, the urban population, and zip codes without a prior ban.References1. WHO, WHO report on the global tobacco epidemic. Implementing smoke-free environments. 2009, WHO: Geneva, Switzerland.2. DC, The health consequences of involuntary exposure to tobacco smoke : a report of the Surgeon General. 2006, U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health: Atlanta, GA.3. Eriksen, M. and F. Chaloupka, The economic impact of clean indoor air laws. CA Cancer J Clin, 2007. 57(6): p. 367-78.4. Foundation, A.N.R. Overview List - How many Smokefree Laws? 2015 10/2/2015 [cited 2015 10/5/2015]; Available from: http://www.no-smoke.org/pdf/mediaordlist.pdf.5. Smoke Free Illinois Act, in Public Act 095-0017. 2007.6. Goodman, P., et al., Effects of the Irish smoking ban on respiratory health of bar workers and air quality in Dublin pubs. Am J Respir Crit Care Med, 2007. 175(8): p. 840-5.7. Callinan, J.E., et al., Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev, 2010(4): p. CD005992

Nativity and Serum Concentrations of Antioxidants in Mexican American Children: A Cross-Sectional Study

There is limited research on the effect of immigration on biological markers of nutrition among children of Mexican origin in the United States. The purpose of this cross-sectional study was to examine data from the Third National Health and Nutrition Examination Survey (NHANES III) (1988–1994), on a national and representative sample of 1559 Mexican American children, 4–16 years of age, and assess the associations of country of birth with serum concentrations of carotenoids, vitamin A, and vitamin E. In multiple regression analyses, Mexico-born Mexican American children had significantly higher serum concentrations of α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin, vitamin A, and vitamin E than their counterparts who were born in the United States after adjustment for age, sex, poverty income ratio, level of education of family reference person, body mass index, total serum cholesterol, serum cotinine, total energy intake, and vitamin/mineral consumption. Our findings confirm evidence for a negative effect of immigration/acculturation on dietary quality in this population. These findings also suggest that immigrant Mexican families should be encouraged to maintain their consumption of fruits and vegetables. Prospective studies are needed to further assess the effects of immigration/acculturation on diet and other health outcomes in children of Mexican origin and immigrants