Linking Structural Capabilities and Workplace Climate in Community Health Centers.

Many strategies to improve health care quality focus on improving the structural capabilities of primary care practices, including quality infrastructure and registry use, which are critical to managing chronic diseases. However, improving structural capabilities requires practices to expend significant resources and can be especially disruptive to community health centers (CHCs) serving high proportions of socioeconomically vulnerable patients. We explore the relationship between the structural capabilities and workplace climate in CHCs. The final sample for this analysis includes 25 CHC sites that could be matched across CHC site director surveys of structural capabilities and CHC adult primary care clinicians and staff (n = 446). To estimate the association between structural capabilities and dimensions of workplace climate, we estimated multivariate linear regression models that included the climate scales as dependent variables and the 5 structural capability scales as the main independent variables, with the 3 clinic-level and 2 staff-level covariates. More manageable clinic workload was associated with lower electronic record functionality (β = -0.47, P = .007), but positively associated with quality infrastructure (β = 0.92, P = .007). Staff relationships and quality improvement orientation were positively associated with quality infrastructure (β = 1.09, P = .006 and β = 0.87, P = .005). Manager readiness was associated with more robust quality infrastructure (β = 1.35, P = .016), but lower electronic record functionality (β = -0.48, P = .015) and less proactive patient outreach (β = -1.32, P = .025). Complex relationships between structural capabilities and workplace climate were found in CHCs. Further clarification of these complex connections may enable policy makers and practitioners to design and implement nuanced strategies to improve quality of care in CHCs

Neighborhood Design and Perceptions: Relationship with Active Commuting

Purpose—Walking to and from school contributes to total physical activity levels. This study investigated whether perceived and actual neighborhood features were associated with walking to or from school among adolescent girls. Methods—A sample of geographically diverse 8th grade girls (N=890) from the Trial for Activity in Adolescent Girls (TAAG) study living within 1.5 miles of their middle school were recruited. Participants completed a self-administered survey on their neighborhood and walking behavior. Geographic information system (GIS) data were used to assess objective neighborhood features. Nested multivariable logistic regression analyses were conducted to determine the contribution of perceived and objective measures of walking to or from school. Results—Fifty-six percent (N=500) of the girls walked to or from school at least one day of the week. White (42%) girls walked more frequently than Hispanic (25%) and African American (21%) girls. Girls were nearly twice as likely to walk to or from school if they perceived their neighborhoods as safe and perceived they had places they liked to walk, controlling for other potential confounders. Additionally, girls who lived closer to school, had more active destinations in their neighborhood, and smaller sized blocks were more likely to walk to or from school than those who did not. Conclusion—Safety, land use, and school location issues need to be considered together when designing interventions to increase walking to and from school

Weekend schoolyard accessibility, physical activity, and obesity: The Trial of Activity in Adolescent Girls (TAAG) study

To assess the accessibility and suitability of schools as recreational sites and to determine whether they are associated with young adolescent girls’ weekend metabolic equivalent-weighted moderate-to-vigorous (MW-MVPA) physical activity and body mass index (BMI)

Neighborhood Socioeconomic Status and Non School Physical Activity and Body Mass Index in Adolescent Girls

Socioeconomic status (SES) has well known associations with a variety of health conditions and behaviors in adults but is unknown in adolescents

Public Parks and Physical Activity Among Adolescent Girls

Proximity to routine destinations is an important correlate of physical activity. We examined the association between distance from school and physical activity in adolescent girls

Can Rationing Through Inconvenience Be Ethical?

In this article, we provide a comprehensive analysis and a normative assessment of rationing through inconvenience as a form of rationing. By “rationing through inconvenience” in the health sphere, we refer to a non-financial burden (the inconvenience) that is either intended to cause or has the effect of causing patients or clinicians to choose an option for health‐related consumption that is preferred by the health system for its fairness, efficiency, or other distributive desiderata beyond assisting the immediate patient. We argue that under certain conditions, rationing through inconvenience may turn out to serve as a legitimate and, compared to direct rationing, even a preferable tool for rationing; we propose a research agenda to identify more precisely when that might be the case and when, alternatively, rationing through inconvenience remains ethically undesirable. After defining and illustrating rationing through inconvenience, we turn to its moral advantages and disadvantages over other rationing methods.We take it as a starting assumption that rationing, understood as scarce‐resource prioritization, is inevitable and, in a society that has goals beyond optimizing health care for individual patients—such as improving societal health care, education, or overall welfare—prudent and fair

Overview of the Role of Environmental Factors in Neurodevelopmental Disorders

Evidence implicates environmental factors in the pathogenesis of diverse complex neurodevelopmental disorders. However, the identity of specific environmental chemicals that confer risk for these disorders, and the mechanisms by which environmental chemicals interact with genetic susceptibilities to influence adverse neurodevelopmental outcomes remain significant gaps in our understanding of the etiology of most neurodevelopmental disorders. It is likely that many environmental chemicals contribute to the etiology of neurodevelopmental disorders but their influence depends on the genetic substrate of the individual. Research into the pathophysiology and genetics of neurodevelopmental disorders may inform the identification of environmental susceptibility factors that promote adverse outcomes in brain development. Conversely, understanding how low-level chemical exposures influence molecular, cellular, and behavioral outcomes relevant to neurodevelopmental disorders will provide insight regarding gene-environment interactions and possibly yield novel intervention strategies

Hyperbaric treatment for children with autism: a multicenter, randomized, double-blind, controlled trial

<p>Abstract</p> <p>Background</p> <p>Several uncontrolled studies of hyperbaric treatment in children with autism have reported clinical improvements; however, this treatment has not been evaluated to date with a controlled study. We performed a multicenter, randomized, double-blind, controlled trial to assess the efficacy of hyperbaric treatment in children with autism.</p> <p>Methods</p> <p>62 children with autism recruited from 6 centers, ages 2–7 years (mean 4.92 ± 1.21), were randomly assigned to 40 hourly treatments of either hyperbaric treatment at 1.3 atmosphere (atm) and 24% oxygen ("treatment group", n = 33) or slightly pressurized room air at 1.03 atm and 21% oxygen ("control group", n = 29). Outcome measures included Clinical Global Impression (CGI) scale, Aberrant Behavior Checklist (ABC), and Autism Treatment Evaluation Checklist (ATEC).</p> <p>Results</p> <p>After 40 sessions, mean physician CGI scores significantly improved in the treatment group compared to controls in overall functioning (p = 0.0008), receptive language (p < 0.0001), social interaction (p = 0.0473), and eye contact (p = 0.0102); 9/30 children (30%) in the treatment group were rated as "very much improved" or "much improved" compared to 2/26 (8%) of controls (p = 0.0471); 24/30 (80%) in the treatment group improved compared to 10/26 (38%) of controls (p = 0.0024). Mean parental CGI scores significantly improved in the treatment group compared to controls in overall functioning (p = 0.0336), receptive language (p = 0.0168), and eye contact (p = 0.0322). On the ABC, significant improvements were observed in the treatment group in total score, irritability, stereotypy, hyperactivity, and speech (p < 0.03 for each), but not in the control group. In the treatment group compared to the control group, mean changes on the ABC total score and subscales were similar except a greater number of children improved in irritability (p = 0.0311). On the ATEC, sensory/cognitive awareness significantly improved (p = 0.0367) in the treatment group compared to the control group. Post-hoc analysis indicated that children over age 5 and children with lower initial autism severity had the most robust improvements. Hyperbaric treatment was safe and well-tolerated.</p> <p>Conclusion</p> <p>Children with autism who received hyperbaric treatment at 1.3 atm and 24% oxygen for 40 hourly sessions had significant improvements in overall functioning, receptive language, social interaction, eye contact, and sensory/cognitive awareness compared to children who received slightly pressurized room air.</p> <p>Trial Registration</p> <p>clinicaltrials.gov NCT00335790</p

Evaluating Sex and Age Differences in ADI-R and ADOS Scores in a Large European Multi-site Sample of Individuals with Autism Spectrum Disorder

Research on sex-related differences in Autism Spectrum Disorder (ASD) has been impeded by small samples. We pooled 28 datasets from 18 sites across nine European countries to examine sex differences in the ASD phenotype on the ADI-R (376 females, 1763 males) and ADOS (233 females, 1187 males). On the ADI-R, early childhood restricted and repetitive behaviours were lower in females than males, alongside comparable levels of social interaction and communication difficulties in females and males. Current ADI-R and ADOS scores showed no sex differences for ASD severity. There were lower socio-communicative symptoms in older compared to younger individuals. This large European ASD sample adds to the literature on sex and age variations of ASD symptomatology