Worksite health

The CDC Worksite Health ScoreCard (HSC) is a tool designed to help employers assess whether they have implemented evidence-based health promotion interventions or strategies in their worksites to prevent heart disease, stroke, and related conditions such as hypertension, diabetes, and obesity. The tool was developed by the CDC Division for Heart Disease and Stroke Prevention in collaboration with the Emory University Institute for Health and Productivity Studies (IHPS), the Research Triangle Institute, the CDC National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Workplace Workgroup, and an expert panel of federal, state, academic, and private sector. To ensure the validity and reliability of the tool, a validation study was conducted by Emory University's IHPS. This study involved a national sample of 93 employers of variable size who agreed to pilot test the survey and provide feedback on the survey's content and structure.Acknowledgements and suggested citation -- Introduction -- Using the Health ScoreCard (HSC) -- Instructions -- Scoring your survey -- CDC worksite health ScoreCard worksheet -- Validation study benchmarking report -- References -- Appendix A. Frequently asked questions (FAQs) -- Appendix B. Resources for action -- Appendix C. Glossary -- Appendix D. Scoring methodology -- Appendix E. Worksite plan and budget templatesDyann M. Matson-Koffman, Lead Scientific Advisor.On cover: Health scorecard manual."CS234218."Available via the World Wide Web as an Acrobat .pdf file (1.77 MB, 72 p.).Centers for Disease Control and Prevention. The CDC Worksite Health ScoreCard: An Assessment Tool for Employers to Prevent Heart Disease, Stroke, and Related Health Conditions. Atlanta: U.S. Department of Health and Human Services; 2012

Addressing chronic disease through community health workers: a policy and systems-level approach : a policy brief on community health workers

This document provides guidance and resources for implementing recommendations to integrate community health workers (CHWs) into community-based efforts to prevent chronic disease. After providing general information on CHWs in the United States, it sets forth evidence demonstrating the value and impact of CHWs in preventing and managing a variety of chronic diseases, including heart disease and stroke, diabetes, and cancer. In addition, descriptions are offered of chronic disease programs that are engaging CHWs, examples of state legislative action are provided, recommendations are made for comprehensive polices to build capacity for an integrated and sustainable CHW workforce in the public health arena, and resources are described that can assist state health departments and others in making progress with CHWs."9/27/11." - date from document propertiesIncludes bibliographical refernces (p. 13-16)

Out-of-hospital cardiac arrest surveillance: Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005-December 31, 2010

PROBLEM/CONDITION: Each year, approximately 300,000 persons in the United States experience an out-of-hospital cardiac arrest (OHCA); approximately 92% of persons who experience an OHCA event die. An OHCA is defined as cessation of cardiac mechanical activity that occurs outside of the hospital setting and is confirmed by the absence of signs of circulation. Whereas an OHCA can occur from noncardiac causes (i.e., trauma, drowning, overdose, asphyxia, electrocution, primary respiratory arrests, and other noncardiac etiologies), the majority (70%--85%) of such events have a cardiac cause. The majority of persons who experience an OHCA event, irrespective of etiology, do not receive bystander-assisted cardiopulmonary resuscitation (CPR) or other timely interventions that are known to improve the likelihood of survival to hospital discharge (e.g., defibrillation). Because nearly half of cardiac arrest events are witnessed, efforts to increase survival rates should focus on timely and effective delivery of interventions by bystanders and emergency medical services (EMS) personnel. This is the first report to provide summary data from an OHCA surveillance registry in the United States. REPORTING PERIOD: This report summarizes surveillance data collected during October 1, 2005-- December 31, 2010. DESCRIPTION OF THE SYSTEM: In 2004, CDC established the Cardiac Arrest Registry to Enhance Survival (CARES) in collaboration with the Department of Emergency Medicine at the Emory University School of Medicine. This registry evaluates only OHCA events of presumed cardiac etiology that involve persons who received resuscitative efforts, including CPR or defibrillation. Participating sites collect data from three sources that define the continuum of emergency cardiac care: 911 dispatch centers, EMS providers, and receiving hospitals. OHCA is defined in CARES as a cardiac arrest that occurred in the prehospital setting, had a presumed cardiac etiology, and involved a person who received resuscitative efforts, including CPR or defibrillation. RESULTS: During October 1, 2005--December 31, 2010, a total of 40,274 OHCA records were submitted to the CARES registry. After noncardiac etiology arrests and missing hospital outcomes were excluded from the analysis (n = 8,585), 31,689 OHCA events of presumed cardiac etiology (e.g., myocardial infarction or arrhythmia) that received resuscitation efforts in the prehospital setting were analyzed. The mean age at cardiac arrest was 64.0 years (standard deviation [SD]: 18.2); 61.1% of persons who experienced OHCA were male (n = 19,360). According to local EMS agency protocols, 21.6% of patients were pronounced dead after resuscitation efforts were terminated in the prehospital setting. The survival rate to hospital admission was 26.3%, and the overall survival rate to hospital discharge was 9.6%. Approximately 36.7% of OHCA events were witnessed by a bystander. Only 33.3% of all patients received bystander CPR, and only 3.7% were treated by bystanders with an automated external defibrillator (AED) before the arrival of EMS providers. The group most likely to survive an OHCA are persons who are witnessed to collapse by a bystander and found in a shockable rhythm (e.g., ventricular fibrillation or pulseless ventricular tachycardia). Among this group, survival to discharge was 30.1%. A subgroup analysis was performed among persons who experienced OHCA events that were not witnessed by EMS personnel to evaluate rates of bystander CPR for these persons. After exclusion of 3,400 OHCA events that occurred after the arrival of EMS providers, bystander CPR information was analyzed for 28,289 events. In this group, whites were significantly more likely to receive CPR than blacks, Hispanics, or members of other racial/ethnic populations (p<0.001). Overall survival to hospital discharge of patients whose events were not witnessed by EMS personnel was 8.5%. Of these, patients who received bystander CPR had a significantly higher rate of overall survival (11.2%) than those who did not (7.0%) (p<0.001). INTERPRETATION: CARES data have helped identify opportunities for improvement in OHCA care. The registry is being used continually to monitor prehospital performance and selected aspects of hospital care to improve quality of care and increase rates of survival following OHCA. CARES data confirm that patients who receive CPR from bystanders have a greater chance of surviving OHCA than those who do not. PUBLIC HEALTH ACTIONS: Medical directors and public health professionals in participating communities use CARES data to measure and improve the quality of prehospital care for persons experiencing OHCA. Tracking performance longitudinally allows communities to better understand which elements of their care are working well and which elements need improvement. Education of public officials and community members about the importance of increasing rates of bystander CPR and promoting the use of early defibrillation by lay and professional rescuers is critical to increasing survival rates. Reporting at the state and local levels can enable state and local public health and EMS agencies to coordinate their efforts to target improving emergency response for OHCA events, regardless of etiology, which can lead to improvement in OHCA survival rates.Bryan McNally, Rachel Robb, Monica Mehta, Kimberly Vellano, Amy L. Valderrama, Paula W. Yoon, Comilla Sasson, Allison Crouch, Amanda Bray Perez, Robert Merritt, Arthur Kellermann.Cover title."Corresponding author: Amy L. Valderrama, [Division for Heart Disease and Stroke Prevention,] National Center for Chronic Disease Prevention and Health Promotion, CDC"--P. 1."July 29, 2011.""U.S. Government Printing Office: 2011-723-011/21060, Region IV"--P. [4] of cover.Also available via the World Wide Web.Includes bibliographical references (p. 19)

Out-of-hospital cardiac arrest surveillance: Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005-December 31, 2010

PROBLEM/CONDITION: Each year, approximately 300,000 persons in the United States experience an out-of-hospital cardiac arrest (OHCA); approximately 92% of persons who experience an OHCA event die. An OHCA is defined as cessation of cardiac mechanical activity that occurs outside of the hospital setting and is confirmed by the absence of signs of circulation. Whereas an OHCA can occur from noncardiac causes (i.e., trauma, drowning, overdose, asphyxia, electrocution, primary respiratory arrests, and other noncardiac etiologies), the majority (70%--85%) of such events have a cardiac cause. The majority of persons who experience an OHCA event, irrespective of etiology, do not receive bystander-assisted cardiopulmonary resuscitation (CPR) or other timely interventions that are known to improve the likelihood of survival to hospital discharge (e.g., defibrillation). Because nearly half of cardiac arrest events are witnessed, efforts to increase survival rates should focus on timely and effective delivery of interventions by bystanders and emergency medical services (EMS) personnel. This is the first report to provide summary data from an OHCA surveillance registry in the United States. REPORTING PERIOD: This report summarizes surveillance data collected during October 1, 2005-- December 31, 2010. DESCRIPTION OF THE SYSTEM: In 2004, CDC established the Cardiac Arrest Registry to Enhance Survival (CARES) in collaboration with the Department of Emergency Medicine at the Emory University School of Medicine. This registry evaluates only OHCA events of presumed cardiac etiology that involve persons who received resuscitative efforts, including CPR or defibrillation. Participating sites collect data from three sources that define the continuum of emergency cardiac care: 911 dispatch centers, EMS providers, and receiving hospitals. OHCA is defined in CARES as a cardiac arrest that occurred in the prehospital setting, had a presumed cardiac etiology, and involved a person who received resuscitative efforts, including CPR or defibrillation. RESULTS: During October 1, 2005--December 31, 2010, a total of 40,274 OHCA records were submitted to the CARES registry. After noncardiac etiology arrests and missing hospital outcomes were excluded from the analysis (n = 8,585), 31,689 OHCA events of presumed cardiac etiology (e.g., myocardial infarction or arrhythmia) that received resuscitation efforts in the prehospital setting were analyzed. The mean age at cardiac arrest was 64.0 years (standard deviation [SD]: 18.2); 61.1% of persons who experienced OHCA were male (n = 19,360). According to local EMS agency protocols, 21.6% of patients were pronounced dead after resuscitation efforts were terminated in the prehospital setting. The survival rate to hospital admission was 26.3%, and the overall survival rate to hospital discharge was 9.6%. Approximately 36.7% of OHCA events were witnessed by a bystander. Only 33.3% of all patients received bystander CPR, and only 3.7% were treated by bystanders with an automated external defibrillator (AED) before the arrival of EMS providers. The group most likely to survive an OHCA are persons who are witnessed to collapse by a bystander and found in a shockable rhythm (e.g., ventricular fibrillation or pulseless ventricular tachycardia). Among this group, survival to discharge was 30.1%. A subgroup analysis was performed among persons who experienced OHCA events that were not witnessed by EMS personnel to evaluate rates of bystander CPR for these persons. After exclusion of 3,400 OHCA events that occurred after the arrival of EMS providers, bystander CPR information was analyzed for 28,289 events. In this group, whites were significantly more likely to receive CPR than blacks, Hispanics, or members of other racial/ethnic populations (p<0.001). Overall survival to hospital discharge of patients whose events were not witnessed by EMS personnel was 8.5%. Of these, patients who received bystander CPR had a significantly higher rate of overall survival (11.2%) than those who did not (7.0%) (p<0.001). INTERPRETATION: CARES data have helped identify opportunities for improvement in OHCA care. The registry is being used continually to monitor prehospital performance and selected aspects of hospital care to improve quality of care and increase rates of survival following OHCA. CARES data confirm that patients who receive CPR from bystanders have a greater chance of surviving OHCA than those who do not. PUBLIC HEALTH ACTIONS: Medical directors and public health professionals in participating communities use CARES data to measure and improve the quality of prehospital care for persons experiencing OHCA. Tracking performance longitudinally allows communities to better understand which elements of their care are working well and which elements need improvement. Education of public officials and community members about the importance of increasing rates of bystander CPR and promoting the use of early defibrillation by lay and professional rescuers is critical to increasing survival rates. Reporting at the state and local levels can enable state and local public health and EMS agencies to coordinate their efforts to target improving emergency response for OHCA events, regardless of etiology, which can lead to improvement in OHCA survival rates.Bryan McNally, Rachel Robb, Monica Mehta, Kimberly Vellano, Amy L. Valderrama, Paula W. Yoon, Comilla Sasson, Allison Crouch, Amanda Bray Perez, Robert Merritt, Arthur Kellermann.Cover title."Corresponding author: Amy L. Valderrama, [Division for Heart Disease and Stroke Prevention,] National Center for Chronic Disease Prevention and Health Promotion, CDC"--P. 1."July 29, 2011.""U.S. Government Printing Office: 2011-723-011/21060, Region IV"--P. [4] of cover.Also available via the World Wide Web.Includes bibliographical references (p. 19)

A summary of primary stroke center policy in the United States

Stroke is a leading cause of death in the United States. Much is known about how to treat stroke victims swiftly and effectively, yet the accessibility of health care facilities with the resources and processes to care for acute stroke patients varies from state to state. Research indicates that patients receiving care at primary stroke centers have a higher incidence of survival and recovery than those treated in hospitals without this type of specialized care. In 2008, the Centers for Disease Control and Prevention (CDC) partnered with the National Association of Chronic Disease Directors and the University of Georgia's Department of Public Administration and Policy to assess the extent of and variation in implementation of state policy related to primary stroke centers in the United States. The first step in this assessment process was to conduct a review of policies in all 50 states and the District of Columbia. CDC updated the review in July 2010. This summary provides a snapshot of laws and regulations related to primary stroke centers in the United States through mid-2010. It includes a summary and synthesis of policy action across states as well as an individual report for each state.Overview of nation-wide stroke policies -- CDC funding snapshot -- At-a-glance state summaries"Publication date: 10/2011."Available via the World Wide Web as an Acrobat .pdf file (2.09 MB, 112 p.).Centers for Disease Control and Prevention. A summary of primary stroke center policy in the United States. Atlanta: U.S. Department of Health and Human Services; 2011

High blood pressure and cholesterol

"Heart disease, stroke, and other cardiovascular (blood vessel) diseases are among the leading cause of death and now kill more than 800,000 adults in the US each year. Of these, 150,000 are younger than age 65. These diseases are also two of the leading causes of health disparities in the US. Treatment of these diseases accounts for 1 in every 6 US health dollars spent. Two main reasons people have heart disease or stroke are high blood pressure and cholesterol, which are common, deadly, and preventable. Nearly 2 out of 3 adults with high cholesterol and about half of adults with high blood pressure don't have their condition yet under control. Clearly, other steps are needed to gain control of these health risks." -p. 1Fact sheet released by the Centers for Disease Control and Prevention's Office of Surveillance, Epidemiology and Laboratory Services (OSELS) in association with: Vital signs: Prevalence, treatment, and control of hypertension--United States, 1999-2002 and 2005-2008, published: MMWR. Morbidity and mortality weekly report ;v. 60, no. 4, p. 103-108; and: Vital signs: Prevalence, treatment, and control of high levels of low-density lipoprotein cholesterol--United States, 1999-2002 and 2005-2008, published: MMWR. Morbidity and mortality weekly report ; v. 60, no. 4, p. 109-114."CS219354D.""February 2011.""Publication date: 02/01/2011."Title from title screen (viewed February 3, 2011).Introduction -- Latest findings -- Who's at risk? -- U.S. state information -- What can be done -- Social mediaMode of access: World Wide WebText document (PDF)

Sodium reduction in communities

"Reducing sodium intake is a priority for the Centers for Disease Control and Prevention (CDC), which is working to reduce sodium intake by promoting local, state, and national strategies; working with public and private stakeholders; enhancing the monitoring of sodium intake and changes in the food supply; and expanding scientific literature on sodium. In 2010, CDC launched the Sodium Reduction in Communities Program (SRCP) to reduce sodium intake by helping create healthier food environments at the local level. Five sites were funded to promote and sustain policy, system, and environ-mental changes in communities and to conduct program evaluations of their progress toward reducing sodium consumption in the population." - p. 1Date from document properties.Also available via the World Wide Web as an Acrobat .pdf file (266 KB, 2 p.)

Non-vitamin K antagonist oral anticoagulants and atrial fibrillation guidelines in practice: barriers to and strategies for optimal implementation.

Stroke is a leading cause of morbidity and mortality worldwide. Atrial fibrillation (AF) is an independent risk factor for stroke, increasing the risk five-fold. Strokes in patients with AF are more likely than other embolic strokes to be fatal or cause severe disability and are associated with higher healthcare costs, but they are also preventable. Current guidelines recommend that all patients with AF who are at risk of stroke should receive anticoagulation. However, despite this guidance, registry data indicate that anticoagulation is still widely underused. With a focus on the 2012 update of the European Society of Cardiology (ESC) guidelines for the management of AF, the Action for Stroke Prevention alliance writing group have identified key reasons for the suboptimal implementation of the guidelines at a global, regional, and local level, with an emphasis on access restrictions to guideline-recommended therapies. Following identification of these barriers, the group has developed an expert consensus on strategies to augment the implementation of current guidelines, including practical, educational, and access-related measures. The potential impact of healthcare quality measures for stroke prevention on guideline implementation is also explored. By providing practical guidance on how to improve implementation of the ESC guidelines, or region-specific modifications of these guidelines, the aim is to reduce the potentially devastating impact that stroke can have on patients, their families and their carers

Sodium reduction tips

Buy fresh, frozen (no sauce), or no-salt- added canned vegetables. Use fresh poultry, fish, pork, and lean meat, rather than canned or processed meats. When available, buy low-sodium, lower- sodium, reduced-sodium, or no-salt-added versions of products. Limit sauces, mixes, and "instant" products, including flavored rice and ready-made pasta. Compare Nutrition Facts labels on food packages for percent Daily Value or amount of sodium in milligrams.Tips for reducting sodium -- Choose wisell: sodium content can vary within food categories -- Which of these sauces is lower in sodium?Publication date: 08/201.Mode of access: World Wide Web as an Acrobat .pdf file (177.42 KB, 1 p.).Text document (PDF)

Are Racial and Ethnic Minorities Less Willing to Participate in Health Research?

BACKGROUND: It is widely claimed that racial and ethnic minorities, especially in the US, are less willing than non-minority individuals to participate in health research. Yet, there is a paucity of empirical data to substantiate this claim. METHODS AND FINDINGS: We performed a comprehensive literature search to identify all published health research studies that report consent rates by race or ethnicity. We found 20 health research studies that reported consent rates by race or ethnicity. These 20 studies reported the enrollment decisions of over 70,000 individuals for a broad range of research, from interviews to drug treatment to surgical trials. Eighteen of the twenty studies were single-site studies conducted exclusively in the US or multi-site studies where the majority of sites (i.e., at least 2/3) were in the US. Of the remaining two studies, the Concorde study was conducted at 74 sites in the United Kingdom, Ireland, and France, while the Delta study was conducted at 152 sites in Europe and 23 sites in Australia and New Zealand. For the three interview or non-intervention studies, African-Americans had a nonsignificantly lower overall consent rate than non-Hispanic whites (82.2% versus 83.5%; odds ratio [OR] = 0.92; 95% confidence interval [CI] 0.84–1.02). For these same three studies, Hispanics had a nonsignificantly higher overall consent rate than non-Hispanic whites (86.1% versus 83.5%; OR = 1.37; 95% CI 0.94–1.98). For the ten clinical intervention studies, African-Americans' overall consent rate was nonsignificantly higher than that of non-Hispanic whites (45.3% versus 41.8%; OR = 1.06; 95% CI 0.78–1.45). For these same ten studies, Hispanics had a statistically significant higher overall consent rate than non-Hispanic whites (55.9% versus 41.8%; OR = 1.33; 95% CI 1.08–1.65). For the seven surgery trials, which report all minority groups together, minorities as a group had a nonsignificantly higher overall consent rate than non-Hispanic whites (65.8% versus 47.8%; OR = 1.26; 95% CI 0.89–1.77). Given the preponderance of US sites, the vast majority of these individuals from minority groups were African-Americans or Hispanics from the US. CONCLUSIONS: We found very small differences in the willingness of minorities, most of whom were African-Americans and Hispanics in the US, to participate in health research compared to non-Hispanic whites. These findings, based on the research enrollment decisions of over 70,000 individuals, the vast majority from the US, suggest that racial and ethnic minorities in the US are as willing as non-Hispanic whites to participate in health research. Hence, efforts to increase minority participation in health research should focus on ensuring access to health research for all groups, rather than changing minority attitudes