bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring the Link Between Completion of Accreditation Prerequisites and Local Health Departments' Decision to Collaborate With Tax-Exempt Hospitals Around the Community Health Assessment
Authors: Singh Simone R. , Carlton Erik L. 
Published: September 2016

Context:
Community health assessments (CHAs) are a core function of local health departments (LHDs). Recently, completing a CHA has become a prerequisite for LHDs seeking accreditation by the Public Health Accreditation Board (PHAB). Similarly, under the Affordable Care Act, nonprofit hospitals are required to conduct periodic community health needs assessments (CHNAs). Opportunities thus exist for LHDs and hospitals to jointly complete CHAs/CHNAs.

Objective:
This study examined existing LHD-hospital collaborations around CHAs/CHNAs, focusing specifically on the relationship between LHDs' level of engagement with PHAB accreditation activities and their collaboration with hospitals around CHAs/CHNAs.

Design:
Data came from the 2013 NACCHO (National Association of County & City Health Officials) Profile Study and the Area Health Resource File. Complete data were available for 1332 LHDs that participated in the 2013 NACCHO Profile Study. Logistic regression explored the relationship between LHDs' completion of accreditation prerequisites, in particular completion of a CHA, community health improvement plan, and strategic plan, and their involvement in collaborations with tax-exempt hospitals around CHAs/CHNAs.

Results:
LHDs that collaborated with tax-exempt hospitals on CHAs/CHNAs were larger, more likely to be locally governed, and more likely to have a local board of health. Bivariate analysis showed that CHA/CHNA-related collaboration with hospitals was significantly correlated (P < .01) with an LHD's completion of accreditation prerequisites. In multivariate regression analysis, completion of all 3 PHAB accreditation prerequisites significantly increased the odds of LHDs collaborating with hospitals when controlling for other LHD and community-level characteristics.

Conclusion:
PHAB accreditation prerequisites together with IRS requirements for hospitals foster potential for collaboration around CHAs/CHNAs. Joint completion of CHAs/CHNAs not only allows partners to complete the assessment more efficiently but has also been shown to produce higher-quality assessments, thus building a strong foundation for continued collaboration to improve community health.
Animal Ownership Among Vulnerable Populations in Regional South Australia: Implications for Natural Disaster Preparedness and Resilience
Authors: Thompson Kirrilly , Trigg Joshua , Smith Bradley 
Published: September 2016

Context:
Few studies have examined the prevalence of animal ownership among populations likely to be at greater risk from disaster events within a bushfire context.

Objective:
To investigate the proportion of vulnerable community members keeping animals and the types of animals kept, as well as perceived risk of harm to pets, and their inclusion in bushfire survival planning.

Design:
Statewide anonymous online survey in 2014 of adult South Australian animal owners threatened by bushfire in January 2014. Respondents were asked about animal ownership, their bushfire risk perception, and household survival planning. Descriptive statistics are presented for 5 groups considered likely to contribute to increased risk of harm for households: linguistically diverse, older adults, families with young children, physically frail, and self-identifying disabled, as well as individuals with mental health considerations.

Setting:
An opt-in purposively targeted sample of anonymous South Australians living in high fire-risk locations.

Participants:
Adult South Australian animal owners threatened or directly impacted by bushfire events, including individuals matching 1 of the 5 vulnerable groups.

Main Outcome Measures:
Self-reported details of animal ownership, perceived fire risk, survival planning, and vulnerability characteristics.

Results:
Animal ownership was found to be more prevalent in these 5 populations than in the wider South Australian population. Perceived risk to pets was low to moderately low in these individuals. Variation was observed in the role of animals generally and pets specifically as motivators for preparing bushfire survival plans.

Conclusions:
Emergency services and associated agencies need to consider how the unique needs of vulnerable populations that keep animals, and their potential differences in risk perception, relate to their bushfire survival planning and preparedness requirements.
A Practice-Grounded Approach for Evaluating Health in All Policies Initiatives in the United States
Authors: Gase Lauren N. , Schooley Taylor , Lee Meredith , Rotakhina Sierra , Vick John , Caplan Julia 
Published: September 2016

Objective:
To address the social determinants of health, an increasing number of public health practitioners are implementing Health in All Policies initiatives aimed at increasing cross-sectoral collaboration and integrating health considerations into decisions made by “nonhealth” sectors. Despite the growth in practice nationally and internationally, evaluation of Health in All Policies is a relatively new field. To help inform evaluation of Health in All Policies initiatives in the United States, this study sought to develop a practice-grounded approach, including a logic model and a set of potential indicators, which could be used to describe and assess Health in All Policies activities, outputs, and outcomes.

Design:
Methods included (a) a review of the literature on current Health in All Policies approaches, practices, and evaluations; and (b) consultation with experts with substantive knowledge in implementing or evaluating Health in All Policies initiatives. Feedback from experts was obtained through individual (n = 11) and group (n = 14) consultation.

Results:
The logic model depicts a range of potential inputs, activities, outputs, and outcomes of Health in All Policies initiatives; example indicators for each component of the logic model are provided. Case studies from California, Washington, and Nashville highlight emerging examples of Health in All Policies evaluation and the ways in which local context and goals inform evaluation efforts.

Conclusion:
The tools presented in this article synthesize concepts present in the emerging literature on Health in All Policies implementation and evaluation. Practitioners and researchers can use the tools to facilitate dialogue among stakeholders, clarify assumptions, identify how they will assess progress, and implement data-driven ways to improve their Health in All Policies work.
Excess Deaths Among the Uninsured Before the Affordable Care Act (ACA), and Potential Post-ACA Reductions
Authors: Powell Dumbiri J. , Xirasagar Sudha 
Published: September 2016

Context:
Despite implementation of the Affordable Care Act (ACA), as of 2015, about 25.8 million working-age Americans remained uninsured and vulnerable to premature death because of poor health care access. The ACA-mandated phasing out of disproportionate share hospital payments that supported charity care may aggravate care access for the residual uninsured.

Objectives:
To estimate excess deaths among the uninsured and the potential ACA impact on the basis of a recent cohort's mortality experience. We hypothesized a higher uninsured mortality risk than the available pre-2000 estimate because of worsening of care disparities owing to technology-driven advances in life-saving care.

Design:
We conducted a retrospective cohort study of the 1999 to 2002 National Health and Nutrition Examination Survey respondents observed through 2011. We estimated (a) weighted Cox proportional mortality hazard of uninsured working-age adults adjusted for demographics, comorbidity, and lifestyle behaviors, (b) weighted mortality rates among the uninsured and insured within age and comorbidity strata, and (c) excess deaths because of uninsurance using the Institute of Medicine methodology.

Setting:
Noninstitutionalized US population.

Participants:
Adults aged 20 to 64 years.

Main Outcome Measure:
Mortality.

Results:
Of 7274 study-eligible respondents, 20.6% were uninsured and 478 died during follow-up, for an adjusted uninsured mortality hazard ratio of 1.57 (95% confidence interval, 1.12-2.21) versus privately insured, translating to 48 529 excess deaths among the population aged 25 to 64 years in 2011 (7.8% of total deaths in this age group). The estimated proportion of excess deaths was 52% higher than the pre-2000 cohort study. The mortality disparity increased with age and comorbidity.

Conclusions:
Findings support our hypotheses, and indicate that post-ACA, a residual 4.7% excess mortality among working-age adults will continue, about 30 428 excess deaths annually. Restoration of disproportionate share hospital supports and continued advocacy for universal health care coverage are needed to reduce avoidable deaths.
CDC's “Flexible” Epidemiologist: A Strategy for Enhancing Health Department Infectious Disease Epidemiology Capacity
Authors: Chung Christina , Fischer Leah S. , O'Connor Angelica , Shultz Alvin 
Published: September 2016

Context:
CDC's Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Cooperative Agreement aims to help health departments strengthen core epidemiology capacity needed to respond to a variety of emerging infectious diseases. In fiscal year 2014, $6 million was awarded to 41 health departments for flexible epidemiologists (FEs). FEs were intended to help meet health departments' unique needs and support unanticipated events that could require the diversion of resources to specific emerging or reemerging diseases.

Objective:
Explore multiple perspectives to characterize how FEs are utilized and to understand the perceived value of this strategy from the health department perspective.

Design, Setting, and Participants:
We conducted 14 in-depth interviews using a semistructured questionnaire with a heterogeneous sample of 8 state health departments; 2 different instruments were administered to ELC principal investigators (PIs) or supervisors, and FEs. The team produced a codebook consisting of both structural and data-driven codes to prepare for a thematic analysis of the data.

Results:
Three major patterns emerged to describe how FEs are being used in health departments; most commonly, FEs were used to support priorities and gaps across a range of infectious diseases, with an emphasis on enteric diseases. Almost all of the health departments utilized FEs to assist in investigating and responding to outbreaks, maintaining and upgrading surveillance systems, and coordinating and collaborating with partners. Both PIs and supervisors highly valued the flexibility it offered to their programs because FEs were cross-trained and could be used to help with situations where additional staff members were needed.

Conclusion:
ELC enhances epidemiology capacity in health departments by providing flexible personnel that help sustain areas with losses in capacity, addressing programmatic gaps, and supporting unanticipated events. Our findings support the notion that flexible personnel could be an effective model for strengthening epidemiology capacity among health departments.

Implications for Policy & Practice:
Our findings have practical implications for addressing the overall decline in the public health workforce, as well as the current context and environment of public health funding at both state and federal levels.
Barriers and Facilitators to Scientific Writing Among Applied Epidemiologists
Authors: Pittman Jessica , Stahre Mandy , Tomedi Laura , Wurster Jessica 
Published: September 2016

Context:
Communication in the form of written and oral reports and presentations is a core competency for epidemiologists at governmental public health agencies. Many applied epidemiologists do not publish peer-reviewed articles, limiting the scientific literature of best practices in evidence-based public health.

Objectives:
To describe the writing and publishing experiences of applied epidemiologists and identify barriers and facilitators to publishing.

Design:
Telephone focus groups and an 18-question multiple-choice and short-answer Web-based assessment were fielded in 2014.

Setting and Participants:
Six focus groups composed of 26 applied epidemiologists and an online assessment answered by 396 applied epidemiologists. Sample selection was stratified by years of experience.

Main Outcome Measures:
Past publishing experience, current job duties as related to publishing, barriers and facilitators to writing and publishing, and desired training in writing and publishing were assessed through focus groups and the online assessment.

Results:
Focus groups identified 4 themes: job expectations, barriers to publishing, organizational culture, and the understanding of public health practice among reviewers as issues related to writing and publishing. Most respondents (80%) expressed a desire to publish; however, only 59% had published in a peer-reviewed journal. An academic appointment (among doctoral educated respondents) was identified as a facilitator to publishing as was access to peer-reviewed literature. Time (68%) was identified as the greatest barrier to writing and publishing. Other major barriers included lack of encouragement or support (33%) within the public health agency and agency clearance processes (32%). Assistance with journal selection (62%), technical writing skills (60%), and manuscript formatting (57%) were listed as the most needed trainings.

Conclusion:
Public health agencies can be facilitators for epidemiologists to contribute to the scientific literature through increasing access to the peer-reviewed literature, creating a supportive environment for writing and publishing, and investing in desired and needed training. The results have implications for modifying workplace policies surrounding writing and publishing.
Pathways to Program Success: A Qualitative Comparative Analysis (QCA) of Communities Putting Prevention to Work Case Study Programs
Authors: Kane Heather , Hinnant Laurie , Day Kristine , Council Mary , Tzeng Janice , Soler Robin , Chambard Megan , Roussel Amy , Heirendt Wendy 
Published: September 2016

Objective:
To examine the elements of capacity, a measure of organizational resources supporting program implementation that result in successful completion of public health program objectives in a public health initiative serving 50 communities.

Design:
We used crisp set Qualitative Comparative Analysis (QCA) to analyze case study and quantitative data collected during the evaluation of the Communities Putting Prevention to Work (CPPW) program.

Setting:
CPPW awardee program staff and partners implemented evidence-based public health improvements in counties, cities, and organizations (eg, worksites, schools).

Participants:
Data came from case studies of 22 CPPW awardee programs that implemented evidence-based, community- and organizational-level public health improvements.

Intervention:
Program staff implemented a range of evidence-based public health improvements related to tobacco control and obesity prevention.

Main Outcome Measure:
The outcome measure was completion of approximately 60% of work plan objectives.

Results:
Analysis of the capacity conditions revealed 2 combinations for completing most work plan objectives: (1) having experience implementing public health improvements in combination with having a history of collaboration with partners; and (2) not having experience implementing public health improvements in combination with having leadership support.

Conclusion:
Awardees have varying levels of capacity. The combinations identified in this analysis provide important insights into how awardees with different combinations of elements of capacity achieved most of their work plan objectives. Even when awardees lack some elements of capacity, they can build it through strategies such as hiring staff and engaging new partners with expertise. In some instances, lacking 1 or more elements of capacity did not prevent an awardee from successfully completing objectives. These findings can help funders and practitioners recognize and assemble different aspects of capacity to achieve more successful programs; awardees can draw on extant organizational strengths to compensate when other aspects of capacity are absent.
Implementation and Operational Research: An Integrated and Comprehensive Service Delivery Model to Improve Pediatric and Maternal HIV Care in Rural Africa
Authors: Gamell Anna , Glass Tracy R. , Luwanda Lameck B. , Mapesi Herry , Samson Leila , Mtoi Tom , Nyamtema Angelo , Muri Lukas , Ntamatungiro Alex , Tanner Marcel , Hatz Christoph , Battegay Manuel , Letang Emilio ,   on behalf of the KIULARCO Study Group
Published: September 2016

Background:
Strategies to improve HIV diagnosis and linkage into care, antiretroviral treatment coverage, and treatment outcomes of mothers and children are urgently needed in sub-Saharan Africa.

Methods:
From December 2012, we implemented an intervention package to improve prevention of mother-to-child transmission (PMTCT) and pediatric HIV care in our rural Tanzanian clinic, consisting of: (1) creation of a PMTCT and pediatric unit integrated within the reproductive and child health clinic; (2) implementation of electronic medical records; (3) provider-initiated HIV testing and counseling in the hospital wards; and (4) early infant diagnosis test performed locally. To assess the impact of this strategy, clinical characteristics and outcomes were compared between the period before (2008–2012) and during/after the implementation (2013–2014).

Results:
After the intervention, the number of mothers and children enrolled into care almost doubled. Compared with the pre-intervention period (2008–2012), in 2013–2014, children presented lower CD4% (16 vs. 16.8, P = 0.08) and more advanced disease (World Health Organization stage 3/4 72% vs. 35%, P < 0.001). The antiretroviral treatment coverage rose from 80% to 98% (P < 0.001), the lost-to-follow-up rate decreased from 20% to 11% (P = 0.002), and mortality ascertainment improved. During 2013–2014, 261 HIV-exposed infants were enrolled, and the early mother-to-child transmission rate among mother–infant pairs accessing PMTCT was 2%.

Conclusions:
This strategy resulted in an increased number of mothers and children diagnosed and linked into care, a higher detection of children with AIDS, universal treatment coverage, lower loss to follow-up, and an early mother-to-child transmission rate below the threshold of elimination. This study documents a feasible and scalable model for family-centered HIV care in sub-Saharan Africa.
Adult-Onset Idiopathic Hypertrophic Pyloric Stenosis Associated With Osteoglophonic Dysplasia and HIV
Authors: Holder Justin , Zinn Daniel , Samin Amiram 
Published: September 2016

Abstract
Adult-onset hypertrophic pyloric stenosis (HPS) is a rare anomaly that can be idiopathic or related to underlying gastric pathology. We describe a case of a 25-year-old man with history of human immunodeficiency virus and osteoglophonic dysplasia who presented with pain and swelling at a gastrostomy site. Computed tomography and upper gastrointestinal barium swallow demonstrated gastric distention and stricture at the distal portion of the gastric antrum. An ultrasound detected HPS. The patient eventually required pyloromyotomy for treatment. Human immunodeficiency virus infection has numerous gastrointestinal ramifications, but HPS has not been identified as one. Osteoglophonic dysplasia has not been an established risk factor for HPS. Idiopathic HPS is extremely rare in adults, but should be considered in this population when patients present with gastric outlet obstruction.
Real-Time Ultrasound Elastographic Features of Primary Open Angle Glaucoma
Authors: Unal Ozlem , Cay Nurdan , Yulek Fatma , Taslipinar Ayse Guzin , Bozkurt Selen , Gumus Mehmet 
Published: September 2016

Objective
To investigate the significance of ultrasound elastography for evaluating the optic nerve in patients with primary open angle glaucoma (POAG).

Methods
This prospective, comparative case series included 40 eyes of 40 patients. Twenty eyes with POAG comprised the POAG group, and 20 eyes of 20 patients without glaucoma who admitted to general eye clinic for near vision glasses comprised the control group. All real-time sonographicelastographic examinations were performed by the same physician. The ratio of orbital fat to optic nerve head (ROFON) and lateral rectus to optic nerve head (RLRON) were determined. Statistical analyses were performed using Student t test, Kolmogorov-Smirnov test, and χ2 test.

Results
The mean ages of the patients in the study and the control groups were 65.10 ± 7.88 years (range, 48–80 years), and 69.15 ± 7.92 years (range, 55–89 years), respectively (P = 0.113). Mean ROFONs were 1.85 and 6.42 (P < 0.05), and mean RLRONs were 0.65 and 1.07 (P < 0.05) in the control and POAG groups, respectively.

Conclusions
Real-time elastography showed increased ROFON and RLRON in POAG patients. This can help to understand optic nerve head biomechanics and clarify glaucoma damage in early glaucoma cases.
Testicular Microlithiasis in the Setting of Primary Extragonadal Germ Cell Tumor
Authors: Thompson Joel P. , Jean-Gilles Jerome , Dogra Vikram 
Published: September 2016

Abstract
The clinical significance of testicular microlithiasis (TM) in patients with primary extragonadal germ cell tumor (EGCT) is not well understood. When EGCT is suspected, sonographic and physical examination of the testicles should be performed to evaluate for testicular lesion or atrophy; negative testicular ultrasound with current technology virtually excludes the possibility of occult primary lesion. Although EGCTs are known to be associated with elevated level of serum tumor markers, the utility of tumor markers in the presence of TM is not well understood. Current guidelines for TM follow-up and management do not include any potential correlation between TM and primary EGCT, an association that should be addressed on future updates.
Reliability of Central Adiposity Assessments Using B-Mode Ultrasound
Authors: Stoner Lee , Geoffron Morgane , Cornwall Jon , Chinn Victoria , Gram Martin , Credeur Daniel , Fryer Simon 
Published: September 2016

AbstractRecently, it was reported that intra-abdominal thickness (IAT) assessments using ultrasound are most reliable if measured from the linea alba to the anterior vertebral column. These 2 anatomical sites can be simultaneously visualized using a linear array transducer. Linear array transducers have different operational characteristics when compared with conventional curved array transducers and are more reliable for some ultrasound-derived measures such as abdominal subcutaneous fat thickness. However, it is unknown whether linear array transducers facilitate more reliable IAT measurements than curved array transducers. The purpose of the current study was to (1) compare the reliability of linear and curved array transducer assessments of IAT and maximal abdominal ratio (MAR) and (2) use the findings to update central adiposity measurement guidelines. Fifteen healthy adults (mean [SD], 27 [10] years; 60% female) with a range of somatotypes (body mass index: mean [SD], 24 [4]; range, 19–33 kg/m2; waist circumference: mean [SD], 75 [11]; range, 61–96 cm) were tested on 3 mornings under standardized conditions. Intra-abdominal thickness was assessed 2 cm above the umbilicus (transverse plane), measuring from linea alba to the anterior vertebral column. Maximal abdominal ratio was defined as the ratio of IAT to abdominal subcutaneous fat thickness. The IAT range was 25 to 87 mm, and the MAR range was 0.15 to 0.77. Between-day intraclass correlation coefficient values for IAT measurements made were comparable (0.96–0.97) for both transducers, as were MAR values (0.95). In conclusion, while both transducers provided equally reliable measurement of IAT, the use of a single linear array transducer simplifies the assessment of central adiposity.