bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of guided self-determination on self-management in persons with type 1 diabetes mellitus and HbA1c≥64 mmol/mol: a group-based randomised controlled trial
Authors: Mohn Jannike , Graue Marit , Assmus Jõrg , Zoffmann Vibeke , Thordarson Hrafnkell , Peyrot Mark , Rokne Berit 
Published: July 2017

ObjectivesTo determine whether the impact of guided self-determination (GSD) applied in group training (GSD-GT) in people with chronically elevated HbA1cand type 1 diabetes mellitus (DM) was superior to ‘care as usual’ in improving HbA1cand psychological functioning.SettingAn outpatient clinic at a university hospital in Western Norway.ParticipantsA total of 178 adults (all Caucasian) aged 18–55 (mean age 36.7±10.7, 62% women) with type 1 DM for at least 1 year and HbA1c≥64 mmol/mol (8.0%) were randomly assigned to participate in either GSD-GT or a control group (CG). Exclusion criteria were severe comorbidity, major psychiatric disorder, cognitive deficiency/language barriers and pregnancy.InterventionIntervention group met seven times for 2 hours over 14 weeks to promote patient autonomy and intrinsic motivation using reflection sheets and advanced professional communication in accordance with the GSD methodology.Primary and secondary outcome measuresThe primary outcome was HbA1cand secondary outcomes (all outcomes 9 months post intervention) were self-monitored blood glucose frequency, self-reported diabetes competence, autonomy support by healthcare providers (Health Care Climate Questionnaire), autonomous versus controlled diabetes motivation (Treatment Self-Regulation Questionnaire), diabetes distress (Problem Areas In Diabetes Scale (PAID) and Diabetes Distress Scale (DDS)), self-esteem (Rosenberg Self-Esteem Scale) and psychological well-being (World Health Organization five-item Well-Being Index scale).ResultsAmong participants allocated to the GSD-GT (=90) 48 completed the study, whereas 83 completed in the CG (n=88). With 95% CIs GSD-GT did not have effect on HbA1c(B −0.18, CI (−0.48, 0.12), p=0.234). GSD-GT improved autonomy-motivated behaviour (B 0.51, CI (0.25, 0.77), p<0.001), diabetes distress (PAID, B −6.96, CI (−11.40, −2.52), p=0.002), total DDS (B −5.15, CI (−9.34, −0.96), p=0.016), DDS emotional burden (B −7.19, CI (−13.20, −1.19), p=0.019) and self-esteem (B 1.43, CI (0.34, 2.52), p=0.011).ConclusionsResults from this behavioural intervention must be interpreted cautiously because of recruitment and attrition problems. Medical outcomes did not improve. Psychological outcomes improved, especially reduced diabetes distress.Trial registration numberClinical Trials.gov NCT 01317459.
Predictors for future activity limitation in women with chronic low back pain consulting primary care: a 2-year prospective longitudinal cohort study
Authors: Nordeman Lena , Thorselius Lena , Gunnarsson Ronny , Mannerkorpi Kaisa 
Published: July 2017

ObjectivesTo assess if body function, activity, participation, health-related quality of life and lifestyle behavioural factors can predict activity limitation in women with chronic low back pain (CLBP) in primary healthcare (PHC) 2 years later.DesignA 2-year prospective longitudinal cohort study within PHC.SettingsPHC in southwestern Sweden.ParticipantsThe cohort comprised 130 women with CLBP attending PHC at baseline 2004–2005 and were reassessed after 2 years.MeasuresThe dependent outcome variable was self-reported activity limitation (Roland Morris disability questionnaire (RMDQ)) at 2-year follow-up. Independent predictors at baseline were age, body mass index, smoking, alcohol consumption, sleep quantity and quality, leisure time physical activity, a questionnaire of clinical manifestation of stress (Stress and Crises Inventory (SCI-93)), pain localisation, pain intensity, fatigue, anxiety, depression, RMDQ, work status, private social support, health-related quality of life and measures of physical performance specified as 6 min walk test (6MWT) and hand grip strength. Relation between baseline predictors and variation in later self-reported activity limitation (RMDQ) was analysed using multivariate linear regression.ResultsNinety-five per cent (n=123/130) were followed up after 2 years. The participants were middle-aged (mean 45 (SD 10) years), mostly educated >9 years (88%; 108/123), mainly living with another adult (76%; 93/122) and born in Sweden (90%; 111/123). Seventy-nine per cent (97/123) were categorised as having work ability at baseline. The final prognostic model including 6MWT, SCI-93 and RMDQ at baseline explained 54% of the variance in self-reported activity limitation (RMDQ) at the 2-year follow-up.ConclusionsLower physical performance, more severe clinical stress symptoms and more severe activity limitation predicted activity limitation after 2 years in women with CLBP within PHC. The results can give guidance for interventional trials aiming to improve physical capacity and decrease stress. The impact of the interaction between prognostic factors and interventions on activity limitation needs further investigation.
Acute Infarct Extracellular Volume Mapping to Quantify Myocardial Area at Risk and Chronic Infarct Size on Cardiovascular Magnetic Resonance Imaging
Authors: Garg Pankaj , Broadbent David A. , Swoboda Peter P. , Foley James R.J. , Fent Graham J. , Musa Tarique A. , Ripley David P. , Erhayiem Bara , Dobson Laura E. , McDiarmid Adam K. , Haaf Philip , Kidambi Ananth , van der Geest Rob J. , Greenwood John P. , Plein Sven 
Published: July 2017

Background—
Late gadolinium enhancement (LGE) imaging overestimates acute infarct size. The main aim of this study was to investigate whether acute extracellular volume (ECV) maps can reliably quantify myocardial area at risk (AAR) and final infarct size (IS).

Methods and Results—

Fifty patients underwent cardiovascular magnetic resonance imaging acutely (24–72 hours) and at convalescence (3 months). The cardiovascular magnetic resonance protocol included cines, T2-weighted imaging, native T1 maps, 15-minute post-contrast T1 maps, and LGE. Optimal AAR and IS ECV thresholds were derived in a validation group of 10 cases (160 segments). Eight hundred segments (16 per patient) were analyzed to quantify AAR/IS by ECV maps (ECV thresholds for AAR is 33% and IS is 46%), T2-weighted imaging, T1 maps, and acute LGE. Follow-up LGE imaging was used as the reference standard for final IS and viability assessment. The AAR derived from ECV maps (threshold of >33) demonstrated good agreement with T2-weighted imaging–derived AAR (bias, 0.18; 95% confidence interval [CI], −1.6 to 1.3) and AAR derived from native T1 maps (bias=1; 95% CI, −0.37 to 2.4). ECV demonstrated the best linear correlation to final IS at a threshold of >46% (
R
=0.96; 95% CI, 0.92–0.98;
P
<0.0001). ECV maps demonstrated better agreement with final IS than acute IS on LGE (ECV maps: bias, 1.9; 95% CI, 0.4–3.4 versus LGE imaging: bias, 10; 95% CI, 7.7–12.4). On multiple variable regression analysis, the number of nonviable segments was independently associated with IS by ECV maps (β=0.86;
P
<0.0001).

Conclusions—
ECV maps can reliably quantify AAR and final IS in reperfused acute myocardial infarction. Acute ECV maps were superior to acute LGE in terms of agreement with final IS. IS quantified by ECV maps are independently associated with viability at follow-up.
A Flexible Scheme for Assigning Timing and Pitch To Synthetic Speech
Authors: Witten Ian H. 
Published: July 2017

A flexible scheme for assigning timing and pitch to synthetic speech is described. The scheme is designed to provide sufficiently adequate and natural control of the prosody of utterances for people to be able to use the speech which it generates as a simple but effective tool for man-machine interaction. The basic prosodic features of the utterance must be marked in the phonemic input string, while more global features are defined by parameters which can be changed as and when desired. This combines a simple input format with the capability of synthesizing many of the nuances encountered when connected passages are spoken in a rich and natural way. Since the scheme has been implemented on a computer, many decisions about precise details of pitch and timing have had to be made, usually in the absence of proper experimental justification. Each point of detail is discussed in the paper, so that the procedure is described sufficiently fully to enable it to be replicated in other research laboratories.
Influence of Cigarette Smoking on the Overall Perception of Dental Health among Adults Aged 20–79 Years, United States, 1988–1994
Authors: Morin Nathalie M. , Dye Bruce A. , Hooper Tomoko I. 
Published: July 2017

Objective. Investigation into the relationship between lifestyle factors (particularly cigarette smoking) and perceived oral health has been limited. Data from the third National Health and Nutrition Examination Survey (NHANES III), 1988–1994, were used to explore this relationship in a large sample of U.S. adults. Methods. This study used data on 13,357 dentate participants in NHANES III aged 20–79 years. In NHANES III, information on perceived dental health, sociodemographic attributes, smoking status, frequency of dental visits, dental insurance, and general health perception were collected during a home interview, and oral health status was assessed at a mobile examination center. Results. Overall, 34.4% of individuals in the study sample reported having an unfavorable perception of their dental health by qualifying it as “fair” or “poor.” Furthermore, 46.6% of smokers had an unfavorable dental health perception, compared to 28.3% of non-smokers. An interaction between smoking and race/ethnicity was found in logistic regression modeling. Stratified results show that cigarette smoking was not a significant predictor for an unfavorable dental health perception among individuals who self-identified as Mexican American, but smoking was a significant predictor for an unfavorable dental health perception among those who identified as non-Hispanic black or non-Hispanic white. Conclusions. This is the first study to describe the effects of smoking on dental health perception while controlling for examined oral health status. Because perceived dental health is a potential indicator for dental care utilization, a better knowledge of the factors that influence dental health perception is not only important for dental services planning, but also for understanding oral health–related quality of life issues. Additionally, given that smoking may negatively affect dental health perception, these findings have potential implications for smoking cessation activities conducted by dental care providers.
A Population-Based Analysis of Pneumococcal Disease Mortality in California, 1989–1998
Authors: Redelings Matthew D. , Sorvillo Frank , Simon Paul 
Published: July 2017

Objectives. Pneumococcal disease is an important cause of vaccine-preventable mortality. It is important to understand the burden and distribution of mortality so that prevention efforts can be targeted appropriately. This study evaluated pneumococcal disease mortality and its demographic correlates in California from 1989 to 1998. Methods. Deaths due to pneumococcal disease were identified from statewide vital records data using multiple cause-coded information. Denominator data were obtained from estimates from the California Department of Finance. Crude and age-adjusted mortality rates and 95% confidence intervals were calculated for each age, gender, and racial/ethnic group. Results. The age-adjusted pneumococcal disease mortality rate was 2.05 deaths per 100,000 population. Mortality was highest in elderly individuals (reaching 38.29 deaths per 100,000 population in individuals older than age 85). Age-adjusted mortality rates were elevated in the African American race/ethnicity group (2.96 deaths per 100,000 population) and males (2.67 deaths per 100,000 population). The majority of individuals who died of pneumococcal disease (78.9%) fell into at-risk groups indicated for vaccination. The majority of all pneumococcal deaths were caused by pneumococcal pneumonia. Mortality was seasonal, reaching a peak in the winter months. A decreasing trend in mortality was observed over the 10-year period examined. Conclusions. Pneumococcal disease remains a significant cause of vaccine-preventable mortality in the California population. Greater efforts must be made to vaccinate at-risk individuals, especially those in demographic groups at highest risk of death.
Integrating Routine HIV Testing into a Public Health STD Clinic
Authors: Campos-Outcalt Doug , Mickey Tom , Weisbuch Jonathan , Jones Robert 
Published: July 2017

Objective. To integrate routine HIV testing into the services offered at a public health department STD clinic and document the rate of acceptance and rate of test positivity during the first 18 months. Methods. Testing for HIV was added to the array of tests offered to all patients at the Maricopa County STD clinic. Patients were informed of this new option at registration and were provided with a consent form and instructions to read the form and sign it, unless they did not desire testing. STD clinicians were responsible for insuring that questions regarding testing were answered and that consent forms were signed. HIV prevention was integrated into the general STD preventive messages during the clinical encounter. Results. Sixty-eight percent of patients accepted testing (12,176 of 17,875). Of these, 68 were HIV-positive, for a rate of 5.6 per 1,000. The positive rate for men was 8.6/1000 and for women 1.2/1,000. The rate for men who reported having sex with men (MSM) was 63.8/1,000. Fourteen of the HIV-positive MSM were co-infected with syphilis. Of the 68 who were HIV-positive, 58 (85.3%) were successfully located, informed of their test results, and referred for HIV treatment and support services. Conclusions. HIV testing can be included in the routine battery of tests offered at an STD clinic with high patient acceptance. Routine testing can discover those who are unaware of their HIV-positive status, providing an opportunity for early referral for treatment, counseling to avoid disease transmission, and notification of sexual contacts.
Baseline Assessment of Public Health Informatics Competencies in Two Hudson Valley Health Departments
Authors: Cunningham Diana J. , Ascher Marie T. , Viola Deborah , Visintainer Paul F. 
Published: July 2017

Information technology has the capability to improve the way public health is practiced. Realization of this potential is possible only with a workforce ready to utilize these technologies. This project team assessed informatics competencies of employees in two county departments of health. The goal was to determine the status quo in terms of informatics competencies by surveying current levels of proficiency and relevance, and identify areas of needed training. A survey was adapted from the recommendations of a Working Group document by the Centers for Disease Control and Prevention and administered to all employees in the two health departments. Respondents evaluated proficiency and relevance for each of 26 recommended competencies. A gap score was generated between these two measures; results were compared to the recommendations of the Working Group. The following data for each job level are presented: mean gap scores by competency class; the percentage of respondents demonstrating a gap in the competencies reported to be most relevant; and the percentage of respondents meeting the target recommendations of the Working Group. The percentage of respondents who reached the targets was low in higher-level staff. And overall, employees reported low levels of relevance for most of the competencies. The average public health employee does not feel that prescribed informatics competencies are relevant to their work. Before the public health system can take advantage of information technology, relevant employee skills should be identified or developed. There needs to be a shift in thinking that will recognize the promise of information technology in everyday work.
Evaluating Accountability in the Vaccines for Children Program: Protecting a Federal Investment
Authors: Ching Pamela L.Y.H. 
Published: July 2017

The Vaccines for Children (VFC) program supplies health-care providers with federally purchased vaccines at no cost for administration to eligible children. Evaluation of vaccine accountability activities ensures appropriate and timely vaccinations are delivered. Program grantees in 50 states, Washington, five large U.S. metropolitan cities, and five U.S. territories and possessions completed a Web-based survey between December 2002 and January 2003 focused on current vaccine accountability operational systems. Most grantees required providers to complete profiles describing the vaccination needs and demographics of their practices. More than half requested providers use benchmarking data, doses-administered reports, and/or claims or encounter data to determine their VFC program-eligible population size; however, >65% did not have written procedures for investigating and reconciling discrepancies between estimated vaccine needs and actual vaccine-use data. Most grantees had written standard policies requiring providers to report vaccine loss and wastage routinely and to explain why they occurred. Ninety percent of grantees did not have procedures to check providers for fraud and abuse sanctions, and 52% did not have written procedures to address complaints of vaccine fraud and abuse. These results suggested specific areas in which the Centers for Disease Control and Prevention should work with grantees to improve vaccine accountability practices. As a result, enhancements to the VFC program are being implemented to address these areas and their impact evaluated for their effectiveness in ensuring the continued success of the VFC program in protecting the nation's most vulnerable children and adolescents.
The Role of Formative Research in the National HIV Behavioral Surveillance System
Authors: Allen Denise Roth , Finlayson Teresa , Abdul-Quader Abu , Lansky Amy 
Published: July 2017

The National Human Immunodeficiency Virus (HIV) Behavioral Surveillance System (NHBS) is the Centers for Disease Control and Prevention's (CDC's) newest system for measuring HIV risk behaviors among three adult populations at highest risk for HIV infection in the U.S.: men who have sex with men, injecting drug users, and heterosexuals at risk of HIV infection. The system is implemented by state and local health departments in designated metropolitan statistical areas with the highest HIV/acquired immunodeficiency syndrome (AIDS) prevalence in the U.S. Prior to implementing the behavioral surveillance survey, project sites conduct a series of formative research activities. The data collected during this preparatory phase provide contextual information about HIV risk behaviors within the study population of interest and help project sites make decisions about field operations and other logistical issues. This article describes the activities undertaken in preparation for the first round of NHBS (2003–2007) and how those activities enhanced data collection for each behavioral surveillance cycle.
State and Metropolitan Variation in Lack of Health Insurance among Working-Age Adults, Behavioral Risk Factor Surveillance System, 2006
Authors: Ahluwalia Indu B. , Bolen Julie , Pearson William S. , Link Michael , Garvin William , Mokdad Ali 
Published: July 2017

Objective. Lack of health insurance coverage for working-age adults is one of the most pressing issues facing the U.S. population, and it continues to be a concern for a large number of people. In the absence of a national solution, the states and municipalities are left to address this need. We examined the disparities in uninsurance prevalence by state and metropolitan areas in the U.S. and among racial/ethnic groups. Method. Data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed for working-age adults 18 to 64 years of age. Results. In 2006, according to the BRFSS data, overall 18.6% (standard error 5 0.20) of working-age adults were without health insurance coverage; by state, this proportion ranged from 9.7% to 29.0%. Health insurance coverage varied by state and metropolitan area and racial/ethnic group, and a higher age-adjusted prevalence of uninsurance was observed for non-Hispanic black and Hispanic respondents. Conclusions. A substantial proportion of working-age Americans remain without health insurance coverage. Disparities in health insurance coverage were observed by population and geographic groups. Overall, black and Hispanic populations fared far worse in terms of lack of health-care coverage than working-age white Americans.
Use of Rabies Postexposure Prophylaxis Supplied by the Alaska Section of Epidemiology, Alaska, 2002–2007
Authors: Castrodale Louisa 
Published: July 2017

Objective. The aim of this study was to summarize the Alaska experience in centralizing distribution of rabies postexposure prophylaxis (PEP). Methods. Data were collected from standard treatment sheets used to track doses and notes related to the exposure investigations. Results. From 2002 to 2007, the annual PEP usage rate was 2.2 per 100,000. Dogs were involved in 79% (68/86) of exposures. More than 50% (49/87) of people were exposed to a confirmed rabid animal; 31 (63%) of those people experienced nonbite exposures. Conversely, of the remaining 38 people exposed to an animal for which rabies status could not be confirmed, 35 (92%) sustained a bite or puncture. Direct and indirect costs averaged more than $3,000 per person. Conclusions. The Alaska PEP usage rate was lower and the proportion of people exposed to confirmed rabid animals was higher when compared with other states. Alaska public health personnel invested significant time to ensure that PEP was only given when indicated. Without this gatekeeper approach, PEP would likely be administered at a much higher rate because medical facility staff lacks the time or ability to investigate animal exposures to rule out rabies. In Alaska, centralizing rabies PEP not only serves the patient's best interest, but it also makes efficient use of a potentially scarce product and supports rabies surveillance efforts by guaranteeing animals for testing. Such a program might not be feasible for a more populous state or jurisdiction, or areas with different rabies epizootiology; however, that may change if the supply of rabies biologics changes in the future.