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共13170条结果
  • 1.

    【2hr】How California Prepared for Implementation of Physician-Assisted Death: A Primer

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    机译 加利福尼亚如何准备实施医师协助的死亡：入门
    摘要：Physician-assisted death is now legal in California, and similar laws are being considered in many other states. The California law includes safeguards, yet health care providers will face practical and ethical issues while implementing physician-assisted death that are not addressed by the law.To help providers and health care facilities in California prepare to provide optimal care to patients who inquire about physician-assisted death, we brought together experts from California, Oregon, and Washington. We convened a conference of 112 stakeholders in December 2015, and herein present their recommendations.Themes of recommendations regarding implementation include (1) institutions should develop and revise physician-assisted death policies; (2) legal physician-assisted death will have implications for California’s culturally and socioeconomically diverse population, and for patients from vulnerable groups; (3) conscientious objection and moral distress for health care providers must be considered; and (4) palliative care is essential to the response to the law. The expert conference participants’ insights are a valuable guide, both for providers and health care facilities in California planning or revising their response, and for other jurisdictions where physician-assisted death laws are being considered or implemented.
  • 2.

    【2hr】Medicaid Expansion and ACA Repeal: Evidence From Ohio

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    机译 医疗补助扩张和ACA废除：来自俄亥俄州的证据
    摘要：Objectives. To examine the health insurance coverage options for Medicaid expansion enrollees if the Affordable Care Act (ACA) is repealed, using evidence from Ohio, where more than half a million adults have enrolled in the state’s Medicaid program through the ACA expansion.Methods. The Ohio Medicaid Assessment Survey interviewed 42 000 households in 2015. We report data from a unique battery of questions designed to identify insurance coverage immediately prior to Medicaid enrollment.Results. Ninety-five percent of new Medicaid enrollees in Ohio did not have a private health insurance option immediately before enrollment. These new enrollees are predominantly older, low-income Whites with a high school education or less. Only 5% of new Medicaid enrollees were eligible for an employer-sponsored insurance plan to which they could potentially return in the case of repeal of the ACA.Conclusions. The vast majority of Medicaid expansion enrollees would have no plausible pathway to obtaining private-sector insurance if the ACA were repealed. Demographic similarities between the expansion population and 2016 exit polls suggest that coverage losses would fall disproportionately on members of the winning Republican coalition.
  • 3.

    【2hr】Restrictions of Hepatitis C Treatment for Substance-Using Medicaid Patients: Cost Versus Ethics

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    机译 使用药物补助患者的丙型肝炎治疗限制：成本与伦理
    摘要：Medicaid programs provide health insurance coverage for many patients with hepatitis C, a public health problem for which effective but very expensive treatments are now available. Facing constrained budgets, most states adopted prior authorization criteria for sofosbuvir, the first of these agents.Using fee-for-service utilization data from 42 Medicaid programs in 2014, we found that strict behavioral criteria—those that limited coverage on the basis of drug or alcohol use and included specific abstinence or treatment requirements—were associated with significantly less spending on sofosbuvir.Despite the potential cost savings, such criteria raise troubling questions in terms of public health as well as medical ethics, clinical evidence, and potentially federal law. Decision-makers should reject these requirements in Medicaid coverage policy and pursue national and state policy strategies to balance short-term budgetary realities with long-term public health benefits.
  • 4.

    【2hr】State Preemption: A Significant and Quiet Threat to Public Health in the United States

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    机译 州优先权：对美国公共健康的重大和安静威胁
    摘要：State and local governments traditionally protect the health and safety of their populations more strenuously than does the federal government. Preemption, when a higher level of government restricts or withdraws the authority of a lower level of government to act on a particular issue, was historically used as a point of negotiation in the legislative process.More recently, however, 3 new preemption-related issues have emerged that have direct implications for public health. First, multiple industries are working on a 50-state strategy to enact state laws preempting local regulation. Second, legislators supporting preemptive state legislation often do not support adopting meaningful state health protections and enact preemptive legislation to weaken protections or halt progress. Third, states have begun adopting enhanced punishments for localities and individual local officials for acting outside the confines of preemption.These actions have direct implications for health and cover such topics as increased minimum wages, paid family and sick leave, firearm safety, and nutrition policies. Stakeholders across public health fields and disciplines should join together in advocacy, action, research, and education to support and maintain local public health infrastructures and protections.
  • 5.

    【2hr】Measures of Local Segregation for Monitoring Health Inequities by Local Health Departments

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    机译 地方卫生部门对地方卫生隔离的不平等措施
    摘要：Objectives. To assess the use of local measures of segregation for monitoring health inequities by local health departments.Methods. We analyzed preterm birth and premature mortality (death before the age of 65 years) rates for Boston, Massachusetts, for 2010 to 2012, using the Index of Concentration at the Extremes (ICE) and the poverty rate at both the census tract and neighborhood level.Results. For premature mortality at the census tract level, the rate ratios comparing the worst-off and best-off terciles were 1.58 (95% confidence interval [CI] = 1.36, 1.83) for the ICE for income, 1.66 (95% CI = 1.43, 1.93) for the ICE for race/ethnicity, and 1.63 (95% CI = 1.40, 1.90) for the ICE combining income and race/ethnicity, as compared with 1.47 (95% CI = 1.27, 1.71) for the poverty measure. Results for the ICE and poverty measures were more similar for preterm births than for premature mortality.Conclusions. The ICE, a measure of social spatial polarization, may be useful for analyzing health inequities at the local level.Public Health Implications. Local health departments in US cities can meaningfully use the ICE to monitor health inequities associated with racialized economic segregation.
  • 6.

    【2hr】Review of Recent Methodological Developments in Group-Randomized Trials: Part 1—Design

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    机译 群体随机化试验的最新方法学进展回顾：第1部分：设计
    摘要：In 2004, Murray et al. reviewed methodological developments in the design and analysis of group-randomized trials (GRTs). We have highlighted the developments of the past 13 years in design with a companion article to focus on developments in analysis. As a pair, these articles update the 2004 review.We have discussed developments in the topics of the earlier review (e.g., clustering, matching, and individually randomized group-treatment trials) and in new topics, including constrained randomization and a range of randomized designs that are alternatives to the standard parallel-arm GRT.These include the stepped-wedge GRT, the pseudocluster randomized trial, and the network-randomized GRT, which, like the parallel-arm GRT, require clustering to be accounted for in both their design and analysis.
  • 7.

    【2hr】Overview of Asian American Data Collection, Release, and Analysis: National Health and Nutrition Examination Survey 2011–2018

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    机译 亚裔美国人数据收集，发布和分析概述：2011–2018年美国国家健康和营养检查
    摘要：Data System. The National Health and Nutrition Examination Survey (NHANES), conducted by the National Center for Health Statistics, is a cross-sectional survey on the health and nutritional status of US adults and children.Data Collection/Processing. A complex, multistage probability design is used to select a sample representative of the US civilian, noninstitutionalized population. NHANES includes in-home interviews, physical examinations, and biospecimen collection. About 5000 persons are examined annually. Since 2011, NHANES has been oversampling Asian Americans in addition to traditionally oversampled groups, including Hispanics and non-Hispanic Blacks.Data Analysis/Dissemination. Data are publicly released online in 2-year cycles. Some data, because of disclosure risk, are only available through the Research Data Center. Data users should read documentation, examine sample sizes and response rates, and account for the complex survey design. With publicly released data, analyses of Asians as a single group is only possible; some Asian subgroup analyses may be conducted through the Research Data Center.Public Health Implications. Oversampling Asians in NHANES 2011–2018 allows national estimates to be computed on health conditions, nutrition, and risk factors of public health importance on this growing subpopulation of Asian Americans.
  • 8.

    【2hr】A Public Health Approach to Hepatitis C in an Urban Setting

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    机译 城市环境中丙型肝炎的公共卫生方法
    摘要：The clinical consequences of HCV infection are increasing because the population with the highest prevalence of the infection, persons born between 1945 and 1965, is aging. As a result, health care expenditures are expected to increase.Now that a cure for HCV infection is the norm, a public health approach is necessary to identify, link to care, and treat infected persons and prevent new infections. We believe that the success of public health interventions, such as those for tuberculosis, can be translated to HCV infection.New York City has many HCV-infected residents and has developed a public health approach to controlling the HCV epidemic. It encompasses surveillance and monitoring, case finding, linkage to care, care coordination, increasing clinical provider capacity for screening and treatment, increasing public awareness, and primary prevention.
  • 9.

    【2hr】A Typical Day With Mild Cognitive Impairment

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    机译 轻度认知障碍的典型一天
    摘要：
  • 10.

    【2hr】US Public Opinion on Carrying Firearms in Public Places

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    机译 美国公众舆论在公共场所携带枪支
    摘要：Objectives. To estimate US public opinion, overall and by gun ownership status, about the public places where legal gun owners should be allowed to carry firearms.Methods. We fielded an online survey among 3949 adults, including an oversample of gun owners and veterans, in April 2015. We used cross-tabulations with survey weights to generate nationally representative estimates.Results. Fewer than 1 in 3 US adults supported gun carrying in any of the specified venues. Support for carrying in public was consistently higher among gun owners than among non–gun owners. Overall, support for carrying in public was lowest for schools (19%; 95% confidence interval [CI] = 16.7, 21.1), bars (18%; 95% CI = 15.9, 20.6), and sports stadiums (17%; 95% CI = 15.0, 19.5).Conclusions. Most Americans, including most gun owners, support restricting public places legal gun owners can carry firearms. These views contrast sharply with the current trend in state legislatures of expanding where, how, and by whom guns can be carried in public. Recent state laws and proposed federal legislation that would force states to honor out-of-state concealed carry permits are out of step with American public opinion.
  • 11.

    【2hr】Machine Learning for Social Services: A Study of Prenatal Case Management in Illinois

    包量

    机译 机器学习为社会服务：伊利诺伊州产前病例管理研究
    摘要：Objectives. To evaluate the positive predictive value of machine learning algorithms for early assessment of adverse birth risk among pregnant women as a means of improving the allocation of social services.Methods. We used administrative data for 6457 women collected by the Illinois Department of Human Services from July 2014 to May 2015 to develop a machine learning model for adverse birth prediction and improve upon the existing paper-based risk assessment. We compared different models and determined the strongest predictors of adverse birth outcomes using positive predictive value as the metric for selection.Results. Machine learning algorithms performed similarly, outperforming the current paper-based risk assessment by up to 36%; a refined paper-based assessment outperformed the current assessment by up to 22%. We estimate that these improvements will allow 100 to 170 additional high-risk pregnant women screened for program eligibility each year to receive services that would have otherwise been unobtainable.Conclusions. Our analysis exhibits the potential for machine learning to move government agencies toward a more data-informed approach to evaluating risk and providing social services. Overall, such efforts will improve the efficiency of allocating resource-intensive interventions.
  • 12.

    【2hr】The Interface Among Poverty, Air Mattress Industry Trends, Policy, and Infant Safety

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    机译 贫困，气垫行业趋势，政策和婴儿安全之间的关系
    摘要：Infants can suffocate on air mattresses, even when the mattress is fully inflated. The interfacing issues of poverty, the bedbug epidemic, and changes in the design and marketing of air mattresses may be increasing consumer use of air mattresses as primary sleep environments and thus increasing the potential for infant death.Despite recent changes to improve air mattress safety labeling, the National Child Death Review Case Reporting System found that between 2004 and 2015 across 24 states, an air mattress was the incident sleep place for 108 infants whose deaths were either during sleep or in a sleep environment. At the same time, design components such as inflatable headboards and memory foam pillow tops potentially increase the hazard to infants, and marketing changes represent air mattresses as a preferred low-cost primary sleep environment.Analysis of current data surveillance systems, published position statements, and consumer materials from national organizations and federal agencies reveal opportunities for changing policy to better protect infants from this hazard.
  • 13.

    【2hr】Humanitarian Needs Among Displaced and Female-Headed Households in Government-Controlled Areas of Syria

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    机译 叙利亚政府控制地区的流离失所和女户主家庭的人道主义需求
    摘要：Objectives. To identify unmet needs and assistance priorities of displaced and female-headed households in government-controlled areas of Syria.Methods. In mid-2016, we undertook a survey of accessible areas, largely urban and government-controlled, to identify unmet needs and assistance priorities. We used a cluster design with probability sampling to attain a final sample of 2405 households from 10 of 14 governorates; 31 of 65 (47.7%) districts were included that are home to 38.1% of people in need.Results. Displaced and female-headed households were more vulnerable than nondisplaced and male-headed households in numerous sectors. Despite approximately half of surveyed households reporting receipt of humanitarian assistance in the preceding month and apparently effective targeting of assistance by vulnerability, unmet needs were nearly ubiquitous.Conclusions. The humanitarian situation in inaccessible areas of Syria is likely to be considerably worse; thus, findings presented here likely underestimate humanitarian needs. Efforts to expand support to Syria’s most vulnerable households are desperately needed as are innovative targeting and modalities that enable more efficient and effective assistance.
  • 14.

    【2hr】The Zika Virus Outbreak in Brazil: Knowledge Gaps and Challenges for Risk Reduction

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    机译 巴西寨卡病毒爆发：知识差距和降低风险的挑战
    摘要：We analyzed uncertainties and complexities of the Zika virus outbreak in Brazil, and we discuss risk reduction for future emergencies. We present the public health situation in Brazil and concurrent determinants of the epidemic and the knowledge gaps that persist despite building evidence from research, making public health decisions difficult.Brazil has adopted active measures, but producing desired outcomes may be uncertain because of partial or unavailable information. Reducing population group vulnerabilities and acting on environmental issues are medium- to long-term measures.Simultaneously dealing with information gaps, uncontrolled disease spread, and vulnerabilities is a new risk scenario and must be approached decisively to face emerging biothreats.
  • 15.

    【2hr】Effect of Legislation on Indoor Tanning Prevalence in Alabama

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    机译 立法对阿拉巴马州室内鞣革流行的影响
    摘要：Objectives. To examine changes in indoor tanning prevalence among Alabama high school students the year before and after its 2014 legal restrictions compared with Florida, which had more lenient legislation.Methods. We analyzed the Alabama and Florida 2015 Youth Risk Behavior Survey (n = 14 389; population = 1 864 241) by gender, age, year (2013, 2015), state (Alabama, Florida), and year-by-state interactions.Results. Prevalence of indoor tanning was higher among Alabama youths, but the difference did not significantly change after the law was passed in Alabama (between-state change differences ranged from a 3.3% increase among 14-year-old Alabama girls to a 9.7% decrease among 14-year-old Alabama boys).Conclusions. We found no significant changes in indoor tanning among adolescents since the enactment of Alabama’s tanning restrictions in 2014. More oversight and monitoring are needed to ensure that indoor tanning facilities are compliant with emerging laws.
  • 16.

    【2hr】Small-Group Randomized Controlled Trial to Increase Condom Use and HIV Testing Among Hispanic/Latino Gay, Bisexual, and Other Men Who Have Sex With Men

    包量

    机译 小规模随机对照试验，以提高西班牙裔/拉丁美洲裔同性恋者，双性恋者和其他与男性发生性关系的男性中避孕套的使用和HIV检测
    摘要：Objectives. To evaluate the HOLA en Grupos intervention, a Spanish-language small-group behavioral HIV prevention intervention designed to increase condom use and HIV testing among Hispanic/Latino gay, bisexual, and other men who have sex with men.Methods. In 2012 to 2015, we recruited and randomized 304 Hispanic/Latino men who have sex with men, aged 18 to 55 years in North Carolina, to the 4-session HOLA en Grupos intervention or an attention-equivalent general health education comparison intervention. Participants completed structured assessments at baseline and 6-month follow-up. Follow-up retention was 100%.Results. At follow-up, relative to comparison participants, HOLA en Grupos participants reported increased consistent condom use during the past 3 months (adjusted odds ratio [AOR] = 4.1; 95% confidence interval [CI] = 2.2, 7.9; P < .001) and HIV testing during the past 6 months (AOR = 13.8; 95% CI = 7.6, 25.3; P < .001). HOLA en Grupos participants also reported increased knowledge of HIV (P < .001) and sexually transmitted infections (P < .001); condom use skills (P < .001), self-efficacy (P < .001), expectancies (P < .001), and intentions (P < .001); sexual communication skills (P < .01); and decreased fatalism (P < .001).Conclusions. The HOLA en Grupos intervention is efficacious for reducing HIV risk behaviors among Hispanic/Latino men who have sex with men.
  • 17.

    【2hr】Trends in Fighting and Violence Among Adolescents in the United States, 2002–2014

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    机译 2002-2014年美国青少年的战斗和暴力趋势
    摘要：Objectives. To examine trends in and correlates of fighting and violence among youths from the 3 largest racial/ethnic groups in the United States.Methods. We derived race/ethnicity-specific prevalence estimates for fighting, group fighting, and attacks with intent to harm from the National Survey on Drug Use and Health, a population-based study of youths aged 12 to 17 years.Results. The prevalence of youth fighting and violence decreased significantly in all racial/ethnic groups over the study period (2002–2014), dropping from a high of 33.6% in 2003 to a low of 23.7% in 2014, reflecting a 29% decrease in the relative proportion of young people involved in these behaviors. However, there was also a clear severity gradient in which year-by-year point estimates for fighting and violence were consistently highest among non-Hispanic African American youths, followed by Hispanic and then non-Hispanic White youths.Conclusions. Although fighting and violence are on the decline among young people in general and across racial/ethnic subgroups, there is a stable pattern of disparities in youth involvement in these behaviors.
  • 18.

    【2hr】The Monetary Cost of Sexual Assault to Privately Insured US Women in 2013

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    机译 2013年对美国有私人保险的女性进行性侵犯的金钱成本
    摘要：Objectives. To determine whether privately insured female rape victims were billed for charges associated with a specific rape in the United States.Methods. We examined 2013 de-identified patient data from Truven Analytics Health MarketScan database for an assault that occurred by using International Classification of Diseases, Ninth Revision, code E960.1.Results. Analysis of insurance providers’ payment patterns for 1355 incident events to female victims aged between 16 and 61 years revealed that victims remit, on average, 14% or $948 of the rape cost, whereas insurance providers pay 86% or $5789 of the total cost.Conclusions. Hospital billing procedures for privately insured victims of rape across the United States are not separate from billing procedures for privately insured nonrape patients. This standardized procedure leads hospitals to bill victims directly for services not paid under the victims’ insurance policy.Public Health Implications. The Violence Against Women Act (passed in 1994, reauthorized in 2000, 2005, and 2013) must be amended to mandate that all costs incurred because of rape are not passed on to the victim.
  • 19.

    【2hr】Mass Media Campaign to Reduce Consumption of Sugar-Sweetened Beverages in a Rural Area of the United States

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    机译 大众传媒运动，以减少美国农村地区含糖饮料的消费
    摘要：Objectives. To evaluate a mass media campaign to reduce the consumption of sugar-sweetened beverages (SSBs).Methods. We disseminated messages emphasizing the health risks of SSBs through television, digital channels, and local organizations over 15 weeks in 2015–2016 in the Tri-Cities region of northeast Tennessee, southwest Virginia, and southeast Kentucky. We evaluated the campaign with pre- and post-telephone surveys of adults aged 18 to 45 years in the intervention area and by examining changes in beverage sales in the intervention and a matched comparison area in western Virginia.Results. Fifty-four percent of postcampaign respondents recalled seeing a campaign advertisement. After the campaign, 53% of respondents believed SSBs were a cause of heart disease, and respondents were more likely postcampaign to consider SSBs a “big cause of diabetes” (75% vs 60%; P < .001). Compared with 12 months before, after the start of the campaign, SSB sales decreased 3.4%, including a 4.1% decrease in soda sales in the intervention area relative to the comparison area (P < .01).Conclusions. This brief media campaign on SSBs was followed by intended changes in beliefs and consumption.Public Health Implications. Additional media campaigns on SSBs should be attempted and evaluated.
  • 20.

    【2hr】The Influence of College Attendance on Risk for Marijuana Initiation in the United States: 1977 to 2015

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    机译 美国上大学的人数对大麻引发风险的影响：1977年至2015年
    摘要：Objectives. To examine a potential increase in marijuana initiation among US college students as compared with their age peers not in college before and after 2013, a watershed year for increasing tolerance of marijuana use in the United States.Methods. Data come from the Monitoring the Future study, which has followed longitudinal panels drawn from annual nationally representative, baseline samples of 12th-grade students starting with the class of 1976. We studied panel members aged 19 to 22 years who had never used marijuana by 12th grade between 1977 and 2015.Results. College as a risk factor for marijuana initiation has increased significantly since 2013. The increased probability of past-year marijuana use for those enrolled versus not enrolled in college was 51% in 2015, 41% in 2014, and 31% in 2013; it averaged 17% to 22% from 1977 to 2012 among youths who had never used marijuana by 12th grade.Conclusions. College has grown as a risk factor for marijuana initiation since 2013.Public Health Implications. College students are in position to usher in new increases in population marijuana use unless colleges soon address the issue with new or modified programs for marijuana prevention and intervention.
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