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Ramezani N, Taylor BG, Balawajder EF, MacLean K, Pollack HA, Schneider JA, Taxman FS. Predictors of mental health among U.S. adults during COVID-19 early pandemic, mid- pandemic, and post-vaccine eras. BMC Public Health 2024; 24:643. [PMID: 38424510 PMCID: PMC10902933 DOI: 10.1186/s12889-024-17781-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 01/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND A collective trauma like COVID-19 impacts individuals differently due to socio-contextual and individual characteristics. Younger adults, minorities, affiliates of certain political parties, and residents of some regions of the United States reported experiencing poorer mental health during the pandemic. Being diagnosed with COVID-19, or losing a friend/family to it, was related to more adverse mental health symptoms. While the negative impact of COVID-19 on health outcomes has been studied, mental health changes during this pandemic need further exploration. METHODS In a study of 8,612 U.S. households, using three surveys collected from a nationally representative panel between May 2020 and October 2021, using a repeated cross-sectional design, a linear mixed effect regression model was performed to investigate factors associated with the mental health status, based on the Mental Health Inventory-5, of individuals throughout different phases of the COVID-19 pandemic, and whether an improvement over time, especially after vaccines became available, was observed. RESULTS An overall improvement in mental health was observed after vaccines became available. Individuals with no COVID-related death in their household, those not wearing masks, those identifying as members of the Republican Party, race/ethnicities other than Asian, men, older adults, and residents of the South were less likely than others to report mental health challenges. CONCLUSIONS Our results highlight the need for widespread mental health interventions and health promotion to address challenges during the COVID-19 pandemic and beyond. Due to the worse mental health observed among Asians, younger adults, women, low-income families, those with a higher level of concern for COVID-19, people who lost someone to COVID-19, and/or individuals with histories of opioid use disorder and criminal legal involvement, over the period of this study, targeted attention needs to be given to the mental health of these groups.
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Affiliation(s)
- Niloofar Ramezani
- Department of Biostatistics, Virginia Commonwealth University, Box 980032, One Capital Square, 830 East Main St, Richmond, VA, 23219, USA.
| | - Bruce G Taylor
- NORC at the University of Chicago, Public Health Department, 4350 East West Highway, 8th floor, Bethesda, MD, 20814, USA
| | - Elizabeth Flanagan Balawajder
- NORC at the University of Chicago, Public Health Department, 4350 East West Highway, 8th floor, Bethesda, MD, 20814, USA
| | - Kai MacLean
- NORC at the University of Chicago, Public Health Department, 4350 East West Highway, 8th floor, Bethesda, MD, 20814, USA
| | - Harold A Pollack
- Crown Family School of Social Work, Policy, and Practice, Department of Public Health Sciences, Urban Health Lab, University of Chicago, 969 E 60th St, Chicago, IL, 60637, USA
| | - John A Schneider
- Department of Medicine and Public Health Sciences, Crown Family School of Social Work, Policy, and Practice, University of Chicago, 5841 South Maryland Avenue MC 5065, Chicago, IL, 60637, USA
| | - Faye S Taxman
- Schar School of Policy and Government, George Mason University, 3351 Fairfax Drive Van Metre Hall, Arlington, VA, 22201, USA
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Lucas CC, Lima IC, Garcia TM, Tavares TCL, Carneiro PBM, Teixeira CEP, Bejarano S, Rossi S, Soares MO. Turbidity buffers coral bleaching under extreme wind and rainfall conditions. MARINE ENVIRONMENTAL RESEARCH 2023; 192:106215. [PMID: 37890231 DOI: 10.1016/j.marenvres.2023.106215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 09/23/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Abstract
Coral reefs in turbid waters have been hypothesized to be a refuge from climate change. These naturally occurring communities were brought into the spotlight because some of their species exhibited record levels of resistance to marine heatwaves (MHWs) by disturbance-tolerant corals. However, long-term monitoring data on the drivers of coral bleaching in these extreme reef habitats are scarce. Here, we describe the population structure and bleaching rates of a widespread and resilient coral (Siderastrea stellata). We examine the links between environmental factors, namely, rainfall, wind speed, turbidity, solar irradiance, sea surface temperature, MHWs, and coral bleaching status under the worst recorded drought cycle in the Tropical South Atlantic (2013-2015). We examined 2880 colonies, most of which (∼93%) fit in the size group of 2-10 cm, with a small number (∼1%) of larger and older colonies (>20 cm). The results indicated the absence of MHWs and normal sea surface temperature variations (between 26.6 °C and 29.3 °C), however, we detected an extreme rainfall deficit (30-40% less annual volume precipitation). In general, a high proportion (44-84%) of bleached colonies was found throughout the months when turbidity decreased. Siderastrea is the only reef-building coral that comprises this seascape with encrusting and low-relief colonies. During drought periods, cloudiness is reduced, turbidity and wind speed are reduced, and solar irradiance increase, driving coral bleaching in turbid reefs. However, episodic rainfall and higher wind speeds increase turbidity and decrease coral bleaching. Our hypothesis is that turbidity decreases during drought periods which increases bleaching risk to corals even without thermal stress. Our results suggest that turbidity may have related to wind and rainfall to provoke the coral bleaching phenomenon.
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Affiliation(s)
- Caroline Costa Lucas
- Institute of Marine Sciences (LABOMAR), Federal University of Ceará (UFC), Fortaleza, Brazil.
| | - Italo Cesar Lima
- Institute of Marine Sciences (LABOMAR), Federal University of Ceará (UFC), Fortaleza, Brazil
| | - Tatiane Martins Garcia
- Institute of Marine Sciences (LABOMAR), Federal University of Ceará (UFC), Fortaleza, Brazil
| | | | | | | | - Sonia Bejarano
- Reef Systems Group, Leibniz Centre for Tropical Marine Research (ZMT), Fahrenheitstraße 6, 28359 Bremen, Germany
| | - Sergio Rossi
- Institute of Marine Sciences (LABOMAR), Federal University of Ceará (UFC), Fortaleza, Brazil; Institut de Ciència i Tecnologia Ambientals (ICTA), Universitat Autònoma de Barcelona (UAB), Cerdanyolla del Vallés, Barcelona, Spain; Dipartimento di Scienze e Tecnologie Biologiche e Ambientali (DISTEBA), Università del Salento, Lecce, Italy
| | - Marcelo O Soares
- Institute of Marine Sciences (LABOMAR), Federal University of Ceará (UFC), Fortaleza, Brazil; Reef Systems Group, Leibniz Centre for Tropical Marine Research (ZMT), Fahrenheitstraße 6, 28359 Bremen, Germany
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Van Pelt AE, Bilker WB, Nkwihorez H, Ghadimi F, Brady KA, Cidav Z, Schriger SH, Beidas RS, Gross R, Momplaisir F. Increasing antiretroviral therapy adherence and retention in care among adults living with HIV in Philadelphia: a study protocol for a stepped-wedge cluster-randomised type 2 hybrid effectiveness-implementation trial of managed problem-solving plus (MAPS+) delivered by community health workers. BMJ Open 2023; 13:e079585. [PMID: 37865411 PMCID: PMC10603537 DOI: 10.1136/bmjopen-2023-079585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/28/2023] [Indexed: 10/23/2023] Open
Abstract
INTRODUCTION To end the HIV epidemic in Philadelphia, implementation of evidence-based practices (EBP) to increase viral suppression and retention in HIV care is critical. Managed problem solving (MAPS), an EBP for antiretroviral therapy adherence, follows a problem-solving approach to empower people living with HIV (PWH) to manage their health. To overcome barriers to care experienced by PWH in Philadelphia, the EBP was adapted to include a focus on care retention and delivery by community health workers (CHWs). The adapted intervention is MAPS+. To maximise the clinical impact and reach of the intervention, evaluation of the effectiveness and implementation of MAPS+ is necessary. METHODS AND ANALYSIS This manuscript describes the protocol for a stepped-wedge cluster-randomised type 2 hybrid effectiveness-implementation trial in 10 clinics in Philadelphia. This research incorporates innovative approaches to accomplish three objectives: (1) to evaluate the effectiveness of the CHW-led MAPS+ intervention to improve viral suppression and retention in care 1 year after the individual implementation period (N=390 participants), (2) to examine the effect of the menu of implementation strategies on reach and implementation cost and (3) to examine processes, mechanisms, and sustainment of the implementation strategies for MAPS+ (N=56 participants). Due to various factors (eg, COVID-19), protocol modifications have occurred. ETHICS AND DISSEMINATION The institutional review board (IRB) at the city of Philadelphia serves as the primary IRB; initial approval was granted on 21 December 2020. The University of Pennsylvania and Northwestern University executed reliance agreements. A safety monitoring committee comprised experts in implementation science, biostatistics and infectious diseases oversee this study. This research will offer insights into achieving the goals to end the HIV epidemic in Philadelphia as well as implementation efforts of MAPS+ and other behavioural interventions aimed at increasing medication adherence and retention in care. Dissemination will include deliverables (eg, peer-reviewed manuscripts and lay publications) to reach multiple constituents. TRIAL REGISTRATION NUMBER NCT04560621.
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Affiliation(s)
- Amelia E Van Pelt
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Warren B Bilker
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hervette Nkwihorez
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Fatemeh Ghadimi
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kathleen A Brady
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
| | - Zuleyha Cidav
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leondard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Simone H Schriger
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rinad S Beidas
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert Gross
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leondard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Florence Momplaisir
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leondard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Beidas RS, Ahmedani BK, Linn KA, Marcus SC, Johnson C, Maye M, Westphal J, Wright L, Beck AL, Buttenheim AM, Daley MF, Davis M, Elias ME, Jager-Hyman S, Hoskins K, Lieberman A, McArdle B, Ritzwoller DP, Small DS, Wolk CB, Williams NJ, Boggs JM. Study protocol for a type III hybrid effectiveness-implementation trial of strategies to implement firearm safety promotion as a universal suicide prevention strategy in pediatric primary care. Implement Sci 2021; 16:89. [PMID: 34551811 PMCID: PMC8456701 DOI: 10.1186/s13012-021-01154-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/24/2021] [Indexed: 01/23/2023] Open
Abstract
Background Insights from behavioral economics, or how individuals’ decisions and behaviors are shaped by finite cognitive resources (e.g., time, attention) and mental heuristics, have been underutilized in efforts to increase the use of evidence-based practices in implementation science. Using the example of firearm safety promotion in pediatric primary care, which addresses an evidence-to-practice gap in universal suicide prevention, we aim to determine: is a less costly and more scalable behavioral economic-informed implementation strategy (i.e., “Nudge”) powerful enough to change clinician behavior or is a more intensive and expensive facilitation strategy needed to overcome implementation barriers? Methods The Adolescent and child Suicide Prevention in Routine clinical Encounters (ASPIRE) hybrid type III effectiveness-implementation trial uses a longitudinal cluster randomized design. We will test the comparative effectiveness of two implementation strategies to support clinicians’ use of an evidence-based firearm safety practice, S.A.F.E. Firearm, in 32 pediatric practices across two health systems. All pediatric practices in the two health systems will receive S.A.F.E. Firearm materials, including training and cable locks. Half of the practices (k = 16) will be randomized to receive Nudge; the other half (k = 16) will be randomized to receive Nudge plus 1 year of facilitation to target additional practice and clinician implementation barriers (Nudge+). The primary implementation outcome is parent-reported clinician fidelity to the S.A.F.E Firearm program. Secondary implementation outcomes include reach and cost. To understand how the implementation strategies work, the primary mechanism to be tested is practice adaptive reserve, a self-report practice-level measure that includes relationship infrastructure, facilitative leadership, sense-making, teamwork, work environment, and culture of learning. Discussion The ASPIRE trial will integrate implementation science and behavioral economic approaches to advance our understanding of methods for implementing evidence-based firearm safety promotion practices in pediatric primary care. The study answers a question at the heart of many practice change efforts: which strategies are sufficient to support change, and why? Results of the trial will offer valuable insights into how best to implement evidence-based practices that address sensitive health matters in pediatric primary care. Trial registration ClinicalTrials.gov, NCT04844021. Registered 14 April 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01154-8.
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Affiliation(s)
- Rinad S Beidas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Kristin A Linn
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Christina Johnson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Melissa Maye
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Joslyn Westphal
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Leslie Wright
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Arne L Beck
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | | | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Molly Davis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marisa E Elias
- Department of Pediatrics, Henry Ford Health System, Detroit, MI, USA
| | - Shari Jager-Hyman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katelin Hoskins
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adina Lieberman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Bridget McArdle
- Department of Pediatrics, Henry Ford Health System, Detroit, MI, USA
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Dylan S Small
- Wharton School of Business, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Jennifer M Boggs
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
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Turner EL, Prague M, Gallis JA, Li F, Murray DM. Review of Recent Methodological Developments in Group-Randomized Trials: Part 2-Analysis. Am J Public Health 2017; 107:1078-1086. [PMID: 28520480 PMCID: PMC5463203 DOI: 10.2105/ajph.2017.303707] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2017] [Indexed: 12/13/2022]
Abstract
In 2004, Murray et al. reviewed methodological developments in the design and analysis of group-randomized trials (GRTs). We have updated that review with developments in analysis of the past 13 years, with a companion article to focus on developments in design. We discuss developments in the topics of the earlier review (e.g., methods for parallel-arm GRTs, individually randomized group-treatment trials, and missing data) and in new topics, including methods to account for multiple-level clustering and alternative estimation methods (e.g., augmented generalized estimating equations, targeted maximum likelihood, and quadratic inference functions). In addition, we describe developments in analysis of alternative group designs (including stepped-wedge GRTs, network-randomized trials, and pseudocluster randomized trials), which require clustering to be accounted for in their design and analysis.
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Affiliation(s)
- Elizabeth L Turner
- Elizabeth L. Turner and John A. Gallis are with the Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, and the Duke Global Health Institute, Duke University. Melanie Prague is with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, and Inria, project team SISTM, Bordeaux, France. Fan Li is with the Department of Biostatistics and Bioinformatics, Duke University. David M. Murray is with the Office of Disease Prevention, Division of Program Coordination and Strategic Planning, and the Office of the Director, National Institutes of Health, Rockville, MD
| | - Melanie Prague
- Elizabeth L. Turner and John A. Gallis are with the Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, and the Duke Global Health Institute, Duke University. Melanie Prague is with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, and Inria, project team SISTM, Bordeaux, France. Fan Li is with the Department of Biostatistics and Bioinformatics, Duke University. David M. Murray is with the Office of Disease Prevention, Division of Program Coordination and Strategic Planning, and the Office of the Director, National Institutes of Health, Rockville, MD
| | - John A Gallis
- Elizabeth L. Turner and John A. Gallis are with the Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, and the Duke Global Health Institute, Duke University. Melanie Prague is with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, and Inria, project team SISTM, Bordeaux, France. Fan Li is with the Department of Biostatistics and Bioinformatics, Duke University. David M. Murray is with the Office of Disease Prevention, Division of Program Coordination and Strategic Planning, and the Office of the Director, National Institutes of Health, Rockville, MD
| | - Fan Li
- Elizabeth L. Turner and John A. Gallis are with the Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, and the Duke Global Health Institute, Duke University. Melanie Prague is with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, and Inria, project team SISTM, Bordeaux, France. Fan Li is with the Department of Biostatistics and Bioinformatics, Duke University. David M. Murray is with the Office of Disease Prevention, Division of Program Coordination and Strategic Planning, and the Office of the Director, National Institutes of Health, Rockville, MD
| | - David M Murray
- Elizabeth L. Turner and John A. Gallis are with the Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, and the Duke Global Health Institute, Duke University. Melanie Prague is with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, and Inria, project team SISTM, Bordeaux, France. Fan Li is with the Department of Biostatistics and Bioinformatics, Duke University. David M. Murray is with the Office of Disease Prevention, Division of Program Coordination and Strategic Planning, and the Office of the Director, National Institutes of Health, Rockville, MD
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Bhatnagar S, Atherton J, Benedetti A. Comparing alternating logistic regressions to other approaches to modelling correlated binary data. J STAT COMPUT SIM 2015. [DOI: 10.1080/00949655.2014.916707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Meropol SB, Schiltz NK, Sattar A, Stange KC, Nevar AH, Davey C, Ferretti GA, Howell DE, Strosaker R, Vavrek P, Bader S, Ruhe MC, Cuttler L. Practice-tailored facilitation to improve pediatric preventive care delivery: a randomized trial. Pediatrics 2014; 133:e1664-75. [PMID: 24799539 PMCID: PMC4035588 DOI: 10.1542/peds.2013-1578] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Evolving primary care models require methods to help practices achieve quality standards. This study assessed the effectiveness of a Practice-Tailored Facilitation Intervention for improving delivery of 3 pediatric preventive services. METHODS In this cluster-randomized trial, a practice facilitator implemented practice-tailored rapid-cycle feedback/change strategies for improving obesity screening/counseling, lead screening, and dental fluoride varnish application. Thirty practices were randomized to Early or Late Intervention, and outcomes assessed for 16 419 well-child visits. A multidisciplinary team characterized facilitation processes by using comparative case study methods. RESULTS Baseline performance was as follows: for Obesity: 3.5% successful performance in Early and 6.3% in Late practices, P = .74; Lead: 62.2% and 77.8% success, respectively, P = .11; and Fluoride: <0.1% success for all practices. Four months after randomization, performance rose in Early practices, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P < .001 for improvement compared with Late practices' control time. During the full 6-month intervention, care improved versus baseline in all practices, for Obesity for Early practices to 86.5%, and for Late practices 88.9%; for Lead for Early practices to 87.5% and Late practices 94.5%; and for Fluoride, for Early practices to 78.9% and Late practices 81.9%, all P < .001 compared with baseline. Improvements were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of practice need. CONCLUSIONS Practice-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained improvements in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care.
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Affiliation(s)
- Sharon B. Meropol
- Departments of Pediatrics,,Epidemiology and Biostatistics,,The Center for Child Health and Policy, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Nicholas K. Schiltz
- Epidemiology and Biostatistics,,The Center for Child Health and Policy, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | | | - Kurt C. Stange
- Epidemiology and Biostatistics,,Family Medicine and Community Health,,Oncology,,Sociology
| | - Ann H. Nevar
- The Center for Child Health and Policy, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Christina Davey
- Departments of Pediatrics,,The Center for Child Health and Policy, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | | | - Diana E. Howell
- Departments of Pediatrics,,The Center for Child Health and Policy, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | | | - Pamela Vavrek
- The Center for Child Health and Policy, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Samantha Bader
- The Center for Child Health and Policy, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | | | - Leona Cuttler
- Departments of Pediatrics,,Bioethics, Case Western Reserve University, Cleveland, Ohio; and,The Center for Child Health and Policy, Rainbow Babies and Children's Hospital, Cleveland, Ohio
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Repeatability of quantitative MRI measurements in normal breast tissue. Transl Oncol 2014; 7:130-7. [PMID: 24772216 DOI: 10.1593/tlo.13841] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/06/2014] [Accepted: 03/13/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the variability and repeatability of repeated magnetic resonance imaging (MRI) measurements in normal breast tissues between and within subjects. METHODS Eighteen normal premenopausal subjects underwent two contrast-enhanced MRI scans within 72 hours or during the same menstrual phase in two consecutive months. A subset of nine women also completed diffusion-weighted imaging (DWI). Fibroglandular tissue (FGT) density and FGT enhancement were measured on the contrast-enhanced MRI. Apparent diffusion coefficient (ADC) values were computed from DWI. Between- and within-subject coefficients of variation (bCV and wCV, respectively) were assessed. Repeatability of all measurements was assessed by the coefficient of repeatability (CR) and Bland-Altman plots. RESULTS The bCV of FGT density and FGT enhancement at visit 1 and visit 2 ranged from 47% to 63%. The wCV was 13% for FGT density, 22% for FGT enhancement, and 11% for ADC. The CRs of FGT density and FGT enhancement were 0.15 and 0.19, respectively, and for ADC, it was 6.1 x 10(-4) mm(2)/s. CONCLUSIONS We present an estimate of the variability and repeatability of MR measurements in normal breasts. These estimates provide the basis for understanding the normal variation of healthy breast tissue in MRI and establishing thresholds for agreement between measurements.
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Suarez C, Galgo A, Mantilla T, Leal M, Escobar C. Variables associated with change in blood pressure control status after 1-year follow up in primary care: a retrospective analysis: the TAPAS study. Eur J Prev Cardiol 2013; 21:12-20. [DOI: 10.1177/2047487313483609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Carmen Suarez
- Internal Medicine Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Alberto Galgo
- Primary Care Health Service, Centro de Salud Espronceda, Madrid, Spain
| | - Teresa Mantilla
- Primary Care Health Service, Centro de Salud Prosperidad, Madrid, Spain
| | - Manuel Leal
- Medical Department, AstraZeneca Madrid, Spain
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Vuchinich S, Flay BR, Aber L, Bickman L. Person mobility in the design and analysis of cluster-randomized cohort prevention trials. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2012; 13:300-13. [PMID: 22249907 DOI: 10.1007/s11121-011-0265-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Person mobility is an inescapable fact of life for most cluster-randomized (e.g., schools, hospitals, clinic, cities, state) cohort prevention trials. Mobility rates are an important substantive consideration in estimating the effects of an intervention. In cluster-randomized trials, mobility rates are often correlated with ethnicity, poverty and other variables associated with disparity. This raises the possibility that estimated intervention effects may generalize to only the least mobile segments of a population and, thus, create a threat to external validity. Such mobility can also create threats to the internal validity of conclusions from randomized trials. Researchers must decide how to deal with persons who leave study clusters during a trial (dropouts), persons and clusters that do not comply with an assigned intervention, and persons who enter clusters during a trial (late entrants), in addition to the persons who remain for the duration of a trial (stayers). Statistical techniques alone cannot solve the key issues of internal and external validity raised by the phenomenon of person mobility. This commentary presents a systematic, Campbellian-type analysis of person mobility in cluster-randomized cohort prevention trials. It describes four approaches for dealing with dropouts, late entrants and stayers with respect to data collection, analysis and generalizability. The questions at issue are: 1) From whom should data be collected at each wave of data collection? 2) Which cases should be included in the analyses of an intervention effect? and 3) To what populations can trial results be generalized? The conclusions lead to recommendations for the design and analysis of future cluster-randomized cohort prevention trials.
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Affiliation(s)
- Sam Vuchinich
- School of Social and Behavioral Health Sciences, Oregon State University, 314 Milam Hall, Corvallis, OR 97331, USA.
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Gislefoss RE, Grimsrud TK, Høie K, Mørkrid L. Stability of testosterone measured in male archival serum samples by two different methods. Scandinavian Journal of Clinical and Laboratory Investigation 2012; 72:555-62. [DOI: 10.3109/00365513.2012.705888] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Durán Pacheco G, Hattendorf J, Colford JM, Mäusezahl D, Smith T. Performance of analytical methods for overdispersed counts in cluster randomized trials: sample size, degree of clustering and imbalance. Stat Med 2010; 28:2989-3011. [PMID: 19672840 DOI: 10.1002/sim.3681] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Many different methods have been proposed for the analysis of cluster randomized trials (CRTs) over the last 30 years. However, the evaluation of methods on overdispersed count data has been based mostly on the comparison of results using empiric data; i.e. when the true model parameters are not known. In this study, we assess via simulation the performance of five methods for the analysis of counts in situations similar to real community-intervention trials. We used the negative binomial distribution to simulate overdispersed counts of CRTs with two study arms, allowing the period of time under observation to vary among individuals. We assessed different sample sizes, degrees of clustering and degrees of cluster-size imbalance. The compared methods are: (i) the two-sample t-test of cluster-level rates, (ii) generalized estimating equations (GEE) with empirical covariance estimators, (iii) GEE with model-based covariance estimators, (iv) generalized linear mixed models (GLMM) and (v) Bayesian hierarchical models (Bayes-HM). Variation in sample size and clustering led to differences between the methods in terms of coverage, significance, power and random-effects estimation. GLMM and Bayes-HM performed better in general with Bayes-HM producing less dispersed results for random-effects estimates although upward biased when clustering was low. GEE showed higher power but anticonservative coverage and elevated type I error rates. Imbalance affected the overall performance of the cluster-level t-test and the GEE's coverage in small samples. Important effects arising from accounting for overdispersion are illustrated through the analysis of a community-intervention trial on Solar Water Disinfection in rural Bolivia.
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Affiliation(s)
- Gonzalo Durán Pacheco
- Department of Public Health and Epidemiology, Interventions and Health Systems Unit, Swiss Tropical Institute, Basel, Switzerland.
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Olsen MK, DeLong ER, Oddone EZ, Bosworth HB. Strategies for analyzing multilevel cluster-randomized studies with binary outcomes collected at varying intervals of time. Stat Med 2008; 27:6055-71. [DOI: 10.1002/sim.3446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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van Marion AM, Auwerda JJ, Lisman T, Sonneveld P, de Maat M, Lokhorst HM, Leebeek FW. Prospective evaluation of coagulopathy in multiple myeloma patients before, during and after various chemotherapeutic regimens. Leuk Res 2008; 32:1078-84. [DOI: 10.1016/j.leukres.2007.12.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Revised: 11/29/2007] [Accepted: 12/10/2007] [Indexed: 11/25/2022]
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15
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Hallett TB, Garnett GP, Mupamberiyi Z, Gregson S. Measuring effectiveness in community randomized trials of HIV prevention. Int J Epidemiol 2007; 37:77-87. [DOI: 10.1093/ije/dym232] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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