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The article presents consensus paper regarding legal healthcare issues in caring for pressure ulcer patients prepared by the International Expert Wound Care Advisory Panel in the U.S. It notes that patients with pressure ulcers carry heavy burden due to human suffering and expensive health care costs. It states that the consensus paper is created to promote legal issue awareness on pressure ulcers and provide medical guidance to health care providers.

This article focuses on a new feature, "Hot Papers in the Literature" of the "Journal of Women's Health & Gender-Based Medicine." This regular feature would publish significant papers covering topics that will keep the readers up-to-date on the ever-expanding literature in women's health. The paper "Vasomotor and vascular effects of hormone replacement therapy," by P. Ganz. Cardiovascular risk factors impair endothelium-dependent vasodilation as well as other functions of the endothelium, thereby predisposing the patient to atherosclerosis and its overt clinical manifestations. Loss of endogenous estrogen also leads to reduced bioavailability of endothelium-derived nitric oxide. Another paper "Risks and benefits of estrogen plus progestin in healthy post-menopausal women: principal results from the Women's Health Initiative randomized controlled trial," has the objective of assessing the major health benefits and risks of the most commonly used combined hormone preparation in the United States.

The article provides information related to medical research for women's health in the U.S. The use of angiotensin-converting-enzyme inhibitors during pregnancy was prohibited by medical specialist because of the associated increased risk of fetopathy. The World Health Organization has collaborated a prospective study regarding the effect of female genital mutilation on obstetric outcome. A study regarding the examination of gender effects on peak exercise oxygen consumption, the implications for cardiac transplantation and the survival health failure patients.

This article presents several research summaries from the medical literature. The first summary deals with the cervical cancer screening among women without a cervix. In association with this research, most women in the United States who have undergone hysterectomy are not at risk of cervical cancer; they underwent the procedure for benign disease and they no longer have a cervix. In 1996, the U.S. Preventive Services Task Force recommended that routine Papanicolaou (Pap) smear screening is unnecessary for these women. The second summary deals with ovarian cancer detected non-invasively by contrast-enhanced power Doppler ultrasound.

The article discusses several studies related to women health. According to a study incidence of invasive lobular carcinoma has been increasing among post-menopausal women in some parts of the U.S. Part of this may be due to changes in classification over time. However, the use of combined (estrogen and progestin) hormone replacement therapy (CHRT) also has increased during the last decade and may account in part for the increase in invasive lobular breast carcinoma. According to the study postmenopausal women who take CHRT appear to be at an increased risk of lobular breast carcinoma. The effect of hormone replacement therapy on cardiovascular events in postmenopausal women is controversial. A study investigated the roles of sex and hormone replacement status in female patients undergoing coronary artery bypass grafting. Postmenopausal women undergoing coronary artery bypass had a significantly improved in-hospital survival if they had been receiving hormone replacement therapy. The improved survival might be related to one or more of the numerous cardiovascular effects of estrogen that are considered beneficial. A prospective randomized trial is needed to validate the observation that hormone replacement therapy is protective in this setting.

This paper describes hospital, insurance, and pharmaceutical price transparency policies and applications in the United States and in selected countries around the world. Many of these policies apply to self-insured employers. So far, the experience in the United States and elsewhere is clear that federal and state price transparency regulations have had little impact on whether employees or dependents search for low-cost or high-quality providers or on the cost and quality of their health care. This is because of weak regulatory oversight, conflicting federal and state reporting requirements, and few economic incentives for providers and insurance companies to supply easily readable or analyzable price information. However, price transparency requirements are here to stay. This paper therefore offers several recommendations to maximize the utility of price transparency tools provided for employees and other insureds, by their employers, providers, commercial insurance carriers, or technology firms. From a policy perspective, coupling reporting requirements with clearer technological guidance and much stronger regulatory oversight would increase the utility of price transparency efforts. For individual employers, the impact of price transparency efforts may increase by coupling price transparency tools with health plan network and design strategies, behavioral economic nudges, and programs designed to improve health, well-being, and quality of care. Many program vendor partners, consultants, and actuarial, technology, and research firms can help make these efforts useful. [ABSTRACT FROM AUTHOR]

The article presents abstracts of issues in women's health. They include "Explaining recent declines in adolescent pregnancy in the United States: The contribution of abstinence and improved contraceptive use," "Hormone replacement therapy and survival after colorectal cancer diagnosis," and "Does smoking increase risk of ovarian cancer? A systematic review."

The article discusses the research of American Medical Women's Association (AMWA) on sex- and gender-specific medicine. It states that sex- and gender-specific healthcare is a crucial health issue for women and the American healthcare system frequently fails to meet women's health care needs. It cites that despite several attempts to systemize data based sex- and gender-specific research, findings confirm that only few providers integrate this knowledge into their clinical practice.

Background: Stillbirth is a devastating event for families as well as hospital staff. Hospital practices around internal and external staff communication, debriefing, and training are unknown. Methods: We systematically sampled U.S. hospitals that provide obstetrical care. Staff knowledgeable of bereavement care on labor and delivery were invited to participate in an anonymous survey linked to hospital descriptors. We evaluated stillbirth communication, debriefing, and training for staff. Results: We received 289 usable surveys from 429 eligible staff (67% response). Most (94%) noted hospitals' marked rooms housing bereaved families, but only a third (37%) reported a marker on the paper or electronic medical record. Half of the hospitals had no standard debriefings post-loss, and 38% reported no perinatal loss training for labor and delivery nurses. Conclusions: Hospitals have significant variations and gaps in staff communication, support, and training, which are key aspects of respectful stillbirth care. [ABSTRACT FROM AUTHOR]

Social determinants of health (SDOH) are the greatest predictors of one's health status. There are clear SDOH disparities present in the United States, many of which have been especially evident during the COVID pandemic. SDOH have become a greater focus of payers, including Centers for Medicare & Medicaid Services (CMS). CMS has updated the reimbursement structure of Medicare and Medicaid to incentivize more SDOH-related interventions. Providers are also growing increasingly attentive to the SDOH needs of their patients, but often are unable to sufficiently address them outside of care settings. The combination of increased SDOH funding with inefficient mechanisms to meet patients' SDOH needs has led to the emergence of the for-profit SDOH industry. The purpose of this paper was to investigate the industry and identify its size, scope, and future implications. The authors conducted an analysis of for-profit SDOH companies using a third-party industry research platform. A collection of 58 companies was identified with $2.4 billion in funding and a total valuation of over $18.5 billion as of July, 2021. Two literature searches were conducted to support strategy recommendations for critically evaluating SDOH outcomes from these companies, and to determine the downstream effects they will have on community-based organizations also working to improve SDOH. [ABSTRACT FROM AUTHOR]

Objectives: To determine the psychosocial needs screening and intervention practices of obstetrician-gynecologists (OBGYNs) and elucidate characteristics associated with screening and resource availability. Methods: We administered a cross-sectional paper and online survey to 6288 U.S. office-based OBGYNs from March 18 to September 1, 2020, inquiring about screening and intervention practices for intimate partner violence, depression, housing, and transportation. We analyzed associations between demographic/practice characteristics and screening/having resources for all four needs. Results: 1210 OBGYNs completed the survey. One hundred ninety-five OBGYNs (16%) reported their practices screened all patients for all four needs. Having resources to address all four needs (prevalence ratio [PR] = 4.39, 95% confidence interval [CI] = 3.04–6.34), working in health centers/clinics (PR = 2.22, 95% CI = 1.43–3.45), and seeing ≥50% Medicaid patients (PR = 1.62, 95% CI = 1.02–2.58) were associated with screening for all four needs. One hundred sixty-eight OBGYNs (14%) reported their practices had resources onsite to address all four needs. Working in health centers/clinics (PR = 3.99, 95% CI = 2.56–6.22), large practices (PR = 3.37, 95% CI = 1.63–6.95), Medicaid expansion states (PR = 2.60, 95% CI = 1.45–4.65), and practices with >11% uninsured patients (PR 2.30, 95% CI = 1.31–4.04) were associated with having resources onsite for all four needs. Conclusion: Most OBGYN practices appeared underresourced to address psychosocial needs within clinical care. Innovative financial models or collaborative care models may help incentivize this work. [ABSTRACT FROM AUTHOR]

The integration of medical schools and clinical partners is effectively established through the formation of academic medical centers (AMCs). The tripartite mission of AMCs emphasizes the importance of providing critical clinical services, medical innovation through research, and the education of future health care leaders. Although AMCs represent only 5% of all hospitals, they contribute substantially to serving disadvantaged populations of patients, including an estimated 37% of all charity care and 26% of all Medicaid hospitalizations. Currently, most AMCs use a business model centered upon revenue generated from hospital services and/or practice plans. In the last decade, mounting financial demands have placed significant pressure on AMC finances because of the rising costs associated with complex clinical care and operating diverse graduate medical education programs. A shift toward population health-centric health care management strategies will profoundly influence the predominant forms of health care delivery in the United States in the foreseeable future. Health systems are increasingly pursuing new strategies to manage financial risk, such as forming Accountable Care Organizations and provider-sponsored plans to provide value-based care. Refocusing research and operational capacity toward population health management fosters collaboration and enables reintegration with hospital and clinical partners across care networks, and can potentially create new revenue streams for AMCs. Despite the benefits of population health integration, current literature lacks a blueprint to guide AMCs in the transformation toward sustainable population health management models. The purpose of this paper is to propose a modern conceptual framework that can be operationalized by AMCs in order to achieve a sustainable future. [ABSTRACT FROM AUTHOR]

Managing municipal solid waste (MSW) presents many challenges, including the production of methane when MSW biodegrades in landfills. The search for methods to predict methane generation easily and accurately has been ongoing as MSW management improves and the damage presented by greenhouse gases is realized. To study MSW biodegradability, samples of solid waste were collected by sorting trash at four landfills and transfer stations in the southeast United States and transported to laboratories where the MSW was processed and analyzed for methane potential using biochemical methane potential assay, fiber content (lignin, cellulose, and hemicellulose), total carbon analysis, and elemental analysis. Searches for correlation between these data and methane generation revealed that average cellulose content correlated with methane generation potential (R2 = 0.90). A formula for predicting the methane potential of MSW samples using elemental analysis and 1 of 14 different correction factors, assigned by waste category type, is also presented. The methods presented in this work can help researchers and landfill operators better evaluate the methane potential of the MSW they work with. [ABSTRACT FROM AUTHOR]

Health and health care in the United States are being jeopardized by top-end spending whose share of the gross domestic product continues to increase even as aggregate health outcomes remain mediocre. This paper focuses on a new approach for improving stakeholder role performance in the marketplace, value-driven population health (VDPHSM). Devoted to maximizing the value of every dollar spent on population health, VDPH holds much promise for ameliorating this dilemma and exerting a constructive influence on the reshaping of the Affordable Care Act. This paper introduces VDPH and differentiates the science underlying it from the management that serves to make good on its potential. To highlight what VDPH brings to the table, comparisons are made with 3 like-minded approaches to health reform. Next, 2 areas are highlighted, workplace wellness and the quality and cost of health care, where without necessarily being recognized as such, VDPH has gained real traction among 2 groups: leading employers and, more recently, leading providers. Key findings with respect to workplace wellness are assessed in terms of psychometric performance to evaluate workplace wellness and to point out how VDPH can help direct future employer initiatives toward firmer scientific footing. Then, insights gleaned from the employer experience are applied to illustrate how VDPH can help guide future provider efforts to build on the model developed. This paper concludes with a framework for the use of VDPH by each of 5 stakeholder groups. The discussion centers on how VDPH transcends and differentiates these groups. Implications for health reform in the recently altered political landscape are explored. [ABSTRACT FROM AUTHOR]

To provide medical and social services to underserved communities, many health care organizations across the United States have expanded the role of emergency medical services to include mobile integrated health and community paramedicine (MIH-CP). Although MIH-CP programs differ in structure and setting, many share the common goal of improving health through home-based, patient-centered care management models. Ideally, these innovative programs reduce use of health care services, including 911 (US emergency system) calls and emergency department visits. In 2018 a large, urban academic medical center partnered with the city's fire department to establish an MIH-CP program to support patients as they transition in their first 30 days at home after hospitalization. Prior to launch, a multidisciplinary team developed a logic model to guide development, implementation, and evaluation of this complex and innovative program. This paper describes the team's structured process for developing a logic model. It also describes key components of the initial logic model and the Transitional Health Support program structure, as well as subsequent revisions to both. [ABSTRACT FROM AUTHOR]

Multiple chronic conditions (MCC) reduce quality of life and are associated with high per capita health care spending. One potential way to reduce Medicare spending for MCC is to identify counties whose populations have high levels of spending compared to level of disease burden. Using a nationally representative sample of Medicare Fee-for-Service beneficiaries, this paper presents a method to measure the collective burden of several chronic conditions in a population, which the authors have termed the concentration of chronic conditions (CCC). The authors observed a significantly positive linear relationship between the CCC measure and county-level per capita Medicare spending. This area-level measure can be operationalized to identify counties that might benefit from targeted efforts designed to optimally manage and prevent chronic illness. [ABSTRACT FROM AUTHOR]

Black women in the United States have experienced substantial improvements in health during the last century, yet health disparities persist. These health disparities are in large part a reflection of the inequalities experienced by Black women on a host of social and economic measures. In this paper, we examine the structural contributors to social and economic conditions that create the landscape for persistent health inequities among Black women. Demographic measures related to the health status and health (in)equity of Black women are reviewed. Current rates of specific physical and mental health outcomes are examined in more depth, including maternal mortality and chronic conditions associated with maternal morbidity. We conclude by highlighting the necessity of social and economic equity among Black women for health equity to be achieved. [ABSTRACT FROM AUTHOR]

In this paper, we investigate how message construction, style, content, and the textual content of embedded images impacted message retransmission over the course of the first 8 months of the coronavirus disease 2019 (COVID-19) pandemic in the United States. We analyzed a census of public communications (n = 372,466) from 704 public health agencies, state and local emergency management agencies, and elected officials posted on Twitter between January 1 and August 31, 2020, measuring message retransmission via the number of retweets (ie, a message passed on by others), an important indicator of engagement and reach. To assess content, we extended a lexicon developed from the early months of the pandemic to identify key concepts within messages, employing it to analyze both the textual content of messages themselves as well as text included within embedded images (n = 233,877), which was extracted via optical character recognition. Finally, we modelled the message retransmission process using a negative binomial regression, which allowed us to quantify the extent to which particular message features amplify or suppress retransmission, net of controls related to timing and properties of the sending account. In addition to identifying other predictors of retransmission, we show that the impact of images is strongly driven by content, with textual information in messages and embedded images operating in similar ways. We offer potential recommendations for crafting and deploying social media messages that can "cut through the noise" of an infodemic. [ABSTRACT FROM AUTHOR]

The US opioid epidemic is national in scope, but many local solutions have been shown to have efficacy. Many nonprofit hospitals have the resources and infrastructure to lead these community-based efforts, but there is evidence that some organizations are not adopting opioid services as part of their community benefit requirements to assess and address critical community health needs. This paper assesses why hospitals do not address opioid abuse after completing a community health needs assessment. For a 20% random sample of nonprofit hospitals, a unique data set was constructed of hospital efforts to address opioid abuse using the most recent publicly available community health needs assessments and implementation strategies adopted by hospitals (calendar years 2015, 2016, 2017, or 2018). Multinomial logistic regression was used to assess the relationship between 5 different reasons hospitals cited for not addressing opioid abuse and both hospital and community characteristics. Results indicate that opioid abuse was not addressed by 32% (143) of hospitals in their formal implementation strategies. State community benefit laws, county overdose level, county poverty rate, hospital region, and hospital system membership all were significantly related to the reasons hospitals cited for not addressing opioid abuse as part of their community health engagement. Hospitals in communities with significant substance abuse needs and few institutional resources may need support to address opioid misuse and adopt treatment and harm reduction initiatives. Policies that support hospital–public health partnerships may be especially important to assist hospitals to address nonmedical or behavioral health needs in their communities. [ABSTRACT FROM AUTHOR]

The United States constantly faces the threat of large-scale disasters caused by natural and human factors. Emergency medical services, other first responders, and emergency department professionals are responsible for triaging and caring for victims of mass casualty incidents that include biological, chemical, and radiological agents. These providers need immediate access to individuals with expertise in infectious disease, medical toxicology, and biological, chemical, and radiological exposure who are readily available or easily accessible in the event of an emergency. Poison centers play a key public health role during disasters, in part because of the specialized training staff—including medical toxicologists—receive in all facets of toxic exposure risk identification, assessment, and management, which are foundational areas critical to disaster health response. Integrating poison centers into the public health infrastructure and public health surveillance is crucial for disaster response. Through enhanced partnerships with public health agencies, poison centers have leveraged their readily accessible expertise and surveillance capabilities to expand their roles in disaster planning and response. This paper highlights the pivotal role the Nebraska Regional Poison Center plays in preparing for and responding to disasters and other public health emergencies at local, state, and regional levels. With an emphasis on its role in risk assessment and management in partnership with healthcare coalitions and public health departments, we recommend the Nebraska Regional Poison Center as a model to inform other poison centers across the United States. [ABSTRACT FROM AUTHOR]

Background: In the United States, female physicians working in academic medical practices are less likely to achieve the academic rank of associate professor or professor than are male physicians of comparable seniority. Lack of mentoring has been suggested as a possible contributor to this difference. Methods: In this paper, we describe a facilitated peer mentorship pilot program that was developed to meet the unique needs of women faculty. Experienced female physicians acted as facilitators to a group of junior women who served as their own peer mentors. Outcome measures for the program included comparison of a pretest and a posttest completed by the peer mentor participants, a skills acquisition survey, published papers, and academic advancement of participants. Results: All the peer participants realized increased academic activity in the form of published papers and promotion in academic rank, skills acquisition, and enthusiasm for continuance of the program. Conclusions: This new model of facilitated peer mentorship demonstrated success in a small-scale pilot program. Expansion of this program and other creative solutions to the lack of mentoring for women may result in greater numbers of women achieving academic advancement. [ABSTRACT FROM AUTHOR]

The 2nd American Samueli Institute symposium was held January 22-25, 2004. The focus of this meeting was an exposition of optimal healing environments (OHE) in American health care. Fifty-five (55) invited guests participated; most had written one of the papers in this Supplement. The conduct of the meeting revolved around small group discussions and two plenary sessions. The ensuing dialogue refined and organized the definitions, components, and research protocols associated with creating and implementing an OHE. This Supplement contains both the invited papers and an abstract of the plenary session discussions. [ABSTRACT FROM AUTHOR]

Sebastian Kneipp (1821-1897) is seen as a vital link between the European nature cure movement of the 19th century and American naturopathy. He promoted a holistic treatment concept founded on five pillars: hydro- and phytotherapy, exercise, balanced nutrition, and regulative therapy. Kneipp attempted to bridge the gap with allopathic medicine, and many modern treatments that are based on his methods indeed blend wellness elements with naturopathic medicine and biomedicine. Because Kneipp's approach to health and healing today are mainly covered in German literature, this paper aims to provide a broader international audience with insights into his life and his treatment methods and to highlight the profound influence Kneipp has had to this day on natural and preventive medicine. The paper emphasizes in particular the continued popularity of Kneipp's holistic approach to health and well-being, which is evident in the many national and international Kneipp Associations, the globally operating Kneipp Werke, postgraduate qualifications in his treatment methods, and the existence of more than 60 accredited Kneipp spas and health resorts in Germany alone. [ABSTRACT FROM AUTHOR]

Background: Increasing emphasis in performance-based payment, public reporting, and quality improvement (QI) has led to widespread interest in measuring and improving the quality of care. By 2014, hospice programs will be required to report quality data to the federal government or incur financial penalties. With this increased interest in quality reporting comes an opportunity to develop informatics tools to capture data that reflect the complex practices involved in palliative care (PC). Therefore, there is a need to disseminate information on developing tools that facilitate capturing data and fostering improved performance. The Veterans Health Care Administration, a national leader in health information technology (HIT) and PC, established the Quality Improvement Resource Center (QuIRC) to develop innovative HIT tools to standardize and improve PC practices throughout the 153 Department of Veterans Affairs (VA) medical centers nationwide. Objective: The aim of the paper is to describe the development of the Palliative Care-National Clinical Template (PC-NCT) for documenting initial PC consults. Results: Domains of quality of life provided the foundation for this template. Principles of user-centered informatics design guided development activities. A national consensus panel of PC experts prioritized quality indicators as targets for QI. An interdisciplinary team of PC providers identified desired aspects of template functionality. QuIRC balanced PC providers' desired aspects of functionality against the feasibility within the VA HIT system. Formal pilot and usability testing contributed to numerous iterations of the PC-NCT currently piloted in five geographically distributed sites. Conclusion: This paper presents a robust approach to developing an informatics tool for PC practice. Data collected via the PC-NCT will bring variations in current practice into view and assist in directing resources at 'important targets' for QI. Although the development of HIT tools to quantify PC practice is complex, there is enormous potential to improve the quality of care for patients and families facing serious illnesses. [ABSTRACT FROM AUTHOR]

Background: Psychiatric research in the 1950s and 1960s showed potential for psychedelic medications to markedly alleviate depression and suffering associated with terminal illness. More recent published studies have demonstrated the safety and efficacy of psilocybin, MDMA, and ketamine when administered in a medically supervised and monitored approach. A single or brief series of sessions often results in substantial and sustained improvement among people with treatment-resistant depression and anxiety, including those with serious medical conditions. Need and Clinical Considerations: Palliative care clinicians occasionally encounter patients with emotional, existential, or spiritual suffering, which persists despite optimal existing treatments. Such suffering may rob people of a sense that life is worth living. Data from Oregon show that most terminally people who obtain prescriptions to intentionally end their lives are motivated by non-physical suffering. This paper overviews the history of this class of drugs and their therapeutic potential. Clinical cautions, adverse reactions, and important steps related to safe administration of psychedelics are presented, emphasizing careful patient screening, preparation, setting and supervision. Conclusion: Even with an expanding evidence base confirming safety and benefits, political, regulatory, and industry issues impose challenges to the legitimate use of psychedelics. The federal expanded access program and right-to-try laws in multiple states provide precendents for giving terminally ill patients access to medications that have not yet earned FDA approval. Given the prevalence of persistent suffering and growing acceptance of physician-hastened death as a medical response, it is time to revisit the legitimate therapeutic use of psychedelics. [ABSTRACT FROM AUTHOR]

Early in the HIV/AIDS epidemic in the United States, relatively few women were diagnosed with HIV infection and AIDS. Today, the epidemic represents a growing and persistent health threat to women in the United States, especially young women and women of color. In 2005, the leading cause of HIV infection among African American women and Latinas was heterosexual contact. In addressing HIV prevention needs among women, community-level strategies are needed to increase consistent condom use by women and their partners and to change community norms to support safer sex behaviors. The Real AIDS Prevention Project (RAPP) is a community-based HIV prevention intervention for women and their partners. RAPP is based on a community mobilization model that involves a combination of activities, including street outreach, one-on-one discussions called stage-based encounters, role model stories, community networks, and small group activities. The objectives of RAPP are to increase consistent condom use by women and their partners and change community norms associated with perceptions of condom use and high-risk behaviors in an effort to make safer sex practice more acceptable. This paper describes the Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention (DHAP) effort to nationally diffuse RAPP from March 2003 through May 2007 and lessons learned from that diffusion experience. The paper specifically discusses (1) collaborating and planning with researchers, (2) a diffusion needs assessment that was designed to assess prior implementation experiences among select agencies, (3) developing the intervention package, (4) developing and piloting training for community-based organizations (CBOs), (5) a rollout of national trainings for health departments and community-based organizations interested in implementing RAPP, and (6) ongoing quality assurance activities and the provision of technical assistance and support. RAPP has been proven effective in reducing HIV transmission risk behaviors and improving communication and negotiation skills necessary for African American women and Latinas to reduce their risk for HIV infection and improve their overall health status. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to highlight specific considerations in the medical management of women with type 2 diabetes mellitus (T2DM). T2DM, a significant source of morbidity and mortality, has become an ever growing epidemic within the United States. Although it is well understood that diabetes can significantly increase the risk for microvascular and macrovascular complications, there has been limited research examining the differential impact of these complications on men and women. Women, in particular, are subject to especially high risk for the development of myocardial infarction (MI), claudication, and stroke and are disproportionately afflicted by cardiovascular, cerebrovascular, and peripheral vascular disease. There is new evidence that tight glycemic control and earlier initiation of insulin therapy can improve outcomes and thereby reduce the risk for development of both macrovascular and microvascular complications of the disease. Although there are many commonalities in the treatment of men and women, women with diabetes have several unique issues, including the possible effects of therapy on reproductive health, fetal health, breastfeeding, potential interactions with hormonal contraceptives, and effects on bone health, that should be considered when determining a therapeutic approach. This paper presents evidence-based treatment strategies for reducing the risk of diabetes-associated complications overall and cardiovascular disease in particular through glycemic control. Special attention is paid to the selection of antidiabetic agents that are best suited to the unique needs of women. [ABSTRACT FROM AUTHOR]

The death of a child has a profound and often long-lasting impact on families. The parent's relationship and their ability to bond with and take care of surviving children may be affected. It is important for healthcare workers to understand the dynamics associated with bereavement, especially when the family comes from a non-Western culture. Islam is one of the three most populous religions along with Christianity and Hinduism and the fastest growing religion in the United States but remains largely misunderstood. This paper seeks to explain what Islam is, who is a Muslim, where they live, and what they believe and practice. It also explains how Islamic beliefs contextualize the meaning of life and death for Muslims and how they are exhorted to grieve upon a child's death. Reading this paper will enable those who care for Muslim families to better attend to the social and emotional needs of Muslim parents and siblings after such a tragic event. [ABSTRACT FROM AUTHOR]

Telemedicine, the use of telecommunication technologies to provide health services over somedistance, has a history that spans more than five decades. Technological development and deploymenthave been interrelated with shifting paradigmatic views. This paper proposes thattelemedicine has evolved through three generations that began with telemedicine as a communicationmedium to complement traditional services to a technology of automation anddecision tools that expands the scope and range of health services and creates a unique healthcommunication context. This paper provides a literature review and overviews three proposedevolutionary stages for telemedicine to date, namely synchronous versus asynchronous modalities,data transfer and storage, and automating decision making and robotics. Finally, weconclude with a discussion of the barriers for telemedicine and a call for engineers to joinwith social scientists and medical professionals to set an agenda for future telemedicine development. [ABSTRACT FROM AUTHOR]

At present, more than 60% of American women of childbearing age are either overweight or obese. As the obesity epidemic in the United States and many other countries continues to grow unchecked, there is greater interest in the relationship between obesity and other major health issues. This paper reviews the literature on the relationship between obesity and pregnancy. We begin with a discussion of the relationship between excess body weight and fertility and then turn to the relationship between maternal body weight and pregnancy-related complications. The role of pregnancy as a possible risk factor for the development of obesity is noted. The studies investigating the efficacy of behavioral interventions to control excessive weight gain during pregnancy or help women lose weight after childbirth are then reviewed. The paper concludes with an agenda for future research examining the relationship between obesity and pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To present a summary of published estimates of the economic burden of uterine fibroids in the United States and identify areas for additional research. Methods: A search of three electronic databases, MEDLINE, EMBASE, and Current Contents, was conducted, along with a review of information on the Internet and abstraction of economic data. Results: Only 10 papers and 1 Internet document met our inclusion criteria and were used to abstract data. Cost estimates for surgically invasive treatments of uterine fibroids included hysterectomy ($5,012–$7,934), myomectomy ($5,425–$11,839), and uterine artery embolization (UAE) ($5,425–$7,645) (2004$). One cost-effectiveness study estimated lower costs and higher quality-adjusted life years with UAE compared with hysterectomy. A second study estimated potential savings of $4.2 million in hospital charges in the United States if higher rates of vaginal (vs. abdominal) hysterectomy would be achieved after pretreatment with gonadotropin hormone-releasing hormone (GnRH) agonists compared to without pretreatment with GnRH agonists (80% vs. 13%). There were no estimates of the total direct and indirect economic burden of uterine fibroids. Neither estimates of the costs for the ambulatory care of fibroids nor studies estimating the indirect costs associated with the management of fibroids and their symptoms were found. Conclusions: This summary of published U.S. economic estimates shows that despite the high prevalence of fibroids and their impact on clinical practice and women's lives, there is very little published information on their economic impact apart from data showing standard treatments for uterine fibroids are invasive and expensive. Reduction in the need for and cost of invasive procedures by the increased usage of noninvasive treatments could potentially achieve significant national cost savings, but further clinical and economic studies are needed. [ABSTRACT FROM AUTHOR]

Cyanide species have been observed in soil and groundwater at manufactured gas plant (MGP) sites throughout the United States. Groundwater impacts at these sites can occur as a result of leaching (dissolution) from spent oxide box residuals, which were sometimes used onsite as fill material. The predominant forms of cyanide compounds in these residuals are iron–cyanide solids, the most prominent among them being Prussian Blue or ferric-ferrocyanide (FFC). The dissolution behavior of these iron–cyanide solids is a strong function of porewater pH and pE. Upon dissolution, FFC primarily releases dissolved-phase iron–cyanide complexes. Dissolved phase cyanide complexes and species can exist in a number of different chemical forms, ranging from free cyanide (HCN or CN–) to weak-acid dissociable complexes (e.g., cyanide complexes with copper, zinc, and nickel) to available cyanides (e.g., weak-acid dissociable complexes plus mercury cyanide complex) to strong-acid dissociable complexes (complexes of cyanide with iron and cobalt). This paper presents the result of a detailed characterization of cyanide species in soil and groundwater samples collected from 10 MGP sites in the State of New York. Also presented in this paper is the confirmation that two different soluble iron–cyanide complexes dominate the site groundwaters and soil leachates at these MGP sites. Finally, site-specific geochemical information, like pH and pE, were used as the master variables to develop semiquantitative predictions of cyanide concentrations in groundwater within or near source materials. [ABSTRACT FROM AUTHOR]

Disease management programs have become increasingly popular over the past 5-10 years. Recent increases in overall medical costs have precipitated new concerns about the cost-effectiveness of medical management programs that have extended to the program directors for these programs. Initial success of the disease management movement is being challenged on the grounds that reported results have been the result of the application of faulty, if intuitive, methodologies. This paper discusses the use of "pre-post" methodology approaches in the analysis of disease management programs, and areas where application of this approach can result in spurious results and incorrect financial outcome assessments. The paper includes a checklist of these items for use by operational staff working with the programs, and a comprehensive bibliography that addresses many of the issues discussed. [ABSTRACT FROM AUTHOR]

Objective: Diabetes has been increasing in incidence and prevalence in the United States. Physical activity and exercise have been shown to lower the risk of noninsulin-dependent diabetes (NIDD), and family history and genetic factors are associated with both insulin-dependent diabetes (IDD) (type 1) and NIDD. The objective of this paper is to examine risk factors for diabetes in female college graduates as part of a study designed to determine the long-term health of former college athletes compared with nonathletes. The study was first conducted in 1981-1982, and a follow-up study was conducted in 1996-1997. Methods: The subjects for this paper are 3940 college alumnae (1945 former athletes and 1995 nonathletes), who participated in the follow-up study by responding to a self-administered questionnaire on medical history, health, family history, and behavioral practices. Results: About 1.3% of the women reported physician-diagnosed diabetes, 0.9% of the former athletes, and 1.7% of the nonathletes. Former athletes had a significantly lower risk of NIDD, with an age-adjusted odds ratio (OR) of 0.41, 95% confidence level (CL) 0.2, 0.9. IDD was associated with a history of paternal diabetes (OR = 4.7, 95% CL 1.5, 14.9) and also with a history of diabetes in siblings (OR = 6.7, 95% CL 1.5, 30.1). NIDD was associated with a history of maternal diabetes (OR = 8.0, 95% CL 3.6, 17.8). Behavioral factors showed no association with IDD but were inversely associated with NIDD. The OR for being an athlete was 0.4, 95% CL 0.2, 0.9; for current regular exercise, OR = 0.4, 95% CL 0.2, 0.9; low body mass index (BMI) compared to high BMI, OR = 0.2, 95% CL 0.05, 0.60. Conclusions: The findings that IDD is associated with paternal diabetes and that NIDD may be maternally transmitted are not widely known, although the mode of transmission of diabetes is receiving increasing attention in the medical and genetic literature. This study confirms that modifiable behavioral practices, such as physical activity and weight control (i.e., optimal BMI), reduce the risk of NIDD. [ABSTRACT FROM AUTHOR]

This paper uses confirmatory structural equation models to develop and test a theoretical model for understanding the service utilization history of 4679 youth who received services from 10 national HIV/AIDS demonstration models of youth-appropriate and youth-attractive services funded by the Special Projects of National Significance (SPNS) Program, HIV/AIDS Bureau, Health Resources and Services Administration. Although the projects differ from one another in the areas of emphasis in their service models, each is targeted to youth at high risk for HIV, or those youth who have already contracted HIV. Collectively, the projects represent a comprehensive adoelscent HIV service model. This paper examines the characteristics of the services provided to young people ranging from outreach to intensive participation in medical treatment. Major typologies of service utilization are derived empirically through exploratory factor and cluster analysis methods. Confirmatory structural equation modeling methods are used to refine the exploratory results using a derivation and replication strategy and methods of statistical estimation appropriate for non-normally distributed service utilization indicators. The model hypothesizes that youth enter the service system through a general construct of connectedness to a comprehensive service model and through service-specific methods, primarily of outreach or emergency services. Estimates are made of the degree to which a comprehensive service model drives the services as opposed to specific service entry points. [ABSTRACT FROM AUTHOR]

To forecast future trends in diabetes prevalence, morbidity, and costs in the United States, the Institute for Alternative Futures has updated its diabetes forecasting model and extended its projections to 2030 for the nation, all states, and several metropolitan areas. This paper describes the methodology and data sources for these diabetes forecasts and discusses key implications. In short, diabetes will remain a major health crisis in America, in spite of medical advances and prevention efforts. The prevalence of diabetes (type 2 diabetes and type 1 diabetes) will increase by 54% to more than 54.9 million Americans between 2015 and 2030; annual deaths attributed to diabetes will climb by 38% to 385,800; and total annual medical and societal costs related to diabetes will increase 53% to more than $622 billion by 2030. Improvements in management reducing the annual incidence of morbidities and premature deaths related to diabetes over this time period will result in diabetes patients living longer, but requiring many years of comprehensive management of multiple chronic diseases, resulting in dramatically increased costs. Aggressive population health measures, including increased availability of diabetes prevention programs, could help millions of adults prevent or delay the progression to type 2 diabetes, thereby helping turn around these dire projections. [ABSTRACT FROM AUTHOR]

Successfully incorporating social determinants of health (SDH) screening into clinic workflows can help care teams provide targeted care, appropriate referrals, and other interventions to address patients' social risk factors. However, integrating SDH screening into clinical routines is known to be challenging. To achieve widespread adoption of SDH screening, we need to better understand the factors that can facilitate or hinder implementation of effective, sustainable SDH processes. The authors interviewed 43 health care staff and professionals at 8 safety net community health center (CHC) organizations in 5 states across the United States; these CHCs had adopted electronic health record (EHR)-based SDH screening without any external implementation support. Interviewees included staff in administrative, quality improvement, informatics, front desk, and clinical roles (providers, nurses, behavioral health staff), and community health workers. Interviews focused on how each organization integrated EHR-based SDH screening into clinic workflows, and factors that affected adoption of this practice change. Factors that facilitated effective integration of EHR-based SDH screening were: (1) external incentives and motivators that prompted introduction of this screening (eg, grant requirements, encouragement from professional associations); (2) presence of an SDH screening advocate; and (3) maintaining flexibility with regard to workflow approaches to optimally align them with clinic needs, interests, and resources. Results suggest that it is possible to purposefully create an environment conducive to successfully implementing EHR-based SDH screening. Approaching the task of implementing SDH screening into clinic workflows as understanding the interplay of context-dependent factors, rather than following a step-by-step process, may be critical to success in primary care settings. [ABSTRACT FROM AUTHOR]

Hypertension is a prevalent chronic disease that requires ongoing management and self-care. The disease affects 31% of American adults and contributed to or caused the deaths of 348,000 Americans in 2008, fewer than 50% of whom effectively self-managed the disease. However, self-management is complex, with patients requiring ongoing support and easy access to care. Telehealth may help foster the knowledge and skills necessary for those with hypertension to engage in successful self-management. This paper considers the applicability, efficacy, associated risks, and cost-effectiveness of telehealth for individuals and populations with hypertension. Telehealth is a broad term, encompassing telemedicine and mobile health that is used for physician-patient interactions, diagnostics, care delivery, education, information sharing, monitoring, and reminders. Telemedicine may have considerable utility for people diagnosed with hypertension who have poor access or social barriers that constrain access, but potential risks exist. Telehealth technology is evolving rapidly, even in the absence of fully proven cost-effectiveness and efficacy. Considering the cost of inpatient and emergency department care for patients with hypertension, telehealth is a highly attractive alternative, but there are risks to consider. Incorporating telehealth, which is increasingly characterized by mobile health, can increase both the capacity of health care providers and the reach of patient support, clinical management, and self-care. Telehealth studies need improvement; long-term outcome data on cardiovascular events must be obtained, and robust risk analyses and economic studies are needed to prospectively evaluate the safety and cost savings for hypertension self-management. ( Population Health Management 2015;18:192-202) [ABSTRACT FROM AUTHOR]

This paper describes the development of an institution-specific website designed to meet the supportive and emotional needs of young adults (18-39 years old) with cancer in the United States. The website contains information about topics of particular interest to young adults, coping skills education, and resources; and has social networking capacity. In a survey of website users, participants reported increased 'connectedness' and variable impact on feelings of sadness, fear, and worry. Recommendations are made for fostering peer interactions, encouraging staff to educate website users around self-monitoring for distress, and incorporating relevant content on the website. [ABSTRACT FROM AUTHOR]

This paper presents a new approach to estimating the indirect costs of health-related absenteeism. Productivity losses related to employee absenteeism have negative business implications for employers and these losses effectively deprive the business of an expected level of employee labor. The approach herein quantifies absenteeism cost using an output per labor hour-based method and extends employer-level results to the region. This new approach was applied to the employed population of 3 health insurance carriers. The economic cost of absenteeism was estimated to be $6.8 million, $0.8 million, and $0.7 million on average for the 3 employers; regional losses were roughly twice the magnitude of employer-specific losses. The new approach suggests that costs related to absenteeism for high output per labor hour industries exceed similar estimates derived from application of the human capital approach. The materially higher costs under the new approach emphasize the importance of accurately estimating productivity losses. ( Population Health Management 2015;18:47-53) [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is a well-recognized public health problem. IPV affects women's physical and mental health through direct pathways, such as injury, and indirect pathways, such as a prolonged stress response that leads to chronic health problems. The influence of abuse can persist long after the violence has stopped and women of color are disproportionately impacted. Successfully addressing the complex issue of IPV requires multiple prevention efforts that target specific risk and protective factors across individual, interpersonal, institutional, community, and societal levels. This paper includes examples of community-based, state led and federally funded public health programs focused on IPV along this continuum. Two community-based efforts to increase access to mental health care for low income, women of color who had experienced IPV, Mindfulness-Based Stress Reduction, and a telehealth intervention are discussed. Core tenets of a patient-centered comprehensive approach to assessment and responses and strategies for supporting a statewide comprehensive response are described in Project Connect: A Coordinated Public Health Initiative to Prevent Violence Against Women. Project Connect provides technical assistance to grantees funded through the Violence Against Women Act's health title and involves developing, implementing, and evaluating new ways to identify, respond to, and prevent domestic and sexual violence and promote an improved public health response to abuse in states and Native health programs. Health care partnerships with domestic violence experts are critical in order to provide training, develop referral protocols, and to link IPV victims to advocacy services. Survivors need a comprehensive response that addresses their safety concerns and may require advocacy around housing or shelter, legal assistance, and safety planning. Gaps in research knowledge identified are health system readiness to respond to IPV victims in health care settings and partner with domestic violence programs, effects of early IPV intervention, and models for taking interventions to scale. [ABSTRACT FROM AUTHOR]

Background: As evidence-based medicine (EBM) becomes a standard in health care, it is essential that practitioners of complementary and alternative medicine (CAM) become experts in searching and evaluating the research literature. In support of this goal, the National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM) provided R25 funding to nine CAM colleges to develop individual programs focused on teaching EBM. An overarching goal of these research education grants has been to provide CAM faculty and students with the skills they need to apply a rigorous evidence-based perspective to their training and practice. Methods/Results: This paper reviews the competencies and teaching strategies developed and implemented to enhance research literacy at all nine R25-funded institutions. While each institution designed approaches suitable for its research culture, the guiding principles were similar: to develop evidence-informed skills and knowledge, thereby helping students and faculty to critically appraise evidence and then use that evidence to guide their clinical practice. Curriculum development and assessment included faculty-driven learning activities and longitudinal curricular initiatives to encourage skill reinforcement and evaluate progress. Conclusion: As the field of integrative medicine matures, the NIH-NCCAM research education grants provide essential training for future clinicians and clinician-researchers. Building this workforce will facilitate multidisciplinary collaborations that address the unique needs for research that informs integrative clinical practice. [ABSTRACT FROM AUTHOR]

In this paper, we review the basis of the U.S. Preventive Services Task Force's recommendations related to routine screening for intimate partner violence (IPV), focus on two of the arguments of those who have rejected these recommendations, and based on these, suggest that this controversy has occurred, in part, as a result of different interpretations of the meaning of “screening.” We differentiate screening from situations in which asking about IPV is essential for differential diagnosis, that is, exploring exposure to IPV when there are signs and symptoms that might result from this exposure. Finally, we describe the randomized, controlled trial CDC is conducting to contribute to the evidence the U.S. Preventive Services Task Force requries to make its recommendations. [ABSTRACT FROM AUTHOR]

Hypothesis: The goal of this paper is to assess the use of complementary and alternative medicine (CAM) use among children with cystic fibrosis (CF) and the communication with the primary care physician. Materials and methods: The paper is based on data from surveys mailed to 97 patients recruited from Monmouth Medical CF Center. The questionnaire was anonymous and included 47 questions referring to demographic data (age, sex, number of years since diagnosed, state of residence, use of pancreatic enzymes, overall lung function and general health) as well as questions referring to all types of CAM practices: whole medical systems, manipulative practices, body mind medicine, biologically based practices, and energy medicine. Results: The response rate was 50.5%, with 81% being pediatric patients under 18 years old. The results showed that 77% of patients use some form of CAM when the definition of CAM therapy included prayer specifically for health reasons. When prayer was excluded from the definition, the use of CAM decreased to 65%. The most commonly used CAM therapies were biologically based practices (53%) followed by body–mind medicine (49%), manipulative practices (14.5%), and whole medical systems (8%). Most of the patients interviewed did not consult a natural practitioner but considered that CAM treatments were beneficial. Conclusions: The present survey provides current data describing the use of CAM in patients with CF and adds to the increasing body of evidence about CAM use in the United States. Further research is needed to explore the relationship and effectiveness of specific types of CAM practices and their benefits on symptom relief and overall quality of life of CF patients. [ABSTRACT FROM AUTHOR]

Introduction: Remote patient monitoring or telemonitoring aims at improving patient care through digitally transmitted health-related data. That allows early detection of disease decompensation and intervention, patient education and improves patient–physician relationship. Despite its relevance, there are no comprehensive reviews evaluating the variables discussed by clinical studies on telemonitoring. Methods: A systematic literature search of PubMed was performed to identify studies about telemonitoring published between 2000 and 2018. These had to be case reports with >5 cases, comparative or clinical studies/trials. The following variables were evaluated: year of publication, author's country, discussed topic, objective of study, follow-up time, number of telemonitoring patients, primary outcome, use of teleconsultation and tele-education, presence of a control group, effectiveness of telemonitoring, telemonitoring strategies, and level of evidence. Results: After screening 947 records, 272 articles were included. The review showed a growing number of publications over the years, with 43.0% being published between 2015 and 2018, providing generally positive results (76.8%). The United States was responsible for 38.2% of articles. Cardiovascular disease was the topic of 47.8% of studies, whereas surgical pathologies and postoperative care represented only 2.6%. Wireless devices or smartphone apps were the most popular strategy (75.7%), with 17.6% of studies employing tele-education and 24.6% employing teleconsultation measures. Most publications were OCEBM Level of Evidence 2 (73.5%). Conclusion: Telemonitoring appears to maximize patient care and effectiveness of treatment. The number of publications illustrates the growing interest in the matter. Telemonitoring has yet to be evaluated in the setting of postoperative care and surgical pathologies. [ABSTRACT FROM AUTHOR]

Background: The effect of an oral antibiotic preparation prior to colorectal surgery was first examined and exalted in the 1973 paper by Nichols et al. Since this commencement, enthusiasm for the oral antibiotic regimen has waxed and waned reflecting the literature focused on this topic over the past 40 years. Polling colorectal surgeons of define current practices has been performed at intervals throughout the years and has demonstrated a trend to decline in the practice. The most recent publication surveying U.S. practices was in 2010, which reported a minority, 36%, use of oral antibiotics prior to elective colorectal surgery; a marked downtrend from the 88% use described in 1990. Since this last survey, the colorectal surgery community has performed considerable research examining the benefit of oral antibiotic and mechanical bowel preparation. This manuscript evaluates the current use of oral antibiotics in colorectal surgery in the U.S. and how practice trends have developed in response to current recommendations in the literature. Methods: An electronic survey was created and distributed to U.S. colorectal surgeons to evaluate current opinions and practice trends. A total of 359 American Society of Colon and Rectal Surgeons members responded. A review of the recent literature pertaining to pre-operative bowel practices and outcomes was performed to compare with current practices. Results: A significant majority (83.2%) of respondents use pre-operative oral antibiotics routinely, and 98.6% routinely use mechanical bowel preparation. The use of a combination of parenteral antibiotics, oral antibiotics, and mechanical bowel preparation is reported by 79.3%. The most commonly employed oral antibiotic regimen is neomycin and metronidazole. The most common mechanical bowel preparation is polyethylene glycol (PEG). The most common parenteral antibiotics are cefazolin and metronidazole. There was no statistically significant difference in this practice by geographic region, Board-certified status, or practice setting. Conclusion: The majority of colorectal surgeons employ a combination of oral antibiotics, mechanical bowel preparation, and parenteral antibiotics prior to colorectal surgery. This is consistent across geographic regions, despite Board certification status or practice setting, and is reflective of the recommendations based on recent literature. [ABSTRACT FROM AUTHOR]