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Introduction Collabo RATE is a brief patient survey focused on shared decision making. This paper aims to (i) provide insight on facilitators and challenges to implementing a real-time patient survey and (ii) evaluate Collabo RATE scores and response rates across multiple clinical settings with varied patient populations. Method All adult patients at three United States primary care practices were eligible to complete Collabo RATE post-visit. To inform key learnings, we aggregated all mentions of unanticipated decisions, problems and administration errors from field notes and email communications. Mixed-effects logistic regression evaluated the impact of site, clinician, patient age and patient gender on the Collabo RATE score. Results While Collabo RATE score increased only slightly with increasing patient age ( OR 1.018, 95% CI 1.014-1.021), female patient gender was associated with significantly higher Collabo RATE scores ( OR 1.224, 95% CI 1.073-1.397). Clinician also predicts Collabo RATE score (random effect variance 0.146). Site-specific factors such as clinical workflow and checkout procedures play a key role in successful in-clinic implementation and are significantly related to Collabo RATE scores, with Site 3 scoring significantly higher than Site 1 ( OR 1.759, 95% CI 1.216 to 2.545) or Site 2 (z=−2.71, 95% CI −1.114 to −0.178). Discussion This study demonstrates that Collabo RATE can be used in diverse primary care settings. A clinic's workflow plays a crucial role in implementation. Patient experience measurement risks becoming a burden to both patients and administrators. Episodic use of short measurement tools could reduce this burden. [ABSTRACT FROM AUTHOR]

Provides information on the June 2003 special issue of "Concurrency and Computation: Practice and Experience" journal featuring research papers from the International Conference on Cluster Computing held in Newport Beach, California in October 2001. Highlights of the event; Selection of papers for publication in the journal; Topics covered by the research papers accepted by the journal for its special issue.

Background: Members of the public are increasingly engaged in health‐service and biomedical research and provide input into the content of research, design and data sharing. As there is variation among different communities on how research is perceived, to engage all sectors of the general public research institutions need to customize their approach. Objective: This paper explores how research institutions and community leaders can partner to determine the best ways to engage different sectors of the public in research. Design: Following a literature review, a research institution engaged with four different sectors of the public through their respective representative community‐based organizations (CBOs) by interviews with leaders, community member focus groups and a joint project. Setting: San Diego and Imperial Counties, California, United States of America (USA). Conclusion: Before embarking on more specific research projects, investigators can gain valuable insights about different communities' attitudes to, and understanding of, health services and biomedical research by interacting directly with members of the community, collaborating with community leaders, and jointly identifying steps of engagement tailored to the community. [ABSTRACT FROM AUTHOR]

Objectives The objectives of this paper were to explore the acceptability of components of a mobile phone/pedometer-based physical activity program and to understand motivators and barriers to increase physical activity in a diverse sample of sedentary women. Design and Sample Face-to-face semi-structured interviews were conducted following a 3-week pilot mobile phone/pedometer-based physical activity intervention. Forty-one sedentary women participated in the study. Measures Subjects were interviewed using a semi-structured interview guide. A qualitative description method was used to thematically analyze the interviews. Two investigators reviewed the transcripts independently and identified codes based on the main concerns in the interview questions. Results Three themes emerged from qualitative data shedding light on the perceived acceptability and usefulness of a mobile phone/pedometer-based intervention: (1) Monitor me: mobile phone/pedometer as self-monitoring tools, (2) Motivate me: cycle of feedback in goal setting and usefulness/uselessness of daily random messages, (3) Mobilize me: engaging and adapting physical activity to fit one's own lifestyle. Conclusion Mobile phone and pedometer-based physical activity programs might be helpful in keeping sedentary women engaged and motivated to increase their physical activity. A randomized controlled trial of this intervention is warranted. [ABSTRACT FROM AUTHOR]

Often, when conducting programme evaluations or studying the effects of policy changes, researchers may only have access to aggregated time series data, presented as observations spanning both the pre- and post-intervention periods. The most basic analytic model using these data requires only a single group and models the intervention effect using repeated measurements of the dependent variable. This model controls for regression to the mean and is likely to detect a treatment effect if it is sufficiently large. However, many potential sources of bias still remain. Adding one or more control groups to this model could strengthen causal inference if the groups are comparable on pre-intervention covariates and level and trend of the dependent variable. If this condition is not met, the validity of the study findings could be called into question. In this paper we describe a propensity score-based weighted regression model, which overcomes these limitations by weighting the control groups to represent the average outcome that the treatment group would have exhibited in the absence of the intervention. We illustrate this technique studying cigarette sales in California before and after the passage of Proposition 99 in California in 1989. While our results were similar to those of the Synthetic Control method, the weighting approach has the advantage of being technically less complicated, rooted in regression techniques familiar to most researchers, easy to implement using any basic statistical software, may accommodate any number of treatment units, and allows for greater flexibility in the choice of treatment effect estimators. [ABSTRACT FROM AUTHOR]

Stockman et al. (2006 ) found that ecological niche models built using DesktopGARP ‘failed miserably’ to predict trapdoor spider (genus Promyrmekiaphila) distributions in California. This apparent failure of GARP (Genetic Algorithm for Rule-Set Production) was actually a failure of the authors’ methods, that is, attempting to build ecological niche models using single data points. In this paper, we present a re-analysis of their original data using standard methods with the data appropriately partitioned into training/testing subsets. This re-evaluation generated accurate distributional predictions that we contrast with theirs. We address the consequences of model-building using single data points and the need for a foundational understanding of the principles of ecological niche modelling. [ABSTRACT FROM AUTHOR]

Background: The financial status of nursing homes (NHs) is a policy concern, especially during a pandemic, because of the higher costs associated with infection prevention and resident care. Methods: This exploratory study was designed to assess the impact of the federal and state COVID‐19 funding support on California NHs profitability during 2020, the first year of the pandemic, compared with 2019, the last pre‐pandemic year. The study examined the association of Medicare and Medicaid days, related‐party transactions, as well as other facility characteristics on net income profit margins, using cross‐sectional regression analysis of data from state NH cost reports and federal NH provider data for 2019 and 2020. Results: California skilled NHs had average reported net income profit margins of 2.26% in 2019 and 7.0% in 2020 with wide variations (from a loss of about 48% to a gain of 74% in 2020). Regression analysis found that the number of beds, occupancy rates, high‐quality rating scores, and medium and high proportions of Medicare resident days were positively associated with net income margins in 2019 and 2020. Chains in 2020 (but not 2019), related‐party expenditures in 2019 and 2020, median Medicaid days (in 2019), high Medicaid resident days (71%–73% or higher) in 2019 and 2020, and medium and high managed care resident days were negatively associated with net income margins in both years. Conclusions: Although NH admissions and occupancy rates declined substantially between 2019 and 2020, some (but not all) California NHs had a substantial increase in profit margins in 2020 over 2019. More studies of nursing home financial patterns and profitability are needed to examine trends over time and variations across states. [ABSTRACT FROM AUTHOR]

The 1997 North American Summer Meeting of the Econometric Society will be held at the California Institute of Technology in Pasadena, California from June 25-29, 1997. The Program Chair will be Tom Palfrey and the Local Arrangements Chair is Kim Border. The program will include both invited and contributed papers. All paper submissions should be mailed to the Program Chair. The specification of paper submissions is also presented. Also, the 1997 Far Eastern Meeting of the Econometric Society will be held at the Chinese University in Hong Kong, Shatin, New Territories, Hong Kong on July 24-26, 1997.

This case study of an inter-university controversy over the publication of research from an interdisciplinary social science project on the forced migration and long- term internment of West Coast Japanese-Americans during World War II shows some of the difficulties of maintaining ownership of research materials. In this particular instance the junior employee was able to override his seniors' demand for control of the dissemination of research results by playing on the concerns about even appearing to suppress work for political reasons. The paper discusses conflicting norms of science and rhetorics of justification ranging from proprietary self-interest through "good science" to "the national interest" and onto "the needs of a free society." [ABSTRACT FROM AUTHOR]

Aims: To test the efficacy of a brief intervention to reduce alcohol or drug use and to promote use of addiction services among patients seeking mental health treatment. Design and setting: A multi‐centre, longitudinal, two‐group randomized controlled trial with randomization within each of two mental health treatment systems located in Ventura County and Los Angeles County in California, USA. Participants: A total of 718 patients (49.2% female) aged 18 and older with a mental health diagnosis and either a heavy drinking day or any use of cannabis or stimulants in the past 90 days. Intervention and comparator: A motivation‐based brief intervention with personalized feedback (screening, brief intervention and referral to treatment (SBIRT) condition) (n = 354) or a health education session (control condition) (n = 364). Measurements Primary outcomes included frequency of heavy drinking days, days of cannabis use and days of stimulant use at the primary end‐point 3 months post‐baseline. Secondary outcomes included frequency and abstinence from substance use out to a 12‐month follow‐up and the use of addiction treatment services. Findings Participants in the SBIRT condition had fewer heavy drinking days [odds ratio (OR) = 0.53; 95% credible interval (CrI) = 0.48–0.6] and fewer days of stimulant use (OR = 0.58; 95% CrI = 0.50–0.66) at the 3‐month follow‐up compared with participants in the health education condition. Participants in the SBIRT condition did not comparatively reduce days of cannabis use at the 3‐month follow‐up (OR = 0.93; 95% CrI = 0.85–1.01). Secondary outcomes indicated sustained effects of SBIRT on reducing the frequency of heavy drinking days and days of stimulant use. No effects were observed on abstinence rates or use of addiction treatment services. Conclusions: Screening and brief intervention for unhealthy alcohol and drug use in mental health treatment settings were effective at reducing the frequency of heavy drinking and stimulant use. [ABSTRACT FROM AUTHOR]

Background: Among Latinas with breast cancer, residence in an ethnic enclave may be associated with survival. However, findings from prior studies are inconsistent.Methods: The authors conducted parallel analyses of California and Texas cancer registry data for adult (aged ≥18 years) Latinas who were diagnosed with invasive breast cancer from 1996 to 2005, with follow-up through 2014. Existing indices applied to tract-level 2000 US Census data were used to measure Latinx enclaves and neighborhood socioeconomic status (nSES). Multivariable Cox proportional hazard models were fit for all-cause and breast cancer-specific survival adjusted for year of diagnosis, patient age, nativity (with multiple imputation), tumor stage, histology, grade, size, and clustering by census tract.Results: Among 38,858 Latinas, the majority (61.3% in California and 70.5% in Texas) lived in enclaves. In fully adjusted models for both states, foreign-born women were found to be more likely to die of breast cancer and all causes when compared with US-born women. Living in enclaves and in neighborhoods with higher SES were found to be independently associated with improved survival from both causes. When combined into a 4-level variable, those in low nSES nonenclaves had worse survival for both causes compared with those living in low nSES enclaves and, in the all-cause but not breast cancer-specific models, those in high nSES neighborhoods, regardless of enclave status, had improved survival from all causes.Conclusions: Applying the same methods across 2 states eliminated previously published inconsistent associations between enclave residence and breast cancer survival. Future studies should identify specific protective effects of enclave residence to inform interventions. [ABSTRACT FROM AUTHOR]

Objective: To develop a nurse staffing prediction model and evaluate deviation from predicted nurse staffing as a contributor to patient outcomes.Data Sources: Secondary data collection conducted 2017-2018, using the California Office of Statewide Health Planning and Development and the California Perinatal Quality Care Collaborative databases. We included 276 054 infants born 2008-2016 and cared for in 99 California neonatal intensive care units (NICUs).Study Design: Repeated-measures observational study. We developed a nurse staffing prediction model using machine learning and hierarchical linear regression and then quantified deviation from predicted nurse staffing in relation to health care-associated infections, length of stay, and mortality using hierarchical logistic and linear regression.Data Collection Methods: We linked NICU-level nurse staffing and organizational data to patient-level risk factors and outcomes using unique identifiers for NICUs and patients.Principal Findings: An 11-factor prediction model explained 35 percent of the nurse staffing variation among NICUs. Higher-than-predicted nurse staffing was associated with decreased risk-adjusted odds of health care-associated infection (OR: 0.79, 95% CI: 0.63-0.98), but not with length of stay or mortality.Conclusions: Organizational and patient factors explain much of the variation in nurse staffing. Higher-than-predicted nurse staffing was associated with fewer infections. Prospective studies are needed to determine causality and to quantify the impact of staffing reforms on health outcomes. [ABSTRACT FROM AUTHOR]

Objective: To estimate the impact of opting-out from Medicare supervision requirements for certified registered nurse anesthetists (CRNAs) on anesthesiologists' work patterns.Data Sources/study Setting: Secondary data from two national surveys of anesthesiologists and the Area Health Resource File.Study Design: We use a matching difference-in-difference regression which contrasts the change in work patterns for anesthesiologists in California, which dropped supervision requirements, to the change for similar anesthesiologists. Key outcome variables include the number of weekly hours worked, the type of work done, and type of care delivery teams.Data Collection/extraction Methods: Self-reported national survey data drawn from members of the American Society of Anesthesiologists.Principal Findings: Anesthesiologists in California saw no change in time spent working or time spent supervising CRNAs. There was a decrease in direct care clinical work hours along with a shift in working more in intraoperative care, a decrease in postoperative care, and an increase in the percentage of cases supervising residents.Conclusions: Anesthesiologists had small but real responses to California's decisions to opt-out of the physician supervision requirement for CRNAs, doing more work in intraoperative care and less outside of the operating room. Total hours worked saw no change. [ABSTRACT FROM AUTHOR]

Objectives: Repeat visits (revisits) to emergency departments (EDs) for psychiatric care reflect poor continuity of care and impose a high financial cost. We test whether rapid expansion of community health centers (CHCs)—which provide regional, low‐cost primary care—correspond with fewer repeat psychiatric‐related ED visits (PREDVs). Methods: We obtained repeated cross‐sectional time‐series data for 7.8 million PREDVs from the State Emergency Department Database for four populous U.S. states (California, Florida, North Carolina, and New York) from 2006 to 2011. We specified as the outcome variable the count of repeat visits per ED visitor with a psychiatric diagnosis. We retrieved aggregate‐level mental health visits at CHCs from the Uniform Data System. Negative binomial regression methods controlled for individual‐level confounders, county health system and sociodemographic attributes, year fixed effects, and county fixed effects. Results: The risk of a repeat PREDV decreased with a county‐level increase in mental health patients seen at CHCs (incidence rate ratio = 0.986, 95% confidence interval = 0.98 to 0.99). Conversion of this rate ratio to the number of revisits averted indicated 34,000 fewer repeat PREDVs in these four states statistically associated with a 1% expansion in CHC mental health visits. Exploratory analyses found that revisits decline for relatively mild/moderate illnesses (e.g., mood, anxiety disorders) but not for severe illnesses (e.g., schizophrenia/psychoses). Conclusion: An increase in mental health services at CHCs corresponds with a modest decline in repeat PREDVs. This decline concentrates among those with less severe mental illnesses. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify specific ictal hand postures (HPs) as localizing signs of the epileptogenic zone (EZ) in patients with frontal or temporal lobe epilepsy.Methods: In this study, we retrospectively analyzed ictal semiology of 489 temporal lobe or frontal lobe seizures recorded over a 6-year period at the Seizure Disorder Center at University of California, Los Angeles in the USA (45 patients) or at the C. Munari Epilepsy Surgery Center at Niguarda Hospital in Milan, Italy (34 patients). Our criterion for EZ localization was at least 2 years of seizure freedom after surgery. We analyzed presence and latency of ictal HP. We then examined whether specific initial HPs are predictive for EZ localization.Results: We found that ictal HPs were present in 72.5% of patients with frontal and 54.5% of patients with temporal lobe seizures. We divided HPs into 6 classes depending on the reciprocal position of the fingers ("fist," "cup," "politician's fist," "pincer," "extended hand," "pointing"). We found a striking correlation between EZ localization and ictal HP. In particular, fist and pointing HPs are strongly predictive of frontal lobe EZ; cup, politician's fist, and pincer are strongly predictive of temporal lobe EZ.Interpretation: Our study offers simple ictal signs that appear to clarify differential diagnosis of temporal versus frontal lobe EZ localization. These results are meant to be used as a novel complementary tool during presurgical evaluation for epilepsy. At the same time, they give us important insight into the neurophysiology of hand movements. ANN NEUROL 2019;86:793-800. [ABSTRACT FROM AUTHOR]

This article presents a text of a research paper regarding correctional work presented at the Third Annual Institutional Workers' Conference held at Chapman College in Orange, California, on January 29, 1964. According to the author, several areas are needed in the practice of correctional work to examine their performance and its implications. First, correctional work is impervious to logical argument. Second, insensitive to basic issues of civil liberty and democratic ideals. Third, indifferent to crime-causing elements in the external political and social world. Lastly, inhospitable to research and novelty. The dual tendency of corrections to fail to do comprehensive research and to ignore such fructifying research when it is done, while less than totally accurate for California, remains in general one of the field's basic shortcomings. More than virtually all persons in society, correctional people are in a position to know where its ugliness and inequity and soreness lies. It is a terrible default to maintain blandly that it is the failure of the individual to come to grips with reality.

Objectives: The objective was to determine whether children surviving to hospital discharge after firearm assault (FA) and nonfirearm assault (NFA) are at increased risk of mortality relative to survivors of unintentional trauma (UT). Secondarily, the objective was to elucidate the factors associated with long‐term mortality after pediatric trauma. Methods: This was a multicenter, retrospective cohort study of pediatric patients aged 0 to 16 years who presented to the three trauma centers in San Francisco and Alameda counties, California, between January 2000 and December 2009 after 1) FA, 2) NFA, and 3) UT. The Social Security Death Master File and the California Department of Public Health Vital Statistics (2000–2014) were queried through December 31, 2014, to identify those who died after surviving their initial hospitalization and to delineate cause of death. Multivariate Cox proportional hazards regression was performed to determine associations between exposure to assault and long‐term mortality. Results: We analyzed 413 FA, 405 NFA, and 7,062 UT patients who survived their index hospital visit. A total of 75 deaths occurred, including 3.9, 3.2, and 0.7% of each cohort, respectively. Two‐thirds of all long‐term deaths were due to homicide. After multivariate adjustment, adolescent age, male sex, black race/ethnicity, and public insurance were independent risk factors for long‐term mortality. FA (adjusted hazard ratio [AHR] = 1.8, 95% confidence interval [CI] = 0.82–4.0) and NFA (AHR = 1.9, 95% CI = 0.93–3.9) did not convey a statistically significant difference in risk of long‐term mortality compared to UT. Being assaulted by any means (with or without a firearm), however, was an independent risk factor for long‐term mortality in the full study population (AHR = 1.9, 95% CI = 1.01–3.4) and among adolescents (AHR = 1.9, 95% CI = 1.01–3.6). Conclusion: Children and adolescents who survive assault, including by firearm, have increased long‐term mortality compared to those who survive unintentional, nonviolent trauma. [ABSTRACT FROM AUTHOR]

The article reports on the 2018 Research Society on Alcoholism Annual Meeting. Discussed are the symposiums on topics including "Sex-Dependent Alcohol Associated Comorbidities" with Organizer/Chairman Liz Simon; "Predicting Outcomes of Fetal Alcohol Exposure in the CIFASD Cohort" with Organizers/Chairmen Michael Charness and Edward Riley and "The Development of Heavy Drinking in African Americans: Understudied Risk and Protective Factors" with Organizer Angela Haeny and Chairman Carolyn Sartor.

The article offers information on the abstracts of the several research studies. Discussed are the topics of the research studies which include "Glycine/Sarcosine Ratio As Novel Biomarker For Alcohol-Induced Liver Fibrosis Under Sumoylation Control"; "Increased Chemokines, Chemokine Receptors, And Neurodegeneration In Postmortem Human Alcoholic Brain" and "The Role Of Microglia-Expressed Trem2 In Ethanol-Induced Neuroimmune Activation"

The article discusses the Research Society on Alcoholism (RSA) 41st Annual Scientific Meeting on June 16-20, 2018 in San Diego, California. Also discussed are the schedule of events which include the Skill Blitz Workshop for undergrads and students; the lecture of Ting-Kai Li on topic "The Molecular Neurobiology And Human Genetics of Specific Addictive Diseases: Implications for Treatments" and the symposium on "Sex-Dependent Alcohol Associated Comorbidities" with Liz Simon as organizer.

Objective: To estimate the effect of out-of-pocket (OOP) cost on nonadherence to classes of cardiometabolic medications among patients with diabetes.Data Sources/setting: Electronic health records from a large, health care delivery system for 223,730 patients with diabetes prescribed 842,899 new cardiometabolic medications during 2006-2012.Study Design: Observational, new prescription cohort study of the effect of OOP cost on medication initiation and adherence.Data Collection: Adherence and OOP costs were based on pharmacy dispensing records and benefits.Principal Findings: Primary nonadherence (never dispensed) increased monotonically with OOP cost after adjusting for demographics, neighborhood socioeconomic status, Medicare, medical financial assistance, OOP maximum, deductibles, mail order pharmacy incentive and use, drug type, generic or brand, day's supply, and comorbidity index; 7 percent were never dispensed the new medication when OOP cost ≥$11, 5 percent with OOP cost of $1-$10, and 3 percent when the medication was free of charge (p < .0001). Higher OOP cost was also strongly associated with inadequate secondary adherence (≥20 percent of time without adequate medication). There was no clinically significant or consistent relationship between OOP costs and early nonpersistence (dispensed once, never refilled) or later stage nonpersistence (discontinued within 24 months).Conclusions: Cost-sharing may deter clinically vulnerable patients from initiating essential medications, undermining adherence and risk factor control. [ABSTRACT FROM AUTHOR]

Background and aims Anhedonia-a transdiagnostic psychopathological trait indicative of inability to experience pleasure-could lead to and result from adolescent marijuana use, yet this notion has not been tested. This study aimed to estimate the association of: (1) anhedonia at age 14 with rate of change in marijuana use over an 18-month follow-up, and (2) marijuana use at age 14 with rate of change in anhedonia over follow-up. Secondary aims were to test whether gender, baseline marijuana use history and peer marijuana use moderated these associations. Design Observational longitudinal cohort repeated-measures design, with baseline (age 14 years), 6-month, 12-month and 18-month follow-up assessments. Settings Ten public high schools in Los Angeles, CA, USA, 2013-15. Participants Students [ n = 3394; 53.5% female, mean (standard deviation) age at baseline = 14.1 (0.42)]. Measurements Self-report level of anhedonia on the Snaith-Hamilton Pleasure Scale and frequency of marijuana use in the past 30 days. Findings Parallel process latent growth curve models adjusting for confounders showed that baseline anhedonia level was associated positively with the rate of increase in marijuana use frequency across follow-ups [β, 95% confidence interval (CI) = 0.115 (0.022, 0.252), P = 0.03]. Baseline marijuana use frequency was not related significantly to the rate of change in anhedonia across follow-ups [β, 95% CI = −0.015 (−0.350, 0.321), P = 0.93]. The association of baseline anhedonia with faster marijuana use escalation was amplified among adolescents with (versus without) friends who used marijuana at baseline [β, 95% CI = 0.179 (0.043, 0.334) versus 0.064 (−0.071, 0.187), interaction P = 0.04], but did not differ by gender or baseline ever marijuana use. Conclusions In mid-adolescence, anhedonia is associated with subsequent marijuana use escalation, but marijuana use escalation does not appear to be associated with subsequent anhedonia. [ABSTRACT FROM AUTHOR]

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Children's developing reasoning skills are better understood within the context of their social and cultural lives. As part of a research-museum partnership, this article reports a study exploring science-relevant conversations of 82 families, with children between 3 and 11 years, while visiting a children's museum exhibit about mammoth bones, and in a focused one-on-one exploration of a "mystery object." Parents' use of a variety of types of science talk predicted children's conceptual engagement in the exhibit, but interestingly, different types of parent talk predicted children's engagement depending on the order of the two activities. The findings illustrate the importance of studying children's thinking in real-world contexts and inform creation of effective real-world science experiences for children and families. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Schools can address critical sexual and reproductive health (SRH) issues among youth. However, little is known about SRH education being implemented in charter schools. Thus, our purpose was to explore implementation of SRH education in charter schools. METHODS Using purposive sampling, semistructured telephone interviews were conducted with 20 charter school principals in San Diego County, California. Questions were guided by the Kaiser Family Foundation National Survey of Public Secondary School Principals. Analyses followed a case-oriented approach, examining aspects within each case (ie, a principal), and then a comparative analysis of a small number of cases (ie, all principals). RESULTS Overall, 17 principals acknowledged offering sexuality education in the previous 2 years. Over half of these schools had provided content on: sexually transmitted diseases/human immunodeficiency virus/acquired immune deficiency syndrome (STDs/HIV/AIDS), reproduction/pregnancy/birth, pregnancy prevention methods, delaying sex, and managing sexual pressure. Condom use, sexual assault, sexual orientation, talking with partners about STD/pregnancy prevention, talking with parents about relationships/sex, and using/where to get contraception were less commonly taught. Abortion was not addressed. When asked the grade they would assign to their schools' sexuality/HIV instruction, principals assigned 1 A, 7 Bs, 7 Cs, and 1 D. CONCLUSIONS Consistency between our findings and what has been reported elsewhere varies. As charter schools often have greater curricular flexibility than traditional schools, this study provides unique preliminary data to inform future innovative, or strengthen existing, SRH programming. [ABSTRACT FROM AUTHOR]

Background Treatment for alcohol use disorders (AUDs) has traditionally been abstinence oriented, but new research and regulatory guidelines suggest that low-risk drinking may also be an acceptable treatment outcome. However, little is known about long-term outcomes for patients who become low-risk drinkers posttreatment. This study explores a posttreatment low-risk drinking outcome as a predictor of future drinking and psychosocial outcomes over 9 years. Methods Study participants were adults with AUDs at treatment entry who received follow-up interviews 6 months posttreatment intake ( N = 1,061) in 2 large randomized studies conducted at Kaiser Permanente Northern California, a large private, nonprofit, integrated health system. Six-month drinking status was defined as abstinent, low-risk (nonabstinent, no 5+ drinking days), or heavy drinking (1 or more days of 5+ drinks). Using logistic regression models, we explored the relationship between past 30-day drinking status at 6 months and odds of being abstinent or a low-risk drinker (compared to heavy drinking), and positive Addiction Severity Index psychosocial outcomes over 9 years (9-year follow-up rate of 73%). Results Abstainers and low-risk drinkers at 6 months had higher odds of recent abstinence/low-risk drinking over 9 years than heavy drinkers; abstainers had better drinking outcomes than low-risk drinkers. Additionally, among those with interview data, 95% of abstainers and 94% of low-risk drinkers at 6 months were abstinent/low-risk drinkers at 9 years; surprisingly, 89% of heavy drinkers at 6 months were also abstinent/low-risk drinkers although still significantly fewer than the other groups. Abstainers and low-risk drinkers at 6 months had better psychiatric outcomes, and abstainers had better family/social outcomes than heavy drinkers; medical outcomes did not differ. Low-risk drinkers and abstainers showed no reliable differences across psychosocial measures. Conclusions The findings suggest that a low-risk drinking outcome may be reasonable over the long-term for some alcohol-dependent individuals receiving addiction treatment. [ABSTRACT FROM AUTHOR]

Objective: We assessed implementation of the 10-item Patient-Reported Outcomes Measurement Information System (PROMIS) physical function form (PF-10a) in routine practice in a racially and ethnically diverse population with rheumatoid arthritis (RA). Objectives were to determine feasibility of implementing PF-10a in the electronic health record (EHR) and PF-10a validity and longitudinal responsiveness.Methods: Clinical and demographic data were abstracted from EHRs for all RA patients seen at a university-based rheumatology clinic between February 2013 and February 2015. We evaluated floor and ceiling (edge) effects and construct validity of PF-10a in a subgroup of patients with Health Assessment Questionnaire (HAQ) scores (n = 189). We used linear mixed-effects models to assess responsiveness of PF-10a to longitudinal changes in the Clinical Disease Activity Index (CDAI) for patients in the entire clinical cohort, with both scores recorded on at least 2 encounters (n = 326).Results: Half of the patients were nonwhite, and 15% were non-English speakers. Over a 2-year period, PF10a was successfully implemented; 97% of patients and 89% of encounters had at least 1 measurement performed. PF-10a had fewer ceiling (defined as best) effects than the HAQ (8% versus 22%), and convergent validity was high (r = -0.85). PF-10a was sensitive to expected differences (older versus younger patients, more versus less active disease). Longitudinal changes in PF-10a were highly associated with changes in the CDAI score (P < 0.0001).Conclusion: PF-10a was feasible to implement in a diverse RA population. It strongly correlates with the HAQ but has fewer ceiling effects and is responsive to changes in RA disease activity, suggesting its validity for use in routine clinical practice. [ABSTRACT FROM AUTHOR]

Aims To determine the prevalence of depression and diabetes distress in adults with Type 1 diabetes and the rate of false-positives when compared with rates of major depressive disorder. Methods The sample consisted of 368 individuals with Type 1 diabetes, aged > 19 years. Individuals completed: the eight-item Patient Health Questionnaire depression scale (PHQ8), which was coded using four scoring criteria (scores > 10, >12 and >15, and Diagnostic and Statistical Manual of Mental Disorders 5 ( DSM) algorithm scores); the Type 1 Diabetes Distress Scale; and the Structured Clinical Interview for DSM Disorders (SCID) to assess major depressive disorder. Results The prevalence rates of depression according to the eight-item Patient Health Questionnaire were: score >10, 11.4%; score >12, 7.1%; score >15, 3.8%; and positive algorithm result, 4.6%. The prevalence of major depressive disorder was 3.5%; and the prevalence of at least moderate diabetes distress was 42.1%. Depending on the criterion used, the false-positive rate when using the Patient Health Questionnaire compared with the results when using the SCID varied from 52 to 71%. Of those classified as depressed on the PHQ-8 or Structured Clinical Interview for DSM Disorders, between 92.3 and 96.2% also reported elevated diabetes distress. No significant association was found between any group classed as having depression according to the PHQ8 or the SCID and HbA1c concentration. Depression was significantly associated with more other life stress, more complications and a lower level of education. Conclusions We found an unexpectedly low rate of current depression and major depressive disorder in this diverse sample of adults with Type 1 diabetes, and a very high rate of false-positive results using the Patient Health Questionnaire. Considering the high prevalence of diabetes distress, much of what has been considered depression in adults with Type 1 diabetes may be attributed to the emotional distress associated with managing a demanding chronic disease and other life stressors and not necessarily to underlying psychopathology. [ABSTRACT FROM AUTHOR]

Objective: To investigate the distribution of known factors for preterm birth (PTB) by severity of maternal underweight; to investigate the risk-adjusted relation between severity of underweight and PTB, and to assess whether the relation differed by gestational age.Design: Retrospective cohort study.Setting: State of California, USA.Methods: Maternally linked hospital and birth certificate records of 950 356 California deliveries in 2007-2010 were analysed. Singleton live births of women whose prepregnancy body mass index (BMI) was underweight (<18.5 kg/m2 ) or normal (18.50-24.99 kg/m2 ) were analysed. Underweight BMI was further categorised as: severe (<16.00), moderate (16.00-16.99) or mild (17.00-18.49). PTB was grouped as 22-27, 28-31, 32-36 or <37 weeks (compared with 37-41 weeks). Adjusted multivariable Poisson regression modeling was used to estimate relative risk for PTB.Main Outcome Measures: Risk of PTB.Results: About 72 686 (7.6%) women were underweight. Increasing severity of underweight was associated with increasing percent PTB: 7.8% (n = 4421) in mild, 9.0% (n = 1001) in moderate and 10.2% (475) in severe underweight. The adjusted relative risk of PTB also significantly increased: adjusted relative risk (aRR) = 1.22 (95% CI 1.19-1.26) in mild, aRR = 1.41 (95% CI 1.32-1.50) in moderate and aRR = 1.61 (95% CI 1.47-1.76) in severe underweight. These findings were similar in spontaneous PTB, medically indicated PTB, and the gestational age groupings.Conclusion: Increasing severity of maternal prepregnancy underweight BMI was associated with increasing risk-adjusted PTB at <37 weeks. This increasing risk was of similar magnitude in spontaneous and medically indicated births and in preterm delivery at 28-31 and at 32-36 weeks of gestation.Tweetable Abstract: Increasing severity of maternal underweight BMI was associated with increasing risk of preterm birth. [ABSTRACT FROM AUTHOR]

Objectives To determine whether lifestyle factors, measured late in life, could compress the disabled period toward the end of life. Design Community-based cohort study of older adults followed from 1989 to 2015. Setting Four U.S. communities. Participants Community-living men and women aged 65 and older (N = 5,248, mean age 72.7 ± 5.5, 57% female, 15.2% minority) who were not wheelchair dependent and were able to give informed consent at baseline. Measurements Multiple lifestyle factors, including smoking, alcohol consumption, physical activity, diet, body mass index ( BMI), social networks, and social support, were measured at baseline. Activities of daily living ( ADLs) were assessed at baseline and throughout follow-up. Years of life (YoL) was defined as years until death. Years of able life ( YAL) was defined as years without any ADL difficulty. YAL/YoL%, the proportion of life lived able, was used to indicate the relative compression or expansion of the disabled period. Results The average duration of disabled years was 4.5 (out of 15.4 mean YoL) for women and 2.9 (out of 12.4 mean YoL) for men. In a multivariable model, obesity was associated with 7.3 percentage points (95% confidence interval ( CI) = 5.4-9.2) lower YAL/YoL% than normal weight. Scores in the lowest quintile of the Alternate Healthy Eating Index were associated with a 3.7% (95% CI = 1.6-5.9) lower YAL/YoL% than scores in the highest quintile. Every 25 blocks walked in a week was associated with 0.5 percentage points (95% CI = 0.3-0.8) higher YAL/YoL%. Conclusion The effects of healthy lifestyle factors on the proportion of future life lived free of disability indicate that the disabled period can be compressed, given the right combination of these factors. [ABSTRACT FROM AUTHOR]

Aims To examine the safety and effectiveness of buprenorphine + naloxone sublingual tablets (BUP, as Suboxone®) provided after administration of extended-release injectable naltrexone (XR-NTX, as Vivitrol®) to reduce cocaine use in participants who met DSM-IV criteria for cocaine dependence and past or current opioid dependence or abuse. Methods This multi-centered, double-blind, placebo-controlled study, conducted under the auspices of the National Drug Abuse Treatment Clinical Trials Network, randomly assigned 302 participants at sites in California, Oregon, Washington, Colorado, Texas, Georgia, Ohio, New York and Washington DC, USA to one of three conditions provided with XR-NTX: 4 mg/day BUP (BUP4, n = 100), 16 mg/day BUP (BUP16, n = 100, or no buprenorphine (placebo; PLB, n = 102). Participants received pharmacotherapy for 8 weeks, with three clinic visits per week. Cognitive behavioral therapy was provided weekly. Follow-up assessments occurred at 1 and 3 months post-intervention. The planned primary outcome was urine drug screen (UDS)-corrected, self-reported cocaine use during the last 4 weeks of treatment. Planned secondary analyses assessed cocaine use by UDS, medication adherence, retention and adverse events. Results No group differences were found between groups for the primary outcome (BUP4 versus PLB, P = 0.262; BUP16 versus PLB, P = 0.185). Longitudinal analysis of UDS data during the evaluation period using generalized linear mixed equations found a statistically significant difference between BUP16 and PLB [ P = 0.022, odds ratio (OR) = 1.71] but not for BUP4 ( P = 0.105, OR = 1.05). No secondary outcome differences across groups were found for adherence, retention or adverse events. Conclusions Buprenorphine + naloxone, used in combination with naltrexone, may be associated with reductions in cocaine use among people who meet DSM-IV criteria for cocaine dependence and past or current opioid dependence or abuse. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study examined gambling behaviors and the relationship between gambling problems and alcohol use disorders (AUDs) among Chinese-, Korean-, and White-American college students.Methods: Participants were 678 (179 Chinese, 194 Korean, and 305 White; 50% female) 21-26 year-old (M = 22.0 ± 1.36) students attending one university in California. The South Oaks Gambling Screen was administered to assess gambling behavior and the Semi-Structured Assessment for the Genetics of Alcoholism was administered to diagnose lifetime AUDs. Chi-squares and multinomial logistic regressions were conducted to test our hypotheses.Results: Rates of lifetime ever gambling and weekly gambling were similar across the three ethnic groups, but participation in five types of gambling behavior differed. Chinese had the highest rates of gambling problems followed by Koreans and then Whites. Univariate odds ratios determined being Chinese or Korean, being male, and having an AUD were risk factors for gambling problems. When stratified by gender and ethnicity, having an AUD was not related to gambling problems in women, but was strongly associated with gambling problems in Chinese and White men and modestly associated in Korean men. This was true despite low rates of AUDs in Chinese men.Discussion and Conclusions: Gambling problems were strongly comorbid with AUDs in Chinese- and White-American men, and moderately comorbid in Korean-American men. No relationship of AUD with gambling problems was found in women.Scientific Significance: The results highlight the importance of assessing disaggregated Asian-American subgroups with respect to addictive behaviors and their comorbidity. [ABSTRACT FROM AUTHOR]

Background Different drinkers may experience specific risks depending on where they consume alcohol. This longitudinal study examined drinking patterns, and demographic and psychosocial characteristics associated with youth drinking in different contexts. Methods We used survey data from 665 past-year alcohol-using youths (ages 13 to 16 at Wave 1) in 50 midsized California cities. Measures of drinking behaviors and drinking in 7 contexts were obtained at 3 annual time points. Other characteristics included gender, age, race, parental education, weekly disposable income, general deviance, and past-year cigarette smoking. Results Results of multilevel regression analyses show that more frequent past-year alcohol use was associated with an increased likelihood of drinking at parties and at someone else's home. Greater continued volumes of alcohol (i.e., heavier drinking) was associated with increased likelihood of drinking at parking lots or street corners. Deviance was positively associated with drinking in most contexts, and past-year cigarette smoking was positively associated with drinking at beaches or parks and someone else's home. Age and deviance were positively associated with drinking in a greater number of contexts. The likelihood of youth drinking at parties and someone else's home increased over time, whereas the likelihood of drinking at parking lots/street corners decreased. Also, deviant youths progress to drinking in their own home, beaches or parks, and restaurants/bars/nightclubs more rapidly. Conclusions The contexts in which youths consume alcohol change over time. These changes vary by individual characteristics. The redistribution of drinking contexts over the early life course may contribute to specific risks associated with different drinking contexts. [ABSTRACT FROM AUTHOR]

Although group-based relative deprivation predicts people's willingness to protest unfair outcomes, perceiving that one's subgroup is respected increases employees' support for organizations. An integration of these perspectives suggests that subgroup respect will dampen the impact of group-based relative deprivation on workers' responses to unfair organizational outcomes. We examined this hypothesis among university faculty ( N = 804) who underwent a system-wide pay cut. As expected, group-based relative deprivation predicted protest intentions. This relationship was, however, muted among those who believed university administrators treated their area of expertise (i.e., their subgroup) with a high (vs. low) level of respect. Moderated mediation analyses confirmed that group-based relative deprivation had a conditional indirect effect on protest intentions via participants' (dis)identification with their university at low to moderate, but not high, levels of subgroup respect. Our finding that satisfying relational needs can attenuate responses to group-based relative deprivation demonstrates the benefits of integrating insights from distinct research traditions. [ABSTRACT FROM AUTHOR]

Background Multiple forms of anxiety psychopathology are associated with alcohol use problems in adolescents. Yet, the mechanisms underlying this association are unclear. Anxiety sensitivity (AS) and distress tolerance (DT) represent 2 distinct, conceptually relevant transdiagnostic constructs implicated in multiple manifestations of anxiety that may also underlie alcohol use problems and thereby explain why people with anxiety are more likely to have alcohol problems. Methods The current cross-sectional study examined whether AS and DT accounted for (i.e., statistically mediated) the relationship between manifest indicators of the 3 common anxiety phenotypes (generalized anxiety, social anxiety, and panic disorders) and alcohol problems in a sample of 534 high school students (14 to 15 years old). Results Multiple manifestations of anxiety were associated with greater alcohol use problems. AS statistically mediated multiple anxiety-alcohol associations, but DT did not. Conclusions These findings provide preliminary evidence suggesting AS may be an important transdiagnostic target for alcohol prevention programs for those in early adolescence that experience elevated anxiety symptoms. [ABSTRACT FROM AUTHOR]

Background Communicating bad news serves different goals in health care, and the extent to which physicians and patients agree on the goals of these conversations may influence their process and outcomes. However, we know little about what goals physicians and patients perceive as important and how the perceptions of physicians and patients compare. Objective To compare physicians' and patients' perceptions of the importance of different communication goals in bad news conversations. Design Survey-based descriptive study. Participants Physicians in California recruited via a medical board mailing list ( n = 67) and patients ( n = 77) recruited via mailing lists and snowball recruitment methods. Measurements Physicians reported their experience communicating bad news, the extent to which they strive for various goals in this task and their perceptions of the goals important to patients. Patients reported their experience receiving bad news, the goals important to them and their perceptions of the goals important to physicians. Main results Physicians and patients were quite similar in how important they personally rated each goal. However, the two groups perceived differences between their values and the values of the other group. Conclusions Physicians and patients have similar perceptions of the importance of various goals of communicating bad news, but inaccurate perceptions of the importance of particular goals to the other party. These findings raise important questions for future research and clinical practice. [ABSTRACT FROM AUTHOR]

Background Despite well-known associations between heavy drinking and child physical abuse, little is known about specific risks related to drinking different amounts of alcohol in different drinking venues. This study uses a context-specific dose-response model to examine how drinking in various venues (e.g., at bars or parties) is related to physically abusive parenting practices while controlling for individual and psychosocial characteristics. Methods Data were collected via a telephone survey of parents in 50 cities in California, resulting in 2,163 respondents who reported drinking in the past year. Child physical abuse and corporal punishment were measured using the Conflict Tactics Scale, Parent-Child version. Drinking behaviors were measured using continued drinking measures. Data were analyzed using zero-inflated Poisson models. Results Drinking at homes, parties, or bars more frequently was related to greater frequencies of physically abusive parenting practices. The use of greater amounts of alcohol in association with drinking at bars appeared to increase risks of corporal punishment, a dose-response effect. Dose-response relationships were not found for drinking at homes or parties or drinking at bars for physical abuse nor for drinking at home and parties for corporal punishment. Conclusions Frequencies of using drinking venues, particularly bars and home or parties, are associated with greater use of abusive parenting practices. These findings suggest that a parent's routine drinking activities place children at different risks of being physically abused. They also suggest that interventions that take into account parents' alcohol use at drinking venues are an important avenue for secondary prevention efforts. [ABSTRACT FROM AUTHOR]

Objective This study explored how multiple bioecological constructs operate to explain health-risk behaviors in late adolescence and to test for moderator effects of gender. Design and Sample This was a descriptive, cross-sectional study with a convenience sample of 437 predominately Caucasian late adolescents with an average age of 19 years who lived in Northern California. Measures Parental Attachment, Shyness, Loneliness, Law Abidance, and Youth Risk Behaviors were measured with self-report tools and analyzed using structural equation modeling. Results Confirmatory factor analysis indicated that the data fit the model well. Analysis of group differences revealed that gender moderated the relationships among the measured variables; thus, data were analyzed in independent gender-based models. Structural modeling demonstrated good model fit for each gender. Shyness and parental attachment each were associated with loneliness. Loneliness was associated with smoking. Loneliness linked the relationship between shyness, parental attachment, and smoking. Parental attachment was associated with law abidance. Law abidance was associated with sexual behaviors for female adolescents only. Conclusions This study provides valuable insights for public health nurses as it pertains to late adolescent health-risk behaviors. Nurses should use screening tools and techniques to ensure appropriate referrals and interventions to meet the needs of at-risk adolescents. [ABSTRACT FROM AUTHOR]

The article announces the launching of the online journal "Technology Innovations in Statistics Education" (TISE) by the Department of Statistics Center for Teaching Statistics at the University of California. TISE presents reports on the study of technology use for the improvement of statistics at all grade levels so that students could better understand the concepts. Furthermore, it states that the December 2007 issue of "International Statistical Review" relates the experiences of professional statisticians in using the technology.

BACKGROUND: School-based human immunodeficiency virus (HIV)/sexually transmitted infection (STI), and pregnancy prevention programs often focus on consistent and correct condom use. Research on adolescents' experience using condoms, including condom slippage/breakage, is limited. This exploratory study examines proper condom use and the occurrence of condom slippage/breakage among alternative school youth. METHODS: Data are from an HIV/STI prevention trial for youth in continuation school settings (N = 776). Analyses included separate hierarchical logistic regression analyses to explore the relationship between potential correlates and each outcome variable. RESULTS: Students' use of steps for proper condom use varied-73.8% put on the condom before sexual contact, 71.1% squeezed air from the tip, and 92.0% unrolled the condom fully. Notably, 28.5% reported condom slippage/breakage. Results from the regression analyses showed that 4 sets of variables (demographic, substance use, sexual risk behaviors, and condom psychosocial factors) were associated with putting on a condom before sexual contact; none of the variable sets were associated with the other 2 condom steps measured. For slippage/breakage, the demographic and sexual risk behaviors were significant correlates; steps for proper condom use approached statistical significance (p = .058). CONCLUSIONS: This study extends the limited research on how adolescents use condoms, and highlights important targets for prevention interventions. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 698-710 Context Traditional block clerkship (BC) structures may not optimally support medical student participation in the workplace, whereas longitudinal integrated clerkship (LIC) structures seem more conducive to students' active engagement in patient care over time. Understanding the ways in which these two clerkship models influence students' roles and responsibilities can inform clinical learning programme design. Methods This was a multicentre qualitative study. We conducted semi-structured interviews with LIC and BC medical students at three institutions early and late in the core clinical year to explore their experiences with patients and the roles they served. Using the framework of 'workplace affordances', qualitative coding focused on students' roles and qualities of the learning environment that invited or inhibited student participation. We compared transcripts of early- and late-year interviews to assess students' changing roles and conducted discrepant case analysis to ensure that coding fit the data. Results Fifty-four students participated in interviews. They described serving three major roles in clinical care that respectively involved: providing support to patients; sharing information about patients across health care settings, and functioning in a doctor-like role. Both LIC and BC students served in the providing support and transmitting information roles both early and late in the year. By contrast, LIC students commonly served in the doctor-like role in managing their patients' care, particularly late in the year, whereas BC students rarely served in this role. Continuity in settings and in supervisors, and preceptors' endorsement of students' legitimate role afforded opportunities for students to participate actively in patient care. Conclusions Although both LIC and BC students reported serving in important roles in supporting their patients and sharing information about their care, only LIC students consistently described opportunities to grow into a doctor role with patients. The high level of integration of LIC students into care systems and their deeper relationships with preceptors and patients enhanced their motivation and feelings of competence to provide patient-centred care. [ABSTRACT FROM AUTHOR]

Objectives To examine in cognitively normal elderly adults whether vascular factors predict cognitive decline and whether these associations are mediated by magnetic resonance imaging ( MRI) measures of subclinical vascular brain injury. Design Prospective multisite longitudinal study of subcortical ischemic vascular diseases. Setting Memory and aging centers in California. Participants Seventy-four participants who were cognitively normal at entry and underwent at least two neuropsychological evaluations and two MRI examinations over an average follow-up of 6.9 years. Measurements Item response theory was used to create composite scores of global, verbal memory, and executive functioning. Volumetric MRI measures included white matter hyperintensities ( WMHs), silent brain infarcts ( SBIs), hippocampus, and cortical gray matter ( CGM). Linear mixed-effects models were used to examine the associations between vascular factors, MRI measures, and cognitive scores. Results History of coronary artery disease ( CAD) was associated with greater declines in global cognition, verbal memory, and executive function. The CAD associations remained after controlling for changes in WMHs, SBIs, and hippocampal and CGM volumes. Conclusion History of CAD may be a surrogate marker for clinically significant atherosclerosis, which also affects the brain. Structural MRI measures of WMHs and SBIs do not fully capture the potential adverse effects of atherosclerosis on the brain. Future longitudinal studies of cognition should incorporate direct measures of atherosclerosis in cerebral arteries, as well as more sensitive neuroimaging measures. [ABSTRACT FROM AUTHOR]

Background: A primary goal of recent research is the development of neurobehavioral profiles that specifically define fetal alcohol spectrum disorders (FASD), which may assist differential diagnosis or improve treatment. In the current study, we define a preliminary profile using neuropsychological data from a multisite study. Methods: Data were collected using a broad neurobehavioral protocol from 2 sites of a multisite study of FASD. Subjects were children with heavy prenatal alcohol exposure and unexposed controls. The alcohol-exposed group included children with and without fetal alcohol syndrome (FAS). From 547 neuropsychological variables, 22 variables were selected for analysis based on their ability to distinguish children with heavy prenatal alcohol exposure from nonexposed controls. These data were analyzed using latent profile analysis (LPA). Results: The results indicated that a 2-class model best fit the data. The resulting profile was successful at distinguishing subjects with FAS from nonexposed controls without FAS with 92% overall accuracy; 87.8% of FAS cases and 95.7% of controls were correctly classified. The same analysis was repeated with children with heavy prenatal alcohol exposure but without FAS and nonexposed controls with similar results. The overall accuracy was 84.7%; 68.4% of alcohol-exposed cases and 95% of controls were correctly classified. In both analyses, the profile based on neuropsychological variables was more successful at distinguishing the groups than was IQ alone. Conclusions: We used data from 2 sites of a multisite study and a broad neuropsychological test battery to determine a profile that could be used to accurately identify children affected by prenatal alcohol exposure. Results indicated that measures of executive function and spatial processing are especially sensitive to prenatal alcohol exposure. [ABSTRACT FROM AUTHOR]

Objective: This study examined the use of a Video Doctor plus provider cueing to promote provider advice and smoking cessation outcomes in pregnancy.Design: A randomized clinical trial was conducted from 2006 to 2008.Setting: Five community prenatal clinics in the San Francisco Bay Area of the United States.Participants: A total of 410 pregnant patients completed screening for behavioral risks including tobacco use in the past 30 days. Pregnant smokers (n = 42) were randomized regardless of their intention to quit smoking.Methods: Participants were assigned to either usual care or intervention. Intervention participants received 15-minute Video Doctor sessions plus provider cueing, at baseline and one month, prior to their routine prenatal visit. The Video Doctor delivered interactive tailored messages, an educational worksheet for participants, and a cueing sheet for providers.Main Outcome Measures: Receipt of advice from the provider and 30-day smoking abstinence, both by self-report.Results: Intervention participants were more likely to receive provider advice on tobacco use at both prenatal visits during the intervention period (60.9 vs. 15.8%, p = 0.003). The intervention yielded a significantly greater decrease in the number of days smoked and in cigarettes smoked per day. The 30-day abstinence rate at two months post baseline was 2.5 times greater in the intervention group; the difference was not significant (26.1 vs. 10.5%, p = 0.12).Conclusions: The Video Doctor plus provider cueing is an efficacious adjunct to routine prenatal care by promoting provider advice and smoking reduction among pregnant smokers. [ABSTRACT FROM AUTHOR]

Objective. The purpose of this study was to examine the association between overweight status and physical activity (PA) among gender and ethnic (Hispanic vs. non-Hispanic) sub-groups in elementary school-age children. Methods. PA was assessed over five days using the Actigraph accelerometer in 169 fourth grade students (mean age 9.4 years; 50% female; 63% Hispanic; and 43% overweight, defined as body mass index, BMI ≥85th percentile for age and gender) from four elementary schools in Los Angeles County, California. Results. In the total sample, boys and normal weight students had higher levels of total PA (counts per minute, cpm; p <0.05). Boys spent less time in sedentary PA (p =0.02) and more time in combined moderate to vigorous PA (MVPA, p =0.01). There was a significant gender, ethnicity, and overweight interaction for total PA and MVPA (both p <0.01). MVPA and counts per minute were significantly lower in overweight non-Hispanic girls and Hispanic boys (p <0.05) and marginally lower in overweight non-Hispanic boys (p =0.10) when compared with non-overweight students, while overweight Hispanic girls were more physically active than Hispanic non-overweight girls, though the difference was non-significant (p >0.05). Conclusions. Data from the present study does not consistently support the prevailing hypothesis that overweight subjects engage in less PA. Results show overweight students engage in less PA than non-overweight students, with the exception that non-overweight Hispanic girls do not engage in more PA than their overweight peers. These results suggest the need for further investigation into the role that ethnicity and overweight status plays in PA levels, particularly among ethnic and gender sub-groups. [ABSTRACT FROM AUTHOR]

Objective: To predict the true cost of developing and maintaining an electronic immunization registry, and to set the framework for developing future cost-effective and cost-benefit analysis.Data Sources/study Setting: Primary data collected at three immunization registries located in California, accounting for 90 percent of all immunization records in registries in the state during the study period.Study Design: A parametric cost analysis compared registry development and maintenance expenditures to registry performance requirements.Data Collection/extraction Methods: Data were collected at each registry through interviews, reviews of expenditure records, technical accomplishments development schedules, and immunization coverage rates.Principal Findings: The cost of building immunization registries is predictable and independent of the hardware/software combination employed. The effort requires four man-years of technical effort or approximately $250,000 in 1998 dollars. Costs for maintaining a registry were approximately $5,100 per end user per three-year period.Conclusions: There is a predictable cost structure for both developing and maintaining immunization registries. The cost structure can be used as a framework for examining the cost-effectiveness and cost-benefits of registries. The greatest factor effecting improvement in coverage rates was ongoing, user-based administrative investment. [ABSTRACT FROM AUTHOR]

This report evaluates whether the characteristics associated with alcohol abuse and dependence are similar in two groups of men despite their enrollment in different research projects and the resulting differences in education and related background variables. Data regarding demographic and substance use characteristics and problems were gathered using similar research instruments from the 15-ear follow-up of 108 highly educated DSM-III-R alcohol-dependent men from the San Diego Prospective Study (Group 1) and 306 similarly diagnosed men with lower education from the Collaborative Study on the Genetics of Alcoholism (COGA ) (Group 2). Both groups of alcoholics reported high rates of alcohol-relatedproblems, a similar maximum number of drinks per day, and similar proportions of drug use/non-use, although Group 1 subjects were less likely to report alcohol withdrawal and items associated with loss of control. Thus, teachers and clinicians may be able to generalize their knowledge and experience across different groups of alcoholics, using common sense modifications of their expectations based on the general characteristics of the groups involved despite differences in background variables, including education, income, marital status, and employment. [ABSTRACT FROM AUTHOR]

This study examined the sensitivity, specificity, and receiver operating characteristics (ROC) curves of a modified version of the CAGE, a screening measure used in the detection of older alcohol- and drug-abusing individuals. In a retrospective review of clinical records of 976 patients screened by a geriatric substance abuse program, the authors examined patients' responses on a modified version of the CAGE that included queries regarding drug use. The CAGE was administered to individuals age 50 or over draw from three diagnostic groups: alcohol abuse/dependence, drug abuse/dependence, and normal controls. Analysis of variance and discriminant function analyses revealed that the modified CAGE was able to discriminate both alcohol and drug abusers from controls. Analyses examining test sensitivity, specificity, and ROC curves revealed the CAGE to demonstrate excellent sensitivity but poor specificity. Omitting the "cut down'' item from the CAGE significantly improved specificity with only a modest drop in sensitivity. Given the ease of administration and sensitivity to both alcohol and drug abuse, these data suggest that the modified CAGE is well suited as a screening instrument for geriatric drug and alcohol abuse. [ABSTRACT FROM AUTHOR]

This study addresses a paradox in the literature involving the parenting style of Asians: Chinese parenting has often been described as "controlling" or "authoritarian". These styles of parenting have been found to be predictive of poor school achievement among European-Americans, and yet the Chinese are performing quite well in school. This study suggests that the concepts of authoritative and authoritarian are somewhat ethnocentric and do not capture the important features of Chinese child rearing, especially for explaining their school success. Immigrant Chinese and European-American mothers of preschool-aged children were administered standard measures of parental control and authoritative-authoritarian parenting style as well as Chinese child-rearing items involving the concept of "training." After controlling for their education, and their scores on the standard measures, the Chinese mothers were found to score significantly higher on the "training" ideologies. This "training" concept has important features, beyond the authoritarian concept, that may explain Chinese school success. [ABSTRACT FROM AUTHOR]