Search

Introduction: There is growing recognition of the important role that social and environmental conditions play in health, and of the interaction needed between clinical providers and the broader community in which patients live, work, play, and manage their health. Through the Safety Net Enhancement Initiative, the Kresge Foundation funded demonstration projects in eight vulnerable communities to address health inequities and increase integration between clinical and community systems.Methods: In 2014, integration efforts in 2011-2013 were qualitatively analyzed within and between sites to identify common features. The series of steps taken by sites during the 3-year implementation period that were necessary to move toward integration were then analyzed.Results: Safety Net Enhancement Initiative sites increased capacities within clinics, including policy and practice changes that expanded the way "health" is defined by clinical providers and the implementation of onsite programs/services. Several sites changed clinic policies to support referral to community programs with partner organizations. Several sites also successfully changed local community policies and practices. Moving toward integration, mechanisms were created to link newly developed or identified community resources to the clinical system.Conclusions: As an established system organized around disease treatment, not prevention, certain changes need to be made within the clinical system to prepare for integration. These changes require shifting perspectives, changing behaviors, and developing novel administrative models. Similarly, integration requires changes within and among community systems, including organizations, services, and residents. Ultimately, there is the need to find ways for these two very different environments to interact and coordinate. [ABSTRACT FROM AUTHOR]

Objectives. We assessed changes in asthma-related health care use by low-income children in communities across the country where 6 Allies Against Asthma coalitions (Hampton Roads, VA; Washington, DC; Milwaukee, WI; King County/Seattle, WA; Long Beach, CA; and Philadelphia, PA) mobilized stakeholders to bring about policy changes conducive to asthma control. Methods. Allies intervention zip codes were matched with comparison communities by median household income, asthma prevalence, total population size, and race/ethnicity. Five years of data provided by the Center for Medicare and Medicaid Services on hospitalizations, emergency department (ED) use, and physician urgent care visits for children were analyzed. Intervention and comparison sites were compared with a stratified recurrent event analysis using a Cox proportional hazard model. Results. In most of the assessment years, children in Allies communities were significantly less likely (P < .04) to have an asthma-related hospitalization, ED visit, or urgent care visit than children in comparison communities. During the entire period, children in Allies communities were significantly less likely (P < .02) to have such health care use. Conclusions. Mobilizing a diverse group of stakeholders, and focusing on policy and system changes generated significant reductions in health care use for asthma in vulnerable communities. [ABSTRACT FROM AUTHOR]

Curtailing the effects of obesity and overweight, especially among children, is high on the U.S. public health agenda. Observers are calling attention to the need for structural and environmental approaches that reduce conditions creating health problems such as obesity and diabetes. These calls for change posit that the food sector and built environment must be altered to more effectively support healthy lifestyles. This article examines aspects of policy and system change at the state and local levels upstream from the problems of obesity and diabetes. The researchers looked at policies affecting school food, community food, and active living/built environment, and they tracked four different types of state-level policies. Findings show that, in at least seven states, there is significant momentum to increase healthy food and physical-activity options for children. The findings also indicate that collectively there has been a slight decrease in school-focused policy efforts in these states along with a slight increase in seeking policy change to affect the availability of food and physical-activity options in neighborhoods. The evident trends are encouraging and suggest growing momentum toward changing structural factors influencing obesity. [ABSTRACT FROM AUTHOR]

Little is known about the epidemiology of renal stones, in spite of the relative frequency of this painful condition. This population-based study examined reported renal stone diagnosis in 1, 309 women aged 20–92 years to determine whether renal stones are associated with 1) food or water exposures or 2) lower bone mineral density and an increased likelihood of fractures. Results indicated a renal stone prevalence of 3.4%. The average age at diagnosis was 42 years. Renal stone formation was not associated with community of residence, hypertension, bone mineral density, fractures, high-oxalate food consumption, or ascorbic acid from food supplements. Women with renal stones consumed almost 250 mg/day less dietary calcium (p < 0.01) than did women without stones and had a lower energy intake (p < 0.04). The authors‘ findings do not support the hypothesis that increased dietary calcium is associated with a greater prevalence of renal stones, nor do they identify renal stones as a risk factor for low bone mineral density. Furthermore, lack of other Identifiable environmental correlates and the relatively young age at initial diagnosis suggest that genetic components of renal stone formation need further study. Am J Epidemiol 1998; 147: 914–20. [ABSTRACT FROM PUBLISHER]