Hawaii's Healthy Start Program of Home Visiting for At-Risk Families: Evaluation of Family Identification, Family Engagement, and Service Delivery

PEDIATRICS ◽  
2000 ◽  
Vol 105 (Supplement_2) ◽  
pp. 250-259 ◽  
Author(s):  
Anne Duggan ◽  
Amy Windham ◽  
Elizabeth McFarlane ◽  
Loretta Fuddy ◽  
LCSW, MPH ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Early Identification ◽  
Home Visiting ◽  
Family Engagement ◽  
Cross Sectional Study ◽  
Family Characteristics ◽  
Sectional Study ◽  
Cross Sectional ◽  
Healthy Start Program

Objective. To describe family identification, family engagement, and service delivery in a statewide home visiting program for at-risk families of newborns. Setting. Six target communities of Hawaii's Healthy Start Program (HSP), which incorporates 1) early identification of at-risk families of newborns via population-based screening and assessment, and 2) paraprofessionalhome visiting to improve family functioning, promote child health and development, and prevent child maltreatment. Design. Cross-sectional study: describes early identification process and family characteristics associated with initial enrollment. Longitudinal study: describes home visiting process and characteristics associated with continued participation. Subjects. Cross-sectional study: civilian births in 6 communities (n = 6553). Longitudinal study: at-risk families in the intervention group of a randomized trial of the HSP (n = 373). Measures. Process: completeness and timeliness of early identification and home visiting activities; family characteristics: sociodemographics, child abuse risk factors, infant biologic risk. Results. Early identification staff determined risk status for 84% of target families. Families with higher risk scores, young mothers with limited schooling, and families with infants at biologic risk were more likely to enroll in home visiting. Half of those who enrolled were active at 1 year with an average of 22 visits. Families where the father had multiple risk factors and where the mother was substance abusing were more likely to have ≥12 visits; mothers who were unilaterally violent toward the father were less likely. Most families were linked with a medical home; linkage rates for other community resources varied widely by type of service. Half of families overall, but ≥80% of those active at 1 year, received core home visiting services. Performance varied by program site. Conclusions. It is challenging to engage and retain at-risk families in home visiting. Service monitoring must be an integral part of operations.

scholarly journals Dysfunctional Adiposity Index as a Useful Clinical Tool for Early Identification of Adipose Tissue Morpho-Functional Abnormalities and Cardiometabolic Disorders in Apparently Healthy Subjects

2020 ◽  
Author(s):  
Juan Reyes-Barrera ◽  
Victor H. Sainz-Escárrega ◽  
Aida X. Medina-Urritia ◽  
Esteban Jorge-Galarza ◽  
Horacio Osorio-Alonso ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adipose Tissue ◽  
Clinical Practice ◽  
Early Identification ◽  
Healthy Subjects ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Adiposity Index ◽  
Apparently Healthy

Abstract BackgroundCompared to body mass index (BMI), waist circumference (WC), and adiposity measurements, adipose tissue morpho-functionality evaluations are more consistent predictors of cardiometabolic abnormalities. However, these evaluations require determination of adipokines and other non-routine biochemical parameters, which is not feasible in clinical practice. The present study establishes dysfunctional adiposity index (DAI) as a simple, accessible, and reliable marker of early adipocytes morpho-functional abnormalities and cardiometabolic diseases.MethodsTo establish the DAI constant parameters, 340 subjects (134 males and 206 females) without cardiovascular risk factors were selected from a cross-sectional study. Then, DAI was calculated in 36 healthy subjects who underwent subcutaneous adipose tissue biopsy, for whom adipocytes number and size, body composition, circulating adipokines, glucose, insulin, and lipids were also determined. The correlation of DAI with adipocyte morphology (size/number of adipocytes) and functionality (adiponectin/leptin ratio) was analyzed. The receiver operating characteristic curve was used to define the optimal DAI cut-off point to identify metabolic abnormalities. Finally, the independent association of DAI with cardiometabolic abnormalities was determined in 1418 subjects from the cross-sectional study through multivariate analyses.ResultsThe constant parameters to calculate the DAI were [WC/[22.79+[2.68*BMI]]]*[triglycerides (TG, mmol/L)/1.37]*[1.19/high density lipoprotein-cholesterol (HDL-C, mmol/L)] for males, and [WC/[24.02+[2.37*BMI]]]*[TG(mmol/L)/1.32]*[1.43/HDL-C(mmol/L)] for females. In subjects underwent biopsy, DAI correlated with adipocytes mean area (r=0.358; p=0.032), adipocyte number (r=-0.381; p=0.024), adiponectin/leptin ratio (r=-0.483; p=0.003), and systemic inflammation markers. Compared to BMI, WC, and visceral fat, DAI was the only determination associated with insulin resistance (area under the curve: 0.743; p = 0.017). In the cross-sectional study, DAI ≥1.065 was independently associated with diabetes (OR: 1.96; 95%CI: 1.36-2.84), non-alcoholic fatty liver disease (OR: 2.57; 95%CI: 1.98-3.33), subclinical atherosclerosis (OR: 1.74; 95%CI: 1.02-2.94), and hypertension (OR: 1.44; 95%CI: 1.10-1.88).ConclusionsThe present study establishes the constant parameters to calculate the DAI and highlights that a DAI ≥ 1.065 is associated with early cardiometabolic abnormalities independently of adiposity and other risk factors. Since DAI is calculated using accessible parameters routinely used in the clinic, this indicator can be easily incorporated in clinical practice for the early identification of adipose tissue abnormalities in apparently healthy subjects.

scholarly journals Virological Outcomes and Risk Factors for Non-suppression for Routine and Repeat Viral Load Testing After Enhanced Adherence Counselling During Viral Load Testing Scale-up in Zimbabwe: Analytic Cross-sectional Study Using Laboratory Data From 2014 to 2018.

2022 ◽  
Author(s):  
Trudy Tholakele Mhlanga ◽  
Bart K.M Jacobs ◽  
Tom Decroo ◽  
Emma Govere ◽  
Hilda Bara ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Viral Load ◽  
Scale Up ◽  
Cross Sectional Study ◽  
Load Testing ◽  
Sectional Study ◽  
Cross Sectional ◽  
Viral Load Testing ◽  
Adherence Counselling

Abstract BackgroundSince the scale-up of routine viral load (VL) testing started in 2016, there is limited evidence on VL suppression rates under programmatic settings and groups at risk of non-suppression. We conducted a study to estimate VL non-suppression (> 1000 copies/ml) and its risk factors using "routine" and "repeat after enhanced adherence counselling" VL results.MethodsWe conducted an analytic cross-sectional study using secondary VL testing data collected between 2014 and 2018 from a centrally located laboratory. We analysed data from routine tests and repeat tests after an individual received enhanced adherence counselling. Our outcome was viral load non-suppression. Bivariable and multivariable logistic regression was performed to identify factors associated with having VL non-suppression for routine and repeat VL.ResultsWe analysed 103 609 VL test results (101 725 routine and 1884 repeat tests results) collected from the country's ten provinces. Of the 101 725 routine and 1884 repeat VL tests, 13.8% and 52.9% were non-suppressed, respectively. Only one in seven (1:7) of the non-suppressed routine VL tests had a repeat test after EAC. For routine VL tests; males (vs females, adjusted odds ratio (aOR)=1.19, [95% CI:1.14-1.24]) and adolescents (vs adults, aOR=3.11, [95%CI:2.9-3.31]) were more at risk of VL non-suppression. The patients who received care at the secondary level (vs primary, aOR=1.21, [95%CI:1.17-1.26]) and tertiary level (vs primary, aOR=1.63, [95%CI:1.44-1.85]) had a higher risk of VL non-suppression compared to the primary level. Those that started ART in 2014-2015 (vs <2010, aOR=0.83, [95%CI:0.79-0.88]) and from 2016 onwards (vs <2010, aOR=0.84, [95%CI:0.79-0.89]) had a lower risk of VL non-suppression. For repeat VL tests; young adults (vs adults, (aOR)=3.48, [95% CI 2.16 -5.83]), adolescents (vs adults, aOR=2.76, [95% CI:2.11-3.72]) and children (vs adults, aOR=1.51, [95%CI:1.03-2.22]) were at risk of VL non-suppression.ConclusionClose to 90% suppression in routine VL shows that Zimbabwe is on track to reach the third UNAIDS target. Strategies to improve the identification of clients with high routine VL results for repeating testing after EAC and ART adherence in subpopulations (men, adolescents and young adolescents) at risk of viral non-suppression should be prioritised.

scholarly journals Are Groote Schuur Hospital anaesthesiologists burnt out? A cross-sectional study of prevalence and risk

2020 ◽  
pp. 155-161 ◽  
Author(s):  
MB Groenewald ◽  
J van Nugteren ◽  
R Parker
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Maslach Burnout Inventory ◽  
Cross Sectional Study ◽  
Personal Accomplishment ◽  
Contributory Factor ◽  
Sectional Study ◽  
Cross Sectional ◽  
Perceived Workload ◽  
Clinically Significant

Background: Burnout and physician wellness are becoming increasingly topical. While some surveys have been performed with South African anaesthesiologists, these have been conducted in limited samples. While burnout is often measured, there is a paucity of research on contributory risk and protective factors. Method: A contextual, prospective, cross-sectional study was conducted. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the Areas of Worklife Survey (AWS) were used to assess burnout and contributory organisational risk factors amongst state-employed anaesthesiologists working at Groote Schuur Hospital. Results: Out of a possible 127 members of staff (medical officers, registrars and consultants), 81 responded with 75 completing the full survey (59% response rate). Only 4% of respondents were classified as “burnt out”, defined as scoring high in all three domains of burnout: high emotional exhaustion and depersonalisation and low personal accomplishment. However, 67% of respondents scored high for at least one of the components of burnout, indicating the majority of the respondents are at risk for developing clinically significant burnout. The AWS showed that respondents found their workload inappropriate. However, responses for the categories of control, reward, community, fairness and values were all in the acceptable range. Conclusion: While the overall rate of burnout was low, the majority of respondents were at risk for developing burnout. High perceived workload appeared to be a particular contributory factor. Protection against burnout in this group may be provided by a combination of few organisational risk factors together with feelings of personal accomplishment.

scholarly journals Colorectal cancer awareness and its predictors among adults aged 50–74 years attending primary healthcare in the State of Qatar: a cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e035651
Author(s):  
Ayman Al-Dahshan ◽  
Mohamad Chehab ◽  
Mohamed Bala ◽  
Mieaad Omer ◽  
Omayma AlMohamed ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
At Risk ◽  
Linear Regression ◽  
Primary Healthcare ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cancer Awareness ◽  
Cross Sectional ◽  
The Mean

ObjectiveThe current study aimed to assess the awareness of colorectal cancer (CRC) symptoms and risk factors among the at-risk population visiting the primary healthcare (PHC) centres in Qatar. The secondary objective was to assess the differences in awareness among population subgroups.DesignA cross-sectional study design was employed.SettingThe study was conducted across six PHC centres in Qatar.ParticipantsPatients, or their accompanying people, aged 50–74 years and Arabic or English speakers, were recruited from the main waiting areas of the selected PHC centres.Data collection and analysisParticipants were interviewed using the validated Bowel/Colorectal Cancer Awareness Measure questionnaire. A non-probability convenient sampling technique was applied to recruit participants. Descriptive and analytic statistics were used when appropriate. A multivariate linear regression model was constructed to identify the independent predictors of CRC awareness.ResultsThe study includes 448 participants (response rate=87%). The mean age of the participants was 58.48 years (SD ±6.37). The mean awareness score among the participants was 3.63/9 (SD ±2.7) for CRC symptoms and 5.43/11 (SD ±3.3) for CRC risk factors. The overall mean awareness score was 9.03/20 (SD ±5.5). Multivariate linear regression identified the female gender (2.52 (95% CI 1.15 to 3.88)), non-Qatari Arab (2.91 (95% CI 1.64 to 4.18)) or non-Arab nationalities (1.76 (95% CI 0.28 to 3.24)), and tertiary education (4.10 (95% CI 2.55 to 5.66)) as independent predictors of higher CRC awareness.ConclusionIn general, the awareness of CRC symptoms and risk factors was low among the at-risk population in Qatar. Specifically, the regression analysis showed men, Qataris, and those with no formal education had low awareness of CRC symptoms and risk factors. Such results emphasise the importance of tailoring future educational campaigns that are relevant, specific and appealing to such cohort.

scholarly journals Depressive symptoms in people with vision impairment: a cross-sectional study to identify who is most at risk

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e026163 ◽  
Author(s):  
Claire Nollett ◽  
Barbara Ryan ◽  
Nathan Bray ◽  
Catey Bunce ◽  
Robin Casten ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Depressive Symptoms ◽  
Controlled Trial ◽  
Depression Scale ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Multivariable Logistic Regression Model ◽  
Cross Sectional ◽  
Reported Health

ObjectiveTo identify the risk factors for significant depressive symptoms in people with visual impairment in England and Wales to provide information on who is most at risk and to whom support services could be targeted in future.DesignA cross-sectional study using baseline data from a pragmatic randomised controlled trial.Setting and participants990 participants aged 18 or over attending 1 of 14 low-vision rehabilitation primary care optometry-based clinics in South Wales or two hospital clinics in London.Outcome measureA score of ≥6 on the Geriatric Depression Scale-15 was classed as clinically significant depressive symptoms.ResultsIn a multivariable logistic regression model, significant depressive symptoms were associated with age (adjusted OR (AOR)=0.82, 95% CI: 0.66 to 0.90, p<0.001), ethnicity (AOR non-white compared with white=1.72, 95% CI: 1.05 to 2.81, p=0.031), total number of eye conditions (AOR for two vs one condition=0.98, 95% CI: 0.67 to 1.43; three or more vs one condition=0.34, 95% CI: 0.15 to 0.75, p=0.026), self-reported health (AOR for excellent vs poor=0.01, 95% CI: 0.00 to 0.12; very good vs poor=0.06, 95% CI: 0.03 to 0.13; good vs poor=0.14, 95% CI: 0.08 to 0.24; fair vs poor=0.28, 95% CI: 0.18 to 0.46, p<0.001) and self-reported visual functioning (AOR=1.45, 95% CI: 1.31 to 1.61, p<0.001).ConclusionYounger age, a non-white ethnicity, fewer eye conditions and poorer self-reported health and visual function are risk factors for significant depressive symptoms in this population.Trial registration numberISRCTN46824140; Pre-results.

PRRSV: Risikofaktoren und Herdenprävalenz in Deutschland

2019 ◽  
Vol 47 (02) ◽  
pp. 132-132
Author(s):  
Sebastian Ganz
Keyword(s):  
Risk Factors ◽  
Cross Sectional Study ◽  
Respiratory Syndrome Virus ◽  
Sectional Study ◽  
Cross Sectional ◽  
Klinische Symptome

Nathues C, Janssen E, Duengelhoef A et al. Cross-sectional study on risk factors for Porcine Reproductive and Respiratory Syndrome virus sow herd instability in German breeding herds. Acta Vet Scand 2018; 60 (1): 1–8 In mit PRRSV (Porcine Reproductive and Respiratory Syndrom Virus) infizierten Schweinebeständen zeigen die Tiere oftmals ernsthafte klinische Symptome. Die Schwere der Symptomatik hängt von der Virulenz der jeweiligen Virusstämme ab. Deshalb ist die Impfung gegen diesen Erreger sinnvoll und wird empfohlen, auch wenn sie nicht immer klinische Fälle verhindert bzw. das Virus vollends eliminiert. Aufgrund dessen rückt die Prävention durch Verbesserung der innerbetrieblichen Abläufe zunehmend in den Fokus. Um solche Maßnahmen erfolgreich etablieren zu können, ist es wichtig, den epidemiologischen Status der Herde und mögliche Risikofaktoren zu kennen. Ziel der Studie war deshalb, die Prävalenz der Infektion in Sauenbetrieben in Norddeutschland zu eruieren und verschiedene Arbeitsabläufe hinsichtlich des Risikos der Erregerverbreitung zu untersuchen.

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