Omer S.B.,Emory University |
Omer S.B.,Emory Vaccine Center |
Omer S.B.,Children's Healthcare Of Atlanta |
Goodman D.,Georgia community health |
And 5 more authors.
PLoS Medicine | Year: 2011
Background: Infections during pregnancy have the potential to adversely impact birth outcomes. We evaluated the association between receipt of inactivated influenza vaccine during pregnancy and prematurity and small for gestational age (SGA) births. Methods and Findings: We conducted a cohort analysis of surveillance data from the Georgia (United States) Pregnancy Risk Assessment Monitoring System. Among 4,326 live births between 1 June 2004 and 30 September 2006, maternal influenza vaccine information was available for 4,168 (96.3%). The primary intervention evaluated in this study was receipt of influenza vaccine during any trimester of pregnancy. The main outcome measures were prematurity (gestational age at birth <37 wk) and SGA (birth weight <10th percentile for gestational age). Infants who were born during the putative influenza season (1 October-31 May) and whose mothers were vaccinated against influenza during pregnancy were less likely to be premature compared to infants of unvaccinated mothers born in the same period (adjusted odds ratio [OR] = 0.60; 95% CI, 0.38-0.94). The magnitude of association between maternal influenza vaccine receipt and reduced likelihood of prematurity increased during the period of at least local influenza activity (adjusted OR = 0.44; 95% CI, 0.26-0.73) and was greatest during the widespread influenza activity period (adjusted OR = 0.28; 95% CI, 0.11-0.74). Compared with newborns of unvaccinated women, newborns of vaccinated mothers had 69% lower odds of being SGA (adjusted OR = 0.31; 95% CI, 0.13-0.75) during the period of widespread influenza activity. The adjusted and unadjusted ORs were not significant for the pre-influenza activity period. Conclusions: This study demonstrates an association between immunization with the inactivated influenza vaccine during pregnancy and reduced likelihood of prematurity during local, regional, and widespread influenza activity periods. However, no associations were found for the pre-influenza activity period. Moreover, during the period of widespread influenza activity there was an association between maternal receipt of influenza vaccine and reduced likelihood of SGA birth. © 2011 Omer et al.
Vaaler M.L.,University of Texas at Austin |
Castrucci B.C.,Georgia community health
Women's Health Issues | Year: 2012
Background: Despite the elevated rates of teen and unplanned pregnancies across the United States, long-acting reversible contraceptives (LARCs) remain a less utilized birth control method. The present study investigated family planning providers' attitudes and considerations when recommending family planning methods and LARCs to clients. Additionally, this study explored whether urban-rural differences exist in providers' attitudes toward LARCs and in clients' use of LARCs. Methods: Data were collected using an online survey of family planning providers at Title X clinics in Texas. Survey data was linked to family planning client data from the Family Planning Annual Report (2008). Results: Findings indicated that, although providers were aware of the advantages of LARCs, clients' LARC use remains infrequent. Providers reported that the benefits of hormone implants include their effectiveness for 3 years and that they are an option for women who cannot take estrogen-based birth control. Providers acknowledged the benefits of several types of LARCs; however, urban providers were more likely to acknowledge the benefits of hormone implants compared with their rural counterparts. Results also indicated barriers to recommending LARCs, such as providers' misinformation about LARCs and their caution in recommending LARCs to adolescents. However, findings also indicated providers lack training in LARC insertion, specifically among those practicing in rural areas. Conclusions: In light of the effectiveness and longevity of LARCs, teenagers and clients living in rural areas are ideal LARC candidates. Increased training among family planning providers, especially for those practicing in rural areas, may increase their recommendations of LARCs to clients. © 2012 Jacobs Institute of Women's Health.
Cory S.,Georgia community health |
Ussery-Hall A.,Ginn Group |
Griffin-Blake S.,Georgia community health |
Easton A.,Georgia community health |
And 4 more authors.
Morbidity and Mortality Weekly Report | Year: 2010
Problem: At least one chronic disease or condition affects 45% of persons and account for seven of the 10 leading causes of death in the United States. Persons who suffer from chronic diseases and conditions, (e.g., obesity, diabetes, and asthma) experience limitations in function, health, activity, and work, affecting the quality of their lives as well as the lives of their family. Preventable health-risk factors (e.g., insufficient physical activity, poor nutrition, and tobacco use and exposure) contribute substantially to the development and severity of certain chronic diseases and conditions.
Ogbuanu C.,Georgia community health
Maternal and child health journal | Year: 2012
We examined factors associated with children's access to quality health care, a major concern in Georgia, identified through the 2010 Title V Needs Assessment. Data from the 2007 National Survey of Children's Health were merged with the 2008 Area Resource File and Health Resources and Services Administration medically underserved area variable, and restricted to Georgia children ages 4-17 years (N = 1,397). The study outcome, access to quality health care was derived from access to care (timely utilization of preventive medical care in the previous 12 months) and quality of care (compassionate/culturally effective/family-centered care). Andersen's behavioral model of health services utilization guided independent variable selection. Analyses included Chi-square tests and multinomial logit regressions. In our study population, 32.8 % reported access to higher quality care, 24.8 % reported access to moderate quality care, 22.8 % reported access to lower quality care, and 19.6 % reported having no access. Factors positively associated with having access to higher/moderate versus lower quality care include having a usual source of care (USC) (adjusted odds ratio, AOR:3.27; 95 % confidence interval, 95 % CI 1.15-9.26), and special health care needs (AOR:2.68; 95 % CI 1.42-5.05). Lower odds of access to higher/moderate versus lower quality care were observed for non-Hispanic Black (AOR:0.31; 95 % CI 0.18-0.53) and Hispanic (AOR:0.20; 95 % CI 0.08-0.50) children compared with non-Hispanic White children and for children with all other forms of insurance coverage compared with children with continuous-adequate-private insurance. Ensuring that children have continuous, adequate insurance coverage and a USC may positively affect their access to quality health care in Georgia.
Brennan L.K.,Transtria LLC |
Brownson R.C.,Washington University in St. Louis |
Kelly C.,University of Colorado at Colorado Springs |
Ivey M.K.,Georgia community health |
Leviton L.C.,Robert Wood Johnson Foundation
American Journal of Preventive Medicine | Year: 2012
Background: From 2003 to 2008, a total of 25 cross-sector, multidisciplinary community partnerships funded through the Active Living by Design (ALbD) national program designed, planned, and implemented policy and environmental changes, with complementary programs and promotions. Purpose: This paper describes the use of concept mapping methods to gain insights into promising active living intervention strategies based on the collective experience of community representatives implementing ALbD initiatives. Methods: Using Concept Systems software, community representatives (n=43) anonymously generated actions and changes in their communities to support active living (183 original statements, 79 condensed statements). Next, respondents (n=26, from 23 partnerships) sorted the 79 statements into self-created categories, or active living intervention approaches. Respondents then rated statements based on their perceptions of the most important strategies for creating community changes (n=25, from 22 partnerships) and increasing community rates of physical activity (n=23, from 20 partnerships). Cluster analysis and multidimensional scaling were used to describe data patterns. Results: ALbD community partnerships identified three active living intervention approaches with the greatest perceived importance to create community change and increase population levels of physical activity: changes to the built and natural environment, partnership and collaboration efforts, and land-use and transportation policies. The relative importance of intervention approaches varied according to subgroups of partnerships working with different populations. Conclusions: Decision makers, practitioners, and community residents can incorporate what has been learned from the 25 community partnerships to prioritize active living policy, physical project, promotional, and programmatic strategies for work in different populations and settings. © 2012 American Journal of Preventive Medicine.
Anderson E.R.,Emory University |
Smith B.,Emory University |
Ido M.,Georgia community health |
Frankel M.,Emory University
Journal of Stroke and Cerebrovascular Diseases | Year: 2013
Therapy with recombinant tissue plasminogen activator is underused in the treatment of ischemic stroke in rural hospitals, due to a lack of local stroke expertise. Telemedicine solutions for stroke are a level I, class A recommendation when a vascular neurologist is absent. However, current solutions require exorbitant startup costs, which are prohibitive for the rural hospitals in which they are needed most. This study demonstrates the efficacy of using the relatively inexpensive iPhone 4 in telestroke management. Twenty patients with stroke were assessed at the bedside using an iPhone 4, and each examination was directed remotely on another iPhone 4. Both the physician performing the bedside exam and the remote physician calculated a National Institutes of Health Stroke Scale (NIHSS) score for each patient. Each physician was blinded to the other's NIHSS score. In the 20 patients assessed, NIHSS scores ranged from 0 to 22. Interrater reliability assessed using the κ statistic demonstrated excellent agreement in 10 items (level of consciousness, month and age, visual fields, right motor arm, left motor arm, right motor leg, left motor leg, sensation, language, and neglect), moderate agreement in 3 items (gaze, facial palsy, and dysarthria), and poor agreement in 1 item (ataxia). Total NIHSS scores obtained remotely and at bedside showed an excellent level of agreement (intraclass correlation coefficient, 0.98). Our findings indicate that the iPhone 4 is an economical mobile solution that can be used to assess stroke patients remotely with high fidelity and can be readily incorporated into a telestroke network. © 2013 by National Stroke Association.
Fan A.Z.,Centers for Disease Control and Prevention |
Li Y.,Georgia community health |
Elam-Evans L.D.,Centers for Disease Control and Prevention |
Balluz L.,Centers for Disease Control and Prevention
Clinical Epidemiology | Year: 2013
Context and objective: Epidemiological studies show the apparent link between excessive alcohol consumption and hypertension. However, the association between alcohol intake and blood pressure among non-hypertensive individuals is scarcely examined. Methods: This analysis included participants in the 1999-2004 National Health and Nutrition Examination Survey who were aged 20 to 84 years without a diagnosis of cardiovascular disease, hypertension or pregnancy, whose systolic/diastolic blood pressure (SBP/DBP) was lower than 140/90 mmHg, who were not on antihypertensive medication, and who consumed 12 drinks or more during the past 12 months (N = 3957). Average drinking volume (average alcohol intake per day), usual drinking quantity (drinks per day when drinking) and frequency of binge drinking were used to predict SBP/DBP. Covariates included age, gender, race/ethnicity, education level, smoking status, average physical activity level, and daily hours spent on TV/ video/computer. Results: Drinking volume was directly associated with higher SBP in a linear dependent manner (an increment of 10 g of alcohol per day increased average SBP by 1 mmHg among both men and women). Drinking above the US Dietary Guidelines (men more than two drinks and women more than one drink per drinking day) was associated with higher SBP. Binge drinking was associated with both higher SBP and higher DBP. Average intake greater than two drinks per day was particularly associated with higher DBP among women (P = 0.0003). Conclusion: This analysis from a population-based survey indicates a direct association between higher alcohol consumption and a higher prevalence of prehypertension among non-hypertensive drinkers. © 2013 Fan et al, publisher and licensee Dove Medical Press Ltd.
Ogbuanu C.,Georgia community health |
Glover S.,University of South Carolina |
Probst J.,University of South Carolina |
Probst J.,South Carolina Rural Health Research Center |
And 2 more authors.
Pediatrics | Year: 2011
OBJECTIVE: We investigated the effect of maternity leave length and time of first return to work on breastfeeding. METHODS: Data were from the Early Childhood Longitudinal Study-Birth Cohort. Restricting our sample to singletons whose biological mothers were the respondents at the 9-month interview and worked in the 12 months before delivery (N = 6150), we classified the length of total maternity leave (weeks) as 1 to 6, 7 to 12, ≥13, and did not take; paid maternity leave (weeks) as 0, 1 to 6, ≥7, and did not take; and time of return to work postpartum (weeks) as 1 to 6, 7 to 12, ≥13, and not yet returned. Analyses included χ 2 tests and multiple logistic regressions. RESULTS: In our study population, 69.4% initiated breastfeeding with positive variation by both total and paid maternity leave length, and time of return to work. In adjusted analyses, neither total nor paid maternity leave length had any impact on breastfeeding initiation or duration. Compared with those returning to work within 1 to 6 weeks, women who had not yet returned to work had a greater odds of initiating breastfeeding (odds ratio [OR]: 1.46 [1.08-1.97]; risk ratios [RR]: 1.13 [1.03-1.22]), continuing any breastfeeding beyond 6 months (OR: 1.41 [0.87-2.27]; RR: 1.25 [0.91-1.61]), and predominant breastfeeding beyond 3 months (OR: 2.01 [1.06-3.80]; RR: 1.70 [1.05-2.53]). Women who returned to work at or after 13 weeks postpartum had higher odds of predominantly breastfeeding beyond 3 months (OR: 2.54 [1.51-4.27]; RR: 1.99 [1.38-2.69]). CONCLUSION: If new mothers delay their time of return to work, then duration of breastfeeding among US mothers may lengthen. Copyright © 2011 by the American Academy of Pediatrics.
Ran T.,Georgia community health |
Chattopadhyay S.K.,Georgia community health
American Journal of Preventive Medicine | Year: 2015
Context: A recently updated Community Guide systematic review of the effectiveness of community water fluoridation once again found evidence that it reduces dental caries. Although community water fluoridation was found to save money in a 2002 Community Guide systematic review, the conclusion was based on studies conducted before 1995. Given the update to the effectiveness review, re-examination of the benefit and cost of community water fluoridation is necessary. Evidence acquisition: Using methods developed for Community Guide economic reviews, 564 studies were identified within a search period from January 1995 to November 2013. Ten studies were included in the current review, with four covering community fluoridation benefits only and another six providing both cost and benefit information. Additionally, two of the six studies analyzed the cost effectiveness of community water fluoridation. All currencies were converted to 2013 dollars. Evidence synthesis: The analysis was conducted in 2014. The benefit-only studies used regression analysis, showing that different measures of dental costs were always lower in communities with water fluoridation. For the six cost-benefit studies, per capita annual intervention cost ranged from $0.11 to $4.92 for communities with at least 1,000 population, and per capita annual benefit ranged from $5.49 to $93.19. Benefit-cost ratios ranged from 1.12:1 to 135:1, and these ratios were positively associated with community population size. Conclusions: Recent evidence continues to indicate that the economic benefit of community water fluoridation exceeds the intervention cost. Further, the benefit-cost ratio increases with the community population size. © 2015.