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Langlois-Klassen D.,University of Alberta | Wooldrage K.M.,University of Manitoba | Manfreda J.,University of Manitoba | Sutherland K.,University of Alberta | And 4 more authors.
European Respiratory Journal | Year: 2011

In major immigrant-receiving countries, annual foreign-born tuberculosis (TB) case counts and rates are relatively constant. Why this is so, and who might be a high-yield target for screening for latent TB infection, remain open questions. Foreign-born TB in Canada during 1986-2002 was retrospectively examined using national TB and immigration data as well as census data. Case counts and rates were analysed in relation to demographics, immigration period and time since arrival. Pre-1986 immigrants (n=3,860,853) and 1986-2002 immigrants (n=3,463,283) contributed 8,662 and 9,613 TB cases, respectively. Immigrants arriving ≤5 yrs ago and those arriving >10 yrs ago contributed almost equally to the annual foreign-born TB case count despite a 3.5-fold difference in in-country person-yrs. Remarkably stable and relatively low TB incidence was observed among immigrants >10 yrs post-arrival. Conversely, TB incidence within 5 yrs of arrival was dynamic, demonstrating a strong inverse association with time since arrival and higher sensitivity to changes in immigration level than shifts toward higher incidence source countries. Relative constancy in foreign-born TB incidence is explained by a complex convergence of several factors. Immigrants born in high-incidence countries who arrived ≤2 yrs ago and were aged 15-34 yrs upon arrival constitute high-yield targets for preventive therapy. Copyright©ERS 2011.

Weil T.P.,Health Consultants Inc.
Journal of Nervous and Mental Disease | Year: 2015

TheAmerican populace currently supports the need for providing additional mental health services for adolescents who frequently express anger and mood instability and maybe are at risk for major psychiatric disorders and behavioral problems; Vietnam, Iraqi, and Afghanistan veterans or military personnel still on duty diagnosed with posttraumatic stress disorder, depression, or other similar combat-related disabilities; the approximately 1 million prisoners currently incarcerated primarily because of substance abuse and needing medically related rehabilitative services; and senior citizens who experience dementia and depression and require improved therapeutics. The problems outlined herein are as follows: far too limited monies are being spent for mental health services (5.6% of total US expenditures for health or roughly one fifth of what is consumed for hospital care); effective therapies are often lacking; and there is a shortage of qualified mental health personnel except in upscale urban and suburban areas. Unfortunately, these problems are so immense that, even with enhanced prioritization of our available resources, they are still not entirely solvable. The American public may continue to impart lip service when attempting to respond to our nation'smental health needs ormay decide to spend vastlymoremoney for such care. The latter choice may not be forthcoming in the near future for various cultural-societal-clinical-fiscal reasons. © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Weil T.P.,Health Consultants Inc.
Journal of Nervous and Mental Disease | Year: 2015

Among the major objectives of the Mental Health Parity and Addiction Equity Act of 2008 and The Patient Protection and Affordable Care Act of 2010, often referred to today in political discussion as "Obamacare," was to significantly extend more health insurance benefits to those seeking mental health services. This commentary suggests that these recent legislative acts have accomplished little to date to enhance the delivery and the financing of additional mental health services because of the significant delays in rule making and other federal bureaucratic snafus, the numerous difficulties that the newly insured patients will experience in gaining access to qualified mental health personnel, and the cultural factors impinging on the hesitancy of the mentally ill to seek care from mental health professionals. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Barker D.C.,Health Consultants Inc. | Gutman M.A.,Gutman Research Associates
American Journal of Preventive Medicine | Year: 2014

Background The Robert Wood Johnson Foundation Active Living Research (ALR) program commissioned an evaluation of its initiative to assess 10 years (2001-2011) of progress in establishing a new interdisciplinary field to develop and translate research focused on policy and environmental factors affecting physical activity in children and families. Purpose The second-phase evaluation (ALR-2) was conducted from March to July 2011 to measure progression from evidence- and field-building (Goals 1 and 2) to policy and practice contributions (Goal 3) to inform childhood obesity strategies, and to develop recommendations for a third phase (ALR-3). Methods The evaluation was a retrospective, in-depth descriptive study utilizing qualitative and quantitative methods. Key informant interviews (N=100) across seven stakeholder groups were conducted and analyzed in 2011. Data from web-based surveys of grantee investigators conducted from 2007 to 2011 and analyzed in 2011 served as the primary quantitative source. Results Key indicators of ALR's overall progress confirmed ALR's success across its three goals: (1) establishing a strong research base: 309 publications filling major knowledge gaps; (2) building an interdisciplinary and diverse field: grantees represented 31 disciplines, with more than one quarter (28%) of investigators having ≤5 years of experience, of which 39% were people of color; and (3) using research to inform policy and practice: 62 examples, of which slightly more than one half (n=32) resulted in actual policy or practice change. Conclusions Overall, ALR met its three goals during ALR-2 and was well positioned to implement a third phase of the program to further accelerate the translation of its research into policy and practice. © 2014 American Journal of Preventive Medicine.

Ohri-Vachaspati P.,Arizona State University | Isgor Z.,University of Illinois at Chicago | Rimkus L.,University of Illinois at Chicago | Powell L.M.,University of Illinois at Chicago | And 2 more authors.
American Journal of Preventive Medicine | Year: 2015

Background: Children who eat fast food have poor diet and health outcomes. Fast food is heavily marketed to youth, and exposure to such marketing is associated with higher fast food consumption. Purpose: To examine the extent of child-directed marketing (CDM) inside and on the exterior of fast food restaurants. Methods: Data were collected from 6,716 fast food restaurants located in a nationally representative sample of public middle- and high-school enrollment areas in 2010, 2011, and 2012. CDM was defined as the presence of one or more of seven components inside or on the exterior of the restaurant. Analyses were conducted in 2014. Results: More than 20% of fast food restaurants used CDM inside or on their exterior. In multivariate analyses, fast food restaurants that were part of a chain, offered kids' meals, were located in middle- (compared to high)-income neighborhoods, and in rural (compared to urban) areas had significantly higher odds of using any CDM; chain restaurants and those located in majority black neighborhoods (compared to white) had signi ficantly higher odds of having an indoor display of kids' meal toys. Compared to 2010, there was a significant decline in use of CDM in 2011, but the prevalence increased close to the 2010 level in 2012. Conclusions: CDM inside and on the exterior of fast food restaurants is prevalent in chain restaurants; majority black communities, rural areas, and middle-income communities are disproportionately exposed. The fast food industry should limit children's exposure to marketing that promotes unhealthy food choices. © 2015 American Journal of Preventive Medicine.

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