ICF Macro

Atlanta, GA, United States

ICF Macro

Atlanta, GA, United States
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Johnson C.J.,Cancer Data Registry of Idaho | Fink A.K.,ICF Macro | German R.R.,Centers for Disease Control and Prevention
American Journal of Forensic Medicine and Pathology | Year: 2012

Death certificates are the source for mortality statistics and are used to set public health goals. Accurate death certificates are vital in tracking outcomes of cancer. Deaths may be certified by physicians or other medical professionals, coroners, or medical examiners. Idaho is one of 3 states that participated in a Centers for Disease Control and Prevention-funded study to assess the concordance between cancer-specific causes of death and primary cancer site among linked cancer registry/death certificate data. We investigated variability in the accuracy of cancer death certificates by characteristics of death certifiers, including certifier type (physician vs coroner), physician specialty, years of experience as death certifier, and number of deaths certified. This study showed significant differences by certifier type/physician specialty in the accuracy of cancer mortality measured by death certificates. Nonphysician coroners had lower accuracy rates compared with physicians. Although nonphysician coroners certified less than 5% of cancer deaths in Idaho, they were significantly less likely to match the primary site from the cancer registry. Results from this study may be useful in the future training of death certifiers to improve the accuracy of death certificates and cancer mortality statistics. Copyright © 2012 by Lippincott Williams & Wilkins.


German R.R.,Centers for Disease Control and Prevention | Fink A.K.,ICF Macro | Heron M.,National Center for Health Statistics | Stewart S.L.,Centers for Disease Control and Prevention | And 2 more authors.
Cancer Epidemiology | Year: 2011

Background: One measure of the accuracy of cancer mortality statistics is the concordance between cancer defined as the underlying cause of death from death certificates and cancer diagnoses recorded in central, population-based cancer registries. Previous studies of such concordance are outdated. Objective: To characterize the accuracy of cancer mortality statistics from the concordance between cancer cause of death and primary cancer site at diagnosis. Design: Central cancer registry records from California, Colorado, and Idaho in the U.S. were linked with state vital statistics data and evaluated by demographic and tumor information across 79 site categories. A retrospective arm (confirmation rate per 100 deaths) compared death certificate data from 2002 to 2004 with cancer registry diagnoses from 1993 to 2004, while a prospective arm (detection rate per 100 deaths) compared cancer registry diagnoses from 1993 to 1995 with death certificate data from 1993 to 2004 by International Statistical Classification of Diseases and Related Health Problems (ICD) version used to code deaths. Results: With n=265,863 deaths where cancer was recorded as the underlying cause based on the death certificate, the overall confirmation rate for ICD-10 was 82.8% (95% confidence interval [CI], 82.6-83.0%), the overall detection rate for ICD-10 was 81.0% (95% CI, 80.4-81.6%), and the overall detection rate for ICD-9 was 85.0% (95% CI, 84.8-85.2%). These rates varied across primary sites, where some rates were <50%, some were 95% or greater, and notable differences between confirmation and detection rates were observed. Conclusions: Important unique information on the quality of cancer mortality data obtained from death certificates is provided. In addition, information is provided for future studies of the concordance of primary cancer site between population-based cancer registry data and data from death certificates, particularly underlying causes of death coded in ICD-10. © 2010 Elsevier Ltd.


Leviton L.C.,Robert Wood Johnson Foundation | Khan L.K.,Centers for Disease Control and Prevention | Rog D.,Rockville Institute and Westat Incorporated | Dawkins N.,ICF Macro | Cotton D.,ICF Macro
Annual Review of Public Health | Year: 2010

Evaluability assessment, also commonly known as exploratory evaluation, has assisted the field of public health to improve programs and to develop a pragmatic, practice-based research agenda. Evaluability assessment was originally developed as a low-cost pre-evaluation activity to prepare better for conventional evaluations of programs, practices, and some policies. For public health programs, however, it serves several other important purposes: (a) giving program staff rapid, constructive feedback about program operations; (b) assisting the core public health planning and assurance functions by helping to develop realistic objectives and providing low-cost, rapid feedback on implementation; (c) navigating federal performance measurement requirements; (d) translating research into practice by examining the feasibility, acceptability, and adaptation of evidence-based practices in new settings and populations; and (e) translating practice into research by identifying promising new approaches to achieve public health goals. Copyright © 2010 by Annual Reviews. All rights reserved.


Brashears F.,ICF Macro | Davis C.,Human Service Collaborative | Katz-Leavy J.,Child and Family Mental Health
American Journal of Community Psychology | Year: 2012

This article presents a brief description of a longitudinal study of system-level change, offers observations about what has been learned about the evolution of systems of care from the unique and qualified perspectives of the group of site visitors who gathered the data for the study, and identifies a set of issues that needs to be addressed to advance the system of care model in community based care of children and youth with behavioral health needs and their families. The article describes the system of care assessment portion of the national evaluation of the Federal Children's Mental Health Initiative and presents a brief summary of accumulated findings from the assessments conducted in communities funded in six successive waves of awards to provide context for the site visitors' observations and the authors' recommendations. The authors draw upon the expert observations of the site visitors, who represent many different disciplines and backgrounds, which suggest that, as a set of guiding principles, the system of care philosophy and approach seem to have become accepted standards of program practice and system operation in the funded sites, although implementation is uneven across principles and sites. The article concludes with the authors' identification of high-level system issues that must be addressed more effectively if systems of care are to come to scale. © 2011 Society for Community Research and Action.


Bernabeo E.C.,American Board of Internal Medicine | Holtman M.C.,ICF Macro | Ginsburg S.,University of Toronto | Rosenbaum J.R.,Yale University | Holmboe E.S.,American Board of Internal Medicine
Academic Medicine | Year: 2011

Purpose The traditional "rotating" model of inpatient training remains the gold standard of residency, moving residents through different systems every two to four weeks. The authors studied the experience and impact of frequent transitions on residents. Method This was a qualitative study. Ninety-seven individuals participated in 12 focus groups at three academic medical centers purposefully chosen to represent a range of geographic locations and structural characteristics. Four groups were held at each site: residents only, faculty only, nurses and ancillary staff only, and a mixed group. Grounded theory was used to analyze data. Results Perceived benefits of transitions included the ability to adapt to new environments and practice styles, improved organization and triage skills, increased comfort with stressful situations, and flexibility. Residents primarily relied on each other to cope with and prepare for transitions, with little support from the program or faculty level. Several potentially problematic workarounds were described within the context of transitions, including shortened progress notes, avoiding pages, hiding information, and sidestepping critical situations. Nearly all residents acknowledged that frequent transitions contributed to a lack of ownership and other potentially harmful effects for patient care. Conclusions These findings challenge the value of the traditional "rotating" model in residency. As residents adapt to frequent transitioning, they implicitly learn to value flexibility and efficiency over relationship building and deep system knowledge. These findings raise significant implications for professional development and patient care and highlight an important element of the hidden curriculum embedded within the current training model. Copyright © by the Association of American Medical Colleges.


Brannan A.M.,Vanderbilt University | Brashears F.,ICF Macro | Gyamfi P.,ICF Macro | Manteuffel B.,ICF Macro
American Journal of Community Psychology | Year: 2012

This study describes development in federally funded systems of care. Data for this study were collected using the System of Care Assessment that rated grantees' enactment of system of care principles in the infrastructure and service delivery domains. Data were collected by trained raters who conducted several site visits over the funding period. This study described system development over time across 61 sites and tested whether gains were statistically significant. Latent profile analysis was used to explore whether sites could be meaningfully grouped based on their baseline service delivery domain scores. Differences across groups were tested in terms of community, system, and client characteristics. Differential growth across groups was also examined. Overall, systems of care developed over time in both the infrastructure and service delivery domains. Although infrastructure scores were generally lower than service delivery scores, greater gains were seen for the infrastructure domain. Three groups of sites were identified that could be distinguished in terms of degree of development overall, and for specific system of care principles. The groups of sites differed in terms of community factors, system features, and client characteristics. In addition, repeated measures analyses found differential growth in system development over time across groups. © 2011 Society for Community Research and Action.


Garrett D.A.,Program for Appropriate Technology in Health | Sangha J.K.,ICF Macro | Kothari M.T.,Program for Appropriate Technology in Health | Boyle D.,Program for Appropriate Technology in Health
American Journal of Clinical Nutrition | Year: 2011

Whereas cost-effective interventions exist for the control of micronutrient malnutrition (MN), in low-resource settings field-friendly tools to assess the effect of these interventions are underutilized or not readily availablewhere they are most needed. Conventional approaches for MN measurement are expensive and require relatively sophisticated laboratory instrumentation, skilled technicians, good infrastructure, and reliable sources of clean water and electricity. Consequently, there is a need to develop and introduce innovative tools that are appropriate forMNassessment in low-resource settings. These diagnostics should be cost-effective, simple to perform, robust, accurate, and capable of being performedwith basic laboratory equipment. Currently, such technologies either do not exist or have been applied to the assessment of a few micronutrients. In the Demographic and Health Surveys (DHS), a fewsuch examples for which "biomarkers" of nutrition development have been assessed in low-resource settings using field-friendly approaches are hemoglobin (anemia), retinol-binding protein (vitamin A),andiron(transferrinreceptor). Inall oftheseexamples,sampleswere collectedmainlybynonmedical staffandanalyseswereconductedinthe survey countrybytechnicians fromthe localhealthor researchfacilities. This article provides information on howtheDHS has been able to successfully adaptfield-friendly techniques in challenging environments in population-based surveys for the assessment of micronutrient deficiencies. Special emphasis is placed on sample collection, processing, and testing in relation to the availability of local technology, resources, and capacity. © 2011 American Society for Nutrition.


Eaton D.K.,National Center for Chronic Disease Prevention and Health Promotion | Kann L.,National Center for Chronic Disease Prevention and Health Promotion | Kinchen S.,National Center for Chronic Disease Prevention and Health Promotion | Shanklin S.,National Center for Chronic Disease Prevention and Health Promotion | And 10 more authors.
Morbidity and Mortality Weekly Report | Year: 2010

Problem: Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, and are interrelated and preventable. Reporting Period Covered: September 2008-December 2009. Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and local school-based YRBSs conducted by state and local education and health agencies. This report summarizes results from the 2009 national survey, 42 state surveys, and 20 local surveys conducted among students in grades 9-12. Results: Results from the 2009 national YRBS indicated that many high school students are engaged in behaviors that increase their likelihood for the leading causes of death among persons aged 10-24 years in the United States. Among high school students nationwide, 9.7% rarely or never wore a seat belt when riding in a car driven by someone else. During the 30 days before the survey, 28.3% of high school students rode in a car or other vehicle driven by someone who had been drinking alcohol, 17.5% had carried a weapon, 41.8% had drunk alcohol, and 20.8% had used marijuana. During the 12 months before the survey, 31.5% of high school students had been in a physical fight and 6.3% had attempted suicide. Substantial morbidity and social problems among youth also result from unintended pregnancies and STDs, including HIV infection. Among high school students nationwide, 34.2% were currently sexually active, 38.9% of currently sexually active students had not used a condom during their last sexual intercourse, and 2.1% of students had ever injected an illegal drug. Results from the 2009 YRBS also indicated that many high school students are engaged in behaviors associated with the leading causes of death among adults aged ≥25 years in the United States. During 2009, 19.5% of high school students smoked cigarettes during the 30 days before the survey. During the 7 days before the survey, 77.7% of high school students had not eaten fruits and vegetables five or more times per day, 29.2% had drunk soda or pop at least one time per day, and 81.6% were not physically active for at least 60 minutes per day on all 7 days. One-third of high school students attended physical education classes daily, and 12.0% were obese. Interpretation: Since 1991, the prevalence of many health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of morbidity and mortality. The prevalence of most risk behaviors does not vary substantially among cities and states. Public Health Action: YRBS data are used to measure progress toward achieving 15 national health objectives for Healthy People 2010 and three of the 10 leading health indicators, to assess trends in priority health-risk behaviors among high school students, and to evaluate the impact of broad school and community interventions at the national, state, and local levels. More effective school health programs and other policy and programmatic interventions are needed to reduce risk and improve health outcomes among youth.


Shapiro D.,Pennsylvania State University | Gebreselassie T.,ICF MACRO
Population Research and Policy Review | Year: 2014

Several decades ago, marriage among women in most of sub-Saharan Africa could reasonably be described as early and near-universal. However, it is apparent from a number of studies published in the past two decades that in many countries in the region, there is a trend toward delays in the onset of marriage, with early marriage becoming less prevalent. This trend is most notable among the urban and better-educated segments of the population. Rising age at first marriage, in turn, has played an important role in the ongoing fertility transition in some parts of sub-Saharan Africa. This paper examines union patterns of young women (aged 15-29) in more than two dozen countries in sub-Saharan Africa, with the objective of documenting and analyzing the extent and nature of the ongoing changes in entry to union that are taking place in the region. We use data from the Demographic and Health Surveys (DHSs), and focus on those countries that have had multiple DHSs, so as to allow examination of within-country trends in union patterns. These countries represent nearly three-quarters of the population of sub-Saharan Africa. In addition to examining national-level data, the paper looks at data separately for urban and rural places, and includes as well an examination of data on union patterns in capital cities. After looking at trends in marriage, we analyze factors associated with these trends, most notably women's education and economic well-being. The final part of the paper assesses the role of the observed declines in the percentages of women in union in contributing to the fertility transition that is taking place in sub-Saharan Africa. © 2013 Springer Science+Business Media Dordrecht.


Gebreselassie T.,ICF Macro | Mishra V.,ICF International
Journal of Biosocial Science | Year: 2011

This study investigates how various social, demographic and economic factors affect spousal agreement on preferred waiting time to next birth. Data for matched cohabiting couples from ten Demographic and Health Surveys in sub-Saharan Africa (Benin, Burkina Faso, Ghana, Guinea, Mali, Ethiopia, Kenya, Mozambique, Zambia and Zimbabwe), conducted between 2003 and 2006, were analysed to compare reported waiting time to next birth by the husband and the wife. Couples where the reported waiting time to next birth was the same for both partners (difference is 0 months) were defined as having agreement on waiting time to next birth. In sub-Saharan Africa, spousal agreement on waiting time to next birth was found to be associated with wanting the next child sooner. When the spouses disagree on waiting time to next birth, the wives want to wait longer than their husbands in most cases. Additionally, the study found that demographic factors are the primary determinants of spousal agreement on waiting time to next birth, not socioeconomic factors. The strongest predictors of spousal agreement on waiting time to next birth were number of living children, difference between the number of ideal and living children and wife's age. Couples with fewer children, a younger wife and those with a difference of five or more children between ideal and living number of children were more likely to agree on waiting time to next birth. Effects of socioeconomic factors, such as education and wealth status, on spousal agreement on waiting time to next birth were generally weak and inconsistent. The findings highlight some of the challenges in developing programmes to promote spousal communication and birth spacing and underscore the need for programmes to be gender-sensitive. © 2011 Cambridge University Press.

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