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Wulff K.C.,Johns Hopkins Bloomberg | Miller F.G.,U.S. National Institutes of Health | Pearson S.D.,U.S. National Institutes of Health
Health Affairs | Year: 2011

To attain the anticipated benefits of increased investments in comparative effectiveness research, the results must translate into improved medical practice and policy. In this article we present an analysis of a case study of percutaneous vertebroplasty, a widely used invasive procedure to treat painful vertebral fractures by injecting bone cement into the spine. In August 2009, results from a pair of rigorous double-blind randomized controlled trials were published and reported that vertebroplasty provided no better pain relief than a sham procedure in which needles were introduced into the back without injecting cement. More than two years after publication of the two studies, insurers' coverage of the procedure continues unchanged. This raises serious questions about the policy mechanisms that exist in the United States to interpret and act upon "negative" research findings from studies of popular health care interventions. © 2011 Project HOPE-The People-to-People Health Foundation, Inc.


Zeoli A.M.,Michigan State University | Webster D.W.,Johns Hopkins Bloomberg
Injury Prevention | Year: 2010

Objective To assess the relationships between intimate partner homicide (IPH) and public policies including police staffing levels in large US cities. Design The research uses a multiple time-series design to examine the effects of statutes aimed at restricting access to firearms for perpetrators of domestic violence, allowing or mandating arrest for violators of domestic violence restraining orders (DVROs), beer excise taxes, and police staffing levels on IPH in 46 of the largest US cities from 1979 to 2003. Both total IPH and IPH committed with a firearm are analysed. Generalised estimating equations using a Poisson distribution are used to regress IPH on the policies and potential confounders. Results State statutes restricting those under DVROs from accessing firearms, and laws allowing the warrantless arrest of DVRO violators, are associated with reductions in total and firearm IPH. Police staffing levels are also negatively associated with total and firearm IPH. There was no evidence that other policies to restrict firearm access to domestic violence offenders or alcohol taxes had a significant impact on IPH. Conclusions Reducing access to firearms for DVRO defendants, increasing police staffing levels and allowing the warrantless arrest of DVRO violators may reduce the city-level risk of IPH. Future research should evaluate factors that may mediate the effects of these laws and increased police staffing levels on IPH to determine whether there are opportunities to increase their protective effects. Further research is needed on firearm law implementation to determine why the other tested laws were not found effective.


Wolff J.L.,Johns Hopkins Bloomberg | Roter D.L.,Behavior and Society
Journal of General Internal Medicine | Year: 2012

Background: Late-life mental health disorders are prevalent, costly, and commonly under-diagnosed and under-treated. Objective: To investigate whether family companion presence in routine primary care visits helps or hinders patient-centered processes among older adults with poor mental health function. DESIGN AND Participants: Observational study of accompanied (n∈=∈80) and unaccompanied (n∈=∈310) primary care patients ages 65 and older. Main Measures: Audio-taped medical visit communication, coded with the Roter Interactional Analysis System, and three process Measures: visit duration (in minutes), patient/companion verbal activity, and a ratio of patient-centered communication, adjusted for patient age, gender, race, and physical function. Participants were stratified by SF-36 mental health subscale (MCS) using two approaches (1) standardized population midpoint to delineate "good" (50+) and "poor" health (< 50) and (2) clinically derived cut-points (<35; 35-49; 50+). RESULTS: When patients with poor mental health were accompanied by a family companion, patient/companions provided less psychosocial information, physicians engaged in less question-asking and partnership-building, and both patient/companions and physicians contributed more task-oriented, biomedical discussion. Accompanied patients with poor mental health were less likely to experience patient-centered communication relative to unaccompanied patients (aOR∈=∈0.21; 95% CI: 0.06, 0.68); no difference was observed for patients with good mental health (aOR∈=∈1.02; 95% CI: 0.46, 2.27). Verbal activity was comparable for accompanied patients/companions and unaccompanied patients in both mental health strata. Medical visits were 2.3 minutes longer when patients with good mental health were accompanied (b∈=∈2.31; p∈=∈0.006), but was comparable for patients with poor mental health (b∈=∈-0.37; p∈=∈0.827). Study findings were amplified in the lowest functioning mental health subgroup (MCS∈<∈35): medical visits were shorter, and communication was least patient-centered (p∈=∈0.019) when these patients were accompanied. Conclusions: Older adults with poor mental health function may experience more communication challenges in the form of shorter visits and less patient-centered communication when a family companion is present. © 2011 Society of General Internal Medicine.


Gollust S.E.,University of Minnesota | Niederdeppe J.,Cornell University | Barry C.L.,Johns Hopkins Bloomberg
American Journal of Public Health | Year: 2013

Objectives. We examined the effects of messages describing consequences of childhood obesity on public attitudes about obesity prevention policy. Methods. We collected data from 2 nationally representative Internet-based surveys. First, respondents (n = 444) evaluated the strength of 11 messages about obesity's consequences as reasons for government action. Second, we randomly assigned respondents (n = 2494) to a control group or to treatment groups shown messages about obesity consequences. We compared groups' attitudes toward obesity prevention, stratified by political ideology. Results. Respondents perceived a message about the health consequences of childhood obesity as the strongest rationale for government action; messages about military readiness, bullying, and health care costs were rated particularly strong by conservatives, moderates, and liberals, respectively. A message identifying the consequences of obesity on military readiness increased conservatives' perceptions of seriousness, endorsement of responsibility beyond the individual, and policy support, compared with a control condition. Conclusions. The public considers several consequences of childhood obesity as strong justification for obesity prevention policy. Activating new or unexpected values in framing a health message could raise the health issue's salience for particular subgroups of the public. Copyright © 2013 by the American Public Health Association®.


El Arifeen S.,International Center for Diarrhoeal Disease Research Bangladesh icddr | Christou A.,International Center for Diarrhoeal Disease Research Bangladesh icddr | Reichenbach L.,International Center for Diarrhoeal Disease Research Bangladesh icddr | Osman F.A.,University of Dhaka | And 5 more authors.
The Lancet | Year: 2013

In Bangladesh, rapid advancements in coverage of many health interventions have coincided with impressive reductions in fertility and rates of maternal, infant, and childhood mortality. These advances, which have taken place despite such challenges as widespread poverty, political instability, and frequent natural disasters, warrant careful analysis of Bangladesh's approach to health-service delivery in the past four decades. With reference to success stories, we explore strategies in health-service delivery that have maximised reach and improved health outcomes. We identify three distinctive features that have enabled Bangladesh to improve health-service coverage and health outcomes: (1) experimentation with, and widespread application of, large-scale community-based approaches, especially investment in community health workers using a doorstep delivery approach; (2) experimentation with informal and contractual partnership arrangements that capitalise on the ability of non-governmental organisations to generate community trust, reach the most deprived populations, and address service gaps; and (3) rapid adoption of context-specifi c innovative technologies and policies that identify country-specifi c systems and mechanisms. Continued development of innovative, community-based strategies of health-service delivery, and adaptation of new technologies, are needed to address neglected and emerging health challenges, such as increasing access to skilled birth attendance, improvement of coverage of antenatal care and of nutritional status, the eff ects of climate change, and chronic disease. Past experience should guide future eff orts to address rising public health concerns for Bangladesh and other underdeveloped countries.

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