Eight Priorities for Improving Primary Care Access Management in Healthcare Organizations: Results of a Modified Delphi Stakeholder Panel.

Objective: To identify priorities for improving healthcare organization management of patient access to primary care based on prior evidence and a stakeholder panel.

Background: Studies on healthcare access show its importance for ensuring population health. Few studies show how healthcare organizations can improve access.

The Role of Serum Procalcitonin in Predicting Bacterial Sepsis in Patients With Hypothyroidism.

Context: Serum levels of procalcitonin (PCT), a protein produced by the thyroid C cells under physiologic conditions, are high during sepsis.

Objective: To assess the test performance of serum PCT in predicting bacterial sepsis and septic shock in patients with hypothyroidism compared with those who have euthyroidism.

Design And Methods: This retrospective study evaluated patients with no history of thyroid dysfunction (euthyroid), primary hypothyroidism [medical hypothyroidism (MH)], and postsurgical hypothyroidism from total thyroidectomy (TT) identified from a prospectively maintained database who had PCT testing from 2005 to 2018.

Household Food Insecurity is Associated with Higher Adiposity among US Schoolchildren Ages 10-15 Years: The Healthy Communities Study.

Background: Limited research exists on the relationship between food insecurity and children's adiposity and diet and how it varies by demographic characteristics in the United States.

Objective: The aim of this study was to assess the relationship between household food insecurity and child adiposity-related outcomes, measured as BMI (kg/m2) z score (BMI-z), weight status, and waist circumference, and diet outcomes, and examined if the associations differ by age, sex, and race/ethnicity.

Methods: Data collected in 2013-2015 from 5138 US schoolchildren ages 4-15 y from 130 communities in the cross-sectional Healthy Communities Study were analyzed.

Organizational readiness for wellness promotion - a survey of 100 African American church leaders in South Los Angeles.

Background: Churches are an important asset and a trusted resource in the African American community. We needed a better understanding of their readiness to engage in health promotion before launching a large-scale health promotion effort in partnership with South Los Angeles churches.

Methods: In 2017, we conducted surveys with leaders of 100 churches.

Stressors in Midlife and Risk of Dementia: The Role of Race and Education.

Background: Posttraumatic stress disorder is associated with increased dementia risk but less is known about stress because of everyday problems in diverse populations.

Methods: A total of 9605 health care plan members who provided information regarding midlife stressors in 1972 to 1973 (ages, 40 to 55 y) were followed for dementia diagnosis between 1996 and 2017. Cox proportional hazard models evaluated associations between midlife stressors and dementia adjusting for demographics and lifecourse health indicators.

Cancer-related Knowledge, Attitudes and Behaviors within the Latino Faith Community in South Los Angeles.

Objectives: The goal of this study was to establish relationships with Latino churches in South Los Angeles and to collect data from parishioners regarding their access to care, cancer risk factors, and cancer-related knowledge, attitudes and screening.

Methods: In 2014, we approached five Latino churches. All allowed us to describe the study and to consent potential respondents at a designated time during the church service.

Randomized trial of care management to improve Parkinson disease care quality.

Objective: To test effects on care quality of Chronic Care Model-based Parkinson disease (PD) management.

Methods: This 2-group stratified randomized trial involved 328 veterans with PD in southwestern United States. Guided care management, led by PD nurses, was compared to usual care.

Cardiovascular Care in Women Veterans.

Cardiovascular disease is the number one cause of death for women in the United States. Of the 1.3 million active duty service members, 16.

Training Community Health Advisors in African American Churches: Do Training Outcomes Predict Performance?

Programs that utilize Community Health Advisors (CHAs) to promote cancer screening are effective in community settings. However, predictors of CHA performance are not well understood. From 2016 to 2018, we partnered with 9 African American churches in South Los Angeles and trained 49 CHAs to promote cancer screening in an effort to build capacity for health promotion in a low-resource community.

Comparison of 30-Day Serious Adverse Clinical Events for Elderly Patients Presenting to the Emergency Department With Near-Syncope Versus Syncope.

Study Objective: Controversy remains in regard to the risk of adverse events for patients presenting with syncope compared with near-syncope. The purpose of our study is to describe the difference in outcomes between these groups in a large multicenter cohort of older emergency department (ED) patients.

Methods: From April 28, 2013, to September 21, 2016, we conducted a prospective, observational study across 11 EDs in adults (≥60 years) with syncope or near-syncope.

The Evolving Cardiovascular Disease Risk Scores for Persons with Diabetes Mellitus.

Purpose Of Review: We briefly introduce the concept and use of cardiovascular disease (CVD) risk scores and review the methodology for CVD risk score development and validation in patients with diabetes. We also discuss CVD risk scores for diabetic patients that have been developed in different countries.

Recent Findings: Patients with diabetes have a gradient of CVD risk that needs to be accurately assessed.

Service Coordination by Public Sector Managers in a Human Service Contracting Environment.

Despite emerging evidence of contracting for evidence-based practices (EBP), little research has studied how managers lead contract-based human service delivery. A 2015 survey of 193 managers from five San Francisco Bay Area county human service departments examined the relationship between contract-based service coordination (i.e.

Segmentation of High-Cost Adults in an Integrated Healthcare System Based on Empirical Clustering of Acute and Chronic Conditions.

Background: High-cost patients are a frequent focus of improvement projects based on primary care and other settings. Efforts to characterize high-cost, high-need patients are needed to inform care planning, but such efforts often rely on a priori assumptions, masking underlying complexities of a heterogenous population.

Objective: To define recognizable subgroups of patients among high-cost adults based on clinical conditions, and describe their survival and future spending.

Transactional Sex among Men Who Have Sex with Men: Differences by Substance Use and HIV Status.

Exchanging money, drugs, and other goods for sex has been associated with sexual risk behaviors and increased STIs/HIV. While female sex work is well described, data on men who exchange sex for money or goods are more limited. This paper examined the prevalence and correlates of transactional sex among young men who have sex with men, especially focusing on substance use and HIV status.

Dialysis Patient-Centeredness and Precision Medicine: Focus on Incremental Home Hemodialysis and Preserving Residual Kidney Function.

An exponential interest in incremental transition to dialysis recently has emerged in lieu of outright three times/wk hemodialysis initiation as the standard of care. Incremental dialysis is consistent with precision medicine, given individualized dialysis dose adjustment based on patient's dynamic needs, leading to reduced patient suffering from longer or more frequent dialysis treatments and improved health-related quality of life. It includes twice-weekly or less frequent hemodialysis treatments with or without a low-protein diet on nondialysis days, or a shorter (<3 h) hemodialysis treatment three times per week or more frequent treatments, a useful approach for home hemodialysis initiation.

Variation in diagnostic testing for older patients with syncope in the emergency department.

Background: Older adults presenting with syncope often undergo intensive diagnostic testing with unclear benefit. We determined the variation, frequency, yield, and costs of tests obtained to evaluate older persons with syncope.

Methods: We conducted a prospective, multicenter observational cohort study in 11 academic emergency departments in the United States of 3686 patients aged ≥60 years presenting with syncope or presyncope.

Proximity to overhead power lines and childhood leukaemia: an international pooled analysis.

Background: Although studies have consistently found an association between childhood leukaemia risk and magnetic fields, the associations between childhood leukaemia and distance to overhead power lines have been inconsistent. We pooled data from multiple studies to assess the association with distance and evaluate whether it is due to magnetic fields or other factors associated with distance from lines.

Methods: We present a pooled analysis combining individual-level data (29,049 cases and 68,231 controls) from 11 record-based studies.

National Distribution of Cancer Genetic Testing in the United States: Evidence for a Gender Disparity in Hereditary Breast and Ovarian Cancer.

This cross-sectional study describes the national distribution of genetic testing for hereditary cancer risk, identifies disparities, and assesses whether a gender gap exists

Residential mobility and childhood leukemia.

Aims: Studies of environmental exposures and childhood leukemia studies do not usually account for residential mobility. Yet, in addition to being a potential risk factor, mobility can induce selection bias, confounding, or measurement error in such studies. Using data collected for California Powerline Study (CAPS), we attempt to disentangle the effect of mobility.

High rates of exposure to tuberculosis patients among HIV-infected health care workers in Botswana.

Objective: To compare daily exposure to tuberculosis (TB) patients between HIV-infected and non-HIV-infected health care workers (HCWs), and examine the uptake of antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) among HIV-infected HCWs in Botswana.

Design: We conducted a cross-sectional study among HCWs in 30 hospitals and clinics. We determined self-reported exposure frequency to TB patients and HIV status through in-person interviews.

Racial/Ethnic Differential Effects of Medicaid Expansion on Health Care Access.

Objective: To assess racial/ethnic differential impacts of the ACA's Medicaid expansion on low-income, nonelderly adults' access to primary care.

Data Sources: Behavioral Risk Factor Surveillance System, State Physicians Workforce Data Book, and Bureau of Labor Statistics, in 2013 and 2015.

Study Design: Quasi-experimental design with difference-in-differences analyses.

Decreasing Use of Radioactive Iodine for Low-Risk Thyroid Cancer in California, 1999 to 2015.

Context: Routine radioactive iodine (RAI) ablation for low-risk differentiated thyroid cancer (DTC) is not supported by current practice guidelines.

Objective: To assess recent stage-specific trends in use of RAI ablation.

Design, Setting, And Patients: Retrospective study of patients with DTC (1999 to 2015) identified from the California Cancer Registry.

Improving correctional healthcare providers' ability to care for transgender patients: Development and evaluation of a theory-driven cultural and clinical competence intervention.

Rationale: Correctional healthcare providers' limited cultural and clinical competence to care for transgender patients represents a barrier to care for incarcerated transgender individuals.

Objective: The present study aimed to adapt, deliver, and evaluate a transgender cultural and clinical competence intervention for correctional healthcare providers.

Method: In the summer of 2016, a theoretically-informed, group-based intervention to improve transgender cultural and clinical competence was delivered to 34 correctional healthcare providers in New England.