BACKGROUND & AIMS: BACKGROUND:Most work sites engage in some form of health promotion programming designed to improve worker health and reduce health care costs. Although these programs have typically been delivered through combinations of seminars and print materials, workplace health promotion programs are increasingly being delivered through the Internet. OBJECTIVE:The purpose of this research was to evaluate the effectiveness of a Web-based multimedia health promotion program for the workplace, designed to improve dietary practices, reduce stress, and increase physical activity. METHODS:Using a randomized controlled trial design with pretest-posttest comparisons within each group, 419 employees of a human resources company were randomly assigned to the Web-based condition or to a condition that provided print materials on the same topics. All subjects were assessed at pretest and posttest through an online questionnaire containing multiple measures of health behavior and attitudes. The test period was 3 months. Questionnaire data were analyzed mainly by analysis of covariance and t tests. RESULTS:Retention rates were good for both groups-85% for the Web-based group and 87% for the print group. Subjects using the Web-based program performed significantly better than the print group on Attitudes Toward a Healthful Diet (F(1,415) = 7.104, P = .008) and Dietary Stage of Change (F(1,408) = 6.487, P = .01), but there were no significant group differences on the five other dietary measures. Both groups also showed improvement from pretest to posttest on most dietary measures, as indicated by significant t tests. Within the Web-based group, dosage analyses showed significant effects of the number of times the subject accessed the program on measures of Dietary Self-Efficacy (F(2,203) = 5.270, P = .003), Attitudes Toward a Healthful Diet (F(2,204) = 2.585, P = .045), and Dietary Stage of Change (F(2,200) = 4.627, P = .005). No significant differences were found between the two groups on measures of stress or physical activity, although t tests of pretest-posttest changes indicated that both groups improved on several of these measures. The Web-based group gave significantly higher ratings to the program materials than the print group on all health topics and in their overall evaluation (F(1,410) = 9.808, P = .002). CONCLUSIONS:The Web-based program was more effective than print materials in producing improvements in the areas of diet and nutrition but was not more effective in reducing stress or increasing physical activity. The higher ratings given to the Web-based program suggest that workers preferred it to the print materials. Both groups showed numerous pretest-posttest improvements in all health topics, although such improvements might be attributable in part to a Hawthorne effect. Results suggest that a multimedia Web-based program can be a promising means of delivering health promotion material to the workforce, particularly in the area of diet and nutrition.

背景与目标：

BACKGROUND & AIMS: :We developed a novel multifaceted psychosocial intervention program which involves screening for psychological distress and comprehensive support including individually tailored psychotherapy and pharmacotherapy provided by mental health professionals. The purpose of the present study was to investigate the feasibility of the intervention program and its preliminary usefulness for reducing clinical psychological distress experienced by patients with recurrent breast cancer. The subjects who participated in the 3 months intervention program completed psychiatric diagnostic interview and several self-reported measures regarding psychological distress, traumatic stress, and quality of life. The assessments were conducted before the intervention (T1), after the intervention (T2), and 3 months after the intervention (T3). A total of 50 patients participated in the study. The rates of participation in and adherence to the intervention program were 85 and 86%, respectively. While the proportion of psychiatric disorders at T2 (11.6%) was not significantly different from that at T1 (22.0%) (p = 0.15), the proportion of that at T3 (7.7%) had significantly decreased compared with that at T1 (p = 0.005). The novel intervention program is feasible, is a promising strategy for reducing clinically manifested psychological distress and further controlled studies are warranted.

背景与目标： : 我们开发了一种新颖的多方面的社会心理干预计划，其中包括筛查心理困扰和全面支持，包括由精神卫生专业人员提供的个性化心理治疗和药物疗法。本研究的目的是研究干预计划的可行性及其对减少复发性乳腺癌患者遭受的临床心理困扰的初步作用。参加3个月干预计划的受试者完成了精神病学诊断访谈，并完成了一些有关心理困扰，创伤压力和生活质量的自我报告措施。评估在干预前 (T1)，干预后 (T2) 和干预后3个月 (T3) 进行。共有50名患者参加了这项研究。参与和遵守干预计划的比率分别为85和86%。尽管T2 (11.6%) 的精神疾病比例与T1 (22.0%) 无显着差异 (p = 0.15)，但与T1 (p = 0.005) 相比，T3 (7.7%) 的精神疾病比例显着降低)。新的干预计划是可行的，是减少临床表现的心理困扰的有前途的策略，需要进一步的对照研究。

BACKGROUND & AIMS: PURPOSE:Long-term evaluation of an empirically based program for the treatment of morbidly obese, low-income, minority adolescents. METHODS:In the first year, 150 participants received cognitive-behavior therapy, nutritional education, medical monitoring, and structured exercise training. Weights and heights were collected at follow-up. Successful and Less Successful groups were delineated based on change in body mass index z-scores. Medical record review provided weight and height data one year before treatment for a subset of participants (comparison group). Analyses of variance examined differences between groups. Discriminant function analyses examined predictors of success in the domains of socioeconomic status, individual factors and psychological functioning, family factors, and prior weight loss behaviors. Correlates of success were explored. RESULTS:Eighty-three adolescents participated in the follow-up, on average 23 months (SD = 3.8) after initial assessment. Nineteen (23%) participants achieved clinically meaningful weight change (-.70 z-scores or better). Discriminant function analyses, correlations, and direct comparisons showed that the Successful group, compared with the Less Successful group, on average, attended 50% more sessions over 84% more weeks, were heavier initially, had somewhat better critical weight control skills (e.g., self-monitoring) before and during the program, and were somewhat more psychologically and intellectually challenged before treatment. CONCLUSION:Although some of these very high risk adolescents made clinically significant progress, more intensive treatments, like long-term residential treatments and bariatric surgery, may produce even more favorable outcomes.

背景与目标：

BACKGROUND & AIMS: PURPOSE:There has been little radiation oncologist (RO)-specific research in continuing medical education (CME) or quality improvement (QI) program efficacy. Our aim was to evaluate a CME/QI program for changes in RO behavior, performance, and adherence to department protocols/studies over the first 12 months of the program. METHODS AND MATERIALS:The CME/QI program combined chart audit with feedback (C-AWF), simulation review AWF (SR-AWF), reminder checklists, and targeted CME tutorials. Between April 2003 and March 2004, management of 75 patients was evaluated by chart audit with feedback (C-AWF) and 178 patients via simulation review audit (SR-AWF) using a validated instrument. Scores were presented, and case management was discussed with individualized educational feedback. RO behavior and performance was compared over the first year of the program. RESULTS:Comparing the first and second 6 months, there was a significant improvement in mean behavior (12.7-13.6 of 14, p = 0.0005) and RO performance (7.6-7.9 of 8, p = 0.018) scores. Protocol/study adherence significantly improved from 90.3% to 96.6% (p = 0.005). A total of 50 actions were generated, including the identification of learning needs to direct CME tutorials, the systematic change of suboptimal RO practice, and the alteration of deficient management of 3% of patients audited during the program. CONCLUSION:An integrated CME/QI program combining C-AWF, SR-AWF, QI reminders, and targeted CME tutorials effectively improved targeted RO behavior and performance over a 12-month period. There was a corresponding increase in departmental protocol and study adherence.

背景与目标：

BACKGROUND & AIMS: :A recently released report of the Exploring Accreditation Project affirmatively answered the questions regarding the desirability and feasibility of establishing a national voluntary public health accreditation program. The report's recommendations were made after 10 months of inquiry from public health experts, elected officials, the general public health workforce, academicians, and other interested parties, more than 650 public health professionals in all. Recommendations regarding how such a program might be implemented insofar as its governance, principles for standards development, financing and incentives, and evaluation were included. The report provides a blueprint for establishing a national voluntary public health accreditation program. This article describes key aspects of the Steering Committee recommendations, with limited linkage to implementation strategies where relevant, in the four areas in which the project was designed. Details are provided in the final reports of the Steering Committee (www.exploringaccreditation.org) and in other articles in this issue.

背景与目标： : 最近发布的 “探索认证项目” 报告肯定地回答了有关建立国家自愿公共卫生认证计划的可取性和可行性的问题。该报告的建议是在公共卫生专家，民选官员，一般公共卫生工作人员，院士和其他有关方面，共有650多名公共卫生专业人员进行了10个月的调查后提出的。包括了关于如何实施此类计划的建议，包括其治理，标准制定原则，融资和激励措施以及评估。该报告提供了建立国家自愿公共卫生认证计划的蓝图。本文介绍了指导委员会建议的关键方面，在设计项目的四个领域中，与相关实施战略的联系有限。指导委员会的最终报告 (www.exploringaccreditation.org) 和本期的其他文章提供了详细信息。

BACKGROUND & AIMS: :Given the heterogeneous nature of multiple sclerosis (MS), we applied DNA microarray technology to determine whether variability is reflected in peripheral blood (PB) cells. In this study, we studied whole-blood gene expression profiles of 29 patients with relapsing-remitting MS (RRMS) and 25 age- and sex-matched healthy controls. We used microarrays with a complexity of 43K cDNAs. The data were analyzed using sophisticated pathway-level analysis in order to provide insight into the deregulated peripheral immune response programs in MS. We found a remarkable elevated expression of a spectrum of genes known to be involved in immune defense in the PB of MS patients compared to healthy individuals. Cluster analysis revealed that the increased expression of these genes was characteristic for approximately half of the patients. In addition, the gene signature in this group of patients was comparable with a virus response program. We conclude that the transcriptional signature of the PB cells reflects the heterogeneity of MS and defines a sub-population of RRMS patients, who exhibit an activated immune defense program that resembles a virus response program, which is supportive for a link between viruses and MS.

背景与目标： : 鉴于多发性硬化症 (MS) 的异质性，我们应用DNA微阵列技术来确定变异性是否反映在外周血 (PB) 细胞中。在这项研究中，我们研究了29例复发缓解型MS (RRMS) 患者和25例年龄和性别匹配的健康对照者的全血基因表达谱。我们使用了复杂的43K cdna的微阵列。使用复杂的途径水平分析对数据进行分析，以便深入了解MS中放松调节的外周免疫反应程序。与健康个体相比，我们发现MS患者PB中已知参与免疫防御的一系列基因的表达显着升高。聚类分析显示，这些基因的表达增加是大约一半患者的特征。此外，这组患者的基因签名与病毒应答程序相当。我们得出的结论是，PB细胞的转录特征反映了MS的异质性，并定义了RRMS患者的亚群，他们表现出类似于病毒应答程序的激活免疫防御程序，这支持了病毒es和MS之间的联系。

BACKGROUND & AIMS: PURPOSE:Determine if a "nondieting" intervention focused on intensive training in eliciting the relaxation response enhances health outcomes compared with nondieting interventions without such training. DESIGN:Randomized trial with follow-up at 10 weeks, 4 months, and 12 months. SETTING:General community. SUBJECTS:Total of 225 overweight and obese women with at least one other cardiovascular risk factor. INTERVENTIONS:Three 10-week nondieting interventions: a group program (P1) focused on intensive training in techniques for eliciting the relaxation response (n = 60), a group program (P2) focused on healthy eating and physical activity (n = 61), and a self-guided, mail-delivered version of P2 (P3; n = 101). MEASURES:The Revised Symptom Checklist measured psychological distress, the Medical Symptoms Checklist measured the experience of medical symptoms, and the Health-Promoting Lifestyle Profile measured a range of lifestyle behaviors. Self-efficacy for low-fat eating intuitive eating, and body mass index were also assessed. ANALYSIS:An intention-to-treat analysis was used. RESULTS:At 12 months, P1 produced statistically greater improvements in stress management behaviors and medical symptom discomfort and was the only program to significantly improve self-efficacy for low-fat eating. In P1, the effect sizes for reductions in depression (0.75) and interpersonal sensitivity (0.85) were large. At 12 months, mean weight was unchanged. CONCLUSION:Inclusion of intensive relaxation response training in a nondieting program for overweight women enhanced stress management and medical symptoms outcomes but not weight outcomes.

背景与目标：

BACKGROUND & AIMS: :A randomized prevention trial contrasted families who participated in the Strong African American Families Program (SAAF), a preventive intervention for rural African American parents and their 11-year-olds, with control families. This article focuses on the program's effect on primary caregivers' depressive symptoms. Among the 167 caregivers with elevated scores on the Center for Epidemiologic Studies-Depression Scale, SAAF participation was associated with reduced depressive symptoms, enhanced parenting, and perceived improvements in youth behavior. Change in parenting (consistent discipline, youth monitoring, and open communication) but not change in youth intrapersonal competencies significantly mediated intervention effects on caregivers' depression. Results support the link between reduced depressive symptoms and stronger family relationships, particularly the importance of enhanced parenting efficacy in alleviating depressive symptoms.

背景与目标： : 一项随机预防试验将参加 “强非裔美国人家庭计划” (SAAF) 的家庭与对照家庭进行了对比，该计划是针对农村非裔美国人父母及其11岁儿童的预防干预措施。本文重点介绍该计划对主要照顾者抑郁症状的影响。在流行病学研究中心-抑郁量表得分较高的167名照顾者中，SAAF的参与与减轻的抑郁症状，增强的育儿能力和青少年行为的改善有关。父母的改变 (一致的纪律，青少年的监督和开放的沟通)，但青少年的个人内部能力的改变却没有显着调节对照顾者抑郁的干预作用。结果支持减轻抑郁症状与加强家庭关系之间的联系，尤其是增强育儿功效对减轻抑郁症状的重要性。

BACKGROUND & AIMS: :This article was developed to provide new radiation safety officers with the basic information needed for ensuring safety, security, and control of industrial radiography sources and to discuss licensing requirements and other information pertaining to the management of radiation safety programs associated with these sources.

背景与目标： : 本文旨在为新的辐射安全官员提供确保工业射线照相术源的安全性，安全性和控制所需的基本信息，并讨论与这些源相关的辐射安全计划管理有关的许可要求和其他信息。

BACKGROUND & AIMS: :"Outings to Your Taste" is an innovative program that aims to improve the nutritional status and social network of elderly people who receive home-delivered meals. This article examines participation in one of the program's components, outings to community restaurants. Participation data were collected on-site and information about client characteristics was collected in at-home interview surveys of targeted clients (n = 144). While about half of the clients had tried at least one outing, more than 25% of them participated in at least one third of the outings offered to them. Results indicate that the program attracted a variety of clients in terms of sociodemographic, health, and social isolation characteristics.

背景与目标： : “按您的口味郊游” 是一项创新计划，旨在改善接受家庭用餐的老年人的营养状况和社交网络。本文探讨了参与该计划的组成部分之一，即社区餐厅的郊游。现场收集参与数据，并在针对目标客户的家庭访谈调查中收集有关客户特征的信息 (n = 144)。虽然大约一半的客户尝试了至少一次郊游，但其中超过25% 的客户参加了至少3分之1的郊游。结果表明，该计划在社会人口统计学，健康和社会隔离特征方面吸引了各种客户。

BACKGROUND & AIMS: :Purpose: Using a new analysis program for scanning laser-Doppler flowmetry (SLDF) by a Heidelberg retina flowmeter (HRF), we studied the relation between flow and visual field or disc morphology.Subjects and Methods: In 42 eyes of 21 patients with normal tension glaucoma (NTG) the mean-flow of the HRF blood flow parameters at the disc rim was measured and analyzed by a new analysis program for perfusion maps (the SLDF analysis tool), to minimize the influence of large vessels or/and artifacts caused by small eye movements. We investigated whether difference of the mean-flow between a pair of eyes had any relation to differences between a pair of eyes in visual field indices and those in disc morphological measurements of the Heidelberg retina tomograph.Results: We found statistically significant correlations between the mean-flow and optic disc parameters (Disk Area, Cup Area, Height Variation Contour, Cup Volume, Rim Volume, Mean RNFL Thickness). We found no statistically significant correlations between the mean-flow and visual field parameters (mean deviation, corrected pattern standard deviation).Conclusion: The results suggested that eyes with less flow in the optic disc rim have more advanced glaucomatous morphological changes.

背景与目标： : 目的: 使用一种新的分析程序，通过海德堡视网膜流量计 (HRF) 扫描激光多普勒流量计 (SLDF)，我们研究了流量与视野或椎间盘形态之间的关系。主题和方法: 在21例正常眼压性青光眼 (NTG) 患者的42眼中，通过新的灌注图分析程序 (SLDF分析工具) 测量并分析了椎间盘边缘处HRF血流参数的平均流量，以最大程度地减少由小眼球运动引起的大血管或/和伪影的影响。我们调查了两只眼睛之间的平均流量的差异是否与两只眼睛在视野指标和海德堡视网膜断层扫描仪的椎间盘形态测量中的差异有任何关系。结果: 我们发现平均流量和视盘参数 (椎间盘面积，杯面积、高度变化轮廓、杯体积、轮辋体积、平均RNFL厚度)。我们发现平均流量与视野参数 (平均偏差，校正模式标准偏差) 之间没有统计学上的显着相关性。结论: 结果表明，视盘边缘流量较少的眼睛具有更高级的青光眼形态变化。

BACKGROUND & AIMS: -2

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BACKGROUND & AIMS: :Parents and school staff play important roles in promoting children's oral health. Our study goals were to investigate whether an intervention targeting parents and school staff can improve the oral-health behavior and oral-health status of schoolchildren. Three-hundred and ninety-two schoolchildren in six schools in Tehran participated in a group randomized trial from September 2010 to March 2011. Schools were randomly allocated into three groups: comprehensive, student, and control. Intervention in the comprehensive group consisted of strategies to encourage children, their parents, and school staff to increase the frequency of toothbrushing and flossing. In the student group, the intervention targeted only children. The control group received no intervention. The primary outcome was change in oral-health behaviors (brushing and flossing), while the secondary outcomes were changes in oral hygiene and Community Periodontal indices and in Health Belief Model components. Multilevel modeling was employed for data analyses. Students who were in the comprehensive intervention group brushed and flossed significantly more frequently compared with those in the student intervention group. Although students' gingival health improved significantly in the comprehensive intervention group, such significant improvement was not seen in the student group. In conclusion, promising results are seen when the oral-health education targets both school and home settings.

背景与目标： : 家长和学校工作人员在促进儿童口腔健康方面发挥着重要作用。我们的研究目标是调查针对父母和学校工作人员的干预措施是否可以改善学童的口腔健康行为和口腔健康状况。德黑兰六所学校的392名学童参加了从2010年9月到2011年3月的分组随机试验。学校被随机分为三组: 综合，学生和对照。综合小组的干预措施包括鼓励儿童，其父母和学校工作人员增加刷牙和使用牙线的频率的策略。在学生群体中，干预针对的是独生子女。对照组不接受干预。主要结局是口腔健康行为 (刷牙和使用牙线) 的变化，而次要结局是口腔卫生和社区牙周指数和健康信念模型成分的变化。采用多级建模进行数据分析。与学生干预组相比，综合干预组的学生刷牙和使用牙线的频率明显更高。尽管综合干预组学生的牙龈健康状况显着改善，但在学生组中并未看到这种显着改善。总之，当口腔健康教育针对学校和家庭环境时，可以看到令人鼓舞的结果。

BACKGROUND & AIMS: BACKGROUND:Blood-borne viral infections, such as HIV and hepatitis C (HCV), are common infections among people who inject drugs (PWID). This study aims to determine the prevalence of HIV and HCV infection among PWID accessing the first legal syringe services program (SSP) in the state of Florida, along with examining baseline correlates of HIV and HCV infection. METHODS:Baseline behavioral enrollment assessments of 837 participants accessing an SSP for the first time were analyzed. Patients self-reporting or testing HIV or HCV positive at the enrollment visit were included. Socio-demographic, drug use, and injection-related risk behaviors in the last 30 days were compared across groups defined by all combinations of HIV and HCV serostatus. Bivariate and multivariable logistic regression models were used to assess correlates of baseline HCV and HIV infection independently. RESULTS:Overall prevalence for HCV and HIV infection were 44.4% and 10.2%, respectively. After adjusting for confounders, the most significant correlates of baseline HCV infection were age (aOR = 1.01), lower education level (aOR = 1.13), currently homeless (aOR = 1.16), injecting more than seven times a day (aOR = 1.14), reusing syringes (aOR = 1.18), and sharing injection equipment (aOR = 1.13). The most significant predictors of baseline HIV infection were age (aOR = 1.01), non-Hispanic Black race (aOR = 1.28), Hispanic ethnicity (aOR = 1.12), gay or bisexual orientation (aOR = 1.22), and methamphetamine injection (aOR = 1.22). In addition, heroin injection (aOR = 0.92) was significantly associated with a lower odds of HIV infection. DISCUSSION/CONCLUSION:Baseline behavioral predictors differed between HIV infection and HCV infection among participants accessing syringe services. Understanding the risk factors associated with each infection should be considered when developing additional harm reduction interventions tailored for diverse PWID populations served at SSPs.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:In the 2011 US hospital prevalence survey of healthcare-associated infections and antimicrobial use 50% of patients received antimicrobial medications on the survey date or day before. More hospitals have since established antimicrobial stewardship programs. We repeated the survey in 2015 to determine antimicrobial use prevalence and describe changes since 2011. METHODS:The Centers for Disease Control and Prevention's Emerging Infections Program sites in 10 states each recruited ≤25 general and women's and children's hospitals. Hospitals selected a survey date from May-September 2015. Medical records for a random patient sample on the survey date were reviewed to collect data on antimicrobial medications administered on the survey date or day before. Percentages of patients on antimicrobial medications were compared; multivariable log-binomial regression modeling was used to evaluate factors associated with antimicrobial use. RESULTS:Of 12 299 patients in 199 hospitals, 6084 (49.5%; 95% CI, 48.6-50.4%) received antimicrobials. Among 148 hospitals in both surveys, overall antimicrobial use prevalence was similar in 2011 and 2015, although the percentage of neonatal critical care patients on antimicrobials was lower in 2015 (22.8% vs 32.0% [2011]; P = .006). Fluoroquinolone use was lower in 2015 (10.1% of patients vs 11.9% [2011]; P < .001). Third- or fourth-generation cephalosporin use was higher (12.2% vs 10.7% [2011]; P = .002), as was carbapenem use (3.7% vs 2.7% [2011]; P < .001). CONCLUSIONS:Overall hospital antimicrobial use prevalence was not different in 2011 and 2015; however, differences observed in selected patient or antimicrobial groups may provide evidence of stewardship impact.

背景与目标：