BACKGROUND & AIMS: OBJECTIVE:Within exercise class settings, group cohesion has consistently been found to predict adherence behaviors, and has been identified as a salient target for intervention-based initiatives. Drawing upon theorizing from the field of group dynamics, exercise class cohesion is often conceptualized as a dynamic construct that requires several classes to form and once it is formed, continues to change over time. Despite the salience of this "dynamic" contention for informing physical activity interventions, this theorizing has yet to be empirically tested. METHOD:In this study a multilevel modeling framework was used to examine changes in exercise class cohesion over time. Exercisers (N = 395) completed measures of cohesion following the second, fifth, and eighth classes of their respective programs (N = 46). RESULTS:Mean levels of social cohesion changed significantly over time whereas mean levels of task cohesion did not. These patterns were largely consistent across persons and groups. CONCLUSIONS:These findings suggest that within group-based exercise programs social and task cohesion possesses different levels of dynamism, and that this dynamism (or lack thereof) might have important implications for future research and interventions involving physical activity groups.

背景与目标：

BACKGROUND & AIMS: :The introduction of new vaccines with much higher prices than traditional vaccines results in increasing budgetary pressure on immunization programs in GAVI-eligible countries, increasing the need to ensure their financial sustainability. In this context, the third EPIVAC (Epidemiology and Vaccinology) technical conference was held from February 16 to 18, 2012 at the Regional Institute of Public Health in Ouidah, Benin. Managers of ministries of health and finance from 11 West African countries (GAVI eligible countries), as well as former EPIVAC students and European experts, shared their knowledge and best practices on immunization financing at district and country level. The conference concluded by stressing five major priorities for the financial sustainability of national immunization programs (NIPs) in GAVI-eligible countries. - Strengthen public financing by increasing resources and fiscal space, improving budget processes, increasing contribution of local governments and strengthen efficiency of budget spending. - Promote equitable community financing which was recognized as a significant and essential contribution to the continuity of EPI operations. - Widen private funding by exploring prospects offered by sponsorship through foundations dedicated to immunization and by corporate social responsibility programs. - Contain the potential crowding-out effect of GAVI co-financing and ensure that decisions on new vaccine introductions are evidence-based. - Seek out innovative financing mechanisms such as taxes on food products or a national solidarity fund.

背景与目标： : 采用价格比传统疫苗高得多的新疫苗，导致符合免疫联盟资格的国家预防接种计划的预算压力增加，增加了确保其财务可持续性的需求。在这方面，第三次EPIVAC (流行病学和疫苗学) 技术会议于2012年2月16日月18日至18日在贝宁Ouidah的区域公共卫生研究所举行。来自11个西非国家 (符合GAVI资格的国家) 的卫生和财政部经理以及前EPIVAC学生和欧洲专家分享了他们在地区和国家一级预防接种筹资知识和最佳做法。会议结束时强调了符合免疫联盟资格的国家中国家预防接种计划 (NIPs) 财务可持续性的五个主要优先事项。-通过增加资源和财政空间，改善预算程序，增加地方政府的贡献并提高预算支出效率来加强公共融资。-促进公平的社区筹资，这被认为是对EPI业务连续性的重要贡献。-通过致力于预防接种基金会和企业社会责任计划探索赞助提供的前景，扩大私人资金。-包含GAVI共同资助的潜在挤出效应，并确保有关新疫苗引进的决定是基于证据的。-寻找创新的融资机制，例如对食品征税或国家团结基金。

BACKGROUND & AIMS: BACKGROUND:There are analogies between the development of therapeutic drugs for cancer and the development of interventions for reducing cancer health disparities. In both cases, it can take between 12 and 15 years for the benefits to become apparent. METHODS:The initial preclinical phase of drug development is analogous to the development of community partnerships and helping the community learn about cancer. The preclinical phase of in vitro and in vivo testing is analogous to identifying the disparities in the community. Then clinical testing begins with phase 1, toxicity, and dose-establishing studies. Analogously, community-based participatory research is used to develop disparities-reducing interventions (DRIs) within the community. RESULTS:The phase 2 clinical studies to determine whether the drug has activity are analogous to the DRI being implemented in the community to determine whether it can cause behavioral changes that will reduce cancer health disparities. If a drug passes phase 1 and 2 studies, phase 3 clinical trials are initiated. These are controlled studies to examine the efficacy of the drug. The similar activity for disparities research is to determine whether the DRI is better than the current standard/usual practice in controlled trials. If the drug is beneficial, the final phase is the dissemination and adoption of the drug. Analogously in disparities, if the DRI is beneficial, it is disseminated and is culturally adapted to other racial/ethnic groups and finally adopted as standard practice. CONCLUSIONS:The process of creating an effective DRI can be envisioned to have 4 stages, which can be used to aid in measuring the progress being made in reducing cancer health disparities.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:Quality improvement and patient safety (QIPS) competencies are increasingly important in emergency medicine (EM) and are now included in the CanMEDS framework. We conducted a survey aimed at determining the Canadian EM residents' perspectives on the level of QIPS education and support available to them. METHODS:An electronic survey was distributed to all Canadian EM residents from the Royal College and Family Medicine training streams. The survey consisted of multiple-choice, Likert, and free-text entry questions aimed at understanding familiarity with QIPS, local opportunities for QIPS projects and mentorship, and the desire for further QIPS education and involvement. RESULTS:Of 535 EM residents, 189 (35.3%) completed the survey, representing all 17 medical schools; 77.2% of respondents were from the Royal College stream; 17.5% of respondents reported that QIPS methodologies were formally taught in their residency program; 54.7% of respondents reported being "somewhat" or "very" familiar with QIPS; 47.2% and 51.5% of respondents reported either "not knowing" or "not having readily available" opportunities for QIPS projects and QIPS mentorship, respectively; 66.9% of respondents indicated a desire for increased QIPS teaching; and 70.4% were interested in becoming involved with QIPS training and initiatives. CONCLUSIONS:Many Canadian EM residents perceive a lack of QIPS educational opportunities and support in their local setting. They are interested in receiving more QIPS education, as well as project and mentorship opportunities. Supporting residents with a robust QIPS educational and mentorship framework may build a cohort of providers who can enhance the local delivery of care.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:School-based smoking prevention programs sometimes fail in unexpected ways. This study tests the hypotheses that both social/cultural contexts and individual dispositional characteristics may interact with program content to produce effects that are variable in potentially predictable ways. METHODS:Students in 24 culturally heterogeneous or primarily Hispanic/Latino middle schools (N = 3,157 6th graders) received a multicultural collectivist-framed social influences (SI) program, an individualist-framed SI program, or a control condition. Three-way linear and nonlinear interactions, program frame x social context x dispositional phenotype, were tested. RESULTS:Three-way interactions were found for the dispositional phenotypes of depression and hostility with social context and program content/frame. In predominantly Hispanic/Latino schools, larger program effects were observed for high depressed and high hostile youth in both the collectivist and individualist framed programs. In culturally mixed schools, prevention effects were greatest for low depressed and low hostile youth, especially in the individualist framed program. In culturally mixed schools, there may have been a negative treatment effect for both programs among adolescents scoring high on depression and hostility. DISCUSSION:Prevention program effects can vary by combination of program content, social setting, and individual dispositional characteristics. The results suggest that prevention program design and implementation should be sensitive to population characteristics at both the individual and sociocultural levels.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Students' perceptions of their academic learning environment have been found to be related to their approaches to learning and learning outcomes. Educational environment is just beginning to be researched in nursing education with the vast majority of studies focusing on the clinical educational environment. Accelerated Bachelor of Science in Nursing (ABSN) programs for students who have obtained a bachelor degree are a popular nursing pedagogue. These programs are instituted on the belief that degreed students have the ability to be successful in a demanding program, are older, are adult learners and tend to be more motivated than their traditional counterparts. There is a paucity of research exploring the differences in student perceptions of the educational environment between the traditional and accelerated programs. OBJECTIVE:Explore students' perceptions of the educational environment in the traditional and ABSN programs within an institution and determine any differences. DESIGN:Comparative descriptive study. SETTING:Private school of Nursing in the Southwest. PARTICIPANTS:Convenience sample of 24 ABSN and 38 traditional graduating senior students. METHODS:Invited students completed the Dundee Ready Education Environment Measure through the online survey application Qualtrics. An independent t-test was used to compare the scores. RESULTS:A total of 62 students completed the survey for an overall response rate of 57%. No statistical difference was found in students' perceptions of academic environment between the two groups on the total score. However, there was a statistically significant difference on the sub-domain pertaining to atmosphere and there were significant differences on 6 out of 50 individual items. CONCLUSIONS:The results of this study indicate that, taken in its entirety, there was no significant difference in student perception of educational environment between the traditional and accelerated cohorts at this institution as measured by the DREEM tool. However, there was a significant difference between the two cohorts within the student perception of Atmosphere sub-domain and on seven individual items. The DREEM tool was found to be a reliable instrument to determine students' perceptions of educational environment.

背景与目标：

BACKGROUND & AIMS: :Screening for bacteriuria by culture of voided midstream urine was done in 6803 puerperal women; significant growth was found in 8.1%. The urine was recollected by suprapubic aspiration and bacteriuria was confirmed in 52%, corresponding to an incidence of bladder bacteriuria of 3.7%. A history of past urinary tract infection, bacteriuria in pregnancy, operative delivery, epidural anesthesia, and bladder catheterization increased the risk of postpartum urinary tract infection. Only 21% of the women complained of dysuria; this symptom occurred significantly more often after operative delivery and in patients with previous urinary tract infection. Two hundred fifty-one women with bladder bacteriuria were subjected to different treatments by randomized allocation: 153 patients with amoxicillin-susceptible bacterias were selected for amoxicillin treatment of 1, 3, and 10 days' duration. The cure rates were 84%, 94%, and 98%, respectively; the single-dose therapy was significantly less effective than 10 days' treatment (p less than 0.05). Forty-six women with amoxicillin-resistant bacterial infections received cephalexin or nitrofurantoin therapy of 7 days' duration; the cure rate was 91%. Fifty-two women served as control subjects and received no treatment. Ten weeks later 27% still had persistent bacteriuria in their suprapubic aspiration control specimens. All therapeutic regimens except the single-dose method showed a cure rate that was significantly higher than the spontaneous cure rate (p less than 0.05). Multiparity seemed to be a predisposing factor for persistence of bacteriuria. The study indicates that puerperal patients with positive midstream urine specimens should not be automatically treated, but more thoroughly examined. In cases of confirmed bladder bacteriuria, treatment should be recommended; 3 days' therapy appears to be sufficient.

背景与目标： : 在6803名产褥期妇女中通过排尿中尿培养筛查细菌尿; 在8.1% 中发现显着生长。通过耻骨上抽吸重新收集尿液，并在52% 中确认了细菌尿，这与3.7% 的膀胱细菌尿的发生率相对应。既往尿路感染史，妊娠期细菌尿，手术分娩，硬膜外麻醉和膀胱导管插入术增加了产后尿路感染的风险。只有21% 的女性抱怨排尿困难; 这种症状在手术分娩后和先前患有尿路感染的患者中明显更频繁地发生。通过随机分配对101名患有膀胱菌尿的妇女进行了不同的治疗: 选择了153名对阿莫西林敏感的细菌的患者进行为期1、3和10天的阿莫西林治疗。治愈率分别为84% 、94% 和98%; 单剂量治疗的效果明显低于10天治疗 (p <0.05)。46名患有阿莫西林耐药细菌感染的妇女接受了7天的头孢氨苄或呋喃妥因治疗; 治愈率为91%。52名妇女作为对照受试者，未接受任何治疗。十周后，27% 的耻骨上抽吸对照标本中仍有持续的细菌尿。除单剂量方法外，所有治疗方案均显示治愈率显着高于自发治愈率 (p小于0.05)。多胎次似乎是细菌尿持续存在的诱因。研究表明，中段尿液标本阳性的产褥期患者不应自动接受治疗，而应进行更彻底的检查。对于确诊的膀胱菌尿，应推荐治疗; 3天的治疗似乎足够。

BACKGROUND & AIMS: PURPOSE:Continuity clinics (ccs) give trainees an opportunity for longitudinal follow-up of a patient cohort. Trainees can function in a semi-autonomous manner and prepare for independent practice. Data about such clinics in Canada are limited. Our objective was to assess the utility of ccs in Canadian oncology training programs. METHODS:Surveys were developed by the authors for medical and radiation oncology program directors (pds) and trainees, to assess the utility of ccs in Canadian oncology training programs.oncology patients, to assess their attitudes toward ccs. The pds were contacted by e-mail, using the Web site of the Canadian Resident Matching Service; the trainees were contacted by e-mail through the pds and their administrative assistants. Surveys were distributed electronically using SurveyMonkey. Patients were approached by staff oncologists during follow-up visits at The Ottawa Hospital Cancer Centre. RESULTS:Completed surveys were received from 33% of trainees and 63% of pds contacted; patient surveys were completed by 95 patients. Participation in a cc was reported by 47% of responding pds and 37% of responding trainees. Among respondents, 80% rated the ccs as "important" or "very important" to training. The biggest challenge identified by trainees and pds was lack of clinic space. Most pds (57%) and trainees (59%) felt that the staff oncologist should review the patient only if the trainee has concerns, but only 37% of patients shared that view (p = 0.0002). However, many patients expressed the desire to participate in trainee education. CONCLUSIONS:Continuity clinics are considered beneficial by pds and trainees. Patients desire more trainee supervision than the trainees themselves and the pds do, a factor that should be considered when implementing a cc.

背景与目标：

BACKGROUND & AIMS: PURPOSE:To assess whether state-sponsored agricultural marketing programs had a positive influence on adult consumers' fruit and vegetable consumption. DESIGN:Differences in fruit and vegetable consumption between 2000 and 2005 in states that initiated marketing campaigns during this period and those that did not were examined. SUBJECTS:A representative sample (n  =  237,320) of adults aged 18 and older from states with and without marketing programs was used. The study used data from the 2000 and 2005 Behavioral Risk Factor Surveillance System. MEASURES:The number of fruit and vegetable servings per week and the percentage of respondents consuming five or more servings of fruits and vegetables per day were examined. ANALYSIS:Between-subjects analysis of variance and logistic regression. RESULTS:In the absence of a marketing campaign, there was a significant decrease in fruit and vegetable consumption between 2000 and 2005. In states with campaigns, consumption remained stable or increased. Marketing effects were stronger for women than for men. Conclusions . State-sponsored agricultural marketing programs had favorable effects on consumers' consumption of fruits and vegetables.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Prescription drug abuse is epidemic in the United States (US). To help address the problem, most states operate prescription drug monitoring programs (PDMPs). PDMPs are designed to monitor and help control the distribution of controlled therapeutic medications and to assist prescribers and dispensers in making informed clinical decisions. To this end, PDMPs rely on timely and accurate data submission, as well as review of the data. Consequently, provider acceptance of these systems is essential to maximize their effectiveness. OBJECTIVES:This article explores licensed prescribers' and dispensers' opinions regarding prescription drug monitoring. METHODS:The study surveyed licensed prescribers and dispensers about their experiences and views on drug monitoring, prescribing and dispensing practices, and on prescription drug abuse in general. Two open-ended questions were posed as part of a larger, end-user survey. The analysis culled thematically-coded excerpts to these two questions. RESULTS:Respondents offered a range of comments that unearthed important disagreements among prescribers and dispensers over the administration and ethics pertaining to PDMPs. At the same time, some respondents suggested means to enhance PDMPs functionality. CONCLUSION:Attending to and rectifying providers' views, while considering their improvement suggestions may boost PDMPs effectiveness by maximizing buy-in and utilization. The potential speaks to advancing a tool that intends to help address alarming rates of prescription drug abuse.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:This retrospective study evaluated iron chelating therapy (ICT) discontinuation and costs in Sickle cell disease (SCD) Medicaid recipients using healthcare claims from 2006-2010. METHODS:Patients with ≥1 SCD diagnosis claim, ≥2 claims for deferoxamine (DFO) or deferosirox (DFX), and continuous enrollment ≥6 months prior to and 18 months following ICT initiation were included. Outcomes included treatment discontinuation, persistence (i.e., refill gaps ≥6 weeks), and total healthcare costs. RESULTS:The average age among 404 SCD patients meeting study inclusion criteria was 18.7 (±11.0) years, with 45.8% being males and 66.7% being Blacks. Switches or combinations from DFO at index occurred in 124 (74.7%) patients compared to 10 (4.2%) with DFX at index. The Cox regression model that assessed long-term medication persistence indicated a 1.30-times higher likelihood of treatment discontinuation with DFO compared to DFX (95% CI: 1.06-1.61). Some 19.7% of patient remained on DFX relative to 4.8% on DFO. Both inpatient and total costs were similar in DFX and DFO treatment groups. Following 1 year of treatment, 37.4% remained on DFX compared to 15.7% on DFO. Meaningful differences in treatment discontinuation between the two treatment groups did not occur until 220+ days during the study period. At 18-months, treatment discontinuation rates were high in both groups; 95% for DFO and 80% for DFX. CONCLUSION:This study of SCD Medicaid patients found more therapeutic switches from DFO to DFX and a higher medication persistency rate with DFX than DFO. The conclusions are limited by the study's retrospective nature, which depends on multivariate statistics to account for patient heterogeneity and risk factors.

背景与目标：

BACKGROUND & AIMS: :Obesity is a major pediatric public health problem. Adolescents are a priority population for intervention strategies. School nurses are in key positions to design intervention strategies to promote healthy lifestyles and prevent adolescent obesity in the students they serve. To design effective programs, school nurses need to know what components their students perceive as important. This study involved the development and administration of a questionnaire to middle school students to determine their attitudes about overweight/obesity and what they felt would work for them. Adolescents are willing to exercise more, to change eating habits to include more fruits and vegetables, drink more water, and eat less junk food. They are not willing to give up soda, video/computer games, and watching television to improve their health. School nurses can use this questionnaire to collect data that will assist in the development of effective programs for their students.

背景与目标： : 肥胖是一个主要的儿科公共卫生问题。青少年是干预策略的优先人群。学校护士在设计干预策略方面处于关键位置，以促进他们所服务的学生的健康生活方式和预防青少年肥胖。为了设计有效的课程，学校护士需要知道学生认为重要的组成部分。这项研究涉及对中学生进行问卷调查的开发和管理，以确定他们对超重/肥胖的态度以及他们认为对他们有用的态度。青少年愿意多运动，改变饮食习惯，以增加水果和蔬菜，多喝水，少吃垃圾食品。他们不愿意放弃苏打水、视频/电脑游戏和看电视来改善健康。学校护士可以使用此问卷收集数据，这些数据将有助于为学生制定有效的计划。

BACKGROUND & AIMS: BACKGROUND:The war in Syria has left millions struggling to survive amidst violent conflict, pervasive unemployment, and food insecurity. Although international assistance funding is also at an all-time high, it is insufficient to meet the needs of conflict-affected populations, and there is increasing pressure on humanitarian stakeholders to find more efficient, effective ways to provide assistance. OBJECTIVE:To evaluate 3 different assistance programs (in-kind food commodities, food vouchers, and unrestricted vouchers) in Idleb Governorate of Syria from December 2014 and March 2015. METHODS:The evaluation used repeated survey data from beneficiary households to determine whether assistance was successful in maintaining food security at the household level. Shopkeeper surveys and program monitoring data were used to assess the impact on markets at the district/governorate levels and compare the cost-efficiency and cost-effectiveness of transfer modalities. RESULTS:Both in-kind food assistance and voucher programs showed positive effects on household food security and economic measures in Idleb; however, no intervention was successful in improving all outcomes measured. Food transfers were more likely to improve food access and food security than vouchers and unrestricted vouchers. Voucher programs were found to be more cost-efficient than in-kind food assistance, and more cost-effective for increasing household food consumption. CONCLUSION:Continuation of multiple types of transfer programs, including both in-kind assistance and vouchers, will allow humanitarian actors to remain responsive to evolving access and security considerations, local needs, and market dynamics.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:People in treatment for substance use disorder commonly have comorbid personality disorders, including antisocial personality disorder. Little is known about treatments that specifically address comorbid antisocial personality disorder. METHODS:Self-rated help received for antisocial personality disorder was assessed during follow-ups at 3, 9 and 15 months post-randomization of a randomized trial of psychoeducation for people with comorbid substance use and antisocial personality disorder (n = 175). RESULTS:Randomization to psychoeducation was associated with increased perceived help for antisocial personality disorder. Perceived help for antisocial personality disorder was in turn associated with more days abstinent and higher treatment satisfaction at the 3-month follow-up, and reduced risk of dropping out of treatment after the 3-month follow-up, and perceived help mediated the effects of random assignment on days abstinent at 3-month. FOLLOW-UP: CONCLUSIONS:Brief psychoeducation for antisocial personality disorder increased patients' self-rated help for antisocial personality disorder in substance abuse treatment, and reporting having received help for antisocial personality disorder was in turn associated with better short-term outcomes, e.g., days abstinent, dropout from treatment and treatment satisfaction. TRIAL REGISTRATION:ISRCTN registry, ISRCTN67266318 , retrospectively registered 17/7/2012.

背景与目标：

BACKGROUND & AIMS: :Despite an essential step in the self-regulation process, the feature of offering rewards - in particular, offering tangible rewards - is underdeveloped in most fitness mobile apps. The present study addressed this issue by harnessing the contributions of corporations in the form of providing incentives to fitness app users as part of their corporate social responsibility initiatives. This study investigated the dual mechanisms through which incentive type and functional congruence shape consumers' intention to use a fitness app and their attitudes toward the sponsor, respectively. Through a 2 (self-benefiting vs. other-benefiting incentives) by 2 (low vs. high congruence) experiment, this study found that when using other-benefiting incentives, incentives provided by high-congruence sponsors elicited more favorable attitude toward the incentive than those provided by low-congruence sponsors and, in turn, increased users' propensity to use the app. But this indirect effect was not in play when using self-benefiting incentives. From the sponsor's perspective, in the low-congruence condition, other-benefiting incentives were more effective in leading users to attribute altruistic motives to the sponsorship, resulting in more favorable attitudes toward the sponsor; however, the mediating mechanism failed to operate under the high-congruence condition. Taken together, this research shed light on the mediating mechanisms and boundary conditions of strategies of partnering sponsorship with fitness apps, making this type of partnership a win-win initiative for both the app users and the corporations involved.

背景与目标： : 尽管在自我调节过程中迈出了重要的一步，但在大多数健身移动应用程序中，提供奖励 (尤其是提供有形奖励) 的功能尚不完善。本研究通过利用公司的贡献来解决此问题，这些公司以向健身应用程序用户提供激励的形式作为其企业社会责任计划的一部分。这项研究调查了双重机制，激励类型和功能一致性分别塑造了消费者使用健身应用程序的意愿及其对赞助商的态度。通过2 (自我受益与其他受益激励) by 2 (低与高一致性) 实验，本研究发现，当使用其他受益激励时，高一致性赞助商提供的激励比低一致性赞助商提供的激励更有利于激励，反过来，增加了用户使用该应用的倾向。但是，在使用自利激励措施时，这种间接影响并未发挥作用。从赞助商的角度来看，在低一致性条件下，其他利益激励更有效地导致用户将利他动机归因于赞助商，从而导致对赞助商的态度更加有利; 然而，调解机制未能在高一致性条件下运行。综合而言，这项研究揭示了与健身应用程序合作赞助策略的中介机制和边界条件，使这种类型的合作伙伴关系成为应用程序用户和相关公司的双赢举措。