Edmund Ricci - Academia.edu (original) (raw)

Papers by Edmund Ricci

Research paper thumbnail of Keane et al. Respond

American Journal of Public Health, 2003

We appreciate Pierce’s and Blackburn’s comment on our article and share their interest in evaluat... more We appreciate Pierce’s and Blackburn’s comment on our article and share their interest in evaluating the effects of privatizing services formerly provided by local health departments.1 A few resources are available, including a workbook that the National Association of County and City Health Officials designed to help local health departments examine their role in the provision of clinical services.2 Also, we recently completed a study of privatization’s effect on access of the uninsured to certain health services. Elsewhere, we reported outcomes of privatization as perceived by local health department directors.3,4 These perceptions reveal a variety of ways that privatization affects the public health infrastructure and suggest some of the measures of process and outcome that should be included in structured evaluations. Such measures include not only indicators of access and outcome associated with specific services but also broader indicators of public health capacity.3–5 Unfortunately, access and public health infrastructure frequently have not been priorities among politicians exerting political or financial control over local health departments. Many local health departments have faced external pressures to privatize. These pressures often have been based on general state or local governmental policies, such as hiring freezes, or general ideologically oriented premises, such as the stance that less government is better.6,7 Carefully designed evaluation studies could provide a factual basis for privatization decisions. Such evaluations should not rely solely on the outcome measures typically used in studies of personal health services; they must also find ways to measure the impact of privatization on broader public health infrastructure. Our survey revealed that many local health department directors were concerned that contracting out certain services, particularly those relating to communicable disease, can result in a loss of capacity to respond to disease outbreaks and other public health crises.1,3 A final point concerns the design of evaluation studies. It was helpful that Pierce and Blackburn compared local to statewide trends in immunization coverage. National and statewide secular trends may be attributable to a variety of factors, such as the Clinton administration’s efforts to increase childhood immunization rates. Ideally, an evaluation study could control for a range of potential confounders, but elaborate evaluations of individual public health privatization initiatives rarely have been funded (one exception was the evaluation of Pennsylvania’s “Community Health Project”).8 It is also important to monitor trends within vulnerable populations. For example, the statewide survey cited by Pierce and Blackburn indicated that vaccination coverage, as defined in the Texas Immunization Survey, decreased among children without health insurance in Texas, while coverage increased among insured children.9 Evaluators should confirm that any overall increase in access associated with privatization is not masking declines in access among the uninsured.

Research paper thumbnail of Brach_CE-1304-6301_FRR_CE.pdf

<b>Objectives: </b>To compare the effectiveness and sustainability of <i>On the... more <b>Objectives: </b>To compare the effectiveness and sustainability of <i>On the Move</i> against a Standard group exercise program consisting of seated strength, endurance, and flexibility exercises in community-dwelling older adults who reside in independent living facilities and senior apartment buildings, and who live elsewhere but regularly attend senior community centers. <b>Methods:</b> The study was a cluster randomized, single-blind intervention trial that compared the effects on function, disability, and mobility of a Standard group exercise program and the <i>On the Move</i> group exercise program in community-dwelling older adults. Thirty-two facilities were randomized, encompassing 424 individuals. <b>Results:</b> The mean ± standard deviation age of the participants was 80.7 ± 7.8 years. The <i>On the Move</i> group had greater improvements than the Standard group in the primary measures of mobility, the 6MWT (20.6 ± 57.1 versus 4.1 ± 55.6 m; adjusted difference = 16.7 ± 7.4; <i>p</i> = 0.0262), and gait speed (0.05 ± 0.13 versus –0.01 ± 0.11 m/s; adjusted difference = 0.05 ± 0.02; <i>p</i> = 0.0008). The between-group differences were adjusted for the baseline value of the outcome and represent a small but meaningful difference. There were no significant differences in self-reported function and disability as measured by the LLFDI scores. <b>Conclusions:</b> When taught by exercise leaders, the <i>On the Move</i> group exercise program was more effective at improving mobility than the Standard group exercise program, more safe, and well-liked by community-dwelling older adults.

Research paper thumbnail of A Social, Behavioral, and Implementation Science Perspective on Convergence Mental Health

Convergence Mental Health, 2021

Convergence is best approached through a systems science lens because it includes multiple levels... more Convergence is best approached through a systems science lens because it includes multiple levels of influence and organization and a host of mutually reinforcing elements. Each of these factors requires behavioral and social science research to ensure that convergence is appropriately anchored in the experience of patients and their communities. For example, the continuous assessment of mental state made possible through real-time mobile app recording of voice, movement, and biosignatures will be much less effective if people reject it because of privacy concerns or if this monitoring is not adequately linked to choices for self-care. Patients may need in-person contact with a therapist to choose an appropriate app and in-person boosters to support effective use. Use of the app and its effectiveness accordingly depend on social-behavioral factors. Likewise, the social and behavioral sciences are central for shortening the time between development and translation of mental health tr...

Research paper thumbnail of Assessment of Prehospital and Hospital Response in Disaster

Critical Care Clinics, 1991

The assessment of the response of a prehospital/hospital system to a disaster will prove a comple... more The assessment of the response of a prehospital/hospital system to a disaster will prove a complex and challenging undertaking for those who attempt it. Data availability and quality will prove to be an immediate problem. Finding the time to devote to assessment is usually difficult. Identifying qualified and interested members of the required multidisciplinary team and, in particular, an individual with health services research background who can assist in all phases of the design and implementation of the project, is often difficult. Obviously, these problems will be less severe if they are addressed to some degree in the disaster plan. That is, a general protocol for assessment could be developed as part of the disaster planning effort and evaluation staff could tentatively be identified by position (e.g., emergency department medical director). The issue of data availability could be confronted and provisions made for the recording of at least minimal information on patient log forms under disaster conditions.

Research paper thumbnail of Racial/Ethnic Differences in Pregnancy Intention, Reproductive Coercion, and Partner Violence among Family Planning Clients: A Qualitative Exploration

Women's health issues : official publication of the Jacobs Institute of Women's Health, Jan 6, 2018

Unintended pregnancy (UIP) is a persistent public health concern in the United States disproporti... more Unintended pregnancy (UIP) is a persistent public health concern in the United States disproportionately experienced by racial/ethnic minorities and women of low socioeconomic status. UIP often occurs with experiences of reproductive coercion (RC) and intimate partner violence (IPV). The purpose of the study was to qualitatively describe and compare contexts for UIP risk between low-income Black and White women with histories of IPV/RC. Semistructured interviews were conducted with low-income Black and White women with histories of IPV or RC, ages 18 to 29 years, recruited from family planning clinics in Pittsburgh, Pennsylvania. Interviews with 10 Black women and 34 White women (N = 44) were included in the analysis. Differences between White and Black women emerged regarding IPV/RC experiences, gender roles in intimate relationships, and trauma histories, including childhood adversity. Fatal threats and IPV related to childbearing were most influential among White women. Among Bla...

Research paper thumbnail of Effectiveness of a Timing and Coordination Group Exercise Program to Improve Mobility in Community-Dwelling Older Adults

JAMA Internal Medicine, 2017

Research paper thumbnail of A planning and evaluation program for assessing telecommunications applications in community radiation oncology programs

Research paper thumbnail of A Model for Evaluation of Disaster Management

Prehospital and Disaster Medicine, 1985

Our ability to manage disaster relief activities at regional, national or international levels of... more Our ability to manage disaster relief activities at regional, national or international levels of socio-political organization has, according to many analysts, not kept pace with the knowledge and technical capability presently available to contend with disasters. In a report released in 1977 a panel of experts assembled by the United Nations Association characterized disaster relief efforts as being routinely mismanaged. For example, the panel described what has been considered one of the better organized disaster relief efforts (the 1976 earthquake in Guatamala) in the following way.

Research paper thumbnail of In Memoriam, Michael Pozen

Prehospital and Disaster Medicine, 1985

The relatively young scientific field of health services research, whose practitioners are still ... more The relatively young scientific field of health services research, whose practitioners are still struggling to establish legitimacy within the vast domain of health care, owes much to Michael Pozen. Indeed, Michael must be counted as one of the founders of this new speciality in that his brief but incredibly productive career began as the field of health services research took form and emerged as a distinct career specialty. His very significant contributions to health care can be assessed from two perspectives.The most visible perspective upon Michael Pozen's professional work can be obtained from a review of his research as reported in his published articles and presented papers. Michael clearly established himself as a creative and resourceful scholar and researcher who had a particular interest in improving the design and delivery of emergency medical services as well as the clinical aspects of emergency medical care.

Research paper thumbnail of Using the 4 Pillars Immunization Toolkit to Increase Adult Immunizations

Open Forum Infectious Diseases, 2015

Research paper thumbnail of An Alternative Technique for Youth Risk Surveillance Outside of the School System

The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2017

When school districts choose not to participate in adolescent health behavior surveys, tracking a... more When school districts choose not to participate in adolescent health behavior surveys, tracking adolescent health indicators can be challenging. We conducted a countywide youth behavior survey outside of the school system. Our purpose is to describe alternative methods used for gathering these data reliably and ethically. We implemented two parallel surveys with youth ages 14-19 residing in a mid-sized county with urban, suburban, and rural neighborhoods. An anonymous phone-based survey used computer-assisted telephone interviewing with a live interviewer in conjunction with an interactive voice response system to survey youth via random digit dialing of landlines and cell phones. A concurrent in-person anonymous survey was conducted with marginalized youth (from juvenile detention centers, shelters, and residential facilities), using audio computer-assisted self-interviewing technology. The survey measures included the Centers for Disease Control Youth Risk Behavior Surveillance Sy...

Research paper thumbnail of Using the 4 pillars™ practice transformation program to increase adult influenza vaccination and reduce missed opportunities in a randomized cluster trial

BMC infectious diseases, Jan 3, 2016

An evidence-based, step-by-step guide, the 4 Pillars™ Practice Transformation Program, was the fo... more An evidence-based, step-by-step guide, the 4 Pillars™ Practice Transformation Program, was the foundation of an intervention to increase adult immunizations in primary care and was tested in a randomized controlled cluster trial. The purpose of this study is to report changes in influenza immunization rates and on factors related to receipt of influenza vaccine. Twenty five primary care practices were recruited in 2013, stratified by city (Houston, Pittsburgh), location (rural, urban, suburban) and type (family medicine, internal medicine), and randomized to the intervention (n = 13) or control (n = 12) in Year 1 (2013-14). A follow-up intervention occurred in Year 2 (2014-15). Demographic and vaccination data were derived from de-identified electronic medical record extractions. A cohort of 70,549 adults seen in their respective practices (n = 24 with 1 drop out) at least once each year was followed. Baseline mean age was 55.1 years, 35 % were men, 21 % were non-white and 35 % were...

Research paper thumbnail of Peter Safar: 12 April 1924 – 03 August 2003

Prehospital and Disaster Medicine, 2005

Several weeks ago I was asked by Marvin Birnbaum if I would write a short article about Peter Saf... more Several weeks ago I was asked by Marvin Birnbaum if I would write a short article about Peter Safar. It should be an article about the person and not his scientific accomplishments. The latter would be endless, as most of the readers might know, Peter Safar wrote more than 1,300 articles, books, book chapters, and abstracts. So I e-mailed back to the Editor that I am honored with his invitation and that I would write my personal reflections. All of the readers of these notes who-like me-have had the privilege of having worked with him (and I am certain that most of you who have had the opportunity of meeting Peter Safar even if just once) will understand why this article is written with a very personal tone. I suggest that all others-especially those who might think that it is inappropriate to publish articles like this in an international, scientific journal-as you read more about this man, you will understand our intense feelings. To be honest, as I was going deeper into preparing these personal impressions, I thought again that it is difficult to write about Peter Safar in a way which describes adequately how unique he was. The first time I saw Peter Safar was at the Medizinische Akademie Magdeburg. At that time, the East-German town of Magdeburg still was a part of the former communist block and it was deeply behind the iron curtain when Peter Safar visited Magdeburg on the invitation of Wolfgang Rose, who at that time was a member of the European Academy of Anaesthesiology's Committee on Cardiopulmonary Resuscitation. Peter Safar was talking in the biggest, but overcrowded, lecture hall on campus. At the podium stood an older, but extremely agile man giving a presentation about the modern aspects in cardiopulmonary resuscitation. The lecture was held in "wienglish" as he called it-a mixture of Viennese German and American English. Most of his slides were in old-fashioned black-and-white; a legendary tradition as I learned years later. The audience was astonished by his fresh and unconventional presentation. We were fascinated by the way he simplified and cross-linked the highly complex pathophysiology, and his vision about future directions of modern reanimatology. About halfway through his presentation, the most horrible nightmare for his hosts occurred-the slide projector broke. Peter Safar took out his Swiss Army Knife and started to repair the old, manually driven, slide projector. Why is this anecdote worth mentioning? Working and communicating with colleagues in eastern countries on a very collegial level was a normal academic behavior for Peter Safar. Since traveling from the west to the east was much easier than vice versa (for most scientists, the latter was absolutely impossible), he visited his colleagues in Moscow, Prague, Magdeburg, and other sites behind the Iron Curtain. His friendship and cooperation with Dr. Negovsky (Moscow) was legendary and was ground breaking especially during the years of the cold war. Peter Safar talked and pursued peace all his life. For him, it was a lifelong philosophy; he called himself a "world citizen". With the same engagement with which he developed an international network of cooperating scientists, he supported peace processes in his own country. Almost every US President learned about his humanitarian commitment; the White House received dozens of letters. Asked about his engagement for peacekeeping and humanitarian activities, he always said that these were the

Research paper thumbnail of Stakeholder involvement in the design of a patient-centered comparative effectiveness trial of the “On the Move” group exercise program in community-dwelling older adults

Contemporary Clinical Trials, 2016

Research paper thumbnail of Clinical and health promotion asthma management: an intervention for children and adolescents

Allergy and Asthma Proceedings, 2016

Asthma is the leading chronic condition among children. Given this international burden, clinicia... more Asthma is the leading chronic condition among children. Given this international burden, clinicians and public health professionals applied the Expanded Chronic Care Model to address health adversities of pediatric patients with asthma. This study examined the influence of a clinical health promotion initiative on asthma control and appropriate medication management among pediatric patients. Patients (n = 304) were recruited and screened for participation in this study. All the patients participated in a motivational interview, received clinical care, and were monitored longitudinally. Eligible patients (n = 53) were referred to one or more intervention pathways regarding physical activity, nutrition, smoking cessation, and psychosocial wellness. A comparison group (n = 90) was eligible for an intervention but chose not to participate. This analysis focused on patients who were identified as needing a health intervention beyond asthma clinical care. Among patients who were invited to participate in the health promotion pathways, significant decreases in asthma exacerbation were achieved by the patients who participated in the intervention compared with those who did not participate (p = 0.018). Significant improvements in asthma exacerbation, activity limitations, and asthma control were attributed to the time in clinical care (p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In this group, asthma control significantly improved with medication (p = 0.002), and age was associated with a significant decrease in asthma exacerbation (p = 0.011). This pilot study demonstrated preliminary benefits in a child asthma population. In addition, this experience addressed the chronicity of pediatric asthma through patient-centered care.

Research paper thumbnail of Using the 4 Pillars™ Practice Transformation Program to increase adult Tdap immunization in a randomized controlled cluster trial

Vaccine, Sep 26, 2016

National adult Tdap vaccination rates are low, reinforcing the need to increase vaccination effor... more National adult Tdap vaccination rates are low, reinforcing the need to increase vaccination efforts in primary care offices. The 4 Pillars™ Practice Transformation Program is an evidence-based, step-by-step guide to improving primary care adult vaccination with an online implementation tracking dashboard. This study tested the effectiveness of an intervention to increase adult Tdap vaccination that included the 4 Pillars™ Program, provider education, and one-on-one coaching of practice-based immunization champions. 25 primary care practices participated in a randomized controlled cluster trial (RCCT) in Year 1 (6/1/2013-5/31/2014) and a pre-post study in Year 2 (6/1/2014-1/31/2015). Baseline year was 6/1/2012-5/31/2013, with data analyzed in 2016. Demographic and vaccination data were derived from de-identified electronic medical record (EMR) extractions. The primary outcomes were vaccination rates and percentage point (PP) changes/year. The cohort consisted of 70,549 patients ⩾18ye...

Research paper thumbnail of Impact Evaluation Of A Community Wide Resuscitation Training Program

Prehospital and Disaster Medicine, 1985

This study focused upon one critical condition, acute respiratory insufficiency (ARI), and the tr... more This study focused upon one critical condition, acute respiratory insufficiency (ARI), and the treatment patterns used before and after a training program designed to teach hospital personnel the most current methods of treating acute respiratory insufficiency. The study was a methodological investigation in which a means for collecting and analyzing data concerning the treatment of an acute health problem was developed, implemented, and assessed. It was also an attempt to evaluate the quality of treatment of ARI in a set of hospitals and to assess the extent to which a training program was able to affect the quality of treatment. Thirdly, the study was an epidemiological investigation of the extent to which ARI exists in hospital critical care units.

Research paper thumbnail of An Analysis of Prehospital Mortality in an Earthquake

Prehospital and Disaster Medicine, 1994

Introduction:Anecdotal observations about prehospital emergency medical care in major natural and... more Introduction:Anecdotal observations about prehospital emergency medical care in major natural and human-made disasters, such as earthquakes, have suggested that some injured victims survive the initial impact, but eventually die because of a delay in the application of life-saving medical therapy.Methods:A multidisciplinary, retrospective structured interview methodology to investigate injury risk factors, and causes and circumstances of prehospital death after major disasters was developed. In this study, a team of United States researchers and Costa Rican health officials conducted a survey of lay survivors and health care professionals who participated in the emergency medical response to the earthquake in Costa Rica on 22 April 1991.Results:Fifty-four deaths occurred prior to hospitatization (crude death rate = 0.4/1,000 population). Seventeen percent of these deaths (9/54) were of casualties who survived the initial impact but died at the scene or during transport. Twenty-two p...

Research paper thumbnail of Disaster Reanimatology Potentials: A Structured Interview Study in Armenia I. Methodology and Preliminary Results

Prehospital and Disaster Medicine, 1989

In general, preparations for disasters which result in mass casualties do not incorporate a moder... more In general, preparations for disasters which result in mass casualties do not incorporate a modern resuscitation approach. We explored the life-saving potential of, and time limits for life-supporting first aid (LSFA), advanced trauma life support (ATLS), resuscitative surgery, and prolonged life support (PLS: intensive care) following the earthquake in Armenia on 7 December 1988. We used a structured, retrospective interview method applied previously to evaluation of emergency medical services (EMS) in the United States. A total of 120 survivors of, and participants in the earthquake in Armenia were interviewed on site (49 lay eyewitnesses, 20 search-rescue personnel, 39 medical personnel and records, and 12 administrators). Answers were verified by crosschecks. Preliminary results permit the following generalizations: 1) a significant number of victims died slowly as the result of injuries such as external hemorrhage, head injury with coma, shock, or crush syndrome; 2) early searc...

Research paper thumbnail of Medical Direction in Skilled Nursing Facilities. NCHSR Research Summary Series

Research paper thumbnail of Keane et al. Respond

American Journal of Public Health, 2003

We appreciate Pierce’s and Blackburn’s comment on our article and share their interest in evaluat... more We appreciate Pierce’s and Blackburn’s comment on our article and share their interest in evaluating the effects of privatizing services formerly provided by local health departments.1 A few resources are available, including a workbook that the National Association of County and City Health Officials designed to help local health departments examine their role in the provision of clinical services.2 Also, we recently completed a study of privatization’s effect on access of the uninsured to certain health services. Elsewhere, we reported outcomes of privatization as perceived by local health department directors.3,4 These perceptions reveal a variety of ways that privatization affects the public health infrastructure and suggest some of the measures of process and outcome that should be included in structured evaluations. Such measures include not only indicators of access and outcome associated with specific services but also broader indicators of public health capacity.3–5 Unfortunately, access and public health infrastructure frequently have not been priorities among politicians exerting political or financial control over local health departments. Many local health departments have faced external pressures to privatize. These pressures often have been based on general state or local governmental policies, such as hiring freezes, or general ideologically oriented premises, such as the stance that less government is better.6,7 Carefully designed evaluation studies could provide a factual basis for privatization decisions. Such evaluations should not rely solely on the outcome measures typically used in studies of personal health services; they must also find ways to measure the impact of privatization on broader public health infrastructure. Our survey revealed that many local health department directors were concerned that contracting out certain services, particularly those relating to communicable disease, can result in a loss of capacity to respond to disease outbreaks and other public health crises.1,3 A final point concerns the design of evaluation studies. It was helpful that Pierce and Blackburn compared local to statewide trends in immunization coverage. National and statewide secular trends may be attributable to a variety of factors, such as the Clinton administration’s efforts to increase childhood immunization rates. Ideally, an evaluation study could control for a range of potential confounders, but elaborate evaluations of individual public health privatization initiatives rarely have been funded (one exception was the evaluation of Pennsylvania’s “Community Health Project”).8 It is also important to monitor trends within vulnerable populations. For example, the statewide survey cited by Pierce and Blackburn indicated that vaccination coverage, as defined in the Texas Immunization Survey, decreased among children without health insurance in Texas, while coverage increased among insured children.9 Evaluators should confirm that any overall increase in access associated with privatization is not masking declines in access among the uninsured.

Research paper thumbnail of Brach_CE-1304-6301_FRR_CE.pdf

<b>Objectives: </b>To compare the effectiveness and sustainability of <i>On the... more <b>Objectives: </b>To compare the effectiveness and sustainability of <i>On the Move</i> against a Standard group exercise program consisting of seated strength, endurance, and flexibility exercises in community-dwelling older adults who reside in independent living facilities and senior apartment buildings, and who live elsewhere but regularly attend senior community centers. <b>Methods:</b> The study was a cluster randomized, single-blind intervention trial that compared the effects on function, disability, and mobility of a Standard group exercise program and the <i>On the Move</i> group exercise program in community-dwelling older adults. Thirty-two facilities were randomized, encompassing 424 individuals. <b>Results:</b> The mean ± standard deviation age of the participants was 80.7 ± 7.8 years. The <i>On the Move</i> group had greater improvements than the Standard group in the primary measures of mobility, the 6MWT (20.6 ± 57.1 versus 4.1 ± 55.6 m; adjusted difference = 16.7 ± 7.4; <i>p</i> = 0.0262), and gait speed (0.05 ± 0.13 versus –0.01 ± 0.11 m/s; adjusted difference = 0.05 ± 0.02; <i>p</i> = 0.0008). The between-group differences were adjusted for the baseline value of the outcome and represent a small but meaningful difference. There were no significant differences in self-reported function and disability as measured by the LLFDI scores. <b>Conclusions:</b> When taught by exercise leaders, the <i>On the Move</i> group exercise program was more effective at improving mobility than the Standard group exercise program, more safe, and well-liked by community-dwelling older adults.

Research paper thumbnail of A Social, Behavioral, and Implementation Science Perspective on Convergence Mental Health

Convergence Mental Health, 2021

Convergence is best approached through a systems science lens because it includes multiple levels... more Convergence is best approached through a systems science lens because it includes multiple levels of influence and organization and a host of mutually reinforcing elements. Each of these factors requires behavioral and social science research to ensure that convergence is appropriately anchored in the experience of patients and their communities. For example, the continuous assessment of mental state made possible through real-time mobile app recording of voice, movement, and biosignatures will be much less effective if people reject it because of privacy concerns or if this monitoring is not adequately linked to choices for self-care. Patients may need in-person contact with a therapist to choose an appropriate app and in-person boosters to support effective use. Use of the app and its effectiveness accordingly depend on social-behavioral factors. Likewise, the social and behavioral sciences are central for shortening the time between development and translation of mental health tr...

Research paper thumbnail of Assessment of Prehospital and Hospital Response in Disaster

Critical Care Clinics, 1991

The assessment of the response of a prehospital/hospital system to a disaster will prove a comple... more The assessment of the response of a prehospital/hospital system to a disaster will prove a complex and challenging undertaking for those who attempt it. Data availability and quality will prove to be an immediate problem. Finding the time to devote to assessment is usually difficult. Identifying qualified and interested members of the required multidisciplinary team and, in particular, an individual with health services research background who can assist in all phases of the design and implementation of the project, is often difficult. Obviously, these problems will be less severe if they are addressed to some degree in the disaster plan. That is, a general protocol for assessment could be developed as part of the disaster planning effort and evaluation staff could tentatively be identified by position (e.g., emergency department medical director). The issue of data availability could be confronted and provisions made for the recording of at least minimal information on patient log forms under disaster conditions.

Research paper thumbnail of Racial/Ethnic Differences in Pregnancy Intention, Reproductive Coercion, and Partner Violence among Family Planning Clients: A Qualitative Exploration

Women's health issues : official publication of the Jacobs Institute of Women's Health, Jan 6, 2018

Unintended pregnancy (UIP) is a persistent public health concern in the United States disproporti... more Unintended pregnancy (UIP) is a persistent public health concern in the United States disproportionately experienced by racial/ethnic minorities and women of low socioeconomic status. UIP often occurs with experiences of reproductive coercion (RC) and intimate partner violence (IPV). The purpose of the study was to qualitatively describe and compare contexts for UIP risk between low-income Black and White women with histories of IPV/RC. Semistructured interviews were conducted with low-income Black and White women with histories of IPV or RC, ages 18 to 29 years, recruited from family planning clinics in Pittsburgh, Pennsylvania. Interviews with 10 Black women and 34 White women (N = 44) were included in the analysis. Differences between White and Black women emerged regarding IPV/RC experiences, gender roles in intimate relationships, and trauma histories, including childhood adversity. Fatal threats and IPV related to childbearing were most influential among White women. Among Bla...

Research paper thumbnail of Effectiveness of a Timing and Coordination Group Exercise Program to Improve Mobility in Community-Dwelling Older Adults

JAMA Internal Medicine, 2017

Research paper thumbnail of A planning and evaluation program for assessing telecommunications applications in community radiation oncology programs

Research paper thumbnail of A Model for Evaluation of Disaster Management

Prehospital and Disaster Medicine, 1985

Our ability to manage disaster relief activities at regional, national or international levels of... more Our ability to manage disaster relief activities at regional, national or international levels of socio-political organization has, according to many analysts, not kept pace with the knowledge and technical capability presently available to contend with disasters. In a report released in 1977 a panel of experts assembled by the United Nations Association characterized disaster relief efforts as being routinely mismanaged. For example, the panel described what has been considered one of the better organized disaster relief efforts (the 1976 earthquake in Guatamala) in the following way.

Research paper thumbnail of In Memoriam, Michael Pozen

Prehospital and Disaster Medicine, 1985

The relatively young scientific field of health services research, whose practitioners are still ... more The relatively young scientific field of health services research, whose practitioners are still struggling to establish legitimacy within the vast domain of health care, owes much to Michael Pozen. Indeed, Michael must be counted as one of the founders of this new speciality in that his brief but incredibly productive career began as the field of health services research took form and emerged as a distinct career specialty. His very significant contributions to health care can be assessed from two perspectives.The most visible perspective upon Michael Pozen's professional work can be obtained from a review of his research as reported in his published articles and presented papers. Michael clearly established himself as a creative and resourceful scholar and researcher who had a particular interest in improving the design and delivery of emergency medical services as well as the clinical aspects of emergency medical care.

Research paper thumbnail of Using the 4 Pillars Immunization Toolkit to Increase Adult Immunizations

Open Forum Infectious Diseases, 2015

Research paper thumbnail of An Alternative Technique for Youth Risk Surveillance Outside of the School System

The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2017

When school districts choose not to participate in adolescent health behavior surveys, tracking a... more When school districts choose not to participate in adolescent health behavior surveys, tracking adolescent health indicators can be challenging. We conducted a countywide youth behavior survey outside of the school system. Our purpose is to describe alternative methods used for gathering these data reliably and ethically. We implemented two parallel surveys with youth ages 14-19 residing in a mid-sized county with urban, suburban, and rural neighborhoods. An anonymous phone-based survey used computer-assisted telephone interviewing with a live interviewer in conjunction with an interactive voice response system to survey youth via random digit dialing of landlines and cell phones. A concurrent in-person anonymous survey was conducted with marginalized youth (from juvenile detention centers, shelters, and residential facilities), using audio computer-assisted self-interviewing technology. The survey measures included the Centers for Disease Control Youth Risk Behavior Surveillance Sy...

Research paper thumbnail of Using the 4 pillars™ practice transformation program to increase adult influenza vaccination and reduce missed opportunities in a randomized cluster trial

BMC infectious diseases, Jan 3, 2016

An evidence-based, step-by-step guide, the 4 Pillars™ Practice Transformation Program, was the fo... more An evidence-based, step-by-step guide, the 4 Pillars™ Practice Transformation Program, was the foundation of an intervention to increase adult immunizations in primary care and was tested in a randomized controlled cluster trial. The purpose of this study is to report changes in influenza immunization rates and on factors related to receipt of influenza vaccine. Twenty five primary care practices were recruited in 2013, stratified by city (Houston, Pittsburgh), location (rural, urban, suburban) and type (family medicine, internal medicine), and randomized to the intervention (n = 13) or control (n = 12) in Year 1 (2013-14). A follow-up intervention occurred in Year 2 (2014-15). Demographic and vaccination data were derived from de-identified electronic medical record extractions. A cohort of 70,549 adults seen in their respective practices (n = 24 with 1 drop out) at least once each year was followed. Baseline mean age was 55.1 years, 35 % were men, 21 % were non-white and 35 % were...

Research paper thumbnail of Peter Safar: 12 April 1924 – 03 August 2003

Prehospital and Disaster Medicine, 2005

Several weeks ago I was asked by Marvin Birnbaum if I would write a short article about Peter Saf... more Several weeks ago I was asked by Marvin Birnbaum if I would write a short article about Peter Safar. It should be an article about the person and not his scientific accomplishments. The latter would be endless, as most of the readers might know, Peter Safar wrote more than 1,300 articles, books, book chapters, and abstracts. So I e-mailed back to the Editor that I am honored with his invitation and that I would write my personal reflections. All of the readers of these notes who-like me-have had the privilege of having worked with him (and I am certain that most of you who have had the opportunity of meeting Peter Safar even if just once) will understand why this article is written with a very personal tone. I suggest that all others-especially those who might think that it is inappropriate to publish articles like this in an international, scientific journal-as you read more about this man, you will understand our intense feelings. To be honest, as I was going deeper into preparing these personal impressions, I thought again that it is difficult to write about Peter Safar in a way which describes adequately how unique he was. The first time I saw Peter Safar was at the Medizinische Akademie Magdeburg. At that time, the East-German town of Magdeburg still was a part of the former communist block and it was deeply behind the iron curtain when Peter Safar visited Magdeburg on the invitation of Wolfgang Rose, who at that time was a member of the European Academy of Anaesthesiology's Committee on Cardiopulmonary Resuscitation. Peter Safar was talking in the biggest, but overcrowded, lecture hall on campus. At the podium stood an older, but extremely agile man giving a presentation about the modern aspects in cardiopulmonary resuscitation. The lecture was held in "wienglish" as he called it-a mixture of Viennese German and American English. Most of his slides were in old-fashioned black-and-white; a legendary tradition as I learned years later. The audience was astonished by his fresh and unconventional presentation. We were fascinated by the way he simplified and cross-linked the highly complex pathophysiology, and his vision about future directions of modern reanimatology. About halfway through his presentation, the most horrible nightmare for his hosts occurred-the slide projector broke. Peter Safar took out his Swiss Army Knife and started to repair the old, manually driven, slide projector. Why is this anecdote worth mentioning? Working and communicating with colleagues in eastern countries on a very collegial level was a normal academic behavior for Peter Safar. Since traveling from the west to the east was much easier than vice versa (for most scientists, the latter was absolutely impossible), he visited his colleagues in Moscow, Prague, Magdeburg, and other sites behind the Iron Curtain. His friendship and cooperation with Dr. Negovsky (Moscow) was legendary and was ground breaking especially during the years of the cold war. Peter Safar talked and pursued peace all his life. For him, it was a lifelong philosophy; he called himself a "world citizen". With the same engagement with which he developed an international network of cooperating scientists, he supported peace processes in his own country. Almost every US President learned about his humanitarian commitment; the White House received dozens of letters. Asked about his engagement for peacekeeping and humanitarian activities, he always said that these were the

Research paper thumbnail of Stakeholder involvement in the design of a patient-centered comparative effectiveness trial of the “On the Move” group exercise program in community-dwelling older adults

Contemporary Clinical Trials, 2016

Research paper thumbnail of Clinical and health promotion asthma management: an intervention for children and adolescents

Allergy and Asthma Proceedings, 2016

Asthma is the leading chronic condition among children. Given this international burden, clinicia... more Asthma is the leading chronic condition among children. Given this international burden, clinicians and public health professionals applied the Expanded Chronic Care Model to address health adversities of pediatric patients with asthma. This study examined the influence of a clinical health promotion initiative on asthma control and appropriate medication management among pediatric patients. Patients (n = 304) were recruited and screened for participation in this study. All the patients participated in a motivational interview, received clinical care, and were monitored longitudinally. Eligible patients (n = 53) were referred to one or more intervention pathways regarding physical activity, nutrition, smoking cessation, and psychosocial wellness. A comparison group (n = 90) was eligible for an intervention but chose not to participate. This analysis focused on patients who were identified as needing a health intervention beyond asthma clinical care. Among patients who were invited to participate in the health promotion pathways, significant decreases in asthma exacerbation were achieved by the patients who participated in the intervention compared with those who did not participate (p = 0.018). Significant improvements in asthma exacerbation, activity limitations, and asthma control were attributed to the time in clinical care (p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In this group, asthma control significantly improved with medication (p = 0.002), and age was associated with a significant decrease in asthma exacerbation (p = 0.011). This pilot study demonstrated preliminary benefits in a child asthma population. In addition, this experience addressed the chronicity of pediatric asthma through patient-centered care.

Research paper thumbnail of Using the 4 Pillars™ Practice Transformation Program to increase adult Tdap immunization in a randomized controlled cluster trial

Vaccine, Sep 26, 2016

National adult Tdap vaccination rates are low, reinforcing the need to increase vaccination effor... more National adult Tdap vaccination rates are low, reinforcing the need to increase vaccination efforts in primary care offices. The 4 Pillars™ Practice Transformation Program is an evidence-based, step-by-step guide to improving primary care adult vaccination with an online implementation tracking dashboard. This study tested the effectiveness of an intervention to increase adult Tdap vaccination that included the 4 Pillars™ Program, provider education, and one-on-one coaching of practice-based immunization champions. 25 primary care practices participated in a randomized controlled cluster trial (RCCT) in Year 1 (6/1/2013-5/31/2014) and a pre-post study in Year 2 (6/1/2014-1/31/2015). Baseline year was 6/1/2012-5/31/2013, with data analyzed in 2016. Demographic and vaccination data were derived from de-identified electronic medical record (EMR) extractions. The primary outcomes were vaccination rates and percentage point (PP) changes/year. The cohort consisted of 70,549 patients ⩾18ye...

Research paper thumbnail of Impact Evaluation Of A Community Wide Resuscitation Training Program

Prehospital and Disaster Medicine, 1985

This study focused upon one critical condition, acute respiratory insufficiency (ARI), and the tr... more This study focused upon one critical condition, acute respiratory insufficiency (ARI), and the treatment patterns used before and after a training program designed to teach hospital personnel the most current methods of treating acute respiratory insufficiency. The study was a methodological investigation in which a means for collecting and analyzing data concerning the treatment of an acute health problem was developed, implemented, and assessed. It was also an attempt to evaluate the quality of treatment of ARI in a set of hospitals and to assess the extent to which a training program was able to affect the quality of treatment. Thirdly, the study was an epidemiological investigation of the extent to which ARI exists in hospital critical care units.

Research paper thumbnail of An Analysis of Prehospital Mortality in an Earthquake

Prehospital and Disaster Medicine, 1994

Introduction:Anecdotal observations about prehospital emergency medical care in major natural and... more Introduction:Anecdotal observations about prehospital emergency medical care in major natural and human-made disasters, such as earthquakes, have suggested that some injured victims survive the initial impact, but eventually die because of a delay in the application of life-saving medical therapy.Methods:A multidisciplinary, retrospective structured interview methodology to investigate injury risk factors, and causes and circumstances of prehospital death after major disasters was developed. In this study, a team of United States researchers and Costa Rican health officials conducted a survey of lay survivors and health care professionals who participated in the emergency medical response to the earthquake in Costa Rica on 22 April 1991.Results:Fifty-four deaths occurred prior to hospitatization (crude death rate = 0.4/1,000 population). Seventeen percent of these deaths (9/54) were of casualties who survived the initial impact but died at the scene or during transport. Twenty-two p...

Research paper thumbnail of Disaster Reanimatology Potentials: A Structured Interview Study in Armenia I. Methodology and Preliminary Results

Prehospital and Disaster Medicine, 1989

In general, preparations for disasters which result in mass casualties do not incorporate a moder... more In general, preparations for disasters which result in mass casualties do not incorporate a modern resuscitation approach. We explored the life-saving potential of, and time limits for life-supporting first aid (LSFA), advanced trauma life support (ATLS), resuscitative surgery, and prolonged life support (PLS: intensive care) following the earthquake in Armenia on 7 December 1988. We used a structured, retrospective interview method applied previously to evaluation of emergency medical services (EMS) in the United States. A total of 120 survivors of, and participants in the earthquake in Armenia were interviewed on site (49 lay eyewitnesses, 20 search-rescue personnel, 39 medical personnel and records, and 12 administrators). Answers were verified by crosschecks. Preliminary results permit the following generalizations: 1) a significant number of victims died slowly as the result of injuries such as external hemorrhage, head injury with coma, shock, or crush syndrome; 2) early searc...

Research paper thumbnail of Medical Direction in Skilled Nursing Facilities. NCHSR Research Summary Series