U.S. Department Of Health And Human Services Research Articles

Physical Activity Associated with Older Adult Pickleball Participation: A Pilot Study

The quantity and quality of physical activity accrued from recreational pickleball participation have not been published. The purpose of this study was to determine the amount and intensity of physical activity older adults (65 years and older) get from pickleball participation. Thirty-three pickleball participants wore FitbitHR monitors for 2 weeks and logged days/times of pickleball participation. On average, participants spent over 68 min of moderate to vigorous intensity physical activity (MVPA) per playing session. Playing pickleball had beneficial cardiovascular benefits, as participants averaged over 86 min at increased heart rate zones. On average, participants gained significantly more steps on pickleball play days versus non-pickleball play days. Pickleball play days were found to have significantly more MVPA minutes, and participants were significantly less sedentary. The results inform sport and leisure providers evidence that pickleball participation helps older adults meet the Centers for Disease Control and Prevention (CDC)/U.S. Department of Health and Human Services (USHHS) recommended guidelines for MVPA per week if played three or more times. Knowing the health benefits of pickleball may assist sport and leisure managers as they accommodate this popular sport activity.

Assessing the Readability of Anesthesia-Related Patient Education Materials from Major Anesthesiology Organizations.

Introduction The National Institutes of Health (NIH), American Medical Association (AMA), and the US Department of Health and Human Services (USDHHS) recommend that patient education materials (PEMs) be written between the 4th to 6th grade reading level to ensure readability by the average American. In this study, we examine the reading levels of online patient education materials from major anesthesiology organizations. Methods Readability analysis of PEMs found on the websites of anesthesiology organizations was performed using the Flesch Reading Ease score, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, Gunning Frequency of Gobbledygook, New Dale-Chall test, Coleman-Liau Index, New Fog Count, Raygor Readability Estimate, the FORCAST test, and the Fry Score. Results Most patient educational materials from the websites of the anesthesiology organizations evaluated were written at or above the 10th grade reading level. Conclusions Online patient education materials from the major anesthesiology societies are written at levels higher than an average American adult reading skill level and higher than recommended by National Institute of Health, American Medical Association, and US Department of Health and Human Services. Online resources should be revised to improve readability. Simplifying text, using shorter sentences and terms are strategies online resources can implement to improve readability. Future studies should incorporate comprehensibility, user-friendliness, and linguistic ease to further understand the implications on overall healthcare.

Child and Family Services Review (CFSR) and child welfare outcomes in the United States

ABSTRACT The Child and Family Services Review (CFSR), created by the U.S. Department of Health and Human Services (USDHHS), was first implemented in 2000 to examine the effectiveness of public child welfare agencies and promote positive child and family outcomes across the nation. After providing a brief history of the CFSR, its methodology, and notable changes that have occurred over the past two decades, this study presents a review of the CFSR results for 50 states, the District of Columbia, and Puerto Rico. This study is the first to compile results from all three rounds of the federal CFSR from 2001 to 2018 to explore nationwide child welfare outcomes over time. This study will provide information to support multiple child welfare stakeholders in their efforts to serve children and families and help public child welfare agencies and practitioners reflect on their own performance over time relative to other states to enhance their policy and practice and improve outcomes for children’s safety, permanency, and well-being.

Implementing the US Department of Health and Human Services definition of multimorbidity: a comparison between billing codes and medical record review in a population-based sample of persons 40–84 years old

ObjectiveTo assess the validity of the US Department of Health and Human Services (DHHS) definition of multimorbidity using International Classification of Diseases, ninth edition (ICD-9) codes from administrative data.DesignCross-sectional comparison...

Non-Opioid Otolaryngology Medical Practice

Introduction: Opioids have been used as pain medications in the United States since the late 1990s and have become increasingly common since then. Following the declaration of a public health emergency by the US Department of Health and Human Services (US-HHS), the author switched from opioid-based pain management to non-opioid-based pain management without any significant pain concerns from his postoperative patients. The primary purpose of this article was to demonstrate how much opioids in morphine milligram equivalents (MME) was prescribed per month by the author according to Michigan Prescription Monitoring Program (PMP) Prescriber Activity Reports before and after 2018 for management of pain in his otolaryngology postoperative surgical patients. Methods: A retrospective research methodology was employed for this investigation. Michigan PMP Prescriber Reports were collected before and after 2018 and were included in this study. Results: The author prescribed opioid pain medications before the HHS declaration. After the HHS declaration, the author prescribes acetaminophen and Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). The number of opioid prescriptions from the author were remarkably low compared to similar prescribers and others within the author’s specialty. Prescription by MME showed no notable difference in MME values from 0-50 before and after the HHS declaration among the author and SP groups, but a notable drop of MME values from 51-90 among all groups after the HHS declaration. Discussion: The author discourages the use of opioid pain medications for routine otolaryngology procedures. This study demonstrates the effective use of acetaminophen with or without NSAIDs (ibuprofen and diclofenac) to facilitate patient care absent of the well-established dangers of opioid use.

A Comparison of Waist-to-Hip Ratio Cutoff Points in a Large Sample of Southern Iranian Adults with Two Standard Procedures and Asian Studies

Background: One of the popular indicators of developing serious health conditions is the waist-to-hip ratio (WHR). The appropriate WHR cutoff points are reported differently in the US department of health and human services (US-DHHS), the world health organization (WHO), and the Asian studies. Objectives: The current study aimed at comparing WHR cutoff points for a large sample of Southern Iranian adults with 2 standard procedures and Asian studies. Methods: In the current cross sectional study, data were collected from 16 341 adults within the age range of 20 to 70 years. Body compositions were determined by the bioelectrical impedance analysis method (BIA). Sensitivity, specificity, positive predictive power (PPV), negative predictive power (NPV), and receiver-operating characteristic (ROC) curves were used to meet the objectives of the investigation Results: The sensitivity and NPV in both classifications were higher in females compared to males. For females and males in both classifications, increase in age was associated with increase in the sensitivity and NPV. In all, the WHO classification was not a good indicator of obesity in males. The US-DHHC was the best to correctly classify the obese or non-obese subjects in various age groups. Conclusions: The suitable cutoff points for Iranian males and females were 0.88 and 0.83, respectively similar to those reported in Southeastern Asian studies. The recommended cutoff point for Iranian males was similar to those reported for Arab males; but the recommended cutoff point for Iranian females was different from that of Arab females. Both the WHO-WHR and US-DHHS classifications were effective to detect obesity among all females. Neither was effective to detect obesity among males under 40 years old.

Working Together to Combat Tobacco Use

It is well-established that tobacco use is associated with a wide range of negative health consequences, and these effects occur at a higher incidence among individuals with co-occurring mental illness. Compared to those in the general population, this vulnerable population smokes more, dies younger, and suffers disproportionately higher rates of cardiovascular disease, diabetes, stroke, and cancer ( U.S. Department of Health and Human Services (USDHHS), 2014 U.S. Department of Health and Human Services (USDHHS) The health consequences of smoking—50 years of progress: A report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA2014 Google Scholar ). The Clinical Practice Guideline for Treating Tobacco Use and Dependence sets forth a series of recommendations for populations of smokers, including those with co-occurring mental illness, and establishes the fact that counseling from a healthcare provider can approximately double patients' odds of quitting ( Fiore et al., 2008 Fiore M.C. Jaen C.R. Baker T.B. Bailey W.C. Benowitz W.C. Curry S.J. et al. Treating tobacco use and dependence: 2008 update. Clinical practice guideline. U.S. Department of Health and Human Services, Rockville, MD2008 Google Scholar ).

Readability Assessment of Internet-based Patient Education Materials Related to Mammography for Breast Cancer Screening

The US Department of Health and Human Services (USDHHS) recommends that Internet-based patient education materials (IPEMs) be written below the sixth-grade reading level to target the average American adult. This study was designed to determine the readability of IPEMs regarding mammography for breast cancer screening. Three-hundred mammography-related Web sites were reviewed for IPEMs. Forty-two IPEMs that met the Health on the Net Foundation Code of Conduct were assessed for readability level with four readability indices that use existing algorithms based on word and sentence length to quantitatively analyze Internet sources for language intricacy including the following: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (Gunning FOG; GFOG). Results were compared to national recommendations, and intergroup analysis was performed. No IPEMs (0%) regarding mammography were written at or below the sixth-grade reading level, based on FKGL. The mean readability scores were as follows: FRES, 49.04±10.62; FKGL, 10.71±2.01; SMOG, 13.33±1.67; and Gunning FOG, 14.32±2.18. These scores indicate that the readability of mammography IPEMs is written at a "difficult" level, significantly above the recommended sixth-grade reading level (P<.05) determined by the USDHHS. IPEMs related to mammography are written well above the recommended sixth-grade level and likely reflect other IPEMs in diagnostic radiology.

Factors that Influence Physicians’ and Medical Students’ Confidence in Counseling Patients About Physical Activity

Less than half of US adults and two-thirds of US high school students do not meet current US guidelines for physical activity. We examined which factors promoted physicians' and medical students' confidence in counseling patients about physical activity. We established an online exercise survey targeting attending physicians, resident and fellow physicians, and medical students to determine their current level of physical activity and confidence in counseling patients about physical activity. We compared their personal level of physical activity with the 2008 Physical Activity Guidelines of the US Department of Health and Human Services (USDHHS). We administered a survey in 2009 and 2010 that used the short form of the International Physical Activity Questionnaire. A total of 1,949 individuals responded to the survey, of whom 1,751 (i.e., 566 attending physicians, 138 fellow physicians, 806 resident physicians, and 215 medical students) were included in this analysis. After adjusting for their BMI, the odds that physicians and medical students who met USDHHS guidelines for vigorous activity would express confidence in their ability to provide exercise counseling were more than twice that of physicians who did not meet these guidelines. Individuals who were overweight were less likely to be confident than those with normal BMI, after adjusting for whether they met the vigorous exercise guidelines. Physicians with obesity were even less likely to express confidence in regards to exercise counseling. We conclude that physicians and medical students who had a normal BMI and met vigorous USDHHS guidelines were more likely to feel confident about counseling their patients about physical activity. Our findings suggest that graduate medical school education should focus on health promotion in their students, as this will likely lead to improved health behaviors in their students' patient populations.

Engaging Families (and Ourselves) in Quality Improvement: An Optimistic and Developmental Perspective

From the Department of Pediatrics, School of Medicine, Oregon Health and Science University, Portland, Ore The views expressed in this report are those of the authors and do not necessarily represent those of the USDepartment of Health andHuman Services, the Agency for Healthcare Research and Quality or the American Board of Pediatrics Foundation. The authors declare that they have no conflict of interest. Publication of this article was supported by the Agency for HealthcareResearch andQuality and the American Board of Pediatrics Foundation. Address correspondence to Christina D. Bethell, PhD, MBA,MPH, Department of Pediatrics, School of Medicine, Oregon Health and Science University, 707 SW Gaiens Rd, Mail Code CDRCP, Portland, OR 97239-2998 (e-mail: bethellc@ohsu.edu).

Cluster Randomized Trials for Health Care Quality Improvement Research

From the Seattle Children’s Research Institute, Center for Child Health, Behavior and Development, Seattle, Wash (Drs Garrison and Mangione-Smith); Department of Health Services, University of Washington, Seattle, Wash (Drs Garrison and Mangione-Smith); and Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry (Dr Garrison), and Department of Pediatrics, University of Washington, Seattle, Wash (Dr Mangione-Smith) The views expressed in this report are those of the authors and do not necessarily represent those of the USDepartment of Health andHuman Services, the Agency for Healthcare Research and Quality or the American Board of Pediatrics Foundation. The authors declare that they have no conflict of interest. Publication of this article was supported by the Agency for HealthcareResearch andQuality and the American Board of Pediatrics Foundation. Address correspondence toMichelle M. Garrison, PhD, Seattle Children’s Research Institute, POBox 5371, Seattle, WA 98145-5005 (e-mail: michelle.garrison@seattlechildrens.org).

Patient Information in Graves' Disease and Thyroid-Associated Ophthalmopathy: Readability Assessment of Online Resources

The Internet is a vital source of information for patients hoping to learn more about their disease. Health literacy of the general population is known to be poor, with the U.S. Department of Health and Human Services (USDHHS) recommending that patient-oriented literature be written at a fourth- to sixth-grade reading level to optimize comprehensibility. In this study we assessed the readability of online literature specifically for Graves' disease (GD) and thyroid-associated ophthalmopathy (TAO). Readability of the content of the top 20 English-language GD patient-oriented online resources and top 30 of the equivalent TAO resources returned by Google search was analyzed. Web pages were identified using the Google search terms "Graves' disease" and "Thyroid-Associated Ophthalmopathy," respectively. Extraneous text (e.g., hyperlinks, affiliations, disclaimers) was removed. Relevant text proceeded to readability analysis using four validated measures: Flesch Reading Ease Score, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook, and Gunning-Fog Index. Readability was compared with USDHHS standards. Overall, median word count (with interquartile range [IQR] and range) was 990 (IQR 846, 195-3867), with a median of 18 words per sentence (IQR 4.0, 7.5-28). Median Flesch Reading Ease Score was 46 (IQR 13, 24-64), Flesch-Kincaid Grade Level 11 (IQR 3.0, 7.2-17), Simple Measure of Gobbledygook 13 (IQR 2.0, 9.6-17), and Gunning-Fog Index 13 (IQR 3.0, 9.2-19), each equivalent to a reading level of >11th grade and "difficult" on the USDHHS classification. None of the web pages evaluated had readability scores in accordance with published guidelines. There was no significant difference with the country of origin of each web page, website commercial status, or with pages predominantly focused on GD or TAO. Readability scores for online GD and TAO patient-focused materials are inferior to those recommended. Screening of this online material, as well as subsequent revision, is crucial to increase future patient knowledge, satisfaction, and compliance.

The Juhnke, Henderson, Juhnke Child Abuse and Neglect Risk Assessment Scale

Family counselors often counsel families where children are at increased risk of maltreatment. Yet there exists a paucity of free, brief, face-to-face, standardized, assessment instruments designed for family counselors to assess child abuse. To address this paucity, the authors created The Juhnke, Henderson, Juhnke Child Abuse and Neglect Risk Assessment scale. The scale is an evidenced informed instrument that considers 20 child maltreatment risk factors identified by the U.S. Department of Health and Human Services (USDHHS) Office of Child Abuse and Neglect. The primary purpose of the scale is to facilitate a thorough maltreatment assessment and to generate guidelines that can be used, in conjunction with clinical judgment, to aid in the creation of an effective child protective agency report and potentially facilitate effective intervention.

Prevalence of meeting physical activity guidelines for cancer prevention in Alberta

Guidelines for recommended physical activity (PA) levels have been developed by the Canadian Society for Exercise Physiology (CSEP) and the U.S. Department of Health and Human Services (USDHHS) for health benefits and by the American Cancer Society (ACS) and the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) for cancer prevention benefits. We examined if these guidelines were met using a sample of 14 294 Albertan participants of the Tomorrow Project, aged 35 to 64 years, enrolled from 2001 to 2005. We used logistic regression to examine correlates of leisure PA behaviour. An estimated 55%, 42%, 26% and 23% of participants met CSEP, ACS, USDHHS, and WCRF/AICR guidelines, respectively. Women were less likely than men to meet ACS (Odds Ratio [OR] = 0.72, 95% confidence interval [CI]: 0.55-0.93), USDHHS (OR = 0.67, 95% CI: 0.50-0.89) and WCRF/AICR (OR = 0.63, 95% CI: 0.47-0.85) guidelines, and being obese was correlated with not meeting USDHHS (OR = 0.45, 95% CI: 0.32-0.65) and WCRF/AICR guidelines (OR = 0.79, 95% CI: 0.63-0.98). Albertans, particularly women and obese individuals, are not sufficiently active for cancer prevention benefits.

Recommendations of the IOM Clinical Preventive Services for Women Committee

In July 2011, in response to language in the Affordable Care Act (ACA) the Office of the Assistant Secretary for Planning and Evaluation of the US Department of Health and Human Services (HHS) tasked the Institute of Medicine (IOM) to develop a report on the clinical preventive services necessary for women. The committee proposed eight new clinical preventive service recommendations aimed at closing significant gaps in preventive healthcare. This article reviews the process, findings, and the implications for obstetrician gynecologists and other primary care clinicians. Obstetricians and gynecologists play a major role in delivering primary care to women and many of the services recommended by the Committee are part of the core set of obstetrics and gynecology services. The women's health amendment to the ACA (Federal Register, 2010) requires that new private health plans cover - with no cost-sharing requirements - preventive healthcare services for women. Congress requested that a review be conducted to ascertain whether there were any additional needed preventive services specific to women's health that should be included. The IOM Committee on Preventive Services for Women recommended eight clinical measures specific to women's health that should be considered for coverage without co-payment. The US Department of HHS reviewed and adopted these recommendations, and, as a result, new health plans will need to include these services as part of insurance policies with plan years beginning on or after 1 August 2012. The authors discuss the implications of the IOM recommendations on practicing clinicians and on their potential impact on women's health and well being.

Richtlinien der Tabakentwöhnung Stand 2010

In 2005, the ÖGP (Austrian Society of Pneumology) worked out the first standards of smoking cessation. With many new therapies, it is timely to update the guidelines of smoking cessation. This time all relevant professionals who are active in smoking cessation in Austria worked together in a big consensus process, not only the diverse medical professionals such as internists, pneumologists, or gynecologists but also psychotherapists, psychologists, and nurses. The Austrian standards for smoking cessation is closely related to the Update for smoking cessation 2008 of the USDHHS (US Department of Health and Human Services) and the Cochrane Reports. Ten main recommendations for smoking cessation have been worked out. The guidelines for smoking cessation was reviewed by three international reviewers.

Building Caries Risk Assessment Models for Children

Despite the well-recognized importance of caries risk assessment, practical models remain to be established. This study was designed to develop biopsychosocial models for caries risk assessment in various settings. With a questionnaire, an oral examination, and biological (salivary, microbiological, and plaque pH) tests, a prospective study was conducted among 1782 children aged 3-6 years, with 1576 (88.4%) participants followed in 12 months. Multiple risk factors, indicators, and protective factors were identified. Various risk assessment models were constructed by the random selection of 50% of the cases and further validated in the remaining cases. For the prediction of a “one-year caries increment”, screening models without biological tests achieved a sensitivity/specificity of 82%/73%; with biological tests, full-blown models achieved the sensitivity/specificity of 90%/90%. For identification of a quarter of the children with high caries burden (baseline dmft > 2), a community-screening model requiring only a questionnaire reached a sensitivity/specificity of 82%/81%. These models are promising tools for cost-effective caries control and evidence-based treatment planning. Abbreviations: decayed, missing, filled teeth in primary dentition (dmft); receiver operation characteristics (ROC); relative risk (RR); confidence interval (CI); National Institutes of Health (NIH); World Health Organization (WHO); US Department of Health and Human Services (US/DHHS); American Academy of Pediatric Dentistry (AAPD).

Planning, surveillance, and reporting for pandemic influenza: A briefing for advanced practice nurses

To provide advanced practice nurses (APNs) with information necessary to participate in pandemic influenza planning and response. Key epidemiological terms and pandemic alert designations are reviewed. Influenza surveillance activities at the local, state, and national levels are summarized. Responsibilities of the APN are discussed, and resources are provided. Review of the published literature, epidemiology text books, U.S. Department of Health and Human Services (USDHHS) Pandemic Influenza Plan, state pandemic influenza plans, U.S. Centers for Disease Control and Prevention, World Health Organization, and USDHHS Internet resources. Recent public health emergencies have brought to light the need for APNs to become educated regarding emergency planning and response. APNs should be familiar with terminology, current activities, and potential responsibilities. Resources presented in this article will help prepare APNs to participate in planning and response activities for pandemic influenza.

The Identification of Key Foods for Food Composition Research

The United States Department of Agriculture's (USDA) National Food and Nutrient Analysis Program (NFNAP) was initiated to update existing component values and to add data on new foods and components to reflect today's marketplace and needs for data. The USDA Nutrient Database for Standard Reference contains data for about 6040 foods for over 100 compounds. To develop a full nutrient profile for each food costs approximately $12 000 (six analytical samples×$2000 per sample). To determine food sampling priorities, the Nutrient Data Laboratory (NDL) has used the Key Foods approach to generate a list of 666 foods. This method utilizes existing nutrient profiles and nationally representative food consumption survey data collected by USDA in the Continuing Survey of Food Intakes by Individuals 1994–1996 (CSFII) and by The U.S. Department of Health and Human Services (USDHHS) in the National Health and Nutrition Examination Survey (NHANES). One premise of the project is that more samples will be collected and prepared for those foods which provide important amounts of nutrients of public health significance to the diet and not every sample will be analyzed for all the nutrients currently in NDL's nutrient databases. Even though the list of 666 Key Foods is much more manageable, procedures to set priorities for analysis are still needed. To accomplish this, two approaches were developed. One is based on a point system, and the other on nutrient consumption data. Based on an analysis of the two approaches, the nutrient consumption approach was chosen to be the primary method of selecting foods for analysis. This paper reports details of the two methods to modify the existing Key Foods list to determine new and specific priorities for NFNAP efforts. This program represents a comprehensive approach to collect baseline nationally representative data. Results will be used to update the USDA Nutrient Database for Standard Reference and to establish future priorities for frequency of updates.

National Nutrition Summit, May 30, 2000: Results of the Obesity Discussion Groups

National Nutrition Summit, May 30, 2000: Results of the Obesity Discussion Groups