American journal of preventive medicine
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Ethnic disparities in healthcare quality have been documented, but knowledge of differences in cardiovascular risk factor prevalence, awareness, treatment, and control between Mexican Americans and non-Hispanic whites remains incomplete. ⋯ The significantly higher prevalence of diabetes in Mexican Americans, in contrast to hypertension and dyslipidemia, may sensitize healthcare providers to its detection and treatment. Communicating the importance of hypertension and dyslipidemia is essential for eliminating disparities.
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Maps depicting the geographic variation in cancer incidence, mortality or treatment can be useful tools for developing cancer control and prevention programs, as well as for generating etiologic hypotheses. An important question with every cancer map is whether the geographic pattern seen is due to random fluctuations, as by pure chance there are always some areas with more cases than expected, or whether the map reflects true underlying geographic variation in screening, treatment practices, or etiologic risk factors. ⋯ When publishing cancer maps we recommend evaluating the spatial patterns observed using Tango's MEET, a global clustering test, and the spatial scan statistic, a cluster detection test.
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Randomized Controlled Trial
A community-based trial of an online intimate partner violence CME program.
There is a broad need to improve physician continuing medical education (CME) in the management of intimate partner violence (IPV). However, there are only a few examples of successful IPV CME programs, and none of these are suitable for widespread distribution. ⋯ The Internet-based CME program was clearly effective in improving long-term individual educational outcomes, including self-reported IPV practices. This type of CME may be an effective and less costly alternative to live IPV training sessions and workshops.
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State central cancer registries are often asked to respond to questions about the spatial distribution of cancer cases. Spatial analysis methods and technology are evolving rapidly, and can be a considerable challenge to registries that do not have staff with training in this area. The purpose of this article is to describe a general methodological approach that potentially might be a starting point for many cancer registry spatial analyses at the county level. ⋯ Mapping disease occurrence by time period is an effective way to explore spatio-temporal patterns. HGLM models and software are available to control for covariates and for unstructured and spatially structured variability that may confound spatial variability patterns.
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Current healthcare evidence relies on relatively narrow efficacy data to make decisions about program impact. This paper illustrates the application of impact indices derived from the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework that takes a broader perspective and includes issues important to decision makers, such as reach, adoption, and cost. ⋯ Greater use of indices focused on public health and external validity criteria could help identify programs most likely to have a meaningful impact on population health and to fit local settings and priorities.