Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-10 (of 10 Records) |
Query Trace: Dunet DO[original query] |
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State and Local Chronic Disease Programs Adapt and Pivot to Address Community Needs During the COVID-19 Pandemic: Examples From CDC Funded SPAN, REACH, and HOP Programs.
O'Toole TP , René Lavinghouze S , Pejavara A , Petersen R . Health Promot Pract 2022 23 12s-20s This supplement issue of Health Promotion Practice (HPP), “Reducing Chronic Disease through Physical Activity and Nutrition: Public Health Practice in the Field” (https://journals.sagepub.com/toc/hppa/23/1_suppl) has a focus on publishing practice wisdom from the field of nutrition, physical activity, and obesity programs. Publishing the practitioner’s perspective facilitates reducing gaps in literature, enhancing education of partners and decision makers, increasing knowledge translations, and improving the evidence base for addressing public health challenges. Practice wisdom draws upon public health practitioners’ experiences and expertise in developing, improving, or adapting practices to implement public health intervention programs (Chen et al., 2011; Dunet et al., 2013). HPP publication allows for a broader, more enduring dissemination of practice wisdom while building upon prior progress. |
Cost of informal caregiving associated with stroke among the elderly in the United States
Joo H , Dunet DO , Fang J , Wang G . Neurology 2014 83 (20) 1831-7 OBJECTIVES: We estimated the informal caregiving hours and costs associated with stroke. METHODS: We selected persons aged 65 years and older in 2006 and who were also included in the 2008 follow-up survey from the Health and Retirement Study. We adapted the case-control study design by using self-reported occurrence of an initial stroke event during 2006 and 2008 to classify persons into the stroke (case) and the nonstroke (control) groups. We compared informal caregiving hours between case and control groups in 2006 (prestroke period for case group) and in 2008 (poststroke period for case group) and estimated incremental informal caregiving hours attributable to stroke by applying a difference-in-differences technique to propensity score-matched populations. We used a replacement approach to estimate the economic value of informal caregiving. RESULTS: The weekly incremental informal caregiving hours attributable to stroke were 8.5 hours per patient. The economic value of informal caregiving per stroke survivor was $8,211 per year, of which $4,356 (53%) was attributable to stroke. At the national level, the annual economic burden of informal caregiving associated with stroke among elderly was estimated at $14.2 billion in 2008. CONCLUSIONS: Recent changes in public health and social support policies recognize the economic burden of informal caregiving. Our estimates reinforce the high economic burden of stroke in the United States and provide up-to-date information for policy development and decision-making. |
Costs of hospitalization for stroke patients aged 18-64 years in the United States
Wang G , Zhang Z , Ayala C , Dunet DO , Fang J , George MG . J Stroke Cerebrovasc Dis 2014 23 (5) 861-8 BACKGROUND: Estimates for the average cost of stroke have varied 20-fold in the United States. To provide a robust cost estimate, we conducted a comprehensive analysis of the hospitalization costs for stroke patients by diagnosis status and event type. METHODS: Using the 2006-2008 MarketScan inpatient database, we identified 97,374 hospitalizations with a primary or secondary diagnosis of stroke. We analyzed the costs after stratifying the hospitalizations by stroke type (hemorrhagic, ischemic, and other strokes) and diagnosis status (primary and secondary). We employed regressions to estimate the impact of event type and diagnosis status on costs while controlling for major potential confounders. RESULTS: Among the 97,374 hospitalizations (average cost: $20,396 +/- $23,256), the number with ischemic, hemorrhagic, or other strokes was 62,637, 16,331, and 48,208, respectively, with these types having average costs, in turn, of $18,963 +/- $21,454, $32,035 +/- $32,046, and $19,248 +/- $21,703. A majority (62%) of the hospitalizations had stroke listed as a secondary diagnosis only. Regression analysis found that, overall, hemorrhagic stroke cost $14,499 more than ischemic stroke (P < .001). For hospitalizations with a primary diagnosis of ischemic stroke, those with a secondary diagnosis of ischemic heart disease (IHD) had costs that were $9836 higher (P < .001) than those without IHD. CONCLUSIONS: The costs of hospitalizations involving stroke are high and vary greatly by type of stroke, diagnosis status, and comorbidities. These findings should be incorporated into cost-effective strategies to reduce the impact of stroke. |
Sodium reduction: an important public health strategy for heart health
Mugavero KL , Gunn JP , Dunet DO , Bowman BA . J Public Health Manag Pract 2014 20 S1-5 High intake of dietary sodium is associated with elevated blood pressure, which increases the risk of heart disease and stroke.1 Heart disease and stroke are the first and fourth leading causes of death in the United States2; from a public health perspective, this makes control of hypertension an important issue. | To address this, the Million Hearts initiative (led by the US Department of Health and Human Services), Dietary Guidelines for Americans, Healthy People 2020, and guidelines from numerous health organizations recommend reducing the amount of sodium consumed in the diet.3 Most sodium consumed by Americans comes from processed and restaurant foods. Because these sources make up a large part of the American diet and because consumers have little control over the level of sodium in these foods, it is often difficult for consumers to reduce their sodium intake.4 Many of the ingredients and food products served in schools, work sites, and group meal sites such as senior citizen centers contain high levels of sodium. Even when food purchasers and food service staff try to offer healthier food options, lower-sodium ingredients and products may not be easily available and accessible. |
A cost analysis of a community health worker program in rural Vermont
Mirambeau AM , Wang G , Ruggles L , Dunet DO . J Community Health 2013 38 (6) 1050-7 Studies have shown that community health workers (CHWs) can improve the effectiveness of health care systems; however, little has been reported about CHW program costs. We examined the costs of a program staffed by three CHWs associated with a small, rural hospital in Vermont. We used a standardized data collection tool to compile cost information from administrative data and personal interviews. We analyzed personnel and operational costs from October 2010 to September 2011. The estimated total program cost was $420,348, a figure comprised of $281,063 (67 %) for personnel and $139,285 (33 %) for operations. CHW salaries and office space were the major cost components. Our cost analysis approach may be adapted by others to conduct cost analyses of their CHW program. Our cost estimates can help inform future economic studies of CHW programs and resource allocation decisions. |
Using evaluability assessment to support the development of practice-based evidence in public health
Dunet DO , Losby JL , Tucker-Brown A . J Public Health Manag Pract 2013 19 (5) 479-82 Practice-based evidence arises from programs implemented in real-world settings. Program success may be judged on the basis of experience; however, formal evaluation studies of methodological rigor can provide a high level of credible evidence to inform public health practice. Such studies can be lengthy and expensive. Furthermore, even well-designed studies may not reach conclusive findings, for example, when a program lacks full implementation, when data systems do not have capacity to collect evaluation data, or when program implementation has not attained stability. An evaluability assessment is used to determine the capacity and readiness of a program for full-scale effectiveness evaluation. Evaluators at the Centers for Disease Control and Prevention use evaluability assessment as a preevaluation consisting of brief, focused, criteria-based assessments, document review, and a site visit. Evaluability assessment is used to guide investments in subsequent rigorously designed evaluations that yield conclusive findings to build strong and credible practice-based evidence. |
Evaluative thinking: a tool to inform policy development and policy impact evaluations
Dunet DO , Gase LN , Oliver ML , Schooley MW . Am J Health Promot 2012 26 (4) 201-3 Policy is generally understood to be a set of guidelines or acourse of action that may be shaped as a law, regulation, rule,procedure, or practice.1Whether public or organizational,policy aims to effect and focus change. In health promotionand health protection, policy can be an efficient strategy foradvancing health initiatives, influencing whole systems, andshifting cultural norms.2,3Evaluative thinking offers a way to consider problemsand potential policy solutions through the lens of logicalreasoning, explicit criteria, and data. Such thinkingexamines how problems are defined and what assumptionsare being made about the underlying causes of a problem.Although many tools and frameworks exist for planningand evaluating health-related programs, fewer resourcesare available for developing and evaluating policies forhealth promotion and disease prevention. Fortunately, themind-set of evaluative thinking that guides programplanning and evaluation methods can be used tostrengthen a policy development process, shape policyoptions, and set the stage for successful policy im-plementation and impact evaluation. When evaluationfindings demonstrate a policy’s effectiveness in advancinghealth goals, this information can become a powerfulmechanism for encouraging the adoption of the policy in other contexts, thus broadening the reach of health-promoting policies. |
Estimating the potential health impact and costs of implementing a local policy for food procurement to reduce the consumption of sodium in the County of Los Angeles
Gase LN , Kuo T , Dunet D , Schmidt SM , Simon PA , Fielding JE . Am J Public Health 2011 101 (8) 1501-7 OBJECTIVES: We examined approaches to reduce sodium content of food served in settings operated or funded by the government of the County of Los Angeles, California. METHODS: We adapted health impact assessment methods to mathematically simulate various levels of reduction in the sodium content of food served by the County of Los Angeles and to estimate the reductions' potential impacts on mean systolic blood pressure (SBP) among food-service customers. We used data provided by county government food-service vendors to generate these simulations. RESULTS: Our analysis predicted that if the postulated sodium-reduction strategies were implemented, adults would consume, on average, 233 fewer milligrams of sodium each day. This would correspond to an average decrease of 0.71 millimeters of mercury in SBP among adult hypertensives, 388 fewer cases of uncontrolled hypertension in the study population, and an annual decrease of $629,724 in direct health care costs. CONCLUSIONS: Our findings suggest that a food-procurement policy can contribute to positive health and economic effects at the local level. Our approach may serve as an example of sodium-reduction analysis for other jurisdictions to follow. (Am J Public Health. Published online ahead of print June 16, 2011: e1-e7. doi:10.2105/AJPH.2011.300138). |
Facilitators and barriers to implementing a local policy to reduce sodium consumption in the County of Los Angeles government, California, 2009
Gase LN , Kuo T , Dunet DO , Simon PA . Prev Chronic Dis 2011 8 (2) A33 INTRODUCTION: This qualitative study explores facilitators and barriers to a proposed food procurement policy that would require food purchasers, distributors, and vendors of food service in the County of Los Angeles government to meet specified nutrition standards, including limits on sodium content. METHODS: We conducted 30 key informant interviews. Interviewees represented 18 organizations from the County of Los Angeles government departments that purchased, distributed, or sold food; public and private non-County entities that had previously implemented food procurement policies in their organizations; and large organizations that catered food to the County. RESULTS: Study participants reported 3 key facilitators: their organization's authority to impose nutrition standards, their organization's desire to provide nutritious food, and the opportunity to build on existing nutrition policies. Eight key barriers were identified: 1) unique features among food service settings, 2) costs and unavailability of low-sodium foods, 3) complexity of food service arrangements, 4) lack of consumer demand for low-sodium foods, 5) undesirable taste of low-sodium foods, 6) preference for prepackaged products, 7) lack of knowledge and experience in operationalizing sodium standards, and 8) existing multiyear contracts that are difficult to change. Despite perceived barriers, several participants indicated that their organizations have successfully implemented nutritional standards that include limits on sodium. CONCLUSION: Developing or changing policies for procuring food represents a potentially feasible strategy for reducing sodium consumption in food service venues controlled by the County of Los Angeles. The facilitators and barriers identified here can inform the formulation, adoption, implementation, and evaluation of sodium reduction policies in other jurisdictions. |
Using the Extended Health Belief Model to understand siblings' perceptions of risk for hereditary hemochromatosis
Bylund CL , Galvin KM , Dunet DO , Reyes M . Patient Educ Couns 2011 82 (1) 36-41 OBJECTIVE: This research focuses on individuals' reactions to news that a sibling has been diagnosed with hereditary hemochromatosis (HH). We used the Extended Health Belief Model (EHBM) to frame our analysis of siblings' perceptions of risk for HH and decision of whether to obtain diagnostic testing. METHOD: 60 patient and 25 sibling interviews were transcribed and thematically analyzed for the six components of the EHBM. RESULTS: Patient and sibling reports of siblings' perceptions were categorized into the six components of the EHBM: susceptibility, severity, benefits, barriers, cue to action, and self-efficacy. CONCLUSION: In the case of HH, siblings' perceptions of HH are varied and include a range of motivators and barriers that may impact family-based detection. Family-based detection can often play an important part of effective public health strategies to address inherited risk of disease. Further research should examine the EHBM with other genetic conditions. PRACTICE IMPLICATIONS: This analysis using the EHBM suggests areas of importance for message development for both medical personnel and HH patients to promote diagnostic testing of at-risk siblings. |
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