Domains of Excellence: A CDC Framework for Developing High-Quality, Impact-Driven Public Health Science Publications.

CONTEXT: The Centers for Disease Control and Prevention (CDC) has a long history of using high-quality science to drive public health action that has improved the health, safety, and well-being of people in the United States and globally. To ensure scientific quality, manuscripts authored by CDC staff are required to undergo an internal review and approval process known as clearance. During 2022, CDC launched a scientific clearance transformation initiative to improve the efficiency of the clearance process while ensuring scientific quality. PROGRAM: As part of the scientific clearance transformation initiative, a group of senior scientists across CDC developed a framework called the Domains of Excellence for High-Quality Publications (DOE framework). The framework includes 7 areas ("domains") that authors can consider for developing high-quality and impactful scientific manuscripts: Clarity, Scientific Rigor, Public Health Relevance, Policy Content, Ethical Standards, Collaboration, and Health Equity. Each domain includes multiple quality elements, highlighting specific key considerations within. IMPLEMENTATION: CDC scientists are expected to use the DOE framework when conceptualizing, developing, revising, and reviewing scientific products to support collaboration and to ensure the quality and impact of their scientific manuscripts. DISCUSSION: The DOE framework sets expectations for a consistent standard for scientific manuscripts across CDC and promotes collaboration among authors, partners, and other subject matter experts. Many aspects have broad applicability to the public health field at large and might be relevant for others developing high-quality manuscripts in public health science. The framework can serve as a useful reference document for CDC authors and others in the public health community as they prepare scientific manuscripts for publication and dissemination.

Preventing Falls Among Older Adults in Primary Care: A Mixed Methods Process Evaluation Using the RE-AIM Framework.

BACKGROUND AND OBJECTIVES: Falls are a leading cause of injuries and injury deaths for older adults. The Centers for Disease Control and Prevention's Stopping Elderly Accidents Deaths and Injuries (STEADI) initiative, a multifactorial approach to fall prevention, was adapted for implementation within the primary care setting of a health system in upstate New York. The purpose of this article is to: (a) report process evaluation results for this implementation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and (b) examine the utility of RE-AIM for assessing barriers and facilitators. RESEARCH DESIGN AND METHODS: This evaluation used mixed methods. Qualitative evaluation involved semistructured interviews with key stakeholders and intercept interviews with health care providers and clinic staff. Quantitative methods utilized surveys with clinic staff. Process evaluation tools were developed based on the AIM dimensions of the RE-AIM framework. The study was conducted over a 2-month period, approximately 18 months postimplementation, and complements previously published results of the program's reach and effectiveness. RESULTS: Primary barriers by RE-AIM construct included competing organizational priorities (Adoption), competing patient care demands (Implementation), and staff turnover (Maintenance). Primary facilitators included having a physician champion (Adoption), preparing and training staff (Implementation), and communicating about STEADI and recognizing accomplishments (Maintenance). DISCUSSION AND IMPLICATIONS: Results revealed a high degree of concordance between qualitative and quantitative analyses. The framework supported assessments of various stakeholders, multiple organizational levels, and the sequence of practice change activities. Mixed methods yielded rich data to inform future implementations of STEADI-based fall prevention.

Trends in pharmacy-based dispensing of buprenorphine, extended-release naltrexone, and naloxone during the COVID-19 pandemic by age and sex - United States, March 2019 - December 2020.

BACKGROUND: COVID-19 stay-at-home orders may reduce access to substance use treatment and naloxone, an opioid overdose reversal drug. The objective of this analysis was to compare monthly trends in pharmacy-based dispensing rates of medications for opioid use disorder (MOUD) (buprenorphine and extended-release [ER] naltrexone) and naloxone in the United States during March 2019-December 2020 by age and sex. METHODS: We calculated monthly prescription dispensing rates per 100,000 persons using IQVIA New to Brand. We used Joinpoint regression to calculate monthly percent change in dispensing rates and Wilcoxon Rank Sum tests to examine differences in median monthly rates overall, and by age and sex between March 2019-December 2019 and March 2020-December 2020. RESULTS: Buprenorphine dispensing increased among those aged 40-64 years and ≥ 65 years from March 2019 to December 2020. Median rates of total ER naltrexone dispensing were lower in March 2020-December 2020 compared to March 2019-December 2019 for the total population, and for females and males. From March 2019 to December 2020, ER naltrexone dispensing decreased and naloxone dispensing increased for those aged 20-39 years. CONCLUSIONS: Dispensing ER naltrexone declined during the study period. Given the increase in substance use during the COVID-19 pandemic, maintaining equivalent access to MOUD may not be adequate to accommodate rising numbers of new patients with opioid use disorder. Access to all MOUD and naloxone could be further expanded to meet potential needs during and after the public health emergency, given their importance in preventing opioid overdose-related harms.

Drowning in Uganda: examining data from administrative sources.

BACKGROUND: Drowning death rates in the African region are estimated to be the highest in the world. Data collection and surveillance for drowning in African countries are limited. We aimed to establish the availability of drowning data in multiple existing administrative data sources in Uganda and to describe the characteristics of drowning based on available data. METHODS: We conducted a retrospective descriptive study in 60 districts in Uganda using existing administrative records on drowning cases from January 2016 to June 2018 in district police offices, marine police detachments, fire/rescue brigade detachments, and the largest mortuary in those districts. Data were systematically deduplicated to determine and quantify unique drowning cases. RESULTS: A total of 1435 fatal and non-fatal drowning cases were recorded; 1009 (70%) in lakeside districts and 426 (30%) in non-lakeside districts. Of 1292 fatal cases, 1041 (81%) were identified in only one source. After deduplication, 1283 (89% of recorded cases; 1160 fatal, 123 non-fatal) unique drowning cases remained. Data completeness varied by source and variable. When demographic characteristics were known, fatal victims were predominantly male (n=876, 85%), and the average age was 24 years. In lakeside districts, 81% of fatal cases with a known activity at the time of drowning involved boating. CONCLUSION: Drowning cases are recorded in administrative sources in Uganda; however, opportunities to improve data coverage and completeness exist. An improved understanding of circumstances of drowning in both lakeside and non-lakeside districts in Uganda is required to plan drowning prevention strategies.

The evolution of the overdose epidemic and CDC's research response: a commentary.

The United States drug overdose epidemic has reached an all-time high, with 2020 provisional mortality data indicating that over 90,000 lives were lost to drug overdose in the 12-months ending in December 2020. The overdose epidemic has evolved over time with respect to the substances involved in overdose deaths and also with respect to the geographic distribution and epidemiology of deaths involving specific substances. Thus, a nimble approach to addressing the epidemic and preventing future overdoses is needed. CDC's response to the overdose epidemic supports implementation efforts at the state and local levels, where partners can better detect and respond to the evolving drug overdose landscape and implement prevention measures that meet their needs. CDC's framework for responding to the overdose epidemic focuses on five areas: (1) conducting surveillance and research; (2) building state, local and tribal capacity; (3) supporting providers, health systems and payers; (4) partnering with public safety; and (5) empowering consumers to make safe choices. Central to informing the implementation of evidence-based strategies to prevent drug overdose is rigorous research that undergirds the evidence. This Commentary describes recent investments in overdose prevention research and outlines opportunities for ensuring that future research efforts allow for the flexibility necessary to effectively respond to the continually evolving epidemic.

Disaggregating Data to Measure Racial Disparities in COVID-19 Outcomes and Guide Community Response - Hawaii, March 1, 2020-February 28, 2021.

Native Hawaiian and Pacific Islander populations have been disproportionately affected by COVID-19 (1-3). Native Hawaiian, Pacific Islander, and Asian populations vary in language; cultural practices; and social, economic, and environmental experiences,† which can affect health outcomes (4).§ However, data from these populations are often aggregated in analyses. Although data aggregation is often used as an approach to increase sample size and statistical power when analyzing data from smaller population groups, it can limit the understanding of disparities among diverse Native Hawaiian, Pacific Islander, and Asian subpopulations¶ (4-7). To assess disparities in COVID-19 outcomes among Native Hawaiian, Pacific Islander, and Asian populations, a disaggregated, descriptive analysis, informed by recommendations from these communities,** was performed using race data from 21,005 COVID-19 cases and 449 COVID-19-associated deaths reported to the Hawaii State Department of Health (HDOH) during March 1, 2020-February 28, 2021.†† In Hawaii, COVID-19 incidence and mortality rates per 100,000 population were 1,477 and 32, respectively during this period. In analyses with race categories that were not mutually exclusive, including persons of one race alone or in combination with one or more races, Pacific Islander persons, who account for 5% of Hawaii's population, represented 22% of COVID-19 cases and deaths (COVID-19 incidence of 7,070 and mortality rate of 150). Native Hawaiian persons experienced an incidence of 1,181 and a mortality rate of 15. Among subcategories of Asian populations, the highest incidences were experienced by Filipino persons (1,247) and Vietnamese persons (1,200). Disaggregating Native Hawaiian, Pacific Islander, and Asian race data can aid in identifying racial disparities among specific subpopulations and highlights the importance of partnering with communities to develop culturally responsive outreach teams§§ and tailored public health interventions and vaccination campaigns to more effectively address health disparities.

Racial and Ethnic Disparities in Incidence of SARS-CoV-2 Infection, 22 US States and DC, January 1-October 1, 2020.

We examined disparities in cumulative incidence of severe acute respiratory syndrome coronavirus 2 by race/ethnicity, age, and sex in the United States during January 1-October 1, 2020. Hispanic/Latino and non-Hispanic Black, American Indian/Alaskan Native, and Native Hawaiian/other Pacific Islander persons had a substantially higher incidence of infection than non-Hispanic White persons.

Racial and Ethnic Disparities in COVID-19 Incidence by Age, Sex, and Period Among Persons Aged <25 Years - 16 U.S. Jurisdictions, January 1-December 31, 2020.

The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups in the United States. Whereas racial and ethnic disparities in severe COVID-19-associated outcomes, including mortality, have been documented (1-3), less is known about population-based disparities in infection with SARS-CoV-2, the virus that causes COVID-19. In addition, although persons aged <30 years account for approximately one third of reported infections,§ there is limited information on racial and ethnic disparities in infection among young persons over time and by sex and age. Based on 689,672 U.S. COVID-19 cases reported to CDC's case-based surveillance system by jurisdictional health departments, racial and ethnic disparities in COVID-19 incidence among persons aged <25 years in 16 U.S. jurisdictions¶ were described by age group and sex and across three periods during January 1-December 31, 2020. During January-April, COVID-19 incidence was substantially higher among most racial and ethnic minority groups compared with that among non-Hispanic White (White) persons (rate ratio [RR] range = 1.09-4.62). During May-August, the RR increased from 2.49 to 4.57 among non-Hispanic Native Hawaiian and Pacific Islander (NH/PI) persons but decreased among other racial and ethnic minority groups (RR range = 0.52-2.82). Decreases in disparities were observed during September-December (RR range = 0.37-1.69); these decreases were largely because of a greater increase in incidence among White persons, rather than a decline in incidence among racial and ethnic minority groups. NH/PI, non-Hispanic American Indian or Alaska Native (AI/AN), and Hispanic or Latino (Hispanic) persons experienced the largest persistent disparities over the entire period. Ensuring equitable and timely access to preventive measures, including testing, safe work and education settings, and vaccination when eligible is important to address racial/ethnic disparities.

Race/Ethnicity, Underlying Medical Conditions, Homelessness, and Hospitalization Status of Adult Patients with COVID-19 at an Urban Safety-Net Medical Center - Boston, Massachusetts, 2020.

As of July 5, 2020, approximately 2.8 million coronavirus disease 2019 (COVID-19) cases and 130,000 COVID-19-associated deaths had been reported in the United States (1). Populations historically affected by health disparities, including certain racial and ethnic minority populations, have been disproportionally affected by and hospitalized with COVID-19 (2-4). Data also suggest a higher prevalence of infection with SARS-CoV-2, the virus that causes COVID-19, among persons experiencing homelessness (5). Safety-net hospitals,† such as Boston Medical Center (BMC), which provide health care to persons regardless of their insurance status or ability to pay, treat higher proportions of these populations and might experience challenges during the COVID-19 pandemic. This report describes the characteristics and clinical outcomes of adult patients with laboratory-confirmed COVID-19 treated at BMC during March 1-May 18, 2020. During this time, 2,729 patients with SARS-CoV-2 infection were treated at BMC and categorized into one of the following mutually exclusive clinical severity designations: exclusive outpatient management (1,543; 56.5%), non-intensive care unit (ICU) hospitalization (900; 33.0%), ICU hospitalization without invasive mechanical ventilation (69; 2.5%), ICU hospitalization with mechanical ventilation (119; 4.4%), and death (98; 3.6%). The cohort comprised 44.6% non-Hispanic black (black) patients and 30.1% Hispanic or Latino (Hispanic) patients. Persons experiencing homelessness accounted for 16.4% of patients. Most patients who died were aged ≥60 years (81.6%). Clinical severity differed by age, race/ethnicity, underlying medical conditions, and homelessness. A higher proportion of Hispanic patients were hospitalized (46.5%) than were black (39.5%) or non-Hispanic white (white) (34.4%) patients, a finding most pronounced among those aged <60 years. A higher proportion of non-ICU inpatients were experiencing homelessness (24.3%), compared with homeless patients who were admitted to the ICU without mechanical ventilation (15.9%), with mechanical ventilation (15.1%), or who died (15.3%). Patient characteristics associated with illness and clinical severity, such as age, race/ethnicity, homelessness, and underlying medical conditions can inform tailored strategies that might improve outcomes and mitigate strain on the health care system from COVID-19.

Assessment of SARS-CoV-2 Infection Prevalence in Homeless Shelters - Four U.S. Cities, March 27-April 15, 2020.

In the United States, approximately 1.4 million persons access emergency shelter or transitional housing each year (1). These settings can pose risks for communicable disease spread. In late March and early April 2020, public health teams responded to clusters (two or more cases in the preceding 2 weeks) of coronavirus disease 2019 (COVID-19) in residents and staff members from five homeless shelters in Boston, Massachusetts (one shelter); San Francisco, California (one); and Seattle, Washington (three). The investigations were performed in coordination with academic partners, health care providers, and homeless service providers. Investigations included reverse transcription-polymerase chain reaction testing at commercial and public health laboratories for SARS-CoV-2, the virus that causes COVID-19, over approximately 1-2 weeks for residents and staff members at the five shelters. During the same period, the team in Seattle, Washington, also tested residents and staff members at 12 shelters where a single case in each had been identified. In Atlanta, Georgia, a team proactively tested residents and staff members at two shelters with no known COVID-19 cases in the preceding 2 weeks. In each city, the objective was to test all shelter residents and staff members at each assessed facility, irrespective of symptoms. Persons who tested positive were transported to hospitals or predesignated community isolation areas.

Implementing a Clinically Based Fall Prevention Program.

Introduction. Among people aged 65 and older, falls are the leading cause of both fatal and nonfatal injuries. The burden of falls is expected to increase as the US population ages. The Centers for Disease Control and Prevention (CDC) developed the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative to help primary care providers incorporate fall risk screening, assessment of patients' modifiable risk factors, and implementation of evidence-based treatment strategies. Methods. In 2010, CDC funded the New York State Department of Health to implement STEADI in primary care sites in selected communities. The Medical Director of United Health Services championed integrating fall prevention into clinical practice and oversaw staff training. Components of STEADI were integrated into the health system's electronic health record (EHR), and fall risk screening questions were added to the nursing staff's patient intake forms. Results. In the first 12 months, 14 practices saw 10 702 patients aged 65 and older. Of these, 8457 patients (79.0%) were screened for fall risk and 1534 (18.1%) screened positive. About 52% of positive patients completed the Timed Up and Go gait and balance assessment. Screening declined to 49% in the second 12 months, with 21% of the patients screening positive. Conclusions. Fall prevention can be successfully integrated into primary care when it is supported by a clinical champion, coupled with timely staff training/retraining, incorporated into the EHR, and adapted to fit into the practice workflow.

Severe Pulmonary Disease Associated with Electronic-Cigarette-Product Use - Interim Guidance.

On September 6, 2019, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). As of August 27, 2019, 215 possible cases of severe pulmonary disease associated with the use of electronic cigarette (e-cigarette) products (e.g., devices, liquids, refill pods, and cartridges) had been reported to CDC by 25 state health departments. E-cigarettes are devices that produce an aerosol by heating a liquid containing various chemicals, including nicotine, flavorings, and other additives (e.g., propellants, solvents, and oils). Users inhale the aerosol, including any additives, into their lungs. Aerosols produced by e-cigarettes can contain harmful or potentially harmful substances, including heavy metals such as lead, volatile organic compounds, ultrafine particles, cancer-causing chemicals, or other agents such as chemicals used for cleaning the device (1). E-cigarettes also can be used to deliver tetrahydrocannabinol (THC), the principal psychoactive component of cannabis, or other drugs; for example, "dabbing" involves superheating substances that contain high concentrations of THC and other plant compounds (e.g., cannabidiol) with the intent of inhaling the aerosol. E-cigarette users could potentially add other substances to the devices. This report summarizes available information and provides interim case definitions and guidance for reporting possible cases of severe pulmonary disease. The guidance in this report reflects data available as of September 6, 2019; guidance will be updated as additional information becomes available.

Evaluation of a hospital-based injury surveillance system for monitoring road traffic deaths in Phuket, Thailand.

Objectives: The objective of this study was to evaluate and injury surveillance (IS) system's ability to monitor road traffic deaths and the coverage of road traffic injury and death surveillance in Phuket, Thailand. Methods: U.S. Centers for Disease Control and Prevention guidelines on surveillance system evaluation were used to qualitatively and quantitatively evaluate IS. Interviews with key stakeholders focused on IS's usefulness, simplicity, flexibility, acceptability, and stability. Active case finding of 2014 road traffic deaths in all paper and electronic hospital record systems was used to assess system sensitivity, positive predictive value, and data quality. Electronic data matching software was used to determine the implications of combining IS data with other provincial-level data sources (e.g., death certificates, electronic vehicle insurance claim system). Results: Evaluation results indicated that IS was useful, flexible, acceptable, and stable, with a high positive predictive value (99%). Simplicity was limited due to the burden of collecting data on all injuries and use of paper-based data collection forms. Sensitivity was low, with IS only identifying 55% of hospital road traffic death cases identified during active case finding; however, IS cases were representative of cases identified. Data accuracy and completeness varied across data fields. Combining IS with active case finding, death certificates, and the electronic vehicle insurance claim system more than doubled the number of road traffic death cases identified in Phuket. Conclusion: An efficient and comprehensive road traffic injury and death surveillance system is critical for monitoring Phuket's road traffic burden. The hospital-based IS system is a useful system for monitoring road traffic deaths and assessing risk behaviors. However, the complexity of data collection and limited coverage hinders the ability of IS to fully represent road traffic deaths in Phuket Province. Combining data sources could improve coverage and should be considered.

Evaluation of an integrated multisector campaign to increase child helmet use in Vietnam.

OBJECTIVE: This study presents child helmet use before, during and after implementing the Vietnamese National Child Helmet Action Plan (NCHAP) and evaluates its effect on child helmet use. The NCHAP, an integrated multisector campaign, incorporated a wide-scale public awareness campaign, school-based interventions, increased police patrolling and enforcement, and capacity building and support to relevant government departments in target provinces. METHODS: In Vietnam's three largest cities, 100 schools in 20 districts were selected to monitor motorcycle helmet use behaviour. The effectiveness of the NCHAP was measured by unannounced, filmed observations of student motorcycle passengers and their adult drivers as they arrived or left their schools at four points. Baseline observations at each school were conducted in March 2014, with subsequent observations in April 2015, December 2015 and May 2016. RESULTS: Across the 84 218 observed students, student helmet prevalence increased from 36.1% in March 2014 to 69.3% immediately after the initiation in April 2015. Subsequent observations in December 2015 and May 2016 showed a reduction and stabilisation of helmet use, with 49.8% and 56.9% of students wearing helmets, respectively. Helmet use in students was higher when adult drivers were also wearing helmets. CONCLUSIONS: Integrated multisectoral interventions between governments, civil society and the corporate sector that incorporate communications, school-based education, incentives for change and police enforcement have the potential to increase helmet use among children. Future integrated campaigns may be more effective with an increased focus on parents and other adult drivers given their potential influence on child helmet use.

Implementation of the Stopping Elderly Accidents, Deaths, and Injuries Initiative in Primary Care: An Outcome Evaluation.

BACKGROUND AND OBJECTIVES: Older adult falls pose a growing burden on the U.S. health care system. The Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative was developed as a multifactorial approach to fall prevention that includes screening for fall risk, assessing for modifiable risk factors, and prescribing evidence-based interventions to reduce fall risk. The purpose of this study was to determine the impact of a STEADI initiative on medically treated falls within a large health care system in Upstate New York. RESEARCH DESIGN AND METHODS: This cohort study classified older adults who were screened for fall risk into 3 groups: (a) At-risk and no Fall Plan of Care (FPOC), (b) At-risk with a FPOC, and (c) Not-at-risk. Poisson regression examined the group's effect on medically treated falls when controlling for other variables. The sample consisted of 12,346 adults age 65 or older who had a primary care visit at one of 14 outpatient clinics between September 11, 2012, and October 30, 2015. A medically treated fall was defined as a fall-related treat-and-release emergency department visit or hospitalization. RESULTS: Older adults at risk for fall with a FPOC were 0.6 times less likely to have a fall-related hospitalization than those without a FPOC (p = .041), and their postintervention odds were similar to those who were not at risk. DISCUSSION AND IMPLICATIONS: This study demonstrated that implementation of STEADI fall risk screening and prevention strategies among older adults in the primary care setting can reduce fall-related hospitalizations and may lower associated health care expenditures.

Primary care providers' discussion of fall prevention approaches with their older adult patients-DocStyles, 2014.

Falls are the leading cause of fatal and non-fatal injuries among older adults. The American and British Geriatric Societies recommend a fall risk assessment to identify risk factors and guide interventions to prevent these falls. This study describes the self-reported discussion of fall prevention approaches used by primary care providers (PCPs)-family practitioners, internists and nurse practitioners-who treat older adults. Results are described overall and by PCP type. We analyzed a sample of 1210 U.S. PCPs who participated in the 2014 DocStyles survey. PCPs reported on their recommendation of fall prevention approaches including general exercise, Tai Chi, medication adjustments, home safety modifications, vitamin D supplements, assistive devices, alarm systems, and referral to physical therapy, foot specialist, or vision specialist. Frequencies and adjusted odds ratios for fall prevention approaches were assessed by provider and practice characteristics. Self-reported discussion of any fall prevention approaches was 89.3%. Controlling for provider and practice characteristics, there were significant differences for some approaches by provider type. Family practitioners were more likely to suggest home modification [adjusted Odds Ratio: 1.8 (1.3-2.4)], exercise [aOR: 2.0 (1.5-2.5)], and Tai Chi [aOR: 1.5 (1.0-2.2)] than internists. Nurse practitioners were more likely to suggest home modification [aOR: 2.1 (1.3-3.4)] and less likely to suggest vitamin D [aOR: 0.6 (0.4-1.0)] than internists. Fall prevention suggestions vary by type of PCP. Dissemination of geriatric guidelines should include all PCPs who routinely see older adults.

A Comprehensive Approach to Motorcycle-Related Head Injury Prevention: Experiences from the Field in Vietnam, Cambodia, and Uganda.

Motorcyclists account for 23% of global road traffic deaths and over half of fatalities in countries where motorcycles are the dominant means of transport. Wearing a helmet can reduce the risk of head injury by as much as 69% and death by 42%; however, both child and adult helmet use are low in many countries where motorcycles are a primary mode of transportation. In response to the need to increase helmet use by all drivers and their passengers, the Global Helmet Vaccine Initiative (GHVI) was established to increase helmet use in three countries where a substantial portion of road users are motorcyclists and where helmet use is low. The GHVI approach includes five strategies to increase helmet use: targeted programs, helmet access, public awareness, institutional policies, and monitoring and evaluation. The application of GHVI to Vietnam, Cambodia, and Uganda resulted in four key lessons learned. First, motorcyclists are more likely to wear helmets when helmet use is mandated and enforced. Second, programs targeted to at-risk motorcyclists, such as child passengers, combined with improved awareness among the broader population, can result in greater public support needed to encourage action by decision-makers. Third, for broad population-level change, using multiple strategies in tandem can be more effective than using a single strategy alone. Lastly, the successful expansion of GHVI into Cambodia and Uganda has been hindered by the lack of helmet accessibility and affordability, a core component contributing to its success in Vietnam. This paper will review the development of the GHVI five-pillar approach in Vietnam, subsequent efforts to implement the model in Cambodia and Uganda, and lessons learned from these applications to protect motorcycle drivers and their adult and child passengers from injury.

Lessons Learned From Implementing CDC's STEADI Falls Prevention Algorithm in Primary Care.

BACKGROUND: Falls lead to a disproportionate burden of death and disability among older adults despite evidence-based recommendations to screen regularly for fall risk and clinical trials demonstrating the effectiveness of multifactorial interventions to reduce falls. The Centers for Disease Control and Prevention developed STEADI (Stopping Elderly Accidents, Deaths, and Injuries) to assist primary care teams to screen for fall risk and reduce risk of falling in older adults. PURPOSE OF THE STUDY: This paper describes a practical application of STEADI in a large academic internal medicine clinic utilizing the Kotter framework, a tool used to guide clinical practice change. DESIGN AND METHODS: We describe key steps and decision points in the implementation of STEADI as they relate to the recommended strategies of the Kotter framework. Strategies include: creating a sense of urgency, building a guiding coalition, forming a strategic vision and initiative, enlisting volunteers, enabling success by removing barriers, generating short-term wins, sustaining change, and instituting change. RESULTS: Fifty-six patients were screened during pilot testing; 360 patients were screened during the first 3 months of implementation. Key to successful implementation was (a) the development of electronic health record (EHR) tools and workflow to guide clinical practice and (b) the proactive leadership of clinical champions within the practice to identify and respond to barriers. IMPLICATIONS: Implementing falls prevention in a clinical setting required support and effort across multiple stakeholders. We highlight challenges, successes, and lessons learned that offer guidance for other clinical practices in their falls prevention efforts.

Implementing STEADI in Academic Primary Care to Address Older Adult Fall Risk.

BACKGROUND AND OBJECTIVES: Falls are the leading cause of injury-related deaths in older adults. Objectives include describing implementation of the Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative to help primary care providers (PCPs) identify and manage fall risk, and comparing a 12-item and a 3-item fall screening questionnaire. DESIGN AND METHODS: We systematically incorporated STEADI into routine patient care via team training, electronic health record tools, and tailored clinic workflow. A retrospective chart review of patients aged 65 and older who received STEADI measured fall screening rates, provider compliance with STEADI (high-risk patients), results from the 12-item questionnaire (Stay Independent), and comparison with a 3-item subset of this questionnaire (three key questions). RESULTS: Eighteen of 24 providers (75%) participated, screening 773 (64%) patients over 6 months; 170 (22%) were high-risk. Of these, 109 (64%) received STEADI interventions (gait, vision, and feet assessment, orthostatic blood pressure measurement, vitamin D, and medication review). Providers intervened on 85% with gait impairment, 97% with orthostatic hypotension, 82% with vision impairment, 90% taking inadequate vitamin D, 75% with foot issues, and 22% on high-risk medications. Using three key questions compared to the full Stay Independent questionnaire decreased screening burden, but increased the number of high-risk patients. DISCUSSION AND IMPLICATIONS: We successfully implemented STEADI, screening two-thirds of eligible patients. Most high-risk patients received recommended assessments and interventions, except medication reduction. Falls remain a substantial public health challenge. Systematic implementation of STEADI could help clinical teams reduce older patient fall risks.

Helmets for Kids: evaluation of a school-based helmet intervention in Cambodia.

OBJECTIVE: This paper analyses helmet use before and after implementing Helmets for Kids, a school-based helmet distribution and road safety programme in Cambodia. METHODS: Nine intervention schools (with a total of 6721 students) and four control schools (with a total of 3031 students) were selected using purposive sampling to target schools where students were at high risk of road traffic injury. Eligible schools included those where at least 50% of students commute to school on bicycles or motorcycles, were located on a national road (high traffic density), had few or no street signs nearby, were located in an area with a history of crash injuries and were in a province where other Cambodia Helmet Vaccine Initiative activities occur. Programme's effectiveness at each school was measured through preintervention and postintervention roadside helmet observations of students as they arrived or left school. Research assistants conducted observations 1-2 weeks preintervention, 1-2 weeks postintervention, 10-12 weeks postintervention and at the end of the school year (3-4 months postintervention). RESULTS: In intervention schools, observed student helmet use increased from an average of 0.46% at 1-2 weeks preintervention to an average of 87.9% at 1-2 weeks postintervention, 83.5% at 10-12 weeks postintervention and 86.5% at 3-4 months postintervention, coinciding with the end of the school year. Increased helmet use was observed in children commuting on bicycle or motorcycle, which showed similar patterns of helmet use. Helmet use remained between 0.35% and 0.70% in control schools throughout the study period. CONCLUSIONS: School-based helmet use programmes that combine helmet provision and road safety education might increase helmet use among children.