Occurrence of 3 Bordetella species during an outbreak of cough illness in Ohio: epidemiology, clinical features, laboratory findings and antimicrobial susceptibility.

BACKGROUND: An increase in laboratory diagnosis of pertussis was noted in central Ohio during 2010. Diagnosis was made using a polymerase chain reaction assay targeting the multicopy insertion sequence IS481, which is found in both Bordetella pertussis (Bp) and Bordetella holmesii (Bh). An increase in specimens testing positive for Bordetella parapertussis (Bpp) using insertion sequence IS1001 was also noted. METHODS: Nasopharyngeal swab specimens submitted April 1, 2010, to March 31, 2011, were tested using a multiplex polymerase chain reaction assay for Bp/Bh (IS481) and Bpp followed by singleplex assays for Bp and Bh. A subgroup of specimens was also cultured for Bordetella species, and antimicrobial susceptibility testing was performed on recovered organisms. Demographic and clinical features were compared for patients with Bp, Bh and Bpp. RESULTS: Of 520 IS481-positive specimens, 214 (41.1%) were positive for Bp, 79 (15.2%) were positive for Bh and 5 (1.0%) were positive for both Bp and Bh; 222 (42.7%) were negative for both targets. An additional 220 specimens were positive for Bpp. Among a sample of 155 IS481-positive specimens, 40, 15 and 0 were culture positive for Bp, Bh and Bpp, respectively. Among a sample of 55 BparaIS1001-positive (Bpp) specimens, 22, 0 and 0 were culture positive for Bpp, Bp and Bh, respectively. All Bordetella species were susceptible to macrolide antibiotics. Patients with Bh were older than patients with Bp, who were older than those positive for Bpp (mean ages: 12.0, 8.0 and 4.2 years, respectively; P < 0.001). One or more classic signs of pertussis (ie, paroxysmal cough, whoop, post-tussive emesis) were seen in 55.9% of 263 patients (59 Bp, 24 Bh, 80 Bpp and 100 negative for Bordetella species), but did not differ statistically among the groups (χ = 5.1, P = 0.17). CONCLUSIONS: All 3 Bordetella species, Bp, Bh and Bpp, were detected during on outbreak of pertussis-like cough illness. There were noted differences in age and seasonality, but clinical features at the time of presentation did not allow clear differentiation of these infections. All Bordetella species recovered from culture and tested were susceptible in vitro to macrolide antibiotics. Additional study is necessary to further characterize epidemiologic and clinical characteristics of Bh-associated cough illness and to determine potential co-occurrence of Bordetella species with other bacterial and viral respiratory tract pathogens.

Results of a transtheoretical model-based alcohol, tobacco and other drug intervention in middle schools.

BACKGROUND: Early use of alcohol, tobacco, and other drugs threatens the physical and mental well-being of students and continued use negatively affects many areas of development. An internet-based, tailored intervention based on the Transtheoretical Model of Behavior Change was delivered to middle school students to reduce alcohol, tobacco, and other drug use. This internet-based approach requires very little faculty and staff time, which is efficient given curricular demands. METHODS: Twenty-two middle schools in the United States were matched and randomly assigned to either the intervention or control conditions (N=1590 students who had ever used substances). Participants received one pre-test assessment, three thirty-minute intervention sessions over three months, and two post-test assessments (3 and 14 months after pre-test, respectively). RESULTS: Random effects logistic models showed significant treatment effects for the intervention group when compared to the control group at the 3-month post-test. CONCLUSIONS: This program has the potential to be applied as stand-alone practice or as part of more intensive interventions to promote substance use cessation.

Proactive health consumerism: an important new tool for worksite health promotion.

Consumerism in health care has taken on the form of a major innovation among employers and health plans. Yet many of our efforts to enhance the skills and attitudes that enable consumerism have met with limited success. Proactive Health Consumerism is proposed as an approach that utilizes many of the hard-won lessons from health promotion research. Along with prerequisites that create the motivation and framework for increased health consumerism, this article provides a theory-driven example of a new tool for health promotion professionals to employ when enhancing the health consumer skills of working populations. Strategies for maximization of effectiveness and integration with supporting resources are also described.

Transtheoretical model-based multiple behavior intervention for weight management: effectiveness on a population basis.

BACKGROUND: The increasing prevalence of overweight and obesity underscores the need for evidence-based, easily disseminable interventions for weight management that can be delivered on a population basis. The Transtheoretical Model (TTM) offers a promising theoretical framework for multiple behavior weight management interventions. METHODS: Overweight or obese adults (BMI 25-39.9; n=1277) were randomized to no-treatment control or home-based, stage-matched multiple behavior interventions for up to three behaviors related to weight management at 0, 3, 6, and 9 months. All participants were re-assessed at 6, 12, and 24 months. RESULTS: Significant treatment effects were found for healthy eating (47.5% versus 34.3%), exercise (44.90% versus 38.10%), managing emotional distress (49.7% versus 30.30%), and untreated fruit and vegetable intake (48.5% versus 39.0%) progressing to Action/Maintenance at 24 months. The groups differed on weight lost at 24 months. Co-variation of behavior change occurred and was much more pronounced in the treatment group, where individuals progressing to Action/Maintenance for a single behavior were 2.5-5 times more likely to make progress on another behavior. The impact of the multiple behavior intervention was more than three times that of single behavior interventions. CONCLUSIONS: This study demonstrates the ability of TTM-based tailored feedback to improve healthy eating, exercise, managing emotional distress, and weight on a population basis. The treatment produced a high level of population impact that future multiple behavior interventions can seek to surpass.

Stage of change for making an informed decision about Medicare health plans.

OBJECTIVE: To assess the applicability of the transtheoretical model of change (TTM) to informed choice in the Medicare population. DATA SOURCES/STUDY SETTING: Two hundred and thirty-nine new Medicare enrollees randomly selected from the Center for Medicare and Medicaid Services' October 2001 Initial Enrollee File, a repository of data for persons who are going to turn 65 and become entitled to enroll in Medicare in the next 3 months. STUDY DESIGN: Study participants completed TTM measures of stage of change, decisional balance, and self-efficacy for informed choice, as well as measures of Medicare knowledge, perceived knowledge, and information seeking. Model testing was conducted to determine whether well-established relationships between stage of change, decisional balance, and self-efficacy replicate for informed choice in the Medicare population, and whether Medicare knowledge and information-seeking increase across the stages. DATA COLLECTION/EXTRACTION METHODS: Survey data were collected using mail surveys with telephone follow-up for nonresponders. PRINCIPAL FINDINGS: Predicted relationships were established between stage of change for informed choice and decisional balance, self-efficacy, Medicare knowledge, and information seeking. The amount of variance accounted for by stage of change for informed choice was larger than that found for smoking cessation, where the TTM has had its greatest successes. CONCLUSIONS: The methods and findings lay the groundwork for development of TTM-based interventions for Medicare beneficiaries, and provide a prototype for the application of the TTM to informed decision making among other types of consumers who are being asked to take more responsibility for their health care.

Prevention profiles: Understanding youth who do not use substances.

This study replicates innovative profiles of prevention among students not using substances but who may be at different risks for acquisition. Using the Transtheoretical Model constructs of Decisional Balance and Temptations, cluster analyses were performed on four independent samples of students (n=1240) in the USA, England and Israel. For each sample, the same four distinct profiles emerged. ANOVAs indicated that the processes of prevention varied significantly across these profiles. The prevention profiles were extended to youth in Elementary, Middle, and High Schools and from a focus on single substances to multiple substances, including alcohol, tobacco, and illicit drugs. Implications for developing prevention programs are also discussed.

Randomized trial of stage-based interventions for informed Medicare choices.

A randomized trial involving 1,351 new Medicare enrollees was conducted to assess the efficacy of a transtheoretical model (TTM) based manual and multimedia expert system program that delivered guidance and feedback matched to individual stage of readiness to compare Medicare health plans. At 6 months post-intervention, compared to enrollees in the control group, those receiving the manual plus expert system intervention or the manual alone exhibited greater increases in Medicare knowledge. The TTM-based interventions also increased use of and satisfaction with traditional Medicare education materials among most enrollees. The interventions' impact on stage of change for comparing plans was observed only among treatment group participants who had examined and evaluated the materials. The challenges to increasing informed choice and possible dissemination channels for stage-based materials are discussed.

Online health behavior and disease management programs: are we ready for them? Are they ready for us?

Advancing the science and practice of health promotion and disease management on the Internet requires a systematic program of research examining the population impact of such programs. With impact described as the combination of effectiveness and participation, such research needs to include the examination of the quality and effectiveness of programs that are available to the general public, as well as descriptive and predictive knowledge about population readiness to participate in such programs. There have been few studies examining the quality of interactive health behavior change (HBC) programs on the Internet, and even fewer investigations of the effectiveness of such programs. Based on the review of over 300 HBC programs on the Internet using the "5 A's" of Health Behavior Change on the Internet (HBC-I Screener), which represent standard minimum guidelines for evaluation, it appears HBC on the Internet is in the early stages of development. As health behavior change on the Internet matures from the provision of health information to meeting the requirements necessary to produce health behavior change, and as program developers take advantage of the interactive nature of the Internet, the basic screening and expanded evaluation criteria developed in this project will provide templates for both consumers and developers of programs. The second component necessary for evaluating the impact of HBC on the Internet is the extent to which the population is ready to participate in such programs. We need to move beyond a narrow focus on early adopters and produce a population perspective that includes those not ready, those getting ready, and those ready to use such programs, as well as those already participating. By understanding participation levels of such programs, and what drives this participation, the development and dissemination of practical tailored and targeted interventions can help maximize population participation in Internet programs for health behavior change.

Assessing stage of change and informed decision making for Internet participation in health promotion and disease management.

The Internet is a potentially powerful source of low- or no-cost programs through which individuals can be guided in changing their behavior to improve health. Using the Transtheoretical Model and survey methodology, the authors sought to produce reliable and valid instruments for assessing "stage of change" and "informed decision making," and to generate cross-sectional and longitudinal stage-of-change data for a sample of Internet users, as they apply to Internet use for health promotion and disease management. They found that only 24.7% of their sample used the Internet for these purposes and concluded that considerably more research will be needed to determine how to help significant percentages of populations to progress toward enhancing their health through the Internet.

Development of review criteria to evaluate health behavior change websites.

A growing number of major health care organizations, such as the American Heart Association and the Mayo Clinic, are investing considerable resources in developing and marketing Internet-based programs for health promotion and disease management. These programs have the potential to provide some of the best-tailored interventions in behavior change science at relatively low costs. This report discusses review criteria developed in order to conduct a systematic evaluation of Internet programs for preventive behaviors (alcohol, diet, exercise and smoking) and disease management (pediatric asthma, depression and diabetes.) These criteria can be used to develop and evaluate the quality of health promotion programs on the Internet.

Strengths and weaknesses of health behavior change programs on the internet.

Full reviews were conducted on 37 public websites on health behavior change for disease prevention and management. All had at least four of five of the `5A's for effective health behavior change treatment on the Internet' (advise, assess, assist, anticipatory guidance and arrange follow-up) that are assumed to be minimum criteria for a program to have the potential for producing behavior change. The strength of these 37 programs included: rationales provided for assessments; privacy and confidentiality protections; some form of feedback provided; and some form of interactivity. The weaknesses included: few were theory driven; few had individualized tailoring; few had empirically based tailoring; and few were evidence based or reported subsequent plans for evaluation.