Development of the Community Health Improvement Navigator Database of Interventions.

With the passage of the Patient Protection and Affordable Care Act, the requirements for hospitals to achieve tax-exempt status include performing a triennial community health needs assessment and developing a plan to address identified needs. To address community health needs, multisector collaborative efforts to improve both health care and non-health care determinants of health outcomes have been the most effective and sustainable. In 2015, CDC released the Community Health Improvement Navigator to facilitate the development of these efforts. This report describes the development of the database of interventions included in the Community Health Improvement Navigator. The database of interventions allows the user to easily search for multisector, collaborative, evidence-based interventions to address the underlying causes of the greatest morbidity and mortality in the United States: tobacco use and exposure, physical inactivity, unhealthy diet, high cholesterol, high blood pressure, diabetes, and obesity.

Text4baby: development and implementation of a national text messaging health information service.

Text4baby is the first free national health text messaging service in the United States that aims to provide timely information to pregnant women and new mothers to help them improve their health and the health of their babies. Here we describe the development of the text messages and the large public-private partnership that led to the national launch of the service in 2010. Promotion at the local, state, and national levels produced rapid uptake across the United States. More than 320,000 people enrolled with text4baby between February 2010 and March 2012. Further evaluations of the effectiveness of the service are ongoing; however, important lessons can be learned from its development and uptake.

Food supply and seawater pCO2 impact calcification and internal shell dissolution in the blue mussel Mytilus edulis.

Progressive ocean acidification due to anthropogenic CO(2) emissions will alter marine ecosystem processes. Calcifying organisms might be particularly vulnerable to these alterations in the speciation of the marine carbonate system. While previous research efforts have mainly focused on external dissolution of shells in seawater under saturated with respect to calcium carbonate, the internal shell interface might be more vulnerable to acidification. In the case of the blue mussel Mytilus edulis, high body fluid pCO(2) causes low pH and low carbonate concentrations in the extrapallial fluid, which is in direct contact with the inner shell surface. In order to test whether elevated seawater pCO(2) impacts calcification and inner shell surface integrity we exposed Baltic M. edulis to four different seawater pCO(2) (39, 142, 240, 405 Pa) and two food algae (310-350 cells mL(-1) vs. 1600-2000 cells mL(-1)) concentrations for a period of seven weeks during winter (5°C). We found that low food algae concentrations and high pCO(2) values each significantly decreased shell length growth. Internal shell surface corrosion of nacreous ( = aragonite) layers was documented via stereomicroscopy and SEM at the two highest pCO(2) treatments in the high food group, while it was found in all treatments in the low food group. Both factors, food and pCO(2), significantly influenced the magnitude of inner shell surface dissolution. Our findings illustrate for the first time that integrity of inner shell surfaces is tightly coupled to the animals' energy budget under conditions of CO(2) stress. It is likely that under food limited conditions, energy is allocated to more vital processes (e.g. somatic mass maintenance) instead of shell conservation. It is evident from our results that mussels exert significant biological control over the structural integrity of their inner shell surfaces.

Effect of the frequency of delivery of reminders and an influenza tool kit on increasing influenza vaccination rates among adults with high-risk conditions.

OBJECTIVE: To evaluate the incremental effect of a second client reminder postcard or an influenza tool kit targeted toward employers on increasing influenza vaccination rates among adults age < 65 years at high risk for complications from influenza illness. METHODS: In this demonstration study, enrollees of 3 managed care organizations (n = 8881) were randomized at the employer level into 4 arms: 1 postcard, 2 postcards, 1 postcard + tool kit, and 2 postcards + tool kit. The postcards and tool kits were mailed during the fall of 2001, and their effect on influenza vaccination rates was assessed through a survey. RESULTS: Compared with a single postcard, 2 postcards increased vaccination rates by 4 percentage points (adjusted relative risk = 1.05; P < .05) among persons aged 50 to 64 years but did not have any effect among younger adults. Older adults had a greater burden of disease and reported more favorable knowledge and attitudes toward the influenza vaccine. The influenza tool kit did not appear to have any incremental effect on vaccination rates. CONCLUSIONS: Our findings underscore the necessity of evaluating the effectiveness of interventions in different population subgroups and of identifying factors that modify the effectiveness of interventions. Rigorous assessment of intervention effectiveness in managed care settings will enable decision makers to optimize use of scarce healthcare dollars for improving the health and well-being of enrollees.