www.mobilehealthmap.org 617‐442‐3200 New research shows that mobile health clinics improve health outcomes for hard to reach populations in cost‐effective and culturally competent ways . A Harvard Medical School study determined that for every dollar invested in a mobile health clinic, the US healthcare system saves $30 on average. Mobile health clinics, which offer a range of services from preventive screenings to asthma treatment, leverage their mobility to treat people in the convenience of their own communities. For example, a mobile health clinic in Baltimore, MD, has documented savings of $3,500 per child seen due to reduced asthma‐related hospitalizations. The estimated 2,000 mobile health clinics across the country are providing similarly cost‐effective access to healthcare for a wide range of populations. Many successful mobile health clinics cite their ability to foster trusting relationships. Qualitative research in such mobile health clinics has found that patients value the informal, familiar environment in a convenient location, with staff who “are easy to talk to,” and that the staff’s “marriage of professional and personal discourses” provides patients the space to disclose information themselves. A communications academic argued that mobile health clinics’ unique use of space is important in facilitating these relationships. Mobile health clinics park in the heart of the community in familiar spaces, like shopping centers or bus stations, which lend themselves to the local community atmosphere.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

Christensen, R. (2002), Plane Answers to Complex Questions: The Theory of Linear Models (3rd ed.), New York: Springer-Verlag. Crocker, D. C. (1980), Review of Linear Regression Analysis, by G. A. F. Seber, Technometrics, 22, 130. Datta, B. N. (1995), Numerical Linear Algebra and Applications, Paci c Grove, CA: Brooks/Cole. Draper, N. R. (2002), “Applied Regression Analysis Bibliography Update 2000–2001,” Communications in Statistics: Theory and Methods, 2051– 2075. Golub, G. H., and Van Loan, C. F. (1996), Matrix Computations (3rd ed.), Baltimore, MD: Johns Hopkins University Press. Graybill, F. A. (2000), Theory and Application of the Linear Model, Paci c Grove, CA: Brooks/Cole. Hocking, R. R. (2003), Methods and Applications of Linear Models: Regression and the Analysis of Variance (2nd ed.), New York: Wiley. Porat, B. (1993), Digital Processing of Random Signals, Englewood Cliffs, NJ: Prentice-Hall. Ravishanker, N., and Dey, D. K. (2002), A First Course in Linear Model Theory, Boca Raton, FL: Chapman and Hall/CRC. White, H. (1984), Asymptotic Theory for Econometricians, Orlando, FL: Academic Press.

Generalized Estimating Equations

Objective This review evaluates the effectiveness of quality improvement (QI) strategies in reducing disparities in health and health care. Data sources We identified papers published in English between 1983 and 2011 from the MEDLINE® database, the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science Social Science Index, and PsycINFO. Review methods All abstracts and full-text articles were dually reviewed. Studies were eligible if they reported data on effectiveness of QI interventions on processes or health outcomes in the United States such that the impact on a health disparity could be measured. The review focused on the following clinical conditions: breast cancer, colorectal cancer, diabetes, heart failure, hypertension, coronary artery disease, asthma, major depressive disorder, cystic fibrosis, pneumonia, pregnancy, and end-stage renal disease. It assessed health disparities associated with race or ethnicity, socioeconomic status, insurance status, sexual orientation, health literacy/numeracy, and language barrier. We evaluated the risk of bias of individual studies and the overall strength of the body of evidence based on risk of bias, consistency, directness, and precision. Results Nineteen papers, representing 14 primary research studies, met criteria for inclusion. All but one of the studies incorporated multiple components into their QI approach. Patient education was part of most interventions (12 of 14), although the specific approach differed substantially across the studies. Ten of the studies incorporated self-management; this would include, for example, teaching individuals with diabetes to check their blood sugar regularly. Most (8 of 14) included some sort of provider education, which may have focused on the clinical issue or on raising awareness about disparities affecting the target population. Studies evaluated the effect of these strategies on disparities in the prevention or treatment of breast or colorectal cancer, cardiovascular disease, depression, or diabetes. Overall, QI interventions were not shown to reduce disparities. Most studies have focused on racial or ethnic disparities, with some targeted interventions demonstrating greater effect in racial minorities--specifically, supporting individuals in tracking their blood pressure at home to reduce blood pressure and collaborative care to improve depression care. In one study, the effect of a language-concordant breast cancer screening intervention was helpful in promoting mammography in Spanish-speaking women. For some depression care outcomes, the collaborative care model was more effective in less-educated individuals than in those with more education and in women than in men. Conclusions The literature on QI interventions generally and their ability to improve health and health care is large. Whether those interventions are effective at reducing disparities remains unclear. This report should not be construed to assess the general effectiveness of QI in the health care setting; rather, QI has not been shown specifically to reduce known disparities in health care or health outcomes. In a few instances, some increased effect is seen in disadvantaged populations; these studies should be replicated and the interventions studied further as having potential to address disparities.

Closing the quality gap: revisiting the state of the science (vol. 3: quality improvement interventions to address health disparities).

Despite evident heightened adolescent risk-taking in real-life situations, not all experimental studies demonstrate that adolescents take more risks than children and adults on risky decision-making tasks. In the current 4 independent meta-analyses, neurodevelopmental imbalance models and fuzzy trace theory were used as conceptual frameworks to examine whether adolescents engage in more risk-taking than children and adults and whether early adolescents take more risks than children and mid-late adolescents on behavioral risk-taking tasks. Studies with at least 1 of the aforementioned age comparisons met the inclusion criteria. Consistent with imbalance models and fuzzy trace theory, results from a random-effects model showed that adolescents take more risks (g = .37) than adults, and early adolescents take more risks (g = .15) than mid-late adolescents. However, inconsistent with both perspectives, adolescents and children take equal levels of risk (g = -.00), and early adolescents and children also take equal levels of risk (g = .04). Meta-regression analyses revealed that, consistent with imbalance models, (a) adolescents take more risks than adults on hot tasks with immediate outcome feedback on rewards and losses; however, contrary to imbalance models but consistent with fuzzy trace theory, (b) adolescents take fewer risks than children on tasks with a sure/safe option. Shortcomings related to studies using behavioral risk-taking tasks are discussed. We suggest a hybrid developmental neuroecological model of risk-taking that includes a risk opportunity component to explain why adolescents take more risks than children in the real world but equal levels of risks as children in the laboratory.

A meta-analysis on age differences in risky decision making: Adolescents versus children and adults.

The neglected role of positive emotion in adolescent psychopathology

Article discussing the proportion of qualitative research over a 10 year period and correlates associated with its publication.

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Is qualitative research second class science? A quantitative longitudinal examination of qualitative research in medical journals.

The feasibility of a newly designed Community Diabetes Education (CoDE) intervention was evaluated in preparation for the development of a pilot study of this program. A comparison between CoDE and similar culturally appropriate diabetes management programs developed specifically for Hispanic Americans demonstrates its unique features. Patient insurance status, duration of the intervention, delivery in individual and/or group settings, the characteristics of the diabetes educator(s), the other professional resources involved in these interventions, the associated costs, and the reported health outcomes were used in the comparison. The significant improvement in hemoglobin A1c observed in patients who completed one year of CoDE suggests that a community health worker can serve as the primary patient educator in the absence of more highly educated personnel required by American Diabetes Association-certified diabetes education programs. This low-cost model can be reproduced de novo in community health centers or inserted into existing diabetes management interventions.

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Effectiveness of a Community Health Worker as Sole Diabetes Educator: Comparison of CoDE with Similar Culturally Appropriate Interventions

Relationship Between Adolescent Risk Preferences on a Laboratory Task and Behavioral Measures of Risk-Taking

Presentation for the 2014 North American Serials Interest Group (NASIG) Annual Conference on the development of the University of North Texas (UNT)'s strategy for determining cancellations.

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Planning for the Budget-ocalypse: The Evolution of a Serials/ER Cancellation Methodology

The University of North Texas (UNT) Libraries are funded almost entirely by undergraduate student use fees. As the undergraduate enrollment has plateaued in recent years, the libraries have not been able to keep up with rising costs, resulting in a series of cuts to the materials budget totaling around $3.25 million. While some of these cuts took the form of reductions in firm orders and dissolution of approval plans, for the past three years the bulk has come from cancellations of serials and electronic resources. With each year’s cuts, the UNT Collection Development department has been forced to modify and refine their deselection process. This article will show the development of UNT’s strategy for determining cancellations using a variety of methods (overlap analysis, usage statistics, faculty input) and tools (EBSCO Usage Consolidation, Serials Solutions 360).

Karen Harker

Papers

Is qualitative research second class science? A quantitative longitudinal examination of qualitative research in medical journals.

Effectiveness of a Community Health Worker as Sole Diabetes Educator: Comparison of CoDE with Similar Culturally Appropriate Interventions

Relationship Between Adolescent Risk Preferences on a Laboratory Task and Behavioral Measures of Risk-Taking

Planning for the Budget-ocalypse: The Evolution of a Serials/ER Cancellation Methodology

Planning for the budget-ocalypse: : The evolution of a Serials/ER cancellation methodology