Evaluating the Sustainability of School-Based Health Centers.

BACKGROUND: The United States is facing a surge in the number of school-based health centers (SBHCs) owing to their success in delivering positive health outcomes and increasing access to care. To preserve this success, experts have developed frameworks for creating sustainable SBHCs; however, little research has affirmed or added to these models. OBJECTIVES: This research seeks to analyze elements of sustainability in a case study of three SBHCs in San Diego, California, with the purpose of creating a research-based framework of SBHC sustainability to supplement expertly derived models. METHODS: Using a mixed methods study design, data were collected from interviews with SBHC stakeholders, observations in SBHCs, and SBHC budgets. A grounded theory qualitative analysis and a quantitative budget analysis were completed to develop a theoretical framework for the sustainability of SBHCs. RESULTS: Forty-one interviews were conducted, 6 hours of observations were completed, and 3 years of SBHC budgets were analyzed to identify care coordination, community buy-in, community awareness, and SBHC partner cooperation as key themes of sustainability promoting patient retention for sustainable billing and reimbursement levels. CONCLUSIONS: These findings highlight the unique ways in which SBHCs gain community buy-in and awareness by becoming trusted sources of comprehensive and coordinated care within communities and among vulnerable populations. Findings also support ideas from expert models of SBHC sustainability calling for well-defined and executed community partnerships and quality coordinated care in the procurement of sustainable SBHC funding.

Small-molecule screen identifies reactive oxygen species as key regulators of neutrophil chemotaxis.

Neutrophil chemotaxis plays an essential role in innate immunity, but the underlying cellular mechanism is still not fully characterized. Here, using a small-molecule functional screening, we identified NADPH oxidase-dependent reactive oxygen species as key regulators of neutrophil chemotactic migration. Neutrophils with pharmacologically inhibited oxidase, or isolated from chronic granulomatous disease (CGD) patients and mice, formed more frequent multiple pseudopodia and lost their directionality as they migrated up a chemoattractant concentration gradient. Knocking down NADPH oxidase in differentiated neutrophil-like HL60 cells also led to defective chemotaxis. Consistent with the in vitro results, adoptively transferred CGD murine neutrophils showed impaired in vivo recruitment to sites of inflammation. Together, these results present a physiological role for reactive oxygen species in regulating neutrophil functions and shed light on the pathogenesis of CGD.

Incorporating the experiences of youth with traumatic injury into the training of health professionals.

Youth violence and related injury continue to be a serious public health problem and are identified as a major priority on the national health care agenda. Despite recommendations by numerous professional organizations to enhance healthcare professionals' roles in youth violence prevention efforts, there has been little documentation of effective training. To address this gap, the University of California, San Diego Department of Pediatrics (UCSD) partnered with San Diego-based Sharp HealthCare's Institute for Injury & Violence Prevention Think First San Diego in a novel program. As part of a panel that highlighted violence as a public health problem and a physician's responsibility in youth violence prevention, youth disabled by violence told fourth year medical students about opportunities for direct intervention in the lives of victims and perpetrators. The personal stories these young people tell of the effect of violence on individuals is a valuable training tool and a powerful way of humanizing the situation. Their participation also highlights physicians' opportunities for intervention and responsibility in directly addressing adolescents at risk.

Family-based weight management with Latino mothers and children.

PURPOSE: This paper aims to design a culturally appropriate weight management intervention for high-risk Latino families and to examine the feasibility of recruiting program participants. DESIGN AND METHODS: A descriptive design using qualitative and quantitative data collected during preliminary phases of an ongoing intervention study. RESULTS: From the preliminary works, a curriculum was revised for Latino families who have overweight children. The curriculum was modified to include suggestions from the focus groups, including helping mothers set limits with their children and make the transition to lighter foods and a more active family life. PRACTICE IMPLICATIONS: The information will aid professionals in the process of program design for Latino families who have weight concerns.

Program self-evaluation: the evolution of an injury prevention foundation.

OBJECT: Injuries are a leading cause of morbidity and mortality in the US. The authors provide a brief discussion of a national injury prevention foundation's self-evaluation of its efforts to decrease the incidence of traumatic injuries through educational programs, legislative efforts, and community programming. METHODS: The authors performed a literature review of evaluation studies and activities of the Think First National Injury Prevention Foundation accomplished between 1986 and 2002 and summarized their findings. Suggestions generated from research studies were incorporated into the foundation's programs. Efficacy studies show that the injury prevention programs have a significant impact on knowledge, attitudes, and practice, and demonstrate the need for injury prevention to be recognized as a valuable component of the US medical system. CONCLUSIONS: After a self-evaluation, the Think First National Injury Prevention Foundation has made strides in developing a multilevel approach to injury prevention by combining education with legislative initiatives, community-wide safety programming, and a large public presence, similar to what has been accomplished with successful smoking cessation programs and seat-belt use campaigns.