Community Health Status and Long-Term Outcomes in 1-Year Survivors of Autologous and Allogeneic Hematopoietic Cell Transplantation

Background: Race/ethnicity and socioeconomic status (SES) have been associated with access to and outcomes after hematopoietic cell transplantation (HCT). The role of health disparity factors beyond race/SES in HCT outcomes, however, has not been well described. This is especially true for long-term HCT survivors, for whom local socio-demographic factors may have a greater impact on outcomes because patients may no longer be under close monitoring of their transplant center. The County Health Rankings and Roadmaps (CHRR) provides updated aggregated information from several publicly available datasets to comprehensively describe the health status of US counties. A recent report demonstrated an association between community health status and 1-year non-relapse mortality in a CIBMTR cohort of allogeneic HCT recipients (Hong et al., Cancer 2021). We conducted a single-center retrospective cohort study to investigate the association between community health and long-term outcomes in 1-year autologous and allogeneic HCT survivors. Methods: Our study included 1,812 consecutive adult patients from Cleveland Clinic's BMT Program database who received their first allogeneic or autologous HCT between 2003 and 2017 and survived at least 1 year after their transplant. We used patient community risk score (PCS) as the surrogate for community health. PCS was nationally standardized and calculated as the sum of weighted Z-scores of the 23 county-level community health factors considered in CHRR. The 23 factors fell under 4 categories of health factors: health behavior (tobacco and alcohol use, etc.), clinical care (access and quality of care), social and economic factors (education, community safety, etc.), and physical environment (environmental quality and built environment). Higher PCS indicate worse community health. We evaluated the association of PCS with overall survival (OS), relapse, and non-relapse mortality (NRM) with Cox or Fine and Gray regression separately for autologous and allogeneic HCTs. Considered co-variables included pre-transplant sociodemographic data, disease diagnosis, and transplant factors. Results: Autologous HCT recipients (n=1,313) lived in 133 of 3,141 CHRR counties, 90% in Ohio. Similarly, allogeneic recipients (n=499) were from 88 counties, 88% in Ohio. Patient characteristics are shown in Table 1. The median (range) PCS scores for autologous and allogeneic HCT recipients were 0.03 (-0.85, 0.97) and 0.03 (-0.85, 0.58), respectively. For comparison, the PCS for the complete US CHRR dataset ranged from -1.43 to 2.54 and ranged from -1.6 to 2.0 in the prior CIBMTR study that included allogeneic HCT recipients (Hong et al., Cancer 2021). PCS was not associated with OS, relapse, or NRM for autologous or allogeneic HCT recipients in univariable analysis, nor were the four categories of health factors that contribute to the total PCS (Table 2). In addition, race and estimated median household income were not associated with mortality. Similar findings were noted in multivariable analysis. Conclusion: In our single center study, PCS was not associated with OS, relapse, or NRM in allogeneic or autologous HCT recipients who survived at least 1 year after HCT. A limitation of our analysis is that our cohort represented a single center with regional representation, where long-term follow up care is provided through a dedicated survivorship clinic and there is a strong emphasis on psychosocial support. A national cohort with greater geographical diversity is needed to better define the association of community factors and outcomes in long-term HCT survivors. Figure 1 Figure 1. Disclosures Hamilton: Syndax: Membership on an entity's Board of Directors or advisory committees; Equilium: Membership on an entity's Board of Directors or advisory committees. Majhail: Anthem, Inc: Consultancy; Incyte Corporation: Consultancy.

Statistical Inference on Nonparametric Spline Models and its Applications

One of the components of the Human Development Index which is still a problem and concern in the world today is the Life Expectancy Rate (LER). United Nations Development Program (UNDP). United Nations Development Program (UNDP) uses the LER to measure community health status as well as a benchmark for development success. LER in Indonesia continues to increase almost throughout the year. That is, the hope of a newborn baby to be able to live longer is getting higher. LER data modelling with parametric regression is not necessarily suitable to be applied because the LER relationship pattern has a pattern that varies at certain age intervals. Spline regression is a regression method that can handle data whose pattern changes at certain intervals. Spline is one of the models in nonparametric regression that has a very special and very good visual statistical interpretation. In addition, splines are also able to handle data characters or functions that are smooth (smooth). This study aims to derive the form of the estimator and the shortest confidence interval for the quadratic spline model and model the LER data in Indonesia.

Rebuilding a US Federal Data Strategy After the End of the “Community Health Status Indicators”

For nearly 2 decades, the Community Health Status Indicators tool reliably supplied communities with standardized, local health data and the capacity for peer-community comparisons. At the same time, it created a large community of users who shared learning in addressing local health needs. The tool survived a transition from the Health Resources and Services Administration to the Centers for Disease Control and Prevention before being shuttered in 2017. While new community data tools have come online, nothing has replaced Community Health Status Indicators, and many stakeholders continue to clamor for something new that will enable local health needs assessments, peer comparisons, and creation of a community of solutions. The National Committee on Vital and Health Statistics heard from many stakeholders that they still need a replacement data source. (Am J Public Health. 2021;111(10):1865–1873. https://doi.org/10.2105/AJPH.2021.306437 )

Blockwise Analysis of Health Indicators of Gadchiroli District using Composite Index: An application of GKG Algorithm

Gadchiroli district is a part of Vidarbha, Traibal district away from 200 KM from sub capital of Maharashtra, Nagpur, Gadchiroli is well known tribal district of vidarbha. Total forest cover of the district is around 78% of total geographic area. District has 12 blocks with 6 revenue division. It is a notified tribal district having 8.61%–81.50% tribal population in different blocks and block-wise urbanization varies from 0.00% to 37.10%. Objective: Objective of present research paper is to device tool to rank the blocks of the district according to community health status exist in blocks and accordingly assess community health status at block level in Gadchiroli district.

Analysis of the Planning Process at the Health Center Level at the Poso Regency Health Office

One of the activities required by every puskesmas (Community Health Center) in overcoming the problems faced in each area is planning at the puskesmas level. To accommodate the need to increase the ability and coverage of health services in an integrated and integrated manner with the problems that exist in the work environment of the Puskesmas. The purpose of this study was to analyze the planning process at the Puskesmas level at the Poso District Health Office. This type of research is qualitative and the unit of analysis from the implementation of this research is carried out on 2 (two) Puskesmas in the Poso District Health Office. Meanwhile, the research informants were employees/staff of the related puskesmas and the key informant was the Head of the Poso District Health Office as a triangulation check for the validity of the data. The results of the research based on the preparation stage, a planning team was formed by the Head of the Puskesmas, in the situation analysis stage the problem analysis process was carried out through Encuesta Mawas Diri (SMD), the problem formulation stage using the USG method (Uraaatanga metoaaa) problems, the last stage was the preparation of the RUK (Proposed Activity Plan) which are prepared at the puskesmas still refer to the applicable government policies. Suggestions in this study are expected that the puskesmas in the Poso District Health Office can arrange their annual activity plans optimally, while still fostering community participation in improving community health status.

The comparing of infant mortality rate in different World Health Organization regions during 1990–2017

Background Infant mortality rate is an important index of community health status and mortality rate. It is also one of the most prominent indexes showing the development of various societies. Regarding the importance of infant mortality rate (IMR), the purpose of current study was to compare and trend analysis of IMR in different areas of the WHO during 1990–2017. In current ecological study, IMR per 1000 live births in different WHO regions from 1990 to 2017 data were derived from the WHO website. The required information included the data about IMR per 1000 live births in different WHO regions from 1990 to 2017. The analysis was performed by using descriptive and analytical methods. Results The IMR during the study period had a significant decreasing trend in all the regions (p < 0.001) but the slope of decrease was greater in Africa than in other regions. The African and European regions had the highest (55.7%) and lowest (17.2%) annual decrease in the infant mortality rate (from 106.3 cases in 1990 to 50.6 in 2017, and from 24.9 in 1990 to 7.7 in 2017), respectively. Conclusion Our results showed that the trend of IMR had a decreasing trend in all WHO regions. It can be due to improving the public health situation in different areas. But the identification of effective factors on IMR needs individuals based studies.

IMPLEMENTING QUALITY A MISSING PIECE WITH A NEED FOR PROCESS OF BEHAVIOR CHANGE: A CASE FOR IMPLEMENTING QUALITY CB-IRS DELIVERY MODEL IN ZAMBIA

Background: In the wake of increasing malaria cases in Zambia, IRS has been coming under increasing accountable pressurefromthe publicfor quality IRS performance and its decentralized approach. In response, anew IRS approach Community-BasedIndoor Residual Spraying (IRS)Delivery model has been introduced in the country and institutionalized in the community health care system.The objective of this study was to introduce quality assurance approach methods to the model in terms of structure, process and outcomes for quality performance. Materials and Methods: We reviewed both published and unpublished documents, articles, papers on quality service delivery and explored field experiences and the understanding of IRS service delivery. The Donabedian model has been found to lead to improvements of quality that in turn could improve the health outcome of the community. Equally, dimensions of quality were analyzed under effectiveness, efficacy, acceptability, equity and relevance to IRS delivery of services and best approaches. Results: Quality assurance becomes strong and successful when its well organized with features of a health atmosphere that motivates IRS teams, Spray operators (SOPs), and the house hold owners, thus becoming a common goal as a result of good level management. The District IRS Operational Committee, typically must possess quality assurance superior technical skills and expertise. However, it is not only quality assurance guidelines that strengthen team building but also established rules, processes, tracking ofprogress, IRS quality assurance learningenvironment, improvements and leadership support initiatives. These could be supplemented by enabling tools and a nurturing qualityfriendly atmosphere within the IRS teams and SOPs as front liners. Donabedian model for improvement of quality has been widely adopted in the hospital care set up, but hasnot yet been fully recognized, utilized and validated in the vector control system. Conclusion: The study suggests that the Donabedian`s structure-process-outcome isa valid modelfor implementingquality CB-IRS Delivery model in the IRS program campaign. The interventions that perform well in terms of structure tend to perform better forquality service delivery processes, that in turn have favorable influence on the community health status outcome.

Pengaruh Kepemimpinan Transformasional Terhadap Kepuasan Kerja Karyawan Dimediasi Oleh Keadilan Organisasi Pada RSIA Cahaya Bunda Cirebon

ABSTRACT Health in the modern era is now an inseparable necessity from the development of healthy and smart Indonesian people. Hospitals as one of the health facilities that provide health services to the community have a very strategic role in accelerating the improvement of community health status. Therefore, hospitals are required to provide quality services in accordance with established standards and can reach all levels of society. For this reason, the need for synergy between leaders and employees. Employees still complain about the way leaders handle each employee's complaints, such as complaints of discrepancies between salaries and work performed, employees still feel discriminated in the sense of being discriminated according to social status, the length of the process of determining to become permanent employees, and so forth. From the factors mentioned above that the role of the leader in leading must be wise and fair both for the organization and employees in the organization. This study aims to obtain empirical evidence of whether or not the influence of transformational leadership on job satisfaction is mediated by organizational justice. This study used a correlational quantitative method and the data processing was assisted with SPSS 22. The population of this study was all employees of RSIA Cahaya Bunda including permanent employees and contract employees while the study sample was only 127 permanent employees. Determination of samples using Slovin formula. The results of this study indicate that transformational leadership has a direct positive effect on job satisfaction, organizational justice has a positive effect on job satisfaction, transformational leadership has a positive effect on organizational justice and organizational justice is able to mediate the relationship between transformational leadership and job satisfaction. Keywords: transformational leadership, job satisfaction, organizational justice, hospital.