BACKGROUND.Colorectal cancer screening is underutilized. The objective of the current study was to determine whether targeted and tailored interventions can increase screening use.METHODS.A total of 1546 primary care practice patients completed a baseline telephone survey and were randomized to 4 study groups: control (387 patients), Standard Intervention (SI) (387 patients), Tailored Intervention (TI) (386 patients), or Tailored Intervention plus Phone (TIP) (386 patients). The control group received usual care throughout the study. The SI group received a targeted intervention by mail (ie, screening invitation letter, informational booklet, stool blood test, and reminder letter). The TI group received the targeted intervention with tailored “message pages.” The TIP group received the targeted intervention, tailored message pages, and a telephone reminder. Intervention group contacts were repeated 1 year later. Screening was assessed 24 months after randomization.RESULTS.Screening rates in study groups were 33% in the control group, 46% in the SI group, 44% in the TI group, and 48% in the TIP group. Screening was found to be significantly higher in all 3 intervention groups compared with the control group (odds ratio [OR] of 1.7 [95% confidence interval (95% CI), 1.3–2.5], OR of 1.6 [95% CI, 1.2–2.1], and OR of 1.9 [95% CI, 1.4–2.6], respectively), but did not vary significantly across intervention groups. Multivariate analyses demonstrated that older age, education, past cancer screening, screening preference, response efficacy, social support and influence, and exposure to study interventions were positive predictors of screening. Having worries and concerns about screening was found to be a significant negative predictor.CONCLUSIONS.Targeted and tailored interventions were found to increase colorectal cancer screening use. However, additional research is needed to determine how to increase the effect of such interventions in primary care. Cancer 2007. © 2007 American Cancer Society.

Community coalitions can successfully achieve asthma policy and system changes and improve health outcomes. Increased core and ongoing community stakeholder participation rather than a higher overall number of participants was associated with more change.

BACKGROUND. Colorectal cancer (CRC) screening is cost‐effective but underused. The objective of this study was to determine the cost‐effectiveness of targeted and tailored behavioral interventions to increase CRC screening use by conducting an economic analysis associated with a randomized trial among patients in a large, racially and ethnically diverse, urban family practice in Philadelphia. METHODS. The incremental costs per unit increase were measured in individuals who were screened during the 24 months after intervention. Percent increase in screening was adjusted for baseline differences in the study groups. Each intervention arm received a targeted screening invitation letter, stool blood test (SBT) cards, informational booklet, and reminder letter. Tailored interventions incrementally added tailored messages and reminder telephone calls. RESULTS. Program costs of the targeted intervention were $42 per participant. Additional costs of adding tailored print materials and of delivering a reminder telephone call were $150 and $200 per participant, respectively. The cost per additional individual screened was $319 when comparing the no intervention group with the targeted intervention group. CONCLUSIONS. The targeted intervention was more effective and less costly than the tailored intervention. Although tailoring plus reminder telephone call was the most effective strategy, it was very costly per additional individual screened. Mailed SBT cards significantly boosted CRC screening use. However, going beyond the targeted intervention to include tailoring or tailoring plus reminder calls in the manner used in this study did not appear to be an economically attractive strategy. Cancer 2008. © 2007 American Cancer Society.

For mapping, quantifying and monitoring regional and global forest health, satellite remote sensing provides fundamental data for the observation of spatial and temporal forest patterns and processes. While new remote-sensing technologies are able to detect forest data in high quality and large quantity, operational applications are still limited by deficits of in situ verification. In situ sampling data as input is required in order to add value to physical imaging remote sensing observations and possibilities to interlink the forest health assessment with biotic and abiotic factors. Numerous methods on how to link remote sensing and in situ data have been presented in the scientific literature using e.g. empirical and physical-based models. In situ data differs in type, quality and quantity between case studies. The irregular subsets of in situ data availability limit the exploitation of available satellite remote sensing data. To achieve a broad implementation of satellite remote sensing data in forest monitoring and management, a standardization of in situ data, workflows and products is essential and necessary for user acceptance. The key focus of the review is a discussion of concept and is designed to bridge gaps of understanding between forestry and remote sensing science community. Methodological approaches for in situ/remote-sensing implementation are organized and evaluated with respect to qualifying for forest monitoring. Research gaps and recommendations for standardization of remote-sensing based products are discussed. Concluding the importance of outstanding organizational work to provide a legally accepted framework for new information products in forestry are highlighted.

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Asthma is a highly prevalent and frequently misunderstood chronic disease with significant morbidity. Integrating client services at the patient-centered level and using coalitions to build coordinated, linked systems to affect care may improve outcomes. All seven Allies Against Asthma coalitions identified inefficient, inconsistent, and/or fragmented care as issues for their communities. In response, the coalitions employed a collaborative process to identify and address problems related to system fragmentation and to improve coordination of care. Each coalition developed a variety of interventions related to its specific needs and assets, stakeholders, stage of coalition formation, and the dynamic structure of its community. Despite common barriers in forming alliances with busy providers and their staff, organizing administrative structures among interinstitutional cultures, enhancing patient and/or family involvement, interacting with multiple insurers, and contending with health system inertia, the coalitions demonstrated the ability to produce coordinated improvements to existing systems of care.

Mobilizing a diverse group of stakeholders, and focusing on policy and system changes generated significant reductions in health care use for asthma in vulnerable communities.

Coalitions develop in and recycle through stages. At each stage (formation, implementation, maintenance, and institutionalization), certain factors enhance coalition function, accomplishment of tasks, and progression to the next stage. The Allies Against Asthma coalitions assessed stages of development through annual member surveys, key informant interviews of 16 leaders from each site, and other evaluation tools. Results indicate all coalitions completed formation and implementation, six achieved maintenance, and five are in the institutionalization stage. Differences among coalitions can be attributed to their maturity and experience working within a coalition framework. Participants agreed that community mobilization around asthma would not have happened without coalitions. They attributed success to being responsive to community needs and developing comprehensive strategies, and they believed that partners' goals were more innovative and achievable than any institution could have created alone.