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Colleen K. Gutman|Liliana Cousins|Jesse Gritton|Eileen J. Klein|Julie C. Brown|Jack W. Scannell|K. Casey Lion

Professional Interpreter Use and Discharge Communication in the Pediatric Emergency Department

University of Washington|Emory University|University of Washington|American Cancer Society|University of Washington|University of Washington|University of Cambridge|University of Washington

h2abstracth2h3objectiveh3 families limited english proficiency lep experience communication barriers risk adverse events discharge pediatric emergency department ed sought describe characteristics ed discharge communication lep families assess whether use professional interpreter associated provider communication quality ed discharge h3methodsh3 transcripts videorecorded ed visits spanishspeaking lep families obtained larger study comparing professional interpretation modalities freestanding childrens hospital caregiverprovider communication interactions included discharge education analyzed content techniques providers used assess caregiver comprehension regression analysis used assess association professional interpreter use discharge education content assessment caregiver comprehension h3resultsh3 analyzed 101 discharge communication interactions 47 lep patient visits 31 communications use professional interpretation although patients 70 received complete discharge education content 65 received instructions medication dosing 55 given return precautions thirteen percent patient visits included openended question assess caregiver comprehension none included teachback professional interpreter use associated greater odds complete discharge education content odds ratio 71 95 confidence interval ci 14370 highquality provider assessment caregiver comprehension 61 95 ci 23159 h3conclusionsh3 professional interpreter use associated superior provider discharge communication behaviors study identifies clear areas improving discharge communication may improve safety outcomes lep children discharged ed

https://doi.org/10.1016/j.acap.2018.07.004

Karen A. Robinson|Cheryl R. Dennison|Dawn M. Wayman|Peter J. Pronovost|Dale M. Needham

Systematic review identifies number of strategies important for retaining study participants

Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins University|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University

h2abstracth2h3objectiveh3 loss followup threatens internal external validity yet little research examined ways limit participant attrition conducted systematic review studies primary focus strategies retain participants health care research h3study design settingsh3 completed searches pubmed cinahl central cochrane methodology register embase august 2005 also examined reference lists eligible articles relevant reviews datadriven thematic analysis retention strategies identified common themes h3resultsh3 retrieved 3068 citations 21 studies eligible inclusion abstracted 368 strategies identified 12 themes studies reported median 17 strategies across median six themes commonly reported strategies systematic methods participant contact scheduling studies retention rates lower mean rate 86 reported fewer strategies difference number different themes used h3conclusionh3 available evidence suggests investigators consider using number retention strategies across several themes maximize retention participants research including explicit evaluation effectiveness different strategies needed

https://doi.org/10.1016/j.jclinepi.2006.11.023

Elizabeth McFarlane|Rachel A.B. Dodge|Lori Burrell|Sarah Shea Crowne|Tina L. Cheng|Anne K. Duggan

The Importance of Early Parenting in At-Risk Families and Children’s Social-Emotional Adaptation to School

Johns Hopkins Medicine|Johns Hopkins University|University of Hawai?i at M?noa|Johns Hopkins Medicine|Johns Hopkins University|University of Hawai?i at M?noa|Johns Hopkins Medicine|Johns Hopkins University|University of Hawai?i at M?noa|Johns Hopkins Medicine|Johns Hopkins University|University of Hawai?i at M?noa|Johns Hopkins Medicine|Johns Hopkins University|University of Hawai?i at M?noa|Johns Hopkins Medicine|Johns Hopkins University|University of Hawai?i at M?noa

h2abstracth2h3objectiveh3 aim study determine specific aspects early parenting psychosocially atrisk families strongly related childrens socialemotional adaptation school h3methodsh3 cohort study families n 318 identified risk maltreatment newborns conducted quality early parenting observed home child 1 year old socialemotional adaptation school reported teachers first grade multivariable models assessed independent influence early parenting variables socialemotional adaptation h3resultsh3 early parenting socialemotional adaptation school varied greatly across families parental warmth associated lower teacher ratings shyness concentration problems peer rejection parental lack hostility associated decreased teacher ratings concentration problems peer rejection parental encouragement developmental advance associated lower ratings aggression peer rejection provision materials promote learning literacy associated lower ratings concentration problems h3conclusionsh3 sample families multiple psychosocial risks child maltreatment specific aspects early parenting associated better socialemotional adaptation school first grade theoretically predicted ways improving parental knowledge positive parenting via anticipatory guidance focus wellchild visits wellchild visitbased interventions improve quality early parenting especially among atrisk families studied impact parenting behavior childrens successful socialemotional adaptation school primary care providers reinforce complementary services home visiting seek promote positive parenting

https://doi.org/10.1016/j.acap.2010.06.011

H. Shonna Yin|Lee Sanders|Russell L. Rothman|Alan L. Mendelsohn|Benard P. Dreyer|Ralph K. White|Joanne Finkle|Stefania Prendes|Eliana M. Perrin

Assessment of Health Literacy and Numeracy Among Spanish-Speaking Parents of Young Children: Validation of the Spanish Parental Health Literacy Activities Test (PHLAT Spanish)

Bellevue Hospital Center|University of Miami|Vanderbilt University Medical Center|Meharry Medical College|University of North Carolina at Chapel Hill|Bellevue Hospital Center|University of Miami|Vanderbilt University Medical Center|Meharry Medical College|University of North Carolina at Chapel Hill|Bellevue Hospital Center|University of Miami|Vanderbilt University Medical Center|Meharry Medical College|University of North Carolina at Chapel Hill|Bellevue Hospital Center|University of Miami|Vanderbilt University Medical Center|Meharry Medical College|University of North Carolina at Chapel Hill|Bellevue Hospital Center|University of Miami|Vanderbilt University Medical Center|Meharry Medical College|University of North Carolina at Chapel Hill|Bellevue Hospital Center|University of Miami|Vanderbilt University Medical Center|Meharry Medical College|University of North Carolina at Chapel Hill|Bellevue Hospital Center|University of Miami|Vanderbilt University Medical Center|Meharry Medical College|University of North Carolina at Chapel Hill|Bellevue Hospital Center|University of Miami|Vanderbilt University Medical Center|Meharry Medical College|University of North Carolina at Chapel Hill|Bellevue Hospital Center|University of Miami|Vanderbilt University Medical Center|Meharry Medical College|University of North Carolina at Chapel Hill

h2abstracth2h3objectiveh3 assess health literacy numeracy skills spanishspeaking parents young children validate new spanish language health literacy assessment parents spanish parental health literacy activities test phlat spanish h3methodsh3 crosssectional study spanishspeaking caregivers young children 30 months enrolled primary care clinics 4 academic medical centers caregivers administered 10item phlat addition validated tests health literacy stofhla numeracy wrat3 arithmetic psychometric analysis used examine item characteristics phlat10 spanish assess correlation sociodemographics performance literacynumeracy assessments generate shorter 8item scale phlat8 h3resultsh3 176 caregivers 77 adequate health literacy stofhla whereas 06 9th grade greater numeracy skills mean phlat10 score 416 sd 211 fewer onehalf 455 able read liquid antibiotic prescription label demonstrate much medication administer within oral syringe less onethird 318 able interpret food label determine whether met wic special supplemental nutrition program women infants children guidelines greater phlat10 score associated greater years education r 049 stofhla r 053 wrat3 r 055 scores ipi 001 internal reliability good kuderrichardson coefficient reliability kr20 061 8item scale highly correlated full 10item scale r 097 ipi 001 comparable internal reliability kr20 064 h3conclusionsh3 many spanishspeaking parents difficulty performing healthrelated literacy numeracy tasks spanish phlat demonstrates good psychometric characteristics may useful identifying parents would benefit receiving lowliteracy child health information

https://doi.org/10.1016/j.acap.2011.08.008

Peter G. Szilâgyi|Christina Albertin|Sharon G. Humiston|Cynthia M. Rand|Stanley J. Schaffer|Howard Brill|Joseph A. Stankaitis|Byung Kwang Yoo|Aaron Blumkin|Shannon Stokley

A Randomized Trial of the Effect of Centralized Reminder/Recall on Immunizations and Preventive Care Visits for Adolescents

University of Rochester|University of Rochester|Children's Mercy Hospital|University of Rochester|University of Rochester|University of California, Davis|University of Rochester

h2abstracth2h3objectiveh3 assess impact managed carebased patient reminderrecall system immunization rates preventive care visits among lowincome adolescents h3methodsh3 conducted randomized controlled trial december 2009 december 2010 assigned adolescents aged 1117 years one three groups mailed letter telephone reminders control publicly insured youths n 4115 identified 37 participating primary care practices main outcome measures immunization rates routine vaccines meningococcus pertussis hpv preventive visit rates study end h3resultsh3 intervention control groups similar baseline demographics immunization rates preventive visits among adolescents behind start immunization rates study end increased 21 mailed ipi 01 vs control 17 telephone ipi 05 13 control groups proportion adolescents preventive visit within 12 months mailed 65 ipi 01 telephone 63 ipi 05 controls 59 number needed treat additional fully vaccinated adolescent 14 mailed 25 telephone reminders additional preventive visit 17 29 intervention cost 1878 mailed 1668 phone per adolescent per year deliver cost per additional adolescent fully vaccinated 46399 mailed 71498 telephone cost per additional adolescent receiving preventive visit 32475 48703 h3conclusionsh3 managed carebased mail telephone reminderrecall improved adolescent immunizations preventive visits modest costs modest impact

https://doi.org/10.1016/j.acap.2013.01.002

Justine Karduck|Karen Chapman?Novakofski

Results of the Clinician Apps Survey, How Clinicians Working With Patients With Diabetes and Obesity Use Mobile Health Apps

University of Illinois Urbana-Champaign|University of Illinois Urbana-Champaign

h2abstracth2h3objectiveh3 develop administer questionnaire determine factors may associated app use including frequency use reasons recommend clientspatients perceived effectiveness health health aspects used features types apps clinicians working diabetes weight management patient care settings h3methodsh3 clinician apps survey developed contained 3 question domains smartphone apps use behavior theory counseling sessions demographics explore frequency types preferred features benefitsbarriers using apps counseling techniques used clinician demographics clinicians n 719 recruited complete online survey 4 dietetics diabetes professional groups clinician use preferences healthrelated apps personal reasons patient care settings determined comparisons made high nonapp users descriptive statistics used current practices attitudes apps chisquare test independence compared using apps personally professionally app enthusiasts vs app use h3resultsh3 app enthusiasts 53 n 380 nonapp users 20 n 145 whereas 68 recommended penpaper methods diet physical activity monitoring 62 recommended apps agreed apps superior traditional methods patients track dietary intake 62 physical activity 58 make better food choices 34 lose weight 45 track blood glucose 43 app enthusiasts used american association diabetes educators selfcare guidelines ipi 001 advanced counseling techniques eg motivational interviewing often nonapp users ipi 004 apps frequently recommended clients myfitnesspal n 425 calorieking n 356 fitbit n 312 h3conclusions implicationsh3 healthrelated smartphone apps widely used recommended patients diabetes obesity clinicians selfmonitoring dietary physical activity behaviors furthermore many clinicians believe types tracking apps may improve patient outcomes compared traditional methods monitoring dietary physical activity behaviors

https://doi.org/10.1016/j.jneb.2017.06.004

John Wesley McWhorter|Denise M. LaRue|Maha Almohamad|Melisa P. Danho|Shweta Misra|Karen C. Tseng|Shannon R. Weston|Laura S. Moore|Casey P. Durand|Deanna M. Hoelscher|Shreela V. Sharma

Training of Registered Dietitian Nutritionists to Improve Culinary Skills and Food Literacy

University of Texas Health Science Center at Dallas|Harris Health System|The University of Texas Health Science Center at Houston|University of Texas Health Science Center at Dallas|The University of Texas Health Science Center at Houston|University of Texas Health Science Center at Dallas|Harris Health System|The University of Texas Health Science Center at Houston|University of Texas Health Science Center at Dallas|University of Texas Health Science Center at Dallas|University of Texas Health Science Center at Dallas|University of Texas Health Science Center at Dallas|University of Texas Health Science Center at Dallas|The University of Texas Health Science Center at Houston|University of Texas Health Science Center at Dallas

h2abstracth2h3objectiveh3 understand culinary medicine training program increases food literacy culinary skills knowledge among practicing registered dietitian nutritionists rdn h3methodsh3 prepost study design evaluating pilot test rdn trainthetrainer curriculum september 2019 january 2020 h3resultsh3 average results indicate increase culinary nutrition skills mean difference 67 44 ipi 0001 range 1030 significant increase 5 8 food literacy factors process evaluation rdns rated training extremely useful practice mean 44 03 h3conclusions implicationsh3 registered dietitian nutritionist participants increased culinary nutrition skills statistically significant scores across individual measures study describes rdn training curriculum culinary medicine across diverse group practicing rdns large county health care system culinary medicine shows promising impact promoting nutrition skills confidence however warrants assessment

https://doi.org/10.1016/j.jneb.2022.04.001

Helen Hughes|Elizabeth C. Matsui|Megan M. Tschudy|Craig Evan Pollack|Corinne Keet

Pediatric Asthma Health Disparities: Race, Hardship, Housing, and Asthma in a National Survey

Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University

h2abstracth2h3objectiveh3 sought determine racial disparities pediatric asthma explained material hardship home ownership h3methodsh3 performed secondary analysis 2011 american housing survey total 33201 households children age 6 17 years surveyed regarding childhood asthma diagnosis emergency department ed visits asthma youngest child asthma household material hardship included poor housing quality housing crowding lack amenities vehicle access used logistic regression determine association race material hardship asthma diagnosis ed visits adjusting potential confounders h3resultsh3 nonhispanic black heads household higher odds child diagnosed asthma home compared nonhispanic white heads household odds ratio 172 95 confidence interval ci 150196 higher odds ed visits asthma odds ratio 302 95 ci 229399 raceasthma association decreased eliminated adjusting material hardship home ownership ed visit adjusted odds ratio aor 207 95 ci 150286 poor housing quality independently associated asthma diagnosis aor 145 95 ci 128166 ed visits aor 159 95 ci 121210 home ownership associated lower odds asthmarelated ed visits aor 062 95 ci 046084 h3conclusionsh3 observed racial disparities pediatric asthma lessened controlling material hardship poor housing quality particular strongly associated asthma morbidity policy makers could target improving housing quality means potentially reducing asthma disparities

https://doi.org/10.1016/j.acap.2016.11.011

Aki Kuroda|T. Tanaka|Hirohiko Hirano|Yuki Ohara|Takeshi Kikutani|Hiroyasu Furuya|Shuichi Obuchi|Hisashi Kawai|Shinya Ishii|Masahiro Akishita|Taishi Tsuji|Katsuya Iijima

Eating Alone as Social Disengagement is Strongly Associated With Depressive Symptoms in Japanese Community-Dwelling Older Adults

Tokyo Metropolitan Institute of Gerontology|The University of Tokyo|Tokyo Metropolitan Institute of Gerontology|The University of Tokyo|Tokyo Metropolitan Institute of Gerontology|Tokyo Medical and Dental University|Nippon Dental University|Nippon Dental University|Tokyo Metropolitan Institute of Gerontology|Tokyo Metropolitan Institute of Gerontology|The University of Tokyo|The University of Tokyo|Tokyo Metropolitan Institute of Gerontology|The University of Tokyo|Tokyo Metropolitan Institute of Gerontology|The University of Tokyo

h2abstracth2h3objectivesh3 depression later life poses grave challenge aging countries reported key risk factors include social disengagement lack social companionship mealtimes namely eating alone examined extensively especially relation living arrangement past studies changes along geriatric trajectories association social engagement depression also remain inadequate study aims examine association social engagement depressive symptoms particular focus eating alone association changes along aging mental frailty trajectories h3designh3 crosssectional study h3settingh3 kashiwacity chibaprefecture japan h3participantsh3 total 1856 communitydwelling older adults h3measurementsh3 15item geriatric depression scale used measure depressive symptoms indicators used assess social engagement included eating alone living arrangement reciprocity social support social participation social stressors social ties h3resultsh3 social engagement significantly associated depressive symptoms live families yet eat alone found particular risk odds ratio 502 95 confidence interval 2599 youngold odds ratio 241 95 confidence interval 1248 oldold younger less mentally frail populations showed stronger associations h3conclusionsh3 eating alone key risk factor depressive symptoms communitydwelling older adults living arrangement eat alone important identifying greatest risk mental health management older adults requires comprehensive assessment social relations takes account companionship mealtimes social preventive measures need involve early interventions order augment effectiveness mental frailty

https://doi.org/10.1016/j.jamda.2015.01.078

David G. Dillon|Fraser Pirie|Stephen K. Rice|Cristina Pomilla|Manjinder S. Sandhu|Ayesha A. Motala|Elizabeth Young

Open-source electronic data capture system offered increased accuracy and cost-effectiveness compared with paper methods in Africa

University of Cambridge|Wellcome Sanger Institute|University of KwaZulu-Natal|Wellcome Sanger Institute|University of Cambridge|Wellcome Sanger Institute|University of Cambridge|Wellcome Sanger Institute|University of KwaZulu-Natal|University of Cambridge|Wellcome Sanger Institute

h2abstracth2h3objectivesh3 existing electronic data capture options often financially unfeasible resourcepoor settings difficult support technically field help facilitate largescale multicenter studies subsaharan africa african partnership chronic disease research apcdr developed opensource electronic questionnaire eq h3study design settingh3 assess relative validity compared eq traditional penandpaper methods using 200 randomized interviews conducted ongoing type 2 diabetes casecontrol study south africa h3resultsh3 3month validation eq lower frequency errors eq 017 errors per 100 questions paper 073 errors per 100 questions ipivalue 0001 lower monetary cost per correctly entered question compared penandpaper method found marked difference average duration interview methods eq 54 minutes paper 56 minutes h3conclusionh3 validation study suggests eq may offer increased accuracy similar interview duration increased costeffectiveness compared paperbased data collection methods apcdr eq software freely available httpsgithubcomapcdrquestionnaire

https://doi.org/10.1016/j.jclinepi.2014.06.012

Laetitia Teixeira|Lia Araújo|Daniela Jopp|Óscar Ribeiro

Centenarians in Europe

Universidade do Porto|Centre for Health Technology and Services Research|Universidade do Porto|Centre for Health Technology and Services Research|Polytechnic Institute of Viseu|FORS – Swiss Centre of Expertise in the Social Sciences|University of Lausanne|Universidade do Porto|Centre for Health Technology and Services Research|Instituto Superior de Serviço Social do Porto|University of Aveiro

h2abstracth2h3objectivesh3 group individuals aged 80 growing faster segments population within group number centenarians risen exponentially worldwide paper reports numbers centenarians total ratio relative total population 32 european countries key characteristics gender distribution level education type residence h3study designh3 population based study h3measuresh3 used national census data collected 2011 individuals aged 100 living austria belgium bulgaria croatia cyprus czech republic denmark estonia finland france germany greece hungary iceland ireland italy latvia liechtenstein lithuania luxembourg malta netherlands norway poland portugal romania slovakia slovenia spain sweden switzerland uk data gender residence education used h3resultsh3 total number centenarians 89156 corresponding 173 centenarians per 100000 inhabitants total population 980 centenarians per 100000 individuals aged 65 older centenarian ratios highest france italy greece lowest bulgaria romania croatia percentage men 165 average ranged around 13 germany latvia belgium 37 hungary across europe 627 centenarians lived private households range 109 iceland 900 romania education levels varied across countries average 136 formal education ranging 00 uk finland iceland 616 portugal h3conclusionsh3 centenarian numbers increased substantially since last available data findings inform specific health promotion policies strengthening current services development innovative care systems

https://doi.org/10.1016/j.maturitas.2017.08.005

Kimberly A. Kaphingst|Colleen M. McBride|Christopher H. Wade|Sharon Hensley Alford|Robert J. Reid|Eric B. Larson|Andreas D. Baxevanis|Lawrence C. Brody

Patients’ understanding of and responses to multiplex genetic susceptibility test results

Washington University in St. Louis|National Human Genome Research Institute|University of Washington Bothell|National Human Genome Research Institute|Henry Ford Hospital|Kaiser Permanente Washington Health Research Institute|Kaiser Permanente Washington Health Research Institute|National Human Genome Research Institute|National Human Genome Research Institute

h2abstracth2h3purposeh3 examination patients responses directtoconsumer genetic susceptibility tests needed inform clinical practice study examined patients recall interpretation responses genetic susceptibility test results provided directly mail h3methodsh3 observational study three prospective assessments testing 10 days receiving results 3 months later participants 199 patients aged 2540 years received free genetic susceptibility testing eight common health conditions h3resultsh3 80 patients correctly recalled results eight health conditions patients unlikely interpret genetic results deterministic health outcomes mean 60 sd 08 scale 17 1 indicating strongly deterministic multivariate analysis patients least deterministic interpretations white ipi 00098 educated ipi 00093 least confused results ipi 0001 1 talked results provider h3conclusionh3 findings suggest patients correctly recall results interpret genetics sole cause diseases subset confused results could benefit consultation healthcare provider could emphasize health habits currently best predictors risk providers could leverage patients interest genetic tests encourage behavior changes reduce disease risk igenet medi advance online publication 5 april 2012

https://doi.org/10.1038/gim.2012.22

Samantha Batchelor|Stoyan Stoyanov|Jane Pirkis|Kairi Kõlves

Use of Kids Helpline by Children and Young People in Australia During the COVID-19 Pandemic

University of Melbourne|Griffith University

h2abstracth2h3purposeh3 benefits helplines particularly valuable pandemic facetoface services natural supports difficult access kids helpline australias national youth helpline provides children young people free 247 information counseling telephone webchat email aimed examine use kids helpline covid19 pandemic h3methodsh3 analyzed monthly weekly time trends demand response kids helpline frequency counseling contacts common concern types age gender also examined used joinpoint regression h3resultsh3 analyses weekly demand kids helpline showed increase pandemic declared followed gradual decline second rise 12 july 2020 parts australia experienced second wave infections followed another decline occurred recently increased demand almost entirely webchat modality answered counseling contacts girls aged 1318 years number contacts mental health suicideselfharm family relationships increased mental health contacts also increasing proportion total contacts covid19related concerns common reason contact april 2020 h3conclusionsh3 australia covid19 pandemic saw rapid increase demand kids helpline mainly webchat virus mental health suicideselfharm relationships common reasons contact responding rapid changes demand particular modalities challenging understanding use effectiveness different modalities needed

https://doi.org/10.1016/j.jadohealth.2021.03.015

Regina Bussing|Bonnie T. Zima|Dana M. Mason|Johanna M. Meyer|Kimberly A. White|Cynthia Wilson Garvan

ADHD Knowledge, Perceptions, and Information Sources: Perspectives From a Community Sample of Adolescents and Their Parents

University of Florida|University of Florida Health|University of California, Los Angeles|Neurobehavioral Systems|University of Florida|University of Florida|University of Florida|University of Florida

h2abstracth2h3purposeh3 chronic illness model advocates psychoeducation within collaborative care model enhance outcomes inform psychoeducational approaches adhd study describes parent adolescent knowledge perceptions information sources explores vary sociodemographic characteristics adhd risk past child mental health service use h3methodsh3 parents adolescents assessed 77 years initial school district screening adhd risk study sample included 374 adolescents 56 high 44 low adhd risk aged average 154 standard deviation18 years 36 african american survey questions assessed adhd knowledge perceptions cues action elicited used preferred information sources multiple logistic regression used determine potential independent predictors adhd knowledge mcnemar tests compared information source utilization preference h3resultsh3 despite relatively high selfrated adhd familiarity misperceptions among parents adolescents common including sugar etiology 25 27 respectively medication overuse 85 67 respectively african american respondents expressed less adhd awareness greater belief sugar etiology caucasians parents used wide range adhd information sources whereas adolescents relied social network members teachersschool however parents adolescents expressed similar strong preferences internet 49 51 respectively doctor 40 27 respectively adhd information sources h3conclusionsh3 culturally appropriate psychoeducational strategies needed combine doctorprovided adhd information reputable internet sources despite time limitations patient visits parents teens place high priority receiving information doctor

https://doi.org/10.1016/j.jadohealth.2012.03.004

Ramon Edmundo D. Bautista|E. Tannahill Glen|Namrata Shetty|Peter Wludyka

The association between health literacy and outcomes of care among epilepsy patients

University of Florida Health

h2abstracth2h3purposeh3 determine association health literacy outcomes care seizure control quality life individuals epilepsy followed level four epilepsy center h3methodsh3 conducted facetoface interview patients seen comprehensive epilepsy program university florida hscjacksonville obtained demographic clinical data administered quality life epilepsy10 inventory performed liverpool seizure severity scale asked three screening questions taken short test functional literacy adults using health literacy question target variable determined predictor variables associated responses questions performed multiple linear regression determine retained significance h3resultsh3 one hundred forty adult patients epilepsy comprised study population univariate analysis patients poorly questions health literacy included difficulty reading hospital materials difficulty filling medical forms lower scores qolie10 lower annual household incomes significance maintained multivariate analysis problems learning medical condition due difficulties understanding written information poorer scores qolie10 increased seizure frequency lower educational levels univariate analysis however multivariate analysis poorer scores quality life independently significant h3conclusionh3 patients epilepsy limited health literacy necessarily poorer seizure control lower quality life scores

https://doi.org/10.1016/j.seizure.2009.02.004

Eileen Fry-Bowers|Sally L. Maliski|Mary Ann Lewis|Aurelia Macabasco?O’Connell|Robin DiMatteo

The Association of Health Literacy, Social Support, Self-Efficacy and Interpersonal Interactions With Health Care Providers in Low-Income Latina Mothers

Children's Hospital of Orange County|Azusa Pacific University|University of California, Riverside

h2objectiveh2 explored relationships maternal health literacy hl communicative selfefficacy se social support ss maternal perception interactions health care providers hcps bmethodsb using crosssectional correlational design assessed sociodemographic characteristics maternal hl social support communicative selfefficacy interpersonal interactions hcps among 124 lowincome latina mothers young children bresultsb informal ss significantly predicted maternal se interactions se predicted maternal perception hcps ability elicit respond concerns bdiscussionb interventions improve maternal selfefficacy interacting hcps among low health literate latina mothers may positively impact pediatric health outcomes

https://doi.org/10.1016/j.pedn.2014.01.006

Urs Gasser|Marcello Ienca|James Scheibner|Joanna Sleigh|Effy Vayena

Digital tools against COVID-19: taxonomy, ethical challenges, and navigation aid

Internet Society|Harvard University|ETH Zurich|ETH Zurich|ETH Zurich|ETH Zurich

data collection processing via digital public health technologies promoted worldwide governments private companies strategic remedies mitigating covid19 pandemic loosening lockdown measures however ethical legal boundaries deploying digital tools disease surveillance control purposes unclear rapidly evolving debate emerged globally around promises risks mobilising digital tools public health help scientists policy makers navigate technological ethical uncertainty present typology primary digital public health applications use include proximity contact tracing symptom monitoring quarantine control flow modelling discuss contextspecific risks crosssectional issues ethical concerns finally recognising need practical guidance propose navigation aid policy makers decision makers ethical development use digital public health tools

https://doi.org/10.1016/s2589-7500(20)30137-0

Asifa Majid|Nicole Kruspe

Hunter-Gatherer Olfaction Is Special

Radboud University Nijmegen|Max Planck Institute for Psycholinguistics|Lund University

people struggle name odors 14 attributed diminution olfaction tradeoff vision 510 presumption challenged recently data huntergatherer jahai unlike english speakers find odors easy name colors 4 superior olfactory performance among jahai ecology tropical rainforest language family aslian subsistence huntergatherers provide novel evidence huntergatherer semaq beri nonhuntergatherer swiddenhorticulturalist semelai subsistence critical factor semaq beri semelai speakerswho speak closely related languages live tropical rainforest malay peninsulatook part controlled odor colornaming experiment swiddenhorticulturalist semelai found odors much difficult name colors replicating typical western finding huntergatherer semaq beri odor naming easy color naming suggesting huntergatherer olfactory cognition special

https://doi.org/10.1016/j.cub.2017.12.014

Vikram Patel|Dan Chisholm|Rachana Parikh|Fiona J Charlson|Louisa Degenhardt|Tarun Dua|Alize J. Ferrari|Steve Hyman|Ramanan Laxminarayan|Carol Levin|Crick Lund|María Elena Medina Mora|Inge Petersen|James G. Scott|Rahul Shidhaye|Lakshmi Vijayakumar|Graham Thornicroft|Harvey Whiteford

London School of Hygiene & Tropical Medicine|Public Health Foundation of India|Sangath|World Health Organization|Public Health Foundation of India|Queensland Centre for Mental Health Research|University of Queensland|Institute for Health Metrics and Evaluation|University of Washington|Institute for Health Metrics and Evaluation|University of Washington|UNSW Sydney|University of Melbourne|World Health Organization|Queensland Centre for Mental Health Research|University of Queensland|Institute for Health Metrics and Evaluation|University of Washington|Broad Institute|Harvard University|Center for Disease Dynamics, Economics & Policy|Public Health Foundation of India|Princeton University|University of Washington|University of Cape Town|King's College London|Instituto Nacional de Psiquiatría|University of KwaZulu-Natal|Royal Brisbane and Women's Hospital|University of Queensland|Maastricht University|Public Health Foundation of India|Society for Nutrition Education and Health Action|University of Melbourne|King's College London|University of Queensland|Institute for Health Metrics and Evaluation|University of Washington

burden mental neurological substance use mns disorders increased 41 1990 2010 accounts one every 10 lost years health globally sobering statistic take account substantial excess mortality associated disorders social economic consequences mns disorders affected persons caregivers society wide variety effective interventions including drugs psychological treatments social interventions prevent treat mns disorders populationlevel platform service delivery best practices include legislative measures restrict access means selfharm suicide reduce availability demand alcohol communitylevel platform best practices include lifeskills training schools build social emotional competencies healthcarelevel platform identify three delivery channels two delivery channels especially relevant public health perspective selfmanagement eg webbased psychological therapy depression anxiety disorders primary care community outreach eg nonspecialist health worker delivering psychological pharmacological management selected disorders third delivery channel hospital care includes specialist services mns disorders firstlevel hospitals providing types services general medicine hiv paediatric care play important part smaller proportion cases severe refractory emergency presentations integration mental health care healthcare channels respectively costs providing significantly scaled package specified costeffective interventions prioritised mns disorders lowincome lowermiddleincome countries estimated us34 per head population per year since substantial proportion mns disorders run chronic disabling course adversely affect household welfare intervention costs largely met government increased resource allocation financial protection measures rather leaving households pay outofpocket moreover policy moving towards universal public finance also expected lead far equitable allocation public health resources across income groups despite evidence less 1 development assistance health government spending health lowincome middleincome countries allocated care people disorders achieving health gains associated prioritised interventions require financial resources committed sustained efforts address range barriers paucity human resources weak governance stigma ultimately goal massively increase opportunities people mns disorders access services without prospect discrimination impoverishment hope attaining optimal health social outcomes

Megan Marx Delaney|Kate Miller|Lauren Bobanski|Shambhavi Singh|Vishwajeet Kumar|Ami Karlage|Danielle E Tuller|Atul A. Gawande|Katherine Semrau

Unpacking the null: a post-hoc analysis of a cluster-randomised controlled trial of the WHO Safe Childbirth Checklist in Uttar Pradesh, India (BetterBirth)

Ariadne Diagnostics (United States)|Ariadne Diagnostics (United States)|Ariadne Diagnostics (United States)|Ariadne Diagnostics (United States)|Ariadne Diagnostics (United States)|Harvard University|Ariadne Diagnostics (United States)|Brigham and Women's Hospital|Harvard University|Ariadne Diagnostics (United States)|Brigham and Women's Hospital

h3backgroundh3 coachingbased implementation safe childbirth checklist uttar pradesh india improved adherence evidencebased practices reduce perinatal mortality maternal morbidity maternal mortality examined facilitylevel correlates outcomes varied widely across 120 study facilities h3methodsh3 posthoc analysis coachingbased implementation safe childbirth checklist uttar pradesh used multivariable modelling identify correlations 30 facilitylevel characteristics health outcome perinatal mortality maternal morbidity maternal mortality identify contexts intervention might effect ran models data restricted period intensive coaching among patients referred facilities h3findingsh3 multivariable context perinatal mortality associated 3 30 variables female literacy district level geographical location previous neonatal mortality maternal morbidity associated geographical location facilitylevel predictors associated maternal mortality among facilities lowest tertile birth volume 95 births per month models estimated perinatal mortality 17 95 ci 117248 per 1000 births intervention group versus 38 316448 per 1000 control group p00001 h3interpretationh3 mortality directly associated measured facilitylevel indicators associated general risk factors absence correlation expected predictors patient outcomes association improved outcomes intervention smaller facilities suggest need additional measures quality care take account complexity h3fundingh3 bill melinda gates foundation

https://doi.org/10.1016/s2214-109x(19)30261-x

Elizabeth L. Prado|Susy Katikana Sebayang|Mandri Apriatni|Siti Robiah Adawiyah|Nina Hidayati|Ayuniarti Islamiyah|Sudirman Sudirman|Benyamin Harefa|Jarrad A. G. Lum|Katie Alcock|Michael T. Ullman|Husni Muadz|Anuraj H Shankar

Maternal multiple micronutrient supplementation and other biomedical and socioenvironmental influences on children's cognition at age 9–12 years in Indonesia: follow-up of the SUMMIT randomised trial

University of California, Davis|Deakin University|Lancaster University|Georgetown University|University of Mataram|Harvard University

h3backgroundh3 brain cognitive development first 1000 days conception affected multiple biomedical socioenvironmental determinants including nutrition health nurturing stimulation improved understanding longterm influence factors needed prioritise public health investments optimise human development h3methodsh3 followup study supplementation multiple micronutrients intervention trial summit doubleblind clusterrandomised trial maternal supplementation multiple micronutrients mmn iron folic acid ifa indonesia 27 356 live infants birth 3 months age 200104 reenrolled 19 274 70 children age 912 years randomly selected 2879 18 230 attending school known location 574 children oversampled mothers anaemic malnourished summit enrolment assessed effects mmn associations biomedical ie maternal child anthropometry haemoglobin preterm birth socioenvironmental determinants ie parental education socioeconomic status home environment maternal depression general intellectual ability declarative memory procedural memory executive function academic achievement fine motor dexterity socioemotional health summit trial registered number isrctn34151616 h3findingsh3 children mothers given mmn mean score 011 sd 95 ci 001020 p00319 higher procedural memory given ifa equivalent increase scores half year schooling children anaemic mothers mmn group scored 018 sd 006031 p00047 higher general intellectual ability similar increase 1 year schooling overall 18 21 tests showed positive coefficient mmn versus ifa p00431 effect sizes 000018 sd multiple regression models socioenvironmental determinants coefficients 000043 sd 22 35 tests significant 95 ci level whereas biomedical coefficients 000010 sd eight 56 tests significant indicating larger consistent impact socioenvironmental factors p00001 h3interpretationh3 maternal mmn longterm benefits child cognitive development 912 years age thereby supporting role early childhood development policy change toward mmn stronger association socioenvironmental determinants improved cognition suggests present reproductive maternal neonatal child health programmes focused biomedical determinants might sufficiently enhance child cognition programmes addressing socioenvironmental determinants essential achieve thriving populations h3fundingh3 grand challenges canada saving brains program

https://doi.org/10.1016/s2214-109x(16)30354-0

Rashida A Ferrand|Victoria Simms|Ethel Dauya|Tsitsi Bandason|Grace McHugh|Hilda Mujuru|Prosper Chonzi|Joanna Busza|Katharina Kranzer|Shungu Munyati|Helen A. Weiss|Richard Hayes

The effect of community-based support for caregivers on the risk of virological failure in children and adolescents with HIV in Harare, Zimbabwe (ZENITH): an open-label, randomised controlled trial

Biomedical Research and Training Institute|London School of Hygiene & Tropical Medicine|London School of Hygiene & Tropical Medicine|Biomedical Research and Training Institute|Biomedical Research and Training Institute|Biomedical Research and Training Institute|University of Zimbabwe|London School of Hygiene & Tropical Medicine|Research Center Borstel - Leibniz Lung Center|London School of Hygiene & Tropical Medicine|Biomedical Research and Training Institute|London School of Hygiene & Tropical Medicine|London School of Hygiene & Tropical Medicine

h3backgroundh3 children adolescents poorer hiv treatment outcomes adults aimed assess effect communitybased support caregivers hivinfected children adolescents key mediators children engaging care treatment outcomes h3methodsh3 openlabel randomised contolled trial recruited children aged 615 years newlydiagnosed hiv attending primary healthcare clinics harare zimbabwe children randomly assigned receive decentralised primary healthcare clinicbased hiv care control group according national guidelines 18 months decentralised care plus structured support visits trained community health workers intervention group according national guidelines 18 months primary outcomes proportion participants died hiv viral load 400 copies per ml higher 12 months antiretroviral therapy art initiation among started art within 6 months enrolment proportion missed two scheduled clinic visits 18 months postenrolment among participants analyses completecase modifiedintentiontotreat trial registered pan african clinical trials registry number pactr201212000442288 h3findingsh3 january 2013 january 2015 470 participants tested hivpositive seven study primary healthcare clinics screened eligibility 334 eligible children adolescents 166 randomly assigned intervention group 168 control group median age participants 11 years iqr 813 178 53 girls among 238 participants started art within 6 months enrolment proportion died viral load 400 copiesml higher 12 months postart initiation significantly lower intervention group control group 31 33 94 participants ivsi 42 49 86 participants respectively adjusted odds ratio aor 046 95 ci 023089 p002 proportion children missing two scheduled visits similar intervention group control group 27 17 155 ivsi 30 18 165 aor 092 95 ci 049174 p079 one participant withdrew trial 240 days enrolment 12 died followup five intervention group seven control group h3interpretationh3 communitybased support caregivers high potential scalability could substantial effect hiv virological suppression children adolescents group disproportionately poor treatment outcomes h3fundingh3 wellcome trust

https://doi.org/10.1016/s2352-4642(17)30051-2

Anja van der Hout|Cornelia F. van Uden?Kraan|Karen Holtmaat|Femke Jansen|Birgit I. Lissenberg?Witte|Grard A. P. Nieuwenhuijzen|José A. Hardillo|Robert J. Baatenburg de Jong|N. L. Tiren-Verbeet|Dirkje W. Sommeijer|Koen de Heer|C. G. Schaar|Robert Jan E. Sedee|K. Bosscha|M.W.M. van den Brekel|Japke F. Petersen|Matthijs Westerman|Jimmie Honings|Robert P. Takes|Ilse Houtenbos|W. T. van den Broek|Remco de Bree|P. Jansen|Simone E. J. Eerenstein|C. René Leemans|Josée M. Zijlstra|Pim Cuijpers|Lonneke V. van de Poll?Franse|Irma M. Verdonck?de Leeuw

Role of eHealth application Oncokompas in supporting self-management of symptoms and health-related quality of life in cancer survivors: a randomised, controlled trial

Vrije Universiteit Amsterdam|Amsterdam University Medical Centers|Vrije Universiteit Amsterdam|Amsterdam University Medical Centers|Vrije Universiteit Amsterdam|Amsterdam University Medical Centers|Amsterdam University Medical Centers|Vrije Universiteit Amsterdam|Vrije Universiteit Amsterdam|Amsterdam University Medical Centers|Catharina Ziekenhuis|Radboud University Nijmegen|Rotterdam University of Applied Sciences|Rotterdam University of Applied Sciences|Erasmus University Rotterdam|University of Amsterdam|Flevoziekenhuis|University of Amsterdam|Amsterdam University Medical Centers|Flevoziekenhuis|Gelre Hospitals|GGD Haaglanden|Jeroen Bosch Ziekenhuis|The Netherlands Cancer Institute|The Netherlands Cancer Institute|Radboud University Nijmegen|Radboud University Medical Center|Radboud University Nijmegen|Radboud University Medical Center|Spaarne Ziekenhuis|Spaarne Gasthuis|St. Anna Ziekenhuis|University Medical Center Utrecht|Utrecht University|Elisabeth-TweeSteden Ziekenhuis|Vrije Universiteit Amsterdam|Amsterdam University Medical Centers|Vrije Universiteit Amsterdam|Amsterdam University Medical Centers|Vrije Universiteit Amsterdam|Amsterdam University Medical Centers|Vrije Universiteit Amsterdam|Netherlands Comprehensive Cancer Organisation|Tilburg University|The Netherlands Cancer Institute|Vrije Universiteit Amsterdam|Amsterdam University Medical Centers

h3backgroundh3 knowledge efficacy behavioural intervention technologies used cancer survivors independently healthcare provider scarce aimed assess efficacy reach usage oncokompas webbased ehealth application supports survivors selfmanagement monitoring healthrelated quality life hrqol cancergeneric tumourspecific symptoms obtaining tailored feedback personalised overview supportive care options h3methodsh3 nonblinded randomised controlled trial recruited patients treated 14 hospitals netherlands head neck cancer colorectal cancer breast cancer hodgkin lymphoma nonhodgkin lymphoma adult survivors aged 18 years recruited netherlands cancer registry ncr invited treating physician patient reported outcomes following initial treatment long term evaluation survivorship profiles registry participants randomly assigned 11 independent researcher intervention group access oncokompas control group access oncokompas 6 months use block randomisation block length 68 stratified tumour type primary outcome patient activation knowledge skills confidence selfmanagement assessed baseline postintervention 3month 6month followup linear mixed models intentiontotreat used assess group differences time baseline 6month followup trial registered netherlands trial register ntr5774 completed h3findingsh3 oct 12 2016 may 24 2018 625 21 2953 survivors assessed eligibility recruited randomly assigned intervention 320 control group 305 median followup 6 months iqr 66 patient activation significantly different intervention control group time difference 6month followup 17 95 ci 0841 p041 h3interpretationh3 oncokompas improve amount knowledge skills confidence selfmanagement cancer survivors study contributes evidence development tailored strategies development implementation behavioural intervention technologies among cancer survivors h3fundingh3 dutch cancer society kwf kankerbestrijding

https://doi.org/10.1016/s1470-2045(19)30675-8

Chris Salisbury|Alicia O’Cathain|Louisa Edwards|Clare Thomas|Daisy Gaunt|Sandra Hollinghurst|Jon Nicholl|Shirley Large|Lucy Yardley|Glyn Lewis|Alexis Foster|Katy Garner|Kimberley Horspool|Mei?See Man|Anne Rogers|Catherine Pope|Padraig Dixon|Alan Montgomery

Effectiveness of an integrated telehealth service for patients with depression: a pragmatic randomised controlled trial of a complex intervention

University of Bristol|University of Sheffield|University of Bristol|University of Bristol|University of Bristol|University of Bristol|University of Sheffield|University of Southampton|University College London|University of Sheffield|University of Bristol|University of Sheffield|University of Bristol|University of Southampton|University of Southampton|University of Bristol|University of Bristol|University of Nottingham

h3backgroundh3 many countries exploring potential telehealth interventions manage rising number people chronic disorders however evidence effectiveness telehealth ambiguous based evidencebased conceptual framework developed integrated telehealth service healthlines service chronic disorders assessed effectiveness patients depression aimed compare healthlines depression service plus usual care usual care alone h3methodsh3 study pragmatic multicentre randomised controlled trial participants recruited 43 general practices three areas england eligible participants needed access internet email patient health questionnaire 9 phq9 score least 10 confirmed diagnosis depression participants individually assigned 11 either healthlines depression service plus usual care usual care alone random assignment done use webbased automated randomisation system stratified site minimised practice phq9 score participants aware allocation outcomes analysed masked healthlines service consisted regular telephone calls nonclinical trained health advisers followed standardised scripts generated interactive software initial assessment goalsetting telephone call advisers called participant six occasions 4 months made three calls intervals roughly 2 months provide reinforcement detect relapse advisers supported participants use online resources including computerised cognitive behavioural therapy sought encourage healthier lifestyles optimise medication improve treatment adherence primary outcome proportion participants responding intervention defined phq9 10 reduction phq9 5 points 4 months randomisation primary analysis based intentiontotreat principle without imputation serious adverse events investigated trial registered current controlled trials number isrctn 14172341 h3findingsh3 july 24 2012 july 31 2013 recruited 609 participants randomly assigning 307 healthlines service plus usual care 302 usual care primary outcome data available 525 86 participants 4 months 68 27 255 individuals intervention group treatment response compared 50 19 270 individuals usual care group adjusted odds ratio 17 95 ci 1125 p0019 compared usual care alone intervention participants reported improvements anxiety better access support advice greater satisfaction support received improvements selfmanagement health literacy trial 70 adverse events reported participants one related intervention increased anxiety discussing depression serious h3interpretationh3 telehealth service based nonclinically trained health advisers supporting patients use internet resources acceptable effective compared usual care results provide support development assessment similar interventions chronic disorders expand care provision h3fundingh3 national institute health research nihr

https://doi.org/10.1016/s2215-0366(16)00083-3

Yang Zhao|Rifat Atun|Brian Oldenburg|Barbara McPake|Shenglan Tang|Stewart W Mercer|Thomas E Cowling|Grace Sum|Vicky Mengqi Qin|John Tayu Lee

Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data

George Institute for Global Health|Peking University|The George Institute for Global Health|University of Melbourne|Harvard Global Health Institute|Harvard University|The George Institute for Global Health|University of Melbourne|The George Institute for Global Health|University of Melbourne|Duke Institute for Health Innovation|Duke University|University of Edinburgh|London School of Hygiene & Tropical Medicine|National University Health System|National University of Singapore|National University Health System|National University of Singapore|Imperial College London|The George Institute for Global Health|University of Melbourne

h3backgroundh3 multimorbidity presence two mental physical chronic noncommunicable diseases major challenge health system china faces unprecedented ageing population examined distribution physical multimorbidity relation socioeconomic status association physical multimorbidity healthcare service use catastrophic health expenditures whether associations varied socioeconomic group social health insurance schemes h3methodsh3 populationbased panel data analysis used data three waves nationally representative china health retirement longitudinal study charls 2011 2013 2015 included participants aged 50 years older 2015 complete followup three waves used 11 physical noncommunicable diseases measure physical multimorbidity annual percapita household consumption spending proxy socioeconomic status h3findingsh3 17 708 participants charls 11 817 eligible inclusion analysis median age participants 62 years iqr 5669 2015 5766 488 participants male 7320 619 eligible participants physical multimorbidity china 2015 prevalence physical multimorbidity increased older age odds ratio 293 95 ci 271315 among women 270 204357 within higher socioeconomic group quartile 4 highest group 150 124182 higher educational level 517 302883 however physical multimorbidity common poorer regions affluent regions additional chronic noncommunicable disease associated increase number outpatient visits incidence rate ratio 129 95 ci 127131 number days spent hospital inpatient 138 135141 saw similar effects health service use additional chronic noncommunicable disease different socioeconomic groups among covered different social health insurance programmes overall physical multimorbidity associated significantly increased likelihood catastrophic health expenditure overall population odds ratio 129 95 ci 126132 adjusted sociodemographic variables effect physical multimorbidity catastrophic health expenditures persisted even among higher socioeconomic groups across health insurance programmes h3interpretationh3 concerted efforts needed reduce health inequalities due physical multimorbidity adverse economic effect population groups china social health insurance reforms must place emphasis reducing outofpocket spending patients multimorbidity provide greater financial risk protection h3fundingh3 none

https://doi.org/10.1016/s2214-109x(20)30127-3

Mariachiara Di Cesare|Zaid Bhatti|Sajid Soofi|Léa Fortunato|Majid Ezzati|Zulfiqar A Bhutta

Geographical and socioeconomic inequalities in women and children's nutritional status in Pakistan in 2011: an analysis of data from a nationally representative survey

Imperial College London|Aga Khan University|Aga Khan University|Imperial College London|Imperial College London|Hospital for Sick Children|Aga Khan University

h3backgroundh3 pakistan one highest levels child maternal undernutrition worldwide little information geographical socioeconomic inequalities available aimed analyse anthropometric indicators childhood maternal nutrition district level pakistan assess association nutritional status food security maternal household socioeconomic factors h3methodsh3 used data 2011 pakistan national nutrition survey included anthropometric measurements 33 638 children younger 5 years 24 826 women childbearing age estimated prevalences stunting wasting underweight among children underweight overweight obesity women 143 districts pakistan using bayesian spatial technique used mixedeffect linear model analyse association nutritional status individual household sociodemographic factors food security h3findingsh3 stunting prevalence pakistans districts ranged 22 95 credible interval 1926 76 6983 lowest figures wasting underweight less 25 highest 42 3450 wasting 54 4959 underweight 106 districts women overweight underweight 49 districts women obese underweight children better nourished mothers taller higher weight lived wealthier households mothers 10 years education severe food insecurity associated worse nutritional outcomes children women h3interpretationh3 noted large social geographical inequalities child maternal nutrition pakistan masked national provincial averages pakistan also beginning face concurrent challenge high burden childhood undernutrition overweight obesity among women reproductive age planning implementation evaluation programmes food nutrition based districtlevel needs outcomes h3fundingh3 bill melinda gates foundation grand challenges canada uk medical research council

https://doi.org/10.1016/s2214-109x(15)70001-x

Preet K. Dhillon|Prashant Mathur|A Nandakumar|Christina Fitzmaurice|G Anil Kumar|Ravi Mehrotra|Deepak Shukla|Goura Kishor Rath|Prakash C. Gupta|Rajaraman Swaminathan|JS Thakur|Subhojit Dey|Christine A. Allen|Rajendra Badwe|Rajesh Dikshit|Rupinder Singh Dhaliwal|Tanvir Kaur|Amal Ch Kataki|Rudrapatna N. Visweswara|P Gangadharan|Eliza Dutta|Melissa Furtado|Chris M Varghese|Deeksha Bhardwaj|Pallavi Muraleedharan|Christopher M Odell|Scott Glenn|Manjit Singh Bal|P. P. Bapsy|James R. Bennett|Vijay Kumar Bodal|Joy Kumar Chakma|Sekhar Chakravarty|Meesha Chaturvedi|Priyanka Das|Vinay Deshmane|Nitin Gangane|James D. Harvey|Padmavathy Amma Jayalekshmi|Kaling Jerang|Sarah Johnson|P.K. Julka|Debnath Kaushik|Vinotsole Khamo|Shravani Koyande|Michael Kutz|W B Langstieh|K B Lingegowda|Rajeev Mahajan|Jagadish Mahanta|Gautam Majumdar|N Manoharan|Aleyamma Mathew|Bhagwan M. Nene|Sanghamitra Pati|P K Pradhan|Vinod Raina|Rama Ranganathan|C. Ramesh|Krishnan Sathishkumar|Kathryn Schelonka|Paul Stolzmann|Katya Anne Shackelford|Janmesh Shah|V. Shanta|Jagannath Dev Sharma|Abhishek Shrivastava|Sopai Tawsik|Brij Bhushan Tyagi|K Vaitheeswaran|Elizabeth Vallikad|Yogesh Kumar Verma|Eric Zomawia|Stephen S Lim|Theo Vos|Rakhi Dandona|K. Srinath Reddy|Mohsen Naghavi|Christopher J L Murray|Soumya Swaminathan|Lalit Dandona

The burden of cancers and their variations across the states of India: the Global Burden of Disease Study 1990–2016

h3backgroundh3 previous efforts report estimates cancer incidence mortality india different parts include national cancer registry programme reports sample registration system cause death findings cancer incidence five continents series globocan present comprehensive picture patterns time trends burden total cancer specific cancer types state india estimated part global burden diseases injuries risk factors study gbd 2016 systematic compilation readily available h3methodsh3 used accessible data multiple sources including 42 populationbased cancer registries nationwide sample registration system india estimate incidence 28 types cancer every state india 1990 2016 deaths disabilityadjusted lifeyears dalys caused part gbd 2016 present incidence dalys death rates cancers together trends types cancers highlighting heterogeneity burden specific types cancers across states india also present contribution major risk factors cancer dalys india h3findingsh3 83 95 uncertainty interval ui 7986 total deaths 50 4655 total dalys india 2016 due cancer double contribution cancer 1990 however agestandardised incidence rate cancer change substantially period agestandardised cancer daly rate 26 times variation across states india 2016 ten cancers responsible highest proportion cancer dalys india 2016 stomach 90 total cancer dalys breast 82 lung 75 lip oral cavity 72 pharynx nasopharynx 68 colon rectum 58 leukaemia 52 cervical 52 oesophageal 43 brain nervous system 35 cancer among cancers agestandardised incidence rate breast cancer increased significantly 407 95 ui 70856 1990 2016 whereas decreased stomach 397 343440 lip oral cavity 64 04186 cervical 397 265573 oesophageal cancer 312 279349 leukaemia 161 43242 found substantial interstate heterogeneity agestandardised incidence rate different types cancers 2016 33 times 116 times variation four frequent cancers lip oral breast lung stomach tobacco use leading risk factor cancers india highest proportion 109 cancer dalys could attributed 2016 h3interpretationh3 substantial heterogeneity statelevel incidence rate health loss trends different types cancer india 26year period taken account strengthen infrastructure human resources cancer prevention control national state levels efforts focus ten cancers contributing highest dalys india including cancers stomach lung pharynx nasopharynx colon rectum leukaemia oesophageal brain nervous system addition breast lip oral cavity cervical cancer currently focus screening early detection programmes h3fundingh3 bill melinda gates foundation indian council medical research department health research ministry health family welfare government india

https://doi.org/10.1016/s1470-2045(18)30447-9

Fiammetta Rita Bianchi|Emma Garnett|Claudia Dorsel|Paul Aveyard|Susan A. Jebb

Restructuring physical micro-environments to reduce the demand for meat: a systematic review and qualitative comparative analysis

University of Oxford|University of Cambridge|Heinrich Heine University Düsseldorf|University of Oxford|University of Oxford

h3backgroundh3 reducing meat consumption could help protect natural environment promote population health interventions restructuring physical microenvironments might help change habitual behaviour synthesised scientific evidence pertaining whether interventions restructuring physical microenvironments effectively reduce demand meat h3methodsh3 systematic review quantitative studies evaluating effectiveness interventions restructuring physical microenvironments reduce demand meat identified relevant records searching six electronic databases cab abstracts embase psycinfo science citation index medline dissertations theses aug 31 2017 contacting experts screening publicly accessible online resources searching references included studies evaluated effectiveness interventions restructuring physical microenvironments reduce demand meat defined actual intended consumption purchase selection meat real virtual environments extracted data pertaining study samples interventions meat demand followup closest intervention completion longest followup former representing primary outcome synthesised data narratively qualitative comparative analysis identify configurations intervention characteristics associated found associated significant reductions meat demand systematic review registered prospero number crd42017081532 h3resultsh3 10 733 titles abstracts screened eligibility assessed 60 full papers included 14 papers reporting 18 studies 22 intervention conditions three interventions reducing portion size meat servings reduced meat consumption randomised trials three interventions providing meat alternatives supporting educational material associated reduced meat demand prepost design studies three four interventions altering sensory properties eg visual presentation meat meat alternatives point purchase reduced meat demand randomised trials four interventions repositioning meat products less prominent point purchase associated lower meat demand two interventions reached statistical significance randomised trial multiple treatment reversal design one five interventions manipulating description meat meat alternatives point purchase associated lower meat demand multiple treatment reversal design evidence randomised trials evaluating pricing intervention interventions restructuring several aspects microenvironments scarce inconsistent conclusive results qualitative comparative analysis supported findings narrative synthesis h3interpretationh3 interventions restructuring physical microenvironments could help promote lower demand meat interventions reducing portion sizes meat servings providing meat alternatives changing sensory properties meat meat alternatives point purchase offered promise context experimental studies h3fundingh3 none

https://doi.org/10.1016/s2542-5196(18)30188-8

Patience A. Afulani|Beth Phillips|Raymond Aborigo|Cheryl A. Moyer

Person-centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and India

Global Brain Health Institute|University of California, San Francisco|Global Brain Health Institute|University of California, San Francisco|Navrongo Health Research Centre|University of Michigan–Ann Arbor

h3backgroundh3 several qualitative studies described disrespectful abusive neglectful treatment women facilitybased childbirth studies document extent personcentred maternity care pcmcie responsive respectful maternity carein lowincome middleincome countries article present descriptive statistics pcmc four settings across three lowincome middleincome countries examine key factors associated pcmc setting h3methodsh3 examined data four crosssectional surveys 3625 women aged 1549 years recently given birth kenya ghana india surveys done august 2016 october 2017 kenya data collected rural county n877 seven health facilities two urban counties n530 ghana data five rural health facilities northern region n200 india data 40 health facilities uttar pradesh n2018 pcmc measure used previously validated scale subscales dignity respect communication autonomy supportive care analysed data using descriptive statistics bivariate multivariate regressions examine predictors pcmc h3findingsh3 highest mean pcmc score found urban kenya 602 sd 123 90 lowest rural ghana 465 69 across sites lowest scores communication autonomy 83 33 27 ghana 151 59 urban kenya 3280 90 total 3625 women across countries reported providers never introduced 2076 57 women 1475 73 1980 india reported providers never asked permission performing medical procedures 120 60 200 women ghana 1393 69 1980 women india reported providers explain purpose examinations procedures 116 58 women ghana 1162 58 india reported receive explanations medications given additionally 104 52 women ghana feel able ask questions overall 576 16 women across countries reported verbal abuse 108 3 reported physical abuse pcmc varied socioeconomic status type facility three settings ie rural urban kenya india h3interpretationh3 regardless setting women getting adequate pcmc efforts needed improve quality facilitybased maternity care h3fundingh3 bill melinda gates foundation marc lynne benioff usaid systems health

https://doi.org/10.1016/s2214-109x(18)30403-0

Carmen Figueroa|Cheryl Johnson|Nathan Ford|Anita Sands|Shona Dalal|Robyn Meurant|Irena Prat|Karin Hatzold|Willy Urassa|Rachel Baggaley

Reliability of HIV rapid diagnostic tests for self-testing compared with testing by health-care workers: a systematic review and meta-analysis

World Health Organization|World Health Organization|London School of Hygiene & Tropical Medicine|World Health Organization|World Health Organization|World Health Organization|World Health Organization|World Health Organization|World Health Organization|World Health Organization

h3backgroundh3 ability individuals use hiv selftests correctly debated inform 2016 recommendation hiv selftesting assessed reliability performance hiv rapid diagnostic tests used selftesters h3methodsh3 systematic review metaanalysis searched pubmed popline embase conference abstracts additional grey literature jan 1 1995 april 30 2016 observational experimental studies reporting hiv selftesting performance excluded studies evaluating home specimen collection patients interpret test results extracted data independently using standardised extraction forms outcomes interest agreement selftesters healthcare workers sensitivity specificity calculated establish level agreement pooled estimates using randomeffects model approach directly assisted unassisted type specimen blood oral fluid examined heterogeneity iiisup2sup statistic h3findingsh3 25 studies met inclusion criteria 22 5662 participants quality assessment quadas2 showed studies low risk bias incomplete reporting accordance stard checklist raw proportion agreement ranged 854 100 reported ranged fair 0277 p0001 almost perfect 099 n25 pooled suggested almost perfect agreement types approaches directly assisted 098 95 ci 096099 unassisted 097 096098 iiisup2sup345 0978 excluding two outliers sensitivity specificity higher bloodbased rapid diagnostic tests 416 compared oral fluid rapid diagnostic tests 1316 common error affected test performance incorrect specimen collection oral swab finger prick study limitations included use different reference standards disaggregation results individuals taking antiretrovirals h3interpretationh3 selftesters reliably accurately hiv rapid diagnostic tests compared trained healthcare workers errors performance might reduced improvement rapid diagnostic tests selftesting particularly make sample collection easier simplify instructions use h3fundingh3 bill melinda gates foundation unitaid

https://doi.org/10.1016/s2352-3018(18)30044-4

Li Zhang|Holly Seale|Shanshan Wu|Peng Yang|Yang Zheng|Caiyun Ma|C. Raina MacIntyre|Quanyi Wang

Post-pandemic assessment of public knowledge, behavior, and skill on influenza prevention among the general population of Beijing, China

Beijing Center for Disease Prevention and Control|Capital Medical University|UNSW Sydney|Beijing Center for Disease Prevention and Control|Capital Medical University|Beijing Center for Disease Prevention and Control|Capital Medical University|Beijing Center for Disease Prevention and Control|Capital Medical University|Beijing Center for Disease Prevention and Control|Capital Medical University|UNSW Sydney|Beijing Center for Disease Prevention and Control|Capital Medical University

h3backgroundh3 aim study assess knowledge behavioral skill responses toward influenza general population beijing pandemic influenza h1n1 2009 h3methodsh3 crosssectional study conducted beijing china january 2011 survey conducted information collected using standardized questionnaire comprehensive evaluation index system health literacy related influenza built evaluate level health literacy regarding influenza prevention control among residents beijing h3resultsh3 thirteen thousand fiftythree valid questionnaires received average score sum knowledge behavior skill 1412322 mean scores knowledge behavior skill 465120 725194 221131 respectively qualified proportions three sections 237 119 434 respectively total proportion qualified level 67 significant differences health literacy level related influenza among different gender age educational level occupational status location groups ipi005 significant association knowledge behavior iri0084 ipi0001 knowledge skill iri0102 ipi0001 h3conclusionsh3 health literacy level remains low among general population beijing extent relativities knowledge behavior skill influenza found weak therefore improvements needed terms certain aspects particularly elderly population rural districts educational level significant factor reducing spread influenza considered seriously intervention strategies implemented

https://doi.org/10.1016/j.ijid.2014.01.003

Margaret E Kruk|Anna Gage|Naima T. Joseph|Goodarz Danaei|Sebastián García-Saisó|Joshua A. Salomon

Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries

Harvard Global Health Institute|Harvard Global Health Institute|Emory University|Harvard Global Health Institute|Stanford University

h3backgroundh3 universal health coverage proposed strategy improve health lowincome middleincome countries lmics however contingent provision goodquality health care estimate excess mortality conditions targeted sustainable development goals sdg amenable health care portion excess mortality due poorquality care 137 lmics excess mortality refers deaths could averted settings strong health systems h3methodsh3 using data 2016 global burden disease study calculated mortality amenable personal health care 61 sdg conditions comparing case fatality lmic corresponding numbers 23 highincome reference countries strong health systems used data healthcare utilisation population surveys separately estimate portion amenable mortality attributable nonutilisation health care versus attributable receipt poorquality care h3findingsh3 156 million excess deaths 61 conditions occurred lmics 2016 excluding deaths could prevented public health measures 86 million excess deaths amenable health care 50 million estimated due receipt poorquality care 36 million due nonutilisation health care poor quality health care major driver excess mortality across conditions cardiovascular disease injuries neonatal communicable disorders h3interpretationh3 universal health coverage sdg conditions could avert 86 million deaths per year expansion service coverage accompanied investments highquality health systems h3fundingh3 bill melinda gates foundation

https://doi.org/10.1016/s0140-6736(18)31668-4

Jane Wardle|Christian von Wagner|Ines Kralj?Hans|Stephen P Halloran|Samuel G. Smith|Lesley McGregor|Gemma Vart|Rosemary Howe|Julia Snowball|Graham Handley|Richard F. Logan|Sandra Rainbow|Steve Smith|Mary Thomas|Nicholas Counsell|Stephen Morris|Stephen W. Duffy|Allan Hackshaw|Sue Moss|Wendy Atkin|Rosalind Raine

Effects of evidence-based strategies to reduce the socioeconomic gradient of uptake in the English NHS Bowel Cancer Screening Programme (ASCEND): four cluster-randomised controlled trials

University College London|University College London|King's College London|Royal Surrey County Hospital|University of Surrey|Royal Surrey NHS Foundation Trust|University College London|Queen Mary University of London|University College London|University College London|Imperial College London|Royal Surrey NHS Foundation Trust|Royal Surrey County Hospital|Gateshead Health NHS Foundation Trust|Queen Elizabeth Hospital|Nottingham University Hospitals NHS Trust|St Mark's Hospital|University Hospitals Coventry and Warwickshire NHS Trust|Hospital of St. Cross|University College London|University College London|London Cancer|University College London|Queen Mary University of London|University College London|London Cancer|Queen Mary University of London|Imperial College London|University College London

h3backgroundh3 uptake national colorectal cancer screening programme england varies socioeconomic status assessed four interventions aimed reducing gradient intention improving health benefits screening h3methodsh3 people eligible screening men women aged 6074 years across england included four clusterrandomised trials randomisation based day invitation trial compared standard information standard information plus following supplementary interventions trial 1 november 2012 supplementary leaflet summarising gist key information trial 2 march 2012 supplementary narrative leaflet describing peoples stories trial 3 june 2013 general practice endorsement programme invitation letter trial 4 julyaugust 2013 enhanced reminder letter banner reiterated screening offer socioeconomic status defined index multiple deprivation score home address primary outcome socioeconomic status gradient uptake across deprivation quintiles study registered number isrctn74121020 h3findingsh3 four trials embedded screening programme loss followup minimal less 05 trials 1 n163 525 2 n150 417 showed effects socioeconomic gradient uptake overall uptake trial 3 n265 434 showed effect socioeconomic gradient associated increased overall uptake adjusted odds ratio 107 95 ci 104110 p00001 trial 4 n168 480 significant interaction seen socioeconomic status gradient p0005 stronger effect deprived quintile adjusted 111 95 ci 104120 p0003 least deprived 100 094106 p098 overall uptake also increased 107 103111 p0001 h3interpretationh3 four evidencebased interventions enhanced reminder letter reduced socioeconomic gradient screening uptake reducing inequalities screening uptake written materials alone challenging h3fundingh3 national institute health research

https://doi.org/10.1016/s0140-6736(15)01154-x

Enrique Castro?Sánchez|Peter Chang|Rafael Vila?Candel|Ángel A. Escobedo|Alison Holmes

Health literacy and infectious diseases: why does it matter?

Imperial College London|Ministry of Health and Welfare|Taipei Hospital|Taipei Medical University|Hospital de La Ribera|Imperial College London

h3objectivesh3 multifactorial interventions crucial arrest threat posed infectious diseases public involvement requires adequate information determinants health literacy impact effective use knowledge influence health literacy infectious diseases examined paper h3methodsh3 databases searched january 1999 july 2015 seeking studies reporting health literacy infections tuberculosis malaria influenza infectionrelated behaviours vaccination hand hygiene hiv excluded comprehensive reviews already published h3resultsh3 studies found antibiotic knowledge use adoption influenza mmr immunizations screening sexually transmitted viral hepatitis infections lack investigations areas tuberculosis malaria hand hygiene diarrhoeal diseases h3conclusionsh3 limited insufficient health literacy associated reduced adoption protective behaviours immunization inadequate understanding antibiotics although relationship consistent large gaps remain relation infectious diseases high clinical societal impact tuberculosis malaria

https://doi.org/10.1016/j.ijid.2015.12.019

David B. Evans|Ajay Tandon|Christopher J L Murray|Jeremy A. Lauer

Comparative efficiency of national health systems: cross national econometric analysis

World Health Organization|World Health Organization|World Health Organization - Pakistan|World Health Organization

h3abstracth3 bobjectiveb improve evidence base health policy devising method measure monitor performance health systems bdesignb estimation relation levels population health inputs used produce health bsettingb 191 countries bmain outcome measureb health system efficiency performance bresultsb estimated efficiency varied nearly fully efficient nearly fully inefficient countries history civil conflict high prevalence hiv aids less efficient performance increased health expenditure per capita bconclusionsb increasing resources health systems critical improving health poor countries important gains made countries using existing resources efficiently h3what already known topich3 evidence effectiveness health system reforms scarce studies used consistent framework specifying goals measuring outcomes h3what study addsh3 countries best levels health always efficient health systems efficiency related expenditure health per capita especially low expenditure methods measuring performance provide basis identifying policies improve health monitoring reforms

https://doi.org/10.1136/bmj.323.7308.307

G. David Batty|Geoff Der|Sally MacIntyre|Ian J. Deary

Does IQ explain socioeconomic inequalities in health? Evidence from a population based cohort study in the west of Scotland

MRC/CSO Social and Public Health Sciences Unit|University of Glasgow|MRC/CSO Social and Public Health Sciences Unit|University of Glasgow|MRC/CSO Social and Public Health Sciences Unit|University of Glasgow|University of Edinburgh

h3abstracth3 bobjectiveb test hypothesis iq fundamental cause socioeconomic inequalities health bdesignb cross sectional prospective cohort study indicators iq assessed written test socioeconomic position self report bsettingb west scotland bparticipantsb 1347 people 739 women aged 56 1987 bmain outcome measuresb total mortality coronary heart disease mortality ascertained 1987 2004 respiratory function self reported minor psychiatric morbidity long term illness self perceived health assessed 1988 bresultsb sex adjusted analyses indices socioeconomic position childhood current social class education income area deprivation significantly associated health outcome thus greatest risk ill health mortality evident socioeconomically disadvantaged groups expected adjustment iq marked attenuation risk occurred poor mental health range attenuation risk ratio across five socioeconomic indicators 1558 long term illness 2553 poor self perceived health 4156 respiratory function 4466 coronary heart disease mortality 31111 total mortality 45131 despite clear reduction magnitude effects controlling iq half associations examined risk ill health socioeconomically disadvantaged people still least twice advantaged people statistical significance lost 525 separate socioeconomic health gradients showed significant relations sex adjusted analyses bconclusionsb scores iq test used completely explain socioeconomic gradients health however controlling iq lead marked reduction magnitude gradients exploration currently scant information iq socioeconomic position health needed

https://doi.org/10.1136/bmj.38723.660637.ae

H. Larum|Gunnar Ellingsen|Arild Faxvaag

Doctors' use of electronic medical records systems in hospitals: cross sectional survey

h3abstracth3 bobjectivesb compare use three electronic medical records systems doctors norwegian hospitals general clinical tasks bdesignb cross sectional questionnaire survey semistructured telephone interviews key staff information technology hospital details local implementation systems bsettingb 32 hospital units 19 norwegian hospitals electronic medical records systems bparticipantsb 227 72 314 hospital doctors responded equally distributed three electronic medical records systems bmain outcome measuresb proportion respondents used electronic system calculated 23 tasks difference proportions users different systems functionality systems similar bresultsb tasks listed questionnaire 1523 generally covered implemented functions electronic medical records systems however systems used 27 tasks mainly associated reading patient data respondents showed significant differences frequency use different systems four tasks systems offered equivalent functionality respondents scored highly computer literacy 722100 computer use showed correlation respondents9 age sex work position user satisfaction scores generally positive 672100 difference systems bconclusionsb doctors used electronic medical records systems far fewer tasks systems supported h3what already known topich3 electronic information systems health care undergone systematic evaluation comparisons electronic medical records systems made given information intensive nature clinical work electronic medical records systems help doctors clinical tasks h3what study addsh3 doctors norwegian hospitals reported low level use electronic medical records systems systems mainly used reading patient data doctors used systems less half tasks systems functional analyses actual use electronic medical records provide information user satisfaction functionality records systems

https://doi.org/10.1136/bmj.323.7325.1344

Rosie Dobson|Robyn Whittaker|Yannan Jiang|Ralph Maddison|Matthew Shepherd|Catherine McNamara|Richard Cutfield|Manish Khanolkar|Rinki Murphy

Effectiveness of text message based, diabetes self management support programme (SMS4BG): two arm, parallel randomised controlled trial

University of Auckland|Waitemata District Health Board|University of Auckland|University of Auckland|Deakin University|University of Auckland|North Shore Hospital|North Shore Hospital|Greenlane Clinical Centre|University of Auckland|Greenlane Clinical Centre

h3abstracth3 h3objectiveh3 determine effectiveness theoretically based individually tailored text message based diabetes self management support intervention sms4bg adults poorly controlled diabetes h3designh3 nine month two arm parallel randomised controlled trial h3settingh3 primary secondary healthcare services new zealand h3participantsh3 366 participants aged 16 years poorly controlled type 1 type 2 diabetes hba1c 65 mmolmol 8 randomised june 2015 november 2016 n183 intervention n183 control h3interventionsh3 intervention group received tailored package text messages nine months addition usual care text messages provided information support motivation reminders related diabetes self management lifestyle behaviours control group received usual care messages delivered specifically designed automated content management system h3main outcome measuresh3 primary outcome measure change glycaemic control hba1c baseline nine months secondary outcomes included change hba1c three six months self efficacy diabetes self care behaviours diabetes distress perceptions beliefs diabetes health related quality life perceived support diabetes management intervention engagement satisfaction nine months regression models adjusted baseline outcome health district category diabetes type ethnicity h3resultsh3 reduction hba1c nine months significantly greater intervention group mean 885 mmolmol standard deviation 1484 control group 396 mmolmol 1702 adjusted mean difference 423 95 confidence interval 730 115 p0007 21 secondary outcomes four showed statistically significant improvements favour intervention group nine months significant improvements seen foot care behaviour adjusted mean difference 085 95 confidence interval 040 129 plt0001 overall diabetes support 026 003 050 p003 health status eq5d visual analogue scale 438 044 833 p003 perceptions illness identity 054 104 003 p004 high levels satisfaction sms4bg found 161 95 169 participants reporting useful 164 97 willing recommend programme people diabetes h3conclusionh3 tailored text message based self management support programme resulted modest improvements glycaemic control adults poorly controlled diabetes although clinical significance results unclear findings support investigation use sms4bg text message based support patient population h3trial registrationh3 australian new zealand clinical trials registry actrn12614001232628

https://doi.org/10.1136/bmj.k1959

Miriam Temin|Craig J Heck

Close to Home: Evidence on the Impact of Community-Based Girl Groups

h3abstracth3 h3purposeh3 communitybased programming promote gender equity often delivered communitybased girl groups cbggs sometimes called safe spaces increasing however evidence weak cbggs implemented effect adolescent girls health wellbeing conducted comprehensive literature review identify relevant cbgg programs h3methodsh3 review included programs impact evaluations used experimental quasiexperimental design data 2 time points controlcomparison groups quantitative program effects ipi values h3resultsh3 analyzed evaluations 30 programs 14 randomized controlled trials 16 quasiexperimental although program designs varied programs targeted unmarried girls aged 13 18 years school school met weekly groups 15 25 girls nearly programs used multisectoral approaches focusing life skills often economic financial content financial literacy microsavings complementary activities community members boys health services common across programs evaluations reported statistically significant effects ipilt05 majority gt50 times measured outcomes related gender health attitudes knowledge education psychosocial wellbeing economic financial outcomes measures outcomes related girls health behaviors health status majority null findings h3conclusionsh3 cbgg program evaluations found positive effects girllevel outcomes independent external factors like gender norm attitudes suboptimal performance health behavior health status rely people systems delivery model promise building girls assets complementary actions engage girls social environments structures needed change behaviors health status

https://doi.org/10.9745/ghsp-d-20-00015

Susan Levenstein

Stress and peptic ulcer: life beyond helicobacter

h3abstracth3 discovery ihelicobacter pylorii cause peptic ulcer tempted many conclude psychological factors unimportant dichotomised thinking solid evidence psychological stress triggers many ulcers impairs response treatment helicobacter inadequate monocausal explanation infected people develop ulcers psychological stress probably functions often cofactor ih pylorii may act stimulating production gastric acid promoting behaviour causes risk health unravelling aetiology peptic ulcer make important contribution biopsychosocial model disease review role psychological stress aetiology peptic ulcer disease undertook conventional journal tracking reference tracing supplemented medline searches using paperchase important keywords used search included peptic ulcer duodenal ulcerpsychology stress life change events personality h3summary pointsh3 psychosomatic factors aetiology peptic ulcer become unfashionable since discovery ihelicobacter pylorii people harbour ih pylorii organism cannot serve sole explanation ulcer disease psychological stress impact onset course ulcer disease psychological stress probably interacts ih pylorii risk factors causing ulcer disease peptic ulcer important example biopsychosocial model disease

https://doi.org/10.1136/bmj.316.7130.538

Petra Boynton|Gary W. Wood|Trisha Greenhalgh

Reaching beyond the white middle classes

University College London

h3abstracth3 rise wildfire frequency severity across globe increased interest secondary succession however despite role soil microbial communities regeneration postfire vegetation biogeochemical cycling lack measurements immediately postfire high temporal resolution resulted limited understanding microbial secondary succession fill knowledge gap collected soils 17 25 34 67 95 131 187 286 376 days southern california wildfire fireadapted chaparral shrublands assessed bacterial fungal biomass qpcr 16s 18s richness composition illumina miseq sequencing 16s its2 amplicons fire severely reduced bacterial biomass 47 richness 46 impacts stronger fungi biomass decreasing 86 richness 68 bacterial biomass richness oscillated response precipitation declines biomass richness groups persisted entire postfire year contrast unburned plots fungi bacteria burned plots experienced rapid succession 56 compositional turnover periods analogous plants fireadapted fireloving pyrophilous microbes drove successional dynamics dominant pyrophilous bacteria fungi experienced marked tradeoffs abundance time especially fungi initial peak basidiomycete yeast igeminibasidiumi followed tradeoffs filamentous ascomycetes ipyronema aspergillusi ipenicilliumi bacteria proteobacteria genus imassiliai dominated burned plots throughout year yet following two dominant bacteria firmicute ibacillusi proteobacteria inoviherbaspirillumi traded abundance time high temporal sampling allowed us capture dynamics microbial secondary succession first time indicates tradeoffs among dominant pyrophilous microbes control microbial succession thus might important impacts ecosystem functions

https://doi.org/10.1136/bmj.328.7453.1433

Julia C. Kim|Charlotte Watts

Gaining a foothold: tackling poverty, gender inequality, and HIV in Africa

University of the Witwatersrand|University of London|London School of Hygiene & Tropical Medicine

h3aimh3 explore acceptability feasibility parental early warning tool called congenital heart assessment tool chat parents going home infant first second stage surgery complex congenital heart disease h3backgroundh3 home monitoring programmes developed aid early recognition deterioration fragile infants first second surgical stage however necessitates good discharge preparation enable parents develop appropriate knowledge understanding signs deterioration look contact h3designh3 longitudinal qualitative feasibility study within constructivist paradigm parents taught use chat taking infant home asked participate semistructured interviews four time points discharge t0 2 weeks discharge t1 8 weeks discharge t2 stage 2 surgery t3 interviews transcribed verbatim thematically analysed h3settingh3 one tertiary childrens cardiac centre uk h3subjectsh3 twelve parents eight infants discharged following first stage cardiac surgery complex congenital heart disease august 2013 february 2015 h3resultsh3 four main themes emerged 1 parental preparation vigilance 2 usability 3 mastery 4 reassurance support h3conclusionsh3 study highlighted benefit appropriately preparing parents discharge using chat enable identification normal infant behaviour detect signs clinical deterioration study also demonstrated importance providing parents information call management advice support

https://doi.org/10.1136/bmj.331.7519.769

M. B. Stoch|P. M. Smythe

Does Undernutrition During Infancy Inhibit Brain Growth and Subsequent Intellectual Development?

Red Cross War Memorial Children's Hospital|University of Cape Town|Red Cross War Memorial Children's Hospital|University of Cape Town

h3aimsh3 ibrca1i gene mutations extensively studied relation breast ovarian cancer susceptibility various genotypephenotype correlation attempts yielded important data pertaining consequences ibrca1i mutations however little known effects recurrent ibrcai mutations expressivity age onset cancer population study addresses whether different exon mutations variable expressivity especially relation age onset breast cancer h3methodsh3 using stepwise systematic approach culminating sequencing ibrca1i ibrca2i exons addition multiplex ligationdependent probe amplification relationship disease phenotypes gene mutations 219 individuals family members examined h3resultsh3 shown different ibrca1i gene mutations distinct effects influence age onset breast ovarian cancer mutations exon 2 ibrca1i gene significantly lower penetrance compared mutations exons 11 13 20 median age affliction breast cancer 55 years 185delag exon 2 95 confidence interval ci 467 595 47 years 4184deltcaa mutation exon 11 95 ci 39 554 41 years exon 13 duplication 95 ci 329 497 ibrca1i gene moreover 14 novel mutations ibrca1i ibrca2i genes yorkshirehumberside population identified conclusions 185delag mutation ibrca1i gene low penetrance mutation age dependent especially compared exon 13 duplication mutation data important ramifications screening genetic counselling prophylactic treatment brca1 gene mutation carriers

https://doi.org/10.1136/adc.38.202.546

David R. Hansberry|Ashley L Donovan|Arpan V. Prabhu|Nitin Agarwal|Mougnyan Cox|Adam E. Flanders

Enhancing the Radiologist-Patient Relationship through Improved Communication: A Quantitative Readability Analysis in Spine Radiology

Thomas Jefferson University Hospital|UPMC Hillman Cancer Center|UPMC Hillman Cancer Center|University of Pittsburgh Medical Center|Neurological Surgery|Thomas Jefferson University Hospital|Thomas Jefferson University Hospital

h3background purposeh3 75 million americans less adequate health literacy skills according national center education statistics readability scores used measure well populations read understand patient education materials purpose study assess readability web sites dedicated patient education radiologic spine imaging interventions h3materials methodsh3 eleven search terms relevant radiologic spine imaging searched public internet top 10 links term collected analyzed determine readability scores using 10 wellvalidated quantitative readability assessments patientcentered education web sites search terms included following xray spine ct spine mr imaging spine lumbar puncture kyphoplasty vertebroplasty discogram myelogram cervical spine thoracic spine lumbar spine h3resultsh3 collectively 110 articles written 113 grade level grade range 71169 none articles written american medical association national institutes health recommended 3rdto7th grade reading levels vertebroplasty articles written statistically significant ipi lt 05 advanced level articles xray spine ct spine mr imaging spine h3conclusionsh3 increasing use internet obtain health information made imperative online patient education written easy comprehension average american however given discordance readability scores articles american medical association national institutes health recommended guidelines likely many patients fully benefit resources

https://doi.org/10.3174/ajnr.a5151

David R. Hansberry|Nitin Agarwal|Sharon F. Gonzales|Stephen R. Baker

Are We Effectively Informing Patients? A Quantitative Analysis of On-Line Patient Education Resources from the American Society of Neuroradiology

h3background purposeh3 ubiquitous use internet public attempt better understand health care requires online resources written appropriate level maximize comprehension average user national institutes health american medical association recommend online patient education resources written thirdtoseventh grade level evaluated readability patient education resources provided web site american society neuroradiology httpwwwasnrorgpatientinfo h3materials methodsh3 patient education material asnr web site society neurointerventional surgery web site downloaded evaluated computer software readability studio professional edition using 10 quantitative readability scales flesch reading ease fleschkincaid grade level simple measure gobbledygook colemanliau index gunning fog index new dalechall forcast formula fry graph raygor reading estimate new fog count unpaired iti test used compare readability level resources available american society neuroradiology society neurointerventional surgery web sites h3resultsh3 20 individual patient education articles written 139 14 grade level 5 written lt11th grade level statistical difference level readability resources american society neuroradiology society neurointerventional surgery web sites h3conclusionsh3 patient education resources web sites fail meet guidelines national institutes health american medical association members public may fail fully understand resources would benefit revisions result comprehensible information cast simpler language

https://doi.org/10.3174/ajnr.a3854

D. C. McCann|Sarah Worsfold|Catherine Law|Mark Mullee|Stavros Petrou|Jim Stevenson|Ho Ming Yuen|Colin Kennedy

Reading and communication skills after universal newborn screening for permanent childhood hearing impairment

University of Southampton|Southampton General Hospital|University of Southampton|University College London|University of Southampton|University of Oxford|University of Southampton|University of Southampton|Southampton General Hospital

h3backgroundh3 birth periods universal newborn screening uns permanent childhood hearing impairment pchi early confirmation pchi associated superior subsequent language ability children pchi however effects reading communication skills addressed populationbased study h3methodsh3 followup study large birth cohort southern england measured reading direct assessment communication skills parent report 120 children bilateral moderate severe profound pchi aged 54117 years 61 born periods uns comparison group 63 children normal hearing h3resultsh3 compared birth periods without uns birth periods uns associated better reading scores intergroup difference 039 sds 95 ci 002 076 p 0042 communication skills scores difference 051 sds 95 ci 006 095 p 0026 compared later confirmation confirmation pchi age 9 months also associated better reading difference 051 sds 95 ci 015 087 p 0006 communication skills difference 056 sds 95 ci 012 100 p 0013 children pchi reading communication language ability highly correlated r 062084 plt0001 h3conclusionh3 birth periods uns early confirmation pchi predict better reading communication abilities primary school age benefits represent functional gains sufficient magnitude important children pchi

https://doi.org/10.1136/adc.2008.151217

Raza Naqvi|Sehrish Haider|George Tomlinson|Shabbir M.H. Alibhai

Cognitive assessments in multicultural populations using the Rowland Universal Dementia Assessment Scale: a systematic review and meta-analysis

Western Caspian University|University of Toronto|Western Caspian University|University of Toronto|Western Caspian University|University of Toronto|Western Caspian University|University of Toronto

h3backgroundh3 canada growing multinational immigrant population many commonly used cognitive assessment tools known cultural biases difficult use ethnically diverse patient populations rowland universal dementia assessment scale rudas cognitive assessment tool created culturally linguistically diverse populations performed systematic review metaanalysis assess psychometric characteristics rudas compare available tools h3methodsh3 identified studies assessed psychometric properties rudas compared reference standard diagnosing dementia compared rudas cognitive assessment tools two independent reviewers screened abstracts fulltext articles reviewed bibliographies references extracted data using standardized forms assessed studies risk bias h3resultsh3 search resulted 148 articles 11 included rudas assessed 1236 participants found pooled sensitivity 772 95 confidence interval ci 674845 pooled specificity 859 95 ci 748926 yielding positive likelihood ratio 55 95 ci 29107 negative likelihood ratio 027 95 ci 017040 pooled estimate correlation rudas minimental state examination mmse 077 95 ci 072081 results rudas less affected language education level mmse h3interpretationh3 rudas brief freely available cognitive assessment tool reasonable psychometric characteristics may particularly useful patients diverse backgrounds

https://doi.org/10.1503/cmaj.140802

Jeffrey Mather|Gilbert Fortunato|Jenifer L Ash|Michael J. Davis|Ajay Kumar

Prediction of Pneumonia 30-Day Readmissions: A Single-Center Attempt to Increase Model Performance

Hartford Hospital

h3backgroundh3 existing models developed predict 30 days readmissions pneumonia lack discriminative ability attempted increase model performance addition variables found benefit studies h3methodsh3 133368 admissions tertiarycare hospital january 2009 march 2012 study cohort consisted 956 index admissions pneumonia using centers medicare medicaid services definition collected variables previously reported associated 30day allcause readmission including vital signs comorbidities laboratory values demographics socioeconomic indicators indicators hospital utilization separate logistic regression models developed identify predictors allcause hospital readmission 30 days discharge index pneumonia admission pneumoniarelated readmissions pneumoniaunrelated readmissions h3resultsh3 965 index admissions pneumonia 148 155 subjects readmitted within 30 days variables multivariatemodel significantly associated 30day allcause readmission male sex odds ratio 159 95 ci 103245 3 previous admissions odds ratio 184 95 ci 122278 chronic lung disease odds ratio 163 95 ci 107248 cancer odds ratio 218 95 ci 124384 median income lt 43000 odds ratio 182 95 ci 118281 history anxiety depression odds ratio 162 95 ci 104252 hematocrit lt 30 odds ratio 186 95 ci 107322 model performance measured c statistic 071 066075 minimal optimism according bootstrap resampling optimism corrected c statistic 067 h3conclusionsh3 addition socioeconomic status healthcare utilization variables significantly improved model performance compared model using centers medicare medicaid services variables

https://doi.org/10.4187/respcare.02563

Gina Agarwal|Ricardo Angeles|Melissa Pirrie|Brent McLeod|Francine Marzanek|Jenna Parascandalo|Lehana Thabane

Evaluation of a community paramedicine health promotion and lifestyle risk assessment program for older adults who live in social housing: a cluster randomized trial

St. Joseph’s Healthcare Hamilton|McMaster University|Impact|St. Joseph’s Healthcare Hamilton|McMaster University|Impact|St. Joseph’s Healthcare Hamilton|McMaster University|Impact|St. Joseph’s Healthcare Hamilton|McMaster University|Impact|St. Joseph’s Healthcare Hamilton|McMaster University|Impact|St. Joseph’s Healthcare Hamilton|McMaster University|Impact|St. Joseph’s Healthcare Hamilton|McMaster University|Impact

h3backgroundh3 lowincome older adults live subsidized housing higher mortality morbidity aimed determine community paramedicine program paramedics provide health care services outside traditional emergency response reduced number ambulance calls subsidized housing older adults h3methodsh3 conducted openlabel pragmatic clusterrandomized controlled trial rct parallel intervention control groups subsidized apartment buildings older adults selected 6 buildings using predefined criteria randomly assigned intervention community paramedicine clinic cpclinic 1 yr control usual health care using computergenerated paired randomization cpclinic paramedicled communitybased health promotion program prevent diabetes cardiovascular disease falls residents 55 years age older primary outcome buildinglevel mean monthly ambulance calls secondary outcomes individuallevel changes blood pressure health behaviours risk diabetes assessed using canadian diabetes risk questionnaire analyzed data using generalized estimating equations hierarchical linear modelling h3resultsh3 3 intervention 3 control buildings 455 637 residents respectively mean monthly ambulance calls intervention buildings 311 standard deviation sd 130 calls per 100 unitsmo significantly lower 088 95 confidence interval ci 045 130 control buildings 399 sd 117 calls per 100 unitsmo adjusted baseline calls building pairs survey participation 284 ini 129 203 ini 129 intervention control buildings respectively residents living intervention buildings showed significant improvement compared living control buildings qualityadjusted life years qalys mean difference 009 95 ci 001 017 ability perform usual activities odds ratio 26 95 ci 12 58 received intervention significant decrease systolic mean change 50 95 ci 10 90 diastolic mean change 48 95 ci 19 76 blood pressure h3interpretationh3 paramedicled communitybased health promotion program cpclinic significantly lowered number ambulance calls improved qalys ability perform usual activities lowered systolic blood pressure among older adults living subsidized housing btrial registrationb clinicaltrialsgov nct02152891

https://doi.org/10.1503/cmaj.170740

V. Stagliano|Lorraine S. Wallace

Brief Health Literacy Screening Items Predict Newest Vital Sign Scores

The Ohio State University|The Ohio State University

h3backgroundh3 numeracy important understudied component health literacy hl purpose study examine predictive ability established general hl numeracy screening items estimating newest vital sign nvs scores h3methodsh3 studied 241 adults attending primary care clinics midwestern united states demographic items hl screening questions nvs administered patients determine accuracy hl numeracy screening items area receiver operating characteristic auroc curves determined screening item using nvs scores reference standard h3resultsh3 patients9 mean age 461 163 years 710 female 534 african american 75 less high school education 444 insured medicaidmedicare mean nvs score 37 20 178 classified inadequate hlnumeracy nvs score 0 1 hl screening item confident filling medical forms best predictor limited auroc 083 95 confidence interval ci 076089 limitedmarginal auroc 079 95 ci 073085 nvs scores numeracy screening item general easy hard find understand medical statistics best predictor limited auroc 083 95 ci 076089 limitedmarginal auroc 078 95 ci 072084 nvs scores h3conclusionh3 brief hl numeracy screening items useful quickly estimating nvs scores among englishspeaking primary care clinic populations

https://doi.org/10.3122/jabfm.2013.05.130096

Sherine El?Toukhy|Alejandra Méndez|Shavonne M. Collins|Eliseo J. Pérez?Stable

Barriers to Patient Portal Access and Use: Evidence from the Health Information National Trends Survey

National Institute on Minority Health and Health Disparities|National Institutes of Health|National Heart Lung and Blood Institute|Indiana University – Purdue University Indianapolis|Emory University|Office of the Director|National Institute on Minority Health and Health Disparities|National Institutes of Health|National Heart Lung and Blood Institute|Indiana University – Purdue University Indianapolis|Emory University|Office of the Director|National Institute on Minority Health and Health Disparities|National Institutes of Health|National Heart Lung and Blood Institute|Emory University|Office of the Director|Indiana University – Purdue University Indianapolis|National Institute on Minority Health and Health Disparities|National Institutes of Health|National Heart Lung and Blood Institute|Indiana University – Purdue University Indianapolis|Emory University|Office of the Director

h3backgroundh3 patient access medical records patient portals pps facilitates information exchange provision quality health care understanding factors characterize patients limited access use pps needed h3methodsh3 data 20172018 health information national trends survey 5 cycles 1 2 nationally representative survey us adults 18 years old n 6789 weighted multivariate logistic regressions modeled associations patient characteristics access facilitators use use pps functions h3resultsh3 individuals without vs regular doctor adjusted odds ratio aor 04 ci 0305 health insurance aor 04 ci 0207 high school aor 04 ci 0305 vocationalsome college aor 05 ci 0407 education vs collegepostgraduate limited english proficiency vs speak english well aor 07 ci 0509 less likely report accessing personal medical records women vs men likely report accessing medical records aor 15 ci 1218 similar patterns found pps access facilitators use less consistent associations emerged patient characteristics use pp functionalities h3conclusionsh3 pp access use low primary care clinician patients educational attainment woman factors associated pp access use raceethnicity access achieved use pp functionalities generally uniform across demographic segments facilitating pp access use among patient populations warranted

https://doi.org/10.3122/jabfm.2020.06.190402

Michelle Mavreles Ogrodnick|Iris Feinberg|Elizabeth L. Tighe|Catherine C Czarnonycz|Ralph D Zimmerman

Health-Literacy Training for First-Year Respiratory Therapy Students: A Mixed-Methods Pilot Study

Georgia State University|Georgia State University|Georgia State University|Georgia State University|Georgia State University

h3backgroundh3 respiratory therapists rts communicate patients way leads patients understanding discharge plans medical device instructions teachback method patientcentered healthliterate technique allows health care professionals confirm patient understanding purpose mixedmethods pilot study measure use teachback firstyear undergraduate rt students simulationcenter experience 1h teachback skills training h3methodsh3 firstyear rt students9 health literacy knowledge belief communication skills measured using pre post survey knowledge beliefs 1h health literacy teachback skills training lecture ie intervention delivered pretesting rt students assessed teachback use regularly scheduled simulation center experience experiences recorded semistructured interview immediately simulationcenter experience h3resultsh3 14 20 rt students used teachback simulation center knowledge scores increased 8278 8944 postintervention median scores belief increased 111 117 postintervention statistically significant postintervention increase knowledge scores ipi lt 001 communication belief scores ipi 038 thematic content analysis revealed 2 primary themes teachback use confirm patient understanding confirm proper use medical devices teachback used due discharge scenario used simulation center due student forgetting andor nervous due engaged patient due individual communication style h3conclusionsh3 results pilot study indicate rt students may benefit 1h health literacy teachback skills training furthermore identified reasons teachback method used determined communication training students perceived would helpful findings used help improve implement communication skills training rt curriculum

https://doi.org/10.4187/respcare.06896

Ying Fang|Lina Dai|Michael Jaung|Xiao Chen|Seung?Do Yu|Hao Xiang

Child drowning deaths in Xiamen city and suburbs, People's Republic of China, 2001 5

Xiamen University|Xiamen University|Nationwide Children's Hospital|Xiamen University|Nationwide Children's Hospital|Nationwide Children's Hospital

h3backgroundh3 riskfactor research prevention programs targeting drowning deaths children well developed industrialized countries little research undertaken developing countries majority drowning deaths occur conducted epidemiological study describe sociodemographic characteristics drowning circumstances medical service drowning deaths children xiamen city suburbs peoples republic china h3material methodsh3 drowning deaths 114yearold children 2001 2005 identified using death certificates parents case interviewed face face sociodemographics family child drowning event medical care received mortalities calculated using census data urban rural areas poisson regression used evaluate confounding effects interactions several major risk factors drowning death h3resultsh3 67 drowning deaths identified 52 776 males higher proportion deaths children aged 59 years 403 1014 years 403 drowning mortality per 100nbsp000 population 584 rural areas 075 urban areas drowning events occurred commonly summer months 567 june august hours 13001759 627 natural manmade bodies water eg ponds ditches construction sites wells none children proficient swimmers majority drowning events 881 occurred absence adult supervision 866 children died scene without medical care results muiltivariable poisson regression analysis indicated 1014yearold boys highest risk drowning deaths area h3discussion conclusionsh3 drowning deaths children xiamen city suburbs follow trends markedly different patterns observed countries different prevention strategies may required preventing child drowning deaths xiamen developing regions

https://doi.org/10.1136/ip.2007.016683

Marcus Richards|Christine Power|A Sacker

Paths to literacy and numeracy problems: evidence from two British birth cohorts

MRC Unit for Lifelong Health and Ageing|Royal College of Paediatrics and Child Health|University of Essex|Institute for Social and Economic Research

h3backgroundh3 test life course model linking circumstances origin selfreported literacy numeracy problems midlife investigate effects model changing social circumstances two postwar cohorts h3methodsh3 based data men women british 1946 1958 birth cohorts used relative index inequality logistical regression test associations fathers occupation childhood cognition educational attainment occupation third decade binary variable representing selfreported literacy numeracy problems fourth decade h3resultsh3 lower frequency literacy numeracy problems 1958 cohort 1946 cohort cohorts associations fathers occupation childhood cognition educational attainment occupation pattern mirrored associations childhood cognition educational attainment occupation adult literacy numeracy problems positive associations childhood cognition educational attainment educational attainment occupation stronger 1946 cohort 1958 cohort however inverse associations educational attainment literacy numeracy problems stronger 1958 cohort possibly reflecting expansion secondary education intervening years h3conclusionsh3 literacy numeracy problems robust structure life course associations although changing pattern associations may reflect important social structural changes early postwar years early 1960s uk

https://doi.org/10.1136/jech.2007.064923

Lorraine S. Wallace|Heather Angier|Nathalie Huguet|James A. Gaudino|Alex H. Krist|Marla Dearing|Marie E. Killerby|Miguel Marino|Jennifer E. DeVoe

Patterns of Electronic Portal Use among Vulnerable Patients in a Nationwide Practice-based Research Network: From the OCHIN Practice-based Research Network (PBRN)

The Ohio State University|Oregon Health & Science University|Ochin|Virginia Commonwealth University|The Ohio State University|Oregon Health & Science University|Ochin|Virginia Commonwealth University|The Ohio State University|Oregon Health & Science University|Ochin|Virginia Commonwealth University|The Ohio State University|Oregon Health & Science University|Ochin|Virginia Commonwealth University|The Ohio State University|Oregon Health & Science University|Ochin|Virginia Commonwealth University|The Ohio State University|Oregon Health & Science University|Ochin|Virginia Commonwealth University|The Ohio State University|Oregon Health & Science University|Ochin|Virginia Commonwealth University|The Ohio State University|Oregon Health & Science University|Ochin|Virginia Commonwealth University|The Ohio State University|Oregon Health & Science University|Ochin|Virginia Commonwealth University

h3backgroundh3 underserved patient populations experience barriers accessing engaging within complex health care system electronic patient portals proposed potential new way improve access engagement studied patient portal use 12 consecutive months 365 days among large nationally distributed underserved patient population within ochin originally created oregon community health information network renamed ochin states joined practicebased research network pbrn h3methodsh3 retrospectively assessed adoption use epic9s mychart patient portal first 12 months mychart made available ochin pbrn examined electronic health record data 36549 patients aged 18 years offered mychart access code may 1 2012 april 30 2013 across ochin pbrn 13 states h3resultsh3 overall 29 patients offered access code logged mychart account superusers minimum 2 logins per month 12month period accounted 6 users overall men nonwhite patients hispanic patients spanishspeaking patients lowest incomes significantly less likely activate publicly insured uninsured patients also less likely log mychart account activated likely privately insured patients use mychart functions h3conclusionsh3 findings suggest compared others certain patient groups may less interested using patient portals may experienced significant barriers prevented use making portal access available first step additional studies need specifically identify health system clinic patientlevel barriers facilitators portal adoption use

https://doi.org/10.3122/jabfm.2016.05.160046

World Health Organization Regional Office for the Americas|Johns Hopkins University|University of California, Berkeley

h3backgroundh3 critical review conducted quantitative literature linking indoor air pollution household use biomass fuels acute respiratory infections young children focused confined acute lower respiratory infection pneumonia children two years less developed countries biomass form wood crop residues animal dung used two fifths world9s households principal fuel h3methodsh3 medline electronic databases used also necessary secure literature colleagues less developed countries publications yet internationally indexed h3resultsh3 studies indoor air pollution household biomass fuels reasonably consistent group show strong significant increase risk exposed young children compared living households using cleaner fuels otherwise less exposed studies able adjust confounders found strong significant risks remained h3conclusionsh3 seems relative risks likely significant exposures considered since acute lower respiratory infection chief cause death children less developed countries exacts larger burden disease disease category world population even small additional risks due ubiquitous exposure air pollution important public health implications case indoor air pollution households using biomass fuels risks also seem fairly strong presumably high daily concentrations pollutants found settings large amount time young children spend mothers household cooking given large vulnerable populations risk urgent need conduct randomised trials increase confidence causeeffect relationship quantify risk precisely determine degree reduction exposure required significantly improve health establish effectiveness interventions

https://doi.org/10.1016/j.jaci.2019.05.030

Andrea J. Apter|A. Russell Localio|Knashawn H. Morales|Xiaoyan Han|Luzmercy Perez|Alyssa N. Mullen|Marisa Rogers|Heather Klusaritz|John T. Howell|Maryori Canales|Tyra Bryant-Stephens

Home visits for uncontrolled asthma among low-income adults with patient portal access

University of Pennsylvania Health System|University of Pennsylvania|University of Pennsylvania|University of Pennsylvania|University of Pennsylvania|University of Pennsylvania|Temple University Health System|University of Pennsylvania Health System|University of Pennsylvania|University of Pennsylvania Health System|University of Pennsylvania|University of Pennsylvania Health System|Children's Hospital of Philadelphia|Children's Hospital of Philadelphia

h3backgroundh3 asthma disproportionately affects lowincome minority adults era electronic records internetbased digital devices unknown whether portals patientprovider communication improve asthma outcomes h3objectiveh3 sought estimate effect asthma outcomes intervention using home visits hvs community health workers chws plus training patient portals compared usual care portal training h3methodsh3 three hundred one predominantly african american hispaniclatino adults uncontrolled asthma recruited primary care asthma specialty practices serving lowincome urban neighborhoods directed internet access given portal training half randomized hvs 6 months chws facilitate competency portal use promote care coordination h3resultsh3 one hundred seventy 56 patients used portal independently rates portal activity differ randomized groups asthma control asthmarelated quality life improved groups 1 year differences improvements time greater hv group outcomes reached conventional levels statistical significance yearly hospitalization rate 053 95 ci 108 0024 poor neighborhoods living conditions plus limited internet access barriers patients complete protocol chws make hvs h3conclusionh3 lowincome adults uncontrolled asthma portal access chws produced small incremental benefits hvs emphasis selfmanagement education might necessary facilitate patientclinician communication improve asthma outcomes

https://doi.org/10.1136/ebmh.13.2.35

Sarah Peters

Qualitative Research Methods in Mental Health

University of Manchester

h3backgroundh3 chondrogenesis occurs result mesenchymal stem cells mscs condensation chondroprogenitor cell differentiation following chondrogenesis chondrocytes remain resting cells form articular cartilage major challenge osteoarthitic oa cartilage reparation stem cellbased approaches understanding multistep process h3objectivesh3 analyse extracellular protein expression profile human bone marrow mscs hbmscs osteoarthritic patients control donors undergoing chondrogenesis order compare mechanisms involved cartilage extracellular matrix ecm remodeling occurs chondrogenic differentiation process h3methodsh3 hbmscs isolated 3 oa patients 3 healthy controls grown different isotope variants lysine arginine arg6 lys4 control population arg10 lys8 oa population 46 weeks achievement full protein labeling labeled populations subjected differentiation 3d cultures micromasses supplemented chondrogenic inducers 14 days proteins conditioned media two cell populations combined separated 1dsdspage subjected ingel trypsin digestion using automatic digestor resulting peptide mixtures analyzed nanolc coupled online ltqorbitrap xl mass spectrometer quantified using maxquant software perseus tool h3resultsh3 realtime pcr assays showed relevant difference gene expression collagen type ii normal donors compared oa patients moreover chondrocyte phenotype confirmed cases proteglycan immunostainings aggrecan chondroitin6sulfate 14 days chondrogenesis using proteomic approach compared extracellular protein profiles oa normal hbmsc time differentiation among 531 proteins 56 significantly altered levels 35 proteins displayed consistently higher levels oa samples compared normal donors many proteins cartilage specific proteoglycans hyaluronan proteoglycan link protein 1 aggrecan core protein lumican well proteins wellknown role pathogenesis oa like comp mmp3 hand 21 proteins exhibited significantly reduced abundance oa patients compared controls interestingly detected several proteins belong tenascin protein family like tenascinx accelerates collagen fibril formation also found wisp2 decreased day 14 suggesting lower activity wnt signaling pathway oa cells h3conclusionsh3 identification quantification secreted proteins enhance knowledge extracellular regulation chondrogenesis allow identification extracellular markers process moreover lower expression oa patients like tenascinx wisp2 suggest putative usefulness molecular monitorization chondrogenesis cell therapybased approaches cartilage repair h3disclosure interesth3 none declared h3doih3 101136annrheumdis2014eular4997

https://doi.org/10.1136/adc.2005.081349

John Massie

Markedly elevated neonatal immunoreactive trypsinogen levels in the absence of cystic fibrosis gene mutations is not an indication for further testing

Royal Children's Hospital

h3backgroundh3 eating disorders eds comprise significant portion mental health morbidity young people yet underdetection major problem identify tackle barriers service engagement health promotion initiatives require concrete information eds viewed adolescents study sought explore young peoples ed literacy attitudes towards people eds h3methodsh3 ethical approval granted st john god research ethics committee 260 schools across ireland invited participate 63 schools agreed recruit students survey could completed either online paper participants randomly allocated view one five vignettes depicting young person symptoms consistent anorexia nervosa bulimia nervosa bn binge eating disorder bed depression type 1 diabetes participants asked identify illness described also indicated beliefs regarding illness duration level personal control illness likely causes illness targets personal characteristics differences vignette conditions explored spss via chisquare tests categorical variables analyses variance post hoc bonferronicorrected comparisons continuous variables met necessary statistical conditions h3resultsh3 290 students completed survey participants aged 1519 imi 1676 isdi 089 attended range school types singlesexmixedsex publicprivate 51 female six participants affected ed 624 knew someone ed however responses vignettes showed poor recognition symptoms eds comparison depression ii 4 2i83 36125 ip lt 0i001 small minorities encountered 204 bn 125 bed 0 vignettes correctly named illness described analysis attitude variables showed three eds seen significantly longer duration depression ifi4267 6208 ip lt 0i001 three eds rated individuallycaused either depression t1 diabetes ifi4269 1853 ip lt 0i001 participants believed bed target significantly personal control disorder depression t1 diabetes targets ifi4264 356 ip 0i008 three ed targets ascribed significantly less positive personality traits t1 diabetes target ifi4255 1291 ip lt 0i001 h3conclusionh3 results indicate need greater public education regarding symptoms eds young people identify seek help problematic eating peers health promotion initiatives also address stigmatising blaming attitudes eds inhibit detection treatment particularly perception eds selfinflicted

https://doi.org/10.1136/jech-2014-205436

Mira Johri|S. V. Subramanian|Marie?Pierre Sylvestre|Sakshi Dudeja|Dinesh Chandra|Georges Karna Koné|Jitendar Kumar Sharma|Smriti Pahwa

Association between maternal health literacy and child vaccination in India: a cross-sectional study

Centre Hospitalier de l’Université de Montréal|Université de Montréal|China Population and Development Research Center|Centre Hospitalier de l’Université de Montréal|Université de Montréal|Pratham|Pratham|Centre Hospitalier de l’Université de Montréal|National Health Systems Resource Centre|Government of India|Ministry of Health and Family Welfare|Pratham

h3backgroundh3 education mothers may improve child health investigated whether maternal health literacy rapidly modifiable factor related mother9s education associated children9s receipt vaccines two underserved indian communities h3methodsh3 crosssectional surveys urban rural site assessed health literacy using indian child health promotion materials outcome receipt three doses diphtheriatetanuspertussis dtp3 vaccine used multivariate logistic regression investigate relationship maternal health literacy vaccination status independently site sites adjusted models considered maternal age maternal paternal education child sex birth order household religion wealth quintile rural analyses used multilevel models adjusted service delivery characteristics urban analyses represented cluster characteristics fixed effects h3resultsh3 rural analysis included 1170 women 60 villages urban analysis included 670 women nine slum clusters site crude adjusted models revealed positive association maternal health literacy dtp3 rural site adjusted 157 95 ci 111 221 p0010 medium health literacy or130 95 ci 089 191 p0172 high health literacy urban site adjusted 110 95 ci 065 188 p0705 medium health literacy or206 95 ci 106 399 p0032 high health literacy h3conclusionsh3 study settings maternal health literacy independently associated child vaccination initiatives targeting health literacy could improve vaccination coverage

https://doi.org/10.1136/jech.2009.099879

Bevin Cohen|Yu?hui Ferng|Jennifer Wong?McLoughlin|Haomiao Jia|Stephen S. Morse|Elaine Larson

Predictors of flu vaccination among urban Hispanic children and adults

Columbia University|Columbia University|Columbia University|Columbia University|Columbia University|Columbia University

h3backgroundh3 flu vaccination effective preventing infection coverage levels usa remain lowespecially among racialethnic minorities study examines factors associated flu vaccination predominantly hispanic community manhattan new york h3methodsh3 households recruited 20062007 20072008 flu seasons primary household respondents interviewed determine knowledge flu transmissiontreatment vaccination status demographic information household members h3resultsh3 vaccination coverage 473 among children lt5 393 among 517yearolds 153 among 1849yearolds 310 among 5064yearolds 371 among adults 65 year 1 531 among children lt5 436 among 517yearolds 195 among 1849yearolds 341 among 5064yearolds 343 among adults 65 year 2 children younger age chronic respiratory condition eg asthma greater primary respondent knowledge flu positively associated vaccination among adults female gender older age higher education greater primary respondent knowledge flu born usa chronic respiratory condition positively associated vaccination common reasons cited vaccinated beliefs flu vaccination unnecessary ineffective h3conclusionsh3 possible methods increasing vaccination levels urban hispanic communities include improving health literacy making lowcost vaccination available encouraging providers use office visits opportunities mention vaccination patients h3registration numberh3 study registered httpclinicaltrialsgov nct00448981

https://doi.org/10.1136/bmjgh-2017-000419

Tambri Housen|Annick Lenglet|Cono Ariti|Showkat Shah|Helal Shah|Shabnum Ara|Kerri Viney|Simon Janes|Giovanni Pintaldi

Prevalence of anxiety, depression and post-traumatic stress disorder in the Kashmir Valley

Australian National University|Médecins Sans Frontières?|Public Health Department|London School of Hygiene & Tropical Medicine|University of Kashmir|Médecins Sans Frontières?|Médecins Sans Frontières?|Australian National University|Médecins Sans Frontières?|Public Health Department

h3backgroundh3 following partition india 1947 kashmir valley subject continual political insecurity ongoing conflict region remains highly militarised conducted representative crosssectional populationbased survey adults estimate prevalence predictors anxiety depression posttraumatic stress disorder ptsd 10 districts kashmir valley h3methodsh3 october december 2015 interviewed 5519 5600 invited participants 18 years age randomly sampled using probability proportional size cluster sampling design estimated prevalence probable psychological disorder using hopkins symptom checklist hscl25 harvard trauma questionnaire htq16 screening instruments culturally adapted translated data weighted account sampling design multivariate logistic regression analysis conducted identify risk factors developing symptoms psychological distress h3findingsh3 estimated prevalence mental distress adults kashmir valley 45 95 ci 426 470 identified 41 95 ci 392 434 adults probable depression 26 95 ci 238 275 probable anxiety 19 95 ci 175 212 probable ptsd three disorders associated following characteristics female 55 years age formal education living rural area widoweddivorced separated doseresponse association found number traumatic events experienced witnessed three mental disorders h3interpretationh3 implementation mental health awareness programmes interventions aimed high risk groups addressing traumarelated symptoms causes needed kashmir valley

https://doi.org/10.1378/chest.10-0292

Barbara J. Daly|Sara L. Douglas|Elizabeth O’Toole|Nahida H. Gordon|Rana Hejal|Joel R. Peerless|James Rowbottom|Allan Garland|Craig M. Lilly|Clareen Wiencek|Ronald L. Hickman

Effectiveness Trial of an Intensive Communication Structure for Families of Long-Stay ICU Patients

Case Western Reserve University|Case Western Reserve University|Case Western Reserve University|Case Western Reserve University|Case Western Reserve University|Case Western Reserve University|Case Western Reserve University|University of Manitoba|University of Massachusetts Chan Medical School|Case Western Reserve University|Case Western Reserve University

h3backgroundh3 formal family meetings recommended useful approach assist goal setting facilitate decision making reduce use ineffective resources icu examined patient outcomes implementation intensive communication system ics test effect regular structured formal family meetings patient outcomes among longstay icu patients h3methodsh3 one hundred thirtyfive patients receiving usual care communication enrolled control group followed enrollment intervention patients n 346 five icus ics included family meeting within 5 days icu admission weekly thereafter meeting discussed medical update values preferences goals care treatment plan milestones judging effectiveness treatment h3resultsh3 using multivariate analysis significant differences control intervention patients length stay los primary end point similarly significant differences indicators aggressiveness care treatment limitation decisions icu mortality los duration ventilation treatment limitation orders use tracheostomy percutaneous gastrostomy exploratory analysis suggested medical icus intervention associated lower prevalence tracheostomy among patients died donotattemptresuscitation orders place h3conclusionsh3 negative findings main analysis combination preliminary evidence differences among types unit suggest examination influence patient family unit characteristics effects system regular family meetings may warranted despite lack influence patient outcomes structured family meetings may effective approach meeting information support needs h3trial registryh3 clinicaltrialsgov nct01057238 url wwwclinicaltrialsgov

https://doi.org/10.1016/j.healun.2016.08.024

Maan Isabella Cajita|Kris Denhaerynck|Fabienne Dobbels|Lut Berben|Cynthia L. Russell|Patricia M. Davidson|Sabina De Geest|María G. Crespo?Leiro|Sandra Cupples|Paolo De Simone|Albert Groenewoud|Christiane Kugler|Linda Ohler|Johan Vanhaecke|Alain Poncelet|Laurent Sebbag|Magali Michel|Andrée Bernard|Andreas Doesch|Ugolino Livi|V. Manfredini|V. Brossa Loidi|Javier Segovia?Cubero|Luis Amenar|C. Segura Saint-Gerons|Paul Mohaçsi|Éva Horváth|Cheryl Riotto|Gareth Parry|Ashi Firouzi|Stella Kozuszko|Haissam Haddad|Annemarie Kaan|Grant Fisher|Tara Miller|Maureen Flattery|Kristin Ludrosky|Bernice Coleman|Jacqueline Trammell|Katherine St. Clair|Andrew Kao|María Molina|Karyn Ryan Canalesa|Samira Scalso de Almeida|Andréa Cotait Ayoub|Fernanda Barone|M. Harkess|J. Maddicks-Law

Health literacy in heart transplantation: Prevalence, correlates and associations with health behaviors—Findings from the international BRIGHT study

Johns Hopkins University|University of Basel|KU Leuven|University of Basel|University of Missouri–Kansas City|Johns Hopkins University|University of Basel|Complexo Hospitalario Universitario A Coruña|United States Department of Veterans Affairs|Veterans Health Administration|Ospedale Cisanello|Astellas Pharma (United Kingdom)|Medizinische Hochschule Hannover|George Washington University|Cliniques Universitaires Saint-Luc|Hôpital Louis Pradel|Hôpital Laennec|Hôpital Nord|Pitié-Salpêtrière Hospital|University Hospital Heidelberg|Heidelberg University|University of Udine|University of Bologna|Hospital de Sant Pau|Hospital Universitario Puerta de Hierro Majadahonda|Hospital Universitari i Politècnic La Fe|Hospital Universitario Reina Sofía|University Hospital of Bern|University Hospital of Zurich|Papworth Hospital|Freeman Hospital|Royal Brompton & Harefield NHS Foundation Trust|Toronto General Hospital|University of Ottawa|St. Paul's Hospital|London Health Sciences Centre|Duke University Hospital|Virginia Commonwealth University|University Health System|Cleveland Clinic|Cedars-Sinai Medical Center|Kaiser Permanente Santa Clara Medical Center|St. Luke's Hospital|St. Vincent's Medical Center|St. Luke's Hospital|St. Vincent's Medical Center|Hospital of the University of Pennsylvania|Ochsner Medical Center|Hospital Israelita Albert Einstein|Instituto Dante Pazzanese de Cardiologia|Hospital do Coração|Universidade de São Paulo|St Vincent's Hospital Sydney|Prince Charles Hospital

h3backgroundh3 health literacy hl major determinant health outcomes however studies exploring role hl among heart transplant recipients objectives study 1 explore compare prevalence inadequate hl among heart transplant recipients internationally 2 determine correlates hl 3 assess relationship hl healthrelated behaviors h3methodsh3 secondary analysis conducted using data 1365 adult patients bright study international multicenter crosssectional study surveyed heart transplant recipients across 11 countries 4 continents using subjective health literacy screener inadequate hl operationalized confident filling medical forms nonea littlesome time hl score 0 2 correlates hl determined using backward stepwise logistic regression relationship hl healthrelated behaviors examined using hierarchical logistic regression h3resultsh3 overall 331 heart transplant recipients inadequate hl lower education level adjusted odds ratio aor 024 ipi 0001 unemployment aor 069 ipi 0012 country residing brazil aor 025 ipi 0001 shown associated inadequate hl heart transplant recipients adequate hl higher odds engaging sufficient physical activity aor 16 ipi 0016 hl significantly associated health behaviors h3conclusionsh3 clinicians recognize almost one third heart transplant participants inadequate health literacy furthermore adopt communication strategies could mitigate potential negative impact inadequate hl

https://doi.org/10.1136/bmjqs-2015-004567

Daren K. Heyland|Roy Ilan|Xuran Jiang|John J. You|Peter Dodek

The prevalence of medical error related to end-of-life communication in Canadian hospitals: results of a multicentre observational study

Queen's University|Queen's University|Kingston General Hospital|McMaster University|University of British Columbia|Centre for Health Evaluation and Outcome Sciences

h3backgroundh3 hospital setting inadequate engagement healthcare professionals seriously ill patients families regarding endoflife decisions common problem may lead medical orders lifesustaining treatments inconsistent patient preferences prevalence patient safety problem previously described h3methodsh3 using data multiinstitutional audit quantified mismatch patients family members expressed preferences care orders lifesustaining treatments recruited seriously ill elderly medical patients andor family members participate audit considered medical error patient preferred resuscitated orders undergo resuscitation overtreatment patient preferred resuscitation cardiopulmonary resuscitation cpr orders resuscitated undertreatment h3resultsh3 16 hospitals canada 808 patients 631 family members included study comparing expressed preferences documented orders use cpr 37 patients experienced medical error patients 8 2 expressed preference cpr cpr withheld documented medical orders undertreatment patients preferred cpr 174 35 orders receive overtreatment considerable variability overtreatment rates across sites range 1482 patients frail less likely overtreated patients participating family member likely overtreated h3conclusionsh3 medical errors related use lifesustaining treatments common internal medicine wards many patients risk receiving inappropriate endoflife care

https://doi.org/10.1093/bja/aeh162

M. Oldman|Dermot J. Moore|S. J. Collins

Drug patient information leaflets in anaesthesia: effect on anxiety and patient satisfaction

Musgrove Park Hospital|Capital and Coast District Health Board|Wellington Hospital|Musgrove Park Hospital

h3backgroundh3 patient information leaflets produced new drugs including anaesthetic drugs licensed solely physician administration effect information patients satisfaction anxiety investigated previously h3methodsh3 eightyfive patients allocated randomly receive standard information leaflet anaesthesia group 1 standard leaflet plus manufacturers patient information leaflets propofol remifentanil group 2 anxiety assessed using state trait anxiety index stai visual analogue scale vas anxiety information read patients attitudes information assessed short questionnaire h3resultsh3 significant difference stai vas scores anxiety two groups information leaflets significantly patients received drug patient information leaflets felt received much information 0 group 1 ivsi 18 group 2 ipi0003 64 patients groups said would wish receive detailed anaesthetic drug information correlation stai vas scores anxiety iri08 h3conclusionsh3 minority patients 36 wish receive detailed anaesthetic drug information anaesthesia manufacturers drug patient information leaflets alter preoperative anxiety may safely issued patients requesting information

https://doi.org/10.1136/jnnp-2012-303309

Sebastian J. Crutch|Manja Lehmann|Jason D. Warren|Jonathan D. Rohrer

The language profile of posterior cortical atrophy

UK Dementia Research Institute|University College London|UK Dementia Research Institute|University College London|UK Dementia Research Institute|University College London|UK Dementia Research Institute|University College London

h3backgroundh3 posterior cortical atrophy pca typically considered visual syndrome primarily characterised progressive impairment visuoperceptual visuospatial skills however patients commonly describe early difficulties word retrieval paper details first systematic analysis linguistic function pca characterising quantifying aphasia associated pca important clarifying diagnostic selection criteria clinical research studies h3methodsh3 15 patients pca seven patients logopenicphonological aphasia lpa 18 age matched healthy participants completed detailed battery linguistic tests evaluating auditory input processing repetition working memory lexical grammatical comprehension single word retrieval fluency spontaneous speech h3resultsh3 relative healthy controls pca patients exhibited language impairments across domains examined anomia reduced phonemic fluency slowed speech rate prominent deficits pca performance closely resembled lpa patients tests auditory input processing repetition digit span relatively stronger tasks comprehension spontaneous speech h3conclusionsh3 study demonstrates addition well reported degradation vision literacy numeracy pca characterised progressive oral language dysfunction prominent word retrieval difficulties overlap linguistic profiles pca lpa commonly caused alzheimer9s disease emphasises notion phenotypic continuum typical atypical manifestations disease clarifying boundaries alzheimer9s disease phenotypes important implications diagnosis clinical trial recruitment investigations biological factors driving phenotypic heterogeneity alzheimer9s disease rehabilitation strategies ameliorate phonological deficit pca required

https://doi.org/10.1053/j.ajkd.2015.03.026

Kailin L. Hsu|Jeffrey C. Fink|Jennifer S. Ginsberg|Marni Yoffe|Min Zhan|Wanda Fink|Corinne Woods|Clarissa J. Diamantidis

Self-reported Medication Adherence and Adverse Patient Safety Events in CKD

University of Maryland, Baltimore|University of Maryland, Baltimore|VA Maryland Health Care System|University of Maryland, Baltimore|University of Maryland, Baltimore|University of Maryland, Baltimore|University of Maryland, Baltimore|University of Maryland, Baltimore|Durham VA Medical Center|Duke University

h3backgroundh3 promoting medication adherence recognized challenge prescribers study examine whether lower medication adherence associated adverse safety events individuals decreased estimated glomerular filtration rates egfrs h3study designh3 crosssectional baseline analysis prospective cohort h3setting participantsh3 baseline analysis safe kidney care skc cohort study prospective study individuals egfrs60 mlmin173 msup2sup intended assess incidence diseasespecific safety events kidney transplant recipients excluded h3predictorh3 selfreported medication adherence based responses 3 questions ascertaining degree medication regimen adherence h3outcomesh3 adverse safety events selfreported baseline class events hypoglycemia fall thought related medication detected incidentally baseline visit class ii events example hypotension hyperkalemia potential drugrelated problems drps determined analyzing participants medications respect dosing guidelines based screening egfrs time medication reporting h3measurementsh3 relationship medication adherence diseasespecific patient safety events h3resultsh3 293 skc participants 154 53 classified lower medication adherence multivariable adjustment lower medication adherence significantly associated class ii safety event prevalence ratio pr 121 95 ci 104141 potential drps pr 129 95 ci 102163 lower medication adherence also significantly associated multiple 2 class events pr 171 95 ci 118249 multiple class ii events pr 135 95 ci 104176 multiple potential drps pr 211 95 ci 108269 compared higher medication adherence h3limitationsh3 use selfreported medication adherence rather pharmacy records clinical relevance detected safety events unclear h3conclusionsh3 lower medication adherence associated adverse safety events individuals egfrs60 mlmin173 msup2sup

https://doi.org/10.1016/j.ajic.2019.12.021

Peggy Pui-Lai Or|Bonny Yee-Man Wong|Joanne W.Y. Chung

To investigate the association between the health literacy and hand hygiene practices of the older adults to help them fight against infectious diseases in Hong Kong

Education University of Hong Kong|University of Hong Kong|Education University of Hong Kong

h3backgroundh3 proper hand hygiene helps prevent infectious diseases health literacy plays critical role preventive health behaviors remains unclear proper hand hygiene practices cannot sustained role health literacy plays older adults fight infectious diseases h3methodsh3 convenience sample 433 old adults aged 65 recruited hygiene practices health literacy evaluated using structured questionnaire adopted centre health protection chinese version hlsasiaq questionnaire h3resultsh3 percentage distribution hand hygiene performance always never 1810 majority 6328 274 classified inadequate health literacy 025 meager 162 7 excellent health literacy 420150 spearman correlation showed significant positive relationship ipi 005 participants health literacy hand hygiene practices h3conclusionsh3 health literacy hand hygiene positively related helping older adults fight infectious diseases sustain proper hand hygiene practices provide frequent hand hygiene training older adults

https://doi.org/10.1378/chest.12-2693

Christian Rosas?Salazar|Sima K. Ramratnam|John M. Brehm|Yueh?Ying Han|Edna Acosta?Pérez|María Alvarez|Angel Colón?Semidey|Glorisa Canino|Andrea J. Apter|Juan C. Celed?n

Parental Numeracy and Asthma Exacerbations in Puerto Rican Children

Children's Hospital of Pittsburgh|University of Pittsburgh|Children's Hospital of Pittsburgh|University of Pittsburgh|Children's Hospital of Pittsburgh|University of Pittsburgh|Children's Hospital of Pittsburgh|University of Pittsburgh|University of Puerto Rico System|University of Puerto Rico System|University of Puerto Rico System|University of Puerto Rico System|University of Pennsylvania|Children's Hospital of Pittsburgh|University of Pittsburgh

h3backgroundh3 puerto ricans share disproportionate burden childhood asthma united states little known impact low parental numeracy health literacy skill asthma morbidity puerto rican children objective examine whether low parental numeracy associated increased asthma morbidity puerto rican children h3methodsh3 crosssectional study 351 children asthma aged 6 14 years living san juan puerto rico parents study participants completed modified version asthma numeracy questionnaire multivariate linear logistic regression used examine relation low parental numeracy defined correct answers modified asthma numeracy questionnaire indicators asthma morbidity severe asthma exacerbations core measures asthma exacerbations lung function measures multivariate models adjusted age sex household income reported use inhaled corticosteroids previous 6 months exposure secondhand tobacco smoke h3resultsh3 low parental numeracy associated increased odds visits ed urgent care asthma adjusted aor 17 95 ci10327 ipi 04 association low parental numeracy hospitalizations asthma significant among children using inhaled corticosteroids aor 28 95 ci1456 ipi 004 association low parental numeracy use systemic steroids lung function measures h3conclusionsh3 low parental numeracy associated increased asthma morbidity puerto rican children

https://doi.org/10.1016/j.ajog.2020.06.049

Melissa Frey|Annie Ellis|Kristen Zeligs|Eloise Chapman?Davis|Charlene Thomas|Paul J. Christos|Valentin Kolev|Monica Prasad-Hayes|Samantha Cohen|Kevin Holcomb|Stephanie V. Blank

Impact of the coronavirus disease 2019 pandemic on the quality of life for women with ovarian cancer

Cornell University|Ovarian Cancer Research Alliance|SHARE|Icahn School of Medicine at Mount Sinai|Cornell University|Cornell University|Cornell University|Icahn School of Medicine at Mount Sinai|Icahn School of Medicine at Mount Sinai|Icahn School of Medicine at Mount Sinai|Cornell University|Icahn School of Medicine at Mount Sinai

h3backgroundh3 coronavirus disease 2019 pandemic resulted unprecedented challenges oncology community people living cancer treatments interrupted surgeries cancelled regular oncology evaluations rescheduled people cancer physicians must balance plausible fears coronavirus disease 2019 cancer treatment consequences delaying cancer care h3objectiveh3 aim evaluate experience women ovarian cancer coronavirus disease 2019 pandemic h3study designh3 women current previous diagnosis ovarian cancer completed online survey focusing treatment interruptions quality life quality life measured cancer worry scale hospital anxiety depression scale survey distributed survivor networks social media univariate multivariable linear regression analysis used evaluate effect participant characteristics quality life survey scores h3resultsh3 total 603 women 41 states visited survey website march 30 2020 april 13 2020 555 920 completed survey median age 58 years range 2085 time survey completion 217 participants 433 active treatment total 175 participants 33 experienced delay component cancer care ten 263 38 participants scheduled surgery experienced delay 18 83 217 participants scheduled nonsurgical cancer treatment total 133 participants 240 delayed physician appointment 84 151 laboratory tests 53 96 cancerrelated imaging among cohort 886 489 reported significant cancer worry 514 285 borderline abnormal anxiety 265 147 borderline abnormal depression univariate analysis age less 65 years scheduled cancer treatment cancer surgery delay oncology care selfdescribed immunocompromised use telemedicine associated higher levels cancer worry higher anxiety scores associated age less 65 years selfdescribed immunocompromised higher depression scores associated age less 65 years scheduled cancer surgery delay oncology care selfdescribed immunocompromised use telemedicine multivariable linear regression analysis age less 65 selfdescribed immunocompromised independently predictive greater cancer worry anxiety depression delay cancer care predictive anxiety depression h3conclusionh3 coronavirus disease 2019 crisis affecting care patients ovarian cancer surgeries treatments scheduled physician appointments laboratory tests imaging cancelled delayed younger age presumed immunocompromise delay cancer care associated significantly higher levels cancer worry anxiety depression providers must work patients balance competing risks coronavirus disease 2019 cancer recognizing communication critical clinical tool improve quality life times

https://doi.org/10.1001/archinte.158.6.626

Lewis E. Kazis|Donald R. Miller|Jack A. Clark|Katherine M. Skinner|Austin Lee|William H. Rogers|Avron Spiro|Susan N. Payne|Graeme Fincke|Alfredo J. Selim|Mark Linzer

Health-Related Quality of Life in Patients Served by the Department of Veterans Affairs

Harvard University Press

h3backgroundh3 department veterans affairs health care system va largest integrated single payer system united states date systematic measurement health status va veterans health study developed methods assess patientbased health status ambulatory populations h3objectivesh3 describe health status veterans examine relationships healthrelated quality life age comorbidity socioeconomic serviceconnected disability status h3methodsh3 participants veterans health study 2year longitudinal study recruited representative sample patients receiving ambulatory care 4 va facilities new england region veterans health study patients received questionnaires health status including medical outcomes study short form 36item health survey health examination clinical assessments medical history taking sixteen hundred sixtyseven patients conducted baseline assessments described h3resultsh3 va outpatients poor health status scores across measures medical outcomes study short form 36item health survey compared scores nonva populations least 50 1 sd worse striking differences also found sample stratified age group 2049 years 5064 years 6590 years 7 8 scales role limitations due physical problems bodily pain general health perceptions vitality social functioning role limitations due emotional problems mental health scores considerably lower among younger patients eighth scale physical function scores young veterans aged 2049 years almost comparable levels old veterans gt65 years mental health scores young veterans substantially worse age groups ipilt001 scores screening measures depression significantly higher youngest age group 51 compared oldest age groups 33 16 ipilt001 h3conclusionsh3 va outpatients substantially worse health status nonva populations mental health differences young old veterans use va health care system sharply contrasting young veterans sicker suggesting substantially higher resource needs mental health differences may explain much worse healthrelated quality life young veterans health care systems continue undergo radical transformation department veterans affairs focus provision mental health services younger veteran

https://doi.org/10.1378/chest.14-0914

Rachel O’Conor|Michael S. Wolf|Samuel G. Smith|Melissa Martynenko|Daniel P. Vicencio|Mary Sano|Juan P. Wisnivesky|Alex D. Federman

Health Literacy, Cognitive Function, Proper Use, and Adherence to Inhaled Asthma Controller Medications Among Older Adults With Asthma

Northwestern University|Northwestern University|Northwestern University|Icahn School of Medicine at Mount Sinai|Mercy Hospital and Medical Center|James J. Peters VA Medical Center|Icahn School of Medicine at Mount Sinai|Mercy Hospital and Medical Center|Icahn School of Medicine at Mount Sinai

h3backgroundh3 sought investigate degree cognitive skills explain associations health literacy asthmarelated medication use among older adults asthma h3methodsh3 patients aged 60 years receiving care eight outpatient clinics primary care geriatrics pulmonology allergy immunology new york new york chicago illinois recruited participate structured inperson interviews part asthma beliefs literacy elderly able study n 425 behaviors related medication use investigated including adherence prescribed regimens metereddose inhaler mdi technique dry powder inhaler dpi technique health literacy measured using short test functional health literacy adults cognitive function assessed terms fluid working memory processing speed executive function crystallized verbal ability h3resultsh3 mean age participants 68 years 40 hispanic 30 nonhispanic black onethird 38 adherent controller medication 53 demonstrated proper dpi technique 38 demonstrated correct mdi technique multivariable analyses limited literacy associated poorer adherence controller medication 23 95 ci 129408 incorrect dpi 351 95 ci 181683 mdi 164 95 ci 101265 techniques fluid crystallized abilities independently associated medication behaviors however fluid abilities added model literacy associations reduced h3conclusionsh3 among older patients asthma interventions promote proper medication use simplify tasks patient roles overcome cognitive load suboptimal performance selfcare

https://doi.org/10.1001/archinternmed.2011.502

Katie Weinger|Elizabeth A. Beverly|Yishan Lee|Lilya Sitnokov|Om P Ganda|A. Enrique Caballero

The Effect of a Structured Behavioral Intervention on Poorly Controlled Diabetes

Joslin Diabetes Center

h3backgroundh3although maintaining nearly normal glycemia delays onset slows progression diabetes complications many patients diabetes physicians struggle achieve glycemic targets best methods support patients follow diabetes prescriptions recommendations unclearh3methodsh3to test efficacy behavioral diabetes intervention improving glycemia longduration poorly controlled diabetes randomized 222 adults diabetes 49 type 1 mean sd age 53 12 years mean sd disease duration 18 12 years mean sd hemoglobin asub1csub hbasub1csub concentration 90 11 attend 1 5session manualbased educatorled structured group intervention cognitive behavioral strategies structured behavioral arm 2 educatorled attention control group education program group attention control 3 unlimited individual nurse dietitian education sessions 6 months individual control outcomes baseline 3 6 12month postintervention hbasub1csub levels primary frequency diabetes selfcare 3day pedometer readings 24hour diet recalls average number glucose checks physical fitness depression coping style selfefficacy quality life secondaryh3resultsh3linear mixed modeling found groups showed improved hbasub1csub levels p lt 001 however structured behavioral arm showed greater improvements group individual control arms 3month hbasub1csub concentration changes 08 vs 04 04 respectively p 04 group time interaction furthermore participants type 2 disease showed greater improvement type 1 p 04 type diabetes time interaction quality life glucose monitoring frequency diabetes selfcare differ intervention timeh3conclusionsh3a structured cognitive behavioral program effective 2 control interventions improving glycemia adults longduration diabetes educators successfully use modified psychological behavioral strategiesh3trial registrationh3clinicaltrialsgov identifier nct000142922

https://doi.org/10.1136/jcp.22.4.508-a

Harry Blyth|B. G. Ockenden

A clinico-pathological and family study of polycystic disease of the kidneys and liver in children.

h3contexth3 covid19 pandemic healthcare providers required rapidly adapt needs patients implement precautions associated reducing covid19 spread federally qualified healthcare centers fqhcs faced unique challenges rapid transition telemedicine financial technological support restrictions demographically diverse needs patients h3objectiveh3 limited research transition telehealth impacted experiences healthcare clinicians quality improvement initiative characterizes provider telehealth experiences perceptions delivery care urban fqhc early stages covid19 pandemic h3study designh3 total 46 healthcare providers surveyed multisite fqhc northern california july august 2020 h3setting dataseth3 study site largest fqhc northern california serving 90000 patients three counties sixtyfour percent patients latinx identifying h3population studiedh3 respondents provide primary care services respondents mainly female 488 mddos 522 h3instrumenth3 36 question google survey tool sent providers included questions 3 domains selfreported telehealth experience covid19 pandemic technological telehealth experiences covid19 pandemic perceptions care provision via telehealth h3main secondary outcome measuresh3 primary outcomes included descriptive statistics associations factors related technological telehealth experience provider perceptions providing care h3resultsh3 statistically significant plt005 relationship overall satisfaction telehealth levels burnout perceptions able provide needed care via telehealth telehealth impact overall stress level also correlation perceptions able provide care telehealth comfort using telehealth finally common technical issue video visit broadband capability h3conclusionsh3 study shows telehealth visits correlated overall satisfaction stress burnout experience healthcare providers fqhcs require additional investment support establishing mechanisms support telemedicine visits broadband capabilities patient education digital literacy holistically enhance telehealth experiences

https://doi.org/10.1001/archgenpsychiatry.2007.26

Rebekah Bradley|Elisabeth B. Binder|Michael P. Epstein|Yi?Lang Tang|Hemu P. Nair|Wei Liu|Charles F. Gillespie|Tiina Berg|Mark Evces|D. Jeffrey Newport|Zachary N. Stowe|Christine Heim|Charles B. Nemeroff|Ann C. Schwartz|Joseph F. Cubells|Kerry J. Ressler

Influence of Child Abuse on Adult Depression

h3contexth3 genetic inheritance developmental life stress contribute major depressive disorder adults child abuse trauma alter endogenous stress response principally corticotropinreleasing hormone downstream effectors suggesting gene environment interaction locus may important depression h3objectiveh3 examine whether effects child abuse adult depressive symptoms moderated genetic polymorphisms within corticotropinreleasing hormone type 1 receptor icrhr1i gene h3designh3 association study examining gene environment interactions genetic polymorphisms theicrhr1ilocus measures child abuse adult depressive symptoms h3settingh3 general medical clinics large public urban hospital emory university atlanta georgia h3participantsh3 primary participant population 974 african american low socioeconomic status high rates lifetime trauma n 422 supportive independent sample n 199 distinct ethnically 877 caucasian socioeconomically less impoverished h3main outcome measuresh3 beck depression inventory scores history major depressive disorder structured clinical interview foridsmiviaxis disorders h3resultsh3 fifteen singlenucleotide polymorphisms spanning 57 kilobases theicrhr1igene examined found significant gene environment interactions multiple individual singlenucleotide polymorphisms eg rs110402ipi 008 well common haplotype spanning intron 1 ipi lt 001 specificicrhr1ipolymorphisms appeared moderate effect child abuse risk adult depressive symptoms protective effects supported similar findings second independent sample n 199 h3conclusionsh3 data support corticotropinreleasing hormone hypothesis depression suggest gene environment interaction important expression depressive symptoms adults withicrhr1irisk protective alleles history child abuse

https://doi.org/10.1001/jama.2010.1362

Lynda H. Powell|James E. Calvin|DeJuran Richardson|?mke Janssen|Carlos F. Mendes de Leon|Kristin J. Flynn|Kathleen L. Grady|Cheryl Rucker?Whitaker|Claudia Eaton|Elizabeth Avery

Self-management Counseling in Patients With Heart Failure

Rush University Medical Center

h3contexth3motivating patients heart failure adhere medical advice translated clinical benefit past trials methodological limitationsh3objectiveh3to determine value selfmanagement counseling plus heart failure education compared heart failure education alone primary end point death heart failure hospitalizationh3design setting patientsh3the heart failure adherence retention trial hart singlecenter multiplehospital partially blinded behavioral efficacy randomized controlled trial involving 902 patients mild moderate heart failure reduced preserved systolic function randomized chicago metropolitan area october 2001 october 2004 undergoing followup 2 3 subsequent yearsh3interventionsh3all patients offered 18 contacts 18 heart failure educational tip sheets course 1 year patients randomized education group received tip sheets mail telephone calls check comprehension patients randomized selfmanagement group received tip sheets groups taught selfmanagement skills implement adviceh3main outcome measureh3death heart failure hospitalization median 256 years followuph3resultsh3patients representative typical clinical populations mean age 636 years 47 women 40 racialethnic minority 52 annual family income less 30 000 23 preserved systolic function rate primary end point selfmanagement group different education group 163 401 vs 171 412 respectively odds ratio 095 95 confidence interval 072126 significant differences secondary end points including death heart failure hospitalization allcause hospitalization quality lifeh3conclusionsh3compared enhanced educational intervention alone addition selfmanagement counseling reduce death heart failure hospitalization patients mild moderate heart failureh3trial registrationh3clinicaltrialsgov identifier nct00018005

https://doi.org/10.1001/jama.299.21.2533

Larry A. Allen|Jonathan E.E. Yager|Michele Jönsson Funk|Wayne C. Levy|James A. Tulsky|Matthew T. Bowers|Gwen C. Dodson|Christopher M. O’Connor|G. Michael Felker

Discordance Between Patient-Predicted and Model-Predicted Life Expectancy Among Ambulatory Patients With Heart Failure

Clinical Research Institute

h3contexth3patients chronic heart failure impaired longterm survival expectations regarding prognosis well studiedh3objectivesh3to quantify expectations survival patients heart failure compare patient expectations model predictions identify factors associated discrepancies patientpredicted modelpredicted prognosish3design setting participantsh3prospective facetoface survey patients singlecenter duke heart failure disease management program july december 2004 followup february 2008 patientpredicted life expectancy obtained using visual analog scale modelpredicted life expectancy calculated using seattle heart failure model actuarialpredicted life expectancy based age sex alone calculated using life tables observed survival determined review medical records search social security death indexh3main outcome measureh3life expectancy ratio ler defined ratio patientpredicted modelpredicted life expectancyh3resultsh3the cohort consisted 122 patients mean age 62 years 47 african american 42 new york heart association nyha class iii iv average patients overestimated life expectancy relative modelpredicted life expectancy median patientpredicted life expectancy 130 years modelpredicted expectancy 100 years median ler 14 interquartile range 0825 younger age increased nyha class lower ejection fraction less depression significant predictors higher ler median followup 31 years 29 original cohort died association higher ler improved survival adjusted hazard ratio overestimated compared concordant ler 105 95 confidence interval 046242h3conclusionsh3ambulatory patients heart failure tended substantially overestimate life expectancy compared modelbased predictions survival differences perceived survival could affect decision making regarding advanced therapies endoflife planning causes discordant predictions warrant study

https://doi.org/10.1001/jama.2011.1433

Christine Roth|Per Magnus|Synnve Schjølberg|Camilla Stoltenberg|Pål Surén|Ian W. McKeague|George Davey Smith|Ted Reichborn?Kjennerud|Ezra Susser

Folic Acid Supplements in Pregnancy and Severe Language Delay in Children

Norwegian Institute of Public Health

h3contexth3prenatal folic acid supplements reduce risk neural tube defects may beneficial effects aspects neurodevelopmenth3objectiveh3to examine associations mothers use prenatal folic acid supplements risk severe language delay children age 3 yearsh3design setting patientsh3the prospective observational norwegian mother child cohort study recruited pregnant women 1999 december 2008 data children born 2008 whose mothers returned 3year followup questionnaire june 16 2010 used maternal use folic acid supplements within interval 4 weeks 8 weeks conception exposure relative risks approximated estimating odds ratios ors 95 cis logistic regression analysish3main outcome measureh3childrens language competency age 3 years measured maternal report 6point ordinal language grammar scale children minimal expressive language 1word unintelligible utterances rated severe language delayh3resultsh3among 38 954 children 204 05 severe language delay children whose mothers took dietary supplements specified exposure interval reference group n 9052 240 severe language delay 81 children 09 adjusted ors 3 patterns exposure maternal dietary supplements 1 supplements folic acid n 2480 66 severe language delay 22 children 09 104 95 ci 062174 2 folic acid n 7127 189 severe language delay 28 children 04 055 95 ci 035086 3 folic acid combination supplements n 19 005 505 severe language delay 73 children 04 055 95 ci 039078h3conclusionh3among norwegian cohort mothers children maternal use folic acid supplements early pregnancy associated reduced risk severe language delay children age 3 years

https://doi.org/10.1001/jamainternmed.2018.4630

Shreya Kangovi|Nandita Mitra|Lindsey Norton|Rory Harte|Xinyi Zhao|Tamala Carter|David Grande|Judith A. Long

Effect of Community Health Worker Support on Clinical Outcomes of Low-Income Patients Across Primary Care Facilities

University of Pennsylvania|Penn Center for AIDS Research|University of Pennsylvania Health System|Philadelphia VA Medical Center|University of Pennsylvania|University of Pennsylvania|University of Pennsylvania|University of Pennsylvania|Penn Center for AIDS Research|University of Pennsylvania Health System|University of Pennsylvania|University of Pennsylvania|Philadelphia VA Medical Center

h3importanceh3 addressing social determinants health difficult health systems operationalize h3objectiveh3 assess standardized intervention individualized management patientcentered targets impact delivered community health workers chws across 3 health systems h3design setting participantsh3 2armed singleblind multicenter randomized clinical trial recruited patients 3 primary care facilities philadelphia pennsylvania january 28 2015 march 28 2016 patients resided highpoverty zip code uninsured publicly insured diagnosis 2 chronic diseases recruited patients randomized either chw intervention control arm goal setting followup assessments conducted 6 9 months enrollment data analyzed using intentiontotreat approach june 2017 march 2018 h3interventionh3 participants set chronic disease management goal primary care physician randomized chw intervention received 6 months tailored support h3main outcomes measuresh3 primary outcome change selfrated physical health secondary outcomes selfrated mental health chronic disease control patient activation patientreported quality primary care allcause hospitalization h3resultsh3 592 participants 370 625 female mean sd age 526 111 years participants arms similar improvements selfrated physical health mean sd 18 112 vs 16 99ipi 89 patients intervention group likely report highest quality care odds ratio 18 95 ci 1424 risk difference rd 012ipi lt 001 spent fewer total days hospital 6 months 155 days vs 345 days absolute event rate reduction 69 9 months 300 days vs 471 days absolute event rate reduction 65 reduction driven shorter average length stay difference 31 days 95 ci 633 022ipi 06 lower mean number hospitalizations difference 03 95 ci 06 00ipi 07 among patients hospitalized patients intervention group lower odds repeat hospitalizations 04 95 ci 0209 rd 024ipi 02 including 30day readmissions 03 95 ci 0109 rd 017ipi 04 h3conclusions relevanceh3 standardized intervention improve selfrated health improve patientperceived quality care reducing hospitalizations suggesting health systems may use standardized intervention address social determinants health h3trial registrationh3 clinicaltrialsgov identifiernct02347787

https://doi.org/10.1001/jamanetworkopen.2020.14639

Katherine Ornstein|David L. Roth|Jin Huang|Emily B Levitan|J. Rhodes|Chanee Fabius|Monika M. Safford|Orla C. Sheehan

Evaluation of Racial Disparities in Hospice Use and End-of-Life Treatment Intensity in the REGARDS Cohort

Icahn School of Medicine at Mount Sinai|Johns Hopkins University|Johns Hopkins University|University of Alabama at Birmingham|University of Alabama at Birmingham|Johns Hopkins University|Cornell University|Johns Hopkins University

h3importanceh3 although hospice use increasing patients us increasingly dying home racial disparities treatment intensity end life including hospice use remain h3objectiveh3 examine differences black white patients endoflife care population sample wellcharacterized causes death h3design setting participantsh3 study used data reasons geographic racial differences stroke regards study ongoing populationbased cohort study enrollment january 25 2003 october 3 2007 linkage medicare claims data multivariable logistic regression models used examine racial regional differences endoflife outcomes stroke mortality among 1212 participants feeforservice medicare died january 1 2013 december 31 2015 owing natural causes excluding sudden death oversampling black individuals residents southeastern states united states initial analyses conducted march 2019 final primary analyses conducted february 2020 h3main outcomes measuresh3 primary outcomes interest hospice use 3 days last 6 months life derived medicare claims files outcomes included multiple hospitalizations emergency department visits use intensive procedures last 6 months life cause death adjudicated expert panel clinicians using death certificates proxy interviews autopsy reports medical records h3resultsh3 sample consisted 1212 participants 630 men 520 378 black individuals 312 mean sd age death 810 86 years 2542 total deaths black decedents less likely white decedents use hospice 3 days 132 378 349 vs 385 834 462ipi lt 001 stratification cause death substantial racial differences treatment intensity service use found among persons died cardiovascular disease among patients died cancer analyses adjusted cause death dementia cancer cardiovascular disease clinical demographic variables black decedents significantly less likely use 3 days hospice odds ratio 072 95 ci 054096 likely multiple emergency department visits 135 95 ci 101180 hospitalizations 139 95 ci 102189 undergo intensive treatment 194 95 ci 140270 last 6 months life compared white decedents h3conclusions relevanceh3 despite increase use hospice care recent decades racial disparities use hospice remain especially noncancer deaths research required better understand racial disparities access quality endoflife care

https://doi.org/10.1001/jamapediatrics.2019.1695

Amy E. Lawrence|Alex J. Carsel|Karen Leonhart|Holden Richards|Calista M. Harbaugh|Jennifer F. Waljee|Daryl J. McLeod|Patrick C. Walz|Peter C. Minneci|Katherine J. Deans|Jennifer N. Cooper

Effect of Drug Disposal Bag Provision on Proper Disposal of Unused Opioids by Families of Pediatric Surgical Patients

Nationwide Children's Hospital|Nationwide Children's Hospital|Nationwide Children's Hospital|Nationwide Children's Hospital|University of Michigan–Ann Arbor|University of Michigan–Ann Arbor|The Ohio State University|Nationwide Children's Hospital|The Ohio State University|The Ohio State University|Nationwide Children's Hospital|The Ohio State University|Nationwide Children's Hospital|Nationwide Children's Hospital|The Ohio State University

h3importanceh3 although opioids important component pain management children recovering surgery postoperative opioid prescribing contributed current opioid crisis united states medications often prescribed excess rarely properly disposed one potential strategy combat opioid misuse remove excess postoperative opioids circulation providing patients drug disposal products enable safe disposal opioids home garbage h3objectiveh3 determine whether provision drug disposal bag increases proper opioid disposal among families pediatric patients undergoing ambulatory surgery h3design setting participantsh3 randomized clinical trial enrolled 202 parents guardians children 1 17 years age underwent otolaryngologic urologic surgery outpatient surgery centers tertiary childrens hospital columbus ohio june december 2018 received opioid prescription prior discharge h3interventionsh3 families randomized intervention provided drug disposal bag containing activated charcoal instructions use plus standard postoperative discharge instructions opioid use storage disposal families standard care arm received standard postoperative discharge instructions participants completed baseline survey followup survey 2 4 weeks postoperatively h3main outcomes measuresh3 primary outcome proper opioid disposal defined disposal using drug disposal bag disposal method recommended us food drug administration h3resultsh3 202 parents guardians enrolled 181 completed followup 92 intervention arm 89 standard care arm patients groups white 75 735 vs 79 806 male 63 612 vs 54 546 median interquartile range age 6 59 years intervention arm 7 610 years standard care arm intentiontotreat analyses 92 families receiving disposal bag 89 families receiving disposal bag included among 66 families 717 randomized receive disposal bag reported properly disposing childs opioids whereas 50 parents 562 receive disposal bag reported proper opioid disposal difference proportions 155 95 ci 17293ipi 03 among families filled opioid prescription leftover opioids resolution childs pain 66 77 parents guardians 857 received disposal bag 50 77 parents guardians 649 received standard care reported properly disposing childs opioids difference proportions 208 95 ci 76340 h3conclusions relevanceh3 results study indicated providing drug disposal bags families children receiving postoperative opioids increased likelihood excess opioid disposal greater availability disposal products may complement ongoing prescribing reduction efforts aimed decreasing opioid misuse h3trial registrationh3 clinicaltrialsgov identifiernct03575377

https://doi.org/10.1001/jamanetworkopen.2020.5867

Sigall K. Bell|Thomas L. Delbanco|Joann G. Elmore|Patricia Fitzgerald|Alan Fossa|Kendall Harcourt|Suzanne G. Leveille|Thomas H. Payne|Rebecca Stametz|Jan Walker|Catherine M. DesRoches

Frequency and Types of Patient-Reported Errors in Electronic Health Record Ambulatory Care Notes

Beth Israel Deaconess Medical Center|Harvard University|Beth Israel Deaconess Medical Center|Harvard University|University of California, Los Angeles|Beth Israel Deaconess Medical Center|Beth Israel Deaconess Medical Center|University of Michigan–Ann Arbor|Beth Israel Deaconess Medical Center|Beth Israel Deaconess Medical Center|Harvard University|University of Massachusetts Boston|University of Washington|Geisinger Health System|Beth Israel Deaconess Medical Center|Harvard University|Beth Israel Deaconess Medical Center|Harvard University

h3importanceh3 health information transparency increases patients often seek health data 44 million patients us readily access ambulatory visit notes online practice increasing abroad studies assessed documentation errors patients identify notes may inform patient engagement safety strategies h3objectiveh3 assess frequency types errors identified patients read open ambulatory visit notes h3design setting participantsh3 survey study total 136 815 patients 3 us health care organizations open notes including 79 academic community ambulatory care practices received invitations online survey june 5 october 20 2017 patients least 1 ambulatory note logged onto portal least past 12 months included data analysis performed july 3 2018 april 27 2020 h3exposuresh3 access ambulatory care open notes patient portals 7 years 20102017 h3main outcomes measuresh3 proportion patients reporting mistake serious perceived mistake factors associated finding errors characterized patients serious categories patientreported errors h3resultsh3 136 815 patients received survey invitations 29 656 217 responded 22 889 patients mean sd age 5516 1596 years 14 447 631 female 18 301 800 white read 1 notes past 12 months completed error questions patients 4830 211 reported perceived mistake 2043 423 reported mistake serious somewhat serious 1563 324 serious 480 99 multivariable analysis female patients relative risk rr 179 95 ci 172185 educated patients rr 138 95 ci 129148 sicker patients rr 189 95 ci 184194 aged 45 64 years rr 223 95 ci 206242 65 years older rr 200 95 ci 173232 read 1 note 23 notes rr 182 95 ci 134247 4 notes rr 309 95 ci 202473 likely report mistake found serious compared reference groups categorization patientreported serious mistakes specifically mentioning wordidiagnosisior describing specific error current past diagnoses common 98 356 275 followed inaccurate medical history 85 356 239 medications allergies 50 356 140 tests procedures results 30 356 84 total 23 65 reflected notes reportedly written wrong patient 433 serious errors 255 589 included least 1 perceived error potentially associated diagnostic process eg history physical examination tests referrals communication h3conclusions relevanceh3 study patients read ambulatory notes online perceived mistakes substantial proportion found serious older sicker patients twice likely report serious error compared younger healthier patients indicating important safety quality implications sharing notes patients may help engage improve record accuracy health care safety together practitioners

https://doi.org/10.1001/jamaoncol.2020.3697

Nicole Senft|Lauren M. Hamel|Mark Manning|Seongho Kim|Louis A. Penner|Tanina Foster Moore|Michael A. Carducci|Elisabeth I. Heath|Dina Lansey|Terrance L. Albrecht|Mark Wojda|Alice Jordan|Susan Eggly

Willingness to Discuss Clinical Trials Among Black vs White Men With Prostate Cancer

Vanderbilt University Medical Center|The Barbara Ann Karmanos Cancer Institute|Wayne State University|The Barbara Ann Karmanos Cancer Institute|Wayne State University|The Barbara Ann Karmanos Cancer Institute|Wayne State University|The Barbara Ann Karmanos Cancer Institute|Wayne State University|The Barbara Ann Karmanos Cancer Institute|Wayne State University|Sidney Kimmel Comprehensive Cancer Center|Johns Hopkins University|The Barbara Ann Karmanos Cancer Institute|Wayne State University|Sidney Kimmel Comprehensive Cancer Center|Johns Hopkins University|The Barbara Ann Karmanos Cancer Institute|Wayne State University|The Barbara Ann Karmanos Cancer Institute|Wayne State University|Sidney Kimmel Comprehensive Cancer Center|Johns Hopkins University|The Barbara Ann Karmanos Cancer Institute|Wayne State University

h3importanceh3 black individuals underrepresented cancer clinical trials h3objectiveh3 examine whether black white men prostate cancer differ willingness discuss clinical trials physicians whether patientlevel barriers statistically mediate racial differences h3design setting participantsh3 crosssectional survey study used baseline data partnering around cancer clinical trials randomized clinical trial increase black individuals enrollment prostate cancer clinical trials data collected 2016 2019 2 national cancer institutedesignated comprehensive cancer centers participants black white men intermediaterisk highrisk prostate cancer mediation analysis path models regressed willingness onto race potential mediator simultaneously including direct paths race mediator significant indirect effect sizes served evidence mediation h3exposuresh3 race primary exposure potential mediators included age education household income perceived economic burden painphysical limitation health literacy general trust physicians groupbased medical suspicion h3main outcomes measuresh3 primary outcome answer single question offered cancer clinical trial would willing hear information h3resultsh3 total 205 participants included 92 black men 113 white men mean range age 657 4589 years 32 high school education lower 275 household income less 40 000 883 reported definitely probably willing discuss trials white participants likely endorse highest category willingness black participants 82 vs 64 sup2supsub2sub 881ipi 01 compared white participants black participants younger ifisub1182sub 867ipi lt 001 less educated ifisub1182sub 2279ipi lt 001 lower income ifisub1182sub 7959ipi lt 001 greater perceived economic burden ifisub1182sub 4246ipi lt 001 lower health literacy ifisub1184sub 984ipi 002 greater groupbased medical suspicion ifisub1184sub 2148ipi lt 001 groupbased medical suspicion significantly mediated association race willingness discuss trials indirect effect 022ipi 002 h3conclusions relevanceh3 study men prostate cancer participants willing discuss trials black men significantly less willing white men black men likely believe members racial group suspicious health care system belief associated lower willingness discuss trials addressing medical mistrust may improve equity clinical research

https://doi.org/10.1001/jama.2022.10951

Carol M. Mangione|Michael J. Barry|Wanda K. Nicholson|Michael D. Cabana|Tumaini R. Coker|Karina W. Davidson|Esa M. Davis|Katrina E Donahue|Carlos Roberto Jaén|Martha Kubik|Li Li|Gbenga Ogedegbe|Lori Pbert|John Ruiz|James J. Stevermer|John B. Wong

Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Disease Risk Factors

University of California, Los Angeles|Harvard University|University of North Carolina at Chapel Hill|Albert Einstein College of Medicine|Seattle University|University of Washington|Feinstein Institute for Medical Research|Northwell Health|University of Pittsburgh|University of North Carolina at Chapel Hill|The University of Texas Health Science Center at San Antonio|George Mason University|University of Virginia|New York University|University of Massachusetts Chan Medical School|University of Arizona|University of Missouri|Tufts University

h3importanceh3 cardiovascular disease cvd includes heart disease myocardial infarction stroke leading cause death us large proportion cvd cases prevented addressing modifiable risk factors including smoking obesity diabetes elevated blood pressure hypertension dyslipidemia lack physical activity unhealthy diet adults adhere national guidelines healthy diet physical activity lower rates cardiovascular morbidity mortality however us adults consume healthy diets engage physical activity recommended levels h3objectiveh3 update 2017 recommendation us preventive services task force uspstf commissioned review evidence benefits harms behavioral counseling interventions promote healthy behaviors adults without cvd risk factors h3populationh3 adults 18 years older without known cvd risk factors include hypertension elevated blood pressure dyslipidemia impaired fasting glucose glucose tolerance mixed multiple risk factors metabolic syndrome estimated 10year cvd risk 75 greater h3evidence assessmenth3 uspstf concludes moderate certainty behavioral counseling interventions small net benefit cvd risk adults without cvd risk factors h3recommendationh3 uspstf recommends clinicians individualize decision offer refer adults without cvd risk factors behavioral counseling interventions promote healthy diet physical activity c recommendation

https://doi.org/10.1001/jamanetworkopen.2018.4852

Marcello Tonelli|Natasha Wiebe|Braden Manns|Scott Klarenbach|Matthew T. James|Pietro Ravani|Neesh Pannu|Jonathan Himmelfarb|Brenda R. Hemmelgarn

Comparison of the Complexity of Patients Seen by Different Medical Subspecialists in a Universal Health Care System

University of Calgary|University of Alberta|University of Calgary|University of Alberta|University of Calgary|University of Calgary|University of Alberta|University of Washington|University of Calgary

h3importanceh3 clinical experience suggests substantial differences patient complexity across medical specialties empirical data lacking h3objectiveh3 compare complexity patients seen different types physician universal health care system h3design setting participantsh3 populationbased retrospective cohort study 2 597 127 residents canadian province alberta aged 18 years older least 1 physician visit april 1 2014 march 31 2015 data analyzed september 2018 h3exposuresh3 type physician seeing patient family physician general internist 11 types medical subspecialist assessed nonmutually exclusive categories h3main outcomes measuresh3 nine markers patient complexity number comorbidities presence mental illness number types physicians involved patients care number physicians involved patients care number prescribed medications number emergency department visits rate death rate hospitalization rate placement longterm care facility h3resultsh3 among 2 597 127 participants median interquartile range age 46 3259 years 541 female 1 year followup 21 792 patients 08 died median range number days spent hospital 0 0365 81 patients least 1 hospitalization median interquartile range number prescribed medications 3 17 complexity markers considered individually patients seen nephrologists highest mean number comorbidities 42 95 ci 4243 vs lowest 11 95 ci 1011 highest mean number prescribed medications 142 95 ci 142143 vs lowest 49 95 ci 4949 highest rate death 66 95 ci 6369 vs lowest 01 95 ci lt0102 highest rate placement longterm care facility 20 95 ci 1822 vs lowest lt01 95 ci lt0101 patients seen infectious disease specialists highest complexity assessed 5 markers rate mental health condition 29 95 ci 2829 vs lowest 14 95 ci 1414 mean number physician types 55 95 ci 5556 vs lowest 21 95 ci 2121 mean number physicians 130 95 ci 129131 vs lowest 38 95 ci 3838 mean days hospital 150 95 ci 149150 vs lowest 04 95 ci 0404 mean emergency department visits 26 95 ci 2626 vs lowest 05 95 ci 0505 types physician ranked according patient complexity across 9 markers order least complex nephrologist infectious disease specialist neurologist respirologist hematologist rheumatologist gastroenterologist cardiologist general internist endocrinologist allergistimmunologist dermatologist family physician h3conclusion relevanceh3 substantial differences found 9 different markers patient complexity across different types physician including medical subspecialists general internists family physicians findings implications medical education health policy

https://doi.org/10.1001/jamainternmed.2018.4637

Michael Dougherty|Alison T. Brenner|Seth D. Crockett|Shivani Gupta|Stephanie B. Wheeler|Manny Coker?Schwimmer|Laura Cubillos|Teri L. Malo|Daniel Reuland

Evaluation of Interventions Intended to Increase Colorectal Cancer Screening Rates in the United States

University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|Icahn School of Medicine at Mount Sinai|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill

h3importanceh3 colorectal cancer screening crc recommended major us medical organizations remains underused h3objectiveh3 identify interventions associated increasing crc screening rates effect sizes h3data sourcesh3 pubmed cumulative index nursing allied health literature cochrane library clinicaltrialsgov searched january 1 1996 august 31 2017 key search terms includedicolorectal canceriandiscreeningi h3study selectionh3 randomized clinical trials usbased interventions clinical settings designed improve crc screening test completion averagerisk adults h3data extraction synthesish3 least 2 investigators independently extracted data appraised studys risk bias sufficient data available randomeffects metaanalysis used obtain either pooled risk ratio rr risk difference rd screening completion type intervention h3main outcomes measuresh3 main outcome completion crc screening examination included interventions increase completion 1 initial crc screening recommended modality 2 colonoscopy abnormal initial screening test result 3 continued rounds annual fecal blood tests fbts h3resultsh3 main review included 73 randomized clinical trials comprising 366 766 patients low medium risk bias interventions associated increased crc screening completion rates compared usual care included fbt outreach rr 226 95 ci 181281 rd 22 95 ci 1727 patient navigation rr 201 95 ci 164246 rd 18 95 ci 1323 patient education rr 120 95 ci 106136 rd 4 95 ci 16 patient reminders rr 120 95 ci 102141 rd 3 95 ci 05 clinician interventions academic detailing rd 10 95 ci 317 clinician reminders rd 13 95 ci 819 combinations interventions clinician interventions navigation added fbt outreach associated greater increases single components rr 118 95 ci 109129 rd 7 95 ci 311 repeated mailed fbts navigation associated increased annual fbt completion rr 209 95 ci 191229 rd 39 95 ci 2949 patient navigation associated colonoscopy completion initial abnormal screening test result rr 121 95 ci 092160 rd 14 95 ci 029 h3conclusions relevanceh3 fecal blood test outreach patient navigation particularly context multicomponent interventions associated increased crc screening rates us trials fecal blood test outreach incorporated populationbased screening programs research needed interventions increase adherence continued fbts followup abnormal initial screening test results costeffectiveness implementation barriers intensive interventions navigation

https://doi.org/10.1001/jamainternmed.2018.2372

Stephen D. Persell|Kunal N. Karmali|Danielle Lazar|Elisha M. Friesema|Ji Young Lee|Alfred Rademaker|Darren Kaiser|Milton Eder|Dustin D. French|Tiffany Brown|Michael S. Wolf

Effect of Electronic Health Record–Based Medication Support and Nurse-Led Medication Therapy Management on Hypertension and Medication Self-management

Northwestern University|Northwestern University|Access Community Health Network|Center for Discovery|Northwestern University|University of Minnesota|Northwestern University|Northwestern University|Northwestern Medicine|Access Community Health Network|Center for Discovery|University of Minnesota|Northwestern University|Northwestern University|Northwestern University

h3importanceh3 complex medication regimens pose selfmanagement challenges particularly among populations low levels health literacy h3objectiveh3 test medication management tools delivered commercial electronic health record ehr without nurseled education intervention h3design setting participantsh3 3group cluster randomized clinical trial performed community health centers chicago illinois participants included 794 patients hypertension selfreported using 3 medications concurrently purpose data collected april 30 2012 february 29 2016 analyzed intention treat h3interventionsh3 clinics randomly assigned groups electronic health recordbased medication management tools medication review sheets visit checkin lay medication information sheets printed visits ehralone group ehrbased tools plus nurseled medication management support ehr plus education group usual care h3main outcomes measuresh3 outcomes 12 months included systolic blood pressure primary outcome medication reconciliation knowledge drug indications understanding medication instructions dosing selfreported medication adherence medication outcomes assessed hypertension prescriptions prescriptions treat chronic disease medications h3resultsh3 among 794 participants 686 women mean sd age 527 96 years systolic blood pressure 12 months greater ehralone group compared usual care group 36 mm hg 95 ci 03 69 mm hg systolic blood pressure ehr plus education group significantly lower compared usual care group difference 20 mm hg 95 ci 52 13 mm hg lower compared ehralone group 56 mm hg 95 ci 88 24 mm hg 12 months hypertension medication reconciliation improved ehralone group adjusted odds ratio 18 95 ci 11 29 ehr plus education group adjusted odds ratio 20 95 ci 13 33 compared usual care understanding medication instructions dosing greater ehr plus education group usual care group hypertension medications 23 95 ci 11 48 medications combined 17 95 ci 10 28 compared usual care ehr tools alone ehr plus education interventions improve hypertension medication adherence 09 95 ci 0614 knowledge chronic drug indications ehr tools alone 10 95 ci 06 15 ehr plus education 11 95 ci 0717 h3conclusions relevanceh3 study found ehr tools isolation improved medication reconciliation worsened blood pressure combining tools nurseled support suggested improved understanding medication instructions dosing lower blood pressure compared usual care h3trial registrationh3 clinicaltrialsgov identifiernct01578577

https://doi.org/10.1001/jamanetworkopen.2020.21457

Donna M. Zulman|Matthew L. Maciejewski|Janet M. Grubber|Hollis J. Weidenbacher|Dan V. Blalock|Leah L. Zullig|Liberty Greene|Heather E. Whitson|S. Nicole Hastings|Valerie A. Smith

Patient-Reported Social and Behavioral Determinants of Health and Estimated Risk of Hospitalization in High-Risk Veterans Affairs Patients

VA Palo Alto Health Care System|Center for Innovation|Stanford University|Durham VA Health Care System|Duke University|Durham VA Health Care System|Durham VA Health Care System|Durham VA Health Care System|Durham VA Health Care System|Duke University|VA Palo Alto Health Care System|Center for Innovation|Stanford University|Duke University|Durham VA Health Care System|Geriatric Research Education and Clinical Center|Geriatric Research Education and Clinical Center|Durham VA Health Care System|Duke University|Durham VA Health Care System|Duke University

h3importanceh3 despite recognition association individual social behavioral determinants health sdh patient outcomes little known regarding value sdh explaining variation outcomes highrisk patients h3objectiveh3 describe sdh factors among veterans high risk hospitalization determine whether adding patientreported sdh measures electronic health record ehr measures improves estimation 90day 180day allcause hospital admission h3design setting participantsh3 survey mailed april 16 june 29 2018 nationally representative sample 10 000 veterans affairs va patients whose 1year risk hospitalization death 75th percentile higher based va ehrderived risk score survey included multiple sdh measures resilience social support health literacy smoking status transportation barriers recent life stressors h3main outcomes measuresh3 ehrbased characteristics survey respondents nonrespondents compared using standardized differences estimation 90day 180day hospital admission risk assessed 3 logistic regression models 1 base model prespecified ehrbased covariates 2 restricted model ehrbased covariates chosen via forward selection based minimizing akaike information criterion aic 3 model ehr surveybased covariates chosen via forward selection based aic minimization h3resultsh3 total 4685 individuals response rate 469 responded survey respondents comparable nonrespondents characteristics survey respondents older eg gt80 years old 881 188 vs 800 151 comprised higher percentage men 4391 937 vs 4794 902 composed white nonhispanic individuals 3366 718 vs 3259 613 based aic regression model surveybased covariates ehrbased covariates better estimated hospital admission 90 days aic 19477 180 days aic 29519 restricted models ehrbased covariates aic 19802 90 days aic 29819 180 days result due inclusion selfreported measures marital partner status healthrelated locus control resilience smoking status health literacy medication insecurity h3conclusions relevanceh3 augmenting ehr data patientreported social information improved estimation 90day 180day hospitalization risk highlighting specific sdh factors might identify individuals high risk hospitalization

https://doi.org/10.1001/jamaophthalmol.2015.6212

Joshua H. Uhr|Kapil Mishra|Wei Chen|Albert Y. Wu

Awareness and Knowledge of Emergent Ophthalmic Disease Among Patients in an Internal Medicine Clinic

Icahn School of Medicine at Mount Sinai|Icahn School of Medicine at Mount Sinai|Icahn School of Medicine at Mount Sinai|Icahn School of Medicine at Mount Sinai

h3importanceh3 emergent ophthalmic disease lead permanent visual impairment blindness medical attention delayed awareness knowledge emergent ophthalmic disease may important early medical presentation maximization visual prognosis cases h3objectiveh3 assess public awareness knowledge 4 emergent ophthalmic diseases h3design setting participantsh3 crosssectional study conducted june 1 july 30 2015 waiting rooms outpatient internal medicine resident clinic mount sinai hospital written survey administered evaluate awareness knowledge retinal detachment acute angleclosure glaucoma giant cell arteritis central retinal artery occlusion awareness disease assessed whether participants knew diseases yes knowledge evaluated responses 3 questions disease including 1 question basic pathophysiologic features 1 question basic symptoms 1 question basic treatment options englishspeaking patients physically cognitively able fill survey without assistance considered eligible offered opportunity participate times survey distribution 237 completed survey demographic information including age sex race income educational level collected data assessed august 1 7 2015 h3main outcomes measuresh3 awareness ophthalmic disease determined proportion respondents answered yes knowledge determined proportion aware respondents answered knowledge questions correctly h3resultsh3 two hundred thirtyseven patients 227 gave complete demographic information 76 men 335 151 women 665 mean sd age 513 168 years completed survey awareness diseases studied low 61 220 respondents 277 95 ci 218336 aware retinal detachment 32 219 respondents 146 95 ci 99193 acute angleclosure glaucoma 11 216 respondents 51 95 ci 2280 giant cell arteritis 10 218 respondents 46 95 ci 1874 central retinal artery occlusion respondents aware knowledgeable ranged 29 199 146 pathophysiologic features retinal detachment 1 208 05 symptoms 2 203 10 treatment giant cell arteritis 1 193 05 pathophysiologic features central retinal artery occlusion h3conclusions relevanceh3 levels awareness knowledge emergent ophthalmic diseases low results indicate need educate public acutely visionthreatening entities ensure early medical presentation achieve best possible visual prognosis preserve quality life

https://doi.org/10.1001/jamanetworkopen.2020.36227

Amytis Towfighi|Eric M. Cheng|Monica Ayala-Rivera|Frances Barry|Heather McCreath|David A. Ganz|Martin L. Lee|Nerses Sanossian|Bijal Mehta|Tara Dutta|Ali Razmara|Robert J. Bryg|Shlee Song|Phyllis Willis|Shinyi Wu|Magaly Ramirez|Adam Richards|Nicholas Jackson|Jeremy Wacksman|Brian Mittman|Jamie Tran|Renee Johnson|Chris Ediss|Theresa Sivers-Teixeira|Betty Shaby|Ana L. Montoya|Marilyn Corrales|Elizabeth Mojarro-Huang|Marissa Castro|Patricia Gomez|Cynthia E. Muñoz|Diamond Garcia|Lilian Moreno|Maura Fernandez|Enrique Moratalla López|Sarah Valdez|Hilary Haber|Valerie Hill|Neal Rao|Bibiana Martínez|Lillie Hudson|Natalie Valle|Barbara G. Vickrey

Effect of a Coordinated Community and Chronic Care Model Team Intervention vs Usual Care on Systolic Blood Pressure in Patients With Stroke or Transient Ischemic Attack

University of Southern California|Los Angeles County Department of Health Services|Rancho Los Amigos National Rehabilitation Center|LAC+USC Medical Center|University of California, Los Angeles|University of Southern California|Los Angeles County Department of Health Services|Rancho Los Amigos National Rehabilitation Center|LAC+USC Medical Center|University of California, Los Angeles|University of California, Los Angeles|University of California, Los Angeles|VA Greater Los Angeles Healthcare System|University of California, Los Angeles|VA Greater Los Angeles Healthcare System|University of Southern California|LAC+USC Medical Center|University of California, Los Angeles|Harbor–UCLA Medical Center|Rancho Los Amigos National Rehabilitation Center|University of Maryland, Baltimore|Rancho Los Amigos National Rehabilitation Center|Kaiser Permanente|University of California, Los Angeles|Olive View-UCLA Medical Center|Cedars-Sinai Medical Center|University of Southern California|University of Washington|Community Partners|University of California, Los Angeles|Dimagi (United States)|VA Greater Los Angeles Healthcare System|Kaiser Permanente|Harbor–UCLA Medical Center|Rancho Los Amigos National Rehabilitation Center|LAC+USC Medical Center|California State University Los Angeles|Rancho Los Amigos National Rehabilitation Center|LAC+USC Medical Center|University of Southern California|Rancho Los Amigos National Rehabilitation Center|Olive View-UCLA Medical Center|Harbor–UCLA Medical Center|Olive View-UCLA Medical Center|Rancho Los Amigos National Rehabilitation Center|LAC+USC Medical Center|University of California, Riverside|University of Southern California|LAC+USC Medical Center|Rancho Los Amigos National Rehabilitation Center|Cedars-Sinai Medical Center|Rancho Los Amigos National Rehabilitation Center|University of Southern California|Rancho Los Amigos National Rehabilitation Center|Rancho Los Amigos National Rehabilitation Center|Harbor–UCLA Medical Center|Rancho Los Amigos National Rehabilitation Center|University of Southern California|LAC+USC Medical Center|Rancho Los Amigos National Rehabilitation Center|Harbor–UCLA Medical Center|Dimagi (United States)|Brigham and Women's Hospital|University of Cincinnati|University of California, Los Angeles|Olive View-UCLA Medical Center|University of Southern California|Rancho Los Amigos National Rehabilitation Center|LAC+USC Medical Center|Harbor–UCLA Medical Center|University of Southern California|Rancho Los Amigos National Rehabilitation Center|St. Jude Medical Center|Icahn School of Medicine at Mount Sinai

h3importanceh3 stroke survivors meet recommended cardiovascular goals particularly among racialethnic minority populations black hispanic individuals socioeconomically disadvantaged populations h3objectiveh3 determine chronic care modelbased community health worker chw advanced practice clinician apc including nurse practitioners physician assistants physician team intervention improves risk factor control stroke safetynet setting ie health care setting individuals receive care regardless health insurance status ability pay h3design setting participantsh3 randomized clinical trial included participants recruited 5 hospitals serving lowincome populations los angeles county california part secondary stroke prevention uniting community chronic care model teams early end disparities succeed clinical trial inclusion criteria age 40 years older experience ischemic hemorrhagic stroke transient ischemic attack tia 90 days prior systolic blood pressure bp 130 mm hg greater 120 130 mm hg history hypertension using hypertensive medications english spanish language proficiency exclusion criterion inability consent among 887 individuals screened eligibility 542 individuals eligible 487 individuals enrolled randomized stratified stroke type ischemic tia vs hemorrhagic language english vs spanish site usual care vs intervention 11 fashion study conducted february 2014 september 2018 data analyzed october 2018 november 2020 h3interventionsh3 participants randomized intervention offered multimodal coordinated care intervention including hypothesized core components ie 3 apc clinic visits 3 chw home visits chronic disease selfmanagement program workshops additional telephone visits protocoldriven risk factor management culturally linguistically tailored education materials selfmanagement tools participants randomized control group received usual care varied site frequently included free bp monitor selfmanagement tools linguistically tailored information materials h3main outcomes measuresh3 primary outcome change systolic bp 12 months secondary outcomes nonhigh density lipoprotein cholesterol hemoglobin asub1csub creactive protein crp levels body mass index antithrombotic adherence physical activity level diet smoking status 12 months potential mediators assessed included access care health stroke literacy selfefficacy perceptions care bp monitor use h3resultsh3 among 487 participants included mean sd age 571 89 years 317 651 men 347 participants 713 hispanic 87 participants 183 black 30 participants 63 asian total 246 participants randomized usual care 241 participants randomized intervention mean sd systolic bp improved 143 17 mm hg baseline 133 20 mm hg 12 months intervention group 146 19 mm hg baseline 137 22 mm hg 12 months usual care group significant differences change groups compared control group participants intervention group greater improvements selfreported salt intake difference 154 95 ci 44 260ipi 004 serum crp level difference log crp 04 95 ci 07 01 mgdlipi 003 differences secondary outcomes although 216 participants 896 intervention group received 3 core components 35 participants 145 received intended full dose h3conclusions relevanceh3 randomized clinical trial complex multilevel multimodal intervention find vascular risk factor improvements beyond usual care however studies may consider testing succeed intervention modifications enhance implementation participant engagement h3trial registrationh3 clinicaltrialsgov identifiernct01763203

https://doi.org/10.1001/jamainternmed.2013.9263

Gary G. Bennett|Perry Foley|Erica Levine|Jessica A. Whiteley|Sandy Askew|Dori Steinberg|Bryan C. Batch|Mary L. Greaney|Heather Miranda|Thomas H. Wroth|Marni Gwyther Holder|Karen M. Emmons|Elaine Puleo

Behavioral Treatment for Weight Gain Prevention Among Black Women in Primary Care Practice

Duke University|Duke Institute for Health Innovation|Duke Institute for Health Innovation|Duke University|Duke Institute for Health Innovation|Duke University|University of Massachusetts Boston|Duke Institute for Health Innovation|Duke University|Duke Institute for Health Innovation|Duke University|Duke University Hospital|Duke Medical Center|Dana-Farber Cancer Institute|Piedmont HealthCare|Piedmont HealthCare|Piedmont HealthCare|Dana-Farber Cancer Institute|University of Massachusetts Amherst

h3importanceh3 weight loss treatments produce clinically meaningful weight loss outcomes among black women particularly primary care setting new weight management strategies necessary population weight gain prevention might effective treatment option particular benefits overweight class 1 obese black women h3objectiveh3 compare changes weight cardiometabolic risk 12month period among black women randomized primary carebased behavioral weight gain prevention intervention relative usual care h3design setting participantsh3 twoarm randomized clinical trial shape program recruited patients 6site community health center system randomized 194 overweight class 1 obese body mass index calculated weight kilograms divided height meters squared 25349 premenopausal black women aged 25 44 years enrollment began december 7 2009 12 18month assessments completed february october 2 2012 h3interventionsh3 mediumintensity intervention included tailored behavior change goals weekly selfmonitoring via interactive voice response monthly counseling calls tailored skills training materials gym membership h3main outcomes measuresh3 twelvemonth change weight body mass index maintenance change 18 months h3resultsh3 participants mean age 354 years mean weight 811 kg mean body mass index 302 baseline socioeconomically disadvantaged 797 educational level less college degree 743 reporting annual income lt30 000 12month weight change larger among intervention participants mean sd 10 05 kg relative usual care 05 05 kg mean difference 14 kg 95 ci 28 01 kgipi 04 month 12 62 intervention participants baseline weights compared 45 usualcare participants ipi 03 18 months intervention participants maintained significantly larger changes weight mean difference 17 kg 95 ci 33 02 kg h3conclusions relevanceh3 mediumintensity primary carebased behavioral intervention demonstrated efficacy weight gain prevention among socioeconomically disadvantaged black women maintain dont gain approach might useful alternative treatment reducing obesityassociated disease risk among premenopausal black women h3trial registrationh3 clinicaltrialsgov identifiernct00938535

https://doi.org/10.1001/jamaoto.2018.1272

Brooke Nickel|Alexandra Barratt|Kevin McGeechan|Juan P. Brito|Ray Moynihan|Kirsten Howard|Kirsten McCaffery

Effect of a Change in Papillary Thyroid Cancer Terminology on Anxiety Levels and Treatment Preferences

University of Sydney|University of Sydney|University of Sydney|Mayo Clinic|University of Sydney|Bond University|University of Sydney|University of Sydney

h3importanceh3 given evidence overdiagnosis overtreatment small papillary thyroid cancers ptcs strategies needed promote consideration less invasive treatment options patients lowrisk ptc h3objectiveh3 determine association treatment preferences anxiety levels ptc terminology used describe condition h3design setting participantsh3 randomized crossover study involved community sample 550 australian men women 18 years older without history thyroid cancer march 16 2016 july 26 2016 participants accessed online study presented 3 hypothetical clinically realistic scenarios described ptc papillary thyroid cancer papillary lesion abnormal cells participants exposed 3 scenarios different terminologies participants randomized order first second third viewed terminologies data analysis conducted september 1 2016 may 15 2017 h3main outcomes measuresh3 treatment choice total thyroidectomy hemithyroidectomy active surveillance diagnosis anxiety treatment choice anxiety h3resultsh3 550 participants completed online study included analysis 279 507 female mean sd age 499 152 years higher proportion participants 108 196 chose total thyroidectomy papillary thyroid cancer used describe condition compared percentage participants chose total thyroidectomy papillary lesion 58 105 abnormal cells 60 109 terminology used first exposure papillary thyroid cancer terminology led 60 186 participants 323 choose surgery compared 46 191 participants 241 chose surgery exposed papillary lesion terminology first risk ratio rr 073 95 ci 053102 47 173 participants 272 exposed abnormal cells rr 082 95 ci 060114 terminology first first exposure participants viewed papillary thyroid cancer terminology reported significantly higher levels anxiety mean 78 11 points compared viewed papillary lesion mean 70 11 points mean difference 08 95 ci 13 03 abnormal cells mean 73 11 points mean difference 05 95 ci 10 001 overall interest active surveillance high higher levels anxiety reported chose surgery regardless terminology viewed first mean difference 15 95 ci 1019 h3conclusions relevanceh3 changing terminology small ptcs may one strategy reduce patients anxiety levels help consider less invasive management options curtail overdiagnosis overtreatment ptc strategies may include providing balanced information risks advantages alternative treatments h3trial registrationh3 anzctrorgau identifieractrn12616000271404

https://doi.org/10.1001/jamainternmed.2013.13639

Mara A. Schonberg|Mary Beth Hamel|Roger B. Davis|Miriam Griggs|Christina C. Wee|Angela Fagerlin|Edward R. Marcantonio

Development and Evaluation of a Decision Aid on Mammography Screening for Women 75 Years and Older

Beth Israel Deaconess Medical Center|Harvard University|Beth Israel Deaconess Medical Center|Harvard University|Beth Israel Deaconess Medical Center|Harvard University|Beth Israel Deaconess Medical Center|Harvard University|Beth Israel Deaconess Medical Center|Harvard University|VA Center for Clinical Management Research|University of Michigan–Ann Arbor|Beth Israel Deaconess Medical Center|Harvard University

h3importanceh3 guidelines recommend women 75 years older informed benefits risks mammography screened however adequately informed h3objectivesh3 develop evaluate mammography screening decision aid da women 75 years older h3designh3 designed da using international standards july 14 2010 april 10 2012 participants completed pretest survey read da appointment primary care physician completed posttest survey appointment medical records reviewed followup information h3setting participantsh3 boston massachusetts academic primary care practice eligible women aged 75 89 years english speaking mammogram 9 months screened within past 3 years history dementia invasive noninvasive breast cancer 84 women approached 27 declined participate 12 unable complete study logistical reasons 45 participated h3interventionsh3 da includes information breast cancer risk life expectancy competing mortality risks possible outcomes screening values clarification exercise h3main outcomes measuresh3 knowledge benefits risks screening decisional conflict screening intentions documentation medical record discussion risks benefits mammography primary care physician within 6 months receipt screening within 15 months used wilcoxon signed rank test mcnemar test compare pretestposttest information h3resultsh3 median age participants 79 years 69 31 45 nonhispanic white raceethnicity 60 27 45 attended least college comparison posttest results pretest results demonstrated 2 findings first knowledge benefits risks screening improved ipi lt 001 second fewer participants intended screened 56 25 45 afterward compared 82 37 45 beforeipi 03 decisional conflict declined significantly ipi 10 following 6 months 53 24 45 participants primary care physician note documented discussion risks benefits screening compared 11 5 45 previous 5 years ipi lt 001 84 36 43 screened within 2 years participating 60 26 43 screened within 15 months participating 2 years since last mammogram ipi 01 overall 93 42 45 found da helpful h3conclusions relevanceh3 da may improve older womens decision making mammography screening

https://doi.org/10.1001/jama.2019.0710

Harriette G.C. Van Spall|Shun Fu Lee|Feng Xie|Urun Erbas Oz|Richard Perez|Peter R. Mitoff|Manish Maingi|Michael C. Tjandrawidjaja|Michael Heffernan|Mohammad I. Zia|Liane Porepa|Mohamed Panju|Lehana Thabane|Ian D. Graham|R. Brian Haynes|Dilys Haughton|K Simek|Dennis T. Ko|Stuart J. Connolly

Effect of Patient-Centered Transitional Care Services on Clinical Outcomes in Patients Hospitalized for Heart Failure

McMaster University|Impact|Population Health Research Institute|Population Health Research Institute|McMaster University|Impact|Centre for Health Evaluation and Outcome Sciences|Institute for Clinical Evaluative Sciences|Institute for Clinical Evaluative Sciences|University of Toronto|St Joseph's Health Centre|Trillium Health Centre|William Osler Health System|HalTech|University of Toronto|Toronto East General Hospital|Southlake Regional Health Center|McMaster University|McMaster University|Impact|University of Ottawa|McMaster University|Impact|Home and Community Care Support Services|Population Health Research Institute|Institute for Clinical Evaluative Sciences|University of Toronto|McMaster University|Population Health Research Institute

h3importanceh3 health care services support hospitaltohome transition improve outcomes patients heart failure hf h3objectiveh3 test effectiveness patientcentered care transitions hf transitional care model patients hospitalized hf h3design setting participantsh3 steppedwedge cluster randomized trial 2494 adults hospitalized hf across 10 hospitals ontario canada february 2015 march 2016 followup november 2016 h3interventionsh3 hospitals randomized receive intervention n 1104 patients nurseled selfcare education structured hospital discharge summary family physician followup appointment less 1 week discharge highrisk patients structured nurse homevisits heart function clinic care provided patients usual care n 1390 patients transitional care left discretion clinicians h3main outcomes measuresh3 primary outcomes hierarchically ordered composite allcause readmission emergency department ed visit death 3 months composite allcause readmission ed visit 30 days secondary outcomes bprepared score discharge preparedness range 0 prepared 22 least prepared 3item care transitions measure ctm3 quality transition range 0 worst transition 100 best transition 5level eq5d version eq5d5l quality life range 0 dead 1 full health qualityadjusted lifeyears qaly range 0 dead 05 full health 6 months h3resultsh3 among eligible patients 2494 mean age 777 years 1258 504 women completed trial significant difference intervention usual care groups first primary composite outcome 545 494 vs 698 502 events respectively hazard ratio hr 099 95 ci 083119 second primary composite outcome 304 275 vs 408 293 events respectively hr 093 95 ci 073118 significant differences intervention usual care groups secondary outcomes mean bprepared score 6 weeks 166 vs 139 difference 265 95 ci 137392ipi lt 001 mean ctm3 score 6 weeks 765 vs 703 difference 616 95 ci 0901143ipi 02 mean eq5d5l score 6 weeks 07 vs 07 difference 006 95 ci 001 011ipi 02 6 months 07 vs 06 difference 006 95 ci 001012ipi 02 significant difference mean qaly groups 6 months 03 vs 03 difference 000 95 ci 002 002ipi 98 h3conclusions relevanceh3 among patients hf ontario canada implementation patientcentered transitional care model compared usual care improve composite clinical outcomes whether type intervention could effective health care systems locations would require research h3trial registrationh3 clinicaltrialsgov identifiernct02112227

https://doi.org/10.1001/jamanetworkopen.2021.27034

James T. Rague|Soojin Kim|Josephine Hirsch|Theresa Meyer|Ilina Rosoklija|Jill E. Larson|Vineeta T. Swaroop|Robin Bowman|Diana K. Bowen|Earl Y. Cheng|Elisa J. Gordon|Daniel I. Chu|Tamara Isakova|Elizabeth B. Yerkes|David I. Chu

Assessment of Health Literacy and Self-reported Readiness for Transition to Adult Care Among Adolescents and Young Adults With Spina Bifida

Lurie Children's Hospital|University of British Columbia|Lurie Children's Hospital|Lurie Children's Hospital|Lurie Children's Hospital|Lurie Children's Hospital|Lurie Children's Hospital|Lurie Children's Hospital|Lurie Children's Hospital|Lurie Children's Hospital|Northwestern University|University of Alabama at Birmingham|Northwestern University|Lurie Children's Hospital|Northwestern University

h3importanceh3 health literacy shown play important role transitions care adult populations low health literacy associated adverse health outcomes role health literacy transition pediatric adult care less well studied among adolescents young adults spina bifida high rates unsuccessful transition shown patient health literacy affects transition readiness remains unknown h3objectiveh3 determine whether health literacy associated transition readiness adolescents young adults spina bifida h3design setting participantsh3 crosssectional study involved collection patientreported questionnaires june 2019 march 2020 multidisciplinary spina bifida center single freestanding childrens hospital patient demographic clinical characteristics obtained medical record review patients aged 12 years older diagnosis spina bifida myelomeningocele nonmyelomeningocele whose primary language english spanish data analysis performed october 2020 march 2021 h3exposuresh3 health literacy assessed brief health literacy screening tool h3main outcomes measuresh3 primary outcome total transition readiness assessment questionnaire traq score normalized units sd nested multivariable linear regression models assessed association health literacy traq scores h3resultsh3 traq brief health literacy screening tool completed 200 individuals median range age 170 120310 years 104 female participants 520 patients younger 18 years 110 participants 550 white 136 participants 680 myelomeningocele 125 participants 625 mean sd traq score 33 11 sixtysix participants 330 reported inadequate health literacy 60 participants 300 reported marginal health literacy 74 participants 370 reported adequate health literacy univariable analysis health literacy age type spina bifida level education selfadministration vs completion questionnaires assistance ambulatory status urinary incontinence associated total traq score nested sequentially adjusted multivariable models higher health literacy remained significant stepwise independent variable associated higher traq score fully adjusted model adequate compared inadequate health literacy associated increase normalized traq score 049 sd 95 ci 019079 h3conclusions relevanceh3 patientreported transition readiness associated health literacy even adjustment education level demographic clinical factors developing implementing health literacysensitive care programs transition process may improve patient transition readiness

https://doi.org/10.1001/jamanetworkopen.2021.2633

Ariel R. Green|Hélène E Aschmann|Cynthia M. Boyd|Nancy L. Schoenborn

Assessment of Patient-Preferred Language to Achieve Goal-Aligned Deprescribing in Older Adults

Johns Hopkins Medicine|Johns Hopkins University|University of Zurich|Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University

h3importanceh3 clinicians communicate deprescribing structured process reducing stopping unnecessary potentially harmful goaldiscordant medicines may associated extent older adults willing h3objectiveh3 examine older adults preferences regarding different rationales clinician may use explain patient stop unnecessary potentially harmful medication h3design setting participantsh3 crosssectional survey study conducted march 25 april 19 2020 among nationally representative probabilitybased online survey panel knowledgepanel knowledgepanel members aged 65 years older recruited random digit dialing addressbased sampling data analyzed may 4 july 8 2020 h3exposuresh3 survey presented 2 vignettes involving hypothetical older adults one described statin used primary prevention person functional impairment polypharmacy second described sedativehypnotic zolpidem used insomnia person good functional status h3main outcomes measuresh3 vignette participants expressed preferences using bestworst scaling method 7 different phrases clinician may use explain reduce stop medication conditional logistic regression used quantify respondents relative preferences h3resultsh3 total 1193 knowledgepanel members invited 835 respondents 700 completed survey mean sd age 73 6 years 414 496 women 671 804 selfidentified white individuals total 496 respondents 598 ever used statin 124 respondents 149 ever used sedativehypnotic medications preferred phrase explain deprescribing focused risk side effects statins phrase 58fold 95 ci 5363 preferred least preferred option focused effort treatment burden involved taking medicine sedativehypnotics phrase side effects 86fold 95 ci 7995 preferred least preferred option medicine unlikely help function better h3conclusions relevanceh3 findings suggest among older adults preferred rationale deprescribing preventive symptomrelief medicines focused risk side effects results could used inform clinical practice improve effective communications around deprescribing older adults

https://doi.org/10.1001/jamadermatol.2018.3114

Raghav Tripathi|Konrad Knusel|Harib H. Ezaldein|Jeffrey F. Scott|Jeremy S. Bordeaux

Association of Demographic and Socioeconomic Characteristics With Differences in Use of Outpatient Dermatology Services in the United States

Case Western Reserve University|University School|University Hospitals of Cleveland|Case Western Reserve University|University School|University Hospitals of Cleveland|Case Western Reserve University|University School|University Hospitals of Cleveland|Case Western Reserve University|University School|University Hospitals of Cleveland|Case Western Reserve University|University School|University Hospitals of Cleveland

h3importanceh3 knowledge regarding differences dermatologic care patients broad range dermatologic conditions limited h3objectiveh3 elucidate nationwide differences use outpatient dermatologic care h3design setting participantsh3 retrospective analysis nationally representative data 2007 2015 medical expenditure panel survey meps provided agency healthcare research quality health care use outcomes dermatologic conditions skin cancers infections dermatologic inflammatory conditionsulcers skin disorders examined via multivariable logistic regression analyses outpatient officebased dermatologist visit rates accounting sex age raceethnicity educational level income insurance status region selfreported condition selfreported health status participants 183 054 meps respondents visited dermatologist 2007 2015 h3main outcomes measuresh3 primary outcome measure whether patient received outpatient care dermatologic condition payment secondary outcomes annual health care use individuals dermatologic conditions including per capita expenditure visit h3resultsh3 183 054 meps respondents mean sd age 34 23 years 521 female 19 561 107 selfreported dermatologic condition 9645 patients total 11 761 outpatient visits dermatologists hispanic adjusted odds ratio aor 055 95 ci 049061 black aor 042 95 ci 038046 patients less likely receive outpatient care dermatologic condition relative nonhispanic white patients male patients less likely receive outpatient dermatologic care female patients aor 066 95 ci 062070 midwestern patients less likely receive outpatient dermatologic care northeastern patients aor 080 95 ci 070091 patients medicaid medicare coverage aor 075 95 ci 068083 uninsured patients aor 039 95 ci 033047 less likely receive outpatient dermatologic care privately insured patients increasing educational level income associated increased odds receiving outpatient care dermatologic condition h3conclusions relevanceh3 findings highlight wideranging differences use dermatologic care united states across various demographic socioeconomic lines results study suggest urgent need characterize potential dermatologic health care differences improve use outpatient dermatologic care among disadvantaged populations

https://doi.org/10.1001/jamasurg.2017.3832

Jesse P. Wright|Gretchen C. Edwards|Kathryn Goggins|Vikram Tiwari|Amelia W. Maiga|Kelvin A. Moses|Sunil Kripalani|Kamran Idrees

Association of Health Literacy With Postoperative Outcomes in Patients Undergoing Major Abdominal Surgery

Vanderbilt University Medical Center|Vanderbilt University Medical Center|Vanderbilt University Medical Center|Vanderbilt University Medical Center|Vanderbilt University Medical Center|Vanderbilt University Medical Center|Vanderbilt University Medical Center|Vanderbilt University Medical Center

h3importanceh3 low health literacy known adversely affect health outcomes patients chronic medical conditions knowledge association health literacy postoperative outcomes studied indepth surgical patient population h3objectiveh3 evaluate association health literacy postoperative outcomes patients undergoing major abdominal surgery h3design setting participantsh3 november 2010 december 2013 1239 patients undergoing elective gastric colorectal hepatic pancreatic resections benign malignant disease single academic institution retrospectively reviewed patient demographics education insurance status procedure type american society anesthesiologists status charlson comorbidity index postoperative outcomes including length stay emergency department visits hospital readmissions reviewed electronic medical records health literacy levels assessed using brief health literacy screen validated tool administered nursing staff members hospital admission multivariate analysis used determine association health literacy levels postoperative outcomes controlling patient demographics clinical characteristics h3main outcomes measuresh3 association health literacy postoperative 30day emergency department visits 90day hospital readmissions index hospitalization length stay h3resultsh3 1239 patients participated study 624 504 women 1083 874 white 96 77 black 60 48 raceethnicity mean sd brief health literacy screen score 129 sd 275 range 315 median educational attainment 130 years patients lower health literacy levels longer length stay unadjusted 95 ci 095099ipi 004 adjusted 95 ci 003026ipi 02 analyses however lower health literacy significantly associated increased rates 30day emergency department visits 90day hospital readmissions h3conclusions relevanceh3 lower health literacy levels independently associated longer index hospitalization lengths stay patients undergoing major abdominal surgery role health literacy needs evaluated within surgical practices improve health care outcomes use

https://doi.org/10.1001/jamainternmed.2016.8653

Alicia Fernández|Judy Quan|Howard H. Moffet|Melissa M. Parker|Dean Schillinger|Andrew J. Karter

Adherence to Newly Prescribed Diabetes Medications Among Insured Latino and White Patients With Diabetes

San Francisco General Hospital|University of California, San Francisco|San Francisco General Hospital|University of California, San Francisco|Kaiser Permanente|Kaiser Permanente|San Francisco General Hospital|University of California, San Francisco|Kaiser Permanente

h3importanceh3 medication adherence essential diabetes care patientphysician language barriers may affect medication adherence among latino individuals h3objectiveh3 determine association patient raceethnicity preferred language physician language concordance patient adherence newly prescribed diabetes medications h3design setting participantsh3 observational study conducted january 1 2006 december 31 2012 large integrated health care delivery system professional interpreter services insured patients type 2 diabetes including englishspeaking white englishspeaking latino limited english proficiency lep latino patients newly prescribed diabetes medication h3exposuresh3 patient raceethnicity preferred language physician selfreported spanishlanguage fluency h3main outcomes measuresh3 primary nonadherence never dispensed earlystage nonpersistence dispensed latestage nonpersistence received 2 dispensings discontinued within 24 months inadequate overall medication adherence gt20 time without sufficient medication supply 24 months initial prescription h3resultsh3 participants included 21 878 white patients 5755 englishspeaking latino patients 3205 lep latino patients total 46 131 prescriptions new diabetes medications among lep latino patients 502 n 1610 primary care physician reporting high spanish fluency oral medications early adherence varied substantially 1032 lep latino patients 322 1565 englishspeaking latino patients 272 4004 white patients 183 either primary nonadherent early nonpersistent inadequate overall adherence observed 1929 lep latino patients 602 2975 englishspeaking latino patients 517 8204 white patients 375 insulin earlystage nonpersistence 428 among lep latino patients n 1372 344 among englishspeaking latino patients n 1980 285 among white patients n 6235 adjustment patient physician characteristics lep latino patients likely nonadherent oral medications insulin englishspeaking latino patients relative risks 111 95 ci 106115 117 95 ci 102134ipi lt 05 white patients relative risks 136 95 ci 131141 149 95 ci 132169ipi lt 05 englishspeaking latino patients likely nonadherent compared white patients relative risks 123 95 ci 119127 130 95 ci 123139ipi lt 05 patientphysician language concordance associated rates nonadherence among lep latinos relative risks 092 95 ci 071119 104 95 ci 09711ipi gt 28 h3conclusions relevanceh3 nonadherence newly prescribed diabetes medications substantially greater among latino white patients even among englishspeaking latino patients limited english proficiency latino patients likely nonadherent englishspeaking latino patients independent spanishlanguage fluency physicians interventions beyond access interpreters patientphysician language concordance required improve medication adherence among latino patients diabetes

https://doi.org/10.1001/jamainternmed.2020.2861