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Marie Bakitas|J. Nicholas Dionne?Odom|Deborah Ejem|Rachel Wells|Andrés Azuero|Macy Stockdill|Konda Keebler|Elizabeth Sockwell|Sheri Tims|Sally Engler|Karen Steinhauser|Elizabeth Kvale|Raegan W. Durant|Rodney Tucker|Kathryn L. Burgio|José Tallaj|Keith M. Swetz|Salpy V. Pamboukian

Effect of an Early Palliative Care Telehealth Intervention vs Usual Care on Patients With Heart Failure

University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham|Durham VA Medical Center|Center for Innovation|Duke University|The University of Texas at Austin|University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham|Geriatric Research Education and Clinical Center|University of Alabama at Birmingham|University of Alabama at Birmingham|University of Alabama at Birmingham

h3importanceh3 national guidelines recommend early palliative care patients advanced heart failure disproportionately affects rural minority populations h3objectiveh3 determine effect early palliative care telehealth intervention 16 weeks quality life mood global health pain resource use patients advanced heart failure h3design setting participantsh3 singleblind intervention vs usual care randomized clinical trial conducted october 1 2015 may 31 2019 among 415 patients 50 years older new york heart association class iii iv heart failure american college cardiology stage c heart failure large southeastern us academic tertiary medical center veterans affairs medical center serving high proportions rural dwellers african american individuals h3interventionsh3 enable chfpc educate nurture advise life ends comprehensive heartcare patients caregivers intervention comprises inperson palliative care consultation 6 weekly nursecoach telephonic sessions 2040 minutes monthly followup 48 weeks h3main outcomes measuresh3 primary outcomes quality life measured kansas city cardiomyopathy questionnaire kccq score range 0100 higher scores indicate better perceived health status clinical summary scores 50 considered fairly good quality life functional assessment chronic illness therapypalliative14 facitpal14 score range 056 higher scores indicate better quality life mood measured hospital anxiety depression scale hads 16 weeks secondary outcomes global health patient reported outcome measurement system global health pain patient reported outcome measurement system pain intensity interference resource use hospital days emergency department visits h3resultsh3 415 participants 221 men baseline mean sd age 638 85 years randomized enable chfpc n 208 usual care n 207 226 545 african american 108 260 lived rural area 190 458 highschool education less mean sd baseline kccq score 526 210 week 16 mean se kccq score improved 39 13 points intervention group vs 23 12 usual care group difference 16 se 17idi 007 95 ci 009 024 mean se facitpal14 score improved 14 06 points intervention group vs 02 05 points usual care group difference 12 se 08idi 012 95 ci 003 028 relevant betweengroup differences mood hadsanxietyidi 002 95 ci 020 016 hadsdepressionidi 009 95 ci 024 006 h3conclusions relevanceh3 randomized clinical trial majority african american sample baseline good quality life demonstrate improved quality life mood 16week early palliative care telehealth intervention however pain intensity interference secondary outcomes demonstrated clinically important improvement h3trial registrationh3 clinicaltrialsgov identifiernct02505425

https://doi.org/10.1001/jamanetworkopen.2018.4796

Renuka Tipirneni|Mary C. Politi|Jeffrey T. Kullgren|Edith C. Kieffer|Susan Dorr Goold|Aaron M. Scherer

Association Between Health Insurance Literacy and Avoidance of Health Care Services Owing to Cost

University of Michigan–Ann Arbor|Washington University in St. Louis|University of Michigan–Ann Arbor|VA Center for Clinical Management Research|University of Michigan–Ann Arbor|University of Michigan–Ann Arbor|University of Iowa

h3importanceh3 navigating health insurance health care choices requires considerable health insurance literacy although recommended preventive services exempt outofpocket costs affordable care act many people may remain unaware provision effect required payment little known association individuals health insurance literacy use preventive nonpreventive health care services h3objectiveh3 assess association health insurance literacy selfreported avoidance health care services owing cost h3design setting participantsh3 survey study us national geographically diverse nonprobability sample 506 us residents aged 18 years older current health insurance coverage recruited participate online survey february 22 23 2016 h3main outcomes measuresh3 validated 21item health insurance literacy measure hilm assessed individuals selfrated confidence selecting using health insurance score range 084 higher scores indicating greater levels health insurance literacy dependent variables included delayed foregone preventive nonpreventive services past 12 months owing perceived costs preventive nonpreventive use services covariates included age sex raceethnicity income educational level highdeductible health insurance plan health literacy numeracy chronic health conditions analyses included descriptive statistics bivariate multivariable logistic regression h3resultsh3 total 506 511 participants began survey completed participation rate 990 506 participants 339 670 younger 35 years mean sd age 34 104 years 228 451 women 406 504 reported race 806 white 245 484 attended college 4 years total 228 participants 451 1 chronic health condition 361 500 722 responded survey item seen physician outpatient setting past 12 months 446 501 890 responded survey item health insurance plan 12 months one hundred fifty respondents 296 reported delayed foregone care cost mean sd hilm score 635 123 multivariable logistic regression 12point increase hilm score associated lower likelihood delayed foregone preventive care adjusted odds ratio aor 061 95 ci 048078 delayed foregone nonpreventive care aor 071 95 ci 055091 h3conclusions relevanceh3 studys findings suggest lower health insurance literacy may associated greater avoidance preventive nonpreventive services appears improve appropriate use recommended health care services including preventive health services clinicians health plans policymakers may need communicate health insurance concepts accessible ways regardless individuals health insurance literacy plain language communication may able improve patients understanding services exempt outofpocket costs

https://doi.org/10.1001/jamanetworkopen.2022.23141

Nandita Khera|Nan Zhang|Talal Hilal|Urshila Durani|Minji Lee|Rema Padman|Sandeep S. Voleti|Rahma Warsame|Bijan J. Borah|K. Robin Yabroff|Joan M. Griffin

Association of Health Insurance Literacy With Financial Hardship in Patients With Cancer

Mayo Clinic in Florida|Winneshiek Medical Center|Mayo Clinic in Florida|Winneshiek Medical Center|University of Mississippi|Mayo Clinic|Mayo Clinic|Carnegie Mellon University|Mayo Clinic in Florida|Winneshiek Medical Center|Mayo Clinic|Mayo Clinic|American Cancer Society|Mayo Clinic

h3importanceh3 patientreported financial hardship increasing challenge cancer care delivery health insurance literacy association financial hardship patients cancer especially controlling financial literacy well examined h3objectiveh3 examine prevalence factors association health insurance literacy financial literacy well overall individual domains financial hardship association health insurance literacy independently adjusted financial literacy patients cancer h3design setting participantsh3 crosssectional survey study recruited enrolled patients 2 separate ambulatory infusion centers mayo clinic arizona phoenix arizona university mississippi medical center jackson mississippi adult patients aged 18 years older enrolled december 2019 february 2020 august october 2020 mayo clinic arizona n 299 september 2020 january 2021 university mississippi medical center n 105 survey respondents received 5 gift card h3exposuresh3 surveys included questions sociodemographic characteristics health insurance literacy financial literacy financial knowledge financial hardship domains material hardship psychological hardship behavioral hardship h3main outcomes measuresh3 financial hardship assessed using costfacit comprehensive score financial toxicityfunctional assessment chronic illness therapy measure national health interview survey questions capture information domains financial hardship health insurance literacy measure validated 21item measure consumers ability select use health insurance five questions national financial capability study assessed financial literacy h3resultsh3 total 404 participants enrolled study median iqr age respondents 63 5471 years 219 women 54 307 nonhispanic white individuals 76 153 38 private insurance 289 72 solid tumors overall financial hardship denoted median costfacit score lt27 points reported 49 95 ci 4453 cohort prevalence financial hardship higher using national health interview survey questions 68 95 ci 6372 respondents reporting least 1 hardship domain n 276 sixtysix percent 95 ci 6069 respondents n 265 high level financial literacy mean sd health insurance literacy measure score 649 133 points multivariable analyses 10point increase health insurance literacy measure score associated lower odds financial hardship odds ratio 082 95 ci 068099ipi 04 however association longer significant adjusting financial literacy h3conclusions relevanceh3 results study showed despite high level health insurance literacy financial literacy prevalence financial hardship high although lower odds financial hardship increased health insurance literacy association longer significant financial literacy added model suggesting high level financial literacy may help mitigate adverse outcome lower health insurance literacy levels patients cancer

https://doi.org/10.1001/jamaophthalmol.2013.5521

Matthew R. Edmunds|Robert J. Barry|Alastair K. Denniston

Readability Assessment of Online Ophthalmic Patient Information

Birmingham and Midland Eye Centre|University of Birmingham|Birmingham and Midland Eye Centre|University of Birmingham|Birmingham and Midland Eye Centre|University of Birmingham|University Hospitals Birmingham NHS Foundation Trust

h3importanceh3 patients increasingly use internet access information related disease poor health literacy known impact negatively medical outcomes multiple agencies recommended patientoriented literature written fourth sixthgrade 912 years age reading level assist understanding readability online patientoriented materials related ophthalmic diagnoses yet known h3objectiveh3 assess readability online literature specifically range ophthalmic conditions h3design settingh3 body text top 10 patientoriented websites 16 different ophthalmic diagnoses covering full range ophthalmic subspecialties analyzed readability source united kingdom vs nonunited kingdom profit vs commercial appropriateness sightimpaired readers h3main outcomes measuresh3 four validated readability formulas used flesch reading ease score fres fleschkincaid grade level fkgl simple measure gobbledygook smog gunning fog index gfog data compared mannwhitney test 2 groups kruskalwallis test 2 groups correlation assessed spearmaniri h3resultsh3 none 160 webpages readability scores within published guidelines 83 assessed difficult readability notforprofit webpages significantly greater length commercial webpages ipi 02 ukbased webpages slightly superior readability scores compared nonuk webpages ipi 004 toipi lt 001 depending readability formula used webpages evaluated 34 included facility adjust text size assist visually impaired readers h3conclusions relevanceh3 knowledge first study assess readability patientfocused webpages specifically range ophthalmic diagnoses keeping previous studies medical conditions determined readability scores inferior recommended irrespective measure used although readability one aspect well patientoriented webpage may comprehended recommend use readability scoring producing resources future minimum readability policies inclusion facilities within webpages maximize viewing potential visually impaired readers important ensure online ophthalmic patient information accessible broadest audience possible

https://doi.org/10.1001/jamadermatol.2015.5240

Derek Y. Hsu|Joaquin C. Brieva|Jonathan I. Silverberg

Costs of Care for Hospitalization for Pemphigus in the United States

Northwestern University|Northwestern University|Northwestern University

h3importanceh3 pemphigus autoimmune blistering disorder associated significant morbidity mortality however little known inpatient burden pemphigus h3objectiveh3 determine incidence risk factors hospitalization pemphigus cost care h3design setting participantsh3 20022012 nationwide inpatient sample provided healthcare cost utilization project agency healthcare research quality analyzed total 87 039 711 children adults mean sd age 577 098 years primary diagnosis pemphigus 706 032 years secondary diagnosis pemphigus 479 019 years without diagnosis pemphigus studied data analysis performed june 1 august 30 2015 h3main outcomes measuresh3 hospitalization rates length stay cost care h3resultsh3 1185 5221 patients admitted primary secondary diagnosis pemphigus respectively factoring weights generalize sample entire hospitalized us cohort admissions represented weighted frequencies 5647 24 880 respectively multivariable logistic regression models stepwise selection increasing age adjusted odds ratios 95 cis 1839 years 553 428714ipilt 001 4059 years 1098 8461424ipilt 001 6079 years 754 575989ipilt 001 80 years 757 5711004ipilt 001 female sex 110 101120ipi 047 nonwhite raceethnicity black 194 175214ipilt 001 hispanic 410 374448ipilt 001 asian 316 268373ipilt 001 native american 211 145308ipilt 001 lower household income quartile 2 119 107132ipilt 001 insured medicare 156 141174ipilt 001 medicaid 155 139173ipilt 001 number chronic conditions 25 236 210265ipilt 001 6 147 129169ipilt 001 hospital location metropolitan area metropolitan micropolitan 060 049072ipilt 001 summer season 112 102123ipi 02 associated hospitalization pemphigus total inflationadjusted cost care patients primary inpatient diagnosis pemphigus 74 466 305 mean sd annual cost 14 52093 91322 inflationadjusted cost care patients primary diagnosis pemphigus increased significantly 2002 2012 analysis varianceipi lt 001 particular length stay higher racialethnic minorities compared whites survey linear regression log 95 ci black 0076 00750076 hispanic 0021 00210022 asian 0037 00360039 native american 0010 000760013 lower quartile household income quartile 1 0024 00230024 quartile 2 00029 0002200035 without private insurance medicare 012 012012 medicaid 0082 00810083 charge 0051 00470055 h3conclusions relevanceh3 significant inpatient burden pemphigus united states moreover appear racialethnic health care disparities respect pemphigus poor nonwhite andor uninsured underinsured patients higher odds hospitalization

https://doi.org/10.1001/jama.2020.14581

Elyse R. Park|Giselle K. Perez|Susan Regan|Alona Muzikansky|Douglas E. Levy|Jennifer S. Temel|Nancy A. Rigotti|William F. Pirl|Kelly Irwin|Ann H. Partridge|Mary E. Cooley|Elisa Friedman|Julia Rabin|Colin Ponzani|Kelly A. Hyland|Susan Holland|Sarah Borderud|Kim Sprunck|Diana Kwon|Lisa A. Peterson|Jacob Miller-Sobel|Irina Gonzalez|C. Will Whitlock|Laura Malloy|Suhana de León-Sanchez|Maureen O’Brien|Jamie S. Ostroff

Effect of Sustained Smoking Cessation Counseling and Provision of Medication vs Shorter-term Counseling and Medication Advice on Smoking Abstinence in Patients Recently Diagnosed With Cancer

Massachusetts General Hospital|Harvard University|Massachusetts General Hospital|Harvard University|Harvard University|Massachusetts General Hospital|Massachusetts General Hospital|Massachusetts General Hospital|Harvard University|Harvard University|Massachusetts General Hospital|Massachusetts General Hospital|Harvard University|Harvard University|Dana-Farber Cancer Institute|Harvard University|Massachusetts General Hospital|Harvard University|Dana-Farber Cancer Institute|Harvard University|Dana-Farber Cancer Institute|Massachusetts General Hospital|Massachusetts General Hospital|Massachusetts General Hospital|Moffitt Cancer Center|Memorial Sloan Kettering Cancer Center|Memorial Sloan Kettering Cancer Center|Dana-Farber Cancer Institute|Memorial Sloan Kettering Cancer Center|Memorial Sloan Kettering Cancer Center|Memorial Sloan Kettering Cancer Center|Massachusetts General Hospital|Memorial Sloan Kettering Cancer Center|Benson-Henry Institute|Memorial Sloan Kettering Cancer Center|Memorial Sloan Kettering Cancer Center|Memorial Sloan Kettering Cancer Center

h3importanceh3 persistent smoking may cause adverse outcomes among patients cancer many cancer centers fully implemented evidencebased tobacco treatment routine care h3objectiveh3 determine effectiveness sustained telephone counseling medication intensive treatment compared shorterterm telephone counseling medication advice standard treatment assist patients recently diagnosed cancer quit smoking h3design setting participantsh3 unblinded randomized clinical trial conducted massachusetts general hospitaldanafarberharvard cancer center memorial sloan kettering cancer center adults smoked 1 cigarette within 30 days spoke english spanish recently diagnosed breast gastrointestinal genitourinary gynecological head neck lung lymphoma melanoma cancers eligible enrollment occurred november 2013 july 2017 assessments completed end february 2018 h3interventionsh3 participants randomized intensive treatment n 153 standard treatment n 150 received 4 weekly telephone counseling sessions medication advice intensive treatment group also received 4 biweekly 3 monthly telephone counseling sessions choice food drug administrationapproved cessation medication nicotine replacement therapy bupropion varenicline h3main outcome measuresh3 primary outcome biochemically confirmed 7day point prevalence tobacco abstinence 6month followup secondary outcomes treatment utilization rates h3resultsh3 among 303 patients randomized mean age 583 years 170 women 561 221 781 completed trial sixmonth biochemically confirmed quit rates 345 n 51 intensive treatment group vs 215 n 29 standard treatment group difference 130 95 ci 30233 odds ratio 192 95 ci 113327ipi lt 02 median number counseling sessions completed 8 interquartile range 411 intensive treatment group total 97 intensive treatment participants 770 vs 68 standard treatment participants 591 reported cessation medication use difference 179 95 ci 63295 odds ratio 231 95 ci 132404ipi 003 common adverse events intensive treatment standard treatment groups respectively nausea n 13 n 6 rash n 4 n 1 hiccups n 4 n 1 mouth irritation n 4 n 0 difficulty sleeping n 3 n 2 vivid dreams n 3 n 2 h3conclusions relevanceh3 among smokers recently diagnosed cancer 2 national cancer institutedesignated comprehensive cancer centers sustained counseling provision free cessation medication compared 4week counseling medication advice resulted higher 6month biochemically confirmed quit rates however generalizability study findings uncertain requires research h3trial registrationh3 clinicaltrialsgov identifiernct01871506

https://doi.org/10.1001/jama.2014.11479

Miriam Kuppermann|Sherri Pena|Judith Bishop|Sanae Nakagawa|Steven E. Gregorich|Anita Sit|Juan Vargas|Aaron B. Caughey|Susan Sykes|Lasha Pierce|Mary E. Norton

Effect of Enhanced Information, Values Clarification, and Removal of Financial Barriers on Use of Prenatal Genetic Testing

University of California, San Francisco|University of California, San Francisco|University of California, San Francisco|University of California, San Francisco|University of California, San Francisco|Santa Clara Valley Medical Center|University of California, San Francisco|Oregon Health & Science University|La Clinica de La Raza|University of California, San Francisco

h3importanceh3 prenatal genetic testing guidelines recommend providing patients detailed information allow informed preferencebased screening diagnostic testing decisions effect implementing guidelines well understood h3objectiveh3 analyze effect decisionsupport guide elimination financial barriers testing use prenatal genetic testing decision making among pregnant women varying literacy numeracy levels h3design setting participantsh3 randomized trial conducted 20102013 prenatal clinics 3 county hospitals 1 community clinic 1 academic center 3 medical centers integrated health care delivery system san francisco bay area participants english spanishspeaking women yet undergone screening diagnostic testing remained pregnant 11 weeks gestation n 710 h3interventionsh3 computerized interactive decisionsupport guide access prenatal testing outofpocket expense n 357 usual care per current guidelines n 353 h3main outcomes measuresh3 primary outcome invasive diagnostic test use obtained via medical record review secondary outcomes included testing strategy undergone knowledge testing risk comprehension decisional conflict regret 24 36 weeks gestation h3resultsh3 women randomized intervention group compared randomized control group less likely invasive diagnostic testing 59 vs 123 odds ratio 045 95 ci 025080 likely forgo testing altogether 256 vs 204 330 95 ci 143764 reference group screening followed invasive testing women randomized intervention group also higher knowledge scores 94 vs 86 15point scale mean group difference 082 95 ci 034131 likely correctly estimate amniocentesisrelated miscarriage risk 738 vs 590 195 95 ci 139275 estimated ageadjusted chance carrying fetus trisomy 21 587 vs 461 166 95 ci 122228 significant differences emerge decisional conflict regret h3conclusions relevanceh3 full implementation prenatal testing guidelines using computerized interactive decisionsupport guide absence financial barriers testing resulted less test use informed choices validated additional populations approach may result informed preferencebased prenatal testing decision making fewer women undergoing testing h3trial registrationh3 clinicaltrialsgov identifiernct00505596

https://doi.org/10.1001/jama.2018.9128

Shari L. Barkin|William J. Heerman|Evan C. Sommer|Nina Martin|Maciej S. Buchowski|David G. Schlundt|Eli K. Po’e|Laura E. Burgess|Juan Escarfuller|Charlotte Pratt|Kimberly P. Truesdale|June Stevens

Effect of a Behavioral Intervention for Underserved Preschool-Age Children on Change in Body Mass Index

Vanderbilt University|Vanderbilt University Medical Center|Vanderbilt University Medical Center|Vanderbilt University|Vanderbilt University Medical Center|Vanderbilt University|Vanderbilt University Medical Center|Vanderbilt University Medical Center|Vanderbilt University Medical Center|National Heart Lung and Blood Institute|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill

h3importanceh3 prevention obesity childhood critical children underserved populations obesity prevalence risk chronic disease highest h3objectiveh3 test effect multicomponent behavioral intervention child body mass index bmi calculated weight kilograms divided height meters squared growth trajectories 36 months among preschoolage children risk obesity h3design setting participantsh3 randomized clinical trial assigned 610 parentchild pairs underserved communities nashville tennessee 36month intervention targeting health behaviors schoolreadiness control eligible children ages 3 5 years risk obesity yet obese enrollment occurred august 2012 may 2014 36month followup occurred october 2015 june 2017 h3interventionsh3 intervention n 304 pairs 36month familybased communitycentered program consisting 12 weekly skillsbuilding sessions followed monthly coaching telephone calls 9 months 24month sustainability phase providing cues action control n 306 pairs consisted 6 schoolreadiness sessions delivered 36month study conducted nashville public library h3main outcomes measuresh3 primary outcome child bmi trajectory 36 months seven prespecified secondary outcomes included parentreported child dietary intake community center use benjaminihochberg procedure corrected multiple comparisons h3resultsh3 participants predominantly latino 914 baseline mean sd child age 43 09 years 519 female household income 25 000 567 families retention 902 36 months mean sd child bmi 178 22 intervention group 178 21 control group significant difference existed primary outcome bmi trajectory 36 months ipi 39 intervention group children lower mean caloric intake 1227 kcald compared control group children 1323 kcald adjusted difference 994 kcal 95 ci 1607 380 correctedipi 003 intervention group parents used community centers children control group parents 568 intervention 444 control risk ratio 129 95 ci 108 153 correctedipi 006 h3conclusions relevanceh3 36month multicomponent behavioral intervention change bmi trajectory among underserved preschoolage children nashville tennessee compared control program whether would effectiveness types behavioral interventions implementation cities would require research h3trial registrationh3 clinicaltrialsgov identifiernct01316653

https://doi.org/10.1001/jamanetworkopen.2021.30479

Anna M. Acosta|Shikha Garg|Huong Pham|Michael Whitaker|Onika Anglin|Alissa O’Halloran|Jennifer Milucky|Kadam Patel|Christopher A. Taylor|Jonathan M. Wortham|Shua J. Chai|Pam Daily Kirley|Nisha B Alden|Breanna Kawasaki|James Meek|Kimberly Yousey?Hindes|Evan J. Anderson|Kyle P. Openo|Andrew Weigel|Maya Monroe|Patricia Ryan|Libby Reeg|Alexander Kohrman|Ruth Lynfield|Erica Bye|Salina Torres|Yadira Salazar-Sanchez|Alison Muse|Grant Barney|Nancy M. Bennett|Sophrena Bushey|Laurie M Billing|Eli Shiltz|Melissa Sutton|Nasreen Abdullah|H. Keipp Talbot|William Schaffner|Jake Ortega|Andrea Price|Alicia M. Fry|Aron J. Hall|Lindsay Kim|Fiona Havers

Racial and Ethnic Disparities in Rates of COVID-19–Associated Hospitalization, Intensive Care Unit Admission, and In-Hospital Death in the United States From March 2020 to February 2021

Centers for Disease Control and Prevention|Centers for Disease Control and Prevention|United States Public Health Service|Centers for Disease Control and Prevention|Centers for Disease Control and Prevention|Centers for Disease Control and Prevention|General Dynamics (United States)|Centers for Disease Control and Prevention|Centers for Disease Control and Prevention|Centers for Disease Control and Prevention|General Dynamics (United States)|Centers for Disease Control and Prevention|Centers for Disease Control and Prevention|United States Public Health Service|Ibis Reproductive Health|Centers for Disease Control and Prevention|Ibis Reproductive Health|Colorado Department of Public Health and Environment|Colorado Department of Public Health and Environment|Veterans Health Administration|Emory University|Georgia Department of Public Health|Emory University|Georgia Department of Public Health|Veterans Health Administration|Iowa Department of Public Health|Maryland Department of Health|Maryland Department of Health|Michigan Department of Health and Human Services|Michigan Department of Health and Human Services|Minnesota Department of Health|Minnesota Department of Health|New Mexico Department of Health|New Mexico Department of Health|New York State Department of Health|New York State Department of Health|University of Rochester|University of Rochester|Ohio Department of Health|Ohio Department of Health|Oregon Health Authority|Oregon Health Authority|Vanderbilt University|Vanderbilt University|Lake County|Lake County|Centers for Disease Control and Prevention|United States Public Health Service|Centers for Disease Control and Prevention|Centers for Disease Control and Prevention|United States Public Health Service|Centers for Disease Control and Prevention|United States Public Health Service

h3importanceh3 racial ethnic minority groups disproportionately affected covid19 h3objectivesh3 evaluate whether rates severe covid19 defined hospitalization intensive care unit icu admission inhospital death higher among racial ethnic minority groups compared nonhispanic white persons h3design setting participantsh3 crosssectional study included 99 counties within 14 us states participating covid19associated hospitalization surveillance network participants persons ages hospitalized covid19 march 1 2020 february 28 2021 h3exposuresh3 laboratoryconfirmed covid19associated hospitalization defined positive sarscov2 test within 14 days prior hospitalization h3main outcomes measuresh3 cumulative ageadjusted rates per 100 000 population hospitalization icu admission death race ethnicity rate ratios rr calculated racial ethnic group compared white persons h3resultsh3 among 153 692 patients covid19associated hospitalizations 143 342 933 information race ethnicity included analysis 105 421 735 50 years older 72 159 503 male 28 762 201 hispanic latino 2056 14 nonhispanic american indian alaska native 7737 54 nonhispanic asian pacific islander 40 806 285 nonhispanic black 63 981 446 white compared white persons american indian alaska native latino black asian pacific islander persons likely higher cumulative ageadjusted rates hospitalization icu admission death follows american indian alaska native hospitalization rr 370 95 ci 354387 icu admission rr 649 95 ci 601701 death rr 719 95 ci 647799 latino hospitalization rr 306 95 ci 301310 icu admission rr 420 95 ci 408433 death rr 385 95 ci 368401 black hospitalization rr 285 95 ci 281289 icu admission rr 317 95 ci 309326 death rr 258 95 ci 248269 asian pacific islander hospitalization rr 103 95 ci 101106 icu admission rr 191 95 ci 183198 death rr 164 95 ci 155174 h3conclusions relevanceh3 crosssectional analysis american indian alaska native latino black asian pacific islander persons likely white persons covid19associated hospitalization icu admission inhospital death first year us covid19 pandemic equitable access covid19 preventive measures including vaccination needed minimize gap racial ethnic disparities severe covid19

https://doi.org/10.1001/jamainternmed.2020.2908

Marleen Kunneman|Megan E. Branda|Ian Hargraves|Angela Sivly|Alexander T. Lee|Haeshik Gorr|Bruce Burnett|Takeki Suzuki|Elizabeth A. Jackson|Erik P. Hess|Mark Linzer|Sarah McCarthy|Juan P. Brito|Peter A. Noseworthy|Víctor M. Montori

Assessment of Shared Decision-making for Stroke Prevention in Patients With Atrial Fibrillation

Leiden University|Mayo Clinic in Arizona|Colorado School of Public Health|University of Colorado Denver|Mayo Clinic in Florida|Mayo Clinic in Arizona|Mayo Clinic in Arizona|Mayo Clinic in Arizona|General Department of Preventive Medicine|Park Nicollet Health Services|University of Mississippi Medical Center|University of Alabama at Birmingham|University of Alabama at Birmingham|General Department of Preventive Medicine|Mayo Clinic in Arizona|Mayo Clinic in Florida|Mayo Clinic in Arizona|Mayo Clinic in Florida

h3importanceh3 shared decisionmaking sdm anticoagulant treatment patients atrial fibrillation af widely recommended effectiveness unclear h3objectiveh3 assess extent use sdm tool affects quality sdm anticoagulant treatment decisions atrisk patients af h3design setting participantsh3 encounterrandomized trial recruited patients nonvalvular af considering starting reviewing anticoagulant treatment clinicians academic community safetynet medical centers january 30 2017 june 27 2019 encounters randomized either standard care arm care included use sdm tool intervention arm data analyzed august 1 november 30 2019 h3interventionsh3 standard care care using anticoagulation choice shared decision making tool presents individualized risk estimates compares anticoagulant treatment options across issues importance patients clinical encounter h3main outcomes measuresh3 quality sdm included quality communication patient knowledge af anticoagulant treatment accuracy patient estimates stroke risk within 30 estimate decisional conflict satisfaction decisions made encounter duration encounter clinician involvement patients sdm process h3resultsh3 clinical trial enrolled 922 patients 559 men 606 mean sd age 71 11 years 244 clinicians total 463 patients randomized intervention arm 459 patients standard care arm participants arms reported high communication quality high knowledge low decisional conflict demonstrated low accuracy risk perception would similarly recommend approach used encounter clinicians significantly satisfied intervention encounters 400 453 encounters 883 vs 277 448 encounters 618 adjusted relative risk 149 95 ci 142153 total 747 873 patients 856 chose start continue receiving anticoagulant medication patient involvement decisionmaking assessed video recordings encounters using observing patient involvement decision making 12item scale scores significantly higher intervention arm mean sd score 330 108 points vs 291 131 points respectively adjusted mean difference 42 points 95 ci 2856 points significant betweenarm difference found encounter duration mean sd duration 32 16 minutes intervention arm vs 31 17 minutes standard care arm adjusted mean betweenarm difference 11 95 ci 03 25 minutes h3conclusion relevanceh3 use sdm encounter tool improved several measures sdm quality clinician satisfaction significant effect treatment decisions encounter duration results help calibrate expectations value implementing sdm tools care patients af h3trial registrationh3 clinicaltrialsgov identifiernct02905032

https://doi.org/10.1001/jamaoncol.2016.6744

Fan Yu|Dominic H. Moon|William R. Carpenter|Bryce B. Reeve|Deborah Usinger|Rebecca L. Green|K. Spearman|Nathan Sheets|Kevin A. Pearlstein|Angela Lucero|Mark R. Waddle|Paul A. Godley|Ronald C. Chen

Comparison of Patient Report and Medical Records of Comorbidities

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|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|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill

h3importanceh3 comorbid conditions patients cancer affect treatment decisions turn affect survival healthrelated qualityoflife outcomes comparative effectiveness research studies must account conditions via medical record abstraction patient report h3objectiveh3 examine agreement medical records patient reports assessing comorbidities h3design setting participantsh3 patientreported information medical records prospectively collected part north carolina prostate cancer comparative effectiveness amp survivorship study populationbased cohort 881 patients newly diagnosed localized prostate cancer enrolled north carolina central cancer registry january 1 2011 june 30 2013 presence absence 20 medical conditions compared based patient report vs abstraction medical records h3main outcomes measuresh3 agreement patient reports medical records condition assessed using statistic subgroup analyses examined differences statistics based age race marital status educational level income logistic regression models condition examined factors associated higher agreement h3resultsh3 total 881 patients participated study median age 65 years age range 4180 years 633 white 719 16 20 conditions agreement patient reports medical records 90 patients agreement lowest hyperlipidemia 68 036 arthritis 66 014 multivariable analysis older age 70 years old significantly associated lower agreement myocardial infarction odds ratio 031 95 ci 012080 cerebrovascular disease 010 95 ci 001078 coronary artery disease 037 95 ci 020067 arrhythmia 044 95 ci 025079 kidney disease 018 95 ci 006052 race educational level significantly associated 18 19 modeled conditions h3conclusions relevanceh3 overall patient reporting provides information similar medical record abstraction without significant differences patient race educational level use patient reports less costly medical record audits reasonable approach observational comparative effectiveness research

https://doi.org/10.1001/jamaoncol.2020.6982

Alejandro Berlín|Mike Lovas|Tran Truong|Sheena Melwani|Justin Liu|Zhihui Amy Liu|Adam Badzynski|Mary Beth Carpenter|Carl Virtanen|Lyndon Morley|Onil Bhattacharyya|Marnie Escaf|Lesley Moody|Avi Goldfarb|Luke Brzozowski|Joseph A. Cafazzo|Melvin L.K. Chua|A. Keith Stewart|Monika K. Krzyzanowska

Implementation and Outcomes of Virtual Care Across a Tertiary Cancer Center During COVID-19

University of Toronto|Princess Margaret Cancer Centre|University Health Network|University Health Network|Princess Margaret Cancer Centre|Princess Margaret Cancer Centre|University Health Network|Princess Margaret Cancer Centre|University Health Network|University Health Network|University Health Network|Public Health Ontario|University of Toronto|Princess Margaret Cancer Centre|University Health Network|University Health Network|University Health Network|Princess Margaret Cancer Centre|University Health Network|Women's College Hospital|Princess Margaret Cancer Centre|University Health Network|Princess Margaret Cancer Centre|University Health Network|University of Toronto|Princess Margaret Cancer Centre|University Health Network|University Health Network|National Cancer Centre Singapore|Duke-NUS Medical School|Princess Margaret Cancer Centre|University Health Network|Cancer Care Ontario|Princess Margaret Cancer Centre|University Health Network

h3importanceh3 coronavirus disease 2019 covid19 pandemic burdened health care resources disrupted care patients cancer virtual care vc represents potential solution however quantitative data support rapid implementation positive associations service capacity quality h3objectiveh3 examine outcomes cancer centerwide virtual care program response covid19 pandemic h3design setting participantsh3 cohort study applied hospitalwide agile service design map gaps develop customized digital solution enable atscale vc across publicly funded comprehensive cancer center data collected highvolume cancer center ontario canada march 23 may 22 2020 h3main outcomes measuresh3 outcome measures care delivery volumes quality care patient practitioner experiences cost savings patients h3resultsh3 vc solution developed launched 12 days declaration covid19 pandemic total 22 085 vc visits mean 514 visits per day conducted comprising 684 range 188100 daily visits compared 08 launch ipi lt 001 ambulatory clinic volumes recovered month deployment 37144091 patients per week whereas chemotherapy radiotherapy caseloads 19432461 patients per week remained stable throughout changes institutional provincial qualityofcare indexes observed total 3791 surveys 3507 patients 284 practitioners completed 2207 patients 82 92 practitioners 72 indicated overall satisfaction vc direct cost initiative cad 202 537 displacementrelated cost savings patients totaled cad 3 155 946 h3conclusions relevanceh3 findings suggest implementation vc scale highvolume cancer center may feasible agile service design approach able preserve outpatient caseloads maintain care quality rendering high patient practitioner satisfaction findings may help guide transformation telemedicine post covid19 era

https://doi.org/10.1001/jamanetworkopen.2021.4157

Neal Yuan|Joshua M. Pevnick|Patrick Botting|Y. Elad|Stacy Ann Miller|Susan Cheng|Susan Cheng

Patient Use and Clinical Practice Patterns of Remote Cardiology Clinic Visits in the Era of COVID-19

Cedars-Sinai Smidt Heart Institute|Cedars-Sinai Medical Center|Cedars-Sinai Medical Center|Cedars-Sinai Smidt Heart Institute|Cedars-Sinai Medical Center|Cedars-Sinai Smidt Heart Institute|Cedars-Sinai Medical Center|Cedars-Sinai Medical Center|Cedars-Sinai Smidt Heart Institute|Cedars-Sinai Medical Center|Cedars-Sinai Smidt Heart Institute|Cedars-Sinai Medical Center

h3importanceh3 covid19 pandemic led unprecedented shift ambulatory cardiovascular care inperson remote visits h3objectiveh3 understand whether transition remote visits associated disparities patient use care diagnostic test ordering medication prescribing h3design setting participantsh3 crosssectional study used electronic health records data ambulatory cardiology visits urban multisite health system los angeles county california 2 periods april 1 2019 december 31 2019 precovid april 1 december 31 2020 covidera statistical analysis performed january february 2021 h3exposureh3 inperson remote ambulatory cardiology clinic visit one 31 precovid period covidera period h3main outcomes measuresh3 comparison patient characteristics frequencies medication ordering cardiologyspecific testing across 4 visit types precovid inperson reference covidera inperson covidera video covidera telephone h3resultsh3 study analyzed data 87 182 precovid inperson 74 498 covidera inperson 4720 covidera video 10 381 covidera telephone visits across visits 79 572 patients female 450 127 080 patients nonhispanic white 719 mean sd age 681 170 years patients accessing covidera remote visits likely asian black hispanic individuals 24 934 precovid inperson visits 286 vs 19 742 covidera inperson visits 265 vs 3633 covidera video visits 304 vs 1435 covidera telephone visits 350ipi lt 001 comparisons private insurance 34 063 precovid inperson visits 391 vs 25 474 covidera inperson visits 342 vs 2562 covidera video visits 543 vs 4264 covidera telephone visits 411ipi lt 001 covidera inperson vs video covidera inperson vs telephone cardiovascular comorbidities eg hypertension 37 166 precovid inperson visits 426 vs 31 359 covidera inperson visits 421 vs 2006 covidera video visits 425 vs 5181 covidera telephone visits 499ipi lt 001 covidera inperson vs telephone heart failure 14 319 precovid inperson visits 164 vs 10 488 covidera inperson visits 141 vs 1172 covidera video visits 248 vs 2674 covidera telephone visits 258ipi lt 001 covidera inperson vs video covidera inperson vs telephone adjusting patient visit characteristics comparison precovid inperson visits video telephone visits clinicians lower odds ordering medication covidera inperson odds ratio 062 95 ci 060064 covidera video 022 95 ci 020024 covidera telephone 014 95 ci 013015 tests electrocardiograms covidera inperson 060 95 ci 058062 covidera video 003 95 ci 002004 covidera telephone 002 95 ci 001003 echocardiograms covidera inperson 121 95 ci 118124 covidera video 047 95 ci 042052 covidera telephone 028 95 ci 025031 h3conclusions relevanceh3 patients asian black hispanic private insurance least one several cardiovascular comorbidities used remote cardiovascular care frequently covidera period clinician ordering diagnostic testing medications consistently decreased comparing precovid vs covidera inperson vs remote visits studies needed clarify whether decreases represent reduction overuse tests medications vs underuse indicated testing prescribing

https://doi.org/10.1001/jamasurg.2016.0730

Alessandra Storino|Manuel Castillo?Angeles|Ammara A. Watkins|Christina R. Vargas|Joseph D. Mancias|Andrea J. Bullock|Aram N. Demirjian|A. James Moser|Tara S. Kent

Assessing the Accuracy and Readability of Online Health Information for Patients With Pancreatic Cancer

Beth Israel Deaconess Medical Center|Beth Israel Deaconess Medical Center|Beth Israel Deaconess Medical Center|Beth Israel Deaconess Medical Center|Beth Israel Deaconess Medical Center|Beth Israel Deaconess Medical Center|University of California, Irvine Medical Center|Beth Israel Deaconess Medical Center|Beth Israel Deaconess Medical Center

h3importanceh3 degree patients empowered written educational materials depends texts readability level accuracy information provided association websites affiliation focus treatment modality readability accuracy yet thoroughly elucidated h3objectiveh3 compare readability accuracy patientoriented online resources pancreatic cancer treatment modality website affiliation h3designh3 online search 50 websites discussing 5 pancreatic cancer treatment modalities alternative therapy chemotherapy clinical trials radiation therapy surgery conducted websites affiliation identified readability measured 9 standardized tests accuracy assessed expert panel h3main outcomes measuresh3 nine standardized tests used compute median readability level website median readability scores compared among treatment modality affiliation categories accuracy determined expert panel consisting 2 medical specialists 2 surgical specialists 4 raters independently evaluated websites belonging 5 treatment modalities score 1 indicates lt25 information accurate score 2 indicates 2650 information accurate score 3 indicates 5175 information accurate score 4 indicates 7699 information accurate score 5 indicates 100 information accurate h3resultsh3 50 evaluated websites differed readability accuracy based focus treatment modality websites affiliation websites discussing surgery median readability level 137 interquartile range iqr 119156 easier read discussing radiotherapy median readability level 152 iqr 130170 ipi 003 clinical trials median readability level 152 iqr 128170 ipi 002 websites nonprofit organizations median readability level 129 iqr 112150 easier read media median readability level 160 iqr 134170 ipi lt 001 academic median readability level 148 iqr 129170 ipi lt 001 websites privately owned websites median readability level 140 iqr 121161 easier read media websites ipi 001 among treatment modalities alternative therapy websites exhibited lowest accuracy scores median accuracy score 2 iqr 14 ipi lt 001 nonprofit median accuracy score 4 iqr 45 government median accuracy score 5 iqr 45 academic median accuracy score 4 iqr 355 websites accurate privately owned median accuracy score 35 iqr 154 media median accuracy score 4 iqr 24 websites ipi lt 004 websites higher accuracy difficult read websites lower accuracy h3conclusions relevanceh3 online information pancreatic cancer overestimates reading ability overall population lacks accurate information alternative therapy absence quality control internet physicians provide guidance patients selection online resources readable accurate information

https://doi.org/10.1001/jamanetworkopen.2019.11120

Joanna Ting Wai Chu|Angela Wadham|Yannan Jiang|Robyn Whittaker|Karolina Stasiak|Matthew Shepherd|Chris Bullen

Effect of MyTeen SMS-Based Mobile Intervention for Parents of Adolescents

University of Auckland|University of Auckland|University of Auckland|University of Auckland|University of Auckland|Massey University|University of Auckland

h3importanceh3 global pressure respond burden posed adolescent mental health problems national mental health commission made call investment mobile health services directed prevention early intervention relieve demand targeted mental health services costly provide parents primary caregivers play significant role lives adolescents important targets efforts currently evidence effectiveness programs delivered solely via text message parents adolescents h3objectiveh3 evaluate effects textmessaging program myteen promoting parental competence mental health literacy parents adolescents h3design setting participantsh3 parallel 2group randomized clinical trial conducted new zealand total 221 parents primary caregivers adolescents aged 10 15 years recruited march 19 august 17 2018 via community outreach social media randomly allocated 11 control intervention group statistical analysis performed principle intention treat adjustment baseline factors ethnicity h3interventionh3 textmessaging program parents adolescents age 1015 years promote parental competence mental health literacy participants received 1 daily text message 4 weeks h3main outcomes measuresh3 parental competence assessed 1 month randomization parenting sense competence scale h3resultsh3 total 221 participants 214 968 female randomized 109 intervention group 112 control group 201 participants 91 completed trial 3 months significant group difference observed primary outcome end 1 month intervention participants reporting higher level parental competence control group estimated mean difference 333 points 95 ci 137529 pointsipi 002 except knowledge mental health secondary outcomes significant including continued improvement parental competence 3 months estimated mean difference 408 points 95 ci 196620 pointsipi lt 001 knowledge help seeking estimated mean difference 099 points 95 ci 049150 pointsipi lt 001 parental distress estimated mean difference 239 points 95 ci 437 040 pointsipi 02 parentadolescent communication estimated mean difference 221 points 95 ci 048395 pointsipi 01 participants intervention group reporting better parentingrelated outcomes control group 1 3 months intervention h3conclusions relevanceh3 textmessaging program parents adolescents appears effective feasible way facilitate implementation delivery evidencebased information populations easily reached intervention modalities program easily scaled delivery early preventive intervention may represent less expensive option service delivery h3trial registrationh3 anzctrorgau identifieractrn12618000117213

https://doi.org/10.1001/jamapediatrics.2019.1197

Megan Y. Roberts|Philip Curtis|Bailey J. Sone|Lauren H. Hampton

Association of Parent Training With Child Language Development

Northwestern University|Northwestern University|Northwestern University|Northwestern University

h3importanceh3 training parents implement strategies support child language development crucial support longterm outcomes given many 2 5 children younger 5 years difficulty learning language h3objectiveh3 examine association parent training language communication outcomes young children h3data sourcesh3 searches eric academic search complete psycinfo psycarticles conducted august 11 2014 august 18 2016 january 23 2018 october 30 2018 h3study selectionh3 studies included review metaanalysis randomized nonrandomized clinical trials evaluated language intervention included parent training children mean age less 6 years studies excluded parent primary implementer intervention study included fewer 10 participants study report outcomes related language communication h3data extraction synthesish3 preferred reporting items systematic reviews metaanalyses prisma guidelines applied total 31 778 articles identified screening full text 723 articles reviewed 76 total studies ultimately included h3main outcomes measuresh3 main outcomes included language communication skills children primary secondary language impairment children risk language impairment h3resultsh3 metaanalysis included 59 randomized clinical trials 17 nonrandomized clinical trials including 5848 total participants 364 female 208 mean sd age 35 39 years intervention approach 63 studies naturalistic teaching approach 16 studies used primarily dialogic reading approach significant moderate association parent training child communication engagement language outcomes mean se hedgesigi033 006ipi lt 001 association parent training parent use language support strategies large mean se hedgesigi055 011ipi lt 001 children developmental language disorder largest social communication outcomes mean se hedgesigi 037 017 large significant associations observed receptive mean se hedgesigi 092 030 expressive language mean se hedgesigi 083 020 children risk language impairments moderate effect sizes across receptive language mean se hedgesigi 028 015 engagement outcomes mean se hedgesigi 036 017 h3conclusions relevanceh3 findings suggest training parents implement language communication intervention techniques associated improved outcomes children increased parent use support strategies findings may direct implications intervention prevention

https://doi.org/10.1001/jamainternmed.2013.9318

Leora I. Horwitz|John Moriarty|Christine Chen|Robert L. Fogerty|Ursula C. Brewster|Sandhya Kanade|Boback Ziaeian|Grace Jenq|Harlan M. Krumholz

Quality of Discharge Practices and Patient Understanding at an Academic Medical Center

Yale University|Yale New Haven Hospital|Yale University|Yale New Haven Hospital|Yale University|Yale University|Yale New Haven Hospital|University of California, Los Angeles|Yale University|Yale New Haven Hospital|Yale New Haven Health System|Robert Wood Johnson Foundation|Yale University

h3importanceh3 growing national focus reducing readmissions need comprehensively assess quality transitional care including discharge practices patient perspectives patient understanding h3objectiveh3 conduct multifaceted evaluation transitional care patientcentered perspective h3designh3 prospective observational cohort study may 2009 april 2010 h3settingh3 urban academic medical center h3participantsh3 patients 65 years older discharged home hospitalization acute coronary syndrome heart failure pneumonia h3main outcomes measuresh3 discharge practices including presence followup appointment patientfriendly discharge instructions patient understanding diagnosis followup appointment patient perceptions satisfaction discharge care h3resultsh3 395 enrolled patients 667 eligible mean age 772 years although 349 patients 956 reported understanding reason hospital 218 patients 596 able accurately describe diagnosis postdischarge interviews discharge instructions routinely included symptoms watch 984 activity instructions 973 diet advice 897 lay language however 99 written reasons hospitalization 263 use language likely intelligible patients 123 patients 326 discharged scheduled primary care cardiology appointment 54 439 accurately recalled details either appointment postdischarge interviews 118 patients 300 reported receiving less 1 days advance notice discharge 246 661 reported staff asked whether would support needed home discharge h3conclusions relevanceh3 patient perceptions discharge care quality selfrated understanding high written discharge instructions generally comprehensive although consistently clear however followup appointments advance discharge planning deficient patient understanding key aspects postdischarge care poor patient perceptions written documentation adequately reflect patient understanding discharge care

https://doi.org/10.1136/ijgc-2021-esgo.265

Rüdiger Klapdor|Peter Hillemanns|Moritz Kleine|Florian Imkamp

394 SOCIUS Mentoring – A novel program to encourage and prepare motivated students for a career as surgical oncologists

Medizinische Hochschule Hannover|Medizinische Hochschule Hannover|Medizinische Hochschule Hannover

h3introductionbackgroundh3 shortage physicians poses increasing challenges surgical oncological disciplines formerly motivated students lose interest surgery studies practical year counteract development students need strongly sustainably inspired surgery equipped important abilities deal various challenges early career surgical oncology curriculum individual support ambitious students socius intended address precisely issue upon completion program students optimally prepared careers university surgical oncology medicine excel specific skills h3methodologyh3 socius mentoring founded joint project gynecology urology visceral surgery prepare motivated students surgical university career individual mentoring training surgical skills soft skills therefore structured curriculum six modules 80 hours developed modules consisted following mentoring senior physician practical surgical skill training suturing laparoscopy robotic surgery soft skill training presentation negotiation skills statistical literacy theoretical skill training three disciplines clinical observations participation scientific meeting effects physician skills student attitudes toward surgery determined questionnaires h3resultsh3 students significantly improved surgical skills soft skills documented increased confidence scores figure 1 improved scores simulator training addition students reported specified career goals gained confidence surgery well seeing development potential surgical career figure 2 satisfaction program also reflected absolute recommendation rate course friends mw 50 scale 15 h3conclusionh3 study describe first successful implementation extracurricular program targeted highly motivated students combines individual mentoring surgical soft skills training individual support students combination mentoring skills training promising way prepare motivate students residency surgical disciplines thus counteract shortage young talent surgical disciplines

https://doi.org/10.1136/bmjopen-2015-009901

Ulrica Nilsson|Maria Jaensson|Karin Dahlberg|Sigrid Odencrants|Åke Grönlund|Lars Hagberg|Mats Eriksson

RAPP, a systematic e-assessment of postoperative recovery in patients undergoing day surgery: study protocol for a mixed-methods study design including a multicentre, two-group, parallel, single-blind randomised controlled trial and qualitative interview studies

Örebro University|Örebro University|Örebro University|Örebro University|Örebro University|Örebro University Hospital|Örebro University

h3introductionh3 day surgery wellestablished practice many european countries limited information available regarding postoperative recovery home though current lack standard procedure regarding postoperative followup furthermore also need improvement modern technology assessing patientrelated outcomes mobile applications article describes recovery assessment phone points rapp study protocol mixedmethods study evaluate systematic eassessment followup patients undergoing day surgery costeffective improves postoperative recovery health quality life h3methods analysish3 study mixedmethods study design includes multicentre twogroup parallel singleblind randomised controlled trial qualitative interview studies 1000 patients gt17 years age undergoing day surgery randomly assigned either eassessed postoperative recovery followup daily 14 days measured via smartphone app including swedish webversion quality recovery swqor standard care ie followup primary aim costeffectiveness secondary aims explore whether systematic eassessment followup day surgery positive effect postoperative recovery healthrelated quality life qol overall health b determine whether differences postoperative recovery association patient characteristic type surgery anaesthesia c determine whether differences health literacy substantial distinct effect postoperative recovery health qol describe day surgery patient staff experiences systematic eassessment followup day surgery primary aim measured 2 weeks postoperatively secondary outcomes ac 1 2 weeks 1 4 months h3trial registration numberh3 nct02492191 preresults

https://doi.org/10.1136/bmjgh-2017-000284

Chinonso Nwamaka Igwesi-Chidobe|Bolaji Coker|Chika Onwasigwe|Isaac Olubunmi Sorinola|Emma Godfrey

Biopsychosocial factors associated with chronic low back pain disability in rural Nigeria: a population-based cross-sectional study

University of Nigeria|King's College London|King's College Hospital NHS Foundation Trust|University of Nigeria|King's College London|King's College London

h3introductionh3 many people nigeria living disability due chronic low back pain clbp greatest burden accounted people living rural nigeria however factors associated disability rural nigeria yet established investigated biomechanical psychosocial predictors clbp disability rural nigerian population h3methodsh3 crosssectional study adults nonspecific clbp recruited rural communities enugu state southeastern nigeria measures selfreported performancebased disability pain intensity anxiety depression coping strategies social support occupational biomechanical factors illness perceptions fear avoidance beliefs collected trained community health workers used univariate multivariate analyses h3resultsh3 200 individuals recruited psychosocial factors important factors associated clbp disability accounted 625 491 variance selfreported performancebased disability respectively significant predictors selfreported disability illness perceptions 0289 plt00005 pain intensity 0230 plt00005 catastrophising 0210 p0001 fear avoidance beliefs 0198 p0001 anxiety 0154 p0023 significant predictors performancebased disability illness perceptions 0366 plt00005 social support 0290 plt00005 fear avoidance beliefs 0189 plt001 female gender 0184 plt001 illness concern salient dimension illness perceptions predicting selfreported performancebased disability h3conclusionsh3 results provide evidence used inform development interventions reduce clbp disability rural nigeria may relevance rural african contexts

https://doi.org/10.1136/bmjqs-2012-001769

Zackary Berger|Tabor Flickinger|Elizabeth R. Pfoh|Kathryn A. Martinez|Sydney M. Dy

Promoting engagement by patients and families to reduce adverse events in acute care settings: a systematic review

University of Virginia|Johns Hopkins University|Johns Hopkins University|Ann Arbor VA Medical Center|Michigan Medicine|Johns Hopkins University

h3introductionh3 patientcenteredness central healthcare hospitals address patients unique needs improve safety quality patient engagement healthcare may help prevent adverse events approached independent patient safety practice psp part multifactorial psp h3objectivesh3 review examines interventions encouraging engagement implemented controlled trials h3methodsh3 searched medline cinahl embase cochrane 2000 2012 english language studies hospital settings prospective controlled designs addressing effectiveness implementation patientfamily engagement psps separately reviewed interventions implemented part selected broader psps way example hand hygiene ventilatorassociated pneumonia rapid response systems care transitions h3resultsh3 six articles met inclusion criteria effectiveness primary focus patient engagement identified 12 studies implementing patient engagement aspect selected broader psps number studies relied patients possible function reporter error healthcare workers patients source reminders regarding safety behaviours others relied direct activation patients families definitions patient family engagement lacking well evidence regarding types patients might feel comfortable engaging providers contexts h3conclusionsh3 patient engagement safety appealing insufficient highquality evidence informing realworld implementation work evaluate effectiveness interventions patient family engagement clarify added benefit incorporating engagement multifaceted approaches improve patient safety endpoints addition strategies assess overcome barriers patients willingness actively engage care investigated

https://doi.org/10.1136/bmjopen-2015-009388

Trisha Greenhalgh|Shanti Vijayaraghavan|Joseph Wherton|Sara Shaw|Emma Byrne|Desirée Campbell-Richards|Satya Bhattacharya|Philippa Hanson|Seendy Ramoutar|Charles Gutteridge|Isabel Hodkinson|Anna Collard|Joanne Morris

Virtual online consultations: advantages and limitations (VOCAL) study

University of Oxford|Barts Health NHS Trust|Queen Mary University of London|University of Oxford|Queen Mary University of London|Barts Health NHS Trust|Barts Health NHS Trust|Barts Health NHS Trust|Barts Health NHS Trust|Barts Health NHS Trust|London Borough of Tower Hamlets|Barts Health NHS Trust|Barts Health NHS Trust

h3introductionh3 remote video consultations clinician patient technically possible increasingly acceptable introduced settings alongside occasionally replacing facetoface telephone consultations h3methodsh3 explore advantages limitations video consultations conduct indepth qualitative studies real consultations microlevel embedded organisational case study mesolevel taking account national context macrolevel study based 2 contrasting clinical settings diabetes cancer national health service nhs acute trust london uk main data sources microlevelaudio video screen capture produce rich multimodal data 45 remote consultations mesolevelinterviews ethnographic observations analysis documents within trust macrolevelkey informant interviews nationallevel stakeholders document analysis data analysed synthesised using sociotechnical framework developed structuration theory h3ethics approvalh3 city road hampstead nhs research ethics committee 9 december 2014 reference 14lo1883 h3planned outputsh3 plan outputs 5 main audiences 1 academics research publications conference presentations 2 service providers standard operating procedures provisional operational guidance key safety issues 3 professional bodies defence societies summary relevant findings inform guidance members 4 policymakers summary key findings 5 patients carers expect virtual consultation h3discussionh3 research literature video consultations sparse consultations offer potential advantages patients spared cost inconvenience travel healthcare system eg may costeffective fears expressed may clinically risky andor less acceptable patients staff bring significant technical logistical regulatory challenges anticipate study contribute balanced assessment circumstances model might introduced

https://doi.org/10.1136/bmjopen-2016-011581

Patricia Parker|Smita C. Banerjee|Matthew J. Matasar|Carma L. Bylund|Kara Franco|Yuelin Li|Tomer T. Levin|Paul B. Jacobsen|Alan B. Astrow|Howard Leventhal|Steven M. Horwitz|David Kissane

Protocol for a cluster randomised trial of a communication skills intervention for physicians to facilitate survivorship transition in patients with lymphoma

Memorial Sloan Kettering Cancer Center|Memorial Sloan Kettering Cancer Center|Memorial Sloan Kettering Cancer Center|Cornell University|Cornell University|Hamad Medical Corporation|Memorial Sloan Kettering Cancer Center|Memorial Sloan Kettering Cancer Center|Cornell University|Moffitt Cancer Center|Maimonides Medical Center|Rutgers, The State University of New Jersey|Memorial Sloan Kettering Cancer Center|Monash University

h3introductionh3 survivors cancer often describe sense abandonment posttreatment heightened worry uncertainty fear recurrence limited understanding lies ahead study examines efficacy communication skills training cst intervention help physicians address survivorship issues introduce new consultation focused use survivorship care plan patients hodgkin9s lymphoma diffuse large bcell lymphoma h3methods analysish3 specifically randomised 4site trial test efficacy survivorship planning consultation physicians receive cst apply skills new survivorshipfocused office visit using survivorship plan patients achieved complete remission completion firstline therapy versus control arm physicians trained subsequently provide timecontrolled manualised wellness rehabilitation consultation focused discussion healthy nutrition exercise rehabilitation postchemotherapy primary outcome physicians uptake usage communication skills maintenance skills time primary outcome patients changes knowledge lymphoma adherence physicians recommendations eg pneumococcus influenza vaccinations secondary outcomes include perceptions doctorpatient relationship decreased levels cancer worry depression quality life changes satisfaction care usage healthcare study also examine moderators mediators change within theoretical model derived leventhal9s commonsense model health beliefs h3ethics disseminationh3 study approved institutional review boards memorial sloan kettering cancer centers participating sites work funded national cancer institute r01 ca 151899 awarded dwk sh coprincipal investigators content solely responsibility authors necessarily represent official views national cancer institute nci national institutes health nih study findings disseminated research medical communities publication peerreviewed journals presentations local national international conferences h3trial registration numberh3 nct01483664

https://doi.org/10.1212/wnl.0000000000003687

Ellen V. Backhouse|Caroline McHutchison|Vera Cvoro|Susan D. Shenkin|Joanna M. Wardlaw

Early life risk factors for cerebrovascular disease

University of Edinburgh|University of Edinburgh|University of Edinburgh|University of Edinburgh|University of Edinburgh

h3objectiveh3 cerebrovascular disease cvd causes subclinical brain vascular lesions detected using neuroimaging childhood factors may increase later cvd risk h3methodsh3 searched medline psycinfo embase metaanalyzed available evidence childhood premorbid iq socioeconomic status ses education subclinical cvd later life overall odds ratios mean difference correlation 95 confidence intervals cis calculated using random effects methods h3resultsh3 identified 30 relevant studies n 22890 lower childhood iq lower childhood ses associated white matter hyperintensities wmh iq n 1512 iri 007 95 ci 012 002 ipi 0007 ses n 243 deep wmh iri 018 periventricular wmh iri 0146 fewer years education associated several cvd markers n 15439 117 95 ci 105 131 ipi 0003 studies assessed early life factors combined h3conclusionsh3 childhood iq ses education associated increased risk cvd neuroimaging later life studies required provide evidence thereby inform policy

https://doi.org/10.9745/ghsp-d-13-00155

Jessica Crawford|Erin Larsen-Cooper|Zachariah Jezman|Stacey C Cunningham|Emily Bancroft

SMS versus voice messaging to deliver MNCH communication in rural Malawi: assessment of delivery success and user experience

VillageReach|VillageReach|VillageReach|VillageReach|VillageReach

h3objectiveh3 determine difference delivery success health messages delivered pushed sms pushed voice messages sent personal phones voice messages retrieved community phone retrieved voice messaging well difference quality user experience h3methodsh3 analyzed project9s electronic monitoring data september 2011 june 2013 including demographics enrollment data messages sent successfully delivered also collected analyzed information quarterly phonebased surveys users assess quality user experience including acceptability comprehension new information learned reported behavior change h3resultsh3 half subscribers enrolled retrieved voice messaging service nearly onethird enrolled pushed sms service less 10 pushed voice messaging message delivery success highest among pushed sms subscribers lowest among retrieved voice subscribers overall 99 survey respondents reported trusting messages received 75 respondents recalled last message received learned something new almost 75 respondents reported already changed intended change behavior based received messages intended actual behavior change significantly higher among pushed sms enrollees among pushed retrieved voice messaging enrollees ipi 01 h3conclusionh3 message modalities led high levels satisfaction comprehension new information learned due lower cost higher delivery success higher levels intended actual behavior change sms preferred delivery modality however majority users included study access personal phone retrieved voice messages provided opportunity access population otherwise could served providing multiple methods users could access service crucial extending reach beyond literate personal phone owners

https://doi.org/10.1212/wnl.0b013e31829e701d

Chang Hyung Hong|Cherie Falvey|Tamara B. Harris|Eleanor M. Simonsick|Suzanne Satterfield|Luigi Ferrucci|Andrea Metti|Kushang V. Patel|Kristine Yaffe

Anemia and risk of dementia in older adults: Findings from the Health ABC study

San Francisco VA Medical Center|University of California, San Francisco|Institute on Aging|Ajou University|University of Pittsburgh|University of Washington|University of Tennessee Health Science Center|San Francisco VA Medical Center|University of California, San Francisco|Institute on Aging|Ajou University|University of Pittsburgh|University of Washington|University of Tennessee Health Science Center|San Francisco VA Medical Center|University of California, San Francisco|Institute on Aging|Ajou University|University of Pittsburgh|University of Washington|University of Tennessee Health Science Center|San Francisco VA Medical Center|University of California, San Francisco|Institute on Aging|Ajou University|University of Pittsburgh|University of Washington|University of Tennessee Health Science Center|San Francisco VA Medical Center|University of California, San Francisco|Institute on Aging|Ajou University|University of Pittsburgh|University of Washington|University of Tennessee Health Science Center|San Francisco VA Medical Center|University of California, San Francisco|Institute on Aging|Ajou University|University of Pittsburgh|University of Washington|University of Tennessee Health Science Center|San Francisco VA Medical Center|University of California, San Francisco|Institute on Aging|Ajou University|University of Pittsburgh|University of Washington|University of Tennessee Health Science Center|San Francisco VA Medical Center|University of California, San Francisco|Institute on Aging|Ajou University|University of Pittsburgh|University of Washington|University of Tennessee Health Science Center|San Francisco VA Medical Center|University of California, San Francisco|Institute on Aging|Ajou University|University of Pittsburgh|University of Washington|University of Tennessee Health Science Center

h3objectiveh3 determine whether anemia associated incident dementia older adults h3methodsh3 studied 2552 older adults mean age 761 years 389 black 518 female participating health aging body composition study free dementia baseline defined anemia using criteria hemoglobin concentration lt13 gdl men lt12 gdl women dementia diagnosis determined dementia medication use hospital records change modified minimental state 3ms score 15 sd mean discrete time cox proportional hazard regression models used examine hazard developing dementia associated anemia h3resultsh3 2552 participants 392 154 older adults anemia baseline 11 years followup 455 178 participants developed dementia unadjusted model baseline anemia increased risk dementia 23 vs 17 hazard ratio 164 95 confidence interval 130 207 compared without anemia association remained significant adjusting demographics iapoei 4 baseline 3ms score comorbidities renal function additional adjustment anemia measures mean corpuscular volume red cell distribution width erythropoietin creactive protein appreciably change results interaction sex race risk developing dementia h3conclusionh3 among older adults anemia associated increased risk developing dementia findings suggest study anemia risk factor dementia target intervention cognitive health warranted

https://doi.org/10.1212/wnl.0b013e3182a08f1b

José Marcelo Farfel|Ricardo Nitríni|Cláudia Kimie Suemoto|Lea T. Grinberg|Renata E.L. Ferretti|Renata Elaine Paraízo Leite|Edilaine Tampellini|Luzia Carreira Lima|Daniela Souza Farias|Ricardo Caires Neves|Roberta Diehl Rodriguez|Paulo Rossi Menezes|Felipe Fregni|David A. Bennett|Carlos Augusto Pasqualucci|Wilson Jacob Filho

Very low levels of education and cognitive reserve

Universidade de São Paulo

h3objectiveh3 conducted clinicopathologic study large population low levels education determine whether years education could contribute cognitive reserve modify relation neuropathologic indices dementia h3methodsh3 crosssectional study included 675 individuals 50 years age older brazilian aging brain study group cognitive abilities evaluated structured interview informant time autopsy including clinical dementia rating cdr scale neuropathologic examinations performed using immunohistochemistry following internationally accepted criteria multivariate linear regression models conducted determine whether association cognitive abilities measured cdr sum boxes years education independent sociodemographic variables neuropathologic indices including neuritic plaques neurofibrillary tangles lacunar infarctions smallvessel disease lewy bodies addition interaction models used examine whether education modified relation neuropathologic indices cognition h3resultsh3 mean education 39 35 years formal education associated lower cdr sum boxes 0197 95 confidence interval 0343 0052 ipi 0008 adjustment sociodemographic variables neuropathologic indices furthermore education modified relationship lacunar infarcts cognitive abilities ipi 004 h3conclusionsh3 even years formal education contributes cognitive reserve

https://doi.org/10.1136/archdischild-2014-308021

Alan R. Tait|Terri Voepel?Lewis|Robert J. Levine

Using digital multimedia to improve parents’ and children's understanding of clinical trials

University of Michigan–Ann Arbor|Michigan Medicine|University of Michigan–Ann Arbor|Michigan Medicine|ArchieMD (United States)|Jackson Memorial Hospital

h3objectiveh3 data show many research subjects difficulty understanding study information using traditional paper consent documents study therefore designed evaluate effect interactive multimedia program improving parents children9s understanding clinical trial concepts participation h3methodsh3 parents n148 children n135 randomised receive information regarding clinical trials using either traditional paper format tf interactive ipad program ip inline exercises participants understanding information assessed using semistructured interviews prior pretest posttest receiving information participants also completed short survey assess perceptions information delivery satisfaction process h3resultsh3 regardless mode information delivery participants demonstrated improved pretest posttest understanding statistical differences parents posttest understanding tf ip groups children ip group significantly greater posttest understanding compared children tf group 1165 41 vs 885 41 28 14 42 018 scale 18complete understanding furthermore ip found significantly easier follow effective presenting information compared tf h3conclusionsh3 results demonstrated importance providing information regarding clinical trial concepts parents children importantly ability interactive multimedia improve understanding clinical trial concepts satisfaction information delivery particularly among children supports approach novel effective vehicle enhancing informed consent process

https://doi.org/10.1016/j.jvs.2010.08.077

A. F. X. Henry|Nathanael D. Hevelone|Michael Belkin|Louis L. Nguyen

Socioeconomic and hospital-related predictors of amputation for critical limb ischemia

Brigham and Women's Hospital|Harvard University|Brigham and Women's Hospital|Harvard University|Brigham and Women's Hospital|Harvard University|Brigham and Women's Hospital|Harvard University

h3objectiveh3 disparities limb salvage procedures may driven socioeconomic status ses access highvolume hospitals sought identify ses factors associated major amputation setting critical limb ischemia cli h3methodsh3 20032007 nationwide inpatient sample queried discharges containing lower extremity revascularization ler major amputation chronic cli n 958120 elixhauser method used adjust comorbidities significant predictors bivariate logistic regression entered multivariate logistic regression dependent variable amputation vs ler h3resultsh3 overall 242 cli patients underwent amputation significant differences seen groups bivariate multivariate analysis ses factors including race income insurance status lowerincome patients likely treated lowlervolume institutions odds ratio 174 ipi 001 patients higherlervolume centers 1516 ipi 001 admitted electively 219 ipi 001 evaluated diagnostic imaging 1063 ipi 001 likely receive ler h3conclusionsh3 controlling comorbidities minority patients lower ses patients medicaid likely receive amputation cli lowvolume hospitals addressing ses hospital factors may reduce amputation rates cli

https://doi.org/10.1136/heartjnl-2016-310699

Maria Auxiliadora Parreiras Martins|Josiane Moreira da Costa|Juliana Vaz de Melo Mambrini|Antônio Luiz Pinho Ribeiro|Emelia J. Benjamin|Luísa Campos Caldeira Brant|Michael K. Paasche?Orlow|Jared W. Magnani

Health literacy and warfarin therapy at two anticoagulation clinics in Brazil

Universidade Federal de Minas Gerais|Hospital Risoleta Tolentino Neves|Fundação Oswaldo Cruz|Hospital das Clínicas da Universidade Federal de Minas Gerais|Boston Medical Center|Boston University|Framingham Heart Study|National Heart Lung and Blood Institute|Hospital das Clínicas da Universidade Federal de Minas Gerais|Boston University|University of Pittsburgh

h3objectiveh3 health literacy related healthrelated conditions health outcomes studies examining association health literacy anticoagulation variable results sought investigate relations health literacy percentage time therapeutic range ttr vulnerable brazilian cohort two hospitalbased anticoagulation clinics h3methodsh3 measured health literacy short assessment health literacy portuguesespeaking adults sahlpa18 20152016 identified demographic clinical characteristics associated health literacy related health literacy ttr h3resultsh3 enrolled 422 adults prescribed chronic warfarin therapy observational study median age 621 years 588 women monthly income 20000 prevalence inadequate health literacy score 014 points 723 median score 12 quartiles q110 q315 sahlpa18 median ttr 661 multivariable logistic analysis cognitive impairment assistance taking warfarin associated inadequate health literacy prosthetic heart valves school years associated adequate health literacy analyses showed significant relation health literacy ttr analysing health literacy categorical adjusted 105 95 ci 065 170 continuous variable spearmans coefficient 002 p070 h3conclusionsh3 inadequate health literacy highly prevalent impoverished brazilian cohort receiving anticoagulation warfarin however identify association health literacy ttr future investigations may consider systemic factors contribute towards successful anticoagulation outcomes vulnerable patient cohorts inadequate health literacy

https://doi.org/10.1136/bmjopen-2014-005582

Serena Barello|Guendalina Graffigna|Elena Vegni|Mariarosaria Savarese|Federico Lombardi|Albino Claudio Bosio

Engage me in taking care of my heart': a grounded theory study on patient-cardiologist relationship in the hospital management of heart failure

Università Cattolica del Sacro Cuore|Università Cattolica del Sacro Cuore|University of Milan|Università Cattolica del Sacro Cuore|University of Milan|Università Cattolica del Sacro Cuore

h3objectiveh3 approaching study practice heart failure hf management authors recognise patientdoctor relationship central role engaging patients care study aims identifying features levers hf patient engagement suggestions orienting clinical encounters h3designh3 using grounded theory approach conducted 22 indepth interviews 13 patients hf 5 physicians 4 caregivers data collected analysed using open axial selective coding procedures according grounded theory principles h3settingsh3 interviews conducted office university hospital located metropolitan area milan italy h3participantsh3 data comprised total 22 patient hospital cardiologist caregiver interviews patients aged 18 years new york heart association nyha functional class ii iii eligible take part patients recruited primarily referral cardiologist h3resultsh3 hf patient engagement process develops four main phases characterised different patients emotional cognitive behavioural dynamics contribute shape process patient9s meaning making towards health illness regarding care emerging model illustrates hf patient engagement entails meaningmaking process enacted patient critical event implies patients ability give sense care experience disease symptomatology treatments changes along illness course doctors recognised crucial fostering patients engagement along phases process contribute providing patients selfcontinuity give new meaning illness experience h3conclusionsh3 study identifies core experiential domains main levers involved driving patients hf effectively engage disease management model emerging study may help clinicians think fresh way encounters patients role fostering patients health engagement

https://doi.org/10.1136/bmjopen-2015-008254

Noor Khalili Mohd Ali|Kate Lifford|Ben Carter|Fiona E. McRonald|Ghasem Yadegarfar|David R Baldwin|David Weller|David M. Hansell|Stephen W. Duffy|John K. Field|Kate Brain

Barriers to uptake among high-risk individuals declining participation in lung cancer screening: a mixed methods analysis of the UK Lung Cancer Screening (UKLS) trial

Cardiff University|Cardiff University|Cardiff University|Cardiff University|University of Liverpool|University of Liverpool|Nottingham University Hospitals NHS Trust|Royal Brompton Hospital|University of Liverpool|Cardiff University

h3objectiveh3 current study aimed identify barriers participation among highrisk individuals uk lung cancer screening ukls pilot trial h3settingh3 ukls pilot trial randomised controlled trial lowdose ct ldct screening recruited highrisk people using population approach cambridge liverpool areas h3participantsh3 highrisk individuals aged 5075 years invited participate ukls individuals excluded ldct scan performed within last year unable provide consent ldct screening unable carried due coexisting comorbidities h3outcome measuresh3 statistical associations individual characteristics ukls uptake examined using multivariable regression modelling completed nonparticipation questionnaire npq thematic analysis freetext data undertaken identify reasons taking part subsequent exploratory linkage key themes risk factors nonuptake h3resultsh3 comparative data available 4061 highrisk individuals consented participate trial 2756 declined participation declining participation 748 271 completed npq factors associated nonuptake included female gender or064 plt0001 older age or073 plt0001 current smoking or070 plt0001 lower socioeconomic group or056 plt0001 higher affective risk perception or052 plt0001 among nonparticipants provided reason two main themes emerged reflecting practical emotional barriers smokers likely report emotional barriers participation h3conclusionsh3 profile risk factors nonparticipation lung screening emerged underlying reasons largely relating practical emotional barriers strategies engaging highrisk hardtoreach groups critical equitable uptake potential future lung cancer screening programme h3trial registration numberh3 ukls trial registered international standard randomised controlled trial register reference 78513845

https://doi.org/10.1016/j.jneb.2023.05.172

Brandon Stroud|Lauren Sastre

Impact and Acceptability of the Fresh Start Produce Rx Program on Food Literacy, Nutrition and Health

East Carolina University

h3objectiveh3 purpose pilot fresh start prx fsprx program impact healthy food access food literacy rural uninsured patients diabetes h3use theory researchh3 fsprx program grounded socioecological model prior prx research similar population included educational handouts recipes significantly impacted diet quality glycemic control however lacked impact food literacy therefore prx programming direct nutrition education support warranted h3target audienceh3 uninsured patients diagnosed type2 diabetes rural eastern north carolina h3program descriptionh3 pilot 20week fsprx program included provision fresh produce directly provided 35 lbsclass participants nine group classes prx focused nonstarchy vegetables aligned class cooking demonstrations recipes taste testing per class group classes focused improving food literacy healthy lifestyle included activitieshandouts developed tailored underresourced lowerliteracy audience additional behavioral support set nutrition physical activity goals provided via individualized telephonebased health coaching h3evaluation methodsh3 validated food literacy questionnaire collected prepost program final program evaluation survey developed specifically evaluate fsprx program conducted postprogram data analysis included descriptive statistics paired sample ttests via ibm spss 280 h3resultsh3 total food literacy scores increased average 128 points statistically significant p 004 t216 participants reported satisfied 833 satisfied 125 program helped better follow medical providers nutrition recommendations 923 improved diet quality 885 increased access fresh produce 846 willingness try newunfamiliar produce 808 participants used 391 426 produce provided recipes 68 h3conclusionh3 pilot fsprx program integrated food literacy focused tailored nutrition education behavioral support impactful wellreceived nutrition education behavioral support support food literacy continue integrated evaluated within prx programming h3fundingh3 duke endowment foundation

https://doi.org/10.1136/bmjdrc-2015-000184

Janie Houle|François Lauzier?Jobin|Marie?Dominique Beaulieu|Sophie Meunier|Simon Coulombe|José Côté|François Lespérance|Jean?Louis Chiasson|Louis Bherer|Jean Lambert

Socioeconomic status and glycemic control in adult patients with type 2 diabetes: a mediation analysis

Université du Québec à Montréal|Université du Québec à Montréal|Université de Montréal|Université du Québec à Montréal|Université du Québec à Montréal|Université de Montréal|Université de Montréal|Université de Montréal|Concordia University|Institut Universitaire de Gériatrie de Montréal|Université de Montréal

h3objectiveh3 purpose study examine contribution health behaviors selfmanagement coping quality care individual characteristics depressive symptoms selfefficacy illness representations mediators relationship socioeconomic status ses glycemic control h3methodsh3 sample 295 adult patients type 2 diabetes recruited end diabetes education course glycemic control evaluated glycosylated hemoglobin hbasub1csub living poverty education level used indicators ses h3resultsh3 bootstrapping analysis showed significant effects poverty education level hbasub1csub mediated avoidance coping depressive symptoms representation diabetes unpredictable significantly mediated relationship living poverty hbasub1csub healthy diet mediated relationship education level hbasub1csub h3conclusionsh3 improve glycemic control among patients low ses professionals regularly screen depression offering treatment needed pay attention patients9 illness representations coping strategies handling stress related chronic disease also support patients improving selfmanagement skills healthy diet

https://doi.org/10.1136/bmjopen-2013-004372

Rajendra Karkee|Andy H. Lee|Vishnu Khanal

Need factors for utilisation of institutional delivery services in Nepal: an analysis from Nepal Demographic and Health Survey, 2011

B.P. Koirala Institute of Health Sciences|Curtin University|College of Medical Sciences

h3objectiveh3 study aims assess role need factors respect utilisation institutional delivery services nepal h3designh3 analytic study conducted using subset 4079 ever married women 2011 nepal demographic health survey utilised twostage cluster sampling logistic regression complex sample analysis performed evaluate effects antenatal care visits birth preparedness activities facility delivery h3outcome measuresh3 facility delivery h3resultsh3 overall facility delivery rate low 369 95 ci 335 402 se 169 half 501 women made four antenatal care visits 629 95 ci 599 658 se 151 indicate four birth preparation activities adjusting external predisposing enabling factors women made four antenatal care visits five times likely deliver health facility compared paid visit adjusted 494 95 ci 314 776 similarly likelihood facility delivery increased 34fold among women prepared least two four activities compared counterparts made preparation adjusted 341 95 ci 201 558 h3conclusionsh3 perceived need expressed frequency antenatal care visits birth preparedness activities plays important role institutional delivery service utilisation nepali women findings implications behavioural interventions change intention deliver health facility

https://doi.org/10.1016/j.acap.2009.05.028

Matthew D. Oettinger|Joanne Finkle|Denise Esserman|Lisa Whitehead|Thomas K. Spain|Steven R. Pattishall|Russell L. Rothman|Eliana M. Perrin

Color-Coding Improves Parental Understanding of Body Mass Index Charting

University of North Carolina at Chapel Hill|Vanderbilt University Medical Center|University of North Carolina at Chapel Hill|Vanderbilt University Medical Center|University of North Carolina at Chapel Hill|Vanderbilt University Medical Center|University of North Carolina at Chapel Hill|Vanderbilt University Medical Center|University of North Carolina at Chapel Hill|Vanderbilt University Medical Center|University of North Carolina at Chapel Hill|Vanderbilt University Medical Center|University of North Carolina at Chapel Hill|Vanderbilt University Medical Center|University of North Carolina at Chapel Hill|Vanderbilt University Medical Center

h3objectiveh3 assess parental understanding body mass index bmi bmi percentiles using standard versus colorcoded charts investigate parental literacy andor numeracy quantitative skills affects understanding h3methodsh3 convenience sample 163 parents children aged 2 8 years 2 academic pediatric centers completed demographics questionnaire mathematics portion wide range achievement test wrat3r short test functional health literacy adults stofhla understanding bmi questionnaire included parallel bmi charting questions compare understanding standard versus colorcoded bmi charting outcomes included parentalreported versus actual understanding bmi odds obtained generalized estimating equations answering parallel questions correctly using standard versus colorcoded charting odds answering questions correctly basis numeracy literacy h3resultsh3 many parents 60 reported knowing bmi 30 could define even roughly correctly parents used colorcoded charts greater odds answering parallel bmi charting questions correctly used standard charts mean 88 vs 65 correct pooled adjusted odds ratio 432 95 confidence interval 314595 ipi 01 additionally parents lower numeracy k5 level benefited colorcoded charts increased 51 81 correct higher numeracy parents high school level greater performed well charts 89 vs 99 correct h3conclusionsh3 parents consistently performed better colorcoded standard bmi charts colorcoding particularly helpful lower numeracy parents future studies investigate whether results translate office setting whether understanding motivates parents implement important lifestyle changes

https://doi.org/10.1136/bmjopen-2014-006340

Olalekan A. Uthman|Charles Shey Wiysonge|Martin O. C. Ota|Mark P. Nicol|Gregory Hussey|Peter M. Ndumbe|Bongani M. Mayosi

Increasing the value of health research in the WHO African Region beyond 2015--reflecting on the past, celebrating the present and building the future: a bibliometric analysis

University of Warwick|Stellenbosch University|South African Medical Research Council|Stellenbosch University|World Health Organization Regional Office for Africa|University of Cape Town|University of Cape Town|World Health Organization Regional Office for Africa|Groote Schuur Hospital|University of Cape Town

h3objectiveh3 assess profile determinants health research productivity africa since onset new millennium h3designh3 bibliometric analysis h3data collection synthesish3 november 2014 searched pubmed articles published 2000 2014 african region obtained countrylevel indicators world bank data used poisson regression examine time trends research publications negative binomial regression explore determinants research publications h3resultsh3 identified 107 662 publications median 727 per country range 2531 757 three countries south africa nigeria kenya contributed 52 publications number publications increased 3623 2000 12 709 2014 relative growth 251 similarly per cent share worldwide research publications per year increased 07 2000 13 2014 trend analysis also significant confirm continuous increase health research publications africa productivity increasing 103 per year 95 cis 101 105 independent predictor publication outputs national gross domestic product every one log us billion increase gross domestic product research publications rose 105 incidence rate ratio irr205 95 ci 139 304 association private health expenditure publications marginally significant irr186 95 ci 100 347 h3conclusionsh3 significant improvement health research african region since 2000 individual countries already strong research profiles countries region implement strategy research health reinforcing research culture organisation focusing research key health challenges priorities strengthening national health research systems capacity encouraging good research practice standards consolidating linkages health research action translation

https://doi.org/10.1001/archpedi.154.9.893

Richard A. Crosby|Ralph J. DiClemente|Gina M. Wingood|Catlainn Sionéan|Brenda K. Cobb|Kathy Harrington

Correlates of Unprotected Vaginal Sex Among African American Female Adolescents

Emory University|Emory University|Emory University|Emory University|University of Alabama at Birmingham

h3objectiveh3 determine associations frequency unprotected vaginal sex uvs female adolescents perceptions particularly perceptions relationship dynamics h3designh3 crosssectional study 522 african american female adolescents enrolled sexually transmitted disease std human immunodeficiency virus prevention intervention trial h3setting participantsh3 volunteer sample adolescents recruited neighborhoods characterized high rates unemployment substance abuse violence stds 28 tested positive stds assessed dna amplification culture h3main outcome measureh3 frequency uvs assessed interview using 6month recall period h3resultsh3 among adolescents steady relationships spending time boyfriends longer relationships reported significantly greater frequency uvs significant correlates included perception girlfriends using condoms history stds stronger normative beliefs favoring male decision making relationships greater pregnancy worry greater perceived invulnerability stds adolescents reporting casual relationships personal barriers condom use history stds reporting boyfriends typically decide sex associated frequent uvs h3conclusionsh3 adolescents perceptions particularly perceptions relationship dynamics played integral role explaining female adolescents frequency uvs steady casual partners female adolescents steady relationships differ casual relationships relative prevention needs findings implications clinic communitybased std human immunodeficiency virus prevention programs

https://doi.org/10.1001/archpediatrics.2010.254

Alan L. Mendelsohn|Harris S. Huberman|Samantha B. Berkule|Carolyn Brockmeyer|Lesley Mandel Morrow|Benard P. Dreyer

Primary Care Strategies for Promoting Parent-Child Interactions and School Readiness in At-Risk Families

Bellevue Hospital Center|New York University|Graduate School USA

h3objectiveh3 determine effects pediatric primary care interventions parentchild interactions families low socioeconomic status h3designh3 randomized controlled trial participants randomized 1 2 interventions video interaction project vip building blocks bb control group h3settingh3 urban public hospital pediatric primary care clinic h3participantsh3 mothernewborn dyads enrolled post partum november 1 2005 october 31 2008 h3interventionsh3 vip group mothers newborns participated 1on1 sessions child development specialist facilitated interactions play shared reading reviewing videos made parent child primary care visit days learning materials parenting pamphlets also provided bb group parenting materials including agespecific newsletters suggesting interactive activities learning materials parentcompleted developmental questionnaires mailed mothers h3main outcome measuresh3 parentchild interactions assessed 6 months stimqinfant 24hour shared reading recall diary h3resultsh3 total 410 families assessed vip group higher increased stimq score mean difference 36 points 95 confidence interval 15 56 points cohen 051 022 081 reading activities compared control group bb group also increased overall stimq score compared control group cohen 031 95 confidence interval 003 060 greatest effects vip group found mothers ninthgrade higher reading level cohen 068 95 confidence interval 033 103 h3conclusionsh3 vip bb groups led increased parentchild interactions pediatric primary care represents significant opportunity enhancing developmental trajectories atrisk children h3trial registrationh3 clinicaltrialsgov identifiernct00212576

https://doi.org/10.1001/archpedi.152.5.459

Pamela High|Marita R. Hopmann|Linda L. LaGasse|Holly E. Linn

Evaluation of a Clinic-Based Program to Promote Book Sharing and Bedtime Routines Among Low-Income Urban Families With Young Children

Women & Infants Hospital of Rhode Island|Providence College|Brown University

h3objectiveh3 evaluate program anticipatory guidance pediatric residents nurse practitioners continuity practice gave parents books young children along developmentally appropriate educational materials describing share books promoting reading part bedtime routine h3study designh3 comparison 2 crosssectional groups using consecutive structured facetoface telephone interviews parents one group historical control comparison group group 1 intervention group group 2 included families received 2 books educational materials children part program promote book sharing bedtime routines h3subjectsh3 institution program promote book sharing bedtime routines parents 51 families healthy children 12 38 months age regularly attended continuity clinics conducted house staff interviewed families constituted group 1 group 1 included lowincome population hispanic african american nonhispanic white families group 2 included 100 families similar sociodemographic characteristics healthy 12 38monthold children received 2 books educational materials 6 36month wellchild visits part program h3resultsh3 intervention found effective promoting childcentered literacy activities asked openended questions 4 8 parents group 1 21 21 parents group 2 said 1 childs 3 favorite activities included books ipi04 11 22 parents group 1 42 42 parents group 2 said 1 3 favorite activities child book sharing ipi01 10 20 parents group 1 35 35 parents group 2 said share books 6 7 times week bedtime ipi05 mentioning 1 3 important childcentered booksharing activities 17 33 parents group 1 69 69 parents group 2 ipilt001 demonstrated positive childcentered literacy orientation multiple logistic regression analysis controlling parental education ethnicity reading habits well sex age children found childcentered literacy orientation likely present group 2 group 1 families odds ratio 47 95 confidence interval ci 21105ipilt001 book sharing part bedtime routine frequent group 2 meansd 3926 nights per week group 1 meansd 2527 nights per weekipi002 however significant differences prolonged bedtime struggles parentchild cosleeping frequent night waking children fell asleep found groups instead multivariate analysis bedtime struggles occurred often younger parents ipi03 fewer children home ipi02 parentchild cosleeping ipilt001 frequent night waking ipi04 less likely occur children usually fell asleep alone beds h3conclusionsh3 simple inexpensive intervention pediatric house staff consisting provision childrens books educational materials wellchild visits resulted increased enjoyment participation childcentered bookrelated activities lowincome families primary care providers ie physicians nurse practitioners serving underserved pediatric populations may unique opportunity promote childcentered literacy atrisk groups

https://doi.org/10.1001/archopht.126.5.608

Joan A. Stelmack|Xiaoyin Tang|Domenic J. Reda|Stephen Rinne|Rickilyn M. Mancil|Robert W. Massof

Outcomes of the Veterans Affairs Low Vision Intervention Trial (LOVIT)

Edward Hines, Jr. VA Hospital

h3objectiveh3 evaluate effectiveness lowvision rehabilitation program h3methodsh3 multicenter randomized clinical trial conducted november 2004 november 2006 4month followup total 126 patients included 98 white male patients referred eye lowvision clinics blind rehabilitation centers visual acuity betterseeing eye worse 20100 better 20500 eligible veterans affairs va services telephone interviews patients conducted homes participation outpatient lowvision program va medical care facility waiting list control group interviewer administering questionnaires telephone masked patients assignments interventions included lowvision examination counseling prescription provision lowvision devices 6 weekly sessions provided lowvision therapist teach use assistive devices adaptive strategies perform daily living tasks independently h3main outcome measureh3 change patients visual reading ability estimated participant responses veterans affairs lowvision visual functioning questionnaire lv vfq48 reading items completed baseline compared 4 months enrollment treatment control groups secondary outcomes changes visual ability domains mobility visual information processing visual motor skills overall visual ability baseline 4 months estimated va lv vfq48 difficulty ratings subsets items h3resultsh3 treatment group demonstrated significant improvement aspects visual function compared control group difference mean changes 243 logits 95 confidence interval ci 207277ipi lt 001 effect size 251 visual reading ability 084 logit 95 ci 058110ipi lt 001 effect size 114 mobility 138 logits 95 ci 115162ipi lt 001 effect size 203 visual information processing 151 logits 95 ci 122180ipi lt 001 effect size 182 visual motor skills 163 logits 95 ci 140186ipi lt 001 effect size 251 overall visual function h3conclusionh3 program effectively provided lowvision rehabilitation patients macular diseases h3applications clinical practiceh3 least 10 hours lowvision therapy including home visit assigned homework encourage practice justified patients moderate severe vision loss macular diseases waitinglist control patients demonstrated decline functional ability lowvision services offered early possible h3trial registrationh3 clinicaltrialsgov identifiernct00223756

https://doi.org/10.1136/bmjopen-2012-001503

Gillian Rowlands|Anita Mehay|Sally Hampshire|Robert Phillips|Paul Williams|Anthony Mann|Andrew Steptoe|Paul Walters|André Tylee

Characteristics of people with low health literacy on coronary heart disease GP registers in South London: a cross-sectional study

London South Bank University|King's College London|King's College - North Carolina|King's College London|King's College - North Carolina|King's College London|King's College - North Carolina|King's College London|King's College - North Carolina|King's College London|King's College - North Carolina|University College London|King's College London|King's College - North Carolina|King's College London|King's College - North Carolina

h3objectiveh3 explore characteristics associated prevalence low health literacy patients recruited investigate role depression patients general practice gp coronary heart disease chd registers upbeat uk study h3designh3 crosssectional cohort health literacy measure rapid estimate health literacy medicine realm univariable analyses identified characteristics associated low health literacy compared health service use health literacy statuses variables statistically significantborderline significant difference health literacy statuses entered multivariable model h3settingh3 16 general practices south london uk h3participantsh3 inclusion patients gt18 years registered gp gp chd register exclusion patients temporarily registered h3primary outcome measureh3 realm h3resultsh3 803 upbeat cohort participants 687 8555 completed realm 106 1543 low health literacy twentyeight participants could included multivariable analysis due missing predictor variable data leaving sample 659 variables remaining final model age gender ethnicity indices multiple deprivation score years education employment body mass index alcohol intake anxiety scores hospital anxiety depression scale univariable analysis also showed people low health literacy may longer practice nurse consultations people adequate health literacy h3conclusionsh3 disadvantaged group people gp chd registers low health literacy multivariable model showed patients low health literacy significantly higher anxiety levels people adequate health literacy addition univariable analyses show patients longer consultations practice nurses collect 4year longitudinal cohort data explore impact health literacy people gp chd registers impact health literacy health service use

https://doi.org/10.1001/archpedi.157.9.867

Arthur B. Elster|Julie Jarosik|Jonathan B. VanGeest|Missy Fleming

Racial and Ethnic Disparities in Health Care for Adolescents

American Medical Association

h3objectiveh3 identify extent racial ethnic disparities primary care mental health care reproductive health care asthma care adolescents independent socioeconomic status ses h3data sourcesh3 systematic review scientific literature using standard bibliographic databases h3study selectionh3 inclusion criteria 1 studies published past 12 years 2 analyses included children adolescents aged 17 years younger 3 data analyzed racialethnic groups accounting ses total 203 studies reviewed 31 met criteria inclusion 14 65 studies primary care 11 61 studies mental health care 2 50 studies reproductive health 4 27 studies asthma services h3data extractionh3 data tables selected studies used determine whether minority children adolescents received fewer greater health care services white children youth taking account ses h3data synthesish3 black youth received fewer primary care services 8 studies whereas 4 studies disparity noted hispanic youth received fewer primary care services 6 studies whereas disparity noted 5 one study include hispanic subjects 2 studies minority youth combined single category received fewer services white youth total 6 studies black youth received fewer mental health services whereas 3 studies disparity noted 1 study black youth received greater number services 3 studies hispanic youth received fewer mental health services 3 studies group differences 1 study racial ethnic groups combined single category minority children youth received fewer mental health services white subjects three studies include hispanic subjects studies reproductive asthma care available draw conclusions h3conclusionsh3 results suggest racial ethnic disparities independent ses exist selected areas adolescent health care studies needed better understand extent causes findings

https://doi.org/10.1016/j.jpeds.2019.06.037

Adriana Weisleder|Carolyn Brockmeyer Cates|Jessica F. Harding|Samantha Berkule Johnson|Caitlin F. Canfield|Anne M. Seery|Caroline D. Raak|Angélica Castilho Alonso|Benard P. Dreyer|Alan L. Mendelsohn

Links between Shared Reading and Play, Parent Psychosocial Functioning, and Child Behavior: Evidence from a Randomized Controlled Trial

New York University|Northwestern University|New York University|Purchase College|Mathematica Policy Research|Marymount Manhattan College|New York University|New York University|New York University|New York University|New York University|New York University|New York University

h3objectiveh3 investigate pathways interventions promote shared reading play help prevent child behavior problems examined whether family processes associated family investment pathway eg parental cognitive stimulation family stress pathway eg mothers psychosocial functioning mediated impacts pediatricbased preventive intervention child behavior h3study designh3 sample included 362 lowincome mothers children participated randomized controlled trial video interaction project pediatricsbased preventive intervention promotes parentchild interactions context shared reading play parentchild dyads randomly assigned group birth three mediatorsparental cognitive stimulation maternal stress parentchild relationship maternal depressive symptomswere assessed child ages 6 36 months outcome child externalizing behaviors assessed 36 months used series path analytic models examine family processes separately together mediated impacts video interaction project child behavioral outcomes h3resultsh3 intervention impacts child behavior mediated enhancements cognitive stimulation improvements mothers psychosocial functioning sequential mediation model showed video interaction project impacts cognitive stimulation 6 months associated later decreases mothers stress parentchild relationship pathway mediated intervention impacts child behavioral outcomes 3 years age ipi 023 h3conclusionsh3 using experimental design study identifies pathways parentchild interactions shared reading play improve child behavioral outcomes h3trial registrationh3 clinicaltrialsgov nct00212576

https://doi.org/10.1016/j.jaac.2015.02.007

Kapil Sayal|Elizabeth Washbrook|Carol Propper

Childhood Behavior Problems and Academic Outcomes in Adolescence: Longitudinal Population-Based Study

Institute of Mental Health|University of Nottingham|University of Bristol|University of Bristol

h3objectiveh3 investigate impact increasing levels inattention hyperactivityimpulsivity oppositionaldefiant behaviors age 7 years academic achievement age 16 years h3methodh3 populationbased sample 7yearold children england information obtained inattention hyperactivityimpulsivity oppositionaldefiant behaviors using parent teacher ratings presence attentiondeficithyperactivity disorder adhd disruptive behavior disorders dbds adjusting confounder variables associations academic achievement national general certificate secondary education gcse examinations using scores minimum expected schoolleaving qualification level 5 good gcses age 16 years investigated n 11640 h3resultsh3 adjusted analyses linear association 1point increase inattention symptoms worse outcomes 2 3point reduction gcse scores 6 7 1012 teacher ratings increased likelihood achieving 5 good gcses adhd associated 27 32point reduction gcse scores boys 2fold increased likelihood achieving 5 good gcses boys oppositionaldefiant behaviors also independently associated worse outcomes dbds associated 19point reduction gcse scores 183increased likelihood achieving 5 good gcses h3conclusionh3 across full range scores population level 1point increase inattention age 7 years associated worse academic outcomes age 16 findings highlight longterm academic risk associated adhd particularly inattentive symptoms adjusting inattention adhd respectively oppositionaldefiant behaviors dbds also independently associated worse academic outcomes

https://doi.org/10.1212/wnl.0000000000007778

Lanka Hospitals|Lanka Hospitals|Lanka Hospitals

h3objectiveh3 investigate maternal comprehension two different growth charts identify group mothers poor comprehension h3designh3 experimental prospective study h3settingh3 child welfare clinic de soysa hospital women colombo sri lanka h3subjectsh3 932 mothers studied regarding interpretation type growth chart infants allocated total 413 mothers interpreted roadtohealth chart 519 mothers interpreted revised chart validated scoring system used assess comprehension two groups mothers comparable h3resultsh3 624 324 mothers interpreted revised chart good comprehension 206 85 mothers similar comprehension roadtohealth chart education beyond grade 8 school significantly improved comprehension h3conclusionh3 design growth chart powerful effect maternal comprehension growth patterns length schooling rather literacy alone marker comprehending mother policy implications findings governments agencies may need redesign parent held growth charts achieve better comprehension mothers

https://doi.org/10.1136/adc.76.6.500

Chloe Verducci|Fizza Hussain|Elizabeth Donner|Brian D. Moseley|Jeffrey Buchhalter|Dale C. Hesdorffer|Daniel Friedman|Orrin Devinsky

SUDEP in the North American SUDEP Registry

Columbia University Irving Medical Center|University of Calgary|Hospital for Sick Children|University of Cincinnati|Columbia University Irving Medical Center|University of Calgary|Hospital for Sick Children|University of Cincinnati|Columbia University Irving Medical Center|University of Calgary|Hospital for Sick Children|University of Cincinnati|Columbia University Irving Medical Center|University of Calgary|Hospital for Sick Children|University of Cincinnati|Columbia University Irving Medical Center|University of Calgary|Hospital for Sick Children|University of Cincinnati|Columbia University Irving Medical Center|University of Calgary|Hospital for Sick Children|University of Cincinnati|Columbia University Irving Medical Center|University of Calgary|Hospital for Sick Children|University of Cincinnati|Columbia University Irving Medical Center|University of Calgary|Hospital for Sick Children|University of Cincinnati

h3objectiveh3 obtain medical records family interviews deathrelated reports sudden unexpected death epilepsy sudep cases better understand sudep h3methodsh3 cases referred north american sudep registry nasr october 2011 june 2018 reviewed cause death determined consensus review available medical records death scene investigation reports autopsy reports nextofkin interviews reviewed cases sudep seizure type eeg mri sudep classification adjudicated 2 epileptologists h3resultsh3 237 definite probable cases sudep among 530 nasr participants sudep decedents median age 26 range 170 years death 38 female 143 sufficient information 40 generalized 60 focal epilepsy sudep affected full spectrum epilepsies benign epilepsy centrotemporal spikes n 3 1 intractable epileptic encephalopathies n 27 11 93 sudeps unwitnessed 70 occurred apparent sleep 69 patients prone 37 cases sudep took last dose antiseizure medications asms reported lifetime generalized tonicclonic seizures gtcs lt10 33 0 4 h3conclusionsh3 nasr participants commonly clinical features previously associated sudep risk young adult age asm nonadherence frequent gtcs however sizeable minority sudep occurred patients thought treatment responsive benign epilepsies results emphasize importance sudep education across spectrum epilepsy severities aim make nasr data biospecimens available researchers advance sudep understanding prevention

https://doi.org/10.1136/bmjopen-2014-006013

Vincenzo Currò|R Lanni|F. Scipione|V. Grimaldi|P Mastroiacovo|Tony Waterston

Randomised controlled trial assessing the effectiveness of a booklet on the duration of breast feeding Commentary

Università Cattolica del Sacro Cuore|Università Cattolica del Sacro Cuore|Università Cattolica del Sacro Cuore|Università Cattolica del Sacro Cuore|Agostino Gemelli University Polyclinic|Agostino Gemelli University Polyclinic

h3objectiveh3 test efficacy information booklet increase duration breast feeding h3research designh3 randomised design stratifying maternal residence working activity two hundred women recruited 103 received booklet verbal counselling 97 verbal counselling h3populationh3 infants observed 15 september 1993 15 june 1994 well baby outpatient clinic paediatric institute catholic university rome italy h3main resultsh3 statistically significant difference found two groups prevalence exclusive complementary breast feeding 6 months age 485 592 intervention group 437 515 control group median duration exclusive complementary breast feeding 24 27 weeks treated group 22 25 control group h3conclusionsh3 information booklet alone seem increase duration prevalence breast feeding 6 months age use written material individualised support extensive use randomised clinical trials evaluation health promoting programmes recommended

https://doi.org/10.1016/j.ajog.2014.05.032

Elard Koch|Monique Chireau|Fernando Pliego|Janet L. Stanford|Sami Haddad|Byron C. Calhoun|Paula Aracena|Miguel Bravo|Sebastián Gatica|JM Thorp

Abortion legislation, maternal healthcare, fertility, female literacy, sanitation, violence against women and maternal deaths: a natural experiment in 32 Mexican states

Duke University Hospital|Duke Medical Center|Universidad Nacional Autónoma de México|University of Utah|Universidad Anáhuac|West Virginia University|University of North Carolina at Chapel Hill

h3objectiveh3 test whether association abortion legislation maternal mortality outcomes controlling factors thought influence maternal health h3designh3 populationbased natural experiment h3setting data sourcesh3 official maternal mortality data 32 federal states mexico 2002 2011 h3main outcomesh3 maternal mortality ratio mmr mmr abortive outcome mmrsubaosub induced abortion mortality ratio iamr h3independent variablesh3 abortion legislation grouped less n18 permissive n14 constitutional amendment protecting unborn n17 skilled attendance birth allabortion hospitalisation ratio low birth weight rate contraceptive use total fertility rates tfr clean water sanitation female literacy rate intimatepartner violence h3main resultsh3 10year period states less permissive abortion legislation exhibited lower mmr 383 vs 496 plt0001 mmrsubaosub 27 vs 37 plt0001 iamr 09 vs 17 plt0001 permissive states multivariate regression models estimating effect sizes coefficients mortality outcomes showed independent associations p values 0001 0055 female literacy 0061 1100 skilled attendance birth 0032 0427 low birth weight 0149 2166 allabortion hospitalisation ratio 0566 0962 clean water 0048 0730 sanitation 0052 0758 intimatepartner violence 0085 0755 tfr showed inverse association mmr 14329 mmrsubaosub 1750 direct association iamr 1383 altogether factors accounted rsup2sup 5188 variance among states overall mortality rates statistically independent effect observed abortion legislation constitutional amendment covariates h3conclusionsh3 although less permissive states exhibited consistently lower maternal mortality rates finding explained abortion legislation rather differences explained independent factors appeared favourable distribution states

https://doi.org/10.1001/archpediatrics.2011.91

Anne Marie Darling|Chloë R. McDonald|Andrea L. Conroy|Kyla Hayford|W. Conrad Liles|Molin Wang|Said Aboud|Willy Urassa|Kevin C. Kain|Wafaie Fawzi

Angiogenic and inflammatory biomarkers in midpregnancy and small-for-gestational-age outcomes in Tanzania

Harvard Global Health Institute|University Health Network|University of Toronto|Toronto General Hospital|University of Toronto|Toronto General Hospital|University Health Network|University Health Network|University of Toronto|Toronto General Hospital|University of Washington|Harvard University|Muhimbili University of Health and Allied Sciences|Muhimbili University of Health and Allied Sciences|University Health Network|University of Toronto|Toronto General Hospital|Harvard Global Health Institute|Harvard University

h3objectiveh3 sought investigate relationship panel angiogenic inflammatory biomarkers measured midpregnancy smallforgestationalage sga outcomes subsaharan africa h3study designh3 concentrations 18 angiogenic inflammatory biomarkers determined 432 pregnant women dar es salaam tanzania participated trial examining effect multivitamins pregnancy outcomes infants falling 10th percentile birthweight gestational age relative applied growth standards considered sga multivariate binomial regression models log link function used determine relative risk sga associated increasing quartiles biomarker restricted cubic splines used test nonlinearity associations h3resultsh3 total 60 participants 139 gave birth sga infants compared first quartile risk sga reduced among fourth quartiles vascular endothelial growth factora adjusted risk ratio rr 038 95 confidence interval ci 019074 placental growth factor adjusted rr 028 95 ci 012061 soluble fmslike tyrosine kinase1 adjusted rr 048 95 ci 023101 monocyte chemoattractant protein1 adjusted rr 048 95 ci 025092 leptin adjusted rr 046 95 ci 022096 h3conclusionh3 findings provide evidence altered angiogenic inflammatory mediators midpregnancy women went deliver sga infants

https://doi.org/10.1001/archpediatrics.2012.1181

Kathryn Falb|Heather L. McCauley|Michele R. Decker|Jhumka Gupta|Anita Raj|Jay G. Silverman

School Bullying Perpetration and Other Childhood Risk Factors as Predictors of Adult Intimate Partner Violence Perpetration

Harvard University

h3objectiveh3to assess relationship bullying peers child adult intimate partner violence perpetration clinicbased sample adult men school bullying perpetration intimate partner violence perpetration thought stem desire power control othersh3designh3a crosssectional survey conducted january 2005 december 2006h3settingh3three urban community health centers boston massachusettsh3participantsh3men aged 18 35 years n 1491 seeking services participating community health centersh3main exposureh3school bullying perpetrationh3outcome measureh3pastyear physical sexual violence perpetration female partner intimatepartner violence ipvh3resultsh3twofifths men reported perpetrating school bullying child n 610 409 men rarely bullied school 153 times likely perpetrate pastyear ipv men bully 95 confidence interval ci 102229 risk elevated 382 times likely perpetrate pastyear ipv men bullied peers frequently 95 ci 255573h3conclusionsh3the present study indicates bullying peers school child especially frequent bullying perpetration associated increased risk mens perpetration ipv adult effect remains strong controlling common prior risk factors bullying ipv perpetration future research needed discern mechanisms underlying root causes abusive behavior power control means prevent violence perpetration across settings life stages

https://doi.org/10.1136/bmjopen-2016-013015

Anna Bowen|Mubina Agboatwalla|Stephen P. Luby|Timothy Tobery|Tracy Ayers|Robert M. Hoekstra

Association Between Intensive Handwashing Promotion and Child Development in Karachi, Pakistan

h3objectiveh3to evaluate associations handwashing promotion child growth developmenth3designh3cluster randomized controlled trialh3settingh3informal settlements karachi pakistanh3participantsh3a total 461 children enrolled trial householdlevel handwashing promotion 2003 younger 8 years reassessment 2009h3interventionsh3in 2003 neighborhoods randomized control n 9 handwashing promotion n 9 handwashing promotion drinking water treatment n 10 intervention households received free soap weekly handwashing promotion 9 monthsh3main outcome measuresh3anthropometrics developmental quotients measured battelle developmental inventory ii 5 7 years ageh3resultsh3overall 249 95 ci 200306 221 95 ci 180268 children z scores 2 sds expected z scores height body mass index age respectively anthropometrics differ significantly across study groups global developmental quotients averaged 1044 95 ci 10191070 among intervention children 983 95 ci 9311034 among control children p 04 differences similar magnitude measured across adaptive personalsocial communication cognitive motor domainsh3conclusionsh3although growth similar across groups children randomized handwashing promotion first 30 months age attained global developmental quotients 04 sds greater control children 5 7 years age gains comparable atrisk children enrolled publicly funded preschools united states suggest handwashing promotion could improve child wellbeing societal productivityh3trial registrationh3clinicaltrialsgov identifier nct01538953

https://doi.org/10.1136/bmjopen-2014-006104

Niveditha Devasenapathy|Suparna Ghosh Jerath|Saket Sharma|Elizabeth Allen|Anuraj H Shankar|Sanjay Zodpey

Determinants of childhood immunisation coverage in urban poor settlements of Delhi, India: a cross-sectional study

Public Health Foundation of India|Institute of Public Health|Public Health Foundation of India|Institute of Public Health|Public Health Foundation of India|Institute of Public Health|London School of Hygiene & Tropical Medicine|Harvard University|Public Health Foundation of India|Institute of Public Health

h3objectivesh3 aggregate data childhood immunisation urban settings may reflect coverage among urban poor study provides information complete childhood immunisation coverage among urban poor explores household neighbourhoodlevel determinants h3settingh3 urban poor community southeast district delhi india h3participantsh3 randomly sampled 1849 children aged 135 years 13 451 households 39 clusters cluster defined area covered community health worker 2 large urban poor settlements 1343 completed survey collected information regarding childhood immunisation bcg oral polio vaccine diphtheriapertussistetanus vaccine hepatitis b measles vaccination cards mothers recall used random intercept logistic regression explore sociodemographic determinants complete immunisation h3resultsh3 complete immunisation coverage 467 75 immunised odds complete vaccination 95 ci lower female children 070 055 089 muslim households 065 045 094 odds complete vaccination higher mother literate 16 115 216 child born within city 27 197 365 health facility 15 119 202 belonged highest wealth quintile compared poorest 246 15 402 possessed birth certificate 140 103 191 cluster effect due unmeasured neighbourhood factors expressed median 132 h3conclusionsh3 immunisation coverage urban poor area much lower regional surveys reporting overall urban data socioeconomic status household female illiteracy health awareness gender inequality important determinants coverage population hence addition enhancing infrastructure providing mother child services efforts also needed address issues order improve immunisation coverage deprived urban communities h3trial registration numberh3 ctri2011091000095

https://doi.org/10.1136/bmjopen-2012-002387

T Sentell|Janice Y. Tsoh|Terry C. Davis|James W. Davis|Kathryn L. Braun

Low health literacy and cancer screening among Chinese Americans in California: a cross-sectional analysis

University of Hawaii System|University of Hawai?i at M?noa|University of California, San Francisco|Louisiana State University Health Sciences Center New Orleans|University of Hawai?i at M?noa|Papa Ola Lokahi|University of Hawai?i at M?noa|University of Hawaii System

h3objectivesh3 cancer leading cause death among asian americans chinese americans comprise largest asian american ethnic group low health literacy lhl associated lower cancer screening rates association studied chinese americans examined relationship lhl meeting us preventive service task force uspstf guidelines cervical colorectal breast cancer screening among chinese americans h3designh3 observational study chinese respondents 2007 california health interview survey populationbased survey interview languages included english cantonese mandarin h3settingh3 california usa h3participantsh3 chinese respondents agegender groupings appropriate uspstf cancer screening guidelines icervicali women ages 2165 n632 icolorectali men women ages 5075 n488 ibreasti women ages 5074 n326 h3outcomesh3 relationships tested using multivariable logistic regression models controlling healthcare access demographic factors including limited english proficiency lep combined effects lhl lep specifically examined lhl measured 2items perceived easeofuse written medical materials study variables selfreported h3resultsh3 cancer screening percentages among chinese americans 778 cervical 509 colorectal 479 women 542 men 855 breast lhl associated lower odds meeting breast cancer screening guidelines 041 95 ci 020 082 respondents lhl lep significantly less likely uptodate colorectal 049 95 ci 025 097 breast cancer screening 021 95 ci 008 054 neither health communication barrier multivariable models seen physician past year significant predictor uptodate screening h3conclusionsh3 chinese americans lhl lep negatively associated uptodate breast colorectal cancer screening independent recent physician visit efforts promote cancer screening among chinese americans consider address lhl lep physician access barriers

https://doi.org/10.1136/bmjopen-2014-005194

Margaret Curtin|Jamie M. Madden|Anthony Staines|Ivan J. Perry

Determinants of vulnerability in early childhood development in Ireland: a cross-sectional study

University College Cork|University College Cork|Dublin City University|University College Cork

h3objectivesh3 early childhood development strongly influences lifelong health early development instrument edi wellvalidated populationlevel measure five developmental domains physical health wellbeing social competence emotional maturity language cognitive skills communication skills general knowledge school entry age aim study explore potential edi indicator early development ireland h3designh3 crosssectional design used h3settingh3 study conducted 42 47 primary schools major irish urban centre h3participantsh3 edi teacher completed scores calculated 1243 children first year fulltime education contextual data subset 865 children collected using parental questionnaire h3primary secondary outcome measuresh3 children scoring lowest 10 population one domains deemed developmentally vulnerable scores correlated contextual data parental questionnaire h3resultsh3 sample population 29 children developmentally ready engage school factors associated increased risk vulnerability male 21 ci 16 27 5 years 15 ci 11 21 english second language 37 ci 26 52 adjusted demographics low birth weight poor parentchild interaction mother9s lower level education showed significant ors developmental vulnerability calculating population attributable fractions greatest populationlevel risk factors male 35 mother9s education 27 english second language 12 h3conclusionsh3 edi linked parental questionnaires promising indicators extent distribution determinants developmental vulnerability among children first year primary school ireland

https://doi.org/10.1136/sti.2010.043158

Dennis Matanda|Maurice B. Mittelmark|Helga Bjørnøy Urke|Dickson A Amugsi

Reliability of demographic and socioeconomic variables in predicting early initiation of breastfeeding: a replication analysis using the Kenya Demographic and Health Survey data

University of Bergen|University of Bergen|University of Bergen|University of Bergen

h3objectivesh3 examine reliability sociodemographic variables predicting initiation breastfeeding within hour birth earlybf using data 1998 2003 20082009 h3study designh3 replication analysis using kenya demographic health survey kdhs data collected 1998 2003 20082009 candidate predictor variables child9s gender home health facility place birth vaginal caesarean mode birth urban rural setting province residence wealth index maternal education occupation literacy media exposure h3settingh3 kenya h3participantsh3 6375 dyads mothers aged 1549 children aged 023 months 2125 dyads survey years h3resultsh3 mode birth province statistically significant predictors earlybf 1998 2003 20082009 children delivered caesarean section nonearlybf 1998 263 95 ci 172 404 2003 336 95 ci 183 616 2008 351 95 ci 217 569 true living western province 1998 267 95 ci 161 443 2003 492 95 ci 301 804 2008 607 95 ci 354 1039 h3conclusionsh3 1998 kdhs data provide basis reliable prediction earlybf reliability conceptualised replicability findings using highly similar data sets 2003 20082009 demographic socioeconomic variables unreliable predictors earlybf speculate activities parts kenya changed analysis context period 1998 20082009 changes sufficient magnitude affect relationships investigation degree general problem child health research known calling research investigate methodological issue health end points data

https://doi.org/10.1136/bmjopen-2016-013518

Sonali Wayal|Frances M. Cowan|Pamela Warner|Andrew Copas|David Mabey|Maryam Shahmanesh

Contraceptive practices, sexual and reproductive health needs of HIV-positive and negative female sex workers in Goa, India

Mortimer Market Centre|University College London|University of Edinburgh|University College London|London School of Hygiene & Tropical Medicine|Voluntary Health Association of Goa|University College London

h3objectivesh3 india female sex workers fsws suffer high hiv prevalence abortions contraceptive use among general population women well understood however fsws contraceptives practices reproductive health needs underresearched investigated contraceptive practices among hivpositive negative fsws goa india explored association sociodemographic sex work related factors h3methodsh3 crosssectional study using respondent driven sampling recruited 326 fsws completed intervieweradministered questionnaire screened stihiv multivariable logistic regression used explore factors associated sterilisation relative contraception h3resultsh3 hiv prevalence high 26 59 fsws planning pregnancy 33 hivpositive 57 igonorrhoeai ichlamydiai itrichomonasi 25 65 fsws screenedpositive isyphilisi iherpesi simplex virus type 2 antibodies respectively among 260 fsws analysed contraceptive use 39 use contraceptives 26 experienced abortion half fsws undergone sterilisation 5 used condoms contraception among hivpositive fsws 45 use contraceptives sterilisation independently associated older age illiteracy intimate nonpaying male partner children financial autonomy exposure national aids control organisation9s hivprevention interventions reported 34 fsws significantly associated contraceptive use adjusted odds ratio 14 95 ci 07 29 h3conclusionh3 hivprevention interventions promote contraception especially among young hivpositive fsws integrating hiv treatment care services hivprevention interventions vital avert hivpositive births

https://doi.org/10.1136/bmjopen-2017-016175

Joseph Tighe|Fiona Shand|Rebecca Ridani|Andrew Mackinnon|Nicole De La Mata|Helen Christensen

Ibobbly mobile health intervention for suicide prevention in Australian Indigenous youth: a pilot randomised controlled trial

Black Dog Institute|UNSW Sydney|Black Dog Institute|UNSW Sydney|Black Dog Institute|UNSW Sydney|Black Dog Institute|UNSW Sydney|UNSW Sydney|Black Dog Institute|UNSW Sydney

h3objectivesh3 rates youth suicide australian indigenous communities 4 times national youth average demand innovative interventions historical persistent disadvantage coupled multiple barriers help seeking mobile phone applications offer opportunity deliver therapeutic interventions directly individuals remote communities pilot study aimed evaluate effectiveness selfhelp mobile app ibobbly targeting suicidal ideation depression psychological distress impulsivity among indigenous youth remote australia h3settingh3 remote remote communities kimberley region north western australia h3participantsh3 indigenous australians aged 1835 years h3interventionsh3 61 participants recruited randomised receive either app ibobbly delivered acceptancebased therapy 6 weeks waitlisted 6 weeks received app following 6 weeks h3primary secondary outcome measuresh3 primary outcome depressive symptom inventorysuicidality subscale dsiss identify frequency intensity suicidal ideation previous weeks secondary outcomes patient health questionnaire 9 phq9 kessler psychological distress scale k10 barratt impulsivity scale bis11 h3resultsh3 although preintervention postintervention changes dsiss significant ibobbly arm t240 df581 p00195 differences significant compared waitlist arm t105 df578 p02962 however participants ibobbly group showed substantial statistically significant reductions phq9 k10 scores compared waitlist differences observed impulsivity waitlist participants improved 6 weeks app use h3conclusionsh3 apps suicide prevention reduce distress depression show significant reductions suicide ideation impulsivity feasible acceptable means lowering symptoms mental health disorders remote communities via appropriately designed selfhelp apps h3trial registration numberh3 actrn12613000104752

https://doi.org/10.1136/bmjopen-2016-013384

Shuhei Yoshida|Masato Matsushima|Hidetaka Wakabayashi|Rieko Mutai|Shinichi Murayama|Tetsuro Hayashi|Hiroko Ichikawa|Yuko Nakano|Takahiro Watanabe|Yasuki Fujinuma

Validity and reliability of the Patient Centred Assessment Method for patient complexity and relationship with hospital length of stay: a prospective cohort study

Ministry of Health Labour and Welfare|Jikei University School of Medicine|Centre for Family Medicine|Jikei University School of Medicine|Yokohama City University Medical Center|Yokohama City University|Jikei University School of Medicine|Jikei University School of Medicine|Ministry of Health Labour and Welfare|Jikei University School of Medicine|Tokyo Medical Center|National Hospital Organization|Jikei University School of Medicine|Tokyo Rinkai Hospital|Jikei University School of Medicine|Japan Small Animal Medical Center|Ministry of Health Labour and Welfare|Jikei University School of Medicine|Centre for Family Medicine|Ministry of Health Labour and Welfare|Chiba University|Centre for Family Medicine

h3objectivesh3 several instruments evaluating patient complexity developed biopsychosocial perspective although relationships results obtained instruments length stay hospital examined many instruments complicated easy use patient centred assessment method pcam candidate practical use study aimed test validity reliability pcam examine correlations length hospital stay pcam scores regional secondary care hospital japan h3designh3 prospective cohort study h3participants settingh3 two hundred one patients admitted ouji coop hospital july 2014 september 2014 h3main predictorh3 pcam total score initial phase hospital admission h3main outcomeh3 length stay hospital h3resultsh3 among 201 patients femalemale98103 mean sd age 774119 years mean pcam score 2573 mean sd length stay hospital los 341409 days using exploratory factor analysis examine construct validity pcam evidently twofactor structure comprising medicineoriented patientoriented complexity spearman rank correlation coefficient evaluating criterionbased validity pcam intermed 090 reliability cronbachs alpha 085 according negative binomial regression analyses pcam scores statistically significant predictor plt0001 los adjusting age gender mini nutritional assessment shortform charlson comorbidity index serum sodium concentration total number medications whether public assistance required another model factor pcam independently correlated length stay hospital adjustment medicineoriented complexity p0001 patientoriented complexity p0014 h3conclusionh3 pcam reliable valid measurement patient complexity pcam scores significant correlation hospital length stay

https://doi.org/10.1136/bmjopen-2014-005227

Liz Bickerdike|Alison L. Booth|Paul Wilson|Kate Farley|Kath Wright

Social prescribing: less rhetoric and more reality. A systematic review of the evidence

University of York|University of York|University of Manchester|University of Leeds|University of York

h3objectivesh3 social prescribing way linking patients primary care sources support within community help improve health wellbeing social prescribing programmes widely promoted adopted uk national health service conducted systematic review assess evidence effectiveness h3settingdata sourcesh3 nine databases searched 2000 january 2016 studies conducted uk relevant reports guidelines websites reference lists retrieved articles scanned identify additional studies searches restricted english language h3participantsh3 systematic reviews published evaluation programmes patient referral made primary care setting link worker facilitator social prescribing eligible inclusion risk bias included studies undertaken independently two reviewers narrative synthesis performed h3primary secondary outcome measuresh3 primary outcomes interest measures health wellbeing andor usage health services h3resultsh3 included total 15 evaluations social prescribing programmes small scale limited poor design reporting rated high risk bias common design issues included lack comparative controls short followup durations lack standardised validated measuring tools missing data failure consider potential confounding factors despite clear methodological shortcomings evaluations presented positive conclusions h3conclusionsh3 social prescribing widely advocated implemented current evidence fails provide sufficient detail judge either success value money social prescribing realise potential future evaluations must comparative design consider well cost h3trial registration numberh3 prospero registration crd42015023501

https://doi.org/10.1136/bmjopen-2013-002976

Aliasghar Ahmad Kiadaliri|Soheil Saadat|Hossein Shahnavazi|Hassan Haghparast?Bidgoli

Overall, gender and social inequalities in suicide mortality in Iran, 2006-2010: a time trend province-level study

Lund University|Kerman University of Medical Sciences|Institute for Futures Studies|Sina Hospital|Tehran University of Medical Sciences|Iranian Legal Medicine Organization|University College London

h3objectivesh3 suicide major global health problem imposing considerable burden populations terms disabilityadjusted life years increasing trend fatal attempted suicide iran past decades aim current study assess overall gender social inequalities across irans provinces 20062010 h3designh3 ecological study h3settingh3 data distribution population provinces obtained statistical centre iran data annual number deaths caused suicide province gathered iranian forensic medicine organization h3methodsh3 suicide mortality rate per 100 000 population calculated human development index used provinces social rank gini coefficient rate ratio kunst mackenbach relative index inequality used assess overall gender social inequalities respectively annual percentage change calculated using joinpoint regression h3resultsh3 suicide mortality slightly increased iran 20062010 substantial constant overall inequality across country study period maletofemale rate ratio 234 95 ci 145 379 period social inequalities suicide mortality favour people betteroff provinces addition increasing trend social disparities time although statistically significant h3conclusionsh3 found substantial overall gender social disparities distribution suicide mortality across provinces iran findings showed men provinces low socioeconomic status higher risk suicide mortality analyses needed explain disparities

https://doi.org/10.1136/bmjopen-2016-011077

Abhinav Vaidya|Umesh Raj Aryal|Alexandra Krettek

Cardiovascular health knowledge, attitude and practice/behaviour in an urbanising community of Nepal: a population-based cross-sectional study from Jhaukhel-Duwakot Health Demographic Surveillance Site

Nordic School of Public Health|Kathmandu Medical College Teaching Hospital|Nordic School of Public Health|Kathmandu Medical College Teaching Hospital|Nordic School of Public Health|University of Gothenburg

h3objectivesh3 study determined knowledge attitude practicebehaviour cardiovascular health residents semiurban community nepal h3designh3 increase understanding knowledge attitude practicebehaviour towards cardiovascular health conducted inhome interviews using questionnaire based stepwise approach surveillance resources scoring responses also recorded blood pressure took anthropometric measurements h3settingh3 study conducted part hearthealthassociated research dissemination community project jhaukhelduwakot health demographic surveillance site two urbanising villages near kathmandu h3participantsh3 study population included 777 respondents six randomly selected clusters villages h3resultsh3 seventy per cent participants women 269 lacked formal education burden cardiovascular risk factors high 201 current smokers 433 exhibited low physical activity 216 hypertensive participants showed poor knowledge heart disease causes 297 identified hypertension 11 identified overweight physical activity causes whereas 22 identified high blood sugar causative around 60 respondents know heart attack symptoms compared 20 knew 24 symptoms median percentage scores knowledge attitude practicebehaviour 793 743 48 respectively nearly 44 respondents insufficient knowledge less 20 highly satisfactory knowledge among highly satisfactory knowledge 147 highly satisfactory attitude 195 139 satisfactory highly satisfactory practices respectively h3conclusionsh3 study demonstrates gap cardiovascular health knowledge attitude practicebehaviour semiurban community lowincome nation even among already affected cardiovascular disease

https://doi.org/10.1136/bmjopen-2015-009627

Lulu Qin|Huilan Xu

A cross-sectional study of the effect of health literacy on diabetes prevention and control among elderly individuals with prediabetes in rural China

Central South University|Central South University

h3objectivesh3 study designed examine effect health literacy diabetes prevention control risk factors low diabetes health literacy among elderly individuals prediabetes rural areas china h3design setting participatesh3 crosssectional survey conducted among elderly individuals rural communities yiyang city china multistaged cluster random sampling used select 42 areas 434 individuals prediabetes interviewed using questionnaire diabetes health literacy china h3main outcome measuresh3 participants asked general information age gender marital status history hyperglycaemia family history diabetes mellitus presence diseases level education binary logistic regression analysis used identify risk factors poor health literacy concerning diabetes prevention control among elderly subjects prediabetes h3resultsh3 median health literacy score diabetes prevention prediabetes control 100 iqr 70130 level diabetes health literacy among men lower among women 2831 95 ci 1818 4408 lower among respondents 16 years education among 6 years education 14274 95 ci 5927 34375 less 1 year education lowest literacy 31148 95 ci 11661 83204 level diabetes health literacy among elderly individuals prediabetes history hyperglycaemia lower among history hyperglycaemia 2676 95 ci 1101 6504 h3conclusionsh3 health literacy concerning diabetes prevention control among elderly individuals prediabetes low rural china appropriate health education elderly individuals low educational levels incorporated diabetes prevention efforts h3trial registration numberh3 chictrior15007033 results

https://doi.org/10.1136/annrheumdis-2011-201142

Karina Friis|Mathias Lasgaard|Richard H. Osborne|Helle Terkildsen Maindal

Gaps in understanding health and engagement with healthcare providers across common long-term conditions: a population survey of health literacy in 29 473 Danish citizens

Central Denmark Region|University of Southern Denmark|Central Denmark Region|Deakin University|Health Strat (Kenya)|Aarhus University

h3objectivesh3 1 quantify levels subjective health literacy people longterm health conditions diabetes cardiovascular disease chronic obstructive pulmonary disease musculoskeletal disorders cancer mental disorders compare levels general population 2 examine association health literacy socioeconomic characteristics comorbidity longterm condition group h3designh3 populationbased survey central denmark region n29 473 h3main outcome measuresh3 health literacy measured using two scales health literacy questionnaire hlq 1 ability understand health information 2 ability actively engage healthcare providers h3resultsh3 people longterm conditions reported difficulties general population understanding health information actively engaging healthcare providers wide variation found disease groups people cancer fewer difficulties people mental health disorders difficulties actively engaging healthcare providers longterm condition groups one longterm condition associated difficulty engaging healthcare providers understanding health information people low levels education lower health literacy people high levels education h3conclusionsh3 compared general population people longterm conditions report difficulties understanding health information engaging healthcare providers two dimensions critical provision patientcentred healthcare optimising health outcomes effort made respond health literacy needs among individuals longterm conditions multiple comorbidities low education levels improve health outcomes reduce social inequality health

https://doi.org/10.1136/sextrans-2011-050276

Nasim A. Khan|Horace J. Spencer|Essam A. Abda|Rieke Alten|Christof Pohl|Codrina Ancu?a|Massimiliano Cazzato|Pál Géher|Laure Gossec|Dan Henrohn|Merete Lund Hetland|Nevsun ?nanç|Johannes W. G. Jacobs|Eduardo Kerzberg|Maria Majdan|Omondi Oyoo|Ruben Peredo-Wende|Zahraa I. Selim|Fotini N. Skopouli|Alberto Sulli|Kim Hørslev?Petersen|Peter Taylor|Tuulikki Sokka

Patient's global assessment of disease activity and patient's assessment of general health for rheumatoid arthritis activity assessment: are they equivalent?

University of Arkansas for Medical Sciences|University of Arkansas for Medical Sciences|Assiut University|Schlosspark-Klinik|Charité - Universitätsmedizin Berlin|Schlosspark-Klinik|Charité - Universitätsmedizin Berlin|Grigore T. Popa University of Medicine and Pharmacy|University of Pisa|Semmelweis University|Université Paris Cité|Délégation Paris 5|Hôpital Cochin|Assistance Publique – Hôpitaux de Paris|Uppsala University|Glostrup Hospital|Copenhagen University Hospital|Marmara University|University Medical Center Utrecht|University of Buenos Aires|Medical University of Lublin|Kenyatta University|University of Nairobi|Michigan Medicine|Sohag University|Athens Euroclinic|Harokopio University of Athens|University of Genoa|University of Southern Denmark|Nuffield Orthopaedic Centre|University of Oxford|Central Finland Health Care District

h3objectivesh3 assess determinants patient9s global assessment disease activity ptgl patient9s assessment general health gh scores rheumatoid arthritis ra patients b whether equivalent individual variables c whether may used interchangeably calculating common ra activity assessment composite indices h3methodsh3 data 7023 patients 30 countries quantitative standard monitoring patients ra questra analysed ptgl gh determinants assessed mixedeffects analyses covariance models ptgl gh equivalence determined blandaltman 95 limits agreement baloa lin9s coefficient concordance lcc concordance ptgl gh based disease activity score 28 das28 clinical disease activity index cdai routine assessment patient index data 3 rapid3 indices calculated using lcc level agreement classifying ra activity four states remission low moderate high using statistics h3resultsh3 significant differences relative absolute contribution ra nonra related variables ptgl gh ratings noted lcc 064 baloa 441 454 showed ptgl gh equivalent excellent concordance lcc 095099 ptgl gh based das28 cdai rapid3 indices gt80 absolute agreement statistics 075084 ra activity state classification three indices h3conclusionsh3 ptgl gh ratings differ determinants although individually equivalent may used interchangeably calculating composite indices ra activity assessment

https://doi.org/10.1001/archpediatrics.2009.269

Béa Vuylsteke|Gisèle Semdé|Lazare Sika|Tania Crucitti|Virginie Ettiègne Traoré|Anne Buvé|Marie Laga

High prevalence of HIV and sexually transmitted infections among male sex workers in Abidjan, Côte d'Ivoire: need for services tailored to their needs

Instituut voor Tropische Geneeskunde|Institut Universitaire d'Abidjan|Instituut voor Tropische Geneeskunde|Instituut voor Tropische Geneeskunde|Instituut voor Tropische Geneeskunde

h3objectivesh3 assess condom use prevalence sexually transmitted infections sti hiv among male sex workers msw abidjan cte d9ivoire h3methodsh3 crosssectional survey conducted october 2007 january 2008 among msw attending sex worker clinic abidjan short questionnaire administered facetoface interview participants asked provide urine sample sti testing selfcollect transudate gingival mucosa anonymous hiv testing using rapid test rectal swab sti testing taken physician molecular amplification assays performed detection ichlamydia trachomatisi ineisseria gonorrhoeaei itrichomonas vaginalisi h3resultsh3 96 msw participated survey median age 27 years median duration sex work 5 years consistent condom use clients last working day 860 consistent condom use regular partner last week 816 hiv infection detected 500 participants prevalence gonorrhoeaei 128 chlamydia infection present 32 itiivaginalisi 21 study participants h3conclusionsh3 hiv sti rates found study confirm high risk vulnerability status msw cte d9ivoire definite need studies exploring risk risk perceptions among msw depth services tailored needs including developing validating simple algorithms diagnosis sti msw men sex men

https://doi.org/10.1136/sti.2010.043422

H. Shonna Yin|Alan L. Mendelsohn|Michael S. Wolf|Ruth M. Parker|Arthur H. Fierman|Linda van Schaick|Isabel Bazán|Matthew D. Kline|Benard P. Dreyer

Parents' Medication Administration Errors

h3objectivesh3 assess parents liquid medication administration errors dosing instrument type examine degree parents health literacy influences dosing accuracy h3designh3 experimental study h3settingh3 interviews conducted public hospital pediatric clinic new york new york october 28 2008 december 24 2008 h3participantsh3 three hundred two parents children presenting care enrolled h3main outcome measuresh3 parents observed dosing accuracy 5ml dose using set standardized instruments 2 dosing cups one printed calibration markings etched markings dropper dosing spoon 2 oral syringes one without bottle adapter h3resultsh3 percentages parents dosing accurately within 20 recommended dose 305 using cup printed markings 502 using cup etched markings 85 dosed accurately remaining instruments large dosing errors gt40 deviation made 258 parents using cup printed markings 233 parents using cup etched markings adjusted analyses cups associated increased odds making dosing error gt20 deviation compared oral syringe cup printed markings adjusted odds ratio aor 267 95 confidence interval ci 168424 cup etched markings aor 110 95 ci 72168 compared oral syringe cups also associated increased odds making large dosing errors cup printed markings aor 73 95 ci 41132 cup etched markings aor 63 95 ci 35112 limited health literacy associated making dosing error aor 17 95 ci 1128 h3conclusionsh3 dosing errors parents highly prevalent cups compared droppers spoons syringes strategies reduce errors address accurate use dosing instruments health literacy

https://doi.org/10.1136/bmjopen-2014-006804

John Richens|Andrew Copas|S Tariq Sadiq|Patricia Kingori|Ona McCarthy|Victoria Jones|P Hay|Kevin Miles|Richard Gilson|John Imrie|Mark Pakianathan

A randomised controlled trial of computer-assisted interviewing in sexual health clinics

Mortimer Market Centre|University College London|St George's, University of London|South West London and St George's Mental Health NHS Trust|St George’s University Hospitals NHS Foundation Trust|London School of Hygiene & Tropical Medicine|University College London|University College London|St George's, University of London|South West London and St George's Mental Health NHS Trust|St George’s University Hospitals NHS Foundation Trust|St Pancras Hospital|University College London|St Pancras Hospital|National Centre for Clinical Research on Emerging Drugs|UNSW Sydney|South West London and St George's Mental Health NHS Trust|St George’s University Hospitals NHS Foundation Trust

h3objectivesh3 assess impact computerassisted interview compared pen paper disclosure sexual behaviour diagnostic testing clinicians infections diagnosed referral counselling h3methodsh3 twocentre parallel threearm randomised controlled open trial computergenerated randomisation allocation concealment using sealed envelopes h3settingh3 two london teaching hospital sexual health clinics h3participantsh3 2351 clinic attenders age 16 years h3interventionsh3 computerassisted selfinterview casi computerassisted personal interview capi pen paper interview papi h3main outcome measuresh3 diagnostic tests ordered sexually transmitted infections sti h3secondary outcomesh3 disclosure sexual risk referral counselling h3resultsh3 801 763 787 patients randomly allocated receive casi capi papi 795 744 779 available intentiontotreat analysis significantly diagnostic testing hepatitis b c rectal samples capi arm odds testing relative papi 132 95 ci 109 159 pattern seen among casi patients hiv testing significantly lower among casi patients odds less testing relative papi 073 95 ci 059 090 sti diagnoses significantly different trial arm summary measure seven prespecified sensitive behaviours found greater reporting casi 14 95 ci 12 16 capi 14 95 ci 12 17 compared papi h3conclusionh3 casi capi generate greater recording risky behaviour traditional papi increased disclosure increase sti diagnoses safeguards may needed ensure clinicians prompted act upon disclosures made selfinterview h3trial registrationh3 isrctn 97674664

https://doi.org/10.1001/archpedi.160.4.369

Omar Ali Aboshady|A. E. Radwan|Asmaa Eltaweel|Ahmed Y Azzam|Amr A. Aboelnaga|Abdul Hanan|Shereen Darwish|Rehab Salah|O. N. Kotb|Ahmed M. Afifi|Areej Muthana Noaman|Dorria Salem|Amira Hassouna

Perception and use of massive open online courses among medical students in a developing country: multicentre cross-sectional study

Menoufia University|Menoufia University|Alexandria University|Al Azhar University|Tanta University|Beni-Suef University|Suez Canal University|Benha University|Assiut University|Ain Shams University|Cairo University|Cairo University|Ain Shams University

h3objectivesh3 assess prevalence awareness use massive open online courses moocs among medical undergraduates egypt developing country well identifying limitations satisfaction using courses h3designh3 multicentre crosssectional study using webbased pilottested selfadministered questionnaire h3settingsh3 ten 19 randomly selected medical schools egypt h3participantsh3 2700 undergraduate medical students randomly selected equal allocation participants university study year h3primary secondary outcome measuresh3 primary outcome measures percentages students knew moocs students enrolled students obtained certificate secondary outcome measures included limitations satisfaction using moocs fivepoint likert scale questions h3resultsh3 2527 eligible students 2106 completed questionnaire response rate 833 students 456 217 knew term moocs websites providing courses latter 136 298 students enrolled least one course 25 184 completed courses earning certificates clinical year students showed significantly higher rates knowledge p0009 enrolment plt0001 academic year students primary reasons failure completion courses included lack time 105 772 slow internet speed 73 537 regarding 25 students completed courses 21 84 satisfied overall experience however less satisfaction regarding studentinstructor 8 32 studentstudent 5 20 interactions h3conclusionsh3 onefifth egyptian medical undergraduates heard moocs 65 actively enrolled courses students actively participated showed positive attitude towards experience better timemanagement skills faster internet connection speeds required studies needed survey enrolled students better understanding experience

https://doi.org/10.1001/archopht.122.4.477

Brian A. Primack|Melanie A. Gold|Galen E. Switzer|Renée Hobbs|Stephanie R. Land|Michael J. Fine

Development and Validation of a Smoking Media Literacy Scale for Adolescents

h3objectivesh3 develop smoking media literacy sml scale using empiric survey data large sample high school students assess reliability criterion validity scale h3designh3 basis established theoretical framework 120 potential items generated items eliminated altered basis input experts students crosssectional responses scale items demographics smokingrelated variables multiple covariates obtained refine scale determine reliability validity h3settingh3 one large pittsburgh pa high school h3participantsh3 total 1211 high school students aged 14 18 years h3main outcome measuresh3 current smoking susceptibility smoking attitudes toward smoking smoking norms h3resultsh3 factor analysis demonstrated strong 1factor scale 18 items 087 controlling covariate data sml statistically significant independent association current smoking ipi 01 susceptibility ipilt001 attitudes ipilt001 norms ipi 42 controlling covariates increase 1 point 10point sml scale associated 22 decrease odds smoker 31 decrease odds susceptible smoking h3conclusionsh3 smoking media literacy measured excellent reliability concurrent criterion validity given independent association sml smoking media literacy may promising tool future tobacco control interventions

https://doi.org/10.1136/bmjopen-2015-010434

Nathan Congdon|Benita J O'Colmain|Caroline C.W. Klaver|Ronald Klein|Beatriz Muñoz|David S. Friedman|John H. Kempen|Hugh R. Taylor|Paul Mitchell

Causes and Prevalence of Visual Impairment Among Adults in the UnitedStates

h3objectivesh3 estimate causespecific prevalence distribution blindness low vision united states age raceethnicity gender estimate change prevalence figures next 20 years h3methodsh3 summary prevalence estimates blindness according us definition 660 20200 bestcorrected visual acuity betterseeing eye world health organization standard lt6120 lt20400 low vision lt612 lt2040 bestcorrected vision betterseeing eye prepared separately black hispanic white persons 5year age intervals starting 40 years estimated prevalences based recent populationbased studies united states australia europe estimates applied 2000 us census data projected us population figures 2020 estimate number americans visual impairment causespecific prevalences blindness low vision also estimated different racialethnic groups h3resultsh3 based demographics 2000 us census estimated 937 000 078 americans older 40 years blind us definition additional 24 million americans 198 low vision leading cause blindness among white persons agerelated macular degeneration 544 cases among black persons cataract glaucoma accounted 60 blindness cataract leading cause low vision responsible approximately 50 bilateral vision worse 612 2040 among white black hispanic persons number blind persons us projected increase 70 16 million 2020 similar rise projected low vision h3conclusionsh3 blindness low vision affects approximately 1 28 americans older 40 years specific causes visual impairment especially blindness vary greatly raceethnicity prevalence visual disabilities increase markedly next 20 years owing largely aging us population

https://doi.org/10.1136/bmjqs-2013-002172

Alison Bruce|Lesley Fairley|Bette Chambers|John Wright|Trevor Sheldon

Impact of visual acuity on developing literacy at age 4–5 years: a cohort-nested cross-sectional study

University of Bradford|University of York|University of Bradford|University of Leeds|University of York|University of Bradford|Hull York Medical School|University of York

h3objectivesh3 estimate prevalence poor vision children aged 45 years determine impact visual acuity literacy h3designh3 crosssectional study linking clinical epidemiological education data h3settingh3 schools located city bradford uk h3participantsh3 prevalence determined 11 186 children participating bradford school vision screening programme data linkage undertaken 5836 born bradford bib birth cohort study children participating bradford vision screening programme bib starting schools programme 2025 children complete data included multivariable analyses h3main outcome measuresh3 visual acuity measured using logmar crowded test higher scorespoorer visual acuity literacy measured woodcock reading mastery testsrevised wrmtr subtest letter identification standardised h3resultsh3 mean sd presenting visual acuity 014 009 logmar range 0010 9 children presenting visual acuity worse 02logmar failed vision screening 4 worse 03logmar poor visual acuity 2 worse 04logmar visually impaired unadjusted analysis showed literacy score associated presenting visual acuity reducing 24 points every 1 line 010logmar reduction vision 95 ci 30 19 association presenting visual acuity literacy score remained significant adjustment demographic socioeconomic factors reducing 17 points 95 ci 22 11 every 1 line reduction vision h3conclusionsh3 prevalence decreased visual acuity high compared populationbased studies decreased visual acuity school entry associated reduced literacy may important implications children9s future educational health social outcomes

https://doi.org/10.1136/bmjopen-2013-004180

George Liu|Weiwei Liu|Yuanyuan Wang|Zhihong Zhang|Peng Wang

Patient safety culture in China: a case study in an outpatient setting in Beijing

La Trobe University|Peking University|Peking University Third Hospital|Peking University|Peking University Third Hospital|Peking University|Peking University Third Hospital|Peking University|Peking University Third Hospital

h3objectivesh3 investigate patient safety culture outpatient setting beijing explore meaning implications safety culture perspective health workers patients h3methodsh3 mixed methods approach involving questionnaire survey indepth interviews adopted among 410 invited staff members 318 completed hospital survey patient safety culture hsopc patient safety culture described using 12 subscale scores intersubscale correlation analysis anova stepwise multivariate regression analyses performed identify determinants patient safety culture scores interviewees included 22 patients selected opportunity sampling 27 staff members selected purposive sampling interview data analysed thematically h3resultsh3 survey respondents perceived high levels unsafe care personally reported events lack communication openness identified major safety culture problem perception penalty greatest barrier encouragement error reporting cohesive teamwork within units found area strength conversely served protective defensive mechanism medical practice low levels trust providers consumers lack management support constituted obstacle building positive patient safety culture h3conclusionsh3 study china demonstrates punitive approach error still widespread despite increasing awareness unsafe care managers slow acknowledging importance building positive patient safety culture strong teamwork within units common area strength could fuel concealment errors

https://doi.org/10.1370/afm.2309

Jonas Gordilho Souza|Daniel Apolinário|Regina Miksian Magaldi|Alexandre Leopold Busse|Flávia Campora|Wilson Jacob?Filho

Functional health literacy and glycaemic control in older adults with type 2 diabetes: a cross-sectional study

Universidade de São Paulo|Universidade de São Paulo|Universidade de São Paulo|Universidade de São Paulo|Universidade de São Paulo|Universidade de São Paulo

h3objectivesh3 investigate relationship functional health literacy glycaemic control sample older patients type 2 diabetes h3designh3 crosssectional study h3settingh3 governmentfinanced outpatient geriatric clinic paulo brazil h3participantsh3 129 older patients type 2 diabetes mean sd age 759 62 years mean glycosylated haemoglobin hba1c 72 14 147 formal education 829 less highschool diploma h3measuresh3 hba1c used measure glycaemic control functional health literacy assessed 18item short assessment health literacy portuguesespeaking adults sahlpa18 validated instrument evaluate pronunciation comprehension commonly used medical terms regression models controlled demographic data depressive symptoms diabetes duration treatment regimen diabetes knowledge assistance taking medications h3resultsh3 functional health literacy adequate encountered 566 sample controlling potential confounding factors patients inadequate functional health literacy likely patients adequate functional health literacy present poor glycaemic control or476 95 ci 136 1663 fully adjusted linear regression model lower functional health literacy 042 plt0001 longer diabetes duration 024 p0012 lack assistance taking medications 023 p0014 associated higher levels hba1c contrary expectations illiterate patients poorer outcomes compared patients adequate functional health literacy raising hypothesis illiterate individuals likely difficulties recognised compensated however small subsample illiterate patients provided limited power reject differences small magnitude h3conclusionsh3 patients inadequate functional health literacy presented higher odds poor glycaemic control findings reinforce importance addressing limited functional health literacy clinical practice

https://doi.org/10.1370/afm.1381

Nancy L. Schoenborn|Ellen Janssen|Cynthia M. Boyd|John F.P. Bridges|Antonio C. Wolff|Xue Qin|Craig Evan Pollack

Older Adults’ Preferences for Discussing Long-Term Life Expectancy: Results From a National Survey

Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins University|The Ohio State University|Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University|Johns Hopkins Medicine|Johns Hopkins University

h3purposeh3 clinical practice guidelines recommend incorporating longterm life expectancy inform number decisions primary care aimed examine older adults preferences discussing life expectancy national sample h3methodsh3 invited 1272 older adults aged 65 older national probabilitybased online panel participate 2016 presented hypothetical patient limited life expectancy imminently dying asked participants patient whether would like talk doctor long may live whether acceptable doctor offer discussion whether want doctor discuss life expectancy family friends discussed h3resultsh3 878 participants 690 participation rate mean age 734 years majority 594 want discuss long might live presented scenario within group 599 also think doctor offer discussion 877 also want doctor discuss life expectancy family friends fully 558 wanted discuss life expectancy less 2 years factors positively associated wanting discussion included higher educational level believing doctors accurately predict life expectancy past experience either lifethreatening illness discussed life expectancy loved one reporting religion important negatively associated h3conclusionsh3 majority older adults wish discuss life expectancy depicted hypothetical patient limited life expectancy many also want offered discussion raising dilemma clinicians may identify patients preferences regarding sensitive topic

https://doi.org/10.1370/afm.1982

Muriel Jean?Jacques|Erin O. Kaleba|John Gatta|Gauthier Gracia|E. R. Ryan|Bechara Choucair

Program to Improve Colorectal Cancer Screening in a Low-Income, Racially Diverse Population: A Randomized Controlled Trial

Northwestern University|Illinois Department of Human Services|Northwestern University|Health Research and Educational Trust|Northwestern University|Chicago Department of Public Health|Northwestern University

h3purposeh3 effective strategies needed improve rates colorectal cancer screening particularly among poor racial ethnic minorities individuals limited english proficiency examined whether direct mailing fecal occult blood testing fobt kits patients overdue screening effective way improve screening population h3methodsh3 adults aged 50 80 years documentation date colorectal cancer screening december 31 2009 least 2 visits community health center prior 18 months randomized outreach intervention usual care patients outreach group mailed colorectal cancer fact sheet fobt kit patients usual care group could referred screening usual clinician visits primary outcome completion colorectal cancer screening fobt sigmoidoscopy colonoscopy 4 months initiation outreach protocol outcome measures compared using fisher exact test h3resultsh3 analyses based 104 patients assigned outreach intervention 98 patients assigned usual care 30 patients outreach group completed colorectal cancer screening study period compared 5 patients usual care group ipi lt001 nearly screenings fobt groups differ significantly respect percentage patients making clinician visit percentage clinician placed order screening test h3conclusionsh3 mailing fobt kits directly patients efficacious promoting colorectal cancer screening among population high levels poverty limited english proficiency racial ethnic diversity nonvisitbased outreach patients may important strategy address suboptimal rates colorectal cancer screening among populations risk screened

https://doi.org/10.1136/adc.2009.179747

Shrikant Patil|Todd Ruppar|Richelle J. Koopman|Erik Lindbloom|Steven Elliott|David R. Mehr|Vicki S. Conn

Peer Support Interventions for Adults With Diabetes: A Meta-Analysis of Hemoglobin A1c Outcomes

University of Missouri|University of Missouri|University of Missouri|University of Missouri|University of Missouri|University of Missouri|University of Missouri

h3purposeh3 peer support intervention trials shown varying effects glycemic control aimed estimate effect peer support interventions delivered people affected diabetes disease caregiver hemoglobin asub1csub hbasub1csub levels adults h3methodsh3 searched multiple databases 1960 november 2015 including ovid medline cochrane central register controlled trials cinahl scopus included randomized controlled trials rcts adults diabetes receiving peer support interventions compared otherwise similar care seventeen 205 retrieved studies eligible inclusion quality assessed cochrane risk bias tool calculated standardized mean difference smd change hbasub1csub level baseline groups using random effects model subgroup analyses predefined h3resultsh3 seventeen studies 3 cluster rcts 14 rcts 4715 participants showed improvement pooled hbasub1csub level smd 0121 95 ci 00260217 ipi 01 isup2sup 6066 peer support intervention group compared control group difference translated improvement hbasub1csub level 024 95 ci 005043 peer support interventions showed hbasub1csub improvement 048 95 ci 025070 ipi lt001 isup2sup 1712 subset studies predominantly hispanic participants 053 95 ci 032073 ipi lt001 isup2sup 924 subset studies predominantly minority participants clinically relevant sensitivity analysis excluding cluster rcts overall effect size changed little h3conclusionsh3 peer support interventions diabetes overall achieved statistically significant minor improvement hbasub1csub levels interventions may however particularly effective improving glycemic control people minority groups especially hispanic ethnicity

https://doi.org/10.1016/j.jhsa.2016.07.096

Dorothy V. M. Bishop|Patricia A. Jacobs|Katherine Lachlan|Diana Wellesley|Angela Barnicoat|Patricia A. Boyd|Alan Fryer|Prisca Middlemiss|Sarah Smithson|Kay Metcalfe|D. Shears|Victoria Leggett|Kate Nation|Gaia Scerif

Autism, language and communication in children with sex chromosome trisomies

University of Oxford|Wessex Regional Genetics Laboratory|University of Southampton|University of Southampton|Great Ormond Street Hospital|University College London|University of Oxford|Royal Liverpool University Hospital|University of Liverpool|St. Mary's Hospital|St Mary's Hospital|Churchill Hospital|University of Oxford|University of Oxford|University of Oxford

h3purposeh3 sex chromosome trisomies scts found amniocentesis 2337 per 1000 samesex births yet limited database base prognosis autism described postnatally diagnosed cases klinefelter syndrome xxy karyotype prevalence nonreferred samples trisomies unclear authors recruited largest sample including three scts reported date including children identified prenatal screening clarify issue h3designh3 parents children sct recruited either via prenatal screening via parental support group give sample 58 xxx 19 xxy 58 xyy cases parents interviewed using vineland adaptive behavior scales completed questionnaires communicative development children scts siblings 42 brothers 26 sisters h3resultsh3 rates language communication problems high three trisomies diagnoses autism spectrum disorder asd found 219 cases xxy 11 1158 xyy 19 excluding asd diagnosis communicative profiles indicative mild autistic features common although wide individual variation h3conclusionsh3 autistic features previously remarked upon studies nonreferred samples scts yet rate substantially population levels sample even attention restricted earlyidentified cases authors hypothesise xlinked ylinked neuroligins may play significant role aetiology communication impairments asd

https://doi.org/10.1016/j.ophtha.2012.02.029

Agnes Z. Dardas|Christopher Stockburger|Sean Boone|Tonya An|Ryan P. Calfee

Preferences for Shared Decision Making in Older Adult Patients With Orthopedic Hand Conditions

Washington University in St. Louis|Washington University in St. Louis|Washington University in St. Louis|Washington University in St. Louis|Washington University in St. Louis

h3purposeh3 practice medicine shifting paternalistic doctorpatient relationship model doctor patient collaborate decide optimal treatment study aims determine whether older orthopedic population desires shared decisionmaking approach care identify patient predictors preferred type approach h3methodsh3 crosssectional investigation enrolled 99 patients minimum age 65 years tertiary hand specialty practice march june 2015 patients completed control preferences scale validated system distinguishes among patient preferences patientdirected collaborative physiciandirected decision making bivariate logistic regression analyses assessed associations among demographic data clinic encounter variables familiarity provider trauma diagnosis treatment decision primary outcome control preferences scale preferences h3resultsh3 total 81 patients analyzed preferred patientdirected role decision making 46 total cohort cited collaborative approach preferred treatment approach sixtyseven percent cited physiciandirected approach least preferred model decision making addition 49 reported spending time physician address questions explain diagnosis would useful making health care decision 73 preferred additional written informational material familiarity provider associated likely prefer collaborative approach h3conclusionsh3 older adult patients symptomatic upperextremity conditions desire patientdirected roles treatment decision making given limited amount reliable information obtained independently outside office visit data suggest written decision aids offer approach shared decision making consistent preferences older orthopedic patient h3clinical relevanceh3 study quantifies older adults desire participate decision making choosing among treatments hand conditions

https://doi.org/10.1016/j.annemergmed.2019.06.008

Lauren Patty|Cathy Wu|Mina Torres|Stanley P. Azen|Rohit Varma

Validity of Self-reported Eye Disease and Treatment in a Population-based Study: The Los Angeles Latino Eye Study

University of Southern California|Doheny Eye Institute|University of Southern California|Doheny Eye Institute|University of Southern California|Doheny Eye Institute|University of Southern California|University of Southern California|Doheny Eye Institute

h3purposeh3 examine validity selfreported eye disease including cataract agerelated macular degeneration amd glaucoma diabetic retinopathy dr selfreported surgical treatment cataract dr los angeles latino eye study lales h3designh3 populationbased crosssectional study h3participantsh3 total 6357 latinos aged 40 years lales h3methodsh3 participants underwent detailed interview including survey questions ocular health diagnoses timing last eye examination standardized clinical examination selfreport compared examination determine sensitivity specificity length time since last eye examination stepwise logistic regression used determine factors associated inaccurate selfreport h3main outcome measuresh3 sensitivity specificity calculated 4 selfreported eye diseases cataract amd glaucoma dr surgical treatment cataract dr odds ratios ors determined factors associated inaccurate selfreport underestimating eye disease treatment h3resultsh3 disease sensitivity specificity reported last eye examination 1 year ago 368 925 cataract 377 963 glaucoma 51 989 amd 257 942 dr respectively selfreport less accurate increasing time since last eye examination inaccurate selfreport independently associated better visual acuity 24 2 comorbidities 17 last eye examinationvisit 1 5 years ago 5 years ago 23 49 respectively less education 13 712 years 17 7 years 88 participants surgically treated cataract reported eye examination 1 year ago sensitivity specificity selfreported surgical history 909 999 respectively 31 participants treated dr lasersurgery reporting eye examination 1 year ago sensitivity specificity selfreported surgical history 194 996 respectively h3conclusionsh3 among latinos selfreporting eye disease surgical history provides significant underestimate disease burden may lead significant misclassification vision research selfreport alone used identify persons eye disease h3financial disclosuresh3 authors proprietary commercial interest materials discussed article

https://doi.org/10.1136/bmj.329.7475.1142

Amber Hoek|Susanne C.P. Anker|Ed F. van Beeck|Alex Burdorf|Pleunie P.M. Rood|Juanita A. Haagsma

Patient Discharge Instructions in the Emergency Department and Their Effects on Comprehension and Recall of Discharge Instructions: A Systematic Review and Meta-analysis

Erasmus MC|Erasmus MC|Erasmus MC|Erasmus MC

h3study objectiveh3 conduct systematic review metaanalysis provide overview different manners providing discharge instructions emergency department ed assess effects comprehension recall 4 domains discharge instructions diagnosis treatment followup return instructions h3methodsh3 performed systematic search pubmed embase web science google scholar cochrane databases studies published march 15 2018 quality assessment included articles performed pooled proportions correct recall manner providing discharge instructions calculated h3resultsh3 total 1842 articles screened selection 51 articles included 51 included studies 12 used verbal discharge instructions 30 used written discharge instructions 7 used video correct recall verbal written video discharge instructions ranged 8 94 23 92 54 89 respectively metaanalysis performed data 1460 patients received verbal information 3395 patients received written information 459 patients received video information pooled data showed differences correct recall average 47 patients received verbal information 95 confidence interval 322 617 58 patients received written information 95 confidence interval 442 712 67 patients received video information 95 confidence interval 579 757 h3conclusionh3 communicating discharge instructions verbally patients ed may sufficient although overall correct recall significantly higher adding video written information discharge instructions showed promising results ed patients

https://doi.org/10.1136/bmj.331.7511.281

Hamish Fraser|Darius Jazayeri|Patrice Nevil|Yusuf Karacaoglu|Paul Farmer|Evan Lyon|Mary Kay C Smith Fawzi|Fernet Léandre|Sharon Choi|Joia Mukherjee

An information system and medical record to support HIV treatment in rural Haiti

Brigham and Women's Hospital|Partners In Health|Harvard University|Brigham and Women's Hospital|Brigham and Women's Hospital|Harvard University|Harvard University|Brigham and Women's Hospital

ilack infrastructure including information communication systems considered barrier successful hiv treatment programmes resource poor areas authors describe set web based medical record system linking remote areas rural haiti used track clinical outcomes laboratory tests drug supplies create reports funding agenciesi

https://doi.org/10.15694/mep.2017.000025

Caroline White

Suspected research fraud: difficulties of getting at the truth

Healthcare Quality Improvement Partnership

iwhen research misconduct suspected researcher working outside jurisdiction official research bodies nowhere editors turn want investigate concerns invariably forced go alonea lengthy costly difficult processi

https://doi.org/10.3724/sp.j.1042.2022.00556

Thomas Clifford|J. Anderson

To enable shared decision making we must understand healthcare statistics

ns4pthis article migrated article marked recommended concept society patients properly informed risks benefits healthcare interventions participate culture shared decision making doctors 30 years old shared decision making work practice doctors must adequate working knowledge healthcare statistics provide patients accurate uptodate information require make informed decisions regarding carethe first part paper argues present doctors lack knowledge provides evidence form previous studies conducted specifically tested doctors statistical literacy simple techniques doctors employ improve statistical literacy reduce susceptibility inherent bias way data presented described evidencedpatients require basic knowledge healthcare statistics expect make informed decisions however outlined paper easily confused misleading risk communication practices especially relation screening combat healthcare authorities doctors responsibility provide evidence transparent way possible tools known decision aids developed help regard assisting doctors communicating healthcare statistics patients consultation level second part paper critiques evidence supporting use one decision aid known option gridns4p

https://doi.org/10.5964/jnc.7047

Haidan LIU|Minyi LI

Associations between home literacy environment and children’s receptive vocabulary: A meta-analysis

Shaanxi Normal University|Beijing Normal University

p idc6home literacy environment hle refers variety resources opportunities provided children well parental skills abilities dispositions resources determine provision opportunities children half century large body studies shown hle significantly promote childrens receptive vocabulary development however blurry operationalization hles construct inconsistency effect sizes ess recent studies made difficult understand really works childrens receptive vocabulary development home metaanalysis systematically reviewed empirical studies published 1990 2021 regarding relationships two variables order clarify hles construct investigate main effects explore potential moderators p idc7through literature review found hle usually conceptualized either perspective ecological system theory interaction theory ecological system theory widely adopted researchers involved home literacy resources motivational atmosphere literacy activities next completed comprehensive search peerreviewed published research 84 articles 212 effect sizes 65550 children finally included used cma 30 statistical analysis results showed 1 except age children began read publication bias ess hle subconstructs items 2 results random effects model indicated significant moderate relation hle childrens receptive vocabulary development italicritalic031 italicpitalic001 among subconstructs items related shared reading ie number childrens books frequency shared reading frequency childrens reading request demonstrated highest ess followed motivational atmosphere including parents literacy beliefs parents reading habits literacy activities ess informal literacy activities low significant formal literacy activities associated childrens receptive vocabulary development 3 ess hle frequency shared reading high level heterogeneity used metaregression explore whether time periods cultural backgrounds childs age measurement methods potential moderators results suggested ess hle decreased significantly across time periods one possible explanation influx multimedia significantly changed hle may lie time children spent preprimary schools increased significantly also found ess frequency shared reading stable past 30 years supported previous literature interactive reading adults children effective way childrens receptive vocabulary development moderating effects measurement methods different hle frequency shared reading specifically ess hle obtained questionnaires home observation measurement environment lead significant differences ess frequency shared reading obtained childrens title checklist ctc significantly higher obtained questionnaires found except problems understanding deviation difficulty recall social desirability effect researchers may different understandings ctc measurements time lastly moderating effects cultural backgrounds childs age detected p idc8taken altogether study supports previous literature hle positively correlated childrens receptive vocabulary especially resources opportunities related shared reading findings also suggest hle changing multifaceted construct research needed extend conceptualization especially techenabled literacy practices furthermore researchers also pay attention cultural differences hle employ crosscultural perspectives improve reliability validity measurements would help advance future hle research practice

https://doi.org/10.24095/hpcdp.36.4.01

Alexa Ellis|Sammy F. Ahmed|Selin Zeytinoglu|Elif Isbell|Susan D. Calkins|Esther M. Leerkes|Jennie K. Grammer|William J. Gehring|Frederick J. Morrison|Pamela Davis?Kean

Reciprocal associations between executive function and academic achievement: A conceptual replication of Schmitt et al. (2017)

University of Michigan–Ann Arbor|University of Michigan–Ann Arbor|University of Maryland, College Park|University of California, Merced|University of North Carolina at Greensboro|University of North Carolina at Greensboro|California Department of Education|University of California, Los Angeles|University of Michigan–Ann Arbor|University of Michigan–Ann Arbor|University of Michigan–Ann Arbor

p xmlnshttpwwwncbinlmnihgovjats1the goal current study conduct conceptual replication reciprocal associations executive function ef academic achievement reported schmitt et al 2017 httpsdoiorg101037edu0000193 using two independent samples n star 279 n pathways 277 examined whether patterns associations ef achievement across preschool kindergarten reported schmitt et al 2017 replicated using model specifications similar ef achievement measures across similar developmental age period consistent original findings ef predicted subsequent math achievement samples specifically star sample ef predicted math achievement preschool kindergarten kindergarten first grade pathways sample ef kindergarten predicted math literacy achievement first grade however contrary original findings unable replicate bidirectional associations math achievement ef either replication samples overall current conceptual replication revealed bidirectional associations ef academic skills might robust slight differences ef measures number measurement occasions implications understanding development ef academic skills across early childhood present findings underscore need standardization measurement modeling approaches without inconsistency findings published studies may continue across area research

https://doi.org/10.3934/publichealth.2017.4.314

Vivian Welch|Jennifer Petkovic|Jordi Pardo Pardo|Tamara Rader|Peter Tugwell

Interactive social media interventions to promote health equity: an overview of reviews

Bruyère|University of Ottawa|University of Ottawa|University of Ottawa|Ottawa Hospital|University of Ottawa|Ottawa Hospital|University of Ottawa

sec titleintroductiontitle social media use increasing public health health promotion remove geographic physical access barriers however interventions also potential increase health inequities people access use social media paper aim assess effects interactive social media interventions health outcomes behaviour change health equity sec sec titlemethodstitle conducted rapid response overview systematic reviews used sensitive search strategy identify systematic reviews included focussed interventions allowing twoway interaction discussion forums social networks eg facebook twitter blogging applications linked online communities media sharing sec sec titleresultstitle eleven systematic reviews met inclusion criteria interventions addressed reviews included online discussion boards similar strategies either standalone interventions combination interventions seven reviews reported mixed effects health outcomes healthy behaviours find disaggregated analyses across characteristics associated disadvantage lower socioeconomic status age however targeted studies reported social media interventions effective specific populations terms age socioeconomic status ethnicities place residence four reviews reported qualitative benefits satisfaction finding information improved social support sec sec titleconclusiontitle social media interventions effective certain populations risk disadvantage youth older adults low socioeconomic status rural indicates interventions may effective promoting health equity however confirmation effectiveness would require study several reviews raised issue acceptability social media interventions four studies reported level intervention use reported low use research established social media platforms existing social networks needed particularly populations risk disadvantage assess effects health outcomes health equity sec

https://doi.org/10.1146/annurev.publhealth.25.050503.153958

Gülay Y?lmazel|Fevziye Çetinkaya

Relation between Health Literacy Levels, Hypertension Awareness and Control among Primary-secondary School Teachers in Turkey

Hitit Üniversitesi|Erciyes University

strongobjectivestrong health literacy plays critical role chronic disease selfmanagement study aimed determine relation health literacy levels hypertension awareness control among primarysecondary school teachers turkey strongmaterials methodsstrong descriptive crosssectional research conducted among school teachers participation 500 volunteer teachers genders response rate 862 determine health literacy levels newest vital sign scale blood pressure concept test used strongresultsstrong mean scores individuals 212 182 six points although showed limited levels health literacy mean scores obtained scale 213 183 nonhypertensives 206 177 hypertensives nonetheless disease knowledge awareness low teachers adequate health literacy levels low according disease awareness control measured health literacy levels teachers didnt overlap assessments health literacy skills strongrecommendationsstrong limited health literacy levels educators gave impression education system poor terms health education programs

https://doi.org/10.1146/annurev.polisci.8.090203.103000

Shoshanna Sofaer|Kirsten Firminger

PATIENT PERCEPTIONS OF THE QUALITY OF HEALTH SERVICES

Baruch College|Baruch College

abstract calls made patientcentered health care system becomes critical define measure patient perceptions health care quality understand fully drives perceptions chapter identifies conceptual methodological issues make task difficult including confusion patient perceptions patient satisfaction difficulty determining whether systematic variations patient perceptions attributed differences expectations actual experiences propose conceptual model help unravel knotty issues review qualitative studies report directly patients define quality provide overview health plans hospitals physicians health care general currently viewed patients assess whether patient health status demographic characteristics relate perceptions health care quality identify appropriately designed research needed aim find patients want need experience health care professionals however wellmotivated believe need get patients eyes 23

https://doi.org/10.1146/annurev.publhealth.20.1.309

Anthony Heath|Stephen Fisher|Shawna N. Smith

THE GLOBALIZATION OF PUBLIC OPINION RESEARCH

University of Oxford|University of Oxford|University of Oxford

abstract globalization opened channels communication different countries increased interest crossnational analysis public opinion survey research expanded reach world article examines breadth depth globalization public opinion research first discuss growth crossnational surveys world values survey international social survey program european social survey various global barometers turn issues data quality comparability globalization survey research meant spread standard product known equivalent quality diverse countries survey research diverse countries contexts deliver meaningful comparisons public opinion globalization led dominance intellectual framework set assumptions may quite appropriate outside original homes finally article suggests new standard grading crossnational programs survey research inspired debates evidencebased medicine

https://doi.org/10.1146/annurev.polisci.6.121901.085655

Colleen A. McHorney

HEALTH STATUS ASSESSMENT METHODS FOR ADULTS: Past Accomplishments and Future Challenges

William S. Middleton Memorial Veterans Hospital|Health Services Research & Development|University of Wisconsin–Madison

abstract past 30 years health status assessment methods adults proliferated numerous generic diseasespecific preferencebased measures exist tap diverse aspects functioning wellbeing symptom states subjective perceptions health evolution state art adult health status assessment reviewed applications tools health services research health policy clinical practice discussed recommendations offered selecting among armamentaria tools conceptual methodological challenges confront instrument users developers alike identified discussed

https://doi.org/10.1146/annurev.energy.27.122001.083425

Fabrice Lehoucq

E<scp>LECTORAL</scp>F<scp>RAUD</scp>: Causes, Types, and Consequences

Centro de Investigación y Docencia Económicas

abstract article reviews research electoral fraudclandestine illegal efforts shape election results handful works classify reports electoral fraud identify nature magnitude causes review therefore looks larger number historical works well ethnographies surveys discuss ballot rigging conclusions threefold first fraud takes panoply forms ranges procedural violations electoral law may may intend distort results outright use violence voters second even ballot rigging integral part electoral competition infrequently decisive fraud nevertheless undermines political stability close races crucial third political competition shapes rhythm nature electoral fraud efforts steal elections increase inequality competitivenesswhich institutions help shapedetermines ballotrigging strategies parties adopt

https://doi.org/10.1146/annurev.energy.30.050504.144228

Paul Craig|Ashok Gadgil|Jonathan Koomey

What Can History Teach Us? A Retrospective Examination of Long-Term Energy Forecasts for the United States

Sierra Club|Lawrence Berkeley National Laboratory|Lawrence Berkeley National Laboratory|Lawrence Berkeley National Laboratory

abstract paper explores longterm energy forecasts created useful focuses forecasts energy use united states year 2000 considers longterm predictions ie covering two decades motivation current interest global warming forecasts run beyond century basic observation forecasters 19501980 period underestimated importance unmodeled surprises key example failure foresee ability united states economy respond oil embargos 1970s increasing efficiency forecasts period systematically high forecasters systematically underestimated uncertainties longterm energy forecasts must make assumptions technologies social systems successful influence people act showing consequences acting useful provide insights energy planners influence perceptions public energy policy community capture current understanding underlying physical economic principles highlight key emerging social economic trends true best see dimly future acknowledge duty posterity feel impelled use foresight upon facts guiding principles possess though many data present wanting doubtful conclusions may rendered far probable lead inquiries 1 p 4

https://doi.org/10.1177/0033688207085852

R. Anil Cabraal|Douglas F. Barnes|Sachin G. Agarwal

PRODUCTIVE USES OF ENERGY FOR RURAL DEVELOPMENT

World Bank|World Bank|World Bank

abstract review utilizes global environment facility gef un food agricultural organization fao working definition productive uses energy states context providing modern energy services rural areas productive use energy one involves application energy derived mainly renewable resources create goods andor services either directly indirectly production income value definition reflects shift toward aspirations millennium development goals mdgs traditionally productive uses energy rather narrowly defined focus direct impact energy use gross domestic product gdp importance motive power agriculture conventional view utility understanding nature development national regional level however order respond international development goals maintaining pace everevolving understanding development important consider traditional thinking may augmented earlier thinking productive uses energy needs updated enhanced understanding tremendous impact energy services education health gender equality indeed refined understanding energy use important public policy implications scarce resources may guided investments may achieve desired national international development goals

https://doi.org/10.1111/j.1751-7133.2012.00308.x

Rachel N. F. Lee|Ann?Marie Bathmaker

The Use of English Textbooks for Teaching English to 'Vocational' Students in Singapore Secondary Schools

Ministry of Education|University of the West of England

study explores teachers beliefs use english textbooks teaching english upper secondary normal technical nt stream singapore nt stream singapore form vocational pathway pupils streamed nt classes considered academically weakest amongst three streams secondary level using semistructured questionnaire study aims identify factors influencing teachers perceptions toward roles textbook plays language teaching learning findings used infer relationship teachers use textbooks attitudes towards less academically inclined nt pupils results show teachers beliefs related factors exist within beyond classroom among factors identified related institution classroom tended greater influence way teachers used textbooks particular teachers refer demands meeting stipulated pass rate english examinations nt students cognitive weakness behavioural problems besides pointing need research discussion brings implications curriculum assessment review teacher education technicalvocational streams singapore

https://doi.org/10.1016/j.lisr.2017.01.005

Catherine N. Marti|Vasiliki V. Georgiopoulou|Grigorios Giamouzis|Robert T. Cole|Anjan Deka|W.H. Wilson Tang|Sandra B. Dunbar|Andrew L. Smith|Andreas P. Kalogeropoulos|Javed Butler

Patient?Reported Selective Adherence to Heart Failure Self?Care Recommendations: A Prospective Cohort Study: The Atlanta Cardiomyopathy Consortium

Emory University|Emory University|University of Thessaly|Emory University|Emory University|Cleveland Foundation|Cleveland Clinic|Emory University|Emory University|Emory University|Emory University

2012 wiley periodicals inc simultaneous adherence multiple selfcare instructions among heart failure hf patients well described patientreported adherence 8 recommendations related exercise alcohol medications smoking diet weight symptoms assessed among 308 hf patients using medical outcomes study specific adherence scale questionnaire 0never 5always maximum score40 baseline cumulative score 3240 average 80 defined good adherence clinical events deathtransplantationventricular assist device resource utilization functional capacity 6minute walk distance health status kansas city cardiomyopathy questionnaire kccq compared among patients without good adherence mean followup 2010 years adherence ranged 263 exercise 899 medications cumulative score indicating good adherence reported 357 whereas good adherence every behavior reported 91 patients good adherence associated fewer hospitalizations allcause 878 vs 1076 p 018 hf 296 vs 438 p 007 hospitalized days allcause 422 vs 465 p 015 hf 228 vs 282 p lt001 per 100personyears better health status kccq overall score 701246 vs 638228 p 011 adherence associated clinical events functional capacity patientreported adherence hf selfcare recommendations alarmingly low selective good adherence associated lower resource utilization better health status

https://doi.org/10.1016/j.tate.2019.07.005

Safirotu Khoir|Jia Tina Du|Robert M. Davison|Andy Koronios

Contributing to social capital: An investigation of Asian immigrants' use of public library services

University of South Australia|University of South Australia|City University of Hong Kong|University of South Australia

asian immigrants use public library services settlement process social capital valuable component immigrant settlement study looks relationship services used social capital development model use public libraries context social capital formation settlement developed public library services used immigrants facilitate development social capital

https://doi.org/10.1177/1367877910376582

Lisbeth M. Brevik|Gréta Björk Guðmundsdóttir|Andreas Lund|Torunn Strømme

Transformative agency in teacher education: Fostering professional digital competence

University of Oslo|University of Oslo|University of Oslo|University of Oslo

student teachers face complex challenges future profession incl developing professional digital competence pdc response teacher education needs address reciprocity pdc students transformative agency demonstrate small private online course spoc integrates pdc university seminars practice student teachers respond challenges transforming opportunities professional development spoc fosters pdc development throught transformative digital agency conceptualised new pdc pillar

https://doi.org/10.1016/j.jpainsymman.2018.12.127

José van Dijck

Search engines and the production of academic knowledge

University of Amsterdam

article argues search engines general google scholar particular become significant coproducers academic knowledge knowledge simply conveyed users coproduced search engines ranking systems profiling systems none open rules transparency relevance privacy manner known library scholarship public domain inexperienced users tend trust proprietary engines neutral mediators knowledge commonly ignorant metadata enable engine operators interpret collective profiles groups searchers theorizing search engines nodal points networks distributed power based notions manuel castells article urges enriched form information literacy include basic understanding economic political sociocultural dimensions search engines without basic understanding network architecture dynamics network connections intersections hard grasp social legal cultural economic implications search engines

https://doi.org/10.1016/j.jpainsymman.2014.11.255

Rebecca L. Sudore|Mary Katen|Ying Shi|John Boscardin|Stacy Osua|Deborah E. Barnes

Engaging Diverse English- and Spanish-Speaking Older Adults in Advance Care Planning: The PREPARE Randomized Clinical Trial (FR421D)

University of California, San Francisco|University of California, San Francisco|University of California, San Francisco|University of California, San Francisco|University of California, San Francisco|University of California, San Francisco

describe design implementation free easytouse patient facing advance care planning tools wwwprepareforyourcareorg particularly vulnerable disenfranchised populationsdescribe comparative efficacy online advance care planning program called prepare wwwprepareforyourcareorg plus easytoread 5thgrade reading level advance directive versus advance directive alone new advance care planning documentation selfreported advance care planning engagement without additional clinician systemlevel interventions advance care planning acp improves valuealigned care yet remains suboptimal among diverse patient populations mitigate literacy cultural language barriers created easytoread advance directives ads patientdirected online acp program called prepare english spanish compare efficacy prepare plus easytoread ad prepare arm ad alone increase acp documentation patientreported engagement conducted comparative efficacy randomized trial february 2014 november 2017 four san francisco safetynet primarycare clinics among english spanishspeaking adults age 55 years 2 chronic serious illnesses participants randomized prepare arm ad alone cliniciansystemlevel interventions staff blinded followup assessments primary outcome new acp ie legal forms andor documented discussions 15 months patientreported outcomes included acp engagement baseline 1 week 3 6 12 months using validated surveys used intentiontotreat mixedeffects logistic linear regression controlling time health literacy baseline acp clustering physician stratifying language mean sd age 986 participants 633 years 64 397 limited health literacy 45 spanishspeaking participant characteristic differed arms retention 859 compared ad alone prepare resulted higher acp documentation adjusted 43 vs 32 p0001 higher selfreported increased acp engagement 981 vs 895 p0001 results remained significant among english spanish speakers patientfacing prepare program easytoread ad without cliniciansystemlevel interventions increased acp documentation patientreported engagement statistically higher gains prepare english spanishspeaking older adults

https://doi.org/10.1016/j.jpainsymman.2018.12.124