Place-Based Initiatives to Improve Health in Disadvantaged Communities: Cross-Sector Characteristics and Networks of Local Actors in North Carolina.

OBJECTIVES: To examine the leadership attributes and collaborative connections of local actors from the health sector and those outside the health sector in a major place-based health initiative. METHODS: We used survey data from 340 individuals in 4 Healthy Places North Carolina counties from 2014 to assess the leadership attributes (awareness, attitudes, and capacity) and network connections of local actors by their organizational sector. RESULTS: Respondents' leadership attributes-scored on 5-point Likert scales-were similar across Healthy Places North Carolina counties. Although local actors reported high levels of awareness and collaboration around community health improvement, we found lower levels of capacity for connecting diversity, identifying barriers, and using resources in new ways to improve community health. Actors outside the health sector had generally lower levels of capacity than actors in the health sector. Those in the health sector exhibited the majority of network ties in their community; however, they were also the most segregated from actors in other sectors. CONCLUSIONS: More capacity building around strategic action-particularly in nonhealth sectors-is needed to support efforts in making widespread changes to community health.

Values-Based Measures of Impacts to Indigenous Health.

Values-based indicators of risks to Indigenous health have the potential to improve the accuracy and quality of a wide range of decisions affecting Native lands and cultures. Current health impact assessment approaches often omit important health priorities rooted in the history, social structures, and cultural context of Indigenous communities. Insights and methods from the decision sciences can be used to develop more culturally appropriate and context-relevant health indicators that can articulate and track changes to important dimensions of Indigenous health. Identifying and addressing priority cultural, social, economic, and environmental contributors to the health of Indigenous communities will help to generate better project alternatives and foster more responsive choices.

Support for population level tobacco control policies in Hungary.

BACKGROUND: Smoking is the leading, preventable risk factor for premature death and disability in Hungary. The objective of this paper was to assess the social acceptability of and the predictors of holding favourable attitudes toward tobacco control policies among the Hungarian population. METHODS: A self-administered questionnaire-based study was carried out among individuals aged 16-70 years. Logistic regression analysis was used to assess whether support for the ten tobacco control policies varies as a function of age, sex, educational level, and smoking status. RESULTS: The majority of the respondents supported the studied tobacco control measures. Over 90 percent of the sample supported: fines for retailers selling tobacco products to minors (92.3%), stricter enforcement of restrictions on selling tobacco products to minors (90.5%), and a ban on smoking in health care institutions (91.4%). The lowest levels of support were for bans on sponsorship by the tobacco industry (52.8%) and price increases on tobacco products (54.9%). For each measure, support was significantly lower among smokers than non-smokers. Age and education were significantly related to support for some but not all measures. CONCLUSIONS: Strong majorities of Hungarians support the enactment and enforcement of a wide range of tobacco control measures, a fact that was acknowledged by Parliament's passage of the 2011 Anti-Smoking Law. Advocacy efforts to encourage the acceptance of tobacco control policies should focus not only on smokers, but also on younger and less educated non-smokers.

Associations Between Mild Cognitive Impairment and Hospitalization and Readmission.

OBJECTIVES: To determine whether older adults with mild cognitive impairment (MCI), a condition not previously explored as a risk factor, have more hospitalizations and 30-day readmissions than those with normal cognition. DESIGN: Post hoc analysis of prospectively gathered data on incident hospitalization and readmission from the Ginkgo Evaluation of Memory Study (GEMS), a randomized, double-blind, placebo-controlled trial designed to assess the effect of Ginkgo biloba on incidence of dementia. SETTING: GEMS was conducted in five academic medical centers in the United States. PARTICIPANTS: Community-dwelling adults aged 75 and older with normal cognition (n = 2,314) or MCI (n = 428) at baseline cognitive testing (N = 2,742). MEASUREMENTS: Index hospitalization and 30-day hospital readmission, adjusted for age, sex, race, education, clinic site, trial assignment status, comorbidities, number of prescription medications, and living with an identified proxy. RESULTS: MCI was associated with a 17% greater risk of index hospitalization than normal cognition (adjusted hazard ratio (aHR) = 1.17, 95% confidence interval (CI) = 1.02-1.34)). In participants who lived with a proxy, MCI was associated with a 39% greater risk of index hospitalization (aHR = 1.39, 95% CI = 1.17-1.66). Baseline MCI was not associated with greater odds of 30-day hospital readmission (adjusted odds ratio = 0.90, 95% CI = 0.60-1.36). CONCLUSION: MCI may represent a target condition for healthcare providers to coordinate support services in an effort to reduce hospitalization and subsequent disability.

Access to radiologic reports via a patient portal: clinical simulations to investigate patient preferences.

PURPOSE: The aim of this study was to determine (1) the patient-preferred timing characteristics of a system for online patient access to radiologic reports and (2) patient resource needs and preferences after exposure to reports. METHODS: Adult outpatients from a single imaging center completed researcher-administered electronic questionnaires. Participants were exposed to 3 simulated clinical scenarios and asked to answer questions on the basis of what they thought they would do in each. Scenarios included symptomatology and written radiology reports that were nearly normal, seriously abnormal, and indeterminate, with reports containing typical medical terminology. Participants were asked about preferred timing for online access to reports, communication methods, educational resources, and alternative formats. McNemar's test correlated proportions and generalized estimating equations were used to evaluate responses. RESULTS: Participants (n = 53) most often preferred immediate access to reports: 32 (60.2%) for the nearly normal scenario, 25 (47.2%) for the seriously abnormal scenario, and 24 (45.3%) for the indeterminate scenario. Three-day delayed access was next most commonly preferred: 15 (28.3%), 19 (35.8%), and 19 (35.8%), respectively. Forty-two participants (79.2%) preferred the portal method of notification over ways they have historically gotten results, with an increased proportion being satisfied with it overall (P < .04). Most would use a variety of educational resources and found alternative lay language conclusions and hyperlinks helpful. CONCLUSIONS: Some outpatients want immediate online access to complete, written radiologic reports and would use multiple resources to understand report contents. Effects of immediate access on provider workflow and on anxiety and autonomy among a diverse population of patients still need to be studied.

Evaluation of free to grow: head start partnerships to promote substance-free communities.

Free to Grow: Head Start Partnerships to Promote Substance-free Communities (FTG) was a national initiative in which local Head Start (HS) agencies, in partnership with other community organizations, implemented a mix of evidence-based family-strengthening and community-strengthening strategies. The evaluation of FTG used a quasi-experimental design to compare 14 communities that participated in the FTG intervention with 14 matched comparison communities. Telephone surveys were conducted with two cohorts of the primary caregivers of children in HS at baseline and then annually for 2 years. The survey was also administered to repeated cross-sectional samples of primary caregivers of young children who were not enrolled in HS. No consistent evidence was found in changes in family functioning or neighborhood conditions when the 14 FTG sites were compared to 14 matched sites. However, caregivers of young children who were not in HS in three high-implementing FTG sites showed evidence of improvements in neighborhood organization, neighborhood norms against substance abuse, and child disciplinary practices. Results provide highly limited support for the concept that family and neighborhood conditions that are likely to affect child development and well-being can be changed through organized efforts implemented by local HS programs.

Patient access to radiology reports: what do physicians think?

PURPOSE: The aim of this study was to seek physicians' perspectives on radiology reporting systems, so that reporting systems can begin to be reorganized and made more patient centered by giving patients greater access to their personal health information. METHODS: Focus-group methodology was used to explore physicians' views on direct patient access to radiologic test results. Subjects for the two groups were physicians at a single academic medical center. Transcripts were analyzed using thematic content analysis. RESULTS: Most participants were dissatisfied with current reporting systems. Both radiologists and referring physicians (RPs) were aware that patients are not satisfied with the current system for notification of radiologic test results, and both thought that patients should have access to personal health information and take responsibility for their own health care. Regarding direct patient online access to results, both radiologists and RPs were concerned that patients would not understand report contents and that such access would lead to greater patient anxiety and demands on RPs' time. Referring physicians were also concerned that direct patient access to results would cause RPs to lose some control in the patient-physician relationship. Both radiologists and RPs preferred that any system for direct patient access incorporate a time delay and be tested for effect before being implemented. CONCLUSIONS: Revisions attempting to increase the patient-centeredness of care in the area of radiology reporting should be developed and tested to 1) minimize adverse effects on patient anxiety; 2) optimize timing, considering effects on both patients and RPs; and 3) simultaneously address problems with between-physician reporting methods.

Insight from patients for radiologists: improving our reporting systems.

PURPOSE: The aim of this study was to seek patients' perspectives on radiology reporting systems, so that reporting systems can begin to be reorganized and made more patient-centered by giving patients greater access to their personal health information. METHODS: Focus group methodology was used to explore which aspects of radiology information are important to patients and to identify their preferred means of access to and format of this information. Subjects for the two groups were outpatients who had recently undergone MR imaging at a single academic medical center. Transcripts were analyzed using thematic content analysis. RESULTS: Most subjects were dissatisfied with current reporting systems, citing delays and a lack of detail as the most important problems. Subjects varied with regard to preferences for who should relay results to them, with some expressing a desire for increased direct input from radiologists because they have greater expertise in imaging interpretation. Most subjects wanted results in writing and in detail, with attached lay language explanations, though a few subjects preferred less detail. Subjects were decidedly in favor of having the option to access results immediately via an online system, proposing some potential problems and potentially multiple benefits of such a system. CONCLUSIONS: Whatever system revisions are attempted to increase the patient-centeredness of care as regards to radiology reporting, patients will need to be able to choose their preferred levels of access and will need to have the option of accessing full details.