Community Health Needs Assessment Data and Community Recovery From COVID-19.

INTRODUCTION: The COVID-19 pandemic has had a significant impact beyond physical morbidity and mortality. A mid-cycle Community Health Needs Assessment survey was administered in 1 community to generate data to evaluate change in community well-being since the beginning of the pandemic. METHODS: Surveys were mailed to 2,000 randomly selected residents in Olmsetd County, Minnesota. The surveys included the WHO Well-being Index (previously included in the 2018 Community Health Needs Assessment) and new subjective questions regarding behavior change. Changes in well-being were calculated using a propensity-matched cohort, and behavior change was reported as proportions of the whole. Data analysis was completed in 2021. RESULTS: Total survey respondents were 569 people in 2018 and 723 people in 2021. Well-being scores from the WHO Well-being Index showed a statistically significant decrease (score reduction of -8.44) from 2018 to 2021. All the 5 questions from the WHO Well-being Index also had an individual significant decrease; with the question regarding interest in life showing the greatest decrease. Individuals reported decreased subjective physical and mental well-being and increased substance use (alcohol, marijuana, and tobacco). Households also reported decreased household incomes and worse household finances since the start of the pandemic. CONCLUSIONS: Using the Community Health Needs Assessment infrastructure, 1 community was able to compare prepandemic with postpandemic data, which showed decreased well-being and increased substance use and financial stress. Other public health planners can similarly conduct interval surveys on the basis of their Community Health Needs Assessment questionnaires to tailor ongoing Community Health Improvement Plan programming to postpandemic needs and track community mental health and well-being recovery.

Evaluating Well-being at Community Level.

OBJECTIVE: To measure well-being at a community level using a valid instrument. PATIENTS AND METHODS: Written surveys were mailed to a random sample of residents in Olmsted County, Minnesota, in 2015 and 2019 including the 5-item World Health Organization Well-being Index (0-100; for which 100 is the best imaginable well-being or quality of life). Multivariable hierarchical regression was used to evaluate the association between well-being and demographic characteristics, comorbid conditions, and environmental factors. RESULTS: The survey was returned by 1232 of 4000 individuals (response rate, 30.80%). The average well-being score was 70.02. Impaired well-being was identified in 223/1187 individuals (18.79%). Adjusted regression models showed that impaired well-being was independently associated with household poverty, financial stress, reduced access to medical or mental health care, ever having depression diagnosed, living in an unsafe community, or being socially isolated. CONCLUSION: One in 5 people in a county in the US Midwest have impaired well-being. Well-being was associated with several modifiable factors. Data provide a rationale for policies that align transportation and housing and create opportunities for community members to connect and interact in a safe environment.

The effect of culinary interventions (cooking classes) on dietary intake and behavioral change: a systematic review and evidence map.

BACKGROUND: Culinary interventions (cooking classes) have been used to improve the quality of dietary intake and change behavior. The aim of this systematic review is to investigate the effects of culinary interventions on dietary intake and behavioral and cardiometabolic outcomes. METHODS: We conducted a systematic review of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus for comparative studies that evaluated culinary interventions to a control group or baseline values. The intervention was defined as a cooking class regardless of its length or delivery approach. Studies included populations of children, healthy adults or adults with morbidities. The risk of bias was assessed using the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale. Outcomes were pooled using the random-effects model and descriptive statistics and depicted in an evidence map. Simple logistic regression was used to evaluate factors associated with intervention success. RESULTS: We included 30 studies (6 were randomized, 7381 patients, average follow up 25 weeks). Culinary interventions were not associated with a significant change in body mass index (- 0.07 kg/m2, 95% CI: -1.53, 1.40), systolic (- 5.31 mmHg, 95% CI: -34.2, 23.58) or diastolic blood pressure (- 3.1 mmHg, 95% CI: -23.82, 17.62) or LDL cholesterol (- 8.09 mg/dL, 95% CI: -84.43, 68.25). Culinary interventions were associated with improved attitudes, self-efficacy and healthy dietary intake in adults and children. We were unable to demonstrate whether the effect of a culinary intervention was modified by various characteristics of the intervention such as its delivery or intensity. Interventions with additional components such as education on nutrition, physical activity or gardening were particularly effective. CONCLUSIONS: Culinary interventions were not associated with a significant change in cardiometabolic risk factors, but were associated with improved attitudes, self-efficacy and a healthier dietary intake in adults and children.

Nut consumption and risk of cancer and type 2 diabetes: a systematic review and meta-analysis.

CONTEXT: The identification of foods that can decrease the risk of cancer and type 2 diabetes may be helpful in reducing the burden of these diseases. Although nut consumption has been suggested to have a disease-preventive role, current evidence remains inconsistent. OBJECTIVE: The aim of this systematic review and meta-analysis was to clarify the association between nut consumption and risk of cancer or type 2 diabetes. DATA SOURCES: Six databases were searched for relevant studies from the time of database inception to August 2014. Reference lists of relevant review articles were hand searched, and authors were contacted when data were insufficient. STUDY SELECTION: Eligible studies included epidemiological studies (case-control and cohort) or clinical trials that reported an association between nut consumption and the outcome of type 2 diabetes or specific cancers. DATA EXTRACTION: Two investigators independently extracted descriptive, quality, and risk data from included studies. DATA SYNTHESIS: Random-effects meta-analysis was used to pool relative risks from the included studies. The I(2) statistic was used to assess heterogeneity. A total of 36 eligible observational studies, which included 30,708 patients, were identified. The studies had fair methodological quality, and length of follow-up ranged between 4.6 years and 30 years. Comparison of the highest category of nut consumption with the lowest category revealed significant associations between nut consumption and decreased risk of colorectal cancer (3 studies each with separate estimates for males and females, RR 0.76, 95% confidence interval [95%CI] 0.61-0.96), endometrial cancer (2 studies, RR 0.58, 95%CI 0.43-0.79), and pancreatic cancer (1 study, RR 0.68, 95%CI 0.48-0.96). No significant association was found with other cancers or type 2 diabetes. Overall, nut consumption was significantly associated with a reduced risk of cancer incidence (RR 0.85, 95%CI 0.76-0.95). CONCLUSIONS: Nut consumption may play a role in reducing cancer risk. Additional studies are needed to more accurately assess the relationship between nut consumption and the prevention of individual types of cancer, given the scarcity of available data.

Care coordination to enhance management of long-term enteral tube feeding: a systematic review and meta-analysis.

BACKGROUND: A systematic review and meta-analysis was completed to summarize care delivery models that used care coordination and/or team approach methods in the management of patients requiring long-term enteral tube feeding. Our aim was to evaluate team composition, implementation strategies, and the effectiveness of these methods. METHODS: We conducted a broad search of 7 databases from inception to May 2012, cross-referenced clinical reviews and medical guidelines, and consulted clinical experts. Independent reviewers screened eligible studies, extracted data, and assessed study quality. RESULTS: Fifteen studies enrolling 2145 patients were included in this review. The studies described multidisciplinary teams composed of primary care physicians, specialists, nurses, dietitians, and language or speech specialists. Patients and their families/caregivers were also an important part of the care team. The interventions were multifaceted and employed multiple simultaneous strategies that particularly included patient and family education, staff education, and continuous auditing and feedback methods. Meta-analysis suggested no significant reductions in complications (incidence rate ratio [IRR], 0.53; 95% confidence interval [CI], 0.27-1.05), infections (IRR, 0.77; 95% CI, 0.48-1.24), and overall hospital admissions (IRR, 0.36; 95% CI, 0.13-1.00) most likely due to lack of statistical power. We found significant reduction of total hospital costs (estimates in US dollars: -623.08; 95% CI, -745.64 to -500.53; P < .01) after the interventions. CONCLUSION: Studies suggested a positive association of care coordination by a multidisciplinary team approach and improved patient outcomes for long-term enteral feeding patients. However, the available evidence does not allow estimating the effectiveness of a particular intervention or team composition.

The effectiveness of self-directed learning in health professions education: a systematic review.

OBJECTIVES: Given the continuous advances in the biomedical sciences, health care professionals need to develop the skills necessary for life-long learning. Self-directed learning (SDL) is suggested as the methodology of choice in this context. The purpose of this systematic review is to determine the effectiveness of SDL in improving learning outcomes in health professionals. METHODS: We searched MEDLINE, EMBASE, ERIC and PsycINFO through to August 2009. Eligible studies were comparative and evaluated the effect of SDL interventions on learning outcomes in the domains of knowledge, skills and attitudes. Two reviewers working independently selected studies and extracted data. Standardised mean difference (SMD) and 95% confidence intervals (95% CIs) were estimated from each study and pooled using random-effects meta-analysis. RESULTS: The final analysis included 59 studies that enrolled 8011 learners. Twenty-five studies (42%) were randomised. The overall methodological quality of the studies was moderate. Compared with traditional teaching methods, SDL was associated with a moderate increase in the knowledge domain (SMD 0.45, 95% CI 0.23-0.67), a trivial and non-statistically significant increase in the skills domain (SMD 0.05, 95% CI-0.05 to 0.22), and a non-significant increase in the attitudes domain (SMD 0.39, 95% CI-0.03 to 0.81). Heterogeneity was significant in all analyses. When learners were involved in choosing learning resources, SDL was more effective. Advanced learners seemed to benefit more from SDL. CONCLUSIONS: Moderate quality evidence suggests that SDL in health professions education is associated with moderate improvement in the knowledge domain compared with traditional teaching methods and may be as effective in the skills and attitudes domains.