Brief Action Planning in Health and Health Care: A Scoping Review.

Achieving maximal health outcomes via health promotion and disease prevention requires the adoption of healthy behaviors. Brief action planning (BAP) is a method for patient self-management, health behavior change, and health coaching with potentially broad implications for and clinical applications in health and health care contexts. This scoping review presents 5 major findings about the literature on BAP: the principal geographic locations and the clinical contexts of its application, the types of research evaluations that it has undergone to date, the theoretic frameworks in which it is grounded, and the fidelity of its use in clinical practice.

Biological sex disparity in survival outcomes following treatment for renal cell carcinoma: A systematic review and meta-analysis.

INTRODUCTION: Renal cell carcinoma (RCC), a type of kidney cancer has biological sex-based differences that play a role in cancer incidence. Specifically, the incidence of urinary system cancers in men is two times greater than in women, while the incidence of genital cancers is three times greater. There is conflicting epidemiologic and limited evidence in the literature to suggest apparent biological sex discrepancy. The primary objective of this review and meta-analysis is to synthesize evidence to understand biological sex disparity in the survival outcomes of RCC following any treatment intervention. METHODS: A three-step search strategy was utilized in this review. We searched MEDLINE, EMBASE and PsycINFO databases for manuscript on biological sex differences in treatment outcomes. Study screening, critical appraisal, and data extraction were executed independently by pairs of reviewers among co-authors. Studies that had any form of treatment modality in the management of RCC were included. Study designs included observational studies in the form of prospective and retrospective studies that utilized cox proportional hazard assumption to conduct survival analysis. The data synthesis was carried out using the R metafor software package (Software version of 1.2.8) and Microsoft Office Excel 2019 package (Microsoft Corporation, USA). The random effects model was estimated using restricted maximum likelihood estimation (REML). Data synthesis included narrative review and meta-analysis. RESULTS: We had 23 eligible studies for this review. On review of the full text, 35 studies were excluded due to irrelevances to measure estimates utilized. Finally, 12 studies were selected for the meta-analysis with a total of n = 21,2453 individuals. Females had a better survival outcome following a treatment intervention for RCC than their male counterpart [Mean effect size = -0.1737 (95 % CI: -0.2524, -0.0949)]. CONCLUSION: Females were more likely to be cancer free than their male counterpart following treatment for RCC. This finding will inform appropriate decision making for stakeholders.

Diversity, Equity, and Inclusion in the Environmental Health Workforce: Mapping the Literature and Moving Toward Liberation.

Introduction: Diversity, equity, and inclusion, also known as DEI, is an essential topic being discussed across society. The field of environmental health (EH) should certainly not be excluded from the conversation. Objective: The purpose of this mini-review was to map the literature and identify gaps on the topic of DEI in the EH workforce. Methods: A rapid scoping review was conducted using standard synthesis science methods to search and map the published literature. All study titles, abstracts, and full texts were screened by 2 independent reviewers among the authorship team. Results: The search strategy yielded 179 English language papers. Of those, 37 met all inclusion criteria after full text screening. Overall, the majority of the articles had weak or moderate DEI engagement and only 3 articles had strong DEI engagement. Discussion: There is a significant need for additional research in this realm. Future studies should explicitly focus on workforce issues, and attempt to achieve the highest level of the evidence possible for this field. Conclusion: Although DEI initiatives are a step in the right direction, the current evidence suggests that inclusivity and liberation may prove to be more impactful and meaningful constructs to fully advance equity in the EH workforce.

Using motivational interviewing and brief action planning for adopting and maintaining positive health behaviors.

Lifestyle medicine practice can be enhanced with interpersonal communication skills to help patients adopt and maintain positive health behaviors, such as improving diet or initiating exercise. We review two approaches that incorporate evidenced-based skills for this purpose: motivational interviewing and brief action planning (BAP). Motivational interviewing involves four processes conducted in a climate of compassion, acceptance, partnership, and empowerment. First, "engaging" (or connecting) with patients uses the "relational" skills of active listening and empathic communication. Second, "focusing" elicits patients' full spectrum of concerns, expectations, and desires to negotiate a collaborative agenda. Third, "evoking motivation," utilizes uniquely innovative skills (e.g., "softening sustain talk" and "cultivating change talk") to increase intrinsic motivation of patients with ambivalence (or resistance) to become more open to choosing healthier behaviors for themselves. Fourth, "planning for change," uses collaborative goal-setting skills to help patients specify concrete action plans for health. To this end, brief action planning (BAP) has been developed as a specific pragmatic algorithmic approach, utilizing collaborative "SMART" (specific, measurable, achievable, relevant, and time-based) action planning, encouragement of patient commitment statements, scaling for confidence, problem-solving to reduce barriers for change, fostering patient accountability, and emphasizing follow-up. BAP can be introduced at any point in a patient encounter when patients are ready or nearly ready for change.

Methods of training lay individuals in the use of evidence-based services for the management of mental and behavioral health disorders: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to describe how lay individuals have been trained in evidence-based therapies to manage mental and behavioral health disorders as defined by the International Classification of Diseases, version 11. INTRODUCTION: Health service delivery by lay individuals is common in under-resourced areas. Prior systematic reviews have examined the characteristics of lay workers, the types of services they provide, and the efficacy of their services. Our goal is to focus on the methods of training. INCLUSION CRITERIA: Participants will include lay individuals who provide services to community residents; we will exclude individuals with formal training in health service delivery. We will consider for inclusion studies that include training programs for evidence-based therapies delivered to individuals with mental and behavioral health disorders, and will exclude those involving pharmacology or focusing on cognitive defects. METHODS: We conducted a preliminary search of the literature on PubMed and CINAHL for articles related to the inclusion criteria and published in the past 10  years. Scanning the title, abstract, keywords, and MeSH terms, we generated comprehensive lists of terms and added search terms from 6 recent systematic reviews. Our search strategy will include MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and gray literature. We will also consult with experts and review the reference lists of articles selected for final inclusion. Articles published in English or Spanish between 1960 and the present will be considered for inclusion. Data analysis will use a mix of descriptive and qualitative approaches, with data presented graphically or in diagrammatic or tabular format.

JBI series paper 2: tailored evidence synthesis approaches are required to answer diverse questions: a pragmatic evidence synthesis toolkit from JBI.

Evidence synthesis is critical in evidence-based healthcare and is a core program of JBI. JBI evidence synthesis is characterised by a pluralistic view of what constitutes evidence and is underpinned by a pragmatic ethos to facilitate the use of evidence to inform practice and policy. This second paper in this series provides a descriptive overview of the JBI evidence synthesis toolkit with reference to resources for 11 different types of reviews. Unique methodologies such as qualitative syntheses, mixed methods reviews, and scoping reviews are highlighted. Key features include standardised and collaborative processes for development of methodologies and a broad range of tailored resources to facilitate the conduct of a JBI evidence synthesis, including appraisal and data extraction tools, software to support the conduct of a systematic review and an intensive systematic review training program. JBI is one of the leading international protagonists for evidence synthesis, providing those who want to answer health-related questions with a toolkit of resources to synthesize the evidence.

A Population Health Perspective on Racism and Racial Microaggressions.

Racism, one of the social determinants of health, often goes unnoticed by those less affected by its pernicious effects. The lived social experience of race has been linked to significant physical and mental health disparities. Individually or together, we know that racism and discrimination are associated with poorer health of persons from racial minority groups as evidenced in higher rates of mortality, earlier onset of disease, greater severity and progression of disease and higher levels of comorbidity and impairment. These disparities are persistent over time and, although may lessen in degree, are evident at every level of income and education. This article provides a glimpse of the impact of racism on individuals and groups, with a focus on microaggressions as a subtle but pervasive form of racism, and how it is an underlying causative factor for health disparities.

Ecosystemic Theory, Practice, and Policy: Training Recommendations for Environmental Public Health.

The readiness of the public health workforce to deliver the essential public health services is benchmarked against training competencies. Consequently, it is expected that the establishment of the Council on Education in Public Health competencies will continue to drive the agenda of the learning continuum, from education to practice. However, the absence of environmental health as a listed competency in the Council on Education in Public Health accreditation criteria weakens the core public health program structure originally outlined by the National Academy of Medicine (formerly known as the Institute of Medicine) and could further dissolve environmental health content from schools and programs of public health. The authors have examined the literature on environmental health and public health education, and propose 3 overarching perspectives to employ from a theory, practice, and policy viewpoint to address this disconnect as follows: The current environmental health competency gap weakens the public health workforce infrastructure by creating graduates without the necessary science-based skills to protect communities from environmental threats. This departure from environmental health devalues the profession of public health and prohibits populations from reaching their full health potential. Practitioners, educators, and the public need to play a role in transforming siloes in environmental public health theory, practice, and policy into coherent learning ecosystems on which current and future populations can confidently depend.

Biological sex disparity in survival outcomes following treatment for renal cell carcinoma: a systematic review protocol.

OBJECTIVE: This systematic review will assess the biological sex disparity in survival outcomes following treatment for renal cell carcinoma and analyze the estimates of biological sex disparity outcomes following supposed or proposed curative treatment. INTRODUCTION: Renal cell carcinoma is a type of kidney cancer. There is a lack of conformity in the literature on the biological sex disparity in survival outcomes after treatment. This review will help inform the decision-making of clinicians, health care administrators, policy makers, public health workers, and pharmaceutical/biotechnology researchers in predicting positive outcomes following treatment. INCLUSION CRITERIA: The review will consider prospective and retrospective studies on any form of treatment for renal cell carcinoma. The Cox proportional hazard assumption will be used to conduct survival analysis. Hazard rates of participants' survivability across biological sex will also be reported. METHODS: A three-step search strategy will be used. First, a limited search of MEDLINE, Embase, and PsycINFO was conducted and text words in the title, abstract, and index terms were analyzed. Second, a search using identified keywords and index terms will be tailored for all included databases. Third, the reference lists of all included reports and articles will be screened to search for additional studies. There will be no language or date restrictions. Papers not written in English but with a professional translated copy will be included. Study screening, critical appraisal, and data extraction will be conducted independently by pairs of reviewers. Data synthesis will include narrative review and meta-analysis, if appropriate. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020195721.

Population Health Rounds: A Novel Vehicle for Training in Population Medicine and Clinical Preventive Medicine.

CONTEXT: Preventive medicine residents must train in population medicine (including analytics and population health) and clinical preventive medicine (including screening, behavioral counseling, and chemoprophylaxis). Yet, opportunities to perform both functions concurrently for the same population are scarce. Residents must also master the art of preventive medicine, but they often lack an established community of practice that provides a continuous forum to do so. This project explored Population Health Rounds as a novel vehicle to optimize preventive medicine residency training. PROGRAM DESCRIPTION: Modeled after traditional medical rounds, Population Health Rounds consist of a 1-hour weekly meeting engaging preventive medicine residents and supervising attendings at Stony Brook Medicine in both population medicine and clinical preventive medicine concurrently, including patient case discussions and targeted population health analytics. EVALUATION AND RESULTS: Because of the pandemic, the rounds have predominantly focused on COVID-19 and its effects on the hospital employee population. In addition to providing direct patient care to COVID-19-positive and exposed employees, residents have analyzed data on this population and made recommendations to hospital leadership based on COVID-19's institutional epidemiology, including incidence, prevalence, and predictive factors. A formative qualitative survey of resident perceptions offers insights on the value and learning outcomes of this new model. DISCUSSION AND CONCLUSION: Factors that may impact the implementation, sustainability, and feasibility of this model are discussed. The preventive medicine residency program is commissioned to address gaps in clinical preventive services for the patient-centered medical home tied to the sponsoring institution's family medicine practice. Additional plans are underway to expand the rounds to other clinical contexts, such as lifestyle medicine in the occupational setting, and for targeted populations, such as the underserved. Replication of the Population Health Rounds model is recommended to determine its effectiveness.

Risk factors for hypertensive crisis in adult patients: a systematic review.

OBJECTIVE: The objective of this review was to examine the best available evidence on the risk factors for hypertensive crisis in adult patients with hypertension. INTRODUCTION: Hypertensive crisis is an acute severe elevation in blood pressure, which can present as hypertensive urgency or emergency. In contrast to hypertensive urgency, which is a markedly elevated blood pressure without acute target organ damage, hypertensive emergency is associated with equally high blood pressure in the presence of potentially life-threatening target organ damage, such as myocardial infarction, stroke, pulmonary edema, or acute kidney injury. Hypertensive crisis results in adverse clinical outcomes and high utilization of health care. INCLUSION CRITERIA: This review considered studies of non-modifiable factors (age, sex, ethnicity) and modifiable factors such as socioeconomic factors (lack of medical insurance, lack of access to medical care), adherence to medical therapies, presence of comorbidities (diabetes, hyperlipidemia, coronary artery disease, history of stroke, chronic kidney disease, congestive heart failure), and substance abuse in persons of either sex, older than 18 years with a diagnosis of hypertension. METHODS: A search of four databases, seven gray literature sites, and relevant organizational websites revealed 11,387 titles. After duplicates were removed, 9183 studies were screened by the title and abstract for eligibility. Forty full-text articles were retrieved, and each was assessed for eligibility. Twenty-one articles were excluded. The remaining 19 full-text studies were critically appraised and included in this review. RESULTS: The risk of hypertensive crisis was higher in patients with a history of comorbid cardiovascular conditions, such as chronic kidney disease (odds ratio [OR] 2.899, 95% confidence interval [CI] 1.32, 6.364), coronary artery disease (OR 1.654, 95% CI 1.232, 2.222), or stroke (OR 1.769, 95% CI 1.218, 2.571). Patients with hypertensive emergency had higher mean systolic blood pressure (mean difference [MD] 2.413, 95% CI 0.477, 4.350) and diastolic blood pressure (MD 2.043, 95% CI 0.624, 3.461). Hypertensive emergency was more common in men (OR 1.390, 95% CI 1.207,1.601), older patients (MD 5.282, 95% CI 3.229, 7.335), and those with diabetes (OR 1.723, 95% CI 1.485, 2.000) and hyperlipidemia (OR 2.028, 95% CI 1.642, 2.505). Non-adherence to antihypertensive medications (OR 0.939, 95% CI 0.647,1.363) and hypertensive diagnosis unawareness (OR 0.807, 95% CI 0.564, 1.154) did not increase the risk of hypertensive emergency. CONCLUSIONS: Comorbid cardiac, renal, and cerebral comorbidities (coronary artery disease, congestive heart failure, cerebrovascular disease, and chronic kidney disease) increase the risk of hypertensive crisis. The risk of hypertensive crisis is higher in patients with unhealthy alcohol and recreational drug use. Systolic and diastolic blood pressure are marginally higher in patients with hypertensive emergency compared to patients with hypertensive urgency. Since these differences are small and not clinically significant, clinicians should rely on other symptoms and signs to differentiate between hypertensive urgency and hypertensive emergency. The risk of hypertensive emergency is higher in older adults. The coexistence of diabetes, hyperlipidemia, and chronic kidney disease increases the risk of hypertensive emergency. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO (CRD42019140093).

Core functions, knowledge bases and essential services: A proposed prescription for the evolution of the preventive medicine specialty.

The pandemonium from the 2020 pandemic calls for a greater emphasis on prevention, public health and population health. Yet the role of preventive medicine specialists, ideally qualified to lead this charge, remains difficult to situate within the houses of medicine and public health. To overcome this challenge to its identity and evolve to better tackle novel and on-going public health and population health problems, the authors propose that the specialty of preventive medicine should assert 3 core functions within preventive care; expand and modernize its knowledge base; and enhance its residency training accordingly. The authors also propose 10 essential services, not otherwise systematically provided by other specialties, that the preventive medicine specialty can optimally fulfill as its unique contributions within medicine and public health.

Organic food consumption and the incidence of cancer: a systematic review protocol.

OBJECTIVE: The objective of this review is to evaluate the association between organic food consumption and the incidence of cancer among adults. INTRODUCTION: Organic foods differ from traditional food in the methods in which they are produced. There is literature to suggest that they are associated with better health outcomes, including a lower incidence of some cancers. The association between organic food consumption and the incidence of cancer has not yet been synthesized. INCLUSION CRITERIA: Studies that compared organic food consumption to conventional food consumption, measured the incidence of cancer among adults, and captured disease incidence, such as prospective and retrospective cohort methodologies, will be included. METHODS: A comprehensive search strategy will be implemented to retrieve relevant studies from PubMed, CINAHL, LILACS, Embase, PsycINFO, Science.gov, Web of Science/Web of Knowledge, and Academic Search Premiere, as well as gray literature sources such as Google Scholar, DARE and Dissertation Abstracts International. The search parameters will include studies for which the full text in English is available, and studies dated 2009 or later, as this was the date of a previous systematic review on the association between organic food consumption and health outcomes that did not find any studies with cancer-related outcomes. Study screening, critical appraisal, and data extraction will be performed independently by pairs of reviewers among the authorship team. Data synthesis will include narrative review and meta-analysis if appropriate. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019126224.

Hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings.

BACKGROUND: Ageing has a degenerative effect on the skin, leaving it more vulnerable to damage. Hygiene and emollient interventions may help maintain skin integrity in older people in hospital and residential care settings; however, at present, most care is based on "tried and tested" practice, rather than on evidence. OBJECTIVES: To assess the effects of hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. SEARCH METHODS: We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL, up to January 2019. We also searched five trials registers. SELECTION CRITERIA: Randomised controlled trials comparing hygiene and emollient interventions versus placebo, no intervention, or standard practices for older people aged ≥ 60 years in hospital or residential care settings. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as expected by Cochrane. Primary outcomes were frequency of skin damage, for example, complete loss of integrity (tears or ulceration) or partial loss of integrity (fissuring), and side effects. Secondary outcomes included transepidermal water loss (TEWL), stratum corneum hydration (SCH), erythema, and clinical scores of dryness or itch. We used GRADE to assess the quality of evidence. MAIN RESULTS: We included six trials involving 1598 residential care home residents; no included trial had a hospital setting. Most participants had a mean age of 80+ years; when specified, more women were recruited than men. Two studies included only people with diagnosed dry skin. Studies were conducted in Asia, Australasia, Europe, and North America. A range of hygiene and emollient interventions were assessed: a moisturising soap bar; combinations of water soak, oil soak, and lotion; regular application of a commercially available moisturiser; use of two different standardised skin care regimens comprising a body wash and leave-on body lotion; bed bath with "wash gloves" containing numerous ingredients; and application of a hot towel after usual care bed bath. In five studies, treatment duration ranged from five days to six months; only one study had post-treatment follow-up (one to eight days from end of treatment). Outcomes in the hot towel study were measured 15 minutes after the skin was wiped with a dry towel. Three studies each had high risk of attrition, detection, and performance bias. Only one trial (n = 984) assessed frequency of skin damage via average monthly incidence of skin tears during six months of treatment. The emollient group (usual care plus twice-daily application of moisturiser) had 5.76 tears per month per 1000 occupied bed-days compared with 10.57 tears in the usual care only group (ad hoc or no standardised skin-moisturising regimen) (P = 0.004), but this is based on very low-quality evidence, so we are uncertain of this result. Only one trial (n = 133) reported measuring side effects. At 56 ± 4 days from baseline, there were three undesirable effects (itch (mild), redness (mild/moderate), and irritation (severe)) in intervention group 1 (regimen consisting of a moisturising body wash and a moisturising leave-on lotion) and one event (mild skin dryness) in intervention group 2 (regimen consisting of body wash and a water-in-oil emulsion containing emollients and 4% urea). In both groups, the body wash was used daily and the emollient twice daily for eight weeks. There were zero adverse events in the usual care group. This result is based on very low-quality evidence. This same study also measured TEWL at 56 ± 4 days in the mid-volar forearm (n = 106) and the lower leg (n = 105). Compared to usual care, there may be no difference in TEWL between intervention groups, but evidence quality is low. One study, which compared application of a hot towel for 10 seconds after a usual care bed bath versus usual care bed bath only, also measured TEWL at 15 minutes after the skin was wiped with a dry towel for one second. The mean TEWL was 8.6 g/m²/h (standard deviation (SD) 3.2) in the hot towel group compared with 8.9 g/m²/h (SD 4.1) in the usual care group (low-quality evidence; n = 42), showing there may be little or no difference between groups. A lower score is more favourable. Three studies (266 participants) measured SCH, but all evidence is of very low quality; we did not combine these studies due to differences in treatments (different skin care regimens for eight weeks; wash gloves for 12 weeks; and single application of hot towel to the skin) and differences in outcome reporting. All three studies showed no clear difference in SCH at follow-up (ranging from 15 minutes after the intervention to 12 weeks from baseline), when compared with usual care. A clinical score of dryness was measured by three studies (including 245 participants); pooling was not appropriate. The treatment groups (different skin care regimens for eight weeks; a moisturising soap bar used for five days; and combinations of water soak, oil soak, and lotion for 12 days) may reduce dryness compared to standard care or no intervention (results measured at 5, 8, and 56 ± 4 days after treatment was initiated). However, the quality of evidence for this outcome is low. Outcomes of erythema and clinical score of itch were not assessed in any included studies. AUTHORS' CONCLUSIONS: Current evidence about the effects of hygiene and emollients in maintaining skin integrity in older people in residential and hospital settings is inadequate. We cannot draw conclusions regarding frequency of skin damage or side effects due to very low-quality evidence. Low-quality evidence suggests that in residential care settings for older people, certain types of hygiene and emollient interventions (two different standardised skin care regimens; moisturising soap bar; combinations of water soak, oil soak, and lotion) may be more effective in terms of clinical score of dryness when compared with no intervention or standard care. Studies were small and generally lacked methodological rigour, and information on effect sizes and precision was absent. More clinical trials are needed to guide practice; future studies should use a standard approach to measuring treatment effects and should include patient-reported outcomes, such as comfort and acceptability.

Risk factors for hypertensive crisis in adult patients: a systematic review protocol.

OBJECTIVE: The objective of this review is to conduct comprehensive appraisal and synthesis of evidence on risk factors for hypertensive crisis and, specifically, hypertensive emergencies among adult patients with hypertension. INTRODUCTION: Hypertensive crisis is the most extreme form of poorly controlled hypertension that may lead to acute target organ damage (hypertensive emergency). Hypertensive crisis is associated with increased mortality, high utilization of health care and escalated healthcare costs. INCLUSION CRITERIA: This review will include epidemiological studies with participants over 18 years old with diagnosis of hypertension. The review will exclude pediatric, pregnant and postpartum patients. The review will consider studies that explore risk factors for hypertensive crisis, defined as an acute elevation of blood pressure equal or above 180/110 mmHg. METHODS: The search strategy aims to find both published and unpublished studies. The databases to be searched will include MEDLINE (Ovid), Embase, Cochrane Database of Systematic Reviews and Web of Science. Following the search, all identified studies will be screened against the inclusion criteria. Selected studies will be critically appraised for methodological quality. Data on exposures and outcomes will be extracted from papers included in the review. Quantitative data, where possible, will be pooled in meta-analysis. Effect sizes expressed as odds ratio and their 95% confidence intervals will be calculated. Heterogeneity of studies will be assessed statistically. Subgroup analysis to determine the association of risk factors with hypertensive emergencies will be conducted, if possible. Where statistical pooling is not possible, the findings will be presented in a narrative form. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019140093.