Enhanced Communication Strategies Research Articles

Linguistic dissection of nursing handoffs: Implications for patient safety in varied-acuity hospital settings.

This study examines the intricate language and communication patterns of nurse-to-nurse handoffs across three units with varying patient acuity levels and nurse-patient ratios, seeking to identify linguistic factors that may affect the quality of information transfer and patient outcomes. A mixed-methods cross-sectional design. This study used the Nurse-to-Nurse Transition of Care Communication Model to explore the content and meaning of language in nursing handoffs within a large academic medical centre. Data were collected on three units through digital audio recordings of 20 handoffs between June and September 2022, which were transcribed and analysed using the Linguistic Inquiry Word Count programme. Trustworthiness was established by adhering to COREQ and STROBE guidelines for qualitative and quantitative research, respectively. Analysis revealed a preference for casual, narrative language across all units, with ICU nurses demonstrating a higher confidence and leadership in communication. Cognitive processes such as insight and causation were found to be underrepresented, indicating a potential area for miscommunication. Communication motives driven by affiliation were more pronounced in ICU settings, suggesting a strong collaborative nature. No significant differences were observed among the units post multiple testing adjustments. Speech dysfluencies were most pronounced in ICU handoffs, reflecting possible stress and cognitive overload. The study highlights the need for improved communication strategies such as interventions to enhance language clarity and incorporating technological tools into handoff processes to mitigate potential miscommunications and errors. The findings advance nursing science by highlighting the critical role of nuanced language in varied-acuity hospital settings and the necessity for structured nurse education in handoff communication and standardized handoff procedures. This study underscores the critical role of language in nurse-to-nurse handoffs. It calls for enhanced communication strategies, technology integration and training to reduce medical errors, improving patient outcomes in high-acuity hospital settings. Nurses only.

Assessing Pollution Sources and Impacts in Gbarnga: A Case Study of Barwror and Kortu Quarters

The rapid urbanization and industrialization of Gbarnga have brought forth significant environmental challenges, including pollution. This study, titled "Assessing Pollution Sources and Impacts in Gbarnga: A Case Study of Barwror and Kortu Quarters," aims to investigate public awareness and participation in pollution reduction initiatives within these communities. The background of the study encompasses the pressing need to address pollution in urban areas like Gbarnga, where industrial activities and urbanization have intensified environmental pressures. Previous research has highlighted the detrimental effects of pollution on public health, ecosystem integrity, and overall well-being, emphasizing the urgency of proactive measures to mitigate pollution levels. The objectives of this research include assessing the level of public awareness regarding environmental regulations and policies aimed at pollution reduction, as well as gauging community willingness to participate in pollution reduction initiatives. Additionally, the study seeks to identify factors influencing public engagement in environmental actions and to provide recommendations for enhancing community involvement in pollution mitigation efforts. The findings reveal a significant gap in public awareness of environmental regulations and policies, with just over half of the population informed about such initiatives. However, there exists a strong willingness among community members to actively engage in pollution reduction initiatives, with over 97% expressing readiness to participate. Further statistical analysis indicates a moderate level of public awareness regarding pollution-related issues, underscoring the need for targeted educational campaigns and enhanced communication strategies. In conclusion, the study emphasizes the importance of strengthening communication channels, launching educational campaigns, fostering inclusive community engagement, encouraging community-research partnerships, and integrating public awareness initiatives into environmental policy frameworks. These recommendations aim to empower communities to actively participate in pollution reduction efforts, ultimately contributing to the attainment of sustainable environmental goals in Gbarnga and similar urban settings.

A National School Health Campaign in Lebanon on Children Aged between 3 and 12 Years Old: Concordance Level between Parents' Reports and Medical Visit Findings about Physical and Mental Health.

A school's commitment to promoting health extends beyond students' efforts to encompass parental involvement and must recognize the critical role of parents in enhancing overall student well-being. This study, conducted in 27 schools across Lebanon, assessed parents' awareness of their children's physical and mental health. A school health campaign involved direct medical interventions on 7184 students, followed by phone interviews with 3880 parents to compare their responses with the medical findings. Discordances ranged from extreme mismatches (≥50%) to mild mismatches (<15%), with notable disparities in incomplete vaccination (67.8%), BMI (59%), and mental health indicators (expressions of sadness (69.1%), loneliness (61.0%), and anxiety (53.4%)). Factors such as school type, child's age, governorate, family income, parents' occupation, education level, and marital status significantly influenced discordance rates. Notably, mental health aspects exhibited higher disparities, emphasizing the need for improved communication between parents, physicians, and children. Bridging these gaps could empower parents with better knowledge, fostering environments conducive to lifelong healthy behaviors in children. The study underscores the urgency for enhanced communication strategies to bridge discrepancies and ensure a more comprehensive understanding of children's physical and mental well-being.

Abstract WP40: Enhanced Team Communication Improves Door to Device Times

Background: Patients experiencing acute ischemic stroke benefit from early reperfusion. The American Heart Association set a goal for hospitals performing mechanical thrombectomy to achieve ‘door to device’ (DTD) time of less than 90 minutes for 50% of eligible patients. In 2021, only 23% of patients were meeting this time target. These patients require complex care and timely communication between various practitioners. It was noted that these practitioners were working in silos, which resulted in unnecessary delays. The need for enhanced communication was identified as an intervention to improve performance. Methods: Key team members are equipped with a dedicated phone using an artificial intelligence application, which provides an early signal when large vessel occlusion is detected. This allows for earlier mobilization of resources. This is particularly important for emergency department and interventional radiology nurses who are the ones driving transition of care between departments. In addition, the anesthesia department uses closed loop communication to notify the team of their readiness to receive the patient. Lastly, timely debriefs for all practitioners involved in the case provide a forum for constructive, thoughtful feedback about ways to be more efficient. Results: After enhanced communication strategies were implemented in quarter 2 of 2022, DTD times improved to 43% in quarter 3 of 2022, 50% in quarter 4 of 2022, 67% in quarter 1 of 2023 and 75% in quarter 2 of 2023. Conclusions: Providing tools to enhance communication amongst various practitioners has resulted in sustained improvement in DTD times. Future data collection should focus on associating these improved DTD times with long term functional outcomes.

Enabling Smart Governance: SIPRAJA Service System Implementation

This study investigates the implementation of SIPRAJA as a manifestation of smart governance in the administration of Suko Village, Sidoarjo Sub-district, Sidoarjo Regency. Employing a descriptive research design with qualitative methodology, data were collected through interviews, documentation, and observation. Findings reveal key aspects for improvement, notably in communication among RT RW entities for more effective dissemination of information to the community. However, the human resource, infrastructure, and disposition factors within SIPRAJA in Sidoarjo Sub-district align effectively with the objectives set by the local government. The village officials in Suko demonstrate optimal performance in service delivery, exhibiting friendly attitudes and assisting residents unfamiliar with the SIPRAJA application. Additionally, the bureaucratic structure ensures clear task allocation and service responsibilities, exemplified by the Village Head's management and the SOP that ensures the issuance of documents without charge, obtainable directly at the village government office. This study underscores the need for enhanced communication strategies while highlighting the successful alignment of resources and bureaucratic structure toward efficient service provision, ultimately advancing the discourse on smart governance implementations in rural settings.&#x0D; Highlights:&#x0D; &#x0D; Improved Communication: Addressing gaps in information dissemination among local entities (RT RW) crucial for community engagement.&#x0D; Efficient Service Provision: Effective utilization of human resources and infrastructure aligned with government objectives.&#x0D; Transparent Bureaucratic Processes: Clear task allocation and SOP ensuring cost-free document issuance, enhancing accessibility for residents.&#x0D; &#x0D; Keywords: Smart Governance, SIPRAJA, Rural Administration, Service Delivery, Bureaucratic Structure

A Descriptive Study of Maternal Vaccination Uptake, Attitudes, and Beliefs in Pregnancy Among Persons Delivering at an Urban Safety Net Hospital.

To estimate uptake of influenza, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap), and COVID-19 vaccines during pregnancy and describe vaccine attitudes and beliefs among predominantly racial and ethnic minority individuals delivering at a publicly funded hospital. We collected survey and electronic medical record data for English-speaking postpartum individuals who delivered a live-born infant from July 7, 2022, through August 21, 2022, and agreed to participate in our study. The 58-item survey included questions about general vaccine attitudes and beliefs as well as vaccine-specific questions. We calculated rates of influenza, Tdap, and COVID-19 vaccinations and compared distributions of survey responses by number (no vaccines, one vaccine, or two or three of the recommended vaccines) and type of vaccines received during pregnancy. Of the 231 eligible individuals, 125 (54.1%) agreed to participate. Rates of influenza, Tdap, and COVID-19 vaccination were 18.4%, 48.0%, and 5.6% respectively. A total of 61 (48.8%) did not receive any recommended vaccines during pregnancy, 40 (32.0%) received one vaccine, and 24 (19.0%) received two or three vaccines. Approximately 66.1% of the no vaccine group, 81.6% of the one vaccine group, and 87.5% of the two or three vaccine group strongly agreed or agreed that they trusted the vaccine information provided by their obstetrician or midwife. While most (>69.2%) agreed that the vaccine-preventable diseases were dangerous for pregnant women, only 24.0%, 29.3%, and 40.3% agreed that they were worried about getting influenza, whooping cough, or COVID-19, respectively, while pregnant. Vaccine uptake in our population was low and may be due, in part, to low perceived susceptibility to vaccine-preventable diseases. Obstetricians and midwives were trusted sources of vaccine information, suggesting that enhanced communication strategies could be critical for addressing maternal vaccine hesitancy, particularly in communities of color justifiably affected by medical mistrust.

Implementing antibiotic stewardship in high-prescribing English general practices: a mixed-methods study.

Trials have identified antimicrobial stewardship (AMS) strategies that effectively reduce antibiotic use in primary care. However, many are not commonly used in England. The authors co-developed an implementation intervention to improve use of three AMS strategies: enhanced communication strategies, delayed prescriptions, and point-of-care C-reactive protein tests (POC-CRPTs). To investigate the use of the intervention in high-prescribing practices and its effect on antibiotic prescribing. Nine high-prescribing practices had access to the intervention for 12 months from November 2019. This was primarily delivered remotely via a website with practices required to identify an 'antibiotic champion'. Routinely collected prescribing data were compared between the intervention and the control practices. Intervention use was assessed through monitoring. Surveys and interviews were conducted with professionals to capture experiences of using the intervention. There was no evidence that the intervention affected prescribing. Engagement with intervention materials differed substantially between practices and depended on individual champions' preconceptions of strategies and the opportunity to conduct implementation tasks. Champions in five practices initiated changes to encourage use of at least one AMS strategy, mostly POC-CRPTs; one practice chose all three. POC-CRPTs was used more when allocated to one person. Clinicians need detailed information on exactly how to adopt AMS strategies. Remote, one-sided provision of AMS strategies is unlikely to change prescribing; initial clinician engagement and understanding needs to be monitored to avoid misunderstanding and suboptimal use.

Improving assessments and follow-up for pediatric emergency department mental health visits

Background: Over the past decade, the number of children presenting to emergency departments (ED) with mental health (MH) concerns has increased substantially. EDs struggle to respond to this increase with approaches that comprehensively address patient needs. The lack of standardized processes to perform risk stratification, assess severity, and ensure access to follow-up care pose barriers to the provision of safe MH care. Our team addressed this gap by introducing an evidence-based care bundle to Alberta’s two pediatric EDs. This report presents the quality improvement (QI) approach used to ensure fidelity of implementation at one of the EDs. This initiative was funded by Alberta Innovates (Partnership for Research and Innovation in the Health System; PRIHS).&#x0D; Methods: We used the Model for Improvement to test and implement each bundle element: suicide risk screening (Ask Suicide-Screening Questions [ASQ]) at ED triage; a tool (HEADS-ED) to streamline and standardize MH assessments by ED-based MH nurse); and an urgent, single-session ‘Choice Appointment’ with a MH professional within 96 hours of the ED visit for patients lacking access to appropriate and timely MH follow-up care. The two ED-based bundle elements did not require additional resources or funding and are expected to reduce length of stay. The follow-up clinic option for ED patients without resources is intended to prevent crisis escalation and match patients with supports. Each new practice was introduced sequentially over a 2-week period. For each practice, we identified 1 to 2 improvement aims, developed key driver diagrams, and selected primary outcomes and measures. Each practice was implemented using Plan-Do-Study-Act (PDSA) cycles with initial tests of change starting small and becoming larger as learning accrued from previous cycles. Our QI team included families with lived experience, patient care and unit managers, nurse educators, frontline healthcare providers, content experts, and clinical leaders who supported staff and led change management strategies. A nurse was hired as a QI lead to support execution of PDSA cycles. We developed a sustainability plan which included embedding education regarding new practices in new healthcare staff orientation, having a measurement strategy to ensure that improvement was maintained, and planning for transition of responsibility for these processes to operational and medical leadership. &#x0D; Evaluation Methods: Primary aims included: 80% of targeted patients would receive the ASQ and HEADS-ED and 100% of children eligible for an Urgent, single-session ‘Choice Appointments’ would be offered it within 96 hours. We used clinical data from the electronic health record (Epic/Connect Care) as well as patient experience data collected via parent/caregiver surveys to determine if the aims for each practice were achieved. We included balancing measures to test whether changes in care in one part of the system introduced unintended consequences in other parts. We evaluated results for the primary aims using run charts to rapidly detect change according to established rules for detecting special cause. We discussed the results from each PDSA cycle in the context of existing healthcare resources to support implementation of each element of the bundle.&#x0D; Results: Tests of change to introduce suicide risk screening began February 1st, 2021. Performance was measured in weekly intervals. The median initial use of ASQ by triage nurses was with 77% of MH patients (686/901 patients), and over time, improved to 93% (319/350 patients), with special cause (shift) in noted September 2021. Tests of change to introduce the HEADS-ED tool began February 16th, 2021. Initial use of the HEADS-ED by MH nurses was 81% (440/555) and improved to 87% (201/227) with special cause (shift) noted August 2021. Urgent, single-session ‘Choice Appointments’ were offered to all patients who did not have timely and access to urgent follow-up with an existing mental healthcare provider with 89.1% having an appointment booked within 96 hours of the ED visit (139/156).&#x0D; Advice and Lessons Learned: Three plans were viewed as crucial to the success of this initiative: 1) a robust strategy to develop proposed changes based on best evidence combined with patient and staff engagement; 2) a comprehensive QI strategy to test, measure, and implement changes; and 3) regular communication and collaboration among ED staff, mental healthcare staff, patients/families, and hospital leadership. There were also lessons learned regarding what could have further enhanced project success: 1) enhanced communication strategies using multiple methods to ensure that project communications reached all stakeholders, including those not regularly present in the ED; 2) hiring the QI lead earlier to begin change management prior to bundle implementation; and 3) outlining a transition plan for clinical data management and bundle monitoring earlier to ease the QI transition to clinical leadership.

O01 Nuances of implementing antibiotic stewardship in high-prescribing English general practices: an implementation study

BackgroundTrials have identified several antimicrobial stewardship (AMS) strategies that effectively reduce antibiotic use in primary care. However, many are not commonly used in England and evidence is lacking around how to support high-prescribing general practices to implement AMS. We co-developed a customizable implementation intervention to improve adoption and use of three AMS strategies; enhanced communication strategies with/without patient leaflets, delayed prescriptions, and point-of-care C-reactive protein testing (POC-CRPT). This study aimed to investigate the use of the implementation intervention in high-prescribing practices and its effect on antibiotic prescribing.MethodsNine high-prescribing practices had access to the intervention for 12 months from November 2019. This was primarily delivered remotely via the ‘Antibiotic Optimisation’ website with practices required to identify an in-practice ‘Antibiotic Champion’. In a mixed-methods evaluation, we compared routinely collected prescribing data between 9 intervention and 45 matched control practices using a difference in differences analysis. Intervention material use was assessed through website monitoring and practice requests for supplies. Surveys and interviews were conducted with professionals at baseline and follow-up timepoints to capture experiences of using the intervention.ResultsThere was no evidence that the intervention affected antibiotic prescribing. Engagement with intervention materials differed substantially between practices and depended on the individual Antibiotic Champion's preconceptions regarding the AMS strategies and opportunity to do the implementation tasks. Champions in five practices initiated changes to encourage use of at least one of the three AMS strategies, mostly POC-CRPT and patient leaflets. One Champion used the website resources to drive discussions about implementation of all three strategies in their practice. Elsewhere, lack of website engagement meant clinicians did not recognize novelty in the communication and delayed prescription content. POC-CRPT was used most often when equipment was allocated to one person in a practice.ConclusionsAMS strategies are complex interventions and require clinicians to have detailed knowledge on how to adopt them in practice if they are to reduce antibiotic prescribing. Successful adoption may be achieved by allocating one or two persons to use an AMS strategy rather than all clinicians. Although effective in trials, remote, one-sided provision of AMS strategies is unlikely to change prescribing; initial clinician engagement and understanding needs to be monitored to avoid misunderstanding and suboptimal use.

"Moving the Science Forward": Faculty Perceptions of Culturally Diverse Mentor Training Benefits, Challenges, and Support.

There is a pressing need for deeper cultural awareness among postsecondary faculty, yet few studies focus on institutions with developing research infrastructure, which enroll large proportions of racially minoritized students. Using social exchange theory, we investigate faculty members’ perceptions of “culturally diverse mentor training,” which includes culturally aware mentor (CAM) training, Entering Mentoring, and self-designed mentor training initiatives. Data come from qualitative interviews with 74 faculty who participated in culturally diverse mentor training activities across 10 master’s and doctoral institutions in the early stages of implementing grant-funded interventions focused on determining the most effective ways to engage and retain racially minoritized students in biomedical research. Findings indicate that faculty perceived a deepened understanding of their mentees’ challenges and developed enhanced communication strategies to better appreciate cultural differences. Faculty reported several challenges, such as difficulty in adopting culturally sustaining practices, balancing multiple commitments internal and external of grant requirements, and dissatisfaction with facilitators from outside their disciplines. They also described supportive structures that decreased their mentoring workload, such as complementary curricula and tiered mentoring models. We conclude with implications for higher education leaders interested in adapting and scaling culturally diverse mentor training interventions within their own departments and institutions.

COVID-19 stories of success: Teaching and learning in a clinical setting during a pandemic

IntroductionThe onset of the COVID-19 pandemic halted in-person activities in universities and caused disruption in the usual iteration of the semesters. When the clinical environment resumed student placement, the potential health risks caused additional anxiety to the students and clinical faculty. This paper aims to examine the measures implemented to support the radiation therapy students during their first clinical placement during the COVID-19 pandemic. BackgroundThe 2nd year radiation therapy students’ first clinical placement was organized around pandemic restrictions that required new activities to support student safety and wellness. The clinical faculty team redesigned the clinical course to integrate enhanced communication, additional safety measures and mental wellness sessions, as well as making COVID-19 related resources available during the week-long orientation and throughout the semester. MethodsRegistered students were asked to participate in a 9-item survey questionnaire to gather their perspective on the effectiveness of the orientation and clinical activities during the pandemic. The responses were tabulated and independently analyzed for emergent themes by the clinical faculty. DiscussionThe students reported that the combination of activities, workshops, exposure to the treatment unit and feedback from both clinical faculty and learning mentors provided the support needed for physical safety and wellness in the clinic. Identified challenges included communication with continuous masking, the timeliness of communicating evolving clinical safety protocols, and the need for enhanced coordination of interprofessional education. ConclusionThe COVID-19 pandemic brought new challenges and opportunities for students and clinical faculty at the University of Alberta's Radiation Therapy department. The results of the quality improvement survey highlighted the importance and effectiveness of the redesigned clinical course, which integrated COVID-19 related activities, enhanced communication strategies, safety, wellness resources and check-ins throughout the course.

Classical communication through quantum causal structures

Quantum mechanics allows operations to be in indefinite causal order. Recently there have been active discussions on enhanced communication strategies through exotic causal structures. In light of this, through the process matrix formalism, we formulate different classical capacities for a bi-partite quantum process. We find that a one-way communication protocol through an arbitrary process cannot outperform a causally separable process, i.e., we can send at most one bit per qubit. Next, we study bi-directional communication through a causally separable process. Our result shows, a bi-directional protocol cannot exceed the limit of one way communication protocol. Finally, we generalise this result to multi-party broadcast communication protocol through a definite ordered process.

Pivoting Nursing Research and Scholarship During the COVID-19 Pandemic.

The global COVID-19 pandemic has brought numerous challenges for conducting the human subjects research needed to advance science and improve health. The purpose of this article is to discuss how a college of nursing at a large public university in the southeast United States has responded to the challenges of conducting research during the novel COVID-19 pandemic. Seven faculty researchers at the University of South Carolina College of Nursing share their experiences in overcoming the unique challenges of conducting research because of the COVID-19 pandemic. Strategies to overcome the challenges posed by COVID-19 are presented within the context of the research process, career implications, communication, and maintaining morale. Fears of COVID-19 and social distancing measures have hindered participant recruitment, enrollment, and involvement in ongoing studies. Increasing virtual technology use and enhancing safety precautions have assisted researchers to overcome barriers. Scholarly writing has increased for some faculty members whose studies have been stalled by the pandemic, yet others have seen a decline because of additional personal responsibilities. The careers of faculty members across all ranks have been uniquely affected by the pandemic. With most faculty working remotely, enhanced communication strategies at the university and college have supported the research enterprise. Morale has been adversely affected, but a variety of personal and collegial efforts have helped faculty cope and preserve a sense of normalcy during this devastating pandemic. Faculty and their ability to conduct the research needed to inform clinical and public health practice have been adversely affected by the COVID-19 pandemic. Despite the challenges of conducting research during this unprecedented crisis, faculty and institutions are taking novel steps to ensure the continuity of scientific progress for improving the health and well-being of patients and populations.

642-P: Identifying Value Propositions to Engage Patients with Type 2 Diabetes in Shared Medical Appointments

Objective: Type 2 diabetes (T2D) affects 12% of U.S. adults and is a major public health burden. Shared medical appointments (SMAs) are an effective strategy to deliver diabetes self-management education and support (DSMES) alongside medical care, yet recruitment is a common challenge. Enhanced communication strategies have been recommended, while identifying specific messaging to engage patients with T2D remains needed. Methods: The Invested in Diabetes project is a cluster-randomized, pragmatic comparative effectiveness trial of two models of SMAs using an evidence-based DSMES curriculum. To aid recruitment at 22 primary care clinics, a group of patient, practice and research stakeholders used value proposition design strategies to develop tailored messaging on how SMAs can reduce pains and yield gains related to T2D. Patient stakeholders further refined messages to ensure patient-driven language. Here we describe value propositions for patients with newly diagnosed or uncontrolled T2D, diabetes distress, and comorbid conditions, plus concerned others. Results: General messaging emphasized how SMAs may help patients with T2D through expert education, addressing concerns, behavior change strategies, problem-solving, stress-coping skills, normalizing, and peer support. Messaging emphasized respect for autonomy (“you are your best health advocate”) coupled with available support (“you don’t have to go it alone”). For uncontrolled T2D, messages further conveyed opportunities to “finally take control” of T2D. For diabetes distress, messages also conveyed how SMAs may reduce feeling overwhelmed by T2D. Concerned others were encouraged to show support by telling patients about diabetes SMAs. Conclusions: Value proposition themes include how diabetes SMAs can improve T2D control and related stress, which may aid patient engagement. For clinics offering diabetes SMAs, messaging can be delivered by care team members and integrated into various recruitment activities. Disclosure N.D. Ritchie: None. A. Begum: None. J. Dailey-Vail: None. J. Rementer: None. R.A. Koren: None. S.A. Trujillo: None. P. Phimphasone-Brady: None. K.A. Cassidy: None. R. Wearner: None. J. Waxmonsky: None. B. Kwan: None. Funding Patient-Centered Outcomes Research Institute (IHS-1609-36322)

Qualitative Study of Treatment Preferences for Rheumatoid Arthritis and Pharmacotherapy Acceptance: Indigenous Patient Perspectives.

ObjectiveTo explore patient preferences that influence decision‐making in the management of rheumatoid arthritis (RA) by indigenous patients living in southern Alberta, Canada.MethodsWe conducted a qualitative narrative‐based study within a social constructivist framework. Thirteen in‐depth interviews with indigenous patients with RA who had attended 1 of 3 rheumatology practices in southern Alberta (1 rural and 2 urban) were completed. Codes generated through 2 phases of analysis were condensed into main themes, triangulated, and used to produce theoretical statements.ResultsPatients preferred to use a combination of nonpharmacologic and pharmacologic treatments to manage their RA. Nonpharmacologic treatments included physical, mental, emotional, and spiritual strategies. Patients’ preferences for taking medications varied and were influenced by factors that were clinical (i.e., trust in health providers and understanding drugs’ mechanisms of action, benefits, harms, and administration burden), familial (i.e., support), and societal (i.e., access to medications and stigmatization of drug dependency).ConclusionIndigenous patients apply a holistic approach to the nonpharmacologic management of RA. Increases in preferences for RA medications could be supported through enhanced communication strategies to increase patient understanding of medication effects and health provider recognition of societal and familial influences on patient decisions. A patient–provider relationship based on trust was fundamental to reaching mutual understanding and should be fostered by models of practice that promote cultural safety, empathy, compassion, openness, acknowledgment, and respect of cultural differences.

COVID-19: what is next for public health?

COVID-19: what is next for public health?

Black Americans' Perspectives of Barriers and Facilitators of Community Screening for Kidney Disease.

Incidence of ESKD is three times higher in black Americans than in whites, and CKD prevalence continues to rise among black Americans. Community-based kidney disease screening may increase early identification and awareness of black Americans at risk, but it is challenging to implement. This study aimed to identify participants' perspectives of community kidney disease screening. The Health Belief Model provides a theoretic framework for conceptualization of these perspectives and optimization of community kidney disease screening activities. Researchers in collaboration with the Tennessee Kidney Foundation conducted three focus groups of adults in black American churches in Nashville, Tennessee. Questions examined views on CKD information, access to care, and priorities of kidney disease health. Content analysis was used. Guided by the Health Belief Model, a priori themes were generated, and additional themes were derived from the data using an inductive approach. Thirty-two black Americans completed the study in 2014. Participants were mostly women (79%) with a mean age of 56 years old (range, 24-78). Two major categories of barriers to kidney disease screening were identified: (1) participant factors, including limited kidney disease knowledge, spiritual/religious beliefs, emotions, and culture of the individual; and (2) logistic factors, including lack of convenience and incentives and poor advertisement. Potential facilitators of CKD screening included provision of CKD education, convenience of screening activities, and use of culturally sensitive and enhanced communication strategies. Program recommendations included partnering with trusted community members, selecting convenient locations, tailored advertising, and provision of compensation. Findings of this study suggest that provider-delivered culturally sensitive education and stakeholder engagement are critical to increase trust, decrease fear, and maximize participation and early identification of kidney disease among black Americans considering community screening.

Mortality and Cardiovascular Complications in Older Complex Chronic Patients with Type 2 Diabetes.

Aims/Introduction Determining the prevalence of diabetes and its cardiovascular complications and all-cause mortality in older chronic complex patients. Materials and Methods We carried out a multicenter retrospective study and included a randomized sample of 932 CCP people. We assessed the prevalence of diabetes according to World Health Organization criteria. Data included demographics and functional, comorbidity, cognitive, and social assessment. Results The prevalence of diabetes was 53% and average age 81.16 ± 8.93 years. There were no significant differences in the survival of CCP patients with or without DM, with or without ischaemic cardiopathy, and with or without peripheral vascular disease. The prognostic factors of all-cause mortality in patients with DM were age ≥ 80 years [HR 1.47, 95% CI 1.02–2.13, p 0.038], presence of heart failure [HR 1.73, 95% CI 1.25–2.38, p 0.001], Charlson score [HR 1.20, 95% CI 1.06–1.36, p 0.003], presence of cognitive impairment [HR 1.73, 95% CI 1.24–2.40, p 0.001], and no treatment with statins [HR 1.49, 95% CI 1.08–2.04, p 0.038]. Conclusions We found high prevalence of DM among CCP patients and the relative importance of traditional risk factors seemed to wane with advancing age. Recommendations may include relaxing treatment goals, providing family/patient education, and enhanced communication strategies.

Global Adoption of Genetically Modified (GM) Crops: Challenges for the Public Sector.

Advances in biotechnology continue to drive the development of a wide range of insect-protected, herbicide-tolerant, stress-tolerant, and nutritionally enhanced genetically modified (GM) crops, yet societal and public policy considerations may slow their commercialization. Such restrictions may disproportionately affect developing countries, as well as smaller entrepreneurial and public sector initiatives. The 2014 IUPAC International Congress of Pesticide Chemistry (San Francisco, CA, USA; August 2014) included a symposium on "Challenges Associated with Global Adoption of Agricultural Biotechnology" to review current obstacles in promoting GM crops. Challenges identified by symposium presenters included (i) poor public understanding of GM technology and the need for enhanced communication strategies, (ii) nonharmonized and prescriptive regulatory requirements, and (iii) limited experience with regulations and product development within some public sector programs. The need for holistic resistance management programs to enable the most effective use of insect-protected crops was also a point of emphasis. This paper provides details on the symposium discussion and provides background information that can be used in support of further adoption of beneficial GM crops. Overall, it emphasizes that global adoption of modern agricultural biotechnology has not only provided benefits to growers and consumers but has great potential to provide solutions to an increasing global population and diminishing agricultural land. This potential will be realized by continued scientific innovation, harmonized regulatory systems, and broader communication of the benefits of the high-yielding, disease-resistant, and nutritionally enhanced crops attainable through modern biotechnology.

MyPlate Celebrates 4 Years

On June 2, 2011, MyPlate was introduced to the country to communicate key recommendations from the 2010 Dietary Guidelines for Americans and provide Americans with a new way to think about their daily food choices. The US Department of Agriculture (USDA) Center for Nutrition Policy and Promotion has experienced phenomenal support for MyPlate, largely from registered dietitian nutritionists (RDNs) who are committed to improving health outcomes for individuals by encouraging healthier food and physical activity behaviors. The Guidelines are a foundation for many nutrition initiatives, and as we move forward in creating the 2015 Dietary Guidelines for Americans we will continue to strengthen our relationship with nutrition and dietetics practitioners. Your hard work has led the way in developing innovative approaches to addressing adult and childhood obesity; providing relevant counseling and education; maintaining effective nutrition and food services; and building healthier school, work, community, and home settings to encourage healthier food and physical activity choices. The USDA Center for Nutrition Policy and Promotion (CNPP) is staffed with like-minded professionals who are responsive to your needs and have worked diligently to expand ChooseMyPlate.gov to offer you more. CNPP supports the efforts of those who work to improve the health of Americans and celebrates this fourth anniversary with a few highlights from the extensive array of resources and tools available for your education and outreach efforts. The growing range of ethnicities in communities across the country requires professionals to offer health education materials in various languages. In an effort to make the Guidelines more accessible, ChooseMyPlate.gov now features the MyPlate icon and select information from the 10 Tips Nutrition Education Series translated into 18 different languages, complementing our English and Spanish versions. The translated MyPlate icons and corresponding tip sheets can be used by providers to assist Americans from diverse language backgrounds in understanding how to build a healthy plate. SuperTracker reaches more than 5 million registered users and can further support your counseling and education efforts when implemented with the SuperTracker Worksite Wellness Toolkit and SuperTracker Nutrition Lesson Plans for High School Students. Our interactive food, physical activity, and weight tracking tool was launched in December 2011 and serves as the public interface for the Guidelines. The comprehensive tool addresses themes from the 2010 Dietary Guidelines and includes features that support individual weight goals and healthy eating patterns such as self-monitoring, personalized recommendations, and customizable goal setting. Get periodic announcements about campaigns, events, and the launch of the 2015 Dietary Guidelines for Americans delivered to your inbox. More than 420,000 individuals have subscribed to stay on top of current MyPlate activities. Becoming an e-mail subscriber to ChooseMyPlate.gov is one more way to keep MyPlate in mind. Social media has exploded in popularity and generates meaningful conversations that we want to participate in. As of June 2015, @MyPlate had amassed over 78,000 followers on Twitter and the MyPlate Facebook page had established a fan base of over 55,000. These MyPlate social media platforms offer a way for consumers and health professionals alike to stay connected and receive daily reminders and tips that encourage healthy lifestyles. We are listening to you and strive to provide content that speaks to your personal and professional networks. By sharing accurate, science-based nutrition information, you too can help drive the conversation online. ChooseMyPlate.gov promotes the Guidelines by featuring actionable information that can be used with specific audiences. Examples include the latest group education resource, MyPlate for My Family Toolkit, which includes a leader’s guide and four discussion sessions to assist registered dietitian nutritionists and other professionals in delivering education to families who have limited resources. The Healthy Eating on a Budget section of ChooseMyPlate.gov also provides consumer-oriented materials to address the daily routine of planning, purchasing, and preparing appealing, budget-conscious meals and snacks. We know that part of the answer to successfully addressing the challenges of chronic disease and obesity lies in being part of your team as you work on the front lines to make an impact. CNPP is motivated to do more and think broader to make your work a little easier as we continue to create new policy, strategies, and resources. Things to come include a new look and feel for ChooseMyPlate.gov, more consumer-oriented resources, new features for SuperTracker, and enhanced communication strategies to support the 2015 Dietary Guidelines for Americans. We will continue to dialogue with you and look forward to hearing your feedback as we all work to make the future healthier with MyPlate.