Routine Health Care Practice Research Articles

Geriatric Health Care During the COVID-19 Pandemic: Managing the Health Crisis.

COVID-19 pandemic significantly threatens the health and well-being of older adults. Aging-related changes, including multimorbidity, weakened immunity and frailty, may make older people more susceptible to severe infection and place them at higher risk of morbidity and mortality from COVID-19. Various quarantine measures have been implemented to control the spread of COVID-19. Nevertheless, such social distancing has disrupted routine health care practices, such as accessibility of medical services and long-term continuous care services. The medical management of older adults with multimorbidity is significantly afflicted by COVID-19. Older persons with frailty or multiple chronic disease may poorly adapt to the altered health care system, having detrimental consequences on their physical and mental health. COVID-19 pandemic has posed great challenges to the health of older adults. We highlighted the difficulties and obstacles of older adults during this unprecedented time. Also, we provided potential strategies and recommendations for actions to mitigate the COVID-19 pandemic threats. Certain strategies like community primary health care, medication delivery and home care support are adopted by many health facilities and caregivers, whereas other services such as internet hospital and virtual medical care are promoted to be accessible in many regions. However, guidelines and policies based on high-quality data are still needed for better health promotion of older groups with increasing resilience during the COVID-19 pandemic.

Patient-Physician Relationships and Mammography Use in Korean American Women.

Breast cancer is prevalent and fatal in Korean American women (KAW) and KAW report low screening rates. This study examined the impact of patient-physician relationships on mammography use in KAW, focusing on patient-physician ethnic and gender concordance, distrust in health professionals, and accessibility to health care. Cross-sectional survey data were collected from 340 KAW in North Carolina, and logistic regression was conducted to identify factors associated with mammography use. Having a non-Korean physician, regular check-ups, and physician recommendations were positively associated with getting mammography. Neither gender concordance nor distrust in health professionals predicted adherence to breast cancer screening guidelines. The findings highlight the critical roles of routine health care practice and usual source of care in compliance with the screening guidelines in KAW. Additional research is warranted to explore breast cancer screening recommendation behaviors and patterns of Korean American physicians compared to non-Korean counterparts.

Missed opportunities for vaccination (MOV) in children up to 5 years old in 19 Médecins Sans Frontières-supported health facilities: a cross-sectional survey in six low-resource countries

ObjectiveTo describe missed opportunities for vaccination (MOV) among children visiting Médecins Sans Frontières (MSF)-supported facilities, their related factors, and to identify reasons for non-vaccination.DesignCross-sectional surveys conducted between 2011 and 2015.Setting...

How long does it take to translate research findings into routine healthcare practice?-the case of biological drugs for rheumatoid arthritis in Brazil.

BackgroundThe literature reports long time lags between the several processes involved in the translation of drug research and development into clinical application. To expedite these processes, translational research has emerged as a process that can be applied to reduce the lag between scientific discoveries and their practical application. Thus, the objective of this study was to estimate the time lag in translational research of biological drugs for the treatment of rheumatoid arthritis included in the Brazilian Unified Health System [Sistema Único de Saúde (SUS)].MethodsA descriptive retrospective study was conducted based on secondary data loaded by SUS users in public sources and systems to estimate the time lag between the publication of phase I clinical trial results to drug use in clinical settings. The dates of translational research activities were identified from markers and steps. Structured searches were conducted in the literature and reports from the National Commission for the Incorporation of Technologies in the SUS (Conitec) as well as from health authorities, and analyzed.ResultsBetween 2012 and 2019, SUS included five biological agents for the treatment of rheumatoid arthritis. The mean time lag from clinical development to use of these agents was 11.13 years (range, 8.57 to 12.90 years). The mean time lag for the stages of translational research were 5.30 (T1—basic research to clinical research), 5.08 (T2—clinical research to research synthesis), and 0.75 (T3—research synthesis to evidence-based practice) years. A shorter time lag was observed in the Brazilian case when it was possible to compare with other studies.ConclusionsThe estimated time lag of biological drugs used in the treatment of rheumatoid arthritis was determined based on the translational research steps model adapted to the Brazilian context. Brazil has instituted legal frameworks that set deadlines for sanitary registration, health technology assessment (HTA), and the availability of drugs in the SUS, thus, allowing for a reduced stage T2 time lag. Nevertheless, improvements are still required in stages T1 and T2, especially in publishing the results of clinical trials.

Challenges and recommendations for the management of asthma in the Middle East and Africa.

Clinical presentation of asthma is variable, and its diagnosis can be a major challenge in routine health-care practice, especially in low-and-middle-income countries. The aim of asthma management is to achieve optimal asthma control and to reduce the risk of asthma exacerbations and mortality. In the Middle East and in Africa (MEA), several patient- and physician-related factors lead to misdiagnosis and suboptimal management of asthma. A panel of experts comprising of specialists as well as general health-care professionals met to identify challenges and provide recommendations for the management of asthma in MEA. The major challenges identified for diagnosis of asthma were lack of adequate knowledge about the disease, lack of specialized diagnostic facilities, limited access to spirometry, and social stigma associated with asthma. The prime challenges for management of asthma in MEA were identified as overreliance on short-acting β-agonists (SABAs), underprescription of inhaled corticosteroids (ICS), nonadherence to prescribed medications, and inadequate insurance coverage for its treatment. The experts endorsed adapting the Global Initiative for Asthma guidelines at country and regional levels for effective management of asthma and to alleviate the overuse of SABAs as reliever medications. Stringent control over SABA use, discouraging over-the-counter availability of SABA, and using as-needed low-dose ICS and formoterol as rescue medications in mild cases were suggested to reduce the overreliance on SABAs. Encouraging SABA alone-free clinical practice in both outpatient and emergency department settings is also imperative. We present the recommendations for the management of asthma along with proposed regional adaptations of international guidelines for MEA.

Protocol of a multiphase study on telemedicine for older adults in primary care

IntroductionTelemedicine (TM) has been adopted by many health authorities to limit unnecessary exposure during COVID-19. Prior to the pandemic, TM was associated with improvement of quality of life of older...

Toward Successful Implementation of Artificial Intelligence in Health Care Practice: Protocol for a Research Program.

BackgroundThe uptake of artificial intelligence (AI) in health care is at an early stage. Recent studies have shown a lack of AI-specific implementation theories, models, or frameworks that could provide guidance for how to translate the potential of AI into daily health care practices. This protocol provides an outline for the first 5 years of a research program seeking to address this knowledge-practice gap through collaboration and co-design between researchers, health care professionals, patients, and industry stakeholders.ObjectiveThe first part of the program focuses on two specific objectives. The first objective is to develop a theoretically informed framework for AI implementation in health care that can be applied to facilitate such implementation in routine health care practice. The second objective is to carry out empirical AI implementation studies, guided by the framework for AI implementation, and to generate learning for enhanced knowledge and operational insights to guide further refinement of the framework. The second part of the program addresses a third objective, which is to apply the developed framework in clinical practice in order to develop regional capacity to provide the practical resources, competencies, and organizational structure required for AI implementation; however, this objective is beyond the scope of this protocol.MethodsThis research program will use a logic model to structure the development of a methodological framework for planning and evaluating implementation of AI systems in health care and to support capacity building for its use in practice. The logic model is divided into time-separated stages, with a focus on theory-driven and coproduced framework development. The activities are based on both knowledge development, using existing theory and literature reviews, and method development by means of co-design and empirical investigations. The activities will involve researchers, health care professionals, and other stakeholders to create a multi-perspective understanding.ResultsThe project started on July 1, 2021, with the Stage 1 activities, including model overview, literature reviews, stakeholder mapping, and impact cases; we will then proceed with Stage 2 activities. Stage 1 and 2 activities will continue until June 30, 2026.ConclusionsThere is a need to advance theory and empirical evidence on the implementation requirements of AI systems in health care, as well as an opportunity to bring together insights from research on the development, introduction, and evaluation of AI systems and existing knowledge from implementation research literature. Therefore, with this research program, we intend to build an understanding, using both theoretical and empirical approaches, of how the implementation of AI systems should be approached in order to increase the likelihood of successful and widespread application in clinical practice.International Registered Report Identifier (IRRID)PRR1-10.2196/34920

A Self-help Tool to Facilitate Implementation of eHealth Initiatives in Health Care (E-Ready): Formative Evaluation.

BackgroundeHealth interventions have the potential to increase the efficiency and effectiveness of health care. However, research has shown that implementing eHealth in routine health care practice is difficult. Organizational readiness to change has been shown to be central to successful implementation. This paper describes the development and formative evaluation of a generic self-help tool, E-Ready, designed to be used by managers, project leaders, or others responsible for implementation in a broad range of health care settings.ObjectiveThe aim of this study is to develop and evaluate a tool that could facilitate eHealth implementation in, for example, health care.MethodsA first version of the tool was generated based on implementation theory (E-Ready 1.0). A formative evaluation was undertaken through expert panels (n=15), cognitive interviews (n=17), and assessment of measurement properties on E-Ready items from 3 different workplaces (n=165) using Rasch analyses. E-Ready 1.0 was also field tested among the target population (n=29). Iterative revisions were conducted during the formative evaluation process, and E-Ready 2.0 was generated.ResultsThe E-Ready Tool consists of a readiness assessment survey and a hands-on manual. The survey measures perceived readiness for change (willingness and capability) at individual and collective levels: perceived conditions for change at the workplace, perceived individual conditions for change, perceived support and engagement among management, perceived readiness among colleagues, perceived consequences on status quo, and perceived workplace attitudes. The manual contains a brief introduction, instructions on how to use the tool, information on the themes of E-Ready, instructions on how to create an implementation plan, brief advice for success, and tips for further reading on implementation theory. Rasch analyses showed overall acceptable measurement properties in terms of fit validity. The subscale Individual conditions for change (3 items) had the lowest person reliability (0.56), whereas Perceived consequences on status quo (5 items) had the highest person reliability (0.87).ConclusionsE-Ready 2.0 is a new self-help tool to guide implementation targeting health care provider readiness and engagement readiness ahead of eHealth initiatives in, for example, health care settings. E-Ready can be improved further to capture additional aspects of implementation; improvements can also be made by evaluating the tool in a larger sample.

COVID-19 pandemisinin meme kanseri tanısına etkisinin değerlendirilmesi

Objective: The COVID-19 pandemic has caused serious changes in our routine healthcare practices. With this study, we aimed to determine the effect of the pandemic on the diagnosis of breast cancer. Methods:The medical records of patients who applied for breast imaging between March 2019 and January 2021 were retrospectively scanned. Among the patients diagnosed with BI-RADS category 4 and 5, those who had percutaneous ultrasound-guided core needle breast biopsy (CNBB) and excisional biopsy after ultrasound guided wire marking (UGWM) were included in the study. The study period was divided into two groups; March 2019-January 2020 was grouped as pre-pandemic and March 2020-January 2021 post-pandemic. Results:A total of, 14200 breast imaging examinations were performed in 9378 patients in the pre-pandemic period, and 3778 breast imaging examinations were performed in 2375 patients in the post-pandemic period. The mean age of the patients was 48.98±14.11 years. While the number of lesions biopsied was 201 (1.4%) in the pre-pandemic period, it was 61 (1.6%) in the post-pandemic period. The number of malignant breast lesions was 97 before the pandemic and 30 after the pandemic. After the pandemic, the number of patients undergoing breast imaging, the number of examinations, the number of biopsy, the number of malignant lesions decreased by 74%, 73%, 69% and 69%, respectively. The highest decrease in the number of examination was in April and May, with 97.55% and 96.35%. Conclusions:With the pandemic, the number of patients admitted to the hospital, the number of breast imaging, the number of biopsy and the number of malignant breast lesions detected decreased about 70%. It has been noticed that during the pandemic process, patients have been delaying their regular check-ups and the time to apply to the hospital has been prolonged.

Responses of a Pre-hospital Emergency Medical Service During Military Conflict Versus COVID-19: A Retrospective Comparative Cohort Study.

ABSTRACTBackgroundDecreases in routine healthcare practices have been shown to occur during disasters. However, research regarding the impacts of natural disasters, pandemics, or military conflicts on emergency medical services (EMS) is scarce.ObjectivesThis study assessed the impact of a military conflict versus the coronavirus disease 2019 (COVID-19) pandemic on a national EMS organization in terms of responses to overall daily emergencies, medical illnesses, motor vehicle collisions, and other injuries.MethodsThis retrospective comparative cohort study assessed daily routine emergency ambulance calls to Magen David Adom (MDA), Israel’s national EMS organization. This included overall emergency calls as well as those related to medical illnesses, motor vehicle collisions (MVCs), and other injuries. All data were obtained from the MDA command and control database. During the military conflict Operation Protective Edge (2014), the civilian population was subjected to intensive rocket attacks for 24 days, followed by 26 days of a progressive withdrawal of operations and then to a post-conflict period. During the first wave of the COVID-19 pandemic (March-April 2020), the population was subjected to 32 days of total lockdown, followed by 27 days of progressive relief of confinement, and then to a post-lockdown period.ResultsThe total number of emergency calls in this study was 330,430. During the conflict, the mean number of daily calls decreased, followed by an increase during Relief and Post-Conflict with higher values in Post-Conflict than in Pre-Conflict. During the COVID-19 pandemic, there was a decrease in the mean daily number of calls during Lockdown. It remained low during Relief and increased during Post-Lockdown. However, it remained lower in Post-Lockdown than during Pre-Lockdown. Calls related to medical illnesses decreased during the conflict and during the lockdown. The post-conflict period was characterized by a similar baseline call magnitude but not during the post-lockdown period. Decreases in calls for MVC and other injuries were significant during the lockdown but not during the military conflict. Post-lockdown was accompanied by return to baseline call volumes for MVC, whereas calls for other injuries increased above baseline both after the lockdown and military conflict.ConclusionThis study shows decreasing trends in routine daily calls for EMS during both Operation Protective Edge and COVID-19. However, different patterns of needs for EMS were evidenced for medical illnesses, MVC, or calls concerning other injuries. These results are instrumental for managing the operational demands of EMS during military conflicts and pandemics.

Safety monitoring experience of single-low dose primaquine co-administered with artemether\u2013lumefantrine among providers and patients in routine healthcare practice: a qualitative study in Eastern Tanzania

BackgroundPrimaquine is a gametocytocidal drug recommended by the World Health Organization (WHO) in a single-low dose combined with artemisinin-based combination therapy (ACT) for the treatment and prevention of Plasmodium falciparum malaria transmission. Safety monitoring concerns and the lack of a universal validated and approved primaquine pharmacovigilance tool is a challenge for a national rollout in many countries. This study aimed to explore the acceptance, reliability and perceived effectiveness of the primaquine roll out monitoring pharmacovigilance tool (PROMPT).MethodsThis study was conducted in three dispensaries in the Coastal region of Eastern Tanzania. The study held six in-depth interviews with healthcare providers and six participatory focus group discussions with malaria patients (3) and parents/guardians of sick children (3). Participants were purposively sampled. Thematic analysis was conducted with the aid of NVivo qualitative analysis software.ResultsThe respondents’ general acceptance and perceived effectiveness of the single-low dose primaquine and PROMPT was good. Screening procedure for treatment eligibility and explaining to patients about the possible adverse events was considered very useful for safety reasons. Crushing and dissolving of primaquine tablet to get the appropriate dose, particularly in children, was reported by all providers to be challenging. Transport costs and poor access to the health facility were the main reasons for a patient failing to return to the clinic for a scheduled follow-up visit. Treatment was perceived to be safe by both providers and patients and reported no case of a severe adverse event. Some providers were concerned with the haemoglobin drop observed on day 7.ConclusionSingle-low dose primaquine was perceived to be safe and acceptable among providers and patients. PROMPT demonstrated to be a reliable and user-friendly tool among providers. Further validation of the tool by involving the National Malaria Control Programme is pivotal to addressing key challenges and facilitating primaquine adoption in the national policy.

Accuracy of Transvaginal Ultrasound in the Diagnosis of Intrauterine Lesions.

To evaluate the accuracy of transvaginal ultrasound in the diagnosis of intrauterine lesions, using hysteroscopy as the gold standard. This was a prospective observational study with 307 patients. All patients underwent hysteroscopy after a previous transvaginal ultrasound to compare the results. The hysteroscopy was performed by experienced examiners, and transvaginal ultrasounds were performed in various public and private services, which is reflective of routine healthcare practices in obstetrics and gynecology. The sensitivity, specificity, and accuracy of the transvaginal ultrasound were calculated using hysteroscopy as the gold standard. The level of agreement between the two exams was calculated using the Kappa test. The mean age was 56.55 ± 12.3 years. For endometrial polyps, we observed a sensitivity of 39.8%, specificity of 72.7%, accuracy of 52.8%, and Kappa index of 0.11 (p = 0.025). For fibroids, the sensitivity was 46.7%, specificity was 95.0%, accuracy was 87.9%, and Kappa index was 0.46 (p < 0.001). For endometrial thickening, the sensitivity was 68.7%, specificity was 41.7%, accuracy was 47.6%, and Kappa index was 0.06 (p = 0.126). For endometrial atrophy, we found a sensitivity of 6.7%, specificity of 99.3%, accuracy of 90.2%, and Kappa index of 0.10 (p = 0.006). For the other findings, the sensitivity was 15.6%, specificity was 99.6%, accuracy was 87.3%, and Kappa index was 0.23 (P < 0.001). Our study demonstrated a low level of accuracy of transvaginal ultrasound for the diagnosis of endometrial lesions, when performed by a non-experienced professional. Thus, it is important to consider the use of hysteroscopy to avoid unnecessary and inappropriate treatments.

A Survey of Smallholder Farms Regarding Demographics, Health Care, and Management Factors of Donkeys in Northeastern China.

Essential information on the population dynamics and the health and welfare of Chinese donkeys is scarce. The objectives of this study were to describe the demographic characteristics, management and health care of a sample of donkeys under smallholder farm conditions of northeastern China. A cross-sectional survey of 731 randomly selected donkey owners on smallholder farms (1,658 donkeys) in 40 villages of northeastern China was conducted. Data on the composition and management of the donkeys and their routine health care were analyzed. The surveyed donkey population consisted of mostly (83.8%) jenny/filly donkeys with a mean age of 6.2 ± 5.0 years. Most (91.2%) of the farms kept 1–4 donkeys. The majority of donkeys were used for breeding and labor. Most (93.8%) of the farms did not have bedding, and their mean stable size was 17.7 ± 10.1 m2. All of the animals were turned out for at least part of the year. The mean size of the turnout areas on the farms was 17.8 m2. The condition of 12.5% of the donkeys was evaluated as “poor” with a body condition score of 1 on a scale of 5. More than one third (37.9%) of the donkeys had never been dewormed. Also, none of them were ever vaccinated or received dental care from a veterinarian. Their hoofs were trimmed once (45.9%) or twice (27.6%) a year. Forty percent of the donkeys were reported to suffer from at least one medical problem in the preceding year. The most common medical problems were colic, respiratory disorders and skin conditions. Owners seemed to underestimate some of the most prevalent diseases in donkeys, suggesting that their knowledge of the management of donkeys, including routine healthcare practices should be improved to ensure the health and welfare of donkeys in northeastern China.

Supporting pharmacogenetic-guided opioid prescriptions for post-operative pain: The design, protocol and preliminary results of the OTP study

The interindividual variability in opioid response is an issue that contributes to the ongoing opioid crisis. Current evidence suggests this variability can be attributed to genetic factors. The pharmacogenetics of Opioid Treatment for acute post-operative Pain (OTP) project was a prospective study that aimed to identify genetic markers associated with opioid treatment outcomes. Healthy patients undergoing third-molar extractions were recruited from dental offices located within the Greater Toronto Area. Participants were evaluated using the Brief Pain Inventory Short Form, the Opioid Related Symptom Distress Scale, and the Leeds Dependence Questionnaire. Seventy-two participants had an active opioid prescription. Participants were prescribed one of the following opioids: codeine, morphine, hydromorphone, tramadol, or oxycodone. The majority of participants were female (57%), ranging from 16 to 44 years of age. Pain severity, pain interference, and side effects declined over the seven-day post-operative period. Additionally, 4% of participants displayed medium to high risk of dependence. It is anticipated that OTP will enable the development of a genetic test for opioid use and facilitate the introduction of this test into routine healthcare practice. The OTP study represents a novel approach to opioid treatment and has significant implications for future interventions targeting the ongoing opioid crisis. Employing a pharmacogenomic-guided strategy for prescribing opioids may improve patients’ response to this treatment and, in so doing, increase adherence to the target treatment plan. Optimized prescriptions may also provide public healthcare systems with beneficial savings and reduce the risks associated with opioid use.

Understanding barriers and facilitators to HIV testing in Canada from 2009-2019: A systematic mixed studies review.

HIV testing is a core pillar of Canada's approach to sexually transmitted and blood-borne infection (STBBI) prevention and treatment and is critical to achieving the first Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target. Despite progress toward this goal, many Canadians remain unaware of their status and testing varies across populations and jurisdictions. An understanding of drivers of HIV testing is essential to improve access to HIV testing and reach the undiagnosed. To examine current barriers and facilitators of HIV testing across key populations and jurisdictions in Canada. A systematic mixed studies review of peer-reviewed and grey literature was conducted identifying quantitative and qualitative studies of barriers and facilitators to HIV testing in Canada published from 2009 to 2019. Studies were screened for inclusion and identified barriers and facilitators were extracted. The quality of included studies was assessed and results were summarized. Forty-three relevant studies were identified. Common barriers emerge across key populations and jurisdictions, including difficulties accessing testing services, fear and stigma surrounding HIV, low risk perception, insufficient patient confidentiality and lack of resources for testing. Innovative practices that could facilitate HIV testing were identified, such as new testing settings (dental care, pharmacies, mobile units, emergency departments), new modalities (oral testing, peer counselling) and personalized sex/gender and age-based interventions and approaches. Key populations also face unique sociocultural, structural and legislative barriers to HIV testing. Many studies identified the need to offer a broad range of testing options and integrate testing within routine healthcare practices. Efforts to improve access to HIV testing should consider barriers and facilitators at the level of the individual, healthcare provider and policy and should focus on the accessibility, inclusivity, convenience and confidentiality of testing services. In addition, testing services must be adapted to the unique needs and contexts of key populations.

Knowledge translation is everybody's business

Successful application of research outcomes into routine healthcare practice rarely occurs as an immediate result of their publication [1]. A much-cited example is the 40-year delay in the British Navy’s adoption of vitamin C for the prevention of scurvy, despite substantial evidence of benefit from the first ever controlled trial conducted by James Lind in the 1770s [2]. The delayed adoption of research outcomes is often referred to as the evidence-practice gap [3]. Whilst science has moved on in the 200+years since Lind’s study, the gap still persists, contributing to inefficient use of resources and avoidable mortality and morbidity. The more recent 10-year delay in the adoption of prenatal corticosteroids to prevent preterm birth despite unequivocal but under- collated evidence, is estimated to have cost the lives of tens of thousands of babies [4]. Similar ‘gaps’ have been shown with the translation of basic science results into clinical practice [5,6].

PPE for your mind: a peer support initiative for health care workers.

PPE for your mind: a peer support initiative for health care workers.

Cancer Screening During the Coronavirus Disease-2019 Pandemic: A Perspective From the National Cancer Institute’s PROSPR Consortium

Cancer Screening During the Coronavirus Disease-2019 Pandemic: A Perspective From the National Cancer Institute’s PROSPR Consortium

A Comparison of the Sexual Well-Being of New Parents With Community Couples

BackgroundChanges in sexual well-being are common for new mothers and their partners after the birth of a baby. However, most research has sampled mothers not couples, assessed only one aspect of sexual well-being, and has not included a control sample of couples. AimThis study aimed to compare the sexual well-being (ie, sexual frequency, sexual satisfaction, sexual desire, sexual distress) of first-time mothers and their partners in the transition to parenthood (first 12-month postpartum) to community couples who are not actively in this transition. We also compared the sexual well-being within couples (eg, mothers to their partners). MethodsCouples in the transition to parenthood (n = 99) completed measures of sexual satisfaction, sexual desire, sexual distress, and sexual frequency at 3, 6, and 12 months postpartum, and community couples (n = 104) completed the measures at a single time point. OutcomesMeasures included the following: (i) Global Measure of Sexual Satisfaction Scale; (ii) Female Sexual Function Index and International Index of Erectile Function sexual desire subscale; (iii) Female Sexual Distress Scale-Revised; and (iv) checklist of sexual behaviors. ResultsCompared with community controls, new parents reported lower sexual satisfaction, lower sexual desire, and higher sexual distress at all time-points; however, these group differences became less pronounced by 12 months postpartum. By 6 months postpartum, there was no difference in sexual frequency between postpartum couples and the control group. Mothers experienced persistently lower sexual desire relative to their partners throughout the 12 months postpartum. Between 39% and 59% of mothers reported clinically low sexual desire, and 47–57% reported significant sexual distress at all time points. There were no significant differences reported in sexual satisfaction, sexual desire, or sexual distress between women and their partners in the community sample. Clinical ImplicationsClinicians should be aware that sexual well-being may be compromised in new parents, and some of these challenges are still present for new parents at 12 months postpartum. Findings can be used to educate new parents regarding their expectations about postpartum sexual well-being. Strengths & LimitationsThe strengths of the present study are the dyadic approach, assessing multiple aspects of sexual well-being in new parents over time, and the comparison with a community sample. An important limitation is that the control sample was not followed up over time. ConclusionEducation regarding postpartum sexual well-being should be incorporated in routine perinatal and postnatal healthcare practices to support new parents in developing realistic expectations about changes during the transition to parenthood, potentially preventing undue distress.Schwenck GC, Dawson SJ, Muise A, et al. A Comparison of the Sexual Well-Being of New Parents With Community Couples. J Sex Med 2020;17:2156–2167.

Public engagement with genomic medicine: a summary of town hall discussions.

Engaging with the public for their input about genomic medicine is critical before it is implemented into routine healthcare practice. In order to inform discussion and planning for the introduction of genome sequencing into clinical care in an Eastern Canadian province, we implemented a program of public engagement activities. Here, we report a qualitative summary of two town hall discussions utilizing a hybrid information-consultation approach with 20 residents of the province of Newfoundland and Labrador, Canada. Discussion revealed largely positive attitudes towards genomic medicine; however, critical reflection around informed consent models, the return of sequencing findings, and access to qualified healthcare professionals revealed numerous public concerns. Public support will be important to realize the potential benefits of genomics and precision medicine to health outcomes. Our findings highlight public concerns that must be addressed in educational and informed consent documents related to sequencing. Town hall attendees endorsed ongoing public education and awareness-building initiatives which could help foster transparency and trust as genomics is integrated into healthcare systems.