BACKGROUND:The objective of this study was to identify patterns of interest in receiving care for sexual concerns among women who were survivors of gynecologic and breast cancers. METHODS: Survey and medical records data were collected from June 2008 to March 2009 from 261 gynecologic and breast cancer patients. Logistic regression was used to estimate the effect of age and months since treatment on interest in receiving sexual healthcare. RESULTS: The mean participant age was 55 years (range, 21-88 years). Only 7% of women had recently sought medical help for sexual issues, yet 41.6% were interested in receiving care. Greater than 30% responded that they would be likely to see a physician to address sexual matters, and 35% of all women were willing to be contacted if a formal program was offered. Compared with older women (aged >65 years), younger women (ages 18-47 years) were significantly more likely to report interest in receiving care to address sexual issues (odds ratio [OR], 2.94; 95% confidence interval [CI], 1.14-7.54) and to see a physician to address sexual matters (OR, 4.51; 95% CI, 1.51-13.43), and they were more willing to be contacted for a formal program (adjusted OR [AOR], 5.00; 95% CI, 1.63-15.28). Compared with women who were currently in treatment, women who last received treatment >12 months previously were significantly more interested in receiving care (AOR, 2.02; 95% CI, 1.02-4.01) and were more willing to be contacted (AOR, 2.49; 95% CI, 1.18-5.26). CONCLUSIONS: Greater than 40% of survivors expressed interest in receiving sexual healthcare, but few had ever sought such care. The current results indicated that there is an unmet need for attention to sexual concerns among women with gynecologic and breast cancers.

Objectives. To test the effect of CommunityRx, a scalable, low-intensity intervention that matches patients to community resources, on mental health-related quality of life (HRQOL) (primary outcome), physical HRQOL, and confidence in finding resources. Methods. A real-world trial assigned publicly insured residents of Chicago, Illinois, aged 45 to 74 years to an intervention (n = 209) or control (n = 202) group by alternating calendar week, December 2015 to August 2016. Intervention group participants received usual care and an electronic medical record–generated, personalized list of community resources. Surveys (baseline, 1-week, 1- and 3-months) measured HRQOL and confidence in finding community resources to manage health. Results. At 3 months, there was no difference between groups in mental (–1.03; 95% confidence interval [CI] = −3.02, 0.96) or physical HRQOL (0.59; 95% CI = −0.98, 2.16). Confidence in finding resources was higher in the intervention group (odds ratio = 2.08; 95% CI = 1.18, 3.63); the effect increased at each successive time point. Among intervention group participants, 65% recalled receiving the intervention; 48% shared community resource information with others. Conclusions. CommunityRx did not increase HRQOL, but its positive effect on confidence in finding resources for self-care suggests that this low-intensity intervention may have a role in population health promotion. Trial Registration. ClinicalTrials.gov Identifier: NCT02435511.

This study reports on implementation of the CommunityRx system, a population health innovation that promoted clinic-community linkages via: a youth workforce (MAPSCorps) that conducted an annual community resource census; Community Health Information Specialists (CHIS) who supported cross-sector resource navigation; and a health information technology (HIT) for prescribing community resources. Between 2012–14, MAPSCorps identified 19,589 public-serving places in the 106mi2 implementation region. CHIS used these data to generate an inventory of nearly 15,000 health-promoting resources. The HIT platform was integrated with 3 electronic health record (EHR) systems at 33 clinical sites to map 37 prevalent health and wellness conditions to community resources; 253,479 personalized HealtheRx “prescriptions” were generated for approximately 113,000 participants. Participants found the HealtheRx very useful (83%); 19% went to a place they learned about from the HealtheRx. This study demonstrates the feasibility of using HIT and workforce innovation to bridge the gap between clinical and other health-promoting sectors.

BackgroundLittle is known about recovery of female sexual function following an acute myocardial infarction (MI). Interventions to improve sexual outcomes in women are limited.Methods and ResultsSemistructured, qualitative telephone interviews were conducted with 17 partnered women (aged 43 to 75 years) purposively selected from the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients’ Health Status Registry to deepen knowledge of recovery of female sexual function following an acute myocardial infarction (MI) and to improve sexual outcomes in women. Sixteen women had a monogamous relationship with a male spouse; 1 had a long‐term female partner. Most women resumed sexual activity within 4 weeks of their MI. Sexual problems and concerns were prevalent, including patient and/or partner fear of “causing another heart attack.” Few women received counseling about sexual concerns or the safety of returning to sex. Most women who discussed sex with a physician initiated the discussion themselves. Inquiry about strategies to improve sexual outcomes elicited key themes: need for privacy, patient‐centeredness, and information about the timing and safe resumption of sexual activity. In addition, respondents felt that counseling should be initiated by the treating cardiologist, who “knows whether your heart is safe,” and then reinforced by the care team throughout the rehabilitation period.ConclusionsPartnered women commonly resume sexual activity soon after an MI with fear but without directed counseling from their physicians. Proactive attention to women's concerns related to sexual function and the safety of sexual activity following an MI could improve post‐MI outcomes for women and their partners.

Objectives To test the diagnostic accuracy of the American Academy of Pediatrics (AAP) recommended food insecurity screener. Methods We conducted prospective diagnostic accuracy studies between July and November 2016, in Chicago, Illinois. We recruited convenience samples of adults from adult and pediatric emergency departments (12-month recall study: n|=|188; 30-day recall study: n|=|154). A self-administered survey included the 6-item Household Food Security Screen (gold standard), the validated 2-item Hunger Vital Sign (HVS; often, sometimes, never response categories), and the 2-item AAP tool (yes-or-no response categories). Results Food insecurity was prevalent (12-month recall group: 46%; 30-day group: 39%). Sensitivity of the AAP tool using 12-month and 30-day recall was, respectively, 76% (95% confidence interval [CI]|=|65%, 85%) and 72% (95% CI|=|57%, 84%). The HVS sensitivity was significantly higher than the AAP tool (12-month: 94% [95% CI|=|86%, 98%; P|=|.002]; 30-day: 92% [95% CI|=|79%, 98%; P|=|.02]). Conclusions The AAP tool missed nearly a quarter of food-insecure adults screened in the hospital; the HVS screening tool was more sensitive. Public health implications Health care systems adopting food insecurity screening should optimize ease of administration and sensitivity of the screening tool.

A multi-site, observational study of sexual activity-related outcomes among patients enrolled in the TRIUMPH Registry during hospitalization for an acute myocardial infarction (AMI) was conducted to identify patterns and loss of sexual activity 1 year following hospitalization for AMI. Gender-specific multivariable hierarchical models were used to identify correlates of loss of sexual activity, including physician counseling. Main outcome measures included “loss of sexual activity” (less frequent or no sexual activity one year after an AMI in those who were sexually active in the year before the AMI) and 1-year mortality. Mean age (years) was 61.1 for women (n=605) and 58.6 for men (n=1274). Many were sexually active in the year before and 1 year after hospitalization (44% and 40% of women, 74% and 68% of men, respectively). A third of women and 47% of men reported receiving hospital discharge instructions about resuming sex. Those who did not receive instructions were more likely to report loss of sexual activity (women: adjusted RR 1.44, 95% CI 1.16–1.79; men: adjusted RR 1.27, 95% CI 1.11–1.46). One year post-AMI mortality was similar among those who reported sexual activity in the first month after their AMI (2.1%) and those who were sexually inactive (4.1%) (p=0.08). In conclusion, although many patients were sexually active prior to AMI, only a minority received discharge counseling about resuming sexual activity. Lack of counseling was associated with loss of sexual activity 1 year later. Mortality was not significantly elevated among individuals who were sexually active soon after their AMI.

Background United States and European cardiovascular society guidelines recommend physicians counsel patients about resuming sexual activity after acute myocardial infarction (AMI), but little is known about patients’ experience with counseling about sexual activity after AMI. Methods and Results The prospective, longitudinal Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study, conducted at 127 hospitals in the U.S. and Spain, was designed, in part, to evaluate gender differences in baseline sexual activity, function and patient experience with physician counseling about sexual activity after an AMI. This study used baseline and 1-month data collected from the 2:1 sample of women (N=2349) and men (N=1152) ages 18-55 years with AMI. Median age was 48 years. Among those who reported discussing sexual activity with a physician in the month after AMI (12% of women, 19% of men), 68% were given restrictions: limit sex (35%), take a more passive role (26%), and/or keep the heart rate down (23%). In risk-adjusted analyses, factors associated with not discussing sexual activity with a physician included: female gender (RR 1.07, 95% CI 1.03-1.11), age (RR 1.05 per 10 years, 95% CI 1.02-1.08) and sexual inactivity at baseline (RR 1.11, 95% CI 1.08-1.15). Among patients who received counseling, women in Spain were significantly more likely to be given restrictions than U.S. women (RR 1.36, 95% CI 1.11-1.66). Conclusions Very few patients reported counseling for sexual activity after AMI. Those who did were commonly given restrictions not supported by evidence or guidelines.

In a real-world controlled trial of 374 adults, intervention recipients improved knowledge (AOR = 2.15; 95% CI, 1.29-3.58) and beliefs (AOR = 1.68; 95% CI, 1.07-2.64) about common resources in the community to manage health, specifically gaining knowledge about smoking cessation (AOR = 2.76; 95% CI, 1.07-7.12) and weight loss resources (AOR = 2.26; 95% CI 1.05-4.84). Positive changes in both knowledge and beliefs about community resources were associated with higher resource use (P = 0.02). CONCLUSIONS: In a middle-age and older population with high morbidity, a low-intensity health IT intervention to deliver resource referrals promoted behavior change by increasing knowledge and positive beliefs about community resources for self-management of health.