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Diversity and Inclusion Matters
Expert guidance and step-by-step instruction for building a successful diversity, equity, and inclusion initiative from scratch In Diversity and Inclusion Matters: Tactics and Tools to Inspire Equity and Game-Changing Performance, award-winning diversity, equity, and inclusion (DE&I) expert Jason R.
eBook
Land use, transport, and population health: estimating the health benefits of compact cities
Using a health impact assessment framework, we estimated the population health effects arising from alternative land-use and transport policy initiatives in six cities. Land-use changes were modelled to reflect a compact city in which land-use density and diversity were increased and distances to public transport were reduced to produce low motorised mobility, namely a modal shift from private motor vehicles to walking, cycling, and public transport. The modelled compact city scenario resulted in health gains for all cities (for diabetes, cardiovascular disease, and respiratory disease) with overall health gains of 420–826 disability-adjusted life-years (DALYs) per 100 000 population. However, for moderate to highly motorised cities, such as Melbourne, London, and Boston, the compact city scenario predicted a small increase in road trauma for cyclists and pedestrians (health loss of between 34 and 41 DALYs per 100 000 population). The findings suggest that government policies need to actively pursue land-use elements—particularly a focus towards compact cities—that support a modal shift away from private motor vehicles towards walking, cycling, and low-emission public transport. At the same time, these policies need to ensure the provision of safe walking and cycling infrastructure. The findings highlight the opportunities for policy makers to positively influence the overall health of city populations.
Journal Article
The need for a complex systems approach in rural health research
On a global scale, many major rural health issues have persisted for decades despite the introduction of new health interventions and public health policies. Although research efforts have generated valuable new knowledge about the aetiology of health, disease and health inequities in rural communities, rural health systems remain to be some of the most deprived and challenged in both the developing and developed world. While the reasons for this are many, a significant factor contributing to the current state of play is the pressing need for methodological innovation and relevant scientific approaches that have the capacity to support the translation of novel solutions into ‘real world’ rural contexts. Fortunately, complex systems approaches, which have seen an increase in popularity in the wider public health literature, could provide answers to some of the most resilient rural health problems in recent times. The purpose of this article is to promote the value and utility of a complex systems approach in rural health research. We explain the benefits of a complex systems approach and provide a background to the complexity sciences, including the main characteristics of complex systems. Two popular computational methods are described. The next step for rural health research involves exploring how a complex systems approach can help with the identification and evaluation of new and existing solutions to policy-resistant rural health issues. This includes generating awareness around the analytical trade-offs that occur between the use of traditional scientific methods and complex systems approaches.
Journal Article
Disparities in Enrollment and Use of an Electronic Patient Portal
Background
With emphasis on the meaningful use of electronic health records, patient portals are likely to become increasingly important. Little is known about patient enrollment in, and use of, patient portals after explicit invitation from providers.
Objectives
To examine enrollment in, and use of, an electronic patient portal by race/ethnicity, gender and age.
Design
Observational, cross sectional study.
Participants
Patients with attending physicians seen at one urban, academic primary care practice between May 2008 and October 2009 who received electronic orders inviting their participation in an electronic patient portal.
Main Measures
(a) Enrollment in the patient portal, (b) Solicitation of provider advice among enrollees, (c) Requests for medication refills among enrollees.
Key Results
Overall, 69% of 7,088 patients enrolled in the patient portal. All minority patients were significantly less likely to enroll than whites: 55% blacks, 64% Latinos and 66% Asians compared with 74% whites (chi-square p < 0.05 for all pairwise comparisons). These disparities persisted in adjusted analyses, although differences for Asians were no longer significant. In addition, the oldest patients were less likely to enroll than the youngest (adjusted OR 0.79, 95% CI 0.65–0.97). Although there were no racial/ethnic disparities in use of the patient portal among enrollees, we found differences by age and gender. The youngest patients were significantly less likely to solicit provider advice or request medication refills than any other age group in unadjusted and adjusted analyses. Similarly, male patients were less likely to solicit provider advice than women in all analyses.
Conclusion
Large racial/ethnic disparities were seen in enrollment in our patient portal. Among enrollees, use of the portal was similar by race/ethnicity, but not by age or gender. Future efforts to expand use of the patient portal need to address potential mechanisms for these disparities to ensure this technology is accessible to diverse patient populations.
Journal Article
Limited‐Transpiration Trait May Increase Maize Drought Tolerance in the US Corn Belt
Yield loss due to water deficit is ubiquitous in maize (Zea mays L.) production environments in the United States. The impact of water deficits on yield depends on the cropping system management and physiological characteristics of the hybrid. Genotypic diversity among maize hybrids in the transpiration response to vapor pressure deficit (VPD) indicates that a limited‐transpiration trait may contribute to improved drought tolerance and yield in maize. By limiting transpiration at VPD above a VPD threshold, this trait can increase both daily transpiration efficiency and water availability for late‐season use. Reduced water use, however, may compromise yield potential. The complexity associated with genotype × environment × management interactions can be explored in a quantitative assessment using a simulation model. A simulation study was conducted to assess the likely effect of genotypic variation in limited‐transpiration rate on yield performance of maize at a regional scale in the United States. We demonstrated that the limited‐transpiration trait can result in improved maize performance in drought‐prone environments and that the impact of the trait on maize productivity varies with geography, environment type, expression of the trait, and plant density. The largest average yield increase was simulated for drought‐prone environments (135 g m−2), while a small yield penalty was simulated for environments where water was not limiting (–33 g m−2). Outcomes from this simulation study help interpret the ubiquitous nature of variation for the limited‐transpiration trait in maize germplasm and provide insights into the plausible role of the trait in past and future maize genetic improvement.
Journal Article