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ABSTRACT: Beginning early in life, sleep health, including adequate quality, quantity, and consistent sleep routines, is critical to growth and development, behavior, and mental and physical health. Children who live in economically stressed urban environments are at particular risk for sleep deficiency and its negative consequences. Although efficacious sleep health interventions are available, few address the context of economically stressed urban environments. The purpose of this paper is to describe a two‐phase protocol for an ongoing NIH/NINR‐funded community‐engaged study designed to understand the perspectives of parents, community child care and pediatric health care providers about sleep habits, factors that contribute to sleep and sleep habits, sleep difficulty, and potentially useful sleep promotion strategies among children living in economically stressed urban environments. The social‐ecological model guides this study. Phase I employs a convergent mixed‐methods design, in which we are conducting semi‐structured interviews with parents, childcare providers, and primary health care providers. We are collecting 9 days of objective sleep data (wrist actigraphy) from children who are 6–18 months (n = 15) and 19–36 months of age (n = 15) and parent reports of sleep and sleep‐related factors using standard questionnaires. In Phase I, we will use a qualitative descriptive approach to analyze the interview data, and descriptive statistics to analyze the survey and actigraph data. In Phase II, we will use the information to develop a contextually relevant program to promote sleep health. Our long‐term goal is to improve sleep health and sleep‐related outcomes in these children. [ABSTRACT FROM AUTHOR]

This article presents a study on public attitudes toward the city police in Hartford, Connecticut during June-July 1966. In recent years the police in the U.S. have attained a certain prominence in the eyes of their public. It appears that the public image of the policeman is assailed by bad publicity and increased conflict with the nominally non-criminal segment of society. The purpose of the study reported in this paper was to determine by interview survey the extent to which hostile attitudes toward police exist in a medium-sized Northern city, namely Hartford, Connecticut. The data for this study were collected as a part of a multi-purpose sample survey. The sample is a self-weighting two-stage stratified area probability sample of households. The first stage was a sample of all square block areas in the city. At the second stage, every dwelling unit in each of the 100 selected primary units was listed and the lists of dwelling units were subsampled. Despite the proliferation of criticism directed toward policemen, the citizens of Hartford on the whole appear to be satisfied with their performance. Differences in satisfaction with the police's job by occupational levels are not statistically significant at the .05 level. Despite some evidence of varying degrees of satisfaction by occupational level, there does not appear to be a linear relationship between occupational level and satisfaction with police performance. Asking subjects to simply evaluate the job which the local police are doing has obvious limitations. The criticism receiving the largest percentage of agreement concerned the policeman's contact with citizens over relatively minor considerations.

Older adults with multiple chronic conditions (MCCs) receive care that is fragmented and burdensome, lacks evidence, and most importantly is not focused on what matters most to them. An implementation feasibility study of Patient Priorities Care (PPC), a new approach to care that is based on health outcome goals and healthcare preferences, was conducted. This study took place at 1 primary care and 1 cardiology practice in Connecticut and involved 9 primary care providers (PCPs), 5 cardiologists, and 119 older adults with MCCs. PPC was implemented using methods based on a practice change framework and continuous plan‐do‐study‐act (PDSA) cycles. Core elements included leadership support, clinical champions, priorities facilitators, training, electronic health record (EHR) support, workflow development and continuous modification, and collaborative learning. PPC processes for clinic workflow and decision‐making were developed, and clinicians were trained. After 10 months, 119 older adults enrolled and had priorities identified; 92 (77%) returned to their PCP after priorities identification. In 56 (46%) of these visits, clinicians documented patient priorities discussions. Workflow challenges identified and solved included patient enrollment lags, EHR documentation of priorities discussions, and interprofessional communication. Time for clinicians to provide PPC remains a challenge, as does decision‐making, including clinicians' perceptions that they are already doing so; clinicians' concerns about guidelines, metrics, and unrealistic priorities; and differences between PCPs and patients and between PCPs and cardiologists about treatment decisions. PDSA cycles and continuing collaborative learning with national experts and peers are taking place to address workflow and clinical decision‐making challenges. Translating disease‐based to priorities‐aligned decision‐making appears challenging but feasible to implement in a clinical setting. See related editorial by William B. Applegate et al. [ABSTRACT FROM AUTHOR]

Objectives: To develop a values‐based, clinically feasible process to help older adults identify health priorities that can guide clinical decision‐making. Design: Prospective development and feasibility study. Setting: Primary care practice in Connecticut. Participants: Older adults with 3 or more conditions or taking 10 or more medications (N=64). Intervention: The development team of patients, caregivers, and clinicians used a user‐centered design framework—ideate → prototype → test →redesign—to develop and refine the value‐based patient priorities care process and medical record template with trained clinician facilitators. Measurements: We used descriptive statistics of quantitative measures (percentage accepted invitation and completed template, duration of process) and qualitative analysis of barriers and enablers (challenges and solutions identified, facilitator perceptions). Results: We developed and refined a process for identifying patient health priorities that was typically completed in 35 to 45 minutes over 2 sessions; 64 patients completed the process. Qualitative analyses were used to elucidate the characteristics and training needed for the patient priorities facilitators, as well as perceived benefits and challenges of the process. Refinements based on our experience and feedback include streamlining the process for greater feasibility, balancing fidelity to the process while customizing to individuals, encouraging patients to share their priorities with their clinicians, and simplifying the template transmitted to clinicians. Conclusion: Trained facilitators conducted this process in a busy primary care practice, suggesting that patient priorities identification is feasible and acceptable, although testing in additional settings is necessary. We hope to show that clinicians can align care with patients' health priorities. See related editorial by William B. Applegate et al [ABSTRACT FROM AUTHOR]

CONTEXT: Given the high rates of infection among urban young adults, STD and HIV testing promotion is a public health priority. To inform future testing efforts, lifetime and recent testing behaviors of this population within casual and serious relationships should be better understood. METHODS: Data from a 2007-2008 study conducted in select neighborhoods in Hartford and Philadelphia were used to examine self-reported STD and HIV testing behaviors and attitudes among 483 sexually active black and Puerto Rican young adults aged 18-25. Multivariate ordered logit regression analyses were conducted to assess characteristics associated with lifetime number of STD tests. RESULTS: More than eight in 10 participants reported having been tested for STDs, and a similar proportion for HIV, most of them multiple times. Nineteen percent had ever had an STD diagnosis. A majority-86%-perceived their risk of STD infection in the next year as 'not at all likely.' Sixty-one percent of those in serious relationships reported that both partners had been tested, compared with 25% of those in casual relationships. Characteristics associated with higher lifetime number of STD tests were being female (odds ratio, 2.2), being from Philadelphia (2.5), being black (1.5), having lived with two or more serious partners (1.7) and having ever received an STD diagnosis (2.3). DISCUSSION: Despite their risks, participants did not perceive themselves to be at risk of STDs. However, they did report testing repeatedly. Testing was highly acceptable, particularly within serious relationships. Questions about the timing of testing initiation and repeat testing merit attention for the benefits of widespread testing to be fully realized. [ABSTRACT FROM AUTHOR]

: Despite the recognized importance of patient involvement in primary care interactions, little information describing women's needs and expectations for these interactions is available. This participatory action study was based in Critical Action Theory and designed to describe any emancipatory interests that surfaced when eight ethnically diverse women examined their interactions with primary care nurse practitioners (PCNPs) over the course of five successive focus group meetings. : Focus group meeting transcripts, field notes, interaction notations, seating maps, and first impression summaries. : Participants wanted to learn how to 'stand up' for themselves in primary care interactions. They believed this could be accomplished by developing a positive sense of self-esteem. Ultimately, they identified the right way to 'talk back' to clinicians and created a method for regaining control of their own health care and maintaining equality in interactions with primary care clinicians. : Nurse practitioners working in the primary setting are especially well situated to support self-management and foster patient participation by women as they live with chronic disease, engage in health promotion activities, and deal with common symptomatic problems for themselves and their families. [ABSTRACT FROM AUTHOR]