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Portland, OR, United States

Macfarlan S.J.,University of Missouri | Quinlan R.,Washington State University | Remiker M.,Oregon Rural Practice based Research Network
Proceedings of the Royal Society B: Biological Sciences

Prosocial reputations play an important role, from the evolution of language to Internet transactions; however, questions remain about their behavioural correlates and dynamics. Formal models assume prosocial reputations correlate with the number of cooperative acts one performs; however, if reputations flow through information networks, then the number of individuals one assists may be a better proxy. Formal models demonstrate indirect experience must track behaviour with the same fidelity as direct experience for reputations to become viable; however, research on corporate reputations suggests performance change does not always affect reputation change. Debate exists over the cognitive mechanisms employed for assessing reputation dynamics. Image scoring suggests reputations fluctuate relative to the number of times one fails to assist others in need, while standing strategy claims reputations fluctuate relative to the number of times one fails to assist others in good standing. This study examines the behavioural correlates of prosocial reputations and their dynamics over a 20-month period in an Afro-Caribbean village. Analyses suggest prosocial reputations: (i) are correlated with the number of individuals one assists in economic production, not the number of cooperative acts; (ii) track cooperative behaviour, but are anchored across time; and (iii) are captured neither by image scoring nor standing strategy-type mechanisms. © 2013 The Author(s) Published by the Royal Society. All rights reserved. Source

Davis M.M.,Oregon Rural Practice based Research Network | Davis M.M.,Oregon Health And Science University | Freeman M.,VA Evidence based Synthesis Program | Kaye J.,Oregon Health And Science University | And 4 more authors.
Telemedicine and e-Health

Objective: Remote monitoring technology (RMT) may enhance healthcare quality and reduce costs. RMT adoption depends on perceptions of the end-user (e.g., patients, caregivers, healthcare providers). We conducted a systematic review exploring the acceptability and feasibility of RMT use in routine adult patient care, from the perspectives of primary care clinicians, administrators, and clinic staff. Materials and Methods: We searched the databases of Medline, IEEE Xplore, and Compendex for original articles published from January 1996 through February 2013. We manually screened bibliographies of pertinent studies and consulted experts to identify English-language studies meeting our inclusion criteria. Results: Of 939 citations identified, 15 studies reported in 16 publications met inclusion criteria. Studies were heterogeneous by country, type of RMT used, patient and provider characteristics, and method of implementation and evaluation. Clinicians, staff, and administrators generally held positive views about RMTs. Concerns emerged regarding clinical relevance of RMT data, changing clinical roles and patterns of care (e.g., reduced quality of care from fewer patient visits, overtreatment), insufficient staffing or time to monitor and discuss RMT data, data incompatibility with a clinic's electronic health record (EHR), and unclear legal liability regarding response protocols. Conclusions: This small body of heterogeneous literature suggests that for RMTs to be adopted in primary care, researchers and developers must ensure clinical relevance, support adequate infrastructure, streamline data transmission into EHR systems, attend to changing care patterns and professional roles, and clarify response protocols. There is a critical need to engage end-users in the development and implementation of RMT. Copyright © 2014, Mary Ann Liebert, Inc. Source

Sun B.C.,Oregon Health And Science University | Chi D.L.,University of Washington | Milgrom P.,University of Washington | Yagapen A.,Oregon Health And Science University | And 7 more authors.
American Journal of Public Health

Objectives: We documented emergency department (ED) visits for nontraumatic dental problems and identified strategies to reduce ED dental visits. Methods. We used mixed methods to analyze claims in 2010 from a purposive sample of 25 Oregon hospitals and Oregon's All Payer All Claims data set and interviewed 51 ED dental visitors and stakeholders from 6 communities. Results: Dental visits accounted for 2.5% of ED visits and represented the second-most-common discharge diagnosis in adults aged 20 to 39 years, were associated with being uninsured (odds ratio [OR] = 5.2 [reference: commercial insurance]; 95% confidence interval [CI]=4.8, 5.5) or having Medicaid insurance (OR=4.0; 95% CI=3.7, 4.2), resulted in opioid (56%) and antibiotic (56%) prescriptions, and generated $402 (95% CI= $396, $408) in hospital costs per visit. Interviews revealed health system, community, provider, and patient contributors to ED dental visits. Potential solutions provided by interviewees included Medicaid benefit expansion, care coordination, water fluoridation, and patient education. Conclusions: Emergency department dental visits are a significant and costly public health problem for vulnerable individuals. Future efforts should focus on implementing multilevel interventions to reduce ED dental visits. Source

Buckley D.I.,Oregon Rural Practice based Research Network | Buckley D.I.,Oregon Health And Science University | Davis M.M.,Oregon Rural Practice based Research Network | Davis M.M.,Oregon Health And Science University | Andresen E.M.,University of Florida

Background: Adults with physical disabilities are less likely than others to receive cancer screening. It is not known, however, whether commonly used measures assess elements of physical ability necessary for successful screening. The objective of this exploratory study was to determine whether patients who reported limitations in activities of daily living (ADLs) or instrumental ADLs (IADLs) are perceived by their primary care clinicians to have physical limitations that may impede cancer screening. Methods: Patients at 2 rural primary care clinics were surveyed about ADLs and IADLs and about their up-to-date status for breast, cervical, and/or colorectal cancer screening. Clinicians and office staff were asked whether they believed each patient had a physical limitation that might impede screening. The agreement between patient and clinician assessments was evaluated. Results: Clinicians believed that 43% of patients with severe disability (ADLs) and 30% of patients with moderate disability (IADLs) had limitations that might affect screening. Agreement between patient and clinician assessments was low according to the kappa statistic (κ = 0.355), but had a high percentage of negative agreement (92.3%) and a low percentage of positive agreement (42.7%). Patients with ADL/IADL-related disability were less likely than nondisabled patients to be current for cervical and breast cancer screening. Patients who were viewed by clinicians as having limitations relevant for screening were less likely to be current for cervical cancer screening. Conclusions: These results indicate that a common measure of general disability may not capture all factors relevant for cancer screening. An instrument designed to include these factors may help identify and accommodate patients who have disabilities that may impede screening. © 2011 American Cancer Society. Source

Secondhand smoke exposure is a concern in multiunit housing, where smoke can migrate between apartments. In 2012, the New York City (NYC) Department of Health and Mental Hygiene conducted a cross-sectional mail and phone survey among a random sample of low-income and market-rate multiunit housing owners and managers in NYC. The study compared experiences and attitudes regarding smoke-free policies between owners/managers (owners) with and without low-income units. Logistic regression analysis was used to assess the correlates of smoke-free residential unit rules and interest in adopting new smoke-free rules. Perceived benefits and challenges of implementing smoke-free rules were also examined. Overall, one-third of owners prohibited smoking in individual units. Among owners, nearly one-third owned or managed buildings with designated certified low-income units. Owners with low-income units were less likely than those without to have a smoke-free unit policy (26 vs. 36 %, p < 0.01) or be aware that owners can legally adopt smoke-free building policies (60 vs. 70 %, p < 0.01). In the final model, owners who believed that owners could legally adopt smoke-free policies were more likely to have a smoke-free unit policy, while current smokers and owners of larger buildings were less likely to have a policy. Nearly three quarters of owners without smoke-free units were interested in prohibiting smoking in all of their building/units (73 %). Among owners, correlates of interest in prohibiting smoking included awareness that secondhand smoke is a health issue and knowledge of their legal rights to prohibit smoking in their buildings. Current smokers were less likely to be interested in future smoke-free policies. Educational programs promoting awareness of owners’ legal right to adopt smoke-free policies in residential buildings may improve the availability of smoke-free multiunit housing. © 2015, The New York Academy of Medicine. Source

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