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Młynarska E, Czarnik W, Fularski P, Hajdys J, Majchrowicz G, Stabrawa M, Rysz J, Franczyk B. From Atherosclerotic Plaque to Myocardial Infarction-The Leading Cause of Coronary Artery Occlusion. Int J Mol Sci 2024; 25:7295. [PMID: 39000400 PMCID: PMC11242737 DOI: 10.3390/ijms25137295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024] Open
Abstract
Cardiovascular disease (CVD) constitutes the most common cause of death worldwide. In Europe alone, approximately 4 million people die annually due to CVD. The leading component of CVD leading to mortality is myocardial infarction (MI). MI is classified into several types. Type 1 is associated with atherosclerosis, type 2 results from inadequate oxygen supply to cardiomyocytes, type 3 is defined as sudden cardiac death, while types 4 and 5 are associated with procedures such as percutaneous coronary intervention and coronary artery bypass grafting, respectively. Of particular note is type 1, which is also the most frequently occurring form of MI. Factors predisposing to its occurrence include, among others, high levels of low-density lipoprotein cholesterol (LDL-C) in the blood, cigarette smoking, chronic kidney disease (CKD), diabetes mellitus (DM), hypertension, and familial hypercholesterolaemia (FH). The primary objective of this review is to elucidate the issues with regard to type 1 MI. Our paper delves into, amidst other aspects, its pathogenesis, risk assessment, diagnosis, pharmacotherapy, and interventional treatment options in both acute and long-term conditions.
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Affiliation(s)
- Ewelina Młynarska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Witold Czarnik
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Piotr Fularski
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Joanna Hajdys
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Gabriela Majchrowicz
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Magdalena Stabrawa
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Beata Franczyk
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
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Liss DT, Yang TY, Hamielec M, McAuliff K, Rusie LK, Mohanty N. Checkup Visits in Adult Federally Qualified Health Center Patients: a Retrospective Cohort Study. J Gen Intern Med 2024; 39:1378-1385. [PMID: 38100007 PMCID: PMC11169303 DOI: 10.1007/s11606-023-08561-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/01/2023] [Indexed: 05/30/2024]
Abstract
BACKGROUND Checkup visits (i.e., general health checks) can increase preventive service completion and lead to improved treatment of new chronic illnesses. After the onset of the COVID-19 pandemic, preventive service completion decreased in many groups that receive care in safety net settings. OBJECTIVE To examine potential benefits associated with checkups in federally qualified health center (FQHC) patients. DESIGN Retrospective cohort study, from March 2018 to February 2022. PATIENTS Adults at seven FQHCs in Illinois. INTERVENTIONS Checkups during a two-year Baseline (i.e., pre-COVID-19) period and two-year COVID-19 period. MAIN MEASURES The primary outcome was COVID-19 period checkup completion. Secondary outcomes were: mammography completion; new diagnoses of four common chronic illnesses (hypertension, diabetes, depression, or high cholesterol), and; initiation of chronic illness medications. KEY RESULTS Among 106,114 included patients, race/ethnicity was most commonly Latino/Hispanic (42.1%) or non-Hispanic Black (30.2%). Most patients had Medicaid coverage (40.4%) or were uninsured (33.9%). While 21.0% of patients completed a checkup during Baseline, only 15.3% did so during the COVID-19 period. In multivariable regression analysis, private insurance (versus Medicaid) was positively associated with COVID-19 period checkup completion (adjusted relative risk [aRR], 1.15; 95% confidence interval, [CI], 1.10-1.19), while non-Hispanic Black race/ethnicity (versus Latino/Hispanic) was inversely associated with checkup completion (aRR, 0.89; 95% CI, 0.85-0.93). In secondary outcome analysis, COVID-19 period checkup completion was associated with 61% greater probability of mammography (aRR, 1.61; 95% CI, 1.52-1.71), and significantly higher probability of diagnosis, and treatment initiation, for all four chronic illnesses. In exploratory interaction analysis, checkup completion was more modestly associated with diagnosis and treatment of hypertension and high cholesterol in some younger age groups (versus age ≥ 65). CONCLUSIONS In this large FQHC cohort, checkup completion markedly decreased during the pandemic. Checkup completion was associated with preventive service completion, chronic illness detection, and initiation of chronic illness treatment.
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Affiliation(s)
- David T Liss
- Health Services Research Scientist, AllianceChicago, 225 W. Illinois Street, 5Th Floor, Chicago, IL, 60654, USA.
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Ta-Yun Yang
- Health Services Research Scientist, AllianceChicago, 225 W. Illinois Street, 5Th Floor, Chicago, IL, 60654, USA
| | - Magdalena Hamielec
- Health Services Research Scientist, AllianceChicago, 225 W. Illinois Street, 5Th Floor, Chicago, IL, 60654, USA
| | | | | | - Nivedita Mohanty
- Health Services Research Scientist, AllianceChicago, 225 W. Illinois Street, 5Th Floor, Chicago, IL, 60654, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Ares-Blanco S, López-Rodríguez JA, Polentinos-Castro E, Del Cura-González I. Effect of GP visits in the compliance of preventive services: a cross-sectional study in Europe. BMC PRIMARY CARE 2024; 25:165. [PMID: 38750446 PMCID: PMC11094967 DOI: 10.1186/s12875-024-02400-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/23/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Performing cardiovascular and cancer screenings in target populations can reduce mortality. Visiting a General Practitioner (GP) once a year is related to an increased likelihood of preventive care. The aim of this study was to analyse the influence of visiting a GP in the last year on the delivery of preventive services based on sex and household income. METHODS Cross-sectional study using data collected from the European Health Interview Survey 2013-2015 of individuals aged 40-74 years from 29 European countries. The variables included: sociodemographic factors (age, sex, and household income (HHI) quintiles [HHI 1: lowest income, HHI 5: more affluent]), lifestyle factors, comorbidities, and preventive care services (cardiometabolic, influenza vaccination, and cancer screening). Descriptive statistics, bivariate analyses and multilevel models (level 1: citizen, level 2: country) were performed. RESULTS 242,212 subjects were included, 53.7% were female. The proportion of subjects who received any cardiometabolic screening (92.4%) was greater than cancer screening (colorectal cancer: 44.1%, gynaecologic cancer: 40.0%) and influenza vaccination. Individuals who visited a GP in the last year were more prone to receive preventive care services (cardiometabolic screening: adjusted OR (aOR): 7.78, 95% CI: 7.43-8.15; colorectal screening aOR: 1.87, 95% CI: 1.80-1.95; mammography aOR: 1.76, 95% CI: 1.69-1.83 and Pap smear test: aOR: 1.89, 95% CI:1.85-1.94). Among those who visited a GP in the last year, the highest ratios of cardiometabolic screening and cancer screening benefited those who were more affluent. Women underwent more blood pressure measurements than men regardless of the HHI. Men were more likely to undergo influenza vaccination than women regardless of the HHI. The highest differences between countries were observed for influenza vaccination, with a median odds ratio (MOR) of 6.36 (under 65 years with comorbidities) and 4.30 (over 65 years with comorbidities), followed by colorectal cancer screening with an MOR of 2.26. CONCLUSIONS Greater adherence to preventive services was linked to individuals who had visited a GP at least once in the past year. Disparities were evident among those with lower household incomes who visited a GP. The most significant variability among countries was observed in influenza vaccination and colorectal cancer screening.
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Affiliation(s)
- Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain.
- Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain.
| | - Juan A López-Rodríguez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- General Ricardos Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, Rey Juan Carlos, University, Alcorcón, Madrid, Spain
| | - Elena Polentinos-Castro
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, Rey Juan Carlos, University, Alcorcón, Madrid, Spain
| | - Isabel Del Cura-González
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, Rey Juan Carlos, University, Alcorcón, Madrid, Spain
- Aging Research Center, Karolinksa Instituted, Stockholm, Sweden
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Feigin VL, Martins SC, Brainin M, Norrving B, Kamenova S, Giniyat A, Kondybayeva A, Aldyngurov DK, Bapayeva M, Zhanuzakov M, Hankey GJ. Twenty years on from the introduction of the high risk strategy for stroke and cardiovascular disease prevention: a systematic scoping review. Eur J Neurol 2024; 31:e16157. [PMID: 38009814 DOI: 10.1111/ene.16157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND PURPOSE Early this century, the high risk strategy of primary stroke and cardiovascular disease (CVD) prevention for individuals shifted away from identifying (and treating, as appropriate) all at-risk individuals towards identifying and treating individuals who exceed arbitrary thresholds of absolute CVD risk. The public health impact of this strategy is uncertain. METHODS In our systematic scoping review, the electronic databases (Scopus, MEDLINE, Embase, Google Scholar, Cochrane Library) were searched to identify and appraise publications related to primary CVD/stroke prevention strategies and their effectiveness published in any language from January 1990 to August 2023. RESULTS No published randomized controlled trial was found on the effectiveness of the high CVD risk strategy for primary stroke/CVD prevention. Targeting high CVD risk individuals excludes a large proportion of the population from effective blood-pressure-lowering and lipid-lowering treatment and effective CVD prevention. There is also evidence that blood pressure lowering and lipid lowering are beneficial irrespective of blood pressure and cholesterol levels and irrespective of absolute CVD risk and that risk-stratified pharmacological management of blood pressure and lipids to only high CVD risk individuals leads to significant underuse of blood-pressure-lowering and lipid-lowering medications in individuals otherwise eligible for such treatment. CONCLUSIONS Primary stroke and CVD prevention needs to be done in all individuals with increased risk of CVD/stroke. Pharmacological management of blood pressure and blood cholesterol should not be solely based on the high CVD risk treatment thresholds. International guidelines and global strategies for primary CVD/stroke prevention need to be revised.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
- Institute for Health Metrics Evaluation, University of Washington, Seattle, Washington, USA
| | - Sheila C Martins
- Hospital de Clínicas de Porto Alegre, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Michael Brainin
- Department of Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Bo Norrving
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Saltanat Kamenova
- Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
| | - Azhar Giniyat
- Minister of Healthcare of the Republic of Kazakhstan, Astana, Republic of Kazakhstan
| | - Aida Kondybayeva
- Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
| | - Daulet K Aldyngurov
- Department of Science and Human Resource, Ministry of Healthcare of the Republic of Kazakhstan, Astana, Republic of Kazakhstan
| | - Magripa Bapayeva
- Department of Internal Medicine, Kazakhstan Medical University «KSPH», Almaty, Republic of Kazakhstan
| | - Murat Zhanuzakov
- Higher School of Medicine, al-Farabi Kazakh National University, Almaty, Republic of Kazakhstan
| | - Graeme J Hankey
- Perron Institute Chair in Stroke Research, Medical School, University of Western Australia, Perth, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
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Fujiwara M, Yamada Y, Etoh T, Shimazu T, Kodama M, Yamada N, Asada T, Horii S, Kobayashi T, Hayashi T, Ehara Y, Fukuda K, Harada K, Fujimori M, Odawara M, Takahashi H, Hinotsu S, Nakaya N, Uchitomi Y, Inagaki M. A feasibility study of provider-level implementation strategies to improve access to colorectal cancer screening for patients with schizophrenia: ACCESS2 (N-EQUITY 2104) trial. Implement Sci Commun 2024; 5:2. [PMID: 38178209 PMCID: PMC10768128 DOI: 10.1186/s43058-023-00541-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/17/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND People with schizophrenia have a lower colorectal screening rate than the general population. A previous study reported an intervention using case management to encourage colorectal cancer screening for patients with schizophrenia in psychiatric outpatient settings. In this feasibility study, we developed provider-level implementation strategies and evaluated the feasibility of conducting a definitive trial in terms of the penetration of the intervention assessed at the patient level. Additionally, we examined the fidelity of strategies to implement the intervention at the provider level in a routine clinical psychiatric setting. METHODS This was a multicenter, single-arm feasibility study with medical staff at psychiatric hospitals in Japan. The provider-level implementation strategies developed in this study included three key elements (organizing an implementation team appointed by the facility director, interactive assistance using a clear guide that outlines who in the hospital should do what, and developing accessible educational materials) to overcome major barriers to implementation of the intervention and four additional elements (progress monitoring, joint meetings and information sharing among participating sites, adaptation of encouragement methods to specific contexts, and education of on-site staff), with reference to the elements identified in the Expert Recommendations for Implementing Change (ERIC). The feasibility of the strategies was evaluated by the proportion of patients who were eligible for encouragement (patients with schizophrenia aged 40, 50, or 60) who received encouragement. We set the goal of providing encouragement to at least 40% of eligible patients at each site. RESULTS Two public and four private psychiatric hospitals in Okayama and Shimane prefectures participated in this study. Regarding fidelity, all elements of the strategies were conducted as planned. Following the procedures in the guide, each team prepared and provided encouragement according to their own facility and region. Penetration, defined as the proportion of eligible patients who received encouragement, ranged from 33.3 to 100%; five of the six facilities achieved the target proportion. CONCLUSIONS The provider-level implementation strategies to implement encouragement were feasible in terms of penetration of the intervention assessed at the patient level. The results support the feasibility of proceeding with a future definitive trial of these strategies. TRIAL REGISTRATION jRCT, jRCT1060220026 . Registered on 06/04/2022.
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Affiliation(s)
- Masaki Fujiwara
- Department of Neuropsychiatry, Okayama University Hospital, Okayama, Japan
| | - Yuto Yamada
- Department of Neuropsychiatry, Okayama University Hospital, Okayama, Japan
| | - Tsuyoshi Etoh
- Department of Nursing, Shimane University Hospital, Izumo, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | | | | | | | | | | | | | | | | | - Keita Harada
- Department of Gastroenterology, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Maiko Fujimori
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Miyuki Odawara
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Hirokazu Takahashi
- Division of Screening Assessment and Management, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Shiro Hinotsu
- Department of Biostatistics and Data Management, Sapporo Medical University, Sapporo, Japan
| | - Naoki Nakaya
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Yosuke Uchitomi
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Masatoshi Inagaki
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Shimane, 693-8501, Japan.
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Shih P, Ding P, Carter SM, Stanaway F, Horvath AR, Langguth D, Saad M, St John A, Bell K. Direct-to-consumer tests advertised online in Australia and their implications for medical overuse: systematic online review and a typology of clinical utility. BMJ Open 2023; 13:e074205. [PMID: 38151277 PMCID: PMC10759116 DOI: 10.1136/bmjopen-2023-074205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/30/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVES The objective of this study is to map the range and variety of direct-to-consumer (DTC) tests advertised online in Australia and analyse their potential clinical utility and implications for medical overuse. DESIGN Systematic online search of DTC test products in Google and Google Shopping. DTC test advertisements data were collected and analysed to develop a typology of potential clinical utility of the tests at population level, assessing their potential benefits and harms using available evidence, informed by concepts of medical overuse. RESULTS We identified 484 DTC tests (103 unique products), ranging from $A12.99 to $A1947 in cost (mean $A197.83; median $A148.50). Using our typology, we assigned the tests into one of four categories: tests with potential clinical utility (10.7%); tests with limited clinical utility (30.6%); non-evidence-based commercial 'health checks' (41.9%); and tests whose methods and/or target conditions are not recognised by the general medical community (16.7%). Of the products identified, 56% did not state that they offered pretest or post-test consultation, and 51% did not report analytical performance of the test or laboratory accreditation. CONCLUSIONS This first-in-Australia study shows most DTC tests sold online have low potential clinical utility, with healthy consumers constituting the main target market. Harms may be caused by overdiagnosis, high rates of false positives and treatment decisions led by non-evidence-based tests, as well as financial costs of unnecessary and inappropriate testing. Regulatory mechanisms should demand a higher standard of evidence of clinical utility and efficacy for DTC tests. Better transparency and reporting of health outcomes, and the development of decision-support resources for consumers are needed.
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Affiliation(s)
- Patti Shih
- School of Health & Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Pauline Ding
- School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Stacy M Carter
- School of Health & Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Fiona Stanaway
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Andrea R Horvath
- NSW Health Pathology, Sydney, New South Wales, Australia
- University of New South Wales, Kensington, New South Wales, Australia
| | - Daman Langguth
- Sullivan Nicolaides Pathology, Wesley Hospital, Brisbane, Queensland, Australia
| | - Mirette Saad
- Australian Clinical Labs, Victorian Central Laboratory Headquarters, Clayton, Victoria, Australia
| | | | - Katy Bell
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Iwaya T, Tanabe H, Ohkuma Y, Ito A, Hayashi K, Ideno Y, Nagai K, Akai M. Statistical model of trajectories of reduced mobility in older people with locomotive disorders: a prospective cohort study with group-based trajectory model. BMC Geriatr 2023; 23:699. [PMID: 37904120 PMCID: PMC10617241 DOI: 10.1186/s12877-023-04405-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/13/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Today we experience "Super-aged society", and a drastic increase in the number of older people needing assistance is an urgent matter for everyone from medical and socio-economical standpoints. Locomotive organ dysfunction due to musculoskeletal disorders is one of the main problems in these patients. Although the concepts of frailty and sarcopenia have been proposed for functional decline, pain remains the main and non-negligible complaint in these of such disorders. This prospective cohort study aimed to observe the changes of reduced mobility in patients with locomotive disorders and to determine the risk factors for functional deterioration of those patients using statistical modeling. METHODS A cohort of older adults with locomotive disorders who were followed up every 6 months for up to 18 months was organized. Pain, physical findings related to the lower extremities, locomotive function in performing daily tasks, and Geriatric Locomotive Function Scale-25 (GLFS-25) score were collected to predict the progress of deterioration. Group-based trajectory analysis was used to identify subgroups of changes of GLFS-25 scores, and multinomial logistic regression analysis was performed to investigate potential predictors of the GLFS-25 trajectories. RESULTS Overall, 314 participants aged between 65 and 93 years were included. The participants were treated with various combinations of orthopedic conservative treatments on an outpatient basis. The in-group trajectory model analysis revealed a clear differentiation between the four groups. The mild and severe groups generally maintained their GLFD-25 scores, while the moderate group included a fluctuating group and a no change group. This study showed that comorbidity of osteoporosis was related to GLFS-25 score over 18 months. Age was a weak factor to be moderate or severe group, but gender was not. In addition, the number of pain locations, number of weak muscles, one-leg standing time, grip strength and BMI significantly contributed to the change in GLFS-25 score. CONCLUSIONS This study proposes an effective statistical model to monitor locomotive functions and related findings. Pain and comorbid osteoporosis are significant factors that related to functional deterioration of activities. In addition, the study shows a patient group recovers from the progression and their possible contributing factors.
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Affiliation(s)
- Tsutomu Iwaya
- Nagano University of Health and Medicine, 11-1 Imaihara, Kawanakajima-chou, Nagano-shi, Nagano, 381-2227, Japan
| | - Hideki Tanabe
- Tanabe Orthopaedic Clinic, 3-2-16 Narimasu, Itabashi-ku, Tokyo, 175-0094, Japan
| | - Yusuke Ohkuma
- National Rehabilitation Center for Persons with Disabilities, 2-1 Namiki, Tokorozawa-shi, Saitama, 359-8555, Japan
| | - Ayumi Ito
- Takasaki University of Health and Welfare, 501 Nakaorui-machi, Takasaki-shi, Gunma, 370-0033, Japan
| | - Kunihiko Hayashi
- School of Health Sciences, Gunma University, 3-39-22 Showa-machi, Maebashi-shi, Gunma, 371-8514, Japan
| | - Yuki Ideno
- Center for Mathematics and Data Science, Gunma University, 3-39-22 Showa-machi, Maebashi-shi, Gunma, 371-8514, Japan
| | - Kazue Nagai
- Center for Mathematics and Data Science, Gunma University, 3-39-22 Showa-machi, Maebashi-shi, Gunma, 371-8514, Japan
| | - Masami Akai
- International University of Health and Welfare, Graduate School, International University of Health and Welfare, 4-1-26 Akasaka, Minato-ku, Tokyo, 107-8402, Japan.
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Christoffersen NB, Nilou FE, Thilsing T, Larsen LB, Østergaard JN, Broholm-Jørgensen M. Exploring targeted preventive health check interventions - a realist synthesis. BMC Public Health 2023; 23:1928. [PMID: 37798691 PMCID: PMC10557298 DOI: 10.1186/s12889-023-16861-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 09/29/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Preventive health checks are assumed to reduce the risk of the development of cardio-metabolic disease in the long term. Although no solid evidence of effect is shown on health checks targeting the general population, studies suggest positive effects if health checks target people or groups identified at risk of disease. The aim of this study is to explore why and how targeted preventive health checks work, for whom they work, and under which circumstances they can be expected to work. METHODS The study is designed as a realist synthesis that consists of four phases, each including collection and analysis of empirical data: 1) Literature search of systematic reviews and meta-analysis, 2) Interviews with key-stakeholders, 3) Literature search of qualitative studies and grey literature, and 4) Workshops with key stakeholders and end-users. Through the iterative analysis we identified the interrelationship between contexts, mechanisms, and outcomes to develop a program theory encompassing hypotheses about targeted preventive health checks. RESULTS Based on an iterative analysis of the data material, we developed a final program theory consisting of seven themes; Target group; Recruitment and participation; The encounter between professional and participants; Follow-up activities; Implementation and operation; Shared understanding of the intervention; and Unintended side effects. Overall, the data material showed that targeted preventive health checks need to be accessible, recognizable, and relevant for the participants' everyday lives as well as meaningful to the professionals involved. The results showed that identifying a target group, that both benefit from attending and have the resources to participate pose a challenge for targeted preventive health check interventions. This challenge illustrates the importance of designing the recruitment and intervention activities according to the target groups particular life situation. CONCLUSION The results indicate that a one-size-fits-all model of targeted preventive health checks should be abandoned, and that intervention activities and implementation depend on for whom and under which circumstances the intervention is initiated. Based on the results we suggest that future initiatives conduct thorough needs assessment as the basis for decisions about where and how the preventive health checks are implemented.
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Affiliation(s)
- Nanna Bjørnbak Christoffersen
- Research Program On Health and Social Conditions, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Freja Ekstrøm Nilou
- Research Program On Health and Social Conditions, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Trine Thilsing
- Research Unit of General Practice, University of Southern, Odense, Denmark
| | - Lars Bruun Larsen
- Research Unit of General Practice, University of Southern, Odense, Denmark
- Steno Diabetes Center Zealand, Holbæk, Denmark
| | | | - Marie Broholm-Jørgensen
- Research Program On Health and Social Conditions, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
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Manca DP, Fernandes C, Lofters A, Aubrey-Bassler K, Shea-Budgell M, Campbell-Scherer D, Sopcak N, Meaney C, Moineddin R, McBrien K, Krueger P, Wong T, Grunfeld E. Results from the BETTER WISE trial: a pragmatic cluster two arm parallel randomized controlled trial for primary prevention and screening in primary care during the COVID-19 pandemic. BMC PRIMARY CARE 2023; 24:200. [PMID: 37770854 PMCID: PMC10537846 DOI: 10.1186/s12875-023-02159-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/16/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Cancer and chronic diseases are a major cost to the healthcare system and multidisciplinary models with access to prevention and screening resources have demonstrated improvements in chronic disease management and prevention. Research demonstrated that a trained Prevention Practitioner (PP) in multidisciplinary team settings can improve achievement of patient level prevention and screening actions seven months after the intervention. METHODS We tested the effectiveness of the PP intervention in a pragmatic two-arm cluster randomized controlled trial. Patients aged 40-65 were randomized at the physician level to an intervention group or to a wait-list control group. The intervention consisted of a patient visit with a PP. The PP received training in prevention and screening and use of the BETTER WISE tool kit. The effectiveness of the intervention was assessed using a composite outcome of the proportion of the eligible prevention and screening actions achieved between intervention and control groups at 12-months. RESULTS Fifty-nine physicians were recruited in Alberta, Ontario, and Newfoundland and Labrador. Of the 1,005 patients enrolled, 733 (72.9%) completed the 12-month analysis. The COVID-19 pandemic occurred during the study time frame at which time nonessential prevention and screening services were not available and in-person visits with the PP were not allowed. Many patients and sites did not receive the intervention as planned. The mean composite score was not significantly higher in patients receiving the PP intervention as compared to the control group. To understand the impact of COVID on the project, we also considered a subset of patients who had received the intervention and who attended the 12-month follow-up visit before COVID-19. This assessment demonstrated the effectiveness of the BETTER visits, similar to the findings in previous BETTER studies. CONCLUSIONS We did not observe an improvement in cancer and chronic disease prevention and screening (CCDPS) outcomes at 12 months after a BETTER WISE prevention visit: due to the COVID-19 pandemic, the study was not implemented as planned. Though benefits were described in those who received the intervention before COVID-19, the sample size was too small to make conclusions. This study may be a harbinger of a substantial decrease and delay in CCDPS activities under COVID restrictions. TRIAL REGISTRATION ISRCTN21333761. Registered on 19/12/2016. http://www.isrctn.com/ISRCTN21333761 .
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Affiliation(s)
- Donna Patricia Manca
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada.
- Covenant Health, Grey Nuns Community Hospital, 1100 Youville Drive Northwest, Edmonton, AB, T6L 5X8, Canada.
| | - Carolina Fernandes
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Kris Aubrey-Bassler
- Discipline of Family Medicine, Memorial University of Newfoundland, 300 Prince Phillip Drive, St. John's, Newfoundland, A1B 3V6, Canada
| | - Melissa Shea-Budgell
- Charbonneau Cancer Institute and Department of Oncology, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Denise Campbell-Scherer
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada
- Office of Lifelong Learning & Physician Learning Program, University of Alberta, 2-590 Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada
| | - Nicolette Sopcak
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Christopher Meaney
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Kerry McBrien
- Departments of Family Medicine and Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Paul Krueger
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Tracy Wong
- Patient Advisor, Alberta Health Services, Strategic Clinical Networks, Calgary, AB, Canada
| | - Eva Grunfeld
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
- Ontario Institute for Cancer Research, 661 University Avenue, Suite 510, Toronto, ON, M5G 0A3, Canada
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Yadav UN, Smith M, Agostino J, Sinka V, Williamson L, Wyber R, Butler DC, Belfrage M, Freeman K, Passey M, Walke E, Hammond B, Lovett R, Douglas KA. Understanding the implementation of health checks in the prevention and early detection of chronic diseases among Aboriginal and Torres Strait Islander people in Australia: a realist review protocol. BMJ Open 2023; 13:e071234. [PMID: 37344121 DOI: 10.1136/bmjopen-2022-071234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION Chronic disease remains the leading cause of morbidity and mortality among Aboriginal and Torres Strait Islander peoples in Australia. Regular structured, comprehensive health assessments are available to Aboriginal and Torres Strait Islander people as annual health checks funded through the Medicare Benefits Schedule. This realist review aims to identify context-specific enablers and tensions and contribute to developing an evidence framework to guide the implementation of health checks in the prevention and early detection of chronic diseases for Aboriginal and Torres Strait Islander people. METHODS AND ANALYSIS The review will involve the following steps: (1) Aboriginal and Torres Strait Islander engagement and research governance; (2) defining the scope of the review; (3) search strategy; (4) screening, study selection and appraisal; (5) data extraction and organisation of evidence; (6) data synthesis and drawing conclusions. This realist review will follow the Realist and MEta-narrative Evidence Syntheses: Evolving Standards guidance and will be reported as set up by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement. The realist programme theory will be developed through a literature review using multiple database searches from 1 November 1999 to 31 June 2022, limited to the English language, and stakeholder consultation, which will be refined throughout the review process. The study findings will be reported by applying the context-mechanism-outcome configuration to gain a deeper understanding of context and underlying mechanisms that influence the implementation of health checks in the prevention and early detection of chronic diseases among Aboriginal and Torres Strait Islander people in Australia. ETHICS AND DISSEMINATION Ethical approval is not required as this review will be using secondary data. Findings will be published in a peer-reviewed journal and presented at scientific conferences. SYSTEMATIC REVIEW REGISTRATION The review protocol has been registered on the international prospective register of systematic reviews: CRD42022326697.
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Affiliation(s)
- Uday Narayan Yadav
- National Centre for Aborginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, Australian Capital Territory, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Smith
- Australian National University Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jason Agostino
- Australian National University Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
- National Aboriginal Community Controlled Health Organisation, Canberra, Australian Capital Territory, Australia
| | - Victoria Sinka
- Centre for Kidney Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Leonie Williamson
- National Centre for Aborginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rosemary Wyber
- National Centre for Aborginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, Australian Capital Territory, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Danielle C Butler
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- The Institute for Urban Indigenous Health, Windsor, Queensland, Australia
| | - Mary Belfrage
- Royal Australian College of General Practitioners, Aboriginal & Torres Strait Islander Health, Melbourne, Victoria, Australia
| | - Kate Freeman
- Royal Australian College of General Practitioners, Aboriginal & Torres Strait Islander Health, Melbourne, Victoria, Australia
| | - Megan Passey
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Emma Walke
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Belinda Hammond
- Royal Australian College of General Practitioners, Aboriginal & Torres Strait Islander Health, Melbourne, Victoria, Australia
| | - Raymond Lovett
- National Centre for Aborginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kirsty A Douglas
- Australian National University Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
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11
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Kalski L, Greiß F, Hartung JJ, Hafermann L, Hofmann MA, Wolfarth B. Preventive health examinations: protocol for a prospective cross-sectional study of German employees aged 45 to 59 years (Ü45-check). Front Public Health 2023; 11:1076565. [PMID: 37377547 PMCID: PMC10291684 DOI: 10.3389/fpubh.2023.1076565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/11/2023] [Indexed: 06/29/2023] Open
Abstract
Objective Early identification of health-related risk factors is of great importance for maintaining workability. Screening examinations can help to detect diseases at an early stage and provide more needs-based recommendations. This study aims (1) to assess the individual need for prevention or rehabilitation based on preventive health examinations compared to a questionnaire survey, (2) to assess the results of the preventive health examinations compared to the Risk Index - Disability Pension (RI-DP), (3) to assess the results of the questionnaire survey compared to the RI-DP, (4) to assess the general health status of the sample (target population > 1,000) in German employees aged 45-59, (5) to identify the most common medical conditions. A further study question aims, and (6) to investigate the general health status of the specific occupational groups. Methods Comprehensive diagnostics including medical examination, anamnesis, anthropometric measurements, bioelectrical impedance analysis (BIA), handgrip strength, resting electrocardiogram (ECG), resting blood pressure, pulse wave velocity (PWV), and laboratory blood analyses added by a questionnaire are conducted. The research questions are analyzed in an exploratory manner. Results and conclusion We expect that the results will allow us to formulate recommendations regarding screening for prevention and rehabilitation needs on a more evidence-based level.Clinical Trial Registration: DRKS ID: DRKS00030982.
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Affiliation(s)
- Linda Kalski
- Institute of Sport Science, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Sports Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Greiß
- Department of Sports Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes J. Hartung
- Department of Sports Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Lorena Hafermann
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maja A. Hofmann
- Department of Dermatology and Venereology, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Federal German Pension Insurance Berlin-Brandenburg, Berlin, Germany
| | - Bernd Wolfarth
- Institute of Sport Science, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Sports Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
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12
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Kherad O, Carneiro AV. General health check-ups: To check or not to check? A question of choosing wisely. Eur J Intern Med 2023; 109:1-3. [PMID: 36609089 DOI: 10.1016/j.ejim.2022.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023]
Abstract
In high-income countries, regular general health check-ups are part of the fabric of the health care systems. The hidden concept of general health check-ups, promoted for more than a century, is to identify diseases at a stage at which early intervention can be effective. However, there has been little evidence to support the benefits of such checkups. Choosing wisely (CW) campaigns may represent a tremendous opportunity to eventually shift patients and physicians away from the non-evidence based yet firmly entrenched practice of the general health check-up. As campaign leaders and members of the CW working group of the European Federation of Internal Medicine, we want to join the discussion by giving our perspective based on the best available evidence.
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Affiliation(s)
- Omar Kherad
- Internal Medicine Division, La Tour Hospital and University of Geneva, Switzerland.
| | - Antonio Vaz Carneiro
- Institute for Evidence Based Healthcare, Faculdade de Medicina, Universidade de Lisboa, Portugal
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13
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Nakayama G, Masumoto S, Haruta J, Maeno T. Family caregivers' experience with healthcare and social care professionals and their participation in health checkups: A cross sectional study in Japan. J Gen Fam Med 2023; 24:110-118. [PMID: 36909789 PMCID: PMC10000252 DOI: 10.1002/jgf2.599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background For family caregivers, who are generally regarded as a vulnerable population, having regular checkups is a desirable health behavior. This study examined family caregivers' habit of having regular checkups prior to becoming involved with professionals who care for patients, and whether they had had recent checkups. We then examined the association between family caregivers' experience with professionals and their participation in checkups after adjusting for the past habit. Methods We conducted a cross sectional survey in Japan between November and December 2020. We recruited family caregivers who were aged 40-74 years and caring for community-dwelling adult patients. The outcome variable was whether family caregivers had undergone any health checkups since April 2019. We assessed family caregivers' experience using the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS). Results Of the 1091 recruited family caregivers, 629 were included in the analysis. Of these, 358 had previously undergone regular checkups, and 158 had no checkups or selected the option "unknown." Outcome rates in each group were 74.6% and 43.0%, respectively, and 62.0% for all 629 caregivers. Multivariate modified Poisson regression analysis revealed that among the J-IEXPAC CAREGIVERS scores, only the domain score for attention for the caregiver was significantly associated with family caregivers' participation in checkups (adjusted prevalence ratio per 1 SD increase = 1.07; 95% CI 1.01-1.14). Conclusions Among family caregivers' experience with professionals, the factor that focused on caregivers themselves was significantly associated with their participation in checkups. This finding underscores the significance of caregiver-focused care.
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Affiliation(s)
- Gen Nakayama
- Department of Primary Care and Medical Education, Faculty of Medicine University of Tsukuba Tsukuba Japan
| | - Shoichi Masumoto
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine University of Tsukuba Tsukuba Japan.,Department of General Medicine Tsukuba Central Hospital Ushiku Japan
| | - Junji Haruta
- Medical Education Center, School of Medicine Keio University Tokyo Japan
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Faculty of Medicine University of Tsukuba Tsukuba Japan
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14
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Hamasaki H, Yanai H. Periodic health checkups reduce the risk of hospitalization in patients with type 2 diabetes. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1087303. [PMID: 36993816 PMCID: PMC10012066 DOI: 10.3389/fcdhc.2023.1087303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/05/2023] [Indexed: 01/28/2023]
Abstract
IntroductionPeriodic health checkups (PHCs) represent a unique system in Japan that is useful for the early detection of lifestyle-related diseases and cardiovascular diseases (CVDs). This study aims to investigate the association of PHCs with the hospitalization risk of patients with type 2 diabetes mellitus (T2DM).MethodsA retrospective cohort study was conducted from April 2013 to December 2015 and included participant information such as CVD history, lifestyle, and whether PHC was conducted in addition to regular medical examinations. Difference in clinical data between patients with and without PHC was examined. Furthermore, Cox regression analysis was performed to investigate the independent association of PHCs with hospitalization.ResultsHerein, 1,256 patients were selected and followed up for 2.35 ± 0.73 years. In the PHC group, body mass index, waist circumference, proportion of patients with a history of CVD, and number of hospitalizations were lower than those in the non-PHC group. Furthermore, the PHC group exhibited a significant association with lower hospitalization risk (hazard ratio = 0.825; 95% confidence interval, 0.684 to 0.997; p = 0.046) in the Cox model.ConclusionThis study revealed that PHCs minimized the risk of hospitalization in patients with T2DM. Furthermore, we discussed the effectiveness of PHCs in enhancing health outcomes and reducing health care costs in such patients.
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Affiliation(s)
- Hidetaka Hamasaki
- Hamasaki Clinic, Kagoshima, Japan
- *Correspondence: Hidetaka Hamasaki,
| | - Hidekatsu Yanai
- Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Japan
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15
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Ohnishi M, Nakao R, Kawasaki R, Tanaka J, Kosaka S, Umezaki M. Factors associated with failure to undergo health check-ups in Nagasaki Prefecture, Japan. J Rural Med 2023; 18:28-35. [PMID: 36700124 PMCID: PMC9832308 DOI: 10.2185/jrm.2022-046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/07/2022] [Indexed: 01/06/2023] Open
Abstract
Objective: Municipal National Health Insurance (NHI) in Nagasaki Prefecture in Japan struggles with poor attendance of health check-ups, which was only 39.6% in 2018. This study aimed to evaluate factors that encourage healthy behaviors, including opting for health check-ups, and the characteristics of middle-aged and older individuals who did not undergo health check-ups. Materials and Methods: This cross-sectional study, using a self-administered questionnaire, was conducted in August 2020 in three municipalities of Nagasaki Prefecture. In addition to questions regarding sociodemographic information, such as sex, age, educational status, self-rated economic status, and family structure, the questionnaire included questions on daily lifestyle habits such as alcohol intake and exercise, current medical treatment, self-rated health, and information related to health check-ups. Of the 18,710 questionnaires distributed in the three municipalities, 8,756 (46.8%) were collected by the end of December 2020, of which 7,840 were valid for analysis. The compliance rate for health check-ups was obtained from the Public Health and Welfare Bureau of Nagasaki Prefecture. Statistical analyses were performed according to two age groups: 40-59 and 60-74 years. Results: Among the respondents who did not undergo health check-ups in the year prior to this study, "lack of time" and being "too bothersome" were the most popular reasons for not attending health check-ups. "Living alone" and "low self-rated economic status" were negative factors for receiving health check-ups regardless of age group. Conclusions: Vulnerable middle-aged and older persons, such as those living alone and with low economic status, were less likely to undergo health check-ups. Emphasis on home visits by public health nurses may also be needed to increase awareness of individual health conditions, especially for people living alone and those who are socioeconomically disadvantaged.
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Affiliation(s)
- Mayumi Ohnishi
- Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Rieko Nakao
- Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Ryoko Kawasaki
- Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Junichi Tanaka
- Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Satoko Kosaka
- Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Masahiro Umezaki
- Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Japan
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16
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Chen YJ, Lin CF, Feng J, Chiu HL. Influencing factors of participation in and satisfaction with elderly health checkups: a cross-sectional study. Front Public Health 2023; 11:1104438. [PMID: 37188280 PMCID: PMC10177394 DOI: 10.3389/fpubh.2023.1104438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/27/2023] [Indexed: 05/17/2023] Open
Abstract
Background Attending health checkups as a primary prevention strategy benefits older adults in facilitating the identification of health issues and risk factors for disease. Little is known about factors influencing participation in and satisfaction with a free annual elderly health checkup program (EHCP) in Taiwan. This study aimed to extend current knowledge related to the uptake of this service and individuals' views of the service. Methods This was a cross-sectional study using a telephone interview survey method to compare influencing factors and satisfaction between participants and non-participants of an EHCP. The individuals involved were older adults in Taipei, Taiwan. The random sampling method included 1,100 people, 550 older adults who had participated in the EHCP within the last 3 years, and 550 older adults who had not. A questionnaire containing personal characteristics and satisfaction with the EHCP was used. Independent t-test and Pearson's Chi-squared test were used to evaluate differences between the two groups. Associations between individual characteristics and health checkup attendance were estimated using log-binomial models. Results Results showed that 51.64% of participants reported being satisfied with the checkups; however, only 41.09% of non-participants were satisfied. In the association analysis, age, educational level, chronic diseases, and subjective satisfaction were related to older persons' participation. Furthermore, having a stroke was associated with a higher attendance rate [prevalence ratio: 1.49; 95% confidence interval: (1.13, 1.96)]. Conclusions The EHCP had a high proportion of satisfaction among participants, but the proportion was low among non-participants. Several factors were associated with participation and might lead to unequal healthcare service uptake. Health checkups need to increase among people at a young age, those with low educational backgrounds, and those without chronic diseases.
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Affiliation(s)
- Ying-Jen Chen
- Division of Geriatrics and General Internal Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiou-Fen Lin
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Jie Feng
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Huei-Ling Chiu
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
- *Correspondence: Huei-Ling Chiu
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17
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Chintapula U, Chikate T, Sahoo D, Kieu A, Guerrero Rodriguez ID, Nguyen KT, Trott D. Immunomodulation in age-related disorders and nanotechnology interventions. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2023; 15:e1840. [PMID: 35950266 PMCID: PMC9840662 DOI: 10.1002/wnan.1840] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/19/2022] [Accepted: 06/01/2022] [Indexed: 01/31/2023]
Abstract
Recently, the aging population has increased exponentially around the globe bringing more challenges to improve quality of life in those populations while reducing the economic burden on healthcare systems. Aging is associated with changes in the immune system culminating in detrimental effects such as immune dysfunction, immunosenescence, and chronic inflammation. Age-related decline of immune functions is associated with various pathologies including cardiovascular, autoimmune, neurodegenerative, and infectious diseases to name a few. Conventional treatment addresses the onset of age-related diseases by early detection of risk factors, administration of vaccines as preventive care, immunomodulatory treatment, and other dietary supplements. However, these approaches often come with systemic side-effects, low bioavailability of therapeutic agents, and poor outcomes seen in the elderly. Recent innovations in nanotechnology have led to the development of novel biomaterials/nanomaterials, which explore targeted drug delivery and immunomodulatory interactions in vivo. Current nanotechnology-based immunomodulatory approaches that have the potential to be used as therapeutic interventions for some prominent age-related diseases are discussed here. Finally, we explore challenges and future aspects of nanotechnology in the treatments of age-related disorders to improve quality of life in the elderly. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Cardiovascular Disease Therapeutic Approaches and Drug Discovery > Nanomedicine for Neurological Disease Therapeutic Approaches and Drug Discovery > Emerging Technologies.
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Affiliation(s)
- Uday Chintapula
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas, USA
- Joint Bioengineering Program, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tanmayee Chikate
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas, USA
| | - Deepsundar Sahoo
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas, USA
| | - Amie Kieu
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas, USA
| | | | - Kytai T. Nguyen
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas, USA
- Joint Bioengineering Program, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daniel Trott
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
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18
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Wang H, Shuai P, Deng Y, Yang J, Shi Y, Li D, Yong T, Liu Y, Huang L. A correlation-based feature analysis of physical examination indicators can help predict the overall underlying health status using machine learning. Sci Rep 2022; 12:19626. [PMID: 36379988 PMCID: PMC9666446 DOI: 10.1038/s41598-022-20474-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
As a systematic investigation of the correlations between physical examination indicators (PEIs) is lacking, most PEIs are currently independently used for disease warning. This results in the general physical examination having limited diagnostic values. Here, we systematically analyzed the correlations in 221 PEIs between healthy and 34 unhealthy statuses in 803,614 individuals in China. Specifically, the study population included 711,928 healthy participants, 51,341 patients with hypertension, 12,878 patients with diabetes, and 34,997 patients with other unhealthy statuses. We found rich relevance between PEIs in the healthy physical status (7662 significant correlations, 31.5%). However, in the disease conditions, the PEI correlations changed. We focused on the difference in PEIs between healthy and 35 unhealthy physical statuses and found 1239 significant PEI differences, suggesting that they could be candidate disease markers. Finally, we established machine learning algorithms to predict health status using 15-16% of the PEIs through feature extraction, reaching a 66-99% accurate prediction, depending on the physical status. This new reference of the PEI correlation provides rich information for chronic disease diagnosis. The developed machine learning algorithms can fundamentally affect the practice of general physical examinations.
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Affiliation(s)
- Haixin Wang
- grid.54549.390000 0004 0369 4060Sichuan Provincial Key Laboratory for Human Disease Gene Study, Center for Medical Genetics, Sichuan Academy of Medical Sciences & Sichuan Provincial People′s Hospital, University of Electronic Science and Technology of China, Chengdu, China ,grid.410646.10000 0004 1808 0950Research Unit for Blindness Prevention of Chinese Academy of Medical Sciences (2019RU026), Sichuan Academy of Medical Sciences, 32 The First Ring Road West 2, Chengdu, 610072 Sichuan China
| | - Ping Shuai
- grid.54549.390000 0004 0369 4060Health Management Center and Physical Examination Center of Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yanhui Deng
- grid.54549.390000 0004 0369 4060Sichuan Provincial Key Laboratory for Human Disease Gene Study, Center for Medical Genetics, Sichuan Academy of Medical Sciences & Sichuan Provincial People′s Hospital, University of Electronic Science and Technology of China, Chengdu, China ,grid.410646.10000 0004 1808 0950Research Unit for Blindness Prevention of Chinese Academy of Medical Sciences (2019RU026), Sichuan Academy of Medical Sciences, 32 The First Ring Road West 2, Chengdu, 610072 Sichuan China
| | - Jiyun Yang
- grid.54549.390000 0004 0369 4060Sichuan Provincial Key Laboratory for Human Disease Gene Study, Center for Medical Genetics, Sichuan Academy of Medical Sciences & Sichuan Provincial People′s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Shi
- grid.54549.390000 0004 0369 4060Sichuan Provincial Key Laboratory for Human Disease Gene Study, Center for Medical Genetics, Sichuan Academy of Medical Sciences & Sichuan Provincial People′s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Dongyu Li
- grid.54549.390000 0004 0369 4060Health Management Center and Physical Examination Center of Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Tao Yong
- grid.54549.390000 0004 0369 4060Medical Information Center of Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuping Liu
- grid.54549.390000 0004 0369 4060Health Management Center and Physical Examination Center of Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lulin Huang
- grid.54549.390000 0004 0369 4060Sichuan Provincial Key Laboratory for Human Disease Gene Study, Center for Medical Genetics, Sichuan Academy of Medical Sciences & Sichuan Provincial People′s Hospital, University of Electronic Science and Technology of China, Chengdu, China ,grid.410646.10000 0004 1808 0950Research Unit for Blindness Prevention of Chinese Academy of Medical Sciences (2019RU026), Sichuan Academy of Medical Sciences, 32 The First Ring Road West 2, Chengdu, 610072 Sichuan China
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Long-Term Psychosocial Consequences of Whole-Body Magnetic Resonance Imaging and Reporting of Incidental Findings in a Population-Based Cohort Study. Diagnostics (Basel) 2022; 12:diagnostics12102356. [PMID: 36292045 PMCID: PMC9600583 DOI: 10.3390/diagnostics12102356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Management of radiological incidental findings (IF) is of rising importance; however, psychosocial implications of IF reporting remain unclear. We compared long-term psychosocial effects between individuals who underwent whole-body magnetic resonance imaging (MRI) with and without reported IF, and individuals who did not undergo imaging. We used a longitudinal population-based cohort from Western Europe. Longitudinal analysis included three examinations (exam 1, 6 years prior to MRI; exam 2, MRI; exam 3, 4 years after MRI). Psychosocial outcomes included PHQ-9 (Patient Health Questionnaire), DEEX (Depression and Exhaustion Scale), PSS-10 (Perceived Stress Scale) and a Somatization Scale. Univariate analyses and adjusted linear mixed models were calculated. Among 855 included individuals, 25% (n = 212) underwent MRI and 6% (n = 50) had at least one reported IF. Compared to MRI participants, non-participants had a higher psychosocial burden indicated by PHQ-9 in exam 1 (3.3 ± 3.3 vs. 2.5 ± 2.3) and DEEX (8.6 ± 4.7 vs. 7.7 ± 4.4), Somatization Scale (5.9 ± 4.3 vs. 4.8 ± 3.8) and PSS-10 (14.7 ± 5.7 vs. 13.7 ± 5.3, all p < 0.05) in exam 3. MRI participation without IF reporting was significantly associated with lower values of DEEX, PHQ-9 and Somatization Scale. There were no significant differences at the three timepoints between MRI participants with and without IF. In conclusion, individuals who voluntarily participated in whole-body MRI had less psychosocial burden and imaging and IF reporting were not associated with adverse long-term psychosocial consequences. However, due to the study design we cannot conclude that the MRI exam itself represented a beneficial intervention causing improvement in mental health scores.
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Ii M, Watanabe S. The paradox of the COVID-19 pandemic: The impact on patient demand in Japanese hospitals. Health Policy 2022; 126:1081-1089. [PMID: 36175199 PMCID: PMC9482718 DOI: 10.1016/j.healthpol.2022.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/26/2022] [Accepted: 09/16/2022] [Indexed: 11/28/2022]
Abstract
Analyzing data from a large, nationally distributed group of Japanese hospitals, we found a dramatic decline in both inpatient and outpatient volumes over the three waves of the COVID-19 pandemic in Japan from February to December 2020. We identified three key reasons for this fall in patient demand. First, COVID-19-related hygiene measures and behavioral changes significantly reduced non-COVID-19 infectious diseases. Second, consultations relating to chronic diseases fell sharply. Third, certain medical investigations and interventions were postponed or cancelled. Despite the drop in hospital attendances and admissions, COVID-19 is said to have brought the Japanese health care system to the brink of collapse. In this context, we explore longstanding systematic issues, finding that Japan's abundant supply of beds and current payment system may have introduced a perverse incentive to overprovide services, creating a mismatch between patient needs and supply of health care resources. Poor coordination among medical providers and the highly decentralized governance of the health care system have also contributed to the crisis. In order to ensure the long-term sustainability of the Japanese health care system beyond COVID-19, it is essential to promote specialization and differentiation of medical functions among hospitals, to strengthen governance, and to introduce appropriate payment reform.
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Affiliation(s)
- Masako Ii
- Asian Public Policy Program, School of International and Public Policy, Hitotsubashi University, 2-1-2, Hitotsubashi, Chiyoda-ku, Tokyo 101-8439, Japan.
| | - Sachiko Watanabe
- Global Health Consulting, Japan (GHC), 6-27-30 Shinjuku, Shinjuku-ku, East Side Square 5F, Tokyo 160-0022, Japan
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21
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Lal S, Nguyen TXT, Sulemana AS, Khan MSR, Kadoya Y. Does financial literacy influence preventive health check-up behavior in Japan? a cross-sectional study. BMC Public Health 2022; 22:1704. [PMID: 36076219 PMCID: PMC9454162 DOI: 10.1186/s12889-022-14079-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background General health check-ups are an important element of healthcare, as they are designed to detect diseases, thereby reducing morbidity and mortality. Recent studies have found that financial literacy promotes preventive healthcare usage and reduces risky health behaviors such as smoking, lack of exercise, and gambling. Based on this evidence, we hypothesize that financial literacy, as a rational decision-making tool, is positively associated with health check-up behavior in Japan. Methods We extracted data on financial literacy, the main explanatory variable of this study, from the 2010 wave of the Preference Parameter Study (PPS) of Osaka University. Data on health check-up behavior as a dependent variable, along with control variables, were obtained from the 2011 PPS wave. Our sample focused on Japan’s middle-aged working population (40–64 years), and we applied probit regressions to test our hypothesis. Results Our final sample size was 2,208 participants after merging the two datasets. Descriptive statistics show that respondents had moderate financial literacy (mean = 0.62, SD = 0.33), low financial education (mean = 0.17, SD = 0.38), and low participation (mean = 31.75%, SD = 46.56%) in the health check-up. The probit regression analysis showed that financial literacy is insignificantly associated with health check-up behavior in Japan (coefficient = -0.0229; 95% CI: -0.2011—0.1551; p-value = 0.801). However, demographic factors such as being male (coefficient = -0.2299; 95% CI: -0.3649—-0.0950; p-value = 0.001), older (coefficient = 0.0280; 95% CI: 0.0188 – 0.0371; p-value = 0.000), and married (coefficient = 0.3217; 95% CI: 0.0728 – 0.5705; p-value = 0.011), as well as risky health behavior such as smoking (coefficient = -0.2784; 95% CI: -0.4262—-0.1305; p-value = 0.000) are significantly related to health check-up behavior. Conclusions Our results suggest that financial literacy insignificantly motivates people to behave rationally and understand the value of health check-ups as a tool for sustainable health.
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Affiliation(s)
- Sumeet Lal
- School of Economics, Hiroshima University, 1-2-1 Kagamiyama, Higashihiroshima, Hiroshima, 7398525, Japan
| | - Trinh Xuan Thi Nguyen
- School of Economics, Hiroshima University, 1-2-1 Kagamiyama, Higashihiroshima, Hiroshima, 7398525, Japan
| | - Abdul-Salam Sulemana
- School of Economics, Hiroshima University, 1-2-1 Kagamiyama, Higashihiroshima, Hiroshima, 7398525, Japan
| | - Mostafa Saidur Rahim Khan
- School of Economics, Hiroshima University, 1-2-1 Kagamiyama, Higashihiroshima, Hiroshima, 7398525, Japan.
| | - Yoshihiko Kadoya
- School of Economics, Hiroshima University, 1-2-1 Kagamiyama, Higashihiroshima, Hiroshima, 7398525, Japan
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22
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Seilo N, Paldanius S, Autio R, Kunttu K, Kaila M. Health check attendance association with health and study-related factors: a register-based cohort study of Finnish university entrants. Environ Health Prev Med 2022; 27:34. [PMID: 35989266 PMCID: PMC9425058 DOI: 10.1265/ehpm.22-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background General health checks are an established component of preventive health care in many countries. Declining participation rates have raised concerns in health care providers. Understanding the reasons for attendance and non-attendance is necessary to improve the preventive health care system. The aim of this study was to examine health- and study-related factors associated with university entrants’ health check attendance. Methods Since 2009, an electronic health questionnaire (eHQ) has been conducted yearly to all Finnish university entrants by the Finnish Student Health Service (FSHS) to screen students for a general health check. The questionnaire comprises 26 questions about health, health habits and studying. The study population consisted of the 3346 entrants from the 2011–2012 academic year who were referred to a health check based on their eHQ responses. The eHQ data were linked with health check attendance information. Multivariable logistic regression was used to study the associations between the questionnaire responses and non-attendance of the health check. Results Male sex (OR 1.6, 95% CI % 1.4–1.9) and low engagement with studies (OR 1.5, 95% CI 1.2–2.0) were the variables most strongly associated with non-attendance. Having low state of mind was negatively associated with health check non-attendance thus enhanced the health-check attendance (OR 0.6, 95% CI 0.5–0.8). Conclusions The results suggest that providing health checks in student health care may serve as a way of reaching students with health concerns. However, motivating males and smokers to attend general health checks continue to be a challenge also in a university student population. That low engagement with studies associates with health check non-attendance points to need to improve collaboration between universities and student health care. Supplementary information The online version contains supplementary material available at https://doi.org/10.1265/ehpm.22-00032.
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Affiliation(s)
- Noora Seilo
- Faculty of Medicine and Health Technology, Tampere University
| | | | - Reija Autio
- Faculty of Social Sciences, Tampere University
| | | | - Minna Kaila
- Public Health Medicine University of Helsinki
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23
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Bouissiere A, Laperrouse M, Panjo H, Ringa V, Rigal L, Letrilliart L. General practitioner gender and use of diagnostic procedures: a French cross-sectional study in training practices. BMJ Open 2022; 12:e054486. [PMID: 35523487 PMCID: PMC9083381 DOI: 10.1136/bmjopen-2021-054486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The acceleration in the number of female doctors has led to questions about differences in how men and women practice medicine. The aim of this study was to assess the influence of general practitioner (GP) gender on the use of the three main categories of diagnostic procedures-clinical examinations, laboratory tests and imaging investigations. DESIGN Cross-sectional nationwide multicentre study. SETTING French training general practices. PARTICIPANTS The patient sample included all the voluntary patients over a cumulative period of 5 days per office between November 2011 and April 2012. The GP sample included 85 males and 43 females. METHODS 54 interns in general practice, observing their GP supervisors, collected data about the characteristics of GPs and consultations, as well as the health problems managed during the visit and the processes of care associated with them. Using hierarchical multilevel mixed-effect logistic regression models, we performed multivariable analyses to assess differences in each of the three main categories of diagnostic procedures, and two specific multivariable analyses for each category, distinguishing screening from diagnostic or follow-up procedures. We searched for interactions between GP gender and patient gender or type of health problem managed. RESULTS This analysis of 45 582 health problems managed in 20 613 consultations showed that female GPs performed more clinical examinations than male GPs, both for screening (OR 1.75; 95% CI 1.19 to 2.58) and for diagnostic or follow-up purposes (OR 1.41; 95% CI 1.08 to 1.84). Female GPs also ordered laboratory tests for diagnostic or follow-up purposes more frequently (OR 1.21; 95% CI 1.03 to 1.43). Female GPs performed even more clinical examinations than male GPs to diagnose or follow-up injuries (OR 1.69; 95% CI 1.19 to 2.40). CONCLUSION Further research on the appropriateness of diagnostic procedures is required to determine to what extent these differences are related to underuse or overuse.
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Affiliation(s)
- Amandine Bouissiere
- Collège universitaire de médecine générale, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Marine Laperrouse
- Collège universitaire de médecine générale, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Henri Panjo
- INSERM CESP, Université Paris-Saclay, Saint-Aubin, France
- Unité Santé et droits sexuels et reproductifs, INED, Paris, France
| | - Virginie Ringa
- INSERM CESP, Université Paris-Saclay, Saint-Aubin, France
- Unité Santé et droits sexuels et reproductifs, INED, Paris, France
| | - Laurent Rigal
- INSERM CESP, Université Paris-Saclay, Saint-Aubin, France
- Unité Santé et droits sexuels et reproductifs, INED, Paris, France
| | - Laurent Letrilliart
- Collège universitaire de médecine générale, Université Claude Bernard Lyon 1, Villeurbanne, France
- Research on Healthcare Performance (RESHAPE), INSERM, Lyon, France
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24
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Sharma M, John R, Afrin S, Zhang X, Wang T, Tian M, Sahu KS, Mash R, Praveen D, Saif-Ur-Rahman KM. Cost-Effectiveness of Population Screening Programs for Cardiovascular Diseases and Diabetes in Low- and Middle-Income Countries: A Systematic Review. Front Public Health 2022; 10:820750. [PMID: 35345509 PMCID: PMC8957212 DOI: 10.3389/fpubh.2022.820750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022] Open
Abstract
Almost all low- and middle-income countries (LMICs) have instated a program to control and manage non-communicable diseases (NCDs). Population screening is an integral component of this strategy and requires a substantial chunk of investment. Therefore, testing the screening program for economic along with clinical effectiveness is essential. There is significant proof of the benefits of incorporating economic evidence in health decision-making globally, although evidence from LMICs in NCD prevention is scanty. This systematic review aims to consolidate and synthesize economic evidence of screening programs for cardiovascular diseases (CVD) and diabetes from LMICs. The study protocol is registered on PROSPERO (CRD42021275806). The review includes articles from English and Chinese languages. An initial search retrieved a total of 2,644 potentially relevant publications. Finally, 15 articles (13 English and 2 Chinese reports) were included and scrutinized in detail. We found 6 economic evaluations of interventions targeting cardiovascular diseases, 5 evaluations of diabetes interventions, and 4 were combined interventions, i.e., screening of diabetes and cardiovascular diseases. The study showcases numerous innovative screening programs that have been piloted, such as using mobile technology for screening, integrating non-communicable disease screening with existing communicable disease screening programs, and using community health workers for screening. Our review reveals that context is of utmost importance while considering any intervention, i.e., depending on the available resources, cost-effectiveness may vary—screening programs can be made universal or targeted just for the high-risk population.
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Affiliation(s)
- Manushi Sharma
- The George Institute for Global Health, New Delhi, India
| | - Renu John
- The George Institute for Global Health, New Delhi, India
| | - Sadia Afrin
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh
| | - Xinyi Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Tengyi Wang
- School of Public Health, Harbin Medical University, Harbin, China
| | - Maoyi Tian
- School of Public Health, Harbin Medical University, Harbin, China.,Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Kirti Sundar Sahu
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Robert Mash
- Department of Family and Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Devarsetty Praveen
- The George Institute for Global Health, New Delhi, India.,Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - K M Saif-Ur-Rahman
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh.,Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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25
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Piessens V, Delvaux N, Heytens S, Aertgeerts B, De Sutter A. Downstream activities after laboratory testing in primary care: an exploratory outcome of the ELMO cluster randomised trial (Electronic Laboratory Medicine Ordering with evidence-based order sets in primary care). BMJ Open 2022; 12:e059261. [PMID: 35379642 PMCID: PMC8981323 DOI: 10.1136/bmjopen-2021-059261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To estimate the rate and type of downstream activities (DAs) after laboratory testing in primary care, with a specific focus on check-up laboratory panels, and to explore the effect of a clinical decision support system (CDSS) for laboratory ordering on these DAs. DESIGN Cluster randomised clinical trial. SETTING 72 primary care practices in Belgium, with 272 general practitioners (GPs), randomly assigned to the intervention arm or the control arm. PARTICIPANTS The study included 10 270 lab panels from 9683 primary care patients (women 55.1%, mean age 56.5). All adult patients who consulted one of the participating GPs during the trial period and needed a laboratory exam were eligible for participation. INTERVENTIONS GPs in the intervention group used a CDSS integrated into their online laboratory ordering system, while GPs in the control arm used their lab ordering system as usual. The trial duration was 6 months, with another 6 months follow-up. MAIN OUTCOME MEASURES This publication reports on the exploratory outcome of DAs after an initial laboratory exam and the effect of the CDSS on these DAs. RESULTS 19.7% of all laboratory panels resulted in further diagnostic procedures (95% CI 18.9% to 20.5%) and 19% (95% CI 18.2% to 19.7%) in treatment changes. Check-up laboratory exams showed similar rates of DAs, with 17.5% (95% CI 13.8% to 21.2%) diagnostic DAs and 18.9% (95% CI 13.9% to 23.9%) treatment changes. Using the CDSS resulted in a significant reduction in downstream referrals (-2.4%; 95% CI -4.2% to -0.6%; p=0008), imaging and endoscopies (-0.9%; 95% CI -1.6% to -0.1%; p=0026) and treatment changes (-5.4%; 95% CI -9.5% to -1.2%; p=0.01). CONCLUSION This is the largest study so far to examine DAs after laboratory testing. It shows that almost one in three laboratory exams leads to further DAs, even in check-up panels. Using a CDSS for laboratory orders may reduce the rate of some DAs. TRIAL REGISTRATION NUMBER NCT02950142.
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Affiliation(s)
- Veerle Piessens
- Public Health and Primary Care, Ghent University Faculty of Medicine and Health Sciences, Gent, Belgium
| | | | - Stefan Heytens
- Public Health and Primary Care, Ghent University Faculty of Medicine and Health Sciences, Gent, Belgium
| | | | - An De Sutter
- Public Health and Primary Care, Ghent University Faculty of Medicine and Health Sciences, Gent, Belgium
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26
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Use of Tactile Contact Accompanying Health Prmotion Messages During Routine Health & Physical Examinations: A Technique for Improving Compliance. JOURNAL OF PUBLIC HEALTH INTERNATIONAL 2022; 4:18-27. [PMID: 35291713 PMCID: PMC8920405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
A daunting challenge for health providers and medical practitioners is communicating the vital importance of health promotion and medical treatment adherence and compliance. This article is an evidence-based, best-practices commentary advocating the use of touch-accompanied verbal suggestions during the touching portions of routine, near-universal Health & Physical examinations. Notional case examples are presented; based on the professional literature, underlying Behavioral Mechanics are discussed. Touch-accompanied verbal health promotion messages skillfully deployed in routine Health & Physical examinations offer a non-harmful and efficient technique to synergistically and substantially enhance the probability of patient compliance with health improvement and medical treatment regimens. Though it is not a magic panacea, the public health applications, extensions and benefits are incalculable in terms of healthy behavior adoption. Additionally, if deftly conducted in accordance with best practices, it has the potential to greatly improve practitioner-patient relations and increase patient satisfaction. Further avenues of research inquiry are considered.
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27
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North F, Nelson EM, Buss RJ, Majerus RJ, Thompson MC, Crum BA. The Effect of Automated Mammogram Orders Paired With Electronic Invitations to Self-schedule on Mammogram Scheduling Outcomes: Observational Cohort Comparison. JMIR Med Inform 2021; 9:e27072. [PMID: 34878997 PMCID: PMC8693199 DOI: 10.2196/27072] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/03/2021] [Accepted: 11/15/2021] [Indexed: 01/15/2023] Open
Abstract
Background Screening mammography is recommended for the early detection of breast cancer. The processes for ordering screening mammography often rely on a health care provider order and a scheduler to arrange the time and location of breast imaging. Self-scheduling after automated ordering of screening mammograms may offer a more efficient and convenient way to schedule screening mammograms. Objective The aim of this study was to determine the use, outcomes, and efficiency of an automated mammogram ordering and invitation process paired with self-scheduling. Methods We examined appointment data from 12 months of scheduled mammogram appointments, starting in September 2019 when a web and mobile app self-scheduling process for screening mammograms was made available for the Mayo Clinic primary care practice. Patients registered to the Mayo Clinic Patient Online Services could view the schedules and book their mammogram appointment via the web or a mobile app. Self-scheduling required no telephone calls or staff appointment schedulers. We examined uptake (count and percentage of patients utilizing self-scheduling), number of appointment actions taken by self-schedulers and by those using staff schedulers, no-show outcomes, scheduling efficiency, and weekend and after-hours use of self-scheduling. Results For patients who were registered to patient online services and had screening mammogram appointment activity, 15.3% (14,387/93,901) used the web or mobile app to do either some mammogram self-scheduling or self-cancelling appointment actions. Approximately 24.4% (3285/13,454) of self-scheduling occurred after normal business hours/on weekends. Approximately 9.3% (8736/93,901) of the patients used self-scheduling/cancelling exclusively. For self-scheduled mammograms, there were 5.7% (536/9433) no-shows compared to 4.6% (3590/77,531) no-shows in staff-scheduled mammograms (unadjusted odds ratio 1.24, 95% CI 1.13-1.36; P<.001). The odds ratio of no-shows for self-scheduled mammograms to staff-scheduled mammograms decreased to 1.12 (95% CI 1.02-1.23; P=.02) when adjusted for age, race, and ethnicity. On average, since there were only 0.197 staff-scheduler actions for each finalized self-scheduled appointment, staff schedulers were rarely used to redo or “clean up” self-scheduled appointments. Exclusively self-scheduled appointments were significantly more efficient than staff-scheduled appointments. Self-schedulers experienced a single appointment step process (one and done) for 93.5% (7553/8079) of their finalized appointments; only 74.5% (52,804/70,839) of staff-scheduled finalized appointments had a similar one-step appointment process (P<.001). For staff-scheduled appointments, 25.5% (18,035/70,839) of the finalized appointments took multiple appointment steps. For finalized appointments that were exclusively self-scheduled, only 6.5% (526/8079) took multiple appointment steps. The staff-scheduled to self-scheduled odds ratio of taking multiple steps for a finalized screening mammogram appointment was 4.9 (95% CI 4.48-5.37; P<.001). Conclusions Screening mammograms can be efficiently self-scheduled but may be associated with a slight increase in no-shows. Self-scheduling can decrease staff scheduler work and can be convenient for patients who want to manage their appointment scheduling activity after business hours or on weekends.
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Affiliation(s)
- Frederick North
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Elissa M Nelson
- Enterprise Office of Access Management, Mayo Clinic, Rochester, MN, United States
| | - Rebecca J Buss
- Enterprise Office of Access Management, Mayo Clinic, Rochester, MN, United States
| | - Rebecca J Majerus
- Enterprise Office of Access Management, Mayo Clinic, Rochester, MN, United States
| | - Matthew C Thompson
- Enterprise Office of Access Management, Mayo Clinic, Rochester, MN, United States
| | - Brian A Crum
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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28
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CLARKE LORCAN, ANDERSON MICHAEL, ANDERSON ROB, KLAUSEN MORTENBONDE, FORMAN REBECCA, KERNS JENNA, RABE ADRIAN, KRISTENSEN SØRENRUD, THEODORAKIS PAVLOS, VALDERAS JOSE, KLUGE HANS, MOSSIALOS ELIAS. Economic Aspects of Delivering Primary Care Services: An Evidence Synthesis to Inform Policy and Research Priorities. Milbank Q 2021; 99:974-1023. [PMID: 34472653 PMCID: PMC8718591 DOI: 10.1111/1468-0009.12536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Policy Points The 2018 Declaration of Astana reemphasized the importance of primary health care and its role in achieving universal health coverage. While there is a large amount of literature on the economic aspects of delivering primary care services, there is a need for more comprehensive overviews of this evidence. In this article, we offer such an overview. Evidence suggests that there are several strategies involving coverage, financing, service delivery, and governance arrangements which can, if implemented, have positive economic impacts on the delivery of primary care services. These include arrangements such as worker task-shifting and telemedicine. The implementation of any such arrangements, based on positive economic evidence, should carefully account for potential impacts on overall health care access and quality. There are many opportunities for further research, with notable gaps in evidence on the impacts of increasing primary care funding or the overall supply of primary care services. CONTEXT The 2018 Declaration of Astana reemphasized the importance of primary health care and its role in achieving universal health coverage. To strengthen primary health care, policymakers need guidance on how to allocate resources in a manner that maximizes its economic benefits. METHODS We collated and synthesized published systematic reviews of evidence on the economic aspects of different models of delivering primary care services. Building on previous efforts, we adapted existing taxonomies of primary care components to classify our results according to four categories: coverage, financing, service delivery, and governance. FINDINGS We identified and classified 109 reviews that met our inclusion criteria according to our taxonomy of primary care components: coverage, financing, service delivery, and governance arrangements. A significant body of evidence suggests that several specific primary care arrangements, such as health workers' task shifting and telemedicine, can have positive economic impacts (such as lower overall health care costs). Notably absent were reviews on the impact of increasing primary care funding or the overall supply of primary care services. CONCLUSIONS There is a great opportunity for further research to systematically examine the broader economic impacts of investing in primary care services. Despite progress over the last decade, significant evidence gaps on the economic implications of different models of primary care services remain, which could help inform the basis of future research efforts.
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Affiliation(s)
- LORCAN CLARKE
- London School of Economics and Political Science
- Trinity College Dublin
| | | | | | | | | | - JENNA KERNS
- London School of Economics and Political Science
| | | | | | | | | | - HANS KLUGE
- World Health Organization Regional Office for Europe (WHO/Europe)
| | - ELIAS MOSSIALOS
- London School of Economics and Political Science
- Imperial College London
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Mertens E, Sagastume D, Peñalvo JL. Quantification of disparities in the distribution of lifestyle and metabolic risk factors, prevalence of non-communicable diseases and related mortality: the Belgian Health Interview Surveys 1997-2018. BMJ Open 2021; 11:e053260. [PMID: 34810190 PMCID: PMC8609944 DOI: 10.1136/bmjopen-2021-053260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Comprehensively measure the trends in health disparities by sociodemographic strata in terms of exposure to lifestyle and metabolic risks, and prevalence and mortality of non-communicable diseases (NCDs) during the last 20 years in Belgium. DESIGN Cross-sectional analysis of periodic national-representative health interview surveys and vital statistics. SETTING Population-based study of adult residents in Belgium between 1997 and 2018. PARTICIPANTS Adults aged 25-84 years and resident in Belgium in the years 1997 (7256 adults), 2001 (8665), 2004 (9054), 2008 (7343), 2013 (7704) and 2018 (8358). MAIN OUTCOME MEASURE Age-standardised prevalence rates of modifiable lifestyle risks (poor diet, smoking, excessive alcohol use and leisure-time physical inactivity), metabolic risks (high body mass index (BMI), blood pressure and cholesterol levels) and major NCDs (type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVDs), cancer, asthma and chronic obstructive pulmonary disease (COPD)), with their relative health disparities across strata by age, sex, region of residence, nationality, education and income level, and according to high versus low engagement in the four lifestyle risks, calculated from a survey-weighted age-adjusted logistic regression. RESULTS Greater avoidable disparities were observed between extremes of education and income strata. The most marked disparities were found for exposure to lifestyle risks (except excessive alcohol use), prevalence of high BMI as well as T2DM, asthma and COPD, with disparities of daily smoking and COPD worsening over time. Still, NCD-specific mortality rates were significantly higher among men (except asthma), residents of Wallonia and Brussels (except cerebrovascular disease), and among the native Belgians (except T2DM and asthma). High engagement in lifestyle risks was generally observed for men, residents of the region Wallonia, and among lower education and income strata. This subgroup (20%) had a worse health profile as compared with those who had a low-risk lifestyle (25%), shown by prevalence ratios varying between 1.1 and 1.6 for metabolic risks, and between 1.8 and 3.7 for CVD, asthma and COPD. CONCLUSIONS Improving population health, including promoting greater health equity, requires approaches to be tailored to high-risk groups with actions tackling driving root causes of disparities seen by social factors and unhealthy lifestyle.
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Affiliation(s)
- Elly Mertens
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Diana Sagastume
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - José L Peñalvo
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Nikander K, Hermanson E, Vahlberg T, Kaila M, Sannisto T, Kosola S. Associations between study questionnaire-assessed need and school doctor-evaluated benefit of routine health checks: an observational study. BMC Pediatr 2021; 21:346. [PMID: 34399731 PMCID: PMC8365945 DOI: 10.1186/s12887-021-02810-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background In Finland, school doctors examine all children at predetermined ages in addition to annual health checks by school nurses. This study explored the association of study questionnaire-assessed need for and school doctor-evaluated benefit of routine health checks conducted by doctors. Methods Between August 2017 and August 2018, we recruited a random sample of 1341 children in grades 1 and 5 (aged seven and eleven years, respectively) from 21 elementary schools in four Finnish municipalities. Children mainly studying in special education groups or whose parents needed an interpreter were excluded. School nurses performed their health check as usual. Parents, nurses, and teachers then completed study questionnaires that assessed the concerns of parents, school nurses, and teachers regarding each child’s physical, mental and social health. Doctors, blinded to the responses, routinely examined all the children. The primary outcome measures were (1) the need for a health check based on the study questionnaires and (2) the benefit/harm of the appointment as estimated by the doctors according to predetermined criteria, and (3) the patient-reported experience measures (PREMs) of benefit/harm of the appointment as estimated by the parents and children. We compared the need for a health check with the doctor-evaluated benefit using multilevel logistic regression. Results The participation rate was 75.5 %. According to all questionnaires, 20–25 % of the 1013 children had no need for a health check. The doctors regarded 410 (40.6 %) and the parents 812 (83.4 %) of the appointments as being beneficial. Respondents rarely reported harm. The children who were classified as needing a health check more often benefitted from the health check (assessed by the doctor) than children with no need for one (OR 3.53; 95 % CI 2.41–5.17). Conclusions The need for a health check is an important predictor of school-doctor evaluated benefit of the health check. This approach could allow school doctors to allocate time for the children who need them most. Trial registration ClinicalTrials.gov, Identifier NCT03178331, registration June 6th 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02810-0.
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Affiliation(s)
- Kirsi Nikander
- City of Helsinki, Department of Social Services and Health Care, School and Student Health Care, P.O. Box 6100, FI-00099, Helsinki, Finland. .,Doctoral School in Health Sciences, Doctoral Program in Population Health, University of Helsinki, Helsinki, Finland. .,Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Elina Hermanson
- Pikkujätti Medical Center for Children and Youth, Annankatu 32, 00100, Helsinki, Finland
| | - Tero Vahlberg
- Faculty of Medicine, Department of Clinical Medicine, Biostatistics, University of Turku, Kiinamyllynkatu 10, FI-20520, Turku, Finland
| | - Minna Kaila
- University of Helsinki, Public Health Medicine, P.O. Box 63, FI-00014, Helsinki, Finland
| | - Tuire Sannisto
- City of Tampere, Social and Health Care Services, Services for Children, Youth and Families, Naulakatu 2, FI-33101, Tampere, Finland
| | - Silja Kosola
- Pediatric Research Center, New Children's Hospital, Helsinki University Hospital, University of Helsinki, HUS, P.O. Box 705, Biomedicum 2 C, FI-00029, Helsinki, Finland
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Törmä J, Lundqvist R, Eliasson M, Nilsson LM, Oskarsson V, Wennberg M. Comparison of dietary trends between two counties with and without a cardiovascular prevention programme: a population-based cross-sectional study in northern Sweden. Public Health Nutr 2021; 25:1-9. [PMID: 34296666 PMCID: PMC9991627 DOI: 10.1017/s1368980021003050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/24/2021] [Accepted: 07/14/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare temporal trends, over a 20-year period, in dietary habits between a county (Västerbotten) with a CVD prevention programme and a county (Norrbotten) without such a programme. DESIGN Cross-sectional data from the Northern Sweden MONICA study (survey period 1994, 1999, 2004, 2009 and 2014). Dietary habits were assessed by a semi-quantitative FFQ. SETTING Counties of Norrbotten and Västerbotten, Northern Sweden. PARTICIPANTS Five thousand four hundred Swedish adults (mean age 56·9 years; 51·2 % women) from Västerbotten (47 %) and Norrbotten (53 %). RESULTS No differences in temporal trend for estimated percentage of energy intake from total carbohydrates, total fat, total protein and alcohol were observed between the counties (Pfor interaction ≥ 0·33). There were no between-county difference in temporal trends for overall diet quality (assessed by the Healthy Diet Score; Pfor interaction = 0·36). Nor were there any between-county differences for the intake of whole grain products, fruits, vegetables, fish, sweetened beverages or fried potatoes (Pfor interaction ≥ 0·09). Consumption of meat (Pfor interaction = 0·05) increased to a greater extent in Norrbotten from 2009 and onwards, mainly in men (sex-specific analyses, Pfor interaction = 0·04). Men in Västerbotten decreased their intake of sweets to a greater extent than men in Norrbotten (Pfor interaction < 0·01). CONCLUSIONS Over a 20-year period in northern Sweden, only small differences in dietary habits were observed in favour of a county with a CVD prevention programme compared with a county without such a programme.
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Affiliation(s)
- Johanna Törmä
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
- Department of Development, Region Norrbotten, Robertsviksgatan 7, SE-971 89, Luleå, Sweden
| | - Robert Lundqvist
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Mats Eliasson
- Department of Public Health and Clinical Medicine, Section of Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Lena Maria Nilsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Viktor Oskarsson
- Department of Public Health and Clinical Medicine, Section of Medicine, Piteå Research Unit, Umeå University, Umeå, Sweden
| | - Maria Wennberg
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
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Expectations about check-up examinations among Swiss residents: A nationwide population-based cross-sectional survey. PLoS One 2021; 16:e0254700. [PMID: 34288961 PMCID: PMC8294504 DOI: 10.1371/journal.pone.0254700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 07/01/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION General health check-up examinations in asymptomatic adults have not been shown to be beneficial. Instead, opportunistic prevention during regular primary care consultations is most cost-effective and recommended. The study aimed to elucidate the expectations about check-ups of the general Swiss population. METHODS A nationwide cross-sectional telephone survey was conducted in a representative sample of the population, stratified by sex, age, and language in November 2019. RESULTS Data of 1077 respondents were analysed. Mean age was 45 years (range 18 to 89), and 51% were female. Overall, 40% of respondents expected to have check-up examinations (yearly: 41.6%), and 42% expected opportunistic prevention. Most expected check-up interventions were sex-specific such as mammography (89% of women), Pap smear test (89% of women), and blood test of prostate-specific antigen (81% of men). The least favoured ones related to counselling (tobacco: 27%; alcohol abuse: 29%). Most significant predictors of positive check-up expectations were being male (OR = 1.45, CI: 1.02-2.05 P = 0.04)), age between 45 and 59 years old (OR = 2.03, CI: 1.27-3.23, P = 0.003 vs. 18 to 29 years), having a degree from professional (OR = 1.73, 95% CIs: 1.11-2.69, P 0.015) or, middle school (OR = 1.99, 95% CIs:1.04-3.78, P = 0.037) or university (OR = 1.66, 95% CIs: 1.06-2.61, P< 0.001, vs. secondary school) and the more importance attributed to regularly checking one's health (OR = 2.12, 95% CIs: 1.70-2.36, P < 0.001). CONCLUSIONS Almost half of the population expected to have mostly yearly check-up examinations in addition to regular care, which is in contradiction to recommendations. This behaviour impacts the rational use of health care resources and must be considered by physicians and given the active role of patients in the health care system.
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Novo S, Diana D, Tomasino C, Zambelli G, Mignano A, Scalmato A, Maniscalco L, Galassi A, Matranga D, Novo G. Electrocardiographic abnormalities, preclinical carotid atherosclerosis andcardiovascular risk, in an apparently healthy real-world population: data from the project "No Stroke, No Infarction" of the rotary international - District 2110 "Sicily & Malta". INT ANGIOL 2021; 40:470-477. [PMID: 34282855 DOI: 10.23736/s0392-9590.21.04637-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVDs) represent important causes of morbidity and mortality. Our study aimed to evaluate cardiovascular risk using the EUROSCORE, ECG and carotid ultrasound for prevention purpose in a 50-70 years population and companions asymptomatic and without CVD. METHODS History of CVD, risk factors (RFs), ECG and carotid ultrasound were evaluated. Intima-media thickness (IMT) was defined as wall thickness > 0.9 mm, while focal thickening ≥ 1.5 mm protruding into the lumen as asymptomatic carotid plaque (ACP). RESULTS Totally, 1860 subjects were screened. 393 (21.1%) had no RFs, 780 (42%) hypertension, 571 (30.7%) hypercholesterolemia, 557 (29.9%) diabetes, 474 (25.5%) smoking, 648 (34.8%) overweight, 300 (16.1%) obesity and 184 (9.9%) metabolic syndrome. Carotid atherosclerosis was detected in 903 (48.5%) subjects, 821 (44.1%) had IMT and 547 (29.4%) ACP, and was significantly related to diabetes, hypertension and hypercholesterolemia. Atrial fibrillation was found in 29 subjects (1.6%) and Brugada pattern in one. Using EUROSCORE, 220 subjects resulted at low (11.8%), 1338 at moderate (71.9%), 292 at high (15.7%) and 10 at very-high risk (0.5%). Adding ACP, the percentages were: low 159 (8,54%), moderate 1020 (54,83%), high 663 (35,64%) and very-high risk 18 (0,96%). CONCLUSIONS A total of 302 (16.2%) subjects were at least at high risk for CV events according to the EUROSCORE, increasing to 681 (36,61% - p < 0.001) adding ACP. The combination of EUROSCORE with ECG may help to stratify CV risk in primary prevention. Carotid ultrasound furtherly increases the power of stratification of asymptomatic patients suitable for pharmacological treatment.
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Affiliation(s)
- Salvatore Novo
- School of Medicine, University of Palermo, Palermo, Italy - .,Paolo Giaccone University Hospital, Palermo, Italy - .,International School of Cardiology, Ettore Majorana Foundation and Center for Scientific Culture, Erice, Trapani, Italy -
| | - Davide Diana
- G. D'Alessandro Department of Health Promotion and of Maternal and Child, Internal, and Specialist Medicine (PROMISE), University of Palermo, Palermo, Italy.,Intensive Coronary Care Unit, Emergency Department, Paolo Giaccone University Hospital, Palermo, Italy
| | - Claudio Tomasino
- G. D'Alessandro Department of Health Promotion and of Maternal and Child, Internal, and Specialist Medicine (PROMISE), University of Palermo, Palermo, Italy.,Intensive Coronary Care Unit, Emergency Department, Paolo Giaccone University Hospital, Palermo, Italy
| | - Giulia Zambelli
- G. D'Alessandro Department of Health Promotion and of Maternal and Child, Internal, and Specialist Medicine (PROMISE), University of Palermo, Palermo, Italy.,Intensive Coronary Care Unit, Emergency Department, Paolo Giaccone University Hospital, Palermo, Italy
| | - Antonino Mignano
- G. D'Alessandro Department of Health Promotion and of Maternal and Child, Internal, and Specialist Medicine (PROMISE), University of Palermo, Palermo, Italy.,Intensive Coronary Care Unit, Emergency Department, Paolo Giaccone University Hospital, Palermo, Italy
| | - Andrea Scalmato
- G. D'Alessandro Department of Health Promotion and of Maternal and Child, Internal, and Specialist Medicine (PROMISE), University of Palermo, Palermo, Italy.,Intensive Coronary Care Unit, Emergency Department, Paolo Giaccone University Hospital, Palermo, Italy
| | - Laura Maniscalco
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
| | - Alfredo Galassi
- G. D'Alessandro Department of Health Promotion and of Maternal and Child, Internal, and Specialist Medicine (PROMISE), University of Palermo, Palermo, Italy.,Intensive Coronary Care Unit, Emergency Department, Paolo Giaccone University Hospital, Palermo, Italy
| | - Domenica Matranga
- G. D'Alessandro Department of Health Promotion and of Maternal and Child, Internal, and Specialist Medicine (PROMISE), University of Palermo, Palermo, Italy
| | - Giuseppina Novo
- G. D'Alessandro Department of Health Promotion and of Maternal and Child, Internal, and Specialist Medicine (PROMISE), University of Palermo, Palermo, Italy.,Intensive Coronary Care Unit, Emergency Department, Paolo Giaccone University Hospital, Palermo, Italy
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Sopcak N, Fernandes C, O'Brien MA, Ofosu D, Wong M, Wong T, Kebbe M, Manca D. What is a prevention visit? A qualitative study of a structured approach to prevention and screening - the BETTER WISE project. BMC FAMILY PRACTICE 2021; 22:153. [PMID: 34275453 PMCID: PMC8287802 DOI: 10.1186/s12875-021-01503-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND This qualitative study is a sub-component of BETTER WISE, a comprehensive and structured approach that proactively addresses chronic disease prevention, screening, and cancer survivorship, including screening for poverty and addressing lifestyle risks for patients aged 40 to 65. Patients (n = 527) from 13 primary care clinics (urban, rural, and remote) in Alberta, Ontario, and Newfoundland & Labrador, Canada agreed to participate in the study and were invited to a one-hour prevention visit delivered by a Prevention Practitioner (PP) as part of BETTER WISE. We identified the key components of a BETTER WISE prevention visit based on patients' and primary care providers' perspectives. METHODS Primary care providers (PPs, physicians and their staff) participated in 14 focus groups and 19 key informant interviews to share their perspectives on the BETTER WISE project. Of 527 patients who agreed to participate in the study and were invited for a BETTER WISE prevention visit with a PP, we received 356 patient feedback forms. We also collected field notes and memos and employed thematic analysis using a constant comparative method focusing on the BETTER WISE prevention visit. RESULTS We identified four key themes related to a BETTER WISE prevention visit: 1) Creating a safe environment and building trust with patients: PPs provided sufficient time and a safe space for patients to share what was important to them, including their concerns related to poverty, alcohol consumption, and mental health, topics that were often not shared with physicians; 2) Providing personalized health education: PPs used the BETTER WISE tools to provide patients with a personalized overview of their health status and eligible screening; 3) Non-judgmental empowering of patients: Instead of directing patients on what to do, PPs evoked patients' preferences and helped them to set goals (if desired); and 4) Integrating care for patients: PPs clarified information from patients' charts and surveys with physicians and helped patients to navigate resources within and outside of the primary care team. CONCLUSIONS The results of this study underscore the importance of personalized, trusting, non-judgmental, and integrated relationships between primary care providers and patients to effectively address chronic disease prevention, screening, and cancer survivorship as demonstrated by the BETTER WISE prevention visits. TRIAL REGISTRATION This qualitative study is a sub-component of the BETTER WISE pragmatic, cRCT, trial registration ISRCTN21333761 (date of registration 19/12/2016).
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Affiliation(s)
- N Sopcak
- Department of Family Medicine, University of Alberta, Edmonton, Canada.
| | - C Fernandes
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - M A O'Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - D Ofosu
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - M Wong
- Department of Family Medicine, University of Alberta, Edmonton, Canada
| | - T Wong
- Strategic Clinical Networks, Alberta Health Services, Calgary, Canada
| | - M Kebbe
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, USA
| | - D Manca
- Department of Family Medicine, University of Alberta, Edmonton, Canada
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Chequeo preventivo basado en la evidencia. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kuneinen SM, Eriksson JG, Kautiainen H, Ekblad MO, Korhonen PE. The feasibility and outcome of a community-based primary prevention program for cardiovascular disease in the 21st century. Scand J Prim Health Care 2021; 39:157-165. [PMID: 34092186 PMCID: PMC8293959 DOI: 10.1080/02813432.2021.1913893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/25/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE There is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality. This study aimed to evaluate the effectiveness of a primary care CVD prevention program on mortality during a 13-year follow-up. DESIGN A risk factor survey was sent, followed by a nurse-led lifestyle counselling to respondents with at least one CVD risk factor, and a general practitioner's (GP) appointment for high-risk persons. Screening and interventions were performed during 2005-2006. SETTING A public health care centre in the town of Harjavalta, Finland. SUBJECTS All home-dwelling 45-70-year old inhabitants without manifested CVD or diabetes. MAIN OUTCOME MEASURES All-cause and CVD mortality. RESULTS Altogether 74% (2121/2856) inhabitants responded to the invitation. The intervention was received by 1465 individuals (52% of the invited population): 398 risk persons had an appointment with a nurse, followed by an appointment with a GP for 1067 high-risk persons. During the follow-up, 370 persons died. Mortality among the non-respondents was twofold compared to the participants'. In subjects who received the intervention, the age- and gender-adjusted hazard ratio for all-cause mortality was 0.44 (95% CI: 0.36 to 0.54) compared to the subjects who did not receive the intervention. CONCLUSIONS Reducing mortality is possible in a primary care setting by raising health awareness in the community with screening, by targeted lifestyle counselling and evidence-based preventive medication for persons at high risk for CVD. Subjects not willing to participate in health surveys have the worst prognosis.Key PointsPreviously, there is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality.With a stepwise screening program it is possible to scale the magnitude of CVD prevention in the community.Reducing mortality in a community is possible by screening, targeted lifestyle counselling, and by evidence-based preventive medication for high-risk persons.Subjects not willing to participate in health surveys have the worst prognosis.
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Affiliation(s)
- Susanna M. Kuneinen
- Department of General Practice, Turku University and Turku University Hospital, Turku, Finland
- Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
| | - Johan G. Eriksson
- Folkhälsan Research Center, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Agency for Science, Technology and Research (A*STAR), Singapore Institute for Clinical Sciences (SICS), Singapore, Singapore
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Mikael O. Ekblad
- Department of General Practice, Turku University and Turku University Hospital, Turku, Finland
| | - Päivi E. Korhonen
- Department of General Practice, Turku University and Turku University Hospital, Turku, Finland
- Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
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Murayama H, Takahashi Y, Shimada S. Effectiveness of an Out-of-Pocket Cost Removal Intervention on Health Check Attendance in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115612. [PMID: 34073994 PMCID: PMC8197396 DOI: 10.3390/ijerph18115612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/19/2021] [Accepted: 05/22/2021] [Indexed: 11/16/2022]
Abstract
Annual health checks are important for identifying individuals at high risk for cardiometabolic diseases. However, there are socioeconomic disparities in health check attendance rates, and an intervention to lower financial barriers could be useful for increasing health check utilization. In this study, we aimed to evaluate the effectiveness of an out-of-pocket cost removal intervention on health check attendance in Japan. Data were obtained on beneficiaries of the National Health Insurance system of Yokohama City, Kanagawa Prefecture, Japan. In 2018, Yokohama started an intervention to remove out-of-pocket costs for specific health checks for all National Health Insurance beneficiaries. We analyzed data from 2015-2018 (131,295 people aged 40-74 years; 377,660 observations). A generalized estimating equation showed that people were more likely to receive specific health checks in 2018 (after the out-of-pocket cost removal intervention started) than in 2017 (immediately before the intervention; odds ratio [95% confidence interval] = 1.167 [1.149-1.185]), after adjusting for age, gender, tax exemption, and residential area. Stratified analyses revealed that the effectiveness of the out-of-pocket cost removal intervention was greater among the older age group and those who did not receive a tax exemption (i.e., those with relatively higher income). The present study showed that the out-of-pocket cost removal intervention could promote specific health check utilization. This indicates that removing financial barriers could motivate people's behavior regarding health check attendance.
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Affiliation(s)
- Hiroshi Murayama
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
- Correspondence: ; Tel.: +81-3-3964-3241
| | - Yuta Takahashi
- Health and Welfare Bureau, City of Yokohama, Kanagawa 231-0005, Japan; (Y.T.); (S.S.)
| | - Setaro Shimada
- Health and Welfare Bureau, City of Yokohama, Kanagawa 231-0005, Japan; (Y.T.); (S.S.)
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O'Flaherty M, Lloyd-Williams F, Capewell S, Boland A, Maden M, Collins B, Bandosz P, Hyseni L, Kypridemos C. Modelling tool to support decision-making in the NHS Health Check programme: workshops, systematic review and co-production with users. Health Technol Assess 2021; 25:1-234. [PMID: 34076574 DOI: 10.3310/hta25350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Local authorities in England commission the NHS Health Check programme to invite everyone aged 40-74 years without pre-existing conditions for risk assessment and eventual intervention, if needed. However, the programme's effectiveness, cost-effectiveness and equity impact remain uncertain. AIM To develop a validated open-access flexible web-based model that enables local commissioners to quantify the cost-effectiveness and potential for equitable population health gain of the NHS Health Check programme. OBJECTIVES The objectives were as follows: (1) co-produce with stakeholders the desirable features of the user-friendly model; (2) update the evidence base to support model and scenario development; (3) further develop our computational model to allow for developments and changes to the NHS Health Check programme and the diseases it addresses; (4) assess the effectiveness, cost-effectiveness and equity of alternative strategies for implementation to illustrate the use of the tool; and (5) propose a sustainability and implementation plan to deploy our user-friendly computational model at the local level. DESIGN Co-production workshops surveying the best-performing local authorities and a systematic literature review of strategies to increase uptake of screening programmes informed model use and development. We then co-produced the workHORSE (working Health Outcomes Research Simulation Environment) model to estimate the health, economic and equity impact of different NHS Health Check programme implementations, using illustrative-use cases. SETTING Local authorities in England. PARTICIPANTS Stakeholders from local authorities, Public Health England, the NHS, the British Heart Foundation, academia and other organisations participated in the workshops. For the local authorities survey, we invited 16 of the best-performing local authorities in England. INTERVENTIONS The user interface allows users to vary key parameters that represent programme activities (i.e. invitation, uptake, prescriptions and referrals). Scenarios can be compared with each other. MAIN OUTCOME MEASURES Disease cases and case-years prevented or postponed, incremental cost-effectiveness ratios, net monetary benefit and change in slope index of inequality. RESULTS The survey of best-performing local authorities revealed a diversity of effective approaches to maximise the coverage and uptake of NHS Health Check programme, with no distinct 'best buy'. The umbrella literature review identified a range of effective single interventions. However, these generally need to be combined to maximally improve uptake and health gains. A validated dynamic, stochastic microsimulation model, built on robust epidemiology, enabled service options analysis. Analyses of three contrasting illustrative cases estimated the health, economic and equity impact of optimising the Health Checks, and the added value of obtaining detailed local data. Optimising the programme in Liverpool can become cost-effective and equitable, but simply changing the invitation method will require other programme changes to improve its performance. Detailed data inputs can benefit local analysis. LIMITATIONS Although the approach is extremely flexible, it is complex and requires substantial amounts of data, alongside expertise to both maintain and run. CONCLUSIONS Our project showed that the workHORSE model could be used to estimate the health, economic and equity impact comprehensively at local authority level. It has the potential for further development as a commissioning tool and to stimulate broader discussions on the role of these tools in real-world decision-making. FUTURE WORK Future work should focus on improving user interactions with the model, modelling simulation standards, and adapting workHORSE for evaluation, design and implementation support. STUDY REGISTRATION This study is registered as PROSPERO CRD42019132087. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 35. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Gyuricza JV, Christensen KB, d'Oliveira AFPL, Brodersen J. Psychometric properties of a condition-specific PROM for the psychosocial consequences of Labelling hypertension by using Rasch analysis. J Patient Rep Outcomes 2021; 5:19. [PMID: 33538939 PMCID: PMC7862460 DOI: 10.1186/s41687-021-00291-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background A previous qualitative assessment of the psychosocial consequences of labelling hypertension describes the diagnosis of hypertension as a labelling event with potential unintended negative long-term psychosocial consequences (labelling effects). Until now, the benefits of diagnosing hypertension have been far more reported than the harms. To obtain the net result of the preventive interventions for cardiovascular disease, such as diagnosing and treating mild hypertension, assessing benefits and harms in the most comprehensive way possible is necessary, including the psychosocial consequences of labelling. When measuring psychosocial consequences of labelling hypertension, a questionnaire with high content validity and adequate psychometric properties is needed. Objectives The aim of this study was to describe the psychometric parameters of face and content-validated pool of items. Other objectives were also to screen the item pool by using Rasch model analysis and confirmatory factor analysis (CFA) for identifying such items with sufficient fit to the hypothesised models. Methods We surveyed the pool of items as a draft questionnaire to Brazilians recruited via social networks, sending e-mails, WhatsApp® messages and posting on Facebook®. The inclusion criteria were to be older than 18 years old, to be healthy and to have only hypertension. We used Rasch model analysis to screen the item pool, discarding items that did not fit the hypothesised domain. We searched for local dependence and differential item functioning. We used CFA to confirm the derived measurement models and complementarily assessed reliability using Cronbach’s coefficient alpha. Results The validation sample consisted of 798 respondents. All 798 respondents completed Part I, whereas 285 (35.7%)—those with hypertension—completed Part II. A condition-specific questionnaire with high content validity and adequate psychometric properties was developed for people labelled with hypertension. This measure is called ‘Consequences of Labelling Hypertension Questionnaire’ and covers the psychosocial consequences of labelling hypertension in two parts, encompassing a total of 71 items in 15 subscales and 11 single items. Conclusion We developed a tool that can be used in future research involving hypertension, especially in scenarios of screening, prevention, population strategies and in intervention studies. Future use and testing of the questionnaire may still be required. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00291-4.
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Affiliation(s)
- János Valery Gyuricza
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Arnaldo, 455 2 andar. CEP, São Paulo, SP, 01246-903, Brazil. .,Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Øster Farimagsgade 5, building 24, P.O. Box 2099, 1014, Copenhagen K, Denmark.
| | - Karl Bang Christensen
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, Building 15, P.O. Box 2099, 1014, København K, Denmark
| | - Ana Flávia Pires Lucas d'Oliveira
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, Av. Dr Arnaldo, 455 2 andar. CEP, São Paulo, SP, 01246-903, Brazil
| | - John Brodersen
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Øster Farimagsgade 5, building 24, P.O. Box 2099, 1014, Copenhagen K, Denmark.,Primary Health Care Research Unit, Copenhagen, Region Zealand, Denmark
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Jeffery U, Jeffery ND, Creevy KE, Page R, Simpson MJ. Variation in biochemistry test results between annual wellness visits in apparently healthy Golden Retrievers. J Vet Intern Med 2021; 35:912-924. [PMID: 33528843 PMCID: PMC7995418 DOI: 10.1111/jvim.16021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
Background Annual wellness testing is widely recommended for apparently healthy dogs, but there is little data to assist with distinguishing normal variation from clinically important changes. Objectives To define variability in biochemistry analytes between annual wellness tests in healthy Golden Retrievers. Animals Four hundred thirty‐four Golden Retrievers undergoing annual health assessments by their primary care veterinarians as part of a prospective cohort study. Methods Changes in 23 biochemistry analytes were calculated between year 1 and year 2 health checks for 196 dogs classified as healthy for ≥3 consecutive years. Using a direct nonparametric method, annual change intervals were constructed to define normal variability. A validation cohort of 238 dogs without a diagnosis of systemic disease for ≥3 consecutive years were compared with the reference and annual change intervals, and the proportions of dogs outside annual change intervals and a population‐based reference interval were compared by using a McNemar test. Results Annual change intervals were calculated based on 190 dogs after outlier removal. For all 23 analytes, >90% of dogs in the validation cohort were within the annual change interval. There were no significant differences in the classification by reference versus annual change intervals. Conclusions and Clinical Importance The annual change intervals met performance requirements for classification of dogs that did not develop systemic disease in the year following wellness testing as normal.
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Affiliation(s)
- Unity Jeffery
- Department of Veterinary Pathobiology, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Nick D Jeffery
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Kate E Creevy
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Rod Page
- Flint animal Cancer Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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A dilemma. Br J Gen Pract 2021; 71:81. [PMID: 33509826 DOI: 10.3399/bjgp21x714845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Mandrola J. Digital Health: Should We Be Concerned? Methodist Debakey Cardiovasc J 2021; 16:309-313. [PMID: 33500760 DOI: 10.14797/mdcj-16-4-309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Type "health and fitness apps" into any search engine, and thousands of options will appear-so many, in fact, that people can now measure their own heart rate, sleep habits, and dozens of other health parameters that once required a doctor's visit. While anecdotes of a personal health device capturing early signs of disease may garner media attention, the increasing quantification of human physiology can have downsides. In essence, the enhanced ability to assess surrogate measures of health, such as temperature, minute-to-minute blood pressure, and genomics, are an expansion of anticipatory health-that is, an attempt to detect and avoid events that might happen in the future. While patients used to seek out doctors when they were sick, digital tools will send increasing numbers of people to their physicians before they are sick. In a Cartesian model of the human body, wherein one system could potentially be fixed independent of another system, having more data may be beneficial. The human body, however, is far more complex than any Cartesian model could explain. This article explores the limitations of digital devices to improve health.
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The Influence of Family Caregivers' Experience of Interprofessional Care on Their Participation in Health Checkups as Preventive Health Behavior in Japan-A Cross-Sectional Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010223. [PMID: 33396716 PMCID: PMC7796015 DOI: 10.3390/ijerph18010223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/24/2020] [Accepted: 12/26/2020] [Indexed: 11/26/2022]
Abstract
Background: The role of family caregivers has been vital, especially in superaging societies like Japan’s. The caregivers’ experience of interprofessional care is a key aspect in their evaluation of the quality of integrated care. We sought to explore whether family caregivers’ experience of interprofessional care is associated with their own participation in health checkups as preventive health behaviors. Methods: We used cross-sectional data obtained during the development of the Japanese version of the Caregivers’ Experience Instrument (J-IEXPAC CAREGIVERS). Participants who had provided care for at least one year were surveyed (n = 251). We assessed family caregivers’ experience of interprofessional care using J-IEXPAC CAREGIVERS and their participation in health checkups. Results: Multivariate logistic regression analysis revealed that the J-IEXPAC CAREGIVERS total score was significantly associated with the caregivers’ participation in health checkups [odds ratio per 1-point increase = 1.05; 95% confidence interval 1.01–1.09]. Two domain scores (attention for the patient and attention for the caregiver) of J-IEXPAC CAREGIVERS were significantly associated with the outcome. Conclusions: Family caregivers with more positive experiences of interprofessional care were more likely to participate in health checkups. These results support the significance of family caregivers’ experience of care, which may promote preventive health behaviors.
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The association between GP organisational factors and the effectiveness of a prevention programme for cardiometabolic diseases: a prospective intervention study. BJGP Open 2020; 4:bjgpopen20X101111. [PMID: 33144369 PMCID: PMC7880196 DOI: 10.3399/bjgpopen20x101111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/30/2020] [Indexed: 11/27/2022] Open
Abstract
Background Owing to the rising disease burden of cardiometabolic diseases (CMD), prevention programmes for CMD are increasingly implemented in primary care. Organisational practice characteristics and availability of preventive services may be associated with a more effective programme. Aim To identify possible organisational success factors from general practices related to an effective primary prevention programme for CMD. Design & setting A prospective intervention study involving 37 Dutch general practices was undertaken. Method Patients aged 45–70 years without known CMD, hypertension, or hypercholesterolemia were invited for the prevention programme. The outcome measures were an improvement (yes/no) in four different CMD risk factors between baseline and 1-year follow-up on an individual level (body mass index [BMI], smoking, systolic blood pressure, and cholesterol ratio). Multivariate logistic regression analysis was used for assessing associations between practice organisational characteristics and outcomes. Results Just over half of the participants showed an improvement on one or more risk factors. Marginal differences were found in the four different outcomes between the practices with different organisational characteristics. None of the practice characteristics that were tested showed a significant association with an improvement in one of the outcome measures. Conclusion In this study, general practice organisational and preventive service characteristics showed no impact on the effectiveness of a CMD prevention programme. Possible explanations could be the effectiveness of protocolised pharmaceutical treatment and only limited contribution of lifestyle programmes on the improvement of CMD risk factors.
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Delvaux N, Piessens V, Burghgraeve TD, Mamouris P, Vaes B, Stichele RV, Cloetens H, Thomas J, Ramaekers D, Sutter AD, Aertgeerts B. Clinical decision support improves the appropriateness of laboratory test ordering in primary care without increasing diagnostic error: the ELMO cluster randomized trial. Implement Sci 2020; 15:100. [PMID: 33148311 PMCID: PMC7640389 DOI: 10.1186/s13012-020-01059-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/22/2020] [Indexed: 12/21/2022] Open
Abstract
Background Inappropriate laboratory test ordering poses an important burden for healthcare. Clinical decision support systems (CDSS) have been cited as promising tools to improve laboratory test ordering behavior. The objectives of this study were to evaluate the effects of an intervention that integrated a clinical decision support service into a computerized physician order entry (CPOE) on the appropriateness and volume of laboratory test ordering, and on diagnostic error in primary care. Methods This study was a pragmatic, cluster randomized, open-label, controlled clinical trial. Setting Two hundred eighty general practitioners (GPs) from 72 primary care practices in Belgium. Patients Patients aged ≥ 18 years with a laboratory test order for at least one of 17 indications: cardiovascular disease management, hypertension, check-up, chronic kidney disease (CKD), thyroid disease, type 2 diabetes mellitus, fatigue, anemia, liver disease, gout, suspicion of acute coronary syndrome (ACS), suspicion of lung embolism, rheumatoid arthritis, sexually transmitted infections (STI), acute diarrhea, chronic diarrhea, and follow-up of medication. Interventions The CDSS was integrated into a computerized physician order entry (CPOE) in the form of evidence-based order sets that suggested appropriate tests based on the indication provided by the general physician. Measurements The primary outcome of the ELMO study was the proportion of appropriate tests over the total number of ordered tests and inappropriately not-requested tests. Secondary outcomes of the ELMO study included diagnostic error, test volume, and cascade activities. Results CDSS increased the proportion of appropriate tests by 0.21 (95% CI 0.16–0.26, p < 0.0001) for all tests included in the study. GPs in the CDSS arm ordered 7 (7.15 (95% CI 3.37–10.93, p = 0.0002)) tests fewer per panel. CDSS did not increase diagnostic error. The absolute difference in proportions was a decrease of 0.66% (95% CI 1.4% decrease–0.05% increase) in possible diagnostic error. Conclusions A CDSS in the form of order sets, integrated within the CPOE improved appropriateness and decreased volume of laboratory test ordering without increasing diagnostic error. Trial registration ClinicalTrials.gov Identifier: NCT02950142, registered on October 25, 2016 Supplementary Information The online version contains supplementary material available at 10.1186/s13012-020-01059-y.
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Affiliation(s)
- Nicolas Delvaux
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 Blok J PB 7001, B-3000, Leuven, Belgium.
| | - Veerle Piessens
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Tine De Burghgraeve
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 Blok J PB 7001, B-3000, Leuven, Belgium
| | - Pavlos Mamouris
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 Blok J PB 7001, B-3000, Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 Blok J PB 7001, B-3000, Leuven, Belgium
| | - Robert Vander Stichele
- Department of Basic and Applied Medical Sciences, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Hanne Cloetens
- Center for General Practice, University of Antwerp, Gouverneur Kinsbergen Centrum, Doornstraat 331, 2610, Wilrijk, Belgium
| | | | - Dirk Ramaekers
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 Blok J PB 7001, B-3000, Leuven, Belgium
| | - An De Sutter
- Department of Public Health and Primary Care, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Bert Aertgeerts
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 Blok J PB 7001, B-3000, Leuven, Belgium
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Kuronen J, Winell K, Kopra J, Räsänen K. Quality improvement activity in occupational healthcare associated with reduced need for disability retirement: A Bayesian mixed effects modelling study in Finland. Scand J Work Environ Health 2020; 46:630-638. [PMID: 33135767 PMCID: PMC7737809 DOI: 10.5271/sjweh.3901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives There is evidence that occupational healthcare (OHC) may improve employees' work ability. This research was designed to study whether common quality improvement (QI) activities in the OHC quality network (OQN) - a voluntary collaborative forum - can reduce the need for disability pensions. Methods The study population comprised employees under the care of 19 OHC units in Finland affiliated with the OQN. The association of 12 QI activities with new disability pensions during the years 2011-2017 was analyzed by Bayesian mixed effects modelling. Results Patients of OHC units affiliated with the OQN have fewer full permanent disability pensions [odds ratio (OR) 0.77, 95% credible interval (CI) 0.60-0.98] and full provisional disability pensions (OR 0.68, 95% CI 0.53-0.87) than patients of unaffiliated units. Of the studied QI activities, the measurements of intervening in excessive use of alcohol had the strongest association with the incidence of all disability pensions (OR 0.53, 95% CI 0.41-0.68). Participation in the focus of work measurements and quality facilitator training was also associated with the reduced incidence of disability pensions (OR 0.84, 95% CI 0.71-0.98, and OR 0.92, 95 CI 0.84-0.99, respectively). Conclusions Affiliation with a quality network seemed to improve outcomes by reducing full disability pensions or replacing them by partial disability pensions. Some QI activities in the OQN were associated with a reduction of disability pensions.
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Affiliation(s)
- Jarmo Kuronen
- Etelä-Savon Työterveys Oy, Maaherrankatu 13, 50100 Mikkeli, Finland.
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Brainin M, Sliwa K. WSO and WHF joint position statement on population-wide prevention strategies. Lancet 2020; 396:533-534. [PMID: 32828183 PMCID: PMC7440876 DOI: 10.1016/s0140-6736(20)31752-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/27/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Michael Brainin
- Department of Neuroscience and Preventive Medicine, World Stroke Organization, Danube University Krems, Krems an der Donau 3500, Austria.
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Moynihan R, Johansson M, Maybee A, Lang E, Légaré F. Covid-19: an opportunity to reduce unnecessary healthcare. BMJ 2020; 370:m2752. [PMID: 32665257 DOI: 10.1136/bmj.m2752] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Ray Moynihan
- Institute for Evidence-Based Healthcare, Bond University, Australia
| | | | | | - Eddy Lang
- Department for Emergency Medicine, Cumming School of Medicine, University of Calgary, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Laval University, Canada
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Kojima N, Klausner JD. Virtual House Calls: Telemedicine and Reforming the Health Care Delivery Model with Strategies Implemented in a Novel Coronavirus Pandemic. J Gen Intern Med 2020; 35:2243. [PMID: 32367391 PMCID: PMC7197919 DOI: 10.1007/s11606-020-05867-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Noah Kojima
- Department of Medicine, University of California Los Angeles, Los Angeles, 90095, USA.
| | - Jeffrey D Klausner
- Department of Medicine, University of California Los Angeles, Los Angeles, 90095, USA
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Affiliation(s)
- Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kamal R Mahtani
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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