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Almevall A, Almevall AD, Öhlin J, Gustafson Y, Zingmark K, Niklasson J, Nordström P, Rosendahl E, Söderberg S, Olofsson B. Self-rated health in old age, related factors and survival: A 20-Year longitudinal study within the Silver-MONICA cohort. Arch Gerontol Geriatr 2024; 122:105392. [PMID: 38492492 DOI: 10.1016/j.archger.2024.105392] [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: 11/28/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Self-rated health (SRH) offers insights into the evolving health demographics of an ageing population. AIM To assess change in SRH from old age to very old age and their associations with health and well-being factors, and to investigate the association between SRH and survival. METHODS All participants in the MONICA 1999 re-examination born before 1940 (n = 1595) were included in the Silver-MONICA baseline cohort. The Silver-MONICA follow-up started in 2016 included participants in the Silver-MONICA baseline cohort aged 80 years or older. Data on SRH was available for 1561 participants at baseline with 446 of them also participating in the follow-up. The follow-up examination included a wide variety of measurements and tests. FINDINGS Most participants rated their health as "Quite good" (54.5 %) at baseline. Over the study period, 42.6 % had stable SRH, 40.6 % had declined, and 16.8 % had improved. Changes in SRH were at follow-up significantly associated with age, pain, nutrition, cognition, walking aid use, self-paced gait speed, lower extremity strength, independence in activities of daily living, weekly physical exercise, outdoor activity, participation in organized activities, visiting others, morale, and depressive symptoms. SRH at baseline was significantly associated with survival (p < 0.05). CONCLUSION This study demonstrates associations between changes in SRH and a multitude of health- and wellbeing-related factors, as well as a relation between survival and SRH, accentuating their relevance within the ageing population.
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Affiliation(s)
- Ariel Almevall
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Luleå University of Technology, Luleå, Sweden.
| | | | - Jerry Öhlin
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden
| | - Yngve Gustafson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Karin Zingmark
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Luleå University of Technology, Luleå, Sweden
| | - Johan Niklasson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Erik Rosendahl
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Section of Medicine Umeå University, Umeå, Sweden
| | - Birgitta Olofsson
- Department of Nursing, Department of Diagnostics and Intervention, Orthopedics, Umeå University, Umeå, Sweden
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Sukumaran L, Winston A, Sabin CA. Understanding the conditions included in data-driven patterns of multimorbidity: a scoping review. Eur J Public Health 2024; 34:35-43. [PMID: 37837614 PMCID: PMC10843942 DOI: 10.1093/eurpub/ckad179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Despite the growing utilization of data-driven methods to investigate multimorbidity patterns, there is currently no consensus or guidance on the conditions to include when identifying patterns. This scoping review aims to systematically examine the nature of conditions included in existing studies using data-driven techniques. METHODS A comprehensive search of three electronic databases (MEDLINE, Web of Science and Scopus) was conducted to identify relevant publications from inception to 28 February 2022 using predefined search terms and inclusion/exclusion criteria. The reference lists and citations of relevant papers were also searched. RESULTS Among 7326 search results, 5444 relevant articles were identified. After screening against the eligibility criteria, 60 articles were included in the review. Half of the reviewed studies reported selection criteria for conditions, with prevalence in the population of interest being the most common criterion (40%). Most studies included at least one neurological [59 (98.3%)], musculoskeletal [58 (96.7%)], respiratory [57 (95.0%)] or mental health [56 (93.3%)] condition. In contrast, only a small proportion of studies included skin [17 (28.3%)], infections [14 (23.3%)] or autoimmune conditions [10 (16.7%)]. Nine conditions (hypertension, diabetes, cancer, arthritis, COPD, asthma, depression, stroke and osteoporosis) were included by more than half of the studies. CONCLUSIONS This review highlights the considerable heterogeneity among the conditions included in analyses of multimorbidity patterns. Researchers should provide a clear rationale for the selection of conditions to facilitate comparisons across studies and ensure reproducibility, as well as consider selecting a diverse range of conditions to capture the complexity of multimorbidity.
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Affiliation(s)
- Luxsena Sukumaran
- Institute for Global Health, University College London, London, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at University College London, London, UK
| | - Alan Winston
- Department of Infectious Disease, Imperial College London, London, UK
| | - Caroline A Sabin
- Institute for Global Health, University College London, London, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood-borne and Sexually Transmitted Infections at University College London, London, UK
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Kabir A, Conway DP, Ansari S, Tran A, Rhee JJ, Barr M. Impact of multimorbidity and complex multimorbidity on healthcare utilisation in older Australian adults aged 45 years or more: a large population-based cross-sectional data linkage study. BMJ Open 2024; 14:e078762. [PMID: 38199624 PMCID: PMC10806611 DOI: 10.1136/bmjopen-2023-078762] [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: 08/11/2023] [Accepted: 11/24/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES As life expectancy increases, older people are living longer with multimorbidity (MM, co-occurrence of ≥2 chronic health conditions) and complex multimorbidity (CMM, ≥3 chronic conditions affecting ≥3 different body systems). We assessed the impacts of MM and CMM on healthcare service use in Australia, as little was known about this. DESIGN Population-based cross-sectional data linkage study. SETTING New South Wales, Australia. PARTICIPANTS 248 496 people aged ≥45 years who completed the Sax Institute's 45 and Up Study baseline questionnaire. PRIMARY OUTCOME High average annual healthcare service use (≥2 hospital admissions, ≥11 general practice visits and ≥2 emergency department (ED) visits) during the 3-year baseline period (year before, year of and year after recruitment). METHODS Baseline questionnaire data were linked with hospital, Medicare claims and ED datasets. Poisson regression models were used to estimate adjusted and unadjusted prevalence ratios for high service use with 95% CIs. Using a count of chronic conditions (disease count) as an alternative morbidity metric was requested during peer review. RESULTS Prevalence of MM and CMM was 43.8% and 15.5%, respectively, and prevalence increased with age. Across three healthcare settings, MM was associated with a 2.02-fold to 2.26-fold, and CMM was associated with a 1.83-fold to 2.08-fold, increased risk of high service use. The association was higher in the youngest group (45-59 years) versus the oldest group (≥75 years), which was confirmed when disease count was used as the morbidity metric in sensitivity analysis.When comparing impact using three categories with no overlap (no MM/CMM, MM with no CMM, and CMM), CMM had greater impact than MM across all settings. CONCLUSION Increased healthcare service use among older adults with MM and CMM impacts on the demand for primary care and hospital services. Which of MM or CMM has greater impact on risk of high healthcare service use depends on the analytic method used. Ageing populations living longer with increasing burdens of MM and CMM will require increased Medicare funding and provision of integrated care across the healthcare system to meet their complex needs.
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Affiliation(s)
- Alamgir Kabir
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Damian P Conway
- Population and Community Health, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Sameera Ansari
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - An Tran
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Joel J Rhee
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Kalantari H, Raeissi P, Aryankhesal A, Hashemi SM, Reisi N. Patient Safety Domains in Primary Healthcare: A Systematic Review. Ethiop J Health Sci 2024; 34:73-84. [PMID: 38957341 PMCID: PMC11217791 DOI: 10.4314/ejhs.v34i1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/23/2023] [Indexed: 07/04/2024] Open
Abstract
Background Healthcare systems should ensure the provision of quality services to patients without harming them. However, the provision of services is occasionally accompanied by harm or complications, most of which are preventable. Most studies have focused on secondary healthcare rather than primary healthcare (PHC). Thus, this study aimed to identify various dimensions and components of patient safety in PHC worldwide. Methods This systematic review study was conducted in November 2022 based on PRISMA reporting guidelines. Studies were retrieved from PubMed, Scopus, Cochrane Library, Web of Science, and EMBASE and searched for English documents using the keywords "patient safety" and "PHC" from 2000 to 2022. Finally, two reviewers extracted the data independently and analyzed using thematic content analysis. Results Overall, 23 out of the initially 4937 identified articles were selected for the final analysis based on the inclusion and exclusion criteria. Most of these studies used a qualitative-quantitative approach (61.9%, seven studies for both), and 64% had been conducted in European countries. Eventually, five dimensions and 22 components were identified for patient safety in PHC, including management measures, quality management, resources and technology, documents, and patient-related factors. Conclusion The patient safety dimensions and components identified in this research can help develop a clear definition of patient safety and its assessment standards and criteria in PHC. Considering that most previous studies on patient safety in PHC were conducted in European and developed countries, it is suggested that researchers conduct more studies in developing countries to fill this research gap.
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Affiliation(s)
- Hadi Kalantari
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Pouran Raeissi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aydin Aryankhesal
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seyyed Masoud Hashemi
- Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nahid Reisi
- Department of Pediatric, Hematology and Oncology, Isfahan University of Medical Sciences, Isfahan, Iran
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Ansari S, Anand A, Hossain B. Exploring multimorbidity clusters in relation to healthcare use and its impact on self-rated health among older people in India. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002330. [PMID: 38153935 PMCID: PMC10754468 DOI: 10.1371/journal.pgph.0002330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/17/2023] [Indexed: 12/30/2023]
Abstract
The conventional definition of multimorbidity may not address the complex treatment needs resulting from interactions between multiple conditions, impacting self-rated health (SRH). In India, there is limited research on healthcare use and SRH considering diverse disease combinations in individuals with multimorbidity. This study aims to identify multimorbidity clusters related to healthcare use and determine if it improves the self-rated health of individuals in different clusters. This study extracted information from cross-sectional data of the first wave of the Longitudinal Ageing Study in India (LASI), conducted in 2017-18. The study participants were 31,373 people aged ≥ 60 years. A total of nineteen chronic diseases were incorporated to identify the multimorbidity clusters using latent class analysis (LCA) in the study. Multivariable logistic regression was used to examine the association between identified clusters and healthcare use. A propensity score matching (PSM) analysis was utilised to further examine the health benefit (i.e., SRH) of using healthcare in each identified cluster. LCA analysis identified five different multimorbidity clusters: relatively healthy' (68.72%), 'metabolic disorder (16.26%), 'hypertension-gastrointestinal-musculoskeletal' (9.02%), 'hypertension-gastrointestinal' (4.07%), 'complex multimorbidity' (1.92%). Older people belonging to the complex multimorbidity [aOR:7.03, 95% CI: 3.54-13.96] and hypertension-gastrointestinal-musculoskeletal [aOR:3.27, 95% CI: 2.74-3.91] clusters were more likely to use healthcare. Using the nearest neighbor matching method, results from PSM analysis demonstrated that healthcare use was significantly associated with a decline in SRH across all multimorbidity clusters. Findings from this study highlight the importance of understanding multimorbidity clusters and their implications for healthcare utilization and patient well-being. Our findings support the creation of clinical practice guidelines (CPGs) focusing on a patient-centric approach to optimize multimorbidity management in older people. Additionally, finding suggest the urgency of inclusion of counseling and therapies for addressing well-being when treating patients with multimorbidity.
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Affiliation(s)
- Salmaan Ansari
- Centre for Health Services Studies, University of Kent, Kent, England, United Kingdom
| | - Abhishek Anand
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, India
| | - Babul Hossain
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, India
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Jaltuszewska S, Chojnacka-Szawlowska G, Majkowicz M, Zdonczyk S, Homenda W, Hebel K. Illness Perception and the Severity of Depression and Anxiety Symptoms in Patients with Multimorbidity: Observational Cohort Studies. J Clin Med 2023; 13:69. [PMID: 38202075 PMCID: PMC10780102 DOI: 10.3390/jcm13010069] [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: 11/14/2023] [Revised: 12/05/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Many studies have shown a correlation between the patient's engagement in treatment and their perception of the illness. AIM The aim of this study has been to explore the link between the patient's perception of their illness with anxiety and depression, and to leverage this link to promote health education. MATERIALS AND METHODS The study was carried out using the following tools: the Hospital Anxiety and Depression Scale and the Illness Perception Questionnaire-Revised. The study participants included N = 143 patients. RESULTS The participants' age was statistically significantly associated with the expected duration of the illness (p < 0.01), the conviction that the treatment was effective (p < 0.01), and the perception of the severity of the disease symptoms (p < 0.05). The employment status was statistically significantly associated with the illness perception (p < 0.01). Anxiety and depression levels were statistically significantly associated with the perceived impact of the illness on life (p < 0.001) and emotional status (p < 0.001), the perceived control over the illness (p < 0.01), the potential for recovery (p < 0.001), the concern about the illness (p < 0.001), and the impact of the illness on emotional well-being (p < 0.001). CONCLUSIONS Individuals who perceived a high severity of illness symptoms also assessed that the illness significantly impacted their life and emotional state. The authors demonstrate a strong link of a "negative" perception of the illness with depression and anxiety. A better understanding of the illness predicted a less severe depression and lower anxiety. IMPLICATIONS FOR PRACTICE The results suggest that the study of illness perception holds significant potential to contribute effectively to educational and psychotherapeutic practices.
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Affiliation(s)
- Sylwia Jaltuszewska
- Institute of Health Sciences, Pomeranian University in Slupsk, Westerplatte 64, 76-200 Slupsk, Poland; (S.J.); (M.M.); (W.H.)
- Provincial Specialist Hospital named after Janusz Korczak in Slupsk, Hubalczyków 1, 76-200 Slupsk, Poland
| | | | - Mikolaj Majkowicz
- Institute of Health Sciences, Pomeranian University in Slupsk, Westerplatte 64, 76-200 Slupsk, Poland; (S.J.); (M.M.); (W.H.)
| | - Sebastian Zdonczyk
- Institute of Pedagogy, Pomeranian University in Slupsk, Westerplatte 64, 76-200 Slupsk, Poland;
- Provincial Specialist Hospital named after Janusz Korczak in Slupsk, Hubalczyków 1, 76-200 Slupsk, Poland
| | - Wojciech Homenda
- Institute of Health Sciences, Pomeranian University in Slupsk, Westerplatte 64, 76-200 Slupsk, Poland; (S.J.); (M.M.); (W.H.)
- Provincial Specialist Hospital named after Janusz Korczak in Slupsk, Hubalczyków 1, 76-200 Slupsk, Poland
| | - Kazimiera Hebel
- Institute of Health Sciences, Pomeranian University in Slupsk, Westerplatte 64, 76-200 Slupsk, Poland; (S.J.); (M.M.); (W.H.)
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Park JI, Lee GE, Lee S. A Data-Driven Approach to Identify the Predictors of Perceived Health Status Among Chinese and Korean Americans. Comput Inform Nurs 2023; 41:730-737. [PMID: 36708544 PMCID: PMC10368790 DOI: 10.1097/cin.0000000000000995] [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] [Indexed: 01/29/2023]
Abstract
Asian Americans are the country's fastest-growing racial group, and several studies have focused on the health outcomes of Asian Americans, including perceived health status. Perceived health status provides a summarized view of the health of populations for diverse domains, such as the psychological, social, and behavioral aspects. Given its multifaceted nature, perceived health status should be carefully approached when examining any variables' influence because it results from interactions among many variables. A data-driven approach using machine learning provides an effective way to discover new insights when there are complex interactions among multiple variables. To date, there are not many studies available that use machine learning to examine the effects of diverse variables on the perceived health status of Chinese and Korean Americans. This study aims to develop and evaluate three prediction models using logistic regression, random forest, and support vector machines to find the predictors of perceived health status among Chinese and Korean Americans from survey data. The prediction models identified specific predictors of perceived health status. These predictors can be utilized when planning for effective interventions for the better health outcomes of Chinese and Korean Americans.
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Affiliation(s)
- Jung In Park
- University of California- Irvine, Sue & Bill Gross School of Nursing, Irvine, CA
| | - Grace Eunyoung Lee
- University of California-Irvine, Department of Medicine, School of Medicine, Irvine, CA
| | - Sunmin Lee
- University of California-Irvine, Department of Medicine, School of Medicine, Irvine, CA
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Guldhammer C, Holden S, Audreucci A, Johansen SK, Thomsen JNL, Rathleff MS. Development of a tool to support general practitioners to help adolescents with knee pain: an analysis using the Theoretical Domains Framework. Prim Health Care Res Dev 2023; 24:e24. [PMID: 37005362 PMCID: PMC10156466 DOI: 10.1017/s1463423623000130] [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: 02/22/2022] [Revised: 09/29/2022] [Accepted: 12/13/2022] [Indexed: 04/04/2023] Open
Abstract
AIM Using the Theoretical Domains Framework (TDF) and COM-B model, this study aimed to determine the facilitators to a support tool for adolescent non-traumatic knee pain in general practice. BACKGROUND Many children and adolescents with non-traumatic knee pain consult their general practice. Currently, there are no tools to support general practitioners in the diagnosis and management of this group. There is a need to identify behavioural targets that would facilitate further development and implementation of such a tool. METHODS This study was designed as a qualitative study using focus group interviews with 12 medical doctors working in general practice. The semi-structured focus group interviews conducted online and followed an interview guide based on the TDF and COM-B model. Data were analysed via thematic text analysis. FINDINGS One of the biggest challenges from the general practitioner's perspective was how to manage and guide adolescents with non-traumatic knee pain. The doctors had doubts in their capability to diagnose knee pain and saw opportunity to help structure the consultation. The doctors felt motivated to use a tool but considered access a potential barrier. Increasing opportunity and motivation by creating access in the community among general practitioners was considered important. We identified several barriers and facilitators for a support tool for the management of adolescent non-traumatic knee pain in general practice. To align with user needs, future tools should support diagnostic workup, structure the consultation and be easily available among doctors working in general practice.
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Affiliation(s)
- Clara Guldhammer
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Sinead Holden
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | | | | | - Janus Nikolaj Laust Thomsen
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Di W, Nie Y, Chua BL, Chye S, Teo T. Developing a Single-Item General Self-Efficacy Scale: An Initial Study. JOURNAL OF PSYCHOEDUCATIONAL ASSESSMENT 2023. [DOI: 10.1177/07342829231161884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
General self-efficacy represents the global sense of personal capability across various situations and tasks. The aim of the present study was to develop and validate a single-item general self-efficacy scale which balances practical demands and psychometric concerns. The psychometric properties of the proposed Single-Item General Self-Efficacy Scale (GSE-SI) were examined among 231 Singaporean adults. Results based on three statistical methods demonstrated good reliability (.594 .607 and .726, respectively, M = .642), as compared with the reliability scores from other single-item scales. It also showed satisfactory criterion-related validity evidence (i.e., correlation with a multiple-item general self-efficacy scale, r = .795). Validity evidence based on relationships with other constructs was supported by the correlations between the scores of general self-efficacy and the scores of six relevant constructs (i.e., positive correlations with life satisfaction and positive emotions, negative correlations with negative emotions, task and perceived stress, and illness symptoms). More importantly, the GSE-SI and multiple-item scale scores showed consistent correlation patterns with their relevant constructs. Both GSE-SI and multiple-item scale scores significantly discriminated between the three clusters in a similar pattern. The present results show that the GSE-SI is a reliable and valid measure of general self-efficacy and can be recommended in future research to complement the constraints of multiple-item scales.
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Affiliation(s)
- Weiwei Di
- Nanyang Technological University, Singapore
| | - Youyan Nie
- Nanyang Technological University, Singapore
| | | | | | - Timothy Teo
- Chinese University of Hong Kong School of Education, Hong Kong
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Mohammadibakhsh R, Aryankhesal A, Sohrabi R, Alihosseini S, Behzadifar M. Implementation Challenges of Family Physician Program: A Systematic Review on Global Evidence. Med J Islam Repub Iran 2023; 37:21. [PMID: 37180861 PMCID: PMC10167646 DOI: 10.47176/mjiri.37.21] [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: 06/14/2022] [Indexed: 03/22/2023] Open
Abstract
Background The family physician program, as one of the core arms of health care systems, has faced various implementation challenges around the world. Experiences in the implementation of family physician program can be helpful for nations that seek to apply for similar programs. The aim of this study is to systematically review the implementation challenges of family physician program across the world. Methods A systematic search was conducted from January 2000 to February 2022 across scientific databases of Embase, MEDLINE, Web of Science, Scopus, CINAHL, EBSCO, and Google Scholar. The Framework approach was used to analyze the selected studies. The quality of the included studies was evaluated using the McMaster Critical Review Form for qualitative studies. Results 35 studies upon the study inclusion criteria were included. Based on the Six Building Blocks frame, seven themes and 21 subthemes were developed as the implementation challenges of family physician program. 1) Governance: policy guidance, intelligence, coalition, regulation, system design, and accountability; 2) Financing: financing and payment system; 3) Health workforce: education, research, recruitment and motivation opportunities; 4) Service delivery: management of health services, service package, referral system, continuity of care; 5) Health information systems: production and evaluating the health information system; 6) Availability: provision basic health services, maintenance of facilities; and 7) Cultural considerations: behavior and social determinants of health. Conclusion Scientific governance, financing, and payment mechanisms, workforce empowerment, designing a strong health information system, and providing access to services with cultural considerations can result in the successful implementation of the family physician program in communities.
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Affiliation(s)
- Roghayeh Mohammadibakhsh
- Management and Resources Development and Planning, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aidin Aryankhesal
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Rahim Sohrabi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
- Iranian Social Security Organization, Zanjan Province Health Administration, Zanjan, Iran
| | - Samira Alihosseini
- Health Management and Economics Research Center, Institute of Health Management, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
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Bevilacqua G, Westbury LD, Bloom I, Zhang J, Ward KA, Cooper C, Dennison EM. Investigating the relationship between self-perception of fracture risk and prior fracture: findings from the Hertfordshire Cohort Study. Aging Clin Exp Res 2023; 35:599-606. [PMID: 36529804 PMCID: PMC9760539 DOI: 10.1007/s40520-022-02322-6] [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: 09/30/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Self-perceived risk of fracture (SPR) is associated with fracture independent of FRAX calculated risk. To understand this better we considered whether lifestyle factors not included in the FRAX algorithm and psychosocial factors (social isolation, self-efficacy, or mental health status) explain the relationship between SPR and fracture. METHODS We studied 146 UK community-dwelling older adults from the Hertfordshire Cohort Study. SPR ranked as 'lower', 'similar' and 'higher' relative to others of the same age, was assessed by questionnaire. Social isolation was assessed using the six-item Lubben Social Network Scale; self-efficacy was assessed using a shortened General Self-Efficacy Scale (GSE); mental health status was assessed using the anxiety/depression item from the EuroQoL questionnaire. SPR in relation to previous self-reported fracture was examined using logistic regression. RESULTS Among participants of median age 83.4 (IQR 81.5-85.5) years, SPR was lower for 54.1% of participants, similar for 30.8%, and higher for 15.1%; 74.7% reported no previous fractures. Greater SPR was associated with increased odds of previous fractures when adjusting for sex and age only (OR 1.72, 95% CI 1.03-2.87, per higher band of SPR). While further individual adjustment for social isolation (1.73, 1.04-2.89), self-efficacy (1.71, 1.02-2.85), or mental health (1.77, 1.06-2.97) did not attenuate the relationship, individual adjustment for diet quality and number of comorbidities did. CONCLUSIONS Adjustment for social isolation, self-efficacy or mental health status did not attenuate the relationship between SPR and fracture. By contrast, lifestyle factors not included in FRAX, such as diet quality, did attenuate relationships, suggesting a possible future area of investigation.
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Affiliation(s)
- Gregorio Bevilacqua
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Leo D Westbury
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Ilse Bloom
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health and Care Research (NIHR), Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
| | - Jean Zhang
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health and Care Research (NIHR), Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
| | - Kate A Ward
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Cyrus Cooper
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health and Care Research (NIHR), Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK
- National Institute for Health and Care Research (NIHR), Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Elaine M Dennison
- Medical Research Council (MRC) Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK.
- National Institute for Health and Care Research (NIHR), Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service (NHS) Foundation Trust, Southampton, UK.
- School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand.
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12
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Whitmore C, Markle-Reid M, McAiney C, Fisher K, Ploeg J. How do individual, social, environmental, and resilience factors shape self-reported health among community-dwelling older adults: a qualitative case study. BMC Geriatr 2023; 23:8. [PMID: 36609212 PMCID: PMC9816521 DOI: 10.1186/s12877-023-03726-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 01/02/2023] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND While older adults are living longer, they often face health challenges, including living with multiple chronic conditions. How older adults respond and adapt to the challenges of multimorbidity to maintain health and wellness is of increasing research interest. Self-reported health, emerging as an important measure of health status, has broad clinical and research applications, and has been described as a predictor of future morbidity and mortality. However, there is limited understanding of how individual, social, and environmental factors, including those related to multimorbidity resilience, influence self-reported health among community-dwelling older adults (≥ 65 years). METHODS Informed by the Lifecourse Model of Multimorbidity Resilience, this explanatory case study research explored older adults' perceptions of how these factors influence self-reported health. Data were generated through semi-structured telephone interviews with community-dwelling older adults. RESULTS Fifteen older adults participated in this study. Four key themes, specific to how these older adults describe individual, social, environmental, and multimorbidity resilience factors as shaping their self-reported health, were identified: 1) health is a responsibility - "What I have to do"; 2) health is doing what you want to do despite health-related limitations - "I do what I want to do"; 3) the application and activation of personal strengths - "The way you think", and; 4) through comparison and learning from others - "Looking around at other people". These themes, while distinct, were found to be highly interconnected with recurring concepts such as independence, control, and psychological health and well-being, demonstrating the nuance and complexity of self-reported health. CONCLUSIONS Findings from this study advance understanding of the factors that influence assessments of health among community-dwelling older adults. Self-reported health remains a highly predictive measure of future morbidity and mortality in this population, however, there is a need for future research to contribute additional understanding in order to shape policy and practice.
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Affiliation(s)
- Carly Whitmore
- grid.25073.330000 0004 1936 8227School of Nursing, McMaster University, 1280 Main Street W., Hamilton, ON L8S 4K1 Canada
| | - Maureen Markle-Reid
- grid.25073.330000 0004 1936 8227School of Nursing, McMaster University, 1280 Main Street W., Hamilton, ON L8S 4K1 Canada
| | - Carrie McAiney
- grid.498777.2School of Public Health Sciences, University of Waterloo & Schlegel-University of Waterloo, Research Institute for Aging, 200 University Ave W., Waterloo, ON N2L 3G1 Canada
| | - Kathryn Fisher
- grid.25073.330000 0004 1936 8227School of Nursing, McMaster University, 1280 Main Street W., Hamilton, ON L8S 4K1 Canada
| | - Jenny Ploeg
- grid.25073.330000 0004 1936 8227School of Nursing, McMaster University, 1280 Main Street W., Hamilton, ON L8S 4K1 Canada
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13
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Hill A, Ellis M, Gillison F. Qualitative exploration of patient and healthcare professional perspectives on barriers and facilitators to foot self-care behaviors in diabetes. BMJ Open Diabetes Res Care 2022; 10:10/6/e003034. [PMID: 36375862 PMCID: PMC9664298 DOI: 10.1136/bmjdrc-2022-003034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Diabetic foot ulcers contribute significantly to morbidity and mortality associated with diabetes, but are preventable with good foot self-care. This study sought to explore the perspectives of patients and healthcare professionals (HCPs) on barriers and/or facilitators to foot self-care behaviors in diabetes and areas of consensus and/or tension between patient and HCP perspectives. RESEARCH DESIGN AND METHODS This was a sequential, qualitative study that used a hermeneutic phenomenological approach. Phase I involved nine in-depth, semi-structured patient interviews. Phase II involved seven in-depth semi-structured interviews with HCPs (podiatrists, diabetes nurses, foot health practitioners (FHPs) and general practitioners (GPs)). In phase III, findings from phases I and II were brought back to two patient interview groups (five patients in total) to try and identify any areas of consensus and tension between HCP and patient perspectives. RESULTS Patient and HCP perspectives had several areas of alignment: concerns over consequences of diabetes complications; the importance of patient education and frustrations around aspects of health service delivery. There were also some notable tensions identified: mixed messaging from HCPs around whose responsibility patient foot health is; and who patients should initially consult following the development of a foot problem. Overall, patients expressed that motivation to undertake good foot self-care behaviors was generated from their lived experiences, and was enhanced when this aligned with the information they received from HCPs. HCPs appeared to attribute lack of patient motivation to lack of knowledge, which was not raised by patients. CONCLUSIONS This study has identified points of misalignment between the views of patients and practitioners that may help to explain why adherence to foot self-care among patients with diabetes is low. Our results suggest that better outcomes may stem from HCPs focusing on supporting autonomous motivation for self-care and enhancing the rationale through referencing patients' own experience rather than focussing on increasing patient knowledge. Renewed focus on consistency of messaging by HCPs around the roles and responsibilities relating to foot health in diabetes, and the benefit of foot-specific training being provided to non-foot specialist HCPs may also help to improve uptake and adherence to foot self-care behaviors in diabetes.
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Affiliation(s)
- Andrew Hill
- Health, University of Bath, Bath, UK
- Health, The Smae Institute, Maidenhead, Windsor and Maidenhead, UK
| | - Mairghread Ellis
- Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry & Readiography, Queen Margaret University, Musselburgh, UK
| | - Fiona Gillison
- Department for Health, Centre for Motivation and Health Behaviour Change, University of Bath, Bath, UK
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14
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Madhu M, Hulmani M, Naveen Kumar AC, Kumar VJ. A Clinical Study of Efficacy of Autologous Platelet-Rich Fibrin (PRF) in Chronic Non-Healing Ulcers. Indian J Dermatol 2022; 67:834. [PMID: 36998844 PMCID: PMC10043654 DOI: 10.4103/ijd.ijd_204_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Background Chronic ulcers are defined as the breakdown of the epidermal and dermal tissue lasting for more than 6 weeks. There will be a lack of necessary growth factors in chronic non-healing ulcers. This study is aimed at accessing the efficacy of autologous platelet-rich fibrin in chronic non-healing ulcers. Aims and Objectives To determine the efficacy of autologous platelet-rich fibrin in chronic non-healing ulcers and to compare the rate of healing in different ulcers based on aetiology. Methods A hospital-based prospective study was conducted at the Department of Dermatology, Venereology, and Leprosy, at a tertiary care centre in Central Karnataka with 50 cases of chronic non-healing ulcers over 2 years. In each case baseline data including age and gender was collected and thorough general physical, local, and systemic examinations were done with the help of a predesigned proforma. PRF dressing was done weekly for 4 weeks with ulcer volume measured each time and improvement accessed. Results In this study, the mean age of the study population was 43.56 ± 14.06 years, with 84% males. Good improvement in the volume of the ulcer was seen in 6 patients out of 50, moderate improvement was seen in 20 out of 50 patients and mild in the rest of the 24 patients. Improvement was more in the educated sector, more so in females and patients with trauma as the cause of ulcers without any comorbidities. Leprosy followed by diabetes was the main cause of chronic non-healing ulcers. Conclusions This study shows that autologous platelet-rich fibrin therapy provides faster wound healing in chronic non-healing ulcers with no adverse events.
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Affiliation(s)
- M Madhu
- From the Department of Dermatology, SSIMS and RC, Davangere, Karnataka, India
| | - Manjunath Hulmani
- From the Department of Dermatology, SSIMS and RC, Davangere, Karnataka, India
| | - A C Naveen Kumar
- From the Department of Dermatology, SSIMS and RC, Davangere, Karnataka, India
| | - V Jagannath Kumar
- From the Department of Dermatology, SSIMS and RC, Davangere, Karnataka, India
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15
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Honda Y, Nakamura M, Aoki T, Ojima T. Multimorbidity patterns and the relation to self-rated health among older Japanese people: a nationwide cross-sectional study. BMJ Open 2022; 12:e063729. [PMID: 36538382 PMCID: PMC9438194 DOI: 10.1136/bmjopen-2022-063729] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Classifying individuals into multimorbidity patterns can be useful to identify the target population with poorer clinical outcomes. Self-rated health (SRH) is one of the core outcomes in multimorbidity patients. Although studies have reported that multimorbidity is associated with poor SRH, whether certain patterns have stronger associations remains unknown. Therefore, this study aimed to identify the prevalence and patterns of multimorbidity and investigate the association between multimorbidity patterns and SRH in an older Japanese population. DESIGN Cross-sectional study. SETTING Data were obtained from the 2013 Comprehensive Survey of Living Conditions, a nationally representative survey of the general Japanese population. PARTICIPANTS This study mainly examined 23 730 participants aged ≥65 years who were not hospitalised or institutionalised. PRIMARY OUTCOME MEASURE Poor SRH was defined as choosing 'not very good' or 'bad' from five options: 'excellent', 'fairly good', 'average', 'not very good' and 'bad'. RESULTS The prevalence of multimorbidity was 40.9% and that of poor SRH was 23.8%. Three multimorbidity patterns were identified by exploratory factor analysis: (1) degenerative/mental health, (3) malignant/digestive/urological/haematological and (3) cardiovascular/metabolic. Multivariable modified Poisson regression analysis revealed that high malignant/digestive/urological/haematological, degenerative/mental health and cardiovascular/metabolic pattern scores, corresponding to the number of affected body systems in each pattern, were significantly associated with poor SRH (adjusted risk ratio (aRR)=1.68, 95% CI: 1.60 to 1.76; aRR=1.63, 95% CI: 1.58 to 1.69; and aRR=1.31, 95% CI: 1.26 to 1.36, respectively). When including the Kessler 6 score, a screening scale for psychological distress, in the analysis, the association between each multimorbidity pattern score and poor SRH decreased. CONCLUSIONS Malignant/digestive/urological/haematological and degenerative/mental health patterns may be associated with a high risk for poor SRH. Further research should focus on interventions to improve SRH in multimorbidity patients.
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Affiliation(s)
- Yuki Honda
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of General Internal Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Mieko Nakamura
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takuya Aoki
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Minato-ku, Japan
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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16
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2022 Malaysian Working Group Consensus Statement on Renal Denervation for management of arterial hypertension. Hypertens Res 2022; 45:1111-1122. [PMID: 35650248 PMCID: PMC9192347 DOI: 10.1038/s41440-022-00937-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 12/28/2022]
Abstract
Hypertension is highly prevalent and a major contributor to cardiovascular mortality and morbidity. In spite of the availability of efficacious, safe and affordable anti-hypertensive drugs, hypertension remains poorly controlled in the majority of hypertensive patients. Various reasons including non-adherence to the anti-hypertensive drugs, account for the poor control. Resistant hypertension is also one of the reasons for poor control of blood pressure (BP). The sympathetic nervous system (SNS) has long been recognized as one of the determinants in the pathophysiology of a raised BP. Overactivity of the SNS is a contributor to sustained arterial hypertension. Renal denervation (RDN) is increasingly recognized as a safe and effective adjunctive therapy to control BP with or without pharmacotherapy. Hence for patients who remain uncontrolled despite all efforts, renal denervation (RDN) is a novel treatment that can potentially improve BP control, hence reducing the major adverse cardiovascular events (MACE). More recent randomized, sham control trials of RDN have shown that RDN produces a sustained lowering of BP. To date, this lowering of BP through RDN is maintained for at least 3 years. Furthermore, this procedure has been found to be safe. Hence this consensus summarises the science behind RDN and the available clinical data to support the use of this therapy. It is hoped that this consensus will offer guidance on the importance of identifying patients who will benefit most from this therapy. A multidisciplinary team approach in the management of the patient undergoing RDN is recommended. ![]()
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17
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Alharbi K, Blakeman T, van Marwijk H, Reeves D, Tsang JY. Understanding the implementation of interventions to improve the management of frailty in primary care: a rapid realist review. BMJ Open 2022; 12:e054780. [PMID: 35649605 PMCID: PMC9161080 DOI: 10.1136/bmjopen-2021-054780] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/24/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Identifying and managing the needs of frail people in the community is an increasing priority for policy makers. We sought to identify factors that enable or constrain the implementation of interventions for frail older persons in primary care. DESIGN A rapid realist review. DATA SOURCES Cochrane Library, SCOPUS and EMBASE, and grey literature. The search was conducted in September 2019 and rerun on 8 January 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We considered all types of empirical studies describing interventions targeting frailty in primary care. ANALYSIS We followed the Realist and Meta-narrative Evidence Syntheses: Evolving Standards quality and publication criteria for our synthesis to systematically analyse and synthesise the existing literature and to identify (intervention-context-mechanism-outcome) configurations. We used normalisation processes theory to illuminate mechanisms surrounding implementation. RESULTS Our primary research returned 1755 articles, narrowed down to 29 relevant frailty intervention studies conducted in primary care. Our review identified two families of interventions. They comprised: (1) interventions aimed at the comprehensive assessment and management of frailty needs; and (2) interventions targeting specific frailty needs. Key factors that facilitate or inhibit the translation of frailty interventions into practice related to the distribution of resources; patient engagement and professional skill sets to address identified need. CONCLUSION There remain challenges to achieving successful implementation of frailty interventions in primary care. There were a key learning points under each family. First, targeted allocation of resources to address specific needs allows a greater alignment of skill sets and reduces overassessment of frail individuals. Second, earlier patient involvement may also improve intervention implementation and adherence. PROSPERO REGISTRATION NUMBER The published protocol for the review is registered with PROSPERO (CRD42019161193).
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Affiliation(s)
- Khulud Alharbi
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Thomas Blakeman
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Harm van Marwijk
- Division of Primary Care and Public Health, University of Brighton, Falmer, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - David Reeves
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jung Yin Tsang
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
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18
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Kjeldsberg M, Tschudi-Madsen H, Bruusgaard D, Natvig B. Factors related to self-rated health: a survey among patients and their general practitioners. Scand J Prim Health Care 2022; 40:320-328. [PMID: 35587746 PMCID: PMC9397452 DOI: 10.1080/02813432.2021.2022341] [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: 11/21/2022] Open
Abstract
OBJECTIVE To explore associations between general practice patients' SRH and symptoms, diagnoses, chronic conditions, unexplained conditions, and life stressors. DESIGN A cross-sectional study. Data were collected from GP and patient questionnaires. SETTING General practices in Southeast Norway. SUBJECTS 47 general practitioners (GPs) who included 866 consecutive patients. MAIN OUTCOME MEASURES SRH was measured with a single question from the COOP-WONCA overall health chart and dichotomized into good/poor SRH. Binary logistic regression models were used in the analyses. RESULTS Poor SRH was reported by 48% of the patients in the past week. A higher prevalence of poor SRH was found for women, middle-aged, recipients of social security grants, patients diagnosed with asthenia, lower back pain, and depression/anxiety, and for patients with reported life stressors and unexplained conditions. We found an almost linear association between the number of symptoms and the likelihood of reporting poor SRH. The probability of reporting poor SRH increased along with an increasing number of symptoms for common diagnoses. In a multivariate analysis, the only number of symptoms, being in receipt of social security grants and being retired was associated with poor SRH. CONCLUSION The likelihood of reporting poor SRH increased with an increasing number of symptoms, partly independent of the diagnosis given by GPs. This result coincides with our previous findings of a strong association between the number of symptoms, function, and health. The symptom burden thus appears to be an important factor for SRH among patients in general practice.KEY POINTSThere is a high prevalence of poor SRH in general practice patients.The likelihood of reporting poor SRH is partly independent of the diagnosis given.The number of symptoms was the factor strongest associated with poor SRH.
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Affiliation(s)
- Mona Kjeldsberg
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
- CONTACT Mona Kjeldsberg General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, P.O. Box 1130Blindern, N-0318, Oslo, Norway
| | - H. Tschudi-Madsen
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - D. Bruusgaard
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - B. Natvig
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
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19
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Ramerman L, Rijpkema C, Bos N, Flinterman LE, Verheij RA. The use of out-of-hours primary care during the first year of the COVID-19 pandemic. BMC Health Serv Res 2022; 22:679. [PMID: 35597939 PMCID: PMC9122805 DOI: 10.1186/s12913-022-08096-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the Netherlands, General Practitioners (GP) are usually the first point of contact with a health professional for most health problems. Out-of-hours (OOH) primary care is provided by regional OOH services. Changes in consultation rates at OOH services may be regarded as a warning system for failures elsewhere in the healthcare system. Therefore in this study, we investigated how the COVID-19 pandemic changed the use of primary care OOH services during the first year of the pandemic. METHODS Routine electronic health records data were used from 60% of OOH services in the Netherlands, collected by the Nivel Primary Care Database. We compared consultation rates per week (2020) for COVID-19-like symptoms and other health problems (e.g. small traumas, urinary tract infections), for different age groups, the proportion of remote consultations, and different levels of urgency during the pandemic compared to the same period in 2019. RESULTS The number of consultations for COVID-19-like symptoms peaked at the start of the COVID-19 pandemic, while consultations for other health problems decreased. These changes in consultation rates differed between age groups. Remote consultations took place more frequently for all health problems, while the proportion of non-urgent health problems increased. CONCLUSION There were significant changes in the number of consultations and the proportion that were remote for COVID-19-like symptoms and other health problems. Especially care for babies and young children decreased, while the number of consultations for older adults remained stable. The continued use of OOH services by older adults suggests there were unmet care needs elsewhere in our healthcare system.
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Affiliation(s)
- Lotte Ramerman
- Nivel, Netherlands Institute for Health Services Research, Postbus 1568, Utrecht, 3500 BN, The Netherlands.
| | - Corinne Rijpkema
- Nivel, Netherlands Institute for Health Services Research, Postbus 1568, Utrecht, 3500 BN, The Netherlands
| | - Nanne Bos
- Nivel, Netherlands Institute for Health Services Research, Postbus 1568, Utrecht, 3500 BN, The Netherlands
| | - Linda E Flinterman
- Nivel, Netherlands Institute for Health Services Research, Postbus 1568, Utrecht, 3500 BN, The Netherlands
| | - Robert A Verheij
- Nivel, Netherlands Institute for Health Services Research, Postbus 1568, Utrecht, 3500 BN, The Netherlands
- Tranzo, Tilburg University, Postbus 90153, Tilburg, 5000 LE, the Netherlands
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20
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Niyibizi JB, Okop KJ, Nganabashaka JP, Umwali G, Rulisa S, Ntawuyirushintege S, Tumusiime D, Nyandwi A, Ntaganda E, Delobelle P, Levitt N, Bavuma CM. Perceived cardiovascular disease risk and tailored communication strategies among rural and urban community dwellers in Rwanda: a qualitative study. BMC Public Health 2022; 22:920. [PMID: 35534821 PMCID: PMC9088034 DOI: 10.1186/s12889-022-13330-6] [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: 08/10/2021] [Accepted: 04/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background In Rwanda, cardiovascular diseases (CVDs) are the third leading cause of death, and hence constitute an important public health issue. Worldwide, most CVDs are due to lifestyle and preventable risk factors. Prevention interventions are based on risk factors for CVD risk, yet the outcome of such interventions might be limited by the lack of awareness or misconception of CVD risk. This study aimed to explore how rural and urban population groups in Rwanda perceive CVD risk and tailor communication strategies for estimated total cardiovascular risk. Methods An exploratory qualitative study design was applied using focus group discussions to collect data from rural and urban community dwellers. In total, 65 community members took part in this study. Thematic analysis with Atlas ti 7.5.18 was used and the main findings for each theme were reported as a narrative summary. Results Participants thought that CVD risk is due to either financial stress, psychosocial stress, substance abuse, noise pollution, unhealthy diets, diabetes or overworking. Participants did not understand CVD risk presented in a quantitative format, but preferred qualitative formats or colours to represent low, moderate and high CVD risk through in-person communication. Participants preferred to be screened for CVD risk by community health workers using mobile health technology. Conclusion Rural and urban community members in Rwanda are aware of what could potentially put them at CVD risk in their respective local communities. Community health workers are preferred by local communities for CVD risk screening. Quantitative formats to present the total CVD risk appear inappropriate to the Rwandan population and qualitative formats are therefore advisable. Thus, operational research on the use of qualitative formats to communicate CVD risk is recommended to improve decision-making on CVD risk communication in the context of Rwanda. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13330-6.
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Affiliation(s)
- Jean Berchmans Niyibizi
- College of Medicine and Health Sciences (CMHS), University of Rwanda, Kicukiro Campus, KK19 Av 101, P.O. Box 4285, Kigali, Rwanda.
| | - Kufre Joseph Okop
- Chronic Diseases Initiative for Africa (CDIA), Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jean Pierre Nganabashaka
- College of Medicine and Health Sciences (CMHS), University of Rwanda, Kicukiro Campus, KK19 Av 101, P.O. Box 4285, Kigali, Rwanda
| | - Ghislaine Umwali
- College of Medicine and Health Sciences (CMHS), University of Rwanda, Kicukiro Campus, KK19 Av 101, P.O. Box 4285, Kigali, Rwanda
| | - Stephen Rulisa
- College of Medicine and Health Sciences (CMHS), University of Rwanda, Kicukiro Campus, KK19 Av 101, P.O. Box 4285, Kigali, Rwanda.,Kigali University Teaching Hospital, Kigali, Rwanda
| | - Seleman Ntawuyirushintege
- College of Medicine and Health Sciences (CMHS), University of Rwanda, Kicukiro Campus, KK19 Av 101, P.O. Box 4285, Kigali, Rwanda
| | - David Tumusiime
- College of Medicine and Health Sciences (CMHS), University of Rwanda, Kicukiro Campus, KK19 Av 101, P.O. Box 4285, Kigali, Rwanda
| | | | | | - Peter Delobelle
- Chronic Diseases Initiative for Africa (CDIA), Department of Medicine, University of Cape Town, Cape Town, South Africa.,Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Naomi Levitt
- Chronic Diseases Initiative for Africa (CDIA), Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Charlotte M Bavuma
- College of Medicine and Health Sciences (CMHS), University of Rwanda, Kicukiro Campus, KK19 Av 101, P.O. Box 4285, Kigali, Rwanda.,Kigali University Teaching Hospital, Kigali, Rwanda
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21
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Stock S, Isselhard A, Jünger S, Peters S, Schneider G, Haarig F, Halbach S, Okan O, Fischer F, Bollweg TM, Bauer U, Schaeffer D, Vogt D, Berens EM, Ernstmann N, Bitzer EM. [DNVF Memorandum Health Literacy (Part 2) - Operationalisation and Measuring of Health Literacy from a Health Services Research Perspective]. DAS GESUNDHEITSWESEN 2022; 84:e26-e41. [PMID: 35472769 PMCID: PMC9050455 DOI: 10.1055/a-1807-0853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Das vorliegende „DNVF Memorandum Gesundheitskompetenz (Teil 2) –
Operationalisierung und Messung von Gesundheitskompetenz aus Sicht der
Versorgungsforschung“ des Deutschen Netzwerks Versorgungsforschung e.V.
(DNVF) stellt die Fortführung des Memorandums „DNVF Memorandum
Gesundheitskompetenz (Teil 1) – Hintergrund, Gegenstand und
Fragestellungen in der Versorgungsforschung“ dar. Neben den allgemeinen
Anforderungen an die Messung der Gesundheitskompetenz, beschäftigt sich
dieses Memorandum auch mit den speziellen Anforderungen, wie die Abgrenzung zu
verwandten Konstrukten, den Unterschieden zwischen performanzbasierten und
Selbsteinschätzungsverfahren, den Unterschieden zwischen generischen und
spezifischen Instrumenten, dem Einsatz von Screeninginstrumenten sowie der
Messung der Gesundheitskompetenz bei speziellen Personengruppen. Weiterhin
werden Besonderheiten bei der Messung der digitalen Gesundheitskompetenz,
Potenziale qualitativer und partizipativer Forschungszugänge sowie
forschungsethische Gesichtspunkte bei der Messung der Gesundheitskompetenz
erarbeitet. Ein besonderer Wert wird auf den Praxisbezug gelegt, der am Ende der
jeweiligen Abschnitte mit einem Fazit für die Versorgungsforschung
aufgegriffen wird. Abschließend wird einen Blick auf Herausforderungen
und Forschungsdesiderate im Zusammenhang mit der Messung von
Gesundheitskompetenz im Rahmen der Versorgungsforschung geworfen.
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Affiliation(s)
- Stephanie Stock
- Institut für Gesundheitsökonomie und klinische Epidemiologie, Universitätsklinikum Köln, Cologne, Germany
| | - Anna Isselhard
- Institut für Gesundheitsökonomie und klinische Epidemiologie, Universitätsklinikum Köln, Cologne, Germany
| | - Saskia Jünger
- Department of Community Health, Hochschule für Gesundheit, Bochum, Germany
| | - Stefan Peters
- Deutscher Verband für Gesundheitssport und Sporttherapie e. V., Hürth Efferen, Germany
| | - Gundolf Schneider
- Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, Standort Berlin, Berlin, Germany
| | - Frederik Haarig
- Zentrum für evidenzbasierte Gesundheitsversorgung (ZEGV), Medizinische Fakultät Carl Gustav Carus der Technischen Universität Dresden, Dresden, Germany
| | - Sarah Halbach
- Bundeszentrale für gesundheitliche Aufklärung (BzgA), Köln, Germany.,Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Forschungsstelle für Gesundheitskommunikation und Versorgungsforschung (CHSR), Universitätsklinikum Bonn, Bonn
| | - Orkan Okan
- Fakutät für Sport- und Gesundheitswissenschaften, Technische Universität München, München, Germany
| | - Florian Fischer
- Institut für Gerontologische Versorgungs- und Pflegeforschung, Hochschule Ravensburg-Weingarten, Weingarten, Germany
| | - Torsten Michael Bollweg
- Fakultät für Erziehungswissenschaft, AG 2 Sozialisation, Interdisziplinäres Zentrum für Gesundheitskompetenzforschung (IZGK), Zentrum für Prävention und Intervention im Kindes- und Jugendalter (ZPI), Universität Bielefeld, Bielefeld, Germany
| | - Ullrich Bauer
- Fakultät für Erziehungswissenschaft, AG 2 Sozialisation, Interdisziplinäres Zentrum für Gesundheitskompetenzforschung (IZGK), Zentrum für Prävention und Intervention im Kindes- und Jugendalter (ZPI), Universität Bielefeld, Bielefeld, Germany
| | - Doris Schaeffer
- Interdisziplinäres Zentrum für Gesundheitskompetenzforschung, Universität Bielefeld, Bielefeld, Germany
| | - Dominique Vogt
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld
| | - Eva-Maria Berens
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld
| | - Nicole Ernstmann
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Forschungsstelle für Gesundheitskommunikation und Versorgungsforschung (CHSR), Universitätsklinikum Bonn, Bonn
| | - Eva Maria Bitzer
- Public Health & Health Education, Pädagogische Hochschule Freiburg, Freiburg, Germany
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22
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Predictors of Clinical Inertia and Type 2 Diabetes: Assessment of Primary Care Physicians and Their Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084436. [PMID: 35457303 PMCID: PMC9031531 DOI: 10.3390/ijerph19084436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022]
Abstract
With the growing prevalence and complex pathophysiology of type 2 diabetes, many patients fail to achieve treatment goals despite guidelines and possibilities for treatment individualization. One of the identified root causes of this failure is clinical inertia. We explored this phenomenon, its possible predictors, and groups of patients affected the most, together with offering potential paths for intervention. Our research was a cross-sectional study conducted during 2021 involving 52 physicians and 543 patients of primary healthcare institutions in Belgrade, Serbia. The research instruments were questionnaires based on similar studies, used to collect information related to the factors that contribute to developing clinical inertia originating in both physicians and patients. In 224 patients (41.3%), clinical inertia was identified in patients with poor overall health condition, long diabetes duration, and comorbidities. Studying the changes made to the treatment, most patients (53%) had their treatment adjustment more than a year ago, with 19.3% of patients changing over the previous six months. Moreover, we found significant inertia in the treatment of patients using modern insulin analogues. Referral to secondary healthcare institutions reduced the emergence of inertia. This assessment of primary care physicians and their patients pointed to the high presence of clinical inertia, with an overall health condition, comorbidities, diabetes duration, current treatment, last treatment change, glycosylated hemoglobin and fasting glucose measuring frequency, BMI, patient referral, diet adjustment, and physician education being significant predictors.
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23
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Coope C, Schneider A, Zhang T, Kadetz P, Feng R, Lambert H, Wang D, Oliver I, Michie S, Cabral C. Identifying key influences on antibiotic use in China: a systematic scoping review and narrative synthesis. BMJ Open 2022; 12:e056348. [PMID: 35338063 PMCID: PMC8961142 DOI: 10.1136/bmjopen-2021-056348] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/15/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The inappropriate use of antibiotics is a key driver of antimicrobial resistance. In China, antibiotic prescribing and consumption exceed recommended levels and are relatively high internationally. Understanding the influences on antibiotic use is essential to informing effective evidence-based interventions. We conducted a scoping review to obtain an overview of empirical research about key behavioural, cultural, economic and social influences on antibiotic use in China. METHODS Searches were conducted in Econlit, Medline, PsycINFO, Social Science citation index and the Cochrane Database of Systematic Reviews for the period 2003 to early 2018. All study types were eligible including observational and intervention, qualitative and quantitative designs based in community and clinical settings. Two authors independently screened studies for inclusion. A data extraction form was developed incorporating details on study design, behaviour related to antibiotic use, influences on behaviour and information on effect (intervention studies only). RESULTS Intervention studies increased markedly from 2014, and largely focused on the impact of national policy and practice directives on antibiotic use in secondary and tertiary healthcare contexts in China. Most studies used pragmatic designs, such as before and after comparisons. Influences on antibiotic use clustered under four themes: antibiotic prescribing; adherence to antibiotics; self-medicating behaviour and over-the-counter sale of antibiotics. Many studies highlighted the use of antibiotics without a prescription for common infections, which was facilitated by availability of left-over medicines and procurement from local pharmacies. CONCLUSIONS Interventions aimed at modifying antibiotic prescribing behaviour show evidence of positive impact, but further research using more robust research designs, such as randomised trials, and incorporating process evaluations is required to better assess outcomes. The effect of national policy at the primary healthcare level needs to be evaluated and further exploration of the influences on antibiotic self-medicating is required to develop interventions that tackle this behaviour.
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Affiliation(s)
- Caroline Coope
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Annegret Schneider
- Population Health Sciences, University of Bristol, Bristol, UK
- Centre for Behaviour Change, University College London, London, UK
| | - Tingting Zhang
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Paul Kadetz
- Queen Margaret University, Institute for Global Health and Development, Edinburgh, UK
| | - Rui Feng
- Library, Anhui Medical University, Hefei, Anhui, China
| | - Helen Lambert
- Population Health Sciences, University of Bristol, Bristol, UK
| | - DeBin Wang
- School of Health Services Management, Anhui Medical University, Hefei, Anhui, China
| | - Isabel Oliver
- Field Service, National Infection Service, Public Health England National Infection Service, Salisbury, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - Christie Cabral
- Population Health Sciences, University of Bristol, Bristol, UK
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24
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Ben Charif A, Zomahoun HTV, Gogovor A, Abdoulaye Samri M, Massougbodji J, Wolfenden L, Ploeg J, Zwarenstein M, Milat AJ, Rheault N, Ousseine YM, Salerno J, Markle-Reid M, Légaré F. Tools for assessing the scalability of innovations in health: a systematic review. Health Res Policy Syst 2022; 20:34. [PMID: 35331260 PMCID: PMC8943495 DOI: 10.1186/s12961-022-00830-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 02/16/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The last decade has seen growing interest in scaling up of innovations to strengthen healthcare systems. However, the lack of appropriate methods for determining their potential for scale-up is an unfortunate global handicap. Thus, we aimed to review tools proposed for assessing the scalability of innovations in health. METHODS We conducted a systematic review following the COSMIN methodology. We included any empirical research which aimed to investigate the creation, validation or interpretability of a scalability assessment tool in health. We searched Embase, MEDLINE, CINAHL, Web of Science, PsycINFO, Cochrane Library and ERIC from their inception to 20 March 2019. We also searched relevant websites, screened the reference lists of relevant reports and consulted experts in the field. Two reviewers independently selected and extracted eligible reports and assessed the methodological quality of tools. We summarized data using a narrative approach involving thematic syntheses and descriptive statistics. RESULTS We identified 31 reports describing 21 tools. Types of tools included criteria (47.6%), scales (33.3%) and checklists (19.0%). Most tools were published from 2010 onwards (90.5%), in open-access sources (85.7%) and funded by governmental or nongovernmental organizations (76.2%). All tools were in English; four were translated into French or Spanish (19.0%). Tool creation involved single (23.8%) or multiple (19.0%) types of stakeholders, or stakeholder involvement was not reported (57.1%). No studies reported involving patients or the public, or reported the sex of tool creators. Tools were created for use in high-income countries (28.6%), low- or middle-income countries (19.0%), or both (9.5%), or for transferring innovations from low- or middle-income countries to high-income countries (4.8%). Healthcare levels included public or population health (47.6%), primary healthcare (33.3%) and home care (4.8%). Most tools provided limited information on content validity (85.7%), and none reported on other measurement properties. The methodological quality of tools was deemed inadequate (61.9%) or doubtful (38.1%). CONCLUSIONS We inventoried tools for assessing the scalability of innovations in health. Existing tools are as yet of limited utility for assessing scalability in health. More work needs to be done to establish key psychometric properties of these tools. Trial registration We registered this review with PROSPERO (identifier: CRD42019107095).
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Affiliation(s)
| | - Hervé Tchala Vignon Zomahoun
- Department of Social and Preventive Medicine, Université Laval, Quebec City, QC, Canada.,Faculty of Medicine and Health Science, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Institut national d'excellence en santé et en services sociaux (INESSS), Quebec City, QC, Canada
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada.,Unité de soutien SSA Québec, Université Laval, Quebec City, QC, Canada
| | - Mamane Abdoulaye Samri
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - José Massougbodji
- Institut national de santé publique du Québec (INSPQ), Quebec City, QC, Canada
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Hunter New England Population Health, Wallsend, NSW, Australia
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Merrick Zwarenstein
- Department of Family Medicine, Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Andrew J Milat
- School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, Australia
| | - Nathalie Rheault
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Unité de soutien SSA Québec, Université Laval, Quebec City, QC, Canada
| | | | - Jennifer Salerno
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Canada Research Chair in Person Centred Interventions for Older Adults with Multimorbidity and their Caregivers, McMaster University, Hamilton, ON, Canada
| | - France Légaré
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada. .,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec City, QC, Canada. .,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada. .,Unité de soutien SSA Québec, Université Laval, Quebec City, QC, Canada. .,Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec City, QC, Canada.
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25
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Melaku T, Bayisa B, Fekeremaryam H, Feyissa A, Gutasa A. Self-care practice among adult hypertensive patients at ambulatory clinic of tertiary teaching Hospital in Ethiopia: a cross-sectional study. J Pharm Policy Pract 2022; 15:23. [PMID: 35317847 PMCID: PMC8939157 DOI: 10.1186/s40545-022-00421-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, hypertension is a major public health problem and a strong predictor of cardiovascular disease complications. To reduce and prevent complications from hypertension, it is important to adapt self-care behaviors. This study aimed to assess the self-care practices of adult hypertensive patients at a tertiary teaching hospital in Ethiopia. METHODS A health facility-based prospective cross-sectional study was conducted at Jimma Medical Center in Ethiopia between February 2021 and July 2021. Binary and logistic regression was performed to assess the strength of associations between independent and dependent variables. Data entry and analysis were done using Statistical Package for social science (SPSS) software version 22.0. A p-value < 0.05 was considered to declare statistical significance. RESULTS From a total of 422 respondents included to the study, male accounted 55.7% and the mean ± SD age of the respondents was 58.7 ± 9.75 years. About 53.1% of patients had poor self-care practices toward hypertension. Not attending formal education [AOR = 2.15; 95% CI (1.74, 6.39); p ≤ 0.001], uncontrolled blood pressure [AOR = 2.14 95% CI (1.27, 3.61); p = 0.003], chronic disease co-morbidity [AOR = 1.48; 95% CI (0.25, 7.73); p ≤ 0.001], unfavorable attitude toward hypertension[AOR = 3.13; 95% CI (1.95, 7.52); p ≤ 0.001], and poor social support [AOR = 2.75; 95% CI (1.45, 6.43); p ≤ 0.001] were independent predictors of poor self-care practice. CONCLUSION The level of self-care practices for hypertension in the study area was low. In particular, the level of adherence to the DASH diet, exercise, and weight control was very low. Patient-specific targeted interventions are required to improve self-care practices for hypertension.
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Affiliation(s)
- Tsegaye Melaku
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Bodena Bayisa
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Helen Fekeremaryam
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Alemayehu Feyissa
- Center for Disease Control and Prevention, Oromia Regional Health Bureau, Finfinnee, Ethiopia
| | - Alemayehu Gutasa
- Department of Pharmacy, Black Lion Specialized Hospital, Addis Ababa University, Addis Ababa, Ethiopia
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26
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Ando T, Nishimoto Y, Hirata T, Abe Y, Takayama M, Maeno T, Fujishima S, Takebayashi T, Arai Y. Association between multimorbidity, self-rated health and life satisfaction among independent, community-dwelling very old persons in Japan: longitudinal cohort analysis from the Kawasaki Ageing and Well-being Project. BMJ Open 2022; 12:e049262. [PMID: 35210335 PMCID: PMC8883229 DOI: 10.1136/bmjopen-2021-049262] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 12/01/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE This study aimed to identify associations between multimorbidity and subjective health outcomes among the very old persons, after adjusting for coexisting conditions such as frailty and depression. STUDY SETTING AND PARTICIPANTS This was an observational cross-sectional study involving 1012 independent, community-dwelling very old persons (507 men, 505 women; aged 85-89 years) in Kawasaki city, Japan. OUTCOME MEASURES The primary outcome was the cross-sectional associations between multimorbidity and poor self-rated health (SRH) and life satisfaction using binary logistic regression. The secondary outcome was the association of subjective health with each chronic condition. RESULTS The prevalence of multimorbidity (≥2 conditions) was 94.7%, and the average number of chronic conditions was 4.47±1.9. Multimorbidity was significantly associated with poor SRH in the adjusted model only when six or more chronic conditions were present (OR 4.80; 95% CI 1.34 to 17.11; p=0.016). Cerebrovascular disease, heart disease, respiratory disease, connective tissue disease and arthritis showed significant associations with poor SRH after multivariate adjustment. Sex-specific analysis replicated associations between multimorbidity with six or more conditions and SRH in both men and women, while the diseases with the greatest impact on SRH differed between men and women. Most conditions were not associated with low satisfaction with life scale, with the exception of arthritis (OR 1.92, 95% CI 1.32 to 2.78, p=0.001). CONCLUSIONS Multimorbidity is prevalent in the independent, community-dwelling very old persons and is associated with poor SRH when six or more conditions are present; conditions causing mobility limitations, such as cerebrovascular disease, connective tissue disease and arthritis, have a negative impact on SRH. TRIAL REGISTRATION NUMBER UMIN000026053.
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Affiliation(s)
- Takayuki Ando
- Center for General Medicine Education, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yoshinori Nishimoto
- Department of Neurology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takumi Hirata
- Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Yukiko Abe
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Midori Takayama
- Faculty of Science and Technology, Keio University, Yokohama, Kanagawa, Japan
| | - Takashi Maeno
- Graduate School of System Design and Management, Keio University, Yokohama, Kanagawa, Japan
| | - Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yasumichi Arai
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Schippert AC, Grov EK, Dahl-Michelsen T, Silvola J, Sparboe-Nilsen B, Danielsen SO, Aaland M, Bjørnnes AK. Development and evaluation of guidelines for prevention of retraumatisation in torture survivors during surgical care: protocol for a multistage qualitative study. BMJ Open 2021; 11:e053670. [PMID: 34740935 PMCID: PMC8573660 DOI: 10.1136/bmjopen-2021-053670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/04/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Healthcare professionals working in somatic departments are not trained to recognise signs of torture or provide appropriate healthcare to torture survivors, which may result in retraumatisation during surgical treatment. METHODS AND ANALYSIS This protocol outlines a four-stage qualitative-method strategy for the development and evaluation of guidelines for prevention of retraumatisation of torture survivors during surgical care. The systematic search for literature review in stages 1 and 2 was conducted in August 2019 and March 2021, respectively, using nine databases. The search strategies employed in stage 1, without imposing any date limits, resulted in the inclusion of eight studies that addressed inadequate healthcare strategies associated with retraumatisation. The clinical guidelines review in stage 2 will include publications from 2000 onwards, which will be appraised using the Appraisal of Guidelines Research and Evaluation Version II instrument. Following multi-institutional recruitment in Norway, stage 3 will explore survivors' experiences of receiving surgical treatment using indepth interviews (n=8-12), which will be audio-recorded, transcribed verbatim and analysed using the interpretative phenomenological analysis approach. In stage 4a, based on the findings from stages 1, 2 and 3, a set of clinical guidelines for preventing retraumatisation during surgical treatment will be developed. Next, the feasibility and acceptability of the guidelines will be assessed in stage 4b in three interdisciplinary focus group interviews (n=5 per group) and text condensation analyses. ETHICS AND DISSEMINATION The Regional (South-East C) Committee for Medical and Health Research Ethics approved the study in May 2021 (#227624). In stages 3 and 4, an informational letter and an informed consent form will be distributed to the participants to sign before the interview. The study results will be disseminated through publications, conference presentations, and national and local public forums to healthcare professionals, service managers, policymakers and refugee-supporting agencies.
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Affiliation(s)
- Ana Carla Schippert
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Akershus University Hospital, Lørenskog, Norway
| | - Ellen Karine Grov
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | | | - Juha Silvola
- Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Bente Sparboe-Nilsen
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Stein Ove Danielsen
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | | | - Ann Kristin Bjørnnes
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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28
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Jürisson M, Pisarev H, Uusküla A, Lang K, Oona M, Kalda R. Prevalence of chronic conditions and multimorbidity in Estonia: a population-based cross-sectional study. BMJ Open 2021; 11:e049045. [PMID: 34610934 PMCID: PMC8493909 DOI: 10.1136/bmjopen-2021-049045] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Prevalence estimates for specific chronic conditions and multimorbidity (MM) in eastern Europe are scarce. This national study estimates the prevalence of MM by age group and sex in Estonia. DESIGN A population-based cross-sectional study, using administrative data. SETTING Data were collected on 55 chronic conditions from the Estonian Health Insurance Fund from 2015 to 2017. MM was defined as the coexistence of two or more conditions. PARTICIPANTS The Estonian Health Insurance Fund includes data for approximately 95% of the Estonian population receiving public health insurance. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence and 95% CIs for MM stratified by age group and sex. RESULTS Nearly half (49.1%) of the individuals (95% CI 49.0 to 49.3) had at least 1 chronic condition, and 30.1% (95% CI 30.0 to 30.2) had MM (2 or more chronic conditions). The number of conditions and the prevalence of MM increased with age, ranging from an MM prevalence of 3.5% (3.5%-3.6%) in the youngest (0-24 years) to as high as 80.4% (79.4%-81.3%) in the oldest (≥85 years) age group. Half of all individuals had MM by 60 years of age, and 75% of the population had MM by 75 years of age. Women had a higher prevalence of MM (34.9%, 95% CI 34.7 to 35.0) than men (24.4%, 95% CI 24.3 to 24.5). Hypertension was the most frequent chronic condition (24.5%), followed by chronic pain (12.4%) and arthritis (7.7%). CONCLUSIONS Hypertension is an important chronic condition amenable to treatment with lifestyle and therapeutic interventions. Given the established correlation between uncontrolled hypertension and exacerbation of other cardiovascular conditions as well as acute illnesses, this most common condition within the context of MM may be suitable for targeted public health interventions.
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Affiliation(s)
- Mikk Jürisson
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Heti Pisarev
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Anneli Uusküla
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Katrin Lang
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - M Oona
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Ruth Kalda
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
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Self-Rated Health and Pain Problems in Mothers of Healthy Children or Children Requiring Outpatient Observation or Hospitalisation: A Pilot Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189543. [PMID: 34574464 PMCID: PMC8466010 DOI: 10.3390/ijerph18189543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022]
Abstract
A child's illness or disability is a considerable stressor for the mother and a risk factor for many psychological problems and somatic diseases. The purpose of the study was to (1) assess the prevalence of poor SRH and pain, (2) compare self-rated health and pain, (3) and identify the determinants of SRH and pain in mothers of healthy children and children requiring ambulatory observation or hospitalization. The study covered 234 mothers of both healthy and unhealthy children who required outpatient observation or treatment at an intensive care unit, neonatal intensive care unit, or oncology department. To analyse the variables obtained, the following tools were used: Self-Rated Health, Numerical Rating, Interpersonal Support Evaluation List, Peritraumatic Distress Inventory, Modified Hospital Anxiety and Depression Scale, and Impact of Effects Scale-Revised. The self-assessment of health in mothers of healthy children and those in need of outpatient observation or hospitalization at units with various specialities differed in a statistically significant way. The severity of the average and maximum pain among mothers of healthy children and those with a history of disease differed statistically significantly. Poor SRH co-occurred with severe maximum pain in all of the examined groups. Both in the control group and the group of mothers of children requiring outpatient observation, poor SRH co-occurred with a high level of anxiety. Only in the control group was a correlation found between the severity of the average and maximum pain and the severity of anxiety and depression symptoms.
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Levkovich I, Rodin D, Shinan-Altman S, Alperin M, Stein H. Perceptions among diabetic patients in the ultra-orthodox Jewish community regarding medication adherence: a qualitative study. BMC Public Health 2021; 21:1559. [PMID: 34404385 PMCID: PMC8369440 DOI: 10.1186/s12889-021-11619-6] [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: 03/24/2021] [Accepted: 08/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Promoting a healthy lifestyle and achieving strict adherence to medical treatment among patients with diabetes are key objectives in public health. Yet health behaviors are often culturally driven, especially in closed religious communities. This study seeks to reveal key cultural-religious factors, attitudes and behaviors characterizing the lifestyle in one such closed community-the ultra-Orthodox Jewish community-by understanding the attitudes of ultra-Orthodox patients with diabetes toward coping with their illness and the factors impacting their adherence to medicinal treatment. METHOD Qualitative interviews were conducted with 16 ultra-Orthodox patients with diabetes using a semi-structured, in-depth questionnaire. RESULTS Three main themes emerged: 1) "The disease as a secret": Hiding the disease among patients with diabetes in ultra-Orthodox society; 2) "Distinguishing between sacred and secular occasions": ultra-Orthodox diabetes patients distinguish between treatment adherence on weekdays and treatment adherence on holidays or special occasions; 3) "Ask the rabbi": In cases of dilemmas that involved conflicts between halakhic rulings and doctors' instructions, the rabbi's decision was usually the final one. CONCLUSIONS The findings of this study may help provide an in-depth understanding of the obstacles and motives of ultra-Orthodox patients in adhering to medicinal treatment of diabetes in particular and to medicinal treatment in general, thus helping family physicians who treat this population provide optimal and appropriate treatment.
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Affiliation(s)
- Inbar Levkovich
- Faculty of Graduate Studies, Oranim Academic College of Education, Haifa, Israel.
| | - David Rodin
- Department of Family Medicine, The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Clalit Health Services, Haifa and Western Galilee District, 36006, Kiryat Tivon, Israel
| | - Shiri Shinan-Altman
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, 52900, Ramat-Gan, Israel
| | - Mordechai Alperin
- Department of Family Medicine, The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Clalit Health Services, Haifa and Western Galilee District, 36006, Kiryat Tivon, Israel
| | - Hodaya Stein
- Department of Family Medicine, The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Clalit Health Services, Haifa and Western Galilee District, 36006, Kiryat Tivon, Israel
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Iheme L, Hirdes JP, Geffen L, Heckman G, Hogeveen S. Psychometric Properties, Feasibility, and Acceptability of the Self-Reported interRAI Check-Up Assessment. J Am Med Dir Assoc 2021; 23:117-121. [PMID: 34197792 DOI: 10.1016/j.jamda.2021.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the feasibility, acceptability, and psychometric properties of the self-report version of the interRAI Check-Up (CUSR). DESIGN Cross-sectional study of participant ratings of item content and difficulty completing the CUSR. Participants were also randomly assigned to complete the assessment by themselves or with help from a lay interviewer. SETTINGS AND PARTICIPANTS A total of 184 older adults from diverse backgrounds, served by 6 Canadian organizations in Ontario and Nova Scotia were recruited. Settings ranged from retirement communities for healthy older adults to assisted living facilities. MEASURES/METHODS Time to complete the interRAI CUSR was tracked automatically. Participants self-reported on what items they wanted to have modified, added, or deleted. The also rated whether items were embarrassing or difficult to complete. Psychometric properties were examined between the 2 approaches to completion and were benchmarked against existing reports on psychometric properties of clinician-led home care assessments. RESULTS The interRAI CUSR takes about 28 minutes to complete with both self-administered and lay interviewer approaches. The convergent validity and reliability of CUSR is comparable to those of clinician-based assessments like the Resident Assessment Instrument-Home Care. Most participants had no difficulty completing the assessment, and none rated the task as very difficult. Poor self-rated health and difficulty with phone use were predictive of any difficult in completing the assessment in a multivariate logistic regression. Most participants reported that CUSR adequately described their health needs, but arthritis, hypertension, and mental health issues were identified as items to be added by participants. CONCLUSIONS AND IMPLICATIONS The CUSR is an appropriate, feasible assessment system with good psychometric properties for use with general populations, including primary care, community services, and patient-reported outcome measurement studies. Interoperability with other interRAI assessments makes it an ideal system to use to obtain a longitudinal view of the person's needs over time.
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Affiliation(s)
- Linda Iheme
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada.
| | - Leon Geffen
- Samson Institute for Ageing Research, Cape Town, South Africa
| | - George Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada; Schlegel Research Institute for Aging, Waterloo, Canada
| | - Sophie Hogeveen
- Women's College Hospital, Institute for Health System Solutions and Virtual Care, Toronto, Canada; Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
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Willadsen TG, Siersma V, Nicolaisdottir DR, Jarbol D, Guassora AD, Reventlow S, Køster-Rasmussen R. Symptom burden in multimorbidity: a population-based combined questionnaire and registry study from Denmark. BMJ Open 2021; 11:e041877. [PMID: 33849847 PMCID: PMC8051398 DOI: 10.1136/bmjopen-2020-041877] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Patients with multimorbidity may carry a large symptom burden. Symptoms are often what drive patients to seek healthcare and they also assist doctors with diagnosis. We examined whether symptom burden is additive in people with multimorbidity compared with people with a single morbidity. DESIGN This is a longitudinal cohort study drawing on questionnaire and Danish national registry data. Multimorbidity was defined as having diagnoses from at least two out of ten morbidity groups. Associations between morbidity groups and symptom burden were estimated with multivariable models. PARTICIPANTS In 2012, 47 452 participants from the Danish Symptom Cohort answered a questionnaire about symptoms (36 symptoms in total), including whether symptoms were affecting their daily activities (impairment score) and their worries about present symptoms (worry score) (the highest score among the 36 symptoms on a 0-4 scale). MAIN OUTCOME MEASURE The primary outcome was symptom burden. RESULTS Participants without morbidity reported 4.77 symptoms (out of 36 possible). Participants with one, two or three morbidities reported more symptoms than patients without morbidity (0.95 (CI 0.86 to 1.03), 1.87 (CI 1.73 to 2.01) and 2.89 (CI 2.66 to 3.12), respectively). Furthermore, they reported a higher impairment score (0.36 (0.32 to 0.39), 0.65 (0.60 to 0.70) and 1.06 (0.98 to 1.14)) and a higher worry score (0.34 (0.31 to 0.37), 0.62 (0.57 to 0.66) and 1.02 (0.94 to 1.10)) than participants without morbidity. In 45 possible combinations of multimorbidity (participants with two morbidities), interaction effects were additive in 37, 41 and 36 combinations for the number of symptoms, impairment score and worry score, respectively. CONCLUSION Participants without morbidity reported a substantial number of symptoms. Having a single morbidity or multimorbidity resulted in approximately one extra symptom for each extra morbidity. In most combinations of multimorbidity, symptom burden was additive.
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Affiliation(s)
| | - Volkert Siersma
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Dorte Jarbol
- The Research Unit for General Practice, University of Southern Denmark, Odense, Denmark
| | | | - Susanne Reventlow
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Racine E, Sattler S, Boehlen W. Cognitive Enhancement: Unanswered Questions About Human Psychology and Social Behavior. SCIENCE AND ENGINEERING ETHICS 2021; 27:19. [PMID: 33759032 PMCID: PMC7987623 DOI: 10.1007/s11948-021-00294-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/10/2021] [Indexed: 05/23/2023]
Abstract
Stimulant drugs, transcranial magnetic stimulation, brain-computer interfaces, and even genetic modifications are all discussed as forms of potential cognitive enhancement. Cognitive enhancement can be conceived as a benefit-seeking strategy used by healthy individuals to enhance cognitive abilities such as learning, memory, attention, or vigilance. This phenomenon is hotly debated in the public, professional, and scientific literature. Many of the statements favoring cognitive enhancement (e.g., related to greater productivity and autonomy) or opposing it (e.g., related to health-risks and social expectations) rely on claims about human welfare and human flourishing. But with real-world evidence from the social and psychological sciences often missing to support (or invalidate) these claims, the debate about cognitive enhancement is stalled. In this paper, we describe a set of crucial debated questions about psychological and social aspects of cognitive enhancement (e.g., intrinsic motivation, well-being) and explain why they are of fundamental importance to address in the cognitive enhancement debate and in future research. We propose studies targeting social and psychological outcomes associated with cognitive enhancers (e.g., stigmatization, burnout, mental well-being, work motivation). We also voice a call for scientific evidence, inclusive of but not limited to biological health outcomes, to thoroughly assess the impact of enhancement. This evidence is needed to engage in empirically informed policymaking, as well as to promote the mental and physical health of users and non-users of enhancement.
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Affiliation(s)
- Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal (IRCM), 110, avenue des Pins Ouest, Montréal, QC, H2W 1R7, Canada.
- Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, 7101, Av du Parc, Montréal, QC, H3N 1X9, Canada.
- Departments of Neurology and Neurosurgery, Experimental Medicine, and Biomedical Ethics Unit, McGill University, 3801, University Street, Montréal, QC, H3A 1X1, Canada.
| | - Sebastian Sattler
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal (IRCM), 110, avenue des Pins Ouest, Montréal, QC, H2W 1R7, Canada.
- Department of Sociology, University of Cologne, Universitätsstrasse 24, 50931, Cologne, Germany.
| | - Wren Boehlen
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal (IRCM), 110, avenue des Pins Ouest, Montréal, QC, H2W 1R7, Canada
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Fung SM, Wu RR, Myers RA, Goh J, Ginsburg GS, Matchar D, Orlando LA, Ngeow J. Clinical implementation of an oncology-specific family health history risk assessment tool. Hered Cancer Clin Pract 2021; 19:20. [PMID: 33743786 PMCID: PMC7981979 DOI: 10.1186/s13053-021-00177-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The presence of hereditary cancer syndromes in cancer patients can have an impact on current clinical care and post-treatment prevention and surveillance measures. Several barriers inhibit identification of hereditary cancer syndromes in routine practice. This paper describes the impact of using a patient-facing family health history risk assessment platform on the identification and referral of breast cancer patients to genetic counselling services. METHODS This was a hybrid implementation-effectiveness study completed in breast cancer clinics. English-literate patients not previously referred for genetic counselling and/or gone through genetic testing were offered enrollment. Consented participants were provided educational materials on family health history collection, entered their family health history into the platform and completed a satisfaction survey. Upon completion, participants and their clinicians were given personalized risk reports. Chart abstraction was done to identify actions taken by patients, providers and genetic counsellors. RESULTS Of 195 patients approached, 102 consented and completed the study (mean age 55.7, 100 % women). Sixty-six (65 %) met guideline criteria for genetic counseling of which 24 (36 %) were referred for genetic counseling. Of those referred, 13 (54 %) participants attended and eight (33 %) completed genetic testing. On multivariate logistic regression, referral was not associated with age, cancer stage, or race but was associated with clinical provider (p = 0.041). Most providers (71 %) had higher referral rates during the study compared to prior. The majority of participants found the experience useful (84 %), were more aware of their health risks (83 %), and were likely to recommend using a patient-facing platform to others (69 %). CONCLUSIONS 65 % of patients attending breast cancer clinics in this study are at-risk for hereditary conditions based on current guidelines. Using a patient-facing risk assessment platform enhances the ability to identify these patients systematically and with widespread acceptability and recognized value by patients. As only a third of at-risk participants received referrals for genetic counseling, further understanding barriers to referral is needed to optimize hereditary risk assessment in oncology practices. TRIAL REGISTRATION NIH Clinical Trials registry, NCT04639934 . Registered Nov 23, 2020 -- Retrospectively registered.
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Affiliation(s)
- Si Ming Fung
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - R Ryanne Wu
- Centre for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA.
- Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA.
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
| | - Rachel A Myers
- Centre for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA
| | - Jasper Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Geoffrey S Ginsburg
- Centre for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA
- Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA
| | - David Matchar
- Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Lori A Orlando
- Centre for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA
- Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Polo-Morales A, Alcocer-Salas Á, Rodríguez-Violante M, Pinto-Solís D, Solís-Vivanco R, Cervantes-Arriaga A. Association Between Somatization and Nonmotor Symptoms Severity in People With Parkinson Disease. J Geriatr Psychiatry Neurol 2021; 34:60-65. [PMID: 32027207 DOI: 10.1177/0891988720901787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the frequency of somatization and its association with motor, nonmotor symptoms, and quality of life in persons with Parkinson disease (PD). METHODS A cross-sectional case-control study was carried out. Assessments included the List of 90 Symptoms somatic factor (SCL-90-R SOM), Movement Disorder Society Unified Parkinson's Ratings Scale (MDS-UPDRS), Non-Motor Symptom Scale (NMSS), Montreal Cognitive Assessment (MoCA), and Parkinson Questionnaire-8 (PDQ-8). RESULTS A total 93 persons with PD and 93 controls were included. Somatization within the PD group was 2 times more frequent compared to the control group (43% vs 21.5%, P = .003). Persons with PD had higher NMSS total scores (48.6 ± 42.6 vs 28.3 ± 30.4, P = .001). Patients with PD with somatization had worst MDS-UPDRS, NMSS, MoCA, and PDQ-8 (all P < .05). CONCLUSION Somatization is more frequent in persons with PD compared to healthy controls. Somatization in PD is associated with nonmotor symptoms and worst quality of life.
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Affiliation(s)
- Aranza Polo-Morales
- Mexican Faculty of Medicine, 27840La Salle University, Mexico City, Mexico.,Clinical Neurodegenerative Research Unit, 61614National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Ángel Alcocer-Salas
- Clinical Neurodegenerative Research Unit, 61614National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Mayela Rodríguez-Violante
- Clinical Neurodegenerative Research Unit, 61614National Institute of Neurology and Neurosurgery, Mexico City, Mexico.,Movement Disorder Clinic, 61614National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Daniella Pinto-Solís
- Clinical Neurodegenerative Research Unit, 61614National Institute of Neurology and Neurosurgery, Mexico City, Mexico.,Faculty of Health Sciences, 27753Anahuac University, South Campus, Mexico City, Mexico
| | - Rodolfo Solís-Vivanco
- Neuropsychology Department, 61614National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Amin Cervantes-Arriaga
- Clinical Neurodegenerative Research Unit, 61614National Institute of Neurology and Neurosurgery, Mexico City, Mexico.,Movement Disorder Clinic, 61614National Institute of Neurology and Neurosurgery, Mexico City, Mexico
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Sweet E, Yang B, Chen J, Vickerman R, Lin Y, Long A, Jacobs E, Wu T, Mercier C, Jew R, Attal Y, Liu S, Chang A, Lin L. 3D microfluidic gradient generator for combination antimicrobial susceptibility testing. MICROSYSTEMS & NANOENGINEERING 2020; 6:92. [PMID: 34567702 PMCID: PMC8433449 DOI: 10.1038/s41378-020-00200-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/25/2020] [Accepted: 08/01/2020] [Indexed: 06/13/2023]
Abstract
Microfluidic concentration gradient generators (µ-CGGs) have been utilized to identify optimal drug compositions through antimicrobial susceptibility testing (AST) for the treatment of antimicrobial-resistant (AMR) infections. Conventional µ-CGGs fabricated via photolithography-based micromachining processes, however, are fundamentally limited to two-dimensional fluidic routing, such that only two distinct antimicrobial drugs can be tested at once. This work addresses this limitation by employing Multijet-3D-printed microchannel networks capable of fluidic routing in three dimensions to generate symmetric multidrug concentration gradients. The three-fluid gradient generation characteristics of the fabricated 3D µ-CGG prototype were quantified through both theoretical simulations and experimental validations. Furthermore, the antimicrobial effects of three highly clinically relevant antibiotic drugs, tetracycline, ciprofloxacin, and amikacin, were evaluated via experimental single-antibiotic minimum inhibitory concentration (MIC) and pairwise and three-way antibiotic combination drug screening (CDS) studies against model antibiotic-resistant Escherichia coli bacteria. As such, this 3D µ-CGG platform has great potential to enable expedited combination AST screening for various biomedical and diagnostic applications.
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Affiliation(s)
- Eric Sweet
- Department of Mechanical Engineering, University of California, Berkeley, CA 94720 USA
- Berkeley Sensor and Actuator Center, Berkeley, CA 94720 USA
| | - Brenda Yang
- Berkeley Sensor and Actuator Center, Berkeley, CA 94720 USA
- Department of Bioengineering, University of California, Berkeley, CA 94720 USA
| | - Joshua Chen
- Berkeley Sensor and Actuator Center, Berkeley, CA 94720 USA
- Department of Bioengineering, University of California, Berkeley, CA 94720 USA
| | - Reed Vickerman
- Department of Mechanical Engineering, University of California, Berkeley, CA 94720 USA
- Berkeley Sensor and Actuator Center, Berkeley, CA 94720 USA
- Department of Materials Science and Engineering, University of California, Berkeley, CA 94720 USA
| | - Yujui Lin
- Berkeley Sensor and Actuator Center, Berkeley, CA 94720 USA
| | - Alison Long
- Berkeley Sensor and Actuator Center, Berkeley, CA 94720 USA
- Department of Bioengineering, University of California, Berkeley, CA 94720 USA
| | - Eric Jacobs
- Berkeley Sensor and Actuator Center, Berkeley, CA 94720 USA
- Department of Bioengineering, University of California, Berkeley, CA 94720 USA
| | - Tinglin Wu
- Berkeley Sensor and Actuator Center, Berkeley, CA 94720 USA
- Department of Bioengineering, University of California, Berkeley, CA 94720 USA
| | - Camille Mercier
- Berkeley Sensor and Actuator Center, Berkeley, CA 94720 USA
- Department of Bioengineering, University of California, Berkeley, CA 94720 USA
| | - Ryan Jew
- Department of Mechanical Engineering, University of California, Berkeley, CA 94720 USA
- Berkeley Sensor and Actuator Center, Berkeley, CA 94720 USA
- Department of Bioengineering, University of California, Berkeley, CA 94720 USA
| | - Yash Attal
- Berkeley Sensor and Actuator Center, Berkeley, CA 94720 USA
- Department of Bioengineering, University of California, Berkeley, CA 94720 USA
| | - Siyang Liu
- Department of Mechanical Engineering, University of California, Berkeley, CA 94720 USA
- Berkeley Sensor and Actuator Center, Berkeley, CA 94720 USA
| | - Andrew Chang
- Berkeley Sensor and Actuator Center, Berkeley, CA 94720 USA
| | - Liwei Lin
- Department of Mechanical Engineering, University of California, Berkeley, CA 94720 USA
- Berkeley Sensor and Actuator Center, Berkeley, CA 94720 USA
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Multimorbidity, physical frailty, and self-rated health in older patients with atrial fibrillation. BMC Geriatr 2020; 20:343. [PMID: 32917137 PMCID: PMC7488548 DOI: 10.1186/s12877-020-01755-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 09/02/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Holistic care models emphasize management of comorbid conditions to improve patient-reported outcomes in treatment of atrial fibrillation (AF). We investigated relations between multimorbidity, physical frailty, and self-rated health (SRH) among older adults with AF. METHODS Patients (n = 1235) with AF aged 65 years and older were recruited from five medical centers in Massachusetts and Georgia between 2015 and 2018. Ten previously diagnosed cardiometabolic and 8 non-cardiometabolic conditions were assessed from medical records. Physical Frailty was assessed with the Cardiovascular Health Study frailty scale. SRH was categorized as either "excellent/very good", "good", and "fair/poor". Separate multivariable ordinal logistic models were used to examine the associations between multimorbidity and SRH, physical frailty and SRH, and multimorbidity and physical frailty. RESULTS Overall, 16% of participants rated their health as fair/poor and 14% were frail. Hypertension (90%), dyslipidemia (80%), and heart failure (37%) were the most prevalent cardiometabolic conditions. Arthritis (51%), anemia (31%), and cancer (30%), the most common non-cardiometabolic diseases. After multivariable adjustment, patients with higher multimorbidity were more likely to report poorer health status (Odds Ratio (OR): 2.15 [95% CI: 1.53-3.03], ≥ 8 vs 1-4; OR: 1.37 [95% CI: 1.02-1.83], 5-7 vs 1-4), as did those with more prevalent cardiometabolic and non-cardiometabolic conditions. Patients who were pre-frail (OR: 1.73 [95% CI: 1.30-2.30]) or frail (OR: 6.81 [95% CI: 4.34-10.68]) reported poorer health status. Higher multimorbidity was associated with worse frailty status. CONCLUSIONS Multimorbidity and physical frailty were common and related to SRH. Our findings suggest that holistic management approaches may influence SRH among older patients with AF.
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What Factors Shape Self-Reported Health Among Community-Dwelling Older Adults? A Scoping Review. Can J Aging 2020; 40:177-192. [PMID: 32758332 DOI: 10.1017/s0714980820000124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Self-reported health is a predictive measure of morbidity and mortality across populations. A comprehensive understanding of the factors that shape self-reported health among community-dwelling older adults, a growing population globally, is lacking. The aim of this review was to summarize the factors that are associated with self-reported health among this population and identify key areas for future research. Accordingly, we conducted a scoping review using the stage-wise framework developed by Arksey and O'Malley. We summarized 42 factors, as identified in 30 publications, and organized them into four categories. Key factors shaping self-reported health included the presence of chronic conditions and depressive symptoms. As the population of community-dwelling older adults continues to increase, there remains a need to understand how these identified factors shape self-reported health. To date, empirical research has been limited to observational and cross-sectional designs. There is a need to further explore these factors in longitudinal data.
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Wilhite CS, Jaco ML, Chavez C, Perez C, Gomez M, Neugebauer TA. Agriculture for Life: A Guide for Health Promotion and Participation for Farmers with Health Challenges. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2020. [DOI: 10.1080/15398285.2020.1750825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Carla Sue Wilhite
- Occupational Therapy Division, University of New Mexico-School of Medicine, 1 University of New Mexico, Albuquerque, New Mexico, USA
| | - Mary Linda Jaco
- Oklahoma State University-Seretean Wellness Center, Stillwater, Oklahoma, USA
| | - Cynthia Chavez
- Occupational Therapy Division, University of New Mexico-School of Medicine, 1 University of New Mexico, Albuquerque, New Mexico, USA
| | - Celicia Perez
- Occupational Therapy Division, University of New Mexico-School of Medicine, 1 University of New Mexico, Albuquerque, New Mexico, USA
| | - Maceala Gomez
- Occupational Therapy Division, University of New Mexico-School of Medicine, 1 University of New Mexico, Albuquerque, New Mexico, USA
| | - Timothy A. Neugebauer
- Occupational Therapy Division, University of New Mexico-School of Medicine, 1 University of New Mexico, Albuquerque, New Mexico, USA
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Grooten L, Fabbricotti IN, Devroey D, Vrijhoef HJM. Assessment of the implementation fidelity of a strategy to scale up integrated care in five European regions: a multimethod study. BMJ Open 2020; 10:e035002. [PMID: 32193271 PMCID: PMC7150600 DOI: 10.1136/bmjopen-2019-035002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The SCaling IntegRated Care in COntext (SCIROCCO) project tested a step-based scaling up strategy to explore what and how to scale up integrated care initiatives in five European regions. To gain a profound understanding of which factors influence the implementation of this strategy, the objective of this study was to assess the extent to which the SCIROCCO strategy was implemented as planned. DESIGN Multimethod study. METHODS The extended version of the conceptual framework for implementation fidelity was used to evaluate what factors influence the implementation of the scaling up strategy. Data were collected in the five participating European regions during the intervention period. Data collection methods included: key informant interviews, focus groups, questionnaire studies and project documents. RESULTS All three main steps of the scaling up strategy were implemented with acceptable fidelity. Variations were observed in the duration of implementing the steps in the regions. Also, variations were observed in the coverage of experts to participate in the steps of the strategy. Several factors were observed to influence the implementation: facilitation conditions (ie, good coordination for implementation) and participant responsiveness (ie, a positive experience of participants in the organised study visits). Factors that may have moderated adherence to the original plan of the strategy were found in facilitating conditions (ie, in the flexible approach), participant recruitment factors (ie, adaptions of the procedure by the regions) and contextual factors (ie, the level of development of integrated care). CONCLUSION This was the first study to assess implementation fidelity of a European project that used a step-based scaling up strategy in five European regions. Similar European projects that are based on collaboration between several European regions can learn from the lessons captured in SCIROCCO and can become more aware of the facilitating factors and pitfalls of implementing such projects.
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Affiliation(s)
- Liset Grooten
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussel, Belgium
| | | | - Dirk Devroey
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussel, Belgium
| | - Hubertus J M Vrijhoef
- Department of Patient & Care, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
- Panaxea B.V, Amsterdam, The Netherlands
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Carneiro JA, Gomes CAD, Durães W, Jesus DRD, Chaves KLL, Lima CDA, Costa FMD, Caldeira AP. Negative self-perception of health: prevalence and associated factors among elderly assisted in a reference center. CIENCIA & SAUDE COLETIVA 2020; 25:909-918. [PMID: 32159661 DOI: 10.1590/1413-81232020253.16402018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 07/06/2018] [Indexed: 11/21/2022] Open
Abstract
The negative self-perception of health is a relevant construct for the analysis of the elderly population health conditions and should be recognized as a guiding tool for health promotion actions. We aimed to verify the prevalence and the associated factors to a negative self-perception of health by elderly assisted in a reference center. This is an analytical cross-sectional study with convenience sampling conducted in 2015. The negative self-perception association with health-related sociodemographic variables was investigated. Bivariate analysis followed by multiple analysis by Poisson regression was performed to verify the variables associated with the outcome. Three hundred sixty elderly were evaluated. The negative self-perception of health prevalence was 60.5%. The following associated factors were identified in the final model: age range 65-79 years (PR=1; CI95%=0.648-0.974; p=0.027); frailty (PR=1.28; CI95%=1.07-1.54; p=0.007); depressive symptoms (PR=1.40; CI95%=1.19-1.67; p=0.000); and providing care to someone (PR=1.49; CI95%=1.18-1.88; p=0.001). The elevated prevalence of negative self-perception of health and the associated factors point to the need for effective health promotion actions and more specific care for the elderly assisted in the reference center.
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Affiliation(s)
- Jair Almeida Carneiro
- Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauricéia. 39401-089, Montes Claros, MG, Brasil.
| | - Caio Augusto Dias Gomes
- Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauricéia. 39401-089, Montes Claros, MG, Brasil.
| | - Weliton Durães
- Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauricéia. 39401-089, Montes Claros, MG, Brasil.
| | - David Rodrigues de Jesus
- Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauricéia. 39401-089, Montes Claros, MG, Brasil.
| | - Keitlen Lara Leandro Chaves
- Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauricéia. 39401-089, Montes Claros, MG, Brasil.
| | - Cássio de Almeida Lima
- Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauricéia. 39401-089, Montes Claros, MG, Brasil.
| | | | - Antônio Prates Caldeira
- Universidade Estadual de Montes Claros. Av. Prof. Rui Braga s/n, Vila Mauricéia. 39401-089, Montes Claros, MG, Brasil.
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42
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Ciola G, Silva MF, Yassuda MS, Neri AL, Borim FSA. Dor crônica em idosos e associações diretas e indiretas com variáveis sociodemográficas e de condições de saúde: uma análise de caminhos. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2020. [DOI: 10.1590/1981-22562020023.200065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Identificar a prevalência de dor crônica em idosos acima de 70 anos de idade e as relações diretas e indiretas entre dor crônica e variáveis sociodemográficas e de condições de saúde. Método Estudo transversal, realizado com 419 idosos de 72 anos ou mais, entre 2016 e 2017. Os participantes são provenientes do estudo de seguimento do Estudo FIBRA, que incluiu idosos não institucionalizados residentes da zona urbana dos municípios de Campinas e Ermelino Matarazzo, do estado de São Paulo, Brasil. A variável mediadora foi dor crônica, avaliada positivamente pelo autorrelato da presença de dor nos últimos seis meses. As variáveis independentes contempladas foram: sociodemográficas, comportamentos relacionados à saúde, multimorbidade, sintomas depressivos, insônia e autoavaliação de saúde. As relações diretas e indiretas foram testadas por meio da análise de caminhos. Resultados 57,0% da população estudada relatou dor crônica. O sexo feminino, o Índice de Massa Corporal (IMC) elevado, a multimorbidade e os sintomas de insônia e de depressão apresentaram associação direta com dor crônica. A dor crônica figurou como variável mediadora das associações entre autoavaliação de saúde e gênero, IMC, multimorbidade e sintomas de insônia. Conclusão Os dados mostram uma rede de interações da dor crônica com variáveis sociodemográficas e de condições de saúde. Esse conhecimento poderá beneficiar o manejo e o cuidado à pessoa idosa acometida por dor crônica.
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Affiliation(s)
| | | | - Monica Sanches Yassuda
- Universidade Estadual de Campinas (Unicamp), Brasil; Universidade de São Paulo (USP), Brasil
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Aftyka A, Rosa W, Taczała J. Self-rated health in mothers of children hospitalised for severe illnesses and mothers of healthy children: cross-sectional study. Scand J Caring Sci 2019; 34:698-709. [PMID: 31657048 DOI: 10.1111/scs.12774] [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: 02/14/2019] [Revised: 09/12/2019] [Accepted: 09/15/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Self-rated health (SRH) is a recognised tool for predicting morbidity and mortality. AIM The aim of the study was to investigate and compare SRH in a group of mothers of hospitalised children and mothers of healthy children and to indicate the variables associated with poor SRH in both groups. METHODS We conducted questionnaire-based cross-sectional research in a group of 184 women. Half of the respondents (n = 92) were the mothers of children hospitalised for a severe illnesses (Group H). The control group (n = 92) comprised mothers of healthy children (Group C). Self-Rated Health (SRH), Numerical Rating Scale (NRS), Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale-Revised (IES-R) and Interpersonal Support Evaluation List (ISEL-40 v. GP) were used. In order to facilitate critical appraisal and interpretation of results, STROBE recommendations were used. RESULTS The prevalence of poor SRH was greater in mothers of children hospitalised for a severe illness than in those of healthy children (35 and 19%, respectively). In both groups, the risk of poor SRH was statistically significantly higher in those mothers who for the past 7 days reported at least moderate pain and in mothers who manifested anxiety symptoms. In both groups, the prevalence of poor SRH was statistically significantly lower if the respondents' children were in good health. The risk of poor SRH was associated with poor financial status in group H and with depression and at least moderate pain for the past 7 days in group C. RELEVANCE TO CLINICAL PRACTICE In order to provide mothers of severely ill children with high-quality health care including preventive measures, it is recommended that their health is assessed by healthcare professionals.
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Affiliation(s)
- Anna Aftyka
- Department of Anaesthesiological and Intensive Care Nursing, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
| | - Wojciech Rosa
- Department of Applied Mathematics, Faculty of Technology Fundamentals, Lublin University of Technology, Lublin, Poland
| | - Jolanta Taczała
- Department of Rehabilitation and Physiotherapy, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland
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Sturm H, Colombo M, Hebeiss T, Joos S, Koch R. Patient Input in Regional Healthcare Planning-A Meaningful Contribution. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3754. [PMID: 31590364 PMCID: PMC6801500 DOI: 10.3390/ijerph16193754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/26/2019] [Accepted: 10/01/2019] [Indexed: 11/25/2022]
Abstract
Background: There are well-known methodological and analytical challenges in planning regional healthcare services (HCS). Increasingly, the need for data-derived planning, including user-perspectives, is discussed. This study aims to better understand the possible contribution of citizen experience in the assessment of regional HCS needs in two regions of Germany. Methods: We conducted a written survey in two regions of differing size-a community (3653 inhabitants) and a county (165,211 inhabitants). Multinomial logistic regression was used to assess the impact of sociodemographic and regional factors on the assessment of HCS provided by general practitioners (GPs) and specialists. Results: Except for age and financial resources available for one's own health, populations did not differ significantly between the regions. However, citizens' perception of HCS (measured by satisfaction with 1 = very good to 5 = very poor) differed clearly between different services (e.g., specialists: 3.8-4.3 and pharmacies: 1.7-2.5) as well as between regions (GPs: 1.7-3.1; therapists: 2.9-4). In the multivariate model, region (next to income and age) was a consistent predictor of the perception of GP- and specialist-provided care. Discussion: Citizens' perceptions of HCS correspond to regional provider density (the greater the density, the better the perception) and add insights into citizens' needs. Therefore, they can provide valuable information on regional HCS strengths and weaknesses and are a valid resource to support decision makers in shaping regional care structures.
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Affiliation(s)
- Heidrun Sturm
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Osianderstraße 5, 72076 Tübingen, Germany.
| | - Miriam Colombo
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Osianderstraße 5, 72076 Tübingen, Germany.
| | - Teresa Hebeiss
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Osianderstraße 5, 72076 Tübingen, Germany.
| | - Stefanie Joos
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Osianderstraße 5, 72076 Tübingen, Germany.
| | - Roland Koch
- University Hospital Tübingen, Institute for General Practice and Interprofessional Care, Osianderstraße 5, 72076 Tübingen, Germany.
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Zhang R, Lu Y, Shi L, Zhang S, Chang F. Prevalence and patterns of multimorbidity among the elderly in China: a cross-sectional study using national survey data. BMJ Open 2019; 9:e024268. [PMID: 31427309 PMCID: PMC6701688 DOI: 10.1136/bmjopen-2018-024268] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 05/30/2019] [Accepted: 07/12/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Examination of the prevalence and patterns of multimorbidity among the elderly in China. DESIGN Cross-sectional study. SETTING More than 10 000 households in 28 of the 34 provinces of mainland China. PARTICIPANTS 11 707 Chinese adults aged 60 and over. PRIMARY OUTCOME MEASURES Prevalence and patterns of multimorbidity among the participants. Relative risks were calculated to estimate the probability of up to 14 chronic conditions coexisting with each other. Observed-to-expected (O/E) ratios were used to analyse the patterns of multimorbidity. RESULTS Multimorbidity was present in 43.6% of respondents from the sample population, with women having the greater prevalence compared with men. There were 804 different comorbidity combinations identified, including 76 dyad combinations and 169 triad combinations. The top 10 morbidity dyads and triads accounted for 69.01% and 47.05% of the total dyad and triad combinations observed, respectively. Among the 14 chronic conditions included in the study, asthma, stroke, heart attack and six other chronic conditions were the main components of multimorbidity due to their high relative risk ratios. The most frequently occurring clusters with higher O/E ratios were stroke along with emotional, nervous, or psychiatric problems; memory-related diseases together emotional, nervous, or psychiatric problems; and memory-related diseases and asthma accompanied by chronic lung diseases and asthma. CONCLUSIONS The results of this study highlight the high prevalence of multimorbidity in the elderly population in China. Further studies are required to understand the aetiology of multimorbidity, and future primary healthcare policies should be made while taking multimorbidity into consideration.
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Affiliation(s)
- Ran Zhang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Yun Lu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Liuyan Shi
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Songlin Zhang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Feng Chang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
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Griffith LE, Gilsing A, Mangin D, Patterson C, van den Heuvel E, Sohel N, St John P, van den Akker M, Raina P. Multimorbidity Frameworks Impact Prevalence and Relationships with Patient-Important Outcomes. J Am Geriatr Soc 2019; 67:1632-1640. [PMID: 30957230 DOI: 10.1111/jgs.15921] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 03/02/2019] [Accepted: 03/13/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore how different frameworks and categories of chronic conditions impact multimorbidity (defined as two or more chronic conditions) prevalence estimates and associations with patient-important functional outcomes. DESIGN Baseline data from a population-based cohort study. SETTING National sample of Canadians. PARTICIPANTS A total of 51 338 community-living adults, aged 45 to 85 years. MAIN OUTCOME MEASURES Chronic conditions from three commonly recognized frameworks were categorized as: (1) diseases, (2) risk factors, or (3) symptoms. Estimates of multimorbidity prevalence were compared among frameworks by age and sex. Separate weighted logistic regression models were used to explore the impact of the different frameworks and categories of chronic conditions on odds ratios (ORs) for multimorbidity for four patient-important functional outcomes: disability, social participation restriction, and self-rated physical and mental health. RESULTS One framework included diseases and risk factors, and two frameworks included diseases, risk factors, and symptoms. The prevalence of multimorbidity differed among the frameworks, ranging from 33.5% to 60.6% having two or more chronic conditions. Including risk factors in frameworks increased prevalence estimates, while including symptoms increased prevalence estimates and associations with most patient-important outcomes. The two frameworks that included symptoms had the largest ORs for associations with disability, social participation restriction, and self-rated physical health but not self-rated mental health. Similar results were found when we compared ORs for patient-important outcome for multimorbidity based on three subframeworks: one including diseases only, one including diseases and risk factors, and one including diseases, risk factors, and symptoms. CONCLUSIONS Including risk factors appeared to increase only the prevalence of multimorbidity without significantly altering relationships to outcomes. The inclusion of symptoms increased prevalence and associations with patient-important outcomes. These findings underscore the importance of considering not only the number, but also the category, of conditions included in multimorbidity frameworks, as simply counting the number of diagnoses may reduce sensitivity to outcomes that are important to individuals. J Am Geriatr Soc 67:1632-1640, 2019.
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Affiliation(s)
- Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anne Gilsing
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Edwin van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Nazmul Sohel
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Philip St John
- Section of Geriatric Medicine, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marjan van den Akker
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands.,Department of Public Health and Primary Care, Academic Center for General Practice - KU Leuven, Leuven, Belgium
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Walker C. A commentary on Martin's "What matters in 'multimorbidity'? Arguably resilience and personal health experience are central to quality of life and optimizing survival." J. Eval. Clin. Pract. 2016; 1-3. J Eval Clin Pract 2018; 24:1291-1292. [PMID: 30264914 DOI: 10.1111/jep.13027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 01/17/2023]
Abstract
This is a commentary on Martin's 2016 article on "What matters in 'multimorbidity'." The relationship between self-reported health and resilience is an important recognition of how all health professionals can work productively with their patients within a shared decision framework.
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Affiliation(s)
- Christine Walker
- Chronic Illness Alliance, 1/650 Mount Alexander Rd., Moonee Ponds, Victoria, 3039, Australia
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Han KM, Ko YH, Yoon HK, Han C, Ham BJ, Kim YK. Relationship of depression, chronic disease, self-rated health, and gender with health care utilization among community-living elderly. J Affect Disord 2018; 241:402-410. [PMID: 30145510 DOI: 10.1016/j.jad.2018.08.044] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/17/2018] [Accepted: 08/12/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND We investigated the interactive effects of depressive symptoms and chronic diseases on health care utilization among elderly people and explored the potential moderating effect of gender and the mediating effect of self-rated health (SRH) on the association between depressive symptoms and health care utilization. METHOD We analyzed data from 5223 people aged 60 years or older living in the community from the Korea Welfare Panel Study in 2015. Depressive symptoms were measured using an 11-item version of the Center for Epidemiologic Studies Depression (CES-D-11) Scale and morbidity within 28 disease categories was assessed. Health care utilization was evaluated as the number of outpatient visits (OV), number of hospitalizations (NH), and number of days spent in the hospital (DH) during past year. Hierarchical moderated regression analyses were applied to investigate the interactive effects. We also adopted the mediation analysis method by Hayes and Preacher. RESULTS A significant interactive effect of CES-D-11 score and chronic disease on OV was found. A positive correlation between CES-D-11 score and OV was only observed in those with chronic disease. Gender had a moderating effect on the association of depression symptoms with OV, NH, and DH among elderly people with chronic disease. SRH had mediating effects on the association of CES-D-11 with OV, NH, and DH only among those with chronic disease. LIMITATIONS The severity or multimorbidity of chronic diseases, which could affect health care utilization among elderly were not considered. CONCLUSIONS We elucidated the complex aspects of the relationship between depressive symptoms and chronic disease and their interactive effects on health care utilization among elderly people, and identified important roles of gender and SRH.
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Affiliation(s)
- Kyu-Man Han
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-Hoon Ko
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, Republic of Korea.
| | - Ho-Kyoung Yoon
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, Republic of Korea
| | - Byung-Joo Ham
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yong-Ku Kim
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, Republic of Korea
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Barrett T, McEntee E, Drew R, O’Reilly F, O’Carroll A, O’Shea A, Cleary B. Influenza vaccination in pregnancy: vaccine uptake, maternal and healthcare providers' knowledge and attitudes. A quantitative study. BJGP Open 2018; 2:bjgpopen18X101599. [PMID: 30564732 PMCID: PMC6189777 DOI: 10.3399/bjgpopen18x101599] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/08/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Influenza during pregnancy is a potentially life threatening illness. There are limited data on influenza vaccination uptake and determinants of uptake in Irish obstetric populations. AIM To determine the uptake of influenza vaccination during pregnancy; determinants of vaccination uptake; knowledge, attitudes, and concerns of postnatal women; and knowledge and attitudes of healthcare professionals (HCPs) surrounding vaccination. DESIGN & SETTING A quantitative study of postnatal women attending the Rotunda Hospital, a tertiary referral maternity hospital in Dublin, Ireland. A separate quantitative study conducted by the North Dublin City GP Training Programme surveyed GPs, pharmacists, and Rotunda Hospital clinical staff. METHOD A paper-based survey was distributed to postnatal women. HCPs completed the survey via the online tool Survey Monkey. RESULTS 330 patient surveys were disseminated, with a 60.0% response rate. Of 198 responders, 109 (55.1%) were vaccinated against influenza. Non-professionals were less likely to be vaccinated (adjusted odds ratio [aOR] 0.29, 95% confidence interval [CI] = 0.09 to 0.89). Vaccination in previous pregnancy (aOR 5.2, 95% CI = 1.69 to 15.62) and information from an HCP were strongly associated with vaccination (aOR 12.8, 95% CI = 2.65 to 62.5). There was a 20.2% (n = 1180) response rate among HCPs. More GPs felt that it was their role to discuss vaccination (92.9%; n = 676), and offer to vaccinate women (91.7%; n = 666) than any other HCP. CONCLUSION Provision of information about the importance of vaccination against influenza and pertussis during pregnancy by HCPs and their consistent recommendations in support of vaccination were key determinants of vaccine uptake during pregnancy. The sociodemographic determinants of a woman's vaccination status should be addressed in health promotion campaigns. Education of HCPs may address knowledge gaps surrounding vaccination.
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Affiliation(s)
- Tina Barrett
- Medical Student, Medicine Department, Royal College of Surgeons in Ireland, Dublin, Ireland
- Clinical Pharmacist, Pharmacy Department, Rotunda Hospital, Dublin, Ireland
| | - Edel McEntee
- GP Graduate, General Practice, North Dublin City GP Training Programme, Dublin, Ireland
| | - Richard Drew
- Consultant Microbiologist, Microbiology Department, Rotunda Hospital, Dublin, Ireland
| | - Fiona O’Reilly
- Programme Director, GP Training Scheme, North Dublin City GP Training Programme, Dublin, Ireland
| | - Austin O’Carroll
- Head of the NDCGP Training Scheme, North Dublin City GP Training Programme, Dublin, Ireland
| | - Aisling O’Shea
- GP Graduate, GP Training Scheme, North Dublin City GP Training Programme, Dublin, Ireland
| | - Brian Cleary
- Chief Pharmacist, Pharmacy Department, Rotunda Hospital, Dublin, Ireland
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Willadsen TG, Siersma V, Nielsen ABS, Køster-Rasmussen R, Guassora AD, Jarbøl DE, Eusebi P, Malterud K, Reventlow S, de Fine Olivarius N. The effect of structured personal care on diabetes symptoms and self-rated health over 14 years after diabetes diagnosis. Prim Care Diabetes 2018; 12:354-363. [PMID: 29705674 DOI: 10.1016/j.pcd.2018.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
Abstract
AIMS To explore the effect of structured personal care on diabetes symptoms and self-rated health over 14 years after diabetes diagnosis while patients are gradually diagnosed with other chronic conditions (multimorbidity). METHODS Post hoc analysis of the Danish randomized controlled trial Diabetes Care in General Practice including 1381 patients newly diagnosed with type 2 diabetes. The effect of structured personal care compared with routine care on diabetes symptoms and self-rated health was analysed 6 and 14 years after diagnosis with a generalized multilevel Rasch model. RESULTS Structured personal care reduced the overall likelihood of reporting diabetes symptoms at the end of the intervention (OR 0.79; 95% CI: 0.64-0.97), but this effect was not explained by glycaemic control or multimorbidity. There was no effect of the intervention on diabetes symptoms after 14 years or on self-rated health after 6 years or 14 years. CONCLUSIONS Structured personal care had a beneficial effect on diabetes symptoms 6 years after diagnosis, but not on self-rated health at either follow up point. To optimally manage patients over time it is important to supplement clinical information by information provided by the patients.
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Affiliation(s)
- Tora Grauers Willadsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anni Brit Sternhagen Nielsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Køster-Rasmussen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ann Dorrit Guassora
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Paolo Eusebi
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy; Health Planning Service, Department of Epidemiology, Regional Health Authority of Umbria, Perugia, Italy
| | - Kirsti Malterud
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Research Unit for General Practice, Uni Research Health, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Susanne Reventlow
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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