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Foster K, Steele M, Metcalfe J, Toomey N, Alexander L. Well-being, turnover intention, and stigma attitudes of mental health transition-to-practice nurses: A cross-sectional study. Int J Ment Health Nurs 2024; 33:409-419. [PMID: 37859339 DOI: 10.1111/inm.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
There is global recognition that mental health nursing can be stressful and have detrimental effects on nurses' well-being and retention. With substantial nursing shortages, there is an urgent need to attract and retain nurses to sustain this workforce and provide effective mental healthcare. Mental health transition programs provide vital recruitment pathways and support novice registered nurses, enrolled nurses and experienced registered generalist nurses moving into this field. There is little evidence, however, on the well-being, resilience, and retention of nurses transitioning into mental health. The primary aims for this cross-sectional study were to describe demographic characteristics, perceived stress, well-being, resilience, mental illness stigma attitudes, work satisfaction, and turnover intention of four nurse cohorts entering mental health transition programs: generalist registered nurses, graduate and post-graduate registered nurses, and enrolled nurses; to explore relationships between these variables; and explore differences between these four nurse cohorts. Findings (n = 87) included overall moderate perceived stress, moderate well-being and resilience, high work satisfaction, low stigma, and low turnover intention. Higher turnover intention was associated with lower age and work satisfaction, and higher perceived stress. Generalist RNs had significantly higher stress and stigmatizing attitudes than Enrolled Nurses. Secondary analysis of well-being scores identified 14 nurses with scores indicating depression, with significantly lower resilience and work satisfaction, and significantly higher stress than the rest of the sample. To help prevent attrition, it is vital that mental health services provide tailored well-being initiatives during transition and intervene early to provide support for nurses with mental distress.
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Affiliation(s)
- Kim Foster
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia
- NorthWestern Mental Health Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael Steele
- School of Allied Health, Australian Catholic University, Banyo, Queensland, Australia
| | - James Metcalfe
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Victoria, Australia
- NorthWestern Mental Health Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Nigel Toomey
- NorthWestern Mental Health Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Louise Alexander
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
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Lenzi J, Messina R, Rosa S, Iommi M, Rucci P, Pia Fantini M, Di Bartolo P. A multi-state analysis of disease trajectories and mental health transitions in patients with type 2 diabetes: A population-based retrospective cohort study utilizing health administrative data. Diabetes Res Clin Pract 2024; 209:111561. [PMID: 38325659 DOI: 10.1016/j.diabres.2024.111561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
AIMS To investigate the risk of major depression and dementia in patients with type 2 diabetes, including dementia resulting from depression, and their impact on diabetes-related complications and mortality. METHODS We conducted a population-based retrospective cohort study including 11,441 incident cases of diabetes in 2015-2017, with follow-up until 2022. A multi-state survival analysis was performed on a seven-state model with 15 transitions to capture disease progression and onset of mental disorders. RESULTS Eight-year probabilities of depression, dementia, diabetes-related complications, and death were 9.7% (95% CI 8.7-10.7), 0.9% (95% CI 0.5-1.3), 10.4% (95% CI 9.5-11.4), and 14.8% (95% CI 13.9-15.7), respectively. Depression increased the risk of dementia up to 3.7% (95% CI 2.0-5.4), and up to 10.3% (95% CI 0.3-20.4) if coupled with diabetes complications. Eight-year mortality was 37.5% (95% CI 33.1-42.0) after depression, 74.1% (95% CI 63.7-84.5) after depression plus complications, 76.4% (95% CI 68.8-83.9) after dementia, and 98.6% (95% CI 96.1-100.0) after dementia plus complications. CONCLUSIONS The interconnections observed across depression, dementia, complications, and mortality underscore the necessity for comprehensive and integrated approaches in managing diabetes. Early screening for depression, followed by timely and targeted interventions, may mitigate the risk of dementia and improve diabetes prognosis.
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Affiliation(s)
- Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Rossella Messina
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Simona Rosa
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marica Iommi
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Di Bartolo
- Diabetes Unit, Local Healthcare Authority of Romagna, Ravenna, Italy
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Li X, Zhang C, Bao Z. Mast cell activation may contribute to adverse health transitions in COVID-19 patients with frailty. Emerg Microbes Infect 2023; 12:2251589. [PMID: 37606034 PMCID: PMC10469413 DOI: 10.1080/22221751.2023.2251589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/30/2023] [Accepted: 08/20/2023] [Indexed: 08/23/2023]
Abstract
A prominent aspect of the post-coronavirus disease-2019 (post-COVID-19) era is long-COVID. Therefore, precise patient classification and exploration of the corresponding factors affecting long-COVID are crucial for tailored treatment strategies. Frailty is a common age-related clinical syndrome characterized by deteriorated physiological functions of multiple organ systems, which increases susceptibility to stressors. Herein, we performed an inclusion and exclusion analysis (definite COVID-19 infection diagnosis, clear underlying disease information, ≥60 years old, and repeated sampling of clinical cases) of 10,613 blood samples and identified frailty cases for further investigation. RNA-Seq data were used for differential gene expression and functional and pathway analyses. The results revealed that patients with frailty were more prone to poor health conversions and more sequelae, and the blood transcriptome had obvious disturbances in pathways associated with immune regulation, metabolism, and stress response. These adverse health transitions were significantly associated with mast cell activation. Additionally, NCAPG, MCM10, and CDC25C were identified as hub genes in the peripheral blood differential gene cluster, which could be used as diagnostic markers of poor health conversion. Our results indicate that healthcare measures should be prioritized to mitigate adverse health outcomes in this vulnerable patient group, COVID-19 patients with frailty, in post-COVID era.
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Affiliation(s)
- Xiangqi Li
- Department of Endocrinology and Metabolism, Gongli Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Chaobao Zhang
- Shanghai Key Laboratory of Clinical Geriatric Medicine; Department of Geriatric Medicine, Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Zhijun Bao
- Shanghai Key Laboratory of Clinical Geriatric Medicine; Department of Geriatric Medicine, Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
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Morgan JP, Marino ON, Finkelman M, Mourão CF, Flubinda FS. Rural Zambian Oral Health Transition: A Long-Term Retrospective Examination of an Outreach Program's Progress and Impact. Ann Glob Health 2023; 89:68. [PMID: 37841806 PMCID: PMC10573654 DOI: 10.5334/aogh.4179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/08/2023] [Indexed: 10/17/2023] Open
Abstract
Objective This study aimed to (a) describe an annual prevention-focused, community-based oral health outreach program in rural Zambia, (b) assess its oral health outcomes using demographic and oral health variables, and c) identify milestones resulting from program activities. Methods A retrospective analysis of demographic and oral health data from a single site between 2007-2014 and 2018-2019 was conducted. Demographic variables included sex and age, while clinical outcomes encompassed pain, untreated caries, and treatment urgency. Bivariate and multivariable analyses were performed, adjusting for sex and age categories. Information on community development was obtained from the Ministry of Health and local community representatives. Results Data from 5,791 subjects were analyzed. The prevalence of pain, untreated caries, and highest treatment urgency category decreased consistently across year categories. Both bivariate and multivariable analyses showed statistically significant differences in clinical outcomes between year categories (p < 0.001). In addition, the percentage of male participants and younger age categories increased during the study period. Key program milestones included the installation of two boreholes for clean water, the development of a local community oral health volunteer program, the establishment of an educational pipeline by the Dental Training School for residents, and the construction of a maternal/oral health center with district and ministry oversight. Conclusion The observed decrease in treatment urgency scores, presence of pain, and untreated caries are consistent with the prevention-seeking behavior of program participants. The increasing participation and changing demographic patterns over time suggest a growing demand for oral health services among males and younger individuals. The positive oral health outcomes and development of a maternal child/oral health facility exemplify a program design aligned with community needs and appropriate care delivery.
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Netto AM, Kashiwagi NM, Minanni CA, Santos RD, Cesena FY. Adiposity, hepatic steatosis, and metabolic health transitions in people with obesity: Influences of age and sex. Nutr Metab Cardiovasc Dis 2023; 33:1149-1157. [PMID: 37095017 DOI: 10.1016/j.numecd.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/19/2023] [Accepted: 03/27/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND AND AIMS Metabolically healthy (MHO) and unhealthy obesity (MUO) may be transient conditions. This study aimed to quantify and identify predictive factors of metabolic transitions in obesity, exploring influences of age and sex. METHODS AND RESULTS We retrospectively evaluated adults with obesity who underwent routine health evaluation. In a cross-sectional analysis of 12,118 individuals (80% male, age 44.3 ± 9.9 years), 16.8% had MHO. In a longitudinal evaluation of 4483 participants, 45.2% of individuals with MHO at baseline had dysmetabolism after a median follow-up of 3.0 (IQR 1.8-5.2) years, whereas 13.3% MUO participants became metabolically healthy (MH). Development of hepatic steatosis (HS, ultrasound) was an independent predictor of MHO conversion to dysmetabolism (OR 2.36; 95% CI 1.43, 3.91; p < 0.001), while HS persistence was inversely associated with transition from MUO to MH status (OR 0.63; 95% CI 0.47, 0.83; p = 0.001). Female sex and older age were associated with a lower chance of MUO regression. A 5% increment in body mass index (BMI) over time increased the likelihood of metabolic deterioration by 33% (p = 0.002) in females and 16% (p = 0.018) in males with MHO. A 5% reduction in BMI was associated with a 39% and 66% higher chance of MUO resolution in females and males, respectively (both p < 0.001). CONCLUSION The findings support a pathophysiological role of ectopic fat depots in metabolic transitions in obesity and identify female sex as an aggravating factor for adiposity-induced dysmetabolism, which has implications for personalized medicine.
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Affiliation(s)
- Alvaro M Netto
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Rua Comendador Elias Jafet, 755, São Paulo, SP, 05653-000, Brazil
| | - Nea M Kashiwagi
- Hospital Israelita Albert Einstein, Av. Brasil, 1085, São Paulo, SP, 01431-000, Brazil
| | - Carlos A Minanni
- Hospital Israelita Albert Einstein, Av. Brasil, 1085, São Paulo, SP, 01431-000, Brazil
| | - Raul D Santos
- Hospital Israelita Albert Einstein, Av. Brasil, 1085, São Paulo, SP, 01431-000, Brazil; Heart Institute (InCor), University of São Paulo Medical School Hospital, Av. Dr. Enéas Carvalho de Aguiar, 44, São Paulo, SP, 05403-900, Brazil
| | - Fernando Yue Cesena
- Hospital Israelita Albert Einstein, Av. Brasil, 1085, São Paulo, SP, 01431-000, Brazil.
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Bailey S. Editorial Perspective: Using the levers to improve the mental health transitions of 15-25 year olds - learning from the evidence across the whole of health, social care and beyond. Child Adolesc Ment Health 2022; 27:430-432. [PMID: 36250455 DOI: 10.1111/camh.12599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/27/2022]
Abstract
Reflecting on the findings from the Scoping Review paper by Adu et al. (2022) and the insightful commentary from Emma and Toni Wakefield (2022) gave me the opportunity to ask all of us whether user, carer, practitioner, educator, researcher or policymaker, how can we together convert the growing evidence about best models of transitions into a reality? One that delivers across pathways of care and across geographies, with positive, sustainable and measurable whole systems change; both for Transitional Age Youth (TAY) with extant mental health problems and also a model that is able to sustain the population mental health and well-being of all 15-25 year olds. In this commentary, I discuss the essential framework needed to develop the system change discussed in these papers.
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Appleton R, Loew J, Mughal F. Young people who have fallen through the mental health transition gap: a qualitative study on primary care support. Br J Gen Pract 2022; 72:e413-e420. [PMID: 35504728 PMCID: PMC9090175 DOI: 10.3399/bjgp.2021.0678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/17/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Owing to poor continuity of care between child and adult mental health services, young people are often discharged to their GP when they reach the upper boundary of child and adolescent mental health services (CAMHS). This handover is poorly managed, and GPs can struggle to support young people without input from specialist services. Little is known about young people's experiences of accessing mental health support from their GP after leaving CAMHS. AIM To explore the experiences and perspectives of young people and the parents/carers of young people receiving primary care support after CAMHS and to identify barriers and facilitators to accessing primary care. DESIGN AND SETTING Qualitative study with young people and parents in two English counties: London and West Midlands. METHOD Narrative interviews were conducted with 14 young people and 13 parents who had experienced poor continuity of care after reaching CAMHS transition boundary. Data were analysed using reflexive thematic analysis. RESULTS Three themes were identified: unmet mental health needs, disjointed care, and taking responsibility for the young person's mental health care. Barriers included the perception that GPs couldn't prescribe certain medication, anxiety caused by the general practice environment, and having to move to a new practice at university. Young people's positive experiences were more likely to include having a long-term relationship with their GP and finding that their GP made time to understand their needs and experiences. CONCLUSION GPs could help to meet the unmet needs of young people unable to access specialist mental health services after leaving CAMHS. There is a need for comprehensive handover of care from CAMHS to GPs, which could include a joint meeting with the young person and a member of the CAMHS team. Future research should focus on interventions which improve continuity of care for young people after leaving CAMHS, and collaborative working across community mental health services.
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Affiliation(s)
- Rebecca Appleton
- National Institute for Health Research (NIHR) Mental Health Policy Research Unit, Division of Psychiatry, UCL, London
| | - Joelle Loew
- Department of Languages and Literatures, University of Basel, Switzerland; lecturer in English business communication, Lucerne University of Applied Sciences and Arts, Switzerland
| | - Faraz Mughal
- School of Medicine, Keele University, Keele; honorary clinical research fellow, Unit of Academic Primary Care, University of Warwick, Coventry; affiliate, NIHR Greater Manchester Patient Safety Translational Research Centre, Keele University, Keele
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Adjaye-Gbewonyo K, Cois A. Explaining population trends in cardiovascular risk: protocol for a comparative analysis of health transitions in South Africa and England using nationally representative survey data. BMJ Open 2022; 12:e061034. [PMID: 35351734 PMCID: PMC8966565 DOI: 10.1136/bmjopen-2022-061034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cardiovascular diseases (CVD) are the leading cause of death globally and share determinants with other major non-communicable diseases. Risk factors for CVD are routinely measured in population surveys and thus provide an opportunity to study health transitions. Understanding the drivers of health transitions in countries that have not followed expected paths compared with those that exemplified models of 'epidemiologic transition', such as England, can generate knowledge on where resources may best be directed to reduce the burden of disease. This study aims to examine the notions of epidemiological transition by identifying and quantifying the drivers of change in CVD risk in a middle-income African setting compared with a high-income European setting. METHODS AND ANALYSIS This is a secondary joint analysis of data collected within the scope of multiple population surveys conducted in South Africa and England between 1998 and 2017 on nationally representative samples of the adult population. The study will use a validated, non-laboratory risk score to estimate and compare the distribution of and trends in total CVD risk in the population. Statistical modelling techniques (fixed-effects and random-effects multilevel regression models and structural equation models) will be used to examine how various factors explain the variation in CVD risk over time in the two countries. ETHICS AND DISSEMINATION This study has obtained approval from the University of Greenwich (20.5.6.8) and Stellenbosch University (X21/09/027) Research Ethics Committees. It uses anonymised microdata originating from population surveys which received ethical approval from the relevant bodies, with no additional primary data collection. Results of the study will be disseminated through (1) peer-reviewed articles in open access journals; (2) policy briefs; (3) conferences and meetings; and (4) public engagement activities designed to reach health professionals, governmental bodies, civil society and the lay public. A harmonised data set will be made publicly available through online repositories.
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Affiliation(s)
- Kafui Adjaye-Gbewonyo
- Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK
| | - Annibale Cois
- Division of Health Systems and Public Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Farrell S, Mitnitski A, Rockwood K, Rutenberg AD. Interpretable machine learning for high-dimensional trajectories of aging health. PLoS Comput Biol 2022; 18:e1009746. [PMID: 35007286 PMCID: PMC8782527 DOI: 10.1371/journal.pcbi.1009746] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 01/21/2022] [Accepted: 12/11/2021] [Indexed: 11/19/2022] Open
Abstract
We have built a computational model for individual aging trajectories of health and survival, which contains physical, functional, and biological variables, and is conditioned on demographic, lifestyle, and medical background information. We combine techniques of modern machine learning with an interpretable interaction network, where health variables are coupled by explicit pair-wise interactions within a stochastic dynamical system. Our dynamic joint interpretable network (DJIN) model is scalable to large longitudinal data sets, is predictive of individual high-dimensional health trajectories and survival from baseline health states, and infers an interpretable network of directed interactions between the health variables. The network identifies plausible physiological connections between health variables as well as clusters of strongly connected health variables. We use English Longitudinal Study of Aging (ELSA) data to train our model and show that it performs better than multiple dedicated linear models for health outcomes and survival. We compare our model with flexible lower-dimensional latent-space models to explore the dimensionality required to accurately model aging health outcomes. Our DJIN model can be used to generate synthetic individuals that age realistically, to impute missing data, and to simulate future aging outcomes given arbitrary initial health states.
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Affiliation(s)
- Spencer Farrell
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Arnold Mitnitski
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew D. Rutenberg
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
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Dwyer AA, Héritier V, Llahana S, Edelman L, Papadakis GE, Vaucher L, Pitteloud N, Hauschild M. Navigating Disrupted Puberty: Development and Evaluation of a Mobile- Health Transition Passport for Klinefelter Syndrome. Front Endocrinol (Lausanne) 2022; 13:909830. [PMID: 35813640 PMCID: PMC9264386 DOI: 10.3389/fendo.2022.909830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Klinefelter syndrome (KS) is the most common aneuploidy in men and has long-term sequelae on health and wellbeing. KS is a chronic, lifelong condition and adolescents/young adults (AYAs) with KS face challenges in transitioning from pediatric to adult-oriented services. Discontinuity of care contributes to poor outcomes for health and wellbeing and transition programs for KS are lacking. We aimed to develop and test a mobile health tool (KS Transition Passport) to educate patients about KS, encourage self-management and support successful transition to adult-oriented care. First, we conducted a retrospective chart review and patient survey to examine KS transition at a university hospital. Second, we conducted a systematic scoping review of the literature on AYAs with KS. Last, we developed a mobile health transition passport and evaluated it with patient support groups. Participants evaluated the tool using the System Usability Scale and Patient Education Materials Assessment Tool (PEMAT). Chart review identified 21 AYAs diagnosed between 3.9-16.8 years-old (median 10.2 years). The survey revealed only 4/10 (40%) were on testosterone therapy and fewer (3/10, 30%) had regular medical care. The scoping review identified 21 relevant articles highlighting key aspects of care for AYAs with KS. An interprofessional team developed the mobile-health KS transition passport using an iterative process. Support group members (n=35) rated passport usability as 'ok' to 'good' (70 ± 20, median 73.5/100). Of PEMAT dimensions, 5/6 were deemed 'high quality' (86-90/100) and participants knew what to do with the information (actionability = 83/100). In conclusion, many patients with KS appear to have gaps in transition to adult-oriented care. Iterative development of a KS transition passport produced a mobile health tool that was usable, understandable and had high ratings for actionability.
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Affiliation(s)
- Andrew A. Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
- Endocrinology, Diabetes & Metabolism Service of the Department of Medicine, Lausanne University Hospital Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Vanessa Héritier
- Pediatric Endocrinology, Diabetes and Obesity Unit, Department of Women-Mother-Child, Lausanne University Hospital Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Sofia Llahana
- School of Health and Psychological Sciences, City University of London, London, United Kingdom
| | - Lauren Edelman
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | - Georgios E. Papadakis
- Endocrinology, Diabetes & Metabolism Service of the Department of Medicine, Lausanne University Hospital Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Laurent Vaucher
- Reproductive Medicine Unit, Department of Obstetrics and Gynecology, Lausanne University Hospital Centre Hospitalier Universitaire Vaudois Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Nelly Pitteloud
- Endocrinology, Diabetes & Metabolism Service of the Department of Medicine, Lausanne University Hospital Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Michael Hauschild
- Pediatric Endocrinology, Diabetes and Obesity Unit, Department of Women-Mother-Child, Lausanne University Hospital Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- *Correspondence: Michael Hauschild,
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Ryan-Ibarra S, Nishimura H, Gallington K, Grinnell S, Bekemeier B. Time to Modernize: Local Public Health Transitions to Population-Level Interventions. J Public Health Manag Pract 2021; 27:464-472. [PMID: 31834010 DOI: 10.1097/phh.0000000000001100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify facilitating factors that guide local health departments (LHDs) in their transition from direct clinical service provision to population-level interventions addressing the social determinants of health. DESIGN Key informant interviews with LHD leaders and their staff were conducted using a semistructured interview guide. Thematic qualitative analysis was used to identify common characteristics and strategies among the LHD leaders and staff. PARTICIPANTS LHDs represented both rural and urban communities with population sizes from 9746 to 919 628 and agencies in Illinois, Montana, North Carolina, Oregon, Tennessee, Washington, and West Virginia. OUTCOME MEASURE The impetus and facilitators for transitioning health department services from clinical to population health. RESULTS Leaders from 7 LHDs emphasized that an impetus for their transition from direct clinical services to population-level interventions was that it was "time to modernize." Among LHDs interviewed, most included the 10 Essential Public Health Services or Public Health 3.0 in their strategic plan. Adding this focus to their strategic plan facilitated buy-in from local government and the ability to maintain the LHDs' focus on population-level interventions. We found that strong relationships and open communication with community members and partner organizations (eg, federally qualified health centers) were critical facilitators of transition. Themes from interviews were used to identify an initial set of 8 key elements of an effective transition: partnership/leadership, vision/goals, communication, community engagement, interventions, data/evaluation, workforce issues, and sustainability. CONCLUSIONS Prevention systems suffer from a lack of adequate health promotion and access to quality care for their community's residents. There is a need for LHDs to access technical support to strategically address complexity and ensure core population-focused prevention. The results shared provide replicable solutions, practices, and methods that enable successful transitions of LHDs toward maximizing their role in population health.
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Affiliation(s)
- Suzanne Ryan-Ibarra
- Survey Research Group (Dr Ryan-Ibarra and Mss Nishimura and Gallington) and Population Health Innovation Lab (Ms Grinnell), Public Health Institute, Oakland, California; and Northwest Center for Public Health Practice, Seattle, Washington (Dr Bekemeier)
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Cleverley K, Stevens K, Davies J, McCann E, Ashley T, Brathwaite D, Gebreyohannes M, Nasir S, O'Reilly K, Bennett KJ, Brennenstuhl S, Charach A, Henderson J, Jeffs L, Korczak DJ, Monga S, de Oliveira C, Szatmari P. Mixed-methods study protocol for an evaluation of the mental health transition navigator model in child and adolescent mental health services: the Navigator Evaluation Advancing Transitions (NEAT) study. BMJ Open 2021; 11:e051190. [PMID: 34187834 PMCID: PMC8245465 DOI: 10.1136/bmjopen-2021-051190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Transition from child and adolescent mental health services (CAMHS) to community or adult mental health services (AMHS) is a highly problematic health systems hurdle, especially for transition-aged youth. A planned and purposeful transition process is often non-existent or experienced negatively by youth and their caregivers. Stakeholders, including youth and their caregivers, have demanded interventions to support more effective transitions, such a transition navigator. The transition navigator model uses a navigator to facilitate complex transitions from acute care CAMHS to community or AMHS. However, despite the widespread implementation of this model, there has been no evaluation of the programme, hindering its scalability. This paper describes the study protocol of the Navigator Evaluation Advancing Transitions study that aims to collaborate with patients, caregivers and clinicians in the evaluation of the navigator model. METHODS AND ANALYSIS A pre and post mixed-method study will be conducted, using the Triple Aim Framework, to evaluate the navigator model. We will recruit participants from one large tertiary and two community hospitals in Toronto, Canada. For the quantitative portion of the study, we will recruit a sample of 45 youth (15 at each site), aged 16-18, and their caregivers at baseline (referral to navigator) (T1) and 6 months (T2). Youth and caregiver participants will complete a set of standardised measures to assess mental health, service utilisation, and satisfaction outcomes. For the qualitative portion of the study, semistructured interviews will be conducted at 6 months (T2) with youth, their caregivers and clinicians to better understand their experience and satisfaction with the model. ETHICS AND DISSEMINATION Research Ethics Board (REB) approval has been obtained from the lead research sites, the University of Toronto and the Hospital for Sick Children. The results of the study will be reported in peer-reviewed publications, webinars and conferences and to all relevant stakeholders.
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Affiliation(s)
- Kristin Cleverley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katye Stevens
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Julia Davies
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Emma McCann
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Tracy Ashley
- Lumenus Community Services, Toronto, Ontario, Canada
| | - Daneisha Brathwaite
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mana Gebreyohannes
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Saba Nasir
- Lumenus Community Services, Toronto, Ontario, Canada
| | - Katelyn O'Reilly
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathryn J Bennett
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Alice Charach
- Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lianne Jeffs
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Daphne J Korczak
- Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Suneeta Monga
- Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Centre for Health Economics and Hull York Medical School, University of York, York, UK
| | - Peter Szatmari
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Wang L, Tang Y, Roshanmehr F, Bai X, Taghizadeh-Hesary F, Taghizadeh-Hesary F. The Health Status Transition and Medical Expenditure Evaluation of Elderly Population in China. Int J Environ Res Public Health 2021; 18:ijerph18136907. [PMID: 34199100 PMCID: PMC8296990 DOI: 10.3390/ijerph18136907] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Because of the rapid expansion of the aging population in China, their health status transition and future medical expenditure have received increasing attention. This paper analyzes the health transition of the elderly and how their health transition impacts medical expenditures. At the same time, feasible policy suggestions are provided to respond to the rising medical expenditure and the demand for social care. (2) Methods: The data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015 and analyzed using the Markov model and the Two-Part model (TPM) to forecast the size of the elderly population and their medical expenditures for the period 2020-2060. (3) Results: The study indicates that: (1) for the elderly with a mild disability, the probability of their health improvement is high; in contrast, for the elderly with a moderate or severe disability, their health deterioration is almost certain; (2) the frequency of the diagnosis and treatments of the elderly is closely related to their health status and medical expenditure; alternatively, as the health status deteriorates, the intensity of the elderly individuals' acceptance of their diagnosis and treatment increases, and so does the medical expense; (3) the population of the elderly with mild and moderate disability demonstrates an inverted "U"-shape, which reaches a peak around 2048, whereas the elderly with severe disability show linear growth, being the target group for health care; (4) with the population increase of the elderly who have severe disability, the medical expenditure increases significantly and poses a huge threat to medical service supply. Conclusions: It is necessary to provide classified and targeted health care according to the health status of the elderly. In addition, improving the level of medical insurance, establishing a mechanism for sharing medical expenditure, and adjusting the basic demographic structure are all important policy choices.
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Affiliation(s)
- Lianjie Wang
- School of Public Administration, Zhejiang University of Finance and Economics, Hangzhou 310018, China;
| | - Yao Tang
- School of Public Administration, Zhejiang University of Finance and Economics, Hangzhou 310018, China;
- Correspondence: (Y.T.); (F.T.-H.)
| | - Farnaz Roshanmehr
- Shibata Laboratory, School of Advanced Science and Engineering, Waseda University, Tokyo 162-8480, Japan;
- Kagawa Nutrition University, Saitama 350-0288, Japan
| | - Xiao Bai
- School of Finance, Zhejiang University of Finance and Economics, Hangzhou 310018, China;
| | - Farzad Taghizadeh-Hesary
- Clinical Oncology Department, Shahid Beheshti University of Medical Sciences, Tehran 19857-17443, Iran;
| | - Farhad Taghizadeh-Hesary
- Social Science Research Institute, Tokai University, Tokyo 259-1292, Japan
- Correspondence: (Y.T.); (F.T.-H.)
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Mühlensiepen F, Kurkowski S, Krusche M, Mucke J, Prill R, Heinze M, Welcker M, Schulze-Koops H, Vuillerme N, Schett G, Knitza J. Digital Health Transition in Rheumatology: A Qualitative Study. Int J Environ Res Public Health 2021; 18:ijerph18052636. [PMID: 33807952 PMCID: PMC7967307 DOI: 10.3390/ijerph18052636] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022]
Abstract
The global COVID-19 pandemic has led to drastic changes in the management of patients with rheumatic diseases. Due to the imminent risk of infection, monitoring intervals of rheumatic patients have prolonged. The aim of this study is to present insights from patients, rheumatologists, and digital product developers on the ongoing digital health transition in rheumatology. A qualitative and participatory semi-structured fishbowl approach was conducted to gain detailed insights from a total of 476 participants. The main findings show that digital health and remote care are generally welcomed by the participants. Five key themes emerged from the qualitative content analysis: (1) digital rheumatology use cases, (2) user descriptions, (3) adaptation to different environments of rheumatology care, and (4) potentials of and (5) barriers to digital rheumatology implementation. Codes were scaled by positive and negative ratings as well as on micro, meso, and macro levels. A main recommendation resulting from the insights is that both patients and rheumatologists need more information and education to successfully implement digital health tools into clinical routine.
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Affiliation(s)
- Felix Mühlensiepen
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf, Germany;
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 14476 Potsdam, Germany;
- Correspondence:
| | - Sandra Kurkowski
- Department of Palliative Medicine, CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Martin Krusche
- Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Johanna Mucke
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich-Heine-University, 40225 Duesseldorf, Germany;
| | - Robert Prill
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 14476 Potsdam, Germany;
- Department of Orthopaedics and Trauma Surgery, Brandenburg Medical School Theodor Fontane, Municipal Clinic Brandenburg, 14770 Brandenburg, Germany
| | - Martin Heinze
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf, Germany;
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, 15562 Rüdersdorf, Germany
| | - Martin Welcker
- Medizinisches Versorgungszentrum für Rheumatologie Dr. M. Welcker GmbH, 82152 Planegg, Germany;
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig-Maximilians-Universität München, 80336 Munich, Germany;
| | - Nicolas Vuillerme
- AGEIS, Faculty of Medicine, Université Grenoble Alpes, 38706 Grenoble, France; (N.V.); (J.K.)
- Institut Universitaire de France, 75006 Paris, France
- LabCom Telecom4Health, Université Grenoble Alpes & Orange Labs, 38400 Grenoble, France
| | - Georg Schett
- Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany;
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Johannes Knitza
- AGEIS, Faculty of Medicine, Université Grenoble Alpes, 38706 Grenoble, France; (N.V.); (J.K.)
- Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany;
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
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Abstract
We explore major trends over the last 75 years that affect care provision to chronically ill older adults. We examine shifting demographics that have altered the nature and dynamics of family and formal care systems. Next, we identify changes in clinical health care approaches, including the rising population of chronically ill older persons and concerns about continuity of care. We conclude with an assessment of the growing impact of the technological revolution on both family and professional care.
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Affiliation(s)
- Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, New York
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York
| | - Sara J Czaja
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York
| | - M Cary Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York
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Leinbach LI, Willink A. Oral Health in Medicare: Considerations for 21st-Century Coverage. JAMA 2020; 324:1288-1289. [PMID: 32910164 DOI: 10.1001/jama.2020.3003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Leah I Leinbach
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland
- Johns Hopkins University Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, Maryland
| | - Amber Willink
- Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
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17
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Abstract
BACKGROUND Digitalisation affects 90% of healthcare. Digital health, however, does not only refer to technological transformation but also has considerable cultural and social consequences. It fundamentally reshapes the roles of physicians and patients, as well as their relationship. Moreover, from the second half of the 20th century, the growing number of chronic patients and the increase in life expectancy have posed new challenges to the medical workforce. OBJECTIVES To explore the digitally engaged physician's knowledge and attitudes towards digital health technologies and the transformation of the doctor-patient relationship. METHODS A qualitative interview study analysed with Interpretative Phenomenological Analysis (IPA). The study is based on qualitative, semi-structured interviews with 11 digitally engaged physicians from 9 countries. We identified four main themes emerging from e-physicians' responses and experience: 1) the past: intentions and experiences of change, 2) the present: the role of digital health and technology in the medical practice and their everyday challenges, 3) the present: the practical and ideal physician-patient relationship, and 4) the future: skills and competencies needed for working with e-patients and visions about the future of the medical practice. RESULTS The interviewed physicians state that digital health solutions could create a deeper doctor-patient relationship: knowledgeable patients are a huge help in the joint work effort and technology is the main tool for creating a more involved and responsible patient. Medical professionals in the future might rather get a role as a translator between technical data and the patient; as a guide in the jungle of digital health. However, the interviewed physicians also noted that digital transition today is more beneficial to patients than to their doctors. CONCLUSIONS We state that digitally engaged physicians are characterized by a kind of dichotomy: they use digital opportunities enthusiastically, but they also feel the difficulties related to digital health.
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Affiliation(s)
- Zsuzsa Győrffy
- Institute of Behavioural Sciences, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Nóra Radó
- Institute of Behavioural Sciences, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Bertalan Mesko
- Institute of Behavioural Sciences, Semmelweis University, Faculty of Medicine, Budapest, Hungary, The Medical Futurist Institute, Budapest, Hungary
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Voigt M, Abellán A, Pérez J, Ramiro D. The effects of socioeconomic conditions on old-age mortality within shared disability pathways. PLoS One 2020; 15:e0238204. [PMID: 32881884 PMCID: PMC7470411 DOI: 10.1371/journal.pone.0238204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/11/2020] [Indexed: 11/18/2022] Open
Abstract
Objective How disability manifests itself in an individual is a highly complex process influenced by a wide range of individual and environmental factors. Its complexity makes the search for generalizable characteristics of the disablement process a challenging task. Consequentially, little is known about how the effect on other health outcomes such as life expectancy are modified after the onset of chronic ailments. In this paper we posit an alternative approach to generalize health trajectories of older people with disability and then analyze how socioeconomic conditions affect the longevity within these trajectory groups. Methods Individual level information about the first three successive onsets of chronic disability after age 50 is transformed into state-sequences. We extract trajectory groups based on onset time and the time spent in a certain state. Mortality hazards are then estimated with a Gompertz proportional hazards model to compare effects of different socioeconomic measures within the trajectory groups. Results Three distinct trajectory groups are identified, the mild (1), the early severe (2), and late severe (3) pathway. Estimates of the mortality analysis suggest that social inequalities in longevity are less pronounced after onset of old-age disability. We found a consistent survival prolonging effect for individuals who engage in daily activities (such as meeting with friends, walking) that ranged between 33.2% and 77.3%. The importance of other variables varies between trajectory groups. Discussion This study shows how health trajectories of individuals with disability can be generalized when information on the onset and severity of single conditions is available. Such an approach may help us to better predict health and care expenditures and help families and individuals with their personal care planning. The findings from the subsequent survival analysis suggest a substantial reduction of socioeconomic mortality differences after onset of old-age disability, which appears to be independent of its nature.
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Affiliation(s)
- Mathias Voigt
- Center for Humanities and Social Sciences, Spanish National Research Council, Madrid, Spain
| | - Antonio Abellán
- Center for Humanities and Social Sciences, Spanish National Research Council, Madrid, Spain
| | - Julio Pérez
- Center for Humanities and Social Sciences, Spanish National Research Council, Madrid, Spain
| | - Diego Ramiro
- Center for Humanities and Social Sciences, Spanish National Research Council, Madrid, Spain
- * E-mail:
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Jiang C, Zou M, Chen M, Jiang Y, Chang P, Cui Y, Jiang L. Reliability and validity of the Mandarin version of the Continuity Assessment Record and Evaluation for older people who are transferred between hospitals and nursing homes in China. Health Soc Care Community 2020; 28:1180-1189. [PMID: 32048425 DOI: 10.1111/hsc.12951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/07/2020] [Accepted: 01/12/2020] [Indexed: 06/10/2023]
Abstract
To date, assessment tools for older people are different between hospitals and nursing homes in China. The difference between assessment tools can lead to poor communication of information between hospitals and nursing homes, which causes discontinuity of care and adverse outcomes when older people are transferred between these different settings. Continuity Assessment Record and Evaluation (CARE) is a comprehensive geriatric assessment tool developed in the United States of America. This study aimed to evaluate the reliability and validity of the Mandarin Version of CARE for older people who are transferred between hospitals and nursing homes. Using a convenience sampling method, 120 older people in hospitals and 120 older people in nursing homes in Shanghai were selected to test the internal consistency, interrater reliability and criterion-related validity of CARE from May to November 2017. When used among hospital, 70.0% (7/10) of the subscales had a Cronbach's alpha coefficients of greater than 0.7, 94.3% (50/53) of the items had an intraclass correlation coefficient (ICC) of greater than 0.75. When used in nursing homes, 90.0% (9/10) of the subscales had a Cronbach's alpha coefficients of greater than 0.7, 94.3% (50/53) of the items had an ICC of greater than 0.75. For both settings, the correlation coefficients of the subscales with their corresponding instruments for criterion-related validity were all greater than 0.8 (p < .01). The Mandarin version of CARE exhibits good reliability and validity. It can be used as an assessment tool for transition between hospitals and nursing homes.
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Affiliation(s)
- Caixia Jiang
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Min Zou
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | | | - Yijun Jiang
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Polun Chang
- Institute of bioMedical Informatics, National Yang-Ming University, Taipei City, Taiwan
| | - Yanyan Cui
- Institute of bioMedical Informatics, National Yang-Ming University, Taipei City, Taiwan
| | - Liping Jiang
- Department of Nursing, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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20
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Abstract
The world's older population continues to grow at an unprecedented rate. This trend amplifies the necessity of improving the care of older patients with chronic health problems. Of those with chronic health problems, those with cardiovascular diseases and depression are particularly challenging due to the multifaceted nature of these conditions. This review discusses the significance of this aging trend and ways to better care for this particular population.
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Affiliation(s)
- Wei Jiang
- Department of Psychiatry and Behavioral Sciences, Duke University Health System, Durham, NC 27710, USA; Department of Medicine, Duke University Health System, Durham, NC 27710, USA.
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Galli M, Borderi M, Viale P. HIV policy in Italy and recommendations across the HIV care continuum. Infez Med 2020; 28:17-28. [PMID: 32172257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The HIV epidemic has not yet ended, and there are ever more challenges: the recent Italian National Plan of Interventions against HIV and AIDS (Piano Nazionale di Interventi Contro HIV e AIDS (PNAIDS) 2017-2019) was hailed for its comprehensiveness. Its likelihood of success across the HIV care continuum was therefore assessed. Awareness interventions are sporadic and continue to miss high risk populations; if effectively implemented, the prescriptive detail in PNAIDS may help address this. Combined prevention needs greater focus and investment. However, there has been recent progress: free anonymous testing is available at multiple settings although improvements to provide access to key vulnerable populations are needed. Clinical management is available to a high standard across the country, with some areas for improvement in ensuring equality of access. Long-term management of people living with HIV is often effective, but discrepancies exist across regions and settings of care. It is recommended to enable implementation of PNAIDS as a matter of urgency, develop integrated awareness and testing interventions for STIs and HIV, make condoms free for high-risk populations, and develop a network of multidisciplinary services for long-term holistic care of people living with HIV.
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Affiliation(s)
- Massimo Galli
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Marco Borderi
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S. Orsola Hospital, "Alma Mater Studiorum" University of Bologna, Italy
| | - Pierluigi Viale
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S. Orsola Hospital, "Alma Mater Studiorum" University of Bologna, Italy
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22
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Abstract
OBJECTIVES This work comes from the interest and need to understand the problems arising from the activity of caring for dependent people, in the world and particularly in the European region. Altogether, it seeks to understand the consequences of informal care on the caregiver adding to the debate a gender perspective. Through a multidisciplinary bibliographic review, the current care crisis becomes clear. The demographic and socio-cultural changes in recent years are causing dependency to increase dramatically, while putting at risk the availability of informal caregivers. Several studies have shown that women are the ones on whom the burden of care mainly falls. Therefore, under the gender perspective, it becomes clear that the consequences of caregiver burden increase gender inequalities worldwide. The study analyzes the current situation and underlines the need to promote alternatives and opportunities so that care is shared and does not fall only on the female gender. Solutions need to be included in public and community health interventions and policies, and to this respect, nurses play an important role in changing the care paradigm.
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24
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Affiliation(s)
- Ana Arroyo de la Rosa
- Grupo de Medicina Rural de SemFYC, Equipo de Atención Primaria, Centro de Salud de La Zarza, Servicio Extremeño de Salud, La Zarza, Badajoz, España
| | - Xavier Bayona Huguet
- Grupo de trabajo de gestión y gestión clínica de la CAMFiC, Equipo de Atención Primaria Bellvitge, Institut Català de la Salut, Hospitalet de Llobregat, Barcelona, España.
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Dudley M, Menzies O, Elder H, Nathan L, Garrett N, Wilson D. Mate wareware: Understanding 'dementia' from a Māori perspective. N Z Med J 2019; 132:66-74. [PMID: 31581183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM To investigate Māori (Indigenous people of Aotearoa New Zealand) understandings of dementia, its causes, and ways to manage a whānau (extended family) member with dementia. METHOD We undertook kaupapa Māori research (Māori informed research) with 223 kaumātua (Māori elders) who participated in 17 focus groups across seven study regions throughout Aotearoa New Zealand and eight whānau from the Waikato region. We audio recorded all interviews, transcribed them and then coded and categorised the data into themes. RESULTS Mate wareware (becoming forgetful and unwell) ('dementia') affects the wairua (spiritual dimension) of Māori. The findings elucidate Māori understandings of the causes of mate wareware, and the role of aroha (love, compassion) and manaakitanga (hospitality, kindness, generosity, support, caring) involved in caregiving for whānau living with mate wareware. Participants perceived cultural activities acted as protective factors that optimised a person's functioning within their whānau and community. CONCLUSION Whānau are crucial for the care of a kaumātua with mate wareware, along with promoting healthy wairua for all. Whanau urgently need information to assist with their knowledge building and empowerment to meet the needs of a member affected by mate wareware. This requires collaborative healthcare practice and practitioners accessing the necessary mātauranga Māori (Māori knowledge) to provide culturally appropriate and comprehensive care for whānau.
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Zandifar A, Badrfam R. Psychiatric challenges among the elderly in Iran: Looking ahead. Asian J Psychiatr 2019; 45:123-124. [PMID: 31574419 DOI: 10.1016/j.ajp.2019.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 09/21/2019] [Accepted: 09/22/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Atefeh Zandifar
- Alborz University of Medical Sciences, Imam Hossein Hospital, Karaj, Islamic Republic of Iran
| | - Rahim Badrfam
- Tehran University of Medical Sciences, Roozbeh Hospital, Tehran, Islamic Republic of Iran.
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Hernández-Torres FA, Hernández-Nava N. [Analysis of the epidemiological profile of the indigenous community of Hueyapan, Morelos]. Rev Med Inst Mex Seguro Soc 2019; 57:291-298. [PMID: 32568484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/13/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The epidemiological transition is a phenomenon that has had a different impact between urban and rural settings. The WHO points out that the population with the lowest socioeconomic status is the most adversely affected for the unequal distribution of resources, indigenous people are a part of this population. OBJECTIVE To analyze the epidemiological profile of the indigenous people of Hueyapan, Morelos during the months of March to June 2017. METHODS A cross-sectional epidemiological study was carried out in the indigenous community of Hueyapan, belonging to the municipality of Morelos, in 2017. A sample of 338 households was calculated; as inclusion criteria, those dwellings where the age of residence in Hueyapan was equal to or greater than four years were taken; a systematic sampling was carried out every three households, in addition, Mexico's INEGI and Health Department databases were analyzed from 2011 to 2015. RESULTS In relation to morbidity, an upward trend was found in the crude rate, from 119.7 per 1,000 in 2011 to 270.7 per 1000 in 2015, among the most prevalent diseases in those years, infectious diseases were identified as major and the appearance of noncommunicable diseases began to be observed. In relation to mortality, a linear trend was observed in the crude rate of 5.7 per 1000 in 2011 to 6.6 per 1000 in 2015. CONCLUSIONS The epidemiological profile of Hueyapan coincides with a process of epidemiological transition where there is a double burden of disease. This suggests a challenge for the public health area that should be addressed from the creation of health strategies, programs and policies aimed at this population from an intercultural approach.
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Affiliation(s)
- Francisca Angélica Hernández-Torres
- Instituto Nacional de Salud Pública, Escuela de Salud Pública de México Campus Cuernavaca, Maestría en Salud Pública. Cuernavaca, Morelos, México
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Zeng Y, Luo J, Ou L, Yuan M, Zhou Z, Han Y, Fang Y. The impact of medical insurance on medical expenses for older Chinese: Evidence from the national baseline survey of CLHLS. Medicine (Baltimore) 2019; 98:e17302. [PMID: 31574856 PMCID: PMC6775349 DOI: 10.1097/md.0000000000017302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
With the deepening population aging process in China, the medical expenses of older adults has become a widespread concerned. Medical insurance is a major source of Chinese medical financing and payment. The study aims to understand the current status of medical expenses for older adults and explore the effect of different types of health insurance on medical expenses in China.The data came from the Chinese Longitudinal Health Longevity Survey (CLHLS) in 2014. The Kruskal-Wallis test and general multivariate linear regression model were applied to analyze the current situation and to explore how medical insurance as the main payment impacts medical expenses.A total of 4376 older participants were included in this study. The median of medical expenses of a total was 1500 Yuan per year. The proportions of participants who had the urban employee-based basic medical insurance (UE-BMI), the urban residents basic medical insurance (UR-BMI), the new rural cooperative medical insurance scheme (NCMS), and the commercial medical insurance were 10.8%, 8.4%, 72.7%, and 0.9%, respectively. 34.8% of older adults paid the health care service via the NCMS and 11.9% paid via the UE-BMI. Participating in the NCMS and UR-BMI are significantly related to the level of the medical fees of older adults. UE-BMI, UR-BMI, and NCMS as main payment eased the pressure of medical expenses.The influence of different types of medical insurances as main payments on the medical expenses of older adults is varied. Implementation of medical insurance should be taken to further relieve the medical expenses of older adults.
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Affiliation(s)
- Yanbing Zeng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jiecheng Luo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Long Ou
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Manqiong Yuan
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Zi Zhou
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Yaofeng Han
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics
- Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, China
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Chiu TY, Yu HW, Goto R, Lai WL, Li HC, Tsai ET, Chen YM. From fragmentation toward integration: a preliminary study of a new long-term care policy in a fast-aging country. BMC Geriatr 2019; 19:159. [PMID: 31174477 PMCID: PMC6555737 DOI: 10.1186/s12877-019-1172-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/29/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Taiwan, one of the fastest-aging countries in the world, started implementing version 1.0 of its long-term care (LTC) plan in 2008. In 2017, LTC Plan 2.0 began a new era with its goal to integrate Taiwan's fragmented LTC service system. LTC Plan 2.0 also aims to establish an integrated community-based LTC system incorporating both health care and disability prevention. This three-tier model consists of the following: two LTC services with a day-care center as their base and case management (Tier A), a day-care center and a single LTC service (Tier B), and LTC stations that provide primary prevention services and respite services for frail community-dwelling older adults to prevent further disabilities (Tier C). A defined cluster of agencies in a local area works together as a Tier ABC team. LTC Plan 2.0 is a new policy for Taiwan, and hence it is important to understand the agencies' initial difficulties with implementation and identify future challenges to help further policy development. METHODS This preliminary study explored the challenges to implementing LTC 2.0 through in-depth interviews based on Evashwick's integration mechanisms with representatives from three service teams. We interviewed three chief executive officers and three case managers. RESULTS We found that the LTC Plan 2.0 mechanisms for service integration have been insufficiently implemented. Recommendations include (1) Build up the trust between agencies and government, avoid duplication of LTC services within Tier ABC team, and encourage agencies within a team to create a shared administrative system with the same mission and vision. (2) Clarify the roles and responsibilities of government care managers and agency case managers. (3) Provide an integrated information system and create an official platform for sharing client records across different agencies and caregivers. (4) Establish a tool and platform to track the budget and payment across different levels of service as soon as possible. CONCLUSION There is an increased demand for LTC services in Taiwan because of its rapidly aging population. Our findings shed some light on the challenges to developing integrated LTC services and thus may help both policymakers and service providers find ways to overcome these challenges.
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Affiliation(s)
- Tzu-Ying Chiu
- Graduate Institute of Long-term Care, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Hsiao-Wei Yu
- Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Rei Goto
- Graduate School of Business Administration, Keio University, Tokyo, Japan
| | - Wen-Lin Lai
- National Health Insurance Administration-Southern division, Ministry of Health and Welfare, Tainan, Taiwan
| | | | - En-Tien Tsai
- Shuan Lien Social Welfare Foundation, Taipei, Taiwan
| | - Ya-Mei Chen
- Institute of Health Policy and Management, National Taiwan University, No.17, Xu-Zhou Road, Taipei, 100 Taiwan
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D’Aquino L, Pyone T, Nigussie A, Salama P, Gwinji G, van den Broek N. Introducing a sector-wide pooled fund in a fragile context: mixed-methods evaluation of the health transition fund in Zimbabwe. BMJ Open 2019; 9:e024516. [PMID: 31167859 PMCID: PMC6561433 DOI: 10.1136/bmjopen-2018-024516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Aid effectiveness and improving its impact is a central policy matter for donors and international organisations. Pooled funding is a mechanism, whereby donors provide financial contributions towards a common set of broad objectives by channelling finance through one instrument. The results of pooled funds as an aid mechanism are mixed, and there is limited data on both methodology for, and results of, assessment of effectiveness of pooled funding. METHODS This study adapted a conceptual framework incorporating the Paris Principles of Aid Effectiveness and qualitative methods to assess the performance of the Health Transition Fund (HTF) Zimbabwe. 30 key informant interviews, and 20 focus group discussions were conducted with informants drawn from village to national level. Descriptive secondary data analysis of Demographic Health Surveys, Health Management Information Systems (HMIS) and policy reports complemented the study. RESULTS The HTF combined the most optimal option to channel external aid to the health sector in Zimbabwe during a period of socioeconomic and political crisis. It produced results quickly and at scale and enhanced coordination and ownership at the national and subnational level. Flexibility in using the funds was a strong feature of the HTF. However, the initiative compromised on the investment in local capacity and systems, since the primary focus was on restoring essential services within a nearly collapsed healthcare system, rather than building long-term capacity. Significant changes in maternal and newborn health outcomes were observed during the HTF implementation in Zimbabwe. CONCLUSION A framework which can be used to assess pooled funds was adapted and applied. Future assessments could use this or another framework to provide new evidence regarding effectiveness of pool donor funds although the frameworks should be properly tested and adapted in different contexts.
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Affiliation(s)
- Luigi D’Aquino
- Department of International Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Thidar Pyone
- Department of International Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Assaye Nigussie
- Maternal, Newborn and Child Health, Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Peter Salama
- Emergency Preparedness and Response, World Health Organization, Geneva, Switzerland
| | | | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Danaei G, Farzadfar F, Kelishadi R, Rashidian A, Rouhani OM, Ahmadnia S, Ahmadvand A, Arabi M, Ardalan A, Arhami M, Azizi MH, Bahadori M, Baumgartner J, Beheshtian A, Djalalinia S, Doshmangir L, Haghdoost AA, Haghshenas R, Hosseinpoor AR, Islami F, Kamangar F, Khalili D, Madani K, Masoumi-Asl H, Mazyaki A, Mirchi A, Moradi E, Nayernouri T, Niemeier D, Omidvari AH, Peykari N, Pishgar F, Qorbani M, Rahimi K, Rahimi-Movaghar A, Tehrani FR, Rezaei N, Shahraz S, Takian A, Tootee A, Ezzati M, Jamshidi HR, Larijani B, Majdzadeh R, Malekzadeh R. Iran in transition. Lancet 2019; 393:1984-2005. [PMID: 31043324 DOI: 10.1016/s0140-6736(18)33197-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 11/20/2018] [Accepted: 12/06/2018] [Indexed: 01/19/2023]
Abstract
Being the second-largest country in the Middle East, Iran has a long history of civilisation during which several dynasties have been overthrown and established and health-related structures have been reorganised. Iran has had the replacement of traditional practices with modern medical treatments, emergence of multiple pioneer scientists and physicians with great contributions to the advancement of science, environmental and ecological changes in addition to large-scale natural disasters, epidemics of multiple communicable diseases, and the shift towards non-communicable diseases in recent decades. Given the lessons learnt from political instabilities in the past centuries and the approaches undertaken to overcome health challenges at the time, Iran has emerged as it is today. Iran is now a country with a population exceeding 80 million, mainly inhabiting urban regions, and has an increasing burden of non-communicable diseases, including cardiovascular diseases, hypertension, diabetes, malignancies, mental disorders, substance abuse, and road injuries.
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Affiliation(s)
- Goodarz Danaei
- Department of Global Health and Population and Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Scientific Association for Public Health in Iran, Boston, MA, USA
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Rashidian
- Endocrinology and Metabolism Clinical Sciences Institute, Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran; Department of Information, Evidence and Research, Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
| | - Omid M Rouhani
- Department of Civil Engineering and Applied Mechanics, McGill University, Montreal, QC, Canada
| | - Shirin Ahmadnia
- Faculty of Social Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Alireza Ahmadvand
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mandana Arabi
- Scientific Association for Public Health in Iran, Boston, MA, USA; Global Alliance for Improving Nutrition, New York, NY, USA
| | - Ali Ardalan
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - Mohammad Arhami
- Department of Civil Engineering, Sharif University of Technology, Tehran, Iran
| | | | - Moslem Bahadori
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Jill Baumgartner
- Institute for Health and Social Policy, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Arash Beheshtian
- Cornell Program in Infrastructure Policy, Cornell University, Ithaca, NY, USA
| | - Shirin Djalalinia
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Deputy of Research and Technology, Tehran, Iran
| | - Leila Doshmangir
- Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Hosseinpoor
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Farhad Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Farin Kamangar
- Scientific Association for Public Health in Iran, Boston, MA, USA; Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA
| | - Davood Khalili
- Scientific Association for Public Health in Iran, Boston, MA, USA; Prevention of Metabolic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Madani
- Department of Physical Geography, Stockholm University, Stockholm, Sweden; Centre for Environmental Policy, Imperial College London, London, UK
| | - Hossein Masoumi-Asl
- Center for Communicable Diseases Control, Tehran, Iran; Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Mazyaki
- Department of Economics, Allameh Tabataba'i University, Tehran, Iran; Institute for Management and Planning Studies, Tehran, Iran
| | - Ali Mirchi
- Department of Biosystems and Agricultural Engineering, Oklahoma State University, Stillwater, OK, USA
| | - Ehsan Moradi
- Department of Civil Engineering and Applied Mechanics, McGill University, Montreal, QC, Canada
| | - Touraj Nayernouri
- Department of Neuroscience, School of Advanced Medical Technologies, Tehran University of Medical Sciences, Tehran, Iran
| | - Debbie Niemeier
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
| | - Amir-Houshang Omidvari
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Niloofar Peykari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Ministry of Health and Medical Education, Tehran, Iran
| | - Farhad Pishgar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Kazem Rahimi
- Scientific Association for Public Health in Iran, Boston, MA, USA; The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Shahraz
- Scientific Association for Public Health in Iran, Boston, MA, USA; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Amirhossein Takian
- Department of Global Health and Public Policy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Tootee
- Diabetes Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
| | - Hamid Reza Jamshidi
- Research Institute for Endocrine Sciences, School of Medicine, Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Majdzadeh
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran; Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran; Community Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzadeh
- Digestive Disease Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Non-Communicable Disease Research Center, Shiraz University of Medical Science, Shiraz, Iran
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Chol RH, Madar A, Slettedal JK, Bjertness KB, Sundby J, Bjertness E. Drivers of health transition in the DPRK. Lancet Planet Health 2019; 3:e118-e119. [PMID: 30904107 DOI: 10.1016/s2542-5196(19)30013-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/11/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Ri Hak Chol
- Pyongyang Medical College, Kim Il Sung University, Pyongyang, North Korea
| | - Ahmed Madar
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Jon Klokk Slettedal
- Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Johanne Sundby
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Espen Bjertness
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway.
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Gedela M, Gohar A, Jonsson O. A Brief Review of Left Ventricular Assist Devices and Their Management. S D Med 2019; 72:19-26. [PMID: 30849224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The number of people older than 65 will double by 2060, and with it, the number of people suffering from heart failure will also surge. In the United States, it is estimated that there are close to 250,000-500,000 endstage/ advanced heart failure cases. Mechanical circulatory support (MCS) is an evolving advanced therapy for end-stage heart failure. MCS can be an interim measure along with acute mechanical circulatory support measures including but not limited to the intra-aortic balloon pump, extracorporeal membrane oxygenation, or temporary ventricular assist devices such as Impella, or MCS can be a more prolonged and ambulatory measure in conjunction with an implantable, durable left ventricular assist device (LVAD). As the technology of LVADs advances, the complication rate is decreasing, and the living LVAD patient population is expanding. This indicates that the probability of a non-heart failure specialist encountering these patients is also on the rise. In this article, we aim to expand the familiarity and basic knowledge of non-heart failure specialists by detailing the concepts and complications of LVADs, enabling them to more comfortably manage these patients.
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Affiliation(s)
- Maheedhar Gedela
- Sanford Cardiovascular Institute, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Ahmed Gohar
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Orvar Jonsson
- University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
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Mboi N, Murty Surbakti I, Trihandini I, Elyazar I, Houston Smith K, Bahjuri Ali P, Kosen S, Flemons K, Ray SE, Cao J, Glenn SD, Miller-Petrie MK, Mooney MD, Ried JL, Nur Anggraini Ningrum D, Idris F, Siregar KN, Harimurti P, Bernstein RS, Pangestu T, Sidharta Y, Naghavi M, Murray CJL, Hay SI. On the road to universal health care in Indonesia, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2018; 392:581-591. [PMID: 29961639 PMCID: PMC6099123 DOI: 10.1016/s0140-6736(18)30595-6] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/21/2018] [Accepted: 02/28/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND As Indonesia moves to provide health coverage for all citizens, understanding patterns of morbidity and mortality is important to allocate resources and address inequality. The Global Burden of Disease 2016 study (GBD 2016) estimates sources of early death and disability, which can inform policies to improve health care. METHODS We used GBD 2016 results for cause-specific deaths, years of life lost, years lived with disability, disability-adjusted life-years (DALYs), life expectancy at birth, healthy life expectancy, and risk factors for 333 causes in Indonesia and in seven comparator countries. Estimates were produced by location, year, age, and sex using methods outlined in GBD 2016. Using the Socio-demographic Index, we generated expected values for each metric and compared these against observed results. FINDINGS In Indonesia between 1990 and 2016, life expectancy increased by 8·0 years (95% uncertainty interval [UI] 7·3-8·8) to 71·7 years (71·0-72·3): the increase was 7·4 years (6·4-8·6) for males and 8·7 years (7·8-9·5) for females. Total DALYs due to communicable, maternal, neonatal, and nutritional causes decreased by 58·6% (95% UI 55·6-61·6), from 43·8 million (95% UI 41·4-46·5) to 18·1 million (16·8-19·6), whereas total DALYs from non-communicable diseases rose. DALYs due to injuries decreased, both in crude rates and in age-standardised rates. The three leading causes of DALYs in 2016 were ischaemic heart disease, cerebrovascular disease, and diabetes. Dietary risks were a leading contributor to the DALY burden, accounting for 13·6% (11·8-15·4) of DALYs in 2016. INTERPRETATION Over the past 27 years, health across many indicators has improved in Indonesia. Improvements are partly offset by rising deaths and a growing burden of non-communicable diseases. To maintain and increase health gains, further work is needed to identify successful interventions and improve health equity. FUNDING The Bill & Melinda Gates Foundation.
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Affiliation(s)
- Nafsiah Mboi
- Centre for Strategic and International Studies, Jakarta, Indonesia; National Commission for Tobacco Control, Jakarta, Indonesia
| | | | | | - Iqbal Elyazar
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | | | | | | | - Kristin Flemons
- Department of Anthropology, McGill University, Montreal, QC, Canada; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sarah E Ray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jackie Cao
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Scott D Glenn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Molly K Miller-Petrie
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Meghan D Mooney
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jeffrey L Ried
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Dina Nur Anggraini Ningrum
- Department of Public Health, Universitas Negeri Semarang, Semarang City, Indonesia; Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei City, Taiwan
| | - Fachmi Idris
- Sriwijaya University, Palembang, Indonesia; Social Security Administering Body for Health, Jakarta, Indonesia
| | - Kemal N Siregar
- Faculty of Public Health, University of Indonesia, Depok, Indonesia
| | | | - Robert S Bernstein
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Global Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Tikki Pangestu
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
| | - Yuwono Sidharta
- Field Epidemiology Training Program Indonesia, Jakarta, Indonesia
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
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Pereira JL, Félix PV, Mattei J, Fisberg RM. Differences over 12 Years in Food Portion Size and Association with Excess Body Weight in the City of São Paulo, Brazil. Nutrients 2018; 10:E696. [PMID: 29848971 PMCID: PMC6024366 DOI: 10.3390/nu10060696] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/24/2018] [Accepted: 05/28/2018] [Indexed: 12/21/2022] Open
Abstract
Although changes in Brazilian diet have occurred over the last decades, there is no evidence about differences in food portion sizes (FPS) over time. Therefore, we aimed to evaluate the association of FPS with excess body weight (EBW), and to monitor differences in the population from São Paulo, Brazil, from 2003 to 2015. Data came from three cross-sectional population-based studies with 5270 individuals aged ≥12 years in 2003, 2008, and 2015. Dietary data were obtained from 24-h recalls. Logistic regression models were used to evaluate the association between FPS and EBW. Over the years, there was a diverse variation in FPS, with an increase in some groups (white meat, salted snacks, coffee/tea, eggs) and decrease in others (rice, red meat, sweets, pasta, sandwiches, cold cuts). The percentage of people reporting the intake of six food groupings (rice, white meat, sweets, fruits, commercial juices, toasts/biscuits) increased in the period. In this population, EBW was associated with larger FPS of 11 of the 30 food groupings investigated (cold cuts, fried snacks, fruit and commercial juices, pizza, red meat, rice, salted snacks, soft drinks, soups, sugar). These findings could support future interventions and policies for optimal food intake in Brazil.
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Affiliation(s)
- Jaqueline Lopes Pereira
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo SP 01246-904, Brazil.
| | - Paula Victória Félix
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo SP 01246-904, Brazil.
| | - Josiemer Mattei
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Regina Mara Fisberg
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo SP 01246-904, Brazil.
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Esposito D, Ragnarsson O, Granfeldt D, Marlow T, Johannsson G, Olsson DS. Decreasing mortality and changes in treatment patterns in patients with acromegaly from a nationwide study. Eur J Endocrinol 2018; 178:459-469. [PMID: 29483205 DOI: 10.1530/eje-18-0015] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/26/2018] [Indexed: 12/13/2022]
Abstract
CONTEXT New therapeutic strategies have developed for the management of acromegaly over recent decades. Whether this has improved mortality has not been fully elucidated. OBJECTIVE The primary aim was to investigate mortality in a nationwide unselected cohort of patients with acromegaly. Secondary analyses included time trends in mortality and treatment patterns. DESIGN A total of 1089 patients with acromegaly were identified in Swedish National Health Registries between 1987 and 2013. To analyse time trends, the cohort was divided into three periods (1987-1995, 1996-2004 and 2005-2013) based on the year of diagnosis. MAIN OUTCOME MEASURES Using the Swedish population as reference, standardized mortality ratios (SMRs) were calculated with 95% confidence intervals (CIs). RESULTS Overall SMR was 2.79 (95% CI: 2.43-3.15) with 232 observed and 83 expected deaths. Mortality was mainly related to circulatory diseases (SMR: 2.95, 95% CI: 2.35-3.55), including ischemic heart disease (2.00, 1.35-2.66) and cerebrovascular disease (3.99, 2.42-5.55) and malignancy (1.76, 1.27-2.26). Mortality decreased over time, with an SMR of 3.45 (2.87-4.02) and 1.86 (1.04-2.67) during the first and last time period, respectively (P = .015). During the same time periods, the frequency of pituitary surgery increased from 58% to 72% (P < 0.001) and the prevalence of hypopituitarism decreased from 41% to 23% (P < 0.001). CONCLUSIONS Excess mortality was found in this nationwide cohort of patients with acromegaly, mainly related to circulatory and malignant diseases. Although still high, mortality significantly declined over time. This could be explained by the more frequent use of pituitary surgery, decreased prevalence of hypopituitarism and the availability of new medical treatment options.
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Affiliation(s)
- Daniela Esposito
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Ragnarsson
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Tom Marlow
- Nordic Health Economics, Gothenburg, Sweden
| | - Gudmundur Johannsson
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel S Olsson
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
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Reus-Pons M, Mulder CH, Kibele EUB, Janssen F. Differences in the health transition patterns of migrants and non-migrants aged 50 and older in southern and western Europe (2004-2015). BMC Med 2018; 16:57. [PMID: 29681241 PMCID: PMC5911969 DOI: 10.1186/s12916-018-1044-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 03/26/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Most previous research on migrant health in Europe has taken a cross-sectional perspective, without a specific focus on the older population. Having knowledge about inequalities in health transitions over the life course between migrants and non-migrants, including at older ages, is crucial for the tailoring of policies to the demands of an ageing and culturally diverse society. We analyse differences in health transitions between migrants and non-migrants, specifically focusing on the older population in Europe. METHODS We used longitudinal data on migrants and non-migrants aged 50 and older in 10 southern and western European countries from the Survey of Health, Ageing and Retirement in Europe (2004-2015). We applied multinomial logistic regression models of experiencing health deterioration among individuals in good health at baseline, and of experiencing health improvement among individuals in poor health at baseline, separately by sex, in which migrant status (non-migrant, western migrant, non-western migrant) was the main explanatory variable. We considered three dimensions of health, namely self-rated health, depression and diabetes. RESULTS At older ages, migrants in Europe were at higher risk than non-migrants of experiencing a deterioration in health relative to remaining in a given state of self-rated health. Western migrants had a higher risk than non-migrants of becoming depressed, while non-western migrants had a higher risk of acquiring diabetes. Among females only, migrants also tended to be at lower risk than non-migrants of experiencing an improvement in both overall and mental health. Differences in the health transition patterns of older migrants and non-migrants remained robust to the inclusion of several covariates, including education, job status and health-related behaviours. CONCLUSIONS Our findings indicate that, in addition to having a health disadvantage at baseline, older migrants in Europe were more likely than older non-migrants to have experienced a deterioration in health over the study period. These results raise concerns about whether migrants in Europe are as likely as non-migrants to age in good health. We recommend that policies aiming to promote healthy ageing specifically address the health needs of the migrant population, thereby distinguishing migrants from different backgrounds.
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Affiliation(s)
- Matias Reus-Pons
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Clara H. Mulder
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
| | | | - Fanny Janssen
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
- Netherlands Interdisciplinary Demographic Institute, The Hague, The Netherlands
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Hernández A, Di Iorio AB, Lansdale J, Salazar MB. Characterization of the Types of Sweeteners Consumed in Honduras. Nutrients 2018; 10:E338. [PMID: 29534480 PMCID: PMC5872756 DOI: 10.3390/nu10030338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/26/2018] [Accepted: 03/02/2018] [Indexed: 12/18/2022] Open
Abstract
Sweeteners are found in all types of foods, and their high consumption is associated with chronic degenerative diseases, such as diabetes and obesity, among others. A characterization was carried out of food products with sweeteners from the three biggest supermarkets at a national level; they were identified by the list of ingredients and classified according to caloric or non-caloric intake, and pursuant to their country of origin. A statistical interpretation of results was made using descriptive measures such as the number of times the sweeteners were found in the formulation of the products and how many of them were found in a product at the same time. In total, 341 products were evaluated and classified according to the processed food categories of the Pan American Health Organization (PAHO) nutrient profile. The category of beverages had the highest quantity of products with sweeteners, and their consumption by the inhabitants represents a high exposure. Overall, 60.1% of the products evaluated were of US origin; these US exports have a significant impact on the Honduran market. A high-fructose corn syrup caloric sweetener was the one most frequently found in these products; at least 51% are combined with additional sweeteners to increase the sweetening effect.
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Affiliation(s)
- Adriana Hernández
- Department of Food Sciences, Zamorano University, 11101 Tegucigalpa, Honduras.
| | | | - Jeffrey Lansdale
- President's Office, Zamorano University, 11101 Tegucigalpa, Honduras.
| | - María Belén Salazar
- Department of Food Sciences, Zamorano University, 11101 Tegucigalpa, Honduras.
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Koo HC, Poh BK, Abd Talib R. The GReat-Child™ Trial: A Quasi-Experimental Intervention on Whole Grains with Healthy Balanced Diet to Manage Childhood Obesity in Kuala Lumpur, Malaysia. Nutrients 2018; 10:E156. [PMID: 29385769 PMCID: PMC5852732 DOI: 10.3390/nu10020156] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 01/16/2018] [Accepted: 01/18/2018] [Indexed: 11/19/2022] Open
Abstract
Background: The GReat-Child Trial was a quasi-experimental intervention that has emphasized whole grain as a strategy to manage childhood obesity. Methods: Two schools in Kuala Lumpur with similar demographic characteristics were assigned as intervention (IG) and control (CG). Eligibility criteria were overweight/obese children aged 9 to 11 years who had no serious co-morbidity. Children who reported consuming wholegrain foods in their 3-day diet-recall during screening were excluded. A total of 63 children (31 IG; 32 CG) completed the entire intervention program. The IG children underwent six 30-min nutrition education lessons and had school delivery of wholegrain food on a daily basis over a 12-week period. Parents of IG children attended 1-h individual diet counseling. Anthropometric outcomes including BMI-for-age z-score (BAZ), body fat percentage and waist circumference were measured at baseline [T0], post-intervention [T1] (3rd month) and follow-up [T2] (9th month). Results: IG showed significantly lower BAZ (weighted difference: -0.12; 95% CI: -0.21, -0.03; p = 0.009), body fat percentage (weighted difference: -2.6%; 95% CI: -3.7, -1.5; p < 0.001) and waist circumference (weighted difference: -2.4 cm; 95% CI: -3.8, -1.0; p = 0.001) compared to CG. IG reported significantly lower body fat percentage (weighted difference: -3.4%; 95% CI: 1.8, 5.0; p < 0.001) and waist circumference (weighted difference: -2.1 cm; 95% CI: -3.7, -0.5; p = 0.014) at T1 compared to T0. Conclusions: The GReat-Child Trial made a positive impact in managing childhood obesity. It can be incorporated into childhood obesity intervention programs that are being implemented by the policy makers.
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Affiliation(s)
- Hui Chin Koo
- Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia.
- Department of Bioscience, Faculty of Applied Sciences, Tunku Abdul Rahman University College, 50300 Kuala Lumpur, Malaysia.
| | - Bee Koon Poh
- Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia.
| | - Ruzita Abd Talib
- Nutritional Sciences Programme, School of Healthcare Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia.
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Abstract
AIMS Diabetes-related complications have declined during the past two decades. We aimed to examine whether mortality in people with diabetes improved over time in the 1999 to 2010 National Health and Nutrition Examination Survey (NHANES). METHODS We conducted a prospective cohort study using 1999 to 2004 and 2005 to 2010 data from the NHANES. For primary analyses, we compared the unadjusted, age-adjusted and multivariable-adjusted hazard ratios (HR) for mortality outcomes (total, cardiovascular, cardiac and cancer deaths) of the participants with diabetes with those without diabetes using Cox proportional hazard models. RESULTS For each mortality outcome, HR (95% confidence interval) in diabetic participants during the period 2005 to 2010 was lower than that during the period 1999 to 2004 (all-cause death, 2.76 [1.87-4.08] vs 4.23 [2.57-6.98]; cardiovascular death, 2.70 [1.20-6.04] vs 8.82 [3.28-23.70]; cardiac death, 2.45 [0.98-6.09] vs 15.55 [7.01-34.50]; cancer death, 2.33 [0.87-6.23] vs 3.03 [1.20-7.65]). Compared with mortality outcome during the period 1999 to 2004, greater declines in mortality during the period 2005 to 2010 were observed for cardiovascular (-54.0%) and cardiac deaths (-64.8%). In age-adjusted and multivariable-adjusted models, the cumulative event rates for total, cardiovascular and cardiac deaths were not significantly different between participants with and without diabetes during the period 2005-2010; this was not the case during the period 1999-2004. The leading cause of death was malignant neoplasm during the period 2005-2010. CONCLUSION Considerably improved outcomes for total, cardiovascular and cardiac deaths were observed in people with diabetes during the 2005 to 2010 NHANES compared to the 1999 to 2004 NHANES.
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Affiliation(s)
- Tetsuro Tsujimoto
- Department of Diabetes, Endocrinology, and MetabolismCenter Hospital, National Center for Global Health and MedicineTokyoJapan
| | - Hiroshi Kajio
- Department of Diabetes, Endocrinology, and MetabolismCenter Hospital, National Center for Global Health and MedicineTokyoJapan
| | - Takehiro Sugiyama
- Department of Clinical Study and Informatics, Center for Clinical SciencesNational Center for Global Health and MedicineTokyoJapan
- Department of Public Health/Health Policythe University of TokyoTokyoJapan
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Kavle JA, Mehanna S, Khan G, Hassan M, Saleh G, Engmann C. Program considerations for integration of nutrition and family planning: Beliefs around maternal diet and breastfeeding within the context of the nutrition transition in Egypt. Matern Child Nutr 2018; 14:e12469. [PMID: 28597475 PMCID: PMC6866077 DOI: 10.1111/mcn.12469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/21/2017] [Accepted: 05/02/2017] [Indexed: 11/30/2022]
Abstract
In Egypt, rising maternal overweight and obesity is consistent with the transition to westernized diets and a growing reliance on energy-dense, low nutrient foods. Although the first 1,000 days of life are the focus of many programmes designed to prevent many forms of malnutrition, little attention has been paid to maternal dietary practices and weight gain during pregnancy. This study used in-depth interviews with pregnant women (N = 40), lactating women (N = 40), and nonlactating women (N = 40) to gain an understanding of behaviours, perceptions, and cultural beliefs in relation to maternal dietary intake during pregnancy, lactation, and nonlactation; weight gain during pregnancy; birth spacing; and family planning. Study findings reveal that food choice was driven by affordability, favoured foods, or foods considered appropriate for a specific life stage (pregnant, lactating, and nonlactating). Knowledge of weight gain during pregnancy is limited, especially with regards to excessive weight gain during pregnancy. Diet is often modified during lactation to support breast milk production, and a normal diet resumed when breastfeeding ceases. Within the context of breastfeeding, the lactational amenorrhea method provides an opportunity to improve exclusive breastfeeding practices, maternal diet during lactation, and the transition to other family planning methods by 6 months postpartum. Health care providers should discuss limiting maternal consumption of low nutrient foods such as junk foods, soda, and teas during pregnancy and postpartum. Dietary counselling should accompany information on appropriate weight gain during pregnancy and exercise to prevent excessive weight gain, in the context of the nutrition transition.
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Affiliation(s)
- Justine A. Kavle
- Maternal and Child Survival Program (MCSP)Washington, DCUSA
- Maternal, Newborn, Child Health and NutritionPATHWashington, DCUSA
- Department of Prevention and Community Health, Milken Institute School of Public HealthGeorge Washington UniversityWashington, DCUSA
| | - Sohair Mehanna
- Social Research CenterAmerican University in CairoCairoEgypt
| | - Ghada Khan
- Department of Prevention and Community Health, Milken Institute School of Public HealthGeorge Washington UniversityWashington, DCUSA
| | - Mohamed Hassan
- Social Research CenterAmerican University in CairoCairoEgypt
| | - Gulsen Saleh
- National Nutrition Institute of EgyptCairoEgypt
- SMART Project Maternal and Child Health Integrated Program (MCHIP)CairoEgypt
| | - Cyril Engmann
- School of Public Health Global HealthUniversity of WashingtonSeattleWashingtonUSA
- School of Medicine PediatricsUniversity of WashingtonSeattleWashingtonUSA
- Maternal, Newborn, Child Health and NutritionPATHSeattleWAUSA
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Abstract
Nonalcoholic fatty liver disease (NAFLD) is a growing epidemic worldwide, particularly in countries that consume a Western diet, and can lead to life-threatening conditions such as cirrhosis and hepatocellular carcinoma. With increasing prevalence of NAFLD in both children and adults, an understanding of the factors that promote NAFLD development and progression is crucial. Environmental agents, including endocrine-disrupting chemicals (EDCs), which have been linked to other diseases, may play a role in NAFLD development. Increasing evidence supports a developmental origin of liver disease, and early-life exposure to EDCs could represent one risk factor for the development of NAFLD later in life. Rodent studies provide the strongest evidence for this link, but further studies are needed to define whether there is a causal link between early-life EDC exposure and NAFLD development in humans. Elucidating the molecular mechanisms underlying development of NAFLD in the context of developmental EDC exposures may identify biomarkers for people at risk, as well as potential intervention and/or therapeutic opportunities for the disease.
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Affiliation(s)
- Lindsey S. Treviño
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, Texas 77030
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas 77030
| | - Tiffany A. Katz
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, Texas 77030
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas 77030
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Bansal A, Henao-Mejia J, Simmons RA. Immune System: An Emerging Player in Mediating Effects of Endocrine Disruptors on Metabolic Health. Endocrinology 2018; 159:32-45. [PMID: 29145569 PMCID: PMC5761609 DOI: 10.1210/en.2017-00882] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 11/08/2017] [Indexed: 12/24/2022]
Abstract
The incidence of metabolic disorders like type 2 diabetes and obesity continues to increase. In addition to the well-known contributors to these disorders, such as food intake and sedentary lifestyle, recent research in the exposure science discipline provides evidence that exposure to endocrine-disrupting chemicals like bisphenol A and phthalates via multiple routes (e.g., food, drink, skin contact) also contribute to the increased risk of metabolic disorders. Endocrine-disrupting chemicals (EDCs) can disrupt any aspect of hormone action. It is becoming increasingly clear that EDCs not only affect endocrine function but also adversely affect immune system function. In this review, we focus on human, animal, and in vitro studies that demonstrate EDC exposure induces dysfunction of the immune system, which, in turn, has detrimental effects on metabolic health. These findings highlight how the immune system is emerging as a novel player by which EDCs may mediate their effects on metabolic health. We also discuss studies highlighting mechanisms by which EDCs affect the immune system. Finally, we consider that a better understanding of the immunomodulatory roles of EDCs will provide clues to enhance metabolic function and contribute toward the long-term goal of reducing the burden of environmentally induced diabetes and obesity.
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Affiliation(s)
- Amita Bansal
- Center for Research on Reproduction and Women’s
Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pennsylvania 19104
- Center of Excellence in Environmental Toxicology,
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
19104
- Division of Neonatology, Department of Pediatrics, The
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104
| | - Jorge Henao-Mejia
- Division of Neonatology, Department of Pediatrics, The
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104
- The Institute for Immunology, Department of Pathology and
Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pennsylvania 19104
| | - Rebecca A. Simmons
- Center for Research on Reproduction and Women’s
Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia,
Pennsylvania 19104
- Center of Excellence in Environmental Toxicology,
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
19104
- Division of Neonatology, Department of Pediatrics, The
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104
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Song YS, Lim JA, Min HS, Kim MJ, Choi HS, Cho SW, Moon JH, Yi KH, Park DJ, Cho BY, Park YJ. Changes in the clinicopathological characteristics and genetic alterations of follicular thyroid cancer. Eur J Endocrinol 2017; 177:465-473. [PMID: 28864536 DOI: 10.1530/eje-17-0456] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/27/2017] [Accepted: 09/01/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Changes in the clinicopathological characteristics and genetic alterations of follicular thyroid cancer (FTC) over time have not been reported. Moreover, the prognostic effects of RAS and TERT promoter mutations in FTC have not been clearly elucidated. We investigated changes in the clinicopathological characteristics of patients with FTC over four decades, as well as the clinical significance of genetic mutations of FTC. DESIGN AND METHODS This retrospective study included 690 patients with FTC who underwent thyroidectomy between 1973 and 2015 at the Seoul National University Hospital. In 134 samples, genetic tests for N/H/KRAS and TERT promoter mutations and PAX8/PPARγ rearrangement were performed. RESULTS The age at diagnosis has increased (P < 0.001) in recent decades and extrathyroidal extension of the tumor has become less common (P = 0.033). Other clinicopathological characteristics and prognosis of FTC have not significantly changed. The prevalence of RAS mutations decreased (P = 0.042) over time, whereas that of TERT promoter mutations remained stable. RAS mutations were associated with distant metastasis and persistent disease, and TERT promoter mutations were associated with distant metastasis, advanced TNM stage, recurrence and disease-specific mortality. FTC patients with coexistent RAS and TERT promoter mutations showed a higher recurrence risk than those with only one mutation. CONCLUSIONS The age at diagnosis of FTC and the frequency of extrathyroidal extension have changed over four decades. Moreover, the prevalence of RAS mutations decreased. RAS and TERT promoter mutations may be associated with poor clinical outcomes in FTC, especially when the two mutations coexist.
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Affiliation(s)
- Young Shin Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung Ah Lim
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Hye Sook Min
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Min Joo Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hoon Sung Choi
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ka Hee Yi
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
- Korea National Institute of Health, Cheongju, Korea
| | - Bo Youn Cho
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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Affiliation(s)
- Jessica Watson
- Centre for Academic Primary Care, University of Bristol, Bristol BS8 2PS, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, University of Bristol, Bristol BS8 2PS, UK
| | - Anant Jani
- Value Based Healthcare Programme, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Muir Gray
- Value Based Healthcare Programme, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian McKinstry
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Chima CC, Salemi JL, Wang M, Mejia de Grubb MC, Gonzalez SJ, Zoorob RJ. Multimorbidity is associated with increased rates of depression in patients hospitalized with diabetes mellitus in the United States. J Diabetes Complications 2017; 31:1571-1579. [PMID: 28893494 DOI: 10.1016/j.jdiacomp.2017.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 01/19/2023]
Abstract
AIMS Information on the burden and risk factors for diabetes-depression comorbidity in the US is sparse. We used data from the largest all-payer, nationally-representative inpatient database in the US to estimate the prevalence, temporal trends, and risk factors for comorbid depression among adult diabetic inpatients. METHODS We conducted a retrospective analysis using the 2002-2014 Nationwide Inpatient Sample databases. Depression and other comorbidities were identified using ICD-9-CM codes. Logistic regression was used to investigate the association between patient characteristics and depression. RESULTS The rate of depression among patients with type 2 diabetes increased from 7.6% in 2002 to 15.4% in 2014, while for type 1 diabetes the rate increased from 8.7% in 2002 to 19.6% in 2014. The highest rates of depression were observed among females, non-Hispanic whites, younger patients, and patients with five or more chronic comorbidities. CONCLUSIONS The prevalence of comorbid depression among diabetic inpatients in the US is increasing rapidly. Although some portion of this increase could be explained by the rising prevalence of multimorbidity, increased awareness and likelihood of diagnosis of comorbid depression by physicians and better documentation as a result of the increased adoption of electronic health records likely contributed to this trend.
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MESH Headings
- Adjustment Disorders/epidemiology
- Adjustment Disorders/therapy
- Adult
- Age Factors
- Cohort Studies
- Comorbidity
- Cross-Sectional Studies
- Depressive Disorder/epidemiology
- Depressive Disorder/therapy
- Depressive Disorder, Major/epidemiology
- Depressive Disorder, Major/therapy
- Diabetes Complications/complications
- Diabetes Complications/epidemiology
- Diabetes Complications/psychology
- Diabetes Complications/therapy
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/psychology
- Diabetes Mellitus, Type 2/therapy
- Dysthymic Disorder/epidemiology
- Dysthymic Disorder/therapy
- Female
- Health Transition
- Hospitalization
- Humans
- Insurance, Health, Reimbursement
- Male
- Personality Disorders/epidemiology
- Personality Disorders/therapy
- Prevalence
- Retrospective Studies
- Risk Factors
- Sex Factors
- United States/epidemiology
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Affiliation(s)
- Charles C Chima
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600 (MS: BCM700), Houston, TX 77098, USA.
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600 (MS: BCM700), Houston, TX 77098, USA
| | - Miranda Wang
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600 (MS: BCM700), Houston, TX 77098, USA
| | - Maria C Mejia de Grubb
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600 (MS: BCM700), Houston, TX 77098, USA
| | - Sandra J Gonzalez
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600 (MS: BCM700), Houston, TX 77098, USA
| | - Roger J Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600 (MS: BCM700), Houston, TX 77098, USA
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47
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Grech A, Rangan A, Allman-Farinelli M. Increases in Alcohol Intakes Are Concurrent with Higher Energy Intakes: Trends in Alcohol Consumption in Australian National Surveys from 1983, 1995 and 2012. Nutrients 2017; 9:E944. [PMID: 28846642 PMCID: PMC5622704 DOI: 10.3390/nu9090944] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/16/2017] [Accepted: 08/23/2017] [Indexed: 01/16/2023] Open
Abstract
This research aimed to provide the first assessment of the contribution of alcohol to Australian adults' diets over time and determine if people reporting alcohol had higher total dietary energy intakes. Secondary analyses of cross-sectional national nutrition surveys from 1983, 1995, and 2011/12 for adults 18 years (n = 26,675) and over were conducted. Alcoholic beverage intake and diet were assessed using 24-h recalls. The proportion of participants reporting alcohol consumption declined over time and in 1983, 1995, and 2011/12 was 52.0%, 44.2%, and 39.8%, respectively, for men (p < 0.001) and 31.6%, 25.7%, and 25.7%, respectively, for women (p < 0.001). A decline in alcohol intake was seen between 1983 and 2012 for all subpopulations, except for women aged over 45 years, for whom alcohol intake increased. Energy intake was higher for participants reporting alcohol intake and the mean difference (SD) in energy intake for those reporting alcohol versus non-consumers was +1514 kJ (462) for men and +1227 kJ (424) for women. Consistent with apparent consumption data, reported alcohol intake for the total population decreased over time. As those reporting alcohol had much higher energy intakes than non-consumers, promoting alcohol intakes consistent with national recommendations may have important implications for the prevention of obesity, particularly for middle-aged women.
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Affiliation(s)
- Amanda Grech
- The University of Sydney, Nutrition and Dietetics Group, The School of Life and Environmental Sciences, The Charles Perkins Centre, John Hopkins Drive, Camperdown, NSW 2006, Australia.
| | - Anna Rangan
- The University of Sydney, Nutrition and Dietetics Group, The School of Life and Environmental Sciences, The Charles Perkins Centre, John Hopkins Drive, Camperdown, NSW 2006, Australia.
| | - Margaret Allman-Farinelli
- The University of Sydney, Nutrition and Dietetics Group, The School of Life and Environmental Sciences, The Charles Perkins Centre, John Hopkins Drive, Camperdown, NSW 2006, Australia.
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48
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Liston P, Conyngham G, Brady M, Byrne PJ, Gilligan P. Growing Old in the Emergency Department. Ir Med J 2017; 110:621. [PMID: 29169003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The research team were concerned that older patients requiring emergency admission seemed to wait longer for a hospital bed, and as such were disproportionately affected by Emergency Department overcrowding. To investigate this theory and explore any changes over time, a ten year dataset (2005-2014 inclusive) was extracted from the information systems at Beaumont Hospital, Dublin. This research examines the changing age profile of ED patients, identifies the relationship between age and the total time spent in the Emergency Department (Patient Experience Time (PET)), and examines the public belief that EDs are busiest in winter when reports of overcrowding and elderly patients waiting on trolleys get most media attention. The results highlight that the ED is busy all year round (but for different seasonal reasons) and point to an overdue need to plan for the current and future healthcare of older patients within and beyond acute hospitals.
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Affiliation(s)
- P Liston
- DCU Business School, Dublin City University, Dublin 9
| | - G Conyngham
- DCU Business School, Dublin City University, Dublin 9
| | - M Brady
- DCU Business School, Dublin City University, Dublin 9
| | - P J Byrne
- DCU Business School, Dublin City University, Dublin 9
| | - P Gilligan
- Emergency Department, Beaumont Hospital, Dublin 9
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49
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Abstract
BACKGROUND Thyroid carcinoma is rare in young children, with a sharp increase in incidence among adolescents and young adults between 15 and 29 years of age. The incidence of thyroid carcinoma is increasing worldwide. Limited prospective population-based data are available to describe diagnostic and treatment practices in this age group. This study undertook a population-based review of thyroid carcinoma among 0- to 29-year-old individuals in Ontario, Canada, utilizing linked administrative data to describe the demographic and care patterns over nearly two decades. METHODS Cases from the Ontario Cancer Registry were identified and linked to administrative data sources at the Institute for Clinical Evaluative Sciences. Cases diagnosed prior to a patient's 30th birthday between 1992 and 2010 were considered eligible. Billing records identified ultrasonography, fine-needle aspiration biopsy, radioiodine therapy, and surgical approach. RESULTS A total of 2552 patients aged 0-29 years were diagnosed with thyroid carcinoma during the study period. There was a 2.1-fold increase in standardized incidence rate over the 19 years of this study. Thyroid carcinoma was diagnosed subsequent to a prior malignancy in 47/2552 patients at a median interval of 11.6 years after initial cancer diagnosis. Seventeen individuals developed a second malignancy after treatment for thyroid carcinoma. Most patients (90.44%) underwent preoperative ultrasound (ranging from 1 to 13 preoperative studies). Preoperative thyroid scintigraphy was used in 44% of patients, with a significant decline in usage over the study period. Fine-needle aspiration biopsy usage rose by 20% over the study period, although 26% of patients had no biopsy prior to surgery. Primary total thyroidectomy followed by two-stage thyroidectomy were the most frequently performed procedures, and 56% of patients received therapeutic radioiodine. CONCLUSIONS This study establishes a foundation of diagnostic and practice patterns over nearly two decades. The study corroborates, in the Ontario population, the rising incidence of thyroid carcinoma in children and adolescents and young adults. Finally, it identifies the use of multiple preoperative ultrasound studies, low rates of thyroid biopsy, and thyroid scintigraphy as targets to improve efficiencies of care and to reduce unnecessary healthcare expenditures through education, standardization of diagnostic approach, and possibly regionalization of care.
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Affiliation(s)
- Jason D Pole
- 1 Pediatric Oncology Group of Ontario , Toronto, Canada
- 2 Dalla Lana School of Public Health, University of Toronto , Toronto, Canada
| | - Aleksandra M Zuk
- 1 Pediatric Oncology Group of Ontario , Toronto, Canada
- 2 Dalla Lana School of Public Health, University of Toronto , Toronto, Canada
| | - Jonathan D Wasserman
- 3 The Hospital for Sick Children, Department of Pediatrics, Division of Endocrinology, University of Toronto , Toronto, Canada
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50
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Silva-Vieira M, Carrilho Vaz S, Esteves S, Ferreira TC, Limbert E, Salgado L, Leite V. Second Primary Cancer in Patients with Differentiated Thyroid Cancer: Does Radioiodine Play a Role? Thyroid 2017; 27:1068-1076. [PMID: 28614983 DOI: 10.1089/thy.2016.0655] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Well-differentiated thyroid cancer (WDTC) is the most common endocrine neoplasia, and its incidence is rising. Studies have reported an increased risk of second primary cancer (SPC) in WDTC survivors, but its relationship with radioiodine treatment (RAIT) and other risk factors remains controversial. This study evaluated whether RAIT is an independent risk factor for SPC in WDTC patients. METHODS This was a retrospective single-center study. A total of 2031 patients with WDTC diagnosed between 1998 and 2009, treated and followed at the authors' tertiary cancer center, were included. RESULTS The median age of patients was 48 years (range 5-90 years); 83% were women and 77% underwent RAIT. The median follow-up was 8.8 years (range 5.0-17.0 years). A total of 130 SPC were diagnosed: 108/1570 (6.9%) received RAIT (RAIT+) and 22/461 (4.8%) did not (RAIT-). The most common SPC was breast cancer (31%), followed by genitourinary and gastrointestinal cancer (18% each). The 10-year cumulative incidence of SPC was 8.2% in RAIT+ and 4.5% in RAIT-. The absolute risk increase in the RAIT+ group versus the RAIT- group at 10 years of follow-up was 0.039 [confidence interval (CI) 0.011-0.067] per patient-year. The number needed to harm (NNH) was 25.6 [CI 15.0-87.2], indicating that on average during a 10-year follow-up period, there is one additional case of SPC for every 26 patients receiving RAIT. When controlling for age, sex, and familial and personal histories of cancer, there was an 84% increase in the risk of SPC in the RAIT+ group compared to the RAIT- group (p = 0.026; relative risk = 1.84 [CI 1.02-3.31]). There was an association between SPC incidence and total cumulative activity administered, which was statistically significant >200 mCi. The incidence of SPC was higher in both the WDCT and the RAIT+ cohorts compared to the general population (standardized incidence ratios = 1.32 and 1.40, respectively). CONCLUSION These results indicate that in spite of the low incidence of SPC in WDTC patients, the risk is increased after RAIT, particularly for activities >200 mCi. Thus, considering the excellent survival of patients with WDTC, clinicians need to weigh the risks and benefits of RAIT, especially in patients with low-risk thyroid cancer.
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Affiliation(s)
- Margarida Silva-Vieira
- 1 Department of Endocrinology, Portuguese Institute of Oncology , Lisbon Center, Lisbon, Portugal
| | - Sofia Carrilho Vaz
- 2 Department of Nuclear Medicine, Portuguese Institute of Oncology , Lisbon Center, Lisbon, Portugal
| | - Susana Esteves
- 3 Clinical Research Unit, Portuguese Institute of Oncology , Lisbon Center, Lisbon, Portugal
| | - Teresa C Ferreira
- 2 Department of Nuclear Medicine, Portuguese Institute of Oncology , Lisbon Center, Lisbon, Portugal
| | - Edward Limbert
- 1 Department of Endocrinology, Portuguese Institute of Oncology , Lisbon Center, Lisbon, Portugal
- 4 South Regional Cancer Registry , Lisbon, Portugal
| | - Lucília Salgado
- 2 Department of Nuclear Medicine, Portuguese Institute of Oncology , Lisbon Center, Lisbon, Portugal
| | - Valeriano Leite
- 1 Department of Endocrinology, Portuguese Institute of Oncology , Lisbon Center, Lisbon, Portugal
- 5 Faculty of Medical Sciences, New University of Lisbon , Lisbon, Portugal
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