On the prediction of SAV transmission among Norwegian aquaculture sites

Pancreas Disease (PD) is a viral disease that affects Atlantic salmon (Salmo salar) in Norwegian, Scottish and Irish aquaculture. It is caused by salmonid alphavirus (SAV) and represents a significant problem in salmonid farming. Infection with SAV leads to reduced growth, mortality, product downgrading, and has a significant financial impact for the farms. The overall aim of this study is to evaluate the effect of various factors on the transmission of SAV and to create a predictive model capable of providing an early warning system for salmon farms within the Norwegian waters. Using a combination of publicly available databases, specifically BarentsWatch, and privately held PCR analyses a feature set consisting of 11 unique features was created based on the input parameters of the databases. An ensemble model was developed based on this feature set using XG-Boost, Ada-Boost, Random Forest and a Multilayer Perceptron. It was possible to successfully predict SAV transmission with 94.4% accuracy. Moreover, it was possible to predict SAV transmission 8 weeks in advance of a 'PD registration' at individual aquaculture salmon farming sites. Important predictors included well boat movement, environmental factors, proximity to sites with a 'PD registration' and seasonality.

Development and psychometric evaluation of the Motivation to Use CPAP Scale (MUC-S) using factorial structure and Rasch analysis among patients with obstructive sleep apnea before CPAP treatment is initiated

BACKGROUND

Continuous positive airway treatment (CPAP) is first-line treatment for obstructive sleep apnea (OSA), but adherence tends to be low. A clinical tool focusing on motivation to use CPAP is missing. The purpose was to develop a brief questionnaire to assess motivation to use CPAP that is psychometrically robust and suitable for use in clinical practice.

METHODS

A convenience sample including 193 treatment naive patients with OSA (67% men; mean age = 59.7 years, SD 11.5) from two CPAP clinics was used. Clinical assessments and full night polygraphy were performed. Questionnaires administered before CPAP treatment included the newly developed Motivation to Use CPAP Scale (MUC-S), Minimal Insomnia Symptoms Scale (MISS), Epworth Sleepiness Scale (ESS), and Attitude towards CPAP treatment Inventory (ACTI). The validity and reliability of the MUC-S were investigated using Rasch and exploratory factor analysis models. Measurement invariance, dimensionality and differential item functioning (i.e., across gender groups, excessive daytime sleepiness (ESS), insomnia (MISS) and attitude towards CPAP (ACTI) groups) were assessed.

RESULTS

The results supported a two-factor solution (autonomous motivation, 6 items, factor loadings between 0.61 and 0.85 and controlled motivation, 3 items, factor loadings between 0.79 and 0.88) explaining 60% of the total variance. The internal consistency was good with Cronbach's alpha of 0.88 and 0.86 for the two factors. No differential item functioning was found. A latent class analysis yielded three profiles of patients with high (n = 111), moderate (n = 60) and low (n = 22) motivation. Patients with high motivation were older, had higher daytime sleepiness scores, more insomnia symptoms and a more positive attitude towards CPAP.

CONCLUSIONS

The MUC-S seems to be a valid tool with robust psychometric properties suitable for use at CPAP clinics. Future studies should focus on how motivation changes over time and if MUC-S can predict objective long-term CPAP adherence.

Psychometric properties of the Ethos Brief Index (EBI) using factorial structure and Rasch Analysis among patients with obstructive sleep apnea before and after CPAP treatment is initiated

BACKGROUND

Continuous positive airway treatment (CPAP) is the recommended treatment for patients with obstructive sleep apnea (OSA). Outcome measures often focus on clinical and/or self-rated variables related to the medical condition. However, a brief validated instrument focusing on the whole life situation (i.e., ethos) suitable for clinical practice is missing. The aim of this study was to investigate factorial structure, categorical functioning of the response scale, and differential item functioning across sub-populations of the Ethos Brief Index (EBI) among patients with obstructive sleep apnea (OSA) before and after initiation of continuous positive airway pressure (CPAP).

METHODS

A prospective design, including 193 patients with OSA (68% men, 59.66 years, SD 11.51) from two CPAP clinics, was used. Clinical assessment and overnight respiratory polygraphy were used to diagnose patients. Questionnaires administered before and after 6 months of CPAP treatment included EBI, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale, and global perceived health (initial item in SF-36). The validity and reliability of the EBI were investigated using Rasch and confirmatory factor analysis models. Measurement invariance, unidimensionality, and differential item functioning across gender groups, Apnea-Hypopnea Index, and ESS groups were assessed.

RESULTS

The reliability of the EBI was confirmed using composite reliability and Cronbach's alpha. The results supported unidimensionality of the EBI in confirmatory factor analysis and the Rasch model. No differential item functioning was found. A latent profile analysis yielded two profiles of patients with low (n = 42) and high (n = 151) ethos. Patients in the low ethos group were younger and had higher depression scores, lower perceived health, and higher body mass index.

CONCLUSIONS

The EBI is a valid tool with robust psychometric properties suitable for use among patients with OSA before and after treatment with CPAP is initiated. Future studies should focus on its predictive validity.

Alcohol prevention in Swedish occupational health care

BACKGROUND

Occupational health care (OHC) was part of the Swedish Risk Drinking Project, a government-supported continuing professional education (CPE) endeavour for health professionals, 2004-10.

AIMS

To investigate OHC professionals' perceived knowledge concerning patient counselling on alcohol, perceived efficiency in achieving patient changes, use of questionnaires and biomarkers, amount and content of their alcohol-related CPE, their reasons for participating in this CPE and improvements experienced in addressing alcohol issues in the last 3 years.

METHODS

Baseline 2005 and follow-up 2008 data were collected by means of anonymous questionnaires to all physicians and nurses in OHC.

RESULTS

Response rates ranged from 53 to 80%. The share of nurses and physicians who had taken part in ≥ 3 days training on risk drinking issues rose from 10 to 59% and from 7 to 59%, respectively. The OHC professionals' perceived knowledge and efficiency concerning lifestyle counselling improved from 2005 to 2008, considerably more so for alcohol than the other lifestyle issues. The most competent nurses and physicians were more likely to have participated in training lasting ≥ 3 days. The most competent nurses and physicians had become better at initiating conversations about alcohol and at informing, providing advice and discussing alcohol with their clients.

CONCLUSIONS

There were major improvements in the OHC professionals' perceived knowledge concerning alcohol counselling and efficiency in influencing patients' alcohol habits after participation in a comprehensive CPE project. Overall, the nurses achieved more improvements than the physicians.

The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care

RATIONALE, AIMS AND OBJECTIVES

The transmission of research findings into routine care is a slow and unpredictable process. Important factors predicting receptivity for innovations within organizations have been identified, but there is a need for further research in this area. The aim of this study was to describe contextual factors and evaluate if organizational climate and implementation strategy influenced outcome, when a computer-based concept for lifestyle intervention was introduced in primary health care (PHC).

METHOD

The study was conducted using a prospective intervention design. The computer-based concept was implemented at six PHC units. Contextual factors in terms of size, leadership, organizational climate and political environment at the units included in the study were assessed before implementation. Organizational climate was measured using the Creative Climate Questionnaire (CCQ). Two different implementation strategies were used: one explicit strategy, based on Rogers' theories about the innovation-decision process, and one implicit strategy. After 6 months, implementation outcome in terms of the proportion of patients who had been referred to the test, was measured.

RESULTS

The CCQ questionnaire response rates among staff ranged from 67% to 91% at the six units. Organizational climate differed substantially between the units. Managers scored higher on CCQ than staff at the same unit. A combination of high CCQ scores and explicit implementation strategy was associated with a positive implementation outcome.

CONCLUSIONS

Organizational climate varies substantially between different PHC units. High CCQ scores in combination with an explicit implementation strategy predict a positive implementation outcome when a new working tool is introduced in PHC.

Computerized lifestyle intervention in routine primary health care: evaluation of usage on provider and responder levels

OBJECTIVE

The aim of this study was to evaluate the use of a computerized concept for lifestyle intervention in routine primary health care (PHC).

METHODS

Nine PHC units were equipped with computers providing a lifestyle test and tailored printed advice regarding alcohol consumption and physical activity. Patients were referred by staff, and performed the test anonymously. Data were collected over a period of 1 year.

RESULTS

During the study period 3,065 tests were completed, representing 5.7% of the individuals visiting the PHC units during the period. There were great differences between the units in the number of tests performed and in the proportion of patients referred. One-fifth of the respondents scored for hazardous alcohol consumption, and one-fourth reported low levels of physical activity. The majority of respondents found the test easy to perform, and a majority of those referred to the test found referral positive.

CONCLUSION

The computerized test can be used for screening and intervention regarding lifestyle behaviours in PHC. Responders are positive to the test and to referral.

PRACTICE IMPLICATIONS

A more widespread implementation of computerized lifestyle tests could be a beneficial complement to face-to-face interventions in PHC.

Physical activity referrals in Swedish primary health care - prescriber and patient characteristics, reasons for prescriptions, and prescribed activities

BACKGROUND

Over the past decade, practitioners in primary health care (PHC) settings in many countries have issued written prescriptions to patients to promote increased physical activity or exercise. The aim of this study is to describe and analyse a comprehensive physical activity referral (PAR) scheme implemented in a routine PHC setting in Ostergötland County. The study examines characteristics of the PARs recipients and referral practitioners, identifies reasons why practitioners opted to use PARs with their clients, and discusses prescribed activities and prescriptions in relation to PHC registries.

METHODS

Prospective prescription data were obtained for 90% of the primary health care centres in Ostergötland County, Sweden, in 2004 and 2005. The study population consisted of patients who were issued PARs after they were deemed likely to benefit from increased physical activity, as assessed by PHC staff.

RESULTS

During the two-year period, a total of 6,300 patients received PARs. Two-thirds of the patients were female and half of the patients were 45-64 years. Half of the patients (50.8%) who received PARs were recommended a home-based activity, such as walking. One third (33%) of the patients issued PARs were totally inactive, reporting no days of physical activity that lasted for 30 minutes, and 29% stated that they reached this level 1-2 days per week. The number of PARs prescribed per year in relation to the number of unique individuals that visited primary health care during one year was 1.4% in 2004 and 1.2% in 2005. Two-thirds of the combined prescriptions were issued by physicians (38%) and nurses (31%). Physiotherapists and behavioural scientists issued the highest relative number of prescriptions. The most common reasons for issuing PARs were musculoskeletal disorders (39.1%) and overweight (35.4%), followed by high blood pressure (23.3%) and diabetes (23.2%).

CONCLUSION

Ostergötland County's PAR scheme reached a relatively high proportion of physically inactive people visiting local PHC centres for other health reasons. PAR-related statistics, including PAR-rates by individual PHC centres and PAR- rates per health professional category, show differences in prescribing activities, both by patient categories, and by prescribing professionals.

Does a physical activity referral scheme improve the physical activity among routine primary health care patients?

Physical activity referral (PAR) schemes or concepts occur in varying forms. Because few physical activity intervention studies have been carried out in routine health care settings, it is difficult to translate research findings into daily practice. The aim of this study was to analyze the effectiveness of a PAR scheme implemented in routine primary health care. The study did not include a control group and was based on the ordinary staff's work efforts and follow-up measures. During a 2-year period, 6300 PARs were issued. Effectiveness was measured by an increase in self-reported physical activity. Half of the patients reached reported increased physical activity both at 3 months (49%) and at 12 months (52%). The proportion of inactive patients decreased from 33% at baseline to 17% at 3 months and 20% at 12 months. The proportion of patients who were physically active on a regular basis increased from 22% at baseline to 33% at 3 months and 32% at 12 months. Neither the patient's age nor the profession of the prescriber was associated with differences in effectiveness. The patient's activity level at baseline, the type of physical activity as well as the reason for the prescription were associated with increased physical activity.

The theory of community based health and safety programs: a critical examination

This paper examines the theoretical underpinning of the community based approach to health and safety programs. Drawing upon the literature, a theory is constructed by elucidating assumptions of community based programs. The theory is then put to test by analyzing the extent to which the assumptions are supported by empirical evidence and the extent to which the assumptions have been applied in community based injury prevention practice. Seven principles representing key assumptions of the community based approach to health and safety programs are identified. The analysis suggests that some of the principles may have important shortcomings. Programs overwhelmingly define geographical or geopolitical units as communities, which is problematic considering that these entities can be heterogeneous and characterized by a weak sense of community. This may yield insufficient community mobilization and inadequate program reach. At the same time, none of the principles identified as most plausible appears to be widely or fully applied in program practice. The implication is that many community based health and safety programs do not function at an optimum level, which could explain some of the difficulties in demonstrating effectiveness seen with many of these programs.

Usual drinking patterns and non-fatal injury among patients seeking emergency care

OBJECTIVES

To explore the association between drinking patterns, irrespective of whether alcohol was consumed in the event of the injury or not, and different injury variables; and to identify settings and situations in which risky drinkers have an increased likelihood of injury.

STUDY DESIGN

The study population consisted of all patients aged 18-70 years registered for an injury according to ICD-10 at a Swedish emergency department during an 18-month period. After informed consent, the injury patients were screened for drinking habits by the AUDIT-C questionnaire. The gender, age and drinking pattern of injury patients were compared with the general population.

METHODS

A total of 2782 patients aged 18-70 years were registered for an injury during the study period. The number of drop-outs was 631. Drop-outs include those who did not consent to participate, were severely injured, too intoxicated or did not fill out the questionnaire satisfactory. Thus, 77.3% of the target group were included for further analysis (1944 drinkers and 207 abstainers). The patients were categorized into three drinking categories: abstainers, non-risky and risky drinkers. Risky drinkers were defined according to usual weekly consumption of 80g or more of alcohol for women and 110g or more for men and/or heavy episodic drinking (i.e. having six glasses or more one glass=12g alcohol), or both, on one occasion at least once a month, valid for both women and men. To estimate the relationship between drinking patterns and the injury variables (environment, cause of injury, activity and diagnosis), odds ratios (OR) were calculated by logistic regression. Multiple logistic regression was used in order to control for age and sex differences between the various drinking and injury categories.

RESULTS

The proportion of risky drinkers was higher in the study population compared with the general population in the same area. When controlling for age and sex, risky drinkers (OR 6.4(adj) Confidence interval CI 1.9-21.2) and non-risky drinkers (OR .4.5(adj) CI 1.4-14.5) displayed an increased risk for injury compared with abstainers, in amusement locations, parks, by or on lakes or seas, especially while engaged in play, hobby or other leisure activities (risky drinkers: OR 2.8(adj) CI 1.3-5.6; non-risky drinkers: OR 2.4(adj) CI 1.2-4.6). All differences between drinking patterns in external cause of injury disappeared when age and sex were considered. During rest, meals and attending to personal hygiene, the non-risky drinkers had a lower probability of injury compared with abstainers (OR 0.3(adj) CI 0.1-0.8). Non-risky drinkers had a higher probability than abstainers of suffering luxation (dislocation) or distortion (OR 1.6(adj) CI 1.1-2.5). Nine per cent of the study population reported that they believed that their injury was related to intake of alcohol. Half of this group were non-risky drinkers (CI for the 13.7% difference was 9.7-17.6).

CONCLUSIONS

Few significant associations between drinking pattern and injury remained when age and sex were controlled for.

The impact of home safety promotion on different social strata in a WHO safe community

OBJECTIVES

Few studies have investigated the impact of home safety promotion programmes on different social strata. The aim of this study was to investigate the distribution of effects of a community-based home safety programme on home injury rates among families with different connections to the labour market.

METHODS

A quasi-experimental design was used, with pre- and post-implementation registrations covering the total populations below 65 years of age in the programme implementation area (population 41,000) and in a neighbouring comparison municipality (population 26,000) in Ostergötland County, Sweden.

RESULTS

In the intervention and comparison areas, households in which the adults were not vocationally active displayed the highest rates of home injury. After 6 years of programme activity, the home injury rates for males and females in all social status categories displayed a decreasing trend in the intervention area. The opposite was true for the comparison area, i.e. the incidence of injury increased, with the exception of females in non-vocationally active households. The decline in injury rates in the intervention area was statistically significant for males and females in the employed category and for males in the non-vocationally active category. Changes in injury rates in the comparison area were not statistically significant.

CONCLUSION

The programme was partially successful in that it reduced the injury rate in non-vocationally active households, but it did not influence the injury rate in the employed households. The study design did not allow for conclusions regarding why the post-intervention injury rates remained higher in non-vocationally active households. Further research on the association between the incidence of home injury and socio-economic factors is warranted.

What makes community based injury prevention work? In search of evidence of effectiveness

Community based injury prevention work has become a widely accepted strategy among safety promotion specialists. Hundreds of community based injury prevention programs have been implemented since the mid-1970s, but relatively few have been evaluated rigorously, resulting in a lack of consensus regarding the effectiveness of this approach. This study sought to identify key components that contribute to the effectiveness of these programs. The objective was to gain a better understanding of the community based model for injury prevention. The study was performed as a structured review of existing evaluations of injury prevention programs that employed multiple strategies to target different age groups, environments, and situations. The results of this study suggested that there are complex relationships between the outcome and the context, structure, and process of community-wide injury prevention programs. The interconnectedness of these variables made it difficult to provide solid evidence to prioritise in terms of program effectiveness. The evaluations of multifaceted community oriented injury prevention programs were found to have many shortcomings. Meagre descriptions of community characteristics and conditions, insufficient assessment of structural program components, and failure to establish process-outcome relationships contributed to the difficulty of identifying key success factors of the programs.