bluuebunny/crossref_metadata_2025_split huggingface dataset:
’The Pyramid of Success” the health promotion program for school- children with visual impairment
Authors: Wrzesinska M , Binder K , Rakoczy J , Tabała K , Lipert A 
Published: November 2019

Abstract

Issue/problem
Young people with visual impairment (VI) are more likely to have low literacy comparing to the rest of population. Additionally, they are at the high risk of obesity what has been attributed to poor food choices or lack of physical activity. Hence, interventions to support their nutrition status are needed.

Description of the problem
One hundred eighty six students aged 10-18 years (M = 13.9; SD = 2.44) selected from 6 schools for pupils with VI. An intervention describing healthy lifestyle guidelines was performed. Two innovative tools concerning nutrition guidelines tailored to the needs of people with VI were used during intervention: The Healthy Lifestyle Pyramid (HLP) and the Puzzle Game (PG). Participants were devoted to the Control Group (CG; N = 94) where only HLP was used and the Study Group (SG, N = 92) who participated in the classes with both tools: HLP and PG. Before and just after intervention a single-choice questionnaire regarding health literacy comprising 15 questions was used to verify the level of required knowledge regarding nutrition.

Results
There was a significant main effect of using HLP in the CG F(1. 132)=14.524, p &lt; 0.001. The main effect of using HLP and PG in the SG was also significant, F(1. 132)=6.188, p = 0.014. The actual difference in mean scores between SG and CG was medium. The effect size, calculated using partial eta squared, was .045.

Lessons
The interventions with tools tailored to the needs of people with VI had positive significant impact on nutrition knowledge. Health promotion activities focusing on the health literacy improvement are more effective when various approaches are used to present information. Future health promotion activities should be adjusted to the needs of different populations to provide an equal access to healthy behaviours and to enhance health literacy.

Key messages
Using tools tailored to the needs of people with VI provide an equal access to health promotion. Health promotion activities are more effective when range approaches are used to present information.
Machine learning application to the reduction of ambulatory care sensitive admissions (ACSA)
Authors: Ngo T , Georgescu V , Gervet C , Laurent A , Libourel T , Mercier G 
Published: November 2019

Abstract

Background
Reducing Ambulatory Care Sensitive Admissions (ACSA) not only enhances patients’ quality of life but could also save substantial costs. ACSA are avoidable admissions for chronic conditions that are associated with socio-economic status, health status, utilization and readiness of primary care service as well as environmental factors. Undoubtedly, health authorities are highly interested in enhancing the health care services in order to reduce the number of ACSA. The objective is to identify the geographic areas where the primary care workforce should be increased in order to maximize the decrease in ACSA.

Methods
Using ambulatory care and inpatient claims data as well as contextual variables, we apply support vector machine regression (SVR) to select the geographic areas (fr. Bassins de vie - BVs) and the number of to-be-added primary care nurses that maximize the ACSA reduction. We also take into account the constraints related to budget and the equality of health care access. Particularly, there are three possible constraints: (1) the total number of nurses can be added in the whole region; (2) the maximum number of the nurses can be added at each area; (3) the maximum density of nurses (numbers of the nurses per 10,000 habitants) can be reached at each area. The results are visualized using spatial maps.

Preliminary results
In 2014, 27,000 ACSA occurred in the Occitanie, France region. For a specific set of constraints values, the model identified 16 BVs (out of 201) where the addition of 30 nurses could lead to the maximum ACSA reduction in number which is 17.

Conclusions
In the French Occitanie region, our SVR model was able to target a small number of geographic areas to maximize the impact of increased primary care workforce on ACSA. Our approach is applied to a single region, and it can be applied to other regions or extended at the national level as well as to other countries.

Key messages
A decision support tool to help health authorities in locating primary health care resources for the maximum reduction of ambulatory care sensitive admissions. An application of machine learning in primary care services.
Patients’ participation in the colorectal cancer screening program and their health beliefs
Authors: Kaseliene S , Mesceriakova-Veliuliene O 
Published: November 2019

Abstract

Background
Both morbidity and mortality rates from colorectal cancer (CRC) have been increasing in Lithuania. However, only about 50% of the target Lithuanian population was involved in CRC screening in 2018. The aim of this study was to evaluate associations between the involvement of 50- to 74-year-old primary care patients in CRC screening and their health beliefs as well as awareness about this screening.

Methods
A cross-sectional study was conducted in September-November 2016. A total of 390 patients aged 50-74 years were anonymously surveyed at 10 primary health care institutions of Šakiai region, Lithuania. The response rate was 86.7%. Chi-square and z tests were used to determine a relationship between two nominal (categorical) variables (α = 0.05).

Results
43.1% of the respondents noted about their participation in the CRC screening program. Those who had participated in the program more often (p &lt; 0.05) than nonparticipants reported to be worried about getting CRC (60.6% vs 43%) and thought that this could happen already in the next year (16.8% vs 6.5%), more frequently believed that the possibility of getting CRC for them was very high (74.8% vs 60.9%), that they had predisposition to CRC (44.9% vs 27.6%) and that CRC screening will prevent them from problems in the future (97.4% vs 90.9%). The participants of the CRC screening program also more frequently (p &lt; 0.05) than nonparticipants noted that they had heard about this program before their involvement in it (98.8% vs 70.9%) and got this information from their family doctor 2.1 times more frequently (88.1% vs 41.4%). Nearly half (47.3%) of the program participants and 30.6% of the nonparticipants mentioned that the responsibility for participation in the CRC screening program should be taken by patients themselves (p &lt; 0.05).

Conclusions
Participation of patients in the CRC screening program is related to their health beliefs, awareness and active engagement of family doctors in CRC screening programs.

Key messages
The patients who had participated in the CRC screening program had more negative health beliefs regarding CRC and were better informed on the program by their family doctor than nonparticipants. Family doctors should pay more attention to informing patients about CRC and its prevention.
Assessement of the influenza burden in nursing homes during two influenza seasons
Authors: Qalla-Widmer L , Petignat C 
Published: November 2019

Abstract

Influenza is a significant cause of morbidity and mortality in elderly. They are at high risk of complications after influenza virus infection. Data on the epidemiology of influenza within nursing homes (NH) are limited. The purpose of this prospective study was to better describe the burden of influenza among residents of NH of canton of Vaud, Switzerland, with influenza-like illness during 2016-2017 and 2017-2018 influenza seasons. First, we determined the proportion of influenza-like illness due to influenza in NH residents. We specifically assessed the impact of a positive influenza PCR on clinical features, morbidity and mortality, 30 and 90 days after diagnosis, as compared to a negative influenza PCR. Moreover, influenza vaccination rates of the residents and the healthcare workers within each nursing home were assessed at the end of each influenza season. A PCR test was performed on 509 residents from 61 NH. 227 influenza virus infections were diagnosed; 181 influenza A and 46 influenza B. Compared to residents without influenza virus infection (IVI), residents with IVI were more often feverish with a high fever (69.1% and 88.5% respectively, p &lt; 0.0001) are significantly more frequently hospitalized within 30 days after diagnosis (17.6% vs 7.1%, p = 0.0003). Any cause mortality at 30 days was similar in both groups (12.8% vs 10.6%, p = 0.48). Only 18.1% of IVI residents were treated with an antiviral and 60.4% of them received antibiotics. Influenza vaccination rates of the healthcare workers and residents were respectively 50% and 82%. During influenza season, the feverish residents should be suspected to have influenza virus infection. Residents should be diagnosed (PCR) and treated with an antiviral where appropriate to limit the risk of hospitalization. Healthcare workers should be encouraged to be vaccinated against influenza in order to acquire a better herd immunity within the NH which will limit the spread of influenza.

Key messages
Influenza virus in nursing homes is not treated enough. Influenza virus infection in nursing homes causes a high number of hospitalizations.
Monitoring inequalities in self-rated health over 36 years among Finnish women and men
Authors: Lahelma E , Pietiläinen O , Pentala-Nikulainen O , Helakorpi S , Rahkonen O 
Published: November 2019

Abstract

Background
Health inequalities across countries and populations are well established, but little is known about their long-term trends and even less about factors shaping the trends. We examined the magnitude of absolute and relative educational inequalities in self-rated health over 36 years among adult Finns, considering individual covariates and macro-economic fluctuations.

Methods
Data were derived from representative annual surveys in 1979-2014 among men and women and covered ages 25-64. Nine periods were used (n = 8870-14235). Our health outcome was less-than-good self-rated health and our socioeconomic indicator was completed years of education as a continuous variable. Nine time-variant sociodemographic and health-related covariates were included. Educational inequalities in self-rated health were examined by relative index of inequality (RII) and slope index of inequality (SII).

Results
Linear trends suggested stable overall development in both relative and absolute health equalities during 36 years. Period specific analyses showed that among men relative and absolute inequalities narrowed immediately after economic recession in Finland in 1993-94, and among women, inequalities narrowed during global financial crisis in 2008-09. Adjusting for covariates reduced the magnitude of inequalities throughout the nine periods, but affected little the period specific patterning of health inequalities.

Conclusions
Educational inequalities in self-rated health persisted during 36 years in Finland. While among men and women health inequalities narrowed during and after recessions, they widened soon back to the pre-recession level. The perseverance calls for powerful measures to tackle health inequalities, such as preventing unhealthy behaviours, obesity and unemployment in particular among the lower educated.

Key messages
Health inequalities have persisted in Finland over 36 years, with unhealthy behaviors and unemployment affecting their magnitude. Health inequalities narrowed during economic recessions, but widened soon back to pre-recession level.
Using e-health to shorten treatment delay in patients with severe aortic stenosis
Authors: Michel M , Hammami J , Vinet M A , Picot-Ngo C ,   NA STOP-AS Investigators, Debroucker F , Gilard M , Chevreul K 
Published: November 2019

Abstract

Background
Transcatheter aortic valve replacement (TAVR) is a relatively new alternative to open surgery in patients with a severe aortic stenosis at high risk of surgery but there are important variations in treatment delay which can lead to increased morbidity and mortality. Those delays have many causes, including patients’ unawareness of the urgency, delays in obtaining the necessary preoperative tests and organizational factors at the hospital level. The aim of our study was to co-construct an e-health tool for patients and their families to empower them and improve knowledge on the disease and TAVR to ultimately decrease the delay between the medical decision for TAVR and the actual procedure.

Methods
A prospective study was first carried out to identify organizational factors associated with variations in treatment delay (both at the patient and hospital level). A preliminary survey was sent to all TAVR centers in France to understand and describe their organization. Descriptive analyses were then carried out on the answers. In a second step, two focus groups were carried with, the first with patients and carers and the second with healthcare professionals in order to elaborate the e-health tool.

Results
A website has been developed for patients and their families. It includes information in video form on aortic stenosis and its different treatments, on TAVR, the necessary tests required prior to TAVR (with a geolocalisation of available facilities nearby so that patients may know where to go), and what they can expect during the hospital admission and after their release. Patients undergoing TAVR will be informed of the website’s existence by their cardiologist. Web pages intended for healthcare professionals who are not TAVR specialists (general practitioners…) will also be available on the website.

Conclusions
A cluster randomized controlled trial will now test the efficacy and efficiency of the e-health tool in reducing TAVR treatment delay.

Key messages
We built a e-health tool in collaboration with patients, carers and healthcare professionals to increase patients’ knowledge on aortic stenosis and TAVR. The website will provide information through videos to empower patients and ultimately decrease treatment delay and its associated morbi-mortality.
E-health and governance models - a scoping review
Authors: Linstad L , Ekeland A G 
Published: November 2019

Abstract

Background
Research has shown that national large-scale e-health projects are rarely defined as successful.

Methods
We have conducted a search in the PubMed database on governance models.

Results
Our search resulted in 220 hits, 11 papers included. We sorted these in four health systems Governance takes three different paths. 1) governance of e-health - how governments govern e-health programs through national and regional strategies, standards, incentives, legislation 2) governance through e-health - e-health as a strategic tool to obtain national health policy goals 3) governance in e-health - governance in medical networks initiated bottom-up and run by clinicians.
In the Single-Payer we find two papers. Both these describe governance of e-health. When the processes had been running for a period of time it shifted to governance through e-health. Two papers from New Zealand describe top-down governance model of e-health. Under the Multi-Payer health system we find a paper that describes the experiences of realizing a national telehealth network in Australia through a governance model in e-health. Under Unknown health system and national governance models, we include a paper that describes a governance model of e-health in Haiti. Two other papers describe the tension between non-profit and for-profit organizations on access to health data and domain names. The authors questions how governments shall realize governance models which captures these new aspects in healthcare. The second paper describes the challenges faced by the authorities’ governance of the purchase and sale of health domains when public health institutions do not have an overview of this. The papers in this category may question if there is a need for a fourth governance model in e-health on the global level.

Conclusions
The development of governance models are not static but part of processes and context dependent. Need for a fourth governance model on the global level.

Key messages
Research has shown that national large-scale e-health projects are rarely defined as successful. Currently scattered knowledge on how large-scale e-health projects that bring economic, clinical and societal benefits are governed.
Media Freedom is the Primary Culprit for Depressive Disorders: A Cross-National Analysis
Authors: Lin Y C , Yan H T 
Published: November 2019

Abstract

Background
There has been much speculation about social environments causing an epidemic of depression. The objectives of this study are to examine how media freedom influences prevalence of depressive disorders. A direct effect of free media is great levels of information complexity causing poor mental health. Two indirect effects are that media freedom facilitates modernization, which is associated with competition-related stress, and government investment in social protection, which impedes the person’s ability to manage stress.

Methods
The study used a cross-sectional analysis on determinants of prevalence of depressive disorders in 2015 covering 98 democratic countries. Media freedom was measured as the degree to which a country allows the freedom of news and information of print media, television, and radio broadcasting (0-100: least to most free). Control variables were then added, including GDP per capita growth, population density, country latitude, and religious affiliations. Further, a mediation analysis was applied to test if there is a causal pathway that links the degrees of media freedom and the levels of economic development or/and social protection to prevalence of depression.

Results
We found that an increase in the score of media freedom by 10 resulted in a 0.20 percentage point increase in prevalence of depressive disorders (%) (0.20, CI = 0.10-0.30). Our theoretical expectations were still confirmed when this study examined the relationship for each year between 2011 and 2014 (e.g. in 2014, 0.19, CI = 0.09-0.29), used an alternative index of media freedom from a practitioners’ view (0.17, CI = 0.02-0.32), or measured each country’s level of internet and digital media freedom (0.30, CI = 0.10-0.49). Further, a mediation test showed that 39.88% and 21.38% of the total effect was mediated through the economic and social pathway respectively.

Conclusions
The findings suggest that great levels of media freedom matter in increasing prevalence of depression.

Key messages
Great levels of media freedom matter in increasing prevalence of depression. There are direct and two indirect effects of media freedom on prevalence of depression.
Effects of a work-stress intervention in Swedish primary care versus treatment as usual: RCT-study
Authors: Sandheimer C , Hedenrud T , Hensing G , Holmgren K 
Published: November 2019

Abstract

Background
Work stress is an increasing burden in society. To identify early symptoms of work stress in primary health care (PHC) could result in earlier and better adjusted care. A work stress questionnaire (WSQ) was developed in PHC for this task. We aimed to evaluate if the use of WSQ, in combination with physician’s feedback, results in differences in health care visits and treatment compared to treatment as usual (TAU) in patients reporting high stress. Our hypothesis was that patients receiving the intervention would generate more visits to rehabilitation providers during follow-up compared to TAU.

Methods
A two-armed RCT was conducted at seven primary health care centres (PHCC) in Region Västra Götaland, Sweden. One group received the WSQ-intervention and the controls received TAU. Employed not sick-listed persons aged 18-64 that sought care for mental and physical health complaints at the PHCCs participated. Register data on health care visits and treatments 12 months prior inclusion and 12 months after was obtained and analysed with Fisher’s exact test together with questionnaire data (WSQ and background features).

Results
A total of 271 participants were included in the study, 132 intervention and 139 controls. The proportion that visited psychologists/psychotherapists was higher among the intervention group with high stress (19.5%, n = 87) during follow-up compared to corresponding controls (7.2%, n = 97) (p = 0.048). Collaborative care measures were more common among the stressed intervention participants (23%) post-inclusion compared to the stressed controls (11.3%) (p = 0.048).

Conclusions
Significant differences were found between the WSQ intervention group and the controls reporting high stress in visits to psychologists and in amount of received collaborative care. This confirms our hypothesis that the WSQ can help physicians to identify work stress and give suitable rehabilitative measures at an earlier stage in the care process compared to TAU.

Key messages
The use of WSQ with physicians’ feedback generated more visits to psychologists and more received collaborative care compared to treatment as usual. Findings of the study indicate that the WSQ can assist in identifying work stress in primary care and accommodate rehabilitative measures compared to treatment as usual.
Childhood adversities and chronic pain among midlife employees
Authors: Salonsalmi A , Lallukka T , Lahelma E , Pietiläinen O , Rahkonen O 
Published: November 2019

Abstract

Introduction
Chronic pain is common among employees. Childhood adversities are known determinants of adult health but their association with chronic pain in adulthood is largely unknown. We aimed to examine the associations between childhood adversities and chronic pain among midlife employees.

Methods
Data on seven childhood adversities and chronic pain (pain having lasted at least 3 months) were derived from the baseline survey of the Helsinki Health Study collected in 2000 to 2002 among 40 to 60-year-old employees of the City of Helsinki in Finland. The study included 8140 employees of whom 80% were women. The analyses were made by logistic regression and the results are presented as odds ratios (OR) and their 95% confidence intervals (CI). Age, gender, father’s education, own education, marital status, working conditions, sleep problems and common mental disorders were included as covariates.

Results
Economic difficulties in the childhood family (OR 1.60, 95% CI 1.41-1.81), childhood illness (1.74, 1.45-2.08), parental divorce (1.26, 1.07-1.48), parental alcohol problems (1.34, 1.18-1.52) and bullying in school or among peers (1.59, 1.37-1.89) were associated with an increased odds of chronic pain in midlife. Adjusting for father’s education, own education and marital status did not contribute to the associations. Working conditions, sleep problems and common mental disorders slightly attenuated the associations between childhood adversities and chronic pain.

Conclusions
Childhood adversities associate to chronic pain in midlife. The results suggest that promoting well-being among children might lead to less pain decades after childhood.

Key messages
Childhood adversities are associated with chronic pain in adulthood. Considering well-being among children might lead to less pain decades after childhood.