bluuebunny/crossref_metadata_2025_split huggingface dataset:
’I had no idea what could come’- health care support for AMD in Germany- The patients’ view
Authors: Thier A , Holmberg C 
Published: November 2019

Abstract

Background
Due to the demographic change visual impairment and blindness in the elderly caused by chronic eye diseases become major public health themes. Age- related macular degeneration (AMD) is one of the most common causes of visual impairment and blindness in older adults above 60 years of age in the western countries, followed by glaucoma and diabetic retinopathy.
Objectives: The purpose of this study is to find out how patients with AMD assess their medical care, tool-based and psychosocial counseling services in Germany.

Methods
Data was collected by using narrative, semi-structured interviews. A purposive sampling strategy was used to sample the study population with patients with AMD, which is characterized by a variety of different life experiences of the patients. The data analysis followed the principles of grounded theory.

Results
The interviewed AMD patients were between 72 and 87 years old. Before the patients were diagnosed with AMD, AMD was not known to them and suffering from an unrecoverable disease resulting in blindness, made many of the patients anxious. Patients with AMD complained about missing information about the AMD and its treatment. Tool-related and psychosocial counseling services and their benefits were unknown to most of the patients. Therapy with Anti-VEGF injections gives hope to many patients with neovascular AMD, but at the same time it is associated with a time, psychological and physical strain. The time spent in clinics and practices, the waiting for appointments, the number of examinations and injections, communication problems with the medical staff, information deficits, the injections themselves and their side effects were often severe and nerve-wracking for the elderly.

Conclusions
New strategies need to be developed to facilitate access to AMD information for patients with AMD, as well as to reduce the time required for medical treatment, e.g. waiting times in clinics and practices.

Key messages
Therapy with Anti-VEGF injections gives hope to many patients with neovascular AMD, but at the same time it is associated with a time, psychological and physical strain. Patients with AMD complained about missing information about the AMD and its treatment.
Integrating priorities of disadvantaged parents and professionals for community family health
Authors: Wink G , Fransen G A J , Huisman M J , Boersma S N , Assendelft W J J , Wagemakers M A E , van der Velden J , van den Muijsenbergh METC 
Published: November 2019

Abstract

Background
Health inequalities persist, and policymakers, researchers and practitioners seek for effective ways to positively impact the health of disadvantaged people. Researchers point to a multi-component program with an integral design including various perspectives and involving different stakeholders. Few studies address the perspectives on health of disadvantaged people themselves. This study describes what parents in a socially disadvantaged situation and professionals working in that community perceived as 1) priority aspects to improve family health 2) barriers and facilitators for health behaviour changes 3) important health program activities.

Methods
Design: Community-based participatory action research. 10 parents participated in 6 panel meetings. 46 professionals received 4 panel meetings summaries. 18 parents and 25 professionals responded to questions in (panel) meetings and consultation by phone and e-mail.

Results
(preliminary) 1) Parents’ top priorities for improving health were: less stress related to finances and communication with related organizations, followed by a safe place for kids to meet. Of the program financers’ aims (reducing tobacco, alcohol use and overweight) reducing overweight got relatively most support of parents. 2) Parents perceived their family financial situation as barrier to behaviours reducing stress and overweight. 3) Program activities related to reducing stress got more support from parents and professionals than activities related to reducing overweight.

Conclusions
Insight in the perspectives of disadvantaged parents and professionals resulted in a program plan supported by them, aiming to reduce stress and overweight. Most participating parents and professionals committed themselves to invest time in program activities execution.

Key messages
Disadvantaged parents perceived reducing stress related to finances as top priority to improve family health. They perceived family finances as barrier to behaviours reducing stress and overweight. Community-based participatory action research with disadvantaged parents and professionals can result in an integrated family health program plan with stakeholder support.
The association between frailty and satisfaction with social contacts in the general older population
Authors: Nguyen D , Braekman E , Demarest S , der Heyden J Van 
Published: November 2019

Abstract

Background
As a result of the demographic evolution, the proportion of older people will continue to increase in the coming decades. Frailty among elderly is one of the important challenges that Europe is facing. From a biomedical, perspective frailty is considered as a clinical syndrome that increases vulnerability. However, the role of social contacts in relation to frailty needs to be investigated. In this study, we assessed the association between frailty and perceived satisfaction with social contacts in a sample of the general older population.

Methods
This study was conducted on a representative sample of 2364, both institutionalized and non-institutionalized older participants (≥65 years) from the Belgian Health Interview Survey 2018. Frailty was assessed with the instrument used in the Survey of Health Ageing and Retirement in Europe (SHARE) including dimensions of the Fried phenotype: exhaustion, weight loss, muscle strength, weakness and physical activity. The Oslo-3 Social Support Scale (OSS-3) was used to assess perceived quality of social support. Logistic regression was used to determine the association between frailty status and satisfaction with social contacts while controlling for age, gender, region, educational attainment and household composition.

Results
The prevalence of frailty was 22.8% (95%CI:21.2-24.6). The results showed that elderly who are unsatisfied with their social contacts are more likely to be frail (OR(95%CI):4.65 (2.82-7.66)). In addition, being older ≥75 years (OR(95%CI):2.40 (1.68-3.43)), being female (OR(95%CI):2.48 (1.73-3.56)), having a lower education (OR(95%CI):2.57 (1.71-3.87)), living alone (OR(95%CI):1.58 (1.10-2.27)) were associated with frailty.

Conclusions
Frailty is associated with living alone and being unsatisfied with the social contacts, among older people in Belgium. These findings confirm that the social component should be taken into account in strategies to reduce frailty in the general older population.

Key messages
Frailty is associated with living alone and being unsatisfied with the social contacts, among older people in Belgium. The social component should be taken into account in strategies to reduce frailty in the general older population.
Social inequalities of postpartum depression: the mediating role of social support during pregnancy
Authors: Nakamura A , Melchior M , van der Waerden J 
Published: November 2019

Abstract

Introduction
A disadvantaged socioeconomic position (SEP), as well as insufficient social support during pregnancy (SSP) increase the probability of subsequent postpartum depression (PPD). The aim of this study was to quantify the part of social inequalities in PPD due to insufficient SSP and in particular assess the impact relative to women’s migrant status.

Methods
The sample included 15,000 women from the nationally representative French ELFE birth cohort study. Depressive symptoms were assessed at two months postpartum by the EPDS. SEP was constructed as a latent factor explaining educational level, occupational grade, employment during pregnancy, household income and financial difficulties. SSP was characterized by informal support (partner perceived support, frequency of quarrels and paternal leave) and formal support (early prenatal psychosocial risk assessment and antenatal classes’ attendance). Causal mediation analyses between SEP, dimensions of SSP and PPD were conducted and stratified on migrant status (categorized as native French, first or second generation migrant or immigrant).

Results
A disadvantaged SEP and a lack of informal SSP during pregnancy were both associated with an increased risk for postpartum depressive symptoms and a disadvantaged SEP was positively associated with lack of SSP. In immigrant women, a larger proportion of social inequalities in PPD could be attributed to lack of SSP, in comparison to native French women (17.5% vs. 8.8%).

Conclusions
Both disadvantaged SEP and SSP are risk factors for PPD. We found evidence that disadvantaged women’s increased risk for PPD can partly be attributed to limited social support.

Key messages
PPD in disadvantaged groups, especially in migrant women, could possibly be prevented early in pregnancy by increasing support from partner and larger family. Access to social support health care systems directed towards pregnant women remains low for women with a disadvantaged SEP, especially in migrant women.
Multidimensional assessment for patients with multimorbidity in primary care – first practice test
Authors: Gredinger G , Trischak C , Reitter-Pfoertner S 
Published: November 2019

Abstract

Background
Multidimensional geriatric assessments are important for early detection of functional deficits, thus contributing to healthy ageing. According to the Austrian Health Care Structure Plan, such bio-psycho-social assessments should be implemented in primary care and build the basis for the care of patients with chronic diseases. Aim of the present study was to test the feasibility of a respective tool at Austrian general practitioners (GP).

Methods
Overall, 16 GP participated in our practice test and conducted the composed assessment in 185 geriatric patients (39% male, Ø82.6 years, Ø8 diagnoses, 9 medications). Data was analyzed using descriptive statistics (SPSS 26.0).

Results
In 181 tested patients (98%), the assessment revealed at least 1 relevant functional deficit (Ø4, max. 8). Level of care and number of functional deficits correlated (Spearman: 0.3, p &lt; 0.01). Defi-cits were mainly found in mobility (55%: Timed Up and Go-Test &gt;20 sec) and activities of daily liv-ing (86% IADL ≤ 15/16 points and 72% Barthel-Index ≤ 95/100 points). The average time to com-plete and document the functional tests was 34 minutes (min. 14, max. 61, n = 121). Use of the elec-tronic (vs. paper) documentation resulted in a significant lower time requirement of 9 minutes. Re-garding subsequent interventions, 11 GP suggested 121 interventions in 57/185 patients (30.8%); thereby, pharmacological interventions were preferred.

Conclusions
We conclude that our tool tool is practicable in primary care as the required time is manageable. Uncovering functional deficits per se did not induce adequate interventions (neither in number nor in quality); therefore, medical algorithms are needed that make precise recommendations for subse-quent diagnosis and/or treatment/care.

Key messages
Multidimensional assessments are manageable in primary care and reveal functional deficits. Subsequent to the assessment, algorithms are important in order to induce a benefit through inter-ventions.
Inequalities in the participation and outcomes of breast cancer screening programs in Valencia, Spain
Authors: Muñoz-Miguel J , Molina-Barceló A , Vanaclocha M , Ibañez J , Romeo P , Pinto M , Hernández M , Alcaraz M , Salas D 
Published: November 2019

Abstract

Background
Breast cancer remains the most frequent tumour and first cancer related cause of death in the Valencian Community. Despite most of the population being aware of the existence of breast cancer screening programs (BCSP), there are great differences in uptake that are likely attributed to social determinants. The objective of this study, alligning with SDGs 3 and 10, is to assess inequalities in breast cancer screening uptake, diagnosis and treatment delay in the city of Valencia.

Methods
The population of study included 128 123 women invited to participate in the BCSP in the city of Valencia between 2014 and 2016. Uptake, diagnosis and treatment delay were assessed as outcomes. Covariates included country of origin, education level, size of family unit, risk of vulnerability, age, presence of disability, assigned health department and a social deprivation index. Bivariate analysis and logistic regression models were performed for each independent variable.

Results
BCSP uptake was of 63,8% with a diagnostic rate of 5,36‰. 76,7% of patients were below the 75th percentile of delay between diagnosis and treatment (52 days). Statistically significant relationships were found between uptake of BCSP and all studied covariates both in the bivariate analysis and regression model. Presence of disability, family unit size, age and health department had a statistically significant relationship with diagnosis in the bivariate analysis, of which only one health department and the social deprivation index’s second quintile remained significant in the regression model. No significant relations were found between treatment delay and any of the covariates.

Conclusions
Strong inequalities in the BCSP have been identified. Influencing factors must be targeted so as to ensure an egalitarian access to BCSP. Given its multifactorial nature, simple analyses must be avoided in the study of inequalities in breast cancer diagnosis. Data on lifestyle may contribute to future models.

Key messages
Social determinants continue to have an impact in the uptake of breast cancer screening programs in the city of Valencia. The assessment of inequalities in breast cancer diagnosis cannot be approached uniquely through the analysis of social determinants and may Benefit from the inclusion of data on lifestyle choices.
Evaluation of the ’sophia’ asthma patient management program at two years
Authors: Aguadé A S , Guillo S , De Rycke Y , Lafourcade A , Chenivesse C , Taillé C , Hejblum G , Tubach F 
Published: November 2019

Abstract

Objectives
To evaluate the impact of a multi-faceted management support program deployed towards asthma patients by the French Health Insurance since February 2015 in 19 (20%) French pilot areas.

Methods
The population is composed of subjects aged 18 to 40 years in 2014, with at least 3 asthma medication deliveries in 2012 as well as in 2013 that were identified and followed-up within the SNDS French claims database. A controlled before-and-after design was used for assessing program impact. Unexposed subjects (i.e. living in non-pilot areas) were matched with exposed subjects (i.e. living in pilot areas) on a propensity score. Adherence to controller treatment (inhaled corticoids), measured by the medication refill adherence MRA, was the primary outcome. Secondary outcomes were medications and heathcare use, sick leaves, exacerbations, costs.

Results
Analysis concerned 29, 746 matched-pairs. With a baseline mean MRA of 40.17% in unexposed subjects, the difference-in-difference was non-significant (0.26%, p = 0.545). However, the program showed a significant impact on the percentage of subjects that moved to a better MRA category or maintained a high adherence (OR = 1.05,p=0.028). The program had no significant impact on the other secondary outcomes. In planned secondary analyses comparing the 11.5% exposed subjects who adhered to the program to their matched-unexposed subjects, the difference-in-difference showed a program impact on specialist consultations, asthma-related and all medication costs, and total asthma-related costs. However, results on this subpopulation must be examined with caution since the matching procedure couldn’t take into account the propensity to adhere.

Conclusions
Although SOPHIA had no impact on the MRA as a continuous variable, more exposed subjects moved to better adherence categories. The program had an impact on asthma-related costs in the adherents to the program, but this result should be considered with caution.

Key messages
Although SOPHIA had no impact on the MRA as a continuous variable, more exposed subjects moved to better adherence categories. The program had an impact on asthma-related costs in the adherents to the program, but this result should be considered with caution.
Patient safety culture in Austrian hospitals – A qualitative study
Authors: Draganović ŠD , Offermanns G O , Brandl J B 
Published: November 2019

Abstract

Background
Adverse events in the healthcare system often have severe consequences for the patient and healthcare institutions. Thus, various risk management tools have been recently introduced to 11 Austrian hospitals to increase patient safety. The goal of our study was to test whether the introduced risk management tools actually improved patient safety culture (PSC).

Methods
An exploratory research approach was used to examine the current status of five aspects from PSC in hospitals. Semi-structured expert interviews with health professionals were conducted (N = 32). The inductive content analysis and technique of content structuring were used to analyze and systemize extensive qualitative data material. Intercoder reliability (κ = .605) shows satisfactory results.

Results
The results of the first aspect, Critical Incident Reporting System (CIRS), show that hospitals still have potential for improvement in terms of education of employees, coordination, and communication. The data of the second issue, surgical checklist, shows that the education was insufficient and that these checklists are not handled properly and used only fragmentarily. Concerning the third aspect “transfer/report”, it can be stated that systematic transfer/reports are widely unknown. Furthermore, the fourth aspect, hand hygiene, lacks a systematic training concept and control of compliance. The fifth aspect, education of risk manager, has brought a number of general benefits (e.g. methodical knowledge) to risk managers.

Conclusions
The results provide valuable insights into strengths and weaknesses of the implementation of risk management tools and thus highlight opportunities on how to influence PSC through organizational development and change management. Furthermore, this study has taken the first essential step towards the understanding of the effective and efficient development of PSC by providing valuable insights into the underlying mechanisms of non-functioning PSC.

Key messages
The study showed where the weakness points in processes of implementing risk management tools are and offered a theoretical solution for the development of a patient safety culture. Risk management tools were not equally effective in every controlled aspect. The effective implementation of these tools requires change management as a foundation to develop PSC.
Preoperative evaluation of patients receiving bariatric surgery: a comprehensive Breton study
Authors: Barataud-Reilhac A R B , Rigault A R , Beauvillain J B , Thereaux J T 
Published: November 2019

Abstract

Background
With large demonstrated benefits, volume of bariatric surgery (BS) has increased almost threefold since the late 2000s in France. However, patients seeking for BS must be carefully preoperatively evaluated to reduce risks for late complications (nutritional, neurological and psychiatric). This study aimed to assess preoperative evaluation of BS according to French recommendations.

Methods
The preoperative evaluation (gastrointestinal, nutritional, cardiovascular and psychiatric) during the year preceding BS was assessed from the French national health insurance database. All patients with a primary BS in Brittany in 2015 were included. For each patient, a score of preoperative evaluation was carried-out (from 0 to 6) and classified as follows: “complete” (6), “incomplete” (4-5), “unsatisfactory” (2-3) or “poor” (0-1). Comparisons (chi-square tests) by sex, geographical department, type of institution and health professionals (HP) were made.

Results
Among the 1,446 patients finally included, 1,195 (83%) were women and the median age was 42 (quartiles: 33-51) years old. Gastric by-pass (66%) and sleeve-gastrectomy (33%) were the most performed procedure. The preoperative evaluation was classified as ’complete’ for 501 (35%) patients, ’incomplete’ for 647 (45%) patients, ’unsatisfactory’ for 238 (17%) patients, and ’poor’ for 60 (4%) patients. Better scores were found in 2 departments (Côtes d’Armor and Finistère, p &lt; 0.001), in public institutions (p &lt; 0.001) and in institutions performing 50 or more acts per year (p &lt; 0.001). Heterogeneity according to the HP was also noted in private institutions (median score per HP: 4.5, min-max: 2-6).

Conclusions
This large regional comprehensive French study confirms that preoperative evaluation before BS is not optimal despite clear French recommendations. Collective reflection should be led to improve the pathway of care of patients seeking BS.

Key messages
There are disparities in the performance of BS’s preoperative evaluation in Brittany. This work suggests that preoperative evaluation for patients seeking for BS should be improved and standardized.
Evaluation of observation of the patients with coronary heart disease after surgical treatment
Authors: Bekbergenova Z , Mauletbayeva G , Umbetzhanova A , Derbissalina G , Koikov V , Akhmetova A , Zemlyanskaya N , Alibekova G 
Published: November 2019

Abstract

Background
To reduce mortality from cardiovascular diseases in Kazakhstan, which occupies the leading position, patients are under observation. To evaluate of patients with coronary artery disease who have undergone myocardial revascularization by installing coronary artery stenting or bypass surgery.

Methods
A retrospective analysis of outpatient medical records of patients.

Results
Analysis included medical records of 4% patients at the age of 40-49 years, 49%-50-59 years, 22%-60-69 years, 11%-70-79 years, 4% patients older than 80 year. 92% patients were admitted to the hospital with acute coronary syndrome and were urgently operated. Patients with chronic heart failure were operated routinely. 12% patients received surgical treatment twice, including 4% patients routinely. All patients had comorbidities: 63% of people-arterial hypertension, 12%-cardiac arrhythmia, 14%-diabetes. The analysis showed that only 51% of patients were regularly observed in accordance with the standards of the survey during one year of observation. According to the standards the scheduled ECG study of the patients after surgery should be done after 1, 2, 3 and 6 months. In accordance of the standard 23% patients were examined, 3 times a year - 19% patients, 23% people-twice a year. Other functional studies-echocardiography 1 time per year have been studied on 14% people, treadmill test-5% patients. Coagulation monitoring during one year- 46% patients. One of the criteria of proper observation is the number of readmissions. 11% patients were readmitted where 5% of them in the first month after surgery-6% patient with hypertensive crisis, 11%-with an increase of CHF, 2%-with postoperative pleural effusion. 2% patients hospitalized with restenosis after 7 months.

Conclusions
It should be noted that irregular visits to the doctor questioned the compliance of patients to treatment. Due to the lack of control by medical workers, the patients were not fully examined.

Key messages
The continuity of work between hospital doctors and primary care organizations is necessary. Patients to improve the favorable prognosis requires regular medication.