NICE public health guidance: healthy workplaces

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Authors: Taylor, E., Mulvihill, C., Baillie, N. & Irwin, H.

Source: J Public Health (Oxf) (2017) 39 (1): 215-216. DOI: https://doi.org/10.1093/pubmed/fdw142
Published: 30 December 2016

“It is not the diet; it is the mental part we need help with.” A multilevel analysis of psychological, emotional, and social well-being in obesity.

"It is not the diet; it is the mental part we need help with." A multilevel analysis of psychological, emotional, and social well-being in obesity. Int J Qual Stud Health Well-being. 2017 Dec;12(1):1306421 Authors: Rand K, Vallis M, Aston M, Price S, Piccinini-Vallis H, Rehman L, Kirk SFL Abstract In this research, we explored the psychological, emotional, and social experiences of individuals living with obesity, and perceptions of health care providers. We conducted a theoretical thematic analysis using two theoretical frameworks applied to transcripts from a previous qualitative study. Themes from a mental well-being framework were subsequently categorized under five environmental levels of the Social-Ecological Model (SEM). Key mental well-being themes appeared across all levels of the SEM, except the policy level. For the individual environment, one main theme was food as a coping mechanism and source of emotional distress. In the interpersonal environment, two themes were (a) blame and shame by family members and friends because of their weight and (b) condemnation and lack of support from health professionals. In the organizational environment, one main theme was inadequate support for mental well-being issues in obesity management programmes. In the community environment, one major theme the negative mental well-being impact of the social stigma of obesity. An overarching theme of weight stigma and bias further shaped the predominant themes in each level of the SEM. Addressing weight stigma and bias, and promoting positive mental well-being are two important areas of focus for supportive management of individuals living with obesity. PMID: 28418818 [PubMed - in process]

Nutritional rickets around the world: an update.

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Nutritional rickets around the world: an update. Paediatr Int Child Health. 2017 May;37(2):84-98 Authors: Creo AL, Thacher TD, Pettifor JM, Strand MA, Fischer PR Abstract Worldwide, nutritional rickets continues to be an evolving problem with several causes. This paper provides an updated literature review characterising the prevalence, aetiology, pathophysiology and treatment of nutritional rickets worldwide. A systematic review of articles on nutritional rickets from various geographical regions was undertaken. For each region, key information was extracted, including prevalence, cause of rickets specific to the region, methods of confirming the diagnosis and current treatment and preventive measures. Calcium deficiency continues to be a major cause of rickets in Africa and Asia. Vitamin D deficiency rickets is perhaps increasing in the Americas, Europe and parts of the Middle East. There continues to be a distinct presentation of calcium-predominant versus vitamin D predominant rickets, although there are overlapping features. More careful diagnosis of rickets and reporting of 25-OHD concentrations has improved accurate knowledge of rickets prevalence and better delineated the cause. Nutritional rickets continues to be an evolving and multi-factorial problem worldwide. It is on a spectrum, ranging from isolated vitamin D deficiency to isolated calcium deficiency. Specific areas which require emphasis include a consistent community approach to screening and diagnosis, vitamin D supplementation of infants and at-risk children, prevention of maternal vitamin D deficiency and the provision of calcium in areas with low calcium diets. PMID: 27922335 [PubMed - indexed for MEDLINE]

Should We Screen for Vitamin D Deficiency?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

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Should We Screen for Vitamin D Deficiency?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med. 2016 Dec 06;165(11):800-807 Authors: Libman H, Malabanan AO, Strewler GJ, Reynolds EE Abstract The U.S. Preventive Services Task Force (USPSTF) recently issued guidelines on screening for vitamin D deficiency. The guidelines were based on randomized trials of vitamin D deficiency screening and treatment, as well as on case-control studies nested within the Women's Health Initiative. The USPSTF concluded that current evidence is insufficient to assess the benefits and harms of screening for vitamin D deficiency in asymptomatic adults. Compared with placebo or no treatment, vitamin D was associated with decreased mortality; however, benefits were no longer seen after trials of institutionalized persons were excluded. Vitamin D treatment was associated with a possible decreased risk for at least 1 fall and the total number of falls per person but not for fractures. None of the studies examined the effects of vitamin D screening versus not screening on clinical outcomes. In this Grand Rounds, 2 prominent endocrinologists debate the issue of screening for vitamin D deficiency in a 55-year-old, asymptomatic, postmenopausal woman. They review the data on which the USPSTF recommendations are based and discuss the potential benefits and risks, as well as the challenges and controversies, of screening for vitamin D deficiency in primary care practice. PMID: 27919096 [PubMed - indexed for MEDLINE]

An audit of empiric antibiotic choice in the inpatient management of community-acquired pneumonia

Adherence to antimicrobial guidelines for empiric antibiotic prescribing in community-acquired pneumonia (CAP) has been reported to be worryingly low. We conducted a review of empiric antibiotic prescribing for sixty consecutive adult patients admitted to the Mercy University Hospital with a diagnosis of CAP. When analysed against local antimicrobial guidelines, guideline concordant empiric antibiotics were given in only 48% of cases, lower than the average rate in comparable studies. Concordance was 100% in cases where the CURB-65 pneumonia severity assessment score, on which the guidelines are based, was documented in the medical notes. The use of excessively broad spectrum and inappropriate antibiotics is a notable problem. This study supports the theory that lack of knowledge regarding pneumonia severity assessment tools and unfamiliarity with therapeutic guidelines are key barriers to guideline adherence, which remains a significant problem despite increased focus on antimicrobial stewardship programs in Ireland.

Authors: Delaney, F; Jackson, A

Source: Irish Medical Journal

Scaling up complex interventions: insights from a realist synthesis.

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Scaling up complex interventions: insights from a realist synthesis. Health Res Policy Syst. 2016 Dec 19;14(1):88 Authors: Willis CD, Riley BL, Stockton L, Abramowicz A, Zummach D, Wong G, Robinson KL, Best A Abstract Preventing chronic diseases, such as cancer, cardiovascular disease and diabetes, requires complex interventions, involving multi-component and multi-level efforts that are tailored to the contexts in which they are delivered. Despite an increasing number of complex interventions in public health, many fail to be 'scaled up'. This study aimed to increase understanding of how and under what conditions complex public health interventions may be scaled up to benefit more people and populations.A realist synthesis was conducted and discussed at an in-person workshop involving practitioners responsible for scaling up activities. Realist approaches view causality through the linkages between changes in contexts (C) that activate mechanisms (M), leading to specific outcomes (O) (CMO configurations). To focus this review, three cases of complex interventions that had been successfully scaled up were included: Vibrant Communities, Youth Build USA and Pathways to Education. A search strategy of published and grey literature related to each case was developed, involving searches of relevant databases and nominations from experts. Data extracted from included documents were classified according to CMO configurations within strategic themes. Findings were compared and contrasted with guidance from diffusion theory, and interpreted with knowledge users to identify practical implications and potential directions for future research.Four core mechanisms were identified, namely awareness, commitment, confidence and trust. These mechanisms were activated within two broad scaling up strategies, those of renewing and regenerating, and documenting success. Within each strategy, specific actions to change contexts included building partnerships, conducting evaluations, engaging political support and adapting funding models. These modified contexts triggered the identified mechanisms, leading to a range of scaling up outcomes, such as commitment of new communities, changes in relevant legislation, or agreements with new funding partners.This synthesis applies and advances theory, realist methods and the practice of scaling up complex interventions. Practitioners may benefit from a number of coordinated efforts, including conducting or commissioning evaluations at strategic moments, mobilising local and political support through relevant partnerships, and promoting ongoing knowledge exchange in peer learning networks. Action research studies guided by these findings, and studies on knowledge translation for realist syntheses are promising future directions. PMID: 27993138 [PubMed - indexed for MEDLINE]

Aluminium content of foods originating from aluminium-containing food additives.

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Aluminium content of foods originating from aluminium-containing food additives. Food Addit Contam Part B Surveill. 2016 Sep;9(3):185-90 Authors: Ogimoto M, Suzuki K, Haneishi N, Kikuchi Y, Takanashi M, Tomioka N, Uematsu Y, Monma K Abstract Aluminium (Al) levels of 90 food samples were investigated. Nineteen samples contained Al levels exceeding the tolerable weekly intake (TWI) for young children [body weight (bw): 16 kg] when consuming two servings/week. These samples were purchased multiple times at specific intervals and were evaluated for Al levels. Al was detected in 27 of the 90 samples at levels ranging from 0.01 (limit of quantitation) to 1.06 mg/g. Of these, the Al intake levels in two samples (cookie and scone mix, 1.3 and 2 mg/kg bw/week, respectively) exceeded the TWI as established by European Food Safety Authority, although the level in the scone mix was equivalent to the provisional TWI (PTWI) as established by Joint Food and Agriculture Organization of the United Nations/World Health Organization Expert Committee on Food Additives. The Al levels markedly decreased in 14 of the 19 samples with initially high Al levels. These results indicated reductions in the Al levels to below the PTWI limits in all but two previously identified food samples. PMID: 27092423 [PubMed - indexed for MEDLINE]

Effectiveness of seasonal influenza vaccine for adults and children in preventing laboratory-confirmed influenza in primary care in the United Kingdom: 2015/16 end-of-season results.

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Effectiveness of seasonal influenza vaccine for adults and children in preventing laboratory-confirmed influenza in primary care in the United Kingdom: 2015/16 end-of-season results. Euro Surveill. 2016 Sep 22;21(38): Authors: Pebody R, Warburton F, Ellis J, Andrews N, Potts A, Cottrell S, Johnston J, Reynolds A, Gunson R, Thompson C, Galiano M, Robertson C, Byford R, Gallagher N, Sinnathamby M, Yonova I, Pathirannehelage S, Donati M, Moore C, de Lusignan S, McMenamin J, Zambon M Abstract The United Kingdom (UK) is in the third season of introducing universal paediatric influenza vaccination with a quadrivalent live attenuated influenza vaccine (LAIV). The 2015/16 season in the UK was initially dominated by influenza A(H1N1)pdm09 and then influenza of B/Victoria lineage, not contained in that season's adult trivalent inactivated influenza vaccine (IIV). Overall adjusted end-of-season vaccine effectiveness (VE) was 52.4% (95% confidence interval (CI): 41.0-61.6) against influenza-confirmed primary care consultation, 54.5% (95% CI: 41.6-64.5) against influenza A(H1N1)pdm09 and 54.2% (95% CI: 33.1-68.6) against influenza B. In 2-17 year-olds, adjusted VE for LAIV was 57.6% (95% CI: 25.1 to 76.0) against any influenza, 81.4% (95% CI: 39.6-94.3) against influenza B and 41.5% (95% CI: -8.5 to 68.5) against influenza A(H1N1)pdm09. These estimates demonstrate moderate to good levels of protection, particularly against influenza B in children, but relatively less against influenza A(H1N1)pdm09. Despite lineage mismatch in the trivalent IIV, adults younger than 65 years were still protected against influenza B. These results provide reassurance for the UK to continue its influenza immunisation programme planned for 2016/17. PMID: 27684603 [PubMed - indexed for MEDLINE]

Understanding views on everyday use of personal health information: Insights from community dwelling older adults.

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Understanding views on everyday use of personal health information: Insights from community dwelling older adults. Inform Health Soc Care. 2017 Apr 11;:1-14 Authors: Hartzler AL, Osterhage K, Demiris G, Phelan EA, Thielke SM, Turner AM Abstract BACKGROUND: Older adults apply various strategies to pursue healthy aging, but we know little about their views and use of personal health information to accomplish those ends. METHODS: As a first step in formulating the role of personal health information management (PHIM) in healthy aging, we explored the perspectives of older adults on health and health information used in their everyday lives through four focus groups with 25 community-dwelling adults aged 60 and over. RESULTS: We found that the concept of wellness-the holistic and multidimensional nature of health and wellbeing-plays prominently in how older adults think about health and health information. Participants expressed wellness from a position of personal strength, rather than health-related deficits, by focusing on wellness activities for staying healthy through: (1) personal health practices, (2) social network support, and (3) residential community engagement. CONCLUSION: Although these themes involve personal health information, existing PHIM systems that focus on disease management are generally not designed to support wellness activities. Substantial opportunity exists to fill this wellness support gap with innovative health information technology designed for older adults. Findings carry implications for the design of PHIM tools that support healthy aging and methods for engaging older adults as co-producers of this critical support. PMID: 28399725 [PubMed - as supplied by publisher]

Caregiver Perspectives About Using Antipsychotics and Other Medications for Symptoms of Dementia.

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Caregiver Perspectives About Using Antipsychotics and Other Medications for Symptoms of Dementia. Gerontologist. 2017 Apr 11;: Authors: Kerns JW, Winter JD, Winter KM, Kerns CC, Etz RS Abstract Background and Objectives: To avoid "chemical restraints," policies and guidelines have been implemented to curb the use of medications for behavioral and psychological symptoms of dementia (BPSD). Antipsychotics have been particularly targeted because of their rare severe side effects. Consequently, caregiver directed non-pharmacologic therapies have increased while medication use for BPSD has diminished. Despite such initiatives, however, antipsychotics continue to be prescribed "off-label" for roughly 20% of nursing home patients. How caregivers impact management approaches and prescribing decisions for BPSD, including antipsychotic use, is poorly understood. Aim: assesses experiences and perceptions of family and nursing caregivers regarding factors influencing medication decisions for BPSD. Research Design and Methods: Semi-structured interviews, analyzed via template, immersion and crystallization, and thematic development. Thirty-two participants from Northwestern Virginia representing five groups of caregivers for dementia patients were interviewed: families of community-dwelling, assisted living, and nursing home patients, and nurses from the same assisted living/nursing home facilities. Results: Caregivers described three major themes regarding medications: (a) Systemic barriers exist for non-pharmacologic BPSD therapies. (b) Medications have few barriers, and seem generally effective and safe. (c) When non-pharmacologic measures fail, medications, including antipsychotics, may be necessary and appropriate for palliation of patient distress. Discussion and Implications: To further reduce medications for BPSD, obstacles to services and alternative therapies must be mitigated. Caregiver perceptions that medications are generally safe and effective contribute to their continued use. Guidelines and policies for behavioural and psychological symptoms of dementia management should incorporate the caregiver position that medications, including anti-psychotics, are sometimes justified and required to alleviate patient suffering. PMID: 28402533 [PubMed - as supplied by publisher]

A personalized medication management platform (PMMP) to improve medication adherence: A randomized control trial.

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A personalized medication management platform (PMMP) to improve medication adherence: A randomized control trial. Comput Methods Programs Biomed. 2017 Mar;140:275-281 Authors: Huang CY, Nguyen PA, Clinciu DL, Hsu CK, Lu JR, Yang HC, Wu CC, Tsai WC, Chou YC, Kuo TB, Chang PL, Jian WS, Li YJ Abstract OBJECTIVES: Medication non-adherence caused by forgetting and delays has serious health implications and causes substantial expenses to patients, healthcare providers, and insurance companies. We assessed the effectiveness of a personalized medication management platform (PMMP) for improving medication adherence, self-management medication, and reducing long-term medication costs. METHODS: We developed a mobile PMMP to reduce delayed and missed medications. A randomized control trial was conducted of three medical centers in Taiwan. A total 1198 participants who aged over 20 years, received outpatient prescription drugs for a maximum period of 14 days. 763 patients were randomly assigned to intervention group as receiving daily SMS reminders for their medications and 434 patients in control group did not. The primary outcome was change in delaying and forgetting medication between before and after intervention (after 7 days). RESULTS: Medication delays were reduced from 85% to 18% (67% improvement) after SMSs for the intervention group and from 80% to 43% (37% improvement) for the control group. Patients forgot medications were significantly reduced from 46% to 5% (41% improvement) for the experimental group after SMSs and from 44% to 17% (27% improvement) for the control group. The SMSs were considered helpful by 83% of patients and 74% of them thought SMSs help in controlling diseases. 92% of patients would recommend this system to their family and friends. CONCLUSIONS: A timely and personalized medication reminder through SMS can improve medication adherence in a nationalized healthcare system with overall savings in medication costs and significant improvements in health and disease management. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02197689. PMID: 28254084 [PubMed - indexed for MEDLINE]

Reproductive, maternal, newborn, and child health: key messages from Disease Control Priorities 3rd Edition.

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Reproductive, maternal, newborn, and child health: key messages from Disease Control Priorities 3rd Edition. Lancet. 2016 12 03;388(10061):2811-2824 Authors: Black RE, Levin C, Walker N, Chou D, Liu L, Temmerman M, DCP3 RMNCH Authors Group Abstract As part of Disease Control Priorities 3rd Edition, the World Bank will publish a volume on Reproductive, Maternal, Newborn, and Child Health that identifies essential cost-effective health interventions that can be scaled up to reduce maternal, newborn, and child deaths, and stillbirths. This Review summarises the volume's key findings and estimates the effect and cost of expanded implementation of these interventions. Recognising that a continuum of care from the adolescent girl, woman, or mother to child is needed, the volume includes details of preventive and therapeutic health interventions in integrated packages: Maternal and Newborn Health and Child Health (along with folic acid supplementation, a key reproductive health intervention). Scaling up all interventions in these packages from coverage in 2015 to hypothetically immediately achieve 90% coverage would avert 149 000 maternal deaths, 849 000 stillbirths, 1 498 000 neonatal deaths, and 1 515 000 additional child deaths. In alternative calculations that consider only the effects of reducing the number of pregnancies by provision of contraceptive services as part of a Reproductive Health package, meeting 90% of the unmet need for contraception would reduce global births by almost 28 million and consequently avert deaths that could have occurred at 2015 rates of fertility and mortality. Thus, 67 000 maternal deaths, 440 000 neonatal deaths, 473 000 child deaths, and 564 000 stillbirths could be averted from avoided pregnancies. Particularly effective interventions in the Maternal and Newborn Health and Child Health packages would be management of labour and delivery, care of preterm births, and treatment of serious infectious diseases and acute malnutrition. Nearly all of these essential interventions can be delivered by health workers in the community or in primary health centres, which can increase population access to needed services. The annual incremental cost of immediately scaling up these essential interventions would be US$6·2 billion in low-income countries, $12·4 billion in lower-middle-income countries, and $8·0 billion in upper-middle-income countries. With the additional funding, greater focus on high-effect integrated interventions and innovations in service delivery, such as task shifting to other groups of health workers and supply and demand incentives, can help rectify major gaps in accessibility and quality of care. In recent decades, reduction of avoidable maternal and child deaths has been a global priority. With continued priority and expansion of essential reproductive, maternal, newborn, and child health interventions to high coverage, equity, and quality, as well as interventions to address underlying problems such as women's low status in society and violence against women, these deaths and substantial morbidity can be largely eliminated in another generation. PMID: 27072119 [PubMed - indexed for MEDLINE]

Hours and Miles: Patient and Health System Implications of Transfer for Psychiatric Bed Capacity.

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Hours and Miles: Patient and Health System Implications of Transfer for Psychiatric Bed Capacity. West J Emerg Med. 2016 Nov;17(6):783-790 Authors: O'Neil AM, Sadosty AT, Pasupathy KS, Russi C, Lohse CM, Campbell RL Abstract INTRODUCTION: An increasing number of behavioral health (BH) patients are presenting to the emergency department (ED) while BH resources continue to decline. This situation-may lead to more external transfers to find care. METHODS: This is a retrospective cohort study of consecutive patients presenting to a tertiary care academic ED from February 1, 2013, through January 31, 2014. Patients were identified through electronic health record documentation of psychiatric consultation during ED evaluation. We reviewed electronic health records for demographic characteristics, diagnoses, payer source, ED length of stay, ED disposition, arrival method, and distance traveled to an external facility for inpatient admission. Univariable and multivariable associations with transfer to an external facility in comparison with patients admitted internally were evaluated with logistic regression models and summarized with odds ratios (OR). RESULTS: We identified 2,585 BH visits, of which 1,083 (41.9%) resulted in discharge. A total of 1,502 patient visits required inpatient psychiatric admission, and of these cases, 177 patients (11.8%; 95% CI = [10.2-13.5]) required transfer to an external facility. The median ED length of stay for transferred patients was 13.9 hours (interquartile range [IQR], 9.3-20.2 hours; range, 3.0-243.0 hours). The median distance for transport was 83 miles (IQR, 42-111 miles; range, 42-237 miles). In multivariable analysis, patients with suicidal or homicidal ideation had increased risk of transfer (odds ratio [OR] [95% CI], 1.93 [1.22-3.06]; P=0.005). Children younger than 18 years (OR [95% CI], 2.34 [1.60-3.40]; P<0.001) and adults older than 65 years (OR [95% CI], 3.46 [1.93-6.19]; P<0.001) were more likely to require transfer and travel farther to access care. CONCLUSION: Patients requiring external transfer for inpatient psychiatric care were found to have prolonged ED lengths of stay. Patients with suicidal and homicidal ideation as well as children and adults older than 65 years are more likely to require transfer. PMID: 27833689 [PubMed - indexed for MEDLINE]

Using nicotine in scalp hair to assess maternal passive exposure to tobacco smoke.

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Using nicotine in scalp hair to assess maternal passive exposure to tobacco smoke. Environ Pollut. 2017 Mar;222:276-282 Authors: Li Z, Li Z, Zhang J, Huo W, Zhu Y, Xie J, Lu Q, Wang B Abstract Quantifying population exposure level to tobacco smoke is important for investigating its adverse effects on human health. We aimed to investigate the feasibility and application of using population hair concentrations of nicotine and cotinine to indicate their exposure level to tobacco smoke among pregnant women. Our study recruited 256 mothers who delivered healthy babies and collected their hair samples from scalp, of which 172 mothers were self-reported non-passive smokers and the other 84 mothers were self-reported passive smokers. We analyzed nicotine and cotinine concentrations of the hair section grown during the early pregnancy. The linear relationship between cotinine and nicotine was developed and validated by internal cross-validation method. Our results revealed that self-reported passive smokers had higher concentrations of nicotine [2.08 (1.00-4.46) ng/mg hair, i.e. median value (inter-quartile range)] and cotinine [0.063 (0.041-0.148) ng/mg hair] than non-passive smokers [1.35 (0.58-2.59) ng/mg hair of nicotine and 0.049 (0.022-0.087) ng/mg hair of cotinine, respectively]. There existed a linear regression model between hair cotinine and nicotine concentrations, i.e. [cotinine] = 0.024 × [nicotine]+0.0184 (R(2) = 0.756) for this population. The internal cross-validation squared correlation coefficient slightly increased from 0.689 to 0.734 with the training subjects varying from 20% to 90%, suggesting that this regression model had high robustness and predictive accuracy. It was concluded that nicotine in maternal hair can evaluate the hair cotinine level and reflect maternal passive exposure level to ambient tobacco smoke with high sensitivity. PMID: 28040338 [PubMed - indexed for MEDLINE]

Sex Trafficking of Minors.

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Sex Trafficking of Minors. Pediatr Clin North Am. 2017 Apr;64(2):413-421 Authors: Moore JL, Kaplan DM, Barron CE Abstract Sex trafficking is an increasingly recognized global health crisis affecting every country and region in the world. Domestic minor sex trafficking is a subset of commercial sexual exploitation of children, defined as engagement of minors (<18 years of age) in sexual acts for items of value (eg, food, shelter, drugs, money) involving children victimized within US borders. These involved youth are at risk for serious immediate and long-term physical and mental health consequences. Continued efforts are needed to improve preventive efforts, identification, screening, appropriate interventions, and subsequent resource provision for victimized and high-risk youth. PMID: 28292455 [PubMed - in process]

The school doctorand suspected child abuse : towards good practice recommendations in the child’s interest

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The school doctorand suspected child abuse : towards good practice recommendations in the child's interest. Rev Med Liege. 2016 Oct;71(10):428-434 Authors: Noirhomme-Renard F, Blavier A, Lachaussée S, Monville C, Nihoul C, Gosset C Abstract Child maltreatment, including all forms of mal¬treatment, remains a major public health problem in high-income countries. Healthcare professionals only contribute to a small proportion of reports. In French-speaking Belgium, almost 100 % of school-aged children are regularly submitted to periodical school health visits. The school health doctor is well placed to recognize neglected or abused children. Based on international good practice recommendations, this paper proposes means for the detection and management of child abuse in the context of school medicine. PMID: 28383850 [PubMed - in process]

Breaking the barriers: Migrants and tuberculosis.

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Breaking the barriers: Migrants and tuberculosis. Presse Med. 2017 Mar;46(2 Pt 2):e5-e11 Authors: Sotgiu G, Dara M, Centis R, Matteelli A, Solovic I, Gratziou C, Rendon A, Battista Migliori G Abstract Tuberculosis (TB) can represent an important clinical and public health in developing and developed countries. Low- and middle-income countries are facing an epidemic which is difficult to address because of the drug-resistance spread and the association of TB with HIV/AIDS. High-income countries, whose TB incidence has decreased in the last decades, can be involved in new TB epidemic waves owing to social, healthcare, and economic hurdles and challenges. In particular, migrants coming from high TB incidence countries can represent a new epidemiological issue in the TB care and control in geographical areas where primary care and specialized centres are not equipped to face the clinical and public health issues associated with the TB disease. The healthcare management of individuals with a latent TB infection or the TB disease is heterogeneous and different policies are in place in Europe, and, specifically, in EU countries. Scientific evidence on how to early and efficiently detect TB cases is missing, as well as diagnostic tools to diagnose those who have latent TB infection do not show adequate accuracy. Countries like Greece and Italy have political difficulties in the management of migrants and the poor living conditions in the migration centres can increase the probability of Mycobacterium tuberculosis transmission. A clear advocacy and political commitment are urgently required. The current migration trends represent a threat from a human and a healthcare perspective. New homogeneous and target-oriented policies and strategies are needed to improve the health of the migrant and of the autochthonous populations. PMID: 28256381 [PubMed - indexed for MEDLINE]

Climate Change and Mental Health.

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Climate Change and Mental Health. Am J Nurs. 2017 Apr;117(4):44-52 Authors: Trombley J, Chalupka S, Anderko L Abstract Climate change is an enormous challenge for our communities, our country, and our world. Recently much attention has been paid to the physical impacts of climate change, including extreme heat events, droughts, extreme storms, and rising sea levels. However, much less attention has been paid to the psychological impacts. This article examines the likely psychological impacts of climate change, including anxiety, stress, and depression; increases in violence and aggression; and loss of community identity. Nurses can play a vital role in local and regional climate strategies by preparing their patients, health care facilities, and communities to effectively address the anticipated mental health impacts of climate change. PMID: 28333743 [PubMed - indexed for MEDLINE]

Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis.

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Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis. Presse Med. 2017 Mar;46(2 Pt 2):e53-e62 Authors: Nathavitharana RR, Bond P, Dramowski A, Kotze K, Lederer P, Oxley I, Peters JA, Rossouw C, van der Westhuizen HM, Willems B, Ting TX, von Delft A, von Delft D, Duarte R, Nardell E, Zumla A Abstract Healthcare workers (HCWs) play a central role in global tuberculosis (TB) elimination efforts but their contributions are undermined by occupational TB. HCWs have higher rates of latent and active TB than the general population due to persistent occupational TB exposure, particularly in settings where there is a high prevalence of undiagnosed TB in healthcare facilities and TB infection control (TB-IC) programmes are absent or poorly implemented. Occupational health programmes in high TB burden settings are often weak or non-existent and thus data that record the extent of the increased risk of occupational TB globally are scarce. HCWs represent a limited resource in high TB burden settings and occupational TB can lead to workforce attrition. Stigma plays a role in delayed diagnosis, poor treatment outcomes and impaired well-being in HCWs who develop TB. Ensuring the prioritization and implementation of TB-IC interventions and occupational health programmes, which include robust monitoring and evaluation, is critical to reduce nosocomial TB transmission to patients and HCWs. The provision of preventive therapy for HCWs with latent TB infection (LTBI) can also prevent progression to active TB. Unlike other patient groups, HCWs are in a unique position to serve as agents of change to raise awareness, advocate for necessary resource allocation and implement TB-IC interventions, with appropriate support from dedicated TB-IC officers at the facility and national TB programme level. Students and community health workers (CHWs) must be engaged and involved in these efforts. Nosocomial TB transmission is an urgent public health problem and adopting rights-based approaches can be helpful. However, these efforts cannot succeed without increased political will, supportive legal frameworks and financial investments to support HCWs in efforts to decrease TB transmission. PMID: 28256382 [PubMed - indexed for MEDLINE]

Risk factors for community-acquired bacterial meningitis.

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Risk factors for community-acquired bacterial meningitis. Infect Dis (Lond). 2017 Jun;49(6):433-444 Authors: Lundbo LF, Benfield T Abstract BACKGROUND: Bacterial meningitis is a significant burden of disease and mortality in all age groups worldwide despite the development of effective conjugated vaccines. The pathogenesis of bacterial meningitis is based on complex and incompletely understood host-pathogen interactions. Some of these are pathogen-specific, while some are shared between different bacteria. METHODS: We searched the database PubMed to identify host risk factors for bacterial meningitis caused by the pathogens Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b, because they are three most common causative bacteria beyond the neonatal period. RESULTS: We describe a number of risk factors; including socioeconomic factors, age, genetic variation of the host and underlying medical conditions associated with increased susceptibility to invasive bacterial infections in both children and adults. CONCLUSIONS: As conjugated vaccines are available for these infections, it is of utmost importance to identify high risk patients to be able to prevent invasive disease. PMID: 28301990 [PubMed - indexed for MEDLINE]

Update of Ireland’s national average indoor radon concentration – Application of a new survey protocol.

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Update of Ireland's national average indoor radon concentration - Application of a new survey protocol. J Environ Radioact. 2017 Apr;169-170:1-8 Authors: Dowdall A, Murphy P, Pollard D, Fenton D Abstract In 2002, a National Radon Survey (NRS) in Ireland established that the geographically weighted national average indoor radon concentration was 89 Bq m(-3). Since then a number of developments have taken place which are likely to have impacted on the national average radon level. Key among these was the introduction of amending Building Regulations in 1998 requiring radon preventive measures in new buildings in High Radon Areas (HRAs). In 2014, the Irish Government adopted the National Radon Control Strategy (NRCS) for Ireland. A knowledge gap identified in the NRCS was to update the national average for Ireland given the developments since 2002. The updated national average would also be used as a baseline metric to assess the effectiveness of the NRCS over time. A new national survey protocol was required that would measure radon in a sample of homes representative of radon risk and geographical location. The design of the survey protocol took into account that it is not feasible to repeat the 11,319 measurements carried out for the 2002 NRS due to time and resource constraints. However, the existence of that comprehensive survey allowed for a new protocol to be developed, involving measurements carried out in unbiased randomly selected volunteer homes. This paper sets out the development and application of that survey protocol. The results of the 2015 survey showed that the current national average indoor radon concentration for homes in Ireland is 77 Bq m(-3), a decrease from the 89 Bq m(-3) reported in the 2002 NRS. Analysis of the results by build date demonstrate that the introduction of the amending Building Regulations in 1998 have led to a reduction in the average indoor radon level in Ireland. PMID: 28027495 [PubMed - indexed for MEDLINE]

A prospective study of maternal, fetal and neonatal outcomes in the setting of cesarean section in low- and middle-income countries.

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A prospective study of maternal, fetal and neonatal outcomes in the setting of cesarean section in low- and middle-income countries. Acta Obstet Gynecol Scand. 2017 Apr;96(4):410-420 Authors: Harrison MS, Pasha O, Saleem S, Ali S, Chomba E, Carlo WA, Garces AL, Krebs NF, Hambidge KM, Goudar SS, Kodkany B, Dhaded S, Derman RJ, Patel A, Hibberd PL, Esamai F, Liechty EA, Moore JL, Wallace D, Mcclure EM, Miodovnik M, Koso-Thomas M, Belizan J, Tshefu AK, Bauserman M, Goldenberg RL Abstract INTRODUCTION: Cesarean section (CS) rates are increasing globally with an unclear effect on pregnancy outcomes. The study objective was to quantify maternal and perinatal morbidity and mortality associated with CS compared with vaginal delivery (VD) both within and across sites in low- and middle-income countries. MATERIAL AND METHODS: A prospective population-based study including home and facility births in 337 153 women with a VD and 47 308 women with a CS from 2010 to 2015 was performed in Guatemala, India, Kenya, Pakistan, Zambia and Democratic Republic of Congo. Women were enrolled during pregnancy; delivery and 6-week follow-up data were collected. RESULTS: Across all sites, CS rates increased from 8.6% to 15.2%, but remained low in African sites. Younger, nulliparous women were more likely to have a CS, as were women with higher education and those delivering an infant weighing 1500-2499 g. Across all sites, maternal and neonatal mortality was higher, and stillbirths were lower, in pregnancies delivered by CS. Antepartum and postpartum complications as well as obstetric interventions and treatments were more common among women who underwent CS. In stratified analyses, all outcomes were worse in women with a CS compared with VD in African compared to non-African sites. CONCLUSIONS: CS rates increased across all sites during the study period, but at more pronounced rates in the non-African sites. CS was associated with reduced postpartum hemorrhage and lower rates of stillbirths in the non-African sites. In the African sites, CS was associated with an increase in all adverse outcomes. Further studies are necessary to better understand the increase in adverse outcomes with CS in the African sites. PMID: 28107771 [PubMed - indexed for MEDLINE]

“Suicide shall cease to be a crime”: suicide and undetermined death trends 1970-2000 before and after the decriminalization of suicide in Ireland 1993.

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"Suicide shall cease to be a crime": suicide and undetermined death trends 1970-2000 before and after the decriminalization of suicide in Ireland 1993. Ir J Med Sci. 2017 Feb;186(1):201-205 Authors: Osman M, Parnell AC, Haley C Abstract INTRODUCTION: Suicide is criminalized in more than 100 countries around the world. A dearth of research exists into the effect of suicide legislation on suicide rates and available statistics are mixed. MATERIALS AND METHODS: This study investigates 10,353 suicide deaths in Ireland that took place between 1970 and 2000. Irish 1970-2000 annual suicide data were obtained from the Central Statistics Office and modelled via a negative binomial regression approach. We examined the effect of suicide legislation on different age groups and on both sexes. We used Bonferroni correction for multiple modelling. Statistical analysis was performed using the R statistical package version 3.1.2. The coefficient for the effect of suicide act on overall suicide deaths was -9.094 (95 % confidence interval (CI) -34.086 to 15.899), statistically non-significant (p = 0.476). The coefficient for the effect suicide act on undetermined deaths was statistically significant (p < 0.001) and was estimated to be -644.4 (95 % CI -818.6 to -469.9). CONCLUSION: The results of our study indicate that legalization of suicide is not associated with a significant increase in subsequent suicide deaths. However, undetermined death verdict rates have significantly dropped following legalization of suicide. PMID: 27189711 [PubMed - indexed for MEDLINE]

Towards a building typology and terminology for Irish hospitals.

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Towards a building typology and terminology for Irish hospitals. Ir J Med Sci. 2017 Feb;186(1):1-16 Authors: Grey T, Kennelly S, de Freine P, Mahon S, Mannion V, O'Neill D Abstract BACKGROUND: The physical form of the hospital environment shapes the care setting and influences the relationship of the hospital to the community. Due to ongoing demographic change, evolving public health needs, and advancing medical practice, typical hospitals are frequently redeveloped, retrofitted, or expanded. It is argued that multi-disciplinary and multi-stakeholder approaches are required to ensure that hospital design matches these increasingly complex needs. To facilitate such a conversation across different disciplines, experts, and community stakeholders, it is helpful to establish a hospital typology and associated terminology as part of any collaborative process. AIMS: Examine the literature around hospital design, and review the layout and overall form of a range of typical Irish acute public hospitals, to outline an associated building typology, and to establish the terminology associated with the planning and design of these hospitals in Ireland. METHODS: Searches in 'Academic Search Complete', 'Compendex', 'Google', 'Google Scholar', 'JSTOR', 'PADDI', 'Science Direct', 'Scopus', 'Web of Science', and Trinity College Dublin Library. The search terms included: 'hospital design history'; 'hospital typology'; 'hospital design terminology'; and 'hospital design Ireland'. RESULTS: Typical hospitals are composed of different layouts due to development over time; however, various discrete building typologies can still be determined within many hospitals. This paper presents a typology illustrating distinct layout, circulation, and physical form characteristics, along with a hospital planning and design terminology of key terms and definitions. CONCLUSION: This typology and terminology define the main components of Irish hospital building design to create a shared understanding around design, and support stakeholder engagement, as part of any collaborative design process. PMID: 28133714 [PubMed - indexed for MEDLINE]

Global Asthma Network survey suggests more national asthma strategies could reduce burden of asthma.

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Global Asthma Network survey suggests more national asthma strategies could reduce burden of asthma. Allergol Immunopathol (Madr). 2017 Mar - Apr;45(2):105-114 Authors: Asher I, Haahtela T, Selroos O, Ellwood P, Ellwood E, Global Asthma Network Study Group Abstract BACKGROUND: Several countries or regions within countries have an effective national asthma strategy resulting in a reduction of the large burden of asthma to individuals and society. There has been no systematic appraisal of the extent of national asthma strategies in the world. METHODS: The Global Asthma Network (GAN) undertook an email survey of 276 Principal Investigators of GAN centres in 120 countries, in 2013-2014. One of the questions was: "Has a national asthma strategy been developed in your country for the next five years? For children? For adults?". RESULTS: Investigators in 112 (93.3%) countries answered this question. Of these, 26 (23.2%) reported having a national asthma strategy for children and 24 (21.4%) for adults; 22 (19.6%) countries had a strategy for both children and adults; 28 (25%) had a strategy for at least one age group. In countries with a high prevalence of current wheeze, strategies were significantly more common than in low prevalence countries (11/13 (85%) and 7/31 (22.6%) respectively, p<0.001). INTERPRETATION: In 25% countries a national asthma strategy was reported. A large reduction in the global burden of asthma could be potentially achieved if more countries had an effective asthma strategy. PMID: 28161283 [PubMed - indexed for MEDLINE]

Human Life History Strategies.

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Human Life History Strategies. Evol Psychol. 2017 Jan;15(1):1474704916677342 Authors: Chua KJ, Lukaszewski AW, Grant DM, Sng O Abstract Human life history (LH) strategies are theoretically regulated by developmental exposure to environmental cues that ancestrally predicted LH-relevant world states (e.g., risk of morbidity-mortality). Recent modeling work has raised the question of whether the association of childhood family factors with adult LH variation arises via (i) direct sampling of external environmental cues during development and/or (ii) calibration of LH strategies to internal somatic condition (i.e., health), which itself reflects exposure to variably favorable environments. The present research tested between these possibilities through three online surveys involving a total of over 26,000 participants. Participants completed questionnaires assessing components of self-reported environmental harshness (i.e., socioeconomic status, family neglect, and neighborhood crime), health status, and various LH-related psychological and behavioral phenotypes (e.g., mating strategies, paranoia, and anxiety), modeled as a unidimensional latent variable. Structural equation models suggested that exposure to harsh ecologies had direct effects on latent LH strategy as well as indirect effects on latent LH strategy mediated via health status. These findings suggest that human LH strategies may be calibrated to both external and internal cues and that such calibrational effects manifest in a wide range of psychological and behavioral phenotypes. PMID: 28164721 [PubMed - indexed for MEDLINE]

Risky sun tanning behaviours amongst Irish University students: a quantitative analysis.

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Risky sun tanning behaviours amongst Irish University students: a quantitative analysis. Ir J Med Sci. 2016 Nov;185(4):887-893 Authors: Flannery C, Burke LA, Grainger L, Williams P, Gage H Abstract BACKGROUND: Despite Ireland's temperate maritime climate, it has the third highest rate of malignant melanoma in the European Union, indicating the need to recognise tanning practices as a risky behaviour, especially amongst those most at risk (the younger population). AIM: To explore the factors associated with deliberate sun tanning amongst university students in Cork, Ireland. METHODS: Self-reported sun exposure, attitudes to tanning and sun protection practices were investigated using an online questionnaire in April 2010. RESULTS: There were 833 responses (8.33 %), mean age 22 years, 75 % female. Reporting deliberate tanning in the previous summer (n = 389, 46.7 %) was positively correlated (r = 0.622, p < 0.001) with stating an intention to tan next summer (n = 532, 63.9 %). Women and respondents with darker (vs. fairer) complexion were more likely to engage in deliberate tanning (p < 0.001). Deliberate tanning was associated with reporting enjoying tanning (p < 0.001), with reporting peer pressure into tanning (p = 0.039), and (marginally) with thinking it is worth getting burnt to get a tan (p = 0.068). Younger students were significantly more likely to report these attitudes; being a current smoker was associated with reporting peer pressure and that burning is worth a tan, indicating a level of risk-taking. Respondents reported (average) three sources of information on sun risks. CONCLUSION: Tanning is a form of strongly motivated risk-taking as much in a sun-limited country like Ireland as in hotter sun-rich climates. Risk communication strategies on sun exposure should be developed that target young people and improve their risk awareness. PMID: 26659080 [PubMed - indexed for MEDLINE]

Attitudes and perceived risk of cannabis use in Irish adolescents.

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Attitudes and perceived risk of cannabis use in Irish adolescents. Ir J Med Sci. 2016 Aug;185(3):643-7 Authors: Barrett P, Bradley C Abstract INTRODUCTION: Cannabis is the most widely used illicit drug in the developed world and its use is associated with several adverse physical and mental health effects and negative social outcomes. Earlier use of cannabis increases the risk of adverse effects. Attitudes and perceived risk towards drugs are regarded as strong influences in determining whether or not a person uses cannabis, but there is little existing research on Irish teenagers' attitudes to the risks of this drug. METHODS: This was a descriptive, cross-sectional study using a structured, anonymous questionnaire. The study was undertaken in nine public and private secondary schools in Cork City and suburbs. Students aged 15-18 and in fourth, fifth or sixth year of school were included. RESULTS: Of the 507 participating students, 39.3 % (n = 199) reported previous cannabis use. There were significantly lower levels of perceived risk of cannabis among those who had used the drug compared with those who had not, for all categories of risk (p < 0.01). Attitudes towards cannabis were more liberal among males and those with previous use of the drug. A minority of students (n = 92; 18.2 %) support legalisation of cannabis. The majority of teenagers (n = 382; 75.8 %) believe that they are not given enough information about the drug. CONCLUSIONS: Cannabis use is very widespread among teenagers in Cork. There are relatively low levels of perceived risk of mental and physical health problems with use of the drug. Attitudes towards cannabis are associated with personal use of the drug and gender. PMID: 26141461 [PubMed - indexed for MEDLINE]

Cardiac syndrome X in Ireland: incidence and phenotype.

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Cardiac syndrome X in Ireland: incidence and phenotype. Ir J Med Sci. 2016 Nov;185(4):857-863 Authors: Dollard J, Kearney P, Dinan TG Abstract BACKGROUND: Cardiac syndrome X (CSX) is typical angina pectoris with objective signs of myocardial ischaemia despite a normal coronary angiogram and may be due to microvascular dysfunction. The incidence of CSX has not been greatly investigated worldwide and its incidence in Ireland is unknown. AIMS: We aimed to determine the incidence of CSX in Cork University Hospital (CUH) and to establish the phenotype of the typical Irish CSX patient. METHODS: All patients undergoing coronary angiography in CUH during regular working hours over a 3-month period were investigated. CSX was diagnosed using standard criteria. An extended recruitment period of 14 months allowed enrolment of a sufficient number of CSX patients to enable phenotyping. RESULTS: Only 5 of 372 (1.3 %) patients undergoing angiography to investigate chest pain met the diagnostic criteria for CSX. None were given a discharge diagnosis of CSX or received cardiology follow-up. Irish CSX patients were predominantly female (88 %) with a mean age of 59.2 ± 6.6 years. Although they were significantly less functionally limited than patients with obstructive CAD, they had an equally substantial impairment in quality of life. CONCLUSIONS: CSX is relatively uncommon in Ireland and is most frequently seen in middle-aged women with hyperlipidaemia. It has significant impacts on patients' quality of life. None of the CSX patients were diagnosed as such, highlighting the lack of awareness or acceptance of this condition in Ireland. These patients require diagnosis and active cardiology follow-up to effectively manage their symptoms. PMID: 26614494 [PubMed - indexed for MEDLINE]

The quasi-market for adult residential care in the UK: Do for-profit, not-for-profit or public sector residential care and nursing homes provide better quality care?

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The quasi-market for adult residential care in the UK: Do for-profit, not-for-profit or public sector residential care and nursing homes provide better quality care? Soc Sci Med. 2017 Feb 27;179:137-146 Authors: Barron DN, West E Abstract There has been a radical transformation in the provision of adult residential and nursing home care in England over the past four decades. Up to the 1980s, over 80% of adult residential care was provided by the public sector, but today public sector facilities account for only 8% of the available places, with the rest being provided by a mixture of for-profit firms (74%) and non-profit charities (18%). The public sector's role is often now that of purchaser (paying the fees of people unable to afford them) and regulator. While the idea that private companies may play a bigger role in the future provision of health care is highly contentious in the UK, the transformation of the residential and nursing home care has attracted little comment. Concerns about the quality of care do emerge from time to time, often stimulated by high profile media investigations, scandals or criminal prosecutions, but there is little or no evidence about whether or not the transformation of the sector from largely public to private provision has had a beneficial effect on those who need the service. This study asks whether there are differences in the quality of care provided by public, non-profit or for-profit facilities in England. We use data on care quality for over 15,000 homes that are provided by the industry regulator in England: the Care Quality Commission (CQC). These data are the results of inspections carried out between April 2011 and October 2015. Controlling for a range of facility characteristics such as age and size, proportional odds logistic regression showed that for-profit facilities have lower CQC quality ratings than public and non-profit providers over a range of measures, including safety, effectiveness, respect, meeting needs and leadership. We discuss the implications of these results for the ongoing debates about the role of for-profit providers of health and social care. PMID: 28273611 [PubMed - as supplied by publisher]

Commitment, confidence, and concerns: Assessing health care professionals’ child maltreatment reporting attitudes.

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Commitment, confidence, and concerns: Assessing health care professionals' child maltreatment reporting attitudes. Child Abuse Negl. 2017 Feb 24;67:54-63 Authors: Foster RH, Olson-Dorff D, Reiland HM, Budzak-Garza A Abstract Given that childhood maltreatment is a significant international public health problem contributing to all major morbidity and mortality determinants, there is need to explore current practices and readiness of health care professionals (HCPs) to assess maltreatment, identify maltreatment risk factors, and complete mandated reporting. HCPs (N=114) completed a child maltreatment mandated reporting measure to assess level of comfort with mandated reporting, commitment to the reporting role, and confidence in the child protection system to take action as needed. Additional questions explored comfort discussing maltreatment and risk factors for maltreatment in a medical setting and knowledge of community resources. Results indicated that HCPs were committed to their mandated reporting role and did not perceive substantial potential negative consequences of reporting. However, there were concerns regarding lack of confidence in the system's ability to respond sufficiently to reports. Despite commitment to the reporting role, results showed that large proportions of HCPs do not routinely screen for maltreatment, feel uncomfortable discussing maltreatment history, and lack knowledge about community resources. Additional training efforts must be prioritized in health care systems to improve short- and long-term health outcomes. PMID: 28242367 [PubMed - as supplied by publisher]

Sexual violence and unwanted pregnancies in migrant women

The Lancet Global Health

Authors:  Giussy Barbara, Federica Collini, Cristina Cattaneo, Laura Marasciuolo, Laura Chiappa, Luigi Fedele, Alessandra Kustermann

Source: The lancet, global health
Volume 5, No. 4, e396–e397, April 2017
http://dx.doi.org/10.1016/S2214-109X(17)30075-X

The eSexual Health Clinic system for management, prevention, and control of sexually transmitted infections: exploratory studies in people testing for Chlamydia trachomatis

Authors: Claudia S Estcourt, Jo Gibbs, Lorna J Sutcliffe, Voula Gkatzidou, Laura Tickle, Kate Hone, Catherine Aicken, Catherine M Lowndes, Emma M Harding-Esch, Sue Eaton, Pippa Oakeshott, Ala Szczepura, Richard E Ashcroft, Andrew Copas, Anthony Nettleship, S Tariq Sadiq, Pam Sonnenberg

Source: Lancet Public Health 2017
http://dx.doi.org/10.1016/S2468-2667(17)30034-8

Finding resiliency in the face of financial barriers: Development of a conceptual framework for people with cardiovascular-related chronic disease.

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Finding resiliency in the face of financial barriers: Development of a conceptual framework for people with cardiovascular-related chronic disease. Medicine (Baltimore). 2016 Dec;95(49):e5561 Authors: Campbell DJ, Manns BJ, Leblanc P, Hemmelgarn BR, Sanmartin C, King-Shier K Abstract Patients with chronic diseases often face financial barriers to optimize their health. These financial barriers may be related to direct healthcare costs such as medications or self-monitoring supplies, or indirect costs such as transportation to medical appointments. No known framework exists to understand how financial barriers impact patients' lives or their health outcomes.We undertook a grounded theory study to develop such a framework. We used semistructured interviews with a purposive sample of participants with cardiovascular-related chronic disease (hypertension, diabetes, heart disease, or stroke) from Alberta, Canada. Interview transcripts were analyzed in triplicate, and interviews continued until saturation was reached.We interviewed 34 participants. We found that the confluence of 2 events contributed to the perception of having a financial barrier-onset of chronic disease and lack of income or health benefits. The impact of having a perceived financial barrier varied considerably. Protective, predisposing, or modifying of factors determined how impactful a financial barrier would be. An individual's particular set of factors is then shaped by their worldview. This combination of factors and lens determines one's degree of resiliency, which ultimately impacts how well they cope with their disease.The role of financial barriers is complex. How well an individual copes with their financial barriers is intimately tied to resiliency, which is related to the composite of a personal circumstances and their worldview. Our framework for understanding the experience of financial barriers can be used by both researchers and clinicians to better understand patient behavior. PMID: 27930562 [PubMed - indexed for MEDLINE]

Generation of global political priority for early childhood development: the challenges of framing and governance.

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Generation of global political priority for early childhood development: the challenges of framing and governance. Lancet. 2017 01 07;389(10064):119-124 Authors: Shawar YR, Shiffman J Abstract Despite progress, early childhood development (ECD) remains a neglected issue, particularly in resource-poor countries. We analyse the challenges and opportunities that ECD proponents face in advancing global priority for the issue. We triangulated among several data sources, including 19 semi-structured interviews with individuals involved in global ECD leadership, practice, and advocacy, as well as peer-reviewed research, organisation reports, and grey literature. We undertook a thematic analysis of the collected data, drawing on social science scholarship on collective action and a policy framework that elucidates why some global initiatives are more successful in generating political priority than others. The analysis indicates that the ECD community faces two primary challenges in advancing global political priority. The first pertains to framing: generation of internal consensus on the definition of the problem and solutions, agreement that could facilitate the discovery of a public positioning of the issue that could generate political support. The second concerns governance: building of effective institutions to achieve collective goals. However, there are multiple opportunities to advance political priority for ECD, including an increasingly favourable political environment, advances in ECD metrics, and the existence of compelling arguments for investment in ECD. To advance global priority for ECD, proponents will need to surmount the framing and governance challenges and leverage these opportunities. PMID: 27717613 [PubMed - indexed for MEDLINE]

IFITM3 and severe influenza virus infection. No evidence of genetic association.

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IFITM3 and severe influenza virus infection. No evidence of genetic association. Eur J Clin Microbiol Infect Dis. 2016 Nov;35(11):1811-1817 Authors: López-Rodríguez M, Herrera-Ramos E, Solé-Violán J, Ruíz-Hernández JJ, Borderías L, Horcajada JP, Lerma-Chippirraz E, Rajas O, Briones M, Pérez-González MC, García-Bello MA, López-Granados E, Rodriguez de Castro F, Rodríguez-Gallego C Abstract Influenza virus infection (IVI) is typically subclinical or causes a self-limiting upper respiratory disease. However, in a small subset of patients IVI rapidly progresses to primary viral pneumonia (PVP) with respiratory failure; a minority of patients require intensive care unit admission. Inherited and acquired variability in host immune responses may influence susceptibility and outcome of IVI. However, the molecular basis of such human factors remains largely elusive. It has been proposed that homozygosity for IFITM3 rs12252-C is associated with a population-attributable risk of 5.4 % for severe IVI in Northern Europeans and 54.3 % for severe H1N1pdm infection in Chinese. A total of 148 patients with confirmed IVI were considered for recruitment; 118 Spanish patients (60 of them hospitalized with PVP) and 246 healthy Spanish individuals were finally included in the statistical analysis. PCR-RFLP was used with confirmation by Sanger sequencing. The allele frequency for rs12252-C was found to be 3.5 % among the general Spanish population. We found no rs12252-C homozygous individuals in our control group. The only Spanish patient homozygous for rs12252-C had a neurological disorder (a known risk factor for severe IVI) and mild influenza. Our data do not suggest a role of rs12252-C in the development of severe IVI in our population. These data may be relevant to recognize whether patients homozygous for rs12252-C are at risk of severe influenza, and hence require individualized measures in the case of IVI. PMID: 27492307 [PubMed - indexed for MEDLINE]

Radiation exposure in diagnostic imaging: wisdom and prudence, but still a lot to understand.

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Radiation exposure in diagnostic imaging: wisdom and prudence, but still a lot to understand. Radiol Med. 2017 Mar;122(3):215-220 Authors: Tomà P, Cannatà V, Genovese E, Magistrelli A, Granata C Abstract Since 2000, a series of scientific articles on CT have been raising increasing concern about the risk of radiation induced cancer in children. The alarming conclusions of some of these articles had international echo through global media, provoking widespread public concern. Actually, many of these alarming scientific publications appeared to be flawed by poor study design, but their conclusions were not openly contradicted. In US and Europe pediatric radiologists had to face a huge challenge, which brought to the Image Gently campaign and the Eurosafe initiative with the aim to rebut misinformation and to support medical radiation protection. The Linear No Threshold model-which is the base of contemporary radioprotection-is increasingly questioned by new recent studies suggesting that low dose radiation would decrease cancer risk thanks to the enhancement of immune system response. Actually, pediatric radiologists have to cope with many important issues and contradictory messages. Good medical practice includes good communication about the benefits and risks of health procedures, thus the communication of radiation risk is a key component for radiologists. When considering benefits and risks, an important risk is too often ignored: the risk that skipping a diagnostic exam may cause a misdiagnosis, and therefore, a poor outcome. We should emphasize that a risk from a radiological investigation is very small, if a risk at all, and we are not sure that there is a risk at very low doses, like those doses in the majority of X-ray procedures including CT. PMID: 27888430 [PubMed - indexed for MEDLINE]

Does vaccination ensure protection? Assessing diphtheria and tetanus antibody levels in a population of healthy children: A cross-sectional study.

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Does vaccination ensure protection? Assessing diphtheria and tetanus antibody levels in a population of healthy children: A cross-sectional study. Medicine (Baltimore). 2016 Dec;95(49):e5571 Authors: Gowin E, Wysocki J, Kałużna E, Świątek-Kościelna B, Wysocka-Leszczyńska J, Michalak M, Januszkiewicz-Lewandowska D Abstract Vaccination effectiveness is proven when the disease does not develop after a patient is exposed to the pathogen. In the case of rare diseases, vaccination effectiveness is assessed by monitoring specific antibody levels in the population. Such recurrent analyses allow the evaluation of vaccination programs. The primary schedule of diphtheria and tetanus vaccinations is similar in various countries, with differences mainly in the number and timing of booster doses. The aim of the study was to assess diphtheria and tetanus antibody concentrations in a population of healthy children.Diphtheria and tetanus antibody levels were analyzed in a group of 324 children aged 18 to 180 months. All children were vaccinated in accordance with the Polish vaccination schedule.Specific antibody concentrations greater than 0.1 IU/mL were considered protective against tetanus or diphtheria. Levels above 1.0 were considered to ensure long-term protection.Protective levels of diphtheria antibodies were found in 229 patients (70.46%), and of tetanus in 306 patients (94.15%). Statistically significant differences were found in tetanus antibody levels in different age groups. Mean concentrations and the percentage of children with high tetanus antibody titers increased with age. No similar correlation was found for diphtheria antibodies. High diphtheria antibody levels co-occurred in 72% of the children with high tetanus antibody levels; 95% of the children with low tetanus antibody levels had low levels of diphtheria antibodies.The percentage of children with protective diphtheria antibody levels is lower than that in the case of tetanus antibodies, both in Poland and abroad, but the high proportion of children without diphtheria protection in Poland is an exception. This is all the more puzzling when taking into account that Polish children are administered a total of 5 doses containing a high concentration of diphtheria toxoid, at intervals shorter than 5 years. The decrease in antibody titers occurring over time is a significant factor in vaccination program planning.Tetanus antibody concentrations were found to be high, but responses to the diphtheria and tetanus components were divergent. The percentage of children protected against diphtheria was significantly lower than protected against tetanus. PMID: 27930568 [PubMed - indexed for MEDLINE]

Factors Associated with Sequelae of Campylobacter and Non-typhoidal Salmonella Infections: A Systematic Review.

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Factors Associated with Sequelae of Campylobacter and Non-typhoidal Salmonella Infections: A Systematic Review. EBioMedicine. 2017 Feb;15:100-111 Authors: Esan OB, Pearce M, van Hecke O, Roberts N, Collins DR, Violato M, McCarthy N, Perera R, Fanshawe TR Abstract Despite the significant global burden of gastroenteritis and resulting sequelae, there is limited evidence on risk factors for sequelae development. We updated and extended previous systematic reviews by assessing the role of antibiotics, proton pump inhibitors (PPI) and symptom severity in the development of sequelae following campylobacteriosis and salmonellosis. We searched four databases, including PubMed, from 1 January 2011 to 29 April 2016. Observational studies reporting sequelae of reactive arthritis (ReA), Reiter's syndrome (RS), irritable bowel syndrome (IBS) and Guillain-Barré syndrome (GBS) following gastroenteritis were included. The primary outcome was incidence of sequelae of interest amongst cases of campylobacteriosis and salmonellosis. A narrative synthesis was conducted where heterogeneity was high. Of the 55 articles included, incidence of ReA (n=37), RS (n=5), IBS (n=12) and GBS (n=9) were reported following campylobacteriosis and salmonellosis. A pooled summary for each sequela was not estimated due to high level of heterogeneity across studies (I2>90%). PPI usage and symptoms were sparsely reported. Three out of seven studies found a statistically significant association between antibiotics usage and development of ReA. Additional primary studies investigating risk modifying factors in sequelae of GI infections are required to enable targeted interventions. PMID: 27965105 [PubMed - indexed for MEDLINE]

Collaboration Between Academia and Practice: Interprofessional Crises Leadership and Disaster Management.

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Collaboration Between Academia and Practice: Interprofessional Crises Leadership and Disaster Management. J Nurs Adm. 2017 Feb;47(2):123-128 Authors: Hoying C, Farra S, Mainous R, Baute R, Gneuhs M Abstract An innovative interprofessional disaster preparedness program was designed and implemented through an academic-practice partnership between a large midwestern children's hospital and a community-based state university. This course was part of a constellation of courses developed in response to Presidential Directive (HSPD) 8, a mandate to standardize disaster response training that was issued after the inefficiencies following Hurricane Katrina. A hybrid immersive and didactic approach was used to train senior leadership and frontline clinicians. Included were simulated experiences at the National Center for Medical Readiness, a workshop, and online modules. The program that focused on crisis leadership and disaster management was developed and implemented to serve patient-centered organizations. PMID: 28106683 [PubMed - indexed for MEDLINE]

Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015.

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Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015. JAMA. 2017 01 10;317(2):165-182 Authors: Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, Alexander L, Estep K, Hassen Abate K, Akinyemiju TF, Ali R, Alvis-Guzman N, Azzopardi P, Banerjee A, Bärnighausen T, Basu A, Bekele T, Bennett DA, Biadgilign S, Catalá-López F, Feigin VL, Fernandes JC, Fischer F, Gebru AA, Gona P, Gupta R, Hankey GJ, Jonas JB, Judd SE, Khang YH, Khosravi A, Kim YJ, Kimokoti RW, Kokubo Y, Kolte D, Lopez A, Lotufo PA, Malekzadeh R, Melaku YA, Mensah GA, Misganaw A, Mokdad AH, Moran AE, Nawaz H, Neal B, Ngalesoni FN, Ohkubo T, Pourmalek F, Rafay A, Rai RK, Rojas-Rueda D, Sampson UK, Santos IS, Sawhney M, Schutte AE, Sepanlou SG, Shifa GT, Shiue I, Tedla BA, Thrift AG, Tonelli M, Truelsen T, Tsilimparis N, Ukwaja KN, Uthman OA, Vasankari T, Venketasubramanian N, Vlassov VV, Vos T, Westerman R, Yan LL, Yano Y, Yonemoto N, Zaki ME, Murray CJ Abstract Importance: Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions. Objective: To estimate the association between SBP of at least 110 to 115 mm Hg and SBP of 140 mm Hg or higher and the burden of different causes of death and disability by age and sex for 195 countries and territories, 1990-2015. Design: A comparative risk assessment of health loss related to SBP. Estimated distribution of SBP was based on 844 studies from 154 countries (published 1980-2015) of 8.69 million participants. Spatiotemporal Gaussian process regression was used to generate estimates of mean SBP and adjusted variance for each age, sex, country, and year. Diseases with sufficient evidence for a causal relationship with high SBP (eg, ischemic heart disease, ischemic stroke, and hemorrhagic stroke) were included in the primary analysis. Main Outcomes and Measures: Mean SBP level, cause-specific deaths, and health burden related to SBP (≥110-115 mm Hg and also ≥140 mm Hg) by age, sex, country, and year. Results: Between 1990-2015, the rate of SBP of at least 110 to 115 mm Hg increased from 73 119 (95% uncertainty interval [UI], 67 949-78 241) to 81 373 (95% UI, 76 814-85 770) per 100 000, and SBP of 140 mm Hg or higher increased from 17 307 (95% UI, 17 117-17 492) to 20 526 (95% UI, 20 283-20 746) per 100 000. The estimated annual death rate per 100 000 associated with SBP of at least 110 to 115 mm Hg increased from 135.6 (95% UI, 122.4-148.1) to 145.2 (95% UI 130.3-159.9) and the rate for SBP of 140 mm Hg or higher increased from 97.9 (95% UI, 87.5-108.1) to 106.3 (95% UI, 94.6-118.1). Loss of disability-adjusted life-years (DALYs) associated with SBP of at least 110 to 115 mm Hg increased from 148 million (95% UI, 134-162 million) to 211 million (95% UI, 193-231 million), and for SBP of 140 mm Hg or higher, the loss increased from 5.2 million (95% UI, 4.6-5.7 million) to 7.8 million (95% UI, 7.0-8.7 million). The largest numbers of SBP-related deaths were caused by ischemic heart disease (4.9 million [95% UI, 4.0-5.7 million]; 54.5%), hemorrhagic stroke (2.0 million [95% UI, 1.6-2.3 million]; 58.3%), and ischemic stroke (1.5 million [95% UI, 1.2-1.8 million]; 50.0%). In 2015, China, India, Russia, Indonesia, and the United States accounted for more than half of the global DALYs related to SBP of at least 110 to 115 mm Hg. Conclusions and Relevance: In international surveys, although there is uncertainty in some estimates, the rate of elevated SBP (≥110-115 and ≥140 mm Hg) increased substantially between 1990 and 2015, and DALYs and deaths associated with elevated SBP also increased. Projections based on this sample suggest that in 2015, an estimated 3.5 billion adults had SBP of at least 110 to 115 mm Hg and 874 million adults had SBP of 140 mm Hg or higher. PMID: 28097354 [PubMed - indexed for MEDLINE]

Folic Acid Supplementation for the Prevention of Neural Tube Defects: An Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.

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Folic Acid Supplementation for the Prevention of Neural Tube Defects: An Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2017 01 10;317(2):190-203 Authors: Viswanathan M, Treiman KA, Kish-Doto J, Middleton JC, Coker-Schwimmer EJ, Nicholson WK Abstract Importance: Neural tube defects are among the most common congenital anomalies in the United States. Periconceptional folic acid supplementation is a primary care-relevant preventive intervention. Objective: To review the evidence on folic acid supplementation for preventing neural tube defects to inform the US Preventive Services Task Force for an updated Recommendation Statement. Data Sources: MEDLINE, Cochrane Library, EMBASE, and trial registries through January 28, 2016, with ongoing surveillance through November 11, 2016; references; experts. Study Selection: English-language studies of folic acid supplementation in women. Excluded were poor-quality studies; studies of prepubertal girls, men, women without the potential for childbearing, and neural tube defect recurrence; and studies conducted in developing countries. Data Extraction and Synthesis: Two investigators independently reviewed abstracts, full-text articles, and risk of bias of included studies. One investigator extracted data and a second checked accuracy. Because of heterogeneity, data were not pooled. Main Outcomes and Measures: Neural tube defects, harms of treatment (twinning, respiratory outcomes). Results: A total of 24 studies (N > 58 860) were included. In 1 randomized clinical trial from Hungary initiated in 1984, incidence of neural tube defects for folic acid supplementation compared with trace element supplementation was 0% vs 0.25% (Peto odds ratio [OR], 0.13 [95% CI, 0.03-0.65]; n = 4862). Odds ratios from cohort studies recruiting participants between 1984 and 1996 demonstrated beneficial associations and ranged from 0.11 to 0.27 (n = 19 982). Three of 4 case-control studies with data from 1976 through 1998 reported ORs ranging from 0.6 to 0.7 (n > 7121). Evidence of benefit led to food fortification in the United States beginning in 1998, after which no new prospective studies have been conducted. More recent case-control studies drawing from data collected after 1998 have not demonstrated a protective association consistently with folic acid supplementation, with ORs ranging from 0.93 to 1.4 and confidence intervals spanning the null (n > 13 990). Regarding harms, 1 trial (OR, 1.40 [95% CI, 0.89-2.21]; n = 4767) and 1 cohort study (OR, 1.04 [95% CI, 0.91-1.18]; n = 2620) found no statistically significant increased risk of twinning. Three systematic reviews found no consistent evidence of increased risk of asthma (OR, 1.06 [95% CI, 0.99-1.14]; n = 14 438), wheezing, or allergy. Conclusions and Relevance: In studies conducted before the initiation of food fortification in the United States in 1998, folic acid supplementation provided protection against neural tube defects. Newer postfortification studies have not demonstrated a protective association but have the potential for misclassification and recall bias, which can attenuate the measured association of folic acid supplementation with neural tube defects. PMID: 28097361 [PubMed - indexed for MEDLINE]

Leveraging the real value of laboratory medicine with the value proposition.

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Leveraging the real value of laboratory medicine with the value proposition. Clin Chim Acta. 2016 Nov 01;462:183-186 Authors: Price CP, John AS, Christenson R, Scharnhorst V, Oellerich M, Jones P, Morris HA Abstract Improving quality and patient safety, containing costs and delivering value-for-money are the key drivers of change in the delivery of healthcare and have stimulated a shift from an activity-based service to a service based on patient-outcomes. The delivery of an outcomes-based healthcare agenda requires that the real value of laboratory medicine to all stakeholders be understood, effectively defined and communicated. The value proposition of any product or service is the link between the provider and the needs of the customer describing the utility of the product or service in terms of benefit to the customer. The framework of a value proposition for laboratory medicine provides the core business case that drives key activities in the evolution and maintenance of high quality healthcare from research through to adoption and quality improvement in an established service. The framework of a value proposition for laboratory medicine is described. The content is endorsed by IFCC and WASPaLM. PMID: 27649855 [PubMed - indexed for MEDLINE]

Tuberculosis care strategies and their economic consequences for patients: the missing link to end tuberculosis.

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Tuberculosis care strategies and their economic consequences for patients: the missing link to end tuberculosis. Infect Dis Poverty. 2016 Nov 01;5(1):93 Authors: Getahun B, Wubie M, Dejenu G, Manyazewal T Abstract BACKGROUND: While investment in the development of Tuberculosis (TB) treatment strategies is essential, it cannot be assumed that the strategies are affordable for TB patients living in countries with high economic constraints. This study aimed to determine the economic consequences of directly observed therapy for TB patients. METHODS: A cross-sectional cost-of-illness analysis was conducted between September to November 2015 among 576 randomly selected adult TB patients who were on directly observed treatment in 27 public health facilities in Addis Ababa, Ethiopia. Data were collected using interviewer-administered questionnaire adapted from the Tool to Estimate Patients' Costs. Mean and median costs, reduction of productivity, and household expenditure of TB patients were calculated and ways of coping costs captured. Eta (η), Odds ratio and p values were used to measure association between variables. RESULTS: Of the total 576 TB patients enrolled, 43 % were smear-positive pulmonary TB (PTB), 17 % smear-negative PTB, 37 % Extra-PTB and 3 % multi-drug resistant TB cases. Direct (Out-of-Pocket) mean and median costs of TB illness to patients were $123.0 (SD = 58.8) and $125.78 (R = 338.12), respectively, and indirect (loss income) mean and median costs were $54.26 (SD = 43.5) and $44.61 (R = 215.6), respectively. Mean and median total cost of TB illness to patient were $177.3 (SD = 78.7) and $177.1 (R = 461.8), respectively. The total cost had significant association with patient's household income, residence, need for additional food, and primary income (P <0.05). Direct costs were catastrophic for 63 % of TB patients, regardless of significant difference between gender (P = 0.92) and type of TB cases (P = 0.37). TB patients mean productivity and income reduced by 37 and 10 %, respectively, compared with pre-treatment level, while mean household expenditure increased by 33 % and working hours reduced by 78 % due to TB illness. Income quartile categories were directly correlated with catastrophic costs (η = 0.684). CONCLUSION: Despite the availability of free-of-charge anti-TB drugs, TB patients were suffering from out-of-pocket payments with catastrophic consequences, which in turn were hampering the efforts to end TB. TB patients in resource-limited countries deserve integrated patient-centered care with comprehensive health insurance coverage, financial incentives, and nutrition support to reduce catastrophic costs and retain them in care. Such countries should induce home-based directly observed therapy programs to reduce costs due to attending health facilities, intensify home treatment of critically-ill patients with impaired mobility, and reduce the spread of TB due to patients traveling to seek care. PMID: 27799063 [PubMed - indexed for MEDLINE]

Methods to reduce prescribing errors in elderly patients with multimorbidity.

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Methods to reduce prescribing errors in elderly patients with multimorbidity. Clin Interv Aging. 2016;11:857-66 Authors: Lavan AH, Gallagher PF, O'Mahony D Abstract The global population of multimorbid older people is growing steadily. Multimorbidity is the principal cause of complex polypharmacy, which in turn is the prime risk factor for inappropriate prescribing and adverse drug reactions and events. Those who prescribe for older frailer multimorbid people are particularly prone to committing prescribing errors of various kinds. The causes of prescribing errors in this patient population are multifaceted and complex, including prescribers' lack of knowledge of aging physiology, geriatric medicine, and geriatric pharmacotherapy, overprescribing that frequently leads to major polypharmacy, inappropriate prescribing, and inappropriate drug omission. This review examines the various ways of minimizing prescribing errors in multimorbid older people. The role of education in physician prescribers and clinical pharmacists, the use of implicit and explicit prescribing criteria designed to improve medication appropriateness in older people, and the application of information and communication-technology systems to minimize errors are discussed in detail. Although evidence to support any single intervention to prevent prescribing errors in multimorbid elderly people is inconclusive or lacking, published data support focused prescriber education in geriatric pharmacotherapy, routine application of STOPP/START (screening tool of older people's prescriptions/screening tool to alert to right treatment) criteria for potentially inappropriate prescribing, electronic prescribing, and close liaison between clinical pharmacists and physicians in relation to structured medication review and reconciliation. Carrying out a structured medication review aimed at optimizing pharmacotherapy in this vulnerable patient population presents a major challenge. Another challenge is to design, build, validate, and test by clinical trials suitably versatile and efficient software engines that can reliably and swiftly perform complex medication reviews in older multimorbid people. The European Union-funded SENATOR and OPERAM clinical trials commencing in 2016 will examine the impact of customized software engines in reducing medication-related morbidity, avoidable excess cost, and rehospitalization in older multimorbid people. PMID: 27382268 [PubMed - indexed for MEDLINE]