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Sample records for health guideline aimed

  1. Process Evaluation of an Occupational Health Guideline Aimed at Preventing Weight Gain Among Employees

    NARCIS (Netherlands)

    Verweij, Lisanne M.; Proper, Karin I.; Hulshof, Carel T. J.; van Mechelen, Willem

    2011-01-01

    Objective: To evuate the process of an occupational health guideline aimed at preventing weight gain. Methods: Quantitative data on seven process items were assessed and linked to effects on employees' waist circumference and body weight at 6 months. Results: Occupational physicians (n = 7)

  2. Design of the Balance@Work project: systematic development, evaluation and implementation of an occupational health guideline aimed at the prevention of weight gain among employees

    Directory of Open Access Journals (Sweden)

    Weel Andre NH

    2009-12-01

    Full Text Available Abstract Background Occupational health professionals may play an important role in preventive health promotion activities for employees. However, due to a lack of knowledge and evidence- and practice based methods and strategies, interventions are hardly being implemented by occupational physicians to date. The aim of the Balance@Work project is to develop, evaluate, and implement an occupational health guideline aimed at the prevention of weight gain among employees. Methods Following the guideline development protocol of the Netherlands Society of Occupational Medicine and the Intervention Mapping protocol, the guideline was developed based on literature, interviews with relevant stakeholders, and consensus among an expert group. The guideline consists of an individual and an environmental component. The individual component includes recommendations for occupational physicians on how to promote physical activity and healthy dietary behavior based on principles of motivational interviewing. The environmental component contains an obesogenic environment assessment tool. The guideline is evaluated in a randomised controlled trial among 20 occupational physicians. Occupational physicians in the intervention group apply the guideline to eligible workers during 6 months. Occupational physicians in the control group provide care as usual. Measurements take place at baseline and 6, 12, and 18 months thereafter. Primary outcome measures include waist circumference, daily physical activity and dietary behavior. Secondary outcome measures include sedentary behavior, determinants of behavior change, body weight and body mass index, cardiovascular disease risk profile, and quality of life. Additionally, productivity, absenteeism, and cost-effectiveness are assessed. Discussion Improving workers' daily physical activity and dietary behavior may prevent weight gain and subsequently improve workers' health, increase productivity, and reduce absenteeism

  3. Design of the Balance@Work project: systematic development, evaluation and implementation of an occupational health guideline aimed at the prevention of weight gain among employees.

    Science.gov (United States)

    Verweij, Lisanne M; Proper, Karin I; Weel, Andre N H; Hulshof, Carel T J; van Mechelen, Willem

    2009-12-14

    Occupational health professionals may play an important role in preventive health promotion activities for employees. However, due to a lack of knowledge and evidence- and practice based methods and strategies, interventions are hardly being implemented by occupational physicians to date. The aim of the Balance@Work project is to develop, evaluate, and implement an occupational health guideline aimed at the prevention of weight gain among employees. Following the guideline development protocol of the Netherlands Society of Occupational Medicine and the Intervention Mapping protocol, the guideline was developed based on literature, interviews with relevant stakeholders, and consensus among an expert group. The guideline consists of an individual and an environmental component. The individual component includes recommendations for occupational physicians on how to promote physical activity and healthy dietary behavior based on principles of motivational interviewing. The environmental component contains an obesogenic environment assessment tool. The guideline is evaluated in a randomised controlled trial among 20 occupational physicians. Occupational physicians in the intervention group apply the guideline to eligible workers during 6 months. Occupational physicians in the control group provide care as usual. Measurements take place at baseline and 6, 12, and 18 months thereafter. Primary outcome measures include waist circumference, daily physical activity and dietary behavior. Secondary outcome measures include sedentary behavior, determinants of behavior change, body weight and body mass index, cardiovascular disease risk profile, and quality of life. Additionally, productivity, absenteeism, and cost-effectiveness are assessed. Improving workers' daily physical activity and dietary behavior may prevent weight gain and subsequently improve workers' health, increase productivity, and reduce absenteeism. After an effect- and process evaluation the guideline will be

  4. Design of the Balance@Work project: systematic development, evaluation and implementation of an occupational health guideline aimed at the prevention of weight gain among employees

    NARCIS (Netherlands)

    Verweij, Lisanne M.; Proper, Karin I.; Weel, Andre N. H.; Hulshof, Carel T. J.; van Mechelen, Willem

    2009-01-01

    Occupational health professionals may play an important role in preventive health promotion activities for employees. However, due to a lack of knowledge and evidence- and practice based methods and strategies, interventions are hardly being implemented by occupational physicians to date. The aim of

  5. Design of the Balance@Work project: systematic development, evaluation and implementation of an occupational health guideline aimed at the prevention of weight gain among employees

    NARCIS (Netherlands)

    Verweij, L.M.; Proper, K.I.; Weel, A.N.H.; Hulshof, C.T.J.; van Mechelen, W.

    2009-01-01

    Background: Occupational health professionals may play an important role in preventive health promotion activities for employees. However, due to a lack of knowledge and evidence-and practice based methods and strategies, interventions are hardly being implemented by occupational physicians to date.

  6. Guidelines for Better Heart Health

    Science.gov (United States)

    Skip Navigation Bar Home Current Issue Past Issues Guidelines for Better Heart Health Past Issues / Winter 2007 ... women either had or did not have CVD. Guidelines at a Glance: Prevention should be tailored to ...

  7. Plasma health care - Aims, constraints and progress

    International Nuclear Information System (INIS)

    Morfill, G.E.; Zimmerman, J.L.

    2013-01-01

    Health Care covers three areas of interest for cold atmospheric pressure plasmas: Cosmetics, Hygiene and Medicine. These areas can be subdivided into personal and professional care. In this review will concentrate on Hygiene and Medicine. In professional hygiene the most important plasma contribution is sterilization, decontamination and disinfection. The main aim is the prevention of diseases or their containment. Progress in the development of efficient bactericidal plasma sources has been rapid, so that it appears realistic to use plasmas to combat nosocomial infections as well as community associated infections in the not too distant future. The advantages of plasma devices – they use air and electricity only, there are no waste products, they are inexpensive to manufacture and operate, easy to transport and install, and bactericidal effects are fast (seconds). Plasmas can efficiently kill resistant bacteria (e.g. MRSA) and tests have shown no resistance build-up so far. With an estimated 2 Million hospital induced infections each year in the US alone, and about 100.000 resulting deaths, very efficient, safe and fast hospital plasma hygiene devices would appear to be a very important weapon to help contain the spread of infectious diseases. In Medicine there are a number of ambitious ideas and aims. Plasmas can be “designed” to some extent. They can include different active species that can have an effect at the cellular level. There are ionic atoms and molecules, whose medical use need to be evaluated – the vision is that a new area of “plasma pharmacy” could develop. First steps are currently being taken in biological studies. Also the excited atoms in cold atmospheric plasmas may make cell walls more permeable for such species. (author)

  8. Guidelines for reporting health economic research.

    Science.gov (United States)

    Haddad, F S; McLawhorn, A S

    2016-02-01

    Health economic evaluations potentially provide valuable information to clinicians, health care administrators, and policy makers regarding the financial implications of decisions about the care of patients. The highest quality research should be used to inform decisions that have direct impact on the access to care and the outcome of treatment. However, economic analyses are often complex and use research methods which are relatively unfamiliar to clinicians. Furthermore, health economic data have substantial national, regional, and institutional variability, which can limit the external validity of the results of a study. Therefore, minimum guidelines that aim to standardise the quality and transparency of reporting health economic research have been developed, and instruments are available to assist in the assessment of its quality and the interpretation of results. The purpose of this editorial is to discuss the principal types of health economic studies, to review the most common instruments for judging the quality of these studies and to describe current reporting guidelines. Recommendations for the submission of these types of studies to The Bone & Joint Journal are provided. Cite this article: Bone Joint J 2016;98-B:147-51. ©2016 The British Editorial Society of Bone & Joint Surgery.

  9. Environmental Management of Pediatric Asthma: Guidelines for Health Care Providers

    Science.gov (United States)

    Roberts, James R.; McCurdy, Leyla Erk

    2005-01-01

    These guidelines are the product of a new Pediatric Asthma Initiative aimed at integrating environmental management of asthma into pediatric health care. This document outlines competencies in environmental health relevant to pediatric asthma that should be mastered by primary health care providers, and outlines the environmental interventions…

  10. Health protection guidelines for electromagnetic field exposures

    International Nuclear Information System (INIS)

    Taki, Masao

    1999-01-01

    In order to protect human health from excessive exposure to electromagnetic fields safety guidelines have been established by national and international organizations. The International Commission on Nonionization Radiation Protection is one of these organizations, whose guidelines are briefly regarded as typical. The activities on this issue in various countries are reviewed. Recent situations and the problems still unsolved are also discussed. (author)

  11. [Good practice guidelines for health information].

    Science.gov (United States)

    2016-01-01

    Evidence-based health information is distinguished by the provision of an unbiased and trustworthy description of the current state of medical knowledge. It enables people to learn more about health and disease, and to make health-related decisions - on their own or together with others - reflecting their attitudes and lifestyle. To adequately serve this purpose, health information must be evidence-based. A working group from the German Network for Evidence-based Medicine (Deutsches Netzwerk Evidenzbasierte Medizin) has developed a first draft of good practice guidelines for health information (Gute Praxis Gesundheitsinformation) with the aim of providing support for authors and publishers of evidence-based health information. The group included researchers, patient representatives, journalists and developers of health information. The criteria for evidence-based health information were developed and agreed upon within this author group, and then made available for public comment. All submitted comments were documented and assessed regarding the need to revise or amend the draft. Changes were subsequently implemented following approval by the author group. Gute Praxis Gesundheitsinformation calls for a transparent methodological approach in the development of health information. To achieve this, evidence-based information must be based on (a) a systematic literature search, (b) a justified selection of evidence, (c) unbiased reporting of relevant results, (d) appropriate factual and linguistic communication of uncertainties, (e) either avoidance of any direct recommendations or a strict division between the reporting of results and the derivation of recommendations, (f) the consideration of current evidence on the communication of figures, risks and probabilities, and (g) transparent information about the authors and publishers of the health information, including their funding sources. Gute Praxis Gesundheitsinformation lists a total of 16 aspects to be addressed

  12. World Health Organization guideline development: an evaluation.

    Directory of Open Access Journals (Sweden)

    David Sinclair

    Full Text Available BACKGROUND: Research in 2007 showed that World Health Organization (WHO recommendations were largely based on expert opinion, rarely used systematic evidence-based methods, and did not follow the organization's own "Guidelines for Guidelines". In response, the WHO established a "Guidelines Review Committee" (GRC to implement and oversee internationally recognized standards. We examined the impact of these changes on WHO guideline documents and explored senior staff's perceptions of the new procedures. METHODS AND FINDINGS: We used the AGREE II guideline appraisal tool to appraise ten GRC-approved guidelines from nine WHO departments, and ten pre-GRC guidelines matched by department and topic. We interviewed 20 senior staff across 16 departments and analyzed the transcripts using the framework approach. Average AGREE II scores for GRC-approved guidelines were higher across all six AGREE domains compared with pre-GRC guidelines. The biggest changes were noted for "Rigour of Development" (up 37.6%, from 30.7% to 68.3% and "Editorial Independence" (up 52.7%, from 20.9% to 73.6%. Four main themes emerged from the interviews: (1 high standards were widely recognized as essential for WHO credibility, particularly with regard to conflicts of interest; (2 views were mixed on whether WHO needed a single quality assurance mechanism, with some departments purposefully bypassing the procedures; (3 staff expressed some uncertainties in applying the GRADE approach, with departmental staff concentrating on technicalities while the GRC remained concerned the underlying principles were not fully institutionalized; (4 the capacity to implement the new standards varied widely, with many departments looking to an overstretched GRC for technical support. CONCLUSIONS: Since 2007, WHO guideline development methods have become more systematic and transparent. However, some departments are bypassing the procedures, and as yet neither the GRC, nor the quality assurance

  13. EM Health and Safety Plan Guidelines

    Energy Technology Data Exchange (ETDEWEB)

    1994-12-01

    This document contains information about the Health and Safety Plan Guidelines. Topics discussed include: Regulatory framework; key personnel; hazard assessment; training requirements; personal protective equipment; extreme temperature disorders or conditions; medical surveillance; exposure monitoring/air sampling; site control; decontamination; emergency response/contingency plan; emergency action plan; confined space entry; and spill containment.

  14. Workplace mental health: An international review of guidelines.

    Science.gov (United States)

    Memish, Kate; Martin, Angela; Bartlett, Larissa; Dawkins, Sarah; Sanderson, Kristy

    2017-08-01

    The aim of this systematic review was to determine the quality and comprehensiveness of guidelines developed for employers to detect, prevent, and manage mental health problems in the workplace. An integrated approach that combined expertise from medicine, psychology, public health, management, and occupational health and safety was identified as a best practice framework to assess guideline comprehensiveness. An iterative search strategy of the grey literature was used plus consultation with experts in psychology, public health, and mental health promotion. Inclusion criteria were documents published in English and developed specifically for employers to detect, prevent, and manage mental health problems in the workplace. A total of 20 guidelines met these criteria and were reviewed. Development documents were included to inform quality assessment. This was performed using the AGREE II rating system. Our results indicated that low scores were often due to a lack of focus on prevention and rather a focus on the detection and treatment of mental health problems in the workplace. When prevention recommendations were included they were often individually focused and did not include practical tools or advice to implement. An inconsistency in language, lack of consultation with relevant population groups in the development process and a failure to outline and differentiate between the legal/minimum requirements of a region were also observed. The findings from this systematic review will inform translation of scientific evidence into practical recommendations to prevent mental health problems within the workplace. It will also direct employers, clinicians, and policy-makers towards examples of best-practice guidelines. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Clinical guideline implementation strategies for common mental health disorders.

    Science.gov (United States)

    Moreno, Eliana María; Moriana, Juan Antonio

    2016-01-01

    There has been a considerable proliferation of clinical guidelines recently, but their practical application is low, and organisations do not always implement their own ones. The aim of this study is to analyse and describe key elements of strategies and resources designed by the National Institute for Health and Care Excellence for the implementation of guidelines for common mental health disorders in adults, which are some of the most prevalent worldwide. A systematic review was performed following PRISMA model. Resources, tools and implementation materials where included and categorised considering type, objectives, target and scope. A total of 212 elements were analysed, of which 33.5 and 24.5% are related to the implementation of generalized anxiety and depression guidelines, respectively. Applied tools designed to estimate costs and assess the feasibility of the setting up at local level are the most frequent type of resource. The study highlights the important variety of available materials, classified into 3 main strategies: tools targeting the professionals (30.6%), structural (26.4%), and organizational (24%). Developing guidelines is not enough; it is also necessary to promote their implementation in order to encourage their application. The resources and strategies described in this study may be potentially applicable to other contexts, and helpful to public health managers and professionals in the design of programmes and in the process of informed decision making to help increase access to efficient treatments. Copyright © 2015. Published by Elsevier España.

  16. Content and quality of workplace guidelines developed to prevent mental health problems

    DEFF Research Database (Denmark)

    Nexø, Mette Andersen; Kristensen, Josefine Vejlby; Grønvad, Majbritt Thorhauge

    2018-01-01

    Objectives A wide range of guidelines have been developed to prevent work-related mental health problems (MHP), but little is known about the quality of such guidelines. We systematically reviewed the content and quality of workplace guidelines aiming to prevent, detect, and/or manage work......-related MHP. Methods We conducted systematic online and database searches (MEDLINE; Web of Science; PsychNET; occupational safety and health databases) to identify guidelines. Eligibility criteria included guidelines recommending primary, secondary, or tertiary preventive interventions to be implemented...... at the workplace by employers, employees or organizational staff. A minimum of minimum three independent reviewers assessed the quality of guidelines using the Guidelines for Research and Evaluation (AGREE II). Guidelines rated ≥65% with regards to domain I, II, and III were considered to be of good developmental...

  17. The 2016 CIOMS guidelines and public-health research ethics

    African Journals Online (AJOL)

    2017-12-01

    Dec 1, 2017 ... CIOMS International Ethical Guidelines for Biomedical Research Involving ... mention of public health in relation to social value. • The new guideline 7, .... reports, can be obtained from conventional media sources such as.

  18. Compliance With Infection Prevention Guidelines By Health Care ...

    African Journals Online (AJOL)

    USER

    the health workers' curricular, provision of in-service training in infection ... cheaper infection prevention and control methods7. In Zambia ... Zambia Infection Prevention Guidelines in 2003. This ..... Control (IPC) Policies and Guidelines or.

  19. Adherence to ministry of health guidelines in management of severe ...

    African Journals Online (AJOL)

    Background: Guidelines have shown to impact positively on the management of medical conditions. The impact of these guidelines has not been evaluated for severe preeclampsia and eclampsia in Kenya. Objective: To evaluate the level of adherence to Kenya Ministry of Health (MOH) guidelines in the management of ...

  20. Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review.

    NARCIS (Netherlands)

    Francke, A.L.; Smit, M.C.; Veer, A.J.E. de; Mistiaen, P.

    2008-01-01

    BACKGROUND: Nowadays more and more clinical guidelines for health care professionals are being developed. However, this does not automatically mean that these guidelines are actually implemented. The aim of this meta-review is twofold: firstly, to gain a better understanding of which factors affect

  1. Predictive analytics in mental health: applications, guidelines, challenges and perspectives.

    Science.gov (United States)

    Hahn, T; Nierenberg, A A; Whitfield-Gabrieli, S

    2017-01-01

    The emerging field of 'predictive analytics in mental health' has recently generated tremendous interest with the bold promise to revolutionize clinical practice in psychiatry paralleling similar developments in personalized and precision medicine. Here, we provide an overview of the key questions and challenges in the field, aiming to (1) propose general guidelines for predictive analytics projects in psychiatry, (2) provide a conceptual introduction to core aspects of predictive modeling technology, and (3) foster a broad and informed discussion involving all stakeholders including researchers, clinicians, patients, funding bodies and policymakers.

  2. ACA and the Triple Aim: Musings of a Health Care Actuary.

    Science.gov (United States)

    McCarthy, Mac

    2015-01-01

    In 2008, the Institute for Healthcare Improvement (IHI) promulgated the Triple Aim, which advocates simultaneous improvements in patient experiences, improved population health and lower cost per capita. In 2010, the Patient Protection and Affordable Care Act (ACA) promised quality, affordable health care for all Americans. It's fair to assume that the framers of ACA were aware of the Triple Aim, and it is likely that much of ACA was heavily influenced by IHI's positions. So it is reasonable, from time to time, to assess ACA's impact on health care against the Triple Aim principles.

  3. An Employee-Centered Care Model Responds to the Triple Aim: Improving Employee Health.

    Science.gov (United States)

    Fox, Kelly; McCorkle, Ruth

    2018-01-01

    Health care expenditures, patient satisfaction, and timely access to care will remain problematic if dramatic changes in health care delivery models are not developed and implemented. To combat this challenge, a Triple Aim approach is essential; Innovation in payment and health care delivery models is required. Using the Donabedian framework of structure, process, and outcome, this article describes a nurse-led employee-centered care model designed to improve consumers' health care experiences, improve employee health, and increase access to care while reducing health care costs for employees, age 18 and older, in a corporate environment.

  4. Influence of qualitative research on women's health screening guidelines.

    Science.gov (United States)

    Abadir, Anna Maria; Lang, Ariella; Klein, Talia; Abenhaim, Haim Arie

    2014-01-01

    Considerable time and resources are allocated to carry out qualitative research. The purpose of our study was to evaluate the availability of qualitative research on women's health screening and assess its influence on screening practice guidelines in the United States, Canada, and the United Kingdom. Medline, CINHAL, and WEB of Science databases were used to identify the availability of qualitative research conducted in the past 15 years on 3 different women's health screening topics: cervical cancer screening, breast cancer screening, and prenatal first-trimester screening. Key national practice guidelines on women's health screening were selected using the National Guideline Clearinghouse web site. Bibliometric analysis was used to determine the frequency of qualitative references cited in the guidelines. A total of 272 qualitative research papers on women's health screening was identified: 109 on cervical cancer screening, 104 on breast cancer screening, and 59 on prenatal first-trimester screening. The qualitative studies focused on health care provider perspectives as well as ethical, ethnographic, psychological, and social issues surrounding screening. Fifteen national clinical practice guidelines on women's health screening were identified. A total of 943 references was cited, only 2 of which comprised of qualitative research cited by only 1 clinical practice guideline. Although there is considerable qualitative research that has been carried out on women's health screening, its incorporation into clinical practice guidelines is minimal. Further exploration of the disconnect between the two is important for enhancing knowledge translation of qualitative research within clinical practice. Copyright © 2014 Mosby, Inc. All rights reserved.

  5. Health physics appraisal guidelines for fusion/confinement devices

    International Nuclear Information System (INIS)

    Neeson, P.M.

    1987-01-01

    Several types of fusion/confinement devices have been developed for a variety of research applications. The health physics considerations for these devices can vary, depending on a number of parameters. This paper presents guidelines for health physics appraisal of such devices, which can be tailored to apply to specific systems. The guidelines can also be useful for establishing ongoing health physics programs for safe operation of the devices

  6. Consensus Among International Ethical Guidelines for the Provision of Videoconferencing-Based Mental Health Treatments

    Science.gov (United States)

    Wakefield, Claire E; McGill, Brittany C; Wilson, Helen L; Patterson, Pandora

    2016-01-01

    Background Online technologies may reduce barriers to evidence-based mental health care, yet they also create numerous ethical challenges. Recently, numerous professional organizations and expert groups have produced best-practice guidelines to assist mental health professionals in delivering online interventions in an ethically and clinically sound manner. However, there has been little critical examination of these international best-practice guidelines regarding appropriate electronic mental health (e-mental health) service delivery via technologies such as videoconferencing (including Skype), particularly for specific, vulnerable populations. Further, the extent to which concordance exists between these guidelines remains unclear. Synthesizing this literature to provide clear guidance to both mental health professionals and researchers is critical to ensure continued progress in the field of e-mental health. Objective This study aims to review all currently available ethical and best-practice guidelines relating to videoconferencing-delivered mental health treatments in order to ascertain the recommendations for which international consensus could be found. Additionally, this review examines the extent to which each set of guidance addresses several key special populations, including children and young people, and populations living with illness. Methods This systematic review examined guidelines using a two-armed search strategy, examining (1) professional organizations’ published guidance; and (2) MEDLINE, PsycINFO, and EMBASE for the past ten years. In order to determine consensus for best-practice, a recommendation was considered "firm" if 50% or more of the reviewed guidelines endorsed it and "tentative" if recommended by fewer guidelines than these. The professional guidelines were also scored by two raters using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) criteria. Results In the study, 19 guidelines were included, yielding 11

  7. ACTIVITY OF HEALTH EDUCATION AIMED AT PREVENTING WORK ACCIDENTS WITH NEEDLESTICK MATERIALS: EXPERIENCE REPORT

    Directory of Open Access Journals (Sweden)

    Prince Vangeris Silva Fernandes de Lima

    2014-02-01

    Full Text Available Introduction: Health services are composed of complex work environments. For this reason, they present several risks to the health of workers and also of people being treated at these places. Among these risks, one that is peculiar to health services is the risk of occupational accidents with biological material involving sharps. Objective: This study aimed to describe a health education activity conducted in a Health Center of the Federal District, Brazil. Methods: This is an experience report that discusses the final paper of the discipline “Administration Applied to Nursing and Internship”, offered by the Department of Nursing, Faculty of Health Sciences, University of Brasilia. A lecture was prepared, aimed at health workers and support staff, on general aspects of occupational accidents involving sharps, as well as preventive aspects. Results: In each clinical room of the Health Center were fixed two posters: the first discussing the proper disposal of sharps and the second, in turn, was a message of reflection. 31 professionals attended the lecture as listeners. Conclusion: We understand the validity of the lecture delivered, based on scientific studies that highlight the need and shortage of health education activities that address the prevention of occupational accidents involving sharps among Health Professionals. Additionally, it is important mentioning that such activity demand was estimated by the workers of the Health Center in study.

  8. Towards local implementation of Dutch health policy guidelines: a concept-mapping approach

    NARCIS (Netherlands)

    Kuunders, T.J.M.; Bon-Martens, M.J.H. van; Goor, I.A.M. van de; Paulussen, T.G.W.M.; Oers, H.A.M. van

    2017-01-01

    To develop a targeted implementation strategy for a municipal health policy guideline, implementation targets of two guideline users [Regional Health Services (RHSs)] and guideline developers of leading national health institutes were made explicit. Therefore, characteristics of successful

  9. Towards local implementation of Dutch health policy guidelines : A concept-mapping approach

    NARCIS (Netherlands)

    Kuunders, T.J.M.; Van Bon-martens, M.J.H.; Van De Goor, L.A.M.; Paulussen, T.G.W.M.; Van Oers, J.A.M.

    To develop a targeted implementation strategy for a municipal health policy guideline, implementation targets of two guideline users [Regional Health Services (RHSs)] and guideline developers of leading national health institutes were made explicit. Therefore, characteristics of successful

  10. Guidelines for Management Information Systems in Canadian Health Care Facilities

    Science.gov (United States)

    Thompson, Larry E.

    1987-01-01

    The MIS Guidelines are a comprehensive set of standards for health care facilities for the recording of staffing, financial, workload, patient care and other management information. The Guidelines enable health care facilities to develop management information systems which identify resources, costs and products to more effectively forecast and control costs and utilize resources to their maximum potential as well as provide improved comparability of operations. The MIS Guidelines were produced by the Management Information Systems (MIS) Project, a cooperative effort of the federal and provincial governments, provincial hospital/health associations, under the authority of the Canadian Federal/Provincial Advisory Committee on Institutional and Medical Services. The Guidelines are currently being implemented on a “test” basis in ten health care facilities across Canada and portions integrated in government reporting as finalized.

  11. Value of partnership for workplace health promotion : guideline for partnership building

    NARCIS (Netherlands)

    Hämäläinen, R.M.; Dijkman, A.; Guobjörg Asgeirsdóttir, A.; Broek, K. van den; Haratau, T.; Kuhn, K.; Masanotti, G.; Pyzalski, J.; Scheppingen, A. van; Solé, M.D.; Ylikoski, M.

    2007-01-01

    This publication is an outcome of the project Workplace Health Promotion (WHP): National Health Policies and Strategies in an Enlarging Europe, carried out during 2005-2007. The guideline aims to offer ideas and ways to build partnerships by providing background for partnership building, a brief

  12. [Guidelines in Dutch mental health institutions for dealing with persons attempting suicide

    NARCIS (Netherlands)

    Verwey, B.; Waarde, J.A. van; Rooij, I.A.L.M. van; Gerritsen, G.; Zitman, F.G.

    2007-01-01

    BACKGROUND: Attempted suicide is a frequent occurrence, even in mental health institutions (mhis). The World Health Organization strongly supports the development and implementation of guidelines for dealing with cases of attempted suicide in mhis. aim To check on the existence, content and quality

  13. Acceptability of health information technology aimed at environmental health education in a prenatal clinic.

    Science.gov (United States)

    Rosas, Lisa G; Trujillo, Celina; Camacho, Jose; Madrigal, Daniel; Bradman, Asa; Eskenazi, Brenda

    2014-11-01

    To describe the acceptability of an interactive computer kiosk that provides environmental health education to low-income Latina prenatal patients. A mixed-methods approach was used to assess the acceptability of the Prenatal Environmental Health Kiosk pregnant Latina women in Salinas, CA (n=152). The kiosk is a low literacy, interactive touch-screen computer program with an audio component and includes graphics and an interactive game. The majority had never used a kiosk before. Over 90% of women reported that they learned something new while using the kiosk. Prior to using the kiosk, 22% of women reported their preference of receiving health education from a kiosk over a pamphlet or video compared with 57% after using the kiosk (peducation; and (3) popularity of the interactive game. The Prenatal Environmental Health Kiosk is an innovative patient health education modality that was shown to be acceptable among a population of low-income Latino pregnant women in a prenatal care clinic. This pilot study demonstrated that a health education kiosk was an acceptable strategy for providing Latina prenatal patients with information on pertinent environmental exposures. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. Guidelines for Psychological Practice in Health Care Delivery Systems

    Science.gov (United States)

    American Psychologist, 2013

    2013-01-01

    Psychologists practice in an increasingly diverse range of health care delivery systems. The following guidelines are intended to assist psychologists, other health care providers, administrators in health care delivery systems, and the public to conceptualize the roles and responsibilities of psychologists in these diverse contexts. These…

  15. A guideline for adults with an indwelling urinary catheter in different health care Settings - methodological procedures

    Science.gov (United States)

    Barbezat, Isabelle; Willener, Rita; Jenni, Giovanna; Hürlimann, Barbara; Geese, Franziska; Spichiger, Elisabeth

    2017-07-01

    Background: People with an indwelling urinary catheter often suffer from complications and health care professionals are regularly confronted with questions about catheter management. Clinical guidelines are widely accepted to promote evidence-based practice. In the literature, the adaptation of a guideline is described as a valid alternative to the development of a new one. Aim: To translate a guideline for the care for adults with an indwelling urinary catheter in the acute and long term care setting as well as for home care. To adapt the guideline to the Swiss context. Method: In a systematic and pragmatic process, clinical questions were identified, guidelines were searched and evaluated regarding clinical relevance and quality. After each step, the next steps were defined. Results: An English guideline was translated, adapted to the local context and supplemented. The adapted guideline was reviewed by experts, adapted again and approved. After 34 months and an investment of a total of 145 man working days, a guideline for the care for people with an indwelling urinary catheter is available for both institutions. Conclusions: Translation and adaptation of a guideline was a valuable alternative to the development of a new one; nevertheless, the efforts necessary should not be underestimated. For such a project, sufficient professional and methodological resources should be made available to achieve efficient guideline work by a constant team.

  16. Hypertension guidelines and their effects on the health system

    Directory of Open Access Journals (Sweden)

    Konta, Brigitte

    2005-12-01

    existing literature at the present time. One can assume from international studies with analogical reasoning that these are confessed and have a high level of acceptance in the medical community. Unfortunately the actual usage is not represented satisfactorily in the scientific literature. The effects of the guidelines on the medical procedures seem to be very strongly individual and the analyses to the compliance show at least an observable effect within the last few years. No publications could be found for the cost effectiveness of the guidelines. The actual compliance with guidelines seems to be in relation with the duration of the professional practice. It seems the shorter the professional practice takes place, the stronger the guidelines are adhered. Discussion: At present, there are only a few notes for the German health service regarding the actual effect of the hypertonus guidelines. However, the reason is not that the effect would not be possibly strong but at the methodical challenge to evaluate the sustaining effects of the application of the hypertonus guidelines. For this reason the literature is very rare regarding this topic. For Germany it can be derived by analogical reasoning from foreign studies that guidelines will facilitate a more and more essential contribution to the design of the health system. Considering that primarily younger physicians accepted guidelines mode, the further construction, update and implementation of guidelines are essential, particularly with regard to the quality assurance. Straight guidelines can express a standard of the quality of a health system as a benchmark. The existence of guidelines or the lack thereof is considered also as a quality indicator of a health system at the organisation for economic cooperation and development (OECD. Conclusion: Guidelines should be evaluated - especially the hypertonus guideline. Also further development and implementation should be emphasised. Methodically oriented work to the approach

  17. An implementation evaluation of a policy aiming to improve financial access to maternal health care in Djibo district, Burkina Faso

    Directory of Open Access Journals (Sweden)

    Belaid Loubna

    2012-12-01

    Full Text Available Abstract Background To bring down its high maternal mortality ratio, Burkina Faso adopted a national health policy in 2007 that designed to boost the assisted delivery rate and improving quality of emergency obstetrical and neonatal care. The cost of transportation from health centres to district hospitals is paid by the policy. The worst-off are exempted from all fees. Methods The objectives of this paper are to analyze perceptions of this policy by health workers, assess how this health policy was implemented at the district level, identify difficulties faced during implementation, and highlight interactional factors that have an influence on the implementation process. A multiple site case study was conducted at 6 health centres in the district of Djibo in Burkina Faso. The following sources of data were used: 1 district documents (n = 23; 2 key interviews with district health managers (n = 10, health workers (n = 16, traditional birth attendants (n = 7, and community management committees (n = 11; 3 non-participant observations in health centres; 4 focus groups in communities (n = 62; 5 a feedback session on the findings with 20 health staff members. Results All the activities were implemented as planned except for completely subsidizing the worst-off, and some activities such as surveys for patients and the quality assurance service team aiming to improve quality of care. District health managers and health workers perceived difficulties in implementing this policy because of the lack of clarity on some topics in the guidelines. Entering the data into an electronic database and the long delay in reimbursing transportation costs were the principal challenges perceived by implementers. Interactional factors such as relations between providers and patients and between health workers and communities were raised. These factors have an influence on the implementation process. Strained relations between the groups involved

  18. An implementation evaluation of a policy aiming to improve financial access to maternal health care in Djibo district, Burkina Faso.

    Science.gov (United States)

    Belaid, Loubna; Ridde, Valéry

    2012-12-08

    To bring down its high maternal mortality ratio, Burkina Faso adopted a national health policy in 2007 that designed to boost the assisted delivery rate and improving quality of emergency obstetrical and neonatal care. The cost of transportation from health centres to district hospitals is paid by the policy. The worst-off are exempted from all fees. The objectives of this paper are to analyze perceptions of this policy by health workers, assess how this health policy was implemented at the district level, identify difficulties faced during implementation, and highlight interactional factors that have an influence on the implementation process. A multiple site case study was conducted at 6 health centres in the district of Djibo in Burkina Faso. The following sources of data were used: 1) district documents (n = 23); 2) key interviews with district health managers (n = 10), health workers (n = 16), traditional birth attendants (n = 7), and community management committees (n = 11); 3) non-participant observations in health centres; 4) focus groups in communities (n = 62); 5) a feedback session on the findings with 20 health staff members. All the activities were implemented as planned except for completely subsidizing the worst-off, and some activities such as surveys for patients and the quality assurance service team aiming to improve quality of care. District health managers and health workers perceived difficulties in implementing this policy because of the lack of clarity on some topics in the guidelines. Entering the data into an electronic database and the long delay in reimbursing transportation costs were the principal challenges perceived by implementers. Interactional factors such as relations between providers and patients and between health workers and communities were raised. These factors have an influence on the implementation process. Strained relations between the groups involved may reduce the effectiveness of the policy

  19. Guidelines for developing effective health education service in a national health agency.

    Science.gov (United States)

    Ochor, J O

    1983-01-01

    The constraints facing health education include: the fragmentation and dispersal of health-educational services among different agencies and personnel; lack of policy guidelines; ineffectively organized and inefficiently managed health education systems; poor hierarchical status and inadequacy of resources. To resolve these constraints, national health education systems in health agencies should be developed on the basis of stipulated guidelines that could ensure their viability, efficiency and effectiveness. A study at the African Regional Health Education Centre, Ibadan, Nigeria, has yielded thirty synthesized guidelines. The "guidelines" were empirically tested as an evaluation tool by assessing the operational and organizational status of Oyo State Health Education Unit, Ibadan, Nigeria. These guidelines are adaptable to local conditions to enhance the re-organization, re-orientation and consolidation of health education in national health agencies.

  20. [Integrated health care organizations: guideline for analysis].

    Science.gov (United States)

    Vázquez Navarrete, M Luisa; Vargas Lorenzo, Ingrid; Farré Calpe, Joan; Terraza Núñez, Rebeca

    2005-01-01

    There has been a tendency recently to abandon competition and to introduce policies that promote collaboration between health providers as a means of improving the efficiency of the system and the continuity of care. A number of countries, most notably the United States, have experienced the integration of health care providers to cover the continuum of care of a defined population. Catalonia has witnessed the steady emergence of increasing numbers of integrated health organisations (IHO) but, unlike the United States, studies on health providers' integration are scarce. As part of a research project currently underway, a guide was developed to study Catalan IHOs, based on a classical literature review and the development of a theoretical framework. The guide proposes analysing the IHO's performance in relation to their final objectives of improving the efficiency and continuity of health care by an analysis of the integration type (based on key characteristics); external elements (existence of other suppliers, type of services' payment mechanisms); and internal elements (model of government, organization and management) that influence integration. Evaluation of the IHO's performance focuses on global strategies and results on coordination of care and efficiency. Two types of coordination are evaluated: information coordination and coordination of care management. Evaluation of the efficiency of the IHO refers to technical and allocative efficiency. This guide may have to be modified for use in the Catalan context.

  1. Community health workers adherence to referral guidelines

    DEFF Research Database (Denmark)

    Lal, Sham; Ndyomugenyi, Richard; Paintain, Lucy

    2016-01-01

    artemisinin-based combination therapy (ACT) and recognize symptoms in children that required immediate referral to the nearest health centre. Intervention arm CHWs had additional training on how to conduct an RDT; CHWs in the control arm used a presumptive diagnosis for malaria using clinical signs......Background Many malaria-endemic countries have implemented national community health worker (CHW) programmes to serve remote populations that have poor access to malaria diagnosis and treatment. Despite mounting evidence of CHWs’ ability to adhere to malaria rapid diagnostic tests (RDTs...

  2. Disseminating hypnosis to health care settings: Applying the RE-AIM framework

    Science.gov (United States)

    Yeh, Vivian M.; Schnur, Julie B.; Montgomery, Guy H.

    2014-01-01

    Hypnosis is a brief intervention ready for wider dissemination in medical contexts. Overall, hypnosis remains underused despite evidence supporting its beneficial clinical impact. This review will evaluate the evidence supporting hypnosis for dissemination using guidelines formulated by Glasgow and colleagues (1999). Five dissemination dimensions will be considered: Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM). Reach In medical settings, hypnosis is capable of helping a diverse range of individuals with a wide variety of problems. Efficacy There is evidence supporting the use of hypnosis for chronic pain, acute pain and emotional distress arising from medical procedures and conditions, cancer treatment-related side-effects and irritable bowel syndrome. Adoption Although hypnosis is currently not a part of mainstream clinical practices, evidence suggests that patients and healthcare providers are open to trying hypnosis, and may become more so when educated about what hypnosis can do. Implementation Hypnosis is a brief intervention capable of being administered effectively by healthcare providers. Maintenance Given the low resource needs of hypnosis, opportunities for reimbursement, and the ability of the intervention to potentially help medical settings reduce costs, the intervention has the qualities necessary to be integrated into routine care in a self-sustaining way in medical settings. In sum, hypnosis is a promising candidate for further dissemination. PMID:25267941

  3. Oral Health Care Reform in Finland – aiming to reduce inequity in care provision

    Directory of Open Access Journals (Sweden)

    Widström Eeva

    2008-01-01

    Full Text Available Abstract Background In Finland, dental services are provided by a public (PDS and a private sector. In the past, children, young adults and special needs groups were entitled to care and treatment from the public dental services (PDS. A major reform in 2001 – 2002 opened the PDS and extended subsidies for private dental services to all adults. It aimed to increase equity by improving adults' access to oral health care and reducing cost barriers. The aim of this study was to assess the impacts of the reform on the utilization of publicly funded and private dental services, numbers and distribution of personnel and costs in 2000 and in 2004, before and after the oral health care reform. An evaluation was made of how the health political goals of the reform: integrating oral health care into general health care, improving adults' access to care and lowering cost barriers had been fulfilled during the study period. Methods National registers were used as data sources for the study. Use of dental services, personnel resources and costs in 2000 (before the reform and in 2004 (after the reform were compared. Results In 2000, when access to publicly subsidised dental services was restricted to those born in 1956 or later, every third adult used the PDS or subsidised private services. By 2004, when subsidies had been extended to the whole adult population, this increased to almost every second adult. The PDS reported having seen 118 076 more adult patients in 2004 than in 2000. The private sector had the same number of patients but 542 656 of them had not previously been entitled to partial reimbursement of fees. The use of both public and subsidised private services increased most in big cities and urban municipalities where access to the PDS had been poor and the number of private practitioners was high. The PDS employed more dentists (6.5% and the number of private practitioners fell by 6.9%. The total dental care expenditure (PDS plus private

  4. Impact of school-based health promotion interventions aimed at different behavioral domains: a systematic review.

    Science.gov (United States)

    Lima-Serrano, Marta; Lima-Rodríguez, Joaquín S

    2014-01-01

    Given that lifestyleshave similar determinants and that school-based interventions are usually targeted at all the risks that affect adolescents, the objective of this systematic review was to summarize the characteristics and effects of school-based interventions acting on different behavioral domains of adolescent health promotion. The review process was conducted by two independent reviewers who searched PubMed, Scopus, PsycINFO, and ERIC databases for experimental or observational studies with at least two measures of results published from 2007 to 2011, given that the research information available doubles every 5 years. Methodological quality was assessed with a standardized tool. Information was extracted from 35 studies aiming to prevent risk behaviors and promote healthy nutrition, physical activity, and mental and holistic health. Activities were based on theoretical models and were classified into interactive lessons, peer mediation, environmental changes, parents' and community activities, and tailored messages by computer-assisted training or other resources, usually including multiple components. In some cases, we identified some moderate to large, short- and long-term effects on behavioral and intermediate variable. This exhaustive review found that well-implemented interventions can promote adolescent health. These findings are consistent with recent reviews. Implications for practice, public health, and research are discussed. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

  5. Revised Guidelines for Comprehensive Health Education, Grades 10-12.

    Science.gov (United States)

    Nebraska State Dept. of Education, Lincoln. Div. of Instructional Services.

    These health curriculum guidelines were designed for teachers of secondary students. Four major topic areas are covered: 1) anatomy, physiology, tissues, systems, heredity, physical activity, and nutriition; 2) family structures, functions, and responsibilities; 3) values, stress, and drug abuse; and 4) the environment, disease control, cancer,…

  6. World Health Organization guidelines should not change the CD4 ...

    African Journals Online (AJOL)

    2013-03-02

    Mar 2, 2013 ... The World Health Organization (WHO) currently recommends that HIV-positive adults start antiretroviral therapy (ART) at. CD4 counts <350 cells/µl. Several countries have changed their guidelines to recommend ART irrespective of CD4 count or at a threshold of 500 CD4 cells/µl. Consequently, WHO is ...

  7. Utilization of standard treatment guidelines (STG) at primary health ...

    African Journals Online (AJOL)

    Objective: Standard Treatment Guideline (STG) is an essential structural resource component for quality of care in health facilities. In Tanzania less information is available on STG availability, prescriber's awareness and adherence to its use in line with WHO recommendations. Methods: A cross sectional descriptive study ...

  8. World Health Organization guidelines should not change the CD4 ...

    African Journals Online (AJOL)

    The World Health Organization (WHO) currently recommends that HIV-positive adults start antiretroviral therapy (ART) at CD4 counts <350 cells/μl. Several countries have changed their guidelines to recommend ART irrespective of CD4 count or at a threshold of 500 CD4 cells/μl. Consequently, WHO is currently revising its ...

  9. Medical Guidelines Presentation and Comparing with Electronic Health Record

    Czech Academy of Sciences Publication Activity Database

    Veselý, Arnošt; Zvárová, Jana; Peleška, Jan; Buchtela, David; Anger, Z.

    2006-01-01

    Roč. 75, č. 3-4 (2006), s. 240-245 ISSN 1386-5056 R&D Projects: GA AV ČR 1ET200300413 Institutional research plan: CEZ:AV0Z10300504 Keywords : medical guidelines * electronic health record * GLIF model * reminder facility Subject RIV: IN - Informatics, Computer Science Impact factor: 1.726, year: 2006

  10. The Gap in Knowledge of Clinical Practice Guidelines by Mental Health Residents in Buenos Aires (Argentina

    Directory of Open Access Journals (Sweden)

    Javier Fabrissin

    2014-05-01

    Full Text Available The aim of this pilot study was to evaluate if the residents of psychiatry and clinical psychology from the city of Buenos Aires knew any of the existing mental health Clinical Practice and Treatment Guidelines (CPTGs. We asked residents their opinion about CPTGs and, also, if they followed their recommendations in clinical practice. We asked 59 mental health residents (28 physicians and 29 psychologists with different years of clinical training to fill a questionnaire to know their opinion about CPTGs and also if they follow the CPTG recommendations in their clinical practice. We found that 79.31% of residents did not know any CPTG. Eighty percent of the residents who did know any CPTG have a positive opinion about CPTGs. Finally, the American Psychiatric Association Guidelines were the most known CPTGs. The authors emphasize the need for a clinical guidelines diffusion policy in Buenos Aires city and particularly as a clinical and training resource for mental health residents.

  11. Ethics, equality and evidence in health promotion Danish guidelines for municipalities.

    Science.gov (United States)

    Vallgårda, Signild

    2014-06-01

    The Danish National Board of Health has expressed its commitment to social equality in health, evidence-informed health promotion and public health ethics, and has issued guidelines for municipalities on health promotion, in Danish named prevention packages. The aim of this article is to analyse whether the Board of Health adheres to ideals of equality, evidence and ethics in these guidelines. An analysis to detect statements about equity, evidence and ethics in 10 health promotion packages directed at municipalities with the aim of guiding the municipalities towards evidence-informed disease prevention and health promotion. Despite declared intentions of prioritizing social equality in health, these intentions are largely absent from most of the packages. When health inequalities are mentioned, focus is on the disadvantaged or the marginalized. Several interventions are recommended, where there is no evidence to support them, notwithstanding the ambition of interventions being evidence-informed. Ethical considerations are scanty, scattered and unsystematically integrated. Further, although some packages mention the importance of avoiding stigmatization, there is little indicating how this could be done. Including reduction of health inequalities and evidence-informed and ethically defendable interventions in health promotion is a challenge, which is not yet fully met by the National Board of Health. When judged from liberal ethical principles, only few of the suggested interventions are acceptable, i.e., those concerning information, but from a paternalistic view, all interventions that may actually benefit the citizens are justified. © 2014 the Nordic Societies of Public Health.

  12. Institutional policy changes aimed at addressing obesity among mental health clients.

    Science.gov (United States)

    Knol, Linda L; Pritchett, Kelly; Dunkin, Jeri

    2010-05-01

    People with mental illness often experience unique barriers to healthy eating and physical activity. For these clients, interventions should focus on changes in the immediate environment to change behaviors. The purpose of this project was to implement and evaluate policy changes that would limit calorie intake and increase calorie expenditure of clients receiving mental health services. This intervention was implemented in a rural mental health system in the southeastern United States. Clients live in small group homes, where they are served breakfast, dinner, and a snack, and attend outpatient day treatment programs, where they are served lunch and can purchase snacks from vending machines. This intervention included institutional policy changes that altered menus and vending machine options and implemented group walking programs. Primary outcome measures were changes in clients' weight at 3 and 6 months after policy implementation. At the 3-month follow-up, the median weight loss for overweight/obese clients (n = 45) was 1.4 kg. The 33 overweight/obese clients who were still in the group homes at the 6-month follow-up either maintained or continued to lose weight. Institutional policy changes aimed at improving dietary intake and physical activity levels among clients receiving mental health services can promote weight loss in overweight clients.

  13. Medical guidelines presentation and comparing with Electronic Health Record.

    Science.gov (United States)

    Veselý, Arnost; Zvárová, Jana; Peleska, Jan; Buchtela, David; Anger, Zdenek

    2006-01-01

    Electronic Health Record (EHR) systems are now being developed in many places. More advanced systems provide also reminder facilities, usually based on if-then rules. In this paper we propose a method how to build the reminder facility directly upon the guideline interchange format (GLIF) model of medical guidelines. The method compares data items on the input of EHR system with medical guidelines GLIF model and is able to reveal if the input data item, that represents patient diagnosis or proposed patient treatment, contradicts with medical guidelines or not. The reminder facility can be part of EHR system itself or it can be realized by a stand-alone reminder system (SRS). The possible architecture of stand-alone reminder system is described in this paper and the advantages of stand-alone solution are discussed. The part of the EHR system could be also a browser that would present graphical GLIF model in easy to understand manner on the user screen. This browser can be data driven and focus attention of user to the relevant part of medical guidelines GLIF model.

  14. Efficiency of measures aimed at improving health by normalization of temperature conditions in the Kochegarka mine

    Energy Technology Data Exchange (ETDEWEB)

    Litvinov, G.I.; Nifonov, V.P.; Kobets, A.N.

    1981-06-01

    This paper evaluates effects of air conditioning in the Kochegarka black coal mine on miners' health. Up to 1975 air temperature in the lowest mine horizon located at a depth of 970 m ranged from 26 to 32 C, in summer from 34 to 36 C. Air humidity ranged from 94 to 98%. Since 1975 KhTMF-248-4000 freon air cooling machines have been used in the mine; their capacity amounts to 3.8 x 10/SUP/6 kcal/h. Use of air cooling systems reduces air temperature to permissible limits. Air temperature measured at a distance of 1 km from mine shaft ranges from 24 to 26 C, and air humidity from 90 to 95%. At a distance of 1.5 km from the mine shaft air temperature in conveyor roadways is 26.4 C, in dead-end development workings 27 C, and at working faces 26 C (with air humidity ranging from 96 to 98%). ARVP systems for local air cooling are used at places distant from the mine shaft. The ARVP reduces air temperature from 2 to 4.5 C at a distance ranging from 4 to 8 m from the machine. Reducing air temperature, combined with other measures aimed at improving miners' health, has caused a decrease in miner absenteeism due to illness by 25.4%.

  15. Mental Health First Aid guidelines for helping a suicidal person: a Delphi consensus study in India

    Directory of Open Access Journals (Sweden)

    Jorm Anthony F

    2010-02-01

    Full Text Available Abstract Background This study aimed to develop guidelines for how a member of the Indian public should provide mental health first aid to a person who is suicidal. Methods The guidelines were produced by developing a questionnaire containing possible first aid actions and asking an expert panel of Indian mental health clinicians to rate whether each action should be included in the guidelines. The content of the questionnaire was based on a systematic search of the relevant evidence and claims made by authors of consumer and carer guides and websites. Experts were recruited by SC, EC and HM. The panel members were asked to complete the questionnaire by web survey. Three rounds of the rating were carried and, at the end of each round, items that reached the consensus criterion were selected for inclusion in the guidelines. During the first round, panel members were also asked to suggest any additional actions that were not covered in the original questionnaire (to include items that are relevant to local cultural circumstances, values, and social norms.. Responses to the open-ended questions were used to generate new items. Results The output from the Delphi process was a set of agreed upon action statements. The Delphi process started with 138 statements, 30 new items were written based on suggestions from panel members and, of these 168 items, 71 met the consensus criterion. These statements were used to develop the guidelines appended to this paper. Translated versions of the guidelines will be produced and used for training. Conclusions There are a number of actions that are considered to be useful for members of the public when they encounter someone who is experiencing suicidal thoughts or engaging in suicidal behaviour. Although the guidelines are designed for members of the public, they may also be helpful to non-mental health professionals working in health and welfare settings.

  16. Sound & Vibration 20 Design Guidelines for Health Care Facilities

    CERN Document Server

    Tocci, Gregory; Cavanaugh, William

    2013-01-01

    Sound, vibration, noise and privacy have significant impacts on health and performance. As a result, they are recognized as essential components of effective health care environments. However, acoustics has only recently become a prominent consideration in the design, construction, and operation of healthcare facilities owing to the absence, prior to 2010, of clear and objective guidance based on research and best practices. Sound & Vibration 2.0 is the first publication to comprehensively address this need. Sound & Vibration 2.0 is the sole reference standard for acoustics in health care facilities and is recognized by: the 2010 FGI Guidelines for the Design and Construction of Health Care Facilities (used in 60 countries); the US Green Building Council’s LEED for Health Care (used in 87 countries); The Green Guide for Health Care V2.2; and the International Code Council (2011). Sound & Vibration 2.0 was commissioned by the Facility Guidelines Institute in 2005, written by the Health Care Acous...

  17. Formalized Medical Guidelines and a Structured Electronic Health Record.

    Czech Academy of Sciences Publication Activity Database

    Peleška, Jan; Anger, Z.; Buchtela, David; Šebesta, K.; Tomečková, Marie; Veselý, Arnošt; Zvára, K.; Zvárová, Jana

    2005-01-01

    Roč. 11, - (2005), s. 4652-4656 ISSN 1727-1983. [EMBEC'05. European Medical and Biomedical Conference /3./. Prague, 20.11.2005-25.11.2005] R&D Projects: GA AV ČR 1ET200300413 Institutional research plan: CEZ:AV0Z10300504 Keywords : formalization of guidelines in cardilogy * GLIF model * structure electronic health record * algorithm in cardiovascular diagnostics and treatment Subject RIV: BD - Theory of Information

  18. Guidelines and Recommendations for Developing Interactive eHealth Apps for Complex Messaging in Health Promotion.

    Science.gov (United States)

    Heffernan, Kayla Joanne; Chang, Shanton; Maclean, Skye Tamara; Callegari, Emma Teresa; Garland, Suzanne Marie; Reavley, Nicola Jane; Varigos, George Andrew; Wark, John Dennis

    2016-02-09

    The now ubiquitous catchphrase, "There's an app for that," rings true owing to the growing number of mobile phone apps. In excess of 97,000 eHealth apps are available in major app stores. Yet the effectiveness of these apps varies greatly. While a minority of apps are developed grounded in theory and in conjunction with health care experts, the vast majority are not. This is concerning given the Hippocratic notion of "do no harm." There is currently no unified formal theory for developing interactive eHealth apps, and development is especially difficult when complex messaging is required, such as in health promotion and prevention. This paper aims to provide insight into the creation of interactive eHealth apps for complex messaging, by leveraging the Safe-D case study, which involved complex messaging required to guide safe but sufficient UV exposure for vitamin D synthesis in users. We aim to create recommendations for developing interactive eHealth apps for complex messages based on the lessons learned during Safe-D app development. For this case study we developed an Apple and Android app, both named Safe-D, to safely improve vitamin D status in young women through encouraging safe ultraviolet radiation exposure. The app was developed through participatory action research involving medical and human computer interaction researchers, subject matter expert clinicians, external developers, and target users. The recommendations for development were created from analysis of the development process. By working with clinicians and implementing disparate design examples from the literature, we developed the Safe-D app. From this development process, recommendations for developing interactive eHealth apps for complex messaging were created: (1) involve a multidisciplinary team in the development process, (2) manage complex messages to engage users, and (3) design for interactivity (tailor recommendations, remove barriers to use, design for simplicity). This research has

  19. Can inequality be tamed through boundary work? A qualitative study of health promotion aimed at reducing health inequalities.

    Science.gov (United States)

    Pedersen, Pia Vivian; Hjelmar, Ulf; Høybye, Mette Terp; Rod, Morten Hulvej

    2017-07-01

    This paper examines the organisational dynamics that arise in health promotion aimed at reducing health inequalities. The paper draws on ethnographic fieldwork among public health officers in Danish municipalities and qualitative interviews from an evaluation of health promotion programmes targeting homeless and other marginalised citizens. Analytically, we focus on 'boundary work', i.e. the ways in which social and symbolic boundaries are established, maintained, transgressed and negotiated, both at the administrative level and among frontline professionals. The paper discusses three types of boundary work: (i) demarcating professional domains; (ii) setting the boundaries of the task itself; and (iii) managing administrative boundaries. The main argument is that the production, maintenance and transgression of these three types of boundaries constitute central and time-consuming aspects of the practices of public health professionals, and that boundary work constitutes an important element in professional practices seeking to 'tame a wicked problem', such as social inequalities in health. A cross-cutting feature of the three types of boundary work is the management of the divide between health and social issues, which the professionals seemingly seek to uphold and transgress at the same time. The paper thus contributes to ongoing discussions of intersectoral action to address health inequalities. Furthermore, it extends the scope and application of the concept of boundary work in the sociology of public health by suggesting that the focus in previous research on professional demarcation be broadened in order to capture other types of boundaries that shape, and are shaped by, professional practices. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Process evaluation of a multifaceted health program aiming to improve physical activity levels and dietary patterns among construction workers

    NARCIS (Netherlands)

    Viester, L.; Verhagen, E.A.L.M.; Bongers, P.M.; Beek, A.J. van der

    2014-01-01

    Objective: To evaluate the process of a health promotion program, aiming to improve physical activity levels and diet among construction workers. Methods: The process evaluation was conducted after the RE-AIM framework for the evaluation of the public health impact of health promotion interventions.

  1. PUBLIC COMMENT ON THE DEPARTMENT OF HEALTH AND HUMAN SERVICES 2018 FEDERAL PHYSICAL ACITIVTY GUIDELINES

    Science.gov (United States)

    Title: Public Comment on Department of Health and Human Services (DHHS) 2018 Physical Activity Guidelines Author: Wayne E. Cascio, Director, Environmental Public Health Division, US EPA Abstract: In the 2008 Physical Activity Guidelines, the effects of air pollution and advers...

  2. Integrating Compassionate, Collaborative Care (the "Triple C") Into Health Professional Education to Advance the Triple Aim of Health Care.

    Science.gov (United States)

    Lown, Beth A; McIntosh, Sharrie; Gaines, Martha E; McGuinn, Kathy; Hatem, David S

    2016-03-01

    Empathy and compassion provide an important foundation for effective collaboration in health care. Compassion (the recognition of and response to the distress and suffering of others) should be consistently offered by health care professionals to patients, families, staff, and one another. However, compassion without collaboration may result in uncoordinated care, while collaboration without compassion may result in technically correct but depersonalized care that fails to meet the unique emotional and psychosocial needs of all involved. Providing compassionate, collaborative care (CCC) is critical to achieving the "triple aim" of improving patients' health and experiences of care while reducing costs. Yet, values and skills related to CCC (or the "Triple C") are not routinely taught, modeled, and assessed across the continuum of learning and practice. To change this paradigm, an interprofessional group of experts recently recommended approaches and a framework for integrating CCC into health professional education and postgraduate training as well as clinical care. In this Perspective, the authors describe how the Triple C framework can be integrated and enhance existing competency standards to advance CCC across the learning and practice continuum. They also discuss strategies for partnering with patients and families to improve health professional education and health care design and delivery through quality improvement projects. They emphasize that compassion and collaboration are important sources of professional, patient, and family satisfaction as well as critical aspects of professionalism and person-centered, relationship-based high-quality care.

  3. Mental Health First Aid guidelines for helping a suicidal person: a Delphi consensus study in Japan

    Science.gov (United States)

    2011-01-01

    Background This study aimed to develop guidelines for how a member of the Japanese public should provide mental health first aid to a person who is suicidal. Methods The guidelines were produced by developing a questionnaire containing possible first aid actions and asking an expert panel of 32 Japanese mental health professionals to rate whether each action should be included in the guidelines. The content of the questionnaire was based on a systematic search of the relevant evidence and claims made by authors of consumer and carer guides and websites. The panel members were asked to complete the questionnaire by web survey. Three rounds of the rating were carried and, at the end of each round, items that reached the consensus criterion were selected for inclusion in the guidelines. During the first round, panel members were also asked to suggest any additional actions that were not covered in the original questionnaire (to include items that are relevant to local cultural circumstances, values, and social norms). Responses to these open-ended questions were used to generate new items. Results The output from the Delphi process was a set of agreed upon action statements. The Delphi process started with 138 statements, 38 new items were written based on suggestions from panel members and, of these 176 items, 56 met the consensus criterion. These statements were used to develop the guidelines appended to this article. Conclusions There are a number of actions that are considered to be useful for members of the Japanese public when they encounter someone who is experiencing suicidal thoughts or engaging in suicidal behaviour. Although the guidelines are designed for members of the public, they may also be helpful to health professionals working in health and welfare settings who do not have clinical mental health training. PMID:21592409

  4. Enhancing health care professionals' and trainees' knowledge of physical activity guidelines for adults with and without SCI.

    Science.gov (United States)

    Shirazipour, Celina H; Tomasone, Jennifer R; Martin Ginis, Kathleen A

    2018-01-11

    Health care providers (HCPs) are preferred sources of physical activity (PA) information; however, minimal research has explored HCPs' knowledge of spinal cord injury (SCI) PA guidelines, and no research has examined HCP trainees' PA guideline knowledge. The current study explored HCPs' and trainees' initial knowledge of PA guidelines for both adults with SCI and the general population, and the utility of an event-based intervention for improving this knowledge. Participants (HCPs n = 129; trainees n = 573) reported guideline knowledge for both sets of guidelines (SCI and general population) immediately after, one-month, and six-months following the intervention. Frequencies determined guideline knowledge at each timepoint, while chi-squared tests examined differences in knowledge of both guidelines, as well as knowledge differences in the short- and long-term. Results demonstrated that HCPs and trainees lack knowledge of PA guidelines, particularly guidelines for adults with SCI. The results further suggest that a single event-based intervention is not effective for improving long-term guideline knowledge. Suggestions are made for future research with the aim of improving interventions that target HCP and HCP trainees' long-term guideline knowledge for adults with SCI and the general population.

  5. Process evaluation of a tailored mobile health intervention aiming to reduce fatigue in airline pilots

    Directory of Open Access Journals (Sweden)

    Alwin van Drongelen

    2016-08-01

    Full Text Available Abstract Background MORE Energy is a mobile health intervention which aims to reduce fatigue and improve health in airline pilots. The primary objective of this process evaluation was to assess the reach, dose delivered, compliance, fidelity, barriers and facilitators, and satisfaction of the intervention. The second objective was to investigate the associations of adherence to the intervention with compliance and with participant satisfaction. Thirdly, we investigated differences between the subgroups within the target population. Methods The intervention consisted of a smartphone application, supported by a website. It provided advice on optimal light exposure, sleep, nutrition, and physical activity, tailored to flight and personal characteristics. The reach of the intervention was determined by comparing the intervention group participants and the airline pilots who did not participate. The dose delivered was defined as the total number of participants that was sent an instruction email. Objective compliance was measured through the Control Management System of the application. To determine the fidelity, an extensive log was kept throughout the intervention period. Subjective compliance, satisfaction, barriers, facilitators, and adherence were assessed using online questionnaires. Associations between the extent to which the participants applied the advice in daily life (adherence, compliance, and satisfaction were analysed as well. Finally, outcomes of participants of different age groups and haul types were compared. Results A total of 2222 pilots were made aware of the study. From this group, 502 pilots met the inclusion criteria and did agree to participate. The reach of the study proved to be 22 % and the dose delivered was 99 %. The included pilots were randomized into the intervention group (n = 251 or the control group (n = 251. Of the intervention group participants, 81 % consulted any advice, while 17 % did this during

  6. Process evaluation of a tailored mobile health intervention aiming to reduce fatigue in airline pilots.

    Science.gov (United States)

    van Drongelen, Alwin; Boot, Cécile R L; Hlobil, Hynek; Smid, Tjabe; van der Beek, Allard J

    2016-08-26

    MORE Energy is a mobile health intervention which aims to reduce fatigue and improve health in airline pilots. The primary objective of this process evaluation was to assess the reach, dose delivered, compliance, fidelity, barriers and facilitators, and satisfaction of the intervention. The second objective was to investigate the associations of adherence to the intervention with compliance and with participant satisfaction. Thirdly, we investigated differences between the subgroups within the target population. The intervention consisted of a smartphone application, supported by a website. It provided advice on optimal light exposure, sleep, nutrition, and physical activity, tailored to flight and personal characteristics. The reach of the intervention was determined by comparing the intervention group participants and the airline pilots who did not participate. The dose delivered was defined as the total number of participants that was sent an instruction email. Objective compliance was measured through the Control Management System of the application. To determine the fidelity, an extensive log was kept throughout the intervention period. Subjective compliance, satisfaction, barriers, facilitators, and adherence were assessed using online questionnaires. Associations between the extent to which the participants applied the advice in daily life (adherence), compliance, and satisfaction were analysed as well. Finally, outcomes of participants of different age groups and haul types were compared. A total of 2222 pilots were made aware of the study. From this group, 502 pilots met the inclusion criteria and did agree to participate. The reach of the study proved to be 22 % and the dose delivered was 99 %. The included pilots were randomized into the intervention group (n = 251) or the control group (n = 251). Of the intervention group participants, 81 % consulted any advice, while 17 % did this during four weeks or more. Fidelity was 67 %. The

  7. 75 FR 8085 - National Institutes of Health Guidelines for Human Stem Cell Research

    Science.gov (United States)

    2010-02-23

    ... Health Guidelines for Human Stem Cell Research SUMMARY: The National Institutes of Health (NIH) is requesting public comment on a revision to the definition of human embryonic stem cells (hESCs) in the ``National Institutes of Health Guidelines for Human Stem Cell Research'' (Guidelines). On July 7, 2009, NIH...

  8. 75 FR 13137 - National Institutes of Health Guidelines for Human Stem Cell Research

    Science.gov (United States)

    2010-03-18

    ... Health Guidelines for Human Stem Cell Research SUMMARY: The National Institutes of Health (NIH) is extending the public comment period on a revision to the definition of human embryonic stem cells (hESCs) in the ``National Institutes of Health Guidelines for Human Stem Cell Research'' (Guidelines). Due to a...

  9. 76 FR 58517 - Public Health Service Guideline for Reducing Transmission of Human Immunodeficiency Virus (HIV...

    Science.gov (United States)

    2011-09-21

    ...-2011-0011] Public Health Service Guideline for Reducing Transmission of Human Immunodeficiency Virus... public comment on the draft Public Health Service Guideline for Reducing Transmission of Human..., Attn: Public Health Service Guideline for Reducing Transmission of Human Immunodeficiency Virus (HIV...

  10. The Mental Health System in North-Eastern Nigeria: A WHO-AIMS ...

    African Journals Online (AJOL)

    PROMOTING ACCESS TO AFRICAN RESEARCH ... The definition of a detailed description of the mental health system of the north-eastern region ... for regional mental health Gap action Plan (mhGAP) policy formulation and implementation.

  11. Impact of school-based health promotion interventions aimed at different behavioral domains: a systematic review

    Directory of Open Access Journals (Sweden)

    Marta Lima-Serrano

    2014-09-01

    Conclusions: This exhaustive review found that well-implemented interventions can promote adolescent health. These findings are consistent with recent reviews. Implications for practice, public health, and research are discussed.

  12. Coaches' Perceptions of French Sports Clubs: Health-Promotion Activities, Aims and Coach Motivation

    Science.gov (United States)

    Van Hoye, Aurélie; Sarrazin, Philippe; Heuzé, Jean-Philippe; Kokko, Sami

    2015-01-01

    Background: Given the benefits of participating in sport, sports clubs have been recognised as health promoting organizations. To examine health-promotion activities in Finnish sports clubs, Kokko et al. developed a set of standards for health-promoting sports clubs (HPSC). Objective: The present study extends this line of research, by (1)…

  13. APSIC guidelines for disinfection and sterilization of instruments in health care facilities

    Directory of Open Access Journals (Sweden)

    Moi Lin Ling

    2018-02-01

    Full Text Available Abstract Background The Asia Pacific Society of Infection Control launched its revised Guidelines for Disinfection and Sterilization of Instruments in Health Care Facilities in February 2017. This document describes the guidelines and recommendations for the reprocessing of instruments in healthcare setting. It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities at Asia Pacific region in achieving high standards in sterilization and disinfection. Method The guidelines were revised by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section. Results It recommends the centralization of reprocessing, training of all staff with annual competency assessment, verification of cleaning, continual monitoring of reprocessing procedures to ensure their quality and a corporate strategy for dealing with single-use and single-patient use medical equipment/devices. Detailed recommendations are also given with respect to reprocessing of endoscopes. Close working with the Infection Prevention & Control department is also recommended where decisions related to reprocessing medical equipment/devices are to be made. Conclusions Sterilization facilities should aim for excellence in practices as this is part of patient safety. The guidelines that come with a checklist help service providers identify gaps for improvement to reach this goal.

  14. Is the aim of the English health care system to maximize QALYs?

    Science.gov (United States)

    Shah, Koonal; Praet, Cecile; Devlin, Nancy; Sussex, Jonathan; Appleby, John; Parkin, David

    2012-07-01

    To compare the types of benefit considered relevant by the English Department of Health with those included by the National Institute for Health and Clinical Excellence (NICE) when conducting economic evaluations of options for spending limited health care resources. We analysed all policy Impact Assessments (IAs) carried out by the Department of Health (DH) in 2008 and 2009. The stated benefits of each policy were extracted and thematic analysis was used to categorise these. 51 Impact Assessments were analysed, eight of which mentioned quality-adjusted life year (QALY) gains as a benefit. 18 benefits other than QALY gains were identified. Apart from improving health outcomes, commonly referred to benefits included: reducing costs, improving quality of care, and enhancing patient experience. Many of the policies reviewed were implemented on the basis of benefits unrelated to health outcome. The methods being used to apply a monetary valuation to QALY gains (in cost-benefit calculations) are not consistent across Impact Assessments or with NICE's stated threshold range. The Department of Health and NICE approach resource allocation decisions in different ways, based upon overlapping but not congruent considerations and underlying principles. Given that all these decisions affect the allocation of the same fixed health care budget, there is a case for establishing a uniform framework for option appraisal and priority setting so as to avoid allocative inefficiency. The same applies to any other national health care system.

  15. Leveraging health information technology to achieve the "triple aim" of healthcare reform.

    Science.gov (United States)

    Sheikh, Aziz; Sood, Harpreet S; Bates, David W

    2015-07-01

    To investigate experiences with leveraging health information technology (HIT) to improve patient care and population health, and reduce healthcare expenditures. In-depth qualitative interviews with federal government employees, health policy, HIT and medico-legal experts, health providers, physicians, purchasers, payers, patient advocates, and vendors from across the United States. The authors undertook 47 interviews. There was a widely shared belief that Health Information Technology for Economic and Clinical Health (HITECH) had catalyzed the creation of a digital infrastructure, which was being used in innovative ways to improve quality of care and curtail costs. There were however major concerns about the poor usability of electronic health records (EHRs), their limited ability to support multi-disciplinary care, and major difficulties with health information exchange, which undermined efforts to deliver integrated patient-centered care. Proposed strategies for enhancing the benefits of HIT included federal stimulation of competition by mandating vendors to open-up their application program interfaces, incenting development of low-cost consumer informatics tools, and promoting Congressional review of the The Health Insurance Portability and Accountability Act (HIPPA) to optimize the balance between data privacy and reuse. Many underscored the need to "kick the legs from underneath the fee-for-service model" and replace it with a data-driven reimbursement system that rewards high quality care. The HITECH Act has stimulated unprecedented, multi-stakeholder interest in HIT. Early experiences indicate that the resulting digital infrastructure is being used to improve quality of care and curtail costs. Reform efforts are however severely limited by problems with usability, limited interoperability and the persistence of the fee-for-service paradigm-addressing these issues therefore needs to be the federal government's main policy target. © The Author 2015

  16. Risk assessment - a research program aimed at health risks from air pollution in the general environment

    International Nuclear Information System (INIS)

    Lindahl-Kiessling, K.; Ahlborg, U.; Bylin, G.; Ehrenberg, L.; Hemminki, K.; Lindell, B.; Nilsson, Robert; Bostroem, C.E.; Swarn, U.

    1991-01-01

    The paper presents a new research program for assessment of health risks caused by air pollutants. It is important to develop general methods for quantitative risk assessments and to improve the scientific base materials. (KAE)

  17. Process Evaluation of a Workplace Health Promotion Intervention Aimed at Improving Work Engagement and Energy Balance

    NARCIS (Netherlands)

    van Berkel, J.; Boot, C.R.L.; Proper, K.I.; Bongers, P.M.; van der Beek, A.J.

    2013-01-01

    OBJECTIVE:: To evaluate the process of the implementation of an intervention aimed at improving work engagement and energy balance, and to explore associations between process measures and compliance. METHODS:: Process measures were assessed using a combination of quantitative and qualitative

  18. Process evaluation of a workplace health promotion intervention aimed at improving work engagement and energy balance

    NARCIS (Netherlands)

    Berkel, J. van; Boot, C.R.L.; Proper, K.I.; Bongers, P.M.; Beek, A.J. van der

    2013-01-01

    OBJECTIVE:: To evaluate the process of the implementation of an intervention aimed at improving work engagement and energy balance, and to explore associations between process measures and compliance. METHODS:: Process measures were assessed using a combination of quantitative and qualitative

  19. Institutional Policy Changes Aimed at Addressing Obesity Among Mental Health Clients

    OpenAIRE

    Knol, Linda L.; Pritchett, Kelly; Dunkin, Jeri

    2010-01-01

    Background People with mental illness often experience unique barriers to healthy eating and physical activity. For these clients, interventions should focus on changes in the immediate environment to change behaviors. The purpose of this project was to implement and evaluate policy changes that would limit calorie intake and increase calorie expenditure of clients receiving mental health services. Context This intervention was implemented in a rural mental health system in the southeastern U...

  20. THE WAY OF ASSESSING THE ADHERENCE TO MODERN DRUG THERAPY CLINICAL GUIDELINES AIMED AT REDUCING THE RISK OF RECURRENT STROKE (ACCORDING TO THE LIS-2 REGISTER

    Directory of Open Access Journals (Sweden)

    A. Yu. Suvorov

    2015-09-01

    Full Text Available Aim. To develop a method for the assessment of quality of medical prevention of recurrent stroke and its’ testing using the results of the LIS-2 register (Lyubertsy study of mortality in patients after stroke.Material and methods. The scale evaluation of the quality of therapy for the prevention of recurrent stroke developed in accordance with the modern clinical practice guidelines, as well as the recurrent stroke prevention index (RSPI for this assessment were elaborated. The analysis of the therapy was performed in patients after stroke in LIS-2 registers (n=219. The assessment of the quality of treatment was performed using RSPI, the influence of the index results on the in-hospital mortality was studied.Results. Two groups of patients [with RSPI=0 (n=137 and RSPI>0 (n=82] were formed on the basis of the results evaluation via RSPI. Significant differences between groups were not found. At the same time higher in-hospital mortality (p=0.014; χ2 Pearson was detected in patients with RSPI=0; relative risk of in-hospital death (after adjustment for sex and age was 2.04 [1.07-3.91] (p=0.031. Analysis of the length of survival and duration of hospital stay was performed in both groups using the Kaplan-Meier method. In-hospital mortality was significantly higher in patients with RSPI=0, which was confirmed by the log-rank test (p=0.032.Conclusion. The results of the quality of medical care assessment in accordance with the developed method are significantly related to the outcomes during the stay in a hospital. The developed method, based on current clinical recommendations, can serve as an example of the implementation of evidence-based medicine in actual practice.

  1. Management Systems for Organic EggProduction - Aiming to Improve AnimalHealth and Welfare

    DEFF Research Database (Denmark)

    Hegelund, Lene

    one production period. In the second part of the project a generic HACCP system was developed, using an expert panel analysis. The two management tools have very different approaches to improving animal health and welfare, and subsequently different methods, cost and advantages. This makes them...

  2. A new independent authority is needed to issue National Health Care guidelines.

    Science.gov (United States)

    Keyhani, Salomeh; Kim, Azalea; Mann, Micah; Korenstein, Deborah

    2011-02-01

    Health experts emphasize that getting doctors to follow clinical guidelines can save both lives and money. Less attention has been paid to how the guidelines are developed and the variability in the recommendations they include. We examined the quality and content of screening guidelines as a proxy for guidelines in general and found that the source of the guidelines affects their quality. Guidelines with inconsistent recommendations are unlikely to serve patients or physicians well. The creation of an independent organization that would work with multiple stakeholders to develop guidelines holds the potential to improve their quality.

  3. Treatment of adult patients with schizophrenia and complex mental health needs - A national clinical guideline

    DEFF Research Database (Denmark)

    Baandrup, Lone; Østrup Rasmussen, Jesper; Klokker, Louise

    2016-01-01

    BACKGROUND AND AIM: The Danish Health and Medicines Authority assembled a group of experts to develop a national clinical guideline for patients with schizophrenia and complex mental health needs. Within this context, ten explicit review questions were formulated, covering several identified key...... therapy for persistent positive and/or negative symptoms, and the combination of cognitive behavioural therapy and motivational interviewing for cannabis and/or central stimulant abuse. SSRI or SNRI add-on treatment for persistent negative symptoms should be used only cautiously. Where no evidence...

  4. An overview of Uganda's mental health care system: results from an assessment using the world health organization's assessment instrument for mental health systems (WHO-AIMS

    Directory of Open Access Journals (Sweden)

    Cooper Sara

    2010-01-01

    Full Text Available Abstract Background The Ugandan government recognizes mental health as a serious public health and development concern, and has of recent implemented a number of reforms aimed at strengthening the country's mental health system. The aim of this study was to provide a profile of the current mental health policy, legislation and services in Uganda. Methods A survey was conducted of public sector mental health policy and legislation, and service resources and utilisation in Uganda, in the year 2005, using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS Version 2.2. Results Uganda's draft mental health policy encompasses many positive reforms, including decentralization and integration of mental health services into Primary Health Care (PHC. The mental health legislation is however outdated and offensive. Services are still significantly underfunded (with only 1% of the health expenditure going to mental health, and skewed towards urban areas. Per 100,000 population, there were 1.83 beds in mental hospitals, 1.4 beds in community based psychiatric inpatient units, and 0.42 beds in forensic facilities. The total personnel working in mental health facilities were 310 (1.13 per 100,000 population. Only 0.8% of the medical doctors and 4% of the nurses had specialized in psychiatry. Conclusion Although there have been important developments in Uganda's mental health policy and services, there remains a number of shortcomings, especially in terms of resources and service delivery. There is an urgent need for more research on the current burden of mental disorders and the functioning of mental health programs and services in Uganda.

  5. Process evaluation of a workplace health promotion intervention aimed at improving work engagement and energy balance.

    Science.gov (United States)

    van Berkel, Jantien; Boot, Cécile R L; Proper, Karin I; Bongers, Paulien M; van der Beek, Allard J

    2013-01-01

    To evaluate the process of the implementation of an intervention aimed at improving work engagement and energy balance, and to explore associations between process measures and compliance. Process measures were assessed using a combination of quantitative and qualitative methods. The mindfulness training was attended at least once by 81.3% of subjects, and 54.5% were highly compliant. With regard to e-coaching and homework exercises, 6.3% and 8.0%, respectively, were highly compliant. The training was appreciated with a 7.5 score and e-coaching with a 6.8 score. Appreciation of training and e-coaching, satisfaction with trainer and coach, and practical facilitation were significantly associated with compliance. The intervention was implemented well on the level of the mindfulness training, but poorly on the level of e-coaching and homework time investment. To increase compliance, attention should be paid to satisfaction and trainer-participant relationship.

  6. Developing and implementing health and sustainability guidelines for institutional food service.

    Science.gov (United States)

    Kimmons, Joel; Jones, Sonya; McPeak, Holly H; Bowden, Brian

    2012-05-01

    Health and sustainability guidelines for institutional food service are directed at improving dietary intake and increasing the ecological benefits of the food system. The development and implementation of institutional food service guidelines, such as the Health and Human Services (HHS) and General Services Administration (GSA) Health and Sustainability Guidelines for Federal Concessions and Vending Operations (HHS/GSA Guidelines), have the potential to improve the health and sustainability of the food system. Institutional guidelines assist staff, managers, and vendors in aligning the food environment at food service venues with healthier and more sustainable choices and practices. Guideline specifics and their effective implementation depend on the size, culture, nature, and management structure of an institution and the individuals affected. They may be applied anywhere food is sold, served, or consumed. Changing institutional food service practice requires comprehensive analysis, engagement, and education of all relevant stakeholders including institutional management, members of the food supply chain, and customers. Current examples of food service guidelines presented here are the HHS and GSA Health and Sustainability Guidelines for Federal Concessions and Vending Operations, which translate evidence-based recommendations on health and sustainability into institutional food service practices and are currently being implemented at the federal level. Developing and implementing guidelines has the potential to improve long-term population health outcomes while simultaneously benefitting the food system. Nutritionists, public health practitioners, and researchers should consider working with institutions to develop, implement, and evaluate food service guidelines for health and sustainability.

  7. Developing and Implementing Health and Sustainability Guidelines for Institutional Food Service123

    Science.gov (United States)

    Kimmons, Joel; Jones, Sonya; McPeak, Holly H.; Bowden, Brian

    2012-01-01

    Health and sustainability guidelines for institutional food service are directed at improving dietary intake and increasing the ecological benefits of the food system. The development and implementation of institutional food service guidelines, such as the Health and Human Services (HHS) and General Services Administration (GSA) Health and Sustainability Guidelines for Federal Concessions and Vending Operations (HHS/GSA Guidelines), have the potential to improve the health and sustainability of the food system. Institutional guidelines assist staff, managers, and vendors in aligning the food environment at food service venues with healthier and more sustainable choices and practices. Guideline specifics and their effective implementation depend on the size, culture, nature, and management structure of an institution and the individuals affected. They may be applied anywhere food is sold, served, or consumed. Changing institutional food service practice requires comprehensive analysis, engagement, and education of all relevant stakeholders including institutional management, members of the food supply chain, and customers. Current examples of food service guidelines presented here are the HHS and GSA Health and Sustainability Guidelines for Federal Concessions and Vending Operations, which translate evidence-based recommendations on health and sustainability into institutional food service practices and are currently being implemented at the federal level. Developing and implementing guidelines has the potential to improve long-term population health outcomes while simultaneously benefitting the food system. Nutritionists, public health practitioners, and researchers should consider working with institutions to develop, implement, and evaluate food service guidelines for health and sustainability. PMID:22585909

  8. Guidelines for breast cancer screening in Lebanon Public Health Communication.

    Science.gov (United States)

    Adib, Salim M; El Saghir, Nagi S; Ammar, Walid

    2009-01-01

    The accumulation of national epidemiological data since the late 1990s has led to the adoption of evidence-based guidelines for breast cancer screening in Lebanon (2006). Almost 50% of breast cancer patients in Lebanon are below the age of 50 years and the age-adjusted incidence rate is estimated at 69 new cases per 100,000 per year (2004). This official notification calls for breast self-examination (BSE) every month starting age 20, and a clinical breast examination (CBE) performed by a physician every three years between the ages of 20 and 40 years. Starting age 40, and for as long as a woman is in good health, an annual CBE and mammography are recommended. Women with known genetic family history of breast cancer should start screening 10 years earlier than the first young patient in the family, or earlier depending on medical advice. The Breast Cancer National Task Force (BCNTF) recommends certification of mammography centers and continued training of personnel to assure high quality mammograms, and to minimize unnecessary investigations and surgeries.It recommends that a national program should record call-backs of women for annual screening and follow-up data on abnormal mammograms. BCNTF encourages the adoption of these guidelines and monitoring of their results, as well as follow-up of breast cancer epidemiology and registry in Lebanon, and scientific progress in early breast cancer detection to determine needs for modifications in the future.

  9. Workplace health and safety during pandemic influenza : CAGC guideline

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2009-11-15

    Pandemic influenza is a possible biological hazard that employers must take into account during hazard assessment and emergency planning. This report presented a guideline to all workplaces in Alberta and provided information on legislated requirements, best practices, guidelines and strategies in workplace health and safety and employment standards in the event of a pandemic influenza. The report explained the difference between a pandemic and a pandemic influenza, and why scientists expect another pandemic influenza. Pandemic influenza was described as being different from seasonal influenza. This document also explained how pandemic influenza relates to the worker and the workplace, and how the workplace can prepare for and respond to pandemic influenza. Pandemic influenza hazard categories were also listed along with steps in the hazard assessment and control of pandemic influenza. The steps involve listing the types of work and work-related activities; identifying the hazard; assessing the hazards; implementing controls; communicating the information to workers and providing training; and evaluating the effectiveness of controls. The guide also addressed emergency response plan development for pandemic influenza; first aid; and employment standards during pandemic influenza. refs., tabs.

  10. Identifying and Intervening in Child Maltreatment and Implementing Related National Guidelines by Public Health Nurses in Finland and Japan

    Directory of Open Access Journals (Sweden)

    Kayoko Suzuki

    2017-01-01

    Full Text Available Aim. This study aimed to investigate how public health nurses identify, intervene in, and implement the guidelines on child maltreatment in Finland and Japan and to compare the data between the two countries. Method. This study employed a cross-sectional design. Public health nurses’ knowledge and skills with respect to child maltreatment prevention were assessed using a questionnaire consisting of three categories: identification, intervention, and implementation of guidelines. Public health nurses working in the area of maternal and child health care in Finland (n=193 and Japan (n=440 were the participants. Results. A significantly higher percentage of Japanese public health nurses identified child maltreatment compared to Finnish public health nurses, while Finnish nurses intervened in child maltreatment better than their Japanese counterparts. In both countries, public health nurses who had read and used the guidelines dealt with child maltreatment better than those who did not. Conclusion. The results suggest that effective training on child maltreatment and the use of guidelines are important to increase public health nurses’ knowledge and skills for identifying and intervening in child maltreatment.

  11. Advances in participatory occupational health aimed at good practices in small enterprises and the informal sector.

    Science.gov (United States)

    Kogi, Kazutaka

    2006-01-01

    Participatory programmes for occupational risk reduction are gaining importance particularly in small workplaces in both industrially developing and developed countries. To discuss the types of effective support, participatory steps commonly seen in our "work improvement-Asia" network are reviewed. The review covered training programmes for small enterprises, farmers, home workers and trade union members. Participatory steps commonly focusing on low-cost good practices locally achieved have led to concrete improvements in multiple technical areas including materials handling, workstation ergonomics, physical environment and work organization. These steps take advantage of positive features of small workplaces in two distinct ways. First, local key persons are ready to accept local good practices conveyed through personal, informal approaches. Second, workers and farmers are capable of understanding technical problems affecting routine work and taking flexible actions leading to solving them. This process is facilitated by the use of locally adjusted training tools such as local good examples, action checklists and group work methods. It is suggested that participatory occupational health programmes can work in small workplaces when they utilize low-cost good practices in a flexible manner. Networking of these positive experiences is essential.

  12. Improvement of information on the nuclear energy health effects, the aim of win Slovakia

    International Nuclear Information System (INIS)

    Petrasova, M.; Nikodemova, D.

    1998-01-01

    International organisation WIN Global and national organisation WIN Slovakia which as a section of Slovak Nuclear Society, offer unique opportunities for the improvement of radiation risk communication. WIN Global was established in 1993 and currently has about 600 members in 39 countries. WIN Slovakia was established in the end of 1997 and has 20 members. WIN Slovakia is the association of women working professionally in the fields of nuclear energy and application of radiation and willing to devote time to public information. Members of WIN Slovakia all have one thing in common: They want the general public to have a better understanding of nuclear and radiation matter. The members of WIN Slovakia would like and plane to make presentations, discuss and give information material on subjects as: energy and sustainable development; radiation, radioactivity, and health effects; medical applications, radiation protection; nuclear energy, uranium mining; nuclear power plants and their safety; radioactive waste; nuclear and environment; natural radiation, radon. In 1996-1997 a comparative risk perception study was carried out in Slovak Republic. Real data were collected through the administration of a questionnaires distributed among a group of 14-17 years old children (N 1 = 308) and teenagers (N 2 = 150). The list of 44 items covered a wide range of risks and hazards, including risks from technology (nuclear power plants, water-dams etc.) pollution (air-, water-, soil, waste management) nature (floods, fire, etc.), life style (smoking, drugs, alcohol abuse) and society (crime, conflicts, war, terror etc.). The questionnaire contains the questions about the sources of risk information. The topic of the study was the self assessment of the knowledge on particular risks too. The results were summarised

  13. [Guidelines for budget impact analysis of health technologies in Brazil].

    Science.gov (United States)

    Ferreira-Da-Silva, Andre Luis; Ribeiro, Rodrigo Antonini; Santos, Vânia Cristina Canuto; Elias, Flávia Tavares Silva; d'Oliveira, Alexandre Lemgruber Portugal; Polanczyk, Carisi Anne

    2012-07-01

    Budget impact analysis (BIA) provides operational financial forecasts to implement new technologies in healthcare systems. There were no previous specific recommendations to conduct such analyses in Brazil. This paper reviews BIA methods for health technologies and proposes BIA guidelines for the public and private Brazilian healthcare system. The following recommendations were made: adopt the budget administrator's perspective; use a timeframe of 1 to 5 years; compare reference and alternative scenarios; consider the technology's rate of incorporation; estimate the target population by either an epidemiological approach or measured demand; consider restrictions on technologies' indication or factors that increase the demand for them; consider direct and averted costs; do not adjust for inflation or discounts; preferably, integrate information on a spreadsheet; calculate the incremental budget impact between scenarios; and summarize information in a budget impact report.

  14. Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review.

    Science.gov (United States)

    Francke, Anneke L; Smit, Marieke C; de Veer, Anke J E; Mistiaen, Patriek

    2008-09-12

    Nowadays more and more clinical guidelines for health care professionals are being developed. However, this does not automatically mean that these guidelines are actually implemented. The aim of this meta-review is twofold: firstly, to gain a better understanding of which factors affect the implementation of guidelines, and secondly, to provide insight into the "state-of-the-art" regarding research within this field. A search of five literature databases and one website was performed to find relevant existing systematic reviews or meta-reviews. Subsequently, a two-step inclusion process was conducted: (1) screening on the basis of references and abstracts and (2) screening based on full-text papers. After that, relevant data from the included reviews were extracted and the methodological quality of the reviews was assessed by using the Quality Assessment Checklist for Reviews. Twelve systematic reviews met our inclusion criteria. No previous systematic meta-reviews meeting all our inclusion criteria were found. Two of the twelve reviews scored high on the checklist used, indicating only "minimal" or "minor flaws". The other ten reviews scored in the lowest of middle ranges, indicating "extensive" or "major" flaws. A substantial proportion (although not all) of the reviews indicates that effective strategies often have multiple components and that the use of one single strategy, such as reminders only or an educational intervention, is less effective. Besides, characteristics of the guidelines themselves affect actual use. For instance, guidelines that are easy to understand, can easily be tried out, and do not require specific resources, have a greater chance of implementation. In addition, characteristics of professionals - e.g., awareness of the existence of the guideline and familiarity with its content - likewise affect implementation. Furthermore, patient characteristics appear to exert influence: for instance, co-morbidity reduces the chance that guidelines

  15. Factors influencing the implementation of clinical guidelines for health care professionals: A systematic meta-review

    Directory of Open Access Journals (Sweden)

    de Veer Anke JE

    2008-09-01

    Full Text Available Abstract Background Nowadays more and more clinical guidelines for health care professionals are being developed. However, this does not automatically mean that these guidelines are actually implemented. The aim of this meta-review is twofold: firstly, to gain a better understanding of which factors affect the implementation of guidelines, and secondly, to provide insight into the "state-of-the-art" regarding research within this field. Methods A search of five literature databases and one website was performed to find relevant existing systematic reviews or meta-reviews. Subsequently, a two-step inclusion process was conducted: (1 screening on the basis of references and abstracts and (2 screening based on full-text papers. After that, relevant data from the included reviews were extracted and the methodological quality of the reviews was assessed by using the Quality Assessment Checklist for Reviews. Results Twelve systematic reviews met our inclusion criteria. No previous systematic meta-reviews meeting all our inclusion criteria were found. Two of the twelve reviews scored high on the checklist used, indicating only "minimal" or "minor flaws". The other ten reviews scored in the lowest of middle ranges, indicating "extensive" or "major" flaws. A substantial proportion (although not all of the reviews indicates that effective strategies often have multiple components and that the use of one single strategy, such as reminders only or an educational intervention, is less effective. Besides, characteristics of the guidelines themselves affect actual use. For instance, guidelines that are easy to understand, can easily be tried out, and do not require specific resources, have a greater chance of implementation. In addition, characteristics of professionals – e.g., awareness of the existence of the guideline and familiarity with its content – likewise affect implementation. Furthermore, patient characteristics appear to exert influence: for

  16. Comparison of Quality And Content of Violence Guidelines For The Health Care Sector

    Directory of Open Access Journals (Sweden)

    Rabia Kahveci

    2018-03-01

    Full Text Available More than 50% of the employees in health sector are exposed to violence at any time. This study investigated international workplace violence guidelines for the health care sector to compare their quality and content and explore whether these guidelines could be used in different settings. We ran a broad review to identify international guidelines for violence in health care. After identification of the guidelines, the quality of the guidelines was assessed by personal experience and views of the authors, also taking AGREE domains into consideration as a guidance. The identified guidelines were later qualitatively analyzed for the content by two researchers and compared to each other. Canada, New Zealand, USA, UK and Turkey’s guidelines were involved in the study. Definitions of workplace violence, risk factors, objectives of the guideline, legal requirements, responsible stakeholders, target population, strategies recommended, physical environment, training and staffing were assessed in the content of the violence guidelines. It was found that current guidelines need improvement in both quality and content, but it is possible to have an international guidance that could be applicable in different settings. The development of violence guidelines should be the first and most strategic step for better protection of the health care workers. We expect our results to be useful in preparation of new guidelines for different settings.

  17. Performing Compliance: The Work of Local Policy Workers during the Implementation of National Health Promotion Guidelines

    Science.gov (United States)

    Wimmelmann, Camila Lawaetz

    2017-01-01

    Guidelines are increasingly used to regulate how local authorities engage in practices. Focusing on the Danish national health promotion guidelines, this article reveals that the local policy workers did not implement the guidelines as proposed. Using a dramaturgical framework, it illustrates how the local policy workers front-staged some…

  18. Economic modelling of diagnostic and treatment pathways in National Institute for Health and Care Excellence clinical guidelines: the Modelling Algorithm Pathways in Guidelines (MAPGuide) project.

    Science.gov (United States)

    Lord, J; Willis, S; Eatock, J; Tappenden, P; Trapero-Bertran, M; Miners, A; Crossan, C; Westby, M; Anagnostou, A; Taylor, S; Mavranezouli, I; Wonderling, D; Alderson, P; Ruiz, F

    2013-12-01

    National Institute for Health and Care Excellence (NICE) clinical guidelines (CGs) make recommendations across large, complex care pathways for broad groups of patients. They rely on cost-effectiveness evidence from the literature and from new analyses for selected high-priority topics. An alternative approach would be to build a model of the full care pathway and to use this as a platform to evaluate the cost-effectiveness of multiple topics across the guideline recommendations. In this project we aimed to test the feasibility of building full guideline models for NICE guidelines and to assess if, and how, such models can be used as a basis for cost-effectiveness analysis (CEA). A 'best evidence' approach was used to inform the model parameters. Data were drawn from the guideline documentation, advice from clinical experts and rapid literature reviews on selected topics. Where possible we relied on good-quality, recent UK systematic reviews and meta-analyses. Two published NICE guidelines were used as case studies: prostate cancer and atrial fibrillation (AF). Discrete event simulation (DES) was used to model the recommended care pathways and to estimate consequent costs and outcomes. For each guideline, researchers not involved in model development collated a shortlist of topics suggested for updating. The modelling teams then attempted to evaluate options related to these topics. Cost-effectiveness results were compared with opinions about the importance of the topics elicited in a survey of stakeholders. The modelling teams developed simulations of the guideline pathways and disease processes. Development took longer and required more analytical time than anticipated. Estimates of cost-effectiveness were produced for six of the nine prostate cancer topics considered, and for five of eight AF topics. The other topics were not evaluated owing to lack of data or time constraints. The modelled results suggested 'economic priorities' for an update that differed from

  19. Guidelines for health technology assessment in Thailand (second edition)--the development process.

    Science.gov (United States)

    Chaikledkaew, Usa; Kittrongsiri, Kankamon

    2014-05-01

    The first Thai-specific HTA guidelines were completed in 2008 with the aim of ensuring that all HTA data was accurate, of high quality, and relevant for making decisions pertaining to healthcare resource allocation. Based on a quality assessment of 89 economic evaluation studies in the Thai context published in international academic journals between 1982 and 2012, the analysis revealed a significant increase in quality of data sources and result reporting in studies published after the dissemination of the first Thai HTA guidelines. As the first Thai HTA guidelines were developed in 2008, a number of areas for improvement have been identified. Therefore, the objective of this chapter is to describe the development process of this second edition of HTA guidelines for Thailand which builds on the success of the first edition, while attempting to address some of the identified limitations of the first edition and reflect the changes that the health care and policy contexts have undergone in the intervening years. It is hoped that this second edition will continue to build on these successes so that policy decision making becomes increasingly evidence-based.

  20. Development of disaster mental health guidelines through the Delphi process in Japan

    Directory of Open Access Journals (Sweden)

    Suzuki Yuriko

    2012-07-01

    Full Text Available Abstract Background The mental health community in Japan had started reviewing the country’s disaster mental health guidelines before the Great East Japan Earthquake, aiming to revise them based on evidence and experience accumulated in the last decade. Given the wealth of experience and knowledge acquired in the field by many Japanese mental health professionals, we decided to develop the guidelines through systematic consensus building and selected the Delphi method. Methods After a thorough literature review and focus group interviews, 96 items regarding disaster mental health were included in Delphi Round 1. Of 100 mental health professionals experienced in disaster response who were invited to participate, 97 agreed. The appropriateness of each statement was assessed by the participants using a Likert scale (1: extremely inappropriate, 9: very appropriate and providing free comments in three rounds. Consensus by experts was defined as an average score of ≥7 for which ≥70% of participants assigned this score, and items reaching consensus were included in the final guidelines. Results Overall, of the 96 items (89 initially asked and 7 added items, 77 items were agreed on (46 items in Round 1, and 19 positive and 12 negative agreed on items in Round 2. In Round 2, three statements with which participants agreed most strongly were: 1 A protocol for emergency work structure and information flow should be prepared in normal times; 2 The mental health team should attend regular meetings on health and medicine to exchange information; and 3 Generally, it is recommended not to ask disaster survivors about psychological problems at the initial response but ask about their present worries and physical condition. Three statements with which the participants disagreed most strongly in this round were: 1 Individuals should be encouraged to provide detailed accounts of their experiences; 2 Individuals should be provided with education if they are

  1. The application of an occupational health guideline reduces sedentary behaviour and increases fruit intake at work: Results from an RCT

    NARCIS (Netherlands)

    Verweij, L.M.; Proper, K.I.; Weel, A.N.H.; Hulshof, C.T.J.; Mechelen, W. van

    2012-01-01

    Objective: To evaluate the effectiveness of a draft occupational health practice guideline aimed at preventing weight gain on employees' physical activity, sedentary behaviour and dietary behaviour and on body weight-related outcomes. Methods: A randomised controlled trial was performed comparing

  2. Managing conflicts of interest in the UK National Institute for Health and Care Excellence (NICE) clinical guidelines programme: qualitative study.

    Science.gov (United States)

    Graham, Tanya; Alderson, Phil; Stokes, Tim

    2015-01-01

    There is international concern that conflicts of interest (COI) may bias clinical guideline development and render it untrustworthy. Guideline COI policies exist with the aim of reducing this bias but it is not known how such policies are interpreted and used by guideline producing organisations. This study sought to determine how conflicts of interest (COIs) are disclosed and managed by a national clinical guideline developer (NICE: the UK National Institute for Health and Care Excellence). Qualitative study using semi-structured telephone interviews with 14 key informants: 8 senior staff of NICE's guideline development centres and 6 chairs of guideline development groups (GDGs). We conducted a thematic analysis. Participants regard the NICE COI policy as comprehensive leading to transparent and independent guidance. The application of the NICE COI policy is, however, not straightforward and clarity could be improved. Disclosure of COI relies on self reporting and guideline developers have to take "on trust" the information they receive, certain types of COI (non-financial) are difficult to categorise and manage and disclosed COI can impact on the ability to recruit clinical experts to GDGs. Participants considered it both disruptive and stressful to exclude members from GDG meetings when required by the COI policy. Nonetheless the impact of this disruption can be minimised with good group chairing skills. We consider that the successful implementation of a COI policy in clinical guideline development requires clear policies and procedures, appropriate training of GDG chairs and an evaluation of how the policy is used in practice.

  3. Built environment interventions aimed at improving physical activity levels in rural Ontario health units: a descriptive qualitative study.

    Science.gov (United States)

    Coghill, Cara-Lee; Valaitis, Ruta K; Eyles, John D

    2015-05-03

    Few studies to date have explored the relationship between the built environment and physical activity specifically in rural settings. The Ontario Public Health Standards policies mandate that health units in Ontario address the built environment; however, it is unclear how public health practitioners are integrating the built environment into public health interventions aimed at improving physical activity in chronic disease prevention programs. This descriptive qualitative study explored interventions that have or are being implemented which address the built environment specifically related to physical activity in rural Ontario health units, and the impact of these interventions. Data were collected through twelve in-depth semi-structured interviews with rural public health practitioners and managers representing 12 of 13 health units serving rural communities. Key themes were identified using qualitative content analysis. Themes that emerged regarding the types of interventions that health units are employing included: Engagement with policy work at a municipal level; building and working with community partners, committees and coalitions; gathering and providing evidence; developing and implementing programs; and social marketing and awareness raising. Evaluation of interventions to date has been limited. Public health interventions, and their evaluations, are complex. Health units who serve large rural populations in Ontario are engaging in numerous activities to address physical activity levels. There is a need to further evaluate the impact of these interventions on population health.

  4. Widening the Aim of Health Promotion to Include the Most Disadvantaged: Vulnerable Adolescents and the Social Determinants of Health

    Science.gov (United States)

    Mohajer, Nicole; Earnest, Jaya

    2010-01-01

    Growing numbers of adolescents are marginalized by social factors beyond their control, leading to poor health outcomes for their families and future generations. Although the role of the social determinants of health has been recognized for many years, there is a gap in our knowledge about the strategies needed to address these factors in health…

  5. Educating APNs for Implementing the Guidelines for Adolescents in "Bright Futures: Guidelines of Health Supervision of Infants, Children, and Adolescents."

    Science.gov (United States)

    Porter, Cornelia P.; Pender, Nola J.; Hayman, Laura L.; Armstrong, Myrna L.; Riesch, Susan K.; Lewis, Mary Ann

    1997-01-01

    Discusses recommendations for preparing advanced practice nurses (APNs) to implement guidelines of a health curriculum: (1) ensuring age-appropriate teaching; (2) emphasizing the complex relationships of race/ethnicity, socioeconomic status, and gender; (3) reinforcing the self-care and resilience of adolescents; and (4) examining transitions…

  6. Using the RE-AIM framework to evaluate physical activity public health programs in México.

    Science.gov (United States)

    Jauregui, Edtna; Pacheco, Ann M; Soltero, Erica G; O'Connor, Teresia M; Castro, Cynthia M; Estabrooks, Paul A; McNeill, Lorna H; Lee, Rebecca E

    2015-02-19

    Physical activity (PA) public health programming has been widely used in Mexico; however, few studies have documented individual and organizational factors that might be used to evaluate their public health impact. The RE-AIM framework is an evaluation tool that examines individual and organizational factors of public health programs. The purpose of this study was to use the RE-AIM framework to determine the degree to which PA programs in Mexico reported individual and organizational factors and to investigate whether reporting differed by the program's funding source. Public health programs promoting PA were systematically identified during 2008-2013 and had to have an active program website. Initial searches produced 23 possible programs with 12 meeting inclusion criteria. A coding sheet was developed to capture behavioral, outcome and RE-AIM indicators from program websites. In addition to targeting PA, five (42%) programs also targeted dietary habits and the most commonly reported outcome was change in body composition (58%). Programs reported an average of 11.1 (±3.9) RE-AIM indicator items (out of 27 total). On average, 45% reported reach indicators, 34% reported efficacy/effectiveness indicators, 60% reported adoption indicators, 40% reported implementation indicators, and 35% reported maintenance indicators. The proportion of RE-AIM indicators reported did not differ significantly for programs that were government supported (M = 10, SD = 3.1) and programs that were partially or wholly privately or corporately supported (M = 12.0, SD = 4.4). While reach and adoption of these programs were most commonly reported, there is a need for stronger evaluation of behavioral and health outcomes before the public health impact of these programs can be established.

  7. European network for promoting the physical health of residents in psychiatric and social care facilities (HELPS: background, aims and methods

    Directory of Open Access Journals (Sweden)

    Marginean Roxana

    2009-08-01

    Full Text Available Abstract Background People with mental disorders have a higher prevalence of physical illnesses and reduced life expectancy as compared with the general population. However, there is a lack of knowledge across Europe concerning interventions that aim at reducing somatic morbidity and excess mortality by promoting behaviour-based and/or environment-based interventions. Methods and design HELPS is an interdisciplinary European network that aims at (i gathering relevant knowledge on physical illness in people with mental illness, (ii identifying health promotion initiatives in European countries that meet country-specific needs, and (iii at identifying best practice across Europe. Criteria for best practice will include evidence on the efficacy of physical health interventions and of their effectiveness in routine care, cost implications and feasibility for adaptation and implementation of interventions across different settings in Europe. HELPS will develop and implement a "physical health promotion toolkit". The toolkit will provide information to empower residents and staff to identify the most relevant risk factors in their specific context and to select the most appropriate action out of a range of defined health promoting interventions. The key methods are (a stakeholder analysis, (b international literature reviews, (c Delphi rounds with experts from participating centres, and (d focus groups with staff and residents of mental health care facilities. Meanwhile a multi-disciplinary network consisting of 15 European countries has been established and took up the work. As one main result of the project they expect that a widespread use of the HELPS toolkit could have a significant positive effect on the physical health status of residents of mental health and social care facilities, as well as to hold resonance for community dwelling people with mental health problems. Discussion A general strategy on health promotion for people with mental

  8. European network for promoting the physical health of residents in psychiatric and social care facilities (HELPS): background, aims and methods

    Science.gov (United States)

    Weiser, Prisca; Becker, Thomas; Losert, Carolin; Alptekin, Köksal; Berti, Loretta; Burti, Lorenzo; Burton, Alexandra; Dernovsek, Mojca; Dragomirecka, Eva; Freidl, Marion; Friedrich, Fabian; Genova, Aneta; Germanavicius, Arunas; Halis, Ulaş; Henderson, John; Hjorth, Peter; Lai, Taavi; Larsen, Jens Ivar; Lech, Katarzyna; Lucas, Ramona; Marginean, Roxana; McDaid, David; Mladenova, Maya; Munk-Jørgensen, Povl; Paziuc, Alexandru; Paziuc, Petronela; Priebe, Stefan; Prot-Klinger, Katarzyna; Wancata, Johannes; Kilian, Reinhold

    2009-01-01

    Background People with mental disorders have a higher prevalence of physical illnesses and reduced life expectancy as compared with the general population. However, there is a lack of knowledge across Europe concerning interventions that aim at reducing somatic morbidity and excess mortality by promoting behaviour-based and/or environment-based interventions. Methods and design HELPS is an interdisciplinary European network that aims at (i) gathering relevant knowledge on physical illness in people with mental illness, (ii) identifying health promotion initiatives in European countries that meet country-specific needs, and (iii) at identifying best practice across Europe. Criteria for best practice will include evidence on the efficacy of physical health interventions and of their effectiveness in routine care, cost implications and feasibility for adaptation and implementation of interventions across different settings in Europe. HELPS will develop and implement a "physical health promotion toolkit". The toolkit will provide information to empower residents and staff to identify the most relevant risk factors in their specific context and to select the most appropriate action out of a range of defined health promoting interventions. The key methods are (a) stakeholder analysis, (b) international literature reviews, (c) Delphi rounds with experts from participating centres, and (d) focus groups with staff and residents of mental health care facilities. Meanwhile a multi-disciplinary network consisting of 15 European countries has been established and took up the work. As one main result of the project they expect that a widespread use of the HELPS toolkit could have a significant positive effect on the physical health status of residents of mental health and social care facilities, as well as to hold resonance for community dwelling people with mental health problems. Discussion A general strategy on health promotion for people with mental disorders must take into

  9. Mental health first aid guidelines: an evaluation of impact following download from the World Wide Web.

    Science.gov (United States)

    Hart, Laura M; Jorm, Anthony F; Paxton, Susan J; Cvetkovski, Stefan

    2012-11-01

    Mental health first aid guidelines provide the public with consensus-based information about how to assist someone who is developing a mental illness or experiencing a mental health crisis. The aim of the current study was to evaluate the usefulness and impact of the guidelines on web users who download them. Web users who downloaded the documents were invited to respond to an initial demographic questionnaire, then a follow up about how the documents had been used, their perceived usefulness, whether first-aid situations had been encountered and if these were influenced by the documents. Over 9.8 months, 706 web users responded to the initial questionnaire and 154 responded to the second. A majority reported downloading the document because their job involved contact with people with mental illness. Sixty-three web users reported providing first aid, 44 of whom reported that the person they were assisting had sought professional care as a result of their suggestion. Twenty-three web users reported seeking care themselves. A majority of those who provided first aid reported feeling that they had been successful in helping the person, that they had been able to assist in a way that was more knowledgeable, skilful and supportive, and that the guidelines had contributed to these outcomes. Information made freely available on the Internet, about how to provide mental health first aid to someone who is developing a mental health problem or experiencing a mental health crisis, is associated with more positive, empathic and successful helping behaviours. © 2012 Wiley Publishing Asia Pty Ltd.

  10. Regional Standards for Rangeland Health and Guidelines for Livestock Grazing Management ... A Progress Report

    OpenAIRE

    1996-01-01

    In August 1995, new BLM regulations for rangeland administration went into effect. The new regulations require BLM to establish regional standards for rangeland health and guidelines for grazing management. This publication is a report on the alternatives being considered for the Montana/Dakotas Rangeland Health Standards and Guidelines process.

  11. [Proposal for a media guideline to improve medical and health journalism].

    Science.gov (United States)

    Kojima, Masami

    2012-01-01

    A lot of healthcare professionals experienced annoyance with biased mass media news regarding medical and health issues. In this paper, I propose "news profiling method" and "media guideline" to improve the medical and health journalism.

  12. [Guidelines for the preventive health care of hairdressing apprentices].

    Science.gov (United States)

    Golińska-Zach, Aleksandra; Wiszniewska, Marta; Walusiak-Skorupa, Jolanta

    2017-07-26

    Hairdressing is one of the most developing branch of the service industry in Poland. Providing representatives of this occupational group with preventive health care services it should be remembered that they are at risk of skin and respiratory diseases, which occur due to a quite frequent exposure to harmful agents in the work environment of hairdressers and hairdressing apprentices. Interestingly, a much lower number of researches concentrate on respiratory symptoms than on skin disorders in hairdressers. The authors of this article have carried out the first Polish follow-up study focused not only on skin disorders but also on respiratory tract symptoms in hairdressing apprentices. The results of the study have been reported in other publications while this paper presents a literature review based on EBSCO and PubMed databases, Elsevier and contained articles (on the subject discussed in this paper). On the basis of information obtained from the authors' own research evidence and from the literature review, the guidelines for the preventive health care of hairdressing apprentices were developed. It was confirmed that neither determination of allergen-specific immunoglobulin E (IgE) nor performance of skin prick tests (SPTs) and patch tests for hairdressing factors are necessary. They should be performed as a part of preventive medical examination only in those apprentice candidates and trainees in this profession who report work-related symptoms and it is suspected that they result from exposure to particular factor in the work environment. Med Pr 2017;68(5):677-687. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  13. Guidelines for the preventive health care of hairdressing apprentices

    Directory of Open Access Journals (Sweden)

    Aleksandra Golińska-Zach

    2017-10-01

    Full Text Available Hairdressing is one of the most developing branch of the service industry in Poland. Providing representatives of this occupational group with preventive health care services it should be remembered that they are at risk of skin and respiratory diseases, which occur due to a quite frequent exposure to harmful agents in the work environment of hairdressers and hairdressing apprentices. Interestingly, a much lower number of researches concentrate on respiratory symptoms than on skin disorders in hairdressers. The authors of this article have carried out the first Polish follow-up study focused not only on skin disorders but also on respiratory tract symptoms in hairdressing apprentices. The results of the study have been reported in other publications while this paper presents a literature review based on EBSCO and PubMed databases, Elsevier and contained articles (on the subject discussed in this paper. On the basis of information obtained from the authors’ own research evidence and from the literature review, the guidelines for the preventive health care of hairdressing apprentices were developed. It was confirmed that neither determination of allergen-specific immunoglobulin E (IgE nor performance of skin prick tests (SPTs and patch tests for hairdressing factors are necessary. They should be performed as a part of preventive medical examination only in those apprentice candidates and trainees in this profession who report work-related symptoms and it is suspected that they result from exposure to particular factor in the work environment. Med Pr 2017;68(5:677–687

  14. Cannabinoid Hyperemesis Syndrome: Public Health Implications and a Novel Model Treatment Guideline

    Directory of Open Access Journals (Sweden)

    Seth Meyer

    2017-11-01

    Full Text Available Introduction: Cannabinoid hyperemesis syndrome (CHS is an entity associated with cannabinoid overuse. CHS typically presents with cyclical vomiting, diffuse abdominal pain, and relief with hot showers. Patients often present to the emergency department (ED repeatedly and undergo extensive evaluations including laboratory examination, advanced imaging, and in some cases unnecessary procedures. They are exposed to an array of pharmacologic interventions including opioids that not only lack evidence, but may also be harmful. This paper presents a novel treatment guideline that highlights the identification and diagnosis of CHS and summarizes treatment strategies aimed at resolution of symptoms, avoidance of unnecessary opioids, and ensuring patient safety. Methods: The San Diego Emergency Medicine Oversight Commission in collaboration with the County of San Diego Health and Human Services Agency and San Diego Kaiser Permanente Division of Medical Toxicology created an expert consensus panel to establish a guideline to unite the ED community in the treatment of CHS. Results: Per the consensus guideline, treatment should focus on symptom relief and education on the need for cannabis cessation. Capsaicin is a readily available topical preparation that is reasonable to use as first-line treatment. Antipsychotics including haloperidol and olanzapine have been reported to provide complete symptom relief in limited case studies. Conventional antiemetics including antihistamines, serotonin antagonists, dopamine antagonists and benzodiazepines may have limited effectiveness. Emergency physicians should avoid opioids if the diagnosis of CHS is certain and educate patients that cannabis cessation is the only intervention that will provide complete symptom relief. Conclusion: An expert consensus treatment guideline is provided to assist with diagnosis and appropriate treatment of CHS. Clinicians and public health officials should identity and treat CHS

  15. Towards guideline implementation for integrated local health policies : Evaluation of an experimental implementation strategy in regional health services

    NARCIS (Netherlands)

    Kuunders, T.J.M.; Cloin, J.C.M.; van Bon, M.J.H.; Paulussen, T.G.W.M.; van Oers, J.A.M.; van de Goor, L.A.M.

    2017-01-01

    To enhance implementation of a Guideline for integrated local health policy, a draft implementation strategy (DIS) was developed. It was hypothesized that the DIS would be feasible and effective to enhance the use of a Guideline for integrated local health policy. To examine its feasibility and

  16. RE-AIM in Clinical, Community, and Corporate Settings: Perspectives, Strategies, and Recommendations to Enhance Public Health Impact

    Directory of Open Access Journals (Sweden)

    Samantha M. Harden

    2018-03-01

    Full Text Available The RE-AIM Framework is a planning and evaluation model that has been used in a variety of settings to address various programmatic, environmental, and policy innovations for improving population health. In addition to the broad application and diverse use of the framework, there are lessons learned and recommendations for the future use of the framework across clinical, community, and corporate settings. The purposes of this article are to: (A provide a brief overview of the RE-AIM Framework and its pragmatic use for planning and evaluation; (B offer recommendations to facilitate the application of RE-AIM in clinical, community, and corporate settings; and (C share perspectives and lessons learned about employing RE-AIM dimensions in the planning, implementation, and evaluation phases within these different settings. In this article, we demonstrate how the RE-AIM concepts and elements within each dimension can be applied by researchers and practitioners in diverse settings, among diverse populations and for diverse health topics.

  17. Family relations, mental health and adherence to nutritional guidelines in patients facing dialysis initiation.

    Science.gov (United States)

    Untas, Aurélie; Rascle, Nicole; Idier, Laetitia; Lasseur, Catherine; Combe, Christian

    2012-01-01

    This study investigated the effect of family relations on patients' adjustment to dialysis. The two main aims were to develop a family typology, and to explore the influence of family profile on the patient's anxiety, depression and adherence to nutritional guidelines. The sample consisted of 120 patients (mean age 63 years; 67.5% of men). They completed several measures 1, 6 and 12 months after dialysis initiation. The scales used were the Family Relationship Index and the Hospital Anxiety and Depression Scale. Perceived adherence to nutritional guidelines was assessed using two visual analogical scales. Results showed that family relations remained stable over time. Cluster analysis yielded three family profiles, which were named conflict, communicative and supportive families. Patients belonging to conflict families perceived themselves as less adhering to nutritional guidelines. For these patients, anxiety and depressive moods increased significantly over time, whereas mental health remained stable over time for communicative and supportive families. This research underlines that family relations are essential in global consideration of the care of patients treated by dialysis. Conflict families seem especially at risk. They should be identified early to help them adapt to this stressful treatment.

  18. Public health facility resource availability and provider adherence to first antenatal guidelines in a low resource setting in Accra, Ghana.

    Science.gov (United States)

    Amoakoh-Coleman, Mary; Agyepong, Irene Akua; Kayode, Gbenga A; Grobbee, Diederick E; Klipstein-Grobusch, Kerstin; Ansah, Evelyn K

    2016-09-21

    Lack of resources has been identified as a reason for non-adherence to clinical guidelines. Our aim was to describe public health facility resource availability in relation to provider adherence to first antenatal visit guidelines. A cross-sectional analysis of the baseline data of a prospective cohort study on adherence to first antenatal care visit guidelines was carried out in 11 facilities in the Greater Accra Region of Ghana. Provider adherence was studied in relation to health facility resource availability such as antenatal workload for clinical staffs, routine antenatal drugs, laboratory testing, protocols, ambulance and equipment. Eleven facilities comprising 6 hospitals (54.5 %), 4 polyclinics (36.4 %) and 1 health center were randomly sampled. Complete provider adherence to first antenatal guidelines for all the 946 participants was 48.1 % (95 % CI: 41.8-54.2 %), varying significantly amongst the types of facilities, with highest rate in the polyclinics. Average antenatal workload per month per clinical staff member was higher in polyclinics compared to the hospitals. All facility laboratories were able to conduct routine antenatal tests. Most routine antenatal drugs were available in all facilities except magnesium sulphate and sulphadoxine-pyrimethamine which were lacking in some. Antenatal service protocols and equipment were also available in all facilities. Although antenatal workload varies across different facility types in the Greater Accra region, other health facility resources that support implementation of first antenatal care guidelines are equally available in all the facilities. These factors therefore do not adequately account for the low and varying proportions of complete adherence to guidelines across facility types. Providers should be continually engaged for a better understanding of the barriers to their adherence to these guidelines.

  19. Mental Health First Aid guidelines for helping a suicidal person: a Delphi consensus study in the Philippines.

    Science.gov (United States)

    Colucci, Erminia; Kelly, Claire M; Minas, Harry; Jorm, Anthony F; Nadera, Dinah

    2010-12-20

    This study aimed to develop guidelines for how a member of the Filipino public should provide mental health first aid to a person who is suicidal. The guidelines were produced by developing a questionnaire containing possible first aid actions and asking an expert panel of 34 Filipino mental health clinicians to rate whether each action should be included in the guidelines. The content of the questionnaire was based on a systematic search of the relevant evidence and claims made by authors of consumer and carer guides and websites. The panel members were asked to complete the questionnaire by web survey. Three rounds of the rating were carried and, at the end of each round, items that reached the consensus criterion were selected for inclusion in the guidelines. During the first round, panel members were also asked to suggest any additional actions that were not covered in the original questionnaire (to include items that are relevant to local cultural circumstances, values, and social norms). Responses to these open-ended questions were used to generate new items. The output from the Delphi process was a set of agreed upon action statements. The Delphi process started with 138 statements, 48 new items were written based on suggestions from panel members and, of these 186 items, 102 met the consensus criterion. These statements were used to develop the guidelines appended to this paper. The guidelines are currently being translated into local languages. There are a number of actions that are considered to be useful for members of the public when they encounter someone who is experiencing suicidal thoughts or engaging in suicidal behaviour. Although the guidelines are designed for members of the public, they may also be helpful to non-mental health professionals working in health and welfare settings.

  20. Mental Health First Aid guidelines for helping a suicidal person: a Delphi consensus study in the Philippines

    Directory of Open Access Journals (Sweden)

    Jorm Anthony F

    2010-12-01

    Full Text Available Abstract Background This study aimed to develop guidelines for how a member of the Filipino public should provide mental health first aid to a person who is suicidal. Methods The guidelines were produced by developing a questionnaire containing possible first aid actions and asking an expert panel of 34 Filipino mental health clinicians to rate whether each action should be included in the guidelines. The content of the questionnaire was based on a systematic search of the relevant evidence and claims made by authors of consumer and carer guides and websites. The panel members were asked to complete the questionnaire by web survey. Three rounds of the rating were carried and, at the end of each round, items that reached the consensus criterion were selected for inclusion in the guidelines. During the first round, panel members were also asked to suggest any additional actions that were not covered in the original questionnaire (to include items that are relevant to local cultural circumstances, values, and social norms. Responses to these open-ended questions were used to generate new items. Results The output from the Delphi process was a set of agreed upon action statements. The Delphi process started with 138 statements, 48 new items were written based on suggestions from panel members and, of these 186 items, 102 met the consensus criterion. These statements were used to develop the guidelines appended to this paper. The guidelines are currently being translated into local languages. Conclusions There are a number of actions that are considered to be useful for members of the public when they encounter someone who is experiencing suicidal thoughts or engaging in suicidal behaviour. Although the guidelines are designed for members of the public, they may also be helpful to non-mental health professionals working in health and welfare settings.

  1. Method to integrate clinical guidelines into the electronic health record (EHR) by applying the archetypes approach.

    Science.gov (United States)

    Garcia, Diego; Moro, Claudia Maria Cabral; Cicogna, Paulo Eduardo; Carvalho, Deborah Ribeiro

    2013-01-01

    Clinical guidelines are documents that assist healthcare professionals, facilitating and standardizing diagnosis, management, and treatment in specific areas. Computerized guidelines as decision support systems (DSS) attempt to increase the performance of tasks and facilitate the use of guidelines. Most DSS are not integrated into the electronic health record (EHR), ordering some degree of rework especially related to data collection. This study's objective was to present a method for integrating clinical guidelines into the EHR. The study developed first a way to identify data and rules contained in the guidelines, and then incorporate rules into an archetype-based EHR. The proposed method tested was anemia treatment in the Chronic Kidney Disease Guideline. The phases of the method are: data and rules identification; archetypes elaboration; rules definition and inclusion in inference engine; and DSS-EHR integration and validation. The main feature of the proposed method is that it is generic and can be applied toany type of guideline.

  2. Everyday life and health concepts among blue-collar female workers in Denmark: implications for health promotion aiming at reducing health inequalities.

    Science.gov (United States)

    Jensen, Jeanette Magne

    2013-06-01

    This article introduces a perspective on the health of women with low levels of education in terms of organisation of their everyday life. The aim is to demonstrate the ways in which the women's concept of health is contingent on the conditions encountered in everyday life. A qualitative study based on interviews with the women forms the basis for the discussion. The analysis shows that the women find it difficult to adopt the official discourse on health and its foundation in a biomedical tradition. The article argues that it is necessary to move away from the educational approach focusing on risk and lifestyle with the goal of regulating individual behaviour. Instead, an approach is suggested which can provide the women with the opportunity to gain control of the everyday health determinants which are normally beyond their immediate reach. This is based on the argument that it is necessary to work with a health promotion and education strategy capable of operating within the various interactive patterns between 'environment' and 'individual' which form the foundation for health.

  3. Evaluating the effects of the Dietary Guidelines for Americans on consumer behavior and health: methodological challenges.

    Science.gov (United States)

    Guthrie, Joanne F; Smallwood, David M

    2003-12-01

    The Dietary Guidelines for Americans is the official nutrition policy statement for the United States. Government involvement in providing information on private behavior, such as food choice, is justified by the high cost of poor diets, as measured in medical expenses and lost productivity. The Guidelines are intended to provide an up-to-date, consistent information base for federal nutrition education and information efforts and food assistance program regulations. Through these policy mechanisms, the Guidelines are assumed to improve dietary behavior, and, ultimately, health. By law, the Dietary Guidelines for Americans must be updated every five years; however, there is no mandate for evaluation. Evaluation could provide useful information to assess the extent to which the Guidelines positively influence health and provide insights into reasons for their successes and limitations. However, evaluation would also present considerable challenges. This paper discusses the critical data and methodological needs for improving evaluation of the Dietary Guidelines for Americans.

  4. Guidelines for Whole-Body Vibration Health Surveillance

    Science.gov (United States)

    POPE, M.; MAGNUSSON, M.; LUNDSTRÖM, R.; HULSHOF, C.; VERBEEK, J.; BOVENZI, M.

    2002-05-01

    There is strong epidemiological evidence that occupational exposure to WBV is associated with an increased risk of low back pain (LBP), sciatic pain, and degenerative changes in the spinal system, including lumbar intervertebral disc disorders. A prototype health surveillance scheme for WBV is presented in this paper. Surveillance is the collection, analysis, and dissemination of data for the purpose of prevention. The aims are to assess health status and diagnose vibration-induced disorders at an early stage, to inform the workers on the potential risk associated with vibration exposure, to give preventive advice to employers and employees and to control whether preventive measures which have been taken, were successful. It is suggested that a pre-placement health examination should be offered to each worker who will be exposed to WBV so as to make the worker aware of the hazards, to obtain baseline health data, and to identify medical conditions that may increase the risk due to WBV. The case history should focus on personal history, work history, and leisure activities involving driving of vehicles. The personal medical history should detail back pain complaints, disorders in the spine, any injuries or surgery to the musculoskeletal system. A physical examination on the lower back should be performed on workers who have experienced LBP symptoms over the past 12 months. The preplacement examination should be followed by periodic health reassessment with a regular interval according to the legislation of the country. It is suggested that periodic medical examination should be made available at least every 2 years to all workers who are exposed to WBV. Any change in vibration exposure at the workplace should be reported by the employer. If an increase in vibration exposure or a change in health status have occurred, the medical re-examination should be offered at shorter intervals at the discretion of the attending physician. There should be a periodic medical

  5. Health impact assessment: A comparison of 45 local, national, and international guidelines

    International Nuclear Information System (INIS)

    Hebert, Katherine A.; Wendel, Arthur M.; Kennedy, Sarah K.; Dannenberg, Andrew L.

    2012-01-01

    This article provides a comparison of health impact assessment (HIA) guidelines from around the world and for multiple geographic scales. We identify commonalities and differences within HIA guides to discuss the plausibility of consensus guidelines and to inform guideline development. The practice of HIA has grown over the last two decades with a concurrent growth of HIA guides. This study expands on earlier review work and includes guides published since 2007 (Mindell, Boltong and Forde, 2008). From April 2010 to October 2011, 45 HIA guides were identified through an internet search and review of previous research. Common characteristics, key features, and the HIA process were analyzed. The 45 documents recommended similar but not identical processes for conducting HIAs. These analyses suggest that guidelines for HIAs are similar in many areas of the world and that new HIA practitioners can use these findings to inform their approach. Further discussion is needed to determine if the approaches established in these guidelines are followed and if one set of common guidelines could be written for use in numerous countries and regions. - Highlights: ► We analyze 45 health impact assessment (HIA) guidelines worldwide. ► We examine similarities and unique attributes of each guideline. ► We discuss the advantages and disadvantages of developing consensus guidelines. ► Identifying additional guidelines aides in future HIA work and evaluation.

  6. Adapting heart failure guidelines for nursing care in home health settings: challenges and solutions.

    Science.gov (United States)

    Radhakrishnan, Kavita; Topaz, Maxim; Masterson Creber, Ruth

    2014-07-01

    Nurses provide most of home health services for patients with heart failure, and yet there are no evidence-based practice guidelines developed for home health nurses. The purpose of this article was to review the challenges and solutions for adapting generally available HF clinical practice guidelines to home health nursing. Appropriate HF guidelines were identified and home health nursing-relevant guidelines were extracted by the research team. In addition, a team of nursing academic and practice experts evaluated the extracted guidelines and reached consensus through Delphi rounds. We identified 172 recommendations relevant to home health nursing from the American Heart Association and Heart Failure Society of America guidelines. The recommendations were divided into 5 groups (generic, minority populations, normal ejection fraction, reduced ejection fraction, and comorbidities) and further subgroups. Experts agreed that 87% of the recommendations selected by the research team were relevant to home health nursing and rejected 6% of the selected recommendations. Experts' opinions were split on 7% of guideline recommendations. Experts mostly disagreed on recommendations related to HF medication and laboratory prescription as well as HF patient assessment. These disagreements were due to lack of patient information available to home health nurses as well as unclear understanding of scope of practice regulations for home health nursing. After 2 Delphi rounds over 8 months, we achieved 100% agreement on the recommendations. The finalized guideline included 153 recommendations. Guideline adaptation projects should include a broad scope of nursing practice recommendations from which home health agencies can customize relevant recommendations in accordance with available information and state and agency regulations.

  7. Documenting the experiences of health workers expected to implement guidelines during an intervention study in Kenyan hospitals

    Directory of Open Access Journals (Sweden)

    Warira Ann

    2009-07-01

    Full Text Available Abstract Background Although considerable efforts are directed at developing international guidelines to improve clinical management in low-income settings they appear to influence practice rarely. This study aimed to explore barriers to guideline implementation in the early phase of an intervention study in four district hospitals in Kenya. Methods We developed a simple interview guide based on a simple characterisation of the intervention informed by review of major theories on barriers to uptake of guidelines. In-depth interviews, non-participatory observation, and informal discussions were then used to explore perceived barriers to guideline introduction and general improvements in paediatric and newborn care. Data were collected four to five months after in-service training in the hospitals. Data were transcribed, themes explored, and revised in two rounds of coding and analysis using NVivo 7 software, subjected to a layered analysis, reviewed, and revised after discussion with four hospital staff who acted as within-hospital facilitators. Results A total of 29 health workers were interviewed. Ten major themes preventing guideline uptake were identified: incomplete training coverage; inadequacies in local standard setting and leadership; lack of recognition and appreciation of good work; poor communication and teamwork; organizational constraints and limited resources; counterproductive health worker norms; absence of perceived benefits linked to adoption of new practices; difficulties accepting change; lack of motivation; and conflicting attitudes and beliefs. Conclusion While the barriers identified are broadly similar in theme to those reported from high-income settings, their specific nature often differs. For example, at an institutional level there is an almost complete lack of systems to introduce or reinforce guidelines, poor teamwork across different cadres of health worker, and failure to confront poor practice. At an individual

  8. Congenital Heart Disease: Guidelines of Care for Children with Special Health Care Needs.

    Science.gov (United States)

    Minnesota State Dept. of Health, Minneapolis. Services for Children with Handicaps.

    These guidelines were written to help families coordinate the health care that may be needed by a child with congenital heart disease. The booklet begins with general information about congenital heart disease. It then discusses the goals of health care, the health care team, the importance of periodic health care, and record keeping procedures.…

  9. Health professionals working with First Nations, Inuit, and Métis consensus guideline.

    Science.gov (United States)

    Wilson, Don; de la Ronde, Sandra; Brascoupé, Simon; Apale, Alisha Nicole; Barney, Lucy; Guthrie, Bing; Harrold, Elizabeth; Horn, Ojistoh; Johnson, Robin; Rattray, Darrien; Robinson, Nicole; Alainga-Kango, Natsiq; Becker, Gisela; Senikas, Vyta; Aningmiuq, Annie; Bailey, Geri; Birch, Darlene; Cook, Katsi; Danforth, Jessica; Daoust, Mary; Kitty, Darlene; Koebel, Jaime; Kornelsen, Judith; Tsatsa Kotwas, Ndakaitedzva; Lawrence, Audrey; Mudry, Amanda; Senikas, Vyta; Turner, Gail Theresa; Van Wagner, Vicki; Vides, Eduardo; Wasekeesikaw, Fjola Hart; Wolfe, Sara

    2013-06-01

    Our aim is to provide health care professionals in Canada with the knowledge and tools to provide culturally safe care to First Nations, Inuit, and Métis women and through them, to their families, in order to improve the health of First Nations, Inuit, and Métis. Published literature was retrieved through searches of PubMed, CINAHL, Sociological Abstracts, and The Cochrane Library in 2011 using appropriate controlled vocabulary (e.g.,cultural competency, health services, indigenous, transcultural nursing) and key words (e.g., indigenous health services, transcultural health care, cultural safety). Targeted searches on subtopics (e.g., ceremonial rites and sexual coming of age) were also performed. The PubMed search was restricted to the years 2005 and later because of the large number of records retrieved on this topic. Searches were updated on a regular basis and incorporated in the guideline to May 2012. Grey (unpublished) literature was identified through searching the websites of selected related agencies (e.g., Campbell Collaboration, Social Care Online, Institute for Healthcare Improvement). The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task force on Preventive Health Care (Table).

  10. Sugar and health: a food-based dietary guideline for South Africa

    African Journals Online (AJOL)

    2013-04-12

    Apr 12, 2013 ... Food-Based Dietary Guidelines for South Africa: Sugar and health: a food-based dietary guidelines for South Africa ... preferable, especially in those at risk of the harmful effects of sugar, e.g. people who are overweight, have prediabetes, ..... regarded as being synonymous with “junk food” into one.

  11. EAACI Food Allergy and Anaphylaxis Guidelines : Food allergy health-related quality of life measures

    NARCIS (Netherlands)

    Muraro, A.; Dubois, Anthony; DunnGalvin, A.; Hourihane, J. O'B.; de Jong, N. W.; Meyer, R.; Panesar, S. S.; Roberts, G.; Salvilla, S.; Sheikh, A.; Worth, A.; Flokstra-de Blok, B. M. J.

    Instruments have been developed and validated for the measurement of health-related quality of life in patients with food allergy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group. It draws on a

  12. Development of the International Guidelines for Home Health Nursing.

    Science.gov (United States)

    Narayan, Mary; Farris, Cindy; Harris, Marilyn D; Hiong, Fong Yoke

    2017-10-01

    Throughout the world, healthcare is increasingly being provided in home and community-based settings. There is a growing awareness that the most effective, least costly, patient-preferred setting is patients' home. Thus, home healthcare nursing is a growing nursing specialty, requiring a unique set of nursing knowledge and skills. Unlike many other nursing specialties, home healthcare nursing has few professional organizations to develop or support its practice. This article describes how an international network of home healthcare nurses developed international guidelines for home healthcare nurses throughout the world. It outlines how the guidelines for home healthcare nursing practice were developed, how an international panel of reviewers was recruited, and the process they used for reaching a consensus. It also describes the plan for nurses to contribute to future updates to the guidelines.

  13. Characteristics of Spanish articles of "scientific quality" cited in clinical practice guidelines on mental health.

    Science.gov (United States)

    Permanyer-Miralda, Gaietà; Adam, Paula; Guillamón, Imma; Solans-Domènech, Maite; Pons, Joan M V

    2013-01-01

    The study aims to illustrate the impact of Spanish research in clinical decision making. To this end, we analysed the characteristics of the most significant Spanish publications cited in clinical practice guidelines (CPG) on mental health. We conducted a descriptive qualitative study on the characteristics of ten articles cited in Spanish CPG on mental health, and selected for their "scientific quality". We analysed the content of the articles on the basis of the following characteristics: topics, study design, research centres, scientific and practical relevance, type of funding, and area or influence of the reference to the content of the guidelines. Among the noteworthy studies, some basic science studies, which have examined the establishment of genetic associations in the pathogenesis of mental illness are included, and others on the effectiveness of educational interventions. The content of those latter had more influence on the GPC, because they were cited in the summary of the scientific evidence or in the recommendations. Some of the outstanding features in the selected articles are the sophisticated designs (experimental or analytical), and the number of study centres, especially in international collaborations. Debate or refutation of previous findings on controversial issues may have also contributed to the extensive citation of work. The inclusion of studies in the CPG is not a sufficient condition of "quality", but their description can be instructive for the design of future research or publications. Copyright © 2012 SEP y SEPB. Published by Elsevier Espana. All rights reserved.

  14. Feasibility of a controlled trial aiming to prevent excessive pregnancy-related weight gain in primary health care

    Directory of Open Access Journals (Sweden)

    Weiderpass Elisabete

    2008-08-01

    Full Text Available Abstract Background Excessive gestational weight gain and postpartum weight retention may predispose women to long-term overweight and other health problems. Intervention studies aiming at preventing excessive pregnancy-related weight gain are needed. The feasibility of implementing such a study protocol in primary health care setting was evaluated in this pilot study. Methods A non-randomized controlled trial was conducted in three intervention and three control maternity and child health clinics in primary health care in Finland. Altogether, 132 pregnant and 92 postpartum women and 23 public health nurses (PHN participated in the study. The intervention consisted of individual counselling on physical activity and diet at five routine visits to a PHN and of an option for supervised group exercise until 37 weeks' gestation or ten months postpartum. The control clinics continued their usual care. The components of the feasibility evaluation were 1 recruitment and participation, 2 completion of data collection, 3 realization of the intervention and 4 the public health nurses' experiences. Results 1 The recruitment rate was slower than expected and the recruitment period had to be prolonged from the initially planned three months to six months. The average participation rate of eligible women at study enrolment was 77% and the drop-out rate 15%. 2 In total, 99% of the data on weight, physical activity and diet and 96% of the blood samples were obtained. 3 In the intervention clinics, 98% of the counselling sessions were realized, their contents and average durations were as intended, 87% of participants regularly completed the weekly records for physical activity and diet, and the average participation percentage in the group exercise sessions was 45%. 4 The PHNs regarded the extra training as a major advantage and the high additional workload as a disadvantage of the study. Conclusion The study protocol was mostly feasible to implement, which

  15. Using a Mixed-Methods RE-AIM Framework to Evaluate Community Health Programs for Older Latinas.

    Science.gov (United States)

    Schwingel, Andiara; Gálvez, Patricia; Linares, Deborah; Sebastião, Emerson

    2017-06-01

    This study used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate a promotora-led community health program designed for Latinas ages 50 and older that sought to improve physical activity, nutrition, and stress management. A mixed-methods evaluation approach was administered at participant and organizational levels with a focus on the efficacy, adoption, implementation, and maintenance components of the RE-AIM theoretical model. The program was shown to be effective at improving participants' eating behaviors, increasing their physical activity levels, and lowering their depressive symptoms. Promotoras felt motivated and sufficiently prepared to deliver the program. Some implementation challenges were reported. More child care opportunities and an increased focus on mental well-being were suggested. The promotora delivery model has promise for program sustainability with both promotoras and participants alike expressing interest in leading future programs.

  16. Sex differences in health research and clinical guideline development

    NARCIS (Netherlands)

    Keuken, D.G.

    2008-01-01

    In current medical practice, research based evidence is an important foundation for clinical decision making. Clinical practice guidelines are a major instrument for keeping physicians up-to-date about this evidence. In order to provide optimal care to both men and women, it is important that sex

  17. Guidelines for kangaroo care in district hospitals and primary health ...

    African Journals Online (AJOL)

    Babies with a weight of between 1.5 kg and 1.6 kg are started with ... to provide guidelines for managing babies with insufficient weight gain, and to provide guidance for ... Gender, birth weight and gestational age at birth also did not have a ...

  18. Duty-to-Warn Guidelines for Mental Health Counselors.

    Science.gov (United States)

    Costa, Luann; Altekruse, Michael

    1994-01-01

    Summarizes legal cases in which duty-to-warn was an issue. Suggests that guidelines for counselors are few and lack definition. Offers a model to guide counselors in making clinical judgments in cases and case examples to exemplify possible ethical dilemmas in the practice of counseling. Includes 36 citations. (Author/CRR)

  19. A recommended guideline for the development of mHealth Apps.

    Science.gov (United States)

    Chatzipavlou, Ioannis A; Christoforidou, Sofia A; Vlachopoulou, Maro

    2016-01-01

    Mobile Health or mHealth applications cope with medical or health issues supported by smartphones. Being a part of great importance in healthcare, mHealth apps are able to improve both the quality of medical services and the safety of the patients. It is regarded to be a new field with great prospect that attracts the interest of the stakeholders and the developers, above all. Of all the entities involved, developers have to face many challenges classified in four pillars: the regulation framework, the market, the technical issues and society. This paper aims to describe the role of the developers in the mHealth apps' market, the barriers they deal with and also, the impact of their work in the mobile healthcare domain. In our viewpoint, we propose a guideline with all of the developers' requirements for the buildup of mHealth apps. The methodology followed includes a Boolean search strategy used in academic libraries (PubMed, IEEE Xplore, JMIR, The Cochrane Library) and search engines additionally (Google and Google Scholar), aiming to identify the developers' perspective. Our research from October until December of 2014 led us to academic papers referring to the various demands that developers have to confront. The major outcome of our research is the general acknowledgement of the dominant role that developers own in the mHealth apps' process. Mobile technology allies multiple groups such as users, patients, providers of medical services, software developers, governments and even, non-governmental organizations. In particular, the developers' perspective involves the legal boundaries, the side of the market, the technological requirements (programming, devices, designing) and the moral aspects, as well. Developers should define the purposes of their apps-either diagnostic or therapeutic-and gain the confidence of the users in order to dominate the market, yet comply with the regulations.

  20. Evaluation of current care effectiveness: a survey of hypertension guideline implementation in Finnish health centres

    DEFF Research Database (Denmark)

    Alanen, Seija I; Johannala-Kemppainen, Riitta; Ijäs, Jarja J

    2007-01-01

    OBJECTIVE: To assess the extent and style of implementation of the Hypertension Guideline (HT Guideline) in Finnish primary health centres, and to identify a scale of contrasting implementation styles in the health centres (with the two ends of the scale being referred to as information...... implementers or disseminators respectively). DESIGN: A cross-sectional study. Development of a questionnaire and criteria for assessing the extent and style of implementation of the HT Guideline. SETTING: Primary healthcare. SUBJECTS: All head physicians and senior nursing officers in Finnish health centres (n...... =290). MAIN OUTCOME MEASURES: The extent of adoption of the HT Guideline in health centres and the characteristics associated with the implementation style. RESULTS: Responses were received from 410 senior medical staff (246 senior nursing officers and 164 head physicians) representing altogether 264...

  1. Sugar and health: a food-based dietary guideline for South Africa

    African Journals Online (AJOL)

    2013-04-12

    Apr 12, 2013 ... Food-Based Dietary Guidelines for South Africa: Sugar and health: a ... of the development of obesity and type 2 diabetes, and probably cardiovascular disease too. ... that there is a strong association between sugar intake.

  2. [Dutch Institute for Health Care Improvement revised guideline, 'Sexually transmitted diseases and neonatal herpes'

    NARCIS (Netherlands)

    Bleker, O.P.; Meijden, W.I. van der; Wittenberg, J.; Bergen, J.E. van; Boeke, A.J.; Doornum, G.J.J. van; Henquet, C.J.; Galama, J.M.D.; Postma, M.J.; Prins, J.M.; Voorst Vader, P.C. van

    2003-01-01

    The Dutch Institute for Health Care Improvement revised guideline, 'Sexually transmitted diseases and neonatal herpes' summarises the current scientific position on the diagnosis and treatment of a great number of sexually transmitted diseases (STD) and neonatal herpes. Symptomatic treatment of

  3. Managing conflicts of interest in the UK National Institute for Health and Care Excellence (NICE clinical guidelines programme: qualitative study.

    Directory of Open Access Journals (Sweden)

    Tanya Graham

    Full Text Available There is international concern that conflicts of interest (COI may bias clinical guideline development and render it untrustworthy. Guideline COI policies exist with the aim of reducing this bias but it is not known how such policies are interpreted and used by guideline producing organisations. This study sought to determine how conflicts of interest (COIs are disclosed and managed by a national clinical guideline developer (NICE: the UK National Institute for Health and Care Excellence.Qualitative study using semi-structured telephone interviews with 14 key informants: 8 senior staff of NICE's guideline development centres and 6 chairs of guideline development groups (GDGs. We conducted a thematic analysis.Participants regard the NICE COI policy as comprehensive leading to transparent and independent guidance. The application of the NICE COI policy is, however, not straightforward and clarity could be improved. Disclosure of COI relies on self reporting and guideline developers have to take "on trust" the information they receive, certain types of COI (non-financial are difficult to categorise and manage and disclosed COI can impact on the ability to recruit clinical experts to GDGs. Participants considered it both disruptive and stressful to exclude members from GDG meetings when required by the COI policy. Nonetheless the impact of this disruption can be minimised with good group chairing skills.We consider that the successful implementation of a COI policy in clinical guideline development requires clear policies and procedures, appropriate training of GDG chairs and an evaluation of how the policy is used in practice.

  4. Organ and tissue donation in clinical settings: a systematic review of the impact of interventions aimed at health professionals

    Science.gov (United States)

    2014-01-01

    In countries where presumed consent for organ donation does not apply, health professionals (HP) are key players for identifying donors and obtaining their consent. This systematic review was designed to verify the efficacy of interventions aimed at HPs to promote organ and tissue donation in clinical settings. CINAHL (1982 to 2012), COCHRANE LIBRARY, EMBASE (1974 to 2012), MEDLINE (1966 to 2012), PsycINFO (1960 to 2012), and ProQuest Dissertations and Theses were searched for papers published in French or English until September 2012. Studies were considered if they met the following criteria: aimed at improving HPs’ practices regarding the donation process or at increasing donation rates; HPs working in clinical settings; and interventions with a control group or pre-post assessments. Intervention behavioral change techniques were analyzed using a validated taxonomy. A risk ratio was computed for each study having a control group. A total of 15 studies were identified, of which only 5 had a control group. Interventions were either educational, organizational or a combination of both, and had a weak theoretical basis. The most common behavior change technique was providing instruction. Two sets of interventions showed a significant risk ratio. However, most studies did not report the information needed to compute their efficacy. Therefore, interventions aimed at improving the donation process or at increasing donation rates should be based on sound theoretical frameworks. They would benefit from more rigorous evaluation methods to ensure good knowledge translation and appropriate organizational decisions to improve professional practices. PMID:24628967

  5. Service Blueprint for Improving Clinical Guideline Adherence via Mobile Health Technology

    OpenAIRE

    Y. O'Connor; C. Heavin; S. O' Connor; J. Gallagher; J. Wu; J. O'Donoghue

    2015-01-01

    Background: To improve the delivery of paediatric healthcare in low resource settings, Community Health Workers (CHW) have been provided with a paper-based set of protocols known as Community Case Management (CCM). Yet research has shown that CHW adherence to CCM guidelines is poor, ultimately impacting health service delivery. Digitising the CCM guidelines via mobile technology is argued in extant literature to improve CHW adherence. However, little research exist which ...

  6. A Reporting Tool for Practice Guidelines in Health Care: The RIGHT Statement.

    Science.gov (United States)

    Chen, Yaolong; Yang, Kehu; Marušic, Ana; Qaseem, Amir; Meerpohl, Joerg J; Flottorp, Signe; Akl, Elie A; Schünemann, Holger J; Chan, Edwin S Y; Falck-Ytter, Yngve; Ahmed, Faruque; Barber, Sarah; Chen, Chiehfeng; Zhang, Mingming; Xu, Bin; Tian, Jinhui; Song, Fujian; Shang, Hongcai; Tang, Kun; Wang, Qi; Norris, Susan L

    2017-01-17

    The quality of reporting practice guidelines is often poor, and there is no widely accepted guidance or standards for such reporting in health care. The international RIGHT (Reporting Items for practice Guidelines in HealThcare) Working Group was established to address this gap. The group followed an existing framework for developing guidelines for health research reporting and the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network approach. It developed a checklist and an explanation and elaboration statement. The RIGHT checklist includes 22 items that are considered essential for good reporting of practice guidelines: basic information (items 1 to 4), background (items 5 to 9), evidence (items 10 to 12), recommendations (items 13 to 15), review and quality assurance (items 16 and 17), funding and declaration and management of interests (items 18 and 19), and other information (items 20 to 22). The RIGHT checklist can assist developers in reporting guidelines, support journal editors and peer reviewers when considering guideline reports, and help health care practitioners understand and implement a guideline.

  7. [A reporting tool for practice guidelines in health care: the RIGHT statement].

    Science.gov (United States)

    Chen, Yaolong; Yang, Kehu; Marušić, Ana; Qaseem, Amir; Meerpohl, Joerg J; Flottorp, Signe; Akl, Elie A; Schünemann, Holger J; Chan, Edwin S Y; Falck-Ytter, Yngve; Ahmed, Faruque; Barber, Sarah; Chen, Chiehfeng; Zhang, Mingming; Xu, Bin; Tian, Jinhui; Song, Fujian; Shang, Hongcai; Tang, Kun; Wang, Qi; Norris, Susan L; Labonté, Valérie C; Möhler, Ralph; Kopp, Ina; Nothacker, Monika; Meerpohl, Joerg J

    2017-11-01

    The quality of reporting practice guidelines is often poor, and there is no widely accepted guidance or standards for such reporting in health care. The international RIGHT (Reporting Items for practice Guidelines in HealThcare) Working Group was established to address this gap. The group followed an existing framework for developing guidelines for health research reporting and the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network approach. A checklist and an explanation and elaboration statement were developed. The RIGHT checklist includes 22 items that are considered essential for good reporting of practice guidelines: basic information (items 1 to 4), background (items 5 to 9), evidence (items 10 to 12), recommendations (items 13 to 15), review and quality assurance (items 16 and 17), funding and declaration and management of interests (items 18 and 19), and other information (items 20 to 22). The RIGHT checklist can assist developers in reporting guidelines, support journal editors and peer reviewers when considering guideline reports, and help health care practitioners understand and implement a guideline. Copyright © 2017. Published by Elsevier GmbH.

  8. A methodological survey identified eight proposed frameworks for the adaptation of health related guidelines.

    Science.gov (United States)

    Darzi, Andrea; Abou-Jaoude, Elias A; Agarwal, Arnav; Lakis, Chantal; Wiercioch, Wojtek; Santesso, Nancy; Brax, Hneine; El-Jardali, Fadi; Schünemann, Holger J; Akl, Elie A

    2017-06-01

    Our objective was to identify and describe published frameworks for adaptation of clinical, public health, and health services guidelines. We included reports describing methods of adaptation of guidelines in sufficient detail to allow its reproducibility. We searched Medline and EMBASE databases. We also searched personal files, as well manuals and handbooks of organizations and professional societies that proposed methods of adaptation and adoption of guidelines. We followed standard systematic review methodology. Our search captured 12,021 citations, out of which we identified eight proposed methods of guidelines adaptation: ADAPTE, Adapted ADAPTE, Alberta Ambassador Program adaptation phase, GRADE-ADOLOPMENT, MAGIC, RAPADAPTE, Royal College of Nursing (RCN), and Systematic Guideline Review (SGR). The ADAPTE framework consists of a 24-step process to adapt guidelines to a local context taking into consideration the needs, priorities, legislation, policies, and resources. The Alexandria Center for Evidence-Based Clinical Practice Guidelines updated one of ADAPTE's tools, modified three tools, and added three new ones. In addition, they proposed optionally using three other tools. The Alberta Ambassador Program adaptation phase consists of 11 steps and focused on adapting good-quality guidelines for nonspecific low back pain into local context. GRADE-ADOLOPMENT is an eight-step process based on the GRADE Working Group's Evidence to Decision frameworks and applied in 22 guidelines in the context of national guideline development program. The MAGIC research program developed a five-step adaptation process, informed by ADAPTE and the GRADE approach in the context of adapting thrombosis guidelines. The RAPADAPTE framework consists of 12 steps based on ADAPTE and using synthesized evidence databases, retrospectively derived from the experience of producing a high-quality guideline for the treatment of breast cancer with limited resources in Costa Rica. The RCN outlines

  9. Methods used in adaptation of health-related guidelines: A systematic survey.

    Science.gov (United States)

    Abdul-Khalek, Rima A; Darzi, Andrea J; Godah, Mohammad W; Kilzar, Lama; Lakis, Chantal; Agarwal, Arnav; Abou-Jaoude, Elias; Meerpohl, Joerg J; Wiercioch, Wojtek; Santesso, Nancy; Brax, Hneine; Schünemann, Holger; Akl, Elie A

    2017-12-01

    Adaptation refers to the systematic approach for considering the endorsement or modification of recommendations produced in one setting for application in another as an alternative to de novo development. To describe and assess the methods used for adapting health-related guidelines published in peer-reviewed journals, and to assess the quality of the resulting adapted guidelines. We searched Medline and Embase up to June 2015. We assessed the method of adaptation, and the quality of included guidelines. Seventy-two papers were eligible. Most adapted guidelines and their source guidelines were published by professional societies (71% and 68% respectively), and in high-income countries (83% and 85% respectively). Of the 57 adapted guidelines that reported any detail about adaptation method, 34 (60%) did not use a published adaptation method. The number (and percentage) of adapted guidelines fulfilling each of the ADAPTE steps ranged between 2 (4%) and 57 (100%). The quality of adapted guidelines was highest for the "scope and purpose" domain and lowest for the "editorial independence" domain (respective mean percentages of the maximum possible scores were 93% and 43%). The mean score for "rigor of development" was 57%. Most adapted guidelines published in peer-reviewed journals do not report using a published adaptation method, and their adaptation quality was variable.

  10. The French National Authority for Health (HAS) Guidelines for Conducting Budget Impact Analyses (BIA).

    Science.gov (United States)

    Ghabri, Salah; Autin, Erwan; Poullié, Anne-Isabelle; Josselin, Jean Michel

    2018-04-01

    Budget impact analysis (BIA) provides short- and medium-term estimates on changes in budgets and health outcomes resulting from the adoption of new health interventions. The purpose of this study is to present the newly developed French National Authority for Health (HAS) guidelines on budget impact analysis as follows: process, literature review, recommendations and comparisons with other guidelines. The development process of the HAS guidelines included a literature review (search dates: January 2000 to June 2016), a retrospective investigation of BIA previously submitted to HAS, a public consultation, international expert reviews and approval from the HAS Board and the Economic and Public Health Evaluation Committee of HAS. Documents identified in the literature review included 12 national guidelines, 5 recommendations for good practices developed by national and international society of health economics and 14 methodological publications including recommendations for conducting BIA. Based on its research findings, HAS developed its first BIA guidelines, which include recommendations on the following topics: BIA definition, perspective, populations, time horizon, compared scenarios, budget impact models, costing, discounting, choice of clinical data, reporting of results and uncertainty exploration. It is expected that the HAS BIA guidelines will enhance the usefulness, quality and transparency of BIA submitted by drug manufacturers to HAS. BIA is becoming an essential part of a comprehensive economic assessment of healthcare interventions in France, which also includes cost-effectiveness analysis and equity of access to healthcare.

  11. Developing a practice guideline for the occupational health services by using a community of practice approach: a process evaluation of the development process

    Directory of Open Access Journals (Sweden)

    Lydia Kwak

    2017-01-01

    Full Text Available Abstract Background One way to facilitate the translation of research into the occupational health service practice is through clinical practice guidelines. To increase the implementability of guidelines it is important to include the end-users in the development, for example by a community of practice approach. This paper describes the development of an occupational health practice guideline aimed at the management of non-specific low back pain (LBP by using a community of practice approach. The paper also includes a process evaluation of the development providing insight into the feasibility of the process. Methods A multidisciplinary community of practice group (n = 16 consisting of occupational nurses, occupational physicians, ergonomists/physical therapists, health and safety engineers, health educators, psychologists and researchers from different types of occupational health services and geographical regions within Sweden met eleven times (June 2012–December 2013 to develop the practice guideline following recommendations of guideline development handbooks. Process-outcomes recruitment, reach, context, satisfaction, feasibility and fidelity were assessed by questionnaire, observations and administrative data. Results Group members attended on average 7.5 out of 11 meetings. Half experienced support from their workplace for their involvement. Feasibility was rated as good, except for time-scheduling. Most group members were satisfied with the structure of the process (e.g. presentations, multidisciplinary group. Fidelity was rated as fairly high. Conclusions The described development process is a feasible process for guideline development. For future guideline development expectations of the work involved should be more clearly communicated, as well as the purpose and tasks of the CoP-group. Moreover, possibilities to improve support from managers and colleagues should be explored. This paper has important implications for future

  12. Ergonomics standards and guidelines for computer workstation design and the impact on users' health - a review.

    Science.gov (United States)

    Woo, E H C; White, P; Lai, C W K

    2016-03-01

    This paper presents an overview of global ergonomics standards and guidelines for design of computer workstations, with particular focus on their inconsistency and associated health risk impact. Overall, considerable disagreements were found in the design specifications of computer workstations globally, particularly in relation to the results from previous ergonomics research and the outcomes from current ergonomics standards and guidelines. To cope with the rapid advancement in computer technology, this article provides justifications and suggestions for modifications in the current ergonomics standards and guidelines for the design of computer workstations. Practitioner Summary: A research gap exists in ergonomics standards and guidelines for computer workstations. We explore the validity and generalisability of ergonomics recommendations by comparing previous ergonomics research through to recommendations and outcomes from current ergonomics standards and guidelines.

  13. The `WikiGuidelines' smartphone application: Bridging the gaps in availability of evidence-based smartphone mental health applications.

    Science.gov (United States)

    Zhang, Melvyn W B; Ho, Roger C M; Mcintyre, Roger S

    2016-07-27

    Over the past decade, there have been massive advances in technology. These advances in technology have significantly transformed various aspects of healthcare. The advent of E-health and its influence on healthcare practice also implies that there is a paradigm shift in the way healthcare professionals work. Conventionally, healthcare professionals would have to refer to books and journals for updates in treatment algorithms, but with the advent of technology, they could access this information via the web or via various smartphone applications on the go. In the field of Psychiatry, one of the commonest mental health disorder to date, with significant morbidity and mortality is that of Major depressive disorder. Routinely, clinicians and healthcare professionals are advised to refer to standard guidelines in guiding them with regards to their treatment options. Given the high prevalence of conditions like Major Depressive Disorder, it is thus of importance that whatever guidelines that clinicians and healthcare professionals refer to are constantly kept up to date, so that patients could benefit from latest evidence based therapy and treatment. A review of the current literature highlights that whilst there are a multitude of smartphone applications designed for mental health care, previous systematic review has highlighted a paucity of evidence based applications. More importantly, current literature with regards to provision of treatment information to healthcare professionals and patients are limited to web-based interventions. It is the aim of this technical note to highlight a methodology to which the authors have conceptualized in the implementation of an evidence based mental health guideline applications, known as the `Wiki Guidelines' smartphone application. The authors hope to illustrate the algorithms behind the development of the application, and how it could be easily updated by the guidelines working group.

  14. Women's Preventive Services Guidelines Affordable Care Act Expands Prevention Coverage for Women's Health and Well-Being

    Science.gov (United States)

    ... in existing guidelines. Health Resources and Services Administration Women's Preventive Services Guidelines Non-grandfathered plans (plans or policies created or sold after March 23, 2010, or older plans or policies that ...

  15. USING EXPERT OPINION IN HEALTH TECHNOLOGY ASSESSMENT: A GUIDELINE REVIEW.

    Science.gov (United States)

    Hunger, Theresa; Schnell-Inderst, Petra; Sahakyan, Narine; Siebert, Uwe

    2016-01-01

    External experts can be consulted at different stages of an HTA. When using vague information sources, it is particularly important to plan, analyze, and report the information processing in a standardized and transparent way. Our objective was to search and analyze recommendations regarding where and how to include expert data in HTA. We performed a systematic database search and screened the Internet pages of seventy-seven HTA organizations for guidelines, recommendations, and methods papers that address the inclusion of experts in HTA. Relevant documents were downloaded, and information was extracted in a standard form. Results were merged in tables and narrative evidence synthesis. From twenty-two HTA organizations, we included forty-two documents that consider the use of expert opinion in HTA. Nearly all documents mention experts in the step of preparation of the evidence report. Six documents address their role for priority setting of topics, fifteen for scoping, twelve for the appraisal of evidence and results, another twelve documents mention experts when considering the dissemination of HTA results. During the assessment step, experts are most often asked to amend the literature search or to provide expertise for special data analyses. Another issue for external experts is to appraise the HTA results and refer them back to a clinical and social context. Little is reported on methods of expert elicitation when their input substitutes study data. Despite existing recommendations on the use of expert opinion in HTA, common standards for elicitation are scarce in HTA guidelines.

  16. What do They Know? Guidelines and Knowledge Translation for Foreign Health Sector Workers Following Natural Disasters.

    Science.gov (United States)

    Dunin-Bell, Ola

    2018-04-01

    Introduction The incidence of natural disasters is increasing worldwide, with countries the least well-equipped to mitigate or manage them suffering the greatest losses. Following natural disasters, ill-prepared foreign responders may become a burden to the affected population, or cause harm to those needing help. Problem The study was performed to determine if international guidelines for foreign workers in the health sector exist, and evidence of their implementation. A structured literature search was used to identify guidelines for foreign health workers (FHWs) responding to natural disasters. Analysis of semi-structured interviews of health sector responders to the 2015 Nepal earthquake was then performed, looking at preparation and field activities. No guidelines were identified to address the appropriate qualifications of, and preparations for, international individuals participating in disaster response in the health sector. Interviews indicated individuals choosing to work with experienced organizations received training prior to disaster deployment and described activities in the field consistent with general humanitarian principles. Participants in an ad hoc team (AHT) did not. In spite of need, there is a lack of published guidelines for potential international health sector responders to natural disasters. Learning about disaster response may occur only after joining a team. Dunin-Bell O . What do they know? Guidelines and knowledge translation for foreign health sector workers following natural disasters. Prehosp Disaster Med. 2018;33(2):139-146.

  17. Public health economic evaluation of different European Union-level policy options aimed at reducing population dietary trans fat intake.

    Science.gov (United States)

    Martin-Saborido, Carlos; Mouratidou, Theodora; Livaniou, Anastasia; Caldeira, Sandra; Wollgast, Jan

    2016-11-01

    The adverse relation between dietary trans fatty acid (TFA) intake and coronary artery disease risk is well established. Many countries in the European Union (EU) and worldwide have implemented different policies to reduce the TFA intake of their populations. The aim of this study was to assess the added value of EU-level action by estimating the cost-effectiveness of 3 possible EU-level policy measures to reduce population dietary TFA intake. This was calculated against a reference situation of not implementing any EU-level policy (i.e., by assuming only national or self-regulatory measures). We developed a mathematical model to compare different policy options at the EU level: 1) to do nothing beyond the current state (reference situation), 2) to impose mandatory TFA labeling of prepackaged foods, 3) to seek voluntary agreements toward further reducing industrially produced TFA (iTFA) content in foods, and 4) to impose a legislative limit for iTFA content in foods. The model indicated that to impose an EU-level legal limit or to make voluntary agreements may, over the course of a lifetime (85 y), avoid the loss of 3.73 and 2.19 million disability-adjusted life-years (DALYs), respectively, and save >51 and 23 billion euros when compared with the reference situation. Implementing mandatory TFA labeling can also avoid the loss of 0.98 million DALYs, but this option incurs more costs than it saves compared with the reference option. The model indicates that there is added value of an EU-level action, either via a legal limit or through voluntary agreements, with the legal limit option producing the highest additional health benefits. Introducing mandatory TFA labeling for the EU common market may provide some additional health benefits; however, this would likely not be a cost-effective strategy.

  18. Guidelines for responsible short-term global health activities: developing common principles.

    Science.gov (United States)

    Lasker, Judith N; Aldrink, Myron; Balasubramaniam, Ramaswami; Caldron, Paul; Compton, Bruce; Evert, Jessica; Loh, Lawrence C; Prasad, Shailendra; Siegel, Shira

    2018-02-07

    Growing concerns about the value and effectiveness of short-term volunteer trips intending to improve health in underserved Global South communities has driven the development of guidelines by multiple organizations and individuals. These are intended to mitigate potential harms and maximize benefits associated with such efforts. This paper analyzes 27 guidelines derived from a scoping review of the literature available in early 2017, describing their authorship, intended audiences, the aspects of short term medical missions (STMMs) they address, and their attention to guideline implementation. It further considers how these guidelines relate to the desires of host communities, as seen in studies of host country staff who work with volunteers. Existing guidelines are almost entirely written by and addressed to educators and practitioners in the Global North. There is broad consensus on key principles for responsible, effective, and ethical programs--need for host partners, proper preparation and supervision of visitors, needs assessment and evaluation, sustainability, and adherence to pertinent legal and ethical standards. Host country staff studies suggest agreement with the main elements of this guideline consensus, but they add the importance of mutual learning and respect for hosts. Guidelines must be informed by research and policy directives from host countries that is now mostly absent. Also, a comprehensive strategy to support adherence to best practice guidelines is needed, given limited regulation and enforcement capacity in host country contexts and strong incentives for involved stakeholders to undertake or host STMMs that do not respect key principles.

  19. Monitoring and evaluation of Blyth Offshore wind farm: Health and Safety guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Pepper, L

    2002-07-01

    Experiences during the construction, operation and maintenance of the wind farm off the coast of Blyth in Northumberland are used to assess the practicality of implementing existing draft British Wind Energy Association (BWEA) guidelines. These best practice guidelines, which were drawn up in consultation with the Health and Safety Executive (HSE) offer advice on health and safety issues specific to the wind industry in the UK. The guidelines are intended to cover both onshore and offshore sites; common advice is followed by advice specific to offshore sites. The Blyth Offshore project, the first offshore wind farm in the UK, features two 2 MW turbines installed on a submerged rocky outcrop about 1 km from the coast in a depth of about 6 m at low tide and a tidal range of about 5 m. The report concluded that, from the experience at Blyth, the draft guidelines will provide a useful tool for those involved in all stages of a wind farm project.

  20. Menopausal women requesting egg/embryo donation: examining health screening guidelines for assisted reproductive technology.

    Science.gov (United States)

    MacArthur, Taleen; Bachmann, Gloria; Ayers, Charletta

    2016-07-01

    As more postreproductive women opt to pursue pregnancy with advanced assisted reproductive technologies (ART), the menopausal practitioner will become more involved in counseling, screening, and referral of premenopausal, perimenopausal, and postmenopausal women for these services. This review was conducted with the aim of (1) evaluating ART screening practices as they pertain to postreproductive women, and (2) reviewing the outcomes of ART using oocyte donation in postreproductive women. A total of 950 unique records were found on PubMed, Clinical Key, and Google Scholar. Of these, 252 records were screened for relevance based on their titles and abstracts. With further review of these 252 records, 93 full-text articles were assessed for eligibility, and 63 were excluded based on relevance to our study. Finally, 30 studies were included in our qualitative synthesis. Despite the increasing use of ART in postreproductive women, there are limited guidelines for determining candidacy with regard to maternal health, the most comprehensive of which are the guidelines from the American Society for Reproductive Medicine (ASRM). Although the American Society for Reproductive Medicine guidelines state that healthy women over 50 who are prepared for parenthood are candidates for ART through oocyte donation, they note that older women should be counseled as to the increased obstetric risk associated with advanced maternal age. With aging, particularly for those women who are menopausal and postmenopausal, the woman and her fetus, however, are at risk of increased morbidity and mortality as compared with younger, healthy pregnant women. Because national trends suggest that women are delaying childbearing, the cohort of postreproductive women looking toward ART using donor oocytes as a fertility option will expand and menopausal practitioners will often participate in the ART counseling of these women. Because maternal and fetal morbidity and mortality increase in

  1. How Public Health Nurses Identify and Intervene in Child Maltreatment Based on the National Clinical Guideline

    Directory of Open Access Journals (Sweden)

    Paavilainen Eija

    2014-01-01

    Full Text Available Objectives. To describe how Finnish public health nurses identify and intervene in child maltreatment and how they implement the National Clinical Guideline in their work. Design and Sample. Cross-sectional survey of 367 public health nurses in Finland. Measures. A web-based questionnaire developed based on the content areas of the guideline: identifying, intervening, and implementing. Results. The respondents reported they identify child maltreatment moderately (mean 3.38, intervene in it better (4.15, and implement the guideline moderately (3.43, scale between 1 and 6. Those with experience of working with maltreated children reported they identify them better P<0.001, intervene better P<0.001, and implement the guideline better P<0.001 than those with no experience. This difference was also found for those who were aware of the guideline, had read it, and participated in training on child maltreatment, as compared to those who were not aware of the guideline, had not read it, or had not participated in such training. Conclusions. The public health nurses worked quite well with children who had experienced maltreatment and families. However, the results point out several developmental targets for increasing training on child maltreatment, for devising recommendations for child maltreatment, and for applying these recommendations systematically in practice.

  2. Evaluation of an mHealth intervention aiming to improve health-related behavior and sleep and reduce fatigue among airline pilots.

    Science.gov (United States)

    van Drongelen, Alwin; Boot, Cécile Rl; Hlobil, Hynek; Twisk, Jos Wr; Smid, Tjabe; van der Beek, Allard J

    2014-11-01

    The aim of this study was to evaluate the effects of an mHealth intervention (intervention using mobile technology) consisting of tailored advice regarding exposure to daylight, sleep, physical activity, and nutrition, and aiming to improve health-related behavior, thereby reducing sleep problems and fatigue and improving health perception of airline pilots. A randomized controlled trial was conducted among 502 airline pilots. The intervention group was given access to both the MORE Energy mobile application (app) with tailored advice and a website with background information. The control group was directed to a website with standard information about fatigue. Health-related behavior, fatigue, sleep, and health perception outcomes were measured through online questionnaires at baseline and at three and six months after baseline. The effectiveness of the intervention was determined using linear and Poisson mixed model analyses. After six months, compared to the control group, the intervention group showed a significant improvement on fatigue (β= -3.76, P<0.001), sleep quality (β= -0.59, P=0.007), strenuous physical activity (β=0.17, P=0.028), and snacking behavior (β= -0.81, P<0.001). No significant effects were found for other outcome measures. The MORE Energy mHealth intervention reduced self-reported fatigue compared to a minimal intervention. Some aspects of health-related behavior (physical activity and snacking behavior) and sleep (sleep quality) improved as well, but most did not. The results show offering tailored advice through an mHealth intervention is an effective means to support employees who have to cope with irregular flight schedules and circadian disruption. This kind of intervention might therefore also be beneficial for other working populations with irregular working hours.

  3. Screening and treatment of obesity in school health care - the gap between clinical guidelines and reality.

    Science.gov (United States)

    Häkkänen, Paula; Ketola, Eeva; Laatikainen, Tiina

    2018-05-06

    School health care offers a natural setting for childhood obesity interventions. Earlier studies reveal inadequate screening and treatment in primary care. However, longitudinal studies in unselected populations are lacking. We aimed to examine how school nurses and physicians identified obesity, diagnosed it and offered interventions over primary school. We compared the results with Finnish recommendations. From our cohort of 2000 primary school sixth graders (aged 12-14), 172 were obese at least once during primary school. We manually collected retrospective electronic health record (EHR) data of these 'ever-obese' children. Of the ever-obese children, 96% attended annual nurse assessments more than twice. School physicians met 53% of the ever-obese children at health checks at first grade and 93% at fifth grade. Of overweight-related extra visits to school nurses, 94% took place without parents. Parents were present in 48% of extra school physician visits. Only 29% of the 157 who became obese during the first five school grades received an obesity diagnosis. However, school physicians mentioned weight problems in EHR for 90% of the children and, similarly, school nurses for 99%. The majority received a treatment plan at least once. For 78%, at least one plan was made with the parents. Still, 28% missed nutrition plans, 31% exercise plans and 90% lacked recorded weight development targets. The gap between clinical guidelines and reality in school health care could be narrowed by improving diagnosing and parent collaboration. Obstacles in parent involvement and work methods in school health care need further study. © 2018 Nordic College of Caring Science.

  4. [Guidelines to productivity bargaining in the health care industry].

    Science.gov (United States)

    Fottler, M D; Maloney, W F

    1979-01-01

    A potential conflict exists between the recent growth of unionization in the health care industry and management efforts to increase productivity. One method of managing this conflict is to link employee rewards to employee productivity through productivity bargaining.

  5. A critical review of health research ethical guidelines regarding ...

    African Journals Online (AJOL)

    Trials, 2006;[22] and Ethics in Health Research Principles, Structures and Procedures, 2015[15]) regarding caregivers' consent in research involving minors as research ..... 11. Jeff H, Ramesh R, Sanjay MB. Pediatric airway management.

  6. Quality Guidelines

    Science.gov (United States)

    ... this page: https://medlineplus.gov/criteria.html MedlinePlus Quality Guidelines To use the sharing features on this ... materials must also meet our existing quality guidelines. Quality, authority and accuracy of health content The organization's ...

  7. [Algorithm for application of the "ethical guidelines for epidemiological research" and taxonomy of public health research].

    Science.gov (United States)

    Okamoto, Etsuji

    2003-11-01

    "Ethical Guidelines for Epidemiological Research" took effect in July 2002, with a moral duty of all researchers to comply when conducting epidemiological studies although it is not legally binding. Public health research entails various forms of studies including not only epidemiological studies but also attention to psychological, societal and economic aspects, which are outside of the jurisdiction of the guidelines. Hence, confusion may arise among members of Japanese Society of Public Health as to whether the study they conduct falls within the definition of epidemiological research. The author discusses legal interpretations of the guidelines arising in the course of translation work as part of government-funded project, "Dissemination of the 'Ethical Guidelines for Epidemiological Research' via Internet (principal investigator: Toru Doi)" and argues that a case-method approach would be best suited to enhance understanding by researchers with diverse, non-legal backgrounds. The author proposes an algorithm for classification of studies as to whether the guideline applies, and applies it to all original articles published in the Japanese Journal of Public Health (JJPH) in one year (March 2002 thru February 2003). The rationale for classification is discussed from the strict legal viewpoint in each case. Sixteen out of 46 original articles published in JJPH for one year were classified as epidemiological studies to which the guidelines apply. Those classified otherwise were psychological studies (10), epidemiological studies not targeting specific diseases and are exempt form the guidelines (3), purely methodological studies (4), economics studies (3), fact-finding or opinion surveys with no hypothesis testing (2), as well as studies authorized by law (4) or using unlinkable anonymous data only (4), all of which are exempt from the guidelines. Reference to ethical considerations in the methodology section as required by the instructions for authors was generally

  8. EAACI Food Allergy and Anaphylaxis Guidelines. Food allergy health-related quality of life measures.

    Science.gov (United States)

    Muraro, A; Dubois, A E J; DunnGalvin, A; Hourihane, J O'B; de Jong, N W; Meyer, R; Panesar, S S; Roberts, G; Salvilla, S; Sheikh, A; Worth, A; Flokstra-de Blok, B M J

    2014-07-01

    Instruments have been developed and validated for the measurement of health-related quality of life in patients with food allergy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group. It draws on a systematic review of the literature on quality of life instruments for food allergy and the Appraisal of Guidelines for Research & Evaluation (AGREE II) guideline development process. Guidance is provided on the use of such instruments in research, and the current limitations of their use in clinical practice are described. Gaps in current knowledge as well as areas of future interest are also discussed. This document is relevant to healthcare workers dealing with food-allergic patients, scientists engaging in food allergy research and policy makers involved in regulatory aspects concerning food allergy and safety. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Considerations in the development of generic human health-based soil quality guidelines for uranium

    International Nuclear Information System (INIS)

    Richardson, G.M.; Petrovic, S.; Purtill, C.; Wilson, R.

    2006-01-01

    At the current time in Canada, no human health-based generic (national) soil quality guidelines (SQG HH ) exist for uranium. This paper explores some of the various methods that could be used to develop human health soil guideline values for this element. To determine possible values that may be appropriate for use in Canada, the authors have applied both the existing CCME approach (1996) and the draft revised CCME approach (2005) to estimate possible SQG HH for uranium for various land uses. (author)

  10. Sistemas de salud mental en El Salvador, Guatemala y Nicaragua: resultados de una evaluación mediante el WHO-AIMS Mental health systems in El Salvador, Guatemala, and Nicaragua: results of a WHO-AIMS evaluation

    Directory of Open Access Journals (Sweden)

    Jorge Jacinto Rodríguez

    2007-11-01

    Full Text Available Los autores realizaron una evaluación de los sistemas de salud mental en El Salvador, Guatemala y Nicaragua, por medio de un grupo de indicadores seleccionados. Para recopilar la información en los países se utilizó el Instrumento de Evaluación para Sistemas de Salud Mental de la Organización Mundial de la Salud (WHO-AIMS, por su sigla en inglés. Nicaragua, Guatemala y El Salvador tienen serias limitaciones en sus sistemas nacionales de salud mental, en especial en la atención primaria, así como una marcada insuficiencia de recursos humanos calificados. El presupuesto dedicado a la salud mental apenas representa 1% del presupuesto general de salud y los hospitales psiquiátricos situados en la capital de los países consumen más de 90% de los fondos de salud mental. Los limitados recursos (materiales y humanos existentes se concentran en las respectivas capitales de los países. No se han formulado políticas ni legislaciones nacionales de salud mental. Sin embargo, las tres naciones cuentan con planes nacionales en ejecución. Asimismo, se ha avanzado en el diseño e implementación de programas de protección de la salud mental en situaciones de desastre. Es necesario establecer acuerdos con las procuradurías de los derechos humanos para incrementar la vigilancia y protección de los derechos humanos en las personas afectadas por enfermedades mentales. En los últimos años se han logrado impulsar algunas experiencias innovadoras que requieren ser generalizadas. La Organización Panamericana de la Salud (OPS/OMS y el proyecto WHO-AIMS han contribuido al desarrollo de modelos comunitarios de servicios de salud mental. También se identificaron prioridades y se plantean recomendaciones para la acción.The authors evaluated the mental health systems of El Salvador, Guatemala, and Nicaragua, using a group of select indicators. The World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS was used to collect

  11. Guidelines for the management of people with foot health problems related to rheumatoid arthritis: a survey of their use in podiatry practice.

    Science.gov (United States)

    Williams, Anita E; Graham, Andrea S; Davies, Samantha; Bowen, Catherine J

    2013-06-18

    In the last decade there has been a significant expansion in the body of knowledge on the effects of rheumatoid arthritis (RA) on the foot and the management of these problems. Aligned with this has been the development of specialist clinical roles for podiatrists. However, despite being recommended by national guidelines, specialist podiatrists are scarce. In order to inform non-specialist podiatrists of the appropriate interventions for these foot problems, management guidelines have been developed and disseminated by a group of specialist podiatrists. The aim of this survey was to investigate the use of these guidelines in clinical practice. Following ethical approval an online questionnaire survey was carried out. The questions were formulated from a focus group and comprised fixed response and open response questions. The survey underwent cognitive testing with two podiatrists before being finalised. An inductive approach using thematic analysis was used with the qualitative data. 245 questionnaires were completed (128-non-specialist working in the private sector, 101 non-specialists working in the NHS and 16 specialist podiatrists). Overall, 97% of the non-specialists (n = 222) had not heard of the guidelines. The non-specialists identified other influences on their management of people with RA, such as their undergraduate training and professional body branch meetings. Three main themes emerged from the qualitative data: (i) the benefits of the foot health management guidelines, (ii) the barriers to the use of guidelines generally and (iii) the features of useable clinical guidelines. This study has revealed some crucial information about podiatrists' level of engagement with the foot health management guidelines and the use of guidelines in general. Specifically, the non-specialist podiatrists were less likely to use the foot health management guidelines than the specialist podiatrists. The positive aspects were that for the specialist practitioners

  12. Health-Based Cyanotoxin Guideline Values Allow for Cyanotoxin-Based Monitoring and Efficient Public Health Response to Cyanobacterial Blooms

    Science.gov (United States)

    Farrer, David; Counter, Marina; Hillwig, Rebecca; Cude, Curtis

    2015-01-01

    Human health risks from cyanobacterial blooms are primarily related to cyanotoxins that some cyanobacteria produce. Not all species of cyanobacteria can produce toxins. Those that do often do not produce toxins at levels harmful to human health. Monitoring programs that use identification of cyanobacteria genus and species and enumeration of cyanobacterial cells as a surrogate for cyanotoxin presence can overestimate risk and lead to unnecessary health advisories. In the absence of federal criteria for cyanotoxins in recreational water, the Oregon Health Authority (OHA) developed guideline values for the four most common cyanotoxins in Oregon’s fresh waters (anatoxin-a, cylindrospermopsin, microcystins, and saxitoxins). OHA developed three guideline values for each of the cyanotoxins found in Oregon. Each of the guideline values is for a specific use of cyanobacteria-affected water: drinking water, human recreational exposure and dog recreational exposure. Having cyanotoxin guidelines allows OHA to promote toxin-based monitoring (TBM) programs, which reduce the number of health advisories and focus advisories on times and places where actual, rather than potential, risks to health exist. TBM allows OHA to more efficiently protect public health while reducing burdens on local economies that depend on water recreation-related tourism. PMID:25664510

  13. Guidelines For Health-Based Ventilation In Europe

    DEFF Research Database (Denmark)

    Wargocki, Pawel; Carrer, Paolo; de Oliveira Fernandes, Eduardo

    2014-01-01

    The burden of disease (BoD) associated with major air exposures indoors in 26 European countries was recently accounted for loss of two million healthy life years annually expressed as disability adjusted life years (DALYs) (Jantunen et al., 2011). The development of health-based ventilation...

  14. Do current sports nutrition guidelines conflict with good oral health?

    Science.gov (United States)

    Broad, Elizabeth M; Rye, Leslie A

    2015-01-01

    For optimal athletic performance, an athlete requires good oral health to reduce the risk of oral pain, inflammation, and infection and thereby minimize the use of analgesics and antimicrobial agents. Increased intake, frequency, and dental contact time of carbohydrate-rich foods, sports nutrition products, and acidic carbohydrate-containing sports and energy drinks may contribute to risks of dental erosion, caries, and inflammatory periodontal conditions in the athlete, especially when he or she also exhibits dehydration and poor oral hygiene habits. Examining the athlete before he or she begins participating in a sport allows the dental care provider to determine the patient's existing oral health, hygiene, and susceptibility to risk factors for erosion, caries, and inflammatory periodontal disease. This oral profile, in conjunction with the individual athlete's dietary needs, can be used to establish a treatment and preventive program, including oral health education. Good oral hygiene practices and application of topical fluoride, especially via fluoridated toothpastes and topical fluoride varnishes, must be available to the athlete. Rinsing with water or a neutral beverage after exposure to carbohydrates or acidic sports nutrition products may reduce carbohydrate contact time and bring oral pH levels back to neutral more quickly, reducing the risk of caries and erosion. Finally, the dentist should encourage the athlete to consult with an experienced sports dietitian to ensure that principles of sports nutrition are being appropriately applied for the type, frequency, and duration of exercise in consideration of the individual's oral health needs.

  15. Integrating Occupational Safety and Health into TAFE Courses: Policy Guidelines.

    Science.gov (United States)

    Hill, Graham L.; Mageean, Pauline

    Intended to help administrators, curriculum developers, and teachers integrate occupational health and safety into Australian vocational courses on bricklaying, metal fabrication, and horticulture, this document suggests specific policies and provides further amplification concerning three general policies for that integration. The three general…

  16. Implications of WHO Guideline on Sugars for dental health professionals

    DEFF Research Database (Denmark)

    Moynihan, Paula; Makino, Yuka; Petersen, Poul Erik

    2018-01-01

    and vegetables, nuts, seeds, and wholegrain starch-rich foods; (iv) discourage the consumption of foods high in saturated fat and salt; and (v) discourage the consumption of all drinks containing free sugars. The dental health professional has an opportunity to support patients to reduce their intake of free...

  17. Effectiveness of the World Health Organization cancer pain relief guidelines: an integrative review

    Science.gov (United States)

    Carlson, Cathy L

    2016-01-01

    Inadequate cancer pain relief has been documented extensively across historical records. In response, in 1986, the World Health Organization (WHO) developed guidelines for cancer pain treatment. The purpose of this paper is to disseminate the results of a comprehensive, integrative review of studies that evaluate the effectiveness of the WHO guidelines. Studies were included if they: 1) identified patients treated with the guidelines, 2) evaluated self-reported pain, 3) identified instruments used, 4) provided data documenting pain relief, and 5) were written in English. Studies were coded for duration of treatment, definition of pain relief, instruments used, findings related to pain intensity or relief, and whether measures were used other than the WHO analgesic ladder. Twenty-five studies published since 1987 met the inclusion criteria. Evidence indicates 20%–100% of patients with cancer pain can be provided pain relief with the use of the WHO guidelines – while considering their status of treatment or end-of-life care. Due to multiple limitations in included studies, analysis was limited to descriptions. Future research to examine the effectiveness of the WHO guidelines needs to consider recommendations to facilitate study comparisons by standardizing outcome measures. Recent studies have reported that patients with cancer experience pain at moderate or greater levels. The WHO guidelines reflect the knowledge and effectual methods to relieve most cancer pain, but the guidelines are not being adequately employed. Part of the explanation for the lack of adoption of the WHO guidelines is that they may be considered outdated by many because they are not specific to the pharmacological and interventional options used in contemporary pain management practices. The conundrum of updating the WHO guidelines is to encompass the latest pharmacological and interventional innovations while maintaining its original simplicity. PMID:27524918

  18. French mental health first aid guidelines for eating disorders: an exploration of user characteristics and usefulness among college students.

    Science.gov (United States)

    Melioli, Tiffany; Rispal, Magali; Hart, Laura M; Chabrol, Henri; Rodgers, Rachel F

    2018-04-01

    The literature has highlighted that strategies to increase appropriate and timely treatment seeking for eating disorders (EDs) are needed. The aim of this study was to use the Internet to disseminate guidelines for providing first aid to individuals suffering from ED among college students. Users were invited to complete two surveys: an initial one assessing user characteristics and, 28 days later, a questionnaire assessing the perceived usefulness of the guidelines. A sample of 651 college students (M age  = 22, standard deviation (SD) = 3.9) responded to the first questionnaire and 50 completed the second questionnaire (M age  = 22.2, SD = 2.6). The guidelines were downloaded 1174 times and 56% of users reported finding them useful. College students might be particularly interested in learning more about ED and the guidelines could be valuable to address the gap in available resources for ED-related mental health literacy. © 2016 John Wiley & Sons Australia, Ltd.

  19. True North: Building Imaginary Worlds with the Revised Canadian (CADTH Guidelines for Health Technology Assessment

    Directory of Open Access Journals (Sweden)

    Paul C Langley

    2017-05-01

    Full Text Available In March 2017 the Canadian Agency for Drugs and Technologies in Health (CADTH released the 4th edition of their Guidelines for the Economic Evaluation of Health Technologies: Canada. These guidelines, which were first published and revised for a 3rd edition in 2006 are intended to help decision makers, health systems leaders and policy makers make well-informed decisions. They are designed, apparently, to support best practice in conducting health technology assessments in Canada. The purpose of this commentary is to consider whether or not the evidence standards proposed and the consequent modeled claims for economic effectiveness meet the standards of normal science: are the CADTH standards capable of generating claims for competing products that are credible, evaluable and replicable? The review argues that the standards proposed by CADTH do not meet the standards expected in normal science. Technical sophistication in building reference case imaginary worlds is not a substitute for claims that are experimentally evaluable or capable of assessment through systematic observation. There is no way of judging whether imaginary claims are right or even if they are wrong. CADTH is not alone in setting standards that fail to meet the standards of normal science. Recent commentaries on formulary submission guidelines in a number of other countries, to include Ireland, the Netherlands, France, Australia, the UK and New Zealand conclude that they are subject to the same criticism. If the CADTH guidelines were never intended to support feedback to health system decision makers, then this should be made clear. If not, then consideration should be given to withdrawing the guidelines to ensure they conform to these standards. Hopefully, future versions of the CADTH guidelines will address this issue and focus on a rigorous research program of claims assessment and feedback and not the building of imaginary worlds.   Type:  Commentary

  20. How institutional change and individual researchers helped advance clinical guidelines in American health care.

    Science.gov (United States)

    Nigam, Amit

    2013-06-01

    Clinical guidelines are important tools for managing health care quality. Research on the origins of guidelines primarily focuses on the institutional causes of their emergence and growth. Individual medical researchers, however, have played important roles. This paper develops knowledge of the role of individual medical researchers in advancing guidelines, and of how researchers' efforts were enabled or constrained by broader institutional changes. Drawing on an analytical case study focused on the role of Kerr White, John Wennberg, and Robert Brook, it shows that guidelines were a product of the interplay between institutional change in the medical field and actions by individual researchers, acting as institutional entrepreneurs. Increased government involvement in the health care field triggered the involvement of a range of new actors in health care. These new organizations created a context that allowed individual researchers to advance guidelines by creating job opportunities, providing research funding, and creating opportunities for researchers to engage with the policy process. Individual researchers availed of this context to both advance their ideas, and to draw new actors into the field. Copyright © 2013. Published by Elsevier Ltd.

  1. Kentucky health system starts online consumer portal program. Web site development aims to drive consumerism and market service lines.

    Science.gov (United States)

    2007-01-01

    Saint Joseph HealthCare in Lexington, KY, is a three-hospital health system comprised of more than 650 beds serving the state's central and eastern regions. As a leading provider in cardiology, orthopedics, and stroke, it was recognized in 2006 as a top hospital in the nation by U.S. News and World Report.

  2. The effect of an e-learning supported Train-the-Trainer programme on implementation of suicide guidelines in mental health care.

    NARCIS (Netherlands)

    Beurs, D.P. de; Groot, M.H. de; Keijser, J. de; Mokkenstorm, J.; Duijn, E. van; Winter, R.F.P. de; Kerkhof, A.J.F.M.

    2015-01-01

    Background: Randomized studies examining the effect of training of mental health professionals in suicide prevention guidelines are scarce. We assessed whether professionals benefited from an e-learning supported Train-the-Trainer programme aimed at the application of the Dutch multidisciplinary

  3. Implementation of a guideline for local health policy making by regional health services : Exploring determinants of use by a web survey

    NARCIS (Netherlands)

    Kuunders, T.J.M.; Jacobs, M.A.M.; Paulussen, T.G.W.M.; van de Goor, L.A.M.; van Bon, M.J.H.; van Oers, J.A.M.

    Background Previous evaluation showed insufficient use of a national guideline for integrated local health policy by Regional Health Services (RHS) in the Netherlands. The guideline focuses on five health topics and includes five checklists to support integrated municipal health policies. This study

  4. Implementation of a guideline for local health policy making by regional health services: exploring determinants of use by a web survey

    NARCIS (Netherlands)

    Kuunders, T.J.M.; Jacobs, M.A.M.; Goor, I.A.M. van de; Bon-Martens, M.J.H. van; Oers, H.A.M. van; Paulussen, T.G.W.M.

    2017-01-01

    Background. Previous evaluation showed insufficient use of a national guideline for integrated local health policy by Regional Health Services (RHS) in the Netherlands. The guideline focuses on five health topics and includes five checklists to support integrated municipal health policies. This

  5. Early food for future health: a randomized controlled trial evaluating the effect of an eHealth intervention aiming to promote healthy food habits from early childhood.

    Science.gov (United States)

    Helle, Christine; Hillesund, Elisabet Rudjord; Omholt, Mona Linge; Øverby, Nina Cecilie

    2017-09-20

    Childhood overweight and obesity is a global public health challenge. Primary prevention initiatives targeting parents have been called for to encourage a positive feeding environment and healthy eating habits that may lay a good foundation for future health. At the same time, there is a need for interventions which combine accessibility and scalability with cost effectiveness. Today's parents are extensive Internet-users, but only a few randomized controlled trials have investigated the use of Internet to promote healthy eating habits in early childhood. In Early Food for Future Health we have developed and will evaluate an Internet-based tool for parents of children between 6 and 12 months, aiming to increase knowledge about infant nutrition and foster protective feeding behavior. During springtime 2016, parents of children aged between 3 and 5 months were recruited through Norwegian child health centres and announcements on Facebook. After completing the baseline questionnaire, 718 parents were individually randomized to intervention- or control group. The intervention group received monthly emails with links to an age-appropriate web-site when their child was between 6 and 12 months. The control group received ordinary care from the child health centres. The data-collection is ongoing. All participants will be followed up at ages 12 and possibly 24 and 48 months, with questionnaires relating to eating behaviour and feeding practices, food variety and diet quality. Providing guidance and counseling to parents of infants is an important task for health authorities and the public child health services. Early Food for Future health is an intervention focusing on promoting early healthy food-habits which may prevent childhood overweight and obesity. If proven to be effective, Early Food for Future Health can be used by parents and public health nurses for supplementary guidance on feeding practices and diet. This study has the potential to provide greater

  6. Investigation of the interactions between wind turbines and radio systems aimed at establishing co-siting guidelines. Phase 1: Introduction and modelling of wind turbine scatter, appendices E, F and G

    International Nuclear Information System (INIS)

    Dabis, H.S.; Chignell, R.J.

    1997-01-01

    The potential for wind turbines to interfere with radio systems can be a source of conflict between radio operators and the wind energy community. In this report, the problem of accurately predicting the effects of wind turbines on radio systems with the aim of establishing guidelines for their installation is investigated. Initially models for the scatter mechanisms that occur at the wind turbine are developed. These models predict the wind turbine radar cross section and the modulation effects due to the rotation of the blades. Initial validation of these models is established by comparing the predicted results with a set of measurements obtained from experiments performed on a 20:1 scale model wind turbine. It is shown that generally these results agree well. These results are then used in the guideline formulation to compute, for specific radio systems, regions where wind turbines cannot be installed. Examples using realistic parameters for various radio systems are presented. Further validation of the derived models is required. (author)

  7. Guidelines and mHealth to Improve Quality of Hypertension and Type 2 Diabetes Care for Vulnerable Populations in Lebanon: Longitudinal Cohort Study

    Science.gov (United States)

    Paik, Kenneth E; Hei Tam, Hok; Fahed, Zeina; Winkler, Eric; Kontunen, Kaisa; Mkanna, Abdalla; Burnham, Gilbert

    2017-01-01

    Background Given the protracted nature of the crisis in Syria, the large noncommunicable disease (NCD) caseload of Syrian refugees and host Lebanese, and the high costs of providing NCD care, the implications for Lebanon’s health system are vast. Objective The aim of this study was to evaluate the effectiveness of treatment guidelines and a mobile health (mHealth) app on quality of care and health outcomes in primary care settings in Lebanon. Methods A longitudinal cohort study was implemented from January 2015 to August 2016 to evaluate the effectiveness of treatment guidelines and an mHealth app on quality of care and health outcomes for Syrian and Lebanese patients in Lebanese primary health care (PHC) facilities. Results Compared with baseline record extraction, recording of blood pressure (BP) readings (−11.4%, PmHealth phase as compared with baseline (−8.4%, P=.001); however, recording of body mass index (BMI) reporting increased at the end of the mHealth phase from baseline (8.1%, PmHealth app showed that a higher proportion of providers offered lifestyle counseling compared with the counseling reported in patients’ paper records (health diet counseling; 77.3% in app data vs 8.8% in paper records, PmHealth implementation (PmHealth phases by 12.9% and 59.6%, respectively, (PmHealth implementation by 66.3% (PmHealth phase by 39.8% (PmHealth app in 10 PHC facilities in Lebanon indicate that the app has potential to improve adherence to guidelines and quality of care. Further studies are necessary to determine the effects of patient-controlled health record apps on provider adherence to treatment guidelines, as well as patients’ long-term medication and treatment adherence and disease control. PMID:29046266

  8. Development of new canine and feline preventive healthcare guidelines designed to improve pet health.

    Science.gov (United States)

    2011-01-01

    The American Veterinary Medical Association (AVMA) and American Animal Hospital Association (AAHA) have jointly introduced the first Canine and Feline Preventive Healthcare Guidelines. These consensus statements provide veterinarians with a new resource for improving patient care by emphasizing the value and scope of regular pet examinations. The two guidelines provide complete recommendations for comprehensive preventive healthcare programs, published as accessible, single-page documents. The guidelines are based on the subjective-objective-assessment-plan (SOAP) methodology of case management, a proven approach traditionally used with sick or injured patients. This logical and disciplined process is equally applicable to healthy patients and is designed to consistently deliver optimal patient care. The guidelines recommend visits for health examinations on at least an annual basis, recognizing that for many pets, more frequent visits may be appropriate, depending on the individual needs of the patient. The guidelines also provide detailed diagnostic, therapeutic, prevention, and follow up plans, to be accompanied by appropriate documentation. The inclusive content and concise format of the guidelines are designed to maximize their practical value and make them easy to implement.

  9. Public social monitoring reports and their effect on a policy programme aimed at addressing the social determinants of health to improve health equity in New Zealand.

    Science.gov (United States)

    Pega, Frank; Valentine, Nicole B; Matheson, Don; Rasanathan, Kumanan

    2014-01-01

    The important role that monitoring plays in advancing global health is well established. However, the role of social monitoring as a tool for addressing social determinants of health (SDH) and health equity-focused policies remains under-researched. This paper assesses the extent and ways in which New Zealand's (NZ) Social Reports (SRs) supported a SDH- and health equity-oriented policy programme nationally over the 2000-2008 period by documenting the SRs' history and assessing its impact on policies across sectors in government and civil society. We conducted key-informant interviews with five senior policy-makers and an e-mail survey with 24 government and civil society representatives on SRs' history and policy impact. We identified common themes across these data and classified them accordingly to assess the intensity of the reports' use and their impact on SDH- and health equity-focused policies. Bibliometric analyses of government publications and media items were undertaken to empirically assess SRs' impact on government and civil society. SRs in NZ arose out of the role played by government as the "benevolent social welfare planner" and an understanding of the necessity of economic and social security for "progress". The SRs were linked to establishing a government-wide programme aimed at reducing inequalities. They have been used moderately to highly in central and local government and in civil society, both within and outside the health sector, but have neither entered public treasury and economic development departments nor the commercial sector. The SRs have not reached the more universal status of economic indicators. However, they have had some success at raising awareness of, and have stimulated isolated action on, SDH. The NZ case suggests that national-level social monitoring provides a valuable tool for raising awareness of SDH across government and civil society. A number of strategies could improve social reports' effectiveness in stimulating

  10. Interventional study to improve diabetic guidelines adherence using mobile health (m-Health) technology in Lahore, Pakistan.

    Science.gov (United States)

    Hashmi, Noreen Rahat; Khan, Shazad Ali

    2018-05-31

    To check if mobile health (m-Health) short message service (SMS) can improve the knowledge and practice of the American Diabetic Association preventive care guidelines (ADA guidelines) recommendations among physicians. Quasi-experimental pre-post study design with a control group. The participants of the study were 62 medical officers/medical postgraduate trainees from two hospitals in Lahore, Pakistan. Pretested questionnaire was used to collect baseline information about physicians' knowledge and adherence according to the ADA guidelines. All the respondents attended 1-day workshop about the guidelines. The intervention group received regular reminders by SMS about the ADA guidelines for the next 5 months. Postintervention knowledge and practice scores of 13 variables were checked again using the same questionnaire. Statistical analysis included χ 2 and McNemar's tests for categorical variables and t-test for continuous variables. Pearson's correlation analysis was done to check correlation between knowledge and practice scores in the intervention group. P values of improvement in knowledge (pimprovement in knowledge (p=0.002) and practice (p=0.001) between non-intervention and intervention groups. Adherence to individual 13 ADA preventive care guidelines level was noted to be suboptimal at baseline. Statistically significant improvement in the intervention group was seen in the following individual variables: review of symptoms of hypoglycaemia and hyperglycaemia, eye examination, neurological examination, lipid examination, referral to ophthalmologist, and counselling about non-smoking. m-Health technology can be a useful educational tool to help with improving knowledge and practice of diabetic guidelines. Future multicentre trials will help to scale this intervention for wider use in resource-limited countries. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is

  11. Cost-effectiveness of guideline-based care for workers with mental health problems

    NARCIS (Netherlands)

    Rebergen, D. S.; Bruinvels, D. J.; van Tulder, M. W.; van der Beek, A. J.; van Mechelen, W.

    2009-01-01

    To evaluate the cost-effectiveness of an activating guideline-based care (GBC) by occupational physicians (OPs). An economic evaluation was conducted in a randomized controlled trial with police workers on sick leave due to mental health problems (n = 240). In the intervention group trained OPs

  12. The diagnostic work up of growth failure in secondary health care ; An evaluation of consensus guidelines

    NARCIS (Netherlands)

    Grote, F.K.; Oostdijk, W.; Muinck Keizer-Schrama, S.M.P.F. de; Dommelen, P. van; Buuren, S. van; Dekker, F.W.; Ketel, A.G.; Moll, H.A.; Wit, J.M.

    2008-01-01

    Background: As abnormal growth might be the first manifestation of undetected diseases, it is important to have accurate referral criteria and a proper diagnostic work-up. In the present paper we evaluate the diagnostic work-up in secondary health care according to existing consensus guidelines and

  13. Evidence-based guidelines, time-based health outcomes, and the Matthew effect

    NARCIS (Netherlands)

    M.L.E. Essink-Bot (Marie-Louise); M.E. Kruijshaar (Michelle); J.J.M. Barendregt (Jan); L.G.A. Bonneux (Luc)

    2007-01-01

    textabstractBackground: Cardiovascular risk management guidelines are 'risk based'; health economists' practice is 'time based'. The 'medical' risk-based allocation model maximises numbers of deaths prevented by targeting subjects at high risk, for example, elderly and smokers. The time-based model

  14. Evidence-based guidelines, time-based health outcomes, and the Matthew effect

    NARCIS (Netherlands)

    Essink-Bot, Marie-Louise; Kruijshaar, Michelle E.; Barendregt, Jan J.; Bonneux, Luc G. A.

    2007-01-01

    BACKGROUND: Cardiovascular risk management guidelines are 'risk based'; health economists' practice is 'time based'. The 'medical' risk-based allocation model maximises numbers of deaths prevented by targeting subjects at high risk, for example, elderly and smokers. The time-based model maximises

  15. Do countries rely on the World Health Organization for translating research findings into clinical guidelines? A case study.

    Science.gov (United States)

    Noor, Ramadhani A; Geldsetzer, Pascal; Bärnighausen, Till; Fawzi, Wafaie

    2016-10-06

    The World Health Organization's (WHO) antiretroviral therapy (ART) guidelines have generally been adopted rapidly and with high fidelity by countries in sub-Saharan Africa. Thus far, however, WHO has not published specific guidance on nutritional care and support for (non-pregnant) adults living with HIV despite a solid evidence base for some interventions. This offers an opportunity for a case study on whether national clinical guidelines in sub-Saharan Africa provide concrete recommendations in the face of limited guidance by WHO. This study, therefore, aims to determine if national HIV treatment guidelines in sub-Saharan Africa contain specific guidance on nutritional care and support for non-pregnant adults living with HIV. We identified the most recent national HIV treatment guidelines in sub-Saharan African countries with English as an official language. Using pre-specified criteria, we determined for each guideline whether it provides guidance to clinicians on each of five components of nutritional care and support for adults living with HIV: assessment of nutritional status, dietary counseling, micronutrient supplementation, ready-to-use therapeutic or supplementary foods, and food subsidies. We found that national HIV treatment guidelines in sub-Saharan Africa generally do not contain concrete recommendations on nutritional care and support for non-pregnant adults living with HIV. Given that decisions on nutritional care and support are inevitably being made at the clinician-patient level, and that clinicians have a relative disadvantage in systematically identifying, summarizing, and weighing up research evidence compared to WHO and national governments, there is a need for more specific clinical guidance. In our view, such guidance should at a minimum recommend daily micronutrient supplements for adults living with HIV who are in pre-ART stages, regular dietary counseling, periodic assessment of anthropometric status, and additional nutritional

  16. Draft Guidelines for the Retrieval and Interpretation of Economic Evaluations of Health Technologies in Ireland, July 2014

    LENUS (Irish Health Repository)

    O'Kelly, R A

    2013-04-11

    BACKGROUND: The Laboratory modernisation process in Ireland will include point of care testing (POCT) as one of its central tenets. However, a previous baseline survey showed that POCT was under-resourced particularly with respect to information technology (IT) and staffing. AIMS: An audit was undertaken to see if POCT services had improved since the publication of National Guidelines and if such services were ready for the major changes in laboratory medicine as envisaged by the Health Service Executive. METHODS: The 15 recommendations of the 2007 Guidelines were used as a template for a questionnaire, which was distributed by the Irish External Quality Assessment Scheme. RESULTS: Thirty-nine of a possible 45 acute hospitals replied. Only a quarter of respondent hospitals had POCT committees, however, allocation of staff to POCT had doubled since the first baseline survey. Poor IT infrastructure, the use of unapproved devices, and low levels of adverse incident reporting were still major issues. CONCLUSIONS: Point of care testing remains under-resourced, despite the roll out of such devices throughout the health service including primary care. The present high standards of laboratory medicine may not be maintained if the quality and cost-effectiveness of POCT is not controlled. Adherence to national Guidelines and adequate resourcing is essential to ensure patient safety.

  17. Trauma care in Africa: a status report from Botswana, guided by the World Health Organization's "Guidelines for Essential Trauma Care".

    Science.gov (United States)

    Hanche-Olsen, Terje Peder; Alemu, Lulseged; Viste, Asgaut; Wisborg, Torben; Hansen, Kari S

    2012-10-01

    Trauma represents a significant and increasing challenge to health care systems all over the world. This study aimed to evaluate the trauma care capabilities of Botswana, a middle-income African country, by applying the World Health Organization's Guidelines for Essential Trauma Care. All 27 government (16 primary, 9 district, 2 referral) hospitals were surveyed. A questionnaire and checklist, based on "Guidelines for Essential Trauma Care" and locally adapted, were developed as situation analysis tools. The questionnaire assessed local trauma organization, capacity, and the presence of quality improvement activity. The checklist assessed physical availability of equipment and timely availability of trauma-related skills. Information was collected by interviews with hospital administrators, key personnel within trauma care, and through on-site physical inspection. Hospitals in Botswana are reasonably well supplied with human and physical resources for trauma care, although deficiencies were noted. At the primary and district levels, both capacity and equipment for airway/breathing management and vascular access was limited. Trauma administrative functions were largely absent at all levels. No hospital in Botswana had any plans for trauma education, separate from or incorporated into other improvement activities. Team organization was nonexistent, and training activities in the emergency room were limited. This study draws a picture of trauma care capabilities of an entire African country. Despite good organizational structures, Botswana has room for substantial improvement. Administrative functions, training, and human and physical resources could be improved. By applying the guidelines, this study creates an objective foundation for improved trauma care in Botswana.

  18. A systematic approach to implementing and evaluating clinical guidelines: The results of fifteen years of Preventive Child Health Care guidelines in the Netherlands

    NARCIS (Netherlands)

    Fleuren, M.A.H.; Dommelen, P. van; Dunnink, T.

    2015-01-01

    Preventive Child Health Care (PCHC) services are delivered to all children in the Netherlands by approximately 5500 doctors, nurses and doctor's assistants. In 1996, The Dutch Ministry of Health, Welfare and Sports asked for the development of evidence-based PCHC guidelines. Since 1998, twenty-five

  19. Single Health System Adherence to 2012 Cervical Cancer Screening Guidelines at Extremes of Age and Posthysterectomy.

    Science.gov (United States)

    Teoh, Deanna; Isaksson Vogel, Rachel; Hultman, Gretchen; Monu, Minnu; Downs, Levi; Geller, Melissa A; Le, Chap; Melton-Meaux, Genevieve; Kulasingam, Shalini

    2017-03-01

    To estimate the proportion of guideline nonadherent Pap tests in women aged younger than 21 years and older than 65 years and posthysterectomy in a single large health system. Secondary objectives were to describe temporal trends and patient and health care provider characteristics associated with screening in these groups. A retrospective cross-sectional chart review was performed at Fairview Health Services and University of Minnesota Physicians. Reasons for testing and patient and health care provider information were collected. Tests were designated as indicated or nonindicated per the 2012 cervical cancer screening guidelines. Point estimates and descriptive statistics were calculated. Patient and health care provider characteristics were compared between indicated and nonindicated groups using χ and Wilcoxon rank-sum tests. A total of 3,920 Pap tests were performed between September 9, 2012, and August 31, 2014. A total of 257 (51%; 95% confidence interval [CI] 46.1-54.9%) of tests in the younger than 21 years group, 536 (40%; 95% CI 37.7-43.1%) in the older than 65 years group, and 605 (29%; 95% CI 27.1-31.0%) in the posthysterectomy group were not indicated. White race in the older than 65 years group was the only patient characteristic associated with receipt of a nonindicated Pap test (P=.007). Health care provider characteristics associated with nonindicated Pap tests varied by screening group. Temporal trends showed a decrease in the proportion of nonindicated tests in the younger than 21 years group but an increase in the posthysterectomy group. For women aged younger than 21 years and older than 65 years and posthysterectomy, 35% of Pap tests performed in our health system were not guideline-adherent. There were no patient or health care provider characteristics associated with guideline nonadherent screening across all groups.

  20. Implementing practice guidelines for anxiety disorders in secondary mental health care: a case study

    Directory of Open Access Journals (Sweden)

    van Dijk Maarten K

    2012-09-01

    Full Text Available Abstract Background Recent years have seen the large-scale development of clinical practice guidelines for mental disorders in several countries. In the Netherlands, more than ten multidisciplinary guidelines for mental health care have been developed since 2003. The first dealt with the treatment of anxiety disorders. An important question was whether it is feasible to implement these guidelines because implementing practice guidelines is often difficult. Although several implementation interventions have proven effective, there seems to be no ready-made strategy that works in all circumstances. Case description The Dutch multidisciplinary guidelines for anxiety disorders were implemented in a community mental health care centre, located in the east of the Netherlands. The centre provides secondary outpatient care. The unit within the centre that specializes in the treatment of anxiety disorders has 16 team members with diverse professional backgrounds. Important steps in the process of implementing the guidelines were analysing the care provided before start of the implementation to determine the goals for improvement, and analysing the context and target group for implementation. Based on these analyses, a tailor-made multifaceted implementation strategy was developed that combined the reorganization of the care process, the development of instruction materials, the organization of educational meetings and the use of continuous quality circles to improve adherence to guidelines. Discussion and evaluation Significant improvements in adherence rates were made in the aspect of care that was targeted for change. An increase was found in the number of patients being provided with recommended forms of psychotherapeutic treatment, ranging from 43% to 54% (p  Conclusion The case study presented here shows that the implementation of practice guidelines for anxiety disorders in mental health care is feasible. Based on the results of our study, the

  1. Implementation of a guideline for local health policy making by regional health services: exploring determinants of use by a web survey.

    Science.gov (United States)

    Kuunders, Theo J M; Jacobs, Monique A M; Goor, Ien A M van de; Bon-Martens, Marja J H van; Oers, Hans A M van; Paulussen, Theo G W M

    2017-08-15

    Previous evaluation showed insufficient use of a national guideline for integrated local health policy by Regional Health Services (RHS) in the Netherlands. The guideline focuses on five health topics and includes five checklists to support integrated municipal health policies. This study explores the determinants of guideline use by regional Dutch health professionals. A web survey was send to 304 RHS health professionals. The questionnaire was based on a theory- and research-based framework of determinants of public health innovations. Main outcomes were guideline use and completeness of use, defined as the number of health topics and checklists used. Associations between determinants and (completeness of) guideline use were explored by multivariate regression models. The survey was started by 120 professionals (39%). Finally, results from 73 respondents (24%) were eligible for analyses. All 28 Dutch RHS organizations were represented in the final dataset. About half of the respondents (48%) used the guideline. The average score for completeness of use (potential range 1-10) was 2.37 (sd = 1.78; range 1-7). Knowledge, perceived task responsibility and usability were significantly related to guideline use in univariate analyses. Only usability remained significant in the multivariate model on guideline use. Only self-efficacy accounted for significant proportions of variance in completeness of use. The results imply that strategies to improve guideline use by RHSs should primarily target perceived usability. Self-efficacy appeared the primary target for improving completeness of guideline use. Methods for targeting these determinants in RHSs are discussed.

  2. Listening instead of reading : The influence of voice intonation in auditory health persuasion aimed at increasing fruit and vegetable intake

    NARCIS (Netherlands)

    Elbert, Sarah; Dijkstra, Arie

    2013-01-01

    Purpose. In auditory health persuasion, the speaker’s speech becomes salient, as there is no visual information available. Intonation of speech is one important aspect that may influence persuasion. It was experimentally tested to what extent different levels of intonation are related to persuasion.

  3. Photovoltaic mini power plants for integration in the third world and Eastern Europe. Market analysis aimed at health and education

    International Nuclear Information System (INIS)

    Lundsgaard, J.S.

    1994-12-01

    Energy is a critical factor which determines the progress of rural development. Energy is therefore an area of concern. The quality, availability and cost of conventional energies, plus the associated environmental effects are a growing problem - not only for the health infrastructure but also for agriculture and domestic life. This is true not only in developing countries where the fast growing industries and urban populations demand a soaring proportion of available energy at the expense of the rural communities, but also in the poorest countries with weak energy infrastructure. Renewable energies, much studied in the last 20 years, can meet the needs of rural health and education services and communities by providing high quality, low cost, non-polluting energy. Solar energy, in particular, has the flexibility to produce electricity, heat and cooling. Solar technologies, furthermore, are backed by an established and experienced industry. This report proposes to meet the energy needs for health and education in rural communities. This report analyses the need and market for photovoltaic Mini Power Plants in the 1-20 kW size. According to WHO and UNESCO such plants will be able to fulfill the requirements in rural community villages, health centres and education centres and be economically feasible. (au)

  4. Mental health first aid for Indigenous Australians: using Delphi consensus studies to develop guidelines for culturally appropriate responses to mental health problems

    Directory of Open Access Journals (Sweden)

    Kelly Claire M

    2009-08-01

    Full Text Available Abstract Background Ethnic minority groups are under-represented in mental health care services because of barriers such as poor mental health literacy. In 2007, the Mental Health First Aid (MHFA program implemented a cultural adaptation of its first aid course to improve the capacity of Indigenous Australians to recognise and respond to mental health issues within their own communities. It became apparent that the content of this training would be improved by the development of best practice guidelines. This research aimed to develop culturally appropriate guidelines for providing first aid to an Australian Aboriginal or Torres Strait Islander person who is experiencing a mental health crisis or developing a mental illness. Methods A panel of Australian Aboriginal people who are experts in Aboriginal mental health, participated in six independent Delphi studies investigating depression, psychosis, suicidal thoughts and behaviours, deliberate self-injury, trauma and loss, and cultural considerations. The panel varied in size across the studies, from 20-24 participants. Panellists were presented with statements about possible first aid actions via online questionnaires and were encouraged to suggest additional actions not covered by the survey content. Statements were accepted for inclusion in a guideline if they were endorsed by ≥ 90% of panellists as essential or important. Each study developed one guideline from the outcomes of three Delphi questionnaire rounds. At the end of the six Delphi studies, participants were asked to give feedback on the value of the project and their participation experience. Results From a total of 1,016 statements shown to the panel of experts, 536 statements were endorsed (94 for depression, 151 for psychosis, 52 for suicidal thoughts and behaviours, 53 for deliberate self-injury, 155 for trauma and loss, and 31 for cultural considerations. The methodology and the guidelines themselves were found to be useful

  5. Barriers to implementing infection prevention and control guidelines during crises: experiences of health care professionals.

    Science.gov (United States)

    Timen, Aura; Hulscher, Marlies E J L; Rust, Laura; van Steenbergen, Jim E; Akkermans, Reinier P; Grol, Richard P T M; van der Meer, Jos W M

    2010-11-01

    Communicable disease crises can endanger the health care system and often require special guidelines. Understanding reasons for nonadherence to crisis guidelines is needed to improve crisis management. We identified and measured barriers and conditions for optimal adherence as perceived by 4 categories of health care professionals. In-depth interviews were performed (n = 26) to develop a questionnaire for a cross-sectional survey of microbiologists (100% response), infection preventionists (74% response), public health physicians (96% response), and public health nurses (82% response). The groups were asked to appraise barriers encountered during 4 outbreaks (severe acute respiratory syndrome [SARS], Clostridium difficile ribotype 027, rubella, and avian influenza) according to a 5-point Likert scale. When at least 33% of the participants responded "strongly agree," "agree," or "rather agree than disagree," a barrier was defined as "often experienced." The common ("generic") barriers were included in a univariate and multivariate model. Barriers specific to the various groups were studied as well. Crisis guidelines were found to have 4 generic barriers to adherence: (1) lack of imperative or precise wording, (2) lack of easily identifiable instructions specific to each profession, (3) lack of concrete performance targets, and (4) lack of timely and adequate guidance on personal protective equipment and other safety measures. The cross-sectional study also yielded profession-specific sets of often-experienced barriers. To improve adherence to crisis guidelines, the generic barriers should be addressed when developing guidelines, irrespective of the infectious agent. Profession-specific barriers require profession-specific strategies to change attitudes, ensure organizational facilities, and provide an adequate setting for crisis management. Copyright © 2010 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights

  6. World Health Organization (WHO) guidelines on use of medically important antimicrobials in food-producing animals.

    Science.gov (United States)

    Aidara-Kane, Awa; Angulo, Frederick J; Conly, John M; Minato, Yuki; Silbergeld, Ellen K; McEwen, Scott A; Collignon, Peter J

    2018-01-01

    Antimicrobial use in food-producing animals selects for antimicrobial resistance that can be transmitted to humans via food or other transmission routes. The World Health Organization (WHO) in 2005 ranked the medical importance of antimicrobials used in humans. In late 2017, to preserve the effectiveness of medically important antimicrobials for humans, WHO released guidelines on use of antimicrobials in food-producing animals that incorporated the latest WHO rankings. WHO commissioned systematic reviews and literature reviews, and convened a Guideline Development Group (GDG) of external experts free of unacceptable conflicts-of-interest. The GDG assessed the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, and formulated recommendations using a structured evidence-to-decision approach that considered the balance of benefits and harms, feasibility, resource implications, and impact on equity. The resulting guidelines were peer-reviewed by an independent External Review Group and approved by the WHO Guidelines Review Committee. These guidelines recommend reductions in the overall use of medically important antimicrobials in food-producing animals, including complete restriction of use of antimicrobials for growth promotion and for disease prevention (i.e., in healthy animals considered at risk of infection). These guidelines also recommend that antimicrobials identified as critically important for humans not be used in food-producing animals for treatment or disease control unless susceptibility testing demonstrates the drug to be the only treatment option. To preserve the effectiveness of medically important antimicrobials, veterinarians, farmers, regulatory agencies, and all other stakeholders are urged to adopt these recommendations and work towards implementation of these guidelines.

  7. Policies on Conflicts of Interest in Health Care Guideline Development: A Cross-Sectional Analysis

    Science.gov (United States)

    Morciano, Cristina; Basevi, Vittorio; Faralli, Carla; Hilton Boon, Michele; Tonon, Sabina; Taruscio, Domenica

    2016-01-01

    Objective To assess whether organisations that develop health care guidelines have conflict of interest (COI) policies and to review the content of the available COI policies. Methods Survey and content analysis of COI policies available in English, French, Spanish, and Italian conducted between September 2014 and June 2015. A 24-item data abstraction instrument was created on the basis of guideline development standards. Results The survey identified 29 organisations from 19 countries that met the inclusion criteria. From these organisations, 19 policies were eligible for inclusion in the content analysis. Over one-third of the policies (7/19, 37%) did not report or did not clearly report whether disclosure was a prerequisite for membership of the guideline panel. Strategies for the prevention of COI such as divestment were mentioned by only two organisations. Only 21% of policies (4/19) used criteria to determine whether an interest constitutes a COI and to assess the severity of the risk imposed. Conclusions The finding that some organisations, in contradiction of widely available standards, still do not have COI policies publicly available is concerning. Also troubling were the findings that some policies did not clearly report critical steps in obtaining, managing and communicating disclosure of relationships of interest. This in addition to the variability encountered in content and accessibility of COI policies may cause confusion and distrust among guideline users. It is in the interest of guideline users and developers to design an agreed-upon, comprehensive, clear, and accessible COI policy. PMID:27846255

  8. Role of poultry meat in a balanced diet aimed at maintaining health and wellbeing: an Italian consensus document

    Directory of Open Access Journals (Sweden)

    Franca Marangoni

    2015-06-01

    Full Text Available The relationship between the consumption of meat and health is multifaceted, and it needs to be analyzed in detail, with specific attention to the relevant differences that characterize the effects of the different meat types, as yet considered by only a limited literature. A variable but moderate energy content, highly digestible proteins (with low levels of collagen of good nutritional quality, unsaturated lipids (mainly found in the skin and easily removed, B-group vitamins (mainly thiamin, vitamin B6, and pantothenic acid, and minerals (like iron, zinc, and copper make poultry meat a valuable food. Epidemiological studies performed across the world, in highly diverse populations with different food preferences and nutritional habits, provide solid information on the association between poultry consumption, within a balanced diet, and good health. Consumption of poultry meat, as part of a vegetable-rich diet, is associated with a risk reduction of developing overweight and obesity, cardiovascular diseases, and type 2 diabetes mellitus. Also, white meat (and poultry in particular is considered moderately protective or neutral on cancer risk. The relevance of poultry meat for humans also has been recognized by the UN Food and Agricultural Organization (FAO, who considers this widely available, relatively inexpensive food to be particularly useful in developing countries, where it can help to meet shortfalls in essential nutrients. Moreover, poultry meat consumption also contributes to the overall quality of the diet in specific ages and conditions (prior to conception, during pregnancy up to the end of breastfeeding, during growth, and in the geriatric age and is suitable for those who have an increased need for calorie and protein compared to the general population.

  9. Role of poultry meat in a balanced diet aimed at maintaining health and wellbeing: an Italian consensus document

    Science.gov (United States)

    Marangoni, Franca; Corsello, Giovanni; Cricelli, Claudio; Ferrara, Nicola; Ghiselli, Andrea; Lucchin, Lucio; Poli, Andrea

    2015-01-01

    The relationship between the consumption of meat and health is multifaceted, and it needs to be analyzed in detail, with specific attention to the relevant differences that characterize the effects of the different meat types, as yet considered by only a limited literature. A variable but moderate energy content, highly digestible proteins (with low levels of collagen) of good nutritional quality, unsaturated lipids (mainly found in the skin and easily removed), B-group vitamins (mainly thiamin, vitamin B6, and pantothenic acid), and minerals (like iron, zinc, and copper) make poultry meat a valuable food. Epidemiological studies performed across the world, in highly diverse populations with different food preferences and nutritional habits, provide solid information on the association between poultry consumption, within a balanced diet, and good health. Consumption of poultry meat, as part of a vegetable-rich diet, is associated with a risk reduction of developing overweight and obesity, cardiovascular diseases, and type 2 diabetes mellitus. Also, white meat (and poultry in particular) is considered moderately protective or neutral on cancer risk. The relevance of poultry meat for humans also has been recognized by the UN Food and Agricultural Organization (FAO), who considers this widely available, relatively inexpensive food to be particularly useful in developing countries, where it can help to meet shortfalls in essential nutrients. Moreover, poultry meat consumption also contributes to the overall quality of the diet in specific ages and conditions (prior to conception, during pregnancy up to the end of breastfeeding, during growth, and in the geriatric age) and is suitable for those who have an increased need for calorie and protein compared to the general population. PMID:26065493

  10. Role of poultry meat in a balanced diet aimed at maintaining health and wellbeing: an Italian consensus document.

    Science.gov (United States)

    Marangoni, Franca; Corsello, Giovanni; Cricelli, Claudio; Ferrara, Nicola; Ghiselli, Andrea; Lucchin, Lucio; Poli, Andrea

    2015-01-01

    The relationship between the consumption of meat and health is multifaceted, and it needs to be analyzed in detail, with specific attention to the relevant differences that characterize the effects of the different meat types, as yet considered by only a limited literature. A variable but moderate energy content, highly digestible proteins (with low levels of collagen) of good nutritional quality, unsaturated lipids (mainly found in the skin and easily removed), B-group vitamins (mainly thiamin, vitamin B6, and pantothenic acid), and minerals (like iron, zinc, and copper) make poultry meat a valuable food. Epidemiological studies performed across the world, in highly diverse populations with different food preferences and nutritional habits, provide solid information on the association between poultry consumption, within a balanced diet, and good health. Consumption of poultry meat, as part of a vegetable-rich diet, is associated with a risk reduction of developing overweight and obesity, cardiovascular diseases, and type 2 diabetes mellitus. Also, white meat (and poultry in particular) is considered moderately protective or neutral on cancer risk. The relevance of poultry meat for humans also has been recognized by the UN Food and Agricultural Organization (FAO), who considers this widely available, relatively inexpensive food to be particularly useful in developing countries, where it can help to meet shortfalls in essential nutrients. Moreover, poultry meat consumption also contributes to the overall quality of the diet in specific ages and conditions (prior to conception, during pregnancy up to the end of breastfeeding, during growth, and in the geriatric age) and is suitable for those who have an increased need for calorie and protein compared to the general population.

  11. Providing culturally appropriate mental health first aid to an Aboriginal or Torres Strait Islander adolescent: development of expert consensus guidelines

    Science.gov (United States)

    2014-01-01

    Background It is estimated that the prevalence of mental illness is higher in Aboriginal and Torres Strait Islander adolescents compared to non-Aboriginal adolescents. Despite this, only a small proportion of Aboriginal youth have contact with mental health services, possibly due to factors such as remoteness, language barriers, affordability and cultural sensitivity issues. This research aimed to develop culturally appropriate guidelines for anyone who is providing first aid to an Australian Aboriginal or Torres Strait Islander adolescent who is experiencing a mental health crisis or developing a mental illness. Methods A panel of Australian Aboriginal people who are experts in Aboriginal youth mental health, participated in a Delphi study investigating how members of the public can be culturally appropriate when helping an Aboriginal or Torres Strait Islander adolescent with mental health problems. The panel varied in size across the three sequential rounds, from 37–41 participants. Panellists were presented with statements about cultural considerations and communication strategies via online questionnaires and were encouraged to suggest additional content. All statements endorsed as either Essential or Important by ≥ 90% of panel members were written into a guideline document. To assess the panel members’ satisfaction with the research method, participants were invited to provide their feedback after the final survey. Results From a total of 304 statements shown to the panel of experts, 194 statements were endorsed. The methodology was found to be useful and appropriate by the panellists. Conclusion Aboriginal and Torres Strait Islander Youth mental health experts were able to reach consensus about what the appropriate communication strategies for providing mental health first aid to an Aboriginal and Torres Strait Islander adolescent. These outcomes will help ensure that the community provides the best possible support to Aboriginal adolescents who

  12. Providing culturally appropriate mental health first aid to an Aboriginal or Torres Strait Islander adolescent: development of expert consensus guidelines.

    Science.gov (United States)

    Chalmers, Kathryn J; Bond, Kathy S; Jorm, Anthony F; Kelly, Claire M; Kitchener, Betty A; Williams-Tchen, Aj

    2014-01-28

    It is estimated that the prevalence of mental illness is higher in Aboriginal and Torres Strait Islander adolescents compared to non-Aboriginal adolescents. Despite this, only a small proportion of Aboriginal youth have contact with mental health services, possibly due to factors such as remoteness, language barriers, affordability and cultural sensitivity issues. This research aimed to develop culturally appropriate guidelines for anyone who is providing first aid to an Australian Aboriginal or Torres Strait Islander adolescent who is experiencing a mental health crisis or developing a mental illness. A panel of Australian Aboriginal people who are experts in Aboriginal youth mental health, participated in a Delphi study investigating how members of the public can be culturally appropriate when helping an Aboriginal or Torres Strait Islander adolescent with mental health problems. The panel varied in size across the three sequential rounds, from 37-41 participants. Panellists were presented with statements about cultural considerations and communication strategies via online questionnaires and were encouraged to suggest additional content. All statements endorsed as either Essential or Important by ≥ 90% of panel members were written into a guideline document. To assess the panel members' satisfaction with the research method, participants were invited to provide their feedback after the final survey. From a total of 304 statements shown to the panel of experts, 194 statements were endorsed. The methodology was found to be useful and appropriate by the panellists. Aboriginal and Torres Strait Islander Youth mental health experts were able to reach consensus about what the appropriate communication strategies for providing mental health first aid to an Aboriginal and Torres Strait Islander adolescent. These outcomes will help ensure that the community provides the best possible support to Aboriginal adolescents who are developing mental illnesses or are in a

  13. Impact of Health Authority Control Measures Aimed at Reducing the Illicit Use of Anabolic-Androgenic Steroids.

    Science.gov (United States)

    Vázquez-Mourelle, Raquel; Carracedo-Martinez, Eduardo; Figueiras, Adolfo

    2018-01-01

    To evaluate two interventions on anabolic-androgenic-steroids (AAS) dispensation in retail pharmacies. The study was conducted in a north-western region of Spain. Data were the AAS supplied by wholesale drug distributors to retail pharmacies over a period of 102 months. It is designed as an ecological time-series study; the dependent variables were daily defined doses per 1,000 inhabitants per day of each drug. The two interventions evaluated were: (1) an inspection program intended for those retail pharmacies where there was an irregular dispensation and (2) a regulation put forth forcing these pharmacies to carry out additional registers. The medications studied were stanozolol, nandrolone, methenolone, testosterone and mesterolone. The pre-intervention use of AAS displayed a rising trend. There was an immediate reduction of 30.56% after the first intervention, and a further reduction of 35.25% after the second. There was a seasonal pattern of use in the pre-intervention period, pointing to an increased demand at the end of spring and beginning of summer. The most abused drugs were stanozolol and nandrolone. The health actions were very effective, in that they brought about a sharp reduction in the illicit use of AAS. These interventions could be applied to other drugs in which abuse were detected. © 2018 S. Karger AG, Basel.

  14. An international comparison of occupational health guidelines for the management of mental disorders and stress-related psychological symptoms.

    Science.gov (United States)

    Joosen, Margot C W; Brouwers, Evelien P M; van Beurden, Karlijn M; Terluin, Berend; Ruotsalainen, Jani H; Woo, Jong-Min; Choi, Kyeong-Sook; Eguchi, Hisashi; Moriguchi, Jiro; van der Klink, Jac J L; van Weeghel, Jaap

    2015-05-01

    We compared available guidelines on the management of mental disorders and stress-related psychological symptoms in an occupational healthcare setting and determined their development and reporting quality. To identify eligible guidelines, we systematically searched National Guideline Clearinghouse, Guidelines International Network Library and PubMed. Members of the International Commission on Occupational Health (ICOH), were also consulted. Guidelines recommendations were compared and reporting quality was assessed using the AGREE II instrument. Of 2126 titles retrieved, 14 guidelines were included: 1 Japanese, 2 Finnish, 2 Korean, 2 British and 7 Dutch. Four guidelines were of high-reporting quality. Best described was the Scope and Purpose, and the poorest described were competing interests (Editorial independence) and barriers and facilitators for implementation (Applicability). Key recommendations were often difficult to identify. Most guidelines recommend employing an inventory of symptoms, diagnostic classification, performance problems and workplace factors. All guidelines recommend specific return-to-work interventions, and most agreed on psychological treatment and communication between involved stakeholders. Practice guidelines to address work disability due to mental disorders and stress-related symptoms are available in various countries around the world, however, these guidelines are difficult to find. To promote sharing, national guidelines should be accessible via established international databases. The quality of the guideline's developmental process varied considerably. To increase quality and applicability, guideline developers should adopt a common structure for the development and reporting of their guidelines, for example Appraisal of Guidelines for Research and Evaluation (AGREE) criteria. Owing to differences in social systems, developers can learn from each other through reviews of this kind. Published by the BMJ Publishing Group Limited

  15. What do we mean when we talk about the Triple Aim? A systematic review of evolving definitions and adaptations of the framework at the health system level.

    Science.gov (United States)

    Mery, Gustavo; Majumder, Shilpi; Brown, Adalsteinn; Dobrow, Mark J

    2017-06-01

    Notwithstanding important contributions of the Triple Aim, uncritical enthusiasm regarding the implications of the framework may be leading to inconsistent use, particularly when applied at the health system level, which goes beyond the original positioning of the framework as a strategic organizing principle to guide improvement initiatives at the organizational or local community level. We systematically identified uses of the Triple Aim that extended beyond its original intention to focus on uses at the whole health system level, to assess convergence and divergence with the original definition. We also attempted to identify consistencies in the way the Triple Aim was adapted for different contexts and settings. Data sources were indexed databases, web search engines, and international experts. Forty-seven articles were included in the analysis. We found that the definition of the Triple Aim has been subject to important modifications when the framework is used to define goals for whole health care systems or globally. Despite widespread recognition of the name, what constitutes the Triple Aim framework varies. We identified the need to consider the inclusion of at least two additional aims of health care systems - the provider experience of care, and the desire to achieve health equity for populations. Copyright © 2017. Published by Elsevier B.V.

  16. Derivation of residual radioactive material guidelines for the Laboratory for Energy-Related Health Research site

    International Nuclear Information System (INIS)

    Chapman, T.E.

    1993-11-01

    Residual radioactive material guidelines were derived for the Laboratory for Energy-Related Health Research (LEHR) Environmental Restoration (ER) site in Davis, California. The guideline derivation was based on a dose limit of 100 mrem/yr. The US Department of Energy (DOE) residual radioactive material guideline computer code was used in this evaluation. This code implements the methodology described in the DOE manual for implementing residual radioactive material guidelines. Three potential site utilization scenarios were considered with the assumption that following ER action, the site will be used without radiological restrictions. The defined scenarios vary with regard to use of the site, time spent at the site, and sources of food consumed. The results of the evaluation indicate that the basic dose limit of 100 mrem/yr will not be exceeded, provided that the soil concentrations of these radionuclides at the LEHR site do not exceed the scenario-specific values calculated by this study. Except for the extent of the contaminated zone (which is very conservative), assumptions used are as site-specific as possible, given available information. The derived guidelines are single- radionuclide guidelines and are linearly proportional to the dose limit used in the calculations. In setting the actual residual soil contamination guides for the LEHR site, DOE will apply the as low as reasonably achievable policy to the decision-making process, along with other factors such as whether a particular scenario is reasonable and appropriate, as well as using site-specific inputs to computer models based on data not yet fully determined

  17. Parents' discursive resources: analysis of discourses in Swedish, Danish and Norwegian health care guidelines for children with diabetes type 1.

    Science.gov (United States)

    Boman, Ase; Borup, Ina; Povlsen, Lene; Dahlborg-Lyckhage, Elisabeth

    2012-06-01

    The incidence of diabetes type 1 in children, the most common metabolic disorder in childhood, increases worldwide, with highest incidence in Scandinavia. Having diabetes means demands in everyday life, and the outcome of the child's treatment highly depends on parents' engagement and involvement. The aim of this study was to explore and describe discourses in health care guidelines for children with diabetes type 1, in Sweden, Norway and Denmark during 2007-2010, with a focus on how parents were positioned. As method a Foucauldian approach to discourse analysis was applied, and a six-stage model was used to perform the analysis. The findings shows a Medical, a Pedagogic and a Public Health discourse embedded in the hegemonic Expert discourse. The Expert discourse positioned parents as dependent on expert knowledge, as recipients of education, as valuable and responsible for their child's health through practicing medical skills. This positioning may place parents on a continuum from being deprived of their own initiatives to being invited to take an active part and could result in feelings of guilt and uncertainty, but also of security and significance. From this study we conclude that guidelines rooted in the Expert discourse may reduce opportunities for parents' voices to be heard and may overlook their knowledge. By broadening the selection of authors of the guidelines to include patients and all professionals in the team, new discourses could emerge and the parents' voice might be more prominent. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.

  18. Levels and Patterns of Objectively Assessed Physical Activity and Compliance with Different Public Health Guidelines in University Students

    Science.gov (United States)

    Arias-Palencia, Natalia María; Solera-Martínez, Monserrat; Gracia-Marco, Luis; Silva, Pedro; Martínez-Vizcaíno, Vicente; Cañete-García-Prieto, Jorge; Sánchez-López, Mairena

    2015-01-01

    Background Physical activity (PA) is associated with health enhancement. The aim of this study was to assess: 1) levels and patterns of PA in university students by using accelerometers; and 2) the percentage of fulfilment of PA recommendations for adults, according to different public health guidelines. Methods Observational cross-sectional study (Cuenca’s Adults Study) involving 296 (206 women) healthy Spanish university students aged 18–25 years old. Participants wore the ActiGraph GT1M accelerometer for seven consecutive days. Total PA, steps and time spent in sedentary time, light, moderate, vigorous, and moderate to vigorous PA (MVPA) was assessed, and the prevalence of sufficient PA was calculated according to various public health guidelines. Results No sex differences in total PA were found. University students were more sedentary during weekend days than weekdays (pstudents met the recommendation of 150 min/week of MVPA or 75 min/week of vigorous PA, in PA bouts of at least 10 min. using the same definition, but on five or more days a week, only 0.5% students were found to meet the recommendation. In addition, only 0.5% of students met the recommendation of 30 min/day of MVPA, at least five days a week and in bouts of at least 10 min. Finally, 28.1% of the students met the recommendation of 10,000 steps/day. Conclusions Our study shows a high incidence of sedentary time in university students. The number of students meeting PA recommendations significantly differed depending on the recommendation proposed. Specific strategies to promote PA in this population are necessary as well as an agreement as to which PA guidelines should be used. PMID:26536605

  19. Simulation as an ethical imperative and epistemic responsibility for the implementation of medical guidelines in health care.

    Science.gov (United States)

    Garbayo, Luciana; Stahl, James

    2017-03-01

    Guidelines orient best practices in medicine, yet, in health care, many real world constraints limit their optimal realization. Since guideline implementation problems are not systematically anticipated, they will be discovered only post facto, in a learning curve period, while the already implemented guideline is tweaked, debugged and adapted. This learning process comes with costs to human health and quality of life. Despite such predictable hazard, the study and modeling of medical guideline implementation is still seldom pursued. In this article we argue that to systematically identify, predict and prevent medical guideline implementation errors is both an epistemic responsibility and an ethical imperative in health care, in order to properly provide beneficence, minimize or avoid harm, show respect for persons, and administer justice. Furthermore, we suggest that implementation knowledge is best achieved technically by providing simulation modeling studies to anticipate the realization of medical guidelines, in multiple contexts, with system and scenario analysis, in its alignment with the emerging field of implementation science and in recognition of learning health systems. It follows from both claims that it is an ethical imperative and an epistemic responsibility to simulate medical guidelines in context to minimize (avoidable) harm in health care, before guideline implementation.

  20. Determining the efficacy of national strategies aimed at addressing the challenges facing health personnel working in rural areas in KwaZulu-Natal, South Africa.

    Science.gov (United States)

    Mburu, Grace; George, Gavin

    2017-07-31

    Shortages of Human Resources for Health (HRH) in rural areas are often driven by poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities amongst others. The South African government has adopted a human resource strategy for the health sector in 2011 aimed at addressing these challenges. This study reviews the challenges faced by health personnel against government strategies aimed at attracting and retaining health personnel in these underserved areas. The study was conducted in six primary health care service sites in the Hlabisa sub-district of Umkhanyakude, located in northern KwaZulu-Natal, South Africa. The study population comprised 25 health workers including 11 professional nurses, 4 staff nurses and 10 doctors (4 medical doctors, 3 foreign medical doctors and 3 doctors undertaking community service). Qualitative data were collected from semi-structured interviews and analysed using thematic analysis. Government initiatives including the rural allowance, deployment of foreign medical doctors and the presence of health personnel undertaking their community service in rural areas are positively viewed by health personnel working in rural health facilities. However, poor living and working conditions, together with inadequate personal development opportunities, remain unresolved challenges. It is these challenges that will continue to dissuade experienced health personnel from remaining in these underserved areas. South Africa's HRH strategy for the Health Sector 2012/13-2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised.

  1. Adopting and implementing nutrition guidelines in recreational facilities: tensions between public health and corporate profitability.

    Science.gov (United States)

    Olstad, Dana Lee; Raine, Kim D; McCargar, Linda J

    2013-05-01

    Little is known about how public entities can partner with industry to achieve public health goals. We investigated industry's perspective of factors that influenced their adoption and implementation of voluntary, government-issued nutrition guidelines (Alberta Nutrition Guidelines for Children and Youth, ANGCY) in recreational facilities. In-depth semi-structured interviews were conducted. Data were analysed using directed content analysis. Food services in recreational facilities. Seven managers from industry participated; five from companies that had adopted and implemented the ANGCY (adopters) in recreational facilities and two from companies that had not (non-adopters). Industry views nutrition guidelines through the lens of profitability. Non-adopters were unwilling to implement the ANGCY for fear of sacrificing short-term profitability, whereas adopters adhered to them in an attempt to position themselves for long-term profitability. Adopters faced barriers including few resources, no training, complex guidelines, low availability of and demand for ANGCY-compliant products, competitive pressures and substantial declines in revenue. Managers believed widespread voluntary adoption of the ANGCY was unlikely without government incentives and/or a mandate, as the environmental context for voluntary action was poor. All managers supported government-mandated implementation of the ANGCY to level the playing field upon which companies compete. Public-private partnerships in recreational facilities can embrace public health goals in the short term, provided industry perceives potential for long-term financial gain. Widespread uptake of voluntary nutrition guidelines in this setting is unlikely, however, as market mechanisms do not encourage industry to sell and promote healthier options. Government legislation may therefore be warranted.

  2. Development of mental health first aid guidelines for panic attacks: a Delphi study

    Directory of Open Access Journals (Sweden)

    Jorm Anthony F

    2009-08-01

    Full Text Available Abstract Background Panic attacks are common, and while they are not life-threatening events, they can lead to the development of panic disorder and agoraphobia. Appropriate help at the time that a panic attack occurs may decrease the fear associated with the attack and reduce the risk of developing an anxiety disorder. However, few people have the knowledge and skills required to assist. Simple first aid guidelines may help members of the public to offer help to people who experience panic attacks. Methods The Delphi method was used to reach consensus in a panel of experts. Experts included 50 professionals and 6 people who had experience of panic attacks and were active in mental health advocacy. Statements about how to assist someone who is having a panic attack were sourced through a systematic search of both professional and lay literature. These statements were rated for importance as first aid guidelines by the expert and consumer panels and guidelines were written using the items most consistently endorsed. Results Of 144 statements presented to the panels, 27 were accepted. These statements were used to develop the guidelines appended to this paper. Conclusion There are a number of actions which are considered to be useful for members of the public to do if they encounter someone who is having a panic attack. These guidelines will be useful in revision of curricula of mental health first aid programs. They can also be used by members of the public who want immediate information about how to assist someone who is experiencing panic attacks.

  3. Clinical practice guidelines in complementary and alternative medicine. An analysis of opportunities and obstacles. Practice and Policy Guidelines Panel, National Institutes of Health Office of Alternative Medicine.

    Science.gov (United States)

    1997-01-01

    An estimated 1 of 3 Americans uses some form of complementary and alternative medicine (CAM), such as acupuncture, homeopathy, or herbal medicine. In 1995, the National Institutes of Health Office of Alternative Medicine convened an expert panel to examine the role of clinical practice guidelines in CAM. The panel concluded that CAM practices currently are unsuitable for the development of evidence-based practice guidelines, in part because of the lack of relevant outcomes data from well-designed clinical trials. Moreover, the notions of standardization and appropriateness, inherent in guideline development, face challenging methodologic problems when applied to CAM, which considers many different treatment practices appropriate and encourages highly individualized care. Due to different belief systems and divergent theories about the nature of health and illness, CAM disciplines have fundamental differences in how they define target conditions, causes of disease, interventions, and outcome measures of effectiveness. These differences are even more striking when compared with those used by Western medicine. The panel made a series of recommendations on strategies to strengthen the evidence base for future guideline development in CAM and to meet better the current information needs of clinicians, patients, and guideline developers who seek information about CAM treatments.

  4. Clinical Guidelines for Management of Bone Health in Rett Syndrome Based on Expert Consensus and Available Evidence

    DEFF Research Database (Denmark)

    Jefferson, Amanda; Leonard, Helen; Siafarikas, Aris

    2016-01-01

    OBJECTIVES: We developed clinical guidelines for the management of bone health in Rett syndrome through evidence review and the consensus of an expert panel of clinicians. METHODS: An initial guidelines draft was created which included statements based upon literature review and 11 open-ended que...

  5. Guideline of guidelines: asymptomatic microscopic haematuria.

    Science.gov (United States)

    Linder, Brian J; Bass, Edward J; Mostafid, Hugh; Boorjian, Stephen A

    2018-02-01

    The aim of the present study was to review major organizational guidelines on the evaluation and management of asymptomatic microscopic haematuria (AMH). We reviewed the haematuria guidelines from: the American Urological Association; the consensus statement by the Canadian Urological Association, Canadian Urologic Oncology Group and Bladder Cancer Canada; the American College of Physicians; the Joint Consensus Statement of the Renal Association and British Association of Urological Surgeons; and the National Institute for Health and Care Excellence. All guidelines reviewed recommend evaluation for AMH in the absence of potential benign aetiologies, with the evaluation including cystoscopy and upper urinary tract imaging. Existing guidelines vary in their definition of AMH (role of urine dipstick vs urine microscopy), the age threshold for recommending evaluation, and the optimal imaging method (computed tomography vs ultrasonography). Of the reviewed guidelines, none recommended the use of urine cytology or urine markers during the initial AMH evaluation. Patients should have ongoing follow-up after a negative initial AMH evaluation. Significant variation exists among current guidelines for AMH with respect to who should be evaluated and in what manner. Given the patient and health system implications of balancing appropriately focused and effective diagnostic evaluation, AMH represents a valuable future research opportunity. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

  6. Direct costs of dengue hospitalization in Brazil: public and private health care systems and use of WHO guidelines.

    Science.gov (United States)

    Vieira Machado, Alessandra A; Estevan, Anderson Oliveira; Sales, Antonio; Brabes, Kelly Cristina da Silva; Croda, Júlio; Negrão, Fábio Juliano

    2014-09-01

    Dengue, an arboviral disease, is a public health problem in tropical and subtropical regions worldwide. In Brazil, epidemics have become increasingly important, with increases in the number of hospitalizations and the costs associated with the disease. This study aimed to describe the direct costs of hospitalized dengue cases, the financial impact of admissions and the use of blood products where current protocols for disease management were not followed. To analyze the direct costs of dengue illness and platelet transfusion in Brazil based on the World Health Organization (WHO) guidelines, we conducted a retrospective cross-sectional census study on hospitalized dengue patients in the public and private Brazilian health systems in Dourados City, Mato Grosso do Sul State, Brazil. The analysis involved cases that occurred from January through December during the 2010 outbreak. In total, we examined 8,226 mandatorily reported suspected dengue cases involving 507 hospitalized patients. The final sample comprised 288 laboratory-confirmed dengue patients, who accounted for 56.8% of all hospitalized cases. The overall cost of the hospitalized dengue cases was US $210,084.30, in 2010, which corresponded to 2.5% of the gross domestic product per capita in Dourados that year. In 35.2% of cases, blood products were used in patients who did not meet the blood transfusion criteria. The overall median hospitalization cost was higher (p = 0.002) in the group that received blood products (US $1,622.40) compared with the group that did not receive blood products (US $550.20). The comparative costs between the public and the private health systems show that both the hospitalization of and platelet transfusion in patients who do not meet the WHO and Brazilian dengue guidelines increase the direct costs, but not the quality, of health care.

  7. Determining the efficacy of national strategies aimed at addressing the challenges facing health personnel working in rural areas in KwaZulu-Natal, South Africa

    Directory of Open Access Journals (Sweden)

    Grace Mburu

    2017-07-01

    Conclusion: South Africa’s HRH strategy for the Health Sector 2012/13–2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised.

  8. The World Health Organization-United Nations Population Fund Strategic Partnership Programme's implementation of family planning guidelines and tools in Asia-Pacific countries.

    Science.gov (United States)

    Mody, Sheila K; Ba-Thike, Katherine; Gaffield, Mary E

    2013-04-01

    The aim of this study was to assess the impact of the Strategic Partnership Programme, a collaboration between the World Health Organization and the United Nations Population Fund to improve evidence-based guidance for country programs through the introduction of selected practice guidelines to improve sexual and reproductive health. Information for this report is from questionnaires sent to Ministries of Health in 2004 (baseline assessment) and in 2007 (assessment of outcome), annual country reports and personal communication with focal points from Ministries of Health and World Health Organization regional and country offices. Following the Strategic Partnership Programme, family planning guidance was used extensively to: formulate and update reproductive health policy; update standards and guidelines; improve training curricula; conduct training activities; develop advocacy and communication materials; and promote change in service. The Strategic Partnership Programme was successful in promoting the introduction of evidence-based guidelines for reproductive health in several Asian countries. The countries that adapted the family planning guidance observed an increase in demand for contraceptives commodities. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

  9. The diagnostic work up of growth failure in secondary health care; An evaluation of consensus guidelines

    Directory of Open Access Journals (Sweden)

    Dekker Friedo W

    2008-05-01

    Full Text Available Abstract Background As abnormal growth might be the first manifestation of undetected diseases, it is important to have accurate referral criteria and a proper diagnostic work-up. In the present paper we evaluate the diagnostic work-up in secondary health care according to existing consensus guidelines and study the frequency of underlying medical disorders. Methods Data on growth and additional diagnostic procedures were collected from medical records of new patients referred for short stature to the outpatient clinics of the general paediatric departments of two hospitals (Erasmus MC – Sophia Children's Hospital, Rotterdam and Spaarne Hospital, Haarlem between January 1998 and December 2002. As the Dutch Consensus Guideline (DCG is the only guideline addressing referral criteria as well as diagnostic work-up, the analyses were based on its seven auxological referral criteria to determine the characteristics of children who are incorrectly referred and the adequacy of workup of those who are referred. Results Twenty four percent of children older than 3 years were inappropriately referred (NCR. Of the correctly referred children 74–88% were short corrected for parental height, 40–61% had a height SDS Conclusion Existing guidelines for workup of children with suspected growth failure are poorly implemented. Although poorly implemented the DCG detects at least 5% pathologic causes of growth failure in children referred for short stature. New guidelines for referral are required with a better sensitivity and specificity, wherein distance to target height should get more attention. The general diagnostic work up for short stature should include testing for celiac disease in all children and for Turner syndrome in girls.

  10. Public health guidelines for physical activity: is there an app for that? A review of android and apple app stores.

    Science.gov (United States)

    Knight, Emily; Stuckey, Melanie I; Prapavessis, Harry; Petrella, Robert J

    2015-05-21

    Physical activity participation is an important behavior for modifying lifestyle-related disease risk. Mobile health apps for chronic disease management and prevention are being developed at a rapid rate. However, it is unclear whether these apps are evidence-based. Current public health recommendations for physical activity participation for adults highlight the importance of engaging in 150 minutes weekly of purposeful exercise, and muscle strengthening activities on at least 2 days of the week. The aims of the present review were to (1) identify available evidence-based physical activity apps, and (2) identify technological features that could be leveraged to improve health outcomes. iTunes and Google Play mobile app stores were searched using keyword and category searching during a single day (February 18, 2014) for physical activity apps available in English. The description pages of eligible apps were reviewed by 4 independent reviewers for evidence-based content, technological, and descriptive features. An a priori subset of apps was downloaded for further review (n=6 affiliated with a non-commercial agency; n=10 top rated; n=10 random selection), and developers were contacted for information regarding evidence-informed content. The initial search yielded 2400 apps, of which 379 apps (n=206 iTunes; n=173 Google Play) were eligible. Primary results demonstrated no apps (n=0) adhering to evidence-based guidelines for aerobic physical activity, and 7 out of 379 implementing evidence-based guidelines for resistance training physical activity. Technological features of apps included social networking (n=207), pairing with a peripheral health device (n=61), and measuring additional health parameters (n=139). Secondary results revealed 1 app that referenced physical activity guidelines (150 minutes/weekly of exercise), and demonstrated that apps were based on various physical activity reports (n=4) or personal expertise (n=2). The present study demonstrated a

  11. GRADE Equity Guidelines 3

    DEFF Research Database (Denmark)

    Welch, Vivian A; Akl, Elie A; Pottie, Kevin

    2017-01-01

    OBJECTIVE: The aim of this paper is to describe a conceptual framework for how to consider health equity in the GRADE (Grading Recommendations Assessment and Development Evidence) guideline development process. STUDY DESIGN AND SETTING: Consensus-based guidance developed by the GRADE working grou...

  12. Setting Priorities in Global Child Health Research Investments: Guidelines for Implementation of the CHNRI Method

    Science.gov (United States)

    Rudan, Igor; Gibson, Jennifer L.; Ameratunga, Shanthi; El Arifeen, Shams; Bhutta, Zulfiqar A.; Black, Maureen; Black, Robert E.; Brown, Kenneth H.; Campbell, Harry; Carneiro, Ilona; Chan, Kit Yee; Chandramohan, Daniel; Chopra, Mickey; Cousens, Simon; Darmstadt, Gary L.; Gardner, Julie Meeks; Hess, Sonja Y.; Hyder, Adnan A.; Kapiriri, Lydia; Kosek, Margaret; Lanata, Claudio F.; Lansang, Mary Ann; Lawn, Joy; Tomlinson, Mark; Tsai, Alexander C.; Webster, Jayne

    2008-01-01

    This article provides detailed guidelines for the implementation of systematic method for setting priorities in health research investments that was recently developed by Child Health and Nutrition Research Initiative (CHNRI). The target audience for the proposed method are international agencies, large research funding donors, and national governments and policy-makers. The process has the following steps: (i) selecting the managers of the process; (ii) specifying the context and risk management preferences; (iii) discussing criteria for setting health research priorities; (iv) choosing a limited set of the most useful and important criteria; (v) developing means to assess the likelihood that proposed health research options will satisfy the selected criteria; (vi) systematic listing of a large number of proposed health research options; (vii) pre-scoring check of all competing health research options; (viii) scoring of health research options using the chosen set of criteria; (ix) calculating intermediate scores for each health research option; (x) obtaining further input from the stakeholders; (xi) adjusting intermediate scores taking into account the values of stakeholders; (xii) calculating overall priority scores and assigning ranks; (xiii) performing an analysis of agreement between the scorers; (xiv) linking computed research priority scores with investment decisions; (xv) feedback and revision. The CHNRI method is a flexible process that enables prioritizing health research investments at any level: institutional, regional, national, international, or global. PMID:19090596

  13. Pilot Study for Managing Complex Chronic Care Medicaid Patients With Diabetes Using a Mobile Health Application Achieves "Triple Aim" Improvement in a Primary Care Setting.

    Science.gov (United States)

    Bovbjerg, Marit L; Lee, Jenney; Wolff, Rosa; Bangs, Bobby; May, Michael A

    2017-10-01

    IN BRIEF Cost-effective innovations to improve health and health care in patients with complex chronic diseases are urgently needed. Mobile health (mHealth) remote monitoring applications (apps) are a promising technology to meet this need. This article reports on a study evaluating patients' use of a tablet device with an mHealth app and a cellular-enabled glucose meter that automatically uploaded blood glucose values to the app. Improvements were observed across all three components of the Patient Protection and Affordable Care Act's "triple aim." Self-rated wellness and numerous quality-of-care metrics improved, billed charges and paid claims decreased, but no changes in clinical endpoints were observed.

  14. World Health organization guidelines for management of acute stress, PTSD, and bereavement: key challenges on the road ahead.

    Science.gov (United States)

    Tol, Wietse A; Barbui, Corrado; Bisson, Jonathan; Cohen, Judith; Hijazi, Zeinab; Jones, Lynne; de Jong, Joop T V M; Magrini, Nicola; Omigbodun, Olayinka; Seedat, Soraya; Silove, Derrick; Souza, Renato; Sumathipala, Athula; Vijayakumar, Lakshmi; Weissbecker, Inka; Zatzick, Douglas; van Ommeren, Mark

    2014-12-01

    Wietse Tol and colleagues discuss some of the key challenges for implementation of new WHO guidelines for stress-related mental health disorders in low- and middle-income countries. Please see later in the article for the Editors' Summary.

  15. Prevention program at construction worksites aimed at improving health and work ability is cost-saving to the employer: Results from an RCT

    NARCIS (Netherlands)

    Oude Hengel, K.M.; Bosmans, J.E.; Dongen, J.M. van; Bongers, P.M.; Beek, A.J. van der; Blatter, B.M.

    2014-01-01

    Background: To prolong sustainable healthy working lives of construction workers, a prevention program was developed which aimed to improve the health and work ability of construction workers. The objective of this study was to analyze the cost-effectiveness and financial return from the employers'

  16. Systematic review on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity

    NARCIS (Netherlands)

    Dongen, J.M. van; Proper, K.I.; Wier, M.F. van; Beek, A.J. van der; Bongers, P.M.; Mechelen, W. van; Tulder, M.W. van

    2011-01-01

    Summary: This systematic review summarizes the current evidence on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity. Data on study characteristics and results were extracted from 18 studies published up to 14 January 2011.

  17. Global Imaging referral guidelines

    International Nuclear Information System (INIS)

    Kawooya, M.; Perez, M.; Lau, L.; Reeed, M.

    2010-01-01

    The medical imaging specialists called for global referral guidelines which would be made available to referring doctors. These referral guidelines should be:- Applicable in different health care settings, including resource-poor settings; Inclusive in terms of the range of clinical conditions; User-friendly and accessible (format/media); Acceptable to stakeholders, in particular to the referrers as the main target audience. To conceive evidence-based medicine as an integration of best research evidence with clinical expertise and patient values. The Direct recipients of the Referral Guidelines would be:- Referrers: general practitioners / family doctors; paediatricians; emergency department doctors; other specialists and health workers. Providers (medical imaging practitioners): radiologists; nuclear medicine physicians; radiographers; other appropriately qualified practitioners providing diagnostic imaging services. For the Referral Guidelines to be effective there need to be: Credibility evidence-based Practicality end user involvement Context local resources, disease profiles Endorsement, opinion leaders Implementation- policy, education, CPOE - Monitoring of the use clinical audit, report feedback. The aim of the Referral Guidelines Project was to: Produce global referral guidelines that are evidence-based, cost effective and appropriate for the local setting, and include consideration of available equipment and expertise (RGWG; SIGs); Include supporting information about radiation doses, potential risks, protection of children and pregnant women (introductory chapter); Facilitate the implementation of the guidelines through guidance and tools (e.g. implementation guides, checklists, capacity building tools, guides on stakeholders engagement, audit support criteria); Conduct pilot testing in different clinical settings from each of the six WHO regions; Promote the inclusion of the referral guidelines in the curricula of medical schools; Develop and implement

  18. Guidelines for eHealth and social media in sexual health promotion for young ethnic minorities

    NARCIS (Netherlands)

    Kulyk, Olga Anatoliyivna; den Daas, C.; Boom, C.; David, S.; van Gemert-Pijnen, Julia E.W.C.

    2014-01-01

    Introduction: Recently a rapid growth of modern technologies addressing sexuality and health has taken place. Young ethnic minorities could especially benefit from these eHealth initiatives, but they have to meet their specific needs. Sexual health is a sensitive subject in many cultures and eHealth

  19. Long-term effects of an occupational health guideline on employees' body weight-related outcomes, cardiovascular disease risk factors, and quality of life: Results from a randomized controlled trial

    NARCIS (Netherlands)

    Verweij, L.M.; Proper, K.I.; Weel, A.N.H.; Hulshof, C.T.J.; Mechelen, W. van

    2013-01-01

    Objective This study aims to evaluate the effectiveness of a draft occupational health guideline, aimed at preventing weight gain, on employees' body weight-related outcomes, cardiovascular disease (CVD) risk factors, and quality of life. Methods In a cluster randomized controlled trial including 16

  20. Implementing tobacco use treatment guidelines in public health dental clinics in New York City.

    Science.gov (United States)

    Shelley, Donna; Anno, Jaime; Tseng, Tuo-Yen; Calip, Greg; Wedeles, John; Lloyd, Madeleine; Wolff, Mark S

    2011-04-01

    In this study we evaluated the effect of a multicomponent intervention to implement the Public Health Service (PHS) guideline Treating Tobacco Use and Dependence in six randomly selected dental clinics in New York University's College of Dentistry. The main outcome measure-provider adherence to tobacco use treatment guidelines-was assessed by auditing a random selection of patient charts pre (698) and post (641) intervention. The intervention components included a chart reminder and referral system, free nicotine replacement therapy (NRT), and provider training and feedback. The results showed that rates of screening for tobacco use did not change between pre and post test chart audits. However, providers were significantly more likely to offer advice (28.4 percent pre, 49 percent post), assess readiness to quit (17.8 percent pre, 29.9 percent post), and offer assistance (6.5 percent pre and 15.6 percent post) in the post test period. Increases in NRT distribution were associated with booster training sessions but declined in the time periods between those trainings. Research is needed to further define sustainable strategies for implementing tobacco use treatment in dental clinics. The results of this study suggest the feasibility and effectiveness of using a tailored multicomponent approach to implement tobacco use treatment guidelines in dental clinics.

  1. [Guidelines for the prevention and control of tuberculosis in health care workers].

    Science.gov (United States)

    Casas, Irma; Dominguez, Jose; Rodríguez, Soledad; Matllo, Joan; Altet, Neus

    2015-12-21

    Tuberculosis remains one of the communicable diseases that cause increased morbidity and mortality worldwide. With an incidence rate of 13,04 per 100,000 population, Spain ranks third among the most affected European countries. These data show a tendency to decrease meaning that it may go unnoticed with the potential to miss the appropriate preventive measures in a suspected case. In centers where patients are treated with tuberculosis, health care worker presents risk of transmission. This risk is higher in some areas or work units. The Occupational health physicians' services, which monitorize the health of health care workers, use different strategies in order to prevent and detect tuberculosis infection. The national guidelines include the tuberculin skin test as a screening test for tuberculosis infection with mention of new diagnostic tests based on the in vitro detection of gamma interferon (IGRA) for certain cases. The purpose of this guide is to establish common criteria for IGRA tests, as a supplementary aid to the tuberculin skin test in health care workers, from the evidence available today. Recommendations for its use have been adapted to the different situations faced by the professionals involved in monitoring the health of health workers. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  2. Development of mental health first aid guidelines for suicidal ideation and behaviour: A Delphi study

    Directory of Open Access Journals (Sweden)

    Kitchener Betty A

    2008-03-01

    Full Text Available Abstract Background Suicide is a statistically rare event, but devastating to those left behind and one of the worst possible outcomes associated with mental illness. Although a friend, family member or co-worker may be the first person to notice that a person is highly distressed, few have the knowledge and skills required to assist. Simple guidelines may help such a person to encourage a suicidal individual to seek professional help or decide against suicide. Methods This research was conducted using the Delphi methodology, a method of reaching consensus in a panel of experts. Experts recruited to the panels included 22 professionals, 10 people who had been suicidal in the past and 6 carers of people who had been suicidal in the past. Statements about how to assist someone who is thinking about suicide were sourced through a systematic search of both professional and lay literature. The guidelines were written using the items most consistently endorsed by all three panels. Results Of 114 statements presented to the panels, 30 were accepted. These statements were used to develop the guidelines appended to this paper. Conclusion There are a number of actions which are considered to be useful for members of the public when they encounter someone who is experiencing suicidal thoughts or engaging in suicidal behaviour. These guidelines will be useful in revision of curricula of mental health first aid and suicide intervention training programs. They can also be used by members of the public who want immediate information about how to assist a suicidal person.

  3. Multi-level barriers analysis to promote guideline based nursing care: a leadership strategy from home health care.

    Science.gov (United States)

    Gifford, Wendy A; Graham, Ian D; Davies, Barbara L

    2013-07-01

    Understanding the types of barriers that exist when implementing change can assist healthcare managers to tailor implementation strategies for optimal patient outcomes. The aim of this paper is to present an organising framework, the Barriers Assessment Taxonomy, for understanding barriers to nurses' use of clinical practice guideline recommendations. Barriers to recommendations are illustrated using the Barriers Assessment Taxonomy and insights discussed. As part of a pilot implementation study, semi-structured interviews (n = 26) were conducted to understand barriers to nurses' use of nine guideline recommendations for diabetic foot ulcers. Content analysis of verbatim transcripts included thematic coding and categorising barriers using the Barriers Assessment Taxonomy. Nineteen barriers were associated with nine recommendations, crossing five levels of the health care delivery system. The Barriers Assessment Taxonomy revealed that all recommendations had individual and organisational level barriers, with one recommendation having barriers at all levels. Individual level barriers were most frequent and lack of knowledge and skills was the only barrier that crossed all recommendations. The Barriers Assessment Taxonomy provides a framework for nursing managers to understand the complexity of barriers that exist, and can assist in choosing intervention strategies to support improved quality care and patient outcomes. © 2013 John Wiley & Sons Ltd.

  4. Difficulties implementing a mental health guideline: an exploratory investigation using psychological theory

    Directory of Open Access Journals (Sweden)

    Eccles Martin P

    2007-03-01

    Full Text Available Abstract Background Evaluations of interventions to improve implementation of guidelines have failed to produce a clear pattern of results favouring a particular method. While implementation depends on clinicians and managers changing a variety of behaviours, psychological theories of behaviour and behaviour change are seldom used to try to understand difficulties in implementation or to develop interventions to overcome them. Objectives This study applied psychological theory to examine explanations for difficulties in implementation. It used a theoretical framework derived from an interdisciplinary consensus exercise to code interviews across 11 theoretical domains. The focus of the study was a National Institute for Health and Clinical Excellence's Schizophrenia guideline recommendation that family intervention should be offered to the families of people with schizophrenia. Methods Participants were recruited from community mental health teams from three United Kingdom National Health Service (NHS Trusts; 20 members (social workers, nurses, team managers, psychologists, and psychiatrists participated. Semi-structured interviews were audio-taped and transcribed. Interview questions were based on the theoretical domains and addressed respondents' knowledge, attitudes and opinions regarding the guideline. Two researchers independently coded the transcript segments from each interview that were related to each theoretical domain. A score of 1 indicated that the transcript segments relating to the domain did not appear to contain description of difficulties in implementation of the family therapy guidelines; similarly a score of 0.5 indicated possible difficulties and a score of 0 indicated definite difficulties. Results Coding respondents' answers to questions related to the three domains 'beliefs about consequences,' 'social/professional role and identity,' and 'motivation' produced the three highest total scores indicating that factors relating

  5. VIP in construction: systematic development and evaluation of a multifaceted health programme aiming to improve physical activity levels and dietary patterns among construction workers

    Directory of Open Access Journals (Sweden)

    Viester Laura

    2012-01-01

    Full Text Available Abstract Background The prevalence of both overweight and musculoskeletal disorders (MSD in the construction industry is high. Many interventions in the occupational setting aim at the prevention and reduction of these health problems, but it is still unclear how these programmes should be designed. To determine the effectiveness of interventions on these health outcomes randomised controlled trials (RCTs are needed. The aim of this study is to systematically develop a tailored intervention for prevention and reduction of overweight and MSD among construction workers and to describe the evaluation study regarding its (cost-effectiveness. Methods/Design The Intervention Mapping (IM protocol was applied to develop and implement a tailored programme aimed at the prevention and reduction of overweight and MSD. The (cost- effectiveness of the intervention programme will be evaluated using an RCT. Furthermore, a process evaluation will be conducted. The research population will consist of blue collar workers of a large construction company in the Netherlands. Intervention The intervention programme will be aimed at improving (vigorous physical activity levels and healthy dietary behaviour and will consist of tailored information, face-to-face and telephone counselling, training instruction (a fitness "card" to be used for exercises, and materials designed for the intervention (overview of the company health promoting facilities, waist circumference measuring tape, pedometer, BMI card, calorie guide, recipes, and knowledge test. Main study parameters/endpoints The intervention effect on body weight and waist circumference (primary outcome measures, as well as on lifestyle behaviour, MSD, fitness, CVD risk indicators, and work-related outcomes (i.e. productivity, sick leave (secondary outcome measures will be assessed. Discussion The development of the VIP in construction intervention led to a health programme tailored to the needs of construction

  6. Patient attributes warranting consideration in clinical practice guidelines, health workforce planning and policy

    Directory of Open Access Journals (Sweden)

    Segal Leonie

    2011-09-01

    Full Text Available Abstract Background In order for clinical practice guidelines (CPGs to meet their broad objective of enhancing the quality of care and supporting improved patient outcomes, they must address the needs of diverse patient populations. We set out to explore the patient attributes that are likely to demand a unique approach to the management of chronic disease, and which are crucial if evidence or services planning is to reflect clinic populations. These were incorporated into a new conceptual framework; using diabetes mellitus as an exemplar. Methods The patient attributes that informed the framework were identified from CPGs, the diabetes literature, an expert academic panel, and two cross-disciplinary panels; and agreed upon using a modified nominal group technique. Results Full consensus was reached on twenty-four attributes. These factors fell into one of three themes: (1 type/stage of disease, (2 morbid events, and (3 factors impacting on capacity to self-care. These three themes were incorporated in a convenient way in the workforce evidence-based (WEB model. Conclusions While biomedical factors are frequently recognised in published clinical practice guidelines, little attention is given to attributes influencing a person's capacity to self-care. Paying explicit attention to predictable threats to effective self-care in clinical practice guidelines, by drawing on the WEB model, may assist in refinements that would address observed disparities in health outcomes across socio-economic groups. The WEB model also provides a framework to inform clinical training, and health services and workforce planning and research; including the assessment of healthcare needs, and the allocation of healthcare resources.

  7. Weight status, gender, and race/ethnicity: are there differences in meeting recommended health behavior guidelines for adolescents?

    Science.gov (United States)

    Minges, Karl E; Chao, Ariana; Nam, Soohyun; Grey, Margaret; Whittemore, Robin

    2015-04-01

    Healthy behaviors including limited screen time (ST), high physical activity (PA), and adequate fruits and vegetables consumption (FV) are recommended for adolescents, but it is unclear how gender, race/ethnicity, and weight status relate to these public health guidelines in diverse urban adolescents. Participants (N = 384) were recruited from three public high schools in or near New Haven, Connecticut. Descriptive statistics and logistic regression analyses were conducted. Most adolescents exceeded recommended levels of ST (70.5%) and did not meet guidelines for PA (87.2%) and FV (72.6%). Only 3.5% of the sample met all three guidelines. Boys were more likely to meet guidelines for PA (p differences in meeting ST, PA, or FV guidelines by weight status for the overall sample or when stratified by gender or race/ethnicity. We found alarmingly low levels of healthy behaviors in normal weight and overweight/obese adolescents. © The Author(s) 2014.

  8. Systematic Information to Health-Care Professionals about Vaccination Guidelines Improves Adherence in Patients With Inflammatory Bowel Disease in Anti-TNFα Therapy

    DEFF Research Database (Denmark)

    Christensen, Katrine R; Steenholdt, Casper; Buhl, Sine S

    2015-01-01

    OBJECTIVES: Implementation of guidelines for prevention of infectious diseases during anti-TNFα therapy in patients with inflammatory bowel disease (IBD) is important but difficult. We investigated whether systematic information to health-care professionals about these guidelines improves patient...

  9. Adolescent health, global guidelines versus local realities: the Sub-Saharan Africa experience

    Directory of Open Access Journals (Sweden)

    Nitaya Vajanapoom

    2013-12-01

    Full Text Available As the field of adolescent sexual and reproductive health (ASRH evolves, further discussion and documentation of national policy and aspects of its implementation is needed to ensure effectiveness of interventions. Further research is required to foster beneficial shifts in policy advocacy, including resource allocation, and in the prioritization of adolescent programs in health and education systems, in communities and in workplaces. Adolescents are exposed to diverse interventions across all the countries under discussion; however there exist obstacles to realization of ASRH goals. In some countries, there exist a conflict of interest between national laws and global policy guidelines on ASRH; moreover national laws and policies are ambiguous and inconsistent. In addition, there have been strong negligence of vulnerable groups such as HIV positive adolescents, pregnant street youth; young sex workers; orphans; adolescents in conflict areas; adolescent refugees; adolescent girls working in the informal sectors and very young adolescents, likewise many adolescents in rural areas remain largely underserved. Furthermore there are consistently less disaggregated data available on adolescents’ key indicators for comparative purposes signifying considerable knowledge gaps. There are multiple obstacles to the realization of ASRH and need for research combining both qualitative and quantitative approaches to determine the extent to which factors are either conducive or impeding to consistency between global guidelines, national ASRH policies, and actual policy implementation.

  10. Adolescent Health, Global Guidelines Versus Local Realities: The Sub-Saharan Africa Experience.

    Science.gov (United States)

    Dube, Kudakwashe; Van der Putten, Marc; Vajanapoom, Nitaya

    2013-12-03

    As the field of adolescent sexual and reproductive health (ASRH) evolves, further discussion and documentation of national policy and aspects of its implementation is needed to ensure effectiveness of interventions. Further research is required to foster beneficial shifts in policy advocacy, including resource allocation, and in the prioritization of adolescent programs in health and education systems, in communities and in workplaces. Adolescents are exposed to diverse interventions across all the countries under discussion; however there exist obstacles to realization of ASRH goals. In some countries, there exist a conflict of interest between national laws and global policy guidelines on ASRH; moreover national laws and policies are ambiguous and inconsistent. In addition, there have been strong negligence of vulnerable groups such as HIV positive adolescents, pregnant street youth; young sex workers; orphans; adolescents in conflict areas; adolescent refugees; adolescent girls working in the informal sectors and very young adolescents, likewise many adolescents in rural areas remain largely underserved. Furthermore there are consistently less disaggregated data available on adolescents' key indicators for comparative purposes signifying considerable knowledge gaps. There are multiple obstacles to the realization of ASRH and need for research combining both qualitative and quantitative approaches to determine the extent to which factors are either conducive or impeding to consistency between global guidelines, national ASRH policies, and actual policy implementation.

  11. The effect of an e-learning supported Train-the-Trainer programme on implementation of suicide guidelines in mental health care.

    Science.gov (United States)

    de Beurs, Derek P; de Groot, Marieke H; de Keijser, Jos; Mokkenstorm, Jan; van Duijn, Erik; de Winter, Remco F P; Kerkhof, Ad J F M

    2015-04-01

    Randomized studies examining the effect of training of mental health professionals in suicide prevention guidelines are scarce. We assessed whether professionals benefited from an e-learning supported Train-the-Trainer programme aimed at the application of the Dutch multidisciplinary suicide prevention guideline. 45 psychiatric departments from all over the Netherlands were clustered in pairs and randomized. In the experimental condition, all of the staff of psychiatric departments was trained by peers with an e-learning supported Train-the-Trainer programme. Guideline adherence of individual professionals was measured by means of the response to on-line video fragments. Multilevel analyses were used to establish whether variation between conditions was due to differences between individual professionals or departments. Multilevel analysis showed that the intervention resulted in an improvement of individual professionals. At the 3 month follow-up, professionals who received the intervention showed greater guideline adherence, improved self-perceived knowledge and improved confidence as providers of care than professionals who were only exposed to traditional guideline dissemination. Subgroup analyses showed that improved guideline adherence was found among nurses but not among psychiatrists and psychologists. No significant effect of the intervention on team performance was found. The ICT environment in departments was often technically inadequate when displaying the video clips clip of the survey. This may have caused considerable drop-out and possibly introduced selection bias, as professionals who were strongly affiliated to the theme of the study might have been more likely to finish the study. Our results support the idea that an e-learning supported Train-the-Trainer programme is an effective strategy for implementing clinical guidelines and improving care for suicidal patients. Netherlands Trial Register (NTR3092 www.trialregister.nl). Copyright © 2015 The

  12. Have CONSORT guidelines improved the quality of reporting of randomised controlled trials published in public health dentistry journals?

    Science.gov (United States)

    Savithra, Prakash; Nagesh, Lakshminarayan Shetty

    2013-01-01

    To assess a) whether the quality of reporting of randomised controlled trials (RCTs) has improved since the formulation of the Consolidated Standards of Reporting Trials (CONSORT) statement and b) whether there is any difference in reporting of RCTs between the selected public health dentistry journals. A hand search of the journals of public health dentistry was performed and four journals were identified for the study. They were Community Dentistry and Oral Epidemiology (CDOE), Community Dental Health (CDH), Journal of Public Health Dentistry (JPHD) and Oral Health and Preventive Dentistry (OHPD). A total of 114 RCTs published between 1990 and 2009 were selected. CONSORT guidelines were applied to each selected article in order to assess and determine any improvement since the publication of CONSORT guidelines. The chi-square test was employed to determine any statistical significant difference in quality of reporting of RCTs before and after the publication of the CONSORT guidelines. A comparison was also done to determine any statistically significant difference in quality of reporting of RCTs between the selected journals. Title, abstract, discussion and conclusion sections of the selected articles showed adherence to the CONSORT guidelines, whereas the compliance was poor with respect to the methodology section. The quality of reporting of RCTs is generally poor in public health dentistry journals. Overall, the quality of reporting has not substantially improved since the publication of CONSORT guidelines.

  13. COMPARATIVE ANALYSIS OF MEDICAL EQUIPMENT USED IN DIAGNOSTIC IMAGING IN BULGARIA AND COUNTRIES WORLDWIDE AND OPTIMIZATION AIMED AT IMPROVING THE HEALTH CARE SYSTEM MANAGEMENT

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    Svetoslav Garov

    2016-07-01

    Full Text Available Purpose: to reveal the current condition of medical equipment in Bulgaria related to those major groups of socially significant diseases and to make an attempt to define guidelines for its optimization in view of improving the functioning and management of the healthcare system in this field. Material and methods: The following research methods have been applied: 1. Document review method – research, processing and analysis of medical statistical information taken from data from WHO and annual reports of NRA. The study includes data from 2009 - 2015. 2. Graphical method – summarizing data in relevant tables and diagram presentations. Results: The article analyzes the condition of medical equipment in the field of oncologic and cardiologic medical aid in Bulgaria based on data taken from WHO (World Health Organization and annual reports of NRA (Nuclear Regulatory Agency. Six types of diagnostic imaging and radiation therapy devices have been studied: Magnetic Resonance Imaging units (MRI; Computed Tomography Scanners (CT, Positron Emission Tomography Scanners, Mammographs, Linear accelerators and Telecobalt units (Cobalt-60. The condition of medical equipment since 2009 has been analyzed, results have been reported and trends - studied. Conclusion: The oncologic and cardiologic medical equipment in Bulgaria has been gradually improving in the last seven years, but quantitative indicators regarding the devices studied are still far away from the figures recommended by WHO with one single exception, i.e. Computed Tomography Scanners.

  14. Sistemas de salud mental en El Salvador, Guatemala y Nicaragua: resultados de una evaluación mediante el WHO-AIMS Mental health systems in El Salvador, Guatemala, and Nicaragua: results of a WHO-AIMS evaluation

    OpenAIRE

    Jorge Jacinto Rodríguez; Thomas Barrett; Silvia Narváez; José Miguel Caldas; Itzhak Levav; Shekhar Saxena

    2007-01-01

    Los autores realizaron una evaluación de los sistemas de salud mental en El Salvador, Guatemala y Nicaragua, por medio de un grupo de indicadores seleccionados. Para recopilar la información en los países se utilizó el Instrumento de Evaluación para Sistemas de Salud Mental de la Organización Mundial de la Salud (WHO-AIMS, por su sigla en inglés). Nicaragua, Guatemala y El Salvador tienen serias limitaciones en sus sistemas nacionales de salud mental, en especial en la atención primaria, así ...

  15. Protocol for the development of a CONSORT-equity guideline to improve reporting of health equity in randomized trials.

    Science.gov (United States)

    Welch, Vivian; Jull, J; Petkovic, J; Armstrong, R; Boyer, Y; Cuervo, L G; Edwards, Sjl; Lydiatt, A; Gough, D; Grimshaw, J; Kristjansson, E; Mbuagbaw, L; McGowan, J; Moher, D; Pantoja, T; Petticrew, M; Pottie, K; Rader, T; Shea, B; Taljaard, M; Waters, E; Weijer, C; Wells, G A; White, H; Whitehead, M; Tugwell, P

    2015-10-21

    Health equity concerns the absence of avoidable and unfair differences in health. Randomized controlled trials (RCTs) can provide evidence about the impact of an intervention on health equity for specific disadvantaged populations or in general populations; this is important for equity-focused decision-making. Previous work has identified a lack of adequate reporting guidelines for assessing health equity in RCTs. The objective of this study is to develop guidelines to improve the reporting of health equity considerations in RCTs, as an extension of the Consolidated Standards of Reporting Trials (CONSORT). A six-phase study using integrated knowledge translation governed by a study executive and advisory board will assemble empirical evidence to inform the CONSORT-equity extension. To create the guideline, the following steps are proposed: (1) develop a conceptual framework for identifying "equity-relevant trials," (2) assess empirical evidence regarding reporting of equity-relevant trials, (3) consult with global methods and content experts on how to improve reporting of health equity in RCTs, (4) collect broad feedback and prioritize items needed to improve reporting of health equity in RCTs, (5) establish consensus on the CONSORT-equity extension: the guideline for equity-relevant trials, and (6) broadly disseminate and implement the CONSORT-equity extension. This work will be relevant to a broad range of RCTs addressing questions of effectiveness for strategies to improve practice and policy in the areas of social determinants of health, clinical care, health systems, public health, and international development, where health and/or access to health care is a primary outcome. The outcomes include a reporting guideline (CONSORT-equity extension) for equity-relevant RCTs and a knowledge translation strategy to broadly encourage its uptake and use by journal editors, authors, and funding agencies.

  16. Designing the Health-related Internet of Things: Ethical Principles and Guidelines

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    Brent Mittelstadt

    2017-07-01

    Full Text Available The conjunction of wireless computing, ubiquitous Internet access, and the miniaturisation of sensors have opened the door for technological applications that can monitor health and well-being outside of formal healthcare systems. The health-related Internet of Things (H-IoT increasingly plays a key role in health management by providing real-time tele-monitoring of patients, testing of treatments, actuation of medical devices, and fitness and well-being monitoring. Given its numerous applications and proposed benefits, adoption by medical and social care institutions and consumers may be rapid. However, a host of ethical concerns are also raised that must be addressed. The inherent sensitivity of health-related data being generated and latent risks of Internet-enabled devices pose serious challenges. Users, already in a vulnerable position as patients, face a seemingly impossible task to retain control over their data due to the scale, scope and complexity of systems that create, aggregate, and analyse personal health data. In response, the H-IoT must be designed to be technologically robust and scientifically reliable, while also remaining ethically responsible, trustworthy, and respectful of user rights and interests. To assist developers of the H-IoT, this paper describes nine principles and nine guidelines for ethical design of H-IoT devices and data protocols.

  17. Petro-state constraints on health policy: guidelines for workable reform in Venezuela.

    Science.gov (United States)

    Trujillo, Antonio J

    2004-01-01

    This article reviews the performance of the Venezuelan health care sector and suggests guidelines for workable health policy under difficult conditions. Two special circumstances constrain policy options. First, Venezuelans share a traditional value, solidarity, which includes a strong desire for equity. Reforms must comply with this norm to succeed. Second, foreign sales of state-controlled oil constitute the bulk of the government budget and the gross domestic product (GDP). Petroleum market fluctuations expose the country to extreme economic cycles. In response, policy making and stakeholders adopt a rentier attitude, focusing on preserving or enlarging entitlements to government oil monies. The side effects of this largesse include poor productivity, a weak private sector, a widespread sense of entitlement without accountability, and a crippled state which controls most of the available resources yet is unable to effectively tax, regulate, steer the economy, or pursue long-term policies. The health care sector shares these problems. As a result, Venezuela's health systems are fragmented, poorly coordinated, excessively centralized, inequitable, and ineffective. Policies to improve public health and public and private medical care must take into account these constraints.

  18. Something fishy? News media presentation of complex health issues related to fish consumption guidelines.

    Science.gov (United States)

    Greiner, Amelia; Clegg Smith, Katherine; Guallar, Eliseo

    2010-11-01

    The news media are an important source of dietary information. Understanding news content, particularly the portrayal of risks and benefits of certain foods, is relevant for effective public health communication. Fish consumption may reduce risk for CVD and aid neonatal development, but recent work shows public confusion about the benefits of fish, challenged by the evidence of mercury and other contaminants in fish. We present an analysis of the messages about fish in US news media over 15 years, identifying trends in coverage and highlighting implications of current messaging. We conducted a descriptive text analysis and coded for manifest content: locality of focus, story frame, reference to studies, inclusion of government guidelines and portrayal of uncertainty. We identified chronological patterns and analysed the data for statistically significant relationships between media source and content. News stories were selected from five daily newspapers and five television networks (1993-2007). We analysed 310 health-related news stories on fish. Risk messages outweighed benefit messages four to one, and health benefits only became prominent after 2002. No difference existed in coverage topic by news source. Fish consumption has increasingly become a national issue. With the bulk of messages about fish consumption focused on risk, the benefits may be lost to consumers. This gap creates a need for public health to work with news media to more effectively communicate benefits and risks around fish consumption and health and to consider options for communicating tailored information where it can be more readily utilised.

  19. COMMUNITTY HEALTH II – SUBJECT THAT PROMOTES THE LEARNING- SERVING-COMUNITTY INTERACTION AIMING THE PROMOTION OF HEALTH, CARE AND COMFORT

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    Onã Silva

    2013-09-01

    Full Text Available Introduction: In the context of the teaching and learning process, the communication between the fields of study and their subjects is important, once such integration reflects on the formation and the learning-serving-community triad. This pedagogical basis figures in the syllabi of the subjects Community Health II and its Training Course, offered by the Nursing Program. Objective: Reporting the teaching and learning process for the academic subject Community Health II, as being an inclusive part of learning-serving-community triad, with regards of developing care for the health of individuals, family and community, according to the reports of the experiences of this author during the training course. Methodological Description: It was reported the events dealing with the data experienced by the author over the second term of 2012. The following places were used in that report. In the academic environment and in the training course which took place in one of the administrative regions of Distrito Federal. The pedagogical theoretical basis was made on Paulo Freire. Data were collected from the studied subjects, legislation, theoretical and practical meetings, communication materials on the virtual environment among other sources. Results and discussion: this experience revealed that the subject CH-II presents an interdisciplinary, multiprofessional and inclusive view of learning-serving-community triad. The participants mediated by the problematization contributed for the construction of theoretical and practical knowledge using reflections, debates, and discussions according to the Pedagogy of Autonomy. The teaching and learning methods permitted the development of independence, competencies and abilities contained in the political project. Conclusion: The training course experienced in the environment of CH-II was an unique experience, generating benefits to all the people involved in the process, besides the resignification of their practices

  20. RE-AIM evaluation of the Alcohol and Pregnancy Project: educational resources to inform health professionals about prenatal alcohol exposure and fetal alcohol spectrum disorder.

    Science.gov (United States)

    Payne, Janet M; France, Kathryn E; Henley, Nadine; D'Antoine, Heather A; Bartu, Anne E; O'Leary, Colleen M; Elliott, Elizabeth J; Bower, Carol; Geelhoed, Elizabeth

    2011-03-01

    The objective was to evaluate the Alcohol and Pregnancy Project that provided health professionals in Western Australia (WA) with educational resources to inform them about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder (FASD). The authors developed, produced, and distributed educational resources to 3,348 health professionals in WA. Six months later, they surveyed 1,483 of these health professionals. The authors used the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to evaluate the project. The educational resources were effective in producing a 31% increase in the proportion of health professionals who routinely provided pregnant women with information about the consequences of drinking alcohol during pregnancy. One hundred percent of the settings adopted the project, it reached 96.3% of the target population, it was implemented as intended, and the resources were maintained (http://www.ichr.uwa.edu.au/alcoholandpregnancy). The educational resources for health professionals have potential to contribute to reducing prenatal alcohol exposure and FASD.

  1. Patterns of objectively assessed physical activity and sedentary time: Are Nigerian health professional students complying with public health guidelines?

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    Adewale L Oyeyemi

    Full Text Available Understanding patterns of physical activity and sedentary time is important to effective population-wide primary prevention and control of non-communicable diseases. This study examined the patterns of objectively assessed physical activity and sedentary time, and the prevalence of compliance with physical activity guidelines according to different public health recommendations in a sub-population of health professional students in Nigeria.A cross-sectional study was conducted among 102 health professional students (age = 19-34 years old, 43.1% women of the University of Maiduguri, Nigeria. Participants wore Actigraph accelerometers on their waist for minimum of 5 days/week to objectively measure intensity and duration of physical activity and sedentary time. Prevalence and demographic patterns of physical activity and sedentary time were examined using descriptive and inferential statistics.The students spent most time in sedentary activity (458.6 ± minutes/day, about 61% of daily time and the least in vigorous-intensity activity (2.1 ± 4.4 minutes/day, about 0.3% of daily time. Sedentary time was higher among older than younger students (P<0.038 and among medical laboratory science students than physiotherapy and nursing students (P = 0.046. Total physical activity was higher among nursing and medical students than medical laboratory science students (P = 0.041. Although, 85.3% of the students engaged in 150 minutes/week of moderate-to-vigorous physical activity, only 2.9% met the guideline of 75 minutes/week of vigorous intensity activity.Prevalence of sedentary time was high while that of vigorous-intensity activity was very low among health professional students in Nigeria. Compliance with physical activity guidelines was mainly through accumulation of moderate intensity activity. The results suggest that age and academic programme may influence physical activity level and sedentary behaviour of health professional students in Nigeria

  2. Writing Technical Reports for Simulation in Education for Health Professionals: Suggested Guidelines.

    Science.gov (United States)

    Dubrowski, Adam; Alani, Sabrina; Bankovic, Tina; Crowe, Andrea; Pollard, Megan

    2015-11-02

    Simulation is an important training tool used in a variety of influential fields. However, development of simulation scenarios - the key component of simulation - occurs in isolation; sharing of scenarios is almost non-existent. This can make simulation use a costly task in terms of the resources and time and the possible redundancy of efforts. To alleviate these issues, the goal is to strive for an open communication of practice (CoP) surrounding simulation. To facilitate this goal, this report describes a set of guidelines for writing technical reports about simulation use for educating health professionals. Using an accepted set of guidelines will allow for homogeneity when building simulation scenarios and facilitate open sharing among simulation users. In addition to optimizing simulation efforts in institutions that are currently using simulation as an educational tool, the development of such a repository may have direct implications on developing countries, where simulation is only starting to be used systematically. Our project facilitates equivalent and global access to information, knowledge, and highest-caliber education - in this context, simulation - collectively, the building blocks of optimal healthcare.

  3. Availability, consistency and evidence-base of policies and guidelines on the use of mask and respirator to protect hospital health care workers: a global analysis.

    Science.gov (United States)

    Chughtai, Abrar Ahmad; Seale, Holly; MacIntyre, Chandini Raina

    2013-05-31

    Currently there is an ongoing debate and limited evidence on the use of masks and respirators for the prevention of respiratory infections in health care workers (HCWs). This study aimed to examine available policies and guidelines around the use of masks and respirators in HCWs and to describe areas of consistency between guidelines, as well as gaps in the recommendations, with reference to the WHO and the CDC guidelines. Policies and guidelines related to mask and respirator use for the prevention of influenza, SARS and TB were examined. Guidelines from the World Health Organization (WHO), the Center for Disease Control and Prevention (CDC), three high-income countries and six low/middle-income countries were selected. Uniform recommendations are made by the WHO and the CDC in regards to protecting HCWs against seasonal influenza (a mask for low risk situations and a respirator for high risk situations) and TB (use of a respirator). However, for pandemic influenza and SARS, the WHO recommends mask use in low risk and respirators in high risk situations, whereas, the CDC recommends respirators in both low and high risk situations. Amongst the nine countries reviewed, there are variations in the recommendations for all three diseases. While, some countries align with the WHO recommendations, others align with those made by the CDC. The choice of respirator and the level of filtering ability vary amongst the guidelines and the different diseases. Lastly, none of the policies discuss reuse, extended use or the use of cloth masks. Currently, there are significant variations in the policies and recommendations around mask and respirator use for protection against influenza, SARS and TB. These differences may reflect the scarcity of level-one evidence available to inform policy development. The lack of any guidelines on the use of cloth masks, despite widespread use in many low and middle-income countries, remains a policy gap. Health organizations and countries should

  4. Smartphone Applications for Educating and Helping Non-motivating Patients Adhere to Medication That Treats Mental Health Conditions: Aims and Functioning

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    Angelos P. Kassianos

    2017-10-01

    Full Text Available Background: Patients prescribed with medication that treats mental health conditions benefit the most compared to those prescribed with other types of medication. However, they are also the most difficult to adhere. The development of mobile health (mHealth applications (“apps” to help patients monitor their adherence is fast growing but with limited evidence on their efficacy. There is no evidence on the content of these apps for patients taking psychotropic medication. The aim of this study is to identify and evaluate the aims and functioning of available apps that are aiming to help and educate patients to adhere to medication that treats mental health conditions.Method: Three platform descriptions (Apple, Google, and Microsoft were searched between October 2015 and February 2016. Included apps need to focus on adherence to medication that treats mental health conditions and use at least a reinforcement strategy. Descriptive information was extracted and apps evaluated on a number of assessment criteria using content analysis.Results: Sixteen apps were identified. All apps included self-monitoring properties like reminders and psycho-educational properties like mood logs. It was unclear how the latter were used or how adherence was measured. Major barriers to medication adherence like patients' illness and medication beliefs and attitudes were not considered nor where information to patients about mediation side effects. Very few apps were tailored and none was developed based on established theories explaining the processes for successful medication adherence like cognitions and beliefs. Reported information on app development and validation was poor.Discussion: A variety of apps with different properties that tackle both intentional and unintentional non-adherence from a different perspective are identified. An evidence-based approach and co-creation with patients is needed. This will ensure that the apps increase the possibility to

  5. Smartphone Applications for Educating and Helping Non-motivating Patients Adhere to Medication That Treats Mental Health Conditions: Aims and Functioning.

    Science.gov (United States)

    Kassianos, Angelos P; Georgiou, Giorgos; Papaconstantinou, Electra P; Detzortzi, Angeliki; Horne, Rob

    2017-01-01

    Background: Patients prescribed with medication that treats mental health conditions benefit the most compared to those prescribed with other types of medication. However, they are also the most difficult to adhere. The development of mobile health (mHealth) applications ("apps") to help patients monitor their adherence is fast growing but with limited evidence on their efficacy. There is no evidence on the content of these apps for patients taking psychotropic medication. The aim of this study is to identify and evaluate the aims and functioning of available apps that are aiming to help and educate patients to adhere to medication that treats mental health conditions. Method: Three platform descriptions (Apple, Google, and Microsoft) were searched between October 2015 and February 2016. Included apps need to focus on adherence to medication that treats mental health conditions and use at least a reinforcement strategy. Descriptive information was extracted and apps evaluated on a number of assessment criteria using content analysis. Results: Sixteen apps were identified. All apps included self-monitoring properties like reminders and psycho-educational properties like mood logs. It was unclear how the latter were used or how adherence was measured. Major barriers to medication adherence like patients' illness and medication beliefs and attitudes were not considered nor where information to patients about mediation side effects. Very few apps were tailored and none was developed based on established theories explaining the processes for successful medication adherence like cognitions and beliefs. Reported information on app development and validation was poor. Discussion: A variety of apps with different properties that tackle both intentional and unintentional non-adherence from a different perspective are identified. An evidence-based approach and co-creation with patients is needed. This will ensure that the apps increase the possibility to impact on non

  6. Guidelines for Guidelines: Are They Up to the Task? A Comparative Assessment of Clinical Practice Guideline Development Handbooks

    Science.gov (United States)

    Ansari, Shabnam; Rashidian, Arash

    2012-01-01

    Objectives We conducted a comparative review of clinical practice guideline development handbooks. We aimed to identify the main guideline development tasks, assign weights to the importance of each task using expert opinions and identify the handbooks that provided a comprehensive coverage of the tasks. Methods We systematically searched and included handbooks published (in English language) by national, international or professional bodies responsible for evidenced-based guideline development. We reviewed the handbooks to identify the main guideline development tasks and scored each handbook for each task from 0 (the handbook did not mention the task) to 2 (the task suitably addressed and explained), and calculated a weighted score for each handbook. The tasks included in over 75% of the handbooks were considered as ‘necessary’ tasks. Result Nineteen guideline development handbooks and twenty seven main tasks were identified. The guideline handbooks’ weighted scores ranged from 100 to 220. Four handbooks scored over 80% of the maximum possible score, developed by the National Institute for Health and Clinical Excellence, Swiss Centre for International Health, Scottish Intercollegiate Guidelines Network and World Health Organization. Necessary tasks were: selecting the guideline topic, determining the guideline scope, identifying relevant existing guidelines, involving the consumers, forming guideline development group,, developing clinical questions, systematic search for evidence, selecting relevant evidence, appraising identifies research evidence, making group decision, grading available evidence, creating recommendations, final stakeholder consultation, guideline implementation strategies, updating recommendations and correcting potential errors. Discussion Adequate details for evidence based development of guidelines were still lacking from many handbooks. The tasks relevant to ethical issues and piloting were missing in most handbooks. The findings

  7. Application of standard treatment guidelines in rural community health centres, Timor-Leste.

    Science.gov (United States)

    Higuchi, Michiyo; Okumura, Junko; Aoyama, Atsuko; Suryawati, Sri; Porter, John

    2012-08-01

    To analyse nurses' and midwives' knowledge of and attitudes towards standard treatment guidelines (STGs), which were developed to help their practices at rural community health centres (CHCs) in Timor-Leste. Fifty-five nurses and midwives were individually interviewed. Data were analysed qualitatively using the Framework approach. Overall, the standard treatments for acute respiratory tract infections, malaria and diarrhoea were well known by the respondents. Clinical nurses showed precise and detailed knowledge, especially for antibiotic use. The respondents were willing to use STGs and believed that they 'should' follow them. This feeling arose due to their self-awareness as frontline health workers and, at the same time, as peripheral civil servants. The changes brought about by the introduction of STGs were positively perceived. Three components of the change were observed: the concept, daily practice and perceived patient satisfaction. The respondents had previously felt a lack of confidence and hoped to improve their capacity as health care workers; they became confident in their practices by using STGs. Self-confidence was identified more clearly in the clinical nurse interviews. Few difficulties in using STGs were indicated, and the respondents suggested ways to deal with these difficulties. By using the STGs, the nurses/midwives gained knowledge and self-confidence. The positive perception of the changes promoted further use of the STGs. Clinical nurse training positively influenced the knowledge of and attitudes towards the STGs. Few difficulties in applying STGs in daily practice were identified, which is contrary to previous studies that targeted physicians in the Western world. Development of STGs within a health policy framework was considered a key factor. The STGs exist across related policies and various programmes, which are interconnected. The Timor-Leste experience indicates the value of STGs for non-physician health care providers at the

  8. Guidelines for conducting rigorous health care psychosocial cross-cultural/language qualitative research.

    Science.gov (United States)

    Arriaza, Pablo; Nedjat-Haiem, Frances; Lee, Hee Yun; Martin, Shadi S

    2015-01-01

    The purpose of this article is to synthesize and chronicle the authors' experiences as four bilingual and bicultural researchers, each experienced in conducting cross-cultural/cross-language qualitative research. Through narrative descriptions of experiences with Latinos, Iranians, and Hmong refugees, the authors discuss their rewards, challenges, and methods of enhancing rigor, trustworthiness, and transparency when conducting cross-cultural/cross-language research. The authors discuss and explore how to effectively manage cross-cultural qualitative data, how to effectively use interpreters and translators, how to identify best methods of transcribing data, and the role of creating strong community relationships. The authors provide guidelines for health care professionals to consider when engaging in cross-cultural qualitative research.

  9. Physical Activity Guidelines

    Science.gov (United States)

    ... use this site. health.gov Physical Activity Guidelines Physical Activity Physical activity is key to improving the health of the Nation. Based on the latest science, the Physical Activity Guidelines for Americans is an essential resource for ...

  10. The Role of Health Services Research in Developing Practice Policy: Development of Practice Guidelines.

    Science.gov (United States)

    Crall, James J.

    1990-01-01

    The paper offers guidance for the incorporation of treatment effectiveness research into clinical dental practice guidelines. Recommended is inclusion of patients' preferences for different outcomes as well as of clinical outcomes in development of valid practice guidelines. (DB)

  11. World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update.

    Science.gov (United States)

    Falzon, Dennis; Schünemann, Holger J; Harausz, Elizabeth; González-Angulo, Licé; Lienhardt, Christian; Jaramillo, Ernesto; Weyer, Karin

    2017-03-01

    Antimicrobial resistance is a major global concern. Tuberculosis (TB) strains resistant to rifampicin and other TB medicines challenge patient survival and public health. The World Health Organization (WHO) has published treatment guidelines for drug-resistant TB since 1997 and last updated them in 2016 based on reviews of aggregated and individual patient data from published and unpublished studies. An international expert panel formulated recommendations following the GRADE approach. The new WHO guidelines recommend a standardised 9-12 months shorter treatment regimen as first choice in patients with multidrug- or rifampicin-resistant TB (MDR/RR-TB) strains not resistant to fluoroquinolones or second-line injectable agents; resistance to these two classes of core second-line medicines is rapidly detectable with molecular diagnostics also approved by WHO in 2016. The composition of longer regimens for patients ineligible for the shorter regimen was modified. A first-ever meta-analysis of individual paediatric patient data allowed treatment recommendations for childhood MDR/RR-TB to be made. Delamanid is now also recommended in patients aged 6-17 years. Partial lung resection is a recommended option in MDR/RR-TB care. The 2016 revision highlighted the continued shortage of high-quality evidence and implementation research, and reiterated the need for clinical trials and best-practice studies to improve MDR/RR-TB patient treatment outcomes and strengthen policy. The content of this work is copyright of the authors or their employers. Design and branding are copyright ©ERS 2017.

  12. Exercise Guidelines to Promote Cardiometabolic Health in Spinal Cord Injured Humans: Time to Raise the Intensity?

    Science.gov (United States)

    Nightingale, Tom E; Metcalfe, Richard S; Vollaard, Niels B; Bilzon, James L

    2017-08-01

    Spinal cord injury (SCI) is a life-changing event that, as a result of paralysis, negatively influences habitual levels of physical activity and hence cardiometabolic health. Performing regular structured exercise therefore appears extremely important in persons with SCI. However, exercise options are mainly limited to the upper body, which involves a smaller activated muscle mass compared with the mainly leg-based activities commonly performed by nondisabled individuals. Current exercise guidelines for SCI focus predominantly on relative short durations of moderate-intensity aerobic upper-body exercise, yet contemporary evidence suggests this is not sufficient to induce meaningful improvements in risk factors for the prevention of cardiometabolic disease in this population. As such, these guidelines and their physiological basis require reappraisal. In this special communication, we propose that high-intensity interval training (HIIT) may be a viable alternative exercise strategy to promote vigorous-intensity exercise and prevent cardiometabolic disease in persons with SCI. Supplementing the limited data from SCI cohorts with consistent findings from studies in nondisabled populations, we present strong evidence to suggest that HIIT is superior to moderate-intensity aerobic exercise for improving cardiorespiratory fitness, insulin sensitivity, and vascular function. The potential application and safety of HIIT in this population is also discussed. We conclude that increasing exercise intensity could offer a simple, readily available, time-efficient solution to improve cardiometabolic health in persons with SCI. We call for high-quality randomized controlled trials to examine the efficacy and safety of HIIT in this population. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  13. Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

    Science.gov (United States)

    Turkova, A; Lyall, H; Foster, C; Klein, N; Bastiaans, D; Burger, D; Bernadi, S; Butler, K; Chiappini, E; Clayden, P; Della Negra, M; Giacomet, V; Giaquinto, C; Gibb, D; Galli, L; Hainaut, M; Koros, M; Marques, L; Nastouli, E; Niehues, T; Noguera‐Julian, A; Rojo, P; Rudin, C; Scherpbier, HJ; Tudor‐Williams, G; Welch, SB

    2015-01-01

    The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV‐1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short‐term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long‐term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first‐ and second‐line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART ‘pipeline’ of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained. PMID:25649230

  14. Systematic review on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity.

    Science.gov (United States)

    van Dongen, J M; Proper, K I; van Wier, M F; van der Beek, A J; Bongers, P M; van Mechelen, W; van Tulder, M W

    2011-12-01

    This systematic review summarizes the current evidence on the financial return of worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity. Data on study characteristics and results were extracted from 18 studies published up to 14 January 2011. Two reviewers independently assessed the risk of bias of included studies. Three metrics were (re-)calculated per study: the net benefits, benefit cost ratio (BCR) and return on investment (ROI). Metrics were averaged, and a post hoc subgroup analysis was performed to compare financial return estimates between study designs. Four randomized controlled trials (RCTs), 13 non-randomized studies (NRSs) and one modelling study were included. Average financial return estimates in terms of absenteeism benefits (NRS: ROI 325%, BCR 4.25; RCT: ROI -49%, BCR 0.51), medical benefits (NRS: ROI 95%, BCR 1.95; RCT: ROI -112%, BCR -0.12) or both (NRS: ROI 387%, BCR 4.87; RCT: ROI -92%, BCR 0.08) were positive in NRSs, but negative in RCTs. Worksite health promotion programmes aimed at improving nutrition and/or increasing physical activity generate financial savings in terms of reduced absenteeism costs, medical costs or both according to NRSs, whereas they do not according to RCTs. Since these programmes are associated with additional types of benefits, conclusions about their overall profitability cannot be made. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.

  15. Do marketing and alcohol treatment/public health experts think televised alcohol advertisements abide by regulatory guidelines?

    Science.gov (United States)

    Lloyd, Kelly; Cameron, Elaine; Williams, Hannah; Banister, Emma; Donmall, Michael; Higgins, Alan; French, David P

    2018-04-01

    Televised alcohol advertisements in the United Kingdom must abide by the Broadcast Committee of Advertising Practice Code, which provides guidelines concerning advertisements not implying, condoning or encouraging immoderate, irresponsible or antisocial drinking. Previously, 75 per cent of 373 general public respondents were shown one of seven advertisements rated a breach of at least one guideline. This study assessed whether experts in marketing ( n = 25) and alcohol treatment/public health ( n = 25) perceived the same seven television alcohol advertisements as complying with the Broadcast Committee of Advertising Practice Code. Overall, 83 per cent of advertisements were rated as breaching at least one guideline. This provides further proof that self-regulatory alcohol guidelines are not fit for purpose.

  16. The Public Health Service guidelines. Governing research involving human subjects: An analysis of the policy-making process

    Science.gov (United States)

    Frankel, M. S.

    1972-01-01

    The policy making process which led to development of the Public Health Service Guidelines governing research involving human subjects is outlined. Part 1 examines the evolution of PHS Guidelines, tracing (1) evolution of thought and legal interpretation regarding research using human subjects; (2) initial involvement of the Federal government; (3) development of the government's research program; (4) the social-political environment in which formal government policy was developed; and (5) various policy statements issued by the government. Part 2 analyzes the process by which PHS Guidelines were developed and examines the values and other underlying factors which contributed to their development. It was concluded that the evolution of the Guidelines is best understood within the context of a mixed-scanning strategy. In such a strategy, policy makers make fundamental decisions regarding the basic direction of policy and subsequent decisions are made incrementally and within the contexts set by the original fundamental decisions.

  17. 2017 European guideline for the screening, prevention and initial management of hepatitis B and C infections in sexual health settings.

    Science.gov (United States)

    Brook, Gary; Brockmeyer, Norbert; van de Laar, Thijs; Schellberg, Sven; Winter, Andrew J

    2018-01-01

    This guideline updates the 2010 European guideline for the management of hepatitis B and C virus infections. It is primarily intended to provide advice on testing, prevention and initial management of viral hepatitis B and C for clinicians working in sexual health clinical settings in European countries. The guideline is in a new question and answer format based on clinical situations, from which population/intervention/comparison/outcome questions were formulated. Updates cover areas such as epidemiology, point-of-care tests for hepatitis B, hepatitis C risk and 'chemsex', and HIV pre-exposure prophylaxis and hepatitis B. We have also included a short paragraph on hepatitis E noting there is no evidence for sexual transmission. The guideline has been prepared in accordance with the Europe protocol for production available at http://www.iusti.org/regions/europe/pdf/2017/ProtocolForProduction2017.pdf.

  18. Recommendations for international gambling harm-minimisation guidelines: comparison with effective public health policy.

    Science.gov (United States)

    Gainsbury, Sally M; Blankers, Matthijs; Wilkinson, Claire; Schelleman-Offermans, Karen; Cousijn, Janna

    2014-12-01

    Problem gambling represents a significant public health problem, however, research on effective gambling harm-minimisation measures lags behind other fields, including other addictive disorders. In recognition of the need for consistency between international jurisdictions and the importance of basing policy on empirical evidence, international conventions exist for policy on alcohol, tobacco, and illegal substances. This paper examines the evidence of best practice policies to provide recommendations for international guidelines for harm-minimisation policy for gambling, including specific consideration of the specific requirements for policies on Internet gambling. Evidence indicates that many of the public health policies implemented for addictive substances can be adapted to address gambling-related harms. Specifically, a minimum legal age of at least 18 for gambling participation, licensing of gambling venues and activities with responsible gambling and consumer protection strategies mandated, and brief interventions should be available for those at-risk for and experiencing gambling-related problems. However, there is mixed evidence on the effectiveness of limits on opening hours and gambling venue density and increased taxation to minimise harms. Given increases in trade globalisation and particularly the global nature of Internet gambling, it is recommended that jurisdictions take actions to harmonise gambling public health policies.

  19. Guidelines for the Detection and Management of Lead Poisoning for Physicians and Health Care Providers.

    Science.gov (United States)

    Illinois State Dept. of Public Health, Springfield.

    These Illinois guidelines provide information on the medical management and treatment of children with lead poisoning, based on Federal guidelines (revised in 1991) for determining lead poisoning at lower levels. The guidelines outline the effects of lead poisoning, sources of lead, estimated incidence of lead poisoning in Illinois, screening…

  20. Occupational physicians' perceived barriers and suggested solutions to improve adherence to a guideline on mental health problems: Analysis of a peer group training

    NARCIS (Netherlands)

    M. Lugtenberg; Van Beurden, K.M. (Karlijn M.); E.P.M. Brouwers (Evelien); Terluin, B. (Berend); J. van Weeghel (Jaap); J.J.L. van der Klink (Jac J. L.); Joosen, M.C.W. (Margot C. W.)

    2016-01-01

    textabstractBackground: Despite the impact of mental health problems on sickness absence, only few occupational health guidelines addressing these problems are available. Moreover, adherence has found to be suboptimal. To improve adherence to the Dutch guideline on mental health problems a training

  1. A Knowledge Transfer Study of the Utility of the Nova Scotia Seniors’ Mental Health Network in Implementing Seniors’ Mental Health National Guidelines

    Science.gov (United States)

    Bosma, Mark; Cassidy, Keri-Leigh; Le Clair, J Kenneth; Helsdingen, Sherri; Devichand, Pratima

    2011-01-01

    Background The Canadian Coalition for Seniors’ Mental Health (CCSMH) developed national best-practice guidelines in seniors’ mental health. Promoting adoption of new guidelines is challenging, as paper dissemination alone has limited impact on practice change. Purpose We hypothesized that the existing knowledge transfer (KT) mechanisms of the Nova Scotia Seniors’ Mental Health Network would prove useful in transferring the CCSMH best-practice guidelines. Methods In this observational KT study, CCSMH best-practice guidelines were delivered through two interactive, case-based teaching modules on Depression & Suicide, and Delirium via a provincial tele-education program and local face-to-face sessions. Usefulness of KT was measured using self-report evaluations of material quality and learning. Evaluation results from the two session topics and from tele-education versus face-to-face sessions were compared. Results Sessions were well attended (N = 347), with a high evaluation return rate (287, 83%). Most participants reported enhanced knowledge in seniors’ mental health and intended to apply knowledge to practice. Ratings did not differ significantly between KT session topics or modes of delivery. Conclusions The KT mechanisms of a provincial seniors’ mental health network facilitated knowledge acquisition and the intention of using national guidelines on seniors’ mental health among Nova Scotian clinicians. Key elements of accelerating KT used in this initiative are discussed. PMID:23251305

  2. Diabetes and hypertension guidelines and the primary health care practitioner in Barbados: knowledge, attitudes, practices and barriers-a focus group study

    Directory of Open Access Journals (Sweden)

    Carter Anne O

    2010-12-01

    Full Text Available Abstract Background Audits have shown numerous deficiencies in the quality of hypertension and diabetes primary care in Barbados, despite distribution of regional guidelines. This study aimed to evaluate the knowledge, attitudes and practices, and the barriers faced by primary care practitioners in Barbados concerning the recommendations of available diabetes and hypertension guidelines. Methods Focus groups using a moderator's manual were conducted at all 8 public sector polyclinics, and 5 sessions were held for private practitioners. Results Polyclinic sessions were attended by 63 persons (17 physicians, 34 nurses, 3 dieticians, 3 podiatrists, 5 pharmacists, and 1 other, and private sector sessions by 20 persons (12 physicians, 1 nurse, 3 dieticians, 2 podiatrists and 2 pharmacists. Practitioners generally thought they gave a good quality of care. Commonwealth Caribbean Medical Research Council 1995 diabetes and 1998 hypertension guidelines, and the Ministry of Health 2001 diabetes protocol had been seen by 38%, 32% and 78% respectively of polyclinic practitioners, 67%, 83%, and 33% of private physicians, and 25%, 0% and 38% of non-physician private practitioners. Current guidelines were considered by some to be outdated, unavailable, difficult to remember and lacking in advice to tackle barriers. Practitioners thought that guidelines should be circulated widely, promoted with repeated educational sessions, and kept short. Patient oriented versions of the guidelines were welcomed. Patient factors causing barriers to ideal outcome included denial and fear of stigma; financial resources to access an appropriate diet, exercise and monitoring equipment; confusion over medication regimens, not valuing free medication, belief in alternative medicines, and being unable to change habits. System barriers included lack of access to blood investigations, clinic equipment and medication; the lack of human resources in polyclinics; and an uncoordinated

  3. Diabetes and hypertension guidelines and the primary health care practitioner in Barbados: knowledge, attitudes, practices and barriers--a focus group study.

    Science.gov (United States)

    Adams, O Peter; Carter, Anne O

    2010-12-03

    Audits have shown numerous deficiencies in the quality of hypertension and diabetes primary care in Barbados, despite distribution of regional guidelines. This study aimed to evaluate the knowledge, attitudes and practices, and the barriers faced by primary care practitioners in Barbados concerning the recommendations of available diabetes and hypertension guidelines. Focus groups using a moderator's manual were conducted at all 8 public sector polyclinics, and 5 sessions were held for private practitioners. Polyclinic sessions were attended by 63 persons (17 physicians, 34 nurses, 3 dieticians, 3 podiatrists, 5 pharmacists, and 1 other), and private sector sessions by 20 persons (12 physicians, 1 nurse, 3 dieticians, 2 podiatrists and 2 pharmacists). Practitioners generally thought they gave a good quality of care. Commonwealth Caribbean Medical Research Council 1995 diabetes and 1998 hypertension guidelines, and the Ministry of Health 2001 diabetes protocol had been seen by 38%, 32% and 78% respectively of polyclinic practitioners, 67%, 83%, and 33% of private physicians, and 25%, 0% and 38% of non-physician private practitioners. Current guidelines were considered by some to be outdated, unavailable, difficult to remember and lacking in advice to tackle barriers. Practitioners thought that guidelines should be circulated widely, promoted with repeated educational sessions, and kept short. Patient oriented versions of the guidelines were welcomed. Patient factors causing barriers to ideal outcome included denial and fear of stigma; financial resources to access an appropriate diet, exercise and monitoring equipment; confusion over medication regimens, not valuing free medication, belief in alternative medicines, and being unable to change habits. System barriers included lack of access to blood investigations, clinic equipment and medication; the lack of human resources in polyclinics; and an uncoordinated team approach. Patients faced cultural barriers with

  4. Guidelines for the field evaluation of desert tortoise health and disease

    Science.gov (United States)

    Berry, Kristin H.; Christopher, Mary M.

    2001-01-01

    Field evaluation of free-ranging wildlife requires the systematic documentation of a variety of environmental conditions and individual parameters of health and disease, particularly in the case of rare or endangered species. In addition, defined criteria are needed for the humane salvage of ill or dying animals. The purpose of this paper is to describe, in detail, the preparation, procedures, and protocols we developed and tested for the field evaluation of wild desert tortoises (Gopherus agassizii). These guidelines describe: preparations for the field, including developing familiarity with tortoise behavior and ecology, and preparation of standardized data sheets; journal notes to document background data on weather conditions, temperature, rainfall, locality, and historic and recent human activities; procedures to prevent the spread of disease and parasites; data sheets for live tortoises to record tortoise identification, location, sex, body measurements and activity; health profile forms for documenting and grading physical abnormalities of tortoise posture and movements, general condition (e.g., lethargy, cachexia), external parasites, and clinical abnormalities associated with shell and upper respiratory diseases; permanent photographic records for the retrospective analysis of progression and regression of upper respiratory and eye diseases, analysis of shell lesions and evaluation of growth and age; and indications and methods for salvaging ill or dying tortoises for necropsy evaluation. These guidelines, tested on 5,000 to 20,000 tortoises over a 10 to 27 yr period, were designed to maximize acquisition of data for demographic, ecological, health and disease research projects; to reduce handling and stress of individual animals; to avoid spread of infectious disease; to promote high quality and consistent data sets; and to reduce the duration and number of field trips. The field methods are adapted for desert tortoise life cycle, behavior, anatomy

  5. Textual analysis of sugar industry influence on the World Health Organization’s 2015 sugars intake guideline

    Science.gov (United States)

    Reeves, Aaron; Loopstra, Rachel; McKee, Martin

    2016-01-01

    Abstract Objective To determine whether sugar industry-related organizations influenced textual changes between the draft and final versions of the World Health Organization’s (WHO’s) 2015 guideline Sugars intake for adults and children. Methods Stakeholder consultation submissions on the draft guideline from seven sugar industry-related and 10 public health organizations were assessed using the Wordscores program. Document scores were rescaled using the Martin–Vanberg transformation to improve comparability. Draft and final guidelines were compared to identify changes influenced by the sugar industry and public health organizations. Findings There was a small shift in transformed Wordscores score between the draft and final guidelines, from 0.25 to 0.24, towards the industry position. The change was linked to increased use of the word “low” to describe the quality of the evidence, consistent with industry arguments. There was also a shift from use of the word “consumption” to “intake”, irrespective of policy position. Scores for World Sugar Research Organisation and Sugar Nutrition UK submissions ( 0.11 and 0.18, respectively) represented strong pro-industry positions and scores for European Public Health Alliance and Wemos submissions (1.00 and 0.88, respectively) represented the strongest public health positions. Industry tactics included challenging the quality of the evidence, distinguishing between different types of sugar and advocating harm reduction. Conclusion There was little change between draft and final versions of the WHO sugars intake guideline 2015, following industry consultation. The main change was linked to emphasizing the low quality of the evidence on sugar’s adverse effects. Guideline development appeared relatively resistant to industry influence at the stakeholder consultation stage. PMID:27516634

  6. Identification of hepatitis B and C screening and patient management guidelines and availability of training for chronic viral hepatitis among health professionals in six European countries: Results of a semi-quantitative survey

    NARCIS (Netherlands)

    A. Bechini (Angela); A. Falla (Abby); R.A. Ahmad (Riris); I.K. Veldhuijzen (Irene); S. Boccalini (Sara); B. Porchia (Barbara); M. Levi (Miriam)

    2015-01-01

    textabstractBackground: As part of the EU funded project "HEPscreen", the aim of this study is to identify hepatitis B and C screening and patient management guidelines, to assess the awareness of these among health professionals (HPs) and to explore the availability of hepatitis B/C training

  7. Urgent need to reevaluate the latest World Health Organization guidelines for toxic inorganic substances in drinking water.

    Science.gov (United States)

    Frisbie, Seth H; Mitchell, Erika J; Sarkar, Bibudhendra

    2015-08-13

    The World Health Organization (WHO) has established guidelines for drinking-water quality that cover biological and chemical hazards from both natural and anthropogenic sources. In the most recent edition of Guidelines for Drinking-water Quality (2011), the WHO withdrew, suspended, did not establish, or raised guidelines for the inorganic toxic substances manganese, molybdenum, nitrite, aluminum, boron, nickel, uranium, mercury, and selenium. In this paper, we review these changes to the WHO drinking-water guidelines, examining in detail the material presented in the WHO background documents for each of these toxic substances. In some cases, these WHO background documents use literature reviews that do not take into account scientific research published within the last 10 or more years. In addition, there are instances in which standard WHO practices for deriving guidelines are not used; for example, rounding and other mathematical errors are made. According to published meeting reports from the WHO Chemical Aspects Working Group, the WHO has a timetable for revising some of its guidelines for drinking-water quality, but for many of these toxic substances the planned changes are minimal or will be delayed for as long as 5 years. Given the limited nature of the planned WHO revisions to the inorganic toxic substances and the extended timetable for these revisions, we suggest that governments, researchers, and other stakeholders might establish independent recommendations for inorganic toxic substances and possibly other chemicals to proactively protect public health, or at the very least, revert to previous editions of the Guidelines for Drinking-water Quality, which were more protective of public health.

  8. Determining health personnel's application trends of new guidelines for preoperative fasting: findings from a survey.

    Science.gov (United States)

    Karadağ, Mevlüde; Pekin İşeri, Ozge

    2014-06-01

    For over a century, the discontinuation of oral food intake preoperatively after midnight has been routinely applied. Although routine fasting during the night before elective surgery has been abandoned by many modern centers, preoperative fasting after midnight continues as a routine practice. The purpose of this study was to determine trends in health personnel's application of new guidelines for preoperative fasting. The research sample of this descriptive study consisted of 73 nurses and physicians who were working in the surgical clinics during the time when the study was conducted and who agreed to participate in the study. The data of the study were collected using a questionnaire designed by the researchers. Of the health personnel included in the study group, 43.8% routinely kept adult patients fasting after midnight, 34.2% discontinued solid food intake 8 hours preoperatively, 5.5% discontinued solid food intake 6 hours preoperatively, and 34.2% discontinued the intake of clear and particulate liquids 4 to 8 hours preoperatively. Compliance of the American Society of Anesthesiologists' "2-4-6-8 rule" by health staff was very low. This study was carried out in a hospital and based on the statements of health staff. Therefore, the findings of the study are suggestive in nature and cannot be generalized. We recommend that the study should be conducted with larger sample groups and that actual preoperative fasting periods of the patients should be determined. Copyright © 2014 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  9. The Eatwell Guide: Modelling the Health Implications of Incorporating New Sugar and Fibre Guidelines.

    Directory of Open Access Journals (Sweden)

    Linda J Cobiac

    Full Text Available To model population health impacts of dietary changes associated with the redevelopment of the UK food-based dietary guidelines (the 'Eatwell Guide'.Using multi-state lifetable methods, we modelled the impact of dietary changes on cardiovascular disease, diabetes and cancers over the lifetime of the current UK population. From this model, we determined change in life expectancy and disability-adjusted life years (DALYs that could be averted.Changing the average diet to that recommended in the new Eatwell Guide, without increasing total energy intake, could increase average life expectancy by 5.4 months (95% uncertainty interval: 4.7 to 6.2 for men and 4.0 months (3.4 to 4.6 for women; and avert 17.9 million (17.6 to 18.2 DALYs over the lifetime of the current population. A large proportion of the health benefits are from prevention of type 2 diabetes, with 440,000 (400,000 to 480,000 new cases prevented in men and 340,000 (310,000 to 370,000 new cases prevented in women, over the next ten years. Prevention of cardiovascular diseases and colorectal cancer is also large. However, if the diet recommended in the new Eatwell Guide is achieved with an accompanying increase in energy intake (and thus an increase in body mass index, around half the potential improvements in population health will not be realised.The dietary changes required to meet recommendations in the Eatwell Guide, which include eating more fruits and vegetables and less red and processed meats and dairy products, are large. However, the potential population health benefits are substantial.

  10. Smoking Cessation Counseling for Asian Immigrants With Serious Mental Illness: Using RE-AIM to Understand Challenges and Lessons Learned in Primary Care–Behavioral Health Integration

    Science.gov (United States)

    Saw, Anne; Kim, Jin; Lim, Joyce; Powell, Catherine; Tong, Elisa K.

    2016-01-01

    Engagement in modifiable risk behaviors, such as tobacco use, substantially contributes to early mortality rates in individuals with serious mental illness (SMI). There is an alarmingly high prevalence of tobacco use among subgroups of Asian Americans, such as immigrants and individuals with SMI, yet there are no empirically supported effective smoking cessation interventions that have been tailored to meet the unique cultural, cognitive, and psychological needs of Asian immigrants with SMI. In this article, we share the experiences of clinicians in the delivery of smoking cessation counseling to Asian American immigrants with SMI, in the context of an Asian-focused integrated primary care and behavioral health setting. Through a qualitative analysis of clinician perspectives organized with the RE-AIM framework, we outline challenges, lessons learned, and promising directions for delivering smoking cessation counseling to Asian American immigrant clients with SMI. PMID:23667056

  11. Smoking cessation counseling for Asian immigrants with serious mental illness: using RE-AIM to understand challenges and lessons learned in primary care-behavioral health integration.

    Science.gov (United States)

    Saw, Anne; Kim, Jin; Lim, Joyce; Powell, Catherine; Tong, Elisa K

    2013-09-01

    Engagement in modifiable risk behaviors, such as tobacco use, substantially contributes to early mortality rates in individuals with serious mental illness (SMI). There is an alarmingly high prevalence of tobacco use among subgroups of Asian Americans, such as immigrants and individuals with SMI, yet there are no empirically supported effective smoking cessation interventions that have been tailored to meet the unique cultural, cognitive, and psychological needs of Asian immigrants with SMI. In this article, we share the experiences of clinicians in the delivery of smoking cessation counseling to Asian American immigrants with SMI, in the context of an Asian-focused integrated primary care and behavioral health setting. Through a qualitative analysis of clinician perspectives organized with the RE-AIM framework, we outline challenges, lessons learned, and promising directions for delivering smoking cessation counseling to Asian American immigrant clients with SMI.

  12. Chiang Mai University Health Worker Study aiming toward a better understanding of noncommunicable disease development in Thailand: methods and description of study population.

    Science.gov (United States)

    Angkurawaranon, Chaisiri; Wisetborisut, Anawat; Jiraporncharoen, Wichuda; Likhitsathian, Surinporn; Uaphanthasath, Ronnaphob; Gomutbutra, Patama; Jiraniramai, Surin; Lerssrimonkol, Chawin; Aramrattanna, Apinun; Doyle, Pat; Nitsch, Dorothea

    2014-01-01

    Urbanization is considered to be one of the key drivers of noncommunicable diseases (NCDs) in Thailand and other developing countries. These influences, in turn, may affect an individual's behavior and risk of developing NCDs. The Chiang Mai University (CMU) Health Worker Study aims to provide evidence for a better understanding of the development of NCDs and ultimately to apply the evidence toward better prevention, risk modification, and improvement of clinical care for patients with NCDs and NCD-related conditions. A cross-sectional survey of health care workers from CMU Hospital was conducted between January 2013 and June 2013. Questionnaires, interviews, and physical and laboratory examinations were used to assess urban exposure, occupational shift work, risk factors for NCDs, self-reported NCDs, and other NCD-related health conditions. From 5,364 eligible workers, 3,204 participated (59.7%). About 11.1% of the participants had high blood pressure (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg) and almost 30% were considered to be obese (body mass index ≥25 kg/m(2)). A total of 2.3% had a high fasting blood glucose level (≥126 mg/dL), and the most common abnormal lipid profile was high low-density lipoprotein (≥160 mg/dL), which was found in 19.2% of participants. The study of health workers offers three potential advantages. The first is that the study of migrants was possible. Socioenvironmental influence on NCD risk factors can be explored, as changes in environmental exposures can be documented. Second, it allows the investigators to control for access to care. Access to care is potentially a key confounder toward understanding the development of NCDs. Lastly, a study of health personnel allows easy access to laboratory investigations and potential for long-term follow-up. This enables ascertainment of a number of clinical outcomes and provides potential for future studies focusing on therapeutic and prognostic issues

  13. [Considerations on the development of nutrition-related guidelines by the World Health Organization and their implementation].

    Science.gov (United States)

    Zamora, Gerardo; Meneses, Daniela; De-Regil, Luz Maria; Neufeld, Lynnette; Peña-Rosas, Juan Pablo; Sinisterra, Odalis Teresa

    2015-03-01

    The World Health Organization (WHO) follows a complex and rigorous process to develop global guidelines. With regard to nutrition-related guidelines, the joint participation of national authorities from Member States and their partners, including those of the social economy, is key to strengthening the process of evidence-informed guideline development and the subsequent implementation as part of national public health strategies. WHO puts forward a series of tools that can assist national authorities on health and social development in the elaboration of evidence-informed policies, considering their pertinence, relevance and implementability. This adoption and adaptation process must consider equity in order to avoid widening existing inequities. WHO global nutrition guidelines contribute to the effective implementation of nutrition interventions in Member States. Two experiences of implementation, one in Panama and one in Peru, exemplify this process. The paper ends by suggesting a deeper understanding and utilization of implementation research during programmes to identify what factors ensure effective interventions, appropriate scale up strategies and greater health equity.

  14. Probing the Issue of Informed Consent in Health Care in Korea–Concept Analysis and Guideline Development

    Directory of Open Access Journals (Sweden)

    Won-Hee Lee, RN, PhD

    2008-06-01

    Conclusion: The guidelines developed in the present study offer empirical parameters for an effective process of obtaining informed consent in Korea by seeking to decrease the gap in perceptions of informed consent among patients, family members, physicians, and nurses. The importance of advocating patients and developing a trusting relationship between health care providers and patients is especially noteworthy.

  15. Efficacy of education with American Society of Health system Pharmacists guidelines on the prevention of stress ulcer

    Directory of Open Access Journals (Sweden)

    Naser Gharebaghi

    2014-01-01

    Conclusion: In this study the majority of cases not been in accordance with the ASHP-based guideline and our education did not affect the quality of stress ulcer prophylaxis. It seems that more attention to the training of physician in the prophylaxis of stress ulcer can be effective in improving the health status of patients and additional costs may be reduced.

  16. Training mental health professionals in suicide practice guideline adherence : Cost-effectiveness analysis alongside a randomized controlled trial

    NARCIS (Netherlands)

    de Beurs, Derek P.; Bosmans, Judith E.; de Groot, Marieke H.; de Keijser, Jos; van Duijn, Erik; de Winter, Remco F. P.; Kerkhof, Ad J. F. M.

    2015-01-01

    Background: There is a lack of information on the cost-effectiveness of suicide prevention interventions. The current study examines the cost-effectiveness of a multifaceted structured intervention aiming to improve adherence to the national suicide practice guideline in comparison with usual

  17. A selective review of prenatal exercise guidelines since the 1950s until present: written for women, health care professionals, and female athletes

    Science.gov (United States)

    Kehler, Ainslie K.; Heinrich, Katie M.

    2017-01-01

    Background Traditional society values have long-held the notion that the pregnant woman is construed as a risk to her growing fetus and is solely responsible for controlling this risk to ensure a healthy pregnancy. It is hard to ignore the participation of pregnant women in sport and exercise today, especially in high-level sports and popular fitness programs such as CrossFit™. This challenges both traditional and modern prenatal exercise guidelines from health care professionals and governing health agencies. The guidelines and perceived limitations of prenatal exercise have drastically evolved since the 1950’s. Aim The goal of this paper is to bring awareness to the idea that much of the information regarding exercise safety during pregnancy is hypersensitive and dated, and the earlier guidelines had no scientific rigor. Research is needed on the upper limits of exercise intensity and exercise frequency, as well as their potential risks (if any) on the woman or fetus. Discussion Pregnant women are physically capable of much more than what was once thought. There is still disagreement about the types of exercise deemed appropriate, the stage at which exercise should begin and cease, the frequency of exercise sessions, as well as the optimal level of intensity during prenatal exercise. Conclusion Research is needed to determine the upper limits of exercise frequency and intensity for pregnant women who are already trained. Healthy women and female athletes can usually maintain their regular training regime once they become pregnant. PMID:26210535

  18. 'A question of balance': addressing the public health impacts of multinational enterprises in the OECD Guidelines for Multinational Enterprises.

    Science.gov (United States)

    Yang, Joshua S; McDaniel, Patricia A; Malone, Ruth E

    2012-01-01

    The global community is beginning to address non-communicable diseases, but how to increase the accountability of multinational enterprises (MNEs) for the health impacts of their products and practices remains unclear. We examine the Organization for Economic Cooperation and Development's (OECD) efforts to do so through voluntary MNE guidelines. We developed a historical case study of how the OECD Guidelines for Multinational Enterprises were developed and revised from 1973 to 2000 through an analysis of publicly available archived OECD and tobacco industry documents. The first edition of the Guidelines was a purely economic instrument. Outside pressures and a desire to ward off more stringent regulatory efforts resulted in the addition over time of guidelines related to the environment, consumer interests, sustainable development and human rights. Despite their voluntary nature, the Guidelines can play a role in efforts to help balance the interests of MNEs and public health by providing a starting point for efforts to create binding provisions addressing MNEs' contributions to disease burden or disease reduction.

  19. Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers

    National Research Council Canada - National Science Library

    1998-01-01

    .... OSHA s new violence prevention guidelines provide the agency s recommendations for reducing workplace violence developed following a careful review of workplace violence studies, public and private...

  20. A Call to Digital Health Practitioners: New Guidelines Can Help Improve the Quality of Digital Health Evidence.

    Science.gov (United States)

    Agarwal, Smisha; Lefevre, Amnesty E; Labrique, Alain B

    2017-10-06

    Despite the rapid proliferation of health interventions that employ digital tools, the evidence on the effectiveness of such approaches remains insufficient and of variable quality. To address gaps in the comprehensiveness and quality of reporting on the effectiveness of digital programs, the mHealth Technical Evidence Review Group (mTERG), convened by the World Health Organization, proposed the mHealth Evidence Reporting and Assessment (mERA) checklist to address existing gaps in the comprehensiveness and quality of reporting on the effectiveness of digital health programs. We present an overview of the mERA checklist and encourage researchers working in the digital health space to use the mERA checklist for reporting their research. The development of the mERA checklist consisted of convening an expert group to recommend an appropriate approach, convening a global expert review panel for checklist development, and pilot-testing the checklist. The mERA checklist consists of 16 core mHealth items that define what the mHealth intervention is (content), where it is being implemented (context), and how it was implemented (technical features). Additionally, a 29-item methodology checklist guides authors on reporting critical aspects of the research methodology employed in the study. We recommend that the core mERA checklist is used in conjunction with an appropriate study-design specific checklist. The mERA checklist aims to assist authors in reporting on digital health research, guide reviewers and policymakers in synthesizing evidence, and guide journal editors in assessing the completeness in reporting on digital health studies. An increase in transparent and rigorous reporting can help identify gaps in the conduct of research and understand the effects of digital health interventions as a field of inquiry. ©Smisha Agarwal, Amnesty E Lefevre, Alain B Labrique. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 06.10.2017.

  1. Predictors of awareness of standard drink labelling and drinking guidelines to reduce negative health effects among Australian drinkers.

    Science.gov (United States)

    Coomber, Kerri; Jones, Sandra C; Martino, Florentine; Miller, Peter G

    2017-03-01

    This study examined rates of awareness of standard drink labelling and drinking guidelines among Australian adult drinkers. Demographic predictors of these two outcomes were also explored. Online survey panel participants aged 18-45 years(n = 1061; mean age = 33.2 years) completed an online survey assessing demographics, alcohol consumption patterns, awareness of standard drink labels and the National Health and Medical Research Council (NHMRC) guidelines, and support for more detailed labels. The majority (80%) of participants had seen standard drink labels on alcohol products; with younger drinkers, those from a regional/rural location and high-risk drinkers significantly more likely to have seen such labelling. Most respondents estimated at or below the maximum number of drinks stipulated in the NHMRC guidelines. However, their estimates of the levels for male drinkers were significantly higher than for female drinkers. High-risk drinkers were significantly less likely to provide accurate estimates, while those who had seen the standard drink logo were significantly more likely to provide accurate estimates of drinking levels to reduce the risk of long-term harms only. Just under three-quarters of respondents supported the inclusion of more information on labels regarding guidelines to reduce negative health effects. The current standard drink labelling approach fails to address high-risk drinkers. The inclusion of information about NHMRC guidelines on alcohol labels, and placing standard drink labelling on the front of products could improve awareness of what constitutes a standard drink and safe levels of consumption among Australian drinkers.[Kerri Coomber, Sandra C. Jones, Florentine Martino, Peter G. Miller. Predictors of awareness of standard drink labelling and drinking guidelines to reduce negative health effects among Australian drinkers. Drug Alcohol Rev 2017;36:200-209]. © 2016 Australasian Professional Society on Alcohol and other Drugs.

  2. Public health economic evaluation of different European Union–level policy options aimed at reducing population dietary trans fat intake12

    Science.gov (United States)

    Mouratidou, Theodora; Livaniou, Anastasia

    2016-01-01

    Background: The adverse relation between dietary trans fatty acid (TFA) intake and coronary artery disease risk is well established. Many countries in the European Union (EU) and worldwide have implemented different policies to reduce the TFA intake of their populations. Objective: The aim of this study was to assess the added value of EU-level action by estimating the cost-effectiveness of 3 possible EU-level policy measures to reduce population dietary TFA intake. This was calculated against a reference situation of not implementing any EU-level policy (i.e., by assuming only national or self-regulatory measures). Design: We developed a mathematical model to compare different policy options at the EU level: 1) to do nothing beyond the current state (reference situation), 2) to impose mandatory TFA labeling of prepackaged foods, 3) to seek voluntary agreements toward further reducing industrially produced TFA (iTFA) content in foods, and 4) to impose a legislative limit for iTFA content in foods. Results: The model indicated that to impose an EU-level legal limit or to make voluntary agreements may, over the course of a lifetime (85 y), avoid the loss of 3.73 and 2.19 million disability-adjusted life-years (DALYs), respectively, and save >51 and 23 billion euros when compared with the reference situation. Implementing mandatory TFA labeling can also avoid the loss of 0.98 million DALYs, but this option incurs more costs than it saves compared with the reference option. Conclusions: The model indicates that there is added value of an EU-level action, either via a legal limit or through voluntary agreements, with the legal limit option producing the highest additional health benefits. Introducing mandatory TFA labeling for the EU common market may provide some additional health benefits; however, this would likely not be a cost-effective strategy. PMID:27680991

  3. Draft Guidelines for Evaluating the Clinical Effectiveness of Health Technologies in Ireland, July 2014

    LENUS (Irish Health Repository)

    Xiao, Liang

    2011-02-01

    Abstract Background In this paper, we give an overview of methadone treatment in Ireland and outline the rationale for designing an electronic health record (EHR) with extensibility, interoperability and decision support functionality. Incorporating several international standards, a conceptual model applying a problem orientated approach in a hierarchical structure has been proposed for building the EHR. Methods A set of archetypes has been designed in line with the current best practice and clinical guidelines which guide the information-gathering process. A web-based data entry system has been implemented, incorporating elements of the paper-based prescription form, while at the same time facilitating the decision support function. Results The use of archetypes was found to capture the ever changing requirements in the healthcare domain and externalises them in constrained data structures. The solution is extensible enabling the EHR to cover medicine management in general as per the programme of the HRB Centre for Primary Care Research. Conclusions The data collected via this Irish system can be aggregated into a larger dataset, if necessary, for analysis and evidence-gathering, since we adopted the openEHR standard. It will be later extended to include the functionalities of prescribing drugs other than methadone along with the research agenda at the HRB Centre for Primary Care Research in Ireland.

  4. Clinical practice guidelines from the French Health High Authority: nutritional support strategy in protein-energy malnutrition in the elderly.

    Science.gov (United States)

    Raynaud-Simon, Agathe; Revel-Delhom, Christine; Hébuterne, Xavier

    2011-06-01

    These guidelines were produced at the request of the General Directorate of Health within the scope of the French Nutrition and Health Program (PNNS). They concern the management of malnutrition in elderly persons living at home, in institutional care, or in hospital. They belong to a recent series of studies published by ANAES(1) or HAS. Preceding studies concerned the "Diagnostic assessment of protein-energy malnutrition in hospitalized adults" (ANAES, September 2003) and the work conducted by the Committee for the Assessment of Devices and Health Technologies (CEPP) on "Reimbursement procedures for dietary foods for special medical purposes for nutritional supplementation and home enteral nutrition" (HAS, September 2006). The objective of these guidelines is to develop a tool for identifying and managing elderly subjects who are malnourished or at risk of malnutrition. Copyright © 2010. Published by Elsevier Ltd.

  5. Use of the National Institutes of Health Consensus Guidelines Improves the Diagnostic Sensitivity of Gastrointestinal Graft-Versus-Host Disease.

    Science.gov (United States)

    Cardona, Diana M; Detweiler, Claire J; Shealy, Michael J; Sung, Anthony D; Wild, Daniel M; Poleski, Martin H; Balmadrid, Bryan L; Cirrincione, Constance T; Howell, David N; Sullivan, Keith M

    2018-04-26

    - Graft-versus-host disease of the gastrointestinal tract is a common complication of hematopoietic stem cell transplant associated with significant morbidity and mortality. Accurate diagnosis can be difficult and is a truly clinicopathologic endeavor. - To assess the diagnostic sensitivity of gastrointestinal graft-versus-host disease using the 2015 National Institutes of Health (NIH) histology consensus guidelines and to analyze histologic findings that support the guidelines. - Patients with allogeneic hematopoietic stem cell transplants were identified via a retrospective search of our electronic medical record from January 1, 2005, to January 1, 2011. Endoscopies with available histology were reviewed by 2 pathologists using the 2015 NIH guidelines. The clinical diagnosis was used as the gold standard. A nontransplant set of endoscopic biopsies was used as a control. - Of the 250 total endoscopies, 217 (87%) had a clinical diagnosis of gastrointestinal graft-versus-host disease. Use of the NIH consensus guidelines showed a sensitivity of 86% and a specificity of 65%. Thirty-seven of 58 (64%) cases with an initial false-negative histopathologic diagnosis were diagnosed as graft-versus-host disease on our review. - Use of the NIH histology consensus guidelines results in a high sensitivity and specificity, thereby decreasing false-negatives. Additionally, use of the NIH guidelines aids in creating uniformity and diagnostic clarity. Correlation with clinical and laboratory findings is critical in evaluating the differential diagnosis and to avoid false-positives. As expected, increased apoptosis with decreased inflammation was associated with a pathologic diagnosis of graft-versus-host disease and supports the NIH guidelines.

  6. Predictors of adherence to screening guidelines for chronic diseases of lifestyle, cancers, and HIV in a health-insured population in South Africa

    Directory of Open Access Journals (Sweden)

    Leegale Adonis

    2014-03-01

    Full Text Available Background: Adherence to screening guidelines has been widely accepted to reduce morbidity, mortality, and cost outcomes. The aim of this study was to identify predictors of adherence to screening guidelines for chronic diseases of lifestyle (CDL, cancers, and HIV in a health-insured population in South Africa, some of whom voluntarily opt into a wellness program that incentivizes screening. Method: A cross-sectional study for the period 2007–2011 was conducted using a random sample of 170,471 health insurance members from a single insurer. Adherence to screening guidelines was calculated from medical claims data. Results: Adherence to screening guidelines ranged from 1.1% for colorectal cancer to 40.9% for cholesterol screening. Members of the wellness program were up to three times more likely to screen for diseases (odds ratio [OR]=3.2 for HIV screening, confidence interval [CI]=2.75–3.73. Plan type (full comprehensive plan was most strongly associated with cholesterol screening (OR=3.53, CI=3.27–3.80, and most negatively associated (hospital-only core plan with cervical cancer screening (OR= 0.44, CI=0.28–0.70. Gender was a negative predictor for glucose screening (OR=0.88, CI=0.82–0.96. Provincial residence was most strongly associated with cervical cancer screening (OR=1.89, CI=0.65–5.54. Conclusion: Adherence to screening recommendations was <50%. Plan type, gender, provincial residence, and belonging to an incentivized wellness program were associated with disproportionate utilization of screening services, even with equal payment access.

  7. Strengthening health human resources and improving clinical outcomes through an integrated guideline and educational outreach in resource-poor settings: a cluster-randomized trial

    Directory of Open Access Journals (Sweden)

    Burciul Barry

    2010-12-01

    Full Text Available Abstract Background In low-income countries, only about a third of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS patients eligible for anti-retroviral treatment currently receive it. Providing decentralized treatment close to where patients live is crucial to a faster scale up, however, a key obstacle is limited health system capacity due to a shortage of trained health-care workers and challenges of integrating HIV/AIDS care with other primary care services (e.g. tuberculosis, malaria, respiratory conditions. This study will test an adapted primary care health care worker training and guideline intervention, Practical Approach to Lung Health and HIV/AIDS Malawi (PALM PLUS, on staff retention and satisfaction, and quality of patient care. Methods/Design A cluster-randomized trial design is being used to compare usual care with a standardized clinical guideline and training intervention, PALM PLUS. The intervention targets middle-cadre health care workers (nurses, clinical officers, medical assistants in 30 rural primary care health centres in a single district in Malawi. PALM PLUS is an integrated, symptom-based and user-friendly guideline consistent with Malawian national treatment protocols. Training is standardized and based on an educational outreach approach. Trainers will be front-line peer healthcare workers trained to provide outreach training and support to their fellow front-line healthcare workers during focused (1-2 hours, intermittent, interactive sessions on-site in health centers. Primary outcomes are health care worker retention and satisfaction. Secondary outcomes are clinical outcomes measured at the health centre level for HIV/AIDS, tuberculosis, prevention-of-mother-to-child-transmission of HIV and other primary care conditions. Effect sizes and 95% confidence intervals for outcomes will be presented. Assessment of outcomes will occur at 1 year post- implementation. Discussion The PALM PLUS trial

  8. AIMES Final Technical Report

    Energy Technology Data Exchange (ETDEWEB)

    Katz, Daniel S [Univ. of Illinois, Urbana-Champaign, IL (United States). National Center for Supercomputing Applications (NCSA); Jha, Shantenu [Rutgers Univ., New Brunswick, NJ (United States); Weissman, Jon [Univ. of Minnesota, Minneapolis, MN (United States); Turilli, Matteo [Rutgers Univ., New Brunswick, NJ (United States)

    2017-01-31

    This is the final technical report for the AIMES project. Many important advances in science and engineering are due to large-scale distributed computing. Notwithstanding this reliance, we are still learning how to design and deploy large-scale production Distributed Computing Infrastructures (DCI). This is evidenced by missing design principles for DCI, and an absence of generally acceptable and usable distributed computing abstractions. The AIMES project was conceived against this backdrop, following on the heels of a comprehensive survey of scientific distributed applications. AIMES laid the foundations to address the tripartite challenge of dynamic resource management, integrating information, and portable and interoperable distributed applications. Four abstractions were defined and implemented: skeleton, resource bundle, pilot, and execution strategy. The four abstractions were implemented into software modules and then aggregated into the AIMES middleware. This middleware successfully integrates information across the application layer (skeletons) and resource layer (Bundles), derives a suitable execution strategy for the given skeleton and enacts its execution by means of pilots on one or more resources, depending on the application requirements, and resource availabilities and capabilities.

  9. The outcomes of a 12-week Internet intervention aimed at improving fitness and health-related quality of life in overweight adolescents: the Young & Active controlled trial.

    Directory of Open Access Journals (Sweden)

    Kirsti Riiser

    Full Text Available Overweight and obesity among adolescents may have consequences, with potentially lasting effects on health and health-related quality of life (HRQoL. Excess weight is also associated with decreases in physical activity and cardiorespiratory fitness. The aim of the current study was to investigate the short-term effects of a 12-week Internet intervention in a primary care setting intended to increase cardiorespiratory fitness and HRQoL among overweight and obese adolescents.In this controlled trial, participants (13-15 years were non-randomly allocated to an intervention- or a control group. The intervention group received 12-weeks access to an online program providing tailored physical activity counseling based on principles from Self-determination Theory and Motivational Interviewing. The control group received standard follow-up by the school nurses. The primary outcome measure of cardiorespiratory fitness was determined using a shuttle run test. The secondary outcomes: HRQoL, leisure time exercise, body image and self-determined motivation for physical activity and exercise, were assessed by self-report measures. Age- and gender-adjusted body mass index (BMI was calculated based on measurements of height and weight. To compare pre-to post intervention differences within groups, a paired samples t-test was used while crude differences between groups were analyzed with an independent samples t-test.Of the 120 participants, 108 completed the study, 75 in the intervention group and 33 in the control group. Exposure to the intervention had a small effect on cardiorespiratory fitness (0.14; 95% CI [0.01;0.28]; P = 0.04, and a moderate effect on HRQoL (5.22; 95% CI [0.90; 9.53]; P = 0.02. Moreover, the control group increased significantly in BMI, yielding a moderate preventive effect on BMI (-0.39; 95% CI [-0.74;-0.03]; P = 0.03 for the intervention group.The results suggest that the Internet intervention with tailored physical activity counseling

  10. A Critical Review of Low Back Pain Guidelines.

    Science.gov (United States)

    Chetty, Laran

    2017-09-01

    Low back pain (LBP) remains one of the most common and challenging musculoskeletal conditions encountered by health care professionals and is a leading cause of absenteeism. Clinical guidelines are often considered best evidence in health care. The aim of this critical review was to assess the quality and recommendations of LBP guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. Electronic databases were used to identify LBP guidelines published between 2000 and 2015. Nine guidelines were selected for review from a total of 17. Only five guidelines effectively addressed the AGREE scoring. On the basis of the appraisal and domain scores, only four guidelines were strongly recommended. Improved translation of research evidence from guidelines to clinical practice is needed.

  11. AIM Data Services

    Directory of Open Access Journals (Sweden)

    Michael Scholz

    2016-05-01

    Full Text Available AIM Data Services as a virtual facility provides virtual 3D reference tracks for simulation applications in the domain of automotive and railway systems. It offers tools for management and analysis of experiment data and a platform for survey and processing of vehicle data in the public transport domain. Collected spatial data is bundled in a database cluster and published through common web mapping interfaces.

  12. AIMES Final Technical Report

    Energy Technology Data Exchange (ETDEWEB)

    Jha, Shantenu [Rutgers Univ., New Brunswick, NJ (United States)

    2017-01-31

    Many important advances in science and engineering are due to large-scale distributed computing. Notwithstanding this reliance, we are still learning how to design and deploy large-scale production Distributed Computing Infrastructures (DCI). The AIMES project was conceived against this backdrop, following on the heels of a comprehensive survey of scienti c distributed applications [1]. The survey established, arguably for the rst time, the relationship between infrastructure and scienti c distributed applications. It examined well known contributors to the complexity associated with infrastructure, such as inconsistent internal and external interfaces, and demonstrated the correlation with application brittleness. It discussed how infrastructure complexity reinforces the challenges inherent in developing distributed applications.

  13. Behavioral consequences of conflict-oriented health news coverage: the 2009 mammography guideline controversy and online information seeking.

    Science.gov (United States)

    Weeks, Brian E; Friedenberg, Laura M; Southwell, Brian G; Slater, Jonathan S

    2012-01-01

    Building on channel complementarity theory and media-system dependency theory, this study explores the impact of conflict-oriented news coverage of health issues on information seeking online. Using Google search data as a measure of behavior, we demonstrate that controversial news coverage of the U.S. Preventive Services Task Force's November 2009 recommendations for changes in breast cancer screening guidelines strongly predicted the volume of same-day online searches for information about mammograms. We also found that this relationship did not exist 1 year prior to the coverage, during which mammography news coverage did not focus on the guideline controversy, suggesting that the controversy frame may have driven search behavior. We discuss the implications of these results for health communication scholars and practitioners.

  14. Improvements for international medicine donations: a review of the World Health Organization Guidelines for Medicine Donations, 3rd edition.

    Science.gov (United States)

    Cañigueral-Vila, Nuria; Chen, Jennifer C; Frenkel-Rorden, Lindsey; Laing, Richard

    2015-01-01

    Some humanitarian and development organizations respond to major natural disasters and emergencies by donating medicines. Many provide medicines on a routine basis to support health systems, particularly those run by Faith-Based Organizations. Although such donations can provide essential medicines to populations in great need, inappropriate donations also take place, with burdensome consequences. The World Health Organization (WHO) has developed the interagency Guidelines for Medicine Donations for use by donors and recipients in the context of emergency aid and international development assistance. Although comprehensive in nature and transferable to various emergency situations, adjustments to both content and formatting would improve this resource. Recommendations for the next version of these guidelines include: specific wording and consistent formatting; definition of who is a recipient, clear distinction between acute and long-term emergencies, and proper donation procedures pertaining to each; inclusion of visual aides such as flowcharts, checklists, and photos; and improving the citations system.

  15. Initial evaluation of the training programme for health care professionals on the use of Malaysian clinical practice guidelines for management of dementia.

    Science.gov (United States)

    Yusoff, S; Koh, C T; Mohd Aminuddin, M Y; Krishnasamy, M; Suhaila, M Z

    2013-09-01

    The Malaysian Clinical Practice Guidelines (CPG) for Management of Dementia (second edition) was launched in April 2010 by the Ministry of Health Malaysia. A training programme for the management of dementia, involving all categories of staff working at primary and secondary centres, was implemented to ensure that care delivery for people with dementia was in accordance with the guidelines. The study aimed to look into improving knowledge and understanding of dementia following training, and to evaluate the effectiveness of the training programme using a clinical audit indicator recommended in the guidelines. The study entailed 2 phases (at national and state levels). The first phase involved the CPG training programme run as a 1.5-day workshop, in which participants filled up pre- and post-workshop questionnaires. A second phase involved analysing all the referral letters to the memory clinic at the Hospital Sultan Ismail, Johor Bahru 1 year before and after the training programme. There was a significant improvement in knowledge about dementia and its management among the health care professionals following training. The mean percentage score for the pre-workshop test was 63% while for the post-workshop test it was 78%, giving a difference of 15%. Although there was an overall improvement in knowledge gain following training in both specialist and non-specialist groups, these differences were not statistically significant (t = 1.32; 95% confidence interval, -2.61 to 9.61; p = 0.25). The proportion of referrals with a possible diagnosis of dementia from primary clinic referrals to the memory clinic also increased from 18% to 44% after training. There was an overall improvement in the knowledge about dementia among the health care professionals following the training, which was reflected in the increase in referrals to the memory clinic. Although the initial results appeared to be promising, a multicentre study is warranted to conclude that the training had been

  16. Dietary Guidelines should reflect new understandings about adult protein needs

    Directory of Open Access Journals (Sweden)

    Layman Donald K

    2009-03-01

    Full Text Available Abstract Dietary Guidelines for Americans provide nutrition advice aimed at promoting healthy dietary choices for life-long health and reducing risk of chronic diseases. With the advancing age of the population, the 2010 Dietary Guidelines confront increasing risks for age-related problems of obesity, osteoporosis, type 2 diabetes, Metabolic Syndrome, heart disease, and sarcopenia. New research demonstrates that the meal distribution and amount of protein are important in maintaining body composition, bone health and glucose homeostasis. This editorial reviews the benefits of dietary protein for adult health, addresses omissions in current nutrition guidelines, and offers concepts for improving the Dietary Guidelines.

  17. Aiming for the ordinary

    DEFF Research Database (Denmark)

    Offersen, Sara Marie Hebsgaard

    that the Danes are encouraged to be alert to still earlier and vaguer bodily signs of potential cancer and seek care ‘in time’. With biomedical constructions such as ‘cancer awareness’ and ‘alarm symptoms of cancer’ and the retrospectively oriented definition of life before symptoms-based healthcare seeking...... and articulation of bodily sensations, and how decisions about healthcare seeking are established in this context. This dissertation aims to explore these matters from the perspective of the Danish middle class, mainly focusing on how sensations are ascribed meaning as symptoms and how they are evoked...... on a continuum between what is locally considered ordinary and extraordinary. Overall, the dissertation argues that inquiries into morality and potentiality provide valuable insights into healthcare seeking practices and the making and management of symptoms in everyday life. The dissertation is based on 18...

  18. A review of national health policies and professional guidelines on maternal obesity and weight gain in pregnancy.

    Science.gov (United States)

    Schumann, N L; Brinsden, H; Lobstein, T

    2014-08-01

    Maternal obesity creates an additional demand for health-care services, as the routine obstetric care pathway requires alterations to ensure the most optimal care for obese women of childbearing age. This review examines the extent to which relevant national health documents reflect and respond to the health implications of maternal obesity and excessive gestational weight gain. A targeted search of peer-reviewed publications and grey literature was conducted for each country to identify national health documents, which were subsequently content analyzed according to an adapted framework. A total of 37 documents were identified, including one policy, 10 strategies and 26 guidelines, published within the last 10 years. Out of the 31 countries investigated, only 13 countries address maternal obesity while none address excessive gestational weight gain. We found inconsistencies and gaps in the recommendations to health-care service providers for the management of maternal obesity and weight gain in pregnancy. The findings show that only limited guidance on maternal obesity and gestational weight gain exists. The authors recommend that international, evidence-based guidelines on the management of maternal obesity and excessive gestational weight gain should be developed to reduce the associated health-care and economic costs. © 2014 The Authors. Clinical Obesity © 2014 World Obesity.

  19. Application of the 2013 American College of Cardiology/American Heart Association Cholesterol Guideline to the Korean National Health and Nutrition Examination Surveys from 1998 to 2012

    Directory of Open Access Journals (Sweden)

    Young Shin Song

    2017-01-01

    Full Text Available BackgroundThe 2013 American College of Cardiology/American Heart Association (ACC/AHA guideline for the treatment of blood cholesterol recommends statin therapy for individuals at high risk of atherosclerotic cardiovascular disease (ASCVD. The aim of this study was to investigate serial trends in the percentages of Korean adults considered eligible for statin therapy according to the new ACC/AHA cholesterol guideline.MethodsData from the Korean National Health and Nutrition Examination Survey (KNHANES I (1998, n=7,698, II (2001, n=5,654, III (2005, n=5,269, IV (2007 to 2009, n=15,727, and V (2010 to 2012, n=16,304, which used a stratified, multistage, probability sampling design, were used as representative of the entire Korean population.ResultsThe percentage of adults eligible for statin therapy according to the ACC/AHA cholesterol guideline increased with time: 17.0%, 19.0%, 20.8%, 20.2%, and 22.0% in KNHANES I, II, III, IV, and V, respectively (P=0.022. The prevalence of ASCVD was 1.4% in KNHANES I and increased to 3.3% in KNHANES V. The percentage of diabetic patients aged 40 to 75 years with a low density lipoprotein cholesterol levels of 70 to 189 mg/dL increased from 4.8% in KNHANES I to 6.1% in KNHANES V. People with an estimated 10-year ASCVD risk ≥7.5% and aged 40 to 75 years accounted for the largest percentage among the four statin benefit groups: 9.1% in KNHANES I and 11.0% in KNHANES V.ConclusionApplication of the 2013 ACC/AHA guideline has found that the percentage of Korean adults in the statin benefit groups has increased over the past 15 years.

  20. Canadian soil quality guidelines for the protection of environmental and human health : benzene

    Energy Technology Data Exchange (ETDEWEB)

    Potter, K.

    2005-07-01

    This report presented soil quality guidelines for benzene to protect humans and ecological receptors in 4 types of land uses: agricultural; residential and parklands; commercial and industrial. The chemical and physical properties of benzene were reviewed, as well as the sources and emissions of benzene in Canada. The distribution and behaviour of benzene in the environment was examined, and the toxicological effects of benzene on microbial processes, plants, animals and humans were reviewed. It was noted that the background information and rationale for the derivation of Canadian Soil Quality Guidelines for this substance were originally published in 1999 by the Canadian Council of Ministers of the Environment (CCME) in Canadian Environmental Quality Guidelines. These guidelines have since been revised to reflect new data and lessons learned during the development of the Canada-wide Standard for Petroleum Hydrocarbons in Soil (CCME 2000). Modifications in this report included the derivation of guidelines for different soil textures and depths. Behaviour and effects in biota were reviewed, including soil microbial processes; terrestrial plants; terrestrial invertebrates; livestock and wildlife; and bioaccumulation. Behaviour and effects in humans and mammalian species were examined. The derivation of environmental soil quality guidelines was outlined. Recommendations for Canadian soil quality guidelines were presented. It was concluded that there is a lack of studies on the toxic effects of benzene on livestock, mammalian wildlife and birds and that studies on the metabolism of benzene in mammals and birds as well as invertebrates are needed. In addition, research is needed on the effects of benzene on nitrogen fixation, nitrification, nitrogen mineralization, decomposition and respiration. 118 refs., 3 tabs., 2 figs.

  1. Use of medicines and adherence to standard treatment guidelines in rural community health centers, Timor-Leste.

    Science.gov (United States)

    Higuchi, Michiyo; Okumura, Junko; Aoyama, Atsuko; Suryawati, Sri; Porter, John

    2015-03-01

    The use of medicines and nurses'/midwives' adherence to standard treatment guidelines (STGs) were examined in Timor-Leste during the early stage of the nation's new health system development. A cross-sectional study was conducted as the quantitative element of mixed methods research. Retrospective samples from patient registration books and prospective observations were obtained in 20 randomly selected rural community health centers. The medicines use indicators, in particular the level of injection use, in Timor-Leste did not suggest overprescription. Prescribers with clinical nurse training prescribed significantly fewer antibiotics than those without such training (P < .01). The adjusted odds ratio of prescribing adherence for clinical nurse training, after accounting for confounders and prescriber clustering, was 6.6 (P < .01). STGs for nonphysician health professionals at the primary health care level have potential value in basic health care delivery, including appropriate use of medicines, in resource-limited communities when strategically developed and introduced. © 2012 APJPH.

  2. The Administrative Consensuality and the Preparation of Clinical Protocols and Therapeutic Guidelines Within the Framework of The Public Health System

    Directory of Open Access Journals (Sweden)

    Clarissa Sampaio Silva

    2016-12-01

    Full Text Available This article deals with the need for the Public Administration rescue his decision spaces in relation to the realization of the right to health, as opposed to excessive judicialization. Based on doctrinal and legislative research seeks to demonstrate that the consensuality, new aspects of administrative action, has importance for the development, under the Public Health System, scientific medical consensus, which recommended observance in statements of the National Justice Council . The increase of social participation in the adoption of those guidelines and the opening of institutional dialogue to discuss certain cases can reduce recourse to the courts.

  3. Do Nutrient-Based Front-of-Pack Labelling Schemes Support or Undermine Food-Based Dietary Guideline Recommendations? Lessons from the Australian Health Star Rating System.

    Science.gov (United States)

    Lawrence, Mark A; Dickie, Sarah; Woods, Julie L

    2018-01-05

    Food-based Dietary Guidelines (FBDGs) promote healthy dietary patterns. Nutrient-based Front-of-Pack Labelling (NBFOPL) schemes rate the 'healthiness' of individual foods. This study aimed to investigate whether the Australian Health Star Rating (HSR) system aligns with the Australian Dietary Guidelines (ADGs). The Mintel Global New Products Database was searched for every new food product displaying a HSR entering the Australian marketplace from 27 June 2014 (HSR system endorsement) until 30 June 2017. Foods were categorised as either a five food group (FFG) food or 'discretionary' food in accordance with ADG recommendations. Ten percent (1269/12,108) of new food products displayed a HSR, of which 57% were FFG foods. The median number of 'health' stars displayed on discretionary foods (2.5; range: 0.5-5) was significantly lower ( p stars across the two food categories was observed, with 56.7% of discretionary foods displaying ≥2.5 stars. The HSR system is undermining the ADG recommendations through facilitating the marketing of discretionary foods. Adjusting the HSR's algorithm might correct certain technical flaws. However, supporting the ADGs requires reform of the HSR's design to demarcate the food source (FFG versus discretionary food) of a nutrient.

  4. [Aiming for zero blindness].

    Science.gov (United States)

    Nakazawa, Toru

    2015-03-01

    -independent factors, as well as our investigation of ways to improve the clinical evaluation of the disease. Our research was prompted by the multifactorial nature of glaucoma. There is a high degree of variability in the pattern and speed of the progression of visual field defects in individual patients, presenting a major obstacle for successful clinical trials. To overcome this, we classified the eyes of glaucoma patients into 4 types, corresponding to the 4 patterns of glaucomatous optic nerve head morphology described: by Nicolela et al. and then tested the validity of this method by assessing the uniformity of clinical features in each group. We found that in normal tension glaucoma (NTG) eyes, each disc morphology group had a characteristic location in which the loss of circumpapillary retinal nerve fiber layer thickness (cpRNFLT; measured with optical coherence tomography: OCT) was most likely to occur. Furthermore, the incidence of reductions in visual acuity differed between the groups, as did the speed of visual field loss, the distribution of defective visual field test points, and the location of test points that were most susceptible to progressive damage, measured by Humphrey static perimetry. These results indicate that Nicolela's method of classifying eyes with glaucoma was able to overcome the difficulties caused by the diverse nature of the disease, at least to a certain extent. Building on these findings, we then set out to identify sectors of the visual field that correspond to the distribution of retinal nerve fibers, with the aim of detecting glaucoma progression with improved sensitivity. We first mapped the statistical correlation between visual field test points and cpRNFLT in each temporal clock-hour sector (from 6 to 12 o'clock), using OCT data from NTG patients. The resulting series of maps allowed us to identify areas containing visual field test points that were prone to be affected together as a group. We also used a similar method to identify visual

  5. The US Public Health Service "treating tobacco use and dependence clinical practice guidelines" as a legal standard of care.

    Science.gov (United States)

    Torrijos, Randy M; Glantz, Stanton A

    2006-12-01

    The important factors in evaluating the role of clinical practice guidelines (CPGs) in medical malpractice litigation have been discussed for several years, but have focused on broad policy implications rather than on a concrete example of how an actual guideline might be evaluated. There are four items that need to be considered in negligence torts: legal duty, a breach of that duty, causal relationship between breach and injury, and damages. To identify the arguments related to legal duty. The Treating Tobacco Use and Dependence (revised 2000) CPG, sponsored by the US Public Health Service, recommends effective and inexpensive treatments for nicotine addiction, the largest preventable cause of death in the US, and can be used as an example to focus on important considerations about the appropriateness of CPGs in the judicial system. Furthermore, the failure of many doctors and hospitals to deal with tobacco use and dependence raises the question of whether this failure could be considered malpractice, given the Public Health Service guideline's straightforward recommendations, their efficacy in preventing serious disease and cost-effectiveness. Although each case of medical malpractice depends on a multitude of factors unique to individual cases, a court could have sufficient basis to find that the failure to adequately treat the main cause of preventable disease and death in the US qualifies as a violation of the legal duty that doctors and hospitals owe to patients habituated to tobacco use and dependence.

  6. Does the Accountable Care Act Aim to Promote Quality, Health, and Control Costs or Has It Missed the Mark? ;Comment on “Health System Reform in the United States”

    Directory of Open Access Journals (Sweden)

    Carol Molinari

    2014-02-01

    Full Text Available McDonough’s perspective on healthcare reform in the US provides a clear, coherent analysis of the mix of access and delivery reforms in the Affordable Care Act (ACA aka Obamacare. As noted by McDonough, this major reform bill is designed to expand access for health coverage that includes both prevention and treatment benefits among uninsured Americans. Additionally, this legislation includes several financial strategies (e.g. incentives and penalties to improve care coordination and quality in the hospital and outpatient settings while also reducing healthcare spending and costs. This commentary is intended to discuss this mix of access and delivery reform in terms of its potential to achieve the Triple Aim: population health, quality, and costs. Final remarks will include the role of the US federal government to reform the American private health industry together with that of an informed consumer.

  7. Meta-regression analyses to explain statistical heterogeneity in a systematic review of strategies for guideline implementation in primary health care.

    Directory of Open Access Journals (Sweden)

    Susanne Unverzagt

    Full Text Available This study is an in-depth-analysis to explain statistical heterogeneity in a systematic review of implementation strategies to improve guideline adherence of primary care physicians in the treatment of patients with cardiovascular diseases. The systematic review included randomized controlled trials from a systematic search in MEDLINE, EMBASE, CENTRAL, conference proceedings and registers of ongoing studies. Implementation strategies were shown to be effective with substantial heterogeneity of treatment effects across all investigated strategies. Primary aim of this study was to explain different effects of eligible trials and to identify methodological and clinical effect modifiers. Random effects meta-regression models were used to simultaneously assess the influence of multimodal implementation strategies and effect modifiers on physician adherence. Effect modifiers included the staff responsible for implementation, level of prevention and definition pf the primary outcome, unit of randomization, duration of follow-up and risk of bias. Six clinical and methodological factors were investigated as potential effect modifiers of the efficacy of different implementation strategies on guideline adherence in primary care practices on the basis of information from 75 eligible trials. Five effect modifiers were able to explain a substantial amount of statistical heterogeneity. Physician adherence was improved by 62% (95% confidence interval (95% CI 29 to 104% or 29% (95% CI 5 to 60% in trials where other non-medical professionals or nurses were included in the implementation process. Improvement of physician adherence was more successful in primary and secondary prevention of cardiovascular diseases by around 30% (30%; 95% CI -2 to 71% and 31%; 95% CI 9 to 57%, respectively compared to tertiary prevention. This study aimed to identify effect modifiers of implementation strategies on physician adherence. Especially the cooperation of different health

  8. Physical Activity Patterns in University Students: Do They Follow the Public Health Guidelines?

    Science.gov (United States)

    Clemente, Filipe Manuel; Nikolaidis, Pantelis Theodoros; Martins, Fernando Manuel Lourenço; Mendes, Rui Sousa

    2016-01-01

    Physical activity is associated with health. The aim of this study was (a) to access if Portuguese university students meet the public health recommendations for physical activity and (b) the effect of gender and day of the week on daily PA levels of university students. This observational cross-sectional study involved 126 (73 women) healthy Portuguese university students aged 18–23 years old. Participants wore the ActiGraph wGT3X-BT accelerometer for seven consecutive days. Number of steps, time spent sedentary and in light, moderate and vigorous physical activity were recorded. The two-way MANOVA revealed that gender (p-value = 0.001; η2 = 0.038; minimum effect) and day of the week (p-value = 0.001; η2 = 0.174; minimum effect) had significant main effects on the physical activity variables. It was shown that during weekdays, male students walked more steps (65.14%), spent less time sedentary (6.77%) and in light activities (3.11%) and spent more time in moderate (136.67%) and vigorous activity (171.29%) in comparison with weekend days (p activities during weekdays than in weekend days (p physical activity in this population, focusing on the change of sedentary behaviour. PMID:27022993

  9. The evolution of health policy guidelines for assisted reproduction in the Republic of Ireland, 2004-2009

    LENUS (Irish Health Repository)

    Walsh, David J

    2011-06-24

    Abstract This analysis reports on Irish regulatory policies for in vitro fertilisation (IVF) from 2004-2009, in the context of membership changes within the Medical Council of Ireland. To achieve this, the current (2009) edition of the Guide to Professional Conduct & Ethics was compared with the immediately preceding version (2004). The statutory composition of the Medical Council from 2004-2009 was also studied. Content analysis of the two editions identified the following differences: 1) The 2004 guide states that IVF "should only be used after thorough investigation has failed to reveal a treatable cause of the infertility", while the 2009 guide indicates IVF "should only be used after thorough investigation has shown that no other treatment is likely to be effective"; 2) The 2004 stipulation stating that fertilized ovum (embryo) "must be used for normal implantation and must not be deliberately destroyed" is absent from the 2009 guidelines; 3) The option to donate "unused fertilised ova" (embryos) is omitted from the 2009 guidelines; 4) The 2009 guidelines state that ART should be offered only by "suitably qualified professionals, in appropriate facilities, and according to the international best practice"; 5) The 2009 guidelines introduce criteria that donations as part of a donor programme should be "altruistic and non-commercial". These last two points represent original regulatory efforts not appearing in the 2004 edition. The Medical Practitioners Act 2007 reduced the number of physicians on the Medical Council to 6 (of 25) members. The ethical guidelines from 2004 preceded this change, while the reconstituted Medical Council published the 2009 version. Between 2004 and 2009, substantial modifications in reproductive health policy were incorporated into the Medical Council\\'s ethical guidelines. The absence of controlling Irish legislation means that patients and IVF providers in Ireland must rely upon these guidelines by default. Our critique traces the

  10. The evolution of health policy guidelines for assisted reproduction in the Republic of Ireland, 2004-2009.

    Science.gov (United States)

    Walsh, David J; Ma, Mary L; Sills, Eric Scott

    2011-06-24

    This analysis reports on Irish regulatory policies for in vitro fertilisation (IVF) from 2004-2009, in the context of membership changes within the Medical Council of Ireland. To achieve this, the current (2009) edition of the Guide to Professional Conduct & Ethics was compared with the immediately preceding version (2004). The statutory composition of the Medical Council from 2004-2009 was also studied. Content analysis of the two editions identified the following differences: 1) The 2004 guide states that IVF "should only be used after thorough investigation has failed to reveal a treatable cause of the infertility", while the 2009 guide indicates IVF "should only be used after thorough investigation has shown that no other treatment is likely to be effective"; 2) The 2004 stipulation stating that fertilized ovum (embryo) "must be used for normal implantation and must not be deliberately destroyed" is absent from the 2009 guidelines; 3) The option to donate "unused fertilised ova" (embryos) is omitted from the 2009 guidelines; 4) The 2009 guidelines state that ART should be offered only by "suitably qualified professionals, in appropriate facilities, and according to the international best practice"; 5) The 2009 guidelines introduce criteria that donations as part of a donor programme should be "altruistic and non-commercial". These last two points represent original regulatory efforts not appearing in the 2004 edition. The Medical Practitioners Act 2007 reduced the number of physicians on the Medical Council to 6 (of 25) members. The ethical guidelines from 2004 preceded this change, while the reconstituted Medical Council published the 2009 version. Between 2004 and 2009, substantial modifications in reproductive health policy were incorporated into the Medical Council's ethical guidelines. The absence of controlling Irish legislation means that patients and IVF providers in Ireland must rely upon these guidelines by default. Our critique traces the evolution

  11. Factors affecting health care workers' adoption of a website with infection control guidelines

    NARCIS (Netherlands)

    Verhoeven, F.; Steehouder, M.F.; Hendrix, Ron M.G.; van Gemert-Pijnen, Julia E.W.C.

    2009-01-01

    In total, 20 semi-structured interviews were conducted with HCWs in 5 different occupational groups and 4 different hospitals in the Netherlands and Germany. A website communicating guidelines for the prevention and control of Methicillin Resistant Staphylococcus aureus served as a casus. The HCWs,

  12. Social media in health care: benefits, concerns, and guidelines for use.

    Science.gov (United States)

    Suby, ChrysMarie

    2013-01-01

    The use of social media and other electronic communication has exploded as the number of social media outlets and applications continue to increase. These are exciting and valuable tools when used wisely, but pose risks when inappropriately used. The purpose of this article is to consider what comprises social media, its benefits and concerns, and guidelines for use that protect patients, employees, and organizations.

  13. Efficacy of World Health Organization guideline in facility-based reduction of mortality in severely malnourished children from low and middle income countries: A systematic review and meta-analysis.

    Science.gov (United States)

    Hossain, Muttaquina; Chisti, Mohammod J; Hossain, Mohammod Iqbal; Mahfuz, Mustafa; Islam, Mohammad Munirul; Ahmed, Tahmeed

    2017-05-01

    Globally more than 19 million under-five children suffer from severe acute malnutrition (SAM). Data on efficacy of World Health Organization's (WHO's) guideline in reducing SAM mortality are limited. We aimed to assess the efficacy of WHO's facility-based guideline for the reduction of under-five SAM children mortality from low and middle income countries (LMICs). A systematic search of literature published in 1980-2015 was conducted using electronic databases. Additional articles were identified from the reference lists and grey literature. Studies from LMICs where SAM children (0-59 months) were managed in facilities according to WHO's guideline were included. Outcome was reduction in SAM mortality measured by case fatality rate (CFR). The review was reported following the Grading of Recommendations Assessment Development and Evaluation and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and meta-analyses done using RevMan 5.3®. This review identified nine studies, which demonstrated reductions in SAM mortality. CFR ranged from 8 to 16% where WHO guideline applied. High rates of poverty, malnutrition, severe co-morbid condition, lack of resources and differences in treatment practices played a key role in large CFR variation. Most death occurred within 48 h of admission in Asia, between 4 days and 4 weeks in Africa and in Latin America. CFR was reduced by 41% (odds ratio: 0.59; 95% confidence interval: 0.46-0.76) when WHO guideline were applied. A 45% reduction in CFR was achieved after excluding human immunodeficiency virus positive cases. Dietary management also differed among WHO and conventional management. Children receiving SAM inpatient care as per WHO guideline have reduced CFR compared to conventional treatment. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  14. Revised dietary guidelines for Koreans.

    Science.gov (United States)

    Jang, Young Ai; Lee, Haeng Shin; Kim, Bok Hee; Lee, Yoonna; Lee, Hae Jeung; Moon, Jae Jin; Kim, Cho-il

    2008-01-01

    With rapidly changing dietary environment, dietary guidelines for Koreans were revised and relevant action guides were developed. First, the Dietary Guidelines Advisory Committee was established with experts and government officials from the fields of nutrition, preventive medicine, health promotion, agriculture, education and environment. The Committee set dietary goals for Koreans aiming for a better nutrition state of all after a thorough review and analysis of recent information related to nutritional status and/or problems of Korean population, changes in food production/supply, disease pattern, health policy and agricultural policy. Then, the revised dietary guidelines were proposed to accomplish these goals in addition to 6 different sets of dietary action guides to accommodate specific nutrition and health problems of respective age groups. Subsequently, these guidelines and guides were subjected to the focus group review, consumer perception surveys, and a public hearing for general and professional comments. Lastly, the language was clarified in terms of public understanding and phraseology. The revised Dietary guidelines for Koreans are as follows: eat a variety of grains, vegetables, fruits, fish, meat, poultry and dairy products; choose salt-preserved foods less, and use less salt when you prepare foods; increase physical activity for a healthy weight, and balance what you eat with your activity; enjoy every meal, and do not skip breakfast; if you drink alcoholic beverages, do so in moderation; prepare foods properly, and order sensible amounts; enjoy our rice-based diet.

  15. AIDS guidelines.

    Science.gov (United States)

    Berger, R

    1986-04-30

    The Sun article, "Employers finding that AIDS in the workplace is a managerial nightmare" (April 3), did not accurately portray the status of AIDS in the workplace. The AIDS virus, HTLV III, is transmitted by body fluids, primarily semen and blood, and there is no known risk of transmitting the virus by casual contact in the workplace. The Center for Disease Control (CDC) released guidelines for child care workers last August. Guidelines on preventing transmission of AIDS in the workplace were issued by CDC in November 1985. These guidelines specifically discussed health care, personal service, and food service workers. The recommendations were against routine screening. Furthermore, employment should not be restricted on the basis of a positive HTLV III antibody test. A person with HTLV III infection should be exempt from the workplace only if there are circumstances interfering with job performance. In Maryland, the Governor's Task Force on AIDS has gone on record as endorsing CDC guidelines related to employment. Furthermore, the task force condemns discrimination based on the disease AIDS, AIDS Related Complex (ARC), or HTLV III infection. Increasingly AIDS patients are being considered legally disabled and therefore are protected by federal and state laws prohibiting discrimination on the basis of a handicap. Marylanders who are subjected to mandatory HTLV III screening in the workplace, or if discriminated against on the basis of HTLV III inefction, should contact the Maryland Commission on Human Relations, the Maryland Department of Health and Mental Hygiene, or the Health Education Resource Organization (HERO). All 3 of these resources guarantee confidentiality. It is only by employees reporting incidents that a nightmare in the workplace can be avoided in Maryland. full text

  16. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)--explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force.

    Science.gov (United States)

    Husereau, Don; Drummond, Michael; Petrou, Stavros; Carswell, Chris; Moher, David; Greenberg, Dan; Augustovski, Federico; Briggs, Andrew H; Mauskopf, Josephine; Loder, Elizabeth

    2013-01-01

    Economic evaluations of health interventions pose a particular challenge for reporting because substantial information must be conveyed to allow scrutiny of study findings. Despite a growth in published reports, existing reporting guidelines are not widely adopted. There is also a need to consolidate and update existing guidelines and promote their use in a user-friendly manner. A checklist is one way to help authors, editors, and peer reviewers use guidelines to improve reporting. The task force's overall goal was to provide recommendations to optimize the reporting of health economic evaluations. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines into one current, useful reporting guidance. The CHEERS Elaboration and Explanation Report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force facilitates the use of the CHEERS statement by providing examples and explanations for each recommendation. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication. The need for new reporting guidance was identified by a survey of medical editors. Previously published checklists or guidance documents related to reporting economic evaluations were identified from a systematic review and subsequent survey of task force members. A list of possible items from these efforts was created. A two-round, modified Delphi Panel with representatives from academia, clinical practice, industry, and government, as well as the editorial community, was used to identify a minimum set of items important for reporting from the larger list. Out of 44 candidate items, 24 items and accompanying recommendations were developed, with some specific recommendations for single study-based and model-based economic evaluations. The final

  17. Employing the church as a marketer of cancer prevention: a look at a health promotion project aimed to reduce colorectal cancer among African Americans in the Midwest.

    Science.gov (United States)

    Lumpkins, Crystal Y; Coffey, Candice R; Daley, Christine M; Greiner, K Allen

    2013-01-01

    Health promotion programs designed to address colorectal cancer disparities among African Americans are increasing. Unfortunately, this group still shoulders a disproportionate mortality burden in the United States; these numbers are also reflective of colorectal cancer (CRC) disparities in the Midwest. The purpose of this study was to extrapolate results from in-depth interviews and brief surveys on the effectiveness of the church as a social marketer of CRC-prevention messages. Results show that pastors believe the congregation has limited knowledge about CRC risk and prevention; they also believe the church can improve cancer-prevention communication among members and those affiliated with the church.

  18. Incidence estimate and guideline-oriented treatment for post-stroke spasticity: an analysis based on German statutory health insurance data

    Directory of Open Access Journals (Sweden)

    Egen-Lappe V

    2013-03-01

    Full Text Available Veronika Egen-Lappe, Ingrid Köster, Ingrid SchubertPMV Research Group, Department of Child and Adolescence Psychiatry and Psychotherapy, University of Cologne, Cologne, GermanyBackground: Spasticity after stroke has been internationally recognized as an important health problem causing impairment of mobility, deformity, and pain. The aim of this study was to assess the frequency of first-ever and recurrent stroke and of subsequent spastic and flaccid paresis. Factors influencing the development of spasticity were analyzed. A further major aim was to provide a "real-life" assessment of the treatment of spasticity in Germany and to discuss this in view of the treatment recommended by German and international clinical guidelines.Methods: The database used in this study comprised a cohort of 242,090 insurants from a large statutory health insurance fund in the federal state of Hesse, Germany. A first hospital discharge diagnosis in 2009 with any of the International Classification of Diseases, Tenth Revision (ICD-10 codes I60–I64 was used to identify patients with acute stroke (hemorrhage and ischemic. These patients were followed up six months after stroke to monitor whether they developed spastic or flaccid paresis (hospital or ambulatory care diagnoses ICD-10 code G81–G83 [excluding G82.6/G83.4/G83.8]. For patients with spastic paresis after stroke the spasticity treatment was analyzed for a six-month period (physiotherapy, oral muscle relaxants, intrathecal baclofen, and botulinum toxin.Results: Standardized to the population of Germany, 3.7 per 1000 persons suffered a stroke in 2009 (raw 5.2/1000. Of all surviving patients, 10.2% developed spasticity within 6 months. Cox regression revealed no significant influence of patient age, gender, morbidity (diabetes, hypertensive diseases, ischemic heart diseases or type of stroke on development of spasticity. 97% of surviving patients with spasticity received physiotherapy (inpatient care 89

  19. Workplace programmes for HIV and tuberculosis: a systematic review to support development of international guidelines for the health workforce.

    Science.gov (United States)

    Yassi, Annalee; O'Hara, Lyndsay M; Lockhart, Karen; Spiegel, Jerry M

    2013-01-01

    The health service sector has a vital role to play in delivering human immunodeficiency virus (HIV) and tuberculosis (TB) prevention, treatment and care, yet evidence indicates that healthcare workers (HCWs) themselves lack adequate access to HIV and TB services. HCWs are also at increased risk from TB and other infectious diseases at work, and therefore accessing HIV services is particularly important. A systematic review was therefore conducted to inform the development of World Health Organization (WHO) guidelines to improve access to HIV and TB services, and specifically, to assess the evidence regarding providing such services through workplace-based programmes. We identified any study published since 1984 that addressed outcomes of interest as defined through multi-stakeholder consultations, and were related to workplace interventions in (1) the healthcare workplace and (2) any workplace that included HIV and/or TB diagnosis and/or treatment. Interventions focusing solely on primary prevention with no diagnostic or treatment services were excluded, as they were the subject of other guidelines. A minimum of two reviewers independently extracted data and assessed the articles against pre-set selection criteria; studies were also profiled and quality assessed by a minimum of two reviewers. Three studies met these criteria specifically for HCWs; all showed a preponderance of positive benefits, with minimal negative outcome. Seven studies met these criteria regarding workplace HIV and/or TB diagnosis and/or treatment from other sectors, public or private. Again, all showed positive results. The paucity of high-quality evidence in this field of research was itself an important finding, beckoning further research on workplace-based programmes for health workers. Nonetheless, while more well-designed intervention studies are definitely desirable, providing programmes for HCWs to obtain HIV and TB diagnosis and treatment at the workplace is supported by the literature

  20. National Institute for Health and Care Excellence updates the stable chest pain guideline with radical changes to the diagnostic paradigm.

    Science.gov (United States)

    Timmis, Adam; Roobottom, Carl A

    2017-07-01

    In the 2016 update of the stable chest pain guideline, the National Institute for Health and Care Excellence (NICE) has made radical changes to the diagnostic paradigm that it-like other international guidelines-had previously placed at the centre of its recommendations. No longer are quantitative assessments of the disease probability considered necessary to determine the need for diagnostic testing and the choice of test. Instead, the recommendation is for no diagnostic testing if chest pain is judged to be 'non-anginal' and CT coronary angiography (CTCA) in patients with 'typical' or 'atypical' chest pain with additional perfusion imaging only if there is uncertainty about the functional significance of coronary lesions. The new emphasis on anatomical-as opposed to functional-testing is driven in large part by cost-effectiveness analysis and despite inevitable resource implications NICE calculates that annual savings for the population of England will be significant. In making CTCA the default diagnostic testing strategy in its updated chest pain guideline, NICE has responded emphatically to calls from trialists for CTCA to have a greater role in the diagnostic pathway of patients with suspected angina. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Adherence to Guidelines for Cancer Survivors and Health-Related Quality of Life among Korean Breast Cancer Survivors

    Directory of Open Access Journals (Sweden)

    Sihan Song

    2015-12-01

    Full Text Available There is limited evidence on the association between adherence to guidelines for cancer survivors and health-related quality of life (HRQoL. In a cross-sectional study of Korean breast cancer survivors, we examined whether adherence to the guidelines of the American Cancer Society (ACS and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR for cancer survivors was related to levels of HRQoL, assessed by the Korean version of Core 30 (C30 and Breast cancer module 23 (BR23 of the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire (EORTC-QLQ. We included a total of 160 women aged 21 to 79 years who had been diagnosed with breast cancer according to American Joint Committee on Cancer (AJCC stages I to III and had breast cancer surgery at least six months before the interview. Increasing adherence to ACS guidelines was associated with higher scores of social functioning (p for trend = 0.05, whereas increasing adherence to WCRF/AICR recommendations was associated with higher scores of arm symptoms (p for trend = 0.01. These associations were limited to those with stage II or III cancer. Diet may be an important factor in relation to quality of life among Korean breast cancer survivors, however our findings warrant further prospective studies to evaluate whether healthy diet improves survivors’ quality of life.

  2. Improving Aboriginal maternal and infant health services in the 'Top End' of Australia; synthesis of the findings of a health services research program aimed at engaging stakeholders, developing research capacity and embedding change.

    Science.gov (United States)

    Barclay, Lesley; Kruske, Sue; Bar-Zeev, Sarah; Steenkamp, Malinda; Josif, Cathryn; Narjic, Concepta Wulili; Wardaguga, Molly; Belton, Suzanne; Gao, Yu; Dunbar, Terry; Kildea, Sue

    2014-06-02

    Health services research is a well-articulated research methodology and can be a powerful vehicle to implement sustainable health service reform. This paper presents a summary of a five-year collaborative program between stakeholders and researchers that led to sustainable improvements in the maternity services for remote-dwelling Aboriginal women and their infants in the Top End (TE) of Australia. A mixed-methods health services research program of work was designed, using a participatory approach. The study area consisted of two large remote Aboriginal communities in the Top End of Australia and the hospital in the regional centre (RC) that provided birth and tertiary care for these communities. The stakeholders included consumers, midwives, doctors, nurses, Aboriginal Health Workers (AHW), managers, policy makers and support staff. Data were sourced from: hospital and health centre records; perinatal data sets and costing data sets; observations of maternal and infant health service delivery and parenting styles; formal and informal interviews with providers and women and focus groups. Studies examined: indicator sets that identify best care, the impact of quality of care and remoteness on health outcomes, discrepancies in the birth counts in a range of different data sets and ethnographic studies of 'out of hospital' or health centre birth and parenting. A new model of maternity care was introduced by the health service aiming to improve care following the findings of our research. Some of these improvements introduced during the five-year research program of research were evaluated. Cost effective improvements were made to the acceptability, quality and outcomes of maternity care. However, our synthesis identified system-wide problems that still account for poor quality of infant services, specifically, unacceptable standards of infant care and parent support, no apparent relationship between volume and acuity of presentations and staff numbers with the

  3. Diet quality: associations with health messages included in the Danish Dietary Guidelines 2005, personal attitudes and social factors

    DEFF Research Database (Denmark)

    Biltoft-Jensen, Anja Pia; Groth, Margit Velsing; Matthiessen, Jeppe

    2009-01-01

    Objective: To Study the association between diet quality and the new health messages in the Danish Dietary Guidelines 2005, i.e. 'Eat a varied diet', 'Engage in regular physical activity' and 'Maintain a healthy body weight'. Design/setting/subjects: The study was cross-sectional, comprising a ra...... with healthy eating. The dietary habits reported were strongly influenced by personal intentions. Thus, the biggest challenge for public health nutritionists will be to reach non-compliers who seldom have intentions to eat healthily.......Objective: To Study the association between diet quality and the new health messages in the Danish Dietary Guidelines 2005, i.e. 'Eat a varied diet', 'Engage in regular physical activity' and 'Maintain a healthy body weight'. Design/setting/subjects: The study was cross-sectional, comprising...... a random sample of 3151 Danish adults aged 18-75 years. Dietary intake was estimated using a 7 d pre-coded food diary. information on social background, leisure-time physical activity, height, body weight and intention to eat healthily was Obtained by in-person interviews. Logistic regression models Were...

  4. Competitive service centers location in the cities with aim to reduce traffic (Case study: Health centers location in the city if Isfahan

    Directory of Open Access Journals (Sweden)

    Hamid Moradi

    2011-03-01

    Full Text Available Abstract   Distribution of goods and services in cities is of utmost importance. Selecting appropriate venues for different service centers in a city not only enables the citizens to access these services much more easily, but also reduces the traffic load caused by trips made to reach them. Unfortunately, the lack of a correct urban planning has led to inappropriate formation of many cities around the world in terms of the locations assumed for different service centers. Since the private sector has been given the responsibility to construct most of these centers, changing their current locations may be restricted due to legal obligations. Therefore, it seems necessary for the government to construct new service centers with high competitive facilities to attract customers and to compete with those built by the private sector. In this paper, the selection of appropriate locations to construct new service centers has been studied. Such locations have been selected in a way to fulfill goals such as rapid and easy accessibility for the customers and reduction of traffic drawbacks caused by the related trips. In this regard, a model for service centers with restricted capacity has been designed and a parallel simulated annealing algorithm has been proposed to solve it. Finally, the proposed algorithm has been utilized to locate the health centers around the city of Isfahan and its efficiency has been investigated. The findings highlight the accuracy and speed of the proposed algorithm in location of the health centers of Isfahan.

  5. Innovation routes and evidence guidelines for eHealth small and medium-sized enterprises

    NARCIS (Netherlands)

    Lianne Bodenstaff; Ruud Janssen; Robbert Menko; Irene Krediet; Hilco Prins; Timber Haaker; Sikke Visser; Marike Hettinga

    2013-01-01

    eHealth applications hold many promises, for instance to improve the quality of health care, to increase its accessibility, or to reduce its cost. Yet, many eHealth innovations never reach the stage where they get embedded into routine health care. This is due in part to a lack of evidence that

  6. A new method for setting guidelines to protect human health from agricultural exposure by using chlorpyrifos as an example

    Directory of Open Access Journals (Sweden)

    Dung Tri Phung

    2015-05-01

    Full Text Available Introduction and objectives. Guidelines set by various agencies for the control and management of chlorpyrifos cover a wide range of values reflecting difficulties in the procedures for their development. To overcome these difficulties a new method to set guidelines would be developed. Published data derived from epidemiological investigations on human populations would be used to develop a dose-response relationship for chlorpyrifos allowing the calculation of threshold values which can be used as guidelines. Materials and Method. Data from the scientific literature on human populations were collected to evaluate the adverse response doses for a range of health effects. The Cumulative Frequency Distribution (CFD for the minimum levels of adverse effects measured in terms of the Lifetime Average Daily Dose (LADD[sub]D[/sub] and the Absorbed Daily Dose for neurological (ADD[sub]DN[/sub] and non-neurological effects were used. Results. Linear regression equations were fitted to the CFD plots giving R 2 values of 0.93 and 0.86 indicating a normal distribution of the data. Using these CFD plots, the chronic and acute threshold values were calculated at the 5% cumulative frequency level for chlorpyrifos exposure giving values at 0.5 µg/kg/d and 3 µg/kg/d respectively. Conclusions. Guidelines set using this technique at the values at 0.5 µg/kg/d and 3 µg/kg/d for chronic and acute exposure respectively provide an alternative to the currently used biological endpoint and safety factor method.

  7. The interplay between policy guidelines and local dynamics in shaping the scope of networks: the experience of the Italian Departments of Mental Health.

    Science.gov (United States)

    Compagni, Amelia; Gerzeli, Simone; Bergamaschi, Mara

    2011-02-01

    In the mental health field, the creation of networks that can guarantee the smooth coordination of services and organizations across sectors is a priority in the policy agenda of several countries. In Italy, Departments of Mental Health (DMHs) have been designated responsible for the system of specialist mental health services, and also mandated as the conveners and leaders of interorganizational and cross-sectoral networks, by a system-wide reform. This study aims to understand how mental health networks have been assembled in this context and the factors and motivations that have shaped their scope. By combining an analysis of policies with a survey of DMH directors, we have determined that DMHs have preferentially formed collaborative relationships with social service providers (local governments) and the voluntary sector. In contrast, relationships with substance abuse and addiction services and primary care providers were weak and stifled by a lack of trust and by conflict about respective contributions to mental care. We explore the reasons for this selectivity in interorganizational relationships and propose that a lack of targeted incentives in policy guidelines, on the one hand, and the existence of a mandated network leadership, on the other, have led to a rather narrow range of collaborations.

  8. Is the time right for quantitative public health guidelines on sitting? A narrative review of sedentary behaviour research paradigms and findings.

    Science.gov (United States)

    Stamatakis, Emmanuel; Ekelund, Ulf; Ding, Ding; Hamer, Mark; Bauman, Adrian E; Lee, I-Min

    2018-06-10

    Sedentary behaviour (SB) has been proposed as an 'independent' risk factor for chronic disease risk, attracting much research and media attention. Many countries have included generic, non-quantitative reductions in SB in their public health guidelines and calls for quantitative SB targets are increasing. The aim of this narrative review is to critically evaluate key evidence areas relating to the development of guidance on sitting for adults. We carried out a non-systematic narrative evidence synthesis across seven key areas: (1) definition of SB, (2) independence of sitting from physical activity, (3) use of television viewing as a proxy of sitting, (4) interpretation of SB evidence, (5) evidence on 'sedentary breaks', (6) evidence on objectively measured sedentary SB and mortality and (7) dose response of sitting and mortality/cardiovascular disease. Despite research progress, we still know little about the independent detrimental health effects of sitting, and the possibility that sitting is mostly the inverse of physical activity remains. Unresolved issues include an unclear definition, inconsistencies between mechanistic and epidemiological studies, over-reliance on surrogate outcomes, a very weak epidemiological evidence base to support the inclusion of 'sedentary breaks' in guidelines, reliance on self-reported sitting measures, and misinterpretation of data whereby methodologically inconsistent associations are claimed to be strong evidence. In conclusion, public health guidance requires a consistent evidence base but this is lacking for SB. The development of quantitative SB guidance, using an underdeveloped evidence base, is premature; any further recommendations for sedentary behaviour require development of the evidence base and refinement of the research paradigms used in the field. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise

  9. Outcomes of biomarker feedback on physical activity, eating habits, and emotional health: from the Americans in Motion-Healthy Intervention (AIM-HI) study.

    Science.gov (United States)

    Mitchell, Nia S; Manning, Brian K; Staton, Elizabeth W; Emsermann, Caroline D; Dickinson, L Miriam; Pace, Wilson D

    2014-01-01

    The purpose of this article was to test whether physical activity, healthy eating, and emotional well-being would improve if patients received feedback about biomarkers that have been shown to be responsive to changes in weight and fitness. Patients were randomized to limited feedback (weight, body mass index [BMI], and blood pressure at 4 and 10 months) or enhanced feedback (weight, BMI, blood pressure, homeostatic insulin resistance, and nuclear magnetic resonance lipoprotein profiles at 2, 4, 7, and 10 months). Repeated measures mixed effects multivariate regression models were used to determine whether BMI, fitness, diet, and quality of life changed over time. Major parameters were similar in both groups at baseline. BMI, measures of fitness, healthy eating, quality of life, and health state improved in both patient groups, but there was no difference between patient groups at 4 or 10 months. Systolic blood pressure improved in the enhanced feedback group, and there was a difference between the enhanced and limited feedback groups at 10 months (95% confidence interval, -6.011 to -0.5113). Providing patients with enhanced feedback did not dramatically change outcomes. However, across groups, many patients maintained or lost weight, suggesting the need for more study of nondiet interventions.

  10. Information and Communication Technologies for the Dissemination of Clinical Practice Guidelines to Health Professionals: A Systematic Review.

    Science.gov (United States)

    De Angelis, Gino; Davies, Barbara; King, Judy; McEwan, Jessica; Cavallo, Sabrina; Loew, Laurianne; Wells, George A; Brosseau, Lucie

    2016-11-30

    The transfer of research knowledge into clinical practice can be a continuous challenge for researchers. Information and communication technologies, such as websites and email, have emerged as popular tools for the dissemination of evidence to health professionals. The objective of this systematic review was to identify research on health professionals' perceived usability and practice behavior change of information and communication technologies for the dissemination of clinical practice guidelines. We used a systematic approach to retrieve and extract data about relevant studies. We identified 2248 citations, of which 21 studies met criteria for inclusion; 20 studies were randomized controlled trials, and 1 was a controlled clinical trial. The following information and communication technologies were evaluated: websites (5 studies), computer software (3 studies), Web-based workshops (2 studies), computerized decision support systems (2 studies), electronic educational game (1 study), email (2 studies), and multifaceted interventions that consisted of at least one information and communication technology component (6 studies). Website studies demonstrated significant improvements in perceived usefulness and perceived ease of use, but not for knowledge, reducing barriers, and intention to use clinical practice guidelines. Computer software studies demonstrated significant improvements in perceived usefulness, but not for knowledge and skills. Web-based workshop and email studies demonstrated significant improvements in knowledge, perceived usefulness, and skills. An electronic educational game intervention demonstrated a significant improvement from baseline in knowledge after 12 and 24 weeks. Computerized decision support system studies demonstrated variable findings for improvement in skills. Multifaceted interventions demonstrated significant improvements in beliefs about capabilities, perceived usefulness, and intention to use clinical practice guidelines, but

  11. Evaluating trauma care capabilities in Mexico with the World Health Organization's Guidelines for Essential Trauma Care publication.

    Science.gov (United States)

    Arreola-Risa, Carlos; Mock, Charles; Vega Rivera, Felipe; Romero Hicks, Eduardo; Guzmán Solana, Felipe; Porras Ramírez, Giovanni; Montiel Amoroso, Gilberto; de Boer, Melanie

    2006-02-01

    To identify affordable, sustainable methods to strengthen trauma care capabilities in Mexico, using the standards in the Guidelines for Essential Trauma Care, a publication that was developed by the World Health Organization and the International Society of Surgery to provide recommendations on elements of trauma care that should be in place in the various levels of health facilities in all countries. The Guidelines publication was used as a basis for needs assessments conducted in 2003 and 2004 in three Mexican states. The states were selected to represent the range of geographic and economic conditions in the country: Oaxaca (south, lower economic status), Puebla (center, middle economic status), and Nuevo León (north, higher economic status). The sixteen facilities that were assessed included rural clinics, small hospitals, and large hospitals. Site visits incorporated direct inspection of physical resources as well as interviews with key administrative and clinical staff. Human and physical resources for trauma care were adequate in the hospitals, especially the larger ones. The survey did identify some deficiencies, such as shortages of stiff suction tips, pulse oximetry equipment, and some trauma-related medications. All of the clinics had difficulties with basic supplies for resuscitation, even though some received substantial numbers of trauma patients. In all levels of facilities there was room for improvement in administrative functions to assure quality trauma care, including trauma registries, trauma-related quality improvement programs, and uniform in-service training. This study identified several low-cost ways to strengthen trauma care in Mexico. The study also highlighted the usefulness of the recommended norms in the Guidelines for Essential Trauma Care publication in providing a standardized template by which to assess trauma care capabilities in nations worldwide.

  12. Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings – Guideline of the German Society for Hospital Hygiene (DGKH

    Directory of Open Access Journals (Sweden)

    Külpmann, Rüdiger

    2016-02-01

    Full Text Available Since the publication of the first “Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems in hospitals” ( in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section “Ventilation and air conditioning technology” attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care.

  13. [Promoting directives of the Quality Law of the Spanish National Health System: Computer-interpretable clinical practice guidelines].

    Science.gov (United States)

    González-Ferrer, Arturo; Valcárcel, María Ángel

    2018-04-01

    The Cohesion and Quality Act of the National Health System promotes the use of new technologies to make it possible for health professionals put the scientific evidence into practice. In order to do this, there are technological tools, known as of computer-interpretable guidelines, which can help achieve this goal from an innovation perspective. They can be adopted using an iterative process, having a great initial potential as an educational tool, of quality and safety of the patient, in the decision making and, optionally, can be integrated with the electronic medical history, once they are rigorously validated. This article presents updates on these tools, reviews international projects, and personal experiences in which they have demonstrated their value, and highlights the advantages, risks, and limitations they present from a clinical point of view. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  14. The utilization of Clinical Protocols and Therapeutic Guidelines and the rationalization of judicialization for the right to health

    Directory of Open Access Journals (Sweden)

    Clarice Seixas Duarte

    2017-08-01

    Full Text Available The article analyzes the adoption of the Clinical Protocols and Therapeutic Guidelines (CPTGs as an objective measure to be used by the courts in cases where the purpose is to offer positive benefits in terms of realization of the right to health. Such a benchmark can assist the judge in the task of deciding the legal situation of medication supplies, guaranteeing the prevalence of rationality as outlined in the formulation of related public policies and, consequently, the use of technical-political arguments in the distribution of healthcare goods and resources. However, this is not an absolute parameter, and the content of the CPTGs may be questioned, even judicially. With this, judicial action is used as an instrument of democratization and social control among public choices, which can impact health policy itself.

  15. Understanding the association between pressure ulcers and sitting in adults what does it mean for me and my carers? Seating guidelines for people, carers and health & social care professionals.

    Science.gov (United States)

    Stephens, M; Bartley, C A

    2018-02-01

    The aim of the publication was to develop a practical guide for people, carers and health and social care professionals on how the research and evidence base on pressure ulcer prevention and management can be applied to those who remain seated for extended periods of time. This publication was developed at the request of the Tissue Viability Society in order to revise the original seating guidelines from 2008 as evidence and subsequent care has moved forward in relation to this area. Since 2008, the costs for the prevention and management of pressure ulcers have increased significantly and there is limited published advice from health and social care organisations on seating and preventing pressure ulcers. These guidelines have been written for: Who live or work in primary, secondary, and tertiary settings. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  16. Japanese Guideline for Atopic Dermatitis

    Directory of Open Access Journals (Sweden)

    Ichiro Katayama

    2011-01-01

    The basics of treatment discussed in this guideline are based on the “Guidelines for the Treatment of Atopic Dermatitis 2008” prepared by the Health and Labour Sciences Research and the “Guidelines for the Management of Atopic Dermatitis 2009 (ADGL2009” prepared by the Atopic Dermatitis Guidelines Advisory Committee, Japanese Society of Allergology in principle.

  17. Health-based audible noise guidelines account for infrasound and low-frequency noise produced by wind turbines.

    Science.gov (United States)

    Berger, Robert G; Ashtiani, Payam; Ollson, Christopher A; Whitfield Aslund, Melissa; McCallum, Lindsay C; Leventhall, Geoff; Knopper, Loren D

    2015-01-01

    Setbacks for wind turbines have been established in many jurisdictions to address potential health concerns associated with audible noise. However, in recent years, it has been suggested that infrasound (IS) and low-frequency noise (LFN) could be responsible for the onset of adverse health effects self-reported by some individuals living in proximity to wind turbines, even when audible noise limits are met. The purpose of this paper was to investigate whether current audible noise-based guidelines for wind turbines account for the protection of human health, given the levels of IS and LFN typically produced by wind turbines. New field measurements of indoor IS and outdoor LFN at locations between 400 and 900 m from the nearest turbine, which were previously underrepresented in the scientific literature, are reported and put into context with existing published works. Our analysis showed that indoor IS levels were below auditory threshold levels while LFN levels at distances >500 m were similar to background LFN levels. A clear contribution to LFN due to wind turbine operation (i.e., measured with turbines on in comparison to with turbines off) was noted at a distance of 480 m. However, this corresponded to an increase in overall audible sound measures as reported in dB(A), supporting the hypothesis that controlling audible sound produced by normally operating wind turbines will also control for LFN. Overall, the available data from this and other studies suggest that health-based audible noise wind turbine siting guidelines provide an effective means to evaluate, monitor, and protect potential receptors from audible noise as well as IS and LFN.

  18. Health-Based Audible Noise Guidelines Account for Infrasound and Low-Frequency Noise Produced by Wind Turbines

    Science.gov (United States)

    Berger, Robert G.; Ashtiani, Payam; Ollson, Christopher A.; Whitfield Aslund, Melissa; McCallum, Lindsay C.; Leventhall, Geoff; Knopper, Loren D.

    2015-01-01

    Setbacks for wind turbines have been established in many jurisdictions to address potential health concerns associated with audible noise. However, in recent years, it has been suggested that infrasound (IS) and low-frequency noise (LFN) could be responsible for the onset of adverse health effects self-reported by some individuals living in proximity to wind turbines, even when audible noise limits are met. The purpose of this paper was to investigate whether current audible noise-based guidelines for wind turbines account for the protection of human health, given the levels of IS and LFN typically produced by wind turbines. New field measurements of indoor IS and outdoor LFN at locations between 400 and 900 m from the nearest turbine, which were previously underrepresented in the scientific literature, are reported and put into context with existing published works. Our analysis showed that indoor IS levels were below auditory threshold levels while LFN levels at distances >500 m were similar to background LFN levels. A clear contribution to LFN due to wind turbine operation (i.e., measured with turbines on in comparison to with turbines off) was noted at a distance of 480 m. However, this corresponded to an increase in overall audible sound measures as reported in dB(A), supporting the hypothesis that controlling audible sound produced by normally operating wind turbines will also control for LFN. Overall, the available data from this and other studies suggest that health-based audible noise wind turbine siting guidelines provide an effective means to evaluate, monitor, and protect potential receptors from audible noise as well as IS and LFN. PMID:25759808

  19. Perceived value of applying Information Communication Technology to implement guidelines in developing countries; an online questionnaire study among public health workers.

    Science.gov (United States)

    Machingura, Pasipanodya Ian; Adekola, Olawumi; Mueni, Eunice; Oaiya, Omo; Gustafsson, Lars L; Heller, Richard F

    2014-01-01

    Practice guidelines can be used to support healthcare decision making. We sought to identify the use, and barriers to the implementation, of electronic based guidelines to support decision-making in maternal and child healthcare (MCH) and the rational use of medicines, in developing countries. Graduates who had gained the Master of Public Health degree through the Peoples-uni (postgraduate public health education in developing countries) were sent an online survey questionnaire which had been piloted. Two reminders were sent to non-respondents at intervals of 10 days. Results were explored using descriptive analyses. 44 of the potential 48 graduates from 16 countries responded - most were from Africa. 82% and 89% of respondents were aware of guidelines on MCH and the rational use of medicines respectively. Electronic guidelines were more available in university hospitals than in provincial hospitals or rural care. All respondents thought that guidelines could improve the delivery of quality care, and 42 (95%) and 41 (93%) respectively thought that computers and mobile or smartphones could increase the use of guidelines in service delivery. Lack of access to computers, need to buy phone credit, need for training in the use of either computerized or phone based guidelines and fear of increased workload were potential barriers to use. There is support for the use of electronic guidelines despite limited availability and barriers to use in developing countries. These findings, and other literature, provide a guide as to how the further development of ICT based guidelines may be implemented to improve health care decision making.

  20. Exploiting Temporal Constraints of Clinical Guidelines by Applying OpenEHR Archetypes.

    Science.gov (United States)

    Cintho, Lilian Mie Mukai; Garcia, Diego; da Silva Santos, Bruno Henrique; Sacchi, Lucia; Quaglini, Silvana; Moro, Claudia Maria Cabral

    2017-01-01

    Studies describing Computer-Interpretable Clinical Guidelines (CIG) with temporal constrains (TC) generally have not addressed issues related to their integration into Electronic Health Record (EHR) systems. This study aimed to represent TCs contained in clinical guidelines by applying archetypes and Guideline Definition Language (GDL) to incorporate decision support into EHRs. An example of each TC class in the clinical guideline for management of Atrial Fibrillation was represented using archetypes and GDL.

  1. Belgian guidelines for economic evaluations: second edition.

    Science.gov (United States)

    Thiry, Nancy; Neyt, Mattias; Van De Sande, Stefaan; Cleemput, Irina

    2014-12-01

    The aim of this study was to present the updated methodological guidelines for economic evaluations of healthcare interventions (drugs, medical devices, and other interventions) in Belgium. The update of the guidelines was performed by three Belgian health economists following feedback from users of the former guidelines and personal experience. The updated guidelines were discussed with a multidisciplinary team consisting of other health economists, assessors of reimbursement request files, representatives of Belgian databases and representatives of the drugs and medical devices industry. The final document was validated by three external validators that were not involved in the previous discussions. The guidelines give methodological guidance for the following components of an economic evaluation: literature review, perspective of the evaluation, definition of the target population, choice of the comparator, analytic technique and study design, calculation of costs, valuation of outcomes, definition of the time horizon, modeling, handling uncertainty and discounting. We present a reference case that can be considered as the minimal requirement for Belgian economic evaluations of health interventions. These guidelines will improve the methodological quality, transparency and uniformity of the economic evaluations performed in Belgium. The guidelines will also provide support to the researchers and assessors performing or evaluating economic evaluations.

  2. Financial penalties for the unhealthy? Ethical guidelines for holding employees responsible for their health.

    Science.gov (United States)

    Pearson, Steven D; Lieber, Sarah R

    2009-01-01

    As health care costs continue to rise, an increasing number of self-insured employers are using financial rewards or penalties to promote healthy behavior and control costs. These incentive programs have triggered a backlash from those concerned that holding employees responsible for their health, particularly through the use of penalties, violates individual liberties and discriminates against the unhealthy. This paper offers an ethical analysis of employee health incentive programs and presents an argument for a set of conditions under which penalties can be used in an ethical and responsible way to contain health care costs and encourage healthy behavior among employees.

  3. Addressing implementation challenges during guideline development - a case study of Swedish national guidelines for methods of preventing disease.

    Science.gov (United States)

    Richter-Sundberg, Linda; Kardakis, Therese; Weinehall, Lars; Garvare, Rickard; Nyström, Monica E

    2015-01-22

    Many of the world's life threatening diseases (e.g. cancer, heart disease, stroke) could be prevented by eliminating life-style habits such as tobacco use, unhealthy diet, physical inactivity and excessive alcohol use. Incorporating evidence-based research on methods to change unhealthy lifestyle habits in clinical practice would be equally valuable. However gaps between guideline development and implementation are well documented, with implications for health care quality, safety and effectiveness. The development phase of guidelines has been shown to be important both for the quality in guideline content and for the success of implementation. There are, however, indications that guidelines related to general disease prevention methods encounter specific barriers compared to guidelines that are diagnosis-specific. In 2011 the Swedish National board for Health and Welfare launched guidelines with a preventive scope. The aim of this study was to investigate how implementation challenges were addressed during the development process of these disease preventive guidelines. Seven semi-structured interviews were conducted with members of the guideline development management group. Archival data detailing the guideline development process were also collected and used in the analysis. Qualitative data were analysed using content analysis as the analytical framework. The study identified several strategies and approaches that were used to address implementation challenges during guideline development. Four themes emerged from the analysis: broad agreements and consensus about scope and purpose; a formalized and structured development procedure; systematic and active involvement of stakeholders; and openness and transparency in the specific guideline development procedure. Additional factors concerning the scope of prevention and the work environment of guideline developers were perceived to influence the possibilities to address implementation issues. This case study

  4. The SQUIRE guidelines and how can they help you report on quality in health

    Directory of Open Access Journals (Sweden)

    Frank Davidoff MD, MCAP

    2014-08-01

    Full Text Available Published in 2008, the SQUIRE guidelines are a set of 19 descriptive items that identify the information readers want and need to know about making and studying improvements in healthcare delivery. They were created over a period of several years, largely in response to earlier concerns about the limited quantity and inadequate quality of published reports of work in this new discipline. They have proven useful in writing about improvement interventions, as well as in designing and implementing them. As improvement concepts and methods continue to develop, SQUIRE is also evolving as part of its continuing effort to contribute to the advancement of the “science of improvement.”

  5. Implementing the European guidelines for cardiovascular disease prevention in the primary care setting in Cyprus: Lessons learned from a health care services study

    Directory of Open Access Journals (Sweden)

    Philalithis Anastasios

    2008-07-01

    Full Text Available Abstract Background Recent guidelines recommend assessment and treatment of the overall risk for cardiovascular disease (CVD through management of multiple risk factors in patients at high absolute risk. The aim of our study was to assess the level of cardiovascular risk in patients with known risk factors for CVD by applying the SCORE risk function and to study the implications of European guidelines on the use of treatment and goal attainment for blood pressure (BP and lipids in the primary care of Cyprus. Methods Retrospective chart review of 1101 randomly selected patients with type 2 diabetes mellitus (DM2, or hypertension or hyperlipidemia in four primary care health centres. The SCORE risk function for high-risk regions was used to calculate 10-year risk of cardiovascular fatal event. Most recent values of BP and lipids were used to assess goal attainment to international standards. Most updated medications lists were used to compare proportions of current with recommended antihypertensive and lipid-lowering drug (LLD users according to European guidelines. Results Implementation of the SCORE risk model labelled overall 39.7% (53.6% of men, 31.3% of women of the study population as high risk individuals (CVD, DM2 or SCORE ≥5%. The SCORE risk chart was not applicable in 563 patients (51.1% due to missing data in the patient records, mostly on smoking habits. The LDL-C goal was achieved in 28.6%, 19.5% and 20.9% of patients with established CVD, DM2 (no CVD and SCORE ≥5%, respectively. BP targets were achieved in 55.4%, 5.6% and 41.9% respectively for the above groups. There was under prescription of antihypertensive drugs, LLD and aspirin for all three high risk groups. Conclusion This study demonstrated suboptimal control and under-treatment of patients with cardiovascular risk factors in the primary care in Cyprus. Improvement of documentation of clinical information in the medical records as well as GPs training for implementation

  6. De standaard vroegtijdige opsporing van gehoorstoornissen 0-19 jaar van de jeugdgezondheidszorg [The youth health care guideline early screening for hearing impairment ages 0-19 years

    NARCIS (Netherlands)

    Leerdam, F.J.M. van

    2000-01-01

    The Youth Health Care guideline 'Early screening for hearing impairment, ages 0-19 years' draws the attention of all parties involved to the case finding of, notably, perceptive hearing loss; it helps workers in the Youth Health Care argue their referrals and improve the next steps in the process.

  7. The Case for Using Evidence Based Guidelines in Setting Hospital and Public Health Policy

    Directory of Open Access Journals (Sweden)

    Ross Hutchison Francis

    2016-03-01

    Full Text Available Objective: Hospital systems and regulating agencies enforce strict guidelines barring personal items from entering the Operating Room - touting surgical site infections and patient safety as the rationale. We sought to determine whether or not evidence supporting this recommendation exists by reviewing available literature.Background data: Rules and guidelines that are not evidence based may lead to increased hospital expenses and limitations on healthcare provider autonomyMethods: PubMed, Embase, Scopus, Cochrane Library, Web of Science, and CINAHL were searched in order to find articles that correlated personal items in the OR to documented surgical site infections. Articles that satisfied the following criteria were included: (1 studies looking at personal items in the OR such as handbags, purses, badges, pagers, backpacks, jewelry phones, and eyeglasses, etc., but not just operating room equipment; and (2 the primary outcome measure was infection at the surgical site.Results: Seventeen articles met inclusion criteria and were evaluated. Of the 17, the majority did not determine if personal items increased risk for surgical site infection. Only 1 article examined the correlation between a personal item near the operative site and surgical site infection, concluding that wedding rings worn in the OR had no impact on surgical site infections. Most studies examined colonization rates on personal items as potential infection risk; however, no personal items were causally linked to surgical site infection in any of these studies.Conclusion: There is no objective evidence to suggest that personal items in the OR increase risk for surgical site infections.

  8. 75 FR 32191 - National Health and Nutrition Examination Survey (NHANES) DNA Samples: Guidelines for Proposals...

    Science.gov (United States)

    2010-06-07

    ...; (5) to study the relation among diet, nutrition and health; (6) to explore emerging public health... race or ethnic groups (only applicable for a subsample request) or if information about the race or... and Ethnic Minorities in Research In NHANES III, NHANES 1999-2002, and NHANES 2007-2008 race...

  9. Occupational Safety and Health Program Guidelines for Colleges and Universities. An Administrative Resource Manual.

    Science.gov (United States)

    Godbey, Frank W.; Hatch, Loren L.

    Designed as an aid for establishing and strengthening occupational safety and health programs on college and university campuses, this administrator guide is divided into four chapters. The first chapter defines and gives background information on the Occupational Safety and Health Act (OSHA). In addition, it presents a discussion of what the OSHA…

  10. Directrices de los Servicios de Salud para Estudiantes Migratorios (Guidelines for Health Services for Migrant Students).

    Science.gov (United States)

    California State Dept. of Education, Sacramento. Bureau of Community Services and Migrant Education.

    To promote uniformity and continuity, standards have been established for planning, implementing, and evaluating student health programs provided by grade K-12 migrant education programs throughout California. In this Spanish language edition, state-mandated health requirements, the rationale for supplemental services, methods of providing…

  11. Clinical Practice Guidelines and Helicobacter pylori Infection in Children

    Directory of Open Access Journals (Sweden)

    Colin Macarthur

    1999-01-01

    Full Text Available The objective of this paper is to review the principles, methods and issues behind the development of clinical practice guidelines. Practice guidelines have been defined as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”. The ultimate goal of guidelines is to improve patient outcomes; however, they may also be used as tools to decrease health care costs, improve medical education and enhance quality assurance. Evidence-based guidelines use explicit methods to link recommendations to the quality of the underlying research. Following development of the guideline, implementation and evaluation are key steps. The ultimate aim of guideline development is to influence physician knowledge, attitudes and behaviour.

  12. Cost-effectiveness of World Health Organization 2010 Guidelines for Prevention of Mother-to-Child HIV Transmission in Zimbabwe

    Science.gov (United States)

    Ciaranello, Andrea L.; Perez, Freddy; Engelsmann, Barbara; Walensky, Rochelle P.; Mushavi, Angela; Rusibamayila, Asinath; Keatinge, Jo; Park, Ji-Eun; Maruva, Matthews; Cerda, Rodrigo; Wood, Robin; Dabis, Francois; Freedberg, Kenneth A.

    2013-01-01

    Background. In 2010, the World Health Organization (WHO) released revised guidelines for prevention of mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT). We projected clinical impacts, costs, and cost-effectiveness of WHO-recommended PMTCT strategies in Zimbabwe. Methods. We used Zimbabwean data in a validated computer model to simulate a cohort of pregnant, HIV-infected women (mean age, 24 years; mean CD4 count, 451 cells/µL; subsequent 18 months of breastfeeding). We simulated guideline-concordant care for 4 PMTCT regimens: single-dose nevirapine (sdNVP); WHO-recommended Option A, WHO-recommended Option B, and Option B+ (lifelong maternal 3-drug antiretroviral therapy regardless of CD4). Outcomes included maternal and infant life expectancy (LE) and lifetime healthcare costs (2008 US dollars [USD]). Incremental cost-effectiveness ratios (ICERs, in USD per year of life saved [YLS]) were calculated from combined (maternal + infant) discounted costs and LE. Results. Replacing sdNVP with Option A increased combined maternal and infant LE from 36.97 to 37.89 years and would reduce lifetime costs from $5760 to $5710 per mother–infant pair. Compared with Option A, Option B further improved LE (38.32 years), and saved money within 4 years after delivery ($5630 per mother–infant pair). Option B+ (LE, 39.04 years; lifetime cost, $6620 per mother–infant pair) improved maternal and infant health, with an ICER of $1370 per YLS compared with Option B. Conclusions. Replacing sdNVP with Option A or Option B will improve maternal and infant outcomes and save money; Option B increases health benefits and decreases costs compared with Option A. Option B+ further improves maternal outcomes, with an ICER (compared with Option B) similar to many current HIV-related healthcare interventions. PMID:23204035

  13. The new production theory for health care through clinical reengineering: a study of clinical guidelines--Part I.

    Science.gov (United States)

    Sharp, J R

    1994-12-01

    Drucker writes that the emerging theory of manufacturing includes four principles and practices: statistical quality control, manufacturing accounting, modular organization, and systems approach. SQC is a rigorous, scientific method of identifying variation in the quality and productivity of a given production process, with an emphasis on improvement. The new manufacturing economics intends to integrate the production strategy with the business strategy in order to account for the biggest portions of costs that the old methods did not assess: time and automation. Production operations that are both standardized and flexible will allow the organization to keep up with changes in design, technology, and the market. The return on innovation in this environment is predicated on a modular arrangement of flexible steps in the process. Finally, the systems approach sees the entire process as being integrated in converting goods or services into economic satisfaction. There is now a major restructuring of the U.S. health care industry, and the incorporation of these four theories into health care reform would appear to be essential. This two-part article will address two problems: Will Drucker's theories relate to health care (Part I)? Will the "new manufacturing" in health care (practice guidelines) demonstrate cost, quality, and access changes that reform demands (Part II)?

  14. Incorporating a gender perspective into the development of clinical guidelines: a training course for guideline developers

    Directory of Open Access Journals (Sweden)

    Burgers Jako S

    2007-11-01

    Full Text Available Abstract Background Dutch guideline-developing organizations do not focus systematically on differences between men and women when developing guidelines, even though there is increasing evidence that being male or female may have an effect on health and health outcomes. In collaboration with two prominent Dutch guideline-developing organizations, we designed a training course to encourage systematic attention to sex differences in guideline development procedures. Methods The course is targeted towards guideline developers. Its aims are to improve awareness concerning the relevance of considering sex differences in the guideline development process, as well as the competence and skills necessary for putting this into practice. The design and teaching methods of the course are based on adult learning styles and principles of changing provider behaviour. It was adjusted to the working methods of guideline organizations. The course was taught to, and evaluated by, a group of staff members from two guideline organizations in the Netherlands. Results The course consists of five modules, each of which corresponds to a key step in the guideline development process. The participants rated the training course positively on content, programme, and trainers. Their written comments suggest that the course met its objectives. Conclusion The training course is the first to address sex differences in guideline development. Results from the pilot test suggest that the course achieved its objectives. Because its modules and teaching methods of the course are widely transferable, the course could be useful for many organizations that are involved in developing guidelines. Follow-up studies are needed to assess the long-term effect of the course on the actions of guideline developers and its utility in other settings.

  15. Practical guidelines on e-cigarettes for practitioners and others health professionals. A French 2016 expert's statement.

    Science.gov (United States)

    Dautzenberg, B; Adler, M; Garelik, D; Loubrieu, J F; Mathern, G; Peiffer, G; Perriot, J; Rouquet, R M; Schmitt, A; Underner, M; Urban, T

    2017-02-01

    A group of 11 French medical experts has developed guidelines through a Delphi progressive consensus about smoking management at the e-cigarette era. The lack of scientific data about e-cigarettes led the experts to set out recommendations, mainly based on clinical practice while waiting for scientific validations. The validated smoking cessation treatments keep the first place in the prevention and the treatment of tobacco-induced damages. The e-cigarette, experimented by a large proportion of smokers, is a safer product than tobacco. The health professional must answer the patients about the e-cigarettes: (1) A smoker who questions about e-cigarettes should receive information. Even if there is a lack of data, e-cigarettes offer much lower risks than tobacco. (2) A dual user is at high risk of returning to exclusive tobacco use; he should also optimize other nicotine intakes by combining nicotine replacement therapy and/or optimizing the nicotine intake through the e-cigarette. (3) A smoker who wish to use the e-cigarette in order to quit with or without associated pharmacological treatment should be accompanied and not discouraged. (4) A vaper who is tired to continuing to vape should be accompanied to quit. Specific guidelines are also provided for adolescents, pregnant women, patients during perioperative periods and also for pulmonary, cardiac and schizophrenic patients. Copyright © 2017 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  16. Perspective: Improving nutritional guidelines for sustainable health policies: Current status and perspectives

    DEFF Research Database (Denmark)

    Magni, Paolo; Bier, Dennis M; Pecorelli, Sergio

    2017-01-01

    a constructive coalition among scientists, policy makers, and communication professionals for sustainable health and nutritional policies. Currently, a strong rationale and available data support a personalized dietary approach according to personal variables, including sex and age, circulating metabolic...

  17. Recommendations for international gambling harm-minimisation guidelines: comparison with effective public health policy

    NARCIS (Netherlands)

    Gainsbury, Sally M.; Blankers, Matthijs; Wilkinson, Claire; Schelleman-Offermans, Karen; Cousijn, Janna

    2014-01-01

    Problem gambling represents a significant public health problem, however, research on effective gambling harm-minimisation measures lags behind other fields, including other addictive disorders. In recognition of the need for consistency between international jurisdictions and the importance of

  18. Recommendations for international gambling harm-minimisation guidelines : comparison with effective public health policy

    NARCIS (Netherlands)

    Gainsbury, Sally M; Blankers, Matthijs; Wilkinson, Claire; Schelleman-Offermans, Karen; Cousijn, Janna

    2014-01-01

    Problem gambling represents a significant public health problem, however, research on effective gambling harm-minimisation measures lags behind other fields, including other addictive disorders. In recognition of the need for consistency between international jurisdictions and the importance of

  19. Canadian Public Health Laboratory Network laboratory Guidelines for the Diagnosis of Neurosyphilis in Canada

    Directory of Open Access Journals (Sweden)

    Tom Wong

    2015-01-01

    Full Text Available Neurosyphilis refers to infection of the central nervous system by Treponema pallidum, which may occur at any stage. Neurosyphilis has been categorized in many ways including early and late, asymptomatic versus symptomatic and infectious versus non-infectious. Late neurosyphilis primarily affects the central nervous system parenchyma, and occurs beyond early latent syphilis, years to decades after the initial infection. Associated clinical syndromes include general paresis, tabes dorsalis, vision loss, hearing loss and psychiatric manifestations. Unique algorithms are recommended for HIV-infected and HIV-uninfected patients, as immunocompromised patients may present with serologic and cerebrospinal fluid findings that are different from immunocompetent hosts. Antibody assays include a VDRL assay and the FTA-Abs, while polymerase chain reaction for T. pallidum can be used as direct detection assays for some specimens. This chapter reviews guidelines for specimen types and sample collection, and identifies two possible algorithms for use with immunocompromised and immunocompetent hosts using currently available tests in Canada, along with a review of treatment response and laboratory testing follow-up.

  20. Compliance with European Guidelines for Diagnostic Mammography in a Decentralized Health-Care Setting

    International Nuclear Information System (INIS)

    Jensen, A.; Mikkelsen, G.J.; Vestergaard, M.; Lynge, E.; Vejborg, I.

    2005-01-01

    Purpose: To evaluate the compliance of Danish mammography clinics with requirements concerning organization, activity volume, and assessment procedures from two European guidelines for quality assurance in diagnostic mammography (EUSOMA and EUREF). Material and Methods: We used individual records on all diagnostic mammographies performed in Denmark in 2000, and questionnaires given to Danish mammography clinics in 2000, 2002, and 2004. Results: The study showed a marked centralization of the diagnostic activity from 2000 to 2004 to a smaller number of public breast assessment centers with full multidisciplinary breast assessment. However, a relatively large number of these centers did not comply with the activity volume requirement of 2000 mammograms per clinic per year. The number of private diagnostic mammography clinics performing basic diagnostic mammography has remained fairly stable in the period 2000 to 2004. Compared with public breast assessment centers, the private diagnostic mammography clinics had a lower compliance with activity volume requirements. Conclusion: A marked proportion of Danish public breast assessment centers operate with less than optimal activity volume, suggesting that further centralization would be appropriate. The situation in private diagnostic mammography clinics may cause concern, as our study showed that the majority of these clinics did not meet the activity volume requirements

  1. The Association between Dietary Quality and Dietary Guideline Adherence with Mental Health Outcomes in Adults: A Cross-Sectional Analysis

    Directory of Open Access Journals (Sweden)

    Amy P. Meegan

    2017-03-01

    Full Text Available The prevalence of adverse mental health outcomes in adults is increasing. Although beneficial effects of selected micronutrients and foods on mental health have been reported, they do not reflect the impact of the habitual diet on mental health. Therefore, our objective is to examine potential associations between dietary quality, dietary composition and compliance with food pyramid recommendations with depressive symptoms, anxiety and well-being (assessed using CES-D, HADS-A and WHO-5 screening tools in a cross-sectional sample of 2047 middle-aged adults. Diet was assessed using a self-completed FFQ. Chi-square tests, t-tests and logistic regression analyses were used to investigate the associations between dietary components and mental health outcomes. Dietary quality, but not dietary composition or guideline adherence, was associated with well-being. Those with high dietary quality were more likely to report well-being (OR =1.67, 95% CI 1.15–2.44, p = 0.007 relative to those with low dietary quality. This remained significant among females (OR = 1.92, (95% CI 1.14–3.23, p = 0.014 and non-obese individuals (OR = 2.03, 95% CI 1.28–3.20, p = 0.003. No associations between any dietary measures with anxiety or depressive symptoms were observed. These novel results highlight the importance of dietary quality in maintaining optimal psychological well-being. Better understanding of the relationship between dietary quality and mental health may provide insight into potential therapeutic or intervention strategies to improve mental health and well-being.

  2. [Challenges in the implementation of clinical practice guidelines in major public health institutions in Mexico: A multiple case study].

    Science.gov (United States)

    Gutiérrez-Alba, Gaudencio; González-Block, Miguel Ángel; Reyes-Morales, Hortensia

    2015-01-01

    To identify, prioritize and relate barriers and facilitators in the implementation of Clinical Practice Guidelines (GPC, in Spanish). We used qualitative methods to study and compare the introduction of GPC across the domains of the consolidated research implementation framework in hospitals of the three main public institutions in a state of Mexico. Authorities and hospital staff were interviewed using a semi-structured questionnaire. The main barriers to implementation are the absence of standards, training, resources and incentives. The most important implementation facilitators are the characteristics of the GPC, which are perceived as properly designed and with simple language as well as with capacity to improve the work environment. The barriers to implementation must be solved to achieve the goal of standardizing the healthcare process across the sector; the positive perception of the GPC should promote the continuous actualization of the evidence and a sectoral view from their development stage to ensure adoption in the heterogeneous environments that characterize health institutions.

  3. Effectiveness of multifaceted implementation strategies for the implementation of back and neck pain guidelines in health care : A systematic review

    NARCIS (Netherlands)

    Suman, Arnela; Dikkers, Marije F.; Schaafsma, Frederieke G.; van Tulder, Maurits W.; Anema, Johannes R.

    2016-01-01

    Background: For the optimal use of clinical guidelines in daily practice, mere distribution of guidelines and materials is not enough, and active implementation is needed. This review investigated the effectiveness of multifaceted implementation strategies compared to minimal, single, or no

  4. An international comparison of occupational health guidelines for the management of mental disorders and stress-related psychological symptoms

    NARCIS (Netherlands)

    Joosen, Margot C. W.; Brouwers, Evelien P. M.; van Beurden, Karlijn M.; Terluin, Berend; Ruotsalainen, Jani H.; Woo, Jong-Min; Choi, Kyeong-Sook; Eguchi, Hisashi; Moriguchi, Jiro; van der Klink, Jac J. L.; van Weeghel, Jaap

    Background We compared available guidelines on the management of mental disorders and stress-related psychological symptoms in an occupational healthcare setting and determined their development and reporting quality. Methods To identify eligible guidelines, we systematically searched National

  5. Assisting the Blind and Visually Impaired: Guidelines for Eye Health Workers and Other Helpers

    Directory of Open Access Journals (Sweden)

    Sue Stevens

    2003-01-01

    Full Text Available As eye health workers, we give much attention to learning and teaching the importance of health education and the prevention and treatment of eye disease. Despite our gained knowledge, sadly, our efforts are not always successful and we are presented with the responsibility and challenge of caring for people who have to cope with visual impairment, perhaps for the rest of their lives. We have to understand their difficulties, recognise their abilities and learn how to cooperate and communicate with them in a social as well as hospital environment. It is often within the eye hospital itself that the lack in education of health workers and their understanding of the assistance needs of blind and visually impaired patients is all too evident.

  6. Guidelines for approved medical officers on health surveillance of radiation workers

    International Nuclear Information System (INIS)

    O'Donovan, N.; Hone, C.

    1988-11-01

    As a result of the adoption of the Council of the European Communities Directive No. 80/836 Euratom which lays down the basic safety standards for the health protection of the general public and workers against the dangers of ionizing radiation, there is a need for nominating Approved Medical Officers whose functions in respect of hospital workers are outlined in the Department of Health Circular, Oct. 1983 (Appendix 1), and which are considered applicable to all other workers. This document outlines the role of the Approved Medical Officer and proides information to aid him/her in this work (author)

  7. Primary care guidelines

    DEFF Research Database (Denmark)

    Ijäs, Jarja; Alanen, Seija; Kaila, Minna

    2009-01-01

    OBJECTIVE: To describe the adoption of the national Hypertension Guideline in primary care and to evaluate the consistency of the views of the health centre senior executives on the guideline's impact on clinical practices in the treatment of hypertension in their health centres. DESIGN: A cross...... Guideline. RESULTS: Data were available from 143 health centres in Finland (49%). The views of head physicians and senior nursing officers on the adoption of the Hypertension Guideline were not consistent. Head physicians more often than senior nursing officers (44% vs. 29%, p ...: Hypertension Guideline recommendations that require joint agreements between professionals are less often adopted than simple, precise recommendations. More emphasis on effective multidisciplinary collaboration is needed....

  8. Academic Institutions' Critical Guidelines for Health Care Workers Who Deploy to West Africa for the Ebola Response and Future Crises.

    Science.gov (United States)

    Cranmer, Hilarie; Aschkenasy, Miriam; Wildes, Ryan; Kayden, Stephanie; Bangsberg, David; Niescierenko, Michelle; Kemen, Katie; Hsiao, Kai-Hsun; VanRooyen, Michael; Burkle, Frederick M; Biddinger, Paul D

    2015-10-01

    The unprecedented Ebola Virus Disease (EVD) outbreak in West Africa, with its first cases documented in March 2014, has claimed the lives of thousands of people, and it has devastated the health care infrastructure and workforce in affected countries. Throughout this outbreak, there has been a critical lack of health care workers (HCW), including physicians, nurses, and other essential non-clinical staff, who have been needed, in most of the affected countries, to support the medical response to EVD, to attend to the health care needs of the population overall, and to be trained effectively in infection protection and control. This lack of sufficient and qualified HCW is due in large part to three factors: 1) limited HCW staff prior to the outbreak, 2) disproportionate illness and death among HCWs caused by EVD directly, and 3) valid concerns about personal safety among international HCWs who are considering responding to the affected areas. These guidelines are meant to inform institutions who deploy professional HCWs.

  9. Developing guidelines for good practice in the economic evaluation of occupational safety and health interventions

    NARCIS (Netherlands)

    Tompa, Emile; Verbeek, Jos; van Tulder, Maurits; de Boer, Angela

    2010-01-01

    One of the objectives of a recently held workshop in Amsterdam, the Netherlands, was to advance methods for the economic evaluation of occupational safety and health (OSH) interventions at the corporate and societal level. Drawing from that workshop, we discuss issues to consider when developing

  10. Guidelines for Stakeholder Engagement in Health Technology Assessment in Ireland 2014

    LENUS (Irish Health Repository)

    Hiligsmann, Mickaël

    2012-07-01

    Medication nonadherence is common for osteoporosis, but its consequences have not been well described. This study aimed to quantify the clinical and economic impacts of poor adherence and to evaluate the potential cost-effectiveness of improving patient adherence by using hypothetical behavioral interventions.

  11. Health problems in childhood cancer survivors: Linkage studies and guideline development

    NARCIS (Netherlands)

    Font-Gonzalez, A.

    2016-01-01

    This thesis comprises two parts. The first part of this thesis aims to increase the evidence on the burden of disease in childhood cancer survivors and to define high-risk groups of survivors by using medical record linkage studies. A two-step record linkage methodology between Dutch national

  12. Evidence-based guidelines

    DEFF Research Database (Denmark)

    Rovira, Àlex; Wattjes, Mike P; Tintoré, Mar

    2015-01-01

    diagnosis in patients with MS. The aim of this article is to provide guidelines for the implementation of MRI of the brain and spinal cord in the diagnosis of patients who are suspected of having MS. These guidelines are based on an extensive review of the recent literature, as well as on the personal...

  13. Prospective systematic review registration: perspective from the Guidelines International Network (G-I-N

    Directory of Open Access Journals (Sweden)

    Van der Wees Philip

    2012-02-01

    Full Text Available Abstract Clinical practice and public health guidelines are important tools for translating research findings into practice with the aim of assisting health practitioners as well as patients and consumers in health behavior and healthcare decision-making. Numerous programs for guideline development exist around the world, with growing international collaboration to improve their quality. One of the key features in developing trustworthy guidelines is that recommendations should be based on high-quality systematic reviews of the best available evidence. The review process used by guideline developers to identify and grade relevant evidence for developing recommendations should be systematic, transparent and unbiased. In this paper, we provide an overview of current international developments in the field of practice guidelines and methods to develop guidelines, with a specific focus on the role of systematic reviews. The Guidelines International Network (G-I-N aims to stimulate collaboration between guideline developers and systematic reviewers to optimize the use of available evidence in guideline development and to increase efficiency in the guideline development process. Considering the significant benefit of systematic reviews for the guideline community, the G-I-N Board of Trustees supports the international prospective register of systematic reviews (PROSPERO initiative. G-I-N also recently launched a Data Extraction Resource (GINDER to present and share data extracted from individual studies in a standardized template. PROSPERO and GINDER are complementary tools to enhance collaboration between guideline developers and systematic reviewers to allow for alignment of activities and a reduction in duplication of effort.

  14. Prospective systematic review registration: perspective from the Guidelines International Network (G-I-N).

    Science.gov (United States)

    Van der Wees, Philip; Qaseem, Amir; Kaila, Minna; Ollenschlaeger, Guenter; Rosenfeld, Richard

    2012-02-09

    Clinical practice and public health guidelines are important tools for translating research findings into practice with the aim of assisting health practitioners as well as patients and consumers in health behavior and healthcare decision-making. Numerous programs for guideline development exist around the world, with growing international collaboration to improve their quality. One of the key features in developing trustworthy guidelines is that recommendations should be based on high-quality systematic reviews of the best available evidence. The review process used by guideline developers to identify and grade relevant evidence for developing recommendations should be systematic, transparent and unbiased. In this paper, we provide an overview of current international developments in the field of practice guidelines and methods to develop guidelines, with a specific focus on the role of systematic reviews. The Guidelines International Network (G-I-N) aims to stimulate collaboration between guideline developers and systematic reviewers to optimize the use of available evidence in guideline development and to increase efficiency in the guideline development process. Considering the significant benefit of systematic reviews for the guideline community, the G-I-N Board of Trustees supports the international prospective register of systematic reviews (PROSPERO) initiative. G-I-N also recently launched a Data Extraction Resource (GINDER) to present and share data extracted from individual studies in a standardized template. PROSPERO and GINDER are complementary tools to enhance collaboration between guideline developers and systematic reviewers to allow for alignment of activities and a reduction in duplication of effort.

  15. National guidelines for high-cost drugs in Brazil: achievements and constraints of an innovative national evidence-based public health policy.

    Science.gov (United States)

    Picon, Paulo D; Beltrame, Alberto; Banta, David

    2013-04-01

    The translation of best evidence into practice has become an important purpose of policy making in health care. In Brazil, a country of continental dimensions with widespread regional and social inequalities, the dissemination and use of the best-evidence in policy making is a critical issue for the healthcare system. The main purpose of this study is to describe an evidence-based public health policy with special emphasis on guidelines creation for high-cost medicines. We also describe how that strategy was diffused to the judiciary system and to other parts of the healthcare system. We present an 11-year follow-up of a national project for creating and updating guidelines for high-cost medicines in Brazil. A total of 109 national guidelines were published (new or updated versions) for 66 selected diseases, the first such effort in Brazilian history. The project influenced the Brazilian legislature, which has recently established a Federal Law requiring national guidelines for any new technology listed for payment by the Brazilian public healthcare system. We were able to involve many different stakeholders in a partnership between academia and policy makers, which made possible the widespread dissemination of the clinical practice guidelines. Problems and constraints were also encountered. This evolving public health strategy might be useful for other developing countries.

  16. European Patient Summary Guideline: Focus on Greece.

    Science.gov (United States)

    Berler, Alexander; Tagaris, Anastassios; Chronaki, Catherine

    2016-01-01

    The European Patient Summary (PS) guideline specifies a minimal dataset of essential and important information for unplanned or emergency care initially defined in the epSOS project with aim to improve patients' safety and quality of Care. The eHealth Network of European Union (EU) Member State (MS) representatives established under Article 14 of the EU directive 2011/24 on patient rights to cross-border healthcare adopted PS guideline in November 2013 and since then the guideline has been part of MS strategic eHealth implementation plans, standardization efforts, and concrete regional, national, European and international projects. This paper reviews implementation efforts for the implementation of an operational patient summary service in Greece drawing on challenges and lessons learned for sustainable standards-based large scale eHealth deployment in Europe and abroad, as well as the reuse of best practices from international standards and integration profiles.

  17. Guidelines for radiological interventions

    International Nuclear Information System (INIS)

    Kauffmann, G.W.

    1998-01-01

    The German Radiological Society, in cooperation with other German professional bodies, set up draft Guidelines for Radiological Interventions and submitted them to the professional community for discussion. The Guidelines are meant to assess the potential of radiological interventions as treatment alternatives to surgery or aggressive therapy such as chemotherapy. In fact, technical practicability on its own is insufficient to warrant intervention. The Guidelines are systematically compiled notions and recommendations whose aim it is to provide support to physicians and patients in choosing suitable medical care provisions (prevention, diagnosis, therapy, aftertreatment) in specific circumstances. A complete Czech translation of the Guidelines is given. (P.A.)

  18. Presence and use of legislative guidelines for the distribution of decentralized decision making authority in the jimma zone health system, southwest ethiopia.

    Science.gov (United States)

    Woldie, Mirkuzie; Jirra, Challi; Azene, Girma

    2011-08-01

    Decentralization ultimately involves the execution of most health care activities at lower levels of the health system. However, when poorly implemented, decentralization can create confusion about roles and responsibilities. Therefore, the objective of this study was to assess the presence and use of legislative guidelines depicting the distribution of decentralized authority for decision making in the Jimma Zone health system, Southwest Ethiopia. A cross sectional study employing both qualitative and quantitative methods was undertaken from 16(th) January to 15(th) March 2007 in Jimma Zone. Health managers at relevant departments of the Federal Ministry of Health, Oromia Regional Health Bureau (RHB), Jimma Zonal Health Department, 13 Woreda Health Offices of Jimma Zone and the health centers and health posts in these districts were included in the study. Data was collected using interview guides and self administered structured questionnaires prepared for each level of the health system. Tape-recorded qualitative data was transcribed and analyzed using thematic framework approach while SPSS for windows version 12.0.1 was used to analyze the quantitative data obtained. According to the regional guidelines, ensuring achievement of regional health service targets is the responsibility of the RHB. This was clear to 97 (97.9%) of the health managers included in this study. However, almost equivalent proportion of the respondents, 95 (95.9%) agreed that the FMOH should be responsible for this. Similarly, 71 (73.9%) of the health managers knew that approval of health budgets and efforts for local resource generation is the responsibility of the Woreda Administrative Council while the remaining 27.1% were uncertain or disagreed about this regional direction. Such confusions were observed in almost every functional area. Moreover, legislative guidelines were not available in most of the district health offices and health facilities. Legislative guidelines depicting the

  19. Scaling up the 2010 World Health Organization HIV Treatment Guidelines in resource-limited settings: a model-based analysis.

    Directory of Open Access Journals (Sweden)

    Rochelle P Walensky

    2010-12-01

    Full Text Available The new 2010 World Health Organization (WHO HIV treatment guidelines recommend earlier antiretroviral therapy (ART initiation (CD4<350 cells/µl instead of CD4<200 cells/µl, multiple sequential ART regimens, and replacement of first-line stavudine with tenofovir. This paper considers what to do first in resource-limited settings where immediate implementation of all of the WHO recommendations is not feasible.We use a mathematical model and local input data to project clinical and economic outcomes in a South African HIV-infected cohort (mean age = 32.8 y, mean CD4 = 375/µl. For the reference strategy, we assume that all patients initiate stavudine-based ART with WHO stage III/IV disease and receive one line of ART (stavudine/WHO/one-line. We rank-in survival, cost-effectiveness, and equity terms-all 12 possible combinations of the following: (1 stavudine replacement with tenofovir, (2 ART initiation (by WHO stage, CD4<200 cells/µl, or CD4<350 cells/µl, and (3 one or two regimens, or lines, of available ART. Projected life expectancy for the reference strategy is 99.0 mo. Considering each of the guideline components separately, 5-y survival is maximized with ART initiation at CD4<350 cells/µl (stavudine/<350/µl/one-line, 87% survival compared with stavudine/WHO/two-lines (66% and tenofovir/WHO/one-line (66%. The greatest life expectancies are achieved via the following stepwise programmatic additions: stavudine/<350/µl/one-line (124.3 mo, stavudine/<350/µl/two-lines (177.6 mo, and tenofovir/<350/µl/two-lines (193.6 mo. Three program combinations are economically efficient: stavudine/<350/µl/one-line (cost-effectiveness ratio, US$610/years of life saved [YLS], tenofovir/<350/µl/one-line (US$1,140/YLS, and tenofovir/<350/µl/two-lines (US$2,370/YLS.In settings where immediate implementation of all of the new WHO treatment guidelines is not feasible, ART initiation at CD4<350 cells/µl provides the greatest short- and long

  20. World Health Organization Guidelines for Containment of Poliovirus Following Type-Specific Polio Eradication - Worldwide, 2015.

    Science.gov (United States)

    Previsani, Nicoletta; Tangermann, Rudolph H; Tallis, Graham; Jafari, Hamid S

    2015-08-28

    In 1988, the World Health Assembly of the World Health Organization (WHO) resolved to eradicate polio worldwide. Among the three wild poliovirus (WPV) types (type 1, type 2, and type 3), WPV type 2 (WPV2) has been eliminated in the wild since 1999, and WPV type 3 (WPV3) has not been reported since 2012. In 2015, only Afghanistan and Pakistan have reported WPV transmission. On May 25, 2015, all WHO Member States endorsed World Health Assembly resolution 68.3 on full implementation of the Polio Eradication and Endgame Strategic Plan 2013-2018 (the Endgame Plan), and with it, the third Global Action Plan to minimize poliovirus facility-associated risk (GAPIII). All WHO Member States have committed to implementing appropriate containment of WPV2 in essential laboratory and vaccine production facilities* by the end of 2015 and of type 2 oral poliovirus vaccine (OPV2) within 3 months of global withdrawal of OPV2, which is planned for April 2016. This report summarizes critical steps for essential laboratory and vaccine production facilities that intend to retain materials confirmed to contain or potentially containing type-specific WPV, vaccine-derived poliovirus (VDPV), or OPV/Sabin viruses, and steps for nonessential facilities† that process specimens that contain or might contain polioviruses. National authorities will need to certify that the essential facilities they host meet the containment requirements described in GAPIII. After certification of WPV eradication, the use of all OPV will cease; final containment of all polioviruses after polio eradication and OPV cessation will minimize the risk for reintroduction of poliovirus into a polio-free world.

  1. Behaviour of health professionals concerning the recommendations for prophylaxis for infectious endocarditis in our setting: Are the guidelines followed?

    Science.gov (United States)

    Anguita, P; Castillo, F; Gámez, P; Carrasco, F; Roldán, R; Jurado, B; Castillo, J C; Martín, E; Anguita, M

    2017-03-01

    The prophylaxis regimens for infectious endocarditis recommended by the clinical practice guidelines have recently changed. We do not know whether the current regimens are correctly followed in our setting. Our objective was to describe the approaches of various health professionals concerning these guidelines. We conducted a survey in Cordoba, using a 16-item online questionnaire on this topic. We randomly selected a sample of 180 practitioners (20 cardiologists, 80 dentists and 80 primary care physicians), of whom 173 responded. Half of the participants were men; 52% had more than 20 years of professional experience. Some 88.3% of the participants considered that prophylaxis of endocarditis is effective (77.8% of the cardiologists, 93.7% of the dentist; p=.086). In general, prophylaxis is performed in conditions of clearly established risk (>90% of those surveyed). However, prophylaxis is also performed in a high proportion of cases with no risk of endocarditis, varying between 30 and 60% according to the procedure (mostly the dentists, between 36 and 67%, followed by the primary care physicians, between 28 and 59%). The antibiotic regimens employed varied significantly. The primary care physicians were furthest from the recommended regimen (only 25.8% used the recommended regimen vs. 54.4% of dentists and 72.2% of cardiologists; p=.002). Compliance with the recommendations on prophylaxis for endocarditis should be improved in our setting. We observed a tendency, especially among noncardiologists, to "overindicate" the prophylaxis. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  2. Competencies and Training Guidelines for Behavioral Health Providers in Pediatric Primary Care.

    Science.gov (United States)

    Njoroge, Wanjiku F M; Williamson, Ariel A; Mautone, Jennifer A; Robins, Paul M; Benton, Tami D

    2017-10-01

    This article focuses on the cross-discipline training competencies needed for preparing behavioral health providers to implement integrated primary care services. After a review of current competencies in the disciplines of child and adolescent psychiatry, psychology, and social work, cross-cutting competencies for integrated training purposes are identified. These competencies are comprehensive and broad and can be modified for use in varied settings and training programs. An existing and successful integrated care training model, currently implemented at Children's Hospital of Philadelphia, is described. This model and the training competencies are discussed in the context of recommendations for future work and training. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Ethically sound technology? Guidelines for interactive ethical assessment of personal health monitoring.

    Science.gov (United States)

    Palm, Elin; Nordgren, Anders; Verweij, Marcel; Collste, Göran

    2013-01-01

    Novel care-technologies possess a transformational potential. Future care and support may be provided via monitoring technologies such as smart devices, sensors, actors (robots) and Information and Communication Technologies. Such technologies enable care provision outside traditional care institutions, for instance in the homes of patients. Health monitoring may become "personalized" i.e. tailored to the needs of individual care recipients' but may also alter relations between care providers and care recipents, shape and form the care environment and influence values central to health-care. Starting out from a social constructivist theory of technology, an interactive ethical assessment-model is offered. The suggested model supplements a traditional analysis based on normative ethical theory (top-down approach) with interviews including relevant stakeholders (a bottom-up approach). This method has been piloted by small-scale interviews encircling stakeholder perspectives on three emerging technologies: (1) Careousel, a smart medicine-management device, (2) Robot Giraff, an interactive and mobile communication-device and (3) I-Care, a care-software that combines alarm and register system. By incorporating stakeholder perspectives into the analysis, the interactive ethical assessment model provides a richer understanding of the impact of PHM-technologies on ethical values than a traditional top-down model. If the assessment is conducted before the technology has reached the market - preferably in close interaction with developers and users - ethically sound technologies may be obtained.

  4. Static magnetic fields: A summary of biological interactions, potential health effects, and exposure guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Tenforde, T.S.

    1992-05-01

    Interest in the mechanisms of interaction and the biological effects of static magnetic fields has increased significantly during the past two decades as a result of the growing number of applications of these fields in research, industry and medicine. A major stimulus for research on the bioeffects of static magnetic fields has been the effort to develop new technologies for energy production and storage that utilize intense magnetic fields (e.g., thermonuclear fusion reactors and superconducting magnet energy storage devices). Interest in the possible biological interactions and health effects of static magnetic fields has also been increased as a result of recent developments in magnetic levitation as a mode of public transportation. In addition, the rapid emergence of magnetic resonance imaging as a new clinical diagnostic procedure has, in recent years, provided a strong rationale for defining the possible biological effects of magnetic fields with high flux densities. In this review, the principal interaction mechanisms of static magnetic fields will be described, and a summary will be given of the present state of knowledge of the biological, environmental, and human health effects of these fields.

  5. Impact of National Physical Activity and Health Guidelines and Documents on Research on Teaching K-12 Physical Education in U.S.A.

    Science.gov (United States)

    Li, Weidong; Xiang, Ping; Gao, Zan; Shen, Bo; Yin, Zhihua; Kong, Qingtao

    2016-01-01

    Purpose: This study examined the impact of published national physical activity (PA) and health guidelines, documents, and initiatives on the evolution of research on teaching K-12 physical education (PE) in U.S.A. from 1996 to October 2013. Methods: A total of 262 peer-reviewed, data-based journal articles meeting our inclusion and exclusion…

  6. An e-learning supported Train-the-Trainer program to implement a suicide practice guideline. Rationale, content and dissemination in Dutch mental health care.

    NARCIS (Netherlands)

    Groot, M. de; Beurs, D.P. de; Keijser, J. de; Kerkhof, A.F.J.M.

    2015-01-01

    An e-learning supported Train-the-Trainer program was developed to implement the Dutch suicide practice guideline inmental health care. Literature on implementation strategies has been restricted to the final reporting of studieswith little opportunity to describe relevant contextual, developmental

  7. Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV-1 infection 2015: optimizing health in preparation for adult life

    NARCIS (Netherlands)

    Bamford, A.; Turkova, A.; Lyall, H.; Foster, C.; Klein, N.; Bastiaans, D.; Burger, D.; Bernadi, S.; Butler, K.; Chiappini, E.; Clayden, P.; della Negra, M.; Giacomet, V.; Giaquinto, C.; Gibb, D.; Galli, L.; Hainaut, M.; Koros, M.; Marques, L.; Nastouli, E.; Niehues, T.; Noguera-Julian, A.; Rojo, P.; Rudin, C.; Scherpbier, H. J.; Tudor-Williams, G.; Welch, S. B.

    2018-01-01

    The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV-1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far

  8. Translating infection control guidelines into practice: implementation process within a health care institution.

    Science.gov (United States)

    Raveis, Victoria H; Conway, Laurie J; Uchida, Mayuko; Pogorzelska-Maziarz, Monika; Larson, Elaine L; Stone, Patricia W

    2014-04-01

    Health-care-associated infections (HAIs) remain a major patient safety problem even as policy and programmatic efforts designed to reduce HAIs have increased. Although information on implementing effective infection control (IC) efforts has steadily grown, knowledge gaps remain regarding the organizational elements that improve bedside practice and accommodate variations in clinical care settings. We conducted in-depth, semistructured interviews in 11 hospitals across the United States with a range of hospital personnel involved in IC (n = 116). We examined the collective nature of IC and the organizational elements that can enable disparate groups to work together to prevent HAIs. Our content analysis of participants' narratives yielded a rich description of the organizational process of implementing adherence to IC. Findings document the dynamic, fluid, interactional, and reactive nature of this process. Three themes emerged: implementing adherence efforts institution-wide, promoting an institutional culture to sustain adherence, and contending with opposition to the IC mandate.

  9. Should trained lay providers perform HIV testing? A systematic review to inform World Health Organization guidelines.

    Science.gov (United States)

    Kennedy, C E; Yeh, P T; Johnson, C; Baggaley, R

    2017-12-01

    New strategies for HIV testing services (HTS) are needed to achieve UN 90-90-90 targets, including diagnosis of 90% of people living with HIV. Task-sharing HTS to trained lay providers may alleviate health worker shortages and better reach target groups. We conducted a systematic review of studies evaluating HTS by lay providers using rapid diagnostic tests (RDTs). Peer-reviewed articles were included if they compared HTS using RDTs performed by trained lay providers to HTS by health professionals, or to no intervention. We also reviewed data on end-users' values and preferences around lay providers preforming HTS. Searching was conducted through 10 online databases, reviewing reference lists, and contacting experts. Screening and data abstraction were conducted in duplicate using systematic methods. Of 6113 unique citations identified, 5 studies were included in the effectiveness review and 6 in the values and preferences review. One US-based randomized trial found patients' uptake of HTS doubled with lay providers (57% vs. 27%, percent difference: 30, 95% confidence interval: 27-32, p lay providers. Studies from Cambodia, Malawi, and South Africa comparing testing quality between lay providers and laboratory staff found little discordance and high sensitivity and specificity (≥98%). Values and preferences studies generally found support for lay providers conducting HTS, particularly in non-hypothetical scenarios. Based on evidence supporting using trained lay providers, a WHO expert panel recommended lay providers be allowed to conduct HTS using HIV RDTs. Uptake of this recommendation could expand HIV testing to more people globally.

  10. Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings - Guideline of the German Society for Hospital Hygiene (DGKH).

    Science.gov (United States)

    Külpmann, Rüdiger; Christiansen, Bärbel; Kramer, Axel; Lüderitz, Peter; Pitten, Frank-Albert; Wille, Frank; Zastrow, Klaus-Dieter; Lemm, Friederike; Sommer, Regina; Halabi, Milo

    2016-01-01

    Since the publication of the first "Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems) in hospitals" (http://www.krankenhaushygiene.de/informationen/fachinformationen/leitlinien/12) in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section "Ventilation and air conditioning technology" attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care.

  11. Poor Adherence to US Dietary Guidelines for Children and Adolescents in the National Health and Nutrition Examination Survey Population.

    Science.gov (United States)

    Banfield, Emilyn C; Liu, Yan; Davis, Jennifer S; Chang, Shine; Frazier-Wood, Alexis C

    2016-01-01

    Poor diet quality in childhood and adolescence is associated with adverse health outcomes throughout life, yet the dietary habits of American children and how they change across childhood and adolescence are unknown. This study sought to describe diet quality among children and adolescents by assessing adherence to the 2010 Dietary Guidelines for Americans (DGA) and to determine whether any differences in adherence occurred across childhood. We employed a cross-sectional design using data from the National Health and Nutrition Examination Survey (NHANES). Of 9,280 children aged 4 to 18 years who participated in NHANES from 2005 to 2010, those with insufficient data on dietary recall (n=852) or who were pregnant or lactating during the time of interview (n=38) were excluded from the final study sample (n=8,390). We measured adherence to the DGA using the Healthy Eating Index 2010 (HEI-2010) and stratified participants into three age groups (4 to 8, 9 to 13, and 14 to 18 years of age). We analyzed each of 12 HEI-2010 components and total HEI-2010 score. The youngest children had the highest overall diet quality due to significantly greater scores for total fruit, whole fruit, dairy, and whole grains. These children also had the highest scores for sodium, refined grains, and empty calories. Total HEI-2010 scores ranged from 43.59 to 52.11 out of 100, much lower than the minimum score of 80 that is thought to indicate a diet associated with good health. Overall, children and adolescents are failing to meet the DGA and may be at an increased risk of chronic diseases throughout life. By analyzing which food groups show differences between age groups, we provide data that can inform the development of dietary interventions to promote specific food groups targeting specific ages and improve diet quality among children and adolescents. Copyright © 2016 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  12. [New Scientific Evidence-based Public Health Guidelines and Practical Manual for Prevention of Sick House Syndrome].

    Science.gov (United States)

    Kishi, Reiko; Yoshino, Hiroshi; Araki, Atsuko; Saijo, Yasuaki; Azuma, Kenichi; Kawai, Toshio; Yamato, Hiroshi; Osawa, Haruki; Shibata, Eiji; Tanaka, Masatoshi; Masuchi, Ayumi; Minatoya, Machiko; Ait Bamai, Yu

    2018-01-01

    Recently, we have published a book containing evidence-based public health guidelines and a practical manual for the prevention of sick house syndrome. The manual is available through the homepage of the Ministry of Health, Labour and Welfare (http://www.mhlw.go.jp/file/06-Seisakujouhou-11130500-Shokuhinanzenbu/0000155147.pdf). It is an almost completely revised version of the 2009 version. The coauthors are 13 specialists in environmental epidemiology, exposure sciences, architecture, and risk communication. Since the 1970s, health problems caused by indoor chemicals, biological pollution, poor temperature control, humidity, and others in office buildings have been recognized as sick building syndrome (SBS) in Western countries, but in Japan it was not until the 1990s that people living in new or renovated homes started to describe a variety of nonspecific subjective symptoms such as eye, nose, and throat irritation, headache, and general fatigue. These symptoms resembled SBS and were designated "sick house syndrome (SHS)." To determine the strategy for prevention of SHS, we conducted a nationwide epidemiological study in six cities from 2003-2013 by randomly sampling 5,709 newly built houses. As a result 1,479 residents in 425 households agreed to environmental monitoring for indoor aldehydes and volatile organic compounds (VOCs). After adjustment for possible risk factors, some VOCs and formaldehyde were dose-dependently shown to be significant risk factors. We also studied the dampness of the houses, fungi, allergies, and others. This book is fully based on the scientific evidence collected through these studies and other newly obtained information, especially from the aspect of architectural engineering. In addition to SHS, we included chapters on recent information about "multi-chemical sensitivity."

  13. Clinical algorithms to aid osteoarthritis guideline dissemination.

    Science.gov (United States)

    Meneses, S R F; Goode, A P; Nelson, A E; Lin, J; Jordan, J M; Allen, K D; Bennell, K L; Lohmander, L S; Fernandes, L; Hochberg, M C; Underwood, M; Conaghan, P G; Liu, S; McAlindon, T E; Golightly, Y M; Hunter, D J

    2016-09-01

    Numerous scientific organisations have developed evidence-based recommendations aiming to optimise the management of osteoarthritis (OA). Uptake, however, has been suboptimal. The purpose of this exercise was to harmonize the recent recommendations and develop a user-friendly treatment algorithm to facilitate translation of evidence into practice. We updated a previous systematic review on clinical practice guidelines (CPGs) for OA management. The guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation for quality and the standards for developing trustworthy CPGs as established by the National Academy of Medicine (NAM). Four case scenarios and algorithms were developed by consensus of a multidisciplinary panel. Sixteen guidelines were included in the systematic review. Most recommendations were directed toward physicians and allied health professionals, and most had multi-disciplinary input. Analysis for trustworthiness suggests that many guidelines still present a lack of transparency. A treatment algorithm was developed for each case scenario advised by recommendations from guidelines and based on panel consensus. Strategies to facilitate the implementation of guidelines in clinical practice are necessary. The algorithms proposed are examples of how to apply recommendations in the clinical context, helping the clinician to visualise the patient flow and timing of different treatment modalities. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  14. Main lines of the EC-guideline and of the advice of the National Council for Public Health related to this

    International Nuclear Information System (INIS)

    Aris, A.R.I.

    1989-01-01

    The author enters into the EG-guideline and the advice, derived from this, of the Dutch National Council for Public Health 'Radiation protection of the patient'. He pointed out that also the Dutch Government is obliged to carry out the European guideline. In order to prepare the relevant government policy and the necessary supplementary legislation, collaboration with the involving employment groups is important. At the hearing on education in the field of radiobiology and radiation protection, held at the end of 1988, it already has appeared that the employment groups are inclined for collaboration.(author)

  15. Associations between meeting combinations of 24-h movement guidelines and health-related quality of life in children from 12 countries.

    Science.gov (United States)

    Sampasa-Kanyinga, H; Standage, M; Tremblay, M S; Katzmarzyk, P T; Hu, G; Kuriyan, R; Maher, C; Maia, J; Olds, T; Sarmiento, O L; Tudor-Locke, C; Chaput, J-P

    2017-12-01

    To examine whether meeting vs not meeting movement/non-movement guidelines (moderate-to-vigorous physical activity [MVPA], screen time, sleep duration), and combinations of these recommendations, are associated with health-related quality of life (HRQoL) in children from 12 countries in five major geographic regions of the world and explore whether the associations vary by study site. Observational, multinational cross-sectional study. This study included 6106 children aged 9-11 years from sites in Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom, and the United States. Participants completed the KIDSCREEN-10 to provide a global measure of their HRQoL. Sleep duration and MVPA were assessed using 24-h accelerometry. Screen time was assessed through self-report. Meeting the recommendations was defined as ≥60 min/day for MVPA, ≤2 h/day for screen time, and between 9 and 11 h/night for sleep duration. Age, sex, highest parental education, unhealthy diet pattern score, and body mass index z-score were included as covariates in statistical models. In the full sample, children meeting the screen time recommendation, the screen time + sleep recommendation, and all three recommendations had significantly better HRQoL than children not meeting any of these guidelines. Differences in HRQoL scores between sites were also found within combinations of movement/non-movement behaviors. For example, while children in Australia, Canada, and USA self-reported better HRQoL when meeting all three recommendations, children in Kenya and Portugal reported significantly lower HRQoL when meeting all three recommendations (relative to not meeting any). Self-reported HRQoL is generally higher when children meet established movement/non-movement recommendations. However, differences between study sites also suggest that interventions aimed at improving lifestyle behaviors and HRQoL should be locally and culturally adapted

  16. Lifestyle guidelines for managing adverse effects on bone health and body composition in men treated with androgen deprivation therapy for prostate cancer: an update.

    Science.gov (United States)

    Owen, P J; Daly, R M; Livingston, P M; Fraser, S F

    2017-06-01

    Men treated with androgen deprivation therapy (ADT) for prostate cancer are prone to multiple treatment-induced adverse effects, particularly with regard to a deterioration in bone health and altered body composition including decreased lean tissue mass and increased fat mass. These alterations may partially explain the marked increased risk in osteoporosis, falls, fracture and cardiometabolic risk that has been observed in this population. A review was conducted that assessed standard clinical guidelines for the management of ADT-induced adverse effects on bone health and body composition in men with prostate cancer. Currently, standard clinical guidelines exist for the management of various bone and metabolic ADT-induced adverse effects in men with prostate cancer. However, an evaluation of the effectiveness of these guidelines into routine practice revealed that men continued to experience increased central adiposity, and, unless pharmacotherapy was instituted, accelerated bone loss and worsening glycaemia occurred. This review discusses the current guidelines and some of the limitations, and proposes new recommendations based on emerging evidence regarding the efficacy of lifestyle interventions, particularly with regard to exercise and nutritional factors, to manage ADT-related adverse effects on bone health and body composition in men with prostate cancer.

  17. Detecting New Evidences for Evidence-Based Medical Guidelines with Journal Filtering

    NARCIS (Netherlands)

    Hu, Qing; Huang, Zisheng; ten Teije, Annette; van Harmelen, Frank; Riaño, David; Lenz, Richard; Reichert, Manfred

    2017-01-01

    Evidence-based medical guidelines are systematically developed recommendations with the aim to assist practitioner and patients decisions regarding appropriate health care for specific clinical circumstances, and are based on evidence described in medical research papers. Evidence-based medical

  18. Computerizing clinical practice guidelines

    DEFF Research Database (Denmark)

    Lyng, Karen Marie

    It is well described that hospitals have problems with sustaining high quality of care and expedient introduction of new medical knowledge. Clinical practice guidelines (CPGs) have been promoted as a remedy to deal with these problems. It is, however, also well described that application and comp......It is well described that hospitals have problems with sustaining high quality of care and expedient introduction of new medical knowledge. Clinical practice guidelines (CPGs) have been promoted as a remedy to deal with these problems. It is, however, also well described that application...... is comprised by fieldwork in three oncology departments and a case study of advanced life support. Although close to all patients within oncology are treated according to a CPG, I found limited application of physical CPGs and web-based CPG portals. However, I found comprehensive application of activity...... of the business strategic aims, and 3) analysis and formalization of CPGs. This will imply orchestration of design teams with competencies from a wide array of disciplines such as health practice, business management, knowledge management and information systems....

  19. Author Guidelines

    Directory of Open Access Journals (Sweden)

    Chief Editor

    2015-12-01

    Full Text Available Author GuidelinesIJCH strictly adheres on the recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals as per the standard universal guidelines given by International Committee of Medical Journal Editors (ICMJE - Recommendations for Uniform Requirements for Manuscripts. Authors are requested to visit http://www.icmje.org/index.html before making online submission of their manuscript(s.  http://www.icmje.org/recommendations/browse/manuscript-preparation/preparing-for-submission.html Preparing for SubmissionPAGE CONTENTSGeneral PrinciplesReporting GuidelinesManuscript SectionsTitle PageAbstractIntroductionMethodsResultsDiscussionReferencesTablesIllustrations (FiguresUnits of MeasurementAbbreviations and Symbols1. General PrinciplesThe text of articles reporting original research is usually divided into Introduction, Methods, Results, and Discussion sections. This so-called “IMRAD” structure is not an arbitrary publication format but a reflection of the process of scientific discovery. Articles often need subheadings within these sections to further organize their content. Other types of articles, such as meta-analyses, may require different formats, while case reports, narrative reviews, and editorials may have less structured or unstructured formats.Electronic formats have created opportunities for adding details or sections, layering information, cross-linking, or extracting portions of articles in electronic versions. Supplementary electronic-only material should be submitted and sent for peer review simultaneously with the primary manuscript.2. Reporting GuidelinesReporting guidelines have been developed for different study designs; examples include CONSORT for randomized trials, STROBE for observational studies, PRISMA for systematic reviews and meta-analyses, and STARD for studies of diagnostic accuracy. Journals are encouraged to ask authors to follow these guidelines because

  20. Author Guidelines

    Directory of Open Access Journals (Sweden)

    Chief Editor

    2016-06-01

    Full Text Available AUTHOR GUIDELINES Indian Journal of Community Health (IJCH accepts only online submission of manuscript(s by using Open Journal software (OJS at http://www.iapsmupuk.org/journal/index.php/IJCH/login Online SubmissionsAlready have a Username/Password for Indian Journal of Community Health (IJCH? GO TO LOGINNeed a Username/Password?GO TO REGISTRATIONNote: Registration and login are required to submit items online and to track the status of current submissions.Author GuidelinesIJCH strictly adheres on the recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals as per the standard universal guidelines given by International Committee of Medical Journal Editors (ICMJE - Recommendations for Uniform Requirements for Manuscripts. Authors are requested to visit http://www.icmje.org/index.html before making online submission of their manuscript(s. http://www.icmje.org/recommendations/browse/manuscript-preparation/preparing-for-submission.html Preparing for SubmissionGeneral PrinciplesReporting GuidelinesManuscript SectionsTitle PageAbstractIntroductionMethodsResultsDiscussionReferencesTablesIllustrations (FiguresUnits of MeasurementAbbreviations and Symbols 1. General PrinciplesThe text of articles reporting original research is usually divided into Introduction, Methods, Results, and Discussion sections. This so-called “IMRAD” structure is not an arbitrary publication format but a reflection of the process of scientific discovery. Articles often need subheadings within these sections to further organize their content. Other types of articles, such as meta-analyses, may require different formats, while case reports, narrative reviews, and editorials may have less structured or unstructured formats.Electronic formats have created opportunities for adding details or sections, layering information, cross-linking, or extracting portions of articles in electronic versions. Supplementary electronic

  1. ENTERPRISE RESTRUCTURING AIM AND TYPES

    Directory of Open Access Journals (Sweden)

    S. P. Baranenko

    2011-01-01

    Full Text Available Enterprise restructuring is aimed at adapting it to market conditions and improving its competitiveness through selection of most effective model of using material, technical, technological, organizational, commercial, economical, financial, tax-related and other resources with due account of the demand. Restructuring classification signs and types as well as restructuring aims specific for industrial enterprises are provided for.

  2. Derivation of strontium-90 and cesium-137 residual radioactive material guidelines for the Laboratory for Energy-Related Health Research, University of California, Davis

    International Nuclear Information System (INIS)

    Nimmagadda, M.; Yu, C.

    1993-04-01

    Residual radioactive material guidelines for strontium-90 and cesium-137 were derived for the Laboratory for Energy-Related Health Research (LEHR) site in Davis, California. The guideline derivation was based on a dose limit of 100 mrem/yr. The US Department of Energy (DOE) residual radioactive material guideline computer code, RESRAD, was used in this evaluation; this code implements the methodology described in the DOE manual for implementing residual radioactive material guidelines. Three potential site utilization scenarios were considered with the assumption that, for a period of 1,000 years following remedial action, the site will be utilized without radiological restrictions. The defined scenarios vary with regard to use of the site, time spent at the site, and sources of food consumed. The results of the evaluation indicate that the basic dose limit of 100 mrem/yr will not be exceeded within 1,000 years for either strontium-90 or cesium-137, provided that the soil concentrations of these radionuclides at the LEHR site do not exceed the following levels: 71,000 pCi/g for strontium-90 and 91 pCi/g for cesium-137 for Scenario A (researcher: the expected scenario); 160,000 pCi/g for strontium-90 and 220 pCi/g for cesium-137 for Scenario B (recreationist: a plausible scenario); and 37 pCi/g for strontium-90 and 32 pCi/g for cesium-137 for Scenario C (resident farmer ingesting food produced in the contaminated area: a plausible scenario). The derived guidelines are single-radionuclide guidelines and are linearly proportional to the dose limit used in the calculations. In setting the actual strontium-90 and cesium-137 guidelines for the LEHR site, DOE will apply the as low as reasonably achievable (ALARA) policy to the decision-making process, along with other factors such as whether a particular scenario is reasonable and appropriate

  3. Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest.

    Science.gov (United States)

    Eccles, Martin P; Grimshaw, Jeremy M; Shekelle, Paul; Schünemann, Holger J; Woolf, Steven

    2012-07-04

    Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emergence of guideline clearing houses and large scale guideline production organisations (such as the UK National Institute for Health and Clinical Excellence). It therefore seems timely to, in a series of three articles, update and extend our earlier paper. In this first paper we discuss: the target audience(s) for guidelines and their use of guidelines; identifying topics for guidelines; guideline group composition (including consumer involvement) and the processes by which guideline groups function and the important procedural issue of managing conflicts of interest in guideline development.

  4. Proportion of preschool-aged children meeting the Canadian 24-Hour Movement Guidelines and associations with adiposity: results from the Canadian Health Measures Survey

    Directory of Open Access Journals (Sweden)

    Jean-Philippe Chaput

    2017-11-01

    Full Text Available Abstract Background New Canadian 24-Hour Movement Guidelines for the Early Years have been released in 2017. According to the guidelines, within a 24-h period, preschoolers should accumulate at least 180 min of physical activity (of which at least 60 min is moderate-to-vigorous physical activity, engage in no more than 1 h of screen time, and obtain between 10 and 13 h of sleep. This study examined the proportions of preschool-aged (3 to 4 years Canadian children who met these new guidelines and different recommendations within the guidelines, and the associations with adiposity indicators. Methods Participants were 803 children (mean age: 3.5 years from cycles 2–4 of the Canadian Health Measures Survey (CHMS, a nationally representative cross-sectional sample of Canadians. Physical activity was accelerometer-derived, and screen time and sleep duration were parent-reported. Participants were classified as meeting the overall 24-Hour Movement Guidelines if they met all three specific time recommendations for physical activity, screen time, and sleep. The adiposity indicators in this study were body mass index (BMI z-scores and BMI status (World Health Organization Growth Standards. Results A total of 12.7% of preschool-aged children met the overall 24-Hour Movement Guidelines, and 3.3% met none of the three recommendations. A high proportion of children met the sleep duration (83.9% and physical activity (61.8% recommendations, while 24.4% met the screen time recommendation. No associations were found between meeting individual or combined recommendations and adiposity. Conclusions Very few preschool-aged children in Canada (~13% met all three recommendations contained within the 24-Hour Movement Guidelines. None of the combinations of recommendations were associated with adiposity in this sample. Future work should focus on identifying innovative ways to reduce screen time in this population, and should examine the associations of

  5. Lower Odds of Poststroke Symptoms of Depression When Physical Activity Guidelines Met: National Health and Nutrition Examination Survey 2011-2012.

    Science.gov (United States)

    Aaron, Stacey E; Gregory, Chris M; Simpson, Annie N

    2016-08-01

    One-third of individuals with stroke report symptoms of depression, which has a negative impact on recovery. Physical activity (PA) is a potentially effective therapy. Our objective was to examine the associations of subjectively assessed PA levels and symptoms of depression in a nationally representative stroke sample. We conducted a cross-sectional study of 175 adults in the National Health and Nutrition Examination Survey 2011-2012 cycle. Moderate, vigorous, and combination equivalent PA metabolic equivalent (MET)-minutes per week averages were derived from the Global Physical Activity Questionnaire, and .the 2008 Physical Activity Guidelines/American College of Sports Medicine recommendations of ≥500 MET-minutes per week of moderate, vigorous, or combination equivalent PA were used as cut points. Depression symptoms were measured using the Patient Health Questionnaire-9. Meeting moderate PA guidelines resulted in 74% lower odds of having depression symptoms (P depression (P = .0003). Meeting vigorous guidelines showed a 91% lower odds of having mild symptoms of depression (P = .04). Participating in some moderate, vigorous, or combination equivalent PA revealed the odds of depression symptoms 13 times greater compared with meeting guidelines (P = .005); odds of mild symptoms of depression were 9 times greater (P = .01); and odds of major symptoms of depression were 15 times greater (P = .006). There is a lower risk of developing mild symptoms of depression when vigorous guidelines for PA are met and developing major symptoms of depression when moderate guidelines met. Participating in some PA is not enough to reduce the risk of depression symptoms.

  6. Barreiras às intervenções relacionadas à saúde do trabalhador do setor saúde no Brasil Barriers to interventions aimed at promoting the health of health care workers in Brazil

    Directory of Open Access Journals (Sweden)

    Érica Lui Reinhardt

    2009-05-01

    Full Text Available OBJETIVO: Identificar na literatura situações que possam impedir ou prejudicar as ações de prevenção de acidentes e doenças ou de promoção da saúde de trabalhadores do setor saúde. MÉTODO: Foi realizada uma revisão da literatura utilizando a base SciELO para o período de 1967 a 2008, complementada por busca na base PubMed para o período de 1950 a 2008. Os seguintes termos foram utilizados para identificar artigos em português, inglês e espanhol: trabalho, trabalhador, ocupacional, riscos, doenças, ergonomia, capacidade para o trabalho, qualidade de vida, organização, acidentes, condições de trabalho, intervenção e administração. Foram selecionados artigos sobre prevenção de doenças e acidentes e sobre promoção da saúde no trabalho em serviços de saúde latino-americanos. Também foram selecionados artigos sobre intervenções em ambientes de trabalho no setor saúde. RESULTADOS: Foram identificadas as seguintes situações desfavoráveis: programas de intervenção sem boa base teórica e não integrados à gestão do serviço como um todo; falhas em avaliar a eficácia das intervenções; vigilância da saúde restrita a doenças e agravos específicos; falta de compromisso da gestão com as intervenções; falhas na comunicação; falta de participação e controle por parte dos trabalhadores sobre o ambiente de trabalho; e programas e intervenções baseados exclusivamente na mudança comportamental dos trabalhadores. CONCLUSÕES: A literatura mostra que todas as barreiras citadas afetam tanto a melhoria do estado de saúde dos trabalhadores em saúde quanto a sua capacidade para o trabalho.OBJECTIVE: To search the literature for circumstances that impede injury and disease prevention and other activities intended to improve the health of the health care worker. METHODS: The SciELO database was searched for articles published in 1967-2008. This was supplemented by a PubMed search for the period 1950-2008. The

  7. Legal duties, professional obligations or notional guidelines? Screening, treatment and referral of domestic violence cases in primary health care settings in South Africa.

    Science.gov (United States)

    Artz, Lillian; Meer, Talia; Aschman, Gray

    2018-06-18

    Since 2013, approximately 4400 women have been murdered by their partners in South Africa. This is five times higher than the per capita global average. Domestic violence is known to be cyclical, endemic and frequently involves multiple victims. It also becomes progressively more dangerous over time and may lead to fatalities. In 2012, the Health Professions Council of South Africa released a domestic violence protocol for emergency service providers. This protocol, or screening guidelines, includes assessing future risk to domestic violence, providing physical and psychosocial care, documentation of evidence of abuse and informing patients of their rights and the services available to them. The extent to which these guidelines have been circulated and implemented, particularly by general health care practitioners (HCPs), is unknown. We review international treaties to which South Africa is a signatory, as well as national legislation and policies that reinforce the right to care for victims of domestic violence, to delineate the implication of these laws and policies for HCPs. We reviewed literature and analysed national and international legislation and policies. The 'norms' contained in existing guidelines and currently practiced in an ad hoc manner are not only compatible with existing statutory duties of HCPs but are in fact a natural extension of them. Proactive interventions such as the use of guidelines for working with victims of domestic violence enable suspected cases of domestic violence to be systematically identified, appropriately managed, properly referred, and should be adopted by all South African HCPs.

  8. Adoption of new HIV treatment guidelines and drug substitutions within first-line as a measure of quality of care in rural Lesotho: health centers and hospitals compared.

    Science.gov (United States)

    Labhardt, Niklaus D; Sello, Motlalepula; Lejone, Thabo; Ehmer, Jochen; Mokhantso, Mohlaba; Lynen, Lutgarde; Pfeiffer, Karolin

    2012-10-01

    In 2007, Lesotho launched new national antiretroviral treatment (ART) guidelines, prioritising tenofovir and zidovudine over stavudine as a backbone together with lamivudine. We compared the rate of adoption of these new guidelines and substitution of first-line drugs by health centers (HC) and hospitals in two catchment areas in rural Lesotho. Retrospective cohort analysis. Patients aged ≥16 years were stratified into a HC- and a hospital-group. Type of backbone at ART-initiation (i), substitutions within first line (ii) and type of backbone among patients retained by December 2010 (iii). A multiple logistic regression model including HC vs. hospital, patient characteristics (sex, age, WHO-stage, baseline CD4-count, concurrent pregnancy, concurrent tuberculosis treatment) and year of ART-start, was used. Of 3936 adult patients initiated on ART between 2007 and 2010, 1971 started at hospitals and 1965 at HCs. Hospitals were more likely to follow the new guidelines as measured by prescription of backbones without stavudine (Odds-ratio 1.55; 95%CI: 1.32-1.81) and had a higher rate of drug substitutions while on first-line ART (2.39; 1.83-3.13). By December 2010, patients followed at health centres were more likely to still receive stavudine (2.28; 1.83-2.84). Health centers took longer to adopt the new guidelines and substituted drugs less frequently. Decentralised ART-programmes need close support, supervision and mentoring to absorb new guidelines and to adhere to them. © 2012 Blackwell Publishing Ltd.

  9. Adaptation of Dutch Allocation Guideline for Patients after Alcohol Detoxification - Results of a Delphi Survey

    NARCIS (Netherlands)

    Friedrichs, A.; Kraus, L.; Berner, M.; Schippers, G.; Broekman, T.; Rist, F.; Piontek, D.; Roehrlg, J.; Buchholz, A.

    2013-01-01

    Aim of the study: In the Netherlands, guidelines for the allocation of patients with alcohol related disorders to different levels of care have been implemented and evaluated nationwide. These guidelines cannot be used in the German health care system without adaptation, but with modifications they

  10. The diverse aims of science.

    Science.gov (United States)

    Potochnik, Angela

    2015-10-01

    There is increasing attention to the centrality of idealization in science. One common view is that models and other idealized representations are important to science, but that they fall short in one or more ways. On this view, there must be an intermediary step between idealized representation and the traditional aims of science, including truth, explanation, and prediction. Here I develop an alternative interpretation of the relationship between idealized representation and the aims of science. I suggest that continuing, widespread idealization calls into question the idea that science aims for truth. If instead science aims to produce understanding, this would enable idealizations to directly contribute to science's epistemic success. I also use the fact of widespread idealization to motivate the idea that science's wide variety aims, epistemic and non-epistemic, are best served by different kinds of scientific products. Finally, I show how these diverse aims—most rather distant from truth—result in the expanded influence of social values on science. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Evaluation of in-hospital management for febrile illness in Northern Tanzania before and after 2010 World Health Organization Guidelines for the treatment of malaria.

    Directory of Open Access Journals (Sweden)

    Andrew M Moon

    Full Text Available In 2010, the World Health Organization (WHO published updated guidelines emphasizing and expanding recommendations for a parasitological confirmation of malaria before treating with antimalarials. This study aimed to assess differences in historic (2007-2008 (cohort 1 and recent (2011-2012 (cohort 2 hospital cohorts in the diagnosis and treatment of febrile illness in a low malaria prevalence area of northern Tanzania.We analyzed data from two prospective cohort studies that enrolled febrile adolescents and adults aged ≥13 years. All patients received quality-controlled aerobic blood cultures and malaria smears. We compared patients' discharge diagnoses, treatments, and outcomes to assess changes in the treatment of malaria and bacterial infections.In total, 595 febrile inpatients were enrolled from two referral hospitals in Moshi, Tanzania. Laboratory-confirmed malaria was detected in 13 (3.2% of 402 patients in cohort 1 and 1 (0.5% of 193 patients in cohort 2 (p = 0.041. Antimalarials were prescribed to 201 (51.7% of 389 smear-negative patients in cohort 1 and 97 (50.5% of 192 smear-negative patients in cohort 2 (p = 0.794. Bacteremia was diagnosed from standard blood culture in 58 (14.5% of 401 patients in cohort 1 compared to 18 (9.5% of 190 patients in cohort 2 (p = 0.091. In cohort 1, 40 (69.0% of 58 patients with a positive blood culture received antibacterials compared to 16 (88.9% of 18 patients in cohort 2 (p = 0.094. In cohort 1, 43 (10.8% of the 399 patients with known outcomes died during hospitalization compared with 12 (6.2% deaths among 193 patients in cohort 2 (p = 0.073.In a setting of low malaria transmission, a high proportion of smear-negative patients were diagnosed with malaria and treated with antimalarials despite updated WHO guidelines on malaria treatment. Improved laboratory diagnostics for non-malaria febrile illness might help to curb this practice.

  12. Suspected cow's milk allergy in everyday general practice: a retrospective cohort study on health care burden and guideline adherence.

    Science.gov (United States)

    van den Hoogen, Sharayke C T A; van de Pol, Alma C; Meijer, Yolanda; Toet, Jaap; van Klei, Céline; de Wit, Niek J

    2014-08-09

    Cow's milk allergy (CMA) is the most common food allergy among infants. No data are available on the health care burden of suspected CMA in general practice. This study was conducted to evaluate the burden of suspected CMA in general practice (GP): (a) prevalence, (b) presenting symptoms, (c) diagnostic process, (d) guideline adherence, and (e) dietary measures. A retrospective cohort study was carried out in four Julius Healthcare Centers (JHCs). These JHCs form the core primary care academic network of the department of general practice of the University Medical Center of Utrecht. Electronic records of the first year of infants born May 2009 - April 2010 registered in the JHCs were screened for possible CMA suspicion. Preventive child healthcare (PCH) records were reviewed for additional information. Clinical presentation, diagnostic strategies and dietary measures were extracted. Of 804 infants evaluated, 55 presented with symptoms fitting the suspicion of CMA (prevalence of 7%). Presenting complaints involved the skin (71%); the gastrointestinal tract (60%); the respiratory tract (13%) or other symptoms (36%) and 23 infants presented with symptoms of two or more organ systems. In 31 children (56%) a food challenge was performed (n = 28 open and n = 3 double-blind). Open challenge test results were difficult to interpret due to inadequate implementation or reporting. None had confirmed CMA after an adequate challenge test. Long term milk substitute formulas were prescribed in 39 (71%) infants. On a yearly basis seven percent of children visit their GP for suspected CMA. A positive CMA diagnosis was rarely established after adequate implementation and reporting of diagnostics, yet long term dietary measures were prescribed in >70% of patients. There is definitely need for improvement of diagnosing CMA in primary care.

  13. Re-development of mental health first aid guidelines for supporting Aboriginal and Torres Strait Islanders who are engaging in non-suicidal self-injury.

    Science.gov (United States)

    Armstrong, Gregory; Ironfield, Natalie; Kelly, Claire M; Dart, Katrina; Arabena, Kerry; Bond, Kathy; Jorm, Anthony F

    2017-08-22

    Non-suicidal self-injury (NSSI) disproportionally affects Indigenous Australians. Friends, family and frontline workers (for example, teachers, youth workers) are often best positioned to provide initial assistance if someone is engaging in NSSI. Culturally appropriate expert consensus guidelines on how to provide mental health first aid to Australian Aboriginal and Torres Strait Islanders who are engaging in NSSI were developed in 2009. This study describes the re-development of these guidelines to ensure they contain the most current recommended helping actions. The Delphi consensus method was used to elicit consensus on potential helping statements to be included in the guidelines. These statements describe helping actions that Indigenous community members and non-Indigenous frontline workers can take, and information they should have, to help someone who is engaging in NSSI. The statements were sourced from systematic searches of peer-reviewed literature, grey literature, books, websites and online materials, and existing NSSI courses. A panel was formed, comprising 26 Aboriginal and Torres Strait Islanders with expertise in NSSI. The panellists were presented with the helping statements via online questionnaires and were encouraged to suggest re-wording of statements and any additional helping statements that were not included in the original questionnaire. Statements were only accepted for inclusion in the guidelines if they were endorsed by ≥90% of panellists as essential or important. From a total of 185 statements shown to the expert panel, 115 were endorsed as helping statements to be included in the re-developed guidelines. A panel of Aboriginal and Torres Strait Islander people with expertise in NSSI were able to reach consensus on appropriate strategies for providing mental health first aid to an Aboriginal and Torres Strait Islander engaging in NSSI. The re-development of the guidelines has resulted in more comprehensive guidance than the earlier

  14. Aim For a Healthy Weight

    Science.gov (United States)

    ... out of your control, you can make positive lifestyle changes to lose weight and to maintain a healthy weight. These include a healthy eating plan and being more physically active. Take the Challenge When it comes to aiming for a healthy ...

  15. The development of the UK National Institute of Health and Care Excellence evidence-based clinical guidelines on motor neurone disease.

    Science.gov (United States)

    Oliver, David; Radunovic, Aleksandar; Allen, Alexander; McDermott, Christopher

    2017-08-01

    The care of people with motor neuron disease/amyotrophic lateral sclerosis is often complex and involves a wide multidisciplinary team approach. The National Institute for Health and Care Excellence (NICE) in the UK has produced an evidence based guideline for the management of patients. This has made recommendations, based on clear evidence or consensus discussion. The evidence is often limited and areas for further research are suggested.

  16. Nurses' experiences of guideline implementation

    DEFF Research Database (Denmark)

    Alanen, Seija; Välimäki, Marita; Kaila, Minna

    2009-01-01

    AIMS: The aim of the study was to address the following questions: What kind of experiences do primary care nurses have of guideline implementation? What do nurses think are the most important factors affecting the adoption of guidelines? BACKGROUND: The implementation of clinical guidelines seems...... to be dependent on multiple context-specific factors. This study sets out to explore the experiences of primary care nurses concerning guideline implementation. DESIGN: Qualitative interview. METHODS: Data were generated by four focus group interviews involving nurses working in out-patient services in primary...... to nurses, (iii) factors related to the anticipated consequences and (iv) factors related to the patient group. Nurses' awareness and acceptance of guidelines and the anticipated positive consequences facilitate the implementation of guidelines. Organisational support, especially the adapting of guidelines...

  17. Aims, assessments and workplace needs

    Science.gov (United States)

    Black, Paul

    1997-03-01

    This paper attempts to consider the aims that undergraduate physics degree courses actually reflect and serve in the light of the employment patterns of graduates and of the expressed needs of employers. Calling on evidence mainly from the UK, it reviews analyses of what degree examinations actually test, and goes on to quote criticisms of their courses and radical proposals to change them adopted by the senior physics professors in the UK. The discussion is then broadened by discussion of evidence, about the employment of graduates and about the priorities that some industrialists now give in the qualities that they look for when recruiting new graduates. The evidence leads to a view that radical changes are needed, both in courses and examinations, and that there is a need for university departments to work more closely with employers in re-formulating the aims and priorities in their teaching.

  18. A survey of tobacco dependence treatment guidelines in 121 countries

    Science.gov (United States)

    Piné-Abata, Hembadoon; McNeill, Ann; Raw, Martin; Bitton, Asaf; Rigotti, Nancy; Murray, Rachael

    2013-01-01

    Aims To report progress among Parties to the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in developing national tobacco treatment guidelines in accordance with FCTC Article 14 guideline recommendations. Design Cross-sectional study. Setting Electronic survey from December 2011 to August 2012; participants were asked to complete either an online or attached Microsoft Word questionnaire. Participants One hundred and sixty-three of the 173 Parties to the FCTC at the time of our survey. Measurements The 51-item questionnaire contained 30 items specifically on guidelines. Questions covered the areas of guidelines writing process, content, key recommendations and other characteristics. Findings One hundred and twenty-one countries (73%) responded. Fifty-three countries (44%) had guidelines, ranging from 75% among high-income countries to 11% among low-income countries. Nearly all guidelines recommended brief advice (93%), intensive specialist support (93%) and medications (96%), while 66% recommended quitlines. Fifty-seven percent had a dissemination strategy, 76% stated funding source and 68% had professional endorsement. Conclusion Fewer than half of the Parties to the WHO FCTC have developed national tobacco treatment guidelines, but, where guidelines exist, they broadly follow FCTC Article 14 guideline recommendations. PMID:23437892

  19. Feeding of low birth weight newborns in tertiary care hospitals in pakistan: do they follow the world health organization latest guidelines

    International Nuclear Information System (INIS)

    Khan, J.; Stafstrom, M.

    2015-01-01

    To determine the extent the World Health Organization (WHO) guidelines on the care of Low Birth Weight (LBW) newborns are followed in Pakistani hospitals and analyze any difference in policy compliance between different hospitals. Study Design: Descriptive analytical study. Place and Duration of Study: Data was collected from five tertiary care hospitals, one each from Peshawar, Lahore, Quetta, Karachi and Islamabad, from January to June 2012. Methodology: LBW newborns data derived from medical records was used. It was collected using a questionnaire, which encompassed the recent WHO recommendations for feeding of LBW. Twenty questionnaires were collected from each hospital. STATA 11.0 was used to analyze the data. Results: Fifty seven LBW newborns (57%) were fed with mother's own milk, and 9 (9%) were fed on donor human milk. Forty four newborns (44%) were initiated breast feeding within the first hour after birth. Most of the babies not able to be breast fed were fed with intra gastric tube. Feeding practices varied markedly across hospitals, ranging from one hospital where all newborns were fed formula milk to one where all were fed breast milk. Conclusion: The WHO guidelines were only partially implemented, with significant differences between hospitals in level of implementation of recommended practices. Given the benefits expected from the application of the guidelines, efforts should be made for the establishment and promotion of a single national policy for LBW feeding that follows the WHO new guidelines and streamlines the LBW feeding practices across the country. (author)

  20. The National Institute for Health and Clinical Excellence (NICE) guidelines for early detection of ovarian cancer: the pivotal role of the clinical laboratory.

    Science.gov (United States)

    Sturgeon, Catharine M; Duffy, Michael J; Walker, Graeme

    2011-07-01

    The National Institute for Health and Clinical Excellence (NICE) has recently reviewed optimal means of early recognition and initial management of ovarian cancer, the leading cause of gynaecological death in the UK. The NICE guidelines state that general practitioners should measure serum CA125 in women presenting with persistent and continuous symptoms suggestive of ovarian cancer (e.g. abdominal distension, early satiety and loss of appetite or pelvic pain). If CA125 is ≥35 kU/L, the general practitioner should arrange an ultrasound scan of the abdomen and pelvis to enable calculation of the risk of malignancy score (RMI). Women with an RMI score of ≥250 should then be referred to a specialist multidisciplinary team. Successful implementation of these guidelines requires close liaison between primary care and laboratory medicine to ensure that CA125 is requested as a diagnostic aid only for women meeting the criteria stated in the guidelines. Preanalytical criteria must also be met and it is essential that both requestors and patients be aware of other possible causes of increases in CA125, as well as the fact that it is not raised in all patients with ovarian cancer. Guidance is being prepared to enable appropriate interpretation and implementation of the NICE guidelines. Continuous audit of the outcomes will also be essential to determine the effectiveness of this approach to early detection of ovarian cancer.

  1. Feeding of Low Birth Weight Newborns in Tertiary Care Hospitals in Pakistan: Do They Follow the World Health Organization Latest Guidelines?

    Science.gov (United States)

    Khan, Jehangir; Stafstrom, Martin; Martines, Jose Carlos

    2015-08-01

    To determine the extent the World Health Organization (WHO) guidelines on the care of Low Birth Weight (LBW) newborns are followed in Pakistani hospitals and analyze any difference in policy compliance between different hospitals. Descriptive analytical study. Data was collected from five tertiary care hospitals, one each from Peshawar, Lahore, Quetta, Karachi and Islamabad, from January to June 2012. LBW newborns data derived from medical records was used. It was collected using a questionnaire, which encompassed the recent WHO recommendations for feeding of LBW. Twenty questionnaires were collected from each hospital. STATA11.0 was used to analyze the data. Fifty seven LBW newborns (57%) were fed with mother's own milk, and 9 (9%) were fed on donor human milk. Forty four newborns (44%) were initiated breastfeeding within the first hour after birth. Most of the babies not able to be breastfed were fed with intra gastric tube. Feeding practices varied markedly across hospitals, ranging from one hospital where all newborns were fed formula milk to one where all were fed breast milk. The WHO guidelines were only partially implemented, with significant differences between hospitals in level of implementation of recommended practices. Given the benefits expected from the application of the guidelines, efforts should be made for the establishment and promotion of a single national policy for LBW feeding that follows the WHO new guidelines and streamlines the LBW feeding practices across the country.

  2. Prevention and management guidelines to oral health care for patients with head and neck cancer: HCT20, Carisolv and Chlorhexidine varnish are suggested

    International Nuclear Information System (INIS)

    Silva Guerra, Eliete Neves da; Melo, N.S. de

    2004-01-01

    Orofacial complications are unfortunately common with all modalities used in the management of patients with head and neck cancer. It is well known that hypo salivation develops if radiation therapy involves the salivary glands. A significant decrease in salivary volume can adversely affect oral comfort, mucous health, dentition, deglutition and mastication. Xerostomia may lead to consumption of diet high in carbohydrates and make good oral hygiene difficult. The purpose of this study is to report a new prevention and management guidelines to oral and dental health care for patients with head and neck cancer who will treat with radiotherapy. New materials as HCT20, Carisolv and chlorhexidine varnish are suggested. (author)

  3. The human milk study, HUMIS. Presentation of a birth cohort study which aims to collect milk samples from 6000 mothers, for the assessment of persistent organic pollutants (POPS), relating it to exposure factors and health outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Eggesboe, M.; Stigum, H.; Becher, G.; Magnus, P. [Norwegian Inst. of Public Health, Oslo (Norway); Polder, A.; Skaare, J.U. [The Norwegian School of Veterinay Science, Oslo (Norway); Lindstroem, G. [Orebro Univ., Orebro (Sweden)

    2004-09-15

    Although PCB has been forbidden for more than 20 years now, and its levels in human milk is declining, it remains among the chemicals in human milk causing most concern with regard to its possible detrimental effects on the fetus and the breastfed child. Due to our industry, amongst others, the Norwegian population has been rather heavily exposed to PCB. Furthermore, new environmental toxicants are steadily entering the scene, such as the Brominated flame retardants. The level of Brominated flame retardants in human milk has shown an exponential increase during the last ten years, and this group of chemicals, are causing increasingly more concern. Studies from Sweden has shown that the levels differ greatly between individuals, however, for reasons yet unknown. In Norway, the highest levels of Brominated flame retardants ever measured in the world was reported from fish in Mjoesa. Surprisingly few attempts has been made to identify dietary habits or other life style factors that are associated with the levels of these toxicants in human milk. Such knowledge is needed in order for accurate prophylactic measures to be taken by the population and of special importance to women before and during child bearing age, in order to keep the levels in human milk as low as possible. Furthermore, there is great need for more knowledge of the effects of these toxicants on child health. The need for more research in this field, especially the need for prospective exposure data and the need for interdisciplinary approaches has been specifically targeted. Therefore a research initiative was taken in Norway to establish a prospective birth cohort which aims to recruit 6000 mother/child pairs, in whom human milk samples are collected in infancy and information on health outcomes are collected throughout the child's first seven years of life. The aim of this presentation is to describe this project in more detail and to give some preliminary results.

  4. Summary guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Halsnaes, K.; Painuly, J.P.; Turkson, J.; Meyer, H.J.; Markandya, A.

    1999-09-01

    This document is a summary version of the methodological guidelines for climate change mitigation assessment developed as part of the Global Environment Facility (GEF) project Economics of Greenhouse Gas Limitations; Methodological Guidelines. The objectives of this project have been to develop a methodology, an implementing framework and a reporting system which countries can use in the construction of national climate change mitigation policies and in meeting their future reporting obligations under the FCCC. The methodological framework developed in the Methodological Guidelines covers key economic concepts, scenario building, modelling tools and common assumptions. It was used by several country studies included in the project. (au) 13 refs.

  5. Cancer related fatigue: implementing guidelines for optimal management.

    Science.gov (United States)

    Pearson, Elizabeth J M; Morris, Meg E; McKinstry, Carol E

    2017-07-18

    Cancer-related fatigue (CRF) is a key concern for people living with cancer and can impair physical functioning and activities of daily living. Evidence-based guidelines for CRF are available, yet inconsistently implemented globally. This study aimed to identify barriers and enablers to applying a cancer fatigue guideline and to derive implementation strategies. A mixed-method study explored the feasibility of implementing the CRF guideline developed by the Canadian Association for Psychosocial Oncology (CAPO). Health professionals, managers and consumers from different practice settings participated in a modified Delphi study with two survey rounds. A reference group informed the design of the study including the surveys. The first round focused on guideline characteristics, compatibility with current practice and experience, and behaviour change. The second survey built upon and triangulated the first round. Forty-five health practitioners and managers, and 68 cancer survivors completed the surveys. More than 75% of participants endorsed the CAPO cancer related fatigue guidelines. Some respondents perceived a lack of resources for accessible and expert fatigue management services. Further barriers to guideline implementation included complexity, limited practical details for some elements, and lack of clinical tools such as assessment tools or patient education materials. Recommendations to enhance guideline applicability centred around four main themes: (1) balancing the level of detail in the CAPO guideline with ease of use, (2) defining roles of different professional disciplines in CRF management, (3) how best to integrate CRF management into policy and practice, (4) how best to ensure a consumer-focused approach to CRF management. Translating current knowledge on optimal management of CRF into clinical practice can be enhanced by the adoption of valid guidelines. This study indicates that it is feasible to adopt the CAPO guidelines. Clinical application may

  6. Web Accessibility and Guidelines

    Science.gov (United States)

    Harper, Simon; Yesilada, Yeliz

    Access to, and movement around, complex online environments, of which the World Wide Web (Web) is the most popular example, has long been considered an important and major issue in the Web design and usability field. The commonly used slang phrase ‘surfing the Web’ implies rapid and free access, pointing to its importance among designers and users alike. It has also been long established that this potentially complex and difficult access is further complicated, and becomes neither rapid nor free, if the user is disabled. There are millions of people who have disabilities that affect their use of the Web. Web accessibility aims to help these people to perceive, understand, navigate, and interact with, as well as contribute to, the Web, and thereby the society in general. This accessibility is, in part, facilitated by the Web Content Accessibility Guidelines (WCAG) currently moving from version one to two. These guidelines are intended to encourage designers to make sure their sites conform to specifications, and in that conformance enable the assistive technologies of disabled users to better interact with the page content. In this way, it was hoped that accessibility could be supported. While this is in part true, guidelines do not solve all problems and the new WCAG version two guidelines are surrounded by controversy and intrigue. This chapter aims to establish the published literature related to Web accessibility and Web accessibility guidelines, and discuss limitations of the current guidelines and future directions.

  7. Nitrogen dioxide - long-term guideline value for health protection; Stickstoffdioxid - (Langzeit-)Richtwert zum Schutz der menschlichen Gesundheit

    Energy Technology Data Exchange (ETDEWEB)

    Tvrdy, C.; Hauck, H.; Neuberger, M. [Vienna Univ. (Austria). Inst. fuer Umwelthygiene

    1999-10-01

    On behalf of the Ministry of Environment the Austrian Academy of Science published guideline values for nitrogen dioxide in 1988. The scientific database concentrated on short-term effects of NO{sub 2} at that time. After checking the current literature it was clear that new data especially for long-term effects of NO{sub 2} were available which should lead to a limitation of an annual average. Two Austrian studies on children from Linz (capital of Upper Austria) showed that high long-term concentrations of NO{sub 2} were negatively associated with the flow parameters of terminal airways in spirometry (MEF{sub 25} and MEF{sub 50}) on a significant level. In addition the children showed an improvement in growth-dependent increase of lung function parameters when long-term NO{sub 2}-concentrations in the ambient air could be decreased by more than 40 {mu}g/m{sup 3}. The most pronounced benefit could be seen when the ambient level of NO{sub 2} decreased during periods of accelerated growth. Based on these and other results summarized in this review, the Austrian Academy of Science recommended an annual average of 30 {mu}g/m{sup 3} for NO{sub 2} in the ambient air not to be exceeded for health protection. (orig.) [German] In Oesterreich werden von der Oesterreichischen Akademie der Wissenschaften (OeAW) im Auftrag des Bundesministeriums fuer Umwelt, Jugend und Familie fuer die konventionellen Luftschadstoffe wirkungsbezogene Immissionsgrenzkonzentrationen erarbeitet, die den jeweiligen Stand der (medizinischen) Wissenschaft repraesentieren. Ausgehend vom Basiswerk aus 1988 wurde 1998 eine neue Literaturstudie erstellt, die auch Publikationen der letzten Jahre umfasste. Anhand dieses neuen Datenmaterials zeigte sich, dass die Einfuehrung einer Langzeitimmissionsgrenzkonzentration aus umwelthygienischer Sicht notwendig war. In zwei Studien an Linzer Kindern konnte festgestellt werden, dass einerseits hohe NO{sub 2}-Konzentrationen signifikant negativ mit den

  8. EUROPAEM EMF Guideline 2016 for the prevention, diagnosis and treatment of EMF-related health problems and illnesses.

    Science.gov (United States)

    Belyaev, Igor; Dean, Amy; Eger, Horst; Hubmann, Gerhard; Jandrisovits, Reinhold; Kern, Markus; Kundi, Michael; Moshammer, Hanns; Lercher, Piero; Müller, Kurt; Oberfeld, Gerd; Ohnsorge, Peter; Pelzmann, Peter; Scheingraber, Claus; Thill, Roby

    2016-09-01

    major impact on the oxidative and nitrosative regulation capacity in affected individuals. This concept also may explain why the level of susceptibility to EMF can change and why the range of symptoms reported in the context of EMF exposures is so large. Based on our current understanding, a treatment approach that minimizes the adverse effects of peroxynitrite - as has been increasingly used in the treatment of multisystem illnesses - works best. This EMF Guideline gives an overview of the current knowledge regarding EMF-related health risks and provides recommendations for the diagnosis, treatment and accessibility measures of EHS to improve and restore individual health outcomes as well as for the development of strategies for prevention.

  9. EUROPAEM EMF Guideline 2015 for the prevention, diagnosis and treatment of EMF-related health problems and illnesses.

    Science.gov (United States)

    Belyaev, Igor; Dean, Amy; Eger, Horst; Hubmann, Gerhard; Jandrisovits, Reinhold; Johansson, Olle; Kern, Markus; Kundi, Michael; Lercher, Piero; Mosgöller, Wilhelm; Moshammer, Hanns; Müller, Kurt; Oberfeld, Gerd; Ohnsorge, Peter; Pelzmann, Peter; Scheingraber, Claus; Thill, Roby

    2015-01-01

    so large. Based on our current understanding, a treatment approach that minimizes the adverse effects of peroxynitrite - as has been increasingly used in the treatment of multisystem disorders - works best. This EMF Guideline gives an overview of the current knowledge regarding EMF-related health risks and provides concepts for the diagnosis and treatment and accessibility measures of EHS to improve and restore individual health outcomes as well as for the development of strategies for prevention.

  10. Implementing clinical guidelines in stroke: a qualitative study of perceived facilitators and barriers.

    Science.gov (United States)

    Donnellan, Claire; Sweetman, S; Shelley, E

    2013-08-01

    Clinical guidelines are frequently used as a mechanism for implementing evidence-based practice. However research indicates that health professionals vary in the extent to which they adhere to these guidelines. This study aimed to study the perceptions of stakeholders and health professionals on the facilitators and barriers to implementing national stroke guidelines in Ireland. Qualitative interviews using focus groups were conducted with stakeholders (n=3) and multidisciplinary team members from hospitals involved in stroke care (n=7). All focus group interviews were semi-structured, using open-ended questions. Data was managed and analysed using NVivo 9 software. The main themes to emerge from the focus groups with stakeholders and hospital multidisciplinary teams were very similar in terms of topics discussed. These were resources, national stroke guidelines as a tool for change, characteristics of national stroke guidelines, advocacy at local level and community stroke care challenges. Facilitators perceived by stakeholders and health professionals included having dedicated resources, user-friendly guidelines relevant at local level and having supportive advocates on the ground. Barriers were inadequate resources, poor guideline characteristics and insufficient training and education. This study highlights health professionals' perspectives regarding many key concepts which may affect the implementation of stroke care guidelines. The introduction of stroke clinical guidelines at a national level is not sufficient to improve health care quality as they should be incorporated in a quality assurance cycle with education programmes and feedback from surveys of clinical practice. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  11. AUTHOR GUIDELINES

    Directory of Open Access Journals (Sweden)

    Chief Editor

    2014-12-01

    Full Text Available AUTHOR GUIDELINESIndian Journal of Community Health (IJCH accepts only online submission of manuscript(s by using Open Journal software (OJS at http://www.iapsmupuk.org/journal/index.php/IJCH/loginOnline SubmissionsAlready have a Username/Password for Indian Journal of Community Health (IJCH? GO TO LOGINNeed a Username/Password?GO TO REGISTRATIONNote: Registration and login are required to submit items online and to track the status of current submissions.Author GuidelinesIJCH strictly adheres on the recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals as per the standard universal guidelines given by International Committee of Medical Journal Editors (ICMJE - Recommendations for Uniform Requirements for Manuscripts. Authors are requested to visit http://www.icmje.org/index.html before making online submission of their manuscript(s.SectionsEditorial:On issues of current public health needAbout 1000 – 1200 wordsReferences: 5 – 10 (PubMed - Citation preferredInvited Commentary:Brief, provocative, opinionated communicationsOn issues of current public health needMain Text: 750-1000 words excluding referencesReferences: 5 – 10 (PubMed - Citation preferredOriginal Article:Articles from Original ResearchStructured abstract: 250 wordsMain Text: 2500 - 3000 words, IMRD formatKey Words: 5 - 8References: 20 – 25 (PubMed - Citation preferredTables / Figures: 3 – 4*Certificate of clearance from respective Institutional Ethical Committee (IECReview Article:On subject of public health relevanceAbstract: 250 wordsMain Text: 2500 - 3000 wordsKey Words: 3 - 4References: 20 – 25 (PubMed - Citation preferredTables / Figures: 3 – 4Short Communication / Article:Short report of a research project / outbreakMain Text : 1000 – 1200 wordsReferences: 10 – 15 (PubMed - Citation preferredTable / Figure: 01*Certificate of clearance from respective Institutional Ethical Committee (IECReport from the field

  12. Hypertension guideline implementation: experiences of Finnish primary care nurses

    DEFF Research Database (Denmark)

    Alanen, Seija; Ijäs, Jarja; Kaila, Minna

    2008-01-01

    RATIONALE, AIMS AND OBJECTIVES: Evidence-based guidelines on hypertension have been developed in many western countries. Yet, there is little evidence of their impact on the clinical practices of primary care nurses. METHOD: We assessed the style of implementation and adoption of the national...... Hypertension Guideline (HT Guideline) in 32 Finnish health centres classified in a previous study as 'disseminators' (n = 13) or 'implementers' (n = 19). A postal questionnaire was sent to all nurses (n = 409) working in the outpatient services in these health centres. Additionally, senior nursing officers...... were telephoned to enquire if the implementation of the HT Guideline had led to a new division of labour between nurses and doctors. RESULTS: Questionnaires were returned from 327 nurses (80.0%), while all senior nursing officers (n = 32) were contacted. The majority of nurses were of the opinion...

  13. [Shared decision-making based on equal information. Patient guidelines as a tool for patient counseling].

    Science.gov (United States)

    Sänger, Sylvia; Kopp, Ina; Englert, Gerhard; Brunsmann, Frank; Quadder, Bernd; Ollenschläger, Günter

    2007-06-15

    In discussions on the quality of cross-sectorial health-care services high importance is attributed to patient education and patient counseling, with guideline-based patient information being considered a crucial tool. Guideline-based patient information is supposed to serve patients as a decision-making basis and, in addition, to also support the implementation of the guidelines themselves. The article highlights how patient guidelines for National Disease Management Guidelines in Germany--within the scope of patient education and patient counseling--may provide a uniform information platform for physicians and patients aiming to promote shared decision-making. The authors will also address the issue which contents should be included in patient guidelines in order to meet these requirements and which measures are required to review their quality. The present paper continues the series of articles on the Program for German National Disease Management Guidelines.

  14. A selective review of prenatal exercise guidelines since the 1950s until present: Written for women, health care professionals, and female athletes.

    Science.gov (United States)

    Kehler, Ainslie K; Heinrich, Katie M

    2015-12-01

    Traditional society values have long-held the notion that the pregnant woman is construed as a risk to her growing fetus and is solely responsible for controlling this risk to ensure a healthy pregnancy. It is hard to ignore the participation of pregnant women in sport and exercise today, especially in high-level sports and popular fitness programs such as CrossFit™. This challenges both traditional and modern prenatal exercise guidelines from health care professionals and governing health agencies. The guidelines and perceived limitations of prenatal exercise have drastically evolved since the 1950s. The goal of this paper is to bring awareness to the idea that much of the information regarding exercise safety during pregnancy is hypersensitive and dated, and the earlier guidelines had no scientific rigor. Research is needed on the upper limits of exercise intensity and exercise frequency, as well as their potential risks (if any) on the woman or fetus. Pregnant women are physically capable of much more than what was once thought. There is still disagreement about the types of exercise deemed appropriate, the stage at which exercise should begin and cease, the frequency of exercise sessions, as well as the optimal level of intensity during prenatal exercise. Research is needed to determine the upper limits of exercise frequency and intensity for pregnant women who are already trained. Healthy women and female athletes can usually maintain their regular training regime once they become pregnant. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  15. Is physician adherence to prescription guidelines a general trait of health care practices or dependent on drug type?--a multilevel logistic regression analysis in South Sweden.

    Science.gov (United States)

    Ohlsson, Henrik; Merlo, Juan

    2009-08-01

    Therapeutic traditions at health care practices (HCPs) influence physicians' adherence to prescription guidelines for specific drugs, however, it is not known if such traditions affect all kinds of prescriptions or only specific types of drug. Our goal was to determine whether adherence to prescription guidelines is a common trait of HCPs or dependent on drug type. We fitted separate multi-level logistic regression models to all patients in the Skåne region who received a prescription for a statin drug (ATC: C10AA, n = 6232), an agent acting on the renin-angiotensin system (ATC: C09, n = 7222) or a proton pump inhibitor (ATC: A02BC, n = 11 563) at 198 HCPs from July 2006 to December 2006. There was a high clustering of adherence to prescription guidelines at HCPs for the different drug types (MOR(agents acting on the renin-angiotensin system) = 4.72 [95% CI: 3.90-5.92], MOR(Statins) = 2.71 [95% CI: 2.23-3.39] and MOR(Proton pump inhibitors) = 2.16 [95% CI: 1.95-2.45]). Compared with HCPs with low adherence to guidelines in two drug types, those HCPs with the highest level of adherence for these two drug types also showed a higher probability of adherence for the third drug type. Physicians' decisions to follow prescription guidelines seem to be influenced by therapeutic traditions at the HCP. Moreover, these therapeutic traditions seem to affect all kinds of prescriptions. This information can be used as basis for interventions to support rational and cost-effective medication use. Copyright 2009 John Wiley & Sons, Ltd.

  16. Interconnection Guidelines

    Science.gov (United States)

    The Interconnection Guidelines provide general guidance on the steps involved with connecting biogas recovery systems to the utility electrical power grid. Interconnection best practices including time and cost estimates are discussed.

  17. Effluent Guidelines

    Science.gov (United States)

    Effluent guidelines are national standards for wastewater discharges to surface waters and municipal sewage treatment plants. We issue the regulations for industrial categories based on the performance of treatment and control technologies.

  18. OSART guidelines

    International Nuclear Information System (INIS)

    1988-02-01

    The IAEA Operational Safety Review Team (OSART) programme provides advice and assistance to Member States to enhance the operational safety of nuclear power plants. These OSART Guidelines provide overall guidance for the experts to ensure the consistency and comprehensiveness of the operational safety review. Specific guidelines are provided as guide for the systematic review in the following areas important to operational safety: management, organization and administration, training and qualification, operations, maintenance, technical support, radiation protection, chemistry, emergency planning and preparedness

  19. Reflections on the United States National Institutes of Health draft guidelines for research involving human pluripotent stem cells--theological perspective.

    Science.gov (United States)

    Sotis, J J

    2000-01-01

    Since the human embryonic stem cell research involves destruction of human embryos and, therefore, hinges on the fundamental question of the status of the embryo, it is essential to examine this status carefully in order to establish fitting guidelines for research. The US National Institutes of Health has proposed its own guidelines on the matter recently (1999). The document, rooted in current pluralistic perspectives in moral philosophy (or bioethics), is criticised in this paper as morally inadequate. The argumentation of the criticism stems from the theological perspective on human personhood, which focuses on a continuity of personal identity from embryos to adult human beings. An additional concern for the author is the moral complicity in which the research dependent upon the destruction of human embryonic life is sanctioned.

  20. Implementing international osteoarthritis treatment guidelines in primary health care: study protocol for the SAMBA stepped wedge cluster randomized controlled trial.

    Science.gov (United States)

    Østerås, Nina; van Bodegom-Vos, Leti; Dziedzic, Krysia; Moseng, Tuva; Aas, Eline; Andreassen, Øyvor; Mdala, Ibrahim; Natvig, Bård; Røtterud, Jan Harald; Schjervheim, Unni-Berit; Vlieland, Thea Vliet; Hagen, Kåre Birger

    2015-12-02

    Previous research indicates that people with osteoarthritis (OA) are not receiving the recommended and optimal treatment. Based on international treatment recommendations for hip and knee OA and previous research, the SAMBA model for integrated OA care in Norwegian primary health care has been developed. The model includes physiotherapist (PT) led patient OA education sessions and an exercise programme lasting 8-12 weeks. This study aims to assess the effectiveness, feasibility, and costs of a tailored strategy to implement the SAMBA model. A cluster randomized controlled trial with stepped wedge design including an effect, process, and cost evaluation will be conducted in six municipalities (clusters) in Norway. The municipalities will be randomized for time of crossover from current usual care to the implementation of the SAMBA model by a tailored strategy. The tailored strategy includes interactive workshops for general practitioners (GPs) and PTs in primary care covering the SAMBA model for integrated OA care, educational material, educational outreach visits, feedback, and reminder material. Outcomes will be measured at the patient, GP, and PT levels using self-report, semi-structured interviews, and register based data. The primary outcome measure is patient-reported quality of care (OsteoArthritis Quality Indicator questionnaire) at 6-month follow-up. Secondary outcomes include referrals to PT, imaging, and referrals to the orthopaedic surgeon as well as participants' treatment satisfaction, symptoms, physical activity level, body weight, and self-reported and measured lower limb function. The actual exposure to the tailor made implementation strategy and user experiences will be measured in a process evaluation. In the economic evaluation, the difference in costs of usual OA care and the SAMBA model for integrated OA care will be compared with the difference in health outcomes and reported by the incremental cost-effectiveness ratio (ICER). The results

  1. [Online information supplied by Italian Hospitals and Local Healthcare Units: a descriptive research on their compliance with the guidelines issued by the Italian Ministry of Health].

    Science.gov (United States)

    Vanzetta, M; Vellone, E; De Marinis, M G; Cavicchi, I; Alvaro, R

    2012-01-01

    In most countries where Internet is widely used the number of people surfing the web for healthcare information equals (and in some countries is more than) the number of people looking for healthcare assistance. More and more often, all over the world, Internet is integrated by advanced healthcare systems as a cornerstone of their e-health infrastructure, to meet citizens' needs for health information. Therefore, information plays a key role in the relationship between healthcare providers and citizenship. In 2010 the Italian Ministry of Health has worked out a set of guidelines to improve online communication, within the framework of health promotion. To analyze if the web sites of the Italian public hospitals (PH) and the local healthcare units (LHU) comply with the guidelines of the Italian Ministry of Health (IMH) on the improvement of online communication within the framework of healthcare promotion. All Italian PH and LHU web sites have been analyzed using the self evaluation tool of the IMH. The total number of web sites analyzed was 245. Their compliance with the IMH guidelines was low. Web sites linking to other professional sites, such as the College of Physicians, the College of Pharmacists, or the College of Nurses, were 32 (13%). One hundred and forty-two (58%) were the sites that did not offer any kind of health information, such as pathophysiology of diseases, the most relevant pathologic conditions, risky behaviors, primary and secondary prevention's interventions. A web navigation menu organized according to the most relevant life events or according to categories of users (I am ... /dedicated to...) was available only in 53 web sites (22%). The IMH's guidelines on online communication -- with reference to the aspects here analyzed -- have been in some ways disregarded and the criteria suggested by them have not been fully adopted by PHs and LHUs. Overall, communication is globally meant (and directed) "towards" citizenship and not "together with

  2. Adherence to a healthy diet according to the World Health Organization guidelines and all-cause mortality in elderly adults from Europe and the United States.

    Science.gov (United States)

    Jankovic, Nicole; Geelen, Anouk; Streppel, Martinette T; de Groot, Lisette C P G M; Orfanos, Philippos; van den Hooven, Edith H; Pikhart, Hynek; Boffetta, Paolo; Trichopoulou, Antonia; Bobak, Martin; Bueno-de-Mesquita, H B; Kee, Frank; Franco, Oscar H; Park, Yikyung; Hallmans, Göran; Tjønneland, Anne; May, Anne M; Pajak, Andrzej; Malyutina, Sofia; Kubinova, Růžena; Amiano, Pilar; Kampman, Ellen; Feskens, Edith J

    2014-11-15

    The World Health Organization (WHO) has formulated guidelines for a healthy diet to prevent chronic diseases and postpone death worldwide. Our objective was to investigate the association between the WHO guidelines, measured using the Healthy Diet Indicator (HDI), and all-cause mortality in elderly men and women from Europe and the United States. We analyzed data from 396,391 participants (42% women) in 11 prospective cohort studies who were 60 years of age or older at enrollment (in 1988-2005). HDI scores were based on 6 nutrients and 1 food group and ranged from 0 (least healthy diet) to 70 (healthiest diet). Adjusted cohort-specific hazard ratios were derived by using Cox proportional hazards regression and subsequently pooled using random-effects meta-analysis. During 4,497,957 person-years of follow-up, 84,978 deaths occurred. Median HDI scores ranged from 40 to 54 points across cohorts. For a 10-point increase in HDI score (representing adherence to an additional WHO guideline), the pooled adjusted hazard ratios were 0.90 (95% confidence interval (CI): 0.87, 0.93) for men and women combined, 0.89 (95% CI: 0.85, 0.92) for men, and 0.90 (95% CI: 0.85, 0.95) for women. These estimates translate to an increased life expectancy of 2 years at the age of 60 years. Greater adherence to the WHO guidelines is associated with greater longevity in elderly men and women in Europe and the United States. © The Author 2014. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. Mental Health Interventions for Parent Carers of Children with Autistic Spectrum Disorder: Practice Guidelines from a Critical Interpretive Synthesis (CIS Systematic Review

    Directory of Open Access Journals (Sweden)

    Denise Catalano

    2018-02-01

    Full Text Available Parent carers of children with Autism Spectrum Disorder (ASD often report increased levels of stress, depression, and anxiety. Unmet parent carer mental health needs pose a significant risk to the psychological, physical, and social well-being of the parents of the child affected by ASD and jeopardize the adaptive functioning of the family as well as the potential of the child affected by ASD. This systematic review identifies key qualities of interventions supporting the mental health of parent carers and proposes practitioner-parent carer support guidelines. A search of four databases (Medline, PubMed, PsycINFO, and Social Science Data was conducted to identify studies that met the following criteria: (1 an intervention was delivered to parent carers of a child with ASD under the age of 18 years; (2 the research design allowed for a comparison on outcomes across groups; and (3 outcome measures of the parent carers’ mental health were used. A total of 23 studies met the inclusion criteria. A critical interpretive synthesis approach was used to produce an integrated conceptualization of the evidence. Findings suggest practitioner guidelines to support the mental health and wellbeing of parent carers should include addressing the parent’s self-perspective taking and skill for real time problem-solving.

  4. Mental Health Interventions for Parent Carers of Children with Autistic Spectrum Disorder: Practice Guidelines from a Critical Interpretive Synthesis (CIS) Systematic Review.

    Science.gov (United States)

    Catalano, Denise; Holloway, Linda; Mpofu, Elias

    2018-02-14

    Parent carers of children with Autism Spectrum Disorder (ASD) often report increased levels of stress, depression, and anxiety. Unmet parent carer mental health needs pose a significant risk to the psychological, physical, and social well-being of the parents of the child affected by ASD and jeopardize the adaptive functioning of the family as well as the potential of the child affected by ASD. This systematic review identifies key qualities of interventions supporting the mental health of parent carers and proposes practitioner-parent carer support guidelines. A search of four databases (Medline, PubMed, PsycINFO, and Social Science Data) was conducted to identify studies that met the following criteria: (1) an intervention was delivered to parent carers of a child with ASD under the age of 18 years; (2) the research design allowed for a comparison on outcomes across groups; and (3) outcome measures of the parent carers' mental health were used. A total of 23 studies met the inclusion criteria. A critical interpretive synthesis approach was used to produce an integrated conceptualization of the evidence. Findings suggest practitioner guidelines to support the mental health and wellbeing of parent carers should include addressing the parent's self-perspective taking and skill for real time problem-solving.

  5. Guidelines prescribed by general practitioners to patients with acute ...

    African Journals Online (AJOL)

    The aim of this study was to investigate the guidelines prescribed by general practitioners (GPs) to patients with acute low back pain (ALBP) regarding 'return to work'. Methods: A systematic sample of 212 GPs, selected from a list supplied by the Health Professions Council of South Africa (HPCSA), was selected to complete ...

  6. Using GRADE methodology for the development of public health guidelines for the prevention and treatment of HIV and other STIs among men who have sex with men and transgender people

    Directory of Open Access Journals (Sweden)

    Akl Elie A

    2012-05-01

    Full Text Available Abstract Background The World Health Organization (WHO Department of HIV/AIDS led the development of public health guidelines for delivering an evidence-based, essential package of interventions for the prevention and treatment of HIV and other sexually transmitted infections (STIs among men who have sex with men (MSM and transgender people in the health sector in low- and middle-income countries. The objective of this paper is to review the methodological challenges faced and solutions applied during the development of the guidelines. Methods The development of the guidelines followed the WHO guideline development process, which utilizes the GRADE approach. We identified, categorized and labeled the challenges identified in the guidelines development process and described the solutions through an interactive process of in-person and electronic communication. Results We describe how we dealt with the following challenges: (1 heterogeneous and complex interventions; (2 paucity of trial data; (3 selecting outcomes of interest; (4 using indirect evidence; (5 integrating values and preferences; (6 considering resource use; (7 addressing social and legal barriers; (8 wording of recommendations; and (9 developing global guidelines. Conclusion We were able to successfully apply the GRADE approach for developing recommendations for public health interventions. Applying the general principles of the approach while carefully considering specific challenges can enhance both the process and the outcome of guideline development.

  7. Clinical practice guidelines within the Southern African development community: a descriptive study of the quality of guideline development and concordance with best evidence for five priority diseases

    Science.gov (United States)

    2012-01-01

    Background Reducing the burden of disease relies on availability of evidence-based clinical practice guidelines (CPGs). There is limited data on availability, quality and content of guidelines within the Southern African Development Community (SADC). This evaluation aims to address this gap in knowledge and provide recommendations for regional guideline development. Methods We prioritised five diseases: HIV in adults, malaria in children and adults, pre-eclampsia, diarrhoea in children and hypertension in primary care. A comprehensive electronic search to locate guidelines was conducted between June and October 2010 and augmented with email contact with SADC Ministries of Health. Independent reviewers used the AGREE II tool to score six quality domains reporting the guideline development process. Alignment of the evidence-base of the guidelines was evaluated by comparing their content with key recommendations from accepted reference guidelines, identified with a content expert, and percentage scores were calculated. Findings We identified 30 guidelines from 13 countries, publication dates ranging from 2003-2010. Overall the 'scope and purpose' and 'clarity and presentation' domains of the AGREE II instrument scored highest, median 58%(range 19-92) and 83%(range 17-100) respectively. 'Stakeholder involvement' followed with median 39%(range 6-75). 'Applicability', 'rigour of development' and 'editorial independence' scored poorly, all below 25%. Alignment with evidence was variable across member states, the lowest scores occurring in older guidelines or where the guideline being evaluated was part of broader primary healthcare CPG rather than a disease-specific guideline. Conclusion This review identified quality gaps and variable alignment with best evidence in available guidelines within SADC for five priority diseases. Future guideline development processes within SADC should better adhere to global reporting norms requiring broader consultation of stakeholders

  8. Guidelines for integrated risk assessment and management in large industrial areas. Inter-Agency programme on the assessment and management of health and environmental risks from energy and other complex industrial systems

    International Nuclear Information System (INIS)

    1998-01-01

    The IAEA, the United Nations Environment Programme (UNEP) within the framework of the Awareness and Preparedness for Emergencies at Local Level (APELL), the United Nations Industrial Development Organization (UNIDO) and the World Health Organization (WHO) decided in 1986 to join forces in order to promote the use of integrated area wide approaches to risk management. An Inter-Agency Programme, which brings together expertise in health the environment, industry and energy, all vital for effective risk management, was established. The Inter-Agency Programme on the assessment and Management of Health and Environmental Risks from Energy and Other Complex Industrial Systems aims at promoting and facilitating the implementation of integrated risk assessment and management for large industrial areas. This initiative includes the compilation of procedures and methods for environmental and public health risk assessment, the transfer of knowledge and experience amongst countries in the application of these procedures and the implementation of an integrated approach to risk management. The purpose of the Inter-Agency Programme is to develop a broad approach to the identification, prioritization and minimization of industrial hazards in a given geographical area. The UN organizations sponsoring this programme have been involved for several years in activities aimed at assessment and management of environmental and health risks, prevention of major accidents and emergency preparedness. These Guidelines have been developed on the basis of experience from these activities to assist in the planning and conduct of regional risk management projects. They provide a reference framework for the undertaking of integrated health and environmental risk assessment for large industrial areas and for the formulation of appropriate risk management strategies

  9. Guidelines for integrated risk assessment and management in large industrial areas. Inter-Agency programme on the assessment and management of health and environmental risks from energy and other complex industrial systems

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-01-01

    The IAEA, the United Nations Environment Programme (UNEP) within the framework of the Awareness and Preparedness for Emergencies at Local Level (APELL), the United Nations Industrial Development Organization (UNIDO) and the World Health Organization (WHO) decided in 1986 to join forces in order to promote the use of integrated area wide approaches to risk management. An Inter-Agency Programme, which brings together expertise in health the environment, industry and energy, all vital for effective risk management, was established. The Inter-Agency Programme on the assessment and Management of Health and Environmental Risks from Energy and Other Complex Industrial Systems aims at promoting and facilitating the implementation of integrated risk assessment and management for large industrial areas. This initiative includes the compilation of procedures and methods for environmental and public health risk assessment, the transfer of knowledge and experience amongst countries in the application of these procedures and the implementation of an integrated approach to risk management. The purpose of the Inter-Agency Programme is to develop a broad approach to the identification, prioritization and minimization of industrial hazards in a given geographical area. The UN organizations sponsoring this programme have been involved for several years in activities aimed at assessment and management of environmental and health risks, prevention of major accidents and emergency preparedness. These Guidelines have been developed on the basis of experience from these activities to assist in the planning and conduct of regional risk management projects. They provide a reference framework for the undertaking of integrated health and environmental risk assessment for large industrial areas and for the formulation of appropriate risk management strategies. Refs, figs, tabs.

  10. pre-art guidelines

    African Journals Online (AJOL)

    Enrique

    2004-11-01

    Nov 1, 2004 ... As these guidelines address pre-ART issues, only conditions that occur at ... All HIV-infected adults who are immunosuppressed, i.e. ... therefore recommended that HIV-infected health care ... vaccine in severely immunosuppressed persons, i.e. those ... with residual insecticides, the use of larvicides, and.

  11. GPs' knowledge, use, and confidence in national physical activity and health guidelines and tools: a questionnaire-based survey of general practice in England.

    Science.gov (United States)

    Chatterjee, Robin; Chapman, Tim; Brannan, Mike Gt; Varney, Justin

    2017-10-01

    Physical activity (PA) brief advice in health care is effective at getting individuals active. It has been suggested that one in four people would be more active if advised by a GP or nurse, but as many as 72% of GPs do not discuss the benefits of physical activity with patients. To assess the knowledge, use, and confidence in national PA and Chief Medical Officer (CMO) health guidelines and tools among GPs in England. Online questionnaire-based survey of self-selecting GPs in England that took place over a 10-day period in March 2016. The questionnaire consisted of six multiple-choice questions and was available on the Doctors.net.uk (DNUK) homepage. Quotas were used to ensure good regional representation. The final analysis included 1013 responses. Only 20% of responders were broadly or very familiar with the national PA guidelines. In all, 70% of GPs were aware of the General Practice Physical Activity Questionnaire (GPPAQ), but 26% were not familiar with any PA assessment tools, and 55% reported that they had not undertaken any training with respect to encouraging PA. The majority of GPs in England (80%) are unfamiliar with the national PA guidelines. Awareness of the recommended tool for assessment, GPPAQ, is higher than use by GPs. This may be because it is used by other clinical staff, for example, as part of the NHS Health Check programme. Although brief advice in isolation by GPs on PA will only be a part of the behaviour change journey, it is an important prompt, especially if repeated as part of routine practice. This study highlights the need for significant improvement in knowledge, skills, and confidence to maximise the potential for PA advice in GP consultations. © British Journal of General Practice 2017.

  12. Evaluating the level of adherence to Ministry of Health guidelines in the management of Severe Acute Malnutrition at Garissa Provincial General hospital, Garissa, Kenya

    Science.gov (United States)

    Warfa, Osman; Njai, Daniel; Ahmed, Laving; Admani, Bashir; Were, Fred; Wamalwa, Dalton; Osano, Boniface; Mburugu, Patrick; Mohamed, Musa

    2014-01-01

    Introduction Half of Kenya's high infant and under five mortality rates is due to malnutrition. Proper implementation of World Health Organization's (WHO) Evidence Based Guidelines (EBG) in management of severe acute malnutrition can reduce mortality rates to less than 5%. The objectives were to establish the level of adherence to WHO guideline and the proportion of children appropriately managed for severe acute malnutrition (steps 1-8) as per the WHO protocol in the management of severe acute malnutrition. This was a short longitudinal study of 96 children, aged 6-59 months admitted to the pediatric ward with diagnosis of severe acute malnutrition. Methods Data was extracted from patients’ medical files and recorded into an audit tool to compare care provided in this hospital with WHO guidelines. Results Non-edematous malnutrition was the commonest presentation (93.8%). A higher proportion (63.5%) of patients was male. Most (85.4%) of patients were younger than 2 years. Patients with non-edematous malnutrition were younger (mean age for non-edematous malnutrition was 16 (± 10.6) months versus 25 (± 13.7) months in edematous malnutrition). The commonest co- morbid condition was diarrhea (52.1%). Overall, 13 children died giving an inpatient case fatality rate of 13.5%. Appropriate management was documented in only 14.6% for hypoglycemia (step1), 5.2% for hypothermia (step 2) and 31.3% for dehydrati