Workplace screening programs for chronic disease prevention: a rapid review

This review examined the effectiveness of workplace screening programs for chronic disease prevention based on evidence retrieved from the main databases of biomedical and health economic literature published to March 2012, supplemented with relevant reports. The review found: 1. Strong evidence of effectiveness of HRAs (when used in combination with other interventions) in relation to tobacco use, alcohol use, dietary fat intake, blood pressure and cholesterol 2. Sufficient evidence for effectiveness of worksite programs to control overweight and obesity 3. Sufficient evidence of effectiveness for workplace HRAs in combination with additional interventions to have favourable impact on the use of healthcare services (such as reductions in emergency department visits, outpatient visits, and inpatient hospital days over the longer term) 4. Sufficient evidence for effectiveness of benefits-linked financial incentives in increasing HRA and program participation 5. Sufficient evidence that for every dollar invested in these programs an annual gain of $3.20 (range$1.40 to $4.60) can be achieved 6. Promising evidence that even higher returns on investment can be achieved in programs incorporating newer technologies such as telephone coaching of high risk individuals and benefits-linked financial incentive

The Health Economic Assessment Tool (HEAT) for walking and cycling - experiences from 10 years of application of a health impact assessment tool in policy and practice

IntroductionIn recent years, walking and cycling have moved into the focus as promising approaches to achieve public health, sustainable transport, climate goals and better urban resilience. However, they are only realistic transport and activity options for a large proportion of the population when they are safe, inclusive and convenient. One way to increase their recognition in transport policy is the inclusion of health impacts of walking and cycling into transport economic appraisals.MethodsThe Health Economic Assessment Tool (HEAT) for walking and cycling calculates: if x people walk or cycle a distance of y on most days, what is the economic value of impacts on premature mortality, taking into account effects of physical activity, air pollution and road fatalities, as well as effects on carbon emissions. Different data sources were collated to examine how the HEAT in more than 10 years of existence, and to identify lessons learned and challenges.ResultsSince its launch in 2009, the HEAT has gained wide recognition as a user friendly, yet robust, evidence-based tool usable by academics, policymakers, and practitioners. Originally designed for use in Europe, it has since been expanded for global use.DiscussionChallenges for a wider uptake of health-impact assessment (HIA) tools including active transport such as HEAT are the promotion and dissemination to local practitioners and policy makers also outside European and English-speaking regions and in low- and middle-income contexts, further increasing usability, and more generally the advancement of systematic data collection and impact quantification related to walking and cycling

Perceptions of risk: understanding cardiovascular disease

Cardiovascular disease (CVD) is still the leading cause of death and disability worldwide despite the availability of well-established and effective preventive options. Accurate perception of a patient’s risk by both the patient and the doctors is important as this is one of the components that determine health-related behavior. Doctors tend to not use cardiovascular (CV) risk calculators and underestimate the absolute CV risk of their patients. Patients show optimistic bias when considering their own risk and consistently underestimate it. Poor patient health literacy and numeracy must be considered when thinking about this problem. Patients must possess a reasonably high level of understanding of numerical processes when doctors discuss risk, a level that is not possessed by large numbers of the population. In order to overcome this barrier, doctors need to utilize various tools including the appropriate use of visual aids to accurately communicate risk with their patients. Any intervention has been shown to be better than nothing in improving health understanding. The simple process of repeatedly conveying risk information to a patient has been shown to improve accuracy of risk perception. Doctors need to take responsibility for the accurate assessment and effective communication of CV risk in their patients in order to improve patient uptake of cardioprotective lifestyle choices and preventive medications

Digital curation and the cloud

Digital curation involves a wide range of activities, many of which could benefit from cloud deployment to a greater or lesser extent. These range from infrequent, resource-intensive tasks which benefit from the ability to rapidly provision resources to day-to-day collaborative activities which can be facilitated by networked cloud services. Associated benefits are offset by risks such as loss of data or service level, legal and governance incompatibilities and transfer bottlenecks. There is considerable variability across both risks and benefits according to the service and deployment models being adopted and the context in which activities are performed. Some risks, such as legal liabilities, are mitigated by the use of alternative, e.g., private cloud models, but this is typically at the expense of benefits such as resource elasticity and economies of scale. Infrastructure as a Service model may provide a basis on which more specialised software services may be provided. There is considerable work to be done in helping institutions understand the cloud and its associated costs, risks and benefits, and how these compare to their current working methods, in order that the most beneficial uses of cloud technologies may be identified. Specific proposals, echoing recent work coordinated by EPSRC and JISC are the development of advisory, costing and brokering services to facilitate appropriate cloud deployments, the exploration of opportunities for certifying or accrediting cloud preservation providers, and the targeted publicity of outputs from pilot studies to the full range of stakeholders within the curation lifecycle, including data creators and owners, repositories, institutional IT support professionals and senior manager

Cardiovascular Stress Reactivity and Health: Recent Questions and Future Directions

OBJECTIVE: High cardiovascular reactions to psychological stress are associated with the development of hypertension, systemic atherosclerosis, and cardiovascular disease. However, it has become apparent that low biological stress reactivity also may have serious consequences for health, although less is known about the mechanisms of this. The objective of this narrative review and opinion paper is to summarise and consider where we are now in terms of the usefulness of the reactivity hypothesis and reactivity research, given that both ends of the reactivity spectrum appear to be associated with poor health, and to address some of the key criticisms and future challenges for the research area. METHODS: This review is authored by the members of a panel discussion held at the American Psychosomatic Society meeting 2019 which included questions such as: How do we measure high and low reactivity? Can high reactivity ever indicate better health? Does low or blunted reactivity simply reflect less effort on task challenges? Where does low reactivity originate from, and what is a low reactor? RESULTS: Cardiovascular (and cortisol) stress reactivity are used as a model to: demonstrate an increased understanding of the different individual pathways from stress responses to health/disease and show the challenges of how to understand and best use the reconstruction of a long-standing reactivity hypothesis given recent data. CONCLUSIONS: This discussion elucidates the gaps in knowledge and key research issues that still remain to be addressed in this field, and that systematic reviews and meta-analyses continue to be required

Prognostic Tools for Early Mortality in Hemorrhagic Stroke: Systematic Review and Meta-Analysis

Background and Purpose: Several risk scores have been developed to predict mortality in intracerebral hemorrhage (ICH). We aimed to systematically determine the performance of published prognostic tools. Methods: We searched MEDLINE and EMBASE for prognostic models (published between 2004 and April 2014) used in predicting early mortality (<6 months) after ICH. We evaluated the discrimination performance of the tools through a random-effects meta-analysis of the area under the receiver operating characteristic curve (AUC) or c-statistic. We evaluated the following components of the study validity: study design, collection of prognostic variables, treatment pathways, and missing data. Results: We identified 11 articles (involving 41,555 patients) reporting on the accuracy of 12 different tools for predicting mortality in ICH. Most studies were either retrospective or post-hoc analyses of prospectively collected data; all but one produced validation data. The Hemphill-ICH score had the largest number of validation cohorts (9 studies involving 3,819 patients) within our systematic review and showed good performance in 4 countries, with a pooled AUC of 0.80 [95% confidence interval (CI)=0.77-0.85]. We identified several modified versions of the Hemphill-ICH score, with the ICH-Grading Scale (GS) score appearing to be the most promising variant, with a pooled AUC across four studies of 0.87 (95% CI=0.84-0.90). Subgroup testing found statistically significant differences between the AUCs obtained in studies involving Hemphill-ICH and ICH-GS scores (p=0.01). Conclusions: Our meta-analysis evaluated the performance of 12 ICH prognostic tools and found greater supporting evidence for 2 models (Hemphill-ICH and ICH-GS), with generally good performance overall

Prognostic models for mortality after cardiac surgery in patients with infective endocarditis: a systematic review and aggregation of prediction models.

Background There are several prognostic models to estimate the risk of mortality after surgery for active infective endocarditis (IE). However, these models incorporate different predictors and their performance is uncertain. Objective We systematically reviewed and critically appraised all available prediction models of postoperative mortality in patients undergoing surgery for IE, and aggregated them into a meta-model. Data sources We searched Medline and EMBASE databases from inception to June 2020. Study eligibility criteria We included studies that developed or updated a prognostic model of postoperative mortality in patient with IE. Methods We assessed the risk of bias of the models using PROBAST (Prediction model Risk Of Bias ASsessment Tool) and we aggregated them into an aggregate meta-model based on stacked regressions and optimized it for a nationwide registry of IE patients. The meta-model performance was assessed using bootstrap validation methods and adjusted for optimism. Results We identified 11 prognostic models for postoperative mortality. Eight models had a high risk of bias. The meta-model included weighted predictors from the remaining three models (EndoSCORE, specific ES-I and specific ES-II), which were not rated as high risk of bias and provided full model equations. Additionally, two variables (age and infectious agent) that had been modelled differently across studies, were estimated based on the nationwide registry. The performance of the meta-model was better than the original three models, with the corresponding performance measures: C-statistics 0.79 (95% CI 0.76–0.82), calibration slope 0.98 (95% CI 0.86–1.13) and calibration-in-the-large –0.05 (95% CI –0.20 to 0.11). Conclusions The meta-model outperformed published models and showed a robust predictive capacity for predicting the individualized risk of postoperative mortality in patients with IE. Protocol registration PROSPERO (registration number CRD42020192602).pre-print270 K

Meta Analysis the Effect of Electronic Health-based Self Management in Controlling Blood Pressure in Hipertensive Patients

Background Consistent application of self-management is important in efforts to improve the quality of life and health status of hypertensive patients. Electronic health is here to facilitate self-management of hypertensive patients and provide health information to health workers in real time and promote lifestyle modifications. The purpose of this study was to analyze the influence of electronic health-based self-management on blood pressure control in hypertensive patients.Subjects and Method: : This study is a meta-analysis using PICO namely Population: Hypertensive patients; Intervention: Self-management based on electronic health; Comparison: No self-management based on electronic health; Outcome: Systolic and diastolic blood pressure. This study uses articles from several databases, i.e Pubmed, Google Scholar, Science Direct and the Cochrane Library using the following keywords “Hypertension” OR “Hypertensive” OR “Blood Pressure” OR “High Blood Pressure” AND “Self Management” OR “Self Care” OR “Self Monitoring” AND “Electronic Health” OR “eHealth” OR “Telemedicine” OR “Telehealth” OR “mHealth” OR “Mobile Health” OR “Mobile Application” OR “Message Text” OR “Phone Calls”. Articles included in the research are articles that use English with an RCT study design whose publication is within the period of 2012-2022. The steps in the systematic review are carried out based on the PRISMA flow diagram guidelines. Quantitative analysis was carried out using Review Manager (Revman) 5.3.Results: There were 9 articles from South Africa, America, South Korea, Spanish, England, Scotland, and Honduras, with a sample size of 3,071 hypertensive patients concluded that electronic health-based self-management could reduce systolic blood pressure by 0.38 units and was statistically significant (SMD= -0.38; 95% CI = -0.55 to -0.20; p&lt;0.001 ). The meta-analysis synthesized 9 studies with a total sample size = 2.095 hypertensive patients concluded that electronic health-based self-management could reduce diastolic blood pressure by 0.21 units and was statistically significant (SMD= -0.21; 95% CI = -0.29 to -0.12; p&lt; 0.001).Conclusion: Electronic health-based self-management can reduce systolic and diastolic blood pressure control in hypertensive patients.Keywords: Self management, electronic health, blood pressure, hypertensionCorrespondence:Aulia Siti Nur Rahmah. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: [email protected]. Mobile: 08156865373.Journal of Health Policy and Management (2023)https://doi.org/10.26911/thejhpm.2023.08.02.0

Epidemiology

Epidemiology is a methodological, well grounded and versatile tool-kit to conduct evidence-based quantitative research in all health sciences. It integrates a wide spectrum of case studies and examples from the different disciplines thereby fostering the multi-disciplinary approach in the health sciences. It follows a two level 'methods based' approach differentiating between "basic" knowledge that all students of epidemiology should be familiar with and "beyond the basics" information for the interested or more advanced reader