284,568 research outputs found

    Randomised controlled trial comparing uptake of NHS Health Check in response to standard letters, risk-personalised letters and telephone invitations

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    Background NHS Health Check is a primary prevention programme offering cardiovascular disease (CVD) risk assessment to adults in England aged 40–74. Uptake remains a challenge and invitation method is a strong predictor of uptake. There is evidence of low uptake when using invitation letters. Telephone invitations might increase uptake, but are not widely used. We explored the potential to improve uptake through personalising letters to patient’s CVD risk, and to compare this with generic letters and telephone invitations. Methods HEalth Check TRial (HECTR) was a three-arm randomised controlled trial in nine general practices in Staffordshire (UK). Eligible patients were randomised to be invited to a NHS Health Check using one of three methods: standard letter (control); telephone invitation; letter personalised to the patient’s CVD risk. The primary outcome was attendance/non-attendance. Data were collected on a range of patient- and practice-level factors (e.g., patient socio-demographics, CVD risk, practice size, Health Checks outside usual working hours). Multi-level logistic regression estimated the marginal effects to explore whether invitation method predicted attendance. Invitation costs were collated from practices to estimate cost benefit. Results In total, 4614 patients were included in analysis (mean age 50.2 ± 8.0 yr.; 52.4% female). Compared with patients invited by standard letter (30.9%), uptake was significantly higher in those invited by telephone (47.6%, P < .001), but not personalised letter (31.3%, p = .812). In multi-level analysis, compared with the standard letter arm, likelihood of attendance was 18 percentage points higher in the telephone arm and 4 percentage points higher in the personalised letter arm. The effect of telephone calls appeared strongest in patients who were younger and had lower CVD risk. We estimated per 1000 patients invited, risk-personalised letters could result in 40 additional attended Health Checks (at no extra cost) and telephone invitations could result in 180 additional Health Checks at an additional cost of £240. Conclusions Telephone invitations should be advocated to address the substantial deficit between current and required levels of NHS uptake, and could be targeted at younger and lower CVD risk adults. Risk-personalised letters should be explored further in a larger sample of high risk individuals

    Affordability of complementary health insurance in France : a social experiment.

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    In order to improve financial access to complementary health insurance (CHI) in France, a CHI voucher program, called Aide Complémentaire Santé (ACS) was introduced in 2005. Four years later, the program covered only 18% of the eligible population. Two main hypotheses are put forward to account for this low take-up rate. The first one is related to the lack of information on the program itself and on its application process. While the second one considers that the amount of the financial support is too small to encourage people to purchase a CHI plan. We conduct a controlled experiment with the National Health Insurance Fund in order to assess these assumptions. A sample of eligible insurees living in an urban area in northern France were randomly split into three groups: a control group who received the standard level of financial aid, a group benefiting from a 75% voucher increase, and a third group benefiting from the same 75% voucher increase plus an invitation to an information meeting on ACS. After six months of follow-up, we observed how many application forms were sent back and how many of them entitled to ACS. Five main conclusions can be drawn from that analysis. (1) The voucher increase has a slight but statistically significant effect on ACS take-up. (2) It also allows better targeting of people actually eligible and thus reduces the number of ACS refusals due to resources above the upper limit. (3) However the invitation to the meeting seems unexpectedly to cancel the positive effect of the voucher increase when both treatments are applied jointly. (4) On the contrary, after controlling for potential selection bias, we observed that attending the briefing has a significant impact on ACS take-up. (5) This study confirms that ACS is complex and reaches poorly its target population. Only 17% of the insurees applied for ACS and only 9% of insures who were invited to the information briefing actually attended it. Moreover, previous CHI holders responded similarly to CHI non holders to treatments, which suggests that the central issue of ACS low take-up rate is not the CHI cost itself but most certainly the access to information, the burden and the complexity of the application process.France; Subsidized Health insurance; low-income population; uninsured; randomized experiment;

    The Use of an Integrative Wellness Care Plan in Primary Care

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    Background: The United States health care system has a segmented approach to patient care when it comes to primary care delivery. Many individuals demand new models of healthcare and choose to integrate non-traditional methods into their health regimen beyond what is typically offered in many primary care settings. This project surveyed a group of patients receiving care at an integrative clinic and explored satisfaction with services based on an Integrative Wellness Care Plan. Materials and Methods: An Integrative Wellness Care Plan (IWCP) that combines standard primary care services with integrative therapies was reviewed, and a six-question survey was developed to evaluate the patient experience. An invitation to participate in a survey was emailed to 52 patients. Each survey participant was screened to ensure that at least one previous clinic appointment incorporated the use of the IWCP. The response rate of the survey was 38%. Content analysis method of data analysis was utilized, and findings were categorized into major themes. Results: Themes identified through analysis of qualitative data suggest that patients are highly satisfied with their integrative primary care experience and believe this model of care supports wellness and achievement of individual health goals. Conclusions: Survey responses suggest patients are highly satisfied with the IWCP and value the provision of integrative care as an adjunct to typical primary care services. Respondents mention preferring this model of care over traditional primary care

    Secure Identification in Social Wireless Networks

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    The applications based on social networking have brought revolution towards social life and are continuously gaining popularity among the Internet users. Due to the advanced computational resources offered by the innovative hardware and nominal subscriber charges of network operators, most of the online social networks are transforming into the mobile domain by offering exciting applications and games exclusively designed for users on the go. Moreover, the mobile devices are considered more personal as compared to their desktop rivals, so there is a tendency among the mobile users to store sensitive data like contacts, passwords, bank account details, updated calendar entries with key dates and personal notes on their devices. The Project Social Wireless Network Secure Identification (SWIN) is carried out at Swedish Institute of Computer Science (SICS) to explore the practicality of providing the secure mobile social networking portal with advanced security features to tackle potential security threats by extending the existing methods with more innovative security technologies. In addition to the extensive background study and the determination of marketable use-cases with their corresponding security requirements, this thesis proposes a secure identification design to satisfy the security dimensions for both online and offline peers. We have implemented an initial prototype using PHP Socket and OpenSSL library to simulate the secure identification procedure based on the proposed design. The design is in compliance with 3GPP‟s Generic Authentication Architecture (GAA) and our implementation has demonstrated the flexibility of the solution to be applied independently for the applications requiring secure identification. Finally, the thesis provides strong foundation for the advanced implementation on mobile platform in future

    Providing health checks as incentives to retain blood donors — evidence from two field experiments

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    The collection of blood given by donors has proven to be a substantial societal and a managerial challenge. Consequently, blood donation services seek for incentive mechanisms to retain donors. However, economic or material rewards might entail negative side effects such as motivational crowding out or even attracting “bad blood”. In an effort to increase the retention of established blood donors, we conducted two randomized field trials (N1 = 53,257, N2 = 31,522) in cooperation with the German Red Cross Blood Donation Service and tested the effectiveness of an incentive strategy that is directly related to the blood donation itself: offering a comprehensive blood health check. Contrary to previous related research, we found substantial positive effects of a comprehensive blood health check incentive on donation behavior. In addition, unlike previous studies, we examine effects of repeated exposure to this incentive and do not find any wearout effects. Considering the positive effect of this incentive on donor retention and the relative low cost for providing this service to donors, our findings suggest that offering comprehensive blood health check incentives is a viable and cost-efficient marketing strategy to increase the retention among previous donors even if offered over the longer run.Accepted manuscrip

    Perswazyjne użycie języka potocznego w kontakcie ogólnym

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    Considered in this article are the functional values attributed to the use of the colloquial language in non-typical, non-standard situations, in which this language is not anticipated. Analysis is applied to the intentions of the speaker, who chooses, in a non-colloquial, public situation, the colloquial element as the most appropriate for the needs of communication. These intentions may be perceived as: 1) identifying oneself with one’s own social group, 2) maintaining one’s own identity, 3) building up one’s own image, 4) offering opposition to the official language, 5) an invitation to a game of words, The use of colloquialisms leads to enhancing of the persuasive effect of the utterance and of removing the asymmetry in the social status as between the speaker and the collective audience

    Antipsychotic Drug Use: Managing Cardiometabolic and Cost Effects

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    Across the US, 30%, or approximately one third of people meet the criteria for at least one mental illness.1 Of those with severe mental illness (SMI), namely schizophrenia and bipolar disorder, the mortality rate is more than twofold compared to the general population.2 The cardiovascular risk factors that contribute to cardiovascular related deaths, including metabolic disease and type II diabetes, are not only modifiable, but staggeringly higher for those with SMI.3 Though antipsychotic drug prescription is the standard protocol for SMI treatment, such drug effects on cardiovascular risk factors and related deaths exacerbate the much higher mortality rate for the severely mentally ill population. Due to both the prevalence of SMI and the physical comorbidities that it entails, analysis of healthcare costs associated with this population are an essential part of general health and policy improvement for the U.S. Therefore, a breakdown of the healthcare costs of this population requires not only acknowledgment of the modes of treatment for mental illness specifically, but also the identification and cost-analysis of the commonly associated physical comorbidities. This is especially important considering SMI is almost always considered chronic, and many SMI patients qualify for either Medicare, Medicaid, or both. Certain gaps in coverage can lead to lack of preventive care, exacerbating the cost burden. From a clinician’s perspective, assessing relevant scientific studies and reviews to change the relationship between primary care and psychiatry is necessary to dampen the high mortality rate of the SMI population. From a policy-maker’s perspective, analyzing the cause and effect balance between managing costs of care directed at the SMI itself against the adjunct costs from physical comorbidity calls for a change in the structure of therapeutic care and how the SMI population accesses primary care. The Collaborative Care model is a health care model that unifies psychiatric, behavioral, and primary care to support the mental, behavioral, and physical health of patients. By supporting holistic healthcare, the high cost of care for the SMI population will be diminished. The model includes four parts: patient-centered care, populationbased care, measurement-based treatment to target, and evidence-based care. Swapping oral antipsychotics with injectable versions will be especially cost-effective by improving adherence rates, and thus, reducing institutionalization and other hospitalizations. By enforcing the Collaborative Care model through community health center interventions, clinicians and policy makers will be able to work together to effectively leverage the health of the SMI population while eroding the high health care expenditure that this population currently imposes on states

    Invitations to laughter : a microanalysis of televised stand-up comedy performances

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    This thesis set out to identify the various techniques used by stand-up comedians to invite laughter and other affiliative responses from their audiences. A corpus of 13 televised stand-up comedy performances was analysed both qualitatively and quantitatively, and comparative analyses of different audience responses (including laughter and applause) were presented. Coding schemes that had been designed for analysing audience applause during political speeches were found to account for many of the audience responses during stand-up comedy performances, but differences between both performer and audience behaviours in the two genres were also identified. A taxonomy of comedy invitation devices was proposed, containing 16 different verbal and non-verbal invitational techniques that were observed in the corpus. In a quantitative comparison of two ofthese, no statistical difference was found between the invitational use of gestures and standard rhetorical devices, although both techniques were used during all of the performances in the corpus. An analysis ofpotential forms of disaffiliation suggested that non-responses were more disaffiliative than either uninvited responses or invited responses ofweak affiliation intensity. Finally, a number of ways of identifying skill as a stand-up comedian were proposed, including the use of subtle invitational cues, combining several comedy invitation devices at salient response invitation points, and moving on swiftly and fluently when laughter invitations are not taken up by the audience

    Does work experience mitigate discrimination?

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    We test whether ethnic discrimination is heterogeneous by job candidates' work experience. Fictitious applications are sent to vacancies. We find significant discrimination when candidates have no or little experience but no unequal treatment when they have twenty years of experience
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