Evaluation design of Urban Health Centres Europe (UHCE): preventive integrated health and social care for communitydwelling older persons in five European cities

Background: Older persons often have interacting physical and social problems and complex care needs. An integrated care approach in the local context with collaborations between community-, social-, and health-focused organisations can contribute to the promotion of independent living and quality of life. In the Urban Health Centres Europe (UHCE) project, five European cities (Greater Manchester, United Kingdom; Pallini (in Greater Athens Area), Greece; Rijeka, Croatia; Rotterdam, the Netherlands; and Valencia, Spain) develop and implement a care template that integrates health and social care and includes a preventive approach. The UHCE project includes an effect and process evaluation. Methods: In a one-year pre-post controlled trial, in each city 250 participants aged 75+ years are recruited to receive the UHCE approach and are compared with 250 participants who receive ‘care as usual’. Benefits of UHCE approach in terms of healthy life styles, fall risk, appropriate medication use, loneliness level and frailty, and in terms of level of independence and health-related quality of life and health care use are assessed. A multilevel modeling approach is used for the analyses. The process evaluation is used to provide insight into the reach of the target population, the extent to which elements of the UHCE approach are executed as planned and the satisfaction of the participants. Discussion: The UHCE project will provide new insight into the feasibility and effectiveness of an integrated care approach for older persons in different European settings. Trial registration: ISRCTN registry number is ISRCTN52788952. Date of registration is 13/03/2017

Linkage to HIV care before and after the introduction of provider-initiated testing and counselling in six Rwandan health facilities.

HIV testing and counselling forms the gateway to the HIV care and treatment continuum. Therefore, the World Health Organization recommends provider-initiated testing and counselling (PITC) in countries with a generalized HIV epidemic. Few studies have investigated linkage-to-HIV-care among out-patients after PITC. Our objective was to study timely linkage-to-HIV-care in six Rwandan health facilities (HFs) before and after the introduction of PITC in the out-patient departments (OPDs). Information from patients diagnosed with HIV was abstracted from voluntary counselling and testing, OPD and laboratory registers of six Rwandan HFs during three-month periods before (March-May 2009) and after (December 2009-February 2010) the introduction of PITC in the OPDs of these facilities. Information on patients' subsequent linkage-to-pre-antiretroviral therapy (ART) care and ART was abstracted from ART clinic registers of each HF. To triangulate the findings from HF routine, a survey was held among patients to assess reasons for non-enrolment. Of 635 patients with an HIV diagnosis, 232 (36.5%) enrolled at the ART clinic within 90 days of diagnosis. Enrolment among out-patients decreased after the introduction of PITC (adjusted odds ratio, 2.0; 95% confidence interval, 1.0-4.2; p = .051). Survey findings showed that retesting for HIV among patients already diagnosed and enrolled into care was not uncommon. Patients reported non-acceptance of disease status, stigma and problems with healthcare services as main barriers for enrolment. Timely linkage-to-HIV-care was suboptimal in this Rwandan study before and after the introduction of PITC; the introduction of PITC in the OPD may have had a negative impact on linkage-to-HIV-care. Healthier patients tested through PITC might be less ready to engage in HIV care. Fear of HIV stigma and mistrust of test results appear to be at the root of these problems

Socioeconomic inequalities in frailty and frailty components among community-dwelling older citizens

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Het aanpakken van ziekteverzuim bij mbo-leerlingen: Een evaluatie van de M@ ZL-methodiek

Inleiding: De M@ZL-methodiek (Medische Advisering van de Ziekgemelde Leerling) is een methodiek die gericht is op het vroegtijdig identificeren van ziekteverzuim en het reduceren ervan door het tijdig en proactief aanbieden van ondersteuning. Dit onderzoek had tot doel de M@ZL-methodiek te evalueren onder leerlingen van het middelbaar beroepsonderwijs (mbo) en jeugdartsen.Methode: Mbo-leerlingen met ‘zorgwekkend’ ziekteverzuim in zowel interventiescholen als controlescholen vulden op twee momenten (een nulmeting en na zes maanden) een zelfrapportagevragenlijst in. Voor de analyse werden lineaire en logistische regressieanalyses toegepast. Ook vulden mbo-leerlingen op interventiescholen en jeugdartsen een evaluatieformulier in.Resultaten: Deelnemende mbo-leerlingen (n = 200) hadden een gemiddelde leeftijd van 18,6 jaar (sd = 2,0) en 78,5% was vrouw. De M@ZL-methodiek liet positieve resultaten zien op het verminderen van ziekteverzuim in dagen (β = −1,13, 95%-BI = −2,22–−0,05, p < 0,05) en op het verminderen van depressieve symptomen (β = −4,11, 95%-BI = −7,06–−1,17, p < 0,05). Voor andere gezondheidsindicatoren werden geen effecten gevonden (p > 0,05). Een significante interactie liet een afname van het ziekteverzuim zien bij mannen (p < 0,05), maar niet bij vrouwen (p > 0,05). De jeugdartsen die M@ZL uitvoerden, vonden de methodiek zinvol en verklaarden dat het consult bijna altijd verliep zoals bedoeld. Leerlingen beoordeelden het consult met een 8,3.Conclusie: De M@ZL-methodiek kan positieve effecten hebben op het verminderen van zowel ziekteverzuim als depressieve symptomen bij mbo-leerlingen. De jeugdartsen en de leerlingen waardeerden de methodiek

Het aanpakken van ziekteverzuim bij mbo-leerlingen: Een evaluatie van de M@ ZL-methodiek

Inleiding: De M@ZL-methodiek (Medische Advisering van de Ziekgemelde Leerling) is een methodiek die gericht is op het vroegtijdig identificeren van ziekteverzuim en het reduceren ervan door het tijdig en proactief aanbieden van ondersteuning. Dit onderzoek had tot doel de M@ZL-methodiek te evalueren onder leerlingen van het middelbaar beroepsonderwijs (mbo) en jeugdartsen.Methode: Mbo-leerlingen met ‘zorgwekkend’ ziekteverzuim in zowel interventiescholen als controlescholen vulden op twee momenten (een nulmeting en na zes maanden) een zelfrapportagevragenlijst in. Voor de analyse werden lineaire en logistische regressieanalyses toegepast. Ook vulden mbo-leerlingen op interventiescholen en jeugdartsen een evaluatieformulier in.Resultaten: Deelnemende mbo-leerlingen (n = 200) hadden een gemiddelde leeftijd van 18,6 jaar (sd = 2,0) en 78,5% was vrouw. De M@ZL-methodiek liet positieve resultaten zien op het verminderen van ziekteverzuim in dagen (β = −1,13, 95%-BI = −2,22–−0,05, p < 0,05) en op het verminderen van depressieve symptomen (β = −4,11, 95%-BI = −7,06–−1,17, p < 0,05). Voor andere gezondheidsindicatoren werden geen effecten gevonden (p > 0,05). Een significante interactie liet een afname van het ziekteverzuim zien bij mannen (p < 0,05), maar niet bij vrouwen (p > 0,05). De jeugdartsen die M@ZL uitvoerden, vonden de methodiek zinvol en verklaarden dat het consult bijna altijd verliep zoals bedoeld. Leerlingen beoordeelden het consult met een 8,3.Conclusie: De M@ZL-methodiek kan positieve effecten hebben op het verminderen van zowel ziekteverzuim als depressieve symptomen bij mbo-leerlingen. De jeugdartsen en de leerlingen waardeerden de methodiek

The association of fear of falling and physical and mental Health-Related Quality of Life (HRQoL) among community-dwelling older persons :: a cross-sectional study of Urban Health Centres Europe (UHCE)

Background: The share of people over 80 years in the European Union is estimated to increase two-and-a-half-fold from 2000 to 2100. A substantial share of older persons experiences fear of falling. This fear is partly associated with a fall in the recent past. Because of the associations between fear of falling, avoiding physical activity, and the potential impact of those on health, an association between fear of falling and low health-related quality of life, is suggested. This study examined the association of fear of falling with physical and mental Health-Related Quality of Life (HRQoL) among community-dwelling older persons in five European countries. Methods: A cross-sectional study was conducted using baseline data of community-dwelling persons of 70 years and older participating in the Urban Health Centers Europe project in five European countries: United Kingdom, Greece, Croatia, the Netherlands and Spain. This study assessed fear of falling with the Short Falls Efficacy Scale-International and HRQoL with the 12-Item Short-Form Health Survey. The association between low, moderate or high fear of falling and HRQoL was examined using adjusted multivariable linear regression models. Results: Data of 2189 persons were analyzed (mean age 79.6 years; 60.6% females). Among the participants, 1096 (50.1%) experienced low fear of falling; 648 (29.6%) moderate fear of falling and 445 (20.3%) high fear of falling. Compared to those who reported low fear of falling in multivariate analysis, participants who reported moderate or high fear of falling experienced lower physical HRQoL (β = -6.10, P < 0.001 and β = -13.15, P < 0.001, respectively). In addition, participants who reported moderate or high fear of falling also experienced lower mental HRQoL than those who reported low fear of falling (β = -2.31, P < 0.001 and β = -8.80, P < 0.001, respectively). Conclusions: This study observed a negative association between fear of falling and physical and mental HRQoL in a population of older European persons. These findings emphasize the relevance for health professionals to assess and address fear of falling. In addition, attention should be given to programs that promote physical activity, reduce fear of falling, and maintain or increase physical strength among older adults; this may contribute to physical and mental HRQoL

Socio-demographic characteristics and frailty outcomes by education level of 26,014 persons of The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS).

<p>Socio-demographic characteristics and frailty outcomes by education level of 26,014 persons of The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS).</p

Population of analysis.

<p>Population of analysis.</p

Association of education level with overall frailty and with its six components (Model 1) and change in association of education level with the five other frailty components after adjustment for the morbidities component (Model 2); stratified by age group among 26,014 persons of The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS).

<p>Association of education level with overall frailty and with its six components (Model 1) and change in association of education level with the five other frailty components after adjustment for the morbidities component (Model 2); stratified by age group among 26,014 persons of The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS).</p

Conceptual framework for the association between socioeconomic status and Frailty Index components, where the morbidities component mediates the association between socioeconomic status and other Frailty Index components.

<p>Conceptual framework for the association between socioeconomic status and Frailty Index components, where the morbidities component mediates the association between socioeconomic status and other Frailty Index components.</p