The relationship between depressive symptoms, health service consumption, and prognosis after acute myocardial infarction: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>The use of cardiovascular health services is greater among patients with depressive symptoms than among patients without. However, the extent to which such associations between depressive symptoms and health service utilization are attributable to variations in comorbidity and prognostic disease severity is unknown. This paper explores the relationship between depressive symptoms, health service cardiovascular consumption, and prognosis following acute myocardial infarction (AMI).</p> <p>Methods</p> <p>The study design was a prospective cohort study with follow-up telephone interviews of 1,941 patients 30 days following AMI discharged from 53 hospitals across Ontario, Canada between December 1999 and February, 2003. Outcome measures were post discharge use of cardiac and non-cardiac health care services. The service utilization outcomes were adjusted for age, sex, income, comorbidity, two validated measures of prognosis (cardiac functional capacity and risk adjustment severity index), cardiac procedures (CABG or PTCA) and drugs prescribed at discharge.</p> <p>Results</p> <p>Depressive symptoms were associated with a 24% (Adjusted RR:1.24; 95% CI:1.19–1.30, P < 0.001), 9% (Adjusted RR:1.09; 95% CI:1.02–1.16, P = 0.007) and 43% (Adjusted RR: 1.43; 95% CI:1.34–1.52, P < 0.001) increase in total, cardiac, and non-cardiac hospitalization days post-AMI respectively, after adjusting for baseline patient and hospital characteristics. Depressive-associated increases in cardiac health service consumption were significantly more pronounced among patients of lower than higher cardiac risk severity. Depressive symptoms were not associated with increased mortality after adjusting for baseline patient characteristics.</p> <p>Conclusion</p> <p>Depressive symptoms are associated with significantly higher cardiac and non-cardiac health service consumption following AMI despite adjustments for comorbidity and prognostic severity. The disproportionately higher cardiac health service consumption among lower-risk AMI depressive patients may suggest that health seeking behaviors are mediated by psychosocial factors more so than by objective measures of cardiovascular risk or necessity.</p

Apps to improve diet, physical activity and sedentary behaviour in children and adolescents: A review of quality, features and behaviour change techniques

Background: The number of commercial apps to improve health behaviours in children is growing rapidly. While this provides opportunities for promoting health, the content and quality of apps targeting children and adolescents is largely unexplored. This review systematically evaluated the content and quality of apps to improve diet, physical activity and sedentary behaviour in children and adolescents, and examined relationships of app quality ratings with number of app features and behaviour change techniques (BCTs) used. Methods: Systematic literature searches were conducted in iTunes and Google Play stores between May-November 2016. Apps were included if they targeted children or adolescents, focused on improving diet, physical activity and/or sedentary behaviour, had a user rating of at least 4+ based on at least 20 ratings, and were available in English. App inclusion, downloading and user-testing for quality assessment and content analysis were conducted independently by two reviewers. Spearman correlations were used to examine relationships between app quality, and number of technical app features and BCTs included. Results: Twenty-five apps were included targeting diet (n=12), physical activity (n=18) and sedentary behaviour (n=7). On a 5-point Mobile App Rating Scale (MARS), overall app quality was moderate (total MARS score: 3.6). Functionality was the highest scoring domain (mean: 4.1, SD: 0.6), followed by aesthetics (mean: 3.8, SD: 0.8), and lower scoring for engagement (mean: 3.6, SD: 0.7) and information quality (mean: 2.8, SD: 0.8). On average, 6 BCTs were identified per app (range: 1-14); the most frequently used BCTs were providing 'instructions' (n=19), 'general encouragement' (n=18), 'contingent rewards' (n=17), and 'feedback on performance' (n=13). App quality ratings correlated positively with numbers of technical app features (rho=0.42, p < 0.05) and BCTs included (rho=0.54, p < 0.01). Conclusions: Popular commercial apps to improve diet, physical activity and sedentary behaviour in children and adolescents had moderate quality overall, scored higher in terms of functionality. Most apps incorporated some BCTs and higher quality apps included more app features and BCTs. Future app development should identify factors that promote users' app engagement, be tailored to specific population groups, and be informed by health behaviour theories. © 2017 The Author(s).Associated Grant:SS (GNT1125586) and AR (GNT1105926) are supported by an Early Career Fellowship from the National Health and Medical Research Council of Australia. SS (ID 101240) is also supported by a Postdoctoral Fellowship from the Australian Heart Foundation of Australia. CV (ID 100427) is supported by a Future Leader Fellowship from the National Heart Foundation of Australi

Apps to improve diet, physical activity and sedentary behaviour in children and adolescents: A review of quality, features and behaviour change techniques

Background: The number of commercial apps to improve health behaviours in children is growing rapidly. While this provides opportunities for promoting health, the content and quality of apps targeting children and adolescents is largely unexplored. This review systematically evaluated the content and quality of apps to improve diet, physical activity and sedentary behaviour in children and adolescents, and examined relationships of app quality ratings with number of app features and behaviour change techniques (BCTs) used. Methods: Systematic literature searches were conducted in iTunes and Google Play stores between May-November 2016. Apps were included if they targeted children or adolescents, focused on improving diet, physical activity and/or sedentary behaviour, had a user rating of at least 4+ based on at least 20 ratings, and were available in English. App inclusion, downloading and user-testing for quality assessment and content analysis were conducted independently by two reviewers. Spearman correlations were used to examine relationships between app quality, and number of technical app features and BCTs included. Results: Twenty-five apps were included targeting diet (n=12), physical activity (n=18) and sedentary behaviour (n=7). On a 5-point Mobile App Rating Scale (MARS), overall app quality was moderate (total MARS score: 3.6). Functionality was the highest scoring domain (mean: 4.1, SD: 0.6), followed by aesthetics (mean: 3.8, SD: 0.8), and lower scoring for engagement (mean: 3.6, SD: 0.7) and information quality (mean: 2.8, SD: 0.8). On average, 6 BCTs were identified per app (range: 1-14); the most frequently used BCTs were providing 'instructions' (n=19), 'general encouragement' (n=18), 'contingent rewards' (n=17), and 'feedback on performance' (n=13). App quality ratings correlated positively with numbers of technical app features (rho=0.42, p < 0.05) and BCTs included (rho=0.54, p < 0.01). Conclusions: Popular commercial apps to improve diet, physical activity and sedentary behaviour in children and adolescents had moderate quality overall, scored higher in terms of functionality. Most apps incorporated some BCTs and higher quality apps included more app features and BCTs. Future app development should identify factors that promote users' app engagement, be tailored to specific population groups, and be informed by health behaviour theories. © 2017 The Author(s)

Discursively ‘Undoing’ and ‘Doing Europe’ the Austrian Way

Literature on European and national identities displays a tension between occasional observations of an emerging ‘banal Europeanism’ (Cram, 2009) and a dominant strand (e.g. Guibernau, 2007; Toplak & Šumi, 2012) that questions the viability of European identifications vis-à-vis historically entrenched nationalisms, particularly in the context of the debt crisis and the resulting (re)nationalization of European politics. This chapter builds on recent work on Austrian European Union (EU) scepticism and its contestation (Karner, 2013) to examine instances – in diverse media coverage, readers’ letters to the editor of Austria’s most widely read newspaper, internet platforms, political essays and party political positions – of national identity negotiations in relation to the EU and as articulated in the context of successive European crises and the most recent elections to the European Parliament. The qualitative, thematic analysis of these wide-ranging materials developed here draws on two key concepts in critical discourse analysis, the notions of deixis (Billig, 1995) or ‘rhetorical pointing’ and of the topos or ‘structure of argument’ (e.g. Reisigl & Wodak, 2001), which are complemented by a third theoretical tool, namely the anthropological concept of ‘grammars of identity’ (Baumann & Gingrich, 2004). The resulting discussion reveals the uneasy coexistence of (critical) Europeanisms and various national reassertions in Austria’s public sphere and their respective discursive features. Further, the theoretical approaches synthesized cast light on internal diversities within political positions that are often too monolithicly classified as being ‘simply’ pro- or anti-European respectively. Instead, the analysis presented here reveals a spectrum of (at least five) competing positions