Factors associated with non-response in routine use of patient reported outcome measures after elective surgery in England

BACKGROUND: Patient-reported outcome measures are increasingly being used to compare providers. We studied whether non-response rates to post-operative questionnaires are associated with patients' characteristics and organisational features of providers. METHODS: 131,447 patients who underwent a hip or knee replacement, hernia repair or varicose vein surgery in 2009-10 in England. Multivariable logistic regression to calculate adjusted odds ratios of non-response for characteristics of the patients and organisational characteristics of providers. Multiple imputation was used for missing patient characteristics. Providers were included as random effects. RESULTS: Response rates to the post-operative questionnaire were 85.1% for hip replacement (n = 37 961), 85.3% for knee replacements (n = 44 422), 72.9% for hernia repair (n = 34 964), and 64.8% for varicose vein surgery (n = 14 100). Across the four procedures, there were higher levels of non-response in men (odds ratios 1.03 [95% CI 0.95-1.11] - 1.35 [1.25-1.46]), younger patients (those under 55 years 3.01 [2.72-3.32] - 6.05 [5.49-6.67]), non-white patients (1.24 [1.11-1.38] - 2.08 [1.89-2.31]), patients in the most deprived quintile of socio-economic status (1.47 [1.34-1,62] - 1.86 [1.71-2.03]), those who lived alone (1.11 [0.99-1.23] - 1.27 [1.18-1.36]) and those who had been assisted when completing their pre-operative questionnaire (1.26 [1.10-1.46] -1.67 [1.56-1.79]). Non-response rates were also higher in patients who had poorer pre-operative health (three or more comorbidities: 1.14 [0.96-1.35] - 1.45 [1.30-1.63]). Providers' patient recruitment rates before surgery and the timing of pre-operative questionnaire administration did not affect the rates of response to post-operative questionnaires. CONCLUSION: If non-response can be shown to be associated with outcome, then rates of non-response to post-operative questionnaires would need to be taken into account when these measures are being used to compare the performance of providers or to evaluate surgical procedures

Reductions in readmission rates are associated with modest improvements in patient-reported health gains following hip and knee replacement in England

Background: Although many hospital readmission reduction initiatives have been introduced globally, health care systems ultimately aim to improve patients' health and well-being. We examined whether the hospitals that report greater success in reducing readmissions also see greater improvements in patient-reported outcomes. Research Design: We examined hospital groups (Trusts) that provided hip replacement or knee replacement surgery in England between April 2010 and February 2013. For each Trust, we calculated risk-Adjusted 30-day readmission rates from administrative datasets. We also obtained changes in patient-reported health between presurgical assessment and 6-month follow-up, using general health EuroQuol five dimensions questionaire (EQ-5D) and EuroQuol visual analogue scales (EQ-VAS) and procedure-specific (Oxford Hip and Knee Scores) measures. Panel models were used to assess whether changes over time in risk-Adjusted readmission rates were associated with changes over time in risk-Adjusted health gains. Results: Each percentage point reduction in the risk-Adjusted readmission rate for hip replacement was associated with an additional health gain of 0.004 for EQ-5D [95% confidence interval (CI), 0.002-0.006], 0.39 for EQ-VAS (95% CI, 0.26-0.52), and 0.32 for Oxford Hip Score (95% CI, 0.15-0.27). Corresponding figures for knee replacement were 0.003 for EQ-5D (95% CI, 0.001-0.004), 0.21 for EQ-VAS (95% CI, 0.12-0.30), and 0.14 in the Oxford Knee Score (95% CI, 0.09-0.20). Conclusions: Reductions in readmission rates were associated with modest improvements in patients' sense of their health and well-being at the hospital group level. In particular, fears that efforts to reduce readmission rates have had unintended consequences for patients appear to be unfounded

Psychosocial stress at work and perceived quality of care among clinicians in surgery

Abstract Background Little is known about the association between job stress and job performance among surgeons, although physicians' well-being could be regarded as an important quality indicator. This paper examines associations between psychosocial job stress and perceived health care quality among German clinicians in surgery. Methods Survey data of 1,311 surgeons from 489 hospitals were analysed. Psychosocial stress at work was measured by the effort-reward imbalance model (ERI) and the demand-control model (job strain). The quality of health care was evaluated by physicians' self-assessed performance, service quality and error frequency. Data were collected in a nationwide standardised mail survey. 53% of the contacted hospitals sent back the questionnaire; the response rate of the clinicians in the participating hospitals was about 65%. To estimate the association between job stress and quality of care multiple logistic regression analyses were conducted. Results Clinicians exposed to job stress have an increased risk of reporting suboptimal quality of care. Magnitude of the association varies depending on the respective job stress model and the indicator of health care quality used. Odds ratios, adjusted for gender, occupational position and job experience vary between 1.04 (CI 0.70-1.57) and 3.21 (CI 2.23-4.61). Conclusion Findings indicate that theoretical models of psychosocial stress at work can enrich the analysis of effects of working conditions on health care quality. Moreover, results suggest interventions for job related health promotion measures to improve the clinicians' working conditions, their quality of care and their patients' health.</p

European code against cancer 4th edition: 12 ways to reduce your cancer risk

This overview describes the principles of the 4th edition of the European Code against Cancer and provides an introduction to the 12 recommendations to reduce cancer risk. Among the 504.6 million inhabitants of the member states of the European Union (EU28), there are annually 2.64 million new cancer cases and 1.28 million deaths from cancer. It is estimated that this cancer burden could be reduced by up to one half if scientific knowledge on causes of cancer could be translated into successful prevention. The Code is a preventive tool aimed to reduce the cancer burden by informing people how to avoid or reduce carcinogenic exposures, adopt behaviours to reduce the cancer risk, or to participate in organised intervention programmes. The Code should also form a base to guide national health policies in cancer prevention. The 12 recommendations are: not smoking or using other tobacco products; avoiding second-hand smoke; being a healthy body weight; encouraging physical activity; having a healthy diet; limiting alcohol consumption, with not drinking alcohol being better for cancer prevention; avoiding too much exposure to ultraviolet radiation; avoiding cancer-causing agents at the workplace; reducing exposure to high levels of radon; encouraging breastfeeding; limiting the use of hormone replacement therapy; participating in organised vaccination programmes against hepatitis B for newborns and human papillomavirus for girls; and participating in organised screening programmes for bowel cancer, breast cancer, and cervical cancer

The role of health literacy in explaining the association between educational attainment and the use of out-of-hours primary care services in chronically ill people: a survey study

Abstract Background Low socioeconomic status (SES) is persistently associated with poor health and suboptimal use of healthcare services, and more unplanned healthcare use. Suboptimal use of emergency and acute healthcare services may increase health inequalities, due to late diagnosis or lack of continuity of care. Given that health literacy has been associated with healthcare utilisation and with education attainment, we sought to explore whether health literacy is related to the use of out-of-hours (OOH) Primary Care Services (PCSs). Additionally, we aimed to study whether and to what extent health literacy accounts for some of the association between education and OOH PSC use. Methods A survey including measures of education attainment, health literacy (assessed by means of the Dutch version of the nine-dimension Health Literacy Questionnaire) and use of PCS was conducted among a sample of adults diagnosed with (any) somatic chronic condition in the Netherlands (response 76.3%, n = 1811). We conducted linear and logistic regression analyses to examine associations between education level and PCS use in the past year. We performed mediation analyses to assess whether the association between education and PCS use was (partly) explained by different aspects of health literacy. We adjusted the models for patient characteristics such as age and morbidity. Results Higher education attainment was associated with higher scores on the health literacy aspects Appraisal of health information, and Navigating the healthcare system. Additionally, appraisal and navigating the healthcare system partially accounted for educational differences in PCS use. Finally, higher appraisal of health information scores were associated with higher PCS utilisation. Conclusion Several aspects of health literacy were demonstrated to relate to PCS use, and partly accounted for educational differences herein. Accordingly, developing health literacy within individuals or communities may help to reduce inappropriate PCS use among people with low education

German-African cooperation in global health. The role of social sciences in higher education degree studies, training, and research projects

Global health has gained in importance in Germany in recent years and became visible quite recently both at German institutions of health education and research and on the political agenda of various ministries. What exactly is meant by global health remains vague. In particular, the inter- and transnational conditions and effects of health and disease outbreaks are seen as specific to global health, which requires an inter- and transdisciplinary perspective that includes social science aspects and methods. Africa has also moved into the focus of Germany\u27s international cooperation policies in recent years. Due to the lack of medical personnel in Africa and also in Germany, the education and training of medical personnel in Africa plays an important role in German-African cooperation in the health sector. Cooperation in the training of health personnel can have primarily economic reasons, but may also follow other interests, such as aid, exchange and cultural diplomacy for the German and African side. While the training of medical personnel is primarily clinically oriented, at least in Germany there is a strong tendency towards less clinically oriented training and study programmes in the health sector. The inclusion of social sciences in the training of physicians and nurses in the curricula is also mandatory. However, the integration of the social sciences is only reflected to a limited extent in the institutional funding of German-African health projects, although it can be assumed that these aspects also play an important role in the training of health personnel in Africa. Greater integration of social sciences into German global health education and research could contribute to this also being incorporated into German-African cooperation. This way, social scientific global health research in Germany and Africa would help to analyse determinants of health at the meta-level so that they can be taken into account in national and international strategies and laws and may be implemented in health projects. (DIPF/Orig.)Global Health hat in den letzten Jahren in Deutschland an Bedeutung gewonnen und erscheint seit kurzem sowohl an Institutionen der Gesundheitsbildung und -forschung als auch auf der politischen Agenda unterschiedlicher Ministerien. Was genau unter Global Health verstanden wird, bleibt allerdings bisher recht vage. Jedoch werden inter-und transnationale Bedingungen und Auswirkungen von Gesundheit und Krankheitsausbrüchen als Spezifikum von Global Health betont, was eine inter- und transdisziplinäre Perspektive erfordert, die insbesondere sozialwissenschaftliche Aspekte und Methoden einbezieht. Afrika ist in den letzten Jahren ebenfalls in den Fokus der internationalen Zusammenarbeit Deutschlands gerückt. In der deutsch-afrikanischen Kooperation im Gesundheitsbereich spielen, aufgrund des Mangels an medizinischem Personal in Afrika und auch in Deutschland, die Ausbildung und das Training von medizinischem Personal in Afrika eine wichtige Rolle. Die Kooperation in der Ausbildung von Gesundheitspersonal kann primär wirtschaftliche Gründe haben, aber ebenso andere Formen der Kooperation, wie Hilfe, Austausch und kulturelle Diplomatie für die deutsche und die afrikanische Seite bedeuten. Während die Ausbildung medizinischen Personals primär klinisch orientiert ist, ist zumindest in Deutschland eine starke Tendenz zu weniger klinisch orientierten Ausbildungs- und Studiengängen im Gesundheitsbereich zu verzeichnen. Ebenso ist die Einbindung von Sozialwissenschaften in die Ausbildung von Ärzten und Pflegekräften in den Curricula vorgeschrieben. Eine solche Einbindung von Sozialwissenschaften spiegelt sich in der institutionellen Förderung deutsch-afrikanischer Gesundheitsvorhaben allerdings nicht wider, obwohl davon auszugehen ist, dass diese Aspekte auch für die Ausbildung von Gesundheitspersonal in Afrika eine wichtige Rolle spielen. Eine stärkere Integration von Sozialwissenschaften in die deutsche Global-Health-Ausbildung und -Forschung könnte dazu beitragen, diese auch in die deutsch-afrikanischen Kooperationen einzubringen. Sozialwissenschaftliche Global-Health-Forschung in Deutschland und Afrika würde so dazu beitragen, Determinanten von Gesundheit auf Metaebene zu analysieren, so dass diese in nationalen und internationalen Strategien und Gesetzen berücksichtigt und in Gesundheitsvorhaben umgesetzt werden können. (DIPF/Orig.

Absatz- und Verwertungsmoeglichkeiten fuer Schlachtnebenprodukte und Schlachtabfaelle in der Bundesrepublik Deutschland

Bibliothek Weltwirtschaft Kiel A152,665 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Absatz- und Verwertungsmoeglichkeiten fuer Schlachtnebenprodukte und Schlachtabfaelle in der Bundesrepublik Deutschland

.Ausgehend von der Versorgungssituation wird auf Absatz- und Verwertungsmoeglichkeiten von Druesen u. Organe fuer pharmazeutische Zwecke, Blut, Innereien, Haeute und Schwarten, Knochen, Fettgewebe, Magen-Darm, Schlachtabfaelle eingegangen. Gewinne von ca. 593 Mio DM koennten auf ca. 1.9 Mrd ansteigen, wenn die Strukturen im Schlachthof- und Tierkoerperbeseitigungssektor verbessert wuerden und die anfallenden Rohstoffe und die daraus hergestellten Produkte vollstaendig abgesetzt wuerdenSIGLEAvailable from: Zentralstelle fuer Agrardokumentation und -information (ZADI), Villichgasse 17, D-53177 Bonn / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman