An Evaluation of Food Environments in Saskatchewan Public Recreation Facilities

The impact of food environments (FEs) on eating behaviours is gaining recognition as the health of our population continues to deteriorate. Food environments in public recreation facilities (PRFs) have been of particular interest as they are a preferred gathering place in communities for families. Although FEs in PRFs have been studied in other Canadian provinces for over a decade, this study was the first of its kind in Saskatchewan (SK). A convergent/parallel mixed methods study design used quantitative methods to determine the healthfulness of FEs and qualitative methods to examine barriers, facilitators and future opportunities. Results were organized and converged using a socio-ecological framework. Similar to other provinces, results indicated that concession and vending services in SK PRFs are mostly unhealthy and unsupportive of health. This contradicts the national recreation priority to have Supportive Environments where healthy choices are the easy choices. Barriers far exceeded facilitators for healthy eating, resulting in a current state that is difficult to change even though there appears to be organizational readiness. Key barriers included a lack of guidelines, resources, capacity, funding, incentives and direction, a lack of healthy options and promotion of healthy options, a lack of infrastructure to store or prepare healthy options, a lack of consumer readiness and economic risk. Several future opportunities emerged some of which included the need for policy, nutrition guidance, strategy, direction, stakeholder engagement, knowledge exchange platforms, increased availability and promotion of healthy options, decreased availability and promotion of unhealthy options, infrastructure to store and prepare healthy options and incentives. A participatory action research approach engaged practitioners and policy makers from health and recreation sectors at a provincial advisory level to design our study, as well as, recreation leaders and food service providers at a facility level to participate in our study. This approach increased awareness and capacity to address concerns related to unhealthy FEs in SK PRFs. The role of the provincial advisory committee goes beyond the life of this study; it will continue to support, monitor and re-evaluate changes to FEs in SK PRFs

Reach of Supplemental Nutrition Assistance Program-Education (SNAP-Ed) interventions and nutrition and physical activity-related outcomes, California, 2011-2012.

IntroductionThis study combined information on the interventions of the US Department of Agriculture's Supplemental Nutrition Assistance Program-Education with 5,927 interview responses from the California Health Interview Survey to investigate associations between levels of intervention reach in low-income census tracts in California and self-reported physical activity and consumption of fruits and vegetables, fast food, and sugar-sweetened beverages.MethodsWe determined 4 levels of intervention reach (low reach, moderate reach, high reach, and no intervention) across 1,273 program-eligible census tracts from data on actual and eligible number of intervention participants. The locations of California Health Interview Survey respondents were geocoded and linked with program data. Regression analyses included measures for sex, age, race/ethnicity, and education.ResultsAdults and children from high-reach census tracts reported eating more fruits and vegetables than adults and children from no-intervention census tracts. Adults from census tracts with low, moderate, or high levels of reach reported eating fast food less often than adults from no-intervention census tracts. Teenagers from low-reach census tracts reported more physical activity than teenagers in no-intervention census tracts.ConclusionThe greatest concentration of Supplemental Nutrition Assistance Program-Education interventions was associated with adults and children eating more fruits and vegetables and adults eating fast food less frequently. These findings demonstrate the potential impact of such interventions as implemented by numerous organizations with diverse populations; these interventions can play an important role in addressing the obesity epidemic in the United States. Limitations of this study include the absence of measures of exposure to the intervention at the individual level and low statistical power for the teenager sample

Gnostic Nature of the World View and Fictional Themes of Herman Melville

The thesis that Melville's world view and fictional themes are those of a thoughtful, sincere interpreter of the gnostic imagination is not original with this study. And this writer acknowledges her indebtedness to those critics who explicitly relate Melville's spiritual idiom to gnosticism. Aspects of the writings of these same critics, however, also serve to illuminate the fact that scholars generally are confused about this form of harmonial religion. The inadequacies of these critical studies suggest the need for an up-to-date, concise, but detailed definition of gnosticism, in terms of its nature, history, and broad implications, written with students of literature in mind. In this study the attempt is ma.de to provide this definition and to analyze Melville's major works in its light. A majority of Melville's most eminent critics, who make up the second group reviewed, point to a lack of awareness about gnosticism. Only one of the eight who are included in this category explicitly links Melville's outlook on life to the gnostic element in the romantic imagination. But in consulting their opinions, I discovered that the burden of their views, in many specific respects, provides better support for the claim that Melville's fiction manifests his adherence to gnostic aims and doctrines than the opinions of those critics who explicitly link his outlook on life to the gnostic impulse. Consequently, in order to lend more credibility to the theory about the esoteric nature of Melville's understanding of reality, to acknowledge my awareness of the contribution to Melville studies of these scholars, and to prepare to set forth some new insights into his most important fiction, I employ the views of these critics and demonstrate that the weight of their opinion supports a theory to which most of them do not ascribe. The most original and noteworthy part of my study concerns the myth that informs Melville's major fiction at the level of the "experienced landscape." The symbolic implications of the monoplot of Typee, Mardi, Moby-Dick, "Bartleby," "Benito Cereno," The Confidence-Man, and "Billy Budd" and the image patterns of this body of fictipn are that, at the level of the "experienced landscape" in each story, the myth of the potential gnostic redeemer is the basic source of Melville's major works. Moreover, Melville's treatment of Tammo, Taji, Ishmael, Bartleby, Delano, the Confidence-Man, and Billy Budd suggests that all of theseprotagonists represent the potential gnostic savior and that all of their quest objects depict the gnostic concept of the fallen world-Soul. (the fallen Thought) of the Unknown God. With these views, this study builds onto the existing theories about gnosticism in regard to Melville's spiritual idiom and art. To be more precise, this discussion shows that the mythos of the potential gnostic savior, dating from ancient times, is a body of religious but imaginative fiction to which Melville's major works are more indebted than anyone has realized. Melville's mythical, symbolic, allegorical, polemical, and cryptic works serve as a vehicle for the expression of gnostic ideas especially about salvation.Englis

Care reality of menopausal women in Germany: healthcare research using quantitative (SHI claims data) and qualitative (survey) data collection.

PURPOSE The transition from the fertile phase of life to menopause is associated with numerous physical changes. Hormone replacement therapy (HRT), as the most effective and efficient form of drug treatment, involves the use of oestrogens and progestins with the aim of increasing health-related quality of life through symptom reduction, sleep improvement and affect enhancement. METHODS The medical care situation and disease burden of menopausal women was investigated by means of a survey of 1000 women aged 45-60 years on the topics of quality of life, menopause and HRT and a quantitative, longitudinal healthcare study based on an anonymised and age- and sex-adjusted Statutory Health Insurance (SHI) routine data set with approximately four million anonymous insured persons per year. RESULTS Out of more than half a million women aged 35-70 years, and with statutory health insurance, (n = 613,104), 14% (n = 82,785) had climacteric disorder documented as a first diagnosis in 2014. The proportion of women with the climacteric disorder, who were prescribed HRT on an outpatient basis, was 21%; according to the forsa survey, 50% of the women surveyed felt moderate to poorly/very poorly informed about treatment options. CONCLUSION Findings from the health insurance research conducted with different data sources (survey and SHI claims data) indicate the need for increasing awareness and providing an early and informative education on HRT and its risks and benefits

Spinal cord stimulation:a real-world data analysis on outcomes and differences between rechargeable and non-rechargeable implantable pulse generators

Objective In this analysis, we examined differences between rechargeable and non-rechargeable spinal cord stimulation (SCS) devices in patients with pain. Methods We conducted a retrospective, longitudinal claims data analysis using a German research database comprising 5 million statutory insured patients (2012–2017). Outcomes of demographics, patient pathways, and health care resource utilization (HCRU) in patients with initial SCS were collected. Results Of 150 patients in the database, 73 (49%) received a rechargeable device and 77 (51%) a non-rechargeable device. The average age was 62.5 years (51% female and 49% male patients). A significant decrease over a 3-year follow-up was observed in analgesic prescriptions (−18%), number of patient visits to a physician, and number of patients who were hospitalized. HCRU-related figures for patients with non-rechargeable neurostimulators increased in the last follow-up year whereas the group receiving rechargeable neurostimulators showed a steady decrease. Conclusions SCS seems to be an effective way for patients with chronic pain to decrease pain and improve quality of life. Rechargeable devices seem to be superior to non-rechargeable devices owing to greater longevity and were found to be associated with continuous reduction of pain diagnoses, hospitalization, physician visits, and use of pain medication in our study

Disease burden and direct medical costs of incident adult ADHD:A retrospective longitudinal analysis based on German statutory health insurance claims data

Background. Adult attention-deficit/hyperactivity disorder (aADHD) is still a largely unrecognized psychiatric condition despite its strong impact on individuals' well-being. Here, we describe the healthcare situation of individuals with incident aADHD over 4 years before and 4 years after initial administrative diagnosis. Methods. A retrospective, longitudinal cohort analysis was conducted using German claims data. The InGef database contained approximately 5 million member-records from over 60 nationwide statutory health insurances (SHI). Individuals were indexed upon initial diagnosis of aADHD. Results. Average age at diagnosis of aADHD was 35 years, and 60% of individuals were male. Comorbidities, resource use, and healthcare costs were substantial before initial diagnosis and decreased within the 4 years thereafter. Only 32% of individuals received initial ADHD medication and adherence was low. The majority received psychotherapy. Individuals with initial ADHD medication showed the highest share in comorbidities, physician visits, medication use for comorbidities, psychotherapy, and costs. Overall, healthcare costs were at over euro4,000 per individual within the year of aADHD diagnosis. Conclusions. We conclude that earlier recognition of aADHD could prevent the development and aggravation of comorbid mental illnesses. At the same time, comorbid conditions may have masked ("over-shadowed") aADHD and delayed diagnosis. The burden of disease in aADHD is high, which was noticeable especially among individuals who received initial ADHD-medication, suggesting that psychopharmacological treatment was mainly considered for the most severely ill. We conclude that measures to facilitate access of aADHD patients to clinical experts are required to improve reality of care in the outpatient setting

Prevalence of Children with Severe Fetal Alcohol Spectrum Disorders in Communities Near Rome, Italy: New Estimated Rates Are Higher than Previous Estimates

Objective: To determine the population-based epidemiology of fetal alcohol syndrome (FAS) and other fetal alcohol spectrum disorders (FASD) in towns representative of the general population of central Italy. Methods: Slightly revised U.S. Institute of Medicine diagnostic methods were used among children in randomly-selected schools near Rome. Consented first grade children (n = 976) were screened in Tier I for height, weight, or head circumference and all childre

Real-world data and treatment patterns of patients with lower urinary tract symptoms due to benign prostatic hyperplasia in Germany:an observational study using health insurance claims data

Purpose Benign prostatic hyperplasia (BPH) is associated with lower urinary tract symptoms (LUTS), representing one of the most common urological conditions. However, insights into the actual healthcare of this patient cohort in Germany are scarce. We aimed to retrospectively analyse management patterns of patients with LUTS in Germany using health insurance claims databases. Methods A retrospective, longitudinal cohort analysis was conducted obtaining claims data from the German InGef health insurance database containing approximately five million member-records from over 60 nationwide statutory health insurances. First, a cross-sectional prevalence analysis was performed on all individuals with a diagnosis on LUTS (ICD-10 GM N40) in 2018. Second, a longitudinal analysis of individuals with either a newly started BPH medication or initial BPH surgery who were indexed in 2014 and followed-up for 4 years. Results In 2018, 132,386 (6.7%) prevalent BPH patients were identified from 1,979,916 continuously insured males. A potential overcoding bias could not be assessed which may influence the outpatient sector estimation. 10,361 (0.7%) patients were identified with incident BPH medication and 1768 (0.1%) patients with incident BPH surgery out of 1,575,604 males (2013-2018). Alpha-blockers were the drug of choice (95.6%) in the first year. Half of patients received specific BPH medications four years after index, while almost 98% of initial BPH surgeries were performed within the inpatient setting. TURP was the most frequent surgical intervention (76%). Conclusions A widespread diffusion of alternative individualized minimally invasive approaches in the outpatient sector might address pharmacotherapy discontinuation and patient-access barriers to other treatments