A structured registration program can be validly used for quality assessment in general practice

ABSTRACT: BACKGROUND: Patient information, medical history, clinical outcomes and demographic information, can be registered in different ways in registration programs. For evaluation of diabetes care, data can easily be extracted from a structured registration program (SRP). The usability of data from this source depends on the agreement of this data with that of the usual data registration in the electronic medical record (EMR). Aim of the study was to determine the comparability of data from an EMR and from an SRP, to determine whether the use of SRP data for quality assessment is justified in general practice. METHODS: We obtained 196 records of diabetes mellitus patients in a sample of general practices in the Netherlands. We compared the agreement between the two programs in terms of laboratory and non-laboratory parameters. Agreement was determined by defining accordance between the programs in absent and present registrations, accordance between values of registrations, and whether the differences found in values were also a clinically relevant difference. RESULTS: No differences were found in the occurrence of registration (absent/present) in the SRP and EMR for all the laboratory parameters. Smoking behaviour, weight and eye examination were registered significantly more often in the SRP than in the EMR. In the EMR, blood pressure was registered significantly more often than in the SRP. Data registered in the EMR and in the SRP had a similar clinical meaning for all parameters (laboratory and non-laboratory). CONCLUSIONS: Laboratory parameters showed good agreement and non-laboratory acceptable agreement of the SRP with the EMR. Data from a structured registration program can be used validly for research purposes and quality assessment in general practice

Migrant children within Europe: a systematic review of children’s perspectives on their health experiences

Objectives: To review the extant literature in order to explore what is known about children’s own perspectives on the ir health experiences , focusing upon children and young people who have migrated into, and within, Europe. Study Design: A systematic review with narrative synthesis. Methods: A review of English language articles was performed in June 2016 using the following databases: Medline, CINAHL, Coc hrane and Web of Science. Included papers had to report data generated directly with children, up to 18 years of age, who had migrated across national borders into, or within, Europe during their own lifetimes. Extraction from articles was undertaken by a ll authors and quality assessment of included reviews was performed using the Mixed Methods Appraisal Tool ( MMAT ) . Results: The articles in the final dataset included research based on 4 broad areas: alcohol, smoking and substance use; diet, eating disorde rs and overweight; emotional, psychological and mental health issues and; children’s views and experiences of health and health services. The majority of studies were cross - sectional analytic or incidence or prevalence studies. Conclusion: There is a gene ral lack of clarity in the literature regarding the reporting of children’s own migration status. Children’s voices are often subsumed within those of their adult parents or carers. There is a need to promote more child - focussed research which gives voice to migrant children to better understand the complex and multidimensional factors that contribute to their (ill) health

Structured primary care for type 2 diabetes has positive effects on clinical outcomes

Background Patients with type 2 diabetes have an increased risk of developing microvascular and macrovascular complications. In routine diabetes care an adequate reduction of risk factors for these complications is often not achieved

Vitamin D levels in children of asylum seekers in The Netherlands in relation to season and dietary intake

Low dietary intake and limited sun exposure during Dutch winters, in particular when combined with highly pigmented skin, could compromise the vitamin D status of asylum seekers' children in The Netherlands. We determined the vitamin D status of children living in The Netherlands, but originating from Africa, Central Asia, or Eastern Europe. In a subgroup, we reassessed the vitamin D status after the summer, during which the children had been assigned at random to remain unsupplemented or to receive vitamin D supplementation. In total 112 children (median age 7.1 yr, range 2-12 yr) were assessed for serum concentrations of 25-Hydroxyvitamin D [25(OH)D], intact parathyroid hormone (I-PTH) and plasma alkaline phosphatase (ALP). Vitamin D deficiency (VDD) and hypovitaminosis D were defined as 25(OH)D below 30 or 50 nmol/L, respectively. Dietary intake of vitamin D and calcium was estimated using a 24 h recall interview. In mid-spring, 13% of the children had VDD, and 42% had hypovitaminos's D. I-PTH and ALP levels were significantly higher in children with VDD. The dietary intake of vitamin D was below 80% of the recommended daily allowances (RDA) in 94% of the children, but the dietary calcium intake was not significantly related to the s-25(OH)D levels found. After the summer, median s-25(OH)D increased with +35 nmol/L (+85%) and +19 nmol/L (+42%) in children with or without supplementation, respectively. The effect of supplementation was most prominent among Aftican children. VDD and hypovitaminosis D are highly prevalent in mid-spring among asylum seekers' children in The Netherlands. Although 25(OH)D levels increase in African children during Dutch summer months, this does not completely correct the compromised vitamin D status. Our data indicate that children from African origin would benefit from vitamin D supplementation

Is pricing a way to affect share of fruits and vegetables in a diet?

Sahlgrenska Akademin vid Göteborgs universitet Avdelningen för invärtesmedicin och klinisk nutrition Sammanfattning Titel: Är priset ett sätt att påverka mängd frukt och grönsaker i kosten? Författare: Maria Popov Handledare: Heléne Bertéus Forslund Examinator: Ingrid Larsson Linje: Dietistprogrammet, 180/240 hp Typ av arbete: Examensarbete, 15 hp Datum: 2013-05-23 Bakgrund: Intag av frukt och grönsaker (FG) är viktigt för hälsan, bland annat för förekomst av fetma, diabetes och hjärt-kärlsjukdomar. I höginkomstländer är en ökning av FG-intaget önskvärd, då endast en liten del av befolkningen äter rekommenderade mängder, samtidigt som nämnda sjukdomar står för flest fall av ohälsa och död. Förutom generella informationskampanjer eller kostråd till individer finns ekonomiska metoder att påverka vad människor väljer att köpa. Syfte: Att undersöka om olika prissättning har samband till FG-intag eller -inköp. Sökväg: Sökningen gjordes i databaser PubMed, Scopus och Summon med sökord "vegetable consumption", "price/pricing policy" och "food choice" i olika kombinationer. Urvalskriterier: Studierna skulle vara gjorda under tiden efter 2000-talet på minst 18 år gamla personer i Nordamerika, Australien eller Europa, och undersöka prisändringar och FG-inköp. Vissa interventionsplatser och undersökta parametrar exkluderades. Datainsamling och analys: Elva artiklar valdes ut, varav fyra uppfyllde alla kriterier. De fyra granskades enligt SBU:s granskningsmallar och evidensstyrkan bedömdes enligt GU:s formulär. Resultat: En tvärsnittsstudie visade att högre FG-priser var associerade med lägre FG-intag, men förklarade inte ett möjligt orsakssamband. De tre resterande studierna var väldesignade RCT med verklighetstrogna köpsituationer och blandade grupper, men grupperna var små. Interventionen var olika stora rabatter på FG och resultaten i alla studier visade med signifikans att interventionsgrupperna köpte mer än kontroller. Underlaget bedömdes ha måttlig evidensstyrka. Slutsats: Resultaten är samstämmiga och signifikanta: prissänkning leder till större inköp av FG. Men det krävs fler studier på större grupper. Det finns dessutom andra faktorer som komplicerar bilden, till exempel köpt total kalorimängd och socioekonomisk tillhörighet.Sahlgrenska Academy at University of Gothenburg Department of Internal Medicine and Clinical Nutrition Abstract Title: Is pricing a way to affect share of fruits and vegetables in a diet? Author: Maria Popov Supervisor: Heléne Bertéus Forslund Examiner: Ingrid Larsson Programme: Dietician study programme, 180/240 ECTS Type of paper: Examination paper, 15 hp Date: May 23, 2013 Background: Fruits and vegetables (FV) are important for health, including occurrence of diabetes, obesity and cardiovascular diseases. Said diseases cause most cases of illness and death in high-income countries. Only a small part of the population achieves the FV-intake goal, so a higher FV-intake is desirable. Besides general information campaigns there is another method of influencing what people might buy. Objective: To examine whether different pricing is connected to FV-intake or –purchase. Search strategy: Databases PubMed, Scopus and Summon were searched with “vegetable consumption", "price/pricing policy" and "food choice” in different combinations. Selection criteria: Studies performed after year 2000 on at least 18 years old persons from North America, Europe or Australia, examining changes in FV-price and -purchase. Some additional parameters were excluded. Data collection and analysis: Eleven articles were selected, whereof four met all the criteria. They were reviewed and the evidence was compiled according to the certain templates. Main results: One cross-sectional study showed an association between higher FV-prices and lower FV-intake, but it didn’t explain any causation. Three RCTs with good design had small assorted groups who participated in realistic shopping situations. The intervention was different price discounts on FV. The studies showed consistent significant results of lower prices leading to higher FV-purchase. Evidence strength was deemed to be moderate. Conclusions: The lowering of prices on FV might increase FV-purchase. Yet the evidence is not strong enough and more research with a larger number of participants is needed. There are further additional factors which may complicate the picture, such as total amount of purchased calories or socioeconomic belonging

Adolescents' Use of Care for Behavioral and Emotional Problems : Types, Trends, and Determinants

Objective: While adolescents use various types of care for behavioral and emotional problems, evidence on age trends and determinants per type is scarce. We aimed to assess use of care by adolescents because of behavioral and emotional problems, overall and by type, and its determinants, for ages 10-19 years. Methods: We obtained longitudinal data on 2,230 adolescents during ages 10-19 from four measurements regarding use of general care and specialized care (youth social care and mental healthcare) in the preceding 6 months, the Child Behavior Checklist (CBCL) and Youth Self-Report, and child and family characteristics. We analyzed data by multilevel logistic regression. Results: Overall rates of use increased from 20.1% at age 10/11 to 32.2% at age 19: general care was used most. At age 10/11 use was higher among boys, at age 19 among girls. Use of general care increased for both genders, whereas use of specialized care increased among girls but decreased among boys. This differential change was associated with CBCL externalizing and internalizing problems, school problems, family socioeconomic status, and parental divorce. Preceding CBCL problems predicted more use: most for mental health care and least for general care. Moreover, general care was used more frequently by low and medium socioeconomic status families, with odds ratios (95%-confidence intervals): 1.52 (1.23; 1.88) and 1.40 (1.17; 1.67); youth social care in case of parental divorce, 2.07 (1.36; 3.17); and of special education, 2.66 (1.78; 3.95); and mental healthcare in case of special education, 2.66 (1.60; 4.51). Discussion: Adolescents with behavioral and emotional problems use general care most frequently. Overall use increases with age. Determinants of use vary per type

Use of various types of care because of behavioral and emotional problems in the past six months, by gender and measurement wave (mean age per wave in years): numbers and percentages of users, p-values for gender differences, and p-values for trend across waves.

<p>P-values for gender differences based on chi-square tests: *p<0.05; **p<.01; ***p<0.001.</p>#<p>P-values for linear trend across waves based on chi-square tests.</p>$<p>The summation of numbers per type exceed the numbers mentioned for ‘Any care’ because some adolescents used more than one type of care. The same holds for ‘Any specialized care’: some adolescents used both youth social care, and mental healthcare.</p

Determinants of use of care, adjusted for gender and wave, and additionally for all shown factors: odds ratios (OR), and 95% confidence intervals (CI) from multilevel logistic regression.

<p>Bold = p<. 05.</p>#<p>measurement of need at preceding wave was used as predictor for use in next wave, e.g. CBCL at T1 was used as predictor of use at T2, etc.</p

Structured diabetes care leads to differences in organization of care in general practices: the healthcare professional and patient perspective

ABSTRACT: BACKGROUND: Care for patients with chronic diseases is challenging and requires multifaceted interventions to appropriately coordinate the entire treatment process. The effect of such interventions on clinical outcomes has been assessed, but evidence of the effect on organization of care is scarce.The aim is to assess the effect of structured diabetes care on organization of care from the perspective of patients and healthcare professionals in routine practice, and to ascertain whether this effect persists METHODS: In a quasi-experimental study the effect of structured care (SC) was compared with care-as-usual (CAU). Questionnaires were sent to healthcare professionals (SC n = 31; CAU n = 11) and to patients (SC n = 301; CAU n = 102). A follow-up questionnaire was sent after formal support of the intervention ended (2007). RESULTS: SC does have an effect on the organization of care. More cooperation between healthcare professionals, less referrals to secondary care and more education were reported in the SC group as compared to the CAU group. These changes were found both at the healthcare professional and at the patient level. Organizational changes remained after formal support for the intervention support had ended. CONCLUSION: According to patients and healthcare professionals, structured care does have a positive effect on the organization of care. The use of these two sources of information is important, not only to assess the value of changes in care for the patient and the healthcare provider but also to ascertain the validity of the results found