Enhancing Primary Adherence to Prescribed Medications through an Organized Health Status Assessment-Based Extension of Primary Healthcare Services

This study was part of monitoring an intervention aimed at developing a general practitioner cluster (GPC) model of primary healthcare (PHC) and testing its eectiveness in delivering preventive services integrated into the PHC system. The aim was to demonstrate whether GPC operation could increase the percentage of drugs actually dispensed. Using national reference data of the National Health Insurance Fund for each anatomical–therapeutic chemical classification ATC group of drugs, dispensed-to-prescribed ratios standardized (sDPR) for age, sex, and exemption certificate were calculated during the first quarter of 2012 (before-intervention) and the third quarter of 2015 (post-intervention). The after-to-before ratios of the sDPR as the relative dispensing ratio (RDR) were calculated to describe the impact of the intervention program. The general medication adherence increased significantly in the intervention area (RDR = 1.064; 95% confidence interval (CI): 1.054–1.073). The most significant changes were observed for cardiovascular system drugs (RDR = 1.062; 95% CI: 1.048–1.077) and for alimentary tract and metabolism-specific drugs (RDR = 1.072; 95% CI: 1.049–1.097). The integration of preventive services into a PHC without any specific medication adherence-increasing activities is beneficial for medication adherence, especially among patients with cardiovascular, alimentary tract, and metabolic disorders. Monitoring the percentage of drugs actually dispensed is a useful element of PHC-oriented intervention evaluation frames.L

(Re)creations : telling about Iron Age Dan and the Hula Valley

This dissertation suggests alternative ways of thinking about the scales of interpretation in Syro-Palestinian archaeology. It does this by outlining a number of ideas prevalent in what has been called post-processual or interpretive archaeology and looking at ways they could be employed in the Iron Age Hula Valley region. Chief among these are considerations of landscape, ethnography, phenomenology, post-colonialism and narrative. The central site examined is that of Tel Dan and, importantly, an overview of the valley itself and its outstanding features - the lake and swamp - are also considered. The purpose of this thesis is to show that it is possible to write small-scale, even personal narratives, about the way people may have lived at a particular place and time without recourse to the biblical texts. I suggest that the use of such narratives can be used to produce alternative accounts of the past and thus subvert the grand-narratives of the region. The method outlined is as opposed to the large-scale Annalistic approaches which currently predominate. To this end a number of sample story-narratives are included which hope to show that this form of writing can be utilised to revivify the personal archaeologies of everyday life

Dietary Profile and Nutritional Status of the Roma Population Living in Segregated Colonies in Northeast Hungary

Nutrition studies among Roma are scarce and to date no quantified dietary data are available. This report provides, for the first time, quantified dietary data and comprehensive anthropometric information for the Hungarian Roma (HR) population, with Hungarian general (HG) adults as reference. Data were obtained from a complex comparative health survey, involving 387 and 410 subjects of HR and HG populations, respectively. Using corporal measurements, body composition indicators were constructed, while daily nutrient intakes were evaluated in comparison with internationally accepted guidelines on nutrient requirements and recommended intakes. Associations between Roma ethnicity and nutrient intakes, as well as odds of achieving dietary recommendations were explored using regression models, adjusted for relevant covariates (i.e., age, gender, education, marital status and perceived financial status). Results showed occasional differences for selected nutrient intakes between the groups, with HR’s intake being less favorable. Total fat intake, predominantly animal-sourced, exceeded recommendations among HR (36.1 g, 95% confidence interval (CI): 35.2–37.0) and was not dissimilar to HG group (37.1 g, 95% CI: 36.3–38.0). Sodium intake among HR was significantly lower (5094.4 mg, 95% CI: 4866.0–5322.8) compared to HG (5644.0 mg, 95% CI: 5351.9–5936.0), but significantly greater than recommended intake in both groups. HR had greater estimated body fatness (25.6–35.1%) and higher average body mass index (BMI, 27.7 kg/m2, 95% CI: 26.9–28.4), compared to HG. In addition, HR had lower odds of achieving dietary recommendations (odds ratio (OR) = 0.81, 95% CI: 0.67–0.97, p < 0.05). Findings warrant further research, while highlighting the importance of establishing and integrating Roma nutrition into national surveillance and monitoring systems for key dietary risk factors.L

Blood-Based Protein Biomarkers for the Management of Traumatic Brain Injuries in Adults Presenting to Emergency Departments with Mild Brain Injury: A Living Systematic Review and Meta-Analysis

Accurate diagnosis of traumatic brain injury (TBI) is critical to effective management and intervention, but can be challengingin patients with mild TBI. A substantial number of studies have reported the use of circulating biomarkers as signaturesfor TBI, capable of improving diagnostic accuracy and clinical decision making beyond current practice standards.We performed a systematic review and meta-analysis to comprehensively and critically evaluate the existing body ofevidence for the use of blood protein biomarkers (S100 calcium binding protein B [S100B], glial fibrillary acidic protein[GFAP], neuron specific enolase [NSE], ubiquitin C-terminal hydrolase-L1 [UCH-L1]. tau, and neurofilament proteins)for diagnosis of intracranial lesions on CT following mild TBI. Effects of potential confounding factors and differentialdiagnostic performance of the included markers were explored. Further, appropriateness of study design, analysis, quality,and demonstration of clinical utility were assessed. Studies published up to October 2016 were identified through aMEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) search. Followingscreening of the identified articles, 26 were selected as relevant. We found that measurement of S100B can help informeddecision making in the emergency department, possibly reducing resource use; however, there is insufficient evidence thatany of the other markers is ready for clinical application. Our work pointed out serious problems in the design, analysis,and reporting of many of the studies, and identified substantial heterogeneity and research gaps. These findings emphasizethe importance of methodologically rigorous studies focused on a biomarker’s intended use, and defining standardized,validated, and reproducible approaches. The living nature of this systematic review, which will summarize key updatedinformation as it becomes available, can inform and guide future implementation of biomarkers in the clinical arena

Socioeconomic status, health related behaviour, and self-rated health of children living in Roma settlements in Hungary

Objective: The poor health of Roma is well documented, but there is only limited data regarding the health of Roma children. The aim of this study was to describe the socioeconomic status, health related behaviour, and health of children living in segregated Roma settlements, and to compare the data with that of non-Roma children. Methods: In March-April of 2011, a cross-sectional questionnaire-based survey among 11-year-old (211 boys and 252 girls) and 13-year-old (205 boys and 247 girls) children living in Roma settlements was performed (response rate: 91.5%). These data were compared with data from the Health Behaviour in School-Aged Children (HBSC) survey carried out in 2009/2010. Results: The parents of Roma children were substantially less educated and less likely to be actively employed, and Roma children reported lower material welfare than non-Roma ones. The prevalence of consuming sweets and soft drinks at least 5 times per week was 1.5-2 times higher among Roma children. The prevalence of regular intense physical activity was higher at the age of 13 years among Roma boys, while physical inactivity was substantially higher in both age groups among Roma girls. Almost one quarter of Roma children and approximately 14% of non-Roma children had tried smoking at the age of 11. More Roma boys tried alcohol at the age of 11 than non-Roma ones. One in ten Roma children was obese in both age groups. The self-rated health status of Roma children was worse than that of non-Roma children. Conclusions: Children living in Roma settlements reported poorer socioeconomic conditions, higher consumption of sweets and soft drinks, earlier smoking and alcohol initiation, and worse self-rated health, but with some exceptions do not differ in fruit or vegetable consumption and BMI from general child population. To promote health of children living in Roma settlements, a multi-sector approach, special health education, plus social and health promotion programmes are needed