Addressing the Health Needs of an Aging America: New Opportunities for Evidence-Based Policy Solutions

This report systematically maps research findings to policy proposals intended to improve the health of the elderly. The study identified promising evidence-based policies, like those supporting prevention and care coordination, as well as areas where the research evidence is strong but policy activity is low, such as patient self-management and palliative care. Future work of the Stern Center will focus on these topics as well as long-term care financing, the health care workforce, and the role of family caregivers

Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis

Objectives To determine the effect of integrating informal caregivers into discharge planning on postdischarge cost and resource use in older adults. Design A systematic review and metaanalysis of randomized controlled trials that examine the effect of discharge planning with caregiver integration begun before discharge on healthcare cost and resource use outcomes. MEDLINE, EMBASE, and the Cochrane Library databases were searched for all English‐language articles published between 1990 and April 2016. Setting Hospital or skilled nursing facility. Participants Older adults with informal caregivers discharged to a community setting. Measurements Readmission rates, length of and time to post‐discharge rehospitalizations, costs of postdischarge care. Results Of 10,715 abstracts identified, 15 studies met the inclusion criteria. Eleven studies provided sufficient detail to calculate readmission rates for treatment and control participants. Discharge planning interventions with caregiver integration were associated with a 25% fewer readmissions at 90 days (relative risk (RR) = 0.75, 95% confidence interval (CI) = 0.62–0.91) and 24% fewer readmissions at 180 days (RR = 0.76, 95% CI = 0.64–0.90). The majority of studies reported statistically significant shorter time to readmission, shorter rehospitalization, and lower costs of postdischarge care among discharge planning interventions with caregiver integration. Conclusion For older adults discharged to a community setting, the integration of caregivers into the discharge planning process reduces the risk of hospital readmission

Obstetrician-assessed maternal health at pregnancy predicts offspring future health

Background: We aimed to examine the association between obstetrician assessment of maternal physical health at the time of pregnancy and offspring cardiovascular disease risk.<p></p> Methods and Principal Findings: We examined this association in a birth cohort of 11,106 individuals, with 245,000 person years of follow-up. We were concerned that any associations might be explained by residual confounding, particularly by family socioeconomic position. In order to explore this we used multivariable regression models in which we adjusted for a range of indicators of socioeconomic position and we explored the specificity of the association. Specificity of association was explored by examining associations with other health related outcomes. Maternal physical health was associated with cardiovascular disease: adjusted (socioeconomic position, complications of pregnancy, birthweight and childhood growth at mean age 5) hazard ratio comparing those described as having poor or very poor health at the time of pregnancy to those with good or very good health was 1.55 (95%CI: 1.05, 2.28) for coronary heart disease, 1.91 (95%CI: 0.99, 3.67) for stroke and 1.57 (95%CI: 1.13, 2.18) for either coronary heart disease or stroke. However, this association was not specific. There were strong associations for other outcomes that are known to be related to socioeconomic position (3.61 (95%CI: 1.04, 12.55) for lung cancer and 1.28 (95%CI:1.03, 1.58) for unintentional injury), but not for breast cancer (1.10 (95%CI:0.48, 2.53)).<p></p> Conclusions and Significance: These findings demonstrate that a simple assessment of physical health (based on the appearance of eyes, skin, hair and teeth) of mothers at the time of pregnancy is a strong indicator of the future health risk of their offspring for common conditions that are associated with poor socioeconomic position and unhealthy behaviours. They do not support a specific biological link between maternal health across her life course and future risk of cardiovascular disease in her offspring.<p></p&gt

Development and feasibility study of very brief interventions for physical activity in primary care

Abstract Background There is increasing interest in brief and very brief behaviour change interventions for physical activity as they are potentially scalable to the population level. However, few very brief interventions (VBIs) have been published, and evidence is lacking about their feasibility, acceptability and which ‘active ingredients’ (behaviour change techniques) would maximise their effectiveness. The aim of this research was to identify and develop promising VBIs for physical activity and test their feasibility and acceptability in the context of preventive health checks in primary care. Methods The process included two stages, guided by four criteria: effectiveness, feasibility, acceptability, and cost. In Stage 1, we used an iterative approach informed by systematic reviews, a scoping review of BCTs, team discussion, stakeholder consultation, a qualitative study, and cost estimation to guide the development of promising VBIs. In Stage 2, a feasibility study assessed the feasibility and acceptability of the short-listed VBIs, using tape-recordings and interviews with practitioners (n = 4) and patients (n = 68), to decide which VBIs merited further evaluation in a pilot trial. Results Four VBIs were short-listed: Motivational intervention; Action Planning intervention; Pedometer intervention; and Physical Activity Diary intervention. All were deliverable in around five minutes and were feasible and acceptable to participants and practitioners. Based on the results of interviews with practitioners and patients, techniques from the VBIs were combined into three new VBIs for further evaluation in a pilot trial. Conclusions Using a two-stage approach, in which we considered the practicability of VBIs (acceptability, feasibility and cost) alongside potential efficacy from the outset, we developed a short-list of four promising VBIs for physical activity and demonstrated that they were acceptable and feasible as part of a preventive health check in primary care. Trial registration Current Controlled Trials ISRCTN02863077 . Registered 5 October 2012

MOToring along: The lives of cars seen through licensing and test data

For the past few years, the authors of this report have applied their expertise in transport studies, mathematical modelling, emissions analytics, statistics and geography to undertake innovative analysis of a dataset consisting of all registered light-duty vehicles in Great Britain and their annual mileages.Box 1 explains how this dataset has been created from two different sources to provide a unique information resource. It comprises a database of over 30 million vehicles in any given year. Statistical analysis of this database at the vehicle level allows for exploration of relationships between a large number of vehicle characteristics such as age, body type, changes in keepership, registered location and levels of vehicle usage – all of which was previously impossible. The dynamics of the car fleet can also be examined longitudinally,and monitored on an ongoing basis as the data comes on stream each year.In this report, we focus on analysis at the area level for one year: 2011. The data allows vehicles and their annual mileages to be attributed to the location of the registered keeper. When linked with other data about each local area such as the economic and demographic profiles, the availability of publictransport, collision rates and even the weather, it is possible to generate original insights about the distribution of cars, motorcycles, vans and other light duty vehicles, and about how the fleet and its usage varies across the country.In these uncertain times of changing vehicle purchasing patterns, possible shifts in attitudes to travel and in actual travel behaviour amongst younger generations, and the rapid growth in van traffic, this work has the potential to contribute to many policy and business objectives.In this report, we offer a selection of some of the topic areas we have investigated in our research to date. Whilst there is significant technical detail behind the generation of the MOT dataset and many of the additional variables that we have linked with it from sources such as the Census, we concentrate here on some key findings and why we believe these are novel and important. Technical details are saved for the final section of this report and in the further publications from the research team, which are detailed in the references section

Perception of carbohydrate availability augments high-intensity intermittent exercise capacity under sleep-low train low conditions

The authors tested the hypothesis that perception of carbohydrate (CHO) availability augments exercise capacity in conditions of reduced CHO availability. Nine males completed a sleep-low train model comprising evening glycogen-depleting cycling followed by an exhaustive cycling protocol the next morning in the fasted state (30 min steady state at 95% lactate threshold followed by 1-min intervals at 80% peak power output until exhaustion). After the evening depletion protocol and prior to sleeping, subjects consumed (a) a known CHO intake of 6 g/kg body mass (TRAIN HIGH) or (b) a perceived comparable CHO intake but 0 g/kg body mass (PERCEPTION) or a known train-low condition of 0 g/kg body mass (TRAIN LOW). The TRAIN HIGH and PERCEPTION trials were conducted double blind. During steady state, average blood glucose and CHO oxidation were significantly higher in TRAIN HIGH (4.01 ± 0.56 mmol/L; 2.17 ± 0.70 g/min) versus both PERCEPTION (3.30 ± 0.57 mmol/L; 1.69 ± 0.64 g/min, p < .05) and TRAIN LOW (3.41 ± 0.74 mmol/L; 1.61 ± 0.59 g/min, p < .05). Exercise capacity was significantly different between all pairwise comparisons (p < .05), where TRAIN LOW (8 ± 8 min) < PERCEPTION (12 ± 6 min) < TRAIN HIGH (22 ± 9 min). Data demonstrate that perception of CHO availability augments high-intensity intermittent exercise capacity under sleep-low, train-low conditions, though this perception does not restore exercise capacity to that of CHO consumption. Such data have methodological implications for future research designs and may also have practical applications for athletes who deliberately practice elements of training in CHO-restricted states

Erratum to: Development and feasibility study of very brief interventions for physical activity in primary care.

Upon publication of this article [1] it has been noted that due to a technical error the publisher missed to include the Open Access Licence statement in the copyright line. The correct copyright line should have read: © 2015 Pears et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​4.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://​creativecommons.​org/​publicdomain/​zero/​1.​0/​) applies to the data made available in this article, unless otherwise stated

Development and feasibility study of very brief interventions for physical activity in primary care

Abstract Background There is increasing interest in brief and very brief behaviour change interventions for physical activity as they are potentially scalable to the population level. However, few very brief interventions (VBIs) have been published, and evidence is lacking about their feasibility, acceptability and which ‘active ingredients’ (behaviour change techniques) would maximise their effectiveness. The aim of this research was to identify and develop promising VBIs for physical activity and test their feasibility and acceptability in the context of preventive health checks in primary care. Methods The process included two stages, guided by four criteria: effectiveness, feasibility, acceptability, and cost. In Stage 1, we used an iterative approach informed by systematic reviews, a scoping review of BCTs, team discussion, stakeholder consultation, a qualitative study, and cost estimation to guide the development of promising VBIs. In Stage 2, a feasibility study assessed the feasibility and acceptability of the short-listed VBIs, using tape-recordings and interviews with practitioners (n = 4) and patients (n = 68), to decide which VBIs merited further evaluation in a pilot trial. Results Four VBIs were short-listed: Motivational intervention; Action Planning intervention; Pedometer intervention; and Physical Activity Diary intervention. All were deliverable in around five minutes and were feasible and acceptable to participants and practitioners. Based on the results of interviews with practitioners and patients, techniques from the VBIs were combined into three new VBIs for further evaluation in a pilot trial. Conclusions Using a two-stage approach, in which we considered the practicability of VBIs (acceptability, feasibility and cost) alongside potential efficacy from the outset, we developed a short-list of four promising VBIs for physical activity and demonstrated that they were acceptable and feasible as part of a preventive health check in primary care. Trial registration Current Controlled Trials ISRCTN02863077 . Registered 5 October 2012