International Journal of Environmental Research and Public Health

Research

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13 pages, 1997 KiB

Open AccessArticle

High Unawareness of Chronic Kidney Disease in Germany

by Susanne Stolpe, Bernd Kowall, Christian Scholz, Andreas Stang and Cornelia Blume

Int. J. Environ. Res. Public Health 2021, 18(22), 11752; https://doi.org/10.3390/ijerph182211752 - 9 Nov 2021

Cited by 8 | Viewed by 3016

Abstract

Chronic kidney disease (CKD) is associated with an increased risk for cardiovascular events, hospitalizations, end stage renal disease and mortality. Main risk factors for CKD are diabetes, hypertension, and older age. Although CKD prevalence is about 10%, awareness for CKD is generally low [...] Read more.

Chronic kidney disease (CKD) is associated with an increased risk for cardiovascular events, hospitalizations, end stage renal disease and mortality. Main risk factors for CKD are diabetes, hypertension, and older age. Although CKD prevalence is about 10%, awareness for CKD is generally low in patients and physicians, hindering early diagnosis and treatment. We analyzed baseline data of 3305 participants with CKD Stages 1–4 from German cohorts and registries collected in 2010. Prevalence of CKD unawareness and prevalence ratios (PR) (each with 95%-confidence intervals) were estimated in categories of age, sex, CKD stages, BMI, hypertension, diabetes and other relevant comorbidities. We used a log-binomial regression model to estimate the PR for CKD unawareness for females compared to males adjusting for CKD stage and CKD risk factors. CKD unawareness was high, reaching 71% (68–73%) in CKD 3a, 49% (45–54%) in CKD 3b and still 30% (24–36%) in CKD4. Prevalence of hypertension, diabetes or cardiovascular comorbidities was not associated with lower CKD unawareness. Independent of CKD stage and other risk factors unawareness was higher in female patients (PR = 1.06 (1.01; 1.10)). Even in patients with CKD related comorbidities, CKD unawareness was high. Female sex was strongly associated with CKD unawareness. Guideline oriented treatment of patients at higher risk for CKD could increase CKD awareness. Patient–physician communication about CKD might be amendable. Full article

(This article belongs to the Special Issue Healthcare Services and Epidemiology for Chronic Disease Management and Prevention)

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10 pages, 506 KiB

Open AccessArticle

Evaluating Effectiveness of Outpatient Monitoring in Type 2 Diabetes: The One-Year Experience in an Italian Group of Primary Care

by Francesca Lazzarini, Luca Barbacane, Giuseppe Scoleri, Rosanna I. Comoretto, Gianni Cogno, Benedetta Disarò, Luigi Gomirato, Francesca Stocco, Alessandro Suppa, Gianluca Toninato, Clara Minto, Danila Azzolina, Sabino Iliceto and Dario Gregori

Int. J. Environ. Res. Public Health 2021, 18(21), 11540; https://doi.org/10.3390/ijerph182111540 - 3 Nov 2021

Viewed by 1878

Abstract

Nowadays, chronic disease management is the primary challenge of the healthcare system. From 2015, in the Veneto region (Italy), patients with a diagnosis of type 2 diabetes mellitus (T2DM) have been included in the diagnostic-therapeutic pathway (PDTA) program, and their clinical condition has [...] Read more.

Nowadays, chronic disease management is the primary challenge of the healthcare system. From 2015, in the Veneto region (Italy), patients with a diagnosis of type 2 diabetes mellitus (T2DM) have been included in the diagnostic-therapeutic pathway (PDTA) program, and their clinical condition has been continuously monitored. The aim of this retrospective study is to determine the effectiveness of PDTA intervention, alone or in combination with a specialized one, in subjects with diagnosis of T2DM. Clinical and behavioral characteristics were collected at baseline and after 1 year of follow-up. Two subgroups were considered: subjects enrolled in PDTA only and subjects enrolled in both the PDTA program and in the care plan proposed by the specialized medical center (CAD group). Longitudinal analysis showed a relevant positive effect of time on diastolic blood pressure, while CAD enrollment appears to be related to higher levels of glycated hemoglobin. When included together in the same model, interaction between time and CAD covariates results in completely nonsignificant effects. As long-term management of chronic disorders, such as T2DM, is often difficult due to disease characteristics and problems in healthcare organization, monitoring programs, such as PDTA, and specialized care programs, such as CAD, do not show a clinically relevant effect in the first year of follow-up. Therefore, they should be analyzed over a longer period. However, they should also carefully consider the need for adequate tools for data collection and sharing, in addition to the context of application, patient expectations and the need for a long-term educational program. Full article

(This article belongs to the Special Issue Healthcare Services and Epidemiology for Chronic Disease Management and Prevention)

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8 pages, 950 KiB

Open AccessArticle

Age and Sex Specific Trends in Incidence of Juvenile Idiopathic Arthritis in Danish Birth Cohorts from 1992 to 2002: A Nationwide Register Linkage Study

by Isabel Cardoso, Peder Frederiksen, Ina Olmer Specht, Mina Nicole Händel, Fanney Thorsteinsdottir, Berit Lilienthal Heitmann and Lars Erik Kristensen

Int. J. Environ. Res. Public Health 2021, 18(16), 8331; https://doi.org/10.3390/ijerph18168331 - 6 Aug 2021

Cited by 9 | Viewed by 2142

Abstract

This study reports age- and sex-specific incidence rates of juvenile idiopathic arthritis (JIA) in complete Danish birth cohorts from 1992 through 2002. Data were obtained from the Danish registries. All persons born in Denmark, from 1992–2002, were followed from birth and until either [...] Read more.

This study reports age- and sex-specific incidence rates of juvenile idiopathic arthritis (JIA) in complete Danish birth cohorts from 1992 through 2002. Data were obtained from the Danish registries. All persons born in Denmark, from 1992–2002, were followed from birth and until either the date of first diagnosis recording, death, emigration, 16th birthday or administrative censoring (17 May 2017), whichever came first. The number of incident JIA cases and its incidence rate (per 100,000 person-years) were calculated within sex and age group for each of the birth cohorts. A multiplicative Poisson regression model was used to analyze the variation in the incidence rates by age and year of birth for boys and girls separately. The overall incidence of JIA was 24.1 (23.6–24.5) per 100,000 person-years. The rate per 100,000 person-years was higher among girls (29.9 (29.2–30.7)) than among boys (18.5 (18.0–19.1)). There were no evident peaks for any age group at diagnosis for boys but for girls two small peaks appeared at ages 0–5 years and 12–15 years. This study showed that the incidence rates of JIA in Denmark were higher for girls than for boys and remained stable over the observed period for both sexes. Full article

(This article belongs to the Special Issue Healthcare Services and Epidemiology for Chronic Disease Management and Prevention)

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17 pages, 1575 KiB

Open AccessArticle

Risk Factors of Undiagnosed Diabetes Mellitus among Korean Adults: A National Cross-Sectional Study Using the KNHANES Data

by Sangwon Lee, Kwang Sun Ryu, Ha Ye Jin Kang, Na Young You, Kui Son Choi, Yul Hwangbo, Jae Wook Lee and Hyo Soung Cha

Int. J. Environ. Res. Public Health 2021, 18(3), 1195; https://doi.org/10.3390/ijerph18031195 - 29 Jan 2021

Cited by 3 | Viewed by 2698

Abstract

In this cross-sectional study, we investigated the baseline risk factors of diabetes mellitus (DM) in patients with undiagnosed DM (UDM). We utilized the Korean National Health and Nutrition Examination Survey (KNHANES) 2010–2017 data. Data regarding the participants’ demographic characteristics, health status, health determinants, [...] Read more.

In this cross-sectional study, we investigated the baseline risk factors of diabetes mellitus (DM) in patients with undiagnosed DM (UDM). We utilized the Korean National Health and Nutrition Examination Survey (KNHANES) 2010–2017 data. Data regarding the participants’ demographic characteristics, health status, health determinants, healthcare accessibility, and laboratory tests were gathered to explore the differences between the DM, UDM, and without-DM groups. Among the 64,759 individuals who participated in the KNHANES 2010–2017, 32,611 individuals aged ≥20 years with fasting plasma glucose levels of <100 or ≥126 mg/dL were selected. The odds ratios (ORs) regarding family history of diabetes and the performance of national health and cancer screening tests were lower in the UDM group than in the DM group (adjusted OR: 0.54; 95% confidence interval (CI): 0.43, 0.66; adjusted OR: 0.74; 95% CI: 0.62, 0.89; adjusted OR: 0.71; 95% CI: 0.60, 0.85). The ORs of hypertension and obesity were higher in the UDM group than in the DM group (adjusted OR: 1.32; 95% CI: 1.06, 1.64; adjusted OR: 1.80; 95% CI: 1.37, 2.36, respectively). Patients with UDM were more likely to be exposed to DM-related risk factors than those with and without DM. Public health interventions to prevent UDM development are necessary. Full article

(This article belongs to the Special Issue Healthcare Services and Epidemiology for Chronic Disease Management and Prevention)

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20 pages, 4169 KiB

Open AccessArticle

Prioritizing Community-Based Intervention Programs for Improving Treatment Compliance of Patients with Chronic Diseases: Applying an Analytic Hierarchy Process

by Do Hwa Byun, Rho Soon Chang, Myung-Bae Park, Hyo-Rim Son and Chun-Bae Kim

Int. J. Environ. Res. Public Health 2021, 18(2), 455; https://doi.org/10.3390/ijerph18020455 - 8 Jan 2021

Cited by 8 | Viewed by 3507

Abstract

The purpose of this study was to apply multicriteria decision making and an analytic hierarchy process (AHP) model for assessing sustainable management of hypertension and diabetes. Perception of two alternative health care priorities was also investigated. One priority was improving treatment compliance of [...] Read more.

The purpose of this study was to apply multicriteria decision making and an analytic hierarchy process (AHP) model for assessing sustainable management of hypertension and diabetes. Perception of two alternative health care priorities was also investigated. One priority was improving treatment compliance of patients with hypertension and diabetes. The other priority was strengthening the healthcare system for continuous care. Our study design to evaluate community-based intervention programs for hypertension and diabetes was developed using brainstorming, Delphi techniques, and content analysis along with literature review. We finally proposed a hierarchical structure of the AHP model with 50 third sub-criteria in six levels. By surveying this AHP questionnaire to a total of 185 community health practitioners in Korea, we found that improving treatment compliance of patients with chronic diseases should be relatively more important than strengthening the healthcare system. Further research is needed to expand survey subjects to primary care physicians and even policymakers of central government for the appropriate application of this AHP model. Full article

(This article belongs to the Special Issue Healthcare Services and Epidemiology for Chronic Disease Management and Prevention)

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9 pages, 514 KiB

Open AccessArticle

Vitamin D Knowledge, Attitudes, and Behaviors in Young Danish Women with a Non-Western Ethnic Minority Background—A Questionnaire Survey

by Erdinc Özel, Lourdes Cantarero-Arevalo and Ramune Jacobsen

Int. J. Environ. Res. Public Health 2020, 17(21), 8053; https://doi.org/10.3390/ijerph17218053 - 1 Nov 2020

Cited by 4 | Viewed by 2347

Abstract

The prevalence of vitamin D deficiency in women with a non-Western ethnic minority background in Nordic countries is high. The aim of this study was to assess vitamin D knowledge, attitudes, and behaviors in women with a non-Western ethic minority background living in [...] Read more.

The prevalence of vitamin D deficiency in women with a non-Western ethnic minority background in Nordic countries is high. The aim of this study was to assess vitamin D knowledge, attitudes, and behaviors in women with a non-Western ethic minority background living in Denmark. A validated vitamin D knowledge, attitudes, and behaviors’ questionnaire was translated into Danish, piloted, and distributed via relevant Facebook groups. The responses were analyzed using parametric and non-parametric tests for descriptive and bivariate analyses. In total, 254 women who considered themselves having a non-Western ethnic minority background responded to the questionnaire. The median age (IQR) was 25 (23–33) years old; 32% had a professional bachelor’s, 28% had high school, and 22% had a master’s or higher university education. Participants scored higher on vitamin D general knowledge (scores above 80 on the scale 0–100) compared to vitamin D nutrition knowledge or vitamin D attitudes and behaviors (scores around 60 on the scale 0–100). In conclusion, the vitamin D knowledge among study participants—i.e., young well-educated non-Western ethnic minority women in Denmark—was pretty good. The further examination of vitamin D knowledge, attitudes, and behaviors should explore specifics related to nationality and religion and focus on less-educated non-Western ethnic minority women in Denmark and other Nordic countries. Full article

(This article belongs to the Special Issue Healthcare Services and Epidemiology for Chronic Disease Management and Prevention)

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13 pages, 334 KiB

Open AccessArticle

Management of Primary Dysmenorrhea among University Students in the South of Spain and Family Influence

by María Laura Parra-Fernández, María Dolores Onieva-Zafra, Ana Abreu-Sánchez, Juan Diego Ramos-Pichardo, María Teresa Iglesias-López and Elia Fernández-Martínez

Int. J. Environ. Res. Public Health 2020, 17(15), 5570; https://doi.org/10.3390/ijerph17155570 - 1 Aug 2020

Cited by 36 | Viewed by 7471

Abstract

The present study analyses the management of primary dysmenorrhea by university students in the south of Spain. In this cross-sectional observational study, 224 women participated, using an ad hoc self-report questionnaire about menstrual pain and self-care and including sociodemographic and gynecological variables. Some [...] Read more.

The present study analyses the management of primary dysmenorrhea by university students in the south of Spain. In this cross-sectional observational study, 224 women participated, using an ad hoc self-report questionnaire about menstrual pain and self-care and including sociodemographic and gynecological variables. Some 76.8% of participants consumed analgesics and the majority self-medicated with non-steroidal anti-inflammatory drugs (NSAIDs) without consulting a health professional, with a correlation between pain intensity and the number of pills ingested during menstruation (r = 0.151, p < 0.05). The higher proportion of women who found their analgesia effective were those who took medication after being prescribed by a health care provider (60.8%) compared to those who self-medicated (40%; p < 0.01). Only 43.8% employed non-pharmaceutical methods, most commonly antalgic positions, massages and local heat. These choices were not related to the intensity of menstrual pain nor with the severity of the dysmenorrhea, nor did these most common methods prove to be the most effective. However, a higher percentage of women using non-pharmacological methods was identified in women with family members suffering from dysmenorrhea (73.2%) compared to those without (60%; p = 0.040), which may indicate that the choice of remedies is more related to learning self-care in the family context. This study identifies the need for education on self-care and management of menstrual pain. Full article

(This article belongs to the Special Issue Healthcare Services and Epidemiology for Chronic Disease Management and Prevention)

11 pages, 326 KiB

Open AccessArticle

Relationship between Lipid Profiles and Glycemic Control Among Patients with Type 2 Diabetes in Qingdao, China

by Shukang Wang, Xiaokang Ji, Zhentang Zhang and Fuzhong Xue

Int. J. Environ. Res. Public Health 2020, 17(15), 5317; https://doi.org/10.3390/ijerph17155317 - 23 Jul 2020

Cited by 19 | Viewed by 3967

Abstract

Glycosylated hemoglobin (HbA1c) was the best indicator of glycemic control, which did not show the dynamic relationship between glycemic control and lipid profiles. In order to guide the health management of Type 2 diabetes (T2D), we assessed the levels of lipid profiles and [...] Read more.

Glycosylated hemoglobin (HbA1c) was the best indicator of glycemic control, which did not show the dynamic relationship between glycemic control and lipid profiles. In order to guide the health management of Type 2 diabetes (T2D), we assessed the levels of lipid profiles and fasting plasma glucose (FPG) and displayed the relationship between FPG control and lipid profiles. We conducted a cross-sectional study that included 5822 participants. Descriptive statistics were conducted according to gender and glycemic status respectively. Comparisons for the control of lipid profiles were conducted according to glycemic control. Four logistic regression models were generated to analyze the relationship between lipid profiles and glycemic control according to different confounding factors. The metabolic control percentage of FPG, triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) was 27.50%, 73.10%, 28.10%, 64.20% and 44.80% respectively. In the fourth model with the most confounding factors, the odds ratios (ORs) and 95% confidence intervals (CIs) of TG, TC, LDL-C and HDL-C were 0.989 (0.935, 1.046), 0.862 (0.823, 0.903), 0.987 (0.920, 1.060) and 2.173 (1.761, 2.683). TC and HDL-C were statistically significant, and TG and LDL-C were not statistically significant with adjustment for different confounding factors. In conclusion, FPG was significantly associated with HDL and TC and was not associated with LDL and TG. Our findings suggested that TC and HDL should be focused on in the process of T2D health management. Full article

(This article belongs to the Special Issue Healthcare Services and Epidemiology for Chronic Disease Management and Prevention)

14 pages, 585 KiB

Open AccessArticle

Colonoscopy Screening Behaviour and Associated Factors Amongst First-Degree Relatives of People with Colorectal Cancer in China: Testing the Health Belief Model Using a Cross-Sectional Design

by Yang Bai, Cho Lee Wong, Xiaolin Peng and Winnie K. W. So

Int. J. Environ. Res. Public Health 2020, 17(14), 4927; https://doi.org/10.3390/ijerph17144927 - 8 Jul 2020

Cited by 14 | Viewed by 4225

Abstract

Colonoscopy is the best screening choice for at-risk persons, because it offers prevention through the removal of preneoplastic lesions in addition to early detection. This study aims to report the participation rate of colonoscopy screening and examine its associated factors amongst Chinese first-degree [...] Read more.

Colonoscopy is the best screening choice for at-risk persons, because it offers prevention through the removal of preneoplastic lesions in addition to early detection. This study aims to report the participation rate of colonoscopy screening and examine its associated factors amongst Chinese first-degree relatives of people with colorectal cancer based on the health belief model (HBM). A cross-sectional study was conducted in Shenzhen, China from March to May 2019. Demographic characteristics, family history, variables derived from the HBM and colonoscopy screening behaviours were measured through online surveys as the independent variables of interest. A total of 186 online surveys were returned, with a final response rate of 57.0%. The participation rate of colonoscopy was 15.6%. Univariate analysis (independent t-test/chi-square test/Fisher test) was applied first to identify the candidate independent variables. Then, multivariate logistic regression was used to examine the association between independent variables and uptake of colonoscopy. Perceived barriers and cues to action were identified as factors associated with undergoing colonoscopy. The participation rate of colonoscopy in the study population was low. Health communication to promote colonoscopy screening for the Chinese at-risk population should include components in reducing barriers to colonoscopy tests, family history information and health professional recommendations on screening. Future studies with large sample size are suggested to examine perceived susceptibility, fatalism and other characteristics considering family history (treatment and outcome of patients) and their potential impacts on cancer screening behaviours for Chinese at-risk populations due to family history. Full article

(This article belongs to the Special Issue Healthcare Services and Epidemiology for Chronic Disease Management and Prevention)

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12 pages, 786 KiB

Open AccessArticle

The Cost of Inflammatory Bowel Disease Management Matches with Clinical Course: A Single Outpatient Centre Analysis

by Mariabeatrice Principi, Nunzia Labarile, Francesco Paolo Bianchi, Antonella Contaldo, Silvio Tafuri, Enzo Ierardi and Alfredo Di Leo

Int. J. Environ. Res. Public Health 2020, 17(12), 4549; https://doi.org/10.3390/ijerph17124549 - 24 Jun 2020

Cited by 9 | Viewed by 2681

Abstract

Inflammatory bowel diseases (IBD) have a large economic burden on health systems. Our single-centre observational retrospective study aimed to assess an economic evaluation in two IBD outpatient cohorts (biological and conventional therapy) in relation to disease activity within a three-year follow-up. Four hundred [...] Read more.

Inflammatory bowel diseases (IBD) have a large economic burden on health systems. Our single-centre observational retrospective study aimed to assess an economic evaluation in two IBD outpatient cohorts (biological and conventional therapy) in relation to disease activity within a three-year follow-up. Four hundred and seventeen consecutive IBD patients referred to our tertiary gastroenterology unit (Bari-Puglia-Southern Italy) on January 2014–December 2016 were included. For each group (conventional/biological), we assessed direct/indirect costs and clinical/endoscopic activity within the first year and along the three-year follow-up. Statistical analyses: Wilcoxon signed-rank test (continuous variables), chi-square and Fisher’s test (categorical variables), Spearman ranks (single outcome) and ANOVA (detection time, clinical/endoscopic scores) were used. Continuous variables were expressed as mean ± standard deviation and range and/or median, interquartile range and range; categorical variables were expressed as proportions with 95% confidence interval. Direct and indirect cost items of 2014 and 2014–2016 were higher in patients treated with biological than conventional therapy. Subjects on biological therapy were younger and showed clinical and endoscopic moderate-to-severe disease activity. After three years, they reached a significant improvement from baseline. Conversely, disease activity was mild when conventional treatment had a beneficial effect. In conclusion, overall IBD management cost matches with clinical course and needs long-term evaluation in critical patients. Full article

(This article belongs to the Special Issue Healthcare Services and Epidemiology for Chronic Disease Management and Prevention)

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15 pages, 387 KiB

Open AccessArticle

Chronic Diseases and Associated Factors among Older Adults in Loja, Ecuador

by Patricia Bonilla-Sierra, Ana-Magdalena Vargas-Martínez, Viviana Davalos-Batallas, Fatima Leon-Larios and Maria-de-las-Mercedes Lomas-Campos

Int. J. Environ. Res. Public Health 2020, 17(11), 4009; https://doi.org/10.3390/ijerph17114009 - 4 Jun 2020

Cited by 10 | Viewed by 3260

Abstract

(1) Background: This study aimed to explore the symptoms, functional status, and depression in patients with chronic diseases in Loja, Ecuador. (2) Methods: A cross-sectional study was carried out with patients over 60 years old having at least one chronic disease and cared [...] Read more.

(1) Background: This study aimed to explore the symptoms, functional status, and depression in patients with chronic diseases in Loja, Ecuador. (2) Methods: A cross-sectional study was carried out with patients over 60 years old having at least one chronic disease and cared for in healthcare centers of the Health Ministry of Ecuador or living in associated geriatric centers. (3) Results: The sample comprised 283 patients with a mean age of 76.56 (SD 7.76) years. The most prevalent chronic diseases were chronic obstructive pulmonary disease, followed by arterial hypertension and diabetes. Patients with a joint disease had the worst scores for the majority of the symptoms assessed with the Edmonton Scale. Cancer, dementia, and arterial hypertension contributed the most to the dependence levels assessed with the Barthel Index. Dementia contributed the most to the poor performance status evaluated with the Karnofsky Performance Status. Cancer and diabetes contributed the most to depression. Patients with a higher number of chronic diseases reported worse functional status. (4) Conclusions: Targeted interventions to address symptoms, functional status, and depression in patients with chronic diseases are needed. Full article

(This article belongs to the Special Issue Healthcare Services and Epidemiology for Chronic Disease Management and Prevention)

8 pages, 597 KiB

Open AccessArticle

Clinical Usefulness of the Inhibitory Control Test (ICT) in the Diagnosis of Minimal Hepatic Encephalopathy

by Agnieszka Stawicka, Jerzy Jaroszewicz, Justyna Zbrzeźniak, Natalia Sołowianowicz, Aleksandra Woszczenko, Magdalena Świderska and Robert Flisiak

Int. J. Environ. Res. Public Health 2020, 17(10), 3645; https://doi.org/10.3390/ijerph17103645 - 22 May 2020

Cited by 5 | Viewed by 2803

Abstract

Background: Minimal hepatic encephalopathy (MHE) refers to a number of neuropsychiatric and neurophysiological disorders in patients with cirrhosis who do not show abnormalities on physical examination or in clinical tests. The aim of this study was to determine the prevalence, risk factors, [...] Read more.

Background: Minimal hepatic encephalopathy (MHE) refers to a number of neuropsychiatric and neurophysiological disorders in patients with cirrhosis who do not show abnormalities on physical examination or in clinical tests. The aim of this study was to determine the prevalence, risk factors, and predictive value of minimal hepatic encephalopathy and the usefulness of the inhibitory control test (ICT) in the diagnosis. Methods: Seventy patients (mean age 53 years, range 24−77) with liver cirrhosis were enrolled in the study. MHE was diagnosed based on PHES (psychometric hepatic encephalopathy score) and ICT. PHES and ICT were validated in a group of 56 control subjects. Results: Minimal hepatic encephalopathy was diagnosed using PHES in 21 patients (30%). ICT diagnosed MHE in 30 patients (42%), and the test had a sensitivity of 65% and a specificity of 57% compared to PHES. The ICT score (lures/target accuracy rate) correlated with the age of subjects (R = 0.35, p = 0.002) and only slightly with education (education in years R = −0.22, p = 0.06). MHE diagnosed with PHES or ICT was associated with a significantly higher model of end-stage liver disease (MELD) score in the follow-up. MHE diagnosed with ICT was correlated with a significantly higher incidence of symptoms of decompensated cirrhosis (p = 0.02) in the follow-up. Conclusions: ICT had moderate sensitivity and specificity in diagnosing MHE compared to PHES. Importantly, MHE detected with PHES or ICT was associated with poorer survival and a more severe progression of the disease. Full article

(This article belongs to the Special Issue Healthcare Services and Epidemiology for Chronic Disease Management and Prevention)

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Review

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13 pages, 651 KiB

Open AccessReview

Assessing Health Consequences of Vitamin D Fortification Utilizing a Societal Experiment Design: Methodological Lessons Learned from the D-Tect Project

by Mina Nicole Händel, Ramune Jacobsen, Fanney Thorsteinsdottir, Amélie Cléo Keller, Maria Stougaard, Camilla Bjørn Jensen, Caroline Moos, Katrine Sidenius Duus, Allan Jensen, Ulrik Schiøler Kesmodel, Bo Abrahamsen and Berit Lilienthal Heitmann

Int. J. Environ. Res. Public Health 2021, 18(15), 8136; https://doi.org/10.3390/ijerph18158136 - 31 Jul 2021

Cited by 2 | Viewed by 3005

Abstract

By utilizing historical changes in Danish legislation related to mandatory vitamin D fortification of margarine, which was implemented in the mid 1930s and abruptly abandoned in June 1985, the studies in the D-tect project investigated the effects of vitamin D on health outcomes [...] Read more.

By utilizing historical changes in Danish legislation related to mandatory vitamin D fortification of margarine, which was implemented in the mid 1930s and abruptly abandoned in June 1985, the studies in the D-tect project investigated the effects of vitamin D on health outcomes in individuals, who during gestation were exposed or unexposed to extra vitamin D from fortified margarine. This paper reviews and narratively summarizes the analytic approaches alongside the results of the societal fortification experiment studies from the D-tect project and addresses the challenges in designing societal experiment studies and evaluating their results. The latter are discussed as lessons learned that may be useful for designers of similar studies, expected to be extensively utilized while researching the health consequences of the COVID-19 pandemic by comparing individuals born before and after the epidemic. In the D-tect project, 16 articles based on the societal fortification experiment were published analyzing 10 different outcomes and using different statistical approaches. Lessons learned included the detail of the analysis of the historical information on the exposure, availability and validity of the outcome data, variety of analytical approaches, and specifics concerning vitamin D effect evaluation, such as consideration of the influence of sunshine or season. In conclusion, the D-tect project clearly demonstrated the cost-effectiveness and research potential of natural- or societal-experiment-based studies. Full article

(This article belongs to the Special Issue Healthcare Services and Epidemiology for Chronic Disease Management and Prevention)

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15 pages, 414 KiB

Open AccessReview

Insufficient Sun Exposure Has Become a Real Public Health Problem

by Lars Alfredsson, Bruce K. Armstrong, D. Allan Butterfield, Rajiv Chowdhury, Frank R. de Gruijl, Martin Feelisch, Cedric F. Garland, Prue H. Hart, David G. Hoel, Ramune Jacobsen, Pelle G. Lindqvist, David J. Llewellyn, Henning Tiemeier, Richard B. Weller and Antony R. Young

Int. J. Environ. Res. Public Health 2020, 17(14), 5014; https://doi.org/10.3390/ijerph17145014 - 13 Jul 2020

Cited by 76 | Viewed by 25249

Abstract

This article aims to alert the medical community and public health authorities to accumulating evidence on health benefits from sun exposure, which suggests that insufficient sun exposure is a significant public health problem. Studies in the past decade indicate that insufficient sun exposure [...] Read more.

This article aims to alert the medical community and public health authorities to accumulating evidence on health benefits from sun exposure, which suggests that insufficient sun exposure is a significant public health problem. Studies in the past decade indicate that insufficient sun exposure may be responsible for 340,000 deaths in the United States and 480,000 deaths in Europe per year, and an increased incidence of breast cancer, colorectal cancer, hypertension, cardiovascular disease, metabolic syndrome, multiple sclerosis, Alzheimer’s disease, autism, asthma, type 1 diabetes and myopia. Vitamin D has long been considered the principal mediator of beneficial effects of sun exposure. However, oral vitamin D supplementation has not been convincingly shown to prevent the above conditions; thus, serum 25(OH)D as an indicator of vitamin D status may be a proxy for and not a mediator of beneficial effects of sun exposure. New candidate mechanisms include the release of nitric oxide from the skin and direct effects of ultraviolet radiation (UVR) on peripheral blood cells. Collectively, this evidence indicates it would be wise for people living outside the tropics to ensure they expose their skin sufficiently to the sun. To minimize the harms of excessive sun exposure, great care must be taken to avoid sunburn, and sun exposure during high ambient UVR seasons should be obtained incrementally at not more than 5–30 min a day (depending on skin type and UV index), in season-appropriate clothing and with eyes closed or protected by sunglasses that filter UVR. Full article

(This article belongs to the Special Issue Healthcare Services and Epidemiology for Chronic Disease Management and Prevention)

Other

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18 pages, 2690 KiB

Open AccessSystematic Review

Effectiveness of Colorectal Cancer Screening Promotion Using E-Media Decision Aids: A Systematic Review and Meta-Analysis

by Nur Suhada Ramli, Mohd Rizal Abdul Manaf, Mohd Rohaizat Hassan, Muhamad Izwan Ismail and Azmawati Mohammed Nawi

Int. J. Environ. Res. Public Health 2021, 18(15), 8190; https://doi.org/10.3390/ijerph18158190 - 2 Aug 2021

Cited by 3 | Viewed by 3061

Abstract

Colorectal cancer (CRC)-screening reduces mortality, yet remains underutilized. The use of electronic media (e-media) decision aids improves saliency and fosters informed decision-making. This systematic review aimed to determine the effectiveness of CRC-screening promotion, using e-media decision aids in primary healthcare (PHC) settings. Three [...] Read more.

Colorectal cancer (CRC)-screening reduces mortality, yet remains underutilized. The use of electronic media (e-media) decision aids improves saliency and fosters informed decision-making. This systematic review aimed to determine the effectiveness of CRC-screening promotion, using e-media decision aids in primary healthcare (PHC) settings. Three databases (MEDLINE, Web of Science, and the Cochrane Library) were searched for eligible studies. Studies that evaluated e-media decision aids compared to usual care or other conditions were selected. Quality was assessed by using Cochrane tools. Their effectiveness was measured by CRC-screening completion rates, and meta-analysis was conducted to calculate the pooled estimates. Ten studies involving 9393 patients were included in this review. Follow-up durations spanned 3–24 months. The two types of decision-aid interventions used were videos and interactive multimedia programs, with durations of 6–15 min. Data from nine feasible studies with low or some risk of bias were synthesized for meta-analysis. A random-effects model revealed that CRC-screening promotion using e-media decision aids were almost twice as likely to have screening completion than their comparisons (OR 1.62, 95% CI: 1.03–2.62, p < 0.05). CRC-screening promotion through e-media has great potential for increasing screening participation in PHC settings. Thus, its development should be prioritized, and it should be integrated into existing programs. Full article

(This article belongs to the Special Issue Healthcare Services and Epidemiology for Chronic Disease Management and Prevention)

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7 pages, 315 KiB

Open AccessBrief Report

Towards Better Health, Social, and Community-Based Services Integration for Patients with Chronic Conditions and Complex Care Needs: Stakeholders’ Recommendations

by Catherine Hudon, Maud-Christine Chouinard, Marie-Dominique Beaulieu, Mathieu Bisson, Danielle Bouliane, Martine Couture, Serge Dumont, Antoine Groulx and Véronique Sabourin

Int. J. Environ. Res. Public Health 2020, 17(22), 8437; https://doi.org/10.3390/ijerph17228437 - 14 Nov 2020

Cited by 3 | Viewed by 2247

Abstract

The objective was to report on issues related to patients with complex care needs and recommendations identified by 160 key participants at a summit in Quebec City about better integration of primary health care services for patients with chronic diseases and complex care [...] Read more.

The objective was to report on issues related to patients with complex care needs and recommendations identified by 160 key participants at a summit in Quebec City about better integration of primary health care services for patients with chronic diseases and complex care needs. A descriptive qualitative approach was used. While focus groups were led by a facilitator, a rapporteur noted highlights and a research team member took independent notes. All notes were analyzed by using a thematic analysis according to an inductive method. Seven issues were identified, leading to the formulation of recommendations: (1) valuing the experience of the patient; (2) early detecting of a non-homogeneous patient population; (3) defining interprofessional collaboration based on patient needs; (4) conciliating services provided by clinical settings according to a registered clientele-based logic with the population-based logic; (5) working with the community sector; (6) aligning patient-oriented research values with existing challenges to primary care integration; and (7) promoting resource allocation consistent with targeted recommendations. The summit highlighted the importance of engaging all stakeholders in improvement of integrated care for patients with complex care needs. The resulting recommendations target shared priorities towards better health, social, and community-based services integration for these patients. Full article

(This article belongs to the Special Issue Healthcare Services and Epidemiology for Chronic Disease Management and Prevention)

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