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The clinical importance of adhering to the regimen in tuberculosis patients has been widely investigated, but most studies were conducted in controlled settings and in limited populations. We aimed to measure the level of real-world adherence during intensive phase and investigate the predictors and the risk of mortality and health outcomes of intensive phase non-adherence in tuberculosis patients. We conducted a nationwide cohort study by linking the Korean National Tuberculosis Surveillance System and the National Health Information Database. We included all incident drug-susceptible tuberculosis patients who initiated the regimens recommended by the World Health Organization from 2013 to 2018. Adherence was measured using the proportion of days covered (poor [<50%], moderate [50%–79%], and high [≥80%]). We used logistic regression model to assess predictors and the Cox proportional hazard model to evaluate the risk of mortality and health outcomes with intensive phase non-adherence. Of 46,818 patients, there were 8% and 11% with poor and moderate adherent groups, respectively. Age ≥45 years, insulin use, and history of renal failure were predictors of non-adherence. Compared with high adherent group, poor and moderate adherent groups were associated with a substantial risk of mortality (poor: hazard ratio, 2.14 [95% confidence interval, 1.95–2.34]; moderate: 1.76 [1.62–1.92]). Similar trends were observed for health outcomes. Stratified analyses showed a higher risk of mortality in patients with medical aid, low income, and history of renal failure, systematic corticosteroids, and immunomodulators. Non-adherence during intensive phase increased mortality risk by twofold, underscoring targeted intervention for high-risk population, including advanced diabetes, and immunocompromised patients. [ABSTRACT FROM AUTHOR]

• Collection of longitudinal health outcomes of seriously injured trauma patients at a health service level is infrequent. • Impairments in physical and emotional health continue to affect many people following serious traumatic injury. • Trauma clinicians are uniquely placed to facilitate collection of longitudinal health outcomes of trauma patients. • Collection of longitudinal health outcome data at the health service level can drive quality improvement initiatives within trauma systems. • Longitudinal follow-up programs are a platform which may provide ongoing specialist trauma informed care after trauma centre discharge. The routine collection of long-term patient health outcomes after serious traumatic injury at the health service level is uncommon. In 2019, we implemented the longitudinal Trauma Service Follow Up (TSFU) program at a level I trauma centre. Delivered by the trauma service clinicians involved in inpatient care, it assesses quality of life and disability. This study reports the 6- and 12-month outcomes of the first two years of operation of the TSFU program. This is a prospective cohort study of seriously injured adult trauma patients admitted to a level I trauma centre with 6- and 12-months post-discharge outcome assessments. Outcomes were quality of life and function/disability as measured using the EQ-5D-5L and WHODAS 2.0 validated instruments. Changes from 6 to 12 months were assessed using generalised estimating equations methods. Logistic regression models were used to identify factors associated with ongoing problems at each time point. Five-hundred and eight seriously injured patients were eligible for the TSFU program with follow-up rates over 80 % at both 6- and 12-month timepoints. At six months, ongoing problems with pain (69.9 %), anxiety and depression (49 %) and carrying out usual activities (57.5 %) were highly prevalent; at 12 months problems with pain (61.4 %) and anxiety and depression (43.8 %) persisted. Lower extremity and/or pelvic surgery was associated with ongoing pain, odds ratio (OR) = 3.77 (95 % CI 1.54–9.21, p =0.01), anxiety and depression (OR 1.95, 95 % CI 1.09–3.48, p =0.02) and problems carrying out their usual activities (OR 3.19, 95 % CI 0.75–13.5, p =0.11) at six months. These patterns mostly persisted at 12 months. Similar associations between surgical intervention and high levels of disability were evident at both time points. Persistent impairments in physical and emotional health continues to affect many people following serious traumatic injury. The collection of longitudinal health outcomes by trauma clinicians enables identification of factors that contribute to disability and a reduction in quality of life. This in turn can drive quality improvement initiatives within the hospital trauma system. Longitudinal follow-up programs may provide a platform to provide ongoing specialist trauma-informed care after hospital discharge. [ABSTRACT FROM AUTHOR]

• High frailty levels are associated with adverse health outcomes after CABG surgery. • Frail patients are at high risk of postoperative readmission and extended hospital stays. • Lab-based frailty could capture a need for thorough frailty assessments for CABG patients. Frailty is associated with adverse surgical outcomes. Patients with cardiovascular diseases have many risk factors of frailty; thus, preoperative frailty evaluation is necessary to predict adverse outcomes after coronary artery bypass graft (CABG) surgery. Laboratory data based-frailty assessments are objective and not time-consuming, addressing the need for an accurate but simple frailty screening for patients awaiting CABG surgery. This retrospective study aimed to determine the association between laboratory based-frailty and patient health outcomes after CABG surgery. We evaluated 896 patients who underwent on-pump or off-pump CABG surgery between August 1, 2015 and July 31, 2020 at a tertiary hospital. The frailty index-laboratory (FI-LAB), which comprises 32 laboratory parameters and vital signs, was used for frailty assessment. The patients were divided into three groups according to their preoperative FI-LAB level as low (FI-LAB <0.25, 23.0%), moderate (FI-LAB ≥0.25 to ≤0.4, 54.9%), and high (FI-LAB>0.4, 22.1%) frailty groups. In the confounder-adjusted analysis, the lengths of hospital stay and intensive care unit stay were longer by 2.20 days (p =.023) and by 0.89 days (p =.009), respectively, in the high frailty group than those in the low frailty group. The odds ratio for 30-day readmission was also 2.58 times higher in the high frailty group than that in the low frailty group. A high preoperative FI-LAB score indicates increasing risks of adverse postoperative outcomes among CABG surgery patients. FI-LAB has potential strengths to capture the need for a more thorough frailty assessment for cardiac surgery patients. [ABSTRACT FROM AUTHOR]

Numerous studies have evaluated the effects of dietary protein on specific health outcomes. The aim of our umbrella review was to summarize the existing evidence between the intake of dietary proteins and multiple health outcomes, and assess their strength and validity. Our study was registered at PROSPERO (No. CRD42021255938). We systematically searched PubMed, Embase, and Web of Science databases from inception to May 18, 2021, to identify relevant systematic reviews and meta-analyses of observational studies. The validated "A Measurement Tool to Assess Systematic Reviews" for assessing the methodological quality of included systematic reviews was utilized. For each association, we estimated the summary effect size using fixed and random effects methods, and the 95% confidence and prediction intervals. We also evaluated heterogeneity, evidence of small-study effects, and excess significance bias. Overall, 16 articles with 58 meta-analyses were included. All studies were categorized as over moderate quality. On employing the random-effects model, fourteen (24.1%) meta-analyses were found to be significant at P < 0.05, whereas only one (1.7%) remained significant at P < 10−6. Twenty-two (37.9%) meta-analyses had large or very large heterogeneity. Evidence of small–study effects and excess significance bias was found for three (5.2%) meta-analyses, respectively. One meta-analysis was supported by highly suggestive evidence, indicating that a 5% increase in energy intake from animal protein was associated with 12% higher risk of type 2 diabetes (95% confidence interval [CI]: 1.08–1.17). Of note, the intake of animal and plant proteins had different health effects on type 2 diabetes, all-cause mortality, and risk of cardiovascular disease mortality. Although the intake of dietary protein was associated with certain health outcomes, the strength of evidence was limited for most outcomes. Moreover, the source of dietary protein is an important factor that requires better consideration in future studies. [ABSTRACT FROM AUTHOR]

[Display omitted] • IMPRESS aimed to understand pesticide exposure assessment methods performance in epidemiological studies. • Indirect methods (e.g., questionnaires) used in most studies. Some issues identified with using recall methods. • Biomonitoring beneficial in focussed exposure assessment of a cohort, being then used to determine relevant exposure factors. • Exposure assessment choice should provide clear exposure contrast within study population. • Improvements in exposure assessment requires a multi-disciplinary approach. The IMPRoving Exposure aSSessment Methodologies for Epidemiological Studies on Pesticides (IMPRESS) project (http://www.impress-project.org/) aimed to further the understanding of the performance of pesticide exposure assessment methods (EAMs). To achieve this the IMPRESS project used two approaches to assess EAM performance, using existing and newly collected data from five studies from three different countries and use of published secondary data to undertake three meta -analyses for selected chronic health outcomes. Based on the findings of the IMPRESS project we provide in this paper insights on the overarching research question "How can exposure assessments for pesticides in epidemiological studies be improved"? Exposure assessment is a critical component of pesticide epidemiological studies. EAMs used and epidemiological practices employed need to reflect the changing nature and complexities of pesticide exposure in various occupational settings. To properly assess the association between exposure and selected health outcomes, the choice of EAM should provide a clear exposure contrast within the study population. Acquiring a practical understanding of the pesticide use practices is crucial to determine whether factors such as frequency or intensity of exposure have to be considered in planned analyses. Biomonitoring may be more beneficially applied intensively in a focussed exposure assessment analysis of a particular cohort, which can be used to determine the most relevant exposure factors within that cohort-specific context. Overall, improving pesticide exposure assessment in epidemiological studies requires a multi-disciplinary approach. A next step for the wider scientific community may be to consider the development of a decision tree to aid the selection of suitable EAMs. Such a decision tree would need to consider and be based on multiple parameters including, but not limited to, study type, health endpoint, socio-demographic context, farming system, pesticide used, and application methods. [ABSTRACT FROM AUTHOR]

To explore the relationship between health coaches' responses to emotional cues/concerns and women's subsequent engagement with the health coaching mHealth platform. 24 face-to-face video-mediated initial conversations between participants and their health coaches were coded using the VR-CoDES-P method. Women with high risk of developing Gestational Diabetes Mellitus were selected from the study, based on their engagement with the smartphone health coaching platform. 12 women with very low engagement and 12 women with high engagement were identified. In interactions with women with high goal engagement, coaches had significantly more counseling codes with prior other codes and no instances of non-explicit response codes that reduce space for further disclosure. Analysis showed that interactions with women with high goal engagement were more frequently met by the coach with affect-acknowledging and empathic responses prior to the counseling speech act. High goal engagement among women with Gestational Diabetes Mellitus may appear to be associated with coaches facilitating the frequent use of empathy. Findings can draw coaches' attention to the impact that their counseling has on goal engagement, increasing the opportunity for intervention to be person-centered and effective. • Behavior change techniques (BCTs) cannot account for success in interventions. • Application and extension of VR-CoDES can qualify delivery of interventions. • Affect acknowledging and Empathic communication is not more time consuming. • Professionals' attentions to clients' emotions enables them to personalize advice. • Empathic communication supports clients' self-management of their condition. [ABSTRACT FROM AUTHOR]

• Higher inflammation was associated with shorter event-free survival, regardless of body mass index. • Inflammation plays an important role in modifying the association between obesity and better outcomes in patients with heart failure. • Obesity does not have a protective role with respect to inflammation in patients with heart failure. Although obesity is a risk factor for cardiovascular disease, higher body mass index is related to longer event-free survival in patients with heart failure (HF). While previous research demonstrated that higher levels of inflammatory mediators were associated with shorter event-free survival, the effect of inflammation on the association between obesity and outcomes of HF have not been considered. Based on the obesity paradox, we hypothesized that patients with higher baseline body mass index (BMI) would experience better event-free survival than those with lower BMI regardless of inflammatory status. A sample of 415 patients with HF (age 61 ± 11.5 years; 31% female) provided blood to measure soluble tumor necrosis factor receptor1 (sTNFR1), a biomarker of inflammation. Patients were divided into 4 groups based on BMI and a median split of sTNFR1 levels: (1) high BMI ≥ 30 and sTNFR1 > 1804 pg/ml, (2) high BMI ≥ 30 and low sTNFR1 ≤ 1804 pg/ml, and (3) low BMI < 30 and high sTNFR1 > 1804 pg/ml vs. (4) low BMI < 30 and sTNFR1 ≤ 1804 pg/ml. Patients were followed for an average of 365 days to determine the time to first event of either all-cause hospitalization or death. There were 177 patients (43%) who experienced either an all-cause hospitalization or death. In a Cox regression, high BMI and high sTNFR1 category predicted time to event (hazard ratio = 1.7, 95% confidence interval = 1.01–2.9) with age, gender, race, left ventricular ejection fraction, New York Heart Association functional class (I/II versus III/IV), log-transformed N-terminal Pro-B-type natriuretic peptide levels, prescribed statin (yes/no), and comorbidity as covariates. Being in a higher inflammation group was associated with shorter event-free survival regardless of BMI. This study provides evidence that inflammation is an important consideration in the association between obesity and better outcomes in patients with HF. [ABSTRACT FROM AUTHOR]

Background: Posterior EEG alpha has been identified as a putative biomarker of clinical outcomes in major depression (MDD). Separately, personal importance of religion and spirituality (R/S) has been shown to provide protective benefits for individuals at high familial risk for MDD. This study directly explored the joint value of posterior alpha and R/S on predicting clinical health outcomes of depression.Methods: Using a mixed-effects model approach, we obtained virtual estimates of R/S at age 21 using longitudinal data collected at 5 timepoints spanning 25 years. Current source density and frequency principal component analysis was used to quantify posterior alpha in 72-channel resting EEG (eyes open/closed). Depression severity was measured between 5 and 10 years after EEG collection using PHQ-9 and IDAS-GD scales.Results: Greater R/S (p = .008, η2p = 0.076) and higher alpha (p = .02, η2p = 0.056) were separately associated with fewer symptoms across scales. However, an interaction between alpha and R/S (p = .02, η2p = 0.062) was observed, where greater R/S predicted fewer symptoms with low alpha but high alpha predicted fewer symptoms with lower R/S.Limitations: Small-to-medium effect sizes and homogeneity of sample demographics caution overall interpretation and generalizability.Conclusions: Findings revealed a complementary role of R/S and alpha in that either variable exerted protective effects only if the other was present at low levels. These findings confirm the relevance of R/S importance and alpha oscillations as predictors of depression symptom severity. More research is needed on the neurobiological mechanism underlying the protective effects of R/S importance for MDD. [ABSTRACT FROM AUTHOR]

Background: Evidence provides inconsistent findings on risk factors and health outcomes associated with loneliness. The aim of this work was to grade the evidence on risk factors and health outcomes associated with loneliness, using an umbrella review approach.Methods: For each meta-analytic association, random-effects summary effect size, 95% confidence intervals (CIs), heterogeneity, evidence for small-study effect, excess significance bias and 95% prediction intervals were calculated, and used to grade significant evidence (p<0.05) from convincing to weak. For narrative systematic reviews, findings were reported descriptively.Results: From 210 studies initially evaluated, 14 publications were included, reporting on 18 outcomes, 795 studies, and 746,706 participants. Highly suggestive evidence (class II) supported the association between loneliness and incident dementia (relative risk, RR=1.26; 95%CI: 1.14-1.40, I2 23.6%), prevalent paranoia (odds ratio, OR=3.36; 95%CI: 2.51-4.49, I2 92.8%) and prevalent psychotic symptoms (OR=2.33; 95%CI: 1.68-3.22, I2 56.5%). Pooled data supported the longitudinal association between loneliness and suicide attempts and depressive symptoms. In narrative systematic reviews, factors cross-sectionally associated with loneliness were age (in a U-shape way), female sex, quality of social contacts, low competence, socio-economic status and medical chronic conditions.Limitations: Low quality of the studies included; mainly cross-sectional evidence.Conclusions: This work is the first meta-evidence synthesis showing that highly suggestive and significant evidence supports the association between loneliness and adverse mental and physical health outcomes. More cohort studies are needed to disentangle the direction of the association between risk factors for loneliness and its related health outcomes. [ABSTRACT FROM AUTHOR]

Background/purpose: The objectives of this study were to describe epidemiological data, treatment outcomes, and quality of life (QOL) of patients with acromegaly in Taiwan.Methods: From 2013 to 2015, subjects with acromegaly were recruited through five medical centers. After enrollment, each patient was kept on observation for 1 year.Results: The analyzed cohort included 272 acromegalic subjects (117 males, 155 females) with a mean age of 51.4 ± 12.9 years. Their mean age at diagnosis was 41.8 ± 12.1 years. About 83.8% patients presented symptoms of facial changes. Galactorrhea was noted at the earliest age of 32.7 ± 9.1 years. The duration between the onset of symptoms/signs and diagnosis was 6.9 ± 8.1 years. Around 70.3% patients harbored a macroadenoma. At enrollment, percentages of patients ever received surgical intervention, radiotherapy, somatostatin analogs, and dopamine agonists were 94.8%, 27.9%, 64%, and 30%, respectively. At the final following-up visit, the random growth hormone (GH), nadir GH after oral glucose tolerance test, and the insulin-like growth factor 1 levels were 2.7 ± 4.9 μg/L, 2.4 ± 6.1 μg/L, and 291.5 ± 162.4 ng/mL, respectively. The remission rate assessed by random GH level (≦2 μg/L) was 63.8%. The mean AcroQoL scores for the total 22 items were 64.0 ± 19.7. About 42.8% patients never sensed or felt discomfort about their changes in appearance.Conclusion: This study described the profiles of acromegaly in Taiwan. It is important to enhance early diagnosis and timely commencement of treatment to prevent serious complications of acromegaly. [ABSTRACT FROM AUTHOR]

Purpose: This article aimed to examine the causal relationships of hours of work with health behaviors and health outcomes.Method: The data were derived from Japan Household Panel Survey/Keio Household Panel Survey. In total, data from 2677 men and 2170 women were analyzed to show the effects of hours of work on body mass index, smoking, and sleeping hours. To deal with the potential endogeneity of decisions about hours of work, the instrumental variable approach was used.Results: Hours of work had a negative impact on hours of sleep among men (coefficient [coef.], -0.371; 95% confidence interval [CI], -0.519 to -0.223). Longer hours of work also increased the probability of men being obese (coef., 1.108; 95% CI, 0.234-1.981) and the number of cigarettes they smoked each day (coef., 1.007; 95% CI, 0.037-1.978). For women, longer hours of work increased the probability of being obese (coef., 0.029; 95% CI, 0.009-0.050) and decreased the hours of sleep (coef., -0.416; 95% CI, -0.618 to -0.214).Conclusions: This article suggests that the health consequences of long hours of work include health behaviors and health outcomes that can lead to higher risks of morbidity and mortality. [ABSTRACT FROM AUTHOR]

Abstract Introduction There are relatively few studies addressing the relationship between the patient's expectation and the short and long-term response to treatment with acupuncture. The aim of this study was to assess the association between pre- and post-treatment expectation of acupuncture and post-treatment and post-follow-up patient outcomes. Methods This was an open-label, randomized controlled clinical trial conducted at the Czech-Chinese Centre for Traditional Chinese Medicine at the University Hospital Hradec Kralove between October 2015 and April 2017. Non-specific factors were examined in the intervention arm using regression analysis. Results Post-treatment positive expectation concerning the success of the treatment, as well as the affective status of the patient, is one of the most significant nonspecific factors contributing to an increased post-treatment effectiveness of acupuncture; however, this positive expectation decreased with time. On the other hand, the post-follow-up effect of acupuncture was significantly improved by the patients' positive perception of the TCM practitioner. Conclusions Correct calibration of a patient's expectation, good mental status, and patients' perceptions of an acupuncturist's skills reduced the number of migraine days in patients treated with acupuncture. Understanding non-specific treatment effects can potentially help clinicians to integrate them in to practice and thus optimise treatment effectiveness. Future research is needed to clarify whether interventions targeting modifiable non-specific factors prior to and during acupuncture treatment can result in better patient outcomes and future cost-savings. [ABSTRACT FROM AUTHOR]

The literature in Intensive Care Units (ICUs) data analysis focuses on predictions of length-of-stay (LOS) and mortality based on patient acuity scores such as Acute Physiology and Chronic Health Evaluation (APACHE), Sequential Organ Failure Assessment (SOFA), to name a few. Unlike ICUs in other areas around the world, ICUs in Ontario, Canada, collect two primary intensive care scoring scales, a therapeutic acuity score called the "Multiple Organs Dysfunctional Score" (MODS) and a nursing workload score called the "Nine Equivalents Nursing Manpower Use Score" (NEMS). The dataset analyzed in this study contains patients' NEMS and MODS scores measured upon patient admission into the ICU and other characteristics commonly found in the literature. Data were collected between January 1st, 2015 and May 31st, 2021, at two teaching hospital ICUs in Ontario, Canada. In this work, we developed logistic regression, random forests (RF) and neural networks (NN) models for mortality (discharged or deceased) and LOS (short or long stay) predictions. Considering the effect of mortality outcome on LOS, we also combined mortality and LOS to create a new categorical health outcome called LMClass (short stay & discharged, short stay & deceased, or long stay without specifying mortality outcomes), and then applied multinomial regression, RF and NN for its prediction. Among the models evaluated, logistic regression for mortality prediction results in the highest area under the curve (AUC) of 0.795 and also for LMClass prediction the highest accuracy of 0.630. In contrast, in LOS prediction, RF outperforms the other methods with the highest AUC of 0.689. This study also demonstrates that MODS and NEMS, as well as their components measured upon patient arrival, significantly contribute to health outcome prediction in ICUs. [ABSTRACT FROM AUTHOR]

Highlights • Inpatients with severe mental disorder are quite heterogenic regarding their perception of health services. • Personality factors are more important than clinical symptomatology to a satisfaction level. • Satisfaction with hospital health care is associated with five indicators: insight, satisfaction with physical health, self-efficacy, family support, and social anhedonia. • Improving knowledge of the determinants of inpatient satisfaction is a way to improve their care experience and to achieve better outcomes. Abstract Background Patients' perception of psychiatric healthcare is a critical indicator in measuring service quality. The aim of the study was to determine patient's level of satisfaction with the quality of health care delivered at the inpatient departments, and to identify the service quality factors that were important to patients. Method The Satisfaction with Psychiatry Care Questionnaire-22 was administered to 125 consecutive inpatients with schizophrenia or schizoaffective disorder in a stable condition. Sociodemographic and background variables, illness and symptom severity, insight, social anhedonia, self-esteem, perceived social support, and satisfaction with quality of life were collected. Results Although the participants generally expressed satisfaction with the inpatient services, they indicated that the weakest aspects of the service were in the domains of 'personal experience', 'information' and 'activity'. Women were significantly more dissatisfied than men with 'staff', 'care', and by general satisfaction. Multiple regression analysis revealed that satisfaction with hospital health care was associated with five indicators: insight, satisfaction with physical health, self-efficacy, family support, and social anhedonia. Conclusion Personality related factors rather than psychopathological symptoms were associated with a satisfaction with care of admitted patients with severe mental illness. These factors could be targets for interventions aimed to improve treatment and hospital services. [ABSTRACT FROM AUTHOR]

Multimorbidity poses an immense burden on the healthcare systems globally, whereas the management strategies and guidelines for multimorbidity are poorly established. We aim to synthesize current evidence on interventions and management of multimorbidity. We searched four electronic databases (PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews). Systematic reviews (SRs) on interventions or management of multimorbidity were included and evaluated. The methodological quality of each SR was assessed by the AMSTAR-2 tool, and the quality of evidence on the effectiveness of interventions was assessed by the grading of recommendations assessment, development and evaluation (GRADE) system. A total of 30 SRs (464 unique underlying studies) were included, including 20 SRs of interventions and 10 SRs summarizing evidence on management of multimorbidity. Four categories of interventions were identified: patient-level interventions, provider-level interventions, organization-level interventions, and combined interventions (combining the aforementioned two or three- level components). The outcomes were categorized into six types: physical conditions/outcomes, mental conditions/outcomes, psychosocial outcomes/general health, healthcare utilization and costs, patients' behaviors, and care process outcomes. Combined interventions (with patient-level and provider-level components) were more effective in promoting physical conditions/outcomes, while patient-level interventions were more effective in promoting mental conditions/outcomes and psychosocial outcomes/general health. As for healthcare utilization and care process outcomes, organization-level and combined interventions (with organization-level components) were more effective. The challenges in the management of multimorbidity at the patient, provider and organizational levels were also summarized. Combined interventions for multimorbidity at different levels would be favored to promote different types of health outcomes. Challenges exist in the management at the patient, provider, and organization levels. Therefore, a holistic and integrated approach of patient-, provider- and organization- level interventions is required to address the challenges and optimize care of patients with multimorbidity. [Display omitted] • Combined interventions were more effective in physical condition outcomes. • Patient-level interventions were more effective in mental condition and psychosocial outcomes. • Organizational-level and combined interventions were more effective in healthcare utilization and care process outcomes. • Challenges exist in the management on patient, provider, and organization levels. [ABSTRACT FROM AUTHOR]

Exposure to indoor formaldehyde has been reported to be relevant to several adverse health effects, especially in occupational exposure scenarios. In this study, a systematic review and meta-analysis has been conducted for epidemiological studies published between January 1980 and December 2017 in order to summarize available evidence and to obtain concentration-response (C-R) relationships between different health outcomes and formaldehyde exposure in residences, offices or schools. We searched four databases to identify the related studies. Finally, we selected 31 studies through the systematic review, and included 23 studies in the meta-analysis. The results show that the pooled odds ratios (ORs) for asthma in children were 1.27 (95% CI: 1.20–1.35) in eastern countries and 1.03 (95% CI: 1.02–1.04) in western countries per 10 μg/m3 increase in formaldehyde concentration. For asthma in adults, the pooled OR was 1.09 (95% CI: 1.03–1.15) per 10 μg/m3 increase of formaldehyde concentration. We did not obtain significant associations of formaldehyde exposure with dermatitis or rhinitis. Our findings provide robust evidences for C-R relationships of formaldehyde exposure in civil buildings for different adverse health outcomes. The obtained C-R relationships can be helpful to estimate the attributable disease burden of indoor formaldehyde exposure. [Display omitted] [ABSTRACT FROM AUTHOR]

Aims: We evaluated a theoretically-derived family-oriented intervention aimed to improve self-efficacy, self-management, glycemic control and quality of life in individuals living with Type 2 diabetes in Thailand.Methods: In a single-blinded randomized controlled trial, 140 volunteer individuals with Type 2 diabetes, recruited from a diabetes clinic in rural Thailand, were randomly allocated to intervention and control arms. Those in the intervention arm received routine care plus a family-oriented program that included education classes, group discussions, a home visit, and a telephone follow-up while the control arm only received routine care. Improvement in outcomes over time (baseline, Week 3, and Week 13 following intervention) was evaluated using Generalized Estimating Equations multivariable analyses.Results: Except for age, no between-group significant differences were observed in all other baseline characteristics. Diabetes self-efficacy, self-management, and quality of life improved in the intervention arm but no improvement was observed in the controls. In the risk-adjusted multivariable models, compared to the controls, the intervention arm had significantly better self-efficacy, self-management, outcome expectations, and diabetes knowledge (p<0.001, in each). Participation in the intervention increased the diabetes self-management score by 14.3 points (β=14.3, (95% CI 10.7-17.9), p<0.001). Self-management was better in leaner patients and in females. No between-group differences were seen in quality of life or glycemic control, however, in the risk-adjusted multivariable models, higher self-management scores were associated with significantly decreased HbA1c levels (p<0.001) and improved patient quality of life (p<0.05) (irrespective of group membership).Conclusions: Our family-oriented program improved patients' self-efficacy and self-management, which in turn could decrease HbA1c levels. [ABSTRACT FROM AUTHOR]

Road traffic noise is one of the most ubiquitous urban environmental pollutants. This paper brings together three related works – in which the author has been involved or is currently completing - that together illustrate essential input to good policy development for the management of the health consequences of this pollutant. These include a guidance document on burden of disease from environmental noise; an assessment of exposure, response, and exposure-response, to road traffic noise in a densely-populated Asian city; and a current systematic evidence review of the effectiveness, in health terms, of interventions to control environmental noise. These provide examples of the nature of the quantitative evidence available to promote noise management through policy interventions. [ABSTRACT FROM AUTHOR]

Context Many people with Whiplash Associated Disorder (WAD) seek treatment though a compensation system where factors such as legal involvement have been reported as having a negative impact on recovery outcomes. Objective To compare those with and without legal involvement in their compensation claim, and identify associations with legal involvement at 12 months post injury; and longer term disability. Study design Inception cohort study. Participants 246 people with WAD compensation claim. Outcome measures Legal involvement and Functional Rating Index at 12 months post injury. Methods Participants were recruited from an insurance database. Baseline health (Functional Rating Index, Pain Catastrophising Scale and SF-36), socio-economic, work capacity, and claims data were collected within three months of injury and 12 months. Logistic regression models were used to identify associations with legal involvement at 12 months; and disability (FRI) at 12 months. Results At baseline 246 participants were enrolled into the study in a median 72 days post injury. At 12 months post injury 52 (25%) had engaged a lawyer. The significant independent associations with legal involvement at 12 months were higher levels of initial disability, work disability, speaking a language other than English at home and lower levels of mental health. Specifically, the odds of lawyer involvement at 12 months post injury was 4.9 times greater for those with work disability; 2.3 times greater for those who spoke a language other than English at home. In terms of health, they had poorer mental health and for every 10 unit increase in the baseline FRI score the odds of having lawyer involvement increased by 38%. Disability at 12 months (FRI) was significantly independently associated with, PCS-helplessness ( p < 0.001), age ( p < 0.001) and prior claim ( p = 0.001). Conclusion This study suggests the people with lawyer involvement in their claim 12 months after injury have socio-economic disadvantage, have had a prior claim and a worse baseline health profile compared to those without a lawyer. Understanding this profile could allow for improved claims processes and targeted interventions to assist this group through any perceived complexities in the system and address the underlying reasons for lawyer participation within compensation schemes. [ABSTRACT FROM AUTHOR]

Within a defined law framework, the Italian central health system dictates the standards for hospitalization to local care units, which are in turn allowed to establish their own effectiveness criteria. The appropriateness of the hospitalization decision is therefore predetermined at patients admission, whereas its effectiveness relies on the ex post patient well-being as a result of the complex system of reciprocal relations between patients and healthcare agents at the ward level. We consider the outcomes in geriatric wards referring to the national health system, with respect both to patients traits at the individual level and wards/hospital settings. The risk that models the healthcare outcome is accordingly adjusted for covariates at the different levels of analysis (Goldstein & Spiegelhalter, 1996), thus allowing to differentiate among outcomes in terms of the hospitalization structure and, when appropriate, of territorial aggregation. [ABSTRACT FROM AUTHOR]

Background Growing up in socioeconomically deprived neighborhoods has been shown to have negative health effects on children. However, the most recent review on which measures are used to investigate the association between neighborhood characteristics and child (0-18 year) health included studies only until 2004. Insight into more recent research is needed for the further development of these measures. To review neighborhood socioeconomic deprivation characteristics used in recent studies investigating the relationship between neighborhood socioeconomic deprivation and child health. Sensitive search in MEDLINE, Embase, PsycINFO, Sociological Abstracts databases (2004-2013). Ultimately, 19 studies were included. We found ten neighborhood socioeconomic deprivation constructs, of which income/wealth, employment, and education were most frequently used. The choice for neighborhood characteristics seemed independent of the health outcome and in most cases was not based on a specific theoretical background or earlier work. Studies vary regarding study designs, measures and outcomes. Researchers should clearly specify their choice of neighborhood socioeconomic deprivation characteristics; preferably, these should be theory-based and used consistently. [ABSTRACT FROM AUTHOR]

Abstract: Using the 2006 China Agricultural Census (CAC), we examine whether the introduction of the New Cooperative Medical System (NCMS) has affected child mortality, maternal mortality, and school enrollment of 6–16year olds. Our data cover 5.9 million people living in eight low-income rural counties, of which four adopted the NCMS by 2006 and four did not adopt it until 2007. Raw data suggest that enrolling in the NCMS is associated with better school enrollment and lower mortality of young children and pregnant women. However, using a difference-in-difference propensity score method, we find that most of the differences are driven by endogenous introduction and take-up of the NCMS, and our method overcomes classical propensity score matching''s failure to address selection bias. While the NCMS does not affect child morality and maternal mortality, it does help improve the school enrollment of six-year-olds. [Copyright &y& Elsevier]

Abstract: The relations of an offspring to its parents are complex, and the ways in which a parent may influence the characteristics of its offspring are many. This review focuses on the relations of parental age to intelligence, health outcomes, longevity and other characteristics of offspring. Many researchers have demonstrated that children of older parents tend to be more intelligent than do children of younger parents, although there are also some negative findings. Either teenage or advanced parental age is associated with risk of birth and health outcomes in offspring. Parental age at birth displays a negative association with offspring longevity. Parental age can also influence dominant characters, sex ratio, personality and development process of the offspring. To fully analyze the influence of parental age on the offspring is of great significance in deciding the optimal age for parenthood. [Copyright &y& Elsevier]

Abstract: Context: People with Whiplash Associated Disorder (WAD) often experience pain and disability for extended periods of time. A large proportion of these people will seek treatment through a compensation process. Rarely is data related to people''s health collected within the compensation process making it difficult to identify those that are at risk of delayed recovery and appropriately direct interventions. Study objective: To compare people with WAD who have recovered with those that have not, within 3 months of injury and identify potential predictors of poorer health and non-recovery to inform claim screening processes. Study design: Cross-sectional analysis of a cohort study. Participants: People who sustained a WAD and claimed compensation within an Australian Motor Accidents Compensation Scheme between November 2007 and June 2009. Measure of recovery: Functional Rating Index (FRI) score (≤25). Health outcome measures: Short Form 36 (SF36), FRI, and the Pain Catastrophising Scale (PCS). Methods: 246 people who had lodged a claim for compensation were enrolled in the Whiplash Outcome Study within 3 months of sustaining a WAD injury. Participants were assigned to a recovered or non-recovered group and analysed for differences between the two groups. Multiple linear regression models were used to identify potential predictors of poorer health and non-recovery. Results: Overall 23% of the study population had recovered within 3 months of sustaining a WAD, whilst only 9% had finalised their insurance claim. The recovered group had significantly better scores on all health outcome measures; SF36 Physical Component Score, SF36 Mental Component Score and the PCS (p <0.001). The significant independent predictors of poorer health and non-recovery were helplessness (p <0.001), older age (p <0.001) and pre-injury work status being affected (p <0.001) (r 2 =.624). Regardless of the health outcome measure used, helplessness was significantly associated with poorer reported health. Conclusion: Including additional information at claim notification, specifically the PCS and information on the effect the injury has on the working population could significantly improve claim screening processes, identifying those with poorer health and risk of non-recovery. [Copyright &y& Elsevier]

Abstract: The prevalence of obesity has progressively increased globally over the last 30 years. The determinants of this pandemic are many, poorly defined and priorities debated. While public health measures to prevent obesity have largely failed we are presented with a growing burden of disease and disability. Cardiovascular disease, type-2 diabetes, obesity related cancers, osteoarthritis and psychological disturbance generate much of the morbidity and years of life lost associated with increasing levels of obesity. Obesity has a clearly measurable impact on physical and mental health, health related quality of life, and generates considerable direct and indirect costs. The evolving obesity pandemic is exacting a considerable toll on those affected, the treating health services, and on our communities. Weight loss appears to be the most effective therapy for obesity and obesity related comorbidity. As health care researchers and providers we are likely to play a peripheral role in the prevention of obesity, but a central role in effectively treating those afflicted by the obesity pandemic. [Copyright &y& Elsevier]

Neonatal follow-up studies traditionally report on long-term neurodevelopmental outcomes as a metric of success of neonatal intensive care. Research endpoints are also typically deficit-based, assessing whether disabilities, such as cerebral palsy, cognitive impairment, deafness or blindness, are present or not. These historical approaches have resulted in neonatal follow-up programs that narrowly focus on the early identification of neurodevelopmental problems, possibly to the detriment of other outcomes that matter to parents. This focus on neurodevelopmental disability may also contribute to the negative stereotypes associated with extreme preterm birth. In this article, we discuss parental perspectives regarding important long-term outcomes. We examine limitations with current definitions of outcomes and propose a strength-based approach to generate meaningful findings both for clinicians and families. [ABSTRACT FROM AUTHOR]

• Investigating the effect of ICT diffusion on public health outcome. • Finding that ICT diffusion can significantly improve the public health outcome in China. • ICT diffusion can improve health outcome via increasing public health care expenditure. • ICT diffusion can improve health outcome via cultivating individual health literacy. This study is an attempt to assess the impact of information and communication technology (ICT) diffusion on public health outcome and investigate the mechanisms through which this causal influence operates. By utilizing China's provincial panel data from 2001 to 2016 and the China Family Panel Studies, we employ population mortality to measure the health outcome and adopt Internet penetration and mobile phone penetration as the proxy variables of ICT diffusion, respectively. Empirical results prove that ICT diffusion significantly reduces the population mortality in China. The conclusion is still reliable after conducting several robustness checks and the instrumental variable estimation. The mechanism analysis reveals that ICT diffusion improves health outcome through its effects on increasing public health care expenditure at the macro level and cultivating individual health literacy at the micro level. This study provides several policy implications for constructing "information superhighway" and conducting health intervention for developing countries in the digital era. [ABSTRACT FROM AUTHOR]

Aim: The implementation of electronic health records (EHRs) in the aged care sector has been shown to improve efficiency and quality of care, administrative and funding processes. The aim of this study was to examine whether implementing EHRs and/or interventions leveraging EHRs in residential aged care facilities has any impact on health outcomes for residents and to review and summarise any published evidence.Methods: Using the Joanna Briggs Institute guidelines for conducting scoping reviews, we searched PubMed, CINAHL, Embase, Cochrane and Scopus databases for articles describing the impact of EHRs and/or EHR-based interventions on health outcomes for residents in residential aged care. We included journal articles published in English between 2009 and 2019. After identifying articles meeting the inclusion criteria, we extracted individual findings and produced a narrative summary.Results: Out of 6576 articles identified through database searches, seven met our inclusion criteria. The articles varied in study design, experimental methods, sample sizes and health outcomes assessed but there were no randomised controlled trials: four articles employed quantitative methods and three employed both quantitative and qualitative methods. The implementation of EHR-based interventions had positive impact on outcomes related to excessive weight loss, malnutrition, mobility, weighing of residents and use of antipsychotic medicines but had mixed impact (i.e., positive impact in some studies but non-significant or negative impact in others) on pressure ulcers, activities of daily living, behavioural symptoms, use of physical restraints and signs of depression. We also found that these interventions had no statistically significant impact on medication discrepancies, adverse drug events, falls or mortality.Conclusion: In conclusion, research in this area is not yet comprehensive enough to reach a definitive conclusion on the impact of EHR-based interventions on health outcomes in residential aged care. As provider organisations increasingly implement EHRs, more research is needed to study their impact on resident health outcomes and examine how this impact eventuates. [ABSTRACT FROM AUTHOR]

In the last two decades, India's central and many state governments launched several public health programs with the goal of improving maternal and child health outcomes. Many individual studies assessed the impact of these programs; however, they focused on select health programs and few specific outcomes. This paper summarizes the literature, published during 2000–2019, investigating the impacts of public health programs on both the uptake of maternal and child health services and the related-health outcomes in India. We followed PRISMA guidelines of systematic review, and carried out a narrative synthesis of the study findings. We found 66 relevant studies covering 11 health programs across India. Most studies had applied non-experimental study designs (n = 50), with few applying experimental (n = 1) and quasi-experimental (n = 15) designs. Most studies (n = 64) assessed the impact on the intermediate outcomes of the uptake of various health services rather on the long-term outcomes of improvement in health. Overall we found studies reporting positive impacts, however, we could not find any strong consensus emerging from these studies about the impact, partly due to differences in: outcome indicators; study designs; study population; data sets. Several studies also reported considerable beneficial impacts among low socioeconomic population groups. However, given that the outreach of the public health programs have been low across the country and population groups, we found that broader objectives of health programs remained unassessed: most studies assessed the impact on who actually participated in the program (average treatment effect on-the-treated) rather on the target population (intent-to-treat effect). Furthermore, there was dearth of research on the impacts of the state-level programs. Future research need to assess the impact of the programs on health outcomes, and on quality adjusted measures of maternal and child health services and its continuum of care. • Most studies have focused on the impact on maternal and child health services. • Most studies reported beneficial impact on health services and the health-related outcomes. • Impact on the intended larger target population remains unassessed. [ABSTRACT FROM AUTHOR]

• Self-esteem and disabled member status were important for social capital and health. • Well-designed and equipped home environments were important for social trust and health. • Safe environments and external facilities for the disabled were important for health. • Perceived access to amenities for daily needs was significant for social capital and health. • Perceived access to amenities for recreational needs showed insignificant results. The increase in the supply of public rental housing since 1989 has mitigated the low-income housing shortage and contributed to stabilizing the housing market in South Korea. However, despite this policy-driven achievement, the living environment quality of public rental housing and its relationship to residents' social capital and health have not been thoroughly examined. Using survey data from 3009 householders located across public rental housing complexes within administrative districts in Seoul, Korea, this study performed a multi-level analysis to examine the associations of multiple domains of perceived and objective residential environments with dependent variables of social capital (trust, interaction, and norm of reciprocity) and health (self-rated health, chronic health conditions, and stress level). While better-perceived residential environments for daily needs (e.g., home environments with better utilities/equipment and barrier-free space, safe environments and external facilities for the disabled, and accessible public transit stations and groceries) were significant for social capital or health, perceived access to amenities for recreational needs (e.g., green and recreational space, cultural facilities) were not significant. Some significance from the objective measures of such recreational needs was found, but most objective measures showed inconsistent, mixed results. Among individual characteristics, self-esteem and having a disabled member appeared important. Our findings suggest the need for inclusive policy strategies that make good use of existing resources and respond to the actual and accessible needs of residents, especially those of low socioeconomic status, from the psychological, physical, and environmental perspectives. More attention needs to be directed to improving the environmental quality of public rental housing. [ABSTRACT FROM AUTHOR]

This study presents the results of an integrated model developed to evaluate the environmental and health impacts of Electric Vehicle (EV) deployment in a large metropolitan area. The model combines a high-resolution chemical transport model with an emission inventory established with detailed transportation and power plant information, as well as a framework to characterize and monetize the health impacts. Our study is set in the Greater Toronto and Hamilton Area (GTHA) in Canada with bounding scenarios for 25% and 100% EV penetration rates. Our results indicate that even with the worst-case assumptions for EV electricity supply (100% natural gas), vehicle electrification can deliver substantial health benefits in the GTHA, equivalent to reductions of about 50 and 260 premature deaths per year for 25% and 100% EV penetration, compared to the base case scenario. If EVs are charged with renewable energy sources only, then electrifying all passenger vehicles can prevent 330 premature deaths per year, which is equivalent to $3.8 Billion (2016$CAD) in social benefits. When the benefit of EV deployment is normalized per vehicle, it is higher than most incentives provided by the government, indicating that EV incentives can generate high social benefits. Image 1 • This study quantified the changes in GHGemissions and air quality impacts of electric vehicles (EV) in Toronto. • The worst-case EV scenario (for electricity supply) can reduce 1500 to 6800Years of Life Lost per year. • The best-case scenario can reduce 330 premature deaths per year, equivalent to $3.8 Billion (2016$CAD). • The economic benefits of EVs under worst-case conditions are higher than current incentives for EV purchase. Main conclusion: Our results indicate that even with the worst-case assumptions for EV electricity supply (100% natural gas), vehicle electrification can deliver substantial health benefits in Toronto region. [ABSTRACT FROM AUTHOR]

• Depression is ranked the top three mental health problem. • Depression is often beglected among Chinese older adult. • The compliance of anti-depressants are relatively poor, thus alternative non-pharmacological is a better choice. • A systematic review on the effect of different non-pharmacology therapies on Chinese older adults with depression was carried out. To conduct a systematic review of randomized controlled trials to evaluate the evidence for the use of non-pharmacological depression therapies in older Chinese adults. The population was individuals of Chinese extraction over the age of 60 who meet the criteria for depression. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Six healthcare databases were systematically searched for publications to the end date July 2018. Included study variables were extracted and methodological quality assessments were performed. Ten studies reported sufficient data for meta-analysis. Fifteen experimental and quasi-experimental studies fulfilled the selection criteria (N = 904 participants). Twelve studies provided sufficient data to evaluate the therapies using Effect Size (ES) (Cohen's d); ranged from low to high. In the Qigong studies ES varied d = 0.31–0.81, Reminiscence d = 0.20–2.37, and for single studies of Tai Chi d = 1.7 and for Life Story d = 1.46. From the meta-analyses, Qigong was the only treatment that had a significant effect on the severity of depression (Z = −4.47, p < 0.01) with acceptable statistical heterogeneity between studies (I2 = 52 %). Overall, there was a large methodological heterogeneity between studies attributed to differing treatments, duration and designs. Reminiscence and Life Story showed an overall effect from a range of measures, as did the exercise therapies Qigong and Tai Chi. Qigong was the only therapy having a significant effect on depression. This therapy may be useful to alleviate depression due to the group and social interaction. [ABSTRACT FROM AUTHOR]

The present study is an attempt to examine the impact of Information and Communication Technology (ICT) on the health outcome of 30 selected Asian countries over the period of 2000-2016. We have applied PCA technique to construct a weighted index of all the ICT drivers into a single factor, which is called the ICT Index and try to examine its relationship with health outcome. To attain this objective, the study applied Pedroni's cointegration technique to investigate the long run relationship among the selected variables. Subsequently, we have applied FMOLS and DOLS estimators to address the endogeneity and serial correlation problems in the model. Results of Pedroni's cointegration test show the existence of long-run relationship among the variables. The core findings of this study confirm the significant impact of ICT on health outcome in selected Asian countries. Based on the results, our study addresses some important issues related to ICT and suggests some important policy implications mainly for developing countries. • Explores the relationship between Information and Communication Technology and Health Outcome. • Employs Pedroni's cointegration technique along with FMOLS and DOLS estimators to understand the long run relationship. • The study finds a significant long run relationship between Information and Communication Technology and Health Outcome. • Based on the findings, the study suggests some important policy implications for developing countries. [ABSTRACT FROM AUTHOR]

Background The Post-Licensure Rapid Immunization Safety Monitoring (PRISM) program is the immunization safety monitoring component of FDA's Mini-Sentinel project, a program to actively monitor the safety of medical products using electronic health information. FDA sought to assess the surveillance capabilities of this large claims-based distributed database for vaccine safety surveillance by characterizing the underlying data. Methods We characterized data available on vaccine exposures in PRISM, estimated how much additional data was gained by matching with select state and local immunization registries, and compared vaccination coverage estimates based on PRISM data with other available data sources. We generated rates of computerized codes representing potential health outcomes relevant to vaccine safety monitoring. Standardized algorithms including ICD-9 codes, number of codes required, exclusion criteria and location of the encounter were used to obtain the background rates. Results The majority of the vaccines routinely administered to infants, children, adolescents and adults were well captured by claims data. Immunization registry data in up to seven states comprised between 5% and 9% of data for all vaccine categories with the exception of 10% for hepatitis B and 3% and 4% for rotavirus and zoster respectively. Vaccination coverage estimates based on PRISM's computerized data were similar to but lower than coverage estimates from the National Immunization Survey and Healthcare Effectiveness Data and Information Set. For the 25 health outcomes of interest studied, the rates of potential outcomes based on ICD-9 codes were generally higher than rates described in the literature, which are typically clinically confirmed cases. Conclusion PRISM program's data on vaccine exposures and health outcomes appear complete enough to support robust safety monitoring. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To describe the literature search strategies and results to inform development of health outcomes of interest (HOI) definitions studied within the Observational Medical Outcomes Partnership (OMOP) research program. These HOIs represent the safety and benefit endpoints that may be associated with the use of particular medications. Methods: Two organizations implemented search strategies to identify articles that described the validation of various HOI definition algorithms and produced systematic reviews of the published literature for the OMOP HOIs; reviews of 5 HOIs were available from each organization. Search results were summarized descriptively. Results: Based on the differences in publications identified by each organization, neither search strategy captured all the relevant literature across 5 HOIs. A composite search strategy developed by the OMOP research team failed to effectively capture all relevant publications as well. Among publications in observational databases, a large proportion did not report actual codes used to identify HOIs in administrative claims databases, nor did they provide substantive detail of any validation studies. Conclusion: No single search strategy or literature database captured all relevant articles efficiently. The lack of specific search terms hampered identification of relevant articles. Due to limited details about positive predictive value of various HOI definitions, information culled from available literature was insufficient to identify one best definition for each HOI. Researchers seeking to capture and understand prior published work that defined relevant outcomes of interest need to be aware of the shortcomings of this approach and the lack of detail of validation studies available in published literature. [Copyright &y& Elsevier]