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Magedanz L, Silva HL, Galato D, Fernandez-Llimos F. Clinical pharmacy key performance indicators for hospital inpatient setting: a systematic review. Int J Clin Pharm 2024; 46:602-613. [PMID: 38570475 PMCID: PMC11133179 DOI: 10.1007/s11096-024-01717-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/21/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Key performance indicators (KPIs) are quantifiable measures used to monitor the quality of health services. Implementation guidelines for clinical pharmacy services (CPS) do not specify KPIs. AIM To assess the quality of the studies that have developed KPIs for CPS in inpatient hospital settings. METHOD A systematic review was conducted by searching in Web of Science, Scopus, and PubMed, supplemented with citation analyses and grey literature searches, to retrieve studies addressing the development of KPIs in CPS for hospital inpatients. Exclusions comprised drug- or disease-specific studies and those not written in English, French, Portuguese, or Spanish. The Appraisal of Indicators through Research and Evaluation (AIRE) instrument assessed methodological quality. Domain scores and an overall score were calculated using an equal-weight principle. KPIs were classified into structure, process, and outcome categories. The protocol is available at https://doi.org/10.17605/OSF.IO/KS2G3 . RESULTS We included thirteen studies that collectively developed 225 KPIs. Merely five studies scored over 50% on the AIRE instrument, with domains #3 (scientific evidence) and #4 (formulation and usage) displaying low scores. Among the KPIs, 8.4% were classified as structure, 85.8% as process, and 5.8% as outcome indicators. The overall methodological quality did not exhibit a clear association with a major focus on outcomes. None of the studies provided benchmarking reference values. CONCLUSION The KPIs formulated for evaluating CPS in hospital settings primarily comprised process measures, predominantly suggested by pharmacists, with inadequate evidence support, lacked piloting or validation, and consequently, were devoid of benchmarking reference values.
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Affiliation(s)
- Lucas Magedanz
- Postgraduate Program in Health Sciences and Technologies, University of Brasília, Brasília, DF, Brazil
| | - Hiolanda Lêdo Silva
- Postgraduate Program in Health Sciences and Technologies, University of Brasília, Brasília, DF, Brazil
| | - Dayani Galato
- Postgraduate Program in Health Sciences and Technologies, University of Brasília, Brasília, DF, Brazil
| | - Fernando Fernandez-Llimos
- UCIBIO-Applied Molecular Biosciences Unit, i4HB-Institute for Health and Bioeconomy, Laboratory of Pharmacology, Faculty of Pharmacy, University of Porto, Porto, Portugal.
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2
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Ou C, Daly Z, Carter M, Hall WA, Zusman EZ, Russolillo A, Duffy S, Jenkins E. Developing consensus to enhance perinatal mental health through a model of integrated care: Delphi study. PLoS One 2024; 19:e0303012. [PMID: 38722862 PMCID: PMC11081323 DOI: 10.1371/journal.pone.0303012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/17/2024] [Indexed: 05/13/2024] Open
Abstract
Perinatal mental illness is an important public health issue, with one in five birthing persons experiencing clinically significant symptoms of anxiety and/or depression during pregnancy or the postpartum period. The purpose of this study was to develop a consensus-based model of integrated perinatal mental health care to enhance service delivery and improve parent and family outcomes. We conducted a three-round Delphi study using online surveys to reach consensus (≥75% agreement) on key domains and indicators of integrated perinatal mental health care. We invited modifications to indicators and domains during each round and shared a summary of results with participants following rounds one and two. Descriptive statistics were generated for quantitative data and a thematic analysis of qualitative data was undertaken. Study participants included professional experts in perinatal mental health (e.g., clinicians, researchers) (n = 36) and people with lived experience of perinatal mental illness within the past 5 years from across Canada (e.g., patients, family members) (n = 11). Consensus was reached and all nine domains of the proposed model for integrated perinatal mental health care were retained. Qualitative results informed the modification of indicators and development of an additional domain and indicators capturing the need for antiracist, culturally safe care. The development of an integrated model of perinatal mental health benefitted from diverse expertise to guide the focus of included domains and indicators. Engaging in a consensus-building process helps to create the conditions for change within health services.
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Affiliation(s)
- Christine Ou
- School of Nursing, University of Victoria, Victoria, Canada
| | - Zachary Daly
- School of Nursing, University of British Columbia, Vancouver, Canada
- Wellstream: The Canadian Centre for Innovation in Child and Youth Mental Health and Substance Use, Vancouver, Canada
| | - Michelle Carter
- School of Nursing, University of British Columbia, Vancouver, Canada
- Wellstream: The Canadian Centre for Innovation in Child and Youth Mental Health and Substance Use, Vancouver, Canada
- St. Paul’s Hospital, Providence Healthcare, Vancouver, Canada
| | - Wendy A. Hall
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Enav Z. Zusman
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Angela Russolillo
- St. Paul’s Hospital, Providence Healthcare, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Sheila Duffy
- Pacific Post Partum Support Society, Burnaby, BC, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, Vancouver, Canada
- Wellstream: The Canadian Centre for Innovation in Child and Youth Mental Health and Substance Use, Vancouver, Canada
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Miranda R, Silvério R, Baptista FM, Oliveira MD. Unlocking Continuous Improvement in Heart Failure Remote Monitoring: A Participatory Approach to Unveil Value Dimensions and Performance Indicators. Telemed J E Health 2024. [PMID: 38436266 DOI: 10.1089/tmj.2023.0560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Introduction: Heart failure (HF) constitutes a public health concern affecting quality of life, survival, and costs. Remote patient monitoring (RPM) can enhance HF management, involving patients actively and improving follow-up. While current HF RPM assessments emphasise cost-effectiveness analysis, there is a need to consider wider RPM impacts and integrate stakeholders' perspectives into assessments for better comprehensiveness. Methods: We developed a four-stage participatory approach to select value dimensions and indicators for continuous HF RPM assessment: Stage 1 involved building a literature-informed initial list; Stage 2 utilized expert interviews for validation and list expansion; Stage 3 involved a web-Delphi process with Portuguese stakeholders and experts for agreement assessment; and Stage 4 included a conclusive expert interview. Results: A literature review identified fourteen studies on telehealth, RPM, and HF, informing an initial list of four value dimensions (Access, Clinical aspects, Acceptability, and Costs) and 22 indicators. Seven semistructured interviews validated and further adjusted the list to 38 indicators. Subsequently, the web-Delphi process engaged 29 stakeholders, giving their opinions regarding assessment aspects' relevance and proposing additional elements - 1 dimension and 12 indicators. Five value dimensions and 38 indicators (76.0%) reached group agreement for selection, while 12 did not reach an agreement. Upon expert appreciation, 5 dimensions, 43 indicators, and 6 case-mix parameters were considered relevant. Discussion: This comprehensive social approach captured diverse stakeholder perspectives, achieving agreement on pertinent HF RPM monitoring and evaluation indicators. Findings can inform visualization and management tool development, aiding day-to-day RPM evaluation and identification of improvement opportunities.
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Affiliation(s)
- Rafael Miranda
- Centro de Estudos de Gestão do Instituto Superior Técnico, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- Enterprise Services Portugal, Siemens Healthineers, Erlangen, Germany
| | - Rita Silvério
- Centro de Estudos de Gestão do Instituto Superior Técnico, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | | | - Mónica Duarte Oliveira
- Centro de Estudos de Gestão do Instituto Superior Técnico, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- iBB-Institute for Bioengineering and Biosciences and i4HB-Associate Laboratory Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
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Duron V, Schmoke N, Ichinose R, Stylianos S, Kernie SG, Dayan PS, Slidell MB, Stulce C, Chong G, Williams RF, Gosain A, Morin NP, Nasr IW, Kudchadkar SR, Bolstridge J, Prince JM, Sathya C, Sweberg T, Dorrello NV. Delphi Process for Validation of Fluid Treatment Algorithm for Critically Ill Pediatric Trauma Patients. J Surg Res 2024; 295:493-504. [PMID: 38071779 DOI: 10.1016/j.jss.2023.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/10/2023] [Accepted: 11/13/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION While intravenous fluid therapy is essential to re-establishing volume status in children who have experienced trauma, aggressive resuscitation can lead to various complications. There remains a lack of consensus on whether pediatric trauma patients will benefit from a liberal or restrictive crystalloid resuscitation approach and how to optimally identify and transition between fluid phases. METHODS A panel was comprised of physicians with expertise in pediatric trauma, critical care, and emergency medicine. A three-round Delphi process was conducted via an online survey, with each round being followed by a live video conference. Experts agreed or disagreed with each aspect of the proposed fluid management algorithm on a five-level Likert scale. The group opinion level defined an algorithm parameter's acceptance or rejection with greater than 75% agreement resulting in acceptance and greater than 50% disagreement resulting in rejection. The remaining were discussed and re-presented in the next round. RESULTS Fourteen experts from five Level 1 pediatric trauma centers representing three subspecialties were included. Responses were received from 13/14 participants (93%). In round 1, 64% of the parameters were accepted, while the remaining 36% were discussed and re-presented. In round 2, 90% of the parameters were accepted. Following round 3, there was 100% acceptance by all the experts on the revised and final version of the algorithm. CONCLUSIONS We present a validated algorithm for intavenous fluid management in pediatric trauma patients that focuses on the de-escalation of fluids. Focusing on this time point of fluid therapy will help minimize iatrogenic complications of crystalloid fluids within this patient population.
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Affiliation(s)
- Vincent Duron
- Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York.
| | - Nicholas Schmoke
- Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Rika Ichinose
- Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Steven Stylianos
- Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Steven G Kernie
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Peter S Dayan
- Department of Emergency Medicine, NewYork-Presbyterian/Columbia University Valegos College of Physicians and Surgeons, New York, New York
| | - Mark B Slidell
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Casey Stulce
- Division of Critical Care, Department of Pediatrics, University of Chicago Medicine Comer Children's Hospital, Chicago, Illinois
| | - Grace Chong
- Division of Critical Care, Department of Pediatrics, University of Chicago Medicine Comer Children's Hospital, Chicago, Illinois
| | - Regan F Williams
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ankush Gosain
- Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Denver, Colorado
| | - Nicholas P Morin
- Division of Critical Care Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Isam W Nasr
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeff Bolstridge
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jose M Prince
- Division of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York
| | - Chethan Sathya
- Division of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York
| | - Todd Sweberg
- Division of Pediatric Critical Care Medicine, Cohen Children's Medical, Northwell Health, New Hyde Park, New York
| | - N Valerio Dorrello
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
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5
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Fontrier AM, Kamphuis B, Kanavos P. How can health technology assessment be improved to optimise access to medicines? Results from a Delphi study in Europe : Better access to medicines through HTA. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023:10.1007/s10198-023-01637-z. [PMID: 37917290 DOI: 10.1007/s10198-023-01637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 10/02/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Access to medicines is a shared goal across healthcare stakeholders. Since health technology assessment (HTA) informs funding decisions, it shapes access to medicines. Despite its wide implementation, significant access variations due to HTA are observed across Europe. This paper elicited the opinions of European stakeholders on how HTA can be improved to facilitate access. METHODS A scoping review identified HTA features that influence access to medicines within markets and areas for improvement, while three access dimensions were identified (availability, affordability, timeliness). Using the Delphi method, we elicited the opinions of European stakeholders to validate the literature findings. RESULTS Nineteen participants from 14 countries participated in the Delphi panel. Thirteen HTA features that could be improved to optimise access to medicines in Europe were identified. Of these, 11 recorded a positive impact on at least one of the three access dimensions. HTA features had mostly a positive impact on timeliness and a less clear impact on affordability. 'Early scientific advice' and 'clarity in evidentiary requirements' showed a positive impact on all access dimensions. 'Established ways to deal with uncertainty during HTA' could improve medicines' availability and timeliness, while more 'reliance on real-world evidence' could expedite time to market access. CONCLUSIONS Our results reiterate that increased transparency during HTA and the decision-making processes is essential; the use of and reliance on new evidence generation such as real-world evidence can optimise the availability of medicines; and better collaborations between regulatory institutions within and between countries are paramount for better access to medicines.
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Affiliation(s)
- Anna-Maria Fontrier
- LSE Health-Medical Technology Research Group and Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Bregtje Kamphuis
- LSE Health-Medical Technology Research Group and Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Panos Kanavos
- LSE Health-Medical Technology Research Group and Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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6
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Jia W, Liu L, Wang Z, Peng G. Analysis of the Impact of Public Services on Residents' Health: A Spatial Econometric Analysis of Chinese Provinces. Int J Public Health 2023; 68:1605938. [PMID: 37577058 PMCID: PMC10412808 DOI: 10.3389/ijph.2023.1605938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Abstract
Objectives: The aim of this study was to explore the mechanism between public services and residents' health, focusing on the role of spatial geographical factors. Methods: Leveraging a comprehensive panel dataset encompassing 30 mainland Chinese provinces from 2007 to 2019, this study engineered a spatial Durbin model furnished with dual fixed effects through the application of the Lagrange multiplier, Hausman, and likelihood ratio tests. The primary objective was to delve into the repercussions of varying public service levels on residents' health outcomes. Results: The empirical findings reveal a palpable spatial autocorrelation between residents' health outcomes and the public services levels dispensed across Chinese provinces. Intriguingly, an elevation in the public service level in a given province not only ameliorates its residents' health outcomes but also triggers a spatial spillover effect, thereby positively influencing residents' health in neighboring provinces. The rigorous endogeneity and robustness checks affirm the reliability of the principal outcomes. Conclusion: Due to the increase in social uncertainty, all regions should break free of the administrative monopoly, enhance regional integration and development, and improve residents' health status by clustering public service supply.
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Affiliation(s)
- Wei Jia
- School of Politics and Public Administration, Qingdao University, Qingdao, China
| | - Lei Liu
- School of Politics and Public Administration, Qingdao University, Qingdao, China
| | - Zhihao Wang
- School of Politics and Public Administration, Qingdao University, Qingdao, China
| | - Gang Peng
- School of Statistics, Southwestern University of Finance and Economics, Chengdu, China
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7
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Ignatenko E, Ribeiro M, Oliveira MD. Informing the Design of Data Visualization Tools to Monitor the COVID-19 Pandemic in Portugal: A Web-Delphi Participatory Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11012. [PMID: 36078728 PMCID: PMC9517757 DOI: 10.3390/ijerph191711012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/07/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
Due to the large amount of data generated by new technologies and information systems in the health arena, health dashboards have become increasingly popular as data visualization tools which stimulate visual perception capabilities. Although the importance of involving users is recognized in dashboard design, a limited number of studies have combined participatory methods with visualization options. This study proposes a novel approach to inform the design of data visualization tools in the COVID-19 context. With the objective of understanding which visualization formats should be incorporated within dashboards for the COVID-19 pandemic, a specifically designed Web-Delphi process was developed to understand the preferences and views of the public in general regarding distinct data visualization formats. The design of the Delphi process aimed at considering not only the theory-based evidence regarding input data and visualization formats but also the perception of final users. The developed approach was implemented to select appropriate data visualization formats to present information commonly used in public web-based COVID-19 dashboards. Forty-seven individuals completed a two-round Web-Delphi process that was launched through a snowball approach. Most respondents were young and highly educated and expressed to prefer distinct visualisation formats for different types of indicators. The preferred visualization formats from the participants were used to build a redesigned version of the official DGS COVID-19 dashboard used in Portugal. This study provides insights into data visualization selection literature, as well as shows how a Delphi process can be implemented to assist the design of public health dashboards.
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Affiliation(s)
- Ekaterina Ignatenko
- Centre for Management Studies of Instituto Superior Técnico (CEG-IST), Universidade de Lisboa, Av. Rovisco Pais, 1, 1049-001 Lisboa, Portugal
| | - Manuel Ribeiro
- Centro de Recursos Naturais e Ambiente (CERENA), Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1, 1049-001 Lisboa, Portugal
| | - Mónica D. Oliveira
- Centre for Management Studies of Instituto Superior Técnico (CEG-IST), Universidade de Lisboa, Av. Rovisco Pais, 1, 1049-001 Lisboa, Portugal
- iBB—Institute for Bioengineering and Biosciences and i4HB—Associate Laboratory Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1, 1049-001 Lisboa, Portugal
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Wilf-Miron R, Avni S, Valinsky L, Myers V, Ziv A, Peretz G, Luxenburg O, Saban M, Feder-Bubis P. Developing a National Set of Health Equity Indicators Using a Consensus Building Process. Int J Health Policy Manag 2022; 11:1522-1532. [PMID: 34273926 PMCID: PMC9808363 DOI: 10.34172/ijhpm.2021.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/30/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Considerable health inequities documented in Israel between communities, populations and regions, undermine the rights of all citizens to optimal health. The first step towards health equity is agreement on a set of national indicators, reflecting equity in healthcare provision and health outcomes, and allowing monitoring of the impact of interventions on the reduction of disparities. We describe the process of reaching a consensus on a defined set of national equity indicators. METHODS The study was conducted between January 2019 and June 2020, in a multistage design: (A) Identifying appropriate and available inequity measures via interviews with stakeholders. (B) Agreement on the screening criteria (public health importance; gap characteristics; potential for change; public interest) and relative weighting. (C) Constructing the consultation framework as an online, 3-round Delphi technique, with a range of experts recruited from the health, welfare and education sectors. RESULTS Participants were of diverse age, gender, geographic location, religion and ethnicity, and came from academia, healthcare provision, government ministries and patient representative groups. Thirty measures of inequity, presented to participants, represented the following domains: Health promotion (11 indicators), acute and chronic morbidity (11), life expectancy and mortality (2), health infrastructures and affordability of care (4), education and employment (2). Of the 77 individuals contacted, 75 (97%) expressed willingness to participate, and 55 (73%) completed all three scoring rounds. The leading ten indicators were: Diabetes care, childhood obesity, adult obesity, distribution of healthcare personnel, fatal childhood injuries, cigarette smoking, infant mortality, ability to afford care, access to psychotherapy and distribution of hospital beds. Agreement among raters, measured as intra-class correlation coefficient (ICC), was 0.75. CONCLUSION A diverse range of consultants reached a consensus on the most important national equity indicators, including both clinical and system indicators. Results should be used to guide governmental decision-making and inter-sectoral strategies, furthering the pursuit of a more equitable healthcare system.
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Affiliation(s)
- Rachel Wilf-Miron
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Avni
- Strategic and Economic Planning Administration, Ministry of Health, Jerusalem, Israel
| | - Liora Valinsky
- Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Vicki Myers
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Arnona Ziv
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Gidi Peretz
- Strategic and Economic Planning Administration, Ministry of Health, Jerusalem, Israel
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
| | - Mor Saban
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Paula Feder-Bubis
- Department of Health Policy and Management, Faculty of Health Sciences & Guildford Glazer Faculty of Business and management, Ben Gurion University of the Negev, Beersheba, Israel
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Establishing an Expert Consensus on Key Indicators of the Quality of Life among Breast Cancer Survivors: A Modified Delphi Study. J Clin Med 2022; 11:jcm11072041. [PMID: 35407649 PMCID: PMC8999421 DOI: 10.3390/jcm11072041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: The needs of cancer survivors are often not reflected in practice. One of the main barriers of the use of patient-reported outcomes is associated with data collection and the interpretation of patient-reported outcomes (PROs) due to a multitude of instruments and measuring approaches. The aim of the study was to establish an expert consensus on the relevance and key indicators of quality of life in the clinical practice of breast cancer survivors. (2) Methods: Potential indicators of the quality of life of breast cancer survivors were extracted from the established quality of life models, depicting survivors’ perspectives. The specific domains and subdomains of quality of life were evaluated in a two-stage online Delphi process, including an international and multidisciplinary panel of experts. (3) Results: The first round of the Delphi process was completed by 57 and the second by 37 participants. A consensus was reached for the Physical and Psychological domains, and on eleven subdomains of quality of life. The results were further supported by the additional ranking of importance of the subdomains in the second round. (4) Conclusions: The current findings can serve to optimize the use of instruments and address the challenges related to data collection and interpretation as the facilitators of the adaption in routine practice.
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Ajimi A, Matsushita M, Mishima K, Haga N, Fujiwara S, Ozono K, Kubota T, Kitaoka T, Imagama S, Kitoh H. Inconvenience and adaptation in Japanese adult achondroplasia and hypochondroplasia: A cross-sectional study. Clin Pediatr Endocrinol 2022; 31:18-24. [PMID: 35002064 PMCID: PMC8713058 DOI: 10.1297/cpe.2021-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022] Open
Abstract
The health-related quality of life is reduced in patients with achondroplasia (ACH) and
hypochondroplasia (HCH); however, the detailed inconveniences in the daily living and
individual adaptations have not been elucidated. This study aimed to evaluate the
inconvenience and adaptation in patients with ACH/HCH. A cross-sectional study was
conducted in patients with ACH/HCH aged 20 yr or older. Questionnaires were sent to 567
patients (described 86) with a medical history at the co-authors’ institutions or who were
registered at the patients’ association with ACH in Japan. The questionnaire included a
free description format for the inconveniences and adaptations in daily living; a content
analysis was performed. The recorded inconveniences included 148 physical, 84 mental, and
52 social problems. Patients who underwent spine surgery had significantly more recorded
physical problems than those who did not (p < 0.05). Pain and numbness were
significantly higher in patients aged ≥ 50 yr (p < 0.05). The 160 and 1 adaptations
were for physical and social problems, respectively. No patient adaptation was found for
mental health problems. Individual adaptations by ACH/HCH patients can improve only some
aspects of physical and social problems. Multilateral social support is needed to resolve
patients’ issues.
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Affiliation(s)
- Akiko Ajimi
- Department of Physical Therapy, Faculty of Health Sciences, Mejiro University, Saitama, Japan
| | - Masaki Matsushita
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichi Mishima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuhiko Haga
- Department of Rehabilitation Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Sayaka Fujiwara
- Department of Rehabilitation Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takuo Kubota
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Taichi Kitaoka
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Kitoh
- Department of Orthopaedic Surgery, Aichi Children's Health and Medical Center, Aichi, Japan.,Department of Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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11
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Murray ET, Shelton N, Norman P, Head J. Measuring the health of people in places: A scoping review of OECD member countries. Health Place 2021; 73:102731. [PMID: 34929525 DOI: 10.1016/j.healthplace.2021.102731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/04/2022]
Abstract
A scoping review was performed to identify how Organisation for Economic Co-operation and Development (OECD) countries measure overall health for sub-national geographies within each country. Sixty publications were selected from MEDLINE, Scopus and Google Scholar, plus information extracted from 37 of 38 OECD countries statistical agency and/or public health institute websites that were available in English. Data sources varied by categorisation into national statistical agency mortality (n = 7) or population-level survey morbidity (n = 5) health indicators. Region was the most common geographic scale (e.g., eight indicators for 26 countries), slightly fewer indicators for urban areas (max countries per most frequent indicator = 24), followed by municipality (range of 1-14 countries per indicator). Other geographies, particularly those at smaller granularity, were infrequently available across health indicators and countries. Wider availability of health indicators at smaller, and non-administrative, geographies is needed to explore the best way to measure comparative population health in local areas.
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Affiliation(s)
- Emily T Murray
- University College London, Research Department of Epidemiology and Public Health, London, UK.
| | - Nicola Shelton
- University College London, Research Department of Epidemiology and Public Health, London, UK
| | - Paul Norman
- University of Leeds, School of Geography, Leeds, UK
| | - Jenny Head
- University College London, Research Department of Epidemiology and Public Health, London, UK
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The Contributions of Biomass Supply for Bioenergy in the Post-COVID-19 Recovery. ENERGIES 2021. [DOI: 10.3390/en14248415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This research investigates how biomass supply chains (BSChs) for bioenergy within the broader bioeconomy could contribute to the post-COVID-19 recovery in three dimensions: boosting economic growth, creating jobs, and building more resilient and cleaner energy systems in four future scenarios, in the short term (by 2023) and long term (by 2030). A SWOT analysis on BSChs was used for generating a questionnaire for foresight by a two-round Delphi study. To interpret the results properly, a short survey and literature review is executed to record BSChs behavior during the pandemic. In total, 23 (55% response rate) and 28 (46% response rate) biomass experts from three continents participated in the Delphi and the short survey, respectively. The strongest impact from investment in BSChs would be on economic growth, followed by a contribution to the resilient and cleaner energy systems and job creation. The effects would be more visible in the long- than in the short-term period. Investments with the most impact on recovery are those that improve biomass material efficiency and circularity. Refurbishment of current policies to enhance the supply of biomass as a renewable resource to the future economy is a must.
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Costa C, Santana P. Trends of amenable deaths due to healthcare within the European Union countries. Exploring the association with the economic crisis and education. SSM Popul Health 2021; 16:100982. [PMID: 34926783 PMCID: PMC8648806 DOI: 10.1016/j.ssmph.2021.100982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 02/03/2023] Open
Abstract
The study of premature deaths from causes that are generally preventable given the current availability of healthcare - called amenable deaths due to healthcare - provides information on the quality of services. However, they are not only impacted by healthcare characteristics: other factors are also likely to influence. Therefore, identifying the association between amenable deaths due to healthcare and health determinants, such as education, might be the key to preventing these deaths in the future. Still unclear however, is how this works and how amenable deaths due to healthcare are distributed and evolve within the European Union (EU) below the national level. We therefore studied the geographical and temporal patterns of amenable deaths due to healthcare in the 259 EU regions from 1999 to 2016, including the 2007-2008 financial crisis and the post-2008 economic downturn, and identified whether any association with education exists. A cross-sectional ecological study was carried out. Using a hierarchical Bayesian model, we estimated the average smoothed Standardized Mortality Ratios (sSMR). A regression model was also applied to measure the relative risks (RR) at 95% credible intervals for cause-specific mortality association with education. Results show that amenable deaths due to healthcare decreased globally. Nevertheless, the decrease is not the same across all regions, and inequalities within countries do persist, with lower mortality ratios seen in regions from Central European countries and higher mortality ratios in regions from Eastern European countries. Also, the evolution trend reveals that after the financial crisis, the number of these deaths increased in regions across almost all EU countries. Moreover, educational disparities in mortality emerged, and a statistical association was found between amenable deaths due to healthcare and early exit from education and training. These results confirm that identifying and understanding the background of regional differences may lead to a better understanding of the amenable deaths due to healthcare and allow for the application of more effective policies.
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Affiliation(s)
- Claudia Costa
- Centre of Studies in Geography and Spatial Planning (CEGOT), Department of Geography and Tourism, University of Coimbra, Portugal
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning (CEGOT), Department of Geography and Tourism, University of Coimbra, Portugal
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Defining two novel sub models of the Anglo-American paramedic system: A Delphi study. Australas Emerg Care 2021; 25:229-234. [PMID: 34838505 DOI: 10.1016/j.auec.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION While brief and fragmented accounts of the differences between systems have been noted in the literature, until recently there has been a lack of research that explores and identifies new sub-models of paramedicine within the Anglo-American paramedic system. METHODS A Delphi method was used to gain consensus among international paramedic experts regarding two new models of paramedicine known as the Directive and Professionally Autonomous paramedic systems. Following the development of a preliminary definition, a set of questions were established for experts aimed at defining the new sub-models; the responses were reviewed and amended based on feedback before being re-distributed to an expanded group of participants for further rounds of questions. Rounds continued until consensus was achieved. RESULTS Consensus was achieved for both statements regarding the Professionally Autonomous paramedic system definition in round 2, 85.7% (n = 18). Following analysis and revision of the definition, the additional two statements regarding the Directive paramedic system achieved consensus in round 3, 100% (n = 19). CONCLUSION This Delphi study was the first study to explore a standardised definition for two newly identified sub-models of the Anglo-American paramedic system with the overall results used to help inform high performing system design for modern Anglo-American paramedic systems into the future.
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Hübelová D, Kuncová M, Vojáčková H, Coufalová J, Kozumplíková A, Lategan FS, Chromková Manea BE. Inequalities in Health: Methodological Approaches to Spatial Differentiation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312275. [PMID: 34886004 PMCID: PMC8656580 DOI: 10.3390/ijerph182312275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/07/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022]
Abstract
The prevalence of inequalities in the general health position of communities can be assessed by using selected determinants. The aims of this article are three-fold: (1) to apply a comprehensive approach to the assessment of inequalities in the general health position of communities, (2) to determine the spatial differentiation of determinants, and (3) to present selected assessment methods and their impact on the results. To present a quantitative assessment of these inequalities in health status in communities, a composite indicator (Health Index) was developed. This Health Index is composed of 8 areas of evaluation and 60 indicators which include, amongst others, determinants of health status and healthcare at district level (LAU 1) in the Czech Republic. The data are evaluated using multicriteria decision-making methods (the WSA and TOPSIS methods). Findings suggest that, when all eight domains are assigned the same weight of one, the spatial differentiation among the districts is similar when using both methods. If different weightings are assigned to the districts, changes occur in both the index values and the rankings of the analyzed districts. For example, the allocation of weightings in both methods results in a rearrangement of the ranking of districts for which the Health Index is around the average.
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Affiliation(s)
- Dana Hübelová
- Department of Social Studies, Faculty of Regional Development and International Studies, Mendel University in Brno, 613 00 Brno, Czech Republic;
- Correspondence: (D.H.); (A.K.); Tel.: +420-545-136-282 (D.H. & A.K.)
| | - Martina Kuncová
- Department of Economic Studies, College of Polytechnics Jihlava, 586 01 Jihlava, Czech Republic;
| | - Hana Vojáčková
- Department of Technical Studies, College of Polytechnics Jihlava, 586 01 Jihlava, Czech Republic;
| | - Jitka Coufalová
- Department of Development, City Municipality of Břeclav, 690 02 Břeclav, Czech Republic;
| | - Alice Kozumplíková
- Department of Environmental Studies, Faculty of Regional Development and International Studies, Mendel University in Brno, 613 00 Brno, Czech Republic
- Correspondence: (D.H.); (A.K.); Tel.: +420-545-136-282 (D.H. & A.K.)
| | - Francois Stefanus Lategan
- Department of Regional and Business Economics, Faculty of Regional Development and International Studies, Mendel University in Brno, 613 00 Brno, Czech Republic;
| | - Beatrice-Elena Chromková Manea
- Department of Social Studies, Faculty of Regional Development and International Studies, Mendel University in Brno, 613 00 Brno, Czech Republic;
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Phoi YY, Bonham MP, Rogers M, Dorrian J, Coates AM. Content Validation of a Chrononutrition Questionnaire for the General and Shift Work Populations: A Delphi Study. Nutrients 2021; 13:nu13114087. [PMID: 34836341 PMCID: PMC8620673 DOI: 10.3390/nu13114087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 12/11/2022] Open
Abstract
Unusual meal timing has been associated with a higher prevalence of chronic disease. Those at greater risk include shift workers and evening chronotypes. This study aimed to validate the content of a Chrononutrition Questionnaire for shift and non-shift workers to identify temporal patterns of eating in relation to chronotype. Content validity was determined using a Delphi study of three rounds. Experts rated the relevance of, and provided feedback on, 46 items across seven outcomes: meal regularity, times of first eating occasion, last eating occasion, largest meal, main meals/snacks, wake, and sleep, which were edited in response. Items with greater than 70% consensus of relevance were accepted. Rounds one, two, and three had 28, 26, and 24 experts, respectively. Across three rounds, no outcomes were irrelevant, but seven were merged into three for ease of usage, and two sections were added for experts to rate and comment on. In the final round, all but one of 29 items achieved greater than 70% consensus of relevance with no further changes. The Chrononutrition Questionnaire was deemed relevant to experts in circadian biology and chrononutrition, and could represent a convenient tool to assess temporal patterns of eating in relation to chronotype in future studies.
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Affiliation(s)
- Yan Yin Phoi
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia;
- Alliance for Research in Exercise, Nutrition and Activity (ARENA) Research Centre, University of South Australia, Adelaide, SA 5001, Australia;
| | - Maxine P. Bonham
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC 3168, Australia;
| | - Michelle Rogers
- Alliance for Research in Exercise, Nutrition and Activity (ARENA) Research Centre, University of South Australia, Adelaide, SA 5001, Australia;
- UniSA Justice and Society, University of South Australia, Adelaide, SA 5072, Australia;
| | - Jillian Dorrian
- UniSA Justice and Society, University of South Australia, Adelaide, SA 5072, Australia;
- Behaviour-Brain-Body Research Centre, University of South Australia, Adelaide, SA 5072, Australia
| | - Alison M. Coates
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia;
- Alliance for Research in Exercise, Nutrition and Activity (ARENA) Research Centre, University of South Australia, Adelaide, SA 5001, Australia;
- Correspondence:
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Candeias P, Alarcão V, Stefanovska-Petkovska M, Santos O, Virgolino A, Pintassilgo S, Pascoal PM, Costa AS, Machado FL. Reducing Sexual and Reproductive Health Inequities Between Natives and Migrants: A Delphi Consensus for Sustainable Cross-Cultural Healthcare Pathways. Front Public Health 2021; 9:656454. [PMID: 34055720 PMCID: PMC8155376 DOI: 10.3389/fpubh.2021.656454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/14/2021] [Indexed: 12/30/2022] Open
Abstract
The increasing number of international migrants (ranging from 153 million in 1990 to ~272 million in 2019) brought to attention the wide variation of national contexts concerning the policy measures to protect migrants' rights and ensuring their equal access to basic and essential services, namely in health. Sexual and Reproductive Health (SRH) is a key component to the overall health and quality of life and is impacted by power inequities inherent to society's institutions, environment, economics, and culture. In Portugal, guidelines for intervention in SRH are insufficient, a gap that is more pronounced with migrant populations due to the absence of culturally sensitive indicators to assess and monitor SRH. The aim of this work was 2-fold: to identify good practices in the SRH field, with a particular focus, whenever possible, on migrant populations, and to identify relevant and inclusive indicators to monitor SRH in Portugal. A Delphi panel (via online survey) with 66 experts (researchers, teachers, and health professionals) and 16 stakeholders (non-governmental organizations, civil society, and governmental organizations) was implemented in two rounds. Panelists were asked to state their level of agreement (5-point Likert-type scale) regarding four different SRH areas: Sexual Health, Reproductive Health, Social-Structural Factors, and Good Practices. Items were based on literature review and a World Café with 15 experts and stakeholders. Participation rate was 68% and response rate was 97% on the first round. From the initial list of 142 items, a total of 118 (83%) items were approved by consensus. Findings may provide extended opportunities for the healthcare system to engage in better informed decisions and more inclusive and integrative strategies regarding SRH, contributing to build political measures toward sexual and reproductive justice.
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Affiliation(s)
- Pedro Candeias
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Violeta Alarcão
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Centro de Investigação e Estudos de Sociologia, ISCTE - Instituto Universitário de Lisboa (ISCTE-IUL), Lisboa, Portugal
| | | | - Osvaldo Santos
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Unbreakable Idea Research, Painho, Portugal
| | - Ana Virgolino
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Sónia Pintassilgo
- Centro de Investigação e Estudos de Sociologia, ISCTE - Instituto Universitário de Lisboa (ISCTE-IUL), Lisboa, Portugal
| | - Patrícia M. Pascoal
- Centro de Investigação em Ciência Psicológica, Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
- Digital Human-Environment Interaction Lab, Universidade Lusófona, Lisboa, Portugal
| | - Andreia Silva Costa
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa, Escola Superior de Enfermagem de Lisboa, Lisboa, Portugal
| | - Fernando Luís Machado
- Centro de Investigação e Estudos de Sociologia, ISCTE - Instituto Universitário de Lisboa (ISCTE-IUL), Lisboa, Portugal
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Ahmed F, Ahmad G, Brand T, Zeeb H. Key indicators for appraising adolescent sexual and reproductive health in South Asia: international expert consensus exercise using the Delphi technique. Glob Health Action 2020; 13:1830555. [PMID: 33076781 PMCID: PMC7594874 DOI: 10.1080/16549716.2020.1830555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/28/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND There is a need for an accurate assessment of the patterns and determinants of sexual and reproductive health in South Asia owing to high fertility rates and high incidence of unplanned pregnancy among adolescents. Health indicator sets, with a wide range of health dimensions, also support in formulating evidence-based policies. For attaining this, indicators should be developed and prioritized based on consensus and relevance. OBJECTIVE This study aimed to develop a comprehensive list of adolescent sexual and reproductive health (ASRH) key indicators for South Asia through systematic participatory expert consultation exercise using the Delphi technique. METHODS Experts were invited to two rounds of an indicator rating exercise and a third round to discuss the results in a broader regional perspective. A list of nine indicator categories, including 41 adolescent health indicators, was rated by the expert panel. Prioritization was based on mean Likert scores while consensus was established using Kendall's W. RESULTS 24, 16 and six experts participated in the first, second and third round, respectively. Out of the nine indicator categories, demographics, reproductive health, violence, and nutrition were ranked high in relevance by the expert panel. Experts had a strong consensus on the relevance of parental control and connection, and behavioral indicators while there was moderate consensus on the relevance of nutrition, infectious disease, and mortality indicators. CONCLUSION As far as we know, this is the first study that employs the Delphi technique for prioritizing ASRH indicators for South Asia. Engaging a diverse group of experts, using an online platform, we developed a comprehensive list of key indicators for appraising ASRH relevant to South Asia based on expert panel consensus and recommendations. Our results also highlight that there is a need for developing a region-specific prioritized list of indicators which might assist in identifying regional health needs.
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Affiliation(s)
- Furqan Ahmed
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Ghufran Ahmad
- NUST Business School (NBS), National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Tilman Brand
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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Freitas Â, Rodrigues TC, Santana P. Assessing Urban Health Inequities through a Multidimensional and Participatory Framework: Evidence from the EURO-HEALTHY Project. J Urban Health 2020; 97:857-875. [PMID: 32860097 PMCID: PMC7454139 DOI: 10.1007/s11524-020-00471-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Urban health inequities often reflect and follow the geographic patterns of inequality in the social, economic and environmental conditions within a city-the so-called determinants of health. Evidence of patterns within these conditions can support decision-making by identifying where action is urgent and which policies and interventions are needed to mitigate negative impacts and enhance positive impacts. Within the scope of the EU-funded project EURO-HEALTHY (Shaping EUROpean policies to promote HEALTH equitY), the City of Lisbon was selected as a case study to apply a multidimensional and participatory assessment approach of urban health whose purpose was to inform the evaluation of policies and interventions with potential to address local health gaps. In this paper, we present the set of indicators identified as drivers of urban health inequities within the City of Lisbon, exploring the added value of using a spatial indicator framework together with a participation process to orient a place-based assessment and to inform policies aimed at reducing health inequities. Two workshops with a panel of local stakeholders from health and social care services, municipal departments (e.g. urban planning, environment, social rights and education) and non-governmental and community-based organizations were organized. The aim was to engage local stakeholders to identify locally critical situations and select indicators of health determinants from a spatial equity perspective. To support the analysis, a matrix of 46 indicators of health determinants, with data disaggregated at the city neighbourhood scale, was constructed and was complemented with maps. The panel identified critical situations for urban health equity in 28 indicators across eight intervention axes: economic conditions, social protection and security; education; demographic change; lifestyles and behaviours; physical environment; built environment; road safety and healthcare resources and performance. The geographical distribution of identified critical situations showed that all 24 city neighbourhoods presented one or more problems. A group of neighbourhoods systematically perform worse in most indicators from different intervention axes, requiring not only priority action but mainly a multi- and intersectoral policy response. The indicator matrices and maps have provided a snapshot of urban inequities across different intervention axes, making a compelling argument for boosting intersectoral work across municipal departments and local stakeholders in the City of Lisbon. This study, by integrating local evidence in combination with social elements, pinpoints the importance of a place-based approach for assessing urban health equity.
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Affiliation(s)
- Ângela Freitas
- CEGOT-UC, Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal.
| | - Teresa C Rodrigues
- CEG-IST, Centre for Management Studies of Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Paula Santana
- CEGOT-UC, Centre of Studies in Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Coimbra, Portugal
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Selecting Indicators to Monitor and Assess Environmental Health in a Portuguese Urban Setting: A Participatory Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228597. [PMID: 33228088 PMCID: PMC7699361 DOI: 10.3390/ijerph17228597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 01/06/2023]
Abstract
Environmental health (EH) is influenced by complex interactions between health and the built and natural environments, there being little research on its specificities in urban settings. The use of suitable indicators to monitor and assess EH is fundamental in informing evidence-based interventions at the local level. A participatory approach to selecting indicators to inform the monitoring and assessment of EH in Lisbon is herein considered. Evidence derived from a systematic review of literature and data from Lisbon and Portuguese databases were analyzed by 12 Portuguese experts in individual semi-structured interviews. The interviews aimed at identifying relevant indicators and important emerging issues in the Lisbon urban setting. The outputs from the interviews were validated by a two-round Web-Delphi process in which panelists (22 experts) from different areas of expertise expressed their views regarding the relevance of the indicators for the analysis of EH in urban settings. Seventeen indicators were validated in the Web-Delphi process. High participation achieved along this process supports the view that this participatory approach was useful for validation. Results from the adopted participatory approach point out gaps in the collection of noise and mobility indicators data and raise emerging issues on housing indicators that require further research. The results also suggest the need for local action to improve indicators and tools in order to help the monitorization of EH in urban contexts. The adopted participatory approach can be replicated for other Portuguese and European urban settings.
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A Review of the Relation between Household Indoor Temperature and Health Outcomes. ENERGIES 2020. [DOI: 10.3390/en13112881] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This paper provides a review of research that addresses the relationship between indoor temperatures and health outcomes, taking into consideration studies that focus heat or cold exposure within the household context. It aims to extend previous research by considering both indoor temperatures from existing housing, and empirical studies that focus on energy efficiency measures and subsequent health impacts. To achieve this aim, a literature review was undertaken, combining engineering and health databases. The review established that, overall, inadequate indoor temperatures are associated with poor health status, whereas energy efficiency measures have been associated to improved indoor temperatures and occupant’s health namely regarding cardiovascular, respiratory and mental health disorders. These health conditions are among the most prevalent non-communicable diseases (NCD). The review also highlighted the need for more empirical studies with an extended timeframe to deal with climate change challenges. It underlined the potential advantages of the convergence between health and energy efficiency studies, for better modelling and planning.
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Santana P, Freitas Â, Costa C, Stefanik I, Santinha G, Krafft T, Pilot E. The Role of Cohesion Policy Funds in Decreasing the Health Gaps Measured by the EURO-HEALTHY Population Health Index. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1567. [PMID: 32121335 PMCID: PMC7084523 DOI: 10.3390/ijerph17051567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/18/2020] [Accepted: 02/25/2020] [Indexed: 01/06/2023]
Abstract
Social, economic, and environmental differences across the European Union significantly affect opportunities to move forward in achieving greater equity in health. Cohesion Policy (CP) funds can contribute positively through investments in the main determinants of health. The aim of this study is to analyze to what extent the planned investments for 2014-2020 are addressing the regional health gaps, in light of the population health index (PHI), a multidimensional measure developed by the EURO-HEALTHY project. The operational programs of all regions were analyzed, namely, the CP planned investments by field of intervention. Analysis of variance was performed to examine whether the regional scores in the PHI dimensions were statistically different across regions with different levels of development (measured by gross domestic product (GDP)). Results show that 98% of regions with worse performances on the PHI are less developed regions. Overall, all regions present planned investments in intervention fields linked to dimensions appraised within the PHI (e.g., employment, income, education, pollution). Yet, more needs to be done to focus regional investments in health determinants where regions still lag behind. The PHI has the potential to inform future CP restructuring, providing evidence to extend the current eligibility criteria to other dimensions beyond the GDP.
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Affiliation(s)
- Paula Santana
- Department of Geography and Tourism, Faculty of Arts and Humanities, University of Coimbra, 3004-530 Coimbra, Portugal
| | - Ângela Freitas
- Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3004-530 Coimbra, Portugal; (Â.F.); (C.C.); (I.S.); (G.S.)
| | - Cláudia Costa
- Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3004-530 Coimbra, Portugal; (Â.F.); (C.C.); (I.S.); (G.S.)
| | - Iwa Stefanik
- Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3004-530 Coimbra, Portugal; (Â.F.); (C.C.); (I.S.); (G.S.)
| | - Gonçalo Santinha
- Centre of Studies in Geography and Spatial Planning (CEGOT), University of Coimbra, 3004-530 Coimbra, Portugal; (Â.F.); (C.C.); (I.S.); (G.S.)
- Department of Social, Political and Territorial Sciences; Governance, Competitiveness and Public Policies Research Unit (GOVCOPP), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Thomas Krafft
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Society, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (T.K.); (E.P.)
- Maastricht Centre for Global Health, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Eva Pilot
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Society, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (T.K.); (E.P.)
- Maastricht Centre for Global Health, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Santana P, Freitas Â, Stefanik I, Costa C, Oliveira M, Rodrigues TC, Vieira A, Ferreira PL, Borrell C, Dimitroulopoulou S, Rican S, Mitsakou C, Marí-Dell'Olmo M, Schweikart J, Corman D, Bana E Costa CA. Advancing tools to promote health equity across European Union regions: the EURO-HEALTHY project. Health Res Policy Syst 2020; 18:18. [PMID: 32054540 PMCID: PMC7020561 DOI: 10.1186/s12961-020-0526-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 01/15/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Population health measurements are recognised as appropriate tools to support public health monitoring. Yet, there is still a lack of tools that offer a basis for policy appraisal and for foreseeing impacts on health equity. In the context of persistent regional inequalities, it is critical to ascertain which regions are performing best, which factors might shape future health outcomes and where there is room for improvement. METHODS Under the EURO-HEALTHY project, tools combining the technical elements of multi-criteria value models and the social elements of participatory processes were developed to measure health in multiple dimensions and to inform policies. The flagship tool is the Population Health Index (PHI), a multidimensional measure that evaluates health from the lens of equity in health determinants and health outcomes, further divided into sub-indices. Foresight tools for policy analysis were also developed, namely: (1) scenarios of future patterns of population health in Europe in 2030, combining group elicitation with the Extreme-World method and (2) a multi-criteria evaluation framework informing policy appraisal (case study of Lisbon). Finally, a WebGIS was built to map and communicate the results to wider audiences. RESULTS The Population Health Index was applied to all European Union (EU) regions, indicating which regions are lagging behind and where investments are most needed to close the health gap. Three scenarios for 2030 were produced - (1) the 'Failing Europe' scenario (worst case/increasing inequalities), (2) the 'Sustainable Prosperity' scenario (best case/decreasing inequalities) and (3) the 'Being Stuck' scenario (the EU and Member States maintain the status quo). Finally, the policy appraisal exercise conducted in Lisbon illustrates which policies have higher potential to improve health and how their feasibility can change according to different scenarios. CONCLUSIONS The article makes a theoretical and practical contribution to the field of population health. Theoretically, it contributes to the conceptualisation of health in a broader sense by advancing a model able to integrate multiple aspects of health, including health outcomes and multisectoral determinants. Empirically, the model and tools are closely tied to what is measurable when using the EU context but offering opportunities to be upscaled to other settings.
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Affiliation(s)
- Paula Santana
- Department of Geography and Tourism, Faculty of Arts and Humanities, University of Coimbra, Colégio S. Jerónimo, Largo D. Dinis, 3001-401, Coimbra, Portugal.
- CEGOT-UC, Centre of Studies in Geography and Territorial Planning, University of Coimbra, Coimbra, Portugal.
| | - Ângela Freitas
- CEGOT-UC, Centre of Studies in Geography and Territorial Planning, University of Coimbra, Coimbra, Portugal
| | - Iwa Stefanik
- CEGOT-UC, Centre of Studies in Geography and Territorial Planning, University of Coimbra, Coimbra, Portugal
| | - Cláudia Costa
- CEGOT-UC, Centre of Studies in Geography and Territorial Planning, University of Coimbra, Coimbra, Portugal
| | - Mónica Oliveira
- CEG-IST, Centre for Management Studies of Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisbon, Portugal
| | - Teresa C Rodrigues
- CEG-IST, Centre for Management Studies of Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisbon, Portugal
| | - Ana Vieira
- CEG-IST, Centre for Management Studies of Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisbon, Portugal
| | - Pedro Lopes Ferreira
- CEISUC, Center for Health Studies and Research, Faculty of Economics, University of Coimbra, Coimbra, Portugal
| | - Carme Borrell
- ASPB, Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Sani Dimitroulopoulou
- PHE-CRCE, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, OX11 0RQ, United Kingdom
| | - Stéphane Rican
- LAboratoire DYnamiques Sociales et Recomposition des espaceS (LADYSS), Paris Nanterre University, Paris, France
| | - Christina Mitsakou
- PHE-CRCE, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, OX11 0RQ, United Kingdom
| | - Marc Marí-Dell'Olmo
- ASPB, Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | | | | | - Carlos A Bana E Costa
- CEG-IST, Centre for Management Studies of Instituto Superior Técnico, Universidade de Lisboa, Avenida Rovisco Pais, 1049-001, Lisbon, Portugal
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Rada MP, Pergialiotis V, Betschart C, Falconi G, Haddad JM, Doumouchtsis SK. A protocol for developing, disseminating, and implementing a core outcome set for stress urinary incontinence. Medicine (Baltimore) 2019; 98:e16876. [PMID: 31517813 PMCID: PMC6750288 DOI: 10.1097/md.0000000000016876] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Randomized trials evaluating interventions for stress urinary incontinence (SUI) have been using variable outcome measures, reporting a variety of outcomes. Alongside this variation across studies, outcome-reporting flaws contribute to a limited use of research to inform clinical practice. The development and use of core outcome sets (COSs) in future trials would ensure that outcomes important to different stakeholders and primarily women with SUI are reported more consistently and comprehensively. METHODS An international steering group including healthcare professionals, researchers, and women with urinary incontinence will guide the development of this COS. Potential outcomes will be identified through comprehensive literature reviews. These outcomes will be entered into an international, multiperspective online Delphi survey. All key stakeholders, including healthcare professionals, researchers, and women with urinary incontinence, will be invited to participate. The modified Delphi method encourages stakeholder group convergence toward collective agreement, also referred as consensus, core outcomes. DISCUSSION Dissemination and implementation of the resulting COS within an international context will be promoted and reviewed. Embedding the COS for SUI within future clinical trials, systematic reviews and clinical practice guidelines could make a significant contribution to advancing the value of research in informing clinical practice, enhancing patient care and improving outcomes. The infrastructure created by developing a COS for SUI could be leveraged in other settings, for example, selecting research priorities and clinical practice guideline development.
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Affiliation(s)
- Maria-Patricia Rada
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, United Kingdom
- “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, 2nd Department of Obstetrics and Gynaecology, “Dominic Stanca” Clinic, Romania
| | - Vasilios Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research N S Christeas, Athens University Medical School, Athens, Greece
| | - Cornelia Betschart
- Department of Gynecology, University Hospital of Zurich, Zurich, Switzerland
| | - Gabriele Falconi
- Department of Obstetrics and Gynaecology, San Bortolo Hospital, Vicenza, Italy
| | - Jorge Milhem Haddad
- Department Obstetrics and Gynaecology, Urogynaecology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Stergios K. Doumouchtsis
- Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, United Kingdom
- Laboratory of Experimental Surgery and Surgical Research N S Christeas, Athens University Medical School, Athens, Greece
- St George's University of London, London, UK
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Costa C, Freitas Â, Stefanik I, Krafft T, Pilot E, Morrison J, Santana P. Evaluation of data availability on population health indicators at the regional level across the European Union. Popul Health Metr 2019; 17:11. [PMID: 31391120 PMCID: PMC6686464 DOI: 10.1186/s12963-019-0188-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/22/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The ability to measure regional health inequalities across Europe and to build adequate population health indices depends significantly on the availability of reliable and comparable data at the regional level. Within the scope of the EU-funded project EURO-HEALTHY, a Population Health Index (PHI) was built. This model aggregates 39 indicators considered relevant by experts and stakeholders to evaluate and monitor population health on the regional level within the European Union (269 regions). The aim of this research was to assess the data availability for those indicators. As a subsequent aim, an adequate protocol to overcome issues arising from missing data will be presented, as well as key messages for both national and European statistical authorities meant to improve data collection on population health. METHODS The methodology for the study includes three consecutive phases: (i) assessing the data availability for the respective indicators at the regional level for the last year available (ii) applying a protocol for missing data and completing the database and (iii) developing a scoring system ranging from 0 (no data available; worst) to 1 (all data available; best) to evaluate the availability of data by indicator and EU region. RESULTS Although the missing data on the set of the PHI indicators was significant, the mean availability score for the EURO-HEALTHY PHI indicators is 0.8 and the regional availability score is 0.7, which reveal the strength of the indicators as well as the data completeness protocol for missing data. CONCLUSIONS This study provides a comprehensive data availability assessment for population health indicators from multiple areas of concern, at the EU regional level. The results highlight that the data completeness protocol and availability scores are suitable tools to apply on any indicator's data source mapping. It also raises awareness to the urgent need for sub-national data in several domains and for closing the data gaps between and within countries. This will require policies clearly focused on improving equity between regions and a coordinated effort from the producers of data (the EU28 national statistics offices and EUROSTAT) and the stakeholders who design policies at EU, regional and local level.
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Affiliation(s)
- Claudia Costa
- Centre of Studies in Geography and Spatial Planning (CEGOT), Department of Geography and Tourism, University of Coimbra, 3004-530 Coimbra, Portugal
| | - Ângela Freitas
- Centre of Studies in Geography and Spatial Planning (CEGOT), Department of Geography and Tourism, University of Coimbra, 3004-530 Coimbra, Portugal
| | - Iwa Stefanik
- Centre of Studies in Geography and Spatial Planning (CEGOT), Department of Geography and Tourism, University of Coimbra, 3004-530 Coimbra, Portugal
| | - Thomas Krafft
- Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Department of Health, Ethics and Society, Maastricht University, Maastricht, The Netherlands
| | - Eva Pilot
- Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Department of Health, Ethics and Society, Maastricht University, Maastricht, The Netherlands
| | - Joana Morrison
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning (CEGOT), Department of Geography and Tourism, University of Coimbra, 3004-530 Coimbra, Portugal
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Viterbo LMF, Dinis MAP, Costa AS, Vidal DG. Development and Validation of an Interdisciplinary Worker's Health Approach Instrument (IWHAI). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2803. [PMID: 31390795 PMCID: PMC6695998 DOI: 10.3390/ijerph16152803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 07/30/2019] [Accepted: 08/05/2019] [Indexed: 12/25/2022]
Abstract
The present study aimed to develop and validate an Interdisciplinary Worker's Health Approach Instrument (IWHAI). The development stage comprised a group of 10 professionals, including physicians, nurses, nutritionists, dentists and physical educators, as well as a judges' committee, composed by 19 recognized experts in the area of worker's health (WH). For the validation of the IWHAI, the Spearman's correlation coefficient (rs) was calculated, the factor analysis to the instrument was applied, and the Cronbach's alpha (α) and the Intraclass correlation coefficient (ICC) were calculated. The IWHAI was structured in five dimensions, integrating 43 health indicators, on a scale of 0-4, totalling 215 sub-indices with closed response coding. The instrument was validated with a Kappa coefficient (KAPPA) (k), with excellent agreement for all attributes, i.e., k = 0.88 for applicability, k = 0.80 for clarity and k = 0.82 for relevance. p > 0.05 results reveal moderate to strong positive correlations between some variables, i.e., pests, vectors and air quality/drinking water quality (rs = 0.69). A total of 14 components of the factor analysis, explaining 62.6% of the data variance, were extracted. α value is considered moderate to high, α = 0.61, the ICC value also being considered moderate to high, with ICC = 0.61. The IWHAI is considered validated, constituting a technological innovation for an interdisciplinary approach in the field of WH, enabling the prevention and integral promotion of health.
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Affiliation(s)
- Lilian Monteiro Ferrari Viterbo
- UFP Energy, Environment and Health Research Unit (FP-ENAS), University Fernando Pessoa, 4249-004 Porto, Portugal.
- Universidade Corporativa, Bahia 41745-002, Brazil.
| | - Maria Alzira Pimenta Dinis
- UFP Energy, Environment and Health Research Unit (FP-ENAS), University Fernando Pessoa, 4249-004 Porto, Portugal
| | | | - Diogo Guedes Vidal
- UFP Energy, Environment and Health Research Unit (FP-ENAS), University Fernando Pessoa, 4249-004 Porto, Portugal
- CNPq Research Group "Dynamics of neuro-musculo-skeletal System", Bahiana School of Medicine and Public Health, Bahia 40290-000, Brazil
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Petros N, Mechelli A, Fusar-Poli P, Vieira S, Rowland E, McGuire P. Towards a framework for good outcome in people at clinical high risk for psychosis: A Delphi consensus study. Schizophr Res 2019; 208:209-216. [PMID: 30948149 DOI: 10.1016/j.schres.2019.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/20/2019] [Accepted: 02/25/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Outcomes in people at clinical high risk for psychosis (CHRP) have usually been defined in terms of psychosis onset. However, within the subgroup of individuals who do not develop psychosis, some have persistent symptoms; while in others, symptoms resolve and functioning is restored. Currently, little is known about what predicts a good outcome (GO) in CHR-P individuals, partly because there is no consensus on how this should be defined. METHOD The Delphi method was used to elicit the opinions of 46 experts to reach a consensus on factors that together could define GO in the CHR-P population. Three online surveys were implemented. The panel rated each survey item according to how important they thought it was as a measure of GO. Participants also answered open-ended questions on how GO should be determined, their responses were subject to content analysis. RESULTS Ninety-eight items were endorsed by 80% of the panel as essential or important for a GO; these fell into 4 domains: Functioning; Symptoms; Distress/Suicidality; and Subjective Wellbeing. The individual item that was rated as the most important, was daily functioning. Themes emerged from the qualitative data, which corresponded to the Delphi domains, including 'functioning'; 'clinical factors; and 'user-defined outcomes'. CONCLUSIONS A GO in CHR-P subjects can be defined by using a combination of measures from domains that reflect level of functioning; symptoms; distress/suicidality; and subjective wellbeing. These results provide a basis for a standardised definition of good outcome in people at clinical high risk of psychosis.
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Affiliation(s)
- Natalia Petros
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Andrea Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Sandra Vieira
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emma Rowland
- Department of Child and Family Health Care, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Mitsakou C, Dimitroulopoulou S, Heaviside C, Katsouyanni K, Samoli E, Rodopoulou S, Costa C, Almendra R, Santana P, Dell'Olmo MM, Borrell C, Corman D, Zengarini N, Deboosere P, Franke C, Schweikart J, Lustigova M, Spyrou C, de Hoogh K, Fecht D, Gulliver J, Vardoulakis S. Environmental public health risks in European metropolitan areas within the EURO-HEALTHY project. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 658:1630-1639. [PMID: 30678019 DOI: 10.1016/j.scitotenv.2018.12.130] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/03/2018] [Accepted: 12/09/2018] [Indexed: 06/09/2023]
Abstract
Urban areas in Europe are facing a range of environmental public health challenges, such as air pollution, traffic noise and road injuries. The identification and quantification of the public health risks associated with exposure to environmental conditions is important for prioritising policies and interventions that aim to diminish the risks and improve the health of the population. With this purpose in mind, the EURO-HEALTHY project used a consistent approach to assess the impact of key environmental risk factors and urban environmental determinants on public health in European metropolitan areas. A number of environmental public health indicators, which are closely tied to the physical and built environment, were identified through stakeholder consultation; data were collected from six European metropolitan areas (Athens, Barcelona, Lisbon, London, Stockholm and Turin) covering the period 2000-2014, and a health impact assessment framework enabled the quantification of health effects (attributable deaths) associated with these indicators. The key environmental public health indicators were related to air pollution and certain urban environmental conditions (urban green spaces, road safety). The air pollution was generally the highest environmental public health risk; the associated number of deaths in Athens, Barcelona and London ranged between 800 and 2300 attributable deaths per year. The number of victims of road traffic accidents and the associated deaths were lowest in the most recent year compared with previous years. We also examined the positive impacts on health associated with urban green spaces by calculating reduced mortality impacts for populations residing in areas with greater green space coverage; results in Athens showed reductions of all-cause mortality of 26 per 100,000 inhabitants for populations with benefits of local greenspace. Based on our analysis, we discuss recommendations of potential interventions that could be implemented to reduce the environmental public health risks in the European metropolitan areas covered by this study.
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Affiliation(s)
- Christina Mitsakou
- Centre for Radiation, Chemical and Environmental Hazards (CRCE), Public Health England, UK.
| | - Sani Dimitroulopoulou
- Centre for Radiation, Chemical and Environmental Hazards (CRCE), Public Health England, UK
| | - Clare Heaviside
- Centre for Radiation, Chemical and Environmental Hazards (CRCE), Public Health England, UK; Environmental Change Institute, University of Oxford, UK
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - Sophia Rodopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - Claudia Costa
- Centre of Studies in Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Portugal
| | - Ricardo Almendra
- Centre of Studies in Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Portugal
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Portugal
| | - Marc Marí Dell'Olmo
- Agencia de Salut Publica de Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carme Borrell
- Agencia de Salut Publica de Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | | | | | - Conrad Franke
- Beuth University of Applied Sciences, Berlin, Germany
| | | | | | - Christos Spyrou
- Department of Atmospheric Physics, School of Physics, National and Kapodistrian University of Athens, Greece
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Daniela Fecht
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, UK
| | - John Gulliver
- UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Imperial College London, UK
| | - Sotiris Vardoulakis
- Centre for Radiation, Chemical and Environmental Hazards (CRCE), Public Health England, UK; Institute of Occupational Medicine, UK
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Costa C, Santana P, Dimitroulopoulou S, Burstrom B, Borrell C, Schweikart J, Dzurova D, Zangarini N, Katsouyanni K, Deboseree P, Freitas Â, Mitsakou C, Samoli E, Vardoulakis S, Marí Dell'Olmo M, Gotsens M, Lustigova M, Corman D, Costa G. Population Health Inequalities Across and Within European Metropolitan Areas through the Lens of the EURO-HEALTHY Population Health Index. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E836. [PMID: 30866549 PMCID: PMC6427561 DOI: 10.3390/ijerph16050836] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/25/2019] [Accepted: 03/02/2019] [Indexed: 12/12/2022]
Abstract
The different geographical contexts seen in European metropolitan areas are reflected in the uneven distribution of health risk factors for the population. Accumulating evidence on multiple health determinants point to the importance of individual, social, economic, physical and built environment features, which can be shaped by the local authorities. The complexity of measuring health, which at the same time underscores the level of intra-urban inequalities, calls for integrated and multidimensional approaches. The aim of this study is to analyse inequalities in health determinants and health outcomes across and within nine metropolitan areas: Athens, Barcelona, Berlin-Brandenburg, Brussels, Lisbon, London, Prague, Stockholm and Turin. We use the EURO-HEALTHY Population Health Index (PHI), a tool that measures health in two components: Health Determinants and Health Outcomes. The application of this tool revealed important inequalities between metropolitan areas: Better scores were found in Northern cities when compared with their Southern and Eastern counterparts in both components. The analysis of geographical patterns within metropolitan areas showed that there are intra-urban inequalities, and, in most cities, they appear to form spatial clusters. Identifying which urban areas are measurably worse off, in either Health Determinants or Health Outcomes, or both, provides a basis for redirecting local action and for ongoing comparisons with other metropolitan areas.
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Affiliation(s)
- Claudia Costa
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal.
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal.
- Department of Geography and Tourism, University of Coimbra, 3004-530 Coimbra, Portugal.
| | - Sani Dimitroulopoulou
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton OX11 0RQ, Oxon, UK.
| | - Bo Burstrom
- Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, 171 77 Stockholm, Sweden.
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
- Institut d'Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain.
- Universitat Pompeu Fabra, 08002 Barcelona, Spain.
| | - Jürgen Schweikart
- Department of Civil Engineering and Geoinformation, Beuth University of Applied Sciences Berlin, 13437 Berlin, Germany.
| | - Dagmar Dzurova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, 128 43 Prague, Czech Republic.
| | - Nicolás Zangarini
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy.
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece.
| | - Patrick Deboseree
- Interface Demography, University of Brussels, 1050 Brussels, Belgium.
| | - Ângela Freitas
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal.
| | - Christina Mitsakou
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton OX11 0RQ, Oxon, UK.
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece.
| | | | - Marc Marí Dell'Olmo
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
- Institut d'Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain.
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
- Institut d'Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain.
- Universitat Pompeu Fabra, 08002 Barcelona, Spain.
| | - Michala Lustigova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, 128 43 Prague, Czech Republic.
| | - Diana Corman
- The National Board of Health and Welfare, 106 30 Stockholm, Sweden.
| | - Giuseppe Costa
- Medical School of the University of Turin, University of Turin, 10124 Turin, Italy.
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