Systematic Review of Psychotropic Adverse Drug Event Monitoring Tools for Use in Long-Term Care Facilities

ObjectivesTo evaluate properties of psychotropic adverse drug event (ADE) monitoring tools intended for use in long-term care facilities.DesignSystematic review.Setting and ParticipantsAdults aged 18 years and older in nursing homes and other long-term care facilities.MethodsMedline, CINAHL, Embase, and PsycInfo were searched from inception to August 2022 for studies reporting the development, validation, or application of tools to monitor psychotropic ADEs. Screening, data extraction, and quality assessment were performed independently by 2 authors. Each tool was assessed under the domains of test-retest reliability, interrater reliability, content validity, and construct validity.ResultsEight studies that described 6 tools were included. Tools were developed in Wales (n = 2), United States (n = 1), Ireland (n = 1), Canada (n = 1), and Singapore (n = 1). Tools monitored 4 to 95 items related to antipsychotics (n = 6 tools), antidepressants (n = 4), benzodiazepines or hypnotics (n = 4), antiepileptics (n = 4), and dementia medications (n = 1). Tools commonly monitored sedation, tiredness, or sleepiness (n = 6), falls (n = 4), and tremor or extrapyramidal symptoms (n = 4). Tools were designed for application by nurses (n = 4), during family conferences (n = 1), and by general medical practitioners before repeat prescribing (n = 1). Two tools were reported to require 10 to 60 minutes to administer. Four tools were determined to have adequate content validity and 2 tools adequate interrater reliability. No tools reported test-retest reliability or construct validity.Conclusions and ImplicationsSix published psychotropic ADE monitoring tools are heterogeneous in design and intended application. Existing tools are predominately designed for application by nurses with or without direct involvement of the wider multidisciplinary team. Further research is needed into models of care that facilitate psychotropic ADE monitoring in the long-term care facility setting, and the extent to which application of specific tools is associated with reduced medication-related harm.     

Nebulous margins: Sexuality and social constructions of risks in rural areas of Central Mexico

This paper reports on research conducted among young people in two rural communities in the state of Morelos, Central Mexico. Methods used included participant observation, indepth interviews and focus groups. Findings suggest that a person's constitution or 'nature', their gender and perceived risks during agricultural work were strongly associated with riskrelated sexual behaviour. Those who perceive themselves as having a strong constitution see themselves at low risk of acquiring STIs/AIDS. Young people reported receiving little information about reproductive matters at school, including condom use. When information was provided, it was often in a form disassociated from its cultural context. Efforts to control female sexuality between puberty and marriage were particularly marked in the communities studied and may interfere with risk reduction among both young women and young men. Policy recommendations for the future development of sexual education in rural areas in Mexico are outlined.     

Development of the Community Healthy Living Index: A tool to foster healthy environments for the prevention of obesity and chronic disease

ObjectivesThis paper presents a new, comprehensive tool for communities to assess opportunities for active living and healthy eating and to mobilize all sectors of society to conquer obesity and chronic disease.MethodRelevant existing tools and input from an expert panel were considered to draft the Community Healthy Living Index (CHLI). CHLI covers five major sectors where people live, work, learn, and play: schools, afterschools, work sites, neighborhoods, and the community-at-large. CHLI and the accompanying procedures enable community teams to assess programs, the physical environment, and policies related to healthy living and to plan improvement strategies. In 2008, with local YMCAs acting as conveners, community assessment teams from six US communities pilot-tested CHLI for cognitive response testing, inter-rater reliability, and implementation feasibility. CHLI was revised to reflect the test results.ResultsPilot analyses demonstrated that the process was feasible, with most questions being interpreted as intended and showing substantial to almost perfect agreement between raters. The final CHLI is being disseminated nationally.ConclusionsPreliminary data illustrate CHLI obtains reliable results and is feasible to implement. CHLI is a promising tool for community-based prevention efforts to draw attention to opportunities for healthy living and create impetus for community changes.     

Assessing Foods and Nutrition Competencies in Youth

ObjectiveTo develop a comprehensive assessment of foods and nutrition competencies with robust psychometric properties for the 4-H Foods and Nutrition Project.DesignThe Assessment of Foods and Nutrition Competencies in Adolescents was developed through a systematic measurement development process by a group of researchers, practitioners, and program alumni familiar with the theory of change and implementation procedures of the 4-H Foods and Nutrition Project.SettingRecruitment was conducted through the 4-H Online membership management program for 4-H members throughout Texas to complete online survey questions.ParticipantsFour hundred twenty-four Texas 4-H members in grades 6–12.Variables MeasuredSurvey items addressing 6 specific foods and nutrition competencies dimensions.AnalysisA series of reliability and confirmatory factor analyses were conducted to assess the psychometric qualities of Assessment of Foods and Nutrition Competencies in Adolescents.ResultsAssessment of Foods and Nutrition Competencies in Adolescents was found to possess good factor structure, reliability, validity, and measurement invariance. Program participants showed an advantage over nonparticipants in most core foods and nutrition competencies concerning positive behavioral changes.Conclusions and ImplicationsAssessment of Foods and Nutrition Competencies in Adolescents comprehensively captures the core competencies promoted by the 4-H Foods and Nutrition Project and possesses the psychometric qualities critical for program evaluation. A more diversity-focused outreach effort is needed for inclusive youth programs like the 4-H Foods and Nutrition Project to benefit the general youth population.     

Suicidal ideation in young males living in rural communities: Distance from school as a risk factor,youth engagement as a protective factor

Abstract

Adolescent males living in rural communities are at particular risk for completed suicides. The objective of the present study was to examine geographic isolation and living distance from school as risk factors, and youth engagement in meaningful extracurricular activities and social support as protective factors, for suicidality. These relationships were examined in rural youth (n?=?242; 128 females, 113 males, 1 missing data on gender). Distance from school was found to be a significant risk factor for males only, whereby living further away from school was associated with higher suicidal ideation. Youth engagement in extracurricular activities was significantly associated with lower levels of suicidality. The further a rural adolescent male lives from school was predictive of significantly lower rates of youth engagement. Policy implications concerning the initiation of structured activity programmes for at-risk youth are discussed.     

Developing a measure of behavior change in a program to help low-income parents prevent unhealthful weight gain in children

ObjectiveTo develop and test a brief measure of changes in eating, active play, and parenting practices after an intervention to help parents shape children’s choices and home environments.DesignSequential phases of development and testing: expert panel review, cognitive testing interviews, field testing, test-retest study, and assessment of convergence with detailed previously validated instruments.Setting and ParticipantsExpanded Food and Nutrition Education Program (EFNEP), New York State. Low-income parents of 3- to 11-year-old children; Cooperative Extension nutrition and parenting educators.Main Outcome MeasuresQuestionnaire reliability, validity, respondent comprehension, and feasibility of use in program contexts.AnalysisQualitative analysis of item comprehension. Correlational analysis of test-retest reliability and convergent validity.ResultsA behavior checklist was developed to assess change in parent-reported family eating, physical activity, and parenting practices addressed by an intervention. The checklist was feasible for use in EFNEP and questions were understood as intended. Test-retest reliability was good (r = 0.83) and scores correlated significantly (range, 0.25 to –0.60; P < .05) with detailed measures of dietary habits, parental modeling, physical activity, and home environment.Conclusions and ImplicationsDevelopment and testing in a program context produced a tool community nutritionists can use to evaluate educational interventions aimed at helping parents promote healthful eating and activity.     

Challenges and solutions in the continuity of home care for rural older people: A thematic analysis

ABSTRACT

Home care is essential for the continuity of care, but rural communities struggle to procure these services regularly. As rural populations age, these difficulties may be exacerbated. This study examines the challenges and solutions for offering home care in rural areas. Healthcare professionals held focus groups and one-on-one interviews in rural communities, and these interviews were recorded and analyzed using thematic analysis. Changing rural contexts, stakeholder relationships, and sustainable communities were the primary themes. Increasing knowledge, sharing information, and dialogue among stakeholders were also crucial. Collaboration between professions may also create more sustainable home care in rural communities.     

Research and rural; EGPRN and EURIPA—finding common ground. October 2013, Malta

Abstract

The European General Practice Research Network (EGPRN) and the European Rural and Isolated Practitioner Association (EURIPA) convened a historic joint meeting in Malta in October 2013. Speakers reviewed the inadequacies of the current system and conduct of clinical science research and the use and misuse of the resulting findings. Rural communities offer extraordinary opportunities to conduct more holistic, integrative, and relevant research using new methods and data sources. Investigators presented exciting research findings on questions important to the health of those in rural areas. Participants discussed several strategies to enhance the capacity and stature of rural health research and practice. EGPRN and EURIPA pledged to work together to develop rural research courses, joint research projects, and a European Rural Research Agenda based on the most urgent priorities and the European definition of general practice research in rural health care.     

Adolescents, Celebrity Worship, and Cosmetic Surgery

PurposeTo evaluate the acceptability, feasibility, and effectiveness of a population-based intervention to promote health of youth (age: 16–24 years) in Goa.MethodsTwo pairs of urban and rural communities were selected; one of each was randomly assigned to receive a multi-component intervention and the other wait-listed. The intervention comprised educational institution-based peer education and teacher training (in the urban community), community peer education, and health information materials. Effectiveness was assessed through before–after population surveys at baseline and at 18 months. Outcomes were measured using a structured interview schedule with all eligible youth. Logistic regression compared each pair, adjusted for baseline differences, on prevalence of outcomes in the domains of reproductive and sexual health (RSH), violence, mental health, substance use, and help seeking for health concerns.ResultsIn both intervention communities, prevalence of violence perpetrated and probable depression was significantly lower and knowledge and attitudes about RSH significantly higher (p < .05). The rural sample also reported fewer menstrual complaints and higher levels of help-seeking for RSH complaints by women, and knowledge and attitudes about emotional health and substance use; and, the urban sample reported significantly lower levels of substance use, suicidal behavior, sexual abuse, and RSH complaints. Although information materials were acceptable and feasible in both communities, community peer education was feasible only in the rural community. The institution-based interventions were generally acceptable and feasible.ConclusionsMulticomponent interventions comprising information materials, educational-institution interventions and, in rural contexts, community peer interventions are acceptable and feasible and likely to be effective for youth health promotion.     

Husbands’ knowledge and attendance at wives’ postpartum care among rural farmers

Abstract

We examined husbands’ knowledge and attendance at their wives’ postpartum visit in a sample of rural husband-and-wife farmer dyads in central Malawi. A cross-sectional matched-pairs survey of 70 husband-and-wife farmer dyads, who lived in rural communities in Ntcheu district, and had a live birth in the past year was conducted. Data were collected using an interviewer-administered, structured postpartum questionnaire adapted from WHO Safe Motherhood Needs Assessment Questionnaires. Many husbands did not know about postpartum assessments and education their wives received from health facilities. Percent agreement between dyads’ responses was lower on questions referring to assessments than to education. The odds of reporting that the woman received postpartum assessments were greater among husbands than among wives. Fifty-nine percent of husbands did not go with their wives for 1-week postpartum visits. Top three reasons for not attending visits were: at work, out of town, and did not see the need.     

Povl Heiberg's 1897 methodological study on the statistical method as an aid in therapeutic trials

ObjectiveTo examine the association between weight status and characteristics of the food and physical activity environments among adults in rural U.S. communities.MethodCross-sectional telephone survey data from rural residents were used to examine the association between obesity (body mass index [BMI] > 30 kg/m²) and perceived access to produce and low-fat foods, frequency and location of food shopping and restaurant dining, and environmental factors that support physical activity. Data were collected from July to September 2005 in Missouri, Arkansas, and Tennessee. Logistic regression models (N = 826) adjusted for age, education and gender comparing normal weight to obese respondents.ResultsEating out frequently, specifically at buffets, cafeterias, and fast food restaurants was associated with higher rates of obesity. Perceiving the community as unpleasant for physical activity was also associated with obesity.ConclusionAdults in rural communities were less likely to be obese when perceived food and physical activity environments supported healthier behaviors. Additional environmental and behavioral factors relevant to rural adults should be examined in under-studied rural U.S. populations.     

Validity and Reliability of Pediatric Nutrition Screening Tools for Hospital,Outpatient, and Community Settings: A 2018 Evidence Analysis Center Systematic Review

BackgroundNutrition screening tools are used to identify risk of malnutrition or change in risk of malnutrition. However, it is unclear which tools have demonstrated high validity, reliability, and agreement.ObjectiveOur aim was to conduct a systematic review of valid and reliable pediatric nutrition screening tools for identifying malnutrition risk (under- or overnutrition), and to determine whether there are differences in validity and reliability according to users of the tools.MethodsA literature search using Medline, Embase, and CINAHL databases was conducted to identify relevant research published between 1995 and May 2017 examining validity and reliability of nutrition screening tools in the pediatric population. A multidisciplinary workgroup developed eligibility criteria, data were extracted and summarized, risk of bias was assessed, and evidence strength was graded, according to a standard process.ResultsTwenty-nine studies met inclusion criteria. Thirteen pediatric nutrition screening tools designed for various settings were included in the review (seven inpatient/hospital, three outpatient or specialty setting, and three community). The most frequently examined tools were the Screening Tool for the Assessment of Malnutrition in Pediatrics, Screening Tool for Risk on Nutritional Status and Growth (13 studies each), and Paediatric Yorkhill Malnutrition Score (nine studies). No tools demonstrated high validity. Reliability and agreement were reported infrequently.ConclusionsNutrition screening tools with good/strong or fair evidence and moderate validity included the Screening Tool for the Assessment of Malnutrition in Pediatrics, Screening Tool for Risk on Nutritional Status and Growth, and Paediatric Yorkhill Malnutrition Score in the inpatient setting and Nutrition Risk Screening Tool for Children and Adolescents with Cystic Fibrosis in the specialty setting. No tools in the community setting met these criteria. While differences in validity and reliability measures among tool users were found, the significance of these findings is unclear. Limitations included few studies examining each tool, heterogeneity between studies examining a common tool, and lack of tools that included currently recommended indicators to identify pediatric malnutrition.     

Walkability indices and children's walking behavior in rural vs. urban areas

PurposeThis study described associations between selected walk indices (WI) and walking and physical activity behaviors in rural and urban children.FindingsWI were higher in urban environments, yet children from rural areas walked for transportation more than children from urban areas. There was a negative correlation between National WI scores and walking for transportation in urban areas, and between the Frank WI scores and walking for exercise in rural areas.ConclusionsIndices of walkability are not associated with objectively measured physical activity or self-reported walking behavior in children living in rural and urban settings.     

农村基层医疗卫生机构视力检查服务提供与利用

目的:分析农村基层医疗卫生机构视力检查服务的可及性对居民视力检查服务利用的影响。方法:利用医疗卫生机构和农户调查数据,采用描述统计和多元回归分析。结果:样本中33.2%的居民自报告视力不良,22.1%的居民曾做过视力检查,86%样本乡镇的卫生院和44%样本村的村卫生室可以提供视力检查服务;回归结果显示,乡镇卫生院提供视力检查服务将显著增加居民进行视力检查的可能性,但村卫生室是否提供视力检查服务对居民视力检查的利用没有显著影响。结论:农村居民对视力检查服务需求很大,但是利用率低。基层医疗卫生机构服务供给不足可能是导致农村居民服务利用率低的重要因素。建议国家继续推进基本公共卫生服务,加强基层医疗卫生服务机构开展基本视力检查的能力,促进农村居民对视力检查服务的利用,改善农村居民视力健康水平。     

Child health inequities in developing countries: differences across urban and rural areas

Background

The reduction of health inequalities is a focus of many national and international health organisations. The need for pragmatic evidence-based approaches has led to the development of a number of evidence-based equity initiatives. This paper describes a new program that focuses upon evidence- based tools, which are useful for policy initiatives that reduce inequities.

Methods

This paper is based on a presentation that was given at the "Regional Consultation on Policy Tools: Equity in Population Health Reports," held in Toronto, Canada in June 2002.

Results

Five assessment tools were presented. 1. A database of systematic reviews on the effects of educational, legal, social, and health interventions to reduce unfair inequalities is being established through the Cochrane and Campbell Collaborations. 2 Decision aids and shared decision making can be facilitated in disadvantaged groups by 'health coaches' to help people become better decision makers, negotiators, and navigators of the health system; a pilot study in Chile has provided proof of this concept. 3. The CIET Cycle: Combining adapted cluster survey techniques with qualitative methods, CIET's population based applications support evidence-based decision making at local and national levels. The CIET map generates maps directly from survey or routine institutional data, to be used as evidence-based decisions aids. Complex data can be displayed attractively, providing an important tool for studying and comparing health indicators among and between different populations. 4. The Ottawa Equity Gauge is applying the Global Equity Gauge Alliance framework to an industrialised country setting. 5 The Needs-Based Health Assessment Toolkit, established to assemble information on which clinical and health policy decisions can be based, is being expanded to ensure a focus on distribution and average health indicators.

Conclusion

Evidence-based planning tools have much to offer the goal of equitable health development.     

Prevalence of Malnutrition or Risk in Residents in Long Term Care: Comparison of Four Tools

Abstract

The ideal tool for determination of malnutrition risk or malnutrition in long term care (LTC) is elusive. This study compares prevalence, association with resident risk factors and sensitivity (SE) and specificity (SP) of malnutrition or risk categorization in 638 residents from 32 LTC homes in Canada using four tools: the Mini-Nutritional Assessment Short Form (MNA-SF); Patient-Generated Subjective Global Assessment (PG-SGA) Global Category Rating and the Pt-Global webtool; and the interRAI Long Term Care Facility undernutrition trigger. Prevalence was most common with MNA-SF (53.7%) and lowest with InterRAI (28.9%), while the PG-SGA Global Category Rating (44%) was higher than the Pt-Global webtool (33.4%). Tools were consistently associated with resident covariates with few exceptions. The PG-SGA Global Category Rating demonstrated the best sensitivity and specificity when compared to all other tools. Further work to determine the predictive validity of this tool in LTC residents is required.     

A qualitative examination of home and neighborhood environments for obesity prevention in rural adults

Background  

The home and neighborhood environments may be important in obesity prevention by virtue of food availability, food preparation, cues and opportunities for physical activity, and family support. To date, little research has examined how home and neighborhood environments in rural communities may support or hinder healthy eating and physical activity. This paper reports characteristics of rural homes and neighborhoods related to physical activity environments, availability of healthy foods, and family support for physical activity and maintaining an ideal body weight.