Population-level interventions to reduce alcohol-related harm: An overview of systematic reviews

Objective

To analyse available review-level evidence on the effectiveness of population-level interventions in non-clinical settings to reduce alcohol consumption or related health or social harm.

Method

Health, social policy and specialist review databases between 2002 and 2012 were searched for systematic reviews of the effectiveness of population-level alcohol interventions on consumption or alcohol-related health or social outcomes. Data were extracted on review research aim, inclusion criteria, outcome indicators, results, conclusions and limitations. Reviews were quality-assessed using AMSTAR criteria. A narrative synthesis was conducted overall and by policy area.

Results

Fifty-two reviews were included from ten policy areas. There is good evidence for policies and interventions to limit alcohol sale availability, to reduce drink-driving, to increase alcohol price or taxation. There is mixed evidence for family- and community-level interventions, school-based interventions, and interventions in the alcohol server setting and the mass media. There is weak evidence for workplace interventions and for interventions targeting illicit alcohol sales. There is evidence of the ineffectiveness of interventions in higher education settings.

Conclusion

There is a pattern of support from the evidence base for regulatory or statutory enforcement interventions over local non-regulatory approaches targeting specific population groups.     

Examination of costs for a lay health educator-delivered translation of the Diabetes Prevention Program in senior centers

Objective

Older adults in the U.S. have high rates of obesity. Despite the demonstrated efficacy of lifestyle interventions among older adults, lifestyle interventions are not widely implemented in community settings. Program delivery by lay health educators (LHEs) might support greater dissemination because of lower delivery cost and greater accessibility. We examined the costs of a LHE-delivered translation of the Diabetes Prevention Program (DPP) evidence-based lifestyle intervention for older adults in Arkansas senior centers.

Methods

This examination of costs used data from a cluster randomized control trial (conducted 2008–2010) in which 7 senior centers (116 participants) were randomized to implement a LHE-delivered 12-session translation of the DPP lifestyle intervention. We compiled direct lifestyle intervention implementation costs, including training, recruitment, materials, and ongoing intervention implementation support. Weight loss data (at 4-month follow-up) were collected from participants.

Results

Participant weight loss averaged 3.7 kg at 4-months. The total estimated cost to implement the lifestyle intervention is $2731 per senior center, or $165 per participant. The implementation cost per kilogram lost is $45.

Conclusions

A LHE-delivered DPP translation in senior centers is effective in achieving weight loss at low cost and offers promise for the dissemination of this evidence-based intervention.     

Desarrollo de IEMAC,un Instrumento para la Evaluación de Modelos de Atención ante la Cronicidad

Objective

To present the context, aim and process of designing the Instrument for the Assessment of Chronic Care Models (Instrumento de Evaluación de Modelos de Atención ante la Cronicidad [IEMAC]), which was developed to make the conceptual framework of the chronic care model operational in the Spanish national health system.

Methods

The IEMAC was developed by a series of national experts with distinct profiles of expertise using qualitative research techniques. A matrix was built with the dimensions selected as basic for the new model. In each dimension, actions were identified and categorized, creating a taxonomy of components and interventions. The clarity and appropriateness of each intervention, and the degree of evidence to support it, were assessed. The resulting questionnaire was validated by other experts from diverse disciplines and settings. Finally, the IEMAC 1.0 was piloted at macro, meso and micro levels.

Results

The IEMAC is a tool to be self-administered by health organizations at macro, meso and micro levels. This instrument is composed of six dimensions, 27 components and 80 interventions, whose implementation is assessed with the aid of a scale that combines deployment, systematic evaluation, and orientation improvement. The IEMAC uses a systemic, population-based approach and integrates promotion, prevention, and coordination with social services.

Conclusions

The IEMAC contains a set of interventions that can be used as a road map by decision makers, managers and clinicians interested in building a state-of-the-art chronic care model. At the same time, the IEMAC allows healthcare organizations to identify their baseline score and the progress achieved after improvement interventions.     

Partner approval and intention to use contraception among Zanzibari women presenting for post-abortion care

Objective

We examined the effect of partner approval of contraception on intention to use contraception among women obtaining post-abortion care in Zanzibar.

Study design

Our data source was a 2010 survey of 193 women obtaining post-abortion care at a large public hospital in Zanzibar. We used multivariable logistic regression analysis to assess associations between partner approval and intention to use contraception.

Results

Overall, 23% of participants had used a contraceptive method in the past, and 66% reported intending to use contraception in the future. We found that partner approval of contraception and ever having used contraception in the past were each associated with intending to use contraception in the future. In the multivariable model, adjusting for past contraception use, partner approval of contraception was associated with 20 times the odds of intending to use contraception (odds ratio, 20.25; 95% confidence interval, 8.45–48.56).

Conclusions

We found a strong association between partner approval and intention to use contraception. Efforts to support contraceptive use must include both male and female partners.

Implications

Public health and educational efforts to increase contraceptive use must include men and be targeted to both male and female partners. Given that male partners are often not present when women obtain health care, creative efforts will be required to meet men in community settings.     

Fußballfans im Training

Background

The prevalence of obesity and chronic diseases in Germany is rising. Although men are exposed to higher risks, they do not attend weight reduction programs. For years the Scottish Premier League’s project Football Fans in Training (FFIT) program has successfully motivated men to lose weight.

Objectives

To examine if the concept of a gender-oriented weight reduction program for men can successfully be implemented into the German Football Bundesliga.

Methods

By adapting FFIT and collaborating with German Football Clubs of the Bundesliga, we aim to encourage overweight male football fans aged 35–65 to participate in a 12-week course, taking place in the very heart of their favorite team. The clubs provide their training grounds and a coach, take on the recruitment and arrange visits by prominent players for further motivation. Goals are sustainable weight loss and a healthier lifestyle.

Results

Twelve months after initiation the professional clubs 1. FC Nürnberg, Bayer Leverkusen, Darmstadt 98, Eintracht Braunschweig, FC Ingolstadt, Hertha BSC, Holstein Kiel, Mainz 05, RB Leipzig and Schalke 04 have been recruited to offer FFIT to their fans. At each club, the program has been well accepted by the fans. Preliminary results show a high attendance and success rate among the participants.

Discussion

German Football Bundesliga clubs can motivate their male fans to participate in a weight reduction program. The setting and emotional attachment to their favorite team seem to be the most effective keys to success.

     

Socio-economic correlates of functional health literacy among patients of primary health care in Kosovo

Objectives

Functional health literacy (FHL) has been related to individual characteristics, ill-health and disease knowledge. However, the information about FHL in Kosovo is very limited and thus the aim of this study was to assess the demographic and socio-economic correlates of FHL among users of primary health care in Kosovo, a postconflict country in the Western Balkans.

Study design

Cross-sectional study.

Methods

A cross-sectional study was conducted in Kosovo between November 2012–February 2013, including a representative sample of 1035 consecutive primary care users aged ≥18 years (60% females; overall mean age: 44.3 ± 16.9 years; overall response rate: 86%). Test of Functional Health Literacy in Adults (TOFHLA) was used to assess FHL. General linear model and logistic regression were used to assess the association of TOFHLA score with demographic and socio-economic characteristics.

Results

Overall, four out of five participants exhibited inadequate or marginal FHL in this Kosovo sample. FHL score was independently and inversely related to age, but positively associated with educational attainment and being in a situation other than unemployed.

Conclusions

Limited or marginal FHL was very common among primary care users in Kosovo and considerably higher than in the neighbouring Serbia. The low health literacy levels in Kosovo may provide an additional barrier towards achievement of health care goals. There is a need to design and implement suitable and effective educational and health system interventions in the Kosovo context.     

Primary eye care skills scores for health workers in routine and enhanced supervision settings

Introduction

Primary health care in Tanzania is provided at two types of health units, the dispensary and the health centre. Theoretically, primary health workers (with knowledge of primary eye care [PEC]) are ideally placed to identify people in need of eye care services. In Tanzania, they are expected to be able to identify, treat, or correctly refer a number of eye conditions including cataract, trauma, presbyopia, and the ‘red eye’. They are also expected to be able to measure visual acuity correctly and to educate the community about prevention.

Objectives

The objective was to determine the effect of enhanced supervision of health workers on PEC knowledge and skills in Kilimanjaro Region, Tanzania.

Study design

This was a quasi-experimental, cluster randomized intervention study of an enhanced supervisory method compared to a routine supervisory method; 36 dispensaries were randomly allocated into the two groups.

Participants

Health workers based at government dispensaries in Mwanga District.

Data collection

Participants were interviewed pre and post intervention and the information was recorded using a standardized pretested questionnaire.

Results

Mean scores of knowledge in healthcare workers was higher in the intervention group (score = 6.43, 80.4% improvement) compared to the non-intervention group (score = 4.71, 58.9% improvement). The ability to describe and demonstrate vision testing was better (score = 1.8) in the enhanced supervision group compared to the routine supervision group (score = 0.88, P = 0.03). There was a high level of attrition (24%) within one year from the time of baseline survey, especially amongst clinical officers (44%).

Conclusion

During the pilot study, enhanced supervision improved PEC knowledge and skills of health workers compared to health workers with routine supervision.

Recommendations

Training in PEC needs revision to become more practicum-based. There is need to revise supervision guidelines (to be skills-based) and the supervision skills of district eye coordinators (DECs) need to be enhanced. There is a huge need to improve governance (accountability and rule of law) of health staff.     

The association between physical activity,cardiorespiratory fitness and self-rated health

Objective

To investigate the joint association between self-reported physical activity as well as cardiorespiratory fitness and self-rated health among healthy women and men.

Method

Data from 10,416 participants in The Danish Health Examination Survey 2007–2008 which took part in 13 Danish municipalities were analyzed. Leisure time physical activity level and self-rated health were based on self-reported questionnaire data. Optimal self-rated health was defined as “very good” or “good” self-rated health. Cardiorespiratory fitness (mL O₂·min^− 1·kg^− 1) was estimated from maximal power output in a maximal cycle exercise test.

Results

A strong dose–response relation between cardiorespiratory fitness and self-rated health as well as between physical activity level and self-rated health among both women and men was found. Within categories of physical activity, odds ratios for optimal self-rated health increased with increasing categories of cardiorespiratory fitness, and vice versa. Hence, participants who were moderately/vigorously physically active and had a high cardiorespiratory fitness had the highest odds ratio for optimal self-rated health compared with sedentary participants with low cardiorespiratory fitness (odds ratio = 12.2, 95% confidence interval: 9.3–16.1).

Conclusion

Although reluctant to conclude on causality, this study suggests that an active lifestyle as well as good cardiorespiratory fitness probably increase self-rated health.     

Environmental attitudes and political partisanship

Objective

To explore the impact of political partisanship on environmental attitudes related to climate change in United States and its implications for public health.

Study design

An integrative literature review.

Methods

A literature review of English articles was performed from January 2013 to March 2013 using the following databases: CINAHL, PubMed, Academic Search Premier, Business Source Premier, ERIC, psychINFO, and Wiley Online Library. Empirical and review articles and Internet sources were included.

Results

Continued mass emission of carbon dioxide and other greenhouse gases will exacerbate the consequences of global warming and climate change. As one of the key global contributors of carbon emissions, the lack of climate change policy and regulatory practices at the federal level in the United States is of great concern. Political partisanship in the US is largely to blame for this inaction, as efforts for drastic remediation action is met with rejection from conservative groups who do not believe that global warming and climate change are a problem, despite scientific evidence to the contrary. To promote the health of the entire population, there needs to be a paradigm shift from consumption driven economic growth as advocated by the Republicans to a realization of true prosperity beyond growth in order to create a sustainable world.

Conclusion

This presents a critical challenge to public health professionals as political partisanship has the power to impact environmental attitudes and have serious implications for public health. Preserving the environment must take precedence over economic growth if we want a habitable planet low in carbon.     

Actitudes de las personas usuarias de atención primaria ante el cribado del cáncer colorrectal

Objective

To describe the cultural, social and gender features that determine attitudes to colorectal cancer screening in a target group of patients aged 50 to 69 years old in the primary health care setting.

Methods

We performed a qualitative ethnographic study from a gender perspective. Participants consisted of men and women aged 50 to 69 years old in the Balearic Islands and Barcelona. Group discussion and a field diary were used.

Results

The key element was diagnosis at an early stage. Until recently, cancer was considered an incurable disease but is currently perceived as a serious health problem that can be cured if diagnosed promptly. The participants requested more information on cancer and felt they were at risk, mainly because of their age. Men tended to pay attention to symptoms while women tended to ignore them. Attitudes to colorectal cancer screening were generally positive, even to colonoscopy. Some barriers to screening were identified in women, such as a fear of having cancer.

Conclusions

The opportunity for early diagnosis is the key element in promoting participation in a colorectal cancer screening program. Perceptions-and hence willingness to participate in screening-differ between men and women. Factors to be taken into account in the design of population-based colorectal cancer programs are health concerns in men and fear of a cancer diagnosis in women.     

Muscle strength and physical activity are associated with self-rated health in an adult Danish population

Objective

To describe associations of muscle strength, physical activity and self-rated health.

Method

Isometric muscle strength by maximal handgrip strength (HGS) or muscle strength by 30 s repeated chair stand test (30 s-CS) was combined with leisure time physical activity. Using logistic regression odds ratio was calculated for good self-rated health according to the combined associations among 16,539 participants (59.7% women), mean age 51.9 (SD: 13.8) years, from a cross-sectional study in Denmark 2007–2008.

Results

Good self-rated health was positively associated with higher levels of physical activity and greater muscle strength. Regarding HGS the highest OR for good self-rated health was in the moderate/vigorous physically active participants with high HGS (OR = 6.84, 95% CI: 4.85–9.65 and OR = 7.34, 95% CI: 5.42–9.96 for men and women, respectively). Similarly the highest OR for good self-rated health was in the moderate/vigorous physically active participants with high scores in the 30 s-CS test (6.06, 95% CI: 4.32–8.50 and 13.38, 95% CI: 9.59–18.67 for men and women, respectively). The reference groups were sedentary participants with low strength (HGS or 30 s-CS).

Conclusion

The combined score for physical activity level with either HGS or 30 s-CS was strongly positively associated with self-related health.     

Baseline predictors of physical activity in a sample of adults with arthritis participating in a self-directed exercise program

Objectives

To examine baseline predictors of moderate-to-vigorous intensity physical activity (MVPA) at the 12-week follow-up in a sample of adults with arthritis participating in a self-directed, multicomponent exercise program.

Study design

Pretest–posttest. Analyses were limited to those randomized to the exercise intervention.

Methods

Participants (n = 152) completed a survey assessing demographic, health-related, and arthritis-related factors, and completed anthropometric and functional measurements at baseline. Self-reported MVPA was assessed at baseline and 12 weeks. Participants were classified as engaging in ≥2.5 or <2.5 h/week of MVPA at the 12-week follow-up. Baseline demographic, health-related, arthritis-related, and functional factors were examined as predictors of engaging in ≥2.5 h of MVPA.

Results

At the 12-week follow-up, 66.5% (n = 101) of participants engaged in ≥2.5 h/week of MVPA. Those with a higher body mass index, more days with poor physical health, a greater number of health conditions, self-reported hypertension, self-reported high cholesterol, and greater pain and stiffness were less likely to engage in ≥2.5 h of MVPA at the 12-week follow-up; those with greater arthritis self-efficacy and better performance on the 6 minute walk test were more likely. None of the other factors examined were associated with MVPA.

Conclusions

This study uncovered health-related, arthritis-related, and functional factors associated with MVPA that may help guide intervention strategies. Participants with less severe symptoms, better functional performance and fewer comorbidities at baseline were more likely to achieve the recommended MVPA level at 12 weeks; therefore self-directed PA interventions may be best suited for those with relatively good health status despite arthritis, while those with worse symptoms and health status may benefit more from other intervention delivery modalities such as structured, individualized programs where additional support for managing arthritis symptoms and comorbidity can be addressed.     

Project ReEngineered Discharge (RED) Lowers Hospital Readmissions of Patients Discharged From a Skilled Nursing Facility

Context

Patients admitted to skilled nursing facilities (SNFs) have a high risk for rehospitalization.

Objective

The goal of this project was to implement Project RED in an SNF to increase patient preparedness for care transitions and lower rehospitalization rates in the 30 days after discharge from the SNF facility.

Design

Intervention study with historical control; phone survey 30 days after discharge from the SNF for data collection.

Setting

The study was conducted in an SNF admitting patients from acute care hospitals in Boston, MA.

Patients or Other Participants

A consecutive sample of patients in the SNF before (n = 524) and after initiation (n = 100) of the intervention. Participants had an average age of 80 (SD = 10), 67% were female, and 84% were non-Hispanic white. Phone surveys were completed with 88% of participants in each group.

Intervention(s)

We adapted Project RED for use in an SNF. This includes a comprehensive approach to transitions of care that includes creating and teaching a personalized care plan to patients and their families. Software facilitating these activities was integrated into the electronic medical record of the SNF; intervention activities were delivered by existing staff.

Main Outcome Measure(s)

The main outcome was hospital readmission within 30 days of discharge from the SNF. Secondary outcomes included attendance to a medical appointment within 30 days of discharge from the SNF and preparedness for care transitions as measured by a 6-item survey.

Results

The rate of hospitalization 30 days after discharge from the SNF for participants prior to the intervention was 18.9% and for participants during the intervention was 10.2 %, P < .05. This remained significant adjusting for multiple potential confounders (P = .045). More patients in the intervention group had attended an outpatient appointment within 30 days of discharge (70.5% versus 52.0%, P < .003). In addition, intervention participants reported a higher level of preparedness for care transitions.

Conclusions

Patients in the intervention had a lower rate of returning to the hospital within 30 days of discharge from the SNF, were more likely to attend medical appointments, and were better prepared for their care transition.     

Interventions to Reduce Inappropriate Prescribing of Antipsychotic Medications in People With Dementia Resident in Care Homes: A Systematic Review

Background

Antipsychotic medications are commonly used to manage the behavioral and psychological symptoms of dementia. Several large studies have demonstrated an association between treatment with antipsychotics and increased morbidity and mortality in people with dementia.

Aims

To assess the effectiveness of interventions used to reduce inappropriate prescribing of antipsychotics to the elderly with dementia in residential care.

Method

Systematic searches were conducted in 12 electronic databases. Reference lists of all included studies and forward citation searching using Web of Science were also conducted. All quantitative studies with a comparative research design and studies in which recognized methods of qualitative data collection were used were included. Articles were screened for inclusion independently by 2 reviewers. Data extraction and quality appraisal were performed by 1 reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary.

Results

Twenty-two quantitative studies (reported in 23 articles) were included evaluating the effectiveness of educational programs (n = 11), in-reach services (n = 2), medication review (n = 4), and multicomponent interventions (n = 5). No qualitative studies meeting our inclusion criteria were identified. Eleven studies were randomized or controlled in design; the remainder were uncontrolled before and after studies. Beneficial effects were seen in 9 of the 11 studies with the most robust study design with reductions in antipsychotic prescribing levels of between 12% and 20%. Little empirical information was provided on the sustainability of interventions.

Conclusion

Interventions to reduce inappropriate prescribing of antipsychotic medications to people with dementia resident in care homes may be effective in the short term, but longer more robust studies are needed. For prescribing levels to be reduced in the long term, the culture and nature of care settings and the availability and feasibility of nondrug alternatives needs to be addressed.     

An exploration of artists' perspectives of participatory arts and health projects for people with mental health needs

Objectives

This study addresses the views and experiences of artists who run participatory arts and health courses for those with mental health or social problems.

Study design

Qualitative research with 11 artists from three different organizations providing participatory arts and health courses.

Methods

Semi-structured in-depth interviews were conducted. Participants provided oral contributions that were transcribed and then thematically analysed by the authors.

Results

Participants described perceived positive benefits of participatory arts and health courses, including developing friendships, self-expression and creativity, a non-judgemental environment, along with key issues arising, including managing challenging behaviours and provision of follow-on options.

Conclusions

Results indicate that improvements in well-being can be identified by artists during courses, the activity can help develop friendships, courses can be well managed in community settings, and benefits of follow-on activities should be investigated in future.     

The Nursing Home Effect: A Case Study of Residents With Potential Dementia and Emergency Department Visits

Objectives

The burden of potential dementia cases without formal diagnosis on the health care system is almost unknown. This study examined the impact of potential dementia without formal diagnosis on the rate of visits to hospital emergency department (ED) of nursing home (NH) residents.

Design

Cross-sectional study.

Setting

NHs (175) located in France.

Participants

A total of 5684 subjects who were living in the NH for at least 1 year.

Measurements

Information on NHs' characteristics and on NH residents' health was recorded by NH staff. Participants were divided in 3 groups according to their dementia status: diagnosed dementia, potential dementia without formal diagnosis, and nondementia. The outcome measure was a binary variable: ED visits in the last 12 months (yes vs no). A mixed-effects logistic regression was performed on ED visits accounting for the random effects of living in a particular NH.

Results

From the 5684 participants, 1036 had been seen in the ED. Adjusted odds ratio (AOR) showed that having a potential dementia without formal diagnosis, compared with a diagnosed dementia, was associated with an increased probability of ED visits (AOR = 1.25, 95% confidence interval: 0.99–1.59, P = .061); however, when a random NH effect was entered into the model, the association between potential dementia without formal diagnosis and ED visits disappeared (AOR = 1.22, 95% confidence interval: 0.95–1.57, P = .11).

Conclusion

The association of potential dementia without formal diagnosis with ED visits varies across NHs. This intra-NH aspect (eg, organization and care habits) should be taken into account when examining the rates of hospitalization and possibly the use of health care services in general among NH residents.     

Evaluación de un programa comunitario para reducir el aislamiento de personas mayores debido a barreras arquitectónicas

Objective

Social isolation impairs health. An intervention to reduce isolation due to architectural barriers in elderly persons was carried out in Barcelona (Spain). This study aimed to evaluate its effects on health.

Methods

We conducted a quasi-experimental before-after study. Isolated older people were identified in three deprived urban areas from 2009 to 2011. Participants had twice-weekly outings with volunteers in a stair-climbing power wheelchair. User satisfaction was evaluated and perceived health status, quality of life, and mental health before and after four outings were compared with McNemar tests.

Results

There were 74 participants (median age: 83 years; IQR: 78-89). Perceived health improved by 21%, mental health by 24%, and psychological distress was reduced by 16%. Most participants (98%) were satisfied.

Conclusion

The intervention improved perceived health and mental health. Elderly people with impaired mobility should not live in buildings with architectural barriers and, if this cannot be avoided, similar programs should be implemented.     

Fallers in Postacute Rehabilitation Have Worse Functional Recovery and Increased Health Services Use

Objectives

To determine characteristics associated with single and multiple fallers during postacute rehabilitation and to investigate the relationship among falls, rehabilitation outcomes, and health services use.

Design

Retrospective cohort study.

Setting

Geriatric postacute rehabilitation hospital.

Participants

Patients (n = 4026) consecutively admitted over a 5-year period (2003–2007).

Measurements

All falls during hospitalization were prospectively recorded. Collected patients' characteristics included health, functional, cognitive, and affective status data. Length of stay and discharge destination were retrieved from the administrative database.

Results

During rehabilitation stay, 11.4% (458/4026) of patients fell once and an additional 6.3% (253/4026) fell several times. Compared with nonfallers, fallers were older and more frequently men. They were globally frailer, with lower Barthel score and more comorbidities, cognitive impairment, and depressive symptoms. In multivariate analyses, compared with 1-time fallers, multiple fallers were more likely to have lower Barthel score (adjOR: 2.45, 95% CI: 1.48–4.07; P = .001), cognitive impairment (adjOR: 1.43, 95% CI: 1.04–1.96; P = .026), and to have been admitted from a medicine ward (adjOR: 1.55, 95% CI: 1.03–2.32; P = .035). Odds of poor functional recovery and institutionalization at discharge, as well as length of stay, increased incrementally from nonfallers to 1-time and to multiple fallers.

Conclusion

In these patients admitted to postacute rehabilitation, the proportion of fallers and multiple fallers was high. Multiple fallers were particularly at risk of poor functional recovery and increased health services use. Specific fall prevention programs targeting high-risk patients with cognitive impairment and low functional status should be developed in further studies.     

Prevalence of Sarcopenia in Community-Dwelling Japanese Older Adults

Background

Sarcopenia, the age-dependent loss of skeletal muscle mass, is highly prevalent among older adults in many countries; however, the prevalence of sarcopenia in healthy Japanese community-dwelling older adults is not well characterized.

Objective

The aim of this study was to evaluate the prevalence of sarcopenia and to examine the association of sarcopenia with falls and fear of falling in community-dwelling Japanese older adults.

Design

This is a cross-sectional study.

Setting and Subjects

Healthy men (568) and women (1314) aged 65 to 89 years participated in this research.

Measurements

For all participants, 3 measurements were taken: skeletal muscle mass measurement using bioelectrical impedance, 10 m at a usual walking speed, and handgrip strength. Sarcopenia was defined as the presence of both poor muscle function (low physical performance or low muscle strength) and low muscle mass.

Results

The prevalence of sarcopenia, determined using the European Working Group on Sarcopenia in Older People–suggested algorithm, in men and women aged 65 to 89 years was 21.8% and 22.1%, respectively. The prevalence of sarcopenia increased age-dependently, especially in those older than 75 years in both genders. In the young old, the prevalence of sarcopenia was higher in women than in men; however, in those older than 85 years, the prevalence of sarcopenia was lower in women than in men (P < .05). In addition, fall incidents and fear of falling were more prevalent in sarcopenic older adults than in nonsarcopenic older adults (P < .05).

Conclusions

These results suggest that sarcopenia is highly prevalent in community-dwelling Japanese older adults and is related to falls and fear of falling.     

National and state-specific estimates of place of influenza vaccination among adult populations – United States, 2011–12 influenza season

Background

Annual influenza vaccination has been recommended for all persons ≥6 months since the 2010–11 season. New partnerships between public health agencies and medical and nonmedical vaccination providers have increased the number of vaccination providers and locations where vaccination services are delivered.

Methods

Data from the 2011–12 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. Point estimates of place of vaccination and 95% confidence intervals were calculated. Multivariable logistic regression and predictive marginal modeling were conducted to identify factors associated with vaccination settings.

Results

Among adults vaccinated during the 2011–12 influenza season, a doctor's office was the most common place (38.4%) for receipt of influenza vaccination, with stores (e.g., supermarkets or drug stores) (20.1%) the next common, and workplaces (17.6%) the third common. Overall, reported vaccination in nonmedical settings by state ranged from 32.2% in California to 60.4% in Nevada, with a median of 45.8%. Characteristics significantly associated with an increased likelihood of receipt of vaccination in nonmedical settings were higher education, not having certain identified high-risk conditions, not having had a routine checkup in the previous 12 months, and not having a primary doctor for health care. Being a member of a racial/ethnic minority group, unemployed or not in the work force were significantly associated with a decreased likelihood of receipt of vaccination in nonmedical settings.

Conclusion

Doctor's offices were the most common medical setting for adult influenza vaccination; workplaces and stores were important nonmedical settings. Increasing access to vaccination services in medical and nonmedical settings should be considered as important strategies for improving vaccination coverage. These results also can help guide development of strategies for achieving Healthy People 2020 objectives for influenza vaccination of adult populations.