The health of their nation: how would citizens develop England's health strategy?

BACKGROUND: England's first health strategy, The Health of the Nation, was formulated without systematic input from the citizens whose health it targeted. Several studies indicate that citizens, when asked to prioritize services, rank interventions for acute and life-threatening conditions highest. But how they view and what they want in the areas of prevention, public health, or care for the chronically and mentally ill is not known. AIM: To explore citizens' attitudes towards England's health strategy as set out in The Health of the Nation and to elicit their ideas for developing it further. METHOD: The study was conducted in four general practices and a secondary school in southwest England. The design was a qualitative analysis of testimony from 24 audiotaped focus groups. Twenty-three groups were drawn from lists of National Health Service registered patients, stratified by The Health of the Nation target category, and one group was drawn from 13 to 15 year-old girls at a mixed secondary school. In all, 173 citizens took part in the 24 focus group meetings. RESULTS: In group discussions, these citizens demonstrated an understanding of The Health of the Nation strategy, which enabled them to form views and develop relevant arguments. They produced 26 specific ideas for developing the strategy across its five key areas. There was congruence with the action plans of a national expert group convened by the Department of Health and charged with reviewing the strategy's progress. The focus groups went beyond the experts' proposals, with further practical ideas to achieve The Health of the Nation targets. CONCLUSION: Citizens in this study contributed a broad range of relevant, appropriate, and innovative ideas on how to develop health strategy. The use of focus groups to achieve this is practical and efficient.     

Alternatives to project-specific consent for access to personal information for health research: Insights from a public dialogue

Background  

The role of consent for research use of health information is contentious. Most discussion has focused on when project-specific consent may be waived but, recently, a broader range of consent options has been entertained, including broad opt-in for multiple studies with restrictions and notification with opt-out. We sought to elicit public values in this matter and to work toward an agreement about a common approach to consent for use of personal information for health research through deliberative public dialogues.     

Authorisation and access control for electronic health record systems

Enabling the shared care paradigm, centralised or even decentralised electronic health record (EHR) systems increasingly become core applications in hospital information systems and health networks. For realising multipurpose use and reuse as well as inter-operability at knowledge level, EHR have to meet special architectural requirements. The component-oriented and model-based architecture should meet international standards. Especially in extended health networks realising inter-organisational communication and co-operation, authorisation cannot be organised at user level anymore. Therefore, models, methods and tools must be established to allow formal and structured policy definition, policy agreements, role definition, authorisation and access control. Based on the author's international engagement in EHR architecture and security standards referring to the revision of CEN ENV 13606, the GEHR/open EHR approach, HL7 and CORBA, models for health-specific and EHR-related roles, for authorisation management and access control have been developed. The basic concept is the separation of structural roles defining organisational entity-to-entity relationships and enabling specific acts on the one hand, and functional roles bound to specific activities and realising rights and duties on the other hand. Aggregation of organisational, functional, informational and technological components follows specific rules. Using UML and XML, the principles as well as some examples for analysis, design, implementation and maintenance of policy and authorisation management as well as access control have been practically implemented.     

Backpackers in the Nepal 2015 earthquake: The contribution of personal and social resources to mental health

Psychologists and social workers are usually called into action after natural disasters such as earthquakes, which obviously arouse psychological distress among locals. However, the question of assisting tourists who have also been affected by the disaster has scarcely been studied. In this study, we focused specifically on backpackers who were in Nepal at the time of the 2015 earthquake, and survived. Our aim was to estimate factors that protect a backpacker's mental health after an earthquake, to deepen social workers’ knowledge regarding potential effective interventions. Based on the conservation of resources theory, we examined the contribution of optimism, emotion regulation, as well as the support of family and friends to backpackers’ mental health. A cross‐sectional sample survey was conducted to collect data from 145 backpackers 1 week to 3 months after the disaster. The findings indicated that optimism, emotion regulation in the form of reassessment, and friends’ support contributed positively to backpackers’ mental health, whereas suppression of expression contributed negatively. Findings are discussed with the aim of providing recommendations for social workers.     

Combining Semantic Web technologies with Multi-Agent Systems for integrated access to biological resources

The increasing volume and diversity of information in biomedical research is demanding new approaches for data integration in this domain. Semantic Web technologies and applications can leverage the potential of biomedical information integration and discovery, facing the problem of semantic heterogeneity of biomedical information sources. In such an environment, agent technology can assist users in discovering and invoking the services available on the Internet. In this paper we present SEMMAS, an ontology-based, domain-independent framework for seamlessly integrating Intelligent Agents and Semantic Web Services. Our approach is backed with a proof-of-concept implementation where the breakthrough and efficiency of integrating disparate biomedical information sources have been tested.     

Chronic inflammatory disorders and their redox control: from molecular mechanisms to therapeutic opportunities

A chronic inflammatory disease is a condition characterized by persistent inflammation. A number of human pathologies fall into this category, and a great deal of research has been conducted to learn more about their characteristics and underlying mechanisms. In many cases, a genetic component has been identified, but also external factors like food, smoke, or environmental pollutants can significantly contribute to worsen their symptoms. Accumulated evidence clearly shows that chronic inflammatory diseases are subjected to a redox control. Here, we shall review the identity, source, regulation, and biological activity of redox molecules, to put in a better perspective their key-role in cancer, diabetes, cardiovascular diseases, atherosclerosis, chronic obstructive pulmonary diseases, and inflammatory bowel diseases. In addition, the impact of redox species on autoimmune disorders (rheumatoid arthritis, systemic lupus erythematosus, psoriasis, and celiac disease) and neurodegenerative diseases (Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, and multiple sclerosis) will be discussed, along with their potential therapeutic implications as novel drugs to combat chronic inflammatory disorders.     

Burnout patterns in rehabilitation: short-term changes in job conditions, personal resources, and health

This longitudinal study reports the patterning of the burnout symptoms and the changes in employees' job conditions, personal resources, and psychological health 4 months after a rehabilitation intervention. The data were gathered by means of questionnaires before and after a rehabilitation period. Four patterns were identified: not burned out (n = 55), exhausted and cynical (n = 36), burned out (n = 26), and low professional efficacy (n = 18). These patterns differed in terms of job resources, personal resources, and depression. There were both positive and negative changes detected in participants' psychological health and job resources at the follow-up. The study shows the importance of identifying different burnout patterns in order to focus rehabilitation activities more effectively.     

大学生积极情绪与心理健康的关系:个人资源的中介效应

目的:探讨大学生积极情绪、个人资源与心理健康水平之间的关系,使用结构方程模型进行验证。方法:采用方便取样,选取陕西师范大学877名大学生,运用正性情感和负性情感检核表(PA-NAS)、自编积极体验问卷,及个人资源问卷,如自编心理弹性问卷、简易应对方式问卷(SCSQ)、人际信任问卷(ITS)、社会支持知觉量表(PSSS)和症状自评量表(SCL-90)进行调查。结果:积极心境、积极体验、心理弹性、积极应对方式、人际信任、社会支持知觉得分与SCL-90总分及各因子分均呈负相关(r=-0.52~-0.11,P<0.05或0.01)。回归分析表明,积极体验、心理弹性、人际信任、社会支持知觉得分与SCL-90总分相关(β=-0.32、-0.38、-0.19、-0.21;均P<0.01)。路径分析表明,积极情绪对心理健康总症状的直接效应不显著(路径系数为-0.01),而对个人资源的直接效应显著(路径系数为0.79,P<0.01);个人资源对心理健康总症状的直接效应显著(路径系数为-0.44,P<0.01)。结论:个人资源在积极情绪与心理健康之间起完全中介作用,积极情绪能够通过建设个人资源而促进个体心理健康水平。     

Empowering family carers of people with multimorbidity as partners in chronic health care: Insights from health professionals

ObjectivesPeople living with multimorbidity often rely on the support of informal family carers, yet challenges frequently arise when carers of people with multimorbidity (PwM) interact with health professionals (HPs) and healthcare systems. This study aimed to provide insights into the experiences and challenges involved in working with carers of PwM, from HPs’ perspectives.MethodsTwenty-one HPs (11 doctors, 5 nurses and 5 allied health professionals) from varying specialities participated in semi-structured interviews. Interviews were transcribed and qualitatively analysed using thematic analysis.ResultsFive themes were identified: carer involvement makes multimorbidity easier to manage, differing views on HP’s responsibilities to carers, multimorbidity makes management harder for HPs, strategies to support carers of PwM, and multimorbidity is one aspect of complexity.ConclusionsHPs recognise unique needs of carers of PwM, yet perceive challenges addressing these needs and supporting this commonly overlooked group.Practice implicationsThe unmet needs of carers of PwM that HPs identified in this study suggest pathways for future improvements and interventions, including HP education and training, and appropriate referral pathways for carers of PwM to access supportive services. Underpinning these findings is the need for greater recognition and respect for the critical work of family carers in healthcare.     

Designing a patient-centered personal health record to promote preventive care

Background

Evidence-based preventive services offer profound health benefits, yet Americans receive only half of indicated care. A variety of government and specialty society policy initiatives are promoting the adoption of information technologies to engage patients in their care, such as personal health records, but current systems may not utilize the technology's full potential.

Methods

Using a previously described model to make information technology more patient-centered, we developed an interactive preventive health record (IPHR) designed to more deeply engage patients in preventive care and health promotion. We recruited 14 primary care practices to promote the IPHR to all adult patients and sought practice and patient input in designing the IPHR to ensure its usability, salience, and generalizability. The input involved patient usability tests, practice workflow observations, learning collaboratives, and patient feedback. Use of the IPHR was measured using practice appointment and IPHR databases.

Results

The IPHR that emerged from this process generates tailored patient recommendations based on guidelines from the U.S. Preventive Services Task Force and other organizations. It extracts clinical data from the practices' electronic medical record and obtains health risk assessment information from patients. Clinical content is translated and explained in lay language. Recommendations review the benefits and uncertainties of services and possible actions for patients and clinicians. Embedded in recommendations are self management tools, risk calculators, decision aids, and community resources - selected to match patient's clinical circumstances. Within six months, practices had encouraged 14.4% of patients to use the IPHR (ranging from 1.5% to 28.3% across the 14 practices). Practices successfully incorporated the IPHR into workflow, using it to prepare patients for visits, augment health behavior counseling, explain test results, automatically issue patient reminders for overdue services, prompt clinicians about needed services, and formulate personalized prevention plans.

Conclusions

The IPHR demonstrates that a patient-centered personal health record that interfaces with the electronic medical record can give patients a high level of individualized guidance and be successfully adopted by busy primary care practices. Further study and refinement are necessary to make information systems even more patient-centered and to demonstrate their impact on care.

Trial Registration

Clinicaltrials.gov identifier: NCT00589173

     

Dutch health websites and their ability to inform people with low health literacy

ObjectiveTo evaluate whether Dutch online health information (OHI) generally reflects message elements that support information processing and understanding among people with low health literacy.MethodsWe content-analyzed one hundred Dutch webpages about Ebola, fibromyalgia, ALS, losing weight, borderline personality disorder, hemorrhoids, ADD, bladder infection, shingles, and chicken pox. The codebook covered the following domains: images and videos, readability level, Suitability Assessment of Materials (SAM), advertising, interactive features, and reliability cues.ResultsThirty-seven webpages contained informative images that visualized the text. Twelve webpages incorporated videos, six of which were animations. Readability varied widely, but 79.2% of the texts exceeded the recommended B1 level. Half of the webpages had inadequate SAM scores; five were classified as superior. Interactive features were infrequently used. Many webpages included only a few elements that help users evaluate the reliability of OHI. Four presented a quality label.ConclusionOver a wide range of health-related topics, Dutch OHI does not generally contain message elements that improve information processing among people with low health literacy.Practice implicationsCommunication professionals should make better use of digital message features. Videos, narration, and interactivity are scarcely used but can be valuable for people with low health literacy.