Patient preference for falls prevention in hospitals revealed through willingness-to-pay, contingent valuation survey

Rationale, aims and objectives Patient preference for interventions aimed at preventing in‐hospital falls has not previously been investigated. This study aims to contrast the amount patients are willing to pay to prevent falls through six intervention approaches. Methods This was a cross‐sectional willingness‐to‐pay (WTP), contingent valuation survey conducted among hospital inpatients (n = 125) during their first week on a geriatric rehabilitation unit in Queensland, Australia. Contingent valuation scenarios were constructed for six falls prevention interventions: a falls consultation, an exercise programme, a face‐to‐face education programme, a booklet and video education programme, hip protectors and a targeted, multifactorial intervention programme. The benefit to participants in terms of reduction in risk of falls was held constant (30% risk reduction) within each scenario. Results Participants valued the targeted, multifactorial intervention programme the highest [mean WTP (95% CI): $(AUD)268 ($240, $296)], followed by the falls consultation [$215 ($196, $234)], exercise [$174 ($156, $191)], face‐to‐face education [$164 ($146, $182)], hip protector [$74 ($62, $87)] and booklet and video education interventions [$68 ($57, $80)]. A ‘cost of provision’ bias was identified, which adversely affected the valuation of the booklet and video education intervention. Conclusion There may be considerable indirect and intangible costs associated with interventions to prevent falls in hospitals that can substantially affect patient preferences. These costs could substantially influence the ability of these interventions to generate a net benefit in a cost–benefit analysis.     

"Too much of that stuff can't be good": Canadian teens, morality, and fast food consumption

Recently, public health agents and the popular media have argued that rising levels of obesity are due, in part, to "obesogenic" environments, and in particular to the clustering of fast food establishments in Western urban centers that are poor and working class. Our findings from a multi-site, cross-national qualitative study of teenaged Canadians' eating practices in urban and rural areas offer another perspective on this topic, showing that fast food consumption is not simply a function of the location of fast food outlets, and that Canadian teens engage in complex ways with the varied dimensions of choosing (or rejecting) fast foods. Drawing on evidence gleaned from semi-structured interviews with 132 teenagers (77 girls and 55 boys, ages 13-19 years) carried out between 2007 and 2009, we maintain that no easy relationship exists between the geographical availability of fast food and teen eating behaviors. We use critical obesity literature that challenges widely accepted understandings about obesity prevalence and etiology, as well as Lamont's (1992, 2000) concept of "moral boundary work," to argue that teen fast food consumption and avoidance is multifaceted and does not stem exclusively nor directly from spatial proximity or social class. Through moral boundary work, in which teens negotiated with moralistic notions of healthy eating, participants made and re-made themselves as "good" and successful subjects by Othering those who were "bad" in references to socially derived discourses of healthy eating.     

A prospective observational cohort study examining the development of head and neck lymphedema from the time of diagnosis

Introduction

Head and neck lymphedema can occur in the internal or external structures of the head and neck region. Little is known about the development of this condition over the course of treatment for head and neck cancer. This study aimed to observe the development of internal and external lymphedema from diagnosis to 12 weeks postacute treatment.

Methods

A single center, prospective observational cohort study assessed participants for external lymphedema, internal lymphedema, quality of life, and symptom burden. Assessments were conducted prior to starting radiotherapy (RT), at the end of RT, 6 and 12 weeks after RT.

Results

Forty-six participants were recruited. External lymphedema as measured by percentage water content, increased from 41.9 at baseline (95% CI: 39.3–44.4) to 50.4 (95% CI: 46.0–54.8) at 12 weeks following RT (p-value < .001). After adjusting for changes in weight and participant age at baseline, a general increase in tape measurements was observed over time with significant increases from baseline to 12 weeks post-RT for all measurement points. By 12 weeks post-RT, all participants had lymphedema present in eight of 13 internal sites assessed.

Conclusions

Internal and external head and neck lymphedema was observed to increase from baseline to 12 weeks after completion of RT without abatement. People with head and neck cancer should be educated about the potentially extended duration of this treatment side effect. Further research is required to determine the point at which swelling symptoms recede.     

Pregnant women’s awareness,knowledge and beliefs about pelvic floor muscles: a cross-sectional survey

Introduction and hypothesis

Pregnant women benefit from completing pelvic floor muscle exercises (PFMEs). The aims of the study were to evaluate pregnant women’s levels of awareness, knowledge, and beliefs about the pelvic floor muscles (PFMs) and PFMEs.

Methods

A cross-sectional survey was conducted. Respondents were pregnant women over the age of 18 years who attended antenatal clinics in Western Australia (WA). Questionnaire items measured awareness and knowledge about PFMs, confidence and beliefs about engaging in PFMEs, and attendance at antenatal education (ANE) classes. Chi-squared tests examined potential associations between questionnaire items and respondent characteristics.

Results

Mean gestation of respondents (n?=?633 out of 850; 74% response rate) was 28.7 (+7.8) weeks and 50% were giving birth for the first time. Although 76% of respondents knew that PFMs can prevent urinary incontinence, only 27% knew that they prevented faecal incontinence and 41% thought it was normal to leak urine when pregnant. Only n?=?72 (11%) were practicing PFMEs. Respondents who had attended ANE (28%) were significantly more knowledgeable about pelvic floor function (p?<?.001) and significantly less likely to believe that leaking urine during pregnancy was normal (p?=?0.02), compared with those who had not attended ANE. Respondents who did not speak English at home (18%) were significantly less knowledgeable about PFMs and PFMEs, and significantly less likely to have attended, or planned to attend, ANE classes.

Conclusion

Pregnant women require more health education regarding PFMs. Education should be provided using diverse modes, especially for women from migrant backgrounds and women who do not plan to attend formal ANE classes.

     

Opportunistic postpartum depression symptom screening at well-child clinics in Alberta, 2012–2016

ObjectivesThe study objective was to assess the reach and delivery of opportunistic postpartum depression (PPD) symptom screening at well-child clinic (WCC) immunization appointments in Alberta. The relationship between socio-demographic factors and PPD symptom screening status, and PPD symptom scores was explored.MethodIn this retrospective population-based cohort study, administrative health data from WCC immunization appointments were used to assess the PPD symptom screening delivery and scores from January 1, 2012 to December 31, 2016. The associations with maternal age and area-level material deprivation were determined by multivariable statistics.ResultsThe number of births ranged from 51,537 to 55,787 annually. The percentage of mothers screened for PPD symptoms using the Edinburgh Postnatal Depression Scale decreased between 2012 and 2016, from 80.1% to 69.7%. Of those screened, 3–3.2% of the mothers were identified to be at high risk for PPD, annually. Screening status varied according to maternal age: mothers ≤29 years were more likely to be screened than mothers 30–34 years, while mothers ≥35 years were the least likely to be screened. Logistic regression analyses, adjusting for age, found the odds of not being screened increased with increases in area-level material deprivation. Language/cultural barriers were the most commonly reported reasons for not screening.ConclusionOpportunistic PPD symptom screening at WCCs can be an efficient method to identify mothers who need postpartum support and to inform population-level public health surveillance. Additional work is needed to further understand barriers to PPD symptom screening, especially language, cultural, and socio-demographic factors.     

Factors associated with older patients' engagement in exercise after hospital discharge

Hill A-M, Hoffmann T, McPhail S, Beer C, Hill KD, Brauer SG, Haines TP. Factors associated with older patients' engagement in exercise after hospital discharge.

Objectives

To identify factors that are associated with older patients' engagement in exercise in the 6 months after hospital discharge.

Design

A prospective observational study using qualitative and quantitative evaluation.

Setting

Follow-up of hospital patients in their home setting after discharge from a metropolitan general hospital.

Participants

Participants (N=343) were older patients (mean age ± SD, 79.4±8.5y) discharged from medical, surgical, and rehabilitation wards and followed up for 6 months after discharge.

Interventions

Not applicable.

Main Outcome Measures

Self-perceived awareness and risk of falls measured at discharge with a survey that addressed elements of the Health Belief Model. Engagement and self-reported barriers to engagement in exercise measured at 6 months after discharge using a telephone survey.

Results

Six months after discharge, 305 participants remained in the study, of whom 109 (35.7%) were engaging in a structured exercise program. Multivariable logistic regression analysis demonstrated participants were more likely to be engaging in exercise if they perceived they were at risk of serious injury from a fall (odds ratio [OR] =.61; 95% confidence interval [CI], .48–.78; P<.001), if exercise was recommended by the hospital physiotherapist (OR=1.93; 95% CI, 1.03–3.59; P=.04), and if they lived with a partner (OR=1.97; 95% CI, 1.18–3.28; P=.009). Barriers to exercise identified by 168 participants (55%) included low self-efficacy, low motivation, medical problems such as pain, and impediments to program delivery.

Conclusions

Older patients have low levels of engagement in exercise after hospital discharge. Researchers should design exercise programs that address identified barriers and facilitators, and provide education to enhance motivation and self-efficacy to exercise in this population.