An online international comparison of palliative care identification in primary care using the Surprise Question

Background: The Surprise Question (‘Would I be surprised if this patient died within 12 months?’) identifies patients in the last year of life. It is unclear if ‘surprised’ means the same for each clinician, and whether their responses are internally consistent. Aim: To determine the consistency with which the Surprise Question is used. Design: A cross-sectional online study of participants located in Belgium, Germany, Italy, The Netherlands, Switzerland and UK. Participants completed 20 hypothetical patient summaries (‘vignettes’). Primary outcome measure: continuous estimate of probability of death within 12 months (0% [certain survival]–100% [certain death]). A threshold (probability estimate above which Surprise Question responses were consistently ‘no’) and an inconsistency range (range of probability estimates where respondents vacillated between responses) were calculated. Univariable and multivariable linear regression explored differences in consistency. Trial registration: NCT03697213. Setting/participants: Registered General Practitioners (GPs). Of the 307 GPs who started the study, 250 completed 15 or more vignettes. Results: Participants had a consistency threshold of 49.8% (SD 22.7) and inconsistency range of 17% (SD 22.4). Italy had a significantly higher threshold than other countries ( p = 0.002). There was also a difference in threshold levels depending on age of clinician, for every yearly increase, participants had a higher threshold. There was no difference in inconsistency between countries ( p = 0.53). Conclusions: There is variation between clinicians regarding the use of the Surprise Question. Over half of GPs were not internally consistent in their responses to the Surprise Question. Future research with standardised terms and real patients is warranted.

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Meeting UK dietary recommendations is associated with higher estimated consumer food costs: an analysis using the National Diet and Nutrition Survey and consumer expenditure data, 2008–2012

Public Health Nutrition ◽

10.1017/s1368980017003275 ◽

2017 ◽

Vol 21 (5) ◽

pp. 948-956 ◽

Cited By ~ 12

Author(s):

Nicholas RV Jones ◽

Tammy YN Tong ◽

Pablo Monsivais

Keyword(s):

Saturated Fat ◽

Population Level ◽

Cross Sectional Study ◽

Primary Outcome Measure ◽

Future Research ◽

Consumer Expenditure ◽

Dietary Recommendations ◽

Nutrition Survey ◽

Cross Sectional ◽

Individual Level

AbstractObjectiveTo test whether diets achieving recommendations from the UK’s Scientific Advisory Committee on Nutrition (SACN) were associated with higher monetary costs in a nationally representative sample of UK adults.DesignA cross-sectional study linking 4 d diet diaries in the National Diet and Nutrition Survey (NDNS) to contemporaneous food price data from a market research firm. The monetary cost of diets was assessed in relation to whether or not they met eight food- and nutrient-based recommendations from SACN. Regression models adjusted for potential confounding factors. The primary outcome measure was individual dietary cost per day and per 2000 kcal (8368 kJ).SettingUK.SubjectsAdults (n 2045) sampled between 2008 and 2012 in the NDNS.ResultsOn an isoenergetic basis, diets that met the recommendations for fruit and vegetables, oily fish, non-milk extrinsic sugars, fat, saturated fat and salt were estimated to be between 3 and 17 % more expensive. Diets meeting the recommendation for red and processed meats were 4 % less expensive, while meeting the recommendation for fibre was cost-neutral. Meeting multiple targets was also associated with higher costs; on average, diets meeting six or more SACN recommendations were estimated to be 29 % more costly than isoenergetic diets that met no recommendations.ConclusionsFood costs may be a population-level barrier limiting the adoption of dietary recommendations in the UK. Future research should focus on identifying systems- and individual-level strategies to enable consumers achieve dietary recommendations without increasing food costs. Such strategies may improve the uptake of healthy eating in the population.

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Exposure to and experience of self-harm and self-harm related content: An exploratory network analysis

10.31234/osf.io/gyhzr ◽

2020 ◽

Author(s):

Olivia J Kirtley ◽

Ian Hussey ◽

Lisa Marzano

Keyword(s):

Network Models ◽

Information Criterion ◽

Future Research ◽

Cross Sectional ◽

Online Study ◽

Graphical Lasso ◽

Temporal Relationships ◽

History Of ◽

Self Harm ◽

Larger Sample

Exposure to the self-harm behaviour of others plays a role in individuals’ own self-harm thoughts and behaviours, but there has been little consideration of the broader range of mediums through which exposure to self-harm related content may occur. N = 477 participants completed an online study, including questions regarding lifetime history of self-harm thoughts and behaviours and the frequency with which they had been exposed to self-harm via various mediums. Gaussian Markov random field network models were estimated using graphical LASSO and extended Bayesian information criterion. Bootstrapping revealed that exposure mediums with a direct connection to self-harm thoughts and behaviours were the internet (rrp = .34, 95% CI [.26, .42]) and in-passing ‘miscellaneous’ exposure (rrp = .14, 95% CI [.00, .23]). However, stability of the network centrality was low (expected influence stability = 0.52). The node with the greatest increase in expected influence within the network was miscellaneous “in-passing” exposure. In-passing exposure is an understudied exposure medium. Our results may suggest new types of exposure mediums for future research. Data were cross-sectional, so temporal relationships between exposure and behaviour could not be determined. Low stability of the networks suggests that future similar studies would benefit from larger sample sizes.

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A Silenced Population

Crisis ◽

10.1027/0227-5910/a000470 ◽

2017 ◽

Vol 38 (6) ◽

pp. 433-442 ◽

Cited By ~ 1

Author(s):

Kim Gryglewicz ◽

Melanie Bozzay ◽

Brittany Arthur-Jordon ◽

Gabriela D. Romero ◽

Melissa Witmeier ◽

...

Keyword(s):

At Risk ◽

Depressive Symptomatology ◽

The United States ◽

Future Research ◽

At Risk Youth ◽

Peer Relationship ◽

Student Records ◽

Cross Sectional ◽

Increased Risk ◽

Method Student

Abstract. Background: Given challenges that exceed the normal developmental requirements of adolescence, deaf and hard-of-hearing (DHH) youth are believed to be at elevated risk for engaging in suicide-related behavior (SRB). Unfortunately, little is known about the mechanisms that put these youth potentially at risk. Aims: To determine whether peer relationship difficulties are related to increased risk of SRB in DHH youth. Method: Student records (n = 74) were retrieved from an accredited educational center for deaf and blind students in the United States. Results: Peer relationship difficulties were found to be significantly associated with engagement in SRB but not when accounting for depressive symptomatology. Limitations: The restricted sample limits generalizability. Conclusions regarding risk causation cannot be made due to the cross-sectional nature of the study. Conclusion: These results suggest the need for future research that examines the mechanisms of the relationship between peer relationship difficulties, depression, and suicide risk in DHH youth and potential preventive interventions to ameliorate the risks for these at-risk youth.

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Cross-Lagged Relationships Between Self-Esteem, Self-Construal, and Happiness in a Three-Wave Longitudinal Study

Journal of Individual Differences ◽

10.1027/1614-0001/a000290 ◽

2019 ◽

Vol 40 (3) ◽

pp. 177-185

Author(s):

Daniela Moza ◽

Laurențiu Maricuțoiu ◽

Alin Gavreliuc

Keyword(s):

Structural Equation ◽

Time Lag ◽

Self Esteem ◽

Equation Modeling ◽

Future Research ◽

Cross Sectional ◽

Self Construal ◽

Self Worth ◽

Practical Implications ◽

Independent Person

Abstract. Previous research established that an independent construal of the self is associated with higher self-esteem, which, in turn, is associated with increased happiness. Regarding the directionality of these relationships, theoretical arguments have suggested that self-construal precedes self-esteem and that self-esteem precedes happiness. However, most research in this area is cross-sectional, thus limiting any conclusions about directionality. The present study tested these relationships in 101 Romanian undergraduates using a 3-wave cross-lagged design with a 6-month time lag between every two waves. Structural equation modeling analyses revealed that self-esteem is an antecedent of both happiness and dimensions of independent self-construal (i.e., consistency vs. variability and self-expression vs. harmony). In other words, one’s positive evaluation of self-worth precedes one’s self-perception as being a happy and independent person. The findings are discussed with respect to the theoretical and practical implications, along with limitations and suggestions for future research.

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Complementary Medicine and Self-Care Strategies in Women with (Recurrent) Urinary Tract and Vaginal Infections: A Cross-Sectional Study on Use and Perceived Effectiveness in The Netherlands

Antibiotics ◽

10.3390/antibiotics10030250 ◽

2021 ◽

Vol 10 (3) ◽

pp. 250

Author(s):

Louise Witteman ◽

Herman A. van Wietmarschen ◽

Esther T. van der Werf

Keyword(s):

Urinary Tract ◽

The Netherlands ◽

Complementary Medicine ◽

Self Care ◽

Future Research ◽

Perceived Effectiveness ◽

Vaginal Infections ◽

Cross Sectional ◽

Treatment Implementation ◽

Specific Symptoms

Due to the excessive use of antibiotic and antimycotic treatments, the risk of resistant microbes and fungi is rapidly emerging. Previous studies have demonstrated that many women with (recurrent) urinary tract infection (UTI) and/or vaginal infections (VIs) welcome alternative management approaches to reduce the use of antibiotics and antifungals and avoid short- and long-term adverse effects. This study aims to determine which complementary medicine (CM) and self-care strategies are being used by women suffering from (recurrent) UTI and VI in The Netherlands and how they perceive their effectiveness in order to define directions for future research on safety, cost-effectiveness, and implementation of best practices. A cross-sectional online survey was performed among women, ≥18 years old, with a history of UTIs; 162 respondents were included in the data analysis, with most participants aged between 50 and 64 years (36.4%). The women reported having consulted a CM practitioner for UTI-specific symptoms (23.5%) and VI-specific symptoms (13.6%). Consultations of homeopaths, acupuncturists, and herbal physicians are most often reported. Overall, 81.7% of the women suffering from UTI used complementary or self-care strategies besides regular treatment, and 68.7% reported using CM/self-care strategies to treat vaginal symptoms. UTI- related use of cranberries (51.9%), vitamin C (43.8%), and D-mannose (32.7%) were most reported. Perceived effectiveness was mostly reported for homeopathic remedies and D-mannose. The results showed a substantial burden of UTI and VI on daily and sexual activities. Besides the frequency of use, the indication of perceived effectiveness seems to be an important parameter for further and rigorously designed research to encourage nonantibiotic/antifungal treatment implementation into daily clinical practice.

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Social Engagement and Episodic Memory in Non-Hispanic Black and White Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.1101 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 343-343

Author(s):

Abbey Hamlin ◽

A Zarina Kraal ◽

Laura Zahodne

Keyword(s):

Social Support ◽

Older Adults ◽

Episodic Memory ◽

Cognitive Aging ◽

Social Engagement ◽

Future Research ◽

Social Activities ◽

Linear Regression Models ◽

Significant Positive Association ◽

Cross Sectional

Abstract Social engagement may confer cognitive benefits in older adulthood, but studies have typically been restricted to largely non-Hispanic White (NHW) samples. Levels of social engagement vary across race such that NHW report larger social networks, more frequent participation in social activities, and greater social support than non-Hispanic Blacks (NHB). Associations between social engagement and cognition may also vary by race, but research is sparse. The current cross-sectional study examined associations between different aspects of social engagement and episodic memory performance, as well as interactions between social engagement and race among NHB and NHW participants in the Michigan Cognitive Aging Project (N = 247; 48.4% NHB; age = 64.19 ± 2.92). Social engagement (network size, activities, support) was self-reported. Episodic memory was a z-score composite of immediate, delayed, and recognition trials of a list-learning task. Separate hierarchical linear regression models quantified interactions between race and each of the three social engagement variables on episodic memory, controlling for sociodemographics, depressive symptoms, and health conditions. Results showed a main effect of more frequent social activity on better episodic memory, as well as an interaction between race and social support indicating a significant positive association in NHB but not NHW. These preliminary findings suggest that participating in social activities may be equally beneficial for episodic memory across NHB and NHW older adults and that social support may be particularly beneficial for NHB. Future research is needed to determine the potential applications of these results in reducing cognitive inequalities through the development of culturally-relevant interventions.

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Comparison of diet quality of US adults based on primary motivation for following a vegetarian diet: A cross-sectional online study

Nutrition Research ◽

10.1016/j.nutres.2021.04.001 ◽

2021 ◽

Author(s):

Elena Torna ◽

Elena Smith ◽

Meagan Lamothe ◽

Dr. Bobbi Langkamp-Henken ◽

Dr. Jeanette M Andrade

Keyword(s):

Diet Quality ◽

Vegetarian Diet ◽

Cross Sectional ◽

Primary Motivation ◽

Online Study

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The Association of School Nurse Workload With Student Health and Academic Outcomes: A Cross-Sectional Study

The Journal of School Nursing ◽

10.1177/10598405211012957 ◽

2021 ◽

pp. 105984052110129

Author(s):

Krista Schroeder ◽

Ally Young ◽

Gail Adman ◽

Ann Marie Ashmeade ◽

Estherlyn Bonas ◽

...

Keyword(s):

Academic Outcomes ◽

Student Outcomes ◽

School Nurse ◽

School Nurses ◽

Future Research ◽

Student Health ◽

Office Visits ◽

School Students ◽

Cross Sectional ◽

Nurse Workload

This study assessed associations between school nurse workload and student health and academic outcomes. We hypothesized that lower school nurse workload would be associated with better student outcomes, with associations being greater for members of groups who experience health disparities. Our methods entailed secondary analysis of data for New York City school students in kindergarten through 12th grade during 2015–2016 ( N = 1,080,923), using multilevel multivariate regression as the analytic approach. Results demonstrated lower school nurse workload was associated with better outcomes for student participation in asthma education but not chronic absenteeism, early dismissals, health office visits, immunization compliance, academic achievement, or overweight/obesity. Our findings suggest school nurses may influence proximal outcomes, such as participation in disease-related education, more easily than downstream outcomes, such as absenteeism or obesity. While contrary to our hypotheses, results align with the fact that school nurses deliver community-based, population health–focused care that is inherently complex, multilevel, and directly impacted by social determinants of health. Future research should explore school nurses’ perspectives on what factors influence their workload and how they can best impact student outcomes.

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Women’s perceptions of factors influencing their food shopping choices and how supermarkets can support them to make healthier choices

BMC Public Health ◽

10.1186/s12889-021-11112-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Preeti Dhuria ◽

Wendy Lawrence ◽

Sarah Crozier ◽

Cyrus Cooper ◽

Janis Baird ◽

...

Keyword(s):

Healthy Eating ◽

Personal Responsibility ◽

Food Preferences ◽

Food Choices ◽

Cross Sectional Study ◽

Future Research ◽

Cross Sectional ◽

Telephone Interviews ◽

Food Shopping ◽

Women’S Perceptions

Abstract Objectives To examine women’s perceptions of factors that influence their food shopping choices, particularly in relation to store layout, and their views on ways that supermarkets could support healthier choices. Design This qualitative cross-sectional study used semi-structured telephone interviews to ask participants the reasons for their choice of supermarket and factors in-store that prompted their food selections. The actions supermarkets, governments and customers could take to encourage healthier food choices were explored with women. Thematic analysis was conducted to identify key themes. Setting Six supermarkets across England. Participants Twenty women customers aged 18–45 years. Results Participants had a median age of 39.5 years (IQR: 35.1, 42.3), a median weekly grocery spend of £70 (IQR: 50, 88), and 44% had left school aged 16 years. Women reported that achieving value for money, feeling hungry, tired, or stressed, and meeting family members’ food preferences influenced their food shopping choices. The physical environment was important, including product quality and variety, plus ease of accessing the store or products in-store. Many participants described how they made unintended food selections as a result of prominent placement of unhealthy products in supermarkets, even if they adopted more conscious approaches to food shopping (i.e. written or mental lists). Participants described healthy eating as a personal responsibility, but some stated that governments and supermarkets could be more supportive. Conclusions This study highlighted that in-store environments can undermine intentions to purchase and consume healthy foods. Creating healthier supermarket environments could reduce the burden of personal responsibility for healthy eating, by making healthier choices easier. Future research could explore the interplay of personal, societal and commercial responsibility for food choices and health status.

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Self-rated health among undocumented and newly regularized migrants in Geneva: a cross-sectional study

BMC Public Health ◽

10.1186/s12889-021-11239-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Julien Fakhoury ◽

Claudine Burton-Jeangros ◽

Idris Guessous ◽

Liala Consoli ◽

Aline Duvoisin ◽

...

Keyword(s):

Social Support ◽

Social Networks ◽

Cross Sectional Study ◽

Future Research ◽

Undocumented Migrants ◽

Long Term Effects ◽

Residence Permit ◽

Cross Sectional ◽

Convenience Sample ◽

Self Rated Health

Abstract Background In Europe, knowledge about the social determinants of health among undocumented migrants is scarce. The canton of Geneva, Switzerland, implemented in 2017–2018 a pilot public policy aiming at regularizing undocumented migrants. We sought to test for associations between self-rated health, proven eligibility for residence status regularization and social and economic integration. Methods This paper reports data from the first wave of the Parchemins Study, a prospective study whose aim is to investigate the effect of residence status regularization on undocumented migrants’ living conditions and health. The convenience sample included undocumented migrants living in Geneva for at least 3 years. We categorized them into those who were in the process of receiving or had just been granted a residence permit (eligible or newly regularized) and those who had not applied or were ineligible for regularization (undocumented). We conducted multivariate regression analyses to determine factors associated with better self-rated health, i.e., with excellent/very good vs. good/fair/poor self-rated health. Among these factors, measures of integration, social support and economic resources were included. Results Of the 437 participants, 202 (46%) belonged to the eligible or newly regularized group. This group reported better health more frequently than the undocumented group (44.6% versus 28.9%, p-value < .001), but the association was no longer significant after adjustment for social support and economic factors (odds ratio (OR): 1.12; 95% confidence interval (CI): 0.67–1.87). Overall, better health was associated with larger social networks (OR: 1.66; 95% CI: 1.04–2.64). This association remained significant even after adjusting for health-related variables. Conclusion At the onset of the regularization program, access to regularization was not associated with better self-rated health. Policies aiming at favouring undocumented migrants’ inclusion and engagement in social networks may promote better health. Future research should investigate long-term effects of residence status regularization on self-rated health.

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