SDGs and public health policies: implementing the S2D grid in the city of Lausanne, Switzerland.

Sustainable development goals (SDGs) and public health are often considered as separate policy fields, whereas there is a considerable potential in better coordinating their objectives and measures. Using an analytical grid (S2D grid) linking SDGs and public health objectives and comprising 6 thematic issues and 56 categories, the research team conducted an assessment of health promotion programs in the city of Lausanne, Switzerland. Their objective was to determine whether SDGs and public health concerns can translate into complementary policy objectives, and what was the level of achievement of Lausanne in terms of implementation, intersectoral collaboration and avoidance of redundancy, regarding the vast array of measures potentially dealing with SDGs and health promotion. Results show that measures implemented by Lausanne deal with 80% of categories included in the S2D grid, with a high level of intersectorality and a low level of redundancy. These results also emphasize the fact that linkages between SDGs and health promotion go well beyond the SDG 3 dedicated to 'good health and well-being', and that the S2D grid could be used as a tool in favor of organizational change, promoting the collaboration between stakeholders often reluctant to engage in public health policies.

Fall determinants and home modifications by occupational therapists to prevent falls: Facteurs déterminants des chutes et modifications du domicile effectuées par les ergothérapeutes pour prévenir les chutes.

BACKGROUND: Approximately one third of older people over 65 years fall each year. Home modifications may decrease occurrence of falls. PURPOSE: This study aims to determine the risk factors of falls for frail older persons and to evaluate the impact of home modifications by an occupational therapist on the occurrence of falls. METHOD: We conducted a longitudinal study using a quasiexperimental design to examine occurrence of falls. All participants 65 years of age and older and were assessed at baseline and 6 months after the intervention. Bivariate analysis and logistic regression models were used to study the risk factors of falls and the effect of home modifications on the incidence of falls. FINDINGS: The main predictors of falls were vision problems, distress of informal caregiver, and insufficient informal support. Home modifications provided by an occupational therapist showed a significant reduction of falls. IMPLICATIONS: Informal caregivers and their health status had an impact on the fall risk of frail older persons. Home modifications by an occupational therapist reduced the fall risk of frail older persons at 6-months follow-up.

Estimating the economic impact of a possible equine and human epidemic of West Nile virus infection in Belgium.

This study aimed at estimating, in a prospective scenario, the potential economic impact of a possible epidemic of WNV infection in Belgium, based on 2012 values for the equine and human health sectors, in order to increase preparedness and help decision-makers. Modelling of risk areas, based on the habitat suitable for Culex pipiens, the main vector of the virus, allowed us to determine equine and human populations at risk. Characteristics of the different clinical forms of the disease based on past epidemics in Europe allowed morbidity among horses and humans to be estimated. The main costs for the equine sector were vaccination and replacement value of dead or euthanised horses. The choice of the vaccination strategy would have important consequences in terms of cost. Vaccination of the country's whole population of horses, based on a worst-case scenario, would cost more than EUR 30 million; for areas at risk, the cost would be around EUR 16-17 million. Regarding the impact on human health, short-term costs and socio-economic losses were estimated for patients who developed the neuroinvasive form of the disease, as no vaccine is available yet for humans. Hospital charges of around EUR 3,600 for a case of West Nile neuroinvasive disease and EUR 4,500 for a case of acute flaccid paralysis would be the major financial consequence of an epidemic of West Nile virus infection in humans in Belgium.

[How to optimize the efficiency of international sanitary aid in the Democratic Republic of Congo]. / Comment optimiser l'efficience de l'aide internationale, dans le domaine de la santé, en République Démocratique du Congo.

Analysis of national health insurance accounts in the Democratic Republic of Congo (DRC) clearly shows the importance of international sanitary aid, particularlyfor thefunding ofgeneral referral hospitals, the management of inpatients with AIDS, administration of health zones andfunding of preventive care providers. It The targeted changes described in this article could possibly optimize the efficiency ofinternational aidfor the DRC population, mainly for disorders considered to be a health care priority (i.e. malaria, AIDS, tuberculosis) as well as in the fight against malnutrition. Recommendations target the implementation of procedures for control offood chain security, changes in lifestyle and dietary habits of the population but also comprise extensive restructuring of the health care administration. A dramatic change of the structure in charge of drug distribution as well as eradication of the transfer of part of public health structure income to public health administrative personnel could result in the allocation of significantfunds to thefight against the most important diseases. Better collaboration between the various departments in charge of health care professional training, together with enhanced responsibility of health care personnel is essential. Independent and respected non-governmental organizations should be involved in an audit process, targeting all aspects of the current DRC health system. Eventually, in an equal opportunity perspective, taking into consideration the very high degree of poverty ofDRC inhabitants, implementation of health insurance programmes, use ofgeneric drugs and generalization ofmicro-credit initiatives should also be implemented.

Development and validation of the French version of a tool assessing patient's expectations in lower limb osteoarthritis.

OBJECTIVE: The Hospital for Special Surgery (HSS) Hip Replacement Expectations Survey and Knee Replacement Expectations Survey are validated tools developed to measure patients' preoperative expectations for hip and knee arthroplasty. These instruments have possible uses in both daily practice and research. Our objective was to assess the test-retest reliability and the construct validity of the French version of the surveys. METHODS: Patients scheduled for total hip (n = 82) or knee replacement (n = 61) aged 38-90 years were included. All completed the HSS Hip or Knee Replacement Expectations Survey and the Expectation WOMAC to determine concurrent validity. The test-retest reliability was assessed using the intraclass coefficient correlation (ICC), the Bland and Altman Method and the coefficient of variation; the internal consistency was assessed by the Cronbach α coefficient. The construct validity was investigated using the Pearson correlation coefficient and floor and ceiling effects by percentage frequency of lowest or highest possible score achieved by respondents. RESULTS: 143 patients scheduled for hip or knee arthroplasty were included. The reliability was excellent between the test and the rested total score, with an ICC of 0.902 (0.853-0.936) and CV of 4.06% for the French Hip Replacement Expectations Survey and 0.865 (0.786-0.917) and CV of 7.7% for the French Knee Replacement Expectations Survey, without bias. The Cronbach α coefficient was 0.72 for hip Survey and 0.82 for knee Survey showing a good internal consistency. Pearson correlation coefficients of 0.45 and 0.48 between Expectations WOMAC and HSS, respectively for hip Survey and knee Survey, were observed but with systematic bias. The lowest possible score was not reported by any patient and only three patients (3.66%) scheduled for hip arthroplasty reported the highest possible score. CONCLUSIONS: The French version of the HSS Hip or Knee Replacement Expectations Survey is a reliable and valid questionnaire and compares favourably with the original English version. Therefore, this new version may help French-speaking clinicians to evaluate expectations before lower limb arthroplasty.

The 24-h recall instrument for home nursing to measure the activity profile of home nurses: development and psychometric testing.

Home health care today is challenged by a shift from an acute to a chronic health-care model, moving the focus of care from the hospital to home-care setting. This increased focus on care at home emphasizes the need for an efficient, effective, and transparent management of home health care. However, it is not precisely known what home-care nurses do; what kind of care is received by patients; what the performance of home nurses is; and what the impact of the increasing need for home nursing is on the current and future role of home nurses. In this respect, it is necessary to gain a clear insight into the activity profile of home nurses, but there is no gold standard to measure their activities. This study reports on the development and psychometric testing of the '24-hour recall instrument for home nursing' to measure the activity profile of home nurses. Five home nurses in Belgium, simultaneously with the researcher, registered the performed activities in a total of 69 patients, using the 24-h recall instrument for home nursing. The validity and the interrater reliability of this instrument were high: the proportions that observed agreement were very high; the strength of kappa agreement was substantial to almost perfect; the prevalence index showed great variety; and the bias index was low. The findings in this study support the validity evidence based on test content and the interrater reliability of the 24-h recall instrument. This instrument can help to shape practice and policy by making the home nursing profession more transparent: a clear insight into the kind of care that is provided by home nurses and is received by the patients in primary care contributes to the development of a clear definition of the role of home nurses in health care.

Multidisciplinary and evidence-based method for prioritizing diseases of food-producing animals and zoonoses.

To prioritize 100 animal diseases and zoonoses in Europe, we used a multicriteria decision-making procedure based on opinions of experts and evidence-based data. Forty international experts performed intracategory and intercategory weighting of 57 prioritization criteria. Two methods (deterministic with mean of each weight and probabilistic with distribution functions of weights by using Monte Carlo simulation) were used to calculate a score for each disease. Consecutive ranking was established. Few differences were observed between each method. Compared with previous prioritization methods, our procedure is evidence based, includes a range of fields and criteria while considering uncertainty, and will be useful for analyzing diseases that affect public health.

The effectiveness of inpatient geriatric evaluation and management units: a systematic review and meta-analysis.

OBJECTIVES: To examine how geriatric evaluation and management units (GEMUs) are organized and to examine the effectiveness of admission on a GEMU. DESIGN: Systematic review and meta-analysis based on literature search of multiple databases and the references lists of all identified articles and by contacting authors. SETTING: GEMUs. PARTICIPANTS: Elderly people admitted to a GEMU. MEASUREMENTS: Quality of the studies was assessed on 10 criteria. The outcome parameters were mortality, institutionalization, functional decline, readmission, and length of stay at different follow-up points. A random-effects meta-analysis was performed using Hedges' gu and variance of relative risk (RR). RESULTS: GEMUs are organized in a heterogeneous way and the included studies gave no thorough description of comprehensive geriatric assessment (CGA). Involvement of a multidisciplinary team was a key element in all GEMUs. The individual trials showed that admission to a GEMU has one or more favorable effects on the outcomes of interest, with two significant effects in the meta-analysis: less functional decline at discharge from the GEMU (RR=0.87, 95% confidence interval (CI)=0.77-0.99; P=.04) and a lower rate of institutionalization 1 year after discharge (RR=0.78, CI=0.66-0.92; P=.003). For the other outcomes in the meta-analysis, a GEMU did not induce significantly different outcomes than usual care. CONCLUSION: This meta-analysis shows a significant effect in favor of the GEMU group on functional decline at discharge and on institutionalization after 1 year. There is heterogeneity between the studies, poor quality of some randomized controlled trials, and shortage of information about CGA. Multidisciplinary CGA offered in a GEMU may add value to the care for frail older persons admitted to the hospital, but the limitations confirm the need for well-designed studies using explicit CGA and more-structured and -coherent assessment instruments such as the Minimum Data Set Resident Assessment Instrument.

Implementation of discharge management for geriatric patients at risk of readmission or institutionalization.

OBJECTIVE: To evaluate whether implementation of discharge management by trained social workers or nurses reduces hospital readmissions and institutionalizations of geriatric patients in a real-world setting. DESIGN: Quasi-experimental design. SETTING: Six general hospitals in Belgium. PARTICIPANTS: A representative sample of 824 patients, 355 of whom were assigned to the experimental group receiving comprehensive discharge management and 469 to the control group receiving usual care. Inclusion criteria were patients admitted to a geriatric, rehabilitation, or internal medicine ward, not residing in a nursing home, and showing risk of readmission or institutionalization on admission in the hospital. INTERVENTION: In-hospital discharge planning according to a case management protocol allowing for adjustment to participating hospitals' case mix and patients' and families' specific needs. MAIN OUTCOME MEASURES: Hospital readmission within 15 and 90 days post discharge; institutionalization at discharge and within 15 and 90 days post discharge. RESULTS: Discharge management resulted in fewer institutionalizations (n = 53; 14.9%) compared with usual care (n = 130; 23.7%) (adjusted odds ratio = 0.47; CI 95% = 0.31-0.70). Readmission rates between the intervention and usual care group were not significantly different. CONCLUSIONS: This implementation project showed that a discharge planning intervention can reduce institutionalization rates of elderly patients in real-life settings.

Provider continuity in family medicine: does it make a difference for total health care costs?

BACKGROUND: International comparisons of health care systems have shown a relationship at the macro level between a well-structured primary health care plan and lower total health care costs. The objective of this study was to assess whether provider continuity with a family physician is related to lower health care costs using the individual patient as the unit of analysis. METHODS: We undertook a study of a stratified sample of patients (age, sex, region, insurance company) for which 2 cohorts were constructed based on the patients' utilization pattern of family medicine (provider continuity or not). Patient utilization patterns were observed for 2 years. The setting was the Belgian health care system. The participants were 4,134 members of the 2 largest health insurance companies in 2 regions (Aalst and Liège). The main outcome measures were the total health care costs of patients with and without provider continuity with a family physician, controlling for variables known to influence health care utilization (need factors, predisposing factors, enabling factors). RESULTS: Bivariate analyses showed that patients who were visiting the same family physician had a lower total cost for medical care. A multivariate linear regression showed that provider continuity with a family physician was one of the most important explanatory variables related to the total health care cost. CONCLUSIONS: Provider continuity with a family physician is related to lower total health care costs. This finding brings evidence to the debate on the importance of structured primary health care (with high continuity for family practice) for a cost-effective health policy.