The Effectiveness of Public Awareness Initiatives Aimed at Encouraging the Use of Evidence-Based Recommendations by Health Professionals: A Systematic Review.

OBJECTIVES: Public awareness initiatives have attracted growing attention globally, as a strategy to reduce low-value care and disinformation. However, knowledge gap remains in determining their effects. The aim of this systematic review was to summarize existing evidence to date on global effectiveness of public awareness initiatives. METHODS: Primary quantitative studies focusing on passive delivery of public awareness initiatives that targeted health professionals were included. Eligible studies were identified through search of MEDLINE, Embase, Emcare, the Cochrane Library, PsycINFO, Business Source Complete, Emerald Insight, and Google (initially on December 19, 2018, followed by updated search between July 8-10, 2019, and then between March 8-9, 2022) and the reference list of relevant studies. Methodological quality of included studies was assessed using modified McMaster critical appraisal tool. A narrative synthesis of the study outcomes was conducted. RESULTS: Twenty studies from United States, United Kingdom, Canada, Australia, and multicountry were included. Nineteen studies focused on Choosing Wisely initiative and one focused on National Institute of Clinical Excellence reminders. Most studies investigated one recommendation of a specialty. The findings showed conflicting evidence on the effectiveness of public awareness initiatives, suggesting passive delivery has limited success in reducing low-value care among health professionals. CONCLUSIONS: This review highlights the complexity of change in an established practice pattern in health care. As passive delivery of public awareness initiatives has limited potential to initiate and sustain change, wide-ranging intervention components need to be integrated for a successful implementation.

Ageing in place: implications of morbidity patterns among older persons--findings from a cross-sectional study in a developing country (Jamaica).

AIM: This paper describes morbidity patterns among older people, relevant health-care resources in a localised population in a developing country (Jamaica) and implications for ageing in place in the community. METHODS: Local morbidity patterns among older people were determined in Jamaica from a 2007 cross-sectional study involving record searches at major hospitals and clinics. Age-specific morbidity distributions were compiled. Data on health-care staff complement were also collected. RESULTS: Non-communicable diseases predominate in older people in Jamaica; 50% of diagnoses related to cardiovascular disorders and diabetes. Staff-to-population ratios were low compared with other international data. CONCLUSION: A high prevalence of non-communicable disease coupled with inadequate staffing threatens the likelihood of ageing in place in the Jamaican community. Secondary prevention efforts and social support services which enhance ageing in place are needed.

Land use regression modeling to estimate historic (1962-1991) concentrations of black smoke and sulfur dioxide for Great Britain.

Land-use regression modeling was used to develop maps of annual average black smoke (BS) and sulfur dioxide (SO(2)) concentrations in 1962, 1971, 1981, and 1991 for Great Britain on a 1 km grid for use in epidemiological studies. Models were developed in a GIS using data on land cover, the road network, and population, summarized within circular buffers around air pollution monitoring sites, together with altitude and coordinates of monitoring sites to consider global trend surfaces. Models were developed against the log-normal (LN) concentration, yielding R(2) values of 0.68 (n = 534), 0.68 (n = 767), 0.41 (n = 771), and 0.39 (n = 155) for BS and 0.61 (n = 482), 0.65 (n = 733), 0.38 (n = 756), and 0.24 (n = 153) for SO(2) in 1962, 1971, 1981, and 1991, respectively. Model evaluation was undertaken using concentrations at an independent set of monitoring sites. For BS, values of R(2) were 0.56 (n = 133), 0.41 (n = 191), 0.38 (n = 193), and 0.34 (n = 37), and for SO(2) values of R(2) were 0.71 (n = 121), 0.57 (n = 183), 0.26 (n = 189), and 0.31 (n = 38) for 1962, 1971, 1981, and 1991, respectively. Models slightly underpredicted (fractional bias: 0∼-0.1) monitored concentrations of both pollutants for all years. This is the first study to produce historic concentration maps at a national level going back to the 1960s.

Social determinants of physical exercise in older men in Jamaica.

BACKGROUND: Physical activity interventions have been demonstrated to improve health-related quality of life and to be of special benefit to older adults with specific chronic conditions including arthritis, hypertension, diabetes mellitus, and heart disease. AIM: This study examined the extent and social determinants of physical exercise in elderly men in Jamaica. MATERIALS AND METHODS: A sample of 2,000 men 55 years of age and older was extracted from a total of 33,674 males in the parish of St. Catherine. A 132-item questionnaire was used to collect the data. A stratified random sampling technique was used to draw the sample. Descriptive statistics were used to provide background information on the sub-sample, and logistic regressions were utilized to model physical exercise. RESULTS: Of the respondents, 55.4% indicated good health status, 51.0% lived in rural areas; 10.4% had moderate to high functional dependence and 67.3% reported that they did some form of physical exercise. Of those who indicated involvement in physical exercise (n = 1,345), 77.2% jogged, ran, and/or walked; 13.3% did aerobics; 4.7% swam; 2.0% cycled and 0.6% did push-ups or sit-ups. The variables that predicted being engaged in physical exercise were education; age of respondents; current good health status; household head; health plan; employment status, and social support. CONCLUSION: Most of the elderly men were engaged in some form of physical activity and had good health. Age and good health status were the most influential social determinants of physical exercise. However, effective interventions to promote physical activity in older men in Caribbean countries such as Jamaica deserve wide implementation.

Re-testing theories on the correlations of health status, life satisfaction and happiness.

BACKGROUND: Empirical evidences have shown that happiness, life satisfaction and health status are strongly correlated with each other. In Jamaica, we continue to collect data on health status to guide policies and intervention programs, but are these wise? AIMS: The current study aims to fill the gap in the literature by examining life satisfaction, health status, and happiness in order to ascertain whether they are equivalent concepts in Jamaica as well as the coverage of the estimates. MATERIALS AND METHODS: The current study used a cross-sectional survey of 2000 men 55 years and older from the parish of St. Catherine in 2007 which is it also generalizable to the island. A132-item questionnaire was used to collect the data. The instrument was sub-divided into general demographic profile of the sample; past and Current Good Health Status; health-seeking behavior; retirement status; social and functional status. Ordinal logistic regression techniques were utilized to examine determinants of happiness, life satisfaction and health status. RESULTS: Happiness was correlated with life satisfaction - Pseudo r-squared = 0.311, -2LL = 810.36, χ(2) = 161.60, P < 0.0001. Life satisfaction was determined by happiness - Pseudo r-squared = 0.321, -2LL = 1069.30, χ(2) = 178.53, P < 0.0001. H ealth status was correlated with health status age, income, education and area of residence - Pseudo r-squared = 0.313, -2LL = 810.36, χ(2) = 161.60, P < 0.0001. CONCLUSION: The current study refuted the empirical finding that self-reported happiness depends on perceived health status for older men in Jamaica.

Health literacy and health seeking behavior among older men in a middle-income nation.

Health literacy is a measure of the patient's ability to read, comprehend and act on medical instructions. This research article examines health literacy and health-seeking behaviors among elderly men in Jamaica, in order to inform health policy. This is a descriptive cross-sectional study. A 133-item questionnaire was administered to a random sample of 2,000 men, 55 years and older, in St Catherine, Jamaica. In this study, 56.9% of urban and 44.5% of rural residents were health literate. Only 34.0% of participants purchased medications prescribed by the medical doctor and 19.8% were currently smoking. Despite the reported good self-related health status (74.4%) and high cognitive functionality (94.1%) of the older men, only 7.9% sought medical care outside of experiencing illnesses. Thirty-seven percent of rural participants sought medical care when they were ill compared with 31.9% of their urban counterparts. Thirty-four percent of the participants took the medication as prescribed by the medical doctor; 43% self-reported being diagnosed with cancers such as prostate and colorectal in the last 6 months, 9.6% with hypertension, 5.3% with heart disease, 5.3% with benign prostatic hyperplasia, 5.3% with diabetes mellitus, and 3.8% with kidney/bladder problems. Approximately 14% and 24% of the participants indicated that they were unaware of the signs and symptoms of hypertension and diabetes mellitus, respectively. The elderly men displayed low health literacy and poor health-seeking behavior. These findings can be used to guide the formulation of health policies and intervention programs for elderly men in Jamaica.

Effects of travel mode on exposures to particulate air pollution.

Monitoring was carried out of particulate concentrations whilst simultaneously walking and driving 48 routes in London, UK. Monitoring was undertaken during May and June 2005. Route lengths ranged from 601 to 1351 m, and most routes were travelled in both directions. Individual journey times ranged from 1.5 to 15 min by car (average 3.7 min) and 7.3 to 30 min (average 12.8 min) whilst walking; car trips were therefore repeated up to 5 times for each single walking trip and the results averaged for the route. Car trips were made with windows closed and the ventilation system on a moderate setting. Results show that mean exposures while walking are greatly in excess of those while driving, by a factor 4.7 for the coarse particle mass (PM10-PM2.5), 2.2 for the fine particle mass (PM2.5-PM1), 1.9 for the very fine particle mass (