Integrating health promotion with and for older people - eHealth (IHOPe) - evaluating remote integrated person-centred care : Protocol of a randomised controlled trial with effectiveness, health economic, and process evaluation.

BACKGROUND: Healthcare and welfare systems worldwide are unprepared to accommodate the growing population of older people. Simultaneously, the cost of reactive care for older people is increasing. However, healthcare systems in many countries are reforming towards integrated and person-centred care with a focus on health promotion and proactive actions. The Integrating Health Promotion with and for Older People - eHealth (IHOPe) project aims to describe and evaluate a person-centred e-support intervention that promotes a sustainable partnership between community-dwelling frail older people and health and social care professionals. METHODS: The IHOPe project is designed as a randomised controlled trial comparing a control group receiving standard care with an intervention group receiving standard care and add-on person-centred care through telephone support and a digital platform. The primary outcome measure is a composite score of changes in general self-efficacy and the need for unscheduled hospital care. The project is conducted in Gothenburg, Sweden. At least 220 participants aged ≥ 75 years will be included after being screened using a frailty instrument. The study design, intervention components, digital platform, and questionnaires were developed in close collaboration with an advisory group of inter-professional researchers, stakeholders, clinicians, and older representatives. Data will mainly be collected through questionnaires at baseline and 3, 6, and 12 months after inclusion in the study. Recruitment is ongoing and should be completed during 2023. Data will be analysed using quantitative and qualitative methods. The evaluation will include effectiveness, process, and health economics. The study was approved by the Regional Ethical Review Board in Gothenburg, Sweden (Dnr 2019-05364, Dnr 2020-03550, Dnr 2021-03255). DISCUSSION: The findings will expand our knowledge of remotely integrated person-centred care for frail older people. Thereby, the IHOPe project is expected to fill highlighted knowledge gaps on intervention evaluations including the triad of person-centred, digital, and integrated care elements, as well as economic evaluations of remote health services for frail older people. The study is ongoing, and the results are not completed but if they turn out to be positive, implementation is not limited to time or location. TRIAL REGISTRATION: ClinicalTrial.gov: NCT04416815. Registered 07/06/2021.

Older adults' provision of informal care and support to their peers - A cornerstone of swedish society: Demographic characteristics and experiences of social isolation.

BACKGROUND: Family members provide the majority of informal care for older adults in Sweden. Nevertheless, by providing a range of assistance, peers often emerge as a central to counter social isolation among older adults. Therefore, there is a need to know more about what informal care provision by older adults to their peers means for different groups of older adults. AIM: This study investigated the types of informal care and support that older adults provide to their peers in Sweden, and how these types of care and support are associated with demographic characteristics and social isolation. We also compared older adults who provide informal care and support with those who do not. METHOD: For this purpose, we used a national online survey named "Involuntary loneliness among senior citizens" answered by 10,044 older adults enrolled in the Swedish Citizen Panel. We adopted a mixed-method design to analyse the survey data, including free-text options (n = 2155) and numerical data. Social isolation was assessed using a score built from the social loneliness items of the UCLA Loneliness Scale. RESULTS: In our population, 21.5% of the older adults were providing informal care and support to their peers. Practical/instrumental help was frequently offered by younger participants (<75 years), men and respondents who were less socially isolated. On a general level, the factors that were positively associated with giving informal care and support to peers were older age, being male, retired, married/living in a relationship, living in an urban area/big city and exhibiting greater isolation. Focusing specifically on social support shows that older participants (>80) and those experiencing less social isolation (score < 24) were more engaged in social activities.  CONCLUSION: This paper is unique in exploring the informal peer-caregiver's perceptions of isolation. Data were collected during the COVID-19 pandemic; this highlights the need to recognise informal care and support between older adults and to acknowledge their contributions as an essential component of Swedish civil society, especially during a societal crisis.

Person-centred care: looking back, looking forward.

An interdisciplinary group of clinical and non-clinical academics in Sweden created a research centre for the study of person-centred care (PCC) in long-term illness: the University of Gothenburg Centre for Person-Centred Care (GPCC). The GPCC steering committee formulated a position paper with three 'simple routines' to initiate, implement, and safeguard PCC in daily clinical practice. The EJCN accepted this position paper for publication in 2011. This brief review seeks to present how PCC, as defined in the position paper, has been used in research and published in EJCN during the past 5 years (2016-20). Clinical implications and future research in PCC are also suggested.

A systematic review on implementation of person-centered care interventions for older people in out-of-hospital settings.

THE PURPOSE: of this study was to explore the content and essential components of implemented person-centered care in the out-of-hospital context for older people (65+). METHOD: A systematic review was conducted, searching for published research in electronic databases: PubMed, CINAHL, Scopus, PsycInfo, Web of Science and Embase between 2017 and 2019. Original studies with both qualitative and quantitative methods were included and assessed according to the quality assessment tools EPHPP and CASP. The review was limited to studies published in English, Swedish, Danish, Norwegian and Spanish. RESULTS: In total, 63 original articles were included from 1772 hits. The results of the final synthesis revealed the following four interrelated themes, which are crucial for implementing person-centered care: (1) Knowing and confirming the patient as a whole person; (2) Co-creating a tailored personal health plan; (3) Inter-professional teamwork and collaboration with and for the older person and his/her relatives; and (4) Building a person-centered foundation. CONCLUSION: Approaching an interpersonal and inter-professional teamwork and consultation with focus on preventive and health promoting actions is a crucial prerequisite to co-create optimal health care practice with and for older people and their relatives in their unique context.

Children's Anxiety and Factors Related to the COVID-19 Pandemic: An Exploratory Study Using the Children's Anxiety Questionnaire and the Numerical Rating Scale.

The repercussions of the COVID-19 pandemic on children's lives deserve attention. This study aimed to assess the prevalence of anxiety among Brazilian children and its associated factors during social distancing during COVID-19. We used a cross-sectional design with an online survey from April to May 2020 in Brazil. We included children aged 6-12 years and their guardians. The Children's Anxiety Questionnaire (CAQ; scores 4-12) and the Numerical Rating Scale (NRS; scores 0-10) were used to measure anxiety. We enrolled 157 girls and 132 boys, with a mean age of 8.84 (±2.05) years; 88.9% of respondents were mothers. Based on CAQ ≥ 9, the prevalence of anxiety was 19.4% (n = 56), and higher among children with parents with essential jobs and those who were social distancing without parents. In logistic regression, the following variables were associated with higher CAQ scores: social distancing without parents; more persons living together in home; and education level of guardians. Based on NRS > 7, the prevalence of anxiety was 21.8% (n = 63); however, no associations with NRS scores were found with the investigated variables. These findings suggest the necessity of implementing public health actions targeting these parents and their children at the population level.

Perceptions, experiences and barriers to lifestyle modifications in first-generation Middle Eastern immigrants to Sweden: a qualitative study.

OBJECTIVE: The prevalence of type 2 diabetes (T2D) among Iraqi immigrants to Sweden is high and partly related to sedentary physical activity and calorie dense food. The aim of the present study was to explore perceptions, experiences and barriers concerning lifestyle modifications (LSM) in Iraqi immigrants to Sweden at risk for T2D. DESIGN: A qualitative thematic analysis was conducted on data collected from gender-specific focus group interviews which took place during a culturally adapted randomised controlled intervention study addressing motivation to lifestyle change, self-empowerment, behavioural modifications and sociocultural barriers to LSM. Seven focus groups were held, with an interval of 1-4 weeks between January and May of 2015; each session lasted approximately 1.5 hours. SETTING: The city of Malmö, Sweden. PARTICIPANTS: Out of 27 women and 23 men assigned to the intervention group, 19 women and 14 men who attended at least one focus group session were included in the study. RESULTS: Participants expressed awareness of the content of healthy lifestyle practices. They also expressed numerous social and cultural barriers to LSM connected to irregular meals, overeating, food and drinking preferences and family expectations. Overeating was described as a consequence of social and cultural norms and expectations and of poor mental well-being. Facilitators for reaching successful LSM were connected to family involvement and support. CONCLUSION: Our study reports that facilitators for LSM are connected to presence of family support. Preventive actions addressing family involvement may benefit Middle Eastern immigrants at high risk for T2D to consider healthier lifestyles practices. Identification of sociocultural barriers and facilitators for LSM are crucial for successful health promotion in minority populations at risk for T2D. TRIAL REGISTRATION: Trial registration number: NCT01420198 for the MEDIM-study; Pre-results.

Calidad de vida relacionada con la salud en escolares de 10 a 14 años con sobrepeso y obesidad en la ciudad de Medellín, Colombia / Health Related-quality of Life in Schoolchildren with Obesity and Overweight in Medellin, Colombia

El exceso de peso a tempranas edades afecta la salud física y mental de niños y niñas y puede repercutir en su calidad de vida. Objetivo: evaluar la calidad de vida relacionada con salud (CVRS) en escolares con y sin sobrepeso y obesidad de una institución educativa de Medellín (Colombia). Población y Métodos: Se realizó un estudio transversal de tipo descriptivo-comparativo. La muestra fue probabilística con 679 escolares participantes de ambos sexos, con edades entre los 10 y 14 años de edad. El instrumento usado para determinar el estado nutricional fue el ANTHRO-PLUS y para medir CVRS utilizó el KIDSCREEN-27. Resultados: el 24 % de los participantes tenían exceso de peso, 19.9 % de ellos con sobrepeso y el 4.1 % con obesidad. En relación con la CVRS, los escolares con sobrepeso y obesidad se perciben con más problemas de actividad física y salud (AF) y menos aceptación social (AS). Para los hombres, el exceso de peso afecta las posibilidades de realizar la misma actividad física que sus pares, convirtiéndose fácilmente en objeto de burla e intimidación. Para las mujeres, la percepción de su CVRS no varió significativamente tuvieran normo o sobrepeso. Conclusiones: la percepción de CVRS de los escolares no es homogénea, está afectada por la edad, el sexo y los condicionantes culturales alrededor de la construcción de la imagen corporal.

Excess weight affects the physical and mental health of children and can affect their quality of life. Objetive: Evaluate the quality of life related to health (HRQOL) in schoolchildren with and without overweight and obesity of an educational institution of Medellin (Colombia). Methods: A descriptive crosssectional study was conducted comparative type. The sample was probabilistic school with 679 participants of both sexes aged between 10 and 14 years old. The instrument used to determine the nutritional status was ANTHRO-PLUS and measure HRQOL used the KIDSCREEN-27. Results: Participants were overweight 24%; overweight children were 19% and 4% of them were obese. Regarding school HRQOL overweight and obesity are perceived more problems physical activity and health (AF) and less social acceptance (AS). For men being overweight it affects the chances of performing the same physical activity as their peers and becoming easily mocked and intimidation. For women, the perception of HRQOL did not differ significantly had normal or overweight. Conclusions: The perception of HRQOL of school is not homogeneous, is affected by age, sex and cultural conditions around the construction of body image.

Perceptions and Practices of Physical Activity Among Colombian Overweight/Obese Schoolchildren.

The purpose of this study was to explore the contexts that shape obese children's engagement in physical activity (PA) focusing on children's perceptions. The qualitative design consisted of non-participant observations, and unstructured and semi-structured focus group and individual interviews. Data were analyzed by use of conventional content analysis. Participants were overweight/obese children from a public school in Colombia. The findings show that the main context where PA took place was during physical education (PE) classes at school and in the children's neighborhoods. The participants perceived the PE classes to be too competitive and demotivating. PA taking place outside school was associated with fun, but occurred only on an infrequent basis and was challenged by living in insecure neighborhoods. Adapting a health promotion approach that emphasizes participation and social environments might motivate obese children to become physically active at school as well as during leisure time.

The effect of the stay active advice on physical activity and on the course of acute severe low back pain.

BACKGROUND: Disability due to acute low back pain (ALBP) runs parallel with distress and physical inactivity. If low back pain persists, this may lead to long-term sick leave and chronic back pain. This prospective randomized study evaluated the effect on physical activity and on the course of ALBP of two different treatment advices provided in routine care. METHODS: Ninety-nine patients with acute severe LBP examined within 48 h after pain onset were randomized to the treatment advices "Stay active in spite of pain" (stay active group) or "Adjust activity to the pain" (adjust activity group). Pedometer step count and pain intensity (Numeric Rating Scale, NRS, 0-10) were followed daily during seven days. Linear mixed modeling were employed for statistical analyses. RESULTS: The step count change trajectory showed a curvilinear shape with a steep initial increase reaching a plateau after day 3 in both groups, followed by an additional increase to day 7 in the stay active group only. At day 1, the step count was 4560 in the stay active group compared to 4317 in adjust activity group (p = 0.76). Although there were no statistical differences between the two groups in the parameters describing the change trajectory for step count, the increase in step count was larger in the stay active group. At day 7 the step count was 9865 in the stay active group compared to 6609 in the adjust activity group (p = 0.008). The pain intensity (NRS) trajectory was similar in the two groups. Between day 1 and day 7 it decreased linearly from 5.0 to 2.8 in the stay active group (p < 0.001), and from 4.8 to 2.3 in the adjust activity group (p < 0.001). CONCLUSIONS: Patients with acute severe LBP advised to stay active in spite of the pain exhibited a considerable more active behavior compared to patients adjusting their activity to pain. This result confirms compliance to the treatment advice as well as the utility of the stay active advice to promote additional physical activity for more health benefits in patients with ALBP. There was minimal effect of the treatment advice on the course of ALBP. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02517762).

Colombian Children With Overweight and Obesity Need Additional Motivational Support at School to Perform Health-Enhancing Physical Activity.

AIMS: The aim of this study is to investigate associations of screen-time and physical activity (PA) with self-efficacy for PA, intrinsic motivation to PA and health-related quality of life (HRQoL) in Colombian schoolchildren from socioeconomically disadvantaged neighborhoods, and to compare these variables among children with normal-weight (NW), overweight (OW) and obesity (OB). METHODS: In 678 schoolchildren (age 10-14 years) screen-time (TV, video games, computer) and number of days being physically active ≥ 60 minutes were self-reported. Multi-item scales were used to assess self-efficacy to PA and intrinsic motivation to PA. The KIDSCREEN-27 was used to assess HRQoL. RESULTS: Screen-time was associated with HRQoL in the school/learning environment dimension. Number of days being physically active was associated with self-efficacy for PA, intrinsic motivation for PA and with HRQoL concerning physical well-being, autonomy/parent relation and social support/peers. Group differences were found for days being physically active (OW = 2.8 and OB = 2.7 vs. NW = 3.3) but not for screen-time (NW = 5.0, OW = 4.7 and OB = 5.7 hrs·d-1). OW and OB scored lower on intrinsic motivation to PA than NW (OW = 19.2 and OB = 17.9 versus NW = 20.1). All 3 groups differed in physical well-being scores (NW = 50.3, OW = 48.1, OB = 40.6, P < .001). CONCLUSIONS: Schoolchildren with overweight and obesity from socioeconomically disadvantaged neighborhoods need additional motivational support to perform health-enhancing PA to experience higher physical well-being.

Biopsychosocial function analyses changes the assessment of the ability to work in patients on long-term sick-leave due to chronic musculoskeletal pain: the role of undiagnosed mental health comorbidity.

AIMS: To study the prevalence of somatic and mental health comorbidity and the use of opioid medication among patients on long-term sick-leave due to chronic musculoskeletal pain (CMP); to compare an orthopaedic-based assessment of ability to work with a team assessment; to investigate the relationship between intensity of pain and psychosocial characteristics in this group. METHODS: A cross-sectional study was carried out with 174 consecutive patients on sick-leave for a mean of 21 months. All were referred from the Social Insurance Office for orthopaedic evaluation and assessment of the ability to work. Of them, only 83/174 patients were referred by the Office for psychiatric evaluation. RESULTS: Neck pain was the main cause of disability. Patients with neck pain often suffered pain in more than two sites, and greater intensity of pain. Thirty-four percent of all participants had been prescribed opioid medication before consultation. Degrees of disability, unemployment, low degree of education and to be an immigrant were related to intensity of pain. Unrecognized psychiatric disorders changed the main cause of inability to work in 69% of patients who underwent both orthopaedic and psychiatric evaluation. CONCLUSIONS: An evaluation based on biopsychosocial function is valuable in reaching an accurate assessment of the patient's diagnosis, and ability to work in CMP. Ability to work and degree of sick-leave in patients on long-term sick-leave is determined to a large extent by undiagnosed mental health comorbidities, and not solely somatic complaints.

Cross-validation of the Depression, Anxiety, and Positive Outlook Scale (DAPOS) for clinical use.

OBJECTIVE: The main objective of this study was to investigate different psychometric properties of the Swedish version of the Depression, Anxiety, and Positive Outlook Scale (DAPOS) in patients with chronic musculoskeletal pain in an orthopedic setting. METHODS: A total of 449 participants took part in the study, including 288 patients with chronic musculoskeletal pain and 161 participants in a reference group. Internal consistency, convergent validity, and measurement invariance of the constructs of DAPOS were investigated across sex and diagnostic groups. The Beck Depression Inventory and the Spielberger Anxiety Inventory were used for measures of convergent validity. Multigroup confirmatory factor analysis was performed to test measurement invariance of the theoretical constructs of DAPOS. RESULTS: Internal consistency was good for all 3 constructs, and correlations concerned with convergent validity were found to be acceptable to good. With regard to cross-validation, the 3 constructs of DAPOS were strictly measurement invariant with respect to sex. Across diagnostic groups, the constructs of anxiety and positive outlook were almost strictly measurement invariant, although there were some restrictions of measurement invariance for the construct of depression. DISCUSSION: To be able to rely on an instrument with as few items as DAPOS, the cross-validation of its constructs for sex and diagnostic groups is a valuable information, particularly when investigated in patients with musculoskeletal pain. Based on these results, we recommend that DAPOS could replace longer and more time-consuming screening tests in clinical settings.

Comparison between the Beck Depression Inventory and psychiatric evaluation of distress in patients on long-term sick leave due to chronic musculoskeletal pain.

BACKGROUND: Chronic musculoskeletal pain (CMP) is associated with psychological distress and long-term disability. Underlying diagnoses causing long-term sickness absence due to CMP have not been explored enough. In a somatic health care setting, it is important to identify mental health comorbidity to facilitate the selection of appropriate treatment. The objectives of this study were to compare the scores of depressed mood obtained on the Beck Depression Inventory (BDI) with the diagnosis of depression made by a psychiatrist, and to study the prevalence of undiagnosed mental health comorbidity in these patients. METHODS AND PATIENTS: 83 consecutive patients on sick leave (mean duration 21 months) due to CMP who had been referred by the Social Insurance Office to an orthopedist and a psychiatrist for assessment of the patient's diagnoses and capacity to work. The mean age was 45 (23-61) years, 58% were women and 52% were immigrants. The accuracy of measurements was calculated using the Diagnostic Statistical Manual of Mental Disorders IV as the Gold standard. RESULTS: Psychiatric illness was diagnosed in 87% of the patients. The diagnosis was depression in 56%, other psychiatric illnesses in 31%, whereas 13% were mentally healthy. Of all the patients, only 10% had a previous psychiatric diagnosis. The median value of the BDI score was 26 points in depressed patients, whereas it was 23 in patients with other psychiatric diagnoses. The sensitivity of the BDI to detect depression was 87.5%. We found good agreement between the BDI score and a diagnosis of depression. CONCLUSION: Undiagnosed psychiatric disorders were commonly seen in patients with CMP. The high sensitivity of the BDI scores enables the screening of mental health comorbidity in patients with a somatic dysfunction. The test is a useful tool for detecting distress in patients who are on long-term sick leave due to CMP and who need additional treatment.

Illness behavior in patients on long-term sick leave due to chronic musculoskeletal pain.

BACKGROUND AND PURPOSE: Methods for identification of patients with illness behavior in orthopedic settings are still being debated. The purpose of this study was to test the association between illness behavior, depressed mood, pain intensity, self-rated disability, and clinical status in patients with chronic musculoskeletal pain (CMP). METHODS: We examined 174 consecutive sick-listed patients (90 women). Musculoskeletal function was estimated by range of motion, muscle strength, and motor and sensory function. The degree of illness behavior was measured by Waddell signs (WS), RESULTS: WS were observed in 47/174 (27%) of the patients, 16% of whom manifested excessive illness behaviour. In general, more patients with WS were depressed (OR = 4.4; 95% CI: 1.8-11) and experienced greater pain (OR = 2.9; CI: 1.1-7.7). No abnormal physical function could be observed in two-thirds of the patients. Other predictive factors for manifesting WS at the clinical examinations were longer sick leave and previous full sick leave (p < 0.05). INTERPRETATION: Excessive illness behavior is related to psychological distress in patients with CMP and long-term disability. Thus, some patients may also require psychological assessment. Looking for WS during consultation is useful for targeting other factors that may be important in the diagnostic process.

Factores de riesgo reproductivo asociados al cáncer mamario, en mujeres colombianas / Reproductive risk factors associated with breast cancer in Columbian women

Introducción El cáncer de mama desde 1992 ha sido la segunda causa de muerte femenina en Colombia (tasa promedio anual de 4,5*100.000 hab.) y se reporta una tendencia ascendente por este tipo de neoplasia, y la información sobre los potenciales factores de riesgo del cáncer de la mama en los países Latinoamericanos es escasa. Los objetivos del trabajo fueron probar la protección ofrecida por la lactancia materna, y establecer los factores reproductivos asociados al cáncer de mama en Colombia. Métodos Se realizó un estudio de casos y controles hospitalarios pareados por edad (+ 2 años) de Julio 1995 a Marzo 1996 en Bogotá. La población de estudio quedó constituída por 171 casos histopatológicamente definidos y 171 controles. La historia reproductiva y sociodemográfica fué recolectada a través de un cuestionario y se utilizó la técnica de regresión logística condicionada para el análisis estadístico de la información. Resultados Se encontraron como factores de riesgo: la nuliparidad , al contrario de las mujeres con paridades mayores de 3 hijos (OR=3,35 IC 1,4 - 8,0), la edad al primer nacimiento (20 años vs. menores de 20. OR= 1,83 IC 0,7 - 4,8), el antecedente familiar de cáncer de mama y la lactancia al primer hijo (OR=0,09 IC 0,01-0,64 de 1-11 meses y OR= 0,01 IC 0,00-0,14 para los 12 meses) y la lactancia acumulada por encima de los 24 meses (p=0,001 prueba de tendencia) como principales factores protectores de la enfermedad. Conclusiones El estudio confirma la importancia de enfocarse en la promoción de la lactancia prolongada y ratifica que el nivel socioeconómico puede determinar los estilos de vida y los eventos reproductivos de las mujeres, explicando el aumento en la mortalidad por cáncer de mama en los países Latinoamericanos, con perfiles de fecundidad y factores de riesgo para el cáncer de mama, similares a los de los países desarrollados