A qualitative synthesis of factors influencing maintenance of lifestyle behaviour change in individuals with high cardiovascular risk.

BACKGROUND: Management of cardiovascular risk factors includes commitment from patients to adhere to prescribed medications and adopt healthy lifestyles. Unfortunately many fail to take up and maintain the four key healthy behaviours (not smoking, having a balanced diet, limiting alcohol consumption and being more active). Five factors (beliefs, knowledge, transport and other costs, emotions, and friends and family support) are known to predict uptake of lifestyle behaviour change. The key factors influencing maintenance of healthy lifestyles are not known but would be helpful to support the development of relapse prevention programmes for this population. Our review aimed to clarify the main patient perceived factors thought to influence maintenance of changed healthy lifestyles. METHODS: We performed a systematic review of qualitative observational studies and applied the principles of content synthesis and thematic analysis to extract reported factors (barriers and facilitators) considered by individuals to be influential in maintaining changed healthy lifestyle behaviours. Factors were then organised into an existing framework of higher order categories which was followed by an analysis of the interrelationships between factors to identify key themes. RESULTS: Twenty two studies met our inclusion criteria. Participants reported barriers and facilitators within 13 categories, the majority of which were facilitators. The most commonly reported influences were those relating to social support (whether provided formally or informally), beliefs (about the self or the causes and management of poor health, and the value of maintaining lifestyle behaviours), and other psychological factors (including attitude, thinking and coping styles, and problem solving skills). Physical activity was the most commonly investigated behaviour in four categories, but overall, the main barriers and facilitators were related to a range of behaviours. Through analysis of the interrelationships between factors within categories, 'social support', 'education and knowledge', and 'beliefs and emotions' were all considered key themes. CONCLUSIONS: Our review suggests that for the most part, factors that influence lifestyle change are also important for maintaining healthy behaviours. This indicates that addressing these barriers and facilitators within lifestyle support programmes would also be of value in the longer-term.

Patient characteristics and quality dimensions related to patient satisfaction.

OBJECTIVE: To examine the relation of respondents' characteristics, and perceived quality dimensions of health care to overall patient satisfaction in out-patient hospital care. DESIGN: A questionnaire concerning the perceived quality of health care sent to patients in out-patient medical care. SETTING: All medical centres in Ostergötland County, Sweden, during a period in 2007. PARTICIPANTS: Seven thousand two hundred and forty-five patients aged 20 or older responded to the survey and provided their own ratings of the care. Main outcome measure Global patient satisfaction as the overall rating of the encounter at the medical centre. The relation between respondent characteristics, quality dimensions and global satisfaction was examined using linear regression. RESULTS: Younger patients in emergency care were the least satisfied group (54%) and older patients with excellent health status were the most satisfied group (90%). Patients with perceived better health status and those with less education were more satisfied than those with more education or poorer health status. The two dimensions most strongly positively associated with global satisfaction were receiving the expected medical help and being treated well by the doctor. To wait at the reception without getting information correlated negatively to patient satisfaction, and participation in the medical decision-making correlated positively. CONCLUSIONS: By using a complete patient population, including all types of medical specialities, we have identified a set of common respondent characteristics and quality dimensions that are related to global satisfaction in out-patient hospital care.

Working shifts and mental health--findings from the British Household Panel Survey (1995-2005).

OBJECTIVE: Our objective was to examine the impact of shift work on mental health at the population level. We expected that this impact would depend on duration of exposure, type of shift work, and gender. METHODS: We analyzed longitudinal data (1995-2005) from the British Household Panel Survey. From the 2005 wave, we selected a subsample of people aged 21-73 years who had been followed annually from 1995 to 2005. We used responses in 2005 to the General Health Questionnaire (GHQ, 12-item) and self-reported anxiety/depression as dependent variables. Controlling for age, marital status, education, number of years working in six occupational categories (1995-2005), and baseline mental health, we performed nested logistic regression models to examine the effect of the duration of night work and varied shift patterns on mental health for men and women. RESULTS: Undertaking night work for > or =4 years in men was associated with an increased risk of having a GHQ score reflecting mental ill health and reporting anxiety/depression [odds ratios (OR) 2.58, 95% confidence interval (95% CI) 1.22-5.48; OR 6.08, 95% CI 2.06-17.92, respectively]. Women were significantly more likely to report anxiety/depression (OR 2.58, 95% CI 1.53-4.35 ) and to have a GHQ score reflecting mental ill health (OR 4.17, 95% CI 1.45-11.98), after working varied shift patterns for 2-3 years, and >/=4 years, respectively. CONCLUSIONS: Different types of shift work had a differential impact on mental health, but this impact varied according to gender. Women's mental health was more adversely affected by varied shift patterns, while night work had a greater negative impact on men's mental health.

Patients retrieving additional information via the Internet: a trend analysis in a Swedish population, 2000-05.

AIMS: To examine the trends over five years for patients' seeking online additional health information about their disease/health problem to what the doctor has been giving, and investigate any differences in information-seeking behaviour according to age, gender, self-perceived health status, living area, and type of medical encounter. METHODS: Data from three independent surveys conducted in 2000, 2002, and 2005 of a population with a recent experience of outpatient care[n]typesetter: please remove blue shading here and elsewhere[/n], including 24,800 respondents aged between 20 and 95, were analysed in a trend analysis and a logistic regression regarding background factors that may influence the seeking behaviour. RESULTS: During the study period, there was a significant increase in Internet use in most age groups. The total use among men 20-95 years old increased from 7% in 2000 to 18% in 2005 and from 9% to 25% for women respectively. The predictors for using the Internet as a source of information were: age, gender, self-perceived health status, living area, and the type of medical encounter (first or repeated). In 2005, women aged 20-49 used the Internet as a source to a significantly greater extent than men, even when all background factors were controlled for (OR 1.46 and CI 1.21-1.77). CONCLUSIONS: Swedish patients, especially the young and middle-aged, are to a substantial degree using the Internet to gather additional information on their disease. The benefits of this increase include more informed patients; however, there are inherent quality issues that require strategies for ensuring public access to high-quality health information online.

Is self-medication with antibiotics in Europe driven by prescribed use?

BACKGROUND: Self-medication with antibiotics may increase the risk of inappropriate use and the selection of resistant bacteria. One of the triggers for using self-medication may be past experience with antibiotics prescribed by health professionals. We examined the association between prescribed use and self-medication with antibiotics. METHODS: A population survey was conducted in 19 European countries, covering 15,548 respondents. Multinomial logistic regression analysis was used to study the relationship between prescribed use and self-medication for all symptoms/diseases and for upper respiratory tract infections (URTIs). RESULTS: The association between prescribed use and self-medication was modified by source of self-medication, region in Europe and education. This association was consistently stronger for self-medication from leftovers than from other sources, primarily directly from a pharmacy. It was stronger also for respondents from Northern/Western Europe than respondents from Eastern Europe and Southern Europe and those with low education. Prescribed use for URTIs (minor ailments such as throat symptom, influenza, etc.) increased the likelihood of self-medication with leftover antibiotics for these symptoms/diseases in all European regions. CONCLUSIONS: Our study shows consistent associations between prescribed use and self-medication with antibiotics from leftovers, but has not been able to support the hypothesis that self-medication from other sources than leftovers is triggered by earlier prescribed use. Preventing leftovers may be one effective way of preventing self-medication. This can be achieved by ensuring that the amount dispensed corresponds to the amount prescribed, by educating patients and by making doctors aware that prescribing for minor ailments may increase the risk of self-medication for such ailments.

Self-medication with antimicrobial drugs in Europe.

We surveyed the populations of 19 European countries to compare the prevalence of antimicrobial drug self-medication in the previous 12 months and intended self-medication and storage and to identify the associated demographic characteristics. By using a multistage sampling design, 1,000-3,000 adults in each country were randomly selected. The prevalence of actual self-medication varied from 1 to 210 per 1,000 and intended self-medication from 73 to 449 per 1,000; both rates were high in eastern and southern Europe and low in northern and western Europe. The most common reasons for self-medication were throat symptoms (e.g., dry, inflamed, red, or sore throat, inflamed tonsils, tonsil pain). The main medication sources were pharmacies and medication leftover from previous prescriptions. Younger age, higher education, and presence of a chronic disease were associated with higher rates of self-medication. Attempts to reduce inappropriate self-medication should target prescribers, pharmacists, and the general public.

Opinions on changes in the Romanian health care system from people's point of view: a descriptive study.

After 10 years of changes, the Romanian people were asked to assess the consequences of the reforms that were carried out through the health care system in the last decennium. This article studies the opinion of changes among individuals and socio-economic-demographic groups living in Dolj region. Such surveys are rare in Romania. People show to have different opinions on quality of care, accessibility and on attitudes of politicians to health care comparing the present state of affaires with the past one. Overall the people judge the actual situation preferable to the past. The elderly, the chronically ill and the people who believe that people were happier 10 years ago have a more critical view on the changes especially in terms of accessibility. The higher educated people have a more positive opinion on the consequences of the reforms. The results may help to improve the communication between policy makers and the population. It is suggested that the involvement of the citizens in the health care reforms may realize a better implementation of Romanian health care reforms. This involvement is lacking.

Reforms of health care system in Romania.

AIM: To describe health care reforms and analyze the transition of the health care system in Romania in the 1989-2001 period. METHOD: We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of the health care system. RESULTS: The reforms of the health care system in Romania have been realized in a rather difficult context of scarcity of financial and human resources. The Gross Domestic Product spent on health care in 2000 was 4% and the number of physicians in 1999 was 42,975. The main changes due to the legislative reforms have been the introduction of a new social health insurance and strengthening of the position of family physicians. Negative effects of the reforms have been the decrease in health care accessibility and growing inequity in utilization of health care services. Health care users still pay physicians under-the-table, and have more out-of-pocket health care expenses. CONCLUSION: Future reforms in Romania should encourage the positive effects of current reforms: free choice of physician, autonomy of the primary health care system, and increasing financial resources for the health care system.