Check Programme Research Articles

Eligibility and Prevalence of the American Heart Association Heart Check Certification Program in the US Packaged Food and Beverage Supply: A Cross-Sectional Study.

Objective: Consumers in the US make choices within a food supply dominated by processed packaged foods and beverage products. Front-of-package nutrition labels (FOPL) equip consumers to make healthier choices, but further evaluation and regulation regarding FOPL format, scope, and display have been recommended by the World Health Organization. As a leader in consumer FOPL guidance, the American Heart Association's (AHA) Heart Check programme certifies food companies seeking to add an AHA Heart Check logo as a FOPL for qualifying heart healthy products. A cross-sectional assessment of the AHA Heart Check Standard Certification was conducted within the US packaged food and beverage supply to assess the eligibility and prevalence of the programme as a FOPL. Methods: Data were derived from Label Insight's Open Data initiative, which is the largest publicly-available US branded food composition database. The proportions of products that were certified and eligible to be certified for the Standard Certification were reported by nutrient attributes, grocery aisles and food brands. Results: Among 153,453 products examined, fewer than 1% exhibited the Heart Check certification on their label. Among products that were not Heart Check certified,13.8% were eligible for Standard Certification. The most common reason for ineligibility was the saturated fat content (52%), followed by total fat content (47%) and sodium content (47%). Heart Check certification and eligibility differed substantially across grocery aisle categories. Conclusions: The abundance of unhealthy products in the US packaged food and beverage supply and absence of harmonized FOPL policies suggest the need for FOPL like the Heart Check label to promote adherence to healthy diets. There are opportunities for food manufacturers and the AHA to certify more heart healthy foods and beverages. However, more consistent criteria and transparent labelling could enhance Heart Check certification to facilitate consumers' ability to make more informed and healthful purchases.

Limiting managerial discretion by regulation: nursing homes and the national background check program

Structuring managerial discretion has been a key government policy tool in contemporary regulation and governance. This article explores how a policy that constrains managers’ discretion in recruitment influences the performance of public services. The National Background Check Program (NBCP) is a federal program aimed at strengthening states’ criminal background checks targeting direct patient access employees in nursing homes, where abuse, neglect and misappropriations have been a persistent concern. We combine secondary administrative panel data on Medicare and Medicaid certified nursing facilities with primary data collected from states on their NBCP efforts. We find that NBCP participation, funding and the implementation of fingerprinting requirement, in particular, are associated with fewer deficiencies and higher star ratings. These findings suggest that, while constraining managerial discretion, government regulation is an important tool that federal and state agencies can use to control the performance of public and private entities in some markets and provide market enhancing signals to consumers.

POS-983 STRATEGIES FOR CULTURALLY SENSITIVE AND INCLUSIVE ENGAGEMENT WITH REMOTE INDIGENOUS COMMUNITIES

Healthcare organizations are increasingly developing and deploying programs that deliver important health services to rural and remote Indigenous communities. While this is critical for ensuring better quality of healthcare for these traditionally underserved communities, the approach is often done in a unidirectional manner, whereby the communities themselves have very little input into the process. New approaches that foster trust, community engagement and cultural appropriateness are needed when implementing healthcare programs in Indigenous communities.Can-SOLVE CKD, a national kidney research network in Canada, sought to develop a more inclusive and culturally sensitive approach for engaging Indigenous communities through its Kidney Check program.

NHS Health Check programme: a rapid review update

ObjectiveTo update a rapid review published in 2017, which evaluated the NHS Health Check programme.MethodsAn enlarged body of evidence was used to readdress six research objectives from a rapid review...

Suggestions for new organizational-level item pools for the national Stress Check Program from management philosophy and mission statement: A qualitative study using unsupervised learning.

ObjectiveThis study aimed to obtain suggestions for new organizational‐level item pools that companies could utilize to accomplish management philosophy and mission statements in the context of survey and work environment improvements for the national Stress Check Program.MethodsA qualitative study was conducted using unsupervised learning. A large amount of text data related to management philosophy and mission statements were collected, that is, management messages described on the websites of all companies listed on the Tokyo Stock Exchange. For the main analysis, topic modeling was performed on the nouns from the management messages using Latent Dirichlet Allocation (LDA) to build a model consisting of 10 latent topics, each represented by a group of the 10 most frequently reoccurring nouns. Each group of nouns was qualitatively summarized based on the topic model.ResultsIn total, 22 524 nouns were extracted from the management messages of 3575 companies. A topic model consisting of 10 latent topics was constructed using the LDA. The suggestion for new item pools included new technologies, business plans/strategies, company shareholders, health/happiness/wealth, profits/sales, development of society, a sustainable society, safety and security, customer/consumer satisfaction, corporate social responsibility, fairness, transparency, and human rights.ConclusionThe suggestions for potential item pools were derived from management philosophy and mission statement that are not covered in the existing survey. The suggestions could be useful for motivating employers to implement work environment improvement. Future studies need to make definite items and investigate whether they correlate to job stressors and mental health among workers.

Engineering Grammar-Based Type Checking for Graph Rewriting Languages

The ability to handle evolving graph structures is important both for programming languages and modeling languages. Of various languages that adopt graphs as primary data structures, a graph rewriting language LMNtal provides features of both (concurrent) programming languages and modeling languages, and its implementation unifies ordinary program execution and model checking functionalities. Unlike pointer manipulation in imperative languages, LMNtal allows us to manipulate graph structures in such a way that the well-formedness of graphs is guaranteed by the language itself. However, since the shapes of graphs can be complex and diverse compared to algebraic data structures such as lists and trees, it is a non-obvious important task to formulate types of graphs to verify individual programs. With this motivation, this paper discusses LMNtal ShapeType, a type checking framework that applies the basic idea of Structured Gamma to a concrete graph rewriting language. Types are defined by generative grammars written as LMNtal rules, and type checking of LMNtal programs can accordingly be done by exploiting the model checking features of LMNtal itself. We gave a full implementation of type checking exploiting the features of the LMNtal meta-interpreter and confirmed that it works for practical operations on various graph structures, including single-step and multi-step operations on non-algebraic data structures and data structures with numerical shape constraints.

Mental Disorders Experienced in Comprehensive Medical Checkup and the Topics of the Japanese Stress Check Program

Mental Disorders Experienced in Comprehensive Medical Checkup and the Topics of the Japanese Stress Check Program

Pengabdian Kepada Masyarakat Dalam Bidang Kesehatan Di Kelurahan Brebes

Brebes Regency has a low vaccination achievement rate. Oneof the requirements for vaccination is to have normal blood pressure,therefore a blood pressure checking program is carried out so that thepublic can find out the latest blood pressure before vaccinating. Effortsto prevent covid-19 apart from vaccination are always having handsanitizers ready, in this case the researchers aim to distribute 25 bottlesof natural hand sanitizer spray as a form of community empowerment.The method of this activity is with public education regarding scientificrefreshment around covid-19 prevention, consultation on bloodpressure, and there is a science and technology simulation in itsapplication. The researcher is a student who is a member of the KSRPMI Campus Unit as a facilitator and was attended by 31 residents ofthe Brebes Village who took part in checking blood pressure andweight. The results of the activity were 14 people with high bloodpressure, 9 people with normal blood pressure, and 8 people with lowblood pressure. The average weight of the 31 people who took part inthis program was 56,48387 kg with an average weight in the age rangeof 6-13 years, namely 21 kg, age 21-25 years, 54.5 kg, age 31-40 years,namely 60.8 kg, the age range of 41-50 years is 61.2, and in the elderlyage range from 51-71 is 63.91 kg.

Effects of pre-pregnancy body mass index on pregnancy and perinatal outcomes in women based on a retrospective cohort

To investigate the prevalence of underweight, overweight and obesity as defined by pre-pregnancy body mass index (BMI) and the relationship between pre-pregnancy BMI and pregnancy and perinatal outcomes in women based on a retrospective cohort. Women registered via the Free Pre-pregnancy Health Check (FPHC) program from 2017 to 2019 in Hunan Province, China, were included to the study cohort. The data regarding maternal characteristics, pregnancy outcomes, and infant characteristics were retrieved from the surveillance system of the FPHC program. Logistic regressions were performed to calculate odds ratios (ORs) and adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs) to assess the associations between pre-pregnancy BMIs and the outcomes. Among a total of 398,368 women, 54,238 (13.62%) were underweight (BMI < 18.5 kg/m2), 51,251 (12.87%) were overweight (24.0 kg/m2 ≤ BMI < 28.0 kg/m2), and 10,399 (2.61%) were obese (BMI ≥ 28.0 kg/m2). Underweight occurred more commonly in the 20–24 years old (17.98%), Han Chinese (13.89), college-educated (16.09%), rural (13.74%), and teacher/public servant/office clerk (16.09%) groups. Obesity occurred more often in the older than 35-year-old (4.48%), minority (3.64%), primary school or below (4.98%), urban (3.06%), and housewife (3.14%) groups (P < 0.001). Compared with the normal BMI group, underweight was associated with increased risk of low birth weight (LBW) (AOR = 1.25) and small-for-gestational age (SGA) (AOR = 1.11), but protected against gestational hypertensive disorder (GHD) (AOR = 0.85), gestational diabetes mellitus (GDM) (AOR = 0.69), macrosomia (AOR = 0.67), post-term pregnancy (AOR = 0.76), and cesarean-section (AOR = 0.81). Overweight and obesity were associated with increased risk of GHD (AOR = 1.28, 2.47), GDM (AOR = 1.63, 3.02), preterm birth (AOR = 1.18, 1.47), macrosomia (AOR = 1.51, 2.11), large-for-gestational age (LGA) (AOR = 1.19, 1.35), post-term pregnancy (AOR = 1.39, 1.66), and cesarean- section (AOR = 1.60, 2.05). Pre-pregnancy underweight is relatively common in Hunan Province, China. Pre-pregnancy underweight to some extent is associated with better maternal outcomes, but it has certain adverse effects on neonatal outcomes. Pre-pregnancy overweight, especially obesity, has a substantial adverse effect on pregnancy and perinatal outcomes.

Model‐based automatic grading of object‐oriented programming assignments

AbstractAutomatic grading of object‐oriented programming (OOP) assignments is an important problem from practical, theoretical, and educational viewpoints. Apart from computing a specific grade, an effective grading method needs to provide systematic feedback comments to both the design and code elements. Existing works have proposed grading methods that make various assumptions about the design. However, none of these methods have considered using a design language for the program model. A challenge here is to use a language that eases learning and application in program design. In this paper, we propose a novel grading method, named OOPGRADER, which automatically grades OOP assignments constructed based on an essentially detailed program model. This model is defined in an embedded design language, which directly uses the annotation feature of OOP language to express the essential design rules. We explain how programming assignments can be designed with this language and propose a program checker and a grader for both student and teacher to use in working on the assignments and in grading them. We implement these components in a tool and develop an Eclipse plugin for this tool. We evaluate our method using a combination of qualitative and quantitative techniques. The main result is that our method helps students effectively learn to program through detailed feedback comments based on a program model. The tool is adaptable, has a good performance, and helps enhance the productivity of both students and teachers through IDE integration.

Predictors of adherence to patient reported outcomes and psychosocial needs questionnaire in a culturally diverse ambulatory oncology setting: The My Wellness Check Program.

173 Background: Electronic health record (EHR) integrated symptom monitoring using patient reported outcomes (PRO) has been associated with improved outcomes, including health-related quality of life (HRQoL), in cancer survivors. However, these improvements have been documented through reasonably high completion rates of PRO measures in predominantly non-Hispanic White patient populations using only English language assessments. This study aimed to 1) examine factors associated with the completion of PRO assessments and 2) test differences in referrals to cancer support services between PRO responders and non-responders in a cohort of cancer survivors with significant racial, ethnic, and primary language diversity. Methods: A retrospective analysis (October 2019-February 2021) was performed for patients who were assigned the My Wellness Check (MWC) program at a tertiary, comprehensive cancer center. MWC is an EHR-based PRO assessment and referral program that uses PROMIS computer adaptive tests for depression, anxiety, pain, fatigue, and physical function as well as a psychosocial needs assessment. MWC PRO questionnaire is available in English or Spanish based on patient preference. Demographic and clinical characteristics of patients were collected and incorporated in multivariable binary logistic regression model to examine factors associated with completion of the MWC PRO questionnaires. The frequency of referrals to cancer support services was compared by Chi-square test between MWC PRO responders and non-responders. Adjusted odds ratio (aOR) and 95% confidence interval (95%CI) were calculated. Results: Of the 5306 patients eligible to complete MWC PRO questionnaire, the majority were female (64.1%), White (86.9%), Hispanic (65.8%), English speaker (55.4%), and 46.0% were responders. Patients who were younger than 65 (aOR 1.39; 95%CI 1.22-1.59; p &lt; 0.0001), female (1.23; 1.09-1.41; p = 0.0019), non-Hispanic/Latino (1.43; 1.25-1.64; p &lt; 0.0001), living with partners ( = 1.28; 1.13-1.46; p = 0.0001), and receipt of active treatment (1.37; 1.18-1.58; p &lt; 0.0001) were significantly associated with MWC PRO completion. Responders were referred to cancer support services more often than non-responders (16.6% vs 5.4%, p &lt; 0.0001). Conclusions: Patient-level and clinical factors predict completion of PRO measures, and responders were more likely to have a referral to cancer support services. To optimize supportive care for ambulatory cancer patients, further research is needed to identify factors that can promote patient engagement, particularly in patients who are under-utilizers of such services.

Understanding primary prevention of cardiovascular disease

Nurses working in general practice play an important role in identifying those at risk of developing cardiovascular disease (CVD) and implementing person-focused risk reduction strategies. The NHS Health Check programme was designed to identify people between the age of 40 and 74 years with risk factors for CVD. Nurses in general practice have a key role to play in encouraging people to attend Health Checks and helping people to understand the potential benefits of CVD risk assessment and reduction strategies. Lifestyle interventions and pharmacological management allow modifiable risk factors to be managed in an evidence-based and person-focused way.

Understanding primary prevention of cardiovascular disease

Cardiovascular disease causes significant morbidity and mortality across the UK. Beverley Bostock looks at the role practice nurses can play in the primary prevention of this condition Nurses working in general practice play an important role in identifying those at risk of developing cardiovascular disease (CVD) and implementing person-focused risk reduction strategies. The NHS Health Check programme was designed to identify people between the age of 40 and 74 years with risk factors for CVD. Nurses in general practice have a key role to play in encouraging people to attend Health Checks and helping people to understand the potential benefits of CVD risk assessment and reduction strategies. Lifestyle interventions and pharmacological management allow modifiable risk factors to be managed in an evidence-based and person-focused way.

A Petri Nets Evolution Method that Supports BPMN Model Changes

The correctness of the business process modelling notation (BPMN) is essential for software success, and the BPMN formalization is the foundation of the correctness verification process. However, dynamically adapting the formalized BPMN model to changes in the BPMN model and protecting tokens from being lost in the remapping formalization are the main limitations of the BPMN formalization under changing business requirements. To overcome these limitations, an approach for evolving a Petri nets model according to the BPMN changes is proposed in this paper. In this approach, a check algorithm is designed to identify the differences between the original BPMN model and the updated BPMN model. Then, the evolution rules of the extended Petri nets (EPN) model are defined according to the results of the checking program. Finally, these evolution rules are described in the query/view/transformation operational mapping (QVTo) language and implemented in the Eclipse platform. We demonstrate the effectiveness of the evolution of the BPMN formalization using a case study of the Web Payment business system. Moreover, the dynamic evolution of the BPMN formalization can maintain the consistency between the original model and the updated model, and this consistency has been successfully verified.

NHS Health Check programme: a protocol for a realist review

IntroductionThe NHS Health Check aims to identify individuals at increased risk of cardiovascular diseases (CVDs) among the adult population in England. The Health Check includes calculation of CVD risk and...

Evaluation of fentanyl test strip distribution in two Mid-Atlantic syringe services programs.

Fentanyl test strip (FTS) programs are designed to promote fentanyl awareness and reduce overdose risk by providing people who use drugs (PWUD) with a method of testing drugs for the presence of fentanyl prior to use. In 2018, two large syringe services programs (SSP) in the U.S. Mid-Atlantic-one in Baltimore City, Maryland and one in the state of Delaware-began distributing FTS. We evaluated the implementation of these programs. A convenience sample of SSP clients was surveyed in Baltimore City (urban) and Delaware (urban, suburban and rural) to assess FTS utilization patterns and drug use behaviors. Data were collected and analyzed in 2019. We surveyed N=123 PWUD in Baltimore and N=102 in Delaware. Collectively, 20,000 strips were distributed over six months. In both locations, high FTS utilization was reported (70% in Baltimore; 77% in Delaware) and clients reported testing a range of drugs including heroin, fentanyl and cocaine. Following utilization, 23% and 69% of respondents in Baltimore and Delaware adopted risk reduction behaviors (e.g., using less than intended, going slower, doing tester shot, asking someone to check on them). When asked about their level of interest in future FTS use, 49% and 74% reported being interested or very interested, respectively. Our findings demonstrate that FTS programs could be helpful in promoting fentanyl awareness and risk reduction among PWUD and in monitoring the evolving drug supply in areas where comprehensive community-based drug checking programs have not been established.

Effects of a Co-Design–Based Invitation Strategy on Participation in a Preventive Health Check Program: Randomized Controlled Trial

BackgroundPreventive primary care programs that aim to reduce morbidity and mortality from lifestyle-related diseases are often affected by low-to-moderate participation rates. Improving participation rates is essential for clinical effectiveness and cost-effectiveness. In 2016-2017, we conducted a pilot study (TOF pilot1) for a preventive primary care intervention (TOF is the Danish abbreviation for “Early Detection and Prevention”). Among 8814 invited patients, 3545 (40.22%) consented to participate, with the highest participation rates among women and patients with higher income, education, and employment.ObjectiveThe aim of this study was to evaluate the effects of a revised invitation strategy on invitation comprehensibility, the overall participation rate, and participant demography. The new strategy specifically targeted men and patients of low educational attainment.MethodsThis study was embedded in the second TOF pilot study (TOF pilot2, initiated in October 2018) that tested an adjusted intervention. The revised invitation strategy comprised a prenotification postcard and a new invitation that specifically targeted men and patients of low educational attainment. The new invitation was developed in a co-design process that included communication professionals and target-group representatives. The study sample consisted of 4633 patients aged between 29 and 59 years, who resided in one of two municipalities in the Region of Southern Denmark. Eligible patients were randomly assigned to one of four invitation groups. The control group (Group 1) received the original invitation used in TOF pilot1. The intervention groups received the original invitation and the prenotification postcard (Group 2), the new revised invitation and the prenotification postcard (Group 3), or the new invitation but no prenotification postcard (Group 4).ResultsOverall, 2171 (46.86%) patients consented to participate. Compared to the control group, participation rates increased significantly in all three intervention groups (all P<.001). Participation across the three intervention groups increased for women and men, as well as for patients with high and low educational attainment and high and low family income. The largest relative increase in participation rates occurred among men, patients with low educational attainment, and patients with low family income. No increase in participation was detected for unemployed patients or patients of non-Danish origin. Most participants found the original (813/987, 82.37%) and new (965/1133, 85.17%) invitations easy to understand with no significant difference (P=.08) in comprehensibility between invitations.ConclusionsThe results suggest that participation in preventive primary care interventions can be greatly increased by implementing a co-design–based invitation strategy that includes prenotification postcards and targeted invitations. Although firm conclusions cannot be made from this study, the observed increased participation rates for men and patients of low socioeconomic status may be relevant in programs that aim to reduce social inequality in health.Trial RegistrationClinicalTrials.gov NCT03913585; https://clinicaltrials.gov/ct2/show/NCT03913585

High concentrations of illicit stimulants and cutting agents cause false positives on fentanyl test strips

BackgroundThe opioid epidemic has caused an increase in overdose deaths which can be attributed to fentanyl combined with various illicit substances. Drug checking programs have been started by many harm reduction groups to provide tools for users to determine the composition of their street drugs. Immunoassay fentanyl test strips (FTS) allow users to test drugs for fentanyl by either filling a baggie or cooker with water to dissolve the sample and test. The antibody used in FTS is very selective for fentanyl at high dilutions, a characteristic of the traditional use of urine testing. These street sample preparation methods can lead to mg/mL concentrations of several potential interferents. We tested whether these concentrated samples could cause false positive results on a FTS.Methods20 ng/mL Rapid Response FTS were obtained from BTNX Inc. and tested against 4 different pharmaceuticals (diphenhydramine, alprazolam, gabapentin, and naloxone buprenorphine) and 3 illicit stimulants [cocaine HCl, methamphetamine, and 3,4-methylenedioxymethamphetamine (MDMA)] in concentrations from 20 to 0.2 mg/mL. The FTS testing pad is divided into 2 sections: the control area and the test area. Control and test area signal intensities were quantified by ImageJ from photographs of the test strips and compared to a threshold set by fentanyl at the FTS limit of detection.ResultsFalse positive results indicating the presence of fentanyl were obtained from samples of methamphetamine, MDMA, and diphenhydramine at concentrations at or above 1 mg/mL. Diphenhydramine is a common cutting agent in heroin. The street sample preparation protocols for FTS use suggested by many online resources would produce such concentrations of these materials. Street samples need to be diluted more significantly to avoid interference from potential cutting agents and stimulants.ConclusionsFentanyl test strips are commercially available, successful at detecting fentanyl to the specified limit of detection and can be a valuable tool for harm reduction efforts. Users should be aware that when drugs and adulterants are in high concentrations, FTS can give a false positive result.

Time from breast cancer diagnosis to treatment among Idaho's National Breast and Cervical Cancer Early Detection Program population, 2011-2017.

Idaho's Women's Health Check (WHC) Program provides breast and cervical cancer screening to under- and uninsured women via funding from the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Because WHC serves populations with less access to health care, this study evaluated time from breast cancer diagnosis to treatment for women enrolled in the WHC program and linked to Cancer Data Registry of Idaho (CDRI) case data (WHC-linked) and the remainder of female Idaho resident breast cases. Among Idaho residents aged 50-64years diagnosed during 2011-2017 with ductal carcinoma in situ or invasive breast cancer, we assessed differences in the median time from definitive diagnosis to treatment initiation overall and by demographic and tumor characteristics, and differences in the distribution of demographic and tumor-related variables between 231 WHC-linked and 3,040 non-linked breast cancer cases. WHC-linked cases were significantly less likely to be non-Hispanic white, and more likely to live in poorer census tracts, be diagnosed at a later stage, and be treated with mastectomy. Most WHC-linked (92%) and non-linked women (94%) began treatment within 60days of diagnosis; no differences in time to treatment were observed. Disparities in the interval from definitive diagnosis to breast cancer treatment initiation were not observed for women enrolled in the WHC program relative to other Idaho women.

An outbreak of novel psychoactive substance benzodiazepines in the unregulated drug supply: Preliminary results from a community drug checking program using point-of-care and confirmatory methods.

From mid-2018, an increase in novel psychoactive substance (NPS) benzodiazepines was noted on surveillance of the unregulated drug market around Vancouver, British Columbia, Canada. The rise was concordant with an outbreak of atypical overdoses suspicious for benzodiazepine adulteration of unregulated opioids. This study sought to describe the number and type of NPS benzodiazepines in a sample drawn from a community drug checking program during this period, and to explore accuracy of point-of-care drug checking technologies when compared to confirmatory methods in this sample. Point-of-care drug checking data using fentanyl and benzodiazepine test strips as well as Fourier transform infrared spectroscopy were gathered at harm reduction sites in the Vancouver area from October 2018 to January 2020. A convenience subsample underwent confirmatory testing with gas chromatography-mass spectrometry, liquid chromatography-mass spectrometry, or quantitative nuclear magnetic resonance spectroscopy. Of 159 samples with both point-of-care and confirmatory results, 24 (15.1%) contained at least one NPS benzodiazepine, including etizolam (n=18), flubromazolam (n=3), flualprazolam (4), and flubromazepam (n=1). Of 114 confirmatory samples expected by participants on self-report to contain opioids, 18 (15.8%) contained some NPS benzodiazepine, with 16 (14.0%) containing both an NPS benzodiazepine and an opioid, always fentanyl. False positive and negative rates were 15.5% and 37.5% for test strips, and 3.9% and 91.7% for FTIR, respectively. Combined together, false positive and negative rates of point-of-care methods were 17.8% and 29.2%. NPS benzodiazepine adulteration in an unregulated drug supply sample reveals new risks compounding ongoing harms associated with the synthetic opioid epidemic. Given substantial false positive and false negative rates noted in our sample for point-of-care detection methods, cautious use of combined point-of-care methods, routinely paired with confirmatory drug checking may aid in early detection and monitoring of unregulated drug markets and inform targeted harm reduction strategies and health policy approaches.