Health Information Services Research Articles

The Effectiveness of an Active Learning Program in Promoting a Healthy Lifestyle among Older Adults with Low Health Literacy: A Randomized Controlled Trial

Background: Older adults often have a greater need for health information and health care services because access to these helps them manage their health and the chronic conditions of aging. Therefore, low health literacy bears a special significance for the population of older adults. Objectives: The aim of this study was to examine the effects of an active learning program on health literacy, lifestyle behaviors, physical function, and mental health among community-dwelling older adults with low health literacy. Methods: This single-blind, randomized controlled trial involved 60 participants aged ≥65 years with a low health literacy who were randomly assigned to an intervention (n = 30) or control (n = 30) group. Across 24 weeks, the intervention group attended weekly 90-min active learning program sessions, which involved exploratory learning, group work, and the self-planning of behavior changes that promote a healthy lifestyle. The control group attended a 90-min class, which was taught in accordance with the didactic teaching method. For both groups, the programs focused on the role of exercise, diet/nutrition, and cognitive activity for promoting health among older adults. The outcome measures were administered at baseline and week 24. Comprehensive health literacy (i.e., primary outcome) was assessed using the Health Literacy Scale-14. Lifestyle factors (i.e., physical activity, dietary variety, life-space mobility, and social network size), physical function, and depressive symptoms were measured. We used a linear mixed model to estimate the intervention effects in accordance with the intention-to-treat approach. Results: When compared to the control group, the intervention group demonstrated a significant improvement in communicative health literacy, step count, engagement in moderate-to-vigorous physical activity, dietary variety, life-space mobility, social network size, grip strength, gait speed, and depressive symptoms. Conclusions: The active learning program can promote a healthy lifestyle and prevent functional decline among older adults who lack the confidence to engage in health communication.

Models for estimating and projecting global, regional and national prevalence and disease burden of asthma: a systematic review.

BackgroundStatistical models are increasingly being used to estimate and project the prevalence and burden of asthma. Given substantial variations in these estimates, there is a need to critically assess the properties of these models and assess their transparency and reproducibility. We aimed to critically appraise the strengths, limitations and reproducibility of existing models for estimating and projecting the global, regional and national prevalence and burden of asthma.MethodsWe undertook a systematic review, which involved searching Medline, Embase, World Health Organization Library and Information Services (WHOLIS) and Web of Science from 1980 to 2017 for modelling studies. Two reviewers independently assessed the eligibility of studies for inclusion and then assessed their strengths, limitations and reproducibility using pre-defined quality criteria. Data were descriptively and narratively synthesised.ResultsWe identified 108 eligible studies, which employed a total of 51 models: 42 models were used to derive national level estimates, two models for regional estimates, four models for global and regional estimates and three models for global, regional and national estimates. Ten models were used to estimate the prevalence of asthma, 27 models estimated the burden of asthma – including, health care service utilisation, disability-adjusted life years, mortality and direct and indirect costs of asthma – and 14 models estimated both the prevalence and burden of asthma. Logistic and linear regression models were most widely used for national estimates. Different versions of the DisMod-MR- Bayesian meta-regression models and Cause Of Death Ensemble model (CODEm) were predominantly used for global, regional and national estimates. Most models suffered from a number of methodological limitations – in particular, poor reporting, insufficient quality and lack of reproducibility.ConclusionsWhilst global, regional and national estimates of asthma prevalence and burden continue to inform health policy and investment decisions on asthma, most models used to derive these estimates lack the required reproducibility. There is a need for better-constructed models for estimating and projecting the prevalence and disease burden of asthma and a related need for better reporting of models, and making data and code available to facilitate replication.

Access to information and use of adolescent sexual reproductive health services: Qualitative exploration of barriers and facilitators in Kisumu and Kakamega, Kenya.

BackgroundKenya has a high prevalence of adolescent pregnancy and low access to and use of adolescent sexual reproductive health services. Despite the enactment of evidence-based policies to address this problem, adolescents continue to face health problems and barriers to adolescent sexual reproductive health information and services.Main objectiveThis study describes barriers to and facilitators of access to adolescent sexual and reproductive health services in Kisumu and Kakamega counties, Kenya.MethodologyWe used a qualitative design. Through 61 data collection sessions, 113 participants were engaged in key informant interviews, in-depth interviews, and/or focus group discussions. Trained Research Assistants (RAs) engaged adolescents, health care workers, teachers, county leaders, and community representatives. Data were captured using audio recorders and field notes. Socio-demographic data were analyzed for descriptive statistics, while audio recordings were transcribed, translated, and coded. Thematic analysis was done with NVivo.ResultsFindings show that the barriers of access to sexual reproductive health services and information were negative health workers’ attitudes, distance to the health facility, unaffordable cost of services, negative social cultural influences, lack of privacy and confidentiality. Facilitators to adolescent sexual reproductive health services were few and included getting priority for school going adolescents and enabling environment for partnerships on adolescent health issues.ConclusionsAdolescents in Kakamega and Kisumu face a myriad of barriers when seeking sexual reproductive health information and/or health services. We recommend that counties sensitize all stakeholders on adolescent sexual reproductive health problems, and support development of multi-sectoral, sustainable solutions to adolescent health needs.

How do mothers exchange parenting-related information in online communities? A meta-synthesis

The increase in online social exchange of health information has raised concerns among information and health professionals about the quality and accuracy of the information exchanged. This study investigates how mothers exchange pregnancy- and parenting-related information in online communities. Through a meta-synthesis, we encoded 31 themes and 9 core themes based on the findings from 39 relevant studies, and observed a general pattern of information exchange in mothers' online communities. We found that mothers behave normatively and have a common perception of information values in the community. We also found interactions between mothers' online communities, offline communities, and lifeworld. The study's findings align with the theory of Information Worlds. The current meta-synthesis sheds light on the practice of health care provision and information service and points toward future empirical research.

Effects of a Mobile and Web App (Thought Spot) on Mental Health Help-Seeking Among College and University Students: Randomized Controlled Trial.

BackgroundMental health disorders are the most prevalent health issues among postsecondary students, yet few solutions to this emerging crisis exist. While mobile health technologies are touted as promising solutions for the unmet mental health needs of these students, the efficacy of these tools remains unclear. In response to these gaps, this study evaluates Thought Spot, a mobile and web app created through participatory design research.ObjectiveThe goal of the research is to examine the impact of Thought Spot on mental health and wellness help-seeking intentions, behaviors, attitudes, self-stigma, and self-efficacy among postsecondary students in Canada.MethodsA 2-armed randomized controlled trial involving students from three postsecondary institutions was conducted. Students were eligible if they were aged 17 to 29 years, enrolled in full-time or part-time studies, functionally competent in English, and had access to a compatible digital device. The usual care group received a mental health services information pamphlet. The intervention group received the Thought Spot app on their digital device. Thought Spot is a standalone app that allows users to add, review, and search crowdsourced information about nearby mental health and wellness services. Users can also track their mood on the app. Outcomes were self-assessed through questionnaires collected at baseline and 3 and 6 months. The primary outcome was change in formal help-seeking intentions from baseline to 6 months, measured by the General Help-Seeking Questionnaire. A mixed-effects model was used to compare the impact of usual care and intervention on the primary outcome (formal help-seeking intentions). Secondary outcomes included changes in informal help-seeking intentions and help-seeking behaviors, help-seeking attitudes, self-stigma, and self-efficacy.ResultsA total of 481 students were randomized into two groups: 240 to usual care, and 241 to the intervention group. There were no significant differences in help-seeking intentions between the usual care and intervention groups over 6 months (F2,877=0.85; P=.43, f=0.04). Both groups demonstrated similar increases in formal help-seeking intentions at 3 and 6 months (F2,877=23.52; P<.001, f=0.21). Compared with males, females sought more help from formal resources (OR 1.86; 95% CI 1.22 to 2.83, P=.001). Females were less likely to seek help from informal sources than males (OR 0.80; 95% CI 0.22 to 0.73, P<.001).ConclusionsPrompting postsecondary students about mental health and help-seeking appears to increase help-seeking intentions. mHealth interventions may be as effective as information pamphlets in increasing formal help-seeking but may confer a small advantage in driving help-seeking from informal sources. Although there is enthusiasm, developers and health policy experts should exercise caution and thoroughly evaluate these types of digital tools. Future studies should explore the cost-effectiveness of digital interventions and develop strategies for improving their efficacy.Trial RegistrationClinicalTrials.gov NCT03412461; https://clinicaltrials.gov/ct2/show/NCT03412461International Registered Report Identifier (IRRID)RR2-10.2196/resprot.6446

Association of Vision Impairment With Preventive Care Use Among Older Adults in the United States

Preventive care is associated with decreased morbidity and mortality among older adults. Vision impairment may be a barrier to accessing care and health promotion information and therefore may contribute to decreased preventive care uptake. To examine the association between self-reported vision impairment and uptake of preventive care services (ie, breast and colon cancer screenings and influenza and pneumococcal vaccinations). Cross-sectional study using the 2015 and 2018 National Health Interview Survey (NHIS) and 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) data, national surveys of US residents conducted through in-person household interviews in NHIS, and state-based telephone interviews in BRFSS. Participants included respondents 50 years and older based on eligibility for each preventive care service examined. Vision impairment, defined as self-reported trouble seeing, in NHIS, and self-reported blindness/serious difficulty seeing in BRFSS. Self-reported uptake of breast cancer screening (women aged 50-74 years), colon cancer screening (aged 50-74 years), influenza vaccination (50 years and older), and pneumococcal vaccination (65 years and older). Multivariable regression models adjusted for relevant confounders, including age, were used to examine the uptake of each preventive care service by vision impairment status. Among NHIS participants, older US individuals with vision impairment (prevalence between 14.3% and 16.3% in the different age groups; n = 12 120-29 654) were less likely to report breast cancer screening (odds ratio [OR], 0.82; 95% CI, 0.71-0.96) and colon cancer screening (OR, 0.89; 95% CI, 0.79-0.99) but not influenza (OR, 1.06; 95% CI, 0.97-1.15) and pneumococcal vaccination (OR, 1.03; 95% CI, 0.91-1.16), as compared with their counterparts without vision impairment. In BRFSS (n = 228 649-530 027), those with vision impairment (5.9%-6.8%) were less likely than those without vision impairment to report breast cancer screening (OR, 0.67; 95% CI, 0.59-0.75), colon cancer screening (OR, 0.70; 95% CI, 0.65-0.76), and pneumococcal vaccination (OR, 0.89; 95% CI, 0.81-0.99) but not influenza vaccination (OR, 0.95; 95% CI, 0.89-1.00). Older Americans with vision impairment may be less likely to use cancer-related preventive services as compared with their counterparts without vision impairments. These findings suggest that interventions to improve access to health information and health care services for individuals with vision impairment may be needed to improve cancer screening among this population.

Medical and health informatics services during and after the COVID-19 pandemic should be virtual, tailored, responsive and interactive: a case study in Belgium.

This is part of a new series in this regular feature regarding trends in the provision of information by health science libraries. By sharing expertise and drawing together relevant trends the series intends to serve as a road map for both health science librarians and health informatics professionals. This article shows how a medical and biomedical research library changed practices, andreassesseduser needs for the COVID-19 emergency. Discusses changes to online education (and collaborative working) to provide user-friendly services, researcher support tailored to need and re-visioning library space. J.M.

Characteristics and Symptoms of App Users Seeking COVID-19-Related Digital Health Information and Remote Services: Retrospective Cohort Study.

BackgroundPatient-facing digital health tools have been promoted to help patients manage concerns related to COVID-19 and to enable remote care and self-care during the COVID-19 pandemic. It has also been suggested that these tools can help further our understanding of the clinical characteristics of this new disease. However, there is limited information on the characteristics and use patterns of these tools in practice.ObjectiveThe aims of this study are to describe the characteristics of people who use digital health tools to address COVID-19–related concerns; explore their self-reported symptoms and characterize the association of these symptoms with COVID-19; and characterize the recommendations provided by digital health tools.MethodsThis study used data from three digital health tools on the K Health app: a protocol-based COVID-19 self-assessment, an artificial intelligence (AI)–driven symptom checker, and communication with remote physicians. Deidentified data were extracted on the demographic and clinical characteristics of adults seeking COVID-19–related health information between April 8 and June 20, 2020. Analyses included exploring features associated with COVID-19 positivity and features associated with the choice to communicate with a remote physician.ResultsDuring the period assessed, 71,619 individuals completed the COVID-19 self-assessment, 41,425 also used the AI-driven symptom checker, and 2523 consulted with remote physicians. Individuals who used the COVID-19 self-assessment were predominantly female (51,845/71,619, 72.4%), with a mean age of 34.5 years (SD 13.9). Testing for COVID-19 was reported by 2901 users, of whom 433 (14.9%) reported testing positive. Users who tested positive for COVID-19 were more likely to have reported loss of smell or taste (relative rate [RR] 6.66, 95% CI 5.53-7.94) and other established COVID-19 symptoms as well as ocular symptoms. Users communicating with a remote physician were more likely to have been recommended by the self-assessment to undergo immediate medical evaluation due to the presence of severe symptoms (RR 1.19, 95% CI 1.02-1.32). Most consultations with remote physicians (1940/2523, 76.9%) were resolved without need for referral to an in-person visit or to the emergency department.ConclusionsOur results suggest that digital health tools can help support remote care and self-management of COVID-19 and that self-reported symptoms from digital interactions can extend our understanding of the symptoms associated with COVID-19.

Understanding information behavior of diabetic patients: a case of the diabetic's institute Pakistan

PurposePakistan is a developing country where one of the rapidly growing diseases is diabetes. Well-informed diabetic patients are expected to improve the quality of life, self-care behaviors and better cooperation with the health care team. The present study is designed to investigate the information behavior of diabetic patients, and to investigate the role of one institution that is working for diabetes management, treatment, education and counseling in Pakistan i.e. Diabetic's Institute Pakistan (DIP).Design/methodology/approachThe “Embedded Design” based on the mixed methods research approach was adopted to carry out the current research. The study was mainly based on quantitative research design, quantitative data were collected through an adapted questionnaire, the supportive/supplementary qualitative data was collected through an in-depth interview of the medical director, observation record sheets and analysis of the available relevant documents i.e. prescription (prescription notepad with information), brochure and the website was applied.FindingsDiabetic patients want to know about how to control diabetes and mostly rely on humans particularly health professionals and interpersonal networks. The use of books, journals, seminars, libraries is comparatively low. It is an important finding that health-related information is mostly required in national language by Pakistani patients. Lack of computer literacy and information overload were among the barriers that were reported by diabetic patients.Practical implicationsHealth information seeking channels, formats and language preferences should be considered to design patients' cantered information services. Health information service providers i.e. government, health practitioners, health-related institutions and libraries should work in a liaison for creating health awareness. Identified barriers faced by diabetic patients are important to consider for designing health-related information services.Originality/valueInvestigating health information behavior is crucial particularly of the patients from developing countries. The study is first of its kind that is reported from Pakistan. The results of the study may help libraries, health professionals and diabetes-related organizations to design patient's centered policies and information-based services. These institutions may work together to create awareness and to help patients in managing their disease. The study findings are maybe helpful for other developing countries also.

Opioid Prescribing and Use Following Common Plastic Surgery Procedures

BACKGROUND: Overprescribing of opioids has become a topic of interest given the potential adverse outcomes associated with their use. Excess prescribing of opioids has been shown to have individual and societal impacts such as addiction, dependence, and misuse. Opioids are frequently prescribed for analgesia following plastic surgery procedures. This study aims to investigate prescribing patterns and explores self-reported patient experiences with opioid use, pain control and disposal of unused tablets following common hand and breast surgeries. METHODS: Patients undergoing 5 common predetermined breast procedures and 6 common hand procedures in a specified 14-week period were identified by billing code through health information services. Sixty-two hand procedures 46 breast procedures were identified. Collaboration with opioid monitoring services of the Nova Scotia Provincial Monitoring Program (NSPMP) allowed for data surrounding prescription filling rates, drug type, dose and tablets dispensed. Additionally, all patients were contacted to participate in a structured telephone interview surrounding prescription awareness, pain control, and disposal of excess medication. RESULTS: 55.4% and 41.6% of patients received and filled an opioid prescription following a hand or breast procedure, respectively. Hydromorphone was the most commonly prescribed narcotic for both hand and breast procedures. Average number of opioid tablets dispensed following hand and breast procedures was 36.1 and 31.9, respectively. Forty-eight percent and fifty-two percent of hand and breast patients completed phone interviews. 4.2% of breast patients required an opioid refill, whereas no hand patients did. Seventy-three percent of hand 75% of breast patients used at least one over-counter analgesic, most common being acetaminophen alone. Average self-reported pain score and total pain period was not significantly different between those using opioids and those not for both hand and breast procedures. 6.7% and 23.1% of patients report returning excess narcotics to pharmacy, whereas the majority report still having or self-disposing excess tablets. CONCLUSIONS: Opioid prescriptions are frequent following the procedures studied. In general, opioids appear to be prescribed in excess as denoted by self-report low prescription usage, statistically insignificant differences in pain for those using and not using opioids and low refill rates. Additionally, the majority of unused opioids were noted to be still at home or disposed of inappropriately. Taken together, this study suggests a role for reviewing opioid prescribing patterns for common hand and breast procedures to reduce contributions of excess opioids to an ongoing opioid epidemic.

\u201cWill you hear my voice?\u201d: to engage older patients online, listen to them about their lives offline

The scope of health information and health care services available online is rapidly expanding. At the same time, COVID-19 is causing vulnerable elders to reconsider in-person provider visits. In that context, recently published research by Y. Mizrachi et al. examining obstacles to the use of online health services (OHS) among adults age 50 and up takes on new importance. An iconic Israeli song begins, “Will you hear my voice?” (Hebrew Songs. Zemer Nugeh (Hatishmah Koli), 2020). What makes Mizrachi et al.’s findings particularly intriguing, despite several caveats, is the manner in which they demonstrated a commitment to genuinely listen to individual voices. The researchers spoke “openly and bluntly” with interviewees as peers and were rewarded with “specific, well-defined and applicable answers with the potential to be used.” The most striking findings came in candid answers that went beyond the factors intrinsic to the online offerings and addressed important factors in what regular Internet users often refer to as IRL (“in real life”), such as support from family. The necessity of avoiding preconceptions about the most effective manner to engage patients underscores the importance of patient and family advisory councils (PFACs). PFACs, increasingly being adopted by health care organizations globally, provide an ongoing ability to listen and respond to the “patient voice.” Effectively addressing obstacles to older adults’ use of the full range of online health resources will require the involvement not just of health plans and government, but also of voluntary organizations, providers, families and others integral to users’ offline “real lives.” Sustained, focused listening must be a central part of that effort.

What are the source selection criteria?: Lessons from mothers' health information‐seeking behavior

AbstractThis research investigated mothers' health information source selection behavior, specifically, what criteria they consider important for their source selection. Online surveys were completed by 851 mothers: 255 U.S.‐born mothers, 296 Korean‐born mothers, and 300 Korean immigrant mothers living in the United States. Results indicated that health information perceived to be “accurate/credible”, “easily accessible”, and “active/updated” tended to be used most often. Moreover, when a series of one‐way analysis of variance (ANOVA) tests was conducted, statistical group differences were identified in 9 out of 10 source characteristics (e.g., “accurate/credible”, “active/updated”, “interactive/able to respond” etc.). Implications for information professionals when providing health information services are also discussed.

Online Navigation for Pre-Exposure Prophylaxis via PleasePrEPMe Chat for HIV Prevention: Protocol for a Development and Use Study.

BackgroundPre-exposure prophylaxis is an HIV medication taken by an individual who is HIV-negative to prevent infection before exposure to the virus. Numerous clinical studies in various communities have shown high rates of effectiveness when pre-exposure prophylaxis is taken as prescribed. Since FDA (US Food and Drug Administration) approval of the first product for pre-exposure prophylaxis in 2012, uptake has been lower than the estimated 1.1 million US adults who could benefit from its use, with an estimated 70,394 individuals on pre-exposure prophylaxis in 2017. Of these, only 11% were Black and 13% were Hispanic despite Black and Hispanic individuals comprising two-thirds of individuals who could benefit, highlighting racial and ethnic disparities in pre-exposure prophylaxis uptake. Patient navigators have been shown to be effective in improving the linkage and retention in care outcomes of people living with HIV across the HIV treatment cascade and can be used throughout the pre-exposure prophylaxis care continuum to assist decision making and connect potential users to pre-exposure prophylaxis services.ObjectivePleasePrEPMe Chat was designed as a novel online strategy aimed at improving engagement in pre-exposure prophylaxis care services with pre-exposure prophylaxis–eligible populations in California via free HIV-prevention information and health care navigation services.MethodsVisitors connected with navigators via online bilingual (English, Spanish) chat. During the chat, navigators helped locate pre-exposure prophylaxis services through the PleasePrEPMe provider directory, provided links to HIV-prevention resources, and supported uninsured, insured, and undocumented visitors with benefits navigation. Data such as date, time, type of encounter, visitor type, key demographics, discussion topics, insurance, and other relevant information were collected via a chat log and through the HealthEngage chat platform.ResultsFrom April 2017 to December 2019, PleasePrEPMe completed 2191 online chats. Mean interaction time was 16 minutes, with 68% of chats covering more than one topic. Conversation topics included health care navigation (1104/2191, 50.39%), provider identification (954/2191, 43.54%), pre-exposure prophylaxis information (773/2191, 35.28%), post-exposure prophylaxis information (318/2191, 14.91%), and the California Pre-Exposure Prophylaxis Assistance Program (232/2191, 10.59%). Referrals to pre-exposure prophylaxis– or non pre-exposure prophylaxis–related resources included directory updates, HIV testing and treatment, undetectable=untransmittable, reproductive health, sexually transmitted infections, and other prevention methods. A total of 368 chat visitors completed a voluntary satisfaction scale rating the quality and helpfulness of the service provided, producing a mean rating of 4.7 out of 5.ConclusionsOnline chat is a method for reaching people not already engaged in HIV-prevention services, supporting HIV-prevention decision making, and linking people seeking information online with in-person services. Additional research to evaluate online sexual health information services and understand how social determinants of health influence online engagement is needed to better understand how to reach priority populations not well served by current HIV-prevention services.International Registered Report Identifier (IRRID)RR1-10.2196/20187

Ease of Use of the Electroconvulsive Therapy App by Its Users: Cross-Sectional Questionnaire Study

Background Electroconvulsive therapy (ECT) is one of the oldest, most effective, and potentially life-saving noninvasive brain stimulation treatments for psychiatric illnesses such as severe depression, mania, and catatonia. The decision-making process to use ECT involves well-informed discussion between the clinician and the client. A platform, like an app, which provides this information in an easy-to-understand format may be of benefit to various stakeholders in making an informed decision. Apps developed by clinicians/hospitals taking into consideration user perspectives will filter and provide trustworthy information to the users. In this regard, the ECT app, an app which is freely available for download at the Apple Store, was developed by the Leicestershire Partnership National Health Service (NHS) Trust and Leicestershire Health Informatics Service (LHIS). Objective The objective of this study is to evaluate and demonstrate the accessibility of the ECT app to the chosen audiences it was created for, via a paper and electronic questionnaire. Methods A survey was conducted between January 2017 and March 2019. A survey questionnaire designed for the study was sent to mental health professionals, medical students, patients, carers, and members of the public via post, email, and SurveyMonkey or informed via posts shared in Psychiatry online groups and face-to-face contact. All participants who were willing to participate in the study were included. Results Results were collected via paper forms, email responses, and SurveyMonkey and all were inputted into SurveyMonkey to facilitate analysis. A total of 20 responses were received during the study period (January 2017 to March 2019). The participants of the survey, which included a mixed group of professionals (12/20, 60%), patients (3/20, 15%), and carers (1/20, 5%), opined that the app was easy to download (14/20, 70%) and use (9/20, 45%); contained adequate information (19/20, 95%); they felt more informed after having used the app (9/20, 45%); and they would recommend it to others (19/20, 95%). The participants of the survey also provided suggestions on the app (10/20, 50%). Conclusions The ECT app can be beneficial in sharing appropriate information to professionals and the public alike and help in gathering unbiased and nonjudgmental information on the current use of ECT as a treatment option.

Factors Influencing Temporal Trends in Pediatric Inpatient Imaging Utilization

Concern exists over exponential growth in cardiac imaging in adults, but there is paucity of such data for cardiac imaging trends in pediatric patients. The aims of this study were to determine temporal trends in the use of noninvasive cardiac imaging and compare these with trends in the use of noncardiac imaging and to identify factors influencing those trends using the Pediatric Health Information Service database. Pediatric inpatient encounter data from January 2004 to December 2017 at 35 pediatric hospitals were extracted from the Pediatric Health Information Service database. Temporal imaging utilization trends in cardiac and noncardiac ultrasound or echocardiography, magnetic resonance imaging (MRI), and computed tomography (CT) were assessed using linear mixed-effects models. Models were adjusted for case-mix index, complex chronic conditions, patient age, length of stay, payer source, and cardiac surgical volume. A total of 5,869,335 encounters over 14years were analyzed (median encounters per center per year, 11,411; median patient age, 4years; median length of stay, 3days). From 2004 to 2017, the rates of pediatric inpatient cardiac and noncardiac ultrasound and MRI increased, whereas the rate of noncardiac CT decreased. Cardiac CT use increased beginning in 2014 (+0.264 cardiac CT encounters per 1,000 encounters per year), surpassing the rate of rise of cardiac MRI. Case-mix index, cardiac surgical volume, and payer source affected the largest number of imaging trends. Among pediatric inpatients, utilization of cardiac and noncardiac ultrasound and MRI has steadily increased. Noncardiac CT use declined and cardiac CT use increased after 2014. Factors influencing imaging trends include case-mix index, cardiac surgical volume, and payer source. This study lays a foundation for investigations of imaging-related resource utilization and outcomes among pediatric inpatients.

The epidemiology of polypharmacy in a large cohort with linked health records in Scotland

Abstract Background Our understanding of the potential harm of taking multiple medications in older, multi-morbid populations is limited. We aimed to investigate the prevalence of polypharmacy and its association with hospitalisation in a large cohort with linked health data. Methods Prescription data and hospital admission records of the Aberdeen Children of the 1950s (ACONF) Cohort were extracted from the National Health Services Scotland database and linked from 2011-2016. We estimated polypharmacy by measuring monthly drug exposure for 1) total number of prescribed medications and 2) total number of defined daily doses (DDDs). Cox proportional hazard models (adjusted for demographics, socioeconomic circumstances and health conditions) were used to examine the association of polypharmacy and hospitalisation. Results Prescription records were linked for 8,713 cohort members. Mean age at baseline was 58.5 years (SD = 1.5) and 50% were female. 1,994 individuals (23%) had at least one health condition and 8% of population had multimorbidity. The proportion of cohort with polypharmacy assessed using taking 5+ medications and taking 5+ DDDs at baseline were 12.7% (female=12.6% vs male=12.7%, P = 0.179), and 15.5% (female=13.8% vs male=17.1%, P &amp;lt; 0.001) respectively. Of all the cohort, 4,365 admitted to hospital (mean follow-up of 3.5 years, total 30,269 person-years). Adjusted hazard ratios for hospitalisation were 1.51 (95 % CI 1.39,1.64, P &amp;lt; 0.001) for polypharmacy measured by number of medications and 1.40 (95 % CI 1.29,1.51 P &amp;lt; 0.001) for polypharmacy estimated by number of daily doses. Conclusions Polypharmacy is independently associated with increased risk of hospitalisation. This association could signify polypharmacy as a risk factor and a marker of poor outcome. Data linkage can generate evidence-based information for future policy and health services to improve polypharmacy measurement and management. Key messages Data linkage is a cost effective and contemporary return on the investment in data collection and research in public health. Improvement in evidence to better understand the relationship between polypharmacy and health outcomes should be a priority to optimise treatment in older people with various chronic conditions.

Evaluation of Vaccination Knowledge, Attitudes and Practices and Health Literacy Levels of Adults

Abstract Background This study aims to evaluate the vaccination and immunization knowledge, attitudes and practices and health literacy levels of adults living in rural area of Eskisehir City in Turkey. Methods The study is a cross-sectional study conducted on individuals aged 18 years and over who live in the rural area of Eskisehir City between November 16 and December 30, 2018. The study group consisted of 955 participants. The survey includes the questions about the evaluation of vaccination and immunization knowledge, attitudes and practices and the questions from the European Health Literacy Scale Short Form (HLS-EU-Q16). The statistical significance value was accepted as p ≤ 0.05. Results 493 participants (51.6%) of the study group was female. Their ages ranged between 18 and 85 years with a mean (SD) 42.6 (15.6) years. In the study, it was found that 325 people (34.0%) had insufficient knowledge of vaccine and immunization. A positive weak correlation was found between the scores obtained from the information questions about vaccination and immunization and the scores obtained from HLS-EU-Q16 (r = 0.252; p = 0.001). It was found that there was a weak positive correlation between the scores obtained from information questions about vaccination and immunization and the scores obtained from questions about their attitudes and practices towards vaccination and immunization services(r = 0.333; p = 0.001). Being 65 years and older, living in the village having not been vaccinated in the last 10 years and lack of previous information about vaccines, were found to be important risk factors for lack of knowledge level on vaccine and immunization. Conclusions In the study, it was observed that one third of the group's vaccine and immunization knowledge levels were insufficient. Determining the factors that affect the level of knowledge about vaccination and immunization may be important in terms of sustaining the effectiveness of vaccination applications and campaigns. Key messages Lack of information about vaccines and insufficient knowledge about vaccine-preventable diseases can feed individuals' indecisiveness to vaccination. Health education and information services can be provided to increase the level of vaccination and immunization knowledge.

How Data from the Institute of Museum and Library Services Describe Ways Public Libraries Provide Health and Wellness Information Services.

ObjectiveThis article describes how funding from the Institute of Museum and Library Services (IMLS) provided resources for state and public libraries to deliver health information to their patrons.MethodsThree IMLS publicly available data collections were used: State Library Administrative Agency Survey data; State Program Report system; and the Awarded Grants Search portal. Data about health related projects from these two administrative data sources for 36 competitive award projects since 2015 and 143 projects supported via the formula-funded Grants to States Program between 2015-2018 (inclusive) were included. Descriptive statistics about projects with a health and wellness focus were presented within the context of others supported by Grants to States.ResultsCompetitive projects supported public libraries’ health resources and built librarians’ skills to facilitate patron access to health information. The Grants to States program supported 143 projects associated with health undertaken by 29 states plus Puerto Rico between 2015 and 2018. The IMLS $14.4 million investment during this period leveraged an additional $5 million from state and local sources to support health information projects in public libraries. Finally, data from the State Library Administrative Agency Survey showed that in addition to projects that relied on IMLS Grants to States funds, 29 state libraries provided program assistance in health literacy to the public libraries in their jurisdictions in 2018.ConclusionsThe findings point to a need to determine whether there are ways to collect additional information via IMLS’s data systems to further support state and public libraries in meeting patron health information needs. The lessons learned in the analyses in this article offer useful food-for-thought about how IMLS might work with our data stakeholders to continue to modify each of these data sources to describe the role of libraries in an increasingly complex information landscape.

Feature: Beating the COVID-19 Surge: How Allina Health Doubled Its ICU Capacity in Eight Weeks.

Feature: Beating the COVID-19 Surge: How Allina Health Doubled Its ICU Capacity in Eight Weeks.

New population health methods require innovative health information business models

Abstract Background InfAct is tackling the European Health Information (HI) sustainability. New population HI methods should be designed to be sustainable European-wide. Internet and digital health developments have also creating the need for innovative business model for the HI-RI that provides value to all involved stakeholders. Methods Leveraging from previous work and from a SWOT analysis, covering both market environment and health data opportunities, a set of health information services was designed. The evaluation of these services was done using Business Model Canvas (BMC), a strategic management template for developing new and innovative business models. Its visual chart was used for describing the services value proposition, infrastructure, customers, and finances. The usefulness of resources is paramount in healthcare. Therefore, it is important to assess the actual benefits obtained with the services. Results The SWOT analysis has shown the importance of addressing innovative HI business models to tackle the challenge of a healthcare sector more and more driven by information. Four main services were selected to support a European health information strategy: One-stop Shop, Innovation Research in HI (e.g. access to more updated HI), Capacity Building in HI (e.g., training support), and Knowledge translation research for decision-making (e.g., support policies with evidence-based). BMC analysis contributed to the identification of services value and innovative approach to the health data market. Moreover, from this analysis proper access to services required sophisticated HI infrastructure that should be able to brokering information in a competitive way. Conclusions Novel HI requires innovative business models services based on priority and planning for the next stages grounded on a sustainable roadmap towards the construction of a HI platform. BMC analysis provided the support for the prioritizations and helped designing the HI marketing and adoption strategy.