Health Performance Measurement Research Articles

Bodily Distress Syndrome Is Associated with Impaired Physical Fitness-A Population Based Cross-Sectional Study (DanFunD).

Background and Aim: Functional somatic disorders (FSDs) are a unifying diagnosis that includes functional somatic syndromes (FSSs) as well as the unifying diagnostic construct of bodily distress syndrome (BDS). FSDs are characterized by persistent and troublesome physical symptoms that are prevalent across all medical settings and for which no clinical tests can establish a definitive diagnosis. The aim of this study was to explore associations between BDSs and objective measurements of body composition, cardiorespiratory health, and physical performance. Methods: Analyses are based on data from the Danish population-based cohort study, DanFunD, comprising data on 9656 participants aged 18-76 years and BDS case status, which was established using self-reported questionnaires. Adjusted multiple linear regression analysis was employed to evaluate associations between BDS and different measures of body composition, cardiorespiratory health, and physical performance assessed as part of a general health examination. Results: Compared to controls, individuals with single- or multi-organ BDS exhibited less optimal body compositions characterized by a higher BMI and fat percentage and larger waist circumference, as well as impaired cardiorespiratory health and reduced physical performance (lower maximal oxygen consumption and lower hand grip strength). Further, individuals categorized with multi-organ BDS had a less healthy body composition, lower cardiorespiratory health, and lower physical performance compared to individuals with single-organ BDS. Conclusions: In this cross-sectional study, we found BDS to be associated with suboptimal body composition, impaired cardiorespiratory health, and reduced physical performance. Individuals with multi-organ BDS tended to exhibit lower physical fitness or reduced cardiorespiratory health than individuals with single-organ BDS.

Exploring genetic variation in potential indicators of resilience in sheep using fibre diameter measured along the wool staple

Production animals are increasingly exposed to a wide variety of disturbances that can compromise their productivity, health and well-being. As a result, there is a growing need to be able to select animals that are more resilient to environmental disturbances. Fibre diameter variation measured along a wool staple is expected to contain information about how resilient sheep are to the disturbances of their internal and external environment. This study aimed to develop potential resilience indicators from fibre diameter variation, estimate their genetic parameters and assess whether these traits are genetically correlated across three age stages. The study used 6 140 Merino sheep from the Sheep Cooperative Research Centre Information Nucleus Flocks recorded at yearling, 2 years old, and adult ages. Eight potential traits were defined based on theory, literature and exploratory analysis, which were suggested to capture the animal’s ability to resist, respond and recover from potential disturbances. Genetic evaluation of the traits was conducted using pedigree-based animal models. The traits were shown to be low to moderately heritable (0.01–0.33) when examined at each of the three age stages. The potential indicators were generally well correlated with one another within age stages. Further, the genetic correlation between the same trait measured at different age stages was moderate to high between yearling and 2 years old (0.35–0.94) and between 2 years old and adults (0.18–0.70), while slightly lower between yearling and adult estimates (0.09–0.62). These results suggest that selection for resilience indicators from fibre diameter is possible; however, further studies are warranted to refine the trait definitions and validate these indicators against other measures of health, fitness and productive performance.

Online mindfulness training for older adults during the COVID-19 pandemic: a randomized controlled trial using a multi-method assessment approach

Objectives The COVID-19 pandemic drastically accelerated the need for studies examining the effectiveness of programs to bolster psychological well-being, particularly for at-risk groups, such as older adults (OAs). Mindfulness Training (MT) has been suggested as a well-suited program for this purpose. The present study examined the impact of a 4-week online, trainer-led MT course tailored for OAs during the early months of the COVID-19 pandemic. Methods Fifty-three OAs were randomly assigned to either Group A or Group B. Group A received the online MT course during the 4-week interval between the first (T1) and second (T2) testing sessions, while Group B received the same MT course during the interval between T2 and the third testing session (T3). The testing sessions included measures of mindfulness, emotional well-being, psychological health, and cognitive performance. In addition, a very brief survey was sent every week during the T1–T2 and T2–T3 intervals to assess weekly emotional well-being. Results The findings revealed that MT may improve some, albeit not all, aspects of mindfulness and well-being, while no significant results were noted for outcomes measuring psychological health and cognitive performance. Conclusions These findings are discussed in the context of the evolving COVID-19 situation.

Promoting psychological well-being in preschool children: study protocol for a randomized controlled trial of a mindfulness- and yoga-based socio-emotional learning intervention

BackgroundMental health issues in youths have cascading negative effects on school outcomes, professional life, and physical health. Psychological well-being (P-WB) is an important protective factor against mental illness. Preliminary research suggests that mindfulness- and yoga-based socio-emotional learning (SEL) interventions can each have a positive impact on preschoolers P-WB. The objective of this trial is to rigorously evaluate the effect of a 24-week combined mindfulness- and yoga- based SEL intervention in preschool children from a French socio-economically disadvantaged area.MethodsThe P-WB promotion intervention is compared to a wait-list control condition in a cluster randomized controlled trial (RCT). Sixty-four pre-Kindergarten classrooms are randomized to the intervention or control group. Primary outcomes measure self-management capacity and core P-WB components: connection, insight, engagement, and positive relationship. Secondary outcomes include measures of mental health, executive functioning, and school performance. Primary and secondary outcomes are assessed through teacher questionnaires, standardized observations of children in school context, and experimental tasks and by collecting results of the national evaluation at first grade. All children-level outcomes are evaluated at pre-intervention, at the end of the intervention, and 1 year later (follow-up analysis), to the exception of school performance which is evaluated at follow-up only. Intention-to-treat analyses, accounting for clustering within classes, will adopt a random effects linear regression model to examine outcomes for the intervention versus control children.DiscussionThis is the first trial to rigorously evaluate a combined mindfulness- and yoga-based P-WB promotion intervention, and the first RCT evaluating a SEL curriculum in French schools. Results may have key implications for P-WB promotion in preschool children.Trial registrationhttps://www.drks.de/ DRKS00028623. Retrospectively registered on 30 May 2022

Dietary inosine monophosphate improved growth, feed utilization, blood biochemical characteristics, and intestinal histo-morphology of slow growing golden mahseer (Tor putitora)

A 10-week long feeding trial was run to determine the effects of inosine monophosphate (IMP) as functional nutrient on growth, feed utilization, haemato-immunological characteristics, and intestinal morphology of juvenile T. putitora. Casein and fishmeal based semi-purified basal diet (control) was formulated to contain 40 % protein and 10 % lipid. Four levels of IMP nucleotide viz., 0.05 %, 0.1 %, 0.2 % and 0.4 % were added to the basal diet for diet groups IMP-0.05, IMP-0.1, IMP-0.2 and IMP-0.4, respectively. Each diet was assigned randomly to triplicate groups of fish occupying an initial average weight of 9.1 ± 0.02 g. The results indicated that dietary IMP significantly enhanced the growth performance of fish and fish fed IMP-0.05 and IMP-0.1 diets showed significantly highest values. Compared to the control, IMP-0.05 diet group showed significantly lower feed conversion ratio, while protein efficiency ratio (PER) was significantly higher in fish fed IMP-0.05 and IMP-0.1 diet groups followed by IMP-0.2 diet group. Control and IMP-0.4 groups showed significantly lower PER. Higher IMP included group (IMP-0.4) showed significantly lower feed intake value. Again, the whole-body lipid content was significantly influenced by dietary IMP inclusion among major whole-body nutrients. Significantly reduced plasma glucose, bilirubin, and alanine aminotransferase level accounted for in IMP supplemented units compared to the control. IMP supplementation also significantly improved total immunoglobulin and hematocrit content. Supplementation of IMP significantly increased and decreased peroxidase and catalase activity, respectively. Fish fed 0.05–0.15 % IMP supplemented diets showed significant improvement in fold height (hF), enterocyte height (hE) and microvillus height (hMV) of anterior intestine compared to the control. In posterior intestine, similar supplementation level of IMP (0.05–0.15 %) showed significant improvement in hE and hMV, while hF showed numerically higher values except in fish fed IMP-0.05 diet group. Based on the current experimental conditions, a dietary IMP of 0.05 % resulted in improved outcomes in the majority of the fish growth and health performance indicators. However, quadratic regression analysis of all the significantly influenced fish performance parameters disclosed that the optimal level of dietary IMP was 0.17 % and this is also consistent with the majority of fish growth and health performance measures.

A Model Proposal for Occupational Health and Safety Performance Measurement in Geothermal Drilling Areas

The energy sources required for general development and maintenance cause environmental pollution due to the carbon emissions released into the atmosphere. For these reasons, countries have turned to renewable energy sources. Energy production methods also cause serious problems in terms of the health and safety of employees. This study aimed to create an occupational health and safety performance model in geothermal energy fields, which generate renewable energy sources, using multi-criteria decision-making methods. A two-stage model was created for OHS performance index measurement. In the first stage, a literature screening was performed, risk analysis criteria were examined, and performance measurement criteria were determined with geophysical engineers and OHS experts. Seven main criteria and forty-seven subcriteria were set. An analytical hierarchy process method (AHP) and a fuzzy analytical hierarchy process (F-AHP) using the main criteria and subcriteria were determined. In the second stage, exposure rates were obtained using the Promethee method in three geothermal wells. The risks in these three wells are listed according to their importance. A performance model was created. The Results section includes conclusions and suggestions. This study, by creating an OHS performance model, can be used by managers and OHS professionals working in geothermal energy production fields to solve problems.

“We cobble together a storyline of system performance using a diversity of things”: a qualitative study of perspectives on public health performance measurement in Canada

BackgroundThere have been longstanding calls for public health systems transformations in many countries, including Canada. Core to these calls has been strengthening performance measurement. While advancements have been made in performance measurement for certain sectors of the health care system (primarily focused on acute and primary health care), effective use of indicators for measuring public health systems performance are lacking. This study describes the current state, anticipated challenges, and future directions in the development and implementation of a public health performance measurement system for Canada.MethodsWe conducted a qualitative study using semi-structured interviews with public health leaders (n = 9) between July and August 2021. Public health leaders included researchers, government staff, and former medical officers of health who were purposively selected due to their expertise and experience with performance measurement with relevance to public health systems in Canada. Thematic analysis included both a deductive approach for themes consistent with the conceptual framework and an inductive approach to allow new themes to emerge from the data.ResultsConceptual, methodological, contextual, and infrastructure challenges were highlighted by participants in designing a performance measurement system for public health. Specifically, six major themes evolved that encompass 1) the mission and purpose of public health systems, including challenges inherent in measuring the functions and services of public health; 2) the macro context, including the impacts of chronic underinvestment and one-time funding injections on the ability to sustain a measurement system; 3) the organizational structure/governance of public health systems including multiple forms across Canada and underdevelopment of information technology systems; 4) accountability approaches to performance measurement and management; and 5) timing and unobservability in public health indicators. These challenges require dedicated investment, strong leadership, and political will from the federal and provincial/territorial governments.ConclusionUnprecedented attention on public health due to the coronavirus disease 2019 pandemic has highlighted opportunities for system improvements, such as addressing the lack of a performance measurement system. This study provides actionable knowledge on conceptual, methodological, contextual, and infrastructure challenges needed to design and build a pan-Canadian performance measurement system for public health.

Flexibility Versus Routineness in Multimodal Health Indicators: A Sensor-based Longitudinal in Situ Study of Information Workers

Although some research highlights the benefits of behavioral routines for individual functioning, other research indicates that routines can reflect an individual's inflexibility and lower well-being. Given conflicting accounts on the benefits of routine, research is needed to examine how routineness versus flexibility in health-related behaviors correspond to personality traits, health, and occupational outcomes. We adopt a nonlinear dynamical systems approach to understanding routine using automatically sensed health-related behaviors collected from 483 information workers over a roughly two-month period. We utilized multidimensional recurrence quantification analysis to derive a measure of health regularity (routineness) from measures of daily step count, sleep duration, and heart rate variability (which relates to stress). Participants also completed measures of personality, health, and job performance at the start of the study and for two months via Ecological Momentary Assessments. Greater regularity was associated with higher neuroticism, lower agreeableness, and greater interpersonal and organizational deviance. Importantly, these results were independent of overall levels of each health indicator in addition to demographics. It is often believed that routine is desirable, but the results suggest that associations with routineness are more nuanced, and wearable sensors can provide insights into beneficial health behaviors.

Use of a Wearable Biosensor to Study Heart Rate Variability in Chronic Obstructive Pulmonary Disease and Its Relationship to Disease Severity

The purpose of this study was to explore the relationships between heart rate variability (HRV) and various phenotypic measures that relate to health and functional status in chronic obstructive pulmonary disease (COPD), and secondly, to demonstrate the feasibility of ascertaining HRV via a chest-worn wearable biosensor in COPD patients. HRV analysis was performed using SDNN (standard deviation of the mean of all normal R-R intervals), low frequency (LF), high frequency (HF), and LF/HF ratio. We evaluated the associations between HRV and COPD severity, class of bronchodilator therapy prescribed, and patient reported outcomes. Seventy-nine participants with COPD were enrolled. There were no differences in SDNN, HF, and LF/HF ratio according to COPD severity. The SDNN in participants treated with concurrent beta-agonists and muscarinic antagonists was lower than that in other participants after adjusting heart rate (beta coefficient −3.980, p = 0.019). The SDNN was positively correlated with Veterans Specific Activity Questionnaire (VSAQ) score (r = 0.308, p = 0.006) and handgrip strength (r = 0.285, p = 0.011), and negatively correlated with dyspnea by modified Medical Research Council (mMRC) questionnaire (r = −0.234, p = 0.039), health status by Saint George’s Respiratory Questionnaire (SGRQ) (r = −0.298, p = 0.008), symptoms by COPD Assessment Test (CAT) (r = −0.280, p = 0.012), and BODE index (r = −0.269, p = 0.020). When measured by a chest-worn wearable device, reduced HRV was observed in COPD participants receiving inhaled beta-sympathomimetic agonist and muscarinic antagonists. HRV was also correlated with various health status and performance measures.

Engaging citizens in the development of a health system performance assessment framework: a case study in Ireland

BackgroundThe launch in 2017 of the Irish 10-year reform programme Sláintecare represents a key commitment in the future of the health system. An important component of the programme was the development of a health system performance assessment (HSPA) framework. In 2019, the Department of Health of Ireland (DoH) and Health Service Executive (HSE) commissioned the technical support of researchers to develop an outcome-oriented HSPA framework which should reflect the shared priorities of multiple stakeholders, including citizens. This study describes the method applied in the Irish context and reflects on the added value of using a citizen panel in the development of an HSPA framework.MethodsA panel of 15 citizens was convened, recruited by a third-party company using a sampling strategy to achieve a balanced mix representing the Irish society. Panellists received lay-language preparatory materials before the meeting. Panellists used a three-colour scheme to signal the importance of performance measures. An exit questionnaire was administered to understand how participants experienced being part of the panel. The citizen panel was the first in a series of three panels towards the development of the HSPA framework, followed by panels including representatives of the DoH and HSE, and representatives from professional associations and special interest groups.ResultsThe citizen panel generated 249 health performance measures ranging across 13 domains. Top-ranking domains to the citizen panel (people-centredness, coordination of care, and coverage) were less prioritized by the other panels; domains less prioritized by the citizen panel, such as accessibility, responsiveness, efficiency, and effectiveness, were of higher priority in the other panels. Citizen panellists shared a similar understanding of what a citizen panel involves and described their experience at the panel as enjoyable, interesting, and informative.ConclusionsThe priorities of the citizen panel were accounted for during all phases of developing the HSPA framework. This was possible by adopting an inclusive development process and by engaging citizens early on. Citizen engagement in HSPA development is essential for realizing citizen-driven healthcare system performance and generating trust and ownership in performance intelligence. Future research could expand the use of citizen panels to assess, monitor, and report on the performance of healthcare systems.

Are prolonged sitting and sleep restriction a dual curse for the modern workforce? a randomised controlled trial protocol

IntroductionProlonged sitting and inadequate sleep are a growing concern in society and are associated with impairments to cardiometabolic health and cognitive performance. However, the combined effect of prolonged sitting and...

Democracy and the Poor Reassessed

By using life expectancy as our core indicator of a country's health status, this paper empirically reassesses the political foundations of human biological development. Our overarching question is: does democracy drive the health of nations? To investigate this, we use both the level and change measures of democracy in our regressions. Our overriding discovery can be summarised as follows: accounting for the various country and time features, a one standard deviation increase in the level of democracy, of 0.35, is associated with a 0.11 standard deviation increase in life expectancy. This is equivalent to an increase in life expectancy of around 5 years for a country initially with a mean life expectancy of 54 years. However, we do not find the change measure of democracy to be consistently influential. These results are robust to employing alternative model specifications, to using different subsamples of the data, and to alternative estimation techniques. Additionally, we find that these critical effects are retained when using other measures of health performance. In particular, we see that as the level of democracy rises, each of infant mortality, child mortality, and crude death falls. We, therefore, conclude that the material role of a democratic system, and its institutions, in promoting human welfare, is of first-order relevance.

Key steps for a mental health and addictions performance measurement framework for Canada.

To inform the development of a pan-Canadian Mental Health and Addictions (MHA) performance measurement framework, we undertook a rapid review of the recent Performance Measurement (PM) literature and solicited input from 20 MHA policy and measurement experts. Six key steps for framework development were identified: recognizing and acknowledging key issues, developing shared language and understanding of key concepts, defining overall scope, defining framework dimension/domains, selecting indicators and using systematic engagement and consultation processes with stakeholders. Subject matter experts underscored the need for a comprehensive engagement process which would honour multiple stakeholder viewpoints and attend to key issues in the codesign of features of the PM framework. Findings from this analysis may be used to inform a comprehensive stakeholder consultation process for the development of a pan-Canadian PM framework for MHA.

Mental health and addictions policy priorities and performance measurement frameworks.

To inform the future development of a pan-Canadian Mental Health and Addictions (MHA) performance measurement framework, we undertook a review and comparison of current provincial/territorial MHA policies and performance measurement frameworks. Most did not have performance measurement approaches that were explicitly linked to policy actions but eleven acknowledged the importance of performance measurement. Among the provinces with a framework, there were few performance domains in common. The common policy priorities and areas of convergence in current performance measurement practices may provide a useful starting point for the development of a pan-Canadian MHA performance measurement framework.

A Partnership to Develop Behavioral Health Quality and Performance Measures

The New York State Medicaid program is pursuing reforms that would shift reimbursement from fee-for-service to value-based models. Behavioral health populations and services are key to these reforms, but important gaps exist in the breadth and relevance of available quality measures for the behavioral health field. This column describes how the state addressed these gaps by using both inter- and intra-agency collaborations. As part of this effort, the state convened a panel of consultants, including academics, providers, and consumers, to develop a behavioral health quality measurement agenda. Panel recommendations and ongoing partnerships are described as a model for states considering similar value-based reform initiatives.

Building a Bridge between Marketing and Finance

Corporate finance executives are often frustrated by spending proposals from their marketing colleagues but cannot seem to be able to quantify the putative benefits. Similarly, the marketing staff is frustrated by the finance team's inability to convert soft marketing metrics, such as “awareness” and “customer satisfaction” into financial forecasts. The challenge is that neither marketers nor finance executives have been able to articulate a single analytical framework which both explains how and why brands come to flourish or flounder and how brand growth contributes to the business's short and long term bottom line.Lacking an effective way to do this now, most managers default to using the hard data they do have, namely how marketing investment is likely to impact sales this quarter and next. This reinforces the widespread focus on quarterly EPS and reduces the perceived value of the marketing department to their ability to hit three month sales targets. This degraded view of marketing's contribution and the inability to link “soft” marketing metrics to longer term financial returns impedes building long‐term brand value. This article focuses on how advances in behavioral science and financial analytics offer an effective way to bridge this gap between marketing and finance.Building that bridge requires better measures of brand health and financial performance to allocate capital and marketing resources. Undoubtedly, brand building is both an art and a science. But, the finance people can develop an evidence‐based framework explaining how some of the “softer” investments such as brand building, contribute to the value of the firm.

Is 8:30 a.m. Still Too Early to Start School? A 10:00 a.m. School Start Time Improves Health and Performance of Students Aged 13-16.

While many studies have shown the benefits of later school starts, including better student attendance, higher test scores, and improved sleep duration, few have used starting times later than 9:00 a.m. Here we report on the implementation and impact of a 10 a.m. school start time for 13 to 16-year-old students. A 4-year observational study using a before-after-before (A-B-A) design was carried out in an English state-funded high school. School start times were changed from 8:50 a.m. in study year 0, to 10 a.m. in years 1–2, and then back to 8:50 a.m. in year 3. Measures of student health (absence due to illness) and academic performance (national examination results) were used for all students. Implementing a 10 a.m. start saw a decrease in student illness after 2 years of over 50% (p < 0.0005 and effect size: Cohen's d = 1.07), and reverting to an 8:50 a.m. start reversed this improvement, leading to an increase of 30% in student illness (p < 0.0005 and Cohen's d = 0.47). The 10:00 a.m. start was associated with a 12% increase in the value-added number of students making good academic progress (in standard national examinations) that was significant (<0.0005) and equivalent to 20% of the national benchmark. These results show that changing to a 10:00 a.m. high school start time can greatly reduce illness and improve academic performance. Implementing school start times later than 8:30 a.m., which may address the circadian delay in adolescents' sleep rhythms more effectively for evening chronotypes, appears to have few costs and substantial benefits.

Oral Health Care Quality Measurement and Its Role in Dental Education.

Concerns about health care quality have affected much of the health care delivery system including dentistry and dental education. Believing measurement is the key element in improving quality, the Dental Quality Alliance brought together major stakeholders in oral health care to lead the development of oral health performance measures that can be used to evaluate the performance of dental programs and practices. These measures complement the quality assurance measures dental schools use to ensure compliance with accreditation standards on patient care delivery. This article describes the rationale for and process of developing these performance measures and argues that dental schools should implement quality measurement processes in their clinical programs to improve the clinical practices of the present and better prepare their graduates for their practices of the future.

Spirituality for Wellbeing of Bereaved Children in Residential Care: Insights for Spiritually Sensitive Child-Centred Social Work Across Country Contexts

This experimental study examines the effect of spiritual intervention programmes. Data include pre and post-tests from 1689 bereaved children in residential homes across 13 countries. Post-treatment scores of bereaved children were higher on outcome measures of psychological wellbeing, self-concept, health, happiness, resilience and academic performance. Post-treatment scores on measures such as depression and discrepancy between perceived and preferred self were markedly lower. Children from South Asian and African countries, boys and Christians scored higher on the self-concept scale, health questionnaire and resilience scale, and lower on the depression and discrepancy measures vis-a-vis their counterparts from European countries, US and Canada, girls and non-Christians. Children who underwent the customized spiritual intervention programme vis-a-vis open-ended sessions on centering and meditation and those who regularly self-practiced, were more likely report higher scores on the wellbeing measure. The results suggest that spiritual intervention programmes work for institutionalized bereaved children and further propose that they should be customized and focused, incorporate diversity, emphasize on positive thinking, futuristic attitude and self-practice.

Improving Quality Outcomes in Veteran-Centric Care.

The University of Alabama at Birmingham (UAB) School of Nursing and the Birmingham Veterans Affairs Medical Center (BVAMC) created a Psychiatric-Mental Health Nurse Practitioner (PMHNP) Residency Continuity Clinic tasked with providing Veteran-centric mental health outpatient treatment informed by measurement-based care (MBC) to provide quality outcomes. Approved by the BVAMC, the UAB Institutional Review Board also approved and exempted the project as quality improvement. PMHNP residents administered the Patient Stress Questionnaire (PSQ)-an MBC tool that incorporates validated tools for assessing depression, anxiety, posttraumatic stress, alcohol use, and pain-to each Veteran from March to August 2016. Patient outcomes focused on depression and anxiety. PSQ scores were reviewed retrospectively via descriptive statistics, paired t tests, and Wilcoxon signed ranks tests. Analysis showed improvement in depression and anxiety that approached significance, and in several national Veterans Affairs mental health performance measures, reinforcing the importance of using MBC in psychiatric assessment. [Journal of Psychosocial Nursing and Mental Health Services, 55(1), 37-44.].