Nationwide Health Promotion Research Articles

Diagnostic performances of Fibrosis-4 index and nonalcoholic fatty liver disease fibrosis score in metabolic dysfunction-associated steatotic liver disease in Asian primary care clinics.

We aimed to explore the extent to which individuals previously diagnosed with nonalcoholic fatty liver disease (NAFLD) meet the criteria fulfilled with the new nomenclature, metabolic dysfunction-associated steatotic liver disease (MASLD), within an Asian primary clinic cohort. Additionally, we assessed the reliability of the diagnostic performance of FIB-4 and NAFLD fibrosis score (NFS) for MASLD within the primary clinic cohort. This retrospective cross-sectional study included participants who underwent magnetic resonance elastography and abdominal ultrasonography during their health checkups at nationwide health promotion centers (n=6740). The prevalence rates of NAFLD and MASLD diagnosed based on ultrasonography results were 36.7% and 38.0%, respectively. Notably, 96.8% of patients in the NAFLD cohort fulfilled the new criteria for MASLD. A small proportion of patients with NAFLD (n=80, 3.2%) did not meet the MASLD criteria. Additionally, 168 patients (6.6%) were newly added to the MASLD group. The areas under the receiver operating characteristic curves for diagnosing advanced hepatic fibrosis for FIB-4 (0.824 in NAFLD vs. 0.818 in MASLD, p=0.891) and NFS (0.803 in NAFLD vs. 0.781 in MASLD, p=0.618) were comparable between the MASLD and NAFLD groups. Furthermore, the sensitivity, specificity, positive predictive value, and negative predictive value of FIB-4 and NFS for advanced fibrosis in MASLD were also comparable to those in NAFLD. Most patients (96.8%) previously diagnosed with NAFLD fulfilled the new criteria for MASLD in an Asian primary clinic cohort. Diagnostic performance of FIB-4 in the MASLD cohort demonstrated satisfactory results.

The Danish investigation on iodine intake and thyroid disease (DanThyr): history and implications.

Due to mild-to-moderate iodine deficiency in Denmark, health authorities initiated a voluntary iodine fortification (IF) program in 1998, which became mandatory in 2000. In line with recommendations from the World Health Organization, the Danish investigation on iodine intake and thyroid disease (DanThyr) was established to monitor the effect on thyroid health and disease. The program involved different study designs and followed two Danish sub-populations in the years before IF and up till 20 years after. Results showed that the IF was successfully implemented and increased the level of iodine intake from mild-moderate iodine deficiency to low adequacy. The level of thyroglobulin and thyroid volume decreased following IF, and there was an indication of fewer thyroid nodules. The incidence of hyperthyroidism increased transiently following IF but subsequently decreased below the pre-fortification level. Conversely, thyroid-stimulating hormone levels and the prevalence of thyroid autoimmunity increased along with an increase in the incidence of hypothyroidism. These trends were mirrored in the trends in treatments for thyroid disease. Most differences in thyroid health and disease between regions with different iodine intake levels before IF attenuated. This review illustrates the importance of a monitoring program to detect both beneficial and adverse effects and exemplifies how a monitoring program can be conducted when a nationwide health promotion program - as IF - is initiated.

S-30-1: THE IMPORTANCE OF MULTIDISCIPLINARY INTERVENTION FOR THE PREVENTION OF CVD IN JAPAN

Preventing illness and promoting health is important for prolonging healthy life expectancy, and it also leads to the reduction of medical and long-term care costs. As Japan has entered a super-aged society, prevention of CVD, which causes stroke and dementia, the main causative diseases of the need for long-term care, is becoming more important. In addition, it is necessary to widely implement these CVD prevention strategy from an early stage. In other words, not only the tertiary preventive measures after the onset, but also the secondary preventive measures that extract high-risk populations and the primary preventive measures that approach the entire community are required. Under these circumstances, the specific health checkup and specific health guidance system was started in 2008 in Japan. This system has a new concept in which medical insurers take the lead in implementing it, and aims to prevent the onset of illness by providing lifestyle modification support to people at high risk of metabolic syndrome. This system has been established nationwide and has been successful. On the other hand, there are not a few people who leave medical treatment of lifestyle-related diseases, discontinued treatment, or even have not received medical checkup, which is an urgent issue. It is expected that various medical professionals will provide health guidance for those undergoing treatment, encourage continuous treatment, support for improving adherence, along with the nationwide health promotion such as increasing the rate of people taking health checkup or improvement of healthy environment in the community and workplace. The extension of healthy life expectancy for the entire nation will be realized by strengthening of cooperation between preventive intervention and medical care by various medical professionals. In the session, we will outline the current status of multidisciplinary collaboration efforts of health professionals in community, and introduce the examples of RCT results of nurse-led alcohol guidance effects in hypertensive outpatient clinics that we have conducted.

A qualitative study of patient perspectives of diabetes and diabetic retinopathy services in Vanuatu.

Diabetes mellitus is an increasing global health problem, particularly in Vanuatu, where it poses a major health burden. There is paucity of information on how patients in Vanuatu perceive diabetes, diabetic retinopathy, access to services and management, health promotion and intervention services to alleviate the issues. This study aimed to explore the perceptions of diabetic patients in Vanuatu on these issues, to help inform the design of health promotion materials and community activities to empower people to self-manage and shape diabetic services that are integrated and people-centred. Qualitative Talanga and Kakala Pacific research methodologies were applied. Participants were diabetic patients from both urban locations and rural villages in Vanuatu. Data were collected from four (two male, two female) focus group interviews and thematically analysed. There were 26 participants. System failures became apparent, including the inability of the health care services to meet the complex needs of patients with diabetes. The protective factors to reduce the risk and increasing incidence of diabetes and diabetic retinopathy included comprehensive village-based health promotion and community development programmes at the primary prevention level. This study described patients' experiences of their diabetic care and identified key barriers and facilitators of service delivery pathways. SO WHAT?: Vanuatu needs to expand nationwide health promotion and education programmes on nutrition and exercise, food insecurity and access through trade agreements and provide well-trained nursing and medical specialists for early diagnosis and adequate management of diabetes that all people can access and afford.

Knowledge, attitudes and behaviour regarding the infant oral health visit: are dentists in Ireland aware of the recommendation for a first visit to the dentist by age 1 year?

To assess the knowledge, attitudes and behaviour of dentists nationwide in Ireland regarding the infant oral health visit, and also to elucidate whether dentists were aware of the recommendation for a first dental visit by age 1 year and of what care should be provided at this visit. A validated 10-item questionnaire was distributed to a representative sample of non-paediatric dentists (non-PDs) and paediatric dentists (PDs) practicing in Ireland. The questionnaire focused on respondents' demographics in addition to their knowledge, attitudes and behaviour regarding the infant dental visit. Seventy-three percent of non-PDs reported seeing patients aged 0-36 months. Compared to all PD respondents, 58% of non-PDs believed that the first dental visit should occur by age 1 year. Furthermore, non-PDs provided the same care as PDs at the infant dental visit, with the exception of evaluating for fluoride needs and placing fluoride varnish. The main barrier to early oral healthcare was reported to be parents not requesting dental appointments for their infants. There remains a need to increase the proportion of non-PDs in Ireland seeing infants by their first birthday. It is recommended that Irish undergraduate and continuing education courses incorporate clinical training regarding the infant oral health visit and emphasise fluoride needs evaluation and fluoride varnish application. Additionally, a nationwide health promotion initiative is indicated to inform parents of the importance of a dental visit by age 1 year.

Securing the health of the nation: life insurance, labor and health improvement in interwar Japan

In 1916, the Japanese Post Office established a public life insurance system especially geared toward poor laborers. By offering laborers the security of insurance, the state hoped to quell the labor agitation that threatened domestic order. A few years later, in 1922, this life insurance system expanded its mandate and created one of the first nationwide health promotion systems in Japan. Post Office officials had grown concerned over the growing discrepancy in mortality rates between Japan and industrialized Western nations. This divergence was especially apparent for serious infectious diseases such as tuberculosis. Within the institutionalized space of the health center, doctors exhorted customers to transform their everyday habits in clothing, dining, household organization and exercise. Japan's famous rajio taisō (radio calisthenics) program, for example, emerged from the Post Office's health guidance stations. I argue that through rajio taisō and the other health practices taught at the health guidance stations, the Japanese state sought to make healthy everyday habits a moral obligation for all Japanese citizens. Within this discourse, the state presented healthy living within a stable domestic space as the key to a happy and productive life, diverting attention from the political and economic crises facing interwar Japan.

Fostering active living and healthy eating through understanding physical activity and dietary behaviours of Arabic-speaking adults: a cross-sectional study from the Middle East

ObjectivesPhysical inactivity and unhealthy diets increase the risk for diabetes, cardiovascular diseases and cancer. Many people in Qatar are sedentary and consume diets high in fats, salt and sugar. The...

Healthy ageing as a visible public health activity and governmental responsibility. Health promotion for older people in the Czech Republic. Institutional and financial dimension

The health status of the Czech population has been improving over the past decades. The life expectancy increased from 67.6 for men/75.5 for women in 1990 to 75.9 for men/82.1 for women in 2014, becoming one of the highest in the Central and Eastern European region. Still, the older population faces many health risks related to obesity, high alcohol consumption, physical inactivity and smoking. Over half of the population above the age of 65 suffers from long-lasting illnesses and over half of the population above the age of 75 reports limitation in activities. Health promotion for older people in the Czech Republic is growing in importance. There have been nationwide health promotion programmes against the main civilisation diseases, which older people could benefit from. In recent years two strategic programmes: the National Strategy for Health Protection and Promotion and Disease Prevention and the National Action Plan for Positive Ageing for the period of 2013–2017 came into existence with healthy ageing being an important target for both of them. Health promotion policy is strongly centralised, supervised on the one hand by the Ministry of Health and the National Institute of Public Health and on the other hand by the Ministry of Labour and Social Affairs. At the same time, the activity of local governments and – especially – non-governmental organisations is important in supporting visible health promotion programmes for older people at the local level.

Peddling a semiotics of fear: a critical examination of scare tactics and commercial strategies in public health promotion

In this study, we critically examine the ways in which a nationwide health promotion campaign – the 2013 Diabetes UK/Tesco diabetes campaign, the largest of its kind in the UK – seeks to raise the general public's awareness of Type 2 diabetes. We subject a series of six campaign images (including their layout and accompanying text) to a multimodal discourse analysis, identifying the presence of a range of fear-inducing, stigmatising and commercial strategies, through which the campaign emphasises the dangers of diabetes and advocates personal responsibility for assessing both individual and others' risk of the disease. Specifically, we describe, in multi-semiotic detail, three discursive techniques deployed in the campaign to achieve these ends: (1) the depiction of grief and amplification of diabetes-related danger, (2) the promotion of diabetes risk and localisation of individuals' responsibility for their health and (3) the commercial branding and framing of the Diabetes UK/Tesco partnership – including the promotion of goods and services – as a means of diabetes prevention and management. Our findings raise concerns about the moral legitimacy of using fear-inducing and commercial strategies in order to (effectively) raise public awareness of and responses to Type 2 diabetes, strategies which do little to address the environmental factors which are associated with increasing rates of the disease.

Population-based reference values for the 1-min sit-to-stand test

To determine reference values for the 1-min sit-to-stand (STS) test in an adult population. Cross-sectional study nested within a nationwide health promotion campaign in Switzerland. Adults performed the STS test and completed questions on demographics and health behavior. 6,926 out of 7,753 (89.3 %) adults were able to complete the STS test. The median number of repetitions ranged from 50/min (25-75th percentile 41-57/min) in young men and 47/min (39-55/min) in young women aged 20-24 years to 30/min (25-37/min) in older men and 27/min (22-30/min) in older women aged 75-79 years. The reference values support the interpretation of 1-min STS test performance and identification of subjects with decreased lower body muscular strength and endurance.

Information System Success Model for Customer Relationship Management System in Health Promotion Centers

ObjectivesIntensified competitiveness in the healthcare industry has increased the number of healthcare centers and propelled the introduction of customer relationship management (CRM) systems to meet diverse customer demands. This study aimed to develop the information system success model of the CRM system by investigating previously proposed indicators within the model.MethodsThe evaluation areas of the CRM system includes three areas: the system characteristics area (system quality, information quality, and service quality), the user area (perceived usefulness and user satisfaction), and the performance area (personal performance and organizational performance). Detailed evaluation criteria of the three areas were developed, and its validity was verified by a survey administered to CRM system users in 13 nationwide health promotion centers. The survey data were analyzed by the structural equation modeling method, and the results confirmed that the model is feasible.ResultsInformation quality and service quality showed a statistically significant relationship with perceived usefulness and user satisfaction. Consequently, the perceived usefulness and user satisfaction had significant influence on individual performance as well as an indirect influence on organizational performance.ConclusionsThis study extends the research area on information success from general information systems to CRM systems in health promotion centers applying a previous information success model. This lays a foundation for evaluating health promotion center systems and provides a useful guide for successful implementation of hospital CRM systems.

Evaluation of nationwide health promotion campaigns in the Netherlands: an exploration of practices, wishes and opportunities

Nationwide health promotion campaigns are an important part of government-funded health promotion efforts. Valid evaluation is important, but difficult because gold standard research designs are not applicable and the allocation of budget and time for evaluation is often very tight. In The Netherlands, Health Promotion Institutes (HPIs) are responsible for these campaigns. We conducted an exploratory study among the HPIs to gain better insight into goals, practices, conditions and perceived barriers regarding evaluation of these campaigns. Data were obtained through personal interviews with representatives of HPIs who had direct management responsibility for the evaluation of their campaigns. The HPIs typically made use of a pre-test-post-test design with single measurements before and after the campaign without a control group. In campaign preparations, HPIs used qualitative research to pre- and pilot-test some campaign materials, but true formative evaluation was rare. Besides, accountability to their sponsors, peers and the population at large, the most important reason to evaluate was to learn for future campaigns. In terms of the RE-AIM framework, evaluation was mostly restricted to Reach and Effects; hardly any evaluation of adoption, implementation or maintenance was reported. Budget and time constraints were reported as the main barriers for more extensive formative and effect evaluation. Evaluation of nationwide campaigns is standard procedure, but the applied research designs are weak, due to lack of time, budget and research methodology expertise. Next to additional budget and a longer-term planning, input from external experts regarding evaluation research designs are needed for evaluation improvement.

Standards for Child and Adolescent Immunization Practices

Standards for Child and Adolescent Immunization Practices

Self‐Reported Utilization of Preventive Health Services by Retired Employees Age 65 and Older

Increased utilization of preventive services among the aging has been associated with improved health status and decreased medical costs. We sought to examine the use of the Health Risk Appraisal (HRA) in benchmarking compliance and characterizing those retired employees who met preventive service guidelines. A retrospective cohort study of retired employees age 65 and older. Nation-wide health promotion program offered by General Motors Corporation. 59,670 retired General Motors employees age 65 and older who participated in a nationwide mailed HRA health promotion program. Preventive health services compliance was measured using selected HRA questions. Gender, HRA participation patterns, overall health risk status, medical plan selection and disease status were examined as predictors of increased compliance. Multivariate logistic regression models were developed to test the relative contributions of participant characteristics to increased utilization. The self-reported HRA data indicated that compliance levels were higher than national averages. The Healthy People 2000 goals for the preventive services studied were met and exceeded (with the exception of tetanus immunization). Higher compliance was associated with being male, younger than 70 years, multiple-year HRA participation, overall low risk status and HMO insurance plan selection. The results from the HRA indicated that this population participated at a higher level than a comparable national sample exceeding goals set by Healthy People 2000.