Acuerdo de Cooperación entre Universidad de Cuenca y Ostwestfalen-Lippe University of Applied Sciences. Lemgo, Germany

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Cooperation Agreement between Hochschule München University of Applied Sciences-Munich, Germany and Universidad de Cuenca, Ecuador

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Memorandum of understanding between Universidad de Cuenca (Ecuador) and NHTV Breda University of Applied Sciences, Academies for Tourism, Leisure and Hotel Management & Facility Management Breda, The Netherlands

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An international survey of health literacy education within schools of pharmacy

Background: Health literacy (HL) influences patients’ health status, use of the healthcare system and medication-relatedbehaviours. However, the concept is relatively new to pharmacy and its incorporation in academic curricula has notbeen examined.Aims: To explore HL training in pharmacy schools internationally, and academics’ opinions in regards to how it shouldbe taught and assessed.Methods: An anonymous, online survey was administered to academics who teach within pharmacy degree coursesfrom countries where English is the main language.Results: Responses were received from 21 pharmacy schools in seven countries; 20 stated that HL was taught withintheir pharmacy degree, in four as a stand-alone topic. Small-group tutorials were thought to be the most beneficial formof teaching health literacy, best assessed using oral and objective structured clinical examinations.Conclusion: The majority of pharmacy schools taught health literacy and had similar opinions regarding best practiceteaching and assessment.

Cycling as a part of daily life: A review of health perspectives

Health aspects of day-to-day cycling have gained attention from the health sector aiming to increase levels of physical activity, and from the transport and planning sector, to justify investments in cycling. We review and discuss the main pathways between cycling and health under two perspectives — generalizable epidemiological evidence for health effects and specific impact modeling to quantify health impacts in concrete settings. Substantial benefits from physical activity dominate the public health impacts of cycling. Epidemiological evidence is strong and impact modeling is well advanced. Injuries amount to a smaller impact on the population level, but affect crash victims disproportionately and perceived risks deter potential cyclists. Basic data on crash risks are available, but evidence on determinants of risks is limited and impact models are highly dependent on local factors. Risks from air pollution can be assumed to be small, with limited evidence for cycling-specific mechanisms. Based on a large body of evidence, planners, health professionals, and decision-makers can rest assured that benefits from cycling-related physical activity are worth pursuing. Safety improvements should be part of the efforts to promote cycling, both to minimize negative impacts and to lower barriers to cycling for potential riders.

Does self-efficacy mediate the cross-sectional relationship between perceived quality of health care and self-management of diabetes? Results from Diabetes MILES - Australia

OBJECTIVE: Quality of health care (QoC) and self-efficacy may affect self-management of diabetes, but such effects are not well understood. We examined the indirect role of diabetes-specific self-efficacy (DSE) and generalised self-efficacy (GSE) in mediating the cross-sectional relationship between self-reported QoC and diabetes self-management.

DESIGN: Diabetes MILES-Australia was a national survey of 3,338 adults with diabetes. We analysed data from 1,624 respondents (Age: M=52.1, SD=13.9) with type 1 (T1D; n=680) or type 2 diabetes (T2D; n=944), who responded to a version of the survey containing key measures.

MAIN OUTCOME MEASURES: Self-reported healthy eating, physical activity, self-monitoring of blood glucose frequency, HbA1c, medication/insulin adherence. RESULTS: We used Preacher and Hayes' bootstrapping method, controlling for age, gender and diabetes duration, to test mediation of DSE and GSE on the relationship of QoC with each self-management variable. We found statistically significant but trivial mediation effects of DSE and of GSE on most, but not all, variables (all effect sizes <0.06).

CONCLUSION: Support for mediation was weak, suggesting that relationships amongst these variables are small and that future research might explore other aspects of self-management in diabetes.

Effects of health labels on expected and actual taste perception of soup

Health labels such as "reduced in salt" or the "healthy choices" logo aim to facilitate consumers' healthy food choices. However, they may act as a warning sign for those consumers who are more worried about the taste of the products, rather than healthiness. This study assessed the potential effect of front-of-pack health labels on consumers' expectations and actual perceived taste quality of a chicken soup. Participants ranging from 19 to 67. years of age (28 females, 18 males, mean age 45.3 ± 13.7. years) were invited to come to a central location to taste a variety of soups. Consumers tasted the same soup with different labels (e.g. now reduced in salt, healthy choices-tick logo) in a within-subjects design. Before and after consumers tasted the soup, they were asked to rate liking, saltiness, and desire to consume the soup. The results suggest that consumers expected the salt taste intensity (P< 0.001) to be lower when the label stated "now reduced in salt", compared to the soup without such label. Furthermore, consumers expected the soup with the tick logo to be more liked than the same soup with the tick logo and the "now reduced salt" label (P= 0.1). After consumers tasted the soups, no differences in liking or desire were found between the soups with the different labels.This study suggests that labels which notify consumers of a reduction in salt may have an adverse effect on consumers' expectation and potentially on the actual perceived taste of products.

Social determinants of health - why we continue to ignore them in the search for improved population health outcomes!

There is now unequivocal evidence that the health status of individuals and of whole communities is socially and economically determined, as are many other aspects of our lives. This suggests, as advocates of public health and population health approaches argue, that our efforts in managing our health and wellbeing should focus much more on early intervention and prevention programs than has been the case to date. However, although this ideology of social and economic determinism is generally accepted, practice does not reflect such values. Indeed, as increasing demand at the critical end of health service provision sees us spending more and more of our limited health care resources on acute and chronic illness, less resources are devoted to constructing and maintaining health-creating communities and environments. Paradoxically, while most of our leaders, academics and policy makers have themselves been nurtured in a sound understanding of cause and effect in the world, they are ignoring these fundamental premises in their approaches to the provision and management of health care. This paper explores some of the reasons why this might be the case and draws on key evidence to suggest that the time has come for us to think more ideologically in approaching health care in the future.

An analysis on the utilisation of health information technology to support clinical operation of chinese medicine

Chinese Medicine (CM) has become increasingly demanding globally. Recent World Health Organisation traditional and complementary medicine strategy of integrating CM to Western Medicine (WM) indicates that it is crucial that CM developments have strong literature, scientific, and evidence-based medical approval and support. To achieve this, there is a need to form a synthesis foundation or platform for future studies. This chapter serves to discover this synthesis that is suitable for CM by discussing the basics of inquiring and Knowledge Management (KM) systems. It suggests that CM should follow a combination of Hegelian and Kantian inquiring systems with the support of Singerian and Leibnizian inquiring systems and KM features. This proposed synthesis is one of the first, if not the first study to apply Churchman's inquiring systems into the context of CM and differentiate them from WM.

Hospital Staff Perceptions of Health Promotion Activities in Public Hospitals

The aim of this study was to determine the level of staff support for health promotion activities in Queensland public hospitals.

Nurses knowledge of health effects of dietary fibre

Introduction: Nurses accompany patients throughout their health care to prevent and treat disease, so their knowledge about diet and dietary fibre is key to successful diet therapy, which is an essential part of a patient's non-pharmacological treatment. It is known from the literature that a high proportion of nurses have limited knowledge about diet therapy and about sources of soluble fibre and other foods that can prevent or treat certain diseases. Given the position of nurses as key providers of dietary guidance, and given the health benefits of dietary fibre, we wanted to assess the level of fibre-related knowledge among nurses in Croatia. Material and Methods: Cross-sectional study based on data collected between October 2014 and March 2015 using a survey developed by the CI&DETS Polytechnic Institute in Viseu, Portugal. The survey contains questions about demographic characteristics as well as about knowledge of sources of dietary fibre, recommended daily intake and effects of fibre intake on particular diseases. The study included a total of 369 nurses from two health institutions and one nursing school from Croatia older than 18 years. Differences in knowledge were assessed for significance using the non-parametric Mann-Whitney U test. Possible associations among variables were explored using Spearman's rank correlation. For all statistical analyses, the threshold of significance was defined as P<0.05. Results: The level of knowledge among nurses in Croatia about dietary fibre varied from «undecided» to «partial knowledge». The median for level of knowledge ranged from 3 to 4 with low variability ranging from 0.11 to 0.33. Average levels of knowledge in percentages varied from 57.6% to 82.1%. Nurses with higher education levels showed significantly higher knowledge levels about the influence of dietary fiber intake on the risk of certain diseases (p = 0.007), constipation (p = 0.016), bowel cancer (p = 0.005) and breast cancer (p = 0.039). Conclusion: The level of nurses’ knowledge about dietary fiber is suboptimal. This indicates the need to strengthen nurse education in the areas of diet and diet therapy. Increase the level of knowledge of nurses about nutrition can positively influence the quality of care.

The complexity in the implementation process of empowerment-based chronic kidney care: a case study

Background: This study is part of an interactive improvement intervention aimed to facilitate empowerment-based chronic kidney care using data from persons with CKD and their family members. There are many challenges to implementing empowerment-based care, and it is therefore necessary to study the implementation process. The aim of this study was to generate knowledge regarding the implementation process of an improvement intervention of empowerment for those who require chronic kidney care. Methods: A prospective single qualitative case study was chosen to follow the process of the implementation over a two year period. Twelve health care professionals were selected based on their various role(s) in the implementation of the improvement intervention. Data collection comprised of digitally recorded project group meetings, field notes of the meetings, and individual interviews before and after the improvement project. These multiple data were analyzed using qualitative latent content analysis. Results: Two facilitator themes emerged: Moving spirit and Encouragement. The healthcare professionals described a willingness to individualize care and to increase their professional development in the field of chronic kidney care. The implementation process was strongly reinforced by both the researchers working interactively with the staff, and the project group. One theme emerged as a barrier: the Limitations of the organization. Changes in the organization hindered the implementation of the intervention throughout the study period, and the lack of interplay in the organization most impeded the process. Conclusions: The findings indicated the complexity of maintaining a sustainable and lasting implementation over a period of two years. Implementing empowerment-based care was found to be facilitated by the cooperation between all involved healthcare professionals. Furthermore, long-term improvement interventions need strong encouragement from all levels of the organization to maintain engagement, even when it is initiated by the health care professionals themselves.

The effect of a Computerised Decision Support System (CDSS) on compliance with the prehospital assessment process: results of an interrupted time-series study

BACKGROUND: Errors in the decision-making process are probably the main threat to patient safety in the prehospital setting. The reason can be the change of focus in prehospital care from the traditional "scoop and run" practice to a more complex assessment and this new focus imposes real demands on clinical judgment. The use of Clinical Guidelines (CG) is a common strategy for cognitively supporting the prehospital providers. However, there are studies that suggest that the compliance with CG in some cases is low in the prehospital setting. One possible way to increase compliance with guidelines could be to introduce guidelines in a Computerized Decision Support System (CDSS). There is limited evidence relating to the effect of CDSS in a prehospital setting. The present study aimed to evaluate the effect of CDSS on compliance with the basic assessment process described in the prehospital CG and the effect of On Scene Time (OST). METHODS: In this time-series study, data from prehospital medical records were collected on a weekly basis during the study period. Medical records were rated with the guidance of a rating protocol and data on OST were collected. The difference between baseline and the intervention period was assessed by a segmented regression. RESULTS: In this study, 371 patients were included. Compliance with the assessment process described in the prehospital CG was stable during the baseline period. Following the introduction of the CDSS, compliance rose significantly. The post-intervention slope was stable. The CDSS had no significant effect on OST. CONCLUSIONS: The use of CDSS in prehospital care has the ability to increase compliance with the assessment process of patients with a medical emergency. This study was unable to demonstrate any effects of OST.

What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure? : An Individual Patient Data Meta-analysis

Background To identify those characteristics of self-management interventions in patients with heart failure (HF) that are effective in influencing health-related quality of life, mortality, and hospitalizations. Methods and Results Randomized trials on self-management interventions conducted between January 1985 and June 2013 were identified and individual patient data were requested for meta-analysis. Generalized mixed effects models and Cox proportional hazard models including frailty terms were used to assess the relation between characteristics of interventions and health-related outcomes. Twenty randomized trials (5624 patients) were included. Longer intervention duration reduced mortality risk (hazard ratio 0.99, 95% confidence interval [CI] 0.97–0.999 per month increase in duration), risk of HF-related hospitalization (hazard ratio 0.98, 95% CI 0.96–0.99), and HF-related hospitalization at 6 months (risk ratio 0.96, 95% CI 0.92–0.995). Although results were not consistent across outcomes, interventions comprising standardized training of interventionists, peer contact, log keeping, or goal-setting skills appeared less effective than interventions without these characteristics. Conclusion No specific program characteristics were consistently associated with better effects of self-management interventions, but longer duration seemed to improve the effect of self-management interventions on several outcomes. Future research using factorial trial designs and process evaluations is needed to understand the working mechanism of specific program characteristics of self-management interventions in HF patients.