Chronic condition management in general practice is projected to account for 50% of all consultations by 2051. General practices under present workforce conditions will be unable to meet this demand. Nurse led collaborative care models of chronic disease management have been successful overseas and are proposed as one solution. This article provides an interim report on a prospective randomised trial to investigate the acceptability, cost effectiveness and feasibility of a nurse led model of care for chronic conditions in Australian general practice. A qualitative study focused on the impact of this model of care through the perceptions of practice staff from one urban and one regional practice in Queensland, and one Victorian rural practice. Primary benefits of the collaborative care model focused on increased efficiency and communication between practice staff and patients. The increased degree of patient self responsibility was noted by all and highlights the motivational aspect ...

Despite policy and practice mandates for patient involvement, people with serious mental illness often feel marginalised in decisions about antipsychotic medication. Aims To examine stakeholder perspectives of barriers and facilitators to involving people with serious mental illness in antipsychotic prescribing decisions. Systematic thematic synthesis. Synthesis of 29 studies identified the following key influences on involvement: patient's capability, desire and expectation for involvement, organisational context, and the consultation setting and processes. Optimal patient involvement in antipsychotic decisions demands that individual and contextual barriers are addressed. There was divergence in perceived barriers to involvement identified by patients and prescribers. For example, patients felt that lack of time in consultations was a barrier to involvement, something seldom raised by prescribers, who identified organisational barriers. Patients must understand their rights to...

Rising concern over the poor level of blood-pressure (BP) control among hypertensive patients has prompted searches for novel ways of managing hypertension. The objectives of this study were to develop and pilot-test a home BP tele-management system that actively engages patients in the process of care.Phase 1 involved a series of focus-group meetings with patients and primary care providers to guide the system’s development. In Phase 2, 33 diabetic patients with uncontrolled ambulatory hypertension were enrolled in a 4-month pilot study, using a before-and-after design to assess its effectiveness in lowering BP, its acceptability to users, and the reliability of home BP measurements.The system, developed using commodity hardware, comprised a Bluetooth-enabled home BP monitor, a mobile phone to receive and transmit data, a central server for data processing, a fax-back system to send physicians’ reports, and a BP alerting system. In the pilot study, 24-h ambulatory BP fell by 11/5 (±13/7 SD) mm Hg (both P < .001), and BP control improved significantly. Substantially more home readings were received by the server than expected, based on the preset monitoring schedule. Of 42 BP alerts sent to patients, almost half (n = 20) were due to low BP. Physicians received no critical BP alerts. Patients perceived the system as acceptable and effective.The encouraging results of this study provide a strong rationale for a long-term, randomized, clinical trial to determine whether this home BP tele-management system improves BP control in the community among patients with uncontrolled hypertension.

Background: Achieving asthma control is central to optimising patient quality of life and clinical outcome. Contemporary models of chronic disease management across a variety of countries point to the importance of micro, meso and macro level influences on patient care and outcome. However, asthma outcomes research has almost invariably concentrated on identifying and addressing patient predictors. Little is known about higher level organisational influences. Objective: This paper explores the contribution of organisational factors on poor asthma control, allowing for patient factors, at three organisational levels: the individual patient, local service deliverers, and strategic regional providers. Design, setting and participants: Prospective cross-sectional observational cohort study of 64,929 people with asthma from 1205 primary care practices spread throughout the United Kingdom (UK). Patient clinical data were recorded during a routine asthma review. Method: Data were analysed using simple descriptive, multiple regression and complex multi-level modelling techniques, accounting for practice clustering of patients. Results: Poor asthma control was associated with areas of higher deprivation [regression coefficient 0.026 (95% confidence intervals 0.006; 0.046)] and urban practice [À0.155 (À0.275; À0.035)] but not all local and regional variation was explained by the data. In contrast, patient level predictors of poor control were: short acting bronchodilator overuse [2.129 (2.091; 2.164)], days-off due to asthma [1.203 (1.148; 1.258)], PEFR < 80 [0.76 (0.666; 0.854)], non-use of a self-management plan (SMP) [0.554 (0.515; 0.593)], poor inhaler technique [0.53 (0.475; 0.585)], poor medication compliance [0.385 (À0.007; 0.777)], and gender [0.314 (0.281; 0.347)]

Home-based healthcare is gaining in popularity as an alternative to conventional care for elderly in many countries. However there is lack of clarity regarding benefits to elderly living in the community with chronic diseases from home-based healthcare intervention (HBI) programs. This review aimed to assess the benefits if any from HBI compared to usual care for mortality, functional status and admission to long term care facility. Specific program components were identified that gave the best outcomes across different interventions.

Dietary modifications are common treatment strategies for patients with various chronic diseases, but it is unclear how often these individuals read food labels. The objective of this study was to determine whether patients with chronic disease who are advised to change their eating habits read nutrition labels more than patients who have not been so advised, and whether that impacts their energy and nutrient intake. Analysis of the 2005-2006 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional survey of the United States population, was performed. Adults (20 years of age or older) who participated in the 2005-2006 National Health and Nutrition Examination Survey and who had type 2 diabetes, hypertension, and/or hyperlipidemia were included for analysis. There were 3,748 unweighted participants, which represents 170,958,166 in the US population. Proportions of patients with chronic disease who read nutrition labels were compared by 2 analysis, mean values of various components of their diet were compared by the two-sample independent t test, and odds ratios and 95% confidence intervals were determined by logistic regression. Among patients with chronic disease, the odds of reading food labels when told by their doctor or another health professional to reduce calories or weight was 50% higher than in those without physician intervention (odds ratioϭ1.50, 95% confidence interval: 1.12 to 2.00). Those who read food labels consumed less energy, saturated fat, carbohydrates, and sugar, and more fiber than those who did not. These findings point to the value of dietary counseling in chronic disease management.

Diabetes Mellitus leads to death if it is not prevented at the initial phase when seeing signs, symptoms, and pain. Diabetes Mellitus is a health crisis in Fiji today. The aim of this paper is a systematic review of diabetes in Fiji. 
The research gathered findings from available medical journals, articles, discussion papers, and reports from previous researchers on Diabetes Mellitus and its health effects within the period of 2007 to 2017. The research study uses 54 articles including databases, reports, journals, discussion and research paper, and media link relevant to the study topic. 
Diabetes mellitus was the number one leading disease in 2007 & 2010. From 2012 to 2017 it was still ranked as the number one NCD disease in Fiji. It was identified that indigenous Fijians iTaukei had higher rates than on non-Fijian population. Males were identified as having higher rates of Diabetes mellitus than females. However females also reported higher rates of Gestational Diabetes mellitus. The review found that Diabetes mellitus was also the cause of poor sedentary lifestyle such as diet, a lack of physical activity and poor nutrition. There was poor management by diabetic patients in controlling there diabetes, an increase in weight, an increase in high Body Mass Index rates, high rates of eye disease, and  high rates of amputations.                           
There are numbers of interventions, awareness, and services provisions in Fiji. The National Ministry of Health and its partners in the country are working together in partnerships to promote national wellness and well-being programmes, and reduce premature mortality and morbidity for diabetes mellitus.  The partners consist of non-governmental organisations, faith based organisations, civil society organisations, the private sector, other government Ministries, and non-health organisations. The recommendations were made to upscale and improve the healthcare system in Fiji that benefits all Fijians.

Emerging evidence has demonstrated the potential for Telehealth systems to reduce unnecessary hospital admission and lower costs of care by assisting patients and healthcare professionals to manage chronic conditions more efficiently. Nonetheless, due to a complex interplay of different barriers, Telehealth has not yet been widely adopted in any country. Understanding barriers to wider Telehealth adoption is vital to enable its embracement by many older people who could greatly benefit from the technology. The aim of this exploratory study was to identify barriers to wider Telehealth adoption in the homes of older people, in the Republic of Ireland. Objectives included identifying barriers from the perspective of five groups of stakeholders, determining the most pressing barriers and suggesting possible approaches to addressing such issues. Fifteen semi-structured interviews were conducted. Findings were analysed against existing literature, current technology adoption trends and successful initiatives implemented in different countries. This study suggests that the lack of incentive to healthcare professionals to embrace Telehealth, technology usability issues, implementation costs and lack of organisational willingness to change are the most pressing barriers to wider Telehealth adoption. Possible approaches to address healthcare professional incentive barriers have been suggested and include government mandates, the establishment of reimbursement schemes and the use of government financial incentives. The provision of Telehealth through devices that people are familiar with such as mobile phones, laptops and computer tablets, and the involvement of end-users during Telehealth technology development stages are also supported by this study as strategies to overcome Telehealth usability challenges.

Planning for a Baby:  https://youtu.be/2iwLh6XCnq8

Pregnancy with IBD: https://youtu.be/br0kciD8xJk

Motherhood with IBD: https://youtu.be/TQjt8pnMv4I


Our aim is to provide an understanding of the experience of women with inflammatory bowel disease (IBD) who have made the transition to motherhood. A total of 22 mothers with IBD were recruited from around the United Kingdom. Semi-structured interviews were conducted and analyzed using thematic analysis. The central concept—Blurred Lines—offers a novel frame for understanding the transition to motherhood with IBD through identifying parallels between having IBD and becoming, and being, a mother. Parallels clustered into three main themes: Need for Readiness, Lifestyle Changes, and Monitoring Personal and Physical Development. Hence, women with IBD are in some ways well prepared for the challenges of motherhood even though, as a group, they tend to restrict their reproductive choices. We recommend health professionals initiate conversations about reproduction early and provide a multidisciplinary approach to pregnancy and IBD in which women have confidence that their ongoing treatment will be integrated successfully with their maternity care.

Le Rapport de la Commission Macroéconomie et santé et le rapport publié ultérieurement par l’OMS Scaling
Up the Response to Infectious Diseases: A Way Out of Poverty établissent les liens irréfutables qui existent
entre la santé et le développement économique ainsi que la demande croissante de soins de santé en
rapport avec les maladies infectieuses telles que le VIH/SIDA et la tuberculose. Plus généralement, la
prise en charge de toutes les affections chroniques - maladies non transmissibles, troubles mentaux de
longue durée et certaines maladies transmissibles telles que le VIH/SIDA - est l’un des plus grands défis
pour les systèmes de soins de santé partout dans le monde. Les affections chroniques sont actuellement
responsables de 60% de la charge mondiale de morbidité. Elles progressent à un rythme tel que, d’ici à
2020, les pays en développement peuvent s’attendre à ce que leur charge de morbidité soit imputable à
80% aux affections chroniques. L’observance des traitements dans ces pays ne dépasse guère 20%, d’où
des résultats médiocres en termes de santé et des coûts très élevés pour la société, les gouvernements et
les familles. Les systèmes de santé, pourtant, n’ont pas de plan relatif à la prise en charge des affections
chroniques et se contentent de traiter les symptômes à mesure qu’ils apparaissent.
Consciente de l’opportunité d’améliorer les soins de santé pour les affections chroniques, l’OMS a
lancé un nouveau projet Des soins novateurs pour les affections chroniques. La première phase de ce projet
a consisté à définir et analyser les meilleures pratiques et les modèles de soins de santé économiquement
accessibles pour les affections chroniques, et à faire le point de la situation. Des experts, des organisations
et des établissements internationaux ont été associés à ces travaux.
Des soins novateurs pour les affections chroniques: éléments constitutifs décrit le travail accompli, à savoir la
mise en place d’un cadre de grande envergure devant permettre l’actualisation des soins de santé compte
tenu des besoins liés aux affections chroniques. Les éléments proposés et le cadre général faciliteront la
prévention et la prise en charge des maladies dans les services de soins de santé. Cela est d’autant plus
important que la plupart des affections chroniques peuvent être prévenues. Réunis pour examiner ces
stratégies et le cadre général, les décideurs ont estimé qu’ils étaient de nature à résister, que les pays en
développement soient appelés, selon le scénario, à faire face à une épidémie de VIH/SIDA, à l’exode
des ressources humaines qualifiées vers le secteur privé, à un effondrement général de l’économie ou à
un changement de gouvernement. Les participants ont également jugé que le cadre était adapté à des
affections chroniques diverses, y compris le VIH/SIDA, la tuberculose, les maladies cardio-vasculaires,
le diabète et les troubles mentaux de longue durée.
Les étapes suivantes incluront des projets de démonstration de la mise en oeuvre des stratégies décrites dans
ce rapport. Les partenaires de la santé publique seront étroitement associés à la réalisation de ce projet.
Ce rapport sera très utile pour les décideurs, les planificateurs des services de santé et les autres parties
intéressées qui envisagent de prendre des mesures pour réduire les menaces que les maladies chroniques
font peser sur la santé des citoyens, le système de soins de santé et l’économie nationale.

Objectives:To study the magnitude of chronic liver disordersin
children  attending  the  only  tertiary  care  hospital. To  study  the
spectrum of chronic liver disorders in children.
Study design:Prospective observational study
Material and methods: The study included prospective (July 2007
to  Dec.2008) analysis of  all  children  < 18  yrs  withchronic liver
disorders.  A  total  of  94  children  with  confirmed  diagnosis  of
chronic liver disease were included in the study. The diagnosis of
all liver diseases was based on established clinical and diagnostic
criteria. Severity of chronic liver disease was defined using Child
grading.
Results:Mean age of patients was 10.4 ± 4 yrs with a rangeof 1-18 yrs. Jaundice(75%), ascites (64%),encephalopathy(29%) were
presenting  symptoms  in  chronic  liver  disease  patients  indicating
decompensation  at  presentation  .Features  of  portal  hypertension
were seen in 65%.Etiology was found to be HBV in 18%, Wilsons
disease in 16% ,HCV in 6.4%, autoimmune in 5.3% and alpha-1
antitrypsin deficiency in 1.1% and no etiology could be found in
52%(cryptogenic) .In acute liver diseases HAV was cause in 43%,
HBV in 27% and HEV in 7% cases.
Conclusion: Chronic  liver  diseases  in  our  set  up  are  mainly
constituted  by  post  hepatitic,  metabolic  and  cryptogenic  etiology
.Lack  of  advanced  biochemical  and  specific  diagnostic  tools
resulted in high percentage of cryptogenic cirrhosis our study.

ABSTRAK Congestive Heart Failure dapat menimbulkan dampak dalam kehidupan pasien secara psikologis. Dampak yang sering ditimbulkan dari segi psikologis salah satunya depresi. Terapi murottal Al-Qur'an merupakan salah satu jenis terapi nonfarmakologis yang digunakan untuk menurunkan depresi karena dapat menimbulkan respon relaksasi bagi yang mendengarkannya. Penelitian ini bertujuan untuk mengetahui pengaruh terapi murottal terhadap skor depresi pada pasien Congestive Heart Failure di Pusat Jantung Terpadu RSUP Dr. Wahidin Sudirohusodo. Metode penelitian ini merupakan jenis penelitian Quasi experimental dengan rancangan penelitian yang digunakan adalah Time Series With Control Group Design. Responden sebanyak 36 dibagi menjadi 2 kelompok, masing-masing kelompok 18 responden. Instrumen yang digunakan adalah kuesioner Hamilton Anxiety and Depression Scale. Data dianalisis menggunakan uji Wilcoxon. Hasil penelitian ini didapatkan nilai p<0,05. Artinya secara umum ada pengaruh intervensi terapi murottal terhadap skor depresi. Kesimpulan adalah terapi murottal Al-Quran dapat menurunkan skor depresi pada pasien Congestive Heart Failure. Oleh karena itu, diharapkan pemberi pelayanan perawatan dalam memberikan intervensi keperawatann dengan menggunakan bacaan Al-Quran sebagai terapi komplementer untuk menurunkan skor depresi. Kata-kata kunci: Congestive Heart Failure, Depresi, Murottal Al-Qur'an ABSTRACT Congestive Heart Failure can have a psychological impact on a patient's life. The effect of the psycological impact which commonly found is depression. Murottal Al-Qur'an therapy is one type of non-pharmacological treatment used to reduce depression because it can cause a relaxation response for those who listen to it. This study aims to determine the effect of Murottal therapy on depression scores in Congestive Heart Failure patients at the Integrated Heart Center Dr. Wahidin Sudirohusodo. This research method was a type of Quasi-experimental research with the research design used is Time Series With Control Group Design. Thirty-six respondents were divided into two groups. Each group was 18 respondents. The instrument used was the Hamilton Anxiety and Depression Scale questionnaire. Data were analyzed using the Wilcoxon test. The results of this study obtained a value of p <0.05. This means that in general, there was the influence of murottal therapy interventions on depression. The conclusion was murottal Al-Quran therapy can reduce depression in Congestive Heart Failure patients. Therefore, care providers were expected to provide nursing interventions using Al-Quran reading as a complementary therapy to reduce depression scores.

พยาบาลวิชาชีพได้รับการยอมรับว่าเป็นบุคลากรสุขภาพที่มีความสำคัญอย่างยิ่งในการจัดการโรคเรื้อรัง บทความนี้มุ่งเน้นการบูรณาการบทบาทของพยาบาลวิชาชีพและกิจกรรมการพยาบาลในการจัดการโรคเรื้อรัง โดยเฉพาะในแต่ละองค์ประกอบที่แสดงให้เห็นว่าพยาบาลมีบทบาทสำคัญในการดำเนินการจัดการโรคเรื้อรัง ประกอบด้วย 1) บทบาทในการกำหนดทิศทางและนโยบายการจัดการโรคเรื้อรัง 2) บทบาทในการจัดระบบการบริการผู้ป่วยโรคเรื้อรัง 3) บทบาทในการใช้ระบบสารสนเทศในการจัดการโรคเรื้อรัง 4) บทบาทในการสนับสนุนการจัดการตนเองของผู้ป่วยโรคเรื้อรัง 5) บทบาทในการใช้ข้อมูลเพื่อสนับสนุนการตัดสินใจทางคลินิกในการจัดการโรคเรื้อรัง และ 6) บทบาทในการส่งเสริมการมีส่วนร่วมของชุมชนในการจัดการโรคเรื้อรัง ซึ่งเป็นบทบาทที่มีความสำคัญอย่างยิ่งของพยาบาลวิชาชีพในการจัดการโรคเรื้อรังเพื่อให้เกิดผลลัพธ์ที่ดีขึ้นของผู้รับบริการ
คำสำคัญ: บทบาทพยาบาลวิชาชีพ, การจัดการโรคเรื้อรัง
Registered nurses in primary care have been indicated as key in implementing the Chronic Care Model. This article focuses on the integration of the role of the nurse and nurse's activities in working with the Chronic Care Model (CCM). Specifically for each of the model's elements, this indicates the nurses as key elements for implementing. The roles of the nurse are presented in six elements: 1) Health care organization 2) Delivery system design 3) Decision support 4) Self-management support 5) Clinical information systems and 6) Community. Nurse's activities in chronic disease management can improve quality outcomes and high quality care.
Keyword: role of the nurse, chronic disease management

Advances in medical science and technology, together with improved medical and nursing care, are continuously improving health outcomes in chronic illness, including epilepsy. The consequent increasing diagnostic and therapeutic complexity is placing a burgeoning strain on health care systems. In response, an international move to transform chronic disease management (CDM) aims to optimize the quality and safety of care while containing health care costs. CDM models recommend: integration of care across organizational boundaries that is supported with information and communication technology; patient self-management; and guideline implementation to promote standardized care. Evidence of the effectiveness of CDM models in epilepsy care is presented in this review article.

This paper presents a proposal for OMG! Obesity Must Go! (OMG!), an employee assistance program (EAP) to be implemented at Thereyouare University (TU), a large university located in Arkansas, one of the top five states for obesity in the United States.  It is intended for consideration by TU’s initial hiring entity, which is composed of the human resources and finance departments, the occupational health, labor/management, and leadership staff; and all entities within the EAP and health promotion communities. The mission of the OMG! program is to educate, inform, and raise the awareness of obesity and its impact on health, to encourage and empower employees to lead healthier, more meaningful lives; and to substantially improve the identified health outcomes by reducing the percent overweight by 5 points in the first year, reducing cholesterol and blood pressure levels, and providing a healthier environment for all.

Pervasive care and chronic disease management to reduce institutionalization is a priority for most western countries. The realization of next generation ubiquitous and pervasive healthcare systems will be a challenging task, as these systems are likely to involve a complex structure. Such systems will consist of various devices, ranging from resourceconstrained sensors and actuators to complex multimedia devices, supporting time critical applications. This is further compounded by cultural and socio-economical factors that must be addressed for next generation healthcare systems to be widely diffused and used. These factors have a direct impact on the system and security models and will require further understanding to encourage users to embrace and adopt the new technology. These models must capture not only the perceived value of the new technology and its ease of use, but most importantly the perceived risk of using this technology. This paper outlines the design space of pervasive health monitoring with body sensor networks and derives the requirements for connected pervasive medical care systems. Commercial and academic mobile medical sensor systems have been mapped to the requirements derived and a comparative analysis of state of the technology is given.

Chronic conditions, such as chronic heart failure, chronic obstructive pulmonary disease, cancer and diabetes are common and burdensome for individuals, their families and societies. Globally, these conditions are the leading cause of mortality in the world, representing 60% of all deaths. Of the 57 million deaths that occurred globally in 2008, 36 million were due to non-communicable diseases. Social determinants of health (SDH) refers to the milieu in which people are born, grow, live, work and age. Socioeconomic status, education, access to healthcare, employment, and social support networks influence health outcomes. Increasingly, SDH are attracting attention in order to reduce health care disparities. Nurses need to understand the impacts of SDH on individuals, communities and nations. In order to address the impact that SDH have on well-being, interventions need to be targeted at the individual, health care provider and health care system in order to optimize health outcomes. Creating an interface and dialogue between policy, practice, education and research is critical for improving chronic care outcomes.

The study deals with the personality and socioeconomic factors influencing the academic track/strand among Senior High Schoolers. It answered the following questions: What is the chosen academic track among Senior High Schoolers?; How may the personality and socioeconomic factors among Senior High Schoolers be described; Is there significant relationship between personality and socioeconomic factors and chosen academic track among Senior High Schoolers?; and To what extend do personality and socioeconomic factors predict the chosen academic track? Descriptive method of research was used with 225 Senior High Schoolers from Wesleyan University-Philippines, Aurora Campus located at Maria Aurora, Aurora, Philippines during the School Year 2018-2019. Questionnaire with the aid of interview were used as data gathering instruments and subjected to frequency distribution, percentage, weighted mean, test of correlation and regression. Humanities and Social Sciences (HUMSS) strand is the first choice among the respondents. Personality factors obtained a weighted mean of 3.51 described as agree, considering that strand which were important and vital in deciding and choosing future career, giving them the challenge to bring out their best, and further development with their values as a person lead the factors. Likewise, supporting the needs of their family and valuing in the future" ruled the socioeconomic factors in choosing strand. Students chose General Academic Strand (GAS) strand still on the process of deciding what degree they will be going to enrol in college which manifested on the finding that high significant correlations were observed to all personality and socioeconomic factors in choosing the academic strand. Fourteen per cent of personality factor; "students' intellectual capacity to finish their studies can predict academic strand while socioeconomic factor; "choosing strand that they value in the future" can predict 13.1%.

Background: Complex older patients represent about half of all acute public hospital admissions in Australia. People with dementia are a classic example of complex older patients, and have been identified to have higher rates of hospital-acquired complications. Complications contribute to poorer patient outcomes, increase length of stay and cost to hospitals. The care for older people with dementia is complex, and this has been attributed to: their cognitive response to being hospitalised; their limited ability to self-care; and lack of nursing engagement with the family caregiver. Registered nurses can offer simultaneous assessment and intervention to prevent or mitigate hospital-acquired complications. However, it is known that when demand for nursing care exceeds supply, care is prioritised according to acute medical need. Consequently some basic but essential nursing care activities such as patient mobility, communication, skin care, hydration and nutrition are implicitly rationed.

Research suggests that treatments for depression among individuals with chronic physical disease do not improve disease outcomes significantly, and chronic disease management programs do not necessarily improve mood. For individuals experiencing co-morbid depression and chronic physical disease, demands on the self-regulation system are compounded, leading to a rapid depletion of selfregulatory resources. Because disease and depression management are not integrated, patients lack the understanding needed to prioritize self-regulatory goals in a way that makes disease and depression management synergistic. A framework in which the management of co-morbidity is considered alongside the management of either condition alone offers benefits to researchers and practitioners and may help improve clinical outcomes.

Background Human resources for health (HRH) include a range of occupations that aim to promote or improve human health. The UN Sustainable Development Goals (SDGs) and the WHO Health Workforce 2030 strategy have drawn attention to the importance of HRH for achieving policy priorities such as universal health coverage (UHC). Although previous research has found substantial global disparities in HRH, the absence of comparable crossnational estimates of existing workforces has hindered efforts to quantify workforce requirements to meet health system goals. We aimed to use comparable and standardised data sources to estimate HRH densities globally, and to examine the relationship between a subset of HRH cadres and UHC effective coverage performance. Methods Through the International Labour Organization and Global Health Data Exchange databases, we identified 1404 country-years of data from labour force surveys and 69 country-years of census data, with detailed microdata on health-related employment. From the WHO National Health Workforce Accounts, we identified 2950 country-years of data. We mapped data from all occupational coding systems to the International Standard Classification of Occupations 1988 (ISCO-88), allowing for standardised estimation of densities for 16 categories of health workers across the full time series. Using data from 1990 to 2019 for 196 of 204 countries and territories, covering seven Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) super-regions and 21 regions, we applied spatiotemporal Gaussian process regression (ST-GPR) to model HRH densities from 1990 to 2019 for all countries and territories. We used stochastic frontier meta-regression to model the relationship between the UHC effective coverage index and densities for the four categories of health workers enumerated in SDG indicator 3.c.1 pertaining to HRH: physicians, nurses and midwives, dentistry personnel, and pharmaceutical personnel. We identified minimum workforce density thresholds required to meet a specified target of 80 out of 100 on the UHC effective coverage index, and quantified national shortages with respect to those minimum thresholds. Findings We estimated that, in 2019, the world had 104•0 million (95% uncertainty interval 83•5-128•0) health workers, including 12•8 million (9•7-16•6) physicians, 29•8 million (23•3-37•7) nurses and midwives, 4•6 million (3•6-6•0) dentistry personnel, and 5•2 million (4•0-6•7) pharmaceutical personnel. We calculated a global physician density of 16•7 (12•6-21•6) per 10 000 population, and a nurse and midwife density of 38•6 (30•1-48•8) per 10 000 population. We found the GBD super-regions of sub-Saharan Africa, south Asia, and north Africa and the Middle East had the lowest HRH densities. To reach 80 out of 100 on the UHC effective coverage index, we estimated that, per 10 000 population, at least 20•7 physicians, 70•6 nurses and midwives, 8•2 dentistry personnel, and 9•4 pharmaceutical personnel would be needed. In total, the 2019 national health workforces fell short of these minimum thresholds by 6•4 million physicians, 30•6 million nurses and midwives, 3•3 million dentistry personnel, and 2•9 million pharmaceutical personnel. Interpretation Considerable expansion of the world's health workforce is needed to achieve high levels of UHC effective coverage. The largest shortages are in low-income settings, highlighting the need for increased financing and coordination to train, employ, and retain human resources in the health sector. Actual HRH shortages might be larger than estimated because minimum thresholds for each cadre of health workers are benchmarked on health systems that most efficiently translate human resources into UHC attainment. .

Background: Sickle cell disease (SCD) is a genetic disease caused by an individual inheriting an allele for sickle cell hemoglobin from both parents and is associated with unusually large numbers of immature blood cells, containing many long, thin, crescent-shaped erythrocytes. It is a disease prevalent throughout many populations. The use of medicinal plants and nutrition in managing SCD is gaining increasing attention.

The objective of this study was to describe a pilot trial of using an omega-3 fatty acid (docosahexaenoic acid [DHA]) to prevent islet cell autoimmunity in infants with an increased risk for developing type 1 diabetes (T1D). Infants from pregnant mothers who either have T1D (or the father or a previous child has T1D) and who entered the study in the third trimester or infants younger than age 5 months having a first-degree family member with T1D were eligible for the study. Infants from either group also had to have an increased genetic (HLA) risk for T1D (or multiple first-degree relatives with T1D) to be eligible. The study is a multicenter, 2-arm, randomized, doublemasked clinical trial that will last 4 years (1 year of recruitment and 3 years of treatment). Treatment with DHA (or control) began in the last trimester of pregnancy or in the first 5 months after birth. Inflammatory mediators, including cytokines, chemokines, eicosanoids, and C-reactive protein, are being measured along with fatty acids in maternal and infant blood. Ninety-eight infants were enrolled (41 during pregnancy and 57 in the 5 months after birth). HLA results of the 97 eligible infants (1 infant had a protective 0602 allele and was thus ineligible) showed that 90 have DR3 and/or DR4. Seven infants were enrolled without DR3/4 but who instead had multiple first-degree relatives with T1D. Compliance has been excellent, and no families have discontinued participation. Intervention trials in this high-risk group are feasible but require significant effort to identify potential participants.

INTRODUCTION: According to the World Health Organisation chronic diseases are the leading cause of mortality in the world, representing 60% of all deaths. Strategies employed to tackle chronic diseases aim to act on risk factors through adopting a healthy lifestyle. These strategies can be greatly implemented from the adoption of wearable devices, which allow a thorough and minimally invasive monitoring of patients’ clinical data.
This article aims to clarify whether wearable devices can help in preventing hospital readmission and improve quality of life in chronic patients.
Method: A literature search of electronic databases was performed in January 2017. The following databases were searched: The Cochrane Database of Systematic Reviews, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Pub Med, EMBASE and MEDLINE. RESULTS: 33 articles met the inclusion criteria and were included in the literature review. DISCUSSION: Various wearable devices are currently available to monitor and keep records of diffe- rent clinical information. Some of them are proved to prevent hospital re-admissions and to treat effectively life-threatening situations in certain categories of chronic patients.
Higher level of acceptability and usability are achieved when users are involved in the testing stage prior to the release of the device and/or the features and terms of use are clearly described to patients and carers. Wearable devices are also proved to be more accurate than clinical assessment only in estimating the risk of falls in chronic patients, thus improving safety in the home care setting.
Regardless of their features, wearable devices are yet to be used by both healthcare professionals and patients on a large scale.
KEYWORDS: wearable devices, chronic conditions, hospital admission prevention, safety, quality of life, healthcare professionals.

In the upcoming years, younger adults will become increasingly important in the promotion of older adults’ health and well-being in both personal and professional aspects. However, negative attitudes about the elderly often harm communication and strain relations between them. Ageism and prejudice against older adults is widespread in the U.S. (Barnes et al., 2008). This study examines an intergenerational communication intervention (ICI) program that aims to (a) reduce ageist attitudes, (b) promote more effective communication between younger and older adults, and (c) teach older adults how to best utilize technology to improve health outcomes. The proposed intervention was designed to positively reduce outgroup-related bias and discrimination, decrease communication-related apprehension, and increase older adults’ ability to access social support and information through mediated contexts. The ICI was further developed through assessing students’ attitudes of ageism, self-efficacy, communication apprehension, and knowledge about aging in undergraduate students. This ICI serves as a critical building block for establishing and understanding communication skills and apprehension on an intergenerational level.

Healthcare systems are in the process of reforming themselves to better meet the needs of people with, or at risk of developing, chronic diseases and long term conditions. One goal of these efforts is the coproduction of activated, informed, engaged and motivated patients and citizens. The clinical, public health and financial benefits of achieving such a goal may be dramatic. Motivational Interviewing (MI) is a proven and practical front-line approach which can help deliver this goal whilst also helping to deliver such policy objectives and intermediate outcomes as increased levels of patient centered care, participatory or shared decision making, evidence-based healthcare and improved clinician-patient relationships. Until now, MI has been passively diffusing through the system as a result of the innovation and early uptake by insightful individuals and organizations. If healthcare systems want to breakthrough to higher levels of performance, investment in the conscious and deliberate implementation of MI into front-line settings may prove helpful.

The potential of the World Wide Web, via both the Internet and intranets, to facilitate the development of clinical information systems has been evident for some time. Most Web-based clinical workstation interfaces, however, merely provide a loose collection of access channels. There are numerous examples of systems for access to either patient data or clinical guidelines, but only isolated cases where clinical decision support is presented integrally with the process of patient care, in particular, in the form of active alerts and ...

This report was prepared in consultation with the project's Advisory Group and a wide range of stakeholders from across British Columbia (see Appendix A for a complete list) who generously shared their knowledge and experiences. Their dedication to promoting health and well-being for all is inspiring, and we recognize and thank each of them for their contribution to this report. A special thank you to Tannis Cheadle who contributed her time and expertise in the final stages of the project to finalize the content and organization of this report.

Objective-While the role of health literacy in chronic disease management is well documented, few intervention studies have been reported. A major barrier to designing and implementing such interventions is the lack of valid health literacy tools. This study developed and tested a novel health literacy scale for individuals with high blood pressure (HBP).

Background: With the burden of chronic illness increasing globally, self-management is a crucial strategy in reducing healthcare costs and increasing patient quality of life. Low income and low health literacy are both associated with poorer health outcomes and higher rates of chronic disease. Thus, self-management represents an important healthcare strategy for these populations. The purpose of this study is to review self-management interventions in populations with low income or low health literacy and synthesize the efficacy of these interventions.
METHODS:

A systematic review of trials evaluating the efficacy of self-management interventions in populations with low income or low health literacy diagnosed with a chronic illness was conducted. Electronic databases were primarily searched to identify eligible studies. Data were extracted and efficacy summarized by self-management skills, outcomes, and content tailoring.
RESULTS:

23 studies were reviewed, with ten reporting an overall positive effect on at least one primary outcome. Effective interventions most often included problem-solving as well as taking action and/or resource utilization. A wide range of health-related outcomes were considered, were efficacious empowerment and disease-specific quality of life were found to be significant. The efficacy of interventions did not seem to vary by duration, format, or mode of delivery or whether these included individuals with low health literacy and/or low income. Tailoring did not seem to impact on efficacy.
DISCUSSION:

Findings suggest that self-management interventions in populations with low income or low health literacy are most effective when three to four self-management skills are utilized, particularly when problem-solving is targeted. Healthcare providers and researchers can use these findings to develop education strategies and tools for populations with low income or low health literacy to improve chronic illness self-management.