Development and application of the Meal and Snack Assessment (MESA) quality scale for children and adolescents using item response theory.

BACKGROUND: Meals differ in terms of food items and nutritional quality. The aim of the present study was to propose a scale to measure the meals quality of schoolchildren according to food processing degree, perform a preliminary evaluation of the scale's validity and reliability and apply the scale to a representative sample of schoolchildren in a city in southern Brazil. METHODS: A methodological study based on the generalized graded unfolding model (GGUM) of item response theory (IRT) with analysis of secondary data was carried out in 6,399 schoolchildren of 6-15y-old attending 2nd to 5th grades of public elementary schools in Florianópolis, Brazil, in 2013-2015 who answered the validated Food Intake and Physical Activities of Schoolchildren (WebCAAFE) questionnaire. Meal quality was the latent trait. The steps for the development of the scale included: latent trait definition; item generation; dimensionality analysis; estimation of item parameters; scale levels definition; assessment of validity and reliability; and assessment of the meal quality of a subsample of schoolchildren aged 7 to 12 years (n = 6,372). RESULTS: Eleven out of eighteen items had adequate parameters, without differential item functioning for sex or age. Meal quality was categorized into three levels: healthy, mixed, and unhealthy. Higher scores indicate a greater prevalence of ultra-processed foods in daily meals. Most schoolchildren had mixed (40.6%) and unhealthy (41%) meal patterns. CONCLUSIONS: IRT analysis allowed the development of the scale, which measures the quality of meals and snacks based on the degree of food processing. At all snack times, there was a higher frequency of ultra-processed foods consumption, therefore foods consumed as snacks are a potential focus for nutritional interventions.

Evaluation of an Innovative Case Management Strategy to Improve Rehabilitation Coverage for People at High Risk of Permanent Work Disability: a Feasibility Study.

PURPOSE: Our process evaluation (trial registration: DRKS00022468) monitored the implementation of a multi-component strategy including case management aiming to improve rehabilitation coverage and work participation of people with a high risk of permanent work disability. METHODS: A risk score using administrative data, particularly on employment and welfare benefits, was employed to identify individuals with higher probability of receiving disability pension and therefore potentially needing support. These individuals were contacted by post and encouraged to phone their regional case manager if they needed assistance. Content for the intervention components was developed collaboratively with the case managers. We examined the sample reached, dose delivered, fidelity, dose received and satisfaction with the intervention. RESULTS: Out of 1074 individuals with high-risk scores were contacted, there were 57 case managements. The participants reached were in poor health, and 42.1% reported at least four diagnosed conditions, mostly musculoskeletal and mental disorders. About two-thirds (63.0%) reported poor work ability at baseline. On average, 72.5% of the content of the initial telephone contacts, 88.7% of the content of the face-to-face interviews and 45.2% of the content of the case management were delivered. The participants were highly satisfied with the various components and content of the intervention. Knowledge about rehabilitation improved significantly, with 43 of the 57 participants (75.4%) applying for rehabilitation, mainly medical rehabilitation. At the end of the case management intervention, most participants (91.7%) were still employed. CONCLUSION: The risk score offers an opportunity to screen for people with a high risk of permanent work disability. Case management participants found participation worthwhile and were significantly better informed about participation services after completing case management. More than every second participant received medical or vocational rehabilitation.

Non-inferiority of a hybrid outpatient rehabilitation: a randomized controlled trial (HIRE, DRKS00028770).

Background: Physiotherapeutic telerehabilitation in various musculoskeletal and internal diseases, including back pain, might be comparable to face-to-face rehabilitation or better than non-rehabilitation. In Germany, a standardized back school for patients with chronic back pain is provided in outpatient rehabilitation centers. The effectiveness of this standardized back school was shown in a randomized controlled trial in face-to-face rehabilitation. This study examines non-inferiority of a hybrid rehabilitation applying a digital version of the standardized back school against a rehabilitation applying the face-to-face back school. Methods/design: We recruit 320 patients in eight German outpatient rehabilitation centers. Patients are randomized equally to the intervention and control groups. Patients aged 18 to 65 years with back pain are included. Patients lacking a suitable private electronic device and German language skills are excluded. Both groups receive the standardized back school as part of the 3-week rehabilitation program. The control group receives the back school conventionally in face-to-face meetings within the outpatient rehabilitation center. The intervention group receives the back school online using a private electronic device. Besides the back school, the patients participate in rehabilitation programs according to the German rehabilitation guideline for patients with chronic back pain. Hence, the term "hybrid" rehabilitation for the intervention group is used. The back school consists of seven modules. We assess data at four time points: start of rehabilitation, end of rehabilitation, 3 months after the end of rehabilitation and, 12 months after the end of rehabilitation. The primary outcome is pain self-efficacy. Secondary outcomes are, amongst others, motivational self-efficacy, cognitive and behavioral pain management, and disorder and treatment knowledge. Guided interviews with patients, physicians, physiotherapists and other health experts supplement our study with qualitative data. Discussion/aim: Our randomized controlled trial aims to demonstrate non-inferiority of the online back school, compared to conventional implementation of the back school. Trial registration: German Clinical Trials Register (DRKS00028770, April 05, 2022). Supplementary Information: The online version contains supplementary material available at 10.1186/s44247-023-00013-4.

An innovative case management intervention for people at high risk of permanent work disability to improve rehabilitation coverage and coordination of health services: a randomized controlled trial (AktiFAME, DRKS00024648).

BACKGROUND: German social law offers services from various providers and agencies for people with chronic disease or disability. Claiming services requires a high level of information and communication. Dealing with a multitude of actors, such as pension insurance agencies, job centers, employers, physicians, and psychotherapists, and coordinating between and with these actors can delay or prevent the utilization of necessary measures like medical or vocational rehabilitation. We developed a case management intervention for people at high risk of receiving a disability pension to address these challenges. METHODS/DESIGN: Our randomized controlled trial tests the effectiveness of the multi-component AktiFAME strategy (Active access, counseling, and case management for people at high risk of permanent work disability). This strategy is comprised of four modules: screening and postal contact, telephone counseling, an initial one-on-one interview, and case management. The randomized controlled trial is complemented by an observational study that exclusively involves the individuals participating in case management and accompanies the implementation of the case management intervention. We enroll 9000 individuals aged 18 to 65 years who were identified as being at increased risk for receiving a disability pension based on administrative data from the German Pension Insurance North but who have not yet applied for rehabilitation. Half of the individuals are randomly assigned to the intervention group and the other half to the control group. The intervention group is contacted and informed about a case management intervention, whereas the control group is not. The primary outcome of the randomized controlled trial is the utilization of rehabilitation services from the German Pension Insurance North (medical or vocational rehabilitation). Data on rehabilitation will be provided by the German Pension Insurance North 1 year after random allocation. Secondary and tertiary outcomes cover additional administrative data (e.g., employment and welfare benefits) and a range of patient-reported outcome measures. DISCUSSION: This randomized controlled trial is designed to determine the effectiveness of a newly implemented multi-component strategy to promote participation and rehabilitation coverage among individuals at high risk of receiving a disability pension. TRIAL REGISTRATION: German Clinical Trials Register (DRKS00024648, April 27, 2021).

Optimizing telemedical care in neurological outpatients by characterizing the patients' needs in the physician-patient relationship-content analysis of guideline-based interviews.

BACKGROUND: The use of new concepts in patient care, such as video-consultations, reminder systems, and online evaluation portals, is becoming increasingly important in the physician-patient relationship and outpatient care. This study examines the acceptance of these approaches in a neurological setting and determines the patients' preferences. METHODS: We analyzed 16 guideline-based qualitative interviews with neurological patients using qualitative content analysis (inductive category formation). RESULTS: The patients commented on the benefits and challenges of integrating new concepts of medical care. They identified advantages of telemedical care, including time savings (7 of 16; 43,8%) for both the patient and the physician, the prospect of more intensive (4 of 16; 25%) care, and the possibility for a quick response in case of urgent needs (3 of 16; 18.8%). Several challenges were reported, such as the limitations for patients with psychiatric (2 of 16; 12.5%) or complex diseases (4 of 16; 25%) and limited options for diagnostic procedures (such as physical examination (4 of 16; 25%)). For individual neurological patients' needs, telemedical and telecommunication structures could be discussed, which support the patients' specific requirements, such as answering questions while having a recall (2 of 16; 12.5%) and avoiding the journey (8 of 16; 50%). Also, patients are rejecting evaluation portals and are skeptical of telecare in the treatment of neurological diseases. DISCUSSION: The perception of telemedical care and the successful integration of new medical care concepts depend on fulfilling the individual patient's needs. Regardless of the preferred nature of physician-patient interactions, there are specific instruments that can intensify the relationship. These individual needs of the patients must be inquired about and accommodated for. CONCLUSIONS: For the first time, we could characterize the properties of optimal telemedical care for neurological patients. Interviews like the ones we conducted should be repeated during and after the pandemic, referring to our results and compare.

Assessing the benefits and challenges of video consultations for the treatment of children with type 1 diabetes - A qualitative study among diabetes professionals.

BACKGROUND: Video consultations are promoted as a tool to effectively supplement paediatric diabetes outpatient care. However, knowledge about attitudes of diabetes professionals towards this new technology is lagging behind. Diabetologists and diabetes nurses participating in a controlled study (the VIDIKI study) with monthly video consultations for children with type 1 diabetes were interviewed about their experience with this type of communication. RESEARCH DESIGN AND METHODS: Guideline-based qualitative interviews with 9 telemedicine experts (7 paediatric diabetologists and 2 diabetes nurses) and 7 paediatric diabetologists who agreed to the telemedical co-treatment of their patients were analysed using qualitative content analysis, in particular inductive category formation. RESULTS: Diabetes experts reported generally positive attitudes towards video consultations. They identified a number of unique benefits of telemedical interventions, including higher frequency of contacts, greater sense of patient´s safety, ability to interact with patients in their own homes, more timely and accurate medical monitoring, and improved data management. Additionally, it was important to the experts to maintain regular face-to-face consultations and to ensure close communication between telemedicine and outpatient clinical experts. CONCLUSIONS: Prerequisites for successful video consultations include a comprehensive initial technical training and an agreement on treatment responsibilities of all health care professionals involved in the patient's care. Under these conditions, the experts reported significant advantages of video consultation in the treatment of children with type 1 diabetes.

Percepção dos cozinheiros escolares sobre o processo de utilização de produtos orgânicos na alimentação escolar em municípios catarinenses / School lunch cooks' perception of the use of organic foods in the school meals served in Santa Catarina state, Southern Brazil

OBJETIVO: Identificar o perfil dos cozinheiros escolares e avaliar a utilização, os benefícios e os possíveis fatores limitantes da introdução de alimentos orgânicos na alimentação escolar. MÉTODOS: Estudo transversal e exploratório incluindo os cozinheiros chefes de 242 escolas públicas municipais dos 52 municípios do estado de Santa Catarina que compraram alimentos orgânicos para a alimentação escolar em 2010. Os entrevistados foram questionados sobre a utilização de alimentos orgânicos, seus benefícios, as dificuldades e a capacitação recebida sobre esse tema. As prevalências e os IC95% foram calculados no software Stata 11.0. RESULTADOS: Dos 242 cozinheiros entrevistados, 97,4% eram do sexo feminino, 86,6% apresentavam 30 ou mais anos de idade e 47,9% não cursaram o ensino médio ou superior. Entre esses, 9,4% (IC95% 6,1-13,9) desconheciam que a escola estava recebendo alimentos orgânicos. Entre aqueles que referiram usar alimentos orgânicos (n=219), 42,7% (IC95% 34,3-51,5) referiram presença diária desses alimentos no cardápio escolar. A qualidade dos alimentos no momento da entrega na escola foi considerada ótima/boa em 93,7% dos casos. Quase 10,0% relataram dificuldades no uso desses alimentos, especialmente por problemas no recebimento/ armazenamento e baixa aceitação pelos alunos. A maioria percebeu benefícios no uso de orgânicos na alimentação escolar, tanto para os alunos (99,8%) quanto para a comunidade (100,0%). CONCLUSÃO: O percentual de dificuldades encontrado pelos cozinheiros no uso dos alimentos orgânicos foi baixo, sendo positiva a avaliação quanto ao rendimento, a durabilidade, a quantidade de trabalho e a qualidade desses produtos em comparação aos não orgânicos. Os possíveis fatores limitantes poderiam ser corrigidos mediante melhoria na estrutura física das escolas, na logística de recebimento/estocagem desses alimentos, na capacitação direcionada dos cozinheiros e na sua maior integração nas políticas de alimentação escolar.

OBJECTIVE: This study investigated the profile of school cooks and assessed the use, benefits, and possible limitations associated with the introduction of organic foods in school meals. METHODS: This cross-sectional, exploratory study included the head cooks of 242 public municipal schools of 52 municipalities from the state of Santa Catarina that bought organic foods in 2010. The interviewees were asked about the use of organic foods, their benefits, the associated difficulties, and the training they were given on this subject. The software Stata 11.0 calculated the prevalences and 95% confidence intervals. RESULTS: Of the 242 interviewed cooks, 97.4% were females, 86.6% were aged 30 or more years, and 47.9% had not completed high school or higher education. Of these, 9.4% (95%CI=6.1-13.9) were not aware that the school was buying organic foods. Of the 219 cooks who used organic foods, 42.7% (95%CI=34.3-51.5) reported that these foods were present every day in the school meals. The quality of these foods upon arrival at the school was considered great/good 93.7% of the time. Almost 10.0% of the interviewees reported difficulties associated with these foods, especially regarding delivery, storage, and low student acceptance. Most interviewees believed that these foods benefited the students (99.8%) and the community (100.0%). CONCLUSION: Few cooks had difficulties using organic foods. The cooks found that their yield, shelf life, required work, and quality exceeded those of non-organic foods. The limitations could be eliminated by improving the layout of the schools, food delivery, food storage, cook training, and integration in school food policies.