bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence From a Multistate Cohort: Enrollment in Affordable Care Act Qualified Health Plans’ Association With Viral Suppression
Authors: McManus Kathleen A , Christensen Bianca , Nagraj V Peter , Furl Renae , Yerkes Lauren , Swindells Susan , Weissman Sharon , Rhodes Anne , Targonski Paul , Rogawski McQuade Elizabeth , Dillingham Rebecca
Published: November 2019

Background

Healthcare delivery changes associated with viral suppression (VS) could contribute to the United States’ “Ending the HIV Epidemic” (EtHE) initiative. This study aims to determine whether Qualified Health Plans (QHPs) purchased by AIDS Drug Assistance Programs (ADAPs) are associated with VS for low-income people living with HIV (PLWH) across 3 states.

Methods

A multistate cohort of ADAP clients eligible for ADAP-funded QHPs were studied (2014–2015). A log-binomial model was used to estimate the association of demographics and healthcare delivery factors with QHP enrollment prevalence and 1-year risk of VS. A number needed to treat/enroll (NNT) for 1 additional person to achieve viral suppression was calculated.

Results

Of the cohort (n = 7776), 52% enrolled in QHPs. QHP enrollment in 2015 was associated with QHP coverage in 2014 (adjusted PR [aPR], 3.28; 95% confidence intervals [CIs], 3.06–3.53) and engagement in care in 2014 (aPR, 1.16; 1.04–1.28). PLWH who were engaged in care (n = 4597) and had QHPs had a higher VS rate than those who received medications from Direct ADAP (86.0% vs 80.2%). QHPs’ NNT for an additional person to achieve VS is 20 (14.1–34.5). Starting undetectable (adjusted risk ratio [aRR], 1.39; 1.28–1.52) and enrolling in QHPs in 2015 (aRR, 1.06; 0.99–1.14) was associated with VS.

Conclusions

Once enrolled in ADAP-funded QHPs, ADAP clients stay enrolled. Enrollment is associated with VS across states/demographic groups. ADAPs, especially in the South and in Medicaid nonexpansion states, should consider investing in QHPs because increased enrollment could improve VS rates. This evidence-based intervention could be part of EtHE.
Optimal bandwidth choice for robust bias-corrected inference in regression discontinuity designs
Authors: Calonico Sebastian , Cattaneo Matias D , Farrell Max H
Published: November 2019

Modern empirical work in regression discontinuity (RD) designs often employs local polynomial estimation and inference with a mean square error (MSE) optimal bandwidth choice. This bandwidth yields an MSE-optimal RD treatment effect estimator, but is by construction invalid for inference. Robust bias-corrected (RBC) inference methods are valid when using the MSE-optimal bandwidth, but we show that they yield suboptimal confidence intervals in terms of coverage error. We establish valid coverage error expansions for RBC confidence interval estimators and use these results to propose new inference-optimal bandwidth choices for forming these intervals. We find that the standard MSE-optimal bandwidth for the RD point estimator is too large when the goal is to construct RBC confidence intervals with the smaller coverage error rate. We further optimize the constant terms behind the coverage error to derive new optimal choices for the auxiliary bandwidth required for RBC inference. Our expansions also establish that RBC inference yields higher-order refinements (relative to traditional undersmoothing) in the context of RD designs. Our main results cover sharp and sharp kink RD designs under conditional heteroskedasticity, and we discuss extensions to fuzzy and other RD designs, clustered sampling, and pre-intervention covariates adjustments. The theoretical findings are illustrated with a Monte Carlo experiment and an empirical application, and the main methodological results are available in R and Stata packages.
Atrioventricular valve closure in Fontan palliation
Authors: King Gregory , Winlaw David S , Alphonso Nelson , Andrews David , Finucance Kirsten , Konstantinov Igor E , d’Udekem Yves
Published: November 2019

OBJECTIVES

Atrioventricular valve regurgitation is known to adversely impact outcomes of single-ventricle palliation, and valve repair rarely provides long-lasting results. Closure of a atrioventricular valve can sometimes be performed, but the long-term outcomes of this manoeuvre are unknown.

METHODS

This retrospective study was conducted using patient data extracted from an existing bi-national, population-based registry of survivors of the Fontan procedure.

RESULTS

Between January 1975 and June 2018, 1574 patients survived to hospital discharge with an intact Fontan circulation. Of these patients, 128 with a common atrioventricular valve were excluded. Thirty-eight patients underwent closure of an atrioventricular valve, and complete follow-up data were available for 36 patients. Twenty-nine patients underwent closure of the tricuspid valve and 7 patients underwent closure of the mitral valve. Seventeen patients underwent valve closure prior to Fontan, 13 patients underwent valve closure concomitant with Fontan and 6 patients underwent valve closure post-Fontan. Valve closure was performed using a patch technique in 29 cases and with direct suture in 7 cases. At the most recent echocardiography, 33 patients had no regurgitation, 2 patients had recurrent mild regurgitation and 1 patient had no echocardiographic follow-up. Six patients required reintervention post-valve closure and 7 patients required permanent pacemaker insertion post-valve closure. Freedom from reintervention at 1, 5 and 18 years post-valve closure was 86% [95% confidence interval (CI) 76–98%], 83% (95% CI 72–96%) and 83% (95% CI 72–96%), respectively.

CONCLUSION

Atrioventricular valve closure is an effective surgical technique in selected patients with a single ventricle providing long-lasting competency in the majority of cases.
Aiming High and Missing the Mark? Educational Choice, Dropout Risk, and Achievement in Upper Secondary Education among Children of Immigrants in Denmark
Authors: Birkelund Jesper Fels
Published: November 2019

Although children of immigrant origin in many European countries are observed to choose higher levels of education than native-origin peers at similar levels of academic performance, little is known about the outcomes of these high-aspiring choices. Using administrative register data covering all children born in 1994–1995 in Denmark, I examine whether the high-aspiring educational choices of children of immigrants convert into educational success or, conversely, into low grades and increased dropout rates. I find that, compared with children of Danish origin, children of immigrants are not only more likely to enrol in academic upper secondary education but also make more ambitious track and subject choices at this educational level. These ethnic choice effects are particularly pronounced at low levels of academic performance. Applying a counterfactual re-weighting approach, I show that, although ethnic choice effects reduce the ethnic gap in overall attainment of academic upper secondary education, they also widen ethnic gaps in dropout rates and achievement. My findings indicate that high aspirations among ethnic minorities operate as a double-edged sword as they help close the educational gap between them and their native-origin peers but at the cost of inducing academically weaker students to embark on less feasible educational trajectories.
Exploring social inequalities in the use and experience of prenatal care in Brussels
Authors: Schönborn C , Racape J , Sow M , De Spiegelaere M
Published: November 2019

Background

The underlying mechanisms of perinatal health inequalities remain under-researched. A possible explanation is inadequate access to healthcare services and suboptimal care for certain groups. To explore this, our study analyses the mothers’ prenatal care trajectories and experiences of care in relation to socioeconomic and migration characteristics.

Methods

A survey of 750 migrant and non-migrant mothers interviewed in 4 maternity wards in Brussels. Based on the adaptation of the Migrant-Friendly Maternity Care Questionnaire, the survey focuses on mothers with a Belgian, North African (NA) and Subsaharan African (SSA) nationality. The data are analysed through descriptive statistics and logistic regression.

Results

This ongoing survey has a high response rate (83%). Preliminary subsample analyses (n = 276) show that the socioeconomic profiles of mothers vary substantially depending on nationality, with mothers from NA generally having a lower level of education, and mothers from SSA being strongly at risk of poverty. SSA women are particularly at risk of starting prenatal care late (32% compared to 4% of Belgians and NAs) and of having less than 7 recommended consultations (25% compared to 6% Belgians and 9% NAs). Low household income and maternal education were also strong predictors of late and infrequent prenatal care. Women from all three nationality groups had the same rate (10%) of planned C-sections, but women from SSA were much more likely to have an emergency c-section (16% vs 7% of Belgians and NAs). Women with a higher household income were less likely to have a c-section at all. Women from both NA and SSA were less likely to always have understood the information given by healthcare professionals. 90% of women with secondary school education understood all the information, compared to 60% of women without it.

Conclusions

Women’s care trajectories and experiences of care vary strongly depending on their nationality and socioeconomic situation.

Key messages

North African and Subsaharan African immigrants in Brussels live in different socioeconomic situations. Their care trajectories and experiences of care also show important differences. Socioeconomic characteristics, in addition to women’s migration status, are important factors affecting women’s perinatal care.
Gender inequality in self-reported health and its evolution in Europe between 2004 and 2016
Authors: Roxo L , Perelman J
Published: November 2019

Background

That women generally have worse health than men has long been shown. Yet, the situation in Europe might have changed recently. Gender inequalities have decreased in access to education, employment, and political representation. However, women have increasingly adopted traditionally masculine unhealthy behaviors, such as smoking. Also, the Great Recession may have hurt women harder, due to their greater socioeconomic vulnerability. This study aims to analyze gender inequalities in 30 European countries, and its evolution over the 2004-2016 period.

Methods

We used data from the Survey on Income and Living Conditions (SILC), from people between 25 and 64 years old (N = 3,109,150). We modeled the probability of bad/very bad self-reported health as function of gender, adjusting for age, country and year, using logistic regressions. We further adjusted for education and employment. Then, we included interactions of gender and year to test changes in inequalities over time. Finally, we stratified the analysis according to countries grouped based on the Gender Development Index (GDI).

Results

Women were 16.8% more likely to report bad health (OR = 1.17, p < 0.01). Considering education and employment, women were 2.6% less likely to report bad health (OR = 0.97, p < 0.01). Over time, adjusting for age, the gender gap reduced from 81.1% (OR = 1.81, p < 0.01) in 2004 to 16.4% in 2016 (OR = 1.16, p < 0.01), and from 31.5% to 2.5% with socioeconomic adjustment. The reduction was larger in countries with a greater GDI.

Conclusions

Gender inequality has decreased, but was still present in 2016, in favor of men. This thinning is partly explained by the narrowing of inequalities in education and employment. A greater GDI has favored a larger improvement.

Key messages

Gender inequalities in self-reported health have narrowed over 2004-2006, following the narrowing of socioeconomic inequalities. A greater GDI has favored a larger improvement in gender inequalities.
Intercultural opening: participant observation in two hospitals and two outpatient care services
Authors: Peppler L , Sonntag P T , Schenk L
Published: November 2019

Background

The German healthcare system is facing intercultural diversity, since numerous migrant patients, nurses, and doctors are involved. This raises the question as to what extent everyday processes, working cultures and institutional framework conditions change because of this and how intercultural healthcare can be improved.

Methods

The participant observation took place on 22 days during summer 2018 in two outpatient care services and two hospitals, which show different degrees of intercultural opening (e.g. more or less migrant employees and patients). The aim was to reconstruct the daily work routine of health staff as well as the patients’ daily routine. The anonymized records include meetings, care tours, handovers and visits. The observation protocols were analyzed by documentary method and compared on two levels: degree of intercultural opening and sector affiliation.

Results

The results show that intercultural opening has a sector-specific impact on organization and daily work processes. The health staff of the hospital with high intercultural opening showed routine handling and relaxed reactions to communication difficulties due to the regular care of migrant patients, whereas that of the hospital with low intercultural opening showed stress-related defensive stance due to rare cases. The situation in the outpatient sector is different: The care of migrant patients was perceived to be more costly in the institution with high intercultural opening, because the migrant employees repeatedly perform additional socio-educational work that is not covered by insurance.

Conclusions

The migration-specific knowledge of employees has a positive effect on patient care in both inpatient and outpatient sector. However, this may be financially disadvantageous for nursing services under the conditions of outpatient care.

Key messages

Synergy effects arise from the involvement of migrant health workers and the care of migrant patients. Framework conditions must support these synergy effects in order to improve cultural sensitive healthcare.
Does adolescents like modern sports experiences? A trivial question for a major public health stake
Authors: Luiggi M , Griffet M
Published: November 2019

Background

Improving adolescents’ levels of sport and physical activity ‘PA’ is an official public health issue. However, national and European studies showed decline in overall levels of PA of European adolescents. In France, a school-based study showed a decrease in sport participation among adolescents of Marseille and area. Despite of this decline, we do not know whether they have a positive appreciation of modern sports experiences promoted in clubs. In this study, we aimed to measure French adolescents’ athletes retrospective reports of pleasure in these experiences.

Methods

A previous data collection among a representative sample of adolescents’ students was used (n = 1132). Adolescents were separated into 4 subgroups based on sex (Boys/Girls) and socioeconomic status ‘SES’ (Low/High). The Sport Experiences Questionnaire was used to measure retrospective reports of pleasure in competition, progress and risk-taking experiences. Multivariate linear regressions were performed to show differences between sex, SES and setting of participation (competition/no-competition). Densities diagrams were also presented.

Results

Among girls and boys, the setting of participation was significantly positively linked to reported pleasure. This effect was greater for competition experiences, respectively 1.45-fold and 1.53-fold increase for competition than no-competition players, for boys and girls. Among girls, high-SES girls presented a lower appreciation of competition experiences than their counterparts with low-SES. This relationship was observed in non-competitive (B=-0.62, p-value=0.016) and competitive (B=-0.70, p-value=0.025) settings. Finally, progress experiences were appreciated by all.

Conclusions

These results may help to step back traditional instituted sports offer. They would help to develop sports initiatives adapted to adolescents’ tastes. Finally, progress experiences may be gold experiences in sport and should be promoted in all context of participation.

Key messages

Modern sport experiences are not appreciated by all subgroups of adolescents. Endeavors to improve sport participation of adolescents should adapt contents to adolescents’ tastes. Pleasure in competition and risk-taking are linked to setting of participation and adolescents’ SES. The progress experiences may be the gold standard of sports experiences.
Adolescents with intellectual disability (ID) and their perceptions of activity and sports
Authors: Hansen E , Nordén H , Ohlsson M
Published: November 2019

Background

Individuals with intellectual disability (ID) are less physically active than individuals without ID, and they rarely or never reach the recommended daily level of physical activity. It is understood that both social interaction and ability in performing work tasks affect participation in daily activity services among people with ID. Individuals with ID generally have a higher risk of hypertension and obesity-related cardiovascular disease than individuals without ID. Professional service providers and parents are often those being asked, it is more seldom that the knowledge comes from the target group (ID) themselves.

Aim

To identify experiences and feelings among adolescents with ID regarding activity and sports participation, and to identify how they express and perceive the opportunities they have for being active in the community and surroundings where they live, including body and health awareness.

Methods

12 adolescents with ID, boys and girls, from Mid-Sweden participated in the study. The participants took part in a semi-structured interview that focused on experiences and aspects regarding activity and sports in their surroundings. Interviews identified three aspects: Activity, Surroundings, and Body- and health awareness. Adolescents with ID seems motivated to participate in activities and sports. The role of significant others, family and friends, support and the feeling of joy all seem crucial when reporting being outdoors, participating in ball games and in music activities. They are aware of limitations, sometimes feel bullied and are afraid of being excluded. Participation in activities and sports may be positively associated with health, but limitations such as awareness and support from society challenge the perception of ‘fitting in’ experienced by adolescents with ID. There is a need for deeper understanding to implement and follow up on the UN convention on rights for individuals with ID, as well as the 2030 sustainable development goals.

Key messages

The project aims to identify how individuals with ID can increase their participation in societal activities and hence feel more active and included as citizens. Special attention is given to include stakeholders in order to promote implementation and long-term success.
Patients with more comorbidities have better detection but poorer management of chronic diseases
Authors: Sum G , Koh G C H , Mercer S W , Lim Y W , Majeed A , Oldenburg B , Lee J T
Published: November 2019

Background

The burden of non-communicable diseases (NCDs) is rising rapidly in middle-income countries (MICs), where NCDs are often undiagnosed, untreated and uncontrolled. How comorbidity impacts diagnosis, treatment, and control of NCDs is an emerging area of research inquiry and have significant clinical implications as highlighted in the recent National Institute for Care Excellence (NICE) guidelines for treating patients suffering from multiple NCDs. This is the first study to examine the association between increasing numbers of comorbidities with being undiagnosed, intreated, and uncontrolled for NCDs, in six large MICs.

Methods

Cross-sectional analysis of WHO SAGE Wave 1 (2007-10), which consisted of adults aged ≥18 years from six populous MICs including, China, Ghana, India, Mexico, Russia and South Africa (overall n = 41, 557).

Results

Higher number of comorbidities was associated with better detection of hypertension, angina and arthritis, and better odds of having treatment for hypertension and angina. However, increasing comorbidity had the opposite effect on being uncontrolled, and was associated with increased odds of uncontrolled hypertension, angina, arthritis, and asthma. Comorbidity with concordant conditions was associated with improved diagnosis and treatment of hypertension and angina. Comorbidity with concordant conditions was not associated with decreased nor increased odds of being uncontrolled for all NCDs.

Conclusions

Patients with more comorbidities have better diagnosis of chronic conditions, but this does not translate into better management and control of these conditions. Improving continuity of care and monitoring treatment are priorities for health systems with ageing populations.

Key messages

Patients with more comorbidities have better diagnosis of chronic conditions. but this does not translate into better management and control of these conditions.
Activity-based hospital payments: a qualitative evaluation by Israeli managers and physicians
Authors: Waitzberg R , Quentin W , Busse R , Greenberg D
Published: November 2019

Background

Israel has expanded procedure-related group (PRG) payments instead of per-diem payments for hospitals. There is scarce literature that documents the process of adoption of DRGs and its entailed economic incentives according to hospital workers’ perspectives. Important issues remain underexplored such as how managers transmit the incentives and considerations to caregivers, how physicians embrace (or not) these new rules of the game.

Methods

We used qualitative, grounded-theory analysis based on 35 semi-structured in-depth interviews with managers, financial directors, surgical ward heads and physicians in 5 hospitals, sampled by maximum variation according to hospital characteristics.

Results

We found two main themes: incentives for change and barriers to change. The most significant change was the creation of a common professional language, which facilitates measurement and supervision of activities, outcomes, and profitability. Measurement enhances transparency and is essential for resource management. Respondents also reported barriers inhibiting their responsiveness to the economic incentives of PRGs: a complicated coding system; inappropriate pricing; dependency on numerous production factors; lack of transparency; lack of coordinated goals among players; and other medical or moral considerations that outweigh or co-exist with financial considerations.

Conclusions

The adoption of PRGs led to changes in managers’ and physicians’ actions and considerations, particularly in situations where it was possible to reprioritize elective procedures without harming patient health or quality of care. However, on a broader level, the impact was modest, leading mainly to a fairer redistribution of resources and the rearrangement of work, such as shifting patients to after-hours. It would be appropriate to allow hospitals and physicians to operate in a less restricted market where regulation allows suppliers some degree of discretion so they can react to the PRG reform.

Key messages

Provider payment reforms change economic incentives, behavior and decision-making. However, structural barriers and other non-economic considerations may lead to unintended consequences of such reforms.
Impact of mental illness on in-patient hospital costs for somatic disorders and associated factors
Authors: Michel M , Hammami A J , Chevreul K
Published: November 2019

Background

People suffering from mental disorders are in poorer somatic health that the general population. This is due in part to poor quality of care in primary care settings, which can in turn have a major impact on hospitals and healthcare systems, in particular in terms of costs. Our objective was to assess the economic burden of acute care admissions for somatic diseases in patients with a mental illness compared to other patients and analyse the factors associated with it.

Methods

An exhaustive study using French hospital discharge databases was carried out between 2009 and 2013. Total acute hospital costs were calculated from the all payer perspective (statutory health insurance, private health insurances and patient out-of pocket payments). A multivariate regression modelled the association between mental illness and hospital costs while adjusting for other explanatory variables, with and without interaction terms.

Results

37,458,810 admissions were included in the analysis. 1,163,972 patients (6.54%) were identified as being mentally ill. Mean total hospital costs at five years per patient were €8,114. Costs per mentally ill patient were on average 34% higher than for a non-mentally patient (€10,637 vs. €7,949). A longitudinal analysis of costs showed a widening of the gap between the two groups as time went by, from 1.60% in 2009 to 10.51% in 2013. In the multivariate model, mental disorders were significantly associated with increased costs, and interaction terms found an increased impact of mental illness on costs in deprived patients.

Conclusions

Improving quality of primary care and health promotion in people with a mental illness both for their own sake and to decrease the economic burden on the healthcare system, is of vital importance.

Key messages

There is a significant increase in hospital costs for somatic care in patients with a mental illness compared to other patients, in particular in patients who are also deprived. It is necessary to improve primary care and health promotion in mentally ill patients, for their sake and for the sake of healthcare systems.
Untreated alcohol use disorder in people who inject drugs: a major barrier to HCV treatment uptake
Authors: Barré T , Marcellin F , Di Beo V , Delorme J , Mathurin P , Protopopescu C , Coste M , Authier N , Carrieri P , Rolland B
Published: November 2019

Aims

Although people who inject drugs (PWID) are the core at-risk population in the hepatitis C (HCV) epidemic in industrialized countries, few initiate treatment. Alcohol use disorder (AUD), common within this population, has been identified as a barrier to HCV treatment uptake in the general population. We investigated whether the arrival of new and well-tolerated HCV treatments (direct-acting antivirals: DAA) has improved HCV treatment uptake in French PWID compared with former treatments (pegylated interferon-based treatments: Peg-IFN).

Methods

Analyses were based on exhaustive care delivery data collected between 2012 and 2016 (study period) in the French national healthcare reimbursement database. Chronic HCV-infected individuals who received opioid agonist therapy (OAT) at least once during the study period were included. Separate analyses were performed for 2012-2013 (Peg-IFN era, 19,700 patients) and 2014-2016 (DAA era, 22,545 patients). Using discrete-time Cox proportional hazards models, we tested for associations between AUD (i.e. AUD-related long-term illness status, diagnosis coding during hospitalization or AUD pharmacological treatment) and first HCV treatment delivery, after adjusting for gender, age, complementary universal health cover, liver disease severity and type of OAT received.

Results

Incidence rate of HCV treatment uptake per 100 person-years [95% confidence interval] was 6.56 [6.30-6.84] and 5.70 [5.51-5.89], for Peg-IFN-based treatment (2012-2013) and DAA (2014-2016), respectively. After multiple adjustment, people with AUD not receiving related medication had 30% and 14% lower Peg-IFN-based treatment and DAA uptake, respectively, than those without AUD (hazard ratio [95%CI]: 0.70 [0.62-0.80] and 0.86 [0.78-0.94]). No difference was observed between those treated for AUD and those without AUD.

Conclusions

Despite the benefits of DAA, untreated AUD is still a major barrier to HCV treatment access for PWID in France.

Key messages

AUD is still a barrier to HCV treatment for French PWID. DAA availability improved HCV treatment uptake for PWID with AUD.
Are Patients with Subclinical Hypothyroidism at Risk of Depressive Symptoms?
Authors: Wildisen L , Moutzouri E , Beglinger S , Syrogiannouli L , Klöppel S , Aujesky D , Rodondi N , Giovane C Del , Feller M
Published: November 2019

Introduction

Subclinical hypothyroidism (SHypo) may be associated with negative health outcomes including depressive symptoms. However, the evidence is conflicting.

Methods

We conducted a systematic review and individual participant data (IPD) meta-analysis to assess the association between SHypo and depressive symptoms. We requested IPD from cohorts identified through a systematic literature search. The exposure was thyroid function at baseline (SHypo vs. euthyroid; SHypo defined as thyroid stimulating hormone ≥ 4.5 mlU/L, in combination with normal free thyroxine). The outcome was depressive symptoms at first follow-up, measured on any validated scale. We calculated conversion factors to convert all scores into the Beck Depression Inventory (BDI) scale (range: 0-63, higher scores indicate more depression, minimal clinically important difference: 5). We performed a two-stage IPD meta-analysis. In each cohort, we estimated the mean difference (MD) in depressive symptoms scores between those with SHypo and euthyroid controls adjusted for depressive symptoms at baseline. Further, we adjusted the multivariable linear regression analysis for age, sex, education, and income. We pooled the study effect estimates by using a random effects model. Heterogeneity was assessed by I2.

Results

Among six cohorts, we analyzed data from 23,367 participants (65% female, mean age 60.3±13.2 years, SHypo N = 1,463). There was no difference in BDI scores between SHypo (10.6) and controls (10.2) at baseline. After a mean follow-up of 8.2±4.3 years, BDI scores did not differ between SHypo and controls (pooled MD 0.3, 95% CI -0.2 to 0.7, I2 14%). Results remained robust in several sensitivity analyses, and no subgroup at increased risk for depressive symptoms could be identified.

Conclusions

In this IPD meta-analysis, SHypo was not associated with the development of depressive symptoms. Depressive symptoms do not seem to be an indication for levothyroxine therapy in SHypo.

PROSPERO: CRD42018091627

Key messages

Individual studies about the association between subclinical hypothyroidism and depressive symptoms show conflicting results. In this IPD meta-analysis from six prospective cohort studies, patients with subclinical hypothyroidism did not have an increased risk to develop depressive symptoms during a mean follow-up of 8 years.
Prevention of mental health effects by climate change and environmental drivers
Authors: Van Den Hazel P
Published: November 2019

Background

There is a growing amount of climate change and health data available in open sources. Inhabitants value their neighbourhood mostly by perception. Local authorities make spatial planning discussions based on environmental data. In the case of heat waves more climate adaptation measures are taken by authorities. However, there is a gap in knowledge on the need for adaptation of our environment and the perception of a growing proportion of the population on the need for adaptation. Furthermore, there is little focus on the mental problems related to climate change. The example of heat wave adaptation has been studied.

Methods

Heat wave plans across Europe have been analysed on participatory processes by the population or by broader group of stakeholders in the health care sector. The existing plans of 20 countries were collected. Interviews with key-persons involved in the implementation of these plans were used. The perception of the population on the measures, the mentioning of individual or group resilience and for mental disturbances during or in the aftermath of a heat wave were studied.

Results

The results show limited attention for the participatory process in heat wave plans. There is no attention for mental problems. Resilience is only addressed the way that simple message is conveyed through the media. There is limited focus on vulnerable groups in society.

Conclusions

It would help if the local authorities would make decisions in adaptation of their spatial planning to include the perception of the population and to focus on some vulnerable groups in society. The extension of caring about vulnerable groups beyond the period of heat waves is needed.
Labor market outcomes before and after first episode of part-time sickness absence
Authors: Ervasti J , Kausto J , Koskinen A , Pentti J , Vahtera J , Joensuu M , Turunen J , Oksanen T , Kivimäki M
Published: November 2019

Background

Previous research suggests that part-time sickness absence (PTSA) results in better work participation compared to full-time sickness absence (FTSA), but few studies have examined trends in FTSA and unemployment before and after PTSA.

Methods

This Finnish population-based cohort study included 3406 individuals with first episode (>30 days) of PTSA in 2011 (=PTSA group), 42 510 individuals with FTSA (>30 days) in 2011 (=FTSA group), and 25 167 individuals with no sickness absence (>30 days) in 2011 from the general working-age population. Annual days of FTSA from 2007 to 2015 and unemployment from 2012 to 2015 were measured for the participants of each group. We modeled trends and relative risks for these labor market outcomes using negative binomial regression with generalized estimation equations.

Results

For the PTSA group, the adjusted mean annual number of FTSA days was 3 in the beginning of the follow-up, 15 a year before the index year, and 8-10 after the index year. The adjusted risk ratio (RR) of FTSA days after versus before PTSA was 1.95 (95% CI 1.75-2.17). For the FTSA group, mean of sickness absence days was 4 in the beginning, 13 a year before the index year and 9-19 after the index year. The mean of FTSA was 1-2 throughout the follow-up in the general population. An increasing slope in unemployment after the index year was observed in all groups, the absolute level of unemployment being highest among FTSA group and lowest among the general population group.

Conclusions

Long-term PTSA marks a decline in labour market participation. In absolute terms this decline is smaller than that in employees with long-term FTSA.

Key messages

Part-time sickness absence lasting >30 days marked an increase in full-time sickness absence although the absence levels did not reach those observed after full-time sickness absence of > 30 days. Our results show smaller impairment in labour market outcomes in employees granted a long-term part-time sickness absence than in those with long-term full-time sickness absence.
Vaccination role on abseteeism during a severe flu season: following the Global Influenza Strategy
Authors: Kakaa O , Gianino M M , Zotti C
Published: November 2019

Background

In March 2019, the WHO published the “The Global Influenza Strategy for 2019-2030”, with the goal of strengthening seasonal prevention and control and preparedness for future pandemics. Accordingly, to the 2B, 2C, 3B goals, this study tries to assess the burden of the disease among the healthcare workers (HCWs). Our study aimed to estimate the impact of severe intensity season on absenteeism among HCWs in a large Italian hospital and if the vaccination rates would be associated with reduced sickness absence.

Methods

We investigated excess of absenteeism that occurred in a large Italian hospital, counting 5300 HCWs, during the flu season of 2017-2018. Data on influenza vaccination were gathered from the Occupational Health Unit, while absenteeism data from the hospital’s Personal Unit Database. The data collection ranged from July 2017 to June 2018, it was divided into two periods: epidemic and non-epidemic, the last one used as a baseline to calculate excess of absenteeism. We also gathered other variables in order to stratify the absenteeism among HCWs.

Results

The total lost days were 53.775. The average number of lost days per week during the epidemic period was 1263. Compared to the non-epidemic period, absenteeism increased by 65% (from 4.05 to 6.68 days/person). Vaccinated HCWs had a lower excess of absenteeism in comparison to non-vaccinated HCWs (1,74 vs 2,71 days/person). Nurses and allied health professionals registered the highest excess of absenteeism (3.16 days/person) while medical doctors showed the lowest (0.76 days/person).

Conclusions

A severe influenza epidemic impacts on the excess of absenteeism among HCWs. Although the low vaccination rate (6,8%), a positive effect on absenteeism is outlined and it may support health care facilities to promote and facilitate flu vaccination among HCWs. As literature states low absenteeism rate, as seen in medical doctors, could be an indicator of presenteeism that might lead to harm the inpatients.

Key messages

The flu vaccination has a positive effect on reducing the absenteeism rate in the HCWs during the epidemic period and should be promoted and advocated among european healthcare facilities. A low absenteeism rate may also be an indicator of presenteeism among HCWs, which may also be harmful to the inpatients.
Household Income, Life Expectancy and Cause Specific Mortality in Norway, 2005-2015
Authors: Øverland S , Kinge J , Knudsen A K
Published: November 2019

Background

Examining causes of death and making comparisons across countries may increase understanding of the income-related differences in life expectancy. We describe income-related differences in life expectancy and causes of death in Norway and compare with US estimates.

Methods

A registry-based study including all Norwegian residents above age 40 between 2005 and 2015. Exposure was household income adjusted for household size and outcomes were life expectancy at age 40 and cause specific mortality.

Results

3 041 828 persons contributed 25 805 277 person years and 441 768 deaths in the study period (mean age: 59.3 (SD, 13.6). Life expectancy was highest for women with the top 1% income at 86.4 (95% CI, 85.7 to 87.1) years, 8.4 (95% CI, 7.2 to 9.6) years longer than women in the lowest 1% income. Men with the lowest 1% income had the lowest life expectancy at 70.6 years (95% CI, 69.6 to 71.6), 13.8 years (95% CI, 12.3 to 15.2) less than men with the top 1% income. From 2005 - 2015, the differences in life expectancy by income increased, largely attributable to deaths from cardiovascular disease, cancers, COPD and dementia in older age groups and substance use deaths and suicides in the younger. Over the same period, women in the top income quartile gained 3.2 years (95% CI, 2.7 to 3.7), while life expectancy for women in the lowest income quartile was reduced by 0.4 years (95% CI, -1.0 to 0.2). For men, the top quartile gained 3.1 years (95% CI, 2.5 to 3.7) and the bottom gained 0.9 years (95% CI, 0.2 to 1.6). Differences in life expectancy by income levels in Norway were similar to those observed in the United States, but life expectancy was higher in Norway in the lower to middle part of the income distribution.

Conclusions

In Norway, there were substantial and increasing gaps in life expectancy by income from 2005 - 2015. The largest differences in life expectancy between Norway and US were for people in the lower to middle part of the income distribution.

Key messages

In Norway, a country with a largely tax financed universal health care system and moderate income differences, life expectancy by income are substantial and have increased between 2005 and 2015. The largest differences in life expectancy between Norway and US were for people in the lower to middle part of the income distribution.
Long-term effects of a housing support intervention in homeless people with severe mental illness
Authors: Lemoine C , Loubiere S , Tinland A , Boucekine M , Girard V , Auquier P
Published: November 2019

Objectives

Recent studies have suggested that the Housing First model is a promising strategy for providing effective services to homeless people with mental illness at a short-term horizon. The paper assesses the long-term effects of an independent housing with a recovery-oriented approach in homeless people with severe mental illness on social recovery, mental symptoms and quality of life among homeless adults with high support needs for mental and physical health services.

Design and methods

“Un Chez Soi d’Abord” was a randomized controlled trial conducted in 4 French cities: Lille, Marseille, Paris and Toulouse. From August 2011 to April 2014, homeless participants with a DSM-IV-TR diagnosis of bipolar disorder or schizophrenia (N = 703) were randomly assigned to Housing First (n = 353) or Treatment as Usual (n = 350). Mental symptoms (MCSI), social recovery (RAS), global physical and mental status (SF-36), subjective quality of life (S-QoL) and addictions (MINI) were collected every 6 months over 48 months. Mixed models using a longitudinal and cluster design were performed, and adjusted to age on the street, gender and mental disorder diagnosis and testing for time*group and site*time interactions.

Results

HF patients exhibited higher recovery (β = 3.6, 95%CI: 0.4 to 6.9), higher S-QoL (4.7, 1.1 to 8.3) such as the self-esteem (10.9, 5.8 to 15.6) and physical well-being (8.4, 3.1 to 13.8) sub-dimensions, and improved mental health symptoms (-3.1, -5.4 to -0.9) over the 4-year follow-up. No significant differences were observed for SF36 scores. HF and TAU participants experienced similar alcohol or substance dependence evolution between baseline and 48 months.

Conclusions

HF is a highly effective intervention associated with improved relational environment, enhancing recovery and quality of life in homeless people with schizophrenia or bipolar disorders. Addiction issues have been identified and should be targeted so as to further improve the Housing First approach.

Key messages

Housing First model is a highly effective intervention. Housing First model enhances recovery and quality of life in homeless people.
The «cartographie» tool (CNAM, France)
Authors: Gastaldi-Ménager C
Published: November 2019

Presentation of the “Cartographie” tool, a mapping of health care expenditures including disease categories and its use by the National Health insurance and policy makers. Complementarity with the GBD study will be discussed.
Cultural values and adolescents’ health inequalities in 21 European countries
Authors: Dierckens M , De Clercq B , Deforche B
Published: November 2019

Background

culture is believed to have an important impact on health and health inequalities and this may vary between countries. Empirical data are however scarce, especially in adolescent populations. We examined the impact of cultural values (emancipatory values index) on cross-national variations in adolescent health, health inequalities and evolutions in these inequalities.

Methods

individual-level data from 21 countries participating in the 2002/2006/2010/2014 waves of the Health Behaviour in School-aged Children (HBSC) study were combined with country-level data from the World Values Longitudinal Dataset (n = 416777). Multilevel linear and logistic regression analyses were performed accounting for the hierarchical data structure (individual, country-year and country level).

Results

cultural value differences between countries were weakly related to adolescents’ health and health behaviour but had a profound impact on the magnitude of inequalities. In countries characterised by a high level of emancipatory values, material (family affluence-based) inequalities in both health and health behaviours tended to be lower whereas non-material (occupational social class-based) inequalities tended to be higher, in particular for health behaviours. Preliminary results also indicated that cultural value differences between countries may play a significant role in the evolution of adolescent health inequalities.

Conclusions

our findings suggest that between-countries’ cultural value differences may partly explain cross-national variations in adolescents’ health inequalities and in the evolution of these inequalities. By identifying cultural value differences in health, health inequalities and evolutions in health inequalities, this study helps informing policies better to tackle these inequalities.

Key messages

Cultural value differences between countries have a profound impact on the magnitude of inequalities in adolescents’ health and health behaviours and on the evolution of these inequalities. Identifying cultural value differences in adolescents’ health, health inequalities and evolutions in these inequalities is necessary to inform policies better to tackle these inequalities.
Transition into secondary education and health-compromising behaviours: A longitudinal study
Authors: Rimpelä A , Dobewall H , Karvonen S , Koivusilta L , Lindfors P , Kinnunen J M , Vainikainen M-P , Kortesoja L
Published: November 2019

Background

We studied the associations of health-compromising behaviours with a transition into secondary education by following a large cohort of Finnish adolescents. Students with a direct (successful) transition into secondary education after the 9th grade (73%) and those with a late transition (7%) were compared.

Methods

We analysed the following health behaviours in the 7th and 9th grades collected in school surveys in the Helsinki Metropolitan Area: late bed time, irregular breakfast pattern, tooth brushing less than twice a day, monthly alcohol consumption, smoking, regular energy drink consumption, physical activity level under recommendations, and excessive screen time, as well as clustering of these behaviours.

Results

In logistics regression models (adjusted for gender, school), in the 7th grade all health-compromising behaviors except physical inactivity were related to the late transition, and in the 9th grade energy drink, smoking, breakfast, tooth brushing and screen time. In multivariate models (controlled for academic achievement, immigrant status, language spoken at home, and parents’ education) only bed time was independently associated in both grades. Bed time, breakfast, tooth brushing, alcohol, smoking, and energy drink formed three behavioral clusters -healthy, mixed, and unhealthy lifestyles. The last two predicted the late start in both grades; in multivariate models unhealthy only. Change in academic achievement over time, but not in lifestyle, predicted the transition.

Conclusions

Students with unhealthy lifestyle are more likely to start secondary education later than those with healthy lifestyle meaning also postponing of their graduation and start of working life.

Key messages

The unhealthy lifestyle of those who start secondary education later than average, may be one of the mechanisms in the origin of socioeconomic health differences in later life. Healthy lifestyle as early as 13 years predicts successful educational paths.