bluuebunny/crossref_metadata_2025 huggingface dataset:
Lung cancer screening by low-dose CT among asbestos-exposed workers in Germany
Authors: Heidrich J , Greiner F , Keller H , Harth V
Published: October 2023

Introduction

The German Social Accident Insurance (DGUV) has introduced lung cancer screening (LCS) by means of annual low-dose CT. Eligibility criteria for the main cohort are age ≥55 years, smoking history of ≥ 30 pack years and occupational asbestos exposure (OAE) of ≥ 10 years with onset before 1985. Medical counselling prior to CT scan is mandatory and supports shared decision-making. After being launched in pilot regions, LCS has been rolled out nationwide since 2017. As guidelines recommend a systematic evaluation for LCS, the research project EVALUNG has been implemented since 2022.

Methods

EVALUNG was designed to evaluate process and outcome of LCS combining quantitative and qualitative elements. The quantitative part is based exclusively on routine administrative and medical data. So far, anonymised data with selected items were used to assess availability of data and potential quality indicators, and to perform initial descriptive analyses in terms of participation rates, suspicious findings and detected lung cancer in first round screening.

Results

By end of 2021, 22,794 eligible persons were offered participation in LCS at least once. Based on first round screening, 12,808 pre-screening medical consultations were carried out and resulted in 9,277 initial CT scans, corresponding to a participation rate of 40.7 % of invited persons, and 72.4 % after medical consultation, respectively. Overall, 931 CT findings (10.0%) required control scans within a shortened interval. A total of 103 persons (1.1 %) were diagnosed with lung cancer, of which almost half (n = 54) were legally recognised as occupational disease.

Conclusions

EVALUNG shows feasibility of a screening evaluation of an occupational cohort based on routine data. However, not all quality indicators for LCS can be covered yet and outcome parameters need to be investigated in more detail in this cohort. Linkage with cancer registry data is an option to enhance data and will be explored further in the project.

Key messages

• Routine administrative data can be used to assess basic outcomes from LCS in an occupational cohort from Germany. Linkage with registry data is desirable to investigate detailed LCS indicators.

• Detection rate in first round LCS in an occupational cohort from Germany was 1.1% and half of detected cases were legally recognised as occupational disease.
Sickness absence after work injuries and post-traumatic stress among white-collar workers
Authors: Farrants K , Alexanderson K
Published: October 2023

Background

There is very little knowledge about sickness absence (SA) and disability pension (DP) after work injuries and post-traumatic stress disorder (PTSD) among white collar workers. The aim was to examine diagnosis-specific SA and DP after healthcare due to a workplace injury and PTSD, respectively, among white-collar workers in the wholesale and retail industry in Sweden.

Methods

A prospective population-based cohort study of all 192,077 such white-collar workers (44% women) in Sweden in 2012, using linked microdata from three nationwide registers covering 2012-2016. We identified individuals who had specialised out- or inpatient healthcare due to a work injury (n = 1114) or to PTSD (n = 216) in the years 2012-2016. Their average number of net days of diagnosis-specific SA and DP was calculated for the 365 days before and 365 days after the healthcare visit.

Results

64% of women and 45% of the men had at least one new SA spell during the 365 days after healthcare due to a work injury. On average, women had 14 SA/DP days the year before the injury and 31 days after; corresponding days for men were 9 and 21 days. SA days with fractures and with other injuries increased most, while SA days with mental diagnoses increased slightly. In the PTSD group, 80% of women and 65% of men had a new SA spell. Women's SA/DP days increased from 121 to 157 and men's from 112 to 174. SA with stress-related disorders and other mental diagnoses increased most, while DP with stress-related diagnoses and SA with musculoskeletal diagnoses increased slightly.

Conclusions

About half of those who had healthcare due to work injuries, and the majority of those who had PTSD, had new SA following the healthcare. SA due to diagnoses related to injury and mental diagnoses, respectively, increased most, however, SA/DP days due to other diagnoses also increased slightly. More knowledge is needed on factors associated with having or not having SA/DP with different diagnoses after work injuries and PTSD.

Key messages

• About half of those who had specialised healthcare due to work injuries, and the majority of those who had PTSD, had new SA in the following 365 days.

• Individuals with healthcare for PTSD had more SA/DP days both before and after their healthcare visit than those with work injuries, but individuals with work injuries had a larger increase.
What hinders me returning to work? Sick listed employees own stories
Authors: Lervik L V , Frostestad E , Strømstad K , Gulliksen I G , Lillefjell M , Skogen J C , Aas R W
Published: October 2023

Background

Long-term sick leave can have extensive consequences ranging from the micro- to the macro-level and poses a challenge globally. Low educational level is negatively associated with return to work (RTW) across disorders. Still, there is limited research into which barriers for RTW this group experience. The aim of this study was to identify self-perceived barriers for RTW among employees on long-term sick leave with low educational level.

Methods

We used material from the NOW WHAT RTW Barrier study, a large-scale interview study with long-term sick listed employees from Norway. Employees on long-term sick leave with low educational level (defined here as primary and secondary school level) were included in the current study (N = 122). Using the World Health Organization's classification system of function, disability, and health (ICF), the data was investigated with a qualitative and quantitative content analytical approach.

Results

We identified N = 1,942 meaning units describing barriers for RTW. The frequency of coded barriers was highest for the ICF domain Body Function n = 552(28%, min 0, max 15, mean=4,5), followed by Environmental factors n = 411(21%, min 0, max 17, mean=3,4), Activity limitations n = 352(18%, min 0, max 14, mean=2,9), Personal factors n = 323(17%, min 0, max 16, mean=2,6), and lowest for Participation restrictions n = 151(8%, min 0, max 5, mean=1,2) and Body structure n = 146(8%, min 0, max 9, mean=1,2). The most prevalent ICF sub-domains were Mental functions n = 229(42% of the Body Functions barriers, min 0, max 11, mean=1,9) and Services, systems, and policies n = 257(63% of the Environmental barriers, min 0, max 16, mean=2.1).

Conclusions

Employees on long-term sick leave with low educational level describe a wide range of barriers to RTW. In addition to functional barriers, identifying environmental barriers are important to increase insight and understanding of potential determinants of absence from work for this group.

Key messages

• Identifying RTW barriers related to functional and environmental factors can increase insight and understanding of absence from work for employees on long-term sick leave with low educational level.

• Insight into self-perceived RTW barriers for long-term sick listed with low educational level can contribute to more effective and sustainable RTW processes and further development of RTW services.
Work-related factors and interest in working while drawing an old-age pension
Authors: Polvinen A , Tenhunen S
Published: October 2023

Background

Working while drawing an old-age pension has become more common in recent years. Working is often occasional and part-time, but it has many benefits for individuals and society. Less is known about the importance of work-related factors to post-retirement employment. The aim of this study was to examine whether pre-retirement work-related factors are associated with working and interest in working alongside a pension.

Methods

The Finnish survey data (response rate=68%), supplemented with register data, included 3,212 old-age pensioners aged 55-68 who retired from work on an old-age pension between 2019-2021. The respondents were asked whether they had worked or would like to work while drawing an old-age pension. The survey also included questions about pre-retirement working conditions. Multinomial logistic regression analysis was used to estimate ORs and 95% CI for working while drawing a pension and the interest in working compared to those who had not worked or were not interested in working alongside the pension.

Results

32 percent of old-age pensioners were working or had worked while drawing an old-age pension and 16 percent had not worked but would like to work. 52 percent had not worked while drawing a pension and they were not interested in working. The experience of work being an important area of life was strongly associated both to working while drawing a pension and to interest in working. Those old-age pensioners who found that working competence requirements had increased too much were working less often alongside a pension. The experience of work being too physically demanding was associated with less interest in working alongside a pension.

Conclusions

Our results suggest that favourable pre-retirement work-related factors increase old-age pensioners’ possibilities of and interest in working alongside a pension.

Key messages

• Many work-related factors, such as physical workload or finding work as an important area of life, are associated with working and being interested in working while drawing an old-age pension.

• From a policy perspective, more attention should be placed on improving older workers’ working conditions to induce more people to continue working while drawing a pension.
The impact of overweight on employment outcomes: a review of the evidence
Authors: Kesaite V , Greve J
Published: October 2023

Background

Overweight has been recognised as a significant public health issue. Several hypotheses have been posed to explain the impact of overweight on employment outcomes, including the role of productivity, labour supply, and discrimination. In this review, we provide a systematic synthesis of the evidence on the causal impact of overweight on labour market outcomes worldwide.

Methods

We searched Econ Lit, Medline, and Web of Science databases for relevant studies from 1st Jan 2010 to 20th Jan 2023. Studies were included if they were either longitudinal analysis, pooled cross-sectional or cross-sectional studies if they used Mendelian Randomisation methodology and have been published since 2010. Only those studies with measures of overweight and employment outcomes were included.

Results

The number of potentially relevant studies constituted 4,321 hits. A total of 59 studies met the inclusion criteria and were qualitatively reviewed by the authors. Most of the included studies were carried out in the USA (N = 18), followed by the UK (N = 9), Germany (N = 6), Finland (N = 4), and non-EU countries (N = 22). Evidence from the included studies suggests that the overweight effect differs by gender, ethnicity, country, and time period. White women with obesity in the USA, the UK, Germany, Canada, and in the EU (multi-country analyses) are more likely to experience overweight/obesity related labour market penalties such as reduced likelihood of employment, and when employed they also face lower wages compared to non-overweight counterparts. For men there is no evidence of an effect of overweight on employment outcomes or the magnitude of the effect is much smaller or even positive in some cases.

Conclusions

This review has shown that despite ample research on the impact of overweight on employment status and wages, robust causal evidence on the effects of weight status on employment outcomes remains scarce and relies significantly on strong statistical and theoretical assumptions.

Key messages

• The first study to evaluate the evidence base and the methodology of studies that assessed the economic consequences of overweight.

• There is a need for better identification approaches and more recent datasets, especially from low-income countries.
Combined Lifestyle Intervention to reduce overweight at the workplace: opinions of stakeholders
Authors: Beurskens P , Houkes I , Norder G , de Rijk A
Published: October 2023

Background

Overweight is a risk factor for employee health and sustainable employability. Multifactorial interventions, addressing both the employee's individual lifestyle and the work environment, are expected to be most effective in overweight reduction. In the Netherlands, primary care patients with overweight are referred to Combined Lifestyle Interventions (CLI), but this is not yet common in occupational health. This study explores the attitudes, intentions and perceived facilitators and barriers of three groups of stakeholders (employees, employers and occupational physicians (OP's)).

Methods

A cross-sectional survey focusing on attitudes, barriers and facilitators was conducted among a convenience sample of, varying in age and gender, Dutch OPs (n = 267), employers (n = 401) and employees (n = 1,023) in 2021/2022.

Results

Preliminary results indicate that 32% of the employers would offer CLIs if accessible and 25% of the overweight employees intend to participate in a CLI. For employers, the main reasons to offer a CLI were reduction of sick leave (42%) and good employment practice (37%), barriers were the conviction that employees would not be interested (33%), lack of finance (21%) and lack of time (21%). Employee's main reason for attending was boost for good lifestyle (27%), facilitators were alignment with working hours (24%) and employer's payment for the CLI (25%). Barriers were ‘I already do enough for my health’ (22%). The main barriers for OPs to refer to a CLI were lack of knowledge (66%) and a preference for known professionals (40%), while a facilitator was having more time during their consultations.

Conclusions

Although not yet common in the Netherlands, a relative large portion of participating employers is willing to invest in lifestyle interventions to reduce overweight. The shared barrier of lack of time needs to be tackled in combination with strengthening of attitudes and facilitators to achieve a successful CLI implementation.

Key messages

• Employers are willing to invest in a combined lifestyle intervention to reduce or prevent employee’s overweight.

• Implementation requires sufficient time for referral and participation, employers to pay and OPs to be informed about the combined lifestyle intervention.
The role of multidimensional health patterns over time in older workers' labor force participation
Authors: Gut V , Baumann I , Gabriel R , Fredriksson D , Fritzell J
Published: October 2023

Background

A non-negligible share of workers is affected by adverse health at the end of their careers. While many of them drop out of the labor force, others remain, prompting the question of how various health indicators interact to influence these different pathways. Therefore, we investigate the effect of multidimensional health patterns on labor force participation among older workers.

Methods

We used six-year-longitudinal data from 5007 older workers (Mean age: 55.8 years; 55.9 % female) from the Survey of Health, Ageing and Retirement in Europe. First, we conducted a latent transition analysis with four indicators (chronic diseases, limitations with activities, perceived health, and depression) to identify multidimensional health patterns. Second, we examined individual change in these patterns over time and their association with workers’ job situations and changes in work hours four years later using Wald-tests.

Results

We identified four multidimensional health patterns with high structural stability over time (ranging from <.005 to .25): (1) Overall healthy workers, (2) workers with moderate activity limitations and low perceived health, (3) overall unhealthy workers, and (4) physically healthy workers with low perceived health and depressive symptoms. Furthermore, individuals predominantly remain in the same pattern over time, except for pattern (4), where 56% of the individuals transition to pattern (1). Moreover, we found differences between the patterns in job situation (p < .001) and changes in work hours (p < .001) four years later with patterns (2) and (4) showing the greatest reduction in working hours.

Conclusions

The high rate of transitions from the pattern (4) to the more favorable pattern (1) may be explained by the relatively high potential for recovery from depression. Our findings suggest that interventions among older workers with depressive symptoms and moderate activity limitations may improve their chances to remain in the labor force.

Key messages

• We identified four largely stable multidimensional health patterns over time.

• Older workers with moderate activity limitations and low perceived health reduced their work hours most strongly.
The prevalence of Sudden Cardiac Death among workers: a systematic review and meta-analysis
Authors: Corona V F , Amantea C , Pilia E , Gualano M R , Moscato U , Ricciardi W
Published: October 2023

Background

Sudden cardiac death (SCD) is one of the main causes of death worldwide, and it continues to be a significant public health concern. In Europe, the prevalence of sudden cardiac death differs between countries and populations; it is estimated to account for approximately 20% of all deaths. However, there are few data regarding the prevalence of SCD among employees. This systematic review and meta-analysis aim to investigate the prevalence of this phenomenon in workers and recommend potential interventions and preventive measures that could be implemented in the workplace to reduce the risk of SCD in employees.

Methods

A systematic review and meta-analysis was performed on three databases: PubMed, Scopus, and Web of Science, according to the PRISMA statement. There were no time restrictions placed on the evaluation of English-language source documents. Using the Egger regression model, publication bias was evaluated. A forest plot was used to demonstrate the pooled prevalence of Sudden Cardiac Death in workers. STATA Software/MP, version 14.1 was used for the statistical analyses.

Results

The initial search resulted 1,408 relevant articles across all three databases; after removing duplicates and filtering the abstracts, the full texts of 23 articles were reviewed, and 17 were excluded due to a wrong outcome. Six articles were subsequently included in the systematic review and meta-analysis. A proportional meta-analysis was carried out on the 6 included studies and the pooled prevalence of Sudden Cardiac Death in employees was 17.48% (95% CI: 6.70-31.91%).

Conclusions

SCD is a severe and potentially preventable illness that can affect employees and cause fallout from European and global health policies. We can reduce the incidence of SCD and enhance the cardiovascular health and well-being of workers by identifying and addressing work-related risk factors, providing appropriate screening and interventions, and promoting healthy lifestyle behaviors.

Key messages

• Promote a healthy lifestyle in the workplace, such as regular physical activity, healthy eating and stress reduction techniques, at European and global level.

• Implement, in European countries and worldwide, screening strategies during health surveillance visit, such as performing ECGs or specialist cardiology consultations, for the work population at risk.
Shielding healthcare workers: the impact of workplace discrimination on workforce health
Authors: Martin A , Jamieson S
Published: October 2023

Aims

To understand the impacts of shielding on junior doctors (JDs) in Scotland during the COVID-19 pandemic.

Methods

11 JDs and 2 consultants took part in qualitative individual semi-structured interviews (September-November 2022). Reflexive thematic analysis was used to analyse the data. The local Research Ethics Committee confirmed ethical approval was not required (‘not research’ letter given).

Results

‘Negativity and stigmatisation’ were discussed by 82% of JDs, with one JD being told that providing reasonable adjustments would set a ‘bad precedent'. Several were threatened with punitive action including dismissal. Other themes included ‘overlooked and undervalued’ as 73% described their contribution as being dismissed or unrecognised and had to ‘pester’ their supervisors for work. All JDs reported inadequate support at workplace and Occupational Health levels. Mental health impacts included guilt, anxiety, and isolation. Consultant interviews were consistent with these themes and provided insight into supervisory challenges including not receiving guidance or resources, and ongoing issues supporting disabled and pregnant JDs.

Discussion

These findings offer novel insight into the experiences of shielding from a JD and supervisor perspective. This ‘natural experiment’ revealed that the support infrastructure available to JDs in Scotland with disabilities and during maternity didn't withstand the pressures upon it or was absent entirely. These findings are in line with existing literature in this area and reflect a concerning paucity of support for these JDs, and a wider culture of stigmatisation and workplace maternity and disability discrimination impacting workforce health. Particularly in the current climate of widespread burnout and a recruitment and retention crisis in healthcare, the medical community stand to lose a lot if they don't recognise the reality of a diverse workforce, where all healthcare workers are given the support they need to thrive.

Key messages

• The infrastructure for supporting junior doctors with disabilities, health issues, and during maternity in Scotland is insufficient.

• These findings indicate concerning workplace maternity and disability discrimination impacting part of the healthcare workforce in Scotland.
Hospital mortality after acute myocardial infarction- really an indicator of quality of acute care?
Authors: Stolpe S , Kowall B , Werdan K , Zeymer U , Bestehorn K , Weber M A , Schneider S , Stang A
Published: October 2023

Introduction

‘AMI 30-day-mortality using unlinked data’ is reported by OECD as indicator for quality of acute care. It relates to hospital mortality after acute myocardial infarction (AMI, ICD-10: I21-I22). AMI hospital mortality in Germany is among the highest in Europe - indicating major problems in quality of acute care. In contrast, Germany ranks high on health expenditure and availability of cardiologists and PCI facilities. We explain these contradictory findings.

Methods

Literature and public health reports on AMI patient characteristics, acute care, patient registration and healthcare organisation were reviewed. OECD indicators ‘AMI 30-day-mortality using unlinked data’ and ‘average length of stay after AMI’ for European countries were downloaded for 2000-2019. The trend in AMI hospital mortality was described graphically. The influence of average length of stay (LOS) on AMI mortality was assessed by linear regression.

Results

Since 2000, AMI hospital mortality fell strongly. In 2019, it was 2.9% in the Netherlands, 3.2% in Norway, but 8.5% in Germany. Different patient characteristics or therapies do not account for the differences in mortality, but health care organization: 1. Day cases are not always included in OECD source data; 2. Average LOS is associated with AMI hospital mortality (R2=0.58) and is itself influenced by patient transfer frequency and reimbursement policy; 3. In centralised health systems, AMI patient transfers are more frequent. These factors reduce the registered AMI deaths or increase the number of cases, all resulting in lower hospital mortality.

Discussion

AMI hospital mortality is highly influenced by factors that are not related to acute patient care, but to health care organization and patient registration rules. AMI registries reporting hospital mortality include selected AMI patient populations, which hampers valid comparisons. European sentinel registries are needed to validly describe quality of acute care and outcomes in AMI.

Key messages

• OECD indicator ‘AMI hospital mortality’ does not allow valid conclusions on quality of acute care.

• AMI hospital mortality is strongly influenced by patient registration rules and healthcare organization, namely frequency of patient transfers and length of stay in hospital after AMI.
Long-term sickness absence among adults with ADHD: the role of psychosocial working conditions
Authors: Ontiveros N , Nevriana A , Almroth M , Falkstedt D , Pan K-Y
Published: October 2023

Background

Symptoms of Attention-deficit/hyperactivity disorder (ADHD) do not only occur during childhood but often persist into adulthood and affect individuals’ ability to work. Adults with ADHD compared to those without ADHD are at a higher risk of negative labour market outcomes, such as long-term sickness absence (LTSA). Identifying modifiable factors in the workplace such as psychosocial working conditions may be a plausible strategy to lower this risk. This study aimed to investigate the effect modification of job control and job demands on the risk of LTSA among adults with ADHD.

Methods

The study population consisted of around 3.7 million individuals aged 20-60 years in Sweden in 2009. Of them, 0.3% had a diagnosis of ADHD extracted from the national patient registers. LTSA was defined as having one sick-leave spell of 90 days or more between 2010-2020. Job control and job demands were measured using job exposure matrices. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of LTSA among adults with ADHD compared to those without. Stratified analysis was conducted to test the effect modification by job demand-control status.

Results

During the follow-up, 812,971 (22%) adults had LTSA. Both men and women with a diagnosis of ADHD were at a higher risk of LTSA (HR 1.75, 95% CI 1.68-1.82 and HR 1.61, 95% CI 1.55-1.68, respectively) compared to those without ADHD, after adjusting for demographics, previous LTSA, and other mental and somatic disorders. The increased risk of LTSA among adults with ADHD was present regardless of the levels of job control, job demands and job demand-control categories (HRs ranged from 1.55 to 2.10).

Conclusions

Adults with a diagnosis of ADHD have a higher risk of LTSA and job demand-control status does not seem to substantially modify this risk. Future studies identifying factors in the workplace that may potentially help prevent LTSA among adults with ADHD are highly warranted.

Key messages

• Adults with ADHD have a higher risk of LTSA regardless of the job demand-control status.

• There is an urgent need to identify factors that may help improve the work ability of this population.
The association between patient experiences in outpatient care and their characteristics in Slovenia
Authors: Murko E , Kralj M , Poldrugovac M , Ropret N , Zaletel M
Published: October 2023

Background

The aim of the cross-sectional study was to measure adult patients’ experiences in the outpatient specialist medical settings in the fields of neurology and neurosurgery, cardiology, ophthalmology, gynaecology and obstetrics, orthopaedics and oncology with radiotherapy, and explore the association between the general score of the healthcare service given by patients and their socio-demographic characteristics and health status.

Methods

The survey used mixed mode design (i.e. paper questionnaire and online survey), took into account various aspects of healthcare such as waiting period to the visit, admission, waiting time in the waiting room, physician work, nurse work, privacy, patient rights information, and familiarity with continuation of treatment. As part of the study, patients evaluated overall care at a specialist outpatient clinic on a scale of 0 to 10. The questionnaire used has been recently developed, based on a review of the literature and focus groups with patients. The questionnaire was also cognitively tested and piloted before national rollout. Multi-level regression analysis was used as the main method of statistical analysis.

Results

The national survey was conducted in autumn 2022. A total of 10,533 valid completed questionnaires from 210 specialist outpatient clinics were received. 82.4% of the surveyed patients rated the medical treatment with a score of 9 or 10 with the average rating 9.34. Preliminary statistical analysis indicates the presence of association between socio-demographic/health status variables on one hand and overall assessment of treatment on the other.

Conclusions

A possible association between socio-demographic and health status factors with overall score on specialist outpatient clinic rating calls for caution when comparing outpatient clinics that care for patients with different socio-demographic characteristics and health status.

Key messages

• There is an association between sociodemographic factors and health status of patients with overall score of healthcare experiences in specialist outpatient clinics.

• The association calls for caution when comparing outpatient clinics.
Trends in acute hospital smoking prevalence and support of campus ban in Dublin, Ireland (1997-2018)
Authors: Mattson A , Lyons A , Doherty K , Douglass A , Stynes S , Kerley M , Fitzpatrick P , Kelleher C
Published: October 2023

Background

St Vincent's University Hospital (SVUH), a major hospital in Dublin, Ireland pioneered a hospital smoke-free campus policy in 2009; pre/post this intervention it conducted periodic surveys of patients, staff & visitors for smoking prevalence and policy attitudes. As rates of smoking decline nationally in Ireland, it is important to monitor trends for at-risk groups, including lower socioeconomic status (SES).

Methods

Repeat questionnaires were administered by census surveys of inpatients, quota or random sub-sample surveys of staff, and quota surveys with outpatients and visitors between 1997 and 2018. As a proxy for social deprivation, the rate of inpatients eligible by income for the state-funded General Medical Services (GMS) card was assessed. Chi square test for trend and SPSS v.27 were used for analysis.

Results

Support for and awareness of the campus smoking ban increased steadily; post ban agreement varied by smoking status (64.7% smokers, 89.7% ex-smokers; 92.5% non-smokers, p = 0.002). Smoking rates declined in all groups but significantly in outpatients (19.5% vs. 10%; p < 0.01), visitors (27.4% vs 9.5%; p < 0.0001) and staff (30.0% vs 10.8%; p < 0.0001). Rates of inpatient GMS entitlement was high at 54.2% average, compared with national rates of approximately 30% in 2021. Rates of smoking were non-significantly higher in GMS entitled inpatients (33.2% vs 26.8%; p = 0.09) across all survey periods.

Conclusions

While hospital smoking prevalence has decreased and campus ban support persists, the campus is not immune to challenges in keeping it smoke-free. There are many socioeconomically deprived patients who smoke; this in part may reflect a private hospital on the same campus where affluent smokers are more likely to attend. Recent national initiatives for free nicotine replacement therapy and targeted smoking cessation courses in deprived areas work to address inequalities. We are not aware of similar studies in a hospital population over 25 years.

Key messages

• Periodic hospital smoking surveys show trends in prevalence which mirror the falling national trends in Ireland.

• Socioeconomic differences persist in smoking rates among hospital patients.
Clustering users of healthcare, social and employment services: a register study from Finland
Authors: Blomgren J , Jäppinen S , Perhoniemi R
Published: October 2023

Background

Understanding the population's overall use of healthcare, social and employment services is important for comprehending service needs and improving the coordination of services. The aim of this exploratory study was to find separate groups in a working-age population based on individuals’ use of various healthcare, social and employment services during one year and to investigate sociodemographic and health-related predictors of user groups.

Methods

Administrative register data on the use of 22 distinct healthcare, social and employment services and on socio-demographic and health-related covariates from year 2018 were linked for all working-age residents of the municipality of Oulu, Finland (N = 119,740). K-means cluster analysis was used to group the study subjects into clusters, based on their yearly frequency of using each service. Multinomial logistic regression was used to assess the associations of sociodemographic and health-related covariates with cluster assignment.

Results

Five distinct clusters were identified, labelled ‘low to moderate users of healthcare’ (82%), ‘regular employment services users with moderate use of healthcare’ (10%), ‘supported employment services users’ (3%), ‘frequent users of healthcare, social and employment services’ (3%) and ‘disability and specialized services users’ (3%). Each cluster showed different patterns of service use and was also uniquely associated with sociodemographic and health-related covariates, reflecting distinct service user types.

Conclusions

The study identified five distinct groups of healthcare, social and employment services users in a working-age population. Knowledge of different user profiles and their determinants can help predict future need and use of services, coordinate and integrate services, and plan early interventions and prevention measures. This is important in order to save costs and improve the overall quality and effectiveness of services for groups with different care needs.

Key messages

• In terms of their use of healthcare, social and employment services, the working-age population can be classified into distinct groups, uniquely associated with various determinants.

• Understanding the population’s use of different services can help predict future needs and improve coordination, integration and effectiveness of services in groups with different needs.
Sustainability of organisational models implementation in primary care: the CIRCE-JA approach
Authors: Borghini A , Scotellaro M , Baldini L , Cosi R , Carriazo A M , Walch Elarre V , Nieto Guerrero V , Carini E , Mantoan D
Published: October 2023

Fostering healthcare is the aim of EU4Health 2021-2027 agenda. To promote it the EU commission has launched calls for projects, in particular, a call for best practices (BPs) in primary healthcare (PHC). The Joint Action (JA) CIRCE-JA that was funded aims to transfer and implement PHC BPs among Member States, raising their capacity in implementing innovative care models and addressing health system transformation. To be fully effective and maintained over time a BP should be sustainable; part of the efforts of CIRCE-JA are dedicated to study and assure sustainability of the project. Sustainability is a key issue to make an intervention, although already proved of good quality, useful for the population through time. To identify factors of a sustainable implementation, a search of the literature has been done to outline a questionnaire that will be validated through DELPHI methodology and submitted to organisations already managing the BPs and the affiliated entities that will introduce the BPs in their organisations. CIRCE JA will lead to the implementation of 6 PHC BPs in 44 implementation sites located in 14 European countries. This variability calls for a solid transferring methodology to sustain the implementation. The theme of sustainability is not new and the literature search is going to provide enough material for the implementation of the questionnaire. The questionnaire will be compiled by BPs owners which have created the organisational model and the implementing sites; this will be done in order to understand the problems faced and assay the perceived issues. PHC is a priority for EU bodies. Sharing experiences and organisational models on PHC and the diffusion of BPs can be useful to improve quality and access of healthcare, also promoting the so-called European Health Union. Furthermore, a proper study of the sustainability of the interventions leads to a better and longer implementation, not causing a waste of effort, money and time.

Key messages

• To effectively transfer and implement an organisational model, a solid study on sustainability should be conducted.

• An efficient PHC organisation and provision is crucial to improve quality and access to healthcare.
Patient Autonomy in Practice - A Privilege or a Burden?
Authors: Connelly Y , Kaplan G , ZiV A , Karni T , Rubin C , Tal O
Published: October 2023

Background

Patient-centered approach contributes to overall quality of healthcare, can reduce healthcare utilization by targeted treatments, and may increase patient-provider trust. Beyond attention to patient's needs and characteristics, granting them with autonomy in the decisions-making process is required. However, it is important to recognize not all patients are capable nor desire to translate autonomy into action.

Methods

A survey among a representative sample of 462 adults in Israel (50% response rate), examined the ability and willingness of individuals to be involved in decisions related to their own care. The questionnaire included items concerning trust in providers, perceived ability, and degree of desired autonomy (decisional and executive).

Results

While 341 (74%) estimated their abilities as medium or high, only 171 participants (37%) express they will to make the decisions (following doctor's opinion, or even against recommendations). A mediation process model demonstrated that high capabilities indirectly effects trust in providers through two mediators - decisional and executive autonomy [F(8,402) = 2.82, R2 = .06, p=.0047]. High perceived capabilities associate participants with higher desired autonomy to take the decision by themselves, and the latter associates with higher tendency to execute willingness to actions (e.g., non-adhere to treatment recommendations). Finally, higher tendency to perform executive autonomy results in lower trust in providers. The indirect effect is significant (-.006, .003, [-.0118-0010]).

Conclusions

we present an innovative model correlating autonomy, trust and willing to act by patients facing health decisions. Providers should be aware that the desire to be autonomous does not always merge with the ability or willing to take actions. Personalized approach based on the autonomous profile of each patient could lead to more efficient utilization of medical resources.

Key messages

• Autonomy may not align with desires and abilities of some patients.

• Autonomy preferences affect adherence, trust and potentially also healthcare utilization, emphasizing the need for personalized care.
Quality of life and Job satisfaction in medical specialists
Authors: Ordaz Lopez K , Quevedo Flores J M , Trujillo Peña G J , Viveros Sosa O , Villegas Dominguez J S
Published: October 2023

Background

Following the COVID-19 pandemic, the outlook for many physicians changed unexpectedly. There is evidence indicating that clinical performance decreases in stressed physicians, or with job dissatisfaction, factors that influence your quality of life.

Objective

To determine the correlation between quality of life and job satisfaction in medical specialists in Veracruz, Mexico.

Methods

A cross-sectional, observational, prospective and analytical study was carried out between November and April 2023. Medical specialists from Veracruz were included; retired physicians and physicians with motor and neoplastic disabilities were excluded. Data collection was carried out using Google Forms, applying the S21/26 job satisfaction (SL) test (A.Cronbach 0.9) and the WHOQOL-BREF quality of life test (A.Cronbach 0.8). The SPSS v22 program was used, X2 test, Pearson correlation, Odds Ratio (OR) and confidence interval (CI95%).

Results

237 medical specialists were included. social characteristics, the points of general quality of life, job satisfaction and its components showed R values between 0.3 and -0.3; Low quality of life was associated (OR/CI95%) with low SL (2.2/1.1-4.1), high SL (0.3/0.2-.7), being a woman (2.7/1.5-4.9), wanting another specialty (3.4/1.3-8.9), hours greater than 12 noon on weekends (0.4/0.1-0.8); High job satisfaction 1.88 (1.06-3.33), Male sex 2.45 (1.34-4.47), Not having children 1.78 (1.01-3.14), Married in 2nd, 3rd, 4th marriage 4.36 (1.6-11.7), Having a salary that satisfies 5.37 (1.59-18.17) are associated with high quality of life (p < 0.05).

Conclusions

Job satisfaction, practicing a desired specialty, favorable working conditions and health directly influence the quality of life of doctors. It is important to point out that some of these factors are modifiable, so we must work so that doctors carry out their work activities in the specialty they want, with fair shifts to favor their quality of life, which would favor better medical care.

Key messages

• There are modifiable factors from the work environment to favor the quality of life of specialist doctors, so investing in them should be considered to increase the quality of care for patients.

• Medical students should know that the quality of life of a specialist doctor must be considered from the moment of choosing our specialty, in order to develop in a satisfactory work environment.
Intersectoral care for children with autism spectrum disorder in Kazakhstan: Parents perspective
Authors: Kozhageldiyeva L , Sabyrdylda Z , Akhtayeva N , Samambayeva A
Published: October 2023

Background

The prevalence of autism spectrum disorder (ASD) is steadily increasing worldwide, including in Kazakhstan. Recognizing the significance of early detection and providing intersectoral assistance encompassing social, medical, and educational support, it is essential for promoting children's socialization in their daily lives. The purpose was to analyze the provision of comprehensive assistance to parents of ASD children. We conducted a descriptive qualitative study that involved semi-structured face-to-face interviews with parents of ASD children. 60 respondents (51,7% under 34 years old, 45,0% - 35-44 years and 3,3% up to 45 years) participated in our study. Framework Analysis used to interpret results.

Results

The average age of ASD children was 6.3. 26.0% of families were single-parent households, 30.0% residents in rural areas, 66.6% had one working parent, and 58.3% had obtained higher education. 52 parents note partial support from the government, mainly the expenses of parents are associated with the purchase of books, receiving other supporting services as sports activities. Due to long waiting list from the government parents noted the other services related to out-of-pocket payments as ABA therapy, a visit to a neurologist, correctional trainings. All parents noted that they want to receive information through organizing seminars, including psychological support.

Conclusions

Intersectoral collaboration plays a crucial role in facilitating comprehensive assistance for ASD children and meeting their needs through government support. Improving access to transportation, resource books, organizing seminars, and implementing programs to reduce waiting lists for medical and pedagogical specialists are necessary steps.

Funding

The Ministry of Science and Higher education of Kazakhstan (BR18574199 «Integrating children with autism spectrum disorder into the social and educational environment based on comprehensive support: challenges and benefits).

Key messages

• To achieve the SDG the decision makers of all three sectors in Kazakhstan need to improve care program for ASD children.

• It is necessary to expand and revise the provision of services to ensure access to educational, medical services.
Seeking mental health services before and during COVID-19 Pandemic in the Acre region of Israel
Authors: Kalyva D , Bakola M , Kitsou K S , Alon S , Ginat K , Plotas P , Charalambous G , Jelastopulu E
Published: October 2023

Background

The Covid-19 pandemic and the measures (social and physical distancing, school closure, etc.) taken to prevent the spread had remarkable psychological and social effects on the population. These measures have been linked to post-traumatic stress disorders, anxiety, depression, and other stress symptoms that negatively impact the psychological well-being. Our aim was to compare the determinants of use of psychiatric services before and during the pandemic.

Methods

We conducted a record-based retrospective study from two periods, before and during the Covid-19 pandemic, utilizing the electronic system Prometheus at the Mazor Mental Health Medical Center (MMHMC) located in the Acre region of Northern Israel.

Results

Our sample consisted of 528 newly admitted patients, 96.6% came voluntarily, 55.9% were male, with a mean age of 41.1 years (SD ± 16) and living approximately 7.1 km (SD ± 8.5) from MMHMC away. 53% were Jewish, 21.8% lived alone, and 79.9% were unemployed. The main diagnoses were psychotic disorders (16.3%), adjustment and posttraumatic stress disorders (both 13.6%), followed by depression (9.3%), anxiety (7.8%), personality disorders (4.7%), and all other diagnoses. Most patients were referred to MMHMC by their primary care physician (58.1%) or psychiatrist (41.5%), and 21.4% had a family psychiatric history. Comparing the two periods, no statistically significant differences were observed in all examined variables and clinical characteristics except for the underlying risk factors for seeking mental health services. In the pre-pandemic period, the rate of suicide attempts is 26.9%, of violence 38.8%, and of other risk factors 34.3%, while the corresponding percentages during the pandemic are 49.1%, 39.6%, and 24.2%, respectively.

Conclusions

Our study revealed approximately the same characteristics of people seeking mental health services during the Covid-19 pandemic. However, a significant increase in suicide attempts was observed during this period.