bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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 (&gt;30 days) of PTSA in 2011 (=PTSA group), 42 510 individuals with FTSA (&gt;30 days) in 2011 (=FTSA group), and 25 167 individuals with no sickness absence (&gt;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 &gt;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 &gt; 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

Abstract

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

Abstract

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

Abstract

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.
Cultural values and adolescents’ health inequalities in 21 European countries
Authors: Dierckens M , De Clercq B , Deforche B 
Published: November 2019

Abstract

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

Abstract

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.