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The authors assessed the utility and cost-effectiveness of using a World Wide Web-based questionnaire in a large prospective cohort study, the Black Women's Health Study (BWHS). In 1995, 59,000 African-American women were recruited into the BWHS through a paper questionnaire. Follow-up paper questionnaires have been mailed every 2 years since then. During the 2003, 2005, and 2007 questionnaire cycles, participants were given the option of completing a Web-based questionnaire. The cost of developing and processing a returned paper questionnaire was 4 times that of a returned Web questionnaire, primarily because of return postage costs and greater processing time for paper questionnaires. The proportion of respondents who completed a Web questionnaire doubled from 2003 to 2007, from 10.1% to 19.9%, but the characteristics of those completing the Web questionnaire remained the same. Web response was greatest at younger ages (20.9% of those aged <30 years) and declined with age to 3.6% among women aged 60 years or more. Web questionnaires were filled out more completely than paper questionnaires, regardless of the sensitivity of a question. The use of a Web questionnaire in the BWHS resulted in cost savings and more complete responses. Although there are advantages to using a Web questionnaire, the use of multiple means of soliciting questionnaire responses is still needed. [ABSTRACT FROM PUBLISHER]

Purpose: To examine (1) the patterns of service use and costs associated with language impairment in a community cohort of children from ages 4–9 years and (2) the relationship between language impairment and health service utilisation. Method: Participants were children and caregivers of six local government areas in Melbourne participating in the community-based Early Language in Victoria Study (ELVS). Health service use was reported by parents. Costs were valued in Australian dollars in 2014, from the government and family perspectives. Depending on age, the Australian adapted Clinical Evaluation of Language Fundamentals – Pre-school, 2nd Edition (CELF-P2) or the CELF, 4th Edition (CELF4) was used to assess expressive and receptive language. Result: At 5, 7 and 9 years respectively 21%, 11% and 8% of families reported using services for speech and/or language concerns. The annual costs associated with using services averaged A$612 (A$255 to government, A$357 to family) at 5 years and A$992 (A$317 to government, A$675 to family) at 7 years. Children with persistent language impairment had significantly higher service costs than those with typical language. Conclusion: Language impairment in 4–9-year-old children is associated with higher use of services and costs to both families and government compared to typical language. [ABSTRACT FROM AUTHOR]

The objective of this study is to compare changes in health among a sample of families living in substandard dwellings or with housing affordability problems assisted by Caritas Diocesana de Barcelona, according to the improvement of their socioeconomic and housing situation during the study period. A quasi-experimental study was performed, including 232 families assisted by Caritas who were interviewed in 2012 and one year later. Participants could have received a set of interventions, including relocation and different types of economic subsidies. Regression models were fitted to identify the association of participants' changes in self-rated general health and mental health between baseline and follow-up with improvements across three dimensions: socio-economic situation and housing affordability, physical housing characteristics, and neighborhood. An improvement in self-reported health status was associated with having found a job and reporting fewer problems in meeting monthly housing costs. Mental health improved among participants with an increased household income, with a reduction in the perceived risk of losing their house, and with reduced housing-related material deprivations. The study shows that health gains can derive from improvements in housing conditions, especially those related to housing affordability. [ABSTRACT FROM AUTHOR]

The purpose of this retrospective, longitudinal study was to assess longitudinal associations between modifiable health risks and workplace absenteeism and presenteeism and to estimate lost productivity costs. Across the 4-year study period (2007-2010), 17,089 unique employees from a large US computer manufacturer with a highly technical workforce completed at least 1 health risk assessment. Generalized estimating equation models were used to estimate the mean population-level absenteeism and presenteeism for 11 modifiable health risks and adjust for 9 sociodemographic and employment-related factors. Because patient age was highly correlated with several other variables, the analysis was stratified by age (<45 vs. ≥45 years). For all ages, poor emotional health, inadequate exercise, tobacco use, and having a body mass index (BMI) greater than 35 (all P<.05) were consistently associated with both absenteeism and presenteeism. Having a BMI over 35 and poor emotional health were associated with the largest impact in absenteeism (0.46 days) and presenteeism (4.03 days), respectively. Younger and older workers had similar associations between health risks and presenteeism; however, hypertension, blood sugar, inadequate exercise, and alcohol were associated ( P⋜.01) with greater absenteeism among older but not younger workers. The results suggest that productivity loss is strongly related to emotional health and obesity-related health risks (eg, BMI, exercise) but differs by age. These findings could help prioritize preventive health programs offered by employers at their worksite health centers. Given the aging of the US workforce, keeping older workers healthy and productive will be crucial to remaining competitive in the global economy. ( Population Health Management 2015;18:30-38) [ABSTRACT FROM AUTHOR]

Background and purpose - The optimal hip replacement for young patients remains unknown. We compared patient-reported outcome measures (PROMs), revision risk, and implant costs over a range of hip replacements. Methods - We included hip replacements for osteoarthritis in patients under 60 years of age performed between 2003 and 2010 using the commonest brand of cemented, cementless, hybrid, or resurfacing prosthesis (11,622 women and 13,087 men). The reference implant comprised a cemented stem with a conventional polyethylene cemented cup and a standard-sized head (28- or 32-mm). Differences in implant survival were assessed using competing-risks models, adjusted for known prognostic influences. Analysis of covariance was used to assess improvement in PROMs (Oxford hip score (OHS) and EQ5D index) in 2014 linked procedures. Results - In males, PROMs and implant survival were similar across all types of implants. In females, revision was statistically significantly higher in hard-bearing and/or small-stem cementless implants (hazard ratio (HR) = 4) and resurfacings (small head sizes (< 48 mm): HR = 6; large head sizes (≥ 48 mm): HR = 5) when compared to the reference cemented implant. In component combinations with equivalent survival, women reported significantly greater improvements in OHS with hybrid implants (22, p = 0.006) and cementless implants (21, p = 0.03) (reference, 18), but similar EQ5D index. For men and women, National Health Service (NHS) costs were lowest with the reference implant and highest with a hard-bearing cementless replacement. Interpretation - In young women, hybrids offer a balance of good early functional improvement and low revision risk. Fully cementless and resurfacing components are more costly and do not provide any additional benefit for younger patients. [ABSTRACT FROM AUTHOR]

Objective To investigate whether financial reimbursement for a bundle of diabetes care items self-reported by general practitioners (GPs) leads to improved outcomes for women with diabetes. Methods Longitudinal cohort study of women in the Australian Longitudinal Study on Women's Health aged 45–50 and 70–75 years when recruited in 1996. Outcomes Short Form 36-item (SF-36), Medicare and pharmaceutical benefits costs 2002–2005, uptake of annual cycle of care for diabetes (ACC). Results Annual cycle of care claims were identified for 23% of 388 mid-age, and 40% of 616 older women with diabetes. ACC was not associated with statistically significantly higher costs in either group. Women for whom the GP had received an ACC fee were more likely to have been overweight, had more GP visits, more medications, and more ‘no cost’ visits. Unlike older women, mid-age women for whom the GP had received an ACC fee were more likely to have difficulty managing on their income and tended to have worse physical and social function scores prior to the time the ACC was introduced and compared with other women with diabetes continued to have poorer scores at subsequent surveys. There was no association between ACC, co-morbidities or country of birth. Women who developed diabetes after the first survey (incident cases) tended to have better SF-36 health profile scores and lower costs than those who reported diabetes on the first survey (prevalent cases). Conclusions General practitioners of women with diabetes, who have more health care encounters and poorer health-related quality of life, have adopted ACC with little impact on the decline in quality of life of the women nor on health care costs. [ABSTRACT FROM AUTHOR]