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WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: There is mounting evidence indicating that the aging process initiates during early life stages, with in utero the individuals environment playing a significant role. Consequently, it is crucial to comprehend the enduring effects of early life circumstances on health in old age. WHAT IS ADDED BY THIS REPORT?: In this study, we conducted a meta-analysis to examine the effects of the Chinese Famine (1959-1961) on the health of older adults. We also explored potential mechanisms underlying these effects. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: The complex interplay between early life circumstances, multiple health-related sectors, and healthy aging necessitates a comprehensive life-course approach and strategic interventions to enhance public health in an aging society.

BACKGROUND:  Telemedicine expanded rapidly during the COVID-19 pandemic, as key policy changes, financial support, and pandemic fears tipped the balance toward internet-based care. Despite this increased support and benefits to patients and clinicians, telemedicine uptake was variable across clinicians and practices. Little is known regarding physician and institutional characteristics underlying this variability. OBJECTIVE:  This study aimed to evaluate factors influencing telemedicine uptake among frontline physicians in the early pandemic response. METHODS:  We surveyed a national stratified sample of frontline clinicians drawn from the American Medical Association Physician Professional Data in June or July 2020. The survey inquired about the first month and most recent month (June 2020) of pandemic telemedicine use; sample data included clinician gender, specialty, census region, and years in practice. Local pandemic conditions were estimated from county-level data on COVID-19 rates at the time of survey response. Data were analyzed in a weighted logistic regression, controlling for county-specific pandemic data, and weighted to account for survey data stratification and nonresponse. RESULTS:  Over the first 3-4 months of the pandemic, the proportion of physicians reporting use of telemedicine in >30% of visits increased from 29.2% (70/239) to 35.7% (85/238). Relative to primary care, odds of substantial telemedicine use (>30%) both during the first month of the pandemic and in June 2020 were increased among infectious disease and critical care physicians and decreased among hospitalists and emergency medicine physicians. At least minimal prepandemic telemedicine use (odds ratio [OR] 11.41, 95% CI 1.34-97.04) and a high 2-week moving average of local COVID-19 cases (OR 10.16, 95% CI 2.07-49.97) were also associated with substantial telemedicine use in June 2020. There were no significant differences according to clinician gender, censu

In this paper we explore the role of media and language used to comment on economic news in nowcasting and forecasting suicides in England and Wales. This is an interesting question, given the large delay in the release of official statistics on suicides. We use a large data set of over 200,000 news articles published in six major UK newspapers from 2001 to 2015 and carry sentiment analysis of the language used to comment on economic news. We extract daily indicators measuring a set of negative emotions that are often associated with poor mental health and use them to explain and forecast national daily suicide figures. We find that highly negative comments on the economic situation in newspaper articles are predictors of higher suicide numbers, especially when using words conveying stronger emotions of fear and despair. Our results suggest that media language carrying very strong, negative feelings is an early signal of a deterioration in a population's mental health.

Background: Precision health is a rapidly developing field, largely driven by the development of artificial intelligence (AI)–related solutions. AI facilitates complex analysis of numerous health data risk assessment, early detection of disease, and initiation of timely preventative health interventions that can be highly tailored to the individual. Despite such promise, ethical concerns arising from the rapid development and use of AI-related technologies have led to development of national and international frameworks to address responsible use of AI. Objective: We aimed to address research gaps and provide new knowledge regarding (1) examples of existing AI applications and what role they play regarding precision health, (2) what salient features can be used to categorize them, (3) what evidence exists for their effects on precision health outcomes, (4) how do these AI applications comply with established ethical and responsible framework, and (5) how these AI applications address equity and social determinants of health (SDOH). Methods: This protocol delineates a state-of-the-art literature review of novel AI-based applications in precision health. Published and unpublished studies were retrieved from 6 electronic databases. Articles included in this study were from the inception of the databases to January 2023. The review will encompass applications that use AI as a primary or supporting system or method when primarily applied for precision health purposes in human populations. It includes any geographical location or setting, including the internet, community-based, and acute or clinical settings, reporting clinical, behavioral, and psychosocial outcomes, including detection-, diagnosis-, promotion-, prevention-, management-, and treatment-related outcomes. Results: This is step 1 toward a full state-of-the-art literature review with data analyses, results, and discussion of findings, which will also be published. The anticipated consequences on equity from t

Background: Precision health is a rapidly developing field, largely driven by the development of artificial intelligence (AI)–related solutions. AI facilitates complex analysis of numerous health data risk assessment, early detection of disease, and initiation of timely preventative health interventions that can be highly tailored to the individual. Despite such promise, ethical concerns arising from the rapid development and use of AI-related technologies have led to development of national and international frameworks to address responsible use of AI. Objective: We aimed to address research gaps and provide new knowledge regarding (1) examples of existing AI applications and what role they play regarding precision health, (2) what salient features can be used to categorize them, (3) what evidence exists for their effects on precision health outcomes, (4) how do these AI applications comply with established ethical and responsible framework, and (5) how these AI applications address equity and social determinants of health (SDOH). Methods: This protocol delineates a state-of-the-art literature review of novel AI-based applications in precision health. Published and unpublished studies were retrieved from 6 electronic databases. Articles included in this study were from the inception of the databases to January 2023. The review will encompass applications that use AI as a primary or supporting system or method when primarily applied for precision health purposes in human populations. It includes any geographical location or setting, including the internet, community-based, and acute or clinical settings, reporting clinical, behavioral, and psychosocial outcomes, including detection-, diagnosis-, promotion-, prevention-, management-, and treatment-related outcomes. Results: This is step 1 toward a full state-of-the-art literature review with data analyses, results, and discussion of findings, which will also be published. The anticipated consequences on equity from t

Bakgrund: Epilepsi är klassat som en folksjukdom, ca 50 miljoner människor i världen har diagnosen. Epilepsi innebär att personen har ett kroniskt anlag för att få oprovocerade epileptiska anfall. Syfte: Syftet var att undersöka vuxna personers upplevelser av vardagslivet med epilepsi. Metod: En litteraturöversikt med kvalitativ metod och induktiv ansats. Artikelsökningen gjordes i CINAHL och Medline samt kompletterandes med en frisökning. Artiklarna är skrivna mellan 2012 och 2022. Analys av elva artiklar skedde med hjälp av Fribergs granskningsmall. Resultat: Personerna upplevde rädsla för anfall, stigmatisering och utanförskap. Epilepsianfall orsakade frustration då de hindrade personernas vardagsliv. Vårdmöten var en del i vardagslivet, upplevelserna av dessa var individuella. Personerna behövde omvärdera drömmar och mål som en följd av epilepsin. Detta upplevdes ansträngande och när omvärderingen skett fortlöpte livet i en ny riktning. Personerna använde sig av olika strategier för att hantera sitt vardagsliv. De använde direkta problemlösande metoder, fysisk aktivitet, psykisk bearbetning, informatik och stöd från omgivningen. Slutsatser: Alla upplevde vardagen med diagnosen olika. Det finns behov av vidare, mer specifika studier. Utveckling av information för vårdpersonal, samhället och individer är vitalt för att skapa möjligheter för en god och fungerande vardag., Background: Epilepsy is classified as an endemic disease. Around 50 million humans have the diagnosis around the world. Epilepsy is a chronic predisposition for unprovoked epileptic seizures. Aim: Describe adult people's everyday life with epilepsy. Method: A qualitative study with an inductive approach. The article search was made in CINAHL and Medline, with a complementing free search. The articles are written between 2012-2022. Twelve articles were analysed with the Friberg’s review template. Result: The individuals experienced fears of seizures, stigmatization, and exclusion. Epileptic seizures caused frustration as they hindered people's everyday lives, this was managed with the help of information and relatives. Healthcare meetings were part of everyday life, the experiences varied. The persons needed to reassess dreams and goals because of their epilepsy. This was a taxing process and afterwards life continued in a new direction. The people used different strategies to manage their everyday life. They adopted direct problem-solving methods, physical activity, mental processing, informatics, and support from society. Conclusion: All subjects experienced everyday life with the diagnosis differently. There is a need for more specific studies. Development of information for healthcare professionals, society and individuals is vital to create opportunities for a good and functioning everyday life.

Background: Physical activity (PA) during pregnancy is an effective and safe way to improve maternal health in uncomplicated pregnancies. However, compliance with PA recommendations remains low among pregnant women. Objective: The purpose of this study was to evaluate the effects of offering structured supervised exercise training (EXE) or motivational counseling on PA (MOT) during pregnancy on moderate-to-vigorous intensity physical activity (MVPA) level. Additionally, complementary measures of PA using the Pregnancy Physical Activity Questionnaire (PPAQ) and gold standard doubly labeled water (DLW) technique were investigated. The hypotheses were that both EXE and MOT would increase MVPA in pregnancy compared with standard care (CON) and that EXE would be more effective than MOT. In addition, the association between MVPA and the number of sessions attended was explored. Methods: A randomized controlled trial included 220 healthy, inactive pregnant women with a median gestational age of 12.9 (IQR 9.4-13.9) weeks. A total of 219 women were randomized to CON (45/219), EXE (87/219), or MOT (87/219). The primary outcome was MVPA (minutes per week) from randomization to the 29th gestational week obtained by a wrist-worn commercial activity tracker (Vivosport, Garmin International). PA was measured by the activity tracker throughout pregnancy, PPAQ, and DLW. The primary outcome analysis was performed as an analysis of covariance model adjusting for baseline PA. Results: The average MVPA (minutes per week) from randomization to the 29th gestational week was 33 (95% CI 18 to 47) in CON, 50 (95% CI 39 to 60) in EXE, and 40 (95% CI 30 to 51) in MOT. When adjusted for baseline MVPA, participants in EXE performed 20 (95% CI 4 to 36) minutes per week more MVPA than participants in CON (P=.02). MOT was not more effective than CON; EXE and MOT also did not differ. MVPA was positively associated with the number of exercise sessions attended in EXE from randomization to delivery

CCS often wish to have biological children yet harbour concerns about fertility impairment, pregnancy risks and the general health risks of prospective offspring. To clarify these concerns, health outcomes in survivor offspring born following ART (n = 74, 4.5%) or after spontaneous conception (n = 1585) were assessed in our European offspring study by descriptive and bivariate analysis. Outcomes were compared to a sibling offspring cohort (n = 387) in a 4:1 matched-pair analysis (n = 1681). (i) Survivors were more likely to employ ART than their siblings (4.5% vs. 3.7%, p = 0.501). Successful pregnancies were achieved after a median of one cycle with, most commonly, intracytoplasmic sperm injection (ICSI) using non-cryopreserved oocytes/sperm. (ii) Multiple-sibling births (p < 0.001, 29.7% vs. 2.5%), low birth weight (p < 0.001; OR = 3.035, 95%-CI = 1.615–5.706), and preterm birth (p < 0.001; OR = 2.499, 95%-CI = 1.401–4.459) occurred significantly more often in survivor offspring following ART utilisation than in spontaneously conceived children. ART did not increase the prevalence of childhood cancer, congenital malformations or heart defects. (iii) These outcomes had similar prevalences in the sibling population. In our explorative study, we could not detect an influence on health outcomes when known confounders, such as multiple births, were taken into account., + ID der Publikation: unilu_59897 + Sprache: Englisch + Letzte Aktualisierung: 2022-09-26 16:30:11

Background: Homelessness has been associated with multiple detrimental health outcomes across observational studies. However, relatively few randomized controlled trials (RCTs) have been conducted on people who experience homelessness (PEH). Thus, this umbrella review ranked the credibility of evidence derived from systematic reviews (SRs) and meta-analyses (MAs) of observational studies investigating the associations between homelessness and any health outcome as well as RCTs targeting health needs in this population. Methods: Several databases were systematically searched from inception through April 28, 2021. Any SR and/or MA reporting quantitative data and providing a control group were eligible for inclusion. The credibility of the evidence derived from observational studies was appraised by considering the significance level of the association and the largest study, the degree of heterogeneity, the presence of small-study effects as well as excess significance bias. The credibility of evidence was then ranked in five classes. For SRs and/or MAs of RCTs, we considered the level of significance and whether the prediction interval crossed the null. The AMSTAR-2 and AMSTAR-plus instruments were adopted to further assess the methodological quality of SRs and/or MAs. The Newcastle-Ottawa Scale (NOS) was employed to further appraise the methodological quality of prospective cohort studies only; a sensitivity analysis limited to higher quality studies was conducted. Results: Out of 1549 references, 8 MAs and 2 SRs were included. Among those considering observational studies, 23 unique associations were appraised. Twelve of them were statistically significant at the p≤0.005 level. Included cases had worst health-related outcomes than controls, but only two associations reached a priori-defined criteria for convincing (class I) evidence namely hospitalization due to any cause among PEH diagnosed with HIV infection, and the occurrence of falls within the past year among

This thesis aims at examining the relationship between single motherhood and the health and academic performance of children in different countries. It was geared toward understanding whether single motherhood has an impact or consequences on the health and academic performance of children. In order to attain this goal, this thesis was sub divided into three main parts (sections) namely; examining whether single motherhood has consequences on the health outcome of children, examining whether single motherhood has consequences on the academic performance of children and finally ascertaining the impact of single motherhood on children's health and academic performance in different economies (Sweden and Germany). Furthermore, this study adopted the quantitative and cross-cultural approach where quantitative data was obtained across different countries. The Health Behaviour of School aged Children (HBSC) constituted the main source from which responses, respondents and data collection instrument was obtained. After thorough statistical analysis, the regression mode was used to establish that single motherhood reduced the quality of health and academic outcome of children and thus reflecting a negative impact of single motherhood on the child's health and academic performance. A cross comparison approach was used to ascertain the economies of Sweden and Germany and compared against the impact of single motherhood on the children's health and academic performance in these two countries. It was then revealed that the impact of single motherhood on children's health and academic performance was dire and common in Germany than Sweden. The study finally concluded that single motherhood negatively impacted the health and academic performance of children with varying impact in different economic context., Denna uppsats syftar till att undersöka förhållandet mellan ensamstående moderskap och barns hälsa och akademiska prestationer i olika länder. Det var inriktat på att förstå om ensamstående moderskap har en inverkan eller konsekvenser för barns hälsa och akademiska prestationer. För att uppnå detta mål delades denna uppsats upp i tre huvuddelar (avsnitt), nämligen; undersöka om ensamstående moderskap har konsekvenser för barns hälsoutfall, undersöka om ensamstående moderskap har konsekvenser för barns akademiska prestationer och slutligen fastställa effekterna av ensamstående moderskap på barns hälsa och akademiska resultat i olika ekonomier (Sverige och Tyskland). Vidare antog denna studie det kvantitativa och tvärkulturella tillvägagångssättet där kvantitativa data erhölls i olika länder. HBSC (Health Behavior of School Age Children) utgjorde den huvudsakliga källan från vilken svar, respondenter och datainsamlingsinstrument erhölls. Efter noggrann statistisk analys användes regressionsläget för att fastställa att ensamstående moderskap minskade barns hälsa och akademiska resultat och därmed återspeglade en negativ inverkan av ensamstående moderskap på barnets hälsa och akademiska prestationer. En tvärjämförelsestrategi användes för att fastställa ekonomierna i Sverige och Tyskland och jämfördes mot inverkan av ensamstående moderskap på barnens hälsa och akademiska prestationer i dessa två länder. Det avslöjades sedan att ensamstående moderskaps inverkan på barns hälsa och akademiska prestationer var hemskt och vanligt i Tyskland än Sverige. Undersökningen drog slutligen slutsatsen att ensamstående moderskap påverkade barns hälsa och akademiska prestationer negativt i olika ekonomiska sammanhang.

While the slow death of retail is unraveling in cities nationwide, some local shopping areas still serve an important community value. Main street retail areas are venues for commercial activity and anchor the neighborhood’s economic environment (Mehta & Bosson, 2010). The types of businesses that are found in these spaces indicate sociodemographic aspects of their nearby neighborhoods. Main streets can be homes to a variety of businesses. From a health perspective, businesses that are considered to be “health-harming” are often concentrated in underprivileged neighborhoods and are associated with higher rates of chronic disease (Cummins et al., 2007). Planning tools and policies permit such retail businesses to exist in these spaces, potentially causing adverse health impacts to the residents. Pinpointing the specific mechanisms that create health-promoting or health-harming conditions in these retail corridors s is crucial to understanding retail’s impact on communities’ health. Developing a scale for scoring business types helps us understand community-specific health outcomes for the neighborhoods near retail corridors; it could also reveal the disparate quality of life impacts that exist in different commercial corridors. With this in mind, the research that follows will examine health disparities within the broader scope of planning and policy practices. To this end, this project aims to explore the extent to which the concentration of healthy and unhealthy establishments along Los Angeles’s Main streets and retail corridors relate to the sociodemographic characteristics of their adjacent neighborhoods. Questions that frame this research are: Do high ranking businesses appear around places where people tend to be healthier because of socio-economic status? Do high ranking businesses relate to better health for the adjacent population? Methods used in this research include the mapping of Main street retail areas, deploying an index that scores the extent to

Background: Health behaviours (physical activity, maintenance of a healthy diet and not smoking) are known to be beneficial to

In response to the rising financial pressure on old-age pension systems in industrialised economies, many European countries plan to increase the eligibility age for retirement pensions. We used data from Sweden to examine whether (and if so, how) retirement after age 65 – the eligibility age for basic pension – compared to retiring earlier affects older adults’ (between ages 70 and 85) cognitive functioning. Using a propensity score matching (PSM) approach, we addressed the selection bias potentially introduced by non-random selection into either early or late retirement. We also examined average and heterogeneous treatment effects (HTEs). HTEs were evaluated for different levels of cognitive stimulation from occupational activities before retirement and from leisure activities after retirement. We drew from a rich longitudinal data-set linking two nationally representative Swedish surveys with a register data-set and found that, on average, individuals who retire after age 65 do not have a higher level of cognitive functioning than those who retire earlier. Similarly, we did not observe HTEs from occupational activities. With respect to leisure activities, we found no systematic effects on cognitive functioning among those working beyond age 65. We conclude that, in general, retirement age does not seem to affect cognitive functioning in old age. Yet, the rising retirement age may put substantial pressure on individuals who suffer from poor health at the end of their occupational career, potentially exacerbating social- and health-related inequalities among older people.

Background: Medication use in people with dementia and/or cognitive impairment (PWD/CI) is challenging. As medication experts, pharmacists have an important role in improving care of this vulnerable population. Objective: Systematically review evidence for the effectiveness of pharmacist-led interventions on quality use of medicines, quality of life, and health outcomes of PWD/CI. Methods: Asystematic review was conducted using MEDLINE, EMBASE, PsycINFO, Allied and Complementary Medicine (AMED) and Cumulative index to Nursing and Allied Health Literature (CINAHL) databases from conception to 20 March 2017. Full articles published in English were included. Data were synthesized using a narrative approach. Results: Nine studies were eligible for inclusion. All studies were from high-income countries and assessed pharmacist-led medication management services. There was great variability in the content and focus of services described and outcomes reported. Pharmacists were found to provide a number of cognitive services including medication reconciliation, medication review, and medication adherence services. These services were generally effective with regards to improving quality use of medicines and health outcomes for PWD/CI and their caregivers, and for saving costs to the healthcare system. Pharmacistled medication and dementia consultation services may also improve caregiver understanding of dementia and the different aspects of pharmacotherapy, thus improving medication adherence. Conclusion: Emerging evidence suggests that pharmacist-led medication management services for PWD/CI may improve outcomes. Future research should confirm these findings using more robust study designs and explore additional roles that pharmacists could undertake in the pursuit of supporting PWD/CI.

Objective: To examine the associations between multiple health behaviours and health outcomes among older Chinese adults. Methods: Data from the World Health Organization’s Study on global AGEing and adult health Wave 1 (2007–2010), collected among the older Chinese population, were included in this study. Smoking, diet, and physical activity were analysed by linear regression for any associations with depressive symptoms, quality of life (QoL), cognitive function, and physical function. Results: A total of 13 367 participants aged >49 years were included in the analyses. After controlling for key socioeconomic factors, healthy diet was significantly associated with higher QoL (b ¼ 0.099) and better cognitive function (b ¼ 0.023). Physical activity was significantly associated with fewer depressive symptoms (b ¼ –0.020), higher QoL (b ¼ 0.086), better cognitive function (b ¼ 0.072), and better physical function (b ¼ –0.155 [higher scores ¼ poorer physical function]). No relationship was found between smoking and any health-related outcome included in this study. Conclusion: This study demonstrates the importance of healthy diet and physical activity for health outcomes in the older Chinese population.

Poverty it is said to have harsh outcomes on one's antisocial or even delinquent behavior. Other factors as well lead an individual to antisocial behavior those are the environment that they are living, and their genes that have passed from one generation to the other one. Parents, poverty, environment, genes and social determinants affect one's involvement in a crime and also affect the health in distinct ways. The focus of this essay is on the African American population within the American society and the health disparities that exist in this situation. We try to understand and answer if these health disparities were created after their birth, or pre-existed and were carried through the generations. One of the main issues is the examination of how much is the prison or incarceration in charge for these health disparities, or how much did these disparities previously exist, out of other reasons. These issues are put on a life-course perspective, and there is shown how much these morbidities affect one's life from the beginning till incarceration. A certain policy implication is made to eliminate those disparities by improving maternal, child and family health status.

The goal of this contribution is to shed light on the benefits for research in health care coming from the use of administrative data, especially in terms of measuring hospitals’ outcomes. The main approaches to health outcome evaluation are reviewed and the possible improvements deriving from the use of administrative data are highlighted. Administrative data may be an essential element in the process of gathering to the public true rankings of health care organizations, reducing the degree of asymmetric information that typically arises in health care. Patients will be more aware of the best institutions, which will induce most of them to demand to be admitted in them, taking into account the costs associated with distance and with the severity of the illness. This in turn may ask for a reorganization of the sector, closing some organizations and expanding others, having as final goal to improve the health status of the population, without income barriers. This is one of the first attempts to provide an overview of the advantages that administrative data may gather in health care.

We study the relationship between macroeconomic conditions and self-reported health in a large sample of Italian individuals, focusing on the mediating role played by health behaviors (smoking, alcohol consumption, physical activity, eating habits) and economic stress. Our findings indicate that, overall, higher local unemployment is negatively related to individuals’ health conditions. A one percentage point increase in the province-level unemployment rate is associated with a significant increase in the probability of experiencing diabetes (0.03 percentage points), infarction (0.01), ulcer (0.06), cirrhosis (0.01) and nervous disorders (0.07), with a time lag that differs across individual health conditions. Employment status and educational level play a significant role as moderators of these relationships. Eating habits, in addition to economic stress, play a key role as mediators, by enhancing the negative relationship between macroeconomic conditions and health outcomes, while physical exercise is found to play a dampening role

Aim To summarize, critically review, and interpret the evidence related to the systematic reviews on health literacy (HL) amongst type 2 diabetes mellitus (T2DM). Methods The methodology for this study consisted of a systematic review of systematic reviews, using the PRISMA statement and flowchart to select studies, and searching on PubMed, CINAHL, Scopus, and Cochrane. The search covered the period between January 2006 and June 2016. Results From the 115 identified record by the queries, only six systematic reviews were included, following a quality evaluation using AMSTAR. The included systematic reviews content was analyzed by the independent work of two authors, using a narrative synthesis approach. The findings of this study (i.e., main themes) are areas of consensus and gaps in knowledge. Areas of consensus are HL definition, HL measurement tools, and the relationship between T2DM patient knowledge (or literacy) and his/her HL. The gaps in knowledge were the assessment of the relations between HL and health outcomes and self-efficacy, the gender differences, the effectiveness of interventions to improve HL, the cost-effectiveness study of interventions to improve HL, and the understanding of the influence of organizational environment on HL. Conclusion This review provides a current state of knowledge to address clinical practice and research proposals. HL could be useful to personalize patients' follow-up and it should be routinely assessed in its three dimensions (i.e. functional, interactive and critical) to enhance patients' ability to cope with clinical recommendations. Future research should be mainly aimed to test the effectiveness of evidence-based interventions to improve HL amongst T2DM patients.

The research project addresses three main questions: Who are the persons that continue to work after “normal” retirement age? What are their motivations? What are the consequences for the individual and for society? To answer these questions we perform an analysis of external and internal factors affecting the choice to stay after 65 years on the labour market or to leave earlier. Among external factors we investigate are: The impact of the prevailing labour laws and regulations on senior citizens’ participation on the labour market ; The socio-economic factors that affect the likelihood to stay on the labour market after the age of 65 ; The impact of employers’ human resource strategies on the possibility for senior workers to remain on the labour market after the age of 65 years. We also analyse the the role of individ specific factors such as motivation and , personal traits but the outcome in terms of subjective well-being and health.

Background: Australia and New Zealand have the highest incidence of colorectal cancer (CRC) in the world, presenting considerable health, economic, and societal burden. Over a third of the Australian population live in regional areas and research has shown they experience a range of health disadvantages that result in a higher disease burden and lower life expectancy. The extent to which geographical disparities exist in CRC management and outcomes has not been systematically explored. The present review aims to identify the nature of geographical disparities in CRC survival, clinical management, and psychosocial outcomes. Methods: The review followed PRISMA guidelines and searches were undertaken using seven databases covering articles between 1 January 1990 and 20 April 2016 in an Australian setting. Inclusion criteria stipulated studies had to be peer-reviewed, in English, reporting data from Australia on CRC patients and relevant to one of fourteen questions examining geographical variations in a) survival outcomes, b) patient and cancer characteristics, c) diagnostic and treatment characteristics and d) psychosocial and quality of life outcomes. Results: Thirty-eight quantitative, two qualitative, and three mixed-methods studies met review criteria. Twenty-seven studies were of high quality, sixteen studies were of moderate quality, and no studies were found to be low quality. Individuals with CRC living in regional, rural, and remote areas of Australia showed poorer survival and experienced less optimal clinical management. However, this effect is likely moderated by a range of other factors (e.g., SES, age, gender) and did appear to vary linearly with increasing distance from metropolitan centres. No studies examined differences in use of stoma, or support with stomas, by geographic location. Conclusions: Overall, despite evidence of disparity in CRC survival and clinical management across geographic locations, the evidence was limited and at times inconsiste

Using a 2004 Japanese natural experiment affecting physician supply, we study the physician labor market and its effects on hospital exits and health outcomes. Although physicians play a central role in determining the performance of a healthcare system, identifying their impacts are difficult because physician supply is endogenously determined. We circumvent the problem by exploiting an exogenous shock to physician supply created by the introduction of a new residency program – our natural experiment. Based on panel data covering all physicians in Japan, we find that the introduction of a new residency program substantially decreased the supply of physicians in some rural markets where local hospitals had relied on university hospitals for filling physician positions. We also find that physician market wages increased in the affected markets relative to less affected markets. Finally, we find that this change in physician market wages forced hospitals to exit affected markets and negatively affected patient health outcomes in those markets. These effects may be exacerbated by the fact that the healthcare market was rigidly price-regulated. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

We study the presence and the magnitudes of trade-offs between health outcomes and hospitals' efficiency using a data set from Lombardy, Italy, for the period 2008–2011. Our goal is to analyze whether the pressures for cost containment may affect hospital performance in terms of population health status. Unlike previous work in this area, we analyze hospitals at the ward level so comparisons can be made across more homogeneous treatments. We focus on two different health outcomes: mortality and readmission rates. We find that there is a trade-off between mortality rates and efficiency, as more efficient hospitals have higher mortality rates. We also find, however, that more efficient hospitals have lower readmission rates. Moreover, we show that focusing the analysis at the ward level is essential, since there is evidence of higher mortality rates in general medicine and surgery, while in oncology mortality is lower in more efficient hospitals. Furthermore, we find that consideration of spatial processes is important since mortality rates are higher for hospitals subject to high degree of horizontal competition, but lower for those hospitals having strong competition but high efficiency. This implies that the interplay of efficient resource allocation and hospital competition is important for the sustainability and effectiveness of regional health care systems.

A provocative finding from several double-blind clinical trials has been the association between greater adherence to placebo study medication and better health outcomes. We used data from the Studies of Left Ventricular Dysfunction (SOLVD) Treatment Trial (SOLVD-TT) and the SOLVD Prevention Trial (SOLVD-PT) to examine whether such associations could be validated and to examine several sources of bias and potential confounding. Survival analytic methods were used to estimate the association between placebo adherence and several health outcomes, employing a number of modeling techniques to test for the existence of alternative explanations for the association. Higher adherence was defined as having taken ≥75% of prescribed study medication. Higher placebo adherence was associated with improved overall survival in both SOLVD-TT and SOLVD-PT [hazard ratio (HR) = 0.52, 95% confidence interval (CI): 0.35 to 0.79 and HR = 0.52, 95%CI: 0.38 to 0.71, respectively]. Associations were similar for fatal or non-fatal cardiovascular or coronary heart disease events. Adjustment for both modifiable and non-modifiable cardiac risk factors (including age, gender, diabetes, blood pressure, smoking, weight, alcohol use, and levels of education) had minimal effect on the strength of the association. Little evidence of bias was found as an explanation for this relationship. In these two trials, better adherence to placebo was associated with markedly superior health outcomes, including total in-study mortality and incident cardiovascular events. No important confounders were identified. These data suggest there may exist strong but unrecognized determinants of health outcomes for which placebo adherence is a marker.

This study aimed to determine whether continuous subcutaneous insulin infusion (CSII) is associated with improved quality of life (QoL) in routine care in the UK. We conducted a multiple cohort survey study of individuals with type 1 diabetes (matched for age, gender and frequency of blood glucose testing) using either CSII or multiple daily insulin injections (MDI). The World Health Organization QoL abbreviated questionnaire (WHOQOL-BREF), the Insulin Delivery System Rating Questionnaire (IDSRQ), the Problem Areas in Diabetes Scale (PAID), and the Hypoglycaemia Fear Scale (HFS) were used to assess QoL. In all, 642 people with type 1 diabetes returned questionnaires: 228 insulin pump users, 332 people using MDI and 82 using non-intensive insulin delivery. After controlling for confounding variables, CSII users reported that their treatment is more helpful (IDSRQ F=38.41, p<0.001), that it generates less worry (IDSRQ F=6.26, p<0.05), and that they are less likely to use hypoglycaemia avoidance behaviours (HFS F=467, p<0.05) and have fewer food-related problems (PAID p<0.01). In conclusion, even after controlling for self-care motivation, duration of current therapy and socio-economic environment, individuals using CSII reported better QoL than a matched cohort of individuals managing their diabetes using MDI.

Currently, there is a need for qualitative research about how insulin pump therapy changes quality of life, which is significant to people with type 1 diabetes. This study aimed to elicit thd experiences of current insulin pump users in order to discover the therapy's benefits, downsides and effect on their quality of life. A qualitative approach was taken in order to reveal subjective experiences. This research will inform future research and assist with policy and guideline development by health care providers about pump therapy. Participants were briefly interviewed by telephone about their experiences of living with an insulin pump. Four questions were asked. These covered the benefits of pump use, effects on quality of life, whether participants experienced downsides to using a pump and any other issues participants wished to raise. In all, 80 insulin pump users participated in the, study. All 80 reported experiencing benefits; insulin pump use had improved their quality of life. Key positive themes emerging from the data included greater control (45), flexibility (33), freedom (28), family effects (seven), convenience (seven) and independence (five). Key drawbacks emerging from the data included visibility - device (25), breakdown (17), visibility - skin (five) and cost (three). Participants overwhelmingly reported experiencing benefits and improvements in their quality of life associated with insulin pump use. These pump users remain on pump therapy by choice, so the benefits clearly outweigh the downsides. However, further work needs to determine if these downsides contribute to explaining why 2-4% of pump users discontinue pump use after a short period of time, or whether this is a result of other factors.

Ireland, M. J., March, S., Crawford-Williams, F., Cassimatis, M., Aitken, J. F., Hyde, M. K., & Dunn, J. (2017). A systematic review of geographical differences in management and outcomes for colorectal cancer in Australia. BMC cancer, 17(1), 95. Available http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made Available in this article, unless otherwise stated.