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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]

Background Schizophrenia is a chronic disease associated with significant and long-lasting effects on health, and it is also a social and financial burden, not only for patients but also for families, other caregivers, and the wider society. It is essential to conduct the assessment of indirect costs, to understand all the effects of the disease on society. Our aim is to gain a better understanding of the indirect costs of schizophrenia in Europe. Methods We conducted a comprehensive systematic literature review covering EMBASE, Medline, and PsycINFO as well as reviewing Health Technology Assessment databases from different countries. We used a qualitative research synthesis for presenting information, as most of the studies were methodologically diverse, a quantitative analysis would have been impractical. Results Indirect cost adjusted to inflation ranged vastly between studies included in the review from 119 Euros to 62, 034 Euros annually. The average proportion of indirect costs of total costs was 44%. Studies highlighted important cost drivers as age, gender, and disease severity, explaining the variation in costs between treatment and patient groups. Conclusions Regardless of the methodological heterogeneity of the reviewed studies, there was an agreement about the significance of indirect costs of schizophrenia on the society. Considering the relatively high prevalence of schizophrenia in Europe, a need for more cost of illness studies especially from Central Eastern and Southern Europe is suggested. [ABSTRACT FROM AUTHOR]

High sodium (Na) diet is one of the leading behavioural risks of disease identified in the Singapore Burden of Disease Study. We aim to estimate the cost attributable to a high Na diet in Singapore in 2019 from a societal perspective by employing a prevalence-based approach in cost-of-illness studies. We extracted national-level healthcare data and population attributable fractions by sex and age. Costs included direct and indirect costs from inpatient treatment and productivity losses. In 2019, the annual societal cost attributable to a high Na diet was conservatively estimated to be USA$262 million (95 % uncertainty interval (UI) 218, 359 million). At least USA$67·8 million (95 % UI 48·4, 120 million) and USA$194 million (95 % UI 153, 274 million) could be saved on healthcare and indirect costs, respectively, if the daily Na intake of Singaporeans was reduced to an average of 3 g. Overall, males had higher costs compared with females at USA$221 million (95 % UI 174, 312 million) and USA$41·1 million (95 % UI 33·5, 61·7 million), respectively. Productivity loss from foregone wages due to premature mortality had the largest cost at USA$191 million (95 % UI 150, 271 million). CVD had the largest healthcare expenditure at USA$61·4 million (95 % UI 41·6, 113 million), driven by ischaemic heart disease at USA$41·0 million (95 % UI 21·4, 88·9 million). Our study found that reducing Na intake could reduce future healthcare expenditures and productivity losses. This result is vital for policy evaluation in a rapidly ageing society like Singapore, where the burden of diseases associated with high Na diet is expected to increase. [ABSTRACT FROM AUTHOR]

Objective: There exists enormous variation in estimates of the lifetime cost of adolescent obesity by race. To justify policy measures to reduce obesity rates nationally in this demographic, the costs of obesity in late adolescence must first be discerned. Although several researchers have sought to quantify obesity's true cost, none has accounted for race-specific age-related weight gain, a vital component in producing an accurate estimate.Methods: This paper employs a Markov model of BMI category state changes separately for black and white males and females from age 18 to 75 applied to updated estimates of obesity's costs and effect on mortality to quantify the median lifetime cost of obesity at age 18.Results: This study found lower lifetime costs than previously, largely because of the dramatic gain in weight among normal-weight individuals, particularly black males, that occurs in early adulthood.Conclusions: A substantial portion of obesity's prevalence, and therefore cost, for black males and females comes from age-related weight gain in early adulthood. This speaks to the persistent threat of obesity beyond adolescence for this demographic, and further research should focus on whether policy can modify the behaviors and environment through which and in which this sharp increase in weight occurs. [ABSTRACT FROM AUTHOR]

In this paper, the effects on aggregate consumption of changes in the age distribution of the population are analysed empirically. Economic theories predict that age influences individuals’ saving and consumption behaviour. Despite this, age structure effects are rarely controlled for in empirical consumption functions. Our findings suggest that they should. By analysing Norwegian quarterly time series data, we find that changes in the age distribution of the population have significant and life-cycle-consistent effects on aggregate consumption. Furthermore, controlling for age structure effects stabilises the other parameters of the consumption function and reveals significant real interest rate effects. [ABSTRACT FROM AUTHOR]

Road traffic crashes have been an increasing threat to the wellbeing of road users worldwide; an unacceptably high number of people die or become disabled from them. While high-income countries have successfully implemented effective interventions to help reduce the burden of road traffic injuries (RTIs) in their countries, low- and middle-income countries (LMICs) have not yet achieved similar results. Both scientific research and capacity development have proven to be useful for preventing RTIs in high-income countries. In 1999, a group of leading researchers from different countries decided to join efforts to help promote research on RTIs and develop the capacity of professionals from LMICs. This translated into the creation of the Road Traffic Injuries Research Network (RTIRN) - a partnership of over 1,100 road safety professionals from 114 countries collaborating to facilitate reductions in the burden of RTIs in LMICs by identifying and promoting effective, evidenced-based interventions and supporting research capacity building in road safety research in LMICs. This article presents the work that RTIRN has done over more than a decade, including production of a dozen scientific papers, support of nearly 100 researchers, training of nearly 1,000 people and 35 scholarships granted to researchers from LMICs to attend world conferences, as well as lessons learnt and future challenges to maximize its work. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to understand the composition and influencing factors of epilepsy patients' hospitalization expenses, thus providing a reference for reducing the disease burden of epilepsy patients in low- and middle-income developing countries. Methods: A total of 4206 hospitalized cases of epilepsy from 2018 to 2020 were collected. Descriptive statistics were used to understand the patient cost composition, path analysis was used to understand the direct and indirect factors of hospitalization expenses. Results: From 2018 to 2020, the average hospitalization expenses for epilepsy patients was 4,299.93 RMB yuan, and the average length of stay was 2.47 days. The highest proportion of hospitalization expenses was diagnosis costs (> 50%), followed by comprehensive medical service costs and drug costs. In terms of the total effect coefficient, the major factors affecting the hospitalization expenses were length of stay (0.880), emergency admission(0.463), and the comorbidities and complications(> 0.250). Hospital length of stay, discharge mode(death) and number of hospitalizations(2 times) affect hospitalization expenses through direct effect. Long-term hospitalization (> 30 days), admission routes(emergency), the comorbidities and complications, presence of drug allergy, and age also affect hospitalization expenses through indirect effects. Conclusion: Diagnosis costs and length of stay are important factors affecting the medical expenses of epilepsy inpatients. In general, the quality control of the hospital is good, but it still needs to standardize the diagnosis and treatment behavior of medical staff through the clinical path. [ABSTRACT FROM AUTHOR]

Background In Britain, the tobacco industry segments cigarettes into four price categories—premium, mid-price, economy and ultra-low-price (ULP). Our previous work shows that tobacco companies have kept ULP prices stable in real terms. Roll your own (RYO) tobacco remains cheaper still. Methods Analysis of 2001–08 General Household Survey data to examine trends in use of these cheap products and, using logistic regression, the profile of users of these products. Results Among smokers, the proportion using cheap products (economy, ULP and RYO combined) increased significantly in almost all age groups and geographic areas. Increases were most marked in under 24 year olds, 76% of whom smoked cheap cigarettes by 2008. All cheap products were more commonly used in lower socio-economic groups. Men and younger smokers were more likely to smoke RYO while women smoked economy brands. Smokers outside London and the South East of England were more likely to smoke some form of cheap tobacco even once socio-economic differences were accounted for. Conclusions This paper demonstrates that cheap tobacco use is increasing among young and disadvantaged smokers compromising declines in population smoking prevalence. Thus, tobacco industry pricing appears to play a key role in explaining smoking patterns and inequalities in smoking. [ABSTRACT FROM PUBLISHER]

Objectives: This paper explores, from the patients' perspective, the likely impact of the Australian after-hours house-call (AHHC) medical services on emergency department (ED) presentations. This has become imperative given the significant cost difference between patient presentations to either the AHHC or ED and their practical implications for health care funding.Design, setting and participants: A cross-sectional, self-reported survey of all 10 838 patients in Australia known to have patronized AHHC services over the last week of January 2016.Main outcome measure: The study used a validated, self-completion questionnaire, dispatched through a mixture of online and postal methods.Results: A total of 1228 questionnaires were returned, of which 1211 included all relevant sections of the survey (11.2% response rate). Four hundred and eighty-six patients (40.1%) indicated that they would have gone to the ED on the same day or night of their illness had the AHHC not been available, with the elderly (≥65) and children (<16) accounting for nearly two-thirds of these (64.6%). Following their AHHC consultations, 103 (8.5%) patients eventually attended the ED, meaning that the service prevented 383 patients from attending the ED, a decrease of 78.8%. Stratification based on location showed that this impact was seen across all states and territories in Australia where AHHC services exist, ranging from a reduction of 73.9% in Western Australia to 85.0% in Tasmania. Similarly, the impact cuts across all patient demographics, including age ranges, gender and social divides.Conclusions: Based on our respondents' reports, AHHC services appear to be associated with a reduction in ED visits in Australia, with the impact cutting across all regions and patient demographics. [ABSTRACT FROM AUTHOR]

Background: The National Institute for Health and Care Excellence (NICE) recommends evidence-based parenting programmes as a first-line intervention for conduct disorders (CD) in children aged 5-11 years. As these are not effective in 25-33% of cases, NICE has requested research into second-line interventions. Child and Adolescent Psychotherapists (CAPTs) address highly complex problems where first-line treatments have failed and there have been small-scale studies of Psychoanalytic Child Psychotherapy (PCP) for CD. A feasibility trial is needed to determine whether a confirmatory trial of manualised PCP (mPCP) versus Treatment as Usual (TaU) for CD is practicable or needs refinement. The aim of this paper is to publish the abridged protocol of this feasibility trial.Methods and Design: TIGA-CUB (Trial on improving Inter-Generational Attachment for Children Undergoing Behaviour problems) is a two-arm, pragmatic, parallel-group, multicentre, individually randomised (1:1) controlled feasibility trial (target n = 60) with blinded outcome assessment (at 4 and 8 months), which aims to develop an optimum practicable protocol for a confirmatory, pragmatic, randomised controlled trial (RCT) (primary outcome: child's behaviour; secondary outcomes: parental reflective functioning and mental health, child and parent quality of life), comparing mPCP and TaU as second-line treatments for children aged 5-11 years with treatment-resistant CD and inter-generational attachment difficulties, and for their primary carers. Child-primary carer dyads will be recruited following a referral to, or re-referral within, National Health Service (NHS) Child and Adolescent Mental Health Services (CAMHS) after an unsuccessful first-line parenting intervention. PCP will be delivered by qualified CAPTs working in routine NHS clinical practice, using a trial-specific PCP manual (a brief version of established PCP clinical practice). Outcomes are: (1) feasibility of recruitment methods, (2) uptake and follow-up rates, (3) therapeutic delivery, treatment retention and attendance, intervention adherence rates, (4) follow-up data collection, and (5) statistical, health economics, process evaluation, and qualitative outcomes.Discussion: TIGA-CUB will provide important information on the feasibility and potential challenges of undertaking a confirmatory RCT to evaluate the effectiveness and cost-effectiveness of mPCP.Trial Registration: Current Controlled Trials, ID: ISRCTN86725795 . Registered on 31 May 2016. [ABSTRACT FROM AUTHOR]

Background: Many community-based self-management programs have been developed for older adults with type-2 diabetes mellitus (T2DM), bolstered by evidence from randomized controlled trials (RCTs) that T2DM can be prevented and managed through lifestyle modifications. However, the evidence for their effectiveness is contradictory and weakened by reliance on single-group designs and/or small samples. Additionally, older adults with multiple chronic conditions (MCC) are often excluded because of recruiting and retention challenges. This paper presents a protocol for a two-armed, multisite, pragmatic, mixed-methods RCT examining the effectiveness and implementation of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP), a new 6-month interprofessional, nurse-led program to promote self-management in older adults (aged 65 years or older) with T2DM and MCC and support their caregivers (including family and friends).Methods/design: The study will enroll 160 participants in two Canadian provinces, Ontario and Alberta. Participants will be randomly assigned to the control (usual care) or program study arm. The program will be delivered by registered nurses (RNs) and registered dietitians (RDs) from participating diabetes education centers (Ontario) or primary care networks (Alberta) and program coordinators from partnering community-based organizations. The 6-month program includes three in-home visits, monthly group sessions, monthly team meetings for providers, and nurse-led care coordination. The primary outcome is the change in physical functioning as measured by the Physical Component Summary (PCS-12) score from the short form-12v2 health survey (SF-12). Secondary client outcomes include changes in mental functioning, depressive symptoms, anxiety, and self-efficacy. Caregiver outcomes include health-related quality of life and depressive symptoms. The study includes a comparison of health care service costs for the intervention and control groups, and a subgroup analysis to determine which clients benefit the most from the program. Descriptive and qualitative data will be collected to examine implementation of the program and effects on interprofessional/team collaboration.Discussion: This study will provide evidence of the effectiveness of a community-based self-management program for a complex target population. By studying both implementation and effectiveness, we hope to improve the uptake of the program within the existing community-based structures, and reduce the research-to-practice gap.Trial Registration: ClinicalTrials.gov, Identifier: NCT02158741 . Registered on 3 June 2014. [ABSTRACT FROM AUTHOR]

Background: Expenditure on medications for highly prevalent chronic conditions such as diabetes mellitus (DM) can result in financial impoverishment. People in developing countries and in low socioeconomic status groups are particularly vulnerable. China and India currently hold the world's two largest DM populations. Both countries are ageing and undergoing rapid economic development, urbanisation and social change. This paper assesses the determinants of DM medication use and catastrophic expenditure on medications in older adults with DM in China and India.Methods: Using national standardised data collected from adults aged 50 years and above with DM (self-reported) in China (N = 773) and India (N = 463), multivariable logistic regression describes: 1) association between respondents' socio-demographic and health behavioural characteristics and the dependent variable, DM medication use, and 2) association between DM medication use (independent variable) and household catastrophic expenditure on medications (dependent variable) (China: N = 630; India: N = 439). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010).Results: Prevalence of DM medication use was 87% in China and 71% in India. Multivariable analysis indicates that people reporting lifestyle modification were more likely to use DM medications in China (OR = 6.22) and India (OR = 8.45). Women were more likely to use DM medications in China (OR = 1.56). Respondents in poorer wealth quintiles in China were more likely to use DM medications whereas the reverse was true in India. Almost 17% of people with DM in China experienced catastrophic healthcare expenditure on medications compared with 7% in India. Diabetes medication use was not a statistically significant predictor of catastrophic healthcare expenditure on medications in either country, although the odds were 33% higher among DM medications users in China (OR = 1.33).Conclusions: The country comparison reflects major public policy differences underpinned by divergent political and ideological frameworks. The DM epidemic poses huge public health challenges for China and India. Ensuring equitable and affordable access to medications for DM is fundamental for healthy ageing cohorts, and is consistent with the global agenda for universal healthcare coverage. [ABSTRACT FROM AUTHOR]

Background: The concurrence of acute myocardial infarction (AMI) with COVID-19 can complicate the clinical conditions of patients and affect the patterns of hospital resource utilization. This study aimed to investigate and analyze the direct treatment costs of AMI patients with concurrent COVID-19. Methods: This cross-sectional study collected and analyzed clinical data, including symptoms, readmission, and interventions, and treatment cost data for all patients at Tehran Heart Center using SPSS26 software. The mean medical costs of patients from January through May 2022 were also calculated. Results: The COVID-19 group was composed of 72.9% male and 27.1% female patients, whereas the non-COVID-19 group consisted of 67.3% male and 32.7% female patients. Most of the patients in the COVID-19 group (60%) were in the elderly age group (>65 y). The length of stay was 8.70±5.84 days for the COVID-19 group and 6.31±4.42 days for the non-COVID-19 group. The mortality rate in the COVID-19 group was 24%, higher than the 5% rate in the other group. Additionally, the average total treatment costs were $6384.54±$6760.13 in the COVID-19 group and $6362.49±$4343.07 in the non-COVID-19 group (P>0.78 and P>0.050). Conclusion: The study found that the COVID-19 group had a significantly higher in-hospital mortality rate than the non-COVID-19 group. During the follow-up period, the incidence of complications (chest pain and heart failure) was higher in the non-COVID-19 group. It also showed that longer hospital stays resulted in higher treatment costs. [ABSTRACT FROM AUTHOR]

Background: Research has shown that individual socio-economic circumstances throughout life affect health in older ages. However, little attention has been paid to the broad economic context affecting individual's life-chances. This paper examines whether economic downturns experienced during young and mid-adulthood have long-run effects on physical health. Methods: We exploit data on economic fluctuations in the period 1945-2010 in 11 European countries, linked to longitudinal data from three waves of the Survey of Health, Ageing and Retirement in Europe. We estimate a country fixed effect model assessing whether downturns experienced at 5-year intervals between ages 25 and 54 are associated with levels and onset of new limitations with Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in older age (55-80). Results: Experiencing an economic downturn at ages 45-59 is associated with increased risk of having at least one disability limitation in later-life (odds ratio [OR] for ADL = 1.66, 95% CI [Confidence Interval] 1.24, 2.22; OR for IADL = 1.46, 95% CI 1.10, 1.94). Economic downturns at ages 40-44 and 45-49 also increase the risk of a new functional limitation in later-life (OR for IADL ages 40-44 = 1.20, 95% CI 1.03, 1.40; OR for IADL ages 45-49 = 1.44, CI 1.10-1.88). Economic downturns experienced around these ages are also associated with significantly greater risks of smoking and excessive alcohol consumption as well as lower incomes in older age. Conclusions: Exposure to an economic downturn at ages 40-49 is associated with poorer health in older ages, possibly by increasing risk of unhealthy behaviours and low incomes persisting into older age. [ABSTRACT FROM AUTHOR]

Background: Systematic reviews suggest that multi-component interventions are effective in reducing bullying victimisation and perpetration. We are undertaking a phase III randomised trial of the INCLUSIVE multi-component intervention. This trial aims to assess the effectiveness and cost-effectiveness of the INCLUSIVE intervention in reducing aggression and bullying victimisation in English secondary schools. This paper updates the original trial protocol published in 2014 (Trials 15:381, 2014) and presents the changes in the process evaluation protocol and the secondary outcome data collection.Methods: The methods are summarised as follows.Design: cluster randomised trial.Participants: 40 state secondary schools. Outcomes assessed among the cohort of students at the end of year 7 (n = 6667) at baseline.Intervention: INCLUSIVE is a multi-component school intervention including a social and emotional learning curriculum, changes to school environment (an action group comprising staff and students reviews local data on needs to review rules and policies and determine other local actions) and staff training in restorative practice. The intervention will be delivered by schools supported in the first two years by educational facilitators independent of the research team, with a third intervention year involving no external facilitation but all other elements. Comparator: normal practice.Outcomes: Primary: Two primary outcomes at student level assessed at baseline and at 36 months: 1. Aggressive behaviours in school: Edinburgh Study of Youth Transitions and Crime school misbehaviour subscale (ESYTC) 2. Bullying and victimisation: Gatehouse Bullying Scale (GBS) Secondary outcomes assessed at baseline, 24 and 36 months will include measures relating to the economic evaluation, psychosocial outcomes in students and staff and school-level truancy and exclusion rates.Sample Size: 20 schools per arm will provide 90% power to identify an effect size of 0.25 SD with a 5% significance level. Randomisation: eligible consenting schools were randomised stratified for single-sex versus mixed-sex schools, school-level deprivation and measures of school attainment.Discussion: The trial involves independent research and intervention teams and is supervised by a Trial Steering Committee and a Data Monitoring Committee.Trial Registration: Current Controlled Trials, ISRCTN10751359 . Registered on 11 March 2014. [ABSTRACT FROM AUTHOR]

Background: Millennium Development Goal (MDG) 5 is focused on reducing maternal mortality and achieving universal access to reproductive health care. India has made extensive efforts to achieve MDG 5 and in some regions much progress has been achieved. Progress has been uneven and inequitable however, and many women still lack access to maternal and reproductive health care. Objective: In this review, a framework developed by the Commission on Social Determinants of Health (CSDH) is used to categorize and explain determinants of inequity in maternal and reproductive health in India. Design: A review of peer-reviewed, published literature was conducted using the electronic databases PubMed and Popline. The search was performed using a carefully developed list of search terms designed to capture published papers from India on: 1) maternal and reproductive health, and 2) equity, including disadvantaged populations. A matrix was developed to sort the relevant information, which was extracted and categorized based on the CSDH framework. In this way, the main sources of inequity in maternal and reproductive health in India and their inter-relationships were determined. Results: Five main structural determinants emerged from the analysis as important in understanding equity in India: economic status, gender, education, social status (registered caste or tribe), and age (adolescents). These five determinants were found to be closely interrelated, a feature which was reflected in the literature. Conclusion: In India, economic status, gender, and social status are all closely interrelated when influencing use of and access to maternal and reproductive health care. Appropriate attention should be given to how these social determinants interplay in generating and sustaining inequity when designing policies and programs to reach equitable progress toward improved maternal and reproductive health. [ABSTRACT FROM AUTHOR]

The U.S. population is undergoing a dramatic shift in demographics, with a rise in the proportion of elderly Americans. Given an increased prevalence of thyroid disease and malignancy with age, understanding the safety of thyroid surgery in this age group is increasingly pertinent. There remains disagreement regarding the clinical outcomes of elderly patients after thyroidectomy and the applicability of single-institution cohorts to the population at large. This paper reviews the epidemiology of thyroid disease in the elderly, current surgical indications and practice patterns, and the clinical and economic outcomes of elderly patients with thyroid disease after surgical intervention. [ABSTRACT FROM AUTHOR]

INTRODUCTION Although both active tobacco use and passive tobacco exposure are well-established as being risk factors for lung cancer, it is challenging to measure tobacco-related exposures at the population level, while considering other factors (gender, race, socioeconomic status) that may modify the relationship between tobacco and lung cancer. Moreover, research to date has focused primarily on relationships between tobacco and endpoints of lung cancer incidence or mortality. Tobacco's role in disease progression, through association with important disease characteristics such as tumor histological type and grade, and stage of disease at diagnosis, has been less well examined. METHODS This research examines associations between area-level tobacco use and social class, as well as individual gender, race and age, and three adverse disease characteristics (tumor type, grade and stage) among incident cases of lung cancer reported to the Maryland Cancer Registry in 2000. Cases were geocoded by residential address. Multi-level logistic regression models included Census block group-level estimates of per capita tobacco spending, from Consumer Expenditure Survey data, and a 4-item social class index, from Census estimates of rates of high school graduation, employment, white collar occupation, and per capita income. RESULTS Analyses of 3223 cases found no significant differences by race, however, results differed by gender. Lower block-group social class and higher tobacco spending were associated with squamous and small cell histological types and poorly differentiated or undifferentiated tumor grade. However, for later stage at diagnosis (SEER stages 2-7), both higher social class and greater tobacco spending were protective, especially for women, suggesting women in high tobacco use communities may benefit from early detection. CONCLUSIONS Results support using area-level behavioral data as tools for identifying high risk communities suitable for more resource-intensive research or interventions. Findings also suggest that area-level social resources are consistent drivers of lung cancer disparities, and merit continued research attention. [ABSTRACT FROM AUTHOR]

This paper aims to estimate the service and social costs of headache presenting in primary care and to identify predictors of headache costs. Patients were recruited from GP practices in England and service use and lost employment recorded. Predictors of cost were identified using regression models. Service and social costs were available on 288 and 282 patients, respectively. Average service costs over 3 months were £117 whilst total costs (including lost production) were £582. Patients referred to neurologists had service costs that were £82 higher than those not referred (90% CI £36-£128). Costs including lost employment were higher by £150, but this was not significant (90% CI -£139-£439). The annual mean service and social costs, weighted to represent population rates of referral, were £468 and £2328, respectively. Higher costs were significantly related to pain. Age was linked to higher service costs and lower social costs. The figures extrapolated to the whole of the UK suggest £956 million due to service use and £4.8 billion including lost employment. These are likely to be underestimates because many people experiencing headaches do not consult their GP. [ABSTRACT FROM AUTHOR]

The Life Journeys of Young Women Project is the first population-based study to examine the role of economic uncertainty throughout early adulthood on age at first childbirth. A retrospective cross-sectional component was added to an existing cohort study that is based on a birth cohort of women born during 1973–1975 in Adelaide, South Australia (n ˜ 1,000). An event history calendar instrument was used to obtain data regarding a range of life domains including partnering, educational attainment, home ownership, higher education debt, employment, and pregnancies over a 20-year period (sometimes as detailed as at monthly intervals). Interviews were conducted between 2007 and 2009. An analysis framework applying time-varying and time-constant survival analysis techniques within a life-course framework was developed that will guide analyses to examine the role of duration and life-course timing of economic uncertainty on age at first childbirth. This paper discusses study objectives and design, fieldwork procedures, planned statistical analyses, and recruitment outcomes, focusing on novel features that would facilitate analogous epidemiologic research. [ABSTRACT FROM AUTHOR]

INTRODUCTION Tobacco use is a major preventable risk factor for many noncommunicable diseases. Smoking-attributable mortality has been well described. However, the prevalence of smoking-attributable hospitalization (SAH) and associated costs have been less documented, especially in low- and middle-income countries. Our objective was to estimate the number of hospital admissions and expenditure attributable to tobacco use during 2007-2014 in Thailand. METHODS Hospitalization data between 2007 and 2014 were used for the analysis. SAHs were derived by applying smoking-attributable fractions, based on Thailand's estimates of smoking prevalence data and relative risks extracted from the published literature, to hospital admissions related to smoking according to the International Classification of Diseases version 10. Age-adjusted SAHs among adults age 35 and older were calculated. Joinpoint regression analysis was used to detect changes in trends among genders and geographical areas, based on annual per cent change (APC) and average annual per cent change (AAPC). Costs related to SAHs were also estimated. RESULTS During 2007-2014, among adults age 35 years and older, smoking accounted for almost 3.6 million hospital admissions, with attributable hospital costs calculated at more than US$572 million annually, which represents 16.8% of the national hospital budget. While the age-adjusted rate of SAHs had been relatively stable (AAPC=1.12), the age-adjusted rate of SAHs due to cancers increased significantly for both sexes (AAPC=2.33). Cardiovascular diseases related to smoking increased significantly among men (AAPC=2.5), whereas, COPD, the most common smoking-related conditions decreased significantly during 2011-2014 (APC= -7.21). Furthermore, more provinces in the northeastern and the southern regions where smoking prevalence was higher than the national average have a significantly higher AAPC of SAH than other parts of the country. CONCLUSIONS Smoking remains a significant health and economic burden in Thailand. Findings from this study pose compelling evidence for Thailand to advance tobacco control efforts to reduce the financial and social burden of diseases attributable to smoking. [ABSTRACT FROM AUTHOR]

This paper revisits the literature on overlapping generations models in the demographic context of a continuous age distribution and a general age schedule of mortality. We show that most of the static results known for the 3 or N age-group models can be extended to the continuous model. Some results, previously established for economies without capital, are extended to productive economies. We also make some progress on the existence of some steady states as well as on the dynamic properties. [ABSTRACT FROM AUTHOR]

This paper examines the influence of social change and economic growth on intergenerational relationships and the formation of families in Taiwan. Using data from two island-wide surveys in 1973 and 1980, the analysis shows that, as expected, social change has been accompanied by rapid changes in family structure and relationships, including the spread of schooling, the employment of young people outside the family, increasing separation of the residences of parents and children before and after marriage, growing independence of young people, and increases in premarital sex and pregnancies. The position of a family in the social structure also influences the way young people interact with their parents and form their own families: women with educated fathers have more nonfamilial experiences than others, and farm origins tend to exert a traditional influence on the life course. Finally, experiences early in the life course have important ramifications for later behavior and transitions. [ABSTRACT FROM AUTHOR]

Introduction: Conditional Cash Transfers (CCTs) have been largely used in the world during the past decades, since they are known for enhancing children's human development and promoting social inclusion for the most deprived groups. In other words, CCTs seek to create life chances for children to overcome poverty and exclusion, thus reducing inequality of opportunity. The main goal of the present article is to identify studies capable of showing if CCTs create equality of opportunity in health for children in low and middle-income countries. Methodology: Comprehensive literature searches were conducted in the Academic Search Complete (EBSCO), PubMed/Medline, Scopus and Web of Science electronic bibliographic databases. Relevant studies were searched using the combination of key words (either based on Medical Subject Headings (MeSH) terms or free text terms) related to conditional cash transfers, child health and equality of opportunity. An integrative research review was conducted on 17 quantitative studies. Results: The effects of CCTs on children's health outcomes related to Social Health Determinants were mostly positive for immunization rates or vaccination coverage and for improvements in child morbidity. Nevertheless, the effects of CCTs were mixed for the child mortality indicators and biochemical or biometric health outcomes. Conclusions: The present literature review identified five CCTs that provided evidence regarding the creation of health opportunities for children under 5 years old. Nevertheless, cash transfers alone or the use of conditions may not be able to mitigate poverty and health inequalities in the presence of poor health services. [ABSTRACT FROM AUTHOR]

Purpose. This paper aims to analyze the household financial burden and poverty impacts of cancer treatment in Vietnam. Methods. Under the “ASEAN CosTs in ONcology” study design, three major specialized cancer hospitals were employed to assemble the Vietnamese data. Factors of socioeconomic, direct, and indirect costs of healthcare were collected prospectively through both individual interviews and hospital financial records. Results. The rates of catastrophic expenditure based on the cut-off points of 20%, 30%, 40%, and 50% of household’s income were 82.6%, 73.7%, 64.7%, and 56.9%, respectively. 37.4% of the households with patient were impoverished by the treatment costs for cancer. The statistically significant correlates of the impoverishment problem were higher among older patients (40–60 years: 1.77, 95% CI 1.14–2.73; above 60 years: 1.75, 95% CI 1.03–2.98); poorer patients (less than 100% national income: 29, 95% CI 18.6–45.24; less than 200% national income: 2.89, 95% CI 1.69–4.93); patients who underwent surgery alone (receiving nonsurgery treatment: 2.46, 95% CI 1.32–4.59; receiving multiple treatments: 2.4, 95% CI 1.38–4.17). Conclusions. Lots of households were pushed into poverty due to their expenditure on cancer care; more actions are urgently needed to improve financial protection to the vulnerable groups. [ABSTRACT FROM AUTHOR]

Aim To evaluate retailer’s compliance and consumer’s perceptions of and experiences with the point-of-sale (POS) tobacco display ban in Norway, implemented 1 January 2010. Methods Retailer compliance was measured using audit surveys. Consumer’s perceptions of the ban were assessed in three web surveys: one conducted before and two after implementation of the ban. The sample for each of these consisted of about 900 people aged 15-54 years and an extra sample of smokers and snus users. 10 focus group interviews with male and female daily, occasional and former smokers aged 16-50 years (N¼62) were also conducted, before and after implementation of the ban. Results Immediately following implementation of the POS display ban, compliance was 97% for cigarettes and rolling tobacco and 98% for snus. Preimplementation, young people were tempted by tobacco products when seeing them in the shop more often than older people. Postimplementation, young people also more often found it difficult to choose brand. The POS tobacco display ban was supported by a majority of the population, and by one out of three daily smokers. The removal of POS tobacco displays was perceived as a barrier for young people’s access to tobacco products, as affecting attachment to cigarette brands and as contributing to tobacco denormalisation. Conclusions Retailer’s compliance with the POS display ban in Norway was high, and the ban was well supported in the population. Consumers believed that the ban could contribute to preventing smoking initiation among young people and to some extent also support cessation efforts. [ABSTRACT FROM AUTHOR]

Objectives To assess the determinants of smoking behaviour and to estimate the impact of tobacco consumption on the consumption of other commodities by Cambodian households. Methods To assess the determinants of smoking in Cambodia, the authors used a logistic regression model that estimated the probability of an individual smoking, given a set of socioeconomic and demographic characteristics. A Seemingly Unrelated Regression method was used to assess the impact of tobacco consumption on the consumption of other commodities. The nationally representative 2004 Cambodia Socio- Economic Survey, collected by the National Institute of Statistics of the Ministry of Planning in Cambodia, was used for the analysis. Results Smoking in Cambodia is influenced by a variety of factors such as gender, marital status, age, ethnicity, literacy, health status and perceptions about the health consequences of tobacco use. The authors found that spending on tobacco crowds out expenditures on education and clothing at the national level and expenditures on food for low- and middle-income households. Conclusions The first analysis of the study showed that increased education is associated with lower daily smoking, and the second analysis revealed that expenditures on tobacco crowds out expenditures on education. Combining these two results points to a vicious circle where low education means higher likelihood of smoking, which in turn results in lower spending on education. Such budget allocation clearly has negative intergenerational consequences. [ABSTRACT FROM AUTHOR]

Objective To assess the impact of a tobacco control law adopted in Albania in 2007 and to estimate the share of illicit cigarettes on the market. Design Comparative analysis of two waves of a nationally representative household survey, one conducted before the new law went into effect and the other after 2 years. Official sales data were contrasted with the consumption estimate based on the survey. Main outcome measures Smoking prevalence, quit attempts, exposure to cigarette advertising, exposure to second-hand smoke, total cigarette consumption, share of illicit packs among packs possessed by smokers. Results Despite the adoption of strong smoke-free policies and adverting restrictions, smoking prevalence in Albania has risen. The increase in prevalence has been driven by higher smoking rates among females (18.9% in 2007 vs 29.3% in 2009) and young adults (23.2% in 2007 vs 38.5% in 2009 among 18-19 year olds). Self-reported exposure to second-hand smoke and cigarette advertising have been reduced since 2007. The majority of respondents are still exposed to second-hand smoke and more than half are exposed to tobacco advertising. Nevertheless, there are signs that the consumption of illicit cigarettes is declining. Conclusions The impacts of smoke-free policies and an advertising ban have been limited due to lack of enforcement and failure to adopt a comprehensive set of tobacco control measures. These measures should include sizeable and regular tobacco tax increases in excess of the general level of inflation and income growth. The decline in the share of illicit cigarettes should improve the effectiveness of the cigarette tax policy. [ABSTRACT FROM AUTHOR]

The effects of the changing U.S. age distribution on various macroeconomic equations are examined in this paper. The equations include consumption, housing-investment, money-demand, and labor-force-participation equations. There seems to be enough variance in the age-distribution data to allow reasonably precise estimates of the effects of the age distribution on the macro variables. [ABSTRACT FROM AUTHOR]

Background In Denmark, a tax-based universal healthcare setting, drug reimbursement for terminal illness (DRTI) should be equally accessible for all terminally ill patients. Examining DRTI status by regions provides new knowledge on inequality in palliative care provision and associated factors. This study aims to investigate geographical variation in DRTI among terminally ill cancer patients. Methods We linked socioeconomic and medical data from 135 819 Danish cancer decedents in the period 2007–15 to regional healthcare characteristics. We analyzed associations between region of residence and DRTI. Prevalence ratios (PR) for DRTI were estimated using generalized linear models adjusted for patient factors (age, gender, comorbidity and socioeconomic profile) and multilevel models adjusted for both patient factors and regional healthcare capacity (patients per general practitioner, numbers of hospital and hospice beds). Results DRTI allocation differed substantially across Danish regions. Healthcare capacity was associated with DRTI with a higher probability of DRTI among patients living in regions with high compared with low hospice bed supply (PR 1.13, 95% CI 1.10–1.17). Also, the fully adjusted PR of DRTI was 0.94 (95% CI 0.91–0.96) when comparing high with low number of hospital beds. When controlled for both patient and regional healthcare characteristics, the PR for DRTI was 1.17 (95% CI 1.14–1.21) for patients living in the Central Denmark Region compared with the Capital Region. Conclusion DRTI status varied across regions in Denmark. The variation was associated with the distribution of healthcare resources. These findings highlight difficulties in ensuring equal access to palliative care even in a universal healthcare system. [ABSTRACT FROM AUTHOR]

Background: In 2013, Turkey introduced one-dose universal varicella vaccination (UVV) at 12 months of age. Inclusion of a second dose is being considered. Methods: We developed a dynamic transmission model to evaluate three vaccination strategies: single dose at 12 months (1D) or second dose at either 18 months (2D-short) or 6 years of age (2D-long). Costs and utilization were age-stratified and separated into inpatient and outpatient costs for varicella and herpes zoster (HZ). We ran the model including and excluding HZ-related costs and impact of exogenous boosting. Results: Five years post-introduction of UVV (1D), the projected varicella incidence rate decreases from 1,674 cases pre-vaccine to 80 cases/100,000 person-years. By 25 years, varicella incidence equilibrates at 39, 12, and 16 cases/100,000 person-years for 1D, 2D-short, and 2D-long strategies, respectively, using a highly effective vaccine. With or without including exogenous boosting impact and/or HZ-related costs and health benefits, the 1D strategy is least costly, but 2-dose strategies are cost-effective considering a willingness-to-pay threshold equivalent to the gross domestic product. The model predicted a modest increase in HZ burden during the first 20–30 years, after which time HZ incidence equilibrates at a lower rate than pre-vaccine. Conclusions: Our findings support adding a second varicella vaccine dose in Turkey, as doing so is highly cost-effective across a wide range of assumptions regarding the burden associated with varicella and HZ disease. [ABSTRACT FROM AUTHOR]

Objective to evaluate the association between first- and second-eye cataract surgery and motor vehicle crashes for older drivers and the associated costs to the community. Design retrospective population-based cohort study. Subjects a total of 2,849 drivers aged 60 years and older who had undergone both first- and second-eye cataract surgery were involved in 3,113 motor vehicle crashes as drivers during the study period. Methods de-identified data were obtained using the Western Australian Data Linkage System from 1 January 2003 to 31 December 2015. Poisson regression analysis based on Generalised Estimating Equations was undertaken to compare the frequency of crashes in the year before first eye cataract surgery, between first and second eye surgery and 1 year after second eye surgery. Results first eye cataract surgery was associated with a significant 61% reduction in crash frequency (P < 0.001) and second eye surgery was associated with a significant 23% reduction in crashes (P < 0.001), compared to the year before first eye cataract surgery after accounting for age, gender, marital status, accessibility, socio-economic status, driving exposure and comorbidities. The estimated cost savings from the reduction in crashes in the year after second eye cataract surgery compared to the year before first eye cataract surgery was $14.9 million. Conclusions first- and second-eye cataract surgery were associated with a significant reduction in motor vehicle crashes, with first eye surgery having the greatest impact. These results provide encouragement for the timely provision of first- and second-eye cataract surgery for older drivers. [ABSTRACT FROM AUTHOR]

Objective to evaluate the association between first- and second-eye cataract surgery and motor vehicle crashes for older drivers and the associated costs to the community. Design retrospective population-based cohort study. Subjects a total of 2,849 drivers aged 60 years and older who had undergone both first- and second-eye cataract surgery were involved in 3,113 motor vehicle crashes as drivers during the study period. Methods de-identified data were obtained using the Western Australian Data Linkage System from 1 January 2003 to 31 December 2015. Poisson regression analysis based on Generalised Estimating Equations was undertaken to compare the frequency of crashes in the year before first eye cataract surgery, between first and second eye surgery and 1 year after second eye surgery. Results first eye cataract surgery was associated with a significant 61% reduction in crash frequency (P < 0.001) and second eye surgery was associated with a significant 23% reduction in crashes (P < 0.001), compared to the year before first eye cataract surgery after accounting for age, gender, marital status, accessibility, socio-economic status, driving exposure and comorbidities. The estimated cost savings from the reduction in crashes in the year after second eye cataract surgery compared to the year before first eye cataract surgery was $14.9 million. Conclusions first- and second-eye cataract surgery were associated with a significant reduction in motor vehicle crashes, with first eye surgery having the greatest impact. These results provide encouragement for the timely provision of first- and second-eye cataract surgery for older drivers. [ABSTRACT FROM AUTHOR]

Studies of rescuing early-career scientists often take narrow approaches and focus on PhD students or postdoc populations. In a multi-method systems approach, we examine the inter-relations between the two ends of the pipeline and ask: what are the effects of late retirement on aging and hiring in academia? With a simulation model, we postulate that the decline in the retirement rate in academia contributes to the aging pattern through two mechanisms: (a) direct effect: longer stay of established professors, and (b) indirect effect: a hiring decline in tenure-track positions. Late retirement explains more than half of the growth in average age and brings about 20% decline in hiring. We provide empirical evidence based on the natural experimental set-up of the removal of mandatory retirement in the 1990s. [ABSTRACT FROM AUTHOR]

Background. The average waiting time for cataract treatment in Poland is 441 days - the longest for any surgical procedures in the country. Objectives. The aim of the study was to examine the availability of surgical cataract treatment among older Polish patients. Material and methods. Using data from 25,970 hospitalizations at the Ophthalmology Ward of the University Clinical Hospital in Wrocław, Poland in years 2012-2017, we analyzed the demographic structure of the patients, the duration of hospital stay, and the average cost; the level of statistical significance was taken to be p < 0.05. Results. Patients 65 years of age or older made up 78% of patients receiving surgical cataract treatment. This treatment required significantly shorter hospitalization time in 2017 than in 2012 (an average of 1.89 vs. 2.19 patient-days, respectively). The average hospital stay length among the older patients was significantly shorter than among younger patients (2.3 vs 3.2 patient-days, respectively) and the average hospitalization cost for patients aged 65 years or older was significantly lower (2105.63 PLN vs 2929.57 PLN , equivalent of 495.44 EUR vs 689.31 EUR , respectively). Conclusions. The duration of the average hospital stay in the ophthalmology ward was shorter, and the average hospitalization cost was lower, for patients aged 65 years or older than for younger patients because older patients mostly undergo modern standardized less-invasive cataract treatment. As more ophthalmological medical staff, infrastructure, and financial assets are available for cataract treatment and have not yet been assigned or spent, Polish hospitals should introduce newer medical technology, process adjustments, and organizational innovations to fully utilize their potential and improve the availability of cataract treatment. [ABSTRACT FROM AUTHOR]

Objective: To illustrate the impact of key quasi-experimental design elements on cost savings measurement for population health management (PHM) programs.Data Sources: Population health management program records and Medicaid claims and enrollment data from December 2011 through March 2016.Study Design: The study uses a difference-in-difference design to compare changes in cost and utilization outcomes between program participants and propensity score-matched nonparticipants. Comparisons of measured savings are made based on (1) stable versus dynamic population enrollment and (2) all eligible versus enrolled-only participant definitions. Options for the operationalization of time are also discussed.Data Collection/extraction Methods: Individual-level Medicaid administrative and claims data and PHM program records are used to match study groups on baseline risk factors and assess changes in costs and utilization.Principal Findings: Savings estimates are statistically similar but smaller in magnitude when eliminating variability based on duration of population enrollment and when evaluating program impact on the entire target population. Measurement in calendar time, when possible, simplifies interpretability.Conclusion: Program evaluation design elements, including population stability and participant definitions, can influence the estimated magnitude of program savings for the payer and should be considered carefully. Time specifications can also affect interpretability and usefulness. [ABSTRACT FROM AUTHOR]

Objective: To determine whether food insecurity, limited or uncertain food access owing to cost, is associated with greater health care expenditures.Data Source/study Setting: Nationally representative sample of the civilian noninstitutionalized population of the United States (2011 National Health Interview Survey [NHIS] linked to 2012-2013 Medication Expenditure Panel Survey [MEPS]).Study Design: Longitudinal retrospective cohort.Data Collection/extraction Methods: A total of 16,663 individuals underwent assessment of food insecurity, using the 10-item adult 30-day food security module, in the 2011 NHIS. Their total health care expenditures in 2012 and 2013 were recorded in MEPS. Expenditure data were analyzed using zero-inflated negative binomial regression and adjusted for age, gender, race/ethnicity, education, income, insurance, and residence area.Principal Findings: Fourteen percent of individuals reported food insecurity, representing 41,616,255 Americans. Mean annualized total expenditures were $4,113 (standard error $115); 9.2 percent of all individuals had no health care expenditures. In multivariable analyses, those with food insecurity had significantly greater estimated mean annualized health care expenditures ($6,072 vs. $4,208, p < .0001), an extra $1,863 in health care expenditure per year, or $77.5 billion in additional health care expenditure annually.Conclusions: Food insecurity was associated with greater subsequent health care expenditures. Future studies should determine whether food insecurity interventions can improve health and reduce health care costs. [ABSTRACT FROM AUTHOR]

Study Objective: To evaluate whether the availability of Electronic Health Records (EHRs) reduces throughput time and utilization of advanced imaging for patients in an academic ED.Data Sources: All patients arriving at an academic Emergency Department (ED) via ambulance between June 1, 2011, and June 4, 2012, were included in the study. This accounted for 9,970 unique ambulance patient visits.Study Design: Retrospective noninterventional analysis of patients in an academic ED. The primary independent variable was whether the patient had a prior EHR at the study hospital. Main outcomes were throughput time, number of advanced diagnostic imaging studies (CT, MRI, ultrasound), and the associated cost of these imaging studies. A set of controls, including age, gender, ICD9 codes, acuity measures, and NYU ED algorithm case severity classifications, was used in an ordinary least-squares (OLS) regression framework to estimate the association between EHR availability and the outcome measures.Principal Findings: A patient with a prior EHR experienced a mean reduction in CT scans of 13.9 percent ([4.9, 23.0]). There was no material change in throughput time for patients with a prior EHR and no difference in utilization of other imaging studies across patients with a prior EHR and those without. Cost savings associated with prior EHRs are $22.52 per patient visit.Conclusion: EHR availability for ED patients is associated with a reduction in CT scans and cost savings but had no impact on throughput time or order frequency of other imaging studies. [ABSTRACT FROM AUTHOR]

Objective: To examine the impact of provider competition under global budgeting on the use of cesarean delivery in Taiwan.Data Sources/study Setting: (1) Quarterly inpatient claims data of all clinics and hospitals with birth-related expenses from 2000 to 2008; (2) file of health facilities' basic characteristics; and (3) regional quarterly point values (price conversion index) for clinics and hospitals, respectively, from the fourth quarter in 1999 to the third quarter in 2008, from the Statistics of the National Health Insurance Administration.Study Design: Panel data of quarterly facility-level cesarean delivery rates with provider characteristics, birth volumes, and regional point values are analyzed with the fractional response model to examine the effect of external price changes on provider behavior in birth delivery services.Principal Findings: The decline in de facto prices of health services as a result of noncooperative competition under global budgeting is associated with an increase in cesarean delivery rates, with a high degree of response heterogeneity across different types of provider facilities.Conclusions: While global budgeting is an effective cost containment tool, intensified financial pressures may lead to unintended consequences of compromised quality due to a shift in provider practice in pursuit of financial rewards. [ABSTRACT FROM AUTHOR]

Background: Since the global economic crisis in 2007, unemployment rates have escalated in most European and North American countries. Unemployment protection policies, particularly the unemployment insurance (UI) system, have become a weighty issue for many modern welfare states. Decades of research have established concrete findings on the adverse impacts of unemployment on poverty- and health-related outcomes. This provided a foundation for further exploration into the potential protective effects of UI in offsetting these adverse outcomes. Methods: We developed a systematic review protocol in four stages (literature search, study selection, data extraction and quality appraisal) to ensure a rigorous data collection and inter-rated reliability. We examined the full body of empirical research published between 2000 and 2013 on the pathways by which UI impacts poverty and health. Results: Out of 2233 primary studies identified, a total of 12 met our inclusion criteria. The selected studies assessed poverty-related outcomes (absolute/relative poverty and material hardship) or one or more health-related outcomes (health behaviors, self-rated health, well-being and mental health). Across various UI systems, jurisdictions from high income countries, and study designs, we found good support for our conceptual framework, by which UI attenuates the effect of unemployment on both poverty and health, with a few exceptions. Conclusion: Whether UI impacts differ by age and region might be explored further in future research. The complex mediating relationship between unemployment, UI, poverty and health should further be assessed in light of economic and historical contexts. This could inform decision-making processes during future periods of economic recession. [ABSTRACT FROM AUTHOR]

Background: Universities have a social responsibility to ensure that they select and train healthcare professionals (HCPs) who can meet the healthcare needs of local communities. The aim of this study was to assess the extent to which the University of KwaZulu-Natal (UKZN) contributes to the training of HCPs working in district hospitals (DHs) in KwaZulu-Natal Province, and the impact that the funding source for their training has on DH staffing.Methods: This was an observational descriptive study, with all doctors, dentists, dental therapists, pharmacists, physiotherapists and radiographers working at DHs in KZN in November 2016 being invited to participate. Data were collected through a validated questionnaire.Results: A total of 514 HCPs working in 29 DHs participated in the study; over half (57%) of the South African medical graduates had trained at UKZN, as had 62% of pharmacists, 64% of physiotherapists and 92% of dental therapists. Some 87% of the HCPs had worked in DHs for five years or less, 65% planned to leave in the near future, and 29% planned to leave at the end of 2016.Discussion: UKZN plays a significant role in training for the short-term needs of DHs in KZN. Much of the workforce is young and transient, which has implications for service provision and expanding the teaching platform to DHs. The lack of long-term staff retention suggests that UKZN needs to continually monitor the selection of students, as well as the content and context of the training, if it is to contribute to the province’s long-term staffing needs. [ABSTRACT FROM AUTHOR]

Study Question: To what extent do financial, demographic and cultural determinants explain the vast cross-national differences in ART treatments in Europe?Summary Answer: The normative cultural acceptance of ART is a major driver of ART treatments in Europe, above and beyond differences in country wealth, demographic aspects and religious composition.What Is Known Already: There are vast differences in the number of ART treatments across European countries, which are to some extent related to country affluence, regulation, and insurance coverage and costs. The role and impact of cultural and normative factors has not been explored in a larger cross-national comparison.Study Design, Size, Duration: A descriptive and comparative cross-national analysis of ART treatment prevalence in over 30 European countries in 2010, with the outcome defined as the total number of ART cycles per million women of reproductive age (15-44 years). Data is drawn from multiple sources (ICMART, US Census Bureau Library, World Bank, Barro-Lee Educational Attainment Dataset, IFFS Surveillance reports, European Values Study and World Religion Database).Participants/materials, Setting, Methods: Our sample includes data from 35 European countries, where we describe the associations between demographic and cultural factors and the prevalence of ART treatments. Bivariate correlation and ordinary least squares multiple regression analysis serves to establish the relationships between predictor variables and the number of ART treatments per million women aged 15-44 years in a country.Main Results and the Role Of Chance: A one-percent increase in national GDP is associated with 382 (95% CI: 177-587) additional ART procedures per million women of reproductive age, yet this effect is reduced to 99 (-92 to 290) treatments once cultural values and demographic factors are accounted for. In our fully adjusted model, normative cultural values measuring the acceptability of ART are the strongest predictor of ART usage, with a one-point increase of average approval in a country associated with 276 (167-385) additional ART treatments per million women of reproductive age.Limitations, Reasons For Caution: Findings are based on a cross-sectional, cross-national analysis, making formal tests of causality impossible and prohibiting inferences to the individual level.Wider Implications Of the Findings: Results indicate that reproductive health policy should openly acknowledge the importance of cultural norms in informally shaping and regulating the wider availability of ART treatment.Study Funding/competing Interest(s): Funding for this project was provided by the European Union's Seventh Framework Program (FP7 2007-2013) (No. 320116 Families and Societies), European Research Council for the SOCIOGENOME Consolidator Grant (ERC-2013-CoG-615603) and the Wellcome Trust Institutional Strategic Support Fund (all to M.C.M.). The authors have no conflicts of interest to declare.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Background: Falls among older adults can cause serious morbidity and pose economic burdens on society. Older age is a known risk factor for falls and age has been shown to influence the effectiveness of fall prevention programs. To our knowledge, no studies have explicitly investigated whether cost-effectiveness of a multifactorial fall prevention intervention (the intervention) is influenced by age. This economic evaluation explores: 1) the cost-effectiveness of a multifactorial fall prevention intervention compared to usual care for community-dwelling adults ≥ 75 years at risk of falling in Canada; and 2) the influence of age on the cost-effectiveness of the intervention.Methods: Net benefit regression was used to examine the cost-effectiveness of the intervention with willingness-to-pay values ranging from $0-$50,000. Effects were measured as change in the number of falls, from baseline to 6-month follow-up. Costs were measured using a societal perspective. The cost-effectiveness analysis was conducted for both the total sample and by age subgroups (75-84 and 85+ years).Results: For the total sample, the intervention was not economically attractive. However, the intervention was cost-effective at higher willingness-to-pay (WTP) (≥ $25,000) for adults 75-84 years and at lower WTP (< $5,000) for adults 85+ years.Conclusions: The cost-effectiveness of the intervention depends on age and decision makers' WTP to prevent falls. Understanding the influence of age on the cost-effectiveness of an intervention may help to target resources to those who benefit most.Trial Registration: Retrospectively registered. Clinicaltrials.gov identifier: NCT00463658 (18 April 2007). [ABSTRACT FROM AUTHOR]

Background This is the first research to examine how the policy of patient choice and commercial contracting where NHS funds are given to private providers to tackle waiting times, impacted on direct NHS provision and treatment inequalities. Methods An ecological study of NHS funded elective primary hip arthroplasties in Scotland using routinely collected inpatient data 1 April 1993-31 March 2013. Results An increased use of private sector provision by NHS Boards was associated with a significant decrease in direct NHS provision in 2008/ 09 (P < 0.01) and with widening inequalities by age and socio-economic deprivation. National treatment rate fell from 143.8 (140.3, 147.3) per 100 000 in 2006/07 to 137.8 (134.4, 141.2) per 100 000 in 2007/08. By 2012/13, territorial NHS Boards had not recovered 2006/07 levels of provision; this was most marked for NHS Boards with the greatest use of private sector, namely Fife, Grampian and Lothian. Patients aged 85 years and over or living in the more deprived areas of Scotland appear to have been disadvantaged since the onset of patient choice in 2002. Conclusions NHS funding of private sector provision for elective hip arthroplasty was associated with a decrease in public provision and may have contributed to an increase in age and socio-economic inequalities in treatment rates. [ABSTRACT FROM AUTHOR]

Like many sports in adolescence, junior hockey is organized by age groups. Typically, players born after December 31st are placed in the subsequent age cohort and as a result, will have an age advantage over those players born closer to the end of the year. While this relative age effect (RAE) has been well-established in junior hockey and other professional sports, the long-term impact of this phenomenon is not well understood. Using roster data on North American National Hockey League (NHL) players from the 2008–2009 season to the 2015–2016 season, we document a RAE reversal—players born in the last quarter of the year (October-December) score more and command higher salaries than those born in the first quarter of the year. This reversal is even more pronounced among the NHL “elite.” We find that among players in the 90th percentile of scoring, those born in the last quarter of the year score about 9 more points per season than those born in the first quarter. Likewise, elite players in the 90th percentile of salary who are born in the last quarter of the year earn 51% more pay than players born at the start of the year. Surprisingly, compared to players at the lower end of the performance distribution, the RAE reversal is about three to four times greater among elite players. [ABSTRACT FROM AUTHOR]

Background: China has been undergoing tremendous demographic and epidemiological transitions during the past three decades and increasing burden from non-communicable diseases and an ageing population have presented great health-care challenges for the country. Numerous studies examine catastrophic healthcare expenditures (CHE) worldwide on whole populations rather than specific vulnerable groups. As hypertension and other chronic conditions impose a growing share of the disease burden in China, they will become an increasingly important component of CHE. This study aims to estimate households with hypertension incurring CHE and its income-related inequality in the rural areas of Shaanxi Province. Methods: Data were obtained from the National Household Health Service Surveys of Shaanxi Province conducted in 2013 and 13104 households were identified for analysis. The households were classified into three types: households with non-chronic diseases, households with hypertension only and households with hypertension plus other chronic diseases. CHE was measured according to the proportion of out-of-pocket health payments to non-food household expenditures and the concentration index was employed to measure the extent of income-related inequality in CHE. A decomposition method based on a probit model was used to decompose the concentration index into its determining components. Results: The incurring of CHE of households with hypertension is at a disconcerting level compared to households with non-chronic diseases. Households with hypertension only and households with hypertension plus other chronic diseases incurred CHE in 23.48% and 34.01% of cases respectively whereas households with non-chronic diseases incurred CHE in only 13.33%. The concentration index of households with non-chronic diseases is -0.4871. However, the concentration index of households with hypertension only and households with hypertension plus other chronic diseases is -0.4645 and -0.3410 respectively. The majority of observed inequalities in CHE were explained by household economic status and having elder members. Conclusions: The proportion of households incurring CHE in the rural areas of Shaanxi Province was considerably high in all three types of households and households with hypertension were at a higher risk of incurring CHE. Furthermore, there existed a strong pro-poor inequality of CHE in all three types of households and the results implied more inequality in households with non-chronic diseases compared with two other groups. Our study suggests that more concern needs to be directed toward households with hypertension plus other chronic diseases and households having elder members. [ABSTRACT FROM AUTHOR]

Background: Like several Southeast Asian countries, Singapore has a complex eating-out environment and a rising eating-out prevalence. However the determinants and drivers of eating-out in urban Asian environments are poorly understood. Methods: We examined the socio-demographic characteristics of persons who frequently ate away from home in local eateries called hawker centres and Western fast-food restaurants, using data from 1647 Singaporean adults participating in the National Nutrition Survey (NNS) 2010. We also assessed the underlying drivers of eating out and evaluated if these were different for eating at local eateries compared to Western fast-food restaurants using 18 focus group discussions of women (130 women). Results: Participants reported a high eating-out frequency with 77.3% usually eating either breakfast, lunch or dinner at eateries. Main venues for eating-out included hawker centres (61.1% usually ate at least 1 of 3 daily meals at this venue) and school/workplace canteens (20.4%). A minority of participants (1.9%) reported usually eating at Western fast-food restaurants. Younger participants and those of Chinese and Malay ethnicity compared to Indians were more likely to eat at Western fast-food restaurants. Chinese and employed persons were more likely to eat at hawker centres. The ready availability of a large variety of affordable and appealing foods appeared to be a primary driver of eating out, particularly at hawker centres. Conclusions: Our findings highlight the growing importance of eating-out in an urban Asian population where local eating venues play a more dominant role compared with Western fast-food chains. Interventions focusing on improving the food quality at venues for eating out are important to improve the diet of urban Asian populations. [ABSTRACT FROM AUTHOR]

The housing foreclosure crisis was harmful to the financial well-being of many households. In the present study, we investigated the health effects of the housing foreclosure crisis on glycemic control within a population of patients with diabetes. We hypothesized that an increase in the neighborhood foreclosure rate could worsen glycemic control by activating stressors such as higher neighborhood crime, lower housing prices, and erosion of neighborhood social cohesion. To test this, we linked public foreclosure records at the census-block level with clinical records from 2006 to 2009 of patients with diabetes. We specified individual fixed-effects models and controlled for individual time-invariant confounders and area-level time-varying confounders, including housing prices and unemployment rate, to estimate the effect of the foreclosure rate per census-block group on glycated hemoglobin. We found no statistically significant relationship between changes in the neighborhood foreclosure rate per block group in the prior year and changes in glycated hemoglobin. There is no evidence that increased foreclosure rates worsened glycemic control in this continuously insured population with diabetes. More research is needed to inform our knowledge of the role of insurance and health-care delivery systems in protecting the health of diabetic patients during times of economic stress. [ABSTRACT FROM AUTHOR]

Objective: The introduction of bundled payment for diabetes care in the Netherlands led to the origination of care groups. This study explored to what extent variation in health care costs per patient can be attributed to the performance of care groups. Furthermore, the commonly applied simple mean aggregation was compared with the more advanced generalized linear mixed model (GLMM) to benchmark health care costs per patient between care groups.Data Source: Dutch 2009 nationwide insurance claims data of diabetes type 2 patients (104,544 patients, 50 care groups).Study Design: Both a simple mean aggregation and a GLMM approach was applied to rank care groups, using two different health care costs variables: total treatment health care costs and diabetes-specific specialist care costs per diabetes patient.Principal Findings: Care groups varied slightly in the first and mainly in the second indicator. Care group variation was not explained by composition. Although the ranking methods were correlated, some care groups' rank positions differed, with consequences on the top-10 and the low-10 positions.Conclusions: Differences between care groups exist when an appropriate indicator and a sophisticated aggregation technique is used. Currently applied benchmarking may have unfair consequences for some care groups. [ABSTRACT FROM AUTHOR]

Background: Fragmented ambulatory care has been associated with high rates of emergency department visits and hospitalizations, but effects on other types of utilization are unclear.Objective: To determine whether more fragmented care is associated with more radiology and other diagnostic tests, compared to less fragmented care.Design: We conducted a cross-sectional study using claims from five commercial payers for 2010. The study took place in the Hudson Valley, a seven-county region in New York State.Participants: We included adult patients who were insured through the participating payers and were attributed to a primary care physician in the region. We restricted the cohort to those with ≥4 ambulatory visits, as measures of fragmentation are not reliable if based on ≤3 visits (N = 126,801).Main Measures: For each patient, we calculated fragmentation using a reversed Bice-Boxerman Index, which we divided into seven categories. We used negative binomial regression to determine the association between fragmentation category and rates of radiology and other diagnostic tests, stratified by number of chronic conditions and adjusting for patient age, gender, and number of visits.Key Results: Patients with the most fragmented care had approximately twice as many radiology and other diagnostic tests as patients with the least fragmented care, across all groups stratified by number of chronic conditions (each adjusted p < 0.0001). For example, among patients with ≥5 chronic conditions, those with the least fragmented care had 258 tests per 100 patients, and those with the most fragmented care had 542 tests per 100 patients (+284 tests per 100 patients, or +110 %, adjusted p < 0.0001).Conclusion: More fragmented care was independently associated with higher rates of radiology and other diagnostic tests than less fragmented care. [ABSTRACT FROM AUTHOR]