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1. Green–blue space exposure changes and impact on individual-level well-being and mental health: a population-wide dynamic longitudinal panel study with linked survey data

Author

Rebecca S Geary, Daniel A Thompson, Joanne K Garrett, Amy Mizen, Francis M Rowney, Jiao Song, Mathew P White, Rebecca Lovell, Alan Watkins, Ronan A Lyons, Susan Williams, Gareth Stratton, Ashley Akbari, Sarah C Parker, Mark J Nieuwenhuijsen, James White, Benedict W Wheeler, Richard Fry, Dialechti Tsimpida, and Sarah E Rodgers

Subjects
green space, blue space, common mental health disorders, well-being, inequalities, longitudinal, data linkage, Public aspects of medicine, RA1-1270
Abstract

Background Cross-sectional evidence suggests that living near green and blue spaces benefits mental health; longitudinal evidence is limited. Objectives To quantify the impact of changes in green and blue spaces on common mental health disorders, well-being and health service use. Design A retrospective, dynamic longitudinal panel study. Setting Wales, UK. Participants An e-cohort comprising 99,682,902 observations of 2,801,483 adults (≥ 16 years) registered with a general practice in Wales (2008–2019). A 5312-strong ‘National Survey for Wales (NSW) subgroup’ was surveyed on well-being and visits to green and blue spaces. Main outcome measures Common mental health disorders, general practice records; subjective well-being, Warwick–Edinburgh Mental Well-being Scale. Data sources Common mental health disorder and use of general practice services were extracted quarterly from the Welsh Longitudinal General Practice Dataset. Annual ambient greenness exposure, enhanced vegetation index and access to green and blue spaces (2018) from planning and satellite data. Data were linked within the Secure Anonymised Information Linkage Databank. Methods Multilevel regression models examined associations between exposure to green and blue spaces and common mental health disorders and use of general practice. For the National Survey for Wales subgroup, generalised linear models examined associations between exposure to green and blue spaces and subjective well-being and common mental health disorders. Results and conclusions Our longitudinal analyses found no evidence that changes in green and blue spaces through time impacted on common mental health disorders. However, time-aggregated exposure to green and blue spaces contrasting differences between people were associated with subsequent common mental health disorders. Similarly, our cross-sectional findings add to growing evidence that residential green and blue spaces and visits are associated with well-being benefits: Greater ambient greenness (+ 1 enhanced vegetation index) was associated with lower likelihood of subsequently seeking care for a common mental health disorder [adjusted odds ratio (AOR) 0.80, 95% confidence interval, (CI) 0.80 to 0.81] and with well-being with a U-shaped relationship [Warwick–Edinburgh Mental Well-being Scale; enhanced vegetation index beta (adjusted) –10.15, 95% CI –17.13 to −3.17; EVI2 beta (quadratic term; adj.) 12.49, 95% CI 3.02 to 21.97]. Those who used green and blue spaces for leisure reported better well-being, with diminishing extra benefit with increasing time (Warwick–Edinburgh Mental Well-being Scale: time outdoors (hours) beta 0.88, 95% CI 0.53 to 1.24, time outdoors2 beta −0.06, 95% CI −0.11 to −0.01) and had 4% lower odds of seeking help for common mental health disorders (AOR 0.96, 95% CI 0.93 to 0.99). Those in urban areas benefited most from greater access to green and blue spaces (AOR 0.89, 95% CI 0.89 to 0.89). Those in material deprivation benefited most from leisure time outdoors (until approximately four hours per week; Warwick–Edinburgh Mental Well-being Scale: time outdoors × in material deprivation: 1.41, 95% CI 0.39 to 2.43; time outdoors2 × in material deprivation −0.18, 95% CI −0.33 to −0.04) although well-being remained generally lower. Limitations Longitudinal analyses were restricted by high baseline levels and limited temporal variation in ambient greenness in Wales. Changes in access to green and blue spaces could not be captured annually due to technical issues with national-level planning datasets. Future work Further analyses could investigate mental health impacts in population subgroups potentially most sensitive to local changes in access to specific types of green and blue spaces. Deriving green and blue spaces changes from planning data is needed to overcome temporal uncertainties. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (Project number 16/07/07) and will be published in full in Public Health Research; Vol. 11, No. 10. Sarah Rodgers is part-funded by the NIHR Applied Research Collaboration North West Coast. Plain language summary We investigated whether people who live near or visit green (parks, woodlands) and blue (riversides, beaches) spaces have fewer common mental health disorders (anxiety or depression), and better well-being. We considered whether changes in the amount of green and blue space around the home affected people’s mental health. We assessed the availability of local green and blue spaces. Annual exposure and access to local green and blue spaces were extracted from planning and satellite data. We linked these data to anonymised health records of 2,801,483 adults registered with a general practice from 2008 to 2019, and to survey answers about leisure visits to natural environments and well-being. We found: people who lived in greener and bluer areas were less likely to seek help for a common mental health disorder than those in less green or blue areas, with those living in the most deprived areas benefiting the most people who used green and blue spaces for leisure, especially those with the greatest levels of deprivation, had better well-being and were less likely to seek help for common mental health disorders no evidence that changing amounts of green and blue space affected how likely people were to seek help for common mental health disorders; this may be because we found mostly small changes in green and blue space, and we may not have allowed enough time between moving home and recording mental health. We found evidence for relationships between green and blue space and mental health. However, some analyses were restricted due to lack of data on changes in green and blue spaces. An important finding was that people in deprived communities appear to benefit the most. Provision of green and blue spaces could be a strategy to improve the mental health of people living in disadvantaged areas. Scientific summary Background Cross-sectional evidence suggests that living close to and spending time in and around green and blue spaces (GBS, e.g. parks, gardens, ponds, lakes, rivers) is associated with higher levels of well-being and fewer mental health problems. Some of these benefits could result from living near GBS; others (e.g. physical activity) are attributed to using GBS. There are few longitudinal studies examining whether changes in GBS affect subsequent mental health. Existing studies have largely had small cohorts, assessed change over a short time, did not investigate socioeconomic inequalities in effects and neglected to consider that some health benefits depend on using GBS rather than simple exposure. Objectives We examined the research questions: Is a greater residential exposure and access to GBS associated with the likelihood of seeking help for a common mental health disorder (CMD) in general practice? Is the association between exposure, or access to, GBS and seeking help for a CMD modified by socioeconomic disadvantage and moving home? Is a greater residential exposure associated with the likelihood of using general practice services? Is greater residential GBS exposure and access to GBS associated with higher subjective well-being or a lower likelihood of seeking help for CMD, and does intentional use of GBS for leisure mediate these associations? Are associations between residential GBS exposure and access to GBS and use and subjective well-being mediated by walking-specific physical activity and modified by socioeconomic disadvantage? Methods We used a dynamic longitudinal panel study design to retrospectively examine natural and non-random variation in GBS exposure during an 11-year period, with individual linkage to survey responses. Data sources We constructed an electronic cohort of the population of Wales using data from the Welsh Demographic Service Dataset. Household-level ambient greenness was determined from satellite imagery, access to GBS from planning records, CMD and service use from Welsh Longitudinal General Practice Dataset (WLGPD) and for a subgroup, well-being and behaviour responses to the National Survey for Wales (NSW, 2016/17 and 2018/19). Data are held in the Secure Anonymised Information Linkage (SAIL) databank. Inclusion criteria The cohort included everyone aged 16 years and over registered with a general practitioner (GP) providing patient records to the SAIL databank between January 2008 and October 2019 (‘the study period’). Those not registered with an appropriate GP, not having a Welsh residential address between January 2008 and October 2019, and not having sex/week of birth recorded were excluded from the study sample. Exposures Our primary environmental exposure was ambient greenness, measured yearly (2008–19) by mean enhanced vegetation index (EVI) averaged over a 300 m circular buffer centred on each residence. Our secondary environmental exposure was the potential for an individual to access GBS along paths/roads within 1600 m of each home, modelled for 2018. We captured changes only when individuals moved home. For research questions 1–3, GBS access was quantified by the number of potentially accessible GBS. For research questions 4–5, access was quantified as the proximity to the nearest GBS. Outcome measures For research questions 1–3, our primary outcome was seeking help for CMD in general practice, identified from practice records using a validated algorithm. Our secondary outcome was the quarterly count of general practice events. For research questions 4 and 5, our primary outcome was subjective well-being, measured by the Warwick–Edinburgh Mental Well-being Scale (WEMWBS) in the NSW. Secondary outcomes were life satisfaction (NSW) and seeking help for CMD in general practice. Self-reported time outdoors on recreational visits to GBS in Wales and walking-specific physical activity were identified (NSW). Statistical analysis Research questions 1–3 were addressed using complementary approaches: We first evaluated associations between cumulative EVI exposure and seeking help for CMD in general practice using multivariate logistic regression. Follow-up stopped when help was first sought for CMD or at the end of the study period. This time aggregated design allowed us to consider environmental exposure prior to seeking help for CMD in general practice and included differences between people. We conducted stratified analyses according to area-level deprivation (Welsh Index of Multiple Deprivation, WIMD) quintiles, home moves (none/one/more than one), history of seeking care for CMD in general practice (before January 2008) and urban-rural home location. Next, we assessed associations between longitudinal change in GBS exposures for the same individuals, and their subsequent likelihood of seeking help for CMD (primary outcome) using multivariate logistic regression. For the association with general practice services use (secondary outcome) we used Poisson regression. We used a panel design with a multilevel model structure (quarterly observations nested within individuals). We accounted for clustering of observations over time (using random effects), and unbalanced data (number of observations varying for individuals). Change in GBS exposure was modelled as a continuous variable relative to previous time periods. For people who did not move home, we modelled EVI change categories to examine in situ exposure changes. Stratified analyses were conducted for quintiles of WIMD and number of home moves. For research questions 4–5 we assessed whether GBS exposures were related to WEMWBS, life satisfaction and seeking help for CMD, and whether there was moderation by socioeconomic disadvantage. We examined whether the association between GBS exposures and WEMWBS, life satisfaction and seeking help for CMD, were mediated by time spent outdoors. Generalised additive models were used to identify any non-linear associations and inform subsequent generalised linear regression. When predicting WEMWBS, linear and quadratic terms for EVI were included and proximity to nearest GBS was categorised. For seeking help for CMD, EVI was categorised, and proximity was continuous. To assess moderation by socioeconomic disadvantage, we included interactions between material deprivation and the GBS exposures. Results The cohort included 2,801,483 individuals (99,682,902 observations). A total of 816,242 individuals (29.1%) sought help for CMD from their general practice at least once in the study period. Research question 1: Is a greater residential exposure and access to GBS associated with the likelihood of seeking health for CMDs in general practice? People who lived in homes surrounded by more ambient greenness (+ 0.1 EVI) were associated with 20% lower odds of seeking help for CMD in general practice [adjusted odds ratio (AOR) 0.80, 95% confidence interval (CI) 0.80 to 0.81]. More potentially accessible GBS (equivalent to 236 more GBS) were associated with 7% lower odds of seeking help for CMD (AOR 0.93, 95% CI 0.93 to 0.93). Every additional 360 m (0.1 unit) to the nearest GBS was associated with 5% higher odds of seeking help for CMD (AOR 1.05, 95% CI 1.04 to 1.05). People experiencing an increase of 0.1 mean EVI was not associated with seeking help for CMD in general practice (exposure change relative to: previous quarter/year/baseline AOR 1.00, 95% CI 1.00 to 1.00). Among the 1,611,581 people who did not move home (57.5% of the cohort), increases or decreases of ≥ 0.15 EVI relative to baseline were not associated with seeking help for CMD (AOR for ≥ +0.15 EVI 1.00, 95% CI 0.99 to 1.00; AOR for ≥ −0.15 EVI 1.00, 95% CI 1.00 to 1.01). Among those who moved home at least once, an increase in the number of potentially accessible GBS was not associated with seeking help for CMD in general practice (GBS increase relative to previous quarter/year/baseline: AOR 1.00, 95% CI 1.00 to 1.00). Research question 2: Is the association between exposure, or access to, GBS and seeking help for a CMD modified by socioeconomic disadvantage and moving home? Living in a home with greater EVI (+ 0.1) and more accessible GBS (+ 236) was associated with lower odds of seeking help for CMD in general practice in all deprivation quintiles and whether people moved. The odds of seeking help were lower for those who did not move (AOR non-movers 0.77, 95% CI 0.77 to 0.78; AOR moved > once 0.92, 95% CI 0.91 to 0.93). There was no evidence that EVI or GBS changes were associated with seeking help for a CMD for people living in either the most or least deprived urban areas. An increase of 0.1 mean EVI (relative to baseline) was associated with slightly lower odds of seeking help for CMD for people who moved home more than once (AOR 0.99, 95% CI 0.99 to 0.99) but not for those who moved once or had not moved. Association between different GBS exposures and seeking help for CMD in general practice were modified by urban–rural home location and a history of seeking help for CMD. Greater EVI was associated with lower odds of seeking help for a CMD for those living in rural areas (AOR 0.59, 95% CI 0.58 to 0.59) compared with urban areas (AOR 0.85, 95% CI 0.84 to 0.85). More potentially accessible GBS were only associated with lower odds of seeking help for CMD for those living in urban areas (AOR 0.89, 95% CI 0.89 to 0.89). In rural areas more GBS access was associated with higher odds of seeking help for CMD (AOR 1.10, 95% CI 1.08 to 1.12). More ambient greenness (+ 0.1 EVI) was associated with lower odds of seeking help for a CMD for those who had historically sought help for CMD (before January 2008) than people who had not (AOR 0.68 vs. 0.84). Research question 3: Is a greater residential exposure associated with the likelihood of using GP services? There was no evidence that an increase in mean EVI was associated with the number of general practice event days/quarter (adjusted incidence rate ratio relative to baseline: 1.00, 95% CI 1.00 to 1.00). Research question 4: Is greater residential GBS exposure and access to GBS associated with higher subjective well-being, or a lower likelihood of seeking help for CMD in general practice, and are these associations mediated by intentional use of GBS for leisure? Among NSW respondents with outcome measures (n = 5971) EVI was significantly related to well-being as measured by WEMWBS with a U-shaped relationship (linear regression; EVI −10.15, 95% CI −17.13 to −3.17; EVI2 12.49, 95% CI 3.02 to 21.97) and weekly time outdoors (linear relationship; EVI 43.41, 95% CI 6.85 to 79.97). Time outdoors was significantly positively related to WEMWBS [time outdoors (hours) 0.88, 95% CI 0.53 to 1.24, time outdoors (hours)2 −0.06, 95% CI −0.11 to −0.01] and life satisfaction [linear relationship; time outdoors (hours) 0.06, 95% CI 0.04 to 0.07]. There was no evidence that time outdoors mediated the relationship between EVI and WEMWBS/life satisfaction. EVI was not associated with CMD (EVI 0.4 to 0.8 vs.

Published
2023
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2. Ambient greenness, access to local green spaces, and subsequent mental health: a 10-year longitudinal dynamic panel study of 2·3 million adults in Wales

Author

Rebecca S Geary, PhD, Daniel Thompson, PhD, Amy Mizen, PhD, Ashley Akbari, MSc, Joanne K Garrett, PhD, Francis M Rowney, PhD, Alan Watkins, ProfPhD, Ronan A Lyons, ProfFmedSci MD, Gareth Stratton, ProfPhD, Rebecca Lovell, PhD, Mark Nieuwenhuijsen, ProfPhD, Sarah C Parker, MSc, Jiao Song, PhD, Dialechti Tsimpida, PhD, James White, ProfPhD, Mathew P White, PhD, Susan Williams, PhD, Benedict W Wheeler, PhD, Richard Fry, PhD, and Sarah E Rodgers, ProfPhD

Subjects
Environmental sciences, GE1-350
Abstract

Summary: Background: Living in greener areas, or close to green and blue spaces (GBS; eg, parks, lakes, or beaches), is associated with better mental health, but longitudinal evidence when GBS exposures precede outcomes is less available. We aimed to analyse the effect of living in or moving to areas with more green space or better access to GBS on subsequent adult mental health over time, while explicitly considering health inequalities. Methods: A cohort of the people in Wales, UK (≥16 years; n=2 341 591) was constructed from electronic health record data sources from Jan 1, 2008 to Oct 31, 2019, comprising 19 141 896 person-years of follow-up. Household ambient greenness (Enhanced Vegetation Index [EVI]), access to GBS (counts, distance to nearest), and common mental health disorders (CMD, based on a validated algorithm combining current diagnoses or symptoms of anxiety or depression [treated or untreated in the preceding 1-year period], or treatment of historical diagnoses from before the current cohort [up to 8 years previously, to 2000], where diagnosis preceded treatment) were record-linked. Cumulative exposure values were created for each adult, censoring for CMD, migration out of Wales, death, or end of cohort. Exposure and CMD associations were evaluated using multivariate logistic regression, stratified by area-level deprivation. Findings: After adjustment, exposure to greater ambient greenness over time (+0·1 increased EVI on a 0–1 scale) was associated with lower odds of subsequent CMD (adjusted odds ratio 0·80, 95% CI 0·80–0·81), where CMD was based on a combination of current diagnoses or symptoms (treated or untreated in the preceding 1-year period), or treatments. Ten percentile points more access to GBS was associated with lower odds of a later CMD (0·93, 0·93–0·93). Every additional 360 m to the nearest GBS was associated with higher odds of CMD (1·05, 1·04–1·05). We found that positive effects of GBS on mental health appeared to be greater in more deprived quintiles. Interpretation: Ambient exposure is associated with the greatest reduced risk of CMD, particularly for those who live in deprived communities. These findings support authorities responsible for GBS, who are attempting to engage planners and policy makers, to ensure GBS meets residents' needs. Funding: National Institute for Health and Care Research Public Health Research programme.

Published
2023
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3. Association Between Patient Factors and the Effectiveness of Wearable Trackers at Increasing the Number of Steps per Day Among Adults With Cardiometabolic Conditions: Meta-analysis of Individual Patient Data From Randomized Controlled Trials

Author

Alexander Hodkinson, Evangelos Kontopantelis, Salwa S Zghebi, Christos Grigoroglou, Brian McMillan, Harm van Marwijk, Peter Bower, Dialechti Tsimpida, Charles F Emery, Mark R Burge, Hunter Esmiol, Margaret E Cupples, Mark A Tully, Kaberi Dasgupta, Stella S Daskalopoulou, Alexandra B Cooke, Ayorinde F Fayehun, Julie Houle, Paul Poirier, Thomas Yates, Joseph Henson, Derek R Anderson, Elisabeth B Grey, and Maria Panagioti

Subjects
Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, RA1-1270
Abstract

BackgroundCurrent evidence supports the use of wearable trackers by people with cardiometabolic conditions. However, as the health benefits are small and confounded by heterogeneity, there remains uncertainty as to which patient groups are most helped by wearable trackers. ObjectiveThis study examined the effects of wearable trackers in patients with cardiometabolic conditions to identify subgroups of patients who most benefited and to understand interventional differences. MethodsWe obtained individual participant data from randomized controlled trials of wearable trackers that were conducted before December 2020 and measured steps per day as the primary outcome in participants with cardiometabolic conditions including diabetes, overweight or obesity, and cardiovascular disease. We used statistical models to account for clustering of participants within trials and heterogeneity across trials to estimate mean differences with the 95% CI. ResultsIndividual participant data were obtained from 9 of 25 eligible randomized controlled trials, which included 1481 of 3178 (47%) total participants. The wearable trackers revealed that over the median duration of 12 weeks, steps per day increased by 1656 (95% CI 918-2395), a significant change. Greater increases in steps per day from interventions using wearable trackers were observed in men (interaction coefficient –668, 95% CI –1157 to –180), patients in age categories over 50 years (50-59 years: interaction coefficient 1175, 95% CI 377-1973; 60-69 years: interaction coefficient 981, 95% CI 222-1740; 70-90 years: interaction coefficient 1060, 95% CI 200-1920), White patients (interaction coefficient 995, 95% CI 360-1631), and patients with fewer comorbidities (interaction coefficient –517, 95% CI –1188 to –11) compared to women, those aged below 50, non-White patients, and patients with multimorbidity. In terms of interventional differences, only face-to-face delivery of the tracker impacted the effectiveness of the interventions by increasing steps per day. ConclusionsIn patients with cardiometabolic conditions, interventions using wearable trackers to improve steps per day mostly benefited older White men without multimorbidity. Trial RegistrationPROSPERO CRD42019143012; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=143012

Published
2022
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4. Regional patterns and trends of hearing loss in England: evidence from the English longitudinal study of ageing (ELSA) and implications for health policy

Author

Dialechti Tsimpida, Evangelos Kontopantelis, Darren M. Ashcroft, and Maria Panagioti

Subjects
Hearing loss, ELSA, inequalities, Social epidemiology, Health geography, Geriatrics, RC952-954.6
Abstract

Abstract Background Hearing loss (HL) is a significant public health concern globally and is estimated to affect over nine million people in England. The aim of this research was to explore the regional patterns and trends of HL in a representative longitudinal prospective cohort study of the English population aged 50 and over. Methods We used the full dataset (74,699 person-years) of self-reported hearing data from all eight Waves of the English Longitudinal Study of Ageing (ELSA) (2002–2017). We examined the geographical identifiers of the participants at the Government Office Region (GOR) level and the geographically based Index of Multiple Deprivation (IMD). The primary outcome measure was self-reported HL; it consisted of a merged category of people who rated their hearing as fair or poor on a five-point Likert scale (excellent, very good, good, fair or poor) or responded positively when asked whether they find it difficult to follow a conversation if there is background noise (e.g. noise from a TV, a radio or children playing). Results A marked elevation in HL prevalence (10.2%) independent of the age of the participants was observed in England in 2002–2017. The mean HL prevalence increased from 38.50 (95%CI 37.37–39.14) in Wave 1 to 48.66 (95%CI 47.11–49.54) in Wave 8. We identified three critical patterns of findings concerning regional trends: the highest HL prevalence among samples with equal means of age was observed in GORs with the highest prevalence of participants in the most deprived (IMD) quintile, in routine or manual occupations and misusing alcohol. The adjusted HL predictions at the means (APMs) showed marked regional variability and hearing health inequalities between Northern and Southern England that were previously unknown. Conclusions A sociospatial approach is crucial for planning sustainable models of hearing care based on actual needs and reducing hearing health inequalities. The Clinical Commissioning Groups (CCGs) currently responsible for the NHS audiology services in England should not consider HL an inevitable accompaniment of older age; instead, they should incorporate socio-economic factors and modifiable lifestyle behaviours for HL within their spatial patterning in England.

Published
2020
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5. Determinants of health- related quality of life (HRQoL) among deaf and hard of hearing adults in Greece: a cross-sectional study

Author

Dialechti Tsimpida, Daphne Kaitelidou, and Petros Galanis

Subjects
Deaf, Hard of hearing, Deafness, Health-related quality of life, Determinants, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Hearing loss is an important public health issue, since it has a very negative impact on peoples’ lives, irrespective of the age at which it develops. However, globally there is a noticeable lack of epidemiological data for health outcomes for people who are deaf and hard of hearing. In Greece, people with hearing disabilities are systematically not included in health policy and planning processes, despite there being a marked tendency for global efforts aimed at improving their quality of life. Methods The sample consisted of 140 adults with hearing loss (86 d/Deaf and 54 hard of hearing) and 97 normal hearing as the control group. We run data collection from April to June 2015, using the Greek version of the 36-Item Short Form Health Survey (SF-36v2). Socio-demographic and characteristics about non-medical determinants of health (tobacco and alcohol consumption levels, BMI and physical activity).were also collected and were analysed as possible determinants. Data analysis included bivariate and multivariate analyses such as linear regression models. Results Multivariate analyses identified that in all the SF-36v2 dimensions, the scores among deaf people were lower than those with normal hearing. Determinants included the hearing loss degree, educational level, body mass index, levels of physical activity, and alcohol consumption levels, while the variable “number of family members per household” was inversely associated with physical health summary scale score. Conclusions Improving knowledge of the health-related determinants that affect quality of life for the population with hearing loss is an important step in designing targeted services and interventions. In light of these findings, a special effort must be made to ensure the wellbeing of this population.

Published
2018
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6. The leaky pipeline of hearing care: primary to secondary care evidence from the English Longitudinal Study of Ageing (ELSA)

Author

Dialechti Tsimpida, Saima Rajasingam, Maria Panagioti, and Helen Henshaw

Subjects
Speech and Hearing, Linguistics and Language, Language and Linguistics
Abstract

ObjectiveThe proportions of older adults’ transitions through acknowledging their hearing loss to getting access to treatment are unknown. This was examined using data from a nationally representative cohort in England.DesignPatient and healthcare factors associated with referrals were examined cross-sectionally, through primary to secondary care. Non-report predictors identified using multiple logistic regression models.Study sample8529 adults with hearing data in the English Longitudinal Study of Ageing Wave 7.ResultsNearly 40% of those with acknowledged hearing loss did not tell a doctor or nurse (n = 857/2249). Women (OR 2.68, 95% CI 2.14–2.98), retirees (OR 1.30, 95% CI 1.17–1.44), those with foreign education (OR 2.74, 95% CI 2.47–3.04), lower education (OR 2.86, 95% CI 2.58–3.18), smokers (OR 4.39, 95% CI 3.95–4.87), and heavy drinkers (OR 1.67, 95% CI 1.58–1.85) were more likely to not report hearing loss. Of those who acknowledged and reported hearing difficulties, willingness to try hearing aid(s) was high (78.9%).ConclusionsUnacknowledged, or acknowledged but not reported hearing loss by individuals, and non-referrals by primary healthcare professionals, are barriers to accessing hearing healthcare. Future research should report hearing aid use as the proportion of individuals who acknowledge their hearing loss, to avoid an overestimation of the non-use of hearing aids within study samples.

Published
2023
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7. The dynamic relationship between hearing loss, quality of life, socioeconomic position and depression and the impact of hearing aids: answers from the English Longitudinal Study of Ageing (ELSA)

Author

Dialechti Tsimpida, Maria Panagioti, Darren M. Ashcroft, and Evangelos Kontopantelis

Subjects
Gerontology, Mediation (statistics), Longitudinal study, Hearing aids, Aging, Health (social science), Social epidemiology, Social Psychology, Epidemiology, Hearing loss, Psychosocial wellbeing, Affect (psychology), Quality of life, medicine, Humans, Longitudinal Studies, Socioeconomic status, Aged, Original Paper, business.industry, Depression, Psychiatry and Mental health, Ageing, Socioeconomic Factors, Quality of Life, medicine.symptom, business, Psychosocial
Abstract

Purpose The adverse impact of hearing loss (HL) extends beyond auditory impairment and may affect the individuals' psychosocial wellbeing. We aimed to examine whether there exists a causal psychosocial pathway between HL and depression in later life, via socioeconomic factors and quality of life, and whether hearing aids usage alleviates depressive symptoms over time. Methods We examined the longitudinal relationship between HL and depressive symptoms (CES-D) applying dynamic cross-lagged mediation path models. We used the full dataset of participants aged 50–89 years (74,908 person-years), from all eight Waves of the English Longitudinal Study of Ageing (ELSA). Their quality of life (CASP-19) and their wealth were examined as the mediator and moderator of this relationship, respectively. Subgroup analyses investigated differences among those with hearing aids within different models of subjectively and objectively identified HL. All models were adjusted for age, sex, retirement status and social engagement. Results Socioeconomic position (SEP) influenced the strength of the relationship between HL and depression, which was stronger in the lowest versus the highest wealth quintiles. The use of hearing aids was beneficial for alleviating depressive symptoms. Those in the lowest wealth quintiles experienced a lower risk for depression after the use of hearing aids compared to those in the highest wealth quintiles. Conclusion HL poses a substantial risk for depressive symptoms in older adults, especially those who experience socioeconomic inequalities. The early detection of HL and provision of hearing aids may not only promote better-hearing health but could also enhance the psychosocial wellbeing of older adults, particularly those in a lower SEP.

Published
2021

8. Forty years on: a new national study of hearing in England and implications for global hearing health policy

Author

Evangelos Kontopantelis, Dr Dialechti Tsimpida, and Maria Panagioti

Subjects
Aged, 80 and over, Linguistics and Language, Health Policy, Middle Aged, Deafness, Language and Linguistics, Speech and Hearing, Cross-Sectional Studies, Hearing, England, otorhinolaryngologic diseases, Prevalence, Humans, Longitudinal Studies, Hearing Loss, Aged
Abstract

We aimed to update the prevalence estimates of hearing loss in older adults in England using a nationally representative sample of adults aged 50 years old and older. A comparative cross-sectional study design was implemented. Hearing loss was defined as ≥35 dB HL at 3.0 kHz, as measured via Hearcheck in the better-hearing ear. We compared the estimates based on the English census in 2015 to estimates from psychoacoustic hearing data available for 8,263 participants in the English Longitudinal Study of Ageing (ELSA) Wave 7 (2014–2015). Marked regional variability in hearing loss prevalence was revealed among participants with similar age profiles. The regional differences in hearing outcomes reached up to 13.53% in those belonging to the 71–80 years old group; the prevalence of hearing loss was 49.22% in the North East of England (95%CI 48.0–50.4), versus 35.69% in the South East (95%CI 34.8–36.50). A socio-spatial approach in planning sustainable models of hearing care based on the actual populations’ needs and not on age demographics might offer a viable opportunity for healthier lives. Regular assessment of the extent and causality of the population’s different audiological needs within the country is strongly supported.

Published
2022

9. Comparative effectiveness of statins on non-high density lipoprotein cholesterol in people with diabetes and at risk of cardiovascular disease: systematic review and network meta-analysis

Author

Alexander Hodkinson, Dialechti Tsimpida, Evangelos Kontopantelis, Martin K Rutter, Mamas A Mamas, and Maria Panagioti

Subjects
Adult, Cholesterol, Diabetes Mellitus, Type 2, Cardiovascular Diseases, Network Meta-Analysis, Humans, Bayes Theorem, General Medicine, Hydroxymethylglutaryl-CoA Reductase Inhibitors
Abstract

ObjectiveTo compare the efficacy of different statin treatments by intensity on levels of non-high density lipoprotein cholesterol (non-HDL-C) for the prevention of cardiovascular disease in people with diabetes.DesignSystematic review and network meta-analysis.Data sourcesMedline, Cochrane Central Register of Controlled Trials, and Embase from inception to 1 December 2021.Review methodsRandomised controlled trials comparing different types and intensities of statins, including placebo, in adults with type 1 or type 2 diabetes mellitus were included. The primary outcome was changes in levels of non-HDL-C, calculated from measures of total cholesterol and HDL-C. Secondary outcomes were changes in levels of low density lipoprotein cholesterol (LDL-C) and total cholesterol, three point major cardiovascular events (non-fatal stroke, non-fatal myocardial infarction, and death related to cardiovascular disease), and discontinuations because of adverse events. A bayesian network meta-analysis of statin intensity (low, moderate, or high) with random effects evaluated the treatment effect on non-HDL-C by mean differences and 95% credible intervals. Subgroup analysis of patients at greater risk of major cardiovascular events was compared with patients at low or moderate risk. The confidence in network meta-analysis (CINeMA) framework was applied to determine the certainty of evidence.ResultsIn 42 randomised controlled trials involving 20 193 adults, 11 698 were included in the meta-analysis. Compared with placebo, the greatest reductions in levels of non-HDL-C were seen with rosuvastatin at high (−2.31 mmol/L, 95% credible interval −3.39 to −1.21) and moderate (−2.27, −3.00 to −1.49) intensities, and simvastatin (−2.26, −2.99 to −1.51) and atorvastatin (−2.20, −2.69 to −1.70) at high intensity. Atorvastatin and simvastatin at any intensity and pravastatin at low intensity were also effective in reducing levels of non-HDL-C. In 4670 patients at greater risk of a major cardiovascular events, atorvastatin at high intensity showed the largest reduction in levels of non-HDL-C (−1.98, −4.16 to 0.26, surface under the cumulative ranking curve 64%). Simvastatin (−1.93, −2.63 to −1.21) and rosuvastatin (−1.76, −2.37 to −1.15) at high intensity were the most effective treatment options for reducing LDL-C. Significant reductions in non-fatal myocardial infarction were found for atorvastatin at moderate intensity compared with placebo (relative risk=0.57, confidence interval 0.43 to 0.76, n=4 studies). No significant differences were found for discontinuations, non-fatal stroke, and cardiovascular deaths.ConclusionsThis network meta-analysis indicated that rosuvastatin, at moderate and high intensity doses, and simvastatin and atorvastatin, at high intensity doses, were most effective at moderately reducing levels of non-HDL-C in patients with diabetes. Given the potential improvement in accuracy in predicting cardiovascular disease when reduction in levels of non-HDL-C is used as the primary target, these findings provide guidance on which statin types and intensities are most effective by reducing non-HDL-C in patients with diabetes.Systematic review registrationPROSPERO CRD42021258819.

Published
2022

10. Comparison of Self-reported Measures of Hearing With an Objective Audiometric Measure in Adults in the English Longitudinal Study of Ageing

Author

Maria Panagioti, Dialechti Tsimpida, Evangelos Kontopantelis, and Darren M. Ashcroft

Subjects
Hearing aid, Male, Longitudinal study, medicine.medical_specialty, Aging, Cross-sectional study, Hearing loss, medicine.medical_treatment, Population, Ear infection, Audiology, Audiometry, medicine, otorhinolaryngologic diseases, Humans, Longitudinal Studies, education, Hearing Loss, Aged, Original Investigation, Aged, 80 and over, education.field_of_study, medicine.diagnostic_test, business.industry, Research, General Medicine, Middle Aged, Online Only, Cross-Sectional Studies, Socioeconomic Factors, Cohort, Female, Self Report, Public Health, medicine.symptom, business
Abstract

Key Points Questions Among middled-aged adults, are self-reported measures of hearing concordant with audiometry findings, and is potential discordance associated with age or lifestyle factors? Findings In this cross-sectional study of 9666 participants in the English Longitudinal Study of Ageing, self-report measures of hearing had limited accuracy and were not sufficiently sensitive to detect hearing loss. Hearing loss went undetected by the self-reported measures. Meaning These findings may inform public health policies relevant to selection of appropriate and validated tools for detecting hearing problems among middle-aged and older adults., Importance An effective and sustainable hearing loss (HL) screening strategy for the early detection of and intervention for HL in older adults is needed. Objectives To examine the concordance of self-reported measures of hearing difficulty with objective hearing data and the factors associated with the potential discordances among these measures across different population subgroups of a representative sample of people 50 years and older in England. Design, Setting, and Participants This study was a cross-sectional analysis of wave 7 of the English Longitudinal Study of Ageing (ELSA), a large, population-based, prospective cohort study that provides a unique resource for exploring issues associated with aging in England in the 21st century. The full analytic cohort was composed of 9666 individuals participating in the ELSA wave 7, which collected information from June 1, 2014, to May 31, 2015. This study further analyzed a sample of 8529 adults 50 to 89 years of age who had an assessment of their hearing by self-reported measures, and consented to assessment by a qualified nurse via a hearing screening device, and did not have an ear infection or a cochlear implant. Bivariate analyses were performed from July 1 to December 30, 2018, and multivariate analysis from January 1 to June 30, 2019. Multiple logistic regression models examined factors associated with misclassification of hearing difficulties across several categories among those with objectively identified HL. Exposures The study examined whether age, marital status, retirement status, indicators of socioeconomic position, and lifestyle factors (such as body mass index, physical activity, and tobacco and alcohol consumption) were associated with the concordance between self-reported hearing problems and manual audiometry among older adults. Main Outcomes and Measures Self-reported hearing measures, including hearing in background noise, compared with objective audiometric assessments. Results A total of 9666 study participants (5368 female [55.5%]; mean [SD] age, 67.4 [14.4] years) provided responses regarding their hearing difficulties, hearing in noise, quality of care in hearing, and hearing aid recommendation in ELSA wave 7. Within the cohort, 684 individuals (30.2%) with objectively measured HL greater than 35 dB HL at 3.0 kHz went undetected by the self-report measure, whereas the new constructed categories for moderate and moderately severe or severe HL resulted in 9.3% increased sensitivity. Factors associated with misreporting hearing difficulties (while they had objectively measured HL >35 dB HL at 3.0 kHz, in the better-hearing ear) were as follows: female sex (odds ratio [OR], 1.97; 95% CI, 1.18-3.28), no educational qualifications (OR, 1.37; 95% CI, 1.26-2.55), routine or manual occupation (OR, 1.43; 95% CI, 1.28-2.61), tobacco consumption (OR, 1.14; 95% CI, 1.08-1.90), alcohol intake above the low-risk-level guidelines (OR, 1.13; 95% CI, 1.11-2.34), and lack of moderate physical activity (OR, 1.25; 95% CI, 1.03-1.42). Age was largely associated with misreporting of moderately severe to severe HL; the odds were 5.75 (95% CI, 1.17-8.13) higher for those 65 to 74 years of age and 7.08 (95% CI, 1.41-9.30) higher for those 75 to 89 years of age to not report their hearing difficulties compared with those 50 to 64 years of age. In addition, socioeconomic indicators, such as educational level (OR, 1.95; 95% CI, 1.63-6.01) and occupation (OR, 2.07; 95% CI, 1.78-5.40), along with lifestyle factors, such as smoking (OR, 1.46; 95% CI, 1.25-2.48) and alcohol intake above the low-risk-level guidelines (OR, 1.86; 95% CI, 1.67-5.12), were factors associated with misreporting moderately severe or severe HL. Conclusions and Relevance The use of a screening measure for audiometric testing and a self-report measure is essential for accurately identifying older people with HL. The results of this study should be considered by HL researchers who analyze self-reported hearing data as a surrogate measurement of audiometric hearing to identify bias in their observed analytic research results., This cross-sectional study examines the concordance of self-reported measures of hearing difficulty with objective hearing data and the factors associated with the potential discordances among these measures in people 50 years and older in England.

Published
2020

11. Predictors of Hearing Help-Seeking among Older Adults in England and Implications for Health Policy Strategies in Primary Care

Author

Dr Dialechti Tsimpida, Evangelos Kontopantelis, Darren Ashcroft, and Maria Panagioti

Subjects
otorhinolaryngologic diseases
Abstract

Background Hearing loss is a major public health issue that affects over 9 million people in England. Traditionally, people with hearing difficulties will present to their GP to seek advice and investigation. Many of these people will be referred to Secondary Care Audiology or ENT for assessment and management. However, as hearing loss almost always develops gradually, people do not see it as a dramatic health problem requiring urgent intervention. In the absence of a HL screening program in England, It is therefore important to examine whether the self-identification of hearing problems is accurate, as it affects the initiation of hearing help-seeking.Method Cross-sectional analysis of participants aged 50-89 years old from a representative sample of adults aged 50 years and over living in England (the English Longitudinal Study of Ageing, Wave 7). Our cohort was composed of 8,529 individuals that had assessment in their hearing by both self-reported measures and consented for assessment by a qualified nurse via a hearing screening device (HearCheck™ Screener). Hearing loss was defined as >35dB HL at 3.0 kHz, in the better-hearing ear. Multiple logistic regression models examined whether the self-reported measures of hearing -including hearing in background noise- are valid in comparison to objective measures of hearing and which the predictors of the potential inaccuracies are across different population subgroups of a representative population sample. Results 30.2% of individuals with HL went undetected by the self-report measure in ELSA. Statistically significant predictors of misreporting hearing difficulties (while they had objectively measured HL >35dBHL at 3.0kHz, in the better-hearing ear) were: female gender (OR 1.97, 95%CI 1.18-3.28), no educational qualifications (OR 1.37, 95%CI 1.26-2.55), routine/manual occupation (OR 1.43, 95%CI 1.28-2.61), tobacco consumption (OR 1.14, 95%CI 1.08-1.90), alcohol intake above the low risk level guidelines (OR 1.13, 95%CI 1.11-2.34), and lack of moderate physical activity (OR 1.25, 95%CI 1.03-1.42). Age was largely associated with misreporting of moderately severe to severe HL; the odds were 5.75 (95%CI 1.17-8.13) higher on those aged 65-74 and 7.08 (95%CI 1.41-9.30) on those aged 75-89 to not report their hearing difficulties compared to those 50-64 years old. Also, socioeconomic indicators such as education (OR 1.95, 95%CI 1.63-6.01) and occupation (OR 2.07, 95%CI 1.78-5.40) along with lifestyle factors such as smoking (OR 1.46, 95%CI 1.25-2.48) and alcohol intake above the low risk level guidelines (OR 1.86, 95%CI 1.67-5.12) were predictors of misreporting moderately severe or severe HL.Implications The self-identification of hearing difficulties is a major barrier for the initiation of help-seeking, which can affect the referral to ear specialists and the consequent hearing aid uptake. Our study showed that the self-report measurement of HL had limited accuracy and was not sufficiently sensitive to detect HL. In England, up to one third of adults with HL may remain undiagnosed and therefore not referred to ear specialists or given access to hearing aids. Importantly, people belonging in high-risk groups for HL, such as older and less educated people that face socioeconomic inequalities and adopt an unhealthy lifestyle, are the least likely to be accurately identified using self-report measures. These findings provide novel insights into clinical practice and reinforce the importance of an effective and sustainable hearing loss screening strategy in primary care, for the early detection and intervention for HL in older adults.

Published
2020

12. Socioeconomic and Lifestyle Factors Associated with Hearing Loss in Older Adults:A Cross-sectional Study of the English Longitudinal Study of Ageing (ELSA)

Author

Maria Panagioti, Evangelos Kontopantelis, Dialechti Tsimpida, and Darren M. Ashcroft

Subjects
Male, Longitudinal study, Cross-sectional study, Hearing loss, Ear infection, Psychological intervention, Social epidemiology, 03 medical and health sciences, Age Distribution, 0302 clinical medicine, Audiometry, Risk Factors, Humans, Medicine, Longitudinal Studies, 030212 general & internal medicine, Sex Distribution, Hearing Loss, 030223 otorhinolaryngology, Life Style, Socioeconomic status, hearing health inequalities, Original Research, Aged, Aged, 80 and over, medicine.diagnostic_test, business.industry, Hearing Tests, socioeconomic position, General Medicine, Middle Aged, social epidemiology, Cross-Sectional Studies, Logistic Models, England, Socioeconomic Factors, Female, Public Health, medicine.symptom, business, healthy ageing, Demography
Abstract

OBJECTIVES:Aims were (1) to examine whether socioeconomic position (SEP) is associated with hearing loss (HL) among older adults in England and (2) whether major modifiable lifestyle factors (high body mass index, physical inactivity, tobacco consumption and alcohol intake above the low-risk-level guidelines) are associated with HL after controlling for non-modifiable demographic factors and SEP.SETTING:We used data from the wave 7 of the English Longitudinal Study of Ageing, which is a longitudinal household survey dataset of a representative sample of people aged 50 and older.PARTICIPANTS:The final analytical sample was 8529 participants aged 50-89 that gave consent to have their hearing acuity objectively measured by a screening audiometry device and did not have any ear infection.PRIMARY AND SECONDARY OUTCOME MEASURES:HL defined as >35 dBHL at 3.0 kHz (better-hearing ear). Those with HL were further subdivided into two categories depending on the number of tones heard at 3.0 kHz.RESULTS:HL was identified in 32.1% of men and 22.3% of women aged 50-89. Those in a lower SEP were up to two times more likely to have HL; the adjusted odds of HL were higher for those with no qualifications versus those with a degree/higher education (men: OR 1.87, 95%CI 1.47 to 2.38, women: OR 1.53, 95%CI 1.21 to 1.95), those in routine/manual occupations versus those in managerial/professional occupations (men: OR 1.92, 95%CI 1.43 to 2.63, women: OR 1.25, 95%CI 1.03 to 1.54), and those in the lowest versus the highest income and wealth quintiles (men: OR 1.62, 95%CI 1.08 to 2.44, women: OR 1.36, 95%CI 0.85 to 2.16, and men: OR1.72, 95%CI 1.26 to 2.35, women: OR 1.88, 95%CI 1.37 to 2.58, respectively). All regression models showed that socioeconomic and the modifiable lifestyle factors were strongly associated with HL after controlling for age and gender.CONCLUSIONS:Socioeconomic and lifestyle factors are associated with HL among older adults as strongly as core demographic risk factors, such as age and gender. Socioeconomic inequalities and modifiable lifestyle behaviours need to be targeted by the health policy strategies, as an important step in designing interventions for individuals that face hearing health inequalities.

Published
2019

13. Conceptual Model of Hearing Health Inequalities (HHI Model): A Critical Interpretive Synthesis

Author

Maria Panagioti, Dialechti Tsimpida, Darren M. Ashcroft, and Evangelos Kontopantelis

Subjects
Gerontology, Hearing loss, media_common.quotation_subject, Population, Health literacy, Review Article, 03 medical and health sciences, Speech and Hearing, Patient safety, 0302 clinical medicine, Quality of life (healthcare), Hearing, Health care, patient safety, otorhinolaryngologic diseases, medicine, Humans, 030212 general & internal medicine, 030223 otorhinolaryngology, education, media_common, critical interpretive synthesis, education.field_of_study, business.industry, Hearing Tests, Cognition, Health Status Disparities, health inequalities, Models, Theoretical, healthy aging, Otorhinolaryngology, Quality of Life, Conceptual model, medicine.symptom, Psychology, business, health literacy
Abstract

Hearing loss is a major health challenge that can have severe physical, social, cognitive, economic, and emotional consequences on people’s quality of life. Currently, the modifiable factors linked to socioeconomic inequalities in hearing health are poorly understood. Therefore, an online database search (PubMed, Scopus, and Psych) was conducted to identify literature that relates hearing loss to health inequalities as a determinant or health outcome. A total of 53 studies were selected to thematically summarize the existing literature, using a critical interpretive synthesis method, where the subjectivity of the researcher is intimately involved in providing new insights with explanatory power. The evidence provided by the literature can be summarized under four key themes: (a) There might be a vicious cycle between hearing loss and socioeconomic inequalities and lifestyle factors, (b) socioeconomic position may interact with less healthy lifestyles, which are harmful to hearing ability, (c) increasing health literacy could improve the diagnosis and prognosis of hearing loss and prevent the adverse consequences of hearing loss on people’s health, and (d) people with hearing loss might be vulnerable to receiving low-quality and less safe health care. This study uses elements from theoretical models of health inequalities to formulate a highly interpretive conceptual model for examining hearing health inequalities. This model depicts the specific mechanisms of hearing health and their evolution over time. There are many modifiable determinants of hearing loss, in several stages across an individual’s life span; tackling socioeconomic inequalities throughout the life-course could improve the population’s health, maximizing the opportunity for healthy aging.

Published
2021

14. Determinants of Health-related Quality of Life (HRQoL) among Deaf and Hard of Hearing Adults in Greece: a Cross-Sectional Study

Author

Petros Galanis, Dialechti Tsimpida, and Daphne Kaitelidou

Subjects
Gerontology, medicine.medical_specialty, Cross-sectional study, Hearing loss, Hard of hearing, Health-related quality of life, Population, Deafness, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), medicine, otorhinolaryngologic diseases, 030212 general & internal medicine, Social determinants of health, 10. No inequality, education, Health policy, Determinants, 2. Zero hunger, education.field_of_study, Research, 4. Education, Public health, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, Health services research, lcsh:RA1-1270, 3. Good health, medicine.symptom, Psychology, Deaf, 030217 neurology & neurosurgery
Abstract

Background Hearing loss is an important public health issue, since it has a very negative impact on peoples’ lives, irrespective of the age at which it develops. However, globally there is a noticeable lack of epidemiological data for health outcomes for people who are deaf and hard of hearing. In Greece, people with hearing disabilities are systematically not included in health policy and planning processes, despite there being a marked tendency for global efforts aimed at improving their quality of life. Methods The sample consisted of 140 adults with hearing loss (86 d/Deaf and 54 hard of hearing) and 97 normal hearing as the control group. We run data collection from April to June 2015, using the Greek version of the 36-Item Short Form Health Survey (SF-36v2). Socio-demographic and characteristics about non-medical determinants of health (tobacco and alcohol consumption levels, BMI and physical activity).were also collected and were analysed as possible determinants. Data analysis included bivariate and multivariate analyses such as linear regression models. Results Multivariate analyses identified that in all the SF-36v2 dimensions, the scores among deaf people were lower than those with normal hearing. Determinants included the hearing loss degree, educational level, body mass index, levels of physical activity, and alcohol consumption levels, while the variable “number of family members per household” was inversely associated with physical health summary scale score. Conclusions Improving knowledge of the health-related determinants that affect quality of life for the population with hearing loss is an important step in designing targeted services and interventions. In light of these findings, a special effort must be made to ensure the wellbeing of this population.

Published
2018

15. Barriers to the use of health services among deaf and hard of hearing adults in Greece: a Cross-Sectional Study

Author

Daphne Kaitelidou, Dialechti Tsimpida, and Petros Galanis

Subjects
medicine.medical_specialty, education.field_of_study, business.industry, Cross-sectional study, Hearing loss, Population, Receptionists, Minor (academic), Sign language, computer.software_genre, 030226 pharmacology & pharmacy, 03 medical and health sciences, 0302 clinical medicine, Family medicine, Health care, otorhinolaryngologic diseases, medicine, 030212 general & internal medicine, business.job_title, medicine.symptom, business, Psychology, education, computer, Interpreter
Abstract

Rationale, Aims and Objectives: To explore the issues related to the use of health services by deaf and hard of hearing adults in Greece.Method: The study population consisted of 140 adults with hearing loss (86 deaf and 54 hard of hearing). We gathered information about sociodemographic characteristics, use of health services characteristics, satisfaction from health providers and complaints during the use of health services.Results: A considerable percentage of the participants did not make appropriate use of healthcare services, as they made avoidable visits to emergency departments even for minor, short-term conditions (p=0.002) or used to just wait for the symptoms to pass in an illness occurrence (p=0.06). They also experienced major difficulties as part of the health visit (p=0.01) and the quality of communication with health providers (p=0.002). The absence of assistive technology, along with the lack of low availability of Sign Language interpreters, were important barriers for those that communicate in Sign Language. Regarding the engagement with healthcare providers, there were high rates of dissatisfaction from doctors, nurses and receptionists related to issues during the use of health services.Conclusions: Our results underscore the fact that deaf and hard of hearing persons constitute a minority population that experience major barriers during the use of health services and considerable difficulties in the healthcare provider-patient relationship. In light of these findings, a special effort must be made to ensure that deaf and hard of hearing individuals receive appropriate, ethical and person-centered healthcare.

Published
2018

17. Mental Health Inequalities among Adults with Hearing Loss: Findings from the English Longitudinal Study of Ageing (ELSA)

Author

Dr Dialechti Tsimpida, Evangelos Kontopantelis, Darren Ashcroft, and Maria Panagioti

Subjects
otorhinolaryngologic diseases
Abstract

Objectives: To examine the relationship between mental health and hearing loss among older adults at various socioeconomic strata. Design: Retrospective cohort study from up to seven waves of data collection covering a period of fourteen years of the English Longitudinal Study of Ageing (ELSA), which is a unique and rich resource of information on the health, social, wellbeing and economic circumstances of the English population aged 50 and older. Methods: Hearing loss was defined as >35dB HL at 3.0 kHz (better-hearing ear). Cross-sectional associations between self-reported and objective (available only in wave 7) hearing measures and depression were examined using multinomial-logistic regression (n=8,529). The longitudinal association between self-reported hearing at Wave 1 (2002/03) and diagnosis of depression up to Wave 7 (2014/15) was modelled using Cox proportional hazards regression. Results: The prevalence of depression among adults with hearing loss increased with time in each net financial wealth quintile in waves 1 to 7. In men, the increase of depression was tripled from wave 1 to wave 7 in the lowest wealth group, whereas in men in the higher wealth groups and in women across all wealth groups, the prevalence approximately doubled. Conclusions: Hearing impairment increases the risk for depression at least twice in the full sample and three times in lower wealth groups. These findings are consistent with the hypothesis that early detection of hearing loss could help delay the onset of depression, or that hearing loss is likely to be driving people to depression, particularly in lower wealth groups.

19. The Role of the Leadership Skills Development and the Building of Effective Nursing Teamwork in the Improvement of Health Services Quality in the National Health System

Author

Dr Dialechti Tsimpida

Subjects
Organizational Leadership, Nursing Administration, education, Nursing teamwork, Quality, Greek Health Care System, Management
Abstract

The Greek Health Care System is experiencing notable gaps in organisational leadership, and additionally, the conditions for the building of effective nursing teamwork are not appropriate. The reasons are, on the one hand, the lack of economic, social and moral incentives in the working environment, which leads to confusing roles and responsibilities and also to inefficient utilisation of nursing services and on the other hand, the fact that the organisational standards in healthcare are dogmatically wedded to “class” hegemony of the medical corps. As a result, the working environment is characterised by ineffective communication, which prevents the staff from a collaborative philosophy, and it leads to the de-coordination of actions within the sanitary units. It is necessary to change the organisational and administrative culture in hospitals in Greek Health System, where there should exist training in teamwork and self-management skills. The building of effective nursing teamwork, which is one of the most important sources of motivation in nursing practice, is feasible by applying the “Gibbs Model”, which provides a Framework so that nurses be able to contribute with maximum performance in the provision of health care, while at the same time ensuring conditions for job satisfaction. In parallel, developmental activities for the nursing staff should take place, which could lead to the development of the leadership skills, particularly of the middle-level managers, who will succeed the current administrators in health care units. The application of developmental methods of leadership skills to nurses in health care units, such as the “Nurse Manager Leadership Collaborative (NMLC)” model, can ensure the satisfactory performance and productivity in hospitals, leading finally to the overall improvement of the quality in health services provision.

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