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PurposeUnderreporting of new tuberculosis (TB) cases is one of the main problems in TB control, particularly in countries with high incidence and dominating role of a private sector in TB cases diagnosing. The purpose of this paper was to explore behavioral determinants of underreporting of new TB cases among private sector physicians in Iran.Design/methodology/approachThe authors conducted a population-based, cross-sectional study of physicians working in private clinics. The data collection tool was designed using the theory of planned behavior (TPB). The authors used structural equation models with maximum likelihood estimation to examine attitude toward the notification behavior.FindingsOf 519 physicians, 433 physicians completed the questionnaire. Attitude toward notification had the highest score (mean score = 87.65; sd = 6.79; range: 0–100). The effect of perceived behavioral controls on the notification behavior ((β^) = 0.13; CI: 0.01–0.25) was stronger than the total effect of attitude ((β^) = 0.06; CI: 0.00–0.12) and subjective norms ((β^) = 0.01; CI: −0.00–0.03) on the behavior. However, the attitude was the main predictor of intention and justified 46% of the intention variance. Intention had a significant effect on the behavior ((ß^) = 0.09; CI: 0.1–0.16).Practical implicationsConsidering stronger effect of perceived behavioral control on the behavior, interventions aiming at facilitating notification process would be more effective than those aiming at changing the attitude or enhancing intention among physicians.Originality/valueTo the best of our knowledge, no other study previously explored determinants of underreporting from the behavioral and cognitive perspective. Specifically, the authors explored the role of the TPB constructs in predicting intention to notify new TB cases.

OBJECTIVE: This systematic review and meta-analysis investigated the effectiveness of occupational e-mental health interventions aimed at stress, depression, anxiety, burnout, insomnia, mindfulness, well-being, and alcohol misuse and their potential treatment moderators. METHODS: We systematically reviewed randomized control trials published in English using three electronic databases (MEDLINE, PsycINFO, CINAHL) and three register trials. A pooled effect size for each mental health area was calculated using random-effects modelling. For each meta-analysis, we conducted an analysis of potential moderators (ie, type of recruitment, age, gender, initial psychological symptoms, guidance, therapy type, and study quality). RESULTS: In total, 50 studies were included in the systematic review, and 34 studies were included in the meta-analyses. We noted moderate treatment effects on stress (Hedges’g=0.54), insomnia (g=0.70), and burnout (g=0.51) and small treatment effects on depression (g=0.30), anxiety (g=0.34), well-being (g=0.35), and mindfulness (g=0.42). The pooled effect on alcohol intake was small and nonsignificant. CONCLUSIONS: Our results suggest that occupational e-mental health interventions are associated with significant health improvements. However, more research is required to understand which factors contribute to the variation in effectiveness of particular interventions depending on the mental health area and characteristics of participants and interventions.

BackgroundBRCA carrier identification offers opportunities for early diagnoses, targeted treatment and cancer prevention. We evaluate BRCA- carrier detection rates in general and Ashkenazi Jewish (AJ) populations across Greater London and estimate time-to-detection of all identifiable BRCA carriers.MethodsBRCA carrier data from 1993 to 2014 were obtained from National Health Service genetic laboratories and compared with modelled predictions of BRCA prevalence from published literature and geographical data from UK Office for National Statistics. Proportion of BRCA carriers identified was estimated. Prediction models were developed to fit BRCA detection rate data. BRCA carrier identification rates were evaluated for an ‘Angelina Jolie effect’. Maps for four Greater London regions were constructed, and their relative BRCA detection rates were compared. Models developed were used to predict future time-to-identify all detectable BRCA carriers in AJ and general populations.ResultsUntil 2014, only 2.6% (3072/111 742 estimated) general population and 10.9% (548/4985 estimated) AJ population BRCA carriers have been identified in 16 696 608 (AJ=190 997) Greater London population. 57% general population and 54% AJ mutations were identified through cascade testing. Current detection rates mirror linear fit rather than parabolic model and will not identify all BRCA carriers. Addition of unselected ovarian/triple-negative breast cancer testing would take >250 years to identify all BRCA carriers. Doubling current detection rates can identify all ‘detectable’ BRCA carriers in the general population by year 2181, while parabolic and triple linear rates can identify ‘detectable’ BRCA carriers by 2084 and 2093, respectively. The linear fit model can identify ‘detectable’ AJ carriers by 2044. We did not find an Angelina Jolie effect on BRCA carrier detection rates. There was a significant difference in BRCA detection rates between geographical regions over time (PConclusionsThe majority of BRCA carriers have not been identified, missing key opportunities for prevention/earlier diagnosis. Enhanced and new strategies/approaches are needed.

Objective To understand the impact of ankylosing spondylitis (AS) on presenteeism and to explore its relationship to sick leave. Methods AS patients completed a questionnaire consisting of sociodemographics, disease characteristics, and work outcomes, including sick leave and presenteeism, assessed by the Work Limitations Questionnaire (WLQ). Associations between a broad range of explanatory variables with the WLQ and AS-related sick leave were assessed by zero-inflated negative binomial and zero-inflated Poisson regressions. Results Of 311 employed patients (204 men [65.6%]), 18% had sick leave in the past month. Limitations in meeting time management demands (33.7%), physical demands (30.2%), mental–interpersonal demands (20.2%), and output (19.0%) were noted. With the mean ± SD WLQ index score of 6.7 ± 5.9, the average decrease in work productivity attributable to health was 6.3%; an extra 7.1% of work hours would be needed to compensate for lost productivity. Helplessness, female sex, and impaired health-related quality of life (Ankylosing Spondylitis Quality of Life instrument [ASQoL]) were major contributors to the level of presenteeism (P < 0.01). At-work limitations (WLQ) and lower quality of life (ASQoL) were significantly associated with probability of sick leave, while the length of sick leave was strongly associated with lower educational level and helplessness (P < 0.01), and in some models, also with disease duration and country of residence (P < 0.05). Conclusion AS hinders patients' work, mainly in time management and physical demand domains. The WLQ and ASQoL are able to identify patients who incur sick leave. Helplessness contributes independently to the level of presenteeism and the length of sick leave.

This paper reviews the empirical evidence on the outcomes of the financial reforms in the Russian public healthcare sector. A systematic literature review identified 37 relevant publications that presented empirical evidence on changes in quality, equity, efficiency and sustainability in public healthcare provision due to the Russian public healthcare financial reforms. Evidence suggests that there are substantial inter-regional inequalities across income groups both in terms of financing and access to public healthcare services. There are large efficiency differences between regions, along with inter-regional variations in payment and reimbursement mechanisms. Informal and quasi-formal payments deteriorate access to public healthcare services and undermine the overall financing sustainability. The public healthcare sector is still underfinanced, although the implementation of health insurance gave some premises for future increases of efficiency. Overall, the available empirical data are not sufficient for an evidence-based evaluation of the reforms. More studies on the quality, equity, efficiency and sustainability impact of the reforms are needed. Future reforms should focus on the implementation of cost-efficiency and cost-control mechanisms; provide incentives for better allocation and distribution of resources; tackle problems in equity in access and financing; implement a system of quality controls; and stimulate healthy competition between insurance companies.