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Van Berkel J, de Bruijn EJ, Waardenburg M, la Grouw Y, van Bennekom E, van der Horst H, Tonnon S, Haggenburg-Mohammed M, Haveman-Nies A, Madern T, Knoef M, de Vet E. Realist Approach to Social Policies (RASP) study to reduce socioeconomic health inequalities through systems change: protocol for a research project combining mixed-methods realist research with institutional action research. BMJ Open 2024; 14:e088571. [PMID: 38871658 DOI: 10.1136/bmjopen-2024-088571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Health inequalities are rooted in inequality in vital resources for health, including financial resources, a supportive informal network, a stable living situation, work or daytime activities or education and literacy. About 25% of Dutch citizens experience deprivation of such resources. Social policy consists of crucial instruments for improving resources in those groups but can also have adverse effects and lead to additional burdens. This project aims to contribute to the reduction of health inequalities through (1) a better understanding of how social policy interventions can contribute to reducing health inequality through the redistribution of burdens and resources and (2) developing anticipatory governance strategies to implement those insights, contributing to a change in social policy systems. METHODS AND ANALYSIS Two systems approaches are combined for establishing a systems change in the Netherlands. First, a realist approach enables insights into what in social policy interventions may impact health outcomes, for whom and under what circumstances. Second, an institutional approach enables scaling up these insights, by acknowledging the crucial role of institutional actors for accomplishing a systems change. Together with stakeholders, we perform a realist review of the literature and identify existing promising social policy interventions. Next, we execute mixed-methods realist evaluations of selected social policy interventions in seven municipalities, ranging from small, mid-size to large, and in both urban and rural settings. Simultaneously, through action research with (national) institutional actors, we facilitate development of anticipatory governance strategies. ETHICS AND DISSEMINATION This study is not liable to the Medical Research Involving Subjects Act (WMO). Informed consent to participate in the study is obtained from participants for the use of all forms of personally identifiable data. Dissemination will be codeveloped with target populations and includes communication materials for citizens, education materials for students, workshops, infographics and decision tools for policy-makers and publications for professionals.
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Affiliation(s)
- Jantien Van Berkel
- Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, The Netherland
- Consumption and Healthy Lifestyles, Wageningen Universiteit en Research, Wageningen, The Netherland
| | - Ernst-Jan de Bruijn
- Institute of Tax Law and Economics | Department of Economics, Leiden University, Leiden, The Netherland
| | - Maikel Waardenburg
- Law, Economics and Governance, School of Governance, Utrecht University, Utrecht, The Netherland
| | - Yvonne la Grouw
- Law, Economics and Governance, School of Governance, Utrecht University, Utrecht, The Netherland
| | - Eline van Bennekom
- Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, The Netherland
- Consumption and Healthy Lifestyles, Wageningen Universiteit en Research, Wageningen, The Netherland
| | - Hilje van der Horst
- Consumption and Healthy Lifestyles, Wageningen Universiteit en Research, Wageningen, The Netherland
| | - Susanne Tonnon
- Debt and Collection, Hogeschool Utrecht, Utrecht, The Netherland
| | | | - Annemien Haveman-Nies
- Consumption and Healthy Lifestyles, Wageningen Universiteit en Research, Wageningen, The Netherland
- AGORA Academische Werkplaats, GGD Noord en Oost Gelderland, Warnsveld, The Netherland
| | - Tamara Madern
- Debt and Collection, Hogeschool Utrecht, Utrecht, The Netherland
| | - Marike Knoef
- Institute of Tax Law and Economics | Department of Economics, Leiden University, Leiden, The Netherland
- Tilburg School of Economics and Management, Tilburg University, Tilburg, The Netherland
| | - Emely de Vet
- Consumption and Healthy Lifestyles, Wageningen Universiteit en Research, Wageningen, The Netherland
- Tilburg School of Humanities and Digital Sciences, Liberal Arts and Sciences, Tilburg University, Tilburg, The Netherland
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Bagheri-Hosseinabadi Z, Bahreyni A, Basirat H, Khalili P, Vakilian A, Amin F. Occupational status and chronic respiratory diseases: a cross-sectional study based on the data of the Rafsanjan Cohort Study. BMC Pulm Med 2024; 24:151. [PMID: 38521907 PMCID: PMC10960458 DOI: 10.1186/s12890-024-02916-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/19/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND The aim of the present study was to investigate the possible connection between occupational status and chronic respiratory diseases (CRDs) among the Iranian population. METHODS The present cross-sectional study was conducted on 9934 individuals aged 35-70 years enrolled in the Rafsanjan Cohort Study (RCS), a component of the Prospective Epidemiological Research Studies in Iran (PERSIAN). Detailed questionnaires were used to collect information on various factors, such as occupation, sociodemographic characteristics, medical history, anthropometric measurements, physical activity, cigarette and hookah smoking, opium use, and alcohol consumption. The association between occupational class and CRD was evaluated using logistic regression models for rare events. RESULTS In the present study, 4624 (46.55%) participants were male, and 5310 (53.45%) were female. The prevalence of CRD among all participants was 2.61%. Occupational activities were classified into two categories: In class I, the largest group was the homemaker and unemployment category (41.73%), followed by self-employment (34.39%), employment (13.03%), and retired individuals (10.84%). In class II, there were pistachio farmers (12.61%), copper miners (3.62%), and others in various occupations (83.76%). Subjects with CRD were significantly more likely to be homemakers, unemployed, elderly, female, less educated, and obese. There was no significant relationship between CRD and job type/occupational status after adjusting for some potential confounding variables. CONCLUSIONS There was no significant relationship between CRD and job type/occupational status. However, longitudinal studies are needed to assess the impact of job type/occupational status on the risk of CRD.
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Affiliation(s)
- Zahra Bagheri-Hosseinabadi
- Molecular Medicine Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Clinical Biochemistry, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ali Bahreyni
- Medical student, Kerman University of medical Sciences, Kerman, Iran
| | - Hosein Basirat
- Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Parvin Khalili
- Social Determinants of Health Research Centre, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Epidemiology, School of Public Health, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Alireza Vakilian
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Neurology Department, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Fatemeh Amin
- Physiology-Pharmacology Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
- Department of Physiology and Pharmacology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
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Goel N, Biswas I, Chattopadhyay K. Risk factors of multimorbidity among older adults in India: A systematic review and meta-analysis. Health Sci Rep 2024; 7:e1915. [PMID: 38420204 PMCID: PMC10900089 DOI: 10.1002/hsr2.1915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 12/18/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Background Multimorbidity among older adults is a growing concern in India. Multimorbidity is defined as the coexistence of two or more chronic health conditions in an individual. Primary studies have been conducted on risk factors of multimorbidity in India, but no systematic review has been conducted on this topic. This systematic review aimed to synthesize the existing evidence on risk factors of multimorbidity among older adults in India. Methods The JBI and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. Several databases were searched for published and unpublished studies until August 03, 2022. The screening of titles and abstracts and full texts, data extraction, and quality assessment were conducted by two independent reviewers. Any disagreements were resolved through discussion or by involving a third reviewer. Data synthesis was conducted using narrative synthesis and random effects meta-analysis, where appropriate. Results Out of 8781 records identified from the literature search, 16 and 15 studies were included in the systematic review and meta-analysis, respectively. All included studies were cross-sectional, and 10 met a critical appraisal score of more than 70%. Broadly, sociodemographic, lifestyle, and health conditions-related factors were explored in these studies. The pooled odds of multimorbidity were higher in people aged ≥70 years compared to 60-69 years (odds ratio (OR) 1.51; 95% confidence interval (CI) 1.20-1.91), females compared to males (1.38; 1.09-1.75), single, divorced, separated, and widowed compared to married (1.29; 1.11-1.49), economically dependent compared to economically independent (1.54; 1.21-1.97), and smokers compared to non-smokers (1.33; 1.16-1.52) and were lower in working compared to not working (0.51; 0.36-0.72). Conclusion This systematic review and meta-analysis provided a comprehensive picture of the problem by synthesizing the existing evidence on risk factors of multimorbidity among older adults in India. These synthesized sociodemographic and lifestyle factors should be taken into consideration when developing health interventions for addressing multimorbidity among older adults in India.
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Affiliation(s)
- Nikita Goel
- Lifespan and Population Health, School of MedicineUniversity of NottinghamNottinghamUK
| | - Isha Biswas
- Lifespan and Population Health, School of MedicineUniversity of NottinghamNottinghamUK
| | - Kaushik Chattopadhyay
- Lifespan and Population Health, School of MedicineUniversity of NottinghamNottinghamUK
- The Nottingham Centre for Evidence‐Based Healthcare: A JBI Centre of ExcellenceNottinghamUK
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Griselda M, Alfian SD, Wicaksono IA, Wawruch M, Abdulah R. Findings from the Indonesian family life survey on patterns and factors associated with multimorbidity. Sci Rep 2023; 13:18607. [PMID: 37903815 PMCID: PMC10616186 DOI: 10.1038/s41598-023-42603-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/12/2023] [Indexed: 11/01/2023] Open
Abstract
The prevalence of multimorbidity tends to increase with age, but it is now also reported in the middle-aged population, which has a negative impact on healthcare systems and health outcomes. This study aims to analyze the patterns and factors associated with multimorbidity in Indonesia. This national cross-sectional population-based survey used publicly available data from the Indonesian Family Life Survey (IFLS-5) for 2014 among middle-aged (40-59 years old) and elderly (≥ 60 years old) respondents. Information on all chronic diseases was assessed using a self-reported questionnaire. Sociodemographic and health-related behavioral factors were obtained from self-reported data. Binary logistic regression analysis was used to identify the factors associated with multimorbidity. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. The study recruited 11,867 respondents. The prevalence of multimorbidity was 18.6% (95% CI 17.9-19.3) with which 15.6% among middle age (95% CI 14.95-16.25) and 24.9% among the elderly (95% CI 24.12-25.68). Hypertension was the most commonly reported disease (23.2%) in all combinations of multimorbidity and among all age groups. Socio-demographic factors: elderly (AOR: 1.66; 95% CI 1.46-1.89), female (AOR: 1.42; 95% CI 1.20-1.69), living in the urban area (AOR: 1.22; 95% CI 1.09-1.38), higher educational level (AOR: 2.49; 95% CI 1.91-3.26), unemployed (AOR: 1.63; 95% CI 1.44-1.84), and higher economic level (AOR: 1.41; 95% CI 1.18-1.68) were associated with multimorbidity. Poor health behavior factors: being former smokers (AOR: 2.03; 95% CI 1.65-2.51) and obesity (AOR: 1.53; 95% CI 1.35-1.75) were also associated with multimorbidity. The prevalence of multimorbidity in the middle-aged and elderly population in Indonesia is relatively high, particularly in populations with poor health behaviors. Therefore, healthcare professionals should integrate more patient-specific factors when designing and implementing tailored interventions to manage multimorbidity in Indonesia.
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Affiliation(s)
- Meliana Griselda
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jl. Raya Jatinangor, KM 21, Jatinangor, Sumedang, Indonesia
- Pharmacist Profession, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Sofa D Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jl. Raya Jatinangor, KM 21, Jatinangor, Sumedang, Indonesia.
- Drug Utilization and Pharmacoepidemiology Research Group, Centre of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia.
- Center for Health Technology Assessment, Universitas Padjadjaran, Jatinangor, Indonesia.
| | - Imam A Wicaksono
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jl. Raya Jatinangor, KM 21, Jatinangor, Sumedang, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Centre of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Martin Wawruch
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jl. Raya Jatinangor, KM 21, Jatinangor, Sumedang, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Centre of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
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Silveira ADSD, Santos JEMD, Cancela MDC, Souza DLBD. [Estimated multimorbity among young Brazilians: results of the 2019 National Health Survey]. CIENCIA & SAUDE COLETIVA 2023; 28:2699-2708. [PMID: 37672458 DOI: 10.1590/1413-81232023289.11842022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/31/2023] [Indexed: 09/08/2023] Open
Abstract
Multimorbidity, namely the presence of two or more chronic non-communicable diseases, is directly associated with behavioral factors. This study sought to estimate the prevalence of multimorbidity among young Brazilians by linking it to different social and lifestyle determinants. It involved a cross-sectional study of the data source, namely the 2019 National Health Survey. Data from individuals aged between 15 and 24 years (n = 10,460) were selected. Associated factors were investigated by calculating the Prevalence Ratio with robust variance, suitable for bivariate and multivariate analysis. The prevalence of multimorbidity in young people was estimated at 7.84% (95%CI: 7.01-8.75; N: 2,455,097). The most common conditions were mental illness, depression, asthma or bronchitis and chronic back problems. In the adjusted model, young females (PR: 1.84; 95%CI: 1.44-2.36), obese youths (PR: 1.97; 95%CI: 1.45-2.68) and former smokers (PR: 1.46; 95%CI: 1.12-1.90) showed a higher prevalence of multimorbidity. It was also revealed that the prevalence ratio for multimorbidity increased by 5% for each year of the individual's life. This study identified an association of multimorbidity with social determinants and lifestyle.
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Affiliation(s)
- Ana Daniela Silva da Silveira
- Faculdade de Odontologia, Instituto de Ciências da Saúde, Universidade Federal do Pará. R. Augusto Corrêa 1, Guamá. 66075-110 Belém PA Brasil.
| | - Jonas Eduardo Monteiro Dos Santos
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Sérgio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
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Zou X, Zou S, Guo Y, Peng D, Min H, Zhang R, Qin R, Mai J, Wu Y, Sun X. Association of smoking status and nicotine dependence with multi-morbidity in China: A nationally representative crosssectional study. Tob Induc Dis 2023; 21:81. [PMID: 37333503 PMCID: PMC10273826 DOI: 10.18332/tid/166110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/11/2023] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
INTRODUCTION Multi-morbidity is a public health priority as it is associated with an increased risk of mortality and a substantial healthcare burden. Smoking is considered a predisposing factor for multi-morbidity, but evidence for an association between multi-morbidity and nicotine dependence is insufficient. This study aimed to explore the association between smoking status, nicotine dependence, and multi-morbidity in China. METHODS We recruited 11031 Chinese citizens from 31 provinces in 2021 using a multistage stratified cluster sampling strategy to ensure the study population represented national population characteristics. The association between smoking status and multi-morbidity was analyzed using binary logistic regression and multinomial logit regression models. We then analyzed the associations between four kinds of smoking status (age at smoking initiation, cigarette consumption per day, smoking when ill in bed, and inability to control smoking in public places), nicotine dependence, and multi-morbidity among participants who were current smokers. RESULTS Compared with non-smokers, the odds of multi-morbidity were higher among ex-smokers (adjusted odd ratio, AOR=1.40, 95% CI: 1.07-1.85). The risk of multi-morbidity was greater in participants who were underweight/overweight/obese (AOR=1.90; 95% CI: 1.60-2.26) compared with those who were normal weight. and also greater for drinkers (AOR=1.34; 95% CI: 1.09-1.63) than non-drinkers. Compared with children who began smoking at the age of <15 years, participants aged >18 years had a lower likelihood of multi-morbidity (AOR=0.52; 95% CI: 0.32-0.83). People who consumed ≥31 cigarettes per day (AOR=3.77; 95% CI: 1.47-9.68) and those who smoked when ill in bed (AOR=1.70; 95% CI: 1.10-2.64) were more likely to have multi-morbidity. CONCLUSIONS Our findings show that smoking behavior, including initiation age, frequency of daily smoking, and still smoking during illness or in public, is a critical risk factor for multi-morbidity, especially when combined with alcohol consumption, physical inactivity, and abnormal weight (underweight, overweight, or obese). This highlights the crucial effect of smoking cessation in the prevention and control of multi-morbidity, especially in patients with three or more diseases. Implementing smoking and lifestyle interventions to promote health would both benefit adults and prevent the next generation from initiating habits that increase the risk of multi-morbidity.
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Affiliation(s)
- Xinye Zou
- Faculty of Education, University of Cambridge, Cambridge, United Kingdom
- School of Public Health, Peking University, Beijing, China
| | - Siyu Zou
- School of Public Health, Peking University, Beijing, China
| | - Yi Guo
- School of Public Health, Peking University, Beijing, China
| | - Di Peng
- School of Education, Qingdao Hengxing University of Science and Technology, Qingdao, China
| | - Hewei Min
- School of Public Health, Peking University, Beijing, China
| | - Ruolin Zhang
- Department of Natural and Applied Science, Duke Kunshan University, Jiangsu, China
| | - Ruiwen Qin
- College of Foreign Languages, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Jianrong Mai
- School of Public Health, Peking University, Beijing, China
- School of Nursing, Guangzhou Xinhua University, Guangzhou, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China
| | - Xinying Sun
- School of Public Health, Peking University, Beijing, China
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Strzelczyk A, Aledo-Serrano A, Coppola A, Didelot A, Bates E, Sainz-Fuertes R, Lawthom C. The impact of epilepsy on quality of life: Findings from a European survey. Epilepsy Behav 2023; 142:109179. [PMID: 37058861 DOI: 10.1016/j.yebeh.2023.109179] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 04/16/2023]
Abstract
INTRODUCTION Epilepsy is a serious neurological disorder affecting the quality of life (QoL) of people with this condition. A survey was conducted in five European countries (France, Germany, Italy, Spain, and the UK) to understand the impact and burden of epilepsy and its treatment on the lives of people with epilepsy (PWE). METHODS Five hundred PWE (taking >1 antiseizure medication [ASM]) and 500 matched controls completed a 30-minute online questionnaire. The 12-Item Short Form Survey (SF-12) was used to measure QoL and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) was used to screen for major depressive disorder (MDD) symptoms. RESULTS Comorbidities such as migraine, high cholesterol, osteoporosis, and Type 1 diabetes were reported more commonly in PWE, while anxiety disorders, high blood pressure, skin disorders, and mood disorders were more common in controls. However, compared to controls, a significantly higher percentage of PWE had an NDDI-E score of 15-24 (54% vs 35%; p < 0.0001), indicative of MDD symptoms. Significantly more PWE than controls were part-time employed (15% vs 11%; p = 0.03). People with epilepsy had a significantly lower total SF-12 score than controls across the physical and the mental components; compared to controls, a significantly higher proportion of PWE defined their general health as 'poor' or 'fair' and felt limited in carrying out daily and work activities. Among PWE, those taking ≥3 ASMs were more likely to experience difficulties in carrying out these activities than those on two ASMs. Ability to drive, mood, and level of self-esteem were reported as concerns for PWE. CONCLUSION Epilepsy has a major impact on the physical and mental health of PWE, interfering with their daily and work activities and overall QoL, and its treatment might also contribute to a lower QoL. The impact of epilepsy on mood and mental health might be under-recognized.
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Affiliation(s)
- Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany.
| | - Angel Aledo-Serrano
- Epilepsy Program, Department of Neurology, Ruber Internacional Hospital, Madrid, Spain
| | - Antonietta Coppola
- Epilepsy Centre, Department of Neuroscience, Odontostomatological and Reproductive Sciences, Federico II University of Naples, Naples, Italy
| | - Adrien Didelot
- Department of Neurology, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | | | | | - Charlotte Lawthom
- Department of Neurology, Aneurin Bevan University Health Board, Newport, United Kingdom
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Hijdra RW, Robroek SJW, Burdorf A, Schuring M. The influence of onset of disease on exit from paid employment among workers in The Netherlands: A longitudinal register-based study with 9 years follow-up. Scand J Work Environ Health 2023; 49:33-42. [PMID: 36265177 PMCID: PMC10549911 DOI: 10.5271/sjweh.4064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES This study investigates the influence of onset of disease on exit from paid employment and whether this differs across diseases and sociodemographic groups. METHODS Register data from Statistics Netherlands on medication prescription was linked to information on employment status and demographics. Persons who were employed in 2009 and 2010 and who did not use medication for the selected disease in 2009 (N=5 889 036) were followed-up over nine years. Six diseases were identified based on medication prescription in 2010 and 2011: cardiovascular diseases, inflammatory diseases, diabetes mellitus, respiratory diseases, common mental disorders, and psychotic disorders. Four pathways out of paid employment were defined: disability benefits, unemployment, no income, and early retirement. Early exit from paid employment was defined as exiting paid employment before retirement age. Cause-specific Cox proportional hazards regression analyses were performed, with interaction terms for age, sex, and migration background. RESULTS Onset of disease increased the likelihood of exit from paid employment, with the strongest associations for psychotic disorders [hazard ratio (HR) 2.88, 95% confidence interval (CI) 2.78-2.98] and common mental disorders (HR 2.00, 95% CI 1.97-2.03). Onset of disease was most strongly associated with disability benefits, followed by unemployment. The influence of common mental and psychotic disorders on disability increased until around middle-age, after which it decreased. The influence of mental health problems on exit from paid employment was stronger for persons with a non-native Dutch background and males. CONCLUSION Onset of diseases, especially mental health disorders, is a risk for exiting paid employment before the retirement age. Effective interventions are needed to enhance an inclusive workforce and prevent involuntary loss of paid employment.
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Affiliation(s)
- Roos W Hijdra
- Erasmus University Medical Center Rotterdam, Department of Public Health, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
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Brady E, Castelli M, Walker R, Grayling M, Alaba O, Chola L. The prevalence and social determinants of multimorbidity in South Africa. WORLD MEDICAL & HEALTH POLICY 2022. [DOI: 10.1002/wmh3.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Elise Brady
- Population Health Sciences Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne UK
| | - Michele Castelli
- Population Health Sciences Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne UK
| | - Richard Walker
- Department of Medicine North Tyneside General Hospital, Rake Lane North Shields Tyne and Wear UK
| | - Michael Grayling
- Population Health Sciences Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne UK
| | - Olufunke Alaba
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences University of Cape Town Cape Town South Africa
| | - Lumbwe Chola
- Department of Public Health Science Univeristy of Oslo Oslo Norway
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Fleitas Alfonzo L, King T, You E, Contreras-Suarez D, Zulkelfi S, Singh A. Theoretical explanations for socioeconomic inequalities in multimorbidity: a scoping review. BMJ Open 2022; 12:e055264. [PMID: 35197348 PMCID: PMC8882654 DOI: 10.1136/bmjopen-2021-055264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/27/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To document socioepidemiological theories used to explain the relationship between socioeconomic disadvantage and multimorbidity. DESIGN Scoping review. METHODS A search strategy was developed and then applied to multiple electronic databases including Medline, Embase, PsychInfo, Web of Science, Scielo, Applied Social Sciences, ERIC, Humanities Index and Sociological Abstracts. After the selection of studies, data were extracted using a data charting plan. The last search was performed on the 28 September 2021. Extracted data included: study design, country, population subgroups, measures of socioeconomic inequality, assessment of multimorbidity and conclusion on the association between socioeconomic variables and multimorbidity. Included studies were further assessed on their use of theory, type of theories used and context of application. Finally, we conducted a meta-narrative synthesis to summarise the results. RESULTS A total of 64 studies were included in the review. Of these, 33 papers included theories as explanations for the association between socioeconomic position and multimorbidity. Within this group, 16 explicitly stated those theories and five tested at least one theory. Behavioural theories (health behaviours) were the most frequently used, followed by materialist (access to health resources) and psychosocial (stress pathways) theories. Most studies used theories as post hoc explanations for their findings or for study rationale. Supportive evidence was found for the role of material, behavioural and life course theories in explaining the relationship between social inequalities and multimorbidity. CONCLUSION Given the widely reported social inequalities in multimorbidity and its increasing public health burden, there is a critical gap in evidence on pathways from socioeconomic disadvantage to multimorbidity. Generating evidence of these pathways will guide the development of intervention and public policies to prevent multimorbidity among people living in social disadvantage. Material, behavioural and life course pathways can be targeted to reduce the negative effect of low socioeconomic position on multimorbidity.
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Affiliation(s)
- Ludmila Fleitas Alfonzo
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tania King
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Diana Contreras-Suarez
- Melbourne Institute: Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Syafiqah Zulkelfi
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ankur Singh
- Centre of Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Duisekova S, Kerimbayeva Z, Mustafin A, Mussakhanova A, Turgambayeva A, Stukas R. Unemployment as a Medical and Social Problem and Incidence among Unemployed Young People. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The problem of unemployment among young people worries the world for many generations, since young people are the stratum of the population on which the future in each country depends (Brydsten et al. 2016). The socioeconomic situation of young people, especially the unemployed, is alarming, which is not always emphasized in the priorities of social policy. The study of incidence among unemployed youth is carried out in many countries, where it is noted that the unemployed people have worse mental and physical health compared to employed one (Grzegorczyk and Wolff, 2020).
AIM: Our study aims to assess the difference between the incidence of working and unemployed youth.
METHODS: The study involved 536 people, from 18 to 29-years-old, among whom women - 69.2%, men - 30.8%, from all regions of Kazakhstan.
RESULTS: The results of the work showed that the level of youth unemployment increased during the pandemic by an average of 1% in the world and in Kazakhstan, young people had limitations in receiving medical and social assistance due to financial constraints, deficiency of health insurance and personal reluctance. It was also found that social status is a significant predictor of vaccination (beta = −0.225, R2 = 0.0507, p < 0.001) and a predictor of alcohol consumption (beta = −0.0908, R2 = 0.00824, p = 0.037). More often unemployed youth noted health problems over the past year (42.3%) than in other social groups (35.6–37.8%), a similar situation was observed when assessing the frequency of chronic diseases (p = 0.365).
CONCLUSION: In our study, we show that the decline in health by virtue of unemployment is likely to be significant, since our estimated effect implies that the health of young people is almost 10% worse (in absolute terms) due to unemployment compared to the employed population. This further underscores that unemployment is a public health problem that needs more attention. Furthermore, the results obtained show that unemployment has the most negative consequences for vulnerable people, including young people.
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Godeau D, Fadel M, Bodin J, Descatha A. Venn Diagram for Three or More Categories in Occupational Health. J Occup Environ Med 2021; 63:e157-e158. [PMID: 33395170 DOI: 10.1097/jom.0000000000002129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Diane Godeau
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP Villejuif, France, AP-HP ("Assistance Publique-Hôpitaux de Paris"), Unité des pathologies professionnelles et environnementales Hôpitaux universitaires Paris Seine-Saint-Denis Hôpital Avicenne, F-93009 Bobigny cedex, France, Université Sorbonne Paris Nord F-93206 Saint-Denis, France
| | - Marc Fadel
- Univ Angers, CHU Angers Univ Rennes, Inserm EHESP, Irset (Institut de recherche en santé environnement et travail) - UMR_S 1085, F-49000 Angers, France
| | - Julie Bodin
- Univ Angers, CHU Angers Univ Rennes, Inserm EHESP, Irset (Institut de recherche en santé environnement et travail) - UMR_S 1085, F-49000 Angers, France
| | - Alexis Descatha
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, Villejuif, France, Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-49000 Angers, France, CHU Angers, Poisoning Control Center-Clinical Data Center, F-49000 Angers, France
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13
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Yildiz B, Burdorf A, Schuring M. The influence of chronic diseases and multimorbidity on entering paid employment among unemployed persons - a longitudinal register-based study. Scand J Work Environ Health 2021; 47:208-216. [PMID: 33350454 PMCID: PMC8126442 DOI: 10.5271/sjweh.3942] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives This study aimed to investigate the influence of chronic diseases and multimorbidity on entering paid employment among unemployed persons. A secondary objective was to estimate the proportion of persons not entering paid employment that can be attributed to specific chronic diseases across different age groups. Methods Data linkage of longitudinal nationwide registries on employment status, medication use and socio-demographic characteristics was applied. Unemployed Dutch persons (N=619 968) were selected for a three-year prospective study. Cox proportional hazards analyses with hazard ratios (HR) were used to investigate the influence of six common chronic diseases on entering paid employment, stratified by age. The population attributable fraction (PAF) was calculated as the proportion of all persons who did not enter paid employment that can be attributed to a chronic disease. Results Persons with chronic diseases were less likely to enter paid employment among all age groups. The impact of a chronic disease on maintaining unemployment at population level was largest for common mental disorders (PAF 0.20), due to a high prevalence of common mental disorders (6%), and for psychotic disorders (PAF 0.19), due to a high likelihood of not entering paid employment (HR 0.21), among persons aged 45-55 years. Multimorbidity increased with age, and the impact of having multiple chronic diseases on remaining unemployed increased especially among persons aged ≥45 years. Conclusion Chronic diseases and multimorbidity are important factors that reduce employment chances among all age groups. Our results provide directions for policy measures to target specific age and disease groups of unemployed persons in order to improve employment opportunities.
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Affiliation(s)
- Berivan Yildiz
- Erasmus University Medical Center, Department of Public Health, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
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Oude Hengel KM, Riumallo-Herl C, Schram JL, Nieboer D, van der Beek AJ, Burdorf A. Effects of changes in early retirement policies on labor force participation: the differential effects for vulnerable groups. Scand J Work Environ Health 2021; 47:224-232. [PMID: 33399213 PMCID: PMC8126444 DOI: 10.5271/sjweh.3946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: This study investigated the effects of a national early retirement reform, which was implemented in 2006 and penalized early retirement, on paid employment and different exit pathways and examined whether these effects differ by gender, income level and health status. Methods: This study included all Dutch individuals in paid employment born six months before (control group) and six months after (intervention group) the cut-off date of the reform (1 January 1950) that fiscally penalized early retirement. A regression discontinuity design combined with restricted mean survival time analysis was applied to evaluate the effect of penalizing early retirement on labor force participation from age 60 until workers reached the retirement age of 65 years, while accounting for secular trends around the threshold. Results: The intervention group postponed early retirement by 7.41 months [95% confidence interval (CI) 6.11–8.72], and partly replaced this by remaining 4.87 months (95% CI 3.60–6.24) longer in paid employment. Workers born after the threshold, annually earning €25 000–40 000, spent 1.24 months (95% CI 0.31–2.18) more in economic inactivity than those born before. The working months lost to unemployment increased by 1.50 months (95% CI 0.30–2.71) for female workers and 1.99 months (95% CI 0.06–3.92) for workers reporting multiple chronic diseases. Conclusions: The national reform successfully prolonged working lives of older workers. However, workers with a middle income, female workers, and workers with chronic diseases were more vulnerable to premature exit from the labor market through unemployment or being without any income or benefit.
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Affiliation(s)
- Karen M Oude Hengel
- Erasmus University Medical Center, Department of Public Health, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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