1,720,990 research outputs found
Gender inequality in healthy ageing: a study of the English older population over a decade.
No full textThe Role of Education at Young and Older Ages in Explaining Health Inequalities in Europe
No full textThe well-educated tend to have lower levels of morbidity and mortality than their less well-educated counterparts. This positive association between education gradient and health outcomes is widely documented in literature. However, the age-specific pattern of this relationship remains largely contested in Europe and elsewhere. Single-country longitudinal studies highlight a peak of relative health inequalities at the early part of old age and then a convergence in later life (status divergence-convergence model). On the other hand, most cross-national studies that use European-wide cross-sectional data reveal a pattern of persisting or even widening inequalities for older ages (status divergence model). We examine regional and country variations of health inequalities for younger and older ages and separately for men and women to test which model, if any, prevails in Europe and use multilevel logistic regression models to understand these variations. Data from the European Social Survey and the Survey of Health, Ageing and Retirement in Europe are used for younger and older ages, respectively. Our findings suggest that health inequalities are greatest for men at younger ages (25-34 years) and for both men and women during pre-retirement ages (50-64 years). Thus, the 'status divergence/convergence model' appears to be common among European countries. While the expectation to find relatively smaller health inequalities in regions with more advanced welfare provision is largely supported, separate country analyses also reveal far more heterogeneity not always consistent with the expected welfare state regime patterning for younger and older ages and for men and women. Copyright (C) 2014 John Wiley & Sons, Ltd
The arrival of the new coronavirus in the era of chronic degenerative diseases
No full textIl 9 gennaio 2020, il Chinese Centre for Disease Control ha identificato un nuovo Coronavirus, SARSCoV- 2, come agente responsabile del Covid-19. In circa due mesi il virus si e diffuso in tutto il mondo e l’11 marzo l’Organizzazione Mondiale della Sanita ha dichiarato il Covid-19 pandemia. L’Italia e stato il primo Paese europeo a esserne duramente colpito. Al suo arrivo, il virus ha trovato una popolazione con eta media elevata e alta prevalenza di patologie croniche. Questo ha aumentato la letalita e gravita del Covid-19 e, a sua volta, l’emergenza sanitaria che ne e derivata rischia di peggiorare gli esiti delle malattie croniche gia esistenti. E fondamentale analizzare fin da subito gli effetti collaterali della pandemia su altre patologie, per valutarne la portata e l’impatto. Utilizzando le conoscenze che abbiamo accumulato nel tempo e acquisito in queste settimane si potranno anticipare alcuni dei bisogni sanitari futuri e limitare gli effetti indiretti negativi di Covid-19
Depression deterioration of older adults during the first wave of the COVID-19 outbreak in Europe
No full textRationale: Determining who is particularly vulnerable to mental health deterioration during the COVID-19 pandemic is essential when designing and targeting interventions to mitigate the adverse psychological impacts of the outbreak. Older people have appeared to be less exposed to mental health deterioration compared with younger individuals, but most exposed to the risk of severe illness and death from the virus, as well as less equipped to use technologies for coping with lockdown measures.Objective: Amongst the old population, we aim at determining how depressive symptoms have changed during the first wave of the COVID-19 pandemic and identifying individual risk factors associated with changes in reporting depression. We are particularly interested in exploring the role of pre-existing mental health problems and evaluating gender differences.Method: Data come from the Survey of Health, Ageing and Retirement in Europe, in particular from the first COVID-19 survey administered in summer 2020. Logistic models are estimated and Average Marginal Effects computed to take the degree of individual unobserved heterogeneity into account comparing point estimates across samples. Multiple Imputation (implemented through Multivariate Imputation by Chained Equations) is used to replace missing data. Statistical power of the effect sizes is estimated by a simulation approach.Results: Pre-existing mental health problems, a diagnosis of affective/emotional disorders, a recent diagnosis of a major illness, and (only for men) job loss during the first wave of the outbreak are the most important risk factors. Statistical differences between genders emerge, with women experiencing higher levels of depression and greater worsening of mental health than men.Conclusions: To identify people at greater risk of depression deterioration during an outbreak it is very important to consider their pre-existing mental and general health, distinguishing severity level. On population level, it is also crucial to evaluate depression disorders separately by gender
Impact of chemotherapy-induced nausea and vomiting on health-related quality of life and resource utilization: A systematic review.
No full textBACKGROUND: Chemotherapy-induced nausea and vomiting (CINV) is a particularly distressing event for oncology patients. This review aims at analyzing the impact of CINV on Health-Related Quality of Life (QoL) and on the use of healthcare resources. METHODS: A systematic search was conducted according to the PRISMA statement on MEDLINE, EMBASE and NHS EED. RESULTS: Sixty-seven studies were included in the final selection. Despite the availability of numerous treatment options, CINV was found to have a strong impact on HRQoL of patients. Direct costs are particularly affected, but this result could be due to scarcity of studies assessing indirect costs. CONCLUSIONS: Evidence supports the notion that CINV continues to have a negative impact on HRQoL of patients, even for those receiving moderately emetic chemotherapy. Further studies need also to collect data on the cost of CINV, particularly indirect costs, to ensure that decisions on use of healthcare resources are better supported
How real can we get in generating real world evidence? Exploring the opportunities of routinely collected administrative data for evaluation of medical devices
Full text linkReal-world data are considered a potentially valuable source of evidence for assessing medical technologies in clinical practice, but their widespread use is hampered by numerous challenges. Using the case of coronary stents in Italy, we investigate the potential of administrative databases for estimating costs and health outcomes associated with the use of medical devices in real world conditions. An administrative dataset was created ad hoc by merging hospital records from patients admitted between 2013 and 2019 for stent implantations with ambulatory records, pharmaceutical use data and vital statistics. Health outcomes were multifold: all-cause and cardiac mortality and myocardial infarction, within 30 days, 1, 2, 5 years. Costs were estimated from the National Health System perspective. We used multivariable Cox models and propensity score (PS) methods (PS matching; stratification on PS; inverse probability of treatment weighting using PS; PS adjustment). 257,907 coronary stents were implanted in 113,912 patients. For all health outcomes and follow-up times, and across all methods, patients receiving drug-eluting stents (DES) presented lower risk. For all-cause mortality, the DES patient advantage over bare-metal stent (BMS) patients declined over time but remained significant even at 5 years. For myocardial infarction, results remained quite stable. The DES group presented lower cumulative total costs (ranging from 3264 to 2363 Euros less depending on methods). Our results confirm the consolidated evidence of the benefits of DES compared to BMS. The consistency of results across methods suggests internal validity of the study, while highlighting strengths and limitations of each depending on research context. Administrative data yield great potential to perform comparative effectiveness and cost-effectiveness analysis of medical devices provided certain conditions are met
Overweight and obesity in childhood and adolescence: Findings from the UK millennium cohort study, up to age 14
Full text linkBACKGROUND: The aims of this work are threefold: (1) Show the pathway of overweight and obesity, for the current generation of adolescents, since early childhood in the UK. (2) Identify factors associated with the risk of overweight/obesity at age 14. (3) Study transitions into and out of overweight/obesity, from early adolescence to mid-adolescence.
METHODS: A sample of 10,825 children in the UK Millennium Cohort Study was selected for analysis. BMI was calculated using measured height and weight available at every sweep since age three, and overweight and obesity were defined using the IOTF classification. Possible factors associated with the risk of excess weight include socio-demographic characteristics, early life circumstances, and behavioural and lifestyle factors in adolescence.
RESULTS: 19.2% of the sample of 14-year-olds in 2015/16 is classified as overweight (95% CI 18.4–20.0), and 7.5% as obese (95% CI 7.0–7.9), with proportions very similar across sexes. Protective factors for excess weight include high maternal education, breastfeeding, home ownership and child's active behaviour. The likelihood of transiting out of excess weight/ obesity between ages 11 and 14 is higher than the likelihood of transiting in. Predictors of transiting out of excess weight/obesity include child's active behaviour and puberty onset by age 14.
CONCLUSIONS: This study provides new evidence that the profile of rising trends in excess weight observed during childhood had stabilised by mid-adolescence. However, rates of excess weight remain high, and overweight and obesity in childhood and adolescence remain a major public health concern. The study identifies some risk and protective factors to reinforce the government commitment to reducing excess weight in childhood
The impact of maternal employment on children's weight: Evidence from the UK
Full text linkPrevious research shows that maternal employment is associated with higher children's body mass index (BMI). Using a large UK longitudinal birth cohort study of almost 20,000 children, we examine the effect of maternal employment during childhood (to age 14) on children's weight. We address the endogeneity of maternal employment by estimating household fixed effects models. We find that maternal employment has a positive effect on children's BMI and therefore on excess weight, and this is particularly the case for single mothers. We investigate potential pathways, including children's sedentary behavior and healthy eating behaviors, and find evidence of more sedentary behavior and poorer eating habits amongst children whose mothers are in employment. This is consistent with higher BMI levels amongst these children
Older adults in the US have worse cardiometabolic health compared to England
Full text linkExplanations for lagging life expectancy in the US compared to other high-income countries have focused largely on "deaths of despair," but attention has also shifted to the role of stalling improvements in cardiovascular disease and the obesity epidemic. Using harmonized data from the US Health and Retirement Study (HRS) and English Longitudinal Study of Ageing (ELSA), we assess differences in self-reported and objective measures of health, among older adults in the U.S. and England and explore whether the differences in Body Mass Index (BMI) documented between the US and England explain the US disadvantage. Older adults in the US have a much higher prevalence of diabetes, low HDL cholesterol, and high inflammation (CRP) compared to English adults. While the distribution of BMI is shifted to the right in the US with more people falling into extreme obesity categories, these differences do not explain the cross-country differences in measured biological risk. We conclude by considering how country differences in health may have impacted the burden of Covid-19 mortality in both countries
Patient characteristics associated with the acceptability of teleconsultation: a retrospective study of osteoporotic patients post-COVID-19
Full text linkBackground: Due to the COVID-19 pandemic, teleconsultations (TCs) have become common practice for many chronic conditions, including osteoporosis. While satisfaction with TCs among patients increases in times of emergency, we have little knowledge of whether the acceptability of TCs persists once in-person visits return to being a feasible and safe option. In this study, we assess the acceptability of TCs across five dimensions for osteoporosis care among patients who started or continued with TCs after the COVID-19 pandemic had waned. We then explore the patient characteristics associated with these perceptions. Methods: Between January and April 2022, 80 osteoporotic patients treated at the Humanitas Hospital in Milan, Italy, were recruited to answer an online questionnaire about the acceptability of TCs for their care. The acceptability of TCs was measured using a modified version of the Service User Technology Acceptability Questionnaire (SUTAQ), which identifies five domains of acceptability: perceived benefits, satisfaction, substitution, privacy and discomfort, and care personnel concerns. Multivariable ordinary least squares (OLS) linear regression analysis was performed to assess which patient characteristics in terms of demographics, socio-economic conditions, digital skills, social support, clinical characteristics and pattern of TC use were correlated with the five domains of acceptability measured through the SUTAQ. Results: The degree of acceptability of TCs was overall good across the 80 respondents and the five domains. Some heterogeneity in perceptions emerged with respect to TCs substituting for in-person visits, negatively impacting continuity of care and reducing the length of consultations. For the most part, acceptability was not affected by patient characteristics with a few exceptions related to treatment time and familiarity with the TC service modality (i.e., length of osteoporosis treatment and number of TCs experienced by the patient). Conclusions: TCs appear to be an acceptable option for osteoporosis care in the aftermath of the COVID-19 pandemic. This study suggests that other characteristics besides age, digital skills and social support, which are traditionally relevant to TC acceptability, should be taken into account in order to better target this care delivery modality
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