Terms Of Health Outcomes Research Articles

The (cost-)effectiveness of preventive, integrated care for community-dwelling frail older people: A systematic review.

Integrated care is increasingly promoted as an effective and cost‐effective way to organise care for community‐dwelling frail older people with complex problems but the question remains whether high expectations are justified. Our study aims to systematically review the empirical evidence for the effectiveness and cost‐effectiveness of preventive, integrated care for community‐dwelling frail older people and close attention is paid to the elements and levels of integration of the interventions. We searched nine databases for eligible studies until May 2016 with a comparison group and reporting at least one outcome regarding effectiveness or cost‐effectiveness. We identified 2,998 unique records and, after exclusions, selected 46 studies on 29 interventions. We assessed the quality of the included studies with the Effective Practice and Organization of Care risk‐of‐bias tool. The interventions were described following Rainbow Model of Integrated Care framework by Valentijn. Our systematic review reveals that the majority of the reported outcomes in the studies on preventive, integrated care show no effects. In terms of health outcomes, effectiveness is demonstrated most often for seldom‐reported outcomes such as well‐being. Outcomes regarding informal caregivers and professionals are rarely considered and negligible. Most promising are the care process outcomes that did improve for preventive, integrated care interventions as compared to usual care. Healthcare utilisation was the most reported outcome but we found mixed results. Evidence for cost‐effectiveness is limited. High expectations should be tempered given this limited and fragmented evidence for the effectiveness and cost‐effectiveness of preventive, integrated care for frail older people. Future research should focus on unravelling the heterogeneity of frailty and on exploring what outcomes among frail older people may realistically be expected.

Job Demands, Job Resources, and Well-being in Police Officers\u2014a Resource-Oriented Approach

This study examined the association between job characteristics, namely job demands and job resources, and mental health outcomes in terms of emotional exhaustion and well-being among police officers. Eight hundred forty-three German police officers participated in a cross-sectional online survey. Structural equation modeling was used to examine the validity of the dual process model of the Job Demands-Resources (JD-R) framework in the context of police work. Job demands (verbal assaults by citizens, workload, and administrative stressors) predicted emotional exhaustion whereas job resources (team support, shared values, and perceived fairness) predicted well-being. Moreover, job resources were directly and negatively associated with emotional exhaustion. The findings confirm the capacity of job resources to simultaneously promote well-being and reduce emotional exhaustion. Work place interventions should thus not merely decrease job demands. To improve and protect police officers’ well-being, it is advisable to promote job resources. A supportive and fair organizational climate based on shared values is required to foster mental health in the context of police work.

Do health consultations for people with learning disabilities meet expectations? A narrative literature review

Accessible Summary People with learning disabilities have unmet health needs. Annual health checks were brought in to improve health care, but do they work? The research shows checks lead to more tests for illness and illness being identified. A lot of people still do not see their doctor, and not all doctors do health checks. Future research needs to understand how people with disabilities feel about seeing their doctor or nurse, and how doctors and nurses feel towards them. AbstractAimTo explore the benefits and disadvantages of annual health checks for people with learning disabilities, including: What are the rationales and outcome measures for health checks? How well do health checks meet the needs of people with learning disabilities? What areas does research in this topic need to focus on in the future? BackgroundHealth consultations are an interpersonal activity that influence health outcomes and attitudes towards self and health professionals for people with learning disabilities. Annual health checks have been introduced to improve health inequalities for people with learning disabilities.MethodA narrative literature review of health care for people with learning disabilities was undertaken to evaluate health care for this population, and specifically the outcomes from annual health checks.FindingsWhile annual health checks have made some improvements in terms of health outcomes, attendance for appointments is still low, provision is variable and experiences of health checks for people with learning disabilities are under‐researched.ConclusionsService user‐led research into their health experiences is needed. Research into the attitudes and experiences of health professionals in relation to people with learning disabilities is needed. Healthcare inequalities are only being partially addressed—improvement is needed in terms of service user experience and engagement.

Adolescents and health-related behaviour: using a framework to develop interventions to support positive behaviours

BackgroundExperimentation is a natural part of adolescent maturation. In conjunction with increased exposure to behaviours such as alcohol or substance use, and the potentially intensified influence of peer groups, unhealthy behaviour patterns may develop as part of this experimentation. However, the adolescent years also provide considerable opportunity for behaviour to be shaped in positive ways that may improve immediate and longer term health outcomes. A systematic review carried out by the authors concluded that physiological changes during adolescence need to be considered when designing or implementing interventions, due to their influence on health behaviours. The aim of the study is to demonstrate how the six steps in quality intervention development (6SQuID) framework can be used, in conjunction with research or review findings, to inform the development of pilot or feasibility studies. Using the synthesised findings from our adolescent systematic review, we sought to illustrate how adolescent interventions might be designed to target specific health behaviours and augment positive adolescent health outcomes.MethodsWe applied the 6SQuID framework to the findings from a review of adolescent physiological influences on health behaviour. This involved following the process defined within 6SQuID and applying the sequential steps to build a proposed pilot study, based on the pre-defined findings of our systematic review. We used the Social Learning Theory to assist in identifying how and why change can be influenced, with and for adolescents.ResultsWe devised a pilot study example, targeting teaching assistants, to illustrate how the detailed steps within the 6SQuID framework can assist the development and subsequent implementation of adolescent interventions that are likely to be effective.ConclusionsThis paper gives details of how the 6SQuID framework can be used for intervention development, using specific research findings, across a variety of adolescent health behaviours. This example provides details of how to operationalise 6SQuID in practical terms that are transferrable to other populations and situations. In this respect, we anticipate that this illustrative case may be of use in the design, development, and implementation of a wide variety of interventions.

Assessment of knowledge and practices regarding menstrual hygiene among adolescent girls of Government higher secondary school, station Murhipar, Rajnandgaon (C.G.)

Background: Poor menstrual hygiene practices result into adverse health outcome in terms of increased vulnerability to reproductive tract infections (RTIs) and its consequences. The objective of present study was to assess the Knowledge and Practices regarding menstrual hygiene among adolescent school girls.Methods: A community-based, cross-sectional study was done among adolescent girls of class VII, VIII, IX and X (who attained menarche) in Government higher secondary school, station Murhipar, Rajnandgaon (C.G.) during September 2017 to October 2017 (two months) using a pre-designed, pre-tested questionnaire. Statistical analysis: Collected data was analyzed by using descriptive statistics (frequency and percentage).Results: A total of 141 adolescent school girls in the age group 12 to 17 years participated in this study. The mean age of menarche of the respondents was 12.9 years (range 11-15 years). Majority of girls (85.8%) were aware about menstruation prior to attainment of menarche. Mother was the first informant in case of 55.4% girls. Majority of girls (90.1%) practiced different restrictions during menstruation. Only 2.1% girls used sanitary pads during menstruation. Regarding hygienic practices, only 29.8% of girls change their cloths/pads three and above times per day and 98.6% girls had daily bath with soap during menstruation. Satisfactory hand washing with soap and water after changing pad during menstruation was present in 96.4%. Cleanliness of external genitalia was satisfactory in case of 80.1% girls.Conclusions: The adolescent girls need to be educated about fact of menstruation and menstrual hygiene practices in order to improve the menstrual hygiene.

NON-INVASIVE VERSUS INVASIVE MANAGEMENT IN PATIENTS WITH PRIOR CORONARY ARTERY BYPASS SURGERY WITH A NON-ST SEGMENT ELEVATION ACUTE CORONARY SYNDROME: COMPARISONS BETWEEN THE RANDOMIZED CONTROLLED PILOT TRIAL AND REGISTRY

Background: Elderly patients with multi-morbidity are often under-represented in clinical trials. The CABG-ACS pilot trial (NCT01895751) prospectively assessed reasons for entering the trial or registry and subsequent outcomes. Methods: Patients with a non-ST segment elevation acute coronary syndrome (NSTE-ACS) and prior coronary artery bypass graft (CABG) admitted to 4 hospitals were randomized to invasive or non-invasive management. Non-randomized patients entered a follow-up registry. The primary efficacy outcome was a composite of all-cause death, rehospitalization for refractory ischemia/angina, myocardial infarction (MI) and hospitalization due to heart failure. The primary safety outcome was the composite of bleeding, stroke, procedure-related MI and worsening renal function. A blinded Clinical Event Committee independently assessed events. EuroQol-5 Dimensions (EQ-5D) was assessed at 6 monthly intervals for ≥18 months. Results: 217 patients with prior CABG and unplanned hospitalization for suspected ACS were screened. 84 subjects did not consent (≥1 reasons): 43 not NSTE-ACS, 35 unsuitable for invasive management, 9 refractory ischemia, 3 unable to consent. Of 133 eligible subjects, 60 (mean±SD age 71±9 years, 28% female) entered the trial and 73 (age 72±10 years, 27% female) entered the registry (preferences: physician 79%, patient 40% or both 18%). Compared to trial patients, registry patients had significantly more valve disease, lower hemoglobin, worse New York Heart Association class and higher frailty index. Baseline EQ-5D, medications and left internal mammary artery grafts were similar. Registry patients had significantly more medication changes due to recurrent angina and more urgent inpatient invasive procedures. The primary efficacy outcome occurred in 49% registry vs. 43% trial patients (HR (95% CI) 1.12 (0.77,1.63); p=0.601). Primary safety outcomes were similar (22% registry vs. 28% trial; HR 0.76 (0.42,1.38); p=0.425). EQ-5D health status was lower in the registry at 6 months (p=0.011) but not at 1 year (p=0.068). Conclusion: Compared to trial patients, the registry had excess morbidity but their longer term health outcomes were similar.

Differential utilization of preventive care among colon cancer survivors compared to non-cancer patients.

577 Background: With advances in diagnosis and treatment, many cancer patients survive more than 5 years. The care of these cancer survivors (CS) represent an area of unmet need. We aim to characterize the patterns of preventive care in colon CS compared to non-cancer controls (NCC) and identify areas of deficiencies within the context of a universal health care system. Methods: Adult patients with non-metastatic colon cancer treated at the BC Cancer Agency between 2000-2012 were included. An age and gender matched cohort constructed from the provincial database served as NCC. Areas of preventive care examined include vaccinations, cancer, osteoporosis and cardiovascular diseases (CVD) screening. Multivariate regressions were done to test for associations between CS and preventive care. Results: In total, 9381 colon CS and 47187 NCC, matched at a ratio of 1:5, were analyzed. Among CS, median age of diagnosis was 68, 58% were male and 47% had stage 3 disease. The median overall survivals were 12/10/8 years for stages 1/2/3 disease respectively. 61% of these survivors died from colon cancer, 12% from other cancers and 25% from non-cancer causes. Deaths from colon cancer are more common within 5 years of diagnosis, particularly stage 3 disease. CS were more likely to receive any preventive care. In CS compared to NCC, 90% vs 85%, 47% vs 39% and 53% vs 46% of eligible patients had CVD screening, cancer screening and other preventive care respectively. This remained significant in multivariate analyses (Table). Patients who were female, had higher income and resided in urban areas were more likely to receive screening. Among CS, patients > 65 years (OR1.2, p = 0.04 95%CI 1.0-1.4), females (OR 1.5, p < 0.01 95%CI 1.3-1.8) and stages 1 or 2 disease (OR 1.3, p < 0.01 95%CI 1.1-1.5) had higher uptake of screening. Conclusions: Many colon cancer patients are long term survivors. CS are more likely to receive screening than NCC but uptake is suboptimal in certain areas. Targeted education towards certain sub-groups such as males, ≤65 years, low income and rural area patients may improve long term health outcomes. [Table: see text]

Reconstructing Infant Dietary Transitions and Composition from Novel Tooth Matrix Biomarkers

Background/Aim: Early life diet is a major determinant of lifelong health trajectories. However, studies of the long term health outcomes of breastfeeding and formula supplementation are difficult to study due to cost and time restraints in collecting data prospectively and the inherent limitations of questionnaires. A biomarker that can retrospectively measure the dose, intake duration and composition of breastmilk and formula would be a major advancement in the study of the health trajectories associated with infant diet, particularly for health outcomes that are rare or can only be measured much later in life, years after the cessation of breastfeeding. Methods: Chemical signals in teeth can be used to reconstruct infant diet transitions and composition from birth till early childhood. Our method precisely analyses aged dentine layers, generating longitudinal, weekly estimates of biomarkers of infant diet. Using reversed distributed lag models (DLM) we investigated which chemical signatures in teeth were the best markers of breastmilk or formula intake. We tested this method in a non-human primate model and have further applied the method in a second primate model of cyclical nursing and human studies. Results: Preliminary studies identified barium as a sensitive marker of infant diet transition from mother’s milk to solid foods in non-human primates and the introduction of infant formula in humans. Reversed DLMs indicated strontium may be a sensitive marker to infant formula use and lithium as a marker for long term breastfeeding. Conclusions: Infant diet transitions and composition can be reconstructed using chemical signatures in teeth. We plan to use a lagged weighted quantile sum regression analyses to identify the chemical mixture unique to breastmilk or formula to precisely measure the dose of breastmilk during mixed feeding. This method can be applied to more accurately investigate associations of breastfeeding with long term health outcomes.

The Effect of Childhood Health Status on Adult Health in China.

Childhood health in China was poor in the 1950s and 1960s because of limited nutrition. In the last three decades, China has distinguished itself through its tremendous economic growth and improvements in health and nutrition. However, prior to such growth, access to good nutrition was more variable, with potentially important implications, not only for childhood health, but also for adult health, because of its long-term effects lasting into adulthood. To shed light on these issues, this study examined the long-run association between childhood health and adult health outcomes among a middle-aged Chinese population and addresses the endogeneity of childhood health. A nationwide database from the 2011 China Health and Retirement Longitudinal Study (CHARLS) was employed. Three adult health outcomes variables were used: self-reported health status, cognition, and physical function. The local variation in grain production in the subjects’ fetal period and the first 24 months following birth was employed as an instrument for childhood health in order to correct for its endogeneity. Childhood health recalled by the respondents was positively and significantly associated with their adult health outcomes in terms of self-reported health status, cognition, and physical function in single-equation estimates that did not correct for the endogeneity of childhood health. A good childhood health status increased the probabilities of good adult health, good adult cognitive function, and good adult physical function by 16% (95% CI: 13–18%), 13% (95% CI: 10–15%), and 14% (95% CI: 12–17%), respectively. After correcting for endogeneity, the estimated effects of good childhood health were consistent but stronger. We also studied the male and female populations separately, finding that the positive effects of childhood health on adult health were larger for males. In China, childhood health significantly affects adult health. This suggests that early interventions to promote childhood health will have long-term benefits in China and that health-care policies should consider their long-term impacts over the life cycle in addition to their effects on specific age groups.

Factors of Skipping Breakfast and Association between Skipping Breakfast and Academic Achievement of Nursing Students

Background: Breakfast eating is related with good outcomes in terms of health. Skipping of breakfast is usually found in adolescents, but research findings on the effects of breakfast skipping on academic performance are scarce. The current study investigated the relation between breakfast skipping and academic performance of nursing students. Aims & Objective: To identify the factors associated with breakfast skipping and assess the academic achievement and to find association between breakfast skipping and academic performance Materials and Method: Cross-sectional survey was done among 527 nursing students. Demographic data of the subjects, and data related to factors for skipping breakfast was collected. Sessional grades of two exams were collected. Immediate visual memory and focus test was conducted via tool designed by researchers. Results: The results revealed, majority of the students 215 (40.7%) lack of time was the major reason to skip breakfast. Most of the 522 (99.1%) students scored good in the immediate visual memory (IMV) test and 500 (94.9 %) scored well in the focus test. No significant association (χ² (3) = 1.902, p = 0.595) was found between breakfast skipping and academic performance. Conclusion: Breakfast is generally accepted to be the most important meal of the day and students should eat breakfast regularly especially when they are going to hospitals. As per the data findings, no association was found between skipping of breakfast and academic achievements. Thus, the study indicates that breakfast skipping does not affect academic achievement but in a longer run it might affect the cognitive levels of students if regularly skipped.

Dental Visit Patterns and Oral Health Outcomes in Saudi Children.

Background:Health education advocates regular dental visits to improve oral health. There is a need to verify the outcomes associated with various dental visits patterns.Objective:To assess the relationship of reported and clinically assessed oral health outcomes in Saudi children with their dental visits' pattern.Methods:This cross-sectional study included 6–12-year-old schoolchildren from six cities in the Eastern Province of Saudi Arabia in 2015. Parents responded to a questionnaire about dental visit patterns. Through a clinical examination, the presence of caries, sealants and need for referral was assessed. Univariate and multivariate regression was used to assess the association between dental visit patterns and pain in the past 6 months, presence of untreated caries and need for referral after controlling for confounders.Results:Of the 3000 questionnaires distributed, 2306 (76.9%) parents responded. Significantly higher odds of pain were associated with visiting when in dental pain (odds ratio = 6.81) and never visiting a dentist (odds ratio = 3.44), whereas significantly lower odds were associated with regular checkups (odds ratio = 0.28). No significant association was observed with visits after recall by dentists.Conclusion:Regular checkups initiated by parents are associated with better reported oral health outcomes in terms of pain, while recall by dentists has no impact on oral health.

PROTOCOL: Efficacy and effectiveness of micronutrient supplementation and fortification interventions on the health and nutritional status of children under-five in low and middle-income countries: a systematic review.

PROTOCOL: Efficacy and effectiveness of micronutrient supplementation and fortification interventions on the health and nutritional status of children under-five in low and middle-income countries: a systematic review.

Associations between dietary patterns and age at natural menopause in the UK Women's Cohort Study

Previous studies have demonstrated an association between a later menopause and reduced risk of cardiovascular diseases and osteoporosis, and a higher risk for endometrial, ovarian and breast cancer(1). It is hypothesized that diet can influence the timing of natural menopause(2). Yet, evidence linking diet and age at natural menopause is still sparse and inconsistent. This study aimed to investigate the prospective association between dietary patterns derived from two different methods and age at natural menopause. Menopausal status was reported at two time points 4 years apart in the UK Women’s Cohort Study. Diet of participants were measured using a 217-item food frequency questionnaire at baseline. Principal component analysis (PCA) and reduced ranked regression (RRR) were used to derive dietary patterns for 13,916 women. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for each pattern in relation to increasing age at natural menopause at follow-up, adjusting for potential confounders. Five patterns were identified from the PCA, which we labelled: ‘vegetables and legumes’, ‘animal proteins’, ‘fruits’, ‘fats and sweets’ and ‘low-fat products’. Three patterns were derived from RRR: ‘sweets, pastries and puddings’, ‘low-fat dairy and meat’, and ‘red meat and processed meat’. Women who scored higher on the ‘animal proteins’ pattern were 6 % less likely to have gone through a natural menopause (HR: 0.94, 95 % CI: 0.90 to 0.97) compared to those who scored lower. The ‘red meat and processed meat’ pattern predicted a 7 % higher risk for a later natural menopause (HR: 0.93, 95 % CI: 0.87 to 1.00). No evidence of an association was observed between the other dietary patterns and incidence of being naturally menopausal. This is the first study ever investigating the associations between dietary patterns and age at natural menopause. Both PCA and RRR are useful in deriving dietary patterns which can influence the onset of natural menopause. These findings will contribute to an improved understanding of the timing of natural menopause in relation to diet, which may also have implications associated with longer term health outcomes in post-menopausal women. This work was supported by the Commonwealth Scholarships, UK. 1. Gold EB (2011) Obstet Gynecol Clin North Am 38, 425–440. 2. Nagata C, Takatsuka N, Inaba S et al. (1998) Maturitas 29, 105–113.

Influence of Shift Work on Manual Dexterity and Reaction Time in Tunisian Nurses.

Major effects of shift schedule are related to sleep alertness and performance, but also to long term health outcomes. For nurses, these negative effects have consequences not only on the individual, but also on the workplace, as decreased alertness and reduced job performance could endanger human lives. The specific aim of our study is to assess the influence of shift schedule on nurses´ cognitive ability and rapidity of execution. Our survey is a cross sectional study which had been conducted for 15 months; it involved a sample of 293 participants representative of 1118 nurses working in two Tunisian university hospitals. It included an evaluation of the rapidity of execution performance through the manual dexterity test and the reaction time test. The study was completed by an assessment of the workability Index through a 7- item survey. No association was found between the groups of work schedules and the cognitive ability of execution speed. However, we found a significant decrease in cognitive performance in the nurses exceeding 10 years of job seniority for both schedules. We concluded to an impaired cognitive performance speed in the over 10-year seniority groups in both schedules. Recommendations should be focused on implementing periodic assessment of cognitive performance based on O'Connor finger dexterity test and time reaction test and on implementing effective preventive measures in hospitals after ten years of seniority at work.

Clinical Evaluation of Antihyperglycemic Activity of Metformin in Treatment of Insulin Sensitivity in Polycystic Ovary Syndrome: A double Blind Placebo-Controlled Study

Polycystic ovary syndrome is the most common endocrinological disorder affecting 4–12% of women and also the most controversial. Metformin was logically introduced to establish the extent to which hyperinsulinaemia influences the pathogenesis of the condition. Early studies were very encouraging. Randomized controlled studies and several metaanalyses have changed the picture and put the drug that was once heralded as magic in a much contracted place. Metformin is one of the longest established oral insulin sensitising agents. For decades its use was restricted to management of type 2 diabetes. However, in the past two decades, its properties as an insulin sensitising agent have been explored in relation to its applicability for women with PCOS. Metformin is an effective ovulation induction agent for non-obese women with PCOS and offers some advantages over other first line treatments for anovulatory infertility such as clomiphene. For clomiphene-resistant women, metformin alone or in combination with clomiphene is an effective next step. Women with PCOS undergoing in vitro fertilisation should be offered metformin to reduce their risk of ovarian hyperstimulation syndrome. Limited evidence suggests that metformin may be a suitable alternative to the oral contraceptive pill (OCP) for treating hyperandrogenic symptoms of PCOS including hirsutism and acne. More research is required to define whether metformin has a role in improving long term health outcomes for women with PCOS, including the prevention of diabetes, cardiovascular disease and endometrial cancer.

SPN Position Statement: The Role of Pediatric Nurses in the Promotion and Protection of Human Milk and Breastfeeding

SPN Position Statement: The Role of Pediatric Nurses in the Promotion and Protection of Human Milk and Breastfeeding

Managing frailty: exploring the effectiveness of integrated primary care interventions by distinguishing subpopulations of frail older people

Introduction: Integrated care has increasingly been promoted as an effective way to organize primary care for community-dwelling frail older people. In the context of the National Care for the Elderly Programme in the Netherlands, a number of integrated primary care interventions were evaluated. These interventions have common components such as screening, assessment, care plan and an integrated, multidisciplinary follow-up. However, the evaluations of these interventions have not shown convincing effects in terms of health outcomes, functional abilities or quality of life. A possible explanation could be that frail older people have been perceived as a homogeneous group by both care professionals involved in the interventions and researchers conducting the evaluation research. Frailty is characterized by its complexity; different components of frailty could influence and reinforce each other. Therefore, it is essential to develop profiles of frail older people. By specifying frailty, interventions could be better designed and implemented to meet specific needs of frail older people and to prevent negative outcomes. The aim of this ongoing research is twofold: 1) to distinguish subpopulations of frail older people and 2) to explore to what extent the effectiveness of integrated care interventions differs between the subpopulations of frail older people. Methods: For this research The Older Person and Informal Caregiver Survey Minimum DataSet (TOPICS-MDS) will be used, containing data of 30,000 older people [1]. First, to distinguish the subpopulations of frail older people, latent class analysis will be applied. Second, the identified subpopulations will be taken into account as a moderator variable in an Individual Patient Data meta-analysis of eight integrated primary care interventions. The eight studies used controlled designs with before and after measurements of 8000 frail older people. The outcome variables will be: health outcomes, functional abilities and quality of life. Discussion: By distinguishing subpopulations of frail older people, we will enhance the understanding of frailty and its complexity for care professionals and researchers. Our results will indicate whether integrated primary care interventions are (more) effective for certain subpopulations of frail older people. Thereby, our study may provide valuable insights into the future design, implementation and evaluation of integrated care interventions for frail older people.

Human sperm cryopreservation in cancer patients: Links with deprivation and mortality

Evidence is mounting for a relationship between human semen quality and environmental/lifestyle/socioeconomic factors including long term health outcomes such as mortality. The relationship between pre-freeze and post-thaw semen quality in cancer patients and these factors are unknown. Frozen semen from 217 cancer patients was thawed and analysed using a validated CASA method. Post-thaw quality was matched and compared with WHO semen analysis performed prior to storage. The English Indices of Deprivation 2010 were matched with patients and then examined for relationships with pre-freeze and post-thaw semen quality. There is a relationship between semen quality and deprivation in cancer patients. Compared with pre-freeze semen quality, post-thaw semen quality has a stronger relationship with deprivation. Sperm cryopreservation may have potential as a systemic health diagnostic test and is predictive of cancer patient mortality.

Assessment of the economic impacts of heat waves: A case study of Nanjing, China

The southeast region of China is frequently affected by summer heat waves. Nanjing, a metropolitan city in Jiangsu Province, China, experienced an extreme 14-day heat wave in 2013. Extreme heat can not only induce health outcomes in terms of excess mortality and morbidity (hospital admissions) but can also cause productivity losses for self-paced indoor workers and capacity losses for outdoor workers due to occupational safety requirements. All of these effects can be translated into productive working time losses, thus creating a need to investigate the macroeconomic implications of heat waves on production supply chains. Indeed, industrial interdependencies are important for capturing the cascading effects of initial changes in factor inputs in a single sector on the remaining sectors and the economy. To consider these effects, this paper develops an interdisciplinary approach by combining meteorological, epidemiological and economic analyses to investigate the macroeconomic impacts of heat waves on the economy of Nanjing in 2013. By adopting a supply-driven input-output (IO) model, labour is perceived to be a key factor input, and any heat effect on human beings can be viewed as a degradation of productive time and human capital. Using this interdisciplinary tool, our study shows a total economic loss of 27.49 billion Yuan for Nanjing in 2013 due to the heat wave, which is equivalent to 3.43% of the city's gross value of production in 2013. The manufacturing sector sustained 63.1% of the total economic loss at 17.34 billion Yuan. Indeed, based on the ability of the IO model to capture indirect economic loss, our results further suggest that although the productive time losses in the manufacturing and service sectors have lower magnitudes than those in the agricultural and mining sectors, they can entail substantial indirect losses because of industrial interdependencies. This important conclusion highlights the importance of incorporating industrial interdependencies and indirect economic assessments in disaster risk studies.

Impact Of Using Overall Survival Or Progression-Free Survival In Outcomes-Based Pricing Arrangements

Outcomes-based pricing arrangements (OBPA) can be attractive for payers to address uncertainty. In oncology overall survival (OS) is considered the gold standard outcomes measure. However, implementing OBPA based on OS poses significant practical hurdles. Here we assess the feasibility and impact of using progression-free survival (PFS) as an alternative measure to enable OBPA. A three-part, mixed-methods study was performed to assess the use of OBPA in oncology. A scoping review was conducted to identify current and past OBPA. Further, the impact of OBPA - using either OS or PFS - on savings and health improvements in the population the payer is paying for was modelled for four metastatic cancer compounds. (Ex-) payers’ perceptions and attitudes where also explored through semi-structured qualitative interviews. In the metastatic setting OBPA based on OS or PFS can both address uncertainty around health outcomes and costs. In the four compounds, OBPA based on OS had a greater impact on payers’ outcomes in the population the payer is paying for (increase in median OS of 6.9 months compared to 2.8 months in median PFS) and potential savings (15% compared to 10%). Although PFS has a smaller impact, the time to trigger a payback was reduced between 18.9 and 4.9 months in the 4 compounds. The definition of a relevant and measurable endpoint is necessary to increase the use of OBPA. OS is seen as the ultimate outcome by the interviewees and is beneficial to payers in terms of health outcomes in the population they pay for and savings. However, it is often not feasible to implement because of the long follow-up time required. Using PFS might be a good alternative to OS in the metastatic setting. More research is needed to further explore alternative outcome measures to successfully support OBPA.