Health Utilization Research Articles

Experiences of ethnic minority personnel in the armed forces: A systematic review

LAY SUMMARY An armed forces consisting of personnel from diverse and ethnic minority backgrounds offers considerable benefits, not just in terms of reflecting society but for improving the effectiveness of military operations. Many ethnic minority individuals serve for long periods, during which they experience personal growth and benefit from military service. However, little research has explored the impact these experiences might have on ethnic minority communities within the Armed Forces, who report higher levels of bullying, harassment, and discrimination. Given the lack of empirical research into armed forces ethnic minority personnel, this systematic review aimed to provide insight into and understanding of existing international research, relevant reports, and policy. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and included articles written in English since 2010. The review identified three themes — cultural identity, health status and health utilization, and trauma and discrimination — and indicated that ethnic minority personnel experience greater disadvantage than their native counterparts, both during and after service.

The interaction of digital devices utilization and behavior indicators of youth health

Nowadays, such digital devices as laptop, tablet, computer, smartphone are an important component of life in all age categories of population that differently affect their health. The article presents analysis of problems of digital behavior of children and youth as related to health. The materials of sociological survey were used to consider mutual effect of recommendations on safe use of digital devices and behavior indicators of health of students. The purpose of the study is to analyze significance of digital behavior for health based on materials of normative legal documents, results of various studies exemplified by students using digital devices in context of various components of self-preservation behavior. The normative legal documents regarding digital educational environment and research materials (including the study "Digital transformation in the life of students" carried out by Russian Society of Sociologists in 2023 in 29 cities of Russia (N=8,734) were analyzed. The study was focused on importance of formation of communication human culture of communication with various types digital devices and advisability to begin this work from children age. The difficulties existing in this area are noted. Among students, almost half of respondents don't follow basic recommendations concerning working with digital devices important for health prevention. The rest of hygiene recommendations are ignored by up to 87% of respondents. The presence of students' attitudes to healthy lifestyle, physical activity and increased self-estimation of health positively affect those who apply recommendations on communication with digital devices. The role of family and pedagogues as subjects in formation of hygienic culture of using digital devices is currently significant, but yet insufficient. The increasing of culture of communication with digital devices among youth and more active orientation on positive health indicators can input into health amelioration.

Cross-sectional analysis of healthcare worker mental health and utilisation of a digital mental health platform from 2020 to 2023

BackgroundHealthcare worker (HCW) anxiety and depression worsened during the pandemic, prompting the expansion of digital mental health platforms as potential solutions offering online assessments, access to resources and counselling. The...

Behaviour change intervention (education and text) to prevent dental caries in secondary school pupils: BRIGHT RCT, process and economic evaluation.

The presence of dental caries impacts on children's daily lives, particularly among those living in deprived areas. There are successful interventions across the United Kingdom for young children based on toothbrushing with fluoride toothpaste. However, evidence is lacking for oral health improvement programmes in secondary-school pupils to reduce dental caries and its sequelae. To determine the clinical and cost effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in secondary-school pupils. A multicentre, school-based, assessor-blinded, two-arm cluster randomised controlled trial with an internal pilot and embedded health economic and process evaluations. Secondary schools in Scotland, England and Wales with above-average proportion of pupils eligible for free school meals. Randomisation occurred within schools (year-group level), using block randomisation stratified by school. Pupils aged 11-13 years at recruitment, who have their own mobile telephone. Two-component intervention based on behaviour change theory: (1) 50-minute lesson delivered by teachers, and (2) twice-daily text messages to pupils' mobile phones about toothbrushing, compared with routine education. Primary outcome: presence of at least one treated or untreated carious lesion using DICDAS4-6MFT (Decayed, Missing and Filled Teeth) in any permanent tooth, measured at pupil level at 2.5 years. Secondary outcomes included: number of DICDAS4-6MFT; presence and number of DICDAS1-6MFT; plaque; bleeding; twice-daily toothbrushing; health-related quality of life (Child Health Utility 9D); and oral health-related quality of life (Caries Impacts and Experiences Questionnaire for Children). Four thousand six hundred and eighty pupils (intervention, n = 2262; control, n = 2418) from 42 schools were randomised. The primary analysis on 2383 pupils (50.9%; intervention 1153, 51.0%; control 1230, 50.9%) with valid data at baseline and 2.5 years found 44.6% in the intervention group and 43.0% in control had obvious decay experience in at least one permanent tooth. There was no evidence of a difference (odds ratio 1.04, 95% confidence interval 0.85 to 1.26, p = 0.72) and no statistically significant differences in secondary outcomes except for twice-daily toothbrushing at 6 months (odds ratio 1.30, 95% confidence interval 1.03 to 1.63, p = 0.03) and gingival bleeding score (borderline) at 2.5 years (geometric mean difference 0.92, 95% confidence interval 0.85 to 1.00, p = 0.05). The intervention had higher incremental mean costs (£1.02, 95% confidence interval -1.29 to 3.23) and lower incremental mean quality-adjusted life-years (-0.003, 95% confidence interval -0.009 to 0.002). The probability of the intervention being cost-effective was 7% at 2.5 years. However, in two subgroups, pilot trial schools and schools with higher proportions of pupils eligible for free school meals, there was an 84% and 60% chance of cost effectiveness, respectively, although their incremental costs and quality-adjusted life-years remained small and not statistically significant. The process evaluation revealed that the intervention was generally acceptable, although the implementation of text messages proved challenging. The COVID-19 pandemic hampered data collection. High rates of missing economic data mean findings should be interpreted with caution. Engagement with the intervention and evidence of 6-month change in toothbrushing behaviour was positive but did not translate into a reduction of caries. Future work should include work with secondary-school pupils to develop an understanding of the determinants of oral health behaviours, including toothbrushing and sugar consumption, particularly according to free school meal eligibility. This trial is registered as ISRCTN12139369. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/166/08) and is published in full in Health Technology Assessment; Vol. 28, No. 52. See the NIHR Funding and Awards website for further award information.

A pilot randomised controlled trial of a telehealth-delivered brief ‘Sleeping Sound Autism’ intervention for autistic children

BackgroundAccess to behavioural sleep intervention is beneficial for autistic children, yet many families face barriers to access associated with location and time. Preliminary evidence supports telehealth-delivered sleep intervention. However, no studies have evaluated brief telehealth sleep intervention. To address this, we evaluated telehealth delivery of the brief behavioural Sleeping Sound Autism intervention, using a two-armed, parallel-group, non-blinded, pilot randomised controlled trial (RCT) design (trial registration: ANZCTR12620001276943). MethodSixty-one families of autistic children without intellectual disability (5–12 years, 46% female) with caregiver-reported moderate–severe behavioural sleep problems participated Australia-wide, randomised to an intervention (n = 30) or treatment as usual control group (n = 31). Intervention group participants were invited to attend two video-conference telehealth sessions and one follow-up phone call with a trained clinician. Survey data was collected from caregivers at baseline and three- and six-months post-randomisation, to evaluate feasibility, acceptability, and efficacy. Ten intervention group caregivers participated in end-of-study semi-structured interviews to explore their experiences. ResultsForty-nine caregivers completed surveys. At baseline, 87% felt positive and 84% felt confident about participating via telehealth, and 75% believed the program would improve child sleep. At three-months, intervention group caregivers (n = 24) reported the usefulness (100%) of and preference for (71%) telehealth, and 95.8% would recommend this sleep program to other families. A significant group by time difference was observed in child sleep (Children's Sleep Habits Questionnaire) with large effect sizes (d = 0.87–1.05), emotion and behaviour (Developmental Behavior Checklist 2) with moderate effect sizes (d = 0.40–0.57), and caregiver mental health (Kessler 10) with small to moderate effect sizes (d = 0.60–0.28), favouring the intervention group (n = 23). There were no significant group differences in child (Child Health Utility instrument) or caregiver (Assessment of Quality of Life) quality of life. However, there were individual differences in the clinical significance of improved child sleep. Qualitative data showed that whilst telehealth was convenient for caregivers, without attenuating the benefits of most key intervention features, not all children were able to engage effectively with the clinician via telehealth. ConclusionsThis first pilot RCT of a brief telehealth behavioural sleep intervention for primary-school-aged autistic children suggests that telehealth delivery is acceptable, feasible and likely efficacious in improving sleep in the short-term. Providing families with ongoing choice of mode of delivery (telehealth/in-person) and examining the person-environment fit of telehealth for autistic children is important.

Where Are the Costs? Using an Economic Analysis of Educational Interventions Approach to Improve the Evaluation of a Regional School Improvement Programme

Education systems are moving to a more evidence-informed paradigm to improve outcomes for learners. To help this journey to evidence, robust qualitative and quantitative research can help decisionmakers identify more promising approaches that provide value for money. In the context of the utilisation of scarce resources, an important source of evidence commonly used in health and social care research is an understanding of the economic impact of intervention choices. However, there are currently very few examples where these methodologies have been used to improve the evaluation of education interventions. In this paper we describe the novel use of an economic analysis of educational interventions (EAEI) approach to understand both the impact and the cost of activities in the evaluation of a formative assessment implementation project (FAIP) designed to improve teachers’ understanding and use of formative assessment strategies. In addition to utilising a mixed method quasi-experimental design to explore the impact on learner wellbeing, health utility and attainment, we describe the use of cost-consequence analysis (CCA) to help decisionmakers understand the outcomes in the context of the resource costs that are a crucial element of robust evaluations. We also discuss the challenges of evaluating large-scale, universal educational interventions, including consideration of the economic tools needed to improve the quality and robustness of these evaluations. Finally, we discuss the importance of triangulating economic findings alongside other quantitative and qualitative information to help decisionmakers identify more promising approaches based on a wider range of useful information. We conclude with recommendations for more routinely including economic costs in education research, including the need for further work to improve the utility of economic methods.

The Impact of Health Policy on Access to Healthcare: Utilizing Geographic Information Systems (GIS) for Detailed Access and Equity Mapping

Health policies are significant in relation to health equity and accessibility. Achieving equity in health care must understand the geographic distribution of health care and the impact of policy decisions on access Planners can use Geographic Information Systems (GIS) as an aid powerful to visualize and scrutinize these differences. The current study addresses some of the challenges of integrating multiple data sources, definitions of access and equity and the dynamic nature of health care processes. Furthermore, sophisticated analytical methods are needed to truly map all complex health care systems. Therefore this paper, describe a cross-sectional mental health treatment (C-SMHT) that uses a fuzzy inference system to assess justice and access to health care. Using ambiguous GIS data to address uncertainty and environmental variability, this approach provides a comprehensive picture of how policy change has shaped health disparities to improve. C-SMHT has many applications for policy makers as well as public health practitioners. This paper will provide a snapshot of mental health provider availability and utilization. Simulation studies to examine how the effectiveness of the C-SMHT approach can help to better identify underserved areas, better allocate resources, and deliver treatment were found to be good. A number of initiatives will be developed as part of this project to assess their impact on the availability of mental health services in defined areas or countries. In addition to providing recommendations to policy makers based on research findings, the simulation will also provide insights into how policies affect equity and access.

Maternal Health Information Access and Utilization among Pregnant Women in Rural Communities of Jalingo, Taraba State, Nigeria

Maternal Health Information Access and Utilization among Pregnant Women in Rural Communities of Jalingo, Taraba State, Nigeria

Varying the intensity of cystoscopic surveillance for high-risk non-muscle-invasive bladder cancer.

To compare the clinical, economic, and health utility outcomes associated with alternative cystoscopic surveillance regimens for high-risk non-muscle-invasive bladder cancer (HRNMIBC). We performed real-world clinical data-driven microsimulations of a hypothetical cohort of 100 000 patients diagnosed with HRNMIBC at age 70 years. The cohort was simulated to undergo alternative surveillance regimens recommended by five guidelines, and two hypothetical regimens-surveillance intensity escalation and de-escalation-which had a surveillance intensity moderately higher and lower, respectively, than the guideline-recommended regimens. We evaluated the 10-year cumulative incidence of muscle-invasive bladder cancer (MIBC), cancer-specific survival (CSS), overall survival (OS), and cost-effectiveness from a United States healthcare payer perspective. The guideline-recommended surveillance regimens led to an estimated 10-year cumulative incidence of MIBC ranging from 11.0% to 11.6%, CSS 95.0% to 95.2%, and OS 69.7% to 69.8%. Surveillance intensity escalation resulted in a 10-year cumulative incidence of MIBC of 10.5% (95% confidence interval [CI] 10.3-10.7%), CSS of 95.4% (95% CI 95.2-95.5%), and OS of 69.9% (95% CI 69.6-70.1%), vs 11.9% (95% CI 11.7-12.1%), 94.9% (95% CI 94.8-95.1%), and 69.6% (95% CI 69.3-69.9%), respectively, from surveillance intensity de-escalation. By increasing surveillance intensity, the number-needed-to-treat to prevent one additional MIBC progression over 10 years was ≥80, and ≥257 to avoid one additional cancer-related mortality. Compared to surveillance intensity de-escalation, higher-intensity regimens incurred an incremental cost of ≥$336 000 per incremental quality-adjusted life year gained, which well exceeded conventional willingness-to-pay thresholds, ≥$686 000 per additional MIBC progression prevented, and ≥$2.2 million per additional cancer-related mortality avoided. In microsimulations testing a wide range of cystoscopic surveillance intensity for patients newly diagnosed with HRNMIBC, moderate surveillance de-escalation appears associated with an insignificant change in 10-year OS and furthermore is cost-effective vs higher-intensity surveillance regimens. These results suggest that moderate surveillance de-escalation can reduce costs of care without compromising life expectancy for many patients.

Effect of increasing β-mannanase supplementation in diets containing copra meal on growth performance, meat quality, liver health, intestinal morphology, and nutrient utilization in broiler chickens.

The current study aimed to investigate the effect of increasing β-mannanase supplementation in diets containing copra meal (CM) on growth performance, meat quality, liver health, intestinal morphology, and nutrient utilization in broiler chickens. A total of 1,600 3-d-old Ross 308 broiler chickens (initial body weight [BW] ± SD = 43.3 ± 1.08 g) were randomly allotted to 1 of 5 treatment groups with 8 replicates. One group was fed a corn-soybean meal-based diet (control). Other 4 diets were prepared by inclusion of 10% commercial CM in the control diet with 0, 400, 800, and 1,600 U β-mannanase/kg. Experiments lasted for 32 d. Birds fed the control diet had less (p=0.001) feed conversion ratio (FCR) than those fed diets containing 10% CM without β-mannanase supplementation. Increasing supplementation of β-mannanase in diets containing 10% CM had no linear and quadratic effects on body weight gain, feed intake, and FCR in broiler chickens. The control diet had greater (p<0.01) apparent total tract retention (ATTR) of DM, GE, and N as compared to the diets containing 10% CM without β-mannanase supplementation; however, no differences in the ATTR of Ca and P were identified between 2 diets. There were no linear and quadratic effects of increasing supplementation of β-mannanase on the ATTR of DM, GE, N, Ca, and P in broiler diets containing 10% CM. Both inclusion of 10% CM and increasing supplementation of β-mannanase in broiler diets did not affect apparent ME (AME) and N-corrected ME (AMEn) values in treatment diets. The use of 10% CM in broiler diets during growing and finishing period impairs growth performance by decreasing energy and nutrient utilization in diets. Increasing β-mannanase supplementation in diets containing 10% CM has no positive effects on performance, meat quality, liver health, intestinal morphology, and nutrient utilization in broiler chickens.

Clinical Applications of Artificial Intelligence in Occupational Health: A Systematic Literature Review.

To identify and critically analyze studies using artificial intelligence (AI) in occupational health. A systematic search of PubMed, IEEE Xplore, and Web of Science was conducted to identify relevant articles published in English between January 2014-January 2024. Quality was assessed with the validated APPRAISE-AI tool. The 27 included articles were categorized as follows: health risk assessment (n = 17), return to work and disability duration (n = 5), injury severity (n = 3), and injury management (n = 2). 47 AI algorithms were utilized, with artificial neural networks, support vector machines, and random forest being most common. Model accuracy ranged from 0.60-0.99 and AUC from 0.7-1.0. Most studies (n = 15) were of moderate quality. While AI has potential clinical utility in occupational health, explainable models that are rigorously validated in real-world settings are warranted.

Prevalence of malignant neoplasms in celiac disease patients - a nationwide United States population-based study.

Celiac disease (CeD) is an autoimmune disorder triggered by the immune response to gluten in genetically predisposed individuals. Recent research has unveiled a heightened risk of developing specific malignant neoplasms (MN) and various malignancies, including gastrointestinal, lymphomas, skin, and others, in individuals with CeD. To investigate the prevalence of MN in hospitalized CeD patients in the United States. Using data from the National Inpatient Sample spanning two decades, from January 2000 to December 2019, we identified 529842 CeD patients, of which 78128 (14.75%) had MN. Propensity score matching, based on age, sex, race, and calendar year, was employed to compare CeD patients with the general non-CeD population at a 1:1 ratio. Positive associations were observed for several malignancies, including small intestine, lymphoma, nonmelanoma skin, liver, melanoma skin, pancreas myelodysplastic syndrome, biliary, stomach, and other neuroendocrine tumors (excluding small and large intestine malignant carcinoid), leukemia, uterus, and testis. Conversely, CeD patients exhibited a reduced risk of respiratory and secondary malignancies. Moreover, certain malignancies showed null associations with CeD, including head and neck, nervous system, esophagus, colorectal, anus, breast, malignant carcinoids, bone and connective tissues, myeloma, cervix, and ovary cancers. Our study is unique in highlighting the detailed results of positive, negative, or null associations between different hematologic and solid malignancies and CeD. Furthermore, it offers insights into evolving trends in CeD hospital outcomes, shedding light on advancements in its management over the past two decades. These findings contribute valuable information to the understanding of CeD's impact on health and healthcare utilization.

Burden of chronic skin disease from an Asian perspective: Assessment of health state utilities and quality of life in a Singapore cohort

BackgroundUnderstanding health state utilities of skin diseases is is essential for health economic evaluations in an era of rising healthcare costs. ObjectiveTo create a catalogue of utilities values of chronic skin diseases among Asians. MethodsThis is a cross-sectional study of adults attending a dermatology outpatient clinic from February 2019 to March 2023 with one of these skin diseases: 1) Eczema, 2) Psoriasis, 3) Acne vulgaris, 4) Chronic Urticaria, 5) Pigmentary disorders, 6) Hair Loss, 7) Viral warts, 8) Fungal infections and 9) Keloids. Demographic and socio-economic information were collected. . Health status and utilities (Dermatology Life Quality Index, Skindex-16, EQ-5D, Visual analogue scale, time-trade-off (TTO) and willingness-to-pay) were measured.. Results183 patients with a median age of 35.5 (21 to 77) years old were included. Majority (76.9%) were Chinese, followed by Malays (11.5%). TTO utilities were lower than EQ-5D utilities across all disease severity and most skin diseases. Patients were willing to pay USD$740 or more for a hypothetical drug to cure conditions such as psoriasis, acne, hairloss and keloids. LimitationsLimited sample size and ethnic representation. ConclusionsThis study provides a catalogue of utilities in skin diseases and highlights the strengths and challenges of different measures.

Health-related quality of life in vibrant soundbridge patients: generic and specific measures, short-term and long-term outcomes.

The goal of the study was to determine the short- and long-term outcome of health-related quality of life (HRQoL) in adults implanted with a Vibrant Soundbridge (VSB). Twenty-one adults (8 females, 13 males; mean age at implantation: 57 ±10 years) who received a unilateral VSB for combined or conductive hearing loss, were administered two questionnaires: the Nijmegen Cochlear Implant Questionnaire (NCIQ) as a measure of hearing-specific HRQoL, and the Health Utility Index 3 (HUI 3) as a measure of generic HRQoL. The questionnaires were administered before implantation and three, six, 12 and 24 months after processor activation. The NCIQ total score raised significantly from 62 points before implantation to 76 points at three months after processor activation (p < 0.005). Thereafter, no significant increases occurred anymore. The HUI 3 multi-attribute score (MAUS) increased from 0.59 before implantation to 0.70 at three months and at six months after processor activation and then declined slightly to 0.68 at 24 months after processor activation. Similar values were observed with the HUI 3 single-attribute score (SAUS) of Hearing. The increases of the HUI 3 scores were not statistically significant, but all pre-post-implantation differences were clinically relevant. VSB recipients experienced a quick improvement of their HRQoL. After just three months of device use, a significant improvement of hearing-specific HRQoL and a clinically relevant improvement of generic HRQoL were seen. After three months, no essential changes of HRQoL occurred in our sample, suggesting that the achieved level of HRQoL may remain stable in the long term.

Is primary trabeculectomy cost-effective for patients with advanced primary open angle glaucoma? Results from the Treatment of Advanced Glaucoma Study economic model

Background/aimsAdvanced primary open angle glaucoma (POAG) is a lifelong condition. The aim of this study is to compare medical treatment against trabeculectomy for patients presenting with advanced POAG using an...

Recurrent patellar dislocation: personalised therapy or operative treatment? The REPPORT randomised trial protocol

IntroductionRecurrent patellar dislocation is a debilitating musculoskeletal condition, affecting mainly adolescents and adults under the age of 30. It can persist for many decades, causing pain and cartilage and soft-tissue...

Contract Termination and Insurance Enrollment Among Medicare Advantage Beneficiaries

Approximately one-fifth of Medicare Advantage (MA) contracts terminated their participation in the MA program between 2011 and 2020. Little is known about subsequent insurance choices following a termination. To examine the insurance destinations of MA enrollees and the characteristics of enrollees who switch into traditional Medicare (TM) after a contract termination. This cross-sectional study examined MA program data of MA beneficiaries in the Medicare Master Beneficiary File from 2016 to 2018. Statistical analysis was performed from June 2023 to April 2024. Beneficiary characteristics, including age, sex, race and ethnicity, dual eligibility; hospital, nursing home, and home health utilization; and contract characteristics, including plan type, vertical integration, premium, and MA star rating. The main outcome was switching to TM in the year immediately after termination. We also evaluated the characteristics of contracts among those who remained in MA. A total of 117 681 beneficiaries were included in this analysis (64 654 [54.9%] female; 409 [0.4%] American Indian or Alaska Native; 2817 [2.4%] Asian; 76 725 [16.8%] Black; 11 131 [9.5%] Hispanic; 81 226 [69.0%] White; and 2373 [2.0%] other race or ethnicity; 27 078 [23.0%] dual-eligible; mean [SD] age, 71.2 [10.4] years). Following a contract termination, 20.1% (95% CI, 19.9%-20.4%) of enrollees switched to TM, including 32.7% (95% CI, 32.4%-33.1%) of dual-eligible beneficiaries and 16.4% (95% CI, 16.2%-16.5%) of non-dual-eligible beneficiaries. In nonterminated contracts, the concurrent switch rate was 6.2% (95% CI, 6.2%-6.2%) for all, 10.4% (95% CI, 10.4%-10.4%) for dual-eligible beneficiaries and 5.1% (95% CI, 5.1%-5.1%) for non-dual-eligible enrollees. The highest switch rates to TM were among Black enrollees (32.3% [95% CI, 31.7%-32.8%]) and those with prior use of hospital (31.3% [95% CI, 30.7%-31.9%], nursing home, 41.4% [95% CI, 40.4%-42.4%], or home health care (28.3% [95% CI, 27.4%-29.2%]). Beneficiaries who stayed in MA selected higher-rated star plans (mean posttermination contract star rating of 3.8 [95% CI, 3.8-3.8] stars compared with 3.3 [95% CI, 3.3-3.3] stars in the terminated year), but did not pay more in monthly premiums with 66.5% (95% CI, 66.2%-66.8%) paying the same or lower premiums. In this cross-sectional study, 1 in 5 MA beneficiaries switched to TM after a contract termination, with Black beneficiaries and those with more intensive health needs having the highest switch rates. These findings highlight the need to examine consequences of contract terminations and subsequent insurance destinations on access to care and health outcomes, especially among those with marginalized race and ethnicity, those who are dual-eligible, and beneficiaries with higher health care needs.

Data profile: the Korean Workers' Compensation-National Health Insurance Service (KoWorC-NHIS) cohort.

The Korean Workers' Compensation-National Health Insurance Service (KoWorC-NHIS) cohort was established to investigate the longitudinal health outcomes of Korean workers who have been compensated for occupational injuries or diseases. This cohort study, which utilized data spanning from 2004 to 2015, merged workers' compensation insurance claim data with the National Health Insurance Database (NHID), encompassing 858,793 participants. The data included socio-demographic factors such as age, sex, income, address, insurance type, and disability grade. It also covered the types of occupational accidents, International Classification of Diseases, 10th revision codes for diseases or accidents, work tenure, industry, occupation code, and company size. Additional details such as the occupational hire date, date of claim, date of recognition, and affected body parts were recorded. The cohort predominantly consisted of male workers (80.0%), with the majority experiencing their first occupational accident in their 40s (27.6%) or 50s (25.3%). Notably, 93.1% of the cases were classified as occupational injuries. By integrating this data with that from the NHID, updates on health utilization, employment status, and income changes were made annually. The follow-up period for this study is set to conclude in 2045.

Spatial and Socioeconomic Patterns of Mental Health and Healthcare Utilization in Cologne, Germany.

Children and adolescents are significantly tied to their family's socioeconomic position and living environment. Neighbourhood and the living environment have been identified as potential risk factors for mental disorders in this age group. The aim of the study was to investigate the distribution of mental and behavioural disorders (prevalence) and the provision of mental health services for children and adolescents aged 0-19 years in the city of Cologne. In particular, the study aimed to examine the association of these factors with area deprivation and the availability of mental health services covered by statutory health insurance. Finally, possible spatial variations in these aspects were analysed. Claims data of children and adolescents aged 0 to 19 years included in four statutory health insurance of the year 2021 were analysed. A deprivation index using data on the level of the ZIP code area was calculated. Analyses were carried out descriptively, using ordinary least squares (OLS) and geographically weighted regression (GWR). The prevalence of mental and behavioural disorders in children and adolescents varied across ZIP code areas, with higher rates in the northern, southern, and eastern parts of the city. The results indicated that the use of services by male children and adolescents with a prevalent diagnosis of mental and behavioural disorders was higher in areas with a higher density of healthcare providers. However, prevalence was on the whole lower in areas with a higher density of healthcare providers. In addition, the density of health care providers was higher in the city centre with comparatively lower deprivation. These results indicate inadequate access to care for children and young people outside the city centre. However, due to the heterogeneity of the population in these areas, this study provides only preliminary insights. Data with a finer geographic resolution are needed for further research in order to analyse the association further.

Neurosensory, cognitive and academic outcomes at 8 years in children born 22–23 weeks’ gestation compared with more mature births

Despite providing intensive care to more infants born <24 weeks’ gestation, data on school-age outcomes, critical for counselling and decision-making, are sparse.ObjectiveTo compare major neurosensory, cognitive and academic impairment among...