Long-standing Health Conditions Research Articles

What role do young people believe Universal Basic Income can play in supporting their mental health?

ABSTRACT The proportion of 16- to 24-year-olds in England reporting a longstanding mental health condition increased almost 10-fold between 1995 and 2014. Studies demonstrate an association between income and anxiety and depression, with bi-directional effects. There is also emerging evidence that cash transfers may mitigate, prevent or delay those conditions. This article presents qualitative data exploring the relationship between income and anxiety and depression and the prospective impact of Universal Basic Income (UBI) as a public health measure. Data was gathered from citizen engagement workshops with 28 young people aged 14–22 from Bradford, England. We present four findings: (i) participants believe that the current work and welfare system has a detrimental impact on their mental health; (ii) most participants believe that UBI would have positive impacts on their mental health by virtue of reducing financial strain; (iii) most participants appear to favour a UBI scheme with larger payments than have traditionally been proposed; (iv) participants believe that there are non-financial benefits of UBI, such as reduction in stigma.

Artificial intelligence and rehabilitation: what’s new and promising

The development of artificially intelligent technological machine systems that can integrate large volumes of data, and also ‘learn’ to recognize notable patterns, are currently being widely discussed and employed in various health and other realms. In this regard, what promise do these systems hold for ameliorating the late life chronic disease burden of increasing numbers of adults globally that may stem from one or multiple chronic longstanding health conditions. To explore this issue, a broad exploration of rehabilitation associated artificial intelligence implications was conducted using leading data bases. Results show that there are some active advances in both artificial intelligence and machine learning realms, but not in the context of desirable robust observations in all cases. Much future work is indicated though and is strongly recommended.

Forecasting the economic consequences of COVID-19 on longstanding illnesses in Wales

IntroductionThe unemployment rate following the COVID-19 pandemic in Wales is increasing and there is a positive link between unemployment and longstanding illnesses. This study aimed to project the percentage of adults with longstanding illnesses and chronic health conditions following COVID-19 associated with the economic consequences.MethodsWe retrieved historical data on the unemployment rates and status of longstanding illnesses among adults from the Office for National Statistics (ONS) and National Survey for Wales (NSW), and used time-series models to project the unemployment rates and percentage of adults with longstanding illnesses and chronic health conditions over a three year period (2020/21 - 2022/23).Results Without reparative interventions, the unemployment rate is expected to increase sharply from 3.8% in 2019 to about 7% in 2020 following COVID-19 and then gradually increase over the projected period.With increased unemployment, longstanding illness (LSI) would be expected to increase gradually following COVID-19, with an estimated increase of around or exceeding 4% over three years depending on the LSI measure. There would be a higher increment in the percentage of adults with limiting LSI compared with adults with any LSI, suggesting implications for wider health and social care services.With current unemployment predictions, the percentage of adults with chronic health conditions is projected to increase following the COVID-19 pandemic over the projected period, with a higher increment for mental health and endocrine/metabolic conditions Conclusions The longstanding illnesses and chronic health conditions are expected to increase in the coming years following COVID-19 pandemic. Therefore, preventative measures for longstanding illnesses and chronic health conditions should be a priority for a sustainable recovery from the COVID-19. Key messages Without reparative interventions, the unemployment rate is expected to increase following the COVID-19 pandemic.The projected prevalence of limiting longstanding illness in adults following COVID-19 suggests implications for wider health and social care services.

The trajectory of loneliness in UK young adults during the summer to winter months of COVID-19

Current research has shown that young adults are at the greatest risk of loneliness during the pandemic. Drawing upon the Understanding Society COVID-19 survey, this study investigated the trajectory of loneliness in young adults (aged 18-25) from June to November 2020 and its association with emotional support as well as demographic and health factors. The analytic sample included 419 young adults (296 females; 123 males). Growth curve modelling revealed a U-shape longitudinal trend in self-reported loneliness, with a sharp rise during the winter months under the national lockdown. Young adults with long-standing physical or mental health conditions were more likely to report feeling lonely. Those with a lower household income and who were unemployed or not in school reported higher levels of loneliness. Gender was found to moderate the association between self-reported emotional support and loneliness. While greater emotional support was associated with less loneliness in males, no association was shown for females. The current findings add to our understanding of how the pandemic has affected the mental health of young adults and the differential effect of emotional support as a potential coping strategy for males and females.

The Lived Experience of Learning Mindfulness as Perceived by People Living With Long-Term Conditions: A Community-Based, Longitudinal, Phenomenological Study.

While a considerable research base demonstrates the positive effects of 8-week secular mindfulness courses, it remains unclear to what degree their participants continue to engage with mindfulness practices; and there is a dearth of published reports on longer-term mindfulness interventions. Studies have also tended to focus on clinical “effectiveness,” with less attention given to participants’ own construal and expectations of mindfulness. To address these gaps, the study reported here implemented a year-long mindfulness program for a group of 20 individuals with long-standing health conditions who gradually transitioned to self-guiding. Their experiences, expectations, and understanding of mindfulness were investigated through the lens of descriptive phenomenology. The findings revealed that mindfulness practice did bring therapeutic improvement but that it was a multi-faceted process where an individual’s intentionality toward practice was key, with a clear division between those pursuing an “embodied integrated” mindfulness and those viewing it as a stress management tool.

Assessing Service Quality Dimensions and Their Effect on Patients Satisfaction in Bahrain Primary Healthcare Using a Modified Version of the General Practice Assessment Questionnaire.

ObjectiveThis study aimed to have an instrument for assessing Bahrain healthcare. For such purpose, we used the General Practice Assessment Questionnaire (GPAQ-R2) and a modified shorter version of it, GPAQ-R2-BDF. The GPAQ-R2-BDF was modified based on the healthcare system and the cultural behavior in Bahrain.Subjects and MethodsThis cross-sectional study was conducted at the general practice (GP) of the Bahrain Defense Force (BDF) Hospital from March 2018 to April 2018. Five hundred and twenty patients visiting the clinics completed the original GPAQ-R2 questionnaire. A validity, reliability, and rotated factor analysis were performed on the original and modified questionnaire. Patients’ characteristics such as age, gender, long-standing health conditions, and employment status were recorded. The score responses of the questionnaire were analyzed, and areas of weakness were identified.ResultsThe validity, reliability, and correlation matrix values of the original GPAQ-R2 in the GP access and GP practice components were unsatisfactory in BDF hospital assessment. However, the modified GPAQ-R2-BDF revealed higher overall validity, reliability, and correlation matrix, and the rotated factor analysis showed values between 0.704 and 0.928. Furthermore, the reliability values ranged from 0.77 to 0.936. As for patients’ satisfaction scores were highest (~90%) in confidence and enablement, and doctor care but lowest in GP access, and GP practice (~77%) (P<0.001). On the other hand, patients with long-standing health conditions were less satisfied with doctor care, confidence and enablement, and GP access (p<0.05–0.01).ConclusionThe present findings demonstrated high reliability and validity for the GPAQ-R2-BDF, which supports its use to assess Bahrain’s GP healthcare system. Furthermore, such an instrument should be adapted in a longitudinal research design to assess Bahrain’s healthcare system better. Lastly, BDF hospital healthcare clinics showed concerns in GP access, GP practice, and quality services for patients with long-standing health conditions requiring strategic interventions to reach better quality services.

Patient-reported outcomes in survivors of breast cancer one, three, and five years post-diagnosis: a cancer registry-based feasibility study.

The burden of treatment toxicities in breast cancer requires longitudinal assessment of patient-centered outcomes. The current study aimed to assess the feasibility of collecting general and breast cancer-specific quality of life (QoL), ongoing symptoms and unmet needs, in patients identified from a population-based cancer registry, and to assess the contribution of demographic, disease, and care-related factors. Eligible patients were identified from the Victorian Cancer Registry (Victoria, Australia) using the ICD-10 code C50, diagnosed during 2013, 2011, and 2009. Data included age, area of residence, cancer diagnosis, date of diagnosis, treatment modality, and staging. Patients completed a number of validated tools including the EQ-5D-5L and FACT-B, symptom items, and unmet needs. Of 1006 eligible patients, the overall response rate was 45.6%. Survivors 1year post-diagnosis had significantly greater problems with pain or discomfort (59.2%) and with anxiety or depression (51.3%) compared with survivors 5years post-diagnosis (45.1% with pain or discomfort, p < 0.05, and 32.7% with anxiety or depression, p < 0.01). For the 5years group, pain or discomfort and anxiety or depression were significantly higher than for the general population (32.2% and 21.6%, respectively). Improved quality of life was found in those who did not receive chemotherapy (coefficient = 0.2269, p = 0.0409) and those who did not have a longstanding health condition (coefficient = 0.6342, p < 0.001). Poorer quality of life was associated with those who were not certain what was happening with their breast cancer (coefficient = - 0.3674, p = 0.0094) and those whose cancer had not been treated, had been treated but was still present, or had returned after treatment (coefficient = - 0.5314, p = 0.0136). Across the total cohort, women were bothered by changes in weight (21.3%) and concerned about the effects of stress on their cancer (19.6%). Fear of cancer recurrence was commonly reported and did not diminish over time (60.7%, 52.2%, and 56.9% at 1, 3, and 5years, respectively). Collecting patient-reported outcomes from a population-based sample of breast cancer survivors was feasible. Physical symptoms and psychosocial issues are common and are persistent. Use of chemotherapy was the only treatment modality that significantly impacted on QoL.

Increasing Health Literacy May Reduce Health Inequalities: Evidence from a National Population Survey in Ireland.

Background. Health literacy has been separately associated with socio-economic status and worse health status and outcomes. However, the magnitude of the associations between health literacy and health status and outcomes may not be evenly distributed across society. This study aims to estimate and compare the associations between health status, health behaviours, and healthcare utilisation within different levels of social status in the Irish population. Materials and methods. Data from Ireland collected as part of the 2011 European Health Literacy Survey were analysed. General health literacy was measured on a 0–50 scale, low to high. There were four binary outcomes: long-standing health conditions, smoking, hospital visits in the last 12 months, and self-rated health status. Logistic regression analysis was conducted to estimate the likelihood of each health outcome. Health literacy was treated as the main independent variable. Marginal effects were calculated using the delta method to demonstrate the change in likelihood of each outcome associated with a 5-point increase in health literacy score. The sample was grouped into tertiles based on self-reported social status, and models were replicated and compared for each tertile. Models were adjusted for known correlates of health literacy and health: age, gender, and education. Analysis was conducted using Stata V14. Results. Higher health literacy scores were associated with a lower probability of having a limiting illness within the low social status group only. Higher health literacy scores were associated with a lower probability of three or more hospital visits in the past 12 months in the low and middle social status groups. For people in the low and middle social status groups, higher health literacy levels were associated with a lower probability of being a current smoker. The associations between health literacy and self-rated health status were similar in each social status group. Conclusions: Improvement in population health literacy may reduce the prevalence of long-term chronic health conditions, reduce smoking levels, and result in fewer hospital visits. Whilst improved health literacy should improve behaviours and outcomes in all groups, it should have a more marked impact in lower social status groups, and hence contribute to reducing the observed social disparities in these health outcomes.

Is owning your home good for your health? Evidence from exogenous variations in subsidies in England

Home ownership is an important component of wealth and may affect health through a range of mechanisms. Using macro- and micro-level data from 2000 to 2008, we seek to estimate the causal effect of home ownership on health by exploiting the Right to Buy policy, which encouraged long-term tenants of publicly rented housing to buy their home at a large discount. At the macro-level we find that a 10 percentage-point increase in home ownership rates is associated with a 2 percentage-point reduction in the number of people reporting having a longstanding health condition. At the individual level we find that home ownership increases the General Health Questionnaire score by 1.46 points on a 37-point scale and self-assessed health by 0.19 points on a 5-point scale and reduces the number of health conditions reported by 0.65. Further analyses show that home ownership affects health via labour markets, with new job opportunities, extra time saved travelling and resources available for healthy leisure activities. These results suggest that housing policies, such as affordable housing, can be an example of non-health policies that improve health.

Experiences of maternity care in New South Wales among women with mental health conditions

BackgroundHigh quality maternity care is increasingly understood to represent a continuum of care. As well as ensuring a positive experience for mothers and families, integrated maternity care is responsive to mental health needs of mothers. The aim of this paper is to summarize differences in women’s experiences of maternity care between women with and without a self-reported mental health condition.MethodsSecondary analyses of a randomized, stratified sample patient experience survey of 4787 women who gave birth in a New South Wales public hospital in 2017. We focused on 64 measures of experiences of antenatal care, hospital care during and following birth and follow up at home. Experiences covered eight dimensions: overall impressions, emotional support, respect for preferences, information, involvement, physical comfort and continuity. Multivariable logistic regression was used to compare experiences of women with and without a self-reported longstanding mental health condition.ResultsCompared to women without a condition, women with a longstanding mental health condition (n = 353) reported significantly less positive experiences by eight percentage points on average, with significant differences on 41 out of 64 measures after adjusting for age, education, language, parity, type of birth and region. Disparities were pronounced for key measures of emotional support (discussion of worries and fears, trust in providers), physical comfort (assistance, pain management) and overall impressions of care. Most women with mental health conditions (75% or more) reported positive experiences for measures related to guidelines for maternity care for women with mental illness (discussion of emotional health, healthy behaviours, weight gain). Their experiences were not significantly different from those of women with no reported conditions.ConclusionsWomen with a mental health condition had significantly less positive experiences of maternity care across all stages of care compared to women with no condition. However, for some measures, including those related to guidelines for maternity care for women with mental illness, there were highly positive ratings and no significant differences between groups. This suggests disparities in experiences of care for women with mental health conditions are not inevitable. More can be done to improve experiences of maternity care for women with mental health conditions.

Examining the Ethical Implications of Health Care Technology Described in US and Swedish PhD Dissertations: Protocol for a Scoping Review.

BackgroundThe development of new biomedical technologies is accelerating at an unprecedented speed. These new technologies will undoubtedly bring solutions to long-standing problems and health conditions. However, they will likely also have unintended effects or ethical implications accompanying them. It may be presumed that the research behind new technologies has been evaluated from an ethical perspective; however, the evidence that this has been done is scant.ObjectiveThis study aims to understand whether and in what manner PhD dissertations focused on health technologies describe actual or possible ethical issues resulting from their research.MethodsThe purpose of scoping reviews is to map a topic in the literature comprehensively and systematically to identify gaps in the literature or identify key evidence. The search strategy for this protocol will include electronic databases (eg, ProQuest, PubMed, Diva, SwePub, and LIBRIS). Searches will be limited to PhD dissertations published in the United States and Sweden in the last 10 years. The study will be mapped in 5 stages: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) retrieving and charting the data, and (5) collating, summarizing, and reporting the results.ResultsThe findings of this study will indicate if and how researchers, PhD students, and their supervisors are considering ethics in their studies, including both research ethics and the ethical implications of their work. The findings can guide researchers in determining gaps and shortcomings in current doctoral education and offer a foundation to adjusting doctoral research education.ConclusionsIn a society where technology and research are advancing at speeds unknown to us before, we need to find new and more efficient ways to consider ethical issues and address them in a timely manner. This study will offer an understanding of how ethics is currently being integrated into US and Swedish PhD dissertations and inform the future direction of ethics education at a doctoral level.International Registered Report Identifier (IRRID)PRR1-10.2196/14157

Reconsidering the relationship between fast-food outlets, area-level deprivation, diet quality and body mass index: an exploratory structural equation modelling approach

BackgroundInternationally, the prevalence of adults with obesity is a major public health concern. Few studies investigate the explanatory pathways between fast-food outlets and body mass index (BMI). We use structural...

Investigating the relationship between multimorbidity and dental attendance: a cross-sectional study of UK adults.

Regular dental attendance is related to better oral health. However, long-standing health conditions (LSHCs) may be related to dental attendance and this relationship may vary by socioeconomic status. Data were collected from wave two (2013–2015) of the Yorkshire Health Study (n= 7,654). Data included dental attendance, LSHC, age, gender, education-level, smoking, body mass index, and area-level deprivation. Logistic regression (attend or not) was used to analyse associations with LSHC and multimorbidity. Overall, 63.1% (n = 4,826) of individuals attended the dentist. Of these, 37.8% (n =2894) had no LSHC, 26.0% (n = 1987) had one LSHC and 36.4% (n = 2784) had two or more LSHC. The presence of a singular LSHC was not associated with dental attendance(OR = 0.91 [0.81, 1.04]), however, those with two or more LSHCs were more likely to attend the dentist (OR = 0.81 [95% CI 0.72, 0.92]). Interactions between individual-level education, as a marker of socioeconomic status, and LSHC revealed few associations with dental attendance. Multimorbidity was associated with dental attendance such that those with multimorbidity were more likely to attend. These important findings highlight the increasing challenge of multimorbidity for global healthcare systems.

Mental health and well-being trends among children and young people in the UK, 1995-2014: analysis of repeated cross-sectional national health surveys.

There is a growing concern about the mental health of children and young people (CYP) in the UK, with increasing demand for counselling services, admissions for self-harm and referrals to mental health services. We investigated whether there have been similar recent trends in selected mental health outcomes among CYP in national health surveys from England, Scotland and Wales. Data were analysed from 140 830 participants (4-24 years, stratified into 4-12, 13-15, 16-24 years) in 36 national surveys in England, Scotland and Wales, 1995-2014. Regression models were used to examine time trends in seven parent/self-reported variables: general health, any long-standing health condition, long-standing mental health condition; Warwick-Edinburgh Mental Wellbeing Score (WEMWBS), above-threshold Strengths and Difficulties Questionnaire Total (SDQT) score, SDQ Emotion (SDQE) score, General Health Questionnaire (GHQ) score. Across all participants aged 4-24, long-standing mental health conditions increased in England (0.8-4.8% over 19 years), Scotland (2.3-6.0%, 11 years) and Wales (2.6-4.1%, 7 years) (all p &lt; 0.001). Among young children (4-12 years), the proportion reporting high SDQT and SDQE scores decreased significantly among both boys and girls in England [SDQE: odds ratio (OR) 0.97 (0.96-0.98), p &lt; 0.001] and girls in Scotland [SDQE: OR 0.96 (0.93-0.99), p = 0.005]. The proportion with high SDQE scores (13-15 years) decreased in England [OR 0.98 (0.96-0.99), p = 0.006] but increased in Wales [OR 1.07 (1.03-1.10), p &lt; 0.001]. The proportion with high GHQ scores decreased among English women (16-24 years) [OR 0.98 (0.98-0.99), p = 0.002]. Despite a striking increase in the reported prevalence of long-standing mental health conditions among UK CYP, there was relatively little change in questionnaire scores reflecting psychological distress and emotional well-being.

Examining the health-related quality of life using EQ-5D-5L in patients with four kinds of chronic diseases from specialist outpatient clinics in Hong Kong SAR, China.

BackgroundHealth-related quality of life (HRQoL) measures have been increasingly employed in the evaluation of health utility. The aim of this study was to evaluate the impact of four different kinds of chronic diseases on the HRQoL of patients from specialist outpatient clinics in Hong Kong (HK) using the 5-level EQ-5D (EQ-5D-5L) value set.Patients and methodsPatients who attended one of the 26 Hospital Authority’s specialist outpatient clinics and met inclusion criteria were potentially sampled. The value of EQ-5D-5L (HK version) that asks the respondent to describe and rate his or her health status was used as the dependent variable. Four kinds of long-term health conditions and other demographic, socioeconomic, and health service use characteristics have been analyzed as independent variables. Chi-square test, robust one-way ANOVA, and the two-part model have been used to analyze the data.ResultsA total of 7,496 (53.7%) patients reported to have at least one kind of chronic diseases. The mean score for hypertension (mean =0.882, standard error [SE] =0.207) is higher than the others, which followed by cancer, diabetes, and heart disease. Patients who were male, young, higher education attainment, and with chronic conditions got a higher EQ-5D score. In the two-part model, all the four long-standing health conditions were statistically significant in logistic model, but the magnitude of coefficients changed significantly in ordinary least squares model.ConclusionChronic diseases have a significant negative impact on patients’ HRQoL, but there might be a varying effect depending on what kind of chronic diseases patients had. Further research is also needed to plan appropriate strategies to improve patient-centered care.

Patient-reported outcomes in cancer survivors: a population-wide cross-sectional study.

There is a lack of robust population-based data regarding the lived experience of cancer survivors. This study assessed the quality of life (QoL) of survivors of breast, colorectal, or prostate cancer, non-Hodgkin lymphoma or melanoma 1, 3 and 5years post-diagnosis. Associations between various demographic and disease-related factors and QoL were assessed. A cross-sectional postal survey was undertaken. Eligible participants were identified from a population-based cancer registry. Patient-reported outcomes including QoL, symptom issues and information needs were collected using validated questionnaires. Difficulties with all QoL domains were more prevalent amongst cancer survivors compared with the general population, particularly difficulties with usual activities (28 vs 15%) and anxiety or depression (35 vs 22%). Symptoms such as trouble sleeping, always feeling tired, trouble concentrating and fear of cancer recurrence persisted up to 5years post-diagnosis. Factors associated with reduced QoL included having another long-standing health condition, cancer not responding fully to treatment, not having or not being certain of having a written care plan and being female. Cancer survivors experience inferior QoL and cancer-related symptoms for years following diagnosis. These results support further investigation into factors that contribute to poorer survivor outcomes and enhanced identification and intervention strategies for those requiring additional support.

Environmental Injustice: Neighbourhood Traffic Hits Sicker Harder

BACKGROUND: Community severance is the of traffic and transport infrastructure on the mobility of individuals, particularly pedestrians. Whilst awareness of the possible negative health consequences of community severance is increasing, valid and reliable measurements are lacking. As part of a cross-disciplinary project to measure community severance, this study investigated associations between characteristics of individuals and reporting an inhibitory effect of traffic volume and speed on ability to walk locally. METHODS: Two case study areas in London, United Kingdom, each bisected by a 6-lane carriageway, were selected by the project team as places likely to exemplify community severance. A questionnaire was administered to residents of the two inner London neighbourhoods: Woodberry Down (N=101and Finchley Road (N=209). Participants provided demographic, socioeconomic and health information; rated volume and speed of traffic on local roads; and indicated the extent to which traffic conditions affected their ability to walk locally. Associations were measured using logistic regression. RESULTS: In both case study areas almost 80% of participants identified the 6-lane carriageway as the busiest road. A majority of participants rated the speed of traffic on the busiest road as fairly/ very fast (52%) and its volume as fairly/ very heavy (74%). Only 14% of the whole study sample reported their ability to walk locally was often/ always affected by the speed of local traffic and the same proportion reported it was often/ always affected by the local traffic volume. However, the ability of those with an activity-limiting longstanding condition to walk locally was around eight times more likely to be often/ always affected by traffic speed (OR=8.1; 95% CI=4.0–16.4) and volume (OR=7.9; 95% CI=3.9–16.2) than those without such a condition. CONCLUSIONS: Participant ratings of local traffic corroborate the research team's selection of the case study areas as places with potential for traffic to constitute a barrier to personal mobility. However, the survey findings suggest that whilst local traffic conditions may be perceived as poor by a majority – as indicated by proportions rating traffic fast and heavy on the busiest road – they tend to inhibit local walking for a particular minority, those with a longstanding health condition whose mobility is already impaired. Longitudinal research is necessary to determine whether, in a vicious cycle, the health conditions of those who report traffic volume and speed inhibit walking are exacerbated by these barriers.

Socioeconomic deprivation and accident and emergency attendances: cross-sectional analysis of general practices in England.

Demand for England's accident and emergency (A&E) services is increasing and is particularly concentrated in areas of high deprivation. The extent to which primary care services, relative to population characteristics, can impact on A&E is not fully understood. To conduct a detailed analysis to identify population and primary care characteristics associated with A&E attendance rates, particularly those that may be amenable to change by primary care services. This study used a cross-sectional population-based design. The setting was general practices in England, in the year 2011-2012. Multivariate linear regression analysis was used to create a model to explain the variability in practice A&E attendance rates. Predictor variables included population demographics, practice characteristics, and measures of patient experiences of primary care. The strongest predictor of general practice A&E attendance rates was social deprivation: the Index of Multiple Deprivation (IMD-2010) (β = 0.3. B = 1.4 [95% CI =1.3 to 1.6]), followed by population morbidity (GPPS responders reporting a long-standing health condition) (β = 0.2, B = 231.5 [95% CI = 202.1 to 260.8]), and knowledge of how to contact an out-of-hours GP (GPPS question 36) (β = -0.2, B = -128.7 [95% CI =149.3 to -108.2]). Other significant predictors included the practice list size (β = -0.1, B = -0.002 [95% CI = -0.003 to -0.002]) and the proportion of patients aged 0-4 years (β = 0.1, B = 547.3 [95% CI = 418.6 to 676.0]). The final model explained 34.4% of the variation in A&E attendance rates, mostly due to factors that could not be modified by primary care services. Demographic characteristics were the strongest predictors of A&E attendance rates. Primary care variables that may be amenable to change only made a small contribution to higher A&E attendance rates.

Chronic and vaccine-preventable diseases in children and adolescents in Germany: results of the KiGGS study: first follow up (KiGGS wave 1)

The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) 2003-2006 is the first nationwide comprehensive study on the health of children and adolescents living in Germany. The KiGGS first interview follow-up is a telephone interview study that collected, among other things, data on a number of chronic and vaccine-preventable diseases in 2009-2012 and is a combined cross-sectional and longitudinal study based on a population registry sample from the 167 KiGGS study points. The analysis is based on 12,368 respondents (7913 KiGGS follow-up participants aged 7-17 years, response 72 % and 4455 newly recruited 0- to 6-year-olds, response 42 %). Based on parent reports the lifetime prevalence of both chickenpox and pertussis has decreased in the population targeted by recently changed vaccination recommendations. For measles the prevalence remained unsatisfactorily high in each investigated age group. Of the children and adolescents aged 0-17 years 16 % (95 % confidence interval CI 15.2-17.0 %) had a long-standing chronic health condition according to the parents. Of these, however, only one in five was affected in their routine daily activities. The lifetime prevalence in 7- to 17-year-olds was 1.2 % (0.9-1.6) for epilepsy (0.4 % for the past 12 months), 5.0 % (4.4-5.7) for migraine, 0.2 % (0.1-0.3) for diabetes and in 0 to 6-year-olds 2.0 % (1.5-2.6) for heart conditions and 3.1 % (2.5-3.8) for febrile seizures with a -prevalence in 0 to 2-year-olds which are most affected of 1.0 % (0.6-1.6) in the past 12 months. The vast majority of children and adolescents in Germany are in good or very good health as suggested by other results reported in this issue; however, chronic conditions are not rare and need continuous monitoring. These results confirm that implementation of the vaccination recommendations of the German Standing Committee on Vaccination (STIKO) can lead to effective prevention of infectious diseases in Germany.

Examining the impact of 11 long-standing health conditions on health-related quality of life using the EQ-5D in a general population sample

Objectives Health-related quality of life (HRQoL) measures have been increasingly used in economic evaluations for policy guidance. We investigate the impact of 11 self-reported long-standing health conditions on HRQoL using the EQ-5D in a UK sample.MethodsWe used data from 13,955 patients in the South Yorkshire Cohort study collected between 2010 and 2012 containing the EQ-5D, a preference-based measure. Ordinary least squares (OLS), Tobit and two-part regression analyses were undertaken to estimate the impact of 11 long-standing health conditions on HRQoL at the individual level.ResultsThe results varied significantly with the regression models employed. In the OLS and Tobit models, pain had the largest negative impact on HRQoL, followed by depression, osteoarthritis and anxiety/nerves, after controlling for all other conditions and sociodemographic characteristics. The magnitude of coefficients was higher in the Tobit model than in the OLS model. In the two-part model, these four long-standing health conditions were statistically significant, but the magnitude of coefficients decreased significantly compared to that in the OLS and Tobit models and was ranked from pain followed by depression, anxiety/nerves and osteoarthritis.ConclusionsPain, depression, osteoarthritis and anxiety/nerves are associated with the greatest losses of HRQoL in the UK population. The estimates presented in this article should be used to inform economic evaluations when assessing health care interventions, though improvements can be made in terms of diagnostic information and obtaining longitudinal data.