Sleep Disorders K. Pavlova, Milena; Latreille, Véronique
The American journal of medicine,
March 2019, 2019-03-00, 20190301, Letnik:
132, Številka:
3
Journal Article
Recenzirano
Sleep disorders are frequent and can have serious consequences on patients’ health and quality of life. While some sleep disorders are more challenging to treat, most can be easily managed with ...adequate interventions. We review the main diagnostic features of 6 major sleep disorders (insomnia, circadian rhythm disorders, sleep-disordered breathing, hypersomnia/narcolepsy, parasomnias, and restless legs syndrome/periodic limb movement disorder) to aid medical practitioners in screening and treating sleep disorders as part of clinical practice.
Abstract
Background
Accreditation is viewed as a reputable tool to evaluate and enhance the quality of health care. However, its effect on performance and outcomes remains unclear. This review aimed ...to identify and analyze the evidence on the impact of hospital accreditation.
Methods
We systematically searched electronic databases (PubMed, CINAHL, PsycINFO, EMBASE, MEDLINE (OvidSP), CDSR, CENTRAL, ScienceDirect, SSCI, RSCI, SciELO, and KCI) and other sources using relevant subject headings. We included peer-reviewed quantitative studies published over the last two decades, irrespective of its design or language. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two reviewers independently screened initially identified articles, reviewed the full-text of potentially relevant studies, extracted necessary data, and assessed the methodological quality of the included studies using a validated tool. The accreditation effects were synthesized and categorized thematically into six impact themes.
Results
We screened a total of 17,830 studies, of which 76 empirical studies that examined the impact of accreditation met our inclusion criteria. These studies were methodologically heterogeneous. Apart from the effect of accreditation on healthcare workers and particularly on job stress, our results indicate a consistent positive effect of hospital accreditation on safety culture, process-related performance measures, efficiency, and the patient length of stay, whereas employee satisfaction, patient satisfaction and experience, and 30-day hospital readmission rate were found to be unrelated to accreditation. Paradoxical results regarding the impact of accreditation on mortality rate and healthcare-associated infections hampered drawing firm conclusions on these outcome measures.
Conclusion
There is reasonable evidence to support the notion that compliance with accreditation standards has multiple plausible benefits in improving the performance in the hospital setting. Despite inconclusive evidence on causality, introducing hospital accreditation schemes stimulates performance improvement and patient safety. Efforts to incentivize and modernize accreditation are recommended to move towards institutionalization and sustaining the performance gains.
PROSPERO
registration number CRD42020167863.
It is well-known that the prevalence of chronic diseases is high among older people, especially those who are poor. Moreover, chronic diseases can result in catastrophic health expenditure. The ...relationship between chronic diseases and their financial burden on households is thus double-sided, as financial difficulties can give rise to, and result from, chronic diseases. Our aim was to examine the levels of catastrophic health expenditure imposed by private out-of-pocket payments among older people diagnosed with diabetes mellitus, cardiovascular diseases and cancer in 15 European countries.
The SHARE dataset for individuals aged 50+ and their households, collected in 2010-2012 was used. The total number of participants included in this study was N = 51,661. The sample consisted of 43.8% male and 56.2% female participants. The average age was 67 years. We applied an instrumental variable approach for binary instrumented variables known as a treatment-effect model.
We found that being diagnosed with diabetes mellitus and cardiovascular diseases was associated with catastrophic health expenditure among older people even in comparatively wealthy countries with developed risk-pooling mechanisms. When compared to the Netherlands (the country with the lowest share of out-of-pocket payments as a percentage of total health expenditure in our study), older people diagnosed with diabetes mellitus in Portugal, Poland, Denmark, Italy, Switzerland, Belgium, the Czech Republic and Hungary were more likely to experience catastrophic health expenditure. Similar results were observed for diagnosed cardiovascular diseases. In contrast, cancer was not associated with catastrophic health expenditure.
Our study shows that older people with diagnosed chronic diseases face catastrophic health expenditure even in some of the wealthiest countries in Europe. The effect differs across chronic diseases and countries. This may be due to different socio-economic contexts, but also due to the specific characteristics of the different health systems. In view of the ageing of European populations, it will be crucial to strengthen the mechanisms for financial protection for older people with chronic diseases.
Public health expenditure is one of the fastest-growing spending items in EU member states. As the population ages and wealth increases, governments allocate more resources to their health systems. ...In view of this, the aim of this study is to identify the key determinants of public health expenditure in the EU member states.
This study is based on macro-level EU panel data covering the period from 2000 to 2018. The association between explanatory variables and public health expenditure is analyzed by applying both static and dynamic econometric modeling.
Although GDP and out-of-pocket health expenditure are identified as the key drivers of public health expenditure, there are other variables, such as health system characteristics, with a statistically significant association with expenditure. Other variables, such as election year and the level of public debt, result to exert only a modest influence on the level of public health expenditure. Results also indicate that the aging of the population, political ideologies of governments and citizens' expectations, appear to be statistically insignificant.
Since increases in public health expenditure in EU member states are mainly triggered by GDP increases, it is expected that differences in PHE per capita across member states will persist and, consequently, making it more difficult to attain the health equity sustainable development goal. Thus, measures to reduce EU economic inequalities, will ultimately result in reducing disparities in public health expenditures across member states.
Undocumented migrants face particular challenges in accessing healthcare services in many European countries. The aim of this study was to systematically review the academic literature on the ...utilization of healthcare services by undocumented migrants in Europe.
The databases Embase, Medline, Global Health and Cinahl Plus were searched systematically to identify quantitative, qualitative and mixed methods studies published in 2007-2017.
A total of 908 articles were retrieved. Deletion of duplicates left 531. After screening titles, abstracts and full texts according to pre-defined inclusion and exclusion criteria, 29 articles were included in the review. Overall, quantitative studies showed an underutilization of different types of healthcare services by undocumented migrants. Qualitative studies reported that, even when care was received, it was often inadequate or insufficient, and that many undocumented migrants were unfamiliar with their entitlements and faced barriers in utilizing healthcare services.
Although it is difficult to generalize findings from the included studies due to methodological differences, they provide further evidence that undocumented migrants in Europe face particular problems in utilizing healthcare services.
Inequalities in diabetes are widespread and are exacerbated by differences in lifestyle. Many studies that have estimated inequalities in diabetes make use of self-reported diabetes which is often ...biased by differences in access to health care and diabetes awareness. This study adds to this literature by making use of a more objective standardised measure of diabetes in South Africa. The study estimates socio-economic inequalities in undiagnosed diabetes, diagnosed diabetes (self-reported), as well as total diabetes (undiagnosed diabetics + diagnosed diabetics). The study also examines the contribution of lifestyle factors to diabetes inequalities in South Africa.
This cross sectional study uses data from the 2012 South African National Health and Nutrition Examination Survey (SANHANES-1) and applies the Erreygers Concentration Indices to assess socio-economic inequalities in diabetes. Contributions of lifestyle factors to inequalities in diabetes are assessed using a decomposition method.
Self-reported diabetes and total diabetes (undiagnosed diabetics + diagnosed diabetics) were significantly concentrated amongst the rich (CI = 0.0746; p < 0.05 and CI = 0.0859; p < 0.05). The concentration index for undiagnosed diabetes was insignificant but pro-poor. The decomposition showed that lifestyle factors contributed 22% and 35% to socioeconomic inequalities in self-reported and total diabetes, respectively.
Diabetes in South Africa is more concentrated amongst higher socio-economic groups when measured using self-reported diabetes or clinical data. Our findings also show that the extent of inequality is worse in the total diabetes outcome (undiagnosed diabetics + diagnosed diabetics) when compared to the self-reported diabetes outcome. Although in comparison to other determinants, the contribution of lifestyle factors was modest, these contributions are important in the development of policies that address socio-economic inequalities in the prevalence of diabetes.
Background
Obesity is a complex health disorder that significantly increases the risk of several chronic diseases, and it has been associated with a 5–20-year decrease in life expectancy. The ...prevalence of obesity is increasing steadily worldwide and Italy follows this trend with an increase of almost 30% in the adult obese population in the last 3 decades. Previous studies estimated that 2–4% of the total health expenditure in Europe is attributed to obesity and it is projected to double by 2050. Currently, there is a lack of sufficient knowledge on the burden of obesity in Italy and most relevant estimates are derived from international studies. The aim of this study is to estimate the direct and indirect costs of obesity in Italy, taking 2020 as the reference year.
Methods
Based on data collected from the literature, a quantitative cost-of-illness (COI) study was performed from a societal perspective focussing on the adult obese population (Body Mass Index (BMI) ≥ 30 kg/m
2
) in Italy.
Results
The study indicated that the total costs attributable to obesity in Italy amounted to €13.34 billion in 2020 (95% credible interval: €8.99 billion < µ < €17.80 billion). Direct costs were €7.89 billion, with cardiovascular diseases (CVDs) having the highest impact on costs (€6.66 billion), followed by diabetes (€0.65 billion), cancer (€0.33 billion), and bariatric surgery (€0.24 billion). Indirect costs amounted to €5.45 billion, with almost equal contribution of absenteeism (€2.62 billion) and presenteeism (€2.83 billion).
Conclusions
Obesity is associated with high direct and indirect costs, and cost-effective prevention programmes are deemed fundamental to contain this public health threat in Italy.
To sustain a viable public pension system, many governments have increased the statutory retirement age and delayed the age of entitlement to public pension benefits. This systematic literature ...review investigates the empirical evidence on the effects of increasing the retirement age on the health, well-being, and labor force participation of older workers. Optimized and broad search queries were used to search for empirical evidence in four databases: EconLit, PsycINFO, PubMed, and SocINDEX. The systematic literature search was conducted in May 2019. Snowballing was performed on the reference lists of the publications to find additional studies. The quality of the included studies was also examined. The PRISMA guidelines were used to guide this systematic literature review. Nineteen studies were included in this review. Twelve studies estimated the effect of an increase in the statutory retirement age, and seven studies examined working beyond the retirement age. The reported findings were classified into health-related outcomes, well-being, and the effects on labor force participation and the perception of the retirement age. The reported findings regarding health-related outcomes and well-being were not comparable. The increase of the retirement age has increased labor force participation among older workers and has increased the preferred and expected retirement age in the direction of the public pension reform. However, evidence on the effects of an increase of the retirement age on the health and well-being of older workers remains scarce and inconclusive.
First seizures are often perceived as devastating events by patients and their families due to the fear of having a life-long disease. One in 10 people experiences one or more seizures during their ...lifetime, while 1 in 26 people develops epilepsy. Acute symptomatic seizures are often related to a provoking factor or an acute brain insult and typically do not recur. Careful history and clinical examination should guide clinicians' management plans. Electroencephalography and brain imaging, preferably with epilepsy-specific magnetic resonance imaging, may help characterize both etiology and risk of seizure recurrence. Antiepileptic drugs should be initiated in patients with newly diagnosed epilepsy. In patients without an epilepsy diagnosis, the decision to prescribe drugs depends on individual risk factors for seizure recurrence and possible complications from seizures, which should be discussed with the patient. Counseling about driving and lifestyle modifications should be provided early, often at the first seizure encounter.
Pulmonary rehabilitation (PR) is not very often used by physicians in Lebanon despite evidence on its positive effects on health-related quality of life. This study assesses the knowledge, attitudes ...and practices of PR among physicians in Lebanon. In addition, the study identifies the main barriers to access to PR according to chest physicians. Insight into these issues will help to increase awareness about the need for PR programs and can contribute to designing such programs in the country. A survey was conducted during the regional conference of the Lebanese Pulmonary Society. One week after the initial survey, the survey questionnaire was sent by email to all chest physicians who were registered with the Lebanese Pulmonary Society but did not attend the conference. A 25-item questionnaire was used to collect information on PR. Responses were analyzed using descriptive statistics. The response rate was 40%. Results show that only one-third of Lebanese chest physicians have good knowledge about the nature and multidisciplinary content of PR. Physicians generally support the current "Pulmonary Rehabilitation Program" in Beirut. Key barriers found are the lack of referral, lack of motivation by patients due to their health, cost of care and lack of qualified health care specialists in Lebanon. Absence of awareness and education about PR among healthcare providers plays an important role in increasing access to the "Pulmonary Rehabilitation Program". Awareness campaigns and education for physicians, health care professionals and patients should be considered to increase PR in the country.
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