Quentin W, Riedel‐Heller SG, Luppa M, Rudolph A, König H‐H. Cost‐of‐illness studies of dementia: a systematic review focusing on stage dependency of costs.
Objective: To review cost‐of‐illness (COI) ...studies of dementia from Europe and North America which report costs per patient by disease stage.
Method: A systematic literature search was performed in electronic databases. Studies were classified according to important determinants of costs. Results were converted into year 2006 USD‐PPP, and summarized as costs for formal and informal care in mild, moderate and severe dementia.
Results: 28 studies were evaluated. They used a wide range of methods. Costs more than doubled from mild to severe dementia. Patterns and size of estimated costs depended primarily on study objectives (estimation of total costs–net costs), living arrangements of patients (community‐dwelling–institutionalized) and inclusion of informal care.
Conclusion: This review is the first to have focused on costs in different stages of dementia. The stage is an important determinant of costs. However, characteristics of individual studies need to be considered, when making use of their results.
To empirically validate the expanded concept of mild cognitive impairment (MCI), which differentiates between four clinical subtypes-amnestic MCI-single domain, amnestic MCI-multiple domains, ...nonamnestic MCI-single domain, and nonamnestic MCI-multiple domains-and to examine the prevalence, course, and outcome of these four clinical MCI subtypes.
We studied a community sample of 980 dementia-free individuals aged 75 years or older who participated in the Leipzig Longitudinal Study of the Aged (LEILA 75+). All participants were examined by neuropsychological testing based on 6 years of observation. The diagnoses of the four clinical MCI subtypes were made according to the original and to slightly modified criteria by Petersen et al. (2001) (both with a cutoff of 1.0 SD and with a cutoff of 1.5 SD). The complete range of outcome types (dementia, death, improvement, stable diagnosis, unstable diagnosis) was described for all subtypes. The relative predictive power of stable MCI for dementia onset was determined.
MCI-single domain is more frequent than MCI-multiple domains, and the nonamnestic MCI type is as frequent as the amnestic MCI type. The "MCI modified, 1.0 SD" criteria have the highest relative predictive power for the development of dementia (sensitivity = 74%, specificity = 73%). Alzheimer disease (AD) was the most common type of dementia at follow-up in all but one MCI subtype. Participants with nonamnestic MCI-multiple domains were more likely to progress to a non-AD dementia.
It has been assumed that each MCI subtype is associated with an increased risk for a particular type of dementia. We can only partially agree with this.
Up to this date, prevalence rates of obesity are still rising. Aside from co-morbid diseases, perceived discrimination and stigmatization leads to worsen outcomes in obese individuals. Higher ...stigmatizing attitudes towards obese individuals may also result in less support of preventive and interventive measures. In light of the immense burden of obesity on health care systems and also on the individuals' quality of life, accepted and subsidized preventive measures are needed. Policy support might be determined by views of the lay public on causes of obesity and resulting weight stigma. This study seeks to answer how representative samples of the lay public perceive people with obesity or overweight status (stigmatizing attitudes); what these samples attribute obesity to (causal attribution) and what types of interventions are supported by the lay public and which factors determine that support (prevention support).
A systematic literature search was conducted. All studies of representative samples reporting results on (a) stigmatizing attitudes towards overweight and obese individuals, (b) causal beliefs and (c) prevention support were included.
Only 7 articles were found. One study reported prevalence rates of stigmatizing attitudes. About a quarter of the population in Germany displayed definite stigmatizing attitudes. Other studies reported causal attributions. While external influences on weight are considered as well, it seems that internal factors are rated to be of higher importance. Across the studies found, regulative prevention is supported by about half of the population, while childhood prevention has highest approval rates. Results on sociodemographic determinants differ substantially.
Further research on public attitudes toward and perception of overweight and obesity is urgently needed to depict the prevailing degree of stigmatization. Introducing a multidimensional concept of the etiology of obesity to the lay public might be a starting point in stigma reduction.
Background:In clinical and research settings, the Mini-Mental State Examination (MMSE) is commonly used to measure cognitive change over time. The interpretation of changes in MMSE is often ...difficult. They do not necessarily result from true clinical change. Their interpretation requires comparison with normative data for change. However, MMSE change norms are lacking for long intervals.Objective:To examine what is a reliable change in MMSE for long follow-up periods commonly used in clinic. To provide normative data for change.Methods:A sample of 119 cognitively normal individuals, aged 75 years and over, who participated in the Leipzig Longitudinal Study of the Aged (LEILA 75+). All participants were tested six times at 1.5 year intervals with the MMSE over a mean period of 7.1 years. Reliable change indices were computed for a common confidence interval (90%).Results:In repeated assessments with 1.5 year intervals, a change in MMSE of at least 2–4 points indicated a reliable change at the 90% confidence level.Conclusion:Small changes in MMSE can be interpreted only with great uncertainty. They have a reasonable probability of being caused by measurement error, regression to the mean or practice.
SUMMARY An accurate magnitude estimation is necessary to properly evaluate seismic hazard, especially in low to moderate seismicity areas such as Metropolitan France. However, magnitudes of small ...earthquakes are subject to large uncertainties caused by major high-frequency propagation effects which are generally not properly considered. To address this issue, we developed a method to separate source, attenuation and site parameters from the elastic radiative transfer modelling of the full energy envelopes of seismograms. The key feature of our approach is the treatment of attenuation—both scattering and absorption—in a simple but realistic velocity model of the Earth’s lithosphere, including a velocity discontinuity at the Moho. To reach this goal, we developed a 2-step inversion procedure, allowing first to extract attenuation parameters for each source-station path from the whole observed energy envelope using the Levenberg–Marquardt and grid-search algorithms, then to determine site amplification and the source displacement spectrum from which the moment magnitude Mw is extracted. In the first step, we use the forward modelling procedure of Heller et al. in order to simulate energy envelopes by taking into account the full treatment of wave polarization, the focal mechanism of the source and the scattering anisotropy. The inversion procedure is then applied to the 2019 ML 5.2 Le Teil and 2014 ML 4.5 Lourdes earthquakes which both occurred in southern France. Data from 6 stations are selected for each event. The inversion results confirm a significant variability in the attenuation parameters (scattering and absorption) at regional scale and a strong frequency dependence. Scattering appears to be stronger towards the French Alps and Western Pyrenees. Absorption is stronger as frequency increases. Although not very resolvable, the mechanism of scattering appears to be forward or very forward. By inverting the source spectrum, we determine moment magnitudes Mw of 5.02 ± 0.17 for the Le Teil earthquake and 4.17 ± 0.15 for the Lourdes earthquake.
To perform a systematic review and quantitative synthesis of studies on recent trends in dementia incidence in high-income countries (HIC), considering study quality.
PubMed and Web of Science were ...searched for eligible studies, that is, population-based/community-based prospective cohort studies investigating dementia incidence with similar methods over time, published after 1990. Study selection, data extraction, and quality assessment were performed independently by two investigators. Random-effect meta-analysis and meta-regression were used to estimate incidence change (IC) and to explore associations with study attributes. PRISMA standards were followed.
The systematic review included seven studies (42,485 individuals), and the meta-analysis included five studies of sufficient quality. Relating dementia incidence of later cohorts to earlier cohorts (reference) yielded a nonsignificant decrease across HIC (IC =0.82; 95% CI 0.51-1.33), with high heterogeneity (
=94.9%,
<0.001) and without publication bias (Egger's
=-1.77;
=0.18). Excluding the Japanese Hisayama study, the only study suggesting an increase, indicated borderline evidence for a decrease across Western HIC (IC =0.69; 95% CI 0.47-1.00;
=88.1%,
<0.001; Egger's
=-0.34,
=0.77), again with high heterogeneity. Meta-regression did not reveal an association of incidence rate with calendar year or study attributes; however, analyses were low powered.
There is evidence of favorable trends in dementia incidence in Western HIC (stabilizing/decreasing). Reverse trends may occur in HIC of other regions, as exemplified by Japan. However, study number was small and heterogeneity was high. Further cohort studies using consistent methods are needed to draw definite conclusions. Our work may inform such future studies.
We have modeled the high‐frequency seismogram envelopes of the large event S1222a and four recently identified near impacts recorded by the InSight mission by introducing a stratification of velocity ...and attenuation into a multiple‐scattering approach. We show that a simple conceptual model composed of a strongly diffusive, weakly attenuating layer overlying a transparent medium captures the essential features of the observed envelopes. The attenuation profiles reveal that the minimal extension of heterogeneities at depth is of the order of 20 km in the vicinity of InSight and 60 km on the path to S1222a. We interpret this result as an indication that the Martian crust as a whole is at the origin of the strong scattering. Our heterogeneity model suggests that the sources of a number of distant Very‐high‐Frequency seismic events are shallow and located to the south or in close vicinity of the Martian dichotomy.
Plain Language Summary
The seismometers deployed at the surface of Mars in the framework of the Interior Exploration using Seismic Investigations, Geodesy and Heat Transport mission have recently recorded seismic waves generated by meteorite impacts and a very large Marsquake. These exceptional data offer the opportunity to study how seismic waves propagate in the interior of Mars and more particularly how they attenuate. This is an important topic because attenuation characterizes the physical state of planetary interiors. There are two basic mechanisms at the origin of seismic attenuation: “absorption,” which is highly sensitive to the presence of fluids—such as water—in the porosity of the rocks and “scattering,” which is caused by the geological heterogeneity at length scales ranging from tens of meters to kilometers. Using advanced modeling techniques which allow for the separate quantification of the two processes, we have determined that scattering is the dominant seismic attenuation mechanism on Mars, that originates from a heterogeneous and dry crust. In the light of this result, we have revised previous interpretations of specific seismic events with a predominantly high‐frequency content and propose that they originate from the vicinity of a major geological feature known as the Martian dichotomy.
Key Points
Envelope modeling of event S1222a and near impacts reveals a strong stratification of scattering properties in the lithosphere of Mars
The whole crust acts as a diffusive layer with a minimal thickness of 20 km below InSight and 60 km at the location of S1222a
Distant Very‐high‐Frequency events are shallow quakes or impacts originating from the south or the vicinity of the Martian dichotomy
Objectives
There is a lack of studies identifying the correlates of institutionalization specifically among the oldest old. Therefore, our aim was to fill this gap in knowledge.
Methods
...Cross‐sectional data (Follow up wave 9; n = 633 observations in the analytical sample) were used from the multicenter prospective cohort study “Needs, health service use, costs and health‐related quality of life in a large sample of oldest‐old primary care patients (85+)” Correlates of institutionalization among the oldest old—Evidence from a multicenter cohort study. The sample consists of primary care patients aged 86 years and over (mean 90.5 years, SD: 2.9 years). Sociodemographic and health‐related independent variables were included in our regression model. Institutionalization was defined as living in a nursing home or an old‐age home (not including assisted living facilities).
Results
Out of the 633 participants, 502 individuals (79.3%) did not live in an institutionalized setting, whereas 73 individuals (20.7%) lived in an institutionalized setting. Multiple logistic regressions showed that the likelihood of institutionalization increased with being divorced/widowed/single (compared to being married; OR: 5.35 95% CI: 1.75–16.36), the presence of social isolation (OR: 2.07 1.20–3.59), more depressive symptoms (OR: 1.11 1.01–1.23), increased cognitive impairment (OR: 1.67 1.31–2.15) and higher levels of frailty (OR: 1.48 1.07–2.06).
Conclusion
The study findings identified various sociodemographic and health‐related factors associated with institutionalization among the oldest old. Longitudinal studies are required to gain further insights into these associations.
Key Points
Based on a large multicenter prospective cohort study, the aim was to examine the correlates of institutionalization among the oldest age group
Institutionalization was associated with being divorced/widowed/single, social isolation, more depressive symptoms, increased cognitive impairment and frailty
Study findings identified various sociodemographic and health‐related factors associated with institutionalization among the oldest old
The implementation of flexible, tailored interventions addressing the specific circumstances of the caregiving situation to delay a transition or assure a well‐timed and well‐organized transition is required
In the light of personnel shortage, the health care sector is facing the challenge to combine increasing employees' as well as patients' needs. The aim of this study was to investigate the ...association between working-time autonomy and health-related (fatigue, psychosomatic complaints and work ability), as well as occupational outcomes (job satisfaction and turnover intention) in a large sample of health care employees.
Based on data of the BauA-Working Time survey, a sample of n = 1,093 employees working in the health care sector was analysed. Outcomes were assessed by the German Fatigue Scale, the Work Ability-Index and single-item measurements. Besides descriptive analyses, latent profile analysis (LPA) was used to determine clusters of employees based on working-time autonomy. Subsequently, regression analyses have been conducted to examine the association between autonomy clusters with health-related and occupational outcomes, controlling for sociodemographic characteristics and employment status.
LPA revealed that a three-cluster model was most suitable: high autonomy (cluster 1), medium autonomy (cluster 2) and low autonomy (cluster 3). The extracted profiles of working-time autonomy differed significantly in terms of sociodemographic and occupational characteristics, but not in terms of average working hours per week or monthly household income. The multivariate regression analysis revealed that being in the low-autonomy cluster was associated with more psychosomatic health complaints (IRR: 1.427, p = 0.008), lower work ability (OR 0.339, p < 0.001), as well as less job satisfaction (OR 0.216, p < 0.001).
Overall, the analyses indicate that it is crucial to prospectively consider working-time autonomy as an important factor of satisfaction, well-being and turnover intention in health care employees.
There is an empirical association between stress and symptoms of food addiction (FA), but it is still not clear which domains of stress are the most relevant when it comes to FA, limiting the ability ...of researchers and practitioners to address problematic eating‐related health outcomes. In order to address this gap in the literature, we analysed how different domains of chronic stress are related to FA. We used data from a subsample of the LIFE‐Adult‐Study (N = 1172), a German cohort study. We conducted a linear regression analysis with stress domains (Trier Inventory for Chronic Stress, TICS) as predictors of FA (Yale Food Addiction Scale, YFAS). In the second regression analysis we included sociodemographic variables, personality, and smoking as control variables. There was a significant and positive association between Social Overload, Work Discontent, Excessive Demands from Work, and Chronic Worrying and FA. After adding control variables, only Social Overload, Excessive Demands from Work, and Chronic Worrying remained significant predictors. Connections between stress domains and FA can serve as starting points for the development of meaningful interventions that support individuals self‐care strategies (Social Overload), complexity management (Excessive Demands from Work), and coping with negative emotions (Chronic Worrying).
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