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Romano S, Monteiro L, Guerreiro JP, Simões JB, Teixeira Rodrigues A, Lunet N, Perelman J. Effectiveness and cost-effectiveness of a collaborative deprescribing intervention of proton-pump-inhibitors on community-dwelling older adults: Protocol for the C-SENIoR, a pragmatic non-randomized controlled trial. PLoS One 2024; 19:e0298181. [PMID: 38530823 DOI: 10.1371/journal.pone.0298181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/13/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION Worldwide, demographic ageing is a major social, economic and health challenge. Despite the increase in life expectancy, elderly often live with multiple chronic conditions, exposing them to multiple medications. Concerns have been raised about the growing issue of inappropriate long-term usage of proton-pump inhibitors (PPI), which have been associated with adverse outcomes and increased healthcare costs. Deprescribing is a recommended intervention to reduce or withdraw medicines that might be causing harm or might no longer be of benefit. This protocol details a trial to assess the effectiveness and cost-effectiveness of a collaborative deprescribing intervention of PPI among community-dwelling elderly, involving community pharmacists and general practitioners. METHODS AND ANALYSIS A pragmatic, multicentre, two-arm, non-randomised controlled trial of a structured PPI collaborative deprescribing intervention in the primary care setting with a 6-month follow-up will be conducted. Patients must be 65 years old or older, live in the community and have been using PPI for more than 8 weeks. We hypothesize that the intervention will reduce the PPI usage in the intervention group compared to the control group. The primary outcome is the successful discontinuation or dose decrease of any PPI, defined as a statistically significant absolute 20% reduction in medication use between the intervention and control groups at 3- and 6-month follow-ups. An economic evaluation will be conducted alongside the trial. This study was approved by the Ethics Research Committee of Nova Medical School, NOVA University of Lisbon and by the Ethics Committee from the Local Health Unit Alto Minho, Portugal. DISCUSSION This pragmatic trial will provide evidence on the effectiveness and cost-effectiveness of a patient-centred collaborative deprescribing intervention in the community setting in Portugal. It will also inform improvements for the development of future multi-faceted interventions that aim to optimise medication for the community-dwelling elderly. CLINICAL TRIAL REGISTRATION ISRCTN 49637686.
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Affiliation(s)
- Sónia Romano
- Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies (CEFAR-IF/ANF), Lisboa, Portugal
- NOVA National School of Public Health, NOVA University Lisbon, Lisbon, Portugal
| | - Luis Monteiro
- Centre for Health Technology and Services Research, Faculty of Medicine of the University of Porto (CINTESIS), Porto, Portugal
- Unidade de Saúde Familiar Esgueira Mais, Aveiro, Portugal
| | - José Pedro Guerreiro
- Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies (CEFAR-IF/ANF), Lisboa, Portugal
| | - João Braga Simões
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- Unidade de Saúde Familiar Terra da Nóbrega, Ponte da Barca, Portugal
| | - António Teixeira Rodrigues
- Centre for Health Evaluation & Research/Infosaúde, National Association of Pharmacies (CEFAR-IF/ANF), Lisboa, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/ Guimarães, Portugal
| | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Julian Perelman
- NOVA National School of Public Health, NOVA University Lisbon, Lisbon, Portugal
- NOVA National School of Public Health, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
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Francois C, Gawlik G, Mestre-Ferrandiz J, Pana A, Perelman J, Yfantopoulos J, Simoens S. New pricing models for generic medicines to ensure long-term sustainable competition in Europe. Front Pharmacol 2023; 14:1200641. [PMID: 37876734 PMCID: PMC10593415 DOI: 10.3389/fphar.2023.1200641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/21/2023] [Indexed: 10/26/2023] Open
Abstract
Background: Price erosion of generic medicines over time as a result of existing pricing policies in combination with increasing operational costs of these products due to high inflation, undermine long-term sustainable competition in European off-patent medicines markets. Therefore, the aim of this study is to identify new potential pricing models for retail generic medicines in Europe, examine their pros and cons, and illustrate them with examples inside or outside the pharmaceutical sector. Methods: A targeted literature review, one-to-one interviews and a joint advisory board meeting with experts from five European countries were carried out to assess potential pricing models for generic medicines. Results: We identified ten pricing models that can be applied to generic medicines. The tiered pricing model is viewed as a sustainable solution ensuring competitiveness, but requires market monitoring using a supportive IT infrastructure. De-linking the price of generic medicines from that of the off-patent originator medicine prevents the originator from forcing generic medicines' prices to unsustainable levels. Higher costs due to inflation can be compensated in the automatic indexation model. Other pricing models that have less implementation potential include the one-in-one/multiple-out model, tax credits, value-based pricing, volume for savings and guaranteed margin/fee models. The hypothecated tax and cost allocation models, which add a patient fee to generic medicines prices, are not likely to be socially acceptable. Conclusion: When considering a new pricing model for generic medicines, the impact on innovative medicines and the characteristics of the healthcare system in a given country need to be taken into account. Also, there is a need to continuously follow up the level of competition in off-patent medicines markets and to identify sustainability risks.
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Affiliation(s)
- Clement Francois
- Aix Marseille University, Marseille, France
- Putnam PHMR, Paris, France
| | | | | | - Adrian Pana
- Department of Public Health, Babes Bolyai University, Cluj Napoca, Romania
| | - Julian Perelman
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | | | - Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
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Smit RA, Kuipers MAG, Federico B, Clancy L, Perelman J, Rozema AD, Kunst AE. The association of adolescents' smoking with the physical activity levels of their friends. Prev Med 2023; 175:107652. [PMID: 37532033 DOI: 10.1016/j.ypmed.2023.107652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/04/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Smoking is inversely related to people's Physical Activity Level (PAL). As the behavior of friends may affect the choices and behavior of adolescents, having friends with a high PAL may potentially protect against adolescent smoking. This study aims to assess whether adolescents' smoking is associated with the PAL of their friends. METHODS SILNE-R survey data of 11.918 adolescents from 55 different schools in 7 European cities was used to determine weekly smoking, individual PAL, PAL of friends, school PAL, and smoking of friends. Multilevel, multivariable logistic regression analysis were used to assess the association between the PAL of friends and weekly smoking. Several socio-demographic variables were included as covariates in the analysis. RESULTS Our results indicated that 10.8% of the respondents was smoking weekly. Weekly smoking was most common among adolescents whose friends had a PAL of 0-42.0 min per day (14.5%). Respondents were significantly more likely to be smoking weekly if their friends were on average 0-42 min vs. 80-180 min physically active (OR 1.27 [95% CI 1.04-1.55]). This association existed independently of the individual PAL of respondents. Stratification for smoking of friends yielded equal results, although the association appeared to be somewhat stronger for those with smoking friends (OR 1.38 [95% CI 1.06-1.82]). CONCLUSION Adolescents are less likely to smoke weekly if they associate with friends who spend >80 min per day on physical activity. Initiatives aimed at the prevention of smoking among adolescents may benefit from organizing group-based physical activity programs.
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Affiliation(s)
- R A Smit
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, Amsterdam, the Netherlands.
| | - M A G Kuipers
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, Amsterdam, the Netherlands
| | - B Federico
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Frosinone, Italy
| | - L Clancy
- TobaccoFree Research Institute Ireland, TU Dublin, Ireland
| | - J Perelman
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - A D Rozema
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - A E Kunst
- Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, Amsterdam, the Netherlands
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Alves J, Perelman J, Ramos E, Kunst AE. The emergence of socioeconomic inequalities in smoking during adolescence and early adulthood. BMC Public Health 2023; 23:1382. [PMID: 37464370 DOI: 10.1186/s12889-023-16182-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/23/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND While it is known that educational inequalities in smoking start during early and middle adolescence, it is unknown how they further develop until adulthood. The aim of this article is to map, in the Portuguese context, how educational inequalities in smoking emerge from pre-adolescence until young adulthood. METHODS This study used longitudinal data from the EPITeen Cohort, which recruited adolescents enrolled in schools in Porto, Portugal. We included the 1,038 participants followed at ages 13 (2003/2004), 17, 21, and 24 years. We computed the odds ratio (OR) for the prevalence of smoking states (never smoking, experimenter, less-than-daily, daily and former smoker) and the incidence of transitions between these states, as function of age and education, stratified by sex. We also added interaction terms between age and education. RESULTS Educational inequalities in daily smoking prevalence, with higher prevalence among those with lower educational level, emerged at 17 years old and persisted until higher ages. They were formed in a cumulative way by the increased risk of experimenting between 13 and 17 years, and increased risk of becoming daily smoker between 17 and 21 years. The incidence of smoking cessation was higher among the higher educated. Inequalities were formed similarly for women and men, but with lower level and showed no significance among women. CONCLUSIONS These results highlight that actions to prevent smoking should also take in account the potential impact in smoking inequalities, and should focus not only on middle adolescence but also on late adolescence and early adulthood.
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Affiliation(s)
- Joana Alves
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Avenida Padre Cruz, Lisbon, 1600-560, Portugal.
| | - Julian Perelman
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Avenida Padre Cruz, Lisbon, 1600-560, Portugal
| | - Elisabete Ramos
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
- EPIUnit - Institute of Public Health, University of Porto, Rua das Taipas 135, Porto, 4050-091, Portugal
| | - Anton E Kunst
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
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Russo G, Perelman J, Zapata T, Šantrić-Milićević M. The layered crisis of the primary care medical workforce in the European region: what evidence do we need to identify causes and solutions? Hum Resour Health 2023; 21:55. [PMID: 37443059 PMCID: PMC10347862 DOI: 10.1186/s12960-023-00842-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Primary care services are key to population health and for the efficient and equitable organisation of national health systems. This is why they are often financed through public funds. Primary care doctors are instrumental for the delivery of preventive services, continuity of care, and for the referral of patients through the system. These cadres are also the single largest health expenditure at the core of such services. Although recruitment and retention of primary care doctors have always been challenging, shortages are now exacerbated by higher demand for services from aging populations, increased burden of chronic diseases, backlogs from the COVID-19 pandemic, and patient expectations. At the same time, the supply of primary care physicians is constrained by rising retirement rates, internal and external migration, worsening working conditions, budget cuts, and increased burnout. Misalignment between national education sectors and labour markets is becoming apparent, compounding staff shortages and maldistribution. With their predominantly publicly funded health systems and in the aftermath of COVID-19, countries of the European region appear to be now on the cusp of a multi-layered, slow-burning primary care crisis, with almost every country reporting long waiting lists for doctor appointments, shortages of physicians, unfilled vacancies, and consequently, added pressures on hospitals' Accident and Emergency services. This articles collection aims at pulling together the evidence from countries of the European Region on root causes of such workforce crisis, impacts, and effectiveness of existing policies to mitigate it. Original research is needed, offering analysis and fresh insights into the primary care medical workforce crisis in wider Europe. Ultimately, the aim of this articles collection is to provide an evidence basis for the identification of policy solutions to present and future primary health care crises in high as well as lower-income countries.
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Affiliation(s)
- Giuliano Russo
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Julian Perelman
- Nova National School of Public Health and Comprehensive Health Research Center, Nova University of Lisbon, Lisbon, Portugal
| | - Tomas Zapata
- Division of Country Health Policies and Systems, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Milena Šantrić-Milićević
- Faculty of Medicine, School of Public Health and Health Management, Institute of Social Medicine, University of Belgrade, Belgrade, Serbia
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Mélard N, Grard A, Delvenne JC, Mercken L, Perelman J, Kunst AE, Lorant V. The Diffusion of Smoking: Association Between School Tobacco Policies and the Diffusion of Adolescent Smoking in 38 Schools in 6 Countries. Prev Sci 2023; 24:752-764. [PMID: 36652097 DOI: 10.1007/s11121-022-01486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/19/2023]
Abstract
Social network research has evidenced the role of peer effects in the adoption of behaviours. Little is known, however, about whether policies affect how behaviours are shared in a network. To contribute to this literature, we apply the concept of diffusion centrality to school tobacco policies and adolescent smoking. Diffusion centrality is a measure of centrality which refers to a person's ability to diffuse a given property-in our case, smoking-related behaviours. We hypothesized that stronger school tobacco policies are associated with less diffusion centrality of smoking on school premises and of smoking in general. A whole network study was carried out in 2013 and 2016 among adolescents (n = 18,805) in 38 schools located in six European cities. Overall, diffusion centrality of smoking in general and of smoking on school premises significantly decreased over time. Diffusion centrality of smoking significantly decreased both in schools where the policy strengthened or softened over time, but for diffusion of smoking on school premises, this decrease was only significant in schools where it strengthened. Finally, stronger school tobacco policies were associated with lower diffusion centrality of smoking on school premises and of smoking in general, though to a lesser extent. With such policies, smoking may, therefore, become less prevalent, less popular, and less clustered, thereby lowering the risk of it spreading within networks in, and even outside the school.
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Affiliation(s)
- Nora Mélard
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.
| | - Adeline Grard
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - Jean-Charles Delvenne
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics, Université catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Liesbeth Mercken
- Department of Health Psychology, Open University, Heerlen, the Netherlands
| | - Julian Perelman
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Anton E Kunst
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Vincent Lorant
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
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Perelman J, Duarte-Ramos F, Melo Gouveia A, Pinheiro L, Ramos F, Vogler S, Mateus C. How do hospital characteristics and ties relate to the uptake of second-generation biosimilars? A longitudinal analysis of Portuguese NHS hospitals, 2015-2021. Expert Rev Pharmacoecon Outcomes Res 2023; 23:99-109. [PMID: 36356294 DOI: 10.1080/14737167.2023.2146579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is limited evidence on within-country discrepancies in biosimilar uptake. This study analyzes differences in timing and diffusion of biosimilar uptake across Portuguese NHS hospitals and explores possible determinants. RESEARCH DESIGN AND METHODS We analyzed publicly accessible consumption data of originator biologic and biosimilar drugs for adalimumab, etanercept, infliximab, rituximab, and trastuzumab, by hospital and month for the years 2015-2021 (N = 9,467). We modeled the time to biosimilar adoption using survival regression models and the share of biosimilar consumption using generalized estimated equations with random hospital effects. RESULTS Academic hospitals were characterized by a quicker uptake of adalimumab and infliximab biosimilars but lower shares for other drugs. A higher total consumption of biologics was related to a lower share of biosimilar uptake. A stronger participation in randomized controlled trials was linked to higher biosimilar shares and quicker uptake, except for rituximab. If all NHS hospitals had biosimilar shares equal to the highest ones, potential annual savings could reach 13.9 million euros. CONCLUSION The findings suggest a need for capacity-building on biosimilar prescribing, including for doctors of academic hospitals and those working in settings where high biosimilar use would be expected.
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Affiliation(s)
- Julian Perelman
- NOVA National School of Public Health, Comprehensive Health Research Center, CHRC, NOVA University of Lisbon, Lisbon, Portugal.,Comprehensive Health Research Center, Nova University of Lisbon, Portugal
| | - Filipa Duarte-Ramos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Portugal
| | | | - Luis Pinheiro
- Centro Hospitalar Universitário de Lisboa Norte, Portugal
| | - Francisco Ramos
- NOVA National School of Public Health, Comprehensive Health Research Center, CHRC, NOVA University of Lisbon, Lisbon, Portugal
| | - Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Austrian National Public Health Institute (Gesundheit Österreich GmbH/GÖG), Austria
| | - Céu Mateus
- Health Economics at Lancaster, Division of Health Research, Lancaster University, Lancaster, UK
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Perelman J, Leão T, Serrano-Alarcon M. Economic evaluation of legislation-based public health interventions – the case of tobacco control. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Economic evaluation of public health interventions have mostly been performed for interventions whose cost and effectiveness can be well identified, such as protective interventions (vaccination or screening), clinical interventions (prevention drugs) or counselling and education programs. Yet, following the Thomas Frieden's health impact pyramid, these public health interventions are less effective than those “changing the context to make individuals’ default decision healthy”. The economic evaluation of population-based interventions that modify the context is rather challenging. First, such interventions include various components, e.g., taxes and subsidies, media campaigns or bans. Second, since they correspond to political decisions applied at a wide scale, their effectiveness can hardly be measured using experimental designs. Third, the cost of such interventions is difficult to assess, since they are not represented by a specific product or service, but rather by political decisions and their implementation, whose costing is not straightforward. Using the case of tobacco control policies, we show how alternative methods can be used to assess their economic value. We show that quasi-experimental methods with country comparisons allow identify the effectiveness of specific policies, and that qualitative approaches are needed to quantify their costs. Results indicate that tobacco-control policies have low costs and are highly effective, so that their cost-effectiveness is quite favorable in light of commonly referred thresholds, and in comparison with widely financed clinical interventions. Population-based interventions that focus contextual factors must also be carefully evaluated from an economic viewpoint. Although economic evaluations are challenging, alternative approaches help obtain results that are valuable for decision making.
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Affiliation(s)
- J Perelman
- NOVA National School of Public Health, NOVA University of Lisbon , Lisbon, Portugal
- Comprehensive Health Research Center, NOVA University of Lisbon , Lisbon, Portugal
| | - T Leão
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto , Porto, Portugal
- Faculdade de Medicina, Universidade do Porto , Porto, Portugal
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Roxo L, Perelman J. Investigating unrecognized needs and structural barriers to treatment of depressive symptoms: A nationwide cross-sectional study in Portugal. Psychiatry Res 2022; 313:114623. [PMID: 35597138 DOI: 10.1016/j.psychres.2022.114623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/03/2022] [Accepted: 05/08/2022] [Indexed: 11/19/2022]
Abstract
This study assesses factors associated with perception of need and affordability concerns regarding mental health services (MHS), among 978 persons with meaningful depressive symptoms (Patient Health Questionnaire≥10). We used data from the 6th Portuguese National Health Interview Survey and used logistic regressions with gender, age, severity of symptoms, education, and income as explanatory variables. Health insurance was added as mediation variable. Unrecognized need (59.3% of the sample) was more likely amongst men, those over 65, high-educated, and those with moderate symptoms, compared to women, aged 18-34, low-educated, and those with severe symptoms. Among those reporting they needed MHS, 44.6% were not able to pay for them. Affordability concerns were more likely amongst men, those under 50, severely depressed, high-educated, and less likely amongst those within the highest income quintile. Adjusting for health insurance did not change the results in a meaningful way. Unrecognized need and affordability concerns are common among depressed persons in Portugal but seem unevenly distributed across social groups. Investing in the capacity of primary healthcare services to treat depression may be crucial to promote perception of need and reduce structural barriers.
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Affiliation(s)
- Luis Roxo
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal; Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal; Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal.
| | - Julian Perelman
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal; Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal; Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal.
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10
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Alves J, Perelman J, Ramos E, Kunst AE. Intergenerational transmission of parental smoking: when are offspring most vulnerable? Eur J Public Health 2022; 32:741-746. [PMID: 35712820 PMCID: PMC9527976 DOI: 10.1093/eurpub/ckac065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous literature has showed that the likelihood of smoking is higher among offspring with smoking parents. The aim of this cohort study is to investigate during which smoking initiation stages and at what ages adolescents are more likely to be influenced by parental smoking. METHODS This study used the EPITeen Cohort, which recruited 13-year-old adolescents born in 1990, enrolled at schools in Porto, Portugal. Participants (n = 996) were followed across four waves at 13, 17, 21 and 24 years old. We computed the odds ratio (OR) and 95% confidence intervals for the prevalence of the different smoking states (never smoking, experimenter, less than daily smoker, daily smoker and former smoker), and incidence transitions between these states (to smoking experimenter; to less than daily smoker, to daily smoker; to former smoker) as function of age, parental smoking status and their interaction. RESULTS Compared with other participants, those with two smoking parents had an increased prevalence of experimentation at 13 years (OR for the interaction at 13 years compared with 24 years = 2.13 [1.50-3.01]) and daily smoking at all ages (OR for parental smoking =1.91 [1.52-2.40]). The latter increase is related to a significantly increased risk to transit from early smoking stages to daily smoking at all ages (OR for parental smoking = 1.83 [1.43-2.34]). CONCLUSIONS Parental smoking influences offspring's daily smoking prevalence especially by increasing the risk to transit to daily smoking up to early adulthood. Prevention should focus on parents and parental influences especially among offspring who may transition to daily smokers.
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Affiliation(s)
- J Alves
- NOVA National School of Public Health, Public Health Research Centre, CISP, NOVA University Lisbon, Lisbon, Portugal.,NOVA National School of Public Health, Comprehensive Health Research Centre, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - J Perelman
- NOVA National School of Public Health, Public Health Research Centre, CISP, NOVA University Lisbon, Lisbon, Portugal.,NOVA National School of Public Health, Comprehensive Health Research Centre, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - E Ramos
- Faculty of Medicine, Department of Public Health and Forensic Sciences, and Medical Education, University of Porto, Porto, Portugal.,EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - A E Kunst
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Alves R, Perelman J. European mature adults and elderly are moving closer to the Mediterranean diet-a longitudinal study, 2013-19. Eur J Public Health 2022; 32:600-605. [PMID: 35712901 PMCID: PMC9341670 DOI: 10.1093/eurpub/ckac070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The decreasing adherence in Mediterranean Diet (M.D.) during the last decades has been attributed to social, cultural and economic factors. However, recent efforts to improve dietary habits and the economic improvement might be reversing this trend. We analyze the changes in M.D. adherence between 2013 and 2019 among a sample of European mature adults and the elderly. METHODS Using data from the Survey of Health, Ageing and Retirement in Europe for adults over 50 years old, we designed a longitudinal cohort study with a sample of participants from waves 5 (2013) and 8 (2019/20). Logistic regressions were used to model the consumption of M.D. adherence as a function of the year. We then stratified the analyses by education, age and transitions in economic status, employment and self-perceived health. RESULTS There was in 2019/20 a significant increase in the M.D. adherence (10.8% vs. 14.3%, OR = 1.367, P < 0.01). The rise was mainly related to the decrease of meat and fish (38.4% vs. 30.5%, OR = 0.703, P < 0.01) and growth of legumes and eggs intake (36.3% vs. 41.8%, OR = 1.260 P < 0.01). The results were consistent in all European regions and most sociodemographic groups. Younger people with higher income and education had a greater rise in adherence. CONCLUSIONS Our analysis shows a generalized growth in adherence to the M.D. across most socioeconomic subpopulations and countries in Europe, suggesting a shift to healthier diet patterns. The more noticeable increase among affluent, educated and healthy respondents, may further entrench dietary and health inequalities.
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Affiliation(s)
- Ricardo Alves
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisboa, Portugal.,Comprehensive Health Research Center (CHRC), Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Julian Perelman
- Public Health Research Center, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisboa, Portugal
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12
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Perelman J. [Syndemic Pandemic in Portugal: Social Inequality in Risk Factors Associated With COVID-19 Mortality]. ACTA MEDICA PORT 2022; 35:433-449. [PMID: 35533082 DOI: 10.20344/amp.16031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/24/2021] [Accepted: 12/22/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION International evidence has unveiled the existence of social inequalities in the risk of death associated with SARS-CoV-2 (COVID-19). In Portugal, the impossibility to identify the socioeconomic condition of deceased people hinders this evaluation. This study analyzes the social inequalities in the risk factors of COVID-19 mortality in Portugal. MATERIAL AND METHODS We used data from the sixth National Health Survey, carried out between September 2019 and December 2019, for the subgroup of people aged between 25 and 79 years old (n = 12 052). We considered the comorbidities with demonstrated link to COVID-19 mortality: asthma, chronic bronchitis, cardiovascular (CVD) and cerebrovascular disease, diabetes, hypertension, chronic renal disease (CRD), and obesity. The inequality, stratified by sex, was measured in terms of education and income, using logistic regression (odds ratios and relative index of inequality). RESULTS Compared to men with the lowest level of formal education, we measured a risk reduction, among men with tertiary education, of CVD (-90%), chronic bronchitis (-75%), stroke (-70%), diabetes (-62%), hypertension (-41%), and obesity (-43%). Among tertiaryeducated women, we observed a reduced risk of CRD (-77%), hypertension, diabetes, stroke (-70%), obesity (-64%), and CVD (-55%). Except for obesity among men, the risk of disease was always significantly lower in the highest income quintile, compared with the lowest. CONCLUSION In 2019, we observed socioeconomic inequalities of high magnitude for the eight diseases with demonstrated link to COVID-19 mortality.
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Affiliation(s)
- Julian Perelman
- NOVA National School of Public Health. Comprehensive Health Research Center. Universidade NOVA de Lisboa. Lisboa. Portugal
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13
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Romano S, Figueira D, Teixeira I, Perelman J. Deprescribing Interventions among Community-Dwelling Older Adults: A Systematic Review of Economic Evaluations. Pharmacoeconomics 2022; 40:269-295. [PMID: 34913143 DOI: 10.1007/s40273-021-01120-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Deprescribing can reduce the use of inappropriate or unnecessary medication; however, the economic value of such interventions is uncertain. OBJECTIVE This study seeks to identify and synthetise the economic evidence of deprescribing interventions among community-dwelling older adults. METHODS Full economic evaluation studies of deprescribing interventions, conducted in the community or primary care settings, in community-dwelling adults aged ≥ 65 years were systematically reviewed. MEDLINE, EconLit, Scopus, Web of Science, CEA-TUFTS, CRD York and Google Scholar databases were searched from inception to February 2021. Two researchers independently screened all retrieved articles according to inclusion and exclusion criteria. The main outcome was the economic impact of the intervention from any perspective, converted into 2019 US Dollars. The World Health Organization threshold of 1 gross domestic product per capita was used to define cost effectiveness. Studies were appraised for methodological quality using the extended Consensus on Health Economics Criteria checklist. RESULTS Of 6154 articles identified by the search strategy, 14 papers assessing 13 different interventions were included. Most deprescribing interventions included some type of medication review with or without a supportive educational component (n = 11, 85%), and in general were delivered within a pharmacist-physician care collaboration. Settings included community pharmacies, primary care/outpatient clinics and patients' homes. All economic evaluations were conducted within a time horizon varying from 2 to 12 months with outcomes in most of the studies derived from a single clinical trial. Main health outcomes were reported in terms of quality-adjusted life-years, prevented number of falls and the medication appropriateness index. Cost effectiveness ranged from dominant to an incremental cost-effectiveness ratio of $112,932 per quality-adjusted life-year, a value above the country's World Health Organization threshold. Overall, 85% of the interventions were cost saving, dominated usual care or were cost effective considering 1 gross domestic product per capita. Nine studies scored > 80% (good) and two scored ≤ 50% (low) on critical quality appraisal. CONCLUSIONS There is a growing interest in economic evaluations of deprescribing interventions focused on community-dwelling older adults. Although results varied across setting, time horizon and intervention, most were cost effective according to the World Health Organization threshold. Deprescribing interventions are promising from an economic viewpoint, but more studies are needed.
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Affiliation(s)
- Sónia Romano
- Centre for Health Evaluation and Research/Infosaúde, National Association of Pharmacies (CEFAR-IF/ANF), Rua Marechal Saldanha 1, 1249-069, Lisbon, Portugal.
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal.
| | - Débora Figueira
- Centre for Health Evaluation and Research/Infosaúde, National Association of Pharmacies (CEFAR-IF/ANF), Rua Marechal Saldanha 1, 1249-069, Lisbon, Portugal
| | - Inês Teixeira
- Centre for Health Evaluation and Research/Infosaúde, National Association of Pharmacies (CEFAR-IF/ANF), Rua Marechal Saldanha 1, 1249-069, Lisbon, Portugal
| | - Julian Perelman
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Lisbon, Portugal
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14
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Perelman J, Xavier M, Barros PP. How do European Mature Adults and Elderly Perceive SARS-COV-2 and Associated Control Measures? A Cross-Country Analysis of Mental Health Symptoms in June and July 2020. Int J Public Health 2022; 67:1604218. [PMID: 35283718 PMCID: PMC8906259 DOI: 10.3389/ijph.2022.1604218] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 01/21/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives: Recent literature points out that elderly people are psychologically resilient to COVID-19, but the studies were performed in specific contexts. We measured the link between the worsening of mental health symptoms, the epidemiologic situation, and control measures among European people aged 50 or older. Methods: We used data from the 2020 wave of SHARE, merged with Oxford COVID-19 Government Response Tracker data (n = 38,358). We modeled the risk of worsening of depression, anxiety, sleeping trouble, and loneliness symptoms’ self-perception, as functions of control measures and 7-days death incidence, using logistic regressions. Results: The worsening of anxiety and depression perception were more common (16.2 and 23.1%, respectively), compared to that of sleeping troubles and loneliness (8.1 and 11.5%, respectively). The worsening of depression and anxiety perception was negatively related to the rigor of control measures. The seven-days death incidence was positively linked to all symptoms except sleeping troubles. Conclusion: Older people were the most exposed to death risk and were affected psychologically by the COVID-19 epidemiological situation; yet control measures were protective (or neutral) to their mental health condition.
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Affiliation(s)
- Julian Perelman
- Center for Research in Public Health, National School of Public Health, New University of Lisbon, Lisbon, Portugal
- Comprehensive Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- *Correspondence: Julian Perelman,
| | - Miguel Xavier
- Comprehensive Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- NOVA Medical School, Faculty of Medical Sciences of Lisbon, New University of Lisbon, Lisbon, Portugal
- National Mental Health Program, General-Directorate for Health, Lisbon, Portugal
| | - Pedro Pita Barros
- School of Business and Economics, New University of Lisbon, Lisbon, Portugal
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15
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Roxo L, Silva M, Perelman J. Gender gap in health service utilisation and outcomes of depression: A cross-country longitudinal analysis of European middle-aged and older adults. Prev Med 2021; 153:106847. [PMID: 34662596 DOI: 10.1016/j.ypmed.2021.106847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 10/04/2021] [Accepted: 10/10/2021] [Indexed: 11/29/2022]
Abstract
Research has shown that health service utilisation for depression (HSUD) is less common among men than women. However, most evidence is cross-sectional, and there is limited information about gendered outcomes of depression. This cross-country study assesses gender differences in HSUD and in the persistence of depression by using cross-sectional and longitudinal data. We used data from the Survey of Health, Ageing and Retirement in Europe (SHARE), from 5428 participants between 50 and 80 from nine European countries, fulfilling criteria for depression in Wave 5 (assessed by the EURO-D depression scale). We modelled non-HSUD among all those depressed in Wave 5 ("cross-sectional data") and those not depressed in Wave 4 ("longitudinal data"), and the persistence of depression in Wave 6, as a function of gender. We used logistic regressions adjusted for age, marital status, country, education, financial strain, and severity of depression. Non-HSUD was more likely among depressed men than women in both cross-sectional (82.4% vs 73.2%, OR = 1.54, 99%CI = 1.54-1.55) and longitudinal analyses (94.4% vs 88.3%, OR = 2.27, 99%CI = 2.25-2.29). Gender differences were greater among low-educated participants and those with less pronounced financial strain. Among those with HSUD, men were more likely to remain depressed (62.3%, OR = 2.26, 99%CI = 2.22-2.30). Among those without HSUD, depression was more likely to persist among women (45.4%, OR = 0.79, 99%CI = 0.78-0.79). Results suggest that cross-sectional analyses underestimate men's disadvantage in HSUD. Interventions are needed to improve the demand for care and treatment adequacy among men, increasing their perception of need and their mental health literacy.
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Affiliation(s)
- Luis Roxo
- NOVA National School of Public Health, Universidade NOVA de Lisboa Avenida Padre Cruz, 1600-560 Lisboa, Portugal.
| | - Manuela Silva
- Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa Rua do Instituto Bacteriológico, n° 5, 1150-190 Lisboa, Portugal; Lisbon Institute of Global Mental Health Rua do Instituto Bacteriológico, n° 5, 1150-190 Lisboa, Portugal.
| | - Julian Perelman
- NOVA National School of Public Health, Universidade NOVA de Lisboa Avenida Padre Cruz, 1600-560 Lisboa, Portugal; Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa Avenida Padre Cruz, 1600-560 Lisboa, Portugal.
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16
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Romano S, Figueira D, Teixeira I, Perelman J. Deprescribing for community-dwelling elderly: A systematic review of economic evaluations. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Multimorbidity among the elderly represents a serious challenge for health systems. Older adults are often exposed to polypharmacy and inappropriate medication, which are associated with adverse events and increased healthcare use. This study aims to identify and synthetize the economic evidence of deprescribing interventions among community-dwelling elderly.
Methods
Literature was systematically reviewed on the cost and effectiveness of deprescribing interventions in adults aged ≥65 years living in the community. MEDLINE, EconLit, Scopus, Web of Science, CEA-TUFTS, CRD York and Google Scholar databases were searched from inception to February 2021. Grey literature was also explored. Titles and abstracts, and subsequently full-text articles were screened according to inclusion and exclusion criteria. Studies' quality was appraised using the extended Consensus on Health Economics Criteria list.
Results
A total of 6,154 articles were identified, of which 89 were retrieved for full-text review, yielding 14 studies. Most were conducted in Europe (n = 9), followed by North (n = 3) and South America (n = 1), and China (n = 1). Settings included community pharmacies, primary care/general practices and patientś homes. Most deprescribing interventions were delivered within a pharmacist-doctor collaboration. Twelve studies were trial-based economic evaluations with a time horizon varying from 2 to 12 months. Cost-effectiveness ranged from dominant to an incremental cost-effectiveness ratio of $112,932/QALY. Nine studies scored >80% (good) and two scored ≤50% (low) on critical quality appraisal.
Conclusions
There are few economic evaluations of deprescribing interventions focused on community-dwelling elderly. Although results varied across settings, time horizon and intervention complexity, most interventions were cost-effective according to the WHO threshold. Deprescribing interventions are promising from an economic viewpoint, but more studies are needed.
Key messages
There is a paucity of economic evaluation studies conducted on deprescribing interventions of community-dwelling elderly. Research suggests that most interventions are cost-effective or even dominant compared to usual care.
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Affiliation(s)
- S Romano
- Centre for Health Evaluation and Research, National Association of Pharmacies, Lisbon, Portugal
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
| | - D Figueira
- Centre for Health Evaluation and Research, National Association of Pharmacies, Lisbon, Portugal
| | - I Teixeira
- Centre for Health Evaluation and Research, National Association of Pharmacies, Lisbon, Portugal
| | - J Perelman
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Lisbon, Portugal
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17
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Roxo L, Perelman J. Gender differences in depressive symptoms and perception of need of mental health services. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Women are more likely than men to use mental health services use (MHS) when depressed. Gendered presentations of depression may contribute to explain this gender gap. This study aims to identify depression symptom profiles among men and women and to understand their relationship with perception of MHS need.
Methods
We used data from the 6th Portuguese National Health Survey, with 3,807 participants fulfilling criteria for mild, moderate or severe depression (scoring 5 or more in Personal Health Questionnaire-8). We used latent-class analysis to identify classes of depressive symptoms (using 8 symptoms from PHQ), separately for men and women. Afterwards, we characterized the needs perception (during previous year), by latent class.
Results
Latent classes identified among men were “Mood and somatic symptoms” (50.6%), “Severe depression” (32.9%), and “Somatic symptoms” (16.5%). Perception of need was low among those with more prominent somatic symptoms (8.1%), and higher for those with severe depression (42.4%). Among women, latent classes were “Mood and somatic symptoms with low self-esteem” (47.8%), “Severe depression” (26.9%), and “Somatic symptoms” (25.3%), and. Less than half (43%) of those with severe depression reported need of MHS, compared to 25.5% of those with mood, somatic and self-esteem struggles and 11.2% with somatic symptoms.
Conclusions
Less than half severely depressed men and women recognized the need for MHS. Somatic symptoms were less associated to needs perception, particularly among men. The need perception is generally low, even in case of severe depression, while gendered symptom profiles may impact MHS help-seeking behaviours.
Key messages
Depression is presented differently among men and women and that may impact mental health service help-seeking behaviours. While the need perception for mental health services is generally low, somatic symptoms were less associated to needs perception, especially among men.
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Affiliation(s)
- L Roxo
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - J Perelman
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
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18
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Perelman J. Value-based care: a good idea, many caveats. Eur J Public Health 2021; 31:676-677. [PMID: 34148089 PMCID: PMC8504993 DOI: 10.1093/eurpub/ckab026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Julian Perelman
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisbon, Portugal
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19
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Falese L, Federico B, Kunst AE, Perelman J, Richter M, Rimpelä A, Lorant V. The association between socioeconomic position and vigorous physical activity among adolescents: a cross-sectional study in six European cities. BMC Public Health 2021; 21:866. [PMID: 33952232 PMCID: PMC8097935 DOI: 10.1186/s12889-021-10791-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background The relationship between socioeconomic position (SEP) and adolescent physical activity is uncertain, as most evidence is limited to specific settings and a restricted number of SEP indicators. This study aimed to assess the magnitude of socioeconomic differences in adolescent vigorous physical activity (VPA) across various European countries using a wide range of SEP indicators, including family-based (education, family affluence, perceived social standing, parents’ employment, housing tenure) and adolescent-based (academic performance and pocket money) ones. Methods We used data from a survey among 10,510 students aged 14–17 from 50 schools in six European cities: Namur (BE), Tampere (FI), Hannover (DE), Latina (IT), Amersfoort (NL), Coimbra (PT). The questionnaire included socio-demographic characteristics and the amount of time spent in VPA. Results The mean time spent practicing VPA was 60.4 min per day, with lower values for Namur (BE) and Latina (IT), and higher values for Amersfoort (NL). In the multivariable analysis, both categories of SEP indicators (family-based and adolescent based indicators) were independently associated with VPA. For each SEP indicator, lower levels of VPA were recorded in lower socioeconomic groups. In the total sample, each additional category of low SEP was associated with a decrease in mean VPA of about 4 min per day. Conclusions This study showed that across European cities adolescent VPA is positively related to both family-based SEP and adolescents’ own SEP. When analysing socioeconomic differences in adolescent VPA, one should consider the use of multiple indicators of SEP. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10791-z.
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Affiliation(s)
- L Falese
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, via S. Angelo (Folcara), 03043, Cassino, FR, Italy.
| | - B Federico
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, via S. Angelo (Folcara), 03043, Cassino, FR, Italy
| | - A E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J Perelman
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - M Richter
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - A Rimpelä
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.,Department of Adolescent Psychiatry, Tampere University Hospital, Nokia, Finland
| | - V Lorant
- Institute of Health and Society, Université Catholique de Louvain, Bruxelles, Belgium
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20
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Velhinho A, Perelman J. Socioeconomic Inequalities in Food Consumption: A Cross-Sectional Study in Portuguese Adults. Port J Public Health 2021. [DOI: 10.1159/000515937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Food is a major determinant of chronic noncommunicable diseases. Because of this, social inequalities in food consumption will likely produce social inequalities in disease and life expectancy. <b><i>Objectives:</i></b> This study analyses the social inequalities in food consumption in Portugal and whether they differ between men and women and between younger and older people. <b><i>Methods:</i></b> Following a cross-sectional observational study, we analyzed data from 11,085 individuals aged 25–64 years who participated in the 2014 National Health Interview Survey (NHIS). Logistic regression models were used to measure the association between socioeconomic conditions, i.e., education and income, and food consumption. The analysis was then stratified by sex and age. <b><i>Results:</i></b> A positive gradient for income and education was observed in the consumption of fish, cakes, natural juices, and dairy products. The consumption of legumes and soft drinks was inversely related to income and education. A socioeconomic gradient for fruits and vegetables was observed only among women and older people. Worse-off people consumed less soup, and underprivileged women consumed fewer fast-food products. <b><i>Conclusion:</i></b> The food consumption patterns of Portuguese adults are related to their socioeconomic condition, with few variations across demographic categories.
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21
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Roxo L, Porto G, Perelman J. Combining jobs and motherhood: is it worse when raising children alone? J Public Health (Oxf) 2021; 44:507-515. [PMID: 33870411 DOI: 10.1093/pubmed/fdab048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Paid employment has been shown to benefit childless women's health, while employed mothers experience poorer health, and more pronounced fatigue. This study measures the association between job characteristics and the health and well-being of employed mothers and the differential susceptibility to job characteristics between coupled and single-parent mothers. METHODS We used data from the 5th Portuguese National Health Survey from 1649 employed women (aged 25-54) living with a child under 16. We modelled depression (assessed by the Personal Health Questionnaire-8) and self-reported health as a function of job characteristics, adding interaction terms to compare coupled and single-parent mothers, using logistic regressions. RESULTS Working part-time was associated with depression (odds ratio (OR) = 3.39, 95% confidence interval (CI) = 3.31-3.48) and less-than-good health (OR = 1.28, 95%CI = 1.26-1.31), compared to working full time. Compared to high-skill jobs, the likelihood for depression among low-skill occupations was lower among coupled mothers (OR = 0.25, 95%CI = 0.24-0.26), and higher among single-parent mothers (OR = 1.75, 95%CI = 1.54-1.99). Unstable jobs were associated with depression among coupled mothers. CONCLUSIONS Part-time jobs are detrimental for mothers' mental health, but high-skilled jobs are protective for single-parent mothers. Part-time and unstable jobs are linked to poorer self-reported health among coupled mothers. Results question the gendered arrangements that may face employed coupled mothers.
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Affiliation(s)
- L Roxo
- NOVA National School of Public Health, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal
| | - G Porto
- NOVA National School of Public Health, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal
| | - J Perelman
- NOVA National School of Public Health, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal.,Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal
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22
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Kislaya I, Leite A, Perelman J, Machado A, Torres AR, Tolonen H, Nunes B. Combining self-reported and objectively measured survey data to improve hypertension prevalence estimates: Portuguese experience. Arch Public Health 2021; 79:45. [PMID: 33827693 PMCID: PMC8028082 DOI: 10.1186/s13690-021-00562-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Accurate data on hypertension is essential to inform decision-making. Hypertension prevalence may be underestimated by population-based surveys due to misclassification of health status by participants. Therefore, adjustment for misclassification bias is required when relying on self-reports. This study aims to quantify misclassification bias in self-reported hypertension prevalence and prevalence ratios in the Portuguese component of the European Health Interview Survey (INS2014), and illustrate application of multiple imputation (MIME) for bias correction using measured high blood pressure data from the first Portuguese health examination survey (INSEF). METHODS We assumed that objectively measured hypertension status was missing for INS2014 participants (n = 13,937) and imputed it using INSEF (n = 4910) as auxiliary data. Self-reported, objectively measured and MIME-corrected hypertension prevalence and prevalence ratios (PR) by sex, age group and education were estimated. Bias in self-reported and MIME-corrected estimates were computed using objectively measured INSEF data as a gold-standard. RESULTS Self-reported INS2014 data underestimated hypertension prevalence in all population subgroups, with misclassification bias ranging from 5.2 to 18.6 percentage points (pp). After MIME-correction, prevalence estimates increased and became closer to objectively measured ones, with bias reduction to 0 pp - 5.7 pp. Compared to objectively measured INSEF, self-reported INS2014 data considerably underestimated prevalence ratio by sex (PR = 0.8, 95CI = [0.7, 0.9] vs. PR = 1.2, 95CI = [1.1, 1.4]). MIME successfully corrected direction of association with sex in bivariate (PR = 1.1, 95CI = [1.0, 1.3]) and multivariate analyses (PR = 1.2, 95CI = [1.0, 1.3]). Misclassification bias in hypertension prevalence ratios by education and age group were less pronounced and did not require correction in multivariate analyses. CONCLUSIONS Our results highlight the importance of misclassification bias analysis in self-reported hypertension. Multiple imputation is a feasible approach to adjust for misclassification bias in prevalence estimates and exposure-outcomes associations in survey data.
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Affiliation(s)
- Irina Kislaya
- Departament of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal.
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal.
| | - Andreia Leite
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Julian Perelman
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Ausenda Machado
- Departament of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Ana Rita Torres
- Departament of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Hanna Tolonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Baltazar Nunes
- Departament of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
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Schreuders M, van den Putte B, Mlinarić M, Mélard N, Perelman J, Richter M, Rimpela A, Kuipers MAG, Lorant V, Kunst AE. The Association Between Smoke-Free School Policies and Adolescents' Perceived Antismoking Norms: Moderation by School Connectedness. Nicotine Tob Res 2021; 22:1964-1972. [PMID: 31723975 PMCID: PMC7593364 DOI: 10.1093/ntr/ntz212] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/11/2019] [Indexed: 11/17/2022]
Abstract
Introduction Many European schools implement smoke-free school policies (SFSPs). SFSPs may decrease adolescent smoking by causing adolescents to perceive stronger antismoking norms, yet there exists no quantitative evidence that indicates for which norms and for whom such effects may occur. This study therefore assessed to what extent adolescents’ perceived antismoking norms among best friends, teachers, and society at large were associated with SFSPs, and whether these associations were moderated by adolescents’ level of school connectedness. Aims and Methods Survey data were collected in 2016/2017 on 10,653 adolescents aged 14–16 years old and 315 staff members in 55 schools from seven European cities. Associations of adolescent-perceived SFSPs and staff-reported SFSPs with best friend, teacher, and societal antismoking norms were estimated in multilevel logistic regression models, adjusted for demographics and school-level smoking prevalence. We tested for interaction between school connectedness and SFSPs. Results Adolescent-perceived SFSPs were positively associated with antismoking norms by teachers (odds ratio [OR]: 1.46, 95% confidence interval [CI]: 1.15–1.85), were negatively associated with antismoking norms by best friends (OR: 0.81, 95% CI: 0.67–0.99), but were not significantly associated with antismoking norms by society at large (OR: 0.87, 95% CI: 0.74–1.02). All interaction tests between adolescent-perceived SFSPs and school connectedness were nonsignificant. Staff-reported SFSPs were not associated with any norm and showed no significant interaction with school connectedness. Conclusions We found that SFSPs are associated with adolescents’ perception of more antismoking norms by teachers, but less antismoking norms by best friends, irrespective of adolescents’ level of school connectedness. Implications Smoke-free school policies, just as many other tobacco control policies, are assumed to foster adolescents’ perception of antismoking norms. Still, current evidence does not demonstrate which antismoking norms may be influenced by SFSPs and whether this influence is equal for adolescents with different levels of school connectedness. This study suggests that SFSPs foster adolescents’ perception of antismoking norms by teachers, but may concurrently lead to the perception of less antismoking norms by best friends, irrespective of adolescents’ school connectedness. SFSPs may therefore need to be complemented with interventions that target antismoking norms in adolescent peer groups.
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Affiliation(s)
- Michael Schreuders
- Department of Public Health, Amsterdam Public Health Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bas van den Putte
- Faculty of Social and Behavioural Sciences, Department of Communication, University of Amsterdam, Amsterdam, The Netherlands
| | - Martin Mlinarić
- Institute of Medical Sociology, Medical Faculty, Martin Luther University, Halle-Wittenberg, Germany
| | - Nora Mélard
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Julian Perelman
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin Luther University, Halle-Wittenberg, Germany
| | - Arja Rimpela
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.,Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Mirte A G Kuipers
- Department of Public Health, Amsterdam Public Health Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Vincent Lorant
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Anton E Kunst
- Department of Public Health, Amsterdam Public Health Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Perelman J, Serranheira F, Pita Barros P, Laires P. Does working at home compromise mental health? A study on European mature adults in COVID times. J Occup Health 2021; 63:e12299. [PMID: 34894172 PMCID: PMC8665463 DOI: 10.1002/1348-9585.12299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has transformed working at home (WAH) into the exclusive mode of working for many European workers. Although WAH will likely remain after COVID-19, its consequences on workers' health are unclear. This study examines the association of WAH and the change of four mental health (MH) domains. METHODS We used data from the last wave of the Survey on Health, Aging, and Retirement in Europe, collected in June and July 2020 on European people aged 50 and older. We restricted our analysis to people aged 50-65 who were working before COVID-19 (N = 7065). We modeled the risk of worsening of depression and anxiety feelings, sleeping trouble, and feelings of loneliness as a function of the working situation (usual setting, at home and usual setting, at home only), using logistic regressions. A first model adjusted for sociodemographic variables, a second one adding country fixed effects, and the last one adding the stringency of COVID-19-related restrictions. RESULTS WAH was significantly associated with a worsening of all MH symptoms. Nevertheless, when the stringency index was factored in, no significant association of WAH was found with any of the health outcomes except for anxiety feelings (+4.3% points). However, the increased anxiety feelings among people in WAH were not greater than the one observed among nonworkers. DISCUSSION Our findings show that WAH was not a major cause of mental health deterioration among European mature adults during the first month of the pandemic. Further evidence is needed on WAH under post-COVID-19 "normal" circumstances.
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Affiliation(s)
- Julian Perelman
- NOVA National School of Public Health, Public Health Research CentreUniversidade NOVA de LisboaLisbonPortugal
- Comprehensive Health Research CentreUniversidade NOVA de LisboaLisbonPortugal
| | - Florentino Serranheira
- NOVA National School of Public Health, Public Health Research CentreUniversidade NOVA de LisboaLisbonPortugal
- Comprehensive Health Research CentreUniversidade NOVA de LisboaLisbonPortugal
| | - Pedro Pita Barros
- Nova School of Business and EconomicsUniversidade NOVA de LisboaCarcavelosPortugal
| | - Pedro Laires
- NOVA National School of Public Health, Public Health Research CentreUniversidade NOVA de LisboaLisbonPortugal
- Comprehensive Health Research CentreUniversidade NOVA de LisboaLisbonPortugal
- NovartisBaselSwitzerland
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25
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Roxo L, Bambra C, Perelman J. Gender Equality and Gender Inequalities in Self-Reported Health: A Longitudinal Study of 27 European Countries 2004 to 2016. Int J Health Serv 2020; 51:146-154. [PMID: 33019863 PMCID: PMC8114429 DOI: 10.1177/0020731420960344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Significant gender-based health inequalities have been observed across Europe, with women reporting worse health than men. Still, there has been little examination of how the gender–health gap has changed over time, and how it has been shaped by societal gender equality. We used data from the Statistics on Income and Living Conditions Eurostat database (EU-SILC), involving 2,931,081 participants aged 25–64, for 27 European countries. Logistic regressions were performed to model the association between self-reported bad health and gender, in general and over time. Analyses were stratified by employment, education, and clusters of countries according to levels of Gender Equality Index (GEI). Adjusting for age, year, and country, bad health was 17% more likely among women, but this disadvantage ceased after accounting for education and employment. Gender–health inequalities were larger among countries with higher GEI scores and among low-educated groups. The gender–health gap did not reduce significantly between 2004 and 2016, in general and within subgroups. Although societies are becoming more equal, persistent inequalities in employment and income still lead to sustained health differences between men and women.
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Affiliation(s)
- Luis Roxo
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Clare Bambra
- Faculty of Medical Sciences, Institute for Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Julian Perelman
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal.,Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisboa, Portugal
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26
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Perelman J, Leão T, Kunst AE. Smoking and school absenteeism among 15- to 16-year-old adolescents: a cross-section analysis on 36 European countries. Eur J Public Health 2020; 29:778-784. [PMID: 31168621 PMCID: PMC6660109 DOI: 10.1093/eurpub/ckz110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Schools have a crucial role to play in preventing youth smoking. However, the well-known long-term health consequences of youth smoking may be insufficient to convince education stakeholders to devote efforts to implement school-based programmes. However, if youth smoking were to have short-term consequences, this evidence could prompt education stakeholders’ action. In this article, we investigate the link between smoking and school absenteeism. Methods We used data from the 2011 wave of the European School Survey Project on Alcohol and Other Drugs, on adolescents aged 15–16. We applied logistic models to assess the risk of more than 3 missed school days, by cause, as function of smoking intensity, adjusting for age, sex, socioeconomic status, academic performance, parental involvement and other risk behaviours (alcohol and cannabis consumption). Consistency was assessed by replicating the analyses for each sex and age group and further adjusting for depression and self-esteem. Results Smoking more than five cigarettes per day was significantly linked to school absenteeism, with a 55% excess risk of missing more than 3 school days per month due to illness (OR = 1.55, 95% CI 1.46–1.64), and a more than two times excess risk due to skipping (OR = 2.29; 95% CI 2.16–2.43). These findings were consistent across age and sex groups. Conclusion We observed an association between smoking intensity and absenteeism among youth in Europe. This implies that, to the extent that this association is causal, school tobacco control policies may reduce the short-term consequences of smoking on adolescents’ education and health.
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Affiliation(s)
- Julian Perelman
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Teresa Leão
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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27
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Perelman J, Avila A, Matias MA, Coelho M. Health and finance in the post-austerity context: the Portuguese experience. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
In March 2018, a Mission Structure (EMSPOS) was created in Portugal, under supervision of both Ministries of Health and Finance, to analyze the economic situation of the National Health Service (NHS), and propose recommendations to ensure its financial sustainability. The main concern was the recurrent cycles of overdue debt of NHS hospitals, which reached, in September 2018, more than 1.3 billion euros. These debts cycles, mainly to the pharmaceutical industry, were viewed as a combination of (i) under-budgeting during and following the Great Recession; (ii) expenditure growth related to population aging and new technologies; and (iii) a hospital financing and governance model that provided few incentives towards adequate management.
Hospitals' overdue debts limit their autonomy to assume investment compromises, while they deteriorate the NHS negotiation power vis-à-vis suppliers/creditors. Also, these debts were paid through financial bailouts, which shifted from punctual to predictable and regular, constituting an “indebtment reward” that destroyed any incentive towards efficiency and cost containment.
The challenge faced by EMSPOS was to ensure better budgets and autonomy to hospitals, both indispensable to face growing needs (the health sector claim), while providing the right monitoring and incentives to avoid new cycles of debt, inefficiencies, and unsustainable expenditure growth (the Ministry of Finance claim). This last request was reinforced by the Post-Program Surveillance (PPS), by the European Commission and Central Bank, that “measure Portugal's capacity to repay its outstanding loans”.
The EMSPOS proposed a new governance model that included better budgets with an efficiency-related performance component, a new management contract for hospitals' executive boards, and a path towards more investment autonomy, through the approval of “Activity and Budget Plans”. We will discuss the details of this new models and the challenges of its implementation.
Key messages
Portuguese NHS hospitals have been facing regular cycles of overdue debt, related to under-budgeting and inadequate governance models. Better budgets and hospital autonomy are needed to face growing needs (MoH claim), and right incentives are needed, to avoid inefficiencies and unsustainable expenditure growth (MoF claim).
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Affiliation(s)
- J Perelman
- National School of Public Health, Nova University of Lisbon, Lisbon, Portugal
- EMSPOS, Ministry of Finance, Lisbon, Portugal
| | - A Avila
- EMSPOS, Ministry of Finance, Lisbon, Portugal
| | - M A Matias
- EMSPOS, Ministry of Finance, Lisbon, Portugal
| | - M Coelho
- Ministry of Finance, Lisbon, Portugal
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28
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Roxo L, Porto G, Perelman J. Combining jobs and motherhood: is it worse when growing children alone? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Women combining paid job and motherhood may experience a poorer health status than those childless. This risk is expectedly higher among lone mothers due to their greater emotional, social, and economic vulnerability. This study aims to assess the impact of employment characteristics on the health of working mothers and to understand differences between lone and coupled mothers.
Methods
We used data from the 5th Portuguese National Health Survey from employed women (N = 1,649) aged 25-55 living with a child (<16). We modelled depression (assessed by the Personal Health Questionnaire-8) and less-than-good self-reported health as a function of employment variables (part-time job; self-employment; instable job situation; skill level and sector of activity) using logistic regressions, adjusting for age, family variables, socioeconomic status, and social support. Interaction terms assessed differences between lone and coupled mothers.
Results
Women in part-time (OR = 3.04, 95%CI=2.97-3.11), high-skilled jobs (OR = 3.57, 95%CI=1.30-1.38), and self-employed (OR = 1.34, 95%CI=1.30-1.38) had higher odds for depression, compared to those working in low-skilled, full time and not self-employed jobs. Less-than-good health was also more likely among those working part-time (OR = 1.34, 95%CI=1.31-1.36) and self-employed (OR = 1.34, 95%CI=1.31-1.37). Mothers' mental health disadvantage was amplified when alone regarding self-employment and part-time jobs.
Conclusions
Employed mothers' physical and mental health may be harmed by part-time jobs, self-employment, and working in more differentiated jobs. Employed lone mothers may experience greater risks than coupled mothers.
Key messages
Part-time, high-differentiated jobs or self-employment may harm the physical and mental health of working mothers. Lone mothers are disproportionately impacted by these employment characteristics.
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Affiliation(s)
- L Roxo
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - G Porto
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - J Perelman
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
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29
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Roxo L, Bambra C, Perelman J. Gender equality and inequalities in self-reported health in 27 European countries (2004 to 2016). Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Across Europe, women tend to report worse health than men, probably due to women's lower position in society. Although societal gender inequalities have decreased, differences persist regarding employment, income and use of time. This study aims to assess the evolution of gender-based inequalities in 27 European countries between 2004 and 2016, and to analyze the impact of societal gender equality in this evolution.
Methods
We used data from the Survey on Income and Living Conditions (EU-SILC), from subjects between 25 and 64 years old (N = 2,931,081) from 27 European countries. Logistic regressions were performed with bad self-reported health as dependent variable, first adjusted for age, country and year, and later also for education and employment. Interactions between gender and year were added to the models to assess changes over time. Countries were clustered according to their societal gender equality, based on their Gender Equality Index of 2005 and 2015 (GEI). Analyzes were stratified by education, employment and cluster of GEI.
Results
Women were 17% (OR = 1.17, 95%CI=1.15-1.19) more likely than men to report bad health. Considering education and employment, women were 3% less likely to report bad health (OR = 0.97, 95%CI=0.96-0.99). Gender-based inequalities were larger among the cluster with higher GEI (OR = 1.37, 95%CI=1.26-1.48) and those with lower education (OR = 1.21, 95%CI=1.18-1.24). Although the gender gap reduced from 26% (OR = 1.26, 95%CI=1.18-1.34) in 2004 to 16% (OR = 1.16, 95%CI=1.08-1.24) in 2016, the decrease was not significant. Differences between years were not significant when analyses were stratified for education, employment or cluster of GEI.
Conclusions
Gender-based inequalities persisted between 2014 and 2016 and were strongly related to differences in education and employment. The gender gap was larger among countries with greater societal gender equality.
Key messages
Women’s disadvantage in self-reported health persisted in 2016 and was connected to socioeconomic differences. The gender gap is not smaller in countries with greater societal gender equality.
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Affiliation(s)
- L Roxo
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - C Bambra
- Institute for Population Health Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - J Perelman
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
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30
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Roxo L, Perelman J. Gender-related treatment gap in depression among the elderly: a study on 18 European countries. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Depression is largely unrecognized and untreated, particularly among men. Help-seeking behaviors are known to differ between genders, yet, these discrepancies are expected to vary along the socioeconomic distribution. This study assesses the gender-related treatment gap for depression and analyzes how it varies with the socioeconomic status.
Methods
We used data from the Wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) from 56,931 participants aged 50-80 from 18 European countries. Among those depressed (assessed by the EURO-D scale), we modelled previous diagnosis of an emotional problem by a doctor, as proxy for the treatment gap. First, a logistic regression with gender as the explanatory variable was performed, adjusting for age and country. Afterwards, employment and education were factored in and interacted with gender, to assess the differential association of these variables for men and women.
Results
Depression was more prevalent among women (35.5%) than men (19.8%). Among those depressed, women (18.9%) were more likely than men (13.9%) to have been previously diagnosed for an emotional problem (OR = 1.43, 95%CI=1.42-1.43). Compared to men, women had a lower likelihood of diagnosis among homemakers (OR = 0.50, 95%CI=0.49-0.52) and a higher likelihood when unemployed (OR = 2.18, 95%CI=2.16-2.20), employed (OR = 1.10, 95%CI=1.10-1.11), disabled (OR = 1.20, 95%CI=1.19-1.21) with low (OR = 1.26, 95%CI=1.25-1.27) or middle educational level (OR = 1.67, 95%CI=1.66-1.68).
Conclusions
Although depression is more frequent among women, results suggest a larger treatment gap among men. Low- and medium-educated men seem less likely to have been previously diagnosed, as well as those unemployed. Among women, those homemakers are less likely to have been diagnosed with depression.
Key messages
Depressed men are less likely to have been diagnosed, particularly those unemployed and less-educated. Among women, depression diagnosis is less frequent when they are homemakers.
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Affiliation(s)
- L Roxo
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - J Perelman
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
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Leão T, Perelman J, Clancy L, Mlinarić M, Kinnunen JM, Nuyts PAW, Mélard N, Rimpelä A, Lorant V, Kunst AE. Economic Evaluation of Five Tobacco Control Policies Across Seven European Countries. Nicotine Tob Res 2020; 22:1202-1209. [PMID: 31350556 PMCID: PMC7291799 DOI: 10.1093/ntr/ntz124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 08/08/2019] [Indexed: 11/25/2022]
Abstract
Introduction Economic evaluations of tobacco control policies targeting adolescents are scarce. Few take into account real-world, large-scale implementation costs; few compare cost-effectiveness of different policies across different countries. We assessed the cost-effectiveness of five tobacco control policies (nonschool bans, including bans on sales to minors, bans on smoking in public places, bans on advertising at points-of-sale, school smoke-free bans, and school education programs), implemented in 2016 in Finland, Ireland, the Netherlands, Belgium, Germany, Italy, and Portugal. Methods Cost-effectiveness estimates were calculated per country and per policy, from the State perspective. Costs were collected by combining quantitative questionnaires with semi-structured interviews on how policies were implemented in each setting, in real practice. Short-term effectiveness was based on the literature, and long-term effectiveness was modeled using the DYNAMO-HIA tool. Discount rates of 3.5% were used for costs and effectiveness. Sensitivity analyses considered 1%–50% short-term effectiveness estimates, highest cost estimates, and undiscounted effectiveness. Findings Nonschool bans cost up to €253.23 per healthy life year, school smoking bans up to €91.87 per healthy life year, and school education programs up to €481.35 per healthy life year. Cost-effectiveness depended on the costs of implementation, short-term effectiveness, initial smoking rates, dimension of the target population, and weight of smoking in overall mortality and morbidity. Conclusions All five policies were highly cost-effective in all countries according to the World Health Organization thresholds for public health interventions. Cost-effectiveness was preserved even when using the highest costs and most conservative effectiveness estimates. Implications Economic evaluations using real-world data on tobacco control policies implemented at a large scale are scarce, especially considering nonschool bans targeting adolescents. We assessed the cost-effectiveness of five tobacco control policies implemented in 2016 in Finland, Ireland, the Netherlands, Belgium, Germany, Italy, and Portugal. This study shows that all five policies were highly cost-effective considering the World Health Organization threshold, even when considering the highest costs and most conservative effectiveness estimates.
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Affiliation(s)
- Teresa Leão
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.,Centro de Investigação em Saúde Pública, Lisboa, Portugal.,Local Health Unit of Matosinhos, Matosinhos, Portugal
| | - Julian Perelman
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.,Centro de Investigação em Saúde Pública, Lisboa, Portugal
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Martin Mlinarić
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Jaana M Kinnunen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Nora Mélard
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Arja Rimpelä
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Vincent Lorant
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Anton E Kunst
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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32
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Alves J, Filipe R, Machado J, Nunes B, Perelman J. Change in the Prevalence and Social Patterning of First-and Second-Hand Smoking in PORTUGAL: A Repeated Cross-Sectional Study (2005 and 2014). Int J Environ Res Public Health 2020; 17:ijerph17103594. [PMID: 32443801 PMCID: PMC7277527 DOI: 10.3390/ijerph17103594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022]
Abstract
Between 2005 and 2007, important reinforcements of the tobacco legislation have been implemented in Portugal, which may have affected smoking patterns. The aim of this study was to measure the change in prevalence of first- and second-hand smoking (SHS) among adults, and its socio-demographic patterning in Portugal from 2005 to 2014. Data from the last two Portuguese National Health Interview Surveys (2005 and 2014) were used. The changes in daily smoking and SHS were measured using Poisson regressions, stratifying by sex and survey year. The inequalities were measured using relative inequality indexes (RII). From 2005 to 2014, there was a reduction in SHS (75%-54% among men, and 52%-38% among women), and a reduction in smoking among men (27%-26%), and an increase among women (9%-12%). SHS reduction was more marked among less privileged people. Among Portuguese men, inequalities in daily smoking have increased slightly, while among women the gap favoring low-educated reduced. Between 2005 and 2014, SHS decreased, but not daily smoking, particularly among women. Additionally, socioeconomic inequalities in smoking increased. Future policies should simultaneously tackle smoking and SHS prevalence, and their socioeconomic patterning. More comprehensive policies such as comprehensive national (non-partial) bans, combined with price increases could be more effective.
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Affiliation(s)
- Joana Alves
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal;
- Correspondence: ; Tel.: +351 217 512 186
| | - Rita Filipe
- ACES Lisboa Ocidental e Oeiras—Public Health Unit, 2780-163 Oeiras, Portugal;
| | - João Machado
- Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, 1649-016 Lisboa, Portugal; (J.M.); (B.N.)
| | - Baltazar Nunes
- Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, 1649-016 Lisboa, Portugal; (J.M.); (B.N.)
| | - Julian Perelman
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisboa, Portugal;
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33
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Rimpelä A, Kinnunen JM, Lindfors P, Soto VE, Salmela-Aro K, Perelman J, Federico B, Lorant V. Academic Well-Being and Structural Characteristics of Peer Networks in School. Int J Environ Res Public Health 2020; 17:E2848. [PMID: 32326162 PMCID: PMC7216150 DOI: 10.3390/ijerph17082848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 11/16/2022]
Abstract
Peer networks at school and students' position in these networks can influence their academic well-being. We study here individual students' network position (isolation, popularity, social activity) and peer network structures at the school level (centralization, density, clustering, school connectedness) and their relations to students' academic well-being (school burnout, SB; schoolwork engagement, SE). Classroom surveys for 14-16-year-olds (N = 11,015) were conducted in six European cities (SILNE survey). Students were asked to nominate up to five schoolmates with whom they preferred to do schoolwork. SB and SE correlated negatively (-0.32; p < 0.0001). Students had on average 3.4 incoming (popularity; range 0-5) and 3.4 outgoing (social activity; 0-5) social ties. Percentage of isolated students was 1.4. Students' network position was associated weakly with academic well-being-popular students had less SB and higher SE, and socially active students had higher SE. School-level peer networks showed high clustering and school connectedness, but low density and low centralization. Clustering was associated with higher SB. Low centralization and high school connectedness protected from SB. Dense networks supported SE as did high average school connectedness. Correlations between these network indicators and academic well-being were, however, low. Our study showed that both students' network position and network characteristics at the school level can influence adolescents' academic well-being.
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Affiliation(s)
- Arja Rimpelä
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, 33014 Tampere, Finland; (A.R.); (P.L.)
- PERLA—Tampere Centre for Childhood, Youth and Family Research, Tampere University, 33014 Tampere, Finland
- Department of Adolescent Psychiatry, Tampere University Hospital, Pitkäniemi Hospital, 33380 Nokia, Finland
| | - Jaana M. Kinnunen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, 33014 Tampere, Finland; (A.R.); (P.L.)
- PERLA—Tampere Centre for Childhood, Youth and Family Research, Tampere University, 33014 Tampere, Finland
| | - Pirjo Lindfors
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, 33014 Tampere, Finland; (A.R.); (P.L.)
- PERLA—Tampere Centre for Childhood, Youth and Family Research, Tampere University, 33014 Tampere, Finland
| | - Victoria Eugenia Soto
- PROESA, Public Health Department, Universidad ICESI, Cali, Colombia;
- Institute of Health and Society, Université Catholique de Louvain, 1200 Brussels, Belgium;
| | | | - Julian Perelman
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, 1600-560 Lisboa, Portugal;
| | - Bruno Federico
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy;
| | - Vincent Lorant
- Institute of Health and Society, Université Catholique de Louvain, 1200 Brussels, Belgium;
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Leão T, Perelman J, Clancy L, Hoffmann L, Kinnunen JM, Mélard N, Nuyts PAW, Richter M, Rimpelä A, Lorant V, Kunst AE. Cost of youth tobacco-control policies in seven European countries. Eur J Public Health 2020; 30:374-379. [PMID: 31535140 PMCID: PMC7183368 DOI: 10.1093/eurpub/ckz150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Tobacco-control policies have been suggested to reduce smoking among adolescents. However, there is limited evidence on the real-world costs of implementation in different settings. In this study, we aimed at estimating the costs of school smoking bans, school prevention programmes and non-school bans (smoking bans in non-educational public settings, bans on sales to minors and bans on point-of-sale advertising), implemented in Finland, Ireland, the Netherlands, Belgium, Germany, Italy and Portugal, for 2016. METHODS We retrospectively collected costs related to the inspection, monitoring and sanctioning activities related to bans and educational activities related to smoking prevention programmes. We used an 'ingredients-based' approach, identifying each resource used, quantity and unit value for one full year, under the state perspective. Costs were measured at national, regional, local and school-level and were informed by data on how these activities were performed in reality. RESULTS Purchasing power parities adjusted-costs varied between €0.02 and €0.74 (average €0.24) per person (pp) for bans implemented outside schools. Mean costs of school smoking bans ranged from €3.31 to €34.76 (average €20.60), and mean costs of school educational programmes from €0.75 to €4.65 (average €2.92). CONCLUSIONS It is feasible to estimate costs of health policies as implemented in different settings. Costs of the tobacco control policies evaluated here depend mainly on the number of person-hours allocated to their implementation, and on the scale of intervention. Non-school bans presented the lowest costs, and the implementation of all policies cost up to €36 pp for 1 year.
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Affiliation(s)
- Teresa Leão
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa
- Public Health Unit, Local Health Unit of Matosinhos, Matosinhos, Portugal
| | - Julian Perelman
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa
| | - Luke Clancy
- Tobacco Free Research Institute, Dublin, Ireland
| | - Laura Hoffmann
- Institute of Medical Sociology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Jaana M Kinnunen
- Tampere University, Faculty of Social Sciences, Unit of Health Sciences, Tampere, Finland
| | - Nora Mélard
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Paulien A W Nuyts
- Department of Public Health, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Matthias Richter
- Institute of Medical Sociology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Arja Rimpelä
- Tampere University, Faculty of Social Sciences, Unit of Health Sciences, Tampere, Finland
- Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Vincent Lorant
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, The Netherlands
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Serrano-Alarcón M, Kunst AE, Bosdriesz JR, Perelman J. Retiring from smoking: Reply to Kleykamp (2019). Addiction 2020; 115:586-587. [PMID: 31691438 DOI: 10.1111/add.14879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jizzo R Bosdriesz
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Julian Perelman
- Escola Nacional de Saúde Pública, NOVA University of Lisbon, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Lisbon, Portugal
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Mrejen M, Perelman J, Machado DC. Environmental disasters and birth outcomes: Impact of a tailings dam breakage in Brazil. Soc Sci Med 2020; 250:112868. [PMID: 32113135 DOI: 10.1016/j.socscimed.2020.112868] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 02/15/2020] [Accepted: 02/18/2020] [Indexed: 11/24/2022]
Abstract
There is evidence of a relationship between in utero exposure to catastrophic events and adverse birth outcomes, usually attributed to heightened maternal stress. The objective of our work was to evaluate if the breakage of a dam containing wastefrom a mining cite in Brazil, in 2015, an environmental disaster popularly known as the Mariana Tragedy, affected the health of newborns exposed in utero. We used administrative data on birth records and reports on the Mariana Tragedy to identify all births from newborns exposed in utero and the intensity of that exposure, according to the mother's municipality of residence. Using a difference-in-differences framework, we estimated the impact of different intensities of exposure on birth outcomes. We found that being directly exposed in utero to the Tragedy resulted in 1.86 days shorter gestational age and 2.6 percentage points higher incidence of preterm birth (<37 weeks). We found no impact on birthweight related outcomes. The effect is larger than previously identified for other catastrophic events. We hypothesize that this is probably due to the Tragedy impacting birth outcomes not exclusively through heightened maternal stress, but also through depressed economic activity in directly affected municipalities.
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Affiliation(s)
- Matias Mrejen
- Graduate Program in Economics, Fluminense Federal University. R. Prof. Marcos Waldemar de Freitas Reis, Gragoata Campus, Building, F.Zip-code: 24210-201, Niteroi, RJ, Brazil.
| | - Julian Perelman
- National School of Public Health, NOVA University of Lisbon, Av. Padre Cruz. Zip-code: 1600-560, Lisboa, Portugal
| | - Danielle Carusi Machado
- Graduate Program in Economics, Fluminense Federal University. R. Prof. Marcos Waldemar de Freitas Reis, Gragoata Campus, Building, F.Zip-code: 24210-201, Niteroi, RJ, Brazil
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Leão T, Perelman J. Depression symptoms as mediators of inequalities in self-reported health: the case of Southern European elderly. J Public Health (Oxf) 2019; 40:756-763. [PMID: 29294060 DOI: 10.1093/pubmed/fdx173] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/27/2017] [Indexed: 11/13/2022] Open
Abstract
Background Inequalities in the distribution of self-reported health (SRH) have been widely reported. Its higher expressivity among women, elderly and least educated groups has been partly attributed to differences in their health perceptions. However, this subjectivity may be masking the burden of mental illness in these groups. Thus, we sought to understand if depression symptoms mediate inequalities in SRH. Methods SHARE waves 4 and 6, pertaining to Spain, Italy and Portugal, were used (n2011 = 8517, n2015 = 11 046). Inequalities in SRH were calculated, comparing the risk amongst education level, gender and age groups, adjusting for chronic diseases, functional limitations and country fixed effects. We then tested depression symptoms as mediators. Results Depression symptoms were associated with poor SRH (odds ratio (OR)2011 = 1.379, OR2015 = 1.384, P < 0.001). Their inclusion reduced the magnitude of the association between SRH and education, annulled the statistical significance for age, and reversed the gender effect. As expected, chronic diseases and functional limitations remained significant predictors of poor SRH. Conclusions Depression symptoms, together with chronic diseases and functional limitations, explain the poorer SRH of the least educated, female and older groups in the Southern European population. Therefore, tackling inequalities in SRH must require focusing on mental health issues, which disproportionately affect the most vulnerable groups.
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Affiliation(s)
- T Leão
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - J Perelman
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.,Centro de Investigação em Saúde Pública, Lisboa, Portugal
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Anastasi D, Federico B, Rimpela A, Richter M, Clancy L, Perelman J, Kunst AE, Lorant V. Prevalence of home smoking bans in six European cities: a repeated cross-sectional study (2013-2016). Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Secondhand smoke exposure is responsible for over half a million premature deaths. With regulation now reducing smoking in most public enclosed spaces, one major source of indoor exposure remains the home environment. Home smoking bans (HSBs) are household rules that restrict smoking from certain (partial HSB) or all areas (complete HSB). Recent data suggest growing trends of HSB adoption over time, but it is not known whether time trends vary according to household characteristics.
Objectives
The aim of this study is to examine changes in the prevalence of HSB in six European cities between 2013 and 2016, according to socioeconomic characteristics of the household and smoking behavior of household members.
Methods
Data were collected in all schools participating in both waves of SILNE study in 6 European cities. A self-administered questionnaire was used, targeting students age 14 to 16 (n = 22,326). Students reported their parents’ smoking status and if there was a HSB at their home. Detailed information on socio-economic characteristics were collected as well.
Results
Between 2013 and 2016 the percentage of households with a complete HSB increased from 51.5% to 53.1%, while partial HSB increased from 30.7% to 32.1%. The prevalence of HSB increased in Hannover (G), Latina (I), Amersfoort (N) and Coimbra (P), whereas decreased in Namur (B) and Tampere (F). Socioeconomic differences in HSB were reduced, with larger increases in HSB in households with a lower parental educational level. Increases in HSB were observed among intact households, those without migration background and those with non-smoking parents.
Conclusions
The increase in the prevalence of HSB observed in most cities and throughout a variety of household types and characteristics between 2013 and 2016 may reflect the effect of smoking denormalization in different social contexts. Further actions of the tobacco control community should target the most vulnerable groups.
Key messages
The percentage of households with a complete HSB increased between 2013 and 2016 in 4 out of 6 European cities. Increases in the prevalence of HSB over time were observed across all socio-economic groups.
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Affiliation(s)
- D Anastasi
- Department of Human Sciences, Society and Health, Università di Cassino, Cassino, Italy
| | - B Federico
- Department of Human Sciences, Society and Health, Università di Cassino, Cassino, Italy
| | - A Rimpela
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - M Richter
- Institute of Medical Sociology, Martin Luther University, Halle-Wittenberg, Germany
| | - L Clancy
- TobaccoFree Research Institute, Dublin, Ireland
| | - J Perelman
- Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - A E Kunst
- Department of Public Health, University of Amsterdam, Amsterdam, Netherlands
| | - V Lorant
- Institute of Health and Society, UCLouvain, Brussels, Belgium
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Leão T, Kunst AE, Schreuders M, Lindfors P, Kuipers MA, Perelman J. Adolescents' smoking environment under weak tobacco control: A mixed methods study for Portugal. Drug Alcohol Depend 2019; 204:107566. [PMID: 31568935 DOI: 10.1016/j.drugalcdep.2019.107566] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Bans on smoking in public places and on sales to minors have been widely implemented across the globe. However, many countries have either adopted non-comprehensive (i.e., partial) bans and/or weakly enforce those bans. Little is known, from the adolescents' perspective, how this affects their smoking-related perceptions and behaviors. We studied the case of Portugal, where bans are partial and/or weakly enforced. We sought to understand how the bans affect adolescents' access to cigarettes from commercial sources, the visibility of smoking in public places, and smoking locations. MATERIAL AND METHODS We used a mixed methods design on data gathered in 2016. Quantitative, cross-sectional surveys were conducted in six schools (n = 2,444) in Coimbra, Portugal. In two of these schools, qualitative data were collected in eight single-sex focus group interviews (n = 42). RESULTS Ninety-five percent of the adolescents who tried to buy cigarettes were able to do so from commercial sources, through vending machines, or directly from the vendor. Bans on smoking on school premises and at enclosed public places did not prevent these adolescents from observing smoking outside school gates (84.0%), in cafes and restaurants (97%), or from smoking at cafes, bars, or nightclubs (72.9%). DISCUSSION Partial and/or weakly enforced policies seem to not prevent adolescents from having access to cigarettes, frequently seeing smoking, and finding ample opportunities to smoke in public places. Adopting and enforcing comprehensive policies are necessary efforts to prevent unfavorable responses and more effectively reduce adolescents' smoking behavior.
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Affiliation(s)
- Teresa Leão
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal; Public Health Unit, Matosinhos Local Health Unit, Rua Dr. Eduardo Torres, 4464-513, Senhora da Hora, Portugal.
| | - Anton E Kunst
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Michael Schreuders
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Pirjo Lindfors
- Faculty of Social Sciences, 33014 Tampere University, Finland
| | - Mirte Ag Kuipers
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Julian Perelman
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal
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Roxo L, Perelman J. Gender inequality in self-reported health and its evolution in Europe between 2004 and 2016. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
That women generally have worse health than men has long been shown. Yet, the situation in Europe might have changed recently. Gender inequalities have decreased in access to education, employment, and political representation. However, women have increasingly adopted traditionally masculine unhealthy behaviors, such as smoking. Also, the Great Recession may have hurt women harder, due to their greater socioeconomic vulnerability. This study aims to analyze gender inequalities in 30 European countries, and its evolution over the 2004-2016 period.
Methods
We used data from the Survey on Income and Living Conditions (SILC), from people between 25 and 64 years old (N = 3,109,150). We modeled the probability of bad/very bad self-reported health as function of gender, adjusting for age, country and year, using logistic regressions. We further adjusted for education and employment. Then, we included interactions of gender and year to test changes in inequalities over time. Finally, we stratified the analysis according to countries grouped based on the Gender Development Index (GDI).
Results
Women were 16.8% more likely to report bad health (OR = 1.17, p < 0.01). Considering education and employment, women were 2.6% less likely to report bad health (OR = 0.97, p < 0.01). Over time, adjusting for age, the gender gap reduced from 81.1% (OR = 1.81, p < 0.01) in 2004 to 16.4% in 2016 (OR = 1.16, p < 0.01), and from 31.5% to 2.5% with socioeconomic adjustment. The reduction was larger in countries with a greater GDI.
Conclusions
Gender inequality has decreased, but was still present in 2016, in favor of men. This thinning is partly explained by the narrowing of inequalities in education and employment. A greater GDI has favored a larger improvement.
Key messages
Gender inequalities in self-reported health have narrowed over 2004-2006, following the narrowing of socioeconomic inequalities. A greater GDI has favored a larger improvement in gender inequalities.
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Affiliation(s)
- L Roxo
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - J Perelman
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
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Schreuders M, Kuipers MA, Mlinarić M, Grard A, Linnansaari A, Rimpela A, Richter M, Perelman J, Lorant V, van den Putte B, Kunst AE. The association between smoke-free school policies and adolescents' anti-smoking beliefs: Moderation by family smoking norms. Drug Alcohol Depend 2019; 204:107521. [PMID: 31476644 DOI: 10.1016/j.drugalcdep.2019.06.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/01/2019] [Accepted: 06/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Smoke-free school policies (SFSPs) may influence adolescents' smoking through the development of anti-smoking beliefs. We assessed which types of anti-smoking beliefs (health, social and societal) are associated with SFSPs and whether these associations were different for adolescents in smoking permissive versus prohibitive families. METHODS Survey data was collected in 2016-2017 from 10,980 adolescents between 14-16 years old and 315 staff in 55 schools from seven European cities. We separately measured adolescent-perceived SFSP and staff-reported SFSP at the school-level. Associations between SFSP and anti-smoking health, social and societal beliefs were studied using multi-level logistic regression, adjusting for demographics and school-level smoking prevalence. We tested for interactions between family norms and SFSP, and estimated associations for adolescents in permissive and prohibitive families, respectively. RESULTS Adolescent-perceived SFSP was not significantly associated with anti-smoking health (OR:1.08, 95%CI:0.94-1.25), social (OR:0.89, 95%CI:0.75-1.04) and societal beliefs (OR:1.15, 95%CI:0.99-1.33). Staff-reported SFSP were associated with anti-smoking health beliefs (OR:1.12, 95%CI:1.01-1.24), but not with social (OR:0.94, 95%CI:0.83-1.07) or societal beliefs (OR:1.02, 95%CI:0.90-1.14). Most results were comparable between adolescents in smoking prohibitive and permissive families. However, in smoking prohibitive families, adolescent-perceived SFSP were associated with societal beliefs (OR:1.24, 95%CI:1.06-1.46), but not in permissive families (OR:1.06, 95%CI:0.90-1.25). Also, in smoking permissive families, staff-reported SFSP were associated with more pro-smoking social beliefs (OR:0.83, 95%CI:0.72-0.96), but not in prohibitive families (OR:1.05, 95%CI:0.92-1.16). CONCLUSIONS We found evidence that SFSP are associated with some anti-smoking beliefs, but more so among adolescents from smoking prohibitive families than from permissive families.
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Affiliation(s)
- Michael Schreuders
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, the Netherlands.
| | - Mirte Ag Kuipers
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, the Netherlands
| | - Martin Mlinarić
- Institute of Medical Sociology, Medical Faculty, Martin Luther University, Halle-Wittenberg, Germany
| | - Adeline Grard
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Anu Linnansaari
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland
| | - Arja Rimpela
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland; Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin Luther University, Halle-Wittenberg, Germany
| | - Julian Perelman
- National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - Vincent Lorant
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Bas van den Putte
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, the Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, the Netherlands
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Moor I, Kuipers MAG, Lorant V, Pförtner TK, Kinnunen JM, Rathmann K, Perelman J, Alves J, Robert PO, Rimpelä A, Kunst AE, Richter M. Inequalities in adolescent self-rated health and smoking in Europe: comparing different indicators of socioeconomic status. J Epidemiol Community Health 2019; 73:963-970. [DOI: 10.1136/jech-2018-211794] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 05/02/2019] [Accepted: 06/27/2019] [Indexed: 11/03/2022]
Abstract
BackgroundAlthough there is evidence for socioeconomic inequalities in health and health behaviour in adolescents, different indicators of socioeconomic status (SES) have rarely been compared within one data sample. We examined associations of five SES indicators with self-rated health (SRH) and smoking (ie, a leading cause of health inequalities) in Europe.MethodsData of adolescents aged 14–17 years old were obtained from the 2013 SILNE survey (smoking inequalities: learning from natural experiments), carried out in 50 schools in 6 European cities (N=10 900). Capturing subjective perceptions of relative SES and objective measures of education and wealth, we measured adolescents’ own SES (academic performance, pocket money), parental SES (parental educational level) and family SES (Family Affluence Scale, subjective social status (SSS)). Logistic regression models with SRH and smoking as dependent variables included all SES indicators, age and gender.ResultsCorrelations between SES indicators were weak to moderate. Low academic performance (OR=1.96, 95% CI 1.53 to 2.51) and low SSS (OR=2.75, 95% CI 2.12 to 3.55) were the strongest indicators of poor SRH after adjusting for other SES-indicators. Results for SSS were consistent across countries, while associations with academic performance varied. Low academic performance (OR=5.71, 95% CI 4.63 to 7.06) and more pocket money (OR=0.21, 95% CI 0.18 to 0.26) were most strongly associated with smoking in all countries.ConclusionsSocioeconomic inequalities in adolescent health were largest according to SES indicators more closely related to the adolescent’s education as well as the adolescent’s perception of relative family SES, rather than objective indicators of parental education and material family affluence. For future studies on adolescent health inequalities, consideration of adolescent-related SES indicators was recommended.
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Almendra R, Perelman J, Vasconcelos J, Santana P. Excess winter mortality and morbidity before, during, and after the Great Recession: the Portuguese case. Int J Biometeorol 2019; 63:873-883. [PMID: 30847575 DOI: 10.1007/s00484-019-01700-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/07/2019] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
Although winter mortality and morbidity are phenomena common to most European countries, their magnitude varies significantly from country to country. The geographical disparities among regions with similar climates are the result of several social, economic, demographic, and biological conditions that influence an individual's vulnerability to winter conditions. The impact of poor socioeconomic conditions may be of such magnitude that an economic recession may aggravate the seasonal mortality pattern. This paper aims to measure the seasonal winter mortality, morbidity, and their related costs during the Great Recession (2009-2012) in mainland Portugal and its Regional Health Administrations (RHAs) and to compare it with the periods preceding and following it. Monthly mortality and morbidity data were collected and clustered into three periods: Great Recession (2009-2012), Pre-Recession (2005-2008), and Post-Recession (2013-2016). The impact of seasonal winter mortality and morbidity during the Great Recession in Portugal and its Regional Health Administrations was measured through the assessment of age-standardized excess winter (EW) death and hospital admissions rate and index, expected life expectancy gains without EW deaths, EW rate of potential years of life lost, and EW rate of emergency hospital admission costs. Important increases of winter deaths and hospital admissions were identified, resulting in an important number of potential years of life lost (87 years of life lost per 100,000 inhabitants in 2009-2012), life expectancy loss (1 year in 2009-2012), and National Health Service costs with explicit temporal and spatial variations. These human and economic costs have decreased consistently during the analyzed periods, while no significant increase was found during the Great Recession. Despite its reduction, the winter excess morbidity and mortality highlight that Portugal still faces substantial challenges related to a highly vulnerable population, calling for investments in better social and health protection.
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Affiliation(s)
- Ricardo Almendra
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal.
| | - Julian Perelman
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Joao Vasconcelos
- Polytechnic Institute of Leiria, IGOT/CEG Universidade de Lisboa, Lisbon, Portugal
| | - Paula Santana
- Centre of Studies on Geography and Spatial Planning, Department of Geography, University of Coimbra, Coimbra, Portugal
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Szabzon F, Perelman J, Dias S. Challenges for psychosocial rehabilitation services in the Lisbon Metropolitan Area: A qualitative approach. Health Soc Care Community 2019; 27:e428-e437. [PMID: 30888096 DOI: 10.1111/hsc.12743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 01/30/2019] [Accepted: 02/25/2019] [Indexed: 06/09/2023]
Abstract
In Portugal, a mental health reform process is in place aiming to redefine the model of service provision. In 2008, a National Mental Health Plan (NMHP) was approved to provide policy guidance over the transition period. The NMHP intended, among others, to develop community-based services, with a specific focus on rehabilitation and deinstitutionalization. This study aims to explore the perspectives of service managers of psychosocial rehabilitation services regarding the main challenges to support the community living of persons with severe mental illnesses (PWSMI) in the Lisbon Metropolitan Area (LMA). The paper also contextualises the provision of psychosocial services within the country's mental health reform process and characterises the profile of service users in socio-occupational units (SOUs) of the LMA. Semi-structured interviews were performed with all SOUs' managers of the LMA (n = 13). Information regarding service user characteristics was collected based on service records (n = 344). Interviews were analysed according to the framework methodology. The results of the interviews were triangulated using document analysis. Fieldwork took place between June and July 2016. The findings suggest that the development of the mental health reform ensured significant changes to service delivery. Community-based mental health organisations are an important actor for service provision. However, important asymmetries were identified in the provision of psychosocial care within the LMA. At the same time, family carers are perceived as responsible for ensuring a large part of the social needs of the PWSMI but there is an increasing concern with their own ageing processes. As a conclusion, it is highlighted the current inequality between services and the need to contemplate a life-course perspective that comprehends the ageing process of caregivers poses an emerging challenge for psychosocial rehabilitation. These findings are also important for other low- and middle-income countries passing through similar reforms.
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Affiliation(s)
- Felipe Szabzon
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa
| | - Julian Perelman
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa
| | - Sónia Dias
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa
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Leão T, Perelman J. Erratum: Depression symptoms as mediators of inequalities in self-reported health: the case of Southern European elderly. J Public Health (Oxf) 2019; 41:428. [DOI: 10.1093/pubmed/fdy130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Indexed: 11/13/2022] Open
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Serrano‐Alarcón M, Kunst AE, Bosdriesz JR, Perelman J. Tobacco control policies and smoking among older adults: a longitudinal analysis of 10 European countries. Addiction 2019; 114:1076-1085. [PMID: 30868688 PMCID: PMC6593806 DOI: 10.1111/add.14577] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/04/2018] [Accepted: 01/30/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS The impact of tobacco control on European older adults has not been studied, despite evidence that smoking cessation at old age can bring significant life expectancy gains. Our aim was to evaluate the impact of tobacco control policies on smoking among older adults in Europe from 2004 to 2013. DESIGN We used longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE, aged 50+ years) from four waves from 2004 to 2013. We used logistic regression models with clustered standard errors to determine whether the implementation of tobacco control policies was associated with changes in smoking status. Furthermore, we studied whether these associations varied by socio-demographic characteristics. Regression coefficients were converted to changes the probability of smoking [marginal effects (ME)]. MEASUREMENTS Smoking status was the dependent variable, and the Tobacco Control Scale (TCS) was the explanatory variable, overall and by its main policy components (pricing and smoke-free policies). Covariates included age, sex, education and country and wave fixed-effects. FINDINGS A 10-point increase in TCS was associated with a lower probability of smoking by 1.6 percentage points [95% confidence interval (CI) = -3.208, -0.056] for those aged 50-65, but not for older Europeans. Among those with primary school or no education, the associated drop was of 1.5 percentage points (95% CI = -2.751, -0.253). By contrast, no significant relation between TCS and smoking was observed among those with high education. Higher TCS scores for pricing (ME = -0.636, 95% CI = -0.998, -0.275) and smoke-free policies (ME = -0.243, 95% CI = -0.445, -0.041) were associated with a significantly lower probability of smoking (P = 0.001 and P = 0.018, respectively). CONCLUSION Increases in tobacco taxes and smoke-free policies are significantly related with a reduction in smoking among European older adults, suggesting potential health gains for this rising share of the population. These policies may be more effective among the lowest educated.
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Affiliation(s)
| | - Anton E. Kunst
- Department of Public Health, Academic Medical CenterUniversity of Amsterdamthe Netherlands
| | - Jizzo R. Bosdriesz
- Leiden University, Institute of Education and Child Studiesthe Netherlands
| | - Julian Perelman
- Escola Nacional de Saúde PúblicaNOVA University of LisbonPortugal,Centro de Investigação em Saúde PúblicaPortugal
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Aristides Dos Santos AM, Perelman J, Jacinto PDA, Tejada CAO, Barros AJD, Bertoldi AD, Matijasevich A, Santos IS. Income-related inequality and inequity in children's health care: A longitudinal analysis using data from Brazil. Soc Sci Med 2019; 224:127-137. [PMID: 30772611 PMCID: PMC6411923 DOI: 10.1016/j.socscimed.2019.01.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/09/2019] [Accepted: 01/17/2019] [Indexed: 11/29/2022]
Abstract
The Brazilian Unified Health System was created in the late 1980s to ensure free universal access to health care and was funded by taxes and social contributions. The persistent inequity in access to health services in favour of richer individuals in Brazil has been observed in the literature. However, to the best of our knowledge, no measurement of inequality in medicine use or private health insurance (PHI) among children has been performed with longitudinal data. This paper uses inequality indices and their decompositions to analyse the income-related inequalities/inequities in children's health care in the city of Pelotas, Brazil, using longitudinal data following children from 12 to 72 months of age. Our sample with data in all waves has between 1877 and 2638 children (varying according to outcome). We seek to answer three questions: i) How does the inequality/inequity in health care evolve as children grow up? ii) What are the main factors associated with inequality in children's health care? iii) How much of the change in inequality/inequity is explained by mobility in children's health care and income mobility? We found that inequities in health care have their beginnings in early childhood but that there was a reduction in inequity at 72 months of age. Ownership of children's PHI was associated with greater pro-rich inequity in health care. The reduction in inequality/inequity was linked to mobility in the sense that initially poorer children had greater gains in health care (a greater increase in PHI ownership and a lower reduction in medicine use). Despite this improvement among the poorest, apparently, the Brazilian public health service seems to fail to ensure equity in health care use among children, with possible long-term consequences on inequalities in health. The inequities in health care have their beginnings even in early childhood. Income and mother's education have a strong contribution in the inequalities. Private health insurance has strong contribution in inequalities of medicine use. There was reduction in inequity for children's health care in Pelotas/Brazil. This improvement for poorest children occurred when they reached 72 months.
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Affiliation(s)
| | - Julian Perelman
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Portugal
| | | | | | - Aluísio J D Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil
| | - Andréa D Bertoldi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil
| | - Alicia Matijasevich
- Department of Preventive Medicine, Faculty of Medicine, FMUSP, University of São Paulo, Brazil
| | - Iná S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil
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Lorant V, Perelman J, Kapadia D, Mackenbach J. Socio-economic inequalities in suicide across European countries: causation or confounding? Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky213.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V Lorant
- Université catholique de Louvain, Bruxelles, Belgium
| | - J Perelman
- Escola Nacional de Saúde Pública, Lisbon, Portugal
| | - D Kapadia
- University of Manchester, Manchester, UK
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Peralta-Santos A, Perelman J. Who wants to cross borders in the EU for healthcare? An analysis of the Eurobarometer data in 2007 and 2014. Eur J Public Health 2018; 28:879-884. [PMID: 29697799 DOI: 10.1093/eurpub/cky071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The European Union (EU) Directive on Patients' Rights in Cross-border Healthcare clarified the entitlements to medical care in other EU Member states. However, little is known about whether EU citizens have been travelling or are willing to travel to receive care. This study aimed to measure the determinants of cross-border patient mobility and willingness to travel to receive medical care in the EU, before and after the adoption of the Directive. Methods We used individual data from the Eurobarometer 210 (2007) and 425 (2014). In the 2 years, 53 439 EU citizens were randomly selected. We performed a logistic regression on the cross-border patient mobility and willingness to travel to other EU countries to use healthcare services as a function of the year (2007 or 2014), adjusting for age, gender, education and country size. Results In 2007, 3.3% of citizens reported cross-border mobility and 4.6% in 2014. The odds of cross-border patients' mobility were 11% higher in 2014, compared with 2007 [odds ratio (OR) 1.11, 95% confidence interval (CI) 1.02-1.21]. Also, mobility was 19% higher in males (OR 1.19, 95% CI 1.08-1.30) and 20% higher amongst the more educated (OR 1.20, 95% CI 1.09-1.31). However, the odds decreased 11% per decade of age (OR 0.89 per decade, 95% CI 0.85-0.93) and country size. In 2014, the willingness to travel decreased by 20% compared with 2007. Conclusions Cross-border patient mobility is more likely amongst the younger, the more educated and those from smaller countries. The directive does not seem to have promoted mobility at a large scale among the neediest citizens.
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Affiliation(s)
- André Peralta-Santos
- Department of Health Economics, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa Av. Padre Cruz, Lisboa, Portugal.,Public Health Research Center, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa Av. Padre Cruz, Lisboa, Portugal
| | - Julian Perelman
- Department of Health Economics, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa Av. Padre Cruz, Lisboa, Portugal.,Public Health Research Center, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa Av. Padre Cruz, Lisboa, Portugal
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50
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Coban FR, Kunst AE, Van Stralen MM, Richter M, Rathmann K, Perelman J, Alves J, Federico B, Rimpelä A, Lorant V, Kuipers MAG. Nicotine dependence among adolescents in the European Union: How many and who are affected? J Public Health (Oxf) 2018; 41:447-455. [DOI: 10.1093/pubmed/fdy136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 06/15/2018] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
Background
Nicotine dependence during adolescence increases the risk of continuing smoking into adulthood. The magnitude of nicotine dependence among adolescents in the European Union (EU) has not been established. We aimed to estimate the number of nicotine dependent 15-year-old adolescents in the EU, and identify high-risk groups.
Methods
The number of nicotine dependent 15-year-olds in the EU was derived combining: (i) total number of 15-year-olds in the EU (2013 Eurostat), (ii) smoking prevalence among 15-year-olds (2013/2014 HBSC survey) and (iii) proportion of nicotine dependent 15-year-olds in six EU countries (2013 SILNE survey). Logistic regression analyses identified high-risk groups in the SILNE dataset.
Results
We estimated 172 636 15-year-olds were moderately to highly nicotine dependent (3.2% of all 15 years old; 35.3% of daily smokers). In the total population, risk of nicotine dependence was higher in males, adolescents with poor academic achievement, and those with smoking parents or friends. Among daily smokers, only lower academic achievement and younger age of smoking onset were associated with nicotine dependence.
Conclusion
According to our conservative estimates, more than 172 000 15-year-old EU adolescents were nicotine dependent in 2013. Prevention of smoking initiation, especially among adolescents with poor academic performance, is necessary to prevent a similar number of adolescents getting addicted to nicotine each consecutive year.
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Affiliation(s)
- F R Coban
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - A E Kunst
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M M Van Stralen
- Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - M Richter
- Institute of Medical Sociology (IMS), Martin Luther University Halle-Wittenberg, Halle, Germany
| | - K Rathmann
- Institute of Medical Sociology (IMS), Martin Luther University Halle-Wittenberg, Halle, Germany
- Faculty for Rehabilitation Science, TU, Dortmund, Germany
| | - J Perelman
- Centro de Incestigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Portugal
| | - J Alves
- Centro de Incestigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Portugal
| | - B Federico
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy
| | - A Rimpelä
- School of Health Sciences, Faculty of Social Sciences, University of Tampere, Tampere, Finland
- Department of Adolescent Psychiatry, Pitkäniemi Hospital, Nokia, Tampere University Hospital, Tampere, Finland
| | - V Lorant
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Institute for Health and Society & Faculty of Public Health, Université Catholique de Louvain, Brussels, Belgium
| | - M A G Kuipers
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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