Hospital inpatients costs dynamics at older ages: A frequency-severity approach

This paper studies the dynamics in end-of-life inpatients hospital expenses. A new model is proposed for hospital care expenditures based on a frequency-severity decomposition including age, calendar time, longevity dynamics, and time-to-death. These features are treated as continuous explanatory variables in nonlinear regression models with Poisson, Gamma and Tweedie error structures. Proximity to death is controlled for, as well as longevity improvements by including projected life tables into the proposed model. This allows the analyst to isolate the different effects impacting late-life hospital costs. A detailed case study performed on Belgian data illustrates the modeling strategy proposed in this paper. A comparison with the alternative model targeting total costs, not distinguishing between frequency and severity components, demonstrates the superior explanatory power of the proposed approach, revealing that total costs are mainly driven by their frequency component for the data under consideration

The missing link between poverty and child maltreatment: Parental burnout

Background Child maltreatment remains a major social welfare and public health issue. The relationship between SES and child maltreatment has been intensively studied. And syntheses of meta-analyses have identified low SES as one of the five major antecedents of child maltreatment. Objective The underlying mechanism that explains the association between low SES and child maltreatment, has however not been clearly demonstrated. Participants and setting In a sample of 3429 parents (51.53 % low SES), we postulated a double mediation to explain this relationship, namely that low SES increased the imbalance between the parent's risk and resource factors, and that this imbalance in turn increased parental burnout, which itself increased parental neglect and violence. Methods We estimated three successive models encompassing the direct and indirect effects of low SES on the imbalance between risk and resource factors, parental burnout, parental neglect and parental violence. Results The results provide little support for the direct effect of poverty on parental burnout, parental neglect and parental violence. They rather confirm the mediating role of the imbalance between risk and resource factors and parental burnout. Conclusions Parental burnout could be the missing link between poverty and child maltreatment. The results are discussed for research and clinical purposes

Consequences of parental burnout: Its specific effect on child neglect and violence

Parental burnout is a specific syndrome resulting from enduring exposure to chronic parenting stress. It encompasses three dimensions: an overwhelming exhaustion related to one’s parental role, an emotional distancing from one’s children and a sense of ineffectiveness in one’s parental role. This study aims to facilitate further identification of the consequences of parental burnout for the parents themselves, their spouses and their child(ren). In a sample of 1551 parents, we examined the relationship between parental burnout and seven possible consequences: escapism and suicidal thoughts, addictions, sleep disorders, marital conflicts, a partner estrangement mindset, and neglect and violence towards one’s child(ren). We examined (1) to what extent parental and job burnout related to each of these possible consequences and (2) whether parental burnout is specifically related to neglectful and violent behaviour towards one’s child(ren). The results suggest that parental burnout has a statistically similar effect to job burnout on addictions and sleep problems, a stronger effect on couples’ conflicts and partner estrangement mindset and a specific effect on child-related outcomes (neglect and violence) and escape and suicidal ideation. These results emphasize the importance of accurately diagnosing this syndrome

The role of trait emotional intelligence in diabetes self-management behaviors: The mediating effect of diabetes-related distress

This article presents two studies about trait emotional intelligence (EI) and diabetes. The first study investigated whether the level of trait EI of people with diabetes differs from the non-diabetes population. The second study explored the impact of trait EI on diabetes-related distress and diabetes self-management behaviors. Methods In study 1, an existing database of 8532 members of a health insurance fund was analyzed through group comparisons to investigate whether the level of trait EI of people suffering from diabetes differs from the non-diabetes people sharing the same gender, age, education level and BMI. Study 2 consisted of a survey among 146 persons with diabetes to investigate the relations between trait EI, distress and diabetes self-management behaviors through regressions and mediation analyses. Results People suffering from diabetes had significantly lower levels of trait EI than controls, but this difference was essentially due to differences in gender, age, educational level and BMI. However, trait EI influenced diabetes self-management behaviors. This relationship was mediated by diabetes-related distress, which proved to be a better predictor of self-management behaviors than depression or anxiety. Conclusion These findings suggest that enhancing trait EI can be an appropriate way to reduce the distress associated with diabetes management and the risk of complications

Health literacy and the use of healthcare services in Belgium

BACKGROUND: Most of the existing studies demonstrating the relationships between health literacy and health service use have been conducted outside Europe and cannot be generalised to European healthcare systems. Moreover, the majority of studies measure healthcare use via self-reports. This study investigated whether health literacy is related to the use of health services measured objectively via patient records in a European country. METHODS: 9617 members of a Belgian health insurance fund (59% females, ages 18-88 years, mean age 55.8 years) completed an online questionnaire including the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q) and agreed to have their responses linked to the insurance fund's health service use records. A two-part model approach was used to assess the association between health literacy and the use of healthcare services and the costs related, adjusting for personal and behavioural characteristics. RESULTS: Low health literacy is associated with more admissions to 1-day clinics, general practitioner (GP) home consultations, psychiatrist consultations and ambulance transports, and with longer stays in general hospitals. Associations with psychiatric hospitalisations and specialist consultations are also found but are not significant when correction for multiple comparisons is applied. In contrast, health literacy is not significantly related to the number of GP consultations, admissions to 1-day surgical clinics or emergency consultations. The relationship between health literacy and medication use is inconsistent. CONCLUSION: The results partly confirm that low health literacy is associated with greater use of healthcare services, and especially of more specialised services. Improving the health literacy of the population can be an effective strategy to promote a more (cost)-effective use of the healthcare services and thus contribute to population health

Littératie en Santé (Health Literacy) et sources d'information

De plus en plus de patients prennent part activement aux décisions liées à leur santé et deviennent des "patients éclairés". Pour assumer ce rôle actif, différentes compétence sont nécessaires Ces compétences sont l'essence même du concept de "littératie en santé"

Exhausted Parents: sociodemographic, child-related, parent-related, parenting and family-functioning correlates of parental burnout

Parental burnout is a specific syndrome resulting from enduring exposure to chronic parenting stress. It encompasses three dimensions: an overwhelming exhaustion related to one’s parental role, an emotional distancing with one’s children and a sense of ineffectiveness in one’s parental role. This study aims to facilitate further identification of antecedents/risk factors for parental burnout in order to inform prevention and intervention practices. In a sample of 1723 french-speaking parents, we examined the relationship between parental burnout and 38 factors belonging to five categories: sociodemographics, particularities of the child, stable traits of the parent, parenting and family-functioning. In 862 parents, we first examined how far these theoretically relevant risk factors correlate with burnout. We then examined their relative weight in predicting burnout and the amount of total explained variance. We kept only the significant factors to draw a preliminary model of risk factors for burnout and tested this model on another sample of 861 parents. The results suggested that parental burnout is a multi-determined syndrome mainly predicted by three sets of factors: parent’s stable traits, parenting and family-functioning