Association of public care in childhood with social, criminal, cognitive, and health outcomes in middle-age: five decades of follow-up of members of the 1958 birth cohort study

BACKGROUND: Children who have been exposed to public (out-of-home) care experience a range of negative outcomes by late adolescence and early adulthood. The longer-term impact of childhood care is, however, uncertain. AIM: To examine if there is a prospective association between childhood public care and adverse life outcomes in middle-age. METHODS: We used data from the UK 1958 birth cohort study of 18 558 individuals. Parents reported offspring care status at age 7, 11 and 16. An array of social, criminal, cognitive, and health outcomes was self-reported by cohort members at age 42 (71% response proportion in eligible sample) and a cognitive test battery was administered at age 50 (62% response). RESULTS: A total of 420 (3.8%) of 11 160 people in the analytical sample experienced childhood public care by age 16. Net of confounding factors, experience of public care (vs none) was linked to 11 of the 28 non-mutually exclusive endpoints captured in middle-age, with the most consistent effects apparent for psychosocial characteristics: 4/7 sociodemographic (eg, odds ratio; 95% confidence interval for homelessness: 2.1; 1.4 to 3.1); 2/2 antisocial (eg, use of illicit drug: 2.0; 1.2 to 3.5); 2/3 psychological (eg, mental distress: 1.6; 1.2 to 2.1); 1/3 health behaviours (eg, current cigarette smoker: 1.7; 1.3 to 2.2); 2/8 somatic health (physical disability: 2.7; 1.9 to 3.8); and 0/5 cognitive function (eg, beta coefficient; 95% confidence interval for immediate word recall: -0.1; -0.3 to 0.1) endpoints. CONCLUSIONS: The present study suggests that selected associations apparent between childhood care and outcomes in adolescence and early adulthood are also evident in middle-age

Examining if there is a differential association between smoking and chronic disease across socioeconomic groups: pooling of data from 15 prospective cohort studies

Background: For the same quantity of cigarettes smoked, relative to the more affluent, socioeconomically disadvantaged people have higher levels of smoking biomarkers. This may be ascribed to inhaling cigarette smoke more deeply and more frequently, and/or choosing higher tar-containing brands. We investigated if this increased tobacco load, as captured using cotinine, is associated with a greater risk of mortality in lower social groups. Methods: We used Cox proportional hazards models stratified by socioeconomic position to calculate hazard ratios in a pooled sample of 15 English and Scottish prospective cohort studies (N=81476). Results: During a mean (SD) follow-up of 10.3 (4.4) years, 8234 deaths occurred. Risk of total mortality (Hazards Ratio; 95% confidence interval) for smokers relative to never-smokers in the high (2.5; 2.1, 3.1), intermediate (2.1; 1.8, 2.4), and low (2.0; 1.9, 2.2) educational groups did not differ markedly (p for interaction=0.61). Similar findings emerged when using cause-specific outcomes, and occupational social class and housing tenure as socioeconomic indices. Conclusion: Contrary to our hypothesis, we found no indication that disadvantaged people were more vulnerable to the impact of smoking on chronic disease mortality

Testing Differential Associations Between Smoking and Chronic Disease Across Socioeconomic Groups: Pooled Data From 15 Prospective Studies.

BACKGROUND: For the same quantity of cigarettes smoked, relative to more affluent people, socioeconomically disadvantaged people have higher levels of smoking biomarkers. This may be ascribed to inhaling cigarette smoke more deeply and more frequently and/or choosing higher tar-containing brands. We investigated whether this increased tobacco load, as captured using cotinine measurements, is associated with a greater risk of mortality in lower social groups. METHODS: We used Cox proportional hazards models stratified by socioeconomic position to calculate hazard ratios in a pooled sample of 15 English and Scottish prospective cohort studies (N = 81,476). RESULTS: During a mean (SD) follow-up of 10.3 (4.4) years, 8234 deaths occurred. Risk of total mortality (hazard ratio; 95% confidence interval) for smokers relative to never-smokers in the high (2.5; 2.1, 3.1), intermediate (2.1; 1.8, 2.4), and low (2.0; 1.9, 2.2) educational groups did not differ markedly (P for interaction=0.61). Similar findings emerged when using cause-specific outcomes and occupational social class and housing tenure as socioeconomic indices. CONCLUSION: Contrary to our hypothesis, we found no indication that chronic disease mortality associated with smoking was higher in disadvantaged people

Evaluasi Penyusunan Anggaran sebagai Alat Pengendalian Manajemen Blu Rsup Prof.dr. R.d. Kandou Manado

Rumah sakit adalah salah satu fasilitas yang diberikan oleh pemerintah dalam bidang kesehatan. Dlaam rangka meningkatkan kualitas pelayanan, rumah sakit membutuhkan dana investasi yang cukup besar. Dengan adanya penyusunan anggaran manajemen rumah sakit dapat membandingkan dan menganalisa biaya yang sesungguhnya dengan biaya yang dianggarkan. Penelitian dilakukan pada penyusunan anggaran di BLU RSUP Prof. Dr. R. D. Kandou Manado (Rumah Sakit Malalayang). Tujuannya untuk mengetahui penyusunan anggaran sabagai alat pengendalian manajemendi rumah sakit. Metode yang digunakan adalah analisis deskriptif, yaitu menggambarkan penyusunan anggaran yang ada pada Rumah Sakit Malalayang. Hasil penelitian menunjukan bahwa penyusunan anggaran di Rumah Sakit Malalayang sebagai alat pengendalian manajemen sudah cukup efektif. Penyusunan anggaran yang digunakan menggunakan pendekatan sistem perencanaan, program, dan anggaran terpadu (PBBS). PBBS tidak seperti penganggaran tradisional, dimana pengambilan keputusan anggaran dilakukan dari atas kebawah melainkan kombinasi antara pengambilankeputusan dari atas kebawah dan bawah keatas. Hal ini terlihat dari bagaimana proses penyusunan anggaran sampai dengan tahap pelaporannya sesuai dengan karakteristik PBBS yaitu pendekatan ini dirumuskan dalam bentuk program atau aktivitas dari visi, misi, dan tujuan yang terdapat dalam dokumen perencanaan di Rumah Sakit Malalayang. Kata kunci: penyusunan anggaran, alat pengendalian manajeme

Thirteen-year trends in the prevalence of diabetes according to socioeconomic condition and cardiovascular risk factors in a Swiss population

Introduction To estimate the prevalence of and trends in diabetes according to sociodemographic indicators and cardiovascular risk factors in a Swiss population.Research design and methods Annual cross-sectional study of adults residing in the state of Geneva. We included 9886 participants (51% women; mean age (SD) of 48.9 (13.4) years). Diagnosed diabetes was self-reported; undiagnosed diabetes was defined as having fasting plasma glucose level of ≥7 mmol/L and no previous diagnosis; total diabetes as the sum of diagnosed and undiagnosed diabetes. To assess trends, we grouped survey years into three time periods: 2005–2010, 2011–2014, and 2015–2017. To assess inequalities, we constructed the relative index of inequality (RII) and the slope index of inequality (SII) for education, income, and health insurance subsidy (state program based on socioeconomic disadvantage).Results In total, 683 diabetes cases were identified. In 2015–2017, total diabetes prevalence was 11.8% (8.6%–14.9%) among lowest income participants, and 4.7% (3.4%–5.9%) among highest income participants (p<0.01). Similar findings were observed for education. Among participants with full health insurance subsidy, diabetes prevalence was 19.4% (12.1%–26.8%), and 6.1% (5.3%–7.0%) among those without (p<0.01). High diabetes prevalence was observed among participants who were men, older, overweight or obese, hypertensive, and hypercholesterolemic. Among participants with diabetes, 74.0% (63.5%–84.4%) in the lowest income group were diagnosed, compared with 90.2% (81.9%–98.4%) in the highest income group (p=0.04). Over the 13-year period, widening relative and absolute inequalities in total diabetes prevalence were observed for education and income. The education-RII (95% CI) increased from 1.51 (95% CI 1.01 to 2.32) in 2005–2010 to 2.54 (95% CI 1.58 to 4.07) in 2015–2017 (p=0.01), and the education-SII (95% CI) from 0.04 (95% CI 0.01 to 0.08) to 0.08 (95% CI 0.04 to 0.10; p<0.01). The income-RII increased from 2.35 (95% CI 1.44 to 3.84) to 3.91 (95% CI 2.24 to 6.85; p<0.01), and the income-SII from 0.08 (95% CI 0.04 to 0.12) to 0.011 (95% CI 0.07 to 0.14; p=0.01). Inequalities by health insurance subsidy were large (RII 3.56 (95% CI 1.90 to 6.66) and SII 0.10 (95% CI 0.05 to 0.15)) but stable across the study period.Conclusion Among adults living in Geneva, Switzerland, substantial differences were observed in diabetes prevalence across socioeconomic and cardiovascular risk groups over a 13-year period, and relative and absolute socioeconomic inequalities appeared to have increased

Thirteen-year trends in the prevalence of diabetes in an urban region of Switzerland: a population-based study

To assess trends in prevalence of total and diagnosed diabetes, and in the probability of detecting undiagnosed diabetes in the Swiss population

Thirteen-year trends in the prevalence of diabetes according to socioeconomic condition and cardiovascular risk factors in a swiss population

To estimate the prevalence of and trends in diabetes according to sociodemographic indicators and cardiovascular risk factors in a Swiss population