Future trends in human resources for health care : a scenario analysis

[Contents] 1. Introduction and scope of this scenario analysis. 2. Demography of health care professionals. 3. Demographic changes in the health workforce. 4. Regulating the demography of health care professionals. 5. Regulating human resources productivity. 6. Scenario analysis. 7. Summary and conclusion. References

Physical activity in daily life is associated with lower adiposity values than doing weekly sports in Lc65+ cohort at baseline.

BACKGROUND: Overweight and obesity prevalence is the highest at age 65-75 years in Lausanne (compared with younger classes). We aimed to describe 1) eating habits, daily physical activity (PA), and sports frequency in community-dwelling adults aged 65-70, 2) the links of these behaviors with socio-economic factors, and 3) with adiposity. METHODS: Cross-sectional analysis of Lc65+ cohort at baseline, including 1260 adults from the general population of Lausanne aged 65-70 years. Eating habits (8 items from MNA) and PA (sports frequency and daily PA: walking and using stairs) were assessed by questionnaires. Body mass index (BMI), supra-iliac (SISF), triceps skin-folds (TSF), waist circumference (WC), and WHR were measured. RESULTS: Prevalence of overweight (BMI 25.0-29.9 kg/m2), obesity (BMI ≥ 30.0 kg/m2), and abdominal obesity was 53%, 24%, and 45% in men; 35%, 23%, and 45% in women.Intake of fruits or vegetables (FV) ≥ twice/day was negatively associated with male sex (prevalence 81% versus 90%, chi-square P < 0.001). The proportion avoiding stairs in daily life was higher among women (25%) than among men (20%, chi-square P=0.003).In multivariate analyses among both sexes, eating FV, using stairs in daily life ("stairs"), and doing sports ≥ once/week were significantly negatively associated with financial difficulties (stairs: OR=0.54, 95% CI=0.40-0.72) and positively with educational level (stairs: OR=1.68, 95% CI=1.17-2.43 for high school).For all five log-transformed adiposity indicators in women, and for all indicators except SISF and TSF in men, a gradual decrease in adiposity was observed from category "no stairs, sports < once/week" (reference), to "no stairs, sports ≥ once/week", to "stairs, sports < once/week", and "stairs, sports ≥ once/week" (for example: WC in men, respectively: ß= -0.03, 95% CI= -0.07-0.02; ß= -0.06, 95% CI= -0.09- -0.03; ß= -0.10, 95% CI= -0.12- -0.07). CONCLUSIONS: In this population with high overweight and obesity prevalence, eating FV and PA were strongly negatively associated with financial difficulties and positively with education. Using stairs in daily life was more strongly negatively associated with adiposity than doing sports ≥ once/week

NUTRITION AND HEALTH IN A COHORT REPRESENTATIVE OF THE GENERAL COMMUNITY-DWELLING POPULATION OF LAUSANNE AGED 65 AND OVER

The objective was to study the links between health characteristics, frailty criteria, lifestyles, adiposity and disability in a population-based cohort of non-institutionalized adults aged 65 to 70 years at baseline (N= 1,260 to 1,293). At baseline, frailty was rare (2%), while pre-frailty was common (26%). Pre-frail participants had significantly more comorbidity and disability (defined as help received for activities of daily living, ADL) than non-frail participants. Weakness was the most frequent frailty criterion and was associated with cardio-vascular diseases (CVD). The prevalence of overweight (body mass index (BMI) 25.0-29.9 kg/m2), obesity (BMI ≥30.0 kg/m2), and abdominal obesity (waist circumference (WC) ≥102 cm in men, WC ≥88 cm in women) was 53%, 24%, and 45% in men; 35%, 23%, and 45% in women. Walking and using stairs in daily life was associated with lower adiposity values than doing sports at least once/week. Eating fruit and vegetables at least twice/day, walking and using stairs in daily life, and doing sports ≥once/week were significantly negatively associated with financial difficulties and positively with educational level. In longitudinal analyses, 130 persons died over a median follow-up of 8.47 years. In fully adjusted Cox models, mortality was significantly associated with neither BMI nor WC, but there were trends toward non- significant J curves across both BMI and WC quintiles. Disability (defined as difficulty with BADL or institutionalization, 231 cases) tended to increase monotonically across both BMI and WC quintiles and was significantly associated with BMI quintile 5 (HR=2.44, 95% CI [1.65-3.63]), and WC quintiles 4 (HR=1.81 [1.15-2.85]) and 5 (HR=2.58, [1.67-4.00]). Almost half of the population had a substantially increased HR of disability, as compared to the reference BMI/WC categories. In conclusion, studies with larger sample sizes and longer follow-up should assess the roles of BMI and WC trajectories since midlife and further clarify the shapes of their associations with disability. These findings, together with the literature review, emphasize the need for life-long strategies aimed at preventing excess weight, muscle loss and functional decline through adequate nutrition and regular physical activity, starting at early age and extending throughout life. -- Nutrition et santé à l'âge de 65 ans et plus : une étude dans la population de Lausanne ne vivant pas en institution L'objectif de ce doctorat était d'étudier les liens entre l'état de santé, le degré de fragilité, le style de vie, le surpoids et le développement d'une dépendance dans les activités de la vie quotidienne en analysant les données fournies par environ 1300 adultes initialement âgés de 65 à 70 ans. Ces personnes ont été suivies sur une durée de plus de 8 ans; elles ont rempli des questionnaires et passé des tests régulièrement. La fragilité a été définie sur la base de 5 critères (perte de poids involontaire, vitesse de marche lente, force de préhension au niveau de la main faible, fatigue ressentie et activité physique basse) dont 3 au moins doivent être remplis pour être considéré comme fragile. Au démarrage de l’étude, la fragilité était rare (2% des participants), mais la pré-fragilité (1 ou 2 critères remplis) fréquente (26%). Les participants pré-fragiles avaient plus souvent des maladies chroniques ou recevaient de l'aide pour effectuer les activités de la vie quotidienne (s’habiller, manger, se doucher, etc.) que les personnes n’ayant aucun des 5 critères de fragilité. La faiblesse de la préhension au niveau de la main était le signe de fragilité le plus fréquent et il était plus souvent observé parmi les personnes souffrant de maladies cardio- vasculaires. L’indice de masse corporelle (IMC) est une mesure de la corpulence. Il s’agit du poids (en kg) divisé par la taille au carré (en m2). La fréquence du surpoids (IMC entre 25.0 et 29.9 kg/m2) était de 53% chez les hommes et de 35% chez les femmes. Celle de l’obésité (IMC ≥30.0 kg/m2) était de 24% chez les hommes et de 23% chez les femmes. L’obésité abdominale (définie par un tour de taille supérieur ou égal à 102 cm chez les hommes, 88 cm chez les femmes) touchait 45% des hommes et des femmes. Les personnes marchant au quotidien et prenant les escaliers étaient plus minces que celles qui évitaient les escaliers mais faisaient du sport au moins 1x/semaine. Les habitudes nutritionnelles favorables à la santé étaient par ailleurs liées aux facteurs socio-économiques: les personnes mangeant des fruits et légumes au moins 2x/jour, utilisant les escaliers au quotidien et faisant du sport au moins une fois par semaine ont moins souvent rapporté des difficultés financières et bénéficiaient d'un niveau d’éducation plus élevé. Lors du suivi de 8 ans, 130 personnes sont décédées. En tenant compte de certains facteurs dans les analyses (sexe, âge, difficultés financières, éducation, tabagisme, perte de poids), il n’y avait pas de lien statistiquement significatif entre l’IMC ou le tour de taille et le risque de décès; cependant la mortalité tendait à être plus élevée aux deux extrêmes, parmi les personnes de très faible corpulence ainsi que parmi les personnes obèses. Au cours du suivi, 231 personnes ont développé des difficultés durables dans les activités de la vie quotidienne. Leur nombre augmentait progressivement dans les catégories d’IMC ou de tour de taille plus élevé. En particulier, parmi les 20% des personnes ayant l’IMC le plus élevé, ou les 40% des personnes ayant le tour de taille le plus élevé, la survenue de ces difficultés était significativement plus fréquente. En conclusion, il faudrait effectuer des études avec plus de participants et un suivi plus long pour mieux connaître le rôle de l’IMC et du tour de taille depuis l’âge de 40-50 ans, et clarifier leurs liens avec les difficultés dans les activités de la vie quotidienne. La littérature suggère qu’il faut prévenir le surpoids, la perte de masse musculaire et le déclin fonctionnel depuis un jeune âge et tout u long de la vie par le biais d’une alimentation équilibrée et d’une activité physique régulière

Prefrailty and chronic morbidity in the youngest old: an insight from the Lausanne Cohort Lc65+.

OBJECTIVES: To estimate the prevalence of prefrailty, frailty, comorbidity, and disability in the youngest old and to identify chronic diseases associated with individual frailty criteria. DESIGN: Population-based cohort study of noninstitutionalized elderly adults at baseline; cross-sectional analysis. SETTING: Lausanne, Switzerland. PARTICIPANTS: One thousand two hundred eighty-three individuals with complete data on frailty, aged 65 to 70 (58.5% women). MEASUREMENTS: Frailty was assessed according to an adaptation of Fried's criteria (shrinking, weakness, exhaustion, slowness, and low activity, three criteria needed for the diagnosis of frailty, 1 to 2 for prefrailty). Other outcomes were diseases diagnosed by a doctor (≥ 2 chronic diseases: comorbidity) and limitations in activities of daily living (ADLs, basic and instrumental). RESULTS: At baseline, of 1,283 participants 71.1% were classified as nonfrail, 26.4% as prefrail, and 2.5% as frail. The proportion of women increased across these three groups (56.5%, 62.8%, and 71.9%, respectively; P = .01), as did the proportion of individuals with one or more chronic diseases (68.0%, 82.8%, and 90.6%, respectively; P < .001) and the proportion with basic or instrumental ADL disability (1.6%, 10.3%, and 59.4%, respectively; P < .001). Weakness (low grip strength) was the most frequent criterion (14.3%). Prefrail participants had significantly more comorbidity and ADL disability than nonfrail participants (P < .001). When present in isolation, weakness was associated with two to three times greater prevalence of coronary heart disease, other heart diseases, diabetes mellitus, and arthritis. Similarly, a significant association was identified between exhaustion and depression. CONCLUSION: Prefrailty is common in the youngest old. The most prevalent frailty criterion is weakness, which is associated with cardiovascular diseases. Longitudinal studies of the evolution of prefrailty should explore the role of potential interactions between individual frailty criteria and specific chronic diseases

Association between Adiposity and disability in the Lc65+ Cohort.

To examine the longitudinal association between body mass index (BMI) and waist circumference (WC) with mortality and incident disability in Lc65+ cohort. Population-based cohort of non-institutionalized adults with up to 8.9 years of follow-up. City of Lausanne, Switzerland. 1,293 individuals aged 65 to 70 at baseline (58% women). BMI, WC and covariates were measured at baseline in 2004-2005. Vital status was obtained up to the 31st December 2013 and difficulty with basic activities of daily living (BADL) was reported in a self-administered questionnaire sent to participants every year. Main outcomes were total mortality and disability, defined as difficulty with BADL for ≥2 years or institutionalization. Cox regression was used with BMI/WC quintiles 2 as the reference. 130 persons died over a median follow-up of 8.47 years (crude mortality rate, men: 16.5/1,000 person-years, women: 9.7/1,000 person-years). In Cox regression adjusted for age, sex, education, financial situation, smoking and involuntary weight loss (IWL) at baseline, mortality was significantly associated with neither BMI nor WC, but there were trends towards non-significant J-curves across both BMI and WC quintiles. Disability (231 cases) tended to increase monotonically across both BMI and WC quintiles and was significantly associated with BMI quintile 5 (HR=2.44, 95% CI [1.65-3.63]), and WC quintiles 4 (HR=1.81 [1.15-2.85]) and 5 (HR=2.58, [1.67-4.00]). Almost half of the study population had a substantially increased HR of disability, as compared to the reference BMI/WC categories. This observation emphasizes the need for life-long strategies aimed at preventing excess weight, muscle loss and functional decline through adequate nutrition and regular physical activity, starting at early age and extending throughout life

Prevalence, awareness, treatment and control of hypertension in a Swiss general population: the CoLaus Study

Objective: To assess the prevalence levels of awareness, treatment and control of hypertension and associated factors in Switzerland. Methods: Population-based cross-sectional study of 6,182 subjects (52.5% women) aged 35-75 years living in Lausanne, Switzerland. Hypertension was defined as blood pressure ≥140/90 mm Hg or current antihypertensive medication. Results: The overall prevalence of hypertension was 36% (95% CI: 35-38%). Among hypertensive participants, 63% were aware of having hypertension. Among aware hypertensives, 78% were treated, and among treated hypertensives 48% were controlled (BP <140/90 mmHg). In multivariate analysis, prevalence of hypertension was associated with older age, male gender, low educational level, high alcohol intake, awareness of diabetes, awareness of dyslipidaemia, obesity and parental history of myocardial infarction (MI). Awareness of hypertension was associated with older age, female gender, awareness of diabetes, awareness of dyslipidaemia, obesity and parental history of MI. Control was associated with younger age, higher educational level and no alcohol intake. Alone or in combination, sartans were the most often prescribed antihypertensive medication category (41%), followed by diuretics, beta-blockers, ACE inhibitors and calcium channel blockers. Only 31% of treated hypertensives were taking ≥2 antihypertensive medications. Conclusion: Although more than half of the participants with hypertension were aware of being hypertensive and more than three quarters of them received a pharmacological treatment, less than half of those treated were adequately controlled. Treated hypertensive subjects should be followed up more closely

Regional differences in self-reported screening, prevalence and management of cardiovascular risk factors in Switzerland

In Switzerland, health policies are decided at the local level, but little is known regarding their impact on the screening and management of cardiovascular risk factors (CVRFs). We thus aimed at assessing geographical levels of CVRFs in Switzerland. Swiss Health Survey for 2007 (N = 17,879). Seven administrative regions were defined: West (Leman), West-Central (Mittelland), Zurich, South (Ticino), North-West, East and Central Switzerland. Obesity, smoking, hypertension, dyslipidemia and diabetes prevalence, treatment and screening within the last 12 months were assessed by interview. After multivariate adjustment for age, gender, educational level, marital status and Swiss citizenship, no significant differences were found between regions regarding prevalence of obesity or current smoking. Similarly, no differences were found regarding hypertension screening and prevalence. Two thirds of subjects who had been told they had high blood pressure were treated, the lowest treatment rates being found in East Switzerland: odds-ratio and [95% confidence interval] 0.65 [0.50-0.85]. Screening for hypercholesterolemia was more frequently reported in French (Leman) and Italian (Ticino) speaking regions. Four out of ten participants who had been told they had high cholesterol levels were treated and the lowest treatment rates were found in German-speaking regions. Screening for diabetes was higher in Ticino (1.24 [1.09 - 1.42]). Six out of ten participants who had been told they had diabetes were treated, the lowest treatment rates were found for German-speaking regions. In Switzerland, cardiovascular risk factor screening and management differ between regions and these differences cannot be accounted for by differences in populations' characteristics. Management of most cardiovascular risk factors could be improved

Trends in self-reported prevalence and management of hypertension, hypercholesterolemia and diabetes in Swiss adults, 1997-2007

Switzerland has a low mortality rate from cardiovascular diseases, but little is known regarding prevalence and management of cardiovascular risk factors (CV RFs: hypertension, hypercholesterolemia and diabetes) in the general population. In this study, we assessed 10-year trends in self-reported prevalence and management of cardiovascular risk factors in Switzerland. data from three national health interview surveys conducted between 1997 and 2007 in representative samples of the Swiss adult population (49,261 subjects overall). Self-reported CV RFs prevalence, treatment and control levels were computed. The sample was weighted to match the sex - and age distribution, geographical location and nationality of the entire adult population of Switzerland. self-reported prevalence of hypertension, hypercholesterolemia and diabetes increased from 22.1%, 11.9% and 3.3% in 1997 to 24.1%, 17.4% and 4.8% in 2007, respectively. Prevalence of self-reported treatment among subjects with CV RFs also increased from 52.1%, 18.5% and 50.0% in 1997 to 60.4%, 38.8% and 53.3% in 2007 for hypertension, hypercholesterolemia and diabetes, respectively. Self-reported control levels increased from 56.4%, 52.9% and 50.0% in 1997 to 80.6%, 75.1% and 53.3% in 2007 for hypertension, hypercholesterolemia and diabetes, respectively. Finally, screening during the last 12 months increased from 84.5%, 86.5% and 87.4% in 1997 to 94.0%, 94.6% and 94.1% in 2007 for hypertension, hypercholesterolemia and diabetes, respectively. in Switzerland, the prevalences of self-reported hypertension, hypercholesterolemia and diabetes have increased between 1997 and 2007. Management and screening have improved, but further improvements can still be achieved as over one third of subjects with reported CV RFs are not treated

Unravelling the effects of age, period and cohort on metabolic syndrome components in a Taiwanese population using partial least squares regression

<p>Abstract</p> <p>Background</p> <p>We investigate whether the changing environment caused by rapid economic growth yielded differential effects for successive Taiwanese generations on 8 components of metabolic syndrome (MetS): body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), triglycerides (TG), high-density lipoprotein (HDL), Low-density lipoproteins (LDL) and uric acid (UA).</p> <p>Methods</p> <p>To assess the impact of age, birth year and year of examination on MetS components, we used partial least squares regression to analyze data collected by Mei-Jaw clinics in Taiwan in years 1996 and 2006. Confounders, such as the number of years in formal education, alcohol intake, smoking history status, and betel-nut chewing were adjusted for.</p> <p>Results</p> <p>As the age of individuals increased, the values of components generally increased except for UA. Men born after 1970 had lower FPG, lower BMI, lower DBP, lower TG, Lower LDL and greater HDL; women born after 1970 had lower BMI, lower DBP, lower TG, Lower LDL and greater HDL and UA. There is a similar pattern between the trend in levels of metabolic syndrome components against birth year of birth and economic growth in Taiwan.</p> <p>Conclusions</p> <p>We found cohort effects in some MetS components, suggesting associations between the changing environment and health outcomes in later life. This ecological association is worthy of further investigation.</p